Tips for integrating human nutrition into research on the interaction between livestock/agricultural production and climate change; overview of the Global Livestock CRSP's ENAM project in Ghana. Presentation given by G. Marquis (McGill University) at the Livestock-Climate Change CRSP Annual Meeting, Golden, CO, April 26-27, 2011.
The Global Nutrition Report's emphasis on nutritional well-being for all, particularly the most vulnerable, has a heightened significance in the face of this new global threat. The need for more equitable, resilient and sustainable food and health systems has never been more urgent.
Former Dietary Guidelines Advisory Committee members discussed the role nutrition science and research plays in shaping U.S. food policy issues, such as the Dietary Guidelines for Americans, and the impact on consumers and industry.
Key Takeaways:
The role federal agencies play in making food and nutrition policy recommendations
Insights into the science and process related challenges faced when creating the DGAC Report
Thoughts from past DGAC members on the newly released 2015 DGAC Report
The Global Nutrition Report's emphasis on nutritional well-being for all, particularly the most vulnerable, has a heightened significance in the face of this new global threat. The need for more equitable, resilient and sustainable food and health systems has never been more urgent.
Former Dietary Guidelines Advisory Committee members discussed the role nutrition science and research plays in shaping U.S. food policy issues, such as the Dietary Guidelines for Americans, and the impact on consumers and industry.
Key Takeaways:
The role federal agencies play in making food and nutrition policy recommendations
Insights into the science and process related challenges faced when creating the DGAC Report
Thoughts from past DGAC members on the newly released 2015 DGAC Report
September of 2012 the CDC released data per state on Obesity in Amercians. Even though this is 2012 the information is even more relavant and more validated by now.
Expositor: Martin Bloem – Jefe de la División de Políticas de Nutrición del Programa Mundial de Alimentos
Seminario Internacional sobre Experiencia exitosas en Nutrición, organizado por el Programa Mundial de Alimentos de las Naciones Unidas (PMA) en Colombia y DSM.
14 y el 15 de mayo de 2015.
Bogotá, Colombia.
Aene project a medium city public students obesity studyCIRINEU COSTA
Identifying undernutrition and obesity on students and propose public policies of health are urgent issues. This paper presents a study with weight and stature from students collected by physical education teachers (PEF) in schools of a city near São Paulo. The PEF collected the data and they were inserted in a program especially developed for each school Department (AENE Project). The datas were analyzed by software and evaluation done based on a World Health Organization (WHO_2007) table, that develops health programs worldwide. The results evaluations were used to raise the students and family, teachers and responsibles for treatment search (when required).
Barry M. Popkin
SPECIAL EVENT
28th Annual Martin J. Forman Memorial Lecture
Confronting the New Face of Malnutrition: Regulatory and Fiscal Approaches to Improving Diets
OCT 29, 2018 - 12:15 PM TO 01:45 PM EDT
"Empowering Women as Key drivers of Food System Change Lindiwe Majele Sibanda...ExternalEvents
"www.fao.org/about/meetings/sustainable-food-systems-nutrition-symposium
The International Symposium on Sustainable Food Systems for Healthy Diets and Improved Nutrition was jointly held by FAO and WHO in December 2016 to explore policies and programme options for shaping the food systems in ways that deliver foods for a healthy diet, focusing on concrete country experiences and challenges. This Symposium waas the first large-scale contribution under the UN Decade of Action for Nutrition 2016-2025. This presentation was part of Parallel session 3.3: Empowering women as key drivers of food system change"
National Food & Nutrition Policy: Balancing the Role of Research, Nutrition S...Corn Refiners Association
At Experimental Biology 2015, the Sponsored Satellite Program "National Food & Nutrition Policy: Balancing the Role of Research, Nutrition Science and Public Health" held in conjunction with the American Society for Nutrition's Scientific Session took place on April 1, 2015.
To watch the Dr. Lichtenstein video on slide 68 "Do Scripted Diets Work for Policy? What about Low-fat Diets?", please download the presentation first.
