Suchergebnisse

Background: Suicide is a global preventable public health problem. About a quarter of all suicides in the world occur in South Asia. As means restriction is an important suicide prevention strategy, gaining knowledge of the common suicide methods and their changing trends in each country and region is crucial. Aims: We aimed to assess the suicide methods in South Asian countries over the last two decades. Methods: A search was performed in PubMed, PubMed Central, Scopus, and Google Scholar with the search terms. Original articles of quantitative studies, published in the English language, from 2001 to 2020, with full-accessible text, that rank different methods of suicide in eight South Asian countries, were included. Results: A total of 68 studies were found eligible for review. The Maximum number of studies were found from India ( n = 38), followed by Bangladesh ( n = 12), Pakistan ( n = 9), Sri Lanka ( n = 6), and Nepal ( n = 3). Hanging ( n = 40, 55.8%) and poisoning ( n = 24, 35.3%) were the two most common suicide methods reported, in that order. Hanging followed by poisoning were the commonest suicide methods in Bangladesh, India, and Pakistan while in Sri Lanka, poisoning was the preferred method to hanging. There is a decline in suicide by poisoning and an increase in suicide by hanging in Sri Lanka, Bangladesh, and India. Although hanging is still the commonest method in Pakistan, the use of firearms is growing in recent years (2011–2020). Conclusions: There is a steady decline in the incidence of suicides by poisoning following pesticide regulations in South Asian countries. However, there is heterogeneity of study methods, probable under-reporting of suicide, and lack of robust suicide data.

BACKGROUND: Traumatic brain injury (TBI) is an important global public health burden, where those injured by high-energy transfer (e.g., road traffic collisions) are assumed to have more severe injury and are prioritised by emergency medical service trauma triage tools. However recent studies suggest an increasing TBI disease burden in older people injured through low-energy falls. We aimed to assess the prevalence of low-energy falls among patients presenting to hospital with TBI, and to compare their characteristics, care pathways, and outcomes to TBI caused by high-energy trauma. METHODS AND FINDINGS: We conducted a comparative cohort study utilising the CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) Registry, which recorded patient demographics, injury, care pathway, and acute care outcome data in 56 acute trauma receiving hospitals across 18 countries (17 countries in Europe and Israel). Patients presenting with TBI and indications for computed tomography (CT) brain scan between 2014 to 2018 were purposively sampled. The main study outcomes were (i) the prevalence of low-energy falls causing TBI within the overall cohort and (ii) comparisons of TBI patients injured by low-energy falls to TBI patients injured by high-energy transfer-in terms of demographic and injury characteristics, care pathways, and hospital mortality. In total, 22,782 eligible patients were enrolled, and study outcomes were analysed for 21,681 TBI patients with known injury mechanism; 40% (95% CI 39% to 41%) (8,622/21,681) of patients with TBI were injured by low-energy falls. Compared to 13,059 patients injured by high-energy transfer (HE cohort), the those injured through low-energy falls (LE cohort) were older (LE cohort, median 74 [IQR 56 to 84] years, versus HE cohort, median 42 [IQR 25 to 60] years; p < 0.001), more often female (LE cohort, 50% [95% CI 48% to 51%], versus HE cohort, 32% [95% CI 31% to 34%]; p < 0.001), more frequently taking pre-injury anticoagulants or/and platelet aggregation inhibitors (LE cohort, 44% [95% CI 42% to 45%], versus HE cohort, 13% [95% CI 11% to 14%]; p < 0.001), and less often presenting with moderately or severely impaired conscious level (LE cohort, 7.8% [95% CI 5.6% to 9.8%], versus HE cohort, 10% [95% CI 8.7% to 12%]; p < 0.001), but had similar in-hospital mortality (LE cohort, 6.3% [95% CI 4.2% to 8.3%], versus HE cohort, 7.0% [95% CI 5.3% to 8.6%]; p = 0.83). The CT brain scan traumatic abnormality rate was 3% lower in the LE cohort (LE cohort, 29% [95% CI 27% to 31%], versus HE cohort, 32% [95% CI 31% to 34%]; p < 0.001); individuals in the LE cohort were 50% less likely to receive critical care (LE cohort, 12% [95% CI 9.5% to 13%], versus HE cohort, 24% [95% CI 23% to 26%]; p < 0.001) or emergency interventions (LE cohort, 7.5% [95% CI 5.4% to 9.5%], versus HE cohort, 13% [95% CI 12% to 15%]; p < 0.001) than patients injured by high-energy transfer. The purposive sampling strategy and censorship