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Selected AbstractsAre clinical practical guidelines (CPGs) useful for health services and health workforce planning?DIABETIC MEDICINE, Issue 5 2010A critique of diabetes CPGs Diabet. Med. 27, 570,577 (2010) Abstract Aims, Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. Methods, This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. Results, Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. Conclusions, Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely. [source] From European Integration to European Integrity: Should European Law Speak with Just One Voice?EUROPEAN LAW JOURNAL, Issue 3 2004Samantha Besson According to the European integrity principle, all national and European authorities should make sure their decisions cohere with the past decisions of other European and national authorities that create and implement the law of a complex but single European legal order. Only by doing so, it is argued, can the European political and legal community gain true authority and legitimacy in the eyes of the European citizens to whom all these decisions apply. Although European integrity is primarily a product of European integration, it has gradually become one of the requirements of further integration. The article suggests that the principle of European integrity would help dealing with the growing pressure for common European solutions under conditions of increasing diversity. It places disagreement at the centre of European politics, as both an incentive and a means of integration by way of comparison and self-reflectivity. It constitutes therefore the ideal instrument for a pluralist and flexible further constitutionalisation of the European Union. [source] The impact of the euro on Europe's financial marketsFINANCIAL MARKETS, INSTITUTIONS & INSTRUMENTS, Issue 3 2003Gabriele Galati This paper presents an overview of the impact of the introduction of the euro on Europe's financial structure over the first four years since the start of EMU. It analyzes changes in money markets, bond markets, equity markets and foreign exchange markets. Euro's role in originating or catalyzing trends has been uneven across the spectrum of financial markets. From the supply side, banks and investors in fixed income markets have become more focused on the characteristics of individual borrowers rather than the nationality of the issuer and have built up expertise to evaluate credit risk. European equity markets have also been affected by the enhanced ability of investors to build strategies with a pan-European perspective as prices increasingly reflected risk factors specific to industrial sectors rather than individual countries. On the borrower side, EMU has increased the attractiveness of market-based financing methods by allowing debt issuers to tap institutional portfolios across the euro area. Lower barriers to cross-border financial transactions have also increased the contestability of the market for financial services, be it at the wholesale or the retail level. The introduction of the euro has also highlighted the shortcomings of existing institutional structures and areas where excessive focus on narrowly defined interests may stand in the way of realizing the full potential benefits from the new environment. Diverging legal and institutional infrastructures and market practices can impede further financial market development and deepening. Hence, the euro has put a premium on cooperation between national authorities and institution as a means of achieving a more harmonized financial environment. The impact of EMU on depth in foreign exchange markets has been less clear-cut, as volatility, spreads, trading volumes and liquidity appear not to have changed in a substantial way. Overall, it seems that the new currency has made some progress towards the goal of becoming a currency of international stature that would rival that of the US dollar. However, a number of the necessary next steps towards achieving this goal are also among the trickiest to implement. [source] Benzodiazepines prescription in Dakar: a study about prescribing habits and knowledge in general practitioners, neurologists and psychiatristsFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 3 2006Amadou Moctar Dièye Abstract Benzodiazepines are relatively well-tolerated medicines but can induce serious problems of addiction and that is why their use is regulated. However, in developing countries like Senegal, these products are used without clear indications on their prescription, their dispensation or their use. This work focuses on the prescription of these medicines with a view to make recommendations for their rational use. Benzodiazepine prescription was studied with psychiatrists or neurologists and generalists in 2003. Specialist doctors work in two Dakar university hospitals and generalists in the 11 health centres in Dakar. We did a survey by direct interview with 29 of 35 specialists and 23 of 25 generalists. All doctors were interviewed in their office. The questionnaire focused on benzodiazepine indications, their pharmacological properties, benzodiazepines prescribed in first intention against a given disease and the level of training in benzodiazepines by doctors. Comparisons between specialists and generalists were made by chi-square test. Benzodiazepines were essentially used for anxiety, insomnia and epilepsy. With these diseases, the most benzodiazepines prescribed are prazepam against anxiety and insomnia and diazepam against epilepsy. About 10% of doctors do not know that there is a limitation for the period of benzodiazepine use. The principal reasons of drugs choice are knowledge of the drugs, habit and low side effects of drugs. All generalists (100%) said that their training on benzodiazepines is poor vs. 62.1% of specialists, and doctors suggest seminars, journals adhesions and conferences to complete their training in this field. There are not many differences between specialists and generalists except the fact that specialists prefer prazepam in first intention in the insomnia treatment where generalists choose bromazepam. In addition, our survey showed that specialists' training in benzodiazepines is better than that of generalists. Overall, benzodiazepine prescription poses problems particularly in training, and national authorities must take urgent measures for rational use of these drugs. [source] Compartmentalisation: flood consequence reduction by splitting up large polder areasJOURNAL OF FLOOD RISK MANAGEMENT, Issue 1 2010F. Klijn Abstract River and coastal floodplains are often protected by vast systems of connected embankments. In the Netherlands, about 55% of the country is protected in this way, by some 3600 km of primary defences. The protection level is probably the highest in the world, and annual mean flood risks are low. Nevertheless, the consequences of a major flood event might be unacceptable. This is a reason to consider whether and how the consequences of floods could be reduced in a cost-effective manner. Splitting up large polder areas into smaller portions, the so-called compartmentalisation, would reduce the area subject to flooding, and thus the economic damage, the number of people exposed and the fatality risk. We carried out a policy analysis for the national authorities in order to establish whether, where and under