Patient self-management of oral anticoagulation with vitamin k antagonists in everyday practice: efficacy and safety in a nationwide long-term prospective cohort study.

Patient self-management (PSM) of oral anticoagulation is under discussion, because evidence from real-life settings is missing. Using data from a nationwide, prospective cohort study in Switzerland, we assessed overall long-term efficacy and safety of PSM and examined subgroups. Data of 1140 patients (5818.9 patient-years) were analysed and no patient were lost to follow-up. Median follow-up was 4.3 years (range 0.2-12.8 years). Median age at the time of training was 54.2 years (range 18.2-85.2) and 34.6% were women. All-cause mortality was 1.4 per 100 patient-years (95% CI 1.1-1.7) with a higher rate in patients with atrial fibrillation (2.5; 1.6-3.7; p<0.001), patients>50 years of age (2.0; 1.6-2.6; p<0.001), and men (1.6; 1.2-2.1; p = 0.036). The rate of thromboembolic events was 0.4 (0.2-0.6) and independent from indications, sex and age. Major bleeding were observed in 1.1 (0.9-1.5) per 100 patient-years. Efficacy was comparable to standard care and new oral anticoagulants in a network meta-analysis. PSM of properly trained patients is effective and safe in a long-term real-life setting and robust across clinical subgroups. Adoption in various clinical settings, including those with limited access to medical care or rural areas is warranted.

Towards an SMS-based Social Network for Health Workers in Rural Areas in Myanmar

Seventy percent of the population in Myanmar lives in rural areas. Although health workers are adequately trained, they are overburdened due to understaffing and insufficient supplies. Literature confirms that information and communication technologies can extend the reach of healthcare. In this paper, we present an SMS-based social network that aims to help health workers to interact with other medical professionals through topic-based message delivery. Topics describe interests of users and the content of message. A message is delivered by matching message content with user interests. Users describe topics as ICD- 10 codes, a comprehensive medical taxonomy. In this ICD-10 coded SMS, a set of prearranged codes provides a common language for users to send structured information that fits inside an SMS.

The struggle to diversify rural livelihoods: Bio-enterprise development initiatives and their impacts on agro-/pastoral communities in the drylands of Kenya

This article analyses the impacts of four different bio-enterprise initiatives on agro-pastoral livelihoods and on improved natural resources management (NRM) in the drylands of Kenya. In this way it contributes to an area of rural development that is gaining increasing interest, but still has little empirical evidence. Data were collected through interviews, focus group discussions, informal discussions and the study of reports. One of the key findings of this article is that diversification into enterprises requires cooperation among the stakeholders with their varying experiences in development, NRM and business development. In addition to initial investments, such enterprises need sustained financial, as well as other support like capacity development to survive the market introduction phase. For such enterprises to defend their market niches, the quantity and quality of the product are critical. In addition to support in human, financial, social, physical and natural capital, mentoring is another crucial factor for success.

Forest regeneration capacity and its enhancement by forest management and silviculture in Cabo Delgado

