Rand health quarterly最新文献

Since fall 2021, the authors of this study have conducted regular enumerations of the unsheltered populations in three Los Angeles neighborhoods known for having high concentrations of people experiencing unsheltered homelessness: Hollywood, Skid Row, and Venice. In addition to counts, the authors have conducted surveys of unsheltered residents in these same neighborhoods to better understand the characteristics, experiences, and needs of these populations. The results of the first year of this study, known as the Los Angeles Longitudinal Enumeration and Demographic Survey (LA LEADS), were presented in a report published by RAND in 2023. The authors continued their enumeration and survey efforts in these three neighborhoods throughout 2023 using an updated survey instrument that includes new questions about employment, income, experiences with service providers, health conditions, and substance use. This study presents their findings from the 2023 data collection period and includes comparisons with the previous year's effort and new information about unsheltered populations' experiences and needs across the same three Los Angeles neighborhoods.

The patchwork of laws and regulations that affect abortion access in the United States has become increasingly complex since the 2022 Dobbs v. Jackson Women's Health Organization U.S. Supreme Court decision that gave states the right to enact and enforce policies facilitating or restricting abortion access. The authors examined state, local, and institutional policies in Virginia-which is one of the only remaining states in the South post-Dobbs with legal access to abortion care past 13 weeks gestational age-to better understand how the policy landscape is influencing provision of care in the state. The authors reviewed existing legislation, bills, and sources detailing the policy landscape in Virginia and interviewed a sample of clinicians and nonclinicians working at organizations providing or supporting abortion care. The study principally focused on state laws, local policies and actions, institutional policies, and reported implementation experiences affecting access to abortion care.

The authors analyze the relationship between heat events in Los Angeles County and (1) emergency medical services, (2) emergency room visits, (3) deaths investigated by the medical examiner, and (4) bookings for violent offenses. Heat events are classified according to the National Weather Service HeatRisk system. Days classified as moderate, major, and severe HeatRisk days are associated with worse results for all these outcomes.

The Los Angeles County Rapid Diversion Program (RDP) is a pretrial mental health diversion program operating in seven courthouses in Los Angeles County, California. Established in 2019 as a faster approach to pretrial mental health diversion compared with the traditional approach, RDP allows for the diversion of individuals who have a mental health diagnosis or substance use disorder and certain qualifying misdemeanor or felony charges. Individuals who complete the program have their case dismissed. In this study, the authors present findings from a formal assessment of program implementation to date. Using a mixed-methods evaluation, they explore current program operations, characteristics of and case outcomes for individuals who participate in RDP, and strengths and areas for improvement. Lessons learned from this evaluation have the potential to inform efforts to scale the program within Los Angeles County and to other counties interested in implementing a similar pretrial diversion program.

Healthy child development is a key driver for better health and well-being throughout a person's life, and the early years set that important foundation. Early childhood development programs play a critical role in mitigating risks to the cognitive, social, behavioral, and physical development of children. Increasingly, there is recognition that early intervention to support child development requires more than separate programs and services. Instead, a full system transformation, such as the national Help Me Grow initiative, is necessary. Help Me Grow Western New York (HMG WNY), a regional effort, aims to build and strengthen a comprehensive and coordinated system of early childhood development services and care to support the development and well-being of children in this region. HMG WNY serves eight counties in western New York that form a diverse community whose socioeconomic composition varies but which all share at least some level of need for better coordination and provision of early childhood development programs and services. In this study, the authors assess how HMG WNY addresses this regional need. The authors focus on how HMG WNY is working to strengthen and expand the early childhood network in western New York and provide insights that will inform the next steps for HMG WNY.

The No More Adverse Childhood Experiences (NACES) pilot project addresses Adverse Childhood Experiences (ACEs) in rural farmworker communities in central California. Informed by engagement of farmworkers, the project included a clinic-based intervention that provided ACE education, screening, and response services during routine health visits with adult and pediatric patients. To understand the impact of the clinic-based intervention, the evaluation team developed a mixed-methods approach that collected and analyzed administrative data on ACE education and screening; clinic readiness for trauma informed health care self-assessments; staff training surveys; and interviews with staff, adult patients, and caregivers of pediatric patients. The evaluation found that clinic staff trained by NACES partners gained confidence in their ability to provide ACE education and screenings to the rural farmworker community they serve. In addition, adult patients and caregivers of pediatric patients said that ACE education was easy to understand and agreed that ACE education and screening was acceptable during routine visits with their or their child's doctor. Overall, results provide early evidence for the feasibility, acceptability, and potential for positive impact of an ACE education, screening, and response model that is informed by farmworker voices.

