Objective To examine whether the socio‐medical needs and imprisonment risk among transitional care clients with serious mental illness (SMI) differ from other transitional care clients. Methods A retrospective cohort study was conducted of adults who entered the Formerly Incarcerated Transition (FIT) Program from 2018 to 2023 following a period of incarceration. At program entry, FIT clients were screened for socio‐medical needs and diagnoses, including those reflecting SMI. Imprisonment outcomes were assessed using administrative records. Cumulative imprisonment risk and relative risk of imprisonment were estimated comparing clients by SMI status. Results Among 759 clients, 78.1% were men, 53.6% were aged 31–50 years, 59.8% reported Black race, and 32.9% had SMI. Clients with SMI were significantly more likely to be female, aged ≤40 years, White race, recently without food, to have healthcare coverage, to be unhoused, and to be in need of housing assistance, disability benefits, or legal assistance. Cumulative imprisonment risk at 360 and 720 days for clients with SMI (0.14 and 0.21) was higher than for those without (0.08 and 0.11), p < 0.001. In a multivariable proportional hazards model, SMI was associated with increased risk of imprisonment (1.75, 95% CI: 1.18, 2.60). Conclusions Released persons with SMI have a particularly heavy burden of socio‐medical needs and high imprisonment rates in North Carolina (NC). Relevance to Clinical Practice Similar programs in other states should consider assessing outcomes among their clients with SMI. In NC, efforts are underway to facilitate greater care continuity upon re‐entry for people with SMI, including direct linkage to co‐located primary and psychiatric care.

Changing our principles: a reply to ‘Fault or need? The UK’s approach to disability benefits since the Second World War’ by Gareth Millward

Social care for adult cystic fibrosis patients in clinical practice

The article is devoted to the peculiarities of the implementation of the right to social protection in the conditions of digital development. Digitalization contributes to the efficiency and effectiveness of social protection, however, the use of achievements in the field of technology is accompanied by the problems of automation of decision-making, personal data protection, bias in algorithmic profiling, and the accessibility of the social protection system. It is noted that the implementation of the right to social protection is carried out mostly in the form of law enforcement, which must be carried out in compliance with the principle of the rule of law, ensuring the fairness and validity of the decisions made. At the same time, in the conditions of digitalization of social protection systems, the paradigm of law enforcement is changing. Currently, there is a consistent practice of competent social security bodies, when preference is given to «digitized» data, and any formal shortcomings are interpreted against a person, which makes it impossible for him to access social protection. It is noted that even the long-awaited Law of Ukraine «On Administrative Procedure» has not improved the state of affairs. Some examples of problems in the implementation of the right to pension provision due to shortcomings in the documents confirming the length of service for the purpose of pension provision are given. It is stated that the classic elements of law enforcement in establishing the factual circumstances of the case, the legal basis of the case and making a decision are reduced exclusively to ascertaining the criteria for compliance, as a rule, only «digitized» data are taken into account. Also, the overload of administrative courts with cases involving the defendant – the bodies of the Pension Fund of Ukraine – indicates a systemic problem with extrajudicial procedures for appealing decisions. The problem with the implementation of the right to receive temporary disability benefits in the amount of 100% of the average salary, regardless of the insurance length of service for war veterans, is analyzed. The need to check automated social protection systems for the absence of discriminatory provisions in algorithmic profiling is noted. Attention is focused on ensuring the inclusiveness of the social protection system in the conditions of digital development. Conclusions were drawn about the need to change the paradigm of law enforcement by social security bodies based on the presumption of the legality of a person’s actions and the introduction of effective mechanisms of extrajudicial protection.

