Policy Changes Research Articles

A Mixed Methods Evaluation of Pharmacists' Readiness to Provide Long-Acting Injectable HIV Pre-exposure Prophylaxis in California.

Pre-exposure prophylaxis (PrEP) uptake remains low among people who could benefit, some of whom may prefer alternatives to oral PrEP, such as long-acting injectable pre-exposure prophylaxis (LAI-PrEP). We evaluated the potential for LAI-PrEP provision in pharmacies through a mixed methods study of pharmacists in California, where Senate Bill 159 enables pharmacists to independently provide oral PrEP. In 2022-2023, we conducted an online cross-sectional survey of California pharmacists and pharmacy students (n = 919) and in-depth interviews with pharmacists (n = 30), both of which included modules assessing attitudes about PrEP provision. Using log-binomial regression, we estimated prevalence ratios (PRs) comparing survey participants' willingness to provide LAI-PrEP by pharmacy- and individual-level characteristics. Qualitative interview data were analyzed using Rapid Qualitative Analysis to identify factors that may affect pharmacists' provision of LAI-PrEP. Half of the survey participants (53%) indicated that they would be willing to administer LAI-PrEP using gluteal injection in their pharmacy. Willingness was higher among participants who worked in pharmacies that provided vaccinations or other injections (56% vs. 46%; PR: 1.2; 95% confidence interval: 1.0-1.4) and/or oral PrEP under Senate Bill 159 (65% vs. 51%; PR: 1.3; 95% confidence interval: 1.1-1.5) than among participants whose pharmacies did not. Interviewed participants reported barriers to LAI-PrEP provision, including the need for increased training and staffing, a private room for gluteal injections, better medication access, and payment for services. Pharmacies offer a promising setting for increased LAI-PrEP access. However, pharmacists may require additional training, resources, and policy changes to make implementation feasible.

A Framework for Studying EU Health Policy through a Political Determinants of Health Lens: The Case of the European Health Union.

The COVID-19 pandemic has highlighted how the European Union (EU) impacts national health systems and people's health. In November 2020, the European Commission launched the European Health Union (EHU) to better coordinate and maximize EU member states' abilities to deal with cross-border health threats. This article scrutinizes the early institutionalization of the EHU and its implications for EU health policy as a political determinant of health (PDoH). The article explores how EU health policy may be appreciated from a PDoH perspective. It draws from EU documents and existing research to analyze the early-stage institutionalization of the EHU. The study complements this policy output-focused perspective with an outcome-based exploratory assessment of EU health policy as a PDoH focusing on three examples: joint vaccine procurement, health reforms and investments under the Recovery and Resilience Facility, and the development of a European Health Data Space. The article shows that the policy change triggered by the EHU and the potential impact on citizens' health are not necessarily congruent. Modest change can have a potentially strong impact on health outcomes and vice versa. The article argues that the PDoH perspective provides a useful approach that is complementary to policy output-based perspectives, allowing for a more comprehensive assessment of the EU's role in health.

Improving possible serious bacterial infection (PSBI) management in young infants when referral is not feasible: lessons from embedded implementation research in Ethiopia and Kenya

