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Interprofessional perspectives on ACEs: Results from a statewide interprofessional training program.Child Abuse & Neglect Jun 2024Adverse childhood experiences (ACEs) are pervasive and well-recognized as having lasting deleterious effects on the physical and mental health of those who experience...
BACKGROUND
Adverse childhood experiences (ACEs) are pervasive and well-recognized as having lasting deleterious effects on the physical and mental health of those who experience them, particularly with accumulated exposure.
OBJECTIVE
This study seeks to identify the perspectives of interprofessional health providers on their personal and professional experiences with ACEs, ACEs screening, how to work with people with ACEs, and make recommendations for the field.
PARTICIPANTS AND SETTING
Sixty-two health professionals and PhD students who completed at least one module of an online course and at least one of the accompanying discussion board sub-prompts.
METHODS
Responses to five course discussion board assignments, each with multiple sub-prompts, were coded to determine and refine major themes and merged with demographic and other background data. From the 561 responses, six themes were identified and used to analyze response patterns.
RESULTS
Twenty-nine percent of responses reflected a macro perspective on ACEs; 29 % of responses reflected workplace experiences; 28 % of responses reflected ACEs complexity, 8 % of responses reflected a personal relationship to ACEs, 3 % reflected perspectives on resilience; and 3 % were related to the course. Participants communicated complex understandings of ACEs, demonstrating the relevance and importance of the topic for public health training.
CONCLUSIONS
Integrating ACEs training into the practice setting provides opportunities to improve the health and lives of those suffering from ACEs, especially when incorporating provider voice and perspectives.
PubMed: 38943769
DOI: 10.1016/j.chiabu.2024.106911 -
Journal of Environmental Management Jun 2024With the growing emphasis on sustainable development, green policies have become a crucial factor influencing both environmental pollution and the career progression of...
With the growing emphasis on sustainable development, green policies have become a crucial factor influencing both environmental pollution and the career progression of officials in China and other countries. However, the mechanisms behind this relationship remain unclear. This paper aims to enhance the understanding of how environmental pollution impacts official promotion by analyzing the performance of provincial leaders in China and their incentives to address pollution. Using provincial panel data from 1998 to 2020 and a probit model, our study uncovers significant findings. We demonstrate that the intensified green attention by China's central government has notably reduced the promotion prospects for provincial officials with poor environmental protection records, particularly since 2013. Furthermore, our research extends the analysis of micro-level mechanisms, illustrating how the central government's political incentives effectively influence local environmental governance. This study underscores the central government's capability to leverage its personnel system to achieve desired outcomes in sustainable development.
PubMed: 38943749
DOI: 10.1016/j.jenvman.2024.121590 -
Journal of Environmental Management Jun 2024This study explores the comprehensive effects of green finance (GF) on the low-carbon transition of the energy system (LTES) by analyzing panel data from 281 cities in...
This study explores the comprehensive effects of green finance (GF) on the low-carbon transition of the energy system (LTES) by analyzing panel data from 281 cities in China from 2006 to 2021. It is found that GF significantly reduces overall energy consumption and exhibits a U-shaped association with energy efficiency, while its relationship with the energy consumption structure is inverted U-shaped. After accounting for endogeneity in the robustness tests, these findings remain consistent and are therefore deemed reliable. A mechanistic analysis reveals that GF promotes industrial upgrading, technological progress, and economic agglomeration, collectively facilitating the LTES. The impact of GF on LTES shows considerable variation among regions, influenced by their levels of economic growth, extents of marketization, and governmental environmental preferences. Our findings provide new evidence for the relationship between GF and LTES, offering a scientific basis for formulating GF policies to accelerate this transformation.
PubMed: 38943748
DOI: 10.1016/j.jenvman.2024.121577 -
Journal of Environmental Management Jun 2024Transboundary lakes are shared by multiple administrative regions. The key to balance the development and protection of transboundary lakes is to properly measure the...
