Key Social Factors Research Articles

Synergies and trade-offs among integrated conservation approaches in Mexico.

Integrated conservation approaches (ICAs) are employed by governments, communities, and nongovernmental organizations worldwide seeking to achieve outcomes with dual benefits for biodiversity conservation and poverty alleviation. Although ICAs are frequently implemented concurrently, interactions among ICAs and the synergies or trade-offs that result are rarely considered during program design, implementation, and evaluation. In support of more deliberate and effective use of ICAs, we examined interactions among four well-known strategies: biosphere reserves (BRs), voluntary protected areas (VPAs), payments for ecosystem services (PES), and community forest management (CFM). Through a comparative case study, we analyzed interactions among spatially or temporally clustered ICAs implemented on communally held and managed lands in three ecologically and socioeconomically distinct regions of Mexico. Our research methods combined policy analysis with data gathered through participant observation and semistructured interviews (n = 78) and focus groups (n = 5) with government officials, implementers, and participants involved in ICAs in 28 communities. Despite the significant differences among the regions in which they were implemented, we found that key actors at each level of involvement generally perceived interactions among ICAs as synergistic. The PES programs were perceived to strengthen protected areas by reducing forest cover loss in and around BRs, fostering proconservation attitudes, and incentivizing the establishment of VPAs. Communities that invested PES income in CFM were motivated to conserve forests beyond the duration of PES programs, and CFM in buffer zones was perceived to strengthen BRs by maintaining forest cover and generating income for communities. We also identified key social and environmental factors that can influence these interaction effects among ICAs. Based on these findings, we recommend further study of ICA interactions and intentionally complementary policy design to maximize positive environmental and social outcomes.

Housing Instability, Structural Vulnerability, and Non-Fatal Opioid Overdoses Among People Who Use Heroin in Washington Heights, New York City

Nationally, opioid overdose remains strikingly persistent among people experiencing homelessness and housing instability. Limited information is available about the characteristics of this phenomenon in economically disadvantaged communities of color. This study sought to evaluate the association between key contextual factors and experiencing a non-fatal opioid overdose among people who use heroin in Washington Heights, New York City. We conducted a cross-sectional survey (N = 101) among participants seeking harm reduction services who reported heroin use in the last three months. Binary logistic regression models examined the association between key social and structural factors and the likelihood of ever experiencing a non-fatal opioid overdose and recently experiencing a non-fatal opioid overdose. The majority of the sample reported housing instability and lived in poverty; almost 42% were homeless. After adjustment, participants who injected heroin were more likely to have ever experienced a non-fatal opioid overdose. Also, younger participants who reported hunger in the last six months were more likely to have experienced a non-fatal opioid overdose in the last three months. Findings suggest the role of structural vulnerability in shaping overdose risk among the participants. Overdose prevention strategies should consider factors of the social and economic environment to mitigate barriers to accessing health and social services within the context of the current opioid crisis.

Spatiotemporal analysis of 11 years of Chlamydia trachomatis data from southern China

BackgroundUrogenital Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection (STI) globally. Reviews suggest high and persistently endemic STI epidemics in low and middle income countries. However population-based prevalence estimates in these settings are less common, underscoring the need for analyses of available data to characterize patterns of disease burden. We identified spatio-temporal clusters and key behavioral, social, or environmental factors contribution to transmission in order to inform the prioritization and targeting of evidence based interventions. MethodsUsing 11 years of data (2006–2016) from the chlamydia case report system of Guangdong, China, we identified county level spatio-temporal hot and cold spots using the Getis-Ord Gi* statistic and discrete Poisson models in SaTScan 9.6. We also estimated associations between observed distribution patterns and area-level demographic, social, and economic factors using quasi-Poisson regression models that controlled for annual counts of certified laboratories to account for fluctuations in location-specific detection capacity. FindingsCluster analysis indicates an expanding chlamydia epidemic in Guangdong, with cases clustered in regions of greatest economic activity. Greater male-to-female sex ratio (RR, 3.63; 95% CI, 1.41–9.45) and greater urbanicity (RR, 2.44; 95% CI, 1.98–2.99) were predictive of higher chlamydia case occurrence. InterpretationWe found that chlamydia case occurrence in Guangdong province has been accelerating over the past 11 years and that its expansion is tied to indicators of social and economic development. These estimates not only identify high prevalence regions to target but also areas where data gaps potentially remain. The salience of sex ratios and urbanicity may best be understood through the lens of China's modern history of labor migration which has reshaped the gender dynamics and health access landscape of urban China. Future chlamydia control efforts will require a population-based approach focused on reengaging sexually active adults of diverse economic and migratory backgrounds. FundingThis was an unfunded study using routinely collected public health data.

