Life cycle assessment of microgreen production: effects of indoor vertical farm management on yield and environmental performance.

The global production of plant-based foods is a significant contributor to greenhouse gas emissions. Indoor vertical farms (IVFs) have emerged as a promising approach to urban agriculture. However, their environmental performance is not well understood, particularly in relation to operational choices where global warming potentials (GWP) can vary between 0.01-54 kg CO2e/kg-1 of leafy greens produced. We conducted a life cycle assessment (LCA) of a building-integrated IVF for microgreen production to analyse a range of operational conditions for cultivation: air temperature, CO2 concentration, and photoperiod. We analyzed a dynamic LCA inventory that combined a process-based plant growth model and a mass balance model for air and heat exchange between the chamber and the outside. Results showed that the GWP of IVFs can vary greatly depending on the operation conditions set, ranging from 3.3 to 63.3 kg CO2e/kg-1. The optimal conditions for minimizing GWP were identified as 20 ℃, maximum CO2 concentration in the chamber, and maximum photoperiod, which led to a minimum GWP of 3.3 kg CO2e/kg-1 and maximum production of 290.5 kg fresh weight week-1. Intensification of production thus led to lower impacts because the marginal increase in yield due to increased resource use was larger than the marginal increase in impact. Therefore, adjusting growing conditions is essential for the sustainability of urban food production.

Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial.

BACKGROUND: Approximately 81% of deaths in Argentina are from chronic non-communicable diseases and 21% caused by cancer. Colorectal cancer (CRC) is the second most frequent cancer in Argentina. Even though CRC screening has been recommended for adults from 50 to 75 years old by using a faecal immunochemical test (FIT) annually, screening rates remain below 20% in the country. METHODS: We conducted an 18-month, two-arm, pragmatic cluster-randomised controlled trial evaluating the effect of a quality improvement intervention, based on the Plan-Do-Study-Act cycles, considering barriers and catalysts to articulate theory and practice, to increase CRC screening rates using FITs at primary care level. The study involved ten public primary health centres in Mendoza province, Argentina. The primary outcome measure was the rate of effective CRC screening. Secondary outcomes were the rate of participants with a positive FIT, tests with invalid results and the rate of participants referred for colonoscopy. RESULTS: Screening was effective in 75% of the participants in the intervention arm vs 54.2% in the control arm, OR 2.5 (95% CI 1.4 to 4.4, p=0.001). These results remained unchanged after adjusting for individual demographic and socioeconomic characteristics. Regarding secondary outcomes, the overall prevalence of positive tests was 17.7% (21.1% in the control arm and 14.7% in the intervention arm, p=0.3648). The overall proportion of participants with inadequate test results was 5.2% (4.9% in the control arm vs 5.5% in the intervention arm, p=0.8516). All the participants with positive tests were referred for colonoscopy in both groups. CONCLUSIONS: An intervention based on quality improvement strategies proved to be highly successful in increasing effective CRC screening in Argentina's primary care setting within the public healthcare system. TRIAL REGISTRATION NUMBER: NCT04293315.

The Use of 2 e-Learning Modalities for Diabetes Education Using Facebook in 2 Cities of Argentina During the COVID-19 Pandemic: Qualitative Study.

BACKGROUND: The COVID-19 pandemic and the confinement that was implemented in Argentina generated a need to implement innovative tools for the strengthening of diabetes care. Diabetes self-management education (DSME) is a core element of diabetes care; however, because of COVID-19 restrictions, in-person diabetes educational activities were suspended. Social networks have played an instrumental role in this context to provide DSME in 2 cities of Argentina and help persons with diabetes in their daily self-management. OBJECTIVE: The aim of this study is to evaluate 2 diabetes education modalities (synchronous and asynchronous) using the social media platform Facebook through the content of posts on diabetes educational sessions in 2 cities of Argentina during the COVID-19 pandemic. METHODS: In this qualitative study, we explored 2 modalities of e-learning (synchronous and asynchronous) for diabetes education that used the Facebook pages of public health institutions in Chaco and La Rioja, Argentina, in the context of confinement. Social media metrics and the content of the messages posted by users were analyzed. RESULTS: A total of 332 messages were analyzed. We found that in the asynchronous modality, there was a higher number of visualizations, while in the synchronous modality, there were more posts and interactions between educators and users. We also observed that the number of views increased when primary care clinics were incorporated as disseminators, sharing educational videos from the sessions via social media. Positive aspects were observed in the posts, consisting of messages of thanks and, to a lesser extent, reaffirmations, reflections or personal experiences, and consultations related to the subject treated. Another relevant finding was that the educator/moderator role had a greater presence in the synchronous modality, where posts were based on motivation for participation, help to resolve connectivity problems, and answers to specific user queries. CONCLUSIONS: Our findings show positive contributions of an educational intervention for diabetes care using the social media platform Facebook in the context of the COVID-19 pandemic. Although each modality (synchronous vs asynchronous) could have differential and particular advantages, we believe that these strategies have potential to be replicated and adapted to other contexts. However, more documented experiences are needed to explore their sustainability and long-term impact from the users' perspective.

