115 research outputs found

    Front-of-Pack Labelling in the Caribbean Community: Power and Policy in Regional Standard Setting

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    The Caribbean Community (CARICOM) identified FOP labelling as a promising policy tool to slow the region’s growing rates of diet-related non-communicable diseases (NCDs). These diseases are associated with the region’s high levels of importation of processed and ultra-processed foods. FOP labels aim to curb the sales and consumption of such foods. Despite emanating from directly within CARICOM’s regional governance architecture for health and progressing through CARICOM’s regional structures for implementing policy, CARICOM failed to adopt a regional and uniform FOP label. This thesis asks why this was the case. Using a combination of policy document analysis and participant interviews, this thesis examines the role and power of different actor groups in developing the policy and their efforts to implement it. It finds several reasons for CARICOM’s failure to adopt a regionally standardized FOP label. First, FOP labelling policy was moved from the realm of public health governance in CARICOM to a regional standard-setting venue to be adopted by individual states. The origins of FOP labelling as a regional public health policy were obscured when it was moved into the regional standard-setting process for implementation. Second, the process of standard setting privileged corporate interests and those with existing knowledge of the process, which meant that industry actors were able to successfully delay, weaken, and circumvent the policy’s adoption and implementation. Ultimately, the aim of FOP labelling, as a health policy instrument, is to curb consumption (and therefore sales) of highly processed foods. This goal put it at odds with the commercial interests of most of the corporate actors who were frequent food labelling standards participants at multiple levels of governance. Because most standard-setting organizations and processes are situated within the international trade regime, where industry actors have more knowledge around the processes, culture, and norms of operating, these actors successfully reframed FOP labelling as anti-trade, ignoring the public health rationale and the policy’s origins as part of the regional political agenda. At the same time, public health actors lacked the authority and the power inside the standard-setting venue to ensure the passage of the policy. The thesis draws lessons from the CARICOM FOP labelling case that can help inform the ways that food systems policies are developed, adopted, and implemented. First, and most importantly, the choice of process matters. Actors who originally had agenda-setting power cannot or do not always maintain authority and power. Second, those with knowledge around the processes, culture and norms of the chosen venue will have a strategic advantage in their approach to resistance. Third, regional governance provides an especially challenging setting for implementing policies that conflict with commercial interests, since more intervention points become more accessible to corporate resistance. The thesis finds that when a food systems policy is contingent on the consensus of actors in different communities, the actors’ familiarity with the process and overarching regime can have a major impact on the ways that power is operationalized and ultimately, the success of the policy’s adoption and implementation


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    ■ Food insecurity challenges in the Global South are changing as a result of rapid urbanization and the globalization of food supply chains. ■ Urban food insecurity is not distinct from rural food security challenges and policy seeking to address either should adopt a systems approach that strengthens their interdependence. There is an opportunity to increase the effectiveness of rural food security programming while concurrently addressing the growing food security needs of vulnerable urban populations. ■ This brief recommends that food security policy should prioritize intra-urban stages of informal food value chains and increase the efficiency and effectiveness of their supply to urban consumers. By supporting urban wholesale infrastructure development and providing technical assistance in intra-urban food transportation, programming can enhance the competitiveness of domestic food product distribution within cities while increasing rural farmers’ access to urban consumers

    HCP policy brief No. 2 : an urban perspective on food security in the Global South

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    By supporting urban wholesale infrastructure development, and providing technical assistance in intra-urban food transportation, national and regional planning and programming can enhance the competitiveness of domestic food distribution within cities while increasing farmers’ access to urban consumers. The policy brief addresses food insecurity challenges in the Global South that are changing due to rapid urbanization and the globalization of food supply chains. Four household food security surveys conducted by the Hungry Cities Partnership (HCP) were analyzed. The cities selected were Mexico City, Mexico; Kingston, Jamaica; Maputo, Mozambique; and Nairobi, Kenya.Social Sciences and Humanities Research Council of Canada (SSHRC

    The feasibility and acceptability of self-testing for proteinuria during pregnancy: A mixed methods approach.

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    OBJECTIVE: To investigate feasibility and acceptability of self-testing for proteinuria during pregnancy. STUDY DESIGN: Mixed methods approach which included: an accuracy study where pregnant women (n = 100) and healthcare professionals (n = 96) tested seven synthetic protein samples and completed a questionnaire, a feasibility study where pregnant women who were self-monitoring their blood pressure were asked to self-test for proteinuria (n = 30), and an online questionnaire about women's experiences of self-testing (n = 200). MAIN OUTCOME MEASURES: Sensitivity and specificity of testing and questionnaire results. RESULTS: There were no significant differences in the accuracy of synthetic sample testing by pregnant women (sensitivity 0.81 (95% confidence intervals (CI) 0.78-0.85), specificity 0.93 (95% CI 0.91-0.95)) and healthcare professionals: (sensitivity 0.83 (95% CI 0.79-0.86), specificity 0.92 (95% CI 0.90-0.94)). Automated readers had significantly better sensitivity (0.94 (0.91-0.97) (p ≤ .001 in each case), but worse specificity 0.78 (0.69-0.85). Similar results were gained using self-tested urine samples compared to staff-testing using a reference standard of laboratory urine protein-creatinine ratio (uPCR). Women who completed the online survey with experience of self-testing (n = 39, 20%) generally found it easy, and with support from healthcare professionals felt it improved involvement in their care and reduced anxiety. CONCLUSIONS: Self-testing for proteinuria by pregnant women had similar accuracy to healthcare professional testing and was acceptable to both groups. Self-testing of urine combined with self-monitoring of blood pressure could provide a useful adjunct to clinic-based surveillance for the detection of pre-eclampsia. Such novel strategies warrant further research

    Blood pressure monitoring in high-risk pregnancy to improve the detection and monitoring of hypertension (the BUMP 1 and 2 trials): protocol for two linked randomised controlled trials.

