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PubMed2003

Midwifery and the enlarged European Union.

The freedom of movement of midwives within the European Union has been guaranteed by the application of midwives' sectoral directives signed in 1980 and applied in 1983. Since then the size of the European Union has grown from 9 to 15 members and is due for a next wave of enlargement of another 10 member states in 2004. The rules and regulations that govern the European Union are being revisited to accommodate this change. Midwifery will be affected and some changes are potentially worrying, in particular the proposed loss of the Advisory Committee on the Training of Midwives. Six other professions regulated in a very similar way are also to lose their own advisory committees. The European Commission has proposed the adoption of a single directive for all professions, together with the setting up of an expert group whose function would be to deal principally with health professions. However, neither its remit nor its membership has been determined. Whereas previous movement of midwives within Europe has been minimal, it is anticipated that this may well be changed at the next enlargement stage. Without clear directives and some form of controlling power at European level, public health may be threatened. In this paper the developments to date and the concerns that have emerged from the recent proposals are outlined.

Education, Nursing↗

PubMed2000

Health and safety at work in Switzerland: impact of European Union directives.

Switzerland, surrounded by European Union (EU) member states, rejected a 1992 referendum to join the European Economic Communities (EEC), which currently includes 15 member states. As a result, the country has had difficulties resolving economic issues with health and safety interests. This study analyzed the consequences of selected EU Directives of Health and Safety at Work in a country that chose not to join the EU. The Directives went into effect throughout the entire EU in 1993. Executive directors and safety advisors from the Swiss company "Migros" participated in a two round Delphi survey focused on timing, feelings, and preference of the legal system in relation to the EU, prioritizing selected EU directives, and implementing health and safety concepts. The results showed the effects of the Directives (although not legally required) demand careful consideration particularly in terms of the timing of the implementation and the priorities of the Swiss health and safety legal system. The two professional groups involved showed congruent opinions on several questions, presenting a solid foundation for planning common action. In conclusion, the growing awareness of occupational health and safety aspects observed during the survey should be pursued among all Migros key staff in decision making positions in occupational safety and health. In this way, Migros could serve as a role model in the occupational health and safety field, much as it has long been recognized as a pioneer in funding social causes throughout Swiss society.

Adult↗

PubMed2002

Why is endometrial cancer less common in Greece than in other European Union countries?

Among European countries, Greece has the lowest incidence of and mortality from endometrial cancer. We have undertaken a case-control study aiming to identify possible reasons for this. Cases were 84 women with histologically confirmed incident endometrial cancer, whereas controls were another 84 women with intact uterus admitted for small gynaecological operations, mainly pelvic prolapse. Women provided information concerning socio-economic, reproductive and medical variables. Most findings were in line with those previously reported from other investigations; no association was as striking as to suggest an effect modification that could underlay the favourable position of Greece with respect to endometrial cancer. Novel findings were the statistically significant inverse associations of endometrial cancer with coffee drinking and suggestive inverse associations with height-induced abortions. Low average height of Greek women, high frequency of induced abortions and low frequency of replacement oestrogens use may contribute to the lower endometrial cancer incidence in Greece.

Age Factors↗

PubMed1999

The future of tobacco product regulation and labelling in Europe: implications for the forthcoming European Union directive.

The European Commission has announced that it is considering legislation concerning further restrictions on cigarette tar and nicotine yields, as well as new provisions to regulate additives and the labelling of tobacco products. This report considers these issues and their relation to public health. In particular, we argue that further reductions in tar and nicotine yields as measured by the International Standards Organisation/Federal Trade Commission (ISO/FTC) method will be largely cosmetic and certainly misleading to consumers. If a new directive uses the ISO/FTC methodology as a basis for regulation, it risks lending further official support to the concept of "low tar" cigarettes, which may be used by smokers as an alternative to smoking cessation. Although new regulations based on the ISO/FTC methodology may appear to offer health gains, these will be illusory and there may even be negative health consequences, as has been the case with these tests up to the present. We therefore make the following recommendations for the way forward.

European Union↗

PubMedDate not supplied

A critical assessment of the European Commission's proposals for the risk assessment and registration of chemical substances in the European Union.

