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Aims and Objectives: This paper describes the development of a SBHC with an innovative model of care that grew out of a partnership between a public‐school district and a university nursing programme in the midwestern region of the United States. Background and Purpose: Persistent barriers to health and health care experienced by youth are well documented. School‐based health centres (SBHCs) can improve educational and health outcomes, positively impacting health equity. Academic systems are positioned to address health care needs of the school‐aged population, yet educators face challenges of accessing quality learning placements for students and faculty practice sites. Methods: A community‐based collaborative methodology guided the planning phases that were driven by priority needs identified by families and stakeholders. With the mission of "partnering with students, families, and communities in the promotion of health and wellness through engagement in practice, education, and research," an ongoing dialogue over a two‐year period led to articulating a vision, designing a plan and implementing a nurse‐managed SBHC. The Standards for Reporting Qualitative Research (SRQR) checklist was considered in the preparation of this paper. Results: In three years, this SBHC has addressed and identified priority needs and served individual youth and families. The SBHC provides opportunities for the faculty to fulfil a practice requirement for certification and accreditation. Nursing students engage with youth and families in health education and health promotion while strengthening their technical and relational skills. Family nurse practitioner students gain valuable clinical experience. Faculty with expertise in family nursing guide family assessments, support family resiliency and direct therapeutic conversations with family units. Conclusion: SBHCs serve youth, families, and community. This academic–practice partnership has the added benefit of providing faculty practice opportunities and nursing student experiential learning. Relevance to Clinical Practice: SHBCs provide practice opportunities that address needs in individuals, families, and communities. Partnerships should be considered at academic nursing programmes to support their needs and fulfil commitments to address health equity gaps. [ABSTRACT FROM AUTHOR]

Checklists, memos, reports, and other standardized forms take up much space on ethnographers' desks and pervade the lives of their research respondents. Despite the omnipresence and significance of paperwork, methodological descriptions of how to use forms as ethnographic research tools remain limited, however. Drawing upon ethnographic fieldwork conducted at a US transgender clinic, I describe three techniques with which ethnographers can study documents, namely by tracing paper forms' origins, studying norms inscribed in them, and examining how people use forms. These three techniques help capture the powerful consequences of, and ethical dilemmas embedded in, health care institutions' documentary practices, dynamics that may be impacted by shifts toward the digitalization of paperwork. I propose that ethnographers are to expand their ethnographic toolbox to include attention to documents as central features of social and institutional life that enable and problematize human action and individual decision-making. [ABSTRACT FROM AUTHOR]

Objective Background Methods Results Conclusion This paper assesses stress disparities among marginalized parents in 2020–21 during the COVID‐19 pandemic through the mechanism of healthcare discrimination.The pandemic upended the lives of American families and had particularly stark mental health consequences for women, racial and ethnic minority (REM), and sexual and gender minority (SGM) parents. Scholars have been called to understand these unequal experiences via marginalizing mechanisms rather than using race, gender, and sexual identities as proxies for racism, sexism, and cis‐heterosexism.Structural equation modeling was used to test associations between marginalized identities and parental stress about COVID among partnered parents using healthcare discrimination, a marginalizing mechanism, as a mediator. The data come from The National Couples' Health and Time Study, a population‐representative study of couples in the United States.Findings indicate that compared to nonmarginalized parents, Black parents, women, transgender and nonbinary parents, and gay, lesbian, and bisexual parents experienced higher levels of parental stress about COVID through heightened healthcare discrimination. When accounting for healthcare discrimination, only one marginalized identity–that of women–was directly associated with parental stress about COVID along with the indirect relationship through healthcare discrimination.These findings highlight healthcare discrimination as a process that puts marginalized parents at risk for heightened stress. Parental stress has the potential to accumulate across the life course and crossover to children and communities. [ABSTRACT FROM AUTHOR]

Papers in the Special Section on Racial Disparities in Health Care stemmed from. the 60th Anniversary of Family Process Conference, The Heart of the Matter: Systemic Imperatives to Address Health Disparities and Racism in the Time of COVID, which took place in Washington, DC in September 2021. Of the 12 presenters at the conference, these four were asked to recreate their talks into articles. They address key issues that help to explain health disparities in people of color, particularly African Americans, in the United States, as well as suggest innovations to clinical interventions and health care delivery systems to better serve people who have suffered adversity from the racial inequities in the American system. [ABSTRACT FROM AUTHOR]

Scientists, public servants, and patient advocates alike increasingly question the validity of published scientific results, endangering the public’s acceptance of science. Here, I argue that emerging flaws in the integrity of the peer review system are largely responsible. Distortions in peer review are driven by economic forces and enabled by a lack of accountability of journals, editors, and authors. One approach to restoring trust in the validity of published results may be to establish basic rules that render peer review more transparent, such as publishing the reviews (a practice already embraced by some journals) and monitoring not only the track records of authors but also of editors and journals. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to clarify the relationship between characteristics that contribute to health care access issues and individual behavior seeking health care. It proposes the different contexts of why African American and Hispanic men are not accessing health care. The study findings provided the target audience with past and present literature to contribute to the future resolution of racial and ethnic health care disparity, as well as health care access. Design/methodology/approach: The paper opted for a descriptive case study using a one-on-one face-to-face semi-structured approach of a case study, including 10 depth interviews representing African American and Hispanic men who are experiencing health care access issues. The data were complemented by archival data analysis, description of personal accounts of the African American and Hispanic men and articles pertaining to racial and ethnic health disparities. Findings: The paper provides insights into how change is brought about the improvement of health care for all races and ethnicity. It suggests that leaders act as "integrating forces" on two levels: integrating the important elements of improved health care coupled with communication, language and health care cost and mediating between the health care structures and the individual. Originality/value: This paper fulfills an identified need to study the characteristics that contribute to health care access issues among African American and Hispanic men. [ABSTRACT FROM AUTHOR]

Background: In the United States chronic illnesses have become a way of life for multiple generations – they are the number one cause of death and disability (accounting for more than 70% of deaths), 60% of American adults have at least one chronic disease, and 40% have multiple chronic conditions. Although multiple factors contribute to the growth in chronic disease prevalence, a major factor has been overreliance on health care systems for promoting health and preventing disease. Large health care systems are ill equipped for this role since they are designed to detect, treat, and manage disease, not to promote health or address the underlying causes of disease. Methods: Improving health outcomes in the U.S. will require implementing broad‐based prevention strategies combining biological, behavioral, and societal variables that move beyond clinical care. According to community medicine, clinical care alone cannot create, support, or maintain health. Rather, health can only ensue from combining clinical care with epidemiology and community organization, because health is a social outcome resulting from a combination of clinical science, collective responsibility, and informed social action. Results: During the past 20 years, our team has developed an operational community medicine approach known as community health science. Our model provides a simple framework for integrating clinical care, population health, and community organization, using community‐based participatory research (CBPR) practices for developing place‐based initiatives. In the present paper, we present a brief overview of the model and describe its evolution, applications, and outcomes in two major urban environments. Conclusion: The paper demonstrates means for integrating the social determinants of health into collaborative place‐based approaches, for aligning community assets and reducing health disparities. It concludes by discussing how asset‐based community development can promote social connectivity and improve health, and how our approach reflects the emerging national consensus on the importance of place‐based population system change. [ABSTRACT FROM AUTHOR]

