Adaptive Social Protection in Rwanda: ‘Climate?proofing’ the Vision 2020 Umurenge Programme

Rwanda has a high rate of rural poverty, population density and pressures on its natural resource base. One government response has been a social protection intervention, the Vision 2020 Umurenge Programme (VUP). VUP provides ‘public works’ employment for members of extremely poor households with able?bodied members, and ‘direct support’ cash transfers for poor households without members who can work. Many public works projects focus on environmental protection. VUP also promotes risk reduction activities related to food security and related health or nutrition issues. With increasing weather?related hazards and possibly climate change, administrators recognise the need to ‘climate?proof’ VUP in a manner that integrates social protection with disaster risk management, climate change adaptation and food security. This article highlights the potential for social protection policies and programmes in Rwanda to increase household and community resilience, by applying concepts of adaptive social protection and ‘no regrets’ approaches in a territorial context

Social Protection in Zambia – Whose Politics?

Attempts have been made to explain why social protection systems seem least likely to become established where they are most needed. Often, however, these attempts have not captured the rather complex politics in the countries in question. Analyses have turned the Minister of Finance into the sole representative of political will, have equated low budgetary allocations with a politically unattractive programme design and have ignored the long and erratic histories of social protection in the Western world. The appropriate roles for donors and civil societies in such political economies remain equally unclear. On the basis of other ‘drivers of change’ studies, this article takes a closer look at the political dynamics behind social protection in Zambia. It examines whether the observed or deduced stagnation in social protection is due to stakeholders in Zambia rejecting policy recommendations, the inappropriate nature of these recommendations or a premature assessment of progress made

Circulating 250HD, dietary vitamin D, PTH, and calcium associations with incident cardiovascular disease and mortality: The MIDSPAN Family Study

<p>Context: Observational studies relating circulating 25-hydroxyvitamin D (25OHD) and dietary vitamin D intake to cardiovascular disease (CVD) have reported conflicting results.</p> <p>Objective: Our objective was to investigate the association of 25OHD, dietary vitamin D, PTH, and adjusted calcium with CVD and mortality in a Scottish cohort.</p> <p>Design and Setting: TheMIDSPAN Family Study is a prospective study of 1040 men and 1298 women from the West of Scotland recruited in 1996 and followed up for a median 14.4 yr. Participants: Locally resident adult offspring of a general population cohort were recruited from 1972–1976.</p> <p>Main Outcome Measures: CVD events (n = 416) and all-cause mortality (n=100) were evaluated.</p> <p>Results: 25OHD was measured using liquid chromatography-tandem mass spectrometry in available plasma (n=2081). Median plasma 25OHD was 18.6 ng/ml, and median vitamin D intake was 3.2 µ g/d (128 IU/d). Vitamin D deficiency (25OHD<15 ng/ml) was present in 689 participants (33.1%). There was no evidence that dietary vitamin D intake, PTH, or adjusted calcium were associated with CVD events or with mortality. Vitamin D deficiency was not associated with CVD (fully adjusted hazard ratio=1.00; 95% confidence interval=0.77–1.31). Results were similar after excluding patients who reported an activity-limiting longstanding illness at baseline (18.8%) and those taking any vitamin supplements (21.7%). However, there was some evidence vitamin D deficiency was associated with all-cause mortality (fully adjusted hazard ratio=2.02; 95% confidence interval=1.17–3.51).</p> <p>Conclusion: Vitamin D deficiency was not associated with risk of CVD in this cohort with very low 25OHD. Future trials of vitamin D supplementation in middle-aged cohorts should be powered to detect differences inmortality outcomes as well as CVD.(J Clin EndocrinolMetab97: 0000 –0000, 2012)</p&gt

The taxation of UK oil and gas production: why the windfalls got away

Starting with evidence that United Kingdom Continental Shelf oil and gas companies have benefitted very disproportionately from the recent period of extraordinarily high oil prices, this paper traces the history of this weakness in the UK's petroleum fiscal regime. Evidence is provided that the progressive relaxations in the UK's petroleum fiscal regime in 1983, 1987–1988 and 1993 were: largely unnecessary to stimulate the development of new, smaller, 'marginal' fields; misguided in their assumption that such fields were more costly to develop than earlier counterparts or larger contemporary fields; and impotent compared with the effects of oil price movements. The paper concludes with a conceptualisation which illuminates why these failures of policy were not just random: they emerged from the UK's 'non-proprietorial' stance with respect to the country’s oil and gas resources, a stance which assumes responsibility for oil company profitability and vainly tries to counter market forces at the expense of government revenues

