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Use of personal medical records for research purposes.

The established practice of doctors using medical records for research purposes is threatened by the recent proposed guidelines from the Department of Health, the BMA, and the European Commission. The European Commission has proposed that explicit consent should be obtained from each patient before his or her medical records can be used; the proposals from the Department of Health and the BMA would require all research that needs access to personal medical records to be submitted to an ethics committee. We believe that these proposals would seriously impair an entire category of research and suggest therefore that another set of guidelines, proposed by a Royal College of Physicians' working group, should be used to modify the proposals. The guidelines of the working group encourage the use of medical records for research and ensure that such use can be made in a confidential manner without causing harm.

Biomedical Research↗

A critical review of the scientific literature on potential endocrine-mediated effects in fish and wildlife.

A rigorous approach to evaluating the reliability and relevance of experimental methods and results is critical for making appropriate, scientifically sound decisions. A literature evaluation framework was modified and adapted based on criteria described by Klimisch et al. (H. J. Klimisch, M. Andrae, and U. Tillman, 1997, Reg. Tox. Pharm. 25, 1-5) and requirements of the USEPA High Product Volume Challenge Program. This simple framework was used to evaluate an appropriate selection of peer-reviewed references to assign a Study Reliability "score" to the study design, endpoints, and conclusions compared to established data quality guidelines. Subsequently, the interpretation of the data was evaluated and assigned a Relevance Index based on the overall strength of evidence of endocrine modulation potential, which was evaluated based on the Weybridge (European Commission (1996). European workshop on the impact of endocrine disrupters on human health and wildlife. Report of proceedings from a workshop held in Weybridge, UK, 2-4 December 1996. Report reference EUR 17549, European Commission, DGXII, Brussels, Belgium.) definition. This report describes the evaluation of 50 peer-reviewed primary publications. The vast majority of studies reviewed were published in the period from 1996 to the present and most examined in vivo responses of fish to natural hormones, organochlorines, or alkylphenolic compounds. Of the studies reviewed, approximately 40% received a score of "2-Reliable with Restrictions," while approximately 60% received a score of "3-Not Reliable," where reliability was interpreted to include scientific integrity, technical credibility, endpoint relevance, and regulatory compliance. The most common deficiencies were inadequate methods, lack of suitable controls, exceeding aqueous solubility, inappropriate statistics, and unsupported conclusions. Based on the Relevance Index, few of the studies examined attained the level of quality necessary to identify the study results as providing an acceptable basis for evaluation of endocrine modulation potential directly resulting from identified deficiencies in meeting the established study reliability criteria.

Animals↗

[Task and function of the European Food Safety Authority].

In 2002, the European Commission and the European Parliament established the European Food Safety Authority (EFSA). The provisional seat of the new Authority is Brussels and the final seat of the authority will be Parma, Italy. EFSA's main task is to carry out risk assessment and to provide independent scientific advice on all matters linked to food and feed safety. This includes animal health and welfare and plant health-as well as nutrition. Therefore, EFSA's risk assessments provide risk managers with a sound scientific basis for regulatory measures in order to ensure a high level of consumer protection. EFSA is confessed to openness and transparence. The authority keeps good links to all European institutions, particularly to the European Commission and the European Parliament, to national authorities, which have similar tasks to EFSA, and to stakeholders such as consumer and food industry organisations.

Advisory Committees↗

Simultaneous determination of lincomycin and five macrolide antibiotic residues in honey by liquid chromatography coupled to electrospray ionization mass spectrometry (LC-MS/MS).

A sensitive and specific method based on high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), for the simultaneous determination of lincomycin and five macrolide antibiotics in honey, was developed and validated. The analytes were extracted with Tris buffer 0.1 M, pH 10.5, and cleaned-up by a single solid-phase extraction step on OASIS HLB column. The chromatographic separation of analytes was performed on a Synergi Hydro-RP reversed-phase column using a gradient programme of aqueous 0.01 M ammonium acetate, pH 3.5, and acetonitrile as the mobile phase, at a flow rate 0.25 ml min-1. The detection of analytes was achieved by positive ionization electrospray in multiple reaction-monitoring mode. Two characteristic transitions were monitored for each substance. The following analytical parameters were validated according to the guidelines laid down by European Commission Decision 2002/657/EC (European Commission 2002): linearity, specificity, decision limit (CCalpha), detection capability (CCbeta), repeatability, within-laboratory reproducibility, recovery and ruggedness.

Animals↗

Ultraviolet tanning equipment: six questions.