4. day 2 session 1 nutrition sensitive programs and policiesPOSHAN
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
September of 2012 the CDC released data per state on Obesity in Amercians. Even though this is 2012 the information is even more relavant and more validated by now.
Expositor: Martin Bloem – Jefe de la División de Políticas de Nutrición del Programa Mundial de Alimentos
Seminario Internacional sobre Experiencia exitosas en Nutrición, organizado por el Programa Mundial de Alimentos de las Naciones Unidas (PMA) en Colombia y DSM.
14 y el 15 de mayo de 2015.
Bogotá, Colombia.
Aene project a medium city public students obesity studyCIRINEU COSTA
Identifying undernutrition and obesity on students and propose public policies of health are urgent issues. This paper presents a study with weight and stature from students collected by physical education teachers (PEF) in schools of a city near São Paulo. The PEF collected the data and they were inserted in a program especially developed for each school Department (AENE Project). The datas were analyzed by software and evaluation done based on a World Health Organization (WHO_2007) table, that develops health programs worldwide. The results evaluations were used to raise the students and family, teachers and responsibles for treatment search (when required).
Barry M. Popkin
SPECIAL EVENT
28th Annual Martin J. Forman Memorial Lecture
Confronting the New Face of Malnutrition: Regulatory and Fiscal Approaches to Improving Diets
OCT 29, 2018 - 12:15 PM TO 01:45 PM EDT
"Empowering Women as Key drivers of Food System Change Lindiwe Majele Sibanda...ExternalEvents
"www.fao.org/about/meetings/sustainable-food-systems-nutrition-symposium
The International Symposium on Sustainable Food Systems for Healthy Diets and Improved Nutrition was jointly held by FAO and WHO in December 2016 to explore policies and programme options for shaping the food systems in ways that deliver foods for a healthy diet, focusing on concrete country experiences and challenges. This Symposium waas the first large-scale contribution under the UN Decade of Action for Nutrition 2016-2025. This presentation was part of Parallel session 3.3: Empowering women as key drivers of food system change"
National Food & Nutrition Policy: Balancing the Role of Research, Nutrition S...Corn Refiners Association
At Experimental Biology 2015, the Sponsored Satellite Program "National Food & Nutrition Policy: Balancing the Role of Research, Nutrition Science and Public Health" held in conjunction with the American Society for Nutrition's Scientific Session took place on April 1, 2015.
To watch the Dr. Lichtenstein video on slide 68 "Do Scripted Diets Work for Policy? What about Low-fat Diets?", please download the presentation first.
4. day 2 session 1 nutrition sensitive programs and policiesPOSHAN
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
Helping countries improve nutrition outcomes through agriculture and food - w...Francois Stepman
11 December 2017. Brussels. DevCo Infopoint. Countries are seeking to improve nutrition through multiple sectors, including agriculture and food systems. This requires navigating dietary transitions, strengthening country ownership of programmes and investment decisions, working with public and private partners, and better understanding drivers that shape demand. These are key considerations for lesson learning moving forward.
Introduction: Bernard Rey, Deputy Head of Unit, DEVCO C1- Rural Development, Food Security, Nutrition
Panel discussion:
John McDermott, Director, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)
Namukolo Covic, Senior Research Coordinator, IFPRI, Addis Ababa, Ethiopia
Roseline Remans, Research Scientist, Bioversity International, Brussels
Thom Achterbosch, Senior Researcher, Wageningen Economic Research, International Policy
Please find also the link to the video of the conference:
https://ec.europa.eu/europeaid/news-and-events/agriculture-nutrition-outcomes-countries_en
Dr C. Dustin Becker, Leeroy Joshua and Dorothy Tavoa of the School of Natural Resources and Applied Sciences from the Solomon Islands National University undertook a rapid country scan on the agriculture-nutrition nexus in 2015. The scan was commissioned by CTA and provides a snapshot of the policies and programmes in the nation.
