Improving the responsiveness of Kitwe City Council to the needs of the stakeholders

This report is centred on the responsiveness of the KCC to the needs of the stakeholders in the city. It arose from the 2nd SINPA workshop at which a strategy for building capacity within the KCC was developed. Responsiveness was identified at this workshop as a priority area where capacity building was required in the KCC. The report has highlighted the importance of responsiveness in urban governance and the critical role that participatory decision making plays in good urban governance. It has defined responsiveness as the extend to which the KCC operates in a demand oriented manner and also the extent to which KCC performs satisfactorily in the eyes of the stakeholders. Therefore, the core of the work is centered on investigating the extent to which the KCC programmes and activities are rooted in the needs and priorities of the stakeholders. The main stakeholders have been identified as: the residents of the city; the business community and the NGOs. The TORs of the report were: (1) To identify and assess the existing structures vis-a vis responsiveness and to what extent they work in identifying the needs and priorities of the stakeholders and whether these are used in development planning by the KCC and; (2) To formulate recommendations to improve the existing structures or recommend new ones where necessary and to suggest ways in which SINPA Zambia can contribute to follow-up

Do complementary agents lower HbA1c when used with standard type 2 diabetes therapy?

Q. Do complementary agents lower HbA1c when used with standard type 2 diabetes therapy? A. No, there is no high-quality evidence that supports using complementary or alternative agents to lower hemoglobin A1c (HbA1c) in patients with noninsulin dependent type 2 diabetes. Oral chromium in widely varying doses reduces HbA1c a small amount (strength of recommendation [SOR]: C, meta-analysis of low-quality randomized, controlled trials [RCTs] of disease-oriented outcomes, with inconsistent results). Oral cinnamon 1 to 3 g/d causes a small (<0.1%) drop in HbA1c (SOR: C, meta-analysis of low-quality RCTs of disease-oriented outcomes). Fenugreek, milk thistle, safflower oil, and sweet potato extract may also reduce HbA1c (SOR: C, small, low-quality RCTs of disease-oriented outcomes)

Serum cholesterol is a risk factor for myocardial infarction in elderly men and women: The Rotterdam Study

Objective. To investigate the associations of serum total and HDL cholesterol with the risk of myocardial infarction in men and women of 55 years and over. Design. The Rotterdam Study is a population-based prospective cohort study. In total 2453 men and 3553 women of 55 years and older were included in this study. The mean duration of follow-up was 4 years. Main outcome measures. Relative risks were estimated with Cox's proportional- hazard analysis. Cholesterol was analysed as a continuous variable and in sex-specific quartiles. Results. In subjects aged 55 years and older the relative risk of myocardial infarction was 1.9 in men (95% confidence interval 1.1-3.3) and 3.2 in women (1.5-6.4) in the highest compared to the lowest serum total cholesterol quartile (Q4 vs. Q1). In men and women of 70 years and older, total cholesterol remained an important risk factor for myocardial infarction (Q4 vs. Q1 relative risk 3.2; 1.3-7.7 and 2.9; 1.3- 6.6, respectively). For HDL cholesterol, the relative risk in the highest compared to the lowest quartile (Q4 vs. Q1) was 0.5 in men (0.3-0.9) and 0.4 in women (0.2-0.9). HDL cholesterol was a weaker predictor in men after the age of 70 (Q4 vs. Q1 0.8; 0.3-2.1). In women of 70 years and older the relative risk was also not significant (Q4 vs. Q1 0.6; 0.3-1.3), although the trend over the quartiles was still significant. Conclusion. Serum total cholesterol remains an important risk factor for myocardial infarction in men and women aged 70 years and older, whilst HDL cholesterol at older age remains important in women only

Организационная модель аудита доходов санаторно-курортных предприятий

Целью статьи является определение сущности с учетом взглядов ученых и обоснование особенностей организационной модели аудита доходов санаторно-курортных организаций.Метою статті є визначення суті з урахуванням поглядів учених і обґрунтування особливостей організаційної моделі аудиту доходів санаторно-курортних організацій

Trends in stroke incidence rates and stroke risk factors in Rotterdam, the Netherlands from 1990 to 2008

