Special Services Research Articles

‘A clash of cultures’: varying perspectives on the Rhodesian incorporation into the South African special forces

ABSTRACT The South African Special Forces shared a close bond with the Rhodesian Special Air Service during the 1970s. Prior to the political changes in Rhodesia in 1980, a secret offer had been extended by the South African Defence Force to the Special Air Service to join the South African Special Forces. Following the 1979 elections in Rhodesia, many Rhodesian SAS operators joined the South African Special Forces to form 6 Reconnaissance Commando. However, the cultural differences and friction between the South African and Rhodesian operators hindered long-term cooperation. The potential for a much broader integration of Rhodesian experience was lost due to the clash in cultures between the South Africans and Rhodesians, and the loss of these Rhodesian operators due to dissatisfaction represented a missed opportunity for South Africa to have significantly strengthened its special forces. After only one operation in 1981, in which three Rhodesian operators were killed in action, most of the Rhodesians opted to end their contract with the South African Special Forces, which ultimately resulted in the closure of the Rhodesian Commando. This article examines why the incorporation of the Rhodesians did not work as envisioned from both a Rhodesian and South African perspective.

Applying integrated enhanced cognitive behaviour therapy (I-CBTE) to severe and longstanding eating disorders (SEED) Paper 2: An in-depth case study for clinicians

BackgroundThis case study examines the application of Integrated Enhanced Cognitive Behavioural Therapy (I-CBTE) for a patient with severe, longstanding anorexia nervosa and multiple comorbidities, including organic hallucinosis, complex post-traumatic stress disorder (CPTSD), and severe self-harm. Such complex presentations often result in patients falling between services, which can lead to high chronicity and increased mortality risk. Commentaries from two additional patients who have recovered from severe and longstanding anorexia nervosa are included.Case studyThe patient developed severe anorexia nervosa and hallucinosis after a traumatic brain injury in 2000. Despite numerous hospitalisations and various psychotropic medications in the UK and France, standard treatments were ineffective for 17 years. However, Integrated Enhanced Cognitive Behaviour Therapy (I-CBTE) using a whole-team approach and intensive, personalised psychological treatment alongside nutritional rehabilitation proved effective.MethodsIn this paper, we describe the application of the I-CBTE model for individuals with severe, longstanding, and complex anorexia nervosa, using lived experience perspectives from three patients to inform clinicians. We also outline the methodology for adapting the model to different presentations of the disorder.OutcomesThe patient achieved and maintained full remission from her eating disorder over the last 6 years, highlighting the benefit of the I-CBTE approach in patients with complex, longstanding eating disorder histories. Successful treatment also saved in excess of £360 k just by preventing further hospitalisations and not accounting for the improvement in her quality of life. This suggests that this method can improve outcomes and reduce healthcare costs.ConclusionThis case study, with commentaries from two patients with histories of severe and longstanding anorexia nervosa, provides a detailed description of the practical application of I-CBTE for patients with severe and longstanding eating disorders with complex comorbidities, and extensive treatment histories. This offers hope for patients and a framework for clinicians to enhance existing treatment frameworks, potentially transforming the trajectory of those traditionally deemed treatment resistant.RecommendationsWe advocate the broader integration of CBT for EDs into specialist services across the care pathway to help improve outcomes for patients with complex eating disorders. Systematic training and supervision for multidisciplinary teams in this specialised therapeutic approach is recommended. Future research should investigate the long-term effectiveness of I-CBTE through longitudinal studies. Patient feedback on experiences of integrated models of care such as I-CBTE is also needed. In addition, systematic health economics studies should be conducted.

