A Research Roadmap for Complementary and Alternative Medicine – What We Need to Know by 2020

Background: The CAMbrella coordination action was funded within the Framework Programme 7. Its aim is to provide a research roadmap for clinical and epidemiological research for complementary and alternative medicine (CAM) that is appropriate for the health needs of European citizens and acceptable to their national research institutes and healthcare providers in both public and private sectors. One major issue in the European research agenda is the demographic change and its impact on health care. Our vision for 2020 is that there is an evidence base that enables European citizens to make informed decisions about CAM, both positive and negative. This roadmap proposes a strategic research agenda for the field of CAM designed to address future European health care challenges. This roadmap is based on the results of CAMbrella’s several work packages, literature reviews and expert discussions including a consensus meeting. Methods: We first conducted a systematic literature review on key issues in clinical and epidemiological research in CAM to identify the general concepts, methods and the strengths and weaknesses of current CAM research. These findings were discussed in a workshop (Castellaro, Italy, September 7–9th 2011) with international CAM experts and strategic and methodological recommendations were defined in order to improve the rigor and relevance of CAM research. These recommendations provide the basis for the research roadmap, which was subsequently discussed in a consensus conference (Järna, Sweden, May 9–11th 2012) with all CAMbrella members and the CAMbrella advisory board. The roadmap was revised after this discussion in CAMbrella Work Package (WP) 7 and finally approved by CAMbrella’s scientific steering committee on September 26th 2012. Results: Our main findings show that CAM is very heterogenous in terms of definitions and legal regulations between the European countries. In addition, citizens’ needs and attitudes towards CAM as well as the use and provision of CAM differ significantly between countries. In terms of research methodology, there was consensus that CAM researchers should make use of all the commonly accepted scientific research methods and employ those with utmost diligence combined in a mixed methods framework. Conclusions: We propose 6 core areas of research that should be investigated to achieve a robust knowledge base and to allow stakeholders to make informed decisions. These are: Research into the prevalence of CAM in Europe: Reviews show that we do not know enough about the circumstances in which CAM is used by Europeans. To enable a common European strategic approach, a clear picture of current use is of the utmost importance. Research into differences regarding citizens’ attitudes and needs towards CAM: Citizens are the driver for CAM utilization. Their needs and views on CAM are a key priority, and their interests must be investigated and addressed in future CAM research. Research into safety of CAM: Safety is a key issue for European citizens. CAM is considered safe, but reliable data is scarce although urgently needed in order to assess the risk and cost-benefit ratio of CAM. Research into the comparative effectiveness of CAM: Everybody needs to know in what situation CAM is a reasonable choice. Therefore, we recommend a clear emphasis on concurrent evaluation of the overall effectiveness of CAM as an additional or alternative treatment strategy in real-world settings. Research into effects of context and meaning: The impact of effects of context and meaning on the outcome of CAM treatments must be investigated; it is likely that they are significant. Research into different models of CAM health care integration: There are different models of CAM being integrated into conventional medicine throughout Europe, each with their respective strengths and limitations. These models should be described and concurrently evaluated; innovative models of CAM provision in health care systems should be one focus for CAM research. We also propose a methodological framework for CAM research. We consider that a framework of mixed methodological approaches is likely to yield the most useful information. In this model, all available research strategies including comparative effectiveness research utilising quantitative and qualitative methods should be considered to enable us to secure the greatest density of knowledge possible. Stakeholders, such as citizens, patients and providers, should be involved in every stage of developing the specific and relevant research questions, study design and the assurance of real-world relevance for the research. Furthermore, structural and sufficient financial support for research into CAM is needed to strengthen CAM research capacity if we wish to understand why it remains so popular within the EU. In order to consider employing CAM as part of the solution to the health care, health creation and self-care challenges we face by 2020, it is vital to obtain a robust picture of CAM use and reliable information about its cost, safety and effectiveness in real-world settings. We need to consider the availability, accessibility and affordability of CAM. We need to engage in research excellence and utilise comparative effectiveness approaches and mixed methods to obtain this data. Our recommendations are both strategic and methodological. They are presented for the consideration of researchers and funders while being designed to answer the important and implicit questions posed by EU citizens currently using CAM in apparently increasing numbers. We propose that the EU actively supports an EUwide strategic approach that facilitates the development of CAM research. This could be achieved in the first instance through funding a European CAM coordinating research office dedicated to foster systematic communication between EU governments, public, charitable and industry funders as well as researchers, citizens and other stakeholders. The aim of this office would be to coordinate research strategy developments and research funding opportunities, as well as to document and disseminate international research activities in this field. With the aim to develop sustainability as second step, a European Centre for CAM should be established that takes over the monitoring and further development of a coordinated research strategy for CAM, as well as it should have funds that can be awarded to foster high quality and robust independent research with a focus on citizens health needs and pan-European collaboration. We wish to establish a solid funding for CAM research to adequately inform health care and health creation decision-making throughout the EU. This centre would ensure that our vision of a common, strategic and scientifically rigorous approach to CAM research becomes our legacy and Europe’s reality. We are confident that our recommendations will serve these essential goals for EU citizens.

