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Micromobility—including bicycles, electric bicycles, and electric scooters—is well-suited to address first- and last-mile connectivity with public transit by bridging the gaps of service for riders. This extends the geographic region where residents are likely to access and exit a transit station, facilitating access to more jobs, services, and recreation. However, public use of micromobility depends on a variety of factors. These include availability of secure parking facilities or other environmental design features at and around public transit stations. UC Davis researchers and urban design experts considered these issues in a case study of the Bay Area Rapid Transit (BART) heavy rail system. The study included environmental audits at 18 BART stations. The study also hosted an online survey of BART and micromobility users and included interviews with government, industry, and community stakeholders. This policy brief summarizes the findings from this study and provides policy implications. View the NCST Project Webpage

The travel experiences of unhoused women in Los Angeles present a critical yet underexplored aspect of urban mobility and homelessness. This report aims to fill the gap in literature addressing the unique travel patterns and challenges this group faces, emphasizing the need for solutions tailored to their mobility needs. Interviews with unhoused women in Los Angeles were conducted to gauge their travel patterns and primary safety concerns. Interviews took place in Van Nuys and Little Tokyo to reflect the differences in travel experiences between the suburbs and the inner city. Homelessness resources are more concentrated in Central City Los Angeles, where Little Tokyo is located, providing a model for what could be possible in terms of mobility, safety, and access to public transportation. Conversely, in Van Nuys, resources are sparse and spread out, compelling unhoused women to travel greater distances and optimize their travel time by multitasking.Key takeaways include reliance on community networks, increasing preference for biking as an affordable and eco-friendly travel mode, and the use of bikes and fare-free transit for feelings of autonomy and independence. Additionally, despite concerns about safety when alone, unhoused women are still wary of law enforcement, and anti-homeless measures like 41.18 lead to continuous displacements, disrupting daily routines.Findings suggest addressing the fundamental issue of housing, implementing robust data collection, partnering with homelessness advocacy groups, securing funding for essential amenities, and making infrastructural improvements to support the autonomy, mobility, and safety of unhoused women. All in all, a comprehensive approach is necessary to provide effective relief.

This project focuses on carless and car-deficit households in the Westlake-MacArthur Park and Pacoima-Panorama City neighborhoods that have experienced challenges in traveling to their destinations due to their limited access to household vehicles. Car ownership in the U.S. is causally linked with positive economic outcomes such as being employed, gaining employment, working additional hours, and earning higher wages (Brown, 2017). In the U.S., however, “carless” households, or zero-car households, make up 7% of all households, and “car-deficit” households, households with fewer cars than drivers, make up 15% of all households (Blumenberg et al., 2020). Those who do not own a vehicle or do not always have access to one due to financial and health/age constraints, however, are left to navigate on modes other than the private vehicle to meet their transportation needs.Using quantitative and qualitative methods, I find that carless and car-deficit respondents from Pacoima-Panorama City reported carpooling and riding the bus as their most used transportation modes, whereas Westlake-MacArthur Park reported higher use of transit such as bus and rail. Over half of all carless and car-deficit respondents, however, shared that they have skipped and/or rescheduled trips to healthcare, school, work, and other destinations due to transportation issues. Furthermore, both neighborhoods reported similar concerns related to safety, time associated with transit use, and saw low rates of participation in public programs that aim to alleviate the cost of transportation.

This paper explores the enduring impact of freeway construction on urban neighborhoods and communities, focusing on Los Angeles. The legacy of freeways in Los Angeles, often and purposefully constructed through marginalized communities during the mid-20th century for the benefit of white suburbanites, is reflected in significant social, economic, and environmental symptoms today. This paper also examines de-freeway methods to reconnect these divided communities, assessing their need and effectiveness through data analysis and case studies.The case studies presented in this paper offer a diverse range of solutions. They include the capping of I-5 for Freeway Park in Seattle, the tunneling of the Central Artery for Boston's Big Dig, the activation of I-5 underpasses for Chicano Park in San Diego, and the creation of the Ricardo Lara embankment park along the I-105 freeway in Lynnwood. These examples provide valuable insights into the processes, challenges, and successes of de-freeway and community reconnection efforts, showcasing the adaptability of these solutions in different urban contexts.The paper introduces three design proposals for freeway sites across six communities in Los Angeles. These proposals are guided by urban reformation around freeways and incorporating urban design principles prioritizing social equity, environmental sustainability, and economic revitalization for the most vulnerable and impacted communities. The proposed designs aim to restore community cohesion and foster resilient urban ecosystems.This study contributes to the ongoing discourse on sustainable urban transformation and the reclamation of public spaces for community benefit by providing a comprehensive analysis of historical impacts and contemporary solutions. The paper's findings should help inform and guide urban planning and policy advocates and professionals inspired by the reconnecting communities movement, underscoring the need for innovative approaches to mending bifurcated and ecologically disadvantaged communities.

Introduction: To expand access to naloxone, the state of Illinois implemented a standing order allowing registered pharmacies to dispense the drug without an individual prescription. To participate under the standing order, pharmacies were required to opt in through a formal registration process. In our study we aimed to evaluate the availability and price of naloxone at registered pharmacies.Methods: This was a prospective, de-identified, cross-sectional telephone survey. Trained interviewers posed as potential customers and used a standardized script to determine the availability of naloxone between February–December, 2019. The primary outcome was defined as a pharmacy indicating it carried naloxone, currently had naloxone in stock, and was able to dispense it without anindividual prescription.Results: Of 948 registered pharmacies, 886 (93.5%) were successfully contacted. Of those, 792 (83.4%) carried naloxone, 659 (74.4%) had naloxone in stock, and 472 (53.3%) allowed purchase without a prescription. Naloxone nasal spray (86.4%) was the formulation most commonly stocked. Chain pharmacies were more likely to carry naloxone (adjusted odds ratio [aOR] 3.16, 95% confidence interval [CI] 1.97–5.01, P < 0.01) and have naloxone in stock (aOR 2.72, 95% CI 1.76–4.20, P < 0.01), but no more likely to dispense it without a prescription. Pharmacies in higher population areas (aOR 0.99, 95% CI 0.99–0.99, P < 0.05) and rural areas adjacent to metropolitan areas (aOR 0.5, 95% CI 025–0.98, P < 0.05) were less likely to have naloxone available without a prescription. Associations of naloxone availability based on other urbanicity designations, overdose count, and overdose rate were not significant.Conclusion: Among pharmacies in Illinois that formally registered to dispense naloxone without a prescription, the availability of naloxone remains limited. Additional interventions may be needed to maximize the potential impact of a statewide standing order.

Since its inception, the specialty of acute care surgery has evolved and now represents a field with a broad clinical scope and large variations in implementation and practice. These variations produce unique challenges and there is no consistent definition of the scope, intensity or value of the work performed by acute care surgeons. This lack of clarity regarding expectations extends to surgeons and non-surgeons outside of our specialty, compounding difficulties in advocacy at the local, regional and national levels. Coupled with a lack of clarity surrounding the definition of full-time employment, these challenges have prompted surgeons to develop initiatives within acute care surgery in collaboration with the American Association for the Surgery of Trauma (AAST). A panel session at the AAST 2023 annual meeting was held to discuss the need to define a full-time equivalent for an acute care surgeon and how to consider and incorporate non-clinical responsibilities. Experiences, perspectives and propositions for change were discussed and are presented here.

