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Background: South Africa has the highest reported prevalence of fetal alcohol spectrum disorders (FASD) globally. The most recent study reported a weighted, estimated FASD prevalence of 310 per 1000 in a community in the Western Cape Province. Because there is as yet no reliable estimate of the national burden of FASD in South Africa, further epidemiological studies are needed in diverse settings. This paper reports on a multiyear, multisite FASD epidemiological study that took place from 2015 to 2022 at eight study sites in four provinces. Methods: The cross‐sectional epidemiological study used an active case‐ascertainment method, specifically in primary schools. All children were recruited when they were enrolled in Grade 1 at a participating school. All consented participants progressed through a tiered‐screening recruitment and diagnostic process. Results: Overall, 3033 children were included in the study. A total of 3001 children were screened for FASD in the first tier, with 1086 progressing to the second and 495 to the third tier. Of the 495 children referred, 475 were discussed during the final case conference. A total of 309 participants were diagnosed with FAS across the eight study sites. The highest reported prevalence was in the Northern Cape Province, with a rate of 199.3/1000 (95% CI, 147.6–251) using all eligible participants as the denominator. The lowest prevalence was in the Eastern Cape Province, with a rate of 57.4/1000 (95% CI, 36.5–78.3). The pooled FAS prevalence for the eight study sites was 80.2/1000 (95% CI, 70.4–89.9). Conclusions: As with previous studies, we found a concerningly high prevalence of FASD in South Africa. Given the scope of the problem it should be a high priority for health and welfare services to address. [ABSTRACT FROM AUTHOR]

International carbon allocation confronts the conflict between efficiency and equality. Previous research based on the intergroup bias perspective has attributed carbon allocation preference to the defence of ingroup interests (i.e., national interests) while overlooking the critical role of trade‐offs between competing moral values. Integrating the contingency theory of justice and moral philosophical theories of utilitarianism and egalitarianism, we proposed that the moral‐values trade‐off between utilitarianism and egalitarianism determines carbon allocation preference through justice reasoning. Analysis of large‐scale survey datasets (Study 1) revealed that aggregated national endorsement of utilitarianism over egalitarianism predicted greater efficiency preference in total and per capita carbon emission levels. Study 2 demonstrated that experimentally manipulating endorsement of utilitarianism versus egalitarianism boosted efficiency (vs. equality) preference in carbon allocation, and justice reasoning characterized by enhanced efficiency‐focused justice and diminished equality‐focused justice accounted for these effects. Using a 'manipulation‐of‐mediator' design, Study 3 further confirmed the causal link in the mediation model. By highlighting the significance of moral trade‐offs in shaping carbon allocation preference, this research not only provides a novel moral perspective in understanding debates on international carbon allocation but also has important implications for fostering international carbon abatement cooperation. [ABSTRACT FROM AUTHOR]

Competition usually exists in groups in everyday interactions, but how children allocate according to competition outcomes (e.g., merit‐based allocation) after intergroup competition and the difference in children's allocations of rewards between interpersonal and intergroup competition remain unclear. Children aged 3–8 years were asked to complete interpersonal or intergroup competitive games and were further asked to allocate rewards between themselves and their partners (Study 1) or between their group and the other group (Studies 2 and 3) and to reason about their decisions. We found that after interpersonal competition, children tended to conduct merit‐based allocations when they won but were more inclined to conduct equal allocations when they lost; after intergroup competition, children were more inclined to make equal allocations regardless of whether they won or lost, only less than half of children followed meritorious principles. However, children conducted more merit‐based allocations with age after both interpersonal and intergroup competitions. In addition, children showed less bias towards their own side after intergroup competition than after interpersonal competition. Finally, they demonstrated an earlier proclivity towards being influenced by winning outcomes than by losing outcomes after interpersonal competition, whereas a converse tendency was found after intergroup competition. [ABSTRACT FROM AUTHOR]

