Suchergebnisse

Процессы естественного и механического движения населения, наблюдаемые в Забайкальском крае в последние два десятилетия, свидетельствуют о крайне негативных тенденциях в формировании демографического потенциала региона. Из числа этих тенденций следует в первую очередь назвать следующие: низкую рождаемость; высокий уровень смертности, особенно мужчин трудоспособного возраста; неуклонное уменьшение доли сельского населения в общей численности жителей региона, что весьма неблагоприятно сказывается на воспроизводстве населения (рождаемость в сельской местности выше в 1,3-1,4 раза, чем в городских поселениях). Увеличивается доля лиц старше трудоспособного возраста. Негативные изменения происходят в институте семьи: усиливается стремление к малодетности. Изменяется отношение к регистрации брака и состоянию в браке: снижается стабильность супружеских союзов. Усиливается миграционный отток, что влечет за собой, даже при естественном приросте, снижение численности населения. Указанные обстоятельства не отвечают экономическим и геополитическим интересам страны. Для исследования факторов, оказывающих воздействие на репродуктивное поведение в Забайкальском крае, применены таксономический метод многомерного анализа и корреляционный анализ. Сформировано шесть групп факторов, в числе которых: здоровый образ жизни, образование, экономические факторы, среда обитания, социально-бытовые факторы, социальная стабильность общества и нравственнопсихологические факторы. Результаты работы показали, что наибольшее воздействие на рождаемость оказывают факторы: «Дошкольное образование» (r = 0,87); «Духовно-нравственное воспитание» (r = 0,76), «Доступность жилья» (r = -0,7) (для характеристики фактора были выбраны такие дестабилизирующие показатели, как доля семей, состоящих на учете в качестве нуждающихся в жилых помещениях, и доля семей, изъявивших желаниеучаствовать в подпрограмме «Обеспечение жильем молодых семей», но не получивших помощь); «Безопасность и уровень преступности» (r = -0,52); «Материальное благополучие» (r = -0,45). В 2013 г. Правительством РФ утверждена Государственная программа РФ «Социально-экономическое развитие Дальнего Востока и Байкальского региона». Реализация Программы может быть успешной только при условии нормализации демографических тенденций и социальной обстановки. ; The processes of natural and mechanical movement of the population observed in the Transbaikal Territory in the past two decades testify to the extremely negative trends in the formation of the demographic potential of the region. Among these trends the following ones should be primarily named: low birth rate, high mortality rate, especially among men of working age, steady decrease in the proportion of rural population in the total population of the region, which is very unfavorable effect on reproduction (fertility in rural areas up to 1,3-1,4 times higher than in urban areas). The share of persons of retirement age increases. Negative changes occur in the family institution: increasing desire for small families. The attitude related to marriage and marital status changes: the stability of married unions decrease. The out-migration enhances, which entails, even natural growth, decline in population. These circumstances do not meet the economic and geopolitical interests. For investigation the factors affecting reproductive behavior in the Transbaikal Territory, the taxonomic method of multivariate analysis and the correlation analysis have been applied. Six groups of factors have been formed, which include: a healthy way of life, education, economic factors, habitat, social and domestic factors, social stability and moral-psychological factors. Results indicated that the greatest impact on the birth rate by factors: "Early childhood education" (r = 0,87); «Spiritual and moral education» (r = 0,76), «Housing Affordability» (r = -0,7) (for describing factor chosen as destabilizing indicators such as the proportion of families standing on the account, as in need of accommodation, the percentage of families, who have expressed a desire to participate in the sub-program "Housing for young families", but didn't get help), "Safety and the level of crime" (r = -0,52); "Material well-being" (r = -0,45). In 2013 the Russian Government approved the State Program of Russian Federation "Socio-economic development of the Far East and the Baikal region". Implementation of the program can be successful only on condition of the normalization of demographic trends and social conditions.

The processes of natural and mechanical movement of the population observed in the Transbaikal Territory in the past two decades testify to the extremely negative trends in the formation of the demographic potential of the region. Among these trends the following ones should be primarily named: low birth rate, high mortality rate, especially among men of working age, steady decrease in the proportion of rural population in the total population of the region, which is very unfavorable effect on reproduction (fertility in rural areas up to 1,3-1,4 times higher than in urban areas). The share of persons of retirement age increases. Negative changes occur in the family institution: increasing desire for small families. The attitude related to marriage and marital status changes: the stability of married unions decrease. The out-migration enhances, which entails, even natural growth, decline in population. These circumstances do not meet the economic and geopolitical interests. For investigation the factors affecting reproductive behavior in the Transbaikal Territory, the taxonomic method of multivariate analysis and the correlation analysis have been applied. Six groups of factors have been formed, which include: a healthy way of life, education, economic factors, habitat, social and domestic factors, social stability and moral-psychological factors. Results indicated that the greatest impact on the birth rate by factors: "Early childhood education" (r = 0,87); «Spiritual and moral education» (r = 0,76), «Housing Affordability» (r = -0,7) (for describing factor chosen as destabilizing indicators such as the proportion of families standing on the account, as in need of accommodation, the percentage of families, who have expressed a desire to participate in the sub-program "Housing for young families", but didn't get help), "Safety and the level of crime" (r = -0,52); "Material well-being" (r = -0,45). In 2013 the Russian Government approved the State Program of Russian Federation "Socio-economic development of the Far East and the Baikal region". Implementation of the program can be successful only on condition of the normalization of demographic trends and social conditions. ; Процессы естественного и механического движения населения, наблюдаемые в Забайкальском крае в последние два десятилетия, свидетельствуют о крайне негативных тенденциях в формировании демографического потенциала региона. Из числа этих тенденций следует в первую очередь назвать следующие: низкую рождаемость; высокий уровень смертности, особенно мужчин трудоспособного возраста; неуклонное уменьшение доли сельского населения в общей численности жителей региона, что весьма неблагоприятно сказывается на воспроизводстве населения (рождаемость в сельской местности выше в 1,3-1,4 раза, чем в городских поселениях). Увеличивается доля лиц старше трудоспособного возраста. Негативные изменения происходят в институте семьи: усиливается стремление к малодетности. Изменяется отношение к регистрации брака и состоянию в браке: снижается стабильность супружеских союзов. Усиливается миграционный отток, что влечет за собой, даже при естественном приросте, снижение численности населения. Указанные обстоятельства не отвечают экономическим и геополитическим интересам страны. Для исследования факторов, оказывающих воздействие на репродуктивное поведение в Забайкальском крае, применены таксономический метод многомерного анализа и корреляционный анализ. Сформировано шесть групп факторов, в числе которых: здоровый образ жизни, образование, экономические факторы, среда обитания, социально-бытовые факторы, социальная стабильность общества и нравственнопсихологические факторы. Результаты работы показали, что наибольшее воздействие на рождаемость оказывают факторы: «Дошкольное образование» (r = 0,87); «Духовно-нравственное воспитание» (r = 0,76), «Доступность жилья» (r = -0,7) (для характеристики фактора были выбраны такие дестабилизирующие показатели, как доля семей, состоящих на учете в качестве нуждающихся в жилых помещениях, и доля семей, изъявивших желаниеучаствовать в подпрограмме «Обеспечение жильем молодых семей», но не получивших помощь); «Безопасность и уровень преступности» (r = -0,52); «Материальное благополучие» (r = -0,45). В 2013 г. Правительством РФ утверждена Государственная программа РФ «Социально-экономическое развитие Дальнего Востока и Байкальского региона». Реализация Программы может быть успешной только при условии нормализации демографических тенденций и социальной обстановки.

