Carving a Path Toward Global Implementation of eConsent in Clinical Trials

[...]countries do not always recognize and allow electronic signatures. In many cases, this calls for a complete revision of existing laws and regulations;it has already been done in the past for some technologies, including the regulation of electronic signatures, but much more important revisions, such as the third revision of International Conference on Harmonization Good Clinical Practice (ICH GCP), are underway for the complete integration of the various aspects of emerging technologies.7 In the scope of our research project, titled "Toward a Global Implementation of eConsent in Clinical Trials," a survey was conducted to understand how eConsent is perceived and experienced by clinical research experts, how it can improve patient comprehension and reduce site burden, as well as to identify areas of opportunities and challenges for further adoption. [...]when stakeholders were asked what the main barrier limiting the implementation of eConsent at their organization is, many sponsors explained that the fragmented guidelines and regulations had considerably hindered their use of eConsent. [...]it requires staff training and adaptation and, here again, the fragmented or-in some cases-even lack of regulation around eConsent makes it difficult to implement on sites.

Advancing patient safety governance in the COVID-19 response

In the backdrop of the COVID-19 pandemic, ensuring the safety of health care services remains a serious, ongoing challenge. This once-in-a-century global health crisis exposed the vulnerability of healthcare delivery systems and the subsequent risks of patient harm. Given the scale of the occurrence and costs of preventable patient safety events, intervention and investment are still relatively modest. Good patient safety governance focuses on what leaders and policy makers can do to improve system performance and reduce the financial burden of avoidable care. Moreover, it is essential in driving progress in improving safety outcomes. This report examines how patient safety governance mechanisms in OECD countries have withstood the test of COVID-19 and provides recommendations for countries in further improving patient safety governance and strengthening health system resilience.

Improving the timeliness of health expenditure tracking in OECD and low-and middle-income countries

The COVID-19 pandemic has highlighted that access to timely health spending data is crucial for informed policy-making. This Health Working Paper summarises and compares the methodologies applied in around half of OECD countries to estimate public and private health spending for the most recent year (i.e. t-1) as well as the approaches taken by the OECD Secretariat to fill existing data gaps for the remaining OECD countries. For the first time, the paper also explores the feasibility of nowcasting health spending for the current year (i.e. t) and examines data sources that could be potentially useful in such an exercise. While this review should help OECD countries that do not yet have experience in estimating health spending for year t-1 to improve the timeliness in their data reporting, a special focus in this paper lies on testing the applicability of the methods in low- and middle-income countries (LMIC), using the WHO Western Pacific Region (WPRO) as an example. Generally, different data sources exist in many countries that would allow for a more timely estimation for health spending aggregates.

Multisystem inflammatory syndrome in children during the first two years of the COVID-19 pandemic in Luxembourg.

Objective: Estimate the incidence of multisystem inflammatory syndrome (MIS-C) in children (0-15 years), the role of SARS-CoV-2 variants during the first two years of COVID-19 pandemic in Luxembourg; and describe the demographic, biological and clinical characteristics of the patients. Method: Observational retrospective cohort study. Cases between March 2020 and February 2022 were ascertained from the national registry of MIS-C cases by a retrospective review of medical records. Reported SARS-CoV-2 infections were obtained from the national COVID-19 surveillance system. We calculated monthly MIS-C incidence, the ratio between MIS-C and SARS-CoV-2 infections and associated rate ratios by the periods corresponding to the circulation of different variants. Results: 18 children were diagnosed with MIS-C among 35,200 reported infections. The incidence rate of MIS-C was 7.2 [95% confidence interval (CI) 4.5-11.4] per 1,000,000 person-months. A higher incidence of MIS-C was observed between September and December 2021, corresponding to the circulation of the Delta variant than during the first year of the pandemic (RR 3.6, 95% CI, 1.1-12.3). The lowest rate of MIS-C per infection was observed during the Omicron (RR 0.17, 95% CI, 0.03-0.82). Median age at diagnosis was 6.5 years. Previously healthy children made up 88% of MIS-C cases, none were vaccinated against SARS-CoV-2. 33% required intensive care. All patients recovered fully. Conclusions: MIS-C incidence and MIS-C risk per infection changed significantly over time during the first two years of COVID-19 pandemic. Monitoring of MIS-C incidence in future SARS-CoV-2 waves will be essential to guide public health interventions and vaccination policies for children.

