Barriers to the development of palliative care in Western Europe.

UNLABELLED: The Eurobarometer Survey of the EAPC Task Force on the Development of Palliative Care in Europe is part of a programme of work to produce comprehensive information on the provision of palliative care across Europe. AIM: To identify barriers to the development of palliative care in Western Europe. METHOD: A qualitative survey was undertaken amongst boards of national associations, eliciting opinions on opportunities for, and barriers to, palliative care development. By July 2006, 44/52 (85%) European countries had responded to the survey; we report here on the results from 22/25 (88%) countries in Western Europe. ANALYSIS: Data from the Eurobarometer Survey were analysed thematically by geographical region and by the degree of development of palliative care in each country. RESULTS: From the data contained within the Eurobarometer, we identified six significant barriers to the development of palliative care in Western Europe: (i) lack of palliative care education and training programmes; (ii) lack of awareness and recognition of palliative care; (iii) limited availability of/knowledge about opioid analgesics; (iv) limited funding; (v) lack of coordination amongst services; and (vi) uneven palliative care coverage. CONCLUSION: Findings from the EAPC Eurobarometer Survey suggest that barriers to the development of palliative care in Western Europe may differ substantially from each other in both their scope and context and that some may be considered to be of greater significance than others. A number of common barriers to the development of the discipline do exist and much work still remains to be done in the identified areas. This paper provides a road map of which barriers need to be addressed.

[Torsion of the great epiploon as cause of acute abdomen]. / Torsión del epiplón mayor como causa de abdomen agudo.

Two patients with long term evolution of inguinal hernia and acute abdomen caused by torsion of the major omentum are reported. The main physiopathologic mechanisms involved in the torsion of epiploon as well as the clinical data that could enable us to suspect the diagnosis before performing laparotomy, are reviewed. After searching the literature, the low frequency of presentation of the illness is confirmed. Experience shows us that is less than 0.25 per thousand in the last 20 years.

Behavior patterns of the aplysiid gastropod Bursatella leachii in its natural habitat and in the laboratory.

The behavior of the ragged sea hare, Bursatella leachii pleii Rang, was observed in its natural habitat and in captivity. An indication of the seasonal availability of Bursatella in Puerto Rico was obtained by making multiple observations at a single site. The behavior patterns of Bursatella in the field were indicative of a daily rhythm. They tended to be found in groups at sunrise and as isolated individuals in the afternoon. They were observed to assemble following sunset and to disperse in the morning. Certain aspects of this rhythmic pattern of behavior persisted in animals held in the laboratory, where copulation was the most common behavior in the morning and feeding-related activities became more prevalent in the afternoon. Specific behaviors related to autonomic function (respiration and digestion) were also observed and quantified. It is proposed that the rich behavioral repertoire exhibited by B. leachii, and the ease with which these animals are observed in their native habitat, provide favorable systems for studying neuronal mechanisms involved in the organization and evolution of complex behavior.