Complementary and conventional medicine in Switzerland: comparing characteristics of general practitioners

OBJECTIVES: Do structural characteristics of general practitioners (GPs) who practice complementary medicine (CAM) differ from those GPs who do not? Assessed characteristics included experience and professional integration of general practitioners (GPs), workload, medical activities, and personal and technical resources of practices. The investigated CAM disciplines were anthroposophic medicine, homoeopathy, traditional Chinese medicine, neural therapy and herbal medicine. MATERIAL AND METHODS: We designed a cross-sectional study with convenience and stratified samples of GPs providing conventional (COM) and/or complementary primary care in Switzerland. The samples were taken from the database of the Swiss medical association (FMH) and from CAM societies. Data were collected using a postal questionnaire. RESULTS: Of the 650 practitioners who were included in the study, 191 were COM, 167 noncertified CAM and 292 certified CAM physicians. The proportion of females was higher in the population of CAM physicians. Gender-adjusted age did not differ between CAM and COM physicians. Nearly twice as many CAM physicians work part-time. Differences were also seen for the majority of structural characteristics such as qualification of physicians, type of practice, type of staff, and presence of technical equipment. CONCLUSION: The study results show that structural characteristics of primary health care do differ between CAM and COM practitioners. We assumed that the activities of GPs are defined essentially by analyzed structures. The results are to be considered for evaluations in primary health care, particularly when quality of health care is assessed.

Effectiveness, safety and cost-effectiveness of homeopathy in general practice - summarized health technology assessment

Introduction: The Health Technology Assessment report on effectiveness, cost-effectiveness and appropriateness of homeopathy was compiled on behalf of the Swiss Federal Office for Public Health (BAG) within the framework of the 'Program of Evaluation of Complementary Medicine (PEK)'. Materials and Methods: Databases accessible by Internet were systematically searched, complemented by manual search and contacts with experts, and evaluated according to internal and external validity criteria. Results: Many high-quality investigations of pre-clinical basic research proved homeopathic high-potencies inducing regulative and specific changes in cells or living organisms. 20 of 22 systematic reviews detected at least a trend in favor of homeopathy. In our estimation 5 studies yielded results indicating clear evidence for homeopathic therapy. The evaluation of 29 studies in the domain 'Upper Respiratory Tract Infections/Allergic Reactions' showed a positive overall result in favor of homeopathy. 6 out of 7 controlled studies were at least equivalent to conventional medical interventions. 8 out of 16 placebocontrolled studies were significant in favor of homeopathy. Swiss regulations grant a high degree of safety due to product and training requirements for homeopathic physicians. Applied properly, classical homeopathy has few side-effects and the use of high-potencies is free of toxic effects. A general health-economic statement about homeopathy cannot be made from the available data. Conclusion: Taking internal and external validity criteria into account, effectiveness of homeopathy can be supported by clinical evidence and professional and adequate application be regarded as safe. Reliable statements of cost-effectiveness are not available at the moment. External and model validity will have to be taken more strongly into consideration in future studies.

Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth

Crown fractures and luxations occur most frequently of all dental injuries. An appropriate treatment plan after an injury is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence, based on literature research and professional opinion. In this first article of three, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

"Death may come on like a stroke of lightening ..." : Phenomenological and morphological aspects of fatalities caused by manure gas

Due to the decomposition of biological material, hydrogen sulphide (H(2)S) is produced. In low concentrations, the well-known smell of "rotten eggs" is associated with H(2)S. In higher concentrations, H(2)S is an odourless and colourless gas that may cause rapid loss of consciousness, neurological and respiratory depression and imminent death-"... like a stroke of lightening". Hydrogen sulphide poisoning is an un-common incident that is often associated with colleague fatalities. In this study, 4 fatal accidents with 10 deceased victims are reported and the morphological and phenomenological aspects are presented. In these cases, the morphological findings, namely, discolouration of the livores, pulmonary pathologies and sub-mucosal or sub-serosal congestion bleeding were found in nearly all cases. Also the impending threat for colleagues, first aid helpers and professional rescue teams is demonstrated. The suspicion of a fatal H(2)S intoxication should be based on a precise scene analysis with respect to the possibility of life-threatening H(2)S intoxication for the helpers, the typical scent of rotten eggs, which may be noted on the corpses and the abovementioned morphological findings. The diagnosis should be confirmed by a qualitative and, if possible, quantitative analysis of H(2)S.

