Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.175
Filtrar
1.
Artigo em Inglês | MEDLINE | ID: mdl-35410040

RESUMO

BACKGROUND: Mental wellbeing is formed by our daily environments, which are, in turn, influenced by public policies, such as the welfare state. This paper looks at how different aspects of life conditions may mediate the welfare state effect on mental wellbeing in oldest old age. METHODS: Data were extracted from Round 6 of the European Social Survey (2012). The dataset comprised of 2058 people aged 80 years and older from 24 countries. Mediation analyses determined possible links between the welfare state, including eleven intervening variables representing life conditions and five mental wellbeing dimensions. RESULTS: Our study confirms that the higher the level of welfare state, the better mental wellbeing, irrespective of dimension. Although several life conditions were found to mediate the welfare state effect on mental wellbeing, subjective general health, coping with income and place in society were the most important intervening variables. CONCLUSIONS: All three variables centre around supporting autonomy in the oldest old age. By teasing out how the welfare state influences mental wellbeing in the oldest old, we can better understand the many drivers of wellbeing and enable evidence informed age-friendly policy making.


Assuntos
Saúde Mental , Seguridade Social , Idoso de 80 Anos ou mais , Europa (Continente) , Humanos
2.
Artigo em Inglês | MEDLINE | ID: mdl-35409935

RESUMO

Population aging has become more and more severe in many countries. As a result, the demand for basic elderly care services has risen. The establishment of an evaluation index system for basic elderly care services can provide guidelines for governments to improve the quality of such services. Based on the "5A" theoretical analysis framework of Penchansky and Thomas, this paper introduces the concept of "accessibility" into evaluation. The "accessibility" model of services, through a literature review, field research, and three rounds of expert correspondence, consists of three first-level indicators, including the accessibility of home-based community elderly care services, the accessibility of institutional elderly care services, and the accessibility of administrative services. The evaluation index system of 15 s-level indicators and 70 third-level indicators, using AHP to determine the weight value of each indicator, provides a quantitative basis for the quality evaluation and improvement of basic elderly care services. Based on our quantitative results, policy recommendations are put forward: strengthen the support for the human and financial resources of community home-based elderly care services; improve the affordability of basic elderly care services; increase the types and numbers of institutional elderly care service projects; improve the availability and adaptability of institutional elderly care services; improve the accessibility of administrative services so that elderly care service institutions and elderly care administrative agencies can establish an effective communication and feedback mechanism.


Assuntos
Serviços de Assistência Domiciliar , Idoso , Envelhecimento , Acesso aos Serviços de Saúde , Humanos , Seguridade Social
3.
BMJ Open ; 12(4): e054338, 2022 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-35487725

RESUMO

OBJECTIVES: Housing is a social determinant of health that impacts the health and well-being of children and families. Screening and referral to address social determinants of health in clinical and social service settings has been proposed to support families with housing problems. This study aims to identify housing screening questions asked of families in healthcare and social services, determine validated screening tools and extract information about recommendations for action after screening for housing issues. METHODS: The electronic databases MEDLINE, PsycINFO, EMBASE, Ovid Emcare, Scopus and CINAHL were searched from 2009 to 2021. Inclusion criteria were peer-reviewed literature that included questions about housing being asked of children or young people aged 0-18 years and their families accessing any healthcare or social service. We extracted data on the housing questions asked, source of housing questions, validity and descriptions of actions to address housing issues. RESULTS: Forty-nine peer-reviewed papers met the inclusion criteria. The housing questions in social screening tools vary widely. There are no standard housing-related questions that clinical and social service providers ask families. Fourteen screening tools were validated. An action was embedded as part of social screening activities in 27 of 42 studies. Actions for identified housing problems included provision of a community-based or clinic-based resource guide, and social prescribing included referral to a social worker, care coordinator or care navigation service, community health worker, social service agency, referral to a housing and child welfare demonstration project or provided intensive case management and wraparound services. CONCLUSION: This review provides a catalogue of housing questions that can be asked of families in the clinical and/or social service setting, and potential subsequent actions.