Approaches to Occupational Mobility under the Conditions of the Current Economic Crisis

The objectives of economic development in the modern world demand new approaches in the study, analysis and research of social aspects, labour markets and local and regional economic development in the context of the new transformations, the multiple crises that humanity is going through today. For the labour market, the geographical approach opens up the lens of analysis, formulation of priorities and the development of new methodologies that will help us build new theories and policies of local and regional economic development, the development of a labour market through the prism of economic geography. This approach will allow us to analyse the migration processes of occupational mobility and to develop viable policies and measures to create new jobs and ensure sustainable, smart and inclusive economic growth.

The Economic Growth and COVID-19 in the European Union Members and the United States

COVID 19 became a global epidemic with new uncertainties and significant consequences. The highest number of cases was observed in the United States, followed by Europe and Southeast Asia. Many sectors downsized or were otherwise hit hard by the pandemic. Governments focused on fighting the disease and mitigating its effects on their economies and health systems. This study examined how countries in the European region and the U.S. were prepared to cope with COVID-19 and its effects on their economies and health systems. After comparing economic growth, the Global Health Security Index, Stringency Index, and health inputs of these countries, it was found that many European nations and the U.S. were not fully prepared for global epidemics. The study results also show that the sharpest contraction in the national economies occurred in the second quarter of 2020.

Covid-19 : les transferts internationaux de patients de réanimation, une solution pour les départements frontaliers

La crise sanitaire de la Covid-19 a imposé une adaptabilité jamais réalisée de notre système de santé. Les services de réanimation et les structures de médecine d'urgence ont dû innover et développer des stratégies novatrices pour garantir des soins de qualité à tous les patients relevant de réanimation. La région Grand-Est, et plus particulièrement les départements de Moselle, du Bas-Rhin et du Haut-Rhin, a été particulièrement touchée. Parmi les 349 patients transférés hors de la région, 164 l'ont été vers des pays européens (Allemagne, Autriche, Luxembourg et Suisse) entre le 14 mars et le 4 avril 2020. Ces transferts internationaux, organisés par l'Agence régionale de santé et les Samu-Centre 15, ont essentiellement fait appel à des moyens aériens des hôpitaux, de l'armée et de la protection civile. L'accompagnement des patients, soigneusement sélectionnés, était assuré par un binôme médecin‒ infirmier spécialisés. Le choix de cette stratégie a permis d'éviter la saturation des services de réanimation et d'avoir à faire un choix entre les patients pouvant ou non bénéficier de soins aigus. L'adaptabilité des professionnels de santé et une organisation au plus près du terrain ont permis de réaliser ces transferts dans de bonnes conditions. Cet épisode témoigne de l'importance de laisser la gestion des crises sanitaires aux professionnels de la santé. Cet article présente l'organisation mise en place en région Grand-Est pour préparer et réaliser ces transferts internationaux.Alternate : The COVID-19 health crisis has imposed an unprecedented adaptability of our health system. Intensive care units and emergency departments had to innovate and develop new strategies to guarantee quality care for patients needing intensive care. The "Grand-Est” region and particularly the counties of Moselle, Bas-Rhin and Haut-Rhin, were strongly impacted. Among the 349 patients transferred out of region, 164 were transferred to European countries (Austria, Germany, Luxembourg, and Switzerland) between March 14 and April 4, 2020. These international transfers, organized by the regional health agency and the emergency medical call centers, mainly use flying ambulances belonging to hospitals, army, and civil protection. The support of these patients was provided by a specialized physiciannurse team. The choice of this strategy made it possible to avoid saturation of intensive care units and to make a choice between patients admitted or not in intensive care. Adaptability of health care providers and an organization as close as possible to the field allowed these transfers to be carried out under good conditions. This episode demonstrates the importance of leaving the management of health crisis to health professionals. This article presents the organization set up to prepare and carry out these international transfers.