of patient outcomes beyond hospital discharge are the main study limitations. CONCLUSIONS: We observed that patients sustaining TBI from low-energy falls are an important component of the TBI disease burden and a distinct demographic cohort; further, our findings suggest that energy transfer may not predict intracranial injury or acute care mortality in patients with TBI presenting to hospital. This suggests that factors beyond energy transfer level may be more relevant to prehospital and emergency department TBI triage in older people. A specific focus to improve prevention and care for patients sustaining TBI from low-energy falls is required. ; CENTER-TBI was supported by the European Union 7th Framework program (EC grant 602150), recipient A.I.R. Maas. Additional funding was obtained from the Hannelore Kohl Stiftung (Germany) - recipient A.I.R. Maas, from OneMind (USA) - recipient A.I.R. Maas and from Integra LifeSciences Corporation (USA) - recipient A.I.R. Maas. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

BACKGROUND: The European Union (EU) aims to optimize patient protection and efficiency of health-care research by harmonizing procedures across Member States. Nonetheless, further improvements are required to increase multicenter research efficiency. We investigated IRB procedures in a large prospective European multicenter study on traumatic brain injury (TBI), aiming to inform and stimulate initiatives to improve efficiency. METHODS: We reviewed relevant documents regarding IRB submission and IRB approval from European neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Documents included detailed information on IRB procedures and the duration from IRB submission until approval(s). They were translated and analyzed to determine the level of harmonization of IRB procedures within Europe. RESULTS: From 18 countries, 66 centers provided the requested documents. The primary IRB review was conducted centrally (N = 11, 61%) or locally (N = 7, 39%) and primary IRB approval was obtained after one (N = 8, 44%), two (N = 6, 33%) or three (N = 4, 23%) review rounds with a median duration of respectively 50 and 98 days until primary IRB approval. Additional IRB approval was required in 55% of countries and could increase duration to 535 days. Total duration from submission until required IRB approval was obtained was 114 days (IQR 75–224) and appeared to be shorter after submission to local IRBs compared to central IRBs (50 vs. 138 days, p = 0.0074). CONCLUSION: We found variation in IRB procedures between and within European countries. There were differences in submission and approval requirements, number of review rounds and total duration. Research collaborations could benefit from the implementation of more uniform legislation and regulation while acknowledging local cultural habits and moral values between countries.

BACKGROUND: The European Union (EU) aims to optimize patient protection and efficiency of health-care research by harmonizing procedures across Member States. Nonetheless, further improvements are required to increase multicenter research efficiency. We investigated IRB procedures in a large prospective European multicenter study on traumatic brain injury (TBI), aiming to inform and stimulate initiatives to improve efficiency. METHODS: We reviewed relevant documents regarding IRB submission and IRB approval from European neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Documents included detailed information on IRB procedures and the duration from IRB submission until approval(s). They were translated and analyzed to determine the level of harmonization of IRB procedures within Europe. RESULTS: From 18 countries, 66 centers provided the requested documents. The primary IRB review was conducted centrally (N = 11, 61%) or locally (N = 7, 39%) and primary IRB approval was obtained after one (N = 8, 44%), two (N = 6, 33%) or three (N = 4, 23%) review rounds with a median duration of respectively 50 and 98 days until primary IRB approval. Additional IRB approval was required in 55% of countries and could increase duration to 535 days. Total duration from submission until required IRB approval was obtained was 114 days (IQR 75-224) and appeared to be shorter after submission to local IRBs compared to central IRBs (50 vs. 138 days, p = 0.0074). CONCLUSION: We found variation in IRB procedures between and within European countries. There were differences in submission and approval requirements, number of review rounds and total duration. Research collaborations could benefit from the implementation of more uniform legislation and regulation while acknowledging local cultural habits and moral values between countries.

