Smallholder milk-quality awareness in Indonesian dairy farms.

In most low- and middle-income countries, milk is produced by smallholders, thereby contributing to the livelihood of their households. With the increasing importance of milk production in these countries, it is essential that milk quality is of a high level to ensure a safe product for consumers. It is, however, unclear whether smallholder dairy farmers are aware of the quality of their milk. The aim of this cross-sectional study was to gain insight on Indonesian smallholder dairy farmer awareness of milk quality parameters and to identify factors associated with the total plate count (TPC) and somatic cell count (SCC). A stratified sampling method was used to select smallholder farms in 4 districts in West Java, Indonesia, that were interviewed between August and September 2017. Factors putatively associated with awareness of TPC were investigated with multinomial regression models, whereas a Firth-type logistic regression was applied to identify factors associated with SCC awareness. Of the total 600 farmers surveyed, 264 (44%), 109 (18%), 170 (28%), 111 (19%), and 23 (4%) farmers were aware of TPC, total solid, fat content, milk density, and SCC, respectively, but did not know its value. Those that were conceptually aware of these quality parameters were generally unaware of their value. Furthermore, this study revealed that the following variables were significantly associated with dairy farmers' awareness of TPC: cooperative to which the farmer belonged, distance to neighboring dairy farmer, technology adoption index, TPC as the most important quality factor for the buyer, milk production information from cooperatives, and cow health information from veterinarians. Similarly, cooperative, dairy business experience, and milk quality test adoption were significantly associated with dairy farmers' awareness of SCC. Cooperative was the only variable that was significant in both final statistical models. This indicates that cooperatives play an important role in increasing farmer awareness of milk quality parameters in these smallholder dairies. This may be valid for other regions in the world also where milk production is dominated by smallholder dairy farmers.

Long-term psychotherapy in tertiary care: A practice-based benchmarking study.

OBJECTIVES: The literature regarding the effectiveness of long-term psychological interventions delivered in tertiary care is scarce. This study sought to quantify and evaluate outcomes delivered in a UK tertiary care psychotherapy service against equivalent service benchmarks. DESIGN: A retrospective analysis of outcomes on the Outcome Questionnaire-45 (OQ-45) over a 10-year period in a tertiary care psychotherapy service. The modalities evaluated were cognitive-behavioural, cognitive-analytic, and psychoanalytic psychotherapies. METHODS: Effectiveness was calculated at the service level and for each modality using pre-post-effect sizes and recovery rates. Benchmarking included a random-effects meta-analysis. Trajectories of change for each modality were examined using growth curve models. RESULTS: Baseline distress on the OQ-45 was higher than comparative norms (M = 102.57, SD = 22.79, N = 364). The average number of sessions was 48.68 (SD = 42.14, range = 5-335). There was a moderate pre-post-treatment effect (d = .46, 95% CI = .37-.55) which was lower than available benchmarks. The modalities differed in duration but were largely equivalent in terms of outcome. The reliable improvement rate was 29.95%, and the recovery rate was 10.16%, and change over time was best explained using a nonlinear (cubic) time trend. CONCLUSIONS: The elevated distress at baseline appears to create the conditions for relatively lengthy interventions and attenuated clinical outcomes. Suggestions are made regarding the clinical role, function, and evaluation of tertiary care psychotherapy services.

How have smallholder farmers used digital extension tools? Developer and user voices from Sub-Saharan Africa, South Asia and Southeast Asia.

Digital extension tools (DETs) include phone calls, WhatsApp groups and specialised smartphone applications used for agricultural knowledge brokering. We researched processes through which DETs have (and have not) been used by farmers and other extension actors in low- and middle-income countries. We interviewed 40 DET developers across 21 countries and 101 DET users in Bihar, India. We found DET use is commonly constrained by fifteen pitfalls (unawareness of DET, inaccessible device, inaccessible electricity, inaccessible mobile network, insensitive to digital illiteracy, insensitive to illiteracy, unfamiliar language, slow to access, hard to interpret, unengaging, insensitive to user's knowledge, insensitive to priorities, insensitive to socio-economic constraints, irrelevant to farm, distrust). These pitfalls partially explain why women, less educated and less wealthy farmers often use DETs less, as well as why user-driven DETs (e.g. phone calls and chat apps) are often used more than externally-driven DETs (e.g. specialised smartphone apps). Our second key finding was that users often made - not just found - DETs useful for themselves and others. This suggests the word 'appropriation' conceptualises DET use more accurately and helpfully than the word 'adoption'. Our final key finding was that developers and users advocated almost ubiquitously for involving desired users in DET provision. We synthesise these findings in a one-page framework to help funders and developers facilitate more useable, useful and positively impactful DETs. Overall, we conclude developers increase DET use by recognizing users as fellow developers - either through collaborative design or by designing adaptable DETs that create room for user innovation.