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This article advances a couple-level framework to examine how parenthood shapes withinfamily gender inequality by education in three countries that vary in their normative and policy context: the United States, Germany, and the United Kingdom. We trace mothers’ share of couple earnings and variation by her education in the 10-year window around first birth, using long-running harmonized panel surveys from the 1990s and 2000s (N = 4,117 couples and 28,488 couple-years) and an event study methodology that leverages withincouple variation in earnings pre- and post-birth. Our results show steep declines in her share of couple earnings following first birth across the three countries that persist over several years of follow-up. Declines are smallest in the United States, due to U.S. mothers’higher employment and longer work hours. Declines are also smaller among female partners without a college degree in the United States, where mothers have less work-family support and fewer options to manage work and family on one income. Results shed light on how parenthood plays into gender inequality within couples, and how country context shapes couple dynamics and inequality across households.

Individuals routinely engage in instrumental transactional legal behavior, from generating tax returns to signing leases to negotiating employment terms. While some individuals undertake these activities equipped with the skills, knowledge, and capacity to behave strategically, others do not. In this article, we introduce the concept of legal actuation to describe this legal behavior and theorize its role as a source of inequality under the law. Using estate planning as an empirical example, we consider how variation in legal actuation may serve to reproduce economic inequalities and investigate the role of legal socialization, knowledge, and capability as mechanisms of advantage. In doing so, we draw attention to an understudied dimension of everyday legal behavior that has important implications for equal justice and the relationship between law and inequality.

Abstract As an increasing number of older adults are aging-in-place, individuals’ perceptions of their neighborhood environments have emerged as significant social-contextual issues for healthy aging. Prior studies have focused on how neighborhood characteristics shape perceptions of residential neighborhoods. Far less research has focused on the role of local banking, despite the intersections between local banking establishments and a host of key community social and economic resources, particularly for the older adult population. We use nationally representative data from older adults interviewed at Rounds 2 and 3 of the National Social Life, Health, and Aging Project (N=4,589) linked with the National Establishment Time Series database to examine neighborhood perceptions as a function of local banking establishment density. We find that older adults who live in areas with higher rates of banking establishments report significantly higher levels of neighborhood safety, even when adjusting for a host of individual and neighborhood characteristics. Importantly, other types of establishments also shape perceived neighborhood safety, however, the significance of certain associations only emerges when we adjust for the presence of local banking. We suggest that local banks may be a lynchpin in catalyzing the broader socioeconomic vitality of a place, supporting older residents’ favorable perceptions of neighborhood safety. We discuss the implications of our findings for inequality in aging in light of unequal access to local banking across social groups, potentially increasing the vulnerability of older adults who are less likely to adopt mobile banking solutions and who are more likely to be susceptible to financial exploitation.

Despite recognition that palliative care is an essential component of any humanitarian response, serious illness-related suffering continues to be pervasive in these settings. There is very limited evidence about the need for palliative care and symptom relief to guide the implementation of programs to alleviate the burden of serious illness-related suffering in these settings. A basic package of essential medications and supplies can provide pain relief and palliative care; however, the practical availability of these items has not been assessed. This study aimed to describe the illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh. Between November 20 and 24, 2017, we conducted a cross-sectional study of individuals with serious health problems (n = 156, 53% male) and caregivers (n = 155, 69% female) living in Rohingya refugee camps in Bangladesh, using convenience sampling to recruit participants at the community level (i.e., going house to house to identify eligible individuals). The serious health problems, recent healthcare experiences, need for medications and medical supplies, and basic needs of participants were explored through interviews with trained Rohingya community members, using an interview guide that had been piloted with Rohingya individuals to ensure it reflected the specificities of their refugee experience and culture. The most common diagnoses were significant physical disabilities (n = 100, 64.1%), treatment-resistant tuberculosis (TB) (n = 32, 20.5%), cancer (n = 15, 9.6%), and HIV infection (n = 3, 1.9%). Many individuals with serious health problems were experiencing significant pain (62%, n = 96), and pain treatments were largely ineffective (70%, n = 58). The average age was 44.8 years (range 2-100 years) for those with serious health problems and 34.9 years (range 8-75 years) for caregivers. Caregivers reported providing an average of 13.8 hours of care per day. Sleep difficulties (87.1%, n = 108), lack of appetite (58.1%, n = 72), and lack of pleasure in life (53.2%, n = 66) were the most commonly reported problems related to the caregiving role. The main limitations of this study were the use of convenience sampling and closed-ended interview questioning. In this study we found that many individuals with serious health problems experienced significant physical, emotional, and social suffering due to a lack of access to pain and symptom relief and other essential components of palliative care. Humanitarian responses should develop and incorporate palliative care and symptom relief strategies that address the needs of all people with serious illness-related suffering and their caregivers.