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    INTRODUCTION: Self-monitoring of blood pressure (BP) in pregnancy could improve the detection and management of pregnancy hypertension, while also empowering and engaging women in their own care. Two linked trials aim to evaluate whether BP self-monitoring in pregnancy improves the detection of raised BP during higher risk pregnancies (BUMP 1) and whether self-monitoring reduces systolic BP during hypertensive pregnancy (BUMP 2). METHODS AND ANALYSES: Both are multicentre, non-masked, parallel group, randomised controlled trials. Participants will be randomised to self-monitoring with telemonitoring or usual care. BUMP 1 will recruit a minimum of 2262 pregnant women at higher risk of pregnancy hypertension and BUMP 2 will recruit a minimum of 512 pregnant women with either gestational or chronic hypertension. The BUMP 1 primary outcome is the time to the first recording of raised BP by a healthcare professional. The BUMP 2 primary outcome is mean systolic BP between baseline and delivery recorded by healthcare professionals. Other outcomes will include maternal and perinatal outcomes, quality of life and adverse events. An economic evaluation of BP self-monitoring in addition to usual care compared with usual care alone will be assessed across both study populations within trial and with modelling to estimate long-term cost-effectiveness. A linked process evaluation will combine quantitative and qualitative data to examine how BP self-monitoring in pregnancy is implemented and accepted in both daily life and routine clinical practice. ETHICS AND DISSEMINATION: The trials have been approved by a Research Ethics Committee (17/WM/0241) and relevant research authorities. They will be published in peer-reviewed journals and presented at national and international conferences. If shown to be effective, BP self-monitoring would be applicable to a large population of pregnant women. TRIAL REGISTRATION NUMBER: NCT03334149.This work is funded from a National Institute for Health Research (NIHR) Programme grant for applied research (RP-PG- 1209-10051) and an NIHR Professorship awarded to RJM (NIHR-RP- R2- 12-015). RJM and KLT receive funding from the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford Health NHS Foundation Trust. JS is a National Institute for Health Research (NIHR) Senior Investigator and supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London (NIHR CLAHRC South London) at King’s College Hospital NHS Foundation Trust. Service support costs will be administered through the NIHR Clinical Research Network

    The On-Site Analysis of the Cherenkov Telescope Array

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    The Cherenkov Telescope Array (CTA) observatory will be one of the largest ground-based very high-energy gamma-ray observatories. The On-Site Analysis will be the first CTA scientific analysis of data acquired from the array of telescopes, in both northern and southern sites. The On-Site Analysis will have two pipelines: the Level-A pipeline (also known as Real-Time Analysis, RTA) and the level-B one. The RTA performs data quality monitoring and must be able to issue automated alerts on variable and transient astrophysical sources within 30 seconds from the last acquired Cherenkov event that contributes to the alert, with a sensitivity not worse than the one achieved by the final pipeline by more than a factor of 3. The Level-B Analysis has a better sensitivity (not be worse than the final one by a factor of 2) and the results should be available within 10 hours from the acquisition of the data: for this reason this analysis could be performed at the end of an observation or next morning. The latency (in particular for the RTA) and the sensitivity requirements are challenging because of the large data rate, a few GByte/s. The remote connection to the CTA candidate site with a rather limited network bandwidth makes the issue of the exported data size extremely critical and prevents any kind of processing in real-time of the data outside the site of the telescopes. For these reasons the analysis will be performed on-site with infrastructures co-located with the telescopes, with limited electrical power availability and with a reduced possibility of human intervention. This means, for example, that the on-site hardware infrastructure should have low-power consumption. A substantial effort towards the optimization of high-throughput computing service is envisioned to provide hardware and software solutions with high-throughput, low-power consumption at a low-cost.Comment: In Proceedings of the 34th International Cosmic Ray Conference (ICRC2015), The Hague, The Netherlands. All CTA contributions at arXiv:1508.0589

    AZD1222 effectiveness against severe COVID-19 in individuals with comorbidity or frailty: the RAVEN cohort study

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    Objectives Despite being prioritized during initial COVID-19 vaccine rollout, vulnerable individuals at high risk of severe COVID-19 (hospitalization, intensive care unit admission, or death) remain underrepresented in vaccine effectiveness (VE) studies. The RAVEN cohort study (NCT05047822) assessed AZD1222 (ChAdOx1 nCov-19) two-dose primary series VE in vulnerable populations. Methods Using the Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub, linked to secondary care, death registration, and COVID-19 datasets in England, COVID-19 outcomes in 2021 were compared in vaccinated and unvaccinated individuals matched on age, sex, region, and multimorbidity. Results Over 4.5 million AZD1222 recipients were matched (mean follow-up ∼5 months); 68% were ≥50 years, 57% had high multimorbidity. Overall, high VE against severe COVID-19 was demonstrated, with lower VE observed in vulnerable populations. VE against hospitalization was higher in the lowest multimorbidity quartile (91.1%; 95% CI: 90.1, 92.0) than the highest quartile (80.4%; 79.7, 81.1), and among individuals ≥65 years, higher in the ‘fit’ (86.2%; 84.5, 87.6) than the frailest (71.8%; 69.3, 74.2). VE against hospitalization was lowest in immunosuppressed individuals (64.6%; 60.7, 68.1). Conclusions Based on integrated and comprehensive UK health data, overall population-level VE with AZD1222 was high. VEs were notably lower in vulnerable groups, particularly the immunosuppressed
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