The 10-year anniversary of the European Association for Cardiovascular Prevention and Rehabilitation: achievements and challenges

On the occasion of the 2014 European Society of Cardiology annual congress in Barcelona the European Association for Cardiovascular Prevention and Rehabilitation (EACPR) will celebrate its 10-year anniversary, having been initiated in Munich in 2004. In this article each EACPR president gives their personal recollections and views on the main achievements under their leadership and discusses the challenges for preventive cardiology that still lay ahead.

Integrating Islamic Positions into European Public Discourse: The Paradigmatic Example of Tariq Ramadan

As the continuing relevance of religion to secular European societies garners increasing recognition, the question remains of which religious positions may assume a public role, with Islam at the center of many debates. This article complements the ongoing theoretical debate with a detailed case study analyzing the major works of Islamic scholar and public intellectual Tariq Ramadan. I show that in the last two decades Ramadan significantly modified his views on Islam and European societies. I argue that these adjustments were interdependent, and as such paradigmatically illustrate that the integration of Islamic positions into public discourse depends on shifts in the understanding of both concepts.

Europe and Islam: Alarmists, Victimists, and Integration by Law

This article reviews the minefield of Muslim integration in Europe, paying special attention to the legal integration of Islam, which has not yet found the attention that it deserves. In a first step, the article contrasts ‘victimist’ and ‘alarmist’ views on contemporary Muslim integration, both of which are found misleading. Instead, as argued in the second part, significant progress has been made through the legal route. The conclusion provides a reflection on the role of Islam for Europe’s ‘liberal identity’ today.

An assessment of self-concept and violence within a delinquent adolescent population

The purpose of this study was to provide further data on the relationship between self-concept and violence focusing on a delinquent adolescent population. Recent research has explored the relationship between self-concept and violence with most of the research being done with adult populations. Within the literature, there are two opposing views on the question of this relationship. The traditional view supports the idea that low self-esteem is a cause of violent behavior while the non-traditional view supports the idea that high self-esteem may be a contributor to violent behavior. ^ Using a sample of 200 delinquent adolescents 100 of whom had committed acts of violence and 100 who had not, a group comparison study was done which addressed the following questions, (1) within a delinquent population of violent and non-violent adolescents, is there a relationship between violence and self-concept? (2) what is that relationship; (3) using the Piers-Harris Children's Self-Concept Scale, can it be determined that attributes such as behavior, anxiety, popularity, happiness, and physical appearance as they relate to self-concept are more predictive than others in determining who within a delinquent population will commit acts of violence. For the purposes of this study, delinquent adolescents were those who had official records of misconduct with either the school or juvenile authorities. Adolescents classified as violent were those who had committed acts such as assault, use of a weapon, use of deadly force, and sexual assault while adolescents classified as non-violent had committed anti-social acts such as, truancy, talking back and rule breaking. ^ The study concluded that there is a relationship between adolescent violence and self-concept. However, there was insufficient statistical evidence that self-concept is a predictor of violence. ^

An international assessment of the comprehensibility of material safety data sheets (MSDSs)

