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This paper studies the downstream effect of expatriate managers' personal financial insecurity on team innovation. Building on resource allocation theory, we propose a moderated serial mediation model. Using four‐wave, multi‐source survey data from 99 R&D expatriate teams within large technology companies in emerging markets, we find that expatriate managers' personal financial insecurity is negatively related to team innovation first through a lower level of state learning goal orientation in the last month, and subsequently through a lower level of intellectual stimulation behavior. The negative effect of expatriate managers' personal financial insecurity on state learning goal orientation is weakened when professional identification is higher (vs. lower). Theoretical and practical implications are discussed. [ABSTRACT FROM AUTHOR]

The limited number of researchers with expertise necessary toaddress treatment gaps for children presents an ongoing challenge. The NationalInstitutes of Health established a national Pediatric Clinical Pharmacology T32Training Program in 2012 to train a multidisciplinary, collaborative pediatricclinical pharmacology workforce. We surveyed all current T32 trainees andgraduates since inception to identify strengths and opportunities to enhanceworkforce development. A total of 85 out of 155 (55%) responded, with themajority of respondents being female gender (61%), white race (75%), andworking in academia (75%). Nearly all (97%) reported using clinicalpharmacology in their current position, with 88% planning to remain in clinicalpharmacology in the long term, reinforcing current training efforts. Lifestylefactors and student debt appeared to influence career decisions. Mentors werecritical for introduction and future success in the field. Time and fundinglimitations were perceived as barriers to successful training. There was also apressing need to improve diversity. For workforce development, we suggestsupporting: (1) trainees' lifestyle, by offsetting financial pressures ofresearch training and expanding the geographic footprint of pediatric clinicalpharmacology training; (2) mentorship, by identifying mentors in the field andproviding dedicated support for mentorship; (3) efficiency, by evaluatingcurrent training activities and focusing on activities that maximizeopportunities for future funding; and (4) diversity, by examining barriers todiversity in the workforce in general and expanding early enrichmentopportunities. [ABSTRACT FROM AUTHOR]

Context Methods Findings Conclusions Policy Points This study examines exposure to out‐of‐pocket (OOP) costs related to childbirth and postpartum care for those with a Medicaid‐insured birth compared with those with a commercially insured birth and subsequent financial outcomes at 12 months postpartum. We find that Medicaid is highly protective against health care costs for childbirth and postpartum care relative to commercial insurance, particularly for birthing people with low income. We find persistent medical debt and worry at 12 months postpartum for Medicaid recipients who reported OOP childbirth expenses. This study examines exposure to out‐of‐pocket (OOP) costs related to childbirth and postpartum care for those with a Medicaid‐insured birth compared with those with a commercially insured birth and subsequent financial outcomes at 12 months postpartum. We find that Medicaid is highly protective against health care costs for childbirth and postpartum care relative to commercial insurance, particularly for birthing people with low income. We find persistent medical debt and worry at 12 months postpartum for Medicaid recipients who reported OOP childbirth expenses.Out‐of‐pocket (OOP) costs related to childbirth and postpartum care may cause financial hardship, depending on type of insurance and income.We estimated OOP spending on childbirth and postpartum care and financial strain 1 year after birth, comparing Medicaid‐insured births with commercially insured births. The Postpartum Assessment of Health Survey followed up with respondents to the Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System after a 2020 birth in six states and New York City. The survey included questions on health care costs and financial well‐being. Our analytic sample consisted of 4,453 postpartum people, 1,544 with a Medicaid‐insured birth and 2,909 with a commercially insured birth.We observe significant financial hardship from childbirth that persists into the postpartum year, with significant differences by insurance and income. We find Medicaid is highly financially protective relative to commercial insurance; 81.4% of Medicaid‐insured births were free to the patient, compared with 15.7% of commercially insured births (p < 0.001). Six of ten commercially insured births (59%) cost over $1,000 OOP. Among respondents reporting OOP costs for childbirth, we found that Medicaid enrollees are more likely to have borrowed money from friends or family to pay for childbirth (8% vs. 1%, p < 0.001) and one in five had not made any payments 1 year postpartum (26% vs. 5% of commercially insured births, p < 0.001). Among the commercially insured, those with incomes under 200% of the federal poverty level (FPL) fared worse financially than those above 200% FPL on a number of indicators, including debt in collection (33% vs. 13%, p < 0.001) and financial worry (55% vs. 34%, p < 0.001).The cost of childbirth and postpartum health care results in significant and persistent financial hardship, particularly for families with lower income with commercial insurance. Medicaid offers greater protection for families with low income by offering reduced cost sharing for childbirth and postpartum health care, but even minimal cost sharing in Medicaid causes financial strain. [ABSTRACT FROM AUTHOR]

Mass incarceration rates have become a financial burden on the country and in 2023, the United States was faced with one of the highest recidivism rates worldwide, with approximately 44% of individuals returning to prison within a year of their release. Although various programs are available to incarcerated individuals and for those considered at risk for offending, access to these programs varies by jurisdiction and the effectiveness in preventing offenses, reducing recidivism, and fostering rehabilitation is not entirely known. In response to recidivism and incarceration rates, there has been a plea for a change in the criminal justice system, with an emphasis on involving behavior analysts. However, the extent of the application of behavior‐analytic interventions within the criminal justice system in the research literature is unclear. Thus, the purpose of the current review was to examine the existing experimental literature to determine the state of this research topic. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Conclusions Trauma can have a range of effects on individuals over time, including the potential for positive changes in favorable outcomes commonly referred to as posttraumatic growth. The posttraumatic growth literature has been criticized for various methodological limitations and has largely neglected the exploration of factors that may strengthen or weaken posttraumatic growth trajectories. The present study contributes to this literature by investigating trajectories of five dimensions of posttraumatic growth during the COVID‐19 pandemic and the moderating effects of health and financial difficulties on these trajectories.Longitudinal data were collected monthly between July 2020 and December 2022 from a sample of employed adults in Germany, involving N = 1678 participants over 30 time points (Nobservations = 29,552).Results suggest that certain dimensions of posttraumatic growth showed significant increases (i.e., relationships) or decreases (i.e., spirituality and possibilities) over time and that trajectories of three dimensions (i.e., relationships, appreciation, and strength) demonstrated distinctive patterns of interaction with health and financial difficulties.Findings are discussed in the context of the pandemic as well as dynamic theories of personality and identity, with implications for advancing posttraumatic growth theory and research. [ABSTRACT FROM AUTHOR]

Rationale Methods Results Conclusion This study was performed to determine the difficulties experienced by the parents of children with autism.A qualitative method was used to determine the difficulties experienced by the parents. The sample of the study consisted of parents with 24 children with autism who met the inclusion criteria. The data were analysed by the MAXQDA qualitative data analysis programme in accordance with Colaizzi's seven‐stage method.Total of 5 themes and 29 codes were gathered in line with the data obtained from the interviews. Five main themes of the interviews emerged; emotions experienced by parents; adaptation to family life; difficulty in social relationships; limited opportunity for entertainment/activity and financial difficulty. Parents whose income were less than or equal to their expenses particularly stated that they had economic difficulties in the transportation of their children to places such as hospitals/schools/special education.In accordance with the findings of this study, it was determined that almost all of the parents with a child diagnosed with autism experienced sadness, denial, shock, depression, self‐blame in the period when their children were first diagnosed, and later accepted the disease. In addition, it was detected that parents had difficulties in family relations, social relations, entertainment/activity and economic aspects. [ABSTRACT FROM AUTHOR]

