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Background: As the number of large-scale outbreaks continues to rise worldwide, clinical trials are increasingly engaging disease-affected peoples within the Minority World (nations with over 80% poverty rates). Yet global health research inadequately addresses potential ethical issues of including impoverished, disease-affected populations and their contextual vulnerabilities in medical research. Objective: This paper presents a mixed-method analysis from our 2022 semi-structured survey capturing the experiences of Liberian Ebola Virus Disease (EVD) survivors serving as study participants in the Partnership for Research on Ebola Virus in Liberia (PREVAIL) clinical trials. Methods: Firstly, we conducted an extensive literature review of the scholarship related to biomedical research and ethical standards protecting study participants to inform our survey method and design. Applying a theoretical framework on vulnerability, we then qualitatively explored the survey responses of 19 EVD survivors' perceptions and experiences taking part in PREVAIL, including their expectations, treatment, delivered benefits, and quality of care. We further quantitatively codified their statements for underlying themes of reported negative experiences against standard ethical regulations in biomedical research, conducting a statistical analysis to inform generalizability. Most of the 19 survivors reported facing extreme ongoing vulnerabilities related to their disease status, including physical impairments, psychosocial stress, and socio-economic inequity. Results: Initially, the survivors tended to experience a sense of hope and pride in volunteering for PREVAIL. One in five participants reported benefiting from PREVAIL's regular medical diagnoses. However, most of their survey responses indicated prevalent negative shared experiences, including continually being confused or misinformed of their study participant rights, roles, and benefits; being burdened by heavy participation transaction costs; and repeated incidents of poor treatment and discrimination by PREVAIL staff after initial recruitment. PREVAIL participant satisfaction ranking is negatively correlated with receiving insufficient financial compensation (r = −0.51), extensive time requirements for each medical visit (−0.40), and being poorly treated by clinical staff (−0.67). [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve implantation (TAVI) has emerged as a safe and effective treatment for severe aortic stenosis across the spectrum of surgical risk cohorts. Subsequently, the dramatic increase in procedural volume worldwide has placed significant financial and logistical pressures on healthcare institutions, particularly regarding hospital length of stay (LOS), which can adversely affect patient flow. In this review article, we discuss different peri-procedural strategies developed to reduce LOS and facilitate early discharge after TAVI. [ABSTRACT FROM AUTHOR]

Background: Type 2 Diabetes Mellitus (T2DM) is a highly prevalent disease with a chronic nature and poses a significant health burden worldwide, with no exception in Pakistan. Hence, this study aimed to explore the financial burden of T2DM in Pakistan through cost of illness analysis. Methods: A prevalence-based, cross-sectional study was conducted using a structured data collection tool from the patient's perspective. Through structured interviews by trained data collectors, the data regarding direct medical costs, direct non-medical costs, and indirect costs were collected and further verified through prescriptions and bills. After testing the normality of data, mean and median with interquartile range were used to present cost data, while non-parametric tests, i.e., the Mann–Whitney U test and the Kruskal–Wallis test, were used to assess factors associated with costs, as cost data were not normally distributed. Results: The study included 522 participants, with a majority being female (54%) and aged between 41 and 60 years (64%). The mean annual total cost per patient was USD 235.1 (median = USD 162.8), comprising direct medical costs, 93.2% (mean = USD 219.2; median = USD 150.0), direct non-medical costs, 5.3% (mean = USD 12.4; median = USD 7.1), and indirect costs, 1.5% (mean = USD 3.5; median = USD 1.9). Costs were significantly higher for patients with advanced age, high literacy, higher household incomes, duration of diabetes, more than one complication, and using combination therapy. Conclusions: The economic burden of T2DM in Pakistan is substantial, with medication costs being the largest component. Effective management strategies and policy interventions are crucial to mitigate this burden and improve the economic and health outcomes for diabetic patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Adolescents and young adults (AYAs) experiencing cancer have support needs that differ from older adult cancer patients. The aim of our qualitative study was to determine the holistic needs of AYA cancer survivors and to develop a patient-centered conceptual model of AYA survivorship care. Analysis of our interview results reveals eight key domains critical to holistic patient-centered AYA survivorship care. We offer a conceptual model that differs from current conceptual models of AYA survivorship care by centering the patient and their support systems, emphasizing the need for continuing supportive navigation, and the importance of repeated support along the identified domains over time. Purpose: Conceptual models provide frameworks to illustrate relationships among patient-, provider-, system-, and community-level factors that inform care delivery and research. Existing models of cancer survivorship care focus largely on pediatric or adult populations whose needs differ from adolescents and young adults (AYAs). We developed a patient-centered conceptual model of AYA survivorship care. Methods: We conducted a narrative literature review of current conceptual and theoretical models of care. We engaged AYA cancer survivors (n = 25) in semi-structured one-hour telephone interviews. Most participants were in their 20s and 30s, and the majority (84%) were women. Recruitment was stratified by age and time since cancer diagnosis. We conducted a thematic analysis of interview transcripts to identify themes that exemplified patient-centered care. Results: Most participants identified as white and female. Leukemia and breast cancer were the most common cancer types. Main themes included the need for (1) care coordination, (2) ongoing mental health support, (3) connection to AYA peer support, (4) support during fertility preservation efforts, (5) support with financial burden, (6) support for quality of life, (7) information about and support with side effects and late effects, and (8) attention to the unique needs of young adults. Conclusions: We present a patient-centered conceptual model of AYA survivorship care needs that can inform future cancer care delivery and research. [ABSTRACT FROM AUTHOR]

Intimate Partner Violence (IPV) is a risk factor for depressive disorders and other harms to women and their pregnancy. There is a need for longitudinal evidence to assist with understanding the subgroups of women including those from refugee background affected by IPV. We recruited women at their prenatal visit from three antenatal clinics in Australia (January 2015–March 2016). A total of 1335 women, 650 (48.7%) born in Australia and 685 (51.3%) from refugee backgrounds, completed baseline assessment; then, Time 2 follow-up was at 6 months and Time 3 follow-up was at 24 months post birth. The WHO Intimate Partner Violence (IPV) measure was used. Latent class growth analysis grouped individuals based on trajectories of IPV across three time points. A three-step process identified characteristics associated with respective latent class membership. Similar three-class solutions were observed across both cohorts, composed of Limited IPV (64% and 48% Australian-born and refugee background, respectively); Changing IPV (31%; 46%)—various combinations of IPV categories across time; Combined IPV (4%; 6%)—IPV at all time points, all transitioning to the combined physical and psychological abuse category at Time 3. Older age, fewer children, being in a couple, having a better partner, family and friend relationships, fewer partner trauma events, and fewer living difficulties emerged as protective factors for the changing and combined categories, with a distinct pattern for the refugee cohort. The findings assist with understanding and defining of the highest risk group for targeting interventions to prevent IPV, and the unique protective factors across the two IPV-affected classes for women born in Australia and those who arrived as refugees. [ABSTRACT FROM AUTHOR]

This study examines the impact of gender diversity in the positions of board commissioners, executive directors, and audit committee members on the financial performance of firms experiencing financial trouble. It also evaluates whether the presence of a CEO with multiple responsibilities moderates this relationship. The analysis encompassed 224 publicly traded companies from the non-financial sector, spanning the years 2012 to 2021. The study employed the dynamic panel model system GMM to address issues of endogeneity, simultaneity, and heterogeneity in the data. The findings indicate that the presence of women on supervisory boards and in senior positions has a substantial impact. Companies with a higher number of female board members have reduced financial hardship among Malaysian listed enterprises. Female directors exhibit a greater level of caution and risk aversion while participating in management choices, which is a significant conclusion. Research indicates that the majority of financial variables are inherently endogenous, so dynamic models are better suited for analyzing the interaction between these variables. This study also presents the notable correlation between gender diversity on boards of management, CEO duality, and financial difficulty. [ABSTRACT FROM AUTHOR]

