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To characterize residential social vulnerability among healthcare personnel (HCP) and evaluate its association with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection.
This study analyzed data collected in May–December 2020 through sentinel and population-based surveillance in healthcare facilities in Colorado, Minnesota, New Mexico, New York, and Oregon.
Data from 2,168 HCP (1,571 cases and 597 controls from the same facilities) were analyzed.
HCP residential addresses were linked to the social vulnerability index (SVI) at the census tract level, which represents a ranking of community vulnerability to emergencies based on 15 US Census variables. The primary outcome was SARS-CoV-2 infection, confirmed by positive antigen or real-time reverse-transcriptase– polymerase chain reaction (RT-PCR) test on nasopharyngeal swab. Significant differences by SVI in participant characteristics were assessed using the Fisher exact test. Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) for associations between case status and SVI, controlling for HCP role and patient care activities, were estimated using logistic regression.
Significantly higher proportions of certified nursing assistants (48.0%) and medical assistants (44.1%) resided in high SVI census tracts, compared to registered nurses (15.9%) and physicians (11.6%). HCP cases were more likely than controls to live in high SVI census tracts (aOR, 1.76; 95% CI, 1.37–2.26).
These findings suggest that residing in more socially vulnerable census tracts may be associated with SARS-CoV-2 infection risk among HCP and that residential vulnerability differs by HCP role. Efforts to safeguard the US healthcare workforce and advance health equity should address the social determinants that drive racial, ethnic, and socioeconomic health disparities.
Optimal stroke care requires access to resources such as neuroimaging, acute revascularization, rehabilitation, and stroke prevention services, which may not be available in rural areas. We aimed to determine geographic access to stroke care for residents of rural communities in the province of Ontario, Canada.
We used the Ontario Road Network File database linked with the 2016 Ontario Acute Stroke Care Resource Inventory to estimate the proportion of people in rural communities, defined as those with a population size <10,000, who were within 30, 60, and 240 minutes of travel time by car from stroke care services, including brain imaging, thrombolysis treatment centers, stroke units, stroke prevention clinics, inpatient rehabilitation facilities, and endovascular treatment centers.
Of the 1,496,262 people residing in rural communities, the majority resided within 60 minutes of driving time to a center with computed tomography (85%), thrombolysis (81%), a stroke unit (68%), a stroke prevention clinic (74%), or inpatient rehabilitation (77.0%), but a much lower proportion (32%) were within 60 minutes of driving time to a center capable of providing endovascular thrombectomy (EVT).
Most rural Ontario residents have appropriate geographic access to stroke services, with the exception of EVT. This information may be useful for jurisdictions seeking to optimize the regional organization of stroke care services.
This chapter explores the interface between co-produced research and community development, drawing on work undertaken in North East England as part of the Imagine project. Discussion of the process and outcomes of Imagine North East provides fruitful material for contributing to perennial debates about whether certain forms of co-produced research (especially participatory action research) are, in fact, indistinguishable from community development. In this chapter we offer a brief overview of the work of Imagine North East before outlining the debates about the relationship between co-production and community development. We then examine three elements of Imagine North East: (1) an academic-led study of community development from the 1970s to the present; (2) a series of community development projects undertaken by local community-based organisations; and (3) a joint process of reflection and co-inquiry. We consider the role of co-produced research in challenging stigma, celebrating place and developing skills and community networks, and also the challenges of a co-inquiry approach.
Exploring community development from the outside and inside: The work of Imagine North East
Imagine North East was a partnership between 12 community-based organisations in Tyneside (including a local museum) and Durham University, officially running during 2014 and 2015, with dissemination and reflection work continuing in 2016. Community development featured in several ways. Not only did community-based sub-projects use processes of community development (mobilising people to work together) and generate community development outcomes (for example, strengthened communities, improved facilities) in their work for Imagine North East, but our study also had community development as its main focus. We adopted three approaches to the study of community development, as outlined below:
1. Studying community development from the outside: The starting point of the research was the community development projects of the 1970s in Benwell (Newcastle-upon-Tyne) and North Shields. These were part of Britain's first anti-poverty programme, combining community development work and research with a view to diagnosing and alleviating poverty locally (Loney, 1983; Banks and Carpenter, 2017). We also looked at community development processes over time (from the 1970s to the present) as these areas were subject to numerous regeneration schemes in which local people were more or less engaged. This research was largely done by academic researchers and then shared in the wider group.
