Provision Of Services Research Articles

Occupational therapy experiences of interprofessional collaboration in the support of autistic children.

Autistic children commonly receive simultaneous services from various health-care and other professionals, including occupational therapy, throughout their journey of diagnosis and consequent therapeutic support. Current best practice guidelines for supporting autistic youth emphasise the importance of interprofessional collaboration. Despite this, collaboration among health-care professionals does not always occur, and little is understood about clinicians' experiences of collaborative care. The aim of this study was to explore Australian paediatric occupational therapists' experiences of interprofessional collaboration and their perception of factors influencing collaboration when supporting autistic children. This study employed an exploratory qualitative descriptive design. Semi-structured interviews were conducted with 13 Australian paediatric occupational therapists involved in service provision to autistic children. Questions explored clinicians' experiences and perceptions of interprofessional collaboration. Reflexive thematic analysis was used to inductively analyse data. This study was conceptualised and conducted by a team of researchers with a range of personal and professional experiences with the autistic community. The research design was strongly informed by the Autism CRC'S research guidelines. Three themes were generated highlighting factors that influence collaboration between occupational therapists and other professionals. The first emphasised that 'clinicians' capacity to collaborate' at both organisational and individual levels was understood to be greatly influenced by funding structures. The second emphasised that 'relationships are key to collaboration' with these often established through shared workplaces or clients. The third, 'shared perceptions make collaboration easier' described how shared perceptions of collaboration, the occupational therapy role, and autism-related frames of reference were perceived to influence interprofessional collaboration. Findings indicate that, while occupational therapists perceive interprofessional collaboration as valuable in the support of autistic children, there are barriers to effective collaboration, particularly in the context of a marketised service delivery model. This study looked at how Australian occupational therapists work with other professionals to support autistic children. Even though it is recommended that professionals work together to support autistic children and their families, this does not always happen. In this study, researchers interviewed 13 occupational therapists and asked what it is like working with other professionals, what is helpful, and what makes working together difficult. From these interviews, it was found that many things affect how well occupational therapists can work with other health professionals and teachers to support autistic children. Factors like funding and workplace rules affect how professionals work together. Having someone take on the role of leader and having good relationships between professionals made it easier to work together. It was also helpful when occupational therapists and other professionals shared similar ideas on how to support autistic children. The study could be improved if it had gathered more information about the occupational therapists' education and what they have learnt about working with other professionals. Overall, the therapists in this study believed that working together to support autistic children and their families was important, but that there are many challenges to making this happen. More research on this topic would be helpful.

Maternal health service utilization in the Jimma Zone, Ethiopia: results from a baseline study for mobile phone messaging interventions

BackgroundOver the last 20 years, global healthcare has placed a major focus on improving the survival rates of mothers and children, recognizing the potential to prevent a significant number of deaths resulting from pregnancy and childbirth. Nevertheless, there remains an ongoing obstacle to the insufficient utilization of critical obstetric services to achieve optimal health outcomes for pregnant women. This study aimed to assess the magnitude and determinants of maternal healthcare use in the Jimma Zone, Ethiopia.MethodsData were obtained from a household survey as part of the baseline assessment of a cluster randomized controlled trial. The study participants comprised 588 women in early pregnancy, specifically those with a gestational age of less than 20 weeks. Logistic regression analysis was employed to identify factors associated with the use of maternal health services. Adjusted odds ratios (AORs) were used to assess the strength of the associations, with significance level set at a p-value ≤ 0.05.ResultsThe overall prevalence of maternal health service utilization was 87.9% (CI: 85.1, 90.4) for antenatal care, 74.7% (CI: 73.2, 79.9) for health facility delivery, and 60.4% (CI: 56.4, 64.3) for postnatal care. Multivariable logistic analysis revealed that maternal health service use was significantly influenced by access to health facilities (AOR: 6.6; 95% CI: 2.39, 18.16), financial hardship (AOR: 3; 95% CI: 1.97, 4.61), perceived respectful care (AOR: 2.3; 95% CI: 1.07, 5.11), perceived privacy of service provisions (AOR: 2.4; 95% CI: 1.47, 4.06), and attitudes toward maternal service use (AOR: 2.2; 95% CI: 1.48, 3.24).ConclusionsThe study revealed slightly higher rates of antenatal care, facility delivery, and postpartum care utilization. However, there was a low proportion of early antenatal care initiation, and high rates of antenatal care dropout. Mobile phone-based messaging intervention may enhance maternal health service use by addressing factors such as lack of access, economic challenges, disrespectful care, no privacy of procedures, and unfavorable attitudes.

