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To assess the role of demographic factors and chronic conditions in maintaining mobility in older persons, this study utilized longitudinal data collected as part of the Established Populations for Epidemiologic Studies of the Elderly between 1981 and 1987 on 6,981 men and women aged 65 years and older in East Boston, Massachusetts; Iowa and Washington counties, Iowa; and New Haven, Connecticut. Results are presented for those who at baseline reported intact mobility, defined as the ability to climb stairs and walk a half mile without help, and who were followed annually for up to 4 years for changes in mobility status. Age, income, education, and chronic conditions present at baseline and occurring during follow-up were evaluated for their association with loss of mobility. Over the follow-up period, 55.1% of subjects maintained mobility, 36.2% lost mobility, and 8.7% died without evidence of mobility loss prior to death. In both men and women, increasing age and lower income levels were associated with increased risk of losing mobility, even after controlling for the presence of chronic conditions at baseline. After adjustment for age, income, and chronic conditions, lower education levels were a significant risk factor for mobility loss in men, but not in women. Baseline reports of previous heart attack, stroke, high blood pressure, diabetes, dyspnea, and exertional leg pain were associated with small but significant risks for mobility loss. There was a stepwise increase in the risk of mobility loss according to the number of chronic conditions present at baseline that was very consistent between men and women. The occurrence during the study of a new heart attack, stroke, cancer, or hip fracture was associated with a substantially greater risk of mobility loss than was associated with the presence of these conditions at baseline.

ObjectiveTo determine whether there is a relationship of low to moderate alcohol consumption with cardiovascular mortality in the elderly.DesignProspective cohort studies with 5-year mortality follow-up.SettingThree populations of community-dwelling elders.ParticipantsPopulation-based cohorts of men and women, aged 65 or older, in three populations. Subjects with prior myocardial infarction, stroke, or cancer, as well as those lacking alcohol consumption data, were excluded from statistical analyses leaving 2,694 subjects in East Boston, Massachusetts, 2,293 subjects in Iowa, and 1,904 subjects in New Haven, Connecticut.Main outcome measurementsAlcohol consumption, total mortality, cardiovascular mortality, and cancer mortality.ResultsLow to moderate alcohol consumption was associated with statistically significant lowered total as well as cardiovascular mortality in East Boston and New Haven. The relative risks of total mortality for low to moderate consumers of alcohol compared to those consuming no alcohol in the previous year were 0.7 (95% CI 0.6-0.8) in East Boston and 0.6 (95% CI 0.5-0.8) in New Haven. For cardiovascular mortality, the RRs were 0.6 in East Boston and 0.5 in New Haven (95% CI's exclude null). These results persisted after control for potential confounding variables. In Iowa, there were no significant differences in total or cardiovascular mortality according to alcohol consumption patterns. For cancer mortality, there were no significant associations with alcohol consumption in any of the three populations.ConclusionsThese data suggest that the relationship of low to moderate alcohol consumption with reduced total and cardiovascular mortality, which are well documented in middle age, also occur in older populations.

The paper aims to analyze the Technical Efficiency of 70 Commercial banks from 19 African countries from 2009-2020. Using the Data Envelopment Analysis (DEA) method of the two main approaches, Variable Return to Scale (VRS) and Constant Return to Scale (CRS) technique on a Panel Data. We find that African banks have a higher efficacy assessment with the VRS than the CRS technique, thus, with a Pure Technical Efficiency (PTE) score than Technical Efficiency (TE) . Our findings show that the majority of the banks are operating at very low levels of efficiency (not technically efficient), and inability to optimize the conversion of bank assets and liabilities into loan production for customers. Furthermore, the banks are operating inefficiently in scale, economic, and allocative manner due to mismatches in scale of production. Considering these findings, the implications of these inefficiencies extend to the overall economic development and financial stability of the region.

