Care Infrastructure Research Articles

Abortion Rights Without Law: A Constitutional Reflection

Abortion rights in Canada seem both too small and too big for law, or perhaps we only think so because of how we think about law, which confirms the view that we are better off without it. Maybe then we should ask a different question: is there an abortion rights law to which we would say yes? Can we imagine a statutory scheme, or, more provocatively, a legislative package, with a radically reimagined role for the state and its power? Could law assemble the diverse experiences of abortion into something material rather than abstract? Could law create a care infrastructure to support people in all their reproductive decisions and throughout their reproductive lives: the right to end a pregnancy, the right to continue one, and the right to parent your child in a safe and healthy environment? Wouldn’t we say yes to a law that holds space for this political future? In Canada, this is no speculative imagination. Our Supreme Court accepts that constitutional futures can take shape in innovative laws that affirm and reach ahead to our political aspirations. We need only make them.

Effectiveness and Cost-Effectiveness of Survivorship Care for Survivors of Hodgkin Lymphoma (INSIGHT Study): Protocol for a Multicenter Retrospective Cohort Study With a Quasi-Experimental Design.

Hodgkin lymphoma (HL) occurs at young ages, with the highest incidence between 20 and 40 years. While cure rates have improved to 80%-90% over the past decades, survivors of HL are at substantial risk of late treatment-related complications, such as cardiovascular diseases, breast cancer, severe infections, and hypothyroidism. To reduce morbidity and mortality from late treatment effects, the Dutch Better care after lymphoma, Evaluation of long-term Treatment Effects and screening Recommendations (BETER) consortium developed a survivorship care program for 5-year survivors of HL that includes risk-based screening for and treatment of (risk factors for) late adverse events. Even though several cancer survivorship care programs have been established worldwide, there is a lack of knowledge about their effectiveness in clinical practice. The Improving Nationwide Survivorship care Infrastructure and Guidelines after Hodgkin lymphoma Treatment (INSIGHT) study evaluates whether Dutch BETER survivorship care for survivors of HL decreases survivors' burden of disease from late adverse events after HL treatment and associated health care costs and improves their quality of life. The INSIGHT study is a multicenter retrospective cohort study with a quasi-experimental design and prospective follow-up, embedded in the national BETER survivorship care infrastructure. The first BETER clinics started in 2013-2016 and several other centers started or will start BETER clinics in 2019-2024. This allows us to compare survivors who did and those who did not receive BETER survivorship care in the last decade. Survivors in the intervention group are matched to controls (n=450 per group) based on sex, age at diagnosis (±5 years), age in 2013 (±5 years), and treatment characteristics. The primary outcome is the burden of disease in disability-adjusted life years from cardiovascular disease, breast cancer, severe infections, and hypothyroidism. In a cost-effectiveness analysis, we will assess the cost of BETER survivorship care per averted or gained disability-adjusted life year and quality-adjusted life year. Secondary outcomes are BETER clinic attendance, adherence to screening guidelines, and knowledge and distress about late effects among survivors of HL. Study data are collected from a survivor survey, a general practitioner survey, medical records, and through linkages with national disease registries. The study was funded in November 2020 and approved by the institutional review board of the Netherlands Cancer Institute in July 2021. We expect to finalize recruitment by October 2024, data collection by early 2025, and data analysis by May 2025. INSIGHT is the first evaluation of a comprehensive survivorship program using real-world data; it will result in new information on the (cost-)effectiveness of survivorship care in survivors of HL in clinical practice. The results of this study will be used to improve the BETER program where necessary and contribute to more effective evidence-based long-term survivorship care for lymphoma survivors. PRR1-10.2196/55601.

