FERTILISER CREDIT AND AGROECOLOGICAL USE OF ORGANIC SOIL AMENDMENTS IN NORTHERN GHANA

Contemporary African agricultural policy embodies the African Green Revolution’s drive towards modernisation and commercialisation. Agroecologists have criticised this movement on ecological, social and political grounds. Northern Ghanaian fertiliser credit schemes provide a good example through which these critiques can be examined in a context where agricultural policy reflects the African Green Revolution’s ideals. This study aimed to determine the relationship of such credit schemes to farmers’ use of organic amendments, elucidate other factors related to organic amendment use, and comment on the relevance of this modernisation policy and its relationship to agroecology. A first research phase employed semi-structured key informant interviews. Qualitative data from these informed construction of a semi-structured questionnaire that was used in a survey of 205 farmers. Multistage sampling purposively identified five villages and selected farmers within who had joined government and donor-funded fertiliser credit schemes. The use of organic and inorganic amendments was compared to that of peers who had not taken part in such schemes. Quantitative data were used in binomial logistic regression, inferential and descriptive statistics. Qualitative data were content analysed. Credit group membership was associated with higher fertiliser application and yield, but had little influence on the extent of commercialisation. Farmers who applied organic amendments were 40% less likely to belong to a fertiliser credit scheme than not, indicating substitution between organic and inorganic fertilisers. Organic amendments were 40% more likely to be applied to compound farms than outfields and six times more likely to be applied by household heads than other household members. However, household heads also preferentially joined credit groups. This was part of an agroecological soil fertility management strategy. Household heads appreciated the soil moisture retention properties of organic amendments, and applied them to compound farms to reduce risk to their household food supply in a semi-arid environment. They simultaneously accessed fertiliser to enhance this household provisioning strategy. They appreciated the increased yields this achieved, yet complained that the repayment terms of credit schemes were unfair, fertiliser did not enhance yields in dry conditions and fertilisers were supplied late. Farmers’ use of credited fertiliser alongside their existing agroecological strategy is helpful to the extent that it raises yields, yet is problematic in that it conflicts with risk-reduction strategies based on organics. There is some potential for modernised and agroecological management paradigms to coexist. For fertiliser credit to play a role in this, schemes must use fairer repayment terms and involve a focus on simultaneous use of organic amendments.

A novel approach to reduce fire exposure and promote nature conservation in Mediterranean ecosystems: the case study of Reserva Natural da Serra da Malcata, Portugal

Mestrado Mediterranean Forestry and Natural Resources Management - Instituto Superior de Agronomia - UL

L’analyse de la vulnérabilité d’une population déplacée suite à un désastre naturel : le cas du site planifié Corail à Port-au-Prince

À travers l’augmentation des désastres dits « naturels » au cours de la dernière décennie, des populations se sont retrouvées soudainement sans maison, sans endroit où loger. L’absence d’endroit où loger amènera donc les populations affectées à se déplacer temporairement et parfois de façon permanente. Cette étude s’intéresse à un cas spécifique de relocalisation dans un site organisé, Corail-Cesselesse, créé quelques mois après le tremblement de terre dévastateur de janvier 2010, en Haïti. Initialement occupé par des ménages provenant surtout des quartiers de Delmas et Port-au-Prince et qui s’étaient réfugiés sur le vaste terrain de golf de Pétionville après avoir perdu leurs habitations, le site de Corail est ainsi étudié de façon descriptive et comparative pour évaluer l’évolution de la vulnérabilité des ménages qui y vivent. Pour ce faire, une revue du concept portant sur la vulnérabilité et la gestion des risques est nécessaire pour y dégager les indicateurs clés servant à l’analyse de l’évolution des états précédant et succédant à une catastrophe naturelle. En particulier, une approche combinant trois méthodes ralliant le qualitatif et quantitatif est utile pour conduire cette évaluation. À travers des questionnaires, des données géospatiales et d’entrevues auprès de professionnels en aménagement dans les pays en développement, on analyse dans quelle mesure la vulnérabilité sociale a évolué. On constate que la prise de décision sur la création de Corail a négligé plusieurs dimensions sociales nécessaires pour permettre aux familles de se rétablir d’un aléa d’une telle amplitude.