Background: Empowering Veterans to age in place is a Department of Veterans Affairs priority. Family or unpaid caregivers play an important role in supporting Veterans to achieve this goal. Effectively meeting the needs of Veterans and caregivers requires identifying unmet needs and relevant gaps in resources to address those needs. Methods: Using a modified Socio‐Ecological Model, we developed a prospective longitudinal panel design survey. We randomly selected 20,000 community‐dwelling Veterans enrolled in the Veterans Health Administration (VHA), across five VHA sites. We oversampled Veterans with a higher predicted 2‐year long‐term institutional care (LTIC) risk. Veterans were mailed a packet containing a Veteran survey and a caregiver survey, to be answered by their caregiver if they had one. The Veteran survey assessed the following health‐related domains: physical, mental, social determinants of health, and caregiver assistance. Caregivers completed questions regarding their demographic factors, caregiving activities, impact of caregiving, use of VA and non‐VA services, and caregiver support resources. Follow‐up surveys will be repeated twice at 12‐month intervals for the same respondents. This article describes the HERO CARE survey protocol, content, and response rates. Results: We received responses from 8,056 Veterans and 3,579 caregivers between July 2021 and January 2022, with 95.6% being received via mail. Veteran respondents were mostly males (96.5%), over 65 years of age (94.9%), married (55.0%), Non‐Hispanic White (75.2%), and residing in urban areas (80.7%). Conclusions: This longitudinal survey is unique in its comprehensive assessment of domains relevant to older Veterans stratified by LTIC risk and their caregivers, focusing on social determinants, caregiver support, and the use of caregiver support resources. Survey data will be linked to Centers for Medicare & Medicaid Services and VA data. The results of this study will inform better planning of non‐institutional care services and policy for Veterans and their caregivers. [ABSTRACT FROM AUTHOR]

Background: Involving consumers in systematic reviews can make them more valuable and help achieve goals around transparency. Systematic reviews are technically complex and training can be needed to enable consumers to engage with them fully. The Cochrane Common Mental Disorders group sought to engage people with lived experience of mental health problems in the Voice of Experience College, three workshops introducing them to systematic review methods and to opportunities to contribute as Cochrane consumers. We aimed to collectively evaluate the College from the perspective of both facilitators and consumers, to critically reflect on the experience, and to identify how the College could be sustained and spread to other review groups. Methods: This study was a longitudinal qualitative and collaborative evaluation, structured around normalisation process theory. Both facilitators and consumers were involved in not only providing their perspectives but also reflecting on these together to identify key learning points. Results: The workshops were positively evaluated as being engaging and supportive, largely due to the relational skills of the facilitators, and their willingness to engage in joint or two‐way learning. The College suffered from a lack of clarity over the role of consumers after the College itself, with a need for greater communication to check assumptions and clarify expectations. This was not achieved due to pandemic disruptions, which nevertheless demonstrated that resources for involvement were not prioritised as core business during this period. Conclusions: Soft skills around communication and support are crucial to effective consumer engagement. Sustaining involvement requires sustained communication and opportunities to reflect together on opportunities and challenges. This requires committed resources to ensure involvement activity is prioritised. This is critical as negative experiences later in the involvement journey can undermine originally positive experiences if contributors are unclear as to what their involvement can lead to. Open discussions about this are necessary to avoid conflicting assumptions. The spread of the approach to other review groups could be achieved by flexibly adapting to group‐specific resources and settings, but maintaining a core focus on collaborative relationships as the key mechanism of engagement. Patient and Public Contribution: Public contributors were collaborators throughout the evaluation process and have co‐authored the paper. [ABSTRACT FROM AUTHOR]

Previous studies examining the relationship between ingroup bias and resource scarcity have produced heterogeneous findings, possibly due to their focus on the allocation of positive resources (e.g. money). This study aims to investigate whether ingroup bias would be amplified or eliminated when perceived survival resources for counteracting negative stimuli are scarce. For this purpose, we exposed the participants and another confederate of the experimenters (ingroup/outgroup member) to a potential threat of unpleasant noise. Participants received some 'relieving resources' to counteract noise administration, the amount of which may or may not be enough for them and the confederate in different conditions (i.e. abundance vs. scarcity). First, a behavioural experiment demonstrated that intergroup discrimination manifested only in the scarcity condition; in contrast, the participants allocated similar amounts of resource to ingroup and outgroup members in the abundance condition, indicating a context‐dependent allocation strategy. This behavioural pattern was replicated in a follow‐up neuroimaging experiment, which further revealed that when contrasting scarcity with abundance, there was higher activation in the anterior cingulate cortex (ACC) as well as stronger functional connectivity of the ACC with the empathy network (including the temporoparietal junction and medial prefrontal cortex) for ingroup compared to outgroup members. We suggest that ACC activation reflects the mentalizing process toward ingroup over outgroup members in the scarcity condition. Finally, the ACC activation level significantly predicted the influence of resource scarcity on ingroup bias in hypothetical real‐life situations according to a follow‐up examination. [ABSTRACT FROM AUTHOR]

Socioeconomic position is often determined by uncontrollable, structural factors, yet people from the United States tend to attribute wealth and poverty to individual control. However, information about behavioural correlates of such beliefs across development is relatively lacking. Thus, we examined adolescents' reasoning about the causes of inequality in a sample of 599 adolescents from a socioeconomically, ethnically, and racially diverse middle school (grades 6–8). Additionally, early adolescents were presented with two novel groups with an unexplained wealth disparity and given a task in which they could perpetuate or rectify inequality. We found that while adolescents tended to give equitably and rectify the inequality, this outcome was predicted by the type of explanation they gave for societal inequality. Furthermore, participants' socioeconomic status and sexual identity predicted their inequality explanations. These results add to our knowledge of adolescent reasoning about inequality by demonstrating a potential link between attributions for inequality and giving behaviour. [ABSTRACT FROM AUTHOR]