How \u2018place\u2019 matters for addressing the HIV epidemic: evidence from the HPTN 071 (PopART) cluster-randomised controlled trial in Zambia and South Africa

BackgroundIn a cluster-randomised trial (CRT) of combination HIV prevention (HPTN 071 (PopART)) in 12 Zambian communities and nine South African communities, carried out from 2012 to 2018, the intervention arm A that offered HIV treatment irrespective of CD4 count did not have a significant impact on population level HIV incidence. Intervention arm B, where HIV incidence was reduced by 30%, followed national guidelines that mid trial (2016) changed from starting HIV treatment according to a CD4 threshold of 500 to universal treatment. Using social science data on the 21 communities, we consider how place (community context) might have influenced the primary outcome result.MethodsA social science component documented longitudinally the context of trial communities. Data were collected through rapid qualitative assessment, interviews, group discussions and observations. There were a total of 1547 participants and 1127 observations. Using these data, literature and a series of qualitative analysis steps, we identified key community characteristics of relevance to HIV and triangulated these with HIV community level incidence.ResultsTwo interdependent social factors were relevant to communities’ capability to manage HIV: stability/instability and responsiveness/resistance. Key components of stability were social cohesion; limited social change; a vibrant local economy; better health, education and recreational services; strong institutional presence; established middle-class residents; predictable mobility; and less poverty and crime. Key components of responsiveness were community leadership being open to change, stronger history of HIV initiatives, willingness to take up HIV services, less HIV-related stigma and a supported and enterprising youth population. There was a clear pattern of social factors across arms. Intervention arm A communities were notably more resistant and unstable. Intervention arm B communities were overall more responsive and stable.ConclusionsIn the specific case of the dissonant primary outcome results from the HPTN 071 (PopART) trial, the chance allocation of less stable, less responsive communities to arm A compared to arm B may explain some of the apparently smaller impact of the intervention in arm A. Stability and responsiveness appear to be two key social factors that may be relevant to secular trends in HIV incidence. We advocate for a systematic approach, using these factors as a framework, to community context in CRTs and monitoring HIV prevention efforts.Trial registrationClinicalTrials.gov NCT01900977. Registered on July 17, 2013.

Quantifying Psychopathology in Rapid Readmissions

Psychiatric readmissions contribute to a significant cost and healthcare burden to physicians, hospitals, and the healthcare system as an entity. Furthermore, as part of the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) began to reduce financial coverage to hospitals with overwhelming rehospitalization rates. The purpose of this study was to do a systematic analysis on inpatient psychiatric readmission data and identify co-morbidities and risk factors that lead to high readmission rates. The data collection includes 163 patients with a total of 348 readmissions over the span of 90 days at one inner-city hospital in the Chicagoland area. Study findings suggest that higher rates of readmission are linked to cocaine abuse in both male and female populations. Diagnosis of bipolar in females and schizoaffective disorder in male populations were the among the highest for readmission. Key social factors such as homelessness and low socioeconomic status were identified to contribute to a large proportion of psychiatric readmission burden. However, an overwhelming amount of information was missing due to unobtained labs and lack of current patient social history. By using this data as well as data from electronic medical records (EMRs) to further investigate and identify other features of at-risk patients, hospitals can potentially address these markers to lower readmission rates. Ultimately, a higher understanding of the patients' needs can be understood and can help develop standardized plans of care for prevalent psychiatric illnesses in these populations.

Understanding Urban Land Growth through a Social-Spatial Perspective

To understand the urbanization process, it is essential to detect urban spatial growth and to study relations with social development. In this study, we take Wuhan as a case to examine urban land growth patterns and how social factors relate to the urban land evolution between 1990, 2000, and 2010. We first classify land cover using Landsat images and examine the urban growth patterns during various stages based on landscape metrics regarding the area, density, and shape. Afterwards, principal component analysis and census data are used to extract key social factors. Thirdly, we apply geographically weighted regression (GWR) to depict the link between urban land metrics and social factors. The results indicate that the urban land coalescence and diffusion simultaneously exist, for which redevelopment, infilling, and edge expansion dominate the city center, and diffusion dominates the peripheral areas. The social factors have global regression relationships with urban land areas while local spatial non-stationarity presents in the relationships with the urban land patch shape irregularities. Industrial upgrading, educational levelling up, and population aging show significant with local heterogeneities in the relationships. The simulation of the relationship provides a social-spatial perspective to understand urban land growth. The authors conclude that sustainable urban management should consider the coexistence of different urban spatial growth models and underline social transitions when examining the urban growth process. This works for cities in rapidly urbanizing countries or regions.