СТАН НАУКОВОГО ДОСЛІДЖЕННЯ ЗЛОЧИННОСТІ У СІМЕЙНІЙ СФЕРІ

The article reveals the need to study crime in the family sphere in the works of Ukrainian scientists. This can be explained by the fact that it is criminological science that investigates such crime as a system with exceptionally complex types of criminal offenses committed by the offender during their common life. So, there is a significant need for a scientifically based and comprehensive analysis of this crime and the development of effective forms and methods of its prevention, because the family is constantly in social relations with the state and its institutions. These relationships are based on social ties that unite people into a functional whole, while creating equality and inequality in the rights and obligations not only of spouses, but also within the social group of society. It was noted that among the criminological problems of crime in the family sphere in Ukraine, the problem of domestic crime, which in most cases was and remains the most latent among other criminal offenses, became the agenda. And therefore, recognizing the family as the center of society, it should be noted that without the support of the state and its institutions, unfortunately, the problem of crime in the family sphere is almost impossible to solve. And this is due to the fact that the family is not always able to fulfill its main function – ensuring the proper well-being and upbringing of children. History shows that the main types of crime in the family sphere are: domestic, economic, psychological, sexual and physical violence. Taking into account that there is a war in Ukraine, the problem of criminalization in the family sphere takes on special importance, and we consider it as an object of criminal offenses committed by the offender. The consequence of this is the divorce of husband and wife, a decrease in the standard of living of children, their lack of protection, poverty, and the weakening of the infrastructure of health care, education and culture. Key words: criminal offenses in the family sphere, offender, family violence, marital conflict.

Incremental housing as care infrastructure: transformations in low-income housing in Alto Hospicio, Chile

The discussion regarding the relationship between housing and care within the general field of housing studies has generated a broadening of the field in many ways. One of such is the reciprocal relationship between the numerous forms of housing transformation and care, particularly for low-income communities in the Global South. We suggest that the main drive to transform housing incrementally is care. Following the work of Power and Mee (2019), we consider housing as an infrastructure of care and therefore, the incremental transformation of housing as part of a set of practices, which produce a sociomaterial assemblage that is constitutive of care. Under these practices, not only does housing pattern care relations, but care relations also pattern housing and therefore housing transformations. This relational way of seeing housing and care is increasingly relevant in the implementation of housing transformation programmes and policies, as this would impact incremental housing design, programme, operation, funding, and implementations, particularly in the context of an increasing incorporation of multiple alternatives of housing transformation and improvement in public housing in the Global South. We show this through ethnographic work on housing transformation for care purposes in the city of Alto Hospicio, Chile.

Automating adult social care in the UK: Extracting value from a crisis

The UK appears fixed in perpetual care crisis propelled by austerity-driven funding cuts and the country’s intensifying care labour shortage. Austerity in the UK has generated an operating environment that has accelerated privatisation and incentivized and necessitated private innovation. In this writing, we examine how the infrastructure and delivery of social care in the UK is being radically reimagined through technology. Promising to deliver critical efficiencies and cost savings, new automating technologies are being tested and introduced to reorder how and where care is managed and delivered. Drawing on a series of interviews conducted with local authorities in the UK and the executives of private companies, our task is not to assess the efficacy of new technologies; rather we examine how these public-private partnerships raise difficult questions: Who will deliver caring futures in the UK? Who is absorbing the fiscal risk of technological innovation? Who is profiting? And what are the limits of technology as a response to our care crisis?

Social Reproduction Under Lockdown: Capital, Labor, and Gender

This article argues that the pandemic-related growth of the gendered burden of care work in the Global North ought to be understood as symptomatic of the entangled contradictions between capitalist accumulation and social reproduction, on the one hand, and between value-production and wealth-creation, on the other. The article addresses whether social reproductive labor produces value. The article, moreover, shows that pandemic-induced lockdowns have extended crises of social reproduction to relatively privileged middle-class households in OECD countries and particularly the US. The article argues that efforts to improve the conditions of reproductive work must move beyond proposals for a more equitable distribution of care work and the expansion of care infrastructure. HIGHLIGHTS Social reproduction is integral to capitalism but also points beyond capitalism. Marxian value-critique helps us better understand social reproduction. The COVID-19 pandemic extended crises of social reproduction to more households. The pandemic showed the need for radical solutions to crises of social reproduction. Redistributing reproductive labor and/or expanding public services is not enough. Wealth-production must be liberated from the capitalist value-form.