This commentary underscores the urgent issue of limited access to dermatologic care in rural areas, leading to adverse health outcomes. With only 10% of dermatologists practicing in rural America, the "rural mortality penalty" contributes to escalating morbidity and mortality. Disparities in dermatologist distribution, particularly in minority-majority counties with lower incomes, worsen health inequities. Despite these challenges, initiatives such as pipeline programs, rural university offices, rural dermatology residency tracks, teledermatology, and Project ECHO (a collaborative model of medical education and care) are promising. This commentary stresses the need for academic dermatologists to recruit more rural medical students and train more residents with a rural upbringing. This predicts future practice in such communities. Immediate action to address the widening rural dermatology gap is needed. The formation of the Rural Access to Dermatology Society, with its first meeting in the spring of 2024 at the annual meeting of the American Academy of Dermatology, is a key part of this process.

BackgroundHuman papillomavirus (HPV) infections can cause cancers of the cervix, vagina, vulva, penis, anus, and oropharynx. The most recently approved HPV vaccine, Gardasil-9, protects against HPV infection and can prevent HPV-associated invasive cancers. However, Gardasil-9 is one of the most underused vaccines in the US today. Young adults are at risk for HPV infection, but many are not vaccinated. This study uses a randomized controlled trial (RCT) to test an innovative multilevel intervention to increase HPV vaccination rates among young adults. In this paper, we describe the research protocol.MethodsThe study uses a two by three factorial design. A total of 1200 young adults in Texas, age 18-26 years, who have not been previously fully vaccinated against HPV will be randomly assigned to one of six conditions to receive: (1) standard CDC information about HPV vaccination (control); (2) video narratives about HPV vaccination; (3) written narratives about HPV vaccination; or (4-6) enhanced access to HPV vaccine combined with (4) standard CDC information, (5) video narratives, or (6) written narratives. The two primary outcomes are the rate of HPV vaccination initiation by 3-month follow-up and rate of HPV vaccination completion by 9-month follow-ups. We will determine the impact of the individual level intervention (i.e., persuasive narratives through video or written format), the systemic level intervention (i.e., enhanced access to HPV vaccines), and the combination of both levels, on HPV vaccination initiation and completion. We will also use purposive sampling to select participants to take part in semi-structured interviews/focus groups to better understand the mechanisms of the intervention.DiscussionRecruitment and data collection began in March 2022. We expect to complete data collection by March 2026. We expect that narratives, enhanced access, and the combination of both will improve HPV vaccination initiation and completion rates among young adults. If proven successful, these individual- and system-level interventions can be easily disseminated in regions with low HPV vaccination rates to improve HPV vaccination, and ultimately decrease HPV-related cancer burden.Trial registrationNCT05057312.

INTRODUCTION: The COVID-19 pandemic led to a dramatic increase in telemedicine use for direct patient care. Inequities in device/internet access can limit the extent to which patients can engage with telemedicine care and exacerbate health disparities. In this review, we examined existing literature on interventions designed to improve patient telemedicine access by providing digital devices including tablets, smartphones, and computers and/or internet connectivity. METHODS: In this systematic scoping review, we searched four databases for peer-reviewed studies published 1/1/2000-10/19/2021 that described healthcare interventions that provided patients with devices and/or internet connectivity and reported outcomes related to telemedicine access and/or usage. Data extraction elements included: study population, setting, intervention design, details on device/connectivity provision, and outcomes evaluated. RESULTS: Twelve articles reflecting seven unique interventions met inclusion criteria. Ten articles examined telemedicine utilization (83%) and reported improved patient show rates/utilization. Seven articles examined patient satisfaction with the interventions (58%) and reported positive experiences. Fewer articles examined health outcomes (17%; 2/12) though these also demonstrated positive results. Across included studies, study quality was low. There were no controlled trials, and the most rigorously designed studies (n = 4) involved pre/post-intervention assessments. DISCUSSION: Findings from this review indicate that providing material technology supports to patients can facilitate telemedicine access, is acceptable to patients and clinicians, and can contribute to improved health outcomes. The low number and quality of existing studies limits the strength of this evidence. Future research should explore interventions that can increase equitable access to telemedicine services. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=183442, identifier, PROSPERO: CRD42020183442.

Large cultural institutions have been given goals that go well beyond their conventional artistic endeavours. Opera houses are no exception. One strategy they attempt is to stage community productions, but how does this activity match with institutions that seek “artistic excellence”? We focus on a case study of the Gran Teatre del Liceu, Barcelona, and firstly see to what extent productions staged by large cultural institutions can be considered community-based programmes. Secondly, we analyse if these programmes are realistic in terms of reaching their target population. Lastly, we study the degree of participation achieved. In order to do so, we review the concepts of access and participation to build our own analytical framework. We also follow a qualitative and quantitative methodology, performing interviews and fielding a questionnaire to participants. We think that our research and results are relevant from both an analytical point of view and an empirical perspective: in terms of access, the Liceu worked towards correcting the underrepresentation of minority groups in artistic forms that obtain public funding, but these efforts were limited; regarding participation, the opera was developed for, with and by the community depending on the action analysed, and it combined crowd-sourcing, co-creation and audience-as-artist actions. [ABSTRACT FROM AUTHOR]

The study assesses how access to climate services influences cropping decisions and, subsequently, household food security. Employing a cross-sectional research design, the study surveyed a total of 217 smallholder crop farmers selected through a multistage sampling approach. Data were collected using a semi-structured questionnaire, and both descriptive statistics and a propensity score matching (PSM) model were employed for data analysis. Household food security was assessed using households' dietary diversity. The study's findings highlight that 69% of the surveyed farmers had access to weather forecasts, while only 24% had access to seasonal forecasts. Consequently, farmers with access to climate services exhibited changes in their farming decisions, including daily farming activities, planting timing, crop selection, and land preparation. Notably, approximately 35% of the respondents were identified as food insecure. The application of the propensity score matching model revealed that access to climate services had a statistically significant positive impact on farmers' decision-making processes and household food security. These results underscore the potential of climate services to enhance farmers' decision-making capabilities and, subsequently, improve household food security. Considering these findings, it is recommended that efforts to expand access to climate services among smallholder farmers in South Africa should be intensified. This can be achieved by developing and disseminating more accessible and tailored climate information, including seasonal forecasts. In addition, initiatives should ensure that climate services are integrated into agricultural extension services and support systems to equip farmers with the knowledge and tools they need to make informed decisions. [ABSTRACT FROM AUTHOR]

The world is not on track to reach the majority of the UNAIDS 2025 targets, and people who inject drugs (PWID) continue to be left behind, hindered by counterproductive law enforcement practices, punitive laws, economic distress, and social stigma and discrimination. Poor access to HIV pre-exposure prophylaxis (PrEP) among PWID is nested within the limited access to broader harm reduction services, including needle and syringe programs, opioid overdose management, opioid agonist therapy (also known as medication-assisted treatment), and condoms. Among PWID, women who inject drugs are disproportionately affected and face additional gender-based barriers. Intersections between PWID and other key and priority population groups also exist. Although the prioritization of PWID for new PrEP products like the dapivirine vaginal ring and injectable cabotegravir has lagged in research, studies have shown that PWID find injectable and long-acting options acceptable and preferrable, including among women who inject drugs. While new PrEP products introduce new opportunities, equity in access must be assured for optimized impact toward achieving epidemic control. Programming for services must engage and empower PWID community leadership to address the structural barriers to services, implement community-led, differentiated, and integrated service modalities, and offer the choice of all harm reduction options to close the equity gaps in health outcomes. While waiting for necessary evidence and approvals, programs should work together with the PWID community to prioritize, expand, and facilitate efforts and investments toward increased access to and integration of PrEP and all recommended harm reduction services for PWID. [ABSTRACT FROM AUTHOR]

