Employment Creation through Credit: A Glimpse from Credit Program for Ultra-poor Households in Bangladesh

This paper examined the impact on employment of a credit plus program designed for ultra-poor households in the Northwest region of Bangladesh. Both descriptive and econometric techniques were used, and four regression models were estimated for each of the dependent variables with linear and log-lin specifications: one is a simple model considering only time effect and program effect, and the others were the extended models which included various characteristics of the households and the regions. The descriptive analysis showed that most of the beneficiary households had shifted from single earning members to multiple earning members. Women had started to contribute to household earnings. The results showed that the participant ultra-poor households had gained around 21.1% additional employment days due to the program participation opportunities within 2008-2013, with an annual rate of 4.2% gain. The extra earning days included wage-employment days and self-employment days and the results showed that due to the program, the wage-employment days had increased by 2.6% annually and the self-employment days increased by 6.6% annually holding the effects of other explanatory variables constant. The working days of non-participants had increased but at a lower rate than that of the program participant households. The results confirmed that the credit program for ultra-poor households had a significantly positive effect on the creation of employment days and employment opportunities.

Australia’s Disability Employment Services Program: Participant Perspectives on Factors Influencing Access to Work

Disability employment programs play a key role in supporting people with disability to overcome barriers to finding and maintaining work. Despite significant investment, ongoing reforms to Australia’s Disability Employment Services (DES) are yet to lead to improved outcomes. This paper presents findings from the Improving Disability Employment Study (IDES): a two-wave survey of 197 DES participants that aims to understand their perspectives on factors that influence access to paid work. Analysis of employment status by type of barrier indicates many respondents experience multiple barriers across vocational (lack of qualifications), non-vocational (inaccessible transport) and structural (limited availability of jobs, insufficient resourcing) domains. The odds of gaining work decreased as the number of barriers across all domains increased with each unit of barrier reported (OR 1.22, 95% CI 1.07, 1.38). Unemployed respondents wanted more support from employment programs to navigate the welfare system and suggest suitable work, whereas employed respondents wanted support to maintain work, indicating the need to better tailor service provision according to the needs of job-seekers. Combined with our findings from the participant perspective, improving understanding of these relationships through in-depth analysis and reporting of DES program data would provide better evidence to support current DES reform and improve models of service delivery.

Automated Text-Based Symptom Monitoring With Rapid Clinician Triage for Patients With Cancer and Suspected or Confirmed COVID-19

PURPOSE Patients with cancer are at greater risk of developing severe symptoms from COVID-19 than the general population. We developed and tested an automated text-based remote symptom-monitoring program to facilitate early detection of worsening symptoms and rapid assessment for patients with cancer and suspected or confirmed COVID-19. METHODS We conducted a feasibility study of Cancer COVID Watch, an automated COVID-19 symptom-monitoring program with oncology nurse practitioner (NP)-led triage among patients with cancer between April 23 and June 30, 2020. Twenty-six patients with cancer and suspected or confirmed COVID-19 were enrolled. Enrolled patients received twice daily automated text messages over 14 days that asked “How are you feeling compared to 12 hours ago? Better, worse, or the same?” and, if worse, “Is it harder than usual for you to breathe?” Patients who responded worse and yes were contacted within 1 hour by an oncology NP. RESULTS Mean age of patients was 62.5 years. Seventeen (65%) were female, 10 (38%) Black, and 15 (58%) White. Twenty-five (96%) patients responded to ≥ 1 symptom check-in, and overall response rate was 78%. Four (15%) patients were escalated to the triage line: one was advised to present to the emergency department (ED), and three were managed in the outpatient setting. Median time from escalation to triage call was 11.5 minutes. Four (15%) patients presented to the ED without first escalating their care via our program. Participant satisfaction was high (Net Promoter Score: 100, n = 4). CONCLUSION Implementation of an intensive remote symptom monitoring and rapid NP triage program for outpatients with cancer and suspected or confirmed COVID-19 infection is possible. Similar tools may facilitate more rapid triage for patients with cancer in future pandemics.

