Individual Services Research Articles

Transitioning to Adult Life for Students With Intellectual Disability in Saudi Arabia: A Systematic Literature Review

Although transition services for individuals with intellectual disability (ID) in Saudi Arabia are required by special education law and regulations, no literature synthesizes peer-reviewed studies focused on transition services for individuals with ID in Saudi Arabia. The purpose of this systematic literature review was to describe the peer-reviewed studies that have been published in English and Arabic over the past 15 years (2008–2023) related to transition services for individuals with ID in Saudi Arabia, the period in which the Saudi Arabian government has provided a new focus on the needs of individuals with disabilities. Our search yielded 22 studies that met the inclusion criteria for this systematic review. Results were discussed in terms of the lack of research focused on transition services and the lack of transition services available for individuals with ID in Saudi Arabia. A discussion of the limitations of this study, as well as the implications for future research, are provided.

Duration of In-patient Physical Therapy at a Tertiary Hospital: Implications of a Time and Motion Study

Background and Objectives. Inpatient physical therapy (PT) care entails careful provision of service for individuals across a spectrum of disorders needing evidence-based physical rehabilitation during their hospital admission. The main difficulty is identifying adequate time allocation for safe patient service within an eight-hour working time frame. At a selected tertiary teaching government-run hospital, an arbitrary personnel-population ratio method is used for human resource allocation which may lead to issues in service delivery and healthcare workforce wellness. Apart from patient care, physical therapists also assume non-clinical roles revolving on administration, clinical education, and research. This highlights the importance of identifying the duration of tasks to assess work efficiency and manage time constraints posed by the limitations of the work shift. Practice guidelines may help improve staff workload scheduling, however, there is a lack of available guidelines regarding physical therapy practice in the hospital or acute care setting for developing countries. The purpose of this study was to determine the duration of care for inpatients with musculoskeletal and neurological conditions and administrative tasks, and to determine the relationship of duration of care with months of experience. Methods. A continuous observation time motion study of a typical workday of all physical therapists in an in-patient setting of a tertiary teaching hospital was conducted. An external observer will time the tasks done by the PT. The external observer kept distance from the direct patient encounter to minimize interference that may affect timing. Patients with conditions of different etiologies and functional levels were included. Results. Nineteen physical therapists with a mean experience of 54.63 months were observed. There were no adverse events during the implementation of this study. The total mean time in minutes of management of neurological patients is 37:32, and musculoskeletal patients is 28:30. Time for administrative tasks took an average of 20:33 minutes. There was also a low positive correlation on months of experience and treatment duration for patients with neurologic conditions (p=0.0471). Results showed that the allocated treatment duration is determined to be sufficient for performing PT activities. The optimal number of patients to be decked can also be appropriately determined to optimize resource allocation. Conclusion. Our pilot study attempted to quantify the duration of PT care in an inpatient setting that caters to patients with different diagnosis and varying needs for PT management. Although descriptive statistics and a weak to insignificant correlation was seen in most of the variables, there may be some benefit in gathering more duration data across different acute care settings within the country. Our pilot time and motion study can contribute to the limited evidence of duration of inpatient care that may inform human resource allocation, deliverables prioritization, and employee wellness and development. Figures have been presented which could be the basis for future policy research for management science and resource allocation studies.

Review of Completeness of Diagnosis Filling in Medical Record for Inpatients at Mental Hospital. Prof. HB. Saanin Padang

Hospitals are health care institutions that provide comprehensive individual health services that provide inpatient, outpatient, and emergency services. To realize this, hospitals need to organize medical record services to support the provision of health services. The important thing that must be considered by medical record personnel in maintaining the quality of medical records is the completeness of medical information related to the patient's medical history starting from the beginning of treatment until discharge from the hospital. The research aim that the results of this study can improve the quality of medical records and hospital accreditation. This research was conducted in June, 2024 at RSJ. Prof. HB. Saanin and continued with data processing at the Academy of Recorders and Health Information IRIS Padang. The type of research used in this study is descriptive research with quantitative methods and direct observation of medical record documents. Population of study was medical record documents for inpatients in in January - March 2024 totaling 600 medical record documents. The sample size using the Slovin formula was 99 samples. Result of research show that highest distribution of diagnoses based on ICD-10 at Prof. Hb Saanin Padang was paranoid schizophrenia with 35 patients, completeness of filling in the main diagnosis and diagnosis code in cases of mental disorders was 96%, Percentage of readability of diagnosis writing, where the writing of the main diagnosis and secondary diagnosis on the medical record is 100%. Keywords: Completeness, Medical record, diagnose.