Multiple myeloma (MM) is a common hematologic malignancy, but due to its incurable nature, patients experience many relapses in their lifetime and hence face unique challenges. This mixed-methods study consisting of an online survey and subsequent focus groups aimed to understand how social and identity experiences affected the diagnostic, treatment, and care journey for patients with MM. Twenty-three adult patients with MM participated in this study. The survey participants identified common determinants negatively impacting their health, including mental health concerns (experienced by 90.5% of respondents), worries about food shortage (42.9%), and transportation concerns (28.6%). Focus group participants described high physical and mental health burdens associated with MM. Frequent monitoring, fear of a relapse, and unpredictable side effects contributed to high anxiety. Participants indicated that MM differed from other types of cancer and chronic health conditions in many ways, particularly how and where the diagnosis was made, disease progression and relapse, treatments and side effects, and financial concerns. Most participants (65.0%) reported ≥1 social need that negatively impacted health outcomes including lack of knowledge about MM, financial instability, and lack of insurance, transportation, and social support. The findings reveal that patients with MM continually experience patient-specific mental and physical health burdens indicating high unmet needs throughout the disease journey. [ABSTRACT FROM AUTHOR]

Simple Summary: Mycosis fungoides and Sézary syndrome can impair multiple dimensions of health-related quality of life due to physical symptoms including pruritus, treatment side effects, time and financial burdens associated with high healthcare utilization, and psychological distress. There are several areas of unmet needs around health-related quality of life in this population, and the optimal way to measure health-related quality of life isn't yet clear. Mycosis fungoides (MF) and Sézary syndrome (SS) can impair multiple dimensions of health-related quality of life (HRQoL). Currently, there is no standardized assessment tool for measuring HRQoL in patients with MF/SS. Here, we describe the existing literature on multiple dimensions of HRQoL in MF/SS with a special focus on the gaps in the current knowledge and identify future directions necessary to assess the HRQoL of patients with this disease. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aims to explore family dynamics and the economic hardships experienced by families during the COVID-19 pandemic and their associations with adolescents' health risk behaviours (HRBs). Methods: Based on a representative study of adolescents aged 11–16 conducted in Bulgaria during the COVID-19 pandemic and HBSC data from the pre-pandemic period, logistic regression models were applied, assessing cigarette smoking, vaping, alcohol use, drunkenness, and cannabis use. The independent variables included demographics, Family Affluence Scale (FAS III), family structure, ease of communication with parents, and the authors' developed questions on parents' income and economic status change, family conflicts, and missing contact with extended family due to the pandemic. Results: Material status of the family showed increasing differentials in adolescents' HRBs during the pandemic. Parental unemployment, income reduction, and temporary lay-offs were associated with a higher risk of substance use. Family conflicts, missing contact with extended family, and difficulties in communication with the mother were related to a higher risk of substance use. Communication with the father was significantly associated with alcohol use and drunkenness. Boys had lower odds of vaping and higher odds of alcohol use, drunkenness, and cannabis use. Higher age and minority status were associated with an increase in adolescents' HRBs. Conclusions: This study highlights the need for special family-focused interventions in times of health and economic crises. [ABSTRACT FROM AUTHOR]

This study aims to investigate the impact of financial stress and uncertainty on the returns of green and conventional bonds and stocks in the United States from 2010 to 2022. The research utilizes nonlinear and nonparametric analysis, which includes the quantile-on-quantile and nonparametric causality-in-quantiles approaches to examine the relationship between variables. The data analyzed using R programming language show that financial stress positively impacts the middle quantiles of both conventional and green equity, while financial uncertainty negatively impacts upper quantiles. The study also finds that financial stress has a more significant impact on all types of bonds compared to financial uncertainty, with conventional bonds being more affected. This study proposes a pyramid that classifies financial assets based on their susceptibility to financial stress, which could help investors evaluate risk levels and make better investment decisions. The study recommends that policymakers should encourage green investments by offering incentives, such as tax credits. They should also focus on enhancing the efficiency of volatile assets by implementing new investment rules and regulations. [ABSTRACT FROM AUTHOR]

This study examines the relationship between various demographic and situational factors and working students' decisions to change their study programmes and abandon higher education. It utilises a sample of 1902 working students derived from the Eurostudent VII survey and employs cross-tabulation and chi-square tests. The findings reveal statistically significant associations between several factors and students' educational decisions. Males are more likely to consider abandoning higher education than females. Younger students, particularly those up to 21 years old, are more inclined to consider changing their study programmes. Financial difficulties significantly influence students' considerations of both changing study programmes and abandoning higher education. Students in the arts, humanities, and ICT are more likely to consider abandoning their studies. Conversely, age does not significantly affect the likelihood of abandoning higher education. Parental educational attainment does not significantly influence decisions to change or abandon study programmes, whereas living situations, such as living independently and not living with parents, significantly affect changing the study programme. Qualification level affects the likelihood of changing study programmes, with bachelor's students more likely to consider changes than masters and long-term national degree students, but it does not significantly affect the likelihood of abandoning higher education. Education–job mismatch significantly affects both changing study programmes and abandoning higher education, while the duration of working hours only influences the decision to alter study programmes. By revealing these findings, this research extends the student retention discourse as well as highlights how cultural, economic, familial, and workplace capital influence working students' educational decisions. [ABSTRACT FROM AUTHOR]

Background: The mental health of Black youth during the COVID-19 pandemic is potentially influenced by various systemic factors, including racism, socioeconomic disparities, and access to culturally sensitive mental health support. Understanding these influences is essential for developing effective interventions to mitigate mental health disparities. Methods: Our project used a community-based participatory (CBP) research design with an intersectional theoretical perspective. An advisory committee consisting of fourteen Black youth supported all aspects of our project. The research team consisted of experienced Black researchers who also trained six Black youths as research assistants and co-researchers. The co-researchers conducted individual interviews, contributed to data analysis, and mobilized knowledge. Participants were recruited through the advisory committee members and networks of Black youth co-researchers and sent an email invitation to Black community organizations. Forty-eight Black identified were interviewed between the ages of 16 and 30 in Canada. The data was analyzed thematically. We kept a reflexive note throughout all aspects of the project. Results: Participants reported significant challenges with online schooling, including a lack of support and access to resources. Lockdowns exacerbated stress, particularly for those living in toxic living/home environments. Financial burdens, such as food insecurity and precarious employment, were prevalent and exacerbated mental health challenges. Additionally, experiences of anti-Black racism and police brutality during the pandemic heightened stress and anxiety among participants. Conclusions: The findings underscore the complex interplay of systemic factors in shaping the mental health of Black youth during the COVID-19 pandemic. Addressing these disparities requires targeted interventions that address structural inequities and provide culturally competent support to mitigate the impact on mental well-being. [ABSTRACT FROM AUTHOR]

School dropout is a pressing social problem that stems from systemic inadequacies in the education system and socio-economic background. The aim of this study was to analyze how the travel time and financial difficulties impact school dropout in satellite towns near Bucharest, the capital of Romania. Data on dropout rates in recent years were provided by the Ilfov County General School Inspectorate and were supplemented by 30 semi-structured interviews with the parents, caregivers, or the legal representatives of students who have dropped out of school or are at risk of dropping out. The study's findings reveal significant correlations between the travel time to school, familial financial situation, and attitudes towards education, impacting dropout rates across various satellite towns. Addressing the challenge of school dropout promises societal improvement and empowers policymakers to enact more inclusive policies benefiting all members of society. [ABSTRACT FROM AUTHOR]

Accurate measurement of systemic financial risk is crucial for maintaining the stability of financial markets. Taking China as the subject of investigation, the Chinese Financial Stress Index (CFSI) indicator system was constructed by integrating six dimensions and employing Gray Relation Analysis (GRA) to reduce the dimensionality of the indicators. The CFSI was derived using the Attribute Hierarchy Model (AHM) method with the Criteria Importance Through the Intercriteria Correlation (CRITIC) method, and an Improved Gravitational Search Algorithm (IGSA)-optimized Radial Basis Function Neural Network (RBFNN) was proposed for out-of-sample prediction of CFSI trends from 2024 to 2026. By analyzing the trends in financial pressure indicators, the intricate relationship between financial pressure and economic activity can be effectively discerned. The research findings indicate that (1) the CFSI is capable of accurately reflecting the current financial stress situation in China, and (2) the IGSA-RBFNN demonstrates strong robustness and generalization capabilities, predicting that the CFSI index will reach a peak value of 0.543 by the end of 2024, and there exists a regular pattern of stress rebound towards the end of each year. The novel methodology enables policymakers and regulatory authorities to proactively identify potential risks and vulnerabilities, facilitating the formulation of preventive measures. [ABSTRACT FROM AUTHOR]