BackgroundSepsis is a leading cause of neonatal mortality, despite the availability of effective treatment of possible serious bacterial illness (PSBI), including when referral to a hospital is not feasible. Gaps in access and delivery worsened during COVID-19. We conducted embedded implementation research in Ethiopia and Kenya aimed at mitigating the impact of COVID-19 and addressing various implementation challenges to improve PSBI management.MethodsThe implementation research projects were implemented at the subnational level in Ethiopia and Kenya between November 2020-June 2022 (Ethiopia) and December 2020-August 2022 (Kenya). Guided by the implementation research frameworks, both projects conducted mixed formative quantitative and exploratory research from April to May 2021, followed by summative evaluations conducted between June and July 2022. Frameworks encompassed Consolidated Framework for Implementation Research (CFIR), Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM), as well as health systems framework that incorporates cascades of care and World Health Organization Health Systems Building Blocks. Results were synthesized across the projects through document review and sharing cross-project measures and strategies through a project community of practice.ResultsDespite differences in settings across the projects, cross-cutting facilitators included community health worker program and support, and existence of guidelines for PSBI management at primary care levels. Barriers included community attitudes towards seeking care for sick newborns, COVID-19 risks and fear, and lack of health care worker competence. Country-specific contextual barriers included supply chain issues, civil conflict (Ethiopia), and labor strikes (Kenya). Strategies chosen to mitigate barriers and support implementation and sustainability in both settings included leveraging community health workers to address resistance to care-seeking, health workers’ training, COVID-19 infection prevention measures, stakeholder engagement, and advocacy to integrate PSBI management into existing programs, policies, and training. Other strategies addressing emerging project-specific barriers, included improving follow-up through a community health desk and PSBI mobile app (Kenya) and supply chain strengthening (Ethiopia). Both projects improved PSBI management coverage, increased adoption and uptake, and informed national policy changes supporting potential for sustainability.ConclusionsPragmatic embedded implementation research effectively supports the identification of barriers and mapping to strategies designed to increase effective coverage of PSBI management when referral is not feasible during the COVID-19 pandemic. Despite differences in context, cross-cutting strategies identified could inform broader scale-up in the region, including during future health system shocks.

From local networks to national reform? Programmatic groups in the regionalization of German health policy

AbstractBefore policy reform initiatives reach the agenda of national decision makers, such initiatives often start at a small‐scale, local level. The Programmatic Action Framework (PAF) emphasizes the importance of biographical connections to understand how a group of policy actors forms, and how it develops programs that may lead to decade‐long policy change. This article applies the PAF to study the emergence of a programmatic group behind initiatives on regionalization in German health policy through discourse analysis and expert interviews. The study contributes to understanding social networks behind policy programs and social‐psychological, partly informal drivers of policy change. The results show that many PAF conditions have already been met in the German health policy subsystem. We describe a network of policy actors with local and organizational drivers that has led to nationwide cooperation on regionalization.Related ArticlesCaliskan, Cantay. 2020. “The Influence of Elite Networks on Green Policy Making.” Politics & Policy 48(6): 1104–37. https://doi.org/10.1111/polp.12382.Petridou, Evangelia, Per Becker, and Jörgen Sparf. “Policy Entrepreneurs in Public Administration: A Social Network Analysis.” Politics & Policy 49(2): 414–45. https://doi.org/10.1111/polp.12400.Svallfors, Stefan, Erica Falkenström, Corrie Hammar, and Anna T. Höglund. 2022. “Networked Reports: Commissioning and Production of Expert Reports on Swedish Health Care Governance.” Politics & Policy 50(3): 580–97. https://doi.org/10.1111/polp.12462.

Toward an assessment of the relevance of proposed public policy in contemporary African society: A retrospective review of Kenya's now‐defunct building bridges initiative, with special reference to post‐election violence

AbstractWhereas competing interests characterize the African public policy sphere today, the lens of mass‐elite differences has hardly been employed to study electoral violence. Accordingly, this article juxtaposes the lived experiences of ordinary Kenyan citizens, obtained through focus groups, with the content of the now‐defunct Building Bridges Initiative (BBI), a comprehensive set of public policy changes proposed by Kenya's political protagonists Uhuru Kenyatta and Raila Odinga in 2017. It poses the following broad question: did the BBI proposals truly intersect with the opinions and lived experiences of the masses? I find that various factors, including the lack of electoral and judicial integrity, and a winner‐takes‐all democratic system, are responsible for post‐election violence according to citizens. A comparative analysis of citizen perspectives and the BBI Report reveals considerable congruence in the understanding of the causes of post‐election violence. The study partly concludes that African leaders should continue to engage in policy entrepreneurship.Related ArticlesHodzi, Obert. 2020. “African Political Elites and the Making(s) of the China Model in Africa.” Politics & Policy 48(5): 887–987. https://doi.org/10.1111/polp.12380.Kouladoum, Jean‐Claude. 2023. “The Role of Freedom of Communication in Modulating the Effect of Political Participation on Electoral Outcome in Africa.” Politics & Policy 51(4): 588–613. https://doi.org/10.1111/polp.12539.Onyango, Gedion. 2024. “DHR‐PA—Democracy and Human Rights in Public Administration in Africa.” Politics & Policy 52(2): 426–49. https://doi.org/10.1111/polp.12584.

