Prenatal Acetaminophen Use and Autism

The NACE-based Q sector, which represents human health and social service activities, has a significant share of employment in Turkey. In the Q sector, the supply of qualified labour process of supplying qualified takes a long time and requires high-cost investments. Due to uncertainties about how and when the demand for health services will arise, the supply should always be higher than the demand. In this context, planning the supply of health services and making predictions about their demands are vital in terms of creating economically effective health service policies. Therefore, this article aims to forecast physicians’ supply and demand for health services. We employed machine learning (ML) methods for time series forecasting. In order to forecast the demand, two data sets from the health care sector between the years 1980–2020 and 2000–2020 were analysed. The supply of physicians per 1,000 people could be 3.04, and the demand 3.12 in 2030, and thus, a shortage in the supply of physicians could be expected in 2030. The main findings of the study demonstrate that there could be an imbalance between the rate at which physicians are expected to be demanded and the rate at which physicians are expected to be supplied.

The increasing integration of health information technology (health IT) into the U.S. healthcare system has brought both opportunities for improvement and new vulnerabilities. The 2024-2030 Federal Health IT Strategic Plan emphasizes equitable data access, quality representative data, and the responsible use of artificial intelligence (AI) to improve health outcomes. Yet, the growing complexity of digital infrastructures has amplified risks related to privacy and the security of protected health information (PHI). This study examines U.S. health system vulnerabilities by analyzing reported PHI breaches and situating them within evolving federal health IT priorities. This mixed-methods descriptive study combines quantitative analysis of the U.S. Department of Health and Human ServiCE's (HHS) Breach Portal data (2013-2023) with a qualitative review of federal policy and regulatory developments related to health IT. Breaches of PHI affecting more than 500 individuals were included, consistent with HHS reporting requirements. Duplicate and incomplete entries were removed. Breaches were categorized by cause and type. Quantitative results describe frequencies, proportions, and trends, while qualitative analysis of policy documents and breach narratives contextualizes these findings within the broader framework of digital health governance. From 2013 to 2023, the total number of reported PHI breaches and the share attributed to hacking and IT incidents increased markedly, while those involving theft, loss, or improper disposal declined. Healthcare providers accounted for most reported breaches, followed by business associates and health plans. Despite advances in interoperability and automation, the healthcare sector remains disproportionately affected by cybersecurity incidents. The qualitative analysis reveals persistent gaps between federal strategic goals and the practical implementation of privacy and security safeguards across healthcare. This study underscores the paradox of digital transformation: while health IT adoption improves efficiency, coordination, and data sharing, it simultaneously exposes the healthcare system to new risks. Strengthening system resilience requires harmonized governance, continuous monitoring, and greater investment in digital literacy. As AI use and automation expand, policy reforms must ensure that innovation does not compromise patient privacy or deepen inequities. These findings contribute to a better understanding of health system vulnerabilities and offer insights for enhancing the security and resilience of the U.S. health system.

To address high-cost inpatient utilization for those with severe and persistent mental illness, stakeholders from a County Department of Human Services, a Behavioral Health Managed Care Organization, and mental health providers created a value-based payment (VBP) model to shift funding from inpatient mental health treatment (IPMH) to intensive, evidence-based, community-based mental health treatment, Assertive Community Treatment (ACT). Using a retrospective observational study, individuals who received ACT from providers participating in the VBP (N = 2) were compared to individuals who received ACT from providers (N = 17) not supported through a VBP. Results show decreasing average ACT and IPMH expenditures as well as shorter lengths of stay over time for providers under a VBP compared to those not in a VBP. Access to care was not impacted. These results, including implications for behavioral health, are discussed in the context of quality of care.

A Declining Incidence of Gastroschisis Parallels Trends in Maternal Smoking Rates in the United States.

