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Background: Access to traditional mental health services in Canada remains limited, prompting exploration into digital alternatives. The Government of Ontario initiated access to two internet-based cognitive behavioral therapy (iCBT) programs, LifeWorks AbilitiCBT and MindBeacon TAiCBT, for adults with mental health issues. Methods: An uncontrolled observational study utilizing secondary retrospective program data was conducted to evaluate the reach, uptake, and psychological symptom changes among participants engaging with either iCBT program. Results: Between May 2020 and September 2021, 56,769 individuals enrolled in LifeWorks AbilitiCBT, and 73,356 in MindBeacon TAiCBT. However, substantial exclusions were made: 56% of LifeWorks participants and 68% of MindBeacon participants were ineligible or failed to initiate treatment. Consequently, 25,154 LifeWorks participants and 23,795 MindBeacon participants were included in the analysis. Of these, 22% of LifeWorks and 26% of MindBeacon participants completed over 75% of iCBT treatment. On average, LifeWorks participants received 13 ± SD 7.1 therapist messages and sent 5 ± SD 10.3 messages, while MindBeacon participants received 25 ± SD 20.7 therapist messages and sent 13 ± SD 16.4 messages. LifeWorks included synchronous therapist contact averaging 1.4 ± SD 1.9 h per participant, while MindBeacon was purely asynchronous. Baseline severity of anxiety (37%) and depression symptoms (22%) was higher for LifeWorks participants compared to MindBeacon participants (24% and 10%, respectively). Clinically significant changes in anxiety and depression scores were observed: 22% of LifeWorks and 31% of MindBeacon participants exhibited reliable recovery in PHQ-9 scores, while 26% of LifeWorks and 25% of MindBeacon participants demonstrated reliable recovery in GAD-7 scores. Conclusion: In conclusion, iCBT programs show promise for engaged participants with varying levels of severity in anxiety and depression symptoms. Future iterations of iCBT should consider adopting a broad entry criterion to iCBT programming to increase accessibility, especially for those with severe symptoms, alongside integrated intake care pathways, and potential payment structure adjustments for iCBT service providers. Taken all together, these factors could temper high dropout rates post-intake assessment. This evaluation underscores the potential and value of digital mental health interventions for individuals with mild to severe anxiety or depression symptoms, emphasizing the importance of addressing participant dropout. [ABSTRACT FROM AUTHOR]

Background and Objectives Coordination of governmental action is crowded with policies and programs that are highly interdependent, sometimes operating in silos if not contradicting each other. These dilemmas, or administrative quagmires, are heightened for older adults in general, but they are particularly problematic for marginalized older adults because these groups often require public assistance and support. This scoping review studies the coordination of governmental action on aging published in social science journals, focusing on 6 groups of marginalized older adults: those with histories of immigration, individuals with severe mental health problems, those who have had experiences of homelessness, formerly incarcerated individuals, members of the LGBT (lesbian, gay, bisexual, and transgender) community, and individuals living in a rural area. Research Design and Methods A 5-stage scoping review methodology was followed, and 53 articles (published between 2000 and 2022) from 5 social science databases were analyzed. Results The analysis revealed a limited number of contributions with coordination as a primary focus. Understandings of coordination varied but tended to examine structure, organization, and relationships between sectors. When coordination was the primary object of a study, it was often analyzed in 1 specific policy area or within a clinical setting along the lines of facilitating care coordination. Discussion and Implications This scoping review reveals a mutual neglect on the part of public administration and policy scholars toward marginalized older adults and a lack of public administration considerations on the part of scholars studying long-term care and social service programs for these marginalized older adults. [ABSTRACT FROM AUTHOR]

The article presents the text of a speech by Dr. Bernard P. Dreyer in receiving the Joseph W. St. Geme, Jr Leadership Award, presented by the Federation of Pediatric Organizations at the Pediatric Academic Societies Meeting in Toronto, Ontario on May 3, 2024. He discussed why he felt honored in receiving the award, his privilege to be a pediatrician, and their major advocacy for reducing child poverty.

OBJECTIVES: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) provide essential nutrition support for low-income families. However, many eligible families do not receive or fully redeem these benefits. We aimed to understand current and former WIC and SNAP beneficiaries' perceptions of and suggestions for improving both programs. METHODS: We conducted semistructured phone interviews with caregivers of pediatric patients who were current or former WIC and SNAP beneficiaries at 2 academic pediatric primary care clinics. Interviews were recorded, transcribed, and coded by 2 independent coders using thematic analysis, resolving discrepancies by consensus. Interviews continued until data saturation was reached. RESULTS: We interviewed 40 caregivers who were predominantly Black (88%) mothers (90%), with 53% and 83% currently using WIC and SNAP, respectively. We identified 4 themes related to participation barriers: (1) limited product variety available through WIC, (2) inconvenience and stigma associated with purchasing WIC products, (3) SNAP income-based eligibility criteria, and (4) burdensome SNAP enrollment and recertification processes. We identified 3 themes related to suggestions for improvement: (a) decreasing stigma associated with participation, (b) allowing online or phone-based enrollment, and (c) improving coordination with health care systems. CONCLUSIONS: WIC and SNAP beneficiaries identified several modifiable barriers to enrollment and benefits redemption. Pediatric providers should advocate for programmatic improvements that make it easier for families to access and redeem benefits and should consider implementing innovative cross-sector interventions like medical--financial partnerships, direct WIC and SNAP referrals, and data sharing with government assistance offices. [ABSTRACT FROM AUTHOR]

The War on Poverty-era Job Corps conservation centers of the National Park Service offer an important narrative about the contributions of young people of color and poor white people to conservation and the national parks. At a time when the agency is eager to diversify both its staff and visitors, this is an important history for the NPS to research and interpret for the public. The Job Corps and other federal youth conservation programs also offer important lessons for current and future job training and conservation programs. These lessons underscore the need to fully consider issues of race and class in federal programs that seek to address poverty and conservation, and to consider whether federal land agencies such as the National Park Service are equipped to handle this task. [ABSTRACT FROM AUTHOR]

