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BACKGROUND: A myriad of federal, state, and organizational policies are designed to improve access to evidence-based healthcare, but the impact of these policies likely varies due to contextual determinants of, reinterpretations of, and poor compliance with policy requirements throughout implementation. Strategies enhancing implementation and compliance with policy intent can improve population health. Critically assessing the multi-level environments where health policies and their related health services are implemented is essential to designing effective policy-level implementation strategies. California passed a 2019 health insurance benefit mandate requiring coverage of fertility preservation services for individuals at risk of infertility due to medical treatments, in order to improve access to services that are otherwise cost prohibitive. Our objective was to document and understand the multi-level environment, relationships, and activities involved in using state benefit mandates to facilitate patient access to fertility preservation services. METHODS: We conducted a mixed-methods study and used the policy-optimized exploration, preparation, implementation, and sustainment (EPIS) framework to analyze the implementation of Californias fertility preservation benefit mandate (SB 600) at and between the state insurance regulator, insurer, and clinic levels. RESULTS: Seventeen publicly available fertility preservation benefit mandate-relevant documents were reviewed. Interviews were conducted with four insurers; 25 financial, administrative, and provider participants from 16 oncology and fertility clinics; three fertility pharmaceutical representatives; and two patient advocates. The mandate and insurance regulator guidance represented two Big P (system level) policies that gave rise to a host of little p (organizational) policies by and between the regulator, insurers, clinics, and patients. Many little p policies were bridging factors to support implementation across levels and fertility preservation service access. Characterizing the mandates functions (i.e., policy goals) and forms (i.e., ways that policies were enacted) led to identification of (1) intended and unintended implementation, service, and patient outcomes, (2) implementation processes by level and EPIS phase, (3) actor-delineated key processes and heterogeneity among them, and (4) inner and outer context determinants that drove adaptations. CONCLUSIONS: Following the midstream and downstream implementation of a state health insurance benefit mandate, data generated will enable development of policy-level implementation strategies, evaluation of determinants and important outcomes of effective implementation, and design of future mandates to improve fit and fidelity.

Systemic reform is needed to address racism as a root cause of mental health inequities, such as understanding how community mental health (CMH) agencies' practices and policies may impact care provided to racially minoritized populations. This study described and examined associations between CMH clinicians' multicultural knowledge and awareness and agency practices and policies to improve care for Clients of Color. CMH clinicians (N = 119) across Washington State reported on their multicultural competence and agencies' practices and policies in an online survey. Multicultural competence was assessed with the Multicultural Counseling Knowledge and Awareness Scale (MCKAS), which assesses respondents' knowledge of multicultural counseling frameworks and awareness of multicultural counseling issues. Agency policies were examined with an adapted version of the Multiculturally Competent Service System (MCSS) Assessment Guide, which asked respondents to endorse the degree to which their agencies had taken specific steps to better serve racially and ethnically minoritized populations across 11 domains, including policies, linguistic diversity in services, and quality monitoring and improvement. Multicultural knowledge and awareness were generally high across the sample. Clinicians commonly endorsed that their agencies had mission statements that were committed to cultural competence. Endorsement of concrete steps to improve services for non-English speaking clients was associated with greater multicultural knowledge and awareness, and practices to monitor and improve care provided to Clients of Color were associated with lower scores. Addressing mental health inequities requires multifaceted solutions. Results highlight the potential of examining agency practices and policies as one solution to improve care for Clients of Color. [ABSTRACT FROM AUTHOR]

This study adopts the multidimensional concept of workplace age-friendliness as reflecting the extent to which organizations maintain age-related organizational values, policies, practices, and climates that support the employability needs of older workers. Using responses from 1,893 employees working in 32 organizations from seven economic sectors in Israel who evaluated their organizations, we examine a novel conceptual model of the joint role of organizational ageism, inter-age contact, and organizational values in the formation of workplace age-friendliness. Multilevel multivariate analysis using a general linear mixed model demonstrated differential involvement of these variables in the formation of workplace age-friendliness: A significant negative association was found between organizational ageism and all dimensions of workplace age-friendliness, while inter-age contact was found to have a positive albeit a moderate association with part of its dimensions. Of the types of organizational cultures examined, a significant positive linkage was found between clan culture and all dimensions of workplace age-friendliness, whereas its associations with other cultural environments were less prominent or comprehensive. The theoretical and practical implications of these findings discussed here may serve policymakers and enrich both age-related organizational research and approaches with an evolving positive organizational perspective towards work in older age. [ABSTRACT FROM AUTHOR]

Objective: Emotional exhaustion (EE)-the first stage of burnout-is related to preventable work environment exposures. We examined the understudied impact of organizational support for safety (OSS) and safety hazards (SH) on EE in a mixed licensed and unlicensed population of healthcare workers (HCWs). Methods: A work environment exposures survey was conducted in five US public healthcare facilities in 2018-2019. A total of 1059 questionnaires were collected from a predominantly female population of mixed HCWs. Results: Mean EE scores were higher among women, direct care workers, and younger subjects. In linear regression models, EE was positively associated with SH, emotional labor, psychological demands, physical demands, job strain, assault, and negative acts, while OSS was negatively associated. Safety hazard s both mediated and moderated the relationship between OSS and EE. Conclusions: When perception of SH is high, OSS has less impact on reducing EE, suggesting a need to effectively put safety policies to practice for improving EE in HCWS. [ABSTRACT FROM AUTHOR]

