A qualitative study on the role of cultural background in patients perspectives on rehabilitation

Background Low back pain (LBP) is one of the major concerns in health care. In Switzerland, musculoskeletal problems represent the third largest illness group with 9.4 million consultations per year. The return to work rate is increased by an active treatment program and saves societal costs. However, results after rehabilitation are generally poorer in patients with a Southeast European cultural background than in other patients. This qualitative research about the rehabilitation of patients with LBP and a Southeast European cultural background, therefore, explores possible barriers to successful rehabilitation. Methods We used a triangulation of methods combining three qualitative methods of data collection: 13 semi-structured in-depth interviews with patients who have a Southeast European cultural background and live in Switzerland, five semi-structured in-depth interviews and two focus groups with health professionals, and a literature review. Between June and December 2008, we recruited participants at a Rehabilitation Centre in the German-speaking part of Switzerland. Results To cope with pain, patients prefer passive strategies, which are not in line with recommended coping strategies. Moreover, the families of patients tend to support passive behaviour and reduce the autonomy of patients. Health professionals and researchers propagate active strategies including activity in the presence of pain, yet patients do not consider psychological factors contributing to LBP. The views of physicians and health professionals are in line with research evidence demonstrating the importance of psychosocial factors for LBP. Treatment goals focusing on increasing daily activities and return to work are not well understood by patients partly due to communication problems, which is something that patients and health professionals are aware of. Additional barriers to returning to work are caused by poor job satisfaction and other work-related factors. Conclusions LBP rehabilitation can be improved by addressing the following points. Early management of LBP should be activity-centred instead of pain-centred. It is mandatory to implement return to work management early, including return to adapted work, to improve rehabilitation for patients. Rehabilitation has to start when patients have been off work for three months. Using interpreters more frequently would improve communication between health professionals and patients, and reduce misunderstandings about treatment procedures. Special emphasis must be put on the process of goal-formulation by spending more time with patients in order to identify barriers to goal attainment. Information on the return to work process should also include the financial aspects of unemployment and disability.

Effects of Silvicultural Practices on Soil Carbon and Nitrogen in a Nitrogen Saturated Central Appalachian (USA) Hardwood Forest Ecosystem

Silvicultural treatments represent disturbances to forest ecosystems often resulting in transient increases in net nitrification and leaching of nitrate and base cations from the soil. Response of soil carbon (C) is more complex, decreasing from enhanced soil respiration and increasing from enhanced postharvest inputs of detritus. Because nitrogen (N) saturation can have similar effects on cation mobility, timber harvesting in N-saturated forests may contribute to a decline in both soil C and base cation fertility, decreasing tree growth. Although studies have addressed effects of either forest harvesting or N saturation separately, few data exist on their combined effects. Our study examined the responses of soil C and N to several commercially used silvicultural treatments within the Fernow Experimental Forest, West Virginia, USA, a site with N-saturated soils. Soil analyses included soil organic matter (SOM), C, N, C/N ratios, pH, and net nitrification. We hypothesized the following gradient of disturbance intensity among silvicultural practices (from most to least intense): even-age with intensive harvesting (EA-I), even-age with extensive harvesting, even-age with commercial harvesting, diameter limit, and single-tree harvesting (ST). We anticipated that effects on soil C and N would be greatest for EA-I and least with ST. Tree species exhibited a response to the gradient of disturbance intensity, with early successional species more predominant in high-intensity treatments and late successional species more predominant in low-intensity treatments. Results for soil variables, however, generally did not support our predictions, with few significant differences among treatments and between treatments and their paired controls for any of the measured soil variables. Multiple regression indicated that the best predictors for net nitrification among samples were SOM (positive relationship) and pH (negative relationship). This finding confirms the challenge of sustainable management of N-saturated forests.

The Increasing Importance of Administrative Practices in the Shaping of the Welfare State

Dans cet article, nous analysons les changements de l' Etat-providence suédois a l' exemple des services municipaux de soins pour personnes agées. On montre qu'il est possible de tracer des processus de transformation à trois niveaux. Analysées comme phénomènes complèmentaires cela montre à quelle envergure les pratiques administratives sont devenues le lieu primordial de la mise en forme de l' Etat-providence. L'incorporation du managérialisme, comme mode prévalent de gouvernance et d'organisation de services et des politiques sociales mène a la conclusion qu'on devient temoin d'une transformation d' un regime (d Etat-providence) moral et politique à un regime administratif. Dans le dernier paragraphe, nous argumentons que cette transformation affaiblit la citoyenneté sociale et transfère les valeurs et principes de la politique sociale a la sphère administrative. Nous argumentons dès lors que cette perspective analytique a des implications plus larges pour la charactérization des “Welfare regimes” et pour l'analyse des différences transnationales.

Phylogeny and prediction of genetic similarity of Cronobacter and related taxa by multilocus sequence analysis (MLSA)

Multilocus sequence analysis (MLSA) based on recN, rpoA and thdF genes was done on more than 30 species of the family Enterobacteriaceae with a focus on Cronobacter and the related genus Enterobacter. The sequences provide valuable data for phylogenetic, taxonomic and diagnostic purposes. Phylogenetic analysis showed that the genus Cronobacter forms a homogenous cluster related to recently described species of Enterobacter, but distant to other species of this genus. Combining sequence information on all three genes is highly representative for the species' %GC-content used as taxonomic marker. Sequence similarity of the three genes and even of recN alone can be used to extrapolate genetic similarities between species of Enterobacteriaceae. Finally, the rpoA gene sequence, which is the easiest one to determine, provides a powerful diagnostic tool to identify and differentiate species of this family. The comparative analysis gives important insights into the phylogeny and genetic relatedness of the family Enterobacteriaceae and will serve as a basis for further studies and clarifications on the taxonomy of this large and heterogeneous family.

