Direct Provision Research Articles

Jail-based interventions to reduce risk for opioid-related overdose deaths: Examples of implementation within Ohio counties participating in the HEALing Communities Study

BackgroundOpioid-related overdose is a leading cause of death for criminal legal-involved individuals and, although naloxone distribution and medications for opioid use disorder (MOUD) are effective means for reducing post-release overdose death risk, jail-based availability is limited. This case report describes the challenges faced by three Ohio communities as they implemented evidence-based practices (EBPs) in jails to combat post-release opioid overdose deaths.MethodWe present case examples of how barriers were overcome to implement jail-based EBPs in three Ohio communities (two urban and one rural) as part of the HEALing Communities Study (UM1DA049417; ClinicalTrials.gov Identifier: NCT04111939). Of the 18 participating Ohio HEALing Communities Study counties, we highlight 3 communities for the novelty of their EBPs implemented, the challenges that they faced, and their rural/urban status. We present descriptive data regarding the EBPs that they implemented and discuss the challenges identified by HEALing Communities Study staff with first-hand experience facilitating their implementation.ResultsNewly implemented interventions included overdose education and direct provision of naloxone to incarcerated individuals upon release (2 of 3 communities), initiating MOUD prior to release (3 of 3), linkage to ongoing MOUD treatment in the community (2 of 3), peer support-facilitated treatment retention efforts (2 of 3) and emergency housing (1 of 3) in the immediate post-incarceration period. Common challenges that emerged included skepticism about the need and feasibility of implementing EBPs to reduce overdose and death, lack of knowledge about the options available and whether external agencies may assist, and difficulty engaging stakeholders to overcome inertia.ConclusionsCreative flexibility, calm persistence, technical facilitation, and collaboration with community service providers were assets that helped these Ohio jails implement evidence-based strategies that combat the opioid epidemic and reduce the likelihood of post-incarceration overdose and death in a high risk, formerly incarcerated population.

Social dialogue acts according to the laws of Ukraine

The article proposes a characterisation of the system of social dialogue acts in Ukraine, which are intended to facilitate collective bargaining regulation of labour relations through the involvement of parties to the social dialogue legal relations. It is noted that the primary objective of social dialogue acts is to balance the interests of the parties involved. Examples of the social significance of achieving these objectives are provided. It is emphasised that balancing the interests of employees and employers makes it possible to ensure high standards in the realisation of collective labour rights and contributes to achieving social harmony in society as a whole. The concept of social dialogue acts and their legal characteristics have been clarified. It is highlighted that these acts are characterised by specific adoption procedures, a particular structure, as well as distinct modes of operation and implementation. It is argued that social dialogue acts may be concluded either on the basis of a direct statutory provision or independently at the initiative of the parties to such dialogue, with the aim of regulating relations that are either not covered by legislation or, in the opinion of the parties to the social dialogue, require additional regulation. The article analyses social dialogue acts for which legislation establishes a clear procedure for their conclusion, as well as those for which the legislator delegates the determination of the procedure for their conclusion and implementation to the parties themselves. The results of such joint activities of the parties are reflected in the form of memoranda, resolutions, and joint statements. Examples are provided of social dialogue acts that can be concluded to establish additional benefits or guarantees for employees within the competence of the parties. The system of social dialogue acts has been defined as follows: 1) collective agreements and contracts, which are concluded in accordance with the Laws of Ukraine «On Collective Agreements and Contracts» and «On Social Dialogue in Ukraine»; 2) agreements aimed at resolving specific issues of social dialogue or aligning positions between the parties, such as a protocol on holding consultations between the parties; 3) local normative-legal acts, which are concluded by agreement between the parties of social dialogue, or at the proposal of the social dialogue parties, such as regulations on remuneration; 4) acts of social dialogue bodies, including proposals, conclusions, and recommendations of national or territorial tripartite socio-economic councils.