The Quality of End-of-Life Care for Women Deceased From Metastatic Breast Cancer.

Metastatic breast cancer (MBC) carries unique disease burdens with potential for poor-quality end-of-life (EOL) care. It is the purpose of this article to explore the association of poor-quality EOL care indicators according to key tumor, demographic, social, and clinical factors. End-of-life quality indicators were based on Emanuel and Emanuel's good death model in conjunction with Earle et al (2003). A single-institution retrospective chart review of women deceased from MBC between November 2016 and November 2019 with double-verification chart review was completed. Data were analyzed with descriptive, correlative, and comparative statistics. Total sample was N = 167 women, with 14.4% (n = 24) Black and 85.6% (n = 143) White. Mean (SD) age was 55.3 (11.73) years. Overall, MBC survival was 3.12 years (SD, 3.31): White women, 41.2 months (3.4 years), and Black women, 19 months (1.6 years). A total of 64.1% (n = 107) experienced 1 or more indicators of poor-quality EOL care. Patients more likely to experience poor-quality EOL care were older (P = .03), estrogen negative (P = .08), human epidermal growth factor receptor 2 negative (P = .07), from more deprived neighborhoods (P = .02), married (P = .05), and with physical (P = .001) and mental (P = .002) comorbidities. Understanding sociodemographic and clinical factors associated with poor EOL MBC care may be useful for proactive patient navigation.

Prevalence, pattern, and probability for goals of care discussions among women diagnosed with metastatic breast cancer.

High quality advanced cancer care includes goals of care (GOC) discussions and should be tailored according to clinical diagnosis, patient characteristics, and in concordance with patient's goals. Metastatic breast cancer (MBC) and treatment has heterogeneity according to subtype which makes the timing of initiating and continuing GOC discussions challenging. With an ever-increasing array of therapy, women with advanced stage disease are unique survivors in that they receive relatively aggressive cancer care to not only palliative symptoms but extend survival time. It is the purpose of this paper to explore the prevalence, pattern, and likelihood of having a GOC discussion according to key tumor, demographic, social, and clinical factors. A single-institution retrospective chart review of women deceased from MBC between November 2016 and November 2019 with double verification chart review was completed. Data were analyzed with descriptive, correlative, and comparative statistics. Total sample was N=167 women, with 14.4% (n=24) Black and 85.6% (n=143) White. Mean age was 55.3 years (SD 11.73). Overall, MBC survival was 3.12 years (SD 3.31), White women 41.2 (3.4 years) months, and Black women 19 (1.6 years) months. A total of 87.4% (n=146) participated in one or more GOC discussions. GOC discussions were more likely among those who were referred to palliative care (p<0.001) and social work (p=0.035) services. Of the GOC discussions, only 29.3% were conducted by the primary oncologist. Black women were more likely to have GOC discussion near death. Advanced stage cancers are treated, at times relatively aggressively, to extend survival time instead of merely offering palliation. This new paradigm of survivorship requires thoughtful integration of GOC conversations. Describing the current status of GOC discussions among a cohort of women deceased from MBC highlights the patients most vulnerable to having a GOC discussion avoided or delayed. These identified vulnerabilities will indicate where targeted interventions can be implemented in the future.

