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Focusing on the experiences of people in Russia and Ukraine, Staging Democracy shows how some national leaders' seeming popularity rests on local economic compacts. Jessica Pisano draws on long-term research in rural communities and company towns, analyzing how local political and business leaders, seeking favor from incumbent politicians, used salaries, benefits, and public infrastructure to pressure citizens to participate in command performances. Pisano looks at elections whose outcome was known in advance, protests for hire, and smaller mises en scène to explain why people participate, what differs from spectacle in totalitarian societies, how political theater exists in both authoritarian and democratic systems, and how such performances reshape understandings of the role of politics. Staging Democracy moves beyond Russia and Ukraine to offer a novel economic argument for why some people support Putin and similar politicians. Pisano suggests we can analyze politics in both democracies and authoritarian regimes using the same analytical lens of political theater.

The overview summarizes the evaluation of community responses (15 studies, including 11 evaluations carried out in 8 countries). It presents the evaluation questions, the methodology, the key results achieved by community responses along the continuum of prevention, treatment, care and support, and the resulting policy and programmatic implications. Before the scale-up of the international response to the AIDS pandemic, community responses in developing countries played a crucial role in providing services and care for those affected. This study is the first comprehensive, mixed-method evaluation of the impact of that response. The evaluation finds that community response can be effective at increasing knowledge of HIV, promoting social empowerment, increasing access to and use of HIV services, and even decreasing HIV incidence, all through the effective mobilization of limited resources. By effectively engaging with this powerful community structure, future HIV and AIDS programs can ensure that communities continue to contribute to the global response to HIV and AIDS.

Although HIV prevalence in South Asia is relatively low, the epidemic is growing among marginalized groups, including sex workers, injection drug users, men who have sex with men, and transgender communities. Despite prevention and other efforts to reduce high-risk behaviors such as unprotected sex, buying and selling of sex, and injecting drug use, HIV vulnerability and risk remain high. This problem is partly due to a widespread failure to respond adequately to key social drivers of HIV: stigma and discrimination. Stigmatizing attitudes in the general population and discriminatory treatment by actors ranging from health providers to local policy makers intensify the marginalization of vulnerable groups at highest risk, driving them further from the reach of health services and much-needed prevention, treatment, care, and support. Daily harassment and abuse also cause health problems and adversely affect mental health, thereby leading to depression, social isolation, and an array of adverse socioeconomic outcomes related to HIV and AIDS. The South Asia Region Development Marketplace1 (SARDM) took an innovative and unique approach to addressing these gaps and needs through its 2008 development marketplace, \"tackling HIV and AIDS stigma and discrimination.\" Part one of this reports describes key findings and lessons learned that emerged across the 26 implementers. Part two contains case studies for six of the implementers, offering a more in-depth look at the lessons and challenges of intervening against stigma and discrimination. Part three provides summaries of all 26 projects.

Following the transition from central planning toward market-based economies, the formerly communist states of Central and Eastern Europe introduced a number of reforms in the finance, management, and organization of the health sector. While health sector reforms in these countries have involved deep structural changes, they have generally been less successful in improving efficiency, enhancing equity in healthcare financing and delivery, and managing clinical quality of health services. Total health expenditures have increased in almost all countries, especially in recent years, and with revenues not keeping pace, huge debts have accumulated in the health sector. Efficiency gains have been few and far between, and with the dynamic nature of technology and demographic changes increasing the complexity of health services and the health marketplace, further reforms are becoming even more difficult. This report takes stock of recent trends in health expenditure aggregates in the public sector and identifies specific areas of health expenditure reform consistent with the objectives of stabilizing the fiscal situation in these countries (the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia) without adversely affecting the production, delivery and utilization of health services.

