Teaching and training in geriatric medicine in the European Union

In 1993 about 20% of the population in the 15 'old' member countries of the European Union (EU) was over 60 years of age and this percentage will increase to more than 25% in 2020. These developments play a key role for the investments in education and training to meet societies needs for health care services. In 2002 about 25% of the medical students in the 'old' EU did not receive any education in geriatric medicine. A question is who will provide the services for older people in related areas, like social care, community care, acute care in the hospitals, long-term care, permanent care and care for psychiatric patients? Geriatric medicine has been recognized as an independent specialty in 8 of the 15 member countries of the 'old' EU. In all EU member states the governments are autonomous regarding all aspects of health care services, including the recognition of specialties and specialist training programmes. A two years training in internal medicine has been recommended in the EU, followed by another four years of training in geriatric medicine. The specialist training has a hospital oriented character, however, it includes also community care and other institutionalised care like nursing homes. The curriculum should contain: biological, social, psychological and medical aspects of common diseases and disturbances in older people. A problem in many EU countries is the shortage of well trained researchers and leading persons for academic positions for geriatric medicine. In a number of countries chairs at the universities remain vacant for long periods of time or even disappear. Good services in the health care for older people need a high quality curriculum and training programme.     

Online Medical Literature Consultation Habits of Academic Teaching Physicians in the EU and CIS Countries: A Cross-Sectional Study

Background

Both in the Commonwealth of Independent States (CIS) and in the European Union (EU2004), ample availability of up to date medical scientific literature is important for progress in medical science and for the education of the next generation of healthcare workers. The aim of this research is to assess if the use of online medical literature among academic teaching (AT) physicians is at the same level in the CIS as in the EU2004.

Methodology/Principal Findings

In the capital cities of the CIS and the EU2004 member states, AT physicians holding an academic position at least equivalent to an associate professor and performing the three classical tasks in academic medicine (teaching, research and patient care) were interviewed about their use of and familiarity with the Internet and 9 online literature services, including journals and bibliographical databases such as PubMed (Medline), The Cochrane Library and Web of Science. Library staff members were interviewed about the availability of these online literature services at their libraries. About 750 physicians and 40 library staff members were invited for participation. Eventually 124 AT physicians and 22 library staff members participated. Internet was everywhere available, but used daily by more AT physicians in the EU2004 (71% versus 48% in the CIS, P = .005). AT physicians in the EU2004 accessed a higher percentage of all articles online (74% versus 43% in the CIS, P<.001). PubMed (P<.001), The Cochrane Library (P<.001) and Web of Science (P<.003) were used more frequently in the EU2004. In the EU2004 more AT physicians were familiar with Open Access journals (89% versus 51% in the CIS, P<.001).

Conclusions/Significance

AT physicians in the CIS use online medical literature less than in the EU2004. It is recommended that the awareness of freely available online literature services such as Open Access journals is enhanced among AT physicians and library staff members, especially in the CIS.     

Overview of the current status of genetically modified plants in Europe as compared to the USA

Genetically modified crops have been tested in 1,726 experimental releases in the EU member states and in 7,815 experimental releases in the USA. The global commercial cultivation area of genetically modified crops is likely to reach 50 million hectares in 2001, however, the commercial production of genetically modified crops in the EU amounts to only a few thousand hectares and accounts for only some 0.03% of the world production. A significant gap exists between the more than fifty genetically modified crop species already permitted to be cultivated and to be placed on the market in the USA, Canada and other countries and the five genetically modified crop species permitted for the same use in the EU member states, which are still pending inclusion in the Common Catalogue of agricultural plant species. The further development of the "green gene technology" in the EU will be a matter of public acceptance and administrative legislation.     

