Roots of a Movement: Community Action and the Impact of Urban Agriculture in Chicago

Efforts to maintain a relationship to food pathways have been consistent throughout U.S. history despite the general evolution towards an increasingly industrialized food system. Urban agriculture serves as a means of reclaiming and furthering knowledge of where food comes from while also addressing larger social, economic, and environmental goals. This has been demonstrated in Chicago where urban farmers have worked to improve food access, increase employment, and revitalize communities all across the city. For many years, federal policies have promoted maximum production of commodity crops and kept supermarket prices low, allowing the government to ignore the impacts these policies are having on local economies, the environment, and public health. State and municipal policies have been similarly unsympathetic to any efforts to subvert the industrial food system. However, the individuals and organizations working to promote urban agriculture in Chicago demonstrate how community activism can break through these obstacles, and create fertile ground for the movement to grow. Chicago is recognized as a national leader in the urban agriculture movement, and the city is becoming an increasingly accommodating place for urban agriculture to thrive. In this thesis I describe the progress some of these urban farmers have made in Chicago, and emphasize how community engagement and support has played a crucial role in achieving this progress; I also discuss obstacles that have prevented the movement from attaining certain goals; and explore the implications of what it would mean for agriculture to change the landscape of a city

Stakeholder ownership: a theoretical framework for cross national understanding and analyses of stakeholder involvement in issues of substance use, problem use and addiction

This project contributes to understanding of the role of different stakeholder groups in the formulation and implementation of policy in the addictions field in Austria, Denmark, Finland, Italy, Poland and the UK. It comprises a number of case studies which draw on a range of theoretical frameworks to examine stakeholder dynamics at international, national and local levels. Mainly qualitative methods were used: interviews, policy and documentation analyses, webcrawler network analysis, and simple surveys; one case study was based on a survey only. The case studies fall into four main categories: three focus on controversial issues in drug treatment policy and practice – opioid substitution treatment, drug consumption rooms, and heroin assisted treatment; three look at stakeholder activity in alcohol control and public health; one pilot case study considers the potential role of researchers in the development of a scientific network around gambling; and one looks at the role of nurses in implementing brief interventions. In addition, themes explored across case studies included the role of evidence and stakeholder activity, drug users as stakeholders, and the role of external stakeholders on national policy. Professional stakeholders at implementation level and families and drug users as stakeholders are also considered. The case studies revealed that, in many instances, the addictions field is characterised by tensions between groups, by entrenched relationships between some addiction-specific stakeholder groups and powerful political stakeholders, and by the dominance of some forms of evidence over other forms of knowledge. Science and scientists are only influential in policy terms if their scientific findings ‘fit’ with the wider political context. Nevertheless, at least within the European context, there are opportunities for new stakeholder groups to emerge and gain policy salience and there are opportunities for stakeholders to challenge prevailing frames of understanding the addictions and prevailing modes of responding to problems of substance misuse and addiction

In-patient treatment in functional and sectorised care: patient satisfaction and length of stay.

BACKGROUND: Debate exists as to whether functional care, in which different psychiatrists are responsible for in- and out-patient care, leads to better in-patient treatment as compared with sectorised care, in which the same psychiatrist is responsible for care across settings. Aims To compare patient satisfaction with in-patient treatment and length of stay in functional and sectorised care. METHOD: Patients with an ICD-10 diagnosis of psychotic, affective or anxiety/somatoform disorders consecutively admitted to an adult acute psychiatric ward in 23 hospitals across 11 National Health Service trusts in England were recruited. Patient satisfaction with in-patient care and length of stay (LoS) were compared (trial registration ISRCTN40256812). RESULTS: In total, 2709 patients were included, of which 1612 received functional and 1097 sectorised care. Patient satisfaction was significantly higher in sectorised care (β = 0.54, 95% CI 0.35-0.73, P<0.001). This difference remained significant when adjusting for locality and patient characteristics. LoS was 6.9 days shorter for patients in sectorised care (β = -6.89, 95% CI -11.76 to -2.02, P<0.001), but this difference did not remain significant when adjusting for clustering by hospital (β = -4.89, 95% CI -13.34 to 3.56, P = 0.26). CONCLUSIONS: This is the first robust evidence that patient satisfaction with in-patient treatment is higher in sectorised care, whereas findings for LoS are less conclusive. If patient satisfaction is seen as a key criterion, sectorised care seems preferable. Declarations of interest None.European Commission 7th Framework Programme. Grant agreement number 602645

Malassezia pachydermatis Carriage in Dog Owners

Malassezia pachydermatis is commonly carried on the hands of dog owners and may cause disease in immunocompromised persons

Impact of measurement and feedback on chlorhexidine gluconate bathing among intensive care unit patients: A multicenter study.

