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Agrifood systems in northern Central America: agrologistics for modern family farms 2022. 117 pp. many ref. ; 2022.
Article in English | CAB Abstracts | ID: covidwho-2168295

ABSTRACT

This report explores the agrologistics challenges and opportunities faced by agri-food systems in three countries in Northern Central America, namely El Salvador, Guatemala and Honduras, with a specific focus on the impacts on family farming systems. As an overarching principle guiding the analysis, the report adopts the World Bank's framework of Green, Resilient, and Inclusive Development (GRID), which recognizes that the challenges of poverty, inequality, climate change, and systemic shocks such as COVID-19 are strongly interrelated, and thus need to be addressed simultaneously and systematically. As such, the study seeks to highlight ways in which enhancing agrologistics systems can drive food system efficiency, environmental sustainability, resilience and inclusion in Northern Central America, thus contributing to wellbeing and overall economic performance. In this study, the term agrologistics is used to refer to the infrastructure, machinery, related services, and information systems that allow agri-food products to move from the original point of production to the final point of consumption. The analysis follows the five key components of agrologistics value chain, namely: (a) on-farm post-harvest management;(b) storage and handling, including cold storage;(c) processing and packaging;(d) transport from the farm to collection and processing centers, and onwards to distribution networks;and (e) distribution by wholesalers, retailers and exporters, which in the case of exports involves customs and other border crossing processes.

2.
Canadian Agency for Drugs and Technologies in Health. CADTH Health Technology Review ; 07:07, 2021.
Article in English | MEDLINE | ID: covidwho-2045439

ABSTRACT

Low levels of vitamin D are common in older adults and associated with a variety of negative health outcomes.1 Studies have found associations between low levels of vitamin D and mortality - all-cause and cardiovascular disease (CVD) -2 , 3 and type 2 diabetes,1 dementia,4 cancer,5 heart failure,6 and respiratory tract infections.7 Since low levels of vitamin D are reversible, vitamin D supplementation may have a potential role in the prevention and/or treatment of conditions associated with low levels of vitamin D. The main function of vitamin D is to enhance the intestinal absorption of calcium and phosphorous.7 Vitamin D can be obtained from dietary sources and is also produced by the skin after exposure to UV light.8 Vitamin D deficiency can result from reduced sunlight exposure or a limited dietary intake of vitamin D. Aging reduces the skin's ability to produce vitamin D.9 When exposed to the same amount of sunlight, the capacity of the skin to produce vitamin D in adults aged 65 years has been estimated to be about 25% of that as compared to adults aged 20 to 30 years.10 This may be a contributing factor to the low levels of vitamin D that are commonly seen in older adults. In Canada, more than 90% of long-term care residents were found to consume amounts of vitamins D, E, K, magnesium, and potassium below the estimated average requirement/adequate intake.11 Vitamin D supplements were shown to resolve inadequate intakes for 50% to 70% of participants.11 Vitamin D has an established role in bone health8 and vitamin D supplementation is recommended to prevent fractures in long-term care residents.12 However, the role of vitamin D supplementation in the prevention and/or treatment of other conditions in long-term care residents remains unclear. A summary of the available literature could help decision-makers to determine the appropriate use of vitamin D supplementation in long-term care facilities. This report is part of a series of 3 CADTH reports on the use of vitamin D supplementation in residents of long-term care facilities. One of the reports aimed to summarize the effectiveness and guidelines of vitamin D supplementation for the prevention and/or treatment of COVID-19 in long-term care residents.13 The other report is an update to a 2019 CADTH report on the clinical effectiveness, cost-effectiveness, and evidence-based guidelines on the use of vitamin D supplementation for the prevention of falls and fractures in long-term care residents.14 The aim of the current report is to summarize the evidence regarding the clinical effectiveness and evidence-based guidelines of vitamin D supplementation for the prevention and/or treatment of CVD, cancer, and other conditions in elderly patients residing in long-term care facilities.

