Secondary prevention through cardiac rehabilitation: physical activity counselling and exercise training: key components of the position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation

Cardiac patients after an acute event and/or with chronic heart disease deserve special attention to restore their quality of life and to maintain or improve functional capacity. They require counselling to avoid recurrence through a combination of adherence to a medication plan and adoption of a healthy lifestyle. These secondary prevention targets are included in the overall goal of cardiac rehabilitation (CR). Cardiac rehabilitation can be viewed as the clinical application of preventive care by means of a professional multi-disciplinary integrated approach for comprehensive risk reduction and global long-term care of cardiac patients. The CR approach is delivered in tandem with a flexible follow-up strategy and easy access to a specialized team. To promote implementation of cardiac prevention and rehabilitation, the CR Section of the EACPR (European Association of Cardiovascular Prevention and Rehabilitation) has recently completed a Position Paper, entitled 'Secondary prevention through cardiac rehabilitation: A condition-oriented approach'. Components of multidisciplinary CR for seven clinical presentations have been addressed. Components include patient assessment, physical activity counselling, exercise training, diet/nutritional counselling, weight control management, lipid management, blood pressure monitoring, smoking cessation, and psychosocial management. Cardiac rehabilitation services are by definition multi-factorial and comprehensive, with physical activity counselling and exercise training as central components in all rehabilitation and preventive interventions. Many of the risk factor improvements occurring in CR can be mediated through exercise training programmes. This call-for-action paper presents the key components of a CR programme: physical activity counselling and exercise training. It summarizes current evidence-based best practice for the wide range of patient presentations of interest to the general cardiology community.

Impact of a national HIV voluntary counselling and testing (VCT) campaign on VCT in a rural hospital in Tanzania

To evaluate the impact of a national HIV voluntary counselling and testing (VCT) campaign on presentation to HIV care in a rural population in Tanzania.

Determining the long-term changes in biodiversity and provisioning services along a transect from Central Europe to the Mediterranean

Climate, land use and fire are strong determinants of plant diversity, potentially resulting in local extinctions, including rare endemic and economically valuable species. While climate and land use are decisive for vegetation composition and thus the species pool, fire disturbance can lead to landscape fragmentation, affecting the provisioning of important ecosystem services such as timber and raw natural resources. We use multi-proxy palaeoecological data with high taxonomic and temporal resolution across an environmental gradient to assess the long-term impact of major climate shifts, land use and fire disturbance on past vegetation openness and plant diversity (evenness and richness). Evenness of taxa is inferred by calculating the probability of interspecific encounter (PIE) of pollen and spores and species richness by palynological richness (PRI). To account for evenness distortions of PRI, we developed a new palaeodiversity measure, which is evenness-detrended palynological richness (DE-PRI). Reconstructed species richness increases from north to south regardless of time, mirroring the biodiversity increase across the gradient from temperate deciduous to subtropical evergreen vegetation. Climatic changes after the end of the last ice age contributed to biodiversity dynamics, usually by promoting species richness and evenness in response to warming. The data reveal that the promotion of diverse open-land ecosystems increased when human disturbance became determinant, while forests became less diverse. Our results imply that the today’s biodiversity has been shaped by anthropogenic forcing over the millennia. Future management strategies aiming at a successful conservation of biodiversity should therefore consider the millennia-lasting role of anthropogenic fire and human activities.