AbstractIn this systematic review on the educational digital divide, we examined 77 studies for publication trends, context, research methods, digital divide factors, dimensions and interventions using a multidimensional approach. This review identified factors such as socioeconomic status, gender, geography, age, ethnicity, parent knowledge/educational level, school type and second language influencing digital divide and found gender, geography, and socio-economic status were the most studied. Among multidimensional digital divide dimensions, utilization and access dimensions were most studied compared to cognitive and affective dimensions. Among 17 digital divide sub-dimensions examined, student use, internet access, and hardware access were the most studied. Interventions recommended in research for digital inclusion include providing technology resources; training, instruction and support for teachers, students and parents; and organizational practices. [ABSTRACT FROM AUTHOR]

The global impact of the Covid‐19 pandemic on school education has been unprecedented, with widespread school closures and the need for education to be delivered remotely. By providing an overview of the continuity of learning and teaching during the 2019–2021 academic years, this study aims to contribute to a better understanding of the impact of the pandemic on the use of digital learning technologies in Wales. This study links usage data from the Government's National Learning Platform (Hwb) to national administrative school records for all pupils in maintained schools. It employs a quantitative methodology to model the inequalities in digital learning technology usage. Multiple linear regression is used to quantify the factors associated with pupils’ use of the national learning platform before and during the pandemic, with a particular emphasis on school closures. The study's findings show notable differences in the level of learning platform usage across school sectors, with primary school pupils using the platform the most. Furthermore, school‐level teacher usage of the platform and household socioeconomic status are key factors influencing pupil usage. The analysis also reveals that levels of learning platform usage prior to the first school closure were associated with learning platform usage in the first school closure period, and usage in the second school closure period was also associated with usage in the first school closure period. [ABSTRACT FROM AUTHOR]

Background: The Department of Veterans Affairs (VA) has long recognized the importance of having a rich complement of home and community‐based resources for the Veteran population. For Veterans experiencing disability‐related impairments, home‐ and community‐based services (HCBS) facilitate aging in place and alleviate family caregivers' burden. However, even in the enriched VA context, HCBS are underutilized. Our objective was to understand unmet needs and barriers to accessing HCBS from the perspectives of Veterans' family caregivers. Methods: This multi‐method study recruited family caregivers of Veterans seen within a major VA Health Care System. Eligible caregivers provided care for at least 8 h/week in the prior 6 months, to a Veteran with 1+ impairments in instrumental activities of daily living. Recruitment was conducted via flyers, physician referrals, registries, and chart reviews. Participants completed 1‐h semi‐structured interviews to assess unmet psychosocial needs and barriers to accessing VA and non‐VA HCBS. Interviews were analyzed using a thematic analysis approach. Results: A total of 23 caregivers (62.9 + 13.5 years; 74% women; 52.2% White; 26.1% Black; 95.2% pre‐9/11) provided 8.4 ± 6.3 h of daily care. Most had provided care for more than 1 year; nine had cared for their Veteran for 5+ years. The following themes were identified: (1) need for clear, accurate, timely information about HCBS; (2) lack of time, amplified by COVID‐19 restrictions; (3) need for respite to manage their own health and other caregiving responsibilities; and (4) perceived difference in care needs that can strain caregivers' relationship with the care recipient. Conclusions: In addition to known barriers including lack of timely knowledge, service delays, and caregiver stress, Veteran–caregiver disagreements emerged as a novel barrier to using HCBS. A multi‐pronged approach that addresses these barriers may increase timely access to HCBS. See related editorial by Nathan A. oucher [ABSTRACT FROM AUTHOR]

Background: The accessibility of Parkinson's disease medicines is limited across sub‐Saharan Africa, which can have negative health, social and financial consequences for people with Parkinson's disease and their families. However, there is a stark gap in the literature regarding the impact of poor access to medicines on individuals. Objectives: The study objective was to understand the accessibility of Parkinson's disease medicines in Kenya from the perspective of people with Parkinson's disease, their caregivers and neurologists. Methods: In‐depth qualitative interviews were conducted with 55 people with Parkinson's disease, 23 caregivers and 8 neurologists to understand their experience regarding challenges with accessing Parkinson's disease medicines and the health, social and financial impact of poor availability and affordability. Results: Medicines for Parkinson's disease were deemed to be largely unavailable and unaffordable across Kenya. People with Parkinson's disease, caregivers and neurologists expressed the financial burden caused by long‐term treatment in the absence of health insurance coverage. Further, barriers accessing medicines negatively impacted symptom control, social relations, and quality of life. Conclusions: Access to Parkinson's disease medicines in Kenya is limited, with severe implications for symptom management and quality of life. People with Parkinson's disease should be able to access and afford the medicines they need to manage their condition. [ABSTRACT FROM AUTHOR]

Purpose: To systematically review the research relating to views and experiences of people with disability eating out in cafés, restaurants, and other settings; and identify factors that impede or enhance accessibility of eating out experiences, inform future inclusive research, and guide policy development. Materials and Methods: This study involved systematic search and review procedures with qualitative metasynthesis of the barriers to and facilitators for participation and inclusion in eating/dining-out activities. In total, 36 studies were included. Results: Most studies reviewed related to people with physical or sensory disability eating out, with few studies examining the dining experiences of adults with intellectual or developmental disability, swallowing disability, or communication disability. People with disability encountered negative attitudes and problems with physical and communicative access to the venue. Staff lacked knowledge of disability. Improvements in the design of dining spaces, consultation with the disability community, and staff training are needed. Conclusion: People with disability may need support for inclusion in eating out activities, as they encounter a range of barriers to eating out. Further research within and across both a wide range of populations with disability and eating out settings could guide policy and practice and help develop training for hospitality staff. IMPLICATIONS FOR REHABILITATION: Some people with disability require support for increased self-determination and self-advocacy to access eating out experiences satisfactorily. Goals and strategies to increase access and participation in eating out activities for people with disability should include attention to the environment and hospitality venues and to staff training. Rehabilitation professionals have a role in training hospitality staff about disability access and inclusion in eating out activities. To enhance community inclusion and participation, rehabilitation professionals could focus more on the skills and strategies needed for people with disability to participate in eating out activities. Rehabilitation professionals could implement a range of facilitators that might strengthen participation in eating out activities for people with disability. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated that access to robotic surgery is influenced by socioeconomic factors, including insurance status. The 2010 Affordable Care Act established an avenue for states to expand Medicaid coverage, which has increased access to surgical care for many conditions. We hypothesized that socioeconomic disparities in access to robotic repair of non-elective emergency general surgery (EGS) hernias are less prevalent in California, a Medicaid expansion state, compared to Florida, which has not adopted Medicaid expansion. Methods: The 2021 California and Florida State Inpatient Databases were used to identify all EGS admissions with an ICD-10 procedure code for ventral or inguinal hernia repair. Elective procedures and those with concurrent unrelated abdominal procedures were excluded. Patient demographics, comorbidity burden, payor status, and income quartile were abstracted. Aggregation of hospital data identified high-volume trauma, robotic, and EGS centers. Results: There were 15,683 EGS hernia procedures of which 11% underwent robotic repair: 14% in Florida and 8% in California. On multivariable logistic regression, older age, male sex, lower income, and Medicare insurance were associated with reduced odds of robotic hernia repair in California, but not in Florida, despite an uninsured rate of 10%. The greatest predictor of robotic surgery in both states was treatment at a robotic surgery center. Overall, accounting for patient- and hospital-level factors, hernia surgeries in Florida were more likely to involve robotics (OR 1.61, CI 1.42–1.81, p < 0.001) compared to California. Conclusion: There were fewer disparities in access to EGS robotic hernia repairs in Florida than in California. This suggests that robotic surgery access for EGS hernia repairs is primarily determined by institutional adoption of robotic surgery, not income or payor status. Compared to California, Florida appears to have greater market penetration of robotic surgery, which has increased access to robotic EGS for all patients. [ABSTRACT FROM AUTHOR]