The Sharing Energy Storage Mechanism for Demand Side Energy Communities

Energy storage (ES) units are vital for the reliable and economical operation of the power system with a high penetration of renewable distributed generators (DGs). Due to ES’s high investment costs and long payback period, energy management with shared ESs becomes a suitable choice for the demand side. This work investigates the sharing mechanism of ES units for low-voltage (LV) energy prosumer (EP) communities, in which energy interactions of multiple styles among the EPs are enabled, and the aggregated ES dispatch center (AESDC) is established as a special energy service provider to facilitate the scheduling and marketing mechanism. A shared ES operation framework considering multiple EP communities is established, in which both the energy scheduling and cost allocation methods are studied. Then a shared ES model and energy marketing scheme for multiple communities based on the leader–follower game is proposed. The Karush–Kuhn–Tucker (KKT) condition is used to transform the double-layer model into a single-layer model, and then the large M method and PSO-HS algorithm are used to solve it, which improves convergence features in both speed and performance. On this basis, a cost allocation strategy based on the Owen value method is proposed to resolve the issues of benefit distribution fairness and user privacy under current situations. A case study simulation is carried out, and the results show that, with the ES scheduling strategy shared by multiple renewable communities in the leader–follower game, the energy cost is reduced significantly, and all communities acquire benefits from shared ES operators and aggregated ES dispatch centers, which verifies the advantageous and economical features of the proposed framework and strategy. With the cost allocation strategy based on the Owen value method, the distribution results are rational and equitable both for the groups and individuals among the multiple EP communities. Comparing it with other algorithms, the presented PSO-HS algorithm demonstrates better features in computing speed and convergence. Therefore, the proposed mechanism can be implemented in multiple scenarios on the demand side.

From legislation to actual health service: evaluation of health provisions in the disability law of Ghana by adolescents with mobility and visual impairments and their families

BackgroundDespite Ghana’s Persons with Disability Act, 2006 (Act 715) making provisions for access to healthcare services for adolescents with disabilities and their families, a corpus of literature has reported that persons with disabilities continue to face challenges in accessing healthcare services. However, the voices of adolescents with disabilities and their families are very scarce in such discourse. This study explored the experiences of adolescents with disabilities and their families in accessing healthcare services as per the provisions described in Ghana’s Act 715.MethodsThis study involved 45 participants, including 25 adolescents with disabilities and 20 family members from a municipality in Ghana. Employing a qualitative descriptive design, semi-structured interviews were conducted which was then analyzed thematically and interpreted using Critical Disability Theory.ResultsThe study identified two major categories of barriers to healthcare access: environmental (socio-economic difficulties, poor built environment, unavailability of rehabilitation services) and systemic (cultural beliefs, poor support at healthcare facilities and inadequate healthcare legislative provisions for families of children with disabilities). Despite legal provisions for free healthcare, participants faced significant financial barriers, with specialist services often not covered by the National Health Insurance Scheme.ConclusionsThe study calls for policy adjustments to fully cover specialist care under Ghana’s National Health Insurance Scheme, establishment of local-level health assessment and resource centers, educational campaigns to change cultural perceptions, and training of healthcare workers to promote quality access to healthcare.

Challenges and opportunities of sustained public involvement in maternal health research: a practice case study with reflections from researchers and public contributors

It is widely agreed that collaboration with people with lived experience of specific health conditions or health services is both a moral imperative and a utility to improve research quality, validity and impact. However, there is little agreement about how to practise public involvement. In this article, we describe the formation and work of the Nottingham Maternity Research Network, an ongoing research reference panel that supports public involvement in maternal health research. Drawing on nine years’ experience, researchers and public contributors reflect together on the key issues to consider when co-producing research with maternity service users: first, pragmatic considerations, and second, creating a safe space for drawing on intimate and sometimes traumatic experiences. We argue that a sustained model of public involvement and engagement – that is, a standing group rather than a series of project-based, time-limited opportunities for involvement – brings opportunities to build trust and to develop a community that is supportive and inclusive. However, the sustained model of public involvement also brings practical challenges.

Optical Networking Gym: an open-source toolkit for resource assignment problems in optical networks

The dynamic provisioning of optical network services requires algorithms to find a suitable solution given the specific service requirements and the current network state. These algorithms are usually evaluated using a software simulator developed ad hoc, which may require different levels of detail depending on the problem addressed and how realistic the evaluation needs to be. Moreover, to demonstrate they are a significant contribution to the field, these new algorithms must be benchmarked against the best-performing previously proposed solutions. Due to the large set of parameters and their wide range of possible values, benchmarking algorithms from the literature is not straightforward and can quickly become challenging and time-consuming. This work introduces the Optical Networking Gym, an open-source toolkit that simplifies implementing optical resource assignment simulations and benchmarking new solutions against previously published algorithms. The toolkit provides environments modeling relevant optical networking scenarios, common algorithms for solving problems related to these scenarios, and a set of scripts to prepare and execute simulations for various use cases. Currently, four environments are available, with the possibility of increasing this number through contributions from the co-authors and the community. This paper describes the architecture, interface, environments, and scripts included with the toolkit. We adopt the quality of transmission (QoT)-aware dynamic resource allocation of optical services as the network scenario under examination. Three use cases highlight the toolkit’s modularity, flexibility, and performance. The toolkit allows researchers to streamline the process of developing simulation scenarios and algorithms, enhancing their ability to benchmark their algorithms.

