Adherence to community versus facility-based delivery of monthly malaria chemoprevention with dihydroartemisinin-piperaquine for the post-discharge management of severe anemia in Malawian children: A cluster randomized trial.

BACKGROUND: The provision of post-discharge malaria chemoprevention (PMC) in children recently admitted with severe anemia reduces the risk of death and re-admissions in malaria endemic countries. The main objective of this trial was to identify the most effective method of delivering dihydroartemesinin-piperaquine to children recovering from severe anemia. METHODS: This was a 5-arm, cluster-randomized trial among under-5 children hospitalized with severe anemia at Zomba Central Hospital in Southern Malawi. Children were randomized to receive three day treatment doses of dihydroartemesinin-piperaquine monthly either; 1) in the community without a short text reminder; 2) in the community with a short message reminder; 3) in the community with a community health worker reminder; 4) at the facility without a short text reminder; or 5) at the facility with a short message reminder. The primary outcome measure was adherence to all treatment doses of dihydroartemesinin-piperaquine and this was assessed by pill-counts done by field workers during home visits. Poisson regression was utilized for analysis. RESULTS: Between March 2016 and October 2018, 1460 clusters were randomized. A total of 667 children were screened and 375 from 329 clusters were eligible and enrolled from the hospital. Adherence was higher in all three community-based compared to the two facility-based delivery (156/221 [70·6%] vs. 78/150 [52·0%], IRR = 1·24,95%CI 1·06-1·44, p = 0·006). This was observed in both the SMS group (IRR = 1·41,1·21-1·64, p<0·001) and in the non-SMS group (IRR = 1·37,1·18-1·61, p<0·001). Although adherence was higher among SMS recipients (98/148 66·2%] vs. non-SMS 82/144 (56·9%), there was no statistical evidence that SMS reminders resulted in greater adherence ([IRR = 1·03,0·88-1·21, p = 0·68). When compared to the facility-based non-SMS arm (control arm), community-based delivery utilizing CHWs resulted in higher adherence [39/76 (51·3%) vs. 54/79 (68·4%), IRR = 1·32, 1·14-1·54, p<0·001]. INTERPRETATION: Community-based delivery of dihydroartemesinin-piperaquine for post-discharge malaria chemoprevention in children recovering from severe anemia resulted in higher adherence compared to facility-based methods. TRIAL REGISTRATION: NCT02721420; ClinicalTrials.gov.

Welfare states as lifecycle redistribution machines: Decomposing the roles of age and socio-economic status shows that European tax-and-benefit systems primarily redistribute across age groups.

Social scientists identify two core functions of modern welfare states as redistribution across (a) socio-economic status groups (Robin Hood) and (b) 'the lifecycle' (the piggy bank). But what is the relative importance of these functions? The answer has been elusive, as the piggy bank is metaphorical. The intra-personal time-travel of resources it implies is based on non-quid-pro-quo transfers. In practice, 'lifecycle redistribution' must operate through inter-age-group resource reallocation in cross-section. Since at any time different birth cohorts live together, 'resource-productive' working-aged people are taxed to finance consumption of 'resource-dependent' younger and older people. In a novel decomposition analysis, we study the joint distribution of socio-economic status, age, and respectively (a) all cash and in-kind transfers ('benefits'), (b) financing contributions ('taxes'), and (c) resulting 'net benefits,' on a sample of over 400,000 Europeans from 22 EU countries. European welfare states, often maligned as ineffective Robin Hood vehicles riddled with Matthew effects, are better characterized as inter-age redistribution machines performing a more important second task rather well: lifecycle consumption smoothing. Social policies serve multiple goals in Europe, but empirically they are neither primarily nor solely responsible for poverty relief and inequality reduction.

Sociodemographic inequities in dental care utilisation among governmental welfare recipients in Japan: a retrospective cohort study.

