Care Policy Research Articles

Antenatal care coverage and early childhood mortality in Zimbabwe: new interpretations from nationally representative household surveys.

Zimbabwe has implemented universal antenatal care (ANC) policies since 1980 that have significantly contributed to improvements in ANC access and early childhood mortality rates. However, Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), two of Zimbabwe's main sources of health data and evidence, often provide seemingly different estimates of ANC coverage and under-five mortality rates. This creates confusion that can result in disparate policies and practices, with potential negative impacts on mother and child health in Zimbabwe. We conducted a comparability analysis of multiple DHS and MICS datasets to enhance the understanding of point estimates, temporal changes, rural-urban differences and reliability of estimates of ANC coverage and neonatal, infant and under-five mortality rates (NMR, IMR and U5MR, separately) from 2009 to 2019 in Zimbabwe. Our two samples z-tests revealed that both DHS and MICS indicated significant increases in ANC coverage and declines in IMR and U5MR but only from 2009 to 2015. NMR neither increased nor declined from 2009 to 2019. Rural-urban differences were significant for ANC coverage (2009-15 only) but not for NMR, IMR and U5MR. We found that there is a need for more precise DHS and MICS estimates of urban ANC coverage and all estimates of NMR, IMR and U5MR, and that shorter recall periods provide more reliable estimates of ANC coverage in Zimbabwe. Our findings represent new interpretations and clearer insights into progress and gaps around ANC coverage and under-five mortality rates that can inform the development, implementation, monitoring and evaluation of policy and practice responses and further research in Zimbabwe.

신규위탁 원장의 국공립어린이집 운영에서의 공공성 저해 요인 탐색

Objectives The purpose of this study is to find out the motivation and background for consignment support of new entrusted public child care center to support consignment, and to exploration of disturbance factors of publicness in the new entrusteded directors’s public child care centers management. Methods The participants in this study were three directors who entrusted a new public child care center in H-si, Gyeonggi-do. Data were collected through a total of three sessions of in-depth interviews, data on the experi-ences of in the new entrusteded directors’s were transcribed, read repeatedly, extracted with meaningful key-words, and analyzed qualitatively to derive research results. Results The results of this study are as follows. First, the motivation and background of the director of the new entrusted public child care center for fostering support was found to be support for entrustment to a stable public child care center due to changes in child care policy and anxiety about operating private daycare centers. Second, the directors of a newly entrusted public child care center found that the factors disturbance the publicness of run-ning the child care center after being appointed include concerns about systematic management of the newly en-trusted public child care center, recruiting and managing teachers, difficulties for parents trying to resolve com-plaints, found that the factors disturbance the and difficulties responding to related organizations. Conclusions In order to ensure the publicness of the management of public child care centers, it is necessary to continuously investigate the factors disturbance that the director of a newly entrusted public child care centers finds difficult, establish a system and training course to provide systematic support from new entrustment. A edu-cation program for new directors should be developed to overcome the difficulties that new directors face when running a public child care center for the first time and to solve the problems that directors face.

Challenges in assessing the immunization status of adults in Germany-lessons from a population-based VACCELERATE survey on polio vaccination.

Considering the re-emergence of poliomyelitis (PM) in non-endemic regions, it becomes apparent that vaccine preventable diseases can rapidly develop epi- or even pandemic potential. Evaluation of the current vaccination status is required to inform patients, health care providers and policy makers about vaccination gaps. Between October 28 2022 and November 23 2022, 5,989 adults from the VACCELEREATE Volunteer Registry completed an electronic case report form on their previous PM vaccine doses including number, types/-valencies and the time of administration based on their vaccination records. A uni-/multivariable regression analysis was performed to assess associations in participant characteristics and immunization status. Among German volunteers (n = 5,449), complete PM immunization schedule was found in 1,981 (36%) participants. Uncertain immunization, due to unknown previous PM vaccination (n = 313, 6%), number of doses (n = 497, 9%), types/-valencies (n = 1,233, 23%) or incoherent immunization schedule (n = 149, 3%) was found in 40% (n = 2,192). Out of 1,276 (23%) participants who reported an incomplete immunization schedule, 62 (1%) never received any PM vaccine. A total of 5,074 (93%) volunteers reported having been vaccinated at least once and 2,087 (38%) indicated that they received vaccination within the last ten years. Female sex, younger age, as well as availability of first vaccination record were characteristics significantly associated with complete immunization (p < 0.001). Full PM immunization schedule was low and status frequently classified as uncertain due to lack of details on administered doses. There is an obviousneed for improved recording to enable long-term access to detailed vaccination history in the absence of a centralized immunization register.

