High-cost Services Research Articles

Development of telecommunications in the Arctic regions of the Sakha Republic (Yakutia)

The article examines the prospects and directions for the development of communications in the Arctic regions of the Republic of Sakha (Yakutia), where ensuring stable and high-quality communications is critical for the social and economic integration of the region, as well as for improving the standard of living of the local population. The paper analyzes the current state of the telecommunications infrastructure, covering satellite, mobile and fiber-optic networks, with a special focus on the key challenges faced by residents of remote areas: high costs of services, complex logistics and limited availability of broadband Internet. The article also considers federal and regional programs, such as the Arctic Synergy project and the Polar Express underwater communication line, aimed at improving telecommunications coverage, eliminating digital inequality and reducing social isolation in remote areas. Technological solutions are proposed, including the introduction of 4G and 5G networks, the use of satellite systems and the integration of renewable energy sources, which are assessed as strategic approaches that can improve the quality of services and support the development of digital infrastructure. In conclusion, the authors point out that sustainable development of communications in the Arctic requires not only the introduction of modern technologies, but also continued government support, including subsidies to reduce the cost of services. They also emphasize the importance of developing infrastructure adapted to extreme climatic conditions and creating backup communication channels that will ensure the reliability and stability of telecommunications services in remote Arctic regions.

Transfusion-dependent b-Thalassemia Major Bangladeshi Child Treated Successfully with Combination of Hydroxyurea and Low- Dose Thalidomide : A Case Report

Beta thalassemia results from absent or reduced production of beta globin gene leading to excess of alpha chain which causes ineffective erythropoiesis and marked anemia. b-thalassemia major patients usually present early within 2 years of life mostly in 2nd six months of first year of life. Only curative treatment till date is bone marrow transplantation. However, it is not feasible for all because of rarity of matched donar and obviously for its high cost and unavailability of services particularly in a developing country like Bangladesh. Hence regular blood transfusion remain the ultimate choice of their survival, growth and development with the cost of iron overload in the resource constraints country like ours. Recently HbF inducing drugs are showing promising result in the management of thalassemia children by inducing fetal hemoglobin. However, data are scarse from Bangladesh.Here we are reporting a case of betathalassemia who was diagnosed at 18 months of age and treated with only blood transfusion upto 2 years then hydroxyurea was given for 12 months with no response and then she was kept on regular blood transfusion with iron chelation up to 6 years with regression splenic size to normal and to maintain normal growth and development. After then she was given hydronix plus thalidomide in combination and responded well and remained transfusion free for last 3 years. Bangladesh J Child Health 2023; Vol 47 (2) : 117-120

Barriers to Occupational Health and Safety Legal Services During Pandemic

Objectives: This study aimed to identify the barriers to accessing legal services related to occupational health and safety during the COVID-19 pandemic. Methods: The study applied qualitative research methods, including in-depth interviews with 12 practicing lawyers in Nepal regarding their experience with hundreds of clients. The data was analysed using a thematic analysis approach. Results: The study identified key themes that characterise workers' experiences in accessing occupational health and safety (OHS) legal services, as viewed by legal practitioners. These themes included limited knowledge about OHS legal service provision and procedures; perceived high cost of legal services; delay and uncertainty in furnishing justice; intent to protect one's job, oneself, and family; authority of lawyers and health workers; the influence of family members, employer and significant others; hiding OHS problems due to potential stigmatisation, penalisation and threat; and COVID-19 pandemic-associated lockdown and travel restrictions. Conclusions: The study's findings underscore the practical challenges faced by workers in accessing OHS legal services during the pandemic. Despite the legal provisions in the current constitution, acts, and rules, the access of marginalised populations like workers to OHS services is challenged. This highlights the need for specific attention and focused interventions to avail of OHS legal services during the pandemic. The importance of targeted actions in this area cannot be overstated. The findings of this study are significant as they would serve to formulate and execute important policy guidelines to materialise the existing legal provisions on OHS, and will also serve as the basis for further studies.

