Consultancy Work Research Articles

80 Yearly change in child zBMI and the COVID-19 pandemic in Canada: A cohort study

Abstract Background Emerging literature suggests accelerated weight gain in children during the pandemic; however, data from Canadian children are limited and individual factors underlying this trend remain unclear. Objectives To determine whether the COVID-19 pandemic was associated with increased yearly change in age- and sex-standardized body mass index (zBMI) in Canadian children and whether staying at home during the pandemic was associated with increased change in zBMI per year. Design/Methods A repeated-measures longitudinal study was conducted with children from an existing practice-based research network in Canada age 1-18y with at least one zBMI measurement pre- and post-onset of the pandemic. Height and weight were measured through primary care office visits and supplemented with at-home parent measurements post-pandemic. Weekly questionnaires were used to measure days stayed at home per week. Piecewise linear mixed effects models accounting for repeated measures through random effects were used to assess yearly change in zBMI. A knot location was placed at the start of the pandemic (March 14, 2020) to compare slopes pre- and post-pandemic onset. Similar mixed effects models were used to explore the association between days at home per week and change in zBMI post-pandemic onset. Stratification by sex and a sensitivity analysis in children with clinic-measured anthropometrics were explored. All models were adjusted for covariates identified a priori. Results In the overall population (n=849 children, 5070 observations), there was no significant difference in slope for yearly change in zBMI post-pandemic (Mar 2020-Sept 2022) compared to prior (Oct 2004-Mar 2020) in fully adjusted models accounting for child age, sex, maternal ethnicity, maternal BMI, family income, birthweight, breastfeeding duration, anthropometrics measurement method (clinic vs parent) and pre-COVID zBMI (post-COVID β=0.03; 95%CI -0.02,0.08; pre-COVID β=0.009; 95%CI-0.009,0.027; p-interaction=0.46). In children with clinic-measured anthropometrics (n=849, 4318 observations), there was a significant increase in yearly change in zBMI after the onset of the pandemic in the fully adjusted model (β=0.07; 95%CI 0.02,0.12) compared to prior (β=0.004; 95%CI -0.01,0.02; p-interaction=0.01). This was driven by changes in boys (post-COVID β=0.08; 95%CI 0.007,0.15; pre-COVID β=-0.003; 95%CI-0.03,0.02; p-interaction 0.04). In boys with clinic-measured anthropometrics post-pandemic onset (n=77 children, 85 observations), there was marginal evidence for increase in yearly zBMI change for every additional day at home per week in the fully adjusted model (β=0.16; 95%CI -0.006,0.32; p=0.06). Conclusion The COVID-19 pandemic was associated with accelerated increase in zBMI per year in Canadian children with clinic-measured height and weight, particularly among boys. Potential competing interests Funding was obtained by J.J. Joseph Jamnik for consultant work for Nutrigenomix Inc, a University of Toronto start-up which offers evidence-based genetic testing for personalized nutrition. Consulting work terminated July 1, 2023. This relationship is unrelated to the work submitted. Research funding: Understanding and mitigating the impacts of the COVID-19 pandemic on children, youth and families in Canada - Operating Grant. CIHR grant 468613. 2021-2024.

