A roadmap for sustainability assessment in the food supply chain

Purpose: To develop a roadmap of sustainability practices and assessment mechanisms to advance in the sustainable supply chain (SSC) performance assessment in the food supply chain. The analysis is grounded on the contingency and stakeholder theories. Design/methodology/approach: The study follows a multiple case study approach analyzing the sustainability practices implementation and assessment across different supply chain stages in the food industry in Italy. The set of cases comprises 12 companies in the fresh fruit and vegetables (FFV), and seven companies in the “Balsamic Vinegar of Modena” (BVM) supply chains. Findings: The sustainability practices and assessment in each company in both supply chains according to their objectives are identified. Different stakeholder pressures for sustainability implementation and assessment are analyzed. The contingency factors that foster sustainability assessment are outlined as well. Finally, the study develops a roadmap with five levels of progress considering the groups of practices implemented and the type of assessment applied. Practical implications: The roadmap is a decision-making tool for planning and monitoring progress on SSC performance along five possible levels of progress. While identifying the assessment mechanisms implemented for different kind of sustainability practices, companies can develop a strategy according to their aims and capabilities and stakeholder's expectations. Originality/value: The novelties in this study are threefold. First, the roadmap with five levels of progress. Second, investigating two different food supply chains that allowed for a broader view regarding sustainability practices and assessment. Third, the adoption of stakeholder and contingency theories in SSC studies

Efecto de marcadores genéticos moleculares en genes inducibles por hipoxia de bovinos criollos y Brown Swiss criados en los Andes de Perú

The genomes of 41 bovines of five breeds, existing in the SRA-NCBI database, were used to identify 17 single nucleotide polymorphisms (SNPs) which generate non-synonymous mutations in 10 hypoxia-inducible genes. Of this, only three SNPs located in positions c.1081G>C, c.2089G>A and c.2101G>A of exons 7 and 12 of the EPAS1 gene had different allelic frequencies between beef and dairy cattle (p<0.05). Based on the results of the bioinformatic analysis of the genomes, exonic regions of the EPAS1, NOS2, EPO and VEGFA genes were chosen, which were studied in 60 DNA samples from Creole and Brown Swiss cattle raised in the high Andean region (3213-4309 m above sea level). The cattle were grouped by their haemoglobin concentration (Hb) in Brown Swiss with high Hb (BSHbA) (n=13), Brown Swiss with low Hb (BSHbB) (n=11), Creoles with high Hb (CRHbA) (n=13) and Creoles with low Hb (CRHbB) (n=12); in addition, there was a Brown Swiss group with brisket disease (BSMA) (n=11). The generated amplicons were sequenced with the Sanger methodology, identifying 10 SNPs; however, no associations were found between these SNPs and the groups considered. Only one SNP located at the intronic position Cr.19: 19403681T>C of the NOS2 gene had a different frequency between Creole and Brown Swiss cattle (p<0.05). In addition, that SNP was found linked to two others that are in exon 12 of the same gene.Los genomas de 41 bovinos de cinco razas existentes en la base de datos del SRA-NCBI, fueron usados para identificar 17 polimorfismos de nucleótido simple (PNSs), los cuales generan mutaciones no sinónimas en 10 genes inducibles por hipoxia. De ese total, solo tres PNSs ubicados en las posiciones c.1081G>C, c.2089G>A y c.2101G>A de los exones 7 y 12 del gen EPAS1 tuvieron frecuencias alélicas diferentes entre bovinos cárnicos y lecheros (p<0.05). Basados en los resultados del análisis bioinformático de los genomas, se eligieron regiones exónicas de los genes EPAS1, NOS2, EPO y VEGFA, que fueron estudiadas en 60 muestras de ADN de bovinos criollos y Brown Swiss criados en la región altoandina (3213-4309 msnm). Los bovinos fueron agrupados por su concentración de hemoglobina (Hb) en Brown Swiss con Hb alta (BSHbA) (n=13), Brown Swiss con Hb baja (BSHbB) (n=11), criollos con Hb alta (CRHbA) (n=13) y criollos con Hb baja (CRHbB) (n=12); además se tuvo un grupo de Brown Swiss con mal de altura (BSMA) (n=11). Los amplicones generados fueron secuenciados con la metodología Sanger, identificándose 10 PNSs. No se encontraron asociaciones entre estos PNSs y los grupos considerados. Únicamente un PNS ubicado en la posición intrόnica Cr.19: 19403681T>C del gen NOS2 tuvo frecuencia diferente entre bovinos criollos y Brown Swiss (p<0.05); además dicho PNS se encontró ligado a otros dos que están ubicados en el exón 12 del mismo gen

