The distribution of healthcare workforces relative to population ill health in England: Repeated cross-sectional analysis of Census data 2001-2021.

ObjectivesThe purpose of this article is to present artificial intelligence in the public security system at local government level of a state. This article answers the following questions: Does artificial intelligence have the potential to be used in the field of public safety by public administrations at the level of local authorities and, if so, are there successful examples of such applications? Is it advisable to expand the understanding of public safety to include such an area where AI is applied to public services?MethodsThe article falls within the theoretical publication stream. The research tools and techniques used are characteristic of the social sciences, including political and administrative sciences and security sciences. Mainly the following were used : desk research, analysis of literature , normative acts, documents and strategies. The analysis was extended with statements of practitioners from local government as representatives of public administration.ResultsThe result of the study is the confirmation of both research theses (H1 and H2) posed in the social science area of public safety and artificial intelligence systems.ConclusionsThis article states that that AI has the potential to be used in the field of public safety by public administrations at the level of local and regional authorities, despite the correlated risks arising from the use of AI by the public sector. It is advisable to expand the understanding of public safety to include such an area where AI is applied in public services.

Public procurement is considered an important driver of an economy and has a considerable power in orienting the market, including toward environmental protection policies and strategies. This study examines the green public procurement practiced at the level of local Romanian authorities with the aim of understanding the real context by highlighting the mix between what is required and/or expected from local authorities and what is actually happening in terms of green public procurement. The research is based on the results of an online survey conducted from 16 August 2019 to 18 September 2019. The research results show that green procurement is not a subject approached in many administrative units; however, it appears that environmental protection in the context of public procurement is considered important. In line with other research, our results enrich the current knowledge on green procurement practices at the local government level and indicate that increased regulatory pressure for green public procurement may lead to market development and innovation for green goods and services.

Background and objective: Most published research on the ecological relationship between suicide rates and indices of deprivation uses only one level of population aggregation—for example, by local authorities. These ecological...

The new ‘Curriculum for Excellence’ in Scotland outlines a policy vision of a more integrated and holistic form of education; a commitment which offers considerable prospects for increased levels of outdoor learning in schools. With reference to Fullan’s theorizing on achieving educational change, this study investigated four main implementation areas, namely: policy aims, partnerships arrangements, and associated professionalism and sustainability issues. Evidence was collected through a series of 16 semi-structured interviews with key stakeholders at national, local authority, and school level. Despite increased agreement on aims, it was found that improving the frequency and quality of outdoor learning in schools was adversely influenced by the patchwork nature of partnership support at national and local authority levels. This has curtailed the prioritizing of outdoor learning in schools and of teachers being supported when trying to make use of their increased curriculum decision-making responsibilities. Thus, only limited evidence was found of policy-related innovation and considerable evidence of policy stasis. As such, building national capacity is proving difficult. It is concluded that further research on how some atypical schools have managed to develop their programmes offers the best prospects for understanding the complexities of achieving greater levels of outdoor learning.

National governments set policies that affect local level development and influence the pace and content of development initiatives. Local economic development (LED) initiatives require a more robust focus on issues that places local government authorities at centre stage. For decades, at the local government authority level, much effort has been seen in the social development arena shadowing efforts to promote local businesses through business development services. National level organs set to promote businesses and to support the business agenda are expected to be the change catalysts and to propagate supportive policies for sustainable local economic development objectives. Nonetheless, the desired integration of efforts between national and local authorities and the civil society is yet to be observed. Additionally, frequent policy changes affecting the balance of power and authority between the national and local level authorities impact less positively local capacity to promote businesses despite the national efforts in infrastructure development. It is observed that better integration of efforts between the different actors, increased capacity of local authorities and implementation of local initiatives to surmount local challenges while working on policy attributed gaps, are necessary for promoting businesses at the local authority level.

