[Survey of Relatives' Perspective on Dying In The Hospital: A Comparison Between Departments of Internal Medicine and Palliative Care In Styria (Austria)]. / Angehörigenbefragung zum Sterben im Krankenhaus: Ein Vergleich zwischen Abteilungen für innere Medizin und Palliativstationen in der Steiermark (Österreich).

BACKGROUND: Currently, 49% of deaths in Austria occur in a hospital which makes in-patient quality of care as well as quality of death and dying a highly relevant topic. In this article, we compare the quality of care and death and dying in departments of internal medicine and palliative care in hospitals from the perspective of relatives. METHODS: In a pilot study, 210 relatives of patients who died on 4 departments of internal medicine and 2 departments of palliative care in the state of Styria (Austria) were interviewed in 2015-2017 by means of a postal survey with regard to communication by hospital personnel, quality of care, and time of dying. RESULTS: Compared to the departments of internal medicine, the 2 departments of palliative care were perceived to provide better quality of care and better service with regard to the time of death and dying, that is, timely communication of critical health deterioration of the patient, enabling relatives' attendance at the time of death, preparing relatives, and the quality of death of the patient. CONCLUSION: Against the background of the large proportion of individuals who die in hospitals in Austria, this exploratory study showed that relatives perceived both better quality of care and better quality of death and dying in the assessed departments of palliative care compared to the departments of internal medicine. Thus, a more comprehensive and systematic evaluation of the potential added value of palliative care teams in Austrian hospitals is recommended.

Spatial Distribution and Sampling Plans for Grapevine Plant Canopy-Inhabiting Scaphoideus titanus (Hemiptera: Cicadellidae) Nymphs.

The paper deals with the study of the spatial distribution and the design of sampling plans for estimating nymph densities of the grape leafhopper Scaphoideus titanus Ball in vine plant canopies. In a reference vineyard sampled for model parameterization, leaf samples were repeatedly taken according to a multistage, stratified, random sampling procedure, and data were subjected to an ANOVA. There were no significant differences in density neither among the strata within the vineyard nor between the two strata with basal and apical leaves. The significant differences between densities on trunk and productive shoots led to the adoption of two-stage (leaves and plants) and three-stage (leaves, shoots, and plants) sampling plans for trunk shoots- and productive shoots-inhabiting individuals, respectively. The mean crowding to mean relationship used to analyze the nymphs spatial distribution revealed aggregated distributions. In both the enumerative and the sequential enumerative sampling plans, the number of leaves of trunk shoots, and of leaves and shoots of productive shoots, was kept constant while the number of plants varied. In additional vineyards data were collected and used to test the applicability of the distribution model and the sampling plans. The tests confirmed the applicability 1) of the mean crowding to mean regression model on the plant and leaf stages for representing trunk shoot-inhabiting distributions, and on the plant, shoot, and leaf stages for productive shoot-inhabiting nymphs, 2) of the enumerative sampling plan, and 3) of the sequential enumerative sampling plan. In general, sequential enumerative sampling was more cost efficient than enumerative sampling.

Implementation of a socio-ecological system navigation approach to human development in sub-saharan african communities.