Phonetic variation among Scottish members of the UK Parliament may be influenced by convergence to Southern English norms (Carr & Brulard, 2006) or political identity (e.g., Hall-Lew, Coppock, & Starr, 2010). Drawing on a year's worth of political speeches (2011–2012) from 10 Scottish members of the UK Parliament (MPs), we find no acoustic evidence for the adoption of a Southern English low vowel system; rather, we find that vowel height is significantly correlated with political party: Scottish Labour Party MPs produce a higher cat vowel (Johnston, 1997) than do Scottish National Party MPs. The results contradict claims that Scottish MPs acquire Anglo-English features while serving in the UK Parliament. Rather, we suggest that the variation indexes political meaning, with a subset of individuals drawing on that indexicality in production.
Background: Few studies have tracked stroke survivors through transitions across the health system and identified the most common trajectories and quality of care received. The objectives of our study were to examine the trajectories that incident stroke patients experience and to quantify the extent to which their care adhered to the best practices for stroke care. Methods: A population-based cohort of first-ever stroke/transient ischemic attack (TIA) patients from the 2012/13 Ontario Stroke Audit was linked to administrative databases using an encrypted health card number to identify dominant trajectories (N=12,362). All trajectories began in the emergency department (ED) and were defined by the transitions that followed immediately after the ED. Quality indicators were calculated to quantify best practice adherence within trajectories. Results: Six trajectories of stroke care were identified with significant variability in patient characteristics and quality of care received. Almost two-thirds (64.5%) required hospital admission. Trajectories that only involved the ED had the lowest rates of brain and carotid artery imaging (91.5 and 44.2%, respectively). Less than 20% of patients in trajectories involving hospital admissions received care on a stroke unit. The trajectory involving inpatient rehabilitation received suboptimal secondary prevention measures. Conclusions: There are six main trajectories stroke patients follow, and adherence to best practices varies by trajectory. Trajectories resulting in patients being transitioned to home care following ED management only are least likely and those including inpatient rehabilitation are most likely to receive stroke best practices. Increased time in facility-based care results in greater access to best practices. Stroke patients receiving only ED care require closer follow-up by stroke specialists.
Objective: Administrative data validation is essential for identifying biases and misclassification in research. The objective of this study was to determine the accuracy of diagnostic codes for acute stroke and transient ischemic attack (TIA) using the Ontario Stroke Registry (OSR) as the reference standard. Methods: We identified stroke and TIA events in inpatient and emergency department (ED) administrative data from eight regional stroke centres in Ontario, Canada, from April of 2006 through March of 2008 using ICD–10–CA codes for subarachnoid haemorrhage (I60, excluding I60.8), intracerebral haemorrhage (I61), ischemic (H34.1 and I63, excluding I63.6), unable to determine stroke (I64), and TIA (H34.0 and G45, excluding G45.4). We linked administrative data to the Ontario Stroke Registry and calculated sensitivity and positive predictive value (PPV). Results:: We identified 5,270 inpatient and 4,411 ED events from the administrative data. Inpatient administrative data had an overall sensitivity of 82.2% (95% confidence interval [CI95%]=81.0, 83.3) and a PPV of 68.8% (CI95%=67.5, 70.0) for the diagnosis of stroke, with notable differences observed by stroke type. Sensitivity for ischemic stroke increased from 66.5 to 79.6% with inclusion of I64. The sensitivity and PPV of ED administrative data for diagnosis of stroke were 56.8% (CI95%=54.8, 58.7) and 59.1% (CI95%=57.1, 61.1), respectively. For all stroke types, accuracy was greater in the inpatient data than in the ED data. Conclusion: The accuracy of stroke identification based on administrative data from stroke centres may be improved by including I64 in ischemic stroke type, and by considering only inpatient data.
