Provision Of Services Research Articles

Factors influencing peripheral intravenous catheter practice of nurses in small and medium sized hospitals: a cross-sectional study

BackgroundThe importance of the peripheral intravenous catheter (PIVC) practices on patient safety is increasing. Small and medium-sized hospitals play a central role in the provision of healthcare services in South Korea, but lack a system for quality improvement, leaving patient safety at risk. This study aimed to identify the extent to which the PIVC practice knowledge of nurses, the nursing working environment, and the patient safety-culture perception affect PIVC practices and thereby provide basic data for improving the PIVC practices in small and medium-sized hospitals.MethodsThis study had a cross-sectional descriptive design to identify the factors affecting PIVC nursing practices in small and medium-sized hospitals. Questionnaires returned by 149 nurses collected data on general characteristics, practical knowledge of PIVC nursing, nursing working environment, patient safety-culture perception, and PIVC practices. The questionnaire data were analysed using descriptive statistics, the independent t-test, one-way ANOVA, Scheffé’s test, Pearson correlation, and hierarchical regression analysis.ResultsThe mean score of PIVC practices was 4.60 out of 5. Length of clinical experience, practical knowledge of PIVC nursing and patient safety-culture perception were significant factors affecting the PIVC nursing practices, with these variables explaining 26.2% of the variance therein.ConclusionsThe PIVC practices of nurses in small and medium-sized hospitals can be improved by providing education and training based on the latest standard or guideline to facilitate the acquisition of knowledge and skills. And campaigns and programs to strengthen patient safety culture perception specific to small and medium-sized hospital should be implemented. to ensure the safety of PIVC practice.

Impact of the COVID-19 pandemic on type 2 diabetes care and factors associated with care disruption in Kenya and Tanzania

ABSTRACT Background The COVID-19 pandemic affected healthcare delivery globally, impacting care access and delivery of essential services. Objectives We investigated the pandemic’s impact on care for patients with type 2 diabetes and factors associated with care disruption in Kenya and Tanzania. Methods A cross-sectional study was conducted among adults diagnosed with diabetes pre-COVID-19. Data were collected in February–April 2022 reflecting experiences at two time-points, three months before and the three months most affected by the COVID-19 pandemic. A questionnaire captured data on blood glucose testing, changes in medication prescription and access, and healthcare provider access. Results We recruited 1000 participants (500/country). Diabetes care was disrupted in both countries, with 34.8% and 32.8% of the participants reporting change in place and frequency of testing in Kenya, respectively. In Tanzania, 12.4% and 17.8% reported changes in location and frequency of glucose testing, respectively. The number of health facility visits declined, 14.4% (p < 0.001) in Kenya and 5.6% (p = 0.001) in Tanzania. In Kenya, there was a higher likelihood of severe care disruption among insured patients (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI][1.05–2.34]; p = 0.029) and a lower likelihood among patients residing in rural areas (aOR, 0.35[95%CI, 0.22–0.58]; p < 0.001). Tanzania had a lower likelihood of severe disruption among insured patients (aOR, 0.51[95%CI, 0.33–0.79]; p = 0.003) but higher likelihood among patients with low economic status (aOR, 1.81[95%CI, 1.14–2.88]; p = 0.011). Conclusions COVID-19 disrupted diabetes care more in Kenya than Tanzania. Health systems and emergency preparedness should be strengthened to ensure continuity of service provision for patients with diabetes.

Exploring the lived experiences of gender-based violence survivors among female sex -workers in Rivers State, Nigeria.

Gender-based violence (GBV) remains a global challenge, with women and young girls being the major victims. Female sex workers are also adversely affected. However, there is limited evidence about the lived experiences and coping strategies of Female Sex Workers (FSW) in Rivers State, Nigeria. Hence, this study was guided by objectives that focused on determining: the effect of GBV on FSW in Rivers State and coping strategies adopted by Gender-based violence survivors to manage the challenges associated with it. Data were collected from 12 female sex workers using semi-structured interviews and were analyzed thematically using the NVivo12 software. Findings showed that enforcement agents, intimate partners, relatives, friends, clients, and recruiters were perpetrators of gender-based violence. The participants identified their lack of agency, poverty, lack of alternative means of livelihood, and desire to protect their parents as drivers of gender-based violence. The participants admitted having experienced physical and mental health challenges. The participants adopted several coping mechanisms: substance abuse, religion, self-defence, and relocation. The researchers concluded that increased awareness about available services, unbiased service provision, designated human rights officers, and prosecution of perpetrators would encourage disclosure and boost access and uptake of services.