Material Safety Data Sheets (MSDSs) are an integral component of occupational hazard communication systems. These documents are used to disseminate hazard information to workers on chemical substances. The primary purpose of this study was to investigate the comprehensibility of MSDSs by workers at an international level. ^ A total of 117 employees of a multi-national petrochemical company participated; thirty-nine (39) each in the United States, Canada and the United Kingdom. Overall participation rate of those approached to participate was 82%. These countries were selected as they each utilize one of the three major existing hazard communication systems for fixed workplaces. The systems are comprised of the Occupational Safety and Health Administration's Hazard Communication Standard in the United States, the Workplace Hazardous Materials Information System (WHMIS) in Canada, and the compilation of several European Union directives addressing classification, labeling of substances and preparations, and MSDSs in Europe. ^ A pretest posttest randomized study design was used, with the posttest being comparable to an open book test. The results of this research indicated that only about two-thirds of the information on the MSDSs was comprehended by the workers with a significant difference identified among study participants based on country comparisons. This data was fairly consistent with the results of previous MSDS comprehensibility studies conducted in the United States. There was no significant difference in the comprehension level among study participants when taking into account the international hazard communication standard that the MSDS complied with. Marginally, age, education level and experience level did not have a significant impact on the comprehension level. ^ Participants did find MSDSs to be satisfactory in providing the information needed to protect them regardless of their views on the readability and formatting of MSDSs. The health-related information was the least comprehended as less than half of it was comprehended on the basis of the responses. The findings from this research suggest that there is much work needed yet to make MSDSs more comprehensible on a global basis, particularly regarding health-related information. ^

End -of -life planning and decision -making: Implications for adults with mental retardation

This research focused on the topic of end-of-life planning and decision-making for adults affected by mental retardation. Adults with mental retardation have unique challenges in this regard, including difficulty communicating their wishes without assistance and diminished decision-making skills. The primary research objective was to identify factors that can affect opportunities for adults with mental retardation in community-based services settings (and their advocates) to be involved in planning and deciding about their own end-of-life experience. ^ A descriptive qualitative inquiry was designed to explore issues related to death and dying, and the notion of end-of-life planning, from the perspective of adults with mental retardation who receive publicly-funded community services ("clients") and family members of individuals who receive such services. Study participants were recruited from a single mental retardation service provider in a large urban setting (the "Agency"). Sixteen clients and 14 families of Agency clients took part. Client data collection was accomplished through face-to-face interviews, focus group meetings, and record reviews; family members were involved in a face-to-face interview only. ^ An initial coding scheme was developed based upon literature and policy reviews, and themes related to the research questions. Analysis involved extracting data from transcripts and records and placing it into appropriate thematic categories, building support for each theme with the accumulated data. Coding themes were modified to accommodate new data when it challenged existing themes. ^ Findings suggest that adults with mental retardation do have the requisite knowledge, interest, and ability to participate in decisions about their end-of-life experience and handling of affairs. Siblings are overwhelmingly the chosen future surrogates and they (or their children) will likely be the end-of-life advocates for their brothers and sisters affected by mental retardation. Findings further point to a need for increased awareness, accurate information, and improved communication about end-of-life issues, both in general and particular to adults affected by mental retardation. Also suggested by the findings is a need to focus on creating accommodations and adaptations that can best uncover a person's authentic views on life and death and related end-of-life preferences. Practical implications and suggestions for further research are also discussed. ^

Geochemical composition of the Trincheira Complex in the southwestern Amazon craton, Brazil

