European Perspective Research Articles

Second primary cancers in patients with a pharyngeal index tumour: a register-based cohort study.

While prior research on the SPC (second primary cancer) risk among pharyngeal carcinoma (PC) patients has been conducted in other regions, the European perspective is underrepresented. Our register-based cohort study aims to assess the subsite-specific risk of SPC among individuals initially diagnosed with a pharyngeal index tumour. Standardized incidence ratios (SIR) of SPC were calculated relative to the general population for all patients diagnosed with a primary oropharyngeal, nasopharyngeal, and hypopharyngeal carcinoma (OPC, NPC, and HPC) in Finland during 1953-2021. A total of 4701 PC patients - 3320 men (71%) and 1381 women (29%) - were identified. The average and median follow-up times were 5.7 and 2.8 years, respectively. A SPC was diagnosed in 561 patients (11.9%): in 12.3% of men (n = 410) and 10.9% of women (n = 151). For male PC patients, the overall SIR for an SPC at any primary site was 1.83 (95% CI: 1.65-2.01). For female patients, the corresponding SIR was 1.89 (95% CI: 1.60-2.22). OPC and HPC showed increased risks for SPCs of the mouth/pharynx (SIR 4.41 and 6.91, respectively) and respiratory organs (SIR 3.51 and 4.80). OPC patients also had an increased risk in digestive organs (SIR 1.83). Male NPC patients exhibited increased risks for oral/pharyngeal, brain, and haematolymphoid SPCs (SIRs 5.14, 6.60, and 3.05, respectively). PC patients face an 80% higher SPC risk, which persists decades after treatment. Healthcare professionals must be aware of this, providing counselling and encouraging a healthy lifestyle, including smoking cessation, while monitoring symptoms.

Sharing Responsibilities for Children After Separation: A European Perspective

ABSTRACT (Policy frameworks in some countries encourage both parents to share responsibility for children after separation, but we know little about whether responsibility for major decision-making or day-to-day living arrangements (placement) are assigned to one parent or shared between them. In this paper we use recently-released data (European Union Statistics on Income and Living Conditions, EU-SILC) to document the extent to which children in 20 countries have responsibilities shared between the parents, assigned to only one, or a mixture. Using an index that combines decision-making and placement, we find substantial differences across countries, confirming research showing great variation in living arrangements and adding variation in decision-making. We explore potential reasons for different levels of shared responsibility across countries. Using simple bivariate statistics, we find higher levels of sharing when the legal context acknowledged sharing longer ago, and when there are higher levels of gender equality, educational attainment, and parental separation.

Ethical entanglements: human remains, museums and ethics in a European perspective

Abstract The ethical treatment of human remains after excavation is a core debate in archaeology. This project explores the treatment of human remains in some European museums with an aim to support open discussion of complex ethical issues among research and heritage professionals involved in the care of human remains.

Towards biocultural realism: Connecting conservation with historical ecology and common sense. A European perspective.

In this perspective, we present and discuss four major causes of the worldwide nature conservation failure: 1) ideologies based on nature-culture dualism, 2) the bias prioritising forests in conservation, 3) the illusory objectiveness of selected biological indicators, and 4) the mismanagement of rural agricultural landscapes. All of these relate to ignorance of historical ecology and neglect of the role past plays in shaping landscapes and fostering biodiversity. These led to a false anthropology focussed on the broader human economy (including agriculture) as the absolute culprit of biodiversity loss. It is believed, therefore, that biodiversity preservation depends on conservation policies and actions providing protection against human activities, such as farming. In this way, nature conservation has been detached from the rich experiences of long and fruitful coexistence of people with other elements of nature. The bio-cultural legacy includes biodiversity-rich rural landscapes, whose habitats are often either neglected or wrongly interpreted as "remnants of natural ecosystems". Consequently, conservation efforts are frequently ineffective or worse still, counter-effective. In the face of policies favouring subsidised intensive agribusiness at the cost of destroying smallholder family farming, even expensive conservation projects are usually nothing more than a "fig leaf" to cover failure. We advocate re-focussing of conservation planning to put more emphasis on landscapes' historical ecology responsible for their bio-cultural diversity. It implies the need for new principles in policies necessary to secure the economic and cultural sovereignty of local socio-ecological systems responsible for the world's bio-cultural diversity.

Sustainable extraction and recycling of non-ferrous metals: a review from a European perspective.

