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Nitrogen ◽  
2022 ◽  
Vol 3 (1) ◽  
pp. 43-57
Author(s):  
Rhys Rebello ◽  
Paul J. Burgess ◽  
Nicholas T. Girkin

Tea (Camellia sinensis L.) is the most widely consumed beverage in the world. It is mostly grown in the tropics with a heavy dependence on mineral nitrogen (N) fertilisers to maintain high yields while minimising the areas under cultivation. However, N is often applied in excess of crop requirements, resulting in substantial adverse environmental impacts. We conducted a systematic literature review, synthesising the findings from 48 studies to assess the impacts of excessive N application on soil health, and identify sustainable, alternative forms of N management. High N applications lead to soil acidification, N leaching to surface and groundwater, and the emission of greenhouse gases including nitrous oxide (N2O). We identified a range of alternative N management practices, the use of organic fertilisers, a mixture of organic and inorganic fertilisers, controlled release fertilisers, nitrification inhibitors and soil amendments including biochar. While many practices result in reduced N loading or mitigate some adverse impacts, major trade-offs include lower yields, and in some instances increased N2O emissions. Practices are also frequently trialled in isolation, meaning there may be a missed opportunity from assessing synergistic effects. Moreover, adoption rates of alternatives are low due to a lack of knowledge amongst farmers, and/or financial barriers. The use of site-specific management practices which incorporate local factors (for example climate, tea variety, irrigation requirements, site slope, and fertiliser type) are therefore recommended to improve sustainable N management practices in the long term.


2022 ◽  
Author(s):  
Mohamad B. Taha ◽  
Javier Valero-Elizondo ◽  
Tamer Yahya ◽  
César Caraballo ◽  
Rohan Khera ◽  
...  

<b>Objective:</b> Health-related expenditures due to diabetes are rising in the US. Medication nonadherence is associated with worse health outcomes among adults with diabetes. <a>We sought to examine the extent of reported cost-related medication nonadherence (CRN) in individuals with diabetes in the US</a>. <p><b>Research Design and Methods: </b>We studied adults ≥18 with self-reported diabetes from the National Health Interview Survey (NHIS; 2013-18), a US nationally representative survey. Adults reporting skipping doses, taking less medication, or delaying filling a prescription to save money in the past year were considered to have experienced CRN. The weighted prevalence of CRN was estimated overall and by age subgroups (<65 and ≥65 years). Logistic regression was used to identify sociodemographic characteristics independently associated with CRN. </p> <p><b>Results: </b>Of the 20,326 NHIS participants with diabetes, 17.6% (weighted: 2.3 million) of those aged <65 reported CRN, compared with 6.9% (weighted: 0.7 million) among those aged ≥65. Financial hardship from medical bills, lack of insurance, low-income, high comorbidity burden and female sex were independently associated with CRN across age groups. Lack of insurance, duration of diabetes, current smoking, hypertension, and hypercholesterolemia were associated with higher odds of reporting CRN among the non-elderly, but not among the elderly. Among elderly, insulin use significantly increased the odds of reporting CRN (OR 1.51, 95% CI 1.18, 1.92).</p> <p><b>Conclusions: </b>In the US, 1 in 6 non-elderly and 1 in 14 elderly adults with diabetes reported CRN. Removing financial barriers to accessing medications may improve medication adherence among these patients, with the potential to improve their outcomes.</p>


2022 ◽  
Author(s):  
Mohamad B. Taha ◽  
Javier Valero-Elizondo ◽  
Tamer Yahya ◽  
César Caraballo ◽  
Rohan Khera ◽  
...  

