Provision Of Services Research Articles

Spatiotemporal evolution and driving factors of ecosystem service bundle based on multi-scenario simulation in Beibu Gulf urban agglomeration, China.

Rapid urbanization is profoundly impacting the ecological environment and landscape patterns, leading to a decline in ecosystem services (ES) and posing threats to both ecological security and human well-being. This study aimed to identify the spatial and temporal patterns of ecosystem service bundles (ESB) in the Beibu Gulf urban agglomeration from 2000 to 2030, analyze the trajectory of ESB evolution, and elucidate the drivers behind ESB formation and evolution. We utilized the Patch-generating Land Use Simulation (PLUS) model to establish baseline (BLS), carbon sequestration priority (CPS), and urbanization priority (UPS) scenarios for simulating land use patterns in 2030. Following the assessment of ecosystem service values (ESV) through the equivalent factor method, we identified the spatiotemporal distribution patterns of ESB using the K-means clustering algorithm. By employing stability mapping and landscape indices, we identified and analyzed various types of ESB evolutionary trajectories. Redundancy analysis (RDA) was employed to pinpoint the drivers of ESB formation and evolution. The results revealed that from 2000 to 2030, land use changes were primarily observed in cropland, forestland, and construction land. Between 2000 and 2020, 92.88% of the region did not experience shifts in ESB types. In UPS, the ESB pattern in the study area underwent significant changes, with only 76.68% of the region exhibiting stabilized trajectories, while the other two scenarios recorded percentages higher than 80%. Key drivers of ESB-type shifts included initial food provision services, elevation, slope, changes in the proportion of construction land, and population change. This multi-scenario simulation of ESB evolution due to land use changes aids in comprehending potential future development directions from diverse perspectives and serves as a valuable reference for formulating and changing ecological management policies and strategies.

By the people, for the people: Local government's representation of voter preferences under the Affordable Care Act

AbstractDecentralized government is hypothesized to lead public service investments to better align with political preferences across geographical regions, yet there has been limited rigorous testing of this hypothesis. We examine how local public provision of hospital services varied according to political preferences between 2006 and 2016. We use state Medicaid expansion under the Affordable Care Act (ACA) as a source of exogenous variation. Consistent with the motivation for federalism, we find that areas less supportive of the ACA tended to convert the state expansion into lower property taxes with lower public hospital expenditures, whereas, in states that expanded Medicaid, local governments tended to increase public provision of healthcare.

Evaluating dynamic tree-species-shifting and height development caused by ungulate browsing in forest regeneration using a process-based modeling approach

Ungulate browsing can prevent the successful regeneration and development of forest-owner-intended and climate-resilient admixed tree species, compromising the future provision of multiple ecosystem services. A reduction of the height increment of palatable tree species caused by ungulate browsing results in a competition shift in favor of less palatable species. While this key process of losing admixed tree species is well understood, forest growth models have not yet captured its full complexity. Therefore, our objectives were to simulate (i) the loss of susceptible tree species from different browsing regimes and its impact on stand development, (ii) changes in the height increment of saplings and trees, and (iii) the shifts in social status during stand development without pre-defined limits a sapling can resist browsing. To address these objectives, we used the process-based model iLand to simulate the exposure of Norway spruce, Silver fir, and European beech stands to varying browsing densities. We successfully reproduced expected dynamic shifts in species composition and height development 24 years after establishment, depending on ungulate pressure and species-specific competitive strength. Stand composition and growth differences already occur with slight changes in ungulate density. When saplings remained in stand structure, independent of the number being browsed, our results led to more individuals with substantially smaller dimensions. We found that dynamic tree species shifting can be simulated realistically by a process-based modeling approach, which can be used to show the strong impact of ungulates on stand development.