Length of stay and associated factors among pediatric patients in the pediatric emergency unit of the Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia

BackgroundLength of stay in the emergency department is used as a quality indicator to gauge the overall efficiency of emergency care. The performance measure was used to evaluate the quality of care provided in the emergency department.ObjectiveTo assess the length of stay and associated factors among pediatric patients admitted to the pediatric emergency unit of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia.MethodsAn institution-based prospective cross-sectional study design was employed. A systematic random sampling technique was used to select the study participants. Data were collected via semi-structured, interviewer-administered questionnaires and chart reviews. Analysis was performed via the Statistical Package for Social Science software version 27. Binary logistic regression analysis was conducted to identify variables associated with the length of stay. The study was conducted in the Pediatric Emergency Unit of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, from March 15 to April 15, 2023.ResultsA total of 268 patients participated in the study, with a response rate of 97.81%. The majority of the participants were male (157, 58.6%), with a median age of 3 years. The study revealed that 180 participants (67.2%) experienced a prolonged length of stay. The variables significantly associated with prolonged length of stay included residency (AOR = 2.04, CI: 1.03, 4.025), triage category (AOR = 3.25, CI: 1.08, 5.974), number of investigations (AOR = 2.381, CI: 1.038, 5.462), and waiting for imaging (AOR = 4.230, CI: 1.638, 10.93).ConclusionMany pediatric patients stayed in the emergency room for more than 24 h because of factors such as residency, triage category, number of investigations, and the need for imaging. To address this, we recommend streamlining triage processes, increasing imaging resources, providing additional staff training, developing integrated care pathways, and advocating for policy changes to increase emergency room efficiency and improve patient outcomes.

An environmental scan of studies reporting current practices for the conduct of environmental scans

Objective: The objective of this environmental scan is to synthesize the published, peer-reviewed literature specific to the term ‘environmental scan’ to determine how it is currently being used in health research and to propose some promising practices. Background: Environmental scans are becoming increasingly popular in synthesizing information on emergent topics and describing practice and research scope. Despite the growing use of environmental scans in health research, including nursing and rehabilitation, limited attention is given to methodological best practices. It is essential that we develop knowledge in this area to assist researchers, trainees, healthcare professionals, educators, and decision-makers with the use and reporting of environmental scans. Study design and methods: This environmental scan included a search of four health databases: CINAHL, Embase, MEDLINE, and PsycINFO. We included peer-reviewed studies published between 2000-2024 in English using two key terms, ‘environmental scan’ and ‘health’. Studies were included that described methods used in conducting an environmental scan. Results: We identified 56 studies describing methods for conducting environmental scans. A synthesis of these studies revealed four promising practices: 1) consider environmental/contextual influences, 2) use of multiple data sources and approaches, 3) engage stakeholders to ensure relevance/need and increase uptake, and 4) use of outcomes to address knowledge or service gap to optimise impact. Conclusion: The findings of this environmental scan are among the first to examine methodological studies to determine promising practices for conducting environmental scans across health disciplines. Implications for research, policy, and practice: The findings of this novel environmental scan are beneficial for health professionals, researchers, trainees, educators, and decision-makers in informing research, practice, and policy change What is already known about the topic? The use of environmental scans is becoming increasingly popular in health research, including nursing and rehabilitation. There is a lack of consistency in the use and reporting of environmental scans across health disciplines. What this paper adds This environmental scan is among the first to contribute foundational knowledge and innovation in promising best practices for the conduct of environmental scans in health research. The novel findings will assist in promoting consistency in the use and reporting of environmental scans.