Impact of Health Education Programme on Adherence to Treatment in Knee Osteoarthritis: An Interventional Study on Egyptian Patients.

To measure the level of adherence of patients with primary knee osteoarthritis (KOA) to an interventional therapeutic and rehabilitation programme and investigate factors that hinder patients' adherence. A total of 154 participants with primary knee osteoarthritis (KOA) were divided into intervention and control groups. The intervention protocol included patient education on the nature and treatment of KOA, therapeutic exercise, a weight loss programme for overweight patients, and a physical therapy programme. Participants were followed for 3months. The Visual Analog Scale for Pain (VAS-p), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and knee Kellgren-Lawrence OA grading were measured before and after the intervention. Additionally, the Morisky adherence questionnaire and the WHO Multidimensional Framework for factors affecting adherence were assessed. One fifty four participants with KOA were randomly allocated into intervention and control groups. A low level of adherence was detected in both groups (68.8% in the intervention group vs. 84.4% in the control group). Patients who followed the interventional programme were more adherent. Adherence to therapy was associated with a reduction in the Visual Analog Scale for Pain (VAS-p) (p=0.016) and improved function as measured by WOMAC (p=0.018). Factors primarily associated with patient non-adherence included unemployment (67.8%), low income (59.3%), no previous response to therapy (58.5%), less frequent follow-up visits (55.1%), lack of insurance (66.9%), difficult access to services (59.3%), and high cost of services (55.1%). Adherence to treatment in OA patients is a significant concern and a common problem, appearing to be associated more with socioeconomic factors than with pain and function.

THE LEVEL OF CONVERGENCE TO SHARI’AH PRINCIPLES AND CORPORATE PROFITABILITY

This study constructs a Shari'ah convergence index for 1,362 companies operating in 10 different Islamic countries between 2017 and 2021 and assesses its relation to corporate profitability. Shari’ah screening variables are based on existing Shari’ah screening literature and applications, and variable weights are assigned using the Integrated Determination of Objective Criteria Weights (IDOCRIW) technique, a widely used, multi-criteria decision-making method. The results suggest that 4% of the sample is completely non-compliant as they engage in non-permissible business activities, 82% has a non-compliant activity level below 30% and the remaining 14% has a non-compliant activity level between 41 and 99%. Our panel data regression analysis shows that, while the Shari'ah convergence index does not affect operating profitability, it does have a statistically positive effect on total corporate profitability. These findings are attributable to two factors, interest burden and debt level. It seems that, for Islamic companies, The high cost of debt service may offset the advantage of high leverage on profitability.

Implication of Macroeconomic Fundamentals on the Twin-Evil of Macroeconomic Phenomena: “With the Focus on Nigeria”

Purpose of the Study: This study was designed to analyze the implication of Macroeconomic fundamentals on twin-evil of Macroeconomic phenomena: “with the focus on Nigeria.’’ Methodology: The study Utilized annual time-series data on exogenous variables (Government Deficit Spending, GDS; Official exchange rate, OEXCHR; Monetary policy rate, MPR) to capture Macroeconomic fundamentals. While, Unemployment rate, UNEMPLR; Inflation rate, INFLR and Consumer price index, CPI were used as a summation of Macroeconomic phenomena to capture Misery index. The data on variables used in the study were sourced from Nigerian federal ministry of finance; Central Bank of Nigeria; and World Bank data bank between 1991and 2022 respectively. The study employed econometric techniques of ordinary least square and Two-stage least to analyze its data. Findings: The study of Ordinary Least Square revealed that Government deficit spending and official exchange rate significantly eradicate misery index in a positive manner. Meanwhile, monetary policy rate insignificantly eradicate misery index in a negative manner. There was also a further revelation from the findings of two-stage least square that government deficit spending and official exchange rate exert concerted significant strength to eradicate misery from every citizen of Nigeria within the periods under study.. Meanwhile, the result found that it was insignificantly weak for monetary policy rate (MPR) to minimize misery index from every Nigerian citizen within the periods under study. Unique Contribution to Theory, Practice and Policy: The study concluded that the authority should maintain a sound policy that will oversee money borrowed for critical projects and use it to create employment opportunity for Nigerian citizenry, ensure exchange rate is kept within a certain band that will reduce high cost of goods and services in the economy that we are currently facing and jettison the idea of increasing monetary policy rate, since this displayed a negative sign to help reducing misery index of the Nigerian populace during the periods of study.