Clinicians’ Perspectives of Activity Monitoring Applications and Facilitators for Lower-Limb Prosthetic Service Provision

ABSTRACT Introduction Clinicians involved in lower-limb prosthetic provision and care do not have an objective method for measuring patients’ real-world prosthesis usage. This results in a poor understanding of the full picture of the patient’s everyday life impacting the reporting of outcome following prosthetic prescriptions. There is need to understand what information from wearable prosthetic monitors would be relevant to clinicians and how that information should be displayed to enable health care professionals to make informed decisions. Moreover, clinicians’ perspectives regarding potential use and application of information from monitoring technologies are important in the development and implementation of this technology to improve evidence-based systems for informed clinical decisions for lower-limb prosthesis users. This study aims to explore clinicians’ experiences and perceptions of information obtained from free-living wearable prosthetic monitors used in clinical practice. Methods Seven clinicians from private practice and academia were recruited to participate in the study. A semistructured interview was held for each participant, which lasted about 30–45 minutes. Data and transcripts were analyzed using inductive thematic analysis method. Results Themes of objectiveness and motivation were identified as specific applications of monitoring technologies. Other themes such as awareness and integration were identified as the facilitators of monitoring technologies for prosthetic care in clinical settings. Clinicians identified frameworks in which these monitoring technologies could be incorporated into the clinic, how they can receive feedback as a multidisciplinary team, and the inclusion within patients’ medical records. Conclusions This information from prosthetic monitoring technologies could potentially change clinical practice in several ways: by improving the clinical assessment process, improving the prescription process, and improving the rehabilitation process. To improve the clinical assessment process, prosthetic monitoring information can provide real-world data of prosthesis user’s utilization, which could be used to quantify patients’ self-reports. To improve the prescription process, prosthetic monitoring information can enable clinicians to see if a patient was actively involved in any form of exercise and support them to position their prescription of components within an activity category for their patients. To improve the rehabilitation process, prosthetic monitoring information can be used to plan goals for patients, to measure the progress of patients, and to check for patients’ compliance. Clinical Relevance Statement The impact of these potential changes in clinical practice can ultimately lead to improved clinical decisions in prosthetic care and creation of an evidence-based system.

Core functions, visitor friendliness and digitalisation: a comparative analysis of corporate museums’ performance

AbstractWe exploit a rich dataset on Italian museums to investigate whether corporate museums’ service provision is quantitatively different from the provision by the rest of private museums and by the three different types of Italian publicly owned museums (whose classification is by organisational mode: traditional, autonomous, and outsourced). We consider service provision in the dimensions of core museum functions (research, collection management, dissemination) and visitor friendliness, and we also focus on digital services. We use count data models estimation methods and include controls referring to museums’ characteristics and contextual factors to account for possible confounding effects. Our analysis reveals that corporate museums do not provide more core services than other museums, as expected given the public good component of this category of services. Contrary to expectations, we find that corporate museums are not among the museums providing the largest number of services enhancing visitor friendliness. Finally, corporate museums provide more digital services than traditional public museums and private museums owned by churches, and not less than other museum types. We argue that this latter evidence may come from their interaction with the parent firm. Corporate museums’ higher levels of digitalisation may be seen as the effect of a knowledge spillover between the more profit-oriented business world and the non-profit cultural sector.

Practitioner Review: Continuity of mental health care from childhood to adulthood for youths with ADHD-who, how and when?