Sustainable approaches to landscape design through diverse environmental waste recycling practices

AbstractIn today’s context, sustainability serves as a pathway to meet current needs while safeguarding those of future generations, encompassing initiatives across various sectors. Whether environmental, social, or economic sustainability, governments, companies, and individuals are increasingly adopting it as a guiding principle to address global challenges like resource depletion and climate change. This paper explores the topic of sustainable landscaping with a focus on using demolition and construction waste into hardscape-like benches. Where waste materials are held for profitable use, particularly in manufacturing sustainable concrete for landscape elements. We address the urgent need for creative solutions to environmental problems, focusing on cooperation, policy changes, and technological improvements. We aim to support sustainable methods in landscape design by reusing resources such as broken ceramics, recycled aggregates, and granite powder. This Study presents a comprehensive methodology that includes application techniques, theoretical frameworks, and recommendations for successful execution. Our study emphasizes integrating sustainability concepts into landscape design, providing observable advantages, including waste reduction, resource conservation, and environmental preservation. We hope this study will help create a future where society and the environment coexist more sustainably.

De-implementation of Routine Maternal Oxygen Supplementation for Intrauterine Fetal Resuscitation: A Retrospective Cohort Study.

Current practice guidelines for laboring patients with category II intrapartum tracings recommend maternal oxygen supplementation despite emerging randomized data challenging its benefit and utility. We aim to validate that de-implementing maternal oxygen supplementation for fetal resuscitation did not increase the risk of neonatal acidemia in a real-world setting. This is a retrospective observational study conducted at a single tertiary care center from January 2019 to June 2021. All laboring deliveries during the study period was reviewed and eligible participants included singleton or twin pregnancies between 23-42 weeks gestational age with persistent category II tracings. Known major fetal anomalies, contraindications to labor, and maternal indication for O2 supplementation, including active COVID-19, were excluded. Cohorts were allocated based on time of delivery. Those occurring prior to our hospital policy change identified as historical controls and deliveries after April 1, 2020, as the post-de-implementation cohort. Primary outcome was fetal acidemia, defined as umbilical cord pH < 7.2. Secondary outcomes included severe acidemia (pH < 7.0), 5-minute Apgar score < 4 and neonatal intensive care admission. Regression analyses controlling for known variables associated with neonatal acidemia generated adjusted odds ratios with 95% confidence intervals. Among 9088 deliveries during the study period, 1162 tracings were flagged as persistent category II, including 681 (59%) in the post-intervention group. The two cohorts had comparable baseline and obstetric characteristics. No difference in neonatal acidemia was observed between the post-de-implementation group and historical controls (13.8% vs 15.4%, aOR 0.87, 95% CI 0.62-1.22). Severe acidemia, 5-minute Apgar < 4 and neonatal intensive care admission were not increased in the post-de-implementation group. De-implementation of routine maternal oxygen supplementation for fetal resuscitation did not increase likelihood for neonatal acidemia in a real-world setting, validating guidelines recommending against the intervention.

Breaking chains of tobacco: empowering African American churches in West Virginia for a healthier future

Across West Virginia, tobacco use continues to be a significant public health challenge. Specifically, tobacco use is linked to high poverty across the state and disproportionately affects African Americans. A faith-based tobacco prevention network was formed to address these concerns and increase education and cessation. The West Virginia African American Tobacco Prevention Network (WVAATPN) was formed in 2021 and since then has expanded its reach across the state, involving 22 congregations. The Network’s model includes annual training for lay leaders on various tobacco-related topics, tailored educational curriculum for congregations, and collaboration with national experts to enhance program efficacy. The Network has run educational and cessation workshops and promoted events such as No Menthol Sunday. Workshops have yielded positive outcomes among participants, including increased awareness of tobacco marketing tactics, higher cessation rates, and improved understanding of the health impacts of tobacco. The WVAATPN continues to expand its reach and effectiveness by advocating for policy change, enhancing community engagement, and fostering partnerships to combat tobacco-related disparities in West Virginia’s African American communities.

