Home- and community-based service (HCBS) recipients often possess multiple fall risk factors, suggesting that the implementation of evidence-based fall prevention guidelines may be appropriate for the HCBS setting. The purpose of this exploratory study was to examine the determinants of fall prevention guideline implementation and the potential strategies that can support implementation in HCBS organizations.
Semistructured interview and focus group data were collected from 26 HCBS professionals representing the home-delivered meals, personal care, and wellness programs. Qualitative codes were mapped to the Consolidated Framework for Implementation Research by means of directed content analysis. The Consolidated Criteria for Reporting Qualitative research checklist was used to report the findings of this study.
We identified 7 major determinants of guideline implementation: recipient needs and resources, cosmopolitanism, external policy and incentives, networks and communication, compatibility, available resources, and knowledge/beliefs. Strategies to support guideline implementation included the involvement of recipient and caregiver feedback, building fall prevention networks, and conducting educational meetings for HCBS staff.
Falls and fall-related injuries will continue to plague the older adult community unless innovative approaches to fall prevention are developed and adopted. The implementation of fall prevention guidelines in the HCBS setting can help mitigate fall risk among a highly vulnerable older adult population and may be facilitated through the application of multifaceted implementation strategies.

Although many resources are available to rehabilitation counselors to utilizing community resources for minority clients with disabilities, guidelines specific to service allocation are not easily available. The purpose of this article is to provide rehabilitation counselors with a simple, modifiable service allocation template for this purpose. A 10-step referral making process with real-world examples is presented. Special attention is given to ways in which counselors can appropriately allocate and monitor services when working with minority clients, followed by a case study demonstrating how the model may be applied.

Clinical practice guidelines (CPGs) for health professionals can have a variety of welfare implications. These may result from a reduction in practice variation in the form of overuse, underuse and misuse or a shift in resources between patient groups. The purpose of this article is to discuss welfare gains and losses caused by CPGs for health professionals. To this end, the article distinguishes between CPGs with and without the inclusion of economic evidence. Based on a framework, this article shows that CPGs, which include economic evidence, can actually lead to a welfare loss by misjudging the maximum cost-effectiveness threshold or ignoring altruistic concerns for patients. Given that a significant portion of CPGs currently considers costs and cost-effectiveness of treatment, this practice may need to be reassessed in jurisdictions where a cost-effectiveness threshold has not been appropriately defined and a public consensus on the trade-off between cost-effectiveness and equity does not yet exist.

The Finnish treatment guarantee includes people with drug problems. The incidence of drug abuse has been stable during the last five years in Finland, with only lifetime prevalence of cannabis use increasing up to 17%. All substance abusers are treated within the health-care system, in special service units of substance-abuse treatment services, and within the social welfare system. Psychosocial treatment and rehabilitation methods, as well as supporting medications are reviewed and recommended. For maintenance treatment of opiate dependence either buprenorphine-naloxone or methadone is recommended.

OBJECTIVE: In this mixed-methods case study, we explored factors influencing the adoption and implementation of the Alberta Nutrition Guidelines for Children and Youth within recreational facilities, and assessed the impact of their implementation on the food environment.
METHODS: Qualitative data were generated via interviews, observations, and document reviews. The quality of the food environment was assessed using validated and newly developed food environment assessment tools.
RESULTS: Whereas few barriers existed in terms of adopting the guidelines, implementing them proved much more challenging. Implementation was impeded by concerns about the lack of profitability of healthy items, time, and resource constraints. Guidelines that do not restrict the availability of unhealthy options are better accepted by stakeholders. Implementation of the guidelines supported creation of a healthy food environment, but the availability of healthy items remained very limited within the concession (16%) and vending machines (20%), and children continued to purchase primarily unhealthy items.
CONCLUSIONS: Findings suggest that children choose healthy options insufficiently when unhealthy items are present. Thus, although introducing the nutrition guidelines in a nonrestrictive format may have been advantageous in some ways, they should be strengthened over time so that they recommend near or total elimination of unhealthy options.

OBJECTIVE: To revise the food-based dietary guidelines for Ireland and assess the affordability of healthy eating.
METHODS: An iterative process was used to develop 4 d food intake patterns (n 22) until average intakes met a range of nutrient and energy goals (at moderate and sedentary activity levels) that represented the variable nutritional requirements of all in the population aged 5 years and older. Dietary guidelines were formulated describing the amounts and types of foods that made up these intake patterns. Foods required for healthy eating by typical households in Ireland were priced and affordability assessed as a proportion of relevant weekly social welfare allowances.
METHODS: Government agency/community.
METHODS: General population aged 5+ years.
RESULTS: Food patterns developed achieved energy and nutrient goals with the exception of dietary fibre (inadequate for adults with energy requirements <9·2 MJ) and vitamin D (inadequate for everyone). A new food group to guide on fats/oils intake was developed. Servings within the Bread, Cereal and Potato group were sub-categorized on the basis of energy content. Recommendations on numbers of servings from each food group were developed to guide on energy and nutrient requirements. Healthy eating is least affordable for families with children who are dependent on social welfare.
CONCLUSIONS: Daily supplementation with vitamin D is recommended. Wholemeal breads and cereals are recommended as the best source of energy and fibre. Low-fat dairy products and reduced-fat unsaturated spreads are prioritized to achieve saturated fat and energy goals. Interventions are required to ensure that healthy eating is affordable.

Systematic and effective welfare for the disabled is possible when there are scientific and objective criteria demonstrating either presence or severity of the impairment. We need our own scientific criteria suitable for our culture and society, since the impairment is influenced by them. In 2007, we established the Developing Committee of Korean Academy of Medical Sciences (KAMS) Guideline for Impairment Rating under KAMS supervision. We included all fixed and permanent physical impairments after a sufficient medical treatment. The impairment should be stable and medically measurable. If not, it should be reevaluated later. We benchmarked the American Medical Association Guides. The KAMS Guideline should be scientific, objective, valid, reasonable and practical. In particular, we tried to secure objectivity. We developed the KAMS Guideline for Impairment Rating.

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This article examines the provision of voluntary hospital facilities for injured workers in the mining valleys of Edwardian South Wales. It considers the co-operation and conflict that characterized efforts to establish hospitals, and examines the attitudes and activities of workers, employers, and other interested groups. Despite certain instances of disagreement and conflict, this article demonstrates the significant levels of co-operation and consensus that characterized the efforts of employers and workers to provide communities with hospital facilities. This co-operation was perhaps surprising considering the bitter industrial conflict and social unrest of that period. The article uses this material to question assertions that hospitals reflect the social and political milieus of the communities in which they were situated and argues that the social relations produced by hospital provision sometimes coincided with wider social and industrial relations, but at other times differed from them or transcended them. Furthermore, the article demonstrates that the co-operation between employers and workers in the provision of hospitals in Edwardian South Wales did not stabilize social and industrial relations in the way that historians of associational voluntarism in other contexts have found.