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This study aimed to identify the proportion and factors influencing the use of maternal health services (MHS) in rural Thawang, Rolpa, Nepal.

This was a community-based cross-sectional study conducted among 417 mothers who had given birth in the previous two years. Bivariate and multivariate logistic regression was applied to identify associations and predictors.

The results showed that the use of maternal health services was 50.8%. Adjusting for all other factors in the final model, age group 25–30 years (AOR: 2.30; 95% CI: 1.199–4.422), spouse communication (AOR: 7.31; 95% CI: 2.574–20.791), high accessibility (AOR: 2.552, 95% CI: 1.402–4.643) and high affordability (AOR: 10.89; 95% CI: 4.66–25.445) were significant predictors.

This is a community-based cross-sectional study, and hence cannot establish causal relationships. The research was conducted in a limited rural area mid-Western Nepal, and this may limit the generalization of results to other settings of the country.

This research supports to local level government and district health authority to develop and implement need based action to increase maternal health service in the local context.

Underutilization of maternal health services is the result of socioeconomic dynamics, poor access to health services and other physical developments. To increase utilization of maternal health services in rural areas, there is a need to tackle the root cause of health inequality such as reducing poverty, increasing female education, involving women in employment and increasing access to health as a priority development agenda by government authorities. This research supports local level government and district health authorities to develop and implement needs-based action to increase MHS in the local context.

Chronic kidney disease (CKD) is a worldwide public health problem which imposes a significant financial burden not only on patients but also on the healthcare systems, especially under the pressure of the rapid growth of the elderly population in China. The purpose of this paper is to examine the hospitalization costs of patients with CKD between two urban health insurance schemes and investigate the factors that were associated with their inpatient costs in Guangzhou, China.

This was a prevalence-based, observational study using data derived from two insurance claims databases during the period from January 2010 to December 2012 in the largest city, Guangzhou in Southern China. The authors identified 5,803 hospitalizations under two urban health insurance schemes. An extension of generalized linear model – the extended estimating equations approach – was performed to identify the main drivers of total inpatient costs.

Among 5,803 inpatients with CKD, the mean age was 60.6. The average length of stay (LOS) was 14.4 days. The average hospitalization costs per inpatient were CNY15,517.7. The mean inpatient costs for patients with Urban Employee-based Basic Medical Insurance (UEBMI) scheme (CNY15,582.0) were higher than those under Urban Resident-based Basic Medical Insurance (URBMI) scheme (CNY14,917.0). However, the percentage of out-of-pocket expenses for the UEBMI patients (19.8 percent) was only half of that for the URBMI patients (44.5 percent). Insurance type, age, comorbidities, dialysis therapies, severity of disease, LOS and hospital levels were significantly associated with hospitalization costs.

The costs of hospitalization for CKD were high and differed by types of insurance schemes. This was the first study to compare the differences in hospitalization costs of patients with CKD under two different urban insurance schemes in China. The findings of this study could provide economic evidence for understanding the burden of CKD and evaluating different treatment of CKD (dialysis therapy) in China. Such useful information could also be used by policy makers in health insurance program evaluation and health resources allocation.

The reasons for and experiences during migration, as well as additional stressors in the new host country, may give rise to mental health problems and additional need for public services. The purpose of the study was to investigate factors related to service utilization among newly arrived refugee youth.

Cross-sectional data were gathered in Sweden where 37 youth aged between 19 and 23 reported on factors related to service utilization, encompassing health-care and support services in school. These factors included predisposition (demographic), need (migration status and mental wellbeing) and enablement (living situation). Service utilization was estimated using multiple logistic regression analysis.

About a fourth of the sample used psychosocial services. Use of general support was more common. Neither predisposing, need nor enabling factors were associated with the use of psychosocial or general health-related services.

Self-reported factors related to use of health-related services have previously not been investigated for refugee youth, which is important in assuring access to appropriate services for this exposed youth population.

The purpose of this paper is to estimate the changes of dental caries status among Thai adults and elderly under the different policy options using system dynamics modeling.

A multi-sector system dynamics model was developed to capture the dynamic interrelationship between dental caries status changes and oral health behavior – including self-care, dental care utilization and sugar consumption. Data used to populate the model was obtained from the Thai national oral health survey in 2000, 2006, 2012 and Thailand Official Statistics Registration. Three policy scenarios were experimented in the model: health promotion policy, dental personnel policy and affordable dental care service policy.

Dental caries experiences among Thai adults and elderly were projected to increase from now to 2040, as the elderly population increases. Among all policies experimented herein, the combined policies of health promotion, increased affordability and capacity of dental health service were found to produce the highest improvement in dental caries status with 3.7 percent reduction of population with high decayed, missing and filled teeth (DMFT) and 5.2 percent increase in population with very low DMFT.