Childbearing under different family policy schemes

Objective: This study assesses whether and how changes in family policies are associated with first and second births in Finland, Germany and the United Kingdom, and whether these associations differ by women’s education. Background: Family policies are expected to impact the direct and indirect costs of childbearing by providing resources that influence the monetary and non-monetary costs of having children. The countries analysed here have undergone substantial changes in family policy throughout the two decades analysed, but each country has changed different aspects of their policies, and they have done so in different policy environments. Method: We analysed women aged 18–44 and their transitions to first and second births using register data from Finland (N = 57,518 / 21,685) and panel data from Germany (G-SOEP, N=37,716 / 16,756) and the UK (BHPS and Understanding Society, N = 13,213 / 9,992) complemented with annual family policy information. The data were analysed using logistic regression models and interactions, and the results are presented as average marginal effects. Results: The results suggest that the association between changes in family policies and transitions to first and second child birth varied by birth parity, women’s education level, and between countries. For example in Finland, increases in paternity leave length were associated with greater propensities to transition to first birth for highly educated women, whereas increases in child allowances had a similar association for lower educated women. In Germany, reductions in maternity leave length were associated with increased transitions to first birth for higher educated women. In the UK, increases in maternity leave length were associated with greater transitions to first births among all women. Conclusion: The results highlight that to the extent that family policies influence fertility, they do so depending on both the country context and often differentially within countries based on women’s education level and birth parity.

Screening for STIs among criminal legal system involved youth of color in community settings

BackgroundSexually transmitted infections are a significant, and growing, public health problem in this country – particularly among youth. Innovative strategies are needed to reduce the community burden of infection. Preliminary studies indicate that individuals involved in the criminal legal system have high rates of infection. While gaps exist in providing screening for incarcerated individuals, there are minimal efforts that have been initiated to screen individuals diverted from incarceration. In this study, we examined the STI risk profile and feasibility of screening for sexually transmitted infections for youth who were attending an alternative sentencing program after arrest for a minor offense. Youth were screened for chlamydia and gonorrhea using urine-based nucleic acid amplification tests.ResultsOf the 307 participants engaged in a program providing supportive services for criminal legal system involved youth at the Brooklyn Court House in New York City, 186 agreed to screening for sexually transmitted infections, and 8% were positive for chlamydia, gonorrhea, or both.ConclusionsScreening programs within carceral settings have proven effective in identifying individuals with STIs. However, with policy changes diverting more young people away from incarceration and into community-based programs, innovative programs are needed to identify STIs among youth in these settings. Our findings indicate that it is feasible to conduct venue-based screening in these settings, and, doing so may identify youth in need of treatment and further evaluation.

An evaluation of financial statement quality in pre-versus post-IFRS-7 implementation: the case of Iraqi banking industry

This study compares Iraqi banking financial statements before and after IFRS-7 financial instruments disclosure. “Nijmegen Centre for Economics (NiCE)” qualitative content analysis was used to assess financial statement quality, which was measured using NiCE disclosure index. This study analysed data using a paired sample test to meet its goals. After IFRS-7, financial reporting quality is represented by 2016–2018. Before IFRS-7, it was represented by 2013–2015. In addition, the OLS regression analysis was implemented to assess hypotheses, incorporating data from 24 Iraqi institutions. The univariate analysis (t-test) and OLS regression showed that IFRS-7 improves financial statement “relevance, faithful representation, comparability, and timeliness”. No correlation was found for “understandability”. This study is the first to use Iraqi data and the most recent disclosure index to test the relationship between financial figure quality before and after applying the IFRS-7 financial instruments disclosure standard in developing countries. The results help regulators and policymakers regulate IFRS in Iraq and suggest policy changes to ensure compliance. The findings have major implications for business and policy that executives, lawmakers, and stockholders should consider. This study is applicable to ME countries that share comparable institutional, cultural, and accounting framework characteristics.

Breaking barriers: Addressing gender disparity in neurosurgery.

