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PubMed2004

[Systemic inflammatory rheumatic diseases competence network].

The foundation of the competence network for rheumatology, which is funded by the "Bundesministerium für Bildung und Forschung" (BMBF) since 1999, succeeded to create a unique research structure in Germany: medical doctors and scientists from six university rheumatology centres (Berlin, Düsseldorf, Erlangen, Freiburg, Hannover und Lübeck/Bad Bramstedt) work closely together with scientists doing basic research at the Deutsches Rheuma-Forschungszentrum (DRFZ), with rheumatological hospitals, reha-clinics, and rheumatologists. Jointly they are searching for causes of systemic inflammatory rheumatic diseases and try to improve therapies-nationwide and with an interdisciplinary approach. The primary objective of this collaboration is to transfer new scientific insights more rapidly in order to improve methods for diagnosis and patients treatment.

Biomedical Research↗
PubMed1997

State Forest Practice Regulatory Programs: An Approach to ImplementingEcosystem Management on Private Forest Lands in the United States

/ Implemented in the context of a long history ofintense public debate, forestry practices applied on private forest land areregulated in some form by 38 states. State regulatory activities can involvemany agencies implementing numerous regulatory laws, a single forestry agencyadministering a comprehensive regulatory program, or a combination of thetwo. Regulatory programs are designed to protect resources such as soils,water, wildlife, and scenic beauty. Program administration often involvesrule promulgation, harvest plan reviews, coordination of interagency reviews,and pre- and postharvest on-site inspections. Forest practice rules usuallyfocus on reforestation, forest roads, harvest procedures, and wildlifehabitat protection. Emerging regulatory trends include growth of multiagencyregulatory authority and associated jurisdictional conflicts, increasedtendencies to narrowly specify standards in statutes and rules, emergence ofcontingent regulations, growing sensitivity to processes enabling theadoption of new forest practice technologies and an ability to addresscumulative effects, interest in collaborative rule-making stemming fromheightened concern over legalization of administration processes, and growingconcern over the constitutional foundations for regulatory programs and thegovernment and private sector cost of implementing such programs.KEY WORDS: Ecosystem management; Forestry practices; Private landowners;Regulatory programs; State government

Journal Article↗
PubMed1999

Conservation in Brazil's Chocolate Forest: The Unlikely Persistence of the Traditional Cocoa Agroecosystem.

/ In southern Bahia, Brazil, the traditional cocoa agroecosystem with a dense shade canopy of native trees is now recognized as a secondary conservation route for highly endangered Atlantic Rainforest species. This "chocolate forest" of the densely shaded farms persists despite a massive 20-year Brazilian government modernization program in which shade was seen as a chief impediment to raising cocoa production. The objective of this study was to determine how this traditional agroecosystem endured. Although dense shade limits cocoa yield, it provides several agroecological benefits: control of insect pests and weeds, microclimate stability, and soil fertility maintenance. A keycomponent of modernization efforts was a shade-tree removal program designed to maximize cocoa production by using low shade and fertilizer while substituting agrochemicals for many beneficial roles of the overhead trees. This research found that many farmers rejected, or only partially accepted, the shade reduction process although it promised much higher cocoa yield and profit. Farmers employing a wide range of shading were interviewed, and it was found that decisions to remove or maintain the shade trees were linked to both agroecological and risk-minimization factors. Farmers' perceptions of the agroecological functions of the shade trees and individual willingness to entertain the economic risk associated with substituting agrochemicals for these were important. A less-profitable, but lower-risk approach of occasional fertilizer and agrochemical use with the traditional shade intact was a rational and widespread choice. Policies designed to maintain the traditional agroecosystem through the current economic crisis should heed the multiple functions of the overhead trees. KEY WORDS: Conservation; Brazil; Atlantic Rainforest; Cocoa; Agroecology; Risk; Agroforestry

Journal Article↗
PubMed2006

[The European Vision Institute. Opening up new frontiers?].