Assuntos
Habitação , Seguridade Social , Adolescente , Criança , Atenção à Saúde , Humanos , Programas de Rastreamento , Serviço Social
4.
Artigo em Inglês | MEDLINE | ID: mdl-35457510

RESUMO

Aging societies have an increased need for care services. To solve the problem of care, we suggest community care, through which medical services are provided that meet individual needs. Korea provides care services in advance of the community care project and implements quality control to improve the quality of these social services. Therefore, this study aims to compare and analyze the factors affecting user satisfaction in care services in both 2013 and 2016. We analyzed secondary data from 2013 and 2016 collected by the Social Security Information Service. These data include standardized metrics for the quality of care. Based on the evaluation indexes for care service in 2013 and 2016, we used commonly used indexes for analysis. Specifically, non-profit organizations were influenced by sales, accounting management, lifetime tenure rate, etc., while for-profit organizations were affected by number of users, contract termination, etc. In addition, on-site evaluation had a negative effect on the change rate of user satisfaction. Therefore, in order to increase satisfaction with care services, evaluation indexes by service type should be diversified and differentiated. In addition, field evaluations related to user satisfaction should be performed in order to provide care services appropriate for local characteristics.


Assuntos
Serviços de Saúde Comunitária , Seguridade Social , Humanos , Satisfação Pessoal , República da Coreia , Serviço Social
5.
Int J Equity Health ; 21(1): 50, 2022 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-35413970

RESUMO

BACKGROUND: Restrictive state laws aimed at immigrants can have unintended consequences for health insurance coverage of United States citizens in immigrant families due to both actual barriers created by the laws and perceived barriers among immigrants. Increasing numbers of children in the U.S. are part of immigrant families, and these children are more likely to be living in poverty than their counterparts in native families. Immigrant restrictive policies could lead to reduced access to Medicaid and CHIP even for citizen children in immigrant families. METHODS: Using data from the Current Population Survey's (CPS) March Supplement, linear probability models with difference-in-differences (DD) estimates compare probability of enrollment in Medicaid/CHIP among low-income U.S. citizen children in immigrant families and low-income children in native families and U.S. citizen children in immigrant families in states that did not adopt restrictive legislation, in order to estimate the impact of restrictive state laws aimed at immigrants. An additional model explores the effect of mother's citizenship on enrollment among all immigrant families in states with and without restrictive legislation. RESULTS: Results suggest a significant chilling effect where the magnitude of the effect varies according to family demographics and by the types of laws being passed. Immigrant restrictive social welfare laws being adopted have a strong negative effect on U.S. citizen children in immigrant families' enrollment in Medicaid/CHIP, a 5.5 percentage point reduction in coverage. Among the subsample of only immigrant families, results point toward a global chilling effect created by an overall restrictive policy environment. All immigrant restrictive related laws, including those aimed at education, job restriction, identification access, and social welfare restrictions have a significant and negative impact on access to public insurance for U.S. citizen children with non-citizen mothers. CONCLUSIONS: This research shows that the unintended consequence of restrictive state legislation aimed at immigrants is the reduction in access to Medicaid and CHIP by low-income U.S. citizen children living in immigrant families. Reduced access to health insurance can increase unmet medical needs for an already vulnerable group.


Assuntos
Emigrantes e Imigrantes , Medicaid , Criança , Feminino , Humanos , Cobertura do Seguro , Seguro Saúde , Pobreza , Seguridade Social , Estados Unidos
6.
BMC Geriatr ; 22(1): 286, 2022 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-35387605