The Social Determinants of Health Industry: Two Years On.

Social determinants of health (SDOH) have been insufficiently addressed by payers and providers despite increased prioritization at the national level. This led to the development of a separate, for-profit "SDOH industry" found to have a valuation of $18.5 billion (all dollar amounts in U.S. dollars) with $2.4 billion in funding as of July 2021. The purpose of this article is to determine the growth of the industry from 2021 to 2023 and provide a multifaceted explanation for this development. The authors conducted an analysis of 57 SDOH industry companies using a third-party market research platform. Over the previous two-year period, 10 out of 57 (18%) companies were acquired, and the industry gained an additional $1.1 billion (46% increase) in funding and $13.7 billion (74% increase) in valuation. The authors propose four contributing factors to explain the nature of this industry's evolution. They include developments in national health care policy favoring SDOH, standardization of SDOH information as actionable claims data, multi-source investment in SDOH, and improved methods of industry intervention measurement. These trends appear likely to continue, requiring additional scrutiny by all relevant stakeholders to ensure maximum improvement of rampant SDOH disparities that impact millions of individuals daily.

Addressing financial toxicity in cancer treatment-An opportunity for the 340B drug pricing program.

Cancer treatment has become increasingly expensive, partially due to the use of specialty drugs. The costs of these drugs are often passed down to patients, who may face the consequences of paying for more than they can afford, leading to financial toxicity. The 340B drug pricing program is a health care policy that may provide an opportunity to mitigate the financial consequences of cancer care. The 340B program requires manufacturers to sell outpatient drugs at a discount to hospitals caring for a significant number of socioeconomically disadvantaged individuals. The program intended for hospitals to use savings from discounted purchases to expand their safety net to vulnerable patients. Some studies have shown that participating hospitals do this by offering more charity and discounted care, whereas others have demonstrated that hospitals fail to sufficiently expand their safety net. A potential flaw of the program is the lack of guidance from governing bodies on how hospitals should use savings from discounted purchases. There has been growing discussion among stakeholders to reform the 340B program given the mixed findings of its effectiveness. With the rising costs of specialty drugs and associated prevalence of financial toxicity in patients with cancer, there is an opportunity to address these issues through reform that improves the program. Directing hospitals to offer specific safety net opportunities, such as passing along discounted drug prices to vulnerable populations, could help the growing number of patients who are financially burdened by medications at the core of the 340B program.

Association between physical activity, peak expiratory flow, and cognitive function in aging: a cross-sectional analysis

