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The effects of migration on ulcerative colitis: a three-year prospective study among Europeans and first- and second- generation South Asians in Leicester (1991-1994).

OBJECTIVE: Our aim was to measure prospectively the incidence of ulcerative colitis in Leicester City and to compare this with a previous retrospective study in the same area. We also sought to compare the incidence and disease extent in the European community with that of the South Asian community and to compare the disease extent between first- and second-generation South Asian migrants. METHODS: A 3-yr prospective study of ulcerative colitis in the city of Leicester took place from October 1, 1991 to September 30, 1994 and included all cases resident in Leicester City and diagnosed as having ulcerative colitis, regardless of the extent and severity of the disease. RESULTS: Extensive colitis was commoner in second-generation migrants than in the first generation (chi2 = 4.3, p = 0.04) and was comparable to the European community. The annual average incidence of ulcerative colitis was 9.1/10(5) population/yr (95% confidence interval [CI] 7.1-11.3), which is similar to the previous retrospective study. However, the annual average incidence of ulcerative colitis in the European population was 7.0/10(5) population/yr (95% CI 5-9.5), whereas that of the South Asian population was 17.2/10(5) population/yr (95% CI 11.8-24.3), confirming that the risk of ulcerative colitis in this particular community is exceptionally high. CONCLUSIONS: These early results suggest that the disease pattern follows that of the indigenous population after only one generation and requires monitoring over the next decade. The incidence of ulcerative colitis in the South Asian population is high and continuing to rise.

Adult↗

Welfare and poverty in the Europe of the 1990s: social progress or social dumping?

Social policy in Europe is changing fundamentally from a system of public (government) support to a welfare pluralism, or a "welfare mix" supported by the private and public sectors and by voluntary agencies. The overall tendencies are privatization, decentralization, and debureaucratization. With the prospect of a single-market economy within the European Communities in 1993, the fight against poverty in member nations may lead to "social dumping." Two major problems are identified: the lack of guaranteed minimum income schemes in the so-called "Latin Rim" countries, and the effect on workers' and citizens' rights in an integrated Europe. The fight against poverty is--despite some efforts from the Commission of the European Communities--basically left to the individual member states. This portends a gloomy scenario for the poorer populations of Europe in the 1990s. The author examines welfare state types within clusters of countries: the modern (Scandinavia), the corporatist (Federal Republic of Germany), the residual (Britain), and the rudimentary (Latin Rim). The conclusion, unfortunately, is that future overall development of European welfare systems in the 1990s will probably be toward "Americanization," with a move away from the modern, or Scandinavian, model toward a corporatist model for welfare policy.

Europe↗

The American manufacturer's view on the EEC texts and harmonization.

In a world that has become increasingly smaller with the aid of modern air travel, computers and facsimile machines, the European Community's efforts toward harmonization are applauded by the Animal Health Institute, representing the major U.S. manufacturers of veterinary biological products. The new and proposed directives and guidelines are based on the latest technology and help ensure that only high-quality safe and effective veterinary biologicals are registered in the European Community. These new legislations are, however, significantly different from the current United States (USDA) licensing requirements. The USDA requirements are designed to ensure the safety and efficacy of veterinary biologicals licensed in the United States and have been effective in doing so. Among major differences between EEC and USDA requirements are the EEC requirements for GLP safety tests, GMP for manufacturing, with increased measures for the prevention of cross-contamination, duration of immunity data, and raw material specifications in excess of those required in the United States. Very tight deadlines for implementing these requirements have been established. In the spirit of international harmonization and with the goal of reducing or preventing potential trade barriers, the AHI would like to propose the formation of an international working group consisting of FEDESA, AHI, CVMP, USDA and other international industry and government officials. It is suggested that annual meetings be held in conjunction with either FEDESA or AHI meetings. Issues to be dealt with include standardization of test requirements, time lines for implementation and other issues that could reduce or prevent trade barriers without adversely affecting product quality.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Testing Alternatives↗

Medical and public health research of the European economic community.

Scientific collaboration within EEC includes medical and health research programmes. Few and rather small activities started up in 1978, but have rapidly grown now to include participation of more than 1,200 teams from all member states involving about 2,000 scientists counted in men-years. Since 1984 primary health care research has been given high priority. The first scientific step has been established in collaboration with the European General Practice Research Workshop (EGPRW). As a necessary start of future research a detailed descriptive study of primary health care in the 12 member countries and some non-member countries, including all Nordic started up in January 1986. Based on this study a source-book of importance for further activities like "the interface between primary and secondary health care services", "sentinel data collecting centres", "reasons for encounter" etc. will be published. EEC-medical and health research in collaboration with other scientific organizations within primary health care surely will be able to give a most valuable contribution to the medical sciences as such in the future and not least to general practice and primary health care.