Research training is important for workforce development in Science, Technology, Engineering, and Mathematics (STEM). The STEM higher education literature has identified various components critical to the success of research training programs such as research mentoring and training. Less work has been conducted on other research training activities such as conference participation even though it is an interactive activity that can allow students to develop science self-efficacy and science identity. Yet, the costs associated with conference attendance may be a barrier for students, especially those who already have financial concerns about funding their education. This paper evaluates how conference participation (i.e., conference attendance and/or presentation) contributes to students' development of research self-efficacy and science identity within a STEM research training program at California State University Long Beach (CSULB) called the Building Infrastructure Leading to Diversity (BUILD) Scholars program. Data were collected from students enrolled in the departments engaged in health-related research across four colleges (natural sciences, engineering, health and human services and liberal arts) at CSULB. This study used propensity score matching and Ordinary Least Squares (OLS) regression to predict research self-efficacy and science identity from exposure to the BUILD intervention and conference participation. Results indicate that both participation in the BUILD Scholars program and conferences have a strong positive association with research self-efficacy and science identity. Overall, the results of this study present a strong case for including conference attendance and presentations as a part of any STEM education research training program.

Socioeconomic Disparities in Prostate Cancer Presentation: The Impact of ADI on Prostate Cancer Stage at Diagnosis.

Bridging ecosystem and human health: distinct neonicotinoids accumulation drivers and human exposure pathways in a multifunctional reservoir.

This article discusses the importance of effective communication tools in public health, highlighting innovations like Quick Response (QR) codes and QR wallet reference cards (QR cards) for enhancing outreach and education. QR codes are scannable barcodes that link to digital content. QR cards are compact cards, similar to business cards, with codes that lead to relevant health information. To our knowledge, there is little published literature on using QR codes and cards for public health programs and health communication outside of health care clinics and education settings. The North Carolina Department of Health and Human Services, Division of Public Health, Community and Clinical Connections for Prevention and Health Branch has successfully implemented QR codes in various public health programs, particularly in diabetes management and nutrition, physical activity, and obesity initiatives. Key lessons learned include using reputable QR code generators, ensuring visibility and scanability of the codes, testing links before use, providing clear calls to action, and considering dynamic versus static codes based on needs. QR codes can be leveraged in public health practice for program promotion, evaluation sharing, and community resource accessibility. However, limitations such as smartphone dependency among some populations should be acknowledged. In conclusion, while QR codes are a simple tool, they hold significant potential for improving public health communication. Research on QR code use in public health settings could help inform best practices for public health programs and health promotion across different contexts.

From the perspective of local governance, this paper systematically analyzes the current state of competitiveness in China’s human resources industry. At present, the human resources service sector is undergoing a critical period of structural transformation, characterized by regional disparities, strong policy orientation, and talent policy-driven development. However, it also faces three key challenges: the lack of a nationwide coordination mechanism, emphasis on talent attraction over cultivation, and policy homogenization. In response, this study proposes three targeted strategies to enhance competitiveness. First, it advocates for the establishment of a "central coordination local collaboration" governance mechanism to promote information sharing and mutual recognition of qualifications. Regions can strengthen local talent cultivation and service capabilities. Simultaneously building a comprehensive talent development chain. Regions can also develop localized human resources policies that are suitable for regional conditions. Thus achieving differentiated competition and coordinated regional development. I hope to provide feasible ways to build a localized human resource governance model.

The efficiency of intake processes for government benefit programs is central to ensuring equitable access to public health and social services. This article analyzes the structural components of intake systems and examines how standardized workflows, interoperable information systems, and trauma-informed practices shape administrative fairness and service quality. The methodology includes a literature review in Portuguese, document analysis, and practice-based insights derived from case management in public health and human services. Results indicate that electronic records, intersectoral integration, and humanized approaches significantly improve timeliness, accuracy, and user experience, particularly among highly vulnerable populations. Findings show that technological innovation, combined with organizational clarity and trauma-sensitive practices, strengthens the capacity of public institutions to deliver efficient and equitable services. The study concludes that the modernization of intake systems demands continuous investment, qualified training, and coordinated public policy efforts to ensure dignified and needs-based access to essential benefits.