SDC has been involved in rural development in Cabo Delgado for more than 30 years. Shortly after the independence of Mozambique, projects in water supply and integrated rural development were initiated. The silvoagropastoral project FO9 based in Mueda was a very early experience in forestry in Cabo Delgado. Andreas Kläy was responsible for the forestry sector in FO9 for 3 years in the early 1980s and had an opportunity to initiate an exchange of ideas and experience in rural development theory and approaches with Yussuf Adam, who was doing research in human anthropology and history in the province. 25 years later, the current situation of forest management in Cabo Delgado was reassessed, with a specific focus on concessions in the North. The opportunity for a partnership between the MITI SA, the University of Eduardo Mondlane, and CDE was created on the basis of this preliminary study1. The aim of this partnership is to generate knowledge and develop capacity for sustainable forest management. The preliminary study showed that “…we have to face weaknesses and would like to start a learning process with the main institutions, organisations, and stakeholder groups active in forest management and research in the North of Cabo Delgado. This learning process will involve studies supported by competent research institutions and workshops …” The specific objectives of ESAPP project Q804 are the following: 1. Contribute to understanding of the forestry sector; 2. Capacity development for professionals and academics; 3. Support for the private sector and the local forest service; 4. Support data generation at Cabo Delgado's Provincial Service; 5. Capacity development for Swiss academic institutions (CDE and ETHZ). A conceptual planning platform was elaborated as a basis for cooperation and research in the partnership (cf. Annex 1). The partners agreed to work on two lines of research: biophysical and socio-economic. In order to ensure a transdisciplinary approach, disciplinary research is anchored in common understanding in workshops based on the LforS methods. These workshops integrate the main stakeholders in the local context of the COMADEL concession in Nangade District managed by MITI SA, and take place in the village of Namiune. The research team observed that current management schemes consist mainly of strategies of nature mining by most stakeholders involved. Institutional settings - formal and informal - have little impact due to weak capacity at the local level and corruption. Local difficulties in a remote rural area facilitate external access to resources and are perpetuated by the loss of benefits. The benefits of logging remain at the top level (economic and political elites). The interests of the owners of the concession in stopping the loss of resources caused by this regime offers a unique opportunity to intervene in the logic of resource degradation and agony in rural development and forest management.

Capacity Building in the Use of Geospatial Tools for Natural Resource Management in Tajikistan: Inception report

The sustainable management of natural resources is a key issue for sustainable development of a poor, mountainous country such as Tajikistan. In order to strengthen its agricultural and infrastructural development efforts and alleviate poverty in rural areas, spatial information and analysis are of crucial importance to improve priority setting and decision making efficiency. However, poor access to geospatial data and tools, and limited capacity in their use has greatly constrained the ability of governmental institutions to effectively assess, plan, and monitor natural resources management. The Centre for Development and Environment (CDE) has thus been mandated by the World Bank Group to provide adequate technical support to the Community Agriculture and Watershed Management Project (CAWMP). This support consists of a spatial database on soil degradation trends in 4 watersheds, capacity development in and awareness creation about geographic information technology and a spatial data exchange hub for natural resources management in Tajikistan. CDE’s support has started in July 2007 and will last until December 2007 with a possible extension in 2008.

Amadir: Livelihood and Resource Management in an Eritrean Highland Community: A development baseline

This publication presents the results of a study conducted in 2003 in Amadir, a village in the Central Highlands of Eritrea. It gives an overview of the natural resource base, livelihoods, farm management, and institutions that are important to the local community. The report concludes with a chapter on options for development as discussed with the village community and local administration. This report supports Eritrea's efforts to promote rural development. It contains an extensive summary in Tigrinya, as well as a large-scale satellite image and a large-scale land use map of the study area. The appendix presents a summary of the methods used in the study.

Maternal health care utilization in rural Jordanian villages: Patterns and predictors

Background. Different individual (demographic) characteristic and health system related characteristics have been identified in the literature to contribute to different rates of maternal health care utilization in developing countries. This study is going to evaluate the individual and quality of health predictors of maternal health care utilization in rural Jordanian villages. ^ Methods. Data from a 2004 survey was used. Individual (predisposing and enabling) variables, quality of health care variables, and maternal care utilization variables were selected for 477 women who had a live birth during the last 5 years. The conceptual framework used in this study will be the Aday-Andersen model for health services utilization. ^ Results. 82.4% of women received at least one antenatal care visit. Individually, village of residence (p=0.036), parity (p=0.048), education (p=0.006), and health insurance (p=0.029) were found to be significant; in addition to respectful treatment (p=0.045) and clean facilities (p=0.001) were the only quality of health care factors found to be significant in predicting antenatal care use. Using logistic regression, living in southern villages (OR=4.7, p=0.01) and availability of transportation (sometimes OR=3.2, p=0.01 and never OR=2.4, p<0.05) were the only two factors to influence maternal care use. ^ Conclusions. Living in the South and transportation are major barriers to maternal care utilization in rural Jordan. Other important cultural factors of interest in some villages should be addressed in future research. Perceptions of women regarding quality of health services should be seriously taken into account. ^