Background: Despite Medicare coverage, financial hardship is a prevalent issue among those diagnosed with cancer at age 65 years and older, particularly among those belonging to a racial or ethnic minority group. Sociodemographic, clinical, and area‐level factors may mediate this relationship; however, no studies have assessed the extent to which these factors contribute to the racial/ethnic disparities in financial hardship. Methods: Surveys assessing financial hardship were completed by 721 White (84%) or Black (16%) patients (aged 65 years and older) who were diagnosed with breast (34%), prostate (27%), lung (17%), or colorectal (14%) cancer or lymphoma (9%) at the University of Alabama at Birmingham between 2000 and 2019. Financial hardship included material, psychological, and behavioral domains. Nonlinear Blinder–Oaxaca effect decomposition methods were used to evaluate the extent to which individual and area‐level factors contribute to racial disparities in financial hardship. Results: Black patients reported lower income (65% vs. 34% earning <$50,000) and greater scores on the Area Deprivation Index (median, 93.0 vs. 55.0). Black patients reported significantly higher rates of overall (39% vs. 18%), material (29% vs. 11%), and psychological (27% vs. 11%) hardship compared with White patients. Overall, the observed characteristics explained 51% of racial differences in financial hardship among cancer survivors, primarily because of differences in income (23%) and area deprivation (11%). Conclusions: The current results identify primary contributors to racial disparities in financial hardship among older cancer survivors, which can be used to develop targeted interventions and allocate resources to those at greatest risk for financial hardship. Racial disparities in financial hardship among older cancer survivors are attributable to the downstream effects of structural racism. Interventions aimed at reducing the Black–White disparity in financial hardship should be targeted toward factors associated with historical racial discrimination. [ABSTRACT FROM AUTHOR]

The Government of Nepal (GoN) introduced a Health Insurance Program (HIP) in 2016 aiming to ensure quality healthcare for all Nepalese citizens without financial hardship. However, the HIP has not attracted as many people as expected. It shows low enrollment and high dropout rates. Studies on this issue are scarce, particularly regarding women. To identify the factors associated with women enrollment in health insurance (HI), this study utilized a cross‐sectional design, analyzing secondary data (n = 14,845) from the Nepal Demographic and Health Survey 2022. Chi‐square test and logistic regression were used to identify associations with women participation in the HIP. Women enrollment in HI was positively and significantly associated with province, age, ethnicity, educational level, religion, place of residence, ecological region, wealth index, women's autonomy in household decisions, household head status, and current employment (p < 0.01). Socioeconomic and demographic factors of the respondents, such as being over 35 years old (aOR = 1.98; 95% confidence interval [CI]: 1.65–2.39), having a secondary or higher education (aOR = 2.96; 95% CI: 2.43–3.64), being currently employed in a paid job (aOR = 1.31; 95% CI: 1.17–1.47), and belonging to the richest wealth status (aOR = 5.64; 95% CI: 4.33–7.34), were more likely to be enrolled in the HIP compared to their respective reference groups. In conclusion, being of privileged socioeconomic status, belonging to a specific ethnic group, having a higher educational level, being employed, and living in the Mountain region are all associated with women enrollment in HIP. Policymakers may consider these findings when planning and implementing future interventions. [ABSTRACT FROM AUTHOR]

Summary Background Objectives Methods Results Conclusions Early life socioeconomic disadvantage and adverse experiences may lead to overeating, which is in turn associated with increased body mass index (BMI). However, recent evidence indicated that the association between childhood BMI and overeating might be bidirectional. This bidirectionality prompts the need for further investigation of early life predictors of BMI in childhood.To longitudinally assess the directionality of the association between childhood BMI and perceived overeating and to investigate their antecedent early life predictors.The sample included data from 5151 children from the ELSPAC study, collected between 18 months and 11 years of child age. The outcomes were child BMI and mother‐reported overeating, assessed at the age of 3, 5, 7 and 11 years. Predictors included maternal BMI, maternal education, single parenthood, financial difficulties and adverse childhood experiences (ACEs) reported by parents and paediatricians. The random intercept cross‐lagged panel model was applied.The mean child's BMI at age 3 was 15.59 kg/m2 and increased to 17.86 kg/m2 at age 11. The percentage of parent‐reported overeating increased in the following period, from about 12% at age 3 to 17% at age 11. The results showed temporal stability in perceived overeating and BMI, with a bidirectional relationship strengthening over time. The child's BMI was associated with maternal BMI. Maternal BMI was positively associated with child‐perceived overeating, but a stronger effect was found for ACEs. ACEs mediated the impact of maternal education, financial difficulties and single parenthood on overeating.We observed stable bidirectional associations between BMI and perceived overeating. The results indicated two main pathways: one linked to maternal BMI and early childhood BMI increase followed by perceived overeating and the second associated with ACEs mediating the effect of early childhood social factors on perceived overeating, leading to gradual BMI gain. [ABSTRACT FROM AUTHOR]

Introduction: Having a lower extremity amputation is a life‐changing decision for people living with a diabetes‐related foot ulcer. Although previous research has described both positive and negative lifestyle and function outcomes of diabetes‐related amputations, limited research has been conducted on the decision‐making processes leading up to the amputation. This study aimed to explore the perspectives of persons, healthcare practitioners and experts (including academics and specialists) on decision‐making for people with a diabetes‐related foot ulcer who may require a non‐emergency amputation. Methods: A qualitative descriptive study using semi‐structured interviews enabled people to share their thought processes when making decisions for amputation. Twenty‐six participants were interviewed, including nine people with a diabetes‐related foot ulcer or amputation, nine health practitioners and eight experts located across five countries. There were 13 female and 13 male participants. Thematic analysis was used for data analysis. Results: Four themes described the decision‐making considerations for amputation: 'Balancing the evidence in decision‐making', 'Trust, respect and timing of conversations inform decision‐making', 'Tailoring decisions for individual circumstance' and 'Reaching the tipping point in decisions for the future'. Work commitments, functional and lifestyle impacts of amputation, the presence of support networks and clinical wound features formed the evidence for a decision for amputation. Conclusion: Understanding quality of life needs ensured that decisions for amputation addressed expectations and lifestyle needs. Living with a diabetes‐related foot ulcer presented daily challenges that pushed people to a tipping point, at which amputation was considered to overcome these hardships and enable them to move on to the next chapter of their life. Further research is required to understand how person‐centred factors can be better incorporated alongside objective clinical assessments in decisions for amputation. Patient or Public Contribution: People with diabetes‐related foot ulcers, health practitioners and experts shared their perspectives on the decision‐making process for amputation through one‐to‐one interviews. Consideration of the person in the context of their life, environment and personal needs alongside the pathological factors is warranted. Practitioner Points: The decision for amputation incorporates a balance between health concerns, health practitioner assessments and the quality of life expectations and lifestyle needs of the person with DFU.Open discussions about living situation and future goals can determine readiness for amputation and initiate consideration of amputation as a possible option.'Leaving the door open' for people with DFU to have ongoing conversations about amputation supports people to feel in control of their decisions. [ABSTRACT FROM AUTHOR]

Introduction: Divided narratives pose long‐standing difficulties in physician and patient communication. In decision‐making on cancer treatment, divided narratives between physicians and patients hinder mutual understanding and agreement over the illness and its treatment. For effective decision‐making on treatments, it is necessary to investigate the similarities and differences in these divided narratives. Methods: This study adopted a qualitative research design of narrative inquiry to examine the data, which included interviews with 32 cancer patients and 16 paired physicians in two hospitals in China. Data analysis was conducted using grounded theory to generate findings. Results: Both physicians and patients were concerned about goals and obstacles to their decision‐making on cancer treatment. Four common aspects of goal setting were identified from the divided narratives: decision pools, treatment goals, identity practice and preferred identity. Four common obstacles were identified: pains and trust, communication gap, financial issues and complex family. However, the meanings attached to these eight aspects differed between physicians and patients. Conclusion: Cancer treatment decision‐making is an encounter of the scientific world and lifeworld. A divided narrative approach can identify the similarities and differences in the decision‐making on cancer treatment between physicians and patients. Physicians generally adopt a rational decision‐making approach, whereas patients generally adopt a relational decision‐making approach. Despite the common concerns in their goals and obstacles, physicians and patients differed in their contextualized interpretations, which demonstrates the physicians' and the patients' pursuit of preferred identities in decision‐making. The results of this study provide a new perspective to treatment decision‐making, emphasizing the importance of narrative integration in reaching mutual agreement. Patient and Public Contribution: The findings were shared with 15 cancer patients and caregivers for feedback and advice in June 2024. This study was also presented at the international conferences of COMET (International and Interdisciplinary Conference on Communication, Medicine, and Ethics) and ICCH (International Conference on Communication in Healthcare) 2023 for continuous feedback and comments. [ABSTRACT FROM AUTHOR]