BackgroundThe aging global population is experiencing escalating challenges related to cognitive deficits and dementia. This study explored the interplay between pulmonary function, physical activity, and cognitive function in older U.S. adults to identify modifiable risk factors for cognitive decline.MethodsUtilizing NHANES 2011–2012 data, we conducted a cross-sectional analysis of 729 participants aged ≥ 60 years. Cognitive function, peak expiratory flow (PEF), and physical activity were assessed. Weighted logistic regression and mediation analyses were employed to examine associations.ResultsThe sample size was 729 (weighted mean [SD] age, 67.1 [5.3] years; 53.6% female participants). Preliminary correlation analysis indicated a positive correlation between the global cognitive score and physical activity (β = 0.16; p < 0.001), recreational activity (β = 0.22; p < 0.001), and PEF in percent predicted (PEF%) (β = 0.18; p < 0.001). Compared to those with a PEF% >100%, the PEF% (80-100%) group (OR, 2.66; 95% CI, 1.34–5.29; p = 0.005) and PEF% <80% group (OR, 3.36; 95% CI, 1.67–6.76; p = 0.001) were significantly associated with higher cognitive deficits risk. Recreational activity meeting guidelines was linked to a lower risk of cognitive deficits (OR, 0.24; 95% CI, 0.10–0.57; p = 0.001). Mediation analysis demonstrated that PEF mediates the relationship between physical activity and cognitive function.ConclusionThis study revealed significant associations between lower PEF, diminished physical activity, and increased cognitive deficits in elderly individuals. The results supported the hypothesis that pulmonary function may mediate the connection between activity and cognitive health, emphasizing the importance of respiratory health in cognitive aging. Recognizing these associations is crucial for clinical care and public health policy aiming to mitigate cognitive decline in aging populations. While these findings are intriguing, validation through longitudinal design studies is deemed necessary.

Sexual Violence Victimization and Substance Use among Individuals Identifying on the Asexual Spectrum: Differences between Asexuality, Graysexuality, and Demisexuality

ABSTRACT Despite the growing visibility of the asexual community across the globe, little is known about how individuals on the asexual spectrum navigate their (a)sexual experiences. Asexual individuals may be highly vulnerable to sexual violence victimization due to prejudice against their lack of sexual attraction. Perpetrators may seek to pressure asexual individuals into sexual activities by invalidating their asexuality or manipulating their need for emotional intimacy. Such non-consensual sexual acts or behaviors may have a profound impact on asexual individuals. The present study aimed to examine the prevalence of sexual violence victimization and its relationship with substance use among individuals identifying on the asexual spectrum. The data for this study were derived from a global sample of 8,752 individuals on the asexual spectrum from the Ace Community Survey. The results indicated that 67.4% of the participants had experienced at least one form of sexual violence victimization in their lifetime. Experiences of sexual violence were related to more frequent engagement in substance use over the past year. Additionally, the results showed that compared with asexual individuals, graysexual and demisexual individuals were more likely to experience sexual violence, which was linked to substance use. Given the widespread prevalence and detrimental effects of sexual violence victimization, it is important to integrate asexual perspectives into prevention and intervention efforts, while simultaneously raising public awareness about affirmative consent and boundaries. The study also offers significant implications for trauma-informed care, public education, and social policies that address the unique needs and experiences of this population.

Harness the Co-Benefit and Avoid the Trade-off: The Complex Relationship between Income Inequality and Carbon Dioxide Emissions

Abstract Given the dual crises of climate change and rising economic inequality, it is imperative to improve the synergy between climate mitigation and income inequality reduction. Domestic income inequality is linked to nations’ carbon dioxide (CO2) emissions through multiple theorized pathways. Using a multidimensional framework, multiregional input–output analysis, panel regression analysis, and a sample of 34 high-income nations from 2004 to 2015, I investigate the relationships between nations’ income inequality and four components of CO2 emissions with distinct implications for climate change mitigation: (1) emissions generated by domestic-oriented supply chain activities; (2) emissions embodied in exports; (3) direct emissions from end-user activities; and (4) emissions embodied in imports. I theorize that income inequality is heterogeneously related to the four emission components via different pathways. Results show that the relationships vary across emission components, change over time, and differ between inequality measures. The Gini coefficient is generally less influential on CO2 emissions than the income share of the top 10%. Notably, the income share of the top 10% is negatively related to direct end-user emissions from 2009 to 2011 and positively related to emissions in exports from 2011 to 2015, indicating variations in pathways both across emission components and over time—especially during and after the Great Recession. The findings underscore the multidimensionality in the income inequality-CO2 emissions relationship. Whether reducing income inequality can generate the co-benefit of emission abatement while avoiding a potential trade-off is a context-specific question that requires careful policy design and implementation.

