Identification of challenges to the availability and accessibility of opioids in twelve European countries:conclusions from two ATOME six-country workshops

Background: Access to many controlled medicines is inadequate in a number of European countries. This leads to deficits in the treatment of moderate to severe pain as well as in opioid agonist therapy. Objective: The study objective was to elaborate the reasons for this inadequacy. The work plan of the Access to Opioid Medication in Europe (ATOME) project included two six-country workshops. These workshops comprised a national situational analysis, drafting tailor-made recommendations for improvement and developing action plans for their implementation. Methods: In total, 84 representatives of the national Ministries of Health, national controlled substances authorities, experts representing regulatory and law enforcement authorities, leading health care professionals, and patient representatives from 13 European countries participated in either one of the workshops. The delegates used breakout sessions to identify key common challenges. Content analysis was used for the evaluation of protocols and field notes. Results: A number of challenges to opioid accessibility in the countries was identified in the domains of knowledge and educational, regulatory, legislative, as well as public awareness and training barriers that limit opioid prescription. In addition, short validity of prescriptions and bureaucratic practices resulting in overregulation impeded availablity of some essential medicines. Stigmatization and criminalisation of people who use drugs remained the major impediment to increasing opioid agonist program coverage. Conclusions: The challenges identified during outcomes of the workshops were used as the basis for subsequent dissemination and implementation activities in the ATOME project, and in some countries the workshop proceedings already served as a stepping-stone for the first changes in regulations and legislation

Barriers to access to opioid medicines:a review of national legislation and regulations of 11 central and eastern European countries

Control measures designed to prevent the misuse of opioid medicines can often unintentionally restrict legitimate medical use, leaving patients with cancer in pain. This study aimed to develop and validate an assessment instrument based on WHO policy guidelines to systematically identify legal and regulatory barriers to opioid access in 11 European countries (Bulgaria, Cyprus, Estonia, Greece, Hungary, Latvia, Lithuania, Serbia, Slovakia, Slovenia, and Turkey) as part of the Access to Opioid Medication in Europe project. Relevant legislation and regulations were independently assessed by three reviewers and potential barriers were identified within nine categories including prescribing, penalties, and others. Potential barriers were identified in all countries, ranging from 22 potential barriers (Cyprus) to 128 potential barriers (Lithuania). The total number of barriers in a single category varied from one (Slovenia, usage category) to 49 (Greece, prescribing category). Differences, such as prescription validity, varied within one category, ranging from 5 days (Hungary) to 13 weeks (Cyprus). The results of this Review should give rise to a national review and revision of provisions that impede access to opioids, disproportionate to their (intended) benefit in preventing misuse, in these 11 European countries

Anthropogenic effect on landscapes: spatial structure, ecological impact, entropy

Structural and thermodynamic applications of entropy related to spatial heterogeneity under growing anthropogenic pressure have been examined. 16 zones from classified LANDSAT TM scenes presenting different anthropogenic effect intensities have been used. Anthropogenic effects, compositional and configurational entropy have been measured. The scatter plot shows bell curves with maximal entropy at intermediate anthropogenic effects. Distinction of natural and anthropogenic classes shows opposed tendencies according to class and compositional/configurational type. These results have been interpreted as spatial transformation processes, energy production and release, and linked to the habitat heterogeneity and intermediate disturbance hypotheses

Anthropogenic effect on landscapes: spatial structure, ecological impact, entropy