Background There is no standard assessment tool for pediatric home care recipients in Canada, limiting the availability of comparable, population-based data. The objective of this study was to describe pediatric home care recipients who were part of a pilot implementation of the interRAI Pediatric Home Care Assessment Form (PEDS-HC) among medically complex children referred to home care agencies in three regions in Ontario, Canada. Methods All 14 agencies providing home care to children in Ontario were invited to participate in the pilot project, and 9 participated in an education session. Three of these agencies used the PEDS-HC during the pilot implementation between February 2018 and March 2020. We used de-identified data to describe the demographics, home care needs, and diagnoses of pediatric home care recipients. Results The sample of 474 assessments was predominantly male (60.34%), with an average age at assessment of 12.36 years (SD 4.56). Most (78.48%) reported English as their primary language. Most children assessed had between two and eight medical diagnoses. Diagnoses reported varied: gastrointestinal, musculoskeletal, respiratory and neurological conditions were most common. The prevalence of urinary incontinence (40.1%) and bowel incontinence (70.9%) were high. Over 60% of children were rarely or only sometimes understood. A majority of children had adequate hearing (83.5%) and vision (68.6%). Extensive services were being provided in 10% of children assessed. Most children received care both at school and at home (70.89%), with 20.89% receiving home care only. Conclusions The PEDS-HC provides a detailed, standardised descriptive profile of medically complex children receiving home care. Expanding use of PEDS-HC would promote consistency in care planning and delivery on the patient level, enable cross-jurisdictional comparisons, and inform utilization tracking and health care funding decisions on the organization and provincial levels.

To explore experiences of pediatric clinicians participating in a serious illness communication program (SICP) for advance care planning (ACP), examining how the SICP supports clinicians to improve their communication and the challenges of implementing new communication tools into clinical practice. A qualitative description study using individual interviews with a diverse group of pediatric clinicians who participated in 2.5-hour SICP training workshops at pediatric tertiary hospitals. Discussions were transcribed, coded, and arranged into overarching themes. Thematic analysis was conducted using interpretive description methodology. Fourteen clinicians from 2 Canadian pediatric tertiary hospital settings were interviewed, including nurses (36%), physicians (36%), and social workers (29%), from the fields of neonatology (36%), palliative care (29%), oncology (21%), and other pediatric specialties (14%). Key themes included specific benefits of SICP, with subthemes of connecting with families, increased confidence in ACP discussions, providing tools to improve communication, and enhanced self-awareness and self-reflection. A second theme of perceived challenges emerged, which included subthemes of not having the conversation guide readily accessible, divergent team communication practices, and particular features of the clinical environment which limited the possibility of engaging in ACP discussions with parents. A structured program to enhance serious illness communication supports clinicians to develop skills and tools to increase their confidence and comfort in conducting conversations about end-of-life issues. Addressing challenges of adopting the newly learned communication practices, by providing access to digital SICP tools and conducting SICP training for clinical teams may further support clinicians to engage in ACP.

Purpose The Global Medical Physics Training and Development Program (GMPTDP) is a novel initiative that provides United States (US)‐based graduate students in medical physics with structured, immersive clinical training in Ghana. Methods The five‐week program begins with a cultural and clinical orientation in the US, followed by 4 weeks of clinical rotations across leading Ghanaian medical institutions. During rotations, students gain experience with teletherapy (LINACs and cobalt‐60), brachytherapy, treatment planning, imaging, and more. Trainees participate in clinical activities, conduct collaborative projects, and engage in community outreach and cultural immersion. The program culminates in a symposium highlighting student experiences and future directions with speakers including physicists, oncologists, engineers, and policymakers. Results The pilot year of the program was successfully completed by three students from May 28 2024–July 2 2024. This article outlines the development, structure, and implementation of GMPTDP as a replicable model for global health training in medical physics, emphasizing sustainable partnerships between high‐income and low‐ and middle‐income countries. Educational objectives include demonstrating effective cross‐border training models, fostering collaborative research, and expanding global clinical experience in the field of medical physics. Conclusions A model for a global medical physics training program was developed and successfully implemented.

