Chain Governance Systems and Sustainable Capital Use – A Conceptual Approach

Due to pressures such as climate change, globalization, price volatility and scarcity of natural resources, our agri-food chain is urged to make a transition towards more sustainable production. How to organize such a transition, given the various stakeholders involved, and how to monitor progress still remain important challenges. This paper presents a new conceptual framework that follows an integrated chain approach to help address these challenges. First, it tackles the complex ecological and socio-economic challenges along the chain and its members (agriculture and food industries), and second, allows for decision support to chain members and policy.This framework combines two existing theoretical frameworks. The first framework is global chain value analysis (GCVA) of Gereffi (2005) which has its roots in institutional economics. GCVA categorizes five governance types of value chains (markets – modular – relational – captive – hierarchy) based on three variables: (i) the complexity of information and knowledge transfer required to sustain a particular transaction, (ii) the ability to regulate transactions, and (iii) the capabilities of actual and potential suppliers. The second framework, which was first formulated in ecological economics, extends the set of traditional economic resources to various forms of capital in the production system. These are natural (land, water, …), manufactured (buildings, machinery, ...), human (labour, skills,…), and social capital (networks,…). The economic system is fully embedded in the social system which in turn is embedded within the finite ecological system. Throughput of natural, social, human, and manufactured capital allows for the description of agri-food systems in terms of the maximal sustainable use of their stocks and flows.These two frameworks can be combined to perform an integrated system analysis of the agri-food chain, including the governance structures and the boundary conditions for the various types of capital. This paper describes this new conceptual framework illustrated by means of a case study of the agri-food chain in Flanders, Belgium

A reflexive assessment of a regional initiative in the agri-food system to test whether and how it meets the premises of transdisciplinary research

In recent sustainability assessments, transdisciplinary approaches have been used to bridge contested normative views among many societal actors, policymakers and researchers. Transdisciplinary research is mainly based on three premises: (1) various perspectives need to be incorporated and discussed to empower actors, (2) the collaboration and co-creation of knowledge between academic and societal actors allows to better grasp the complexity of a real-world problem, and (3) a mutual learning process arises which could increase the legitimacy of decisions and their implementation in practice. Despite many examples of transdisciplinary projects, few assessments have been done that question whether such a project fulfils the premises of transdisciplinary research. Therefore, we report on a reflexive assessment of an initiative set up to foster the transformation of the Flemish agri-food system towards sustainability. The case study involved both scientific and societal actors with different views, making it possible to implement a transdisciplinary process, evaluate the expectations and give suggestions for future processes. Evaluation criteria are linked to context, process and outcomes. Analysis of the qualitative and quantitative data indicates that the initiative did empower the transformation towards sustainability. Furthermore, results show that, in this case, a transdisciplinary approach can fulfil its premises. However, some critical factors are identified, such as the importance of the context specificity and a flexible, adaptive and iterative process

Rapid and sustained improvements in health-related quality of life, fatigue, and other patient-reported outcomes in rheumatoid arthritis patients treated with certolizumab pegol plus methotrexate over 1 year: results from the RAPID 1 randomized controlled trial

Abstract Introduction The objective of this study was to assess the impact of certolizumab pegol (CZP) treatment on health-related quality of life (HRQoL), fatigue and other patient-reported outcomes (PROs) in patients with rheumatoid arthritis (RA). Methods Patients with active RA (N = 982) were randomized 2:2:1 to subcutaneous CZP (400 mg at weeks 0, 2 and 4; followed by CZP 200 mg or 400 mg) plus methotrexate (MTX) every other week, or placebo (PBO) plus MTX. PRO assessments included HRQoL, fatigue, physical function, arthritis pain and disease activity. Adjusted mean changes from baseline in all PROs were obtained using analysis of covariance (ANCOVA) applying last observation carried forward (LOCF) imputation. The proportion of patients achieving clinically meaningful improvements in each PRO was obtained using logistic regression and by applying non-responder imputation to missing values after rescue medication or withdrawal. The correlations between PRO responses and clinical responses were also assessed by tetrachoric correlation using non-responder imputation. Results Patients treated with CZP plus MTX reported significant (P < 0.001), clinically meaningful improvements in HRQoL at the first assessment (week 12); reductions in fatigue, disease activity and pain and improvements in physical function were reported at week 1. In particular, CZP-treated patients reported improvements in mental health. Mean changes from baseline in the SF-36 Mental Component Summary (MCS) at week 52 for CZP 200 mg and 400 mg plus MTX, and PBO plus MTX were 6.4, 6.4 and 2.1, respectively (P < 0.001). In addition, mental health and vitality scores in CZP-treated patients approached age- and gender-adjusted US population norms. Improvements in all PROs were sustained. Similar benefits were reported with both CZP doses. Changes in SF-36 MCS scores had the lowest correlation with disease activity scores (DAS28) and American College of Rheumatology 20% improvement (ACR20) response rates, while improvements in pain showed the highest correlation. Conclusions Treatment with CZP plus MTX resulted in rapid and sustained improvements in all PROs, indicating that the benefits of CZP extend beyond clinical efficacy endpoints into areas that are more relevant and meaningful for patients on a daily basis. Trial Registration ClinicalTrials.gov NCT00152386

Evolution of benzodiazepine receptor agonist prescriptions in general practice: A registry-based study

BackgroundContrary to most European guidelines, benzodiazepine receptor agonists (BZRA) are often used continuously at a low dosage, being the most common form of long-term use. In Belgium, BZRA use is monitored by analyzing self-report data about medication use in the last 24 h. This method provides insufficient insight into the terms of use of these psychoactive drugs.AimTo describe trends in BZRA prescribing in Flanders, Belgium, between 2000 and 2019.Design and settingPopulation-based trend analysis and a case-control study for the year 2019 were done with data from a morbidity registry in general practice.MethodsRepeated cross-sectional and joinpoint regression analyses revealed trends in sex- and age-standardized prescription rates among adult patients (18+).ResultsOverall, BZRA prescriptions increased. The highest overall increase was found among male patients 18–44 years old, with an average annual percentage change of 2.5 (95% CI: 0.9, 4.3). Among 65+ female patients, a decrease was found since 2006, with an annual percentage change of −0.7 (95% CI: −1.3, −0.1). In 2019, 12% of registered patients received minimally one prescription, long-term use was observed in 5%, back pain was the most common morbidity significantly associated with a rise in BZRA prescriptions, and zolpidem was the most prescribed BZRA (22%).ConclusionDespite some statistically significant decreasing trends, an overall increase in BZRA prescriptions was observed throughout the 19-year study period, especially among long-term users of 18–44 years and 65-plus. Zolpidem became the most prescribed BZRA and warrants more attention