Innovative Partnerships to Address Food Insecurity during the COVID-19 Pandemic: The Brighter Bites Produce Voucher Program

The purpose of this communication is to describe the Brighter Bites produce voucher program, and its implementation and utilization across Brighter Bites families in four cities in the U.S., during the COVID-19 pandemic. The voucher program was implemented over nine weeks starting April 2020, with up to four USD 25 store-specific produce coupons sent bi-weekly to the homes of each participating Brighter Bites family (USD 100 total/family). Measures included type of produce purchased, amount of voucher that was used, number of vouchers distributed and redeemed by families, and a post-program participant satisfaction survey. Descriptive statistics, including count, frequency, and percent, were computed, both overall and stratified by city. During this time, Brighter Bites distributed a total of over 43,982 vouchers to 12,482 low-income families, with a redemption rate of 60% (at least one voucher redeemed) across all cities. During times of crisis, non-profit–for-profit partnerships, such as the one between Brighter Bites and the grocery retail industry, are feasible, and successful in providing produce to families in need.

Implementation of Road Safety Countermeasures in Four Cities to Reduce the Harmful Effects of Alcohol: A Progress Report

BackgroundBeginning in 2016, the Anheuser-Busch InBev Foundation (ABIF) provided funding to six pilot cities to implement evidence-based interventions to reduce the harmful use of alcohol and its deleterious consequences such as alcohol-impaired driving. The cities receiving funding are Alexandra Township in Johannesburg, South Africa; Brasilia, Brazil; Columbus, Ohio, United States; Jiangshan, China; Leuven, Belgium; and Zacatecas, Mexico.MethodsFour of the city pilot coalitions are implementing a wide array of interventions to deter driving under the influence (DUI). Columbus made efforts to get more judges to apply Ohio’s alcohol ignition interlock law and implemented and evaluated a Safe Rides program. Brasilia increased the number of roadside checkpoints and planned an educational campaign about the dangers of impaired driving to be delivered at bars by firefighters and paramedics. Alexandra expanded and upgraded the Metropolitan Police Department’s Alcohol Evidence Center (AEC). In Zacatecas, among other interventions, a new Driving While Intoxicated (DWI) facility is being constructed to expedite case processing and adjudication.ResultsIn Columbus, the evaluation of the Safe Rides program showed an estimated reduction of 2.9 impaired driving crashes but also an average increase of 0.4 alcoholic drink per program participant. There was a reduction in harmful alcohol use of .02% in 2017 associated with the Safe Rides campaign, but with no carryover to 2018. In Brasilia, the combined effect of the road safety measures and other factors resulted in a 35% decrease in traffic deaths between 2016 and 2019. In Alexandra, there were 46 fatal crashes over the Easter weekend in 2018, 25 fatal crashes in 2019 (46% reduction), and 3 fatal crashes in 2020 (88% reduction from 2019). To date, Zacatecas’ road safety measures have not yet been evaluated.ConclusionsFull implementation of the city pilots’ planned road safety interventions has been slow, and presently the COVID-19 pandemic has halted most operations. Interim evaluations can be conducted once a pilot city’s countermeasures are fully implemented and have operated for at least one year. ABIF should continue to donate funds to increase or enhance evidence-based DUI enforcement strategies while also implementing awareness campaigns to inform the public and enhance the deterrent effect of those efforts.