3.
Canadian Agency for Drugs and Technologies in Health. CADTH Health Technology Review ; 04:04, 2021.
Article in English | MEDLINE | ID: covidwho-1335747

ABSTRACT

Major depressive disorder (MDD) is a common and disabling illness and 1 of the most common mood disorders. It affects the entire body and mind, leading to reductions in quality of life and significant costs to the health care sector and society.1 MDD is associated with a high risk of mortality with a relative risk of 1.81 compared with persons without depression.2 According to Statistics Canada's 2012 Canadian Community Health Survey on Mental Health, it is estimated that 5.4% of the Canadian population aged 15 years and older have reported mood disorders in the previous 12 months, including 4.7% for major depression.1 A recent survey on COVID-19 and mental health during the last 3 months of 2020 found that 1 in 5 Canadians had a positive screening for at least 1 of the 3 mental disorders: MDD, generalized anxiety disorder, and post-traumatic stress disorder.3 MDD was the most prevalent mental disorder, with 15% Canadians screening positive with moderate or severe symptoms.3 A variety of antidepressant agents have been used for the treatment of patients with MDD including selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor (SNRI), tricyclic antidepressant (TCA), monoamine oxidase inhibitor (MAOI), glutamate antagonist, and atypical antidepressants such as bupropion.4 Despite advances in understanding the efficacy and safety of those pharmacological agents, 10% to 15% of patients do not respond to their first course of antidepressant pharmacotherapy, and 30% to 40% achieve only partial remission.5 After proper diagnosis and adequate treatment of MDD with antidepressants, individuals who are still nonresponders or partial responders are considered to have treatment-resistant depression (TRD). Although there is no universally accepted definition of TRD, approximately half of clinical trials required a minimum of 2 treatment failures to be considered TRD.6 The pharmacological options for treating TRD are not well-established and remain a challenge for physicians.7 Options for treatment of TRD include augmentation and switching of the initial antidepressant.7 Bupropion is an atypical antidepressant which inhibits the reuptake of noradrenaline and dopamine and has been used for treatment of MDD.8 It is generally well-tolerated but can cause weight loss and low rates of sexual dysfunction.8 However, its clinical effectiveness and cost-effectiveness in the treatment of TRD is less well understood. The current report aims to review the clinical effectiveness and cost-effectiveness of bupropion for the treatment of adults with TRD.

4.
Annals of Emergency Medicine ; 76(4):S74, 2020.
Article in English | EMBASE | ID: covidwho-898420

ABSTRACT

Study Objectives: During the COVID-19 surge in New York City, our hospital system put in place a 24-hour helpline to connect Emergency Department (ED) physicians to Palliative Care specialists. During the surge of critically ill COVID-19 patients, there was concern that large volumes, high acuity, and the need to wear protective equipment, were barriers to ED physicians calling the helpline. To address this concern, we placed ophthalmology residents in the ED from 8am to 11pm each day to act as palliative care extenders, helping connect ED physicians, Palliative Care physicians, patients and families. Ophthalmology residents were chosen for this role due to their clinical expertise and availability after the cessation of elective surgeries during the state of emergency. We sought to evaluate the number of palliative care connections made with this model. Methods: We performed a retrospective review of admissions from the acute areas of our ED from April 6, 2020 to April 19, 2020. During the first week, only the 24-hour helpline was available. During the second week, both the palliative care helpline and in-situ residents were available. Number of palliative care notes from the ED were compared before and after the intervention. Results: In the week when only the helpline was available, 443 ED visits occurred, of which 169 (38.1%) were admitted and 10 (5.9%) had palliative care notes written in the ED. In the week when both the helpline and in-situ residents were available 464 ED visits occurred, of which 131 (30.0%) were admitted and 36 (27.4%) had palliative care notes written in the ED. Conclusion: Compared to a helpline alone, in situ palliative care presence in the ED increased the opportunity for early palliative care intervention, as reflected by an increase in the number of palliative care notes written in the ED. This model was an effective re-tasking of specialized health care practitioners from a specialty that was less strained by the pandemic to one that was under pressure.

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