Care Arrangements Research Articles

Chinese older adults’ prior-to-death disability profiles and their correlates

BackgroundDisability prior to death complicates end-of-life care. The present study aimed to explore the prior-to-death disability profiles of Chinese older adults, the profiles’ links to end-of-life care arrangements and place of death, and predictors of the profiles.MethodsIn total, data were extracted from the records of 10,529 deceased individuals from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Latent profile analyses, bivariate analysis, and multivariate logistic regression were applied to identify prior-to-death disability profiles, explore the profiles’ links to end-of-life care arrangements and place of death, and examine predictors in the profiles, respectively.ResultsThree prior-to-death disability profiles, namely, Disabled-Incontinent (37.6%), Disabled-Continent (34.6%), and Independent (27.8%), were identified. Those with the Independent profile were more likely to live alone or with a spouse and receive no care or care only from the spouse before death. Disabled-Continent older adults had a higher chance of dying at home. Being female, not “married and living with a spouse”, suffering from hypertension, diabetes, stroke or cerebrovascular disease (CVD), bronchitis/emphysema/pneumonia, cancer, or dementia, and dying in a later year were associated with more severe prior-to-death disability patterns. Not having public old-age insurance predicted lower chances of having a Disabled-Incontinent profile, and advanced age increased the chance of having a Disabled-Continent profile.ConclusionsThree prior-to-death disability patterns were identified for Chinese adults aged 65 years and older. These profiles were significantly linked with the end-of-life caregiving arrangements and place of death among older adults. Both demographic information and health status predicted prior-to-death disability profiles.

“This is Not My War:” Moral Challenges Faced by Migrant Home Care Workers at Times of War

ObjectiveThe present study aimed to examine the experiences of migrant home care workers following the October 7 massacre and the Israel-Hamas war that followed. MethodsAbout 25 interviews with migrant home care workers were conducted. Interviews were analyzed thematically. ResultsAn overarching theme of moral challenges at times of war was identified. The first theme addressed the challenges faced by migrant home care workers who find themselves during a war that is not theirs. A second theme concerned the requirement to seek shelter within a very short period, which means that at least some older care recipients under certain conditions are unable to reach a safe room on time. The third theme concerned the dilemma of staying in Israel versus going home to a safe place, given the ongoing war. ConclusionsThe findings highlight the interdependence which is formed within the migrant home care arrangement and the challenges faced by migrant home care workers, who transitioned for financial reasons, but found themselves in a war situation with financial, emotional, and social commitments that challenge their loyalties.

Informalizing childcare during the COVID-19 pandemic: Policy responses to childcare and their implications for working parents in Denmark, England and Germany

The closure of extra-familial childcare facilities by European governments in 2020 was an important part of interventions against the spread of the COVID-19 pandemic. One consequence was that childcare was provided by parents at home, mainly by women. As a result, women mainly experienced financial and employment risks related to this “informalization” of childcare. The childcare policies of European welfare states differ in the extent to which they include measures to reduce the social risks related to informalization. Against this backdrop, this paper asks: How should one understand cross-national differences in childcare policies during the pandemic? We are also particularly interested in the effects of childcare policies on the social risks connected with the informalization of childcare and what these mean for the gendered division of paid work and care. Differences in childcare policies during the pandemic are commonly explained in terms of the path dependence of such policies. Using the theoretical approach of “care arrangement,” this article introduces a broader theoretical framework that considers the role of cultural and institutional factors for understanding the cross-national differences in childcare policies during the pandemic. We introduce the findings of a comparative empirical study of childcare policies in three European welfare states—Denmark, Germany and England—that represent different types of care arrangements. This paper uses policy and media documents, quantitative data on childcare and women’s employment, cultural ideas and secondary analysis of empirical studies. We find that governments did not per se respond to the pandemic based on institutional path dependence regarding childcare policies, while the integration of culture into the theoretical framework allows for a more comprehensive understanding.

Implementation of a geriatric in-reach service improves acute surgical unit outcomes; a retrospective before-and-after study.