Impact of E-Governance on Public Service Efficiency

This study examines the complex relationship between e-governance implementation and public service efficiency across diverse socio-economic contexts. Through a comprehensive review of recent literature, the research investigates how digital technologies reshape government operations and citizen interactions. The analysis reveals that while e-governance generally leads to improvements in service delivery, cost reduction, and increased transparency, these benefits vary significantly based on factors such as technological infrastructure, digital literacy, and specific service domains. The study challenges assumptions about immediate efficiency gains, particularly in developing countries where initial costs may increase due to the need for parallel traditional systems. The research emphasizes the importance of context-specific approaches, continuous evaluation, and addressing digital divide issues for successful e-governance implementation. These findings contribute to a nuanced understanding of e-governance's impact on public service efficiency, offering valuable insights for policymakers and public administrators navigating the digital transformation of government services.

Direct annual healthcare costs in survivors of acute pulmonary embolism: estimates based on a prospective multicentre cohort study

Abstract Background Patients surviving acute pulmonary embolism (PE) necessitate long-term care and follow-up. However, the economic impact of PE on healthcare systems after the acute event remains largely unknown. Purpose To estimate the direct cost of PE during the first year after discharge from hospital for the index event, focusing on rehospitalizations, anticoagulant medication, and outpatient follow-up. Methods We analyzed the data from a multicentre cohort study of 1017 unselected patients with confirmed acute symptomatic PE in Germany. After the index episode, the costs of which were not considered, patients prospectively followed an outpatient visit plan at 3, 12 and 24 months. All rehospitalisations were documented with the main and accompanying diagnoses; hospital costs were calculated based on current reimbursement in the German Diagnosis Research Groups (G-DRG) system. The duration and type (central unique drug identifier) of anticoagulant treatment was documented at each visit. Per-patient costs of ambulatory follow-up visits and tests were calculated by multiplying (i) the costs of each visit/test (German ambulatory healthcare services reimbursement catalogue) by (ii) the probability π (0.0≤π≤1.0) of needing that specific service, based on the PE follow-up algorithm of the ESC Guidelines which we populated with the actual results per step in the present study (Figure). The primary analysis was conducted in all patients with ≥3-month follow-up. An additional sensitivity analysis included only the patients completing ≥12-month follow-up. We additionally identified the baseline predictors for the number of rehospitalizations and costs using multivariable zero-inflated Poisson and hurdle regression and accounting for censored data. Results Of 1017 enrolled patients, 958 (94%) were included in the primary analysis. Of them, 24% were rehospitalized, for a marginal mean of 0.34 (bootstrapped 95% CI: 0.30-0.39) readmissions per PE survivor. Age, coronary artery, pulmonary and kidney disease, diabetes, and (in the sensitivity analysis) cancer, emerged as independent cost predictors by multivariable hurdle gamma regression (Table). Estimated overall rehospitalisation costs were €1138 (95% CI 896-1420) per patient (€1171 [908-1479] in the sensitivity analysis). Mean anticoagulation duration was 330 days, with estimated per-patient costs of €1050 (€1190 in the sensitivity analysis). Per-patient costs of ambulatory follow-up visits and tests were estimated at €182, yielding a total cost of illness per PE survivor of €2370-2543. For the entire country, the annual direct costs after acute PE would thus amount to €202-217 million. Conclusions By estimating per-patient costs and identifying major cost drivers of post-PE care, the present study may inform decisions concerning implementation and reimbursement of follow-up programmes aiming at improved overall cardiovascular prevention.TableFigure