The development of resistance by organisms to antimicrobials is a natural phenomenon. Although it is increased by the use of antimicrobials, reduction in use of them will not necessarily reduce resistance, and there is a possibility that eventually most, if not all, antimicrobials will become largely ineffective. However, current estimates of the economic burden are modest – at anything from less than £5 to more than £20,000 in reported additional costs per patient per episode for hospital costs, and anything up to around £10 billion per year in societal costs, they are far lower than estimates of economic burden from other health problems, such as cancers, heart disease and mental disorders. The reason that current estimates of the cost of resistance are modest is that they are based loosely on the 'incremental' cost related to the extra treatment of resistant over susceptible primary infection. This masks the most critical economic burden, which is when resistance leads to the loss of many of the advantages in medical care that antimicrobials have enabled. For instance, advanced surgical procedures and cancer chemotherapy might become far more dangerous as rates of associated infection increase and cannot be treated. The effective 'removal' of antimicrobials could mean soaring rates of post-operative infection, mortality and morbidity from what are currently considered to be trivial infections, presenting an apocalyptic blow to health system development. The full economic burden of this is not only inestimable at present, but unimaginable. It is therefore urgent that a full system analysis of resistance is undertaken. Rather than continuing the focus solely on the additional cost of treating an infectious disease in the presence of resistance, what is needed now is to look at how health services more broadly might be affected if resistance becomes endemic, and the wider implications of this to society. Incentive mechanisms also need to be developed at a number of levels, and could require radical change, such as moving to more restrictive prescription (for example, through a hospital setting only, removing the ability to prescribe from primary and community care). Clearly the necessity of, and ability to implement, such radical change will need to be informed by the system analysis, and also supported by it when it comes to engaging the wider political and popular support that would be required. In needing to consider a system approach, resistance shares many of the characteristics of climate change. Both provide future significant threats to human well-being, both are subject to considerable uncertainty about their future extent and trajectory, both are global problems where the response differs across nations, and both have as an underlying cause the over-consumption of 'goods' that lead to short term benefit. Yet for both there is considerable inertia to major, radical, change because there is a focus on current burden and because the personal incentives seldom match those of society more generally. However, there appears to be increasing scientific consensus about the impact of global warming in a way that is perhaps less clear – or at least less coherent – for antimicrobial resistance. For global warming this has led to clear, simple and consistent messages from the scientific community, underpinning increasing acceptance of the desirability of action by a broader policy-making community including politicians, economists and philanthropists. For antimicrobial resistance there is a clear danger that waiting for the burden to become significant before taking action may mean waiting until it is too late to stop an apocalyptic scenario – the very drive behind the early environmental movement's advocacy of the 'precautionary principle'.

Suid-Afrika, soos ander ontwikkelende lande in Sub-Sahara Afrika, bly in gebreke om die Verenigde Nasies se Millennium Ontwikkelingsdoelwitte te haal. In hierdie artikel word daar verduidelik dat hierdie onvermoë waarskynlik verband hou met grootskaalse wanvoeding in Afrika. Ekonomiese ontwikkeling en modernisering het 'n verandering in leefstyl en eetpatrone veroorsaak wat tot oorgewig en verwante siektes lei, voordat die probleem van ondervoeding opgelos is. In Suid-Afrika is 'n derde van die kinders nog steeds ondervoed terwyl byna 'n derde van volwasse mans en meer as die helfte van volwasse vroue reeds oorgewig of vetsugtig is. Hierdie dubbele lading van ondervoeding en oorvoeding lei tot hoë vlakke van beide oordraagbare (infektiewe) en nie-oordraagbare kroniese siektes, wat saam met die menslike immuniteitsgebrekkige virus (MIV) en verworwe immuniteitsgebrek sindroom (VIGS) epidemie verantwoordelik is vir die afname in lewensverwagting in Afrika. Armoede lei tot wanvoeding in swanger vroue, tot wangevoede fetusse, epigenetiese programmering van metaboliese paaie in 'n fetus, lae-geboortegewig babas en kinders met belemmerde fisiese en intellektuele ontwikkeling. Hierdie kinders ontwikkel in volwassenes met beperkte menskapitaal en het 'n verhoogde risiko vir oorgewig en kroniese siektes. Hulle vind dit moeilik om te ontsnap uit die intergeneratiewe siklus van armoede en wanvoeding. 'n Denkraamwerk word voorgestel as basis vir die beplanning van holistiese, transdissiplinêre en multisektoriale programme om ondervoeding en oorvoeding gelyktydig aan te spreek. Verder word daar aanbeveel dat Suid-Afrika meer openbare gesondheidsvoedingkundiges oplei en dat alle gesondheidswerkers beter toegerus word om die goeie voedingstrategieë van die Departement Gesondheid (Direktoraat Voeding) meer doeltreffend te implementeer. ; Developing countries, including South Africa, are lagging behind in reaching the United Nations' Millennium Development Goals (MDGs). These countries are at present experiencing a nutrition transition that is an outcome of economic development, urbanisation and acculturation. In this article, the nutritional situation in South Africa based on anthropometric characteristics of its population, is briefly reviewed. The vicious cycle between poverty, undernutrition and an increased vulnerability for over-nutrition and related noncommunicable diseases (NCDs) is explained and hypothesised to be a major determinant of the coexistence of under-nutrition and over-nutrition in developing countries. In South Africa the coexistence of under-nutrition and over-nutrition underlies a double burden of high morbidity and mortality from both infectious and noncommunicable diseases, which is further exacerbated by the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) pandemic. Clearly, it would be difficult to escape this intergenerational vicious circle of poverty and malnutrition, without optimising the nutritional status of all women who plan to become pregnant. There are many psychological reasons, apart from nutrition transition, why people eat more than they need to, including an inherent partiality for refined, sweet, salty and fatty foods. A conceptual framework, based on the constitutional right to food and nutrition security, is proposed to guide policy makers to plan holistic, integrated, transdisciplinary and multisectorial interventions to address under-nutrition and over-nutrition simultaneously. Individuals should be empowered, facilitated and motivated by appropriate education and training programmes and by strategies to improve socio-economic situations to be able to buy or produce food and to make healthy choices. This food environment will be created only if there is a common agenda, or even legislation, to improve the nutritional status in multisectorial and transdisciplinary programmes. The Directorate of Nutrition in the South African Department of Health has an excellent integrated nutrition strategy, but lacks the required implementation capacity. More public health nutritionists should be trained and other health professionals should be better equipped to implement nutritional interventions in all poverty alleviation and health promotion programmes. ; http://dx.doi.org/10.4102/satnt.v30i1.29

