Care Grant Research Articles

Cardiovascular equity and health center funding: Associations of unmet hypertension and diabetes need by race/ethnicity and federal grants at federally qualified health centers, 2014-2019.

Racial and ethnic disparities in chronic disease are a major public health priority. To determine if the amount of federal grant funding to federally-qualified health centers (FQHCs) was associated with baseline overall prevalence of uncontrolled hypertension and uncontrolled diabetes, as well as prevalence by racial and ethnic subgroup. Cross-sectional multivariate regression analysis of Uniform Data System 2014-2019, which includes clinic-level data from each FQHC regarding demographics, chronic disease control by race and ethnicity, and grant funding. Our main exposure were the average values of the prevalence of uncontrolled hypertension and uncontrolled diabetes among the overall population and by racial and ethnic group from 2014-2016. Average federal grant funding per patient from 2017-2019, as measured by annual health center funding from the Bureau of Primary Health Care (BPHC) and overall federal grant funding. We analyzed 1,205 FQHCs from 2014-2019; the average BPHC grant per patient across all FQHCs in 2019 was $168 while the average total federal grant was $184 per patient. Increasing shares of total patients with uncontrolled hypertension or uncontrolled diabetes were not associated with increased total federal grant funding in either unadjusted or adjusted analysis. Increased shares of patients who are American Indian or Alaskan Native (AI-AN) with uncontrolled hypertension and diabetes were associated with increasing total federal grant funding in both unadjusted and adjusted analysis (adjusted beta hypertension $168.3, p <0.001; adjusted beta diabetes 59.44, p = 0.02). However, cardiovascular clinical need among other racial and ethnic groups was not significantly associated with grant funding. FQHCs with higher overall rates of uncontrolled hypertension or diabetes do not receive more federal funds, and there is no significant association between federal funding levels and rates of uncontrolled blood pressure or diabetes within most racial and ethnic groups, with the exception of AI-AN populations. To narrow inequities in cardiovascular disease, HRSA should consider more explicitly targeting federal grants to clinics with higher levels of clinical need.

Is There a Relationship Between Damage-Associated Molecular Patterns (DAMPs) And Colorectal Cancer?

Objectives: Interleukin 1 α (IL-1α) and High Mobility Group Box 1 (HMGB1) are damage-associated molecular patterns (DAMPs), which have been associated with cancer progression by promoting proliferation, angiogenesis, invasion, and metastasis. This study aimed to determine the expression of IL-1α and HMGB1 in CRC tumours compared to their normal tissue adjacent to tumour (NAT) in CRC patients and their relationship with clinicopathological features. Methods: Ethics approval was obtained from Medical Research Ethics Committee University of Malaya Medical Centre (UMMC). 40 adult patients who underwent CRC tumour resection were recruited. Important clinical information was noted from the patient’s medical records. DAMPs expression levels in tumour and NAT samples were determined based on the percentage of area stained using immunohistochemistry (IHC). Images were analysed using Image J software and subjected to statistical analysis testing for comparison and correlations. Results: 20 male and 20 female patients were recruited with a mean age of 67.93 ± 1.697 years. Patients presented with stage I, 11, III and IV were 11 (27.5%), 11 (27.5%), 16 (40%) and 2 (5%) respectively. Stage IV subjects were excluded from analysis due to low numbers. IL-1α and HMGB1 were significantly higher in tumour samples when compared to NAT, with IL-1α in tumour 17.29% ± 1.685% and 8.326% ± 0.994% in NAT (p &lt; 0.0001), and HMGB1 expressions being 0.04% ± 2.383% in tumour and 22.95% ± 1.848% in NAT (p = 0.0213). A significant difference and positive correlation were observed in the levels of HMGB1 with disease staging (p = 0.0461, r = 0.344). No significant correlations were found with other clinicopathological features. Conclusion: Higher levels of DAMPS in tumour tissues and higher levels of HMGB1are correlated with more advanced disease staging could serve as potential diagnostic and prognostic markers for CRC. This work was supported by UMSC Care Grant PV017-2020.International Journal of Human and Health Sciences Supplementary Issue 01: 2024 Page: S52

Bridging gaps: Transforming dental public health training for modern job market demands.

