Appraisal and disposition of government records at Library and Archives Canada (LAC) focuses primarily on acquiring the “right” records to best document a given function of the Government of Canada. Once records pass into LAC’s care, access is provided through an inconsistent approach of online descriptive records and on-site finding aids, often with minimal or incorrect contextualizing information that hinders their overall discoverability and use. Through a study of both the legacy photographic records in the National Film Board of Canada Fonds and the recontextualization project currently underway at LAC, the author examines the history of the record, from recordkeeping practices to the transfer to LAC, and some of the interventions by the archives to describe and shape these records over several generations of custodial care. All of these various actions have had a hidden impact on the use and understanding of both the individual records and the larger collection. This article provides a case study in how rearrangement based on research into creators, organizational recordkeeping systems, and archival custodial practices can draw out complex, multiple provenances and provide researchers with a fuller contextual history of the record.
The current coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus (SARS-CoV)-2, is affecting every aspect of global society, including public healthcare systems, medical care access, and the economy. Although the respiratory tract is primarily affected by SARS-CoV-2, emerging evidence suggests that the virus may also reach the central nervous system (CNS), leading to several neurological issues. In particular, people with a diagnosis of Alzheimer’s disease (AD) are a vulnerable group at high risk of contracting COVID-19, and develop more severe forms and worse outcomes, including death. Therefore, understanding shared links between COVID-19 and AD could aid the development of therapeutic strategies against both. Herein, we reviewed common risk factors and potential pathogenetic mechanisms that might contribute to the acceleration of neurodegenerative processes in AD patients infected by SARS-CoV-2.
Background and Objectives
Little is known on effects of the Affordable Care Act (ACA) Medicaid expansions on health care access and health status of adults closest to 65. This study examines the effects of ACA Medicaid expansion on access and health status of poor adults aged 60-64 years.
Research Design and Methods
The study employs a difference-in-differences design comparing states that expanded Medicaid in 2014 under the ACA and non-expansion states over six years post expansion. The data are from the 2011-2019 Behavioral Risk Factor Surveillance System for individuals aged 60–64 years below the Federal Poverty Level.
Having any health care coverage rate increased by 8.5 percentage-points (p<0.01), while the rate of forgoing a needed doctor’s visit due to cost declined by 6.6 percentage points (p<0.01). Similarly, rates of having a personal doctor/provider and completing a routine checkup increased by 9.1 (p<0.01) and 4.8 (p<0.1) percentage-points, respectively. Moreover, days not in good physical health in the past 30 declined by 1.5 days (p<0.05), with suggestive evidence for decline in days not in good mental health and improvement in self-rated health.
Discussion and Implications
The ACA Medicaid expansions have improved health care access and health status of poor adults aged 60-64 years. Expanding Medicaid in the states that have not yet done so would reduce barriers to care and address unmet health needs for this population. Bridging coverage for individuals 60-64 years old by lowering Medicare eligibility age could have long-term effects on wellbeing and health services utilization.
Background: Good access to primary care is an important determinant of population health. Whilst the academic literature on access to care emphasises its complexity, policies aimed at improving access to general practice in the UK have tended to focus on measurable aspects, such as timeliness or number of appointments. Aim: To fill the gap between the complex understanding of primary care access in the literature and the narrow definition of access assumed in UK policies. Design and Setting: Qualitative, community-based participatory case study within the geographic footprint of a Clinical Commissioning Group in northwest England. Method: We applied Levesque et al.’s conceptual framework of patient-centred access and used multiple qualitative methods (interviews, focus groups, observation). Analysis was ongoing, iterative, inductive, and abductive with the theory. Results: The comprehensiveness of Levesque et al.’s access theory resonated with diverse participant experiences. However, while a strength of Levesque et al. was to highlight the importance of people’s abilities to access care, our data suggest equal importance of healthcare workforce abilities to make care accessible. Thus, we present a definition of access as the ‘human fit’ between the needs and abilities of people in the population and the abilities and capacity of people in the healthcare workforce, and provide a modified conceptual framework reflecting these insights. Conclusion: An understanding of access as ‘human fit’ has the potential to address longstanding problems of access within general practice, focusing attention on the need for staff training and support, and emphasising the importance of continuity of care.