Digital systemic practices in Europe: A survey before the COVID-19 pandemic

Knowledge regarding digital practices in the field of systemic therapy is poor. A few surveys have been conducted in non-European countries investigating the provision of digitally based therapy, counselling, training, and supervision by systemic family and couple therapists (SCFTs). Thus, a survey aiming to investigate the use of information and communication technology (ICT) among European SCFTs was launched in 2017. A sample of 220 SCFTs was included in the survey. The majority were residents in Greece, France and Italy. Descriptive analysis compared SCFTs' digital practices and concerns from the above three countries with those from the rest of Europe. Results showed that 81.4 per cent of European SCFTs used ICT for clinical purposes and 47.7 per cent in training and supervision. Main concerns among European SCFTs related to the quality of therapeutic relationship, ethical and legal issues, and a lack of national and transnational regulation. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement ICT use and e-therapy increase access to mental health services and maintain therapeutic contact. Systemic individual therapy, supervision and training are workable online settings. Legislation regulating ICT use in therapy, supervision and training (e.g. General Data Protection Regulation) has to be respected. Training and continuous education in online practices enhance therapists' and clients' options, and ensure digital safeness and effective treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Quality of maternal and newborn care around the time of childbirth in Luxembourg during the COVID-19 pandemic: Results of the IMAgiNE EURO study.

OBJECTIVE: To investigate the quality of maternal and newborn care (QMNC) during childbirth in Luxembourg from women's perspectives. METHODS: Women giving birth in facilities in Luxembourg between March 1, 2020, and July 1, 2021, answered a validated online WHO standards-based questionnaire as part of the multicountry IMAgINE EURO study. Descriptive and multivariate quantile regression analyses were performed. RESULTS: A total of 493 women were included, representing 5.2% of women giving birth in the four maternity hospitals in Luxembourg during the study period. Most quality measures suggested high QMNC, although specific gaps were observed: 13.4% (n = 66) of women reported not being treated with dignity, 9.1% (n = 45) experienced abuse, 42.9% (n = 30) were not asked for consent prior to instrumental vaginal birth, 39.3% (n = 118) could not choose their birth position, 27% (n = 133) did not exclusively breastfeed at discharge (without significant differences over time), 20.5% (n = 101) reported an insufficient number of healthcare professionals, 20% (n = 25) did not receive information on the newborn after cesarean, and 41.2% (n = 203) reported lack of information on newborn danger signs before discharge. Multivariate analyses highlighted higher reported QMNC indexes among women born outside Luxembourg and delivering with a gynecologist, and significantly lower QMNC indexes in women with the highest education levels and those delivering in the hospital offering some private services. CONCLUSIONS: Despite maternal reports suggesting an overall high QMNC in Luxembourg, improvements are needed in specific aspects of care and communication, mostly related to maternal autonomy, respect, and support, but also number and competencies of the health workforce.

Developpement de nouveaux "endpoints" cliniques a l'aide de biomarqueurs numeriques bases sur la voix pour le suivi a distance, en vie reelle, de patients en recherche clinique: exemple de biomarqueurs vocaux pour le suivi du statut symptomatique de patients avec COVID-19

References 1. Fagherazzi G, et al. Voice for Health: The Use of Vocal Biomarkers from Research to Clinical Practice. Digit Biomark. 2021;5: 78-88. 2. Fagherazzi G, et al. Protocol for a prospective, longitudinal cohort of people with COVID-19 and their household members to study factors associated with disease severity: the Predi-COVID study. BMJ Open. 2020;10:e041834. 3. Fagherazzi G, et al. A Voice-Based Biomarker for Monitoring Symptom Resolution in Adults with COVID-19: Findings from the Prospective Predi-COVID Cohort Study. SSRN Electronic Journal. doi:10.2139/ssrn.3949487 Figures [Formula presented] Fig.1. Pipeline d'identification, de validation et d'implementation d'un biomarqueur vocal (Luxembourg Institute of Health, Deep Digital Phenotyping Research Unit). [Formula presented] Fig. 2. Performances du biomarqueur vocal de suivi du statut symptomatique chez les patients avec COVIS-19. Copyright © 2022

Digital Writer" - a support for older persons

Digitalization enables significant opportunities for individuals as well as for society as a whole. However, the number of "offliners"remains high. It is true that pressure to use social media has increased in recent years, especially as a result of the Corona pandemic, as many shops and authorities had closed and in many cases appointments could only be made online. However, the so-called "age gap"has only decreased slightly in recent years. Previous support programmes by the state for older people using more internet services had only moderate success. But not everyone can use digital media, and many do not want to. However, it must be asked whether it is the right of every individual not to use digital media. What do we do with those? Caritas in Luxembourg has revived what itself is an "old idea": the establishment of a "writer"- here: the establishment of a "digital writer". © 2022 ACM.