The current study tested a longitudinal mediation model throughout the COVID‐19 pandemic focused on whether students' housing instability stress and food/financial instability stress at the beginning of the pandemic in spring 2020 (T1) informed sleep dissatisfaction and duration in fall 2020 (T2) and, in turn, physical and mental health in spring 2021 (T3). Further, we tested whether relations varied based on students' ethnic‐racial backgrounds. Participants included 879 Asian, Black, Latine, Multiracial, and White emerging adult college students (Mage = 19.95, SD = 0.33) from a large public university in the mid‐Atlantic region of the United States who attended college during the COVID‐19 pandemic and completed surveys about their experiences. Findings indicated a significant mediation process, such that T1 housing instability stress predicted greater T2 sleep dissatisfaction and, in turn, less physical health, greater depressive symptoms, and greater anxiety symptoms at T3. Additionally, T1 food/financial instability stress was significantly associated with less T2 sleep duration but was not, in turn, associated with any T3 outcomes. Findings did not vary by students' ethnicity/race. Results highlight that sleep dissatisfaction is an important factor that accounts for relations between COVID‐19 stressors predicting mental and physical health outcomes throughout the pandemic. [ABSTRACT FROM AUTHOR]

Background: International students account for a significant proportion of medical graduates Australia‐wide, and most opting to remain in Australia for their first year of practice (Internship). Hence, understanding this particular demographic's perspectives is crucial for curriculum and workforce planning. Despite this, very few studies have addressed this demographic, and none have explored the impact of the COVID‐19 pandemic on international medical students specifically. Aim: A qualitative design was used to explore the perspectives of final‐year international medical students at an Australian medical school as they prepared for transition to internship during the COVID‐19 pandemic. Methods: Participants engaged in a semi‐structured interview about the pandemic's personal and professional implications. The data were analysed using inductive thematic analysis. Results: Seven out of 34 final‐year international medical students at the University of Adelaide participated. The main themes identified were that isolation was magnified, institutional support was lacking and that uncertainty was challenging. The pandemic did not deter participants from pursuing an Australian internship, as Australia was considered a desirable place for internship compared to their home countries. Conclusions: While the COVID‐19 pandemic exacerbated the situation, many of the challenges identified by international students already existed. Issues such as social isolation, racial discrimination, financial hardship and lack of institutional support have been prevalent for decades. Insights from this study reveal a need to improve the medical school experience. Australian Universities have a responsibility to ensure fair treatment of international students by training faculty, implementing support programmes and ensuring an inclusive and culturally safe learning environment. [ABSTRACT FROM AUTHOR]

Aim: Caregivers in home care settings may experience significant physical, emotional, and financial burdens in providing toileting assistance. However, few studies have evaluated these three aspects of caregiver burden. Therefore, this study aimed to clarify the physical, emotional, and financial burdens of toileting assistance and examine the factors associated with each burden. Methods: A self‐administered postal questionnaire was distributed to 405 family caregivers of older adults receiving home care and subsidies for incontinence products in Japan in 2019. Family caregivers answered questions about toileting assistance, the perceived physical, emotional, and financial burdens of providing toileting assistance at home, and the urinary/fecal symptoms of older adults. Results: Of the 242 family caregivers who reported each burden, 213 (88%) had experienced at least one physical, emotional, or financial burden. The prevalence of physical, emotional, and financial burdens was 77.3%, 78.1%, and 70.7%, respectively. Approximately 60% of respondents reported experiencing all three burdens. Physical burden was associated with spouses acting as primary caregivers, nocturia, fecal incontinence, and the odor of urine/feces from toileting assistance. Emotional burden was associated with nighttime assistance, urinary/fecal leakage from absorbent incontinence products, and the odor of urine/feces. Financial burden was associated with frequent assistance, disposal costs of absorbent incontinence products, and the degree of toileting assistance. Conclusions: The results revealed a high prevalence of the three burdens of toileting assistance among family caregivers, suggesting the need to assess these burdens. Furthermore, they suggested the importance of providing guidance to family members, which may help reduce these burdens. [ABSTRACT FROM AUTHOR]

Background: People experiencing socio‐economic disadvantage face significantly higher rates of diet‐related health inequities. This study aimed to explore barriers, opportunities and potential solutions in providing food and nutrition services to people experiencing socio‐economic disadvantage from the perspective of services providers. The present study is part of a broad co‐design model to improve service provision for people experiencing socio‐economic disadvantage. Methods: A cross‐sectional online survey involving 33 open and closed‐ended questions was distributed to Australian governmental and non‐governmental organisations providing nutrition‐related support to people experiencing socio‐economic disadvantage aged 16 years and over. Data were analysed using frequency distributions and conceptual content analyses. Results: Sixty‐eight responses were analysed. Services are predominantly offered by charitable organisations (90%), funded through private donations (66%) and reliant on volunteers (100%). Barriers to supporting clients' nutrition needs include financial constraints, limited community engagement, understaffing, insufficient resources and knowledge gaps. Opportunities and solutions for enhancing support include increasing government funding, advocacy initiatives, stronger community collaboration and more holistic, customised services. Proposed recommendations include establishing purpose‐built facilities or wrap‐around services to expand access to health services, life skills, training and educational programs. Conclusions: Services face challenges including volunteer reliance, limited resources and inadequate government support, hindering food provision. Client barriers include transportation costs and lack of social support. With dedicated financial support, services can offer comprehensive assistance, including community spaces, staffing, health and social services and training. Community partnerships can maximise funding impact. Solutions must address overall well‐being and broader social determinants such as income inequality and housing. Highlights: People experiencing socio‐economic disadvantage face significantly higher rates of diet‐related health inequities, which are a major contributor to the global public health burden, resulting in substantial direct financial costs for societies and governments.Charitable services involved in food and nutrition‐related support have the potential to extend their services beyond food provision by offering comprehensive assistance tailored to the specific needs of their clients.Dedicated financial support from government funding or grants can provide community‐specific spaces, staff, health and social services, resources and training.Collaborations with the community and higher education sector can enhance the effectiveness of this funding and political and policy interventions are essential to support these initiatives. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to assess whether psychological distress mediates the association between financial strain and oral health and dental attendance in the Dutch adult population. Methods: The study followed a cross‐sectional design based on 2812 participants from the 2014 wave of the Dutch population‐based GLOBE study. Financial strain was considered the exposure, while psychological distress measured with the Mental Health Inventory‐5 (MHI‐5) was the mediator. The outcomes included self‐reported number of teeth, self‐rated oral health, and self‐reported dental attendance. Generalized regression analyses were used for the mediation analysis adjusted for several covariables. Results: Greater financial strain was significantly associated with poorer self‐rated oral health (total effect: 0.09, 95%CI: 0.05; 0.14) and restorative or no dental attendance (i.e. participants never visiting a dentist or only visiting a dentist for regular treatments or when they have complaints with their mouth, teeth, or prosthesis) (total effect: 0.05, 95%CI: 0.02; 0.09). Greater financial strain was not significantly associated with self‐reported number of teeth (total effect: −0.14, 95%CI: −0.91; 0.64). Psychological distress significantly mediated the association of financial strain with self‐rated oral health (average causal mediation effect [ACME]: 0.02, 95%CI: 0.01; 0.03) and self‐reported dental attendance (ACME: 0.01, 95%CI: 0.00; 0.02), respectively. However, it did not significantly mediate the association of financial strain with self‐reported number of teeth (ACME: −0.11, 95%CI: −0.25; 0.02). The estimated proportion of the total effect of financial strain on self‐rated oral health and self‐reported dental attendance that could be explained by psychological distress was respectively 24% (95%CI: 14%; 48%) and 19% (95%CI: 6%; 62%). Conclusions: Psychological distress partly explains the association of financial strain with self‐rated oral health and dental attendance, but not with self‐reported number of teeth. Future studies using longitudinal data are necessary to confirm the results. [ABSTRACT FROM AUTHOR]

