Age of Entry into Early Intervention: Influence of the COVID-19 Pandemic, Telehealth, and Other Factors.

Genomic sequencing (GS) for patients and families with rare disease creates the opportunity for precise diagnosis as well as the option to learn about medically actionable secondary findings (SF). Debate persists internationally on how to manage the analysis and disclosure of SF, especially in settings where service delivery models for GS are still in development and outcomes are preliminary. This study aimed to understand parents' decision to opt-out of learning about their child's SF for adult-onset conditions and whether an SF identified in a child was inherited. All children received GS as part of their diagnostic work-up for a rare disease. Sixteen semistructured interviews were conducted with parents. Guided by a qualitative approach, interviews were analyzed with inductive content analysis. Participants reported that the timing of decision-making, competing priorities, anticipated adverse psychological outcomes, and health-related beliefs and worldviews contributed to their decision to opt-out of receiving SF. An emphasis was placed on a preference for flexible SF delivery models to aid in reducing the burden of SF decision-making at the time of indication-based testing. Genetic service delivery models that separate the timing of decisions about indication-based test results and SF may address patient preferences. Findings from this work may inform clinical practice and policy in jurisdictions where SF delivery models are still being developed and optimized.

Situational analysis of health systems for ear and hearing care in the World Health Organization (WHO) Eastern Mediterranean Region: A systematic review and evidence synthesis to inform national policies and strategies.

Addressing the double burden of malnutrition in Bangladesh: Evidence from National Policy Documents and gaps in policy integration.

“Every time I had to pay $50, it was adding up, but there was no option”: A qualitative study with parents and primary caregivers in Australia on barriers to timely childhood vaccination

This paper has explored disruptive innovation as a driving force in corporate entrepreneurship in Federal Medical Centres in southeast Nigeria. In particular, it examined how the digital health innovation, use of telemedicine, process innovation, and service delivery innovation affect innovativeness, proactiveness, risk-taking behaviour, and strategic renewal, respectively. A cross-sectional survey was performed, and the data of 300 healthcare workers of three Federal Medical Centres using a structured questionnaire was collected. The analysis of data was done by descriptive statistics and Pearson Product-Moment Correlation at the level of significance of 0.05 in SPSS. The analysis showed the strong and statistically significant positive correlation: digital health innovation and innovativeness (r = .953); telemedicine adoption and proactiveness (r = .900); process innovation and risk-taking behaviour (r = .895); and service delivery innovation and strategic renewal (r = .884). These findings indicate that disruptive innovation contributes greatly to the aspects of corporate entrepreneurship in the public healthcare facilities. Based on this, the study concludes that the adoption of digital technologies, innovative processes, and patient-centred service models enhances organisational flexibility, responsiveness, and long-term sustainability within Federal Medical Centres. It suggested further investments in the digital infrastructure, improved practice in telemedicine, institutionalisation of continued improvement in the process, and the introduction of new models of service delivery to foster the development and performance of the entrepreneurship in the publicly owned medical organisations.

ABSTRACT Background and aim Telehealth is increasingly used within healthcare, including by Speech and Language Therapists working with people who have aphasia. Aphasia is a communication disability common post stroke that presents challenges for telehealth, (e.g. people with aphasia are more dependent on multimodal communication techniques), which can be difficult to interpret through videoconferencing platforms. Assessments are a core part of the SLT role, and can pose particular challenges for telehealth, (e.g. testing receptive language skills). This study explored how people with aphasia and clinicians experience telehealth in the context of completing assessments, including their priorities for future directions. Methods and procedures This study integrated four different research activities from the “Improving access to healthcare: Face-to-face And Telehealth Equivalence of assessments in Aphasia (FATE-A)” study. The four data sources used were: qualitative responses to a survey (n = 124 Speech and Language Therapists), a focus group study (n = 14 Speech and Language Therapists), usability testing sessions (n = 4 Speech and Language Therapists, n = 6 advisers with aphasia) and Patient and Public Involvement and Engagement (PPIE) workshops (n = 7 advisers with aphasia). Findings from the four sources were inductively analysed to develop descriptive themes taking a meta-synthesis approach. Divergence and convergence of themes between sources was explored. Outcomes and Results There were three main themes: barriers, facilitators, and current and future preferences. Barriers and facilitators included severity of aphasia and other impairments; presence or absence of helpers; competence with technology (both clinician and person with aphasia); challenges around hardware and video-conferencing platforms; poor versus reliable internet connectivity; factors specific to assessments (e.g. lack of standardized assessment for online use); challenges setting up online assessments; and the emotional impact. Additional facilitators included preparation and support with set-up, and support with emotional wellbeing. Clinicians wanted more resources to facilitate online assessment, better hardware and platforms. While clinicians and people with aphasia perceived benefits to telehealth, both stakeholder groups wanted a flexible personalized hybrid service. Although there was broad congruence of themes, different data sources contributed uniquely, for example, the challenges of negotiating multiple steps to get online (usability testing), and preferred terminology (PPIE). Conclusions It is likely that telehealth will continue to be a component of Speech and Language Therapy services. Both people with aphasia and clinicians considered telehealth a valid model of service delivery, so long as it is tailored to the needs of the individual, and is part of a person-centred model of care.

