Toward optimal early management after whiplash injury to lessen the rate of transition to chronicity: discussion paper 5

Expert debate and synthesis of research to inform future management approaches for acute whiplash disorders.

The role of tissue damage in whiplash-associated disorders: discussion paper 1

Nonsystematic review of cervical spine lesions in whiplash-associated disorders (WAD).

What are the implications of changing treatment delivery models for patients with inflammatory bowel disease: a discussion paper.

An integrated model of care has been used effectively to manage chronic diseases; however, there is limited, yet encouraging evidence on its introduction in the management of inflammatory bowel disease (IBD), a chronic gastrointestinal condition. Here, the rationale for and implications of introducing an integrated model of care for patients with IBD are discussed, with a particular focus on psychology input, patient-centred care, efficiency as perceived by patients and doctors, financial implications and the possible means of model introduction. This is a discussion paper on the integrated model of care for IBD against a background of what has been learned from an integrated model of care established in other chronic conditions. Although limited, the emerging data on an integrated model of care in IBD are encouraging with respect to patient outcomes and savings in healthcare costs. In other conditions, the model has been well received by both patients and practitioners, although the loss of autonomy by doctors is listed among its drawbacks. The cost-effectiveness data are now sufficiently convincing to recommend the model's acceptance in principle. The model should be promoted at the policy level rather than by individual practitioners to facilitate equal access for patients with IBD on a larger scale than currently.

Vulnerability to risk among small farmers in Tajikistan: results of a 2011 survey

Tajikistan is judged to be highly vulnerable to risk, including food insecurity risks and climate change risks. By some vulnerability measures it is the most vulnerable among all 28 countries in the World Bank’s Europe and Central Asia Region – ECA (World Bank 2009). The rural population, with its relatively high incidence of poverty, is particularly vulnerable. The Pilot Program for Climate Resilience (PPCR) in Tajikistan (2011) provided an opportunity to conduct a farm-level survey with the objective of assessing various dimensions of rural population’s vulnerability to risk and their perception of constraints to farming operations and livelihoods. The survey should be accordingly referred to as the 2011 PPCR survey. The rural population in Tajikistan is highly agrarian, with about 50% of family income deriving from agriculture (see Figure 4.1; also LSMS 2007 – own calculations). Tajikistan’s agriculture basically consists of two groups of producers: small household plots – the successors of Soviet “private agriculture” – and dehkan (or “peasant”) farms – new family farming structures that began to be created under relevant legislation passed after 1992 (Lerman and Sedik, 2008). The household plots manage 20% of arable land and produce 65% of gross agricultural output (GAO). Dehkan farms manage 65% of arable land and produce close to 30% of GAO. The remaining 15% of arable land is held in agricultural enterprises – the rapidly shrinking sector of corporate farms that succeeded the Soviet kolkhozes and sovkhozes and today produces less than 10% of GAO (TajStat 2011) The survey conducted in May 2011 focused on dehkan farms, as budgetary constraints precluded the inclusion of household plots. A total of 142 dehkan farms were surveyed in face-to-face interviews. They were sampled from 17 districts across all four regions – Sughd, Khatlon, RRP, and GBAO. The districts were selected so as to represent different agro-climatic zones, different vulnerability zones (based on the World Bank (2011) vulnerability assessment), and different food-insecurity zones (based on WFP/IPC assessments). Within each district, 3-4 jamoats were chosen at random and 2-3 farms were selected in each jamoat from lists provided by jamoat administration so as to maximize the variability by farm characteristics. The sample design by region/district is presented in Table A, which also shows the agro-climatic zone and the food security phase for each district. The sample districts are superimposed on a map of food security phases based on IPC April 2011.

Land use policies and practices for reducing vulnerability in rural Tajikistan

Tajikistan, with 93% of its surface area taken up by mountains and 65% of its labor force employed in agriculture, is judged to be highly vulnerable to risks, including climate change risks and food insecurity risks. The article examines a set of land use policies and practices that can be used to mitigate the vulnerability of Tajikistan’s large rural population, primarily by increasing family incomes. Empirical evidence from Tajikistan and other CIS countries suggests that families with more land and higher commercialization earn higher incomes and achieve higher well-being. The recommended policy measures that are likely to increase rural family incomes accordingly advocate expansion of smallholder farms, improvement of livestock productivity, increase of farm commercialization through improvement of farm services, and greater diversification of both income sources and the product mix. The analysis relies for supporting evidence on official statistics and recent farm surveys. Examples from local initiatives promoting sustainable land management practices and demonstrating the implementation of the proposed policy measures are presented.

Promoting gender equality in responses to climate change: The case of Kenya

The paper discusses how Kenyan policies and organisations address gender equality in climate change-related responses. The political support for gender issues is reflected in presidential directives on various actions for achieving gender equality such as the establishment of gender desk officers and ensuring 30 per cent female representation in government. Despite the well-advanced gender mainstreaming policy in Kenya, few policies focus on climate change and even fewer on its inter-linkages with gender. At the field level, encrusted traditions, inadequately trained staff, limited financial resources, and limited awareness of the inter-linkages between gender and climate change remain major challenges to promoting gender equality in the work of government organisations. The paper thus proposes measures for addressing these challenges and strengthening gender equality in responses to climate change.

Adapting agricultural water governance to climate change: Experiences from Germany, Spain and California

This study describes and discusses initiatives taken by public (water) agencies in the state of Brandenburg in Germany, the state of California in the USA and the Ebro River Basin in Spain in response to the challenges which climate change poses for the agricultural water sector. The drivers and actors and the process of changing agricultural water governance are its particular focus. The assumptions discussed are: (i) the degree of planned and anticipatory top-down implementation processes decreases if actions are more decentralized and are introduced at the regional and local level; (ii) the degree of autonomous and responsive adaptation approaches seems to grow with actions at a lower administrative level. Looking at processes of institutional change, a variety of drivers and actors are at work such as changing perceptions of predicted climate impacts; international obligations which force politicians to take action; socio-economic concerns such as the cost of not taking action; the economic interests of the private sector. Drivers are manifold and often interact and, in many cases, reforms in the sector are driven by and associated with larger reform agendas. The results of the study may serve as a starting point in assisting water agencies in developing countries with the elaboration of coping strategies for tackling climate change-induced risks related to agricultural water management.