Essential Nutrition Actions (ENA) Update - India RMNCH conference, Feb 2015JSI
This presentation highlights the Essential Nutrition Actions framework to promote key practices in women's and children's nutrition by: 1. emphasizing do-able actions to demystify nutrition, 2. building capacity of existing systems and interventions and 3. strengthening the system of delivery.
The presentation gives specific WHO-recommended, high-impact nutrition interventions and how they can be delivered through a life-cycle approach by using existing health contacts like schools, mass media, and other community channels.
This presentation was made by Dr. Agnes Guyon at the 14th World Congress on Public Health in Kolkata, India in February 2015.
Presented at the European Obesity Forum which took place in Bucharest on October 16th, the presentation describes the concept "Healthy Living" and outcome of its first school-based pilot in ORT junior-high schools.
Presentation made at a two-day workshop "Stepping up to India’s Nutrition Challenge: The Critical Role of Policy Makers" for district administrators from India’s Aspirational Districts, on 6-7 Aug 2018, at Mussoorie.
Images of recent research activities of Dr. Gillies' (Utah State University) project: Past and Future Climate Assessments of Livestock Vulnerability in Nepal
Adapting Livestock Production System to Climate Change in Nepal (Durga D. Pou...Colorado State University
A talk presented by Dr. Durga Poudel, Project Leader of the LCC CRSP SLPS Project (http://lcccrsp.org/projects/central-asia/slps/), to the School of Geosciences at the University of Louisiana, Lafayette on September 20, 2011.
Livestock-Climate Change CRSP Annual Meeting 2011: Mali Poultry Project Updat...Colorado State University
An update on the Livestock-Climate Change CRSP's Mali Poultry Project and project status report. Presentation given by M. Lacy (University of Georgia) at the Livestock-Climate Change CRSP Annual Meeting, Golden, CO, April 26-27, 2011.
Livestock-Climate Change CRSP Annual Meeting 2011: MLPI-2 Project Update (J. ...Colorado State University
An update on the Livestock-Climate Change CRSP's Mali Livestock and Pastoralist Initiative-2 Project and project status report. Presentation given by J. McPeak (Syracuse University) at the Livestock-Climate Change CRSP Annual Meeting, Golden, CO, April 26-27, 2011.
Livestock-Climate Change CRSP Annual Meeting 2011: CHAINS Project Update (P. ...Colorado State University
An update on the Livestock-Climate Change CRSP CHAINS Project (Climate variability, pastoralism, and commodity chains in Ethiopia and Kenya) and the current status of the project. Presentation given by P. Littel (Emory University) at the Livestock-Climate Change CRSP Annual Meeting, Golden, CO, April 26-27, 2011.
Livestock-Climate Change CRSP Annual Meeting 2011: CARBON Project Update (J. ...Colorado State University
An update on the Livestock-Climate Change CRSP CARBON Project (A cost-effectiveness framework for landscape rehabilitation and carbon sequestration in North Kenya) and the current status of the project. Presentation given by J. Belnap (USGS) at the Livestock-Climate Change CRSP Annual Meeting, Golden, CO, April 26-27, 2011.
Livestock-Climate Change Annual Meeting 2011: Gender and Climate Change (S. R...Colorado State University
Tips on incorporating gender equity assessments into research on the interactions of climate change and livestock or agricultural production. Presentation given by S. Russo (University of Florida) at the Livestock-Climate Change CRSP Annual Meeting, Golden, CO, April 26-27, 2011.
Livestock-Climate Change CRSP Annual Meeting 2011: PTRF Project Update (K. Ga...Colorado State University
An overview of the Livestock-Climate Change CRSP PTRF (Pastoral Transformations to Resilient Futures--Understanding Climate from the Ground Up) Project and update on the project's current status. Presentation given by K. Galvin (Colorado State University) at the Livestock-Climate Change CRSP Annual Meeting, Golden, CO, April 26-27, 2011.