The purpose of the study was to test the effects of a nudge on patients return-to-work (RTW) and benefits in a clinical service aimed to promote RTW and prevent sickness absence in patients referred for musculoskeletal disorders or mental illness. The study was a multicentre, single-blinded, parallel two-arm randomised controlled trial design. The setting was five outpatient clinics in Northern Norway, offering a work-focussed treatment to patients referred for common mental- and/or musculoskeletal disorders. Patients were randomised to receive either a questionnaire mapping health factors only, or a questionnaire mapping also Motivation for work, Barriers for return-to-work and Work environment (MBW). Clinicians were also nudged by receiving patient reports based on the patient survey. Data on sickness absence and benefits was retrieved from national registries after one year of follow-up. Among 1171 patients consenting to participate in the study, 1091 were eligible for inclusion in the main analyses. The intervention group (n = 558) did not differ significantly from the control group (n = 533) with respect to key variables at baseline. The nudge had no effect on days of sickness absence, return to work rates, or disability benefits during follow-up. This attempt to nudge patients and clinicians on MBW factors did not influence RTW or benefits during one year of follow-up. Although MBW factors were prevalent at baseline, the results suggest that increasing work focus in a setting where clinicians already address these factors to some extent has little effect. The trial was prospectively registered at clinicaltrials.gov on August 9th, 2021. Trial identifier NCT05006976 ( https://clinicaltrials.gov/study/NCT05006976 ). In this study we report on the primary outcome listed as "Functional recovery: sickness absence registry data".

Sub-Population Differences in Connecting to Resources to Address Social Needs.

Hearing loss affects communication and participation. Empowerment initiatives support individuals to manage their condition and facilitate patient-centered care. The Empowerment Audiology Questionnaires (EmpAQ-15/5), recently translated and validated in Swedish (EmpAQ SWE), were evaluated for convergent validity, internal consistency, and test-retest reliability. This study evaluates the convergent validity, internal consistency, and test-retest reliability of EmpAQ SWE. A total of 136 adults with hearing loss completed an online survey twice. The survey consisted of EmpAQ-SWE and five measures assessing hearing disability, everyday functioning, hearing aid benefit, and general disability. For analysis, Spearman's correlation coefficient and Cronbach's alpha were used. There were significant correlations between the EmpAQ SWE and measures of hearing disability (r = -.389), everyday functioning (r = -.350), and hearing aid benefit (r = .542 and r = -.326). There were no significant correlations between the EmpAQ and general disability. The test-retest results for the EmpAQ-SWE indicated strong reliability (r = .760) and moderate internal consistency (α = .678). EmpAQ SWE demonstrated positive associations with everyday functioning and hearing aid benefit and negative associations with hearing disability. Although causality cannot be established, the findings support the convergent validity and reliability of EmpAQ SWE, underscoring its potential utility in clinical and research contexts.

Brain-based tools are being developed to identify infants at ultra-high likelihood for developing autism and enable presymptomatic intervention, though such interventions are not yet clinically available. Given persistent challenges in accessing autism services, we sought to understand how families might use early predictive results to seek support. We analyzed 55 interviews with parents of infants aged 6–13 months; one group had experience parenting an older autistic child (n = 30), the other had no prior autism parenting experience (n = 25). All parents were asked what steps they would take if told their infant was likely to develop autism. Both groups described an intent to find appropriate services; parents with prior autism experience provided more specifics based on prior knowledge. The groups diverged in their anticipated supports and information sources. Parents with autism experience anticipated seeking financial support via insurance and disability benefits; those without autism experience reported they would consult their pediatrician for information or search online. This qualitative study was conducted with a sample of parents selected for their specific life experiences, but likely does not capture the full range of potential responses to biomarker testing in infancy. Given that most services and benefits require a formal diagnosis, families receiving predictive results in infancy will likely face challenges finding appropriate services. Prior to implementing predictive testing in the first year of life, researchers should consider their obligation to support families who receive predictive results.

This study investigates how the implementation of AtestMed, digital tool introduced by the Brazilian Social Security Institute (INSS) to streamline disability benefit requests, may have influenced the volume of judicial claims filed. Using monthly data from January 2022 to July 2024, we analyze the behavior of judicial filings in relation to the number of processed benefit requests, including both granted and denied cases. We apply time series decomposition techniques to detect changes in trends and seasonal patterns before and after the program's implementation. The findings point to a decline in the ratio of judicial claims per processed administrative decision following AtestMed, suggesting that digitalization and procedural simplification can contribute to reducing litigation in the social security system. The article discusses both the opportunities and challenges of implementing human-centered technological innovation in public administration, highlighting AtestMed as a tangible example of how Social Security can evolve in alignment with the values of the Fifth Industrial Revolution.