BACKGROUND: Maintaining oral health is one of the global public health challenges. Income and out-of-pocket payments for dental care services are predictors of dental care utilisation. Although public assistance programmes guarantee income security for impoverished people, access barriers other than financial costs may cause unmet dental care needs. We aimed to explore the potential sociodemographic factors determining dental care utilisation among recipients of public assistance in Japan using linkage data of public assistance database and medical assistance claim data administered by municipalities. METHODS: This was a retrospective cohort study involving a sample of public assistance recipients. We extracted the recipients' sociodemographic data (age, sex, household number, employment status, nationality, disability certificates, and long-term care status) in January 2016 and observed them until December 2016 to identify incidences of dental care utilisation as outcomes. We performed a multivariable modified Poisson regression analysis with a robust standard error estimator to calculate the incidence ratio (IR) of dental care utilisation in each variable. RESULTS: We identified a total of 4497 recipients at risk. Among them, 839 recipients used dental care services. Younger age was associated with a higher incidence of dental care utilisation. The female recipients had a higher incidence of dental care utilisation when compared to the male ones (adjusted IR, 1.22; 95% confidence interval [CI], 1.08-1.38). Immigrant recipients had a higher incidence of dental care utilisation than the Japanese ones (IR, 1.53; 95% CI, 1.16-2.01). Recipients with mental disabilities had higher incidences than those without disability certificates (IR, 1.30; 95% CI, 1.08-1.56). CONCLUSIONS: Non-financial sociodemographic inequities in dental care utilisation stemming from age, sex, nationality, and presence of mental disability were found despite minimum income protection and equitable financial dental service access amongst public assistance recipients in Japan. Providing targeted preventive care and treatments for dental care among underserved populations is required to tackle oral health inequities.

The experience of professional nurses working with newly qualified nurses placed for community service in public health facilities in the City of Tshwane, South Africa.

BACKGROUND: The newly qualified nurses (NQNs) were mandated to work for one year as community service nurses before being registered. During the placement, NQNs were supposed to be supervised and supported by professional nurses. On the contrary, professional nurses expected NQNs to be hands-on and provide quality care on completion of their training. Expectations of professional nurses created misperceptions regarding the objectives of community service. Therefore, exploring their experience would identify skills gap that is needed to be addressed. OBJECTIVES: This study explored and described the experiences of professional nurses working with NQNs placed for community service in the City of Tshwane. METHOD: A qualitative exploratory design was conducted. Individual interviews were carried out with 22 professional nurses in various public healthcare settings, such as a hospital, a community health centre and a clinic. Informed consent was obtained from all the participants and confidentiality and anonymity were maintained throughout the interviews. Creswell's data analysis process was implemented. RESULTS: Two themes emerged from this study, namely, experience of participants with NQNs and professional nurses. Participants experienced NQNs as not being competent to work independently and had to deal with unprofessional behaviour of NQNs. Participants supported NQNs, even though they were not empowered as mentors to NQNs. CONCLUSION: Participants were disappointed that NQNs were not competent and confident to work independently. They expressed their frustrations in behaviours displayed by NQNs. However, participants acknowledged NQNs' individual differences and were supportive towards them even though they were not empowered for such responsibility.

Social Democratic Solidarity and the Welfare State: Health Care and Single-Tier Universality in Sweden and Canada.

Although it is not generally done, it is useful to compare the history of the evolution of universal health coverage (UHC) in Canada and Sweden. The majority of citizens in both countries have shared, and continue to share, a commitment to a strong form of single-tier universality in the design of their respective UHC systems. In the postwar era, they also share a remarkably similar timeline in the emergence and entrenchment of single-tier UHC, despite the political and social differences between the two countries. At the same time, UHC was initially designed, implemented, and managed by social democratic governments that held power for long periods of time, creating a path dependency for single-tier Medicare that was difficult for future governments of different ideological persuasions to alter.

Effects of a service-learning experience on health-related students' attitudes toward the homeless.

OBJECTIVES: A community engagement service-learning experience was planned to provide health services for the homeless during a local 1-day event. The objectives were to (a) determine the feasibility of a service-learning experience, and to (b) examine the effects on students' attitudes toward persons experiencing homelessness. METHODS: A quasi-experimental, institutional review board approved study, including health-related students enrolled in a local university or community college, was planned. The attitudes toward the homeless survey was administered before and after participation in the service-learning experience. Qualitative data were through student reflections of the experience. RESULTS: Participants (n = 106) completed a pre and post questionnaire and a self-reflection. A statistically significant t(26) = -2.2, p = .04 change in attitudes toward the homeless were found. Three themes were revealed from the reflections: inherent bias, individualized care, and the societal context of people experiencing homelessness. CONCLUSION: Both quantitative and qualitative findings may help students reflect on preconceived stereotypes; therefore, affecting their attitudes toward the homelessness.