Livestock-Climate Change CRSP Annual Meeting 2011: RPRA Project Update (S. Mc...Colorado State University
An overview of the Livestock-Climate Change CRSP RPRA (Risk, perception, resilience and adaptation to climate change in Niger and Tanzania) Project and update on the project's current status. Presentation given by S. McKune (University of Florida) at the Livestock-Climate Change CRSP Annual Meeting, Golden, CO, April 26-27, 2011.
Livestock-Climate Change CRSP Annual Meeting 2011: TRANS Project Update (N. H...Colorado State University
An overview of the Livestock-Climate Change CRSP TRANS (Transhumance, natural resources, and conflict in the Sahel: a pilot project) Project and update on the project's current status. Presentation given by N. Hanan (South Dakota State University) at the Livestock-Climate Change CRSP Annual Meeting, Golden, CO, April 26-27, 2011.
Livestock-Climate Change CRSP Annual Meeting 2011: GSFA/RIVERS Project Update...Colorado State University
A description of the Livestock-Climate Change CRSP's GSFA/RIVERS Project (Management of River Systems for the Future) and update on the current status of the project. Presentation given by J. McPeak (Syracuse University) at the Livestock-Climate Change CRSP Annual Meeting, Golden, CO, April 26-27, 2011.
Livestock-Climate Change CRSP Annual Meeting 2011: FORT Project Update (N. Jo...Colorado State University
A description of the Livestock-Climate Change CRSP's FORT Project (Enhancing livestock production systems in Tajikistan to mitigate potential impacts of climate change) and update on the project's current status. Presentation given by N. Joshi (Michigan State University) at the Livestock Climate Change CRSP Annual Meeting, Golden, CO, April 26-27, 2011.
Livestock-Climate Change Annual Meeting 2011: REMM Project Update (R. Reid)Colorado State University
A description of the Livestock-Climate Change CRSP's REMM Project (Increasing adaptive capacity of Mongolian livestock herders under a changing climate through rangeland ecosystem monitoring and community-based conservation) and update on the project's current status. Presentation given by R. Reid (Colorado State University) at the Livestock Climate Change CRSP Annual Meeting, Golden, CO, April 26-27, 2011.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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2. LCC & nutrition frameworks reflect multiple layers of determinants that contribute to human well-being & livelihoods UNICEF. Global Framework for Action. 2006 LCC-CRSP Technical Approach.
3. Cognitive development Reproductive success Work capacity/efficiency Adult-onset chronic diseases Environmental Health Production Animal & Human Health Climate change Training, management Policies, laws, markets
4. Take-home messages Prevalence of malnutrition remains unacceptably high, especially in SSA and Asia, and urban/rural disparities continue Maternal and young child nutritional status matters for society and should be the focus of interventions There are interventions that have been proven effective (SUN) Nutrition lends itself to being integrated (relatively easily) into diverse projects There is a growing recognition of the need and desire for integrated approaches
5. In Sept., 2000,Millennium Declaration was signed by 189 countries “to create an environment – at the national and global levels alike – which is conducive to development and the elimination of poverty” Improving nutrition is key to achieving the majority of the MDGs Nutrition interventions should 1st focus on vulnerable populations - women of reproductive age - children < 2 y
6. ~ 25% reduction in mortality for every 1 g/dL increase in hemoglobin Stoltzfus www.who.int/publications/cra/chapters/volume1/0163-0210.pdf
7. Low maternal prepregancy BMI and inadequate weight gain are primary predictors of low birth weight. Low birth weight is ~ at least 30% of deaths among children < 5 y (75% of neonatal deaths) MDG Report 2010
8. Underweight in < 5 y as an indicator of Goal 1 Will not meet 2015 goal (i) Starts at birth: birth weights & lengths in LMC are below WHO growth standards (ii) Early growth faltering is faster than currently assumed. (iii) Nutrition interventions needed before birth & in 1st 2 y of life. Victora et al. 2010
9. “Unfortunately, there has been little appreciable change over the last two decades in the high worldwide prevalence of iron deficiency anaemia. Few active programmes in both developed and developing countries have succeeded in reducing iron deficiency and anaemia. Important factors contributing to the lack of progress include failure to recognize the causes of iron deficiency and anaemia, lack of political commitment to control it, inadequate planning of control programmes, insufficient mobilization and training of health staff, and insufficient community involvement in solving the problem.” (WHO 2000)
10. Maternal & young child nutrition matters – Lancet 2008 series Short-term consequences Significant increased risk before classified as underweight Black et al. Lancet. 2008
11.