Australia's ageing population is challenging for surgical units and there is a paucity of evidence for geriatric co-management in acute general surgery. We aimed to assess if initiating a Geriatric Medicine in-reach service improved outcomes for older adults in our Acute Surgical Unit (ASU). The Older Adult Surgical Inpatient Service (OASIS) was integrated into ASU in 2021. We retrospectively reviewed all patients over age 65 admitted to ASU over a 12-month period before and after service integration with a length of stay (LOS) greater than 24 h. There was no subsequent truncation or selection. Primary outcomes were 30-day mortality, LOS, and 28-day readmissions. Secondary outcomes were discharge disposition, in-hospital mortality, and hospital-acquired complications (HACs). 1339 consecutive patients were included in each group, with no differences in baseline characteristics. There was a significant decrease in 28-day readmissions from 20.2% to 16.0% (P < 0.05), greatest in patients undergoing non-EL operative procedures (21.9% pre-OASIS vs. 12.6% post-OASIS; P < 0.05). Trends towards reduced 30-day mortality (7.17% vs. 5.90%; P = 0.211), in-hospital mortality (3.88% vs. 2.91%; P = 0.201), permanent care placement (7.77% vs. 7.09%; P = 0.843) and HACs (8.14% vs. 7.62%; P = 0.667) were seen, although statistical significance was not demonstrated. LOS remained unchanged at 4 days (P = 0.653). The addition of a geriatric in-reach service to a tertiary ASU led to a significant reduction in 28-day readmissions. Downtrends were seen in mortality, permanent care placement, and HAC rates, while LOS remained unchanged.

Exploring alternative care options for children in China: recent developments and challenges

ABSTRACT In recent years, there has been increasing recognition of the complexities surrounding alternative care arrangements for children, especially within China’s changing childcare landscape. This paper addresses the gap in understanding the nuances of alternative care options in China by conducting a narrative review of existing literature and governmental documents, focusing specifically on kinship care, institutional care, family foster care, and adoption. The review reveals recent developments and current challenges associated with each form of alternative care, providing insights into the evolving childcare system in China. Key findings include significant progress in diversifying childcare options, increased funding investment in the system, and efforts to standardize alternative childcare practices through policies and legislative measures. However, challenges persist in promoting psychosocial development and preparing individuals living in institutions for leaving care, ensuring adequate resources and support for kinship caregivers, and enhancing participation rates in family foster care and adoption practices. Practical implications for policymakers and child welfare agencies are discussed, emphasizing the importance of promoting family-based care options, providing quality caregiver training, considering various aspects of children’s needs, extending support for kinship care, and formulating inclusive adoption policies.

A qualitative study of the value of simulation-based training for nursing students in primary care

BackgroundClinical placement is an essential component of nursing education, providing students with the opportunity to apply theoretical knowledge to practice. However, challenges such as lack of supervision and passive involvement in tasks can hinder the learning experience. Supplementing clinical placement with simulation-based training (SBT) has been explored as a potential solution, though this approach has been underexplored within primary care. This study aimed to explore the educational value of a supplemental SBT course for nursing students during primary care placement, as well as the adaption of this approach to a primary care setting.MethodsA qualitative descriptive study was conducted at a medical education and simulation academy in Denmark. Sixth-semester nursing students on placement in primary care were invited to participate. The intervention consisted of a three-day simulation course covering core nursing competencies and common clinical conditions encountered within primary care. Simulation adopted a standardised patient approach. Data was collected using focus group interviews, which was analysed using inductive thematic analysis.ResultsThirty-one nursing students participated in the study. Seven themes emerged from the analysis, including perceptions, educational value, simulation adjustments to primary care, educators’ competencies, learning needs within primary care, challenges of clinical placement and career guidance. Generally, participants perceived the intervention positively, appreciating its relevance to their clinical placement and its educational impact in this context. Participants also provided insights into the adaptation of SBT to a primary care setting, as well as nursing students’ learning needs within this context.ConclusionThe findings indicate that the intervention had a positive impact on participant competencies within this context and enhanced their clinical practice within primary care. Furthermore, the results inform educators on how to effectively employ primary care-related SBT. Overall, this study supports the need for an increased application of SBT within primary care.Trial registrationNot relevant.