Les paysages, ensembles d’écosystèmes en interaction, sont de plus en plus affectés par les activités humaines (anthropisation), ce qui modifie leur structure spatiale et affecte les processus biologiques qui y siègent. L’Ecologie du Paysage étudie les liens entre ces deux composantes (cf. pattern /process paradigm). L’étude présentée ici examine le lien entre anthropisation, hétérogénéité spatiale et entropie (sens thermodynamique) au niveau du paysage. 16 paysages du Bénin et de R.D.C., étudiés dans le cadre de projets de coopération universitaire, servent de base à cette étude transversale. L’hypothèse centrale de cette recherche est que l’hétérogénéité spatiale et l’entropie peuvent être modélisées en fonction de l’anthropisation des paysages avec un optimum à des niveaux intermédiaires d’anthropisation. En effet, de précédentes théories traitant d’hétérogénéité, d’anthropisation et de biodiversité (intermediate disturbance & habitat heterogeneity hypotheses) laissent supposer que la biodiversité serait maximale dans des conditions d’hétérogénéité maximale et d’anthropisation intermédiaire.Structural and thermodynamic applications of entropy related to spatial heterogeneity under growing anthropogenic pressure have been examined. 16 zones from classified LANDSAT TM scenes presenting different anthropogenic effect intensities have been used. Anthropogenic effects, compositional and configurational entropy have been measured. The scatter plot shows bell curves with maximal entropy at intermediate anthropogenic effects. Distinction of natural and anthropogenic classes shows opposed tendencies according to class and compositional/configurational type. These results have been interpreted as spatial transformation processes, energy production and release, and linked to the habitat heterogeneity and intermediate disturbance hypotheses

Anthropisation des paysages: structure spatiale, impact écologique, entropie

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Origins of Allium ampeloprasum horticultural groups and a molecular phylogeny of the section Allium (Allium: Alliacea)

The identification of a universal law that can predict the spatiotemporal structure of any entity at any scale has long been pursued. Thermodynamics have targeted this goal, and the concept of entropy has been widely applied for various disciplines and purposes, including landscape ecology. Within this discipline, however, the uses of the entropy concept and its underlying assumptions are various and are seldom described explicitly. In addition, the link between this concept and thermodynamics is unclear. The aim of this paper is to review the various interpretations and applications of entropy in landscape ecology and to sort them into clearly defined categories. First, a retrospective study of the concept genesis from thermodynamics to landscape ecology was conducted. Then, 50 landscape ecology papers that use or discuss entropy were surveyed and classified by keywords, variables and metrics identified as related to entropy. In particular, the thermodynamic component of entropy in landscape ecology and its various interpretations related to landscape structure and dynamics were considered. From the survey results, three major definitions (i.e. spatial heterogeneity, the unpredictability of pattern dynamics and pattern scale dependence) associated with the entropy concept in landscape ecology were identified. The thermodynamic interpretations of these definitions are based on different theories. The thermodynamic interpretation of spatial heterogeneity is not considered relevant. The thermodynamic interpretation related to scale dependence is also questioned by complexity theory. Only unpredictability can be thermodynamically relevant if appropriate measurements are used to test it.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Changement anthropique du paysage: synthèse des concepts et des méthodes de quantification

Anthropogenic disturbances impact the whole biosphere, at least indirectly, and are of major concern in various disciplines and policies. To tackle it, most studies, specific to their thematic, create their own reference framework without connection with related purposes in other disciplines. This results in a plethora of terms and concepts that in turn impedes addressing that issue on a comprehensive way as well as complementarity between studies. Here, we clarify and synthesize the most frequently employed terms to characterise human impact on the environment (anthropisation, naturalness, hemeroby, novel ecosystem, analogous ecosystem, climax, etc.), their synonyms, the nuances and relationships between each of them, as well as the concepts used to designate the responses given by humans to environmental disturbances (restoration, management, conservation). We go on reviewing the methods used to assess anthropogenic changes, exploring different branches of ecology and geography. The strengths and weaknesses of the existing approaches are then used as a basis to develop a new analytical framework: we propose an action-oriented type of naturalness, and we develop a general methodology to quantify landscape anthropisation. Our methodology combines object-oriented and gradient analyses. Moreover, it is based on the assessment of ecosystem disturbance, landscape configuration and dynamics as well as on easily acquired data sets. Our integrated approach of the concern could be at the basis of land planning, environmental restoration and management practices as well as policies

Assessing the peasantness degree of a farm. Lessons learned from the comparison of neighbouring farms in Wallonia, Belgium

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