ABSTRACT This study investigates barriers to help-seeking among crime victims across diverse geographic areas utilizing data from a statewide victim needs assessment survey (n = 1, 114). Among the 951 participants who attempted to access services, 78.8% experienced systematic barriers to formal services. Logistic regression analysis uncovered that those in suburban and rural areas experienced differences in systemic barriers to those in urban areas. Developing targeted outreach strategies, addressing specific barriers in different settings (e.g., transportation in rural areas, cultural competence in suburban areas), and tailoring service delivery models to meet the diverse needs of crime victims, including diverse and immigrant populations, are crucial.

Increasing physical activity in rural Pennsylvanians: The PA moves trial study protocol for a cluster randomized controlled trial.

Use of emergency medical services by adults with developmental disabilities receiving integrated or usual care.

The World Health Organization has identified the long-term care system as a critical area for enhancing the health and quality of life of older adults. Within this system, case management is a prevalent service delivery model implemented by interdisciplinary teams comprising professionals from various sectors. However, the absence of a comprehensive transdisciplinary competency framework applicable across different disciplines obstructs the development of relevant training programs and hinders workforce capacity building and professionalization. This studywasconducted in the context of Hong Kong's long-term care system and aimed to establish a transdisciplinary competency framework through expert consensus to advance case management practices. This study employed an online five-stage participatory Delphi approach, with two rounds of questionnaire surveys and three roundtable discussions. The expert panel featured 40 health and social care professionals in the long-term care field. Their task was to develop a list of essential competencies for the long-term care workforce in case management. To determine the list of competencies, metrics such as the percentage of agreement, mean rating scores for each statement, and interquartile range were assessed using a 5-point Likert scale that measured clarity, relevance, and importance. The panel reached consensus on a comprehensive transdisciplinary framework that includes 49 competencies organized into six key domains: overarching values; knowledge of long-term care and case management practices; assessment skills; analytical and intervention skills; communication skills and teamwork; and advocacy. Experts highlighted that this framework can significantly improve the capacity-building efforts of interdisciplinary teams involved in long-term care case management. The competencies are further organized into three progressive levels-basic, intermediate, and advanced-to support the growth of practitioners' professional skills. The proposed transdisciplinary competency framework provides a foundation for developing and implementing training curricula for frontline professionals in the long-term care sector. Governments can utilize this framework to create career progression pathways that attract more talent to the field and enhance the supervision and evaluation of practitioners' competencies. This approach will help ensure the quality of long-term care services.

ABSTRACT Efforts to advance inclusive education have gained increasing attention in Sweden and the Netherlands. Effective cross-sector collaboration among diverse stakeholders is essential to ensure that all children’s needs are adequately met. However, existing service delivery models remain largely referral-based, focusing on the individual needs of a child. There is a growing need for system-wide, context-based approaches that enable inclusion and belonging of all children. One such model is Partnering for Change (P4C), developed in Canada. Implementing P4C in new contexts requires careful consideration of cultural and systemic differences. This paper describes the process of adapting the P4C model for the Dutch and Swedish educational contexts, guided by a four-phase framework and a multiphase mixed-methods approach. It presents the adapted P4C model and shares key lessons, offering insights into effectively embedding inclusion-related service delivery in education.

