Understanding Effectiveness in its Broader Context: Assessing Case Study Methodologies for Evaluating Collaborative Conservation Governance

Collaborative forms of governance are increasingly favored in conservation and potentially offer a range of practical and outcome-based benefits. However, tools for critically assessing whether and how collaboration enhances the attainment of conservation objectives are lagging behind the enthusiasm. We use a framework that considers effectiveness in relation to capacity of key actors and institutions to achieve outcomes and respond to emergent problems, robustness over time (i.e. adapting to changes while still achieving objectives), context-specific drivers of change, and the structure of networks and institutions to assess common approaches for evaluating effectiveness. Network analysis performs well in terms of structure, while action research and the diagnostic method offer deep insights into capacity and context. Scenario planning performs well in understanding robustness and context but performs better when combined with a diagnostic. The evaluation reveals important insights for approaching and standardizing investigations of collaborative governance regimes and their effectiveness

Factores que conllevan a las adolescentes al embarazo y consecuencias que estas afrontan

Este tema es de gran importancia ya es preocupante en cada una de las ciudades y Municipio donde vivimos los embarazos en adolescentes, hecho que observamos con más frecuencia en los últimos años y, lo que es más grave; se produce en edades cada vez menores y destacar las consecuencias que es trae al establecer un embarazo a temprana edad y enfrentar la vida con una nueva vida que se trae al mundo sin saber para que ni por qué. Este proyecto de campo describe los factores relevantes del porque se está presentando los embarazos a tan temprana edad, y de igual forma se destaca la dura realidad en la que las jóvenes enfrentan sin orientación este problema sin duda un problema de todo tipo. El embarazo en la adolescencia tiene unas consecuencias adversas tanto de tipo físico y psicosocial, en especial en las más jóvenes (10-16 años) y sobre todo en las pertenecientes a las clases sociales más desfavorecidas, ya que siguen una dieta inadecuada a su estado y utilizan tarde o con poca frecuencia el servicio de atención prenatal , lo que supone una dificultad mayor para aceptar la realidad, retraso de la primera visita, desconocimiento del tiempo de gestación, incumplimiento del tratamiento, pasividad, falta de respaldo, depresión y dificultad en la relación asistencial, entre otras cosas. Una de las características socio demográficas de las madres adolescentes, es la particular composición de la estructura familiar; destaca que un 17,5% de las madres siguen constando como residentes en la residencia paterna, mientras que un 15% se incorpora a la residencia del padre, un 65% crea una unidad familiar independiente y un 2,5% vive sola o con otras personas, pensiones, casas de acogida, etc. En lo concerniente al aspecto psicológico, es conveniente que la madre adolescente reoriente toda su vida y asuma responsabilidades de adulto. Según numerosos estudios realizados, éstas desempeñan bien su papel de madre, estableciendo buenas relaciones con su hijo, no siendo menos competentes que las adultas. Por lo tanto más allá de una investigación se quiere concientizar a los adolecentes tanto hombres como mujeres en la gran responsabilidad de traer al mundo un hijo y todas sus consecuencias a los que se ven enfrentados al comenzar una vida como padres. Las charlas educativas fueron un apoyo para el grupo de adolecentes a quien se aplico las encuetas, quienes recibieron orientación por parte del grupo de investigación y profesionales en salud y educación sexual. Porque es necesario identificar el riesgo reproductivo y las complicaciones asociadas, para contribuir de alguna manera a mejorar la salud materna y perinatal de nuestras ciudades y municipios en fin en todo el mundo. 