Surveillance of the Second Wave of COVID-19 in Europe: Longitudinal Trend Analyses.

BACKGROUND: The COVID-19 pandemic has severely impacted Europe, resulting in a high caseload and deaths that varied by country. The second wave of the COVID-19 pandemic has breached the borders of Europe. Public health surveillance is necessary to inform policy and guide leaders. OBJECTIVE: This study aimed to provide advanced surveillance metrics for COVID-19 transmission that account for weekly shifts in the pandemic, speed, acceleration, jerk, and persistence, to better understand countries at risk for explosive growth and those that are managing the pandemic effectively. METHODS: We performed a longitudinal trend analysis and extracted 62 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in Europe as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS: New COVID-19 cases slightly decreased from 158,741 (week 1, January 4-10, 2021) to 152,064 (week 2, January 11-17, 2021), and cumulative cases increased from 22,507,271 (week 1) to 23,890,761 (week 2), with a weekly increase of 1,383,490 between January 10 and January 17. France, Germany, Italy, Spain, and the United Kingdom had the largest 7-day moving averages for new cases during week 1. During week 2, the 7-day moving average for France and Spain increased. From week 1 to week 2, the speed decreased (37.72 to 33.02 per 100,000), acceleration decreased (0.39 to -0.16 per 100,000), and jerk increased (-1.30 to 1.37 per 100,000). CONCLUSIONS: The United Kingdom, Spain, and Portugal, in particular, are at risk for a rapid expansion in COVID-19 transmission. An examination of the European region suggests that there was a decrease in the COVID-19 caseload between January 4 and January 17, 2021. Unfortunately, the rates of jerk, which were negative for Europe at the beginning of the month, reversed course and became positive, despite decreases in speed and acceleration. Finally, the 7-day persistence rate was higher during week 2 than during week 1. These measures indicate that the second wave of the pandemic may be subsiding, but some countries remain at risk for new outbreaks and increased transmission in the absence of rapid policy responses.

The Contributions of the Scientists across the Globe in the COVID-19 Pandemic

Background: The COVID-19 disease, which was declared pandemic by WHO on the 11th of March 2020, has affected more than 200 countries worldwide and adversely affected whole areas of life. Aim: Our aim in this study is to investigate whether scientists in countries with low mortality rates and a higher reported number of COVID-19 cases among OECD countries sufficiently share their scientific knowledge. Methodology: A literature search was conducted with the keywords, "COVID-19, SARS-CoV2, Coronavirus" in scientific databases such as PubMed, EMBASE, Scopus and Medline to find the number of published articles conducted by scientists in OECD countries between the period 01 March 2020 to 01 July 2020. To define the number of academic population of the countries, the number of residents in tertiary education levels of OECD countries was obtained from the educational attainment of 25-64 year-olds report published on the OECD website. Results: In regards to the countries with the lowest fatality rates, India (n:1578), Australia (n:1097), and Korea (n:876) are the top three countries that have contributed to the scientific literature with the most published studies on COVID-19 issue. Conclusions: Concerning the current scientific data, about 2,000 papers regarding COVID-19 disease have been registered in the PubMed database since the early beginning of this year. The number of scientific publications is not consistent with the rate of tertiary education levels. Besides, the number of observed cases, and the data-sharing policies of the countries are determinants of the number of scientific publications.