Incidence of Cognitive Impairment during Aging in Rural South Africa: Evidence from HAALSI, 2014 to 2019

Introduction: Despite rapid population aging, there are currently limited data on the incidence of aging-related cognitive impairment in sub-Saharan Africa. We aimed to determine the incidence of cognitive impairment and its distribution across key demographic, social, and health-related factors among older adults in rural South Africa. Methods: Data were from in-person interviews with 3,856 adults aged ≥40 who were free from cognitive impairment at baseline in the population-representative cohort, “Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI), in Agincourt sub-district, Mpumalanga province, South Africa (2014–19). Cognitive impairment was defined as scoring <1.5 standard deviations below the mean of the baseline distribution of orientation and episodic memory scores. Incidence rates and rate ratios for cognitive impairment were estimated according to key demographic, social, and health-related factors, adjusted for age, sex/gender, and country of birth. Results: The incidence of cognitive impairment was 25.7/1,000 person-years (PY; 95% confidence interval [CI]: 23.0–28.8), weighted for mortality (12%) and attrition (6%) over the 3.5-year mean follow-up (range: 1.5–4.8 years). Incidence increased with age, from 8.9/1,000 PY (95% CI: 5.2–16.8) among those aged 40–44 to 93.5/1,000 PY (95% CI: 75.9–116.3) among those aged 80+, and age-specific risks were similar by sex/gender. Incidence was strongly associated with formal education and literacy, as well as marital status, household assets, employment, and alcohol consumption but not with history of smoking, hypertension, stroke, angina, heart attack, diabetes, or prevalent HIV. Conclusions: This study presents some of the first incidence rate estimates for aging-related cognitive impairment in rural South Africa. Social disparities in incident cognitive impairment rates were apparent in patterns similar to those observed in many high-income countries.

Achieving Health Equity by Addressing Legacies of Racial Violence in Public Health Practice

Health equity means that everyone, regardless of their abilities, economic status, or race/ethnicity, has the opportunity to reach their optimal level of health. However, the inequitable distribution of resources, power, and privilege in the United States means that historically marginalized communities bear a disproportionate burden of poor health and disease. The COVID-19 pandemic has compounded the problem for Black Americans: already bearing an unequal burden of social, economic, and health inequities and experiencing systemic racism in various sectors of American life, Black Americans have been at even greater risk of COVID-19 transmission and severity of the disease. I use critical race theory (CRT) to show how key social and historical factors fuel racial health inequities. Further, I use key tenets of CRT to argue that redressing historical legacies of racism cannot be done without using a critical, race conscious lens and lifting up the voices of Black people.

Local perception of watershed degradation in the upper Gibe basin, southwest Ethiopia: implications to sustainable watershed management strategies

ABSTRACT Local perception of watershed degradation is a key social factor that plays a great role for sustainable watershed management strategies. However, there are little efforts in systematically documenting farmers’ perception of watershed degradation in Ethiopia. This study intended to explore farmers’ perception of severity, causes and indicators of watershed degradation across topographic positions – upper, middle and lower, and analyse factors affecting farmers’ perception of watershed degradation in Rebu watershed, southwest Ethiopia. Data were obtained from field observations, group discussions, key informant interviews and household survey. The data obtained were subjected to descriptive and binary logistic regression analysis. The results of the investigation showed that the majority of the households (96.6%) were aware of or perceived watershed degradation as a problem constraining agricultural production in their farmlands and surrounding landscapes. Farmers perceived exposed stone and tree roots, gullies and rills as the major indicators of soil erosion, while decline in crop yields, loss of cultivable land and changes in crop colour were for diminishing soil quality. Cultivation of steeper slopes by clearing vegetation induced by population pressure, overgrazing and land management practices were perceived as the major causes of watershed degradation. Problems of watershed degradation were better perceived in the upper and middle topographic settings and by respective watershed programme participants implying the need for site-specific appropriate watershed management. The majority of respondents (over 75%) also confirmed that they observed a decreasing trend in watershed degradation following the introduction of the watershed management program. Binary logistic regression results indicated that farm land size, topographic settings, extension services, group membership, credit services and the number of livestock owned were significant factors influencing farmers’ perception. Hence, decision makers and planners need to consider location and/or socio economic context-specific conditions to understand watershed degradation and towards restoration activities in a given landscape.

Study protocol for the COvid-19 Toolbox for All IslaNd (CONTAIN) project: A cross-border analysis in Ireland to disentangle psychological, behavioural, media and governmental responses to COVID-19.