7984 A Challenging Case Of Hyperphosphatemic Familial Tumoral Calcinosis

Abstract Disclosure: T.G. de Souza: None. T.J. Weber: None. Introduction: Hyperphosphatemic Familial Tumoral Calcinosis (hFTC) is a rare, autosomal recessive metabolic disorder characterized by elevated serum phosphate levels and the accumulation of calcium phosphate deposits in soft tissues. There are fewer that 150 genetically confirmed cases in the literature. There are no consensus guidelines; therapeutic approaches are guided by case reports or series. This case serves to heighten awareness of therapeutic strategies including global health considerations for the disabled adult with a rare bone disorder. Case: A 32-year-old African-American woman presented to establish care for hFTC, for which she takes ibuprofen for disabling bilateral hip pain. hFTC was diagnosed in early childhood and managed at a large children’s hospital. Therapeutic modalities relied on operative resection of skin lesions on eruption. She describes cosanguinous parentage, consignment to foster care as a child and homelessness as an adult. She has not had adult endocrine care for her hFTC. Her medical comorbidities include major depressive disorder, PTSD and suicide attempt. She reports one uncle with hFTC noting that his phenotype was not significantly disabling and apparent recession of his lesions with age. Her parents did not have symptoms of hFTC. Radiographically, she had amorphous calcium deposits over both hips (her primary sites of severe pain), upper back (site of painless spontaneous eruptions), and left elbow without pain or skin penetration, as well as hyperostosis of the ilium bilaterally. She noticed waxing and waning of her eruptions with her menstrual cycle, such that lesions worsen in the luteal phase. Megestrol acetate also induced new eruptions. Examination shows brown staining to all teeth with several missing teeth. She had a marked lower extremity limb length discrepancy with severe restriction of hip abduction. Blood chemistries were grossly normal, including renal function, calcium, uric acid and PTH. Serum phosphorous was elevated at 5.2 (2.3 - 4.5 mg/dL). CT showed bilateral nephrocalcinosis. We instituted treatment with a low phosphorous diet, sevelamer to reduce intestinal phosphate absorption and acetazolamide to increase urinary phosphate excretion. For her pain and functional disability, we recommended continued NSAIDs, physical therapy and social work consultation to facilitate continued access to care. Conclusions: This case uniquely describes hFTC symptom fluctuation with the menstrual cycle, worsening with increased progesterone, suggesting a possible role of gonadal hormones on FGF-23 biology. It also highlights the socioeconomic burdens that can accompany rare bone disease, which become more pronounced as the patient achieves adulthood. Successful transition of care from pediatric to adult endocrinologist, in addition to engaging multi-disciplinary support, is essential in optimizing life-long care in hFTC. Presentation: 6/1/2024

Potential Bias in Social Work Consultations in the Pediatric Inpatient Setting.

Failure to thrive, brief resolved unexplained event, accidental ingestion, and drowning admissions commonly involve social work (SW) consultation. Care team biases likely influence SW consultation decisions. We examined whether SW consultations varied by patient race for these diagnoses. We conducted a retrospective cohort study of children <6 years of age admitted for failure to thrive, brief resolved unexplained event, accidental ingestion, and drowning between July 1, 2012 and June 30, 2020 at a single, academic, standalone children's hospital in an urban environment. The outcome was SW consultation; the predictor was patient race. We used multivariable logistic regression, adjusting for ethnicity, language, insurance, and diagnosis. We completed a supplemental chart review of a random sample of 10% of patients with SW consultation to determine the reasons that consultations were placed. We included 1199 unique patients; 64% identified as white, and 22% identified as Black. Black patients had 1.61 times higher adjusted odds of SW consultation compared with white patients (95% confidence interval 1.14-2.29). Publicly insured, compared with privately insured, patients had 6.10 times higher adjusted odds of SW consultation (95% confidence interval 4.28-8.80). Upon supplemental chart review, Black patients had SW consultations that focused more often on abuse, neglect, and safety; this was also found for publicly insured patients. There was parity in consultation for resource needs across groups. Black children were more likely than white children to receive SW consultation during hospitalization, as were publicly insured children compared with their privately insured peers; in supplemental review, this was not due to differences in consultations for resource needs. The standardization of SW consultation may promote equitable care.

The Right to Oncological Oblivion: A Legislative Response to Cancer Survivor Discrimination in Italy.

Despite the increasing efficacy of modern medicine in diagnosing and treating cancer, survivors often face discrimination in employment, economics, insurance, and society. Law no. 193/2023, also known as the "Oncological Oblivion Law", aims to provide an initial legislative response to discrimination against cancer survivors in Italy. After defining oncological oblivion in Article 1, the Law provides, in Articles 2, 3, and 4, directives to prevent discrimination against cancer survivors in the area of access to banking and insurance services, adoption procedures and access to or retention in employment. The aim of this work is to illustrate the content and the critical aspects of the recent Law 193/2023 in the landscape of European directives. The legislative process at the Chamber of Deputies and the Senate of the Italian Republic has been retraced through the consultation of preparatory works and bills registered on institutional databases. Law 193/2023 represents the first initiative in Italy aimed at the recognition of the right to oncological oblivion, not only in access to banking and insurance services as in other countries, but also in adoption, employment, and re-employment. Our opinion piece highlights the need for further clarification and expansion to prevent discrimination and protect the social-work-relational rights of people who have been affected by oncological diseases.