BACKGROUND: Traumatic brain injury is a major cause of death and severe disability worldwide with 1,000,000 hospital admissions per annum throughout the European Union.Therapeutic hypothermia to reduce intracranial hypertension may improve patient outcome but key issues are length of hypothermia treatment and speed of re-warming. A recent meta-analysis showed improved outcome when hypothermia was continued for between 48 hours and 5 days and patients were re-warmed slowly (1 °C/4 hours). Previous experience with cooling also appears to be important if complications, which may outweigh the benefits of hypothermia, are to be avoided. METHODS/DESIGN: This is a pragmatic, multi-centre randomised controlled trial examining the effects of hypothermia 32-35 °C, titrated to reduce intracranial pressure 20 mmHg in accordance with the Brain Trauma Foundation Guidelines, 2007. DISCUSSION: The Eurotherm3235Trial is the most important clinical trial in critical care ever conceived by European intensive care medicine, because it was launched and funded by the European Society of Intensive Care Medicine and will be the largest non-commercial randomised controlled trial due to the substantial number of centres required to deliver the target number of patients. It represents a new and fundamental step for intensive care medicine in Europe. Recruitment will continue until January 2013 and interested clinicians from intensive care units worldwide can still join this important collaboration by contacting the Trial Coordinating Team via the trial website http://www.eurotherm3235trial.eu. TRIAL REGISTRATION: Current Controlled Trials ISRCTN34555414.

<i>Aim:</i> Our goal wasto produce a field synopsis of genetic associations with preterm birth and to set up a publicly available online database summarizing the data. <i>Methods:</i> We performed a systematic review and meta-analyses to identify genetic associations with preterm birth. We have set up a publicly available online database of genetic association data on preterm birth called PTBGene (http://ric.einstein.yu.edu/ptbgene/index.html) and report on a structured synopsis thereof as of December 1, 2008. <i>Results:</i> Data on 189 polymorphisms in 84 genes have been included and 36 meta-analyses have been performed. Five gene variants (4 in maternal DNA, one in newborn DNA) have shown nominally significant associations, but all have weak epidemiological credibility. <i>Conclusion:</i> After publishing this field synopsis, the PTBGene database will be regularly updated to keep track of the evolving evidence base of genetic factors in preterm birth with the goal of promoting knowledge sharing and multicenter collaboration among preterm birth research groups.

Die Welt nähert sich dem Jahr 2015 und damit dem Ablauf der Frist zum Erreichen der Millenniumsentwicklungsziele (MDGs), die unter anderem die Halbierung des Anteils hungernder Menschen anstreben. Gerade zu diesem Zeitpunkt bietet der Welthunger-Index (WHI) eine nützliche und mehrdimensionale Momentaufnahme der weltweiten Hungersituation. Der weltweite WHI-Wert 2010 zeigt gegenüber dem WHI 1990 eine Verbesserung: Er ist um fast ein Viertel gesunken. Dennoch bleibt der WHI weltweit auf einem Niveau, das als ernst zu bezeichnen ist. Dies überrascht nicht, wenn man bedenkt, dass die Gesamtzahl der hungernden Menschen 2009 die Milliardengrenze überschritten hatte. Die höchsten regionalen WHI-Werte erzielen Südasien und Afrika südlich der Sahara, wobei Südasien seit 1990 deutlich größere Fortschritte gemacht hat. Dort geht der hohe Anteil untergewichtiger Kinder unter fünf Jahren zu einem großen Teil auf den schlechten Ernährungs-, Bildungs- und Sozialstatus der Frauen zurück. In Afrika südlich der Sahara erklären sich dagegen die hohe Kindersterblichkeit und der hohe Anteil an Menschen, die ihren Kalorienbedarf nicht decken können, hauptsächlich aus einer schlechten Regierungsführung, Konflikten, politischer