Comparison of financial trends in small rural and urban hospitals in Texas, 1983--1985

The purpose of this study was to compare the financial performance of small rural hospitals to that of small urban hospitals in Texas. Hospital-specific and environmental factors were studied as control variables.^ Small rural hospitals were found to be financially stronger on measures of liquidity but weaker on measures of profitability. Small urban hospitals performed better on measures of profitability and long-range solvency. When all measures in the five dimensions of financial performance were analyzed, no significant difference was found between the two groups of hospitals. None of the control variables included in the study was significantly associated with financial performance both for rural and urban hospitals. Conclusions were that small rural hospitals in Texas are experiencing a deterioration in financial condition but small, rural hospitals are not doing any worse than small urban hospitals; and that the financial hardship which rural hospitals suffer may be inherent in the nature of the institutions themselves, and not as a result of their smallness nor their rural settings. ^

FEASIBILITY OF CORRELATING INCIDENCE OF DIARRHEA WITH CHARACTERISTICS OF RURAL EGYPTIAN HOUSEHOLDS BY MEANS OF AN ENVIRONMENTAL SURVEY

Few, if any studies, have attempted to identify the specific environmental factors associated with the incidence of diarrheal disease and to rank these by their contribution to the total incidence of diarrheal illness. Potentially those factors with the greatest contribution are the variables on which intervention could be expected to have the greatest impact on the incidence of diarrhea.^ In 317 rural Egyptian households participating in a longitudinal study of diarrheal disease, selected environmental characteristics were observed and recorded on a questionnaire. Characteristics of the environment were classified into seven categories including water usage, proximity of animals to the house, waste management, food preparation area, toilet area, the household structure and hygiene. The variables from each of the seven major groupings most associated with the incidence of diarrhea in infants were selected through the application of stepwise multiple regression. Each area was then ranked by the portion of the incidence of diarrhea in infants that each composite group of area-specific variables alone would explain. The groups of household structure and water usage variables were found to be more associated with the incidence of diarrhea in infants than variables describing the toilet area, proximity to animals or others. It was also found that 24.7% of the total variance in incidence of diarrheal illness was explained by environmental variables. ^

Identificación de la pobreza rural y algunas estrategias de intervención : Mendoza (Argentina)

En Mendoza, Argentina, más del 60 % de los productores agrícolas tiene predios menores de 10 ha, algunos de ellos con modelos productivos que no alcanzan para la sustentabilidad del grupo familiar. La presente investigación identifica la situación actual de la población estudiada, mediante variables de ingreso familiar, grado de asociativismo, características de la comercialización y algunas prácticas de gestión, para establecer comparaciones entre grupos poblacionales. Se trabajó en una muestra de productores regantes del Río Mendoza. Para los de menos de 10 ha se agregó un cuestionario complementario que indagó sobre niveles de asociación y sus resultados. Se analizó con mayor detalle el sector vitícola y olivícola con nuevas encuestas y entrevistas en profundidad. El 42 % de los productores tiene vid, el 30 % olivos y el 28 % horticultura, fruticultura y floricultura. El mayor nivel de asociación se encuentra entre los viticultores. En los demás sectores, éste es muy bajo o nulo. En la comparación de grupos, los mayores niveles de pobreza están en los productores de menos de 10 ha y baja tecnología. Además, en el sector vitícola, los menores niveles de ingreso se encuentran en aquellos no asociados y en toda la población estudiada la pobreza es mayor en el sector asalariado que en los propietarios de la tierra. Este proyecto identifica la capacitación como una de las acciones para mejorar la situación socioeconómica de los productores.