Abstract Allometric models which are used to describe the structure of trees in agroforestry systems are usually extrapolated from models developed for trees in forest ecosystems. This makes quantitative assessment of the functions of shade trees in agroforestry systems challenging since increased availability of light and space in these systems may induce structural differences from those growing under forest conditions. We addressed this issue by providing species-specific allometric information on the structural characteristics of associated shade trees on cocoa agroforestry systems and assessed if allometries conformed to theoretical predictions. At the plot level, stand and soil characteristics affecting tree structural characteristics were assessed. The study was conducted in cocoa agroforestry systems at Suhum, Ghana. The height-diameter at breast height (H-DBH) allometry had the best fits (R2 = 53–89%), followed by the crown area (CA)-DBH allometry (R2 = 27–87%) and then the CA-H allometry (R2 = 22–73%). In general, the scaling exponents of the CA-DBH, H-CA and H-DBH allometries conformed to the metabolic scaling theory (MST). However, both the CA-DBH and H-DBH allometries diverged from the geometric similarity model. Though forest tree species had similar crown areas as fruit trees, they were slenderer than fruit trees. Tree slenderness coefficients were positively correlated with soil P, Ca, Cu and the ratios (Ca + Mg):K, (Ca + Mg):(K + Na) and Ca:Mg, but not C:N while DBH and H were correlated with soil P and C:N ratio. Our results show that critical soil nutrients and their ratios affects shade tree structural attributes (e.g. slenderness and CA), which possibly restrict variations in species-specific allometries to a narrow range on cocoa systems. Furthermore, shade tree species richness and density are better predictors of relative canopy projection area (a proxy for shade intensity) than tree species diversity. In conclusion, the results have implications for shade tree species selection, monitoring of woody biomass and maintenance of biodiversity.

Abstract Background Food security is a major development concern worldwide. The use of arable lands to grow cash crops raises additional concerns, yet empirical evidence on the relationship between cash cropping and food security remains inconclusive. Using survey data from 408 randomly sampled households, this paper assesses the income and food security implications of reviving cocoa farming in the Forest-Savannah Transition Zone of Ghana. In addition, the paper examines the influence of socioeconomic factors and diversification into cashew on the food security of cocoa households. Data was collected from 12 rural communities, where food crop production was the main source of livelihood. A causal-comparative design was used. Food security was measured using the USDA Food Security Core Module. Results Contrary to the literature that cash crops undermine food security, findings indicate a positive relationship between cocoa farming, household crop income and food security, highlighting complementarities between cocoa, food crop and cashew production. Although income from cocoa alone was not sufficient enough to guarantee food security, it enhanced the financial ability of farmers to diversify into cashew and expand food crop production. This minimised market dependency for food staples, enhanced annual crop income, and ensured a continuous flow of income. Overall, the food security advantage of cocoa farming was predicted by diversification into cashew, displacement of food crops using cocoa, socioeconomic factors, such as land ownership, livestock ownership, and formal education; and marginally by total annual crop income. Conclusions Income from cocoa alone is not high enough and widely distributed to guarantee food security. Reinvesting the returns from cocoa in cashew and food crops seems to be a more reliable pathway to enhancing food security than merely depending on the income to buy food. A semi-subsistence system that ensures optimum combination of cash and food crops is, therefore, recommended, but this may require sufficient access to land.

IntroductionThe Coronavirus disease 2019 (COVID-19) burden, coupled with unprecedented control measures including physical distancing, travel bans, and lockdowns of cities, implemented to stop the spread of the virus, have undoubtedly far-reaching aftereffects on other diseases. In low and middle-income countries (LMICs), a particular worry is the potential impact on Human Immunodeficiency Virus (HIV) and Tuberculosis (TB), as a consequence of possible disruption to health services and limiting access to needed life-saving health care. In Ghana, there is a paucity of information regarding the impact of COVID-19 on disease control, particularly TB and HIV control. This study sought to contribute to bridging this knowledge gap.MethodThe study involved the analysis of secondary data obtained from the District Health Information Management System-2 (DHIMS-2) database of Ghana Health Service, from 2016 to 2020. Data were analysed using an interrupted time-series regression approach to estimate the impact of COVID-19 on TB case notification, HIV testing, and Antiretroviral Therapy (ART) initiations, using March 2020 as the event period.ResultsThe study showed that during the COVID-19 pandemic period, there was an abrupt decline of 20.5% (955CI: 16.0%, 24.5%) in TB case notifications in April and 32.7% (95%CI: 28.8%, 39.1%) in May 2020, with a median monthly decline of 21.4% from April-December 2020. A cumulative loss of 2,128 (20%; 95%CI: 13.3%, 26.7%) TB cases was observed nationwide as of December 2020. There was also a 40.3% decrease in people presenting for HIV tests in the first month of COVID-19 (April 2020) and a cumulative loss of 262620 (26.5%) HIV tests as of December 2020 attributable to the COVID-19 pandemic. ART initiations increased by 39.2% in the first month and thereafter decreased by an average of 10% per month from May to September 2020. Cumulatively, 443 (1.9%) more of the people living with HIV initiated ART during the pandemic period, however, this was not statistically significant.ConclusionThis study demonstrated that the COVID-19 pandemic negatively impacted TB case notifications and HIV testing and counselling services, However, ART initiation was generally not impacted during the first year of the pandemic. Proactive approaches aimed at actively finding the thousands of individuals with TB who were missed in 2020 and increasing HIV testing and counselling and subsequent treatment initiations should be prioritised.