Adaptación y confiabilidad inter-observador de un protocolo para evaluar la disponibilidad de alimentos en supermercados en Buenos Aires, Argentina.

Introducción: La Red Internacional para la Investigación, Monitoreo y Apoyo a la Acción para la Alimentación, Obesidad y Enfermedades No Transmisibles (INFORMAS por su sigla en inglés) ha desarrollado el Protocolo para evaluar la Disponibilidad de Alimentos en Supermercados. Objetivos: Describir el proceso de adaptación del protocolo para utilizarlo en la Ciudad de Buenos Aires (BA) y evaluar la variabilidad inter-observador al aplicarlo en supermercados de la ciudad. Metodología: El principal indicador del protocolo es la disponibilidad relativa de alimentos saludables (AS) vs. no saludables (ANS), calculado como el cociente entre la longitud (m) de estantes asignados a AS y ANS (longitudAS/ANS). Se adaptó la selección de alimentos a incluir en el indicador para utilizarlo en BA. Para explorar el funcionamiento del indicador se construyó una referencia, midiendo todos los alimentos y bebidas ofrecidos en 5 supermercados, que se clasificaron en AS y ANS según las guías alimentarias argentinas. El indicador se comparó con la disponibilidad relativa calculada a partir de la referencia. Para evaluar la confiabilidad inter-observador dos observadores realizaron mediciones en tres supermercados y se calculó el coeficiente de correlación intra-clase (CCI). Resultados: Según la referencia, el cociente longitudAS/ANS varió entre 0,16 y 0,61, con una media de 0,34 (DE 0,18). El indicador adaptado produjo resultados similares con una diferencia media de -0,05 (DE 0,04). El CCI entre la mediciones de ambos observadores resultó 0,92 (IC95% 0,86-0,98). Conclusión: Se adaptó el protocolo para aplicarlo en BA, con modificaciones en los alimentos a evaluar y una adecuada confiabilidad inter-observador.

An innovative approach to improve the detection and treatment of risk factors in poor urban settings: a feasibility study in Argentina.

BACKGROUND: The effective management of cardiovascular (CVD) prevention among the population with exclusive public health coverage in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). METHODS: We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were having exclusive public health coverage, age ≥ 40 years, residence in the PCC's catchment area and 10-year CVD risk ≥10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC's staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs). RESULTS: A total of 185 participants were included in the study. Of the total number of eligible participants, 82.2% attended at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21 to 32.6% in hypertensive participants, 7.4 to 33.3% in high CVD risk and 1.4 to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP < 140/90 mmHg) increased from 20.3 to 35.5%. CONCLUSION: The proposed CHWs-led intervention was feasible and well accepted to improve the detection and treatment of risk factors in the poor population with exclusive public health coverage and with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs did not only stimulate teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.

Urban Retail Food Environments: Relative Availability and Prominence of Exhibition of Healthy vs. Unhealthy Foods at Supermarkets in Buenos Aires, Argentina.

There is growing evidence that the food environment can influence diets. The present study aimed to assess the relative availability and prominence of healthy foods (HF) versus unhealthy products (UP) in supermarkets in Buenos Aires, Argentina and to explore differences by retail characteristics and neighborhood income level. We conducted store audits in 32 randomly selected food retails. Food availability (presence/absence, ratio of cumulative linear shelf length for HF vs. UP) and prominence inside the store (location visibility) were measured based on the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) protocol. On average, for every 1 m of shelf length for UP, there was about 25 cm of shelf length for HF (HF/UP ratio: 0.255, SD 0.130). UP were more frequently available in high-prominence store areas (31/32 retails) than HF (9/32 retails). Shelf length ratio differed across commercial chains (p = 0.0268), but not by store size or type. Retails in the lower-income neighborhoods had a lower HF/UP ratio than those in the higher-income neighborhoods (p = 0.0329). Availability of the selected HF was overcome largely by the UP, particularly in high prominence areas, and in neighborhoods with lower income level, which may pose an opportunity for public health interventions.

Health care access and health-related quality of life among people with diabetes in the Southern Cone of Latin America-a cross-sectional analysis of data of the CESCAS I study.