Background While a core aim of early intervention psychosis services (EIPS) is to prevent hospitalisation, many with a first episode of psychosis (FEP) will require inpatient care. We explored young people’s (YP) and their carers’ hospitalisation experiences prior to and during EIPS engagement and how factors across these services influenced these experiences. Methods Using purposive sampling, we recruited twenty-seven YP, all of whom had been involved with the hospital system at some stage, and twelve support persons (parents and partners of YP) from state and federally funded EIPS in Australia with different models of care and integration with secondary mental health care. Audio-recorded interviews were conducted face-to-face or via phone. A diverse research team (including lived experience, clinician, and academic researchers) used an inductive thematic analysis process. Results Four key themes were identified as influential in shaping participant’s hospital experiences and provide ideas for an approach to care that is improved by the effective coordination of that care, and includes this care being delivered in a trauma informed manner: (1) A two-way street: EIPS affected how participants experienced hospitalisation, and vice versa; (2) It’s about people: the quality and continuity of relationships participants had with staff, in hospital and at their EIPS, was central to their experience; (3) A gradual feeling of agency: participants viewed EIPS as both reducing involuntary care and supporting their self-management; and (4) Care coordination as navigation for the healthcare system: great when it works; frustrating when it breaks down. Conclusions Hospitalisation was viewed as a stressful and frequently traumatic event, but a approach to care founded on trust, transparency, and collaboration that is trauma-informed ameliorated this negative experience. Consistent EIPS care coordination was reported as essential in assisting YP and carers navigate the hospital system; conversely, discontinuity in EIPS staff and lack of integration of EIPS with hospital care undermined the positive impact of the EIPS care coordinator during hospitalisation. Care coordinator involvement as a facilitator, information provider, and collaborator in inpatient treatment decisions may improve the usefulness and meaningfulness of hospital interventions.

Background People living with dementia (PLWD) have poorer outcomes than cognitively normal people when admitted to hospital. One reason for this difference is related to the challenges in learning and integrating the needs and preferences of PLWD into clinical care. We aimed to obtain a range of perspectives on the challenges in supporting PLWD in hospital and explore opportunities for improvement. Methods Using an exploratory qualitative study design, we conducted interviews with nine people supporting PLWD (current / ex-spouses or children of PLWD) and 11 nursing, medical and allied health staff members at a single Australian hospital. Data were thematically analysed using a framework approach. Results Participants described how best practice in supporting PLWD included understanding and integrating patient needs and highlighted the importance of family and the multidisciplinary team working in partnership. A number of factors inhibiting quality care provision were described, including uncertainty around responsibility for communicating with families to understand needs of PLWD; unsuitable tools; lack of opportunities for families to communicate with staff; and, resource and environmental constraints. Participants discussed potential for improvement, emphasising the need for a pre-emptive, rather than reactive solution. They expressed support for the idea of a ‘hospital admission kit’, containing both information about PLWD and their familiar items. Implementation considerations were also noted, with various perspectives on the timing of initiation, updating, responsible person(s), format, content and how it should be incorporated into clinical workflows. Conclusions We found that hospital staff and those supporting PLWD felt that integrating the needs and preferences of PLWD into hospital care was important. The concept of a pre-prepared ‘toolkit’ that was ready in the case of a need to attend hospital was felt to be valid and potentially helpful. More work is required to design aspects such as format, content and the workflows needed to generate accountability and reliability in creating, updating and incorporating it into hospital care. Clinical trial number Not applicable.