Primary care utilization in Bulgaria: some effects of the COVID-19 pandemic

Abstract Background Disruptions to primary care provision during the pandemic set back prior advancements in screening and chronic disease management. Delays in routine vaccination added to preexisting hesitancy and sustained the downward trend in vaccination rates. The study examines the magnitude and duration of primary care disruptions in Bulgaria between 2020 and 2022. Methods The impact of the pandemic on primary care is assessed using administrative data from the National Health Insurance Fund covering the annual number of primary care services. To evaluate the effect on healthcare utilization, the average number of check-ups per person during the pandemic is compared to a pre-pandemic period (2017-2019). Results After the onset of the pandemic, all visits declined significantly on an annual basis. In 2020, overall prophylactic check-ups dropped by 6-13% and remained lower than the baseline until 2022. Initial figures for 2023 suggest some recovery, while specific services are likely to experience an ongoing decrease. During the pandemic, the average number of prophylactic examinations for children fell between 6.9 and 9.3%. In 2022, there was a modest resumption, although these services did not reach the preceding levels. Adult prophylactic visits declined by approximately 10-12% between 2020 and 2021, but following a U-shaped pattern, they rebounded in 2022. Visits associated with chronic diseases experienced a drop of 7.8% in 2020 and continued to decrease in the next two years. Child vaccination was affected for a shorter period. In 2022, the coverage for most vaccine-preventable diseases was close to the pre-pandemic levels. However, the uptake of MMR and pneumococcal vaccines failed to demonstrate a clear path to recovery. Conclusions During the pandemic, a considerable drop in primary care utilization has been recorded. Effective recovery requires sustained service delivery and a rapid post-lockdown rebound to mitigate the negative impact on health outcomes. Key messages • Primary care needs additional recovery measures to prevent long-term harmful impacts on health outcomes. • Investing in service delivery innovations can boost resilience during disruptive events.

Evaluation of specific offers for mothers with mental stress

Abstract Background As part of the Austrian early intervention programme ‘Frühe Hilfen’, specific interventions (a psychotherapeutic short-term intervention and a therapeutic group) were implemented in some regions. An evaluation was carried out to gain general insights into the need for and benefits of psychosocial services as well as in-depth information on the benefits of the two selected services. The results of the project should also enable further conclusions/recommendations for appropriate services. Methods Mixed-methods approach: qualitative (focus groups, individual interviews, online surveys, participant observation) and quantitative (screening questionnaires) instruments involving a large number of relevant stakeholders and actors. Data analysis: content-structuring qualitative content analysis according to Kuckartz; descriptive analysis of the screening questionnaires. Results The analysis revealed a great need for specific psychosocial services for this target group as well as a high level of satisfaction with the psychosocial services utilised. However, all respondents pointed out barriers to the utilisation of psychosocial services. The evaluation results show that the two specific services make an important contribution to improving the well-being of mothers with mental health problems. Both services largely reach their target group well and, thanks to their focus, contribute to the well-being of mothers with mental health problems. The effectiveness of the service is underpinned by the fact that all participants perceive a reduction in mental stress and notice a reduction in stress during the screenings. Conclusions Based on the evaluation results, it is generally recommended that low-threshold, free and needs-based services be established or expanded. In addition, there is a need for more educational and public relations work on psychosocial stress/diseases and more information on support services. Key messages • There is a great need for psychosocial support among mothers. • The high level of satisfaction with the services evaluated indicates that more such services are needed to support families.