PURPOSE: Little is known on the association of health care access and health-related quality of life (HRQoL) in people with diabetes in the Southern Cone of Latin America (SCLA). METHODS: We analyzed data of 1025 participants of CESCAS I. To determine HRQoL, we used the SF-12 physical (PCS-12) and mental component summary (MCS-12). We compared four groups regarding HRQoL: (a) insured people without self-reported barriers to health care, (b) uninsured people without self-reported barriers to health care, (c) insured people with self-reported barriers to health care, and (d) uninsured people with self-reported barriers to health care. We conducted linear regressions with PCS-12 and MCS-12 as outcome. We adjusted for sociodemographic and disease-related factors and having access to a primary physician. RESULTS: In the first group, there were 407, in the second 471, in the third 44, and in the fourth group 103 participants. Compared to the first group, PCS-12 was 1.9 points lower (95% Confidence Interval, CI: - 3.5, - 0.3) in the second, 4.5 points (95% CI: - 8.1, - 1) lower in the third, and 6.1 points lower (95% CI: - 8.7, - 3.6) in the fourth group. Compared to the first group, MCS-12 was 0.6 points lower (95% CI: - 2.7, 1.4) in the second, 4.8 points lower (95% CI: - 9.3, - 0.3) in the third, and 5.8 points lower (95% CI: - 9.1, - 2.5) in the fourth group. CONCLUSION: In the SCLA, impeded access to care is common in people with diabetes. Self-reported barriers to care may be more important than insurance status in determining HRQoL.

Efectividad y factibilidad de una estrategia de salud móvil sobre la adherencia a un tratamiento crónico en contexto de la pandemia COVID-19 / Effectiveness and feasibility of a mobile health strategy on adherence to chronic treatment in the context of the COVID-19 pandemic

INTRODUCCIÓN La adherencia al tratamiento es uno de los principales factores asociados al mal control de las enfermedades crónicas no transmisibles. La pandemia COVID-19 dificultó aún más el seguimiento y control de las personas con enfermedades crónicas. El objetivo del presente estudio es evaluar el efecto y factibilidad de una intervención a través del envío de video educativos breves sobre la adherencia terapéutica y la presión arterial en personas hipertensas bajo tratamiento médico en contexto de la pandemia COVID-19 luego de 8 meses de seguimiento. MÉTODO Se invitó a participar del estudio a 123 pacientes hipertensos. Los participantes recibieron 6 videos breves con mensajes de consejería basados en la guía de práctica clínica de HTA del Ministerio de Salud de la Nación. Se analizó la tasa de posesión de la medicación previo a la intervención y por un periodo de 4 meses posterior a la misma. RESULTADOS 96.4% de los participantes completaron el seguimiento. 43.6% era de sexo masculino, promedio de edad de 57.7 años (DE 8.1), 85.1% declaró tener cobertura en salud pública exclusiva y 69.1% poseía nivel educativo con primaria completa o menor. No se observó diferencia en la proporción de pacientes con tasa de posesión de la medicación adecuada (TPM ≥ 80%) pre- intervención (47.3%) y post-intervención (42.7%), p = 0.6143. Las variaciones promedio de tensión arterial (TA) ente el inicio y el final del seguimiento fueron de -2.7(IC 95%: -5.92; 0.38) para lTA sistólica, p=0.07886 y de -2.61 (IC 95%: -4.88; -0.34) para la TA diastólica, p=0.0249. Proporción de personas con TA controlada 50% pre-intervención y 61.3% post-intervención, p< 0.001. DISCUSIÓN No se observó un incremento significativo en la proporción de participantes con adherencia suficiente luego de la implementación de la intervención. Sin embargo, la intervención se asoció significativamente con una reducción promedio de la TA diastólica y con una mayor proporción de pacientes con TA controlada.

Brechas en la respuesta de los adultos mayores para lograr un envejecimiento saludable / Gaps in the response of older adults to achieve healthy aging

INTRODUCCIÓN Consideramos al envejecimiento saludable como el proceso de fomentar y mantener la capacidad funcional que permite el bienestar en la vejez. En Argentina, existen programas dirigidos a las personas mayores que persiguen este objetivo. Sin embargo, para definir políticas, es preciso esforzarse por comprender mejor las necesidades de la población. La finalidad de este proyecto es identificar brechas entre las necesidades de los adultos mayores, para alcanzar un envejecimiento saludable, y las acciones promovidas por los programas para favorecer este propósito. MÉTODOS Enfoque mixto, cuali-cuantitativo desarrollado en cuatro etapas, 1. Revisión documental de programas vigentes. 2. Visualización de necesidades de personas mayores de 60 años. 3. Identificación de brechas entre las necesidades planteadas y lo propuesto por los programas. 4. Priorización del abordaje de las brechas Identificadas. RESULTADOS Relevamos 28 programas que abordan el envejecimiento saludable, los componentes ofrecidos en mayor medida fueron, entretenimiento, relación con los pares, inclusión social y promoción y prevención de la salud. Al evaluar las principales necesidades para el envejecimiento saludable los participantes respondieron que las tres más importantes fueron; mantener la salud física, mente activa y continuar realizando actividades. En el análisis de brechas observamos que necesidades como continuar realizando actividades, relación con la familia y mantener actitudes positivas fueron más jerarquizadas por las personas mayores 60 de años que por los programas relevados. Y para abordar estas brechas se propuso; realizar un análisis comunicacional, erradicación del concepto de "viejismo" y considerar las distintas vejeces a la hora de elaborar propuestas dirigidas a esta población. DISCUSIÓN Es imprescindible a la hora de elaborar políticas públicas conocer las características de la población a la que están dirigidas, conocer sus necesidades y tener en cuenta su punto de vista.