Caring at the edges: Infrastructures of care and repair in urban deprivation

Care is an activity vital to making the world liveable. Alternative infrastructures of care have emerged that re-centre care and repair within everyday life. These infrastructures often require more care to address care deficits and repair the social fabric of society; however, insights are limited as to the implications of demands on people and the places they reside for such extra care. Through an ethnographic study of a community food hub in an area of entrenched deprivation, we examine how an alternative infrastructure of care is built in practice. We demonstrate how care unfolds expansively across people and place to (reactively) repair care deficits and (proactively) generate new care relations. We contribute to the complexity of care theorising by revealing the challenges of care provision that stem from a position of necessity and repair. We offer a critical discussion of alternative infrastructures of care that simultaneously recognises the opportunities for hope, whilst acknowledging their limits.

Demographical and Epidemiological Contribution to Cancer Incidence in Delhi and Its Trends from 1991-2015.

Cancer incidences are rising worldwide, and India ranked third globally in cancer incidence as of 2020, according to estimates from GLOBOCAN. The three components that contributed to changes in cancer incidence include cancer-related risk factors, population size, and population structure. The present study aim is to derive the contribution of these factors to cancer incidence and to evaluate their trend from 1991 to 2015. The Data were extracted from the Delhi population-based cancer registry published reports. This longstanding registry covers nearly 100% of the Delhi population. The secular trends of cancer incidence from 1991-2015 were assessed for all sites combined as well as top-five cancer sites among males and females. Joinpoint regression and Riskdiff software were performed to assess the trend among the components of cancer incidence change. Both males and females exhibited nearly equal age-standardised incidence rates over 25 years. Albeit, an overall trend in age-standardised rate was not significant for both sexes (0.68% for males and -0.16% for females) when considering all cancer sites combined. Lung, prostate, oral, and gallbladder cancer exhibits a significant rising trend in the age-standardised rates in males while in females only breast and endometrial cancer showed a rising trend. The cancer counts surged by 252% in males and 208.5% in females from 1991 to 2015. The population size component contributed a 180% increase in males and a 170% increase in females, respectively. The site-specific risk changes were more than 100% for the prostate, oral, and gallbladder cancers in males and endometrial cancer in females. The population structure (aging) contributed to rising cancer incidence varying from 35% to 60% in both genders. A significant contribution to new cancer cases was observed due to a demographical shift in both population size and structure, in addition to plausible cancer-specific risk factors. This transformation could surge a potential burden on the Delhi healthcare system. Persistent endeavours are essential to expand and enhance the existing cancer care infrastructure to meet the rising demand driven by aging and population growth. Implementing a stringent population policy can help to mitigate the impact of population growth on cancer incidence.

Rheumatic Diseases Amidst Conflict in Northwest Syria: Unveiling Health Challenges and Implications

Abstract Background The ongoing conflict in Syria has significantly affected the health care system, particularly in the realm of rheumatology. The purpose of this study is to assess the current state of rheumatic diseases in the northwestern region of Syria, where the health care infrastructure has been severely impacted. Methods This was a retrospective study reviewing all patients with rheumatologic conditions seen in internal medicine clinics in northwest Syria between September 2019 and February 2022. Baseline demographic data and diagnoses were collected retrospectively, without any data duplication, from outpatient clinic records. The study also reviewed the availability of investigations and drugs in the northwestern region of Syria. Results We analyzed data from 488 patients (average age: 37.4; 63% female) diagnosed with rheumatic diseases. The most prevalent condition was connective tissue disorders (25.6%), with osteoarthritis (12.1%) and rheumatoid arthritis (8.2%) following. The ongoing conflict has led to a significant shortage of rheumatologists, with only three serving a population of 5.5 million. Furthermore, the conflict has disrupted the provision and quality of rheumatology diagnostic tests, reducing patient accessibility. The dearth of medications and increased costs have compounded the complexity of health care for those with rheumatic diseases. Conclusions This study highlights the urgent need for improved health care services and proposes solutions to address gaps in rheumatic care in northwest Syria.

How Should We Draw on Pharmacists' Expertise to Manage Drug Shortages in Hospitals?

