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2021 ◽  
Vol 2 (1) ◽  
Sophia Lüttringhaus ◽  
Willy Pradel ◽  
Víctor Suarez ◽  
Norma C. Manrique-Carpintero ◽  
Noelle L. Anglin ◽  

Abstract Background Potato landraces (Solanum spp.) are not only crucial for food security and sustenance in Andean communities but are also deeply rooted in the local culture. The crop originated in the Andes, and while a great diversity of potato persists, some landraces have been lost. Local communities and the genebank of the International Potato Center (CIP) partnered to re-establish some of these landraces in situ by supplying clean seed potatoes to farmers. Over time, the genebank formalized a repatriation program of potato landraces. Repatriation is the process of returning native germplasm back to its place of origin, allowing a dynamic exchange between ex situ and in situ conditions. So far, no comprehensive description of CIP’s repatriation program, the changes it induced, nor its benefits, has been carried out. Methods We addressed this research gap by analyzing CIP genebank distribution data for repatriated accessions, conducting structured interviews with experts of the repatriation program, and applying duration and benefit analyses to a survey dataset of 301 households. Results Between 1997 and 2020, 14,950 samples, representing 1519 accessions, were distributed to 135 communities in Peru. While most households (56%) abandoned the repatriated material by the fourth year after receiving it, the in situ survival probability of the remaining material stabilized between 36% in year 5 and 18% in year 15. Households where the plot manager was over 60 years old were more likely to grow the repatriated landraces for longer periods of times. While male plot management decreased survival times compared to female plot management, higher levels of education, labor force, wealth, food insecurity, and geographic location in the southern part of Peru were associated with greater survival times. Most farmers reported nutritional and cultural benefits as reasons for maintaining landrace material. Repatriated potatoes enabled farmers to conserve potato diversity, and hence, re-establish and broaden culinary diversity and traditions. Conclusions Our study is the first to apply an economic model to analyze the duration of in situ landrace cultivation by custodian farmers. We provide an evidence base that describes the vast scope of the program and its benefits.

2021 ◽  
Vol 30 (21) ◽  
pp. S20-S27
Alison Coutts

Maintaining a healthy weight is a concern for a large proportion of adults in the UK, with obesity rates having almost doubled between 1993 and 2011. With overweight and obesity linked to several diseases and health conditions, nurses are often tasked with raising the subject with their clients/patients and advising on lifestyle modifications. This article examines ways to identify whether a person needs to lose weight and establishing targets. It then reviews the evidence base for different approaches to weight management currently available and the advice nurses can provide.

Deborah Warr ◽  
Georgina Luscombe ◽  
Danielle Couch

Despite high unmet demand for health services across rural Australia, uptake of telehealth has been slow, piecemeal and ad hoc. We argue that widespread failure to understand telehealth as a socio-technical practice is key to understanding this slow progress. To develop this argument, we explore how technocentric approaches to telehealth have contributed to critical blind spots. First, the ‘hype’ associated with the technological possibilities of telehealth discourages thoughtful consideration of the unanticipated consequences when technologies are rolled out into complex social fields. Second, it contributes to critical gaps in the telehealth evidence base, and particularly a paucity of analyses focussing on the experiences of service users and patients. A third blind spot concerns the limited attention paid to the social determinants of health and digital divides in rural areas. The final blind spot we consider is an apparent reluctance to engage community stakeholders in co-designing and coproducing telehealth services. We used an iterative approach to identify studies and commentary from a range of academic fields to explain the significance of the telehealth blind spots and how they might be addressed. Insights suggest how expanding understanding of the social dimensions of telehealth could enhance its accessibility, effectiveness and responsiveness to community needs and contexts.