The health sector plays an important role in the delivery of high‐quality nutrition interventions to women and children in low‐ and middle‐income countries (LMICs). However, there are no standardized approaches to defining and measuring nutrition service quality in these contexts. This study aims to systematically develop quality of care indices for direct health systems nutrition interventions using a five‐step process: (1) identify recommended interventions for inclusion in indices, (2) extract service readiness, provision of care, and experience of care items from intervention‐specific clinical guidelines, (3) map items to data available in global health facility surveys, (4) conduct an expert survey to prioritize interventions and items, and (5) use findings from previous steps to propose quality of care metrics. Thirty‐two recommended interventions were identified, for which the guidelines review yielded 763 unique items that were reviewed by experts. The proposed nutrition quality of care indices for pregnant women reflects eight interventions and the indices for children under 5 reflects six interventions. The indices provide a standardized measure for nutrition intervention quality and can be operationalized using existing health facility assessment data, facilitating their use by LMIC decision makers for planning and resource allocation. [ABSTRACT FROM AUTHOR]

Background: One of the core ethical principles in the Norwegian welfare state is the principle of justice; all citizens should have equal access to healthcare services, including nursing homes, independent of where they live, socioeconomic status or age. Patients who apply for a permanent place in a nursing home are among society's most vulnerable. Hence, it is of great importance that the process of nursing home placement is just. The purpose of this study was to explore which criteria and values allocation of nursing home placements are built on, and whether the process is just. Methods: The study has a qualitative design. Data were collected through individual interviews and observation. Executive officers in different municipalities who have the formal responsibility for the placements, and GPs and nurses on short‐term wards in nursing homes were interviewed. In addition, one of the researchers observed meetings where allocation of municipal healthcare services was discussed. Results: Healthcare personnel in primary health care mainly agree on which criteria are the most important in order to safeguard the principle of justice. However, some unintended and less highlighted factors could jeopardise the ideal of fair and just allocation. Some of these were organizational variations, variations in the municipalities' economy, variations in individual judgments and resourceful and strong‐willed relatives. Conclusions: Our study indicates that some of the weakest and most vulnerable patients in the Norwegian society are not treated equally. In order to safeguard the principle of justice, specific national criteria should be used in allocation of nursing home placements. However, national criteria are not enough. We suggest that in addition to guiding criteria, the unintended factors should be given more attention and focus on how to control them in a better way. [ABSTRACT FROM AUTHOR]

Characterizing the leadership in research is important to revealing the interaction pattern and organizational structure through research collaboration. This research defines the leadership role based on the corresponding author's affiliation, and presents the first quantitative research on the factors and evolution of 5 proximity dimensions (geographical, cognitive, institutional, social, and economic) of research leadership. The data to capture research leadership consist of a set of multi‐institution articles in the fields of "Life Sciences & Biomedicine," "Technology," "Physical Sciences," "Social Sciences," and "Humanities & Arts" during 2013–2017 from the Web of Science Core Citation Database. A Tobit regression‐based gravity model indicates that the mass of research leadership of both the leading and participating institutions and the geographical, cognitive, institutional, social, and economic proximities are important factors for the flow of research leadership among Chinese institutions. In general, the effect of these proximities for research leadership flow has been declining recently. The outcome of this research sheds light on the leadership evolution and flow among Chinese institutions, and thus can provide evidence and support for grant allocation policies to facilitate scientific research and collaborations. [ABSTRACT FROM AUTHOR]

Aim: To estimate healthcare use and related costs for 2-year-old very preterm (VP) children after discharge from the neonatal unit.Methods: As part of a European project, we recruited an area-based cohort including all VP infants born in three Italian regions (Lazio, Emilia-Romagna and Marche) in 2011-2012. At 2 years corrected age, parents completed a questionnaire on their child health and healthcare use (N = 732, response rate 75.6%). Cost values were assigned based on national reimbursement tariffs. We used multivariable analyses to identify factors associated with any rehospitalisation and overall healthcare costs.Results: The most frequently consulted physicians were the paediatrician (85% of children), the ophthalmologist (36%) and the neurologist/neuropsychiatrist (26%); 38% of children were hospitalised at least once after the initial discharge, for a total of 513 admissions and over one million euros cost, corresponding to 75% of total healthcare costs. Low maternal education and parental occupation index, congenital anomalies and postnatal prematurity-related morbidities significantly increased the risk of rehospitalisation and total healthcare costs.Conclusion: Rehospitalisation and outpatient care are frequent in VP children, confirming a substantial health and economic burden. These findings should inform the allocation of resources to preventive and rehabilitation services for these children. [ABSTRACT FROM AUTHOR]

