The increasing rate of urbanization along with its socio-environmental impact are major global challenges. Therefore, there is a need to assess the boundaries to growth for the future development of cities by the inclusion of the assessment of the environmental carrying capacity (ECC) into spatial management. The purpose is to assess the resource dependence of a given entity. ECC is usually assessed based on indicators such as the ecological footprint (EF) and biocapacity (BC). EF is a measure of the biologically productive areas demanded by human consumption and waste production. Such areas include the space needed for regenerating food and fibers as well as sequestering the generated pollution, particularly CO2 from the combustion of fossil fuels. BC reflects the biological regeneration potential of a given area to regenerate resources as well to absorb waste. The city level EF assessment has been applied to urban zones across the world, however, there is a noticeable lack of urban EF assessments in Central Eastern Europe. Therefore, the current research is a first estimate of the EF and BC for the city of Wrocław, Poland. This study estimates the Ecological Footprint of Food (EFF) through both a top-down assessment and a hybrid top-down/bottom-up assessment. Thus, this research verifies also if results from hybrid method could be comparable with top-down approach. The bottom-up component of the hybrid analysis calculated the carbon footprint of food using the life cycle assessment (LCA) method. The top-down result ofWrocław’s EFF were 1% greater than the hybrid EFF result, 0.974 and 0.963 gha per person respectively. The result indicated that the EFF exceeded the BC of the city of Wrocław 10-fold. Such assessment support efforts to increase resource efficiency and decrease the risk associated with resources—including food security. Therefore, there is a need to verify if a city is able to satisfy the resource needs of its inhabitants while maintaining the natural capital on which they depend intact. Original article at: https://doi.org/10.3390/resources7030052 © 2018 by the authors. Licensee MDPI.
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Background: Structured psychotherapy is recommended as the preferred treatment of personality disorders. A substantial group of patients, however, has no access to these therapies or does not benefit. For those patients who have no (longer) access to psychotherapy a Collaborative Care Program (CCP) is developed. Collaborative Care originated in somatic health care to increase shared decision making and to enhance self management skills of chronic patients. Nurses have a prominent position in CCP’s as they are responsible for optimal continuity and coordination of care. The aim of the CCP is to improve quality of life and self management skills, and reduce destructive behaviour and other manifestations of the personality disorder. Methods/design: Quantitative and qualitative data are combined in a comparative multiple case study. This makes it possible to test the feasibility of the CCP, and also provides insight into the preliminary outcomes of CCP. Two treatment conditions will be compared, one in which the CCP is provided, the other in which Care as Usual is offered. In both conditions 16 patients will be included. The perspectives of patients, their informal carers and nurses are integrated in this study. Data (questionnaires, documents, and interviews) will be collected among these three groups of participants. The process of treatment and care within both research conditions is described with qualitative research methods. Additional quantitative data provide insight in the preliminary results of the CCP compared to CAU. With a stepped analysis plan the ‘black box’ of the application of the program will be revealed in order to understand which characteristics and influencing factors are indicative for positive or negative outcomes. Discussion: The present study is, as to the best of our knowledge, the first to examine Collaborative Care for patients with severe personality disorders receiving outpatient mental health care. With the chosen design we want to examine how and which elements of the CC Program could contribute to a better quality of life for the patients.
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BACKGROUND: Since 2011, a tailored, interdisciplinary head and neck rehabilitation (IHNR) program, covered by the basic healthcare insurance, is offered to advanced head and neck cancer (HNC) patients in the Netherlands Cancer Institute (NKI). This program is developed to preserve or restore patients' functioning, and to optimize health-related quality of life (HRQoL). It applies an integrated approach to define patients' individual goals and provide rehabilitation care throughout the cancer care continuum. The aim of the current study is to assess the (cost-) effectiveness of the IHNR approach compared to usual supportive care (USC) consisting of monodisciplinary and multidisciplinary care in advanced HNC patients.METHODS: This multicenter prospective observational study is designed to compare (cost-)effectiveness of the IHNR to USC for advanced HNC patients treated with chemoradiotherapy (CRT) or bioradiotherapy (BRT). The primary outcome is HRQoL represented in the EORTC QLQ-C30 summary score. Functional HRQoL, societal participation, utility values, return to work (RTW), unmet needs (UN), patient satisfaction and clinical outcomes are secondary outcomes, assessed using the EORTC QLQ-H&N35, USER-P, EQ-5D-5 L, and study-specific questionnaires, respectively. Both patient groups (required sample size: 64 per arm) are requested to complete the questionnaires at: diagnosis (baseline; T0), 3 months (T1), 6 months (T2), 9 months (T3) and 12 months (T4) after start of medical treatment. Differences in outcomes between the intervention and control group will be analyzed using mixed effects models, Chi-square test and descriptive statistics. In addition, a cost-effectiveness analysis (CEA) will be performed by means of a Markov decision model. The CEA will be performed using a societal perspective of the Netherlands.DISCUSSION: This prospective multicenter study will provide evidence on the effectiveness and cost-effectiveness of IHNR compared to USC. RTW and societal participation, included as secondary outcomes, have not been studied sufficiently yet in cancer rehabilitation. Interdisciplinary rehabilitation has not yet been implemented as usual care in all centers, which offers the opportunity to perform a controlled clinical study. If demonstrated to be (cost-)effective, national provision of the program can probably be advised.TRIAL REGISTRATION: The study has been retrospectively registered in the Netherlands Trial Registry on April 24th 2018 ( NTR7140 ).