Convergence of EU nitrogen surplus,the RDP indicator of water quality

The EU Water Framework Directive (WFD), EU Nitrate Directive and EU Rural Development Policy (RDP) aim to improve water quality. The nutrient content of water can be decreased by reducing nitrogen emission. In this article a novel approach is applied to the evaluation of the impact of Agri Environmental Measures (AEM), which are part of axis 2 of the EU Rural Development Programme. The spending on AEM is linked to the reduction of nitrogen surplus, and hence, to the improvement of water quality. Reduction of nitrogen surplus is considered as a beta convergence process, in which the nitrogen surplus of EU member states converges to a steady state level. The convergence is tested, applying spatial econometrics on a panel data set of EU member states. The development over time of nitrogen surplus is explained applying the conditional beta convergence methodology. To allow for varying steady state nitrogen surpluses, structural variables are added to the analysis. RDP spending on AEM was added as structural variable to evaluate whether they affect the reduction of nitrogen surplus. The fixed effects panel data specification was tested to be the best model and preferred over spatial econometric specifications. A significantly negative effect is found between AEM expenditures and nitrogen surplus. Based on these estimation results it can be concluded that spending on AEM affects the convergence of nitrogen surplus towards a steady state level. A causal relationship cannot be tested with data on EU Member State level and additional analysis at smaller spatial level is warranted.     

Could EU herbal monographs contribute to Malta’s treatment armamentarium?

Ten years have passed since Directive 2004/24/EC regulating herbal medicinal products across the EU were published. The directive created the Committee on Herbal Medicinal Products within the European Medicines Agency whose remit includes the creation and publishing of official EU monographs on herbal medicinal products. These monographs include the official uses of the products and their evidence for efficacy and safety. To this effect, we are interested in analysing the potential impact herbal product EU monographs could have on the therapeutic treatment options available for prescribers in Malta. Therefore our aim was two-fold. First, to rationalise the spread of indications of the herbal substances listed in the community herbal monograph inventory and subsequently determine if these herbal substances could potentially contribute to the treatment options available in our local scenario (Malta). 128 EU monographs were analysed resulting in a total of 230 indications which subsequently codified into 42 unique ATC codes. The Malta Medicines List contains 1456 unique ATC codes. Comparative analysis of the Malta Medicines List revealed that the 21 therapeutic areas had 4 or less pharmaceutically used substances (5th level ATC codes) registered and therefore in our opinion are areas with limited therapeutic choice. The following 4 therapeutic areas, A05 bile and liver therapy, A13 tonics, A15 appetite stimulants and D03 preparations for treatment of wounds and ulcers, could potentially benefit from the registration of herbal medicinal products according to the EU herbal monographs. If such registration is effected the aforementioned areas would no longer be considered limited because more than 4 therapeutic choices would be available to prescribers. This study is the first study across the EU to analyse the potential impact of published EU herbal monographs on therapeutic coverage in an EU member state and confirms the notion that herbal products could potentially increase the treatment options available in areas where few medical products have been registered due to Malta's small market size.     

The ecosystem service assessment challenge: Reflections from Flanders-REA

This paper aims to improve ecosystem assessment practice by sharing the lessons learned from the Flanders Regional Ecosystem Assessment. The ‘EU biodiversity strategy to 2020’, requests the EU member states ‘to map and assess the state of ecosystems and their services by 2014’. However, a large number of member states have yet to start this assessment, and depend on assistance from the European Commission and on experiences from ongoing national assessments. In the region of Flanders (Belgium), several ecosystem service projects have since 2009 led the way to the ‘Flanders Regional Ecosystem Assessment’ (Flanders-REA), led by the governments’ leading research institute on biodiversity. To attain high regional requirements on scientific quality, acceptance and effective local policy impact, this assessment has tackled a number of challenges. The challenges discussed in this paper are obtaining conceptual clarity and consensus across disciplines and partners, the integration of multiple sources of information, critical handling of maps and the inclusion of experts and stakeholders. This paper also critically reflects on the definition of EU targets, their implementation, the current EU assistance to the member states, and the alignment with actual local and global policy needs.     

杜仲叶及提取物营养价值和药用成分研究

对不同产地和不同收获季节的杜仲叶常规营养成分、杜仲叶及其提取物中药用成分进行了研究 ,结果表明不同收获季节的杜仲叶营养有差异 ,杜仲叶及其提取物中含有较高的绿原酸和单宁。生产实践中 ,可利用秋末落叶作为很好的饲料资源     

Failed promises: economic integration, bureaucratic encounters, and the EU-Turkey Customs Union

