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Evidence from various sources suggests that females with schizophrenia tend to report lower quality of life than males with schizophrenia despite having a less severe course of the disorder. However, studies have not examined this directly.
To examine gender differences in the association between quality of life and the risk of subsequent psychiatric hospital admissions in a national sample with schizophrenia.
The sample consisted of 989 (60.90%) males and 635 (39.10%) females with an ICD-10 diagnosis of schizophrenia. Quality of life was assessed and scored using the Manchester Short Assessment of Quality of Life. The course of schizophrenia was assessed from the number of psychiatric hospital admissions. Participants completed the quality of life assessment and were then followed up for 18-months for subsequent psychiatric admissions. Hazard ratios (HR) from Cox proportional hazards regression models were estimated unadjusted and adjusted for covariates (age at schizophrenia onset and birth year). Analyses were computed for males and females separately, as well as for the entire cohort.
A subsample of 93 males and 55 females was admitted to a psychiatric hospital during follow-up. Higher quality of life scores were significantly (P < 0.05) associated with a reduced risk of subsequent admissions among males (unadjusted: HR = 0.96, 95% CI 0.93–0.99; adjusted HR = 0.96, 95% CI 0.93–0.99) but not among females (unadjusted: HR = 0.97, 95% CI 0.93–1.02; adjusted HR = 0.97, 95% CI 0.93–1.02).
Quality of life in schizophrenia is a gender-specific construct and should be considered as such in clinical practice and future research.
Background: Healthcare-associated infections (HAIs) represent an ongoing problem for all clinics. Children’s clinics have waiting rooms that include toys and activities to entertain children, possibly representing reservoirs for HAIs. This study focuses on a newly constructed children’s outpatient clinic associated with a teaching hospital. We studied waiting room bacterial colonization of floors and play devices from the last phase of construction through 6 months of clinical use. Methods: Waiting room areas on the first 2 floors of the facility were studied due to high patient volume in those areas. In total, 16 locations were sampled: 11 on floors and 5 on play items. Using sterile double-transport swabs, all locations were sampled on 5 separate occasions over 2 months during the last phase of construction and 13 times over 6 months after the clinic was opened. After collection swabs were placed on ice, transported to a microbiology lab, and used to inoculate Hardy Diagnostics Cdiff Banana Broth (for Clostridium difficile - Cdiff), CHROM MRSA agar (for methicillin resistant Staphylococcus aureus - MRSA), Pseudomonas isolation agar (for Pseudomonas spp and P. aeruginosa), and tryptic soy agar to detect Bacillus spp. Media were incubated for 48 hours at 37°C and were scored for bacterial presence based on observation of colonies or change in the medium. Results: During the construction phase, waiting-room-floor bacterial colonies were dominated by Bacillus spp, and first-floor waiting rooms had nearly 7 times more colonies than those on the second floor (P < .05). A similar pattern was observed for C. difficile and MRSA. No Pseudomonas spp were observed during construction. Once patients were present, Bacillus spp contamination dropped for the first floor, but increased for the second floor. All other bacterial types (C. difficile, MRSA, Pseudomonas spp, and P. aeruginosa) increased on the second floor after the clinic opened (eg, from 23% to 42% for C. difficile and from 7% to 46% for MRSA; P < .05). The play devices showed small increases in bacterial load after clinic opening, most notably Pseudomonas spp. Conclusions: This study provides evidence that a shift from bacterial species associated with soil (eg, Bacillus spp) toward species commonly associated with humans occurred in waiting rooms after construction in this children’s outpatient clinic. Increases for MRSA, Pseudomonas spp, and P. aeruginosa were linked to patient presence. These data suggest that patients, their families, and clinic staff transport bacteria into clinic waiting rooms. This outpatient clinic environmental contamination may increase potential for HAIs and may represent a target for intervention.