India is aging. The growth of India's older population has increased our concerns about their well-being. While it is critical to explore the diverse needs and aging experience of older Indians, their voices are largely missing in the aging literature. In this context, data was collected from 63 community-dwelling and OAH residing older men and women of Delhi NCR to understand their aging experience, views about old age and perceived need for government intervention in old age care and support. Reflexive thematic analysis of their aging experience and perception of old age generated five themes and six sub-themes: The aging body encompassing three sub-themes "the older we become the more diseases we have", "the ointment called positive thinking", "women's quest for self-care"; Psychological gains and social losses; Affiliation, distraction and anticipation; The aging parent and the adult child comprising three sub-themes "filial relations—quality and quantity", "children these days and their mobile phones", "our daughter shows us more love and care"; and A time for religious and spiritual devotion. Lastly, the analysis of their perceived need for government support in old age care generated five sub-themes – Political cynicism, I was a private employee but am I not a part of this country? Government or Private Hospitals: A no-win situation, Everyday life and Reforms in OAHs. The present findings highlight the multidimensional and multidirectional experience of aging and the diverse needs of older persons in the Indian context. [ABSTRACT FROM AUTHOR]

Purpose The 340B Drug Pricing Program is important to healthcare organizations that serve vulnerable communities. However, it is unknown whether healthcare providers in these organizations understand the 340B program and how it supports enhanced patient services. This study aims to characterize the knowledge, attitudes, and beliefs of healthcare providers toward the 340B program in a multisite federally qualified health center (FQHC). Methods This was a cross-sectional study. A 27-item survey designed to assess prescriber knowledge and perspectives toward the 340B program was developed and administered. Closed-ended items were summarized using descriptive statistics, and open-ended items were analyzed with qualitative methods. Results A total of 198 healthcare providers with prescribing authority received the survey; of those, 65 (32.8%) participated. The majority of respondents (66.2%) were female; 41.5% were 35 years of age or younger, and 49.2% were physicians. The majority of respondents agreed that patients benefited from access to the organization's 340B pharmacies (95.0%) and that 340B pricing is important to consider when prescribing medications (78.3%). However, knowledge of the 340B program was limited, with only half of respondents (54.0%) able to correctly answer at least 4 of 7 knowledge-focused items. Reponses to a patient case suggested that some providers may be unfamiliar with which drugs are available at reduced prices. Conclusion The findings suggest that providers believe the 340B program benefits patients and the organization but often lack a complete understanding of the program. Future research should focus on prescriber education as a strategy to help organizations optimize their 340B programs and facilitate patient access to medications. [ABSTRACT FROM AUTHOR]

Migrant families face challenges to health and well-being from COVID-19. We deployed Mobile Health for Migrant Health (mHealth-4-Mhealth) to migrant families, a household-based program with mHealth-assisted at-home testing and linkages to community resources. We assessed the reach, adoption, and implementation of the program among rural migrant families enrolled in the Title IC Nebraska Migrant Education Program from February 2022 to July 2023. We describe successful adoption and longitudinal use of mHealth screening tools for severe acute respiratory syndrome coronavirus 2 infection risk and social determinants of health. (Am J Public Health. 2024;114(11):1212–1216. https://doi.org/10.2105/AJPH.2024.307746) [ABSTRACT FROM AUTHOR]

Once established, government spending programs tend to continue. A commonly held view is that spending inertia leads to unsustainable debt, ultimately requiring fiscal adjustments such as "sequestration." We show that by insuring against political turnover, inertia may reduce politicians' incentives to accumulate debt. However, large preexisting commitments and the prospect of future stabilization can lead to overspending to dilute past administrations' commitments. Finally, we show that political polarization amplifies incentives to prioritize inertial programs, potentially explaining the increased share of mandatory spending in the US budget. (JEL D72, E62, H61, H63) [ABSTRACT FROM AUTHOR]

Engaging the US Office of Personnel Management's inaugural Federal Work‐life Survey (2017), this study deconstructs the gender and race differences in employee satisfaction with federal work‐life programs. We examine whether women of color employees in particular stand to benefit differently from the federal work‐life programs in comparison to their male and white colleagues. Notably, this study operationalizes the federal employee's work‐life interference and dependent care responsibilities to determine gender and race‐related differences in employee satisfaction with federal work‐life programs. Study results indicate that federal employees belonging to historically marginalized racial and ethnic groups are satisfied to a lesser extent with partaking in federal work‐life programs than their white counterparts. [ABSTRACT FROM AUTHOR]

Objective: Care partners of persons living with dementia perform significant financial planning in partnership with the person for whom they care. However, research is scarce on care partners' confidence and experiences with financial planning. The purpose of this study was, first, to quantify care partners' confidence across different financial planning topics. We sought to understand whether income, education, relationship type, and years of experience are related to care partners' level of confidence in financial planning. Second, we sought to better understand the reasons for these confidence ratings by examining care partners' experiences of financial planning. Methods: We conducted an online survey that asked a combination of quantitative and qualitative questions to understand care partners' confidence and experiences with financial planning. Participants were nationally recruited care partners of persons living with dementia. Multivariate linear regression was used to understand different subgroups' levels of confidence in each financial planning topic. Inductive thematic analysis was used to understand qualitative data. Results: The financial planning topics in which participants (N = 318) felt the least confident were: options when there is not enough money to provide care; tax deductions available to cut care costs; and sources of money from government programs for which the care recipient is eligible. Differences in confidence were observed among care partners with lower incomes, less experience, and caring for a parent. Qualitatively, participants described the challenges of care budgeting and protecting personal finances; confusion about long-term care insurance and accessing resources; and, among confident care partners, reasons for this sense of preparedness. Conclusions: These results underscore the need for tailored interventions and technologies that increase care partners' confidence in specific aspects of financial planning, including long-term care insurance, available financial support, and what to do when money runs out. [ABSTRACT FROM AUTHOR]