Community-Based Service Providers' Experiences With Activities for Persons With Dementia.

Persons with dementia (PWD) benefit from participating in meaningful activities. This study's objective was to learn the characteristics of successful meaningful activities from community-based service providers who work with PWD. Six group interviews were performed with 15 unique professionals from an adult day service or community-based coordinated care program. These were supplemented by 100 hr of researcher immersion through weekly volunteering. Data were analyzed by a team, using qualitative content analysis. Participants reported successful activity content incorporated personalization; continuity and incremental challenges; and social engagement. Successful delivery of activities required managing necessary resources; involving informal (family/friend) caregivers; having a backup plan; monitoring time of day and energy levels; facilitating a domino effect; and ensuring safety. Outcomes of successful activities were experiencing fulfillment and purpose; overcoming challenges; and unexpected triggers. Research and practice recommendations include testing innovative, dynamic, and technology-enabled approaches to providing such activities.

Family-centeredness of services for young children with Down syndrome: an observational study from Turkey

Background/aim: Physicians require information on the family centeredness of services for children with Down syndrome, one of the most frequently encountered disabilities in childhood. We aimed to determine the family-centeredness of services for young children with Down syndrome and using a bioecological theory framework we hypothesized that child, family and service-related factors would be associated with such services. Materials and methods: In a crosssectional design, children with Down syndrome seen at Ankara University Developmental Pediatrics Division (AUDPD) between February 2020 and June 2020 were included if they had received services in the community for at least 12 months. Mothers responded to the measure of process of care-20 (MPOC-20) used to measure family centeredness. Results: All 65 eligible children were included; 57% were boys and median age was 25.0 (IQR: 18.5­38.0) months. The MPOC-20 subscale scores were highest for the "respectful and supportive care (RSC)" (median 6.0; IQR: 4.8­6.8) and lowest for the "providing specific information" (median 3.0; IQR: 4.4­6.5) subscales. On univariate analyses, maternal education

Rising mean incomes for whom?

Not everybody is benefiting equally from rising mean incomes. We discuss the mean-income population share (MPS), the population percentage of earners below mean income, whose evolution can capture how representative rising mean values are for middle income households. Tracking MPS and its associated income share MIS over time indicates to what extent economic growth is inclusive of both the middle and the bottom of the income distribution. We characterize MPS and MIS analytically under different growth scenarios and compare their parametric estimation using micro-level and grouped income data. Our empirical application with panel data of 16 high- and middle-income countries shows that in the last decades rising mean incomes have mostly not favored middle income households in relative perspective, while the overall welfare effects of the changes in MPS and the correlation structure with the Gini coefficient are mixed.

Perspective of an International Online Patient and Caregiver Community on the Burden of Spasticity and Impact of Botulinum Neurotoxin Therapy: Survey Study.

BACKGROUND: Patient- and caregiver-reported data are lacking on the burden of spasticity, and the impact of botulinum neurotoxin type A (BoNT-A) treatment for this condition, on patients' daily lives. As recommended in recent guidance from the US Food and Drug Administration, online patient communities can represent a platform from which to gather specific information outside of a clinical trial setting on the burden of conditions experienced by patients and caregivers and their views on treatment options in order to inform evidence-based medicine and drug development. OBJECTIVE: The objective of our study is to characterize spasticity symptoms and their associated burdens on Western European and US patients and caregivers in the realms of work, daily activities, quality of life (QoL), as well as the positive and negative impacts of treatment with BoNT-A (cost, time, QoL) using Carenity, an international online community for people with chronic health conditions. METHODS: We performed a noninterventional, multinational survey. Eligible participants were 18 years old or older and had, or had cared for, someone with spasticity who had been treated with BoNT-A for at least 1 year. Patients and caregivers were asked to complete an internet-based survey via Carenity; caregivers reported their own answers and answered on behalf of their patients. Questions included the burden of spasticity on the ability to work, functioning, daily-living activities, and QoL, the impact of BoNT A therapy on patients' lives, and the potential benefits of fewer injections. RESULTS: There were 615 respondents (427 patients and 188 caregivers). The mean age of patients and caregivers was 41.7 years and 38.6 years, respectively, and the most commonly reported cause of spasticity was multiple sclerosis. Caregivers were most often the parents (76/188, 40%) or another family member (51/188, 27%) of their patients. Spasticity had a clear impact on patients' and caregivers' lives, including the ability to work and injection costs. For patients, spasticity caused difficulties with activities of daily living and reduced QoL indices. The median number of BoNT-A injections was 4 times per year, and 92% (393/427) of patients reported that treatment improved their overall satisfaction with life. Regarding the BoNT-A injection burden, the greatest patient-reported challenges were the cost and availability of timely appointments. Overall, 86% (368/427) of patients believed that a reduced injection frequency would be beneficial. Caregivers answering for their patients gave largely similar responses to those reported by patients. CONCLUSIONS: Spasticity has a negative impact on both patients' and caregivers' lives. All respondents reported that BoNT A treatment improved their lives, despite the associated challenges. Patients believed that reducing the frequency of BoNT-A injections could alleviate practical issues associated with treatment, implying that a longer-acting BoNT-A injection would be well received.