Crossing the lines a human approach to improving the effectiveness of the three lines model in practice

Purpose Financial services firms have a significant societal responsibility to prevent issues. The three lines model helps them do that though faces challenges in its effectiveness. This paper aims to offer a behavioural perspective on these challenges and practical solutions to help improve the model and herewith better prevent issues. Design/methodology/approach The authors detail key behavioural pitfalls and underlying psychological mechanisms that hinder the effectiveness of the model. The authors illustrate these with examples from the corporate practice, alluding to the behavioural patterns and drivers identified in the academic and consultancy work. The authors conclude with offering practical solutions how to enhance the effectiveness of the model. Findings The authors discuss common ineffective intergroup behaviours between the controllers (here: internal audit) and the controlled (here: the audited business or 2nd line functions): the controllers responding to issues with increased scrutiny; the controlled dismissing the feedback and challenging the issues raised; and the controlled and the controller competing for power. The root causes of these ineffective intergroup behaviours include: psychological defence mechanisms, social categorisation and collective beliefs about intrusiveness. The offered solutions range from actions the controllers can take, actions the controlled can take and actions both can take to improve the effectiveness of the model in practice. Originality/value The authors argue that the behavioural perspective on the effectiveness of the model is a blind spot and largely omitted from organisations’ agendas. This paper adds this behavioural perspective to help organisations improve the effectiveness of the model.

Benchmarking Large Language Models for Cervical Spondylosis.

Cervical spondylosis is the most common degenerative spinal disorder in modern societies. Patients require a great deal of medical knowledge, and large language models (LLMs) offer patients a novel and convenient tool for accessing medical advice. In this study, we collected the most frequently asked questions by patients with cervical spondylosis in clinical work and internet consultations. The accuracy of the answers provided by LLMs was evaluated and graded by 3 experienced spinal surgeons. Comparative analysis of responses showed that all LLMs could provide satisfactory results, and that among them, GPT-4 had the highest accuracy rate. Variation across each section in all LLMs revealed their ability boundaries and the development direction of artificial intelligence.

Evaluation of Sustainable Development for Low-Volume Roads in Sarawak

The national socio-economic development programme prioritises rural development, and the state of Sarawak requires many rural roads to connect existing villages to the main roads. This programme can be achieved by upgrading existing non-standard access roads or constructing new access roads. The current challenges and issues related to the sustainable development of low-volume roads (LVRs) in the Malaysian state of Sarawak were investigated in this study. The key goals of the study were to understand the challenges of sustainable development in Low Volume Roads (LVRs) in Sarawak using expert interviews as well as surveys on experienced engineers. It aimed at clarifying what LVRs are, highlighting challenges to do with designing and planning them, and also discussing pavement design aspects. The data for the research was collected through interviews with experts in state Public Work Department (PWD) and consultants with more than 15 years’ experience in road planning and construction. An online questionnaire was distributed and it targeted government agencies, consultants, contractors, with 52 respondents out of 200 possible. This helped to identify important problems associated with LVR development; it stressed that a proper knowledge of LVR design, planning difficulties and those specific concerning pavement designs is needed among professionals within Sarawak road building industry. Based on the findings, immediate need for actions was required to be taken by road agencies to investigate the development and appropriate design of LVRs also to record and gather historical data on current LVRs for further improvement.

Effectiveness of interventions on improving early-life dental care utilization: a systematic review and meta-analysis.