European integration is based upon the promise to bring prosperity by creating economic and social equilibrium among member states and its regions via integrationist policies jointly managed by states and the institutions of the EU. As one common market initiative for greater economic integration in the wider region, goods circulate without tariff and customs duty barriers in the EU’s common customs area. Turkey, not an EU member, has been in this common market since 1996. The EU-Turkey Customs Union, which promised to bring deeper economic and political integration through eventual Turkish membership, represents Turkey’s aspirations to move from the periphery of Europe into its core. As an anthropological contribution to investigations of advanced European capitalism, this paper examines fundamental conflicts of interest between the EU and Turkey and locates them in their unequal power relations and in the disjuncture of each side’s overall objectives from economic integration. Most importantly, it shows that these interest conflicts have ramifications at the individual bureaucratic level and in daily bureaucratic practice. Dramatic expressions of Turkish state power, which are initially geared toward balancing out power inequities, exacerbate Turkish and EU officials’ failures to maintain at least a facade of mutually sustainable interests. Interpreted by EU officials as Turkish bureaucratic inertia, such disintegration of interests has implications for ongoing economic integration and membership negotiations between the two parties, with Turkish officials experiencing loss of control. The paper calls for a critical political economy that pays due attention to the cultural settings in which the former is embedded.     

The EU Nitrates Directive: a European approach to combat water pollution from agriculture

From 1991 onward, the European Union (EU) member states have had to comply with the Nitrates Directive. The aim of this directive is to sustainably protect ground and surface waters from pollution with nitrogen (nitrate) originating from agriculture. Agriculture is, on an EU level, the largest single source of nitrate (runoff, leaching) pollution, although households and industries also contribute to some extent. An important element in the directive is the reporting every 4 years on the monitoring of ground- and surface-water quality. Furthermore, all 15 member states are compelled to designate so-called Nitrate Vulnerable Zones (NVZs). These are regions where the nitrate concentrations in the groundwater amount to 50 mg/l or more. In addition to Codes of Good Agricultural Practice, valid on a countrywide basis and often consisting of voluntary-based measures, specific Action Programmes with mandatory measures have to be developed for the NVZs. The first reporting period ended in 1995. This paper describes the progress in member states" compliance with the Nitrates Directive during the second period (1996-1999), with a focus on the agricultural practices and action programmes. An evaluation of the member states' reports shows that good progress is being made on the farmers" awareness of the need to comply with EU regulations on the protection of the aquatic environment. Action programmes are valuable tools to enforce measures that lead to a reduction of the water pollution by agricultural activities. Regional projects show that significant improvements can be achieved (e.g., reduced fertiliser inputs) while maintaining crop yields and thus maintaining the economic potential of agriculture.     

Enforcement of the anti-Racism legislation of the European Union against antigypsyism

The European Union (EU) became a pioneer of the promotion of human rights and democratic values especially during the last decades. However, the members of the EU are not immune from the human rights violations including the areas of “equality” and “non-discrimination” that are related to racism, discrimination and xenophobia. “Antigypsyism”, a form of racism, is among the most challenging human rights areas for the member states despite all recent initiatives. In this research, the use of EU competences to combat antigypsyism is analysed with case studies. It is argued that the use of the competences is limited.     

Interpreting ‘favourable conservation status’ for large carnivores in Europe: how many are needed and how many are wanted?

The EU Habitats Directive is a key biodiversity conservation instrument. It contains legal obligations for the 28 EU member states in order to safeguard a ‘favourable conservation status’ (FCS) for selected species and habitat types. The crucial FCS concept itself, however, remains subject to considerable confusion regarding its proper interpretation and operationalization, impairing the Directive’s effective implementation. Diminishing this confusion is the purpose of this review. It focuses specifically on large carnivores—wolf (Canis lupus), brown bear (Ursus arctos), Eurasian lynx (Lynx lynx) and wolverine (Gulo gulo). These pose particular challenges, given their low densities, transboundary populations, and human-wildlife conflict potential. Large carnivores are also the only species for which specific guidance has been adopted by the European Commission—and subsequently contested. Our methodology combines legal analysis with an understanding of the species’ ecology and associated social, economic and cultural dimensions. We analyze the methods and processes through which EU law is interpreted, implemented, and enforced, by member states, European Commission, and EU Court of Justice—which is the ultimate authority regarding EU law interpretation. On that basis, we engage three particularly complex interpretation questions which are also of great practical significance: (1) the appropriate scale to achieve FCS (national or transboundary population level); (2) the respective roles of demographic, genetic and ecological factors in determining FCS; and (3) the use of extinction versus carrying capacity as benchmark. Regarding these questions, we identify approaches that are workable and effective, as well as likely to be endorsed by the EU Court.     