Academic labor has expanded beyond the walls of academic institutions. Academics are expected to communicate with students online, use digital tools to complete their work, and share their research with broad audiences—often through online spaces like social media. Academics also face technology-facilitated violence and abuse (TFVA) in these same spaces. When this happens, employers have a responsibility to protect and support workers. However, recent events have shown that universities are not always prepared to do so. We use data from a discourse analysis of harassment and discrimination policies and interviews with university managers (including Vice President Academics/Provost, Faculty Deans, and directors of human rights offices) to examine how prepared Canadian universities and colleges are to support academics targeted by TFVA. We found that institutions are unprepared in three ways: first, they focus on physical safety over non-contact harms; second, they envision perpetrators to be named, local, and part of the campus community; and third, the reporting process is cumbersome and outpaced by the speed and frequency with which TFVA occurs. We consider these findings in the context of work-overflow and context collapse to demonstrate how the institutional apparatus for maintaining a safe and respectful working environment has not expanded in kind with the extensification of contemporary academic labor. [ABSTRACT FROM AUTHOR]

The aim of the current research is to explore and understand organizational policy and its relationship to the stages of crisis management emerging in the field of work of the General Authority for Dams and Reservoirs of the Iraqi Ministry of Water Resources by adopting a main measurement tool from... To design a questionnaire and distribute it to a sample of (40) employees at the Authority’s headquarters in Bab Mostly in Baghdad to reach the desired results through the use of the statistical package (SPSS.V.25) with the aim of determining the relationship between the two research variables (organizational policy and stages of crisis management), as the research discovered that organizational policy With its dimensions that included (general political behavior, the policy of moving forward to achieve Self, wages and promotion policy) have a clear role and impact in the stages of crisis management (detecting warning signals, preparedness and prevention, containing and reducing damage, restoring activity, learning). The research recommended a number of recommendations to urge the organizations’ management to reduce the negative effects of organizational policy on the researched body, invest in its positive aspects, educate in awareness of its dimensions, and train on crisis management in its various stages according to the latest scientific methods and methods discovered.

Background Long COVID (LC) compromises work ability (WA). Female worker WA has been more adversely impacted than WA in men. Exploration of lived experiences could elucidate the WA support required. Aims To explore the working conditions and circumstances experienced as affecting sustained WA amongst female workers with LC, to help mitigate worklessness risks. METHODS Online semi-structured qualitative interviews were conducted with 10 female workers self-reporting or formally diagnosed with LC who had made some attempt to return to work (RTW). Interviews were analysed using template analysis to map themes informing WA enablers and obstacles onto a biopsychosocial model of rehabilitation. RESULTS All participants were professionals working in an employed or self-employed capacity. Key themes reflecting circumstances that afforded sustained WA included the autonomy over where, when and how to work indicated as facilitated by a professional role, rapid health care access, predominantly sedentary work, competent colleagues able to cover for transient reduced WA, a strong interface between specialist health and management support, and accessible organizational policies that steer health management according to equity rather than equality. Highly flexible, iterative, co-produced RTW planning, tolerant of fluctuating symptom expression appears vital. In return for providing such flexibility, participants felt that employers' workforce diversity and competence would be protected and that workers would need to reciprocate flexibility. Conclusions These qualitatively derived findings of workers' lived experiences add to existing guidance on supporting WA for people struggling with LC. Moreover, the same principles seem appropriate for tackling worklessness amongst working-age adults with complex long-term health conditions. [ABSTRACT FROM AUTHOR]

The aims and objectives of medical science education -as one of the effective social organizations- require the use of appropriate organizational policy approaches. Before providing healthcare services, the health system needs to ensure the health of its own organization. Due to the importance of political health, especially the health system, the present study was conducted with the aim of reviewing the health of organizational politics. A simple descriptive review was conducted by searching two approaches of books and databases during the years 2014-2024 (10 years) in Persian and English. The keywords used in the search include: organizational health, organizational policy, system. Health, health policy has been in the study of library and database databases including; ISI, isc Googlescholar, Pubmed, there were 4 bases. The search was conducted in a targeted manner in 4 stages and by reducing the number of articles in 3 stages by applying the inclusion criteria, and at the end, 9 Persian articles and 4 English articles were included in the study. The findings showed that having organizational health requires having a perceived organizational policy format in order to elevate the organization, and an organization like medical sciences needs to restore organizational policy and have intra-organizational health. Based on the results of the studies, the way forward for the advancement of medical science education requires the modification and restoration of the current policies of the health system in order to form a new vision of medical science education with predictable goals. [ABSTRACT FROM AUTHOR]

In an ageing society, organizations must consider the inclusion and effective management of older professionals if they wish to remain competitive. Besides having harmful and far-reaching effects on people's health, age discrimination in the workplace leads to absenteeism, lower levels of productivity, and early retirement. Within such a context, this problematic organizational feature of most Western, now ageing, organizations and labour markets starts gaining more relevance. However, to date there has been little discussion, research, or policy development to ensure that older employees' skills and capabilities are optimally put to use by organizations without the occurrence of ageism. We present the results of a systematic literature review based on 30 studies in the context of ageing organizations to make recommendations for human resource management. We suggest an approach to effectively manage intergenerational organizations, reducing the occurrence of age discrimination and its related consequences, as well as to achieve high employee engagement. Our review indicates that a strong ethics framework that is continuously followed, disseminated, and updated by management, together with a combination of efforts from all stakeholders, may accomplish the best results towards a culture that respects and values people of all ages at work, positively impacting on productivity. [ABSTRACT FROM AUTHOR]

