Quality or equality? The Norwegian experience with medical monopolies

BACKGROUND: In order to maintain both quality and efficiency of health services in a small country with a scattered population, Norway established a monopoly system for 38 highly specialized medical services. The geographical distributions of these services, which are provided by one or two university hospitals only, were analysed. METHODS: The counties of residence for 2 711 patients admitted for the first time in 2001 to these 31 monopolies and 7 duopolies were identified. RESULTS: The general tendency observed was that with increasing distance from residential home to monopoly hospitals there was a declining coverage of these health services. The same pattern was found even with regard to explicit diagnoses or treatments such as organ transplantations (except renal transplantations). Duopolies seemed to yield a more even geographical distribution of the services. CONCLUSION: Monopolies may serve as a useful means for maintaining quality in highly specialized medical services, but seem to have an inherent tendency to do this at the expense of geographical equality

How generalist are these forest specialists? What Sweden's avian indicators indicate

Monitoring of forest biodiversity and habitats is an important part of forest conservation, but due to the impossible task of monitoring all species, indicator species are frequently used. However, reliance on an incorrect indicator of valuable habitat can reduce the efficiency of conservation efforts. Birds are often used as indicators as they are charismatic, relatively easy to survey, and because we often have knowledge of their habitat and resource requirements. In the Swedish government's environmental quality goals, there are a number of bird species identified as being associated with 'older' and 'high natural value' forests. Here we evaluate the occurrence of four of these indicator species using data from 91 production forest stands and 10 forest reserves in southern Sweden. The bird species assessed are willow tit Poecile montanus, coal tit Periparus ater, European crested tit Lophophanes cristatus and Eurasian treecreeper Certhia familiaris. For the production stands assessed, these indicator species exhibited no significant preferences regarding forest composition and structure, indicating a wider range of habitat associations than expected. These species frequently showed territorial behavior in forest stands <60 and even 40 years of age; much younger than the 120-year threshold for 'older forest' as defined by governmental environmental goals. As almost 80% of the production stands >= 10 years old included at least one of the four indicator species, this raises questions regarding the suitability of these species as indictors of forests of high conservational value in southern Sweden. Notably, besides the four species assessed here, none of the additional indicator taxa identified by the government, were recorded in the 10 reserves. This outcome may reflect the difficulties involved in finding bird indicator species indicative of high natural values in this region. Our results highlight the importance of coupling bird surveys with quantified assessments of proximate vegetation cover

Pollen-based quantitative reconstructions of Holocene regional vegetation cover (plant-functional types and land-cover types) in Europe suitable for climate modelling

We present quantitative reconstructions of regional vegetation cover in north-western Europe, western Europe north of the Alps, and eastern Europe for five time windows in the Holocene [around 6k, 3k, 0.5k, 0.2k, and 0.05k calendar years before present (bp)] at a 1 degrees x1 degrees spatial scale with the objective of producing vegetation descriptions suitable for climate modelling. The REVEALS model was applied on 636 pollen records from lakes and bogs to reconstruct the past cover of 25 plant taxa grouped into 10 plant-functional types and three land-cover types [evergreen trees, summer-green (deciduous) trees, and open land]. The model corrects for some of the biases in pollen percentages by using pollen productivity estimates and fall speeds of pollen, and by applying simple but robust models of pollen dispersal and deposition. The emerging patterns of tree migration and deforestation between 6k bp and modern time in the REVEALS estimates agree with our general understanding of the vegetation history of Europe based on pollen percentages. However, the degree of anthropogenic deforestation (i.e. cover of cultivated and grazing land) at 3k, 0.5k, and 0.2k bp is significantly higher than deduced from pollen percentages. This is also the case at 6k in some parts of Europe, in particular Britain and Ireland. Furthermore, the relationship between summer-green and evergreen trees, and between individual tree taxa, differs significantly when expressed as pollen percentages or as REVEALS estimates of tree cover. For instance, when Pinus is dominant over Picea as pollen percentages, Picea is dominant over Pinus as REVEALS estimates. These differences play a major role in the reconstruction of European landscapes and for the study of land cover-climate interactions, biodiversity and human resources.Peer reviewe