Many youths with attention-deficit/hyperactivity disorder (ADHD) experience significant long-term impairment and may develop concurrent mental and somatic health difficulties as adults. This is associated with burden and costs for the individual and society which could be prevented through continued support in youth. Yet, only few young people transition to adult mental health services for ongoing care in different countries worldwide. We provide an overview on current transition practices, highlighting the gaps in knowledge and the barriers to effective service transitioning, while considering the large geographical variation in available guidelines and service provision. For ease of use, this review is organized in a question-and-answer format covering different aspects of the transition process and considering both service users' and clinicians' perspectives. Consensus is needed to identify those that require continued care, the optimal timing to arrange transition, and the most suitable services. Finally, we discuss cost-effectiveness of transition practices, consider examples of best practice, and propose recommendations on how to improve transitional care, including the importance of service users' input into transition planning.

PROBLEMS OF ELIMINATING LEGAL CONFLICTS OF LEGISLATION REGARDING PUBLIC ADMINISTRATION ACTIVITIES IN THE FIELD OF HEALTH PROTECTION

Introduction. The relevance of the topic lies in the fact that the problem of legal conflicts regarding the activities of public administration in the field of health care is extremely important for any legal democratic society that is in the process of building or reforming its state system. The issue of collisions becomes especially important in the context of the reform of the administrative system and public administration in Ukraine, which has been going on for ten years, as well as in the conditions of bringing the legal framework into compliance with the requirements of martial law and European integration processes. Legal disputes can lead to inconsistencies in legislation, delays in decision-making, and even legal confusion, which is unacceptable in wartime. Understanding how to overcome legal conflicts can lead to faster and more efficient governance, especially between authorities in different countries and regions. This ensures not only better coordination, but also protection of the rights of citizens who may suffer from unclear legislation. The aim of the study. Identify and characterize conflicting points in the current legislation that regulate the activities of public administration in the field of health care. Materials and methods. In the course of conducting an in-depth study on the regulatory and legal regulation of the activities of the public administration in the field of health care, as a result of which 250 workers in the field of health care were interviewed, which confirm the imperfection of the current legislation in the field of health care. The results showed that the majority of medical workers do not support making any amendments to the legislation – 86% of them, 2% – support the global change of the current legislation, 2% refrained from answering. Results and discussion. The authors comprehensively define legal disputes in the field of healthcare as legal contradictions that arise due to subjective or objective reasons or errors during the implementation by patients of their rights and obligations due to the adoption of legal acts containing conflicting norms. In addition, legal disputes have the following features. First, they depend on the national legal system and, accordingly, on the legal regulation in the field of health care. Secondly, the sphere of public medical legal relations, in which legal disputes most often arise, is the question of medical significance. Thirdly, legal disputes most often arise when regulating typical issues, such as establishing the quality and efficiency of the provision of medical services; management of medical teams; possession, use and disposal of communal property. Conclusions. the proposed reforms of public administration in the field of health care have the potential to further guarantee the realization of everyone's right to health care. Summarizing the key directions of solving legal conflicts in the field of health care, the following tasks can be identified: 1) state guarantees of free medical care for socially vulnerable population groups; 2) introduction of adequate health care financing and an effective system of mandatory health insurance; 3) creation of conditions for the free development of entrepreneurship in the field of health care and formation of the basis for competition between medical institutions and formation of the basis for fair competition between health care institutions; 4) improvement of the country's legislation in the field of health care in accordance with international legal standards; 5) create optimal conditions for healthy childbirth, primarily in terms of living conditions, education and nutrition; 6) implement an active demographic policy aimed at increasing the birth rate and reducing the mortality rate; 7) ensure the ability to meet the needs of the population, primarily in the sphere of health care, education and nutrition.