Background: Costs of cancer care can result in patient financial hardship; many professional organizations recommend provider discussions about treatment costs as part of high‐quality care. In this pilot study, the authors examined patient–provider cost discussions documented in the medical records of individuals who were diagnosed with advanced non–small cell lung cancer (NSCLC) and melanoma—cancers with recently approved, high‐cost treatment options. Methods: Individuals who were newly diagnosed in 2017–2018 with stage III/IV NSCLC (n = 1767) and in 2018 with stage III/IV melanoma (n = 689) from 12 Surveillance, Epidemiology, and End Results regions were randomly selected for the National Cancer Institute Patterns of Care Study. Documentation of cost discussions was abstracted from the medical record. The authors examined patient, treatment, and hospital factors associated with cost discussions in multivariable logistic regression analyses. Results: Cost discussions were documented in the medical records of 20.3% of patients with NSCLC and in 24.0% of those with melanoma. In adjusted analyses, privately insured (vs. publicly insured) patients were less likely to have documented cost discussions (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.37–0.80). Patients who did not receive systemic therapy or did not receive any cancer‐directed treatment were less likely to have documented cost discussions than those who did receive systemic therapy (OR, 0.39 [95% CI, 0.19–0.81] and 0.46 [95% CI, 0.30–0.70], respectively), as were patients who were treated at hospitals without residency programs (OR, 0.64; 95% CI, 0.42–0.98). Conclusions: Cost discussions were infrequently documented in the medical records of patients who were diagnosed with advanced NSCLC and melanoma, which may hinder identifying patient needs and tracking outcomes of associated referrals. Efforts to increase cost‐of‐care discussions and relevant referrals, as well as their documentation, are warranted. The authors examined patient–provider cost discussions documented in the medical records of individuals who were diagnosed with advanced non–small cell lung cancer and melanoma—cancers with high‐cost treatment options. Cost discussions were infrequently documented, which may hinder identifying patient cost barriers to care and tracking outcomes of associated referrals. [ABSTRACT FROM AUTHOR]

Currently, manufacturers can collaborate with online platforms to better sell green products and also finance from platforms to relieve financial pressure. To cater to this trend, we establish a platform supply chain model by considering a manufacturer with capital constraints that invests in a green production program. Then, it can sell green products via the reselling or the agency channel on a platform and finance from a bank, the platform, or both. In this context, we examine the choices of financial strategies and selling channels from the perspectives of both parties, as well as the corresponding environmental benefit and social welfare. Our findings show that the manufacturer prefers bank financing in most cases when the bank's interest rate is smaller than that offered by the platform. However, in the reselling channel, the manufacturer may choose platform financing even if its interest rate is higher. The platform tends to provide the agency channel when the commission rate is within a reasonable range. It is possible to realize the highest environmental benefit and social welfare in specific regions where both parties agree on the financing and selling modes to maximize their profits. When the manufacturer has only partial access to bank financing, it can choose mixed financing. However, the manufacturer cannot always treat mixed financing as a complete replacement of bank financing. [ABSTRACT FROM AUTHOR]

The article discusses the current state of business investment in the UK, highlighting factors such as weak post-pandemic recovery, financial constraints, and fragile corporate sentiment. It mentions the impact of rising debt servicing costs, low levels of investment in buildings, and the role of government policies in influencing investment decisions. Despite expectations of a gradual recovery in business investment, the UK still lags behind peers like the US, indicating ongoing challenges in productivity and economic performance. [Extracted from the article]

We contribute to the literature by being the first to examine the direction of causality between the different sources of oil price shocks and financial stress in the global financial markets (OFR), US, other advanced economies (OAE), and emerging markets (EM). Specifically, we aim to empirically answer a key question: Do global oil market shocks drive financial stress, or does financial stress spur oil market shocks? Using a two‐stage methodology based on the structural VAR (SVAR) and entropy‐based analysis over the period January 2000–October 2022, the results show that the links between financial stress and oil shocks are contingent on the type of shock. Within this, oil supply shock is mildly connected to financial stress; oil demand shock is vulnerable to innovation from financial stress; and oil‐specific demand shock has a noticeable time‐variable element wherein the shock prevails at the beginning of the sample and financial stress dominates the transmission at the end of the sample. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion The 2022 Massachusetts Shield Law protects telemedicine providers who care for abortion seekers in other states from criminal, civil, and licensure penalties. In this article we explore the characteristics of patients of The Massachusetts Medication Abortion Access Project (The MAP).The MAP is an asynchronous telemedicine service that offers mifepristone/misoprostol to abortion seekers in all 50 states who are at or under 11 weeks pregnancy gestation on initial intake. The MAP charges USD250 using a pay‐what‐you‐can model. We analyzed medical questionnaires and payments submitted by patients who received care from The MAP during its first 6 months of operations using descriptive statistics and for content and themes.From October 1, 2023–March 31, 2024, 1994 patients accessed care through The MAP. Almost all (n = 1973, 99%) identified as women/girls and about half (n = 984, 49%) were aged 20–29. The MAP cared for patients in 45 states; 84% (n = 1672) of these patients received pills in abortion ban or restricted southern states. Patients paid USD134.50 on average; 29% (n = 577) paid USD25 or less. Nearly two‐thirds (n = 1293, 65%) received subsidized care; financial hardship featured prominently in patient comments.Considerable demand exists for medication abortion care from Shield Law providers. The MAP demonstrates that providers can trust women and other pregnancy capable people to decide for themselves whether to obtain medication abortion pills by mail and to pay what they can afford without being required to justify their need. Identifying ways to support Shield Law provision and further subsidize abortion care are needed. [ABSTRACT FROM AUTHOR]

Background: This study systematically reviewed interventions mitigating financial hardship in patients with cancer and assessed effectiveness using a meta‐analytic method. Methods: PubMed, Cochrane, Scopus, CINAHL, and Web of Science were searched for articles published in English during January 2000–April 2023. Two independent reviewers selected prospective clinical trials with an intervention targeting and an outcome measuring financial hardship. Quality appraisal and data extraction were performed independently by two reviewers using a quality assessment tool. A random‐effects model meta‐analysis was performed. Reporting followed the preferred reporting items for systematic review and meta‐analyses guidelines. Results: Eleven studies (2211 participants; 55% male; mean age, 59.29 years) testing interventions including financial navigation, financial education, and cost discussion were included. Financial worry improved in only 27.3% of 11 studies. Material hardship and cost‐related care nonadherence remained unchanged in the two studies measuring these outcomes. Four studies (373 participants; 37% male, mean age, 55.88 years) assessed the impact of financial navigation on financial worry using the comprehensive score of financial toxicity (COST) measure (score range, 0–44; higher score = lower financial worry) and were used for meta‐analysis. There was no significant change in the mean of pooled COST score between post‐ and pre‐intervention (1.21; 95% confidence interval, –6.54 to 8.96; p =.65). Adjusting for pre‐intervention COST, mean change of COST significantly decreased by 0.88 with every 1‐unit increase in pre‐intervention COST (p =.02). The intervention significantly changed COST score when pre‐intervention COST was ≤14.5. Conclusion: A variety of interventions have been tested to mitigate financial hardship. Financial navigation can mitigate financial worry among high‐risk patients. A variety of interventions have been tested to mitigate financial hardship. Financial navigation can mitigate financial worry among high‐risk patients. [ABSTRACT FROM AUTHOR]