This paper presents a framework for the development of socio-ecological systems towards enhanced sustainability. Emphasis is given to the dynamic properties of complex, adaptive social-ecological systems, their structure and to the fundamental role of agriculture. The tangible components that meet the needs of specific projects executed in Kenya and Ethiopia encompass project objectives, innovation, facilitation, continuous recording and analyses of monitoring data, that allow adaptive management and system navigation. Two case studies deal with system navigation through the mitigation of key constraints; they aim to improve human health thanks to anopheline malaria vectors control in Nyabondo (Kenya), and to improve cattle health through tsetse control and antitrypanosomal drug administration to cattle in Luke (Ethiopia). The second case deals with a socio-ecological navigation system to enhance sustainability, establishing a periurban diversified enterprise in Addis Ababa (Ethiopia) and developing a rural sustainable social-ecological system in Luke (Ethiopia). The project procedures are briefly described here and their outcomes are analysed in relation to the stated objectives. The methodology for human and cattle disease vector control were easier to implement than the navigation of social-ecological systems towards sustainability enhancement. The achievements considerably differed between key constraints removal and sustainability enhancement projects. Some recommendations are made to rationalise human and cattle health improvement efforts and to smoothen the road towards enhanced sustainability: i) technology system implementation should be carried out through an innovation system; ii) transparent monitoring information should be continuously acquired and evaluated for assessing the state of the system in relation to stated objectives for (a) improving the insight into the systems behaviour and (b) rationalizing decision support; iii) the different views of all stakeholders should be reconciled in a pragmatic approach to social-ecological system management. Significance for public healthRecently, there is a growing interest in studying the link between human, animal and environmental health. The connection between these different dimensions is particularly important for developing countries in which people face the challenge of escaping vicious cycle of high diseases prevalence, food insecurity driven by absolute poverty and population growth, and natural capital as a poverty trap. The design and implementation of such efforts, aiming at human health improvement and poverty alleviation, should be framed into adaptive social-ecological system management perspectives. In this paper, we present few case studies dealing with human health improvement through anopheline malaria vectors control in Kenya, cattle health improvement through tsetse vectored nagana control, antitrypanosomal drug administration to cattle in Ethiopia and with the development of rural sustainable communities in Ethiopia. Some recommendations are given to rationalise human and cattle health improvement efforts and to smoothen the road towards enhanced sustainability.

Towards an improved understanding of the dynamics of vineyard-infesting Scaphoideus titanus leafhopper populations for better timing of management activities.

BACKGROUND: This paper deals with supervised management of Scaphoideus titanus (Homoptera Cicadellidae) and describes a phenology model designed for improving the understanding of the within-vineyard dynamics and the timing of insect growth regulator (IGR) applications. RESULTS: The model consists of five components dealing with (a) the beginning of the post-dormancy development of overwintering eggs, (b) the egg hatching patterns, (c) the duration of first-instar nymphs, (d) the development and survival of subsequent instars and (e) the stochastic development of cohorts and their passage into the adult stage. Laboratory data permitted the parameterisation of temperature-dependent development and survival functions. Field data consisting mainly of beating tray catches allowed model parameterisation and validation. The model satisfactorily predicts the dynamics of age structures, the beginning as well as the pattern of egg hatching, the occurrence of the third instar and the emergence of adults. CONCLUSION: The phenology model is useful for timing IGR applications and for setting up monitoring activities in supervised S. titanus control. The model is an entry point into an adaptive management system, in that real-time weather and monitoring data are continuously integrated into the model for improving its explanatory and predictive capabilities.

The relationships between phenolic content, pollen diversity, physicochemical information and radical scavenging activity in honey.

Honey is rich in different secondary plant metabolites acting as natural antioxidants and contributing to human health. Radical scavenging activity (RSA) is related to antioxidant activity, while the correlation between the phenolic content and RSA is often weak. Consequently, exclusive information on phenolics is often insufficient to qualify the RSA and the health promoting effects of honey. The paper deals with a case study of honey samples originating from the alpine areas of Italy's Lombardia and Veneto regions and realized by standard physicochemical and statistical analytical methods. In pure honey, the total phenolic content and the RSA were measured in spectrophotometric tests with the 2,2-diphenyl-1-picrylhydrazyl (DPPH·) free radical and Folin-Ciocalteu assays, respectively. Melissopalynological data was used to qualify pollen diversity through rank-frequency curves separating the samples into two groups. On the basis of physicochemical data, the samples were analyzed through multivariate classification and ranking procedures resulting in the identification of an outlier. Elimination of the outlier produced a high correlation between the total phenolic content and RSA in the two pollen diversity groups. The case study suggests that, after disregarding outliers, the RSA activity can be satisfactorily qualified on the basis of phenolics with pollen diversity as a covariate.

Planning training seminars in palliative care: a cross-sectional survey on the preferences of general practitioners and nurses in Austria.