Although early-life dental care is crucial for preventing early childhood caries and has numerous benefits, the utilization rate of such care remains remarkably low worldwide, especially in families of low socioeconomic status. The aim of this study was to systematically review the scientific evidence relating to the effectiveness of interventions on improving early-life dental care utilization of very young children. We reviewed scientific evidence relating to these positive changes, with 7 randomized controlled trials after qualitative evaluation. Interventions assessed included prenatal oral health promotion, motivational interviewing, intraoral camera use alongside social work consultations to aid in decreasing barriers to care, monetary incentives for tooth brushing, fluoride varnish applications, and probiotic usage. The intervention was significantly effective in reducing the incidence of dental caries among children, especially in caries risk. Caries reduction was significant when oral health information was provided at frequent intervals prenatally. Caries increment was also reduced when probiotics were introduced when administered daily. Interventions that attempted to increase parental involvement in oral health care by increasing motivation and decreasing barriers had inconclusive results within the study groups. Considering high rates ECC, early establishment and preservation of a dental home should be a focus in public health measures. Continuous monitoring and parental involvement are key components to maintaining healthy oral conditions. Future studies could explore and test various innovative strategies that utilize technological platforms to engage with parents and promote early-life dental care utilization among the underserved population.

Early Validation using Architectural Overviews (A3AO) a Case Study in an IoT Consultancy

AbstractThis paper focuses on the use of A3 Architectural Overviews (A3AO) for early validation of stakeholder needs and system concept as part of a tender proposal in an IoT consultancy. Tender proposals are an essential part of communication between most companies working in the engineering field. Often with hightech companies, a technical knowledge gap exists between the different stakeholders reading tender proposals. This knowledge gap increases the risk of miscommunication and wasteful work. A real‐life case from an IoT consultancy tendering an IoT concept for a processing facility forms the basis for the research. Applying an action research approach, the researchers tailored the A3AO framework to fit within the consultancy's work flow and developed an A3AO describing the tendered system concept. The customer received and later accepted the tender proposal including the A3AO containing the stakeholders' problems and needs, a concept solution, and a roadmap detailing further work. In this study, we collected data from observations, semi‐structured interviews, surveys, and a follow‐up questionnaire to the customer. The study found that the A3AO functions as a tool for early validation and that it helped bridge the knowledge gap between the consultancy and customer. The study also raises questions and criticism regarding cost and complexity. The consultancy later decided to implement A3AOs in future proceedings.

Methodological Proposal for Sustainable Territorial Communication—The Case of Castilla y León

The proximity television model adopted by Castilla y León since 1999 is based on promoting territorial identity and closeness to citizens, in line with the principles of identity and proximity in regional television, albeit with the particularity in the Spanish context of being a regional television system managed by a private concessionaire. In response to the current challenges of the television sector, a consultancy project is implemented with a methodological approach based on a SWOT analysis and the participation of multiple actors. This work details the methodology followed during the different phases of this interdisciplinary consultancy work: definition of bases, development of a base document, and concretion of actions, until reaching the elaboration of a detailed guide that establishes strategic objectives and specific actions. This strategic approach translates into a proposal to improve the performance of regional television and its contribution to the economic and social development of the region; however, the difficulty for its effective implementation due to an uncertain political scenario is pointed out.

Meet the AI expert

In this interview, Touchpoint Editor-in-Chief Jesse Grimes interviews Yifan Gan, a Shanghai-based consultant working at the intersection of service design and AI, and a Guest Editor of thisissue of Touchpoint. In addition to his consultancy work assisting Chinese firms with AI strategy and implementation, he is a lecturer for TongJi University and Shanghai Jiaotong University in service design and strategy.

Implementing Inpatient Social Needs Screening in an Urban Tertiary Care Children's Hospital.

The American Academy of Pediatrics recommends screening for unmet social needs, and the literature on inpatient screening implementation is growing. Our aim was to use quality improvement methods to implement standardized social needs screening in hospitalized pediatric patients. We implemented inpatient social needs screening using the Model for Improvement. An interprofessional team trialed interventions in a cyclical manner using plan-do-study-act cycles. Interventions included a structured screening questionnaire, standardized screening and referrals workflows, electronic health record (EHR) modifications, and house staff education, deliberate practice, and feedback. The primary outcome measure was the percentage of discharged patients screened for social needs. Screening for social needs was defined as a completed EHR screening questionnaire or a full social work evaluation. Process and balancing measures were collected to capture data on screening questionnaire completion and social work consultations. Data were plotted on statistical process control charts and analyzed for special cause variation. The mean monthly percentage of patients screened for social needs improved from 20% at baseline to 51% during the intervention period. Special cause variation was observed for the percentage of patients with completed social needs screening, EHR-documented screening questionnaires, and social work consults. Social needs screening during pediatric hospitalization can be implemented by using quality improvement methods. The next steps should be focused on sustainability and the spread of screening. Interventions with greater involvement of interdisciplinary health care team members will foster process sustainability and allow for the spread of screening interventions to the wider hospitalized pediatric population.

