Designing a package of sexual and reproductive health and HIV outreach services to meet the heterogeneous preferences of young people in Malawi: results from a discrete choice experiment.

BACKGROUND: This article examines young people's preferences for integrated family planning (FP) and HIV services in rural Malawi. Different hypothetical configurations for outreach services are presented using a Discrete Choice Experiment (DCE). Responses are analysed using Random Parameters Logit and Generalised Mixed Logit (GMXL) models in preference space and a GMXL model parameterised in willingness-to-pay space. Simulations are used to estimate the proportion of respondents expected to choose different service packages as elements are varied individually and in combination. RESULTS: Responses were collected from 537 young people aged 15-24. Results show that when considering attending an outreach service to access family planning young people value confidentiality and the availability of HIV services including HIV counselling and testing (HCT) and HIV treatment, though significant observable and unobservable heterogeneity is present. Female respondents and those aged 20-24 were less concerned with service confidentiality compared to male respondents and those aged 15-19; respondents who were in a relationship at the time of the survey valued confidentiality more than those who reported being single. The addition of sports and recreation for young people may also be an attractive feature of a youth-friendly service; however, preferences for this attribute vary according to respondent gender. Results of the simulation modelling indicate that the most preferred service package is one that offers confidential services, both HCT and HIV treatment and sports for youth, with up to 32% of respondents expected to choose this service over a service where clients may have concerns over confidentiality, only HCT is available and there are no additional activities for young people. Estimates of willingness-to-pay for service attributes indicate that respondents were willing to pay up to USD$1.76 for confidentiality, USD$0.65 for a service offering both HCT and HIV treatment and USD$0.26 for a service including sports for youth. CONCLUSIONS: Young people were able to complete a complex DCE and appeared to trade between the different characteristics used to describe the outreach services. These findings may offer important insight to policy makers designing youth friendly SRH outreach services and providers aiming to improve the acceptability and uptake of FP services

Consideration Sets and Their Role in Modelling Doctor Recommendations About Contraceptives

Copyright © 2015 John Wiley & Sons, Ltd. Decisions about prescribed contraception are typically the result of a consultation between a woman and her doctor. In order to better understand contraceptive choice within this environment, stated preference methods are utilized to ask doctors about what contraceptive options they would discuss with different types of women. The role of doctors is to confine their discussion to a subset of products that best match their patient. This subset of options forms the consideration set from which the ultimate recommendation is made. Given the existence of consideration sets we address the issue of how to model appropriately the ultimate recommendations. The estimated models enable us to characterize doctor recommendations and how they vary with patient attributes and to highlight where recommendations are clear and when they are uncertain. The results also indicate systematic variation in recommendations across different types of doctors, and in particular we observe that some doctors are reluctant to embrace new products and instead recommend those that are more familiar. Such effects are one possible explanation for the relatively low uptake of more cost effective longer acting reversible contraceptives and indicate that further education and training of doctors may be warranted. Copyright © 2015 John Wiley & Sons, Ltd

The Warden Attitude: An investigation of the value of interaction with everyday wildlife

Using a discrete choice experiment, we elicit valuations of engagement with ‘everyday wildlife’ through feeding garden birds. We find that bird-feeding is primarily but not exclusively motivated by the direct consumption value of interaction with wildlife. The implicit valuations given to different species suggest that people prefer birds that have aesthetic appeal and that evoke human feelings of protectiveness. These findings suggest that people derive wellbeing by adopting a warden-like role towards ‘their’ wildlife. We test for external validity by conducting a hedonic analysis of sales of bird food. We discuss some policy implications of the existence of warden attitudes

Socioeconomic determinants of organic cotton adoption in Benin, West Africa

Organic cotton relies on ecological processes and the use of natural resources to sustain the production system, unlike conventional cotton, mainly characterized by massive utilization of synthesis chemicals. In West Africa, where rural livelihoods are particularly vulnerable, organic cotton is expected to contribute not only to poverty reduction but also to strengthen households’ resilience. The objective of this study was to assess institutional and socioeconomic factors determining farmers’ decisions to adopt organic cotton. For this purpose, we applied a probit model on empirical data collected from producers of the Centre and the Northern parts of Benin. Overall, we found that organic cotton adoption is mainly determined by farmers’ socioeconomic characteristics, the physical distance between farm and house, and contact with extension and advisory services. Organic farming is more attractive to women compared to conventional farming. This because such type of cotton farming enables women to hold a separate cotton farm and thus increase their economic independence, whereas with the conventional system they depend mainly on the farm of the (male) head of the household. Older, less educated and low-income farmers who express environmental concern are more likely to adopt organic cotton. Subsequently, organic cotton should be considered as a prospective policy option to reach the poor and strengthen their livelihoods conditions while contributing to preserve the environment and natural resources. Furthermore, farmers who have their farm near home are more likely to adopt organic farming than those who have the farm far from their home. It also came out that organic farmers have more contacts with advisory and extension services. Finally, the study noted that there is still a need to enhance the extension system by: (1) exploring, designing, and upgrading innovative pedagogic tools such as videos and mobile phone technology to foster learning; and (2) strengthening organic farmer’s organizations and the linkage with agricultural research organizations for technology development