Contributions of Service-Learning on PETE Students' Effective Personality: A Mixed Methods Research.

Service-learning (SL) is a pedagogical model focused on achieving curricular goals while providing a community service. Previous research suggests that SL might promote qualities such as self-esteem, motivation, problem-focused coping, decision-making, empathy, and communication, which are associated with a psychological construct known as students' Effective Personality (EP). These studies, however, did not specifically analyse the direct effects of SL on this construct. The aim of this study is to explicitly analyse the effect of SL on Physical Education Teacher Education (PETE) students' EP using a mixed methods approach. The quantitative part of the approach followed a quasi-experimental design using the validated "Effective Personality Questionnaire for University Students", which includes four dimensions: "Academic self-efficacy", "Social self-realisation", "Self-esteem", and "Resolutive self-efficacy". A non-probabilistic sampling on a total of 181 PETE students was then carried out, with 98 participating in the experimental group (42 male, 56 female), and 83 in the control group (34 male, 49 female). The comparisons revealed significant improvements in the experimental group, especially in the social self-realisation and resolutive self-efficacy dimensions. These findings were complemented by a qualitative analysis of 12 students' semi-structured interviews. In conclusion, the study reported a positive influence of SL on the PETE students' EP, providing valuable design patterns for future SL implementations.

Evolución de la estructura de clases y el bienestar material en la Ciudad Autónoma de Buenos Aires contemporánea (2004-2015) / Evolution of class structure and material well-being in the contemporary City of Buenos Aires (2004-2015)

En este artículo analizamos los rasgos que asumió la estructura de clases de la Ciudad Autónoma de Buenos Aires (CABA) en el período 2004-2015. Utilizando como fuente de datos, principalmente, la Encuesta Anual de Hogares (EAH) relevada anualmente por la Dirección General de Estadística y Censos del Gobierno de la CABA, nos preguntamos acerca de cómo han evolucionado las clases sociales en términos de tamaño y composición, y cuánto se han distanciado o acercado respecto al bienestar material de los hogares que las conforman. Del análisis de los datos se desprende que la estructura de clases mantiene la configuración signada durante los años noventa, aunque con una relativa composición de la clase obrera calificada y la clase directivo-profesional. Por otro lado, el estudio de los ingresos y el acceso a la vivienda, en tanto dos activos del bienestar material de los hogares, muestra cierta reducción de la desigualdad respecto al primero, pero un fortalecimiento en las brechas respecto a la propiedad de la vivienda. (AU)

Forged By AIDS, Storied NYC Residence Boosts Aging In Place.

Driven by a mission of justice, Manhattan Plaza and Penn South create beloved communities that care for people at all stages of life.

Digital Divide in Perceived Benefits of Online Health Care and Social Welfare Services: National Cross-Sectional Survey Study.