Vascular service provision during the COVID-19 pandemic worsened major amputation rates in socially deprived diabetic populations.

The Coronavirus Disease - 2019 (COVID-19) pandemic significantly impacted healthcare service provision and put diabetic patients at increased risk of adverse health outcomes. We aimed to assess the impact of the COVID-19 pandemic on the incidence and demographic shift of major lower-limb amputation in diabetic patients. We performed a retrospective analysis of diabetic patient records undergoing major lower-limb amputation between 01/03/2019 and 01/03/2021 at the Royal Sussex County Hospital, the regional arterial hub for Sussex. Primary outcomes were amputation incidence rates and patient demographics compared between the prepandemic and pandemic cohorts. The incidence rate ratio of major lower-limb amputations shows a drop in amputations during the pandemic compared to pre-pandemic (IRR 0.82; 95% CI 0.57-1.18). Data suggests a shift in the social deprivation background of patients receiving amputations to disproportionately affect those in the more deprived 50% of the population (p=0.038). Younger patients received more amputations during the pandemic compared to prepandemic levels (p=0.001). Results suggest that during the COVID-19 pandemic there was a paradoxical reduction in amputations compared to prepandemic levels. However, changes to the demographic makeup of patient's receiving amputations are alarming as younger, and more deprived patients have been disproportionately affected by the pandemic.

Economic Alternatives for the Provision of URLLC and eMBB Services Over a 5G Network

This research work analyzes economic alternatives for the provision of ultra-reliable low latency communication (URLLC) and enhanced mobile broadband (eMBB) services by mobile network operators over the same fifth-generation (5G) network. Two business models are proposed to provide the two services to end users. Concretely, a monopoly is a single operator who offers both services, and a duopoly is two different operators that share network resources and offer one service each. In addition, two types of network scenarios for resource sharing are studied. Specifically, a shared network (SN) is a type of network scenario allowing resources to be shared between the two services without priority. A differentiated network (DN) is a type of network scenario that allows resources to be shared between the two services with a priority to URLLC service using network slicing (NS). Regarding the economic aspects, the incentive is modeled through the user’s utility and the operator’s benefit. At the same time, game theory is used to model the strategic interaction between users and operators, and queuing theory is used to model the interaction between the two services. We conclude that the monopoly social welfare (SW) is closer to the SW of the social optimum than the duopoly SW. In addition, the DN scenario to offer the services through NS is more suitable than the SN scenario since the point of view of service prices, user utilities, and operator benefit.

Using proxy data and vegetation modelling to predict past, current and future distributional shifts of Butea monosperma, a marker of land degradation in India

Extensive deviations in spatio-temporal social and environmental dynamics currently alter the health of ecosystems and the services they provide. Detecting the causes that contribute to the distribution of a natural forest species capable of restoring the lost ecosystem function and productivity will aid in determining better food security, livelihoods and provision of ecosystem goods and services. We modelled the spatial range of Butea monosperma (B. monosperma) under past, that is, Last Glacial Maximum (LGM), Middle Holocene (MH), current and future (2070) climatic scenarios with Maximum Entropy (MaxEnt) trained on present-day occurrences. We identified areas of suitable habitats for which the estimation of habitat stability is predicted in all the models at different times. To validate the inferred suitable habitat, we tested the model by the current occurrence and fossil pollen data of B. monosperma. Our distribution models agree with the fossil pollen records for the MH (4,500–7,000 yr BP) and predict the prevalence of B. monosperma covering 84.22% of the Indian subcontinent with maximum habitat stability in western and southwestern India (10.95%). The widespread potential distribution of the plant species during the LGM supports the presence of the last remnants of tropical dry deciduous forest in the region. However, a decline in habitat suitability (62.84%) is predicted under current and future climatic scenarios with maximum stability (0.90%–3.09%) along the Western Ghats, Nilgiri hills, Gir range in the western India and north-eastern region covering the Assam Valley and foothills of Tripura and Mizo hills. Temperature seasonality (33.6%) measured in terms of variable contribution in MaxEnt model significantly affects the distribution shift of B. monosperma, along with annual precipitation (22.8%) and annual mean temperature (16.2%). Model results provide evidence of habitat reduction and identify the stability hotspots for B. monosperma for its conservation and establishment of land management policies mainly for the dry tropics.

