Lack Of Transportation Research Articles

People of Advanced Age Who Have either Ceased Driving or Have never Driven at all

Background: A comparable number of advanced aged New Zealand Maori and non-Maori are either still driving, have decided to cease to drive or have never driven. However regardless of which ever group they may fall into there remains a high degree of independence. Method: Under the Transport, Nottingham Extended Activities of Daily Living and Screen II, Neighbourhood subsections questions were directed towards whether the sample group had ever driven, when they stopped driving and why they had decided to cease driving; were they able to get in/out of their car, have any problems obtaining groceries and difficulties in going to their shops. Methods of analysis included binomial logistic regression, chi-square lest for association, ordinal logistic regression analysis, Mann -Whitney U test, questionnaire and descriptive analysis.Results: Participants totalled 931 with 421 New Zealand Maori and 510 New Zealand Maori non-Maori.New Zealand Maori: New Zealand Maori aged between 83-86 years presented the highest figures for those found to be (still) driving. Overall New Zealand Maori females also had 1.028 times higher odds of having ever driven compared to that of New Zealand Maori males. Those that had ceased driving both New Zealand Maori males and females had made that decision more than twelve months ago (with the most notable number being 88 years of age). Despite a list of possible reasons for ceasing to drive it was personal motivation supplied by respondents that presented a more detailed/informative picture. Both male and female indicated that did get in and out of their car on the own or with difficulty. Of those that did not, it was New Zealand Maori females who made use of outside family members or external sources rather than close family/closer relations. New Zealand Maori males indicated that they either never or rarely had any problems in obtaining their groceries compared to the greater number of New Zealand Maori females. Primarily New Zealand Maori males and females indicated that transporting themselves to the shops was not a problem for them. New Zealand Maori males also walked, were as New Zealand Maori females obtained help. Reasons given for any complications New Zealand Maori males highlighted lack of public transport while New Zealand Maori females said it was due to their health.New Zealand non-Maori: Similarly, the results of New Zealand non-Maori females also offered greater numbers in those who either continued or had ceased driving. Of those who had stopped driving both New Zealand non-Maori males and females had also made that decision more than twelve months ago. Likewise, with personal incentives being the prime cause behind their decision. New Zealand non-Maori also indicated that they could get in and out of their car on their own or with difficulty. However, some males did go on to say that they did utilise family or household members; whereas females made use of outside help. A lack of transport was particularly identified by the New Zealand non-Maori males when asked about problem in obtaining groceries. Both New Zealand non-Maori males and females expressed health concerns as being their prime reason for having difficulty in getting to their shops. However, females also indicated a feeling of being unsafe, inadequate footpaths and or public transport.Conclusion: Ceasing to drive primarily resulted through personal motivation with the decision being made generally more than twelve months ago. Continued transportation of themselves to required destinations was not a problem but respondents did indicate possible consequences such as health, lack of public transport facilities, inadequate amenities and unsafe environment.

Education and training experiences of early childhood care and education practitioners in rural and urban settings of Durban, South Africa

Background: The education and training experiences of Early Childhood Care and Education (ECCE) practitioners reflect gaps and inequalities in South Africa’s educational system. Most South African ECCE centre practitioners do not have the appropriate qualifications to provide quality education to young learners.Aim: The study aimed to explore how the education and training experiences of ECCE practitioners impact their professional identity in urban and rural settings in KwaZulu-Natal province and to develop a model that would enhance the education and training of ECCE practitioners.Setting: Ten participants were selected for this study: one centre head and four practitioners from a rural setting, and one centre head and four practitioners from an urban area.Methods: Wenger’s social theory of learning was used to obtain an in-depth understanding of ECCE practitioners’ education and training experiences and how they function as professional workers. An interpretative, qualitative case study was adopted. Data was collected through focus group semi-structured interviews and non-participants’ observation and then analysed thematically.Results: The findings revealed that practitioners in rural settings had to contend with unfair working conditions daily, working all day in challenging circumstances whilst earning low incomes. Urban practitioners worked reasonable hours and received living wages, although they also experienced challenges such as a lack of parental involvement, lack of transport for children and high rates of absenteeism.Conclusion: Inequalities between rural and urban practitioners existed concerning resources, salaries, working conditions and further study and professional growth opportunities. Ensuring that practitioners attain proper Early Childhood Care (ECC) qualifications will raise the profession’s esteem amongst wider communities.