Suid-Afrika, soos ander ontwikkelende lande in Sub-Sahara Afrika, bly in gebreke om die Verenigde Nasies se Millennium Ontwikkelingsdoelwitte te haal. In hierdie artikel word daar verduidelik dat hierdie onvermoë waarskynlik verband hou met grootskaalse wanvoeding in Afrika. Ekonomiese ontwikkeling en modernisering het 'n verandering in leefstyl en eetpatrone veroorsaak wat tot oorgewig en verwante siektes lei, voordat die probleem van ondervoeding opgelos is. In Suid-Afrika is 'n derde van die kinders nog steeds ondervoed terwyl byna 'n derde van volwasse mans en meer as die helfte van volwasse vroue reeds oorgewig of vetsugtig is. Hierdie dubbele lading van ondervoeding en oorvoeding lei tot hoë vlakke van beide oordraagbare (infektiewe) en nie-oordraagbare kroniese siektes, wat saam met die menslike immuniteitsgebrekkige virus (MIV) en verworwe immuniteitsgebrek sindroom (VIGS) epidemie verantwoordelik is vir die afname in lewensverwagting in Afrika. Armoede lei tot wanvoeding in swanger vroue, tot wangevoede fetusse, epigenetiese programmering van metaboliese paaie in 'n fetus, lae-geboortegewig babas en kinders met belemmerde fisiese en intellektuele ontwikkeling. Hierdie kinders ontwikkel in volwassenes met beperkte menskapitaal en het 'n verhoogde risiko vir oorgewig en kroniese siektes. Hulle vind dit moeilik om te ontsnap uit die intergeneratiewe siklus van armoede en wanvoeding. 'n Denkraamwerk word voorgestel as basis vir die beplanning van holistiese, transdissiplinêre en multisektoriale programme om ondervoeding en oorvoeding gelyktydig aan te spreek. Verder word daar aanbeveel dat Suid-Afrika meer openbare gesondheidsvoedingkundiges oplei en dat alle gesondheidswerkers beter toegerus word om die goeie voedingstrategieë van die Departement Gesondheid (Direktoraat Voeding) meer doeltreffend te implementeer. ; Developing countries, including South Africa, are lagging behind in reaching the United Nations' Millennium Development Goals (MDGs). These countries are at present experiencing a nutrition transition that is an outcome of economic development, urbanisation and acculturation. In this article, the nutritional situation in South Africa based on anthropometric characteristics of its population, is briefly reviewed. The vicious cycle between poverty, undernutrition and an increased vulnerability for over-nutrition and related noncommunicable diseases (NCDs) is explained and hypothesised to be a major determinant of the coexistence of under-nutrition and over-nutrition in developing countries. In South Africa the coexistence of under-nutrition and over-nutrition underlies a double burden of high morbidity and mortality from both infectious and noncommunicable diseases, which is further exacerbated by the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) pandemic. Clearly, it would be difficult to escape this intergenerational vicious circle of poverty and malnutrition, without optimising the nutritional status of all women who plan to become pregnant. There are many psychological reasons, apart from nutrition transition, why people eat more than they need to, including an inherent partiality for refined, sweet, salty and fatty foods. A conceptual framework, based on the constitutional right to food and nutrition security, is proposed to guide policy makers to plan holistic, integrated, transdisciplinary and multisectorial interventions to address under-nutrition and over-nutrition simultaneously. Individuals should be empowered, facilitated and motivated by appropriate education and training programmes and by strategies to improve socio-economic situations to be able to buy or produce food and to make healthy choices. This food environment will be created only if there is a common agenda, or even legislation, to improve the nutritional status in multisectorial and transdisciplinary programmes. The Directorate of Nutrition in the South African Department of Health has an excellent integrated nutrition strategy, but lacks the required implementation capacity. More public health nutritionists should be trained and other health professionals should be better equipped to implement nutritional interventions in all poverty alleviation and health promotion programmes.