Beginning in fiscal year (FY) 2019, the U.S. Centers for Disease Control and Prevention in Zambia transitioned from non-governmental organizations to a government to government provincial health office service delivery model in four provinces in Zambia. We reviewed programmatic and financial data during and after this transition to assess outcomes of service delivery and financial investment through a government-led approach. Programmatic performance using U.S. President's Emergency Plan for AIDS Relief's (PEPFAR) Monitoring, Evaluation, and Reporting and expenditure reporting data were used to assess changes over the period of transition. Data were reviewed across six FYs from October 2018-September 2019 (FY19) through October 2023-September 2024 (FY24) in four provinces. Programmatic and expenditure performance indicators were analysed across time. From FY19 to FY24, the number of people living with HIV (PLHIV) on antiretroviral therapy (ART) across the four provinces increased from 520,628 to 680,781 (31%). Viral load coverage and suppression in the transition provinces increased from 345,849/472,554 to 592,399/672403 (15%) and 313,384/345,849 to 578,832/592,399 (7%), respectively. Annual PEPFAR financial investments for care and treatment activities (in 2019 US dollars) increased by $12.7 million (25%) from $38.3 million in FY19 to $51.0 million in FY21, as the amount invested in direct service delivery increased concurrently with investments to implementing partners. From FY21 to FY24, spending declined by $21.1 million (41%), while the total number of PLHIV on ART increased. The amount spent per PLHIV on ART decreased by from $79 in FY21 to $44 in FY24 (44%). The government-led model in Zambia shows a path forward to achieving HIV program success, reductions in costs, and expanded government ownership of the HIV program.

Women who are impacted by diverse forms of violence and structural disadvantage such as poverty, health inequities, and precarious housing experience significant barriers to health care. Outreach is a promising strategy to mitigate barriers to care. Until recently, outreach has focused on women's behaviors, with less attention paid to the intersecting systemic inequities inclusive of stigma and discrimination, poverty, and compartmentalized health service delivery models that impact care engagement and access. The research study aims to (1) describe the demographic characteristics, baseline health status, and care access among diverse women impacted by gender-based violence; (2) explore preliminary changes in trust in the outreach program over time; (3) explore trends in participants' access to health and social care services and safety planning over time; and (4) explore the contextual factors impacting trends in trust, service access, and safety. An exploratory outreach intervention will be conducted in 2 Canadian cities in partnership with community-based service organizations focused on housing security and victim support. Participants will be women eligible for these services who are experiencing barriers to timely and appropriate health and social services commensurate with their self-identified needs. The analysis will adopt a convergent mixed methods design in which quantitative and qualitative data will be collected concurrently and subsequently analyzed in parallel and then merged for data integration to fully contextualize study findings. Data will include surveys conducted at up to 4 time points to assess service access, trust and safety planning, and qualitative interviews with participants detailing sociostructural and individual factors impacting service access and trust and safety planning. Case notes will be recorded for all outreach engagement with participants. Descriptive statistics and data visualization analytic techniques will be used to document demographic characteristics and trends in trust, safety planning, and access to and engagement with care over time. Interview data will be thematically analyzed to note contextual factors associated with safety, engagement, and trust. Data integration will be carried out to examine how observed trends are influenced by contextual features and to identify nuance in variation over time. The study was funded in April 2019. Intervention implementation began in the first of 2 study hubs in October 2023 and in the second hub in October 2024, and participant enrollment was open from November 2023 to June 2025. A total of 86 women were enrolled during that time; though enrollment has now closed, data collection is ongoing and is expected to continue through January 2026. Data analysis will commence in February 2026. Results are expected in late spring 2026. Study results will be presented at community forums within study settings and at international conferences and will be submitted for publication in relevant journals. This study is expected to generate insight into interpersonal and structural factors shaping trends observed, extending beyond behavioral investigation with new insights into how intersecting inequities can impact trust, engagement in care, and women's safety.