Recent data from the US Energy Information Administration reveals that nearly one in three households in the United States report experiencing energy poverty, and this number is only expected to rise. Federal assistance programs exist, but allocations across states have been nearly static since 1984, while the distribution of energy poverty is dynamic in location and time. We implement a LASSO-based machine learning approach using sociodemographic and geographical information to estimate energy burden in each US census tract for 2015 and 2020. We then compare the allocation to states from the Low Income Home Energy Assistance Program to an optimized allocation. We allocate funds to the most burdened households, providing them with enough assistance to reduce their energy expenditures so that their household energy burden is equal to a new maximum allowable energy burden. This markedly shifts funds from the northern cold-weather states to the southern warm-weather states. [ABSTRACT FROM AUTHOR]

Background: Between 1962 and 1975, a chlor-alkali plant in Canada discharged approximately 9 metric tons of mercury (Hg) into the Wabigoon River. Over the following decades, biomarkers of Hg exposure of persons from Grassy Narrows First Nation (Asubpeeschoseewagong Anishinabek), located downriver from the discharge, reflected Hg concentrations in fish. Hg exposure is known to target the calcarine fissure, resulting in visual field (VF) loss. Most studies and clinical reports focus solely on peripheral VF loss; little is known about the impact of Hg on the central and paracentral portions. The present study sought to characterize the patterns of VF loss with respect to past and current Hg. Methods: A 28-year hair-Hg (HHg) database, created from a 1970–97 government biomonitoring program, served to select study participants with ≥ 4 year-based HHg measurements (n = 81). Blood-Hg was assessed for current exposure. Light sensitivity thresholds across the VF were analyzed monocularly, using a Humphrey Field Analyzer (HFA). Following post-hoc exclusions, based on HFA interpretation indices, 65 participants were retained. Both eyes were combined for analyses (n = 130 eyes). Unsupervised hierarchical clustering of HFA plot data was used to identify patterns of VF loss. A series of mixed effects models (MEM) were performed to test the associations for current Hg exposure with respect to HFA interpretation indices and clusters, as well as for longitudinal past Hg exposure. Results: The clustering approach decomposed the light sensitivity deficits into 5 concentric clusters, with greatest loss in the peripheral clusters. No relation was observed between any of the cluster scores and current blood-Hg. VF deficits increased with past Hg exposure. Longitudinal MEM showed that HHg was significantly (p < 0.05) associated with all peripheral, paracentral, and central cluster scores, as well as with HFA interpretation indices. Conclusions: Past Hg exposure in Grassy Narrows First Nation was associated with present day VF loss. The cluster-based location-specific approach identified patterns of VF loss associated with long-term Hg exposure, in both the peripheral and the central areas. The functional implications of this type of visual loss should be investigated. [ABSTRACT FROM AUTHOR]

This study examines the impact of foreign and local investors' interference in the national development as a form of President Joko Widodo's government program on social equality and environmental support for Indonesia's lower-level communities. Joko Widodo as the Indonesian President since the beginning of his term initiated infrastructure development throughout Indonesia, inviting foreign and local investors. These investors can rapidly raise the value of the Indonesian economy. The high value of the Indonesian economy also hurts various communities, especially on the social level of Indonesian society. Social equality in Indonesia has not achieved a balanced value among its people, which leads to social inequality in all aspects of social welfare of the Indonesian people.. Environmental support for people who experience social inequality is not achieved, this can be viewed in terms of shelter, food, clean water intake, and several other aspects that do not support the lives of people with social inequality. This research aims to realize how influential investors and the development of the Indonesian nation are on their communities, especially among the lower level who are not reached by the Indonesian government as a form of support for environmental welfare. The study recommends investors make breakthroughs that provide benefits for people with low social levels so that they do not experience further deterioration in life, the government must also play an effective role in realizing decent environmental support (green environment) to achieve social equality. [ABSTRACT FROM AUTHOR]

The Indonesian government, including local governments, has spent large sums of money and many programs to reduce poverty. However, in several regions in Indonesia, the number of poor people has increased, as in Central Kalimantan, where the poverty rate has increased in the last three years. The number of poor people in Central Kalimantan in 2020 is 132 thousand people; this number increased to 140 thousand people in 2021, then increased again to 145 thousand in 2022. Research on poverty has been carried out in Indonesia. However, research analyzing poverty caused by natural factors and mismanaged government policies has not been carried out. This research was conducted to analyze poverty in Central Kalimantan between state policy governance factors and natural factors. The research uses analytical qualitative methods and case study designs. The analysis uses the new institutional theory and the natural resource curse theory. The research finds that mistakes in managing government policies (structural dimension) and nature (natural dimension) are factors that both play a role in increasing poverty in Central Kalimantan. As a practical suggestion, the government needs to make more intense and detailed efforts to alleviate poverty in Central Kalimantan that are adapted to natural conditions. [ABSTRACT FROM AUTHOR]

Background: Whether to manage malpractice claims by a proactive communication and resolution program or by the traditional adversarial legal process remains an important but unsettled question in health care risk management and the long-term durability of a communication and resolution program is unknown. We report here on the current outcomes of the Michigan Medicine communication and resolution program after 20 years in operation. Methods: Deidentified data from the Michigan Medicine claims database for fiscal years 2013 through 2022 were analyzed to delineate the processes and outcomes of the Michigan Medicine communication and resolution program. Results: During the period of study, patient safety event reports increased by 37.5% while the proportion of events associated with harm fell from 10.5% to 6.7%. The Clinical Care Review Committee, a multidisciplinary medical staff quality and safety oversight panel, deemed care reasonable in 638 of 989 claims (65%), guiding communication and resolution program discussions. 564 (88%) of these were closed or dismissed without payment. 288 (83%) of the 349 cases in which care was deemed unreasonable were settled. The rate of liability claims remained stable at 3.8/100,000 exposures per month. The median time to resolve claims was 11 months. Conclusions: Analysis of the most recent 10 years of Michigan Medicine's communication and resolution program activity confirms that the program is well-integrated into its system-wide patient safety program and that its early success has proven durable. It also illustrates the benefits of integrating multidisciplinary quality review and improvement into a communication and resolution program. It may serve as a model for other health care systems. [ABSTRACT FROM AUTHOR]

