Will International Pursuit of the Millenium Development Goals Alleviate Poverty in Mountains?

Since September 2000, when world leaders agreed on time-bound, measurable goals to reduce extreme poverty, hunger, illiteracy, and disease while fostering gender equality and ensuring environmental sustainability, the Millennium Development Goals (MDGs) have increasingly come to dominate the policy objectives of many states and development agencies. The concern has been raised that the tight timeframe and financial restrictions might force governments to invest in the more productive sectors, thus compromising the quality and sustainability of development efforts. In the long term, this may lead to even greater inequality, especially between geographical regions and social strata. Hence people living in marginal areas, for example in remote mountain regions, and minority peoples risk being disadvantaged by this internationally agreed agenda. Strategies to overcome hunger and poverty in their different dimensions in mountain areas need to focus on strengthening the economy of small-scale farmers, while also fostering the sustainable use of natural resources, taking into consideration their multifunctionality.

Content comparison of health status measures for obesity based on the international classification of functioning, disability and health

OBJECTIVE: To compare the content covered by twelve obesity-specific health status measures using the International Classification of Functioning, Disability and Health (ICF). DESIGN: Obesity-specific health status measures were identified and then linked to the ICF separately by two trained health professionals according to standardized guidelines. The degree of agreement between health professionals was calculated by means of the kappa (kappa) statistic. Bootstrapped confidence intervals (CI) were calculated. The obesity-specific health-status measures were compared on the component and category level of the ICF. MEASUREMENTS: welve condition-specific health-status measures were identified and included in this study, namely the obesity-related problem scale, the obesity eating problems scale, the obesity-related coping and obesity-related distress questionnaire, the impact of weight on quality of life questionnaire (short version), the health-related quality of life questionnaire, the obesity adjustment survey (short form), the short specific quality of life scale, the obesity-related well-being questionnaire, the bariatric analysis and reporting outcome system, the bariatric quality of life index, the obesity and weight loss quality of life questionnaire and the weight-related symptom measure. RESULTS: In the 280 items of the eight measures, a total of 413 concepts were identified and linked to the 87 different ICF categories. The measures varied strongly in the number of concepts contained and the number of ICF categories used to map these concepts. Items on body functions varied form 12% in the obesity-related problem scale to 95% in the weight-related symptom measure. The estimated kappa coefficients ranged between 0.79 (CI: 0.72, 0.86) at the component ICFs level and 0.97 (CI: 0.93, 1.0) at the third ICF's level. CONCLUSION: The ICF proved highly useful for the content comparison of obesity-specific health-status measures. The results may provide clinicians and researchers with new insights when selecting health-status measures for clinical studies in obesity.

The PRO-AGE study: an international randomised controlled study of health risk appraisal for older persons based in general practice

BACKGROUND: This paper describes the study protocol, the recruitment, and base-line data for evaluating the success of randomisation of the PRO-AGE (PRevention in Older people-Assessment in GEneralists' practices) project. METHODS/DESIGN: A group of general practitioners (GPs) in London (U.K.), Hamburg (Germany) and Solothurn (Switzerland) were trained in risk identification, health promotion, and prevention in older people. Their non-disabled older patients were invited to participate in a randomised controlled study. Participants allocated to the intervention group were offered the Health Risk Appraisal for Older Persons (HRA-O) instrument with a site-specific method for reinforcement (London: physician reminders in electronic medical record; Hamburg: one group session or two preventive home visits; Solothurn: six-monthly preventive home visits over a two-year period). Participants allocated to the control group received usual care. At each site, an additional group of GPs did not receive the training, and their eligible patients were invited to participate in a concurrent comparison group. Primary outcomes are self-reported health behaviour and preventative care use at one-year follow-up. In Solothurn, an additional follow-up was conducted at two years. The number of older persons agreeing to participate (% of eligible persons) in the randomised controlled study was 2503 (66.0%) in London, 2580 (53.6%) in Hamburg, and 2284 (67.5%) in Solothurn. Base-line findings confirm that randomisation of participants was successful, with comparable characteristics between intervention and control groups. The number of persons (% of eligible) enrolled in the concurrent comparison group was 636 (48.8%) in London, 746 (35.7%) in Hamburg, and 1171 (63.0%) in Solothurn. DISCUSSION: PRO-AGE is the first large-scale randomised controlled trial of health risk appraisal for older people in Europe. Its results will inform about the effects of implementing HRA-O with different methods of reinforcement.

The Dynamics of Secondary Forest Landscapes in the Lower Mekong Basin: A Regional-Scale Analysis

Secondary forests in the Lower Mekong Basin (LMB) are increasingly recognized as a valuable component of land cover, providing ecosystem services and benefits for local users. A large proportion of secondary forests in the LMB, especially in the uplands, are maintained by swidden cultivation. In order to assess the regional-scale status and dynamic trends of secondary forests in the LMB, an analysis of existing regional land cover data for 1993 and 1997 was carried out and forms the basis of this paper. To gain insight into the full range of dynamics affecting secondary forests beyond net-change rates, cross-tabulation matrix analyses were performed. The investigations revealed that secondary forests make up the largest share of forest cover in the LMB, with over 80% located in Laos and Cambodia. The deforestation rates for secondary forests are 3 times higher than the rates for other forest categories and account for two-thirds of the total deforestation. These dynamics are particularly pronounced in the less advanced countries of the LMB, especially in Laos, where national policies and the opening up of national economies seem to be the main drivers of further degradation and loss of secondary forests.