Legal and institutional principles and guidelines for strengthening the role of local government in Bangladesh to facilitate food security impacted by climate change

This research aims to identify legal and institutional principles and guidelines that could strengthen the role of Bangladesh local government to address food security impacted by climate change. Bangladesh has made some successes in improving food security, however, climate change impacts are threatening Bangladesh’s successes, particularly at the local level. It is recommended, internationally, that local government has the potential to address the growing impacts of climate change at local level, such as impacts on local food security. Therefore, strengthening local government role in addressing climate impacted food security is necessary. In order to improve local governance of climate change, many international policy responses have prescribed some future roles of local government and have suggested adopting some legal and institutional principles and guidelines to strengthen the roles. This research has developed a set of appropriate legal and institutional principles and guidelines for strengthening local governments’ role in climate impacted food security by integrating the recommendations of international policy responses of environment and sustainable development, climate change, food security and good governance. This research has also investigated relevant laws, policies and strategies of a developed country (Australia) and a developing country (Indonesia). Both Australia and Indonesia have a reputation for addressing climate change impacts on food security and a strong local government system. The research has identified some legal and institutional principles and guidelines in the relevant laws, policies and strategies of these two countries that are enabling local government to play an effective role in addressing climate change impacts on food security. The existing food security, climate change and local government laws, policies and strategies of Bangladesh indicate some potential roles of local government in addressing climate change impacts on food security. However, the research has identified some weaknesses in Bangladesh approaches to involve local government effectively; such as inconsistencies in laws and policies to strengthen local government, lack of legal acknowledgement of the capacity of local government, lack of resources, lack of coordination mechanisms and lack of guidelines for carrying out their effective role. This research, by considering the international recommendations and the experiences of comparative examples (Australia and Indonesia), recommends the adoption of some legal and institutional principles and guidelines to address the existing weaknesses and further strengthen Bangladesh local government roles in addressing climate impacted food security. The recommendations are: 1. Good local governance principles should be applied for strengthening local government 2. The importance of local government roles in addressing climate change impacts on food security should be acknowledged properly 3. Local government roles in climate impacted food security should be consistently reflected in climate change, food security and local government laws in Bangladesh 4. Capacity building and detailed guidelines to address climate change impacts on food security should be provided to local government. 5. Local government should have access to resources to facilitate local adaptation programs; and 6. Guideline for cooperation and coordination with other stakeholders should be provided

Bringing About a Behavioural Change in Providers to Meet the Reproductive Health Needs of Clients

The international conference on population and development held in Cairo in 1994 has became a historical turning point in the way population policies and programmes are perceived and sexual and reproductive health services are conceptualised and delivered. Inherent in the ICPD plan of action is the concept of care that recommends providing a range of reproductive health services to both men and women, that are safe and effective, and that satisfy clients, needs and wants. Clients are far more likely to use services that are of high quality. Achieving quality care requires complying with high technical and ethical standards (such as freedom of choice, informed consent, and freedom from coercion and abuse) and providing services at costs that are affordable to both clients and health care system. The most common barriers to quality are negative provider attitudes or behaviours, poor interactions between clients and providers, a lack of essential drugs and supplies in facilities, and delays in referrals to other necessary services. Pakistan has among the worst reproductive health indicators in the developing world. It has lagged behind many of its neighbours in terms of its social indicators. Access to health and educational facilities, especially in the rural areas has remained outstandingly weak. Maternal and infant mortality rates are unacceptably high at above 500 per 100,000 and 80 per 1000 births, respectively. Malnutrition, anaemia and reproductive tract infections are widely prevalent in women.

Clinical evaluation of efficacy and safety of α-keto analogs of essential amino acids supplementation in patients of chronic kidney disease

Background: The objective was to evaluate the efficacy and safety of α-keto analogs of essential amino acids (KAA) as a supplement in chronic kidney disease (CKD).Methods: A prospective comparative study was conducted in patients of CKD of a tertiary care center of North India. Patients were randomly divided into two interventional groups. Group I (control) was advised conservative management and placebo while Group II (KAA) given conservative management along with KAA (600 mg, thrice daily) for 12 weeks. Hemogram, renal function tests, lipid profiles were done, and adverse effects were recorded at 0, 4, 8, and 12 weeks of treatment.Results: There was progressive improvement in clinical features in both groups after 12 weeks of treatment, but KAA group showed more marked improvement as compared with the control group. Both groups showed gradual improvement in the biochemical parameters as compared to their pre-treated values, which was more marked in KAA supplemented group. There was a reduction in blood glucose, blood urea, serum creatinine, and 24 h total urine protein. There was an increase in hemoglobin, 24 h total urine volume and glomerular filtration rate. KAA group showed significant (p<0.05) improvement in lipid profiles as compared with the control group. There was no statistical difference in two groups with respect to side-effects (p>0.05).Conclusion: KAA supplementation along with conservative management is efficacious and safe in preventing the progression of disease in patients of CKD

Racial Differences in the Use of Most Commonly Performed Medical Procedures in the United States

