Focus groups of value concepts of producers: National Report Netherlands

The Organic Revision project was funded by the EU with the aim of supporting the further development of the EU Regulation 2092/91 on organic production. As part of the project focus groups were run in five European countries on value concepts of organic producers and other stakeholders, during 2004-2005. The project aims to provide an overview of values held among organic stakeholders, and of similarities and differences among the various national and private organic standards. In the Netherlands four focus groups were held, one pre-test with researchers, and three groups with established organic producers both of livestock and horticulture. It was not possible to recruit any newly converted producers to a meeting in the Netherlands. The following conclusions were reached: Summarising the values in the words of the participants of these focus groups, organic agriculture could be defined as follows: "Organic agriculture is about producing endlessly, with care and respect for humans, animals, plants and soil. Organic farmers produce healthy and tasty food without harming the environment or the development of others. Their farms and agriculture in general are inter-connected with small and big world problems." Overall there seem to be many similarities between the groups. Values related to all principles were discussed in all the groups; the differences observed were related to the different backgrounds. The researchers spoke about their own experiences from work but also about their ideas from a consumer’s point of view. For the dairy farmers animal welfare was an important value while soil was more important to the arable farmers. Also with regard to the values nearness and proximity, differences between arable and dairy farmers seemed to reflect their daily practice. Arable farmers are faced with an anonymous market, with high and changing quality standards of the trade, and regard local production and consumption as a solution to their problems. The other groups of farmers also support this quest for another economic system. The researchers mention the unrealistic ideas of consumers concerning organic agriculture and they wonder how to make consumers more aware. The farmers would like to educate the consumer more, also about the relation of production in their country compared with production and development elsewhere. The farmers see the inter-connectedness of agriculture with income and development in developing countries very clearly and for some this was an important argument to convert. The farmers have a great feeling of responsibility for the world (ecologically and socially). For all of them the intentions are more important than the norms. On the basis of the coding, it appears that values in relation to three principles were most important in the discussion. These are the ecology principle, holism and systems approach and professional pride, in order of importance. The following values were mentioned in relation to the principle of ecology: Recycling (the cycle) and saving energy were of major importance and nature conservation or nature integration on the farm was an important aim for some farmers. Co-operation between arable and animal production is seen as a very important means to close the cycle. And in the Netherlands with far going specialisation of farms this is sometimes a real challenge. Conflicts with the economy easily arise but also conflicts with national legislation restrict the farmers in their development. The values itself are not experienced as restricting. All groups except for the arable farmers see a combination and balance of all principles as important in the future. Arable farmers see the soil as most important and other values as complementary. All groups of experienced farmers were worried about new converters, who seem to stick to the minimum values, as a threat to their profession. All participants seem to have the feeling to be part of the good guys and are being recognised by society in that way. They are proud of their profession and the sector. For the continuation of the sector a clear distinction from conventional agriculture is needed, but they are not afraid that conventional moves in the direction of organic. For the future, steady development and growth is preferred above fast growth. Others should also get the chance and time to develop in the way they did, but the new converters should not decrease the credibility of organic. Therefore, acceptable minimum rules should do justice to the values held by the sector as a whole

Contextual determinants associated with children's and adolescents' mental health care utilization:a systematic review

Determinants at the contextual level are important for children's and adolescents' mental health care utilization, as this is the level where policy makers and care providers can intervene to improve access to and provision of care. The objective of this review was to summarize the evidence on contextual determinants associated with mental health care utilization in children and adolescents. A systematic literature search in five electronic databases was conducted in August 2021 and retrieved 6439 unique records. Based on eight inclusion criteria, 74 studies were included. Most studies were rated as high quality (79.7%) and adjusted for mental health problems (66.2%). The determinants that were identified were categorized into four levels: organizational, community, public policy or macro-environmental. There was evidence of a positive association between mental health care utilization and having access to a school-based health center, region of residence, living in an urban area, living in an area with high accessibility of mental health care, living in an area with high socio-economic status, having a mental health parity law, a mental health screening program, fee-for-service plan (compared to managed care plan), extension of health insurance coverage and collaboration between organizations providing care. For the other 35 determinants, only limited evidence was available. To conclude, this systematic review identifies ten contextual determinants of children's and adolescents' mental health care utilization, which can be influenced by policymakers and care providers. Implications and future directions for research are discussed PROSPERO ID: CRD42021276033.</p

Are BRCA1- and BRCA2-related breast cancers associated with increased mortality?