Purpose: In the USA, the well-being of older people is increasingly precarious. There is a paucity of research into methods of care outside of traditional, costly, intensive methods. Moreover, any literature that does so fails to connect different fields of study or aspects of well-being. This paper aims to identify alternate, cheaper methods to traditional care methods that also take a more holistic approach to older peoples' lives. Design/methodology/approach: Connecting research conducted by gerontologists, psychologists and neurologists, and framing the results through Census data and economic research, the author proposes music therapy interventions for older people. Findings: Music therapy has significant benefits on physical, cognitive and psychological well-being. Moreover, these treatment methods are significantly cheaper than traditional methods and are even more effective in specific cases. Specifically, though, the research methods reveal that music therapy that engages participants formally, is group-based and uses participants' preferred music is the most potent form of therapy to achieve the stated goals. Implementing such interventions across the country could be easily done by coordinated efforts by legislatures, administrative agencies, community groups and health-care infrastructure. Originality/value: As opposed to varied methods used, which undermine the broad application of results, research should primarily use the proposed three-pronged approach as "music therapy" in future investigation. Moreover, proposing music therapy as a valuable alternative in some cases of elderly care may alleviate some stress on future American health-care resources. [ABSTRACT FROM AUTHOR]

Purpose: The number of prisoners over 55 years is increasing and many are at risk of developing dementia. This has generated new responsibilities for prisons to provide health and social care for older persons. The purpose of this paper is to synthesize the existing research literature regarding the phenomenon of the health and social care needs of older persons living with dementia in correctional settings.Design/methodology/approach: Using an integrative review method based on Whittemore and Knafl, the inclusion criteria for the review are: articles written in English; a focus on some form of dementia and/or older persons with discussion of dementia; to be set in a correctional context (correctional facility, prison and jail); be derived from a published peer-reviewed journal or unpublished dissertation/thesis; and be a qualitative, quantitative or mixed methods study. Based on those criteria, a search strategy was developed and executed by a health sciences librarian in the following databases: Medline, CINAHL, Embase, PsychINFO, Proquest Nursing and Allied Health and Web of Science; searches were completed up to April 2019. After data were extracted from included studies, synthesis of findings involved an iterative process where thematic analysis was facilitated by Braun and Clarke's approach.Findings: Eight studies met the inclusion criteria. Key findings of the eight studies include recognition of dementia as a concern for correctional populations, dementia-related screening and programming for older persons and recommendations for improved screening and care practices. Most significant is the paucity of research available on this topic. Implications for research are discussed.Originality/value: This paper identified and synthesizes the limited existing international research on the health and social care needs of older persons with dementia living in correctional settings. Although existing research is scant, this review highlights the need for increased awareness of dementia as a concern among older persons living in correctional settings. As well, the review findings emphasize that enhanced screening and interventions, particularly tailored approaches, are imperative to support those living with dementia in correctional settings. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide an overview of rural older veterans in the USA and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas.Design/methodology/approach This is a descriptive paper summarizing population and program data about rural veterans.Findings VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas.Originality/value This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans. [ABSTRACT FROM AUTHOR]

Purpose -- This paper aims to present a two-decade effort to improve team functioning and patient outcomes in inpatient stroke rehabilitation settings. Design/methodology/approach -- The principal improvement effort was conducted over a nine-year period in 50 Veterans Administration Hospitals in the USA. A comprehensive team-based model was developed and tested in a series of empirical studies. A leadership development intervention was used to improve team functioning, and a follow-up cluster-randomized trial documented patient outcome improvements associated with the leadership training. Findings -- Iterative team and leadership improvements are presented in summary form, and a set of practice-proven development observations are derived from the results. Details are also provided on the leadership training intervention that improved teamwork processes and resulted in improvements in patient outcomes that could be linked to the intervention itself. Research limitations/implications -- The practice-proven development observations are connected to leadership development theory and applied in the form of suggestions to improve leadership development and teamwork in a broad array of medical treatment settings. Practical implications -- This paper includes suggestions for leadership improvement in medical treatment settings using interdisciplinary teams to meet the customized needs of the patient populations they serve. Originality/value -- The success of the team effectiveness model and the team-functioning domains provides a framework and best practice for other health care organizations seeking to improve teamwork effectiveness. [ABSTRACT FROM AUTHOR]

The 2010 Affordable Care Act (ACA) increased healthcare access for many Americans. But, its exclusion of most noncitizens and imperfect state-level implementation stratified coverage by documentation status, place, income level, race, and ethnicity across the U.S.A. Drawing from the sociological literature on boundaries, this paper argues that these demographic boundaries facilitate de jure and de facto stratification for immigrants and low-income Americans of various ethnoracial backgrounds. Using existing survey research regarding national ACA implementation and a qualitative study of ACA implementation in Boston, MA, this paper shows how such stratification may worsen existing disparities in healthcare coverage and access among the U.S. population. Implications regarding President Donald Trump and conservative lawmakers’ plans to repeal the ACA are also discussed. The paper contributes to researchers’ understanding of how public policies produce boundaries by place, documentation status, race, ethnicity, and income that facilitate inequality. [ABSTRACT FROM AUTHOR]

Purpose: Whistleblowing is a procedure where an existing or past participant of an establishment reveals actions and practices believed to be illegal, immoral or corrupt, by individuals who can influence change. Whistleblowing is an important means of recognising quality and safety matters in the health-care system. The aim of this study is to undergo a literature review exploring perceived barriers of whistleblowing in health care among health-care professionals of all grades and the possible influences on the whistleblower. Design/methodology/approach: An integrative review of both quantitative and qualitative studies published between 2000 and 2020 was undertaken using the following databases: CINAHL Plus, Embase, Google Scholar, Medline and Scopus. The primary search terms were "whistleblowing" and "barriers to whistleblowing". The quality of the included studies was appraised using the Critical Appraisal Skills Programme criteria. The authors followed preferred reporting items for systematic review and meta-analysis (Prisma) in designing the research and also reporting. Findings: A total of 11 peer-reviewed articles were included. Included papers were analysed using constant comparative analysis. The review identified three broad themes (cultural, organisational and individual) factors as having a significant influence on whistleblowing reporting among health-care professionals. Originality/value: This study points out that fear is predominantly an existing barrier causing individuals to hesitate to report wrongdoing in care and further highlights the significance of increasing an ethos of trust and honesty within health care. [ABSTRACT FROM AUTHOR]