В статье анализируется законодательство Республики Казахстан в области трансплантологии органов, тканей и их компонентов. Данный вид правоотношений регламентируется Кодексом «О здоровье народа и системе здравоохранения» и представляется в форме социальных услуг. Определяются следующие направления правовой регламентации: 1. Основные проблемы законодательного регулирования пересадки органов их слагаемых, донорства крови, ее компонентов, половых, стволовых клеток. 2. Анализируется порядок предоставления таких медицинских услуг, проведения операций в Республике Казахстан и зарубежных государствах гражданам Казахстана. 3. Правовой статус доноров и рецепиентов. 4. Порядок транспортировки трансплантологического материала. 5. Направления международного сотрудничества. ; The article analyses the legislation of the Republic of Kazakhstan in the field of transplantation of organs, tissues and their components. This type of legal relations regulated by the Code "On people's health and healthcare system" and is presented in the form of social services. Identifies the following directions of legal regulation: 1. The main problems of legislative regulation of organ transplants their terms, donation of blood, its components, sexual, stem cells. 2. Analyses the procedure of provision of such health services, conducting operations in the Republic of Kazakhstan and foreign states, citizens of Kazakhstan. 3. The legal status of donors and reshepients. 4. Procedure of transportation of transplantation material. 5. Directions of international cooperation. The presence of gaps in the national legislation shall entail frequent use of citizens in need of data operations, the assistance of foreign clinics. It is often the criterion of choice is not the quality and skills of medical activities, and the availability of donor organs and low prices. So, for example, in Pakistan, the donors are waiting for the patients, and not vice versa, and the price of the transaction in some times below, than in other states. However, the quality of operations is very low. Until recently between the Republic of Kazakhstan and Pakistan was signed bilateral agreement, approved by the Governments of the countries, to conduct operations on transplantation of kidney, selection of donors, the organization of preoperative and postoperative care of the patients. However, in view of the fact that the mortality rate in the last two years amounted to almost one hundred per cent, this agreement was terminated. Other agreements of the republic of Kazakhstan on the issues of transplantation were not. There are no other international documents in this type of medical care. Thus, the direction of the legal regulation, in fact completely absent. None of the present day and common international standards in the field of transplantation of organs, tissues and their components. No less urgent is the problem of legal regulation of the supply of organs and tissues. Fantastic price in conjunction with a legal vacuum, entail criminal actions. These may be classified, such as the removal of organs or tissue from the dead, without the consent of the relatives, and also the traffic of citizens, including international, with the purpose of withdrawal of corresponding body material "illegal transplantation". Under Kazakhstan law, the legal status of the donor shall be determined subject principle. So, the donor germ cells can be only the citizens at the age from eighteen to thirty-five years of age, physically and mentally healthy, they do not have the right to information about the fate of their donor germ cells. They have no privileges. Donor blood and its components can be a person at the age of 18 years, passed the medical examination and has no contraindications, regardless of the mental state, and the donor tissues and organs of a man may be, the corpse of a man or an animal. With special requirements to donor status, the legislation does not clearly prescribes the procedure and the form of consent to this operation.

The Guidelines of the 4th Joint Societies Task Force on Cardiovascular Disease Prevention in Clinical Practice (4th JTF)* were issued in 2007, summarising and evaluating available evidence on reducing the incidence of atherosclerotic events arising from coronary heart disease, cerebrovascular disease and peripheral arterial disease. The purpose of the guidelines is to assist physicians in selecting the best strategies for managing cardiovascular disease. They are an important agreed protocol across countries and professionals that have the ultimate aim of improving outcomes from the disease. The value of these guidelines depends on the extent to which they are used by physicians in daily practice. Introducing the guidelines, the 4th JTF authors stressed that 'implementation programmes for new guidelines form an important component of the dissemination of knowledge'.1 Transferring guidelines from paper into practice has proven to be frustrating for the many who endeavour to standardise the management of cardiovascular disease across Europe. The EUROASPIRE I, II and III surveys, which audited the practice of preventive cardiology in patients with coronary heart disease over a decade, illustrated that patients were not being managed to the standards set by the ESC guidelines and that limited attention was given to prevention in patients with established heart disease. Evidence of the need for more effective lifestyle management was compelling: blood pressure management remained stubbornly unchanged, and lipid targets were not achieved in almost half of patients. Other studies report disappointing levels of guideline observance among physicians; they are often unaware of recommendations given in guidelines and, even when they are, many fail to consistently apply them in treating patients.2-3 Commonly cited barriers to guideline adherence among physicians include lack of time during consultations, financial constraints and lack of confidence in patients' motivation to comply. Physicians also find that guideline documents are difficult to translate into practice. To address the gap between publication of guidelines and their use in practice, the ESC at a European level organises presentations at conferences for its member national societies and key opinion leaders. It works at a political level to promote the prevention agenda and to directly influence EU health policy, leading, for example, to the EU Commission endorsement of the European Heart Health Charter. However, such efforts must be paralleled by concerted strategies at a national level to realise implementation in the front line. The 4th JTF urged national societies to develop implementation programmes, starting with the translation of guidelines to the local language and their adaptation to the national context. It recommended that the guidelines issued by the 4th JTF be regarded as a framework from which national guidance 'to suit local political, economic, social, and medical circumstances' would be developed. The recalibration of the SCORE risk assessment charts to reflect mortality and risk factor distributions in individual countries as part of this adaptation was emphasised. The 4th JTF saw as vital the establishment a multidisciplinary alliance of experts from national professional organisations to oversee the adaptation and to drive implementation. It was necessary that alliances would have the support of national health authorities and work with other sectors such as the medical education and business communities to advance their aims. Other recommendations included: An information and education programme aimed at practising doctors that would include an audit of practices and feedback. The development of supplementary materials to the guidelines, specifically electronic versions for use in hand-held devices, such as PDAs, and of A4 sheet versions of risk algorithms and treatment recommendations. A population health approach addressing lifestyle risk factors in general. A public information campaign explaining the concept of multiple risk assessment and treatment and intervention thresholds, as well as describing how risk can be reduced.