Retirement Makes You Old? Causal Effect of Retirement on Biological Age.

Retirement is a critical life event for older people. Health scholars have scrutinized the health effects of retirement, but its consequences on age-related diseases and mortality are unclear. We extend this body of research by integrating measurements of biological age, representing the physiological decline preceding disease onset. Using data from the UK Biobank and a fuzzy regression discontinuity design, we estimated the effects of retirement on two biomarker-based biological age measures. Results showed that retirement significantly increases biological age for those induced to retire by the State Pension eligibility by 0.871-2.503 years, depending on sex and specific biological age measurement. Given the emerging scientific discussion about direct interventions to biological age to achieve additional improvements in population health, the positive effect of retirement on biological age has important implications for an increase in the State Pension eligibility age and its potential consequences on population health, public health care policy, and older people's labor force participation. Overall, this study provides novel empirical evidence contributing to the question of what social factors make people old.

Coproduced, arts interventions for nurturing care (0-5 years) in low-income and middle-income countries (LMICs): a realist review.

Community-based arts interventions have the potential to support contextually relevant nurturing care programmes and policies that adapt to different settings. Understanding the distinctive features of using the arts in local, culturally specific ways in low/middle-income countries (LMICs); how this varies by context; and gaining a better understanding of the perspectives on desirable outcomes for communities is important evidence that this review generates. We conducted a realist review of papers that covered outcomes related to child health or development (0-5 years) AND arts-based approaches AND community-based, participatory approaches AND based in LMICs using a range of databases and other networks. A coding framework was developed covering context, intervention, outcomes, mechanisms, study, sustainability, transferability and scalability. The included papers reported 18 unique interventions. Interventions covered 14 countries, with evidence lacking for South America, Arab countries and parts of Africa. Lead authors came from mostly clinical science-based disciplines and from institutions in a different country to the country/countries studied. Intended outcomes from interventions included clinical, health systems/organisation, changes in practices/behaviours/knowledge/attitudes, and wider social and educational goals. We identified three demi-regularities (semi-predictable patterns or pathways of programme functioning): participatory design based on valuing different sources of expertise; dynamic adaptation of intervention to context; and community participation in arts-based approaches. Our findings suggest that arts-based, nurturing care interventions have greater potential when they include local knowledge, embed into existing infrastructures and there is a clear plan for ongoing resourcing of the intervention. Studies with better documentation of the lessons learnt, regarding the intervention delivery process and the power dynamics involved, are needed to better understand what works, for whom and in which contexts.

Case volume and specialization in critically ill emergency patients: a nationwide cohort study in Japanese ICUs.

Previous studies have explored the association between the number of cases and patient outcomes for critical illnesses such as sepsis and trauma, as well as various surgeries, with the expectation that a higher number of cases would have a more favorable effect on patient outcomes. The aim of this study was to elucidate the association among intensive care unit (ICU) case volume, specialization, and patient outcomes in critically ill emergency patients and to determine how ICU case volumes and specializations impact the outcomes of these patients in Japanese ICUs. Utilizing data from the Japanese Intensive Care PAtient Database (JIPAD) from April 2015 to March 2021, this retrospective cohort study was conducted in 80 ICUs across Japan and included 72,214 emergency patients aged ≥ 16years. The primary outcome measure was in-hospital mortality, and the secondary outcomes encompassed ICU mortality, 28-day mortality, ventilator-free days, and the lengths of ICU and hospital stays. Bayesian hierarchical generalized linear mixed models were used to adjust for patient- and ICU-level variables. This study revealed a significant association between a higher ICU case volume and decreased in-hospital mortality. In particular, ICUs with a higher percentage (> 75%) of emergency patients showed more pronounced effects, with the odds ratios for in-hospital mortality in the higher case volume quartiles (Q2, Q3, and Q4) being 0.92 (95% credible interval [CI]: 0.88-0.96), 0.70 (95% CI: 0.67-0.73), and 0.78 (95% CI: 0.73-0.83), respectively, compared with the lowest quartile (Q1). Similar trends were observed for various secondary outcomes. Higher ICU case volumes were significantly associated with lower in-hospital mortality rates in Japanese ICUs predominantly treating critically ill emergency patients. These findings emphasize the importance of ICU specialization and highlight the potential benefits of centralized care for critically ill emergency patients. These findings are potential insights for improving health care policy in Japan and may be valuable in emergency care settings in other countries with similar healthcare systems, after careful consideration of contextual differences.

