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Introduction: Exclusive breastfeeding is recognized as the optimal source of nutrition for infants. Although exclusive breastfeeding rates have increased overall in the United States, substantial inequities exist in breastfeeding among individuals of different socioeconomic statuses, races, and ethnicities. The purpose of this study was to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. Methods: The current study included a cross-sectional design, with a sample of 242 pregnant women in Arkansas enrolled in a Healthy Start program. Results: The majority of the participants (56.6%) indicated their infant feeding intentions included a combination of breastfeeding and formula feeding. There were substantial differences in breastfeeding intentions among women of different races/ethnicities, with 18.5% of Marshallese women indicating they planned to exclusively breastfeed, compared to 42.1% of White women, 47.6% of Black women, and 31.8% of Hispanic women (p < 0.001). Women over the age of 18 and with higher educational attainment were more likely to intend on exclusively breastfeeding. Discussion: This is the first study to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. The study found that race/ethnicity and age were most strongly associated with breastfeeding intentions. These findings are critical to identifying populations for resource allocation and to developing culturally-tailored interventions to help women in Arkansas achieve their desired infant feeding methods. Significance: What is already known on this subject?: Exclusive breastfeeding is recognized as the optimal source of nutrition for infants, and it has been associated with decreased risk of obesity and cardiometabolic disease for both mother and infant. Although exclusive breastfeeding rates have increased overall in the United States, substantial inequities exist in breastfeeding among individuals of different socioeconomic statuses, races, and ethnicities. What this study adds?: This is the first study to examine characteristics associated with exclusive breastfeeding intentions among pregnant women in Arkansas enrolled in a Healthy Start program. The study found that race/ethnicity and age were most strongly associated with breastfeeding intentions. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Poverty-reduction efforts that seek to support households with children and enable healthy family functioning are vital to produce positive economic, health, developmental, and upward mobility outcomes. The Supplemental Nutrition Assistance Program (SNAP) is an effective poverty-reduction policy for individuals and families. This study investigated the non-nutritional effects that families experience when receiving SNAP benefits. Methods: We conducted a scoping review using the PRISMA Guidelines and strategic search terms across seven databases from 01 January 2008 to 01 February 2023 (n=2456). Data extraction involved two researchers performing title-abstract reviews. Full-text articles were assessed for eligibility (n=103). Forty articles were included for data retrieval. Results: SNAP positively impacts family health across the five categories of the Family Stress Model (Healthcare utilization for children and parents, Familial allocation of resources, Impact on child development and behavior, Mental health, and Abuse or neglect). Discussion/Conclusion: SNAP is a highly effective program with growing evidence that it positively impacts family health and alleviates poverty. Four priority policy actions are discussed to overcome the unintentional barriers for SNAP: distributing benefits more than once a month; increasing SNAP benefits for recipients; softening the abrupt end of benefits when wages increase; and coordinating SNAP eligibility and enrollment with other programs. Significance: What is already known on this subject?: Poverty-reduction efforts that invest in children have especially significant positive benefits by producing positive economic, health, developmental, and upward mobility outcomes. SNAP is among the leading poverty-reducing policies and enrolls the largest number of participants for both nutritional and non-nutritional benefits. What this study adds?: To our knowledge, no study has synthesized the non-nutritional impact of SNAP on family health. We found that SNAP positively impacts family health across five categories of the Family Stress Model (Healthcare utilization for children and parents, Familial allocation of resources, Impact on child development and behavior, Mental health, and Abuse or neglect). Further, we present four policy actions resulting from this scoping review that deserve attention from policymakers, program administrators, and retailer establishments: distribute benefits more than once a month; increase SNAP benefits for recipients; soften the abrupt end of benefits when wages increase; and coordinate SNAP eligibility and enrollment with other programs. [ABSTRACT FROM AUTHOR]