The Guidelines of the 4th Joint Societies Task Force on Cardiovascular Disease Prevention in Clinical Practice (4th JTF)* were issued in 2007, summarising and evaluating available evidence on reducing the incidence of atherosclerotic events arising from coronary heart disease, cerebrovascular disease and peripheral arterial disease. The purpose of the guidelines is to assist physicians in selecting the best strategies for managing cardiovascular disease. They are an important agreed protocol across countries and professionals that have the ultimate aim of improving outcomes from the disease. The value of these guidelines depends on the extent to which they are used by physicians in daily practice. Introducing the guidelines, the 4th JTF authors stressed that 'implementation programmes for new guidelines form an important component of the dissemination of knowledge'.1 Transferring guidelines from paper into practice has proven to be frustrating for the many who endeavour to standardise the management of cardiovascular disease across Europe. The EUROASPIRE I, II and III surveys, which audited the practice of preventive cardiology in patients with coronary heart disease over a decade, illustrated that patients were not being managed to the standards set by the ESC guidelines and that limited attention was given to prevention in patients with established heart disease. Evidence of the need for more effective lifestyle management was compelling: blood pressure management remained stubbornly unchanged, and lipid targets were not achieved in almost half of patients. Other studies report disappointing levels of guideline observance among physicians; they are often unaware of recommendations given in guidelines and, even when they are, many fail to consistently apply them in treating patients.2-3 Commonly cited barriers to guideline adherence among physicians include lack of time during consultations, financial constraints and lack of confidence in patients' motivation to comply. Physicians also find that guideline documents are difficult to translate into practice. To address the gap between publication of guidelines and their use in practice, the ESC at a European level organises presentations at conferences for its member national societies and key opinion leaders. It works at a political level to promote the prevention agenda and to directly influence EU health policy, leading, for example, to the EU Commission endorsement of the European Heart Health Charter. However, such efforts must be paralleled by concerted strategies at a national level to realise implementation in the front line. The 4th JTF urged national societies to develop implementation programmes, starting with the translation of guidelines to the local language and their adaptation to the national context. It recommended that the guidelines issued by the 4th JTF be regarded as a framework from which national guidance 'to suit local political, economic, social, and medical circumstances' would be developed. The recalibration of the SCORE risk assessment charts to reflect mortality and risk factor distributions in individual countries as part of this adaptation was emphasised. The 4th JTF saw as vital the establishment a multidisciplinary alliance of experts from national professional organisations to oversee the adaptation and to drive implementation. It was necessary that alliances would have the support of national health authorities and work with other sectors such as the medical education and business communities to advance their aims. Other recommendations included: An information and education programme aimed at practising doctors that would include an audit of practices and feedback. The development of supplementary materials to the guidelines, specifically electronic versions for use in hand-held devices, such as PDAs, and of A4 sheet versions of risk algorithms and treatment recommendations. A population health approach addressing lifestyle risk factors in general. A public information campaign explaining the concept of multiple risk assessment and treatment and intervention thresholds, as well as describing how risk can be reduced.

O trabalho tem como objetivo analisar a distribuição espacial das organizações sociais no Brasil e correlacionar esses resultados com dados socioeconômicos. Como indicadores das organizações sociais que exercem funções na sociedade, foram tomadas as informações do IBGE sobre as fundações privadas e associações sem fins lucrativos. Já os indicadores socioeconômicos são os seguintes: Índice dos desequilíbrios regionais de Williamson, PIB per capita, Índice de desenvolvimento humano (IDH), Índice de Gini, Taxa de mortalidade infantil, Esperança de vida ao nascer e Média de anos de estudo (20 a 24 anos). Os resultados, após o emprego de uma metodologia de análise estatística e cartográfica em diferentes escalas do território nacional, indicam uma variedade de situações, mas é possível afirmar que, para os estados com melhor relação entre habitantes por organizações sociais, existe uma correlação significativa com melhores indicadores econômico-sociais. Assim, há relevância dos resultados para o entendimento da diversidade geográfica brasileira. PALAVRAS-CHAVE: organização social, capital social, indicadores socioeconômicos, desenvolvimento, Brasil. SOCIAL ORGANIZATION AND SOCIAL AND ECONOMIC INDICATORS IN BRAZIL: an exploratory study Sylvio Bandeira de Mello e Silva Barbara-Christine Nentwig Silva Maina Pirajá Silva The purpose of this work is to analyze the spatial distribution of social capital in Brazil and correlate these results with several indicators of social economic development. Information gathered from IBGE on Private and Non-Profitable Associations that play an important role in society were used. The indicators of social-economic development are the following: Williamson index of regional unbalance, GDP per capita, Human Development Index (HDI), Gini index, rate of infant mortality, life expectancy at birth and school year mean (20-24 years). We used a methodology of statistical and cartographical analysis in different scales of Brazil's territory. The results showed a great variety of situations. However, it is possible to assert that there is a significant correlation between better indicators of social-economic development in states with a greater balance between its number of inhabitants and the presence of social organizations. Therefore, the results are relevant for understanding Brazil's geographic variety. KEYWORDS: social organization, social capital, socioeconomic indicators, development, Brazil. ORGANISATION SOCIALE ET INDICATEURS SOCIO-ECONOMIQUES AU BRESIL: une etude exploratoire Sylvio Bandeira de Mello e Silva Barbara-Christine Nentwig Silva Maina Pirajá Silva L'objectif de cette étude est d'analyser la distribution spatiale des organisations sociales au Brésil et de faire la corrélation de ces résultats avec des données socio-économiques. Les informations fournies par l'IBGE concernant les fondations privées et les associations sans buts lucratifs ont servi d'indicateurs pour les organisations sociales qui jouent un rôle dans la société. Les indicateurs socioéconomiques sont les suivants: l'indice des déséquilibres régionaux de Williamson, le PIB par habitant, l'indice de développement humain (IDH), l'indice de Gini, le taux de mortalité infantile, l'espérance de vie à la naissance et la durée moyenne d'études (de 20 à 24 ans). Après avoir utilisé une méthodologie d'analyse statistique et cartographique, à différentes échelles du territoire national, les résultats témoignent d'une variété de situations. Il est cependant possible d'affirmer qu'il y a une corrélation significative avec des indicateurs économiques et sociaux meilleurs pour les états où le rapport entre personnes et organisations sociales est meilleur aussi. Ces résultats ont donc une importance fondamentale pour comprendre la diversité géographique brésilienne. MOTS-CLÉS: organisation sociale, capital social, indices sociaux économiques, développement, Brésil. Publicação Online do Caderno CRH: http://www.cadernocrh.ufba.br