BACKGROUND: The number of online services in health care is increasing rapidly in developed countries. Users are expected to take a more skilled and active role in taking care of their health and prevention of ill health. This induces risks that users (especially those who need the services the most) will drop out of digital services, resulting in a digital divide or exclusion. To ensure wide and equal use of online services, all users must experience them as beneficial. OBJECTIVE: This study aimed to examine associations of (1) demographics (age, gender, and degree of urbanization), (2) self-rated health, (3) socioeconomic position (education, experienced financial hardship, labor market position, and living alone), (4) social participation (voting, satisfaction with relationships, and keeping in touch with friends and family members), and (5) access, skills, and extent of use of information and communication technologies (ICT) with perceived benefits of online health care and social welfare services. Associations were examined separately for perceived health, economic, and collaboration benefits. METHODS: We used a large random sample representative of the Finnish population including 4495 (56.77% women) respondents aged between 20 and 97 years. Analyses of covariance were used to examine the associations of independent variables with perceived benefits. RESULTS: Access to online services, ICT skills, and extent of use were associated with all examined benefits of online services. ICT skills seemed to be the most important factor. Poor self-rated health was also consistently associated with lower levels of perceived benefits. Similarly, those who were keeping in touch with their friends and relatives at least once a week perceived online services more often beneficial in all the examined dimensions. Those who had experienced financial hardship perceived fewer health and economic benefits than others. Those who were satisfied with their relationships reported higher levels of health and collaboration benefits compared with their counterparts. Also age, education, and degree of urbanization had some statistically significant associations with benefits but they seemed to be at least partly explained by differences in access, skills, and extent of use of online services. CONCLUSIONS: According to our results, providing health care services online has the potential to reinforce existing social and health inequalities. Our findings suggest that access to online services, skills to use them, and extent of use play crucial roles in perceiving them as beneficial. Moreover, there is a risk of digital exclusion among those who are socioeconomically disadvantaged, in poor health, or socially isolated. In times when health and social services are increasingly offered online, this digital divide may predispose people with high needs for services to exclusion from them.

Emergency department utilisation by vulnerable paediatric populations during the COVID-19 pandemic.

OBJECTIVE: To determine if changes to community-based services have effected paediatric ED attendances for mental health issues and neonates during the COVID-19 pandemic. METHODS: Analysis of total presentations, presentations with a mental health diagnoses and presentation of neonates during the early stages of the pandemic compared with the previous year for four Victorian hospitals. RESULTS: There was a 47.2% decrease in total presentations compared with 2019, with a 35% increase in mental health diagnoses and a 2% increase in neonatal presentations. CONCLUSION: Vulnerable paediatric patients are seeking care elsewhere during the pandemic because of the closure of community services.

Public Health Systems and Social Services: Breadth and Depth of Cross-Sector Collaboration.

Objectives. To examine the extent to which social service organizations participate in the organizational networks that implement public health activities in US communities, consistent with recent national recommendations.Methods. Using data from a national sample of US communities, we measured the breadth and depth of engagement in public health activities among specific types of social and community service organizations.Results. Engagement was most prevalent (breadth) among organizations providing housing and food assistance, with engagement present in more than 70% of communities. Engagement was least prevalent among economic development, environmental protection, and law and justice organizations (less than 33% of communities). Depth of engagement was shallow and focused on a narrow range of public health activities.Conclusions. Cross-sector relationships between public health and the housing and food sectors are now widespread across the United States, giving most communities viable avenues for addressing selected social determinants of health. Relationships with many other social and community service organizations are more limited.Public Health Implications. Public health leaders should prioritize opportunities for engagement with low-connectivity social sectors in their communities such as law, justice, and economic development.

Cohort Trends in the Association Between Sibship Size and Educational Attainment in 26 Low-Fertility Countries.

Children with many siblings have lower average educational attainment compared with children raised in smaller families, and this disadvantage by sibship size has been observed across many countries. We still know remarkably little, however, about how sibship size disadvantage has changed within countries and how such trends vary across countries. Using comparative data from 111 surveys from 26 low-fertility countries, we find an overall trend of growing sibship size disadvantage across cohorts in the majority of countries: between the 1931-1940 birth cohort and the 1971-1980 birth cohort, 16 of 26 countries showed a statistically significant increase in sibship size disadvantage in education, while only two countries showed a significant reduction in sibship size disadvantage. The disadvantage in years of education associated with having an additional sibling increased remarkably in post-socialist (0.3) and East Asian countries (0.34) and, to a lesser extent, Western European countries (0.2). In contrast, this disadvantage showed little change in Nordic countries (0.05) and even decreased in Anglo-Saxon countries (-0.11). We discuss explanations and implications of our comparative evidence in the context of the intergenerational transmission of education.