Modern tax Havens: the Experience of European Countries

This paper aims to assess the European tax havens in terms of corporate financial misconduct risks. The study relies on an index method developed by a group of economists belonging to the international non-governmental organization - the Tax Justice Network. The method allowed the authors to calculate the Corporate Tax Harbor Index (CTHI) and determine the role of a particular jurisdiction in global corporate financial misconduct risks. The study established a ranking of European tax havens and jurisdictions with features of tax havens and classified these tax havens based on corporate financial misconduct risks. The study found that European tax havens and tax haven jurisdictions accounted for nearly 40% of global corporate financial misuse risks in 2020. The classification of European tax havens according to corporate financial misconduct risks demonstrated that the Netherlands, Switzerland, the UK, Ireland, and Luxembourg accounted for more than half of the risks. The shares of Liechtenstein (1%), Monaco (1%), Andorra, and San Marino (less than 1%) did not exceed 3% of the European share of the global risk. The results show the need for adjustments to the regulatory policy of international organizations currently focused on fighting classic tax havens. Their real share of global misuse risks is very small compared to the share of 'gray cardinals' of the offshore market.

INTERVAL HYPOXIC-HYPEROXIC TRAINING in REHABILITATION of PATIENTS with OSTEOARTHRITIS and POST-COVID SYNDROME

Background: Intermittent hypoxia conditioning reduces the levels of infam-matory parameters and cytokines (C-reactive protein, TNF-α, IL-4, IL-6, IL-8), increases the tolerance to acute hypoxia, the functional capacity and improves parameters of respiratory and cardiovascular systems [1-4]. Objectives: To evaluate the efficiency of the interval hypoxic-hyperoxic training (Reoxy therapy) in the rehabilitation of patients with osteoarthritis (OA) and post-COVID syndrome. Methods: 36 patients with OA (78% females, age of 43 to 68 years, generalized OA, OA of the knee or hip joints) where included in the randomized placebo-controlled study. Coronavirus infection COVID-19 were diagnosed from 12 to 26 weeks before the study. The main symptoms of post-COVID syndrome were dry cough, smell loss, breathlessness, weakness, fatigue, sleep disorders, cognitive symptoms, memory problems, anxiety, depression, headache, dizziness, joint and muscle pain. All patients were randomized into 3 groups. 13 study group patients received 10 Reoxy therapy procedures, 9 placebo group patients-10 placebo procedures of Reoxy therapy, 14 control group patients-only standard rehabilitation. The patients of all groups underwent 2-week standard rehabilitation program: 10 procedures of electrostatic massage for muscles and periar-ticular tissues, 10 sessions of general magnetic therapy, 10 group sessions of physical exercises with elements of breathing exercises. All patients received NSAIDs and SYSADOA at standard dosages. Intra-articular corticosteroids was not used. The study group patients were breathing hypoxic (FiO2 13-15%) and hyperoxic (FiO2 up to 40%) gas mixture through the mask in the interval mode with biofeedback using device «ReOxy» (Ai Mediq S.A., Luxembourg). 10-min hypoxic test (FiO2 12-13%) was performed before the frst and fourth procedures. The duration of 1-4 procedures was 30 min, 5-10 procedures-40 min. The placebo procedures were performed using the mask with the atmospheric air hole. Joint pain and general health on 100-mm VAS, Lequesne and WOMAC indexes, Spielberger-Khanin anxiety test, Beck depression inventory and breath-lessness on Modifed Borg scale were evaluated at baseline and at 2 weeks. Results: After 2 weeks in the study group pain on VAS decreased by 49,6% (p<0,05), Lequesne index-by 39,3% (p<0,05), WOMAC-by 1,4 times (p<0,01), anxiety level on Spielberger-Khanin test-by 40,9% (p<0,05), depression level on Beck depression inventory-by 64,1% (p<0,01), general health on VAS improved by 69,3% (p<0,01). The level of breathlessness on Modifed Borg scale in the study group initially was 2,5±0,9 score (moderate-slight breathlessness). After rehabilitation in the study group the level of breathlessness decreased to 0,3±0,4 score (extremely slight-no breathlessness). In the study group there were statistically signifcant differences from the placebo group (p<0,05) and the control group (p<0,05) in all parameters. Conclusion: 2-week complex rehabilitation program, including interval hypox-ic-hyperoxic training (Reoxy therapy), reduces pain, breathlessness, depression and anxiety, improves functional status and general health in patients with OA and post-COVID syndrome.