149 Background: Advanced Non-Small Cell Lung Cancer (aNSCLC) impacts the lives of patients and their caregivers. This analysis aimed to provide insight into the clinical, patient and caregiver factors associated with increased caregiver burden. Methods: Data from a cross-sectional study of aNSCLC patients and informal (unpaid) caregivers in France, Germany and Italy, were collected from May 2015 to June 2016, consisting of a chart review and patient and caregiver surveys. Caregiver burden was assessed using the Zarit Burden Interview (ZBI), measured on a 0-88 scale. An ordinary least square regression model was constructed to assess clinical, patient and caregiver factors associated with ZBI. Measured at time of survey completion, covariates included: country, patient age, sex, body mass index, stage of NSCLC, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), disease duration, smoking status, presence of brain metastases, histology, comorbidities, chemotherapy treatment, caregiver age and sex, and the number of formal (paid) and informal caregiver hours provided per week by additional caregivers. A significance level of 0.05 was used. Results: 331 caregivers were analysed. Mean (SD) caregiver age was 53.8 years (12.4), 239 (72.2%) were female. Caregivers provided a mean (SD) of 17.8 (23.4) hours of care per week. Mean (SD) formal / informal caregiver hours provided by other caregivers was 3.9 (13.3) / 3.9 (12.0). Many caregivers did not receive support from additional formal (75.5%) or informal (68.6%) caregivers. Mean (SD) ZBI score was 31.3 (14.8). Significant independent predictors of ZBI were patient’s ECOG-PS and number of additional informal caregiver hours provided. ZBI scores for caregivers of patients with an ECOG-PS of 3-4 were 7.68 units higher compared to those with an ECOG-PS of 0-2 (p = 0.006). Also, ZBI scores increased by 0.16 units per hour of informal caregiver provided by additional caregivers (p = 0.008). Conclusions: The key drivers of caregiver burden found in the study reinforce the need to develop supportive and personalised interventions to maintain patient performance status by delaying progression, and reduce informal caregiver hours supporting the patient.

ObjectiveWe examine the health‐related lifestyle behaviors of informal Spanish caregivers while controlling for sociodemographic characteristics.BackgroundInformal caregiving is an essential, albeit invisible, component of any health care delivery system that results in vast savings for national economies. Nevertheless, it remains unknown whether healthy lifestyle behaviors and the subsequent well‐being of informal caregivers may compromise their ability to continue providing their essential service.MethodWe compared the health‐related lifestyle behaviors between informal caregivers and non‐caregivers, applying generalized estimating equations analysis.ResultsWe observed no significant differences in self‐rated health status between caregivers and non‐caregivers. Women and men older than 44 years of age with less than 20 hours of care per week were more likely to eat fruit and engage in physical activity. Younger women caregivers (18–44 years) with less than 20 hours of care per week were also more physically active. However, younger men with less than 20 hours of care per week smoked more, and women were more likely to use alcohol. No differences were observed between non‐caregivers and caregivers with 20 or more of care per week.ConclusionsInformal caregiving affects women and men equally, being hours of care per week a determinant of caregiver/non‐caregiver differences on diet, physical activity, smoking, and drinking.ImplicationsThe results from these nationally representative data suggest both a healthy and unhealthy lifestyle caregiver effect for both women and men. This effect differs on the different health‐related behaviors and is related to the amount of time devoted to care.

Informal caregivers are integral components in the lives of individuals with health problems. However, little is known if the number of hours of informal care correlates with healthcare literacy levels. Thus, using the Center for Disease Control (CDC) Behavioral Risk Factor Surveillance (BRFSS) 2016 public dataset, the aim of this study examines the association between informal caregivers’ hours of care and their health literacy level, by controlling their social/emotional support, type of care they provide, and socioeconomic level. Data was weighted for complex sampling design and logistic regression to examine the data (Nf3,249). The study’s results show that being full-time or part-time caregiver has no association to healthcare literacy in verbal (OR=0.99, 95% CI=0.57–1.71) and written (OR=1.21, 95% CI=0.78–1.85) comprehensions. Further, caregiver’s type of care does not correlate to healthcare literacy level in verbal (OR=0.87, 95% CI=0.58–1.32; OR=0.93, 95% CI=0.59–1.45) and written (OR=0.91, 95% CI=0.66–1.27; OR=0.81, 95% CI=0.57–1.16) comprehensions. However, caregivers who rarely-to-never receive social/emotional support are four times more likely to have difficulties understanding verbal health information than those who have always-to-usually receive social/emotional support (OR=4.02, 95% CI=2.45–6.61). Caregivers who rarely-to-never receive social/emotional support are two times more likely to have difficulties understanding written health information compared to those that have always-to-usually receive social/emotional support (OR=2.30, 95% CI=1.51–3.51). Caregivers with lower socioeconomic backgrounds are at higher probability of low healthcare literacy level. Our study suggests further longitudinal and qualitative research, to understand healthcare literacy level among informal caregivers, and how social support systems correlates to healthcare literacy level.