European Union↗

The precautionary principle, toxicological science, and European-U.S. scientific cooperation.

Although it is an ages old concept, the precautionary principle is only a few decades old as a formal expression of a philosophy guiding protection of the environment and of human health. The emergence of the precautionary principle in the European Community and its relatively slower acceptance in the United States reflects differences in underlying social, cultural, and legal approaches to environmental and public health protection. Unfortunately, this poorly defined principle in some of its manifestations can lead to a loss of the toxicological scientific base that is necessary for short-term and long-term protection of the environment and public health. Examples of problems caused by using the precautionary principle include trade barriers erected by the European Community, and the loss of the impetus to develop understanding of the toxicity of hazardous air pollutants due to precautionary aspects of the 1990 U.S. Clean Air Act amendments. There are other U.S.-European differences in the organization and funding of science that are threatening the legacy of Herbert Remmer which was built on close trans-Atlantic scientific cooperation to the benefit of all.

Animals↗

European registration: today, tomorrow, and beyond.

Within the European Community (EC) countries the national pharmaceutical regulatory systems work with varying degrees of efficiency and scientific sophistication. At the Community level the objective of mutual recognition has failed to be realized. To achieve for one registration application within the EC, timely and simultaneous marketing approvals throughout the member states will require changes to the present regulatory procedures or the single market concept for pharmaceuticals will not be realized. To have the greatest chances for success we should move cautiously, identifying and correcting deficiencies in the present procedures, which are known from experience, rather than abandoning such hard won knowledge for a new system with all its attendant potential unknowns and uncertainty. The free movement of drugs within the Internal European market will be a reality. The question remaining is at what price will it be achieved? It is vital to the European economy and consumer, as well as to the innovative pharmaceutical industry, that Europe does not exchange its present competitive edge in the time to develop and register new drugs for a costly drug lag. The experiment must equally succeed as a torch showing the way forward not only for an enlarging European Community, but also to the ever increasing interest in global harmonization of drug regulation.

Drug Industry↗

Analysis of dyes in illicit pills (amphetamine and derivatives).

The determination of dyes present in illicit pills is shown to be useful and easy-to-get information in strategic and tactical drug intelligence. An analytical strategy including solid-phase extraction (SPE) thin-layer chromatography (TLC) and capillary zone electrophoresis equipped with a diode array detector (CZE-DAD) was developed to identify and quantify 14 hydrosoluble, acidic, synthetic food dyes allowed in the European Community. Indeed, these may be the most susceptible dyes to be found in illicit pills through their availability and easiness of use. The results show (1) that this analytical method is well adapted to small samples such as illicit pills, (2) that most dyes actually found belong to hydrosoluble, acidic, synthetic food dyes allowed in the European Community, and (3) that this evidence turns out to be important in drug intelligence and may be assessed into a Bayesian framework.

Amphetamines↗

EUROCARE: a cross-national study of co-resident spouse carers for people with Alzheimer's disease: I--Factors associated with carer burden.

BACKGROUND: The challenges presented by the increasing public health and social impact of caring for people with dementia have become clear in recent years. Previous research has identified that, while there are positive as well as negative elements to the caring role, carers are at high risk of mental health problems and that the comprehensive burden of caring has social, economic and health based elements. Co-resident carers, especially spouses, are of primary importance in maintaining people with dementia in their own homes in the community rather than in institutional settings which may be both more costly and have greater environmental poverty. There have, however, been few studies which have sought to investigate factors associated with carer burden and differences and similarities between countries. In this study we aimed to produce a cross-national profile of co-resident spouse carers across the European Community, with particular attention to: living arrangements; formal and informal support; service satisfaction; perceived burden; and psychological well-being. METHOD: Twenty co-resident spouse carers of people with NINCDS-ADRDA probable dementia, who had been diagnosed as such within the past 12-36 months, were recruited from service contacts in each of 14 out of the 15 countries of the EU. All completed a semi-structured interview which included: sociodemographic data; data on health and social service use; the Carer Burden Inventory (CBI); the General Health Questionnaire-12 (GHQ-12); and open-ended qualitative questions about the experience of caring. RESULTS: Two hundred and eighty couples were recruited. There was marked variation in all variables of interest between countries, but there were consistently high ratings of carer burden (mean CBI scores between 28 and 52) and psychological distress (between 40% and 75% scoring 4 or more on the GHQ-12). Using multivariate analyses (generalized linear modelling) to estimate the individual associations of variables of interest with carer burden, controlling for the effects of all other variables in the model, the following results were obtained: 11.4% (p = 0.003) of the variance was accounted for by between-country variation; 4.9% (p < 0.001) by expressed financial dissatisfaction; 4.5% (p = 0.001) by lower carer age; 3.2% (p = 0.004) by difficulties with spouse behavioural deficits; and 2.0% (p = 0.024) by perceived negative social reactions. There was a low level of contact with support groups and Alzheimer's disease societies despite the samples having been of service contacts. CONCLUSIONS: This study confirms the high level of burden and mental distress in spouse carers for people with Alzheimer's disease in the European Community. It suggests that there are elements of burden which may vary by country but also elements which have a common effect in all. These data suggest avenues for the primary and secondary prevention of burden by addressing clinical issues (e.g. behavioural disturbance); public attitudes and education (e.g. negative social reactions); economic support for carers (e.g. financial dissatisfaction); and higher risk groups (e.g. younger spouse carers).