Previous studies have found a solid correlation between payment problems and health, and a large body of literature has recognised the impact of debt burden on ill health. However, few have looked at the reversed causality—the impact of health on over‐indebtedness and payment problems. In this article, we investigate whether or not a person with mental and physical health challenges is more likely to experience debt enforcement, and we take a step further to explore the role of health status on receiving debt settlement for those with severe payment problems. The article uses register data from Statistics Norway, the Norwegian Patient Registry and the Mortgages Registry from 2009 to 2018. When using conditional logistic models and fixed‐effects Poisson regressions with a one‐year lagged effect, we find that mental disorders significantly contribute to individuals' financial strains, while physical health does not play a substantial role. When integrating the models with dynamic health effects, all health indicators turned out to have substantial impacts, indicating an extended delayed physical health effect on financial outcomes. Poor health leads to increased payment problems, yet individuals facing health challenges have a lower likelihood of receiving necessary assistance in debt settlement. These findings emphasise the need for tailored services to address the financial challenges of debtors with diverse health conditions. [ABSTRACT FROM AUTHOR]

This longitudinal study investigates whether the quality of family interactions at 3–5 years of age predicts narrative abilities in 7–9‐year‐old children from socioeconomically disadvantaged families. The sample consists of 67 children and their parents receiving social welfare. Family interactions were filmed during mealtime at home and coded using the Mealtime Interaction Coding System. Children's narrative abilities were measured based on their capacity to coherently elaborate and resolve stories from the Attachment Story Completion Task. Results revealed that children exposed to family interactions of higher quality make their narratives more accessible and understandable and include more appropriate expression of affects in their stories 4 years later, even after accounting for maternal education and verbal abilities. The results of this study highlight the importance of considering family interactions in the context of financial insecurity when studying socioemotional competence in childhood. [ABSTRACT FROM AUTHOR]

Young people and their families around the world are especially vulnerable to macroeconomic hard times. This study sought to provide a more comprehensive view on how families with emerging adult children can successfully overcome economic distress. Specifically, we examined the links between economic strain—that is, the subjective perceptions of one's current and future financial situation—family ritual meaning, family problem‐solving communication, and quality of life, as reported by emerging adults and their parents. Data were collected from 1017 individuals nested in 334 families living in Portugal in 2016/2017. Results from multilevel modeling provided evidence for a negative impact of economic strain on family members' quality of life (β = −0.30, p < 0.001); and for the role of family ritual meaning (β = 0.01, p = 0.022), but not family problem‐solving communication, as a buffer against the negative effect of economic strain on quality of life. Findings also suggested that the subjective evaluations that family members formulated about their financial situations played a greater role than objective economic conditions (e.g., income) in establishing a deeper understanding on the impact of economic demands on individuals and families' lives in today's complex financial world. This study provides a significant contribution to family economic stress research, advancing family ritual meaning as a key family dynamic contributing to positive adaptation to economic distress. The implications of these findings for clinical interventions include the potential benefits of symbolic forms of family communication in the work carried out with economically stressed family members. [ABSTRACT FROM AUTHOR]

Background: Cancer survivors may face challenges affording food, housing, and other living necessities, which are known as health‐related social needs (HRSNs). However, little is known about the associations of HRSNs and mortality risk among adult cancer survivors. Methods: Adult cancer survivors were identified from the 2013–2018 National Health Interview Survey (NHIS) and linked with the NHIS Mortality File with vital status through December 31, 2019. HRSNs, measured by food insecurity, and nonmedical financial worries (e.g., housing costs), was categorized as severe, moderate, and minor/none. Medical financial hardship, including material, psychological, and behavioral domains, was categorized as 2‐3, 1, or 0 domains. Using age as the time scale, the associations of HRSNs and medical financial hardship and mortality risk were assessed with weighted adjusted Cox proportional hazards models. Results: Among cancer survivors 18–64 years old (n = 5855), 25.5% and 18.3% reported moderate and severe levels of HRSNs, respectively; among survivors 65–79 years old (n = 5918), 15.6% and 6.6% reported moderate and severe levels of HRSNs, respectively. Among cancer survivors 18–64 years old, severe HRSNs was associated with increased mortality risk (hazards ratio [HR], 2.00; 95% confidence interval [CI], 1.36–2.93, p <.001; reference = minor/none) in adjusted analyses. Among cancer survivors 65–79 years old, 2‐3 domains of medical financial hardship was associated with increased mortality risk (HR, 1.58; 95% CI, 1.13–2.20, p =.007; reference = 0 domain). Conclusions: HSRNs and financial hardship are associated with increased mortality risk among cancer survivors; comprehensive assessment of HRSN and financial hardship connecting patients with relevant services can inform efforts to mitigate adverse consequences of cancer. Health‐related social needs (HRSNs), including food insecurity and nonmedical financial worries, are associated with higher mortality risk among younger adult cancer survivors. Standardized and comprehensive assessment of HRSNs and medical financial hardship is essential to identify and mitigate adverse economic impacts of cancer. [ABSTRACT FROM AUTHOR]

Background: Ethical conflict is embedded in healthcare and is common in critical care setting. However, there is a paucity of research on the nature of ethical conflict in China. Ethical conflict has cultural and context sensitivity. Therefore, evidence is needed from different backgrounds to help discuss this issue across borders. Aim: This study aimed to qualitatively identify the experience of ethical conflict in critical care professionals in China. Study design: From December 2021 to February 2022, we performed semi‐structured, face‐to‐face interviews with 21 critical care professionals from five intensive care units in a tertiary general hospital in China. A thematic analysis approach was used to analyse the data. Results: Five themes and 14 sub‐themes emerged from the data. Critical care professionals probably felt unable to navigate uncertainty, torn by family issues, outraged by unprofessional behaviours of medical staff, being trapped in a socioeconomic dilemma when having experience of ethical conflict. In addition, they also perceived that they could turn struggle into growth. Conclusions: The experience of ethical conflict in critical care professionals involved a mixture of feelings. This study builds a comprehensive understanding of how ethical conflict affected their perceptions of themselves and their profession and provides implications to develop effective coping strategies. Relevance to Clinical Practice: The identification of critical care professionals' experience of ethical conflict would help identify what might trigger the ethical issues and what would be the potential target to optimize in critical practice. [ABSTRACT FROM AUTHOR]

When Greece was hit by the global financial crisis in 2009, families with children paid the heaviest toll. In this article, we draw on individual interviews and focus groups with 17 sixth graders, six teachers and six parents at a primary school in the Magnesia region. We use a relational approach to unpacking everyday austerity as it is lived, felt and experienced by Greek children. The empirical material shows how children's well‐being is conditioned by the well‐being of their families, where emotional stress spills over through witnessing parents' worries. Relational agency enables children to contribute to adversity relief, which seems to enhance not only their well‐being but also their resilience, as it is embedded in relations of mutual empowerment and development. Lastly, the study documents how macro policies of austerity measures trickle into the fabric of children's everyday lives and shape familial and intergenerational practices of care and responsibility. [ABSTRACT FROM AUTHOR]

Children's early experiences have potential to shape their development through early childhood, middle childhood, and into adolescence. Family structure at birth and material hardship may offer insight into how children's health and well‐being are shaped within their family of origin. The current paper examined (a) the association between family structure at birth and material hardship 1‐year post‐birth and (b) the differential impact of race on the associations between family structure and material hardship. We further explored the association between family structure and material hardship on self‐reported health in (a) middle childhood and (b) adolescence. Using the Future of Families and Child Wellbeing dataset, an ordinary least squares (OLS) regressions and structural equation path models (SEM) were used to examine associations between family structure, material hardship, and health outcomes (body mass index [BMI], anxiety, and suicidal ideation). Results indicated that family structure predicted material hardship at 1‐year until maternal characteristics were taken into account. Race/ethnicity did not moderate the association. Also, family structure at birth was indirectly associated with youth anxiety through material hardship but did not account for BMI or sucidical ideation. Social supports and state policies should prioritize maternal health access and ensure families are able to meet their basic needs to mitigate children's health risks. [ABSTRACT FROM AUTHOR]