Alzheimer’s disease and related dementias (ADRD) affect >5 million Americans. Persons with ADRD experience functional limitations and often require support from informal caregivers (e.g., help with feeding). Little is known about how caregiving evolves over the full course of the disease. We used data from the Health and Retirement Study to identify incident predicted community-dwelling persons with ADRD (n=565), their informal caregivers, and the total hours of care they received in a month from predicted incidence up to 8-years post incidence. We estimated linear mixed-effects models to determine the characteristics of the person with ADRD that are associated with trajectories of caregiving hours. At predicted incidence, persons with ADRD received 120 hours of care in a month of which spouses provided 30% of care hours, adult children provided 32% of care hours, other relatives provided 12% of care hours, and non-relatives (including paid support) provided 25% of care hours. By 8-years post incidence, persons with ADRD still in the community (n=23) received 303 hours of care in a month of which spouses provided 28% of care hours, adult children provided 41% of care hours, other relatives provided 3% of care hours, and non-relatives provided 28% of care hours. Having great grandchildren and more functional limitations were associated with receiving more hours of informal care. Attrition (mortality and residing in a nursing home) was influenced by hours of care received in the previous interview and resulted in those that remained in the community being persons that required less care.

Background: Caregiver burden has negative effects on mental and physical health along with quality of life. Meanwhile, social and physical distancing protocols during the COVID-19 pandemic have created additional impacts on informal caregiving in a rapidly changing environment. Early research over the past year suggests that the pandemic has caused increased caregiver burden as well as caregiving intensity among these individuals. Purpose: Our primary purpose in this informational literature review is to describe the impacts of the pandemic on informal caregiver burden and the sudden shift in roles and responsibilities as a result of pandemic-related changes in caregiving. This review will describe emerging effects on various aspects of health among informal caregivers and explore the growing need to support unpaid caregiving during this time. Methods: A streamlined search was conducted to fit the scope of this review, with key terms determined to identify relevant publications. Common research databases and up-to-date mainstream resources were utilized. Notably, we focused on research published or released since March 2020, primarily rapidly reviewed studies, to align with the timing of the COVID-19 pandemic in the US. Results: Early research suggests that the pandemic has worsened caregiver burden and increased caregiving intensity and hours of care among unpaid, informal family caregivers. Reported health impacts include higher stress, pain, and depression, along with decreased social connectedness and quality of life. Notably, however, COVID-related research generally does not focus on the positive aspects of caregiving, such as its role as a source of purpose in life, creating an opportunity to explore ways to boost certain valuable personal resources among caregivers. Conclusions: Informal family caregivers face their own negative health outcomes and distress as a result of greater caregiver burden, intensity, and the changing landscape of caregiving during the ongoing COVID-19 pandemic. Immediate policy and support recommendations should be considered to alleviate informal caregiver burden and provide ongoing resources over the longer term. In addition, future work should explore the potential of boosting positive resources such as resilience and purpose to ease caregiver burden.

BackgroundSubstantial inequalities in age-standardised cardiovascular disease (CVD) mortality rates exist at the local authority (LA) level within England, with particular areas having consistently higher rates. Higher deprivation is associated with...

BackgroundThere are few data sets that provide detailed population health data at a geographic scale below Government Office Region, and few estimates at a finer scale are validated against real-world...

Economic Valuation of Informal Care: Conjoint Analysis Applied in a Heterogeneous Population of Informal Caregivers

The provision of informal nursing care can adversely affect a caregiver's mental health, but the dynamic association of the variables is still under debate. We examined how an informal caregiver's psychological distress is associated with prolonged caregiving. We used data collected from a nationwide six-wave panel survey in Japan, with 25,186 observations of 9192 individuals. We focused on informal caregivers, who provided help and support for ill family members. We used Kessler 6 (K6) scores (range 0-24), where higher scores reflect higher levels of psychological distress. We employed mixed-effects models to examine how caregivers' psychological distress was associated with caregiving commencement and duration. Commencement of caregiving raised the K6 score for female caregivers by 0.55 (equivalent to 0.12 SD, 95% CI 0.34-0.75) and that for male caregivers by 0.41 (0.09 SD, 95% CI 0.18-0.63). However, prolonged caregiving had gender-asymmetric, dynamic associations with psychological distress. One additional year of caregiving added 0.22 (0.05 SD, 95% CI 0.10-0.35) to the K6 score of female caregivers, while it had no significant association for male caregivers. For female caregivers, prolonged caregiving was positively associated with K6 score entirely through its interaction effects with longer hours of care, co-residence with a care recipient, and the non-working status of a caregiver. Results revealed a gender-asymmetric, dynamic association between informal care provision and caregivers' psychological distress. Additional policy measures targeted at caregivers deeply involved in in-house care are needed to reduce their distress.

Commentaries on health services research