Physical activity habits among members of the Athens Medical Society in Greece

Abstract Introduction Benefits of regular physical activity and exercise are well documented. Healthcare workers play a crucial role in counseling and appropriately referring their patients to adopt physical activity. However, doctors’ exercise habits range between different medical specialties and health service infrastructure. Purpose In this study, we assess physicians’ exercise performance according to the recommendations of 2020 ESC Guidelines. Methods The population of this cross-sectional study comprised 742 physicians of the Athens Medical Society (AMS), Greece. The study instrument was a self-administered questionnaire mailed in October 2023 to investigate physicians’ exercise habits, baseline characteristics of population, specialty, and health service infrastructure [Greek National Healthcare System (GNHS) or Private Practice (PP)]. European Society of Cardiology (ESC) Guidelines recommend at least 150 min/week of moderate-intensity exercise in all healthy adults. Subjects were divided in two groups according to their compliance to ESC Guidelines: 1. Moderate-intensity endurance exercise training per week ≥ 150 min (Group A); 2. Moderate-intensity endurance exercise training per week <150 min (Group B). Results The recommended exercise training per week goal is achieved by the majority of AMS members (53.4%) with an estimated mean exercise endurance training time of 240 ± 285 minutes. Between Group A and Group B there was no difference in age (50±12years vs. 50±13years, p=0.73), whereas there was significant difference in male sex prevalence (58% vs. 43%, p <0.001), in Body Mass Index (24.7 ± 3.8 kg/m2 vs. 26.2 ± 4.7 kg/m2, p <0.001), in Smoking habits (17.4% vs. 23.5%, p=0.04), in diabetes mellitus incidence (6.6% vs. 11.8%, p= 0.01) and in the use of activity monitoring wearables (45.2% vs. 29.8%, p<0.001). Interestingly, there was significant difference between GNHS and PP doctors representation in Group A and B with more doctors in the PP categorized in the Group A (p=0.008) (Figure 1). Importantly, logistic regression analysis revealed that even after adjustment for the aforementioned confounders there was significant under-representation of the GNHS in the Group A or otherwise doctors in the GNHS have 33% decrease odds of achieving the recommended exercise training per week (Odds Ratio: 0.676, 95%CI 0.484, 0.943, p=0.02) (Table 1). Conclusion A significant proportion of the AMS members follows the recommended ESC guidelines for minimum exercise training per week. Several factors affect their adherence to exercise time recommendation. Interestingly, AMS doctors working on the GNHS independently of other factors are less adherent to exercise recommendations. These findings emphasize the need to strengthen prevention strategies to AMS.

Healthcare access for people with disabilities: a scoping review of COVID-19 policies in Europe

Abstract Introduction The COVID-19 pandemic raised healthcare inequalities, affecting the most vulnerable groups. There is limited evidence of whether the COVID-19 measures and the health system’s preparedness for outbreaks among European countries were sufficient to cover the health access needs of PWDs. Aim To provide a structured overview of the COVID-19 measures and policies addressing access to primary and specialist health services for PWDs during the COVID-19 pandemic in the European Members States (MS) and the United Kingdom (UK), using ten dimensions of healthcare access by Levesque et al. (2013) and the PoliMap taxonomy. Methods This study followed the PRISMA guidelines for Scoping Reviews. A search strategy was employed on PubMed, Embase, Scopus, and Web of Science databases from January 2020 to January 2023. Studies published in peer-reviewed journals in English, Portuguese, and Spanish were included, informing a COVID-19 measure or policy and assessing or providing a rationale with access to primary or special healthcare services. Results The final search strategy yielded 2.076 results, 188 studies were reviewed for full-text analysis, and 74 were included in the final analysis. One hundred twenty-one policies or measures addressing primary or specialist care access were identified. Only thirteen target PWDs, focussing on intellectual or mental disability and addressing mental healthcare services. Results revealed that COVID-19 measures for PWDs were oriented to increase health system response capacity and reduce virus transmission, describing a predominantly negative effect on healthcare access for PWDs. Conclusions The needs of PWDs in access to primary and specialist care were not fully covered by the policies and measures placed during the COVID-19 pandemic among the MS and the UK. One-size approaches focussing on the attendance of COVID-19 infection with stigmatizing measures overlook the specific health necessities of this population. Key messages • Adopting disabled-inclusive measures in the daily healthcare provision and engaging PWDs in the policy cycle is paramount to preparing for the next outbreak and public health crises. • Additional research focusing on primary and specialized healthcare access during outbreaks for PWDs, especially with sensory and physical disabilities, is crucial to furthering health equity.