Implementation of a community-based referral project to improve access to emergency obstetric and newborn care in Rohingya population during COVID-19 pandemic in Bangladesh

IntroductionThe delay in seeking emergency obstetric care leads to significant maternal morbidity and mortality and can worsen during pandemics, especially in humanitarian conflict settings with low uptake of obstetric services....

Barriers associated with inadequate follow-up of abnormal fecal immunochemical test results in a safety-net system: A mixed-methods analysis

In safety-net healthcare systems, colonoscopy completion within 1-year of an abnormal fecal immunochemical test (FIT) result rarely exceeds 50%. Understanding how electronic health records (EHR) documented reasons for missed colonoscopy match or differ from patient-reported reasons, is critical to optimize effective interventions to address this challenge. We conducted a convergent mixed-methods study which included a retrospective analysis of EHR data and semi-structured interviews of adults 50–75 years old, with abnormal FIT results between 2014 and 2020 in a large safety-net healthcare system. Of the 299 patients identified, 59.2% (n = 177) did not complete a colonoscopy within one year of their abnormal result. EHR abstraction revealed a documented reason for lack of follow-up colonoscopy in 49.2% (n = 87/177); patient-level (e.g., declined colonoscopy; 51.5%) and multi-factorial reasons (e.g., lost to follow-up; 37.9%) were most common. In 18 patient interviews, patient (e.g., fear of colonoscopy), provider (e.g., lack of result awareness), and system-level reasons (e.g., scheduling challenges) were most common. Only three reasons for lack of colonoscopy overlapped between EHR data and patient interviews (competing health issues, lack of transportation, and abnormal FIT result attributed to another cause). In a cohort of safety-net patients with abnormal FIT results, the most common reasons for lack of follow-up were patient-related. Our analysis revealed a discordance between EHR documented and patient-reported reasons for lack of colonoscopy after an abnormal FIT result. Mixed-methods analyses, as in the present study, may give us the greatest insight into modifiable determinants to develop effective interventions beyond quantitative and qualitative data analysis alone.

Perspectives of HIV specialists and cardiologists on the specialty referral process for people living with HIV: a qualitative descriptive study

BackgroundCardiology care may be beneficial for risk factor management in people living with HIV (PLWH), yet limited information is available about the referral process from the perspectives of HIV specialists and cardiologists.MethodsWe conducted 28 qualitative interviews at academic medical centers in the United States from December 2019 to February 2020 using components of the Specialty Referral Process Framework: referral decision, entry into referral care, and care integration. We analyzed the data using applied thematic analysis.ResultsReasons for cardiology referral most commonly included secondary prevention, uncontrolled risk factors, cardiac symptoms, and medication management. Facilitators in the referral process included ease of referral, personal relationships between HIV specialists and cardiologists, and close proximity of the clinic to the patient’s home. Barriers included lack of transportation, transportation costs, insurance coverage gaps, stigma, and patient reluctance.ConclusionsOur results will inform future studies on implementation strategies aimed at improving the specialty referral process for PLWH.Trial RegistrationClinicalTrials.gov Identifier: NCT04025125.