Variation in care for inpatients with avoidant restrictive food intake disorder leads to development of a novel inpatient clinical pathway to standardize care

IntroductionThere is limited evidence to guide management of patients with avoidant restrictive food intake disorder (ARFID) admitted for medical stabilization. We describe variations in inpatient care which led to the development of a multidisciplinary inpatient clinical pathway (ICP) to provide standardized management and examine differences after the ICP was implemented.MethodsA retrospective review of patients with ARFID admitted to Adolescent Medicine, Gastroenterology, and General Pediatrics at a single academic center was conducted. We compare hospital utilization and use of consulting services during the pre-ICP (2015–2017) and post-ICP (2018–2020) periods.Results110 patients were admitted with ARFID (n = 57 pre- vs. n = 53 post-ICP). Most presented with moderate/severe malnutrition (63% pre vs. 81% post; p = 0.11) and co-morbid anxiety and/or depression (74% pre vs. 92% post; p = 0.01). There was some variation in use of enteral tube feeding by service in both periods (p = 0.76 and p = 0.38, respectively), although overall use was consistent between periods (46% pre vs. 58% post; p = 0.18). Pre-ICP, use of the restrictive eating disorder protocol differed across services (p < 0.001), with only AM using it. Overall, utilization of the restrictive eating disorder protocol decreased from 16% pre-ICP to 2% post-ICP (p = 0.02). There was variation by service in psychiatry/psychology (range 82–100% by service; p = 0.09) and social work consultations (range 17–71% by service; p = 0.001) during the pre-ICP period, though variation was reduced in the post-ICP period (p = 0.99 and p = 0.05, respectively). Implementation of the ICP led to improvements in these consultative services, with all patients in the post-ICP period receiving psychiatry/psychology consultation (p = 0.05) and an increase in social work consults from 44 to 64% (p = 0.03). Nutrition consults were consistently utilized in both periods (98% pre vs. 100% post; p = 0.33).ConclusionThe ICP was developed to standardize inpatient medical stabilization for patients with ARFID. In this single center study, implementation of the ICP increased standardized care for inpatients with ARFID with variation in care reduced: there were improvements in the use of consulting services and a reduction in the use of the restrictive eating disorder protocol. The ICP demonstrates the potential to further standardize and improve care over time.

Sociodemographic profile and clinical presentation of young children unintentionally exposed to marijuana: A single site retrospective cohort.

Legalization of medical marijuana has increased unintentional exposure to marijuana in young children. We aim to explore the sociodemographic disadvantage profile, prevalence, and clinical presentation of children diagnosed with unintentional exposure to marijuana. We conducted a retrospective chart abstraction of 121 children (aged 0-6) seen at the Emergency Department (ED) at a single tertiary hospital center in Dayton, Ohio between January 01, 2010 and January 09, 2022. Majority were female (62.8%), white (50.4%), and with Medicaid as their primary insurance (84.3%). The median age at exposure was 1.8 years. There was a 14-fold increase in unintentional marijuana cases pre-2017 (7 cases) versus post-2017 (114 cases), the year of legalization of medical marijuana in the state of Ohio. Majority of the patients were using public assistance (66.4%). 26.7% of the cases had a prior social work consultation and 38.1% had a prior children services consultation. 51.3% of the children had a social disadvantage index score of 3 or greater (range 0-5) with higher scores indicating greater disadvantage. The number of patients presenting to the ED at the hospital has increased 14-fold since the legalization of medical marijuana in Ohio. Half of the children displayed a higher sociodemographic disadvantage index score. Our study is the first study investigating the sociodemographic profile of children exposed to marijuana. The findings of this study may be utilized to inform policy for safely dispensing recreational and medicinal marijuana products and focus the efforts on families with sociodemographic disadvantage.

