Provision Of Services Research Articles

The missing economies of density and south Australian local government efficiency

ABSTRACT Sound theoretical grounds exist to assume that economies of density will have pervasive effects on municipal service provision. However, to date the available empirical literature offers inconsistent and confusing findings on the potential impact of density. Moreover, the extant empirical evidence of substantial density economies is unconvincing. This paper investigates this apparent contradiction by addressing (a) significant non-monotonicity in density economies, (b) confusion over density economies through its disparate impact on various municipal activities and (c) underlying differences in how density affects different types of local council. These questions are investigated employing multiple regression analysis using a panel data set covering all 68 South Australian local authorities over the seven-year period from 2014 to 2020. We find evidence of economies of density across the entire data set. We infer that the measurement of population density imposes constraints on identifying density economies and the empirical methodology employed.

Can Support Groups Improve Treatment Adherence and Reduce Sexual Risk Behavior among Young People Living with HIV? Results from a Cohort Study in South Africa.

Adolescents and young adults living with HIV (AYLHIV) in sub-Saharan Africa experience poorer HIV outcomes than adults, including lower ART adherence and virologic suppression. They also have high rates of unprotected sex, increasing the risk of adverse sexual health outcomes and onward transmission. This one-arm, pre-post study investigates a structured 14-session support group aiming to boost treatment adherence and sexual protective behavior for AYLHIV in South Africa. Logistic and Poisson regression analyses were performed on self-reported pre- and post-intervention survey data collected approximately 7.5 months apart from a cohort of 548 AYLHIV. Participants were significantly more likely to report at least 95% adherence at follow-up and rate their health as "good;" they also demonstrated greater treatment knowledge and had fewer absences from school overall and due to illness. Among sexually active AYLHIV, contraception use at last sex increased significantly, while condom use did not. Effects were small, and greater programmatic emphasis on adherence and multifaceted service packages is likely necessary to promote viral suppression. Nonetheless, the intervention addresses an important gap in service provision for AYLHIV in South Africa. Findings denote the potential for incorporating care and treatment components into sexual and reproductive health interventions tailored for AYLHIV.

Mapping access to medical service provision at micro-scale: Dynamics in supply and demand in Germany

Mapping access to medical service provision at micro-scale: Dynamics in supply and demand in Germany

Contraceptive access and use before and during the COVID-19 pandemic: a mixed-methods study in South Africa and Zambia

Background The COVID-19 pandemic affected global access to health services, including contraception We sought to explore effects of the pandemic on family planning (FP) service provision and use in South Africa and Zambia, including on implant and intrauterine device (IUD) users’ desire and ability to obtain removal. Methods Between August 2020 and April 2021, we conducted surveys with 537 women participating in an ongoing longitudinal contraceptive continuation study. We also carried out in-depth interviews with 39 of the survey participants and 36 key informants involved in FP provision. We conducted descriptive analysis of survey responses and thematic analysis of interviews. Results Contraceptive use changed minimally in this sample with the emergence of COVID-19. Fewer than half of women (n=220) reported that they tried to access FP since the start of the pandemic. The vast majority of those seeking services were using short-acting methods and 95% were able to obtain their preferred method. The proportion of women not using a method before and after the start of the pandemic did not change in Zambia (31%), and increased from 8% to 10% in South Africa. Less than 7% of implant or IUD users in either country reported wanting removal. Among the 22 who sought removal, 10 in Zambia and 6 in South Africa successfully obtained removal. In qualitative interviews, those reporting challenges to service access specifically mentioned long queues, deprioritization of contraceptive services, lack of transportation, stock-outs, and fear of contracting COVID-19 at a facility. Key informants reported stock-outs, especially of injectables, and staff shortages as barriers. Conclusions We did not find a substantial impact of COVID-19 on contraceptive access and use among this sample; however, providers and others involved in service provision identified risks to continuity of care. As the COVID-19 pandemic wanes, it continues to be important to monitor people’s ability to access their preferred contraceptive methods.