Patient Perspectives on Care Transitions From Hospital to Home

Understanding the patient's perspective of their care transition process from hospital or skilled nursing facility (SNF) to home may highlight gaps in care and inform system improvements. To gather data about patients' care transition experiences and factors associated with follow-up appointment completion. A survey tool was developed with input from patient advisors and organizations participating in a collaborative quality initiative. Seventeen hospitals, 12 practitioner organizations, and 6 SNFs in Michigan collaborated to identify shared patients who were aged 18 years and older, had a working telephone number, recently returned home or to an assisted living facility with a diagnosis of congestive heart failure or chronic obstructive pulmonary disease, or after an SNF stay. Using consecutive sampling, interviewers collected 5 telephone surveys per month. From October 2018 to December 2019, patients or caregivers were surveyed via telephone 8 to 12 days after discharge from a hospital or SNF. Data were analyzed from March 2020 to January 2022. Care transition experiences. The primary outcome was to identify patient-perceived gaps during care transition experiences, including postdischarge follow-up. On the basis of pilot data, the response rate was estimated at 34%, yielding 1257 surveys. Of 1257 survey respondents (mean [SD] age, 70 [12.94] years for 968 patients for whom age data was available), 654 (52%) were female; 829 (74%) were White, 250 (22%) were Black or African American, and 40 (4%) were another race. Eleven percent of patients reported not receiving a telephone number to call for postdischarge questions. Nearly 80% of patients (977 patients) received a follow-up telephone call, and most found it valuable. Twenty percent of patients (255 patients) reported at least 1 social determinant of health issue. Lack of transportation was associated with reduced likelihood of completing a follow-up visit, decreasing the odds of completing a follow-up by nearly 70% (odds ratio [OR], 0.31; 95% CI, 0.18-0.53; P < .001). Compared with other patient groups, Black patients were less likely to report completing a postdischarge follow-up visit (OR, 0.49; 95% CI, 0.36-0.67; P < .001) or to receive prescribed medical equipment (OR, 4.23; 95% CI, 1.30-13.83; P = .02). An examination of patient discharge experiences from a hospital or SNF identified inconsistencies in care transition processes, social determinants of health issues needing to be addressed after discharge, and racial disparities between patients who attend follow-up appointments. Physicians should be aware of these findings and their consequences for patient experiences.

Using the Tools of Today to Advance the Life Course Interventions of Tomorrow.

Using the Tools of Today to Advance the Life Course Interventions of Tomorrow.

PD25-01 SOCIAL DETERMINANTS OF HEALTH AND OVERACTIVE BLADDER IN A LARGE NATIONWIDE CROSS-SECTIONAL STUDY

You have accessJournal of UrologyCME1 May 2022PD25-01 SOCIAL DETERMINANTS OF HEALTH AND OVERACTIVE BLADDER IN A LARGE NATIONWIDE CROSS-SECTIONAL STUDY Elisabeth Sebesta, Stephanie Gleicher, Melissa Kaufman, Roger Dmochowski, and W. Stuart Reynolds Elisabeth SebestaElisabeth Sebesta More articles by this author , Stephanie GleicherStephanie Gleicher More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , Roger DmochowskiRoger Dmochowski More articles by this author , and W. Stuart ReynoldsW. Stuart Reynolds More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002567.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is growing interest in how social determinants of health (SDOH) may explain relationships between social conditions and health. Overactive bladder (OAB) is common in the United States, posing a significant public health burden. Previously, lower socioeconomic status has been associated with more severe urge urinary incontinence (UUI). Most recently, a multicenter cross-sectional study demonstrated a link between certain SDOH and OAB severity in women in an urban setting. It was the goal of the present study to assess whether OAB was associated with unmet social needs in a large nationwide cross-sectional sample of patients. METHODS: A community-based sample of adult patients was recruited electronically to complete questionnaires on clinical and demographic information, urinary symptoms (LURN SI-10 and ICIQ-SF UI), and social needs. Excluded patients were currently pregnant, with history of cystectomy or neurologic lower urinary tract dysfunction. Variables were assessed with multivariable logistic regression. RESULTS: A total of 3,673 patients were included for analysis, with a mean age of 40.7±17.3 years. The majority of patients identified as white, non-Hispanic (84.0%) and female (77.1%). Of all patients, 1,485 (40.4%) were classified as having OAB (UUI in a 7-day period and/or urgency with frequency >8 times/day). The presence of OAB was associated with numerous unmet social needs, including worry about a stable/safe place to live, food insecurity, worry about utilities, lack of transportation, skipping medical appointments, needing legal help, stress in personal relationships, worry about a place to urinate at home, stress about home plumbing, and lack of social supports (Table). On multivariable analysis adjusting for age, gender, race, BMI, parity, and history of pelvic radiation or surgeries, all associations between OAB and SDOH remained significant. CONCLUSIONS: In this large nationwide sample, multiple SDOH were associated with the presence of OAB, which may have implications on the overall management of OAB patients. As providers it is important to consider these unmet social needs of patients, and suggests a role for collaboration with social workers and/or mental health providers in order to offer OAB patients with the best and most comprehensive care. Source of Funding: UL1 TR000445 from NCATS/NIH © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e421 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elisabeth Sebesta More articles by this author Stephanie Gleicher More articles by this author Melissa Kaufman More articles by this author Roger Dmochowski More articles by this author W. Stuart Reynolds More articles by this author Expand All Advertisement PDF DownloadLoading ...