To create optimal oral and overall community health, dental public health (DPH) specialists must be competent and appropriately skilled to deal with contemporary and emergent public health issues. This study aims to evaluate the current job market demands related to the DPH profession and suggest contemporary skills and qualities that would enable DPH professionals to address emerging issues more effectively in their field. A multimethod qualitative study was conducted involving two distinct groups: employers and potential employees. Interviews of stakeholders (employers)representing different job market domains, and a surveywas administered to recent DPH residency graduates (employees). Qualitative analysis was applied to the data collected. Employers identified the following skills as crucial for future DPH employees: proficiency in care delivery systems, health informatics, clinical training, leadership, and professional and grant writing skills. Many employers assumed the presence of a clinical component in the residency program. DPH residency graduates emphasized that the most significant barrier to securing positions is the lack of clinical experience within the residency program. This research highlights skills currently valued by the DPH job market and proposes that DPH specialty training may consider revising its curriculum to include these skills. Implementing such updates would ensure that graduates are well equipped and competitive, thus significantly contributing to the broader objective of attaining optimal oral health and overall well-being of the community.

Policies addressing suspension and expulsion in state early care and education subsystems: A national census of policy alignment and integration

Exclusion from early care and education (ECE) programs creates employment challenges for families and disrupts learning for children, often differentially impacting children placed at-risk due to income, race, and disability. Federal policy guidance and changes in the Child Care and Development Fund (CCDF) Block Grant requirements are meant to influence states to create policies that will both regulate and prevent disciplinary exclusions, especially suspension and expulsion. We present a national census of states’ CCDF plans, center-based child care licensing regulations, and state pre-K policies addressing suspension and expulsion. Using content analysis methodology, we evaluate the presence of key policy components of suspension and expulsion prevention including data collection, parent/family involvement in the process of exclusions, accessing community resources, and the use of developmental information to inform the use of exclusionary discipline. Our results indicate that expulsion and suspension policies vary widely both across states, and within the same state's subsystems. The component found most frequently across all subsystems is an expulsion policy, with noticeable variation in specifying and defining suspension. Our findings also point to a great deal of variance in policy alignment, with pre-K including the most information on expulsion and suspension policies and prevention. As state-level policymakers seek to adopt policies that reduce exclusion in ECE, our findings point to a need to consider the importance of creating policies that protect children, especially those over exposed to exclusionary discipline, and then aligning those components within and across ECE subsystems to promote equitable access to ECE. This is particularly important for low-income families, Black children, children with disabilities, and boys.

Prospective MRI and Neurocognitive Assessment of “Chemobrain” in Acute Myeloid Leukaemia: The Mineral Study

CONCLUSIONS “Chemobrain” is commonly reported by patients treated for Acute Myeloid Leukaemia (AML), potentially attributable to chemotherapy or iron overload. We aimed to determine whether “chemobrain” could be objectively detected in AML patients. We performed a prospective, observational, longitudinal cohort study in adults commencing chemotherapy for AML, powered to capture a potential 25% incidence of “chemobrain.” Participants underwent neurocognitive assessment (NCA) and brain magnetic resonance imaging (MRI), including iron quantitative susceptibility mapping (QSM), as a biomarker of neuro-inflammation, at three timepoints: pre-treatment (T1), end of treatment (T2), and 6 months later (T3). Longitudinal changes of minimum 1.64 SD were considered significant. The primary outcome was change in NCA score between T1-T2, with secondary correlation analyses between NCA, MRI, QSM and clinical data. This study was funded by a RBWH Foundation 2018 Diamond Care Grant. Between January 2019 and June 2021, 20 patients were enrolled; of these, 15 and 10 remained alive/enrolled for evaluation at T2 and T3 respectively. Overall NCA scores for the cohort between T1-T2 were similar; however, four (27%) participants performed significantly worse (-1.64SD) in Language or Verbal Memory, with three returning to baseline at T3. Objective NCA score did not correlate with subjective symptoms, and quality of life and physical fatigue improved T1-T2. Cohort brain volumes were similar T1-T2; however, correlation analysis identified interesting potential associations between worse Language performance and volume loss in grey matter (GM; p=0.021) and Wernicke's area (p=0.02), and suggested increased iron susceptibility in frontal lobe (p=0.041) and possibly cortical GM (p=0.055). Despite patient-reported symptoms, objective neurological toxicity appears uncommon in AML patients, and those with measurable impairment appear to subsequently return to baseline.