Une enquéte publiée en 1988 avait révélé que, bien que de nombreuses conditions favorables au développement rapide de l'élevage du tapín fussent réunies au Bénin, beaucoup d'actions restaient a entreprendre dans le domaine de la recherche, le formation et l'information. C'est pour répondre a ces impératifs de développement que le Centre Cunicole de Recherche et d'lnformation (CECURI) a été créé. Sa vocation est d'accroitre les connaissances concernant le tapín, son élevage et sa pathologie, pour améliorer les productions locales et de vulgariser l'élevage rationnel de cet herbivore a travers l'information au sens le plus large du terme. Mis a part les résultats médiocres d'exploitation observés la premiere année, inhérents a l'inexpérience et aux hésitations de démarrage, le CECURI a rapidement maitrisé la gestion technico-économique de son élevage de démonstration. En 1991, le taux de saillies fécondantes a atteint 80 % contre 45 % en 1988. Dans le méme temps, la taille de portée au sevrage et la mortalité sevrage-vente sont passés respectivement de 2,8 et 40 % en 1988 a 5, 1 et 5% en 1991. Par ailleurs, malgré les moyens limités, il a eu, depuis sa création, un impact tres positif sur la recherche et te développement de la cuniculture : augmentation tres sensible du nombre de chercheurs dans le secteur cunicole et intensification des travaux de recherche, introduction de l'enseignement de la cuniculture dans les lycées agricoles et a l'université, recyclage et formation continua des éleveurs et des techniciens, diffusion de reproducteurs plus performants, augmentation numérique de petits ateliers dans les zones rurales et périurbaines, naissance de l'Association Béninoise des Cuniculteurs, sensibilisation des décideurs politiques et des partenaires financiers, tenue en Mars 1992 d'un Congres Cunicole Africain . etc. Toutefois, pour qu'un développement plus rapide et durable s'opère dans ce secteur, les activités d'un tel Centre doivent etre appuyées par un programme national voire régional de développement. ; lnvestigation results published in 1988 showed that despite of favourable conditions for a quick development of the rabbit rearing in Republic of Benin, many actions were still needed to be led in this domain for research, formation and information. To satisfy these obligations, CECURI (Rabbit Research and lnformation Center) was created. lts vocation is the increasing of the knowledge about rabbit as animal production species, the way of its breeding and all its pathology, in order to inprove local production and to extend a rational method for rearing this herbivore, by a very large information. Despite dithering before starting and poor exploitation results, linked to the lake of experience during the first year, CECURI was quickly qualified for the economic and technical management of its demonstration breeding unit. In 1988 the percentage of fertile mating was only 45 % ; it was increase upto 80 % in 1991. During the sama period, the number of youngs per litter at weaning and mortality from weaning to the slaughter age were also improved : 2.8 and 40 % respectively in 1988 and 5.1 and 5 % in 1991. Another way, in spite of short means since the creation, its impacts on research and rabbitries development are fully positiva obvious increasing of the researchers number, intensification of their activities, introduction of the rabbit breeding programme into agricultura! secondary school and university, retrain and advanced training for technicians and rabbit breeders, spray of results oustanding breeders, increasing of the number of small rabbitries around towns and village countries, creation of a Rabbit Breeders Association in Bénin, sensibilization of the financia! partners, holding on March 1992 an african rabbit congress . etc. However, for a quicker and lasting development of this section, the activities of such a center must be helped by even regional programme timming.

Большая статья о смерти впервые появляется на страницах журнала «Мир России», и это одновременно и удивительно, и закономерно. Удивительно поскольку все связанное со смертью органично входит в то, что называется «миром России», и поэтому соответствующая проблематика уже давно могла бы заинтересовать и редакцию, и авторов. Закономерно поскольку журнал последовательно, из номера в номер открывает читателю Россию как удивительный цивилизационный феномен во всей полноте его проявлений, а смерть, ее бытование, восприятие и культура из их числа. В недавние (по историческим меркам) времена в России от «меча, мора и глада» вымирали города и области, уходили в небытие целые поколения и в конце концов начала вымирать и сама Россия. Многие предрекают скорую и бессмысленную кончину нашей страны как таковой, но предмет этой статьи иной: смерть как естественное явление повседневности, с которым сосуществуют все живущиеThe attitude to death is an inalienable and rather characteristic part of Russian culture. Death is connected with unbelievably large number of superstitions, magic ceremonies and rituals. Death became firmly established in all kinds of art a long time ago: music and cinema, opera and ballet, prose and poetry, painting and sculpture, landscape design and architecture. Death and everything related to it is being studied by many sciences. A lot of actions related to death and carried out by certain people and organizations are regulated by constitutional, regional and local law. Death is being served by special kinds of economic activities and their unique infrastructure. Each of these topics may become a reason for independent ethnological, sociological, economic, lawful, philosophical, etc. study; but in this article the attention is being drawn just to these two issues; what do people die from and how are they being buried in Russia at present. Russia belongs to a number of such few states, where birthrate is law as in the developed countries (depopulation of aboriginal population), and the mortality is as high as in the developing ones. It is shown in the article that such situation is connected with legal income of the major part of the population and inadequate accessibility of the health service's up-to-date achievements, but not to the same degree as with uncertainty about the future and indifferent attitude to the value of life, especially among men. This is the main reason why Russia is a country of widows, where each second child born during the recent years doesn't have a chance to reach the retirement age. Specific features of extremely detailed legislation in the sphere of funeral services are regarded and examples of unique legal collisions appearing in that sphere are given. It is also shown why, despite huge land resources of Russia, a keen problem of cemetery territories and neglected cemeteries has emerged. The data related to the cost of living and burial expenses is given. In recent years the Russian state undertakes measures aimed at stimulating birthrate growth. But to resist a slump run-down of population size is possible by cutting abnormally high death rate (especially among children and capable for work people). It isn't less difficult than to stimulate birthrate growth, because to achieve the first goal, as well as the second one, it is necessary to change, first of all, the most conservative mental component of our existence. It is necessary that ideology of life value will begin to penetrate in mass consciousness, ousting stereotypes of aggressive-infantile and irresponsible behavior. It is necessary to refuse to perceive death, as it is cultivated in cheap novels, special effects of the cinema and computer games, as something insignificant. It is necessary to bring out the attitude to death as to the grand total, but not to the end of life