Healthcare accessibility of individuals at increased risk of STIs: a cross-sectional survey in Italy

Abstract Access to STI prevention and sexual health services in Italy, especially among vulnerable and marginalized groups, is inadequately documented. With the support of community organizations, a cross-sectional survey was conducted between September 2023 and March 2024 to assess health services accessibility among individuals at increased risk of STIs. A total of 1456 responses were analyzed. The respondents comprised 1327 (91.14%) cisgender men, 58 (3.98%) cisgender women, 11 (0.76%) transgender men, 10 (0.69%) transgender women, and 47 (3.23%) non-binary individuals. Overall, 93.8% were men who have sex with men, and 2.8% were women who have sex with women. Mean age was 38 (SD 12). Among respondents, 1284 (88.2%) had undergone HIV testing at least once [102 (7%) living with HIV; 45.1% diagnosed during prior year]. Overall, 563 (38.7%) had been diagnosed with at least one STI in the prior year. Chemsex was reported by 106 (7.3%), with 4.7%, 75.5%, and 35.5% using injective, inhaled or oral substances. Despite a high risk for STIs, 728 (50%) and 410 (28.2%) individuals, respectively, did not visit a specialist in infectious diseases or their primary care provider in the prior year. PrEP awareness was high: 1286 (88.2%) respondents were knowledgeable about it, but only 342 (23.5%) attended PrEP centers and 297 (20.4%) used it. Among PrEP users, 27 (7.9%) encountered difficulties obtaining the drug and 174 (50.9%) considered the cost prohibitive (before it became free). Additionally, 27 (7.9%) of those attending PrEP centers felt judged or disrespected. Overall, 1179 (80.9%) had heard of Mpox, and 1012 (69.5%) were aware of the vaccine, with 301 (20.6%) being vaccinated. Among those vaccinated, 18 (5.2%) felt judged or disrespected. Out of 55 (3.8%) individuals tested for Mpox, 13 (23.6%) tested positive, among which one reported feeling disrespected. The survey highlights critical gaps in healthcare access and awareness among individuals at increased risk of STIs in Italy. Key messages • In a final open-ended question, responders commented on various issues including high costs of services, insufficient provider training and the necessity for improved inclusion of LGBTQ+ individuals. • The robust response from typically hard-to-reach groups underscores the pivotal role of community involvement in enhancing awareness and accessibility of sexual health services, fostering inclusivity.

Defining medical deserts—an international consensus-building exercise

Abstract Background Medical deserts represent a pressing public health and health systems challenge. The COVID-19 pandemic further exacerbated the gap between people and health services, yet a commonly agreed definition of medical deserts was lacking. This study aims to define medical deserts through a consensus-building exercise, explaining the phenomenon to its full extent, in a manner that can apply to countries and health systems across the globe. Methods We used a standard Delphi exercise for the consensus-building process. The first phase consisted of one round of individual online meetings with selected key informants; the second phase comprised two rounds of surveys when a consensus was reached in January 2023. The first phase-the in-depth individual meetings-was organized online. The dimensions to include in the definition of medical deserts were identified, ranked and selected based on their recurrence and importance. The second phase-the surveys-was organized online. Finally, external validation was obtained from stakeholders via email. Results The agreed definition highlights five major dimensions: ‘Medical deserts are areas where population healthcare needs are unmet partially or totally due to lack of adequate access or improper quality of healthcare services caused by (i) insufficient human resources in health or (ii) facilities, (iii) long waiting times, (iv) disproportionate high costs of services or (v) other socio-cultural barriers’. Conclusions The five dimensions of access to healthcare: insufficient human resources in health or; facilities; long waiting times; disproportionate high costs of services and; other socio-cultural barriers, ought to be addressed to mitigate medical deserts. The term medical deserts might not be the most appropriate term for defining areas with insufficient access to health services as it excludes essential domains, such as access to public health and preventive services. Key messages • Medical deserts directly and negatively impact the health outcomes of the people living in it. • Medical deserts might not be the most appropriate term for defining areas with insufficient access to medical services, as it excludes public health and preventive services.