Deciphering the new governance experiment of dilapidated neighborhoods in China: A case of Xi'ma New Village, Wuhan

Approximately 100 million residents in Chinese cities inhabit former work-unit neighborhoods and municipal housing areas. Since the 1990s, the state has retreated from the direct provision of neighborhood services. However, as the alternative approach, commercialized property management has largely failed in these neighborhoods, leading to their gradual decline into “dilapidated neighborhoods.” Consequently, the poor living conditions and inadequate services severely constrained the well-being of these residents. Recently, new governance experiments have emerged in dilapidated neighborhoods across Chinese cities, warranting significant attention and exploration. Drawing on fieldwork and interviews conducted from 2019 to 2023 in Xi'ma New Village, Wuhan City, this research investigates the evolving governance shaped by affordable property management. Our findings indicate that, first, when sponsoring dilapidated neighbourhoods for affordable property management, the state's rationale is to address the crisis and alleviate social tensions; second, state leadership is reinforced through a multi-scalar governance network surrounding property management; third, in this case, the process of how the state achieved the above goals through deploying and mobilizing market and society exemplifies “state entrepreneurialism” in Chinese cities. Thus, the study offers nuanced insights, particularly at the neighborhood level, enabling readers to understand the evolving governance modalities in Chinese cities, especially in the context of (re)increasing state control and leadership.

Pandemic COVID-19 as a challenge for telemedicine in the Czech Republic.

The COVID-19 Pandemic contributed to accelerating the process of using information and communication technologies and digital technologies in healthcare management and delivery within healthcare systems. At that time, the Czech healthcare system faced the same problems as other European systems and struggled with a temporary limitation of direct provision of healthcare services. It was solved by switching to telemedicine. The Czech healthcare system used telemedicine to a minimal extent until then. Despite adopting the law on healthcare digitisation, it is still one of the countries with a lower level of digitisation of healthcare processes. The article presents the results of an exploratory expert investigation focused on the implementation and development of telemedicine in the Czech Republic. The conducted research aimed to identify problems related to the implementation of telemedicine in practice, place them in the broader framework of the healthcare system and structure them, propose possible solutions, and identify the future challenges of telemedicine in the Czech Republic. We based our study on the results of a three-phase QUAL-QUAN-QUAL research. Data collection in the first phase took the form of individual semi-structured interviews with patients (25) with practical experience in the field of telemedicine, followed by the second quantitative phase of the questionnaire survey with patients (650). The third qualitative phase included semi-structured interviews with experts (17) with practical experience in telemedicine. The introduction and expansion of telemedicine require several fundamental changes. These include adjustments to the legislative environment and changes to the technological infrastructure, organisation of care and work. Several barriers have been identified at the healthcare system level, healthcare providers, healthcare professionals and patients.

National Trends in Breastfeeding by Gestational Age Category

National breastfeeding (direct breastfeeding and/or provision of pumped breast milk) rates among preterm infants are unclear. We report rates of breastfeeding initiation and continuation at 12 weeks after birth by gestational age category from a nationally representative survey between 2009 to 2019. Breastfeeding rates were lowest among infants born late preterm compared with other gestational age categories.

TIDieR-WASH: A Guideline for Reporting Implementation of Water, Sanitation, and Hygiene Interventions.

Accurate information on context and implementation of public health interventions is necessary to replicate, adapt, and scale effective interventions and to interpret evaluations. Reporting the context and implementation of water, sanitation, and hygiene (WASH) interventions has been inconsistent and incomplete. To improve the reporting of WASH interventions, we developed the Template for Intervention Description and Replication for WASH (TIDieR-WASH) checklist and guide, by adapting and expanding the original TIDieR guide. We performed a scoping review of existing implementation reporting guidelines, and of current implementation reporting in WASH evaluations, to develop a list of candidate items to include in this checklist. We then used a 4-stages of review by international experts to reach consensus. The resulting 14-item checklist comprises: a) name, b) theory of change, c) prior evidence, d) location and setting, e) context, f) suitability, g) implementers, h) recipients, i) targeting, j) activities, k) intervention dose, l) fidelity, m) costs, and n) materials. Definitions, explanations, examples, and instructions for use are reported in this article. The checklist can be applied to all types of evaluations of WASH interventions, including direct service provision, behavior change, and systems strengthening interventions. We deliberately developed this guidance document to be accessible and relevant to practitioners and researchers. Adoption of this checklist will support transparent reporting of WASH implementation for research and practice. As with other sectors that have used TIDieR checklists, clear implementation reporting can assist with evidence synthesis, adaptation, and policy guidance. https://doi.org/10.1289/EHP14780.