Wartime service provision and post-conflict state legitimacy: Perception-based foundation of sustainable development in Northwestern Pakistan

Promoting a peaceful environment is integral for socioeconomic reconstruction in conflict-affected societies. However, the absence of violence does not immediately result in national endeavors for development because a post-conflict state often lacks a popular base of state legitimacy owing to the wartime fragmentation of socio-political groups. Implementing a questionnaire survey in northwestern tribal areas in Pakistan, specifically the former Federally Administered Tribal Areas, this study explores how and why state legitimacy rises and declines as a result of wartime interactions between political actors and civilians. Empirical analyses of novel survey data reveal that wartime service provision is associated with post-conflict sustainable development regarding the civilian perception of legitimacy of the state. State legitimacy is strongly perceived by civilians who have received public services from the state and weakly by those who have been exposed to rebel services. We further disaggregate wartime service provision to explore the influence of providers and variety/types of services. The results indicate that the provision of a wider variety of wartime services impresses upon civilians’ perceived legitimacy; furthermore, while the delivery of basic and extra services beyond justice and security is associated with state legitimacy, the impact is conditional on service providers. State legitimacy has an important role in political stability and national collectivity needed for post-conflict sustainable development. As wartime civil–military relations persistently influence civilians’ perception of political legitimacy, post-conflict reconstruction needs to take locals’ experiences into consideration so that the development initiatives can be legitimate and sustainable.

Complete Blood Count Reference Intervals for Children Aged Less Than 1 to 12 Years in the Northern Region of Ghana

Reliable laboratory diagnostic results are key for evaluating and improving children’s health. To interpret these results, child-specific reference intervals (RIs), which account for constant biological changes and physiological development with sex and age, are required, as recommended by the Clinical and Laboratory Standards Institute (CLSI). This study presents age- and sex-specific reference intervals for complete blood count (CBC) parameters in children (<1–12 years old) in the Northern Region of Ghana. In this cross-sectional study, 600 healthy children from randomly sampled schools in Tamale (the Northern Region) were recruited and screened. Data from 388 eligible children were used to nonparametrically determine the reference intervals of CBC parameters at the 2.5th and 97.5th percentiles. The CBC reference intervals were compared for variations in sex and age groups using the Wilcoxon rank-sum test. There were no statistically significant differences in most CBC parameters by sex (RBC, Hb, HCT, MCH, RDW (CV/SD), WBC, LYM#, MON#(%) NEU#(%), EOS#(%), and BAS#(%); p>0.05) and age group (RBC, MCV, RDW (CV/SD), WBC, LYM#, MON#(%) NEU#(%), EOS#(%), and BAS%; p>0.05). However, there were observable differences between this locally established CBC reference interval and that used for children at Tamale Teaching Hospital (manufacturer’s RIs). This study emphasises the importance of determining reference intervals representative of the local child population and incorporating them into the current reporting system of laboratories in the Northern Region to ensure the provision of effective and efficient healthcare services.

Nurses’ characteristics and spiritual care knowledge in hospital setting: A cross-sectional study

Background: The low awareness among nurses regarding the provision of spiritual services in healthcare settings results in unmet spiritual needs among patients, leading hospitals to be perceived solely as centers focusing on physical aspects. This stems from nurses’ low competence in providing spiritual care services. Objective: This study aims to analyze the correlation between nurses’ characteristics and their knowledge of spiritual care in a hospital setting. Methods: A retrospective cross-sectional study was conducted, with respondents recruited using a purposive sampling technique. Inclusion criteria included nurses working in hospitals who directly care for patients. Data were analyzed using univariate analysis (frequency and percentage) and bivariate analysis using Fisher’s exact test. Result: A total of 117 nurses participated in this study, of whom 59.8% were female, 63.25% were aged <31 years old, 77.8% were permanent workers, 57.2% had work experience < 5 years, 91.5% were Muslim, 55.6% attended workshops/seminars, and 76.9% had moderate knowledge. Workshops/seminars had a positive correlation with knowledge and were statistically significant. Conclusion: Spiritual workshops/seminars have a positive correlation and are statistically significant in enhancing nurses’ knowledge of spiritual care in a hospital setting. Therefore, there is a need to improve nurses’ spiritual care knowledge through continuing education, such as training, seminars, or workshops.