In May, 2003, the European Commission published detailed proposals relating to its 2001 White Paper - Strategy for a Future Chemicals Policy. The White Paper described a new registration system called the REACH (Registration, Evaluation and Authorisation of Chemicals) system, for both new and existing chemicals. Subsequently, these detailed proposals were available for an eight-week consultation period for stakeholders to voice their views and concerns. In this paper, we describe our reactions to the Commission's more-detailed proposals. These include the creation of a European Chemicals Agency to implement the REACH system in conjunction with Competent Authorities (CAs) in Member States and the Commission itself. Unfortunately, many of our concerns and suggestions, previously voiced and shared with several other key stakeholders, remain unanswered, but are as relevant as when the White Paper was published. In particular, we are concerned about the lack of a clear and coherent strategy. There is no guidance for registrants on intelligent testing to maximise the use of non-animal approaches to safety testing, based on a combination of factors for estimating exposure levels, rather than mainly on production volumes. We are also concerned about the absence of a clear programme for the development, improvement and validation of new alternative methods, in conjunction with the Commission's own unit, the European Centre for the Validation of Alternative Methods, as well as other organisations with relevant expertise and experience, including FRAME. Finally, we explain why such measures should be introduced, together with clearer guidelines for the respective roles of the Agency, the CAs and the Commission in implementing and harmonising the REACH system at the European Union and Member State levels. A series of recommendations are made, to improve the situation and to improve the risk assessment process.

Animal Use Alternatives↗

PubMed2000

An overview of European Union tobacco control legislation.

The European Union (EU) has been active in tobacco control policy since 1985 when the Milan Council announced its intention to establish a Europe Against Cancer (EAC) Programme, although it had previously adopted several Directives on aspects of tobacco taxation prior to this date. Shortly after the establishment of the EAC first action plan the European Commission presented its first legislative proposals on tobacco control. Three of these proposals on labelling and maximum tar yields became Directives by 1992. The fourth on tobacco advertising finally became law in 1998 and is currently being transposed into national law in the 15 EU Member States. In 1996 the Commission published a Communication on the future of EU tobacco control and in 1999 at the 2nd European Conference on Tobacco or Health the Social Affairs Commissioner announced his intention to bring forward further legislative proposals to amend an consolidate existing EU legislation in this sector. This article is intended to present an overview of EU tobacco control legislation from 1970 until 1998 and to look at future options post year 2000.

Advertising↗

PubMed2006

New modes of regulation for health and safety: post-enlargement policy perspectives for the European Union.

The recent joining of ten new member states to the European Union, eight of which are former communist countries, has reopened inherent tensions in current European Union (EU) policy-making on safety and health in the workplace. These spring from seemingly incompatible objectives; the need to ensure broad EU member state compliance with regulation, around agreed minimum standards through active regulatory enforcement, and the promotion of "softer" voluntary initiatives in the management of workplace risks and hazards in order to create "a culture of prevention." The present EU strategy which ends in 2006, seeks to secure a balance between both sets of objectives. However, with respect to the post-communist new member states of Central and Eastern Europe, the appropriateness of the current strategy is doubtful. This article therefore focuses on the implications of the expansion of the European Union in May 2004 in the context of the elaboration of the new "soft law" modes of regulatory governance at the EU level. In turn, this provokes the question: will the "new" European policy for occupational health and safety from 2007 onwards, be "new," or simply more of the same? If the latter, it is suggested that the future for working environment standards in Europe as a whole may be significantly compromised.

Accidents, Occupational↗

PubMed1997

Healthcare access and mobility between the UK and other European Union states: an 'implementation surplus'.

European Union (EU) policy on mobility requires ensuring healthcare access for EU residents who travel between EU states. This case-study investigates how this policy has been implemented in respect of EU visitors to the UK. EU visitors to the UK have similar access to 'immediately needed' National Health Service (NHS) healthcare to UK residents. For non-urgent healthcare, the NHS has official systems to discourage 'medical tourism' and divert such patients to the private sector or to reclaim the costs of NHS hospital treatment for EU visitors. Yet these official systems contrast with the flexibility and liberality of actual NHS practice towards EU visitors. Research on health policy implementation mostly examines reasons for 'implementation failure'. However, the present study indicates a health policy being implemented more fully than policy-makers may have anticipated. In the case of healthcare access for EU visitors to the UK, an implementation surplus is evident rather than an implementation deficit.

Europe↗

PubMedDate not supplied

Setting occupational exposure limits for sensory irritants: the approach in the European Union.

Beginning in 1990, the European Commission initiated a program to establish European Union (EU)-wide occupational exposure limits (OELs). As in the United States and other countries, a panel of experts known as the Scientific Committee on Occupational Exposure Limits (SCOEL) was identified and brought together to identify the proper values. This article describes the approach used by SCOEL to identify appropriate values for sensory irritants. The EU panel believes that irritant effects in the eyes and respiratory tract can produce symptoms that range from trivial to serious, and that responses to irritants may be viewed as belonging to a continuum. One of the interesting differences between the approach used by the ACGIH TLV committee and the SCOEL is the use of five grades of irritation to evaluate this class of chemicals. For purposes of setting an OEL, the SCOEL makes no distinction between irritation or nuisance and related somatic effects such as headache. How the committee established an OEL for ethyl acetate is offered as an illustrative example.

Acetates↗

PubMed2000

Introduction: health technology assessment and the European Union.