Analisis Aspek-Aspek Keberhasilan Pembelajaran di Indonesia: Ditinjau dari Studi Observasi

The importance of this research lies in its contribution to the development of educational policy, the formulation of more effective teaching strategies, and the provision of direction to educational practitioners. By better understanding the factors that influence learning success, it is hoped that this research can become a valuable guide in improving the quality of education in Indonesia so that it meets global demands and prepares future generations optimally. Observational analysis research is a research approach in which researchers make direct observations of certain phenomena or events to gain a deeper understanding. In this context, "observational analysis" refers to the process of analyzing data obtained through direct observation. This method is usually used to explore in-depth information about behavior, interactions, or certain situations in the natural environment. Observational analysis research is often adopted in the fields of psychology, sociology, anthropology and education (Moleong, 2010). Based on the description of the research background related to the analysis of aspects of successful learning in Indonesia through observational studies, it can be concluded that education in Indonesia faces complex and diverse challenges. Several obstacles, such as regional disparities, varying teacher quality, access to technology, and the role of parents in education, provide a context that requires serious attention.

Perspectives of healthcare providers around providing family planning services to women living with HIV attending six HIV treatment clinics in Lusaka, Zambia

ABSTRACT While international guidelines recommend integration of family planning (FP) and HIV services, limited research has been done to explore how healthcare providers perceive the feasibility and utility of integrated services. To address this gap, we administered a standardized questionnaire to 85 providers from 6 HIV clinics in Lusaka, Zambia, before (April–May 2018) and after (May–June 2019) implementing an enhanced model of FP/HIV service integration. We tested for differences in FP knowledge, attitudes and practices between the two time periods with tests appropriate for paired observations. The proportion of providers self-reporting direct provision of contraceptives increased significantly for several methods including oral contraceptives (14% vs. 26%, p = 0.03), injectables (9% vs. 25%, p < 0.001), implants (2% vs. 13%, p = 0.007) and intra-uterine devices (2% vs. 13%, p = 0.007). In-depth interviews were also conducted post-integration with 109 providers to solicit their feedback on the benefits and challenges of offering integrated services. While providers were highly supportive of integrated services, they identified several challenges including widespread belief in FP myths among female clients, the need to consult a male partner prior to starting FP, lack of trained staff and space, and frequent stockouts of contraceptives and equipment. Addressing these challenges will be critical in designing future services.

The Court of Justice in Staatsanwaltschaft Berlin v. M.N. (EncroChat): From cross-border, data-driven police investigations to evidence admissibility

The ruling of the Grand Chamber of the Court of Justice of the EU (CJEU) in Case C-670/22 Staatsanwaltschaft Berlin v. M.N. addresses the realities of data-driven police investigations in the light of the Directive 2014/41/EU on the European Investigation Order (EIO Directive). In particular, it examines the cross-border, digital investigation of the encrypted communication network EncroChat and the use and sharing of intercepted telecommunication data in criminal proceedings. In doing so, the CJEU offers clarifications as to the interpretation of the term ‘issuing authority’ under the EIO Directive and the proportionality requirements for issuing an EIO, taking into account its prior jurisprudence on the implications of access to traffic and location data for the private life of the persons concerned. More importantly, this CJEU ruling takes a stand on admissibility of intercepted data as evidence in criminal proceedings, considering the technical complexity of contemporary investigation measures and the secrecy of said police methods. Overall, although this judgment seems to hold no great surprises regarding the interpretation of the EIO Directive's provisions, it underscores the important role of the national legislator and national courts in striking the right balance between rearing the rewards of data-driven policing and safeguarding defence rights.

Elevated Circulating Levels of Gut Microbe-Derived Trimethylamine N-Oxide Are Associated with Systemic Sclerosis.