People with disability are an 'at‐risk' group in a pandemic context for various clinical and structural reasons. However, in the early stages of the COVID‐19 pandemic, people with disability were not identified as a priority group, which exacerbated this risk, particularly for those living in congregate settings. This paper examines inter‐organisational issues during the second wave of the COVID‐19 pandemic in disability residential settings gathered from senior managers, team leaders, and disability support workers. We use Victoria as a case study since several Victorian disability residential settings were in mid‐transition from state provision to non‐profit organisations. We argue that residential settings in mid‐transition had clearer lines of organisational accountability and communication, which was thought to reduce the impact of outbreaks compared to residential settings in other States and Territories with multiple lines of communication and blurred accountability. The paper contributes to the literature on inter‐organisational collaboration by reinforcing the necessity of clear lines of accountability and leadership in collaborative governance during emergencies. The evidence suggests how government and disability residential settings could better support residents and staff in future COVID‐19 outbreaks or other pandemics. Points for practitioners: People with disability, particularly those living in congregate settings, are often at heightened risk during public health emergencies.Clearer lines of responsibility, administrative, and communication arrangements across organisations and governments, alongside tailored responses within residential settings, are required to keep 'at‐risk' individuals safe.Emergency management block funding could be designed to alleviate the financial pressures identified in this study for residential disability services in future pandemic responses. [ABSTRACT FROM AUTHOR]

Aim: To explore internationally qualified nurses' perceptions regarding the facilitators and barriers to specialty skill transfer in Australia. Design: The study utilised a descriptive research design with a cross‐sectional survey. Data were collected from July to September 2022. Methods: A self‐designed survey was distributed through social media, snowballing and nursing professional organisations. The survey included six open‐ended questions which were analysed using thematic content analysis. Results: Sixty‐three participants completed the open‐ended questions in the survey. The findings identified a range of facilitators (support, previous experience, self‐agency) and barriers (systems barriers, bias/discrimination, being undervalued, lack of trust) to skill transition. Conclusion: Recognising and addressing facilitators and barriers, coupled with creating customised pathways for specialty skill integration, are essential for optimising the utilisation of specialised skills in internationally qualified nurses. Impact: This study aims to explore the barriers and facilitators involved in maximising skill utilisation among internationally qualified nurses in Australia. Identifying these barriers and facilitators is essential for improving patient care, as it will guide the development of strategies for safe nursing service delivery and the optimisation of skill usage. These findings hold significant implications for policymakers, healthcare organisations and nurses, providing valuable insights into how to address these obstacles and capitalise on the factors that make skill transfer smoother and more effective. Patient or Public Contribution: Sixty‐three internationally qualified nurses shared their experiences and opinions. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates which local area characteristics, included in the Healthy Ageing/Vulnerable ENvironment (HAVEN) Index, are the strongest factors predicting transition into permanent residential aged care (PRAC) and mortality, and the geographic distribution of these factors. Methods: A retrospective cohort study of older individuals living in the community in Adelaide who received their first eligibility assessment for age care services between 2013 and 2015 (n = 16,939) was conducted. The study cohort, from the Registry of Senior Australians (ROSA), was linked by postcode to HAVEN Index items, selected following item response theory (IRT) analysis to determine the strongest local area factors associated with PRAC and mortality. Geospatial mapping of the factors determined the geographic distribution of these significant factors. Results: Fourteen HAVEN Index items were associated with entry into PRAC and mortality. Three area‐level items, lower educational attainment, financial housing stress and low levels of volunteering by older people, were risk factors for entry into PRAC and mortality while the remainder of the items identified were different for each outcome. The mapped local area risk factors for each outcome highlighted similar geographical areas of vulnerability. Conclusions: Local area characteristics are associated with entering PRAC and mortality. Our findings can inform area‐level responses to make neighbourhoods more age‐friendly, potentially allowing more people to age longer in place. Similar analyses, conducted for other areas, could provide evidence to support the widespread development of age‐friendly neighbourhoods reducing area‐level inequalities in ageing. [ABSTRACT FROM AUTHOR]

This review aims to consolidate and appraise evidence exploring the caregiver burden of parents of children with mental disorders. A mixed‐studies review structure was adopted and six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus and ProQuest Dissertations and Theses Global) were searched from each database's inception date until September 2023. Thomas & Harden's thematic analysis framework was utilised for data analysis. Twenty‐three studies were included in this review. The results‐based convergent integration method identified an overarching theme titled 'hiding behind the walls on fire, engulfed in chaos: dark and alone', three main themes named 'Invisible scars': role of psychological factors on caregiver burden, navigating through social and economic influences on caregiving burden, and influence of illness‐related variables and nine subthemes. This review highlighted that the parents perceived insufficient support from healthcare providers and a lack of insight regarding their children's medical condition as the primary contributors to the burden experienced. It is imperative for healthcare professionals to collaboratively engage with parental caregivers, offering accessible treatment options for their children with mental disorders and providing comprehensive educational resources to facilitate a profound understanding of their children's mental health conditions. In addition to addressing caregivers' informational needs, the establishment of an integrated support system is advocated, one involving active participation from healthcare professionals, healthcare institutions, community resources, social services and policymakers. This holistic approach could better meet the multifaceted needs of caregivers, encompassing psychosocial, emotional and financial aspects. Trial Registration: International Prospective Register of Systematic Reviews: PROSPERO ID: CRD42022363420 [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has taken a significant toll on the US population, with birthing people having special clinical needs. The Pregnancy Risk Assessment Monitoring System (PRAMS) is a population‐based surveillance system for monitoring birthing people's experiences. Comment data from the PRAMS survey can provide further insight into birthing people's experiences. This study aims to use PRAMS data to describe pandemic‐related experiences in a representative sample of birthing people in Wisconsin to help inform future emergency preparedness planning. Methods: This study analyzed 2020 Wisconsin PRAMS data for births in March or later. Content analysis of pandemic‐related comment data was conducted, and quantitative data on demographic characteristics and pandemic‐related experiences were examined. Results: Findings from 1406 respondents indicated that many birthing people were affected by the pandemic, including changes in healthcare visits and employment. One hundred respondents commented on pandemic‐related experiences; four interrelated themes emerged from content analysis: changed nature and quality of healthcare, limited social support, increased anxiety, stress, or fear, and employment or financial burden. Most comments discussed negative impacts; some expressed positive aspects. Discussion: Findings suggest opportunities for improving support for birthing people during public health emergencies, for example, through developing healthcare policies and public health guidelines that prioritize the protective mechanisms of social support for birthing people, identifying additional and immediately accessible policy protections to support birthing and postpartum people (e.g., insurance and paid leave) during public health emergencies, and implementing additional screening and support to help address increased mental health needs during public health emergencies. [ABSTRACT FROM AUTHOR]

Summary: Background: Economic hardship associated with chronic liver disease (CLD) may delay timely access to healthcare. Aim: To estimate the national burden of financial hardship across the spectrum of CLD in the United States (US) during the coronavirus disease 2019 (COVID‐19) pandemic. Methods: A cross‐sectional analysis was performed using the 2020–2021 US National Health Interview Survey database. The questionnaire defined financial hardship from medical bills and cost‐related nonadherence to medications in patients with CLD. We used weighted survey analysis to obtain the national estimates. Results: While 6.9% (95% confidence interval [CI]: 6.7%–7.2%) out of 60,689 US adults (weighted sample: 251 million) reported financial hardship and inability to pay medical bills; 10.6% (95% CI: 8.3%–13.4%), 18.2% (95% CI: 14.5%–22.6%), 22.6% (95% CI: 11.0%–41.0%) with hepatitis, CLD/cirrhosis, and liver cancer experienced an inability to pay their medical bills due to financial hardship, respectively. 19.8% (95% CI: 15.9%–24.5%) and 23.3% (95% CI: 12.5%–39.3%) with CLD/cirrhosis and liver cancer, respectively experienced cost‐related nonadherence to medications, compared to a tenth of US adults (10.7%, 95% CI: 10.3%–11.2%). CLD/cirrhosis demonstrated an independent association with financial hardship from medical bills and cost‐related nonadherence to medications. Overall, these disparities were more pronounced in individuals aged <65 years old. In addition, over 40% of individuals with CLD/cirrhosis reported difficulties accessing medical care during the COVID‐19 pandemic. CLD/cirrhosis showed an independent association with difficulties accessing medical care due to COVID‐19. Conclusions: Financial hardship from medical bills and cost‐related nonadherence to medication can negatively impact individuals with CLD and need further evaluation. [ABSTRACT FROM AUTHOR]