Instabilität und hohen HIV-/Aids-Raten. Einige Staaten haben bedeutende Fortschritte bei der Bekämpfung des Hungers erzielt: Zwischen 1990 und 2010 konnten Angola, Äthiopien, Ghana, Mosambik, Nicaragua und Vietnam ihre absoluten Werte im WHI besonders deutlich verbessern. In 29 Ländern ist die Hungersituation noch immer gravierend beziehungsweise sehr ernst. Die Länder mit gravierenden WHI-2010-Werten – Burundi, die Demokratische Republik Kongo, Eritrea und der Tschad – liegen in Afrika südlich der Sahara. Sehr ernste WHI-Werte sind in afrikanischen Ländern südlich der Sahara und in Südasien zu finden. Die deutlichste Verschlechterung der WHI-Werte zeigte die Demokratische Republik Kongo, größtenteils aufgrund von Konflikten und politischer Instabilität. Wirtschaftliche Leistung und Hunger stehen in negativer Korrelation zueinander. Länder mit einem hohen Bruttonationaleinkommen (BNE) pro Kopf, ein wichtiger Messwert für wirtschaftliche Leistung, haben in der Regel niedrige WHI-Werte, während Länder mit einem niedrigen BNE pro Kopf eher hohe WHI-Werte aufweisen. Dieser Zusammenhang besteht jedoch nicht immer. Konflikte, Krankheiten, ungleiche Einkommensverteilung, schlechte Regierungsführung und Diskriminierung von Frauen sind Faktoren, die die Hungersituation in einem Land gegenüber dem, was gemäß dem BNE zu erwarten wäre, verschlechtern können. Andersherum können breitenwirksames wirtschaftliches Wachstum, eine starke Landwirtschaft und die verbesserte Gleichberechtigung von Mann und Frau den Hunger-Index gegenüber dem, was das BNE erwarten ließe, verbessern. Ein hoher Anteil von unterernährten Kindern trägt entscheidend dazu bei, dass Hunger weiterhin existiert. Global gesehen trägt Untergewicht bei Kindern am meisten zum weltweiten WHI-Wert bei. Obwohl der Anteil der untergewichtigen Kinder unter fünf Jahren nur eines von drei Elementen des WHI darstellt, ist er für fast die Hälfte des globalen WHI-Werts verantwortlich. Das Auftreten von Unterernährung bei Kindern ist dabei nicht gleichmäßig über den Globus verteilt, sondern konzentriert sich auf wenige Länder und Regionen. Über 90 Prozent der stunted Kinder (Kinder, die für ihr Alter zu klein sind) weltweit leben in Afrika und Asien, wo die Stunting-Raten von Kindern 40 beziehungsweise 36 Prozent betragen. Um ihre WHI-Werte zu verbessern, müssen die Länder die Bekämpfung der Unterernährung von Kindern vorantreiben. Neue Belege zeigen, dass das entscheidende Handlungsfenster zur Verbesserung der Ernährungssituation von Kindern den Alterszeitraum -9 bis +24 Monate umfasst (also die 1.000 Tage zwischen Empfängnis und der Vollendung des zweiten Lebensjahres). In diesem Zeitraum haben Kinder den größten Bedarf an nahrhafter Kost, Gesundheitsvorsorge und medizinischer Behandlung sowie einer altersgerechten Fürsorge für eine gesunde Entwicklung. Zudem beugen innerhalb dieser Zeitspanne entsprechende Maßnahmen einer Unterernährung am wirkungsvollsten vor. Ab einem Alter von zwei Jahren hingegen lassen sich die Folgen von Unterernährung größtenteils nicht mehr rückgängig machen. Um der Unterernährung bei Kindern entgegenzuwirken, müssten die Regierungen in wirksame Ernährungsprogramme investieren, die innerhalb dieses Handlungsfensters sowohl bei den Müttern als auch bei den Kindern ansetzen. Diese Maßnahmen müssten auf eine bessere Ernährung der Mütter während Schwangerschaft und Stillzeit abzielen, gesunde Stillpraktiken und altersgemäße Beikostgabe fördern, wichtige Mikronährstoffe zur Verfügung stellen, die Anreicherung der Nahrung mit Jodsalz fördern sowie angemessene Schutzimpfungen gewährleisten. Eine umfangreiche Umsetzung dieser Maßnahmen wird eine schnelle Verbesserung der Ernährungssituation in der frühen Kindheit zur Folge haben. Die Regierungen sollten zudem die indirekten Ursachen der Unterernährung wie Ernährungsunsicherheit, begrenzter Zugang zu medizinischer Versorgung sowie unzureichende Versorgungs- und Ernährungspraktiken, die durch Armut und mangelnde Gleichberechtigung verstärkt werden, stärker in ihre Politik einbeziehen. Strategien zur Armutsbekämpfung, die auf eine Verminderung von Ungleichheit ausgerichtet sind, sind daher ebenso Teil der Bekämpfung frühkindlicher Unterernährung wie politische Maßnahmen zur Verbesserung der Gesundheit, der Ernährungssituation und des sozialen Status von Frauen und Mädchen. ; PR ; IFPRI1; GRP24 ; DGO; PHND; COM