Addressing how employment impacts older adults, including their psychological well-being, we contribute to the study of this topic by examining the association between paid work in community-dwelling older adults and their depressive mood, while considering the extent of their financial pressure. Methods: The data are from the Kashiwa longitudinal cohort study, with a 2014 baseline and a 2016 follow-up. Of the 1308 participants in the 2014 survey, 781 people were included. We conducted binary logistic regression analyses stratified by economic status with regard to the extent of the financial pressure experienced. The independent variable of interest was paid work in 2014, and the dependent variable was the extent of depressive mood (a score of 5 or more on the Geriatric Depression Scale 15) in 2016. Results: Paid work was associated with lower odds of depressive mood among those under financial pressure (odds ratio [OR] 0.46, 95% confidence interval [95%CI] 0.26, 0.81), whereas for those financially stable, we did not find an association between paid work and odds of depressive mood (OR 0.99, [95%CI] 0.26, 2.63). Discussion: We evidence that for older adults under financial pressure, employment supports the maintenance of their psychological well-being. We contribute to the literature by understanding when employment is beneficial for older adults, which is important in developing appropriate older adult employment social policies. [ABSTRACT FROM AUTHOR]

Fetal Alcohol Spectrum Disorder (FASD) is considered a lifelong disability that has been framed with neurobiological descriptions focused on the brain. These are important features but fail to tell the story of living with FASD. By surveying those with FASD, this work expanded upon prior survey work which illustrated a multitude of early-onset physiological issues occurring at rates much higher than is typical of the general population. The current project, again using an anonymous survey methodology, sought to open up other direct experiences to better understand the complexity of living with FASD. An anonymous online survey was used to gather data on adversity in childhood, schooling, employment, housing and finances, and involvement with the criminal justice system, as well as relationships and parenting. Results indicate high levels of adversity throughout the life span; vulnerability to manipulation, which is connected to involvement in the criminal justice system; struggles with housing; economic instability; and struggles maintaining employment, as well as difficulties with social and familial relationships. Systemic stigma was also identified. Suggestions are offered to inform others on how support can be enhanced and targeted with a goal of improving quality of life, as well as dealing with self-imposed stigma. The survey was developed by adults living with FASD who have served as a long-standing advocacy and educational group influencing policy and practice in the field. [ABSTRACT FROM AUTHOR]

Simple Summary: We investigated financial toxicity in Japanese patients with metastatic renal cell carcinoma using the COST tool. Despite universal coverage, patients in Japan had similar levels of financial toxicity as in other countries. There was a positive correlation between the FACT-G total score and the COST score. Age < 65 years and not having private health insurance were associated with higher financial toxicity. Information on the financial toxicity experienced by Japanese patients with metastatic renal cell carcinoma (mRCC) is lacking, even though Japan has its own unique public health insurance system. Thus, a web-based survey was conducted to evaluate the financial toxicity experienced by Japanese mRCC patients using the COmprehensive Score for financial Toxicity (COST) tool. This study enrolled Japanese patients who underwent, or were undergoing, systemic therapy for mRCC. The outcomes evaluated were the distribution of COST scores, the correlation between COST and quality of life (QOL) assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) scale, and demographic factors associated with financial toxicity. The median (range) COST score was 19.0 (3.0–36.0). The Pearson correlation coefficient for COST and FACT-G total scores was 0.40. Univariate analysis revealed that not having private health insurance and lower household income per year were significantly associated with lower COST scores. Multivariate analyses showed that age < 65 years and not having private health insurance were significantly associated with lower COST scores. This study revealed that Japanese mRCC patients experience adverse financial impacts even under the universal health insurance coverage system available in Japan, and financial toxicity negatively affects their QOL. [ABSTRACT FROM AUTHOR]

Background: In the United States, Medicare beneficiaries diagnosed with cancer often face significant financial challenges due to the expensive nature of cancer treatments and increased cost-sharing responsibilities. However, there is limited knowledge regarding the financial hardships and healthcare utilizations faced by those enrolled in Medicare Advantage (MA) compared to those in traditional fee-for-service Medicare (TM) during the COVID-19 pandemic. Our study aims to investigate the subjective financial hardships experienced by individuals enrolled in TM and MA and to determine whether these two Medicare programs exhibit differences in healthcare utilization during the pandemic. Methods: We utilized data from the 2020–2022 National Health Interview Survey (NHIS), focusing on nationally representative samples of cancer survivors aged 65 or older. Financial hardship was categorized into three distinct groups: material (e.g., problems with medical bills), psychological (e.g., worry about paying), and behavioral (e.g., delayed care due to cost). Healthcare utilization included wellness visits (preventive care), emergency care services, hospitalizations, and telehealth. We used survey design-adjusted analysis to compare the study outcomes between MA and TM. Results: Among a weighted sample of 4.4 million Medicare beneficiaries with cancer (mean age: 74.9), 76% were enrolled in MA plans. Cancer survivors with a college degree (59.3% vs. 49.8%) and high family income (38.2% vs. 31.1%) were more likely to enroll in MA plans. There were no significant differences in any material, psychological, or behavioral financial hardship domains between beneficiaries with MA and TM plans except forgone counseling due to cost. For healthcare utilization measures, cancer survivors in MA were more likely than those in TM to have flu vaccination (77.2% vs. 70.1%) and experience lower hospitalizations (16.0% vs. 20.0%). However, there were no differences in other health service utilizations between MA and TM. Conclusion: While no significant differences were observed in any materialized, psychological, or behavioral financial hardships, older cancer survivors enrolled in MA plans were more likely to receive vaccinations and lower hospitalization rates during COVID-19. Although other preventive or primary care visits (i.e., wellness visits) were higher, their difference did not reach statistical significance. As MA grows in popularity, it is essential to consistently monitor and evaluate the performance and outcomes of Medicare plans for cancer survivors as we navigate the post-pandemic landscape. [ABSTRACT FROM AUTHOR]

Simple Summary: Prostate cancer is the most common cancer among men. Diagnosis and risk stratification of prostate cancer can be challenging due to gaps in our understanding of the disease as well as the limitations of tests used in clinical practice. Extracellular vesicles are microscopic particles containing genetic material, proteins and other molecules that are released by cells. Urine contains extracellular vesicles which can originate from the prostate gland. This review addresses how extracellular vesicles are involved in the development of prostate cancer, as well as how urinary extracellular vesicles can be analysed to diagnose and monitor prostate cancer. Prostate cancer is the most common non-cutaneous cancer among men in the UK, causing significant health and economic burdens. Diagnosis and risk prognostication can be challenging due to the genetic and clinical heterogeneity of prostate cancer as well as uncertainties in our knowledge of the underlying biology and natural history of disease development. Urinary extracellular vesicles (EVs) are microscopic, lipid bilayer defined particles released by cells that carry a variety of molecular cargoes including nucleic acids, proteins and other molecules. Urine is a plentiful source of prostate-derived EVs. In this narrative review, we summarise the evidence on the function of urinary EVs and their applications in the evolving field of prostate cancer diagnostics and active surveillance. EVs are implicated in the development of all hallmarks of prostate cancer, and this knowledge has been applied to the development of multiple diagnostic tests, which are largely based on RNA and miRNA. Common gene probes included in multi-probe tests include PCA3 and ERG, and the miRNAs miR-21 and miR-141. The next decade will likely bring further improvements in the diagnostic accuracy of biomarkers as well as insights into molecular biological mechanisms of action that can be translated into opportunities in precision uro-oncology. [ABSTRACT FROM AUTHOR]