Russian-Ukrainian War, Innovation, Creative Imitation & Sustainable Development

The Russian-Ukrainian war shows a rapidly (and a long-term, probably) worsening outlook for the world economy, that will change specifically the European sustainable development. In addition to COVID-19's tremendous impact on global economies, the Russian-Ukrainian war is producing a new major economic shock, pushing the biggest global corporations towards an outburst of the basic drivers of global capitalism: Health;Energy;Food;Communication. In the current state of play of market globalisation (Network Globalisation), a company's profit and development objectives are induced to target R&D spending on innovation policies in which the boundaries between imitation and innovation are fluid, and anyway dominated by shortage management policies.

Two cases of COVID vaccine-induced immune thrombotic thrombocytopenia in Luxembourg

Introduction: In March 2021, a signal for embolic and thrombotic events with Vaxzevria (COVID-19 Vaccine AstraZeneca) was raised in Austria and Germany, and on 7 April 2021, the European Pharmacovigilance Risk Assessment Committee (PRAC) concluded that a causal relationship between Vaxzevria and thrombosis combined to thrombocytopenia (TTS) was at least a reasonable possibility [1]. TTS mechanism is close to heparin-induced thrombocytopenia [2,3]. We report two Luxembourg cases of TTS that occurred one before and one after this confirmed signal. Results: The first case is a 74-year-old woman, with no medical history, who received her first dose of Vaxzevria in March 2021. Fourteen days later, she was hospitalised for sudden loss of consciousness. On admission she had thrombocytopenia (18 G/L), D-Dimers >20 000 ng/mL, antithrombin III 79%, fibrinogen 0.69 g/dL. Brain CT scan showed cerebral and meningeal haemorrhages. She died three days later. Autopsy confirmed multiple intracranial haemorrhages and showed right transverse sinus organised thrombosis. Post-mortem analysis revealed positive heparin-Platelet Factor 4 (PF4) antibodies (HIPA and PIPA). The second case is a 31-year-old man with medical history of splenic infarction in 2017 during mononucleosis. He received his first dose of Vaxzevria in June 2021, and 12 days later was admitted for right lower limb and lumbar pain with severe thrombocytopenia (28 G/L), low fibrinogen and elevated D-Dimers. Angiography showed sub-occlusive cruoric impactions of the left carotid bifurcation, the sub-renal abdominal aorta and the right common femoral artery. PF4 antibody initially negative (Zymutest Hyphen) were positive with IMMUCOR technique. Management included clots removal, intravenous immunoglobulins started for 3 days and anticoagulation with sodium danaparoid. The patient recovered within one month without sequelae. Discussion/Conclusion: The quick communication about TTS signal and the rapid identification of its mechanism both allowed, as reported here for the second patient, adapted management (prohibiting heparin), with full recovery.