Mentre il mondo si avvicina alla scadenza fi ssata nel 2015 per il raggiungimento degli Obiettivi di Sviluppo del Millennio (MDG, Millennium Development Goals) - tra i quali rientra il dimezzamento della percentuale di persone che soffrono la fame - l'Indice Globale della Fame (GHI, Global Hunger Index) 2010 offre una utile fotografi a pluridimensionale della fame nel mondo. Il GHI 2010 mostra alcuni miglioramenti rispetto al GHI 1990, essendo diminuito di un quarto. Cionononostante, l'indice della fame nel mondo resta a un livello "grave". Questo risultato non sorprende se si pensa che il numero complessivo di persone affamate ha superato il miliardo nel 2009. I punteggi più elevati di GHI a livello regionale si registrano in Asia meridionale e Africa subsahariana, ma l'Asia meridionale ha fatto molti più progressi rispetto al 1990. In Asia meridionale, tra i principali fattori che contribuiscono a un'alta prevalenza dei bambini sottopeso in età compresa tra 0 e 5 anni, ci sono lo scarso accesso delle donne a una nutrizione ed educazione adeguate e il loro basso status sociale. In Africa subsahariana, invece, la scarsa effi cienza dei governi, i confl itti, l'instabilità politica e gli alti tassi di HIV e AIDS sono tra i principali fattori responsabili dell'alta mortalità infantile e dell'alta percentuale di persone che non possono soddisfare il proprio fabbisogno calorico. Alcuni paesi hanno fatto passi avanti signifi cativi in termini assolutinel miglioramento del proprio GHI. I progressi più evidenti tra il GHI 1990 e il GHI 2010 si sono registrati in Angola, Etiopia, Ghana, Mozambico, Nicaragua e Vietnam. Ventinove paesi hanno comunque ancora livelli di fame "estremamente allarmanti" o "allarmanti". I paesi con punteggi di GHI 2010 "estremamente allarmanti" - Burundi, Ciad, Repubblica Democratica del Congo e Eritrea - sono in Africa subsahariana. La maggior parte dei paesi con punteggi di GHI "allarmanti" sono in Africa subsahariana e in Asia meridionale. Il più grave deterioramento dei livelli di GHI si è registrato nella Repubblica Democratica del Congo, in gran parte a causa dei confl itti e dell'instabilità politica. Prestazioni economiche e fame sono inversamente correlate. I paesi con alti livelli di reddito nazionale lordo (RNL) pro capite - un'importante misura dell'attività economica - hanno tendenzialmente bassi punteggi di GHI 2010, e i paesi con bassi livelli di RNL pro capite hanno tendenzialmente alti punteggi di GHI. Ma questa non è una relazione sempre valida. Confl itti, malattie, disuguaglianze, cattive pratiche di governo e discriminazione di genere sono fattori che possono rendere il livello di fame di un paese più alto di quanto ci si aspetterebbe sulla base del suo reddito. Al contrario, una crescita economica favorevole ai poveri, una solida attività agricola e una crescente parità di genere possono ridurre la fame oltre i livelli attesi sulla base delle entrate procapite. L'alta prevalenza della denutrizione infantile è uno dei fattori maggiormente responsabili della persistenza della fame. A livello generale, il fattore che più contribuisce al livello di GHI mondiale è l'insuffi cienza di peso tra i bambini. Anche se la percentuale di insuffi cienza di peso nei bambini al di sotto dei cinque anni è solo uno dei tre elementi che compongono il GHI, è responsabile di quasi la metà del punteggio mondiale di GHI. La denutrizione infantile non è uniformemente diffusa nel mondo, ma piuttosto si concentra in pochi paesi