Oral anticoagulation in atrial fibrillation, the patients and physicians experiences of the consultation:a qualitative study

Background: Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF), however it is still underutilized and sometimes refused by patients. This project was divided in two inter-related studies. Study 1 explored the experiences that influence prescription of OAC by physicians. Study 2 explored the experiences which influence patients' decisions to accept, decline or discontinue OAC. Methods: Semi-structured individual interviews were conducted in both studies. In Study 1four sub-groups of physicians (n = 16) experienced with OAC in AF were interviewed: consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. In Study 2 three sub-groups of patients (n = 11) diagnosed with AF were interviewed; those who accepted, refused, and who discontinued warfarin. Results: Study 1: Two over-arching themes emerged from doctors' experiences: (1) communicating information and (2) challenges with OAC prescription for AF. Physicians still adopt a paternalistic approach to decision-making. They should instead motivate patients to take part in treatment discussions and choices should reflect the patient's needs and concerns. Physician education should focus more on communication skills, individualised care and time-management as these are critical for patient adherence. Continuous OAC education for AF should adopt a multi-disciplinary approach. Further, interpreters should also be educated on medical communication skills. Study 2: Three over-arching themes comprised patients' experiences: (1) the initial consultation, (2) life after the consultation, and (3) patients' reflections. Patient education during the initial consultation was critical in increasing patient's knowledge of OAC. On-going patient education is imperative to maintain adherence. Patients valued physicians' concern for their needs during decision-making. Patients who had experience of stroke were more receptive to education aimed towards stroke risk reduction rather than bleeding risk. Patients' perceptions of warfarin are also influenced by the media. Comment: Qualitative research is crucial in exploring barriers to treatment as it provides an excellent insight into patients' experiences of healthcare. A patient-centred approach should be adopted and incorporated into physicians' education. Education and patient involvement in the decision-making process is essential to promote treatment acceptance and long-term adherence

L’analyse de la vulnérabilité d’une population déplacée suite à un désastre naturel : le cas du site planifié Corail à Port-au-Prince

À travers l’augmentation des désastres dits « naturels » au cours de la dernière décennie, des populations se sont retrouvées soudainement sans maison, sans endroit où loger. L’absence d’endroit où loger amènera donc les populations affectées à se déplacer temporairement et parfois de façon permanente. Cette étude s’intéresse à un cas spécifique de relocalisation dans un site organisé, Corail-Cesselesse, créé quelques mois après le tremblement de terre dévastateur de janvier 2010, en Haïti. Initialement occupé par des ménages provenant surtout des quartiers de Delmas et Port-au-Prince et qui s’étaient réfugiés sur le vaste terrain de golf de Pétionville après avoir perdu leurs habitations, le site de Corail est ainsi étudié de façon descriptive et comparative pour évaluer l’évolution de la vulnérabilité des ménages qui y vivent. Pour ce faire, une revue du concept portant sur la vulnérabilité et la gestion des risques est nécessaire pour y dégager les indicateurs clés servant à l’analyse de l’évolution des états précédant et succédant à une catastrophe naturelle. En particulier, une approche combinant trois méthodes ralliant le qualitatif et quantitatif est utile pour conduire cette évaluation. À travers des questionnaires, des données géospatiales et d’entrevues auprès de professionnels en aménagement dans les pays en développement, on analyse dans quelle mesure la vulnérabilité sociale a évolué. On constate que la prise de décision sur la création de Corail a négligé plusieurs dimensions sociales nécessaires pour permettre aux familles de se rétablir d’un aléa d’une telle amplitude.

Análisis de la relación entre la gestión del riesgo y la vulnerabilidad. Caso de estudio: Brisas del Volador, Ciudad Bolívar

Este estudio analiza la relación entre la gestión del riesgo y la vulnerabilidad en el barrio Brisas del Volador, ubicado en Ciudad Bolívar, Bogotá. Se explicó el cambio en el enfoque de estudio y manejo de los desastres a partir de la consolidación de términos relacionados a procesos sociales, como lo son la vulnerabilidad y el riesgo. Así mismo, se describieron los cambios que se han establecido en la forma de abordar el riesgo en Colombia, tanto a nivel nacional como distrital. La investigación reveló la forma como se ha generado la vulnerabilidad a partir de la intersección de distintos procesos en un asentamiento informal y como se materializan diferentes elementos para conformar la vulnerabilidad global. A partir de esto, se recopilaron las acciones implementadas en la zona de estudio desde la gestión del riesgo, se clasificaron en cada uno de los tres procesos: conocimiento, reducción o manejo del desastre y posteriormente se estudiaron. Con base en esto, se analizaron las medidas que tuvieron una incidencia en la reducción de la vulnerabilidad y los resultados que generaron.