Strategic dilemmas of biosecurity in the European Union

Systems for societal/homeland security in both Europe and the United States are in flux to adjust to 21st century threats, such as terrorism, the proliferation of weapons of mass destruction, regional conflicts, state failures, and organized crime. It is important that reforms take place on both sides of the Atlantic that recognize the interdependence of Europe and the United States. Security, including biosecurity, for Europe is strongly connected to security in the U.S. Diseases transcend borders, and their consequences can be the same, irrespective of where the outbreak occurs or whether it is a natural occurrence or an act of bioterrorism. This article examines the political and strategic dilemmas and complexities that would confront the European Union (EU) in the event of a bioterrorism attack or a naturally occurring outbreak. Although several initiatives have been taken by the 15 member states and within the EU Commission, the EU is not institutionally prepared for transnational, rapidly moving diseases that could cause grave consequences in Europe and other regions, including the U.S. The prime responsibility for protecting European citizens against outbreaks rests with each member state. However, with intertwined and open European societies, the consequences would likely spill across borders. The EU Commission would have to become involved because such aspects as the internal market and freedom of movement would be affected. Responsibility, but not authority, would be pushed to the top. A coordinated EU response to such crises depends on European political leadership.     

Harnessing the biodiversity value of Central and Eastern European farmland

A large proportion of European biodiversity today depends on habitat provided by low‐intensity farming practices, yet this resource is declining as European agriculture intensifies. Within the European Union, particularly the central and eastern new member states have retained relatively large areas of species‐rich farmland, but despite increased investment in nature conservation here in recent years, farmland biodiversity trends appear to be worsening. Although the high biodiversity value of Central and Eastern European farmland has long been reported, the amount of research in the international literature focused on farmland biodiversity in this region remains comparatively tiny, and measures within the EU Common Agricultural Policy are relatively poorly adapted to support it. In this opinion study, we argue that, 10 years after the accession of the first eastern EU new member states, the continued under‐representation of the low‐intensity farmland in Central and Eastern Europe in the international literature and EU policy is impeding the development of sound, evidence‐based conservation interventions. The biodiversity benefits for Europe of existing low‐intensity farmland, particularly in the central and eastern states, should be harnessed before they are lost. Instead of waiting for species‐rich farmland to further decline, targeted research and monitoring to create locally appropriate conservation strategies for these habitats is needed now.     

Dairy cattle production in Europe

The European Union (EU) is a major player on world markets for most dairy products and produces the largest single share of the global market. Dairying is one of the most profitable sectors of EU agriculture. Milk yields per cow have increased steadily in every member state between 1985 and 1997. Overall EU dairy production continues to follow a trend towards increased intensification on a smaller number of larger, more specialised production units. In this paper we highlight the main characteristics of dairy cattle production in the EU, as well as their impact on cow and herd reproductive performances. AI is widely used in areas where there is high input:high output farming and farmers' primary objective is to have each cow produce a calf every 12 months without any particular calving pattern. The use of embryo technologies is increasing and in some areas (e.g. IVP embryo transfers) Europe leads the world. In most areas of Europe, because of both year round calving and ethical or consumer concerns, hormones are mainly used to treat reproductive diseases and not for pharmaceutical control of breeding.     

欧盟生物经济政策过程与特点及相关讨论

在对欧盟生物经济概念演变进行梳理的基础上,从欧盟与成员国两个层面对欧盟生物经济的政策过程进行了系统考察,分析并归纳出欧盟生物经济政策的特点,包括:与产业绿色转型结合,多方位促进人类经济社会的可持续发展;与农业多功能性结合,促进地区农村和农业的发展;重视生物经济发展的政策与技术双平台系统建设.在相关讨论中,进一步阐明生物经济发展的动力机制、农业在生物经济中的基础作用、生物经济的平台价值及其时代意义.     