Inequalities in Longitudinal Health Trajectories in Middle to Later Life: a Comparison of European Countries and Korea.

BACKGROUND: This study compared inequalities in the longitudinal trajectory of health measured by latent growth curves (LGCs) in Korea and six other developed European countries. METHODS: Unconditional and conditional LGCs were fitted, with standardized self-rated health (SRH) as the outcome variable. Two nationally-representative longitudinal datasets were used: the Survey of Health, Aging and Retirement in Europe (2007-2015; 2,761 Swedish, 2,546 Danish, 2,580 German, 2,860 French, 2,372 Spanish, and 2,924 Italian respondents) and the Korean Longitudinal Study of Aging (2006-2014; 8,465 Korean respondents). RESULTS: The unconditional patterns of SRH trajectory were similar and unfavorable for women across the countries. Social factors such as education and income generally exerted a significant impact on health trends among older adults. Korea showed less favorable results for the disadvantaged than the advantaged as compared with Denmark, Germany, and France, which was consistent with theoretical expectations. In contrast, the relative SRH trajectory of the disadvantaged as against the advantaged was better as compared with Sweden and worse as compared with Spain/Italy, which was inconsistent with theories that would predict Korea's results were worse than Sweden and similar to Spain/Italy. Women had good SRH trajectory in Denmark and poorer SRH trajectory in Spain, Italy, and Korea, which were consistent. However, women in Sweden showed poorer and mixed outcome, which does not correspond to theoretical predictions. CONCLUSION: These findings suggest that it is inconclusive whether Sweden and Denmark (with the most generous welfare arrangements) have better trajectories of health, and Spain, Italy, and Korea (with the least advanced state policies) have worse SRH paths among older adults. However, it can be inferred that Korean governmental policies may have produced a relatively worse context for the less-educated than the six European countries, as well as poorer settings for women than Denmark in terms of their initial SRH status.

Effectiveness of interventions targeting community integration among individuals with lived experiences of homelessness: A systematic review.

Community integration (CI) has been identified as a key outcome of programs designed to improve the lives of homeless and recently housed individuals (Gaetz, The State of Homelessness in Canada 2016, 2016). Although researchers have explored the extent to which Housing First (HF) impacts on social integration (Quilgars & Pleace, Soc. Incl., 4, 2016), little is known about the range and effectiveness of other interventions on CI more broadly. We conducted a systematic review of experimental studies using Joanna Briggs Institute (JBI) guidelines. Our search strategy was deployed in six databases: EMBASE, CINAHL, PsychINFO, Medline, Sociological Abstracts, and Proquest Dissertations and Theses. Our search was initiated in 2017 and updated on May 5, 2019. Using the definition of CI identified by Wong & Solomon (Ment. Health Serv. Res., 4:13-28, 2002), two independent raters screened 14,158 titles and abstracts after the removal of duplicates. A total of 157 articles were subjected to full-text review. Studies published in the English language and involving participants of any age were included. We conducted a critical appraisal of 25 studies using the JBI checklists for quasi-experimental and randomised controlled trials (Tufanaru, Joanna Briggs Institute Reviewers Manual, 2017), and subsequently excluded four studies as they did not meet a pre-established quality threshold score of 50/100. A total of 21 studies were included in a narrative synthesis. Critical appraisal scores ranged from 53.8-100 (Mdn = 69.2). Interventions evaluated in existing literature included housing and housing support interventions (n = 9), HF (n = 5), psychosocial interventions (n = 5), and employment interventions (n = 2). A meta-analysis could not be performed due to the heterogeneity of outcomes in included studies. Aspects of CI measured by researchers included social (n = 17), psychological (n = 6), and physical (n = 4) integration. Studies that evaluated HF and housing and housing support interventions demonstrated surprisingly mixed or a lack of effectiveness for promoting CI. Psychosocial interventions were the most promising, specifically those which incorporated an element of peer support. Findings of literature included in this review suggests that there is inconsistency in the extent to which existing interventions are effectively targeting CI as an outcome. Furthermore, we contend that existing systems-level interventions, including HF and permanent supportive housing alone may not be enough to promote CI among homeless and formerly homeless individuals. Future research should focus on the development and evaluation of interventions that more effectively target this critical construct.