According to data from 2021, Turkey has the highest incarceration rate among European countries. The probation system in Turkey is managed by the government and includes programs, resources, and services to help prevent individuals from engaging in criminal activities. Hope is a crucial factor in coping with adversity, and studies have shown resilience can be the protector of those involved in the criminal justice system. Additionally, adverse childhood experiences (ACEs) can have a significant impact on future victimization and criminal behavior, as individuals with higher ACE scores are more likely to engage in criminal activities. This study was conducted among 107 individuals who were under probation in Turkey to examine the relationship between hope, resilience, and ACEs. The scores were analyzed using a regression model, and the results showed that ACEs did not notably moderate the relationship between hope and resilience. Additionally, having higher levels of hope or ACEs did not play a significant role in predicting the resilience of the individual, which contradicts the previous literature. The implications of these findings will be discussed in terms of cultural differences and the criminal justice system. Future studies should explore the impact of culture on the relationship between hope and resilience. [ABSTRACT FROM AUTHOR]

Over 10 million uninsured individuals are eligible for subsidized health insurance coverage through the Affordable Care Act (ACA) marketplaces, and millions more were projected to become eligible with the end of the federal COVID-19 Public Health Emergency in 2023. Individual studies on behaviorally informed interventions designed to encourage enrollment suggest that some are more effective than others. This study summarizes evidence on the efficacy of these interventions and suggests which administrative burdens might be most relevant for potential enrollees. Published and unpublished studies were identified through a systematic review of studies assessing the impact of behaviorally informed interventions on ACA marketplace enrollment from 2014 to 2022. Thirty-four studies comprising over 18 million participants were included (32 randomized controlled trials and 2 quasiexperimental studies). At the time of data extraction, 8 were published. Twenty-seven of the studies qualified for inclusion in a meta-analysis, which found that the average rate of enrollment was about 1 percentage point higher for those who received an intervention (0.009, P < 0.001), a 24% increase relative to control households; for every 1000 people who receive an intervention, that would correspond to about 9 additional enrollees. When stratifying by intervention intensity, support-based interventions increased enrollment by 2 percentage points (0.020, P = 0.004), while information-based interventions increased enrollment by 0.6 percentage points (0.006, P < 0.001). The meta-analysis found that behaviorally informed interventions can increase ACA marketplace enrollment. Interventions aimed at alleviating compliance costs by providing enrollment support were about three times as effective as information alone. [ABSTRACT FROM AUTHOR]

The Senior Community Service Employment Program (SCSEP) is a U.S.-based job-training program that serves unemployed workers aged 55 and older with incomes at or below 125% of the federal poverty level. While federal funds are set aside to serve Asian workers in SCSEP, little is known about their characteristics and experiences. In response, this pilot study aimed to document the health, well-being, and experiences of older Asian SCSEP participants in Massachusetts through the completion of a survey. Respondents (N = 39) ranged in age from 58 to 73 and identified as either Chinese (72%) or Vietnamese (28%). All were immigrants, and almost all spoke a language other than English at home. Most reported "good" health as well as financial difficulties. They also stated that their supervisors in their placements were supportive. On average, respondents noted moderate interest in searching for a paid job after exiting SCSEP, although more reported interest in searching for a volunteer role. Key to the success of this study was a robust collaboration with a local human services organization with strong ties to the Chinese and Vietnamese communities. The findings highlight the importance of this growing group of older workers. [ABSTRACT FROM AUTHOR]

A lead testing act was passed in Colorado mandating that all licensed child care facilities and public schools serving fifth grade and lower test all drinking water locations for lead by May 31, 2023. Colorado's Water Quality Control Division created the Test & Fix Water for Kids program to implement this act. Aspects of the program included establishing a database, outreach and education, technical assistance, lead analyses at the Colorado State Laboratory, remediation, and reimbursement. Of a total of 6000 licensed child care providers and public elementary schools, 4500 entities enrolled and tested 53 000 water samples for lead at drinking water fixtures. Testing results showed that 93% (46 000 total) of the fixtures tested were below the 5 parts per billion (ppb) action level. As a result, 7% (3700) of the fixtures tested were above the action level. Of the fixtures that tested above 5 ppb, 47% were classroom faucets. Many of these faucets had not been used since COVID-19 when several schools switched to using bottle fillers. The program identified all fixtures associated with low usage as well as older fixtures to be replaced with lead-free options to reduce lead levels below 5 ppb. Almost 600 000 children have been protected from potential exposure to lead in drinking water through this program. This article outlines the methods of launching a statewide lead testing program and the importance of testing fixtures for lead in drinking water in early childhood education buildings. [ABSTRACT FROM AUTHOR]

In 2020, the Ilısu Dam partially flooded the historic town of Hasankeyf in southeast Türkiye. To mitigate the impact of flooding, the government launched a program to relocate the town’s residents, along with some historic monuments and archaeological remains, to a new town situated on the opposite shore. Hasankeyf’s heritage embodied strong social values for its residents and had a central presence in their daily, spiritual, and recreational lives. The mitigation efforts, however, failed to recognize these values, and the townspeople played no role in the decision-making processes. This article examines the adverse impacts of the Ilısu Dam project on Hasankeyf’s social values by bringing to the fore local relocation experiences and discussing the sociocultural and economic outcomes that have emerged in the post-relocation context. As the case of Hasankeyf illustrates, mitigation efforts that overlook local concerns might result in heritage destruction for dam-affected populations. [ABSTRACT FROM AUTHOR]

Objective: The state of Illinois' Opioid Alternative Pilot Program (OAPP) is the first and only official harm-reduction program in the US to address the opioid crisis via facilitation of safe and legal access to medical cannabis. This study evaluates the association of medical cannabis use with pain level and frequency of opioid use in the first cohort of OAPP participants in 2019. Methods: A survey was sent OAPP enrollees between February and July 2019. Cannabis users (n = 626) were compared to non-users (n = 234) to determine whether there was an association between cannabis use and self-reported (a) pain level and (b) frequency of opioid use. Backward stepwise regression models were used. Results: A total of 860 participants was included in the analysis. Overall, 75% of the study sample reported pain as their primary medical symptom, and 67% of cannabis users reported having a disability. The mean difference in pain level between cannabis users and non-users was 4.5 units (on a 100-point scale) higher among cannabis users than non-users (p = 0.03); and cannabis use was statistically associated with pain level. High-frequency opioid users had lower odds of reporting cannabis use within the past year than low/no opioid users. Conclusions: Although there was a statistical association between cannabis use and pain, the difference of 4.5 points in pain level between users and non-users was too small to reflect a clinically meaningful relative difference. This study may provide useful information to providers and clinicians about how the OAPP and similar programs may reduce opioid use and improve health outcomes. [ABSTRACT FROM AUTHOR]