While basic access to clean water is critical, another important issue is the affordability of water access for people around the globe. Prior international work has highlighted that a large proportion of consumers could not afford water if priced at full cost recovery levels. Given growing concern about affordability issues due to rising water rates, and a comparative lack of work on affordability in the developed world, as compared to the developing world, more work is needed in developed countries to understand the extent of this issue in terms of the number of households and persons impacted. To address this need, this paper assesses potential affordability issues for households in the United States using the U.S. EPA’s 4.5% affordability criteria for combined water and wastewater services. Analytical results from this paper highlight high-risk and at-risk households for water poverty or unaffordable water services. Many of these households are clustered in pockets of water poverty within counties, which is a concern for individual utility providers servicing a large proportion of customers with a financial inability to pay for water services. Results also highlight that while water rates remain comparatively affordable for many U.S. households, this trend will not continue in the future. If water rates rise at projected amounts over the next five years, conservative projections estimate that the percentage of U.S. households who will find water bills unaffordable could triple from 11.9% to 35.6%. This is a concern due to the cascading economic impacts associated with widespread affordability issues; these issues mean that utility providers could have fewer customers over which to spread the large fixed costs of water service. Unaffordable water bills also impact customers for whom water services are affordable via higher water rates to recover the costs of services that go unpaid by lower income households. [ABSTRACT FROM AUTHOR]

Background: There have been growing recommendations to include education in multi-disciplinary interventions targeting chronic pain management. However, effects of this strategy on short- and long-term self-management of chronic pain, remain largely unexplored. Objectives: 1. To provide an updated overview of studies that report on the impact of patient education in multi-disciplinary interventions, on self-management of chronic pain; 2. To explore associations between education and chronic pain self-management techniques; and 3. To identify the format and duration of suitable chronic pain interventions targeted at patient self-management. Methods: Design: Narrative systematic literature review of randomised or controlled study designs. Data Sources: PubMed, CINAHL, EMBASE, PsycINFO. Participants: Adult patients with chronic pain of any aetiology participating in multi-disciplinary programs that included education. Main outcome measures: Assessments of level of pain, function, quality of life, self-efficacy, self-management, and any other relevant assessments. Study Appraisal and Synthesis Methods: PRISMA guidelines, Cochrane Risk of Bias tool, and TIDieR model. Results: Database searching identified 485 potential papers. After removal of duplicates, and irrelevant articles by title and abstract, 120 full-text articles were reviewed and 27 studies were included in this systematic review. Studies were predominantly from the United States (n = 8; 29.6%). Over one hundred outcome measures were identified across all studies, with significant variation also observed in terms of how chronic pain duration was defined, and how education was delivered to participants. Overall, positive benefits of education were reported. Conclusions: Education, as part of multi-disciplinary programs, is likely to improve self-management and self-efficacy in people with chronic pain of any aetiology. Heterogeneity in terms of: chronic pain duration; educational resources; healthcare professionals; and outcome measures, were identified as limitations. Further research, in the form of Randomised Controlled Trials addressing these limitations, is recommended. [ABSTRACT FROM AUTHOR]

Artificial intelligence models represented in machine learning algorithms are promising tools for risk assessment used to guide clinical and other health care decisions. Machine learning algorithms, however, may house biases that propagate stereotypes, inequities, and discrimination that contribute to socioeconomic health care disparities. The biases include those related to some sociodemographic characteristics such as race, ethnicity, gender, age, insurance, and socioeconomic status from the use of erroneous electronic health record data. Additionally, there is concern that training data and algorithmic biases in large language models pose potential drawbacks. These biases affect the lives and livelihoods of a significant percentage of the population in the United States and globally. The social and economic consequences of the associated backlash cannot be underestimated. Here, we outline some of the sociodemographic, training data, and algorithmic biases that undermine sound health care risk assessment and medical decision-making that should be addressed in the health care system. We present a perspective and overview of these biases by gender, race, ethnicity, age, historically marginalized communities, algorithmic bias, biased evaluations, implicit bias, selection/sampling bias, socioeconomic status biases, biased data distributions, cultural biases and insurance status bias, conformation bias, information bias and anchoring biases and make recommendations to improve large language model training data, including de-biasing techniques such as counterfactual role-reversed sentences during knowledge distillation, fine-tuning, prefix attachment at training time, the use of toxicity classifiers, retrieval augmented generation and algorithmic modification to mitigate the biases moving forward. [ABSTRACT FROM AUTHOR]

Addressing critical global health issues, such as antimicrobial resistance, infectious disease outbreaks, and natural disasters, requires strong coordination and management across sectors. The One Health approach is the integrative effort of multiple sectors working to attain optimal health for people, animals, and the environment, and is increasingly recognized by experts as a means to address complex challenges. However, practical application of the One Health approach has been challenging. The One Health Systems Mapping and Analysis Resource Toolkit (OH-SMART) introduced in this paper was designed using a multistage prototyping process to support systematic improvement in multi-sectoral coordination and collaboration to better address complex health concerns through an operational, stepwise, and practical One Health approach. To date, OH-SMART has been used to strengthen One Health systems in 17 countries and has been deployed to revise emergency response frameworks, improve antimicrobial resistance national action plans and create multi agency infectious disease collaboration protocols. OH-SMART has proven to be user friendly, robust, and capable of fostering multi-sectoral collaboration and complex system-wide problem solving. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to present the three critical changes needed to reform the US health care system -- these changes will drive cascades of other beneficial changes. These three changes include the use of transparent market prices, alignment of incentives and systematic assessment and ratings of quality. Design/methodology/approach -- The paper used an analysis based on the literature on the comparison between non-market and market systems. The current US health care system is similar to the Soviet economic system, and the paper proposes moving it gradually to where it can respond to market-based signals. Findings -- The US health care system needs to adopt transparent and real pricing, independent quality assessment of health provider organizations and portable electronic patient records. These changes will lead to continuing cascades of innovation and improvement. Research limitations/implications -- The recommended changes will be opposed by vested interest groups, and so will be easier with regulatory guidance and encouragement. It would also be useful to protect against "regulatory capture" by interested parties during the change process. Practical implications -- Health care in the USA will gradually become better and cheaper. Health organizations will become more transparent. Regulators would have to set up and supervise private quality ratings agencies. Social implications -- Social implications of this paper include greater labor mobility and higher productivity, as well as increased competitiveness of the USA. Originality/value -- In spite of numerous writings on the subject, this issue has not been analyzed in this way. This paper is unique in the way in which it layouts the process of movement to a market-based system for the US health care system. [ABSTRACT FROM AUTHOR]

Objectives: As gentrification continues in New York City as well as other urban areas, residents of lower socioeconomic status maybe at higher risk for residential displacement. Yet, there have been few quantitative assessments of the health impacts of displacement. The objective of this paper is to assess the association between displacement and healthcare access and mental health among the original residents of gentrifying neighborhoods in New York City. Methods: We used 2 data sources: 1) 2005–2014 American Community Surveys to identify gentrifying neighborhoods in New York City, and 2) 2006–2014 Statewide Planning and Research Cooperative System. Our cohort included 12,882 residents of gentrifying neighborhoods in 2006 who had records of emergency department visits or hospitalization at least once every 2 years in 2006–2014. Rates of emergency department visits and hospitalizations post-baseline were compared between residents who were displaced and those who remained. Results: During 2006–2014, 23% were displaced. Compared with those who remained, displaced residents were more likely to make emergency department visits and experience hospitalizations, mainly due to mental health (Rate Ratio = 1.8, 95% confidence interval = 1.5, 2.2), after controlling for baseline demographics, health status, healthcare utilization, residential movement, and the neighborhood of residence in 2006. Conclusions: These findings suggest negative impacts of displacement on healthcare access and mental health, particularly among adults living in urban areas and with a history of frequent emergency department visits or hospitalizations. [ABSTRACT FROM AUTHOR]