Health technology assessment (HTA) has become increasingly important in the European Union as an aid to decision making. As agencies and programs have been established, there is increasing attention to coordination of HTA at the European level, especially considering the growing role of the European Union in public health in Europe. This series of papers describes and analyzes the situation with regard to HTA in the 15 members of the European Union, plus Switzerland. The final paper draws some conclusions, especially concerning the future involvement of the European Commission in HTA.

European Union↗

PubMed2002

[Recent initiatives of the European Union on the field of drug use and trafficking].

Moving from the general framework offered by the Treaties of the European Union and European Community, the paper presents the more recent specific initiatives of the Union in the field of fight against drugs and in particular on the European Union Plan of Action, adopted by the European Council in June 2000, and on the need for a global and balanced approach which it proposes as the main focus of the action of the European institutions. The paper then examines separately the initiatives taken both at the level of the reduction of the demand, mainly at the preventive and sanitary level, and of the supply reduction, of a mainly repressive character. Conclusively, the main initiatives in the field of international co-operation among the European Union and third Countries.

Commerce↗

PubMed1999

Epidemiological data of treated end-stage renal failure in the European Union (EU) during the year 1995: report of the European Renal Association Registry and the National Registries.

BACKGROUND: The new Centre Questionnaire, mainly based on the collection of epidemiological data, was launched in 1996 and the overall response rate of centres for the 15 countries constituting the European Union (EU) reached 82.2% (66-100%) for 1995. RESULTS: We could derive the following information for a general population of 372.6 million. In 1995, the incidence of new end-stage renal failure (ESRF) patients (Ni/P) was 120 p.m.p. (per million population) with a clear north to south/west gradient (69 in Ireland, 131 in Italy and 163 in Germany). The incidence of ESRF deaths (No/P) was 67 p.m.p. (from 35 in Ireland to 89 in Germany). The net increase of patients was therefore 53 p.m.p. (from 13 in Greece to 74 in Germany). The point prevalence of treated ESRF patients (Ns/P) alive on 31 December 1995 was 644 p.m.p. (from 444 in Finland to 773 in Italy). The mean increase in the stock of ESRF patients was +8.2% (4.6 to 13.0) as a linear rate and +0.085 as a fractional rate (exponential). The first treatment of new patients (Ni) was haemodialysis (HD; 81%), peritoneal dialysis (PD; 18%) and pre-emptive renal transplantation (Tx; 1%). The latest treatment for patients still alive was HD (58.5%), PD (9%) or functional Tx (32.5%). The number of Tx was 30 p.m.p. (from 14 in Greece to 45 in Spain). The death rate was 10.4% for all those with ESRF, with 14.4% for those dialysed and 2.2% for transplanted patients. In 1995, 6.5% of dialysed patients received a graft and 4.0% of transplant patients returned to dialysis. The linear expansion rate of the dialysis pool and the transplant pool was respectively 8.3% and 7.9%. CONCLUSIONS: This data shows considerable disparities among countries of the EU which merit further evaluation. Also this analysis by the ERA Registry provides data of value for health and economic purposes.

Europe↗

PubMedDate not supplied

[Women and tobacco in the European Union].

Over the last decades, the prevalence of smoking in the European Union has followed different trends by sex. While the prevalence has declined for men, it has increased or is stable for women. In some countries where these changes took place earlier, the prevalence of smoking is now higher among women than among men. This document provides quantitative data for these trends in the European Union, with special reference to the situation in Spain. In 1995 there were 60 million men and 42 million women smokers in the European Union. Up to 48% of female smokers used light cigarettes, that is 20 million women. There are documents from the tobacco industry showing that the goal of the promotion of light cigarettes is to reassure their clients and to keep as smokers those concerned about their health who are considering the possibility of quitting. There is evidence confirming that this policy is successful, and that the misconceptions of smokers about light cigarettes deter them from quitting. There is evidence on the role of smoking in weight control. Women are more concerned than men about their weight, and for young women body image is very relevant. Young girls often have the perception that they are overweight. Although fear of being overweight is more common than actual overweight, the evidence suggests that being afraid of gaining weight plays a role in keeping women as smokers, and that young girls begin smoking taking into consideration weight issues. The advice on how to maintain weight should be included in any smoking cessation program for women. Any preventive action for teen age smokers should include weight control issues.

Adolescent↗

PubMed2006

More politics, stronger consumers? A new division of responsibility for food in the European Union.

In less than a decade, European food institutions have gone through a period of important reform. This reform was intended to address new challenges posed by a succession of food safety crises, the entry into the world markets of novel foods, and general public distrust of the actions of the European Commission. This paper sketches the most salient institutional changes that have occurred in the history of the European Union (EU). It also maps the redistribution of responsibilities in the European food system. After years of harmonisation in the name of free trade, in the mid-1990s food safety and consumer protection became the guiding principles of European food policy. Having described these changes, the paper suggests that a specifically European food policy style is emerging in juxtaposition with 'transatlantic' food policy.