Transboundary lakes are shared by multiple administrative regions. The key to balance the development and protection of transboundary lakes is to properly measure the value of water resources. Most of previous studies on the measurement of lake water resources value have not fully considered the ecosystem service function. This paper proposes a new concept "composite water value" to measure the value of transboundary lakes by integrating the external runoff value and the internal runoff value of water resources. The study constructs a composite water value measurement system for transboundary lakes, further analyzes its influencing factors,and applies the system to the case of Nansi Lake, a representative transboundary lake in eastern China. The results show that: (1) The composite water value of lakes is influenced by various factors, including industrial structure, water withdrawal, and water use methods, which impact the external runoff water value; meanwhile, the composite water quality and fluctuations in lake level are closely associated with the internal runoff water value. From 2008 to 2021, the average annual composite water value of Nansi Lake was 39.628 billion yuan, exhibiting a "rising-falling-fluctuating rising" trend due to pollution control policies, reduced precipitation, and enhanced water-saving technologies successively. (2) From a long-term perspective, it is necessary to focus on the internal runoff water use value of lakes. The internal runoff water value of Nansi Lake has been over 75% of the composite water value, and flood storage and water conservation are important manifestations of its ecosystem service value. (3) The external runoff water value of lake is closely related to the internal runoff water value, and relevant departments need to consider the balance between the water withdrawal of multiple cities along the lake and the retained water volume of the lake to achieve the maximum benefit of composite water value.
PubMed: 38943747
DOI: 10.1016/j.jenvman.2024.121618 -
Journal of Environmental Management Jun 2024Achieving net-zero greenhouse gas emissions in the construction sector is essential to sustainable development policy. Previous studies have ignored the impact of the...
Achieving net-zero greenhouse gas emissions in the construction sector is essential to sustainable development policy. Previous studies have ignored the impact of the digital economy on carbon emissions in the construction industry. Using relevant city-level data from China from 2011 to 2021 and employing ArcGIS and Stata software, this study examines the current status of carbon emissions from the construction industry and investigates the impact of the digital economy on these emissions. The findings reveal that (1) from 2011 to 2021, carbon emissions of the construction industry have a pattern of decreasing-increasing-decreasing-increasing across the country. There is an increasing concentration of areas with high and relatively high carbon discharges in Heilongjiang, Jilin, Ningxia, Inner Mongolia, Shanxi, Guangxi, and Guizhou. (2) The standard deviation ellipse indicates the core area of carbon emissions in China's construction industry is moving northeast and becoming more decentralized. (3) Through a series of robustness tests, the digital economy has been proven to effectively reduce carbon emissions from the construction sector in municipal areas. (4) In severely cold regions, mild regions, and high-population-density cities, the digital economy reduces building sector's carbon output. However, it stimulates carbon emissions in the hot summer and cold winter regions. (5) Mechanism tests show that the digital economy reduces China's urban construction carbon emissions by fostering technological progress and green innovation. Urban resilience further strengthens the contribution of the digital economy to reducing carbon discharges in the urban construction sector of China. This article presents empirical evidence demonstrating how the digital economy empowers the construction industry to curtail emissions.
PubMed: 38943745
DOI: 10.1016/j.jenvman.2024.121548 -
JAMA Health Forum Jun 2024States resumed Medicaid eligibility redeterminations, which had been paused during the COVID-19 public health emergency, in 2023. This unwinding of the pandemic...
IMPORTANCE
States resumed Medicaid eligibility redeterminations, which had been paused during the COVID-19 public health emergency, in 2023. This unwinding of the pandemic continuous coverage provision raised concerns about the extent to which beneficiaries would lose Medicaid coverage and how that would affect access to care.
OBJECTIVE
To assess early changes in insurance and access to care during Medicaid unwinding among individuals with low incomes in 4 Southern states.
DESIGN, SETTING, AND PARTICIPANTS
This multimodal survey was conducted in Arkansas, Kentucky, Louisiana, and Texas from September to November 2023, used random-digit dialing and probabilistic address-based sampling, and included US citizens aged 19 to 64 years reporting 2022 incomes at or less than 138% of the federal poverty level.
EXPOSURE
Medicaid enrollment at any point since March 2020, when continuous coverage began.
MAIN OUTCOMES AND MEASURES
Self-reported disenrollment from Medicaid, insurance at the time of interview, and self-reported access to care. Using multivariate logistic regression, factors associated with Medicaid loss were evaluated. Access and affordability of care among respondents who exited Medicaid vs those who remained enrolled were compared, after multivariate adjustment.