Comments and conclusions on the I International Seminary “Interdiscipline in Territorial Management "

El objetivo principal del I Seminario Internacional “ La Interdisciplina en el Ordenamiento Territorial, fue debatir sobre el aporte de las diversas disciplinas que confluyen en el Ordenamiento Territorial. Las ponencias presentadas fueron de un alto nivel científico y a partir de los casos analizados se demuestra que en la realidad coexisten espacios fragmentados social y económicamente, ya que se verifica la existencia de espacios globalizados con fuertes inversiones frente a otros que quedan marginados. Esta situación se manifiesta a través de la presencia de nuevos procesos de expansión y suburbanización, espacios rurales que se desvalorizan y se abandonan, ecosistemas naturales que deben ser protegidos para evitar un mayor deterioro medioambiental. Entre las conclusiones de los trabajos presentados se destacan: • La necesidad del mejoramiento de la capacidad de gestión a través de propuestas de nuevas metodológicas de trabajo, • la búsqueda de soluciones a las grandes disparidades socioeconómicas y al progresivo deterioro ambiental a partir del consenso de los agentes que intervienen, • la formulación de nuevas normativas acordes a las exigencias que impone la economía de mercado, entre otros.

Territorial quality and sustainable development : Indicators of performance in the context of a model for participatory rural tourism certification

El turismo rural ha sido incorporado por pequeños establecimientos agropecuarios del partido de Cnel. Suárez, provincia de Buenos Aires, Argentina, como actividad alternativa para mejorar la calidad de vida de sus miembros y superar situaciones de crisis agravadas por la marginalidad productiva del SO bonaerense, región a la que pertenecen. Bajo el programa Cambio Rural del INTA (Instituto Nacional de Tecnología Agropecuaria) conforman el Grupo 'Cortaderas II', junto a otros emprendedores interesados en valorar el medio rural. Han avanzado en el proceso de reconocimiento de su identidad y puesta en valor de recursos específicos con anclaje en el territorio. Esta identidad comienza a apreciarse internamente, a raíz de la dinámica grupal lograda y la incipiente articulación con otros actores para la construcción de un partenariado público y privado que genere sinergias y contribuya al desarrollo sustentable del territorio. Sin embargo, aún no es claramente percibida por el turista, cada vez más exigente. Por lo tanto, el presente trabajo persigue proponer indicadores para evaluar el desempeño de un Sistema de Gestión de Calidad con enfoque territorial que, adaptando el modelo europeo 'Marca de Calidad Territorial', sustente una estrategia comercial de diferenciación del servicio y simultáneamente, mida el progreso hacia una mejor calidad de vida y fortalecimiento de vínculos con la cultura local y el entorno físico-natural en el marco del desarrollo sustentable. La investigación se plantea para la micro escala, ya que se trata de un estudio de caso, relevándose información primaria mediante observación directa y entrevistas semi-estructuradas, complementada con información secundaria diagnóstica utilizada por INTA. Las características del grupo y su dinámica de funcionamiento bajo el programa Cambio Rural revelan que es posible adoptar un proceso de certificación participativa propuesto para cuatro pilares de la calidad: de Bienes y Servicios, Institucional, Social y Ambiental. El modelo se integra con indicadores de evaluación de desempeño, agrupados en áreas clave para cada una de las dimensiones de la sustentabilidad, que contemplan el paisaje y la gestión de los recursos naturales; el impacto económico de la actividad, la calidad de la oferta y satisfacción del turista; así como las relaciones sociales internas y los vínculos con otros actores del territorio. Principalmente se encontraron fortalezas en la búsqueda de partenariados y debilidades en aspectos de comunicación y promoción. Se considera que este sistema de herramientas de gestión sustentable permitiría superar las dificultades de una certificación individual, pudiendo aplicarse a emprendimientos con otra ubicación geográfica