Consumer Advocacy↗

PubMed1999

Recent activities of EC4 in the harmonization of clinical chemistry in the European Union.

This article describes the recent activities of the European Communities Confederation of Clinical Chemistry (EC4). Main goal of EC4 is harmonization of clinical chemistry in the European Union and Europe. EC4's actions connected to that are training and registration of professionals, and accreditation of laboratories. The 35000 professionals practising clinical chemistry in the EU have different backgrounds (medical, pharmaceutical, science-oriented, veterinary, or microbiological). Thus, for the harmonization of training of clinical chemists, EC4 has published a European Syllabus for Postgraduate Training, and instituted a European Union Register for Clinical Chemists. The Syllabus is an indication of the level of requirements in postgraduate training. The EC4 initiative to implement the European Register for Clinical Chemists is based on the 8 years vocational training necessary to obtain sufficient knowledge in clinical chemistry according to the European Syllabus. A guide to the EC4 Register has been published; registration leads to the title European Clinical Chemist (EurClinChem). The accreditation of laboratories must be based on a total quality management system. EC4 has described guidelines (essential criteria) which it judges appropriate for establishing the quality of medical laboratory service; it does not wish to fulfil the role of an accrediting body. Moreover, a working group has been set up to seek to harmonize the work of national accrediting bodies. Therefore, it is logical that EC4 monitors the activities of the different standardizing bodies that might influence the practice of clinical chemistry in the EU. Finally, some aspects concerning the future strategy of EC4 are brought forward.

Chemistry, Clinical↗

PubMed2004

Good clinical practice is now obligatory in academic clinical drug research in the European Union.

By May 2004, all clinical trials in the European Union (EU) on medicinal products have to be initiated and conducted in compliance with the principles in the new directive on Good Clinical Practice (GCP). This requirement will also apply to non-commercial trials involving registered drugs and may therefore restrain the academic clinical drug research. In Denmark, three public GCP units connected in a national network and associated with the university hospitals in Copenhagen, Odense and Aarhus have been established. The GCP units offer academic researchers the necessary quality assurance and quality control systems to ensure that clinical drug research can be performed according to GCP. The Danish initiative is presented here as a contribution to the future work with implementation of the principles of GCP in academic clinical drug research in the European Union.

Academic Medical Centers↗

PubMed2005

['European primary care': a visionary report of the Dutch Health Council on primary health care in the European Union].

Although the agenda of the European Union (EU) does not directly provide for it, it seems reasonable to assume that due to the process of European social and economic integration there will be mounting pressure on the presently widely differing systems for primary care to move towards a more uniform orientation. In 2004, during its rotating presidency of the EU, the Dutch government asked its Health Council for advice on the current level of knowledge with regard to the organisation and significance of primary care. The Council formulated a set of key recommendations for the future development of primary care in Europe. The Council defines primary care as: generalist care, consisting of general medical, paramedical and pharmaceutical care, nursing and supportive care and non-specialised mental and social health care together with preventive and health educational activities linked to these forms of care. This care is for all health problems, is aimed at ambulatory patients, and is delivered close to the patients' homes. It is easily accessible to all, and provides emergency care when necessary. The main differences in the provision of primary care between countries in Europe concern the presence or absence of registration with a general practitioner and the gate-keeper role of primary care. International comparative research has identified the presence of precisely these features as predictors of better health outcomes in terms of morbidity and mortality. They therefore form a prominent role in the key recommendations, which state, among other things, that a patient should choose a primary-care team in the context of an integrated care circuit, thereby giving up his or her freedom to select care givers outside that circuit, in the interest of quality continuity and the efficiency of care. Other key recommendations are: close cooperation between primary-care teams, preventive services and public health and occupational health, a transparent provision on information between all providers of care, and the creation of a European Center for primary-care development.

Delivery of Health Care↗

PubMed1998

[Evolution of fox rabies in Belgium and the European Union].

Since 1989, after experimental trials, Belgium like other concerned member States within the European Union, organizes campaigns of fox vaccination against rabies. These vaccination campaigns are using a recombinant vaccinia-rabies virus as vaccine in Belgium, Grand-Duchy of Luxemburg and a large part of France. The results of epidemiological surveillance show a dramatic reduction of the incidence of rabies in the treated areas; this reduction is also observed in domestic animals and as a consequence, the number of post-exposure treatments in man is considerably reduced. After a period of elimination, rabies did reappear in the south of Belgium in 1994. Strains of rabies virus isolated in the infected area showed similar nucleic acid sequences both in Belgium and along the border in France. The situation of rabies in the continental part of the European Union permits to envisage its elimination in the short run. This elimination could provoke a modification in the quarantine regulations on pet importation in United Kingdom and, as a result, improve the movement of people within the entire European Union.

Animals↗