Abstract Background Standardized cancer patient pathways as a new policy has been adopted in healthcare to improve the quality of cancer care. Within the health systems, actors at different levels manage the adoption of new policies to develop healthcare. The various actors on different levels play an important role and influence the policy adoption process. Thus, knowledge about how these actors use strategies when adopting cancer patient pathways as a policy in the health system becomes central. Method The study’s aim was to explore how actors at different organizational levels in the health system adopted cancer patient pathways. Our overarching case was the Swedish health system at the national, regional, and local levels. Constructivist Grounded Theory Method was used to collect and analyze qualitative interviews with persons working in organizations directly involved in adopting cancer patient pathways at each level. Twelve individual and nine group interviews were conducted including 53 participants. Results Organizational actors at three different levels used distinct strategies during the adoption of cancer patient pathways: acting as—missionaries, fixers, and doers. Acting as missionaries consisted of preaching the idea of cancer patient pathways and framing it with a common purpose to agree upon. Acting as fixers entailed creating a space to put cancer patient pathways into practice and overcome challenges to this. Acting as doers comprised balancing breadth and speed in healthcare provision with not being involved in the development of cancer patient pathways for the local context. These strategies were not developed in isolation from the other organizational levels but rather, each level interacted with one another. Conclusions When adopting new policies, it is important to be aware of the different strategies and actors at various organizational levels in health systems. Even when actors on different levels developed separate strategies, if these contribute to fulfilling the four domains of inter-organizational collaboration, they can work well together to adopt new policies. Our study highlighted that the application of two domains was lacking, which meant that local actors were not sufficiently involved in collaboration, thus constricting the local use and optimization of cancer patient pathways in practice.

In an ageing society, organizations must consider the inclusion and effective management of older professionals if they wish to remain competitive. Besides having harmful and far-reaching effects on people’s health, age discrimination in the workplace leads to absenteeism, lower levels of productivity, and early retirement. Within such a context, this problematic organizational feature of most Western, now ageing, organizations and labour markets starts gaining more relevance. However, to date there has been little discussion, research, or policy development to ensure that older employees’ skills and capabilities are optimally put to use by organizations without the occurrence of ageism. We present the results of a systematic literature review based on 30 studies in the context of ageing organizations to make recommendations for human resource management. We suggest an approach to effectively manage intergenerational organizations, reducing the occurrence of age discrimination and its related consequences, as well as to achieve high employee engagement. Our review indicates that a strong ethics framework that is continuously followed, disseminated, and updated by management, together with a combination of efforts from all stakeholders, may accomplish the best results towards a culture that respects and values people of all ages at work, positively impacting on productivity.

Abstract Aim To explore the experiences and needs of family members during the course of COVID‐19 critical illness from onset to rehabilitation. Design An exploratory qualitative study. Methods Twelve family members of surviving critically ill COVID‐19 patients and restricted from visiting the patients, were interviewed digitally. Reflexive thematic analysis was used. Results Three themes were generated from the data; ‘Experiencing a double burden’, ‘Becoming an insignificant other’ and ‘Regaining significance’. Family members were often ill themselves, which represented an extra burden when the patient deteriorated. From admission, the family members became bystanders, deprived of most contact with the patients, as communication and information from the intensive care unit appeared unstructured and haphazard. However, when patients were discharged, great responsibility was placed on the family members.

Background: Standardized cancer patient pathways as a new policy has been adopted in healthcare to improve the quality of cancer care. Within the health systems, actors at different levels manage the adoption of new policies to develop healthcare. The various actors on different levels play an important role and influence the policy adoption process. Thus, knowledge about how these actors use strategies when adopting cancer patient pathways as a policy in the health system becomes central. Method: The study's aim was to explore how actors at different organizational levels in the health system adopted cancer patient pathways. Our overarching case was the Swedish health system at the national, regional, and local levels. Constructivist Grounded Theory Method was used to collect and analyze qualitative interviews with persons working in organizations directly involved in adopting cancer patient pathways at each level. Twelve individual and nine group interviews were conducted including 53 participants. Results: Organizational actors at three different levels used distinct strategies during the adoption of cancer patient pathways: acting as—missionaries, fixers, and doers. Acting as missionaries consisted of preaching the idea of cancer patient pathways and framing it with a common purpose to agree upon. Acting as fixers entailed creating a space to put cancer patient pathways into practice and overcome challenges to this. Acting as doers comprised balancing breadth and speed in healthcare provision with not being involved in the development of cancer patient pathways for the local context. These strategies were not developed in isolation from the other organizational levels but rather, each level interacted with one another. Conclusions: When adopting new policies, it is important to be aware of the different strategies and actors at various organizational levels in health systems. Even when actors on different levels developed separate strategies, if these contribute to fulfilling the four domains of inter-organizational collaboration, they can work well together to adopt new policies. Our study highlighted that the application of two domains was lacking, which meant that local actors were not sufficiently involved in collaboration, thus constricting the local use and optimization of cancer patient pathways in practice. [ABSTRACT FROM AUTHOR]