Effects of two traits of the ecological state equation on our understanding of species coexistence and ecosystem services

Species coexistence has been a fundamental issue to understand ecosystem functioning since the beginnings of ecology as a science. The search of a reliable and all-encompassing explanation for this issue has become a complex goal with several apparently opposing trends. On the other side, seemingly unconnected with species coexistence, an ecological state equation based on the inverse correlation between an indicator of dispersal that fits gamma distribution and species diversity has been recently developed. This article explores two factors, whose effects are inconspicuous in such an equation at the first sight, that are used to develop an alternative general theoretical background in order to provide a better understanding of species coexistence. Our main outcomes are: (i) the fit of dispersal and diversity values to gamma distribution is an important factor that promotes species coexistence mainly due to the right-skewed character of gamma distribution; (ii) the opposite correlation between species diversity and dispersal implies that any increase of diversity is equivalent to a route of “ecological cooling” whose maximum limit should be constrained by the influence of the third law of thermodynamics; this is in agreement with the well-known asymptotic trend of diversity values in space and time; (iii) there are plausible empirical and theoretical ways to apply physical principles to explain important ecological processes; (iv) the gap between theoretical and empirical ecology in those cases where species diversity is paradoxically high could be narrowed by a wave model of species coexistence based on the concurrency of local equilibrium states. In such a model, competitive exclusion has a limited but indispensable role in harmonious coexistence with functional redundancy. We analyze several literature references as well as ecological and evolutionary examples that support our approach, reinforcing the meaning equivalence between important physical and ecological principles.

Current Regulating and Supporting Services: Nutrient Cycles

The study forest regulates nutrient cycles as a supporting ecosystem service mainly via retention in the biosphere and the soil organic layer. How tight the nutrient cycles are depends on environmental conditions. In this chapter, we focus on the roles of (1) deposition from the atmosphere, (2) soil moisture regime, and (3) conversion to pasture in the nutrient cycle. Between 1998 and 2010, there were a seasonal deposition of salpetric acid, an episodic deposition of Ca and Mg from Sahara dusts, and a continuous increase in reactive N inputs related to Amazonian forest fires, the El Niño Southern Oscillation cycle, and the economic development, respectively. Simultaneously, soils became increasingly drier enhancing nutrient release by mineralization. An increasing number of rain storms could considerably increase the export of N and base metals (K, Ca, Mg) via fast surface-near lateral transport in soil. Land-use change from forest to pasture introduces alkaline ashes and grass-derived organic matter. The resulting increases in soil pH and nutrient and substrate supply increase nutrient cycling rates because of enhanced microbial activity.

Humans and Scavengers: The Evolution of Interactions and Ecosystem Services

Since the origin of early Homo species during the Late Pliocene, interactions of humans with scavenging birds and mammals have changed in form through shifting ecological scenarios. How humans procured meat during the Quaternary Period changed from confrontational scavenging to hunting; shepherding of wild animals; and, eventually, intensive husbandry of domesticated animals. As humans evolved from carcass consumers to carcass providers, the overall relationship between humans and scavengers shifted from competition to facilitation. These changing interactions have translated into shifting provisioning (by signaling carcass location), regulating (e.g., by removing animal debris and controlling infectious diseases), and cultural ecosystem services (e.g., by favoring human language and social cooperation skills or, more recently, by enhancing ecotourism) provided by scavenging vertebrates. The continued survival of vultures and large mammalian scavengers alongside humans is now severely in jeopardy, threatening the loss of the numerous ecosystem services from which contemporary and future humans could benefit.

Climate change impacts on tree species, forest properties, and ecosystem services

– Swiss forests experience strong impacts under the CH2011 scenarios, partly even for the low greenhouse gas scenario RCP3PD. Negative impacts prevail in low-elevation forests, whereas mostly positive impacts are expected in high-elevation forests. – Major changes in the distribution of the two most important tree species, Norway spruce and European beech, are expected. Growth conditions for spruce improve in a broad range of scenarios at presently cool high-elevation sites with plentiful precipitation, but in the case of strong warming (A1B and A2) spruce and beech are at risk in large parts of the Swiss Plateau. – High elevation forests that are temperature-limited will show little change in species composition but an increase in biomass. In contrast, forests at low elevations in warm-dry inner-Alpine valleys are sensitive to even moderate warming and may no longer sustain current biomass and species. – Timber production potential, carbon storage, and protection from avalanches and rockfall react differently to climate change, with an overall tendency to deteriorate at low elevations, and improve at high elevations. – Climate change will affect forests also indirectly, e.g., by increasing the risk of infestation by spruce bark beetles, which will profit from an extended flight period and will produce more generations per year.