The aim of this scoping review was to provide evidence for health practitioners to improve patient education practice for chronic pain management.

Historically, infectious diseases have generated fears among populations. Unhealthy handling of these fears result in the stigma and discrimination of infected patients. Globally, measures taken so far by governments to curb the spread of the novel coronavirus disease-2019 (COVID-19) pandemic, although helpful, have created fears in people. Consequently, there are reported Ghanaian media cases of stigmatisation against persons who were infected and recovered from COVID-19. However, these reports remain unsubstantiated. This study, therefore, sought to examine stigma and discriminatory tendencies towards COVID-19 survivors among the adult population in Ghana. This was a population-based cross-sectional study among 3,259 adults. A multi-stage sampling technique was used to recruit study participants. Descriptive and inferential statistics comprising frequency, percentage, chi-square, and multivariable logistic regression were employed in analysing the data. Knowledge on COVID-19 was poor among 33.6% of the participants. Forty-three per cent had a good attitude towards COVID-19. Nearly half (45.9%) exhibited stigma and discriminatory tendencies towards COVID-19 survivors. Participants who had poor COVID-19 related knowledge (aOR = 1.91, 95%CI = 1.59-2.29, p

En busca de responder a la pregunta, ¿Cómo el Museo de Memoria de Colombia contribuye a la reparación de las víctimas? Se analiza la relación entre memoria e historia, así como los usos de la memoria y su relación con las víctimas en Colombia a través del Centro Nacional de Memoria Histórica, también, la importancia y cómo se piensa el Museo de Memoria de Colombia.

Litterfall is a critical link between vegetation and soils by which nutrients are returned to the soils, thus the amount and pattern of litterfall regulates nutrient cycling, soil fertility and primary productivity for most terrestrial ecosystems. We quantified, analyzed and compared macro- and micro-nutrients return through litterfall in organic and conventional cocoa agroforestry systems in Suhum, Ghana. We further assessed the contribution of shade tree species to litterfall and nutrient dynamics. The annual pattern of litterfall was affected by seasonality, with a major peak in the dry season and minor peaks during the rainy season. In terms of annual fractional litterfall, mean leaf litter from shade tree species was significantly higher (50 %) in organic systems (5.0 ± 0.5 Mg ha−1 yr−1) compared to conventional systems (3.3 ± 0.6 Mg ha−1 yr−1). Whereas cocoa leaves (45.0 %) were the predominant fraction of annual litterfall from conventional farms, both shade leaves (40.0 %) and cocoa leaves (39.4 %) dominated litterfall from organic farms. The return of primary macro-nutrients (P and K), secondary macro-nutrients (Ca, Mg and S) and micro-nutrients (Mn, B, Cu, Zn and Mo) via litterfall varied significantly with season, and annual return of nutrients were similar in organic and conventional cocoa systems. Shade tree leaf litter accounted for 30–47 % of annual macro- and micro-nutrient return (except Ni and Zn) in organic cocoa systems versus 20–35 % in conventional cocoa systems. The results emphasize the complementary role of the different shade tree species which compose organic and conventional cocoa systems in nutrient recycling. We conclude that organic management of cocoa agroforestry systems ensure nutrients return similar to those receiving synthetic fertilizer inputs, highlighting its potential to support cocoa production.