Background: The bacteria that inhabit outpatient healthcare facilities influence patient outcomes and recovery, although the diversity and quantity of these bacterial communities is largely unknown. Whether differences in bacterial presence exist in individual medical specialty units of an outpatient clinic is also largely unknown. The purpose of this study was to compare bacterial species found in the general medicine and pulmonary units of an outpatient children’s clinic associated with a teaching hospital. Methods: In total, 6 locations (4 floor sites, counters, air ducts) were sampled in 3 rooms in the pulmonary (PUL) unit and 3 rooms in the general medicine (GM) unit on 13 days over a 6-month period. Sterile double transport swabs were utilized, transported on ice to a microbiology lab, and used to inoculate Hardy Diagnostics Cdiff Banana Broth (for Clostridium difficile), CHROM MRSA agar (for methicillin-resistant Staphylococcus aureus [MRSA]), eosin methylene blue (Levine-type, for Lac+ gram negatives [GN]), and Pseudomonas isolation agar (for Pseudomonas spp and P. aeruginosa [PS and PSA]). Media were incubated for 48 hours at 37°C and were scored for bacterial presence based on colonial observation. Results: The presence of bacteria isolated from GM and PUL units differed by species and location. Based on the percentage of positive swabs, the presence of GN was widespread in both units (Fig 1). Additionally, bacterial presence was greatest on the floors (GN ranged from 72% to 85% on floors in the 2 units), whereas counters had fewer positive swabs (GN ranged from 23% to 38% on counters), and swabs from return air ducts rarely led to bacterial growth. The 1 case in which swabs from the PUL unit resulted in higher levels of bacterial growth than for the GM unit was for PSA (GM, 8%; PUL, 13%). C. difficile detection was the same on both units (ie, 35% of floor samples showed contamination). Conclusions: The levels of environmental bacterial presence observed for these clinic units differed in some cases by unit and ranged from not detectable to very high levels. Detection of C. difficile on 35% of floor samples in both units could be problematic. Additionally, for the PUL unit, contamination of 13% of floor samples by PSA should raise concerns because many patients in this clinic have cystic fibrosis (CF). Although many CF patients are colonized by PSA, others may potentially contract an infection by this pathogen from the clinical environment. This observation supports current infection control recommendations for CF patients in outpatient settings.
Chapter 4 directly links the regulations introduced in Chapter 3 with public meetings. This chapter focuses on why proposals end up in public meetings and what types of issues members of the public and zoning officials raise. We introduce the novel data on meeting minutes from Massachusetts cities and towns that we use in Chapters 4, 5, and 6. Using these meeting minutes, we trace 100 randomly selected proposals in which we collected especially detailed project and meeting information. We show that once a project requires a public hearing, members of the public raise any and all concerns—not just those directly pertaining to the regulations that necessitated a meeting in the first place. The regulations described in Chapter 3 provide the opportunities for neighborhood defenders to air virtually all of their concerns and objections.
Chapter 2 develops our theory, highlighting how land use regulations and participatory inequalities come together to constrain the supply of new housing. We use a detailed case study of a Catholic Church redevelopment project to illustrate how neighbors opposed to development are able to delay development and reduce what gets built by participating in the planning and permitting process.
Chapter 1 uses several illustrative case studies to introduce the central argument of this book: that land use institutions ostensibly designed to empower underrepresented neighborhood groups actually amplify the power of neighborhood defenders to stop and delay the construction of new housing. We then situate this argument in the broader context of rising national housing costs, and the negative social, economic, and environmental consequences of the nationwide housing crunch.
Chapter 3 uses land use regulation and housing permitting data to: (1) clearly describe how land use regulations operate and (2) statistically link their proliferation with a diminished housing supply. We show how regulations create opportunities for opponents to file lawsuits, and how these lawsuits in turn reduce development. In order to address potential selection bias in our empirical analyses, we then use the redevelopment of Catholic Church properties across the greater Boston area as a natural experiment, and show that zoning regulations of all types decreased the density of the housing built on former church sites.
Chapter 6 then explores how these individuals stymy housing development using a mix of quantitative analysis of meeting minutes, in-depth case studies, and dozens of interviews with government officials, developers, and community activists. We analyze the wide range of concerns raised by meeting attendees and how commenters use in-depth knowledge of local zoning regulations to raise objections to special permits and variances.
Chapter 7 investigates potential policy solutions and the challenges facing building an affordable housing coalition. It uses a mix of elite survey data, interviews, and archival analysis to explore how gentrification has made prospects for reform more challenging, exploring the state-level politics surrounding SB 827 in California and Chapter 40B in Massachusetts. It concludes by outlining: (1) prospects for successful housing reform and (2) how the insights derived from housing politics might apply to other salient policy arenas, such as environmental and immigration policy.