Barcode 100K Specimens: In a Single Nanopore Run.

It is a global priority to better manage the biosphere, but action must be informed by comprehensive data on the abundance and distribution of species. The acquisition of such information is currently constrained by high costs. DNA barcoding can speed the registration of unknown animal species, the most diverse kingdom of eukaryotes, as the BIN system automates their recognition. However, inexpensive sequencing protocols are critical as the census of all animal species is likely to require the analysis of a billion or more specimens. Barcoding involves DNA extraction followed by PCR and sequencing with the last step dominating costs until 2017. By enabling the sequencing of highly multiplexed samples, the Sequel platforms from Pacific BioSciences slashed costs by 90%, but these instruments are only deployed in core facilities because of their expense. Sequencers from Oxford Nanopore Technologies provide an escape from high capital and service costs, but their low sequence fidelity has, until recently, constrained adoption. However, the improved performance of its latest flow cells (R10.4.1) erases this barrier. This study demonstrates that a MinION flow cell can characterise an amplicon pool derived from 100,000 specimens while a Flongle flow cell can process one derived from several thousand. At $0.01 per specimen, DNA sequencing is now the least expensive step in the barcode workflow.

HUBUNGAN PENGETAHUAN AKSEPTOR KB TENTANG IUD DENGAN KEIKUTSERTAAN MENGGUNAKAN IUD DI PMB BDN. NI WAYAN SUSIANTI, S.S.T.KEB

Contraception is a method or tool used with the aim of preventing pregnancy. The decrease in the number of IUD family planning participants over the years can be caused by the participants' lack of knowledge about the advantages of IUD contraception. Knowledge of contraceptive devices is a consideration in determining the contraceptive method used. The quality of family planning services is seen in terms of the availability of health service personnel tools, the high cost of IUD services, and the existence of barriers from husband support in the use of IUD contraceptive devices. The purpose of this study is to determine the Relationship of Family Planning Acceptors' Knowledge About IUD With Participation in Using IUD at PMB Bdn. Ni Wayan Susianti, S.S.T.Keb. This study uses a correlational analytic design with a cross-sectional approach. The sample selection in this study used purposive sampling technique. The sample for this study is 40 acceptors. Data were analyzed using Chi-square test analysis. The results of the analysis using the Chi-square test showed that from 40 respondents, a p-value of 0.001 was obtained. This result indicates that H0 is rejected and Ha is accepted, which means there is a significant relationship between the knowledge of family planning acceptors about IUD and participation in using IUD at PMB Bdn. Ni Wayan Susianti, S.S.T.Keb. Based on the results of this study, it is hoped that family planning acceptors will increase their knowledge about IUD with participation in using IUD.

Evaluation of Social Media Tools in Health Tourism Marketing with Multi Criteria Decision Making Methods

Today, countries are turning to alternative tourism types due to the destructive and corrosive effect of mass tourism. Various factors in the global market affect consumer preferences and shape their demands. This situation leads countries to seek alternative tourism types. While developed countries tend to focus more on sports tourism, the rising value of health tourism stands out for developing countries. The high costs of healthcare services in developed countries, waiting times, and the lack of many health services offered by insurance companies lead consumers to outsource their helthcare needs. Relationship marketing plays a key role in health tourism services, and consumers seek first-hand answers to their questions. The health sector's sensitive and complex structure informs and raises consumers' awareness on the axis of relational marketing dimensions. This study aims to via multi criteria decision making to determine and rank the social media channels used in health tourism marketing. While the criteria weights are determined by the Best-Worst Method, the priority order of social media channels is determined by COmbinative Distance-based ASsessment. Expert opinions were consulted during the criteria determination and the ranking of the alternatives. As a result of the analyses, the importance of social media is emphasised once again. Social media tools, especially through mobile application applications, shape the age with the audience it reaches, the distribution between regions, the time spent and the information transmitted. The need for socialisation accelerates the development of technology with the rapid orientation of people towards this field. In this case, youtube, which has gained momentum with the number of users and the use of visual and auditory elements together, holds the leadership in the reflection of relational marketing on health tourism today, as it creates space for all segments, even though information pollution is experienced.