Services in Minoritized Autistic Adolescents and Adults Varying in Language Skills.

Racially and ethnically minoritized (minoritized) autistic individuals face intersectional disparities in service access in the transition to adulthood. Our understanding of disparities is limited by systematic exclusion from research and inadequate approaches to characterizing services. To address these gaps and effect advocacy, this study (1) examined services received, unmet service needs, and barriers in minoritized autistic adolescents and adults and (2) determined if language, NVIQ, and autism traits predict services when deployed as binary or continuous variables. Academic and community partners tailored community-based participatory research (CBPR) to a local context. Participants (N = 73, ages 13-30) completed a behavioral assessment protocol. Participants and caregivers provided information on services received, unmet service needs, and barriers to services. Data were analyzed using descriptive and regression. Participants received multiple services yet had multiple unmet service needs and barriers. Effects of services differed by approach. Language impairment, but not language scores, predicted receiving more services. High levels of autism traits and autism trait scores predicted more unmet service needs. While the number of services and unmet service needs was similar to prior work, differences in individual service variables and effects support attention to heterogeneity. Findings support intersectional approaches to CBPR and autism research.

Faktor-faktor Yyng Mempengaruhi Rendahnya Motivasi Belajar Siswa

The low motivation to learn varies depending on the goals to be achieved in the learning process at school. The level of motivation can be seen from the attitude of students during teaching and learning activities. Motivation to learn can arise or change influenced by various factors. According to Dimyati & Mudjiono (2002) factors that influence learning motivation include students' ideals or aspirations, individual abilities, personal conditions, student environment, dynamic elements in the learning process, and teacher efforts in teaching. This study aims to describe: 1) Factors that influence students' low motivation to learn in terms of factors: a. students' ideals or aspirations, b. students' abilities, c. students' conditions, d. students' environmental conditions, e. dynamic elements in learning and teaching, f. teachers' efforts in teaching students. The method used in this study is quantitative with a descriptive research type. The research sample was 69 students of SMK Pariwisata Aisyiyah Padang in grades X, XI, and XII who were registered in the 2024/2025 academic year who were selected based on the Total Sampling technique. Data were obtained by distributing research instruments in the form of questionnaires on factors that influence low student learning motivation that have been tested for validity and reliability. Data were processed using the Percentage Technique. The results of this study indicate that: 1) factors that influence low student learning motivation are reviewed from the following factors: a. Student ideals or aspirations: difficulty in determining interests and talents (56.62%), b. Student abilities: difficulty focusing on processing lesson materials (47.83%), c. Student conditions: difficulty attending school due to health problems (44.93%), d. Student environmental conditions: avoid talking to deskmates (39.13%), d. Dynamic elements in learning and teaching: easily distracted by things around them that hinder the ability to focus on lesson materials (46.38%), e. Teacher efforts in teaching students: teachers do not provide good examples in learning discipline (44.93%). The implications of guidance and counseling services that can be provided are information services, individual counseling services and group counseling services.

INFORMATION SERVICES ABOUT BIOGRAPHIES OF SUCCESSFUL FIGURES ON LEARNING INTEREST OF NINTH GRADE STUDENTS IN JUNIOR HIGH SCHOOL

The main research focus is the low learning enthusiasm of ninth grade students at junior high school. This can be seen from various behaviors shown during the teaching and learning process, such as delayed learning, difficulty maintaining concentration, engaging in conversations with peers, and daydreaming. In addition, students tend to be less active in both individual and group learning sessions. The purpose of this study is to explore how biographical information services provided by successful individuals can affect students' interest in learning. The research design used in this study is pre-experimental, specifically using a one group pretest-posttest approach. The sample size of this study consisted of 33 ninth grade students of junior high school. Through the research findings, the calculated T value is 5.525. Furthermore, the Sig (2-tailed) value of 0.05 corresponds to the two-sided T table value of 2.042. Notably, the calculated T value exceeds the T table value, indicating a large difference between the results before and after the application of biographical information services for successful individuals. After careful examination of the decision-making process and acceptance criteria, it was determined that Ha was accepted and Ho was rejected. In conclusion, the utilization of biographical information services for successful individuals has a significant impact on increasing students' interest in learning.

