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Noting the importance of food assistance programs to low income families in New York City (NYC), the research questions for the present study were: (1) What are the facilitators and barriers to social service utilization for food pantry clients in the South Bronx?, and (2) Does receiving food pantry services serve as a point of entry for social service utilization? We surveyed 218 food pantry clients at a community-based, social service organization based in the South Bronx. Our findings indicate that being aware of local social services was the strongest predictor for utilizing social services. Social service utilization was also predicted by high use of the food pantry (weekly or more); high levels of food insecurity, depressive symptoms; and the ability to communicate ef-fectively in English. Given rising inflation costs and the continued higher expenses as-sociated with food consumption in the United States generally and in NYC specifically, our findings suggest that food pantry sites in the South Bronx bear the potential to be vital entry points for social service referral and utilization, particularly for the screen-ing and assessment of depressive symptoms. Given these findings, nonprofit leaders and social service funders should prioritize capacity building of food pantries as sites for the delivery of health promotion interventions and social services.

Background: Transgender individuals experience unique vulnerabilities to intimate partner violence (IPV) and may experience a disproportionate IPV burden compared with cisgender (nontransgender) individuals. Objectives: To systematically review the quantitative literature on prevalence and correlates of IPV in transgender populations. Search Methods: Authors searched research databases (PubMed, CINAHL), gray literature (Google), journal tables of contents, and conference abstracts, and consulted experts in the field. Authors were contacted with data requests in cases in which transgender participants were enrolled in a study, but no disaggregated statistics were provided for this population. Selection Criteria: We included all quantitative literature published before July 2019 on prevalence and correlates of IPV victimization, perpetration, or service utilization in transgender populations. There were no restrictions by sample size, year, or location. Data Collection and Analysis: Two independent reviewers conducted screening. One reviewer conducted extraction by using a structured database, and a second reviewer checked for mistakes or omissions. We used random-effects meta-analyses to calculate relative risks (RRs) comparing the prevalence of IPV in transgender individuals and cisgender individuals in studies in which both transgender and cisgender individuals were enrolled. We also used meta-analysis to compare IPV prevalence in assigned-female-sex-at-birth and assigned-male-sex-at-birth transgender individuals and to compare physical IPV prevalence between nonbinary and binary transgender individuals in studies that enrolled both groups. Main Results: We identified 85 articles from 74 unique data sets (n total  = 49 966 transgender participants). Across studies reporting it, the median lifetime prevalence of physical IPV was 37.5%, lifetime sexual IPV was 25.0%, past-year physical IPV was 16.7%, and past-year sexual IPV was 10.8% among transgender individuals. Compared with cisgender individuals, transgender individuals were 1.7 times more likely to experience any IPV (RR = 1.66; 95% confidence interval [CI] = 1.36, 2.03), 2.2 times more likely to experience physical IPV (RR = 2.19; 95% CI = 1.66, 2.88), and 2.5 times more likely to experience sexual IPV (RR = 2.46; 95% CI = 1.64, 3.69). Disparities persisted when comparing to cisgender women specifically. There was no significant difference in any IPV, physical IPV, or sexual IPV prevalence between assigned-female-sex-at-birth and assigned-male-sex-at-birth individuals, nor in physical IPV prevalence between binary- and nonbinary-identified transgender individuals. IPV victimization was associated with sexual risk, substance use, and mental health burden in transgender populations. Authors’ Conclusions: Transgender individuals experience a dramatically higher prevalence of IPV victimization compared with cisgender individuals, regardless of sex assigned at birth. IPV prevalence estimates are comparably high for assigned-male-sex-at-birth and assigned-female-sex-at-birth transgender individuals, and for binary and nonbinary transgender individuals, though more research is needed. Public Health Implications: Evidence-based interventions are urgently needed to prevent and address IPV in this high-risk population with unique needs. Lack of legal protections against discrimination in employment, housing, and social services likely foster vulnerability to IPV. Transgender individuals should be explicitly included in US Preventive Services Task Force recommendations promoting IPV screening in primary care settings. Interventions at the policy level as well as the interpersonal and individual level are urgently needed to address epidemic levels of IPV in this marginalized, high-risk population.

Background Fragmented delivery of health and social services can impact access to high-quality, person-centred care. The goal of system navigation is to reduce barriers to healthcare access and improve the quality of care. However, the effectiveness of system navigation remains largely unknown. This systematic review aims to identify the effectiveness of system navigation programs linking primary care with community-based health and social services to improve patient, caregiver, and health system outcomes. Methods Building on a previous scoping review, PsychInfo, EMBASE, CINAHL, MEDLINE, and Cochrane Clinical Trials Registry were searched for intervention studies published between January 2013 and August 2020. Eligible studies included system navigation or social prescription programs for adults, based in primary care settings. Two independent reviewers completed study selection, critical appraisal, and data extraction. Results Twenty-one studies were included; studies had generally low to moderate risk of bias. System navigation models were lay person-led ( n  = 10), health professional-led ( n  = 4), team-based ( n  = 6), or self-navigation with lay support as needed ( n  = 1). Evidence from three studies (low risk of bias) suggests that team-based system navigation may result in slightly more appropriate health service utilization compared to baseline or usual care. Evidence from four studies (moderate risk of bias) suggests that either lay person-led or health professional-led system navigation models may improve patient experiences with quality of care compared to usual care. It is unclear whether system navigation models may improve patient-related outcomes (e.g., health-related quality of life, health behaviours). The evidence is very uncertain about the effect of system navigation programs on caregiver, cost-related, or social care outcomes. Conclusions There is variation in findings across system navigation models linking primary care with community-based health and social services. Team-based system navigation may result in slight improvements in health service utilization. Further research is needed to determine the effects on caregiver and cost-related outcomes.