Background/Objectives: Alterations in fecal microbial communities in patients with systemic sclerosis (SSc) are common, but the clinical significance of this observation is poorly understood. Gut microbial production of trimethylamine (TMA), and its conversion by the host to trimethylamine N-oxide (TMAO), has clinical and mechanistic links to cardiovascular and renal diseases. Direct provision of TMAO has been shown to promote fibrosis and vascular injury, hallmarks of SSc. We sought to determine levels of TMAO and related metabolites in SSc patients and investigate associations between the metabolite levels with disease features. Methods: This is an observational case:control study. Adults with SSc (n = 200) and non-SSc controls (n = 400) were matched for age, sex, indices of renal function, diabetes mellitus, and cardiovascular disease. Serum TMAO, choline, betaine, carnitine, γ-butyrobetaine, and crotonobetaine were measured using stable isotope dilution liquid chromatography tandem mass spectrometry. Results: Median TMAO concentration was higher (p = 0.020) in SSc patients (3.31 [interquartile range 2.18, 5.23] µM) relative to controls (2.85 [IQR 1.88, 4.54] µM). TMAO was highest among obese and male SSc participants compared to all other groups. Following adjustment for sex, BMI, age, race, and eGFR in a quantile regression model, elevated TMAO levels remained associated with SSc at each quantile of TMAO. Conclusions: Patients with SSc have increased circulating levels of TMAO independent of comorbidities including age, sex, renal function, diabetes mellitus, and cardiovascular disease. As a potentially modifiable factor, further studies examining the link between TMAO and SSc disease severity and course are warranted.

School health services in the Southern District of Israel—between privatization and nationalization

BackgroundFor decades, Israel’s economic policy has favored either outsourcing or privatization of public services, including healthcare, generating an ongoing and prolonged debate of this approach. In 1997 school health services (SHS) for elementary and middle school pupils was outsourced to a sub-contractor firm, reducing budget, but also standards, for nurses and physicians. Consequently, the service has dwindled and was focused more and more on vaccinations. Between 2007 and 2012, under full private contractor delivery, SHS quality diminished substantially, leading to a significant decline in vaccination coverage in the Southern District. In 2012, a decision was made to return SHS to state control.MethodsThis study analyzes the delivery parameters of SHS between the period when the service was operated by a private contractor from 2011to 2/2012, and the subsequent provision of the service directly by Ministry of Health (MoH) between 3/2012 and 2013. We compared the rates of vaccination coverage, screening tests and health education programs.ResultsA statistically significant increase in SHS delivery for vaccinations and screening was observed in the Southern District of MoH after the transfer of service from contractor. The increase was variable in different population subgroups, and especially notable in the Bedouin schools of the District, where the MMRV vaccination rose from 19.3% to 96.8%. However, a substantial and significant reduction in health education activities was also noted, overall from 24.9% to 5.0%.ConclusionsThe findings suggest that substantial benefits can be derived from direct provision of SHS by MoH and its regional offices, especially in the areas of reduced accessibility and lower socio-economic status. The case study of SHS in the Southern District of Israel can serve as an important example highlighting the impacts of privatization vs nationalization, with potential implications in other fields. These insights should be integral to future discussions of healthcare service provision.

Характеристика способов вовлечения в занятие проституцией и организации занятия проституцией, осуществляемых участниками организованных преступных формирований

The article examines the preparatory stage of criminal activity related to the organization of prostitution, including: finding certain categories of persons who form the necessary structural, administrative, personnel and financial foundation for the effective implementation of this type of criminal business; developing rules for interaction between these categories of persons and with the external environment; selecting and equipping places where both direct provision of sexual services and performance of security functions will be carried out, as well as finding means to ensure the commission of crimes. It also describes in detail such methods of involving persons in this illegal activity as fraud, coercion, placing in financial dependence and others. The article considers various categories of persons participating in the organization of prostitution as part of organized groups. The following forms of organizing prostitution are described: street; in a home at the place of residence of the client or the person providing sexual services; organizing the provision of sexual services under the guise of the activities of leisure facilities; hotel, escort services.

Toward effective protection of victims of human trafficking in mixed migration flows: referral mechanisms shaped on individual need. The Italian experience and the European perspective