People who experience symptoms of autoimmune diseases often have to struggle for illness recognition. Women experiencing such symptoms face additional challenges as their accounts of pain are frequently treated with skepticism. This study examines experiences of people living with Sjögren's Syndrome, an autoimmune disease which is primarily diagnosed in women, by conducting an analysis of individual vlogs posted on YouTube using the themes of gender, chronic illness and neoliberal governmentality. Sjögren's Syndrome is the second most common rheumatic disease after rheumatoid arthritis and affects nearly 4 million people in the United States alone. An analysis of 70 vlogs posted by people living with the disease revealed the challenges faced by them including diagnostic delays and perceived attitudinal biases amongst medical professionals, especially in the context of the gender of the patients. Apart from highlighting the impact of the disease on their gendered roles, the vloggers urged viewers to conduct their own research on the disease and advocate for themselves during interactions with physicians. The study illuminates how dissatisfaction with healthcare services reinforces neoliberal rationalities such as individual advocacy, resilience and self-labor. The findings of the study delineate the role of neoliberal governmentality in making self-management of chronic illnesses such as Sjögren's Syndrome an internalized ideal for women living with the disease. Additionally, the study provides empirical evidence of the need for addressing the medical and socio-cultural factors that contribute to delays in the diagnosis and management of Sjögren's Syndrome. [ABSTRACT FROM AUTHOR]

The authors encourage increased support for Title X programs to offer comprehensive early pregnancy confirmation services to promote equitable, patient-centered, evidence-based reproductive health care. Topics include background on Title X program, early pregnancy engagement to improve quality, and significance of early pregnancy assessment clinics (EPACs).

Austerity measures have become a contentious topic, shaping the landscape of health care systems around the world. As governments grapple with economic challenges, the impact of austerity on health care has emerged as a critical concern. This study focuses on the consequences of austerity actions adopted by the Zimbabwean government under the Transitional Stabilization Program (TSP) from August 2018 to December 2025. This research examines the impact of austerity measures on Zimbabwe's health care sector, exploring its connections with health infrastructure and resources, accessibility and affordability of health care, health funding, health care inequalities, and the health care workforce. Using a quantitative approach and data from 970 participants, including the general populace, health care providers, and government officials, significant positive correlations between austerity measures and these health care variables were identified. The findings indicated a noteworthy positive correlation between the independent variable "austerity measures" and five dependent variables: health care accessibility and affordability, health care inequalities, infrastructure and resources, health care funding, and health care workforce. The t -statistics values exceeded the threshold of 1.96, with values of 5.085, 3.120, 6.459, 8.517, and 3.830, respectively. These findings highlight the importance of considering the effects of austerity on health care access, health funding, health care inequalities, health workforce, health infrastructure and resources development. Policymakers should prioritize equitable resource allocation and targeted investments to strengthen the resilience of the health care system during economic challenges. Understanding these associations is crucial for evidence-based policy decisions and fostering a more equitable and resilient health care system in Zimbabwe. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to emphasize the need for holistic geriatric health care in rural India. Many older people in Indian villages suffer from chronic ailments without any relief or intervention because of inaccessible and unaffordable health-care services. This paper explores how holistic health care can be assured for older people in Indian villages. Design/methodology/approach: This paper is based on reflections of the authors who have had experiences as caregivers to older persons within their respective families rooted in the Indian villages. Besides, they interacted with 30 older persons (18 males and 12 females in the age group of 60–80 years) living in the villages in three states of India, namely, Haryana, Rajasthan and Madhya Pradesh to develop a comprehensive viewpoint on the need of geriatric health care in rural India. Relevant reports, newspaper articles and research papers were also reviewed while developing viewpoints on such an important topic. Findings: Geriatric health-care facilities in rural India are abysmal. The older people in the villages cannot leverage health-care facilities that are generally inaccessible, inadequate and unaffordable. Even the government support for medical treatment is minuscule. Furthermore, there is lack of trained health-care professionals at all levels, namely, doctors, nurses and paramedic personnel. Training opportunities in geriatrics are also negligible. The scenario vis-à-vis geriatric health care in rural India can be upturned by increasing public spending on health-care infrastructure, increasing numbers of health-care professionals and expanding training programmes in geriatrics. Originality/value: This paper is based on the critical reflections of the authors as well as their informal interactions with some of the older people in the Indian villages. [ABSTRACT FROM AUTHOR]

Inequality in access to high-quality teachers is an important driver of socioeconomic student achievement gaps. We experimentally evaluate a novel nationwide low-cost government program that deployed two behavioral strategies to motivate teachers to apply to job vacancies in disadvantaged schools. These strategies consisted of an "altruistic identity" treatment, which primed teachers' altruistic identity by making it more salient, and an "extrinsic incentives" treatment, which simplified the presentation and increased the salience of an existing government monetary incentive scheme that rewards teachers who work in underprivileged institutions. Both strategies successfully encouraged teaching candidates to apply to disadvantaged schools. [ABSTRACT FROM AUTHOR]

We document large gender disparities within a government program that entitles 46 million poor individuals to free hospital care. We show that care is not free in practice and higher costs are associated with larger disparities. Lowering care costs increases female utilization but does not reduce gender disparities because marginal beneficiaries are as likely to be male as inframarginals. Long-term exposure to local female leaders reduces disparities by addressing factors lowering female care. In the presence of gender bias, subsidizing social services may fail to address gender inequalities without actions that specifically target females. (JEL H51, I12, I13, I14, J16, O15) [ABSTRACT FROM AUTHOR]

Despite social work's about three decades of history and most populations being at risk of multiple natural disasters, Nepali social workers are yet to establish their foothold in the sector of disaster in Nepal. Part of this has happened due to ineffective curriculum on disaster and social work. And hence, this article proposes how the curriculum for disaster and social work can be advanced in the future. [ABSTRACT FROM AUTHOR]