Reasons for disengagement in first-episode psychosis - perspectives from service users and their caregivers.

The efforts of early psychosis intervention programmes can be impeded by difficulties in maintaining the engagement of service users. As disengagement is often an autonomous decision made by service users, the main aim of this study was to gain insight into the reasons for service user disengagement through qualitative interviews with the service users themselves, and caregivers as proxies or secondary informants. Participants recruited for the study were enrolled in the Early Psychosis Intervention Programme in Singapore for at least a year, aged 21 and above, able to communicate in English, and had disengaged for at least three months. The recruitment and interview processes were conducted independently for service user and caregiver participants. Potential participants were invited to a face-to-face semi-structured interview over video call or in-person. Each interview spanned one to two hours, and comprised five phases - icebreaker, exploration of the participant's experience with EPIP before deciding to disengage, discussion of reasons for disengagement, exploration of the post-disengagement experience, and feedback and suggestions for EPIP. Recruitment aimed to conclude after 10-15 participants were interviewed for both service user and caregiver groups, with the expectation that data sufficiency would be reached with no new themes being generated. Ultimately, 12 service user and 12 caregiver participants were recruited. There were six pairs of service user and caregiver dyads, where the caregivers interviewed were caring for service users also enrolled in the study. Valuable qualitative insights were gathered, including the type of disengagement, medication compliance during disengagement, the decision-making process behind disengaging, and circumstances surrounding re-engagement. A total of five categories each with subthemes were identified from the reasons for service user disengagement - individual factors, stigma, progression, treatment factors, and external factors. There is a need to narrow down urgent areas of attention, aligning the study themes with established risk factors so that feasible solutions can be developed and appropriate care models can be adopted, to minimise adverse outcomes related to disengagement. It is important to keep an open mind to understand what personal recovery means to the individual service user, so that treatment goals can be better harmonised.

Stres Akademik Siswa Full Day School di SMA N 1 Ampek Angkek

Academic stress is a condition where there is a mismatch between school demands and students' abilities so that students are burdened by various school or academic demands. The reality in the field is that there are students who experience academic stress in following the teaching and learning process at school, plus now many schools have implemented a full day school learning system, which makes students spend more time at school. This study aims to describe the academic stress of full day school students in high school from physical responses, emotional responses and behavioral responses.This type of research is quantitative research with a descriptive approach. This research was conducted at SMA N 1 Ampek Angkek, with a population of 680 students and a sample of 282 students. Data was obtained by providing research instruments in the form of questionnaires to students. The results of the study were processed to find the percentage and then categorized according to the level of academic stress.The results of the study revealed that, first, the academic stress of SMA N 1 Ampek Angkek students was in the moderate category with a percentage of 43%. This means that SMA N 1 Ampek Angkek students have not been able to control the situation or conditions that cause stress related to academics. Second, academic stress of students related to physical responses is in the moderate category, Third, academic stress of high school students related to emotional responses is in the high category. Fourth, academic stress of high school students related to behavioral responses is in the high category. The implications in guidance and counseling services such as providing information services, individual counseling services, group guidance services and group counseling services.

