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Barriers to Access to Care Evaluation Scale - Proxy Report (BACE-PR) evidence of reliability and validity for caregivers reporting on children and adolescents with mental health concerns in Greece
No full textTo improve access to mental health care for children and adolescents, it is necessary to identify the barriers faced by their caregivers. The aim of this study is to identify these barriers in Greece and to investigate the reliability and validity of the modified version of the Barriers to Access to Care Evaluation scale (BACE) - the BACE Proxy Report (BACE-PR). A total of 265 caregivers who reported that their offspring had mental health difficulties completed the BACE-PR. Descriptive statistics were used to identify the major barriers to accessing care. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to investigate the factor structure of the instrument. Item parameters were assessed via Item Response Theory. Interpretability was assessed by linking summed scores to IRT-based scores. Caregivers reported care costs, their willingness to resolve problems on their own, and their own concern that their children might be seen as weak, as the major barriers to services access. Obsessive compulsive symptoms and self-harm were the conditions for which caregivers reported the highest level of barriers. EFA and CFA suggested that a one-factor solution fit the data well (RMSEA = 0.048, CFI = 0.991, TLI = 0.990). Internal consistency was found to be high (ω = 0.96). Average z-scores provided five meaningful levels of caregivers’ perceived barriers compared to the national average. Caregivers face a variety of barriers to access mental health care for their children, and this could partly explain the treatment gap in the Greek mental health sector. Our study provides evidence for the reliability and validity of the BACE-PR scale, which can aid to identify caregiver-perceived barriers and to design interventions to improve access to mental health care
Understanding the scaling of transport energy use with operational density
No full textGiven the substantial contribution of transport operations to global energy demand, enhancing their energy efficiency is crucial for sustainable urban mobility. This study investigates whether intensifying the use of fixed transport networks, termed operational densification, reduces energy consumption. Grounded in economic theory, we develop a novel causal model to estimate the energy impacts of densification across two major commuting modes: urban rail transit (metro) and private car travel. Using a unique panel dataset of 27 metro operations worldwide, we find that a 10% increase in passenger-kilometres travelled on a fixed network reduces energy use per passenger-kilometre by 3.45%. These gains surpass what kinetic energy principles alone predict, as fixed energy inputs such as infrastructure and maintenance are distributed across increased usage. In contrast, analysis of the Millennium Cities Database reveals no significant energy savings from densification in private car travel, likely due to limited shared infrastructure or operational scale economies
Structural distress: LGBTQ+ communities in ‘creative health’ and the limits of care
No full textThe concept of ‘creative health’ has come to represent a discrete field of art practice and research, enfolding participatory art within its remit over the last 30 years by way of policies devised at national (UK arts councils) and local government level. Forging cross-sector structures and links, creative health claims a virtuous role in policy discourse and civic life, presented as a means by which a healthier, more equitable society might be brought about. An All-Party Parliamentary Group report cast creative health activities as an ‘essential vaccine’ that can help mitigate the negative effects of social inequality. This chapter seeks to query – and queer – understandings of creative health through examining its interpretation by way of a very specific community context, working out of a certain place and time. It will explore the findings of a community-informed evaluation report written in 2023 which used queer research methods to question assumptions around the restoration of normative states of health and well-being. The claim that creative health interventions are good for us is problematised within the context of a hostile sociopolitical environment and skewed power relations. Ethical obligations of care, we argue, act as necessary interventions within what has become a rigid, top-down, policy paradigm
The city and collective violence
No full textThe focus of this chapter is on crowd or collective violence, sometimes referred to, broadly speaking, as rioting. Work in this field has a lengthy history, one which grew out of nineteenth-century concerns with collective behaviour, the potential for revolution and, initially at least, focused on the supposed irrationality of crowds. More recently, such approaches have been superseded by work that has highlighted the patterns, structures and rationality of crowd violence, often viewing it through the lens of political protest. Having examined the broad contours of the history of work in this field, the chapter offers a general approach to thinking analytically and comparatively about the study of contemporary urban collective violence
Mayor's political party affiliation and local outcomes: evidence from SEE
No full textWe examine how political-ideological congruence between central and municipal governments affects local governments' budgetary decisions and economic performance in Croatia and North Macedonia. We apply fixed effects models as well as a regression discontinuity methodology, using the margin of victory of the local mayor as the assignment-to-treatment variable in a local linear regression estimation context. The results show evidence of both fiscal laxity and fiscal tightening, post-election, for local authorities aligned politically with the party in government, depending on the national-institutional context. Ethnic divisions and affiliations can play a role in this
Pathways, pressure, and profit: adaptive innovation and strain in a convicted cybercrime academy called Hustle Kingdom