The present study focuses on the role of family support to young adult children during COVID‐19 in ameliorating the negative financial impact of the pandemic. Guided by the Conservation of Resources (COR) Theory of stress and coping, we conceptualize the negative financial impact due to COVID‐19 as a source of financial stress that would be associated with lower levels of both financial wellbeing and positive outlook of young adults. We rely on data collected from a multinational sample of young adults (ages 18–30) from six countries (China, Italy, Lithuania, Portugal, Slovenia, US; N = 2102) over a 3‐month period (July 2020–September 2020). We tested the potential effects of two types of support (i.e., parental financial support and family emotional support) using path analysis. While we find a consistent positive association between family emotional support and both financial wellbeing and positive outlook, we also find a consistent negative association between parental financial support and financial wellbeing, and a nonsignificant or negative association (Lithuania only) with a positive outlook. The significant interaction between COVID‐19 financial impact and family emotional support on young adults' positive outlook reveals that the benefit of family emotional support is more evident when the negative financial impact is low or moderate. We discuss the implications of these findings in assisting young adults to cope with financial disruptions. [ABSTRACT FROM AUTHOR]

Aim: This study aims to identify the key risk factors that lead to subtypes of physical frailty assessed by walking speed and grip strength among community‐dwelling Japanese individuals, stratified by the presence of musculoskeletal diseases (MSDs) and age group. Methods: We included 302 participants aged 70 or 80 years who did not exhibit subtypes of physical frailty at baseline through the Septuagenarians, Octogenarians, Nonagenarians, Investigation with Centenarians (SONIC) study. Our study was a longitudinal study. The outcome was the incidence of subtypes of physical frailty after 3 years. Subtypes of physical frailty were defined as a weak grip strength or slow walking speed, or both, based on the Japanese version of the Cardiovascular Health Study Index. The risk factors for subtypes of physical frailty incidence were examined by age group and MSD, using multivariate logistic regressions. Results: Of the 302 participants, 110 (36.4%) had MSD. Those with MSD were significantly more likely to have subtypes of physical frailty after 3 years compared with those without MSD. Among all participants, older age was a risk factor of subtypes of physical frailty (P < 0.05). Without MSD, older age and dissatisfied financial status were risk factors (P < 0.05). With MSD, older age was a risk factor (P < 0.05). By age group, in individuals aged 70 years old, a dissatisfied financial status was a risk factor for those without MSD (P < 0.05), and a higher BMI was one for those with MSD (P < 0.05). Conclusions: Older age was a risk factor for subtypes of physical frailty, but other risk factors differed according to the presence of MSD and age. Geriatr Gerontol Int 2024; 24: 797–805. [ABSTRACT FROM AUTHOR]

The number of people providing informal care has increased considerably in the last years while, at the same time, about one in four Australians have financial stress problems. This study uses rich longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey to estimate the effect of informal care on financial stress. To establish causality, we exploit a fixed effect‐instrumental variable approach to address omitted variable bias and reverse causality problems. Our findings show that informal caregiving increases financial stress between 9.9 and 14.5 percentage points. This finding is robust across a battery of quasi‐experimental methods. The effect of informal caregiving on financial stress is more pronounced among males, rural residents and those living in low socioeconomic areas. Our analyses further show that financial fragility and social isolation are important channels through which informal caregiving affects financial stress. [ABSTRACT FROM AUTHOR]

Background: Kaiser Permanente Southern California began offering a 4‐week supplemental benefit of home‐delivered meals to Medicare Advantage members after discharge from a hospitalization for heart failure and other medical conditions in 2021. The purpose of this study is to explore the associations between socioeconomic disadvantage and food insecurity with patient uptake of and satisfaction with the meals. Methods: Data for this cross‐sectional study were drawn from survey and electronic medical record data for members referred for the meals benefit (n = 6169) and linked to a hospitalization encounter (n = 2254) between January and December 2021. Uptake was assessed using vendor records; measures of socioeconomic status included the neighborhood deprivation index (NDI) and prior receipt of medical financial assistance (MFA) from the health system. Patients were invited to complete an email or phone survey about their satisfaction with the meals and food insecurity. Multivariable log‐binomial regression models were used to examine the association between socioeconomic disadvantage and food insecurity with meals uptake and satisfaction. Results: Sixty‐two percent of patients referred for the benefit accepted the meals (mean age: 79 ± 9, 59% people of color). While there was no significant relationship between NDI and meals uptake (RR: 0.99, 95% CI: 0.92–1.07, p = 0.77), patients who received prior MFA were more likely to accept the meals (RR: 1.09, 95% CI: 1.02–1.16, p < 0.01). Sixty‐nine percent of patients who completed the survey (23% response rate) reported that meals were very or extremely helpful. Patients with food insecurity (29% of survey respondents) were more likely to report that the meals were helpful for their recovery compared to food secure patients (RR: 1.21, 95% CI: 1.09–1.35, p < 0.01). Conclusions: The home‐delivered meals appeared to be particularly utilized by and helpful to patients with greater financial strain and/or food insecurity, suggesting that supplemental benefits could be more targeted toward addressing unmet needs of vulnerable adults. See related Editorial by Amit Kumar. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic had negative effects on many people's well‐being and quality of life. In the present work, we focused on Norwegian mothers with elementary school children, and investigated whether their well‐being, stress, and worries (and the relationships between them) changed across the early months of the pandemic. We collected data at two time points in 2020. In June 2020, 231 mothers (mean age = 40.09, SD = 6.22) responded to an online questionnaire in which they were asked to indicate their well‐being, stress, and worries before the pandemic, during the lockdown (i.e., March 2020), and currently (i.e., June 2020). Of these 231 mothers, 97 (mean age = 40.58, SD = 5.66) answered the same questionnaire again in November 2020. Mothers' well‐being was lower in November 2020 than before the pandemic (retrospectively reported). The age of the youngest child showed the strongest and most consistent relationship with mothers' well‐being across all time points. In addition, we found that the stress mothers felt during the national lockdown in March 2020 was strongly associated with their well‐being both during the lockdown and in June 2020. Finally, in November 2020, mothers' financial pandemic‐related worries were negatively related to their well‐being. Implications and suggestions for future research and for how societies can cope with future health‐related crises are discussed. [ABSTRACT FROM AUTHOR]

Previous research shows that being in a situation of economic scarcity promotes a more concrete mindset that motivates behavioral decisions based on action difficulty and their short‐term outcomes, which frequently entails negative consequences. However, a concrete mindset can be counteracted by inducing an abstract mindset to help people focus on final broad goals. We explored how focusing on transcendent motives (vs. self‐oriented) promotes a more abstract mindset facilitating prosocial behavioral intentions. Study 1 (pre‐post design) explored whether focusing on transcendent motives for engaging in activities promoted a more abstract mindset compared to focusing on self‐oriented motives. Using a 2 × 2 design with two consecutive opposing primes, Study 2 tested how inducing a transcendent orientation could reverse the effect caused by perceiving economic scarcity, promoting greater orientation toward others and prosocial behavioral intentions. In Study 1 participants who generated transcendent motives for behaviors presented a greater increase in the abstraction of construal level, compared to those who only generated self‐oriented motives for the same behaviors. Study 2 demonstrated that, when participants who perceived economic scarcity were focused on transcendent motives (vs. self‐oriented) to promote a more abstract mindset, their orientation toward others increased. Interestingly, for people perceiving economic scarcity, whose own difficulties could reduce prosocial behaviors, the greater orientation toward others promoted a greater intention to engage in demanding prosocial behaviors. We provide evidence of new strategies to promote abstraction in individuals and increase their involvement in prosocial behavioral intentions, especially for those perceiving economic scarcity. [ABSTRACT FROM AUTHOR]