Newborn infants are among those most severely affected by humanitarian crises. Aid organisations increasingly recognise the necessity to provide for the medical needs of newborns, however, this may generate distinctive ethical questions for those providing humanitarian medical care. Medical ethical approaches to neonatal care familiar in other settings may not be appropriate given the diversity and volatility of humanitarian disasters, and the extreme resource limitations commonly faced by humanitarian aid missions. In this paper, we first systematically review existing guidelines relating to the treatment and resuscitation of newborns in humanitarian crises, finding little substantive ethical guidance for those providing humanitarian healthcare. We next draw on paradigm cases and published literature to identify and describe some of the major ethical questions common to these settings. We divide these questions into quality of life considerations, allocation of limited resources, and conflicting cultural norms and values. We finally suggest some preliminary recommendations to guide ethical decision-making around resuscitation of newborns and withdrawal of treatment in humanitarian settings. [ABSTRACT FROM AUTHOR]

Context: Engaging underrepresented communities in health research priority setting could make the scientific agenda more equitable and more responsive to their needs. Objective: Evaluate democratic deliberations engaging minority and underserved communities in setting health research priorities. Methods: Participants from underrepresented communities throughout Michigan (47 groups, n = 519) engaged in structured deliberations about health research priorities in professionally facilitated groups. We evaluated some aspects of the structure, process, and outcomes of deliberations, including representation, equality of participation, participants' views of deliberations, and the impact of group deliberations on individual participants' knowledge, attitudes, and points of view. Follow‐up interviews elicited richer descriptions of these and also explored later effects on deliberators. Results: Deliberators (age 18‐88 years) overrepresented minority groups. Participation in discussions was well distributed. Deliberators improved their knowledge about disparities, but not about health research. Participants, on average, supported using their group's decision to inform decision makers and would trust a process like this to inform funding decisions. Views of deliberations were the strongest predictor of these outcomes. Follow‐up interviews revealed deliberators were particularly struck by their experience hearing and understanding other points of view, sometimes surprised at the group's ability to reach agreement, and occasionally activated to volunteer or advocate. Conclusions: Deliberations using a structured group exercise to engage minority and underserved community members in setting health research priorities met some important criteria for a fair, credible process that could inform policy. Deliberations appeared to change some opinions, improved some knowledge, and were judged by participants worth using to inform policymakers. [ABSTRACT FROM AUTHOR]

BACKGROUND: Farm‐to‐school interventions are recommended strategies to improve dietary behaviors among school‐aged children. Tools are needed to assess community readiness and capacity to optimize farm‐to‐school implementation. The objective of this study was to identify and prioritize factors to inform tailored farm‐to‐school implementation by practitioners working in diverse contexts. METHODS: Practitioners and community residents (N = 194) participated in semistructured interviews (N = 18) and focus groups (N = 23). Thematic analysis was conducted to identify themes and subthemes influencing farm‐to‐school implementation. The subthemes were operationalized into measureable indicators. The themes and their associated indicators were prioritized through a consensus conference with an expert panel (N = 18). RESULTS: The qualitative data analysis and consensus conference yielded 4 themes and 17 indicators associated with community readiness and capacity to implement farm‐to‐school. The themes represent school capacity, networks and relationships, organizational and practitioner capacity, and community resources and motivations. CONCLUSIONS: Findings highlight a range of indicators of community readiness and capacity needed to support farm‐to‐school implementation. Results offer guidance for tailoring intervention delivery based on levels of community, school, practitioner, and organizational readiness and capacity. [ABSTRACT FROM AUTHOR]

Abstract: The aim of the study was to describe the telephone nurses' experiences of encountering callers with mental illnesses. Telenursing services are solely staffed with telenurses, who with the support of a decision support system (CDSS) independently triage callers based on the severity of the main symptoms presented by the care seeker. The system focuses on somatic symptoms, while information regarding mental health and mental illnesses is limited. Information about telenurses' experiences of encountering care seekers with mental illnesses is scarce, despite the increase in mental illnesses in the population. The study used a descriptive design with a qualitative approach. Twenty telenurses were interviewed, and the data were then analysed using inductive qualitative content analysis. The results are elaborated in the following three categories: (i) Experiences of encountering care seekers with mental illnesses; (ii) Experiences of facing difficulties and challenges; and (iii) Experiences of facing dissatisfaction and threats. Encountering care seekers with mental illnesses is metaphorically addressed as ‘when all other doors are closed’. Encountering care seekers with mental illnesses was perceived as time‐consuming and did not adequately correspond to the resources given by the service. Even though telenurses strive to achieve agreement, there is a collision between human needs and organizational structures. The study pinpoints the lack of resources for and education about mental illnesses and the limitations of the decision system, which needs to be updated in order to provide all care seekers care on equal terms. [ABSTRACT FROM AUTHOR]