FORMATION OF FUTURE MANAGERS' PROFESSIONAL STRESS RESISTANCE AS A CONDITION FOR THEIR COMPETITIVENESS

The article is devoted to the issue of formation of professional stress resistance of managers in terms of their competitiveness. The state of research in scientific sources on the issue of managers’ professional stress resistance is analyzed and the necessity of targeted influence to level up the future managers’ professional stress resistance at the stage of master’s training in a higher educational institution is substantiated. The study's purpose: to clarify the essence of professional stress resistance, to develop a comprehensive program for its formation in future managers, and determine the content, directions, and ways of its implementation at the stage of master's training. The results of a diagnostic study using the developed questionnaire and the SACS-strategy and coping behavior model (S. Hobfoll) are presented. A comprehensive program for the formation of future managers’ professional stress resistance is created. Ways of its implementation at the stage of master’s training in a higher educational institution are outlined. This program provides for the search and activation of stress resistance resources, the formation of constructive coping strategies in management activities, the development of assertiveness, and the harmonization of the personality of future managers. The ways of implementing a comprehensive program for the formation of professional stress resistance of future managers are identified: educational activities (lectures, practical classes, independent work), individual consultative and methodological work, participation in training groups, independent and research work, participation in volunteer activities/volunteer educational projects, non-formal education of master's students. The role of anti-stress training in increasing professional stress resistance is revealed.

Beyond access: (re)designing archival guides for changing landscapes

In 2013, the authors of this article and their colleague Gavan McCarthy published Stories in Stone: an annotated history and guide to the collections of Ernest Westlake (1855–1922). The guide provided contextual information and digital access to the entire paper archives relating to the three large stone collections formed by Westlake during his lifetime: French and English geological specimens housed in the Oxford University Museum of Natural History from 1924, and a collection of Tasmanian Aboriginal stone tools stored in the Pitt Rivers Museum since 1923. The Tasmanian collections, formed by Westlake from 1908 to 1910, are highly significant to the Palawa (or Pakana or Tasmanian Aboriginal) community because they include objects made by ancestors, and words spoken by ancestors to Westlake and recorded in his field notebooks. Stories in Stone was created to improve access to Westlake’s Tasmanian collections for the Palawa community with whom author Rebe Taylor had worked closely since 1999. Nonetheless, the structural and technical design of Stories in Stone was not Palawa-led. It was driven by Australian and international archiving standards; by stipulations set out by the collecting institutions; and by the stories of collecting and subsequent scholarship on the collections. In 2023, Stories in Stone is offline, and the authors are planning a relaunch. This time they aim to reach beyond their original aim of providing archival access to the Palawa community, and work with Palawa community to co-design how that access is delivered. This consultative work will be done at the University of Tasmania, where Palawa advisors and other Indigenous scholars have been integral to developing international Indigenous data sovereignty principals. This article precedes those formal discussions and thus offers a timely reflection on the original aims and design of Stories in Stone as well as an extensive analysis of broader changes in the management and dissemination of First Nations collections and culture. Such changes include: international human rights frameworks; movements supporting data and archival sovereignty; co-designed archival technologies; and increased focus on archives as process not merely product. These developments will lay the foundations for the next version of Stories in Stone, which aims to go beyond access, scholarship, and standards by helping to facilitate First Nations’ aspirations for dignity, sovereignty, and self-determination.