The Individual Placement and Support (IPS) model of supported employment is an evidenced-based practice that is highly effective at helping people with psychiatric disabilities to obtain gainful employment. Within the State Vocational Rehabilitation CVR) system, the On-the-Job Training (OJT) service supports the rapid placement, client choice, competitive work, disclosure, and follow- along support components of the IPS model. We reviewed the Rehabilitation Services Administration (RSA) 911 data for fiscal years 2015 and 2016 to examine California’s utilization of RSA Title I funds to provide the OJT service and examined the employment outcomes for individuals with psychiatric disabilities who utilized this service. We found that OJT, although highly effective (71.4% successfully employed), was underutilized (N=14,384, n=105). Furthermore, in an analysis of individuals with serious psychiatric disabilities (as indicated by receipt of Social Security Administration [SSAJ disability benefits at application, coded as significantly or most significantly disabled, and coded with a primary psychiatric disability), 59.3% of the OJT clients were employed, compared to 15.4% of the non-OJT clients (x2 = 10.85, p < .01). We provide a number of recommendations to both enhance the use of OJT services and improve employment outcomes for this population.

The COVID-19 pandemic had a lasting global health impact, with many survivors facing Long Covid. Older adults, already vulnerable to disability and cognitive decline, may also experience long-term challenges after COVID-19 infection. This study explores whether a history of COVID-19 infection interacts with pre-existing impairments in older adults, focusing on its effects on health services and work-related outcomes. This longitudinal cohort study used data from the Health and Retirement Study (HRS), spanning 2018 to 2022. Participants ≥ 50years old in 2018 with documented functional and cognitive status scores and self-reported presence or absence of COVID-19 infection were included. Functional status was assessed using the Functional Limitation score, and cognitive status using the Crimmins cognitive scale or Langa scale if the HRS respondents were represented by a proxy. Health services use and work outcomes were evaluated using the 2022 HRS survey. Multivariable logistic regression models examined the association between baseline functional and cognitive status and outcomes, controlling for COVID-19 history, 2018 functional or cognitive status, age, gender, marital status, number of chronic conditions, household size, graduation from high school, and self-report of COVID-19 vaccination. The study included 8,621 respondents. Those with severe functional limitations in 2018 were more likely to report health services use in 2022, irrespective of COVID-19 history. COVID-19 history did not significantly interact with baseline functional or cognitive impairments when evaluating health services use, ability to work, or disability benefit access. While older adults with moderate or severe functional limitations were more likely to report hospitalizations and nursing home stays, these outcomes were not significantly different based on COVID-19 history. In this cohort of older adults, the relationship between baseline functional and cognitive impairment with health services use, ability to work, or disability benefit access did not significantly vary by self-reported COVID-19 infection history. While COVID-19 may have long-term impacts on older populations, our data suggest that infection history alone did not amplify the effects of pre-existing impairments in those who survived the pandemic. Further research using validated measures of persistent symptoms is needed to understand how Long Covid may manifest in older adults.