This review article provides a comprehensive examination of sustainable extraction and recycling methods for non-ferrous metals, which are critical to a wide range of industries including electronics, construction and renewable energy. Focusing on metals such as aluminium, copper and silicon, the study highlights the importance of recycling in conserving resources and minimizing environmental impact. It discusses the challenges posed by material diversity in recycling processes and the advances in recycling technologies that have emerged in response. Special emphasis is placed on the importance of a circular economy in maintaining a sustainable balance between consumption and conservation of metal resources. Through detailed analysis, it advocates innovative recycling practices and improved design for recyclability and highlights the role of policy, industry and consumer behaviour in achieving sustainability goals. The findings contribute to the discourse on strategic self-sufficiency in Europe through recycling, providing insights into how to improve efficiency and manage the complexity of the global material cycle. This work calls for a collaborative effort towards sustainable metallurgy and underlines the critical need for advances in recycling infrastructure and technology to ensure the long-term availability and environmental stewardship of non-ferrous metals.This article is part of the discussion meeting issue 'Sustainable metals: science and systems'.

Cost-Effectiveness and Budget Impact of Cement Augmentation for the Fixation of Unstable Trochanteric Fractures from a European Perspective: Cost-Effectiveness and Budget Impact of Cement Augmentation in Europe

Cost-Effectiveness and Budget Impact of Cement Augmentation for the Fixation of Unstable Trochanteric Fractures from a European Perspective: Cost-Effectiveness and Budget Impact of Cement Augmentation in Europe

Bibliographical Exploration of Public Relations and Diplomacy: Public, Organisational, and Civil Society Perspectives

Abstract: This paper aims to describe, infer and interpret the corpus of references extracted from the book “Diplomacy, Organisations and Citizens. A European Communication Perspective” (Sebastião & Spínola, 2022), a collective volume published as an output of a three-year research and educational project exploring the intersection of public relations with public, organisational and civil society diplo¬macy, from a European perspective. A mixed methods approach of quantita¬tive and statistical techniques in conjunction with social network analysis (SNA) was applied to a corpus formed out of 785 unique entries corresponding to the book references. Borrowing from bibliometric approaches, the techniques of di¬rect citation networks, co-citation networks, and topic networks were used to map perspectives used in the book. Results point to a clear linguistic preference for English, to a saliency of journal articles overlapping with the increase in re¬search accessibility through digitalisation, to a clear dominance of a few journals coming from the fields of public relations and public diplomacy, and to a clear alignment of the perspectives on public, organisational and civil society diplo¬macy at the intersection of public relations and diplomacy, albeit from a debatable European perspective. The research is relevant to any scholar or practitioner in¬terested in how public relations and the democratised forms of diplomacy intersect and influence each other. It can also serve as a roadmap to how the explo¬ration of the bibliographical universe of a research project can be used as a self-reflection and evaluation tool. Keywords: public relations, public diplomacy, organisational diplomacy, civil society diplomacy, bibliography, social network analysis.

Cost-Effectiveness Analysis of Pharmaceutical-Grade Chondroitin Sulfate for Knee Osteoarthritis Based on Individual Patient Data from a Randomized Clinical Trial.

In a previously published randomised, placebo-controlled trial, 800mg/day of pharmaceutical-grade chondroitin sulfate (CS) was shown to be superior to placebo in reducing pain and improving function over 6months in patients with symptomatic knee osteoarthritis (OA). The aim of the current posthoc analyses was to evaluate the cost-effectiveness of CS compared with placebo in a European perspective using individual patient data from this clinical trial. Patients with knee OA randomised to CS or placebo were followed up at 1, 3 and 6months. The algo-functional Lequesne index was used to derive the EuroQol Five-Dimension Five-Level (EQ-5D-5L) score based on a validated formula. The EQ-5D-5L scores at each time point were used to calculate the changes in quality-adjusted life years (QALYs) with the area under the curve method. Costs were assessed using the average price of CS in the countries where the original study took place and where CS is currently marketed. The costs of CS in three countries were then used (i.e. the Czech Republic, Italy and Switzerland). The incremental cost-effectiveness ratio (ICER) threshold for CS to be considered cost-effective was set at 91,870EUR per QALY (equivalent to the usually recommended threshold of US$100,000). The study used an intention-to-treat population, i.e. patients who received one dose of the study drug, and imputed missing values using the basal observation carried forward method. No significant differences in baseline characteristics were observed between the CS group (N = 199) and the placebo group (N = 205). The mean cost of CS for 6months of treatment was 194.74EUR. After 6months of treatment, CS showed a mean ICER of 33,462 (95%CI 5130-61,794) EURper QALY gained, indicating cost-effectiveness compared with placebo. The acceptability curve for cost-effectiveness shows that the CS treatment is likely to be cost-effective compared with placebo, with a 93% probability when the ceiling ratio is set at 91,870EUR per QALY gained. These results highlight the role of CS as a cost-effective therapeutic option in the management of OA. However, further studies taking into account the use of other healthcare resources are warranted for a more complete understanding.