14 El embarazo en la adolescencia tiene unas consecuencias adversas tanto de tipo físico y psicosocial, en especial en las más jóvenes (15-16 años) y sobre todo en las pertenecientes a las clases sociales más desfavorecidas, ya que siguen una dieta inadecuada a su estado y utilizan tarde o con poca frecuencia el servicio de atención prenatal , lo que supone una dificultad mayor para aceptar la realidad, retraso de la primera visita, desconocimiento del tiempo de gestación, incumplimiento del tratamiento, pasividad, falta de respaldo, depresión y dificultad en la relación asistencial, entre otras cosas. Una de las características socio demográficas de las madres adolescentes, es la particular composición de la estructura familiar; destaca que un 17,5% de las madres siguen constando como residentes en la residencia paterna, mientras que un 15% se incorpora a la residencia del padre, un 65% crea una unidad familiar independiente y un 2,5% vive sola o con otras personas, pensiones, casas de acogida, etc. En lo concerniente al aspecto psicológico, es conveniente que la madre adolescente reoriente toda su vida y asuma responsabilidades de adulto. Según numerosos estudios realizados, éstas desempeñan bien su papel de madre, estableciendo buenas relaciones con su hijo, no siendo menos competentes que las adultas.Este tema es de gran importancia ya es preocupante en cada una de las ciudades y Municipio donde vivimos los embarazos en adolescentes, hecho que observamos con más frecuencia en los últimos años y, lo que es más grave; se produce en edades cada vez menores y destacar las consecuencias que es trae al establecer un embarazo a temprana edad y enfrentar la vida con una nueva vida que se trae al mundo sin saber para que ni por qué. Este proyecto de campo describe los factores relevantes del porque se está presentando los embarazos a tan temprana edad, y de igual forma se destaca la dura realidad en la que las jóvenes enfrentan sin orientación este problema sin duda un problema de todo tipo. El embarazo en la adolescencia tiene unas consecuencias adversas tanto de tipo físico y psicosocial, en especial en las más jóvenes (10-16 años) y sobre todo en las pertenecientes a las clases sociales más desfavorecidas, ya que siguen una dieta inadecuada a su estado y utilizan tarde o con poca frecuencia el servicio de atención prenatal , lo que supone una dificultad mayor para aceptar la realidad, retraso de la primera visita, desconocimiento del tiempo de gestación, incumplimiento del tratamiento, pasividad, falta de respaldo, depresión y dificultad en la relación asistencial, entre otras cosas. Una de las características socio demográficas de las madres adolescentes, es la particular composición de la estructura familiar; destaca que un 17,5% de las madres siguen constando como residentes en la residencia paterna, mientras que un 15% se incorpora a la residencia del padre, un 65% crea una unidad familiar independiente y un 2,5% vive sola o con otras personas, pensiones, casas de acogida, etc. En lo concerniente al aspecto psicológico, es conveniente que la madre adolescente reoriente toda su vida y asuma responsabilidades de adulto. Según numerosos estudios realizados, éstas desempeñan bien su papel de madre, estableciendo buenas relaciones con su hijo, no siendo menos competentes que las adultas. Por lo tanto más allá de una investigación se quiere concientizar a los adolecentes tanto hombres como mujeres en la gran responsabilidad de traer al mundo un hijo y todas sus consecuencias a los que se ven enfrentados al comenzar una vida como padres. Las charlas educativas fueron un apoyo para el grupo de adolecentes a quien se aplico las encuetas, quienes recibieron orientación por parte del grupo de investigación y profesionales en salud y educación sexual. Porque es necesario identificar el riesgo reproductivo y las complicaciones asociadas, para contribuir de alguna manera a mejorar la salud materna y perinatal de nuestras ciudades y municipios en fin en todo el mundo. 14 El embarazo en la adolescencia tiene unas consecuencias adversas tanto de tipo físico y psicosocial, en especial en las más jóvenes (15-16 años) y sobre todo en las pertenecientes a las clases sociales más desfavorecidas, ya que siguen una dieta inadecuada a su estado y utilizan tarde o con poca frecuencia el servicio de atención prenatal , lo que supone una dificultad mayor para aceptar la realidad, retraso de la primera visita, desconocimiento del tiempo de gestación, incumplimiento del tratamiento, pasividad, falta de respaldo, depresión y dificultad en la relación asistencial, entre otras cosas. Una de las características socio demográficas de las madres adolescentes, es la particular composición de la estructura familiar; destaca que un 17,5% de las madres siguen constando como residentes en la residencia paterna, mientras que un 15% se incorpora a la residencia del padre, un 65% crea una unidad familiar independiente y un 2,5% vive sola o con otras personas, pensiones, casas de acogida, etc. En lo concerniente al aspecto psicológico, es conveniente que la madre adolescente reoriente toda su vida y asuma responsabilidades de adulto. Según numerosos estudios realizados, éstas desempeñan bien su papel de madre, estableciendo buenas relaciones con su hijo, no siendo menos competentes que las adultas