Aged↗

Epidemiological and clinical features of 139 patients with tuberculosis at a teaching hospital in Italy (Pisa, 1996-2000).

In order to describe epidemiologic and clinical features of patients with tuberculosis (TB) identified recently in the hospital of Pisa (Tuscany, Italy), a retrospective study of all cases of TB notified to the Local Public Health Service during January 1996-December 2000 was performed. The diagnosis of TB was made following the criteria of the WHO. A total of 139 patients affected by TB were identified. Diagnosis was microbiologically proved in 81 patients. Mean age was 53.8+/-20.5 S.D. yrs. Thirty-five (25.2%) patients were extra European community citizens (mostly from Africa). The incidence of TB (N/100.000) was 8.4 in 1996 and 6.8 in 2000. Sixty-eight point three per cent of patients had pulmonary TB, 24.5% extrapulmonary and 7.2% mixed TB. The rate of extrapulmonary TB was 15.9% and 39.2% in the 1996-98 and in the 1999-2000 periods, respectively (p = 0.002). Extrapulmonary TB was more frequent in extra European community citizens (42.8%) than in Italian ones (18.3%), p = 0.003. Seven patients were presenting also advanced HIV infection. Microscopic examination for acid fast bacilli in sputum or bronchial secretion resulted negative in 17.4% of proved pulmonary TB (positive culture for Mycobacterium tuberculosis). The chest x-rays showed pleural effusion in 19 patients. Pulmonary cavitation was documented in 15 patients with negative chest x-rays. Fever was not present in 42.4% of the patients at the moment of diagnosis. Three point eight percent of the isolated strains of M. tuberculosis were in vitro multidrug-resistant. The data presented showed an important rate of TB in Pisa. We have yet to understand if the decreased rate observed in 2000 represents a new trend as reported in other North American and European countries. The rate of extrapulmonary TB shows a trend to increase accordingly to recent literature. The isolation rate of multidrug-resistant strains of M. tuberculosis in Pisa seems to be similar to the rates reported in other areas of Europe.

Antitubercular Agents↗

Fluorimetric determination of menadione sodium bisulphite (vitamin K3) in animal feed and premixes by high-performance liquid chromatography with post-column derivatization.

A high-performance liquid chromatographic (HPLC) method for the determination of menadione sodium bisulphite (vitamin K3) in animal feed and premixes is described. After aqueous extraction, the vitamin is converted into menadione, which is extracted and separated on a reversed-phase HPLC column. After menadione has been reduced in a post-column reaction coil, fluorimetric measurement of the reduced vitamin permits the determination of menadione sodium bisulphite in animal feed and premixes at concentrations as low as 0.02 microgram/g. Several types of animal feed have been analysed according to the method described and also with the European Community colorimetric method. From high concentration levels down to ca. 15 micrograms/g the results obtained with the two methods are in good agreement. For concentrations in the range 1-3 micrograms/g (complete diets) a tendency to lower results by the HPLC method is observed. The detection limit of the HPLC method is considerably lower than that of the European Community colorimetric method. The within-assay coefficient of variation of the method applied to feeds is 6.0%. The within-assay analytical recovery of menadione sodium bisulphite added to feeds is 94.4 +/- 6.8% (mean +/- S.D.).

Animal Feed↗

Farm management indicators and farm typologies as a basis for assessments in a changing policy environment.