Evaluation of Barriers to Implementation of Environmental Education with Fuzzy FUCOM Technique

In this study, in order to examine the significance and encourage the adoption of Environmental Education (EE), it is fundamentally important to determine the strength and levels of the obstacles encountered in the EE process and to present the proposed solution. First of all, with the literature review, the factors that were found to affect the EE process in the past studies were determined. Then, a new subjective weighting method called the fuzzy Full Consistency Method (FUCOM) was used to determine the criterion weights of the obstacles. The final values of the weight coefficients were obtained using the GAMS/CPLEX package program. As a result of the application, it was determined that the most important obstacles encountered during the implementation of EE are financial inadequacies, lack of transportation, safety, responsibility, and classroom management, lack of content information, and lack of natural science knowledge. Based on the findings obtained in the last part of the study, recommendations were made for the dissemination of EE.

COVID-19 sample management: experiences of Harare City, 2021.

COVID-19 sample management is pivotal in controlling the pandemic. Results of 28/45 (62.2%) cases identified at a high school COVID-19 outbreak in Harare’s Northern district were not reported within the recommended 24 hours of notification. This leads to delayed patient management. We evaluated the sample management system for COVID-19 in Harare City. A descriptive cross-sectional study was conducted in Harare City. Health care workers involved in COVID-19 sample management at a high school outbreak in the Northern district namely clinicians, laboratory, environmental and administrative personnel were purposively sampled. Interviewer-administered questionnaires were used to collect data. Quantitative data were analyzed using Epi info version 7. Medians and proportions were generated. A 3-point Likert Scale was used to measure knowledge levels of health care workers on COVID-19 sample management. Thirty health care workers were interviewed and females were 20/30 (66%). Participants had not been trained in sample management. Overall knowledge level was good for 7/30 (23%) of the participants. Of the samples collected, 156/451 (34.6%) were wrongly sent to the national microbiology laboratory and 53/156 (34.0%) of the results were received. Sample management of COVID-19 samples in Harare City was found to affect patient management because of poor knowledge of healthcare workers, lack of transportation and communication means. The need for training cadres involved in the management process and availing adequate resources can improve turnaround time of results hence patient management.

Hypoxaemia prevalence and management among children and adults presenting to primary care facilities in Uganda: A prospective cohort study.