Acute frailty services: results of a national day of care survey

IntroductionOlder people living with frailty are at high risk of emergency hospital admission and often have complex care needs which may not be adequately met by conventional models of acute care. This has driven the introduction of adaptations to acute care pathways designed to improve outcomes in this patient group. The identification of differences in the organisational approach to frailty may highlight opportunities for quality improvement.MethodsThe Society for Acute Medicine Benchmarking audit is a national service evaluation which uses a single day-of-care methodology to record patient and organisational level data. All acute hospitals in the United Kingdom are eligible to participate. Emergency admissions referred to acute medical services between 00:00 and 23:59 on Thursday 23rd June 2022 were recorded. Information on the structure and operational design of acute frailty services was collected. The use of a validated frailty assessment tool, clinical frailty scale within the first 24 h of admission, assessment by an acute frailty service and clinical outcomes were reported in patients aged 70 year and above. A mixed effect generalised linear model was used to determine factors associated same-day discharge without overnight stay in patients with frailty.ResultsA total of 152 hospitals participated. There was significant heterogeneity in the operational design and staffing model of acute frailty services. The presence of an acute frailty unit was reported in 57 (42.2%) hospitals. The use of validated frailty assessment tools was reported in 117 (90.0%) hospitals, of which 107 (91.5%) used the clinical frailty scale. Patient-level data were recorded for 3604 patients aged 70 years and above. At the patient level, 1626 (45.1%) were assessed using a validated tool during the admission process. Assessment by acute frailty services was associated with an increased likelihood of same-day discharge (adjusted OR 1.55, 95%CI 1.03- 2.39).ConclusionThere is significant variation in the provision of acute frailty services. Frailty-related policies and services are common at the organisational level but implemented inconsistently at the patient level. Older people with frailty or geriatric syndromes assessed by acute frailty services were more likely to be discharged without the need for overnight bed-based admission.

The role of sub-national actors in coordinative Europeanisation: insights from the digitalisation of asylum services

AbstractCoordinative Europeanisation is a powerful frame to explain the rapid response of EU institutions in times of permanent emergency. So far, though, little is known about sub-national actors’ role in this process. Moving away from a state-centric approach, this article investigates the role of sub-national actors through the case study of the digital provision of services to asylum seekers. Given the field’s high salience and state-centric nature, this article elucidates the critical role of European sub-national actors, particularly at the municipality level, to accelerate the digital provision of services to refugees. Comparing 3 European cities (Paris, Palermo and Malaga), we argue that sub-national actors can play a role in coordinative Europeanisation and that 2 main mechanisms may enable it. In the cases observed, discursive coordination around humanitarian duty facilitated the emergence of similar digital solutions across countries. Subsequently, horizontal and vertical networking was used by sub-national actors to legitimise their actions and enhance their anchoring in processes of coordinative Europeanisation.

«Digital nomads» in the modern labor market

The purpose of the research: Analyze the economic situation of digital nomads, their infl uence on the labor market, taking into account that they differ in dynamism of geographic mobility. To study the problems of non-traditional employment in the context of digitalization of the economy. Methodology: The paper uses a comparative analysis between digital nomads, freelancers and self-employed citizens, which showed that they form overlapping sets with such common feature as remote non-standard employment. Study of digital nomads involves the use of a non-ethnographic approach, including methods such as online immersive interaction, content analysis of websites, forums, blogs, etc. Originality/value of the research: Despite many publications, there are still a number of diffi culties in studying the phenomenon of digital nomads. The article discusses defi nition of digital nomads, their essential characteristics, differences from self-employed citizens and freelancers. The article proves an important role of digital nomads in the modern labor market, who provide information, technological, managerial support, and various types of services. Findings: Increase in level of the population mobility stimulated emergence of a new form of employment on the labor market. Digital nomads are distinguished by a high level of education and professional training; considerable freedom in choosing the production sphere and provision of services in the fi eld of intangible production. In post-covid conditions, digital nomads can contribute to replacement of lost workers.

Human Capital Portability and Careers in Finance

Abstract How does firm-specific human capital shape careers in the finance industry? We build a dynamic model where workers accumulate portable and nonportable (firm-specific) human capital and learn about their match quality with employers. Estimating the model using granular data on M&A advisory bankers, we show that a large fraction of bankers’ human capital is nonportable, ranging from 12% to 46% across different firm types. Bankers make a dynamic trade-off between portability and returns on human capital, leading to time-varying job preferences over their life cycle. Our results have broad implications for careers in finance and the provision of financial services.