Ghanaian tomato farmers are severely impacted by changing climate and related more frequent and extreme weather events such as drought and heavy rainfall. Furthermore, tomato production represents one of the main sources of income for these farmers, which leaves them highly exposed to market price variations. However, the full impact of changing climate and price variations for these farmers has not been assessed. Here, we examined how Ghanaian tomato farmers experience and respond to a double exposure from climate and market related shocks. The objectives were threefold: (i) to investigate how farmers in two different agroecological zones (savannah and semi-equatorial) experience climate and market shocks, (ii) to examine the major response strategies implemented in face of this double exposure, and (iii) to identify paths toward systemic changes to enhance resilience. A survey was conducted with 344 tomato smallholder farmers in the two agroecological zones. The results from the survey were complemented by semi-structured interviews and focus groups. We found that farmers are severely exposed to climate and market shocks, which causes a reduction in both production activities and revenues. A set of agricultural and water management practices, such as crop rotation, supplementary fertilization, and water tanks, have been adopted by farmers as response mechanisms to climate variations. However, no response mechanisms, other than agricultural diversification, are in place yet to face the economic shocks. Thus, enhancing systemic resilience becomes particularly important to face this double exposure and restructure and change feedback mechanisms within the current system. The reestablishment of tomato processing plants or formalizing the stakeholders’ network could both be ways to integrate value-chain stakeholders and support appropriate structures. Encompassing both climate and trading attributes through specific agro-food policies are much-needed for a sustainable and resilient transformation of the tomato production system.

Shade grown cocoa systems have been credited with stocking high quantities of carbon and therefore possess the potential to mitigate climate change and help achieve targets of the United Nations Collaborative Program on Reduced Emissions from Deforestation and Forest Degradation (REDD+). This study quantifies and compares carbon stored as well as estimated cocoa yields in two shade management types (i.e., shaded and full sun) across three agroecological zones: Dry Semi-Deciduous Fire Zone (DSFZ), Moist Evergreen Zone (MEZ) and Upland Evergreen Moist Zone (UEMZ) in Ghana. Results show that Soil organic carbon (SOC) stored decreased with increasing soil depth across all agroecological zones. Cocoa farms with shade trees stored 6 times more soil carbon (35.90±1.56 Mg C ha-1) compared to the full sun systems (5.98±1.56 Mg C ha-1). Carbon stocks in the DSFZ and the MEZ were 61.73±1.02 Mg C/ha and 67.46±1.02 Mg C ha-1 respectively whiles the UEMZ recorded 85.10 Mg C ha-1. Across agroecological zones, pod count in the UEMZ and the MEZ were similar but varied from that of the DSFZ, which recorded the least. Wilting of pods and cherrelles, was minimal and similar in the UMEZ and the MEZ but was significantly higher in the DSFZ. It is recommended that farmers should be encouraged through strong policies to adopt the integration of shade trees in the production of cocoa in Ghana to mitigate the effects of climate change.

on life, it is important that steps are taken to mitigate its effects. With the intensification of cocoa production, there has been a shift in traditional cocoa farming over the years leading to the removal of shade trees, hence, removal of carbon sinks. This study was carried out to compare the amount of carbon stored in cocoa ecosystems to that of a 20 years teak plantation and to calculate the trade-off of carbon between the two systems. Cocoa farms of similar ages (20 years) were selected in which three-subplots were demarcated on each farm at Piase in the Bosomtwe District. Tree Diameter at Breast Height (DBH) was measured and soils samples were collected and analyzed for organic carbon percentage and bulk density. One-way Analysis of Variance was used to analyze above and belowground tree carbon and two-way analysis of variance was used to analyze soil organic carbon stored. Teak plantation recorded higher carbon stock (739.33±2.24 Mg C.ha-1) compared to full sun cocoa (9.36±2.24 Mg C.ha-1). Soil organic carbon across the three farms showed significant (p = 0.0010) variations with depths. The 0-20 cm soil depth stored significantly more (p = 0.0000) organic carbon compared to 20-40 cm soil depth. Total soil carbon stored revealed significant differences amongst the various farms with the full sun (40.857±0.52 Mg C.ha-1) being the least whilst the teak plantation stored the highest (72.42±0.52 Mg C.ha-1). Total carbon (above-ground tree carbon + below-ground tree carbon + soil organic carbon) showed significant difference (p= 0.0000) between land use types with shaded cocoa farm (74.3±0.89 Mg C.ha-1), full sun cocoa farm (32.02±0.89Mg C.ha-1) and that of the teak plantation (950.91±0.89 Mg C.ha-1) respectively. Traditional cocoa ecosystem (shaded cocoa farms) has the potential to store carbon significantly higher than that of the full sun systems.