COVID-19 represents a serious challenge to governments and healthcare systems. In addition to testing/contact tracing, behavioural and social responses such as handwashing and social distancing or cocooning are effective tools for mitigating the spread of the disease. Psychological (e.g., risk perceptions, self-efficacy) and contextual factors (government, public health messaging, etc.) are likely to drive these behaviours. Collated real-time information of these indicators strengthens local, national and international public health advice and messaging. Further, understanding how well public health and government messages and measures are understood, communicated via (social) media and adhered to is vital. There are two governments and public health jurisdictions on the island of Ireland, the Republic of Ireland (ROI) and Northern Ireland (NI). This represents an opportunity to explore implications of differing measures and messaging across these two jurisdictions as they relate to COVID-19 on two similar populations. The expert research team are drawn from a range of disciplines in the two countries. This project has four nested studies: Assessment of key behavioural, social and psychological factors through a large, prospective representative telephone survey of individuals aged over-18 on a weekly basis over eight weeks (n=3072); and conduct qualitative focus groups over the same period.Interrogation of social media messaging and formal media responses in both jurisdictions to investigate the spread of (mis)information.Modelling data from Studies 1 and 2, plotting the psychosocial/behavioural and media messaging information with international, ROI and NI incidence and mortality data.Conducting an assessment of health policy transfer in an attempt to incorporate the most significant public health and political insights from each jurisdiction. The CONTAIN project will develop an evidence-based toolbox for targeting public health messaging and political leadership and will be created for use for the anticipated second wave of COVID-19, and subsequently for future epidemics/pandemics.

Socioeconomic Determinants of Caste-based Endogamy: A Qualitative Study

The present study is aimed at exploring the socioeconomic determinants and implications of caste-based endogamous marriages in Punjab, the most populous province in Pakistan. The data for this study were collected from a sample of 24 participants (14 males and 10 females), who were married-within-caste, with diverse socioeconomic, educational, and geographic backgrounds. This study found social pressure, protection of family honor, geographic propinquity, and caste-based stereotyping as key social factors reinforcing endogamous marriages in the province. Finally, the desire to avoid distribution of family’s economic resources like property and land was found to be a leading economic determinant of caste-based endogamy. Further, endogamy hinders economic mobility of lower castes since economic capitals such as land and property are preserved through this marital practice.

Study protocol for the COvid-19 Toolbox for All IslaNd (CONTAIN) project: A cross-border analysis in Ireland to disentangle psychological, behavioural, media and governmental responses to COVID-19

COVID-19 represents a serious challenge to governments and healthcare systems. In addition to testing/contact tracing, behavioural and social responses such as handwashing and social distancing or cocooning are effective tools for mitigating the spread of the disease. Psychological (e.g., risk perceptions, self-efficacy) and contextual factors (government, public health messaging, etc.) are likely to drive these behaviours. Collated real-time information of these indicators strengthens local, national and international public health advice and messaging. Further, understanding how well public health and government messages and measures are understood, communicated via (social) media and adhered to is vital. There are two governments and public health jurisdictions on the island of Ireland, the Republic of Ireland (ROI) and Northern Ireland (NI). This represents an opportunity to explore implications of differing measures and messaging across these two jurisdictions as they relate to COVID-19 on two similar populations. The expert research team are drawn from a range of disciplines in the two countries. This project has four nested studies: Assessment of key behavioural, social and psychological factors through a large, prospective representative telephone survey of individuals aged over-18 on a weekly basis over eight weeks (n=3072); and conduct qualitative focus groups over the same period.Interrogation of social media messaging and formal media responses in both jurisdictions to investigate the spread of (mis)information.Modelling data from Studies 1 and 2, plotting the psychosocial/behavioural and media messaging information with international, ROI and NI incidence and mortality data. Conducting an assessment of health policy transfer in an attempt to incorporate the most significant public health and political insights from each jurisdiction. The CONTAIN project will develop an evidence-based toolbox for targeting public health messaging and political leadership and will be created for use for the anticipated second wave of COVID-19, and subsequently for future epidemics/pandemics.

