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Climate-induced migration is increasingly affecting communities, disrupting livelihoods, and intensifying socio-economic inequalities, particularly in disaster-prone regions. Despite the prevalence of recurring flood hazards, there remains limited research on the multi-dimensional impacts of migration particularly in socio-culturally sensitive and resource-constrained settings like Khyber Pakhtunkhwa (KPK), Pakistan. This study seeks to bridge this gap by exploring the post-migration challenges of flood-affected communities in District Nowshera. Using a qualitative methodology, we conducted in-depth interviews with 25 diverse key informants. The study results revealed profound socioeconomic instability, inadequate access to essential services, and cultural disruptions. Key findings include significant challenges such as inadequate housing, the loss of traditional livelihoods, persistent financial hardships, health issues, and the breakdown of social support networks. Moreover, displaced families face marginalization and language barriers, which hinder integration into host communities, amplifying feelings of isolation and identity loss. Environmental degradation in resettlement areas further intensifies these challenges, prolonging poor living conditions and heightened vulnerability. To address these issues, the study recommends community-based interventions such as developing resilient, culturally appropriate housing, implementing targeted skills training programs to restore livelihoods, promoting climate-smart agricultural practices, and enacting inclusive social policies to promote integration and cohesion to address climate-induced migration in disaster-prone regions. [ABSTRACT FROM AUTHOR]

Common institutional ownership, as a pivotal link of equity interconnection among diverse enterprises and a vital medium of information dissemination, possesses enhanced motivation and capability of decision-making in the course of business operation and development. This paper examines the effect of common institutional ownership on corporate leverage manipulation by applying panel data analysis method based on a sample of Chinese A-share listed companies from 2007 to 2021. We find that firms with high levels of common institutional ownership significantly reduce leverage manipulation. We also find that common institutional ownership can significantly reduce corporate leverage manipulation by improving internal capital management capabilities and external audit environment. At the same time, we find that the synergistic governance effect of common institutional equity has heterogeneity in the aspects of capacity utilization rate, equity nature, leverage manipulation motivation, and macro industry environment. These conclusions collectively highlight the important role of institutional cross-holdings in enhancing internal management levels and facilitating information transmission within the same industry. They also demonstrate that, under circumstances where internal agency problems are prominent, financial stress is high, and external risks are increasing, institutional cross-holdings play a supervisory and mitigating role in corporate financial management. This can not only contribute to the existing literature on the factors that positively constrain corporate leverage manipulation and the economic implications of common institutional ownership, but also has implications for how to enhance corporate governance and promote high-quality economic development in China's context. [ABSTRACT FROM AUTHOR]

Forecasting stock markets is challenging due to the influence of various internal and external factors compounded by the effects of globalization. This study introduces a data-driven approach to forecast S&P 500 returns by incorporating macroeconomic indicators including gold and oil prices, the volatility index, economic policy uncertainty, the financial stress index, geopolitical risk, and shadow short rate, with ten technical indicators. We propose three hybrid deep learning models that sequentially combine convolutional and recurrent neural networks for improved feature extraction and predictive accuracy. These models include the deep belief network with gated recurrent units, the LeNet architecture with gated recurrent units, and the LeNet architecture combined with highway networks. The results demonstrate that the proposed hybrid models achieve higher forecasting accuracy than the single deep learning models. This outcome is attributed to the complementary strengths of convolutional networks in feature extraction and recurrent networks in pattern recognition. Additionally, an analysis using the Shapley method identifies the volatility index, financial stress index, and economic policy uncertainty as the most significant predictors, underscoring the effectiveness of our data-driven approach. These findings highlight the substantial impact of contemporary uncertainty factors on stock markets, emphasizing their importance in studies analyzing market behaviour. [ABSTRACT FROM AUTHOR]

Background: Brucellosis, one of the most common zoonotic diseases globally, is a serious public health problem. The complex and diverse clinical manifestations pose numerous challenges for patients when coping with brucellosis. Scarce studies have been performed in China. Objectives: This study aimed to explore the process of coping with brucellosis and different aspects of the phenomenon from the perspective of patients, and propose a conceptual framework of patients' processes in coping with brucellosis. Methods: Qualitative study based on constructivist grounded theory methodology using in-depth interviews and focus group discussions. The data analysis included initial coding, focused coding, and theoretical coding using the constant comparative method and memo writing. Results: The conceptual framework of "compelled metamorphosing" was constructed, which conceptualized three primary types of coping strategies: "blind persistence", "resignation to avoidance", and "proactive pacing". Symptoms, financial strain, information cocoon, emotional value, and family responsibility had an important impact on coping strategies and played a significant role in driving their development. Conclusions: This paper provides new insight into patients' lives and describes the strategies patients use to cope with the challenges and problems caused by brucellosis. Compelled metamorphosing represents a basic psychosocial process. These findings can be used to develop future complex interventions and studies. [ABSTRACT FROM AUTHOR]

