Changing Governance Processes to Make Way for Civic Involvement: The Case of Gebrookerbos in Heerlen, Netherlands

The effects of shrinkage can be manifold. Vacant green areas are a typical manifestation of shrinkage in deindustrialized cities, such as Heerlen, Netherlands. Such challenges are usually managed by the municipality which, due to financial reasons, often has to turn to citizens to aid in accommodating those effects. The example of Gebrookerbos in Heerlen shows how an adaptation of governance processes can take place in order to facilitate the involvement of citizens in reusing vacant spaces. The introduction of the position of account manager as well as brooker are being regarded as essential for shortening the distance between municipality and citizens as well as contributing to replacing the mistrust towards the municipality, which is in line with existing research on depopulating areas. Further, making a plethora of funding options and projects available for civic initiatives ensures the longevity of civic involvement. Finally, the findings show how working on the “hardware”, the visible vacancy and deterioration of the land—by adapting the “software”, the institutional set up and focusing on civic empowerment—of a shrinking city can go hand in hand

Treatment of stiff thoracic scoliosis by thoracoscopic anterior release combined with posterior instrumentation and fusion

Background. Thoracoscopic anterior release has been shown that it can effectively improve spinal flexibility in animal and human cadaveric studies, and has been advocated for use in patients with scoliosis. This prospective case series aims to investigate the improvement of the spinal flexibility and the effectiveness in deformity correction by anterior thoracoscopic release and posterior spinal fusion. Methods. Eleven patients with stiff idiopathic thoracic scoliosis underwent anterior thoracoscopic release followed by posterior instrumentation. The average number of discs excised was five. Spinal flexibility was assessed by the fulcrum bending technique. Cobb angle before and after the anterior release was compared. Results. The patients were followed for an average of 5.6 years (range 2.2 to 8.1 years). Fulcrum bending flexibility was increased from 39% before the thoracoscopic anterior spinal release to 54% after the release. The average Cobb angle before anterior release was 74° on the standing radiograph and 45° with the fulcrum-bending radiograph. This reduced to 34° on the fulcrum-bending radiograph after the release, and highly corresponded to the 31° measured at the post-operative standing radiograph. Conclusion. It was demonstrated in patients with stiff idiopathic thoracic scoliosis that thoracoscopic anterior spinal release can effectively improve the spinal flexibility and increase the correction of the spinal deformity.published_or_final_versio

Patients’ and family caregivers’ experiences with a newly implemented hospital at home program in British Columbia, Canada: Preliminary results

The Hospital at Home (HaH) model of care, which enables the provision of acute-level care in the patient’s own home as an alternative to brick and mortar hospital admission, was introduced in British Columbia, Canada in November 2020, starting with 9 inpatient “beds” in the community. The AT-HOME research group applied a patient-oriented approach to evaluate the patients’ and family caregivers’ (FCGs) experiences with the program as it was implemented and expanded throughout Victoria, BC. In this paper, we discuss the development of the survey instruments, including process and timelines (three phases); and present preliminary findings of the observational research study (six months of patient and FCG feedback data). The preliminary results show that 100% of patients (n=75) and 95% of FCGs (n=57) had an overall positive experience with the program (rated 6-10 on a 10-point scale where 0 meant ‘very poor’ and 10 ‘very good’). 100% of these patients and 96% of these FCGs would recommend the program to their friends and family and 97% of these patients and 96% of these FCGs would choose the program again if faced with the same situation. The preliminary results on metrics pertaining to care quality; information sharing and experiences with the admission and discharge processes; FCG’s roles, medication management, and more are discussed here. The final results of the patient and FCG experiences will be reported at the end of the data collection period. We can conclude that this new HaH program has been positively received by patients and FCGs thus far and they support program expansion Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this len

Engaging patients and families in developing, implementing, and evaluating hospital at home: A Canadian case study

The Hospital at Home (HaH) care model is naturally patient-centred, with improved patient and family experiences and outcomes firmly anchoring the innovative approach to care. Existing literature focuses largely on the health care and patient care outcomes of HaH; however, to date, none of the identified literature has reported on engaging patients and families in the development, implementation, or evaluation of the HaH model of care. A multi-stakeholder, Patient-Oriented Research team in Victoria, British Columbia, Canada engaged patients and family/friend caregivers (PFCs) across all components of the HaH program. Guided by best practices in patient and public engagement, the team collaborated to 1) explore the potential impact of in-home acute care on PFCs’ experiences; 2) identify health, social, and practice outcomes that matter to PFCs; 3) examine the social and environmental factors which may impact delivery of HaH; and 4) inform the HaH evaluation framework that includes PFC priority measures related to experience and outcomes. A public, online survey (n=543 PFC respondents) revealed both program-specific and evaluation-specific themes. These included a focus on patients achieving their own health goals and standard health outcomes, as well as patients and caregivers receiving training to support care at home. Engaging PFCs throughout HaH conception and implementation ensured the end program accurately reflected the priorities, concerns, and values of those that HaH is meant to serve. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Does Obsessive-Compulsive Personality Disorder Belong Within the Obsessive-Compulsive Spectrum? Focus Points