Neurosurgery is still dominated by men, with only 16.7% of neurosurgeons being women and even fewer in leadership roles. This disparity affects research, patient care, and health policy. To enhance care and equity, addressing barriers for women through targeted mentorship, inclusive practices, and policy changes is essential. CORRESPONDENCE: Despite significant progress in medical education and practice, neurosurgery remains a male-dominated specialty. This gender disparity is not merely a reflection of societal biases but a systemic issue that affects both the professional advancement of women and the quality of care delivered to patients. As the global health community strives for equity, the underrepresentation of women in neurosurgery demands urgent attention.

Balancing act: Examining the trade‐offs between regional convergence and economic growth in China's province managing county reform

AbstractThe study examines the relationship between regional convergence, economic growth and government hierarchies, with a specific focus on the province managing county (PMC) reform policy in China. The motivation for this research stems from the observation that a substantial portion of the increased inequality in China is attributable to disparities at the county level. This underscores the necessity for policies that address regional inequalities at the county level while simultaneously promoting sustained economic growth. We employ a time‐varying quasi‐natural experiment to explore how this reform has influenced regional convergence and economic growth within the sample period. The outcomes reveal that the PMC reform had a detrimental impact on regional convergence, hindering it by an average of 2.6%, while economic growth received a modest increase of 0.36%. The study also reveals notable heterogeneity in the effects of the reform, contracted disparities in western region, alongside exhibiting widened disparities and higher growth in eastern &amp; central region. The study also investigates the underlying mechanisms, finding that expenditures on basic provisions reduced, while county revenue and investment expenditures increased following the policy change. It proposes that the increased investment in capital expenditures stimulated economic growth but came at the cost of hindering regional convergence.

Enhancing structural protection of reinforced concrete structures against high dynamic loads using post-installed UHPFRC/UHPFRSC

Recently there has been an observed change in security policy across the globe which implies that humanity must prepare for hybrid and asymmetric acts of war. This security situation will result in spontaneous attacks from non-military groups. The threats include ballistic attacks from commercially available weapons, detonation of explosives, and impact of vehicles. These attacks are focused on critical infrastructures. Reinforced concrete (RC) elements with ballistic and explosion protection are of huge relevance. This requires new concepts and innovative solutions for the protection of new buildings and/or for the strengthening of existing structures. In this paper a method for the increase of structural safety is shown using Ultra-High Performance Fiber Reinforced Concrete (UHPFRC) or sprayed UHPFRC, so called UHPFRSC, as a surface layer for reinforced concrete structures. The UHPFRC/UHPFRSC is applied in thin layers of 30 - 80 mm on the protection side. The interaction of the two different cementitious materials results in increased resistance to high dynamic loads. The traditional reinforced concrete on the impact side absorbs a major fraction of the energy of impact. On the back side (protection side), tensile forces are generated by the impact, which can excellently be handled by the UHPFRC/UHPFRSC. For proof of concept of the hybrid strengthening method, tests were carried out on UHPFRC - RC composite elements. In the test campaign, ballistic tests were performed using test specimens with dimensions of 500 × 500 mm. The layer thicknesses were 120 mm reinforced concrete and 40 mm UHPFRC. Additional steel rebars in the UHPFRC layer were applied for half of the specimens. The investigation demonstrated the effectiveness of the strengthening method, showing high resistance to high-dynamic loads. This behavior is attributed to the absorption and transfer of tensile stresses by the UHPFRC, that reduces penetration depth and damage, ensuring remaining load-bearing capacity after gunfire.

Причины модификации внешнеполитических усилий Турецкой Республики в отношении государств Центральной Азии в 1991–2022 гг.

The article analyzes the reasons behind the modification of the foreign policy efforts of the Republic of Turkey towards Central Asian states (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan) from 1991 to 2022. During this period, Turkey’s efforts were modified due to several general factors: global historical events, shifts in international relations, the emergence or decline of new actors in international relations, the evolution of ideas within the state’s political framework, rapid scientific and technological advancement, increased accessibility to information, and the development of new methods of societal engagement. The analysis identifies specific reasons for these modifications: the diversification of Turkey’s foreign relations aimed at enhancing its geopolitical role in the world, the resurgence of Pan-Turkism in Turkey’s foreign policy, the variability and frequent changes in the ruling parties within the country, the absence of foreign policy invariants and constants in the execution of its foreign policy course, the political struggle between pro-Islamic parties and Kemalists, and the multi-vector nature of the country’s foreign policy from 1991 to 2022. The results obtained may assist Central Asian states in formulating strategies and tactics for their international relations with Turkey and other actors.

