De afgelopen maanden is de Hongaarse overheid druk bezig geweest met bezoekjes aan Brussel om de Europese Commissie te overtuigen van de puike staat van de rechtsstaat in Hongarije. Reden voor deze bezoeken van de Hongaarse regering is het voorstel van de Europese Commissie om het uitkeren van EU-fondsen aan een lidstaat te blokkeren. Eurocommissaris Hahn stelt dat Hongarije mogelijk zo’n €7,5 miljard aan EU-fondsen misloopt als het niet snel 17 afgesproken hervormingen doorvoert die de rechtsstaat waarborgen. Het zou gaan om 65% van de voor Hongarije beschikbare middelen van de cohesiefondsen.
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BackgroundMechanical ventilation affects the respiratory muscles, but little is known about long-term recovery of respiratory muscle weakness (RMW) and potential associations with physical functioning in survivors of critical illness. The aim of this study was to investigate the course of recovery of RMW and its association with functional outcomes in patients who received mechanical ventilation.MethodsWe conducted a prospective cohort study with 6-month follow-up among survivors of critical illness who received ≥ 48 hours of invasive mechanical ventilation. Primary outcomes, measured at 3 timepoints, were maximal inspiratory and expiratory pressures (MIP/MEP). Secondary outcomes were functional exercise capacity (FEC) and handgrip strength (HGS). Longitudinal changes in outcomes and potential associations between MIP/MEP, predictor variables, and secondary outcomes were investigated through linear mixed model analysis.ResultsA total of 59 participants (male: 64%, median age [IQR]: 62 [53–66]) were included in this study with a median (IQR) ICU and hospital length of stay of 11 (8–21) and 35 (21–52) days respectively. While all measures were well below predicted values at hospital discharge (MIP: 68.4%, MEP 76.0%, HGS 73.3% of predicted and FEC 54.8 steps/2m), significant 6-month recovery was seen for all outcomes. Multivariate analyses showed longitudinal associations between older age and decreased MIP and FEC, and longer hospital length of stay and decreased MIP and HGS outcomes. In crude models, significant, longitudinal associations were found between MIP/MEP and FEC and HGS outcomes. While these associations remained in most adjusted models, an interaction effect was observed for sex.ConclusionRMW was observed directly after hospital discharge while 6-month recovery to predicted values was noted for all outcomes. Longitudinal associations were found between MIP and MEP and more commonly used measures for physical functioning, highlighting the need for continued assessment of respiratory muscle strength in deconditioned patients who are discharged from ICU. The potential of targeted training extending beyond ICU and hospital discharge should be further explored.
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European clothing consumption has increased dramatically in recent decades, leading to a current average of 26 kg of textiles annually purchased per capita (EEA, 2019). While garments (and most of clothing’s environmental impacts) are produced in other parts of the world, European municipalities face a problem of increasing volumes of textile waste. Moreover, the revised waste directive of 2018 specifies that European Union countries will be obliged to collect textiles separately by 2025. This study investigates how these phenomena are affecting city-level policy and strategy, including but not limited to textile waste management. It builds on a comparative analysis of official documents informed by interviews with policy makers and waste management authorities in five European cities. The research points out that, in these cities, clothing environmental policy and other public initiatives are at varied levels of development. The paper identifies three kinds of measures, namely (a) improving separate collection, (b) waste prevention, and (c) consumption reduction. Reducing the share of textiles disposed of in general household waste (and therefore increasing separate collection) has been a central aim in cities where textiles fall under local waste regulation. The waste directive mentioned above makes separate collection of all textiles compulsory for EU members, leading to revisions in some cities’ collection systems. Some municipalities have gone one step further in preventing these textiles from reaching waste streams by supporting local initiatives for repair and reuse. The most advanced and recent approach is aiming at reductions in new clothing demand through citizen campaigns and monitoring the effect of repair and reuse actions in consumption levels. The comparative analysis leads to recommendations for future policy and strategy including developing the three approaches mentioned above simultaneously, further exploring measures for consumption reduction, and the integration of more concrete targets and monitoring plans, so that the most effective paths in social and environmental terms can be identified.