Hypoxaemia (low blood oxygen) is common among hospitalised patients, increasing the odds of death five-fold and requiring prompt detection and treatment. However, we know little about hypoxaemia prevalence in primary care and the role for pulse oximetry and oxygen therapy. This study assessed the prevalence and management of hypoxaemia at primary care facilities in Uganda. We conducted a cross sectional prevalence study and prospective cohort study of children with hypoxaemia in 30 primary care facilities in Uganda, Feb-Apr 2021. Clinical data collectors used handheld pulse oximeters to measure blood oxygen level (SpO2) of all acutely unwell children, adolescents, and adults. We followed up a cohort of children aged under 15 years with SpO2<93% by phone after 7 days to determine if the patient had attended another health facility, been admitted, or recovered. Primary outcome: proportion of children under 5 years of age with severe hypoxaemia (SpO2<90%). Secondary outcomes: severe (SpO2<90%) and moderate hypoxaemia (SpO2 90-93%) prevalence by age/sex/complaint; number of children with hypoxaemia referred, admitted and recovered. We included 1561 children U5, 935 children 5-14 years, and 3284 adolescents/adults 15+ years. Among children U5, the prevalence of severe hypoxaemia was 1.3% (95% CI 0.9 to 2.1); an additional 4.9% (3.9 to 6.1) had moderate hypoxaemia. Performing pulse oximetry according to World Health Organization guidelines exclusively on children with respiratory complaints would have missed 14% (3/21) of severe hypoxaemia and 11% (6/55) of moderate hypoxaemia. Hypoxaemia prevalence was low among children 5-14 years (0.3% severe, 1.1% moderate) and adolescents/adults 15+ years (0.1% severe, 0.5% moderate). A minority (12/27, 44%) of severely hypoxaemic patients were referred; 3 (12%) received oxygen. We followed 87 children aged under 15 years with SpO2<93%, with complete data for 61 (70%), finding low rates of referral (6/61, 10%), hospital attendance (10/61, 16%), and admission (6/61, 10%) with most (44/61, 72%) fully recovered at day 7. Barriers to referral included caregiver belief it was unnecessary (42/51, 82%), cost (8/51, 16%), and distance or lack of transport (3/51, 6%). Hypoxaemia is common among acutely unwell children under five years of age presenting to Ugandan primary care facilities. Routine pulse oximetry has potential to improve referral, management and clinical outcomes. Effectiveness, acceptability, and feasibility of pulse oximetry and oxygen therapy for primary care should be investigated in implementation trials, including economic analysis from health system and societal perspectives.

Determination of Distribution Routes Using the Saving Matrix Method to Minimize Shipping Costs at PT. SUKUN TRANSPORT LOGISTICS

PT. Sukun Transport Logistics is a company engaged in shipping,logistics and also transportation vehicle rental services. Theproblems faced by PT. Sukun Transport Logistics is a lack oftransport vehicle capacity, causing the use of transport vehiclesthat are not suitable and the distribution of sub-routes is notbalanced. Therefore, to overcome these problems, it is necessaryto determine the optimal distribution route using the saving matrixmethod. The saving matrix method is a method to shortenmileage, estimate distribution time and minimize shipping costs atPT. Sukun Transport Logistics. From the results of the routeresearch in this study, it is known that the route proposal with thesaving matrix method opens 2 sub routes from the previous 3 subroutes, the total distance through the saving matrix method andthe closest calculation method is 299 km. While the total distanceof the actual route delivery to the company is 313 km. Thedistance saving of this research with the company's actual routeis 14 km or 4.47%. At the time of saving of 164 minutes or20.97%, and distribution cost savings of Rp. 141,658 or 25.53%.

Fishing Participation, Motivators and Barriers among UK Anglers with Disabilities: Opportunities and Implications for Green Social Prescribing.

Green social prescribing, which includes the referral of patients to nature-based activities, could exacerbate inequalities between people with disabilities and people without. Research suggests fishing could be more inclusive relative to other outdoor sports. To understand if fishing is an inclusive sport, and the potential benefits and barriers to prescribing fishing, the present study compared participation, motivators and barriers to fishing, between anglers with and without disabilities. UK adults were invited to participate in an online survey. Chi-square tests examined differences between anglers with and without disabilities regarding the type of fishing anglers engaged in, the frequency of fishing, the length of time spent fishing, motivators for fishing and barriers to fishing. Among 1799 anglers (97.5% male), 292 (16.2%) anglers reported having a disability. Most anglers with disabilities were over 55 years old (56.5%). There was no difference in fishing participation, or motivators for fishing, between anglers with and without disabilities; however, anglers with disabilities were more likely to report ‘costs’, ‘lack of transport’ and ‘having no one to go with them’ as barriers. Overall, there appeared to be no differences in fishing participation between anglers with versus without disabilities, although additional barriers to participation may exist.