Little is known about the role of agency in transitions in tracked education systems or whether it varies by socioeconomic background. This study addressed this gap by estimating structural equation models based on longitudinal data that are representative of the German- and French-speaking parts of Switzerland (N = 1273 individuals, surveyed from age 6 to 18, mean age at wave 1: Mage = 6.54, SDage = 0.50, female = 49%). The findings reveal that agency (captured by study effort and occupational aspirations) and socioeconomic background (measured by parental education and family income) significantly predicted students' transitions to academically demanding tracks in lower- and upper-secondary education. In the transition to upper-secondary education, students with fewer socioeconomic resources benefitted less than their more advantaged peers from ambitious aspirations, but they benefitted more from exerting effort. These findings suggest that both an optimistic forward-looking orientation and the exertion of effort are required to make it to an academic track. Effort may serve as a "substitutive" resource for less socioeconomically advantaged students, whereas ambitious aspirations may enhance the positive effect of family socioeconomic resources on academic educational trajectories. Overall, the evidence from this study calls for greater attention to investigating not only how agency shapes adolescents' educational trajectories and opportunities but also how its role differs across social groups. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) disparities among vulnerable populations are of paramount concern that extend to vaccine administration. With recent uptick in infection rates, dominance of the delta variant, and authorization of a third booster shot, understanding the population-level vaccine coverage dynamics and underlying sociodemographic factors is critical for achieving equity in public health outcomes. This study aimed to characterize the scope of vaccine inequity in California counties through modeling the trends of vaccination using the Social Vulnerability Index (SVI). Overall SVI, its four themes, and 9228 data points of daily vaccination numbers from December 15, 2020, to May 23, 2021, across all 58 California counties were used to model the growth velocity and anticipated maximum proportion of population vaccinated, defined as having received at least one dose of vaccine. Based on the overall SVI, the vaccination coverage velocity was lower in counties in the high vulnerability category (v = 0.0346, 95% CI 0.0334, 0.0358) compared to moderate (v = 0.0396, 95% CI 0.0385, 0.0408) and low (v = 0.0414, 95% CI 0.0403, 0.0425) vulnerability categories. SVI Theme 3 (minority status and language) yielded the largest disparity in coverage velocity between low and high-vulnerable counties (v = 0.0423 versus v = 0.035, P < 0.001). Based on the current trajectory, while counties in low-vulnerability category of overall SVI are estimated to achieve a higher proportion of vaccinated individuals, our models yielded a higher asymptotic maximum for highly vulnerable counties of Theme 3 (K = 0.544, 95% CI 0.527, 0.561) compared to low-vulnerability counterparts (K = 0.441, 95% CI 0.432, 0.450). The largest disparity in asymptotic proportion vaccinated between the low and high-vulnerability categories was observed in Theme 2 describing the household composition and disability (K = 0.602, 95% CI 0.592, 0.612; versus K = 0.425, 95% CI 0.413, 0.436). Overall, the large initial disparities in vaccination rates by SVI status attenuated over time, particularly based on Theme 3 status which yielded a large decrease in cumulative vaccination rate ratio of low to high-vulnerability categories from 1.42 to 0.95 (P = 0.002). This study provides insight into the problem of COVID-19 vaccine disparity across California which can help promote equity during the current pandemic and guide the allocation of future vaccines such as COVID-19 booster shots. [ABSTRACT FROM AUTHOR]

Background: This overview aimed to synthesize existing systematic reviews to produce a draft framework of evidence-informed health priority setting that supports countries in identifying appropriate steps and methods when developing and implementing national research agendas. Main body: We searched Ovid MEDLINE® and the WHO Institutional Repository for Information Sharing from 2010 to 2020 for critical or systematic reviews that evaluated research priority setting exercises. We adapted the AMSTAR checklist to assess the quality of included reviews and used adapted frameworks for data extraction and analysis. The search resulted in 2395 titles, of which 31 were included. Populations included in the reviews typically involved patients, families and carers, researchers, clinicians, policymakers and research funders. The topics covered in the reviews varied from specific diseases or conditions, approaches for healthcare practice or research priority setting methods itself. All the included systematic reviews were of low or critically low quality. The studies were thematically grouped based on their main focus: identifying and engaging with stakeholders; methods; context; and health area. Conclusion: Our overview of reviews has reconfirmed aspects of existing frameworks, but has also identified new concepts for countries to consider while developing their national research agendas. We propose a preliminary framework for consideration that highlights four key phases: (1) preparatory, (2) priority setting, (3) follow-up phase and (4) sustainability phase, which have thirteen sub-domains to consider. [ABSTRACT FROM AUTHOR]

This article provides an educational review covering the consideration of conducting 'value for money' analyses as part of non-randomised study designs including service evaluations. These evaluations represent a vehicle for producing evidence such as value for money of a care intervention or service delivery model. Decision makers including charities and local and national governing bodies often rely on evidence from non-randomised data and service evaluations to inform their resource allocation decision-making. However, as randomised data obtained from randomised controlled trials are considered the 'gold standard' for assessing causation, the use of this alternative vehicle for producing an evidence base requires careful consideration. We refer to value for money analyses, but reflect on methods associated with economic evaluations as a form of analysis used to inform resource allocation decision-making alongside a finite budget. Not all forms of value for money analysis are considered a full economic evaluation with implications for the information provided to decision makers. The type of value for money analysis to be conducted requires considerations such as the outcome(s) of interest, study design, statistical methods to control for confounding and bias, and how to quantify and describe uncertainty and opportunity costs to decision makers in any resulting value for money estimates. Service evaluations as vehicles for producing evidence present different challenges to analysts than what is commonly associated with research, randomised controlled trials and health technology appraisals, requiring specific study design and analytic considerations. This educational review describes and discusses these considerations, as overlooking them could affect the information provided to decision makers who may make an 'ill-informed' decision based on 'poor' or 'inaccurate' information with long-term implications. We make direct comparisons between randomised controlled trials relative to non-randomised data as vehicles for assessing causation; given 'gold standard' randomised controlled trials have limitations. Although we use UK-based decision makers as examples, we reflect on the needs of decision makers internationally for evidence-based decision-making specific to resource allocation. We make recommendations based on the experiences of the authors in the UK, reflecting on the wide variety of methods available, used as documented in the empirical literature. These methods may not have been fully considered relevant to non-randomised study designs and/or service evaluations, but could improve and aid the analysis conducted to inform the relevant value for money decision problem. [ABSTRACT FROM AUTHOR]