THE THEORY OF CONSUMER BEHAVIOUR AND DEMAND IN A NEW PARADIGM OF DIGITAL HEALTHCARE

The article assesses the changing trends in the behaviour of consumers of medical services and building a new behavioural integrated model of medical services in the context of digital transformation of healthcare. The methodological basis of the study is the analysis of relevant domestic and foreign scientific literature on the issues under consideration, as well as the results of published expert interviews with healthcare specialists. The authors describe the concept of digital healthcare as a fundamental ecosystem in terms of the formation of new channels of interaction with the patient while providing medical services. They then characterise the role of new investors in the field of digital medicine - the largest technological leaders in terms of market capitalisation. The paper examines the basic principles of consumer behaviour in the medical services market underlying the demand in the traditional doctorcentered model of medical care, formulates the key approaches to changing the behaviour of the consumer s under the influence of healthcare digital transformation. The authors argue that through digitalisation healthcare goes far beyond the medical industry and acquires an intersectoral integrated character. They build a behavioural patient-centered model of a consumer of medical services in the new paradigm of digital healthcare. The new role of the patient as a partner in managing the healthcare system is substantiated. The results of the work contribute to the economic theory of consumer behaviour in the provision of medical services, as well as to the theory of health economics. The practical significance of the work lies in the possibility to implement the proposed target model for the provision of medical care in primary and secondary health care organisations as part of digitalisation programs.

Creating Family-Centred Support for Preschoolers with Developmental Disabilities in Low-Income Countries: A Rapid Review to Guide Practitioners.

Preschoolers with disabilities and their caregivers have been neglected in health and social service provision in most low-income countries and arguably also in low-resourced areas of more affluent nations. Yet as this rapid review of the published literature identifies, there are low-cost, evidence-based strategies to address their needs that can be implemented in communities by local people. Five key features of the necessary supports are examined. First, the leadership functions required to create and implement the support services. Second, the family-centred, home-based support provided to caregivers and the personnel undertaking this form of support. Third, providing opportunities for peer support to flourish and encouraging the formation of advocacy groups across families. Fourth, mobilizing the support of significant groups within the community: notably, traditional healers and leaders, health services and poverty alleviation initiatives. Fifth, devising ways in which preschool educational opportunities can be offered to children as a prelude to their inclusion in primary schools. The review serves a further purpose. It provides an example of how public health researchers and academics could achieve more rapid implementation of evidence-based knowledge into existing and new support services through dissemination to community practitioners.

Towards inclusive mechanization? Two-wheel tractor-based service markets in Ethiopia, Burkina Faso, and Zimbabwe

PurposeAfrican agricultural mechanization could lead to a mechanization divide, where only large farms have access to machines. Technological solutions such as scale-appropriate machines and institutional solutions like service markets offer hope for more inclusive mechanization. Two-wheel tractor-based service markets combine both technological and institutional elements, but there is limited research on their economic viability and challenges.Design/methodology/approachWe analyze the economic viability of two-wheel tractor-based service provision based on data from service providers in Ethiopia, Burkina Faso, and Zimbabwe. We also examine the institutional framework conditions for such service providers based on qualitative interviews with these service providers and stakeholders such as machinery dealers, spare parts providers, and banks.FindingsTwo-wheel tractor-based service provision is economically highly viable, largely due to multifunctionality. Post-production services such as threshing and transportation are particularly lucrative. However, the emergence and economic sustainability of service providers can be undermined by bottlenecks such as access to finance, knowledge and skills development, access to fuel and spare parts, and infrastructure problems.Originality/valueThis is the first study on the economics of two-wheel tractor-based service provider models. Past studies have focused on large four-wheel tractors, but two-wheel tractors are different in many aspects, including regarding investment costs, repair and maintenance costs, capacity, and multifunctionality.