which conditions a further compartmentalisation of the country would be desirable. This paper gives some results, discusses our experiences in four case studies and finally focuses on the fundamental questions of assessment and the trade-off between better flood protection and the benefit/cost ratio of reducing consequences. [source] The need for an evidence-based decision-making process with regard to control of hepatitis AJOURNAL OF VIRAL HEPATITIS, Issue 2008A. Gentile Summary., Universal hepatitis A (HA) vaccination was implemented by the Argentinean Ministry of Health in June 2005 with a single dose at age 12 months. The decision was made taking into account the following factors. (1) Disease burden: The incidence rate for the disease increased from 2003 to 2004; the northern and western regions of the country were the most affected. Sero-prevalence data for children 1,15 years old was 54% for the whole country, with differences per region and age. From May 1982 to September 2002, 210 patients were recruited with acute hepatic failure; HA was the aetiology in 61% of them. (2) Cost-effectiveness: Compared with no vaccination, the one-dose schedule would save US$15.3 millions, with regional variations. (3) Vaccine features: Immunization with one-dose schedule HA vaccine confers good immunogenicity and effectiveness. (4) Programmatic feasibility: The National Immunizations Program has appropriate distribution system for vaccines, with adequate cold chain. (5) Social acceptance and political compromise: The population largely accepts HA vaccination and the national authorities should be committed to providing it regularly. The main global issue is that hepatitis A virus infection remains the most commonly reported vaccine-preventable disease in many parts of the world despite the availability of vaccines. [source] Acrylamide: An Update on Current Knowledge in Analysis, Levels in Food, Mechanisms of Formation, and Potential Strategies of ControlNUTRITION REVIEWS, Issue 12 2004Richard H. Stadler PhD This review summarizes the research to date on acrylamide levels in food, analytical methods, main sources of dietary exposure, mechanisms of formation, and mitigation research in the major food categories. Significant progress in the research has been made over the past 18 months, as reflected by the numerous publications and national and international workshops on the subject. This rapid pace of developments is mainly attributable to the coordinated and collaborative efforts of all of those concerned: the food industry, academia, private/enforcement laboratories, and national authorities. Most of the information gaps identified since the findings in early 2002 on the occurrence of acrylamide in foods and exposure assessments have been addressed, and public databases have been established by several authorities. Today, the performance of analytical methods, particularly for "difficult" food matrices, is adequate, and any modifications made over the past 12 to 18 months in analytical procedures did not significantly impact the initial exposure calculations. Several avenues into mitigation have been explored in the different food categories, with much emphasis being placed on potato-based products, and empirical trials (mostly pilot studies) have provided better knowledge of the key parameters that influence acrylamide formation. However, despite these intensive efforts, only marginal reductions have been achieved by the food industry, and any further progress will entail long-term studies at the primary production level. Any measures devised to reduce exposure to acrylamide in commercial foods must be carefully assessed in terms of food safety and quality. A hitherto poorly addressed concern is the formation of acrylamide in foods prepared by consumers in the home, and more guidance on this by national authorities is warranted. [source] Current International Approaches to Food ClaimsNUTRITION REVIEWS, Issue 12 2000No-Seong Kwak Ph.D. The market for functional foods is rapidly increasing. It is necessary to establish a legal framework for these foods. This has proved difficult in a number of countries. The control through health claims is generally accepted as the most appropriate measure. Activity in this area has been developing both at the national and international levels. However, the regulations and proposals from a number of national authorities and other nongovernmental sectors are varied and difficult to reconcile. This paper examines the range of health claim controls being used in the food area. They are considered in detail so as to establish a better understanding of the claims. In this paper, the claims have been classified into six categories: nutrient content claims, comparative claims, nutrient function claims, claims related to dietary guidelines or healthy diets, enhanced function claims, and reduction of disease risk claims. Of these, the latter four claims are considered to have significant implications for functional foods. [source] Regime change and nation building: can donors restore governance in post-conflict states?PUBLIC ADMINISTRATION & DEVELOPMENT, Issue 1 2005Dennis A. Rondinelli Foreign aid agencies and international assistance organisations are now heavily involved in nation building in post-conflict states. Their record of strengthening democratic governance in countries where civil war or military force replaced unpopular regimes is mixed. Experience suggests that a complex set of conditions must be created quickly in order to rebuild indigenous governance. Ensuring security, providing assistance through a transparent and coherent plan of action, coordinating donors' activities, establishing strong and legitimate national authority, strengthening democratic political processes, transferring responsibility and resources for development to a new government, stabilising the economy and strengthening social capital and human assets must all be done in quick succession. Achieving these goals requires a cadre of civilian and, sometimes, military personnel with expertise in post-conflict nation building. The frequency with which government aid programmes and international assistance organisations engage in post-conflict reconstruction also suggests the need for more explicit national and international policies and the creation of specialised nation-building agencies to undertake these difficult tasks. Copyright © 2005 John Wiley & Sons, Ltd. [source] The clean development mechanism in China and India: A comparative institutional analysisPUBLIC ADMINISTRATION & DEVELOPMENT, Issue 5 2008Sukumar Ganapati Abstract The clean development mechanism (CDM) is a project-based instrument that allows developed countries to receive credits toward meeting their obligatory targets under the Kyoto Protocol by investing in emission reduction projects in developing countries. This article provides a comparative institutional analysis of the CDM in China and India. It focuses on each country's ,designated national authority' (DNA), which is the national agency to approve CDM projects. Three dimensions of the DNAs are considered: their structures, their policies and the CDM project market. Although the DNAs in both China and India have their strengths and weaknesses, China's approach in particular has some positive lessons for other DNAs. Copyright © 2008 John Wiley & Sons, Ltd. [source] | ||||||||||