e regioni. Oltre il 90% dei bambini al mondo che soffrono di ritardi nella crescita (bambini la cui statura è inadeguata in rapporto all'età) vivono in Africa e in Asia, dove i tassi di ritardo nella crescita sono rispettivamente al 40 e al 36%. Per migliorare i rispettivi punteggi di GHI, ai paesi servono progressi più rapidi nella riduzione della denutrizione infantile. Dati recenti mostrano che l'intervallo utile per migliorare l'alimentazione del bambino va dai -9 ai +24 mesi (ovvero i mille giorni che intercorrono tra il momento del concepimento e il secondo compleanno). È in questa fase che i bambini hanno maggior necessità di adeguate quantità di cibo nutriente, di assistenza sanitaria preventiva e curativa, e di cure adatte alla loro età che favoriscano uno sviluppo sano; inoltre è il momento in cui gli interventi hanno più probabilità di prevenire l'insorgere di uno stato di malnutrizione. Dopo i due anni di età, gli effetti della sottonutrizione sono in gran parte irreversibili. Per ridurre la malnutrizione infantile, i governi dovrebbero investire in interventi alimentari effettivi diretti alle madri e ai fi gli durante i primi mille giorni. Questi interventi dovrebbero concentrarsi sul miglioramento dell'alimentazione materna durante la gravidanza e l'allattamento, promuovendo un corretto allattamento al seno e pratiche alimentari integrative, fornendo i micronutrienti essenziali, praticando la iodurazione del sale e garantendo al contempo appropriate vaccinazioni. Un'elevata copertura di questi interventi potrebbe comportare un rapido miglioramento dell'alimentazione della prima infanzia. I governi dovrebbero anche adottare strategie in grado di affrontare con più ampio respiro le cause alla radice della sottonutrizione, come l'insicurezza alimentare, la mancanza di accesso ai servizi sanitari e le cattive pratiche nutrizionali e di cura del bambino: problemi resi ancor più gravi dalla povertà e dalla disparità di genere. Le strategie di riduzione della povertà basate sulla riduzione delle disuguaglianze sono quindi parte della soluzione dei problemi di alimentazione nella prima infanzia, così come le politiche mirate al miglioramento della salute, dell'alimentazione e dello status sociale delle bambine e delle donne. ; PR ; IFPRI1; GRP24 ; COM; DGO; PHND

In 2012, Tetrodotoxin (TTX) was identified in mussels and linked to the presence of Prorocentrum minimum (P. minimum) in Greece. The connexion between TTX and P. minimum was further studied in this paper. First, the presence of TTX-producer bacteria, Vibrio and Pseudomonas spp, was confirmed in Greek mussels. In addition these samples showed high activity as inhibitors of sodium currents (INa). P. minimum was before associated with neurotoxic symptoms, however, the nature and structure of toxins produced by this dinoflagellate remains unknown. Three P. minimum strains, ccmp1529, ccmp2811 and ccmp2956, growing in different conditions of temperature, salinity and light were used to study the production of toxic compounds. Electrophysiological assays showed no effect of ccmp2811 strain on INa, while ccmp1529 and ccmp2956 strains were able to significantly reduce INa in the same way as TTX. In these samples two new compounds, m/z 265 and m/z 308, were identified and characterized by liquid chromatography tandem high-resolution mass spectrometry. Besides, two TTX-related bacteria, Roseobacter and Vibrio sp, were observed. These results show for the first time that P. minimum produce TTX-like compounds with a similar ion pattern and C9-base to TTX analogues and with the same effect on INa ; Inés Rodríguez is supported by a fellowship from Subprograma de Formación de Personal Investigador MINECO (AGL2012-40185-CO2-01), Spain. The research leading to these results has received funding from the following FEDER cofunded-grants. From CDTI and Technological Funds, supported by Ministerio de Economía y Competitividad, AGL2012-40185-CO2-01, AGL2014-58210-R, and Consellería de Cultura, Educación e Ordenación Universitaria, GRC2013-016. From CDTI under ISIP Programme, Spain, IDI-20130304 APTAFOOD. From the European Union's Seventh Framework Programme managed by REA – Research Executive Agency (FP7/2007-2013) under grant agreement 312184 PHARMASEA. ; SI