Referral care for high-risk pregnant women in rural Rajasthan, India: a qualitative analysis of barriers and facilitators

ObjectiveTo qualitatively assess the barriers and facilitators to uptake of referral services amongst high-risk pregnant women in rural Rajasthan.MethodsA purposive sample of pregnant women with high-risk conditions requiring referral follow-up care (severe hypertension, moderate anemia, and severe anemia) were considered for inclusion. In-depth individual interviews were conducted in the local dialect, Mewari. Interviews were transcribed, coded, and organized for thematic generation as per the analytical framework described in the socio-ecological model.Results19 high risk pregnant women of low socioeconomic backgrounds across 15 villages were interviewed. Barriers to referral care included lack of transportation, household responsibilities, and limited awareness, education, and social support. The most prominent barrier was lack of accompaniment to the referral center by a family member or health worker. Facilitators included available husbands, engaged heath workers, supportive neighbors, and other female family members who shared past experiences.ConclusionsSocial support at the interpersonal and community level was key to overcoming referral care barriers faced by high-risk pregnant women in rural Rajasthan. Interventions that enhance social support may improve uptake of referral care services by high-risk pregnant women.

Cancer Prevention in a Postpandemic World: A One-Stop-Shop Approach

Cancer Prevention in a Postpandemic World: A One-Stop-Shop Approach

Barriers to education and employment among Arabic speaking refugee and immigrant women

PurposeDuring the refugee resettlement process, women are often subject to discriminatory policies, which may put them at risk of a difficult transition. This study aims to extend and contextualize previous findings documenting the barriers Arabic-speaking refugee and immigrant women face with regards to gaining education and employment.Design/methodology/approachThrough telephone-based surveys, the authors examined the social situations, barriers and assets to gaining education and employment among Arabic speaking refugee and immigrant women (N = 50) in North Carolina.FindingsFindings include barriers to education and employment such as the need for childcare, English proficiency and lack of transportation. Assets include connections to the community and special skills such as cooking and sewing.Research limitations/implicationsThis study has limitations such as a lack of representation among asylees, reliance on self-report and small sample size. Implications: this study’s findings have implications for community and medical providers’ efforts to assist refugees and immigrant’s women in education and employment and to close the gap in the social determinants of health as well as for research in this area. Minimizing the barriers that prevent them from learning English or attaining employment will require coordinated efforts across the local community, county and even the state.Practical implicationsThe findings from this study inform research that may be relevant to other communities seeking an understanding of the social challenges faced by Arabic-speaking refugees and immigrant women, Muslim and Christian.Originality/valueThis study adds important information about the health and social lives of an understudied population. The authors’ discuss the implications of these findings for community members and health practitioners to better assist this population in a successful resettlement process.

Partnering to Improve Pediatric Asthma Quality.

Partnering to Improve Pediatric Asthma Quality.

Barriers for the uptake of cataract surgery: A rural community-based study

Background: Cataract is the leading cause of blindness. Various national programmes have been undertaken to reduce its prevalence. Several barriers in the rural community and individuals exist which decreases the uptake of cataract surgery. Knowledge of factors would help in improving surgical uptake in rural patients and a decrease in blindness rate.Aim: This study aimed to evaluate the factors preventing cataract surgery acceptance in rural patients.Setting: An observational cross-sectional study was conducted between June 2019 to December 2019 in eye screening camps in rural areas of south Karnataka, India.Methods: An observational cross-sectional study was conducted between June 2019 and December 2019. A total of 4114 patients were screened at camps, out of which 500 patients above the age of 50 years, diagnosed with cataracts but had refused cataract surgery earlier, were included. Data were collected on demography, visual acuity, cataract or lens status, source of information on cataract surgery in camps, reasons for refusal of cataract surgery previously. Barriers to cataract surgery uptake (CSU) were classified as attitudinal, social, economical and psychological factors and reasons for uptake of cataract surgery in the current visit were recorded in the form of a questionnaire and analysed.Results: The mean age of the participants was 65.8 years. The male to female ratio was 1.1:1. The prevalence of cataract blindness in our study population was 11.5%, which was significant (p = 0.000). Announcements and pamphlets were the most common source of information on cataract surgery in camps. Significant barriers to CSU were attitudinal factors, mainly the ability to manage daily work (66.4%) with cataract; one eye had an adequate vision (57.4%). The next common barrier was an economic factor as they waited for a camp to avail themselves of free service (61.5%). The least common barriers were female gender (13.2%), fear related to surgery (11.8%), old age (9.6%), God’s will/fate (6.2%), lack of transport (5.4%). The critical factors in CSU in the camps were a provision of free surgery, accessible transport, the camp being conducted closer to their home and motivation by the health workers.Conclusion: Although economic barriers were efficiently taken care of by the government through national programmes, attitudinal barriers seem to be the most important barriers to achieve the goal of reducing blindness because of cataract in rural population.