E061 Attitudes and barriers to pulmonary arterial hypertension screening in systemic sclerosis patients: a survey of UK-based rheumatologists

Abstract Background/Aims Pulmonary arterial hypertension (PAH) affects approximately 10% of patients with SSc and is a major cause of morbidity and mortality. PAH is often asymptomatic, and therefore, proactive screening is crucial for early detection and improved survival, including through early treatment intervention. Although there are various proposed international guidelines for screening, there is currently no dedicated UK-based guidance. Our aim is to explore current UK screening practices for SSc-PAH patients, including identifying barriers and potential solutions. Methods A survey of 31 questions was developed and included six sections: clinician demographics, the importance of screening, screening practices, barriers to screening, treatment, and patient education. The survey was disseminated among rheumatologists working in the UK. Results Forty-four rheumatologists working in the UK participated in the study, and the majority completed all the questions. Around one-third (37.0%) worked in specialised SSc units (university or general hospitals [54.5% and 45.4%, respectively]). The majority recognised that SSc-PAH is a major cause of morbidity and mortality. Over half (60.0%) reported using the DETECT algorithm to screen for SSc-PAH, although other algorithms were also sometimes used. All of the respondents utilised transthoracic echocardiogram, and almost all (95.0%) performed pulmonary function tests for screening purposes. Various challenges and barriers were identified relating to SSc-PAH screening (Figure 1A), with the difficulty in interpreting results from other hospitals and extended wait times for diagnostic tests being the most reported (76.0% and 74.0%, respectively). Most respondents agreed that access to key investigations (87.0%), ongoing clinician education (82.0%), multidisciplinary meetings (79.5%) and a better understanding of proposed screening algorithms (79.5%) could be potential solutions (Figure 1B). Conclusion Rheumatologists recognise that SSc-PAH screening is crucial to improve outcomes including survival; however, variable practices exist. There are various barriers to SSc-PAH screening and we have identified a number of practical potential solutions. Disclosure M.P. Álvarez Hernández: None. Y. Allanore: Honoraria; Speaking fees from Janssen outside the submitted work. I. Andrade: Other; Honoraria (speaker) fees, scientific board member for EchoRight™and advisory board participant for ‘Pulmonary hypertension in the primary care setting’ for Janssen, outside the submitted work. M.H. Buch: Other; Speaker fees from Boehringer Ingelheim, outside the submitted work. G. Coghlan: Other; Consultancy and working groups fees from Janssen and MSD; honoraria from Inari and Janssen; grants from Janssen. F. Del Galdo: Other; Consulting fees and research support from Janssen, outside the submitted work. C. Denton: Honoraria; Consulting fees and research support from Janssen, outside the submitted work. D. Khanna: Honoraria; Consultant: Amgen, Abbvie, BI, AZ, Merck, Horizon, Prometheus, Janssen, GSK. Grants- Pfizer, BI, Horizon. D.G. Kiely: Honoraria; Participation in advisory boards, steering committees, speaker fees and support to attend educational meetings from Acceleron, Gossamer, GSK, Janssen, Ferrer, MSD and United Therapeutics. Other; grant funding from GSK and Janssen. His work is supported by a grant from the NIHR Biomedical research Centre Sheffield. J. Pauling: Honoraria; Consultancy work for AstraZeneca, Boehringer Ingelheim, IsomAb, Janssen, Permeatus and Sojournix; speaker honoraria and educational support from Janssen. S. Ramjug: Consultancies; Consulting fees from Janssen, outside the submitted work. M. Hughes: Other; Speaking fees from Actelion, Eli Lilly, Janssen and Pfizer, outside the submitted work; research funding from Janssen; member of a data and safety monitoring board for Certa Therapeutics.