12. Scaling Up Nutrition (SUN) Cost of scaling up a minimal package of 13 proven nutrition interventions to full coverage in 36 countries with highest burden (90% of stunting). World Bank 2010
15. Example of successful community-based nutrition education intervention on complementary feeding (where common 1st foods were soups & porridges) Effectiveness of an educational intervention delivered through the health services to improve nutrition in young children: a cluster-randomised controlled trial ME Penny et al. Lancet 2005;365:1863-72
16. General Objectives To implement and evaluate an educational intervention to improve breastfeeding and complementary feeding of infants in Trujillo 2. To implement the intervention through existing and feasibily enhanced resources in health facilities and the community.
17. Study Design Randomized controlled effectiveness trial 6 pairs of matched health facilities with their communities in peri-urban Trujillo, a town on the northern coast of Peru
18. Rationale for Health Services The health service in Peru is well organized, extensively used by poorer families and there is a clear policy facilitating community outreach activities. In urban shanty towns there is easy access to government health facilities which offer a comprehensive service. The health service is the most sustainable institution in these poor areas.
19. Formative Research Methods Community Motivations Interviews with mothers of development Perception and Perception of CRED Focus Groups Feeding practices of micronutrient Attributes rich foods Household Trials Difficulties with feeding Interviews with community agents : midwives , presidents of community kitchens glass of milk program , health promoters
22. 4 5 3 2 1 5 4 3 2 1 Feasibility Specialingredient (liver, fish, egg) Thick puree Puree first 5 times a day Love,patience and good humour Avoid sweets before lunch Eat with dad Repeat serving Different flavours Imitation Finger pieces Impact Eat with hands Portion mid afternoon Give own plate Small servings Have child sit Results: “Teach your child to eat with love, patience, and good humour” High acceptability, High impact factor, lasting
30. Evaluation of Exposure to Intervention: Structured observations 197 children 6-24 months Exit interviews, 216 children, 6-24 months Midterm survey, 9 months after starting 476 children 6-14 months Evaluation of exposure to “How” questions Spontaneous recall Recognition of educational material Prompted recall
31. 100 90 80 70 60 50 40 30 20 10 Intervention center Control center Intervention center Control center Intervention center Control center Intervention center Control center Intervention center Control center Intervention center Control center Intervention center Control center Intervention center Control center N=6 N=39 N=55 N=8 N=39 N=6 N=8 N=39 N=3 N=56 N=37 N=9 N=56 N=3 N=9 N=56 Example: Exit Interviews with messages reported received Any “how” message Any nutrition message Any “how” message Any nutrition message Any “how” message Any nutrition message Key message Key message Key message Nutrition Well Baby Clinic Doctor Vaccines Well Baby Clinic Doctor Vaccines Well Baby Clinic Doctor Vaccines % caretakers reporting message % caretakers reporting message % caretakers reporting message
34. The importance of animal source foods for young child growth The ENAM project
35. Iowa State U Co-PIs U of Ghana Co-PIs Grace Marquis US PI Owuraku Sakyi-Dawson Ghana PI Lorna Butler Manju Reddy Helen Jensen Elizabeth Lonergan Anna Lartey Ben Ahunu Emmanuel Canacoo Esi Colecraft Project manager Richard Tweneboah-Kodua, Aaron Christian Field supervisors / data management Selasie Agamah, Gymfiwah Nikoi Administrative officer Mawunyo Timbo, Gifty Nyarko Data entry 24 sponsored students (Ghana, USA, Canada) Felix Boadu Driver William Quarmine, Clifford Marquaye Data analysis assistants Temporary region-based data collection team Staff from: Women in Agricultural Development/MoFA Ghana Health Services Heifer International-Ghana Freedom from Hunger-Ghana Rural banks Felicia Kudomor Winneba Dinah Amoah Techiman Thomas Kambonga Navrongo Regional managers
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38. Meat group showed increases in indicators of physical growth, cognitive function and school performance, and physical activityGlobal Livestock CRSP (2002) Sought proposals that address the question: What are the constraints to the availability, accessibility, preparation, and allocation of ASF for children in developing countries?