After decades-old efforts to nudge consumers towards healthier lifestyles through dietary guidelines, diet-related diseases are on the rise. In addition, a growing share of U.S. consumers proactively chooses nutritional supplements as an alternative preventative way of maintaining good health, a $25.5 billion industry in the United States. This paper investigates possible linkages between the economics of consumer supplement choices and the relationship to important dietary and health outcomes. We use National Health and Nutrition Examination Survey (NHANES) data to estimate the impact of nutritional supplements intake on respondent’s body weight outcomes, controlling for diet quality.: The focus of this article is to determine whether nutritional supplements takers differ from non-takers with regard to their health outcomes when controlling for differences in diet quality, based on individual Healthy Eating Index (HEI-2010) score. The analysis applies treatment effects estimators that account for the selection bias and endogeneity of self-reported behavior and diet-health outcomes. The analysis demonstrates a negative association between supplement intake and BMI but no significant effect on an individual’s diet quality. Our findings suggest that individuals proactively invest into their health by taking nutritional supplements instead of improving diet quality through more nutritious food choices. Our results provide important contributions to the literature on a key food policy issue. Knowledge of the determinants of supplement demand in the context of strong diet-health trends should also be helpful to stakeholders in the U.S. produce sector in their competition over consumer market share. [ABSTRACT FROM AUTHOR]

Objective: Heroin use in the United States has reached epidemic proportions. The objective of this paper is to estimate the annual societal cost of heroin use disorder in the United States in 2015 US dollars. Methods: An analytic model was created that included incarceration and crime; treatment for heroin use disorder; chronic infectious diseases (HIV, Hepatitis B, Hepatitis C, and Tuberculosis) and their treatments; treatment of neonatal abstinence syndrome; lost productivity; and death by heroin overdose. Results: Using literature-based estimates to populate the model, the cost of heroin use disorder was estimated to be $51.2 billion in 2015 US dollars ($50,799 per heroin user). One-way sensitivity analyses showed that overall cost estimates were sensitive to the number of heroin users, cost of HCV treatment, and cost of incarcerating heroin users. Conclusion: The annual cost of heroin use disorder to society in the United States emphasizes the need for sustained investment in healthcare and non-healthcare related strategies that reduce the likelihood of abuse and provide care and support for users to overcome the disorder. [ABSTRACT FROM AUTHOR]

Much of the political rhetoric about healthcare in the United States is couched in terms of healthcare as a right or entitlement. Healthcare as a right, like all welfare rights, carries with it the obligation to pay for it. This paper proposes that healthcare be considered, not a right, but rather a duty within the framework of a Kantian approach to ethics. The categorical imperatives of rational beings include the duties of self-preservation and self-development. As a precondition for these duties, health is essentially bound up with the nature and duties of physical, rational beings. The complexity of healthcare ensures that virtually all persons will need the services of others, and the expense of healthcare can exceed the resources even of those who are insured. Therefore, a just society has a moral duty to ensure access to healthcare to all of its members. [ABSTRACT FROM AUTHOR]

This article examines how a profit-centered restructuring of labor relations in an academic medical center undermined team-based care practices in its intensive care unit. The Institute of Medicine has promoted team-based care to improve patient outcomes, and the staff in the intensive care unit researched for this paper had established a set of practices they defined as teamwork. After hospital executives rolled out a public relations campaign to promote its culture of teamwork, they restructured its workforce to enhance numerical and functional flexibility in three key ways: implementing a "service line" managerial structure; cutting a range of staff positions while combining others; and doubling the capacity of its profitable and highly regarded intensive care unit. Hospital executives said the restructuring was necessitated by changes to payment models brought forth by the Affordable Care Act. Based on 300 hours of participant-observation and 35 interviews with hospital staff, findings show that the restructuring lowered staff resources and intensified work, which limited their ability to practice care they defined as teamwork and undermined the unit's collective identity as a team. Findings also show how staff members used teamwork as a sensitizing concept to make sense of what they did at work. The meanings attached to teamwork were anchored to positions in the hospitals' organizational hierarchy. This paper advances our understanding of he flexible work arrangements in the health care industry and their effects on workers. [ABSTRACT FROM AUTHOR]

With the rise of clinical management, new skills of medical doctors stand out, including leadership skills. Medical doctors organize medical work and improve patient care. The training of frontline leadership skills, however, is weakly developed in residency programmes. Medical professional cultures tend to resist organizational techniques and values. This paper analyses cultural interventions in health-care organizations, aimed at overcoming ‘clashes’ between professional and organizational logics in frontline domains. These interventions do not work against, but ‘use’ professional traditions, styles and customs as cultural resources. We use one particular project to illustrate this, a project in which internal medicine residents are invited to join quality improvement sessions, during which they identify critical (organizational) experiences with care provision and realize change. We show how residents feel enabled to establish results and cooperate with other professionals. We also show how this project links organizational responsibilities and medical professionalism – how complementarity (instead of conflict) is established. This is done in practical ways, which commit instead of alienate medical professionals. [ABSTRACT FROM PUBLISHER]

Background: Reductions in smoking in Arizona and California have been shown to be associated with reduced per capita healthcare expenditures in these states compared to control populations in the rest of the US. This paper extends that analysis to all states and estimates changes in healthcare expenditure attributable to changes in aggregate measures of smoking behavior in all states.Methods and Findings: State per capita healthcare expenditure is modeled as a function of current smoking prevalence, mean cigarette consumption per smoker, other demographic and economic factors, and cross-sectional time trends using a fixed effects panel data regression on annual time series data for each the 50 states and the District of Columbia for the years 1992 through 2009. We found that 1% relative reductions in current smoking prevalence and mean packs smoked per current smoker are associated with 0.118% (standard error [SE] 0.0259%, p < 0.001) and 0.108% (SE 0.0253%, p < 0.001) reductions in per capita healthcare expenditure (elasticities). The results of this study are subject to the limitations of analysis of aggregate observational data, particularly that a study of this nature that uses aggregate data and a relatively small sample size cannot, by itself, establish a causal connection between smoking behavior and healthcare costs. Historical regional variations in smoking behavior (including those due to the effects of state tobacco control programs, smoking restrictions, and differences in taxation) are associated with substantial differences in per capita healthcare expenditures across the United States. Those regions (and the states in them) that have lower smoking have substantially lower medical costs. Likewise, those that have higher smoking have higher medical costs. Sensitivity analysis confirmed that these results are robust.Conclusions: Changes in healthcare expenditure appear quickly after changes in smoking behavior. A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. State and national policies that reduce smoking should be part of short term healthcare cost containment. [ABSTRACT FROM AUTHOR]