Background/Objectives: Patients requiring haemodialysis often perceive the cost of their travels to the dialysis centres as a significant burden. The study aimed to collect a first Swiss national data set on transport costs and assess their impact on patients and their relatives. Methods: In addition to interviews with patients, a quantitative survey was developed and distributed online using a voluntary sampling strategy. Data were analysed by means of descriptive statistics. A Sounding Board of patients, relatives, and healthcare professionals accompanied all steps of the project. Results: A total of 6 dialysis patients were interviewed; 437 respondents of the national survey met the inclusion criteria. Patients travel a median distance of 7.5 km to their dialysis centres. For 78% of them, the journey takes up to 30 min, and nearly half use their private car as their main mode of transport. The median annual transport costs are CHF 2925 (mean = CHF 5041). Approximately half of the patients perceive transport costs as a burden or limitation, yet only about 30% receive financial support, for which there is no standard process. Patients requiring financial support reported difficulties navigating the system. Conclusions: This study highlighted that many dialysis patients are burdened by transport costs and receive limited financial support and counselling services. Implementation of a standardised process for financial support should be explored. [ABSTRACT FROM AUTHOR]

Amidst significant reforms in Moroccan higher education designed to enhance educational quality and align with the evolving demands of the job market, this study examined the primary factors influencing students' quality of life. Using a quantitative methodology, we surveyed students from various Moroccan higher education institutions to assess key elements including the quality of higher education services, academic stress, and financial stress. Structural equation modeling, conducted through SMART-PLS on data from 426 student responses, revealed that higher education quality positively impacts students' well-being, while academic and financial stress significantly undermine their quality of life, emphasizing the need to address these stressors. These results offer valuable insights for policymakers and education leaders, emphasizing the need to prioritize service quality improvement and stress reduction strategies to foster better educational outcomes and an enhanced student experience. [ABSTRACT FROM AUTHOR]

Long COVID affects millions of people worldwide and has emerged as a major health consequence of the COVID-19 pandemic. While quantitative studies have helped paint a picture of ongoing symptomatology, there are very few longitudinal qualitative studies that present patients' perspectives about the significant and persistent impact Long COVID has on their daily lives. To address this gap, we conducted semi-structured qualitative interviews with nine Long COVID patients about 15 months after we performed an initial set of interviews with those patients who were seeking care at a Long COVID specialty clinic. Most patients that we re-interviewed reported having lingering symptoms that continue to impact their lives. Many described suffering with mental health issues, particularly depression and anxiety. Others described financial stress. Most reported not yet being unable to return to their pre-COVID level of health and well-being. Our work demonstrates the ongoing need to study Long COVID and provide robust social support, mental health resources, and healthcare focused on symptom relief. [ABSTRACT FROM AUTHOR]

Profitability reveals the key financial ratios that ensure the long-term sustainability of an enterprise's ability to invest in further growth. Without knowledge of the course of development, particularly changes in profitability, enterprises face financial difficulties that threaten their existence. Although the homogeneity tests serve as a reliable tool for identifying changes, their application in financial management often receives insufficient attention. The aim of this research is to evaluate the detection power of homogeneity tests and identify the one with the highest ability based on testing changes in the development of profitability ratios across sectors in the Visegrad Four. Buishand's test, Pettitt's test, the SNHT, and the von Neumann test were run for 8671 enterprises during 2016–2021 and gained from Moody's Orbis. Comparison tables for ROA, ROC, ROE, ROS, ROR, and ROW using Monte Carlo simulation with a million replications identified the number of Slovak, Czech, Polish, and Hungarian enterprises in which heterogeneity was divided according to the Nomenclature of Economic Activities, NACE. The SNHT disclosed the greatest number of changes in the development of all profitability ratios. The results validate the use of selected tests for ratio assessment. Furthermore, business agencies may replicate this approach to determine the economic situation and sector performance. [ABSTRACT FROM AUTHOR]