People, protected areas and ecosystem services: a qualitative and quantitative analysis of local people's perception and preferences in Côte d'Ivoire

The long-term integrity of protected areas (PAs), and hence the maintenance of related ecosystem services (ES), are dependent on the support of local people. In the present study, local people's perceptions of ecosystem services from PAs and factors that govern local preferences for PAs are assessed. Fourteen study villages were randomly selected from three different protected forest areas and one control site along the southern coast of Côte d'Ivoire. Data was collected through a mixed-method approach, including qualitative semi-structured interviews and a household survey based on hypothetical choice scenarios. Local people's perceptions of ecosystem service provision was decrypted through qualitative content analysis, while the relation between people's preferences and potential factors that affect preferences were analyzed through multinomial models. This study shows that rural villagers do perceive a number of different ecosystem services as benefits from PAs in Côte d'Ivoire. The results based on quantitative data also suggest that local preferences for PAs and related ecosystem services are driven by PAs' management rules, age, and people's dependence on natural resources.

Fertility-preservation counselling and treatment for medical reasons: data from a multinational network of over 5000 women.

Fertility-preservation techniques for medical reasons are increasingly offered in national networks. Knowledge of the characteristics of counselled patients and techniques used are essential. The FertiPROTEKT network registry was analysed between 2007 and 2013, and included up to 85 university and non-university centres in Germany, Austria and Switzerland; 5159 women were counselled and 4060 women underwent fertility preservation. In 2013, fertility-preservation counselling for medical reasons increased significantly among nullipara and women aged between 21 and 35 years (n = 1043; P < 0.001). Frequency of GnRH applications slowly decreased, whereas tissue, oocytes and zygote cryopreservation increased. In 2013, women with breast cancer mainly opted for tissue freezing, whereas women with lymphoma opted for GnRH agonist. Women younger than 20 years predominantly opted for GnRH agonists and ovarian tissue cryopreservation; women aged between 20 and 40 years underwent a variety of techniques; and women over 40 years opted for GnRH agonists. The average number of aspirated oocytes per stimulation cycle decreased as age increased (< 30 years: 12.9; 31-35 years: 12.3; 36-46: 9.0; > 41 years: 5.7). For ovarian tissue cryopreservation, removal and cryopreservation of fewer than one ovary was preferred and carried out in 97% of cases in 2013.

A feasibility study for the provision of electronic healthcare tools and services in areas of Greece, Cyprus and Italy

Background Through this paper, we present the initial steps for the creation of an integrated platform for the provision of a series of eHealth tools and services to both citizens and travelers in isolated areas of thesoutheast Mediterranean, and on board ships travelling across it. The platform was created through an INTERREG IIIB ARCHIMED project called INTERMED. Methods The support of primary healthcare, home care and the continuous education of physicians are the three major issues that the proposed platform is trying to facilitate. The proposed system is based on state-of-the-art telemedicine systems and is able to provide the following healthcare services: i) Telecollaboration and teleconsultation services between remotely located healthcare providers, ii) telemedicine services in emergencies, iii) home telecare services for "at risk" citizens such as the elderly and patients with chronic diseases, and iv) eLearning services for the continuous training through seminars of both healthcare personnel (physicians, nurses etc) and persons supporting "at risk" citizens. These systems support data transmission over simple phone lines, internet connections, integrated services digital network/digital subscriber lines, satellite links, mobile networks (GPRS/3G), and wireless local area networks. The data corresponds, among others, to voice, vital biosignals, still medical images, video, and data used by eLearning applications. The proposed platform comprises several systems, each supporting different services. These were integrated using a common data storage and exchange scheme in order to achieve system interoperability in terms of software, language and national characteristics. Results The platform has been installed and evaluated in different rural and urban sites in Greece, Cyprus and Italy. The evaluation was mainly related to technical issues and user satisfaction. The selected sites are, among others, rural health centers, ambulances, homes of "at-risk" citizens, and a ferry. Conclusions The results proved the functionality and utilization of the platform in various rural places in Greece, Cyprus and Italy. However, further actions are needed to enable the local healthcare systems and the different population groups to be familiarized with, and use in their everyday lives, mature technological solutions for the provision of healthcare services.