The Impact of E-commerce and M-commerce Variations on Customers' Usage Shift from Online to Mobile

The increase of the demand, for higher-quality services is made possible by the flexibility, power, and desire for cellular offers. Indeed, this may refer to the provision of actual services at all times (regardless of the individual's location). Mobile commerce, or M-Commerce, has been introduced into the banking, services, retail, communications, and information technology sectors of today's business enterprises. Not only is mobile commerce (M-Commerce) becoming more broadly accepted in these areas, but it is also becoming a more popular method of conducting business. We attempt to give a summary of the foundations of both e- and m-commerce in this paper. This essay aims to assist business managers, especially those without an IT experience, in comprehending the fundamentals and components of m-commerce as well as evaluating the world.

Cloud Technologies as a Tool for Increasing Sales in Modern Trade Organizations.

In the context of increasing business digitalization and the need to adapt to the challenges of the digital economy, cloud technologies are becoming a key tool for enhancing the efficiency and competitiveness of trade organizations. This study is dedicated to analyzing the prospects and opportunities for using cloud solutions to increase sales in the trade sector. The article discusses the main models of cloud service provision, their advantages, and their impact on various tasks in the activities of trading enterprises. Special attention is given to the capabilities of cloud technologies in improving analytics, managing customer relationships, and implementing an omnichannel interaction strategy. The research concludes that the implementation of cloud solutions contributes to increased sales, cost optimization, and the formation of competitive advantages for trade organizations, setting the foundation for sustainable growth and development in the conditions of digital transformation and the increasing digital divide.

BPS DSEP position statement: Psychological skills training for performance enhancement, long-term development, and wellbeing in youth sport

Young athletes have become an increasingly important client group for sport psychology practitioners and a population whose physical, cognitive, emotional, and social development should be carefully considered by a practitioner when delivering their services (Visek et al., 2009). The aim of this British Psychological Society (BPS) Division of Sport and Exercise Psychology (DSEP) position statement is to summarise existing knowledge about psychological skills training (PST) interventions and discuss optimal service provision of PST in youth sport. In the first section of this position statement, we provide a brief overview of the literature exploring PST during childhood (5–11 years), early adolescence (12–15 years), and mid-to-late adolescence (16–18 years). Within each sub-section, key developmental considerations (i.e. physical, cognitive, emotional, and social) are provided followed by short summaries of research on basic single strategy (i.e. goal setting, imagery, relaxation, and self-talk) and alternative strategy interventions (e.g. mindfulness, music, perceptual training, and self-modelling) with young athletes. In the second section, optimal service provision of PST is discussed by drawing upon practitioners’ experiences of working with young athletes, concluding with 10 recommendations for youth sport organisations, training and accrediting bodies, researchers, and practitioners.

Cost-effectiveness of implementing performance-based financing for improving maternal and child health in Ethiopia.

Performance Based Financing (PBF) supports realization of universal health coverage by promoting bargaining between purchasers and health service providers through identifying priority services and monitoring indicators. In PBF, purchasers use health statistics and information to make decisions rather than merely reimbursing invoices. In this respect, PBF shares certain elements of strategic health purchasing. PBF implementation began in Ethiopia in 2015 as a pilot at one hospital and eight health centers. Prior to this the system predominantly followed input-based financing where providers were provided with a predetermined budget for inputs for service provision. The purpose of the study is to determine whether the implementation of PBF is cost-effective in improving maternal and child health in Ethiopia compared to the standard care. The current study used cost-effectiveness analysis to assess the effects of PBF on maternal and child health. Two districts implementing PBF and two following standard care were selected for the study. Both groups of selected districts share common grounds before initiating PBF in the selected group. The provider perspective costing approach was used in the study. Data at the district level were gathered retrospectively for the period of July 2018 to June 2021. Data from health service statistics were transformed to population level coverages and the Lives Saved Tool method used to compute the number of lives saved. Additionally for purpose of comparison, lives saved were translated into discounted quality-adjusted life years. The number of lives saved under PBF was 261, whereas number of lives saved under standard care was 194. The identified incremental cost per capita due to PBF was $1.8 while total costs of delivering service at PBF district was 8,816,370 USD per million population per year while the standard care costs 9,780,920 USD per million population per year. QALYs obtained under PBF and standard care were 6,118 and 4,526 per million population per year, respectively. The conclusion made from this analysis is that, implementing PBF is cost-saving in Ethiopia compared to the standard care. Due to lack of district-level survey-based data, such as prevalence and effects on maternal and child health, national-level estimates were used into the LiST tool.There may be some central-level PBF start-up costs that were not captured, which may have spillover effects on the existing health system performance that this study has not considered.There may be health statistics data accuracy differences between the PBF and non-PBF districts. The researchers considered using data from records as reported by both groups of districts.