With the rise of an innovation agenda in science policy, previous studies have identified a shift in how the state delegates responsibility to funding agencies in order to change the behaviour of the scientific community. This paper contributes to this literature through a micro-level study of how one of Canada's largest research funding agencies, the Natural Sciences and Engineering Research Council (NSERC), has changed resource allocation for research over 25 years. Our study foregrounds research funding agencies as key sites for examining the reconfiguration of the relationship between the state and science, as expressed in programmatic and resource allocation decisions. Through analysis of an original dataset compiled from NSERC's funding and documentary data, we demonstrate the relationship between the introduction of innovation objectives in funding instruments, the adoption of new delegation modes to guide resource allocation, and changes in funding among research fields over time. Our study empirically demonstrates the cumulative effect of programmatic and funding decisions in a major agency, going beyond previous accounts of more general trends at the national level. [ABSTRACT FROM AUTHOR]

Introduction Natural disasters in resource-poor countries have differential effects on socially disadvantaged groups such as women. In addition to the acute reproductive health needs of women during the immediate response phase of a disaster, research suggests that maternal, newborn, and child health (MNCH) may continue to be seriously impacted for numerous months, even years, after the event. Methods This ethnographic field research investigates the impacts of the 2015 Nepal earthquakes on mothers and children under five on the 6-month anniversary of the earthquakes. Results Though families were not channeling household funds away from health care expenses for pregnant and lactating women and children under five, the findings suggest that a delayed response by the Nepali government in administering funds for rebuilding combined with an ongoing fuel crisis were negatively impacting families' abilities to provide adequate shelter, warmth, cooking gas, and transportation for mothers and young children. This study highlights the importance of understanding the impacts of specific social and political contexts on intra-household family finances as they relate to MNCH, not just variables related to the disaster itself. Discussion Future research and policies on MNCH during the long-term recovery period after a natural disaster such as the 2015 Nepal earthquakes therefore should take into account the social and political context as well as institute multiple periodic assessments of MNCH in the first few years following the disaster. [ABSTRACT FROM AUTHOR]

Background: A better understanding of the attributes of patients who require more effort to manage may improve risk adjustment approaches and lead to more efficient resource allocation, improved patient care and health outcomes, and reduced burnout in primary care clinicians.Objective: To identify and characterize high-effort patients from the physician's perspective.Design: Cohort study.Participants: Ninety-nine primary care physicians in an academic primary care network.Main Measures: From a list of 100 randomly selected patients in their panels, PCPs identified patients who required a high level of team-based effort and patients they considered complex. For high-effort patients, PCPs indicated which factors influenced their decision: medical/care coordination, behavioral health, and/or socioeconomic factors. We examined differences in patient characteristics based on PCP-defined effort and complexity.Key Results: Among 9594 eligible patients, PCPs classified 2277 (23.7 %) as high-effort and 2676 (27.9 %) as complex. Behavioral health issues were the major driver of effort in younger patients, while medical/care coordination issues predominated in older patients. Compared to low-effort patients, high-effort patients were significantly (P < 0.01 for all) more likely to have higher rates of medical (e.g. 23.2 % vs. 6.3 % for diabetes) and behavioral health problems (e.g. 9.8 % vs. 2.9 % for substance use disorder), more frequent primary care visits (10.9 vs. 6.0 visits), and higher acute care utilization rates (25.8 % vs. 7.7 % for emergency department [ED] visits and 15.0 % vs. 3.9 % for hospitalization). Almost one in five (18 %) patients who were considered high-effort were not deemed complex by the same PCPs.Conclusions: Patients defined as high-effort by their primary care physicians, not all of whom were medically complex, appear to have a high burden of psychosocial issues that may not be accounted for in current chronic disease-focused risk adjustment approaches. [ABSTRACT FROM AUTHOR]