Early loading of sandblasted and acid-etched implants: a randomized-controlled double-blind split-mouth study. Five-year results

OBJECTIVES: The aim of the present split-mouth study is to assess the peri-implant conditions around early-loaded sandblasted and acid-etched (SLA) implants, 5 years after abutment connection and to compare, in the same patients, the results obtained with a standard protocol using identical implants with a TPS surface. MATERIAL AND METHODS: Surgical procedure was performed by the same operator and was identical at test (SLA) and control (TPS) sites, in 32 healthy patients. Abutment connection was carried out at 35 N cm 6 weeks postsurgery for test sites and 12 weeks for the controls. Patients were seen regularly, for control and professional cleaning. At 60 months, clinical measures and radiographic bone changes were recorded by the same operator, blind to the type of surface of the implant, on 27 patients, as five patients were lost to follow-up. RESULTS: A total number of 106 implants were examined. No implant was lost. No significant differences were found with respect to the presence of plaque [modified plaque index (mPI) 0.27+/-0.56 vs. 0.32+/-0.54], bleeding on probing (29% vs. 32%), mean pocket depth (3.2+/-1 vs. 3.2+/-1 mm) or mean marginal bone loss (0.32+/-1.04 vs. 0.44+/-1.12 mm) between test and control. Four implants that presented 'spinning' at the time of abutment connection presented no significant differences from the rest of the test sites. CONCLUSION: The results of this prospective study confirm that SLA implants, under defined conditions, are suitable for early loading at 6 weeks in both the mandible and the maxilla. Limited implant spinning, occasionally found at abutment connection, produces no detrimental effect on the clinical outcome when properly handled.

Preparing writing centers and tutors for literacy mediation for working class campus-staff

Writing centers work with writers; traditionally services have been focused on undergraduates taking composition classes. More recently, centers have started to attract a wider client base including: students taking labs that require writing; graduate students; and ESL students learning the conventions of U.S. communication. There are very few centers, however, which identify themselves as open to working with all members of the campus-community. Michigan Technological University has one such center. In the Michigan Tech writing center, doors are open to “all students, faculty and staff.” While graduate students, post docs, and professors preparing articles for publication have used the center, for the first time in the collective memory of the center UAW staff members requested center appointments in the summer of 2008. These working class employees were in the process of filling out a work related document, the UAW Position Audit, an approximately seven-page form. This form was their one avenue for requesting a review of the job they were doing; the review was the first step in requesting a raise in job level and pay. This study grew out of the realization that implicit literacy expectations between working class United Auto Workers (UAW) staff and professional class staff were complicating the filling out and filing of the position audit form. Professional class supervisors had designed the form as a measure of fairness, in that each UAW employee on campus was responding to the same set of questions about their work. However, the implicit literacy expectations of supervisors were different from those of many of the employees who were to fill out the form. As a result, questions that were meant to be straightforward to answer were in the eyes of the employees filling out the form, complex. Before coming to the writing center UAW staff had spent months writing out responses to the form; they expressed concerns that their responses still would not meet audience expectations. These writers recognized that they did not yet know exactly what the audience was expecting. The results of this study include a framework for planning writing center sessions that facilitate the acquisition of literacy practices which are new to the user. One important realization from this dissertation is that the social nature of literacy must be kept in the forefront when both planning sessions and when educating tutors to lead these sessions. Literacy scholars such as James Paul Gee, Brian Street, and Shirley Brice Heath are used to show that a person can only know those literacy practices that they have previously acquired. In order to acquire new literacy practices, a person must have social opportunities for hands-on practice and mentoring from someone with experience. The writing center can adapt theory and practices from this dissertation that will facilitate sessions for a range of writers wishing to learn “new” literacy practices. This study also calls for specific changes to writing center tutor education.