8.M. Skills building seminar: Mental health and substance use in Europe

Abstract The impact of social factors on individual and population mental health are well established (Kirkbride, et al., 2024). The same social factors may trigger the substance use behavior developing into substance use disorders. Mental health disorders can contribute to the substance use and substance use disorders with worsening effects over time (EMCDDA, 2016). This association between substance use, substance use disorders and mental health disorders is a key objective for the scientific consideration and policy development. Respective phenomena are universal and a broader perspective would be useful for a better understanding of how the issue of comorbidities of substance use and mental disorders are addressed on a European level. Identification of the substance use problem, especially among populations in vulnerable situations, like migrants, becomes utterly important. Heterogenous systematic reviews show that there is a need for socially and culturally refugee sensitive instruments to measure the substance use in migrants. Oftentimes substance use is followed by the substance use disorders and drug use related infections. Injecting drug use is also a risk factor for having drug use related infections, such as hepatitis B and C, HIV, tuberculosis. Assessment of risk behaviour patterns among people who inject drugs may contribute to a higher participation in treatment and health programmes, reduce the burden of substance use and tackle comorbidities of substance use and mental health disorders. The skill building seminar aims to increase the knowledge and capacities on substance use and comorbidities, applied methodological approaches and tools in different European contexts. This workshop will support researchers, policy makers, public health planners by providing evidence base to address substance use and mental health issues. The added value of this workshop is based on the structure, content and mode of presentations - presentations will be followed by questions from participants and short discussions. The workshop will start with the general introduction to the topic of comorbidities of substance use and mental health disorders (EUPHA-PMH and EUDA). Then the European level perspective on comorbidities of substance use and mental health disorders will be presented including recent policy developments (1 presentation by Linda Montanari, EUDA). It will be supported with research results from the study conducted in Germany on substance use assessment tool development in migrant population (2 presentation by Kim-Julian Behr, Germany) and behavioural risk factor assessment study among people who inject drugs in Lithuania (3 presentation by Marija Jakubauskiene, Lithuania). Key messages • Participatory approach is useful to address the substance use problem in assessment tool development and further monitoring. • Better understanding of comorbidity of substance use and mental disorders leads to a more effective prevention.

THE JEAN MONNET PROJECT RESEARCH ON DIGITAL CULTURE AND EDUCATION: THE ANALYSIS OF CATEGORIES IN STUDENT RESPONSES

This paper presents one of the results of the project on “Digital culture in higher education: European perspective” funded by European Comission Jean Monnet Module (JMM) for the years of 2022-2025. The aim of this funded project is to convey European perspectives on digital culture in higher education. Within this projectthe authors have developped and introduced a breif module designed for students majoring in information technologies at Astana IT University in Kazakhstan. The authors have conducted an online survey among 452 students who have participated in the module. The purpose of this survey was to explore student persepctives and awarness about digital culture and digitalization in education. The data obtained from the student responses have been clustered into sixteen categories. The authors conclude that the respondents are aware of digital culture and education and opportunities in these fields. The student responses demonstrate multifaceted nature of digital culture and digitalization in education. Key themes include the use of digital tools in academic and professional life, digital interaction, and the societal impact of technology. Student responses also emphasized the democratization and accessibility of education through digital platforms. The findings of the study have revealed that there is still lack of familiarity among the respondents with the concept of digital culture and digitalization in education and a synchronous impact on society and culture.

Measuring Digital Sustainability Paying Attention to the Economic, Social, and Environmental Dimensions: A European Perspective

Measuring Digital Sustainability Paying Attention to the Economic, Social, and Environmental Dimensions: A European Perspective

Transnational chain ownership of news media: Integration and independence across borders in DPG media

So far, studies that investigate the effects of increased media ownership concentration across countries on corporations’ management have been limited in size and scope, particularly from a European perspective. To approach this research gap, we conduct and analyze a series of expert interviews with executives and chief personnel of one transnational European media. The findings allow us to shine light on how cultural and linguistic diversity and proximity play crucial roles in either fostering or limiting opportunities for synergy operations, digital transformation, and an internationally oriented management style of news media firms.