Agricultural Information Needs and Resources of Smallholder Sugarcane Farmers in Swaziland

Abstract The sugar industry is the dominant agricultural sector in Swaziland’s economy, contributing significantly to the gross domestic product. Provision of relevant and timely information to smallholder sugarcane farmers is crucial for them to have a competitive footing with large-scale counterparts and reduce poverty. However, there is limited literature on the information needs and the kind of information communication resources that could make the dissemination of information to farmers efficient and effective. This study thus aims to investigate the information needs and resources of smallholder sugarcane farmers in Swaziland to inform the provision of information services in the sugar industry. It was underpinned by a positivist paradigm and used the survey research method complemented by methodological triangulation to collect quantitative and qualitative data. Data was collected using survey questionnaires and face-to-face interviews, with 168 responses and six interviews conducted. The findings revealed that 71 % of information needs of farmers were primarily in legislative compliance, sugarcane crop husbandry, markets and transport, and financial advice information, however, there were no statistically significant differences between the three mill groups in information needs. The smallholder sugarcane farmers also mostly obtained agricultural information through extension officers, farmer groups, and mobile phones, indicating that required information was mainly accessed through face-to-face interactions. The empirical findings of the study have implications for practice, policy, and theory with respect to guiding the implementation of agricultural information services by information providers in the context of rural farmers in developing countries.

A bridge between worlds: Embedding research in telepractice co‐design with disability community

AbstractIntroductionCo‐production approaches are increasingly being advocated for as a way of addressing the research translatory gap while including patient and public involvement in development of services they access, and particularly in disability service provision. Embedded research (ER) is a method which integrates the researcher within the target organization to better facilitate both co‐production of research outputs and the reduction of the research translation gap. The aim of this reflection is to better understand the commonalities and differences between ER in a disability context to accounts published in academic literature.MethodA review of embedded researcher literature was completed in combination with a personal reflection of lived experience as an embedded researcher within a disability support service organization. The reflective process included review of research journal entries and other records of lived experience (photographs, audio recordings, drawings) maintained throughout the period in the role of embedded researcher. A reflexive thematic analysis process was used.ResultsI reflect throughout the article upon five themes which highlight both the commonalities between my experiences and those of other embedded researchers as well as instances where they differed. The five themes include (1) A knowledge bridge, (2) Considerations of positionality, (3) Ethical complexity, (4) Anticipating change, and (5) Existing in the in‐between together.ConclusionExperiences of ER appear to transcend the discipline in which the research is being embedded, and while the lived experience in a disability host organization was invaluable in facilitating a successful co‐produced research project, significant avenues for improvement exist in terms of ethical frameworks, methodological guidance, and communities of support.

Evaluating video and hybrid group consultations in general practice: mixed-methods, participatory study protocol (TOGETHER 2)

Background General practice is facing an unprecedented challenge in managing the consequences of the pandemic. In the midst of a policy drive to balance remote and in-person service provision, substantial workload pressures remain, together with increasing prevalence of long-term conditions, and declining staff numbers and morale. To address these challenges, some practices in the UK have been delivering video and hybrid group consultations (VHGCs). Despite positive initial findings and enthusiasm, there are still gaps in our understanding of the influence VHGCs have on patient experience, healthcare utilisation, quality, safety, equity and affordability. Objectives To generate an in-depth understanding of VHGCs for chronic conditions in general practice, surface assumptions and sociotechnical dynamics, inform practice and extend theorisation. Methods Mixed-methods, multi-site research study using co-design and participatory methods, from qualitative, quantitative and cost-related perspectives. WP1 includes a national, cross-sectional survey on VHGC provision across the UK. In WP2 we will engage patients and general practice staff in co-design workshops to develop VHGC models with emphasis on digital inclusion and equity. In WP3 we will carry out a mixed-methods process evaluation in up to 10 GP practices across England (5 sites already running VHGCs and 5 comparison sites). Qualitative methods will include interviews, focus groups and ethnographic observation to examine the experiences of patients, carers, clinical and non-clinical NHS staff, commissioners and policy-makers. Quantitative methods will examine the impact of VHGCs on healthcare utilisation in primary and secondary care, patient satisfaction, engagement and activation. We will also assess value for money of group and individual care models from a health economics perspective. Conclusions We aim to develop transferable learning on sociotechnical change in healthcare delivery, using VHGCs as an exemplar of technology-supported innovation. Findings will also inform the design of a future study.