Multi-sensitive attunement: exploring the relationship between the toddler and the nursery teacher in the institutional arrangement of early childhood education and care

ABSTRACT In the area of Early Childhood Education and Care (ECEC), intersubjectivity between the child and the nursery teacher is seen as a core element of professional work. The notion of affect attunement, proposed by Daniel Stern, is central in this regard. Based on ethnographic fieldwork, I explore the relationship between the toddler and the nursery teacher within this frame. However, engaging with perspectives from Actor-Network-Theory, I argue that the interplay is more than mere reciprocal attunement between humans. Through empirical examples, I show how elements such as bibs, sandboxes, wardrobes, rules and routines, all part of the institutional arrangement, are vibrantly at play in the attunement. Thus, I propose the blurry concept of multi-sensitive attunement to point to the heterogeneous connections that make up the relationship. My ambition in exploring and proposing such a blurry concept is to expand our understanding of what goes on in ECEC and what professional work is. It is an ambition to theoretically move the relationship between the toddler and the professional out of an implicit mother-child ideal and into the formalised setting in which it takes place.

Maternal health in cities: analysis of institutional maternal mortality and health system bottlenecks in Kampala City Uganda, 2016-2021

Background Recent estimates have shown a stagnation in maternal mortality reduction globally. Levels and trends in maternal mortality in urban settings in Africa are of interest due to health system challenges posed by rapid urbanisation. Given the high percentage of births occurring in city health facilities, tracking the institutional maternal mortality ratio (IMMR) can reveal key performance issues. We described the trends in IMMR between 2016 and 2021, and the causes and characteristics of maternal deaths in Kampala, Uganda. Methods This retrospective study utilised routine data from all facilities in Kampala that provided childbirth services from 2016 to 2021. Three key variables were used: number of deliveries, live births, and maternal deaths. Additionally, from medical records in three purposively selected hospitals, we extracted information on characteristics of women recorded as maternal deaths and their causes for the period 2016-2021 from death notification and review forms. We conducted descriptive analysis and assessed time trends in IMMR. Results For the six-year period, the Kampala-level IMMR was 189/100,000 deliveries (194/100,000 livebirths). The IMMR declined from 213 (2016) to 109/100,000 deliveries in 2019 (p=0.04) and then increased to 258 in 2021 (p=0.12). A review of 358 maternal death records showed that 65% of deaths were women referred from other health facilities, and 47% lived in the surrounding district (Wakiso). Obstetric haemorrhage (44%) and hypertensive disorders in pregnancy (28%) were the most commonly recorded causes of death. Health system factors such as lack of blood and other supplies contributed to 65% of the deaths reviewed. Conclusions IMMR in Kampala increased from 2019-2021. Health infrastructure changes and maternal health initiatives potentially accounted for the observed trend by affecting data quality. Referral and facility readiness were underlying reasons for maternal deaths. Addressing bottlenecks in emergency referral processes may contribute to mortality reduction. Further research should determine the relative contribution of key influences on mortality levels and examine the dynamics between women’s care-seeking pathways and service delivery arrangements for emergency obstetric care in urban settings.

Damaged Goods: Victimhood‐Survivorship and the Social Marking of Identity

This article offers a cultural cognitive theory of sexual violence: a Zerubavelian reading of its classificatory, attentional, perceptual, semiotic, mnemonic, and temporal dimensions. It maps the asymmetric syntactic contrasts between the cultural trifecta of “Victim‐Survivors,” “Victimizers,” and the hitherto unnamed, taken‐for‐granted “Unvictims,” arguing that those who experience sexual violence are marked in contrast to both those who victimize and those who have never been victimized. Suggesting that one need not be the actor of a marked act to be marked by it, a victimizing person's marked act crystallizes as a marked identity for the person they victimize, a process I call “semiotic ricochet.” Extending critiques of the victimhood‐survivorship frame, this article argues that the “rigid‐minded,” binary classificatory scheme of “Victim” or “Survivor” reifies, universalizes, derivatizes, and temporally displaces its attributed. It proposes hyphenating, encasing in scare quotes, and capitalizing the identity category of “Victim‐Survivor,” as well as referring to individuals as “those who experience sexual violence.” Using the Zerubavelian theoretico‐methodological practice of “concept‐driven” sociology, it identifies the “Victim‐Survivor” as merely one specific instantiation of the generic social type the “Damaged Good,” alongside other identities derived from marked non‐acts such as placement in foster care or undergoing a mastectomy for breast cancer.