Gender Incongruence in Danish Youth (GenDa): A Protocol for a Retrospective Cohort Study of Danish Children and Adolescents Referred to a National Gender Identity Service

Background/Objectives In recent years, the national Gender Identity Service for individuals under 18 years of age in Denmark has seen a considerable increase in referrals of youngsters during puberty. Given this development, it is important to deepen our understanding of the characteristics of contemporary youngsters seeking help for gender incongruence. This understanding can serve as the foundation for improving current treatment regimens by ensuring optimal individual assessment and care. In this study, we aim to describe the sociodemographic characteristics, health profiles, and treatment trajectories in detail, as well as any changes in these characteristics, of all transgender and gender-diverse youngsters referred to the Gender Identity Service in Denmark from 2016 through 2022. Methods: This is a retrospective observational study of a national cohort comprising all individuals under 18 years of age referred to the Danish Gender Identity Service from 1 January 2016 to 1 January 2023. We will use data from medical records obtained at routine visits from the first assessment through repeated visits. Data on demographics, physical and mental health profiles, and information regarding gender identity will be collected and analyzed. The characteristics of those individuals who progressed to hormone therapy will be compared to those who did not. Results: This study aims to enhance our understanding of the characteristics and needs of contemporary youngsters with gender identity issues. Conclusions: The scientific evidence for the assessment and treatment of gender incongruence in youngsters is limited. The characteristics of youngsters seeking healthcare for gender incongruence today may differ from earlier.

“Knowing and Working With Someone Who Has Made It Means I’m Going to Make It Too”: Experiential Knowledge as a Catalyst for Transformation in Reentry and Beyond

Of the 2.2 million adults incarcerated in the United States, between 600,000 and 700,000 return to society annually. The U.S. federal evaluations reveal over a quarter of these individuals are rearrested within 6 months, while studies in more than 40 states find that close to half are reincarcerated within 3 years. Recidivism rates reveal a pressing need to understand reentry from the perspective of those who have experienced it. This study analyzes interviews with previously incarcerated individuals, identifying four key categories of experiential knowledge: impact of clinical staff, re-entry programming staff, mentors, and founder’s experiences. Experiential knowledge, and understandings acquired through direct personal experience, emerge as pivotal in supporting successful reintegration. The discussion highlights its impact beyond reentry, aligning with individuals’ aspirations to help others. By emphasizing the significance of experiential knowledge, conclusions advocate for its integration into re-entry programs to enhance support and services for justice-involved individuals.

Diabetic Retinopathy Detection with Deep Learning Techniques on Fundus Photographs: A Review

Diabetic retinopathy (DR) is an ocular condition that can affect individuals with diabetes mellitus (DM) and may lead to reduced vision or even blindness if not detected on time. Delay in diagnosis and disagreement in interpretation of retinal images by different health experts are some of the challenges that can occur during screening for DR. Deep learning (DL) techniques are currently used for classification of images across various domains including the ophthalmic imaging field. The implementation of this cutting edge technology for detection of DR could lead to improvement of existing eye care services for diabetic individuals. This paper discussed the publicly available datasets of retinal images of diabetic individuals used for training DL models. The efficiency of several convolutional neural networks (CNNs) created for the detection of different classes of DR was also reviewed. Furthermore, the achievements and the challenges faced in the application of DL techniques for the DR detection were discussed. Finally, future works that can be performed in this research area has been suggested.

Impact of land use/land cover (LU/LC) changes on ecosystem service values in Muger Sub-basin, Upper Blue Nile Basin, Ethiopia

This study was conducted to estimate the impact of land use/land cover (LULC) changes on the ecosystem service value (ESV) in the Upper Blue Nile basin over three-decade (1986–2020). The findings revealed that there is a decline in total ESV from US$ 492.77 × 106 in 1986 to US$ 400.65 × 106 for the year 2020. The ESV lost between 1986 and 2020 was about US$ 92.11 × 106. In terms of the individual ecosystem services, the contribution of all service values declined except food production and biological control. Among the major contributors of ESVs, food production, water regulation, erosion control, climate regulation, nutrient cycling, waste treatment, and water supply represent 89%, 88%, 86% in 1986, 2003, and 2020, respectively. Soil erosion and sediment transport under environmental pressure significantly contributed for the loss of ecosystem services (ES) in the sub-basin. In addition, FGD and KII ranked provisioning ecosystem services first in order of importance for communities in the study area. Therefore, it is important to pay attention to the sustainable conservation and restoration of natural resources through natural vegetation protection, enhanced vegetation cover, conservation practices and wetland management to enhance the natural capital and ecosystem services in the Muger Sub-basin.