The Army Medical Corps comprises the physicians of the U.S. Army. In recent years, the Medical Corps' rate of recruitment has not been able to keep up with the pace of separations. Retention is down. A larger-than-expected proportion of Army physicians who have fulfilled their active-duty service obligation are separating rather than extending their careers and, possibly, serving until they are eligible for military retirement. This trend results in positions at military treatment facilities and other units being unfilled, compromising the Medical Corps' ability to fulfill its missions, whether in deployed operations or in caring for service members and other beneficiaries at home. In this study, the authors examine alternative strategies for the Army Medical Corps to ensure that it has access to the personnel it needs to support operational requirements. The authors consulted with subject-matter experts and gathered and analyzed data to help identify five courses of action (COAs) that could increase retention, increase accessions, or reduce the requirement for uniformed physicians.

Many veterans and their advocates are concerned that military service may cause impaired respiratory function resulting from occupational exposures to environmental hazards (e.g., Agent Orange in the Vietnam War, burn pits in the Global War on Terror) or infectious diseases (e.g., pneumonia). Such exposures occurring in service members' young adulthoods may not have immediately discernible effects on lung health; some symptoms may emerge in the immediate months or years after separation from the military, and diagnosable conditions may not manifest until decades later. Health care providers serving veteran populations must consider both the unique combat circumstances surrounding the time of veterans' service and the age-graded nature of health conditions that might result from military service. To characterize lung health across a broad age range of veterans, the authors analyzed data from two nationally representative surveys of health and well-being that include samples of veterans and their civilian peers. With these data, the authors compared respiratory health outcomes observed for the veteran and civilian populations who were of prime age for military service during different periods of national conflict: the Korean War, the Vietnam War, Operation Desert Shield/Storm, and the Global War on Terror. The authors estimated that differences in smoking behaviors-including differences prior to enlistment-account for at least half of the veteran-civilian disparities in respiratory outcomes. This suggests the need for military-based and post-transition smoking cessation efforts and further research into other factors that might contribute to these veteran and civilian disparities, such as environmental exposures during military service.

On-demand gene synthesis is a growing industry that has democratized access to customized synthetic deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) products used in biological research. However, the increasing availability and decreasing cost of custom synthetic nucleic acids presents a risk of misuse that could allow nefarious actors to obtain sequences of dangerous organisms or novel-engineered pathogens to construct a biological weapon. Securing nucleic acid synthesis is a policy priority for the U.S. government and the synthetic biology industry. But there is currently no legal requirement that gene synthesis providers screen their customers or their orders to ensure that the requested synthetic DNA and RNA constructs are not used for harmful purposes. Many providers screen orders voluntarily, but there is currently no universally accepted standard for screening customers or orders. In this study, the authors review government screening guidelines, industry consortium requirements, legislative proposals, and the scientific literature to assess the current state of commercial gene synthesis screening; summarize proposals for strengthening screening; and contribute recommendations for implementing comprehensive screening policies to secure commercial nucleic acid synthesis. These recommendations expand on and strengthen government communications, industry consortium rules and best practices, and proposals developed by researchers and provider organizations.

RAND researchers present findings from the qualitative arm of the America's Military and Veteran Caregivers: Hidden Heroes Emerging from the Shadows research project, sharing insights from interviews with U.S. military and veteran caregivers. Thirty-eight qualitative interviews were conducted between December 2023 and February 2024. In the interviewed caregivers' own words, they provided rich descriptions of their experiences, complementing the main study's survey findings with illustrative anecdotes that deepen our understanding of the challenges and joys of caregiving and elucidate opportunities to improve supportive services. Caregivers highlighted aiding care recipients with a broad array of activities of daily living and instrumental activities of daily living, often leveraging a variety of informal and formal supports. They often faced challenges, such as balancing caregiving with other priorities and commitments; managing care recipients' health-related conditions and needs; financial, emotional, and physical struggles; and difficulty accessing respite and navigating health care systems. Caregivers reflected on their identities, highlighting ways in which they are similar to and different from other caregivers; they generally said that they found caregiving to be rewarding. They also discussed the economic impacts of caregiving and pointed to opportunities for organizations to improve outreach and provision of services.