Background. Given the risks of long-term disability and job loss in workers on sick leave, quick return-to-work is a primary focus of occupational rehabilitation across health fields. This study sought to identify the return-to-work obstacles and self-efficacy beliefs that predict sick leave duration after kidney transplantation. Given a lack of instruments, the Return-to-Work Obstacles and Self-Efficacy Scale was adapted for Solid Organ Transplantation (ROSES-SOT). Methods. Workers on sick leave recruited across 3 Canadian health centers were administered the ROSES-SOT 0.5–7.3 mo postkidney transplantation (n = 62). Half of the sample was administered the tool again 2 wk later (reliability over time). Workers were then called, and return-to-work dates were collected up to 1 y posttransplantation. Cronbach’s alpha coefficients were calculated (internal consistency), and univariable and multivariable linear regression analyses were performed on sick leave duration. Control variables were age, gender, ethnicity, education, income, disability benefits coverage, manual work, complications, comorbidities, donor, physical and mental health status, and stress about returning to work during the COVID-19 pandemic. Results. The face and content validity of the ROSES-SOT were assessed and deemed satisfactory. Eight of 10 ROSES-SOT dimensions demonstrated satisfactory reliability. COVID-related stress, job demands, fear of relapse, loss of motivation, and organizational injustice predicted sick leave duration. COVID-related stress and organizational injustice remained multivariable predictors. Conclusions. The ROSES-SOT showed adequate reliability and predictive value. Self-efficacy and perceived obstacles could be intervention targets when providing return-to-work support after kidney transplantation. Future studies could investigate the replicability of findings for other transplant types.

Modeling disability reduction through low-dose prophylaxis versus on-demand therapy in hemophilia A: A meta-analysis and gbd-inspired yld framework for resource-limited settings

Substantial Clinical Benefit Thresholds for Hip Disability and Osteoarthritis Outcome Score Subscales and Associated Risk Factors for Nonattainment After Total Hip Arthroplasty: A Prospective Cohort Study of 9,229 Patients.

This study proposes an innovative financing model for temporary disability benefits in Brazil, integrating the General Social Security Regime (RGPS) with private sector participation under a competitive framework. Grounded in Constitutional Amendment No. 103/2019, the model addresses the sustainability challenges of the PAYG system, exacerbated by population aging and the expansion of informality. Through econometric analysis, the study demonstrates that adopting a mixed system—where the private sector covers short-term benefits in measurable-risk sectors while the National Social Security Institute (INSS) acts as a reinsurer—can generate annual savings of several billion reais. The model's pillars include dynamic sector-based pricing mechanisms, risk transfer strategies, and governance supported by distributed ledger technologies. The findings suggest that the proposal aligns with the constitutional principles of social security, offering a legally viable solution for fiscal balance without compromising protective coverage, provided it is regulated by a complementary law that ensures beneficiary safeguards and objective criteria for private sector involvement.

The use of genetic testing within the pediatric population continues to expand as broad-based sequencing becoming more incorporated into routine practice. While these evaluations are also utilized within the military population, key points should be considered when providing these recommendations. This review aims to highlight the important differences between civilian and military genetics evaluations. Review of the available literature and recent current events including an emphasis on military readiness and operational mission completion, reveals that the role of a military geneticist both within the pediatric and Active Duty population will only continue to expand. Broad-based sequencing is increasingly offered as a first-line evaluation during routine genetic appointments for entities, such as unexplained symptoms, multiple congenital anomalies, or developmental delay. Within the military realm, considerations for potential impact to the Active Duty Service Member must be understood regarding future eligibility, current retainability, and possible effect on disability benefits. This is imperative as protection such as the Genetic Information Non Discrimination Act do not apply to the military population, but with proper and thorough pretest counseling, Soldiers will be able to make sound, informed decisions surrounding their own healthcare and their families as well.