No full textThis research offers the first empirical examination of the “Hustle Kingdom (HK)” phenomenon. Hustle Kingdoms are underground cybercrime training centers in West Africa that recruit and train young men to become digital fraudsters. The empirical foundation of this study draws on case files from the Economic and Financial Crimes Commission (EFCC) concerning the prosecution and eventual conviction of the proprietor and students of a Hustle Kingdom. Ethnographic field notes and informal conversations with relevant authorities supplement this dataset. It examines the significance of Merton’s Strain Theory, focusing on the innovation mode of adaptation, to understand how economic pressures and socio-fabric elements of society drive individuals toward illicit entrepreneurship. Our findings reveal key characteristics of these academies, including their structure, recruitment and governance strategies, motivations, indirect enablers, and prosecutorial challenges. While this pioneering investigation positions Hustle Kingdoms as an alternative route to economic mobility for many youths, it situates Hustle Kingdoms within broader processes of deviant innovation and informal economic adaptation. The study concludes by reflecting on the broader ecosystem of subtle enablers
Why the Russia-Ukraine war isn't just about NATO and Putin
No full textMost explanations of Russia’s invasion of Ukraine focus on NATO expansion or Vladimir Putin’s personal ambitions. Yet as Gabriel A. Pierzynski and Jonathan Joseph argue, such accounts miss that Russia’s imperial state structure shapes the state’s behaviour regardless of who leads it or how the West reacts
Local election candidates should be contactable by voters
No full textIn a digital age of social media online election campaigns, one would expect it’s easy to contact political candidates. But, Edward de Quay argues, that is not the case. In the recent local elections, only a quarter of candidates offered a campaign email where they could be reached at by voters. When voters can’t seek clarification about specific issues, the democratic process is weakened
Analysing the engagement with pandemic preparedness, prevention and response in selected English language political manifestoes in 2024
No full textDespite the devastating impact of COVID-19 and repeated calls for political commitment to health security, our analysis of 43 manifestos from 16 countries and the European Parliamentary elections revealed that only four parties made specific policy pledges on pandemic prevention, preparedness and response , with six providing brief mentions. The vast majority (33 parties) did not mention pandemic prevention, preparedness and response. When referenced, the pandemic was often framed as a rare, one-off crisis or an economic shock rather than a catalyst for systemic health reform. Some parties used it for political critique or validation of past performance, while others framed preparedness in terms of national security or economic resilience rather than public health. In contrast, manifestos overwhelmingly prioritized healthcare system expansion, equity, and access, with a significant emphasis on universal health coverage, mental health, and workforce development. The findings underscore a stark misalignment between global health priorities and domestic political agenda. Political reluctance to emphasize pandemic prevention, preparedness and response appears to be influenced by pandemic fatigue, voter preferences for forward-looking narratives, and institutional incentives favouring short-term tangible outcomes. This persistent neglect of the pandemic in electoral discourse raises concerns about the global community's ability to sustain momentum for pandemic resilience. We call for stronger engagement between the global health community and political actors to elevate pandemic prevention, preparedness and response as a strategic, cross-cutting priority for future policymaking
Economic evaluation of the FIBROWALK multicomponent intervention in online and outdoor formats for fibromyalgia (The On&Out Study)
No full textFibromyalgia (FM) is a chronic condition with substantial healthcare and societal costs. Although multicomponent interventions are widely available, evidence of their economic impact remains scarce. This study evaluated the cost-utility and cost-effectiveness of the FIBROWALK intervention in online (FIBRO-On) and outdoor (FIBRO-Out) formats, compared to treatment as usual (TAU), for individuals with FM. An economic evaluation (n = 225) was conducted over six months from government (total costs) and healthcare (direct costs) perspectives. The follow-up assessment was conducted six months after baseline, which corresponds to three months after the end of the 12-week intervention. Direct and indirect costs were collected through the Client Service Receipt Inventory. Cost-utility was assessed with Quality Adjusted Life Years (QALYs) and cost-effectiveness with the Revised Fibromyalgia Impact Questionnaire (FIQR). FIBRO-On was superior to TAU in reducing specialized healthcare costs (Cohen’s d = 0.71), improving perceived health (d = 0.50), and reducing FM severity (d = 0.56). Compared to FIBRO-Out, FIBRO-On also reduced healthcare costs and improved both QALYs and FIQR scores. In contrast, FIBRO-Out led to significantly higher costs than TAU and showed no significant benefit in QALYs or FIQR scores. Across intention-to-treat, complete case, and per-protocol analyses, FIBRO-On was also the more favorable intervention, particularly in comparison to FIBRO-Out. These findings suggest that FIBRO-On may be a cost-effective intervention for managing FM compared to TAU or FIBRO-Out. Furthermore, they underscore the potential benefits of exploring digital interventions such as FIBRO-On to improve accessibility and promote efficient use of healthcare resources to manage FM. Trial number NCT05377567 Perspective Economic evaluations of interventions for fibromyalgia are crucial to guide healthcare decisions and optimize resource allocation. This study shows that the multicomponent FIBROWALK intervention in its online format (FIBRO-On) offers good value for money compared to TAU or the outdoor format (FIBRO-Out), based on cost-utility and cost-effectiveness analyses performed from a government and healthcare perspective