The Disability Royal Commission (the Commission) investigated many issues, one of which was whether people with cognitive disabilities, including people with intellectual disabilities, faced systemic neglect in the Australian health system. Using a method of co-design with people with intellectual disabilities, we analysed the Commission's approach and recommendations about preventive health care. We identified how the Commission's recommendations can inform the achievement of the National Preventive Health Strategy (the Strategy) for people with intellectual disabilities. We found that a strength of the Commission's process was the multiple ways it inquired about the experience of accessing preventive health care. However, the inclusiveness of the invitations to participate in the Commission's work and the location of the public hearings were limitations for key stakeholders. Our analysis also noted that the Commission's public hearings focused on the supply side of healthcare access (health services) compared to the demand side of access (health users). This was a missed opportunity to learn from health users about their experiences. Two challenges to the implementation of the recommendations include the focus on cognitive disability instead of intellectual disability, and the focus on health care in general, rather than specifically on preventive health care. We also found that the Commission's recommendations mainly relate to the leadership, governance and funding elements in the Strategy, with a few actions relevant to prevention, partnerships, information, research, surveillance and preparedness. It is important that all the elements required to mobilise prevention systems are considered and actioned to achieve the Strategy. [ABSTRACT FROM AUTHOR]

Access to medical and supportive care services is important for the health and quality of life of cancer survivors; however, services are not always available or accessible to all survivors equally. This study aims to explore the experiences of cancer services among cancer survivors in urban and rural settings to inform social work practice. Authors conducted interviews with 25 cancer survivors (colorectal, n = 13; hematological, n = 12) in the West of Ireland, using a narrative inquiry approach. Thematic analysis was used to analyze the data. Authors found variations in the availability of supportive care services for urban and rural cancer survivors. Often, services designed to maximize survivors' individualized choices and needs in community care were limited in rural communities, preventing some survivors from having their physical and psychological needs met. Additionally, access to services proved to be a barrier for rural cancer survivors. Rural survivors stated that traveling to appointments required time and planning, and the implications of travel costs were an increased burden. When rural survivors had good social support, access to services became less of an issue. The study confirms geographical disparities and recommends a review of supports that better meet survivors' needs and informs social work practice. [ABSTRACT FROM AUTHOR]

A lack of access to a sequence of introductory to top-level curricula in rural schools has widened the achievement disparity between rural and urban students and influenced the number of college degree holders in rural areas. Recently, surging diversity and differentiation in income levels across nonurbanized areas can serve as determinants of the development of academically rigorous course pipelines in rural schools. This study examines differentiation in spatial access to the curriculum ladder for rigorous mathematics in three southern U.S. states during the 2017–18 school year: Alabama, Arkansas, and Mississippi. Policy variations in these states yield different effects on the sequence of rigorous mathematics courses in rural high schools. Given that the mathematics course pipeline reinforces college access, access to academically challenging courses likely outweighs the rural disadvantages of college readiness in non-urban students and the persistence of inequality in public education. [ABSTRACT FROM AUTHOR]

Background: Research shows that undocumented migrants have difficulties in accessing healthcare. Act 2013:407 came into force in 2013 and entitled undocumented migrants to healthcare that cannot be deferred. To date, studies about undocumented migrants' access to care in Sweden and the impact of Act 2013:407 are sparse. Hence, the aim of this study was to describe professionals' experiences of access to healthcare for undocumented migrants in Sweden and the impact of Act 2013:407. Methods: A qualitative design with semi-structured interviews was employed. Nine interviews were carried out in 2015 with nurses at two NGO healthcare centres for undocumented migrants – and an additional seven interviews in 2022 with staff at an NGO healthcare centre for undocumented migrants and personnel at a regional health and medical care administration. Interpretive description was used for the analyses. Ethical considerations: Permission to carry out the study was obtained from managers at the participating NGOs and the regional health and medical care administration. Participants received verbal and written information about the study, and informed consent was obtained from all participants. Findings: Six categories emerged from the analysis: Changes since the Act was introduced, General problems with healthcare access, Care for undocumented migrants – politics and social economy, Lack of knowledge, 'Healthcare that cannot be deferred' and Being an undocumented migrant. Conclusion: Undocumented migrants' social needs are as great as their needs for healthcare. Healthcare staff are burdened with healthcare cost considerations which affect their judgement of care provision and prioritization. Healthcare staff attitudes towards undocumented migrants affect their access to healthcare. Undocumented migrants in need of healthcare are especially vulnerable due to their legal status, being ill and the fear of being reported and deported. To assure undocumented migrants' access to healthcare and maintain healthcare ethics, the only possible solution is to provide healthcare based on needs. [ABSTRACT FROM AUTHOR]

Purpose: Apprenticeships in England, while defined by level and typical duration, are not quantified regarding the number of learning hours required to achieve the outcomes specified, as with other regulated qualifications and accredited programmes. This paper proposes an approach to ascribe credit to apprenticeships recognising both on-and-off-the-job learning to remove some of the existing barriers to accessing higher education (HE) and the professions. Design/methodology/approach: A mixed methodological approach resulting in a total learning hours/credit value was proposed. Findings: There is significant HE-wide confusion regarding the amount of learning/training that is required to complete apprenticeships in England. Whilst sector guidance made it clear that there was no prescribed method to ascribe credit to qualifications, programmes, modules, units or apprenticeships by drawing out the core principles within current practice, a key outcome of this project was the development of a method to ascribe a credit value to apprenticeships. Research limitations/implications: There is potential to support further research into the recognition of prior learning as a specialised pedagogy and for reflecting on apprenticeship practice in other roles and sectors. Practical implications: Whilst the project underpinning this paper focused on the healthcare sector, the method used to ascribe credit to the level-3 healthcare support worker apprenticeship was not sector specific and can therefore be applied to apprenticeships within other contexts providing more widespread benefits to workforce development. Social implications: Policy makers must ensure that employers and providers are clear that the minimum statutory off-the-job hours constitute an apprentice employment entitlement, which must not be conflated with total apprenticeship learning hours requirements. This recommended policy clarification could assist in simplifying the process required for ascribing credit to apprenticeships and at the same time support a move towards better and more consistent recognition of the value of apprenticeship learning. Originality/value: It is a first attempt to ascribe a credit value to an apprenticeship in England for the specific purpose of facilitating progression to HE. [ABSTRACT FROM AUTHOR]

Purpose: Interventions that improve timely access to outpatient health services are essential in managing demand. This process evaluation aimed to describe the implementation, mechanism of impact and context of an intervention to reduce waiting for first appointments in an outpatient epilepsy clinic. Design/methodology/approach: The UK Medical Research Council framework was used as the theoretical basis for a process evaluation alongside an intervention trial. The intervention, Specific Timely Appointments for Triage (STAT), is a data-driven approach that combines a one-off backlog reduction strategy with methods to balance supply and demand. A mixed methods process evaluation synthesised routinely collected quantitative and qualitative data, which were mapped to the domains of implementation, mechanisms of impact and contextual elements. Findings: The principles of the STAT model were implemented as intended without adaptation. The STAT model reached all patients referred, including long waiters and was likely generalisable to other medical outpatient clinics. Mechanisms of impact were increased clinic capacity and elimination of unwanted variation. Contextual elements included the complexity of healthcare systems and the two-tier triage practice that contributes to prolonged waiting for patients classified as non-urgent. Originality/value: This process evaluation shows how a data-driven strategy was applied in a medical outpatient setting to manage demand. Improving patient flow by reducing waiting in non-urgent, outpatient care is a complex problem. Understanding how and why interventions work is important for improved timeliness of care, and sustainability of public health services. [ABSTRACT FROM AUTHOR]