Children and Youth with Special Health Care Needs: Progress Towards More Family-Centered Systems of Care.

Children and youth with special health care needs have increasingly been included in community and society over the past 50 years. Changing definitions and programs in the education, health, and public health/Title V sectors document this greater inclusion. The most profound change was in the education system, with the passage of legislative mandates for inclusion and parental rights. Although the health system has no similar universal mandate, the sequential passage of Medicaid, Children's Health Insurance Plan, and the Patient Protection and Affordable Care Act led to expanded health care coverage with no pre-existing conditions and lifetime caps. Title V of the Social Security Act, originally passed in 1935, evolved from a focus on individual medical services to a public health systems approach focusing on building family-centered, coordinated, comprehensive care in community settings. Most of the changes in all the sectors are the result of the advocacy and engagement of parents and families; the Maternal and Child Health Bureau was a supportive and innovative leader for family-professional partnerships. Much work on understanding disparities across the sectors has led to more recent focus on equity.

Implementasi Program Bimbingan Karir dalam Kurikulum Merdeka Belajar di SMKN 3 Madiun

Aditya Yudha Wicaksono: "Implementation of the Career Guidance Program in the Independent Learning Curriculum at SMKN 3 Madiun". Thesis. Jakarta: Guidance and Counseling Study Program, Faculty of Teacher Training and Education, University of PGRI Madiun, 2024. This study aims to find out the first, to find out the level of student career planning when the career guidance program is in the independent learning curriculum, the second is whether there is a difference after being given a career guidance program in the independent learning curriculum. This research is a descriptive qualitative research. The subjects of this study included school principals, deputy principals for curriculum, vice principals for student affairs, counseling teachers and students at SMKN 3 Madiun. Data collection methods used are observation, interviews, and documentation. From the results of this study it can be seen First; The implementation of the counseling program at SMKN 3 Madiun is quite good. Judging from the implementation of information services where the teacher always provides information about the world of work and the industrial world, the counseling teacher always provides counseling services to their students through class hours determined by the classical service method, the counseling teacher is also ready to provide individual counseling services when there are students who experience problems. . Second; The implementation of the Merdeka Curriculum at SMKN 3 Madiun was carried out well. Judging from the curriculum program that has been implemented and compiled by several teachers, it is sufficient to facilitate the implementation of learning for teachers and streamline learning or material provided to students. Supporting factors for the implementation of student career planning are categorized as quite good, schools always support the implementation of student career planning by carrying out several activities such as EduFair or JobFair to determine student career plans whether they want to continue on to higher education or the world of work.

1.O. Scientific session: Trans & Gender-Diverse Individuals’ Mental & Behavioral Health Risks & Intervention Needs

Abstract Transgender and gender-diverse (TGD) individuals are at a greater risk for various poor mental and behavioral health outcomes than cisgender individuals, including higher rates of suicide, psychiatric diagnoses, and behavioral health problems. For example, research has documented a seven-fold increased risk for lifetime suicide attempts among young TGD people, compared with the general population. Less is known about the age of onset of such mental and behavioral health disparities and how these disparities may vary across other intersectional socio-demographic variables. It has been well-documented that trans and gender-diverse individuals often encounter discrimination and transphobia across various social, educational, professional, administrative, and healthcare settings. This discrimination, as highlighted in the literature, frequently poses obstacles to accessing both general and trans-specific healthcare services due to experiences of discrimination (e.g., misgendering, refusal of care, lack of adequate services). The right and ability to self-determine and the accessibility to gender-affirming care without discrimination are key to closing the gap in TGD individuals’ mental and behavioral health outcomes, and for them to live authentically and thrive. Tailored and affirming mental and behavioral health interventions to reduce these health inequities are pivotal for TGD individuals to achieve the highest attainable standard of physical and mental health: a key fundamental human right. Considerable gaps in the literature remain concerning the onset and determinants of gender identity-based health disparities and healthcare approaches that are respectful, inclusive, non-pathologizing, and grounded in human rights principles for TGD individuals. This workshop intends to address these knowledge gaps by delving into the mental and behavioral health needs of TGD individuals. The workshop seeks to further foster dialogue on strategies to overcome resistance to implementing approaches that uphold the human rights and well-being of these communities. Dr. Richard Bränström (Karolinska Institutet) will present a study that explores the age at which gender identity-based disparities in psychiatric diagnoses and treatment can be first identified. Dr. Gonzales (Vanderbilt University) will examine disparities in mental health and social determinants of health among TGD individuals with private insurance. Dr. Moleiro (Lisbon University Institute) will review TGD persons’ ways of identifying with the choices and trajectories in social, legal, and affirmative healthcare processes in Portugal. Dr. Lelutiu-Weinberger (Columbia University School of Nursing) will present findings from a study that assessed tobacco use and cessation attitudes, facilitators, and barriers to quitting, and intervention components and delivery modality acceptability among TGD individuals, as well as sexual minority individuals, in Romania to inform a tailored and affirming smoking cessation intervention. Key messages • Transgender and gender-diverse are at increased risk for a variety of poor mental and behavioral health compared with the general public. • There is a critical need to foster healthcare services for transgender and gender-diverse individuals that are tailored and affirming.