2021 ◽  
Vol 7 (1) ◽  
Ann Single ◽  
Ariana Cabrera ◽  
Simon Fifer ◽  
Jane Tsai ◽  
Jin-Young Paik ◽  

Abstract Background In some jurisdictions, patients and patient groups may be invited to provide input when Health Technology Assessment (HTA) is used to inform decisions about which medicines should be subsidised or funded. This input can help frame the evidence from a patient perspective, address uncertainties in the evidence and interpret it for the local setting. However, there is currently no evidence linking patient involvement with positive reimbursement decisions. Aim We aimed to understand the expectations of patient involvement in the reimbursement process, especially among cancer patient advocacy groups (PAGs) in New Zealand (Aotearoa), South Korea and Taiwan. Methods We developed an online survey to help understand the role that cancer PAGs play in reimbursement processes and identify knowledge gaps about the processes that might impact the efforts of PAGs. The survey elicited the views of staff and patients affiliated with PAGs (n = 43) on current practices and how the assessment and reimbursement of new cancer drugs might be improved. Results There was variability in knowledge of the HTA assessment processes and in experience of being involved in them. Those with HTA experience were more likely to have confidence in the process. Those who had not been involved tended to have little awareness of, or frustration with, decision-making processes. Most identified cost, finances and economic assessments as key considerations in current processes. Some respondents had clear ideas about how their knowledge and involvement could improve processes to determine the value of new medicines. However, for many, a lack of information about the basis for decision making and opportunities to be involved was a barrier to identifying process improvement. Conclusions HTA is implemented primarily in countries seeking to have fair and equitable processes for funding medicines. PAGs often recognise the financial challenges of funding new medicines and share the desire for procedural fairness. The connection PAGs make between patient involvement and improved access to new medicines may be based on the belief they can add information to the evidence base, help solve problems, ensure fairness through transparency and/or influence the culture towards increased access to medicines they value.

2021 ◽  
Sian Price ◽  
Hannah Shaw ◽  
Fiona Morgan ◽  
Rocio Rodriguez-Lopez ◽  
Kirsty Little ◽  

Objectives This systematic review addresses the question Is any job better than no job? Specifically, it compares health and well-being outcomes in those who are unemployed with those who are in jobs that could be considered poor or low quality and the impact of any movement between them. Method We conducted a systematic review following a PROSPERO-registered protocol (CRD42020182794). Medline, Embase, PsycINFO, HMIC, ASSIA, TRIP, Google Scholar and 10 websites were searched in April 2020 and again in May 2021 without date limits. Two reviewers working independently screened search results against the inclusion/exclusion criteria. A checklist for quantitative studies reporting correlations was used to critically appraise articles included at full text. We undertook synthesis without meta-analysis (narrative synthesis) and explored a range of variables (for example, study design and quality, type of outcome measure) that we considered might have an impact on the association between exposure and outcome. Results We included 25 studies reported in 30 journal articles. All 25 studies involved secondary analysis of data from national cohorts, including six from the UK. The most frequent outcomes reported were measures of mental well-being. There was considerable heterogeneity across included studies in terms of design, population, definition of poor/bad or low quality job and outcome types and measures. Overall the quality of the included studies was moderate. The evidence base is inconsistent. There are studies that suggested either labour market position might be preferable, but a number of studies found no statistically significant difference. Cohort and case-control studies looking at mental well-being outcomes showed some support for a poor job being better than unemployment. However, we did not find sufficient numbers of well-designed studies showing a strong association to support a causal relationship. Most included study designs were unable to distinguish whether changes in employment status occurred before a change in outcome. Three studies looking at employment transitions found that moving to a poor job from unemployment was not associated with improved mental health, but moving from a poor job to unemployment was associated with a deterioration. Conclusion Evidence that better health and well-being outcomes are more likely to be associated with a poor/bad or low quality job than with unemployment is inconsistent. Studies conducted in the UK suggest that a poor job is not significantly associated with better health and well-being outcomes than unemployment. The studies we identified do not allow us to distinguish whether this lack of association is the result of a state welfare regime preventing some of the worst ills associated with unemployment, or a reflection of job quality. The evidence base has significant limitations in study design and conduct. In summary, the evidence we found suggests it is not safe to assume that, in the UK, any job will lead to better health and well-being outcomes than unemployment.