As debates in industrialized countries over the last century indicate, health care and the role of government in its provision are complex and contentious issues. This article provides an orientation to the variety of topics guiding research and discourse in U.S. health policy, as well as how those topical areas influence and engage each other. This paper introduces five prominent themes in health policy research, namely (i) biomedical policy, (ii) public health policy, (iii) health economics, (iv) health care policy, and (v) health informatics policy. It also provides specific examples from current scholarship. Broad themes that connect those lines of inquiry are highlighted with recommendations for future research. [ABSTRACT FROM AUTHOR]

This paper presents data from the Program for the International Assessment of Adult Competencies with a focus on the interrelationships among health information seeking behavior (HISB), and health status or use of preventive health measures for U.S. adults both with and without a high school diploma. Key results of ordinal and binary logistic regression analyses indicated that, after controlling for demographic factors, (1) adults with a high school diploma use more text-based health information sources while adults without a high school diploma use more oral sources, (2) using the Internet as a source of health information is more strongly related to reporting excellent/very good health status than having a high school diploma, (3) those without a high school diploma who use the Internet report the largest increase in health status over any other health information source, and (4) for those with learning disability or vision problem, a high facility in reading English is an important predictor of whether the Internet is used as a health information source. The Internet appears to play a key role in both enhancing health status and enabling use of preventive measures for those with and without a high school diploma; although, individuals without a high school diploma who use the Internet for health information derive substantial benefit in health status. [ABSTRACT FROM AUTHOR]

Human Health in each country depends on the government's official policy and strategy, and then of health policy and the results in terms of implemented health goals, programs and proper handling of the available resources. This paper is actually affirmed the role of the United States of America because it is crucial in determining the programs and measures of health policy and control and evaluation of realized strategic objectives. The objectives related to increased coverage of citizens with health insurance, raising the overall quality of health care, employing the available and finding new resources and to prevent upward flow of medical expenses. Timely implementation of the goals can be achieved by increasing the value of health, a detailed analysis of the results of specific health programs, rational use of the factors involved and the preparation of materials for taking the next action. Although a relevant indicator, high-quality health fails to free the citizens of the United States a permanent and unconvincing assurances that in reaching its greatest credit goes to insurers and their unselfish effort. It is not and can not be true, and the goal of this work is to prove it. Assurances of its kind covering the truth because the quality of the health of every citizen in the largely depends on his attitude towards personal and other people’s health and the impact of political, social, social, technical and economic factors. This is why contemporary analysts believe that the United States should leave philosophy to all valued money, and especially the life and health of citizens. As for large-coverage of citizens with health insurance probably not be a particular problem, however, it is even greater as the settlement of the dispute does not want to in the right way. Inequality in health treatment insured because they belong to individual, particularly on vulnerable would not be a problem if there were greater willingness to masse people an equally valued. United States of America have long remained only a highly developed, industrial country that is not secured by the conditions in which all citizens have health care (state insurance or some kind of private insurance). A deeper analysis of this and similar problems it shows that critics of the current health policies are beginning to themselves to bother. In fact, they are concerned that the health of the United States older and sicker populations extensively using compensation of employees (and wealthy) layers of the population which, in their opinion causes irregular distribution of budget funds. If so (things are fine or OK), but the question is, why is there so much concern and imperative desire for an increased life expectancy of their citizens? [ABSTRACT FROM AUTHOR]

Prior to the Patient Protection and Affordable Care Act of 2010 (the ACA), the US health care system left many low-income families facing limited access to medical care, struggling with high-health costs, or lacking health insurance altogether. The ACA aims to increase access to care, improve the quality of care, and lower total health care costs. While the ACA can benefit all individuals and families, it has significant potential for expanding and improving services for those experiencing homelessness. This paper describes specific opportunities under the ACA and Medicaid that can be used to strengthen services for homeless families and provides examples of efforts under way. It also offers guidance for how homeless service agencies can effect change in their respective states. The examples described here are promising approaches to strengthening homeless services. Pursuing these ideas for homeless families will require initiative, creativity, and perseverance, but recent progress is encouraging. [ABSTRACT FROM PUBLISHER]

U.S. hospitals are confronted with challenges of increasing service volume demand and inequitable payment by different private payers. Under this circumstance, budgeting the medical service volume efficiently and allocating the volume among private payers strategically becomes very important. Our paper proposes a hospital service volume assignment model to provide feasible solutions for hospitals. We develop our base model in the radiology department that provides comparatively homogenous medical service and involves high fixed cost. Under the fee-for-service payment schedule, the base model suggests that the hospital contracting decision with a private payer (insurance company) depends on an intuitive critical ratio. The critical ratio measures the tradeoff between the outsourcing cost generated from the actual service volume in excess of the capacity and the idling cost generated from the actual service volume below the capacity. Besides the base model, we explore two model extensions. First, we examine the criteria to budget the service volume above or below the service volume capacity. Second, we include the processing cost in the cooperation of the hospital and the insurance company. Efficient algorithms are presented for all models. Our findings provide managerial insight on hospital service volume budgeting decision by incorporating inequitable payment information. [ABSTRACT FROM PUBLISHER]

As the demand for publicly funded health care continues to rise in the U.S., there is increasing pressure on state governments to ensure patient access through adjustments in provider compensation policies. This paper longitudinally examines the fees that states paid physicians for services covered by the Medicaid program over the period 1998-2004. Controlling for an extensive set of economic and health care industry characteristics, the elasticity of states' Medicaid fees, with respect to Medicare fees, is estimated to be in the range of 0.2-0.7 depending on the type of physician service examined. The findings indicate a significant degree of price competition between the Medicaid and Medicare programs for physician services that is more pronounced for cardiology and critical care, but not hospital care. The results also suggest several policy levers that work to either increase patient access or reduce total program costs through changes in fees. [ABSTRACT FROM AUTHOR]

Background: Improving access to high-quality healthcare for individuals in correctional settings is critical to advancing health equity in the United States. Compared to the general population, criminal-legal involved individuals experience higher rates of chronic health conditions and poorer health outcomes. Implementation science frameworks and strategies offer useful tools to integrate health interventions into criminal-legal settings and to improve care. A review of implementation science in criminal-legal settings to date is necessary to advance future applications. This systematic review summarizes research that has harnessed implementation science to promote the uptake of effective health interventions in adult criminal-legal settings. Methods: A systematic review of seven databases (Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Social Work Abstracts, ProQuest Criminal Justice Database, ProQuest Sociological Abstracts, MEDLINE/PubMed) was conducted. Eligible studies used an implementation science framework to assess implementation outcomes, determinants, and/or implementation strategies in adult criminal-legal settings. Qualitative synthesis was used to extract and summarize settings, study designs, sample characteristics, methods, and application of implementation science methods. Implementation strategies were further analyzed using the Pragmatic Implementation Reporting Tool. Results: Twenty-four studies met inclusion criteria. Studies implemented interventions to address infectious diseases (n=9), substance use (n=6), mental health (n=5), co-occurring substance use and mental health (n=2), or other health conditions (n=2). Studies varied in their operationalization and description of guiding implementation frameworks/taxonomies. Sixteen studies reported implementation determinants and 12 studies measured implementation outcomes, with acceptability (n=5), feasibility (n=3), and reach (n=2) commonly assessed. Six studies tested implementation strategies. Systematic review results were used to generate recommendations for improving implementation success in criminal-legal contexts. Conclusions: The focus on implementation determinants in correctional health studies reflects the need to tailor implementation efforts to complex organizational and inter-agency contexts. Future studies should investigate policy factors that influence implementation success, design, and test implementation strategies tailored to determinants, and investigate a wider array of implementation outcomes relevant to criminal-legal settings, health interventions relevant to adult and juvenile populations, and health equity outcomes. Trial registration: A study protocol (CRD42020114111) was registered with Prospero. [ABSTRACT FROM AUTHOR]