Etapas de cambio comportamental frente al consumo de drogas ilegales, tabaco y alcohol en escolares de 9 a 17 años de Bogotá – Colombia

Objetivo: El propósito del estudio fue describir estadísticamente las etapas de cambio comportamental frente al consumo de sustancias psicoactivas –SPA– (alcohol, tabaco y drogas ilegales) en escolares entre 9 y 17 años de Bogotá- Colombia, pertenecientes al estudio FUPRECOL. Método: Se trata de un estudio descriptivo y transversal en 6.965 niños y adolescentes entre 9 y 17 años, pertenecientes a 24 instituciones educativas oficiales de Bogotá - Colombia. La medición de los procesos de cambio propuestos por el Modelo Transteórico (MTT), aplicados al consumo de drogas, tabaco y alcohol se aplicaron de manera auto-diligenciada mediante un cuestionario estructurado. Resultados: De la muestra evaluada, el 58,4% fueron mujeres con un promedio de edad 12,74 ± 2.38 años. En la población en general, frente al consumo de drogas, el 6% de los escolares se encontraban en etapa de pre-contemplación, 44 % en contemplación; 30% en preparación/acción, 20% en mantenimiento. Con relación al consumo de alcohol, el 5% de los niños y adolescentes se encontraban en etapa de pre-contemplación, 36 % en contemplación; 12% en preparación/acción, 46% en mantenimiento. Frente al tabaco, el 4% de los niños y adolescentes se encontraban en etapa de pre-contemplación, 33 % en contemplación; 12% en preparación/acción, 51% en mantenimiento. Conclusiones: En los escolares evaluados, un importante porcentaje se ubica en la etapa de mantenimiento frente a la intención de consumo de tabaco y alcohol. Frente al consumo de drogas ilegales los niños y adolescentes están en la etapa de contemplación. Se requieren esfuerzos mayores para fomentar programas preventivos que enseñen sobre el riesgo del abuso/dependencia de este tipo de sustancias psicoactiva sobre la salud; dándole prioridad en las agendas y políticas públicas dentro del ámbito escolar.

Coastal modelling studies for forecasting and remediation solutions

The coastal area along the Emilia-Romagna (ER), in the Italian side of the northern Adriatic Sea, is considered to implement an unstructured numerical ocean model with the aim to develop innovative tools for the coastal management and a forecasting system for the storm surge risk reduction. The Adriatic Sea has been the focus of several studies because of its peculiar dynamics driven by many forcings acting at basin and local scales. The ER coast is particularly exposed to storm surge events. In particular conditions, winds, tides and seicehs may combine and contribute to the flooding of the coastal area. The global sea level rise expected in the next decades will increase even more the hazard along the ER and Adriatic coast. Reliable Adriatic and Mediterranean scale numerical ocean models are now available to allow the dynamical downscaling of very high-resolution models in limited coastal areas. In this work the numerical ocean model SHYFEM is implemented in the Goro lagoon (named GOLFEM) and along the ER coast (ShyfER) to test innovative solutions against sea related coastal hazards. GOLFEM was succesfully applied to analyze the Goro lagoon dynamics and to assess the dynamical effects of human interventions through the analysis of what-if scenarios. The assessment of storm surge hazard in the Goro lagoon was carried out through the development of an ensemble storm surge forecasting system with GOLFEM using forcing from different operational meteorological and ocean models showing the fundamental importance of the boundary conditions. The ShyfER domain is used to investigate innovative solutions against storm surge related hazard along the ER coast. The seagrass is assessed as a nature-based solution (NBS) for coastal protection under present and future climate conditions. The results show negligible effects on sea level but sensible effects in reducing bottom current velocity.

Nature-based solutions for urban heat island effect mitigation: the case study of Isla, Malta

Global population growth reflects how humans increasingly exploited Earth's resources. Urbanization develops along with anthropization. It is estimated that nearly 60% of the world's population lives in urban areas, which symbolize the denaturalized dimension of current modernity. Cities are artificial ecosystems that suffer most from environmental issues and climate change. The Urban Heat Island (UHI) effect is a common microclimatic phenomenon affecting cities, which causes considerable differences between urban and rural areas temperatures. Among the driving factors, the lack of vegetation in urban settlements can damage both humans and the environment (health diseases, heat waves caused deaths, biodiversity loss, and so on). As the world continues to urbanize, sustainable development increasingly depends on successful management of urban areas. To enhance cities’ resilience, Nature-based Solutions (NbSs), are defined as an umbrella concept that encompasses a wide range of ecosystem-based approaches and actions to climate change adaptation (CCA) and disaster risk reduction (DRR). This paper analyzes a 15-days study on air temperature trends carried out in Isla, a small locality in the Maltese archipelago, and proposes Nature-based Solutions-characterized scenarios to mitigate the Urban Heat Island effect the Mediterranean city is affected by. The results demonstrates how in some areas where vegetation is present, lower temperatures are recorded than in areas where vegetation is absent or scarce. It also appeared that in one location, the specific type of vegetation does not contribute to high temperature mitigation, whereas in another one, different environmental parameters can influence the measurements. Among the case-specific Nature-based Solutions proposed there are vertical greening (green wall, façades, ground based greening, etc.), tree lines, green canopy, and green roofs.