This paper focuses on the assessment of farm management indicators and argues that typologies are a necessary tool for comprehensive environmental assessments. In the paper Andersen et al., [(2004a). Farming and the Environment in the European Community--using agricultural statistics to provide farm management indicators. Paper presented at OECD Expert meeting, March 2004, New Zealand. < http:webdomino1.oecd.org/comnet/agr/farmind.nsf/viewHtml/index/$FILE/Anderson_et_al.PDF> (1st of February 2006).] presented at the OECD expert meeting on farm management indicators in New Zealand in March 2004, a set of farm management indicators was presented in the framework of a typology of grazing livestock farming systems in the EU-15 (includes all Member States of the European Union before 2004). The present paper presents new results on farm management indicators within the framework of an extended typology for all farming sectors. It presents an environmentally oriented extension to the EU typology of farms currently used for assessing the situation of farming within the European Union. The extended typology is tested in relation to emerging policy issues such as environmental sustainability and rural viability by analysing some of the farm management indicators suggested in Andersen et al., [(2004a). Farming and the Environment in the European Community--using agricultural statistics to provide farm management indicators. Paper presented at OECD Expert meeting, March 2004, New Zealand. (1st of February 2006).]. Finally, recommendations in relation to the next generation EU farm typology are given.

Agriculture↗

[Europan: the European project for the study of hypocaloric peripheral parenteral nutrition in surgical patients].

This is the first time that a concerted action in the field of biomedicine proposed by Spain has been accepted by the European Communities. The research project, presented by one of the authors under the name of EUROPAN, proposes the study of hypocaloric peripheral parenteral nutrition in surgical patients. At present the concerted actions committee in biology (COMAC-BIO) of the E.C. is financing an exploratory phase in order to elaborate a prospective protocol by means of a workshop that will take place in Madrid in march 13 and 14. Twenty four European experts and several Spanish observers will take part in the meeting. The exploratory phase will conclude in june 1989, date in which it will be submitted for approval to the Commission of the European Communities and their consultative committees. If the concerted action proposal is finally approved, it will have to be executed during the next three years, ending by january 1992. Legal aspects of the E.C. in which this project is considered, as well as scientific, social and organizational goals and actions to be executed are described in this article.

Congresses as Topic↗

Counselling in the European Economic Community.

Counselling is becoming increasingly important in modern general practice and the relationship between counsellors and general practitioners varies in different places and in different countries. Through a Stanning Overseas Fellowship I had the opportunity of examining this relationship in several countries in Europe in order to compare and contrast arrangements.

Counseling↗

Risk by use of hearing protectors--expert programme supports SMEs in appropriate selection and use.

Comprehensive protection by use of PPE against the hazards at work requires more than proper selection based on the protection level needed: The PPE user directive (Council Directive 89/656/EEC, Official Journal of the European Communities L 393, 30/12/1989 p.0018 - 0028) requires an assessment of personal protective equipment itself, which has to consider the risks which may be introduced by use of PPE or use of combinations of PPE. As an example risks which may be introduced by use of hearing protectors are described. Assistance in the assessment required by PPE user directive (Council Directive 89/656/EEC, Official Journal of the European Communities L 393, 30/12/1989 p. 0018 - 0028) and in selection and use of hearing protectors with regard to this assessment is presented.

Decision Making↗

The animal scientist in a changing society.

Despite the lack of any credible scientific evidence to oppose the use of animal performance-enhancing agents, acceptance of performance enhancers seems no closer than it was a decade ago--at least among the European Community and its major trading partners. Consumers are suspicious of new technologies, and politicians are wary of legalizing growth promoters when the relative price of animal products has never been cheaper. Among the factors that have recently re-fuelled consumer concerns over farming methods are: bovine spongiform encephalopathy, cloning of farm animals, and genetic manipulation of crops. Meanwhile, politicians try to balance the interests of the environmentalist, farming, and welfare lobbies with the politico-economic realities of an expanding European Community and the demands of the GATT agreement. In the United States, where corporate influence over political actions is more overtly established than in Europe, some new technologies have been introduced. This has further antagonized many consumers. As scientists with a direct interest in animal performance enhancers, we need to re-assess our positions--if for no other reason than to protect our research (and personal) incomes. We could probably better protect our own interests--and those of the farming community--if we raised our eyes from the microscope to look at the wider view. There are two challenges for animal production scientists: to identify truly acceptable ways of enhancing animal performance and to be highly active in bringing scientific consensus to the attention of both the public and the political establishments.

Animal Husbandry↗

Specialist training in rheumatology in Europe.