<b>Objective:</b> Health-related expenditures due to diabetes are rising in the US. Medication nonadherence is associated with worse health outcomes among adults with diabetes. <a>We sought to examine the extent of reported cost-related medication nonadherence (CRN) in individuals with diabetes in the US</a>. <p><b>Research Design and Methods: </b>We studied adults ≥18 with self-reported diabetes from the National Health Interview Survey (NHIS; 2013-18), a US nationally representative survey. Adults reporting skipping doses, taking less medication, or delaying filling a prescription to save money in the past year were considered to have experienced CRN. The weighted prevalence of CRN was estimated overall and by age subgroups (<65 and ≥65 years). Logistic regression was used to identify sociodemographic characteristics independently associated with CRN. </p> <p><b>Results: </b>Of the 20,326 NHIS participants with diabetes, 17.6% (weighted: 2.3 million) of those aged <65 reported CRN, compared with 6.9% (weighted: 0.7 million) among those aged ≥65. Financial hardship from medical bills, lack of insurance, low-income, high comorbidity burden and female sex were independently associated with CRN across age groups. Lack of insurance, duration of diabetes, current smoking, hypertension, and hypercholesterolemia were associated with higher odds of reporting CRN among the non-elderly, but not among the elderly. Among elderly, insulin use significantly increased the odds of reporting CRN (OR 1.51, 95% CI 1.18, 1.92).</p> <p><b>Conclusions: </b>In the US, 1 in 6 non-elderly and 1 in 14 elderly adults with diabetes reported CRN. Removing financial barriers to accessing medications may improve medication adherence among these patients, with the potential to improve their outcomes.</p>


Diabetes Care ◽  
2022 ◽  
Author(s):  
Mohamad B. Taha ◽  
Javier Valero-Elizondo ◽  
Tamer Yahya ◽  
César Caraballo ◽  
Rohan Khera ◽  
...  

OBJECTIVE Health-related expenditures resulting from diabetes are rising in the U.S. Medication nonadherence is associated with worse health outcomes among adults with diabetes. We sought to examine the extent of reported cost-related medication nonadherence (CRN) in individuals with diabetes in the U.S. RESEARCH DESIGN AND METHODS We studied adults age ≥18 years with self-reported diabetes from the National Health Interview Survey (NHIS) (2013–2018), a U.S. nationally representative survey. Adults reporting skipping doses, taking less medication, or delaying filling a prescription to save money in the past year were considered to have experienced CRN. The weighted prevalence of CRN was estimated overall and by age subgroups (&lt;65 and ≥65 years). Logistic regression was used to identify sociodemographic characteristics independently associated with CRN. RESULTS Of the 20,326 NHIS participants with diabetes, 17.6% (weighted 2.3 million) of those age &lt;65 years reported CRN, compared with 6.9% (weighted 0.7 million) among those age ≥65 years. Financial hardship from medical bills, lack of insurance, low income, high comorbidity burden, and female sex were independently associated with CRN across age groups. Lack of insurance, duration of diabetes, current smoking, hypertension, and hypercholesterolemia were associated with higher odds of reporting CRN among the nonelderly but not among the elderly. Among the elderly, insulin use significantly increased the odds of reporting CRN (odds ratio 1.51; 95% CI 1.18, 1.92). CONCLUSIONS In the U.S., one in six nonelderly and one in 14 elderly adults with diabetes reported CRN. Removing financial barriers to accessing medications may improve medication adherence among these patients, with the potential to improve their outcomes.


2022 ◽  
pp. 625-634
Author(s):  
Luis Saboga-Nunes ◽  
Uwe H. Bittlingmayer ◽  
Pauline Bakibinga

AbstractIn this chapter, the authors explore salutogenesis in the context of the ‘digital world’, concerning both high- and low-resource countries. The digital world is rapidly developing and can transcend physical and financial barriers of health care and health promotion. The digital world also has many challenges, especially for equity. On the one hand, digitalization carries the risk of excluding many people – also healthcare workers – because they cannot access the digital world or do not have the technical skills to understand it (make sense of it). On the other hand, the digital world offers both new generalized resistance resources (GRRs) and specific resistance resources (SRRs) to improve population health and promote healthy lifestyles and health literacy. The authors nicely illustrate how the sense of coherence (SOC) helps people find a balance in the digital world’s stress-rich environment. Important steps forward in this field include work to strengthen the evidence base and to document the preconditions for a digital world that supports decision making in health care, health behaviour change (e.g. quitting smoking) and – above all – supports empowerment and social justice.