Adherence to antiretroviral therapy and the associated factors among people living with HIV/AIDS in Northern Peru : a cross-sectional study

Altres ajuts: This study was partially funded by a research Grant from the Fundació Autònoma Solidària (Resolució Convocatòria FSXXXIII-Peru); and the Oficina de Investigación y Creatividad Intelectual from the Universidad María Auxiliadora (OICI-001-2017).There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiretroviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru). This was a cross-sectional study with 180 PLHIV adults, non-randomly but consecutively selected with self-reported ART compliance (78.2% of the eligible population). The PLHIV profile (PLHIV-Pro) and the Simplified Medication Adherence Questionnaire (SMAQ) were used to collect sociodemographic information, clinical variables, and data specific to ART adherence. Descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was performed with the Mann-Whitney test, Chi square test, and Yates correction. The 180 PLHIV sample included 78.9% men, 49.4% heterosexual, 45% with a detectable HIV-1 viral load less than 40 copies/ml, 58.3% not consistently adherent, and only 26.1% receiving Tenofovir + Lamivudine + Efavirenz. Risk factors significant for non-adherence included concurrent tuberculosis, discomfort with the ART regime, and previous pauses in ART. Multivariate analysis of nested models indicated having children is a protector factor for adherence. Self-reported adherence appeared to be low and the use of first-line therapy is not being prescribed homogeneously. Factors associated with nonadherence are both medical and behavioral, such as having tuberculosis, pausing ART, or experiencing discomfort with ART. The Peruvian government needs to update national technical standards, monitor medication availability, and provide education to health care professionals in alignment with evidence-based guidelines and international recommendations. Instruments to measure adherence need to be developed and evaluated for use in Latin America

Women with psychotic episodes during pregnancy show increased markers of placental damage with Tenney-Parker changes

y. Psychosis is a hazardous and functionally disruptive psychiatric condition which may affect women in pregnancy, entailing negative consequences for maternofetal well-being. The precise pathophysiological basis and consequences of a psychotic episode in pregnancy remain to be further elucidated. The placenta is a pivotal tissue with many functions in the gestational period, critically influencing the fate and development of pregnancy. Although detrimental alterations have been observed in women undergoing severe psychiatric disorders in pregnancy, there are little studies evaluating the consequences of suffering from a psychotic episode in the placental tissue In this work, we have evaluated the histopathological consequences of a first episode of psychosis in pregnancy (FE-PW; N=22) and compare them with healthy pregnant women (HC-PW; N=20) by using histological, immunohistochemical and gene expression techniques. Our results define that the placental tissue of FE-PW display an increase in the number of placental villi, bridges, syncytial knots and syncytial knots/villi. Besides, we have also observed an enhanced gene and protein expression in FE-PW of the hypoxic marker HIF-1α, together with the apoptotic markers BAX and Bcl-2. To our knowledge, this is the first study demonstrating significant histopathological changes in the placenta of women suffering a new-onset psychotic episode in pregnancy. Further studies should be aimed at deepening the knowledge about the pernicious effects of psychosis in the maternofetal tissues, as well as the potential implications of these alterations

Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? : A Systematic Review and Meta-Analysis

Copyright: © 2014 Durand et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background: Increasing patient engagement in healthcare has become a health policy priority. However, there has been concern that promoting supported shared decision-making could increase health inequalities. Objective: To evaluate the impact of SDM interventions on disadvantaged groups and health inequalities. Design: Systematic review and meta-analysis of randomised controlled trials and observational studies.Peer reviewe

Maternal, Perinatal and Neonatal Outcomes of Triplet Pregnancies According to Chorionicity: A Systematic Review of the Literature and Meta-Analysis