IMPACT OF COOPERATIVE ON SELECTED SMALL BUSINESS IN IJEBU NORTH LOCAL GOVERNMENT AREA, OGUN STATE.

This study investigated the impact of cooperative society on selected small businesses in Ijebu-North, Ogun State. It specifically examined the impact of cooperative society loans on the operation of small businesses, identified the role of cooperative society in sustaining small businesses, and identified the challenges of small businesses in IjebuNorth. A descriptive survey research design was adopted for the study. A multistage sampling technique was used to select eighty (80) respondents from five cooperative societies in Ijebu-North, Ogun State. A well-structured questionnaire was used to gather information from the respondents. The data were analysed using descriptive statistics for the demographic information and one sample test to analyse the hypotheses at a 0.05 level of significance. Results showed that cooperative loans play a significant role in supporting and enhancing the operation and success of small-scale businesses in Ijebu-North. Findings revealed that cooperative loans have a significant contribution to small-scale businesses in Ogun State. Also, the study revealed that small-scale businesses face a range of constraints in accessing cooperative society loans, including poor infrastructure, high financial service costs, and high tax rates. The result of the hypotheses suggests that there is a significant impact of cooperative loans on the operation of small-scale businesses in Ijebu North Local Government Area, Ogun State. It was concluded that cooperative societies play a significant role in sustaining these businesses. Among other recommendations is that steps should be taken to improve the accessibility of cooperative society loans.

Facilitating and limiting factors of cultural norms influencing use of maternal health services in primary health care facilities in Kogi State, Nigeria; a focused ethnographic research on Igala women

BackgroundFacilitating factors are potential factors that encourage the uptake of maternal health services, while limiting factors are those potential factors that limit women’s access to maternal health services. Though cultural norms or values are significant factors that influence health-seeking behaviour, there is a limited exploration of the facilitating and limiting factors of these cultural norms and values on the use of maternal health services in primary health care facilities.AimTo understand the facilitating and limiting factors of cultural values and norms that influence the use of maternal health services in primary healthcare facilities.MethodsThe study was conducted in two primary healthcare facilities (rural and urban) using a focused ethnographic methodology described by Roper and Shapira. The study comprised 189 hours of observation of nine women from the third trimester to deliveries. Using purposive and snowballing techniques, data was collected through 21 in-depth interviews, two focus group discussions comprising 13 women, and field notes. All data was analyzed using the steps described by Roper and Shapira (Ethnography in nursing research, 2000).ResultsUsing the enabler and nurturer constructs of the relationships and the expectations domain of the PEN-3 cultural model, four themes were generated: 1, The attitude of healthcare workers and 2, Factors within primary healthcare facilities, which revealed both facilitating and limiting factors. The remaining themes, 3, The High cost of services, and 4, Contextual issues within communities revealed factors that limit access to facility care.ConclusionSeveral facilitating and limiting factors of cultural norms and values significantly influence women’s health-seeking behaviours and use of primary health facilities. Further studies are needed on approaches to harness these factors in providing holistic care tailored to communities' cultural needs. Additionally, reinvigoration and strengthening of primary health facilities in Nigeria is critical to promoting comprehensive care that could reduce maternal mortality and enhance maternal health outcomes.