An Analysis of the Beef Production Industry and Marketing in Zambia

This paper studies and provide a comprehensive and critical research by analyzing and evaluating the beef marketing channels, determine marketing efficiency, examine key social and economic factors contributing to the success and failure and establish the regional market interactions across the three agro-ecological regions in Zambia.&#x0D; To achieve this, the research used both primary and secondary qualitative and quantitative data from national representative surveys by Rural Agricultural Livelihood Surveys Reports which were implemented by Indaba Agricultural Policy Research Institute, and the 2017/18 Livestock and Aquaculture Census Report by Ministry of Fisheries and Livestock, Central Statistics Office, and other relevant literature related to this study. A questionnaire was used in primary data collection through snowball sampling technique, physically asking, and observing cattle farmers, abattoirs, wholesalers, processing companies and various players or actors in the beef market. Thereafter, intermediation theory was applied to develop a conceptual framework, transaction cost analysis was used to understand how and why different supply channels develop, and finally market performance was determined by analyzing the level of marketing margins.&#x0D; It was found that there are two major channels (Channel A and Channel B used by small-scale and commercial scale farmers respectively) which have channel subdivisions and several social and economic factors influence the farmers choice of marketing channel as well as influence consumer choices. Channel A was dominated by intermediaries while channel B be was vertically integrated. It was determined that all beef channels in Zambia were efficient and three major consumer types were observed and the regional market interactions showed that region I supplies both II and III, region II supplies III while region III is more of a consumer region.&#x0D; This study will help to fully understand cattle producers marketing channel selection, consumer choice of market and product quality, regional market interactions and develops recommendations making available valuable information to farmers, beef traders, companies, and policy makers thereby has the potential to improving beef trade and markets in Zambia.

“Whatever it takes”: first budgetary responses to the COVID-19 pandemic in France

PurposeThis paper highlights the emergency budgetary measures taken by the French government in response to the COVID-19 pandemic health crisis and identifies some of the key political, economic, social and environmental factors and consequences associated with those measures.Design/methodology/approachThe authors conduct a thorough analysis of official reports, bills and academic and news articles related to the pandemic management in France. The authors’ analysis covers the period from January 24 to July 31, 2020.FindingsDespite previous austerity policies, France faced the health crisis with a very high level of debt, which has complicated the management of the COVID-19 crisis. Although significant, the response brought by the French government seems in the end to be rather choppy.Originality/valueThis paper highlights three elements of analysis that allow a better understanding of the budgetary management process in France. The authors first discuss the notion of budgetary flexibility. Then, they show that the growth of participatory budgets in local communities gives hope for a possible and much needed decentralization process implying a stronger commitment of citizens. Finally, they highlight a budgetary paradox; that is, massive funding of polluting industries versus ecological issues. These three elements of analysis all advocate the need for a deeper engagement among different levels of government and actors.

SEMILLA: Study of Environmental Exposure of Mothers and Infants Impacted by Large-Scale Agriculture

Introduction Toxic exposure, combined with poor working conditions, poor nutrition, poverty, maternal stress, and other key social and economic factors, contributes to the loss of developmental potential in young children. Although fungicide use is growing exponentially in the United States and globally, a significant gap exists in scientific knowledge about the neurodevelopmental toxicity of fungicides, and their interaction with critical social and structural determinants of health. Ethylenebisdithiocarbamates are commonly-used fungicides in floriculture and horticulture, which metabolizes ethylenethiourea (ETU). Research indicates that prenatal ETU exposure may cause maternal and neonatal thyroid dysfunction, potentially leading to adverse pregnancy outcomes and impaired neurodevelopment. This presentation will describe the SEMILLA study, a community-engaged cohort study, building on years of previous work, which assesses environmental and occupational toxic exposures among women workers in a major flower-growing region of Ecuador. Methods SEMILLA follows pregnant workers and their infants up to 18 months of age, incorporating prenatal measures of ETU exposure. Methods include obtaining monthly prenatal urine samples and maternal and neonatal blood samples to assess thyroid hormone levels. At each visit throughout the study, we collect detailed data on key social and structural factors including working conditions, environmental exposures in home and work environments, stress, social support, maternal health and lifestyle, socio-economic and demographic factors. We will administer highly sensitive tests to assess neurodevelopment and visual function as well as growth and nutritional status in enrolled infants. Results and Discussion SEMILLA will contribute key data to inform our understanding of how toxic exposure, combined with key social and structural factors, impact child development; data which is critical for developing and initiating appropriate and sustainable interventions in affected communities that promote optimal child health and development, reduce environmentally-associated community exposures, and improve worker health policies. We will discuss important strengths and challenges in the implementation of SEMILLA.