Non-coresidential intergenerational relations from the perspective of adult children in China: typology and social welfare implications

The social changes in the new century and the shifting concept of filial piety have jointly shaped the unique intergenerational relationships in China. Intergenerational relationships are closely connected to arrangements for care of the older adults, particularly those who live alone. Based on data from the 2017 China General Social Survey (CGSS), the latent profile analysis method was used to explore the profiles of intergenerational family relationships and their influencing factors in the context of “non-co-residence” based on the five dimensions of intergenerational solidarity theory and related indicators. The study found that family intergenerational relationships can be categorised into five profiles: distant-emotional, proximity-detached, proximity-loose, distant-support, and traditional-reciprocal, which share commonalities with previous studies and have their own characteristics. The results of the multiple regression analysis showed that gender, education level, annual personal income for the previous year, self-rated happiness, and self-rated health had significant effects on the latent profiles of intergenerational relationships. Specifically, adult children who are male, living in a rural area, no legal spouse, a primary school education or less, an annual income above 50,001 RMB in the last year (2016), low or average self-rated happiness, and good self-rated health are more likely to deviate from the traditional filial support track (i.e. they are less likely to be the traditional-reciprocal) than their counterparts in these profiles. In the future, it will be important to increase attention to those families in which older parent live apart from their adult child through relevant legislation, social welfare systems, and social older-care services. This will help ensure that adult children provide intergenerational support and will enable the normal functioning of home- and community-based older adults’ care.

Tailored videoconferencing counselling program to support family carers of people living with dementia during the transition to permanent residential care: a pilot and feasibility randomised trial

BackgroundDecisions surrounding the permanent residential care placement of people living with dementia can be stressful and distressing; however, providing access to targeted information and support prior to placement may help carers better cope. This mixed methods study aimed to test the feasibility, acceptability, and potential benefits of providing a tailored, individual counselling program (the Residential Care Transition Module), delivered via videoconferencing, to Australian family carers of a relative with dementia during the transition to permanent residential care.MethodsA total of 18 family carers were randomly allocated to receive either the counselling intervention (six sessions delivered over 12 weeks) or a check-in call, delivered by a trained Transition Counsellor. Both groups received help-sheets about residential care, coping with placement, and managing feelings. Carers completed online surveys about stress, guilt, anxiety, depression, grief, and support for caring at baseline and four months post-baseline. Carers were also invited to participate in semi-structured exit interviews, conducted after follow-up surveys were completed. Process data relating to recruitment, retention, intervention dose and delivery were collected via logs. Quantitative data were analysed using descriptive statistics and repeated measures ANOVA. Qualitative data, relating to feasibility, acceptability, and perceived benefits of the program, were analysed using the ‘framework’ approach developed by the Medical Research Council to inform the process evaluation of complex interventions.ResultsQualitative findings indicated that delivery of the counselling program during the transition period was deemed by participants to be feasible and acceptable. Delivery via videoconferencing was deemed convenient and acceptable, with few technical issues. The skills and knowledge of the Transition Counsellor were perceived to be important mechanisms of impact. Though not statistically significant, promising quantitative findings were identified in terms of reduced carer stress and guilt and improved support for caring.ConclusionsDelivery of a tailored counselling program via videoconferencing to family carers of people living with dementia during the transition to residential care was feasible and acceptable. The program has the potential to improve transitional support to family carers.Trial registrationThis study was registered in the Australian New Zealand Clinical Trials Registry: ACTRN12621001462875.

Assessing the variation and drivers of cost in 1-level lumbar fusion: a time-driven activity-based costing analysis