YOUTH ENGAGEMENT IN CIVIL SOCIETY DEVELOPMENT IN UKRAINE: PROBLEMS AND SOLUTIONS

The article outlines the ways of engaging young people in the development of civil society in Ukraine. Socially and politically active young people are one of the necessary conditions for forming a democratic society and establishing sustainable and functioning civil society institutions. Therefore, in this paper, the scholars aim to identify the ways of youth interaction with public authorities in Ukraine and general levels of youth civic engagement, as well as to characterize the culture of citizenship as a factor in involving young people in civil society development. The research reveals the relevant issue regarding the prominent role of civil society in various spheres of activity of state authorities and local self-government bodies, a qualitatively new level of interaction between civil society, especially youth as an active part of it, and state and local self-government bodies in order to establish effective dialogue and partnership relations of state bodies authorities, local self-government bodies with civil society organizations.&#x0D; The research combined interdisciplinary approaches of several related scientific fields (political science, public administration and education), which allowed to set broader goals and find new ways for improving youth engagement in the development of civil society in Ukraine. The authors developed and conducted an expert survey on youth engagement in the development of civil society and identified possible ways to improve youth participation in public and political life. Authors interviewed 24 experts aged from 18 to 60 years from various fields who are interested in building a democratic state governed by the rule of law: leaders and members of public organizations, teachers of higher education institutions, scholars, deputies of regional and local councils, civil society activists and businessmen.&#x0D; It was determined that the effective participation of youth in decision-making processes consists in creating opportunities to involve youth in influencing, shaping, developing and promoting policy and development of services and programs. These opportunities are created by developing a range of formal and informal mechanisms for youth participation, from youth advisory groups to focus groups, from ongoing consultation work to supporting youth projects. As a result of the study, the authors developed a set of conclusions and recommendations addressed to educational institutions, public authorities, local governments and civil society organizations.

Perceived Benefits and Disadvantages Associated with the Use of the Electronic Consultation Register by Health Providers in the Health District of Toma, Burkina Faso.

Most countries in sub-Saharan Africa need to catch up in integrating information and communication technologies (ICT) into their health systems. This is mainly because of the need for more infrastructure that allows for reasonable use of the technologies. To support the actions of the Ministry of Health of Burkina Faso, a Non-governmental Organization (NGO) has implemented the integrated electronic diagnostic approach (IeDA) Project. The project includes the deployment of an electronic consultation register (ECR). This article aims to explore the perceptions of healthcare providers on the benefits and disadvantages of using the ECR. We conducted a qualitative, descriptive study through individual semi-structured interviews with healthcare providers. Data were collected in the Toma health district in December 2021. In addition, a thematic analysis was performed using NVivo software. Thirty-five healthcare workers were interviewed (19 nurses, 7 midwives, 6 mobile community health and hygiene workers, and 3 birth attendants). Two main themes emerged from our analyses, which are the advantages and disadvantages perceived by ECR users. Our data suggest that using the ECR had many benefits ranging from improving healthcare providers' knowledge and performance in terms of patients' care, assisting and helping in patient diagnosis and treatment and improving patient satisfaction. However, the participants also shared their negative perceptions about the ECR, mentioning that it increased their workload. They also reported lengthened consultation time and work duplication as the tool was still in its trial phase and was used along with the paper consultation register. The ECR is an effective tool for diagnosis and management, which has several advantages and reasonably satisfies patients. However, disadvantages, including increased workload and lack of fluidity and stability of the system, must be considered to ensure better usability.

Evaluating the Impact of a Pediatric Inpatient Social Care Program in a Community Hospital.

To evaluate the impact of implementing a stakeholder-informed social risk screening and social service referral system in a community hospital setting. We implemented a stakeholder-informed social care program at a community hospital in April 2022. The evaluation included patients aged 0 to 17 years admitted to the pediatric unit between April 2021 and March 2022 (1 year preimplementation) and between April 2022 and March 2023 (1 year postimplementation). For a random subset of 232 preimplementation and 218 postimplementation patients, we performed manual data extraction, documenting program process measures and preliminary effectiveness outcomes. We used χ square and Wilcoxon rank tests to compare outcomes between the preimplementation and postimplementation groups. Multivariable logistic regression was used to assess the preliminary effectiveness of the social care program in identifying social risks. Screening rates were higher in the postimplementation group for nearly all social domains. Compared with preimplementation, the postimplementation group had higher rates of social risks identified (17.4% vs 7.8% [P < .01]: adjusted odds ratio 2.9 [95% confidence interval 1.5-5.5]) on multivariate testing. Social work consults were completed more frequently and earlier for the postimplementation group (13.8.% vs 5.6% [P < .01]) and median (19 hours vs 25 hours [P = .03]), respectively. Rates of communication of social risks in discharge summaries were higher in the postimplementation group (46.8% vs 8.2% [P < .001]). The implementation of a stakeholder-informed social care program within a community hospital setting led to the increased identification of social risks and social work consultations and improved timeliness of social work consultations and written communication of social risks in discharge summaries for primary care providers.