Purpose This study examined the feasibility of implementing an efficacious, statistically-based, word learning intervention, Vocabulary Acquisition and Usage for Late Talkers (VAULT), in a caregiver-implemented service delivery model primarily via telehealth with late talkers exposed to Spanish or Spanish and English. Caregivers were coached by professionals with experience supporting Latine 1 families in early childhood development, but who were not speech-language pathologists. The aim was to explore the feasibility of train-the-trainer models. Method Four caregiver-child pairs participated in a single-subject, multiple baseline design. Coaches trained caregivers who administered VAULT. Outcomes included fidelity to the coaching protocol, VAULT, social validity, and child expressive vocabulary. Result Two caregivers completed the study, while two exited mid-treatment citing scheduling difficulties. Coaches demonstrated high fidelity with some variability to teach-model-coach-review and VAULT. Caregivers reached the target rate of nine models per minute on average, though with variability. VAULT had evidence of social validity, however there may have been too many required research-specific tasks. All children learned some treatment words and increased their expressive vocabulary. Conclusion Fidelity varied by triad, indicating the need for more supports for consistency. Acceptability of VAULT was promising, however participant drop-out showed the need for fewer research activities or more supports.

The global digital transformation and increasing geopolitical instability have fundamentally changed the role of IT consulting, shifting it from a supportive function to a core driver of economic resilience. This is particularly evident in the Central and Eastern European (CEE) region, which has emerged as a key technological hub over the last fifteen years. The study employs a comparative analysis of the IT consulting markets in Ukraine, Poland, Romania, and the Czech Republic during 2010–2025. The research methodology is based on a systematic review of market dynamics, including the number of registered companies, revenue per specialist, and the evolution of service delivery models. The author uses data from international analytical platforms (Statista, PwC) and industry reports (IT Ukraine Association, N-iX) to identify regional patterns. The analysis identifies three distinct waves of IT consulting transformation: the post-crisis recovery (2010–2014), the digital transformation boom (2015–2021), and the current shift toward adaptive and resilient strategies (2022–2025). The study categorizes three dominant regional models. The Western European model (Germany, France) focuses on Industry 4.0 and strategic IIoT consulting. The Central European model (Poland, Romania) leverages EU institutional support to function as a technological integrator. The Ukrainian model, defined as “Resilient Consulting,” has unique characteristics shaped by extreme security challenges, leading to the emergence of world-class expertise in MilTech and cybersecurity. Financial metrics reveal a performance gap: the Czech Republic leads in revenue per specialist ($77.5k) due to high-value industrial consulting, while Ukraine is rapidly increasing its consulting share from 12% to 18.4% despite wartime risks. The findings suggest that the Ukrainian IT sector is undergoing a qualitative transition from staff augmentation to solution architecture. By the end of 2025, the share of consulting in Ukraine's IT export structure is projected to reach 22%. The study concludes that Ukraine's strategic priority until 2030 should be adopting Western intellectual property standards and further integrating MilTech solutions into global security chains.