RESUMO

BACKGROUND: A consequence of demographic trends and economic prosperous is the increasing diversity in needs for care services. However, the traditional family support for older people has been largely supplanted by the wider provision of community care services. This study aims to investigate the current status of demand and supply in community care services across different villages of Zhejiang province and assess service effectiveness for healthy ageing. METHODS: A questionnaire survey was carried out towards 207 rural villages across 9 cities in Zhejiang province. One hundred eighty-six valid responses were received, representing a response rate of around 89.9%. Descriptive statistics were employed to identify older villagers' care needs and available community services. Comparative analysis examined the balance between the demand and supply of community care services. Correlation analysis were applied to determine key factors that impacted the supply of social services in rural communities. RESULTS: The research found that rural older residents normally lived with their children or spouse with limited literacy and income. On average the categories of community care services is substantially small in comparison with the increasingly diverse demands of older people in rural areas. There was an obvious mismatch between service demand and service supply in rural communities, which often caused the waste of public resources. Moving forward, the uppermost priority is given to infrastructure construction service and daily life service, while little attention is paid to mental health service and specialized nursing service. CONCLUSION: There needs to be an improvement in the socio-economic capacity of rural communities and in the diversity of social care services. Policies and strategies are also needed to encourage private sectors' involvement in providing care services for rural older people. Local government should have a clear vision of the potential demands for community care services, practical guidelines will be useful in guaranteeing better service quality.


Assuntos
Envelhecimento Saudável , População Rural , Idoso , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Seguridade Social , Inquéritos e Questionários
7.
J Healthc Eng ; 2022: 9689769, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35392145

RESUMO

The objective of this study was to discuss the health management of elderly patients in the community and the management of community rehabilitation under the support of the new Internet of Things (IoT). The IoT technology was adopted to monitor the wearable devices through mobile medical physiological data. The heart rate, blood pressure, respiratory rate, and other physiological indicators of the elderly were collected in real time. The support vector machine (SVM) algorithm was selected as the core algorithm for the elderly physiological index disease risk assessment, the fuzzy comprehensive evaluation method was adopted as the core method of the elderly disease risk quantitative assessment model to process the physiological indicators, and finally, a reasonable physiological index processing model and quantitative indicators of disease risk were obtained. The data on vascular disease were selected from the MIMIC database. In addition, the advantages and disadvantages of the SVM algorithm and the Backpropagation Neural Network (BPNN) algorithm were compared and analysed. The final verification results showed that the fusion accuracy of the SVM processing MIMIC database and the University of California Irvine (UCI) dataset was 0.8327 and 0.8045, respectively, while the fusion accuracy of the BPNN algorithm in processing the same data was 0.7792 and 0.7288, respectively. It was obvious that the fusion accuracy of the SVM algorithm was higher than that of the BPNN algorithm, and the accuracy difference of the SVM algorithm was lower than that of the BPNN algorithm in different groups of data. In the verification of the elderly disease risk quantitative assessment model, the results were consistent with the selected data, which verified the effectiveness of the design model in this study. Therefore, it can be used as a quantitative assessment model of general elderly physiological indicators of disease risk and can be applied to the community medical communication management system. It proved that the model of medical communication and rehabilitation services for elderly patients in the community constructed in this study can definitely help the development of community service for the elderly.


Assuntos
Internet das Coisas , Idoso , Algoritmos , Comunicação , Humanos , Redes Neurais de Computação , Seguridade Social , Máquina de Vetores de Suporte
8.
BMC Public Health ; 22(1): 764, 2022 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-35428220

RESUMO

BACKGROUND: Planning and decision-making for the elderly requires a special attention due to the beginning of aging process in Iran. By emphasizing the concept of active aging, determining the status of the elderly like their ability to continue work over time, to attain income and to participate in social and political life is significant. Active aging uses the indicators measuring the non-used potential of the elderly for having an active and healthy aging. This study aimed to determine the level of active aging among the provinces of Iran in 2018 by considering 11 indicators related to elderly's health, well-being and socioeconomic participation. METHODS: The raw data were obtained from Statistical Center of Iran. After establishing the indicators based on the Global Age Watch approach, the provinces were ranked by the TOPSIS method in terms of aging status. RESULTS: The results indicated that only Tehran and Alborz had the highest development level of active aging while 16% of the provinces had a semi-developed status and 77% failed at experiencing a satisfactory welfare, economic and social status. CONCLUSIONS: Four indicators had the highest importance included the percentage of the elderly with a diploma and academic degree, the percentage of the elderly with lower incomes than the median income, the median income of the elderly to the median income of the other people in society, and life expectancy among the 65-year old men. Studying the indicators deeply can result in the appropriate planning for each area in line with the improvement of the elderly status.


