Does cash crop adoption detract from childcare provision?

Using data from fieldwork conducted in Nepal, the impact of a project designed to commercialize vegetables and fruits — the Vegetable and Fruit Cash Crop Program (VFC)— on male and female time allocation is examined. Using a rigorous time collection methodology, activity patterns in households that adopt and do not adopt the new technology are profiled. Very few studies examine changing activity patterns of both men and women in response to commercialization of agriculture. Though women's time is valuable in agriculture, it is also valuable in the production of child nutrition. The recent evolution in thinking as to the causes of child malnutrition—the three pillars being food intake, health, and time to care—warrants further analyses of the time trade-offs that women and men face when adopting new agricultural technologies. The VFC program was successful at targeting both men and women farmers in the sense that household participation resulted in increased head male and head female time spent growing vegetables and fruits. The responses varied, however, by the number of preschool children in residence. In households with more than one preschooler, the time trade-offs associated with VFC participation were not sizeable for the care of children under 5 years. In households with just one preschooler, the trade-offs were more important. In these households, preschoolers received less care from the male and female heads, who spent more time in both the cash crop and in the food crop. In these same households, the nonwork (leisure) time of men increased as a result of VFC participation, but for women, leisure time was unaffected. Thus in the short run, there is perhaps scope for protecting childcare time by reducing time to leisure. In the medium run, benefits may well accrue to unborn preschoolers if VFC participation empowers women.Child care. ,Malnutrition Nepal. ,Children Nutrition. ,Cash crops Nepal. ,

Does cash crop adoption detract from childcare provision?

Using data from fieldwork conducted in Nepal, the impact of a project designed to commercialize vegetables and fruits — the Vegetable and Fruit Cash Crop Program (VFC)— on male and female time allocation is examined. Using a rigorous time collection methodology, activity patterns in households that adopt and do not adopt the new technology are profiled. Very few studies examine changing activity patterns of both men and women in response to commercialization of agriculture. Though women's time is valuable in agriculture, it is also valuable in the production of child nutrition. The recent evolution in thinking as to the causes of child malnutrition—the three pillars being food intake, health, and time to care—warrants further analyses of the time trade-offs that women and men face when adopting new agricultural technologies. The VFC program was successful at targeting both men and women farmers in the sense that household participation resulted in increased head male and head female time spent growing vegetables and fruits. The responses varied, however, by the number of preschool children in residence. In households with more than one preschooler, the time trade-offs associated with VFC participation were not sizeable for the care of children under 5 years. In households with just one preschooler, the trade-offs were more important. In these households, preschoolers received less care from the male and female heads, who spent more time in both the cash crop and in the food crop. In these same households, the nonwork (leisure) time of men increased as a result of VFC participation, but for women, leisure time was unaffected. Thus in the short run, there is perhaps scope for protecting childcare time by reducing time to leisure. In the medium run, benefits may well accrue to unborn preschoolers if VFC participation empowers women.Child care. ,Malnutrition Nepal. ,Children Nutrition. ,Cash crops Nepal. ,

Cardiac Resynchronization Therapy Outcomes in Type 2 Diabetic Patients: Role of MicroRNA Changes

Heart failure (HF) and type 2 diabetes mellitus (T2DM) are two growing and related diseases in general population and particularly in elderly people. In selected patients affected by HF and severe dysfunction of left ventricle ejection fraction (LVEF), with left bundle brunch block, the cardiac resynchronization therapy with a defibrillator (CRT) is the treatment of choice to improve symptoms, NYHA class, and quality of life. CRT effects are related to alterations in genes and microRNAs (miRs) expression, which regulate cardiac processes involved in cardiac apoptosis, cardiac fibrosis, cardiac hypertrophy and angiogenesis, and membrane channel ionic currents. Different studies have shown a different prognosis in T2DM patients and T2DM elderly patients treated by CRT-D. We reviewed the literature data on CRT-D effect on adult and elderly patients with T2DM as compared with nondiabetic patients

Brief episodes of silent atrial fibrillation predict clinical vascular brain disease in type 2 diabetic patients

ObjectivesThis study evaluated whether subclinical episodes of atrial fibrillation (AF) were associated with an increased risk of silent cerebral infarct (SCI) and stroke in diabetic patients younger than 60 years who did not have other clinical evidence of AF and cerebrovascular disease at baseline.BackgroundIn type 2 diabetic patients, one-fourth of strokes are of unknown cause, and subclinical episodes of AF may be a common etiologic factor.MethodsA total of 464 type 2 diabetic patients younger than 60 years were included in a longitudinal observational study and matched to patients without diabetes. Patients underwent 48-h electrocardiographic Holter monitoring quarterly to detect brief subclinical episodes of AF (duration of AF <48 h) and were followed up for 37 months. The outcomes were SCI, assessed by magnetic resonance imaging of the brain, and stroke events during the follow-up period.ResultsThe prevalence of subclinical episodes of AF was significantly greater among patients with diabetes compared with matched healthy subjects (11% vs. 1.6%, p < 0.0001). During an average duration of 37 months, 43 stroke events occurred in the diabetic population and no events occurred in healthy subjects. Diabetic patients with silent episodes of AF (n = 176) had a higher baseline prevalence of SCI (61% vs. 29%; p < 0.01) and a higher number of stroke events (17.3% vs. 5.9%; p < 0.01) during the follow-up period than the other patients (n = 288). An episode of silent AF was an independent determinant of SCI (odds ratio: 4.441; p < 0.001; confidence interval: 2.42 to 8.16) and an independent predictor of the occurrence of stroke in diabetic patients (hazard ratio: 4.6; p < 0.01; confidence interval: 2.7 to 9.1).ConclusionsSubclinical episodes of AF occurred frequently in type 2 diabetic patients and were associated with a significantly increased risk of SCI and stroke