The study aims to critically assess the safe-haven properties of Bitcoin and a diverse set of commodities in mitigating stock market risks during periods of extreme financial turbulence. Specifically, this research seeks to evaluate the effectiveness of these assets as hedging tools or diversifiers in the portfolios of both OPEC and non-OPEC countries, focusing on their behavior during the COVID-19 pandemic. We employ a wavelet coherence approach to analyze the dynamic relationships between the variables. Portfolio optimization is conducted using CVaR to assess the effectiveness of these assets as safe havens, hedges, or diversification tools in mitigating financial risks during periods of heightened market volatility. The diversification benefits of commodities and Bitcoin in OPEC and non-OPEC stock portfolios decrease over time as their co-movement with stock markets increases. During the COVID-19 period, BTC did not act as a safe haven. However, gold served as a hedge for non-OPEC countries. Using CVaR, we found that BTC provides stronger diversification benefits than commodities, followed by gold. We examine the safe-haven role of Bitcoin and various commodities, specifically within the context of both OPEC and non-OPEC countries. Our study offers a more comprehensive analysis of how BTC and commodities function as portfolio assets during financial stress, providing valuable insights for investors and policymakers. [ABSTRACT FROM AUTHOR]

This study examines economic policy responses in Brazil during periods of financial stress, with a particular emphasis on the dynamics of both the impulse and rule components of fiscal policy. We offer novel empirical evidence on policy responses under both low and high stress conditions, utilizing monthly data that span the past two decades. To this end, we construct a Financial Stress Index (FSI) and integrate it into a threshold-VAR framework. Additionally, we employ five distinct methodologies to decompose fiscal policy into its impulse and rule components. Our analysis yields two main findings. First, fiscal policy exhibits procyclical behavior in its impulse component and countercyclical behavior in its rule component across both regimes. Second, while monetary policy is countercyclical during high stress conditions, its impact remains largely statistically non-significant. These results suggest that policymakers should exercise caution when timing the implementation of expansionary fiscal policies, carefully considering the phase of the business cycle. Moreover, our findings carry significant implications for the ongoing discourse on fiscal stimulus and debt stabilization strategies, particularly in the context of financial stress. [ABSTRACT FROM AUTHOR]

Background/Objectives: The Brazilian health system provides healthcare financed by the public and private sector, being the first designed to encompass universal healthcare coverage delivered to the population without charge to patients (Sistema Único de Saúde, SUS), whilst the second refers to healthcare coverage delivered for individuals with the capacity to pay for assistance through health insurance or out-of-pocket disbursements. Health insurance companies with beneficiaries receiving publicly financed healthcare from the SUS are required to provide the reimbursement of healthcare expenditures to the government, considering that the health insurance beneficiaries obtain deductions of income taxes designed to fund the SUS. Therefore, the study investigated patterns of healthcare utilization and public expenditure due to the use of public healthcare by beneficiaries of health insurance between 2003 and 2019. Methods: Datasets including annual information on healthcare utilization by beneficiaries of health insurance from the National Agency of Supplementary Health (Agência Nacional de Saúde Suplementar, ANS) were organized into a single database to allow for the identification of patterns of interest to inform public policies of health. The empirical strategy adopted included the estimation of regression models and agglomerative hierarchical cluster analysis to identify factors associated with public sector expenditure. Results: The regression results indicated lower expenditure with female patients, particularly children and adolescents under 20 years old, receiving treatment in public sector facilities linked to the federal government. The cluster analysis showed five types of health insurance beneficiaries with a higher level of healthcare utilization, being three clusters referring to medium complexity procedures with lower public expenditures, and two clusters with higher public expenditures, one cluster that refers to high complexity procedures, and one cluster referring to health insurance schemes without hospitalization. Conclusions: The findings of the study highlight the existence of patterns of healthcare utilization by health insurance beneficiaries that may compromise the sustainability of public funding within the Brazilian health system. [ABSTRACT FROM AUTHOR]