Interrogating the spaces of personal photography : women, identity, and the cultural formation of photographic practice

Personal photographs permeate our lives from the moment we are born as they define who we are within our familial group and local communities. Archived in family albums or framed on living room walls, they continue on after our death as mnemonic artifacts referencing our gendered, raced, and ethnic identities. This dissertation examines salient instances of what women “do” with personal photographs, not only as authors and subjects but also as collectors, archivists, and family and cultural historians. This project seeks to contribute to more productive, complex discourse about how women form relationships and engage with the conventions and practices of personal photography. In the first part of this dissertation I revisit developments in the history of personal photography, including the advertising campaigns of the Kodak and Agfa Girls and the development of albums such as the Stammbuch and its predecessor, the carte-de-visite, that demonstrate how personal photography has functioned as a gendered activity that references family unity, sentimentalism for the past, and self-representation within normative familial and dominant cultural groups, thus suggesting its importance as a cultural practice of identity formation. The second and primary section of the dissertation expands on the critical analyses of Gillian Rose, Patricia Holland, and Nancy Martha West, who propose that personal photography, marketed to and taken on by women, double-exposes their gendered identities. Drawing on work by critics such as Deborah Willis, bell hooks, and Abigail Solomon-Godeau, I examine how the reconfiguration, recontextualization, and relocation of personal photographs in the respective work of Christine Saari, Fern Logan, and Katie Knight interrogates and complicates gendered, raced, and ethnic identities and cultural attitudes about them. In the final section of the dissertation I briefly examine select examples of how emerging digital spaces on the Internet function as a site for personal photography, one that both reinscribes traditional cultural formations while offering new opportunities for women for the display and audiencing of identities outside the family.

Federal and state policy influence on woody biomass utilization

A considerable portion of public lands in the United States is at risk of uncharacteristically severe wildfires due to a history of fire suppression. Wildfires already have detrimental impacts on the landscape and on communities in the wildland-urban interface (WUI) due to unnatural and overstocked forests. Strategies to mitigate wildfire risk include mechanical thinning and prescribed burning in areas with high wildfire risk. The material removed is often of little or no economic value. Woody biomass utilization (WBU) could offset the costs of hazardous fuel treatments if removed material could be used for wood products, heat, or electricity production. However, barriers due to transportation costs, removal costs, and physical constraints (such as steep slopes) hinder woody biomass utilization. Various federal and state policies attempt to overcome these barriers. WBU has the potential to aid in wildfire mitigation and meet growing state mandates for renewable energy. This research utilizes interview data from individuals involved with on-the-ground woody biomass removal and utilization to determine how federal and state policies influence woody biomass utilization. Results suggest that there is not one over-arching policy that hinders or promotes woody biomass utilization, but rather woody biomass utilization is hindered by organizational constraints related to time, cost, and quality of land management agencies’ actions. However, the use of stewardship contracting (a hybrid timber sale and service contract) shows promise for increased WBU, especially in states with favorable tax policies and renewable energy mandates. Policy recommendations to promote WBU include renewal of stewardship contracting legislations and a re-evaluation of land cover types suited for WBU. Potential future policies to consider include the indirect role of carbon dioxide emission reduction activities to promote wood energy and future impacts of air quality regulations.

INTERACTIVE CONTROLS OF WATER TABLE POSITION AND PLANT FUNCTIONAL TYPES ON PEAT POREWATER CHARACTER IN NORTHERN BOG ECOSYSTEMS: IMPLICATIONS FOR CARBON CYCLING DYNAMICS

Northern wetlands, and particularly peatlands, have been shown to store around 30% of the world's soil carbon and thus play a significant role in the carbon cycle of our planet. Changes in climate are altering peatland hydrology and vegetation communities. These changes are possibly resulting in declines in the ability of peatlands to sequester carbon because losses through carbon oxidation and mineralization are likely to increase relative to C inputs from net primary production in a warmer, drier climate. However, the consequences of interactive effects of altered hydrology and vegetation on carbon storage are not well understood. This research evaluated the importance of plant species, water table, and their interactive effects on porewater quality in a northern peatland with an average pH of 4.54, ranging from 4.15 to 4.8. We assessed the effects of plant functional group (ericaceous shrubs, sedges, and bryophytes) and water table position on biogeochemical processes. Specifically, we measured dissolved organic carbon (DOC), total dissolved nitrogen (TDN), potential enzyme activity, organic acids, anions and cations, spectral indexes of aromaticity, and phenolic content. Our results indicate that acetate and propionate concentrations in the sedge-dominated communities declined with depth and water table drawdown, relative to the control and ericaceous treatments. DOC increased in the lowered water table treatments in all vegetation community types, and the peat porewater C:N ratio declined in the sedge-dominated treatments when the water table was lowered. The relationship between DOC and ferrous iron showed significant responses to vegetation type; the exclusion of Ericaceae resulted in less ferrous iron per unit DOC compared to mixed species treatments and Ericaceae alone. This observation was corroborated with higher mean oxidation redox potential profiles (integrating 20, 40, and 70 cm) measured in the sedge treatments, compared with the mixed and Ericaceae species treatments over a growing season. Enzymatic activities did not show as strong of a response to treatments as expected; the oxidative enzyme peroxidase and the hydrolytic enzyme phosphatase were the only enzymes to respond to water table, where the potential activity of both enzymes increased with water table drawdown. Overall, there were significant interactive effects between changes in vegetation and water table position on peat porewater composition. These data suggest that vegetation effects on oxidation reduction potentials and peat porewater character can be as important as water table position in northern bog ecosystems.

