Agroecology on the periphery: A case from the Maya-Achí territory, Guatemala

En este documento examina la ampliación de las prácticas agroecológicas en el territorio maya achí de Guatemala. Comparamos este caso con otros documentados en la literatura, así como los factores clave o “impulsores” importantes para su escalamiento. Hemos constatado la complejidad de sus factores impulsores y que estos, como los métodos constructivistas de aprendizaje/enseñanza, las políticas públicas favorables y el fuerte tejido social, parecen ser débiles, ausentes o incluso negativos, lo que en parte se debe a la violencia y la represión de los años ochenta, que resultó en el asesinato del 20% de la población dejando el territorio socialmente fragmentado. En este marco, los proyectos que incorporan la agroecología se consideran una estrategia potencial para la recuperación de la comunidad, de modo que son promovidos por asociaciones locales, instituciones y ONG internacionales. Si bien en un principio se planteó que la recuperación social y cultural era la causa principal de la adopción de tales prácticas, nos encontramos con distintos factores adicionales y complejos, entre estos, la expectativa de beneficios económicos y la presencia de organizaciones de ayuda y desarrollo. Analizando estos factores y las barreras contribuimos al debate en curso sobre cómo se pueden ampliar las prácticas agroecológicas, en particular en las regiones que no tienen las condiciones ideales.In this paper we examine processes of scaling agroecological practices in the Maya-Achí territory of Guatemala. We compare the Achí case to other examples documented in the literature and the key factors, or “drivers,” reported as important if not essential for scaling to occur. We find that the Achí scase is complex with regard to these drivers. Factors such as constructivist learning/teaching methods, favorable public policies, and strong social fabric appear to be weak, absent, or even negative. This is due in part to the violence and repression of the 1980s, which resulted in the assassination of 20 percent of the population by the military and paramilitaries, leaving the territory socially fragmented. Projects incorporating agroecology (revalorization of ancestral practices, seed saving, elimination of external inputs, strengthening soil health, increasing/guarding agrobiodiversity) are viewed as a potential strategy to aid in community recovery, and are promoted by local associations as well as by international institutions and NGOs. While social and cultural recuperation were initially hypothesized as primary causes for the adoption of practices, we encounter a range of additional and complex factors, such as the expectation of economic benefits and the presence of aid and development organizations. By analyzing these drivers and barriers we contribute to the ongoing debate over how agroecological practices may be scaled-out, particularly in regions exhibiting less than ideal conditions

Artificial reefs: from ecological processes to fishing enhancement tools

info:eu-repo/semantics/publishedVersio

Prevalence and factors affecting home blood pressure documentation in routine clinical care: a retrospective study

<p>Abstract</p> <p>Background</p> <p>Home blood pressure (BP) is closely linked to patient outcomes. However, the prevalence of its documentation has not been examined. The objective of this study was to analyze the prevalence and factors affecting documentation of home BP in routine clinical care.</p> <p>Methods</p> <p>A retrospective study of 142,973 encounters of 9,840 hypertensive patients with diabetes from 2000 to 2005 was performed. The prevalence of recorded home BP and the factors associated with its documentation were analyzed. We assessed validity of home BP information by comparing the difference between home and office BP to previously published prospective studies.</p> <p>Results</p> <p>Home BP was documented in narrative notes for 2.08% of encounters where any blood pressure was recorded and negligibly in structured data (EMR flowsheets). Systolic and diastolic home BP in narrative notes were lower than office BP readings by 9.6 and 2.5 mm Hg, respectively (p < 0.0001 for both), consistent with prospective data. Probability of home BP documentation increased by 23.0% for each 10 mm Hg of office systolic BP (p < 0.0001), by 6.2% for each $10,000 in median income of zip code (p = 0.0055), and by 17.7% for each decade in the patient's age (p < 0.0001).</p> <p>Conclusions</p> <p>Home BP readings provide a valid representation of the patient's condition, yet are seldom documented despite their potential utility in both patient care and research. Strong association between higher patient income and home BP documentation suggests that the cost of the monitors may be a limiting factor; reimbursement of home BP monitoring expenses should be pursued.</p

Home dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference

Home dialysis modalities (home hemodialysis [HD] and peritoneal dialysis [PD]) are associated with greater patient autonomy and treatment satisfaction compared with in-center modalities, yet the level of home-dialysis use worldwide is low. Reasons for limited utilization are context-dependent, informed by local resources, dialysis costs, access to healthcare, health system policies, provider bias or preferences, cultural beliefs, individual lifestyle concerns, potential care-partner time, and financial burdens. In May 2021, KDIGO (Kidney Disease: Improving Global Outcomes) convened a controversies conference on home dialysis, focusing on how modality choice and distribution are determined and strategies to expand home-dialysis use. Participants recognized that expanding use of home dialysis within a given health system requires alignment of policy, fiscal resources, organizational structure, provider incentives, and accountability. Clinical outcomes across all dialysis modalities are largely similar, but for specific clinical measures, one modality may have advantages over another. Therefore, choice among available modalities is preference-sensitive, with consideration of quality of life, life goals, clinical characteristics, family or care-partner support, and living environment. Ideally, individuals, their care-partners, and their healthcare teams will employ shared decision-making in assessing initial and subsequent kidney failure treatment options. To meet this goal, iterative, high-quality education and support for healthcare professionals, patients, and care-partners are priorities. Everyone who faces dialysis should have access to home therapy. Facilitating universal access to home dialysis and expanding utilization requires alignment of policy considerations and resources at the dialysis-center level, with clear leadership from informed and motivated clinical teams