Abstract This mixed-methods study examines undergraduate and graduate students' beliefs about educational priorities for preschool- and elementary-aged children and their perceptions of the biggest threats to healthy development. Participants ( n = 230) in education, psychology, and human services programs completed a forced-ranking survey of instructional materials and experiences and responded to open-ended questions about their rationale and perceived developmental risks. Quantitative analyses (chi-squared, Mann-Whitney U , Kruskal-Wallis H tests) revealed a clear shift in priorities by age group. Preschool rankings emphasized play-based and exploratory activities (e.g., dramatic play, sensory exploration), while elementary responses prioritized structured academic tasks (e.g., group instruction, literacy tools). Demographic subgroup differences were minimal; gender and socioeconomic status had no significant effect, though age and household composition influenced select rankings, such as greater emphasis on STEM materials among younger participants. Qualitative findings highlighted both systemic and classroom-level concerns. Participants expressed worry over inadequate teacher preparation, excessive screentime, high-stakes testing, and the disproportionate impact of accountability systems on marginalized students. Additional perceived threats included poor classroom management and limited opportunities for creativity and social-emotional development. These results illuminate the complex interplay between structural pressures and classroom practices in shaping future professionals’ beliefs. Preparation programs must foster critically reflective learning environments that help candidates integrate developmentally appropriate practices with policy awareness and systemic advocacy. This study contributes to ongoing discussions about coherence across preschool and elementary education, highlighting the need for inclusive, play-based learning environments that promote both equity and rigor.

Burnout and cognitive workload present major challenges to coach well-being, yet few studies examine how these factors relate to practice structure preferences and coaching experience. This cross-sectional study investigated 103 elite Turkish basketball coaches (M age = 42.1 ± 6.3 years; M experience = 13.6 ± 4.2 years). Burnout was measured using the Maslach Burnout Inventory–Human Services Survey, cognitive workload via the NASA-TLX, and practice structure preference through a single-item measure based on the constraints-led approach (CLA). Coaches reported moderate burnout (M = 23.3, SD = 3.7) and high cognitive workload (M = 66.5, SD = 8.1). Correlation analyses revealed a small, nonsignificant inverse relationship between CLA preference and burnout (r = –.10, p = .29), and a significant but modest inverse association between experience and burnout (r = –.25, p = .011). Regression analysis showed that experience predicted lower burnout (β = –.23, p = .008, f² = .09), while CLA preference did not (β = –.16, p = .184). The model explained 7.9% of the variance in burnout (R² = .08). A second regression indicated no significant links between either predictor and cognitive workload (R² = .03, n.s.). T-tests showed nonsignificant burnout differences between high- and low-CLA groups (d = –0.17, p = .44). These results suggest that experience may provide some protection against burnout, while cognitive workload remains high regardless of practice design. Given the cross-sectional nature and single-item CLA measure, findings should be interpreted cautiously. Coach education should integrate pedagogical innovation with stress-management strategies to promote psychological sustainability.

Background: Over 500,000 children were abused or neglected in the United States in 2023, and over 2,000 children died from abuse-related injuries. A decline in child abuse reporting was observed both nationally and in Pennsylvania during the COVID-19 pandemic, likely due to limited interactions between victims and mandated reporters including health care providers. Inconsistencies have been observed when comparing prevalence rates of child maltreatment obtained through electronic health record (EHR) documentation to those obtained from child welfare data. We aimed to determine whether the prevalence of child abuse coded within EHRs mirrored the national underreporting trends observed during the COVID-19 pandemic and to assess the reliability of EHR documentation of child maltreatment for public health surveillance. Methods: Medical records for pediatric patients were extracted from a large, integrated health care system. Fourteen child maltreatment diagnosis codes were used to identify EHR encounters involving abuse in the emergency department, primary care, well-child, specialist, and hospital settings prior to and during the COVID-19 pandemic. Over 5,300 patients were identified with more than 7,600 encounters since Jan. 1, 2000. Systematic chart reviews were conducted in representative samples to determine the validity of child abuse coding for each encounter. The Pennsylvania Department of Human Services reports child abuse and market share data and estimates of the percent of visits affiliated with this health care system per county were obtained to approximate the number of child abuse reports expected from health care providers within the system. Values were compared to the actual number of cases documented with maltreatment-associated diagnosis codes in the EHRs. Results: Preliminary analyses identified trends inconsistent with the anticipated declines in reporting during the pandemic period. Three potential sources of data bias were investigated via targeted review of 83 charts: the use of adult abuse codes for pediatric patients, the overuse of a single sexual abuse code, and the repeating of certain abuse codes over time. This chart review suggested that overlap in the coding criteria for pediatric and adult patients and coding error contributes to the first source of bias. Outside laboratory testing and lab-specific protocol for coding pediatric sexual abuse were responsible for the second source of bias. Of charts reviewed with repeated abuse codes, less than 5% contained evidence of new or continued maltreatment. Just over 50 substantiated reports of child maltreatment were expected from system-affiliated health care providers. Approximately 96 new cases of child maltreatment were documented in EHRs using maltreatment-associated diagnosis codes. Conclusion: Documentation of child maltreatment within the EHR did not mirror trends observed nationally during the COVID-19 pandemic. While EHR data may improve monitoring of health care utilization and aid in the development of primary prevention strategies, epidemiological investigations are limited by potentially inflationary or inconsistent coding practices. Data biases that decrease reliability include overlap in pediatric and adult coding, laboratory-specific coding protocol, and inappropriate coding of follow-up visits. As an adjunct to diagnosis codes, EHR-based surveillance may be improved by artificial intelligence-based algorithms programmed to detect or predict pediatric abuse from free text within charts.