This article argues that drug shortages should be addressed as crises that exacerbate already compromised US health care infrastructure. Clinicians, especially pharmacists, can help limit threats that shortages pose to patients. For example, pharmacists can canvass procurement options, consolidate inventory, and prepare medications to prevent need for some clinical interventions. This article describes how pharmacists' preparation and training equip them to help clinical teams navigate shortages by equitably rationing limited medicines, suggesting appropriate therapeutic alternatives, modifying drug administration routes, or delaying interventions. Pharmacists' roles can be key, since good management of supplies during drug shortages can mitigate risk of worse-than-usual clinical outcomes, mitigate risk of medication errors, and reduce some financial burdens on the overall health care system.

The role of stroke care infrastructure on the effectiveness of a hub-and-spoke telestroke model in South Carolina

ObjectiveTo examine the relationship between stroke care infrastructure and stroke quality-of-care outcomes at 29 spoke hospitals participating in the Medical University of South Carolina (MUSC) hub-and-spoke telestroke network. Materials and methodsEncounter-level data from MUSC's telestroke patient registry were filtered to include encounters during 2015-2022 for patients aged 18 and above with a clinical diagnosis of acute ischemic stroke, and who received intravenous tissue plasminogen activator. Unadjusted and adjusted generalized estimating equations assessed associations between time-related stroke quality-of-care metrics captured during the encounter and the existence of the two components of stroke care infrastructure—stroke coordinators and stroke center certifications—across all hospitals and within hospital subgroups defined by size and rurality. ResultsTelestroke encounters at spoke hospitals with stroke coordinators and stroke center certifications were associated with shorter door-to-needle (DTN) times (60.9 min for hospitals with both components and 57.3 min for hospitals with one, vs. 81.2 min for hospitals with neither component, p <.001). Similar patterns were observed for the percentage of encounters with DTN time of ≤60 min (63.8% and 68.9% vs. 32.0%, p <.001) and ≤45 min (34.0% and 38.4% vs. 8.42%, p <.001). Associations were similar for other metrics (e.g., door-to-registration time), and were stronger for smaller (vs. larger) hospitals and rural (vs. urban) hospitals. ConclusionsStroke coordinators or stroke center certifications may be important for stroke quality of care, especially at spoke hospitals with limited resources or in rural areas.

Understanding Gender Disparities in Caregiving, Stress, and Perceptions of Institutional Support among Faculty during the COVID-19 Pandemic

The loss of the care infrastructure that occurred during the COVID-19 crisis exposed society’s continued reliance on women and mothers as default caregivers. But less is known about how this crisis produced gendered mental health outcomes, especially in occupations characterized by intensive work cultures such as academia. Drawing on quantitative and qualitative responses from a May 2021 campus-wide survey of faculty at a large research university in the United States, we explore gendered patterns in faculty caregivers’ time use, stress, and perceptions of institutional support. Our findings demonstrate that childcare responsibilities were not merely more substantial for women than men in terms of hours, but they were also qualitatively different, with women’s hours being more unpredictable, interruptive, and mentally and emotionally demanding. We also show that the pandemic took a higher toll on women faculty’s mental health compared to men’s. This gap in mental health emerged not merely because women were spending more time caregiving on average, but also because the university’s policies did not effectively support the most strained caregivers. This study contributes empirical evidence to research on academic caregivers during the pandemic and to work demonstrating how (1) gendered caregiving dynamics shape mental health and remote work experiences and (2) the reliance on individual solutions to balancing work and family has failed even relatively privileged workers.

Is Primary Care Adapting to Medicaid Managed Care in North Carolina? Implications for Expansion and Future Managed Care Transitions.

Realizing North Carolina's comprehensive vision for Medicaid transformation requires strengthening the state's primary care infrastructure. This can be done by build-ing upon the value-based care incentives in the Advanced Medical Home model, strengthening payor data, aligning quality measures, easing administrative burdens, investing in primary care and its workforce pipeline, and ensuring pay-ment models adequately support serving Medicaid expan-sion and the growing number of Medicaid health plans.

Improving rural intensive care infrastructure in the USA

Improving rural intensive care infrastructure in the USA

Generative AI in Medical Practice: In-Depth Exploration of Privacy and Security Challenges.

