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Urban agriculture (UA) is a strategic means of achieving sustainable urban food security now and into the future. While a number of different models of agriculture will be required to provide food for the concentrated number of people in urban spaces, UA can be key tool in helping urban residents meet micronutrient requirements, whose deficiency is now recognized as the most important cause of “hidden hunger” globally. UA, or the cultivation of crops for food in small and irregular spaces within a city and its periphery, has been practiced for as long as cities have existed. However, it is gaining increased attention for both its limited scale, its effects on nutrition and community building, the associated possibilities for employment and social mobility, its relevance in a vibrant and diverse food system and for all of these reasons, its sustainability. UA projects are springing up in cities all over the world, always engaging the collaboration of multiple urban stakeholders and increasingly with a focus on the most vulnerable people in society: the poor, the elderly, children and those suffering malnutrition and chronic disease. For all city dwellers, UA improves livelihoods within the city environment by reducing city ecological footprint, strengthening city resilience to climate change and environmental hazards, reducing noise, improving air quality and the city microclimate, minimizing drought by improving storm water management and contributing to solid waste management. It increases human health and well-being through stress recovery, encouragement of exercise, reduction of urban violence, facilitating social contact, and providing sources of added employment and income. Using the concept of urban political ecology as a foundation for understanding food dynamics, this chapter will describe a range of different UA initiatives across the globe, giving special attention to their multi-functionality in the context of social vulnerabilities within urban spaces. In so doing, it will present UA as an important platform for community engagement and sustainability building toward increased food security. Turning concrete into green productive lands results in changes in physical, psychological, environmental and community health. At the same time, the application of social leftovers (abandoned lands, unused rooftops, plastic and wood containers, etc.) onto productive means creates a new model for adding micronutrition to urban diets that integrates and takes seriously social, cultural, nutritional and economic outcomes.

Background and aim: PAC-SYM is widely adopted to asses constipation severity. However, it has been validated in a small sample, few items have been included based on expert opinion and not on empirical grounds, and its factor structure has never been replicated. We aimed at evaluating the psychometric properties of PAC-SYM in patients with chronic constipation. Methods: We enrolled 2,203 outpatients with chronic constipation in two waves. We used wave I sample to test the psychometric properties of the PAC-SYM and wave II sample to cross-validate its factor structure, to assess criterion validity, responsiveness to clinical change, and its minimal clinically important difference. Results: Only a minority of patients reported any rectal tearing (38 %). Deletion of such item leads to a 11-item version (M:PAC-SYM). The remaining items in the rectal domain were moderately correlated with the stool domain. Exploratory factor analysis and confirmatory factor analysis revealed a bifactor structure with two subscales (stool and abdominal symptoms) and a general severity factor. The M:PAC-SYM demonstrated excellent reliability, moderate correlation with SF-12 and treatment satisfaction (r = 0.28–0.45), discrimination across Rome III criteria for functional constipation and abdominal pain, and responsiveness to clinical change (β = −0.49; ω 2 = 0.25). M:PAC-SYM minimal clinically important difference was 0.24. Conclusion: Our analysis shows that the rectal domain may not represent a relevant cluster of symptoms for patients with chronic constipation. We developed a modified version of the PAC-SYM which might better represent symptom severity of most patients seeking care in gastroenterology referral centers

Anorectal manometry is an objective means of assessing the resistance to spontaneous defecation provided by anorectal sphincter mechanism and the sensory capabilities of the rectum to provide a feeling of imminent need to defecate. Since there is no single all-encompassing defecatory function test, the information provided by manometry works together with other function test to determine the causes of anorectal sphincter dysfunction. A systematic approach to the study of anal canal pressures provides several information about the anal canal at rest and during various physiological functions such as squeezing and simulated defecation. The computerized approach to obtaining longitudinal and radial pressures in eight directions provides for the exploration of the anal canal deficiencies mm by mm. Such a technique becomes fundamental to the diagnostic of pelvic floor disorders. Only a manometric technique, combined with proper acquisition and analysis on the computer that takes into account all these physiological and methodological considerations, can represent a valid enhancement of defecography in the study of the functional disorders of the pelvic floor, furnishing to physician and surgeon useful data leading to proper conservative or surgical therapeutic approaches.

Aestimum, Atti del X Incontro di Studio (1980)