This study is the first comprehensive simulation model that attempts to explore the dynamic interrelationship among dental caries experiences and behavioral factors that impact on oral health outcomes. In addition, the simulation model herein offers a framework for policy experimentation that provides policymakers with additional insights to inform health policy planning.

Technology access, digital skills, and digital services are increasingly prerequisites for public life and accessing public services. The digital divide in contemporary societies matters for efforts to digitalize the welfare state. Research has already mapped individual determinants of digital exclusion and the existence of an age-related digital divide. However, far less attention has been paid to variations in digital inclusion between countries and to their potential explanations related to political systems. This study explores the influence of variations in welfare regimes on the digital divide among seniors (aged 65+) in Europe.

This article presents time-series cross-sectional analyses of the relationship between welfare state regimes and digital inclusion among seniors in European countries. The analyses are based on data from Eurostat, the World Bank, and the UN E-Government Survey.

The authors find extensive variation in the digital inclusion of citizens between welfare regimes and argue that considering regime differences improves the understanding of these variations. The findings indicate that the age-related digital divide seems to be least evident in countries with more universalistic welfare regimes and most evident in countries where seniors rely more on their families.

This is the first comparative study of the association between welfare state regimes and digital inclusion among seniors.

This study aims to examine the relationship between medication for opioid use disorder (MOUD) among pregnant individuals, referral source, mental health, political affiliation and substance use policies in all 50 states in the USA.

This study describes MOUD receipt among pregnant people with an opioid use disorder (OUD) in 2018. The authors explored sociodemographic differences in MOUD receipt, referrals and co-occurring mental health disorders. The authors included a comparison of MOUD receipt among states that have varying substance use policies and examined the impact of these policies and the political affiliation on MOUD. The authors used multilevel binary logistic regression to examine effects of individual and state-level characteristics on MOUD.

Among 8,790 pregnant admissions with OUD, the majority who received MOUD occurred in the Northeast region (71.52%), and 14.99% were referred by the criminal justice system (n = 1,318). Of those who were self-referred, 66.39% received MOUD, while only 30.8% of referrals from the criminal justice system received MOUD. Those referred from the criminal justice system or who had a co-occurring mental health disorder were least likely to receive MOUD. The multilevel model showed that while policies were not a significant predictor, a state’s political affiliation was a significant predictor of MOUD.

The study has some methodological limitations; a state-level analysis, even when considering the individual factors, may not provide sufficient description of community-level or other social factors that may influence MOUD receipt. This study adds to the growing literature on the ineffectiveness of prenatal substance use policies designed specifically to increase the use of MOUD. If such policies are consistently assessed as not contributing to substantial increase in MOUD among pregnant women over time, it is imperative to investigate potential mechanisms in these policies that may not facilitate MOUD access the way they are intended to.

Findings from this study aid in understanding the impact that a political affiliation may have on treatment access; states that leaned more Democratic were more likely to have higher rates of MOUD, and this finding can lead to research that focuses on how and why this contributes to greater treatment utilization. This study provides estimates of underutilization at a state level and the mechanisms that act as barriers, which is a stronger assessment of how state-specific policies and practices are performing in addressing prenatal substance use and a necessary step in implementing changes that can improve the links between pregnant women and MOUD.

To the best of the authors’ knowledge, this is the first study to explore individual-level factors that include mental health and referral sources to treatment that lead to MOUD use in the context of state-level policy and political environments. Most studies estimate national-level rates of treatment use only, which can be useful, but what is necessary is to understand what mechanisms are at work that vary by state. This study also found that while substance use policies were designed to increase MOUD for pregnant women, this was not as prominent a predictor as other factors, like mental health, being referred from the criminal justice system, and living in a state with more Democratic-leaning affiliations.

The purpose of this paper is to examine the relation between estate transformations produced during the governments of the Citizen Revolution (CR) in Ecuador (2007-2017) and welfare regime transformations.

The CR’s project registers an array of specificities that make it a relevant case study to understand it. Among them, it articulated the transformation of the development model with a comprehensive state reform: emphasized both the modernization of the state and the productive structure, and the creation of the basic pillars of a welfare state. The ambitious project materialized in an ambivalent manner, revealing accomplishments and limitations.

The recovery of resources for the state, the efficient organization of resources, decentralization and deconcentration processes, public administration transformations and policy de-corporatization processes accompanied and even propelled important achievements in the social sphere in terms of decommodification, stratification, commodification and defamiliarization. Ecuador’s starting point, as a small and impoverished country with pubic and communal goods and services dismantled through neoliberal reforms, was quite precarious. But, progress was made. Beyond the identified limitations, its accomplishments must be highlighted because they are novel in comparison to other progressive government experiences, especially in the context of Central Andean countries.