Background: Primary care (PC) is essential to overall wellness and management of comorbidities. In turn, patients without adequate access to PC may face healthcare disparities. We sought to characterize the impact of established PC on postoperative outcomes among patients undergoing a surgical procedure for a digestive tract cancer. Methods: Medicare beneficiaries with a diagnosis of hepatobiliary, pancreas, and colorectal cancer between 2005 and 2019 were identified within the Surveillance, Epidemiology, and End Results program and Medicare-linked database. Individuals who did versus did not have PC encounters within 1-year before surgery were identified. A postoperative textbook outcome (TO) was defined as the absence of complications, no prolonged hospital stay, no readmission within 90 days, and no mortality. Results: Among 63,177 patients, 50,974 (80.7%) had at least one established PC visit before surgery. Patients with established PC were more likely to achieve TO (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09–1.19) with lower odds for complications (OR, 0.85; 95% CI, 0.72–0.89), extended hospital stay (OR, 0.86; 95% CI, 0.81–0.94), 90-day readmission (OR, 0.94; 95% CI, 0.90–0.99), and 90-day mortality (OR, 0.87; 95% CI, 0.79–0.96). In addition, patients with established PC had a 4.1% decrease in index costs and a 5.2% decrease in 1-year costs. Notably, patients who had one to five visits with their PC in the year before surgery had improved odds of TO (OR, 1.21; 95% CI, 1.16–1.27), whereas individuals with more than 10 visits had lower odds of a postoperative TO (OR, 0.91; 95% CI, 0.84–0.98). Conclusion: Most Medicare beneficiaries with digestive tract cancer had established PC within the year before their surgery. Established PC was associated with a higher probability of achieving ideal outcomes and lower costs. In contrast, patients with more than 10 PC appointments, which was likely a surrogate of overall comorbidity burden, experienced no improvement in postoperative outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Many youth with pain lack access to pediatric pain expertise. There is a critical shortage of pediatric pain physicians, due partly to a paucity of training programs in Pediatric Pain Medicine. Pain fellowships are Anesthesiology-based and there is no pathway to fellowship training or Pain Medicine board certification for pediatricians. This workforce assessment sought to examine the current state of Pediatric Pain Medicine in the United States and future interest in pursuing Pain Medicine among pediatricians. Methods: A multidisciplinary working group of Pain Medicine clinicians designed three surveys to examine pediatric comprehensive pain programs in the US, practice patterns of pediatricians and their motivations and opinions regarding Pain Medicine board certification, and current residents' exposure to and interest in Pediatric Pain Medicine. Results: Wait times for initial evaluations are two months or longer for two-thirds of responding centers, and barriers to increase staff size and resources were reported, including an inadequate number of trained or available physicians. Pediatricians expressed interest in earning board certification in Pain Medicine, given the opportunity. Additionally, there is interest among pediatric residents in pursuing Pediatric Pain Medicine, and qualitative data highlight information residents perceived needing in order to pursue a career in the field. Discussion: Results demonstrate the need for increased training opportunities in pediatric pain medicine. A formal pathway to Pain Medicine for Pediatricians should be developed to increase the potential workforce and to address the lack of trained pediatric pain specialists, thereby improving access to care for youth with pain. [ABSTRACT FROM AUTHOR]

ABSTRACT Background/Objective Methods Results Conclusions The demand for pediatric dermatology services in the U.S. is high, especially at large academic healthcare centers. eConsultation programs provide a solution to poor in‐person access by offering diagnostic and management support to primary care providers (PCPs). To determine the real‐world utility of eConsultation in pediatric dermatology within a closed system at a major academic center, we assessed the outcomes, diagnostic and management concordance, and predictors of eConsult completion of an asynchronous provider‐to‐provider pediatric dermatology eConsult program.Retrospective cohort study of 900 consecutive outpatient pediatric dermatology eConsult referrals from PCPs at a tertiary academic center from 2017 to 2021.Of 900 eConsult referrals, 621 (69%) were completed without the need for in‐person dermatology follow‐up. 46 (5%) were completed but required follow‐up. 233 eConsult referrals (26%) were declined, primarily due to medical complexity. Thirty referrals (3%) were declined because of inadequate clinical photos. The PCP communicated eConsult recommendations to the patient/family on an average of 1.6 days (SD 3) after receiving the completed eConsult. eConsults for adolescents were less likely to be completed compared to infants (p = 0.03). Diagnostic and management concordance between PCP and dermatologist was 78% and 67%, respectively.Provider‐to‐provider eConsultation provides rapid speciality guidance to PCPs managing low‐complexity skin conditions in pediatric outpatients. The lower rate of management plan concordance compared to diagnostic concordance suggests that eConsultation improves outpatient skin management by PCPs. [ABSTRACT FROM AUTHOR]

The Korean demilitarised zone (DMZ) has traditionally been understood as an alienated borderland consistent with ideas of no-man’s lands as abandoned and enclosed spaces. However, far from being an empty space or geopolitical vacuum, the withdrawal of human bodies and activity from the DMZ has (inadvertently) established an ecological haven where non-human life thrives. The near complete inaccessibility of the space poses significant obstacles to researching the species thriving within and, indeed, to how we envision, sense, and engage with the DMZ to begin with. Yet, the difficulties and challenges associated with researching such spaces also provide stimulating ways of thinking with and through the subfield of animal geographies. Drawing upon fieldwork experiences with birds at and along the DMZ, with a particular focus on the red-crowned crane (Grus japonensis), this paper explores how the subfield of animal geographies can itself become a means of exploring, interacting, and engaging with (de)limited spaces. In doing so, it considers how we might push animal geographies beyond its current limits whilst also expanding both the conceptual and methodological toolboxes through which we approach less accessible spaces of study. [ABSTRACT FROM AUTHOR]

Background: Being attached to a primary care (PC) provider is at the core of a strong primary health care system. Centralized waiting lists (CWL) for unattached patients have been implemented in eight provinces of Canada to support the attachment process. In Quebec, the Ministry of Health mandated the implementation of Primary Care Access Points (GAP) across the province to help unattached patients navigate the health system while awaiting attachment through the CWL. Several local health territories developed complementary innovations to the GAP to respond to local population needs. This paper aims to describe five organizational innovations implemented locally. Methods: This multi-case qualitative study was conducted in four local health territories in the province of Quebec. Fifty-two semi-structured interviews with healthcare managers, nurses, physicians, other health professionals and administrative staff were conducted between April 2023 and April 2024. An interview guide was developed based on existing frameworks on the implementation of innovations and the evaluation of the GAP. Thematic analysis was conducted using NVivo software. Inductive and deductive approaches were used to develop relevant codes and themes. Logic models were built to describe the organizational innovations. Results: Five organizational innovations are described. First, a multidisciplinary clinic aimed at responding to patients with mental health issues was implemented. Second, a nurse clinic was implemented to provide temporary care for patients with unstable chronic illnesses. The third innovation is a mobile proximity clinic where unattached GAP patients are first evaluated by a paramedic before receiving care from a nurse. Fourth, a pharmacist trajectory was implemented to increase engagement of community pharmacists to respond to GAP patients. The last innovation is a decentralized GAP offering in-person nursing care to unattached GAP patients. Conclusions: Descriptions of these five innovations are key to inform other territories and provinces on ways to improve access for unattached patients while they are waiting to be attached. The introduction of the GAP and the organizational innovations, suggests a transition where access to PC services does not rely solely on attachment status. [ABSTRACT FROM AUTHOR]