Background: Health‐care expenditure is rapidly increasing in Australia with increasing pressure on health‐care services to review processes, improve efficiency and ensure equity in service delivery. The nursing profession have improved efficiency and patient care by investigating time‐use to describe current practice and support development of workforce planning models. There is, however, a lack of information to understand factors that impact on occupational therapists time‐use in the clinical setting impacting the development of workforce planning models which adapt occupational therapy service delivery to match resources with demand. The objective of this review was to systematically identify known factors which impact on occupational therapists time‐use in the clinical setting. Method: A systematic review of Medline, PsycINFO and CINAHL databases and grey literature was completed in September 2016. Two authors independently screened studies for inclusion and quality was evaluated using the Downs and Black scale. Variables impacting on occupational therapists time‐use were categorised and thematically analysed to synthesise key themes. Results: Twenty studies met the inclusion criteria and were included in the review. Three key categories of factors influencing time‐use were identified. These were: patient‐related factors (e.g. level of function, therapy required, type, complexity of injury), therapist‐related factors (e.g. experience, clinical vs non‐clinical responsibility), and organisational‐related factors (e.g. workplace characteristics, availability of staff, presence of students). Conclusion: Occupational therapist time‐use in clinical settings is complex and difficult to quantify in research. How occupational therapists spend their time is impacted by a number of patient, clinician and service related factors reflecting the breadth of occupational therapy practice and client‐centred nature of the profession. [ABSTRACT FROM AUTHOR]

Objective: To assess the availability of key resources for the management of maternal sepsis and evaluate the feasibility of implementing the Surviving Sepsis Campaign (SSC) recommendations in Malawi and other low-resource settings.Methods: A cross-sectional study was conducted at health facilities in Malawi, other low-income countries, and lower-middle-income countries during January-March 2016. English-speaking healthcare professionals (e.g. doctors, nurses, midwives, and administrators) completed a questionnaire/online survey to assess the availability of resources for the management of maternal sepsis.Results: Healthcare centers (n=23) and hospitals (n=13) in Malawi showed shortages in the resources for basic monitoring (always available in 5 [21.7%] and 10 [76.9%] facilities, respectively) and basic infrastructure (2 [8.7%] and 7 [53.8%], respectively). The availability of antibiotics varied between Malawian healthcare centers (9 [39.1%]), Malawian hospitals (8 [61.5%]), hospitals in other low-income countries (10/17 [58.8%]), and hospitals in lower-middle-income countries (39/41 [95.1%]). The percentage of SSC recommendations that could be implemented was 33.3% at hospitals in Malawi, 30.3% at hospitals in other low-income countries, and 68.2% at hospitals in lower-middle-income countries.Conclusion: The implementation of existing SSC recommendations is unrealistic in low-income countries because of resource limitations. New maternal sepsis care bundles must be developed that are applicable to low-resource settings. [ABSTRACT FROM AUTHOR]

Background Public sources fund the majority of UK infection research, but citizens currently have no formal role in resource allocation. To explore the feasibility and willingness of citizens to engage in strategic decision making, we developed and tested a practical tool to capture public priorities for research. Method A scenario including six infection themes for funding was developed to assess citizen priorities for research funding. This was tested over two days at a university public festival. Votes were cast anonymously along with rationale for selection. The scenario was then implemented during a three-hour focus group exploring views on engagement in strategic decisions and in-depth evaluation of the tool. Results 188/491(38%) prioritized funding research into drug-resistant infections followed by emerging infections(18%). Results were similar between both days. Focus groups contained a total of 20 citizens with an equal gender split, range of ethnicities and ages ranging from 18 to >70 years. The tool was perceived as clear with participants able to make informed comparisons. Rationale for funding choices provided by voters and focus group participants are grouped into three major themes: (i) Information processing; (ii) Knowledge of the problem; (iii) Responsibility; and a unique theme within the focus groups (iv) The potential role of citizens in decision making. Divergent perceptions of relevance and confidence of 'non-experts' as decision makers were expressed. Conclusion Voting scenarios can be used to collect, en-masse, citizens' choices and rationale for research priorities. Ensuring adequate levels of citizen information and confidence is important to allow deployment in other formats. [ABSTRACT FROM AUTHOR]