This article vindicates the need to link state transformation processes to welfare regime transformations, as well as the academic literature that informs both fields. The description of what took place in Ecuador in the field of social welfare during the ten years of the CR continues to confirm the theoretical potential of the concept of welfare regime with the necessary translations and appropriations that allow for the analysis of countries in the region. It enables an approach to a more theoretically and methodologically elusive object that is at the same time tremendously potent in analytical terms and in its contributions to social transformations. An object that alludes to areas gravely affected during neoliberal hegemony, linked to public institutionality, state capacity and state autonomy. This is why everything that affects the state and the management of public goods and services must be incorporated into the analysis.

Purpose: Previous research identified a measurement gap in the individual assessment of social misconduct in the workplace related to gender. This gap implies that women respond to comparable self-reported acts of bullying or sexual discrimination slightly more often than men with the self-labeling as “bullied” or “sexually discriminated and/or harassed.” This study tests this hypothesis for women and men in the scientific workplace and explores patterns of gender-related differences in self-reporting behavior.

Basic design: The hypotheses on the connection between gender and the threshold for self-labeling as having been bullied or sexually discriminated against were tested based on a sample from a large German research organization. The sample includes 5,831 responses on bullying and 6,987 on sexual discrimination (coverage of 24.5 resp. 29.4 percentage of all employees). Due to a large number of cases and the associated high statistical power, this sample for the first time allows a detailed analysis of the “gender-related measurement gap.” The research questions formulated in this study were addressed using two hierarchical regression models to predict the mean values of persons who self-labeled as having been bullied or sexually discriminated against. The status of the respondents as scientific or non-scientific employees was included as a control variable.

Results: According to a self-labeling approach, women reported both bullying and sexual discrimination more frequently. This difference between women and men disappeared for sexual discrimination when, in addition to the gender of a person, self-reported behavioral items were considered in the prediction of self-labeling. For bullying, the difference between the two genders remained even in this extended prediction. No statistically significant relationship was found between the frequency of self-reported items and the effect size of their interaction with gender for either bullying or sexual discrimination. When comparing bullying and sexual discrimination, it should be emphasized that, on average, women report experiencing a larger number of different behavioral items than men.

Interpretation and relevance: The results of the study support the current state of research. However, they also show how volatile the measurement instruments for bullying and sexual discrimination are. For example, the gender-related measurement gap is considerably influenced by single items in the Negative Acts Questionnaire and Sexual Experience Questionnaire. The results suggest that women are generally more likely than men to report having experienced bullying and sexual discrimination. While an unexplained “gender gap” in the understanding of bullying was found for bullying, this was not the case for sexual discrimination.

The purpose of this study is to examine the role of selected sociodemographic variables in the ethical decision-making (EDM) process of professional accountants in Nigeria.

The study obtained data from 329 professional accountants with the aid of a structured questionnaire containing four dilemmatic ethical vignettes. The data were analysed using Kendall correlation, Kruskal–Wallis and Jonckheere–Terpstra tests.

The results revealed that upbringing, especially parental discipline, and education are significant sociodemographic determinants of EDM. Religion and experience played little or no significant role in predicting accountants’ EDM in the face of ethical dilemmas.

The study used a questionnaire to measure its variables, which may bias and somewhat inflate the findings. Hence, caution should be applied regarding its conclusion.

The evidence in this study could stimulate policy change and review to include a separate ethics course in the accounting education curriculum, which could enhance the ethics training of future accountants. This is important for countries like Nigeria, where no provision is made for a discrete ethics course in the curriculum for accounting under-graduate education.

The study draws attention to the fact that ethical conduct among professionals and in society could be enhanced through proper upbringing and formal education.

The study adds some uniqueness in focusing on professional accountants in Nigeria, a developing country with high corruption profile and weak government institutions, and, as such, contributes to the limited research output on accounting ethics in developing countries.

This study reviews and discusses the accounting literature that analyzes the role of auditors and enforcers in the context of fraud.

This literature review includes both qualitative and quantitative studies, based on the idea that the findings from different research paradigms can shed light on the complex interactions between different financial reporting controls. The authors use a mixed-methods research synthesis and select 64 accounting journal articles to analyze the main proxies for fraud, the stages of the fraud process under investigation and the roles played by auditors and enforcers.

The study highlights heterogeneity with respect to the terms and concepts used to capture the fraud phenomenon, a fragmentation in terms of the measures used in quantitative studies and a low level of detail in the fraud analysis. The review also shows a limited number of case studies and a lack of focus on the interaction and interplay between enforcers and auditors.

This study outlines directions for future accounting research on fraud.

The analysis underscores the need for the academic community, policymakers and practitioners to work together to prevent the destructive economic and social consequences of fraud in an increasingly complex and interconnected environment.

This study differs from previous literature reviews that focus on a single monitoring mechanism or deal with fraud in a broadly manner by discussing how the accounting literature addresses the roles and the complex interplay between enforcers and auditors in the context of accounting fraud.