Objetivos. Sistematizar la información publicada sobre la situación y los avances en el logro de los Objetivos de Desarrollo del Milenio relacionados con la salud (ODMS), así como analizar su asociación con algunos factores económicos y los pronósticos de cumplimiento. Métodos. Se realizó una búsqueda de los artículos científicos sobre los Objetivos de Desarrollo del Milenio en general publicados entre el 1 de enero de 2000 y el 31 de agosto de 2006 en las bases bibliográficas electrónicas EBSCO, CSA Illumina, Thomson Gale, SwetsWise y BIREME. Se seleccionaron los artículos originales en inglés o español que evaluaran la situación de los ODMS o sus avances y se refirieran a factores determinantes. Se analizó la distribución de los factores determinantes de la situación de los ODMS o sus avances, los ODMS referidos, el tipo de evaluación, la relación entre los indicadores económicos y la salud, el lugar estudiado, y la situación y los pronósticos del cumplimiento de los ODMS. Se valoró la calidad de los artículos. Resultados. Se identificaron 304 artículos originales, de ellos 114 (37,5%) se ocupaban de uno o varios ODMS. Los objetivos relacionados con la mortalidad infantil y materna fueron los más frecuentemente abordados. De los 39 artículos que evaluaban los ODMS y su relación con los factores económicos, en 13 se consideraban factores económicos relacionados con la equidad, la política o la globalización. Los factores económicos y políticos fueron los más frecuentemente asociados con la situación de los ODMS o sus avances. Conclusiones. Existe una tendencia a utilizar variables económicas vinculadas con las condiciones de la población para analizar la situación de los ODMS y sus avances. Falta información sobre la relación con el gasto gubernamental, el comercio exterior, la ayuda externa y las políticas económicas mundiales. Los pronósticos para lograr los ODMS en los países pobres son desfavorables. ; Objectives. To systematize all the information published on the status of and progress made toward the Health-related Millennium Development Goals (HMDGs), as well as to understand associations with certain economic factors and the potential for success. Methods. A search was conducted for all scientific articles covering the Millennium Development Goals in general, published from 1 January 2000 to 31 August 2006, in the electronic databases of the EBSCO, CSA Illumina, Thomson Gale, SwetsWise, and BIREME. All original articles in English or Spanish that evaluated HMDG status, progress, and determinants were selected. The analysis evaluated the distribution of determinants of HMDG status or progress, the HMDGs referred to, the study type, the relationship between economic indicators and health, the study location, and the status and potential for attaining the HMDGs. The quality of the articles was also rated. Results. Of the 304 original articles found, 114 (37.5%) covered one or more HMDGs. The most frequently addressed goals were those concerning infant and maternal mortality. Of the 39 articles that evaluated HMDGs and their association with economic variables, 13 dealt with economic factors related to equity, policy, or globalization. Economic and policy factors were most frequently associated with HMDG status or progress. Conclusions. There is a definitive trend toward measuring HMDG status and progress according to economic factors that reflect the population's condition. There is an information gap regarding government spending, international commerce, international aid, and global economic policy. The potential for achieving HMDGs in poor countries is low.

Alternative methods in ecotoxicology play an increasingly important role in chemical and risk assessment. Already in 1986, the Directive 86/609/EEC stated that an alternative method, once it is "practicably and reasonably available", should replace the corresponding animal method. In 2007, REACH (Registration, Evaluation, Authorization and Restriction of Chemicals) came into force to systematically evaluate the risk to human health and the environment of approx. 30,000 chemical substances produced, used or imported in quantities of 1 - 100 t/a. Within the framework of REACH, animal testing should be reduced or even replaced by alternative methods. The 96 h acute fish test, however, is still a mandatory component in the base set of data required for chemical risk assessment. With mortality as the exclusive endpoint, it is not compatible with most current animal welfare legislations in Europe. Furthermore, there is increasing concern that some form of pain perception, similar to what is present in mammals, may be present in bony fish, and adult fish exposed to acute toxic concentrations of chemicals may at least be suspected to suffer severe distress and pain. A promising candidate to replace the acute fish test in chemical assessment is the fish embryo toxicity (FET) test. In Germany, the FET has already replaced the acute fish test in whole effluent testing since 2005. A major advantage of the FET concerning animal welfare is the fact that embryos may have not yet developed the same complex mental processes and may have not pain perception identical to adult fish. Since the correlation between the alternative and the test to be replaced is one of the most important facts to accept a test as alternative, a detailed literature research and a thorough re-evaluation of FET and acute fish test data has been conducted. The analyses resulted in an overall R2 of 0.90 for the comparison of FET data and acute fish test data. Restricting the data to zebrafish (Danio rerio) FET data and all fish data, the correlation resulted in an R2 of 0.87. In general, all correlations with different restrictions of the complete dataset (e.g. only zebrafish FET and zebrafish acute fish test data, only 48 h FET and 96 h fish toxicity data, etc.) showed no R2 lower than 0.81. For comparison between different biotests, these are almost perfect correlations, and compared to correlations of 96 h acute fish data among different fish species, they are in the same range or even better. However, outliers are inevitable. In order to investigate if the static procedure of the FET may be the reason for outliers, a flow-through protocol was developed. The applicability of the flow-through system in chemical assessment was checked by testing four different "outlier chemicals" (hydroquinone, 4-chlorophenol, pyraclostrobin and α-endosulfan), which were selected according to increasing log Pow. Independent of chemical nature and lipophilicity, the flow-through and the static FET gave almost identical results for all substances. Thus, at least for these chemicals, the differences between the results from the FET and the acute fish toxicity test could not be traced back to reduced bioavailability due to adsorption to the polystyrene plates. Further investigations are necessary to identify reasons for the poor correlation between FET and acute fish test results for specific chemicals. However, the static protocol seems to be a sufficient testing procedure and should definitely be used in further chemical assessment.