Objective Describe the rates of CPR/ AED training in high schools in the state of Washington after passage of legislation mandating CPR/ AED training. Design and Sample A web-based survey was sent to administrators at 660 public and private high schools in the state of Washington. Results and Conclusions The survey was completed by 148 schools (22%); 64% reported providing CPR training and 54% provided AED training. Reported barriers to implementation included instructor availability, cost, and a lack of equipment. Descriptive statistics were used to describe the sample characteristics and implementation rates. Mandates without resources and support do not ensure implementation of CPR/ AED training in high schools. Full public health benefits of a CPR mandate will not be realized until barriers to implementation are identified and eliminated through use of available, accessible public health resources. [ABSTRACT FROM AUTHOR]

Objectives To explore how older adults in the community with a limited life expectancy make healthcare decisions and the processes used when they are not in an acute crisis. Design Grounded theory. Setting Medical programs and geriatrics clinics at the University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center. Participants Community-dwelling adults aged 67 to 98 with a life expectancy of less than 1 year (N = 20). Measurements In-depth semistructured interviews in participants' homes. Constant comparative analysis was used to develop codes and identify themes. Results Participants generally delegated decisions to others, expressing their wishes by describing desired end-of-life outcomes and highlighting meaningful aspects of their lives. They did this in the belief that the delegate would make appropriate decisions on their behalf. In this way, participants were able to achieve a sense of control without being in control of decisions. Four themes emerged from the analysis that reflect the various approaches participants used to articulate their goals and maintain a sense of control: direct communication, third-party analogies, adaptive denial, and engaged avoidance. Conclusion These findings challenge the prevailing view of personal autonomy. These older adults suggest a path to decision-making that focuses on priorities and goals, allowing them to take a more-passive approach to decision-making while still maintaining a sense of control. [ABSTRACT FROM AUTHOR]

Aims To assess the direct costs of necessary consumables for minimal care of a child with Type 1 diabetes in countries where the public health system does not regularly provide such care. Methods Supply costs were collected between January 2013 and February 2015 from questionnaires submitted by centres requesting International Diabetes Federation Life for a Child Program support. All 20 centres in 15 countries agreed to the use of their responses. Annual costs for minimal care were estimated for: 18 × 10 ml 100 IU/ml insulin, 1/3 cost of a blood glucose meter, two blood glucose test strips/day, two syringes/week, and four HbA1c tests/year. Costs were expressed in US dollars, and as % of gross national income (purchasing power parity) per capita. Results The ranges (median) for the minimum supply costs through the private system were: insulin 10 ml 100 IU/ml equivalent vial: $5.10-$25 ($8.00); blood glucose meter: $15-$121 ($33.33); test strip: $0.15-$1.20 ($0.50); syringe: $0.10-$0.56 ($0.20); and HbA1c: $4.90-$20 ($9.75). Annual costs ranged from $255 (Pakistan) to $1,185 (Burkina Faso), with a median of $553. Annual % gross national income costs were 12-370% (median 56%). For the lowest 20% income earners the annual cost ranged 20-1535% (median 153%). St Lucia and Mongolia were the only countries whose governments consistently provided insulin. No government provided meters and strips, which were the most expensive supplies (62% of total cost). Conclusions In less-resourced countries, even minimal care is beyond many families' means. In addition, families face additional costs such as consultations, travel and indirect costs. Action to prevent diabetes-related death and morbidity is needed. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to examine the fairness consideration of the cost-effectiveness ratio (CER) approach, compared with other prioritization approaches. The study developed and tested a questionnaire to ask participants about their selected prioritization approaches using a dichotomous choice technique. Results showed that majority of the students prioritized cost-effectiveness second after minimum health.

Rationale, aims and objectives The debate about whether to dedicate funds to rare diseases ( RD) may hinge on the existence of a societal preference for prioritizing rarity. There are scarce studies about the interest of doctors and general society in RD. Method Four groups of future health and non-health professionals were surveyed in a region of Spain to evaluate their opinion on RD. Questions of the study were organized into four groups: general knowledge on RD, prioritization of research of RD, willingness to assign resources to RD and real distribution of resources to RD. Results A total of 234 students were surveyed. The mean age of the whole study population was 24.0 years and the 83.3% were female. Only around 25% of the survey sample knew the definitions of RD and orphan drugs. Questions related to willingness to assign resources to RD did not reveal statistically significant differences between study groups. Seventy-three per cent considered that the majority of the budget should be used to treat common diseases. However, resident doctors recognized that they have neither experience nor time to diagnose and treat RD. Conclusion Although resident doctors have a little more general knowledge on RD than other surveyed groups, health and non-health future professionals have a low general knowledge on this topic and none of them prioritized the assignment of funds to RD. [ABSTRACT FROM AUTHOR]