Asian American and Pacific Islanders (AAPI) youth report a high prevalence rate of youth violence. Logic models that guide violence prevention programming are often not culturally specific and may not address the unique structural/social drivers of youth violence in minoritized communities. Monsoon has received Rape Prevention and Education (RPE) funding from the Iowa Department of Health and Human Services (Iowa HHS) since 2007 through a competitive application process. The specific aim of Monsoon's Youth Sexual Violence Prevention Program (YVPP) is to "prevent gender-based violence by educating and empowering peers through outreach and workshops." In response to growing awareness at IowaHHS about the limitations of the State RPE programmatic logic model in addressing AAPI-specific context for youth violence, Monsoon received additional RPE funds to establish the first culturally specific RPE logic model in Iowa. This initiative aims to fill a gap in culturally relevant evaluation resources. This paper describes the academic-community partnership initiated in 2023 that guided the participatory development of the culturally specific logic model and evaluation plan, for youth violence prevention in AAPI communities. Monsoon partnered with staff and faculty from the Center for Disease Control and Prevention (CDC)-funded Prevention Research Center for Rural Health (PRC-RH) in this work. PRC-RH faculty and staff reviewed documents and interviewed Monsoon leaders and youth staff. An AAPI-specific youth staff logic model and evaluation research questions were developed using a community-based research approach. Based on these, a mixed-methods evaluation plan was outlined. This case study highlights the critical importance of community-engaged research and practice to develop culturally specific logic models and evaluation designs for youth sexual violence prevention in the AAPI community.

Omadacycline versus moxifloxacin for community-acquired bacterial pneumonia (OPTIC-2): a phase 3b, randomised, double-blind, multicentre, controlled, noninferiority trial

Context:The Public Health Workforce Interests and Needs Survey (PH WINS) was fielded in 2014, 2017, and 2021. In the last 10 years, it has provided participating health departments and the field with data to improve recruitment and retention, strengthen workforce development efforts, guide strategic planning, and raise critical funds to improve public health infrastructure. It captures individual perspectives on engagement and satisfaction, intention to leave, training needs, and workplace infrastructure. This article describes the methods used for the 2024 administration of PH WINS.PH WINS 2024:PH WINS 2024 was fielded to a nationally representative sample of staff in State Health Agency Central Offices (SHA-CO) and local health departments (LHDs) from September 9, 2024, to January 17, 2025. The instrument was revised to improve the actionability of the results, reduce respondents’ cognitive burden, and align with existing standards or survey questions. PH WINS 2024 had 12 sampling frames, compared with the 3 in previous years: SHAs, members of the Big Cities Health Coalition (BCHC), and LHDs in each of the 10 Health and Human Services (HHS) Regions. All participating agencies were surveyed using a census approach.Participation:Overall, staff lists for 48 SHAs, 1,178 LHDs were collected, and the survey was sent to 159 627 individuals. PH WINS received a total of 56 595 responses, a 37% of eligible respondents. The SHA frame received responses from 29% of eligible respondents, BCHC members received 33%, and all other LHDs received 51%. The nationally representative SHA-CO frame included a total of 18 110 individuals, and the nationally representative LHD frame included 38 485 individuals from all 1178 LHDs. For the first time, the national sample of LHDs included small LHDs.Reflections:With the 2024 administration of PH WINS, all state and local public health departments in the United States had the opportunity to participate, yielding a nationally representative sample of small LHDs for the first time. State and local health department leaders should be empowered to use the results for workforce development and other planning. Questions were modified to become more action-oriented, rigorous, and stable over time to maximize the utility of PH WINS for years to come. Given the changing public health landscape associated with new outbreaks, disasters, and the political environment, these changes are critical.