Rheumatology is a broad discipline managing a spectrum of different conditions and there are divergences in what is routinely treated by rheumatologists both within and between countries. The free movement of doctors throughout the European Community has lead to moves to harmonize specialist training to ensure common standards of care. The Union Européene des Médecins Spécialistes (UEMS) has developed recommendations for the specialist training of rheumatologists in Europe that recognizes the broad definition of the discipline and the diversity of clinical practice in Europe. The core curriculum aims to provide a common standard around which to develop locally applicable national curricula. The provision of high quality care requires some assessment of training and competency as well as continuing professional development and ways of ensuring the provision of this throughout the European Community to a mutually high standard are being developed. The future may see more overlap in the training of all the disciplines concerned with the management of those with musculoskeletal conditions to their benefit.

Curriculum↗

Efficacy and quality in clinical trials. Requirements to the investigator site. European Economic Community.

Guidelines and recommendations to conduct clinical trials have been defined for Europe since 1st July 1991 to ensure high quality standards. Thus, cost and speed of clinical trials are becoming more and more important in clinical research. The article tries to summarize specific requirements to the investigator site considering the aspects of quality and data evaluation. Furtheron a model is proposed to optimize realization of clinical trials in hospital institutions. Realization of "Good Clinical practice" (GCP) at the sponsor and the investigator site will improve the quality of clinical trials for the sake of the patients and finally leads to the acceptance of European clinical trials abroad.

Clinical Trials as Topic↗

[The preparation and characterization of fine dusts carried out in the Clinica del Lavoro di Milano in support of experimental studies].

This paper aims to illustrate the conditions selected at the Clinica del Lavoro of the University of Milan to prepare and analyze a large number of fine dust samples produced over a period of about 50 years, that were initially used for studies within the Clinic performed in its own facilities, and since 1956 were sent to other Italian and overseas laboratories (Luxembourg, UK, Germany, Norway, Sweden, South Korea, USA). The total quantity of material distributed (with maximum size 7-10 microns) was about 2 kg and consisted of the following mineral and artificial compounds: quartz, HF-treated quartz, tridymite, HF-treated tridymite, cristobalite, chromite, anthracite, quartz sand for foundry moulds, sand from the Lybian desert, vitreous silica, pumice, cement, as well small quantities of metallic oxides, organic resins, chrysotile, crocidolite, fibres (vitreous, cotton and polyamidic). About half of the entire quantity of dusts produced consisted of partially HF-treated tridymite. Initially, research on the etiology of silicosis used quartz dust samples, simply sieved or ventilated (consisting of classes finer than 0.04 mm, containing a 15-20% respirable fraction). From 1956 to 1960 the dusts were produced by manual grinding in an agate mortar, below about 10 microns, starting from quartz from Quincinetto (near Ivrea, Province of Turin), containing about 99.5% quartz: particle size and composition were checked using an optical-petrographic technique, with identification of the free and total silica content. Subsequently, the dusts used for biological research were obtained by grinding coarse material with a cast iron pestle and planetary mills, agate and corundum jars. The grinding products were sized by means of centrifugal classification, using the selector developed by N. Zurlo, ensuring control of dust size both optically and by means of wet levigators and hydraulic classifiers (in cooperation with the Institute of Mines of Turin Polytechnic School). After 1990 pestles and rotating drum mills with autogenic grinding load were used for grinding: the size of the treated samples was reduced to 0.05 mm and an extremely fine fraction was extracted, smaller than 7-10 microns, which was used for pneumoconioses research. The characterization of the dust produced was in any case achieved by means of preliminary examination under the optical microscope (polarized light, sometimes supplemented with phase contrast), followed by quantitative analysis using chemical/petrographic, chemical diffraction or, more commonly, petrographic/diffraction techniques. Microscopic examination, if necessary supplemented with photo-micrography, was also used for particle size control, for numerical counting and subsequent reference to weight proportion. For all operational procedures the essential data on instruments and methods are reported. During studies on production, separation of fine dusts and their characterization, partly performed with support from the European Community (EEC/European Coal and Steel Commission), the following topics in particular were addressed: connections between particle size and free silica content in the measurable dust size fraction of the grinding products and in airborne dusts; characteristics of the dusts and risk indices in Italian iron and pyrite mines; possibility of abatement of the ultrafine classes of airborne dusts in pneumatically filled stopes by the addition of salts; comparison of the latest dust selectors used within the European Community; influence of the grinding methods on the results of fibrous and soft mineral measurement using X-ray diffraction analysis.

Academies and Institutes↗