Background: Transient ischemic attack (TIA) and minor stroke are associated with
a substantial risk of subsequent stroke; however, there is uncertainty about
whether such patients require admission to hospital for their initial
management. We used data from a clinical stroke registry to determine the
frequency and predictors of hospitalization for TIA or minor stroke across
the province of Ontario, Canada. Methods: The Ontario Stroke Registry collects information on a
population-based sample of all patients seen in the emergency department
with acute stroke or TIA in Ontario. We identified patients with minor
ischemic stroke or TIA included in the registry between April 1, 2008, and
March 31, 2011, and used multivariable analyses to evaluate predictors of
hospitalization. Results: Our study sample included 8540 patients with minor ischemic stroke
or TIA, 47.2% of whom were admitted to hospital, with a range of 37.6% to
70.3% across Ontario’s 14 local health integration network regions. Key
predictors of admission were preadmission disability, vascular risk factors,
presentation with weakness, speech disturbance or prolonged/persistent
symptoms, arrival by ambulance, and presentation on a weekend or during
periods of emergency department overcrowding. Conclusions: More than one-half of patients with minor stroke or TIA were not
admitted to the hospital, and there were wide regional variations in
admission patterns. Additional work is needed to provide guidance to health
care workers around when to admit such patients and to determine whether
discharged patients are receiving appropriate follow-up care.
Africa has been at the centre of a "land grab" in recent years, with investors lured by projections of rising food prices, growing demand for "green" energy, and cheap land and water rights. But suchland is often also used or claimed through custom by communities. What does this mean for Africa? In what ways are rural people's lives and livelihoods being transformed as a result? And who will control its land and agricultural futures?
The case studies explore the processes through which land deals are being made; the implications for agrarian structure, rural livelihoods and food security; and the historical context of changing land uses, revealing that these land grabs may resonate with, even resurrect, forms of large-scale production associated with the colonial and early independence eras. The book depicts the striking diversity of deals and dealers: white Zimbabwean farmers in northern Nigeria, Dutch and American joint ventures in Ghana, an Indian agricultural company in Ethiopia's hinterland, European investors in Kenya's drylands and a Canadian biofuel company on its coast, South African sugar agribusiness in Tanzania's southern growth corridor, in Malawi's "Greenbelt" and in southern Mozambique, and white South African farmers venturing onto former state farms in the Congo.
Ruth Hall is Associate Professor at the Institute for Poverty, Land and Agrarian Studies (PLAAS) at the University of the Western Cape, South Africa; Ian Scoones is a Professorial Fellow at the Institute of Development Studies (IDS) at the University of Sussex and Director of the ESRC STEPS Centre; Dzodzi Tsikata is Associate Professor at the Institute of Statistical, Social and Economic Research (ISSER) at the University of Ghana, Legon.
Africa is at the centre of a ‘global land grab’. This is what critics have named the rapid growth in land-based investments or land deals since 2007, a phenomenon unmatched since colonial times. By some estimates, 70 per cent of the land transacted in large-scale transnational deals in recent years has been in Africa, often considered the world's last reserve of unused and under-utilised fertile and irrigable farmland (Deininger et al. 2011; World Bank 2009). It is this potential that has lured investors motivated by projections of rising food prices, by growing demand for ‘green’ energy, and by the allure of cheap land and water rights. But governments have often allocated to investors land that is occupied, used, or claimed through custom by local people, resulting in disrupted livelihoods and even conflict.
The case studies presented in this book depict the striking diversity of such deals: white Zimbabwean farmers in northern Nigeria, Dutch and American joint ventures in Ghana, an Indian agricultural company in Ethiopia's hinterland, European investors in Kenya's drylands and a Canadian biofuel company on its coast, South African sugar agribusiness in Tanzania's southern growth corridor, in Malawi's ‘Greenbelt’ and in southern Mozambique, and white South African farmers venturing on to former state farms in Congo. In all cases, acquiring land is intimately linked to gaining access to water: land and water ‘grabbing’ are thus inseparable (Mehta et al. 2012; Woodhouse 2012).