The Future of Liberal World Order from a Central and Eastern European Perspective

It is now generally accepted that the global order is shifting, but the literature is divided on how. Consequently, it is not surprising that there is a lack of strong scholarship on the characteristics of the order from a Central and Eastern European (CEE) perspective. Therefore, this article aims to explore the future of the Liberal World Order (LWO) from this perspective through the lens of mainstream theories. The article looks at the geopolitical dynamics of the region and the evolving strategic perceptions of the LWO. It examines how CEE, traditionally seen as the frontier of the LWO (EU and NATO), is navigating the complexities of the current global political landscape in the light of the changing order. The second part of the article specifically analyses the security perceptions of CEE governments. The article seeks to contribute to the understanding of the future trajectory of the LWO, the potential implications for global peace and security, and the interplay of realism and liberalism in shaping our understanding of this trajectory from the CEE perspective.

Forest certification and economic insights: a European perspective

In recent years, there has been an increasing demand for forest certification and certified forest products in Europe. This trend is related to major worldwide challenges, such as the need to decarbonize the economy and mitigate climate change but also social and consumer demands for wider fair trade. However, whether forest certification influences economic valorization in forestry remains a question. The aim of this study is to analyze forest certification levels across Europe and identify potential relationships between the level of certification in forest areas and relevant economic indicators at country level. This study collected openly available data on total and certified forest areas, economic indicators, and environmental indicators for 28 European countries and explored the correlation between certified forest areas and economic performance in the forestry sector. Findings show that forest certification can significantly improve the economic performance of European forests. It has a more pronounced positive effect on economic incomes than on costs’ reduction. While certification costs do rise with the extent of forest area, they tend to stabilize at larger scales, suggesting that the certification process is economically sustainable and scale is relevant. Czechia and the Netherlands stand out for having the highest net values added related to forest certification, reflecting an effective economic exploration of forest resources. This study offers new perspectives to natural and social scientists, as well as to industry and policy makers, by proving contextualized data to support decision making. Additionally, it provides hints for further studies and policy guidelines on sustainable development and the impact of forest certification schemes.

Russian Notions of Power and State in a European Perspective, 1462–1725: Assessing the Significance of Peter’s Reign, by Endre Sashalmi

Russian Notions of Power and State in a European Perspective, 1462–1725: Assessing the Significance of Peter’s Reign, by Endre Sashalmi

Uncertainty of climate models and policy implications: a European perspective

AbstractIn this paper we show that both climate models and economic models studying the effects of climate change are characterized by high uncertainty. Hence, far reaching policy implications such as the net zero goal lack a definite scientific foundation. Nevertheless, it cannot be excluded that the continued global warming will go along with high damages in the future. Therefore, decreasing greenhouse gas emissions could be justified due to the precautionary motif. However, there are strong signals from non-European economic regions that they definitely put a higher weight on economic growth rather than on greenhouse gas mitigation. The reduction of greenhouse gases in the European Union cause tremendous costs without influencing the climate on earth. Further, these investments do not raise the aggregate stock of productive capital nor do they lead to factor augmenting technical progress. Therefore, the net zero goal of the Green Deal of the European Union is to be seen sceptical.

Governance and policy implications of the Inflation Reduction Act: A European perspective

AbstractThis paper examines the US 2022 Inflation Reduction Act (IRA) alongside the EU's Net‐Zero Industry Act (NZIA) and Critical Raw Materials Act (CRMA) of 2023. We analyze their differential approaches to accelerating investment in clean technology, enhancing energy security and fortifying supply chains. Both regions share the objective of diminishing reliance on Chinese dominance in clean industries. The US seeks to stimulate private investment primarily via uncapped tax credits from 2022 to 2031, some of them subject to stringent domestic content requirements. The EU has reacted to the potential violation of World Trade Organization's rules and a possible green investment shift to the US In doing so, the EU is relying heavily on a regulatory strategy, with emphasis on the simplification of procedures. However, the EU's public funding model is vague and leaves details to the discretion of member states, risking fragmentation within the single market. Through the application of a dynamic computable general equilibrium model, we show that a 50% increase in demand for the IRA's uncapped tax credits could nearly triple US GDP outcomes by 2027. We highlight the contrast between the IRA's immediate fiscal incentives and the NZIA's regulatory approach, emphasising that the former are more attractive for firms.