Stroke incidence rates have decreased in developed countries over the past 40 years, but trends vary across populations. We investigated whether age-and-sexspecific stroke incidence rates and associated risk factors as well as preventive medication use have changed in Rotterdam in the Netherlands during the last two decades. The study was part of the Rotterdam Study, a large populationbased cohort study among elderly people. Participants were 10,994 men and women aged 55-94 years who were stroke-free at baseline. Trends were calculated by comparing the 1990 subcohort (n = 7516; baseline 1990-1993) with the 2000 subcohort (n = 2883; baseline 2000-2001). Poisson regression was used to calculate incidence rates and incidence rate ratios in age-and-sex-specific strata. We further compared the prevalence of stroke risk factors and preventive medication use in the two subcohorts. In the 1990 subcohort 467 strokes occurred during 45,428 person years; in the 2000 subcohort 115 strokes occurred in 18,356 person years. Comparing the subcohorts, incidence rates decreased by 34% in men, but remained unchanged in women. Blood pressure levels increased between 1990 and 2000, whereas the proportion of current cigarette smokers decreased in men, but not in women. There was a strong increase in medication use for treatment of stroke risk factors across all age categories in both sexes. Our findings suggest that in Rotterdam between 1990 and 2008 stroke incidence rates have decreased in men but not in women

Parameterization of oceanic whitecap fraction based on satellite observations

In this study, the utility of satellite-based white-cap fraction (W) data for the prediction of sea spray aerosol (SSA) emission rates is explored. More specifically, the study aims at evaluating how an account for natural variability of whitecaps in the W parameterization would affect SSA mass flux predictions when using a sea spray source function (SSSF) based on the discrete whitecap method. The starting point is a data set containing W data for 2006 together with matching wind speed U-10 and sea surface temperature (SST) T. Whitecap fraction W was estimated from observations of the ocean surface brightness temperature T-B by satellite-borne radiometers at two frequencies (10 and 37 GHz). A global-scale assessment of the data set yielded approximately quadratic correlation between W and U-10. A new global W(U-10) parameterization was developed and used to evaluate an intrinsic correlation between W and U-10 that could have been introduced while estimating W from T B. A regional-scale analysis over different seasons indicated significant differences of the coefficients of regional W(U-10) relationships. The effect of SST on W is explicitly accounted for in a new W(U-10, T) parameterization. The analysis of W values obtained with the new W(U-10) and W(U-10, T) parameterizations indicates that the influence of secondary factors on W is for the largest part embedded in the exponent of the wind speed dependence. In addition, the W(U-10, T) parameterization is able to partially model the spread (or variability) of the satellite-based W data. The satellite-based parameterization W(U-10, T) was applied in an SSSF to estimate the global SSA emission rate. The thus obtained SSA production rate for 2006 of 4.4 x 10(12) kg year(-1) is within previously reported estimates, however with distinctly different spatial distribution.Peer reviewe

Insulin resistance and the risk of stroke and stroke subtypes in the nondiabetic elderly

Insulin resistance, which plays a key role in the development of diabetes mellitus, is a putative modifiable risk factor for stroke. The aim of this study was to investigate if markers of insulin resistance were associated with risk of stroke in the general elderly population. This study was part of the large population-based Rotterdam Study and included 5,234 participants who were aged 55 years or older and stroke free and diabetes free at baseline (1997-2001). Fasting insulin levels and homeostasis model assessment for insulin resistance were used as markers for insulin resistance. Cox regression was used to determine associations between insulin resistance markers and stroke risk, adjusted for age, sex, and potential confounders. During 42,806 person-years of follow-up (median: 8.6 years), 366 first-ever strokes occurred, of which 225 were cerebral infarctions, 42 were intracerebral hemorrhages, and 99 were unspecified strokes. Fasting insulin levels were not associated with risk of any stroke, cerebral infarction, or intracerebral hemorrhage. Homeostasis model assessment for insulin resistance, which almost perfectly correlated with fasting insulin levels, was also not associated with risk of stroke or stroke subtypes. In conclusion, in this population-based cohort study among nondiabetic elderly, insulin resistance markers were not associated with risk of stroke or any of its subtypes