Mounting evidence suggests that law enforcement organizational factors contribute to higher incidence and racial disparities in police killings. To determine whether agency policies contribute to race-specific civilian fatalities, this exploratory study compared fatality rates among agencies with and without selected policies expected to reduce killings. A cross-section of 1085 fatalities in the 2015-2016 The Counted public-use database were matched to 481 agencies in the 2013 Law Enforcement Management and Administrative Statistics (LEMAS) database. Negative binomial regression estimated incidence rate ratios (IRR) adjusted for agency type, number of officers, percent female personnel, median income, percent with a bachelor's degree, violent crime rate, and population size, with inference using robust standard errors. Agencies with greater proportions of full-time personnel (range 43-100%) had lower rates of all (IRR = 0.85; 95% confidence interval [CI] = 0.77-0.93) and non-White civilian killings (IRR = 0.85; CI = 0.73-0.99). Mission statements predicted lower rates of all (IRR = 0.70; CI = 0.58-0.84) and White killings (IRR = 0.60; CI = 0.40-0.90). Community evaluation and more types of personnel incentives predicted lower rates of White (IRR = 0.82; CI = 0.68-0.99) and non-White killings (IRR = 0.94; CI = 0.89-1.00), respectively. Increasing video use predicted higher rates of White killings (IRR = 1.13; CI = 1.01-1.28). No policies were significantly associated with Black civilian killings. Law enforcement policies that help reduce police killings may vary across racial groups with the least benefit for Black civilians. Impact evaluations and meta-analyses of initiatives aimed to mitigate fatalities should be explored, particularly policies to address anti-Black bias. A national registry tracking all police killings and agency policies is urgently needed to inform law enforcement policies aimed to mitigate civilian fatalities.

Aim: To explore the experiences and needs of family members during the course of COVID‐19 critical illness from onset to rehabilitation. Design: An exploratory qualitative study. Methods: Twelve family members of surviving critically ill COVID‐19 patients and restricted from visiting the patients, were interviewed digitally. Reflexive thematic analysis was used. Results: Three themes were generated from the data; 'Experiencing a double burden', 'Becoming an insignificant other' and 'Regaining significance'. Family members were often ill themselves, which represented an extra burden when the patient deteriorated. From admission, the family members became bystanders, deprived of most contact with the patients, as communication and information from the intensive care unit appeared unstructured and haphazard. However, when patients were discharged, great responsibility was placed on the family members. [ABSTRACT FROM AUTHOR]

How does boundary management (BM) preference influence the effectiveness of work–nonwork policies? Drawing on BM and person–environment fit theory, we examine the effects of off-hours work-related communication restriction on policy satisfaction, organizational commitment, emotional exhaustion, and work engagement. We suggest a moderated mediation model, assuming that the interaction between communication restriction and BM preference predicts perceived BM fit, positively affecting the outcomes. We investigated this assumption using an experimental vignette study (Study 1, N = 257) and a correlational study (Study 2, N = 239). The findings of both studies show moderated indirect effects of the work–nonwork policy on policy satisfaction, organizational commitment, emotional exhaustion, and work engagement (only investigated in Study 2) via perceived BM fit and conditional on BM preference. Specifically, restricting work-related communication only benefits employees preferring low levels of integration. Contrarily, employees who prefer high levels of integration do not benefit from the policy. Due to using two studies with different methodological approaches, these findings rest on data with high internal and external validity. In particular, the experimental method in Study 1 allows for causal inferences on the effects of communication restriction, supporting the literature on BM fit and offering practical implications. [ABSTRACT FROM AUTHOR]

PurposeAxicabtagene ciloleucel (axi-cel) is an autologous CD19-directed chimeric antigen receptor (CAR) T-cell therapy approved for relapsed/refractory large B-cell lymphoma (LBCL) on the basis of the single-arm phase II ZUMA-1 trial, which showed best overall and complete response rates in infused patients of 83% and 58%, respectively. We report clinical outcomes with axi-cel in the standard-of-care (SOC) setting for the approved indication.Patients and methodsData were collected retrospectively from all patients with relapsed/refractory LBCL who underwent leukapheresis as of September 30, 2018, at 17 US institutions with the intent to receive SOC axi-cel. Toxicities were graded and managed according to each institution's guidelines. Responses were assessed as per Lugano 2014 classification.ResultsOf 298 patients who underwent leukapheresis, 275 (92%) received axi-cel therapy. Compared with the registrational ZUMA-1 trial, 129 patients (43%) in this SOC study would not have met ZUMA-1 eligibility criteria because of comorbidities at the time of leukapheresis. Among the axi-cel-treated patients, grade ≥ 3 cytokine release syndrome and neurotoxicity occurred in 7% and 31%, respectively. Nonrelapse mortality was 4.4%. Best overall and complete response rates in infused patients were 82% (95% CI, 77% to 86%) and 64% (95% CI, 58% to 69%), respectively. At a median follow-up of 12.9 months from the time of CAR T-cell infusion, median progression-free survival was 8.3 months (95% CI, 6.0 to15.1 months), and median overall survival was not reached. Patients with poor Eastern Cooperative Oncology Group performance status of 2-4 and elevated lactate dehydrogenase had shorter progression-free and overall survival on univariable and multivariable analysis.ConclusionThe safety and efficacy of axi-cel in the SOC setting in patients with relapsed/refractory LBCL was comparable to the registrational ZUMA-1 trial.

The coronavirus disease 2019 (COVID-19) pandemic challenged program leaders to respond rapidly to changes in health care delivery, protect trainee safety, and transform educational activities. The pandemic demanded that program directors prioritize and address myriad threats to trainees' well-being. In this paper, we adapt Maslow's needs framework to systematically address trainee well-being during the COVID-19 pandemic and identify potential interventions to meet trainee needs at the program, institution, and extrainstitutional levels. Transforming education to effectively respond to trainee well-being needs requires leadership, and we use Kotter's 8-step change management model as an example of a framework to effectively lead change. Program leaders can take this opportunity to reflect upon their training programs and take the opportunity to improve them. Some of the systems of education we develop during the COVID-19 pandemic, such as telehealth, tele-education, and ways to stay connected may provide advantages and will be important to continue and expand upon post-COVID-19.

This quality improvement study reviews the human resources policies for childbearing and family leave for administrative staff at 12 leading US medical schools.

This is a joint policy statement from the American Academy of Pediatrics, American College of Emergency Physicians, Emergency Nurses Association, National Association of Emergency Medical Services Physicians, and National Association of Emergency Medical Technicians on pediatric readiness in emergency medical services systems.