Simple Summary: The prevalence of cancer related to the digestive system keeps rising. We examined the 2024 literature on gastric cancer. Apart from surgery, which remains the primary treatment option for gastric cancer, immunotherapy and therapeutic targeting are becoming increasingly significant in the management of this disease. Following gastric cancer surgery, a multidisciplinary approach is required, with nutritionists and psychologists playing fundamental roles. Due to the high death rate associated with gastric cancer, a great deal of research has been conducted on this disease. The goal of this paper was to start a trimestral review of 2024 for the year that had just started. The scientific literature from 1 January 2024 was chosen with consideration of the the guidelines of the European Society of Medical Oncology (ESMO), which are updated with new findings but not systematically reviewed annually. We used the search term "gastric cancer" to find the most current publications in the PubMed database related to the prognosis and treatment of gastric cancer. As previously said, the only articles that satisfied the inclusion criteria were those from 2024. Articles with case reports were eliminated since they had nothing to do with our research. The treatment of gastric cancer is the focus of the majority of articles from 2024. The primary research axes include surgery and immunonutrition, immunotherapy and Helicobacter pylori, and therapeutic targets. Patients with GC may experience less psychological, social, and financial hardship if the recently identified markers discovered in circulation are better assessed and validated. This could be achieved by either including the markers in an artificial intelligence-based diagnostic score or by using them in conjunction with traditional diagnostic methods. Due to the rising death rate associated with GC, funding for research into diagnosis, prognosis, therapy, and therapeutic targets is essential. [ABSTRACT FROM AUTHOR]

Background and Objectives: Little is known about patients' and caregivers' experiences with atopic dermatitis (AD) in Argentina, so a survey was administered to learn more. Materials and Methods: A 53-item anonymous survey was administered in Spanish to adult AD patients (n = 334) and caregivers (n = 339) of pediatric AD patients in Argentina (total n = 673). Demographics, healthcare provider information, financial burden, disease severity, disease burden, level of disease-specific education, and experience with shared physician/patient decision making were collected. Linear and logistic regression models were used for statistical comparisons. Results: Survey respondents were overwhelmingly female (90.8%), as was the overall patient population (72.8%). Patients were seen mostly by healthcare specialists (66.8% dermatologists, 13.5% pediatricians, 7.7% allergists, and 7.2% general practitioners). Only 2.8% of respondents reported no symptoms, while 33.3%, 52.4%, and 11.5% reported mild, moderate, and severe AD disease, respectively. Anxiety/depression and pain/discomfort were the most impactful on respondents' quality of life. Caregivers of children with moderate to severe AD and adult patients with severe AD reported a significant financial burden, including using savings or not purchasing food or other essentials to afford medical care. Few people reported receiving disease-specific education or having their own treatment priorities taken into consideration. For adult patients, receiving disease education and being asked about treatment priorities were associated with higher treatment satisfaction and AD control. Discussion: Mental health, pain/discomfort, and financial worries are the most important burdens for adult AD patients and caregivers of children with AD in Argentina. We recommend prioritizing disease-specific education and shared decision making to improve AD care in Argentina. [ABSTRACT FROM AUTHOR]

Children placed with kinship foster parents can experience less disruption and stronger family ties than children in non-kinship placements. However, financial hardship can restrict kinship caregivers from taking in relatives' children. This study investigated (1) kinship caregivers' financial standing compared to a national subsample of caregivers and (2) whether certain factors moderate the likelihood that a kinship caregiver will be able to provide care for additional non-relative children without additional financial assistance from the Department of Social Services (DSS). This study utilized primary data from 345 relatives across North Carolina and nationally representative secondary data on 6394 individuals' financial circumstances. One-sample t-tests and chi-square goodness-of-fit tests revealed that caregivers who participated in our study generally fared better financially than caregivers at the national level. Model-based recursive partitioning results showed that if an additional child is placed in the home, the caregiver's perceived capacity to provide care without extra DSS support decreased by approximately 19%, with a greater decrease (35%) among a subgroup of caregivers with low financial well-being status. The heterogeneity in caregivers' experiences, capacities, and financial needs buttresses the need for nuanced interventions and programs targeting these caregivers, enabling them to provide more stable care for children placed in their homes. [ABSTRACT FROM AUTHOR]

Financial stress can have significant implications for individuals, businesses, asset prices and the economy as a whole. This study examines the nonlinear structure and dynamic changes in the multifractal behavior of cross-correlation between the financial stress index (FSI) and four well-known commodity indices, namely Commodity Research Bureau Index (CRBI), Baltic Dry Index (BDI), London Metal Index (LME) and Brent Oil prices (BROIL), using multifractal detrended cross correlation analysis (MFDCCA). For analysis, we utilized daily values of FSI and commodity index prices from 16 June 2016 to 9 July 2023. The following are the most important empirical findings: (I) All of the chosen commodity market indices show cross correlations with the FSI and have notable multifractal characteristics. (II) The presence of power law cross-correlation implies that a noteworthy shift in FSI is likely to coincide with a considerable shift in the commodity indices. (III) The multifractal cross-correlation is highest between FSI and Brent Oil (BROIL) and lowest with LME. (IV) The rolling windows analysis reveals a varying degree of persistency between FSI and commodity markets. The findings of this study have a number of important implications for commodity market investors and policymakers. [ABSTRACT FROM AUTHOR]

Scientifically measuring the level of environmental governance (EGL) and understanding its spatial convergence has important reference value for ecological governance. In this paper, the global entropy method is applied to measure the EGL of 284 prefecture-level cities in China from 2007 to 2019, which are divided into three major river basins, including the Yellow River, Yangtze River, and Pearl River, to observe the spatial–temporal evolutionary characterization through a standard deviation ellipse model. The coefficient of variation and the spatial econometric model are the tools used to conduct the spatial convergence test. The results are as follows: (1) China's EGL is low overall, though it is fluctuating upward at low magnitude, and the three major river basins follow the ranking: The Pearl River Basin > The Yangtze River Basin > The Yellow River Basin. (2) Spatially, the distribution pattern of China's EGL changes from "scattered and sporadic" to "multipolar core". (3) The center of China's environmental governance was concentrated in the east from 2007 to 2019, and the EGL in the midstream and downstream regions of the three major river basins increased rapidly. (4) Environmental governance in China has significant absolute and conditional β-convergence characteristics, as do the three major basins, while the ranking of convergence speed remains "Yangtze River Basin > Yellow River Basin > Pearl River Basin". Of these, economic development accelerated the convergence rate of environmental governance in China and its three major river basins; financial pressure significantly inhibited the convergence of the EGL of the Yellow River Basin. The improvement of the EGL in the Pearl River Basin was also negatively influenced by the industrial structure. [ABSTRACT FROM AUTHOR]

Water scarcity is a global concern and poses significant problems to countries with arid and semi-arid climates, like Iran. Considering financial difficulties, a lack of knowledge about high-tech alternatives, low incomes, a lack of access to high-tech tools, and low maintenance capabilities in developing countries, solar still desalination is a decent technology for providing proper water, especially for rural areas. However, the low water-production rate using this method dictates a very vast area requirement for solar still farms in order to provide significant amounts of water. In this research, we proposed a mirror-enhanced solar still and mathematically compared its water-production rate to that of conventional ones. In comparison to conventional solar stills, our proposed reflector-enhanced solar still benefits from several improvements, including lower glass temperatures, increased water basing temperatures, and receiving much more solar irradiation. Hence, the proposed system can increase water production from 7.5 L/day to 24 L/day. The results showed that the proposed method is highly effective and could be used in field-scale projects in arid and semi-arid climates. [ABSTRACT FROM AUTHOR]