An overview of emerging trends on trafficking of human beings in Italy shows not only an extremely heterogeneous phenomenon but also a complex overlapping of experiences and need of protection of every single victim. In the context of mixed migration flows, persons reaching Italy through the Central Mediterranean and the Balkan routes have often experienced or are at risk of trafficking, and they also apply for international protection upon arrival. Legal categories such as “victims,” “asylum seekers,” and “refugees” are increasingly interconnected and not exhaustive in describing individual experiences and multifaceted vulnerabilities. Against this background, ensuring early identification and assistance for victims of trafficking among asylum seekers is extremely relevant. In Italy, this has led to the development of good practices aimed at implementing the coordination between the asylum and the anti-trafficking systems. In particular, specific Guidelines for Asylum authorities have been adopted to preliminarily identify potential victims of trafficking within the asylum procedure and enable their effective access to protection measures. To comply with specific provisions of the European Trafficking Directive and its transposition into the Italian legal framework, the Guidelines have created a referral mechanism among the asylum authorities and the anti-trafficking system that is unique in the European context. For this reason, the present contribution aims at describing this good practice, its implementation and effects—also at the juridical level—and its limits. Indeed, after the adoption of the instrument, a higher recognition rate of international protection for victims of trafficking has been registered in Italy, both at the administrative and judicial levels; asylum seekers and refugees have also increased their access to the specific protection program for trafficking survivors. In general, the system has strengthened its capacity to fulfill the legal obligation of identifying victims through a multi-agency approach. On the other hand, the ability to conduct screening and preliminary identification of victims of trafficking among asylum seekers is still limited to the “victim model” in terms of gender (women) and form of exploitation (sexual), and to certain stages of the asylum procedure (the first instance before the asylum authorities). With reference to this latter, a comprehensive protection response at the borders is missing despite the political debate on sea and land arrivals to Italy and the recent introduction of border procedures for the assessment of asylum applications. Given the geographical and political centrality of the south-Mediterranean situation in the current migration agenda, the goal of this paper is to analyze the Italian experience on referral mechanisms among trafficking and asylum as an experience that would help to shape future European prospects. The ongoing evolution of mixed migration flows—with particular reference to secondary movement across European countries—and the revised European Directive on trafficking in persons impose the promotion of a reflection on referral mechanisms with a transnational perspective enabling effective protection and the meeting of specific human rights.

Leveraging Multi-Sectoral Partnership for Colorectal Cancer Education and Screening in the African American Community: A Protocol and Preliminary Results.

Colorectal cancer (CRC) awareness and screening rates are still low in African Americans (AAs), especially for those who do not have regular access to health care. We established a multi-sector community partnership between academia, health system, cancer advocacy, and local county treasurer's office (CTO), to test a pilot CRC screening intervention using a tailored educational brochure and fecal immunochemical test (FIT). Participants were recruited at a local CTO in an urban midwestern region. Once eligible, participants were assigned to 2-by-2 intervention arms by educational strategy (brochure vs. no brochure) and FIT provision strategy (direct provision by onsite staff vs. indirect provision via phone/online request). We compared the effect of different strategies on FIT return rates. Of 1500 individuals approached, 212 were eligible for the study. The final sample consisted of 209 participants who were predominantly men (57%) and AAs (85%). No differences were found in the return rates by educational brochure (24% [brochure] vs. 23% [no brochure]; p = 0.82). In regard to FIT provision strategy, direct FIT provision yielded higher return rates than indirect provision (31% vs. 15%; p = 0.01). When the four groups were compared, direct provision with education brochure yielded the highest return rates (33.9%), followed by direct provision only (27.5%), indirect provision only (18%), and indirect provision with a brochure (12.2%). For community-based CRC screening intervention using stool-based test, the direct provision of FIT kits with educational brochure outperforms the other three strategies.

Copyright in the functioning of libraries and archives

The article is devoted to the legal analysis of the features of copyright in the functioning of libraries and archives in Ukraine. It is noted that in the legal framework, the functioning of libraries and archives is closely related to copyright, in particular, in the context of using works stored in the collections of libraries and archives. It is established that the main mechanism required to maintain a balance between the needs of society and the interests of copyright holders is the application of restrictions and exceptions to copyright in the functioning of libraries and archives. The author analyzes the provisions of the Law of Ukraine «On Copyright and Related Rights» No. 2811-IX dated December 1, 2022, and concludes that this law introduces significant changes to the legal regulation of copyright in the functioning of libraries and archives. The author concludes that the Law of Ukraine «On Copyright and Related Rights» includes in the non-exhaustive list of works that may be reprographically reproduced. It is noted that the Law of Ukraine «On Copyright and Related Rights» has expanded the range of entities that can freely use works in their activities. These institutions include libraries, museums with open access to visitors, archives, and organizations for the storage of audio and video recordings. The author concludes that the Law of Ukraine «On Copyright and Related Rights» No. 2811-IX dated December 1, 2022, for the first time legislated the definition of an orphan work and established the basis for legal regulation of orphan works in Ukraine. The analysis of Ukrainian legislation and EU directives regulating copyright issues in the functioning of libraries and archives shows that that the provisions of the Law of Ukraine «On Copyright and Related Rights» are in line with the provisions of Directive (EU) 2019/790 of the European Parliament and of the Council of 17 April 2019 on copyright and related rights in the Digital Single Market and amending Directives 96/9/EC and 2001/29/EC and Directive 2012/28/EU of the European Parliament and of the Council of 25 October 2012 on certain permitted uses of orphan works.