Background: Globally, more than 97% of children needing palliative care reside in low- and middle-income countries, where there is very limited access to palliative care. Several community-based palliative care programs focused on adults, have been described in resource limited settings, suggesting a simple and low-cost approach to providing palliative care. The implementation of community-based palliative care for children has not previously been described. Context: This community case study describes the implementation of an innovative model of community-based palliative care program in and urban informal settlement, (Korail Slum, Bangladesh). The program is led by a local government hospital, with experience in community-based palliative care, in partnership with the local community. Problem: Children with serious conditions in an urban unformal settlement do not have access to health services which address their medical, psychosocial and spiritual needs. This gap leads to a significant burden of preventable suffering for them and their families. Solution: A community-based palliative care program was implemented, which includes home care by trained community health workers, with support and supervision from palliative care nurses and physicians. The program’s objective is to provide effective symptom management, clear communication about the child’s condition with parents, and psychosocial support including support for basic needs. The program was free for families including medications, medical equipment, physiotherapy, and speech therapy. The program was monitored through regular assessments of quality of life using standardized tools (PedsQL Family Impact Module), as well as interviews and focus group discussions. Conclusion and lessons learned: A model of community-based palliative care for children can be implemented in an urban informal settlement. Program effectiveness is enhanced by community health workers who share language, culture, and life-experiences with the individuals they serve. Partnerships with local health care facilities and community groups strengthen the program’s sustainability. Ensuring financial sustainability remains a challenge.

Abstract Background Perinatal palliative care is a relatively new component of paediatric palliative care which supports families who are expecting the birth of a child with a life-limiting condition. This study seeks to understand the characteristics of the infants and families referred for perinatal palliative care and the context for referrals in terms of diagnoses, referral characteristics, interventions, and outcomes. Methods A retrospective chart review of infants with prenatally diagnosed life-limiting conditions that were referred for perinatal palliative care. Results Eighty-five referrals were made for perinatal palliative care during the 10-year period, of which, 84 chose to continue with the service. Average gestational age at diagnosis was 23 weeks, and the mean time between diagnosis and referral to palliative care was 7 weeks. Stillbirths were common, occurring in 29% cases. Of livebirths, 59% of the infants survived for 2 days, and 80% died within 30 days. The most commonly referred conditions were trisomy 13 or 18 (24%), severe central nervous system malformations (20%), and severe congenital cardiac disease (16%). Referrals were most often made by neonatologists (39%), and maternal–fetal medicine specialists (36%). Discussion Our study confirms previously observed characteristics of diagnosis, referrals, and outcomes, while providing the most detailed account of lifespans for particular diagnoses to date. Our findings validate the need for perinatal palliative care, as 99% of those referred continued with the service. Future research should adopt a prospective approach to identify critical factors affecting decision making of families and physicians in the wake of a life-limiting diagnosis.

Neonatal palliative care is a specialized area within children’s palliative care, which focusses on the needs of infants with life-limiting or life-threatening conditions. Nearly one quarter of global neonatal deaths occur in India, where neonatal palliative care evidence is limited. This study describes the development and implementation of a neonatal palliative care program within a neonatal intensive care unit (NICU) at a government hospital, describing the implementing an 8-month pilot palliative care program for neonates, including the patterns of care, and barriers and enablers of success. The hospital-based palliative care team included trained pediatric palliative care physicians, a nurse, and a counselor. There was a steady increase in monthly referrals. There were 110 referrals in total, including 89 (81%) deaths and 18 (16%) babies were alive at the time of final follow-up, 10 months after the pilot program was completed. The program addressed physical symptoms, including providing morphine, as well as psychosocial and spiritual concerns of families. A model of hospital-based palliative care for neonates can be implemented within NICUs in tertiary government hospitals in India. Neonatal palliative care programs should include partnerships with charitable organizations to support implementation costs and provide palliative care training, mentorship, and capacity-building support.