RESULTS
The sample contained 2210 adults (1282 women [58.0%]; 505 Black non-Hispanic individuals [22.9%], 393 Hispanic individuals [17.8%], and 1133 White non-Hispanic individuals [51.3%]) with 2022 household incomes less than 138% of the federal poverty line. On a survey-weighted basis, 1564 (70.8%) reported that they and/or a dependent child of theirs had Medicaid at some point since March 2020. Among adult respondents who had Medicaid, 179 (12.5%) were no longer enrolled in Medicaid at the time of the survey, with state estimates ranging from 7.0% (n = 19) in Kentucky to 16.2% (n = 82) in Arkansas. Fewer children who had Medicaid lost coverage (42 [5.4%]). Among adult respondents who left Medicaid since 2020 and reported coverage status at time of interview, 47.8% (n = 80) were uninsured, 27.0% (n = 45) had employer-sponsored insurance, and the remainder had other coverage as of fall 2023. Disenrollment was higher among younger adults, employed individuals, and rural residents but lower among non-Hispanic Black respondents (compared with non-Hispanic White respondents) and among those receiving Supplemental Nutrition Assistance Program benefits. Losing Medicaid was significantly associated with delaying care due to cost and worsening affordability of care.
CONCLUSIONS AND RELEVANCE
The results of this survey study indicated that 6 months into unwinding, 1 in 8 Medicaid beneficiaries reported exiting the program, with wide state variation. Roughly half who lost Medicaid coverage became uninsured. Among those moving to new coverage, many experienced coverage gaps. Adults exiting Medicaid reported more challenges accessing care than respondents who remained enrolled.
Topics: Humans; Medicaid; United States; Health Services Accessibility; Adult; Female; Male; Insurance Coverage; Middle Aged; COVID-19; Poverty; Young Adult; Arkansas
PubMed: 38943683
DOI: 10.1001/jamahealthforum.2024.2193 -
Journal of Burn Care & Research :... Jun 2024Burn survivors can experience social participation challenges throughout their recovery. The aim of this study was to develop a novel Australian English translation of...
Burn survivors can experience social participation challenges throughout their recovery. The aim of this study was to develop a novel Australian English translation of the Life Impact Burn Recovery Evaluation (LIBRE) Profile, the Aus-LIBRE Profile. This study consisted of three stages: 1) translation of the LIBRE Profile from American to Australian English by Australian researchers/burns clinicians; 2) piloting and cognitive evaluation of the Aus-LIBRE Profile with burn survivors to assess the clarity and consistency of the interpretation of each individual item, and 3) review of the Aus-LIBRE Profile by colleagues who identify as Aboriginal Australians for cross-cultural validation. In stage 2, investigators administered the translated questionnaire to 20 Australian patients with burn injuries in the outpatient clinic (10 patients from xx and 10 patients from yy). Face validity of the Aus-LIBRE Profile was tested in 20 burns survivors (11 females) ranging from 21 to 74 years (median age 43 years). The total body surface area (TBSA) burned ranged from 1% to 50% (median 10%). Twelve language changes were made based on the feedback from the burn clinicians/researchers, study participants and colleagues who identify as Aboriginal Australians. Using a formal translation process, the Aus-LIBRE Profile was adapted for use in the Australian burn population. The Aus-LIBRE Profile will require psychometric validation and testing in the Australian burn patient population before broader application of the scale.
PubMed: 38943673
DOI: 10.1093/jbcr/irae134 -
International Journal For Quality in... Jun 2024Ensuring quality in healthcare calls for a coordinated, systematic, congruous and sustained approach. Nevertheless, it demands defining what the quality of healthcare...
BACKGROUND
Ensuring quality in healthcare calls for a coordinated, systematic, congruous and sustained approach. Nevertheless, it demands defining what the quality of healthcare means in the local context. Presently the Malaysian healthcare system utilises various definitions of quality of healthcare across the different initiatives and levels of healthcare which can lead to fragmented or ineffective quality improvement. The study aims to describe the process undertaken in developing an explicit definition of the quality of healthcare tailored to the Malaysian context, which is currently lacking.