Triplet pregnancies are rare events that affect approximately 93 in 100,000 deliveries in the world, especially due to the increased use of assisted reproductive techniques and older maternal age. Triplet pregnancies are associated with a higher risk of fetal and maternal morbidity and mortality compared to twins and singletons. Chorionicity has been proposed as a major determinant of perinatal and maternal outcomes in triplet pregnancies, although further evidence is needed to clarify the extent and real influence of this factor. Thus, the aim of this study was to conduct a systematic review of the literature and a meta-analysis of the maternal and perinatal outcomes of triplet pregnancies, evaluating how chorionicity may influence these results. A total of 46 studies with 43,653 triplet pregnancies and 128,145 live births were included. Among the main results of our study, we found a broad spectrum of fetal and maternal complications, especially in the group of monochorionic and dichorionic pregnancies. Risk of admission to NICU, respiratory distress, sepsis, necrotizing enterocolitis, perinatal and intrauterine mortality were all found to be higher in non-TCTA pregnancies than in TCTA pregnancies. To date, our meta-analysis includes the largest population sample and number of studies conducted in this field, evaluating a wide variety of outcome measures. The heterogeneity and retrospective design of the studies included in our research represent the main limitations of this review. More evidence is needed to fully assess outcome measures that could not be studied in this review due to scarcity of publications or insufficient sample size

Maternal-Perinatal Variables in Patients with Severe Preeclampsia Who Develop Acute Kidney Injury

Introduction: At present, we are witnessing an increase in preeclampsia, especially the most severe forms, which are associated with an increased risk of maternal-perinatal morbidity and mortality. As a severity criterion, acute kidney injury (AKI) has been associated with a worse prognosis, and for this reason, the maternal and perinatal variables associated with AKI in patients with severe preeclampsia (SP) were analysed in this study. Methods: An observational, retrospective, single-centre study of patients with SP treated at a tertiary hospital between January 2007 and December 2018 was conducted. The case criteria based on the criteria established by the ACOG Practice Guidelines for Gestational Hypertension and Preeclampsia. AKI is considered when serum creatinine exceeds 1.1 mg/dL in a pregnant woman with previously normal renal function. In patients with existing chronic kidney disease (CKD), it is referred to as AKI if the baseline serum creatinine increases by 1.5 fold. Pregestational, gestational and postpartum variables were analysed up to 12 weeks postpartum using univariate and multivariate logistic regression analysis. Results: During the study period, 76,828 births were attended, and 303 pregnant women were diagnosed with SP. The annual incidence of SP increased gradually throughout the study period, reaching 1.79/100 births/year in 2018. Acute kidney injury (AKI) occurred in 24.8% of the patients. The multivariate analysis revealed an increased association with a history of previous CKD, the use of assisted reproductive techniques and caesarean section. Uric acid and thrombotic microangiopathy (TMA) had a high correlation with AKI. Indications for caesarean section are associated with AKI in SP. Regarding perinatal outcomes in cases of AKI, there was a higher percentage of neonates who required foetal lung maturation with steroids and an increased need for NICU admission. No case of maternal death was recorded; however, an increase in neonatal mortality was found among patients who did not develop AKI. After 12 weeks postpartum, 72 patients were referred to the nephrology consultation for persistent hypertension, proteinuria or renal failure. Conclusions: In preeclampsia, AKI is a common complication, especially among patients with a history of CKD, those who became pregnant using assisted reproduction techniques and those who delivered via caesarean section. The perinatal impact of AKI is mainly centred on a higher rate of NICU admission and a lower mortality rate. Among biochemical and haematological markers, the uric acid level prior to renal failure has a direct and significant correlation with the risk of AKI, as does the development of TMA in patients with preeclampsia. Therefore, the monitoring of renal function in cases of preeclampsia should be strict, and referral for a nephrology consultation may be necessary in some cases

The Use of Prebiotics from Pregnancy and Its Complications: Health for Mother and Offspring—A Narrative Review

Pregnancy involves a metabolic reprogramming that includes changes in the gut microbiota composition in women. Evidence shows that maternal dysbiosis is linked to neonatal dysbiosis, and this factor can determine health status in adulthood. Although there is little literature available on this topic, high heterogeneity is a limitation when examining nutritional interventions. Information has been gathered to contrast the benefits of prebiotic usage, specifically in pregnancy, in its possible complications and in newborns’ gut microbiota development. The objective pursued in this brief narrative review is to provide a clear summary of relevant content when searching with regard to the use of prebiotics in pregnancy, the effects in prenatal and postnatal periods, and to help in clinical decision-making in pregnancy management and lactation. A search has found that the nutritional status of the pregnant mother is key for the earliest microbial colonization in newborns, and thus intervention programs from pregnancy could assure better outcomes in both the mother and offspring. In this sense, prebiotics (administered to mothers who breastfeed or provided in formula milk) are feasible and cost-effective elements that can prevent allergies, colic, and other maladies in newborn