Modeling the growth barriers of fresh produce supply chain in the Indian context

PurposeOver the years, the fruit and vegetable supply chain has encountered several challenges. From the harvesting stage until it reaches the consumer, a significant portion of fruits and vegetables gets wasted in the supply chain. As a result, the present study attempts to identify and analyze the growth barriers in the fresh produce supply chain (FPSC) in the Indian context.Design/methodology/approachAn integrated grey theory and DEMATEL based approach is used to analyze growth barriers in the FPSC. The growth barriers were analyzed and sorted based on their influence and importance relations.FindingsThe results emphasize that the most critical growth barriers in the FPSC that should be addressed to ensure food waste reduction are as follows: Lack of cold chain facilities (B2), lack of transportation or logistic facilities (B1), lack of collaboration and information sharing between supply chain partners (B3), lack of proper quality and safety protocols (B15), a lack of processing and packaging facilities (B14), and poor productivity and efficiency (B13). Results are also verified by conducting a sensitivity analysis.Practical implicationsThe results are highly useful for policymakers to exploit growth barriers within the FPSC that require more attention. The obtained results show that the managers and policymakers need to utilize more funds to develop the cold chain facilities and logistics facilities to develop the FPSC. By improving the cold chain facilities, it is possible to improve the quality of food, make the food safe for human consumption, reduce waste, and increase the efficiency and productivity of the supply chain. Also, this study may encourage policymakers and industrial managers to adopt the most influential SCM practices for food waste reduction.Originality/valueMany researchers have attempted to analyze the causes of food waste and growth barriers in the FPSC using various decision-making methods. Still, no attempts are made to explore the causal relations among various growth barriers in FPSC through the integrated Grey-DEMATEL technique. Also, we devise policy implications in the light of the new farm bills or the Indian agricultural acts of 2020. Lack of cold chain facilities (B2) was found to be the critical driving barrier in the FPSC, as it influences multiple barriers. Also, there is a dire need for cold chain facilities and transportation systems to enhance productivity and efficiency.

Estimating the Impact of COVID-19 Pandemic Related Lockdown on Utilization of Maternal and Perinatal Health Services in an Urban Neighborhood in Delhi, India.

ObjectiveTo estimate utilization of maternal, perinatal healthcare services after the lockdown was implemented in response to the COVID-19 pandemic compared to the period before.MethodsThis study conducted in Dakshinpuri, an urban neighborhood in Delhi, reports data over a 13-month period which includes the period “before lockdown” i.e., October 1, 2019 to March 21, 2020 and “after lockdown” i.e., March 22 to November 5, 2020. The period “after lockdown” included the lockdown phase (March 22 to May 31, 2020) and unlock phase (June 1 to November 5, 2020). Mothers delivered during this period in the study area were interviewed using semi-structured questionnaires. In-depth interviews (IDIs) were conducted in a subsample to understand the experiences, challenges, and factors for underutilization of healthcare services.FindingsThe survey covered a total population of 21,025 in 4,762 households; 199 eligible mothers (mean age 27.4 years) were interviewed. In women who delivered after lockdown against before lockdown, adjusted odds of having >2 antenatal care visits in the third trimester was 80% lower (aOR 0.2, 95% CI 0.1–0.5); proportion of institutional deliveries was lower (93 vs. 97%); exclusive breastfeeding during first 6 months of birth (64.5 vs. 75.7%) and health worker home visitation within 6 weeks of birth (median, 1 vs. 3 visits) were substantially lower. Fear of contracting COVID-19, poor quality of services, lack of transportation and financial constraints were key issues faced by mothers in accessing health care. More than three-fourth (81%) of the mothers reported feeling down, depressed or hopeless after lockdown. The major factors for stress during lockdown was financial reasons (70%), followed by health-related concerns.ConclusionCOVID-19 pandemic-related lockdown substantially affected maternal and perinatal healthcare utilization and service delivery.