Rapid reduction in coronary risk for those who quit cigarette smoking

The objective of this study was to determine the rate of the decline in risk of a major coronary event after quitting cigarette smoking. It was a population-based case-control study of men and women aged 35 to 69 years in Newcastle, Australia, and men and women aged 35 to 64 years in Auckland, New Zealand, between 1986 and 1994. Cases were 5,572 people identified in population registers of coronary events and controls were 6,268 participants in independent community-based risk factor prevalence surveys from the same study populations. There was a rapid reduction in risk after quitting cigarette smoking. The risk of suffering a major coronary event for men who were current cigarette smokers was 3.5 (95% CI 3.0-4.0) times higher than the risk for never smokers but this fell to 1.5 (95% CI 1.1-1.9) for men who had quit for 1-3 years. Women who were current cigarette smokers were 4.8 (95% CI 4.0-5.9) times more likely to suffer a major coronary event than never smokers and this fell to 1.6 (95% CI 1.0-2.5) for women who had quit for 1-3 years. Those who had quit cigarette smoking for 4-6 years or more had a similar risk to never smokers. These results reinforce the importance of smoking cessation. The public health message is that the benefit of giving up smoking occurs rapidly.

Improvement of Insulin Resistance and Reduction of Cardiovascular Risk Among Obese Patients with Type 2 Diabetes with the Duodenojejunal Bypass Liner

This study aims to evaluate the effectiveness of the duodenojejunal bypass liner (DJBL) in the improvement of insulin resistance and reduction of cardiovascular risk among morbidly obese patients with type 2 diabetes mellitus, using the triglyceride/high-density lipoprotein (HDL) cholesterol ratio, percentage of weight loss, and glycemic control. We used the TG/HDL ratio with a cutoff value of 3.5 to identify patients with insulin resistance. The value of the initial ratio was compared with the ratio obtained 6 months after implantation to evaluate whether an improvement in insulin resistance occurred. We also evaluated the improvement of glycated hemoglobin levels and the weight loss resulted from the use of the device and correlated that with the improvement of the TG/HDL ratio. All patients implanted with the device presented a statistically significant reduction of the HbA1c levels, with most patients (70.3%) obtaining diabetes control with HbA1c levels lower than 7% at the end of the study. All patients also presented a significant weight reduction, with an average loss of 12.6% of their initial weight. We observed an important improvement in insulin resistance and metabolic syndrome, with a significant reduction of the TG/HDL ratio from 5.75 to 4.36 (p < 0.001) and 42.6% of the patients presenting a TG/HDL ratio lower than 3.5 at the end of the study. The DJBL, when used for a period of 6 months, is effective in the control of diabetes, weight loss, improvement of insulin resistance, and decrease of cardiovascular risk among morbidly obese patients with type 2 diabetes mellitus.

The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: a Markov model.

OBJECTIVES: To determine whether nalmefene combined with psychosocial support is cost-effective compared with psychosocial support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels (DRLs) as defined by the WHO, and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases, injuries and deaths. DESIGN: Decision modelling using Markov chains compared costs and effects over 5 years. SETTING: The analysis was from the perspective of the National Health Service (NHS) in England and Wales. PARTICIPANTS: The model considered the licensed population for nalmefene, specifically adults with both alcohol dependence and high/very high DRLs, who do not require immediate detoxification and who continue to have high/very high DRLs after initial assessment. DATA SOURCES: We modelled treatment effect using data from three clinical trials for nalmefene (ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941)). Baseline characteristics of the model population, treatment resource utilisation and utilities were from these trials. We estimated the number of alcohol-attributable events occurring at different levels of alcohol consumption based on published epidemiological risk-relation studies. Health-related costs were from UK sources. MAIN OUTCOME MEASURES: We measured incremental cost per quality-adjusted life year (QALY) gained and number of alcohol-attributable harmful events avoided. RESULTS: Nalmefene in combination with psychosocial support had an incremental cost-effectiveness ratio (ICER) of £5204 per QALY gained, and was therefore cost-effective at the £20,000 per QALY gained decision threshold. Sensitivity analyses showed that the conclusion was robust. Nalmefene plus psychosocial support led to the avoidance of 7179 alcohol-attributable diseases/injuries and 309 deaths per 100,000 patients compared to psychosocial support alone over the course of 5 years. CONCLUSIONS: Nalmefene can be seen as a cost-effective treatment for alcohol dependence, with substantial public health benefits. TRIAL REGISTRATION NUMBERS: This cost-effectiveness analysis was developed based on data from three randomised clinical trials: ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941).