Background ContextAs value-based health care arrangements gain traction in spine care, understanding the true cost of care becomes critical. Historically, inaccurate cost proxies have been used, including negotiated reimbursement rates or list prices. However, time-driven activity-based costing (TDABC) allows for a more accurate cost assessment, including a better understanding of the primary drivers of cost in 1-level lumbar fusion. PurposeTo determine the variation of total hospital cost, differences in characteristics between high-cost and nonhigh-cost patients, and to identify the primary drivers of total hospital cost in a sample of patients undergoing 1-level lumbar fusion. Study Design/SettingRetrospective, multicenter (one academic medical center, one community-based hospital), observational study. Patient SampleA total of 383 patients undergoing elective 1-level lumbar fusion for degenerative spine conditions between November 2, 2021 and December 2, 2022. Outcome MeasuresTotal hospital cost of care (normalized); preoperative, intraoperative, and postoperative cost of care (normalized); ratio of most to least expensive 1-level lumbar fusion. MethodsPatients undergoing a 1-level lumbar fusion between November 2, 2021 and December 2, 2022 were identified at two hospitals (one quaternary referral academic medical center and one community-based hospital) within our health system. TDABC was used to calculate total hospital cost, which was also broken up into: pre-, intra-, and postoperative timeframes. Operating surgeon and patient characteristics were also collected and compared between high- and nonhigh-cost patients. The correlation of surgical time and cost was determined. Multivariable linear regression was used to determine factors associated with total hospital cost. ResultsThe most expensive 1-level lumbar fusion was 6.8x more expensive than the least expensive 1-level lumbar fusion, with the intraoperative period accounting for 88% of total cost. On average. the implant cost accounted for 30% of the total, but across the patient sample, the implant cost accounted for a range of 6% to 44% of the total cost. High-cost patients were younger (55 years [SD: 13 years] vs 63 years [SD: 13 years], p=.0002), more likely to have commercial health insurance (24 out of 38 (63%) vs 181 out of 345 (52%), p=.003). There was a poor correlation between time of surgery (ie, incision to close) and total overall cost (ρ: .26, p<.0001). Increase age (RC: -0.003 [95% CI: -0.006 to -0.000007], p=.049) was associated with decreased cost. Surgery by certain surgeons was associated with decreased total cost when accounting for other factors (p<.05). ConclusionsA large variation exists in the total hospital cost for patients undergoing 1-level lumbar fusion, which is primarily driven by surgeon-level decisions and preferences (eg, implant and technology use). Also, being a “fast” surgeon intraoperatively does not mean your total cost is meaningfully lower. As efforts continue to optimize patient value through ensuring appropriate clinical outcomes while also reducing cost, spine surgeons must use this knowledge to lead, or at least be active participants in, any discussions that could impact patient care.

Navigating multiple and complex systems of care and support with ageing family carers from multicultural backgrounds in Australia

Ageing family caregivers of family members with disability must navigate complex social care systems within a single household for long-term and end-of-life transitions. This is particularly challenging for migrants from culturally and racially marginalised (CaRM) backgrounds, given their historical exclusion from developing disability and aged care support systems. Limited research exists on the lived experiences of new and second-generation CaRM communities providing informal care to family members with disabilities, globally and in Australia. This paper highlights the challenges faced by CaRM families navigating racial, ethnic, and immigration politics while seeking access to appropriate disability and ageing social care supports. The findings reveal that Many CaRM families face isolation and difficulty accessing needed support due to misconceptions about their strong local networks. Moreover, the significance of place, especially in low-resource urban areas, poses challenges for ageing family primary caregivers managing a dual long-term care arrangement, leading to uncertainties about their future.

The Meaning of Shared Parenthood in Long‐Term Foster Care: The Perspectives of Parents and Foster Carers

ABSTRACTShared parenthood is increasingly emphasized in long‐term foster care placements across European countries, including Flanders, where our study was conducted. However, despite its growing importance, there is a lack of comprehensive understanding regarding the dynamics and pedagogical conceptualization of shared parenthood. This research seeks to bridge the gap by investigating how parents and foster carers perceive and navigate parenting roles. Through in‐depth interviews with 12 parents and 12 foster carers from 10 long‐term foster care cases, thematic and narrative analyses were employed to explore shared parenting dynamics. The findings underscore the significant impact of power dynamics on the relationship, often resulting in prolonged silences and reluctance to address issues openly. By elucidating both the promoting and impeding factors, this study sheds light on the complexities of shared parenting within long‐term foster care arrangements. In conclusion, the study emphasizes the importance of recognizing and discussing the normative notion of shared parenting to facilitate its successful implementation in long‐term foster care placements.