The financial difficulties of parents have a negative impact on the health of their children. This problem is more pronounced in single mother families. There is limited research on low-income, single mothers and how interventions to help them address financial difficulties may also benefit their children. The purpose of this study was to evaluate the effect of a year-long financial education and coaching program on school absenteeism and health care utilization of children in employed, low-income, single mother households. This was a post hoc analysis of the Finances First study, a randomized controlled trial conducted in 2017–2020 examining the impact of a financial coaching and education program on economic stability and health outcomes in 345 low-income, single mothers. Either generalized estimating equations (GEEs) or generalized linear mixed models (GLMMs) were used to account for relationships between participants. For the continuous outcomes of child absenteeism, physician visits, emergency room visits, and hospitalization days, a linear mixed-effects model was used. The Finances First study demonstrated improvements in various financial strain measures. Compared to the control group, children of intervention group participants experienced 1 fewer day of school absence (p = 0.049) and 1 fewer physician visit (p = 0.032) per year, but no impact was seen on emergency room visits (p = 0.55) or hospitalizations (p = 0.92). Addressing social determinants of health in parents is necessary for improving child health outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: Recently, robotic-assisted minimally invasive esophagectomy (RAMIE) has become more common for patients with esophageal cancer. However, healthcare providers worried that RAMIE might be more expensive than the traditional minimally invasive esophagectomy (MIE). Therefore, we aimed to compare the results and costs of RAMIE and MIE in 128 patients who underwent surgery between 2017 and 2021. We found that surgical costs of RAMIE were higher. However, total costs were similar between RAMIE and MIE. Fewer cases of postoperative pneumonias were observed after RAMIE. RAMIE also tended to result in shorter hospital stays, which could explain why overall costs were about the same. All in all, our study suggests that RAMIE is not more expensive and might even be a better choice for many patients. In recent decades, robotic-assisted minimally invasive esophagectomy (RAMIE) has been increasingly adopted for patients with esophageal cancer (EC) or cancer of the gastroesophageal junction (GEJ). However, concerns regarding its costs compared to conventional minimally invasive esophagectomy (MIE) have emerged. This study examined outcomes and costs of RAMIE versus total MIE in 128 patients who underwent Ivor Lewis esophagectomy for EC/GEJ at our department between 2017 and 2021. Surgical costs were higher for RAMIE (EUR 12,370 vs. EUR 10,059, p < 0.001). Yet, median daily (EUR 2023 vs. EUR 1818, p = 0.246) and total costs (EUR 30,510 vs. EUR 29,180, p = 0.460) were comparable. RAMIE showed a lower incidence of postoperative pneumonia (8% vs. 25%, p = 0.029) and a trend towards shorter hospital stays (15 vs. 17 days, p = 0.205), which may have equalized total costs. Factors independently associated with higher costs included readmission to the intensive care unit (hazard ratio [HR] = 7.0), length of stay (HR = 13.5), anastomotic leak (HR = 17.0), and postoperative pneumonia (HR = 5.4). In conclusion, RAMIE does not impose an additional financial burden. This suggests that RAMIE may be considered as a valid alternative approach for esophagectomy. Attention to typical cost factors can enhance postoperative care across surgical methods. [ABSTRACT FROM AUTHOR]

Simple Summary: Financial toxicity, defined as the financial distress experienced by patients related to their cancer care, can adversely impact clinical outcomes. Little is known about financial toxicity and associated factors among patients with breast cancer during the COVID-19 pandemic. Our study of 669 patients shows that financial toxicity was prevalent in patients with breast cancer, particularly those with metastatic disease, during COVID-19. Lower income and elevated depression symptom severity were the primary factors associated with greater financial toxicity and socioeconomic stress from COVID-19. Patient financial burden is substantial and must be considered when managing breast cancer. This study reported the prevalence of financial distress (financial toxicity (FT)) and COVID-19-related economic stress in patients with breast cancer (BC). Patients with BC were recruited from the Ciitizen platform, Breastcancer.org, and patient advocacy groups between 30 March and 6 July 2021. FT was assessed with the COmprehensive Score for financial Toxicity (COST) instrument. COVID-19-related economic stress was assessed with the COVID-19 Stress Scale. Among the 669 patients, the mean age was 51.6 years; 9.4% reported a COVID-19 diagnosis. The prevalence rates of mild and moderate/severe FT were 36.8% and 22.4%, respectively. FT was more prevalent in patients with metastatic versus early BC (p < 0.001). The factors associated with FT included income ≤ USD 49,999 (adjusted odds ratio (adj OR) 6.271, p < 0.0001) and USD 50,000–USD 149,999 (adj OR 2.722, p < 0.0001); aged <50 years (adj OR 3.061, p = 0.0012) and 50–64 years (adj OR 3.444, p = 0.0002); living alone (adj OR 1.603, p = 0.0476); and greater depression severity (adj OR 1.155, p < 0.0001). Black patients (adj OR 2.165, p = 0.0133), patients with income ≤ USD 49,999 (adj OR 1.921, p = 0.0432), or greater depression severity (adj OR 1.090, p < 0.0001) were more likely to experience COVID-19-related economic stress. FT was common in patients with BC, particularly metastatic disease, during COVID-19. Multiple factors, especially lower income and greater depression severity were associated with financial difficulties during COVID-19. [ABSTRACT FROM AUTHOR]

Simple Summary: Contradictory research exists on the association of self-reported quality of life at tumor diagnosis (baseline quality of life, bQL) with treatment and disease-specific characteristics in oncological patients. The aim of our prospective study was to examine the role of bQL as a treatment predictor in oncological patients. We show that self-reported pain and low physical functioning or financial burden at tumor diagnosis were linked to lower systemic treatment, reduced surgery or reduced oncological treatment compliance, respectively. Thus, we found for the first time that survival-relevant quality-of-life variables reported during diagnosis are significantly associated with the subsequent oncological treatment of oncological patients. In addition, our results indicate that these treatment patterns were distinguishable between genders, as well as younger or older ages. Linking survival-predicting baseline QL scores to treatment-specific patterns emphasizes the importance of patient baseline physio-emotional state over the course of the disease and paves the way for early integration of patient-reported outcomes into oncological supportive concepts. Background: Baseline quality of life (bQL) has been shown to be a predictor of the clinical outcome of oncological patients. The primary objective of the present study was to examine the role of bQL as a treatment predictor in oncological patients. Methods: In this prospective study, all-stage cancer patients registered in the Network Oncology registry were enrolled, and their bQL at diagnosis was evaluated. Results: Five hundred and thirty-eight oncological patients were eligible (median age 64 years). We show that survival-predicting bQL variables such as pain, low physical functioning or financial burden at tumor diagnosis were linked to lower systemic treatment (p = 0.03), reduced surgery (p = 0.007) or reduced oncological treatment compliance (0.01), respectively. Lastly, female gender and older cancer patients exhibited a tempered bQL. Conclusion: Our study is one of the first to reveal that bQL at tumor diagnosis is significantly associated with the prediction of oncological treatment with distinctive age- and gender-related patterns. Our results emphasize the need to address the physical, psychosocial, and financial burden of cancer patients prior to their oncological treatment with respect to age and gender. The associations found here pave the way for early integration of patient-reported outcomes into oncological supportive concepts. [ABSTRACT FROM AUTHOR]