Approaches for prevention of mother-to-child transmission of HIV services during coronavirus disease 2019

Background: During the coronavirus disease 2019 (COVID-19) pandemic, there was a reduction in access to prevention of mother-to-child transmission (PMTCT) of human Immunodeficiency virus (HIV) services globally, yet this programme is critical for reducing paediatric HIV incidence. To minimise the impact of COVID-19 and prevent disruptions to the PMTCT service provision, innovative strategies had to be developed and implemented.Aim: The study aimed to describe the approaches that were developed and utilised during the COVID-19 pandemic in enhancing PMTCT services in Tshwane primary healthcare facilities.Settings: Three primary healthcare facilities that were providing PMTCT services during the COVID-19 pandemic located in the Tshwane district, Gauteng province, South Africa.Methods: The study is part of a larger study that focused on the experiences of healthcare workers who were rendering PMTCT services during the COVID-19 pandemic. An interpretative phenomenological analysis (IPA) design was employed to gain insight into the experiences of 16 purposively sampled healthcare workers who were providing PMTCT services during the pandemic in Tshwane district facilities. In-depth individual audio-recorded interviews were conducted with study participants, following a semi-structured interview guide. Data analysis was performed using an IPA framework.Results: Three superordinate themes emerged: strategies utilised for providing care, community-based initiatives, and support systems to enhance the PMTCT service access.Conclusion: Strengthening community-based initiatives and support systems is important for the enhancement of the PMTCT programme during and beyond the pandemic.Contribution: Community-based initiatives are critical in continuity of PMTCT services, reducing HIV incidence, under-five child morbidity and mortality particularly during emergency situations.

Design and development of the clinical pharmacy key performance indicators dashboard for equity of service provision at regional and rural hospitals in North Queensland, Australia

AbstractBackgroundProvision of a Medication Action Plan (MAP) on admission and a Discharge Medication Record (DMR) are associated with reduced medication‐related harm.AimTo report factors associated with the provision of MAPs and DMRs in rural and regional hospitals in Queensland, Australia.MethodA literature search, environmental scan and department consultations were conducted to develop Clinical Pharmacy Key Performance Indicators (cpKPIs) and design a cpKPI dashboard. Two of the five KPIs included in the dashboard, relating to medication action plans on admission and medication records on discharge, were reported for all the hospitals and were included in the study. A retrospective, period‐prevalence study was conducted to evaluate the coverage and equity of clinical pharmacy service provision for patients admitted for longer than 24 h. The proportions of patients who received MAPs and DMRs were stratified by age, gender, Indigeneity and hospital type. Statistical analysis used chi‐squared tests and logistic regression in R. This project was exempt due to the local policy requirements that constitute research by the Far North Queensland Human Research Ethics Committee (Reference no: EX/2023/QCH/94383‐1684QA). The justification for this exemption is as follows: the project was determined to be negligible risk research and involved the use of existing collection of data or records that contain only non‐identifiable data about human beings.ResultsIn total, 13 818 patients (37.9% of admissions) received a MAP and 11 631 patients (32.7% of discharges) received a DMR. The proportion of MAPs and DMRs was significantly higher in rural hospitals than in regional hospitals (MAP 50.6% vs 34.6%, DMR 33.1% vs 31.3%) and for male patients than female patients (MAP 42.2% vs 33.7%, DMR 36.4% vs 29.2%). When stratified by age, First Nations patients received a higher proportion of MAPs and DMRs in each age group, except for age 85 years and over. The proportion of First Nations patients aged 50 years and over who received MAP was lower compared to that for non‐Indigenous patients aged 65 years and over (56.3% vs 59.8%), whilst the proportion for DMRs was similar (50.4% vs 49.3%).ConclusionThe study defined the clinical pharmacy key performance indicators for measuring equity of clinical pharmacy service provision in Australia. When adjusted for a difference in life expectancy, the proportion of MAPs for First Nations patients was lower compared to the proportion of MAPs for non‐Indigenous patients. Further improvements are required to achieve equity of service provision for First Nations patients and female patients.