Abstract Background The last two decades have seen a significant decrease in mortality for children

Morris MC, Evans DA, Bienias JL, et al. Arch Neurol 2002;59:1125-1132. BACKGROUND: Previous studies raise the possibility that antioxidants protect against neurodegenerative diseases. OBJECTIVE: To examine whether intake of antioxidant [...]

Background: Global fight against tuberculosis (TB) has received increasing attention over the years. However, the disease remains one of the top-most global health problems, especially in Sub-Saharan Africa and Ghana. Aims: This paper examined geographical (regional) and seasonal distribution of TB cases providing relative risk of TB exposure in Ghana and step by step procedure to perform the analysis. Methods and material: We modelled reported TB cases between 2015 and 2018 using wavelet analysis and applied maximum covariance analysis (MCA) to determine regional and seasonal patterns and the risk of TB exposure in Ghana. This study is based on the old administrative regions of Ghana. Results: More TB cases were recorded in the Greater Accra and Ashanti regions and less cases in the rest of the regions. There is significant increase in the number of TB cases from 2015 to 2018. High number of TB cases is observed in the dry season relative to the rainy season. There is high variability in TB prevalence with high prevalence moving towards the Southern part of Ghana. Conclusion: The study highlights that TB cases is clustered in space and time and that even at small spatial scale, differences in prevalence can be substantial. The prevelance of TB exposure is higher in the dry season relative to the rainy season. Hence, enough resources should be timely provided during the dry season as well as intensifying preventive strategies to control the spread of the disease. Keywords: Space-time modelling, Tuberculosis, Tuberculosis prevalence, Wavelet analysis, Wavelet cluster analysis

Agroecosystem strategies to enhance agrobiodiversity can curb many of the negative impacts associated with current food production systems. With rising interest in agrobiodiversity and agroforestry as farming interventions that confer ecological and socioeconomic benefits, understanding the intended pathways of interventions is important for successful agroecological transformations. Yet, the patterns of agrobiodiversity introduction and adoption remain elusive. Drawing upon social network research from the regions of Ghana where cocoa (Theobroma cacao) is grown, we synthesize the relationships between agroforestry interventions, information networks, and the adoption of diversified agroecosystems. We illustrate middle-level patterns from independent studies in three regions of Ghana and nearly 500 farmer interviews. Strong structural indicators at the network level are linked to agrobiodiversity; farmers in larger, less dense information networks with ties to external organizations tend to have higher reported and measured agrobiodiversity. Remarkably, these trends were found in environmentally and socio-culturally different contexts in Ghana. However, these trends do not, in all cases, scale to the community level. For example, we did not observe any clear relationship between the density of community networks and the measures of agrobiodiversity at the community scale. This may be on account of the type of agrobiodiversity measure applied (above-ground biomass) to assess community-level outcomes. Selection of environmental attributes with meaningful spillover effects, such as pest management, would more likely uncover nontrivial network effects at the collective level. Our findings support that both innovation and cooperation are indispensable for successful agrobiodiversity interventions, and that networks can operate to overcome negative outcomes of agrobiodiversity. Based on these studies, we conclude that agrobiodiversity adoption via interventions and established farmer-to-farmer networks may trigger the formation of other, observation-based networks that draw in socially distant actors. Our research strategy of ex-post qualitative comparisons allowed for in-depth insight into the complexities of information networks and agrobiodiversity adoption but also generated new hypotheses on the role of social networks in diversified farming systems.