Toward effective protection of victims of human trafficking in mixed migration flows: referral mechanisms shaped on individual need. The Italian experience and the European perspective

An overview of emerging trends on trafficking of human beings in Italy shows not only an extremely heterogeneous phenomenon but also a complex overlapping of experiences and need of protection of every single victim. In the context of mixed migration flows, persons reaching Italy through the Central Mediterranean and the Balkan routes have often experienced or are at risk of trafficking, and they also apply for international protection upon arrival. Legal categories such as “victims,” “asylum seekers,” and “refugees” are increasingly interconnected and not exhaustive in describing individual experiences and multifaceted vulnerabilities. Against this background, ensuring early identification and assistance for victims of trafficking among asylum seekers is extremely relevant. In Italy, this has led to the development of good practices aimed at implementing the coordination between the asylum and the anti-trafficking systems. In particular, specific Guidelines for Asylum authorities have been adopted to preliminarily identify potential victims of trafficking within the asylum procedure and enable their effective access to protection measures. To comply with specific provisions of the European Trafficking Directive and its transposition into the Italian legal framework, the Guidelines have created a referral mechanism among the asylum authorities and the anti-trafficking system that is unique in the European context. For this reason, the present contribution aims at describing this good practice, its implementation and effects—also at the juridical level—and its limits. Indeed, after the adoption of the instrument, a higher recognition rate of international protection for victims of trafficking has been registered in Italy, both at the administrative and judicial levels; asylum seekers and refugees have also increased their access to the specific protection program for trafficking survivors. In general, the system has strengthened its capacity to fulfill the legal obligation of identifying victims through a multi-agency approach. On the other hand, the ability to conduct screening and preliminary identification of victims of trafficking among asylum seekers is still limited to the “victim model” in terms of gender (women) and form of exploitation (sexual), and to certain stages of the asylum procedure (the first instance before the asylum authorities). With reference to this latter, a comprehensive protection response at the borders is missing despite the political debate on sea and land arrivals to Italy and the recent introduction of border procedures for the assessment of asylum applications. Given the geographical and political centrality of the south-Mediterranean situation in the current migration agenda, the goal of this paper is to analyze the Italian experience on referral mechanisms among trafficking and asylum as an experience that would help to shape future European prospects. The ongoing evolution of mixed migration flows—with particular reference to secondary movement across European countries—and the revised European Directive on trafficking in persons impose the promotion of a reflection on referral mechanisms with a transnational perspective enabling effective protection and the meeting of specific human rights.

NAVIGATING NEW CHALLENGES: WESTERN BALKANS AT THE CROSSROADS OF EU INTEGRATIONS

For several years now, European integration has been recognized as a key strategy to achieve dual goals in the Western Balkans: peace and stability. The European perspective is a commitment not only to the foreign policy of this region but also a great expectation of the citizens of these countries. The Western Balkans, as the European Union calls it after the integration of Bulgaria and Romania in 2007, is a political notion with more than a geographical definition. The Western Balkans, a region which includes: Albania, Bosnia and Herzegovina, Croatia, North Macedonia, Montenegro, Serbia, and Kosovo, throughout the Cold War period was the area where East and West were divided. After the fall of the communist regimes in Eastern and Southeastern Europe, which followed the signing of the Maastricht Treaty and the establishment of the European Union, euphoria and enthusiasm for joining a united Europe grew. Thus, the prospect of a common future of the Western Balkans in a democratic and prosperous Europe now seemed more than feasible. Today, the countries of the Western Balkans that have passed the transition period, still encounter the difficulties of their consolidation or the stability of bilateral agreements. Although they are located in the European continent with cultural diversity in a narrow space, they continue to remain out of place in the Euro-integration process. Economic development, commercial exchanges, investments, unemployment, etc., are another dimension of the countries of the Western Balkans, but also the initiatives of some countries for an opening within the area called a mini-Schengen, and then turned into “Open Balkan” which was specifically replaced by the “Berlin Process”, which began in 2014, as a proposal by the German Chancellor Angela Merkel to accelerate the European integration of the Western Balkan countries. The difficult economic situation combined with inherited political problems has created large discrepancies between countries of this region in relation to the benefits that come from the EU. The created situation has contributed to some states expanding and increasing their influencing power in this region, such as the influence of Russia. These issues represent some of the main points of view of the conference, which aims to bring together researches from the countries of the region to present their studies and views on the issues of the integration of Western Balkans into the EU and to exchange experiences, ideas and discuss other relevant issues related to the topics of the conference.

SY24-KL1 Perioperative chemotherapy for gastric and gastroesophageal junction cancer, European perspective

SY24-KL1 Perioperative chemotherapy for gastric and gastroesophageal junction cancer, European perspective