Cultura, identidad y territorio : Reflexiones para el desarrollo de una estrategia de diferenciación del servicio agroturístico en emprendimientos de un Grupo de Cambio Rural (INTA) del partido de Coronel Suárez (Buenos Aires)

A partir de los conceptos convergentes identidad, cultura, patrimonio y territorio, se plantea analizar la posibilidad de formular e implementar una estrategia de diferenciación para la actividad de agroturismo desarrollada por los establecimientos del grupo Cortaderas II (Cambio Rural, INTA), en el partido de Coronel Suárez (BA), provincia de Buenos Aires. Con este fin, se ha efectuado un diagnóstico mediante entrevistas directas y observaciones in situ de los emprendimientos participantes. Destacando aspectos propios de su ambiente rural, se procuró identificar valores culturales y productos con anclaje territorial que impongan un sello distintivo al servicio turístico que ofrecen. Complementariamente, se indagó en qué medida los integrantes están preparados para gestionar el negocio, reconociendo en ellos competencias gerenciales y características emprendedoras. Por último, se reflexiona acerca del grado de madurez alcanzado, tipificando la cultura empresarial individual y según el trabajo grupal, de modo de evaluar si la puesta en valor de sus recursos evoluciona desde un "carácter doméstico" hasta llegar a un "carácter comercial formal". Se observa la construcción de una identidad de índole socio-cultural-económica que hace viable una estrategia competitiva diferencial con anclaje en el territorio, así como condiciones para el desarrollo de una actividad turística más formalizada basada en la gestión de calidad

Sistemas de información geográfica aplicados al inventario y gestion de información rural

El objetivo del trabajo es explorar las ventajas de los SIG como herramienta para el inventario y gestión de información agropecuaria de pequeñas explotaciones. En el área de estudio, la planificación de la actividad rural muchas veces se realiza de manera intuitiva, lo que genera una deficiente utilización de la información y los recursos. Actualmente, los Sistemas de Información Geográfica (SIG) son una herramienta que posibilita el fácil almacenaje, acceso y gestión de datos. Los establecimientos ejemplo se seleccionaron por la disponibilidad de información registrada y porque las actividades realizadas son representativas del área. Se inventarió y relacionó la información, lo que generó cartografía que permitió visualizar diferentes escenarios productivos. Quedó demostrada la eficiencia de los SIG como una herramienta que mejora la gestión de la información inventariada y posibilita la planificación de la actividad futura

Cultura, identidad y territorio : Reflexiones para el desarrollo de una estrategia de diferenciación del servicio agroturístico en emprendimientos de un Grupo de Cambio Rural (INTA) del partido de Coronel Suárez (Buenos Aires)

A partir de los conceptos convergentes identidad, cultura, patrimonio y territorio, se plantea analizar la posibilidad de formular e implementar una estrategia de diferenciación para la actividad de agroturismo desarrollada por los establecimientos del grupo Cortaderas II (Cambio Rural, INTA), en el partido de Coronel Suárez (BA), provincia de Buenos Aires. Con este fin, se ha efectuado un diagnóstico mediante entrevistas directas y observaciones in situ de los emprendimientos participantes. Destacando aspectos propios de su ambiente rural, se procuró identificar valores culturales y productos con anclaje territorial que impongan un sello distintivo al servicio turístico que ofrecen. Complementariamente, se indagó en qué medida los integrantes están preparados para gestionar el negocio, reconociendo en ellos competencias gerenciales y características emprendedoras. Por último, se reflexiona acerca del grado de madurez alcanzado, tipificando la cultura empresarial individual y según el trabajo grupal, de modo de evaluar si la puesta en valor de sus recursos evoluciona desde un "carácter doméstico" hasta llegar a un "carácter comercial formal". Se observa la construcción de una identidad de índole socio-cultural-económica que hace viable una estrategia competitiva diferencial con anclaje en el territorio, así como condiciones para el desarrollo de una actividad turística más formalizada basada en la gestión de calidad