Antimicrobial use on pig farms in Thailand: Farmer perceptions of use and resistance

Limiting the use of antimicrobial agents in intensive livestock production is a challenge due to different perceptions between the short-term benefits of antimicrobial use (AMU) by livestock producers and the long-term social costs of antimicrobial resistance (AMR) and its impact on human, animal, and environmental health. Pig farmers are key stakeholders supporting Thailand’s national strategic plan on AMR which aims to reduce antimicrobial consumption in the livestock sector. Consequently, this study explored the knowledge, perceptions, attitudes, and practices of pig farmers towards AMU and AMR, expecting to provide information that would help guide policymakers in the development of a proper interventional program for antimicrobial stewardship. The qualitative approach utilized individual, face-to-face, in-depth, semi-structured interviews with the 20 owners of middle- and large-scale pig farms in eastern Thailand. The major themes identified in this finding were: (1) the use of antimicrobials on farms and the knowledge of antimicrobials; (2) AMU on pig farms (the purpose of AMU, antimicrobial prescription practices, and performing antimicrobial susceptibility testing); (3) attitudes towards prescribing practices and record keeping; (4) farm animal husbandry practices and AMU; (5) factors influencing AMU; and (6) awareness regarding AMR. Most of the pig farm owners recognized that achieving Good Agricultural Practices certification required following the legislation and regulations for AMU. Other observations were that the respondents had positive attitudes towards prescribing practices, performing antimicrobial susceptibility testing before antimicrobial therapy, and recording drug use on farms; however, there was low awareness of AMR. In addition, alternative substances, such as medicinal plants, and proper biosecurity practices were mentioned. Factors influencing AMU on pig farms were intensive enforcement of legislation and regulations, the implementation of farm management practices, the provision of information and consultancy services by veterinary professionals, farmer experience, and consumer trends.

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

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

Healthcare workers' views on type 2 diabetes mellitus management at selected clinics in Mthatha.

Diabetes is a non-communicable disease of global public health importance. Healthcare workers play a vital role in the management of this disease. This study aimed to explore healthcare workers' views on managing patients with type 2 diabetes at primary health care facilities. The study was conducted at two primary health care facilities in Mthatha, South Africa. This exploratory descriptive qualitative study included 28 primary health care workers. Data were collected through individual interviews and focus group discussions and analysed using a thematic analysis approach. Study participants' views of poor control of type 2 diabetes mellitus were categorised under patient- and healthcare system-related factors. The patient-related factors included poor adherence to an ideal diabetic diet, poor medication adherence, a lack of personal glucometers, and dearth of support systems. The healthcare system-related factors identified were inadequate patient education, long waiting times at the health facilities, high patient volumes, limited resources, and delayed service provision. Proposed solutions to address poor control of diabetes included improving patient health education, providing diabetic patients with glucometers, multi-stakeholder management of diabetes, allocating designated areas for patients with chronic illnesses, improved resource allocation, and regular staff training. Study participants perceived an improved level of control of diabetes among patients managed at the Community Health Centres. When designing interventions for the management of diabetes, both patient and healthcare system-related factors and the proposed solutions should be considered.Contribution:This study's findings could promote better management of diabetes at the primary health care level.

From document-centric to data-centric public service provision

From document-centric to data-centric public service provision

Crowded‐out? Changes in informal childcare during the expansion of formal services in Germany

AbstractInformal childcare care by grandparents, other relatives or friends is an important source of support in many Western countries, including Germany. Yet the role of this type of care is often overlooked in accounts of social policies supporting families with children, which tend to focus on formal childcare. This article examines whether the large formal childcare expansion occurring in Germany in the last two decades has been accompanied by similar or opposite trends in informal childcare usage. It argues that accounting for both formal and informal childcare can offer a more accurate assessment of defamilisation effects of family policies. Drawing on representative data from the German Socio‐Economic Panel the analysis identifies long‐run developments of childcare arrangements for children aged 1–10 between 1997 and 2020, offering for the first time a comprehensive picture of how families with children of different ages mix informal care and service provision. Results show that on average the expansion of formal childcare was not associated with an equal reduction in informal childcare, lending little support to the crowding‐out hypothesis. Further analyses distinguishing between population groups with different propensity to use formal childcare reveal, unexpectedly, remarkable similarities in the use of informal care throughout the period examined. The only exception are families with a migrant background, who tend to use informal childcare less than their counterparts. The general trend is, however, one whereby informal and formal care are increasingly combined.