Factors Associated With Stability for Children in Family Foster Care: A Study of Case Files in Six Municipalities in Sweden

ABSTRACTStability is vital for the development, health and relationships of children in family foster care. Instability can lead to social and school issues, low self‐esteem and diminished trust in caregivers. This article examines the risk and protective factors for stability for these children. Data, drawn from case files in six municipalities (n = 116), combine qualitative and quantitative analyses for a comprehensive understanding. Twenty children from each municipality were selected, with 10 in stable placements (lived in one family foster home for over a year) and 10 in unstable placements (lived in at least two different family foster homes). Quantitative results highlight the importance of factors like familiar placements, a child's age at the time of placement, behavioural challenges and the number of children in the foster home. Stable placements were more common in homes with fewer children (including foster and biological children). Qualitative findings show that in some instances, breakdowns in foster care placements could not be foreseen, often arising from stressful events within the foster family's life after the child's placement. Additionally, we observed that breakdowns sometimes resulted from foster parents lacking the necessary resources to address the child's requirements, particularly in cases involving children with behavioural challenges or extensive needs.

“I never planned for it”—Exploration of expectations about caring for older parents

AbstractThe projected increase in older dependent adults will continue straining formal care services whilst increasing the reliance on unpaid carers, in England and internationally. While motivations and willingness to care among unpaid carers have been explored, expectations around the caregiving role remain under‐researched. This article delves into expectations of middle‐aged individuals around providing care to an older parent in the future. Data collected through six focus groups with 35 mid‐life individuals, a mix of individuals with and without caring experience, were analysed thematically, cross‐sectionally, and with reference to different phases in the caregiving trajectory. Participants showed predicted, in some cases normative, expectations about taking on the role of carer for an older parent. Such expectations were rooted in emotional and socio‐cultural factors and influenced how people self‐identified as a carer. Expectations about what the role would entail were unformed: they were described as conditional on the uncertain and changing care needs of the older parents (‘caregiving creep’). Those with caring experience highlighted that, in hindsight, their prior expectations did not match their actual experience of the role, requiring greater time commitment and impacting their life in ways they had not anticipated. When thinking about the future, participants envisaged stepped changes in care arrangements to meet increasing, albeit uncertain, care needs, but acknowledged their lack of awareness around the care options available to them. Policies aiming to improve general awareness about caregiving, support early identification of carers, and address their information need throughout their caregiving journey should be a priority.

Foster Care Leads to Lower Irritability Among Adolescents with a History of Early Psychosocial Deprivation.

Irritability reflects a propensity for frustration and anger, and is a transdiagnostic symptom of both externalizing and internalizing psychopathology. While early adverse experiences are associated with higher levels of irritability, experiences of early psychosocial deprivation and whether family-based placements can mitigate the impact on subsequent irritability, remain underexplored. The current study examined irritability in 107 16-year-olds with a history of institutional care from a randomized controlled trial of foster care as an alternative to institutional care and 49 community comparison children. At age 16 years, irritability was assessed using parent- and self-report forms of the Affective Reactivity Index. Compared to community adolescents, those with a history of institutional care exhibited significantly elevated irritability levels. Among those who experienced institutional care, those randomized to foster care had lower levels of irritability compared to participants randomized to the care-as-usual group, and this effect persists after controlling for baseline negative emotionality. These findings suggest a causal link between high-quality foster care and lower irritability following psychosocial deprivation. Additionally, longer duration in institutional care and non-family placement at age 16 years were associated with higher levels of irritability, highlighting the role of caregiving in explaining variation in irritability in adolescence. Policies that support long-term, high-quality family placements for children without regular caregivers should be prioritized.

A retrospective audit of adult and paediatric anaphylaxis management from two Australian metropolitan mixed emergency departments