SAFE – A risk management tool to protect both people and pets in residential aged care facilities

Abstract Pet ownership has known health and well-being benefits for people of all ages. Most previous research on pet ownership among older people has focussed on older people with pets living independently in their own homes or the effects of visiting pet programs in residential aged care. With structural ageing of populations globally, the number of humans living into old age is increasing. Even with home support and care policies, an increasing number will need to live in communal aged care settings. Currently, pets rarely accompany older persons into communal residential aged care. This article presents a risk management tool – Safe Animal Friendly Environments (SAFE) – designed to facilitate and maintain private pet ownership among older people living in residential aged care facilities. SAFE was developed to identify best practice for both human and animal well-being in residential aged care. The tool supports both human and animal well-being during a human stage of life with many losses and pains while reducing the number of pet animals needlessly relinquished or even euthanised when owners need to ‘go into care’. It was developed using a Delphi process with multidisciplinary expert input. We identify the different types of risks for stakeholders (residents with pets, aged care facility staff and pets), including physical, zoonotic and psychological risks. None of the identified risks of pets in aged care are unmanageable. SAFE reduces risks to acceptable levels and directs how to remove them where possible. SAFE has a summative table listing 17 general risks: from animals to humans, humans to animals and animals to animals. Each identified risk has a pre-mitigation risk assessment (low, medium or high), recommended mitigation actions and a post-mitigation risk rating (low, medium or high). Post-mitigation risk is reduced to ‘low’ in almost all scenarios. SAFE has separate tables for dogs, cats, small mammals, birds and fish, each preceded by a best practice case study. The discussion links the Ottawa Charter for (human) health promotion and use of SAFE. SAFE contributes to the inclusion of residential aged care as a context for the personal human-animal bond.

Beyond omission: analysing the erasure of disability and inclusion in the developmentally appropriate practices

ABSTRACT The 4th edition of the National Association for the Education of Young Children’s (NAEYC) guidelines for developmentally appropriate practice (DAP) had an opportunity to provide the field an inclusive blueprint. While there was an attempt in this edition to respond to decades of critiques (e.g. Bloch [1992]. “Critical Perspectives on the Historical Relationship Between Child Development and Early Childhood Education Research.” In Reconceptualizing the Early Childhood Curriculum: Beginning the Dialogue, edited by S. Kessler, and E. B. Swadener, 3–20. New York, NY: Teachers College Press.; Cannella [1997]. Deconstructing Early Childhood Education: Social Justice and Revolution. New York, NY: Peter Lang.; Escayg [2019]. “Who’s got the Power?”: A Critical Examination of the Anti-Bias Curriculum.” International Journal of Child Care and Education Policy 13 (1): 1–18. https://doi.org/10.1186/s40723-019-0062-9.; Langford [2010]. “Critiquing Child-Centered Pedagogy to Bring Children and Early Childhood Educators Into the Center of a Democratic Pedagogy.” Contemporary Issues in Early Childhood 11 (1): 113–127. https://doi.org/10.2304/ciec.2010.11.1.113.; Pérez and Saavedra [2017]. “A Call for Onto-Epistemological Diversity in Early Childhood Education and Care: Centering Global South Conceptualizations of Childhood/s.” Review of Research in Education 41 (1): 1–29. https://doi.org/10.3102/0091732X16688621.; Souto-Manning and Rabadi-Raol [2018]. “(Re)Centering Quality in Early Childhood Education: Toward Intersectional Justice for Minoritized Children.” Review of Research in Education 42 (1): 203–225. https://doi.org/10.3102/0091732X187595.), the new edition continues to centre dominant developmental approaches where adults hyperfocus on children’s differences or individual characteristics rather than on changing educational structures and practices that promote inequity (Ferri and Bacon [2011]. “Beyond Inclusion: Disability Studies in Early Childhood Teacher Education.”). The revised guidelines do not go far enough to address inequity and to give teachers and programmes tools for addressing injustice for all young children. This manuscript builds on previous critiques of DAP by explicitly addressing the exclusion of disabled children from the guidelines.