Simple Summary: Proton therapy is a highly effective type of radiotherapy that is used to treat cancer while minimizing damage to healthy tissue. In Switzerland, health insurance typically covers the cost of proton therapy. However, patients may still need to pay for their lodging and travel expenses during the treatment's 5–7 week duration. This can lead to financial stress, also known as financial toxicity. The present study is the first to measure patient-reported financial toxicity in a group of patients receiving proton therapy, including both patients and caregivers of pediatric cancer patients. It shows that many patients receiving proton therapy experience financial toxicity, which is measured by the COST score. Low income, long travel distances, and marriage can contribute to this financial burden. Patients often had to save money by cutting back on expenses in different areas. The study emphasizes the importance of considering financial aspects as part of cancer patients' overall care during proton therapy. Background: Proton therapy is indicated for cancers that would be difficult to treat with conventional radiotherapy. Compulsory healthcare insurance covers the costs of this therapy in Switzerland, but this does not mean that proton therapy is cost-neutral for every cancer patient. Significant out-of-pocket (OOP) costs may arise due to expenses associated with proton therapy, and patients may experience treatment-related financial distress—an effect known as "financial toxicity." This study investigates the financial toxicity of patients undergoing proton therapy in a high-income country with a compulsory health insurance policy. Methods: Between September 2019 and November 2021, 146 Swiss cancer patients treated with proton therapy participated in this study, of whom 90 (62%) were adults and 56 (38%) were caregivers of child cancer patients. Financial toxicity was assessed using the FACIT Comprehensive Score for Financial Toxicity (COST). OOP costs during proton therapy were recorded weekly, and financial coping strategies were captured at the end of treatment. Findings: The median COST score, indicating financial toxicity, was 29.9 (IQR 21.0; 36.0) for all patients, 30.0 (IQR 21.3; 37.9) for adults, and 28.0 (IQR 20.5; 34.0) for children's caregivers. Higher income (estimate 8.1, 95% CI 3.7 to 12.4, p ≤ 0.001) was significantly associated with higher COST scores, indicating less financial toxicity. Further distance from home to the treatment centre per 100 km (estimate −3.7, 95% CI −5.7 to −1.9, p ≤ 0.001) was significantly associated with lower COST scores, indicating increased financial toxicity. Married adult patients had substantially lower COST scores than single patients (estimate: −9.1, 95% CI −14.8 to −3.4, p ≤ 0.001). The median OOP cost was 2050 Swiss francs (CHF) and was spent mainly on travel, accommodation, and eating out. Sixty-three (43%) patients used their savings; 54 (37%) cut spending on leisure activities; 21 (14.4%) cut living expenses; 14 (9.6%) borrowed money; nine (6.2%) worked more; and four (2.7%) sold property. Patients with high COST scores used significantly fewer coping strategies such as saving on leisure activities (estimate −9.5, 95% CI −12.4 to −6.6, p ≤ 0.001), spending savings (estimate −3.9, 95% CI −6.3 to −1.4, p = 0.002), borrowing money (estimate −6.3, 95% CI −10.4 to −2.2, p = 0.003), and increasing workload (estimate −5.5, 95% CI −10.5 to −0.4, p = 0.035). Interpretation: A substantial number of cancer patients treated with proton therapy experience financial toxicity in Switzerland. Long travel distances to the proton therapy centre and low income negatively affect the financial well-being of these patients during proton therapy. [ABSTRACT FROM AUTHOR]

Economic disruptions can alter the likelihood of defaults on peer-to-peer loans, causing those impacted to adjust. The option to declare economic hardship and temporarily reduce the payment burden can provide some relief. When this occurs, the borrower's financial qualifications have changed. The qualities instrumental in successfully securing the original loan terms must be reanalyzed to manage risk. This is a critical point in the life of the loan because the declaration of financial hardship can signal that the borrower's ability to repay has diminished. We present a novel default detection scheme for borrowers experiencing an economic disruption based on the Two-Class Support Vector Machine, a data classification algorithm for supervised learning problems. The method utilizes data from actual loan records (15,355 loans from 2016 through 2020), specifically from borrowers who declared economic hardship. We provide a detailed description of the default detection process and present results that show defaults among borrowers experiencing financial hardship can be predicted accurately. [ABSTRACT FROM AUTHOR]

Growing concern for the mental health and wellbeing of higher education students has been linked to increasing financial pressures associated with studying at university, a factor potentially magnified by the recent global pandemic and economic downturn. With limited longitudinal research to date, this study used cross-sectional survey data collected annually at a large UK university (n = 10,876) to examine overall trends in students' experience of financial stress between 2018 and 2022. Logistic regression investigated changes in students' self-reported financial stress across the four-year period, adjusting for variation in survey response rates and respondent characteristics. Our findings showed a 55% increase in students reporting financial stress (OR = 1.55, 95% CI = 1.29–1.86) compared to none between 2018 and 2022. With the exception of 2020 and the early stages of the COVID-19 pandemic, the proportion of students experiencing financial stress increased each year. At a time of economic uncertainty, policymakers need to ensure appropriate advice, support, and funding frameworks are in place to ensure all students can continue to study successfully. Ongoing research should robustly examine the links between financial circumstances, mental health, and academic outcomes, to clearly identify intervention opportunities for relieving financial stress. [ABSTRACT FROM AUTHOR]

The main objective of this study was to study the effect of occupational stress on turnover intentions, as well as determine whether this relationship is mediated by burnout levels and moderated by motivation. The sample size of this study consisted of 603 participants, all employees of the Portuguese Tax and Customs Authority, which is part of the Ministry of Finance and belongs to the Direct State Administration. The results indicate that occupational stress (with managers, career and pay, and overwork) has a positive and significant effect on turnover intentions and that this relationship is mediated by burnout. Motivation (intrinsic and identified) has a negative and significant effect on turnover intentions. Intrinsic motivation moderates the relationship between occupational stress (with managers, colleagues, career and pay, and family problems) and turnover intentions. These results indicate that among the dimensions of occupational stress, the most critical are the stress caused by managers, work overload, and career and pay. These are factors that the Direct State Administration should be concerned with to reduce employees' stress levels, as well as their turnover intentions. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic introduced unprecedented challenges for households globally, serving as a precursor to and trigger for financial stress. This study examined the associations across various factors thought to be associated with financial stress (a psychological syndrome) resulting from the COVID-19 pandemic. Using survey data collected in 2019 (n = 997) and 2021 (n = 988), propensity score matching and hierarchical linear modeling were employed to identify the association between financial stress and the pandemic. Results indicated that financial stress increased during the COVID-19 pandemic. Three covariate groups, including financial characteristics, health status, and socio-demographic characteristics, were found to be associated with financial stress levels. The primary contribution of this paper lies in offering a comprehensive understanding of how the dynamics of financial stress evolve with shifting macroeconomic events. This paper serves as a framework to employ a comprehensive financial stress measure and matched samples at various data points. Findings from this study contribute to the existing literature on financial well-being, financial stress, and societal outcomes associated with global health events while providing implications for policy and practice. [ABSTRACT FROM AUTHOR]

Human mortality has been improving faster than expected over the past few decades. This unprecedented improvement has caused significant financial stress to pension plan sponsors and annuity providers. The widely recognized Lee–Carter model often assumes linearity in its period effect as an integral part of the model. Nevertheless, deviation from linearity has been observed in historical mortality data. In this paper, we investigate the applicability of four nonlinear time-series models: threshold autoregressive model, Markov switching model, structural change model, and generalized autoregressive conditional heteroskedasticity model for mortality data. By analyzing the mortality data from England and Wales and Italy spanning the years 1900 to 2019, we compare the goodness of fit and forecasting performance of the four nonlinear models. We then demonstrate the implications of nonlinearity in mortality modeling on the pricing of longevity bonds as a practical illustration of our findings. [ABSTRACT FROM AUTHOR]

In this study, we implement a linear programming farm model to explore the impact of climate change-induced multiple stress on the financial viability of greenhouse tomato growers. The main results are that new technologies and innovations can compensate growers for any profit loss associated with climate change. However, if the cost of adaptation is high enough, then its financial benefits are constrained by how efficient these innovations are in terms of productivity. We did not observe significant differences in input use between 'innovative' and 'conventional' production, and the yield under the adoption of new technologies was higher compared to 'conventional' production. [ABSTRACT FROM AUTHOR]

Nowadays, suicide (especially adolescents' suicide) has been an increasingly prominent social problem worldwide; suicide ideation, as an important predictor, has been the focus of relevant studies and practices. Against this background, the present study aimed to examine the association between perceived family financial stress and adolescents' suicidal ideation, as well as the potential roles of depression and parent-child attachment. A sample of 526 junior middle school students was recruited voluntarily to participate in this cross-sectional study, and the results indicated that the prevalence of suicidal ideation among junior high school students was 15.45%; perceived family financial stress was positively associated with suicidal ideation, and depression could significantly mediate this relation; parent–child attachment significantly moderated the mediating effect of depression (in particular, the relation between depression and suicidal ideation); specifically, this relation was stronger among adolescents with lower values of parent–child attachment. These findings could deepen our understanding of the influences of perceived family financial condition and the risky factors of adolescents' suicidal ideation, which could provide guidance for the prevention and intervention of adolescents' depression and suicidal ideation. [ABSTRACT FROM AUTHOR]