Prescription drug use has reached historic highs in the United States--a trend linked to increases in medicalization, institutional factors relating to the health care and pharmaceutical industries, and population aging and growing burdens of chronic disease. Despite the high and rising prevalence of use, no estimates exist of the total number of years Americans can expect to spend taking prescription drugs over their lifetimes. This study provides the first estimates of life course patterns of prescription drug use using data from the 1996-2019 Medical Expenditure Panel Surveys, the Human Mortality Database, and the National Center for Health Statistics. Newborns in 2019 could be expected to take prescription drugs for roughly half their lives: 47.54 years for women and 36.84 years for men. The number of years individuals can expect to take five or more drugs increased substantially. Americans also experienced particularly dramatic increases in years spent taking statins, antihypertensives, and antidepressants. There are also important differences in prescription drug use by race and ethnicity: non-Hispanic Whites take the most, Hispanics take the least, and non-Hispanic Blacks fall in between these extremes. Americans are taking drugs over a wide and expanding swathe of the life course, a testament to the centrality of prescription drugs in Americans' lives today. [ABSTRACT FROM AUTHOR]

Context: The Affordable Care Act resulted in unprecedented reductions in the uninsured population through subsidized private insurance and an expansion of Medicaid. Early estimates from the beginning of 2014 showed that the Medicaid expansion decreased uninsured discharges and increased Medicaid discharges with no change in total discharges. Objective: To provide new estimates of the effect of the ACA on discharges for specific conditions. Design, setting, and participants: We compared outcomes between states that did and did not expand Medicaid using state-level all-capture discharge data from 2009–2014 for 42 states from the Healthcare Costs and Utilization Project’s FastStats database; for a subset of states we used data through 2015. We stratified the analysis by baseline uninsured rates and used difference-in-differences and synthetic control methods to select comparison states with similar baseline characteristics that did not expand Medicaid. Main outcome: Our main outcomes were total and condition-specific hospital discharges per 1,000 population and the share of total discharges by payer. Conditions reported separately in FastStats included maternal, surgical, mental health, injury, and diabetes. Results: The share of uninsured discharges fell in Medicaid expansion states with below (-4.39 percentage points (p.p.), -6.04 –-2.73) or above (-7.66 p.p., -9.07 –-6.24) median baseline uninsured rates. The share of Medicaid discharges increased in both small (6.42 p.p. 4.22–6.62) and large (10.5 p.p., 8.48–12.5) expansion states. Total and most condition-specific discharges per 1,000 residents did not change in Medicaid expansion states with high or low baseline uninsured rates relative to non-expansion states (0.418, p = 0.225), with one exception: diabetes. Discharges for that condition per 1,000 fell in states with high baseline uninsured rates relative to non-expansion states (-0.038 95% p = 0.027). Conclusions: Early changes in payer mix identified in the first two quarters of 2014 continued through the Medicaid expansion’s first year and are distributed across all condition types studied. We found no change in total discharges between Medicaid expansion and non-expansion states, however residents of states that should have been most affected by the Medicaid expansion were less likely to be hospitalized for diabetes. [ABSTRACT FROM AUTHOR]

Health care systems throughout the United States are developing programmes to address patients' 'social determinants of health' – such as housing, food, income and transportation. I investigate the concepts, technologies and infrastructures through which health care systems are turning towards 'the social' as an object of clinical knowledge and intervention. Proponents of this movement suggest that developing the clinical capacity to prescribe social resources promises to improve the 'value' of care, defined as the amount of health achieved per dollar spent. I argue that initiatives to improve value through social intervention are reconstituting broader arrangements of welfare provisioning. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse (POP) is a very common gynecological disorder greatly affecting the quality of life (QoL) of females in the society. Studies have shown that approximately 40% of women in the United States have POP that requires medical intervention. In clinical practice, there are four treatment options for POP: watchful waiting, conservative treatment, reconstructive surgery, and obliterative surgery. In this study, we utilize practical data obtained through surveys and clinical literature and develop a model to help physicians and POP patients dynamically select treatment options in order to maximize a patient's expected future QoL. Results from the model are presented in the form of optimal policy tables, which can be used by physicians and patients by entering several attributes as inputs, such as the patient's age, current observed QoL defined by the severity of POP symptoms, preferences over preserving coital function, and other potential restrictive conditions. The results show significant socioeconomic incentives for potential utilization of optimal treatment policies in POP treatment. We estimate based on QoL to dollar conversions that the expected value of improved QoL for an individual POP patient is around $10,000. When aggregated over the entire POP population seeking treatment, the total annual expected value for the society is at least $675 million under medium‐level valuations of QoL. Although the optimization‐based policies imply an overall increase of about $200 million in annual POP treatment costs, the net positive gains can make this trade‐off an acceptable one. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Academic productivity within orthopaedic subspecialties is important in developing generalizable knowledge, challenging biases, and evolving practice management. Productivity is linked to academic status and can affect compensation. This study evaluated the research activity of faculty at foot and ankle surgery fellowship programs in the United States and associated Canadian programs. The primary objective was to describe the publishing productivity of American Orthopaedic Foot & Ankle Society (AOFAS) fellowship faculty. Methods: Program characteristics from orthopaedic foot and ankle fellowship programs across the United States and Canada were collected from AOFAS and each program's respective websites. The studied faculty characteristics consisted of years in practice, academic rank, extent of training, and gender. Specific program characteristics were recorded, including Accreditation Council for Graduate Medical Education approval, academic affiliation, fellow research requirement, number of fellows, number of associated faculty members. Data analysis of faculty productivity (Publications, number of publications in specific journals, number of citations, and Hirsch index [h index]) was gathered using the Scopus database. Results: A total of 48 AOFAS foot and ankle surgery fellowship programs were identified with an associated 185 faculty members. The mean number of publications per faculty member was 44.9 (sd 53.0; range 0-323) with a mean h-index of 11.9 (sd 10.6; range 0-54). One-hundred and forty-four (77.8%) academic-affiliated faculty had a significantly greater number of publications (p<0.01), total citations (p<0.05), and publications in FAI (p<0.05), JBJS (p<0.05), CORR (p<0.05), and JAAOS (p<0.05) compared to the 41 (22.2%) nonacademic faculty. Nonacademic faculty maintained a h-index of 9.5 (95% CI 7-12), while academic faculty had a h-index of 12.6 (95% CI 11-14), which did not meet statistical significance (p=0.062). There were no significant differences between measures of publication productivity in male and female faculty, except for maximum citations in a single paper (67.1 vs 142.3; p<0.05) Conclusion: Academic-affiliated foot and ankle fellowship faculty have higher research productivity than non-academic surgeons. The mean h-index of foot and ankle fellowship faculty was 11.9, which is lower than that reported in sports, joints, and spine fellowship faculty but higher than that reported for hand fellowship faculty. The analyses presented can aid foot and ankle surgeons in assessing their academic productivity. [ABSTRACT FROM AUTHOR]