The European Vision Institute EEIG (EVI) creates a new legal entity based on Community law to facilitate and encourage cross-border co-operation in vision research. Its major objectives are to conduct and support research, training, health information dissemination and other programmes with respect to blinding eye diseases, visual disorders, mechanisms of visual function, preservation of sight and the special health problems and requirements of the blind and visually disabled. EVI aims to foster centres in the EU in capacity building for innovative projects, to increase the flexibility, attractiveness and competitiveness of research careers, especially for young researchers. In addition, EVI will serve to co-ordinate activities with patient organisations and to build a pan-European platform for clinical trials.

Academies and Institutes↗
PubMed2005

[Strategies to improve the life situation of minority ethnic elders shown by means of the example of a model project in the Unna district].

In Germany, the topic 'Ethnicity and Age' is a central concomitant of demographic and social change and has become a big challenge for existing structures of community care for elders. In this context, the Kreis Unna implemented a model project, which aimed at informing minority ethnic elders about the German care and welfare system. The project also tried to promote their usage of services and offers for elders in a sustainable way. Within the frame of the project, two information series were held. The first addressed minority ethnic elders and informed them about the German care and welfare system. The second qualified staff in the field of care and work for elders for the special needs of minority ethnic elders. The project was supported and evaluated by the Institute for Gerontology at the University of Dortmund. By viewing the results of the evaluation, it becomes evident that the two information and qualification series proved successful for both groups and, in general, are transferable to other municipalities. However, it also became clear that reducing barriers of access to the German care and welfare system is a very difficult process for both sides. A better usage of institutions and services of community care for elders by minority ethnic elders can only be accomplished by constant measures.

Aged↗
PubMed2006

The burden of musculoskeletal disease--a global perspective.

Musculoskeletal diseases are one of the major causes of disability around the world and have been a significant reason for the development of the Bone and Joint Decade. Rheumatoid arthritis, osteoarthritis and back pain are important causes of disability-adjusted-life years in both the developed and developing world. COPCORD studies in over 17 countries around the world have identified back and knee pain as common in the community and are likely to increase with the ageing population. Musculoskeletal conditions are an enormous cost to the community in economic terms, and these figures emphasise how governments need to invest in the future and look at ways of reducing the burden of musculoskeletal diseases by encouraging exercise and obesity prevention campaigns.

Cost of Illness↗
PubMed2003

Psychological and social aspects in management of Alzheimer's patients: an inquiry among caregivers.

A survey in the cities of Genoa and Savona (Italy) was performed to examine stress levels in caregivers of patients with Alzheimer's disease in the context of a project of the Italian Ministry of Health named Cronos. It offered free anticholinesterase inhibitor therapy to patients who addressed dedicated Neurological Units; in this occasion caregivers could be invited to express the main difficulties encountered in managing demented people during an interview conducted by health personnel of the Neurophysiology Service. Caregivers were mainly women, daughters or spouses, with a medium educational level, retired, housekeepers, employees or teachers; they claimed a lowering of economic standard of living of the family owing to extra expenses for assistance. Satisfaction was expressed towards specialists, while support by general practitioners and other sanitary services was usually lacking and money contribution from the government or territorial services was considered inadequate. From the emotional point of view, caregivers claim loss of free time, friendships and hobbies, and feel isolated in the social context; sometimes the patient's death is thought of as a solution. A strong need for information and support is clearly emerging and any further interventions should take these requirements into consideration.

Aged↗
PubMed2006

Targeted sustainable development: 15 years of government and community intervention on the St. Lawrence River.

From 1988 to 2003, the St. Lawrence Action Plan, a Canada - Quebec cooperation agreement on the St. Lawrence River, helped to mobilize a still-growing number of stakeholders in the conservation and protection of this great river and generated tangible results in a number of areas of intervention. The successes enjoyed in the area of industrial, agricultural and urban clean-up, in protecting plant and animal species and their habitats, and in acquiring new knowledge on the state and trends of the ecosystem reflect the sustained efforts of government and non-government partners over the course of those 15 years. The committed involvement of local communities provides assurance of the sustainable development of this vast ecosystem.

Community Networks↗
PubMed2006

Health promotion and the freedom of the individual.

This article considers the extent to which health promotion strategies pose a threat to individual freedom. It begins by taking a look at health promotion strategies and at the historical development of health promotion in Britain. A theoretical context is then developed in which Berlin's distinction between negative and positive liberty is used alongside the ideas of John Stuart Mill, Charles Taylor and T.H. Green to discuss the politics of health promotion and to identify the implications of conflicting perspectives on freedom. The final section looks at current health promotion policy in Britain and beyond and argues that, if freedom is seen in terms of empowerment, health promotion can enhance individual freedom.

Choice Behavior↗
PubMed1999

Geometric control of switching between growth, apoptosis, and differentiation during angiogenesis using micropatterned substrates.

Past studies using micropatterned substrates coated with adhesive islands of extracellular matrix revealed that capillary endothelial cells can be geometrically switched between growth and apoptosis. Endothelial cells cultured on single islands larger than 1500 microm2 spread and progressed through the cell cycle, whereas cells restricted to areas less than 500 microm2 failed to extend and underwent apoptosis. The present study addressed whether island geometries that constrained cell spreading to intermediate degrees, neither supporting cell growth nor inducing apoptosis, cause cells to differentiate. Endothelial cells cultured on substrates micropatterned with 10-microm-wide lines of fibronectin formed extensive cell-cell contacts and spread to approximately 1000 microm2. Within 72 h, cells shut off both growth and apoptosis programs and underwent differentiation, resulting in the formation of capillary tube-like structures containing a central lumen. Accumulation of extracellular matrix tendrils containing fibronectin and laminin beneath cells and reorganization of platelet endothelial cell adhesion molecule-positive cell-cell junctions along the lengths of the tubes preceded the formation of these structures. Cells cultured on wider (30-microm) lines also formed cell-cell contacts and aligned their actin cytoskeleton, but these cells spread to larger areas (2200 microm2), proliferated, and did not form tubes. Use of micropatterned substrates revealed that altering the geometry of cell spreading can switch endothelial cells among the three major genetic programs that govern angiogenesis-growth, apoptosis and differentiation. The system presented here provides a well-defined adhesive environment in which to further investigate the steps involved in angiogenesis.

Animals↗
PubMed1994

Parasite-associated morbidity: liver fluke infection and bile duct cancer in northeast Thailand.

Infection with the liver fluke, Opisthorchis viverrini, remains a major public health problem in Northeast Thailand, where approximately one-third of the population is infected. The northeast region is largely populated by Laos-descendent Thais who enjoy eating raw fish, which harbour the infective stage of the fluke. The parasite has maintained its presence in the population despite the widespread use of praziquantel and dissemination of health education material throughout the region by vigorous government-sponsored programs in recent years. The most severe consequence of liver fluke infection is cholangiocarcinoma, i.e. cancer of the bile duct epithelium. Although mortality due to the parasites alone appears to be uncommon, cholangiocarcinoma arising as a result of infection is one of the leading causes of death in the region. This paper reviews the pathogenesis of infection and the geographic, hospital-based and community studies which demonstrate the close relationship between infection and cancer. In addition, data from the Cancer Registry of Khon Kaen, Northeast Thailand and population-based studies using ultrasonography to visualize early tumours which illuminate the very high frequency of the cancer among heavily infected individuals and communities are discussed. Finally, the paper will close with a brief commentary on the prospects for control of the parasite and its likely impact on the frequency of cancer given the current epidemiological situation of liver fluke infection.

Animals↗
PubMed1982

Institutional structures: catalysts of or barriers to quality care for the institutionalized aged in Scotland and the U.S.

The care of the elderly in two long-term care institutions, one in Scotland and one in the United States, is described, compared, and analyzed. In Scotland three institutional structures, the National Health Service, the Geriatric Service, and the specialty of geriatrics are identified as catalysts of quality care. In the U.S. Medicare and Medicaid, the absence of geriatrics as a specialty, and the nursing home are identified as barriers to quality care for the institutionalized aged. The findings suggest that three components, an adequate government insurance program, professionals who specialize in the care of the aged, and a structure to provide continuing comprehensive care, are essential for a successful program of care for the institutionalized elderly.

Aged↗
PubMed1988

Schistosomiasis in Ethiopia.

The literature on schistosomiasis in Ethiopia is reviewed with the objective of bringing together in one paper diverse sources which may not be available to those interested in schistosomiasis. Particular attention is given to the influence of altitude and climate, snail ecology and government economic programs on the distribution of schistosomiasis. Out of 365 communities studied between 1961 and 1986 for Schistosomiasis mansoni, cases were reported from 225 (62%), and in 85 (23%) the prevalence ranged from 10 to 92%. Most transmission sites and S. mansoni infections are in agricultural communities along streams between 1300 and 2000 m altitude infested with Biomphalaria pfeifferi, the major snail intermediate host. S. mansoni transmission above 2200 m and below 800 m is precluded in many parts of Ethiopia by low and high water temperatures, respectively. Schistosomiasis haematobium cases have been reported from 30 of the 54 communities studied, 17 of them with infection rates between 14 and 75%. Endemic S. haematobium appears to be confined in its distribution to lowlands below 800 m altitude. The highly focal distribution of S. haematobium transmission is largely due to the nonsusceptibility of most bulinine snails to the Ethiopian strain of the parasite and low water temperatures in the highlands. Water resources development, resettlement programs, refugee migration and other population movements may result in the spread of endemic S. mansoni. Lack of information on snail host/parasite relationships and the ecology of proven and suspected snail hosts does not permit predictions on the spread of endemic S. haematobium. Past and present schistosomiasis control programs in Ethiopia are reviewed and recommendations made for the national control program.

Adolescent↗
PubMed1995

Perspectives on collaboration and infrastructure development: industry perspectives.

Industry continues to promote the use of sound science in regulatory decision making. The use of decision support methodologies for hazard identification/risk assessment of toxic substances such as models employing physiologically based pharmacokinetics (PBPK) and structure-activity relationships (SAR) are recommended. A collaborative program involving government and industry is needed to further the use of these decision support methodologies. The formation of federal and state working groups is recommended. Organizations such as the Halogenated Solvents Industrial Alliance (HSIA), American Industrial Health Council (AIHC), and the Chemical Manufacturers Association (CMA) are suitable industry representatives.

Animals↗
PubMed2004

Integrating the Accreditation Council for Graduate Medical Education Core competencies into the model of the clinical practice of emergency medicine.

In response to public pressure for greater accountability from the medical profession, a transformation is occurring in the approach to medical education and assessment of physician competency. Over the past 5 years, the Accreditation Council for Graduate Medical Education (ACGME) has implemented the Outcomes and General Competencies projects to better ensure that physicians are appropriately trained in the knowledge and skills of their specialties. Concurrently, the American Board of Medical Specialties, including the American Board of Emergency Medicine (ABEM), has embraced the competency concept. The core competencies have been integral in ABEM's development of Emergency Medicine Continuous Certification and the development of the Model of Clinical Practice of Emergency Medicine (Model). ABEM has used the Model as a significant part of its blueprint for the written and oral certification examinations in emergency medicine and is fully supportive of the effort to more fully define and integrate the ACGME core competencies into training emergency medicine specialists. To incorporate these competencies into our specialty, an Emergency Medicine Competency Taskforce (Taskforce) was formed by the Residency Review Committee-Emergency Medicine to determine how these general competencies fit in the Model. This article represents a consensus of the Taskforce with the input of multiple organizations in emergency medicine. It provides a framework for organizations such as the Council of Emergency Medicine Residency Directors (CORD) and the Society for Academic Emergency Medicine to develop a curriculum in emergency medicine and program requirement revisions by the Residency Review Committee-Emergency Medicine. In this report, we describe the approach taken by the Taskforce to integrate the ACGME core competencies into the Model. Ultimately, as competency-based assessment is implemented in emergency medicine training, program directors, governing bodies such as the ACGME, and individual patients can be assured that physicians are competent in emergency medicine.

Accreditation↗