Simple Summary: In this Perspective, we explore the benefits of telemedicine in extending cancer care to patients who face difficulties due to functional limitations, high symptom burden, and financial or geographic constraints. We also acknowledge the risk that telemedicine may worsen existing healthcare inequalities for patients who already face systemic disadvantages. To address these concerns and increase the likelihood that telemedicine is a tool to improve equity, we suggest practical strategies and policy recommendations aimed at ensuring high-quality, accessible telemedicine-based cancer care. Telemedicine has the potential to improve access to cancer care, particularly for patients with functional limitations, high symptom burdens, or financial or geographic constraints. However, there is also a risk that telemedicine can widen healthcare disparities among patients facing systemic disadvantages like those with technological barriers, poor digital literacy, older age, or non-English language preferences. To optimize telemedicine usage, we must implement practical strategies like video onboarding programs, user-friendly technology platforms, optimizing the clinician's environment, and best practices for using interpreters. Policy changes such as state licensing requirements, controlled substance prescribing requirements, and payment parity are also crucial. This Perspective highlights these practical strategies and policy recommendations to ensure accessible and equitable cancer care augmented by telemedicine. [ABSTRACT FROM AUTHOR]

Objectives: This study's objectives were to compare the participation rates of people with and without disabilities who had type 2 diabetes in a diabetes pay-for-performance (DM P4P) program, as well as their care outcomes after participation. Methods: This was a retrospective cohort study. The data came from the disability registry file, cause of death file, and national health insurance research database of Taiwan. The subjects included patients newly diagnosed with type 2 diabetes between 2001 and 2013 who were followed up with until 2014 and categorized as disabled and non-disabled patients. The propensity score matching method was used to match the disabled with the non-disabled patients at a 1:1 ratio. Conditional logistic regression analysis was used to determine the odds ratio between the disabled and non-disabled patients who joined the P4P program. The Cox hazard model was used to compare the risk of dialysis and death between the disabled and non-disabled patients participating in the P4P program. Results: There were 110,645 disabled and 110,645 non-disabled individuals after matching. After controlling for confounding factors, it was found that the disabled individuals were significantly less likely (odds ratio = 0.89) to be enrolled in the P4P program than the non-disabled individuals. The risk of dialysis was 1.08 times higher for people with disabilities than those without, regardless of their participation in the P4P program. After enrollment in the P4P program, the risk of death for people with disabilities decreased from 1.32 to 1.16 times that of persons without disabilities. Among the people with disabilities, the risk of death for those enrolled in the P4P program was 0.41 times higher than that of those not enrolled. The risk of death was reduced to a greater extent for people with disabilities than for those without disabilities upon enrollment in the DM P4P program. Conclusion: People with disabilities are less likely to be enrolled in the P4P program in Taiwan and have unequal access to care. However, the P4P program was more effective at reducing mortality among people with disabilities than among those without. [ABSTRACT FROM AUTHOR]

This study aimed to analyze areas of concern and support of the Austrian general population two years into the COVID-19 pandemic. A representative sample (N = 1031) of the Austrian general population was surveyed online between 19 April 2022 and 26 April 2022. A qualitative study design was used to explore the factors of most considerable current concern (Question 1) and the most important sources of support (Question 2). The responses to the two open-ended questions were evaluated using a conventional content analysis, and categories were formed according to the frequency of the answers. The analysis revealed that inflation and finances (30% of participants) and the war in Ukraine (22%) were the greatest sources of concern, followed by mental health (11%), and physical health (11%). Factors such as social contacts within and outside the family were mentioned most frequently as sources of support (36% of participants), followed by recreational activities (23%) and attitudes and abilities (22%). Compared to data collected at the end of the first year of the pandemic (between 23 December 2020 and 4 January 2021), concern about one's financial situation was now mentioned more frequently (30% vs. 8,5%). On the other hand, different types of pandemic-related concerns were mentioned less often. Social contacts and recreation were mentioned as the most important sources of support at both time points (46% and 36% of the participants). The results suggest that the economic concerns are lagging behind the restrictions imposed by the pandemic. In addition, the impending war in Ukraine seems to have a relevant impact on mental health in Austria. Further nuanced qualitative research, particularly involving vulnerable groups such as low-income individuals and the unemployed, is crucial. [ABSTRACT FROM AUTHOR]

Antibacterial resistance is a renewed public health plague in modern times, and the COVID-19 pandemic has rekindled this problem. Changes in antibiotic prescribing behavior, misinformation, financial hardship, environmental impact, and governance gaps have generally enhanced the misuse and improper access to antibiotics during the COVID-19 pandemic. These determinants, intersected with antibacterial resistance in the current pandemic, may amplify the potential for a future antibacterial resistance pandemic. The occurrence of infections with multidrug-resistant (MDR), extensively drug-resistant (XDR), difficult-to-treat drug-resistant (DTR), carbapenem-resistant (CR), and pan-drug-resistant (PDR) bacteria is still increasing. The aim of this review is to highlight the state of the art of antibacterial resistance worldwide, focusing on the most important pathogens, namely Enterobacterales, Acinetobacter baumannii, and Klebsiella pneumoniae, and their resistance to the most common antibiotics. [ABSTRACT FROM AUTHOR]

Simple Summary: Survival rates among Non-Hodgkin Lymphoma patients have significantly improved in recent years. However, the impact of Non-Hodgkin Lymphoma persists in survivors. The aim of this population-based study was to describe Health-Related Quality of Life and to identify the association between sociodemographic, clinical and psychosocial factors, and self-reported Health-Related Quality of Life among Non-Hodgkin Lymphoma survivors. In total, 251 patients received the questionnaires, of whom 157 responded (63%). The main factors found to be associated with poor HRQoL of NHL survivors were age, sex, presence of anxiety, depression and economic problems. These findings suggest the need for supportive care to improve Health-Related Quality of Life and the consideration of these problems when developing care plans for Non-Hodgkin Lymphoma survivors. Purpose: To describe Health-Related Quality of Life (HRQoL) and to identify the association between sociodemographic, clinical and psychosocial factors, and self-reported HRQoL among NHL survivors. Methods: The data of the cancer registry specialized in hematological malignancies in Côte d'Or (France) were used to identify all patients diagnosed with follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) from 2010 to 2017. Patients were invited to complete SF-12 and other questionnaires. Results: The HRQoL of NHL survivors was poorer than that of the French general population (p < 0.05) in vitality (48 vs. 56), general health (56 vs. 63), role physical scores (60 vs. 70), role emotional scores (64 vs. 72) and the Mental Component Scale (45 vs. 49). The mean difference in physical functioning decreased per unit increase in age (β = −1.1 (0.3); p < 0.001). Men had better vitality than women (β = 12.4 (6.1); p = 0.04) and the high education level was associated with greater role emotional scores (β = 14.1 (5.4); p = 0.01). Symptoms of anxiety and depression were associated with poorer HRQoL. The satisfaction of social support was associated with significantly greater scores on mental health (β = 17.3 (5.1); p = 0.001) and social functioning (β = 15.7 (7.8); p = 0.04). Socioeconomic deprivation was associated with poorer general health (β = −12.8 (5.2); p = 0.01). Conclusions: From 3 to 11 years post-diagnosis, the main factors found to be associated with poor HRQoL of NHL survivors were age, sex, presence of anxiety, depression and economic problems. These findings suggest the need for supportive care to improve HRQOL and the consideration of these problems when developing care plans for NHL survivors. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has had a marked impact on healthcare businesses since 2020. Healthcare organizations suffered greatly from financial stress coupled with disruptions in national and global supply chains. Healthcare workers and patients alike experienced significant downturns in their physical and mental health. Large government and legislative reforms were enacted to combat the progression of the pandemic. This paper explores these areas in detail in order to provide a clearer understanding of the successes and inadequacies that exist within the United States healthcare system as illuminated by the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Financial difficulties experienced by cancer patients negatively impact the mental health of the patients. The objective of this study was to examine the mediating role of financial difficulties between physical symptoms and depression in patients with advanced cancer. A prospective, cross-sectional design was adopted in the study. The data were collected from 861 participants with advanced cancer in 15 different tertiary hospitals in Spain. The participants' socio-demographic characteristics were collected using a standardized self-report form. Hierarchical linear regression models were used to explore the mediating role of financial difficulties. In the results, 24% of patients reported a high level of financial difficulties. Physical symptoms were positively associated with financial difficulties and depression (β = 0.46 and β = 0.43, respectively), and financial difficulties was positively associated with depression (β = 0.26). Additionally, financial difficulties played a role in explaining the relationship between physical symptoms and depression, showing a standardized regression coefficient of 0.43 which decreased to 0.39 after the financial difficulties were controlled. Healthcare professionals should consider the importance of providing financial resources and emotional support to help patients and their families cope with the financial burden associated with cancer treatment and its symptoms. [ABSTRACT FROM AUTHOR]