In the 2015 United States Trans Survey, trans people overwhelmingly indicated that training health-care providers about trans health is an urgent policy priority within the US. This literature review examines the types of educational training interventions health professional schools have developed from 2015–2020 focused on trans health. This review revealed that the fields of medicine and interprofessional education have created the majority of interventions, which tend to increase students' knowledge, comfort, and confidence working with trans patients. Schools of counseling, social work, and public health are not adequately developing curriculum and interventions that prepare students in health professional schools to work with trans people. Recommendations include schools of medicine developing more faculty expertise in trans medicine, professional organizations requiring trans content on licensure exams, state licensure boards requiring continuing education in trans health, and health professional schools increasing the use of trans standardized patients and trans panels. [ABSTRACT FROM AUTHOR]

Some of the news about insulin is shocking. In the United States, people have died because they were rationing a life-saving medication discovered in the 1920s. How could this happen? Perhaps a better question is why anyone should be surprised. The insulin story both illustrates and challenges many understandings of the problems with insurance, treatment, payment, and politics in the US health care system. It particularly highlights consequences of structuring price discounts as rebates to health plans or government instead of as lower individual prices to patients. Perversely, this encourages higher list prices, which, for patients without insurance or with high cost sharing, make insulin less affordable than it would be without the rebates. [ABSTRACT FROM AUTHOR]

Research links restrictive immigration policies to immigrant health and health care outcomes. Yet most studies in this area focus on the impact of single policies in particular years, with few assessing how broader state-level immigration policy contexts affect groups by nativity, race/ethnicity, and legal status. Linking data from the National Agricultural Workers Survey (2005-2012) with information on state immigration policies, we use an intersectional approach to examine the links between policy contexts and health care utilization by nativity, race/ethnicity, and legal status. We also assess the associations between two specific types of state immigration policies--those governing immigrant access to Medicaid and driver's licenses--and health care utilization disparities. We find that state-level immigration policy contexts are associated with health care utilization among U.S.-born and naturalized U.S. citizen non-White Latinx agricultural workers, who report lower levels of health care utilization and greater barriers to care-seeking in more restrictive policy contexts. By contrast, we find little evidence that state policies shaped health care utilization among undocumented workers. These findings advance understanding of the impact of "policies of exclusion" on the lives of marginalized groups and underscore the importance of racialized legal sta tus in considering the links between sociopolitical contexts and health and health care disparities. [ABSTRACT FROM AUTHOR]

Federally Qualified Health Centers (FQHCs) are critical to providing care to underserved populations in the United States. Their focus on interprofessional care has also made FQHCs ideal locations to integrate pharmacists into care teams and advance pharmacy practice. However, despite long‐standing involvement by pharmacists, there have been limited attempts to synthesize this literature. We conducted a comprehensive search for published literature on the roles of pharmacists in FQHCs and narrowed our search to 54 manuscripts and abstracts for inclusion in this narrative review. We found that pharmacists in FQHCs are providing care that is interprofessional, multifaceted, and evolving rapidly in response to environmental changes. Pharmacists are routinely involved in the traditional management of chronic disease, such as diabetes, hypertension, behavioral health, and respiratory conditions. In addition, pharmacists have forged roles in preventive care, infectious disease, and pain management. Models include appointment‐based approaches; however, there was also heterogeneity in approaches consistent with the dynamic nature of the healthcare system in the United States with engagement in population health, transitions of care, and telehealth, as a few examples. Collaborative practice agreements were used to deliver care in some cases, although this was not commonplace, and reimbursement by third party payers was rarely addressed. Relationships with community pharmacies, often driven by the 340B Drug Pricing Program, were also noted. Recommendations for future research in this area include increasing the rigor of future research by standardizing pharmacy interventions and including comparator groups, a greater focus on financial sustainability, and further exploration of how state laws surrounding pharmacist provider status and scope of practice impact pharmacy service development. [ABSTRACT FROM AUTHOR]

Organizational life is rife with conflict between groups that pursue different goals, particularly when groups have strong commitments to professional identities developed outside the organization. I use data from a 30-month comparative ethnographic field study of four U.S. Army combat brigades to examine conflict between commanders who had a goal of fielding a mission-ready force and mental health providers who had a goal of providing rehabilitative mental health care to soldiers. All commanders and providers faced goal and identity conflict and had access to similar integrative mechanisms. Yet only those associated with two brigades addressed these conflicts in ways that accomplished the army’s superordinate goal of having both mission-ready and mentally healthy soldiers. Both successful brigades used what I call “anchored personalization” practices, which included developing personalized relations across groups, anchoring members in their home group identity, and co-constructing integrative solutions to conflict. These practices were supported by an organizational structure in which professionals were assigned to work with specific members of the other group, while remaining embedded within their home group. In contrast, an organizational structure promoting only anchoring in one’s home group identity led to failure when each group pursued its own goals at the expense of the other group’s goals. A structure promoting only personalization across groups without anchoring in one’s home group identity led to failure from cooptation by the dominant group. This study contributes to our understanding of how groups with strong professional identities can work together in service of their organization’s superordinate goals when traditional mechanisms fail. [ABSTRACT FROM AUTHOR]

Sexual minority people in the United States are less likely to have access to health services when compared to their heterosexual counterparts. Less is known about the within‐group sociodemographic memberships among sexual minority people regarding access to health services. Using data from a nationally representative sample, a series of univariate and bivariate analyses were used to determine associations between sociodemographic group membership and access to health services. Results suggest there are significant differences in access to health services within the sexual minority population. Differences in access to health services when considering sex‐at‐birth, sexual identity, age, race/ethnicity, urbanicity, education level and income status were found. These findings offer insight into the role sociodemographic group membership has on the equity of access to health services. Specifically, results indicated that disproportionate access to health services among sexual minority people were more pronounced among those with group membership who experience social marginalisation. This was particularly true for sexual minority people who were bisexual, younger, Black and Latinx, lower‐income earners and sexual minority people with less education attainment. Results from this study may be used to inform policies and practices aimed at improving access to health services including, but not limited to, the expansion of the Affordable Care Act and continued development of Federally Qualified Health Centers, while acknowledging the role of within‐group differences among sexual minority people. [ABSTRACT FROM AUTHOR]

