ABSTRACT
Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are chronic immune-mediated diseases with a high incidence and prevalence in Europe. Since these are diseases with associated disability, they require complex management and the availability of high-quality healthcare resources. We focused on the analysis of IBD care in selected countries of Central and Eastern Europe (Croatia, the Czech Republic, Hungary, Moldova, Poland, Romania and Slovakia) targeting the availability and reimbursement of diagnostic and therapeutic modalities, the role of IBD centers and also education and research in IBD. As part of the analysis, we created a questionnaire of 73 statements organized in three topics: (1) diagnostics, follow-up and screening, (2) medications and (3) IBD centers. The questionnaire was filled out by co-authoring IBD experts from individual countries, and then the answers and comments on the questionnaire were analyzed. We identified that despite the financial burden, which still partially persists in the region, the availability of some of the cost-saving tools (calprotectin test, therapeutic drug monitoring) differs among countries, mainly due to variable reimbursement from country to country. In most participating countries, there also remains a lack of dedicated dietary and psychological counseling, which is often replaced by recommendations offered by gastroenterologists. However, there is adequate availability of most of the currently recommended diagnostic methods and therapies in each participating country, as well as the implementation of established IBD centers in the region.
ABSTRACT
Environmental assessment models are used as decision-aiding tools in the selection of remediation options for radioactively contaminated sites. In most cases, the effectiveness of the remedial actions in terms of dose savings cannot be demonstrated directly, but can be established with the help of environmental assessment models, through the assessment of future radiological impacts. It should be emphasized that, given the complexity of the processes involved and our current understanding of how they operate, these models are simplified descriptions of the behaviour of radionuclides in the environment and therefore imperfect. One way of testing and improving the reliability of the models is to compare their predictions with real data and/or the predictions of other models. Within the framework of the Remediation Assessment Working Group (RAWG) of the BIOMASS (BIOsphere Modelling and ASSessment) programme coordinated by IAEA, two scenarios were constructed and applied to test the reliability of environmental assessment models when remedial actions are involved. As a test site, an area of approximately 100 ha contaminated by the discharges of an old radium extraction plant in Olen (Belgium) has been considered. In the first scenario, a real situation was evaluated and model predictions were compared with measured data. In the second scenario the model predictions for specific hypothetical but realistic situations were compared. Most of the biosphere models were not developed to assess the performance of remedial actions and had to be modified for this purpose. It was demonstrated clearly that the modeller's experience and familiarity with the mathematical model, the site and with the scenario play a very important role in the outcome of the model calculations. More model testing studies, preferably for real situations, are needed in order to improve the models and modelling methods and to expand the areas in which the models are applicable.