Background: Cervical myofascial pain syndrome (MPS) frequently co-occurs with forward head posture (FHP), operationalized by a reduced craniovertebral angle (CVA). In clinical practice, patients often receive passive/manual physiotherapy techniques to modulate pain, improve CVA and normalize soft tissues before engaging in active rehabilitation. Objective: To conduct a systematic review of randomized controlled trials (RCTs) and metanalyses/systematic reviews (SRs) on passive/manual physical therapy interventions for cervical Myofascial Pain Syndrome (MPS). Methods: Following PRISMA guidance, we searched PEDro and PubMed/MEDLINE (January 2015–February 2025). Studies which included adults with clinically confirmed cervical MPS (trigger points with characteristic pain pattern), interventions restricted to passive/manual physiotherapy, outcomes including pain (VAS/NPRS), disability (NDI), CVA, ROM, pressure-pain threshold (PPT), soft-tissue compliance, and subcutaneous hemodynamics. Risk of bias for RCTs was appraised via PEDro; SRs via AMSTAR-2. Results: Twenty-five studies met criteria (18 RCTs, 7 SR/MA). Manual therapy (including suboccipital techniques) consistently reduced pain and disability; several trials reported modest CVA improvements. Myofascial release/IASTM improved pain and PPT with emerging signals for posture change. Dry needling yielded short-term analgesia; disability improvements while CVA effects were mixed. Cupping/vacuum approaches produced immediate pain relief and improved soft-tissue compliance; durability remains uncertain. Electrotherapy (e.g., TENS) provided short-term analgesia. Most included RCTs were moderate-to-high quality (PEDro ≈7–9/10). Conclusions: Passive/manual physiotherapy offers clinically meaningful short-term benefits for pain and disability in cervical MPS with FHP, with early evidence of posture (CVA) change especially following suboccipital/upper cervical techniques. Standardized CVA protocols and longer follow-ups are needed to determine durability and optimal dosing.

Objective: To highlight the impacts of the 2019 Pension Reform and its effects on the health of the Economically Active Population in Brazil. Theoretical Framework: The analysis is based on social security legislation, specifically Constitutional Amendment n. 103/2019, and on studies about population aging, worker's health, and the socioeconomic impacts of pension reforms in Brazil. Method: A quantitative, retrospective study was conducted, covering the period from 2020 to 2024. Data were collected from secondary sources, such as the SmartLab Platform of the Public Ministry of Labor, the Statistical Yearbook of Social Security, and the Brazilian Institute of Geography and Statistics. Results and Discussion: The results indicate that the increased exposure time to harmful agents and unhealthy environments has raised occupational illness. There has been a growth in the demand for Permanent Disability Retirement and a general increase in the demand for Disability Benefits, suggesting that the reform may overload the social security system with early retirements, contrary to the objective of actuarial balance. Research Implications: The research warns of the unforeseen consequences of the Reform of the 2019, such as increased costs for the health and social security systems due to the premature illness of the Economically Active Population. Originality/Value: The study provides a critical and updated analysis of the effects of the 2019 Pension Reform, contributing quantitative evidence on the direct impact on workers' health and the sustainability of the social security system itself, a topic of high social and economic relevance for Brazil.

Francesca Martinez’s All of Us (2022) offers a critical examination of the social abjection of disabled bodies within the context of neoliberal Britain. This article conducts a close reading of the play to analyse how austerity policies, labour market pressures, and ableist assumptions intersect to reinforce the marginalisation of disabled individuals. Drawing on Judith Butler’s concept of social abjection, this article argues that the play exposes the paradoxical nature of neoliberal rhetoric: While claiming to promote independence and self-reliance, the neoliberal state’s restrictive disability assessment processes and benefit reductions ultimately reinforce dependence and economic precarity. Through its portrayal of disabled characters affected by systemic injustice, the play exposes how neoliberalism renders certain bodies socially and politically unintelligible. Martinez challenges these exclusions by rejecting the notion that disability is a condition to be fixed, instead portraying it as a site where systemic injustice is enacted and exclusion is normalised, contributing to broader debates on disability justice and exposing the structural dynamics of social abjection under neoliberal governance.

ABSTRACT Students with disabilities benefit from being taught by well-prepared, high-quality special education teachers. State-level special education teacher licensure policies, which directly influence teacher preparation and training, vary considerably across multiple dimensions, including dual licensure, grade bands, and disability categories. This article presents a summary of special education licensure policies across all 50 states and Washington D.C. taking into account these dimensions. Results indicate most states favor standalone special education licensure, defined by no required additional licensure in general education, and cross-categorical licensure, in which teachers can work with students across disability categories. We outline the various sources of complexity in special education licensure policies as they relate to issues of causal inference research, policy, and practice, and provide guidance and considerations for moving forward.