Objective To investigate how participants in an economic resource allocation survey construct notions of fairness. Design Qualitative interview study guided by interpretive grounded theory methods. Setting and participants Qualitative interviews were conducted with volunteer university- ( n = 39) and community-based ( n = 7) economic survey participants. Intervention or main variables studied We explored how participants constructed meanings to guide or explain fair survey choices, focusing on rationales, imagery and additional desired information not provided in the survey scenarios. Main outcome measures Data were transcribed and coded into qualitative categories. Analysis iterated with data collection iterated through three waves of interviews. Results Participants compared the survey dilemmas to domains outside the health system. Most compared them with other micro-level, inter-personal sharing tasks. Participants raised several fairness-relevant factors beyond need or capacity to benefit. These included age, weight, poverty, access to other options and personal responsibility for illness; illness duration, curability or seriousness; life expectancy; possibilities for sharing; awareness of other's needs; and ability to explain allocations to those affected. They also articulated a fairness principle little considered by equity theories: that everybody must get something and nobody should get nothing. Discussion and conclusions Lay criteria for judging fairness are myriad. Simple scenarios may be used to investigate lay commitments to abstract principles. Although principles are the focus of analysis and inference, participants may solve simplified dilemmas by imputing extraneous features to the problem or applying unanticipated principles. These possibilities should be taken into account in the design of resource allocation surveys eliciting the views of the public. [ABSTRACT FROM AUTHOR]

Context The responsiveness of NIH (National Institutes of Health) funding to disease burden is a long-standing issue of policy interest. Previous analyses of this issue have been hindered by data constraints, have not specified channels through which the NIH funding process could be responsive to disease considerations, and have not examined differences across NIH institutes and centers. Methods We collected data from the NIH's new RCDC (Research, Condition, and Disease Categorization) database on funding for 107 diseases in 2008 and linked these to data on deaths and hospitalizations for these diseases. We used RCDC data and information from another NIH database-RePORTER-to determine institute-specific funding for these diseases and also funding by award type. We used these data to examine the overall responsiveness of NIH funding to disease burden, within-institute responsiveness, and the responsiveness of different types of NIH awards. Findings Overall, we found a strong and statistically significant relationship between NIH funding and deaths and hospitalizations associated with a disease. We detected some evidence that more 'applied' grant mechanisms-in particular, funding for clinical trials-are more responsive than other types of funding. We also found evidence of differences across institutes in their extent of responsiveness. Conclusions Overall, the data suggest that NIH funding is responsive to the two measures of disease burden. More applied grant mechanisms also may serve as 'safety valves' in the allocation process, allowing Congress, disease advocacy groups, and others to apply pressure to address particular health priorities in a more fine-grained way than is possible through investigator-initiated 'basic' research grants alone. [ABSTRACT FROM AUTHOR]

Recent work provides evidence that expectations regarding a fair (i.e., equal) distribution of goods and resources arise sometime in the second year of life. To investigate the developmental trajectory of fairness expectations, and their potential relation to prosocial behavior, infants participated in a violation-of-expectancy (VOE) paradigm designed to assess expectations regarding how resources are typically distributed, and in a sharing task, an informational helping task, and an instrumental helping task. Infants' expectations regarding resource distribution showed age-related changes between 12 and 15 months, with only 15-month-old infants showing greater attention to unfair (unequal) over fair (equal) outcomes in the VOE. Individual differences in infants' sensitivity to unfair outcomes were related to infants' willingness to share a preferred toy. In contrast, helping behavior was unrelated to infants' sensitivity to unfair outcomes and did not vary according to whether infants shared a preferred or non-preferred toy during the sharing task. Our findings suggest a developmental transition in expectations regarding how resources are distributed from 12 to 15 months of age, linked to infants' sharing behavior, suggesting that such expectations are learned through experience. Our results also contribute to the ongoing discussion regarding how best to assess the construct of prosociality in infancy. [ABSTRACT FROM AUTHOR]

Relatively little public opinion research has explored beliefs about consumption. This lack of research is surprising given the increasing attention paid by many commentators to the relationship between consumption and ecological sustainability. Reporting on data collected from a series of five statewide surveys of Oregonians conducted between 2008 and 2009, we find that a strong majority (74-88%) of the Oregon public supports reducing consumption and believes doing so would improve societal and individual well-being. These findings appear to challenge conventional wisdom about our collective and never-ending need for consumption of material goods. Our results reveal broad agreement on the consumption issue across traditional ideological divides. We also conducted in-depth qualitative interviews, which allowed us to explore what 'consumption' means to Oregonians and why people think our country would be better off if we reduced consumption. Our findings suggest that populist attitudes toward reducing consumption may fill a role that policymakers avoid for a variety of reasons. We discuss the relevance of consumption beliefs to public policy aimed at reducing greenhouse gas ( GHG) emissions, as well as directions for future research. [ABSTRACT FROM AUTHOR]