2021 ◽  
pp. 152483992110660
Author(s):  
Jennifer B. Unger ◽  
Daniel Soto ◽  
Ryan Lee ◽  
Sohini Deva ◽  
Kush Shanker ◽  
...  

Background School-based COVID-19 testing is a potential strategy to facilitate the safe reopening of schools that have been closed due to the pandemic. This qualitative study assessed attitudes toward this strategy among four groups of stakeholders: school administrators, teachers, parents, and high school students. Methods Focus groups and interviews were conducted in Los Angeles from December 2020 to January 2021 when schools were closed due to the high level of COVID transmission in the community. Results Findings indicated similarities and differences in attitudes toward in-school COVID-19 testing. All groups agreed that frequent in-school COVID-19 testing could increase the actual safety and perceived safety of the school environment. School administrators expressed pessimism about the financial cost and logistics of implementing a testing program. Parents supported frequent testing but expressed concerns about physical discomfort and stigma for students who test positive. Teachers and parents noted that testing would prevent parents from sending sick children to school. Students were in favor of testing because it would allow them to return to in-person school after a difficult year of online learning. Conclusion In-school COVID-19 testing could be a useful component of school reopening plans and will be accepted by stakeholders if logistical and financial barriers can be surmounted and stigma from positive results can be minimized.


2021 ◽  
Vol 14 (1) ◽  
pp. 270
Author(s):  
Daniela M. Salvioni ◽  
Luisa Bosetti ◽  
Tommaso Fornasari

The transition from a linear to a circular economy (CE) is at the center of the debate among institutions, enterprises, practitioners, and scholars. Small- and medium-sized enterprises (SMEs), with their high presence in the business environment, play a pivotal role in the successful implementation of CE principles. Therefore, this paper aims to understand the state of the CE among Italian SMEs, considering both their different sizes and sectors. This study investigates CE knowledge and application, strategic relevance, benefits from and barriers to the transition towards circular business models, and the use of CE-related performance indicators in management control and external reporting. Through an online survey carried out in cooperation with the Italian Confederation of Craft Trades and Small- and Medium-Sized Enterprises (CNA), we collected primary data from 623 respondents. Findings revealed the existence of cultural, technological, market and financial barriers, which have hampered the adoption of circular practices among Italian SMEs. Poor understanding of CE potential, combined with difficulty in raising public and private funds to finance the transition from linear to circular, are the greatest problems. To overcome such issues, we recommend serious intervention by public institutions, trade and consumer associations, and the higher education system to develop a climate more favorable to the CE.


2021 ◽  
Vol 8 ◽  
Author(s):  
Shaili Johri ◽  
Maria Carnevale ◽  
Lindsay Porter ◽  
Anna Zivian ◽  
Melina Kourantidou ◽  
...  