Equity considerations in clinical practice guidelines for traumatic brain injury and homelessness: a systematic review

Clinical practice guidelines (CPGs) predominantly prioritise treatment and cost-effectiveness, which encourages a universal approach that may not address the circumstances of disadvantaged groups. We aimed to advance equity and quality of care for individuals experiencing homelessness and traumatic brain injury (TBI) by assessing the extent to which homelessness and TBI are integrated in CPGs for TBI and CPGs for homelessness, respectively, and the extent to which equity, including consideration of disadvantaged populations and the PROGRESS-Plus framework, is considered in these CPGs. For this systematic review, CPGs for TBI or homelessness were identified from electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google Search, and reference lists of eligible CPGs on November 16, 2021 and March 16, 2023. The proportion of CPGs that integrated evidence regarding TBI and homelessness was identified and qualitative content analysis was conducted to understand how homelessness is integrated in CPGs for TBI and vice versa. Equity assessment tools were utilised to understand the extent to which equity was considered in these CPGs. This review is registered with PROSPERO (CRD42021287696). Fifty-eight CPGs for TBI and two CPGs for homelessness met inclusion criteria. Only three CPGs for TBI integrated evidence regarding homelessness by recognizing the prevalence of TBI in individuals experiencing homelessness and identifying housing as a consideration in the assessment and management of TBI. The two CPGs for homelessness acknowledged TBI as prevalent and recognised individuals experiencing TBI and homelessness as a disadvantaged population that should be prioritised in guideline development. Equity was rarely considered in the content and development of CPGs for TBI. Considerations for equity in CPGs for homelessness and TBI are lacking. To ensure that CPGs reflect and address the needs of individuals experiencing homelessness and TBI, we have identified several guideline development priorities. Namely, there is a need to integrate evidence regarding homelessness and TBI in CPGs for TBI and CPGs for homelessness, respectively and engage disadvantaged populations in all stages of guideline development. Further, this review highlights an urgent need to conduct research focused on and with disadvantaged populations. Canada Research Chairs Program (2019-00019) and the Ontario Ministry of Health and Long-Term Care (Grant #725A).

Southern Care: A Rapid Response to Supporting Southern CBOs at the onset of COVID-19.

Southern community-based and HIV/AIDS service organizations (CBOs) were particularly vulnerable to the onset of COVID-19 due to already fragile infrastructures and underfunded budgets. At the height of the pandemic, the Gilead COMPASS Coordinating Centers launched the Southern CARE Grant, awarding 41 grants to provide supplemental operational support funds.

Measurement of social connection in people with dementia living in care homes

AbstractBackgroundSocial connection is a fundamental human need. For those living in long‐term care (LTC) settings, social connection influences quality of life and care. However, social connection has not been clearly conceptualized, nor is it routinely measured, in LTC. LTC residents have complex health needs, and are separated from previous social networks while residing in communal care environments, so measurement instruments need to be tailored and tested in these settings. Currently, there is no evidence‐based consensus on the best approaches to defining or measuring social connection in LTC homes. In this project, funded by an Alzheimer’s Association/Brain Canada Advancing Research on Care and Outcome Measurement grant, we aim to systematically describe all previous of social connection measures in LTC residents and evaluate their psychometric properties.MethodsWe searched eight databases until November 18th, 2021. We used the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) filter to identify studies reporting instrument measurement properties. We included primary studies reporting ≥1 psychometric property (including validity, reliability, internal consistency, responsiveness) of a measure of social connection (including social engagement/ support/ networks/ isolation, loneliness, and other related constructs), tested among LTC residents. Two reviewers will independently screen titles and abstracts and then conduct full text review.To assess measure form and content, we will describe the measures and their target settings, and conduct a thematic content analysis on all items. To evaluate psychometric properties, we will assess each measure using the COSMIN risk of bias checklist and summarize the evidence for the nine measurement properties. We will rate the measure overall using a Grading of Recommendations Assessment, Development, and Evaluation approach.ResultsAfter removing duplicates, our search yielded 5945 studies. We excluded 5818 studies after screening titles and abstracts, leaving 127 papers for full text review.ConclusionsWe will present results of this ongoing systematic review on content and psychometric properties of social connection measures in LTC residents. Through this presentation, we will elicit feedback from stakeholders on our findings to date. This feedback will inform our development of a new measure to assess social connection in people living in LTC homes.