Research on China's End-of-Life Care Policy from the Perspective of Aging Population: A Textual Analysis of 30 Policies from 2017 to 2022

As the proportion of elderly population increases and the level of social development continues to rise, the issue of end-of-life care for the elderly has gradually gained societal attention. End-of-life care, as an emerging field, relies crucially on optimizing top-level policy design for its healthy development. This study focuses on 30 national-level end-of-life care policy texts from 2017 to 2022. Utilizing analysis tools such as ROST CM 6 software, NLPIR Chinese word segmentation system, and SPSS, the research employs a three-dimensional framework of keyword frequency analysis, semantic network analysis, and "policy tools-policy time-policy intensity" to comprehensively explore the current state of China's end-of-life care policy. The study reveals existing issues in the policy's practical operability, uneven application of policy tools, neglected funding and information technology support, and weak regulatory aspects. It emphasizes the need to prioritize a people-centered approach, enhance the overall balance in policy tools, promote the standardization of end-of-life care, and improve a diversified service system. These findings broaden the research perspective in the field of end-of-life care, providing insights for optimizing policy design and advancing nationwide end-of-life care efforts.

Absolute and relative outcomes of psychotherapies for eight mental disorders: a systematic review and meta-analysis.

Psychotherapies are first-line treatments for most mental disorders, but their absolute outcomes (i.e., response and remission rates) are not well studied, despite the relevance of such information for health care users, providers and policy makers. We aimed to examine absolute and relative outcomes of psychotherapies across eight mental disorders: major depressive disorder (MDD), social anxiety disorder, panic disorder, generalized anxiety disorder (GAD), specific phobia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and borderline personality disorder (BPD). We used a series of living systematic reviews included in the Metapsy initiative (www.metapsy.org), with a common strategy for literature search, inclusion of studies and extraction of data, and a common format for the analyses. Literature search was conducted in major bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane Register of Controlled Trials) up to January 1, 2023. We included randomized controlled trials comparing psychotherapies for any of the eight mental disorders, established by a diagnostic interview, with a control group (waitlist, care-as-usual, or pill placebo). We conducted random-effects model pairwise meta-analyses. The main outcome was the absolute rate of response (at least 50% symptom reduction between baseline and post-test) in the treatment and control conditions. Secondary outcomes included the relative risk (RR) of response, and the number needed to treat (NNT). Random-effects meta-analyses of the included 441 trials (33,881 patients) indicated modest response rates for psychotherapies: 0.42 (95% CI: 0.39-0.45) for MDD; 0.38 (95% CI: 0.33-0.43) for PTSD; 0.38 (95% CI: 0.30-0.47) for OCD; 0.38 (95% CI: 0.33-0.43) for panic disorder; 0.36 (95% CI: 0.30-0.42) for GAD; 0.32 (95% CI: 0.29-0.37) for social anxiety disorder; 0.32 (95% CI: 0.23-0.42) for specific phobia; and 0.24 (95% CI: 0.15-0.36) for BPD. Most sensitivity analyses broadly supported these findings. The RRs were significant for all disorders, except BPD. Our conclusion is that most psychotherapies for the eight mental disorders are effective compared with control conditions, but absolute response rates are modest. More effective treatments and interventions for those not responding to a first-line treatment are needed.