La imagen y la narrativa como herramientas de abordaje psicosocial en escenarios de violencia Departamento de Boyacá

En el acompañamiento psicosocial en escenarios de violencia, se visualizaron diferentes escenarios donde las victimas requieren de acompañamiento psicosocial. Dentro de los impactos psicosociales, que se observaron en las narraciones de los sucesos de cada persona víctima del conflicto armado, se resalta la experiencia traumática como sucesos que suponen una amenaza real o potencial para la vida, la salud mental o integridad física de una persona (Sánchez Acosta, D., Castaño Pérez, G. A., Sierra Hincapié, G. M., Moratto Vásquez, N. S., Salas Zapata, C., Buitrago Salazar, J. C., & Torres de Galvis, Y., 2019). Estos cambios que experimentan a través de sucesos violentos transforman drásticamente la vida de sus familiares, amigos e inclusive de su comunidad. En muchas ocasiones estas personas viven un duelo por la pérdida física de alguna parte de su cuerpo esto conlleva a que la víctima experimente inferioridad por sus limitaciones físicas para ejercer actividades que anteriormente hacía. La función que cumple un psicólogo en los diferentes contextos de violencia, cobran un papel importante, ya que en Colombia es una realidad que todos tenemos de cerca o presenciemos diferentes tipos de violencia, donde se ven afectadas personas desde la primera infancia hasta la tercera edad, todos somos participes ya sea de manera directa o indirecta en los diferentes eventos donde se vulneran derechos, se sufren pérdidas, donde se debe fortalecer el alma y se demuestra lo resilientes que somos los Colombianos, así mismo se implementan estrategias de apoyo psicosocial para que esta población tenga una vida digna y sean personas resilientes.In the experience of the diploma in deepening and psychosocial support in scenes of violence, different scenarios were visualized where the victims need psychosocial support. Within the psychosocial impacts, which were observed in the narratives of the events of each person victim of the armed conflict, the traumatic experience is highlighted as events that pose a real or potential threat to the life, mental health, or physical integrity of a person (Sánchez Acosta, D., Castaño Pérez, G. A., Sierra Hincapié, G. M., Moratto Vásquez, N. S., Salas Zapata, C., Buitrago Salazar, J. C., & Torres de Galvis, Y., 2019). These changes that they experience through violent events drastically transform the lives of their family, friends and even their community. On many occasions, these people mourn for the physical loss of some part of their body, this leads to the victim experiencing inferiority due to their physical limitations to carry out activities that they previously did. The role of a psychologist in the different contexts of violence takes on an important role, since in Colombia it is a reality that we all have up close or witness different types of violence where people are affected from early childhood to old age, We are all participants, either directly or indirectly, in the different events where rights are violated, losses are suffered, where the soul must be strengthened and how resilient we Colombians are is demonstrated

Biochemical Recurrence Surrogacy for Clinical Outcomes After Radiotherapy for Adenocarcinoma of the Prostate

PURPOSE: The surrogacy of biochemical recurrence (BCR) for overall survival (OS) in localized prostate cancer remains controversial. Herein, we evaluate the surrogacy of BCR using different surrogacy analytic methods. MATERIALS AND METHODS: Individual patient data from 11 trials evaluating radiotherapy dose escalation, androgen deprivation therapy (ADT) use, and ADT prolongation were obtained. Surrogate candidacy was assessed using the Prentice criteria (including landmark analyses) and the two-stage meta-analytic approach (estimating Kendall's tau and the R2). Biochemical recurrence-free survival (BCRFS, time from random assignment to BCR or any death) and time to BCR (TTBCR, time from random assignment to BCR or cancer-specific deaths censoring for noncancer-related deaths) were assessed. RESULTS: Overall, 10,741 patients were included. Dose escalation, addition of short-term ADT, and prolongation of ADT duration significantly improved BCR (hazard ratio [HR], 0.71 [95% CI, 0.63 to 0.79]; HR, 0.53 [95% CI, 0.48 to 0.59]; and HR, 0.54 [95% CI, 0.48 to 0.61], respectively). Adding short-term ADT (HR, 0.91 [95% CI, 0.84 to 0.99]) and prolonging ADT (HR, 0.86 [95% CI, 0.78 to 0.94]) significantly improved OS, whereas dose escalation did not (HR, 0.98 [95% CI, 0.87 to 1.11]). BCR at 48 months was associated with inferior OS in all three groups (HR, 2.46 [95% CI, 2.08 to 2.92]; HR, 1.51 [95% CI, 1.35 to 1.70]; and HR, 2.31 [95% CI, 2.04 to 2.61], respectively). However, after adjusting for BCR at 48 months, there was no significant treatment effect on OS (HR, 1.10 [95% CI, 0.96 to 1.27]; HR, 0.96 [95% CI, 0.87 to 1.06] and 1.00 [95% CI, 0.90 to 1.12], respectively). The patient-level correlation (Kendall's tau) for BCRFS and OS ranged between 0.59 and 0.69, and that for TTBCR and OS ranged between 0.23 and 0.41. The R2 values for trial-level correlation of the treatment effect on BCRFS and TTBCR with that on OS were 0.563 and 0.160, respectively. CONCLUSION: BCRFS and TTBCR are prognostic but failed to satisfy all surrogacy criteria. Strength of correlation was greater when noncancer-related deaths were considered events.</p

Sequencing of Androgen-Deprivation Therapy of Short Duration With Radiotherapy for Nonmetastatic Prostate Cancer (SANDSTORM): A Pooled Analysis of 12 Randomized Trials