Reduction in the use of diagnostic tests in infants with risk factors for early-onset neonatal sepsis does not delay antibiotic treatment.

Despite a low positive predictive value, diagnostic tests such as complete blood count (CBC) and C-reactive protein (CRP) are commonly used to evaluate whether infants with risk factors for early-onset neonatal sepsis (EOS) should be treated with antibiotics. We investigated the impact of implementing a protocol aiming at reducing the number of diagnostic tests in infants with risk factors for EOS in order to compare the diagnostic performance of repeated clinical examination with CBC and CRP measurement. The primary outcome was the time between birth and the first dose of antibiotics in infants treated for suspected EOS. Among the 11,503 infants born at ≥35 weeks during the study period, 222 were treated with antibiotics for suspected EOS. The proportion of infants receiving antibiotics for suspected EOS was 2.1% and 1.7% before and after the change of protocol (p = 0.09). Reduction of diagnostic tests was associated with earlier antibiotic treatment in infants treated for suspected EOS (hazard ratio 1.58; 95% confidence interval [CI] 1.20-2.07; p <0.001), and in infants with neonatal infection (hazard ratio 2.20; 95% CI 1.19-4.06; p = 0.01). There was no difference in the duration of hospital stay nor in the proportion of infants requiring respiratory or cardiovascular support before and after the change of protocol. Reduction of diagnostic tests such as CBC and CRP does not delay initiation of antibiotic treatment in infants with suspected EOS. The importance of clinical examination in infants with risk factors for EOS should be emphasised.

Reduction in the use of diagnostic tests in infants with risk factors for early-onset neonatal sepsis does not delay antibiotic treatment

BACKGROUND: Despite a low positive predictive value, diagnostic tests such as complete blood count (CBC) and C-reactive protein (CRP) are commonly used to evaluate whether infants with risk factors for early-onset neonatal sepsis (EOS) should be treated with antibiotics. STUDY DESIGN: We investigated the impact of imple- menting a protocol aiming at reducing the number of dia- gnostic tests in infants with risk factors for EOS in order to compare the diagnostic performance of repeated clinical examination with CBC and CRP measurement. The primary outcome was the time between birth and the first dose of antibiotics in infants treated for suspected EOS. RESULTS: Among the 11,503 infants born at 35 weeks during the study period, 222 were treated with antibiotics for suspected EOS. The proportion of infants receiving an- tibiotics for suspected EOS was 2.1% and 1.7% before and after the change of protocol (p = 0.09). Reduction of dia- gnostic tests was associated with earlier antibiotic treat- ment in infants treated for suspected EOS (hazard ratio 1.58; 95% confidence interval [CI] 1.20-2.07; p <0.001), and in infants with neonatal infection (hazard ratio 2.20; 95% CI 1.19-4.06; p = 0.01). There was no difference in the duration of hospital stay nor in the proportion of infants requiring respiratory or cardiovascular support before and after the change of protocol. CONCLUSION: Reduction of diagnostic tests such as CBC and CRP does not delay initiation of antibiotic treat- ment in infants with suspected EOS. The importance of clinical examination in infants with risk factors for EOS should be emphasised.

Participants' perceptions of their involvement in a cardiovascular disease risk factor reduction program

A cardiovascular disease risk factor reduction program was implemented in the Niagara region. To gain an understanding of this program from the participants ' perspective, 10 participants of the program were interviewed to document their perceptions of what they learned in the program, their perceptions of their behaviour change and their perceptions of factors that facilitated or impeded any behaviour change. The learning style inventory and PET test were also given to the participants to further understand their perceptions. Findings unique to this study highlighted aspects of the andragogical model, self-directed learning theory, learning style preference and psychological type that were prominent in the participants' comments and perspectives. Implications for practice, theory development and further research are suggested.