Background: Sickle cell anemia (SCD) is a relatively uncommon health condition in many countries, but it is prevalent in Saudi Arabia mainly due to the high incidence of consanguineous marriages. Regrettably, there are elevated rates of vaso-occlusive crises (VOCs) and blood transfusions, leading to poor quality of life and significant financial strain. Objective(s): This study aimed to assess the frequency of blood transfusions, out-of-pocket expenditures (OOPEs), and health-related quality of life (HRQoL) in SCD patients. Methods: This was a questionnaire-based cross-sectional study that involved SCD patients at a university-affiliated tertiary care center in Riyadh, Saudi Arabia. The patients' medical and sociodemographic characteristics were obtained from the electronic medical records. Data on HRQoL and OOPEs were collected through a questionnaire-based interview. To present the baseline characteristics, descriptive statistics such as mean, standard deviation, frequency, and percentage were used. In addition, various statistical tests, including the Chi-Square test, Student t-test, one-way ANOVA, and multiple linear regression, were performed. Results: One hundred and eighteen patients consented to participate and were included in the analysis. Almost 53% of the patients were females. The mean age of the sample was 31 years, while the age-adjusted quality-adjusted life years (QALYs) was 24.33 years (p-value < 0.0001). Most patients (83.05%) reside in Riyadh with a monthly family income of less than USD 2666.67 (75.42%). Monthly OOPEs were, on average, USD 650.69 ± 1853.96, and one-third of the adult patients reported income loss due to illness, further exacerbating their financial strain. High frequency of blood transfusion (β = −0.0564, p-value = 0.0066) and higher number of comorbidities (β = −0.10367, p-value = 0.0244) were negatively associated with the HRQoL among adult patients. On the other hand, adult patients with higher levels of education had better HRQoL (β = 0.05378, p-value = 0.0377). Conclusions: The findings of this study highlight the negative impact of SCD on patients' HRQoL and financial well-being. This underscores the urgent need for comprehensive systemic approaches to address the challenges posed by SCD in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Background: Refugee children with disabilities are vulnerable to developing dysfunctional coping skills due to barriers in accessing health care services, including occupational therapy (OT). This study investigated the perceptions of refugee caregivers regarding the use of mindfulness-based interventions (MBIs) as a treatment for coping skills among their children with disabilities. Methods: A qualitative survey was used to analyse the coping mechanisms and access to services among refugee children with disabilities, as well as their caregivers' perceptions regarding the use of MBIs. The caregivers were recruited using convenience sampling from a database of individuals at the Al-Baqa'a refugee camp in Jordan via their community-based rehabilitation (CBR) centre. A demographic survey was sent to 156 refugees using WhatsApp. Refugees above the age of 18 years identifying as the caregivers of children with disabilities were eligible. Twenty-eight individuals completed the survey, and twenty-six were eligible. Open-ended questions asked about their child's struggles, supports, barriers to support, and perceptions of MBIs. The data were collected via Google Sheets. Three researchers coded the responses using a descriptive coding method and line-by-line analysis. Results: Five themes were derived from the responses: "Daily Challenges", "Support and Strategies", "barriers to accessing support", "MBIs: Caregiver Perceptions", and "MBIs: Barriers". The participants identified the behavioural, emotional, and cognitive challenges impacting their child's participation. Financial and environmental constraints, stigma, and timing were the reported barriers to services. The participants felt positive about the potential of MBIs to support their children. Conclusions: Overall, this study obtained foundational data to establish accessible mental health programmes for refugees with disabilities. Further research is needed to transcend the barriers and maintain MBI programmes in the community and the home settings. [ABSTRACT FROM AUTHOR]

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]

Malnutrition is a global problem that affects all countries in one or more of its forms, representing one of the greatest challenges worldwide. One of the key contributing factors is food insecurity, which must be evaluated in children with moderate and severe acute malnutrition, as they are at imminent risk of death. Objective: Our objective was to assess food insecurity among children under 5 years old with moderate, and severe malnutrition from Valle del Cauca, a state located in the southwestern region of Colombia. Methods: A descriptive observational study was conducted, including children whose weight-for-height (W/H) indicator was below 2 SD, as recorded on the World Health Organization (WHO) growth charts, or who exhibited severe malnutrition phenotypes such as marasmus or Kwashiorkor. Family and child food security were evaluated using the Latin American and Caribbean Food Security Scale (ELCSA). Results: 58.6% of households with acutely malnourished children experienced food insecurity. A statistically significant relationship was found between food insecurity and children of Afro-Colombian and Indigenous descent. According to caregivers' perceptions, 30.2% of child malnutrition cases were related to poor feeding and caregiving practices. Conclusions: Not all children with acute malnutrition suffer from food insecurity. Therefore, the findings of this research suggest that governmental efforts should focus not only on ensuring food availability, but also on educating caregivers about the importance of a balanced and nutritious diet tailored to the specific characteristics of each region and promoting appropriate caregiving practices. [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]

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]

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]

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]

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]

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 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]

Urban couples spend much time working, which poses challenges in their daily life. These challenges can cause stress, affecting relationship quality and an individual's well-being. We identified and described stressors and explored the use of technology to manage their stress. The participants consisted of three couples living in the Greater Jakarta area. A focus group discussion was used to collect the data, and inductive thematic analysis was used to analyze it. Urban couples experienced relationship stress, parenting stress, financial stress, work-related stress, and daily hassles. Couples can manage stress by using digital media and smart communication technology to provide entertainment and communication, as well as to search for information. [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]

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]

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]

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]

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]

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]

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]

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 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]

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]

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]