BackgroundHospital policies restricting access to trial of labor after cesarean (TOLAC) are prevalent. Many women with a previous cesarean birth are affected by these bans, but there are limited data on the effect of these bans and whether women would consider changing delivery hospitals in the setting of a real or hypothetical TOLAC ban.MethodsThis was a survey of TOLAC-eligible women receiving prenatal care at four hospitals where TOLAC is available, and 1 non-TOLAC site. Participants were asked about their likelihood of switching hospitals to pursue TOLAC if it were unavailable. Women at the non-TOLAC site had their medical records reviewed to ascertain final location and approach to delivery.ResultsA total of 297 women were interviewed, 48 from the non-TOLAC site. 162 (54%) participants indicated they would transfer care if TOLAC were unavailable. Among women at the non-TOLAC site, 57% who indicated an intention to switch hospitals did so. In a multivariable logistic regression model, variables associated with transferring care included race/ethnicity other than Latina (aOR 25.20 [95% CI 2.23-284.26]), being unaware of the TOLAC ban (19.81 [1.99-196.64]), and perceiving that a close friend/relative thought they should undergo TOLAC (17.31 [1.70-176.06]).ConclusionsMore than half of women with prior cesarean would consider transferring care if TOLAC became unavailable, and more than 1 of 3 of women at a non-TOLAC site transferred care. More research is needed on the impact of TOLAC bans and how to facilitate transfer for those who desire TOLAC.

Job insecurity and organizational identification are significant constructs in an organization. This study aims to survey the relationship between these constructs. The researchers reached 233 employees and they could collect 220 usable questionnaires. SPSS V27 software was used to analyze the data. Factor analysis, reliability analysis, ANOVA test, and lineer regression analysis are applied to the data. The results suggested that job insecurity is a significant antecedent of organizational identificaiton and they have a negative relationship between each other. These results are useful for the scholars who study job insecurity and organizational identification. Moreover, the human resources departments and managers can use the results of this study to determine efficient organizational policies.

Tattoos historically have been considered taboo and viewed as unprofessional in workplace environments. However, tattoos are increasing in frequency as an avenue of self-expression, forcing organizations to create and enforce policies about tattoo displays. Human Resource (HR) professionals are on the front lines of enforcing organizational policies, such as tattoo visibility, regardless of their personal agreement with organizational values or policy. This qualitative study uses semi-structured interviews with seven HR professionals to understand policy communication related to tattoos and how value dissonance influences communication. Findings indicate that HR professionals informally and formally engage in unique policy enforcement communication tactics that evoke organizational and personal values through hypotheticals (authority), throwing the book down (security), and modeling (conformity). HR professionals who experience value dissonance use additional tactics including identification (benevolence) and changing the policy (self-direction). When HR professional's values align with perceived organizational values, they are less likely to experience value dissonance. [ABSTRACT FROM AUTHOR]

The article presents excerpts from the documents of the past of domestic psychiatry. Their analysis allows, with the help of primary sources, to assess the difficult period of the middle of the last century in the development of biological science, scientific and practical psychiatry in our country. The intertwining of ideological, pseudoscientific, personal and career interests at that time, as in many areas of science, pushed aside the problems of creative scientific developments and created for many professionals an atmosphere of distrust, suspicion, and discredit of leading specialists.

BackgroundJob satisfaction is associated with health and productivity. Workplace support for breastfeeding may affect working mothers' job satisfaction.MethodsWe analyzed responses from 488 women from the Infant Feeding Practices Study II (2005-2007). Using logistic regression, we assessed whether workplace breastfeeding problems at 3 months postpartum were related to low job satisfaction concurrently and, for a subsample (n = 265), at 9 and 12 months postpartum.ResultsCompared with women reporting no problems, women reporting three or more problems had higher odds (odds ratio [OR] = 4.76; 95% confidence interval [CI]: 2.03-11.18) of low job satisfaction at 3 months, and at 12 months (OR = 6.88, 95% CI: 1.33-35.58) after controlling for baseline job satisfaction. Models isolating problems with break time and space to pump/nurse showed more modest results.ConclusionsWork-related breastfeeding problems at 3 months postpartum were associated with low job satisfaction concurrently and at follow-up. Improving workplace breastfeeding accommodations could improve mothers' job satisfaction.

OBJECTIVE:More effective transitions and transfers of young people with sickle cell disease (SCD) into the adult healthcare setting is a focus of both primary care and specialty care medical organizations. Effective transition and transfer requires six core elements: establishing a policy, tracking progress, administering transition readiness assessments, planning for adult care, transferring to adult care, and integrating into an adult practice. We developed a program using these six core elements. The objective of our report was to assess the development and implementation of this program. METHODS:We used the six core elements to develop and implement a program at Virginia Commonwealth University for children and adolescents with SCD to transition to adult health care. RESULTS:We assessed individuals' differences by age and grade, their independent living skills, their feelings about moving to adult care; tallied and analyzed several assessment scales; and assessed transfer success and patient retention. CONCLUSIONS:The principles and lessons we learned in developing and implementing this program over 5 years, accompanied by caring, flexible, and dedicated care team members, often can overcome even severe barriers to care transitions.