How does policy mix credibility affect citizen participation? Evidence from pilot of household waste sorting policy

ABSTRACT A burgeoning collaborative government-citizen public service delivery mode is hindered by insufficient policy mix credibility for boosting citizen participation. One reason is the unclear understanding of systematic pathways linking policy mix credibility and citizen participation. This article focuses on the relationship between policy mix credibility and citizen participation behavior based on the policy feedback theory. It also introduces citizen participation willingness as a mediator, and ICT tool functionality as moderators to further understand their boundary effects. Using a panel data from four follow-up surveys during the waste sorting policy pilot in Chongqing, China, and employing the difference-in-difference method, we found that policy mix credibility influences citizen participation behavior through citizen participation willingness. And the translation of willingness into actual participation action depends on policy resources represented by the ICT tool functionality. The findings solve the theoretical perplexity about the role of policy mix credibility in citizen participation in public service provision and provide new ideas for mobilizing it.

Integrated System Responses for Families Impacted by Violence: A Scoping Review.

Violence within families is a complex problem which significantly impacts health and wellbeing. Despite the ubiquitous call for integrated family violence service delivery, integrated approaches vary significantly and challenges to implementation remain. This scoping review explored how integrated approaches to family violence service delivery are conceptualised within international and Aotearoa New Zealand literature. Following a documented scoping review process identified from literature, dynamic interplay between system agents within integrated family violence service delivery were mapped with the assistance of a complexity theory lens. We analysed characteristics of included studies, agents involved, how they interacted and the methods and mechanisms of integration among them. Seventy-two published reports were included. The most common interactions occurred between statutory agencies such as police and child protection. While health care service providers were included within 55 studies, their engagement was often peripheral. Qualitative analysis elucidated three broad pathways to service delivery impact underpinned by systems-centred, person-centred, or Indigenous-centred worldviews. Integrated approaches to family violence service delivery are highly variable. Despite a strong assumption that integration leads to improved safety, health, and wellbeing for care-seekers, most studies did not include evidence of such impact. Consideration of how worldviews characterise service provision provides insight into why integration has proven challenging over time.

Exploration of how youth justice staff perceive the speech-language pathology role and service provision in an Australian youth justice setting

Purpose The aims of this project were to explore how youth justice staff perceive the speech-language pathology role and provision in an Australian youth justice setting, including the speech-language pathologist’s role in supporting young people to participate in the activities of the youth justice service studied. Method A narrative inquiry approach was employed to guide semi-structured interviews with youth justice staff. Perceptions and experiences were analysed via reflexive thematic analysis, with member checking and inter-rater coding utilised for rigour. Result Seven semi-structured interviews were conducted. Interviewees worked in either the custodial setting (n = 3) or the community setting (n = 4) for the youth justice service studied, though most had worked in both settings. Six themes and six subthemes were identified from the interview data and related to factors that supported improved participation in the activities of the youth justice service studied. These factors were the speech-language pathology skillset and approach, and that there were systemic barriers within the service. All participants perceived speech-language pathology input as valuable for the young people in the service studied. There was also acknowledgement by the participants of how speech, language, and communication needs of the young people impacted their participation in the activities of the service studied. These findings were despite the perceived need for organisation-wide education on the speech-language pathologist role and offering. Conclusion Increased understanding of how youth justice staff perceive the role and benefits of speech-language pathology in supporting young people in contact with the youth justice system will assist with service planning, inform education strategies, and may support policy change.