There has been contradictory evidence as to whether BRCA1 associated breast cancers have a poorer prognosis than non-BRCA1 cancers. In this issue of Breast Cancer Research Robson and colleagues provide further evidence for poorer survival in BRCA1 carriers and show that it could be attributed to failure to treat small node-negative grade 3 breast cancers with chemotherapy. There still remains little evidence for a survival difference for BRCA2 related breast cancers. Although the high contralateral breast cancer risk is confirmed by this study there is no real evidence for an increase in ipsilateral recurrence or new primary breast cancers in mutation carriers up to the 10-year point

Prophylactic Mastectomy in BRCA1/2 Mutation Carriers and Women at Risk of Hereditary Breast Cancer: Long-Term Experiences at the Rotterdam Family Cancer Clinic

Background BRCA1/2 mutation carriers and women from a hereditary breast(/ovarian) cancer family have a highly increased risk of developing breast cancer (BC). Prophylactic mastectomy (PM) results in the greatest BC risk reduction. Long-term data on the efficacy and sequels of PM are scarce. Methods From 358 high-risk women (including 236 BRCA1/2 carriers) undergoing PM between 1994 and 2004, relevant data on the occurrence of BC in relation to PM, complications in relation to breast reconstruction (BR), mutation status, age at PM and preoperative imaging examination results were extracted from the medical records, and analyzed separately for women without (unaffected, n = 177) and with a BC history (affected, n = 181). Results No primary BCs occurred after PM (median follow-up 4.5 years). In one previously unaffected woman, metastatic BC was detected almost 4 years after PM (primary BC not found). Median age at PM was younger in unaffected women (P < .001), affected women more frequently were 50% risk carriers (P < .001). Unexpected (pre)malignant changes at PM were found in 3% of the patients (in 5 affected, and 5 unaffected women, respectively). In 49.6% of the women opting for BR one or more complications were registered, totaling 215 complications, leading to 153 surgical interventions (71%). Complications were mainly related to cosmetic outcome (36%) and capsular formation (24%). Conclusions The risk of developing a primary BC after PM remains low after longer follow-up. Preoperative imaging and careful histological examination is warranted because of potential unexpected (pre)malignant findings. The high complication rate after breast reconstruction mainly concerns cosmetic issues

Molecular profiles of BRCA1-mutated and matched sporadic breast tumours: relation with clinico-pathological features

About 5–10% of breast cancers are hereditary; a genetically and clinically heterogeneous disease in which several susceptibility genes, including BRCA1, have been identified. While distinct tumour features can be used to estimate the likelihood that a breast tumour is caused by a BRCA1 germline mutation it is not yet possible to categorize a BRCA1 mutated tumour. The aim of the present study is to molecularly classify BRCA1 mutated breast cancers by resolving gene expression patterns of BRCA1 and matched sporadic surgical breast tumour specimens. The expression profiles of 6 frozen breast tumour tissues with a proven BRCA1 gene mutation were weighed against those from 12 patients without a known family history but who had similar clinico-pathological characteristics. In addition two fibroblast cultures, the breast cancer cell-line HCC1937 and its corresponding B-lymphoblastoid cell line (heterozygous for mutation BRCA1 5382insC) and an epithelial ovarian cancer cell line (A2780) were studied. Using a high density membrane based array for screening of RNA isolated from these samples and standard algorithms and software, we were able to distinguish subgroups of sporadic cases and a group consisting mainly of BRCA1-mutated breast tumours. Furthermore this pilot analysis revealed a gene cluster that differentially expressed genes related to cell substrate formation, adhesion, migration and cell organization in BRCA1-mutated tumours compared to sporadic breast tumours. © 2001 Cancer Research Campaign http://www.bjcancer.co

Concepts of Animal Health and Welfare in Organic Livestock Systems

In 2005, The International Federation of Organic Agricultural Movements (IFOAM) developed four new ethical principles of organic agriculture to guide its future development: the principles of health, ecology, care, and fairness. The key distinctive concept of animal welfare in organic agriculture combines naturalness and human care, and can be linked meaningfully with these principles. In practice, a number of challenges are connected with making organic livestock systems work. These challenges are particularly dominant in immature agro-ecological systems, for example those that are characterized by industrialization and monoculture. Some of the current challenges are partly created by shortages of land and manure, which encourage zero-grazing and other confined systems. Other challenges are created in part by the conditions for farming and the way in which global food distribution systems are organized, e.g., how live animals are transported, how feed is traded and transported all over the globe, and the development of infrastructure and large herds. We find that the overall organic principles should be included when formulating guidelines for practical organic animal farming. This article explores how the special organic conceptions of animal welfare are related to the overall principles of organic agriculture. The aim is to identify potential routes for future development of organic livestock systems in different contexts and with reference to the specific understanding of animal welfare in organic agriculture. We include two contrasting cases represented by organic livestock systems in northwestern Europe and farming systems in tropical low-income countries; we use these cases to explore the widely different challenges of organic livestock systems in different parts of the world