Background: Accessing sexual and reproductive health (SRH) services in rural Australia presents complex challenges that negatively impact women's health and exacerbate health inequities across the life course. This systematic review synthesises evidence on the barriers and facilitators to women's access to SRH services in rural Australia, considering both supply and demand dimensions. Methods: We systematically searched peer-reviewed literature published between 2013 and 2023. Search terms were derived from three major topics: (1) women living in rural Australia; (2) spatial or aspatial access to SRH services; and (3) barriers or facilitators. We adopted the "best fit" approach to framework synthesis using the patient-centred access to healthcare model. Results: Database searches retrieved 1,024 unique records, with 50 studies meeting the inclusion criteria. Most studies analysed access to primary care services (n = 29; 58%), followed by hospital services (n = 14; 28%), health promotion and prevention (n = 5; 10%), and specialist care (n = 2; 4%). The type of care accessed was mostly maternity care (n = 21; 42%), followed by abortion services (n = 11; 22%), screening and testing (n = 8; 16%), other women's health services (n = 6; 12%), and family planning (n = 4; 8%). There were numerous barriers and facilitators in access from supply and demand dimensions. Supply barriers included fragmented healthcare pathways, negative provider attitudes, limited availability of services and providers, and high costs. Demand barriers encompassed limited awareness, travel challenges, and financial burdens. Supply facilitators included health system improvements, inclusive practices, enhanced local services, and patient-centred care. Demand facilitators involved knowledge and awareness, care preferences, and telehealth accessibility. Conclusion: This review highlights the urgent need for targeted interventions to address SRH service access disparities in rural Australia. Understanding the barriers and facilitators women face in accessing SRH services within the rural context is necessary to develop comprehensive healthcare policies and interventions informed by a nuanced understanding of rural women's diverse needs. [ABSTRACT FROM AUTHOR]

In the heart of Kenya's vibrant agricultural landscape lies a fundamental aspect crucial for food security, cultural heritage, and economic resilience: the right to seed. Embedded within the fabric of traditional farming practices, the right to seed encompasses the freedom of farmers to save, exchange, and utilize traditional and farmer-bred seeds. In Kenya, as in many other countries, this right is not only a legal concept but a cornerstone of agricultural sovereignty. However, its preservation faces challenges in the face of globalization, corporate interests, and evolving intellectual property regimes. Yet, amidst these challenges, significant strides are being made, with collaborative efforts at the global level, particularly through initiatives led by the Convention on Biological Diversity (CBD) and the International Treaty on Plant Genetic Resources for Food and Agriculture (ITPGRFA), aimed at promoting and protecting farmers' rights. Every smallholder farmer has the right to safe, nutritious and healthy food and the ability to sustain themselves and their societies with the existing endorsed resources. The concept of farmers' rights came out as a subject of debate in international agricultural circles, spearheaded by the Food and Agriculture Organisation of the United Nations (FAO). This includes the right to save, use, exchange and sell farm-saved seed and propagating materials, the right to protect traditional knowledge among others. In developing countries, the right to seed is a fundamental aspect of agricultural sovereignty and food security. This still emulates the subject debate from FAO. However, attention in scientific literature and policy circles for both seeds and farmers' rights are compromised. This paper employs mediation analysis to explore the causal relationship between seed rights, farmers' rights, and food sovereignty, highlighting the pivotal role of smallholder farmers in shaping sustainable food systems. The findings underscore the importance of inclusive policies that prioritize farmers' rights and empower local communities to sustainably manage their seed resources. [ABSTRACT FROM AUTHOR]

An Archaeology of Disability is a research station designed for the Venice Biennale, Architettura 2021 by David Gissen, Jennifer Stager, and Mantha Zarmakoupi and exhibited later at La Gipsoteca di Arte Antica of Pisa in 2022, at the Canellopoulos Museum of Athens in 2023, and at the Archaeological Museum of Thessaloniki in 2024. The research station works with languages and forms used by contemporary disabled people to reproduce elements—a ramp, a seat, an art gallery—from the ancient Acropolis in Athens that vanished long ago and that have little or no extant material forms. Among the many people who contributed to the research station are two performers, Christopher Tester and Pia Hargrove, who performed, respectively, the ekphrastic film and audio description Sēmata (Signs) (2021). The following dialogic essay draws on conversations with the curators and performers led by Brooke Holmes and Pasquale Toscano. This dialogic form surfaces some of the collaborative aspects of the research station to highlight the ways in which such collaboration brings different lenses to antiquity. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic, relapsing inflammatory skin disorder that is associated with substantial physical and psychosocial comorbidity. Although biologic agents have offered transformative therapeutic advantages to those unresponsive to traditional treatments, data from recent literature indicate significant undertreatment of certain populations, highlighting potential barriers to access. This review aims to comprehensively elucidate barriers to biological therapy, addressing a recognized gap in the current literature. A search was conducted using MEDLINE, Embase, and Web of Science to investigate the obstacles and disparities that prevent access to biologic treatments in biologic‐naïve psoriatic patients. Emergent themes were then systematically categorized into five primary domains: patient‐level, prescriber‐level, medicine‐level, organizational‐, and external environment‐level factors. Our results demonstrate pronounced barriers and disparities encompassing increased age, race, socioeconomic status, rural location, cost and insurance, and insufficient knowledge that may hinder access to biologic treatments among psoriatic patients. Further research on how these barriers can be effectively addressed is needed to optimize treatment outcomes. [ABSTRACT FROM AUTHOR]

In many countries, such as Canada, the USA, England, and Australia, to graduate from a regulated profession such as nursing, students must complete a set of work‐integrated learning (WIL) hours and demonstrate their ability to safely perform physical skills and apply knowledge in relation to professional standards. For a disabled nursing student (DNS) undergoing training in higher education institutions (HEI), securing proper accommodations to participate effectively in WIL experiences has been difficult due to concerns related to risks to self and patient safety. This study used critical discourse analysis to investigate the framing of risk and safety in association with providing DNS with accommodation in WIL. Our data were collected from an intensive codesign (group‐based discussion) session with participants (n = 16), including clinicians and DNS, from four institutions (two WIL‐sites and two HEI organizations). Using an iterative thematic approach based on Foucauldian framework, our analysis revealed three ways in which health professionals discursively framed risk and safety: (a) beliefs that a lack of disclosure by disabled students decreases patient safety and indicates poor self‐reflection, (b) concerns that accommodating students poses a risk to institutions offering WIL experiences and to the relationships between HEI and institutions offering WIL‐sites, and (c) a framing which challenges the dominant discourse by thinking about safety and risk more expansively. Our findings suggest the first two of these framings are ableist and function to enact barriers to access for DNSs in WIL, whereas the third framing serves the goal of inclusion. Recommendations to address the current ableist discourse within the Canadian nursing context are provided, which may also be applicable across other regulated health professions. [ABSTRACT FROM AUTHOR]

Technological advances in analytics, as well as scientific and regulatory knowledge and experience gained from biosimilar development/approvals over the last decade, enabled the World Health Organization (WHO) in 2022 to revise its guidelines on the evaluation of biosimilars. Among the revisions, there is more reliance on analytical and functional aspects to prove similarity (and likely fewer clinical requirements). WHO international reference standards for biosimilars provide additional confidence to regulators looking for evidence‐ and data‐based regulatory convergence in scientific and technical measures of quality attributes. These standards serve as a benchmark for harmonizing the bioactivity or potency of biosimilars, ensuring their future sustainability. This article discusses the availability and role of WHO international reference standards throughout the product life cycle of biosimilars. [ABSTRACT FROM AUTHOR]