We document the first-known Mesoproterozoic ophiolite from the southwestern part of the Amazon craton, corresponding to the Trincheira Complex of Calymmian age, and propose a tectonic model that explains many previously enigmatic features of the Precambrian history of this key craton, and discuss its role in the reconstruction of the Columbia supercontinent. The complex comprises extrusive rocks (fine-grained amphibolites derived from massive and pillowed basalts), mafic-ultramafic intrusive rocks, chert, banded iron formation (BIFs), pelites, psammitic and a smaller proportion of calc-silicate rocks. This sequence was deformed, metasomatized and metamorphosed during the development of the Alto Guaporé Belt, a Mesoproterozoic accretionary orogen. The rocks were deformed by a single tectonic event, which included isoclinal folding and metamorphism of the granulite-amphibolite facies. Layered magmatic structures were preserved in areas of low strain, including amygdaloidal and cumulate structures. Metamorphism was pervasive and reached temperatures of 780-853°C in mafic granulites and 680-720°C in amphibolites under an overall pressure of 6.8 kbar. The geochemical composition of the extrusive and intrusive rocks indicates that all noncumulus mafic-ultramafic rocks are tholeiitic basalts. The mafic-ultramafic rocks display moderately to strongly fractionation of light rare earth elements (LREE), near-flat heavy rare earth elements (HREE) patterns and moderate to strong negative high field strength elements (HFSE) anomalies (especially Nb), a geochemical signature typical of subduction zones. The lowest units of mafic granulites and porphyroblastic amphibolites in the Trincheira ophiolite are similar to the modern mid-ocean ridge basalt (MORB), although they locally display small Ta, Ti and Nb negative anomalies, indicating a small subduction influence. This behavior changes to an island arc tholeiites (IAT) signature in the upper units of fine-grained amphibolites and amphibole rich-amphibolites, characterized by progressive depletion in the incompatible elements and more pronounced negative Ta and Nb anomalies, as well as common Ti and Zr negative anomalies. Tectono-magmatic variation diagrams and chondrite-normalized REE and primitive mantle normalized patterns suggest a back-arc to intra-oceanic island arc tectonic regime for the eruption of these rocks. Therefore, the Trincheira ophiolite appears to have originated in an intraoceanic supra-subduction setting composed of an arc-back-arc system. Accordingly, the Trincheira Complex is a record of oceanic crust relics obducted during the collision of the Amazon craton and the Paraguá block during the Middle Mesoproterozoic. Thus, the recognition of the Trincheira ophiolite and suture significantly changes views on the evolution of the southern margin of the Amazon craton, and how it can influence the global tectonics and the reconstruction of the continents.

De la España africana a la América teocrática : notas sobre el ideario de Simón Bolívar

Las ideas de Simón Bolívar sobre América y sobre Europa han recibido alguna atención de los investigadores. Mucho menos las que expresó sobre Asia y África. Aunque fueron marginales a su pensamiento, la reunión de sus alusiones al respecto permite arrojar alguna luz sobre la reflexión de la Independencia y sobre los cambios que el Libertador experimentó en su percepción del naciente mundo que aparecía ante sus ojos. Partiendo de una actitud orientalista y despectiva inicial, con el tiempo llegó a pensar que el Oriente no podía descartarse como influencia en las instituciones americanas.

La historia es de los poetas : Tradición y crítica en algunas voces del 27

En el artículo se contrastan los escritos de algunos de los poetas representativos del 27 en su faceta menos estudiada: la de críticos de poesía española contemporánea, relacionándolos entre sí y destacando la relevancia del modelo propugnado por T. S. Eliot. El ensayo literario de Pedro Salinas, Max Aub y Luis Cernuda se sitúa dentro del proceso 'en construcción' de la historia de la lírica de la modernidad que desarrollaron desde el exilio, coincidiendo o divergiendo en su concepción de aspectos como la tradición, el papel y la función de la crítica, la definición del canon, y, fundamentalmente, la idoneidad de un modelo u otro de análisis literario. La particularidad con la que los tres autores manejaban estos conceptos requiere investigaciones específicas sobre un importante material ensayístico. Estas páginas lo abordan para llamar la atención sobre una especie de "manual colectivo de poesía" que se fue gestando lejos de la efervescencia cultural que los aglutinó como grupo.

Programas de asistencia alimentaria : Un caso de estudio de intervención social en la alimentación familiar en un barrio pobre de la ciudad de La Plata, Argentina

El objetivo del artículo es presentar un análisis de la importancia que adquieren diferentes intervenciones de los programas alimentarios en un barrio pobre de la Ciudad de La Plata, Argentina, entre los años 2006 y 2008, señalando el lugar que ocupan en la resolución de las necesidades alimentarias tal como son reconocidas y evaluadas por sus destinatarios. Se detallan las características del trabajo empírico realizado en ese barrio y, a partir de los relatos de las beneficiarias, se reconstruyeron las visiones sobre el lugar que ocupan los productos y prestaciones de esos programas en los consumos habituales, junto con la adaptación, aceptación y utilización de los mismos, destacando los distintos aportes de la ayuda alimentaria estatal en términos de seguridad y soberanía alimentaria mediante la aplicación del enfoque de derechos al análisis de políticas sociales