Objective: This study investigates racial disparities in the use of commonly performed medical procedures in U.S. hospitals. Methods: To examine racial disparities, we calculated age-adjusted rate of procedures used by all Whites, Blacks, Hispanics, Asians or Pacific Islanders and Native Americans and calculated corresponding Relative Risks(RRs) of White vs. all other races based on procedure utilizations and insurance types using 20% random sample of Nationwide Inpatient Sample (NIS) data between 2001 and2003. Results: Whites were significantly more likely to receive 3 of the study procedures than Blacks, 3 of the procedures than Hispanics, 2 of the procedures than Asians or Pacific Islanders and 4 of the procedures than Native Americans (p\u3c0.05). We also found racial disparities to receive medical procedures based on patients’ insurance status.However, only in a few cases were these differences substantial. Conclusion: Race plays a significantly important role in the use of commonly performed medical procedures in U.S. hospitals

Role of rhubarb and α-keto analogues of essential amino acids supplementation in halting progression of chronic kidney disease

Background: Chronic kidney disease (CKD) is an emerging chronic disease due to rapidly increasing incidence of diabetes and hypertension worldwide. Newer drugs are being searched which can stop nephron damage and are cost effective. This study was undertaken to compare the efficacy and safety profile of rhubarb and α-keto analogues of essential amino acids supplementation in patients of chronic kidney disease.Methods: A prospective comparative study was conducted in patients of chronic kidney disease attending Renal Clinic of a tertiary care centre. Randomization of patients was done into three interventional groups: conservative management along with placebo was given in first group (Control); conservative management along with Rhubarb capsule (350 mg, thrice daily) was given in second group (Rhubarb) and conservative management along with α-keto analogues of essential amino acids (600 mg, thrice daily) was given in third group (KAA). The treatment was given for 12 weeks. Clinical and biochemical parameters were assessed at 0, 4, 8 and 12 weeks of treatment.Results: Patients of all three groups showed gradual improvement in clinical features and biochemical parameters as compared to their pre-treated values which was more marked in KAA supplemented group. There was reduction in: fasting blood glucose (12.51%, 19.15% and 20.78%), PPBG (14.80%, 19.00% and 20.89%), serum creatinine (25.00%, 30.54% and 39.52%), blood urea (25.55%, 33.64% and 38.09%), and 24-hour total urine protein (TUP) (19.80%, 30.18% and 38.34%) in Group I, II and III respectively. There was increase in: haemoglobin level (12.64%, 14.99% and 19.77%), 24-hour total urine volume (TUV) (19.41%, 28.82% and 33.32%) and GFR (22.6%, 46.5% and 49.2%) in Group I, II and III respectively. Rhubarb and KAA supplementations were safe and well-tolerated.Conclusions: KAA is more effective than Rhubarb as add on therapy with conservative management in patients of chronic kidney disease

EVALUATION OF EFFICACY AND SAFETY OF NIGELLA SATIVA OIL SUPPLEMENTATION IN PATIENTS OF CHRONIC KIDNEY DISEASE

ABSTRACTObjective: To evaluate efficacy and safety of add-on therapy of Nigella sativa oil in patients of stage 3 and 4 of chronic kidney disease (CKD).Materials and Methods: The study was conducted in a tertiary care center of north India in stage 3 and 4 patients of CKD. It was a prospective,comparative, and open label study. Patients were randomly divided into two interventional groups. Group I (Control) received conservativemanagement of CKD while Group II (Test) received conservative management along with N. sativa oil (2.5 mL, per orally, once daily) for 12 weeks.Hemogram and renal function tests were done, and adverse events were recorded at 0, 6, and 12 weeks of treatment.Results: After 12 weeks of treatment, there was a progressive improvement in clinical features and biochemical parameters in both the groups, but itwas more marked in the test group compared to control group. Both groups showed gradual improvement in the biochemical parameters as comparedto their pre-treated values which were more marked in N. sativa oil supplemented group. There was a reduction in blood glucose, blood urea, serumcreatinine, and 24-hr total urine protein. There was an increase in hemoglobin, 24-hr total urine volume, and glomerular filtration rate.Conclusion: N. sativa oil supplementation along with conservative management is efficacious and safe in averting the progression of disease in stage 3and 4 patients of CKD.Keywords: Chronic kidney disease, Nigella sativa oil, End-stage renal disease, Glomerular filtration rate

Bringing About a Behavioural Change in Providers to Meet the Reproductive Health Needs of Clients

The international conference on population and development held in Cairo in 1994 has became a historical turning point in the way population policies and programmes are perceived and sexual and reproductive health services are conceptualised and delivered. Inherent in the ICPD plan of action is the concept of care that recommends providing a range of reproductive health services to both men and women, that are safe and effective, and that satisfy clients, needs and wants. Clients are far more likely to use services that are of high quality. Achieving quality care requires complying with high technical and ethical standards (such as freedom of choice, informed consent, and freedom from coercion and abuse) and providing services at costs that are affordable to both clients and health care system. The most common barriers to quality are negative provider attitudes or behaviours, poor interactions between clients and providers, a lack of essential drugs and supplies in facilities, and delays in referrals to other necessary services