IMPORTANCE Uncertainty remains about the efficacy of folic acid therapy for the primary prevention of stroke because of limited and inconsistent data. OBJECTIVE To test the primary hypothesis that therapy with enalapril and folic acid is more effective in reducing first stroke than enalapril alone among Chinese adults with hypertension. DESIGN, SETTING, AND PARTICIPANTS The China Stroke Primary Prevention Trial, a randomized, double-blind clinical trial conducted from May 19, 2008, to August 24, 2013, in 32 communities in Jiangsu and Anhui provinces in China. A total of 20 702 adults with hypertension without history of stroke or myocardial infarction (MI) participated in the study. INTERVENTIONS Eligible participants, stratified by MTHFR C677T genotypes (CC, CT, and TT), were randomly assigned to receive double-blind daily treatment with a single-pill combination containing enalapril, 10 mg, and folic acid, 0.8 mg (n = 10 348) or a tablet containing enalapril, 10 mg, alone (n = 10 354). MAIN OUTCOMES AND MEASURES The primary outcome was first stroke. Secondary outcomes included first ischemic stroke; first hemorrhagic stroke; MI; a composite of cardiovascular events consisting of cardiovascular death, MI, and stroke; and all-cause death. RESULTS During a median treatment duration of 4.5 years, compared with the enalapril alone group, the enalapril-folic acid group had a significant risk reduction in first stroke (2.7% of participants in the enalapril-folic acid group vs 3.4% in the enalapril alone group; hazard ratio [HR], 0.79; 95% CI, 0.68-0.93), first ischemic stroke (2.2% with enalapril-folic acid vs 2.8% with enalapril alone; HR, 0.76; 95% CI, 0.64-0.91), and composite cardiovascular events consisting of cardiovascular death, MI, and stroke (3.1% with enalapril-folic acid vs 3.9% with enalapril alone; HR, 0.80; 95% CI, 0.69-0.92). The risks of hemorrhagic stroke (HR, 0.93; 95% CI, 0.65-1.34), MI (HR, 1.04; 95% CI, 0.60-1.82), and all-cause deaths (HR, 0.94; 95% CI, 0.81-1.10) did not differ significantly between the 2 treatment groups. There were no significant differences between the 2 treatment groups in the frequencies of adverse events. CONCLUSIONS AND RELEVANCE Among adults with hypertension in China without a history of stroke or MI, the combined use of enalapril and folic acid, compared with enalapril alone, significantly reduced the risk of first stroke. These findings are consistent with benefits from folate use among adults with hypertension and low baseline folate levels.

No abstract

The aim of the paper is to explore how multinational corporations (MNCs) orchestrate internal and external resources to help their multi-tier supply chains learn sustainability related knowledge. Design/methodology/approach-An exploratory multiple case study approach was adopted and three MNCs' sustainable initiatives in China were examined. The data were primarily collected through 43 semi-structured interviews with managers of focal companies and their multi-tier suppliers. Findings-We found that in order to facilitate their supply chains to learn sustainability, MNCs tend to orchestrate in breadth by internally setting up new functional departments and externally working with third parties; and orchestrate in depth working directly with their extreme upstream suppliers adopting varied governance mechanisms on lower-tier suppliers along the project lifecycle. The resource orchestration in breadth and depth and along the project lifecycle results in changes of supply chain structure. Practical implication-The proposed conceptual model provides an overall framework for companies to design and implement their multi-tier sustainable initiatives. Companies could learn from our suggested learning stages and the best practices of case companies. Originality/value-We extend and enrich Resource Orchestration Perspective (ROP), which is internally focused, to a supply chain level; and answer a theoretical question of how MNCs orchestrate their internal and external resources to help their supply chains to learn sustainability. Our extension of ROP refutes the resource dependence theory, which adopts a passive approach of relying on external suppliers and proposes that MNCs should proactively work with internal and external stakeholders to learn sustainability.

The purpose of this paper is to present an analysis of the academic literature addressing Sustainable Supply Chain Management (SSCM) practices in developing countries. A systematic literature review method was adopted; selected papers were reviewed from 2000 to 2016 that matched our inclusion criteria. Common themes across the literature were identified covering four factors regarding the adoption of SSCM: drivers, barriers, mechanisms and outcomes. A conceptual model integrating these factors and based on institutional theory was advanced to explain the adoption of sustainability practices along supply chains in developing countries. The paper concludes by identifying gaps in the literature that require further research on this topic, particularly for the context of developing countries. To the best of our knowledge this is the first paper reviewing the existing research on SSCM in developing countries that includes both social and environmental dimensions.

No abstract