BackgroundAnaphylaxis is a potentially life-threatening allergic reaction, with presentations to emergency departments (EDs) increasing across Australia. Understanding the features of those presenting with anaphylaxis and aspects related to its optimal clinical management across the admission, treatment and discharge settings is needed to minimise its impact. We aimed to evaluate the nature and management of presentations related to anaphylaxis across two Australian EDs.MethodsRetrospective audit of paediatric and adult patients presenting to a community or tertiary level ED with anaphylaxis from 1 May 2018 to 30 April 2019. Data extracted from medical records included demographic characteristics, causative agents, clinical features, treatments administered across community, ambulance or ED settings, as well as post-discharge care arrangements including provision of Adrenaline Auto-Injector (AAI) and Allergy/Anaphylaxis Action Plan (AAP).ResultsA total of 369 (107 paediatric and 262 adult) ED presentations were identified. A total of 94 (36%) adult and 46 (43%) paediatric patients received pre-hospital adrenaline, with a further 91 (35%) adult and 29 (27%) paediatric patients receiving a dose of adrenaline in the ED. The most commonly administered treatment in ED were corticosteroids, given to 157 (60%) adult and 55 (51%) paediatric patients. Among those requiring an AAI for discharge, 123/210 (59%) adult and 57/91 (63%) of paediatric patients left hospital with an AAI. In contrast, among those requiring an allergy/anaphylaxis action plan (AAP) on discharge, 61/206 (30%) adult and 30/90 (33%) of paediatric patients left hospital with one. Factors associated with an increased likelihood of receiving AAI on discharge in paediatric and adult patients included receipt of any adrenaline, receipt of two or more doses of adrenaline, and longer duration of hospital stay. Adults presenting within business hours were more likely to be discharged with AAI, but no such difference was observed for paediatric patients. Similar findings were evident for provision of AAP on discharge.ConclusionThese findings demonstrate the need to improve assessment and treatment in the ED. In particular, the observed large variability in provision of AAI and AAP on discharge presents opportunities to explore strategies to improve awareness and provision of these critical components of post-discharge care.

Labour market gender gaps and childcare policies in countries with different social investment strategies

AbstractWe study the role of formal and informal childcare within the ECEC policies for gender employment and pay gaps, considering the life course stages distinctive for childcare tasks. The ECEC policies are framed within the types of social investment strategies identified in the EU countries to picture developments in social investments after 2005. The aggregated EU‐SILC data from 2005 to 2019 for 27 European countries have been used in the panel regression models to uncover how the caring arrangements influence labour market gendered outcomes of women at different ages (15–24, 25–49, 50–65). We find that better provision and use of early education and childcare not only contribute to early investment in human capital but it also facilitates mothers' employment and thus contributes to lowering gender employment and pay gaps. However, better coverage of care for children older than 3 years old results in negative employment effects for grandmothers. These effects vary also across countries, depending on their overall institutional setting depicted by the types of social investment strategies distinguished. Consequently, the ECEC agenda should be extended by addressing the employment of women at the pre‐retirement age. It is crucial not only for reducing gender gap in employment and pay but also in the light of challenges generated by demographic developments—the labour force shrinking and the population ageing processes.

Beyond Audio-Video Telehealth: Perspective on the Current State and Future Directions of Digital Neurological Care in the United States

Background The COVID-19 pandemic transformed neurological care by both requiring digital health modalities to reach patients and profoundly lowering barriers to digital health adoption. This combination of factors has given rise to a distinctive, emerging care model in neurology characterized by new technologies, care arrangements, and uncertainties. As the pandemic transitions to an endemic, there is a need to characterize the current and future states of this unique period in neurology. Objective We sought to describe the current state of the pandemic- and postpandemic-related changes in neurological care and offer a view of the possible future directions of the field. Methods We reviewed several themes across the “new digital normal” in neurology, including trends in technology adoption, barriers to technology access, newly available telehealth services, unresolved questions, and an outlook on the future of digital neurology. Results In this new era of neurological care, we emphasize that synchronous audio-video telehealth remains the predominant form of digital interaction between neurologists and patients, mainly due to pandemic-related regulatory changes and the preexisting, steady adoption of video platforms in the prepandemic era. We also identify a persistent digital divide, with audio-only telehealth remaining a necessity for preserving care access. Asynchronous telehealth methods and services, including care coordination, interprofessional consultations, remote patient monitoring, and teletreatment are becoming increasingly important for neurological care. Finally, we identify several unanswered questions regarding the future of this “new normal,” including the lasting effects of emergency regulatory changes, the value proposition of telehealth, the future of telehealth reimbursement in neurology, as well as privacy considerations and trade-offs in asynchronous neurological care models. Conclusions The COVID-19 pandemic has ushered in an era of digital adoption and innovation in neurological care, characterized by novel care models, services, and technologies, as well as numerous unresolved questions regarding the future.