We performed a health needs assessment for three Plain communities in Lancaster County, Pennsylvania from a random sample of households. Compared with the general population of adults, Plain respondents were more likely to be married, to have children, and they had large families; they were more likely to drink well water, to eat fruit and vegetables, to drink raw milk, and to live on a farm. Plain respondents had better physical and mental health and were less likely to have been diagnosed with various medical conditions compared with the general population of adults in Lancaster County but Old Order Mennonite respondents were more likely to have been diagnosed compared with Old Order Amish respondents. Plain respondents usually have a regular doctor and often receive preventive care but Old Order Mennonite respondents were more likely to have a regular doctor, to receive preventive care, to have had their children vaccinated, and to receive routine dental care compared with Old Order Amish respondents. Despite their relative geographic and genetic isolation, and despite the small, relative differences noted, the health of Plain communities in Lancaster County is similar to that of other adults in the County. [ABSTRACT FROM AUTHOR]

Community health workers (CHWs) are increasingly utilized to reach low-resource communities. A critical domain influencing success is the CHWs' ability to create and maintain a therapeutic relationship with the participants they serve. A limited evidence base exists detailing this construct, and evaluating CHW-participant relationships in the context of CHW-led programs. In a longitudinal study design, data on this therapeutic relationship were collected [as captured using The Scale to Assess the Therapeutic Relationship in Community Mental Health Care (STAR)] on 141 participants who had been assigned to a CHW during their perinatal period. Results indicate that therapeutic relationship was associated with the participant's psychosocial health, and independently predicted study adherence in the longitudinal intervention. Changes in therapeutic relationship over the months following birth were strongly associated with changes in anxiety and depression symptoms. A trustful relationship is critical in ensuring CHWs can effectively reach the population they serve. The findings offer additional psychometric evidence of the uses and benefits of STAR outside of the traditional clinical setting in the context of public health research. [ABSTRACT FROM AUTHOR]

Purpose: High-dependency care units (HDUs) are a focus of research to optimize critical care resource allocation. HDUs provide a level of care between the general ward and the intensive care unit (ICU). However, few data report on the case mix and outcomes of patients in these units.Methods: Retrospective observational cohort study of patients admitted to 11 stand-alone HDUs in the UK from 2008 to 2011. We stratified patients by location prior to HDU admission and location on discharge from HDU, and we summarized the case mix, transitions of care, and mortality.Results: Of 9008 patients admitted to 11 stand-alone HDUs, 56.5% were male and the mean age was 62.7 ± 17.9 years. The majority of patients admitted to HDUs were non-surgical (59.3%), with 22.4 and 20.1% admitted from the ICU and general ward, respectively; 41.3% were admitted from the operating room or recovery suite. The median length of stay in HDU was 1.8 days (IQR 0.9-3.5) and in-HDU mortality was 5.1%. Among HDU survivors (n = 8551), 8.5% were discharged to an ICU, 80.9% to a general ward, and 10.6% to other care areas. For patients admitted to HDU from an ICU, only 5.8% were readmitted to ICU. Hospital mortality for the HDU population was 14.8%; for patients discharged to an ICU, hospital mortality was 43.6%.Conclusions: In a sample of 11 stand-alone HDUs in the UK, patients are from many different hospital locations. Hospital mortality for patients requiring HDU care is high, particularly for patients who require transfer to an ICU. [ABSTRACT FROM AUTHOR]

Many science systems are witnessing the rise of intermediary organizations with a coordinating mission, but to date a systematic understanding of their function and effects is lacking. The aim of this paper is to contribute to the understanding of the coordinating efforts of intermediary organizations. Starting from the definition of coordination as the establishment or strengthening of a relationship among the activities in a system, with the aim to enhance their common effectiveness, I develop a heuristic framework that facilitates the systematic analysis of coordination in science. I illustrate and substantiate my framework with the empirical case study of a Dutch coordination task force in the area of chemical technologies. Thanks to the framework I could disentangle a number of functions that this task force fulfils concerning research programming, funding allocation and supporting interactions and collaborations. This approach enabled me to systematically analyse a very heterogeneous set of processes that each deserve to be called coordination. The analysis yields a clear overview of eight coordination processes that are each described in terms of activities, intervention, relationships, mechanisms and performance. I conclude my paper with suggestions for further research on coordination in the science system. [ABSTRACT FROM AUTHOR]

The article presents funding resources for paediatric radiology research in Great Britain and Europe. The available research funding resources are discussed including those from the Scientific Foundation Board, Royal College of Physicians, Medical Research Council and Cancer Research UK. Funding from the European Society of Radiology and the European framework grants are also mentioned.

The article presents funding resources for junior radiology research in the U.S. The available research funding resources are discussed including those from the National Institutes of Health, Department of Defense, radiological associations, and foundations. Also mentioned are those imaging research conducted without formal funding.