METHODS
A pluralistic method was used to explore the different perspectives. Three distinct approaches were used to understand how quality is defined among the different stakeholder groups: 1) interactive policy-makers engagement sessions, 2) a review of local quality-related documents, and 3) an online survey engaging the public. The domains depicting quality of healthcare that emerged through these three approaches were mapped against a framework and synthesised to form the local definition of quality. A national quality-related technical working group convened on several sessions to achieve consensus and finalise the definition of quality of healthcare.
RESULTS
Quality healthcare in Malaysia is defined as providing high quality healthcare that is safe, timely, effective, equitable, efficient, people-centred, and accessible [STEEEPA] which is innovative and responsive to the needs of the people, and is delivered as a team, in a caring and professional manner in order to improve health outcomes and client experience.
CONCLUSION
The consensus-driven local definition of healthcare quality will guide policies and ensure standardisation in measuring quality, thereby steering efforts to improve the quality of healthcare services delivered in Malaysia.
PubMed: 38943635
DOI: 10.1093/intqhc/mzae063 -
The Gerontologist Jun 2024Since the origin of the Successful Aging (SA) model by Rowe and Kahn, scholars have been working on enriching the content of SA and taking actions to promote this...
Since the origin of the Successful Aging (SA) model by Rowe and Kahn, scholars have been working on enriching the content of SA and taking actions to promote this concept worldwide. While most studies primarily focus on older individuals, only a few scholars have considered the environmental aspect of SA. However, the environment, directly and indirectly, enhances older adults' abilities to achieve SA. To measure SA comprehensively and address inequalities among older adults, this theoretical article aims to challenge current SA models by incorporating both individual and environmental aspects and proposing four measurement dimensions: inclusivity of disadvantaged groups, culture-specific adaptation, balance between physical and social environments, and dynamics of the whole lifecycle. Moreover, this article provides examples to illustrate how environment can support older adults especially those who would be defined as "unsuccessful" under the original SA model. Our proposed model would provide theoretical guidance for future research and spark new ideas for policies and programs that support every older adult in achieving SA.
PubMed: 38943554
DOI: 10.1093/geront/gnae081 -
Military Medicine Jun 2024Preventing military sexual assault (SA) is a DoD priority. Building prevention capacity could strengthen the impact of prevention programs and improve outcomes. Capacity...
INTRODUCTION
Preventing military sexual assault (SA) is a DoD priority. Building prevention capacity could strengthen the impact of prevention programs and improve outcomes. Capacity was conceptualized as implementation knowledge and skills using the Getting To Outcomes (GTO) process and organizational-level capacities using the Prevention Evaluation Framework, a framework that applies best practices in prevention and implementation science to prevention at the program and organizational level. The present study assesses implementation knowledge and skills currently possessed by SA prevention personnel in one U.S. Army installation with the goal of identifying preexisting proficiencies and potential gaps. The study uses the Prevention Evaluation Framework organizational-level domains to identify organizational capacities that could be improved.
MATERIALS AND METHODS
Fifteen SA prevention program personnel were recruited for individual 1-hour interviews from one U.S. Army installation. A semi-structured interview guide was developed by the study team to assess knowledge and skills within the GTO framework. Applied thematic analysis guided data coding and analysis.
RESULTS
Participants reported a range of proficiencies and gaps in capacity for SA prevention. Within the prevention workforce capacity, proficiencies were skill in tailoring training, and an existing train-the-trainer model. Gaps were training to facilitate difficult conversations, and an inability to tailor trainings to audience needs. Two proficiencies related to the comprehensive approach were having a victim advocate present during trainings, and providing training across leadership levels. The final proficiency involved data. Existing data sources were viewed as useful for identifying the nature and extent of local problems. However, participants reported a lack of confidence and skill in selecting appropriate outcome measures and collecting and using primary data. Gaps in leadership capacity were cultural norms, lack of trust, leader investment, logistical difficulty working with leaders, and comfort engaging with leaders. Gaps in collaborative relationships were the lack of informal networking within the SA prevention area to include civilians.
CONCLUSIONS
The GTO-specific knowledge and skills of SA prevention personnel at one U.S. Army installation revealed proficiencies and gaps in organizational capacities influencing the prevention mission. Findings indicate that GTO support could be useful for improving the quality of program activities. However, results also indicate that GTO support would be more effective if they were paired with sufficient prevention infrastructure at the organizational level.
PubMed: 38943537
DOI: 10.1093/milmed/usae332