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42. Phase 1Participatory process to develop problem model Phase 2Implement an income-generation and education/training intervention Phase 3Transfer of activities to local agents for sustainability
43. Phase 1Participatory process to develop problem model for constraints on animal source foods (ASF)Availability (does it exist?)Accessibility (is it affordable?)Utilization (does the child get it?)
44. Selection of research communities Distinct ecological zones Upper East Region Communities chosen with ministry …1. availability or use of ASF typical to the agro-ecological zone 2. presence of community- or household-level livestock/animal-rearing activities 3. logistical accessibility to the community Brong-Ahafo Region Central Region
60. Research question Does the implementation of an intervention with micro-credit,entrepreneurship training, and nutrition educationimprove household food security, use of animal source foods for children, and children’s nutritional status in rural Ghana?
62. Step 1: Income-generation activities Community ENAM Team Community Develop list of IGA Consensus on IGA to support Promotion of selected IGA Reviewed IGA suitability Develop support packages for selected IGA Cash flow analysis
68. Organization of micro-credit for IGA Caregiver self-selection CSA leadership President Treasurer Secretary Organizer Orientation training Eligible caregivers for solidarity groups (3-5/group) Loan requirements: Group concept $50 maximum initially Loan cycle (16 wk) Repayment weekly Savings (10%) Education Future loans require: Meeting attendance Savings Group appraisal Solidarity group Solidarity group Village Credit & Savings Association (CSA) Solidarity group Solidarity group Develop group rules and by-laws Membership requirements Penalties Loan appraisal
69. Example of support for IGA: Specialized training Poultry raising Coup construction & maintenance Poultry health Feed management Marketing poultry products Technical assistance: Heifer Int’l, Ghana Veteran poultry farmers U of CA Avian Flu School
81. Participants interviewed 179 participants open to all women with 2- 5 y old children living in community self-selected 142 non-participants living in community with 2-5 y old child matched wealth ranking 287 controls living in control community with 2-5 y old child matched wealth ranking
82. Data collection Baseline FUP1, 4 mo FUP2, 8 mo FUP3, 12 mo FUP4, 16 mo Longitudinal data collected Microcredit performance Meeting attendance Repayments Savings Cash flow for IGA (sub-sample) Household Socio-demographic Food security ASF expenditures Caregiver Child nutrition/health knowledge Child Dietary intakes FFQ Weighed food (subsample) Anthropometry Other data collected Case studies (post intervention only)
87. SUCCESS Previous business experiences Higher loan amount Supportive family Business commitment and vision Healthy maternal status What factors contribute to participants’ success ……. … implications for interventions
88. Research question Does the implementation of an intervention with micro-credit,entrepreneurship training, and nutrition educationimprove household food security, use of animal source foods for children, and children’s nutritional status in rural Ghana?
90. Food insecurity is linked to quality of diet Food secure/at risk Food insecure P<0.05 0 5 10 15 20 Percent of hh (%) 0 2 4 6 8 10 Number of ASF types consumed Food secure/at risk Food insecure (moderate & severe) * 100 * 80 * * * * 60 Percent of hh (%) * 40 20 0 1 Accounting for region, ethnicity, and child age * P<0.05 Children in moderate-severe food insecure households consumed fewer types of ASF1. They were less likely to eat individual ASF types except for fish powder. *
91. There were no differences in food insecurity among groups at baseline. After 16 months, intervention families were half as likely to report food insecurity as comparison families (OR=0.50; p<0.001).