Europe's lost forests: a pollen-based synthesis for the last 11,000 years

8000 years ago, prior to Neolithic agriculture, Europe was mostly a wooded continent. Since then, its forest cover has been progressively fragmented, so that today it covers less than half of Europe’s land area, in many cases having been cleared to make way for fields and pasture-land. Establishing the origin of Europe’s current, more open land-cover mosaic requires a long-term perspective, for which pollen analysis offers a key tool. In this study we utilise and compare three numerical approaches to transforming pollen data into past forest cover, drawing on >1000 14C-dated site records. All reconstructions highlight the different histories of the mixed temperate and the northern boreal forests, with the former declining progressively since ~6000 years ago, linked to forest clearance for agriculture in later prehistory (especially in northwest Europe) and early historic times (e.g. in north central Europe). In contrast, extensive human impact on the needle-leaf forests of northern Europe only becomes detectable in the last two millennia and has left a larger area of forest in place. Forest loss has been a dominant feature of Europe’s landscape ecology in the second half of the current interglacial, with consequences for carbon cycling, ecosystem functioning and biodiversity

Forest biodiversity, carbon sequestration, and wood production: modeling synergies and trade-offs for ten forest landscapes across Europe

Original ResearchEurope’s forests provide vital habitat for biodiversity and essential ecosystem services whose provision must be sustained or enhanced over the coming century. However, the potential to secure or increase forest ecosystem services, while securing the habitat requirements of taxa remains unclear, especially within the context of uncertain climate and socio-economic developments. To tease out the associated trade-offs and synergies, we used 10 case study landscapes within nine countries throughout Europe. Starting with the current status of the forests in the case study landscapes, we simulated forest development 100 years into the future. Simulations were embedded in three combined climate and socio-economic frame scenarios based on global and European policies which varied in their climate change mitigation efficiency. Scenarios were translated into country specific projections of climate variables, and resultant demands for wood products. Forest management regimes were projected to vary in response to these scenarios at local scales. The specific combinations of alternative forest management practices were based on parallel research and input from local forest stakeholders. For each case study, a specific forest growth simulator was used. In general, the climate scenarios applied did not cause fundamentally different ecosystem service outputs at the case study level. Our results revealed almost no reduction in outcomes for biodiversity indicators with an increase in wood production, and in some cases synergistic results occurred when diversity was actively promoted as part of the management concept. Net carbon uptake was not strongly correlated with biodiversity, indicating that biodiversity-friendly forest management doesn’t need to curtail carbon sequestration. Notably, we obtained heterogeneous results for the relation between sustainable wood production and net carbon uptake. Most scenarios resulted in a more or less reduced net carbon uptake over the long term, often due to stand age class distribution shifts. Levels of sustainable wood production varied widely during the simulation period, from significant increases (Sweden, Lithuania) to minor changes (Slovakia, Turkey) and slight decreases (Ireland, Netherlands). We place our results within the larger context of European forest policy and the challenges of simulating and contrasting forest biodiversity and the ecosystem services that societies depend on outcomes for biodiversity indicators with an increase in wood production, and in some cases synergistic results occurred when diversity was actively promoted as part of the management concept. Net carbon uptake was not strongly correlated with biodiversity, indicating that biodiversity-friendly forest management doesn’t need to curtail carbon sequestration. Notably, we obtained heterogeneous results for the relation between sustainable wood production and net carbon uptake. Most scenarios resulted in a more or less reduced net carbon uptake over the long term, often due to stand age class distribution shifts. Levels of sustainable wood production varied widely during the simulation period, from significant increases (Sweden, Lithuania) to minor changes (Slovakia, Turkey) and slight decreases (Ireland, Netherlands). We place our results within the larger context of European forest policy and the challenges of simulating and contrasting forest biodiversity and the ecosystem services that societies depend oninfo:eu-repo/semantics/publishedVersio