News Media Coverage of Childcare: How U.S. Local TV News Framed the Problem Before and During the Early Stage of the COVID-19 Pandemic

Early care and education (ECE), or the care young children receive before entering formal schooling, can take multiple forms and is delivered in different settings, such as a center, church, or public school. Federal and state governments regularly fund ECE programs and policies through the Child Care and Development Block Grant Act (CCDBG). Many families, however, face significant challenges in access, cost, and quality of ECE programs, and ECE professionals report substantial challenges in the workplace (e.g., inadequate training) and beyond (e.g., low wages). Policies addressing issues related to ECE were proposed in 2021, but stalled on the U.S. federal policy agenda. In this study, we examine the ECE content of local television news coverage both for its representations of and for its potential influences on ECE policy agendas. We use data from local stations affiliated with the major networks (ABC, NBC, CBS, and FOX) in media markets across the U.S., airing before and during the pandemic. We analyze elements of coverage that could affect public recognition of ECE-related issues, including how problems were framed (e.g., news coverage highlighting scandals or adverse events at ECE facilities) and solutions identified (e.g., public policy). We find that during 2018 and 2019, more coverage highlighted scandalous activity than public policy. The reverse was true, however, during the early period of the pandemic (from mid-March through June of 2020). Researchers and health professionals were seldom included in stories in either sample, and very few stories offered context about the benefits of ECE for health and well-being. These coverage patterns have implications for the public’s understanding of ECE policy and the perceived need for reform. Policymakers, advocates, and researchers looking to advance support for ECE should consider ways to use local television news to present health and policy-relevant information to broad segments of the public.

Sustainability of health services in refugee hosting districts: a qualitative study of health services in three west Nile refugee hosting districts, Uganda

BackgroundHumanitarian health assistance programmes have expanded from temporary approaches addressing short-term needs to providing long-term interventions in emergency settings. Measuring sustainability of humanitarian health services is important towards improving the quality of health services in refugee settings.ObjectiveTo explore the sustainability of health services following the repatriation of refugees from the west Nile districts of Arua, Adjumani and Moyo.MethodsThis was a qualitative comparative case study conducted in three west Nile refugee-hosting districts of Arua, Adjumani, and Moyo. In-depth interviews were conducted with 28 purposefully selected respondents in each of the three districts. Respondents included health workers and managers, district civic leaders, planners, chief administrative officers, district health officers, project staff of aid agencies, refugee health focal persons and community development officers.ResultsThe study shows that in terms of organization capacity, the District Health Teams provided health services to both refugee and host communities with minimal support from aid agencies. Health services were available in most former refugee hosting areas in Adjumani, Arua and Moyo districts. However, there were several disruptions notably reduction and inadequate services due to shortage of drugs and essential supplies, lack of health workers, and closure or relocation of health facilities in around former settlements. To minimize disruptions the district health office reorganized health services. In restructuring health services, the district local governments closed or upgraded health facilities to address reduced capacity and catchment population. Health workers employed by aid agencies were recruited into government services while others who were deemed excess or unqualified were laid off. Equipment and machinery including machines and vehicles were transferred to the district health office in specific health facilities. Funding for health services was mainly provided by the Government of Uganda through the Primary Health Care Grant. Aid agencies, however, continued to provide minimal support health services for refugees who remained in Adjumani district.ConclusionOur study showed that while humanitarian health services are not designed for sustainability, several interventions continued at the end of the refugee emergency in the three districts. The embeddedness of the refugee health services in the district health systems ensured health services continued through public service delivery structures. It is important to strengthen the capacity of the local service delivery structures and ensure health assistance programmes are integrated into local health systems to promote sustainability.

Dedicated Parents, Successful Mathematicians: Child Care Grant Recipients Share Their Stories

Dedicated Parents, Successful Mathematicians: Child Care Grant Recipients Share Their Stories

American Indian and Native Hawaiian Nonprofit Organization Child Care Grant (ACF)

Federal Grants & ContractsVolume 46, Issue 12 p. 7-7 Grants Alerts American Indian and Native Hawaiian Nonprofit Organization Child Care Grant (ACF) First published: 17 May 2022 https://doi.org/10.1002/fgc.32392Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume46, Issue1219 May 2022Pages 7-7 RelatedInformation