Assessing the resilience of HIV healthcare services provided to adolescents and young adults after the COVID-19 pandemic in the city of Beira (Mozambique): an interrupted time series analysis

BackgroundThe COVID-19 pandemic has put the provision of health services globally at risk. In Sub-Saharan Africa, it had a major impact on HIV services. However, there is a lack of data on the post-pandemic period. This study aims to evaluate the resumption of HIV services and retention in care for adolescents and young people in the period following the COVID-19 pandemic.MethodsA retrospective cohort study was conducted using interrupted time series analysis. Three periods were considered: pre-pandemic (form June 2019 to March 2020), pandemic (form April 2020 to March 2022) post-pandemic (from April 2022 to March 2023). Six outcome measures were considered: number of outpatient visits, HIV tests, HIV positivity ratio, the antiretroviral treatment (ART) non-adherence ratio, recall ratio, and the return ratio for adolescent and young adults on ART.ResultsDuring the study period, 447,515 outpatient visits and 126,096 HIV tests were recorded. After a reduction at the beginning of the pandemic period, both visits and tests increased during the pandemic (p < 0.05) and decreased in the post-pandemic (p < 0.05), recovering the pre-pandemic trends. The HIV positivity ratio slightly decreased from 3.3% to 1.7% during the study period (p < 0.05). The ART non-adherence ratio decreased from 23.4% to 2.4% throughout the study period (p < 0.05), with a drop at the beginning of the post-pandemic period (p < 0.05). The recall ratio increased during the study period (p < 0.05) with a drop at the beginning of the pandemic and post-pandemic periods (p < 0.05). The return ratio decreased at the beginning of the pandemic (p < 0.05) but returned to the pre-pandemic ratio in the post-pandemic period.ConclusionsThe post-pandemic values of the investigated outcomes were comparable to pre-pandemic period, or even improved. Differently from other services, such as the community activities, that have been severely affected by COVID-19 pandemic, the HIV service system has shown resilience following emergency situation.

Overlooked by the obstetric gaze – how women with persistent health problems due to severe perineal trauma experience encounters with healthcare services: a qualitative study

BackgroundDuring the first year postpartum, about 25 per cent of Swedish women with severe perineal trauma (SPT), i.e., a third- or fourth-degree perineal laceration at childbirth, are unsatisfied with their healthcare contacts. Further, there is a lack of research on the more long-term experiences of healthcare encounters among women with persistent SPT-related health problems. This study explores how women with self-reported persistent SPT-related health problems experience their contact with healthcare services 18 months to five years after childbirth when the SPT occurred.MethodsIn this descriptive qualitative study, a purposive sample of twelve women with self-reported persistent health problems after SPT were individually interviewed from November 2020 – February 2022. The data was analysed using inductive qualitative content analysis.ResultsOur results showed a paradoxical situation for women with persistent health problems due to SPT. They struggled with their traumatised body, but healthcare professionals rejected their health problems as postpartum normalities. This paradox highlighted the women’s difficulties in accessing postpartum healthcare, rehabilitation, and sick leave, which left them with neglected healthcare needs, diminished emotional well-being, and loss of financial and social status. Our results indicated that these health problems did not diminish over time. Consequently, the women had to search relentlessly for a ‘key person’ in healthcare who acknowledged their persistent problems as legitimate to access needed care, rehabilitation, and sick leave, thus feeling empowered.ConclusionsOur study revealed that women with persistent SPT-related health problems experienced complex health challenges. Additionally, their needs for medical care, rehabilitation, and sick leave were largely neglected. Thus, the study highlights an inequitable provision of SPT-related healthcare services in Sweden, including regional disparities in access to care. Hence, the authors suggest that Swedish national guidelines for SPT-related care need to be developed and implemented, applying a woman-centered approach, to ensure equitable, effective, and accessible healthcare.

