Demographic Scenarios for the EU: Migration, population and education

Over the recent decades, the EU has been shaped by population growth, but now its population is ageing. Together with North America and East Asia, the EU is moving towards longer-living, lower-fertility, and higher-educated societies. Facing this new demographic frontier naturally prompts the questions: Who will live and work in Europe in the coming decades? How many, and with what skills? To answer these, this report examines the key factors that will shape European demographics over the coming decades. By examining not only the role of migration, fertility and mortality, but also education levels and labour force participation rates, a more comprehensive view of possible futures can be outlined than the conventional demographic projections allow for. The first five sections of this report focus on demographic challenges inside the EU, such as population ageing, a shrinking labour force, more non-working people being dependent on working people, and showing the impact of high levels of emigration in some EU Member States. With these challenges in mind and with a view towards 2060, the report builds scenarios to understand the long-term effects of changes in key trends, and whether undesirable consequences can be limited or counteracted. As the EU and its demographics do not exist in isolation, the following sections explore the relevant trends for world demographics and for migration flows

Human Capital Investment and the Sustainability of Public Transfer Systems Across Europe

We evaluate the sustainability of the public transfer systems in 24 EU countries using a new cohort-specific indicator, the Human Capital Investment Gap (HKIG). The indicator measures for a certain cohort the difference between the public benefits in old age and the public contributions of the child generation. Calculating the HKIG for the cohort born in 1950, we show that in none of the analyzed countries the contributions of the child generation will be sufficient to finance the old age benefits of the 1950 cohort, given the age- and employment-specific transfer pattern observed in 2010. This result holds for most of the countries even when assuming very optimistic employment scenarios. The decomposition of the HKIG into its components indicates that the cross-country differences in the HKIG are mainly driven by the level of public contributions and benefits, while retirement age and employment rates play a comparably minor role

Severe adverse events during sirolimus "off-label" therapy for vascular anomalies.

OBJECTIVES Clinical studies have shown low toxicity and a favorable safety profile for sirolimus in vascular anomalies. Here, we describe severe adverse events (SAEs) observed during "off-label use" for vascular anomalies. METHODS We performed a retrospective, multicenter chart review for SAEs during "off-label" sirolimus therapy for vascular anomalies and analyzed these cases by a predesigned workflow. RESULTS We identified 17 SAEs in 14 patients diagnosed with generalized lymphatic anomaly (n = 4), Gorham-Stout disease (n = 2), central conducting lymphatic anomaly (n = 1), lymphatic malformation (n = 4), tufted angioma (n = 1), kaposiform hemangioendothelioma (n = 1), and venous malformation in a patient with CLOVES syndrome (n = 1). Three patients presented two SAEs each. The age at initiation of sirolimus therapy was under 2 years (n = 5), 2-6 years (n = 5), and older than 12 years (n = 4). SAEs occurred during the first 3 months of sirolimus therapy (n = 7), between 3 and 12 months (n = 7) and after 1 year of therapy (n = 3). The most frequent SAE was viral pneumonia (n = 8) resulting in one death due to a metapneumovirus infection in a 3 months old and a generalized adenovirus infection in a 28-month-old child. Sirolimus blood level at the time of SAEs ranged between 2.7 and 21 ng/L. Five patients were on antibiotic prophylaxis. CONCLUSIONS Most SAEs are observed in the first year of sirolimus therapy; however, SAEs can also occur after a longer treatment period. SAEs are potentially life threatening, especially in early infancy. Presence of other risk factors, that is, underlying vascular anomaly or immune status, may contribute to the risk of SAEs. Sirolimus is an important therapeutic option for vascular anomalies, but patients and physicians need to be aware that adequate monitoring is necessary, especially in patients with complex lymphatic anomalies that are overrepresented in our cohort of SAEs

Combining Working Life and Health Expectancies

People around the world are living longer while fertility has been declining in the great majority of countries. Increasing the length of working lives is a commonly sought remedy to deal, at least in part, with the financial consequences for the public welfare system of longer lives. A crucial question is whether people are physically and mentally capable of working until continuously higher ages, i.e. whether the planned or already implemented increases in official retirement ages will be faced by persons of good health. Hence, it is important to not only look at the development of working lives and focus on lengthening them but, at the same time, to take a close look at developments of the health status of people around retirement ages. An existing indicator that can be used to monitor developments of working life for people at any age is working life expectancy (WLE). The calculation and analysis of WLE has relevance in itself, but it is the combination of WLE with analyses of health indicators that are gaining prominence, particularly in the context of aging societies. Simultaneous consideration of both dimensions – economic activity and health – is useful for a range of reasons. It allows the detection of inequalities in the development of both indicators, for example for different subgroups of the population; it indicates where the limits of increasing WLE might lie, given current levels of population health; and, particularly, the analysis of trends in both indicators can point to possible issues in extending WLE further