Feasibility of novel robot-assisted, remotely-performed echocardiographic examination

Abstract Background Access to echocardiography services outside metropolitan areas is persistently limited. We sought to determine the feasibility and efficiency of performing remotely-controlled, semi-automated robot-assisted echocardiographic examinations (robot-assisted echo) by cardiac sonographers as a potential avenue to provide standard echocardiographic specialist services to remote and rural areas as well as permit expedited diagnoses enabling earlier management of disease. Methods Two accredited cardiac sonographers (Cardiac Investigations Unit) undertook 6 hours virtual training, and 10 hours hands-on robot-assisted echo simulation training; using a novel, semi-automated robotic arm system to remotely manipulate an ultrasound probe to acquire echocardiographic images. Sonographers then performed remotely-performed robot-assisted echo examinations on staff volunteers, and consenting inpatients in whom echocardiography was clinically indicated. Cameras, probe pressure sensors and an ultrasound platform remote console were utilised to support remote operation. Traditional echocardiography (manipulation of probe by hand) was also performed as a reference. Feasibility to obtain a comprehensive robot-assisted echo was compared to traditional echocardiography. Sonographer learning curve and efficiency (image acquisition time and offline measurement time) was also investigated. Results Total cohort was n=78 (age 51±15yrs; 57% male) with 63% patients. All participants had robot-assisted echo and traditional echocardiograms performed within 72hrs. Average feasibility (%) of robot-assisted echo as (a) 11 averaged assessments and (b) 38 averaged measures was 92±9 (a) and 86±11 (b), compared to (a) 99±1 and (b) 97±7 by traditional examination (all respectively). Sonographer learning curve was identified via 1:1 block subcohort analysis, with averaged assessment feasibility (n=33:31) being 86±19 (first block) to 98±3 (last block) and averaged measurement feasibility (n=32:31) being 77±11 (first block) to 92±7 (last block), all respectively. In the staff participant cohort (n=31), average image acquisition efficiency in robot-assisted echo was poorer than that of traditional examination (47+9 minutes compared to 19+2 minutes; p<0.0001), respectively. Average efficiency of offline measurement time was 13+7 minutes by robot-assisted echo; comparable (p=0.33) to traditional examination at 12+6 minutes. There was no learning curve effect on image acquisition efficiency; 42+10 vs 51+7 minutes (1:1; n=16:15; p=0.007). Conclusion Remotely-performed, robot-assisted echo using a commercially-available ultrasound platform performed by briefly-trained, cardiac sonographers is feasible, with reasonable efficiency even though less efficient in image acquisition compared to traditional echocardiograms. Further investigation of performance as a remote service is warranted in larger, clinically-indicated populations.

Health literacy and access to health services: insights from a national survey in Italy

Abstract Background Health Literacy (HL) entails accessing, understanding, evaluating, and applying healthcare (HC) information. Aim of this study is to assess HL association with HC services use in the Italian adult population. Methods A national survey was conducted in Italy in 2021, in the framework of the WHO network Measuring Population and Organizational Health Literacy (M-POHL). A validated questionnaire was administered to a representative sample of the Italian resident population aged 18+ years (N = 3,500). A 4-point Likert scale was used for answers: very easy, easy, difficult, very difficult. The HL index, as the percentage of very easy/easy responses, was categorized as Inadequate (0-50%), Problematic (51-66%), Sufficient (67-80%), Excellent (81-100%). Inadequate/Problematic were combined in ‘Limiting’ and Sufficient/Excellent in ‘Not limiting’ categories. A multivariate logistic regression analysis, adjusted by sex, age, geographical area, education, and financial deprivation, was used to explore the associations between HL and the frequency, of utilization of general practitioners-GPs (never, once/twice, three/more times), medical or surgical specialist services-MSS (never, once, twice/more), inpatient hospital services-IHS (never, once/more), day-patient hospital services-DPS (never, once/more), taking sick days at work-SD (never, once/twice, three/more) in the last 12 months, and emergency services-ES (never, once/more) in the last 24 months. Results In Limiting HL (64.6%), the prevalence of never using ES is significantly lower compared to Not limiting HL (81.83% vs 83.80%); likewise for never using MSS (45.84% vs 51.24%) and never using DPS (90.87% vs 93.80%). Significant association with Limiting HL was found for using MSS once (Odds Ratio-OR=1.55), twice/more (OR = 1.76) and taking SD once/twice (OR = 1.58). Conclusions Results demonstrate that people using HC services more frequently, in particular MSS and taking SD, require dedicated support to improve HL. Key messages • This study aims to evaluate the association of the individual Health literacy level with the use of several healthcare services in the Italian adult population. • ‘Limiting’ Health Literacy is associated with using medical or surgical specialist services twice or more times and taking sick days at work once or twice.