A case of aspirin-resistance probably related to glycemic excursion

Diabetes is characterised by development of specific microvascular complications and by a high incidence of accelerated atherosclerosis. Several Authors demonstrated that post-prandial hyperglycaemia is certainly an independent risk factor of vascular complications in type 2 diabetes. The endothelial dysfunction, the oxidative stress, the post-prandial hyperglycaemia and the haemostatic and thrombotic parameters alterations are the principal causes for the cardiovascular risk increase in diabetic patient. For this reason many studies on anti-platelet therapy have been made in order to reduce thrombotic complication of diabetes mellitus. However, data suggest that the clinical efficacy of low-dose aspirin in patients with diabetes is substantially lower than in individuals without diabetes. Indeed, several evidences support the hypothesis that diabetes might represent a case of “aspirin resistance”

A stimulating effect of guanyl nucleotides on the rat-liver soluble cyclic GMP high-affinity phosphodiesterase activity

AbstractThe high affinity (low Km) cyclic GMP phosphodiesterase (PDE) is activated by GTP, while the cyclic AMP PDE is not. GTP and its hydrolysis-resistant analogue, guanylylimidodiphosphate (GppNHp), display a half-maximal stimulating effect at almost the same concentration (5 × 10−6M). The GTP stimulating effect is not observed when the socalled cyclic GMP low affinity (high Km) PDE is operative. GTP cooperates with the increase of the substrate concentration on removing the IBMX inhibitory effect. The isolation through a classical chromatographic procedure on a DEAE-cellulose column, of a PDE fraction specific for cyclic GMP, results in the loss of the GTP stimulating effect

Evidence for human diabetic cardiomyopathy.

Growing interest has been accumulated in the definition of worsening effects of diabetes in the cardiovascular system. This is associated with epidemiological data regarding the high incidence of heart failure (HF) in diabetic patients. To investigate the detrimental effects both of hyperglycemia and insulin resistance, a lot of preclinical models were developed. However, the evidence of pathogenic and histological alterations of the so-called diabetic cardiomyopathy (DCM) is still poorly understood in humans. Here, we provide a stringent literature analysis to investigate unique data regarding human DCM. This approach established that lipotoxic-related events might play a central role in the initiation and progression of human DCM. The major limitation in the acquisition of human data is due to the fact of heart specimen availability. Postmortem analysis revealed the end stage of the disease; thus, we need to gain knowledge on the pathogenic events from the early stages until cardiac fibrosis underlying the end-stage HF

Blood pressure and cardiac autonomic nervous system in obese type 2 diabetic patients: Effect of metformin administration

Background: Hyperinsulinemia/insulin resistance and elevated plasma free fatty acids (FFA) levels are involved in the hypertension and cardiac sympathetic overactivity. Metformin improves insulin action and lower plasma FFA concentrations. We investigate the possible effect of metformin on arterial blood pressure (BP) and cardiac sympathetic nervous system. Methods: One hundred twenty overweight type 2 diabetic patients were treated by placebo (n = 60) + diet or metformin (850 mg twice daily) (n = 60) + diet for 4 months, to evaluate the effect of metformin treatment on the cardiac autonomic nervous system. Insulin resistance was measured by the Homeostasis Model Assessment (HOMA) index. Heart rate variability (HRV) assessed cardiac sympathovagal balance. Results: Metformin treatment, but not placebo treatment, was associated with a decrease in fasting plasma glucose (P < .05), insulin (P < .05), triglyceride (P < .05), and FFA (P < .03) concentrations and HOMA index (P < .03). Metformin treatment was also associated with a significant improvement in cardiac sympathovagal balance but not in mean arterial BP. Furthermore, in a multivariate analysis, delta change in sympathovagal balance index (LF/HF ratio) were associated with delta change in plasma FFA concentrations and HOMA index independently of gender and delta change in plasma triglyceride and HbA1c concentrations. Conclusions: Our study demonstrated that metformin treatment might be useful for improving cardiac sympathovagal balance in obese type 2 diabetic patients

Assessing Nephrological Competence among Geriatricians: A Proof of Concept Internet Survey

Chronic kidney disease (CKD) is highly prevalent in the elderly and negatively impacts survival and health status. Thus, nephrological competence is mandatory for a skilled geriatrician. The present study aimed to assess nephrological competence in a sample of geriatricians recruited through a web survey. To this aim, a 12-items questionnaire was produced by an expert panel of nephrologists and geriatricians and was available online for members of the Italian Society of Gerontology and Geriatrics (SIGG). Two-hundred-eighty-seven geriatricians volunteered to fill in the questionnaire. The majority of them indirectly estimated the glomerular filtration rate (GFR) using mainly the Cockroft-Gault (C-G) formula. Selected nephrological exams, such as urinary Na and serum D-vitamin measurements, did not qualify as routine exams although the majority of geriatricians supplemented their patients with fat-soluble secosteroids. Ten percent of geriatricians asked for nephrological consultation only for stage 5 CKD patients and 30,9% only for stage 4 or 5. Erythropoietin supplementation was common practice for the majority of geriatricians, while only one third of them systematically used a procedure intended to prevent the contrast induced nephropathy (CIN). Finally, an alleged 50% adherence to the international guidelines for the management of CKD patients emerged from the questionnaire. Overall, results from this survey strongly recommend promoting nephrological education among geriatricians. Didactic standards for in training geriatricians need to be updated and the cooperation between geriatrics and nephrological societies promoted