93. “Before the project, I would sell all the fish because I wanted the money. But now, I make sure there is always some fish left at home for them [the children]…My other children did not benefit from what I now know and they were always falling ill…Dominic is very good in school, even the teachers say so. And I know this is because of what I feed him”.
94. Micronutrient intakes increased among children in intervention households Dietary intakes based on 2-day weighed food records (Mean ±SE) In bold P<0.05 Lartey A. 2008
95. Intervention effect on child weight-for-age * * * Wt-for-age Z-score Baseline and Follow-up time points 1-4 Mixed linear regression hierarchical model Includes district, lives with partner, income, caregiver occupation, time Intervention effect overall: + 0.26 Z-score P< 0.001
96. Intervention effect on child height-for-age * Ht-for-age Z-score Baseline and Follow-up time points 1-4 Mixed linear regression hierarchical model Includes district, lives with partner, income, caregiver occupation, time Intervention effect + 0.11 z-score P= 0.12
98. Partnership framework for sustainability Freedom from Hunger, Ghana Institutionalization Rural Banks MOU signed ENAM Project Adoption and scale-up Logistical support Rural Women’s Credit & Savings Associations
99. Sustainability – (i) Access to credit Enabling institutions Freedom from Hunger, Ghana MOU ENAM, FFH, banks “Credit with Education” program for private banks Permanent institutions Rural banks (private) Akyimpem Rural Bank (Central) Fiagya Rural Bank (Techiman) Naara Rural Bank (Navrongo) Mechanism of sustainability 15% interest / 4 month cycle Offer 1st to ENAM mothers, then expand
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101. “We must say that at the end of the Credit with Education loan cycle we had 100% recovery which is Unprecedented in the history of any loan product of the bank “ Microfinance coordinator, participating rural bank, Northern Ghana
102. Sustainability – (ii) access to education (a) Enabling institutions Freedom from Hunger, Ghana “Credit with Education” program Permanent institutions Three rural banks Mechanism of sustainability Sessions with loan payment & savings
103. Sustainability – (ii) access to education (b) Enabling institutions University of Ghana Permanent institutions Communities Mechanism of sustainability Peer educators Peer educator manuals
104. Sustainability – (ii) access to education (c) Enabling institutions University of Ghana Permanent institutions University of Ghana NGO Ghana Health Services Mechanism of sustainability Undergraduate course Continuing education short course
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106. Expanding the LCC-CRSP overall vision... To reduce vulnerability, increase adaptive capacity, and augment the income of livestock producers in regions where agricultural systems are rapidly changing, available resources are shrinking, and climate change is having an impact, to assure the physical and cognitive development of at-risk populations so that society reaches its full potential.
107. The ENAM Project is funded through the Global Livestock -CRSP funded in part by US-AID Grant No. PCE-G-00-98-00036-00; Women in Development, US-AID; and the Jim Ellis Graduate Mentorship Program. In addition, substantial support was provided by Iowa State University, the University of Ghana, and McGill University.
Editor's Notes
We used a variety of data collection tools to document the effect of the intervention on our outcomes of interest : - household food security - children’s dietary intakes and the incorporation of ASF - children’s nutritional statusData were collected on the participants, the non-participants from the intervention communities, and the non-participants from the control communities at: Baseline 4 follow-up time points, 4 months apart.In addition, there was a baseline and project survey of the entire community.The data collected included: Microcredit performance:attendance, Repayments, Savings Cash flow for IGA (sub-sample) Household socio-demographic, food security, ASF expenditures Caregiver expenditures, child nutrition and health knowledge (related to topics taught in our sessions), Child dietary intakes using FFQ, Weighed food (subsample), and anthropometryOther data collected Case studies (post intervention only)Analysis is on-going so the quantitative analysis is preliminary