Survey of occupational health-related activities in Hokkaido and Tohoku hospitals

This study aimed to evaluate occupational health-related activities and factors related to the violation of labor-related regulations in hospitals in Hokkaido and Tohoku districts. The study questionnaires were distributed to 1,108 Hokkaido and Tohoku hospitals in April 2024, among whom 307 (answered by June 2) participated. The questionnaires included queries on hospital characteristics, occupational health-related activities, and labor-related laws. Relationships between the hospital location, number of hospital beds, number of employees, and provision of emergency services and the number of labor-related regulation violations (assignments of occupational physicians and health officers, agreement on overtime [per Article 36 of the Labour Standards Act], physician interviews for workers with prolonged overtime, and implementation of the Stress Check program) were analyzed using multivariable ordinal logistic regression. Among the hospitals, 4.2%, 11.9%, 11.1%, 8.5%, and 2.6% did not assign occupational physicians, assigned directors as occupational physicians, did not assign health officers, did not have an agreement on overtime, and did not implement the Stress Check program, respectively. The multivariable ordinal logistic regression analysis revealed that hospitals with few beds and employees and those that did not offer emergency services had significantly higher odds of violating labor-related regulations. Smaller hospitals and hospitals that did not offer emergency services in Hokkaido and Tohoku districts had some difficulties complying with labor-related regulations. These hospitals may need external support for occupational health-related activities.

E-Government Issues in Developing Countries Using TOE and UTAUT Frameworks: A Systematic Review

E-government, or electronic government, refers to the utilization of information and communication technology to improve and simplify the provision of government services and information to citizens, businesses, and government agencies. The adoption and implementation of e-government may be seen as an imperative for governments in developing nations. This research observes the intricacies of e-government implementation in developing countries, aiming to identify and analyze pivotal issues. By employing the preferred reporting items for systematic review and meta-analysis method, this research discovers the intricate landscape of e-government implementation. Also, utilizing the Technology-Organization-Environment and Unified Theory of Acceptance and Use of Technology frameworks, the study uncovers substantial issues rooted in organizational limitations like limited awareness and inadequate top management support. The scarcity of essential infrastructure, notably reliable internet access, exacerbates these issues, deepening the digital divide between urban and rural areas. These findings emphasize the crucial role of clear regulations and unwavering top management support. Success in technology adoption hinges on the synergy between organizational, technological, and environmental factors. This thorough investigation illuminates the complex dynamics associated with the implementation of e-government in developing countries, providing invaluable insights for policymakers, practitioners, and researchers navigating the complexities of digital governance.

Spatial distribution and determinants of intermittent preventive treatment for malaria during pregnancy: a secondary data analysis of the 2019 Ghana malaria indicators survey

BackgroundMalaria during pregnancy is associated with poor maternal, foetal, and neonatal outcomes. To prevent malaria infection during pregnancy, the World Health Organization recommended the use of intermittent preventive therapy with sulfadoxine-pyrimethamine (IPTp-SP) in addition to vector control strategies. Although Ghana’s target is to ensure that all pregnant women receive at least three (optimal) doses of SP, the uptake of SP has remained low; between 2020 and 2022, only 60% of pregnant women received optimal SP during their most recent pregnancy. This study sought to map the geospatial distribution and identify factors associated with SP uptake during pregnancy in Ghana.MethodsSecondary data analysis was conducted using the 2019 Ghana Malaria Indicator Survey dataset. The data analysed were restricted to women aged 15–49 years who reported having a live birth within the two years preceding the survey. A modified Poisson regression model was used to determine factors associated with SP uptake during pregnancy. Geospatial analysis was employed to map the spatial distribution of optimal SP uptake across the ten regions of Ghana using R software.ResultsThe likelihood that pregnant women received optimal SP correlated with early initiation of first antenatal care (ANC), number of ANC contacts, woman’s age, region of residence, and family size. Overall, the greater the number of ANC contacts, the more likely for pregnant women to receive optimal SP. Women with four or more ANC contacts were 2 times (aPR: 2.16; 95% CI: [1.34–3.25]) more likely to receive optimal SP than pregnant women with fewer than four ANC contacts. In addition, early initiation and a high number of ANC contacts were associated with a high number of times a pregnant woman received SP. Regarding spatial distribution, a high uptake of optimal SP was significantly observed in the Upper East and Upper West Regions, whereas the lowest was observed in the Eastern Region of Ghana.ConclusionsIn Ghana, there were regional disparities in the uptake of SP during pregnancy, with the uptake mainly correlated with the provision of ANC services. To achieve the country’s target for malaria control during pregnancy, there is a need to strengthen intermittent preventive treatment for malaria during pregnancy by prioritizing comprehensive ANC services.