• In this article, we consider the advantages and disadvantages of current categorical models for diagnosing obsessive-compulsive personality disorder (OCPD). • We review the similarities and differences between OCPD and obsessive-compulsive spectrum disorders. • We present a novel, neurocognitive approach to investigating OCPD. Abstract It has been proposed that certai

Quality of anti-malarial drugs provided by public and private healthcare providers in south-east Nigeria

BACKGROUND: There is little existing knowledge about actual quality of drugs provided by different providers in Nigeria and in many sub-Saharan African countries. Such information is important for improving malaria treatment that will help in the development and implementation of actions designed to improve the quality of treatment. The objective of the study was to determine the quality of drugs used for the treatment of malaria in a broad spectrum of public and private healthcare providers. METHODS: The study was undertaken in six towns (three urban and three rural) in Anambra state, south-east Nigeria. Anti-malarials (225 samples), which included artesunate, dihydroartemisinin, sulphadoxine-pyrimethamine (SP), quinine, and chloroquine, were either purchased or collected from randomly selected providers. The quality of these drugs was assessed by laboratory analysis of the dissolution profile using published pharmacopoeial monograms and measuring the amount of active ingredient using high performance liquid chromatography (HPLC). FINDINGS: It was found that 60 (37%) of the anti-malarials tested did not meet the United States Pharmacopoeia (USP) specifications for the amount of active ingredients, with the suspect drugs either lacking the active ingredients or containing suboptimal quantities of the active ingredients. Quinine (46%) and SP formulations (39%) were among drugs that did not satisfy the tolerance limits published in USP monograms. A total of 78% of the suspect drugs were from private facilities, mostly low-level providers, such as patent medicine dealers (vendors). CONCLUSION: This study found that there was a high prevalence of poor quality drugs. The findings provide areas for public intervention to improve the quality of malaria treatment services. There should be enforced checks and regulation of drug supply management as well as stiffer penalties for people stocking substandard and counterfeit drugs

Investigation of HIV Incidence Rates in a High-Risk, High-Prevalence Kenyan Population: Potential Lessons for Intervention Trials and Programmatic Strategies

Abstract Cost-effective HIV prevention programs should target persons at high risk of HIV acquisition. We conducted an observational HIV incidence cohort study in Kisumu, Kenya, where HIV prevalence is triple that of the national rate. We used referral and venue-sampling approaches to enroll HIV-negative persons for a 12-month observational cohort, August 2010 to September 2011, collected data using computer-assisted interviews, and performed HIV testing quarterly. Among 1292 eligible persons, 648 (50%) were excluded for HIV positivity and other reasons. Of the 644 enrollees, 52% were women who were significantly older than men (P < .01). In all, 7 persons seroconverted (incidence rate [IR] per 100 person-years ¼ 1.11; 95% confidence interval [CI] 0.45-2.30), 6 were women; 5 (IR ¼ 3.14; 95% CI 1.02-7.34) of whom were 25 years. Most new infections occurred in young women, an observation consistent with other findings in sub-Saharan Africa that women aged 25 years are an important population for HIV intervention trials in Africa

Rural-Urban Differences in Maternal Responses to Childhood Fever in South East Nigeria

Childhood fevers due to malaria remain a major cause of morbidity and mortality among under-five children in Nigeria. The degree of vulnerability perceived by mothers will affect their perception of the severity and threat of their child's fever and the patterns of health care use. This study was undertaken to compare maternal responses to childhood fever in urban and rural areas of Enugu, south east Nigeria.Data was collected with pre-tested interviewer-administered questionnaires from 276 and 124 urban and rural households respectively. In each household, only one woman aged 15-49 years who had lived in each of the urban and rural communities for at least one year and had at least one child less than 5 years old was interviewed. Malaria was mentioned as the commonest cause of childhood fevers. Rural mothers were more likely to recognize danger signs and symptoms than urban mothers. Rural mothers use more of informal than formal health services, and there is more home management of the fever with urban than rural mothers. Chloroquine, ACT, SP and Paracetamol are the main drugs given at home for childhood fevers, but the rural mothers were more likely to use leftover drugs from previous treatment to treat the fevers than urban mothers. The urban respondents were also more likely to use a preventive measure. Urban mothers sought actions faster than rural mothers and the total cost of treatment was also higher in urban areas.Both urban and rural mothers are aware that malaria is the major cause of childhood fevers. Although rural mothers recognize childhood fever and danger signs better than urban mothers, the urban mothers' responses to fever seem to be better than that for rural mothers. These responses and differences may be important for geographical targeting by policy makers for malaria interventions