PURPOSE: The sequencing of androgen-deprivation therapy (ADT) with radiotherapy (RT) may affect outcomes for prostate cancer in an RT-field size-dependent manner. Herein, we investigate the impact of ADT sequencing for men receiving ADT with prostate-only RT (PORT) or whole-pelvis RT (WPRT). MATERIALS AND METHODS: Individual patient data from 12 randomized trials that included patients receiving neoadjuvant/concurrent or concurrent/adjuvant short-term ADT (4-6 months) with RT for localized disease were obtained from the Meta-Analysis of Randomized trials in Cancer of the Prostate consortium. Inverse probability of treatment weighting (IPTW) was performed with propensity scores derived from age, initial prostate-specific antigen, Gleason score, T stage, RT dose, and mid-trial enrollment year. Metastasis-free survival (primary end point) and overall survival (OS) were assessed by IPTW-adjusted Cox regression models, analyzed independently for men receiving PORT versus WPRT. IPTW-adjusted Fine and Gray competing risk models were built to evaluate distant metastasis (DM) and prostate cancer-specific mortality. RESULTS: Overall, 7,409 patients were included (6,325 neoadjuvant/concurrent and 1,084 concurrent/adjuvant) with a median follow-up of 10.2 years (interquartile range, 7.2-14.9 years). A significant interaction between ADT sequencing and RT field size was observed for all end points (P interaction < .02 for all) except OS. With PORT (n = 4,355), compared with neoadjuvant/concurrent ADT, concurrent/adjuvant ADT was associated with improved metastasis-free survival (10-year benefit 8.0%, hazard ratio [HR], 0.65; 95% CI, 0.54 to 0.79; P < .0001), DM (subdistribution HR, 0.52; 95% CI, 0.33 to 0.82; P = .0046), prostate cancer-specific mortality (subdistribution HR, 0.30; 95% CI, 0.16 to 0.54; P < .0001), and OS (HR, 0.69; 95% CI, 0.57 to 0.83; P = .0001). However, in patients receiving WPRT (n = 3,049), no significant difference in any end point was observed in regard to ADT sequencing except for worse DM (HR, 1.57; 95% CI, 1.20 to 2.05; P = .0009) with concurrent/adjuvant ADT. CONCLUSION: ADT sequencing exhibits a significant impact on clinical outcomes with a significant interaction with field size. Concurrent/adjuvant ADT should be the standard of care where short-term ADT is indicated in combination with PORT

Biochemical Recurrence Surrogacy for Clinical Outcomes After Radiotherapy for Adenocarcinoma of the Prostate

PURPOSE: The surrogacy of biochemical recurrence (BCR) for overall survival (OS) in localized prostate cancer remains controversial. Herein, we evaluate the surrogacy of BCR using different surrogacy analytic methods. MATERIALS AND METHODS: Individual patient data from 11 trials evaluating radiotherapy dose escalation, androgen deprivation therapy (ADT) use, and ADT prolongation were obtained. Surrogate candidacy was assessed using the Prentice criteria (including landmark analyses) and the two-stage meta-analytic approach (estimating Kendall's tau and the R2). Biochemical recurrence-free survival (BCRFS, time from random assignment to BCR or any death) and time to BCR (TTBCR, time from random assignment to BCR or cancer-specific deaths censoring for noncancer-related deaths) were assessed. RESULTS: Overall, 10,741 patients were included. Dose escalation, addition of short-term ADT, and prolongation of ADT duration significantly improved BCR (hazard ratio [HR], 0.71 [95% CI, 0.63 to 0.79]; HR, 0.53 [95% CI, 0.48 to 0.59]; and HR, 0.54 [95% CI, 0.48 to 0.61], respectively). Adding short-term ADT (HR, 0.91 [95% CI, 0.84 to 0.99]) and prolonging ADT (HR, 0.86 [95% CI, 0.78 to 0.94]) significantly improved OS, whereas dose escalation did not (HR, 0.98 [95% CI, 0.87 to 1.11]). BCR at 48 months was associated with inferior OS in all three groups (HR, 2.46 [95% CI, 2.08 to 2.92]; HR, 1.51 [95% CI, 1.35 to 1.70]; and HR, 2.31 [95% CI, 2.04 to 2.61], respectively). However, after adjusting for BCR at 48 months, there was no significant treatment effect on OS (HR, 1.10 [95% CI, 0.96 to 1.27]; HR, 0.96 [95% CI, 0.87 to 1.06] and 1.00 [95% CI, 0.90 to 1.12], respectively). The patient-level correlation (Kendall's tau) for BCRFS and OS ranged between 0.59 and 0.69, and that for TTBCR and OS ranged between 0.23 and 0.41. The R2 values for trial-level correlation of the treatment effect on BCRFS and TTBCR with that on OS were 0.563 and 0.160, respectively. CONCLUSION: BCRFS and TTBCR are prognostic but failed to satisfy all surrogacy criteria. Strength of correlation was greater when noncancer-related deaths were considered events

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe