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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.

Obesity and associated morbidity and mortality are major challenges for people with severe mental illness, particularly in secure (forensic) mental health care (patients who have committed a crime or have threatening behaviour). This study aims to explore experiences of weight management in secure mental health settings.

This study used a mixed-methods approach, involving thematic analysis. A survey was delivered to secure mental health-care staff in a National Health Service (NHS) mental health trust in Northern England. Focus groups were conducted with current and former patients, carers and staff in the same trust and semi-structured interviews were undertaken with staff in a second NHS mental health trust.

The survey received 79 responses and nine focus groups and 11 interviews were undertaken. Two overarching topics were identified: the contrasting perspectives expressed by different stakeholder groups, and the importance of a whole system approach. In addition, seven themes were highlighted, namely: medication, sedentary behaviour, patient motivation, catered food and alternatives, role of staff, and service delivery.

Secure care delivers a potentially “obesogenic environment", conducive to excessive weight gain. In future, complex interventions engaging wide-ranging stakeholders are likely to be needed, with linked longitudinal studies to evaluate feasibility and impact.

To the best of the authors’ knowledge, this is the first study to involve current patients, former patients, carers and multidisciplinary staff across two large NHS trusts, in a mixed-methods approach investigating weight management in secure mental health services. People with lived experience of secure services are under-represented in research and their contribution is therefore of particular importance.

The integration of industry 4.0 has become a priority for many organizations. However, not all organizations are suitable and capable of implementing industry 4.0 because it requires a dynamic and flexible implementation strategy. The implementation of industry 4.0 often involves overcoming several tensions between internal and external stakeholders. This paper aims to explore the paradoxical tensions that arise for health-care organizations when integrating industry 4.0. Moreover, it discusses how a paradox lens can support the conceptualization and proposes techniques for handling tensions during the integration of industry 4.0.

This qualitative and in-depth study draws upon 32 semi-structured interviews. The empirical case concerns how two health-care organizations handle paradoxical tensions during the integration of industry 4.0.

The exploration resulted in six recurring technology tensions: technology invention (modularized design vs. flexible design), technology collaboration (automation vs. human augmentation), technology-driven patient experience (control vs. autonomy), technology uncertainty (short-term experimentation vs. long-term planning), technology invention and diffusion through collaborative efforts among stakeholders (selective vs. intensive collaboration) and technological innovation (market maintenance vs. disruption).

A paradox theory-informed conceptual model is proposed for how to handle tensions during the integration of industry 4.0. To the best of the authors’ knowledge, this is the first paper to introduce paradox theory for quality management, including lean and Six Sigma.

The purpose of this systematic review is to critically analyze pharmaceutical industry case studies on the implementation of Lean 4.0 methodologies to synthesize key lessons, benefits and best practices. The goal is to inform decisions and guide investments in related technologies for enhancing quality, compliance, efficiency and responsiveness across production and supply chain processes.

The article utilized a systematic literature review (SLR) methodology following five phases: formulating research questions, locating relevant articles, selecting and evaluating articles, analyzing and synthesizing findings and reporting results. The SLR aimed to critically analyze pharmaceutical industry case studies on Lean 4.0 implementation to synthesize key lessons, benefits and best practices.

Key findings reveal recurrent efficiency gains, obstacles around legacy system integration and data governance as well as necessary operator training investments alongside technological upgrades. On average, quality assurance reliability improved by over 50%, while inventory waste declined by 57% based on quantified metrics across documented initiatives synthesizing robotics, sensors and analytics.

As a comprehensive literature review, findings depend on available documented implementations within the search period rather than direct case evaluations. Reporting bias may also skew toward more successful accounts.

Synthesized implementation patterns, performance outcomes and concealed pitfalls provide pharmaceutical leaders with an evidence-based reference guide aiding adoption strategy development, resource planning and workforce transitioning crucial for Lean 4.0 assimilation.

This systematic assessment of pharmaceutical Lean 4.0 adoption offers an unprecedented perspective into the real-world issues, dependencies and modifications necessary for successful integration, absent from conceptual projections or isolated case studies alone until now.

People with intellectual disability die prematurely and from avoidable causes. Innovative solutions and proactive strategies have been limited in addressing this disparity. This paper aims to detail the process of developing a risk stratification tool to identify those individuals who are higher risk of premature mortality.

This study used population health management principles to conceptualise a risk stratification tool for avoidable deaths in people with intellectual disability. A review of the literature examined the existing evidence of causes of death in people with intellectual disability. A qualitative methodology using focused groups of specialist clinicians was used to understand the factors that contributed towards avoidable deaths in people with intellectual disability. Delphi groups were used for consensus on the variables for inclusion in the risk stratification tool (Decision Support Tool for Physical Health).

A pilot of the Decision Support Tool for Physical Health within specialist intellectual disability service demonstrated effective utility and acceptability in clinical practice. The tool has also demonstrated good face and construct validity. A further study is currently being completed to examine concurrent and predictive validity of the tool.

To the best of the authors’ knowledge, this is the only study that has used a systematic approach to designing a risk stratification tool for identifying premature mortality in people with intellectual disability. The Decision Support Tool for Physical Health in clinical practice aims to guide clinical responses and prioritise those identified as at higher risk of avoidable deaths.

Evidence-based practice is a professional standard for occupational therapists, but limited time, resources and knowledge challenge its implementation. This study aims to identify what free evidence summary sources (FESS) can be found through a simple online search, related to child/youth interventions surrounding cerebral palsy (CP), autism spectrum disorder (ASD), developmental coordination disorder (DCD), mental health or attention-deficit/hyperactivity disorder (MH/ADHD). Evidence summaries share research in concise, time-efficient manners.

An internet-based scoping review was conducted between February 2022 and July 2022, using Google, and known evidence summary producers. Evidence summaries meeting the inclusion criteria were located and catalogued. Type of agency, target audiences, purpose and distribution of evidence summaries related to diagnosis were identified for each FESS.

Ten FESS were found, which produced 113 intervention-focused evidence summaries within the past 10 years. These FESS were aimed at a variety of target audiences: service providers, service users, parents/families, researchers and commissioners, and were produced primarily by non-profit/charity organisations (6 of 10) who were trying to fill a gap in evidence. Forty-eight evidence summaries were related to ASD, 34 to CP, 29 to MH/ADHD and two to DCD.

A catalogue of FESS that exist online was produced, to support evidence-based practice for paediatric occupational therapists with limited resources, and may support improved health promotion and informed decision-making for service users. No consistent framework for FESS evidence summaries exists at this time.

This study intend to investigate a theoretical model looking at how particular tourist emotions, such as “joy,” “love,” and “positive surprise,” might predict their behavior by looking at how satisfied they are with their whole experience when visiting spas, and to examine the relationship of emotional experience, destination image, satisfaction and intention to revisit for spa tourism.

A sample of 345 individuals who traveled to Alleppey as domestic tourists participated in the research study. A non-probability (purposive) sampling method in this study. The structural model was analyzed using Structural Equation modeling (SEM), and the path coefficients were examined to test the hypotheses.

The results supported the hypotheses, indicating that specific emotions, image of the destination, and satisfaction significantly impacted tourists' intentions to revisit Alleppey as a spa tourism destination. This study demonstrated that “emotions of joy, love, and positive surprise” have a considerable influence on the image of the destination and satisfaction. The findings reveal a substantial correlation between satisfaction and behavioral intention (“Intention to revisit”). The research suggests that a higher degree of satisfaction would encourage visitors to revisit the location.

The research suggests that a higher degree of satisfaction would encourage visitors to revisit the location. This research offers vital information for developing, planning, and putting into practice tourism policies in the spa tourism sector. This article focuses on domestic travelers who travel to Alleppey, so the conclusions may not be relevant to research utilizing foreign tourists.

According to the literature study, and to the authors` knowledge, only limited number of studies that look at spa tourism from a wellness perspective. Additionally, Alleppey is used in the study as the study’s setting, providing insight into the visitor experiences of this expanding spa tourism business. This study gives understanding about how emotional experience predicts behavioral intentions.