Validation of the Client Satisfaction Scale for Youth in Residential Psychiatric Care

ABSTRACT Youth with severe mental and behavioral health symptoms often require high levels of care, such as residential placement. Given the acuity of the residential population, the high cost of services, and the separation of children from their families, remarkably little research exists on engagement, mechanisms, and outcomes. Treatment satisfaction is a critical process and outcome indicator but is not always assessed in residential care. When satisfaction is assessed, the quality of the assessment tools varies and is rarely assessed as part of treatment progress, so little is known about how and if it might change during treatment. This study aimed to examine the psychometric properties of the newly developed Client Satisfaction Scale (CSS) for youth in residential psychiatric care. The CSS was administered to all patients in the current study (N = 2,933, M age = 15.36, SD = 1.35). Results of exploratory and confirmatory factor and item response theory analysis support evidence of structural validity, and bivariate correlation and regression supported evidence of concurrent and predictive validity, respectively. Findings suggested the CSS scale may be a viable tool for assessing youth satisfaction with treatment outcome and services at residential treatment centers.

LIBRARIANS’ PERCEPTION ON THE USE OF SOCIAL MEDIA AS A TOOL FOR INFORMATION SERVICE PROVISION IN KASHIM IBRAHIM LIBRARY, AHMADU BELLO UNIVERSITY, ZARIA, NIGERIA

Social media have become an indispensable and current trend of communication in the modern era today, as a result of this, academic libraries adopt social media such as Facebook, X (formally Twitter), YouTube, and Flickr for effective and efficient information services provision in the 21st century. The study investigates the librarians’ perception on the use of social media (SM) as a tool for information service provision in Kashim Ibrahim Library, Ahmadu Bello University, Zaria. A total number of 91 copies of the questionnaire were administered to the respondents and a total of 85 were returned and found useful for the study. All data were categorized and analysed using tables, frequency, and simple percentage were used to analyse the data. Findings revealed that SM are used to render various library services. However, the major challenges faced by the academic library staff when using SM for information services provision include inadequate power supply, inadequate bandwidth, security privacy and copyright issues, high cost of Internet services. The study recommended that the academic librarians should be encouraged in the use of SM to develop their skills in information services provision.

A Cross-Sectional Study to Assess the Perceived Oral Health Care Needs, Barriers to Accessing Oral Health Care Services, and Utility Among the Rural Population in Chengalpattu District, Tamil Nadu.

Introduction Utilization is the actual attendance of people at oral healthcare facilities to receive treatment. This study aimed to determine the perceived oral health care needs and barriers to utilizing dental services among rural populations. Materials and methods A cross-sectional survey using a questionnaire was designed to identify the perceived oral health care needs and obstacles to accessing dental facilities and their utility among rural populations. The sample size was set at 570. A data collection sheet was used to collect the required data, which included informed consent, demographic details, and the questionnaire.A pretested and validated questionnaire was used in the study. Result Among the 570 respondents, 43.3% of the population had experienced toothache, out of which 67.6% perceived the need for dental care. Only around 37.5% reported that their dental needs were met during the past year. Dental expenses were significantly related to access to the dentist. Conclusion This survey revealed that the majority of the population tends to utilize the available services only when absolutely necessary. High dental service costs and inadequate knowledge about oral problems act as major barriers.

Barriers and Attitudes towards Mental Health Services in Nigeria: A Systematic Review

Mental health services in Nigeria consists mainly of large government psychiatric hospitals. There are eight Neuropsychiatric hospitals and a similar number of teaching hospital psychiatric departments for a population of 200 million people. There is only one private community residential facility available with ten beds in Lagos State and it is administered by a religious organization for rehabilitation of persons with drug problems.In Nigeria, an estimated 20-30%of the population are believed to suffer from mental disorders.MEDLINE EntrezPubmed search was done in November, 2018. Studies conducted on mental health and mental health services in Nigeria done from 2009 till date were selected for review. The studies were grouped into two categories according to the key words used in the search. Category 1: Keywords used in the search: mental health,Nigeria.This search yielded a total of one thousand and fifty (1,051) publications. Category 2: Keywords used in the search: mental health services,Nigeria. Lack of incentives for health care workers and inadequate workforce were identified as some of the barriers against the use of mental health services in Nigeria. Other major barriers identified were- poor education, ignorance, and stigmatization. Absence of services in rural communities, waiting time at the facilities, bureaucracy in treatment and poor information management, high cost of service, travel distance, feelings of shame and loss of productive income were the barriers identified in some other studies conducted in Nigeria.