Objective: This study examined employment prior to discharge and the source of treatment payment as physical recovery capital that predicts the completion of treatment for cocaine use. Methods: The 2020 Treatment Episode Data Set: Discharges of the United States was analyzed using binary logistic regression to estimate the adjusted odds ratio of treatment completion with employment and the primary source of payment among those whose primary substance of use was cocaine. Results: A significant increase in the odds of completing treatment was observed among those with full-time or part-time employment. By contrast, those not in the labor force had significantly lower odds of treatment completion. Significantly high odds of treatment completion were also noted among those whose primary source of payment was private insurance or government payment schemes. Conclusions: Treatment services should include the promotion of employment or offer sub-services that assist in securing a job. Future studies should investigate the impact of Medicaid on treatment completion when the Institutions for Mental Diseases (IMD) service exclusion waivers for Medicaid funding are further adopted by states. The policy for substance treatment under Medicare needs to be improved for older people to access treatment facilities and options. [ABSTRACT FROM AUTHOR]

While the number of women in government has increased, prior research on whether enhancing women's political representation alters policy choices has produced inconclusive findings. This study asks if higher women's participation in electoral institutions at the local level is associated with a different spending profile. Using Peterson's typology of developmental, redistributive, and allocational government programs, we argue that legislative bodies with more female members will spend more on redistributive programs than on developmental or allocational. Using data from Florida's 67 counties between 2005 and 2015, our analysis supports this theoretical expectation. In line with critical mass theory, women's representation in county commissions must reach a threshold of about 33% to sway budgetary decision-making toward more extensive redistribution. We also find that the traditional commission form of government intensifies the redistributive effect of women commissioners on county spending while having a home rule charter has no significant effect. [ABSTRACT FROM AUTHOR]

Objectives: To describe nursing home (NH) characteristics associated with antipsychotic use and test whether associations changed after implementation of the National Partnership to Improve Dementia Care's antipsychotic reduction initiative (ARI). Methods: Longitudinal quasi-experimental design using data from multiple sources and piecewise linear mixed models were used for statistical analyses. Results: There was a significant decrease in monthly antipsychotic use across the study period (pre-ARI b = −0.0003, p <.001; post-ARI b = −0.0012, p <.001), which held after adjusting for NH characteristics. Registered nurse hours (b = −0.0026, p <.001), licensed practical nurse hours (b = −0.0019, p <.001), facility chain membership (b = −0.0013, p <.01), and health inspection ratings (b = −0.0003, p >.01) were associated with decreased antipsychotic use. Post-ARI changes in associations between NH characteristics and antipsychotic use were small and not statistically significant. Conclusions: Decreases in antipsychotic use were associated with most NH characteristics, and associations persisted post-ARI. Further research is warranted to examine the interactions between ARI policy and NH characteristics on antipsychotic prescribing, as well as other NH factors, such as facility prescribing cultures and clinical specialty of staff. Clinical Implications: Decreases in monthly antipsychotic use were observed following the ARI. The decreases in monthly antipsychotic use were associated with most NH characteristics, and these associations persisted during the post-ARI period. [ABSTRACT FROM AUTHOR]

Background: In China, national immunization program (NIP) vaccines benefit from robust financial support and have achieved high coverage. Non-NIP vaccines rely on fragmented funding sources, mostly out-of-pocket payment, and face sub-optimal and inequitable coverage. Sustainable financing needs to be secured for addressing equity in non-NIP vaccine delivery. However, discussion and understanding of this issue remain limited. This study aims to analyze the current situation, comprehensively identify challenges and opportunities in non-NIP vaccine financing, and offer suggestions to enhance vaccine uptake and improve public health. Methods: Between July and December 2023, we conducted a series of semi-structured, in-person interviews with 55 stakeholders from the Health Bureau, Centers for Disease Control and Prevention, Medical Insurance Bureau, and Finance Bureau across five provinces in China. Participants were selected through stratified sampling, and the interviews mainly included their involvement in non-NIP vaccine financing, challenges faced, and strategies for improvement to enhance financing performance. Informed consent was obtained, and thematic analysis was used to analyze the data. Results: Non-NIP vaccine financing sources include out-of-pocket payments, government fiscal, health insurance and other external funds. These four channels differ in vaccine types covered, costs, and target populations, each with unique challenges and opportunities. High out-of-pocket costs remain a significant barrier to equitable vaccine uptake, while market competition has lowered the vaccine price and improved accessibility. Local fiscal support for free vaccination programs faces challenges related to sustainability and regional disparity, though governmental commitment to vaccination is growing. Nevertheless, centralized procurement organized by the government has lowered the price and reduced the financial burden. Despite legal restrictions on using basic health insurance for vaccinations and limited commercial insurance options, private medical savings accounts and mutual-aid mechanisms present new opportunities. Although the scope and impact of external support are limited, it has successfully increased awareness and social attention to vaccination. Conclusion: Relying on individual payments as the main financing channel for non-NIP vaccines is unsustainable and inadequate for ensuring universal vaccine access. A concerted and synergistic approach is essential to ensure sufficient, sustainable resources and enhance public financial management to improve equity in the non-NIP vaccines. [ABSTRACT FROM AUTHOR]

Background: Local governments have a critical role to play in addressing health inequities. Health equity impact assessments are recommended to help governments apply an equity lens to the development and implementation of policies and programs. Despite evidence of equity-positive benefits of such tools, adoption remains limited, prompting calls for evaluations to assess their impact and identify factors that will promote uptake across various contexts. Methods: We conducted a mixed method study to evaluate the impact of an equity impact assessment (EIA) tool and process on policies and organisational capacity in a local government in Victoria, Australia, and identify factors that influenced this impact. We analysed 33 documents related to 18 EIAs, and conducted surveys (n = 40) and in-depth interviews (n = 17) with staff involved in EIAs. Results: Almost all (17 of 18) EIAs resulted in equity-positive changes to policies and programs, most frequently addressing individual-level factors, such as making community communications and consultations more accessible to under-represented or under-served groups. Structural-level recommendations from one EIA, such as increasing diversity in decision-making panels, were found to impact both the current policy and a broad range of future, related projects and services. Improvements in equity-centric organisational culture and capacity (including staff awareness, skills and confidence) and increased engagement with under-represented communities were also reported. Factors perceived to influence the impact of EIA's related to organisational commitment and capacity to prioritise equity, process-level factors related to the type and timing of EIAs, and extent of implementation support. Conclusion: Our study supports wider uptake of health equity impact assessments in local government policies and programs. Legislation, leadership and resources from upper-tiers of government can help increase the adoption of equity tools to reduce disparities in population health. [ABSTRACT FROM AUTHOR]