Medicines Regulatory Authorities (MRAs) are an essential part of national health systems and are charged with protecting and promoting public health through regulation of medicines. However, MRAs in resource-constrained settings often struggle to provide effective oversight of market entry and use of health commodities. This paper proposes a regulatory value chain model (RVCM) that policymakers and regulators can use as a conceptual framework to guide investments aimed at strengthening regulatory systems. The RVCM incorporates nine core functions of MRAs into five modules: (i) clear guidelines and requirements; (ii) control of clinical trials; (iii) market authorization of medical products; (iv) pre-market quality control; and (v) post-market activities. Application of the RVCM allows national stakeholders to identify and prioritize investments according to where they can add the most value to the regulatory process. Depending on the economy, capacity, and needs of a country, some functions can be elevated to a regional or supranational level, while others can be maintained at the national level. In contrast to a "one size fits all" approach to regulation in which each country manages the full regulatory process at the national level, the RVCM encourages leveraging the expertise and capabilities of other MRAs where shared processes strengthen regulation. This value chain approach provides a framework for policymakers to maximize investment impact while striving to reach the goal of safe, affordable, and rapidly accessible medicines for all. [ABSTRACT FROM AUTHOR]

The use of complementary/alternative medicine (CAM) is typically modeled as a function of individual health beliefs, including changes in perceptions of conventional medicine, an orientation toward more holistic care, and increasing patient involvement in health care decision-making. Expanding on research that shows that health-related behavior is shaped by social networks, this paper examines the possibility that CAM usage is partly a function of individuals' social network structure. We argue that people are more likely to adopt CAM when they function as bridges between network members who are otherwise not (or poorly) connected to each other. This circumstance not only provides individuals with access to a wider range of information about treatment options, it also reduces the risk of sanctioning by network members if one deviates from conventional forms of treatment. We test this idea using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative study of older Americans. Analyses of egocentric social network data show that older adults with bridging potential in their networks are significantly more likely to engage in a greater number of types of CAM. We close by discussing alternative explanations of these findings and their potential implications for research on CAM usage. [ABSTRACT FROM AUTHOR]

In a Persepctive, Richard Fluck and Maarten Taal discuss the potential value of implementing multidisciplinary care programs for chronic kidney disease. [ABSTRACT FROM AUTHOR]

Background: Engaging adolescents and young adults (AYAs) who are at elevated risk for HIV acquisition or who are living with HIV in health care has posed a major challenge in HIV prevention and care efforts. Mobile health (mHealth) interventions are a popular and accessible strategy to support AYA engagement despite barriers to care present along the HIV care continuum. Even with progress in the field of mHealth research, expert recommendations for the process of designing, evaluating, and implementing HIV-related mHealth interventions are underdeveloped. Objective: The aim of this study was to compile expert recommendations on the development, evaluation, and implementation of AYA-focused HIV prevention and care mHealth interventions. Methods: Experts from adolescent mHealth HIV research networks and investigators of recently funded HIV mHealth projects and programs were identified and invited to complete a series of electronic surveys related to the design, implementation, and evaluation of HIV-related mHealth interventions. A modified Delphi method was used to ask experts to score 35 survey items on a 4-point Likert scale from not important to very important and encouraged experts to leave additional comments in textboxes. Responses were reviewed by the researchers, a team of 4 HIV mHealth intervention experts. The average importance ratings from survey responses were calculated and then categorized as retained (high importance), flagged (mid-level importance), or dropped (no/low importance). Additionally, thematic analysis of expert comments helped modify survey items for the next survey round. An evaluation of the level of agreement among experts on the most important items followed each round until consensus was reached. Results: Of the 35 invited experts, 23 completed the first survey representing a variety of roles within a research team. Following two rounds of Delphi surveys, experts scored 24 of the 28 (86%) survey items included in round two as important to very important. The final consensus items included 24 recommendations related to the mHealth intervention design process (n=15), evaluation (n=2), and implementation (n=7). The 3 survey items with the highest average scores focused on the design process, specifically, (1) the creation of a diverse team including researchers, app software developers, and youth representation; (2) the importance of AYA-focused content; and (3) the value of an iterative process. Additionally, experts highlighted the importance of establishing the best ways to collect data and the types of data for collection during the evaluation process as well as constructing a plan for participant technology disruption when implementing an mHealth intervention. Conclusions: The modified Delphi method was a useful tool to convene experts to determine recommendations for AYA-focused HIV prevention and care mHealth interventions. These recommendations can inform future mHealth interventions. To ensure the acceptability, feasibility, and efficacy of these AYA HIV prevention interventions, the focus must be on the specific needs of AYAs by including representation of AYAs in the process, including consistent and relevant content, ensuring appropriate data is collected, and considering technology and health accessibility barriers. [ABSTRACT FROM AUTHOR]

Background: Women physicians face unique obstacles while progressing through their careers, navigating career advancement and seeking balance between professional and personal responsibilities. Systemic changes, along with individual and institutional changes, are needed to overcome obstacles perpetuating physician gender inequities. Developing a deeper understanding of women physicians' experiences during important transition points could reveal both barriers and opportunities for recruitment, retention, and promotion, and inform best practices developed based on these experiences. Objective: The aim is to learn from the experiences and perspectives of women physicians as they transition from early to mid-career, then develop best practices that can serve to support women physicians as they advance through their careers. Methods: Semistructured interviews were conducted with women physicians in the United States in 2020 and 2021. Eligibility criteria included self-identification as a woman who is in the process of transitioning or who recently transitioned from early to mid-career stage. Purposeful sampling facilitated identification of participants who represented diversity in career pathway, practice setting, specialty, and race/ethnicity. Each participant was offered compensation for their participation. Interviews were audio-recorded and professionally transcribed. Interview questions were open-ended, exploring participants' perceptions of this transition. Qualitative thematic analysis will be performed. We will use an open coding and grounded theory approach on interview transcripts. Results: The Ethics Review Committee of the Faculty of Health, Medicine, and Life Sciences at Maastricht University approved the study; Stanford University expedited review approved the study; and the University of California, San Diego certified the study as exempt from review. Twelve in-depth interviews of 50-100 minutes in duration were completed. Preliminary analyses indicate one key theme is a tension resulting from finite time divided between demands from a physician career and demands from family needs. In turn, this results in constant boundary control between these life domains that are inextricable and seemingly competing against each other within a finite space; family needs impinge on planned career goals, if the boundary between them is not carefully managed. To remedy this, women sought resources to help them redistribute home responsibilities, freeing themselves to have more time, especially for children. Women similarly sought resources to help with career advancement, although not with regard to time directly, but to first address foundational knowledge gaps about career milestones and how to achieve them. Conclusions: Preliminary results provide initial insights about how women identify or activate a career shift and how they marshaled resources and support to navigate barriers they faced. Further analyses are continuing as of March 2022 and are expected to be completed by June 2022. The dissemination plan includes peer-reviewed open-access journal publication of the results and presentation at the annual meeting of the American Medical Association's Women Physicians Section. [ABSTRACT FROM AUTHOR]

Contemporary organizations operate in highly interconnected environments where they are frequently confronted by the challenge of balancing the protection of information resources with the need for sharing information. This tension between the expected benefits and the potential security risks inherent in the information sharing process, exists in many domains, including business, health care, law enforcement, and military—yet it is not well-understood. We propose an information security control theory to explain and manage this tension. We evaluate this theory through a longitudinal case study of the iterative development of the information security policies for a health information exchange in the western United States. Our study shows that the theory offers a good framework through which to understand the information security policy development process, and a way to reconcile the tension between information sharing and information protection. The theory has practical applicability to many business domains. [ABSTRACT FROM PUBLISHER]