Dinâmica populacional de Bemisia tabaci biótipo B em tomate monocultivo e consorciado com coentro sob cultivo orgânico e convencional.

A mosca-branca Bemisia tabaci Biótipo B (Hemiptera: Aleyrodidae), é um herbívoro de difícil controle devido à alta plasticidade genotípica da espécie. No tomateiro pode causar danos severos principalmente pela transmissão de diversas viroses. O manejo do sistema de produção e o consórcio de culturas podem ter um efeito direto nas populações desse herbívoro, sem que seja necessária a aplicação de inseticidas. Avaliou-se a influência dos sistemas de produção orgânico e convencional e o consórcio tomate-coentro na dinâmica populacional da mosca-branca no campo experimental da Embrapa Hortaliças, de maio a setembro/06. O monitoramento dos adultos da mosca-branca e de seus inimigos naturais foi realizado utilizando-se armadilhas adesivas amarelas fixadas nas bordas e no interior das parcelas experimentais e a amostragem de ninfas foi realizada por observação direta das folhas de tomate no campo. Embora as populações ao redor dos diferentes tratamentos fossem equivalentes, a abundância de adultos de mosca-branca foi significativamente menor nas parcelas de tomate consorciado com coentro, tanto no sistema convencional como orgânico. Apenas o consórcio tomatecoentro em sistema orgânico apresentou redução significativa na quantidade de ninfas por planta em relação aos demais tratamentos. Os inimigos naturais foram significativamente mais abundantes em sistema orgânico e foi verificada uma correlação negativa da abundância dos inimigos naturais e a quantidade de ninfas por planta. A associação tomate-coentro e o manejo orgânico do agroecossistema favoreceram ao controle biológico natural da mosca-branca

The use of discrete choice experiments to inform health workforce policy: a systematic review.

BACKGROUND: Discrete choice experiments have become a popular study design to study the labour market preferences of health workers. Discrete choice experiments in health, however, have been criticised for lagging behind best practice and there are specific methodological considerations for those focused on job choices. We performed a systematic review of the application of discrete choice experiments to inform health workforce policy. METHODS: We searched for discrete choice experiments that examined the labour market preferences of health workers, including doctors, nurses, allied health professionals, mid-level and community health workers. We searched Medline, Embase, Global Health, other databases and grey literature repositories with no limits on date or language and contacted 44 experts. Features of choice task and experimental design, conduct and analysis of included studies were assessed against best practice. An assessment of validity was undertaken for all studies, with a comparison of results from those with low risk of bias and a similar objective and context. RESULTS: Twenty-seven studies were included, with over half set in low- and middle-income countries. There were more studies published in the last four years than the previous ten years. Doctors or medical students were the most studied cadre. Studies frequently pooled results from heterogeneous subgroups or extrapolated these results to the general population. Only one third of studies included an opt-out option, despite all health workers having the option to exit the labour market. Just five studies combined results with cost data to assess the cost effectiveness of various policy options. Comparison of results from similar studies broadly showed the importance of bonus payments and postgraduate training opportunities and the unpopularity of time commitments for the uptake of rural posts. CONCLUSIONS: This is the first systematic review of discrete choice experiments in human resources for health. We identified specific issues relating to this application of which practitioners should be aware to ensure robust results. In particular, there is a need for more defined target populations and increased synthesis with cost data. Research on a wider range of health workers and the generalisability of results would be welcome to better inform policy

Therapeutic efficacy of alpha-1 antitrypsin augmentation therapy on the loss of lung tissue: an integrated analysis of 2 randomised clinical trials using computed tomography densitometry