Vegetated coastal ecosystems provide goods and services to billions of people. In the aftermath of a series of recent natural disasters, including the Indian Ocean Tsunami, Hurricane Katrina and Cyclone Nargis, coastal vegetation has been widely promoted for the purpose of reducing the impact of large storm surges and tsunami. In this paper, we review the use of coastal vegetation as a "bioshield" against these extreme events. Our objective is to alter bioshield policy and reduce the long-term negative consequences for biodiversity and human capital. We begin with an overview of the scientific literature, in particular focusing on studies published since the Indian Ocean Tsunami in 2004 and discuss the science of wave attenuation by vegetation. We then explore case studies from the Indian subcontinent and evaluate the detrimental impacts bioshield plantations can have upon native ecosystems, drawing a distinction between coastal restoration and the introduction of exotic species in inappropriate locations. Finally, we place bioshield policies into a political context, and outline a new direction for coastal vegetation policy and research. ©2009 Wiley Periodicals, Inc. ; SCOPUS: re.j ; info:eu-repo/semantics/published

Vegetated coastal ecosystems provide goods and services to billions of people. In the aftermath of a series of recent natural disasters, including the Indian Ocean Tsunami, Hurricane Katrina and Cyclone Nargis, coastal vegetation has been widely promoted for the purpose of reducing the impact of large storm surges and tsunami. In this paper, we review the use of coastal vegetation as a "bioshield" against these extreme events. Our objective is to alter bioshield policy and reduce the long-term negative consequences for biodiversity and human capital. We begin with an overview of the scientific literature, in particular focusing on studies published since the Indian Ocean Tsunami in 2004 and discuss the science of wave attenuation by vegetation. We then explore case studies from the Indian subcontinent and evaluate the detrimental impacts bioshield plantations can have upon native ecosystems, drawing a distinction between coastal restoration and the introduction of exotic species in inappropriate locations. Finally, we place bioshield policies into a political context, and outline a new direction for coastal vegetation policy and research.

Funding Information: The author(s) have made the following disclosure(s): R.G.: Personal fees ? Heidelberg Engineering.S.S.: Grants and personal fees ? Bayer, during the conduct of the study; Grants and personal fees ? Novartis, Boehringer Ingleheim; Grants ? Allergan, Roche; Personal fees ? Apellis, Oxurion, Heidelberg Engineering, Optos, outside the submitted work; Funded by the Moorfields Biomedical Research Centre and Clinical Research Facility.The project was funded by the National Institute for Health Research Health Technology Assessment Programme (Project Number: 12/142/07) and will be published in full in Health Technology Assessment. The Health Services Research Unit and the Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate. F.G.: Grants ? NIHR, during the conduct of the study; Grants and personal fees ? Novartis, Roche, Bayer; Personal fees ? Allergan, Alimera; Grants ? Chengdu Pharma; Grants and nonfinancial support ? NIHR, outside the submitted work. J.A.C.: Study grant ? NIHR. K.B.: Grants ? NIHR HTA Programme, during the conduct of the study. Obtained funding: Chakravarthy, Ramsay, Sivaprasad, Scotland, Azuara-Blanco, Heiman and Cook Publisher Copyright: © 2021 ; Peer reviewed ; Publisher PDF