Effects of the antibiotic growth promoters flavomycin and florfenicol on the autochthonous intestinal microbiota of hybrid tilapia (Oreochromis niloticus ♀ × O. aureus ♂)

The 16S rDNA PCR-DGGE and rpoB quantitative PCR (RQ-PCR) techniques were used to evaluate the effects of dietary flavomycin and florfenicol on the autochthonous intestinal microbiota of hybrid tilapia. The fish were fed four diets: control, dietary flavomycin, florfenicol and their combination. After 8 weeks of feeding, 6 fish from each cage were randomly chosen for the analysis. The total number of intestinal bacteria was determined by RQ-PCR. The results showed that dietary antibiotics significantly influenced the intestinal microbiota and dramatically reduced the intensity of total intestinal bacterial counts. The intensity of some phylotypes (EU563257, EU563262 and EU563255) were reduced to non-detectable levels by both dietary antibiotics, while supplementation of florfenicol to the diet also reduced the intensity of the phylotypes EU563242 and EU563262, uncultured Mycobacterium sp.-like, uncultured Cyanobacterium-like and uncultured Cyanobacterium (EU563246). Dietary flavomycin only reduced the OTU intensity of one phylotype, identified as a member of the phylum Fusobacteria. The antibiotic combination only reduced the phylotypes EU563242 and EU563262. Based on our results, we conclude that the reduced effect of florfenicol on intestinal microbiota was stronger than that of flavomycin, and when flavomycin and florfenicol were added in combination, the effect of florfenicol overshadowed that of flavomycin.     

Regulating coexistence of GM and non-GM crops without jeopardizing economic incentives

The ongoing debate about the coexistence of genetically modified (GM) and non-GM crops in the European Union (EU) mainly focuses on preventive measures needed to keep the adventitious presence of GM material in non-GM products below established tolerance thresholds, as well as on issues covering questions of liability and the duty to redress the incurred economic harm once adventitious mixing in non-GM products has occurred. By contrast, the interplay between the economic incentives and costs of coexistence has attracted little attention. The current overemphasis on the technical aspects and cost of coexistence over its economic incentives might lead EU policy-makers to adopt too stringent and rigid regulations on coexistence. Therefore, we argue for flexible coexistence regulations that explicitly take into account the economic incentives for coexistence. Our arguments provide a timely and important framework for EU policy-makers, who are currently struggling to implement coherent coexistence regulations in all member states.     

Safe biotechnology. 7. Classification of microorganisms on the basis of hazard

 The current systems for classifying human pathogens on the basis of hazard are well developed and their basic criteria are in general agreement one with another. Of more importance, the safety practices based on these classifications have generally been successful. They have enabled extensive research activities, medical practice and industrial production to be conducted on an ever-increasing scale, involving dangerous microorganisms (e.g. in vaccine production and treatment of infected patients) with a very low incidence of adverse effects on the workers involved and the general public. Although the EU has adopted a harmonised list of agents in groups 1–4 there is as yet no complete agreement among member states and individual microbiologists. The purpose of this paper is to present a historical survey and to discuss the current processes for identifying and classifying the hazards posed by the use of microorganisms in research and technology. This is essential in the design of appropriate methods of counteracting potential risks. Received: 8 December 1995/Received revision: 29 February 1996/Accepted: 4 March 1996     

How Does Medical Device Regulation Perform in the United States and the European Union? A Systematic Review

Background

Policymakers and regulators in the United States (US) and the European Union (EU) are weighing reforms to their medical device approval and post-market surveillance systems. Data may be available that identify strengths and weakness of the approaches to medical device regulation in these settings.

Methods and Findings

We performed a systematic review to find empirical studies evaluating medical device regulation in the US or EU. We searched Medline using two nested categories that included medical devices and glossary terms attributable to the US Food and Drug Administration and the EU, following PRISMA guidelines for systematic reviews. We supplemented this search with a review of the US Government Accountability Office online database for reports on US Food and Drug Administration device regulation, consultations with local experts in the field, manual reference mining of selected articles, and Google searches using the same key terms used in the Medline search. We found studies of premarket evaluation and timing (n = 9), studies of device recalls (n = 8), and surveys of device manufacturers (n = 3). These studies provide evidence of quality problems in pre-market submissions in the US, provide conflicting views of device safety based largely on recall data, and relay perceptions of some industry leaders from self-surveys.

Conclusions

Few studies have quantitatively assessed medical device regulation in either the US or EU. Existing studies of US and EU device approval and post-market evaluation performance suggest that policy reforms are necessary for both systems, including improving classification of devices in the US and promoting transparency and post-market oversight in the EU. Assessment of regulatory performance in both settings is limited by lack of data on post-approval safety outcomes. Changes to these device approval and post-marketing systems must be accompanied by ongoing research to ensure that there is better assessment of what works in either setting. Please see later in the article for the Editors'' Summary.