The book explores the investors and their interests, the processes through which these land deals were concluded, and analyses their outcomes for changing agrarian structure, rural livelihoods and food security. Analysis of emerging patterns of social differentiation focuses attention on who wins, who loses out, and what new dynamics of accumulation and marginalisation result, both within directly affected communities and the broader society. The case studies also investigate the political and policy narratives through which these deals are justified and understood, the contested views of land and property that underpin them, and the degree to which new agrarian struggles are emerging in response.
After the term ‘land grabbing’ captured headlines around the world in the late 2000s, researchers embarked on a spate of new studies to understand this dramatic new trend. Africa was the focus, but in Southeast Asia and Latin America too, researchers and activists started to document large corporate takeovers of community and state land. A great deal of attention at this time revolved around how much land was being acquired, where, by whom and for what. All this was important and helped to sketch out the contours of a new era of agrarian restructuring.
The research reported in this book was conducted under the auspices of the Future Agricultures Consortium's land theme (www.futureagricultures. org/research/land). Centred on a network of Africa-based researchers, our studies set out to investigate what these ‘land grabs’ actually meant to the people directly affected. Our work from 2010 to 2014 investigated 13 cases across 8 countries in Africa.
Our interest in writing this book was to ground the narratives of a ‘land grab’ and of ‘agricultural investment’ in detailed local studies that would illuminate how these are experienced on the ground. What did these deals look like? Why did they happen in the particular places and at the particular times that they did? What transformations in rural people's lives and livelihoods were being produced? And what were the implications for future trajectories of agrarian change across the continent?
Across the studies, we chose to adopt a political economy perspective. We were motivated by a conviction that large-scale land deals in Africa must be understood in terms of the economic interests that animate national politics, and that such investments – many of which did not materialise in practice – were best understood at the intersection of global drivers and local institutions, mediated through national politics and economy. We asked: what political conditions enabled and promoted big land deals? How did investors come to identify certain sites? Who were their intermediaries? To what degree did national law and policy facilitate or shape the deals? And through what processes did local people engage with proposed deals, what were their responses, what happened to them and what did they do?
In the tropical southern belt of the Republic of Congo, a group of South African commercial farmers have cleared trees and long elephant grass on some parts of their 50,000ha to commence large-scale production of maize. As this case shows, alongside the former colonial powers and Northern economies in the rush for African farmland is a new generation of investors from the ‘emerging economies’. Among these are the BRICS countries, including South Africa. Unlike China and Brazil which have launched bilateral partnerships with many African countries for technical assistance in agriculture, from India and South Africa the main actors are private companies that have secured deals with African governments, often in the form of long-term leases, to expand commercial farming operations in their countries. According to the Land Matrix (2014) database, South African companies have 28 large land deals either under negotiation or concluded in nine countries, with a total area of 679,262ha acquired in the deals concluded. Among these land deals involving South African investors is one brokered by the commercial farmers’ association, Agri South Africa (AgriSA), for 80,000ha of prime farmland in Congo's Niari province, about 200km inland from the port city of Pointe-Noire.
As with many large land acquisitions that are reported in the media, contradictions have emerged in the information regarding this investment. There have been significant discrepancies between ambitious announcements and the area of land actually provided under a legal agreement, and again between the land acquired and the area cleared and cultivated. The deal was initially mooted to involve 10 million hectares, the total area the government claimed was available for investors, but the contract, which was ultimately signed in 2011 by the government of the Republic of Congo and the South African farmers, concerns 80,000ha. The South African farmers initially occupied 50,000ha, with the other 30,000ha to be released by the Minister of Agriculture upon a satisfactory record of harvest. By 2013, only 2,500ha were under cultivation (Land Matrix 2014). But by 2014, three years after taking occupation, with over 5,000ha (10 per cent) under production and finally achieving successful harvests, the farmers reported that the government had released the further 30,000ha to them, on which they would expand in the future (Dirk Hanekom, head of AgriSA's Africa Policy Committee, on the South African television channel Kyknet, 2 October 2014).