A Bi-Level Optimized Dispatching Method for Grids with High Penetration of New Energy Considering Ancillary Service Costs

To address the issue of high auxiliary service costs caused by the grid connection of new energy generation, a dual layer optimization scheduling method for high penetration new energy power grids is proposed, taking into account the auxiliary service costs of grid connection. The correlation between the output fluctuations and load fluctuations of new energy generation is analyzed, and a calculation model for auxiliary service costs caused by grid connection of new energy generation is established. Taking into account the timescale division requirements for grid energy trading and auxiliary service market transactions, a new high penetration energy grid two-level optimization scheduling model is established. The upper level scheduling model aims to minimize the sum of grid energy procurement costs and auxiliary service costs caused by new energy generation and completes the optimization scheduling of the grid for several hours. The lower level scheduling model aims to closely follow the upper level scheduling plan for new energy power plants/groups. Optimization and scheduling of the power grid for tens of minutes is completed, taking into account the balanced allocation of wind and solar losses among various power plants within the new energy power plant group. The simulation results show that the method proposed in this paper can reduce the energy transaction costs and auxiliary service transaction costs of the power grid during low and peak load periods.

Cost and financing of paratransit services and their effect on dissatisfaction with participation in daily activities of persons with disabilities

IntroductionTransportation use affects participation in daily activities, health and well-being. Persons with disabilities rely on paratransit services if they are not able to use public transport. The per-trip costs of paratransit services in Switzerland are high, and the responsibility for financing these trips (e.g., social insurance, canton) varies depending on the purpose of travel. We hypothesized that cost and financing factors of paratransit services increase dissatisfaction with participation in daily activities of persons with disabilities in Switzerland. The study's objective is to investigate which cost and financing factors affect dissatisfaction with participation in daily activities. MethodsUsing a cross-sectional study design, we conducted a self-administered online questionnaire. We included paratransit service users or relatives of paratransit service users aged 18 years or older. We analyzed the data using the multiple correspondence-, lasso- and regression analysis. ResultsA statistically significant effect on lower levels of dissatisfaction with participation in daily activities had high costs of paratransit services (Odds ratio (OR) = 3.45, 95% Confidence interval (CI) [1.41, 8.36]), not using paratransit services to leisure activities (OR = 2.39, 95% CI [1.28, 4.58]) and work (OR = 4.11, 95% CI [1.22, 20.89]), and getting trips financed to leisure activities by social insurances and benefits (OR = 3.06, 95% CI [1.08, 8.42]). ConclusionConcerning the influence of transportation on health and wellbeing, policy-makers and transportation planners may reflect on the effect of cost and financing factors of paratransit services on dissatisfaction with participation in daily activities of persons with disabilities. This is particularly important when the dissatisfaction stems from reduced use of paratransit services for leisure activities, due to high costs.

Generative AI Applications in Helping Children with Speech Language Issues

This paper reports how generative AI can help children with specific language impairment (SLI) issues by developing an AI-assisted tool to support children with challenges in phonological development in English, especially children with English as the secondary language in the United States. Children from bilingual families often experience challenges in developing proficiency in English pronunciation and communication, which has been exacerbated by remote learning during the pandemic and led to learning loss. School-aged children with speech problems require timely intervention because children with language disorders find it difficult to communicate with others, leading to social isolation and academic difficulties. The needed intervention is often delayed due to the high cost of speech services and the shortage of Speech and Language Pathologists (SLPs). Individuals with a history of SLI have an increased risk of unemployment. An AI-assisted Phonological Development (AI-PD) tool was prototyped, aiming to alleviate these challenges by assisting caregivers in evaluating children's phonological development, assisting SLPs in lesson preparation, and mitigating the severe shortage of SLPs.