JA ImpleMENTAL Implementing the Belgian Best Practice on Community Mental Health system Reform

Abstract Mental health challenges affect more than one in six people across the EU. In order to support Member States to proceed with mental health care system transformation and suicide prevention JA ImpleMENTAL, was initiated on the request of Member States, on October 2021 under the European Union 3rd Health Program. The JA consists of 39 organizations from 21 countries, more than 180 persons are working. Two advisory bodies support the consortium and provide their insights and expertise, a stakeholder forum with 10 key European Organizations in Mental Health including EUPHA Mental Health Section and WHO Europe and OECD, and the Member State Policy Committee which ensures the involvement of ministries and enables the practices to be embedded in health systems. Within the 11 countries implementing pilots under the Belgium model using a common Implementation Strategy, a total 163 activities are implemented under the 5 following key areas: 62 on structural measures needed for the establishment of local networks promoting a user’s centered, human’s right based recovery approach, 43 for the development and/or transformation of mental health services, 22 on training & capacity building in support of the reform and cultural change, 22 on continuous communication, information and awareness raising, and 13 on data collection, monitoring and evaluation. An analysis of MS pilot action plans shows that most service transformation efforts have concentrated on: defining care pathways for people at risk and for those with mild to severe mental health conditions including smooth transition from child and adolescent to Adult Mental Health services, as well as from inpatient to community services, the nomination of case managers for assisting individuals to their recovery process the development of individual service plans, the Involvement of users in various layers of service delivery including peer support and the provision of assertive treatment through mobile units.

Gambaran Kecenderungan Perilaku Self Injury pada Siswa SMP

This research is motivated by the phenomenon of junior high school students who have difficulty channeling negative emotions when facing problems. Self-injury behavior will have a negative impact on students, therefore students are expected to be able to carry out positive activities to vent their negative emotions. The objectives of this study are (1) to describe the tendency of students' self-injury behavior, (2) to describe the tendency of students' self-injury behavior from the environmental dimension, (3) to describe the tendency of students' self-injury behavior from the biological dimension, (4) to describe the tendency of students' self-injury behavior from the cognitive dimension, (5) to describe the tendency of students' self-injury behavior from the affective dimension and (6) to describe the tendency of students' self-injury behavior from the behavioral dimension. The method used is quantitative descriptive, with a sample of 49 students and the instrument used is a self-injury behavior tendency instrument with a Likert scale. The results of the study showed that: (1) the tendency of self-injury behavior in students as a whole is in the moderate category (56.44%), (2) the tendency of self-injury behavior in students from the environmental dimension is in the moderate category (55.10%), (3) the tendency of self-injury behavior in students from the biological dimension is in the moderate category (61.22%), (4) the tendency of self-injury behavior in students from the cognitive dimension is in the low category (48.98%), (5) the tendency of self-injury behavior in students from the affective dimension is in the moderate category (42.86%) and (6) the tendency of self-injury behavior in students from the behavioral dimension is in the moderate category (46.94%). Based on the results of this study, it is recommended that guidance and counseling teachers provide services to reduce the tendency of self-injury behavior in students in the form of information services, individual counseling services, group counseling services and group guidance services.