Survey of patient satisfaction with genetic counseling services in Korea.

Since the 1990s, genetic clinics have been established in South Korea, enabling the provision of clinical genetics services. However, genetic counseling services are not widely used in the medical system. In contrast, recently, the demand for genetic counseling has increased due to the rapid development of genomic medicine. Therefore, it is important for medical geneticists and genetic counselors to collaboratively provide genetic counseling services. This study aimed to evaluate the perception and satisfaction of patients with rare genetic diseases and their families regarding genetic counseling services provided by a genetics team at the medical genetics center of a tertiary general hospital for rare genetic diseases. From April to November 2021, a survey was conducted with 203 individuals, including 111 and 92 individuals in the patient and family groups, respectively. Overall, 164 individuals (80.8%) responded that they were aware of genetic counseling services, and 135 individuals (66.5%) responded that they were aware of the role of genetic counselors. Patients and their families wanted to receive information about the following from genetic counseling: clinical manifestation and prognosis of the diagnosed disease (78.8%), treatment and management of the disease (60.6%), risk of recurrence within the family (55.7%), treatment options and alternatives for family and prenatal testing, and various support services. The score of satisfaction with genetic counseling services provided by the genetics team was 8.19 ± 1.68 out of 10. Patients with rare genetic diseases and their families were satisfied with genetic counseling services regarding their diseases, test results, and treatment options. Moreover, the patients could receive psychosocial support and referrals to other medical service providers and support services. As a genetic team approach, collaboration between medical geneticists and certified genetic counselors would be useful in providing information and in diagnosing, treating, and managing patients.

Mobilizing stakeholders for implant removals in Burkina Faso using landscape assessment data

BackgroundSuccessful efforts to encourage uptake of subdermal contraceptive implants, with a lifespan of three to five years, necessitate planning to ensure that quality removal services are available when desired. In Burkina Faso, implant use has tripled over the past 8 years and now comprises almost half of the contraceptive method mix. Population Monitoring for Action (PMA) surveys identified barriers to obtaining quality removal when desired, particularly when the implant is not palpable, or providers lack needed skills or supplies. The Expanding Family Planning Choices (EFPC) project supported ministries of health in four countries with evaluation and strengthening of implant removal services.MethodsAn implant removal landscape assessment was conducted at 24 health facilities in three regions of Burkina Faso with high implant use that included provider observations of implant removal, interviews with providers and health facility managers, and facility readiness surveys. The project used landscape data to mobilize stakeholders through a series of participatory workshops to develop a collaborative roadmap and commit to actions supporting quality implant removals.ResultsLandscape findings revealed key gaps in provision of quality removal services, including high levels of provider confidence for implant insertion and removal (82% and 71%, respectively), low competence performing simple and difficult removals (19.2% and 11.1%, respectively), inadequate supplies and equipment (no facilities had all necessary materials for removal), lack of difficult removal management systems, and a lack of standard data collection tools for removal. Exposure to the data convinced stakeholders to focus on removals rather than expanding insertion services. While not all roadmap commitments were achieved, the process led to critical investments in quality implant removals.ConclusionLandscape data revealed that facilities lack needed supplies and equipment, and providers lack skills needed to perform quality implant removals, limiting client reproductive choice. Disseminating this data enabled stakeholders to identify and commit to evidence-based priority actions. Stakeholders have since capitalized on program learnings and the roadmap, including following MOH guidance for implant removal supplies and health provider training. Our experience in Burkina Faso offers a replicable model of how data can direct collective action to improve quality of contraceptive implant removals.