Influencing Factor on School-Age Children’s Holistic Health Care Who Using Online Media by Working-Age Parents in Northeast Thailand

Background. Thailand tends to have more access to online media. In 2020, the northeastern region had the highest usage rate. Especially school-age children have the highest usage rate. If misused for a long time, the consequences can adversely affect health in many aspects. Their parents should closely supervise and monitor them for this health problem. However, parents have limitations in caring because they have to work a lot. The aim was to study factors that influence working-age parents in holistic health care (HHC) of school-age children using online media in northeast Thailand. Materials and Methods. This research was a descriptive study, with a sample of parent amount 222. The questionnaire performed an item-objective congruence (IOC) = 0.60–1.00, the content validity index (CVI) = 0.90, and the Cronbach’s alpha coefficient was 0.93. The data collected then include the characteristics, use of online media, health problems, and health care. Finally, data were analyzed using descriptive statistics, frequency, percentage, standard deviation, and multiple regressions. Result. The results of the study are factors that influenced HHC with statistical significance (p≤.001) including the child’s gender, the child’s age, the child’s class, the type of internet, activities, the device, and the device owner. In addition, it was holistic health problems of school-age children such as physical, emotional, social, and intellectual. Importantly, these could explain the variation for HHC of 21.2% (adjusted R2 = 0.212), and the standard error in the model estimation was 25.06 (SEE = 25.06). Conclusion. Factors that influence school-age children’s health care are beneficial to preventing and solving health problems by using online media. Parents or health care professionals can use it as a guide to develop more effective health care strategies and policies. Ultimately, it will help to promote better health for children in an ever-changing digital world.

Connecting unstably housed veterans living in rural areas to health care: Perspectives from Health Care Navigators.

To understand existing care practices and policies, and potential enhancements, to improve the effectiveness of the US Department of Veterans Affairs (VA) Supportive Services for Veteran Families (SSVF) Health Care Navigators (HCN) in linking Veterans experiencing housing instability in rural areas with health care services. We used primary data collected during semistructured interviews with HCNs (n = 21) serving rural areas across the United States during Spring 2022. We applied the Consolidated Framework for Implementation Research (CFIR) 2009 and the Social Ecological Model (SEM) to the collection and analysis of qualitative data to understand how HCNs administer services within SSVF and the larger community. We used rapid qualitative methods to summarize and analyze data. Templated matrix summaries identified facilitators and barriers to linking Veterans with health care services and policy and practice implications. Using CFIR 2009, we identified contextual factors affecting successful implementation of HCN services within SSVF; we offer a crosswalk between CFIR 2009 and the version updated in 2022. Framing facilitators and barriers within the SEM provided insight into whether implementation strategies should be addressed at a community, interpersonal, or intrapersonal level within the SEM. Facilitators included sufficient knowledge, training, and mentorship opportunities for HCNs and their capacity to collaborate within their organization and with other community-based organizations. Barriers included lack of local technology and housing resources, inadequate understanding of Veterans' service eligibilities and pathways to access those services, and deficient collaboration with the VA. Understanding facilitators and barriers experienced by HCN when linking unstably housed Veterans in rural areas with health care services can inform future strategies, including policy changes such as increased training to support HCNs' understanding of eligibility, benefits, and entitlements as well as improving communication and collaboration between VA and community partners.