Reflexiones sobre la gestión "integrada" de cuencas hídricas en Buenos Aires : Las redes de organización social en las políticas de saneamiento ambiental

La gestión integrada de cuencas resulta ser una directriz de los organismos internacionales. Desde la gestión local se apela a la participación social, al tiempo que las redes de organizaciones socio-territoriales reclaman mayor injerencia en procesos de control para el saneamiento de las cuencas en Buenos Aires. En cualquier caso, sobrevuelan ideas tales como "integración" (de componentes) y "participación" (de grupos y sectores), que no necesariamente son concebidas unívocamente por todos los actores sociales en juego. Mientras tanto, el control de la contaminación del agua sigue siendo una zona gris en la gestión, a pesar de la creación de autoridades de cuenca. Desde un enfoque de redes, el presente trabajo rastrea en documentos de organismos internacionales, entrevistas a funcionarios locales y miembros de organizaciones territoriales, las acepciones sobre la "gestión integrada" y la "participación" en torno a cuencas metropolitanas degradadas

Discusiones en torno a las políticas públicas para la soberanía alimentaria y la agricultura familiar en Misiones (Argentina)

El objetivo del trabajo es analizar las políticas para la soberanía alimentaria en Misiones y su relación con las demandas de organizaciones de la agricultura familiar, teniendo en cuenta distintas visiones sobre el tema que tienen los actores involucrados y las acciones que se proponen desde algunas dependencias del Estado provincial y nacional. Para ello se revisaron y sistematizaron fuentes diversas (primarias y secundarias). El trabajo muestra divergencias entre las concepciones de soberanía alimentaria del Estado provincial (sustitución de la importación de alimentos) y nacional (democratización de su acceso), que sustentan estrategias de intervención en algunos puntos contradictorias y que se distancian de las demandas de las organizaciones de la agricultura familiar (centrada en la tierra para producir alimentos)

La historia es de los poetas : Tradición y crítica en algunas voces del 27

En el artículo se contrastan los escritos de algunos de los poetas representativos del 27 en su faceta menos estudiada: la de críticos de poesía española contemporánea, relacionándolos entre sí y destacando la relevancia del modelo propugnado por T. S. Eliot. El ensayo literario de Pedro Salinas, Max Aub y Luis Cernuda se sitúa dentro del proceso 'en construcción' de la historia de la lírica de la modernidad que desarrollaron desde el exilio, coincidiendo o divergiendo en su concepción de aspectos como la tradición, el papel y la función de la crítica, la definición del canon, y, fundamentalmente, la idoneidad de un modelo u otro de análisis literario. La particularidad con la que los tres autores manejaban estos conceptos requiere investigaciones específicas sobre un importante material ensayístico. Estas páginas lo abordan para llamar la atención sobre una especie de "manual colectivo de poesía" que se fue gestando lejos de la efervescencia cultural que los aglutinó como grupo.

Programas de asistencia alimentaria : Un caso de estudio de intervención social en la alimentación familiar en un barrio pobre de la ciudad de La Plata, Argentina

El objetivo del artículo es presentar un análisis de la importancia que adquieren diferentes intervenciones de los programas alimentarios en un barrio pobre de la Ciudad de La Plata, Argentina, entre los años 2006 y 2008, señalando el lugar que ocupan en la resolución de las necesidades alimentarias tal como son reconocidas y evaluadas por sus destinatarios. Se detallan las características del trabajo empírico realizado en ese barrio y, a partir de los relatos de las beneficiarias, se reconstruyeron las visiones sobre el lugar que ocupan los productos y prestaciones de esos programas en los consumos habituales, junto con la adaptación, aceptación y utilización de los mismos, destacando los distintos aportes de la ayuda alimentaria estatal en términos de seguridad y soberanía alimentaria mediante la aplicación del enfoque de derechos al análisis de políticas sociales