Marine conservation sciences have traditionally been, and remain, non-diverse work environments with many barriers to justice, equity, diversity, and inclusion (JEDI). These barriers disproportionately affect entry of early career scientists and practitioners and limit the success of marine conservation professionals from under-represented, marginalized, and overburdened groups. These groups specifically include women, LGBTQ+, Black, Indigenous, and people of color (BIPOC). However, the issues also arise from the global North/South and East/West divide with under-representation of scientists from the South and East in the global marine conservation and science arena. Persisting inequities in conservation, along with a lack of inclusiveness and diversity, also limit opportunities for innovation, cross-cultural knowledge exchange, and effective implementation of conservation and management policies. As part of its mandate to increase diversity and promote inclusion of underrepresented groups, the Diversity and Inclusion committee of the Society for Conservation Biology-Marine Section (SCB Marine) organized a JEDI focus group at the Sixth International Marine Conservation Congress (IMCC6) which was held virtually. The focus group included a portion of the global cohort of IMCC6 attendees who identified issues affecting JEDI in marine conservation and explored pathways to address those issues. Therefore, the barriers and pathways identified here focus on issues pertinent to participants’ global regions and experiences. Several barriers to just, equitable, diverse, and inclusive conservation science and practice were identified. Examples included limited participation of under-represented minorities (URM) in research networks, editorial biases against URM, limited professional development and engagement opportunities for URM and non-English speakers, barriers to inclusion of women, LGBTQ+, and sensory impaired individuals, and financial barriers to inclusion of URM in all aspects of marine conservation and research. In the current policy brief, we explore these barriers, assess how they limit progress in marine conservation research and practice, and seek to identify initiatives for improvements. We expect the initiatives discussed here to advances practices rooted in principles of JEDI, within SCB Marine and, the broader conservation community. The recommendations and perspectives herein broadly apply to conservation science and practice, and are critical to effective and sustainable conservation and management outcomes.


Author(s):  
Candice Rademaker ◽  
Shital Bhandary ◽  
Helena Harder

Abstract Aim Breast and cervical cancers have emerged as major global health challenges and disproportionately affect women in low- and middle-income countries, including Nepal. This scoping review aimed to map the knowledge, attitudes and screening practices for these cancers among Nepali women to improve cancer outcomes and reduce inequality. Methods Five electronic databases (CINAHL, Embase, Global Health, PsycINFO and PubMed), grey literature, and reference and citation lists were searched for articles published in English up to June 2021. Articles were screened against inclusion/exclusion criteria, and data from eligible studies were extracted. Results were summarised narratively. Results The search yielded 615 articles, 38 of which were included in this scoping review (27 cervical cancer, 10 breast cancer, 1 both cancers). Levels of knowledge regarding breast and cervical varied widely. The main knowledge gaps were misconceptions about symptoms and risk factors, and poor understanding of screening behaviours. Screening practices were mostly inadequate due to socio-cultural, geographical or financial barriers. Positive attitudes towards cervical screening were associated with higher education and increased knowledge of screening modalities. Higher levels of knowledge, (health) literacy and participation in awareness campaigns facilitated breast cancer screening. Conclusion Knowledge and screening practices for breast and cervical cancer among Nepali women were poor and highlight the need for awareness and education programmes. Future research should explore community health worker-led awareness and screening interventions for cervical cancer, and programmes to increase the practice of breast self-examination and clinical breast examinations to support early diagnosis of breast cancer.


2021 ◽  
pp. 154041532110575
Author(s):  
Roman Pabayo ◽  
Claire Benny ◽  
Sze Yan Liu ◽  
Erin Grinsteyn ◽  
Peter Muennig

Objectives: In the United States, Hispanics are more likely to experience financial barriers to mental health care than non-Hispanics. We used a unique survey to study the effect of these financial barriers on the severity of depressive symptoms among Hispanics who had previously been diagnosed as having depression. Methods: This cross-sectional study used data from the 2015 Washington Heights Community Survey, administered to 2,489 households in Manhattan, New York City. Multiple regression models and propensity score matching were used to estimate the association between financial barriers to mental health care and depressive symptoms and the likelihood of being clinically depressed. Results: Among those diagnosed with depression, those with financial barriers to mental health services or counseling had significantly higher (β = 0.36, 95% CI = 0.03, 0.70) depressive symptoms. When propensity score matching was utilized, those with financial barriers to mental health services had significantly greater depressive symptoms (β = 0.63, 95% CI = 0.37, 0.89) and were significantly more likely to be currently depressed (OR = 2.38, 95% CI = 1.46, 3.89), in comparison to those who had access. Conclusions: Making mental health care more affordable and therefore more accessible to Hispanics is one step toward mitigating the burden on mental illness and decreasing health disparities.


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