A crucial policy question for the government is whether publicly funded insurance programs effectively improve access to care. Using 2015 and 2018 Canadian Community Health Survey (CCHS) data, we first estimated the effect of government dental insurance for seniors on promoting regular care access and lowering cost barrier. When controlling for individual heterogeneity, we found that having government coverage is associated with significantly lower probability of reporting avoidance of dental care due to cost compared to having no coverage. This effect is comparable with other types of insurance. However, the impact of the government program on regular access to dental care is modest. Secondly, using a portion of data collected in Alberta, we found that the government plan does not increase the overall coverage rate. Moreover, switching from an employer-based plan to government-provided coverage for seniors reduces the probability of regular access to care and increases the probability of experiencing cost barrier. This finding indicates that without expansion of overall coverage rate, the current government dental program may not be generous enough to offset the negative impact of leaving the employer-based plan. [ABSTRACT FROM AUTHOR]

Aim: This paper highlights the difficulties and lacunae in the Mental Health Care Act 2017 that hinder its implementation and use for the care and treatment of persons with mental illness in India. Methods: An online nationwide survey, involving structured questions as well as open-ended questions, to elicit the level of implementation, experience in complying with the provisions of the Act, and level of satisfaction, of practicing psychiatrists was carried out. Responses were analyzed using appropriate statistics. Results: 600 respondents answered the online questionnaire. A majority of psychiatrists were senior practitioners with over 10 years of experience. 92.5% respondents were dissatisfied with the MHCA, wherein 73.3% wanted it amended, and 19.2% asked for repeal. Procedural issues were deterrent for 66.5% from taking medically necessary or helpful decisions for patients. Non-implementation of the Act was a major finding. Major dissatisfaction was expressed regarding judicial over reach in admission and discharge procedures, inclusion of general hospital psychiatry units in the definition of mental health establishment, non-applicability of provisions like advance directive and nominated representative in Indian setting, and that all treatment should be covered under insurance. Conclusion: The Act in its present form defies the spirit of its own objectives and is unimplementable. It needs major revisions. [ABSTRACT FROM AUTHOR]

Embedded liberalism prescribes compensating workers hurt by globalization, but government compensation programs are often criticized for their lack of responsiveness. I explain the lack of responsiveness by illuminating bureaucrats who approve the compensation programs in the frontline. I examine how career bureaucrats distribute Trade Adjustment Assistance (TAA) benefits, the single largest federal program in the United States that compensates workers displaced by international trade. Exploiting the quasi-random assignment of TAA petitions to individual investigators at different stages of their careers, I find that career bureaucrats are less likely to certify TAA petitions and are more likely to delay investigations during Republican presidencies relative to Democratic presidencies. This partisan performance, however, applies uniquely to career bureaucrats who are not tenured and increases in magnitude during periods of high alignment between labor and the Democratic Party. The political sustainability of globalization depends on an institutional design that shapes the career incentives of bureaucrats. [ABSTRACT FROM AUTHOR]

Objectives: The federal Section 317 Immunization Program, administered by the Centers for Disease Control and Prevention (CDC), provides funding to support adult immunization efforts; however, current information on program implementation at the jurisdictional level is limited. We assessed the use of Section 317 and other funding sources to support routine adult immunization activities among the 64 immunization programs ("awardees"). Methods: We conducted a survey and key informant interviews with awardees in October to December 2022 to collect quantitative and qualitative data on current adult vaccine purchase and program operation activities funded by Section 317 and other funding sources. We assessed total vaccine cost and data on vaccine purchase projections for each awardee with CDC's Cost and Affordability Tool for 2023. Results: Immunization program managers or their designees from 62 of 64 awardees (97%) completed the survey; 12 awardees participated in key informant interviews. Of 62 awardees, 32 (52%) used a single funding source to support adult vaccine purchases, of which 29 (91%) used only Section 317 funds, 21 (34%) reported not planning to purchase ≥1 age-based recommended vaccine for adults in 2023, and 33 (53%) reported using Section 317 funds only to support adult immunization program operations. Key informant interviews showed varied operational activities among awardees, but 8 awardees stated the need for additional staff to expand adult immunization program services in health care provider education (n = 5), program administration (n = 5), and site visits (n = 6). Conclusions: Additional efforts are needed to understand how to better support routine adult immunization activities implemented at the jurisdictional level. [ABSTRACT FROM AUTHOR]

Objectives: Veteran homelessness has declined in the past decade, but the proportion of unsheltered homeless veterans has increased. We identified characteristics of unsheltered homelessness in a large contemporary veteran cohort and examined outpatient and inpatient encounters before and after intake to US Department of Veterans Affairs (VA) homeless programs. Methods: National data from the Homeless Operations Management Evaluation System (HOMES) database and the Corporate Data Warehouse were analyzed on 191 204 veterans experiencing housing instability from January 2018 through December 2021. We used hierarchical multivariate logistic regressions to model associations between sheltered status and veteran correlates. Repeated-measures analysis of variance assessed changes in care utilization after intake in homeless programs. Results: Age <50 years (odds ratio [OR] = 1.3; 95% CI, 1.2-1.4), Hispanic ethnicity (OR = 1.2; 95% CI, 1.1-1.3), some college education (OR = 1.1; 95% CI, 1.0-1.1), and a bachelor's degree (OR = 1.2; 95% CI, 1.1-1.2) were associated with veteran unsheltered homelessness. Unsheltered veterans were more likely to have a VA service-connected disability (OR = 1.4; 95% CI, 1.4-1.5), military sexual trauma (OR = 1.1; 95% CI, 1.0-1.1), and/or combat exposure (OR = 1.1; 95% CI, 1.0-1.1). Unsheltered and sheltered homeless veterans had an increase in outpatient encounters and a decrease in inpatient care after intake to the VA homeless program. Conclusions: Contemporary unsheltered homeless veterans are younger and Hispanic with some college education. Innovative public health approaches that better engage and reduce barriers to entry need to be tested for a diverse unsheltered homeless population. [ABSTRACT FROM AUTHOR]