BACKGROUND: Training in palliative care is frequently requested by health care professionals. However, little is known in detail about the subject matters and the educational preferences of physicians and staff or assistant nurses in this field. METHODS: All 897 registered GPs and all 933 registered home care nurses in the district of Steiermark/Austria were sent postal questionnaires. RESULTS: Results from 546 (30%) respondents revealed that GPs prefer evening courses and weekend seminars, whereas staff and assistant nurses prefer one-day courses. Multidisciplinary sessions are preferred by almost 80% of all professional groups. GPs preferred multi disciplinary groups most frequently when addressing psychosocial needs (88.8%) and ethical questions (85.8%). Staff and assistant nurses preferred multidisciplinary groups most frequently in the area of pain management (88%) and opted for multi disciplinary learning to a significantly higher extent than GPs (69%; p < 0.01). Those topics were ranked first which are not only deepening, but supplementing the professional training. On average, GPs were willing to spend a maximum amount of euro 400 per year for training seminars in palliative care, whereas nurses would spend approximately euro 190 for such classes.The results provide a detailed analysis of the preferences of GPs and nurses and offer guidance for the organisation of training seminars in palliative care. CONCLUSIONS: Medical and nursing education programs often pursue separate paths. Yet our findings indicate that in palliative care multidisciplinary training seminars are favoured by both, doctors and nurses. Also, both groups prefer topics that are not only deepening, but supplementing their professional knowledge.

Ecosocial consequences and policy implications of disease management in East African agropastoral systems.

International research and development efforts in Africa have brought ecological and social change, but analyzing the consequences of this change and developing policy to manage it for sustainable development has been difficult. This has been largely due to a lack of conceptual and analytical models to access the interacting dynamics of the different components of ecosocial systems. Here, we examine the ecological and social changes resulting from an ongoing suppression of trypanosomiasis disease in cattle in an agropastoral community in southwest Ethiopia to illustrate how such problems may be addressed. The analysis combines physiologically based demographic models of pasture, cattle, and pastoralists and a bioeconomic model that includes the demographic models as dynamic constraints in the economic objective function that maximizes the utility of individual consumption under different level of disease risk in cattle. Field data and model analysis show that suppression of trypanosomiasis leads to increased cattle and human populations and to increased agricultural development. However, in the absence of sound management, these changes will lead to a decline in pasture quality and increase the risk from tick-borne diseases in cattle and malaria in humans that would threaten system sustainability and resilience. The analysis of these conflicting outcomes of trypanosomiasis suppression is used to illustrate the need for and utility of conceptual bioeconomic models to serve as a basis for developing policy for sustainable agropastoral resource management in sub-Saharan Africa.

Competency and educational needs in palliative care.

PURPOSE: To explore general practitioners' (GPs') and nurses' self assessment of professional education, competency and educational needs in palliative care. METHODS: All 897 registered GPs and all 933 registered home care nurses in the Province of Styria/Austria were sent postal questionnaires to evaluate their professional training in (i) pain control and symptom management, (ii) handling psychosocial needs and (iii) ability to cope with work-related distress. RESULTS: 61.8% of 546 evaluable respondents felt not at all or not sufficiently prepared for palliative care by their professional education (GPs: 70%, nurses: 50.4%). GPs rated the competency of their professional guild significantly higher and their educational needs significantly lower than nurses (p<0.01). Both, GPs and nurses emphasised a great need for education in the area of neuropsychiatric symptom management. CONCLUSION: Our results provide a detailed analysis of needs and may help to target goals for training seminars in palliative care.

Population models for threshold-based control of Tetranychus urticae in small-scale Kenyan tomato fields and for evaluating weather and host plant species effects.

The spatial distribution of motile life stages of the two-spotted spider mite Tetranychus urticae Koch in Kenyan small-scale tomato fields was described by Taylor's power law and an enumerative sampling plan was designed for research purposes. The exponential increase of T. urticae populations during three growing seasons permits the development and use of a simple exponential model for the design of a threshold-based chemical control system. For this purpose, a critical threshold of 440 motile mites per sample unit at the end of the growing season (12 weeks after transplanting) was translated into a proportion of 0.83 infested units in sample 3, i.e. five weeks after transplanting. A sequential binomial sampling plan with respect to the proportion of 0.83, five weeks after transplanting, was designed. The exponential model was extended to account for the influence of weather and host plant species. Model development and parameter estimation were based on three data sets (Kenyan tomato fields, Italian and Californian strawberry fields). The model satisfactorily predicted a positive influence on growth rates by (i) changing the host plant from tomato to strawberry, and (ii) temperature, while a negative effect resulted from (iii) rainfall; both (ii) and (iii) are controlled by temperature-rainfall interactions. In contrast, the estimated parameter values did not satisfactorily describe the expected responses at specific temperature and rainfall values. Nevertheless, the model allowed the rating of host plant species in the field. A fourth data set from Swiss apple orchards was used to test the model, and population build-up on the apple host plant appeared to be higher than on tomatoes but lower than on strawberry.