Stress, anxiety, depression and sleep disturbance among healthcare professional during the COVID-19 pandemic: An umbrella review of 72 meta-analyses

The outbreak of SARS-CoV-2, which causes COVID-19, has significantly impacted the psychological and physical health of a wide range of individuals, including healthcare professionals (HCPs). This umbrella review aims provide a quantitative summary of meta-analyses that have investigated the prevalence of stress, anxiety, depression, and sleep disturbance among HCPs during the COVID-19 pandemic. An umbrella review of systematic reviews and meta-analyses reviews was conducted. The search was performed using the EMBASE, PubMed, CINAHL, MEDLINE, PsycINFO, and Google Scholar databases from 01st January 2020 to 15th January 2024. A random-effects model was then used to estimate prevalence with a 95% confidence interval. Subgroup analysis and sensitivity analyses were then conducted to explore the heterogeneity of the sample. Seventy-two meta-analyses involved 2,308 primary studies were included after a full-text review. The umbrella review revealed that the pooled prevalence of stress, anxiety, depression, and sleep disturbance among HCPs during the COVID-19 pandemic was 37% (95% CI 32.87–41.22), 31.8% (95% CI 29.2–34.61) 29.4% (95% CI 27.13–31.84) 36.9% (95% CI 33.78–40.05) respectively. In subgroup analyses the prevalence of anxiety and depression was higher among nurses than among physicians. Evidence from this umbrella review suggested that a significant proportion of HCPs experienced stress, anxiety, depression, and sleep disturbance during the COVID-19 pandemic. This information will support authorities when implementing specific interventions that address mental health problems among HCPs during future pandemics or any other health crises. Such interventions may include the provision of mental health support services, such as counseling and peer support programs, as well as the implementation of organizational strategies to reduce workplace stressors.

An assessment of future rewilding potential in the United Kingdom.

Restoring ecosystems is an imperative for addressing biodiversity loss and climate change, and achieving the targets of the Kunming-Montreal Global Biodiversity Framework. One form of restoration, rewilding, may have particular promise but may also be precluded by requirements for other forms of land use now or in the future. This opportunity space is critical but challenging to assess. We explored the potential area available for rewilding in Great Britain until the year 2080 with a multisectoral land-use model with several distinct climatic and socioeconomic scenarios. By 2080, areas from 5000 to 7000km2 were either unmanaged or managed in ways that could be consistent with rewilding across scenarios without conflicting with the provision of ecosystem services. Beyond these areas, another 24,000-42,000km2 of extensive upland management could provide additional areas for rewilding if current patterns of implementation hold in the future. None of these areas, however, coincided reliably with ecosystems of priority for conservation: peatlands, ancient woodlands, or wetlands. Repeatedly, these ecosystems were found to be vulnerable to conversion. Our results are not based on an assumption of support for or benefits from rewilding and do not account for disadvantages, such as potential losses of cultural landscapes or traditional forms of management, that were beyond the modeled ecosystem services. Nevertheless, potential areas for rewilding emerge in a variety of ways, from intensification elsewhere having a substantial but inadvertent land-sparing effect, popular demand for environmental restoration, or a desire for exclusive recreation among the wealthy elite. Our findings therefore imply substantial opportunities for rewilding in the United Kingdom but also a need for interventions to shape the nature and extent of that rewilding to maintain priority conservation areas and societal objectives.