Molecular Evolution of Regulatory Genes in Spruces from Different Species and Continents: Heterogeneous Patterns of Linkage Disequilibrium and Selection but Correlated Recent Demographic Changes

Genes involved in transcription regulation may represent valuable targets in association genetics studies because of their key roles in plant development and potential selection at the molecular level. Selection and demographic signatures at the sequence level were investigated for five regulatory genes belonging to the knox-I family (KN1, KN2, KN3, KN4) and the HD-Zip III family (HB-3) in three Picea species affected by post-glacial recolonization in North America and Europe. To disentangle neutral and selective forces and estimate linkage disequilibrium (LD) on a gene basis, complete or nearly complete gene sequences were analysed. Nucleotide variation within species, haplotype structure, LD, and neutrality tests, in addition to coalescent simulations based on Tajima’s D and Fay and Wu’s H, were estimated. Nucleotide diversity was generally low in all species (average π = 0.002–0.003) and much heterogeneity was seen in LD and selection signatures among genes and species. Most of the genes harboured an excess of both rare and frequent alleles in the three species. Simulations showed that this excess was significantly higher than that expected under neutrality and a bottleneck during the Last Glacial Maximum followed by population expansion at the Pleistocene/Holocene boundary or shortly after best explains the correlated sequence patterns. These results indicate that despite recent large demographic changes in the three boreal species from two continents, species-specific selection signatures could still be detected from the analysis of nearly complete regulatory gene sequences. Such different signatures indicate differential subfunctionalization of gene family members in the three congeneric species

Palaeoecological data indicates land-use changes across Europe linked to spatial heterogeneity in mortality during the Black Death pandemic

Historical accounts of the mortality outcomes of the Black Death plague pandemic are variable across Europe, with much higher death tolls suggested in some areas than others. Here the authors use a 'big data palaeoecology' approach to show that land use change following the pandemic was spatially variable across Europe, confirming heterogeneous responses with empirical data.The Black Death (1347-1352 ce) is the most renowned pandemic in human history, believed by many to have killed half of Europe's population. However, despite advances in ancient DNA research that conclusively identified the pandemic's causative agent (bacterium Yersinia pestis), our knowledge of the Black Death remains limited, based primarily on qualitative remarks in medieval written sources available for some areas of Western Europe. Here, we remedy this situation by applying a pioneering new approach, 'big data palaeoecology', which, starting from palynological data, evaluates the scale of the Black Death's mortality on a regional scale across Europe. We collected pollen data on landscape change from 261 radiocarbon-dated coring sites (lakes and wetlands) located across 19 modern-day European countries. We used two independent methods of analysis to evaluate whether the changes we see in the landscape at the time of the Black Death agree with the hypothesis that a large portion of the population, upwards of half, died within a few years in the 21 historical regions we studied. While we can confirm that the Black Death had a devastating impact in some regions, we found that it had negligible or no impact in others. These inter-regional differences in the Black Death's mortality across Europe demonstrate the significance of cultural, ecological, economic, societal and climatic factors that mediated the dissemination and impact of the disease. The complex interplay of these factors, along with the historical ecology of plague, should be a focus of future research on historical pandemics

The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

<p>Abstract</p> <p>Background</p> <p>A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs). The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory.</p> <p>Methods/design</p> <p>A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis) and field of family medicine (macro-level of analysis). The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original framework and new themes introduced by the participants. We will conduct within-case and cross-case analyses of the data.</p> <p>Discussion</p> <p>The question of the role of economic evaluation in FPs' decision-making is of great interest to scientists, health care practitioners, managers and policy-makers, as well as to consultants, industry, and society. It is believed that the proposed research approach will make an original contribution to the development of knowledge, both empirical and theoretical.</p