Intellectual Disabilities and Neurocognitive Impairment in Adult Patients with Inherited Metabolic Diseases: A UK Single Centre Experience

Inherited metabolic diseases (IMDs) are a group of heterogeneous genetic disorders resulting in substrate accumulation, energy deficiency, or complex molecular defects due to the failure of specific molecules to act as enzymes, cofactors, transporters, or receptors in specific metabolic pathways. The pathophysiological changes seen in IMDs are sometimes associated with intellectual disability (ID) or neurocognitive decline, necessitating multidisciplinary input. We here describe our experience at one tertiary metabolic centre in the UK. We reviewed the case prevalence and existing service provision in one adult IMD service covering a multi-ethnic population of 10 million in North England. In our cohort of 2268 IMD patients, 1598 patients had general metabolic conditions (70.5%), and 670 had lysosomal storage disease/disorders (LSD)s (29.5%). The overall prevalence of ID and neurocognitive decline was found to be 15.7% (n = 357), with patients with LSDs accounting for 23.5% (n = 84) of affected patients. Given the prevalence of ID in adults with IMDs, access to multidisciplinary input from neuropsychology and neuropsychiatry services is important. Education of healthcare professionals to diagnose IMDs in patients with ID, in addition to neurocognitive and neuropsychiatric presentations, will avoid missed diagnoses of IMD and will have a positive effect on patient outcomes.

The disintegration and reproduction of communities: A social capital perspective of urban village's urbanisation in China

The urbanisation of rural communities with urban villages (chengzhongcun) as intermediates represents both a distinct rural-to-urban transition and a distinct formalization of informal urban settlements. This study examines, from a social capital perspective, how the urban village communities have shifted in their long-term urbanisation process (from rural villages to urban villages and then to urban neighbourhoods) in the past decades. Personal interviews with former villagers who have experienced such a process are the major data sources for this study. Key conclusions include: i) the urban village communities consistently lose social capital since the pre-redevelopment stage, resulting in gradual community disintegration; ii) the social capital loss is both an inevitable result of the internalisation of urban-rural differences in the community and an effective governance approach ensuring the rehousing neighbourhoods are not reproduced into informal settlements; iii) formalization of informal communities with losing social capitals requires significant public investments on public service provision, to compensate to the communities' loss of power over urban space (re)production; therefore, iv) reproduce social capital in the rehousing neighbourhood is in need in the long-term to reduce governance costs and enhance social service provision.

Non-participation of asymptomatic candidates in screening protocols reduces early diagnosis and worsens prognosis of colorectal cancer

The Agatsuma et al ’s study shows that despite the evidence of the benefits of an early colorectal cancer (CRC) diagnosis, through screening in asymptomatic subjects, up to 50% of candidates reject this option and many of those affected are diagnosed later, in advanced stages. The efficacy of screening programs has been well-established for several years, which reduces the risk of CRC morbidity and mortality, without taking into account the test used for screening, or other tools. Nevertheless, a significant proportion of patients remain unscreened, so understanding the factors involved, as well as the barriers of the population to adherence is the first step to possibly modify the participation rate. These barriers could include a full range of social and political aspects, especially the type of financial provision of each health service. In Japan, health services are universal, and this advantageous situation makes it easier for citizens to access to these services, contributing to the detection of various diseases, including CRC. Interestingly, the symptomatic CRC group had a lower early-stage diagnosis rate than the patients detected during follow-up for other comorbidities, and symptomatic and cancer screening groups showed similar early-stage diagnosis.