MP48-03 PREVALENCE AND NATURAL HISTORY OF NON-METASTATIC CASTRATE RESISTANT PROSTATE CANCER: A POPULATION-BASED ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP48-03 PREVALENCE AND NATURAL HISTORY OF NON-METASTATIC CASTRATE RESISTANT PROSTATE CANCER: A POPULATION-BASED ANALYSIS Amanda Hird, Erind Dvorani, Refik Saskin, Sender Herschorn, Ronald Kodama, Girish Kulkarni, and Robert Nam Amanda HirdAmanda Hird More articles by this author , Erind DvoraniErind Dvorani More articles by this author , Refik SaskinRefik Saskin More articles by this author , Sender HerschornSender Herschorn More articles by this author , Ronald KodamaRonald Kodama More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , and Robert NamRobert Nam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002619.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The natural history of non-metastatic castrate resistant prostate cancer (nmCRPC) prior to the introduction of novel anti-androgen agents in a real-world setting is largely unknown. Our primary aim was to determine the prevalence and natural history of nmCRPC. METHODS: This was a retrospective population-based cohort study of men with nmCRPC in Ontario, Canada. Patients with a diagnosis of prostate cancer, castrate level of testosterone (<1.7 nmol/L) and a PSA >2.0 nmol/L with a subsequent rise >25% from the nadir, and without diagnostic or treatment codes for metastasis were included. Annual prevalence of nmCRPC was calculated. Crude time from nmCRPC to metastasis and death are presented as medians with interquartile range (IQR). Predictors of time from nmCRPC to prostate cancer death were compared using univariable and multivariable Fine and Gray subdistributional hazard models to account for the competing risk of non-prostate cancer death. RESULTS: From January 2007 until March 2018, we identified 2045 patients with nmCRPC. Median age was 79 years (IQR: 72-84). A total of 984 patients (48.1%) received upfront hormonal therapy while 584 (25.8%) received initial radiotherapy (RT) and 478 (23.4%) previously underwent radical prostatectomy. Median time from primary treatment to nmCRPC was 6 years (IQR: 3-10). PSA at the time of meeting nmCRPC criteria was a median of 3.0 ng/L. Patients were followed for a median 31.1 months (IQR: 19.8-47.9). The overall annual prevalence of nmCRPC ranged from 1,519-1,913 patients, representing 7-12% of men with prostate cancer prescribed androgen deprivation therapy each year. Crude median time from nmCRPC to all-cause death was 37.6 months (IQR: 22.1-55.4). Median time from nmCRPC to metastasis and metastasis to all-cause death was 20.0 and 8.3 months, respectively. On regression analysis, older patients, patients who had a higher PSA at the time of meeting nmCRPC criteria, and patients with grade group 4-5 disease had a shorter time from nmCRPC to prostate cancer death. CONCLUSIONS: This is the largest analysis of the prevalence and natural history of nmCRPC. The current study can be used as a historical cohort to compare how novel imaging modalities and advancements in systemic therapy for patients with nmCRPC impact prevalence estimates and disease trajectory over time. Source of Funding: This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and Ministry of Long-Term Care (MLTC) (grant number not applicable). This study also received funding from the Ajmera Family Chair in Urologic Oncology awarded to RKN (grant number not applicable). We thank IQVIA Solutions Canada Inc. for use of their Drug Information File © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e821 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Hird More articles by this author Erind Dvorani More articles by this author Refik Saskin More articles by this author Sender Herschorn More articles by this author Ronald Kodama More articles by this author Girish Kulkarni More articles by this author Robert Nam More articles by this author Expand All Advertisement PDF DownloadLoading ...

Restoring An Inclusionary Safety Net For Children In Immigrant Families: A Review Of Three Social Policies

Since the enactment of the Personal Responsibility and Work Opportunity Reconciliation Act, known as "welfare reform," in 1996, US social policy has increasingly stratified immigrants by legality, extending eligibility exclusions, benefit limitations, and administrative burdens not only to undocumented immigrants but also to lawful permanent residents and US citizens in immigrant families. This stratification is a form of structural discrimination, which is a social determinant of health. Children in immigrant families, most of whom are US citizens, have not been able to fully realize the benefits from social safety-net programs-including the 2020 Coronavirus Aid, Relief, and Economic Security Act stimulus payments. Policy deliberations over pandemic recovery, the equity focus of the Biden administration, and proposals to address child poverty provide an opportunity to reexamine immigrant exclusions, restrictions, and administrative burdens in public programs. We discuss immigrant stratification by legal status in social policy and review how it affects citizen children in mixed-status families in three safety-net programs: the Earned Income Tax Credit, Supplemental Nutrition Assistance Program, and Child Care and Development Block Grant. We provide eight policy recommendations to restore equity to the social safety net for children in immigrant families.