Predicting difficult discharge from surgical wards: a cohort study in an Italian sample

Abstract Background Poor discharge planning (DP) can increase costs for European hospitals and worsen patient's experience. Validated scores are used in internal medicine to identify clinical or social difficulties in discharges upon admission but there is a lack of such a tool in the surgical context. This study aims to detect early predictors of difficult discharge. Methods Socio-demographic and clinical data from 15,165 surgical Hospital Discharge Records (SDOs) of the Molinette hospital of Turin, including an additional pre-surgery evaluation of social vulnerabilites from a subgroup of 388 patients, were collected between 2017 and 2019. Outcomes were length of stay (LOS), discharge destination (home, Long Term Care - LTC). Descriptive analysis and multivariable regressions were performed. Results 52.3% of patients were male and the median age was 61 (IQR 22). Median LOS was 6 days (IQR 6) but 15 (IQR 30) for patients discharged to LTC. 18.7% were admitted through the Emergency Department (ED) with a median LOS of 7 (IQR 10). 17.6% of the subsample declared living alone. Linear regression showed associations between discharge to LTC, admission through ED, diagnosis of neoplasia and a longer LOS (Bs 10.76, 5.21 and 2.57 respectively, p &amp;lt; 0.001). Logistic regression showed associations between admission by ED, age and discharge to LTC (OR 1.77 and 1.02 respectively, p &amp;lt; 0.001). Preliminary analysis of the subsample did not show any new association with social vulnerabilities, but 98.2% attended elective surgery and thus probably had time to prepare for discharge. Conclusions Surgery LOSs are extremely diversified among patients. This study identified several predictors of difficult discharge, mainly admission through ED, discharge to LTC and diagnosis of neoplasia, suggesting difficulties handling an unexpected event by patients' relatives. Further studies gathering patients' data at admission are required in order to develop a predictive tool useful for European hospitals. Key messages Clinical (cancer) and social (sudden event, no housing solutions) factors can determine a difficult discharge for European patients and should be investigated to anticipate discharge planning. Elective surgery patients seem less prone to social vulnerabilities (e.g. living alone), probably because relatives have time to prepare, while ED patients often need help in the discharge process.

Stretching the public purse: budgetary responses to COVID-19 in Canada

PurposeThis paper summarizes the emergency measures taken by Canada in response to the COVID-19 pandemic, and discusses the key political, economic, and social factors that influenced the design of these measures.Design/methodology/approachThis paper collects the announcement of emergency measures in the Canadian provincial and federal governments between March 18 and May 30, 2020 in response to the COVID-19 pandemic and categorizes them by type of emergency response.FindingsCanada has a diversified response of emergency measures mediated by its various provinces. This suggests that Canada may be more robust to biological and economic threats than nations that have less policy diversity.Originality/valueCanada's diversity of emergency measures allows for several different avenues for future research, including countercyclical spending by subnational polities, organizational diversity's effect on resilience, the effect of tax breaks versus direct or indirect payments, effectiveness of public-private partnerships, and the effect of transparency on citizen satisfaction.

Study protocol for the COvid-19 Toolbox for All IslaNd (CONTAIN) project: A cross-border analysis in Ireland to disentangle psychological, behavioural, media and governmental responses to COVID-19

COVID-19 represents a serious challenge to governments and healthcare systems. In addition to testing/contact tracing, behavioural and social responses such as handwashing and social distancing or cocooning are effective tools for mitigating the spread of the disease. Psychological (e.g., risk perceptions, self-efficacy) and contextual factors (government, public health messaging, etc.) are likely to drive these behaviours. Collated real-time information of these indicators strengthens local, national and international public health advice and messaging. Further, understanding how well public health and government messages and measures are understood, communicated via (social) media and adhered to is vital. There are two governments and public health jurisdictions on the island of Ireland, the Republic of Ireland (ROI) and Northern Ireland (NI). This represents an opportunity to explore implications of differing measures and messaging across these two jurisdictions as they relate to COVID-19 on two similar populations. The expert research team are drawn from a range of disciplines in the two countries. This project has four nested studies: Assessment of key behavioural, social and psychological factors through a large, prospective representative telephone survey of individuals aged over-18 on a weekly basis over eight weeks (n=3072); and conduct qualitative focus groups over the same period.Interrogation of social media messaging and formal media responses in both jurisdictions to investigate the spread of (mis)information.Modelling data from Studies 1 and 2, plotting the psychosocial/behavioural and media messaging information with international, ROI and NI incidence and mortality data.Conducting an assessment of health policy transfer in an attempt to incorporate the most significant public health and political insights from each jurisdiction. The CONTAIN project will develop an evidence-based toolbox for targeting public health messaging and political leadership and will be created for use for the anticipated second wave of COVID-19, and subsequently for future epidemics/pandemics.