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Modern agriculture is associated with numerous environmental predicaments, such as land degradation, water pollution, and greenhouse gas emission. Socio-economically, it is characterized by a treadmill of technological change, increased mechanization, and economic consolidation, while depressing economic returns to farmers. A root cause is the dominance of annual plants cultivated in monocultures. Annual crops require the yearly clearing of vegetation resulting in soil erosion and other forms of ecosystem degradation. Monocultures are susceptible to agricultural pests and weeds. By contrast, perennial polycultures informed by natural ecosystems, promise more sustainable agroecosystems with the potential to also revitalize the economic foundation of farming and hence rural societies.
Adaptation to climate change impacts has eventually become widely accepted in science and climate policy as an inevitable social process in need of extensive funding and explicit action (Stern 2006; Pielke et al. 2007). From a geopolitical perspective the promotion of adaptation is a step forward to overcome political tensions between a focus on mitigation in richer countries versus a focus on adaptation in poorer countries.
From a sustainability point of view it is of great concern to ensure that adaptation reaches and involves vulnerable people in places exposed to climate change impacts and responses. The acceptance and promotion of adaptation in science and policy circles alike may represent a promise for such vulnerable communities where adaptation is to be translated into short-term practices and longer-term livelihood strategies. For adaptation to be successful, the local level must be bridged in an effective way with the global level where funds and mechanisms are available. The bridging between the local and the global creates challenges for science and policy. A first challenge is to organize participatory learning processes where local experiences and priorities in vulnerable communities can be used as a knowledge basis for adaptation. A second challenge is to mobilize sufficient global funds for adaptation and make them available for local adaptation needs. Even though the global policy framework is adjusting to generate funds for adaptation, this is at much lower levels than for mitigation (Müller 2006, 2007; Möhner and Klein 2007). The low funding for adaptation is unfortunate for several reasons. First, adaptation is a legal obligation of the rich countries towards poorer countries to be paid as a compensation for historical inequalities in emissions. Second, adaptation is a moral obligation of the world’s less vulnerable people towards the more vulnerable people across the world who are increasingly exposed to natural hazards, climate variability and climate change now and in the future (Paavola and Adger 2006). Among those who are vulnerable to climate change impacts and climate change responses certain people are even more vulnerable and also difficult to reach with policies and measures. This group we call the poorest of the poor.
The aim of this study was to examine health-related quality of life (HRQoL), individual QoL, anxiety and depression in patients with amyotrophic lateral sclerosis (ALS) and their next of kin in relation to patients' physical function over time.
35 patients and their next of kin were studied using the Short Form-36 Health Survey (SF-36), Schedule for Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), and Hospital Anxiety and Depression Scale (HADS) and patients also by the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised and the Norris scale every fourth to sixth month, one to four times.
Changes were found over time in both patients and their next of kin in the SF-36 but not in the SEIQoL-DW or HADS. Patients rated worse than their next of kin in the SF-36 physical subscales and next of kin rated worse than the patients in the global QoL score in SEIQoL-DW. Health, hobbies, and total relations were important areas in the SEIQoL-DW among all participants, but some important areas also differed between the patients and their next of kin. In most important areas among the pairs, the next of kin estimated their functioning/satisfaction worse than patients estimated their functioning/satisfaction.
Significance of results:
There were few changes over time in the QoL among the participants. Although most of the estimates in patients and their next of kin were equal, there were also some differences. These results emphasize the importance of support for both patients and their next of kin and that support ought to be given on both individual bases and together in pairs. The SEIQoL-DW might give signposts in the care through the course of the disease about what should be focused on to increase satisfaction of the important areas of life and might help the person to find coping strategies to handle his or her life situation.
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