The novel coronavirus pandemic (hereafter COVID-19) is likely to have unprecedented impacts on the incidence and impacts of crime and violence globally. This includes impacts to the risk, consequences, and decision-making of women experiencing violence by an intimate partner (hereafter IPV). Most importantly, the COVID-19 pandemic, and its impact on the risk of IPV is likely to differentially impact vulnerable populations, including minority women and those with long histories of victimization and mental health issues. This review paper explores the potential short- and long-term implications of COVID-19 on the risk of IPV, highlighting some of the most recent preliminary data. The economic impact of the COVID-19 pandemic, record levels of male unemployment, added stressors in the home, including the care and home schooling of children, and the social distancing measures required by the epidemiological response, may serve to undermine the decades of progress made in keeping women and children safe at home. Victim police reporting, help-seeking decisions, and social service utilization during the pandemic are likely to be impacted by stay-at-home orders and social distancing requirements. The paper concludes with a discussion of the implications for providing safety planning and self-care for victims and their children.

Abstract Non-malignant diseases cause 60% of non-communicable diseases requiring palliative care, yet specialist palliative care services primarily focus on cancer. We investigated end-of-life healthcare and social services utilization among cancer and non-malignant patients, and, secondarily, access to specialist palliative care and its effect on services utilization. This retrospective, nationwide register-based study included all adults (n = 38 540) who died from non-communicable life-limiting diseases in Finland in 2019, categorized into neurodegenerative (31%), other non-malignant (36%), and cancer (33%) groups. Hospital was the most common place of death (61%). Healthcare utilization substantially increased during the final weeks of life in all groups but remained highest in cancer patients. Social services utilization was highest in neurodegenerative diseases. Specialist palliative care contact was significantly (P < .001) higher in cancer (30.1%) compared to neurodegenerative (10.9%) and other non-malignant (7%) diseases. Early (>30 days before death) compared to late/no specialist palliative care contact significantly reduced emergency care contacts (47.8% vs. 52.2%) and hospitalizations in secondary hospitals (24.7% vs. 33.7%), and increased specialist palliative care ward (15.5% vs. 1.5%) and hospital-at-home (36.8% vs. 3.4%) utilization during the final month (P < .001). Healthcare utilization was high in all disease groups, highest among cancer patients. Hospital was the most common place of death. Specialist palliative care contact was rare in non-malignant diseases. Early contact with specialist palliative care associated with lower emergency care utilization and secondary hospital inpatient care during the last month of life. These results highlight the necessity for timely equitable specialist palliative care services for all.

Background Caring for people with dementia in communities inevitably brings heavy burden for their family caregivers. Senses of positive aspects from caring and proper service support may help shape a healthy care journey for carers. This study aims to evaluate the caregiving burden, positive aspects, and service utilization of informal caregivers for community‐living older adults with neurocognitive disorders (NCDs). Method 448 informal caregivers of older adults aged ≥60 (major NCD/ dementia: 68, mild NCD: 254, normal cognition: 126) were recruited from in a community‐based prevalence survey in Hong Kong. Caregivers’ subjective burden was measured by Zarit Burden Interview (ZBI), while their gain was measured by positive aspect of caregiving scale (PACS). Caregivers’ use of medical and social service was also recorded. Differences in measures across three disease groups were examined by analysis of variance and t‐test. Correlations between measures were estimated by Pearson coefficient. Result Nearly 60% of interviewed carers were female, spouses of care recipients, and not in employment. Over 75% of them cohabited with care recipients and take the major responsibility for caring. Compared to normal controls, carers of major and mild NCD had higher scores in caring burden, and over one in ten dementia carers were suffering moderate to severe degree of burden. Regarding positive aspects, carers of major and mild NCDs also have higher scores, mainly in items of “feel needed”, “feel appreciated”, and “feel important”. As for service utilization, dementia carers used more psychological and home help services. Finally, caring burden was positively correlated to positive gain (r = 0.233, P<0.001), psychological (r = 0.186, P<0.001) and social services (r = 0.146, P<0.001). The sense of positive aspects was uncorrelated to psychological services (r = ‐0.064, P = 0.174) but positively correlated to social services (r = 0.149, P = 0.002). Conclusion Informal caregivers of major and mild NCD are experiencing heavier caring burden. They also have higher sense of positive aspects from caring and more utilization of psychological and social care. Relationships between positive and negative experience of caregivers and their service utilization need further investigations.