Development of an adaptive tsetse population management scheme for the Luke community, Ethiopia.

Since 1996, tsetse (Glossina spp.) control operations, using odor-baited traps, have been carried out in the Luke area of Gurage zone, southwestern Ethiopia. Glossina morsitans submorsitans Newstead was identified as the dominant species in the area, but the presence of Glossina fuscipes Newstead and Glossina pallidipes Austen also was recorded. Here, we refer to the combined number of these three species and report the work undertaken from October 2002 to October 2004 to render the control system more efficient by reducing the number of traps used and maintaining the previously reached levels of tsetse occurrence and trypanosomiasis prevalence. This was done by the design and implementation of an adaptive tsetse population management system. It consists first of an efficient community-participatory monitoring scheme that allowed us to reduce the number of traps used from 216 to 127 (107 monitoring traps and 20 control traps). Geostatistical methods, including kriging and mapping, furthermore allowed identification and monitoring of the spatiotemporal dynamics of patches with increased fly densities, referred to as hot spots. To respond to hot spots, the Luke community was advised and assisted in control trap deployment. Adaptive management was shown to be more efficient than the previously used mass trapping system. In that context, trap numbers could be reduced substantially, at the same time maintaining previously achieved levels of tsetse occurrences and disease prevalence.

[Participation of radiotherapy in interdisciplinary palliative care units--challenge and chance]. / Strahlentherapeutische Beteiligung an interdisziplinären palliativmedizinischen Einrichtungen--Herausforderung und Chance.

BACKGROUND: In Germany, a sufficient system of palliative care does not exist. Possibilities for participation of radiooncologists in the further development of this promising part of medical action are reported. MATERIAL AND METHODS: Experiences from interdisciplinary work in the field of palliative care are described. This experience is communicated for use in the actual discussion about the future of palliative care in Germany, especially in the field of radiooncology. RESULTS: A palliative care unit can only work in a team of different professions, which means different physicians, but also nurses, social workers, psychologists or pastors. A palliative care unit will benefit from working with radiooncologists as well as radiooncologists will do from working in the field of palliative care. CONCLUSION: In times of growing interest in and need for palliative care, radiooncologists should actively participate in the development of palliative care units in Germany. The aim of this participation should be to reasonably arrange the treatment of incurably ill patients with the chances of modern radiotherapy. Another aim should be to improve the treatment of "classic" radiation oncology patients by ideas of palliative care. The further development of palliative care in Germany should not take place without the participation of radiooncologists. This will meet the interests of palliative care and radiotherapy and-most importantly-the patients' interests.

Human health improvement in Sub-Saharan Africa through integrated management of arthropod transmitted diseases and natural resources

Se presenta un concepto, basado en el ecosistema, para el mejoramiento de la salud humana en la región del Africa al sur del Sahara. Las condiciones físicas del cuerpo humano estan afectadas por tres factores: factores ambientales abióticos, enfermedades transmitidas por vectores, y por los recursos naturales. Este concepto se basa en princípios ecológicos dentro de un contexto social, e identifica tres series de subsistemas para estudio y manejo: subsistemas de enfermedades humanas, subsistemas de recursos naturales y subsistemas participativos de toma de decisiones. En el manejo de enfermedades humanas, así como en el manejo de recursos tales como ganadería o agricultura, se da prioridad a programas preventivos de manejo integrado. El concepto de sostenibilidad ambiental - base para el manejo de materia y de aguas - contribuye a un medio ambiente favorable para las condiciones de vida del ser humano, y es la base de la sostenibilidad social. Para la planificación y la ejecución del esquema de mejoramiento de la salud humana, se necesita un sistema participativo de toma de decisiones, adaptado a las condiciones locales y desarrollado en base a acuerdos institucionales. La aplicabilidad de este esquema es demostrada en la zona rural y urbana de Etiopia.