Trends in utilization of antidepressants in twenty European Countries

Introduction: The use of antidepressants seems to be increasing in most countries worldwide, probably due to the increasing burden of stressful life (1). Apart from their therapeutic application, antidepressants are sometimes used as lifestyle drugs. Monitoring antidepressant usage is crucial to prevent unnecessary consumption and avoid adverse effects and additional costs (2). Objectives: The aim of this work was to study trends in antidepressants utilization in various European countries, and to note changes in their usage between the years 2013 and 2019, before the outbreak of COVID 19 pandemic. Methods: Data on antidepressants consumption in 20 European countries were collected from the Organization for Economic Cooperation and Development (OECD) data bases. Antidepressants consumption was expressed in Defined Daily Doses (DDDs) per 1,000 inhabitants per day, and calculations referred to years 2013 and 2019. Changes in antidepressants use during this six-year period in each European country were assessed. The statistical package SPSS (Chicago, IL, USA) was used for calculations. Results: There was a huge variation in antidepressants usage among the 20 countries of our study. The mean consumption of antidepressants was 52.67 DDDs per 1,000 inhabitants per day in 2013 (range 10.2-113.7 DDDs) and 62.51 DDDs per 1,000 inhabitants per day in 2019 (range 17.6-146.0 DDDs), with a mean increase of 9.84 DDDs per 1,000 inhabitants per day (18.68%) in just six years. The countries with the highest consumption of antidepressants in 2013 were Iceland (113.7 DDDs), Portugal (87.5 DDDs), Sweden (84.3 DDDs), Belgium (72.1 DDDs), Finland (69.4 DDDs) and Spain (65.2 DDDs). The countries with the highest consumption of antidepressants in 2019 were Iceland (146.0 DDDs), Portugal (123.7 DDDs), Sweden (102.7 DDDs), Spain (83.6 DDDs) and Belgium (81.9 DDDs). The countries with the lowest consumption of antidepressants in 2013 were Latvia (10.2 DDDs), Estonia (21.4 DDDs), Lithuania (24.7 DDDs), and Hungary (27,5 DDDs). The countries with the lowest consumption of antidepressants in 2019 were Latvia (17.6 DDDs), Hungary (29.5 DDDs), Estonia (34,8 DDDs) and Lithuania (35,4 DDDs). The use of antidepressants was increased in all European countries in the study period. There was only one exception: Finland, being one the countries with the highest consumption of antidepressants, reduced their use by 13%. In the countries with the lowest consumption of antidepressants (Latvia, Estonia and Lithuania), the increase in antidepressants usage was higher than 40%. A similarly high increase (41.37%) was also observed in Portugal, which was second in antidepressant use in both years studied (2013 and 2019). The Countries with the lowest increase (less than 5%) were Austria, Norway and Luxemburg, which displayed an average consumption of antidepressants in the study period. Conclusion: There was a huge variation in antidepressants use among the 20 European countries of our study. A trend for increase in antidepressants use was observed in almost all countries during the six-year study period.

Sexual satisfaction and sexual behaviors during the COVID-19 pandemic: results from the International Sexual Health And REproductive (I-SHARE) health survey in Luxembourg.

AIM: To identify the impact of COVID-19 measures on sexual behaviors and sexual satisfaction in Luxembourg residents. METHODS: We conducted a cross-sectional online survey of adults (> 18 years of age) residing in Luxembourg, while COVID-19 restrictions were in place. The survey was available from January 15 to February 12, 2021 in four languages (French, German, English and Portuguese). Survey questions focused on masturbation, cuddling, condom use, sex frequency, sexting, cybersex, watching porn, and sexual satisfaction. RESULTS: 557 volunteers completed the survey (35.5% men, 64.3% women). Sexual satisfaction and sexual problems variables were assessed on 4-point Likert scales (0 = not at all/never to 3 = very/often). Sexual problems increased during the COVID-19 measures while sexual satisfaction decreased compared to before the introduction of COVID-19 restrictions (assessed retrospectively). Factors associated with increased odds of sexual satisfaction included having a steady relationship before COVID-19 restrictions, engaging in sexting, reporting good mental health and not altering alcohol intake. CONCLUSIONS: The context of the COVID-19 pandemic and the measures implemented in Luxembourg affected sexual behaviors and sexual satisfaction. Sexual and reproductive health care centers and health professionals in general should take these results into consideration when providing care. Recommendations on the importance of sexual health for general wellbeing and behaviors associated with sexual satisfaction should be offered and possibilities to experience sexuality while reducing contamination risks be discussed.

Cross-border cooperation in the border region of Germany, France, and Luxembourg in times of Covid-19

The process of European integration has tended to diminish the significance of borders within the EU. In that respect, the impact of the Covid-19 pandemic in spring 2020 was all the greater: 35 years after the signing of the Schengen Agreement, checks and closures suddenly reappeared at many former border crossing points;long queues at crossing points, families and friends cut off from each other, and complex individual fates descended like a pall on European societies. At the same time, the advanced state of integration of borderlands became apparent - a striking example being the SaarLorLux region across the common borders of Germany, France, and Luxembourg. The article inquires into the political response to the impact of the Corona crisis across this border region. The analysis shows that on many levels SaarLorLux is perceived as a tightly meshed integration area in which functional exchange is normal, and that a corresponding ideational shock was felt at all political levels when border controls were reintroduced. However, the situation also had positive effects in terms of cross-border cooperation. Many political actors see the institutionalization of cross-border integration as having grown in the pandemic and are unanimous in wanting future developments in this respect. [ FROM AUTHOR] Copyright of European Societies is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)