More Money, More Problems? Addressing the Funding Conditions Required for Rights-Based Child Welfare Services in England

Policymakers and academics continue to debate the criteria used in formulas to allocate funding to children’s services, but few studies have considered how well the results of these formulas align with rights-based entitlements and commitments after implementation. This research measured correspondence between local authority spending per child and levels of income deprivation, special educational needs, and child development from 2011–2019 to assess the extent to which funding matches local authorities’ statutory responsibilities to provide support to children ‘in need’ under the Children Act 1989. There was weak and worsening correspondence between funding and needs, especially for preventative services.

Racial-Ethnic Disparities in Access to Preventive Services Among Privately Insured Adults With Disabilities

Introduction Cerebral palsy (CP) and spina bifida (SB) are congenital disabilities. Due to life-long disability, adults with CP/SB are with greater needs for preventative care. Little is known about racial/ethnic disparities in use of preventative services in this population. Our objective was to examine racial/ethnic disparities in use of preventative care. Methods Using 2007-2017 private claims data, we identified White, Black, and Hispanic adults (18+) with CP/SB [n=11,635; White=8,935; Black=1,457; Hispanic=1,243)]. We quantified the National Institute of Medicine (NAM) definition of disparity by matching health related variables (age, sex, comorbid conditions, and Elixhauser index) between Whites and each minority subpopulation. Generalized estimating equations were used and all models were adjusted for age, sex, comorbidities, income, education, and U.S. Census divisions. Outcomes of interest were: (1) any office visit; (2) any physical therapy/ occupational therapy (PT/OT); (3) annual wellness visit; (4) bone density screening; (5) cholesterol screening; (6) diabetes screening. Results Rate of recommended services for all adults with CP/SB were low and no significant results were found for most preventative services across race/ethnicity. Compared with Whites, Hispanics had lower odds of annual wellness visit (OR: 0.71; 95% CI: 0.53, 0.96) but higher odds of diabetes screening (OR: 1.48; 95% CI: 1.13, 1.93). Blacks had lower odds of bone density screening (OR: 0.54; 95% CI: 0.31-0.95), and annual wellness visit (OR: 0.50; 95% CI: 0.24-1.00). Conclusions There were no substantial racial/ethnic disparities in use of preventive services among privately insured adults with CP/SB who had a higher-than-average income and education level.

Reducing missed opportunities for vaccination in Mozambique: findings from a cross-sectional assessment conducted in 2017

ObjectiveMissed opportunities for vaccination (MOV) are a significant contributor to low vaccination coverage. To better understand the magnitude and underlying causes of MOV among children aged 0–23 months in Mozambique, we conducted an assessment and developed a roadmap for strengthening the country’s childhood immunisation programme.SettingThree provinces in North, South and Central Mozambique.MethodsThe assessment applied a mixed-method approach. From a sample of 41 health facilities, we conducted exit interviews with caregivers of children aged 0–23 months (n=546), surveys with health workers (n=223), focus group discussions with caregivers (n=6) and health workers (n=5), and in-depth interviews with health facility managers (n=9). We analysed the data to assess the magnitude of MOV and to identify causes of MOV and ways of preventing them.ResultsVaccination records were available for 538 children. Sixty per cent (n=324) were eligible for vaccination on arriving for their health facility visit. Of these, 76% (n=245) were not fully vaccinated, constituting MOV. Our analysis shows that these MOV were most frequently attributable to practices of caregivers and health workers and also to health systems reasons. Inadequate information about vaccination among both caregivers and health workers, poor or poorly understood health facility practices, inadequate integration of curative and preventative services, inadequate tracking systems to identify children due for vaccination and, less often, limited supply of vaccines, syringes and other related supplies at service points resulted in MOV.ConclusionsThe results of the assessment informed the development of roadmaps for reducing MOV that may be applicable to other settings. The global immunisation community should continue to invest in efforts to reduce MOV and thereby make health service visits more effective and efficient for vaccination.

Il controllo e la gestione della performance delle attività di prevenzione in contesti interorganizzativi: il caso dei controlli frontalieri sugli alimenti

I servizi sanitari di prevenzione sono caratterizzati da un'elevata complessita principalmente legata al contesto inter-organizzativo e ambientale in cui operano. Da cio consegue una notevole difficolta nel misurarne e valutarne i risultati. Per tali motivi, il controllo e la gestione della performance delle attivita di prevenzione si avvalgono di diversi meccanismi, formali e informali, che hanno l'obiettivo di orientare i comportamenti e le decisioni degli individui e delle organizzazioni coinvolte verso fini comuni. Lo scopo del presente lavoro e quello di approfondire i sistemi di controllo e gestione della performance impiegati nei servizi di prevenzione che operano in contesti inter-organizzativi - e in particolare nell'ambito dei controlli frontalieri sugli alimenti - al fine di supportare il disegno e l'implementazione degli stessi. Per fare cio, la ricerca si concentra sui casi di studio delle infrastrutture portuali di Genova e Livorno. Parole chiave: prevenzione, controlli condottools. To explore performance management in such contexts, this research suggests the adoption of management control as a "package" approach. Thus, the research's objective is to understand how management control operates in the delivery of preventative services operating in inter-organizational environment. To do so, this study focuses on the cases of Genoa's and Leghorn's ports.

Age and Cervical Cancer Screening Recommendations

Recommendations for cervical cancer screening have had remarkable agreement from a number of medical societies, including the American College of Obstetricians and Gynecologists (ACOG), American Cancer Society (ACS), American Society of Cervical Colposcopy and Pathology (ASCCP), and the US Preventative Services Task Force (USPSTF). Reference to the recommended age for screening may need to be re-examined, in light of current data regarding the comparative age-related incidence of cervical malignancy, especially when recognizing the past utility of screening with exfoliative cytology in reducing subsequent mortality.