EXPLORING CHANGES IN DETRITAL FLOCCULENT LAYER DYNAMICS DUE TO SHIFTS IN MACROPHYTE COMMUNITIES IN THE NORTHERN EVERGLADES

A shift in plant communities of the Water Conservation Areas (WCAs) within the Everglades has been linked to changes in hydrology and high levels of nutrient loading from surrounding agicultural areas. This has resulted in the encroachment of dense cattail stands (Typha domingensis) into areas that had previously been a ridge and slough landscape populated primarily by native sawgrass (Cladium jamaicense). In order to study ecological management solutions in this area, WCA-2A was broken into study plots; several of which became open water areas through the application of herbicide and burning regimens. The open water areas allowed for Chara spp (a submersed algal species) to replace Typha domingensis as the dominant macrophyte. This study investigated the polymer and ionic profiles of Chara spp, Typha domingensis and Cladium jamaicense and their contributions to detrital flocculent (floc) in the study plots where they are the dominant macrophytes. Floc is not only an important food source for aquatic species; it also supports many algal, fungal and bacterial communities. Data gathered in this study indicated that the floc sample from a phosphorus enriched open water study plot (EO1) where Chara spp was the dominant macrophyte may contain cell wall polymers from sources other than Chara spp (most likely Typha domingensis), while the chemical and polymeric profile of the floc of the study plot where Typha domingensis is the dominant macrophyte (EC1) suggests that the floc layer has contributions from algal sources as well as Typha domingensis. Additionally, monoclonal antibodies to Arabinoglalactan protein (AGP) and (1,4)-β-D galactan were identified as possible biomarkers for distinguishing algal dominated floc layers from layers dominated by emergent vegetation. Calcium labeling could be a useful tool for this as well because of the high amount of Ca2+ associated with Chara spp cell walls. When looking into the soluble phosphorus content of the macrophytes and paired floc samples of WCA-2A, it was found that Chara spp may be contributing a greater amount of Ca-bound phosphorus to floc layers where it is the dominant macrophyte when compared to floc layers from study plots dominated by emergent macrophytes. Floc layers also appear to be acting as a nutrient sink for soluble phosphorus. The findings of this study support the overall hypothesis that the shift from native emergent macrophyte communities to submersed macrophyte communities in study sites of the northern Everglades is affecting the polymeric/chemical profile and ionic content of detrital floc layers. The effects of this shift may contribute to changes in complex flocculent community dynamics.

The James Lind Library: explaining and illustrating the evolution of fair tests of medical treatments

The James Lind Library (www.jameslindlibrary.org) has been established to improve public and professional general knowledge about fair tests of treatments in healthcare and their history. Its foundation was laid ten years ago at the Royal College of Physicians of Edinburgh, and its administrative centre is in the College's Sibbald Library, one of the most important collections of historic medical manuscripts, papers and books in the world. The James Lind Library is a website that introduces visitors to the principles of fair tests of treatments, with a series of short, illustrated essays, which are currently available in English, Arabic, Chinese, French, Portuguese, Russian and Spanish. A 100-page book-- Testing Treatments--is now available free through the website, both in English and in Arabic and Spanish translations. To illustrate the evolution of ideas related to fair tests of treatments from 2000 BC to the present, the James Lind Library contains key passages and images from manuscripts, books and journal articles, many of them accompanied by commentaries, biographies, portraits and other relevant documents and images, including audio and video files. New material is being added to the website continuously, as relevant new records are identified and as methods for testing treatments evolve. A multinational, multilingual editorial team oversees the development of the website, which currently receives tens of thousands of visitors every month.