Assuntos
Envelhecimento , Expectativa de Vida , Idoso , Humanos , Renda , Irã (Geográfico)/epidemiologia , Masculino , Seguridade Social , Fatores Socioeconômicos
9.
Artigo em Inglês | MEDLINE | ID: mdl-35328912

RESUMO

In the carbon neutrality era, firms are facing increasingly intense environmental pressure and market competition. This paper considers two competitive supply chains with consumers' low-carbon preference under the cap-and-trade regulation, each of which consists of one manufacturer and one retailer. Considering competition or integration in vertical and horizontal directions, four different supply chain structures are modeled. By applying a game-theoretical approach, the equilibrium pricing, carbon emission reduction (CER) level, profit, and social welfare are obtained. Through comparison and analysis, the economic and environmental impacts of supply chain competition are explored. The results show that (1) the carbon quota acts as a kind of financial subsidy and brings direct economic profit to the supply chain, which cannot be used to incentivize the firm to invest in CER technology; (2) the HCVI strategy can bring the highest CER level, the most market demand, and social welfare among the four strategies; (3) for the enterprise and the government, it is recommended to take measures and enact policies to strengthen the vertical integration and horizontal competition between supply chains. Our study can guide firms on how to cope with increasingly fierce industry competition and environmental pressure by adjusting their operational decisions and supply chain structure.


Assuntos
Carbono , Comércio , Comportamento do Consumidor , Custos e Análise de Custo , Seguridade Social
10.
Autism ; 26(3): 628-639, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35301876

RESUMO

LAY ABSTRACT: Expert recommendations for toddlers who are likely to develop autism include caregivers being actively involved in the services children receive. However, many services available in the community may not follow these recommendations. Evidence suggests that an intervention named Project ImPACT for Toddlers demonstrates positive parent and child outcomes for families in the community. Project ImPACT for Toddlers was designed specifically for toddlers by a group of parents, clinicians, researchers, and funders. It teaches parents of young children strategies to support their child's development in daily routines. This study reports the perspectives of early intervention providers who learned to use Project ImPACT for Toddlers on whether the intervention was a good fit for their practice and easy to use. The study also examines how many agencies are using Project ImPACT for Toddlers and how many families have received the intervention in the community. The goal of the study is to inform the continued use of Project ImPACT for Toddlers in the community and support offering the intervention in other regions. Participants include 38 community providers who participated in a training study of Project ImPACT for Toddlers and completed a survey and semi-structured interview after approximately 3 months of using Project ImPACT for Toddlers with families. Participants perceived the training model as acceptable and appropriate, and identified the group-based model of training, comprehensive materials, and agency support as strengths of the approach. Survey findings complemented the results from the interviews. Data indicate an increasing number of agencies and families accessing Project ImPACT for Toddlers. Efforts to expand evidence-based intervention in early intervention should continue to build upon the model used for Project ImPACT for Toddlers.


Assuntos
Transtorno do Espectro Autista , Pré-Escolar , Intervenção Educacional Precoce , Medicina Baseada em Evidências , Humanos , Pais/educação , Seguridade Social
11.
BMC Med Educ ; 22(1): 143, 2022 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-35246114

