This dedicated issue of Chronobiology International is devoted to the selected proceedings of the 20th International Symposium on Shift Work and Working Time held in Stockholm, Sweden, 28 June to 1 July 2011. It constitutes the fifth such issue of the journal since 2004 dedicated to the selected proceedings to the meetings of the Working Time Society. The key theme of the 20th Symposium was "Biological Mechanisms, Recovery, and Risk Management in the 24-h Society." The collection of papers of this dedicated issue represents the best of contemporary research on the effects of night and rotating shift schedules on worker health and safety. The contents cover such topics as sleep restriction, injuries, health, and performance of night work and rotating shiftwork, plus light treatment as a countermeasure against the circadian disruption of shiftwork. The majority of the papers are observational field studies, including some of large sample size, and three studies are well-designed laboratory experiments.
To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.
The diagnosis of hypertension is dependent on appropriate blood pressure measurement, the timely assessment of serially elevated readings, the degree of blood pressure elevation, the method of measurement (office, ambulatory, home) and associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk and determine the urgency, intensity and type of treatment required.
MEDLINE searches were conducted from November 2007 to October 2008 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed full-text articles only.
Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of global risk assessment and the need for ongoing monitoring of hypertensive patients to identify incident type 2 diabetes.
All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations were required to be supported by at least 70% of task force members. These guidelines will continue to be updated annually.
The conceptual rubric of ecosystem management has been widely discussed and deliberated in conservation biology, environmental policy, and land/resource management. In this paper, I argue that two critical aspects of the ecosystem management concept require greater attention in policy and practice. First, although emphasis has been placed on the "space" of systems, the "time" -- or rates of change -- associated with biophysical and social systems has received much less consideration. Second, discussions of ecosystem management have often neglected the temporal disconnects between changes in biophysical systems and the response of social systems to management issues and challenges. The empirical basis of these points is a case study of the "Crown of the Continent Ecosystem," an international transboundary area of the Rocky Mountains that surrounds Glacier National Park (USA) and Waterton Lakes National Park (Canada). This project assessed the experiences and perspectives of 1) middle- and upper-level government managers responsible for interjurisdictional cooperation, and 2) environmental nongovernment organizations with an international focus. I identify and describe 10 key challenges to increasing the extent and intensity of transboundary cooperation in land/resource management policy and practice. These issues are discussed in terms of their political, institutional, cultural, information-based, and perceptual elements. Analytic techniques include a combination of environmental history, semistructured interviews with 48 actors, and text analysis in a systematic qualitative framework. The central conclusion of this work is that the rates of response of human social systems must be better integrated with the rates of ecological change. This challenge is equal to or greater than the well-recognized need to adapt the spatial scale of human institutions to large-scale ecosystem processes and transboundary wildlife.
Adaptation to climate change is given increasing international attention as the confidence in climate change projections is getting higher. Developing countries have specific needs for adaptation due to high vulnerabilities, and they will in this way carry a great part of the global costs of climate change although the rising atmospheric greenhouse gas concentrations are mainly the responsibility of industrialized countries. This article provides a status of climate change adaptation in developing countries. An overview of observed and projected climate change is given, and recent literature on impacts, vulnerability, and adaptation are reviewed, including the emerging focus on mainstreaming of climate change and adaptation in development plans and programs. The article also serves as an introduction to the seven research articles of this special issue on climate change adaptation in developing countries. It is concluded that although many useful steps have been taken in the direction of ensuring adequate adaptation in developing countries, much work still remains to fully understand the drivers of past adaptation efforts, the need for future adaptation, and how to mainstream climate into general development policies.
Climate change is among the major challenges for health this century, and adaptation to manage adverse health outcomes will be unavoidable. The risks in Ontario - Canada's most populous province - include increasing temperatures, more frequent and intense extreme weather events, and alterations to precipitation regimes. Socio-economic-demographic patterns could magnify the implications climate change has for Ontario, including the presence of rapidly growing vulnerable populations, exacerbation of warming trends by heat-islands in large urban areas, and connectedness to global transportation networks. This study examines climate change adaptation in the public health sector in Ontario using information from interviews with government officials.
Fifty-three semi-structured interviews were conducted, four with provincial and federal health officials and 49 with actors in public health and health relevant sectors at the municipal level. We identify adaptation efforts, barriers and opportunities for current and future intervention.
Results indicate recognition that climate change will affect the health of Ontarians. Health officials are concerned about how a changing climate could exacerbate existing health issues or create new health burdens, specifically extreme heat (71%), severe weather (68%) and poor air-quality (57%). Adaptation is currently taking the form of mainstreaming climate change into existing public health programs. While adaptive progress has relied on local leadership, federal support, political will, and inter-agency efforts, a lack of resources constrains the sustainability of long-term adaptation programs and the acquisition of data necessary to support effective policies.
This study provides a snapshot of climate change adaptation and needs in the public health sector in Ontario. Public health departments will need to capitalize on opportunities to integrate climate change into policies and programs, while higher levels of government must improve efforts to support local adaptation and provide the capacity through which local adaptation can succeed.
The financial costs associated with Adverse Events (AEs) for older patients (> or = 65 years) in Canadian hospitals are unknown. The objective of this paper is to describe and compare costs between patients who experienced an AE and those who did not during an acute hospital admission to a tertiary care facility. Patients with an AE had twice the hospital length of stay (20.2 versus 9.8 days, p