Background: Despite a growing body of literature supporting the safety of robotic hepatopancreatobiliary (HPB) procedures, the adoption of minimally invasive techniques in HPB surgery has been slow compared to other specialties. We aimed to identify barriers to implementing robotic assisted surgery (RAS) in HPB and present a framework that highlights opportunities to improve adoption. Methods: A modified nominal group technique guided by a 13-question framework was utilized. The meeting session was guided by senior authors, and field notes were also collected. Results were reviewed and free text responses were analyzed for major themes. A follow-up priority setting survey was distributed to all participants based on meeting results. Results: Twenty three surgeons with varying robotic HPB experience from different practice settings participated in the discussion. The majority of surgeons identified operating room efficiency, having a dedicated operating room team, and the overall hospital culture and openness to innovation as important facilitators of implementing a RAS program. In contrast, cost, capacity building, disparities/risk of regionalization, lack of evidence, and time/effort were identified as the most significant barriers. When asked to prioritize the most important issues to be addressed, participants noted access and availability of the robot as the most important issue, followed by institutional support, cost, quality of supporting evidence, and need for robotic training. Conclusions: This study reports surgeons' perceptions of major barriers to equitable access and increased implementation of robotic HPB surgery. To overcome such barriers, defining key resources, adopting innovative solutions, and developing better methods of collecting long term data should be the top priorities. [ABSTRACT FROM AUTHOR]

There is scant evidence on the level of arts education available in U.S. public schools and how this has changed over time. In this paper, I present new evidence on broad trends in arts education in U.S. public schools from 1988 through 2018 using nationally representative data from the Schools and Staffing Survey (SASS) and the National Teachers and Principals Survey (NTPS) and administrative data from North Carolina. Both the SASS/NTPS and North Carolina data cover several school years after the Every Student Succeeds Act was passed in 2015, which may have impacted arts education. I first calculate the percentage of full-time teachers whose main teaching assignment is in the arts. In the aggregate, about 5.5% of public school teachers are arts teachers, and this has been stable for decades. There are substantial regional differences that have also changed little. I also find substantial and persistent differences by school characteristics: Schools with higher percentages of both Black, Indigenous, and people of color (BIPOC) and low-income students consistently have a lower percentage of full-time arts teachers than other schools. I also examine of school-level and student-level trends in arts access using administrative data from North Carolina from 1998–2013. I find narrowing gaps in the presence of licensed art teachers between low-performing schools and other schools, and high-BIPOC schools and other schools. I also assess access to the arts at the student level from 2007–2018. I find narrowing gaps in arts enrollment between White students and Black and Hispanic students, consistent with the school-level trends I report. This descriptive evidence from both national and North Carolina data improves our understanding of how arts have been prioritized by schools in recent decades and highlights gaps in access students have had to the arts over time. [ABSTRACT FROM AUTHOR]

The conservation field has recently experienced a significant paradigm shift called "peoples-based" conservation, which centers collaboration with communities for whom cultural heritage has meaning. This turn is so significant that it has the possibility of upending core preservation practices of dress museology, and yet, few dress studies professionals might be aware that this shift has even occurred, or that it has a name. This article describes the transformative move in conservation ethics towards peoples-based approaches and points to potential impacts this shift might have on the preservation of dress artifacts. One specific fashion museological practice—the prohibition against the wearing of historic dress—is explored as an example of how this shift towards peoples-based conservation approaches opens exciting opportunities for dress professionals, empowering them to consider how collaborative preservation and interpretive strategies might sustain and even enhance the meaning of the collection objects. [ABSTRACT FROM AUTHOR]

Turkey currently pursues an aggressive pronatalist population politics which has created wide-reaching reproductive governance regulating reproductive health care and family planning choices. One aspect of this orientation centres on restricting access to abortion services despite the fact that abortion is legal through ten weeks of pregnancy. This article uses nationwide data collected from mystery patient surveys administered to all public (in 2016 and 2020), and all private (2021) hospitals in the country to determine the availability of abortion services in Turkey. Less than half of all hospitals responding provided abortions to the full extent provided by law. Abortion without restriction as to reason was largely unavailable at public hospitals and the cost of care at private hospitals remained prohibitive for many. Among those hospitals we reached, in four provinces, there was no public or private hospital providing any type of abortion care. The most frequent explanation for the lack of abortion services was that abortion is illegal. This was particularly the case for public hospitals. Despite a 10-week cutoff for abortions, 39% of private hospitals responding to the survey invoked even earlier time limits creating further restrictions. The extreme pronatal orientation of the reproductive governance currently in place has created a state of reproductive injustice that makes enhanced access to abortion of vital importance. [ABSTRACT FROM AUTHOR]

Purpose: Rehabilitation can positively affect quality of life, functional status, and physiological status for patients with head and neck or lung cancer. However, barriers and facilitators regarding access, referral, and participation in rehabilitation have not been outlined in the literature either from a healthcare professional or from a structural perspective. Therefore, the objective of this paper was to identify and map barriers and facilitators from structural and healthcare professionals' perspectives in relation to access, referral, and participation in rehabilitation for patients with head and neck or lung cancer. Materials and methods: Two systematic searches were conducted in five databases mapping peer-reviewed research literature. Results: In total, 17 studies of 3918 potential sources were included. Seven themes were identified. Four themes concerned access: Understanding Patients' Resources; Collaboration Determining Access; Education, Knowledge, and Evidence Impact Access to Rehabilitation; and Resources Affecting Availability to Rehabilitation Services. Two themes concerned referral: Referral Criteria; and Elements Affecting Referral Pathway. One theme concerned participation: Factors Influencing Participation. Conclusion: From structural and healthcare professionals' perspectives, barriers and facilitators impact access, referral and participation in rehabilitation. However, the findings on facilitators were limited; only one theme addressed participation and two findings concerned patients with low socioeconomic status. IMPLICATIONS FOR REHABILITATION: Healthcare professionals should be mindful that a diverse array of barriers and facilitators may impact the rehabilitation pathway for patients with head, neck, and lung cancer. Engagement by healthcare professionals and structural initiatives are needed to ensure comprehensive access to information concerning rehabilitation options. Local guidelines should be developed to prescribe methods for informing and guiding patients towards suitable rehabilitation options. It is important that healthcare professionals take the individual patient's resources into account when navigating aspects of access, referral, and participation in rehabilitation. [ABSTRACT FROM AUTHOR]

Access to smartphone and data plan services may impact levels of connection and opportunities for health management for patients with a diagnosis of a serious mental illness. Such smartphone-based services provide opportunities that extend the reach of physical and mental health care programs. The purpose of this study was to explore barriers and facilitators faced by individuals with mental health challenges when accessing Medicaid SafeLink smartphones and data plans. Interview guides were developed using the Consolidated Framework for Implementation Research. Individual semi-structured interviews were conducted to collect qualitative data on 18 participants' experiences with SafeLink services. Two main themes were identified– barriers and facilitators. Sub-themes included monthly data limits, followed by account management (barriers), opportunities for safety, and connection (facilitators). Massachusetts SafeLink policies provide individuals with an opportunity for smartphone ownership. However, results imply that expanding the current policy's usage limits may provide additional opportunities for connection and access to health services. [ABSTRACT FROM AUTHOR]