Social Safety for Black Women in Perinatal Health Care: A Concept Analysis

IntroductionNon‐Hispanic Black women and their infants experience the worst pregnancy‐related outcomes in the United States. Social safety is a health‐relevant resource found in environments communicating safety, connectedness, inclusion, and protection. Approaches promoting social safety may be particularly relevant to preventing adverse perinatal health outcomes among Black women. However, there remains a lack of conceptual clarity. The purpose of this concept analysis was to provide a theoretical clarification of the concept social safety for Black women within perinatal health care.MethodsPubMed, PsycINFO, and CINAHL were searched using Boolean search strategy. Retrieved articles were managed in Zotero. Duplicates were removed, and each article was assessed and categorized by both investigators. Articles reporting Black women's perinatal health care experiences were included. Thematic analysis guided by Rodgers’ evolutionary method identified defining attributes, antecedents, and consequences of social safety in perinatal care for Black women.ResultsSocial safety for Black women is defined as the process of feeling understood, respected, cared for, and in control in perinatal health care settings that make space, care for, and recognize strengths, thereby cultivating safety and empowerment.DiscussionSocial safety offers actionable insights for practice and research that have the potential to drive positive change in perinatal care delivery for Black women. Developing interventions and measurements that are valid, reliable, and reflect social safety are essential to promote positive experiences and equity in health care practices and policies.

Enhancing healthcare access for an older population: The age-friendly emergency department.

Healthcare systems face significant challenges in meeting the unique needs of older adults, particularly in the acute setting. Age-friendly healthcare is a comprehensive approach using the 4Ms framework-what matters, medications, mentation, and mobility-to ensure that healthcare settings are responsive to the needs of older patients. The Age-Friendly Emergency Department (AFED) is a crucial component of a holistic age-friendly health system. Our objective is to provide an overview of the AFED model, its core principles, and the benefits to older adults and healthcare clinicians. The AFED optimizes the delivery of emergency care by integrating age-specific considerations into various aspects of (1) ED physical infrastructure, (2) clinical care policies, and (3) care transitions. Physical infrastructure incorporates environmental modifications to enhance patient safety, including adequate lighting, nonslip flooring, and devices for sensory and ambulatory impairment. Clinical care policies address the physiological, cognitive, and psychosocial needs of older adults while preserving focus on emergency issues. Care transitions include communication and involving community partners and case management services. The AFED prioritizes collaboration between interdisciplinary team members (ED clinicians, geriatric specialists, nurses, physical/occupational therapists, and social workers). By adopting an age-friendly approach, EDs have the potential to improve patient-centered outcomes, reduce adverse events and hospitalizations, and enhance functional recovery. Moreover, healthcare clinicians benefit from the AFED model through increased satisfaction, multidisciplinary support, and enhanced training in geriatric care. Policymakers, healthcare administrators, and clinicians must collaborate to standardize guidelines, address barriers to AFEDs, and promote the adoption of age-friendly practices in the ED.

Reform and reverberation: Australian aged care policy changes and the unintended consequences for allied health.

Allied health has a valuable role in providing services to people living in residential aged care. The recent Royal Commission into Aged Care Quality and Safety included several important recommendations relating to the nursing, personal care, and allied health workforce and the care that they provide. The purpose of this paper is to review these recommendations and the Australian Government's policy responses and explore the emerging changes in allied health service provision in residential aged care. Data from the four available Quarterly Financial Reports from the 2022-2023 financial year were extracted and analysed in relation to staff costs and time per person per day across personal care, nursing, and allied health workers. Supplementary data sources including the 2020 Aged Care Workforce Census were accessed to provide contextual data relating to individual allied health professions, including occupational therapy. The analysis shows a modest increase in median registered nurse minutes per person per day, and cost per person per day, from the first to second quarter, and again in the third and fourth. By contrast, median time and cost for allied health declined. From 5.6minutes per person per day in the first quarter, reported allied health minutes fell to 4.6minutes per person per day in the second quarter, an 18% decrease, and by the fourth quarter was 4.3minutes per person per day. This is just over half the Australian average of 8minutes reported to the RCACQS in 2019. Under recent residential aged care reforms, aged care providers have regulatory incentives to concentrate their financial resources on meeting the mandated care hours for registered nurses, enrolled nurses, personal care workers, and assistants in nursing. These same reforms do not mandate minutes of allied health services. Although providers of residential aged care in Australia continue to employ and value allied health, we argue that mandating care minutes for personal and nursing care without mandating the provision of allied health creates a perverse incentive whereby access to allied health services is unintentionally reduced.