<p>Abstract</p> <p>Background</p> <p>Two randomised, double-blind, placebo-controlled trials have investigated the efficacy of IV alpha-1 antitrypsin (AAT) augmentation therapy on emphysema progression using CT densitometry.</p> <p>Methods</p> <p>Data from these similar trials, a 2-center Danish-Dutch study (n = 54) and the 3-center EXAcerbations and CT scan as Lung Endpoints (EXACTLE) study (n = 65), were pooled to increase the statistical power. The change in 15^thpercentile of lung density (PD15) measured by CT scan was obtained from both trials. All subjects had 1 CT scan at baseline and at least 1 CT scan after treatment. Densitometric data from 119 patients (AAT [Alfalastin^®or Prolastin^®], n = 60; placebo, n = 59) were analysed by a statistical/endpoint analysis method. To adjust for lung volume, volume correction was made by including the change in log-transformed total lung volume as a covariate in the statistical model.</p> <p>Results</p> <p>Mean follow-up was approximately 2.5 years. The mean change in lung density from baseline to last CT scan was -4.082 g/L for AAT and -6.379 g/L for placebo with a treatment difference of 2.297 (95% CI, 0.669 to 3.926; p = 0.006). The corresponding annual declines were -1.73 and -2.74 g/L/yr, respectively.</p> <p>Conclusions</p> <p>The overall results of the combined analysis of 2 separate trials of comparable design, and the only 2 controlled clinical trials completed to date, has confirmed that IV AAT augmentation therapy significantly reduces the decline in lung density and may therefore reduce the future risk of mortality in patients with AAT deficiency-related emphysema.</p> <p>Trial registration</p> <p>The EXACTLE study was registered in ClinicalTrials.gov as 'Antitrypsin (AAT) to Treat Emphysema in AAT-Deficient Patients'; ClinicalTrials.gov Identifier: NCT00263887.</p

Discrete Choice Experiments: A Guide to Model Specification, Estimation and Software

We provide a user guide on the analysis of data (including best–worst and best–best data) generated from discrete-choice experiments (DCEs), comprising a theoretical review of the main choice models followed by practical advice on estimation and post-estimation. We also provide a review of standard software. In providing this guide, we endeavour to not only provide guidance on choice modelling but to do so in a way that provides a ‘way in’ for researchers to the practicalities of data analysis. We argue that choice of modelling approach depends on the research questions, study design and constraints in terms of quality/quantity of data and that decisions made in relation to analysis of choice data are often interdependent rather than sequential. Given the core theory and estimation of choice models is common across settings, we expect the theoretical and practical content of this paper to be useful to researchers not only within but also beyond health economics

Life cycle assessment of the environmental performance of conventional and organic methods of open field pepper cultivation

Summarization: As the scale of the organic cultivation sector keeps increasing, there is growing demand for reliable data on organic agriculture and its effect on the environment. Conventional agriculture uses chemical fertilizers and pesticides, whilst organic cultivation mainly relies on crop rotation and organic fertilizers. The aim of this work is to quantify and compare the environmental sustainability of typical conventional and organic pepper cultivation systems. Methods: Two open field pepper cultivations, both located in the Anthemountas basin, Northern Greece, are selected as case studies. Life cycle assessment (LCA) is used to quantify the overall environmental footprint and identify particular environmental weaknesses (i.e. unsustainable practices) of each cultivation system. Results are analysed at both midpoint and endpoint levels in order to obtain a comprehensive overview of the environmental sustainability of each system. Attributional LCA (ALCA) is employed to identify emissions associated with the life cycles of the two systems. Results are presented for problem-oriented (midpoint) and damage-oriented (endpoint) approaches, using ReCiPe impact assessment. Results and discussion: At midpoint level, conventional cultivation exhibits about threefold higher environmental impact on freshwater eutrophication, than organic cultivation. This arises from the extensive use of nitrogen and phosphorus-based fertilizers, with consequent direct emissions to the environment. The remaining impact categories are mainly affected by irrigation, with associated indirect emissions linked to electricity production. At endpoint level, the main hotspots identified for conventional cultivation are irrigation and fertilizing, due to intensive use of chemical fertilizers and (to a lesser degree) pesticides. For organic pepper cultivation, the main environmental hotspots are irrigation, machinery use, and manure loading and spreading processes. Of these, the highest score for irrigation derives from the heavy electricity consumption required for groundwater pumping associated with the fossil-fuel-dependent Greek electricity mix. Conclusions: Organic and conventional cultivation systems have similar total environmental impacts per unit of product, with organic cultivation achieving lower environmental impacts in ‘freshwater eutrophication’, ‘climate change’, ‘terrestrial acidification’ and ‘marine eutrophication’ categories. Conventional cultivation has a significantly greater effect on the freshwater eutrophication impact category, due to phosphate emissions arising from application of chemical fertilizers.Presented on: International Journal of Life Cycle Assessmen