As advances in artificial intelligence (AI) continue to transform and revolutionize the field of medicine, understanding the potential uses of generative AI in health care becomes increasingly important. Generative AI, including models such as generative adversarial networks and large language models, shows promise in transforming medical diagnostics, research, treatment planning, and patient care. However, these data-intensive systems pose new threats to protected health information. This Viewpoint paper aims to explore various categories of generative AI in health care, including medical diagnostics, drug discovery, virtual health assistants, medical research, and clinical decision support, while identifying security and privacy threats within each phase of the life cycle of such systems (ie, data collection, model development, and implementation phases). The objectives of this study were to analyze the current state of generative AI in health care, identify opportunities and privacy and security challenges posed by integrating these technologies into existing health care infrastructure, and propose strategies for mitigating security and privacy risks. This study highlights the importance of addressing the security and privacy threats associated with generative AI in health care to ensure the safe and effective use of these systems. The findings of this study can inform the development of future generative AI systems in health care and help health care organizations better understand the potential benefits and risks associated with these systems. By examining the use cases and benefits of generative AI across diverse domains within health care, this paper contributes to theoretical discussions surrounding AI ethics, security vulnerabilities, and data privacy regulations. In addition, this study provides practical insights for stakeholders looking to adopt generative AI solutions within their organizations.

Data analysis based on COVID-19Important factors in the COVID-19 outbreak

Data analysis based on COVID-19Important factors in the COVID-19 outbreak

2024 Watch List: Top 10 Technologies and Issues Related to Caring for Children and Youth With Medical Complexity

What Is the 2024 Watch List?&#x0D; &#x0D; The Watch List annual Horizon Scan report presents emerging technologies and issues that have the potential to shape the future of health care in Canada.&#x0D; CADTH’s 2024 Watch List focuses on care for children and youth with medical complexity. This top 10 has been divided in 2 parts — the top 5 technologies and top 5 issues related to children and youth with medical complexity that have the potential to make a significant and meaningful impact in transforming health systems in Canada over the next 5 years. These technologies and issues could shape the future of health care for not only children and youth with medical complexity, but also for others with chronic health conditions.&#x0D; &#x0D; Why Is This an Issue?&#x0D; &#x0D; Children and youth (people aged 24 years and younger) with medical complexity are a diverse group with a range of needs (e.g., single or multiple conditions, rare diseases). Although there is no single definition, common characteristics include significant functional limitations often causing the child or youth to be reliant on technology; high health care utilization, often requiring specialized care and services from different providers in multiple settings; and high health care service needs, such as care provision in the home and care coordination, which can have significant social and financial impacts on caregivers and the family.&#x0D; Children and youth with medical complexity account for less than 1% of all children and youth in Canada, but they account for 37% of hospital stays and 17% of emergency department visits. Due in part to the high number of health care interactions, this group experiences the effects of challenges within the health care system more acutely than their less medically complex peers.&#x0D; &#x0D; What Is the Potential Impact?&#x0D; &#x0D; The Watch List highlights areas for innovation, systems change, and investment.&#x0D; Advances in medical care have resulted in more children living with conditions that previously would not have been survivable in infancy and childhood. Now there are more children and youth with medical complexity, and they are living longer. Our current health systems were not designed to meet the complex needs of this group of people and their caregivers, including that many of them face challenges in accessing needed care. This year’s Watch List spotlights new and emerging technologies and key issues that could have a major impact on how patient care is provided to children and youth with medical complexity.&#x0D; &#x0D; What Else Do We Need to Know?&#x0D; &#x0D; In the 2024 Watch List, we identify and describe the top 5 new and emerging technologies that could shape the future of health care for children and youth with medical complexity in Canada, including new models of care and technologies and systems to improve communication. We also explore some considerations for health care decision-makers about the potential impact of these technologies on care pathways, health care human resources, health care infrastructure, and health equity.&#x0D; The 2024 Watch List also identifies the top 5 issues that limit health systems from providing optimal quality of care for children and youth with medical complexity. Key issues such as the need for increased interoperability between health systems and the need for strategies to improve sustainability warrant more attention and will influence the wider adoption, diffusion, and implementation of new and emerging technologies for children and youth with medical complexity.&#x0D; Monitoring ongoing developments and evidence related to the top technologies and issues highlighted in the 2024 Watch List can help guide health system planning in Canada and improve access to high-quality care.&#x0D;