Keeping Kids in Care: Reducing Administrative Burden in State Child Care Development Fund Policy

Abstract With limited federal requirements for block grants, states have developed very different welfare policies, often with onerous recertification or reporting requirements, creating barriers to continuous program enrollment. Examined through the framework of Administrative Burden, our study examines how changes to burdensome policies in states’ Child Care Development Fund (CCDF) programs affect the length of children’s continuous enrollment in child care through the CCDF program, known as subsidy “spells.” We exploit state-level changes in three key policies during a 10-year period (2004–13) that capture administrative burden: (1) length of eligibility redetermination; (2) reporting requirements for income changes; and (3) grace period for care before termination. Using state fixed effects analyses in a sample of 38 states using data from the Administration for Children and Families and multiple other sources, we find that administrative burdens meaningfully and robustly affect continuous enrollment in CCDF; switching to a 12-month redetermination period, as required 2014 Child Care and Development Block Grant reauthorization, increases children’s continuous enrollment in CCDF care (i.e., state median spell length) by 30%. In contrast, requiring all changes in family income to be reported while enrolled in CCDF decreases spell length by 7%. Results underscore the importance of reducing administrative burdens related to compliance costs to better support low-income citizens, especially those with young children, and improve child development.

An examination of child care provider participation in state subsidy contract systems

Under the Child Care and Development Block Grant Act of 2014, the federal government requires that states build their supply of high quality child care and ensure that subsidy-receiving children have equal access to care. While the majority of states use child care vouchers as their primary or only subsidy mechanism, federal policy encourages states to directly contract with child care providers for subsidized slots as a strategy to promote quality and access to care, particularly for underserved populations. However, little is known about the characteristics of providers that participate in contracts or the factors that hinder or facilitate their participation. This study seeks to identify correlates of provider participation in contracts versus vouchers using administrative data on licensed center-based child care providers participating in Massachusetts’ subsidy system. The study finds that while centers that are members of umbrella organizations or are accredited are more likely to participate in contracts compared to vouchers only, centers that are for-profit organizations or located in communities with higher median household incomes are less likely to participate in contracts. No evidence is found to suggest that a larger gap between centers’ private pay prices and the subsidy reimbursement rate influences their participation in contracts. These results suggest that higher administrative capacity or mission-driven providers are more likely to participate in contracts and that contracted slots are likely to be available in low-income areas, which can help to improve access to care for low-income families.

Support for Non-Relative Female Foster Parents in South Africa: Quality of Care and Placement Outcomes

Caring for and protecting vulnerable children in foster care continues to be an important realisation of the rights of children in South Africa. The weakening of the extended family and the increasing number of orphaned and vulnerable children give rise to the relevance of non-relative fostering. This article discusses the different sources of support used by female non-relative foster parents when caring for the children. The findings come from a broader doctoral study that explored the experiences of non-relative foster parents. The data were collected using semi-structured interviews and a focus group discussion. The findings indicate that the participants received the same support as relative foster parents, including financial support from the government in foster care grants, support from faith-based organisations, and support from nuclear family members. Most participants were self-supported through personal incomes and savings, which differed from relative foster parents who relied solely on the foster care grant. The participants received limited or no support from social workers or agencies. This article concludes that the type of support available to non-relative foster parents is the same as that for relative foster parents, and it influences the quality of care and placement outcome. With adequate support, the burden of caring is lessened therefore improving the quality of care. Therefore, it is necessary to provide holistic support to non-relative foster parents to secure their willingness to continue caring, thus improving the quality, recruitment, and retention of foster parenting.