Food poverty: The role of the school nurse

The cost of living crisis and food poverty continue to be a significant challenge for children, young people and their families. In SAPHNA's augural survey of school nurses, 70% of respondents reported to have supported children, young people, and families where the cost of living and/or food poverty was an issue. Comments include that services had noticed ‘an increased demand for community services – food banks, uniform banks, charity funding for white goods, etc.’ School nurses reported a range of activities in relation to supporting children, young people and families, which broadly fell into direct provision, supported access to community services and provision, and advocacy work. You will be able to read more about this in the full survey report which will be published soon. Ann Marie Gallogly, deputy professional officer shares how SAPHNA works as part of a coalition to support children, young people and their families and respond to the challenges of food poverty and the cost of living crisis, and explains how school nurses support children and young people.

The problem of proving the use and non-use of a trademark arises in the context of disputes on revocation of a Ukrainian trademark certificate

The article contains a practical analysis of the challenges faced by parties in Ukrainiancourt when proving the use or non-use of a trademark in a dispute on the revocation (earlytermination) of the Ukrainian trademark certificate. From the theoretical and practical pointof view, the problem arises due to the absence of a direct legal provision and well-establishedcourt practice regarding the sufficient scope and manners of a trademark use, when each ofthe parties must prove the opposite facts before the court — use and non-use of the trademarkin question. Thus, the essence of such litigation revolves around the plaintiff’s need to provethe non-use and the defendant’s need to prove the use of the trademark in question. In general,the following questions arise: Is the trademark certificate owner (the defendant) obliged touse the trademark to label goods (proving its real, genuine use) for each good under the Niceclassification? Additionally, how many of the manners of using the trademark, as listed inlaw, are sufficient to confirm real (genuine) use? These questions arise in every court case,since this is not directly regulated in the laws of Ukraine. Consequently, the parties oftenrefer to Article 198 of the Association Agreement between the EU and Ukraine regarding«genuine use» as opposed to «formal/symbolic use» of the trademark.In a result of conducted research and made analysis, it appears that the subject of proof insuch cases is the defendant’s (or licensee’s) use (or non-use) of the trademark for eachgood/service listed in the trademark certificate, and the use must be demonstrated in at leastone of the manners listed in Art. 16(4) of the Law of Ukraine «On Protection of Rights toMarks for Goods and Services» dated 15.12.1993 No.3689-XII. Therefore, a proper and admissibleevidence of trademark use may include presenting the court with the labeled good, aswell as any documents, writings, papers, which demonstrate use of a trademark in, at least,one manner per each good/service for which a trademark is registered. Article contains withextracts from the numerous court decisions to provide for examples of written documents,submitted by parties in alike cases, as evidence of trademark use (non-use). Theoretical conclusionsand practical recommendations are summarized based on analysed court decisions.

The Impact of Rape Myth Education on Jury Decision-Making: A Systematic Review.

A systematic review of research exploring the impact of providing rape myth countering information to mock-jurors was conducted. The primary aim of the review was to inform the development of an educational intervention for jurors to reduce potential bias in their decision-making based on belief in prevalent rape myths. In total, the following 12 databases were searched: British Education Index, CINAHL, Child Development and Adolescent Studies, Criminal Justice Abstracts, Educational Administration Abstracts, ERIC, MEDLINE, PsycArticles, PsycInfo, PubMed, Scopus, and Social Care Online. The databases were filtered to return peer-reviewed publications, written in English, and published between 1980 and 2023. The search returned 6,119 potential articles. After duplicates were removed, the 3,202 remaining publications were screened. Only studies that presented rape myth countering information to participants within a mock-juror paradigm were included. Studies that did not compare an information condition to a no-information control condition were excluded, as were those which concerned male rape myths, given the focus on female rape myth beliefs in this review. Eight studies were reviewed and were critically appraised according to validity criteria utilized by Dinos et al. Some evidence emerged to suggest that the provision of judicial directions, expert witness testimony, and complainant statements regarding rape myths can impact upon jury decision-making although the findings were mixed overall. Study limitations regarding internal and external validity were frequently present. Recommendations regarding future research questions and methods are advanced, including those that can inform the development of an effective intervention for jurors.