Healthcare management in rural and underserved regions remains one of the most complex challenges within contemporary public health systems, particularly in developing economies where disparities in infrastructure, workforce availability, and financial resources significantly influence healthcare outcomes. This study examines the structural, administrative, and policy-related dimensions that shape healthcare delivery in rural and underserved communities, with a focus on identifying practical management strategies capable of improving accessibility, efficiency, and quality of care. Rural populations frequently experience limited availability of medical facilities, shortages of trained healthcare professionals, inadequate diagnostic services, and poor transportation networks, all of which contribute to delayed treatment and higher rates of preventable morbidity and mortality. In addition to geographic isolation, socioeconomic factors such as poverty, low health literacy, and limited insurance coverage further complicate the management of healthcare services in these settings. The research analyzes how healthcare administrators, policymakers, and local institutions can collaboratively address these challenges through integrated planning, community-based service delivery models, and innovative resource allocation approaches. Particular emphasis is placed on the role of decentralized healthcare management, mobile health initiatives, telemedicine platforms, and community health worker programs in extending essential medical services to remote populations. The study also explores the importance of strengthening primary healthcare systems as the foundational pillar for rural health management, ensuring early diagnosis, preventive care, and effective referral networks. Furthermore, the research evaluates the influence of government policies, public– private partnerships, and non-governmental organizations in bridging systemic gaps in rural healthcare infrastructure and service delivery. Through a comprehensive examination of existing frameworks and emerging healthcare management practices, the paper highlights how strategic planning, digital health integration, workforce training, and community participation can collectively enhance healthcare accessibility and sustainability in underserved areas. The findings suggest that effective healthcare management in rural contexts requires a multidimensional approach that integrates technological innovation, administrative efficiency, and culturally responsive healthcare practices. Strengthening health information systems, improving supply chain management for essential medicines, and promoting locally adapted healthcare policies are also identified as critical components for long-term improvement. Ultimately, the study contributes to the ongoing discourse on equitable healthcare systems by presenting practical insights into how management strategies can reduce disparities and support inclusive health service delivery. By addressing both systemic limitations and emerging opportunities, the research underscores the importance of adaptive, community-centered healthcare management models that can ensure equitable access to quality healthcare for rural and underserved populations while promoting sustainable public health development.

Utilizing Library Spaces for Promoting Mental Health and Substance Abuse Information Resources: A Case Study of Higher and Tertiary Educational Institutions (HTEIs) in Masvingo Province, Zimbabwe

Many low- and middle-income countries (LMICs) have large networks of public primary care facilities (PCF) to provide affordable and quality health services close to communities. Public PCFs are expected to serve as the principal source of primary care. This study documents the extent to which public PCFs are used for illnesses treatable at the primary care level, and investigates the association between public PCF use, economic development, and UHC achievement. A cross-section of Demographic and Health Surveys conducted after 2014 in 46 LMICs were analysed. The sources of medical advice for children seeking care outside their home for the following illnesses were identified - acute respiratory infections (ARI), diarrhoea, and fever. There is considerable between-country variation in utilisation of public PCFs; in most countries public PCFs received less than half the patients seeking medical advice for conditions treatable at the primary care level. Second, economic development is associated with a 'health service transition' characterised by two related trends - decline in the share of patients seeking medical advice at public providers overall and at public PCFs, and a proportionate increase in the share of patients seeking medical advice at private providers; use of public PCFs declined by around 24 percentage points between the average low-income and middle-income country. However, most of the between-country variation in public PCF use was due to factors other than income. Third, cross-country regression analysis indicated that public PCF use was not associated with UHC achievement because a similar range of services are offered by private providers. Public PCF use was associated with lower catastrophic health expenditures. The changes in care-seeking patterns and use of public PCFs brought about by economic development makes it critical to re-think primary health care service delivery models and financial protection mechanisms in transition countries.

Primary care behavioral health (PCBH) is a service delivery model that embeds behavioral health consultants in primary care. PCBH has been implemented across several health care systems and has been shown to increase access to behavioral health services. Most of the patient access research in PCBH settings has focused on initial engagement with behavioral health services via the warm handoff, a process of referral where the primary care provider can connect the patient with an on-site behavioral health consultant the moment a need is identified. In contrast, fewer studies have examined factors that contribute to continued engagement with PCBH services beyond the first visit. The present study aimed to address this gap by interviewing adult PCBH patients (n = 15, 93% White, 80% female) to learn about factors that influenced their intentions to attend planned follow-up visits. Reflexive thematic analysis yielded four themes: (a) "Patient Factors" (e.g., high need and high motivation), (b) "Treatment Factors" (e.g., therapeutic alliance and treatment perceived as helpful), (c) "PCBH Factors" (e.g., convenience of receiving treatment in medical home), and (d) "Logistical Factors" (e.g., cost and insurance coverage). These findings underscore the importance of psychotherapy common factors as they relate to treatment engagement, highlight unique strengths of PCBH that increase accessibility of care, and offer insights into how administrators can ensure the expectations of PCBH are clearly communicated to and understood by patients. Findings also demonstrate that even when patients are offered care in a setting that maximizes access, logistical challenges remain. (PsycInfo Database Record (c) 2026 APA, all rights reserved).