Improving Women’s Representation in Politics through Gender Quotas

Gender quotas for women in local government bodies can improve women’s representation in politics, increase provision of public services, and improve perceptions of women as leaders. Gender quotas are one policy tool designed to increase women’s representation in politics. Women hold fewer than 25 percent of parliamentary seats worldwide, and just 12 percent of the world’s heads of state and government are women. In many countries this imbalance extends to local governments. Countries are taking action In 2013, 118 countries were implementing a form of gender quotas for an elected office. Women's empowerment and their full participation on the basis of equality in all spheres of society, including participation in the decision making process and access to power ,are fund a mental for the achievement to fequality , development and peace. One way to implement gender quotas is by reserving a certain number of leadership positions for women. A review of eleven randomized evaluations in India, Lesotho, and across 28 states in India found that reservation quotas influenced women’s political participation and policy outcomes and increased the provision of public goods aligned with female voters’ preferences. Further, quotas improved men’s perceptions of women as leaders, increased the aspirations of girls, and helped women get elected even after quotas were removed. Most of the rigorous research drawn on in this insight comes from India comparative conclusions should be drawn cautiously. This evidence largely suggests that governments seeking to improve women’s representation in politics should consider reservation quotas for local leadership positions. overview of the three main types of quota policies reserved seats, party quotas, and legislative quotas. These are found in all major world regions in countries with a broad range of institutional, social, economic, and cultural characteristics. At the same time, the mere advent of gender quotas has not resulted in uniform increases in the percentage of women in parliament worldwide some countries have witnessed dramatic increases, while others have seen more modest changes or even setbacks in the number of women elected to national assemblies. Despite the rapid international diffusion of these measures, most research has focused on single countries or, at most, the presence of quotas within one world region. Consequently, explanations for the adoption and impact of gender quotas derived from one study often contradict .

Co-creation of a novel approach for improving supply chain management for SARS-CoV-2 point of care diagnostic services in Mopani District, Limpopo Province: nominal group technique

IntroductionEffective supply chain management (SCM) of point-of-care (POC) tests for diseases like severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) requires active participation from diverse stakeholders, government entities, and regulatory bodies. The responsibility for overseeing various aspects of POC tests, including procurement, quality assurance, storage, inventory management, distribution, and human resource capacity, lies with national, provincial, and local levels of government. This study aimed to collaboratively develop an innovative approach to enhance SCM for SARS-CoV-2 POC diagnostic services in resource-limited settings, using the Mopani District in Limpopo province, South Africa, as a case study.MethodsKey stakeholders were invited to participate in an online workshop using purposive sampling. The study employed the nominal group technique (NGT) for data collection, which consisted of two phases. Phase 1 focused on identifying barriers in the supply chain of COVID-19 rapid tests, while phase 2 aimed to devise strategies to overcome the priority barriers identified in phase 1. Participants used a Likert scale of 1–5 to rank barriers and strategies, and an overall ranking score was calculated for each. The participants were provided with the results of the ranking exercise for their feedback.ResultsEleven key stakeholders from national (n = 1), provincial (n = 4), and local government (n = 2) levels, research entities (n = 3), and non-governmental organizations (n = 1) took part in the study. Participants identified significant barriers in the supply chain, such as the availability of testing kits, unknown demand, information on SCM during a pandemic, methods of controlling stock, and procurement processes. Strategies suggested by key stakeholders included monitoring stock levels and optimizing stock visibility systems to improve test availability, enhancing information visibility and consistent data updates to address unknown demand and improve SCM during a pandemic, employing data capturing and digitization for effective stock control, and implementing demand planning and standardized procurement processes at the national level to enhance stock procurement.DiscussionThe successful collaboration with key stakeholders, facilitated by the NGT, resulted in the co-creation of a novel approach to enhance SCM for COVID-19 diagnostic services in resource-limited settings. This study holds the potential to support the provision of COVID-19 diagnostic services in such settings. A recommended follow-up study would assess the feasibility of implementing this approach.

Foot and ankle problems in children and young people: a population-based cohort study.

