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Minimizing the impact of climate change on farmer livelihoods is crucial, but adaptation efforts may have unintended consequences for ecosystems, with potential impacts on farmers' welfare. Unintended outcomes of climate adaptation strategies have been widely discussed, however, empirical exploration has been neglected. Grounded in scholarship on climate adaptation, environmental governance, social-ecological systems, and land-use change, this paper studies whether farmers' climate adaptation contributes to deforestation or forest conservation. The paper draws on interviews with 353 farmers from 46 communities in Calakmul Biosphere Reserve in Mexico and Maya Biosphere Reserve in Guatemala. Farmers in the area of study have implemented adaptation strategies that people around the world have used for centuries, including migration, diversification, savings, and pooling. The findings show that climate adaptation can increase deforestation or support forest conservation depending on the type of adaptation strategy farmers implement. Saving, based on cattle ranching, is a deforestation-driving strategy. The choice of this strategy is influenced by distance to the commercial and administrative center and cash benefits from the forest. Deforestation can have a negative impact on farmers' welfare, as well as harm biodiversity and contribute to increased climate change. Thus, deforestation-driving adaptation strategies may be ineffective. However, diversification, based on off-farm jobs and operating provision shops, is a conservation-driving strategy influenced by distance as well as by family size. Farmers who choose diversification to adapt may contribute to a virtuous circle in which livelihood improvement in the short term leads to enhanced social-ecological resilience in the longer term. The need for farmers to implement adaptation strategies thus represents great risk but also opportunities. [ABSTRACT FROM AUTHOR]

We have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management. Patient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained. Thirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system. The existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment. [ABSTRACT FROM AUTHOR]