Lifestyle and stroke risk: a review

PURPOSE OF REVIEW: In recent years, many epidemiological studies have given new insights into old and new lifestyle factors that influence the risk of cerebrovascular events. In this review, we refer to the most important articles to highlight recent advances, especially those important for stroke prevention. RECENT FINDINGS: This review focuses on the most recent studies that show the association of environmental factors, nutrition, alcohol, tobacco, education, lifestyle and behavior with the risk of vascular disease, including ischemic stroke and cerebral hemorrhage. The link between air pollution and stroke risk has become evident. Low education levels and depression are established as risk factors. This is also true for heavy alcohol consumption, although moderate drinking may be protective. Active and passive smoking are independent risk factors, and a smoking ban in public places has already reduced cardiovascular events in the short term. Physical activity reduces stroke risk; overweight increases it. However, clinical trials to assess the effect of weight reduction on stroke risk are still lacking. Fruits, vegetables, fish, fibers, low-fat dairy products, potassium and low sodium consumption are known and recommended to reduce cardiovascular risk. Data on omega 3 fatty acid, folic acid and B vitamins are inconsistent, and antioxidants are not recommended. SUMMARY: Stroke can be substantially reduced by an active lifestyle, cessation of smoking and a healthy diet. Both public and professional education should promote the awareness that a healthy lifestyle and nutrition have the potential to reduce the burden of stroke.

Analyzing online communication from a social network point of view: questions, problems, perspectives

This programmatic paper investigates the possibilities, chances, and risks of analyzing personal and professional online communication from the point of view of interactional sociolinguistics combined with modern social network analysis (SNA). Thus, it has two complementing goals: One is the exploration of adequate, innovative concepts and methods for analyzing online communication, the other is to use online communication and its ontological and functional specificities to enrich the conceptual and methodological background of SNA. The paper is organized in two parts. It begins with an introduction to recent developments in sociolinguistic social network analysis. Here, three interesting new concepts and tools are discussed: latent versus emergent networks (Watts 1991), coalitions (Fitzmaurice 2000a, Fitzmaurice 2000b), and communities of practice (Wenger 1998

Access for All? The promise and problems of universalism.

In what follows, I explore why the question of ‘access for all’ is both important and difficult. Beginning by treating it as a contested claim, I will consider some of its political, institutional and professional implications. What do I mean by saying that access for all is a contested claim? First of all, it is a claim – a demand that access for all needs to be created. It is a claim about change. To demand ‘access for all’ is to speak about, and speak against, social conditions that are unjust, unequal or excluding. At its simplest, then, to claim ‘access for all’ is to address social arrangements in which all people do not have access. Secondly, it is a claim made by – or on behalf of – specific social groups against their experience of exclusion, marginalization or subordination. I have added these other terms because I think that ‘exclusion’ is too simple, and too problematic, a term to capture all the aspects of unjust social arrangements that produce claims for ‘access’.1 Access is a demand to be treated equitably in relation to a range of valued social resources, conditions and relationships. It is a claim to be a member: of the society, the polity or the nation. It is a claim to be a citizen: to possess rights and the capacity to make legitimate demands on the state. It is a claim on the apparatuses and agencies that sustain social citizenship: citizenship brings with it access to benefits, services and rights of ‘fair dealing’ or ‘fair treatment’. As this last point suggests, it is a claim about equality: the expectation that all citizens will be dealt with by public agencies in ways that are not discriminatory or oppressive.

Women in Prostitution and Social Responsibility

The aim of the paper is to show how prostitution is embedded in historically changing gender relationships regulated by the state and part of each societies understanding of sexuality. An important role to improve the situation of women in prostitution is played by engaged social work, often linked to the womens movement on a local, national and an international level in spite of differing positions on the institution of prostitution. The authors argumentation is based on qualitative and quantitative empirical findings concerning shared experiences as well as differences between women in prostitution and findings on professional possibilities and limits of supporting the women. Important dimensions of heterogeneity amongst the women are legality versus illegality, decision making possibilities respectively dependencies und choice versus force, which also are the base of different political and professional positions taken by experts.