A Paradigm Model of School Counseling Services based on Grounded Theory

Aim: The purpose of this research is to provide a model of school counseling services based on the conditions and implications of the grounded theory to help school counselors use appropriate services for the integrated development of students. Methods: The research method was a qualitative research that was conducted using the grounded theory approach. Semi-structured interviews and the translation of authentic school counseling documents were used in this study to collect data. Eight professional school counselors with doctoral degrees in counseling, who worked in schools as a school counselor for more than 10 years, and many of whom teach at universities, participated in this study.Results: The findings of this research are based on the field of grounded theory, including concepts of the factors and consequences of school counseling services. These concepts include: developmental needs of students, professional competence of school counselors, necessity of family awareness, cultural context, family lifestyle, education policy, entrance exam phenomenon, psychiatrists and drug prescription, therapeutic attitude instead of preventive attitude, non-governmental institutions and schools, student standards, and counselor standards. Conclusions: The findings of the research showed that the provision of school counseling services should be based on the developmental needs of students, the cultural context and lifestyle of families should be considered, school counselors should have the necessary standards to provide services, and finally, direct and indirect counseling services. The school should be provided in a specialized manner and in a regular framework to facilitate the integrated growth of students.

Including patient perspectives in secondary prevention: one step closer to patients needs

Abstract Introduction Including patients in the decisions regarding their health is challenging. Patients’ understanding of their health conditions and lifestyle behaviors are strongly influenced by the interactions between patients and health care providers (1). Putting their needs up-front when you are designing projects for a global approach on Secondary Prevention is even more defiant. Following up to the person-centered care approach, the best way to tailor anything is to focus on the patients’ needs, by including the patient in the choices of the services they can have/need available. Having initiated the partnership, it is also necessary to implement it and safeguard it (2). Purpose To identify the patients’ needs, regarding the Prevention Program, in order to better shape the health care services provision. Methods A qualitative design approach was carried out. A focus group was conducted with patients enrolled in the Cardiovascular Risk Prevention Program (N=8), that have participated in more than two components of the program. The aim of this focus group was to obtain feedback from patients in order to improve and develop the services included in the Secondary Prevention Program. Content analysis was performed, results were assessed with dedicated software. Results There were tree specific topics that were evidenced: communication/access; education; time. Regarding the communication/access, patients mostly outlined the need for a close-up partnership, in order for them to have faster and easier communication channel with the health care professionals team. In the education topic, patients identified the need for increasing the number of educational sessions and repeating some contents, in order to have more discussion moments. The need for increase of the interactive component of certain sessions was also outlined. Patients also identified time as an issue, considering that the sessions are during lunch time, the multidisciplinary consultations take longer than the pre-established timings, and they’re only one day per week. Conclusion(s) The obtained results were used for Program improvement, by creating new communication and educational opportunities. They also served as fuelers for safeguarding this partnerships, as patients were involved in the update and further development of the Program, that they were and are still benefiting from. Patient involvement in the development of healthcare services is a great step towards improvement of health systems performance globally.

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

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

Examining the Evolution of Energy Storing in the Ecuadorian Electricity System: A Case Study (2006–2023)

Ensuring a balance between supply and demand is critical within electricity grids, requiring a supply composition that guarantees consistent service provision in the short and medium term. Between 2008 and 2017, Ecuador’s electricity generation capacity expanded significantly, with an investment of approximately USD 8150 million into harnessing the potential energy of water. This led to the construction of five high-capacity hydroelectric projects by 2017, contributing 33.4% of the sector’s energy output by 2023. However, it is important to note that if installed hydroelectric projects operate as run-of-river plants, with limited reservoir capacity, they can only regulate water use for electricity generation on an hourly basis. As of 2023, these run-of-river plants represent 68.8% of Ecuador’s total hydroelectric capacity within the National Interconnected System (SNI). Consequently, during periods of low inflows, supplementary energy from other power generation plants is necessary to prevent energy crises. This paper addresses the impact on energy storing for electricity generation resulting from the evolution of hydroelectric power plant entry from 2006 to 2023. This aspect has not been thoroughly examined in hydrothermal systems, which primarily focus on potential energy obtained from dams. Our approach involves a statistical analysis of hydroelectric dam reservoir operational levels. We further explore the influence on demand service within Ecuador’s electricity system, particularly during observed energy crises towards the end of 2023.

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

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

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

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

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

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

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

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

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

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

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

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

«Digital nomads» in the modern labor market

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