Biodiversity conservation is an important contemporary issue on global, EU and national policy agendas. However, in the face of human economic development, the important question is how to protect, maintain and restore biodiversity, without compromising economic and social dimensions of sustainability. Two sectors that can to a large extent influence biodiversity are forestry and road infrastructure development. Forestry is a sector very important for biodiversity conservation, since a large amount of protected and threatened species resides in forest ecosystems and many natural processes crucial for biodiversity occur in the forest. In addition, forests and woodlands form a network of habitats for many area-demanding species. Due to intensive forest management and fragmentation of forest and woodlands many elements of biodiversity are threatened, including species, habitats and processes. Road infrastructure development is another process that can negatively influence biodiversity. A growing network of transport infrastructure without doubt affects the functionality of the forest habitat networks. Negative effects include traffic mortality due to road collisions and barrier effect for individuals caused by high traffic volume, noise, wide roads and fencing. Cumulative effects of the infrastructure development can also lead to a loss of different elements of biodiversity at the landscape scale. Poland, with a legacy of less intensive forest management and still without a well-developed road infrastructure, is fortunate in terms of biodiversity maintenance. Due to economic underdevelopment of some regions of the country, Poland is rich in natural values including specialized species, functional habitat networks and ecological processes. However, after entering the European Union, Poland has started a process of rapid economic development, mainly with the help of EU funding. Enhancing road infrastructure is presently a key issue of economic development in this country. Dramatic growth in the amount of new roads can have large scale consequences for the biodiversity of the country, and can even influence biodiversity at the European scale. Policies aiming at biodiversity maintenance underline the need for implementing sustainability ideas in the planning and management for biodiversity. Traditionally, economic, environmental and social pillars of sustainability are identified. To be able to balance these three dimensions in the efforts for biodiversity conservation, there is a need to incorporate social dimensions in the nature science research concerning biodiversity. Especially, consideration of local attitudes is necessary in planning for biodiversity conservation. The aim of this thesis is to examine actors' attitudes and underlying values in two situations of conflict related to biodiversity conservation in Poland. One case concerns forest management in a biodiversity hot-spot, Białowieża forest and the other is about a development of a controversial road project of Augustów bypass. The results show that differences in attitudes may have various sources. The knowledge possessed by actors, their values, as well as scale at which they perceived biodiversity issues were identified as the main reasons for different attitudes. It was observed that in general, the actors whose attitudes were more "ecologically oriented" had to a large extent a cognitive view, that is their attitudes were mainly based on cognition (ecological knowledge) while "socially" or "economically oriented" actors' attitudes were more connected to emotions. In addition to differing attitudes, lack of trust was recognized in both cases as a factor escalating the conflict. The results showed also that legal issues are crucial to consider when biodiversity conservation is at stake. The results may have implications for the practical biodiversity conservation, since they show that both learning and legal incentives would be beneficial for the biodiversity conservation in controversial planning cases. This calls for the need for neutral forum for efficient public participation, communication and trust building between the actors and learning about important issues

Malaria is a serious tropical disease that is an increasing problem for many hospitals across Canada. Between 370 and 460 cases are reported annually in this country,1 and these numbers are known to underestimate the true incidence by 30% to 50%.2 Between 2001 and 2006, a mean of 17.2 cases of severe or complicated malaria were reported to the Canadian Malaria Network each year.3 This rate may rise with increases in the number of people at risk for malaria and the number with the disease who actually present to the Canadian health care system for care. Increases in the numbers of immigrants, refugees, travellers, and military personnel returning from service overseas are some possible contributors to this trend. Locally, cases reported in the Calgary Health Region may account for 4% to 8% of the national caseload. The drug of choice for severe malaria in Canada (quinine, administered intravenously) has restricted availability and can be obtained only through 13 repository sites designated by the Canadian Malaria Network. These repositories are located in all provinces except New Brunswick and Prince Edward Island; no repositories are located in the Northwest Territories, Yukon Territory, or Nunavut. Most cases of malaria in the Calgary Health Region are caused by the potentially deadly parasitic species Plasmodium falciparum; such infections can progress to organ failure within 24 to 48 h after introduction to the bloodstream. For people infected with P. falciparum, timely recognition and appropriate antimalarial treatment are essential to minimize associated morbidity and mortality.4 Yet, in a review of 100 consecutive malaria cases in the greater Toronto area, 23% of the patients had delays of greater than 6 h before initiation of antimalarial therapy (after receipt of a laboratoryconfirmed diagnosis), and 36% of patients infected with P. falciparum had no follow-up within the first 4 days of therapy.4 Incorrect treatment regimens and errors in initial management of severe malaria were 2 "major errors" cited. Nationally, the Canadian Malaria Network reported treatment delays of more than 24 h in 17.5% of severe or complicated malaria cases over the period 2001 to 2006.3 These factors led pharmacy department staff of the Calgary Health Region to ask, "How prepared are pharmacists to deal with uncommon yet important malaria orders in the dispensary?" Observations in acute care dispensaries in the Calgary Health Region revealed that malaria resources (e.g., hard-copy publications, bookmarked websites) at individual workstations were limited and that few pharmacists knew that there was an infectious diseases consultant with advanced training in travel and tropical health on staff. Importantly, several drug information sources routinely used by pharmacists in the Calgary Health Region are published in the United States, where quinidine for IV administration is available and is currently used as first-line treatment for severe malaria. Use of such references could lead to discrepancies or errors in dosing under the current Canadian guidelines. Published evaluations have shown positive results of using web-based media to educate pharmacists and pharmacy students.5-7 This literature, along with local confusion and delays in treatment experienced within the Calgary Health Region, prompted the development of a malaria education initiative for pharmacists that was disseminated through the region's internal pharmacy website. The module was intended to support inpatient dispensary pharmacists in the management of malaria and to aid in the timely administration of antimalarial therapy. This study was undertaken to evaluate the effectiveness of the module in making pharmacists more knowledgeable about the triage process for malaria, regional procedures concerning supplies of quinine for IV administration, and the locations of standardized malaria information. The secondary objectives were to evaluate pharmacists' comfort levels in processing malaria orders and user satisfaction with respect to the web-based education module.