Purpose Studies have examined the social costs of luxury consumption in terms of how observers perceive luxury brand consumers. However, how consumers perceive luxury consumption and collaboration with luxury brands by a social media influencer known for engaging in sustainable practices is underexplored. Proposing social media influencers as human service providers, this study aims to examine (i) the effect of luxury consumption by sustainable influencers on consumer relationship avoidance and positive word-of-mouth (WOM) intentions, (ii) the role of the sustainable influencer’s collaboration with non-sustainable vs sustainable luxury brands and (iii) the mechanism that explains this effect. Design/methodology/approach Two scenario-based experiments were conducted. The hypothesized relationships were tested using ANCOVA, and a mediation analysis was performed using Hayes’ PROCESS Model 4. Findings The study results show that when a sustainable influencer engages in luxury consumption, consumers’ relationship avoidance increases and positive WOM intention decreases. In addition, when sustainable influencers collaborate with sustainable luxury brands as opposed to non-sustainable luxury brands, consumers respond with higher relationship avoidance, driven by perceived narcissism. Originality/value The findings contribute to the sustainable influencer literature by tapping into the negative effect of a sustainable influencer’s luxury consumption and collaboration. Another contribution comes from the proposal of social media influencers as human service providers. This study also offers important managerial implications to sustainable influencers who rely on visual content featuring themselves in content creation and luxury brand managers seeking to collaborate with sustainable influencers.

Approximately one in three people in Latin America and the Caribbean live in poverty, and one in seven in extreme poverty. This paper provides an overview of who the poor are and how they live, using 18 recent household surveys from the region. It examines (1) how many people are poor, (2) how the poor are distributed geographically, (3) how poverty affects specific groups, (4) how much of the poverty in the region is chronic versus transitory, and (5) how poverty numbers have changed over time. Second, it identifies how the poor live. Specifically, it discusses (6) the living arrangements of the poor, (7) their assets, (8) how they earn their incomes, (9) how they access human capital services, and (10) their access to social safety nets. This descriptive analysis may be useful for targeting efforts and for generating hypotheses for poverty reduction that can be tested causally. JEL Classification Codes: I25; J20; O10; O12; O15; O18

The implementation of the referral system from First Level Health Facilities (FKTP) to Advanced Referral Health Facilities (FKRTL) occurs when a health facility faces limitations in resources, such as infrastructure, tools, personnel, or budget. Referrals are also made when patients require specialized care, hospitalization, diagnostic tools, or services that the initial health facility cannot provide, including emergency situations. The BPJS Health annual report on referrals at the Layang Health Center indicates a steady increase in the number of referrals year by year. This study aims to analyze the factors supporting and hindering the referral system, focusing on input and process aspects. The research adopts a qualitative case study approach with 17 informants, including health service employees, center heads, doctors, nurses, pharmacists, laboratory staff, JKN officers, and referred patients. The findings show that human resources at the Layang Health Center are adequate, but there are challenges with the availability of medicines, such as shortages and delays in distribution. Referrals are generally made based on medical needs, but some patients request their own referrals. The center’s health facilities are insufficient, and some essential tools are missing. Although the referral system is based on BPJS Health regulations, its implementation faces obstacles. Patients are often unaware of referral requirements, highlighting the need for better socialization and improved medicine and facility provision to optimize the system.