AI-based service usage can be expanded if individuals perceive that they have the ability to control vulnerabilities and risks (e.g. data leakage, inaccurate information) associated with these technologies. Additionally, the issues of trust in AI and user privacy protection are key discussions in the implementation of e-government services. Accordingly, this study empirically verified the influence of individuals' online skills, trust in AI, and privacy-protective behaviour on their AI-based service usage. The dataset comprised 48,420 respondents aged 14–90 who were part of a South Korean survey on Internet usage in 2021. The main findings are as follows. First, trust in AI and privacy-protective behaviour positively impact AI-based service usage. Second, online skills do not impact AI-based service usage significantly. These findings offer implications for improving technical issues related to privacy protection and inaccurate information; they can also be used to inform efforts to bridge the digital divide in AI-based service usage. By empirically verifying the impact of an individual's vulnerability control behaviour and digital service utilisation ability in the use of AI-based services, this study suggests developing AI-based services with user trust in mind and implementing smart government policies. [ABSTRACT FROM AUTHOR]

Background: Space travel is experiencing a renaissance with expanding commercial and international efforts. Space surgery will have growing relevance as mission frequency and distances increase beyond low Earth orbit. Methods: This white paper from the SAGES Space Surgery Task Force raises awareness among the SAGES membership regarding the challenges and opportunities surrounding this emerging field that anticipates surgical care in the most extreme, austere environments. Results: Innovation in technology and preventive medicine principles will enhance the effectiveness of space surgical care when the need arises. The impact of advancements in space and terrestrial medicine to support space exploration indicates the need for a surgeon to oversee medical/surgical invasive treatment to ensure astronaut health and mission success. Advanced technology, including semi- and autonomous robotic systems, may be a preferred way to deliver this care in the foreseeable future. There is currently a need to develop training curricula and flight-compatible supplies and technology for physicians that deliver surgical care to this special patient population. The protocols and technology developed to address the unique challenges of space travel will provide value for care in space as well as in extreme, austere terrestrial environments on Earth. Conclusion: Space surgery will continue to evolve as commercial and government programs explore further into space. The SAGES Space Surgery Task Force is favorably positioned to significantly contribute to addressing some capability gaps in delivering surgical care in space. [ABSTRACT FROM AUTHOR]

An editorial is presented the Scientific Advisory Committee on Nutrition's (SACN) 2016 report, which determined that blood vitamin D levels below 25nmol/L increase the risk of poor musculoskeletal health. Topics include the recommended daily intake of vitamin D, historical changes in UK fortification practices, and current government advice on vitamin D supplementation.

The government-sponsored welfare programmes are instrumental in balancing economic growth and reducing inequalities in society. Society becomes inclusive only when the deprived people have access to banking and financial services. The policymakers and financial players emphasized the importance of financial inclusion programmes because of their significant impact on economic growth and the financial health of the economy. The Pradhan Mantri Jan-Dhan Yojana (PMJDY) is a government-led intervention programme with a national mission to provide banking facilities to all deprived sections in the country. The study focuses to examine the determinants of customer perception towards PMJDY. The study includes the slum dwellers of Bhubaneswar as the target group of beneficiaries for empirical research. The determinants include the delivery process (SERVQUAL) and outcome attributes associated with the social scheme. As customer perception is a categorical variable, the multinomial logistic regression model is adopted to test the hypothesis. The study results indicate that the beneficiaries consider reliability, assurance, tangibility and social connect dimensions as the likely factors to obtain a higher level of perception towards the welfare programme. [ABSTRACT FROM AUTHOR]

Background: The SARS-CoV-2 pandemic has become the greatest public health challenge worldwide. Soon after the appearance of the virus in 2019, intensive efforts to develop vaccines were initiated, and by late 2020, delivery of vaccines for the targeted population as a campaign had started. Aim: Collect information from European Union countries regarding how and to what extent were family physicians (FPs)/general practitioners (GPs) involved in the vaccination campaigns in 2021 and how these were organized at the national level. Method: A short questionnaire was distributed through the secretariats of WONCA (World Organization of Family Doctors) Europe and the European Forum for Primary Care (EFPC). Results: In most of the countries, participation of FPs/GPs was compulsory. The vaccination was usually centrally organized by governmental authorities. In the beginning, registration (web-based) of patients was required, mainly at the national level. By the middle of 2021, vaccination on a walk-in basis became available in almost every country for the first immunization as well as for the booster injections. The remunerations of GPs/FPs differed; in some countries, no extra payments were offered. The Pfizer vaccine was used in all countries, while in nine countries, non-European Medicines Agency (EMA)-approved vaccines were also given in primary care settings and at vaccination centers. In some countries, professional homepages helped the GPs. The involvement of primary health care (PHC) providers did not correlate to the vaccination coverage of the entire population of the respective countries. It was the highest in the more developed countries with higher living standards, where participation of GPs was voluntary and appropriate financial incentives were offered to them. Conclusions: The vaccination campaign was a professional and logistic challenge and an excellent performance of PCH providers. Experiences gained could be used in the future to manage similar pandemic challenges. [ABSTRACT FROM AUTHOR]

This viewpoint analyzes recent experiments in guaranteed income (GI) projects and identifies implementation issues that extend the frontiers of public administration. GI programs provide low‐income individuals with substantial and regular cash with few or no strings or conditions attached and are being used to assist the lower income population, including informal workers who are left out of many government programs. The following implementation issues are discussed as frontiers in current public administration research and theory: (1) increasing the federal role in vertical collaboration; (2) improving data integration across levels of government; and (3) finding new solutions to financial and political sustainability. As GI programs and experiments proliferate, it becomes critical to examine implementation and not just outcomes or impact. [ABSTRACT FROM AUTHOR]