Recreational tanning, particularly as promoted by commercial salons with 'sunbeds' or booths, has generated increasing attention from the regulatory and the biomedical communities. Several agencies have weighed in with opinions on recommended modifications in guidelines, training procedures, regulatory controls, and consumer awareness. Currently there is little uniformity in the guidance provided by trade groups, in recommendations supplied by health agencies and medical associations, or in regulatory approaches taken or proposed by the many countries involved. In an effort to provide a clearer focus for its concerns in this area, the EU Directorate General Health and Consumer Affairs formulated six questions on ultraviolet (UV) tanning, all of a technical or biomedical nature. The questions were stimulated in part by the fact that the European Commission no longer regards the European standard EN 60335-2-27:1997 ('Particular requirements for appliances for skin exposure to ultraviolet and infrared radiation') as giving presumption of conformity to the Low Voltage Directive 73/23/EEC. (The latter Directive governs marketing of electrical devices in EC countries.) Initially, the questions were posed to an EU Scientific Committee. Subsequently, industry representatives and the European Commission jointly requested that the scientific community provide answers to the questions. We received the questions with a request for our technical responses and opinions. Our response was in the form of the following essay, submitted earlier this year to the European Commission. We offer it here in the hope of stimulating constructive discussion and comment.

Beauty Culture↗

Specialist training in gastroenterology in the European Community: the case for European boards. European Board of Gastroenterology.

Gastroenterological training differs so greatly from country to country in Europe it is impossible to believe that training is equally good in each one. This in turn, provides a barrier to the free migration of doctors with the European Community. These differences also create confusion for migrating patients, and call into question the validity of the European Commission directives, which pronounce all qualifications obtained in European Community countries to be equally acceptable within the community. The European Commission does not have the power to unify medical training, but the medical profession itself acting in concert as a European body could harmonise the differences to ensure acceptable standards of training across the community. The Union of European Medical Specialists (UEMS) is the representative body of national medical specialists bodies, which reports to the European Commission. The European Board of Gastroenterology, a working party of the Gastroenterology Section of the UEMS has agreed acceptable and fair standards of training for gastroenterologists, and has developed a system for external assessment of training centres and faculty. All three, candidates, faculty, and centre would, in the event of a successful application, be awarded the European Diploma of Gastroenterology or, in full, the Diploma of Recognition of Quality of Training in Gastroenterology. This paper discusses these problems, some of their origins, and the proposals of the European Board.

Education, Medical, Graduate↗

Report of the European Working Group on Dementia Drug Guidelines Meeting--Brussels, November 1997.

A conference was held in Brussels in November 1997 under the auspices of the International Working Group for Harmonization of Dementia Drug Guidelines. The meeting reviewed development of European Dementia Guidelines, with a focus on the roles of academics, industry, the European Commission, the European Parliament, and the European Medicines Evaluation Agency. The objectives of the meeting were to review progress in development of dementia drug guidelines across Europe, with particular reference to harmonization of these efforts with developments in other countries, particularly the United States and Japan. Specific topics covered included issues in developing trials to address disease progression, very mild disease, severe disease, and the non-Alzheimer dementias. Clinical trial designs and the types of measures chosen in these new areas are unlikely to be the same as those used in previous trials for symptomatic relief of mild-to-moderate Alzheimer disease. The assessment tools need to be specific for the purpose of the trial and ongoing research is still needed in this area. Little is known about the natural progression of disease based on the types of measures used in clinical trials. Evidence suggests that rates of decline are variable and nonlinear. Improved collaboration between academics, industry personnel, and regulators, particularly through the sharing of placebo data sets, could allow considerable advances in our understanding of natural disease progression.

Aged↗

The second parabolic flight campaign for students.

In conjunction with the European Commission's 'European Week for Scientific and Technological Culture' in November, ESA organised the second parabolic flight campaign for students. Students selected through a competition, were again given the unique opportunity of experiencing weightlessness as they performed their own scientific experiment during a parabolic flight. The experiments covered a wide variety of disciplines. Some illustrated well the effect of microgravity while others may offer new and far-reaching scientific results. The primary goal, however, is to educate and motivate the students rather than to obtain new research. It is hoped that the campaign will stimulate the next generation to think about space and the potential of microgravity. It is in that way that an innovative future user community for the International Space Station Alpha can be built. The great enthusiasm shown by many students and the wide coverage provided by the media also demonstrate the interest in space and the promotional value of the campaign.

Biological Science Disciplines↗

Quality control of equipment in home mechanical ventilation: a European survey.

