Ilse Simoens

Science?policy challenges for biodiversity, public health and urbanization: examples from Belgium

Internationally, the importance of a coordinated effort to protect both biodiversity and public health is more and more recognized. These issues are often concentrated or particularly challenging in urban areas, and therefore on-going urbanization worldwide raises particular issues both for the conservation of living natural resources and for population health strategies. These challenges include significant difficulties associated with sustainable management of urban ecosystems, urban development planning, social cohesion and public health. An important element of the challenge is the need to interface between different forms of knowledge and different actors from science and policy. We illustrate this with examples from Belgium, showcasing concrete cases of human–nature interaction. To better tackle these challenges, since 2011, actors in science, policy and the broader Belgian society have launched a number of initiatives to deal in a more integrated manner with combined biodiversity and public health challenges in the face of ongoing urbanization. This emerging community of practice in Belgium exemplifies the importance of interfacing at different levels. (1) Bridges must be built between science and the complex biodiversity/ecosystem–human/public health–urbanization phenomena. (2) Bridges between different professional communities and disciplines are urgently needed. (3) Closer collaboration between science and policy, and between science and societal practice is needed. Moreover, within each of these communities closer collaboration between specialized sections is needed.

CICES going Local : Ecosystem Services Classification Adapted for a Highly Populated Country

Abstract Multiple classification systems for ecosystem services (ES) make comparison and integration between studies and assessments very difficult. With the fast-growing number of ecosystem services assessment and valuation studies, there is a need to identify generally agreed definitions and to design a common base that will enable comparisons between ecosystem services assessments at different places. The recently developed Common International Classification for Ecosystem Services (CICES) is aiming to fill this gap. One advantage of the CICES approach is that it allows adjustment to local conditions. Through an iterative consultation round with Belgian experts from administrations, policy support units, and research centers CICES has been adapted to the needs of a highly populated country, where multifunctional land use is very common. The goal of CICES-Be is to introduce a common reference base for ecosystem services in Belgium, which is locally adapted and compatible with an international standard.

BLOOD PRESSURE MANAGEMENT IN PATIENTS WITH CHRONIC KIDNEY DISEASE: AN APPRAISAL AND SUMMARY OF EXISTING GUIDELINES

Abstract Background: Hypertension is a prevalent problem with huge impact on health and health care budgets. Several guidelines on how to manage blood pressure have been published, and it is unclear which one should be preferred. Methods: Eight guidelines dealing with blood pressure management of chronic kidney disease patients were evaluated for methodological quality by the AGREE II instrument by 4 appraisers. They were also analysed for consistency in their recommendations. Results: Most problematic domains were “applicability”, “stakeholder involvement” and “editorial independence”. Three guidelines scored below 50% for 5, and one for 4 of the 6 AGREE II domains. The guideline produced by Canadian Hypertension Education Program was preferred most, followed by KDIGO. There were discrepancies between the different guidelines with regard to blood pressure targets and thresholds, with the best and most recent advocating 140/90 mmHg. There was a consensus on the use of ACE-I/ARB‘s in patients with but not for those without proteinuria. However, only two guidelines specify a second line treatment (thiazides), whereas others do not, although it is well known that most patients need more than one drug to control their blood pressure. Three out of eight guidelines did not provide guidance on life-style modification. Those who did, advocated different levels of sodium restriction,, weight control, and physical activity. Remarkably, 5 out of 8 guidelines did not specify how exactly blood pressure should be measured. Conclusion: Blood pressure guidelines seem to be of low methodological quality, with clear improvements for the ones produced the latest. Especially the “applicability” domain, evaluating how the guideline can be put into practice, seems problematic, with as biggest hurdles that it is unclear what should be second or third line treatments, and how blood pressure should be measured or defined. The most recent guidelines advocate an office blood pressure of 140/90 mmHg for patients with chronic kidney disease.