Sistem Layanan Metrologi Legal Terpusat Berbasis Web

The development of information technology, especially in data management, can have a significant impact on improving efficiency and effectiveness in legal metrology services. Technological transformation not only changes how information is obtained but also fundamentally alters service systems for the public. A centralized web-based Legal Metrology Service System is being developed to streamline administrative data management and enhance services for individuals applying for metrological calibration and re-verification. Therefore, this system is designed using the waterfall method, ensuring each development stage, from needs analysis to implementation and maintenance, is conducted in a structured and systematic manner. The primary objective of this research is to improve the quality of calibration and re-verification services in Legal Metrology at the Office of Trade and Industry in Jombang Regency. With this system in place, it is expected that administrative processes and data management in legal metrology will operate more effectively and efficiently, thereby delivering better services to the public.

Exploring the impact of population agglomeration on ecosystem services: an empirical study based on Fenhe River Basin

Abstract Since the 21st century, cities have experienced rapid expansion, posing serious threats to the health of non-urban ecosystems. It is generally believed that continued urbanization will put increasing pressure on ecosystems. However, in recent decades, the degree of population agglomeration and ecological environment have simultaneously increased in China. This paper takes Fenhe River Basin as the study area, measures the spatial Gini coefficient of population distribution (Gini) and ecosystem services in 165 sub-basins from 2000 to 2020, and adopts two-way fixed effects model to study the impacts of population agglomeration on ecosystem services and its mechanism. The results show that population agglomeration is positively correlated with the overall benefit (OB) of ecosystem services, and the effect is moderated by vegetation coverage, slope and distance from market centre, only when the values are greater than 0.198, less than 6.62° and 17.90 km, respectively, will the positive effects become apparent. The phenomenon of ‘people withdrawing and vegetation entering’ makes population agglomeration have significant impacts on individual ecosystem services and trade-offs and synergies. In order to give better play to the positive effect, the population needs to migrate from areas with worse geographical conditions and farther away from market centres to better places, and the return of farmland to forests should be accelerated in areas with population concentration. Following the laws of nature to promote population agglomeration and vegetation restoration, so as to achieve a ‘win–win’ situation between economic development and ecological civilization construction through the optimization of resource allocation.

Predictors of Outpatient and Inpatient Service Utilization Among Publicly-Insured Youth With Eating Disorders.

Although eating disorders (EDs) affect youth from all socioeconomic backgrounds, little is known about the treatment experiences of under-resourced youth with EDs. To address this gap, we examined patterns of outpatient and inpatient service utilization among publicly-insured youth with EDs in California and potential disparities for youth with additional marginalized identities. Participants were identified from the full sample of California Medicaid/Medi-Cal beneficiaries aged 7-18 with ≥ 1 service episode between January 1, 2014 and December 31, 2016. Claims data were extracted for youth with a full year of claims after the first known ED diagnosis (N = 3311) to analyze outpatient mental health, outpatient medical/physical, inpatient mental health, and inpatient medical/physical service use across ED diagnosis and demographic characteristics (sex, age, race/ethnicity, and preferred language). Outpatient individual and family therapy service utilization was low across ED diagnoses (4-7 individual therapy sessions and ≈5 family therapy sessions annually). Conversely, hospitalization rates were high, particularly among youth with anorexia nervosa (27.8%) and bulimia nervosa (30.0%). Youth with other specified feeding or ED had high medical service utilization, with more days of outpatient medical care and greater odds of medical hospitalization than youth with all other diagnoses. Latinx youth, Black youth, and boys tended to receive fewer services after accounting for diagnosis, with disparities particularly pronounced for Latinx youth. Publicly-insured youth with EDs in California experience high hospitalization rates but receive limited outpatient therapy. Additional research is needed to identify possible unmet needs and factors contributing to treatment disparities among these youth.