Happiness is receiving more and more interest both as a determinant of health and a measure of outcome in biomedical and psychological sciences. The main objective of this study was to assess how the levels of happiness vary in a large sample of Italian adults and to identify the socio-demographic conditions which impair happiness domains the most. The participants of this survey consisted of 1695 Italian adults (85.9% women; 14.1% men) who completed the Measure of Happiness (MH) questionnaire online. In this study, the differences between groups in total and single domain (life perspective, psychophysical status, socio-relational sphere, relational private sphere, and financial status) happiness levels were examined through a propensity score matching analysis with respect to socio-demographic conditions, including gender, age, annual income, relationship status, having children, and education level. The results show that low income has a negative impact on happiness levels, whereas being in a relationship has a positive effect. Having children appears to have a negative impact on male happiness. Males appear to be happier than females, especially with regard to the psychophysics status. This evidence emphasizes the urgency for Italian policymakers to take actions on removing obstacles to people's happiness, especially with regard to financial distress, parenthood, and gender gaps. [ABSTRACT FROM AUTHOR]

People's health is a necessary condition for the country's prosperity. Under the background of the COVID-19 pandemic and frequent natural disasters, exploring the spatial and temporal distribution, regional differences and convergence of China's provincial public health level is of great significance to promoting the coordinated development of China's regional public health and achieving the strategic goal of a "healthy China". Based on China's provincial panel data from 2009 to 2020, this paper constructs an evaluation index system for China's public health level from five dimensions: the popularization of a healthy life, optimization of health services, improvement of health insurance, construction of a healthy environment, and development of a health industry. In this paper, the entropy method, Dagum Gini coefficient, Kernel density function and spatial econometric model are used to analyze the spatiotemporal distribution, regional differences, dynamic evolution and convergence of China's public health level since the new medical reform. The study found that, first, China's public health level is generally low, structural contradictions are prominent and the construction of a healthy environment has become a shortcoming hindering the improvement of China's public health level since the new medical reform. The public health level of the four major regions showed a spatial distribution pattern of "high in the eastern, low in the northeastern, central and western" areas. Second, the overall Gini coefficient of China's public health level showed a "V-shaped" trend of first decreasing and then rising, but the overall decrease was greater than the increase, among which the regional difference was the main source of regional differences in China's public health level, but its contribution rate showed a downward trend. Third, except for the basic maintenance of a healthy environment, the Kernel density curves of China's public health level and its sub-dimensions have shifted to the right to a certain extent, and there is no polarization phenomenon. Finally, the level of public health in China has a significant spatial correlation. Except for the northeast region, the growth rate of low-level public health provinces in China and the other three major regions is higher than that of high-level public health provinces, showing a certain convergence trend. In addition, the impact of economic development, financial pressure, and urbanization on the convergence of public health levels in the four major regions is significantly heterogeneous. [ABSTRACT FROM AUTHOR]

The process of ageing is characteristic of multicellular organisms associated with late stages of the lifecycle and is manifested through a plethora of phenotypes. Its underlying mechanisms are correlated with age-dependent diseases, especially neurodegenerative diseases such as Alzheimer's disease (AD), Parkinson's disease (PD) and multiple sclerosis (MS) that are accompanied by social and financial difficulties for patients. Over time, people not only become more prone to neurodegeneration but they also lose the ability to trigger pivotal restorative mechanisms. In this review, we attempt to present the already known molecular and cellular hallmarks that characterize ageing in association with their impact on the central nervous system (CNS)'s structure and function intensifying possible preexisting pathogenetic conditions. A thorough and elucidative study of the underlying mechanisms of ageing will be able to contribute further to the development of new therapeutic interventions to effectively treat age-dependent manifestations of neurodegenerative diseases. [ABSTRACT FROM AUTHOR]

Simple Summary: According to the forecasts, the share of pancreatic cancer in the structure of gastrointestinal malignancies will increase. This cancer is characterized by high mortality and due to non-specific symptoms, it is mostly diagnosed at an advanced stage of the disease. Late detection and the required highly specialized treatment result in an increased economic burden of the disease. PC generates costs both for the health care system, but also indirect costs resulting mainly from work absence caused by the disease. PC is becoming a significant problem from the perspective of limited system resources and the loss of potential GDP. With the progressive aging of the population, where the demographic structure in developed countries is reversed, it is important to keep as many people of working age in the labor market as possible. (1) Background: Pancreatic cancer is the cancer with the third-highest mortality rate, and forecasts indicate its growing share in morbidity. The basis of treatment is inpatient chemotherapy and there is a strong focus on palliative care. (2) Methods: A literature review was conducted based on the rapid review methodology in PubMed and Cochrane databases. The search was supplemented with publications from the snowball search. Qualitative assessment of included publications was performed using AMSTAR2 modified scheme. (3) Results: The review included 17 publications, of which majority concerned direct costs related to the adopted treatment regimen. Most of the publications focused on comparing the cost-effectiveness of drug therapies and the costs of palliative treatment. Other publications concerned indirect costs generated by pancreatic cancer. They particularly focused on the economic burden of lost productivity due to sickness absence. (4) Conclusion: The increase in the incidence of pancreatic cancer translates into an increase in the costs of the health care system and indirect costs. Due to the significant share of hospitalization in the health care structure, direct costs are increasing. The inpatient treatment regimen and side effects translate into a loss of productivity for patients with pancreatic cancer. Among gastrointestinal cancers, pancreatic cancer generates the second largest indirect costs, although it has a much lower incidence rate than the dominant colorectal cancer. This indicates a significant problem of the economic burden of this cancer. [ABSTRACT FROM AUTHOR]

In a default event, several obligors simultaneously experience financial difficulty in servicing their debt to the point where the entire market can experience a sudden yet significant jump to a credit default. To help protect lenders against a jump-to-default event, regulators require banks to hold capital equivalent to the default risk charge as a buffer against the losses they may incur. The Basel regulatory committee has articulated and set default risk modelling guidelines to improve comparability amongst banks and enable a consistent bank-wide default risk charge estimation. Emerging markets are unique because they usually have illiquid markets and sparse data. Thus, implementing an emerging market default risk model and, at the same time, complying with the regulatory guidelines can be non-trivial. This research presents a framework for modelling the default risk charge in emerging markets in line with the regulatory requirements. The default correlation model inputs are derived and empirically calibrated using emerging market data. The paper ends with some considerations that regulators, supervisors, and banks can use to get financial institutions to adopt an emerging markets default risk charge model. [ABSTRACT FROM AUTHOR]

Against the background of Chinese decentralization, the preferences and choices of local governments significantly affect the scale and structure of urban construction land supply. Due to the shortage of financial funds and the political performance pursuit of local governments, environmental decentralization gives local governments greater autonomy in environmental management, and increases the possibility for local governments relying on land transfer income to make up for the financial gap and provide public goods and services. This paper analyses the impact of environmental decentralization on the construction land supply scale of local government based on the panel data of 30 provinces in China from 2003 to 2015. The results indicate that: (1) environmental decentralization has a positive effect on the increase in urban construction land supply scale; (2) environmental decentralization affects urban construction land supply by strengthening land financial dependence and distorting land resources misallocation; (3) there are regional disparities in the effect of environmental decentralization on urban construction land supply. The impact is greater in regions with high financial pressure, high economic growth pressure, and low environmental protection pressure. In summary, some policy suggestions are put forward to reasonably supply urban construction land against the background of Chinese decentralization. [ABSTRACT FROM AUTHOR]