• The Chicago UPK expansion increased access to free, full-day pre-K for 4-year-olds. • There was no negative effect on 3-year-old enrollment in free, full-day pre-K. • Most of the full-day expansion was offset by declines in half-day seats. • An earlier, targeted system had increased access in economically disadvantaged neighborhoods. • All communities across the city had increases in access through the UPK expansion. In 2019, Chicago began transitioning from a targeted pre-K program to free, full-day universal pre-K (UPK). By design, the transition intended to expand capacity over a few years, prioritizing access in more disadvantaged areas before moving on to more advantaged areas. We analyzed the transition path, showing capacity and enrollment over time across neighborhoods categorized by poverty rates, racial and ethnic composition, and economic resources. We also used a difference-in-differences approach to examine the causal impact of the expansion on access and explore implications for equity. We found that Chicago's UPK increased 4-year-old enrollment in free, full-day pre-K programs in Chicago Public Schools, largely through replacing half-day seats with full-day seats, with no negative effect on 3-year-old enrollment. We also found that capacity and enrollment generally were expanded earlier in neighborhoods with higher levels of disadvantage. Importantly, all communities across the city experienced increases in capacity and enrollment through the UPK expansion, suggesting it is possible to expand access across sociodemographic groups without compromising access for children living in historically underinvested neighborhoods. As local efforts across the nation expand to increase access to publicly funded programs, the Chicago UPK expansion can serve as a model. [ABSTRACT FROM AUTHOR]

• Maryland enacted several policies to increase access to quality ECE from January 2015–March 2020. • Provider subsidy participation grew following elevated income limits and reimbursement rates. • Neighborhoods with lower-poverty density had greater increases in provider subsidy participation. • The percent of children using subsidies to attend higher-rated programs increased between 2018 and 2019. • Increased use of higher-rated ECE over time was not due to families changing providers. Documenting how federal and state child care policies increase equitable access to high-quality early care and education (ECE) for families with low- and moderate-incomes remains a challenge in part due to overlaps in policy enactment. This study used an interrupted time series analysis (ITSA) to describe changes to providers' participation in Maryland's child care subsidy program following implementation of a constellation of child care policies enacted between January 5, 2015, and March 2, 2020 (i.e., prior to the COVID-19 pandemic). Findings indicate a marked increase in the percentage of licensed family child care (FCC) and center-based providers serving children with a subsidy following increases in household income eligibility levels and provider reimbursement rates in 2018. Provider participation rates varied by neighborhood income level, with participation expanding more in neighborhoods with lower poverty density relative to their starting level in 2015. Changes in child participation rates by income eligibility mirrored changes in state subsidy policy: children residing in income-eligible households above 200 % federal poverty level represented 4.4 % of the child sample in 2018, 13 % in 2019, and 18 % in 2020. The proportion of children with a subsidy who used higher-rated ECE increased significantly between January 2018 and January 2020 for all racial/ethnic groups, income eligibility levels, and urbanicity categories. The majority (62 %) of children who stayed in the subsidy program between 2018 and 2019 stayed with their same provider, many of which obtained their first rating or increased their quality rating during this time frame in accordance with a new requirement for providers to participate in the state's quality rating system to receive a subsidy reimbursement. Implications for future research, policy, and practice are discussed. [ABSTRACT FROM AUTHOR]

Access to health services has received increasing attention, and the International Agency for Research on Cancer (IARC) includes 'availability' as one of the indicators to evaluate cancer screening. Evaluating, monitoring, and decision-making on cancer screening depends on systematic quantitative evidence on access to cancer screening, but indicators are currently inconsistently, if they are reported at all. This can be improved by developing systematic indicators for evaluating and reporting access to cancer screening. This requires a thorough understanding of current indicators of access to cancer screening. Scoping review. We completed a scoping review of studies on access to cancer screening services from 2013 to 2022. The relevant indicators were extracted, quantified, and then matched to two widely used frameworks: a universal five-dimensional conceptual framework for access to healthcare ('U5D') and a cancer-specific framework/list on the availability/use of screening indicators endorsed by the IARC. A total of 331 studies on access to cancer screening services were included. Based on the U5D framework, publications from supply side reported approachability (number of publications = 16), acceptability (6), availability and accommodation (44), affordability (30), and appropriateness (11); among this process, 17 sub-indicators were identified. Correspondingly, publications from demand side reported ability to perceive (170), ability to seek (85), ability to reach (58), ability to pay (59), and ability to engage (2); 26 sub-indicators were identified. More macroscopically, the publications of the IARC-endorsed indicators reported availability of policies and guidelines for screening (13), type of screening provided (3), extent of population coverage and participation rates (76), and demographic/behavioural related considerations (167). By integrating the universal and cancer-specific frameworks, a new adapted framework was proposed. This study identified and collated indicators for evaluating access to cancer screening services, and determined the gaps in the current application of various indicators. The findings are anticipated to facilitate further development of an evaluation indicator system for access to cancer screening services. [Display omitted] [ABSTRACT FROM AUTHOR]

We evaluated the available literature on the association between characteristics of the food environment and household food insecurity. Systematic review. Studies published until January 9th, 2023, were searched in the PubMed, Web of Science, Science Direct, EMBASE and LILACS databases. The included studies were summarized with a narrative synthesis with information on the study location, population studied, prevalence and type of measure/instrument used to assess food (in)security, method of evaluating the food environment and measure between food insecurity and food environment. Twenty-two articles were included. Different methods were used to measure food security and the food environment. Most food insecurity assessment tools assessed the dimension of access to food, more precisely economic access. The dimensions of the food environment most evaluated were food availability and affordability. An association between characteristics of the food environment and food insecurity was found in 18 of these studies. Homes with food insecurity have a greater availability of unhealthy foods, more frequent purchasing of foods in convenience stores and small markets as well as a lower availability of healthy foods, such as fruits and vegetables. This review revealed that household food insecurity was associated with the food environment, highlighting the importance of policies to promote healthy diets, especially in vulnerable communities. Few studies were found in the Global South, demonstrating the gap in this knowledge in these locations. [ABSTRACT FROM AUTHOR]

Most cancer-associated pain is experienced in low- and middle-income countries (LMICs) due to inequitable access to opioids. To determine opioid access as estimated by both patients and providers and to understand patient and facility-level factors influencing access among patients with advanced cancer in LMICs in Asia using the Behavioral Model of Health Services Use. The APPROACH cross-sectional study was conducted in seven LMICs in Asia, involving in-depth surveys with providers and advanced cancer patients. A hierarchical logistic regression model was used to assess predisposing (i.e. individual factors), enabling (i.e. health care system and facility-level resources) and need (i.e. pain severity) factors predicting opioid access. Among patient participants (n=1,933), approximately 40% reported opioid use. Meanwhile 80% of facilities, as reported by providers, indicated at least half of their advanced cancer patients receive oral morphine prescriptions. Predisposing characteristics factored in the least in the model, with patient education positively associated with access (Odds ratio (OR): 1.01; 95% CI=1.00, 1.03). Facility-level enabling resources, factoring the most, included oral morphine prescription duration >14 days (OR: 1.27; 95% CI=1.05, 1.53) and the extent of physician palliative care training (extensive (>160 hours) OR: 3.95; CI=3.19, 4.88; basic (up to 40 hours) OR: 1.03; CI=1.03, 1.04). Patient need as indicated by greater pain severity predicted access (OR: 1.55; CI=1.47, 1.64). Study findings emphasize the importance of palliative care training—even a minimal amount—in supporting access to opioids for advanced cancer patients. This study also highlights pragmatic site-level policies, such as extended morphine prescription durations, enabling access. [ABSTRACT FROM AUTHOR]