Treatment of cryptosporidiosis in immunocompromised individuals: systematic review and meta-analysis

Cryptosporidium is a common cause of gastroenteritis and is associated with severe life-threatening illness among immunocompromised individuals. This review aimed to assess the efficacy of interventions for the treatment and prevention of cryptosporidiosis among immunocompromised patients. A search of Medline, Embase and other electronic databases was carried out up to August 2005. Two reviewers independently extracted data and assessed study quality. The relative risk for each intervention was calculated. Seven trials involving 169 participants were included. Nitazoxanide and paramomycin were associated with a relative risk (RR) of reduction in the duration and frequency of diarrhoea of 0.83 [95% confidence interval (CI) 0.36, 1.94] and 0.74 (95% CI 0.42, 1.31), respectively, showing no evidence of effectiveness. Nitazoxanide led to significant evidence of oocyst clearance compared with placebo with a RR of 0.52 (95% CI 0.30, 0.91). The effect was not significant for HIV-seropositive participants (RR 0.71, 95% CI 0.36, 1.37). HIV-seronegative participants on nitazoxanide had a significantly higher relative risk of achieving parasitological clearance of 0.26 (95% CI 0.09, 0.80) based on a single study. No other intervention was associated with either a reduction in diarrhoea, mortality or a significant parasitological response. This review confirms the absence of evidence for effective agents in the management of cryptosporidiosis. The results indicate that nitaxozanide reduces load of parasites and may be useful in immunocompetent individuals. The absence of effective therapy highlights the importance of preventive interventions in this group of patients

Environmental Policy and Sustainable Development

With changing and mounting pressures on environmental resources due to economic and demographic developments, environmental policymaking is a wide and continuously growing field. The birth hour of modern environmental policymaking is the 1950s and 1960s, with the United States (US) as a pioneer country in adopting the first instruments for resource protection and combating pollution (Andrews 2006). Around the same time, environmental movements became visible in terms of mobilization and organization (Ruckelshaus 1985), although the origins and philosophical foundations of such movements date back to the fifteenth century (Kline 2011). Similarly, environmental economics, as one of the main instruments of environmental policy analysis, was acknowledged as a scientific field during the 1960s, although the economic analysis of environmental problems had been under way for at least two centuries before (Sandmo 2015). Since these early days of environmental policy, the topics and analysis tools have advanced greatly in order to keep up with new knowledge on environmental issues. The concerns of policymakers and scientists moved beyond resource protection and pollution to cover issues such as resource-use efficiency, problems with common-pool resources, renewable resources, intergenerational equity, and incorporating environmental issues into a wider understanding of sustainable development. Environmental policies were thus transformed from a simply command-and-control perspective toward efficiency-based reforms and later, the more recent issues of integrated approaches toward community and sustainable development (Mazmanian and Kraft 2009). The rise of ecological economics, especially in the 1970s and 1980s, has contributed to an increasing number of tools to address the broad issues of environmental policies. Ecological economics adopted a diversified perspective and broadened the neoclassical approach of environmental economics, leading to pluralism of approaches and policy tools (Venkatachalam 2007). Nowadays, environmental policy is a rich field of investigation and an integral part of public policy. This chapter introduces this field in relation to sustainable development. It outlines the key elements required to define environmental policies and briefly explains the history of issues related to sustainable development. Later, it explains the tools and instruments used as inputs into environmental policies. Finally, it discusses key terms and concepts for analyzing the process, performance, and impacts of environmental policies

Methods and Global Environmental Governance

10.1146/annurev-environ-072811-114530Annual Review of Environment and Resources38441-47

Treatment options for the eradication of intestinal protozoa

Pathogenic intestinal protozoa are responsible for clinically important infections in both the developed and the developing world. These organisms are responsible for both acute and chronic diarrhea, and Entamoeba histolytica, which affects the colon, can spread to involve the liver. Many of these pathogens, particularly the intracellular protozoa that predominantly affect the small intestine, produce their most devastating effects in patients with HIV/AIDS and other forms of immune deficiency. There are also various intestinal protozoa that do not seem to have any adverse effects on humans and can, therefore, be regarded as harmless commensal organisms. Although treatment has been available for several decades for giardiasis, isosporiasis and amoebiasis, until recently there have been no effective remedies for infection with intestinal coccidia—Cryptosporidium, Microsporidium and Cyclospora species. Cyclospora respond well to co-trimoxazole, microsporidia respond variably to albendazole, and cryptosporidia can often be eradicated by nitazoxanide. In chronically infected HIV-positive patients, treatment with multidrug regimens usually results in rapid resolution of the diarrhea and, in many instances, eradication of the parasite

Postharvest agriculture in changing climates: Its importance to African smallholder farmers

Climate change and variability affect not only the field stages and yields of crops, but also what happens to them after harvest. There has been little discussion of the impacts of climate change on postharvest agriculture, and still less on these impacts in developing countries. Many studies have focused on potential crop yield and pre-harvest implications of different climatic projections, but have omitted an analysis of the need and ability to then protect this increasingly valuable harvest as a vital aspect of food security. Postharvest systems will be affected by changes in temperature, rainfall, humidity, extreme events and the natural and human responses to climate change and variability. This study describes typical grain postharvest systems in east and southern Africa and discusses the likely impacts of different climate change trends on postharvest activities, assets and human well-being outcomes. Adaptation opportunities for creating more climate resilient postharvest agricultural systems and associated livelihoods are identified. Many of these adaptation opportunities are already known and understood by postharvest service providers, highlighting the significant challenge of getting postharvest knowledge into use at a larger scale. A discussion is presented on the factors influencing attempts to strengthen the adaptive capacity of postharvest systems, such as its invisibility, its omission from training curricula, innovation system challenges, the policy bias towards pre-harvest agricultural spending, limited understanding of gender and diversity aspects of postharvest roles, and the dominance of maize in the food system. The study recognises the crucial role of postharvest agriculture in helping communities adapt and cope with change