National Rural Health Mission reforms in light of decentralised planning in Kerala, India: a realist analysis of data from three witness seminars

BackgroundThe People’s Planning Campaign (PPC) in the southern Indian state of Kerala started in 1996, following which the state devolved functions, finances, and functionaries to Local Self-Governments (LSGs). The erstwhile National Rural Health Mission (NRHM), subsequently renamed the National Health Mission (NHM) was a large-scale, national architectural health reform launched in 2005. How decentralisation and NRHM interacted and played out at the ground level is understudied. Our study aimed to fill this gap, privileging the voices and perspectives of those directly involved with this history.MethodsWe employed the Witness Seminar (WS), an oral history technique where witnesses to history together reminisce about historical events and their significance as a matter of public record. Three virtual WS comprised of 23 participants (involved with the PPC, N(R)HM, civil society, and the health department) were held from June to Sept 2021. Inductive thematic analysis of transcripts was carried out by four researchers using ATLAS. ti 9. WS transcripts were analyzed using a realist approach, meaning we identified Contexts, Mechanisms, and Outcomes (CMO) characterising NRHM health reform in the state as they related to decentralised planning.ResultsTwo CMO configurations were identified, In the first one, witnesses reflected that decentralisation reforms empowered LSGs, democratised health planning, brought values alignment among health system actors, and equipped communities with the tools to identify local problems and solutions. Innovation in the health sector by LSGs was nurtured and incentivised with selected programs being scaled up through N(R)HM. The synergy of the decentralised planning process and N(R)HM improved health infrastructure, human resources and quality of care delivered by the state health system. The second configuration suggested that community action for health was reanimated in the context of the emergence of climate change-induced disasters and communicable diseases. In the long run, N(R)HM’s frontline health workers, ASHAs, emerged as leaders in LSGs.ConclusionThe synergy between decentralised health planning and N(R)HM has significantly shaped and impacted the health sector, leading to innovative and inclusive programs that respond to local health needs and improved health system infrastructure. However, centralised health planning still belies the ethos and imperative of decentralisation – these contradictions may vex progress going forward and warrant further study.

A case of co-infection with head lice and varicella in a child: considerations for rational management

A case of co-infection with head lice and varicella in a child: considerations for rational management

Private health insurance in the United States and Sweden: A comparative review.

The United States of America and Sweden both contain a public and private component to their healthcare systems. While both countries spend a similar amount per capita on public healthcare expenditures, the United States spends significantly more in the private healthcare sector. Sweden has a social democratic model of health care, and given its identity as a welfare state, private health insurance providers have a small and nuanced role. This paper was completed after searches were queried for "Sweden," "United States," and variants of the words "insurance," "public," "private," "Medicare," "Medicaid," "public," and "costs." A preliminary search in May 2022, yielded 78 articles, of which 45 were ultimately considered relevant for this review. Inclusion criteria consisted of English language articles, topic relevance, and verification of MEDLINE-indexed journals. These searches were performed in PubMed, Google Scholar, Embase, and Cochrane. Summary findings of these searches are compiled in this review. Sweden guarantees low-cost appropriate care to all citizens with equitable access; however, drawbacks of its system include high financial burden, lack of primary care infrastructure, as well as geographical and socioeconomic inequities. On the other hand, the United States' healthcare system is built around the private sector with public health insurance reserved only for the most vulnerable patient populations. Our goal is to provide an overview, compare the role of private health insurance in both countries, and highlight policies that have had beneficial effects in each nation. Possible solutions to the drawbacks of each nation's health insurance policies could be addressed by additional support to Sweden's vulnerable population by developing a program similar to the US' Medicare Advantage program. Conversely, the United States may benefit from increasing access to public health insurance, especially in instances where families face unemployment.