Landscape mosaics maps as a basis for spatial assessment and negotiation of ecosystem services and their trade-offs at the meso-scale: Examples from Laos, Madagascar and China

Mapping ecosystem services (ES) and their trade-offs is a key requirement for informed decision making for land use planning and management of natural resources that aim to move towards increasing the sustainability of landscapes. The negotiations of the purposes of landscapes and the services they should provide are difficult as there is an increasing number of stakeholders active at different levels with a variety of interests present on one particular landscape.Traditionally, land cover data is at the basis for mapping and spatial monitoring of ecosystem services. In light of complex landscapes it is however questionable whether land cover per se and as a spatial base unit is suitable for monitoring and management at the meso-scale. Often the characteristics of a landscape are defined by prevalence, composition and specific spatial and temporal patterns of different land cover types. The spatial delineation of shifting cultivation agriculture represents a prominent example of a land use system with its different land use intensities that requires alternative methodologies that go beyond the common remote sensing approaches of pixel-based land cover analysis due to the spatial and temporal dynamics of rotating cultivated and fallow fields.Against this background we advocate that adopting a landscape perspective to spatial planning and decision making offers new space for negotiation and collaboration, taking into account the needs of local resource users, and of the global community. For this purpose we introduce landscape mosaicsdefined as new spatial unit describing generalized land use types. Landscape mosaics have allowed us to chart different land use systems and land use intensities and permitted us to delineate changes in these land use systems based on changes of external claims on these landscapes. The underlying idea behindthe landscape mosaics is to use land cover data typically derived from remote sensing data and to analyse and classify spatial patterns of this land cover data using a moving window approach. We developed the landscape mosaics approach in tropical, forest dominated landscapesparticularly shifting cultivation areas and present examples ofour work from northern Laos, eastern Madagascarand Yunnan Province in China.

Ecosystem services, biodiversity and environmental change in a tropical mountain ecosystem of south Ecuador

An interdisciplinary research unit consisting of 30 teams in the natural, economic and social sciences analyzed biodiversity and ecosystem services of a mountain rainforest ecosystem in the hotspot of the tropical Andes, with special reference to past, current and future environmental changes. The group assessed ecosystem services using data from ecological field and scenario-driven model experiments, and with the help of comparative field surveys of the natural forest and its anthropogenic replacement system for agriculture. The book offers insights into the impacts of environmental change on various service categories mentioned in the Millennium Ecosystem Assessment (2005): cultural, regulating, supporting and provisioning ecosystem services. Examples focus on biodiversity of plants and animals including trophic networks, and abiotic/biotic parameters such as soils, regional climate, water, nutrient and sediment cycles. The types of threats considered include land use and climate changes, as well as atmospheric fertilization. In terms of regulating and provisioning services, the emphasis is primarily on water regulation and supply as well as climate regulation and carbon sequestration. With regard to provisioning services, the synthesis of the book provides science-based recommendations for a sustainable land use portfolio including several options such as forestry, pasture management and the practices of indigenous peoples. In closing, the authors show how they integrated the local society by pursuing capacity building in compliance with the CBD-ABS (Convention on Biological Diversity - Access and Benefit Sharing), in the form of education and knowledge transfer for application.

Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

INTRODUCTION HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. METHODS Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. RESULTS Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services - nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) - were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services. CONCLUSIONS This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care.