OBJECTIVE: To assess whether measurement and feedback of chlorhexidine gluconate (CHG) skin concentrations can improve CHG bathing practice across multiple intensive care units (ICUs). DESIGN: A before-and-after quality improvement study measuring patient CHG skin concentrations during 6 point-prevalence surveys (3 surveys each during baseline and intervention periods). SETTING: The study was conducted across 7 geographically diverse ICUs with routine CHG bathing. PARTICIPANTS: Adult patients in the medical ICU. METHODS: CHG skin concentrations were measured at the neck, axilla, and inguinal region using a semiquantitative colorimetric assay. Aggregate unit-level CHG skin concentration measurements from the baseline period and each intervention period survey were reported back to ICU leadership, which then used routine education and quality improvement activities to improve CHG bathing practice. We used multilevel linear models to assess the impact of intervention on CHG skin concentrations. RESULTS: We enrolled 681 (93%) of 736 eligible patients; 92% received a CHG bath prior to survey. At baseline, CHG skin concentrations were lowest on the neck, compared to axillary or inguinal regions (P &lt; .001). CHG was not detected on 33% of necks, 19% of axillae, and 18% of inguinal regions (P &lt; .001 for differences in body sites). During the intervention period, ICUs that used CHG-impregnated cloths had a 3-fold increase in patient CHG skin concentrations as compared to baseline (P &lt; .001). CONCLUSIONS: Routine CHG bathing performance in the ICU varied across multiple hospitals. Measurement and feedback of CHG skin concentrations can be an important tool to improve CHG bathing practice

Mental health care for irregular migrants in Europe: Barriers and how they are overcome

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

The same or different psychiatrists for in- and out-patient treatment? A multi-country natural experiment.

AimsA core question in the debate about how to organise mental healthcare is whether in- and out-patient treatment should be provided by the same (personal continuity) or different psychiatrists (specialisation). The controversial debate drives costly organisational changes in several European countries, which have gone in opposing directions. The existing evidence is based on small and low-quality studies which tend to favour whatever the new experimental organisation is.We compared 1-year clinical outcomes of personal continuity and specialisation in routine care in a large scale study across five European countries. METHODS: This is a 1-year prospective natural experiment conducted in Belgium, England, Germany, Italy and Poland. In all these countries, both personal continuity and specialisation exist in routine care. Eligible patients were admitted for psychiatric in-patient treatment (18 years of age), and clinically diagnosed with a psychotic, mood or anxiety/somatisation disorder.Outcomes were assessed 1 year after the index admission. The primary outcome was re-hospitalisation and analysed for the full sample and subgroups defined by country, and different socio-demographic and clinical criteria. Secondary outcomes were total number of inpatient days, involuntary re-admissions, adverse events and patients' social situation. Outcomes were compared through mixed regression models in intention-to-treat analyses. The study is registered (ISRCTN40256812). RESULTS: We consecutively recruited 7302 patients; 6369 (87.2%) were followed-up. No statistically significant differences were found in re-hospitalisation, neither overall (adjusted percentages: 38.9% in personal continuity, 37.1% in specialisation; odds ratio = 1.08; confidence interval 0.94-1.25; p = 0.28) nor for any of the considered subgroups. There were no significant differences in any of the secondary outcomes. CONCLUSIONS: Whether the same or different psychiatrists provide in- and out-patient treatment appears to have no substantial impact on patient outcomes over a 1-year period. Initiatives to improve long-term outcomes of psychiatric patients may focus on aspects other than the organisation of personal continuity v. specialisation.European Commission Seventh Framework Programme. Grant agreement 60264

Predictors of personal continuity of care of patients with severe mental illness: A comparison across five European countries.

BACKGROUND: In Europe, at discharge from a psychiatric hospital, patients with severe mental illness may be exposed to one of two main care approaches: personal continuity, where one clinician is responsible for in- and outpatient care, and specialisation, where various clinicians are. Such exposure is decided through patient-clinician agreement or at the organisational level, depending on the country's health system. Since personal continuity would be more suitable for patients with complex psychosocial needs, the aim of this study was to identify predictors of patients' exposure to care approaches in different European countries. METHODS: Data were collected on 7302 psychiatric hospitalised patients in 2015 in Germany, Poland, and Belgium (patient-level exposure); and in the UK and Italy (organisational-level exposure). At discharge, patients were exposed to one of the care approaches according to usual practice. Putative predictors of exposure at patients' discharge were assessed in both groups of countries. RESULTS: Socially disadvantaged patients were significantly more exposed to personal continuity. In all countries, the main predictor of exposure was the admission hospital, except in Germany, where having a diagnosis of psychosis and a higher education status were predictors of exposure to personal continuity. In the UK, hospitals practising personal continuity had a more socially disadvantaged patient population. CONCLUSION: Even in countries where exposure is decided through patient-clinician agreement, it was the admission hospital, not patient characteristics, that predicted exposure to care approaches. Nevertheless, organisational decisions in hospitals tend to expose socially disadvantaged patients to personal continuity.European Commission’s 7th Framework Programm.e Grant agreement number 602645