Background Different Early Intervention Psychosis Service (EIPS) models of care exist, but many rely upon community-based specialist clinical teams, often with other services providing psychosocial care. Time-limited EIPS care creates numerous service transitions that have potential to interrupt continuity of care. We explored with young people (YP) and their support people (SP) their experiences of these transitions, how they affected care and how they could be better managed. Methods Using purposive sampling, we recruited twenty-seven YP, all of whom had been hospitalised at some stage, and twelve SP (parents and partners of YP) from state and federally funded EIPS in Australia with different models of care and integration into secondary mental health care. Audio-recorded interviews were conducted face-to-face or via phone. A diverse research team (including lived experience, clinician and academic researchers) used an inductive thematic analysis process. Two researchers undertook iterative coding using NVivo12 software, themes were developed and refined in ongoing team discussion. Results The analysis identified four major service-related transitions in a YP’s journey with the EIPS that were described as reflecting critical moments of care, including: transitioning into EIPS; within service changes; transitioning in and out of hospital whilst in EIPS care; and, EIPS discharge. These service-related transition affected continuity of care, whilst within service changes, such as staff turnover, affected the consistency of care and could result in information asymmetry. At these transition points, continuity of care, ensuring service accessibility and flexibility, person centredness and undertake bio-psychosocial support and planning were recommended. State and federally funded services both had high levels of service satisfaction, however, there was evidence of higher staff turnover in federally funded services. Conclusion Service transitions were identified as vulnerable times in YP and SP continuity of care. Although these were often well supported by the EIPS, participants provided illustrative examples for service improvement. These included enhancing continuity and consistency of care, through informed and supportive handovers when staff changes occur, and collaborative planning with other services and the YP, particularly during critical change periods such as hospitalisation.

The Wall of Berlin felt more than 20 years ago. Since then a deep transformation has characterised the Eastern countries. People in both Eastern and Western Europe have known dramatic changes related to the integration of former communist countries in the “western world”. Using a new empirical approach, this paper proposes an inquiry into the people’s preferences and attitudes towards competition and market regulation. The results show that strong and significant differences between Eastern and Western citizens still persist. The new approach is compared to the traditional, to show that the results are robust to different methodologies.

The aim was to examine the relationships between oral functions and support/care-need certification in older people aged ≥ 75 years using the National Health Insurance (NHI) database system and data from Kani City, Gifu, Japan. In total, 732 older Japanese people aged ≥ 75 years who did not have support/care-need certification and underwent dental check-ups in Kani City in 2017 were followed up until 2020. Chewing state, tongue and lip function, and swallowing function were assessed by a self-administered questionnaire, an oral diadochokinesis test, and a repetitive saliva-swallowing test, respectively. The presence or absence of systemic diseases and of support/care-need certification was based on data collected by the NHI database. At follow up, 121 (17%) participants had support/care-need certification. The participants with support/care-need certification included more women (p < 0.001) and older people (p < 0.001); and had more hypertension (p = 0.003), musculoskeletal disorders (p < 0.001), pneumonia (p = 0.044), poor chewing state (p < 0.001), and poor swallowing function (p = 0.003) than those without support/care-need certification. Furthermore, the presence of support/care-need certification at follow up was associated with sex (woman: odds ratio [OR], 2.120; 95% confidence interval [CI], 1.354 to 3.317), age (OR, 1.203; CI, 1.139 to 1.270), chewing state (poor: OR, 2.534; CI, 1.409 to 4.557), and swallowing function (poor: OR, 2.372; CI, 1.248 to 4.510) at baseline. However, tongue and lip function were not associated with support/care-need certification. The results indicate that older Japanese people aged ≥ 75 years with a poor chewing state and poor swallowing function at baseline had a higher risk for support/care-need certification after three years.

Aim This study aims to develop the Social Activities Scale for Community‐Dwelling Older People Requiring Support (SASOS). Design This study is a cross‐sectional investigation. Methods The participants were healthy older people (HOP; N = 140) and those requiring support (OPRS; N = 250). An anonymous questionnaire included items on SASOS, subjective health and ikigai (Japanese well‐being concept). Criterion‐related validity was examined using the Social Activity Index for Elderly People (SAI‐E). Results Seventy‐five HOP and 157 OPRS provided effective responses. The scale (α = 0.805) had three subscales: \"interactions with friends and neighbors (F1),” \"close relationships with family (F2)” and \"interactions with others through activity programs (F3).” SASOS and SAI‐E scores were correlated (r = .558, p < .01), indicating criterion‐related validity. In known‐groups validity analysis, F1 were significantly higher among HOP and F3 were significantly higher among OPRS. Total scores correlated with perceived health (r = .240, p < .01) and ikigai (r = .419, p < .01).