The aim of this research was to describe the epidemiology, presentation and healthcare use in primary care for foot and ankle problems in children and young people (CYP) across England. We undertook a population-based cohort study using data from the Clinical Practice Research Datalink Aurum database, a database of anonymised electronic health records from general practices across England. Data was accessed for allCYP aged 0-18 years presenting to their general practitioner between January 2015 and December 2021 with a foot and/or ankle problem. Consultation rates were calculated and used to estimate numbers of consultations in an average practice. Hierarchical Poisson regression estimated relative rates of consultations across sociodemographic groups and logistic regression evaluated factors associated with repeat consultations. A total of 416,137 patients had 687,753 foot and ankle events, of which the majority were categorised as "musculoskeletal" (34%) and "unspecified pain" (21%). Rates peaked at 601 consultations per 10,000 patient-years among males aged 10-14 years in 2018. An average practice might observe 132 (95% CI 110 to 155) consultations annually. Odds for repeat consultations were higher among those with pre-existing diagnoses including juvenile arthritis (OR 1.73, 95% CI 1.48 to 2.03). Conclusions: Consultations for foot and ankleproblems were high among CYP, particularly males aged 10 to 14 years. These data can inform service provision to ensure CYP access appropriate health professionals for accurate diagnosis and treatment. What is Known: • Foot and ankle problems can have considerable impact on health-related quality of life in children and young people (CYP). • There is limited data describing the nature and frequency of foot and ankle problems in CYP. What is New: • Foot and ankle consultations were higher in English general practice among CYP aged 10 to 14 years compared to other age groups, and higher among males compared to females. • The high proportion of unspecified diagnoses and repeat consultations suggests there is need for greater integration between general practice and allied health professionals in community-based healthcare settings.

A Qualitative Analysis of the Effects of COVID-19 on Home Visiting Service Provision.

Home visiting programs have been found to improve parenting practices and to reduce negative child outcomes. The 2019 coronavirus disease (COVID-19) resulted in an abrupt transition to telehealth services for many home visiting services. Limited research has examined the impacts of delivering home visiting services via telehealth, and the effects of this abrupt transition during COVID-19 is understudied as well. This study examined the impact of the abrupt transition to telehealth as a result of COVID-19 on home visiting service provision in one mid-sized midwestern community from the perspective of clients and providers. We conducted semi-structured interviews with both home visiting clients and providers (N = 26) in prevention-focused home visiting services. Although some benefits to telehealth were reported, providers discussed challenges with regard to engaging clients in services and difficulties in completing important home visiting tasks (i.e., assessment of child development, teaching parent-child interaction). Providers and clients also noted that they missed face-to-face interactions. Effective use of telehealth in home visiting requires provision of devices that allow for video-chatting as well as development of effective methods to engage in observation and teaching tasks.

Structural and social changes due to the COVID-19 pandemic and their impact on engagement in substance use disorder treatment services: a qualitative study among people with a recent history of injection drug use in Baltimore, Maryland

BackgroundSubstance use disorder treatment and recovery support services are critical for achieving and maintaining recovery. There are limited data on how structural and social changes due to the COVID-19 pandemic impacted individual-level experiences with substance use disorder treatment-related services among community-based samples of people who inject drugs.MethodsPeople with a recent history of injection drug use who were enrolled in the community-based AIDS Linked to the IntraVenous Experience study in Baltimore, Maryland participated in a one-time, semi-structured interview between July 2021 and February 2022 about their experiences living through the COVID-19 pandemic (n = 28). An iterative inductive coding process was used to identify themes describing how structural and social changes due to the COVID-19 pandemic affected participants’ experiences with substance use disorder treatment-related services.ResultsThe median age of participants was 54 years (range = 24–73); 10 (36%) participants were female, 16 (57%) were non-Hispanic Black, and 8 (29%) were living with HIV. We identified several structural and social changes due the pandemic that acted as barriers and facilitators to individual-level engagement in treatment with medications for opioid use disorder (MOUD) and recovery support services (e.g., support group meetings). New take-home methadone flexibility policies temporarily facilitated engagement in MOUD treatment, but other pre-existing rigid policies and practices (e.g., zero-tolerance) were counteracting barriers. Changes in the illicit drug market were both a facilitator and barrier to MOUD treatment. Decreased availability and pandemic-related adaptations to in-person services were a barrier to recovery support services. While telehealth expansion facilitated engagement in recovery support group meetings for some participants, other participants faced digital and technological barriers. These changes in service provision also led to diminished perceived quality of both virtual and in-person recovery support group meetings. However, a facilitator of recovery support was increased accessibility of individual service providers (e.g., counselors and Sponsors).ConclusionsStructural and social changes across several socioecological levels created new barriers and facilitators of individual-level engagement in substance use disorder treatment-related services. Multilevel interventions are needed to improve access to and engagement in high-quality substance use disorder treatment and recovery support services among people who inject drugs.