Delivering PrEP to Young Women in a Low-Income Setting in South Africa: Lessons for Providing Both Convenience and Support

Daily oral pre-exposure prophylaxis (PrEP) is a key tool in addressing high HIV incidence among young women, and breaking the cycle of transmission. From 2017 to 2020, Médecins Sans Frontières (MSF) offered PrEP, in conjunction with contraception and risk-reduction counselling, to women aged 18–25, in a government-run clinic in Khayelitsha, a low income high HIV prevalence area in South Africa. Drawing on clinical, quantitative, and qualitative interview data, we describe participants’ experiences and engagement with the PrEP program, participant adherence (measured by TFV-DP levels in dried blood spots) over time, and the indirect benefits of the PrEP program. Of 224 screened and eligible participants, 164 (73.2%) initiated PrEP, with no large differences between those who initiated and those who did not. Overall, 47 (29%) completed 18 months follow-up, with 15 (9.1%) attending all visits. 76 (46.9%) participants were lost to follow-up, 15 (9.1%) exited when leaving the area, and 28.7% of exits happened in the first month of the study. We identified two different trajectories of PrEP adherence: 67% of participants had, on average, consistently low TFV-DP levels, with the remaining 33% having sustained high adherence. Few baseline characteristics predicted good adherence. The main reported barrier to taking PrEP was forgetting to take or travel with the pills. Encouragement from others declined as a reported facilitator from month 6 to 18 (family: 93.1% vs 77.6%, p = 0.016, friends: 77.6% vs 41.4%, p ≤ 0.001, partners: 62.1% vs 46.6%, p = 0.096, other PrEP users: 89.7% vs 74.1%, p = 0.020). Disclosure to friends and family in some cases opened dialogue around sex, and helped to educate others about PrEP. Self-reported sex with more than one partner, and sex without a condom, decreased significantly after enrolment (p < 0.001, p = 0.063). In the individual interviews, participants credited their PrEP experience with changing their behaviour. Recognising the challenges with, but overall benefits from a package of care that includes the option of PrEP, lessons drawn from this study can help maximise persistence on PrEP within resource constraints. PrEP providers need to address participants’ need for both convenience and social support.

Peers supporting reintegration after occupational stress injuries: A qualitative analysis of a workplace reintegration facilitator training program developed by municipal police for public safety personnel

Public safety personnel (PSP) are at increased risk of developing operational stress injuries. Peer-led reintegration programs (RPs) for PSP, evidence-based research is lacking. This study explored the experiences of PSP participating in a Reintegration Program Facilitator Training (RPFT) program. Participant ( n = 57) responses were collected from surveys, satisfaction and knowledge questionnaires, and a World Cafe. Four themes emerged: (1) traits of an ideal RF; (2) holistic/complementary workplace reintegration approach; (3) necessary features of the reintegration program; and (4) culture-specific considerations. While RPs hold promise, it is essential that evidence-based research be used to guide RPFT and RP spread and sustainability.

A Contemporary Analysis of the Effect of Trauma Center Verification Level on Mortality in Severe Injury

Background Literature demonstrates increased mortality for the severely injured at a Level II vs. Level I center. Our objective is to reevaluate the impact of trauma center verification level on mortality for patients with an Injury Severity Score (ISS) > 15 utilizing more contemporary data. We hypothesize that there would be no mortality discrepancy. Study Design Utilizing the ACS Trauma Quality Program Participant Use File admission year 2017, we identified severely injured (ISS >15) adult (age >15 years) patients treated at an ACS-verified Level I or Level II center. We excluded patients who underwent interfacility transfer. Logistic regression was performed to determine adjusted associations with mortality. Results There were 63 518 patients included, where 43 680 (68.8%) were treated at a Level I center and 19 838 (31.2%) at a Level II. Male gender (70.1%) and blunt injuries (92.0%) predominated. Level I admissions had a higher mean ISS [23.8 (±8.5) vs. 22.9 (±7.8), <.001], while Level II patients were older [mean age (y) 52.3 (±21.6) vs. 48.6 (±21.0), <.001] with multiple comorbidities (37.7% vs. 34.9%, <.001). Adjusted mortality between Level I and II centers was similar (12.0% vs. 11.8%, .570). Conclusions Despite previous findings, mortality outcomes are similar for severely injured patients treated at a Level I vs. Level II center. We theorize that this relates to mandated Level II resourcing as defined by an updated American College of Surgeons verification process.