RESUMO

BACKGROUND: Medical school curricular hours dedicated to ophthalmology are low and declining. Extracurricular ophthalmology activities, such as participation in community vision screenings, may serve an important adjunctive role in medical school curricula. The Johns Hopkins University (JHU) Vision Screening In Our Neighborhoods (ViSION) Program is an example of a voluntary medical student-directed community service-learning program. METHODS: We used a mixed-methods cross-sectional approach, including an online survey and semi-structured interviews. JHU School of Medicine students enrolled in MD or MD/PhD programs during the 2019-2020 academic year were surveyed regarding demographics, career and service interests, involvement in ophthalmology-related activities, and confidence in their ophthalmology-related skills. Survey responses were compared between ViSION volunteers and non-volunteers using Fisher's exact chi-square tests. Semi-structured interviews were conducted via webconference with 8 prior or current ViSION volunteers and responses analyzed using inductive thematic analysis. Data were collected when ViSION volunteers were in variable stages of their medical education and involvement with the ViSION program. RESULTS: A total of 118 medical students were included, representing an overall response rate of 24.6% of JHU medical students. ViSION volunteers reported greater involvement in ophthalmology-related research (42% vs. 4%, p < 0.001), intent to apply to ophthalmology residency programs (35% vs. 1%, p = 0.001), and confidence with multiple ophthalmology knowledge and clinical skill domains. In particular, ViSION volunteers were more likely to feel confident estimating cup-to-disc ratio using direct ophthalmoscopy (20% vs. 0%, p < 0.001). In open-ended survey and interview questions, most volunteers attributed at least some degree of their ophthalmology skill development and desire to pursue ophthalmology and public health careers to their ViSION experience. CONCLUSIONS: Medical students who volunteered with a student-led community vision screening program were more likely to have a prior interest in ophthalmology than those who did not volunteer, but only 1/3 of volunteers planned to pursue a career in ophthalmology. Overall, volunteers reported higher confidence performing ophthalmology-related clinical skills, suggesting that student-led community vision screening programs may provide an important avenue for medical students to explore public health aspects of ophthalmology, while practicing ophthalmology exam skills and learning about common ophthalmic pathologies, regardless of their career intentions.


Assuntos
Oftalmologia , Estudantes de Medicina , Seleção Visual , Escolha da Profissão , Demografia , Humanos , Seguridade Social , Inquéritos e Questionários , Voluntários
12.
Sci Total Environ ; 826: 154065, 2022 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-35217038

RESUMO

Clean heating (CH) is regard as a key strategy to address the serious air pollution problem in northern China. A "one-fit-all" CH strategy will harm social welfare and engender resistance, due to the differences in heating habits and residents' income between urban and rural areas. To solve this problem, a 5 km × 5 km gridded cost-benefit analysis model for CH is build. Taking the case city as an example, an improved CH solution integrating multiple heat sources is proposed. By utilizing ISH resources, which are low-cost and low-emission-intensity, the improved solution reduces heating-induced PM2.5 emissions to one-fifth, and achieves higher net social benefits than existing CH strategies. Moreover, the spatial distributions of PM2.5 emission reductions and indoor and outdoor health benefits induced by CH strategy, including coal-to-gas/electricity and the improved strategy we propose, are simulated; revealing that the spillover effects of pollutants make CH will somewhat inevitably bring about a transfer of social welfare from rural areas to urban areas, but this can be compensated by opposite direction subsidies.


Assuntos
Poluentes Atmosféricos , Poluição do Ar em Ambientes Fechados , Poluição do Ar , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Poluição do Ar em Ambientes Fechados/análise , China , Análise Custo-Benefício , Monitoramento Ambiental , Calefação , Material Particulado/análise , Seguridade Social
13.
S Afr J Commun Disord ; 69(1): e1-e9, 2022 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-35144439

RESUMO

BACKGROUND: The compulsory community service programme (CSP) was implemented to improve access to healthcare and arguably facilitate the transition of graduates into independent professionals. However, its role and outcomes as a developmental platform for audiology graduates remains unclear and scant in literature. OBJECTIVE: To explore the qualitative differences in the experiences of professional development among new Audiology graduates during their community service year at their fixed-placements in KwaZulu-Natal, South Africa. METHODS: Within a phenomenographic design and framework, semi-structured interviews were conducted with 12 purposively sampled Community Service Officers (CSOs) of the year 2017, after obtaining ethical clearance, gatekeeper permission and participant's consent. RESULTS: The findings were interpreted according to the tenets of phenomenography. An outcome space based on the participants' reported experiences, revealed three categories of description: transitioning from graduate to professional, learning in the workplace during community service and professional development. The findings reflected that the work environment, supervision, resource allocation, socialisation and infrastructure contributed to qualitatively different developmental experiences of the CSP. CONCLUSION: The current model of fixed-placement of the CSOs exposes them to qualitatively different developmental experiences, resulting in them attaining different developmental outcomes despite being in the same programme at the same time. Hence, we argue for an urgent CSP review, with the aim of standardising and redefining its intended outcomes and pertinent criteria for the attainment of the independent practitioner status.