Disparities in Receipt of Early Intervention Services by Toddlers with Autism Diagnoses: an Intersectional Latent Class Analysis of Demographic Factors.

We examined receipt of general early intervention services and autism-specific specialized services across demographic groups among toddlers with autism diagnoses who were receiving Part C Early Intervention (EI). Latent class analysis (n = 508) identified five demographically distinct subgroups associated with intersecting marginalization and privilege. Analyses of longitudinal parent interviews (n = 225) revealed service receipt disparities across these demographically distinct latent classes; children from White, U.S. born, English-proficient parents with incomes above poverty level received more EI services (M = 12.0h/week) than other subgroups, with children from Latiné immigrant families receiving the fewest hours (M = 6.9h/week). Across all groups, average intervention hours were 8.8h/week. Despite early identification, racial, ethnic, and other sociodemographic disparities were evident in receipt of Part C Early Intervention services, indicating the need to address barriers to equitable care.

Using Unsupervised Learning Methods to Explore the Trajectory of Long-Term Care Service in Taiwan

Abstract Background Understanding the temporal trends in long-term care (LTC) utilization enables more effective planning by government and service providers. This study employed machine learning methods to explore LTC utilization trajectories among care recipients in a southern county of Taiwan. Methods Administrative data from the government-funded LTC programme was utilized, with a total of 24,614 participants included after excluding those with less than six months of data. Daily service utilization records, mainly focusing on caregiving services, were aggregated, and the number of days each participant used LTC services within every 30-day period post-application was calculated. Utilization rates during 6 and 12 months post-application were separately analyzed. K-means clustering, an unsupervised machine learning method, was employed to select the optimal classification and identify LTC utilization trajectories using 10-fold cross validation. Temporal frequency variations of each caregiving service within each trajectory group were visualized using heatmaps. Results In the analysis of LTC utilization within the first 6 months post-application, trajectories were classified into 7 groups; while within 12 months, trajectories were divided into 4 groups. These trajectories can be categorized into 4 distinct patterns: High-Stable (6 mo: 21.3%; 12 mo: 35.7%), Low-Stable (6 mo: 33.1%; 12 mo: 37.2%), High-Decrease (6 mo: 12.8%; 12 mo: 10.7%), and Low-Increase (6 mo: 32.7%; 12 mo: 16.5%). We further explored differences in socio-demographic characteristics and needs factors among trajectory groups. Heatmaps were used to illustrate temporal variations in the utilization rates of specific service items, which played a significant role in determining the trajectories. Conclusions K-means clustering is useful in identifying distinct patterns among LTC users. Tailored service delivery strategies can be designed to meet the diverse needs of these different user groups. Key messages • The unsupervised machine learning method distinguished various temporal dynamic patterns in LTC utilization. • Tailored service delivery strategies can be designed to meet the diverse needs of these different user groups.

Health care provider payment schemes in Central and Eastern European countries

Abstract Background Health care provider payment schemes are key elements of the health care system that influence providers behavior, quality of care, and efficient use of resources. In recent decades, Central and Eastern European (CEE) counties have implemented various reforms that have changed payments methods and other elements of the purchasing process. The aim of the study was to provide an overview of the current provider payment schemes within the public health system in selected CEE countries and identify the main directions of their reforming. Methods Based on existing literature, a theoretical framework and data collection form were first developed. Next, desk research was conducted to collect data on provider payment methods and other elements of the purchasing process in primary care, outpatient specialized care, hospital care, and long-term care. The collected information was verified and supplemented though consultations with national experts. Nine countries were included: Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Hungary, Poland, and Romania. The study was conducted in 2023. Results Capitation, fee-for-service, and case-based payments are the most commonly used methods in the analyzed countries. The countries are increasingly using blended payment methods. Primary and hospital care have the most diverse payment method mix and have experienced the most substantial changes in their payment schemes since 2010. The most common changes focused on modifying existing methods (detailing payment categories, changing the principles of tariff valuation), and introducing additional methods to pay for specific services or performance (fee-for-service, bonus payments). Conclusions CEE countries are following similar directions in reforming provider payment systems, with the goal of strengthening primary health care, shifting emphasis from inpatient to outpatient care and improving cooperation between health care providers. Key messages • CEE countries largely use output-based methods to pay for health care services. • Provider payment systems are becoming more blended as countries look for the most effective payment method mix to meet policy objectives.