Social inequality and smoking in young Swiss men: intergenerational transmission of cultural capital and health orientation

OBJECTIVES Smoking is related to income and education and contributes to social inequality in morbidity and mortality. Socialisation theories focus on one's family of origin as regards acquisition of norms, attitudes and behaviours. Aim of this study is to assess associations of daily smoking with health orientation and academic track in young Swiss men. Further, to assess associations of health orientation and academic track with family healthy lifestyle, parents' cultural capital, and parents' economic capital. METHODS Cross-sectional data were collected during recruitment for compulsory military service in Switzerland during 2010 and 2011. A structural equation model was fitted to a sample of 18- to 25-year-old Swiss men (N = 10,546). RESULTS Smoking in young adults was negatively associated with academic track and health orientation. Smoking was negatively associated with parents' cultural capital through academic track. Smoking was negatively associated with health orientation which in turn was positively associated with a healthy lifestyle in the family of origin. CONCLUSIONS Results suggest two different mechanisms of intergenerational transmissions: first, the family transmission path of health-related dispositions, and secondly, the structural transmission path of educational inequality.

The Protection and Promotion of Cultural Diversity at the International Level

The Convention on the Protection and Promotion of the Diversity of Cultural Expressions, adopted under the auspices of the United Nations Educational, Cultural and Scientific Organization (UNESCO) in 2005, entered into force on 18 March 2007 after an incredibly swift ratification process. The Convention is the culmination of multiple-track efforts that spread over many years with the objective of providing a binding instrument for the protection and promotion of cultural diversity at the international level. These efforts, admirable as they may be, are not however isolated undertakings of goodwill, but a reaction to economic globalisation, whose advancement has been significantly furthered by the emergence of enforceable multilateral trade rules. These very rules, whose bearer is the World Trade Organization (WTO), have been perceived as the antipode to "culture" and have commanded the formulation of counteracting norms that may sufficiently "protect" and "promote" it. Against this backdrop of institutional tension and fragmentation, the present chapter explicates the emergence of the concept of cultural diversity on the international policy- and law-making scene and its legal dimensions given by the new UNESCO Convention. It critically analyses the Convention's provisions, in particular the rights and obligations of the State Parties, and asks whether indeed the UNESCO Convention provides a sufficient and appropriate basis for the protection and promotion of a thriving and diverse cultural environment.

Trade versus Culture : The Policy of Cultural Exception and the World Trade Organization

This chapter is a contribution to the Palgrave Handbook of European Media Policy (co-edited by Pauwels, Donders & Loisen). It is the chapter’s purpose to examine the proponents of the cultural exception policy, their strategies and demands, and to explore how they came to be reflected in the law and policy of the World Trade Organization (WTO). The chapter also looks at the current state of affairs, as although WTO law has not undergone any substantial amendments since its entry into force in 1995, the media landscape has in the meantime been truly transformed, in some aspects in a revolutionary manner. The broader picture of global governance has not remained still either, with new and emergent powers, changing mechanisms of rule-making and taking.

The Protection and Promotion of Cultural Diversity in a Digital Networked Environment : Mapping Possible Advances to Coherence

The present paper is the result of a four-year-long project examining the concept and the policies of cultural diversity and the impact of digital media upon the regulatory environment where the goal of cultural diversity is to be achieved. The focus of the project was primarily on the international level and in particular on the World Trade Organization (WTO) and the United Nations Educational Scientific and Cultural Organization (UNESCO), which also epitomise the often framed as opposing pair of trade and culture. In the broad context of the project, we sought to pinpoint the essential elements of an international trade-and-culture conducive framework that can also overcome the existing fragmentation in the field of international law and move towards more coherent solutions. In a narrower context, we sketched some possible improvements to the WTO law that can make it more suitable to the digital networked environment and to the objective of diverse media that some states aspire. . Our key messages are: (1) Neither the WTO nor UNESCO currently offers appropriate solutions to the trade and culture predicament and allows for efficient protection and promotion of cultural diversity; (2) The trade and culture discourse is overly politicised and due to the related path dependencies, a number of feasible solutions appears presently blocked; (3) The digital networked environment has profoundly changed the ways cultural content is created, distributed, accessed and consumed, and may thus offer good reasons to reassess and readjust the present models of governance; (4) Access to information appears to be the most appropriate focus of the discussions with view to protecting and promoting cultural diversity in the new digital media setting, both in local and global contexts; (5) This new focal point demands also broadening and interconnecting the policy discussions, which should go beyond the narrow scope of audiovisual media services, but cautiously account for the developments at the network and applications levels, as well as in other domains, such as most notably intellectual property rights protection; (6) There are various ways in which the WTO can be made more conducive to cultural policy considerations and these include, among others, improved and updated services classifications; enhanced legal certainty with regard to digitally transferred goods and services; incorporation of rules on subsidies for services and on competition.

Book Review: Protection of Cultural Diversity from a European and International Perspective

A review of the volume of collected essays edited by Hildegard Schneider and Peter van den Bossche (Intersentia 2008), which looks at diverse implications of the recently adopted UNESCO Convention on Cultural Diversity and discusses these from European and international law perspectives.

Advancing the Goals of the 2005 UNESCO Convention on the Diversity of Cultural Expressions in the Fields of Education, Participation of Civil Society and Sustainable Development

This is a contribution to an expert opinion to be submitted to Intergovernmental Committee of the UNESCO Convention on Cultural Diversity. It seeks to identify recommendations for action in the fields of education, participation of the civil society and sustainable development (under respectively Articles 10, 11 and 13 of the Convention), which are to be specifically targeted taking into account the changed and changing conditions of the digital networked environment.