Assuntos
Audiologistas , Seguridade Social , Atenção à Saúde , Humanos , Aprendizagem , África do Sul
14.
PLoS One ; 17(2): e0263231, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35134053

RESUMO

INTRODUCTION: Capability-adjusted life years Sweden (CALY-SWE) are a new Swedish questionnaire-based measure for quality of life based on the capability approach. CALY-SWE are targeted towards use in cost-effectiveness evaluations of social welfare consequences. Here, we first motivate the measure both from a theoretical and from a Swedish policy-making perspective. Then, we outline the core principles of the measure, namely the relation to the capability approach, embedded equity considerations inspired by the fair-innings approach, and the bases for which capabilities should be considered. The aims were to 1) the most vital capabilities for individuals in Sweden, 2) to define a sufficient level of each identified capability to lead a flourishing life, and to 3) develop a complete questionnaire for the measurement of the identified capabilities. MATERIAL AND METHODS: For the selection of capabilities, we used a Delphi process with Swedish civil society representants. To inform the questionnaire development, we conducted a web survey in three versions, with each Swedish 500 participants, to assess the distribution of capabilities that resulted from the Delphi process in the Swedish population. Each version was formulated with different strictness so that less strict wordings of a capability level would apply to a larger share of participants. All versions also included questions on inequality aversion regarding financial, educational, and health capabilities. RESULTS: The Delphi process resulted in the following six capabilities: Financial situation & housing, health, social relations, occupations, security, and political & civil rights. We formulated the final phrasing for the questionnaire based on normative reasons and the distribution of capabilities in the population while taking into account inequality aversion. CONCLUSION: We developed a capability-based model for cost effectiveness economic evaluations of broader social consequences, specific to the Swedish context.


Assuntos
Qualidade de Vida/psicologia , Validade Social em Pesquisa/métodos , Inquéritos e Questionários/normas , Análise Custo-Benefício , Humanos , Avaliação de Programas e Projetos de Saúde/métodos , Anos de Vida Ajustados por Qualidade de Vida , Reprodutibilidade dos Testes , Seguridade Social , Inquéritos e Questionários/economia , Suécia/epidemiologia
15.
PLoS One ; 17(2): e0262655, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35143496

RESUMO

This paper studies the pharmaceutical production supply chain system composed of upstream and downstream pharmaceutical enterprises, and explores the impact of government subsidy strategies on the new drug research and development (R&D) decision variables and profits of pharmaceutical enterprises as well as social welfare, when considering both the horizontal spillover effects within the industry and the vertical spillover effects between industries. Comparing and analyzing the impact of these strategies including non-government subsidy strategy, pharmaceutical enterprise innovation input subsidy strategy, pharmaceutical enterprise innovative product subsidy strategy, patient price subsidy strategy, and patient medical insurance subsidy strategy. By establishing a four-stage Cournot duopoly model incorporating spillover effects, the equilibrium solutions are obtained by backward induction, and the impact of spillover effects on decision variables is investigated accordingly. Studies have shown that: (a) Government subsidy strategies can promote pharmaceutical enterprises' R&D investment and have a positive incentive effect on the pharmaceutical enterprises' profits and social welfare. (b) The patient medical insurance subsidy strategy is the optimal subsidy strategy, which can generate higher profits for pharmaceutical enterprises and higher social welfare.