Educational management in personnel training of hydrometeorological services: world experience

Introduction. The relevance of the presented study is determined by the fact that the acceleration of climate change on the planet has a significant impact on almost all spheres of economic and social life of mankind, which imposes new requirements both on the information provided by hydrometeorological services and on the personnel of managers and specialists providing it.Purpose setting. The purpose of the presented studies is to summarize the world experience in the development of promising requirements for the skills and competence of managers and specialists of national meteorological services in the interests of forming a system of requirements for staffing and training of managers and specialists of hydrometeorological services of the Roshydromet system.Methodology and methods of the study. The methodological base of the research consists of well-known scientific works devoted to the promising requirements for the skills and competencies of managers and specialists of the hydrometeorological service. Results. The novelty of the obtained results lies in the fact that, based on the generalization of world experience in the development of promising requirements for the skills and competence of managers and specialists of national hydrometeorological services, it was found that when forming personnel management strategies, on the one hand, requirements are put forward for a wide range of competencies of personnel who own both traditional technologies and innovative technologies for processing and interpreting information based on IT. On the other hand, hydrometeorological services impose increased demands on themselves, which is manifested in strategic aspirations to form a holistic motivation system for their employees, covering all levels of human needs, according to substantive theories of motivation – from economic competitiveness to opportunities for training, development and self-expression.Conclusion. The practical significance of the obtained results lies in the possibility of using world experience in developing promising requirements for the skills and competence of managers and specialists of national meteorological services when forming strategies for personnel management of hydrometeorological structures of the Roshydromet system.

Latin Transgender and Gender-Diverse Individuals’ Perceptions of Well-Being During the COVID-19 Pandemic

Latin transgender and gender-diverse (LTGGD) individuals experienced the public health measures mandated during the COVID-19 pandemic in unique ways. Intersecting ethnic and gender-identifying frameworks contributes to differing access, support, and well-being observations. The aim of this study was to examine emerging adult LTGGD individuals’ perceptions of their health and well-being experiences during the COVID-19 pandemic in South Florida. Interviews were conducted with nine self-identifying LTGGD individuals. Using a thematic analysis, a total of three major themes were identified as shaping the participants’ experiences and perceptions of health during COVID-19, including (a) healthcare interactions, (b) challenges, and (c) opportunities. Some of the participants were mixed in their perceptions of their well-being during the COVID-19 pandemic; negative concerns included the inability to access general and transgender/gender-diverse specific health services. However, others note that they were happy that the pandemic allowed them to avoid contexts where they regularly experienced microaggressions due to their identities. Additionally, various participants were able to use this time of isolation to identify providers with greater knowledge about LTGGD health needs. These findings highlight the importance of providing culturally competent and humility-centered skills to healthcare providers and others supporting the LTGGD population’s well-being.

Autism spectrum disorder (ASD) presentations among referrals to a child and adolescent mental health service (CAMHS) inpatient unit in Ireland.

This retrospective chart review aimed to identify the intersection between young people with Autism Spectrum Disorder (ASD)'s needs and CAMHS inpatient service needs. A retrospective chart review was conducted on all referrals to a CAMHS inpatient unit over three years (n = 352). Referrals which specified a formal diagnosis or suspected diagnosis of ASD were identified (n = 111), and basic demographic data were collected. Young people with either a formal or suspected diagnosis of ASD referred to the unit presented with a wide range of co-occurring conditions. Of these young people, 30 were admitted to the unit and only 6 of them were engaged with an ASD specialist service. Young people with diagnosed or suspected ASD were more likely to be admitted if they presented with suicidality. Males with diagnosed or suspected ASD were more likely to have a diagnosis of OCD while females with diagnosed or suspected ASD were more likely to present with eating and feeding disorders and personality development difficulties. Findings highlight the lack of a clear care pathway for young people with co-occurring autism or suspected autism and complex mental health problems.