Quality control of the equipment used in home mechanical ventilation is necessary in order to ensure that patients safely and accurately receive the prescribed ventilatory support. The aim of this study was to carry out a survey on the quality-control procedures in different centres and countries. The survey was carried out in the context of a European Commission Concerted Action covering 16 European countries. The study was extensive and detailed, involving 326 centres, which provided home ventilation to >20,000 patients. The survey showed that: 1) ventilator servicing was mainly carried out by external companies (62% of centres), with a servicing frequency ranging 3-12 months; 2) interaction between servicing companies and prescribers was limited (only 61% of centres were always informed of major incidents); 3) participation of centres in equipment quality control was poor (only 56% of centres assessed that patients/caregivers correctly cleaned/maintained the ventilator); and 4) centres were insufficiently aware of vigilance systems (only 23% of centres). Moreover, the data showed considerable inter- and intra-country differences. The size of the centre was an important determinant of many of these quality-control aspects. This survey provides information that will enable the European Commission Concerted Action to formulate recommendations on procedures for home-ventilator quality control.

Chronic Disease↗

Quality assurance for the measurements and monitoring of radioactivity in the environment.

During the Fifth Framework Programme (FP5) of the European Commission--according to an institutional programme in support to the policy of the European Commission for the implementation of Art. 35 and 36 of the Euratom Treaty as well as in the framework of the OSPAR Convention for the protection of marine environment of the north-east Atlantic--at the Institute for Transuranium Elements (ITU--General Directorate Joint Research Centre--European Commission), a reference laboratory for the measurement of radioactivity in the environment (MaRE laboratory) has been set up. In this paper, the principles and philosophy in order to improve the quality and reliability of analytical data for the measurement and monitoring of radioactivity in the environment under a quality assurance (QA) programme are presented. Examples of how a QA programme at the MaRE laboratory is developed and applied are given. Internal and external quality control (QC) programmes are also discussed.

Environmental Monitoring↗

ECCO peer review--development since 1996 and future prospects.

Plant protection products have to be evaluated and authorized in the EC-Member States since 1993 in accordance with Directive 91/414/EEC. The programme for evaluating existing active substances (which were on the market before July 1993) involves several steps and stages, stretching over a period of up to formerly 10, and now 15 years. The programme is co-ordinated by the European Commission, with the assistance of the European Community Co-Ordination (ECCO)-Team since 1996. The ECCO-Team consists of two groups; one is situated at the Pesticides Safety Directorate in York (United Kingdom) and the other at the Bundesamt für Verbraucherschutz und Lebensmittelsicherheit-BVL (Federal Office for Consumer Protection and Food Safety) in Braunschweig (Germany). They provide technical and administrative support to the programme for the evaluation of active substances on behalf of the European Commission, and are responsible for the ECCO peer review programme in particular. The programme has been extremely successful, with over 160 active substances having been peer reviewed, facilitating over 100 decisions on the acceptability of those actives at Community level.

Animals↗

Evaluation of controlled vocabulary resources for development of a consumer entry vocabulary for diabetes.

BACKGROUND: Digital information technology can facilitate informed decision making by individuals regarding their personal health care. The digital divide separates those who do and those who do not have access to or otherwise make use of digital information. To close the digital divide, health care communications research must address a fundamental issue, the consumer vocabulary problem: consumers of health care, at least those who are laypersons, are not always familiar with the professional vocabulary and concepts used by providers of health care and by providers of health care information, and, conversely, health care and health care information providers are not always familiar with the vocabulary and concepts used by consumers. One way to address this problem is to develop a consumer entry vocabulary for health care communications. OBJECTIVES: To evaluate the potential of controlled vocabulary resources for supporting the development of consumer entry vocabulary for diabetes. METHODS: We used folk medical terms from the Dictionary of American Regional English project to create extended versions of 3 controlled vocabulary resources: the Unified Medical Language System Metathesaurus, the Eurodicautom of the European Commission's Translation Service, and the European Commission Glossary of popular and technical medical terms. We extracted consumer terms from consumer-authored materials, and physician terms from physician-authored materials. We used our extended versions of the vocabulary resources to link diabetes-related terms used by health care consumers to synonymous, nearly-synonymous, or closely-related terms used by family physicians. We also examined whether retrieval of diabetes-related World Wide Web information sites maintained by nonprofit health care professional organizations, academic organizations, or governmental organizations can be improved by substituting a physician term for its related consumer term in the query. RESULTS: The Dictionary of American Regional English extension of the Metathesaurus provided coverage, either direct or indirect, of approximately 23% of the natural language consumer-term-physician-term pairs. The Dictionary of American Regional English extension of the Eurodicautom provided coverage for 16% of the term pairs. Both the Metathesaurus and the Eurodicautom indirectly related more terms than they directly related. A high percentage of covered term pairs, with more indirectly covered pairs than directly covered pairs, might be one way to make the most out of expensive controlled vocabulary resources. We compared retrieval of diabetes-related Web information sites using the physician terms to retrieval using related consumer terms We based the comparison on retrieval of sites maintained by non-profit healthcare professional organizations, academic organizations, or governmental organizations. The number of such sites in the first 20 Results from a search was increased by substituting a physician term for its related consumer term in the query. This suggests that the Dictionary of American Regional English extensions of the Metathesaurus and Eurodicautom may be used to provide useful links from natural language consumer terms to natural language physician terms. CONCLUSIONS: The Dictionary of American Regional English extensions of the Metathesaurus and Eurodicautom should be investigated further for support of consumer entry vocabulary for diabetes.