The aim of this paper was to compare published studies of care interventions for the management and promotion of continence, with urinary incontinence as the primary focus, in older care home residents. Incontinence is a prevalent and serious problem amongst older people in care homes, with an increasing international focus. MEDLINE and CINAHL searches via OVID (January 1966 to May 2010) were carried out, with studies limited to English language publications only. Included in this search were studies investigating urinary and fecal incontinence in people aged 65 years or older in care homes. Studies on surgical or pharmacological interventions or fecal incontinence alone were excluded. A total of 33 interventional studies were identified. Toileting programs and incontinence pads are the mainstays of treatment, with some studies implying significant economic and labor costs. Drug therapy as an adjunct to toileting programs has so far shown only moderate benefits. Combined physical therapy/behavioral therapies have shown effective short-term improvements. Adaptations to physical environment and staff training techniques might also be paramount. Exercise and Functional Incidental Training programs, although expensive, might provide additional benefit by reducing wetness rates and improving appropriate toileting rates. Combined complex behavioral interventions are now a common feature and their effectiveness for the management of urinary incontinence should be determined in future studies. Studies including long-term effectiveness on maintaining continence with full economic evaluation are also warranted in this population. Geriatr Gerontol Int 2012; 12: ••-••. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to define an improved classification for allocating incentives to support the recruitment and retention of doctors in rural Australia. Design and setting: Geo-coded data (n = 3636 general practitioners (GPs)) from the national Medicine in Australia: Balancing Employment and Life study were used to examine statistical variation in four professional indicators (total hours worked, public hospital work, on call after-hours and difficulty taking time off) and two non-professional indicators (partner employment and schooling opportunities) which are all known to be related to difficulties with recruitment and retention. Main outcome measures: The main outcome measure used for the study was an association of six sentinel indicators for GPs with practice location and population size of community. Results: Four distinct homogeneous population size groups were identified (0-5000, 5001-15 000, 15 001-50 000 and >50 000). Although geographical remoteness (measured using the Australian Standard Geographical Classification - Remoteness Areas (ASGC-RA)) was statistically associated with all six indicators (P < 0.001), population size provided a more sensitive measure in directing where recruitment and retention incentives should be provided. A new six-level rurality classification is proposed, based on a combination of four population size groups and the five ASGC-RA levels. A significant increase in statistical association is measured in four of six indicators (and a slight increase in one indicator) using the new six-level classification versus the existing ASGC-RA classification. Conclusions: This new six-level geographical classification provides a better basis for equitable resource allocation of recruitment and retention incentives to doctors based on the attractiveness of non-metropolitan communities, both professionally and non-professionally, as places to work and live. [ABSTRACT FROM AUTHOR]

XIAO LD. Nursing Inquiry 2010; 17: 208–220 Continuing nursing education policy in China and its impact on health equity The aim of this study was to evaluate the mandatory continuing nursing education (MCNE) policy in China and to examine whether or not the policy addresses health equity. MCNE was instituted in 1996 in China to support healthcare reform was to include producing greater equity in health-care. However, the literature increasingly reports inequity in participation in MCNE, which is likely to have had a detrimental effect on the pre-existing discrepancies of education in the nursing workforce, and thereby failing to really address health equity. Despite a growing appeal for change, there is lack of critical reflection on the issues of MCNE policy. Critical ethnography underpinned by Habermas’ Communicative Action Theory and Giddens’ Structuration Theory were used to guide this study. Findings are presented in four themes: (i) inaccessibility of learning programs for nurses; (ii) undervaluation of workplace-based learning; (iii) inequality of the allocation of resources; and (iv) demands for additional support in MCNE from non-tertiary hospitals. The findings strongly suggest the need for an MCNE policy review based on rational consensus with stakeholders while reflecting the principles of health equity. [ABSTRACT FROM AUTHOR]

This study represents a first attempt at estimating Danish resource allocation to brain research including both public and private spending. It appears that private spending is at a reasonable level because a highly developed Danish pharmaceutical industry invests significantly in this branch of science. However, public spending is at a low level compared with several other European countries with a similar economic status. As for other European countries the funding is very low compared with the USA. Dedicated national investigations of the resource allocation to different branches of biomedical research are warranted. Brain research should of course be an important part of such studies. The USA and the European Union have selected brain research as one of their priority areas within health-related research. The present figures indicate that this is highly justified and should be copied in Denmark and in all other European countries. [ABSTRACT FROM AUTHOR]

The author reflects on a research about resource allocation to brain research in Europe. He stresses that the study clearly demonstrates public funding of brain research in Denmark is insufficient. He also suggests that neurological society should explain to the legislators that increased public investment in brain research is to be highly cost-effective.