The role of market concentration in the agrifood industry

The role of market concentration and potential market power exertion in the agri-food industry is a topic of longstanding interest and concern to policymakers, stakeholders, and researchers. This study provides a comprehensive overview of recent trends in market concentration upstream, midstream, and downstream the agri-food industry at the global, regional, and country level, and assesses how and to what extent concentration could be affecting market conduct and performance of food systems in developed and developing countries. The analysis additionally discusses, to the extent detectable, implications of concentration, including vertical and horizontal integration that favor concentration, for food security and nutrition and environmental sustainability. While market concentration in the agri-food industry has increased across most segments, the evidence on market power exertion is inconclusive. Several knowledge and data gaps are identified and additional research is necessary to derive more general conclusions and policy recommendations

Cultural and economic barriers and opportunities for the participation of women in agricultural production systems: a case study in Guatemala

As in other Latin American countries, agricultural activities in Guatemala contribute with 32% of the total employment (65% in rural areas), but only one in every ten individuals employed in these activities are women. This study examines the cultural and economic barriers and opportunities for the participation of women in agricultural (crop and livestock) production systems. We rely on a qualitative approach involving focus group discussions with 15–20 women in each of the eight communities visited in the departments of Chiquimula (Dry Corridor) and Huehuetenango (Western Highlands) in October 2022. The study provides several interesting findings, which generally hold across locations. First, women do not seem to have a strong preference for crop production activities, except harvesting, and only get involved in specifically assigned tasks. This lack of interest and participation in crop-related activities, which can be related to low empowerment levels and traditional stereotypes in the community about gender roles, persist even in locations with a higher emigration of men, where women could be expected to take over traditionally male crop-related tasks. Second, participants carry out a variety of other unpaid activities, including raising small-scale livestock and maintaining home gardens, which they do not recognize as formal, income-generating occupations despite their more active role. Third, women consider the commercialization of their products a persistent challenge as they do not have access to markets beyond their community, which additionally results in a deterrent to applying for credits due to a generalized fear of defaulting. Despite their day-to-day economic hardship, participants’ main aspirations point to generating more income in non-crop-related activities, mainly livestock farming and raising, or, alternatively, emigrating to provide a better future for their children. These findings remark the importance of offering extensive support to women to not only start new activities, as it has been the case of several public and private initiatives in the area, but help them through continuous extension services on production, storage, and commercialization; management and accounting; and financial literacy, as well as on building agency capacity through existing women groups and organizations and enabling the environment for improved access to markets and credit

COVID-19 and livelihoods in rural Guatemala: Lessons from a long term assessment and the path to recovery

The COVID-19 pandemic has had profound effects on livelihoods and food security across rural populations worldwide. This study offers a long-term assessment of the impacts of the pandemic and the path to recovery among smallholder agricultural households in the Western Highlands of Guatemala. We rely on a unique longitudinal survey of 1,262 households collected over four survey rounds between 2019 and 2022. The results show substantial recoveries in incomes, food security, and dietary diversity in the region by mid-2022 compared to 2020, but at levels still worse than pre pandemic ones. There is also a sustained increase in the intention to emigrate. The households that were initially more affected in terms of food security and nutrition but recovered faster include those located in one (San Marcos) of the three departments and families living above the poverty line, while smallholders affected by the ETA and IOTA tropical storms, non-coffee producers, and indigenous populations have taken longer to recover. In addition, we provide quantitative estimates for a subsample of households interviewed during a fifth survey round at the end of 2022, showing an average decline of about 16 percent in total household income three years after the start of the pandemic, mainly driven by a decrease in agricultural income, combined with a 26 percent increase in expenditures and an important surge in indebtedness. Overall, the study offers valuable lessons regarding the recovery of vulnerable households following a major global crisis and in a context of additional shocks, remarking the importance of continue monitoring the situation of vulnerable households, especially those exposed to recurrent (weather) shocks that also have a more exhausted portfolio of coping mechanisms & express a higher willingness to emigrate.Non-PRIFPRI1; 1 Fostering Climate-Resilient and Sustainable Food Supply; 2 Promoting Healthy Diets and Nutrition for all; 3 Building Inclusive and Efficient Markets, Trade Systems, and Food Industry; Feed the Future InitiativeMarkets, Trade, and Institutions (MTI); Food and Nutrition Polic

Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes)

International audienc

Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes)

Abstract: Background: Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)\u2013defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). Methods: An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. Results: A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52\u20131.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. Conclusions: Antiplatelet therapy with ticagrelor in patients with acute ischemic stroke or transient ischemic attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01994720.Abstract: BACKGROUND: Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)-defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). METHODS: An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. RESULTS: A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52-1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. CONCLUSIONS: Antiplatelet therapy with ticagrelor in patients with acute ischemic stroke or transient ischemic attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care