Background Although most individuals experiencing cognitive impairment reside with another, as many as one third may live alone. Such individuals may have difficulty managing their health and wellbeing. Further, they may be more isolated from healthcare and social services. Developing strategies to circumvent premature institutional placement and reduce use of emergency services is vital to keeping healthcare expenditures lower, and also recognizes the needs of individual’s safety, autonomy, and quality‐of‐life. Methods This study utilized a single‐arm, non‐randomized trial design. This proof‐of‐concept study aimed to establish feasibility of Services To Age in Your Home (STAY Home) service utilization and care management intervention to improve utilization of healthcare and social support services for persons living alone with cognitive impairment. The intervention implemented one session weekly for twelve weeks through in‐person visits by a team of social workers and student interns of approximately one hour. Potential participants underwent cognitive screenings, the Adapted Informed Consent Questionnaire, and the informed consent process was repeated every 30 days to try to ensure that participants were appropriate to participate. The primary outcome was to increase healthcare and social service utilization. Exploratory outcomes examined social support and biopsychosocial needs. Results Of the 12 participants, individuals reported limited, non‐traditional forms of social support. Analyses of the data demonstrate a significant need for this population to link those living alone with cognitive impairment to healthcare and social services (pre‐intervention only 42% had been seen by a social serivce provider in the last year; only 33% had seen a healthcare provider in the last year). Analyses demonstrate the intervention is feasible with high adherence to weekly visits (75%). While the study was not powered to compare secondary outcomes, quality‐of‐life increased for participants from pre‐ to post‐intervention (pre‐intervention x̄ = 2.7; post‐intervention x̄ = 3.3; p‐value = 0.01). Conclusion While many participants were willing to engage in the pilot program, additional barriers contributed to utilizing health and social services. Future studies must continue to explore potential solutions for this difficult‐to‐support population. In addition to increasing access to healthcare and support services, participants may also benefit from a medication adherence component to the intervention.

Background Cost‐of‐illness studies are essential for care planning and policy making. It is increasing recognized that care for people living with neurocognitive disorders (NCDs) is costly. This study estimated the service utilisation and economic cost of mild and major NCDs among older adults in Hong Kong. Method Based on a population‐based prevalence survey of NCDs in Hong Kong, a total of 461 community‐dwelling older adults aged 60 and over (major NCD: 68, mild NCD: 264, normal cognition: 129) completed the COI survey and were included in analysis. Service utilisation of participants, including medical, social, and informal care, was measured by the adapted version of Resource Utilisation of Dementia questionnaire. Per person cost was estimated from a societal perspective and expressed in 2022 US dollars. Associated factors of service utilisation and economic cost were examined by two‐part models fitting for mixed discrete‐continuous outcomes. Result Annual cost per community‐living adult with major and mild NCD was US $9,542 (95%CI: 7,728‐11,356) and US$ 4,218 (3,670‐4,766) in Hong Kong, respectively, significantly higher than that of normal cognition. The territory‐wide cost of major and mild NCD in community was estimated at US $2.0 (1.7‐2.2) and US$ 1.5 (1.2‐1.8) billion, accordingly. The majority of cost of major NCD (76%) and mild NCD (50%) was attributable to social care and informal care. Costs of major NCDs even doubled from moderate to severe stages, and diagnosed cases incurred half and more costs than hidden cases. Conclusion Economic burden of NCDs in Hong Kong is great, reflecting a striking social and care needs particularly in moderate and severe stages. Care planning should prepare for the blowout needs being revealed by hidden cases of NCDs, as well as the diversified needs by patients in different stages and their caregivers.

Background The study aimed to provide estimates of healthcare resource utilization (HCRU) of clinically diagnosed AD, which can be used as input parameters for economic modeling of future pharmacological treatments for AD. Method We used longitudinal data between 2013 and 2020 from the Swedish Register of Cognitive Disorders (SveDem) to identify 20366 individuals (mean age: 78.4 years) with clinically diagnosed AD dementia. AD dementia stages were defined by MMSE as follows: very mild (MMSE = 26‐30), mild (MMSE = 21‐25), moderate (MMSE = 11‐20), and severe (MMSE = 0‐10). SveDem was linked to the following registers to derive data on HCRU for these individuals: (1) the National Patient Register for information on inpatient admissions, inpatient bed days, and outpatient specialist visits, (2) the Drug Prescription Register for information on drug prescriptions, and (3) the Register of social care for elderly and persons with functional disability for information on social care (daytime activity, housing support, homecare, short‐term residence, and institutionalization). We described the HCRU by stages of AD dementia and HCRU categories. Result The number of outpatient specialist visits decreased as AD severity increased, while the number of drug prescriptions increased with advancing stages. Social care, especially day activity, homecare, and institutionalization days, evidently increased in more advanced AD stages compared with earlier stages. The use of inpatient care was similar across different stages. The detailed HCRU by AD stages are shown in Table 1. Conclusion In people with AD dementia, drug prescriptions and social care utilization increase with advancing AD severity. In contrast, outpatient specialist care utilization decreases with advancing AD severity. The results of this study can serve to provide better understanding on HCRU and the type of care provided to individuals with AD by AD stages and can also be used as input parameters for future economic evaluations of new treatments for AD.