A systematic review of the use of FHIR to support clinical research, public health and medical education

PurposeThis systematic review aimed to identify and categorize applications using Fast Healthcare Interoperability Resources (FHIR) to support activities outside of direct healthcare provision.Design/methodology/approachA systematic electronic search was performed, and 53 studies were included after the selection process.FindingsThe results show that FHIR is being used to support (1) clinical research (i.e. clinical research based on interventional trials, data interoperability to support clinical research and advanced communication services to support clinical research), (2) public health and (3) medical education. Despite the FHIR potential to support activities outside of direct healthcare provision, some barriers were identified, namely difficulties translating the proposed applications to clinical environments or FHIR technical issues that require further developments.Originality/valueThis study provided a broad review of how FHIR is being applied in clinical activities outside of direct clinical care and identified three major domains, that is, clinical research, public health and medical education, being the first and most representative in terms of number of publications.

The Resilience Hub approach for addressing mental health of health and social care workers during the COVID-19 pandemic: a mixed-methods evaluation.

Resilience Hubs provide mental health screening, facilitation of access and direct provision of psychosocial support for health and social care keyworkers in England affected by the coronavirus disease 2019 pandemic. To explore implementation of the Hubs, including characteristics of staff using the services, support accessed, costing data and a range of stakeholder perspectives on the barriers and enablers to Hub use and implementation of staff well-being support within the context of the pandemic. Mixed-methods evaluation. Four Resilience Hubs. Findings were integrated via mixed-method case studies, including: analyses of Hub mental health screening (N = 1973); follow-up questionnaire data (N = 299) on service use and health status of Hub clients; economic information provided by the Hubs; 63 interviews with Hub staff, wider stakeholders, Hub clients and keyworkers who did not use the Hubs. Findings were consistent across Hubs and workstreams. Most Hub clients were NHS staff. Under-represented groups included men, keyworkers from minority ethnic communities, care homes and emergency services staff. Clients reported comorbid mental health needs across multiple domains (anxiety; depression; post-traumatic stress; alcohol use; functioning). Their health status was lower than population norms and relevant pre-pandemic data. Several factors predicted higher needs, but having pre-pandemic emotional well-being concerns was one of the most robust predictors of higher need. Sixty per cent of participants who completed follow-up questionnaires reported receiving mental health support since Hub screening, most of which was directly or indirectly due to Hub support. High levels of satisfaction were reported. As in many services, staffing was the central component of Hub cost. Hubs were predominantly staffed by senior clinicians; this staffing model was consistent with the generally severe difficulties experienced by clients and the need for systemic/team-based working. Costs associated with health and social care use for Hub clients were low, which may be due to barriers to accessing support in general. Enablers to accessing Hubs included: a clear understanding of the Hubs, how to self-refer, and managerial support. Barriers included confusion between Hubs and other support; unhelpful beliefs about job roles, unsupportive managers, negative workplace cultures and difficulties caused by systemic issues. Some keyworkers highlighted a perceived need for further diversity and cultural competency training to improve reach to under-represented communities. Other barriers for these groups included prior negative experiences of services, structural inequalities and stigma. Some wider stakeholders had concerns around growing waiting times for Hub-provided therapy, and insufficient data on Hub usage and outcomes. Feedback was otherwise very positive. Main limitations included lack of comparative and pre-pandemic/baseline data, small numbers from under-represented groups limiting fine-grained analysis, and participant self-selection. Findings highlighted the value of the Hub model of outreach, screening, support navigation and provision of direct support during the coronavirus disease 2019 pandemic, and as a potential model to respond to future crises. The research provided recommendations to improve Hub promotion, equality/diversity/inclusion access issues, management of specialist resources and collection of relevant data on Hub outcomes and activities. Broader recommendations for the primary prevention of mental health difficulties across the health and care system are made, as individual support offers should be an adjunct to, not a replacement for, resolutions to systemic challenges. Research recommendations are made to conduct more robust evaluations of the clinical and cost-effectiveness of the Hubs, using larger data sets and comparative data. This study is registered as researchregistry6303. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132269) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 29. See the NIHR Funding and Awards website for further award information.