Heart rate variability and target organ damage in hypertensive patients

Background: We evaluated the association between linear standard Heart Rate Variability (HRV) measures and vascular, renal and cardiac target organ damage (TOD). Methods: A retrospective analysis was performed including 200 patients registered in the Regione Campania network (aged 62.4 ± 12, male 64%). HRV analysis was performed by 24-h holter ECG. Renal damage was assessed by estimated glomerular filtration rate (eGFR), vascular damage by carotid intima-media thickness (IMT), and cardiac damage by left ventricular mass index. Results: Significantly lower values of the ratio of low to high frequency power (LF/HF) were found in the patients with moderate or severe eGFR (p-value < 0.001). Similarly, depressed values of indexes of the overall autonomic modulation on heart were found in patients with plaque compared to those with a normal IMT (p-value <0.05). These associations remained significant after adjustment for other factors known to contribute to the development of target organ damage, such as age. Moreover, depressed LF/HF was found also in patients with left ventricular hypertrophy but this association was not significant after adjustment for other factors. Conclusions: Depressed HRV appeared to be associated with vascular and renal TOD, suggesting the involvement of autonomic imbalance in the TOD. However, as the mechanisms by which abnormal autonomic balance may lead to TOD, and, particularly, to renal organ damage are not clearly known, further prospective studies with longitudinal design are needed to determine the association between HRV and the development of TOD

Prevalence, Predictive Factor, and Clinical Significance of White-Coat Hypertension and Masked Hypertension in Korean Hypertensive patients

Smoking is associated with common sight-threatening eye conditions. We suspected that this link was little known and it might be a potent novel health promotional tool. We therefore developed a programme ultimately aiming to reduce the burden of eye disease attributable to smoking. The programme aims were to (1) raise awareness of the link between smoking and eye disease and advocate changes in relevant policies and (2) investigate and promote change in professional practice so that smokers are identified and routinely offered smoking cessation advice/support in eyecare settings. An inter-professional team developed a programme of research and education targeting policy-makers, healthcare professionals, the public and patients. We reviewed evidence about the causal link between smoking and eye disease, researched current awareness of the link, researched current practice of eyecare health professionals, produced health education materials and campaigned for policy changes. The series of projects was completed successfully, achieving media coverage, confirming the causal link between smoking and eye disease and demonstrating low awareness of this association. Healthcare leaders and policy-makers were engaged in our programme resulting in commitment, in principle, from the UK's Chief Medical Officer and the European Commission to consider including warning labels related to blindness on cigarette packets

MGNREGA in Tamil Nadu: a story of success and transformation?

Social protection has emerged as a key driver of development policy at the beginning of the twenty‐first century. It is widely considered a ‘good thing’ that has the potential not only to alleviate poverty and vulnerability, but also to generate more transformative outcomes in terms of empowerment and social justice. Based on an ethnographic study of the implementation of the M ahatma G andhi N ational R ural E mployment G uarantee A ct (MGNREGA ), India's flagship social protection policy, this paper takes a critical look at what this policy's ‘success’ consists of. The study was carried out in T amil Nadu, a state widely presented as a ‘success’ in terms of MGNREGA 's implementation, and describes who participates in the scheme and how success is understood and expressed at different social and bureaucratic levels. In terms of MGNREGA 's outcomes, we conclude that the scheme is benefitting the poorest households – and D alits and women in particular – especially in terms of providing a safety net and as a tool for poverty alleviation. But the scheme does more than that. It has also produced significant transformative outcomes for rural labourers, such as pushing up rural wage levels, enhancing low‐caste workers' bargaining power in the labour market and reducing their dependency on high‐caste employers. These benefits are not only substantial but also transformative in that they affect rural relations of production and contribute to the empowerment of the rural labouring poor. However, in terms of creating durable assets and promoting grassroots democracy, the scheme's outcomes are much less encouraging