Community Participation↗

A European Master's Programme in Public Health Nutrition.

Effective population-based strategies require people trained and competent in the discipline of Public Health Nutrition. Since 1997, a European Master's Programme in Public Health Nutrition has been undergoing planning and implementation, by establishing initial quality assurance systems with the aid of funding from the European Commission (DG SANCO/F3). Partners from 17 European countries have been involved in the process. A European Network of Public Health Nutrition has been developed and accredited by the European Commission.

Adult↗

Applying to the European Research Area Network Scheme (ERA-NET): collaborative working for nursing and midwifery research.

AIM: This paper reports on work undertaken to achieve an application for monies from the European Commission's 6th Framework Programme by some key stakeholders, working with a nursing and midwifery research agenda at national policy levels. BACKGROUND: A short outline of the European Commission's European Research Area Network scheme is given in order to set the paper in context, and the vision underpinning the application is discussed. CONCLUSION: The paper describes the processes that were undertaken to bring to fruition such collaborative work, and some key lessons are outlined. Seeking opportunities to enhance nursing and midwifery research within a European context gives value to the application, which was ultimately successful.

Europe↗

Limits and regulations for mycotoxins in food and feed.

Mycotoxins are natural contaminants whose presence in food- and feedstuffs cannot be completely avoided. Since several mycotoxins have been associated with and implicated in human and animal diseases there is a need to establish maximum levels, guidelines or action levels for them in some kinds of commodities. International and government authorities in many countries have been investing in mycotoxins research and initiating administrative actions for elaboration of legislation and implementing regulatory measures for the control of mycotoxins. Codex Alimentarius Commission is established international legislation on food and feed. In European Union specific limits and regulations for mycotoxins and other contaminants are constructed under the general Codex standards and based on proposal from European Commission. The legal basis for European Commission became available with the framework Council Regulation (EEC) No 315/93. In this paper, legislation regarding maximum levels for certain mycotoxins in food- and feedstuffs in European Community and other countries were reviewed and discussed.

Animal Feed↗

Putting the International Space Station to work.

The International Space Station (ISS) is the largest international cooperative science and technology project ever undertaken. Involving the United States, Russia, Japan, Canada and 10 ESA Member States, it is now rapidly becoming a reality in orbit, offering unprecedented access for research and applications under space conditions. Europe has invested heavily in this endeavour and plans to exploit that investment by a vigorous utilisation of the ISS for life and physical sciences research and applications, space science, Earth observation, space technology development, the promotion of commercial access to space, and the use of space for educational purposes. In recent years, ESA has engaged in an intensive promotional effort to encourage potential user communities to exploit the novel opportunities that the ISS offers. It has also made significant financial commitments to develop both multi-user facilities for life and physical sciences studies in the Columbus Laboratory, and observational and technology exposure instruments using the external Columbus mounting locations, as well as giving financial support to promote commercial and educational activities. ESA has now elaborated a European Strategy for the efficient utilisation of the ISS by European scientists and other users, which is being coordinated with the Agency's Member States contributing to the ISS Programme, and with the European Science Foundation (ESF). In cooperation with the European Commission, ESA is also fostering synergy with the European Commission's Framework Programmes in terms of shared R&D objectives. This article describes the plan that has been evolved to integrate all of these various elements.

Astronomical Phenomena↗

Report of the Consensus Conference on Antibiotic Resistance; Prevention and Control (ARPAC).

Antimicrobial resistance is a key public health concern in Europe. It is known that there are significant variations in the prevalence of resistance across Europe, and methods to reduce the problem are also assumed to vary significantly. The 'Antibiotic Resistance; Prevention and Control (ARPAC)' Concerted Action project was funded by the European Commission and conducted by four study groups of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). The project established a network of European hospitals and collated data on antimicrobial resistance prevalence, antimicrobial susceptibility testing methods, typing methods employed, antimicrobial use, antibiotic policies and practices, and infection control policies and practices. The ARPAC Consensus Conference, entitled 'Control of antibiotic resistance in European hospitals-informing future evidence-based practice', was held in Amsterdam in November 2004. The conference was co-hosted by the European Commission, ESCMID and the Dutch Working Party on Antibiotic Policy (SWAB). Key ARPAC findings were presented and discussed in the context of the worldwide situation. The conference delivered a set of high-priority recommendations likely to have a significant impact on antimicrobial resistance. This report summarises these recommendations.

Anti-Bacterial Agents↗