There is a national call for academic medicine to use evidence-based initiatives to improve its culture and climate. The authors report data-driven policy and programmatic interventions that were associated with increased faculty diversity, equity, respectful behavior and improved faculty climate, at UC San Diego Health Sciences.MethodsBased on demographic and survey data, interventions were designed to improve the climate between 2005 and 2015. Interventions included routine measuring and dissemination of demographic data, changes and dissemination of policy and procedures, and new and improved faculty development programming. Impact was measured using demographic data over time, salary equity studies, and school-wide climate surveys in 2005, 2011, and 2015. Specific outcomes included measures of diversity, salary equity, behavior, and climate.ResultsOver the ten-year period, the proportion of women increased from 16% to 23% of tenure/tenure-track faculty and 31%-40% of all faculty. Underrepresented minority faculty increased from less than 1%-7% of tenure/tenure-track faculty and from 5% to 8% of all faculty. While women continued to be paid less than men, the adjusted difference dropped from 23% to 12%. Reports of inappropriate behavior by faculty decreased significantly, while satisfaction and knowledge about institutional mentoring and resources improved.ConclusionMultiple interventions including new faculty development programs, changes in policy, and measuring demographics/climate supported diverse faculty recruitment, enhanced a culture of respect and improved faculty morale. Cultural changes in policy, periodic faculty data collection with dissemination, and increased faculty development, improve the climate in academic medicine.

ABSTRACT Objective: to analyze the professional struggles between nursing organizational entities, in Rio de Janeiro, during the Regional Nursing Council’s electoral process (1990-1993 administration). Method: historical study. We used journalistic articles, normative documents, legislation and semi-structured interviews with five nursing professionals who participated in this process. Interpretation of findings was supported by Bourdieu’s concepts of habitus, field, capital, and symbolic power. Results: Electoral Code changes of the aforementioned council, under the influence of administration (1987-1990), candidate for re-election, influenced the disclosure and eligibility criteria, making it difficult for broad participation, especially of Associação Brasileira de Enfermagem Rio de Janeiro Section. Final considerations: nursing, in this period, generated a field of disputes related to positions of power and gender, which was evidenced in the electoral process studied, which highlighted using limiting strategies by a group, making it difficult for the entire category to participate.

Objective: To Know the political participation of nursing professionals as a reflection of their representative entities. Methods: qualitative research of a historical-social nature in the history of 1975 to 2018, between March and September 2019. Interviewed 5 former presidents of the Brazilian Nursing Association - Santa Catarina Section and the Regional Nursing Council of Santa Catarina. The understanding of the data took place through the analysis of Bardin's content and interpretation through the conceptual framework of Denise Elvira Pires de Pires, profession, discipline and work. Results: there is a significant change in the framework of political participation in nursing over the decades. With a fragile articulation between the entities representing the category. Conclusion: The demobilization of the professional category is multifactorial. Reflection of the disarticulation of the entities representing the profession, the historical and cultural roots of its foundation and the individual and social imagery of the profession. [ABSTRACT FROM AUTHOR]

Objective: While patient participation in individual health technology assessments (HTAs) has been frequently described in the literature, patient and citizen participation at the organizational level is less described and may be less understood and practiced in HTA bodies. We aimed to better understand its use by describing current practice. Method: To elicit descriptive case studies and insights we conducted semi-structured interviews and open-ended questionnaires with HTA body staff and patients and citizens participating at the organizational level in Belgium, France, Quebec, Scotland, and Wales. Results: We identified examples of organizational participation in managerial aspects: governance, defining patient involvement processes, evaluation processes and methods, and capacity building. Mechanisms included consultation, collaboration, and membership of standing (permanent) groups. These were sometimes combined. Participants were usually from umbrella patient organizations and patient associations, as well as individual patients and citizens. Discussion: Although the concept, participation at the organizational level, is not wellestablished, we observed a trend toward growth in each jurisdiction. Some goals were shared for this participation, but HTA bodies focused more on instrumental goals, especially improving participation in HTAs, while patients and citizens were more likely to offer democratic and developmental goals beyond improving participation processes. Conclusion: Our findings provide rationales for organizational-level participation from the perspectives of HTA bodies and patients. The case studies provide insights into how to involve participants and who may be seen as legitimate participants. These findings may be useful to HTA bodies, the patient sector, and communities when devising an organizational-level participation framework. [ABSTRACT FROM AUTHOR]

The ridesharing-or ride-hailing-industry has grown exponentially in recent years, transforming quickly into a fee-for-service, unregulated taxi industry. While riders are experiencing the benefits of convenience and affordability, two key regulatory and safety issues deserve consideration. First, individuals who work as drivers in the ridesharing industry are often employed in a primary job, and they work as drivers during their off time. Such a schedule may lead to driving after extended periods of wakefulness or during nights, both of which are factors that increase the risk of drowsy driving accidents. Second, these drivers are often employed as independent contractors, and therefore they are not screened for medical problems that can reduce alertness, such as obstructive sleep apnea. Some ridesharing companies now require a rest period after an extended driving shift. This measure is encouraging, but it is insufficient to impact driving safety appreciably, particularly since many of these drivers are already working extended hours and tend to drive at non-traditional times when sleepiness may peak. Therefore, it is the position of the American Academy of Sleep Medicine (AASM) that fatigue and sleepiness are inherent safety risks in the ridesharing industry. The AASM calls on ridesharing companies, government officials, medical professionals, and law enforcement officers to work together to address this public safety risk. A collaborative effort is necessary to understand and track the scope of the problem, provide relevant education, and mitigate the risk through thoughtful regulation and effective fatigue risk management systems.