2021 ◽  
pp. 105413732110471
K. Jones ◽  
Sharon Mallon ◽  
Katy Schnitzler

Background The COVID-19 pandemic has resulted in many changes to the lives of children and young people. Our aim is to explore the impact of the pandemic on the mental health of children and young people (ages 5–21). Methods The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines was used to report the findings of this rapid review. Results Children and young people are potentially very vulnerable to the emotional impact of traumatic events that disrupt their daily lives. Key areas of concern include: Death Anxiety and Fear of Infection; lack of social interaction and loss of routine. Conclusions Despite some early and responsive studies, the evidence base for pandemic impact on children and young people is very limited. Such evidence is urgently needed if adequate and responsive services, that can mitigate the long-term impact of the pandemic for children and young people can be established.

2021 ◽  
pp. bmjsrh-2021-201225
Michelle C Chan ◽  
Roopan Kaur Gill ◽  
Caron Rahn Kim

AimThe aim of this review was to systematically review the outcome of routine anti-D administration among unsensitised rhesus (RhD)-negative individuals who have an abortion. This review is registered with Prospero.MethodsA search for all published and ongoing studies, without restrictions on language or publication status, was performed using the following databases from their inception: EBM Reviews Ovid - Cochrane Central Register of Controlled Trials, MEDLINE Ovid (Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily), Embase.com, Popline and Google Scholar. Study types included: randomised controlled trials, controlled trials, cohort and case–control studies from 1971 onwards. The population included women who undergo an abortion (induced, incomplete, spontaneous or septic abortion), medical or surgical <12 weeks, and isoimmunisation in a subsequent pregnancy. The primary outcomes were: (1) development of a positive Kleihauer–Betke test and (2) development of Rh alloimmunisation in a subsequent pregnancy.ResultsA total of 2652 studies were screened with 105 accessed for full-text review. Two studies have been included with high bias appreciated. Both studies found few women to be sensitised in forming antibodies after an abortion. The limited studies available and heterogeneity prevent the conduction of a meta-analysis.ConclusionsRh immunoglobulin has well-documented safety. However, it is not without risks and costs, is a possible barrier to delivering efficient services, and may have limited availability in some countries. The evidence base and quality of studies are currently limited. There is unclear benefit from the recommendation for Rh testing and immunoglobulin administration in early pregnancy. More research is needed as clinical practice guidelines are varied, based on expert opinions and moving away from testing and administration at time of abortion.ImplicationsThere is limited evidence surrounding medical benefit of Rh testing and immunoglobulin administration in early pregnancy. Further research is needed to define alloimmunisation and immunoglobulin benefit to update standards of care. Additionally, other factors should be considered in forming clinical policies and guidelines such as costs, feasibility and impact on access to care for patients.

2021 ◽  
Helene Eckhardt ◽  
Susanne Felgner ◽  
Marie Dreger ◽  
Sabine Fuchs ◽  
Hanna Ermann ◽  

Abstract Background: The reimbursement of new technologies in inpatient care is not always linked to a requirement for evidence-based evaluation of patient benefit. In Germany, every new technology approved for market was until recently reimbursable unless explicitly excluded. It was therefore unclear whether the implementation of innovative technologies is guided by scientific evidence. This work aimed to explore the relationship between clinical evidence and utilization for 25 selected technologies in German inpatient care.Methods: Different methods were applied. A systematic search for evidence published between 2003 and 2017 was conducted in four bibliographic databases; clinical trial registries; resources for clinical guidelines; and health technology assessment - databases. Information was also collected on funding mechanisms and safety notices. Utilization was measured by hospital cases captured in claims data. The body of evidence, funding and safety notices per technology were analysed descriptively. The relationship between utilization and evidence was explored empirically using a multilevel regression analysis.Results: The number of included publications per technology ranges from two to 498. For all technologies, non-comparative studies form the bulk of the evidence. The number of randomised controlled clinical trials per technology ranges from zero to 19. Some technologies were utilized for several years without an adequate evidence base. A relationship between evidence and utilization could be shown for several but not all technologies.Conclusions: This study reveals a mixed picture regarding the evidence available for new technologies, and the relationship between the development of evidence and the use of technologies over time. Although the influence of funding and safety notices requires further investigation, these results re-emphasize the need for strengthening market approval standards and HTA pathways as well as approaches such as “coverage with evidence development”.

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