The Great Recession and its Impact on Families

In 2009, Clark University was accepted as the university to represent Massachusetts in the National Policy Institute for Family Impact Seminars at the University of Wisconsin – Madison (http://familyimpactseminars.org). Family Impact Seminars are a series of annual seminars, briefing reports, and discussion sessions that provide up-to-date, solution-oriented research on current issues for state legislators, legislative staff, and executive branch personnel. The seminars provide objective, nonpartisan research on current issues and do not lobby for particular policies. Seminar participants discuss policy options and identify common ground where it exists.

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.

Patients motives for choosing a physician: Comparison between conventional and complementary medicine in Swiss primary care

Background The study is part of a nationwide evaluation of complementary and alternative medicine (CAM) in primary care in Switzerland. The Objective was to identify patients' expectations and reasons governing the choice of complementary medicine compared with conventional primary care (CONV). Methods The data were derived from the PEK study (Programm Evaluation Komplementärmedizin), which was conducted in 2002–2003 with 7879 adult patients and parents of 1291 underage patients, seeking either complementary (CAM) or conventional (CONV) primary care. The study was performed as a cross-sectional survey. The respondents were asked to document their (or their children's) self-perceived health status, reasons governing their choice, and treatment expectations. Physicians were practicing conventional medicine and/or complementary methods (homeopathy, anthroposophic medicine, neural therapy, and traditional Chinese medicine). Reasons governing the choice of physician were evaluated on the basis of a three-part classification (physician-related, procedure-related, and pragmatic/other reasons) Results and Discussion Patients seeing CAM physicians tend to be younger and more often female. CAM patients referred to procedure-related reasons more frequently, whereas pragmatic reasons dominated among CONV patients. CAM respondents expected fewer adverse side effects compared to conventional care patients. Conclusion The majority of alternative medicine users appear to have chosen CAM mainly because they wish to undergo a certain procedure; additional reasons include desire for more comprehensive treatment, and expectation of fewer side-effects.

Provenance discrimination of Lower Cretaceous synrift sandstones (eastern Iberian Chain Spain) Constraints from detrital modes heavy minerals and geochemistry

Petrography, geochemical whole-rock composition, and chemical analyses of tourmaline were performed in order to determine the source areas of Lower Cretaceous Mora, El Castellar, and uppermost Camarillas Formation sandstones from the Iberian Chain, Spain. Sandstones were deposited in intraplate subbasins, which are bound by plutonic and volcanic rocks of Permian, Triassic, and Jurassic age, Paleozoic metamorphic rocks, and Triassic sedimentary rocks. Modal analyses together with petrographic and cathodoluminescence observations allowed us to define three quartz-feldspathic petrofacies and recognize diagenetic processes that modified the original framework composition. Results from average restored petrofacies are: Mora petrofacies = P/F >1 and Q(r)70 F(r)22 R(r)9; El Castellar petrofacies = P/F >1 and Q(r)57 F(r)25 R(r)18; and Camarillas petrofacies = P/F ∼ zero and Q(r)64 F(r)28 R(r)7 (P—plagioclase; F—feldspar; Q—quartz; R—rock fragments; r—restored composition). Trace-element and rare earth element abundances of whole-rock analyses discriminate well between the three petrofacies based on: (1) the Rb concentration, which is indicative of the K content and reflects the amount of K-feldspar modal abundance, and (2) the relative modal abundance of heavy minerals (tourmaline, zircon, titanite, and apatite), which is reproduced by the elements hosted in the observed heavy mineral assemblage (i.e., B and Li for tourmaline; Zr, Hf, and Ta for zircon; Ti, Ta, Nb, and their rare earth elements for titanite; and P, Y, and their rare earth elements for apatite). Tourmaline chemical composition for the three petrofacies ranges from Fe-tourmaline of granitic to Mg-tourmaline of metamorphic origin. The three defined petrofacies suggest a mixed provenance from plutonic and metamorphic source rocks. However, a progressively major influence of granitic source rocks was detected from the lowermost Mora petrofacies toward the uppermost Camarillas petrofacies. This provenance trend is consistent with the uplift and erosion of the Iberian Massif, which coincided with the development of the latest Berriasian synrift regional unconformity and affected all of the Iberian intraplate basins. The uplifting stage of Iberian Massif pluton caused a significant dilution of Paleozoic metamorphic source areas, which were dominant during the sedimentation of the lowermost Mora and El Castellar petrofacies. The association of petrographic data with whole-rock geochemical compositions and tourmaline chemical analysis has proved to be useful for determining source area characteristics, their predominance, and the evolution of source rock types during the deposition of quartz-feldspathic sandstones in intraplate basins. This approach ensures that provenance interpretation is consistent with the geological context.

Gene and stem cell therapy in peripheral arterial occlusive disease

Peripheral arterial occlusive disease (PAOD) is a manifestation of systemic atherosclerosis strongly associated with a high risk of cardiovascular morbidity and mortality. In a considerable proportion of patients with PAOD, revascularization either by endovascular means or by open surgery combined with best possible risk factor modification does not achieve limb salvage or relief of ischaemic rest pain. As a consequence, novel therapeutic strategies have been developed over the last two decades aiming to promote neovascularization and remodelling of collaterals. Gene and stem cell therapy are the main directions for clinical investigation concepts. For both, preclinical studies have shown promising results using a wide variety of genes encoding for growth factors and populations of adult stem cells, respectively. As a consequence, clinical trials have been performed applying gene and stem cell-based concepts. However, it has become apparent that a straightforward translation into humans is not possible. While several trials reported relief of symptoms and functional improvement, other trials did not confirm this early promise of efficacy. Ongoing clinical trials with an improved study design are needed to confirm the potential that gene and cell therapy may have and to prevent the gaps in our scientific knowledge that will jeopardize the establishment of angiogenic therapy as an additional medical treatment of PAOD. This review summarizes the experimental background and presents the current status of clinical applications and future perspectives of the therapeutic use of gene and cell therapy strategies for PAOD.

Diagnosis and treatment of peripartum bleeding

Severe peripartum hemorrhage (PPH) contributes to maternal morbidity and mortality and is one of the most frequent emergencies in obstetrics, occurring at a prevalence of 0.5-5.0%. Detection of antepartum risk factors is essential in order to implement preventive measures. Proper training of obstetric staff and publication of recommendations and guidelines can effectively reduce the frequency of PPH and its resulting morbidity and mortality. Therefore, an interdisciplinary expert committee was formed, with members from Germany, Austria, and Switzerland, to summarize recent scientific findings. An up-to-date presentation of the importance of embolization and of the diagnosis of coagulopathy in PPH is provided. Furthermore, the committee recommends changes in the management of PPH including new surgical options and the off-label use of recombinant factor VIIa.

Position, professional expertise and functions of an educator of child care homes in Lithuania

Speaking about professionals, working with children at child care homes in Lithuania, first of all we encounter a problem of terminology. This problem rises, because in various countries and languages we call these professionals differently. In Lithuania we call them ”aukletojai”. We also use the word ”aukletojas” when speaking about both professionals, working directly with children at kindergartens, and parents, as all parents are educators of their children. We suppose, that the word ”aukletojas” corresponds to the German “erzieher”, and “aukleti” to “erziehen”. Every “aukletojas” in Lithuania clearly realizes, that he is a pedagogue, because in this country every professional, involved in educational work with children – an ”aukletojas”, a teacher, a social pedagogue and a special pedagogue – is called a pedagogue. In this context it is essential to conceive that in Lithuania an ”educator” and a ”social pedagogue” are different pedagogical professions and that none of the ”aukletojas” identify himself as a social pedagogue.