The diagnosis and effective treatment of obstructive sleep apnea (OSA) in adults is an urgent health priority. Positive airway pressure (PAP) therapy remains the most effective treatment for OSA, although other treatment options continue to be explored. Limited evidence citing small pilot or proof of concept studies suggest that the synthetic medical cannabis extract dronabinol may improve respiratory stability and provide benefit to treat OSA. However, side effects such as somnolence related to treatment were reported in most patients, and the long-term effects on other sleep quality measures, tolerability, and safety are still unknown. Dronabinol is not approved by the United States Food and Drug Administration (FDA) for treatment of OSA, and medical cannabis and synthetic extracts other than dronabinol have not been studied in patients with OSA. The composition of cannabinoids within medical cannabis varies significantly and is not regulated. Synthetic medical cannabis may have differential effects, with variable efficacy and side effects in the treatment of OSA. Therefore, it is the position of the American Academy of Sleep Medicine (AASM) that medical cannabis and/or its synthetic extracts should not be used for the treatment of OSA due to unreliable delivery methods and insufficient evidence of effectiveness, tolerability, and safety. OSA should be excluded from the list of chronic medical conditions for state medical cannabis programs, and patients with OSA should discuss their treatment options with a licensed medical provider at an accredited sleep facility. Further research is needed to understand the functionality of medical cannabis extracts before recommending them as a treatment for OSA.

BackgroundMedically hospitalized patients who lack decisional capacity may request, demand, or attempt to leave the hospital despite grave risk to themselves. The treating physician in this scenario must determine how to safeguard such patients, including whether to attempt to keep them in the hospital. However, in many jurisdictions, there are no laws that address this matter directly. In this absence, psychiatrists are often called upon to issue an involuntary psychiatric hold (civil commitment) to keep the patient from leaving. Yet, civil commitment statutes were not intended for, and generally do not address, the needs of the medically ill patient without psychiatric illness. Civil commitment is permitted for patients who pose a danger to themselves or others, or who are gravely disabled, specifically as the result of a mental illness, and allows the transport of such individuals to facilities for psychiatric evaluation. It does not permit detention for medical illnesses nor the involuntary administration of medical treatments. Therefore, the establishment of hospital policies and procedures may be the most appropriate means of detaining medically hospitalized patients who lack capacity to understand the risks of leaving the hospital, in addition to mitigating the potential tort risk faced by the physician for acting in a manner that protects the patient.ObjectiveThe purpose of this article is to identify the array of clinical and medical-legal concerns in these scenarios, and to describe the development of a "medical incapacity hold" policy as a means of addressing this unresolved issue.

This study characterizes variations in duration, salary support, policy clarity, and constraints or prerequisites for childbearing and family leave policies at 12 top-tier US medical schools.

While more women are in leadership positions in academic medicine now than ever before in U.S. history, evidence from recent surveys of women and graduating medical students demonstrates that sexual harassment continues in academic health centers. Academic medicine's ability to change its culture is hampered by victims' fear of reporting episodes of harassment, which is largely due to fear of retaliation. In this Perspective, the authors describe efforts in scientific societies to address the issue of sexual harassment and to begin to establish safe environments at national meetings. The authors contend that each institution must work to make it safe for individuals to come forward, to provide training for victims and for bystanders, and to abolish "locker room" talk that is demeaning to women.

PurposeAcademic medical and biomedical professionals need workplace flexibility to manage the demands of work and family roles and meet their commitments to both, but often fail to use the very programs and benefits that provide flexibility. This study investigated the reasons for faculty underutilization of work-life programs.MethodAs part of a National Institutes of Health-funded study, in 2010 the authors investigated attitudes of clinical and/or research biomedical faculty at the University of California, Davis, toward work-life policies, and the rationale behind their individual decisions regarding use of flexibility policies. The analysis used verbatim responses from 213 of 472 faculty (448 unstructured comments) to a series of open-ended survey questions. Questions elicited faculty members' self-reports of policy use, attitudes, and evaluations of the policies, and their perceptions of barriers that limited full benefit utilization. Data were coded and analyzed using a grounded theory approach.ResultsFaculty described how their utilization of workplace flexibility benefits was inhibited by organizational influences: the absence of reliable information about program eligibility and benefits, workplace norms and cultures that stigmatized program participation, influence of uninformed/unsupportive department heads, and concerns about how participation might burden coworkers, damage collegial relationships, or adversely affect workflow and grant funding.ConclusionsUnderstanding underuse of work-life programs is essential to maximize employee productivity and satisfaction, minimize turnover, and provide equal opportunities for career advancement to all faculty. The findings are discussed in relation to specific policy recommendations, implications for institutional change, and department chair leadership.

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, if it is considered that educated manpower is the most valuable resource of countries, it can be thought that various policies should be developed both at the macro- and micro-levels to minimize the loss of healthcare employees. OBJECTIVE: This study aims to determine the effects of the corporate policies for COVID-19 on the work stress and anxiety of healthcare employees. METHOD: The sample of the study consists of 136 of 265 healthcare employees in Sakarya Provincial Health Directorate Emergency Health Services in Turkey. The average age of the participants was 34.43 years, and the average duration of professional experience was 12.12 years. Approximately 61% of the participants are male and 51% have a bachelor's degree or higher level. A questionnaire form was used in the study as the data collection tool consisting of socio-demographic characteristics, institutional policies on COVID-19, work stress, and the Status Anxiety Scale. Process Macro Model 4, descriptive statistics and correlation analysis were used for the data analysis. RESULTS: According to the results of the study, the corporate policies for COVID-19 perception of participants were above average (3.30±0.82) while work stress (2.99±0.88) and anxiety (2.65±0.56) were below average. The corporate policies for COVID-19 perception of participants reduced their work stress (β= – 0.430) and anxiety (β= – 0.361). Additionally, anxiety played a mediating role in the effect of the corporate policies for COVID-19 perception on work stress, and it further raised the impact of corporate policies for COVID-19 perception on the work stress reduction (β= – 0.169). CONCLUSIONS: During the COVID-19 pandemic, health managers should determine and control the anxiety and stress levels of the health employees on their staff and take a number of steps to reduce their anxiety and stress. [ABSTRACT FROM AUTHOR]