Grasping the opportunity for small state leadership: Estonia’s response to the Russian invasion of Ukraine

Russia’s invasion of Ukraine reinforced Estonia’s long-held worldview and strategic posture rather than bringing about any principled foreign policy change. There was a remarkable change, though, in Estonia’s international visibility. The turbulent security environment created an opportunity for small state leadership especially in the framework of regional organisations. During the two first years of the full-scale war in Ukraine, Estonia’s foreign and security policy focused on shaping the policies of North Atlantic Treaty Organization and the European Union with a view to providing maximum support to Ukraine and increasing the cost of aggression for Russia. Estonia acted as a leader through shaping the public narrative, setting the agenda, leading by example, building coalitions and orchestrating the desired outcomes. Through analysing the Estonian experience, the article addresses the broader puzzle of how small states can overcome their relative lack of power and take leadership in matters of international security, usually dominated by great powers.

Safer dementia care spaces: Perspectives from LGBTQ+ people with cognitive impairment and caregivers.

The number of caregivers and people living with dementia and other related forms of cognitive impairment is increasing worldwide. Compared to heterosexual and cisgender individuals, studies suggest that lesbian, gay, bisexual, queer, or other sexual and/or gender minority people (LGBTQ+) are at a higher risk for known risk factors for cognitive impairment and dementia, stemming from minority stress experiences. Limited research has explored the distinct obstacles that LGBTQ+ people with cognitive impairment and caregivers encounter, especially within dementia care. The purpose of this study was to deepen our understanding regarding LGBTQ+ people with cognitive impairment and caregivers' experiences with dementia care spaces, and to identify the strategies that they perceive as effective in creating safer and more inclusive spaces. Fourteen LGBTQ+ participants aged 27-78 (M = 58.07), consisting of two individuals with cognitive impairment and 12 caregivers, were interviewed about the care needs of LGBTQ+ people with cognitive impairment and caregivers, and their experiences with dementia care spaces. Using reflexive thematic analysis, we identified three overarching themes from the data, indicating that LGBTQ+ people with cognitive impairment and caregivers feel left "on the margins" of dementia care and express a desire for their identities to be celebrated and recognized. Additionally, they proposed recommendations for policy change to foster safer and more inclusive spaces for dementia care. The findings call attention to the negative experiences of LGBTQ+ people with cognitive impairment and caregivers with dementia care, but also highlight the ways in which care practices can be transformed to effectively address their care needs.

From ‘Born’ Bilinguals to Monolinguals: Understanding Korean‐Chinese Bilingual Family Language Policy in China

ABSTRACTIn recent years, China has implemented a national language policy promoting the use of Putonghua (Standard Chinese) in ethnic minority schools. This study investigates how mesolevel institutions (i.e., schools) have responded to this macro‐level national language policy change, and how the institutional policy changes have affected Korean‐Chinese bilingual family language policies in Yanbian, China. Based on an analysis of the teaching and learning materials used in schools and data gathered through interviews with and observations of 16 Korean‐Chinese bilingual families, this study finds that schools have actively responded to macro‐level policy changes with organised, large‐scale language practice activities. As a result of factors such as educational pressure and broader societal ideologies, families have been pressured to align with the meso‐level language policy despite their desire to maintain their heritage language and culture. Consequently, it is likely that future generations of Korean‐Chinese individuals, who would previously have been ‘born’ bilinguals, may become monolinguals. This study contends that in countries with a unified language ideology and a dominant language, the impact of macro‐level policy reforms can restrict or promote micro‐level family language policies through the mediating influence of meso‐level institutions. Family language policy researchers may need to recognise that there is a one‐way, rather than two‐way, relationship between the aims of the state and the desires of families in such contexts.