Self-Reported Social Determinants of Health and Area-Level Social Vulnerability

Many health care systems are investing resources in identifying social determinants of health (SDoH) needs and facilitating interventions among the populations they serve. Because self-reported SDoH information is lacking, area-level measures are often used to estimate needs and direct resources. To describe the large-scale deployment of SDoH assessments by a health system and determine the extent to which self-reported SDoH needs identified therein are associated with census tract-level social vulnerability measured using the Social Vulnerability Index (SVI). This cross-sectional study assessed SDoH needs between January 1, 2020, and April 30, 2023, in both payer and clinical care settings. Modalities included telephonic outreach, face-to-face clinical interactions, self-entry into a tablet or kiosk, and web-based survey tools. Participants included individuals who responded to the assessment and had sufficient information for census tract identification. Respondents included both Highmark Health Plan members and nonmembers. Health plan members responded to the assessment through health plan programs or platforms, and both members and nonmembers responded to assessments during inpatient or outpatient encounters with the affiliated health system. Overall and domain-specific SDoH needs self-reported through assessments, and severity and complexity of needs identified. Residential social vulnerability measures included overall SVI and the 4 conceptual themes comprising overall SVI. In total, 841 874 assessments were recorded for 401 697 individuals (55.1% women; median [IQR] age, 55 [41-70] years). Social determinants of health needs were identified in 120 769 assessments (14.3%). Across all SDoH domains, increasing SVI was associated with a higher positivity rate (eg, 11.2% of those residing in the lowest-risk SVI quintile reported a need compared with 22.7% among those residing in the highest-risk quintile). Associations varied by SDoH domain and SVI theme. After adjusting for demographic and screening characteristics, odds of positive screening among those residing in the highest-risk SVI quintile were 1.74 (95% CI, 1.62-1.86) to 3.73 (95% CI, 3.48-4.00) times the odds among those residing in lowest risk quintile. In this cross-sectional study, the overall level of SDoH needs generally corresponded to area-level vulnerability. Some SDoH domains appeared far more sensitive to community characteristics than others. Notably, even among individuals from the highest-risk areas, the positive screening rate was roughly 1 in 4. These findings underscore the importance of individual-level SDoH data for service provision planning and health services research.

Conceptualising overlapping politics: Cross-class political relationships in urban Pakistan

Citizen-led activism to demand and secure adequate housing rights, infrastructure, and services in Islamabad forms part of a longstanding socio-political movement in Pakistan. This activism brings together different classes of urban residents. Drawing from qualitative research comprising of 129 interviews, this article reveals an emerging ‘overlapping politics’, defined as the political relationship between two (or more) distinct socio-economic classes of citizen(s) in response to any form of injustice or inequality. This (re)conceptualises everyday forms of urban political practice by countering existing assumptions that urban politics is rooted in class homogeneity. Inspired by the Islamabad case, I argue that ‘overlapping politics’ emerges largely as an alternative to, and progression from, clientelistic politics through four modes where ‘overlapping’ occurs across class lines: knowledge and information; networks and membership; support; and ownership and responsibility. The outcomes of ‘overlapping politics’ manifest spatially in the city, for example through increased interaction between urbanites, privately organised service provision, and urban protests. Although the practice of ‘overlapping politics’ has limitations, it provides an important new conceptual tool and language for understanding and analysing forms of politics that are embedded in cross-class relationships between urban citizens.

Painless cost control as a central strategy for universal oral health coverage: A critical review with policy guide.

This study aimed to critically review the methods used to control the significantly increasing costs of dental care. Through a comprehensive search of the available literature, the cost control (CC) mechanisms for health services were identified from a healthcare system perspective. The probable applicability of each CC method was evaluated mainly based on its potential contribution to oral health promotion. Each mechanism was then classified and discussed under any of the two headings of financing and service provision. An operational guide was finally presented for policy-making in each of the three main models of healthcare systems, including National Health Services, social/public health insurance and private insurance. From a total of 142 articles/reports retrieved in PubMed, 73 in Scopus and 791 in Google Scholar, 35 were included in the final review after eliminating the duplicates and screening process. Totally ten mechanisms were identified for CC of dental care. Seven were discussed under the financing function, including cost sharing, preauthorization, mixed payment method and an evidence-based approach to benefit package definition, among others. Three further methods were classified under the service provision function, including workforce skill mix with emphasis on primary oral healthcare providers, development of primary healthcare (PHC) network and an appropriate use of tele-dentistry. Painless control of dental expenditures requires a smart integration of prevention into the CC plans. The suggested policy guide emphasizes organizational factors; particularly including the development of PHC-based networks with midlevel providers (desirably extended-duty dental hygienists) as the frontline oral healthcare providers.