Background: The aim of the study is to investigate doctors' and nurses' beliefs and attitudes towards family presence and open visiting policies in Pediatric Intensive Care Units (PICUs) in Italy., Methods: A multicentric nationwide study was carried out in all 30 Italian PICUs. All doctors and nurses were asked to complete the Italian version of the Beliefs and Attitudes toward Visitation in ICU Questionnaire (BAVIQ). The questionnaire consists of 20 questions on beliefs and 14 on attitudes towards visiting., Results: The response rate was 89% (925 questionnaires), with 87% of nurses and 94% of doctors responding. Most respondents (85%) believed that visiting has a beneficial effect on the patient and that an open visiting policy can reduce parental anxiety (68%). However, nearly half the respondents believed that an open policy interferes with direct nursing care (45%) and makes them feel checked up on (49%). Multiple logistic regression conducted on the eight most representative items showed that factors associated with beliefs and attitudes opposing open visiting policies were: being a nurse, geographic area (working in PICUs in Central Italy or the South and Islands) and working in a cardiac surgery unit. Age showed a trend of younger professionals being more convinced that an open visiting policy can be beneficial for patients., Conclusions: Most healthcare professionals in Italian PICUs believe that an open visiting policy for families is beneficial for both the patient and his/her family. However, despite an overall positive attitude among PICU staff members, there is still some resistance in Italy, particularly among nurses and in cardiac surgery units.

Sport governing bodies, such as the International Olympic Committee, have recommended youth sport organizations develop policies, procedures, and/or ethical guidelines to prevent and respond to sexual harassment and abuse (SHA) experienced by young athletes. To our knowledge, no studies have investigated SHA policies or procedures in U.S. youth sport programs. The purpose of this exploratory study was to examine U.S. youth sport programs' policies regarding SHA. The results are based on a cross-sectional survey completed by youth sport coaches ( n  = 200) from various organizations (e.g., public recreation organizations, private nonprofit organizations, and interscholastic sports). Findings suggest that most organizations have several SHA policies, such as education and training requirements, written policies and codes of conduct regarding coach-athlete sexual relationships, and formal complaint and disclosure procedures for investigating SHA. A bivariate analysis suggests that the presence of several SHA policies was associated with an increased number of self-reported SHA incidents. Moreover, youth sport programs located in urban areas had a greater extent of SHA policies compared to those located in suburban or rural areas. These results are discussed with respect to the potential relationships between the presence of policies and increased cases of SHA. Also, we discussed advocating for equitable resources among youth sport programs regardless of geographic and/or demographic factors. Future research should identify social and cultural barriers that inhibit the successful implementation of SHA policies. While developing and implementing SHA policies is a step in the right direction, it may not be used as the only means to address this complex, systematic, and structural issue., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Successful innovation clusters are notoriously difficult to establish, and many attempts fail. How can we go about designing such systems reliably? We describe how ecosystems can be strengthened through grassroots bottom-up efforts that empower user and community innovation, as opposed to economic policies that dictate innovation. Specifically focusing on the healthcare industry, we advocate that community hospitals which constitute 90% of all hospitals in Canada are the ideal setting for such community innovation efforts. We investigated the distribution of innovation output from hospitals over the past 13 years and found a decrease in predominance of major teaching hospitals, supporting the potential role for community hospitals in this space. We categorize different types of innovations and recommend institutional policies that can sustain bottom-up, micro-level efforts. Such policies could improve and enhance the development of micro-innovations and the creation of health innovation clusters., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: The aim of this study was to gain an understanding of employers' attitudes to, knowledge about, and policies relating to employing someone with a spinal cord injury (SCI)., Methods: Semi-structured interviews were conducted with nine employers located in Australia from a range of backgrounds and different sized businesses. The interviews were thematically analysed., Results: Three themes were identified: Organisational policies (sub-themes: Recruitment - inherent requirements of the role vs risk mitigation; Recruitment strategies and targets; Disclosure; Accommodations needed or offered); Barriers & facilitators (sub-themes: Lack of knowledge about SCI; Physical accessibility; Workplace culture); Personal attitudes (sub-themes: Personal attitudes don't align with organisational policy; Personal experiences informed understanding)., Conclusions: Organisational policies and practices of the employers' organisations, and workplace culture impact the likelihood of someone with a SCI being employed, particularly in relation to recruitment, employment targets, and available accommodations. Individual staff attitudes and knowledge also influence this process. Multi-faceted approaches are needed to increase the employment of people with SCI.

Objective: This study assessed changes (in relation to smoking status) in tobacco use, attitudes toward TFC policies, and tobacco use risk knowledge by applying a three Wave repeated cross-sectional assessment., Participants: Participants were students at Wave 1 ( n  = 2,169), Wave 2 ( n  = 2,576), and Wave 3 ( n  = 2,169) and faculty at Wave 1 ( n  = 256), Wave 2 ( n  = 204), and Wave 3 ( n  = 180)., Methods: Measures regarding sociodemographics, tobacco use, attitudes toward TFC policies, and tobacco use risk knowledge were completed., Results: Compared with Wave 1, more students reported having quit smoking within the last six months at Waves 2 and 3. The negative attitudes toward TFC policies of those who reported quitting in the last six months aligned with those of nonsmokers., Conclusions: Study findings suggest smoking status as a relevant covariate to focus on to further strengthen and refine existing TFC policies.