The view of foster parents’ on the adequacy of foster care grant in meeting the needs of recipients in Amathole District, South Africa

Initially, foster care grant originated to assist children removed from their families of origin and placed in alternative care due to their vulnerability, neglect and abuse. Foster care grant forms part of the child protection system and it is issued to children whom require care and protection and are deprived of proper upkeep. The aim of the study was to explore the view of foster parents on the sufficiency of the child support grant in meeting the basic needs of beneficiaries. The study adopted a qualitative research approach. Moreover, in-depth interviews were used to collect data with purposively selected participants. The finding of this study revealed that the grant is sufficient in providing for the nutritional, educational and sartorial needs of beneficiaries. The study sample consisted of twenty-five participants. The study concluded that the grant is sufficient but could be increased to provide funds for some additional stuffs like educational policies, which is essential in securing a decent future for children. &#x0D; Keywords: &#x0D; Sufficiency, basic needs, foster care grant, beneficiaries.

Child Care During the COVID-19 Pandemic: A Bad Situation Made Worse.

* Abbreviation: COVID-19 — : coronavirus disease 2019 Pediatricians have long recognized that social determinants (the circumstances in which children live, learn, and play) influence the health and well-being of children and their families.1 The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of this broader scope of health care, which encompasses more than simply addressing a child’s medical conditions. Although the vast majority of COVID-19 cases in children have been mild, the secondary effects on the health of children have been profound. Downstream effects of the virus on a family’s social circumstances, including increased food insecurity, housing instability, school closures, and lack of child care, have exacerbated preexisting socioeconomic and racial disparities.2 Although it has often been overlooked, the need for safe and enriching child care that allows parents to be able to work, particularly for the most vulnerable children in our society, has become more acute over the last several months and requires urgent action. The pandemic has brought to light the lack of safe, reliable, and affordable child care options. Even before the closure of many facilities, child care was plagued by long waitlists, ballooning costs, and safety concerns. Child care costs for preschool-aged children can rival college tuition,3 making high-quality child care nearly inaccessible for many families, especially those experiencing material hardships. With recent school closures due to … Address correspondence to Nikita Kalluri, MD, Boston Medical Center, 801 Albany St, Boston, MA 02119. E-mail: nikita.kalluri{at}childrens.harvard.edu

Static Socio-Ecological COVID-19 Vulnerability Index and Vaccine Hesitancy Index for England

Background: Population characteristics can be used to infer vulnerability of communities to COVID-19, or to the likelihood of high levels of vaccine hesitancy. Communities harder hit by the virus, or at risk of being so, stand to benefit from greater resource allocation than their population size alone would suggest. This study reports a simple but efficacious method of ranking small areas of England by relative characteristics that are linked with COVID-19 vulnerability and vaccine hesitancy.Methods: Publicly available data on a range of characteristics previously linked with either poor COVID-19 outcomes or vaccine hesitancy were collated for all Middle Super Output Areas of England (MSOA, n=6790, excluding Isles of Scilly), scaled and combined into two numeric indices. Multivariable linear regression was used to build a parsimonious model of vulnerability (static socio-ecological vulnerability index, SEVI) in 60% of MSOAs. Spearman correlation coefficients were calculated between the SEVI and cumulative COVID-19 case rates at MSOA level in the remaining 40% of MSOAs over periods both during and out with national lockdowns. Similarly, a novel vaccine hesitancy index (VHI) was constructed using population characteristics aligned with factors identified by an Office for National Statistics (ONS) survey analysis. The relationship between the VHI and vaccine coverage in people aged 12+years (as of 24/06/2021) was determined using Spearman correlation. The indices were split into quintiles, and MSOAs in with the highest vulnerability and vaccine hesitancy quintiles were mapped.Findings: The SEVI showed a strong relationship with case rates in the validation dataset across the whole study period, and for every intervening period studied except early in the pandemic when testing was highly selective. The SEVI was more strongly correlated with case rates than any of its domains and outperformed an existing MSOA-level vulnerability index. The VHI was significantly negatively correlated with vaccine coverage in the validation data at the time of writing (r -0·43 95% CI -0·46 to -0·41). London had the largest number and proportion of MSOAs in quintile 5 of SEVI and VHI concurrently.Interpretation: The indices presented offer an efficacious way of identifying geographical disparities in COVID-19 risk, thus helping focus resources according to need.Funding Information: Grant from Integrated Covid Hub North East.Declaration of Interests: DS and CW are part-funded by a Department of Health and Social Care grant to the Newcastle upon Tyne Hospitals NHS Foundation Trust for the Integrated COVID Hub North East for the purposes of local pandemic response, paid via the University of Newcastle (the primary employer of all authors). Grant awarded to FM.