Assuntos
Financiamento Governamental , Pesquisa/economia , Indústria Farmacêutica/economia , Modelos Teóricos , Preparações Farmacêuticas/provisão & distribuição , Seguridade Social
16.
BMJ Open ; 12(2): e053884, 2022 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-35193912

RESUMO

OBJECTIVE: The 2-2½ year universal health visiting review in England is a key time point for assessing child development and promoting school readiness. We aimed to ascertain which children were least likely to receive their 2-2½ year review and whether there were additional non-mandated contacts for children who missed this review. DESIGN, SETTING, PARTICIPANTS: Cross-sectional analysis of the 2-2½ year review and additional health visiting contacts for 181 130 children aged 2 in England 2018/2019, stratified by ethnicity, deprivation, safeguarding vulnerability indicator and Looked After Child status. ANALYSIS: We used data from 33 local authorities submitting highly complete data on health visiting contacts to the Community Services Dataset. We calculated the percentage of children with a recorded 2-2½ year review and/or any additional health visiting contacts and average number of contacts, by child characteristic. RESULTS: The most deprived children were slightly less likely to receive a 2-2½ year review than the least deprived children (72% vs 78%) and Looked After Children much less likely, compared with other children (44% vs 69%). When all additional contacts were included, the pattern was reversed (deprivation) or disappeared (Looked After children). A substantial proportion of all children (24%), children with a 'safeguarding vulnerability' (22%) and Looked After children (29%) did not have a record of either a 2-2½ year review or any other face-to-face contact in the year. CONCLUSIONS: A substantial minority of children aged 2 with known vulnerabilities did not see the health visiting team at all in the year. Some higher need children (eg, deprived and Looked After) appeared to be seeing the health visiting team but not receiving their mandated health review. Further work is needed to establish the reasons for this, and potential solutions. There is an urgent need to improve the quality of national health visiting data.


Assuntos
Grupos Minoritários , Criança , Estudos Transversais , Inglaterra , Humanos , Seguridade Social
17.
Econ Hum Biol ; 45: 101101, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34995949

RESUMO

This study estimates the effects of welfare reform in the 1990s, which permanently restructured and contracted the cash assistance system in the U.S., on food insecurity-a fundamental form of material hardship-of the next generation of households. An implicit goal underlying welfare reform was the disruption of an assumed intergenerational transmission of disadvantage; however, little is known about the effects of welfare reform on the well-being of the next generation of adults. Using intergenerational data from the Panel Study of Income Dynamics and a variation on a difference-in-differences framework, this study exploits 3 sources of variation in childhood exposure to welfare reform: (1) risk of exposure across birth cohorts; (2) variation of exposure within cohorts because different states implemented welfare reform in different years; and (3) variation between individuals with the same exposure who were more likely and less likely to rely on welfare. We found that exposure to welfare reform led to decreases in food insecurity of the next generation of households, by about 10% for a 5-year increase in exposure, with stronger effects for individuals exposed for longer durations during childhood, individuals exposed in early childhood (0-5 years), and women. We also found smaller favorable effects for individuals whose mothers had less than a high school education, indicating that in terms of food insecurity, welfare reform led to relative disadvantages among the most disadvantaged and thus could be exacerbating socioeconomic and health inequalities.


Assuntos
Insegurança Alimentar , Abastecimento de Alimentos , Adulto , Pré-Escolar , Feminino , Humanos , Renda , Mães , Seguridade Social
18.
Econ Hum Biol ; 45: 101114, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35074717

RESUMO

This paper investigates the effects of the introduction of Medicaid during the 1960s on next generations' birth outcomes. A federal mandate that all states must widen the coverage to all cash welfare recipients generated cross-state variations in Medicaid eligibility, specifically among nonwhites who largely overrepresented the target population. I implement a reduced-form difference-in-differences strategy that compares the birth outcomes of mothers born in states with higher cash welfare recipiency versus low welfare recipiency and different years relative to the Medicaid implementation year. Using Natality data (1970-2004), I find that Medicaid significantly improves birth outcomes. The effects are considerably larger among nonwhites, specifically blacks. The effects do not appear to be driven by preexisting trends in birth outcomes, preexisting trends in households' socioeconomic characteristics, changes in other welfare expenditures, and selective fertility. A back-of-an-envelope calculation points to a minimum of 3.9% social externality of Medicaid through income rises due to next generations' improvements in birth outcomes.


Assuntos
Cobertura do Seguro , Medicaid , Definição da Elegibilidade , Feminino , Humanos , Seguro Saúde , Seguridade Social , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...