Non-participation of asymptomatic candidates in screening protocols reduces early diagnosis and worsens prognosis of colorectal cancer

The Agatsuma et al ’s study shows that despite the evidence of the benefits of an early colorectal cancer (CRC) diagnosis, through screening in asymptomatic subjects, up to 50% of candidates reject this option and many of those affected are diagnosed later, in advanced stages. The efficacy of screening programs has been well-established for several years, which reduces the risk of CRC morbidity and mortality, without taking into account the test used for screening, or other tools. Nevertheless, a significant proportion of patients remain unscreened, so understanding the factors involved, as well as the barriers of the population to adherence is the first step to possibly modify the participation rate. These barriers could include a full range of social and political aspects, especially the type of financial provision of each health service. In Japan, health services are universal, and this advantageous situation makes it easier for citizens to access to these services, contributing to the detection of various diseases, including CRC. Interestingly, the symptomatic CRC group had a lower early-stage diagnosis rate than the patients detected during follow-up for other comorbidities, and symptomatic and cancer screening groups showed similar early-stage diagnosis.

Lessons Learned Implementing Syringe Services Programs at Rural Health Departments in Kentucky.

Until recently, most syringe services programs (SSPs) in the United States operated in metropolitan areas. This study explores how SSP implementers at rural health departments in Kentucky secured support for SSP operations. In late 2020, we conducted in-depth, semi-structured interviews with 18 people involved with rural SSP implementation in Kentucky. Participants were asked to reflect on their experiences building support for SSP operations among rural health department staff and community members. Participants reported that attitudes and beliefs about SSP implementation among rural health department staff shifted quickly following engagement in educational activities and interaction with SSP clients. Participants explained that successful SSP implementation at rural health departments required sustained educational activities among community members and authorizing authorities. Future work should explore how rural communities may advocate for low-threshold and evidence-based policies that support the provision of harm reduction services.

Формування умов ефективного функціонування транспортної системи автотранспортного підприємства

Road transport enterprises must constantly pay attention to increasing the efficiency of the production of quality transport services, in accordance with the requirements and expectations of consumers. During the production and provision of transport services, the flow of production processes in the transport system, problems often arise in the external and internal environment of the enterprise, which require a mandatory solution. The most common problems include the following: non-compliance of technical means with the requirements and expectations of service consumers in terms of the quality of passenger service, ensuring the necessary conditions for cargo transportation; significant negative impact of the transport process on the natural environment; not fully ensuring the safety of passenger transportation and ensuring the safety of traffic on the roads; imperfection of the system, methods, mechanism of planning and monitoring of transportation processes; imperfection of regulatory and legal regulation and control of the technical condition of vehicles in the organization of transportation; the level of driver training is not always sufficient. When conducting research on the organization of transport processes and ensuring traffic safety on roads, the enterprise must use a methodical approach to evaluate the process of production of transport services, the functioning of the enterprise's production process, which must include three main stages: development of indicators and mechanisms for evaluating the flow of processes; assessment of the efficiency of the transportation process; analysis of assessment results and development of measures to improve service production processes. The main tasks of improving the processes of service production are the formation of the transport system of the enterprise, which includes: transport flows, personnel and technical support of transport, road environment in the transport zone. The transport system and all its constituent parts must be provided with means of monitoring and mechanisms of influence and improvement of the processes of production of transport services. The process of improving the functioning of the enterprise's transport system should be conducted in three important directions: monitoring the transport process, studying and analysing the service market and taking into account the requirements and expectations of consumers, using calculation methods to determine negative impacts on the process and developing measures and mechanisms to prevent them.