Non‐alcoholic fatty liver disease (NAFLD) is the most prevalent liver disease. Global Burden of Disease (GBD) data from 1990 to 2019 reported a rise in prevalence (9–13%) in Australia, which also ranked third highest for NAFLD prevalence compared to 14 similar countries. As a result of underdiagnosis, NAFLD burden is underestimated by GBD. [ABSTRACT FROM AUTHOR]

Background: Epidermolysis bullosa (EB) comprises a group of rare types of genodermatoses characterized by extreme mucocutaneous fragility, leading to blistering and/or erosions, even with minimal trauma. Continuous care through wound management is an integral part of daily life for the families and individuals affected. The aim of this study was to assess the social reality and impacts on families of having minor members diagnosed with EB in Spain. Methods: A qualitative methodology was employed, utilizing four focus groups entailing participation by 24 parents (19 mothers and five fathers) of minors diagnosed with EB in Spain. Results: Negative impacts on the family nucleus were evident in four priority areas of analysis: sociorelational, economic‐labour, physical and psychoemotional, with significant differences observed based on the severity of the symptoms. Conclusion: Impacts on the family nucleus are noticeable from birth, influencing all other daily life routines and complicating family planning and organization. There is an imperative need to enhance the availability of sociohealth resources and to adopt an interdisciplinary approach to address their biopsychosocial needs. Patient or Public Contribution: The active participation of relatives of minors diagnosed with Epidermolysis Bullosa (EB) is invaluable to sociohealth professionals, legislators and researchers. A team member conducts their professional activities at DEBRA España (national patient association dedicated to enhancing the quality of life for individuals with EB and their families), actively engaging in all study phases. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop and validate FinTox, a concise tool for screening and managing financial toxicity in oncology settings. Methods: Development involved qualitative interviews with healthcare providers and patients, and feedback from a 7‐member expert panel resulting in a 5‐item measure that evaluates financial strain, psychological responses, and care modifications. Psychometric evaluations examined factor structure, internal consistency, test–retest reliability, and concurrent and convergent validity. Associations between FinTox scores and sociodemographic/medical factors were also analyzed using univariate and multivariable regression models. Results: Twelve healthcare providers and 20 patients were interviewed, and 268 patients (69.8% female, 47.4% non‐Hispanic White) completed surveys including FinTox, the Comprehensive Score for Financial Toxicity (COST), health‐related quality of life (HRQOL) measures, and sociodemographic questions. FinTox demonstrated excellent internal consistency (Cronbach's alpha = 0.90) and test–retest reliability (ICC = 0.95). Significant correlations with the COST (r = −0.62, p < 0.001) and HRQOL measures corroborated content and convergent validity. Diagnostic accuracy was evidenced by a sensitivity of 72.3%, specificity of 85.2%, positive predictive value of 83.2%, and negative predictive value of 70.3%. Higher FinTox scores were also associated with receiving care at a safety‐net hospital, Black race, household income <600% of the federal poverty level, and Stage 4 cancer. Conclusion: FinTox's robust psychometric properties and diagnostic accuracy position it as a reliable tool for detecting financial toxicity. Future research should evaluate its responsiveness to changes over time and integration into clinical workflows. [ABSTRACT FROM AUTHOR]

Objective: We aimed to examine the feasibility of applying natural language processing (NLP) to unstructured electronic health record (EHR) documents to detect the presence of financial insecurity among patients with rheumatologic disease enrolled in an integrated care management program (iCMP). Methods: We incorporated supervised, rule‐based NLP and statistical methods to identify financial insecurity among patients with rheumatic conditions enrolled in an iCMP (n = 20,395) in a multihospital EHR system. We constructed a lexicon for financial insecurity using data from available knowledge sources and then reviewed EHR notes from 538 randomly selected individuals (training cohort n = 366, validation cohort n = 172). We manually categorized records as having "definite," "possible," or "no" mention of financial insecurity. All available notes were processed using Narrative Information Linear Extraction, a rule‐based version of NLP. Models were trained using the NLP features for financial insecurity using logistic, least absolute shrinkage operator (LASSO), and random forest performance characteristic and were compared with the reference standard. Results: A total of 245,142 notes were processed from 538 individual patient records. Financial insecurity was present among 100 (27%) individuals in the training cohort and 63 (37%) in the validation cohort. The LASSO and random forest models performed identically and slightly better than logistic regression, with positive predictive values of 0.90, sensitivities of 0.29, and specificities of 0.98. Conclusion: The development of a context‐driven lexicon used with rule‐based NLP to extract data that identify financial insecurity is feasible for use and improved the capture for presence of financial insecurity with high accuracy. In the absence of a standard lexicon and construct definition for financial insecurity status, additional studies are needed to optimize the sensitivity of algorithms to categorize financial insecurity with construct validity. [ABSTRACT FROM AUTHOR]

Based on the formation and evolution of systemic risk, we study the high‐low volatility spillovers between economic policy uncertainty (EPU) and commodity futures and identify the source of risk accumulation and risk outbreak, as well as the corresponding contagion mechanisms. Upon comparing topological characteristics on each volatility layer, our results demonstrate that high and low volatility spillover networks have different network characteristics and evolution behaviors. At the system level, high volatility spillovers are relatively stronger than spillovers in in low volatility network, while the risk propagation efficiency in the low volatility network is higher. At the market level, EPU is not only an important risk‐emitter but also a risk‐recipient most of the time. Additionally, compared with high volatility network, low volatility network characteristics have greater predictive ability for risk spillover among commodity futures, which means that it contains additional information and provides early warning signals for financial stress. [ABSTRACT FROM AUTHOR]

The 1882 religious schism in the mission village of Metlakatla, British Columbia, and the subsequent battle over land rights between the Tsimshian First Nations and settler governments, are some of the most extensively analysed events in the history of missions in nineteenth‐century Canada. Yet historians have overlooked the role played by the Church Missionary Society in perpetuating these events. Most importantly, historians have failed to ask why a society that was in financial difficulties and that regularly abandoned mission stations all over the world was so determined to hold on to this one station. The Society's official story was that it needed to protect its converts from persecution, but this article argues that two economic factors also contributed to the value of Metlakatla for the Society. First, competition with Methodist missionaries in the region made Metlakatla a valuable asset for attracting government grants and private donations. Second, the religious schism in Metlakatla undermined the Society's branding as a bastion of doctrinal purity, rendering it necessary to protect the Society's marketing strategy. Attending to these economic factors complicates simplistic narratives of imperial missionary work as only about Christianisation and civilisation, and contributes to ongoing efforts to understand missionary societies as corporations. [ABSTRACT FROM AUTHOR]

Background: Deprescribing is the planned/supervised method of dose reduction or cessation of medications that might be harmful, or no longer be beneficial. Though benefits of deprescribing are debatable in improving clinical outcomes, it has been associated with decreased number of potentially inappropriate medications, which may potentially reduce the risk of adverse events among hospitalized older adults. With unclear evidence for deprescribing in this population, this study aimed to examine time‐to‐first unplanned healthcare utilization, which included 90‐day emergency department (ED) visits or hospital readmission and associated predictors, during a deprescribing intervention. Methods: A secondary data analysis of a clinical trial (Shed‐MEDS NCT02979353) was performed. Cox regression was used to compare the time‐to‐first 90‐day ED visit/readmission/death from hospital discharge for the intervention and control groups. Additionally, we performed exploratory analysis of predictors (comorbidities, functional health status, drug burden index (DBI), hospital length of stay, health literacy, food insecurity, and financial burden) associated with the time‐to‐first 90‐day ED visit/readmission/death. Results: The hazard of first 90‐day ED visits/readmissions/death was 15% lower in the intervention versus the control group (95% CI: 0.61–1.19, p = 0.352, respectively); however, this difference was not statistically significant. For every additional number of comorbidities (Hazard ratio (HR): 1.12, 95% CI: 1.04–1.21) and each additional day of hospital length of stay (HR: 1.04, 95% CI: 1.01–1.07) were significantly associated with a higher hazard of 90‐day ED visit/readmission/death in the intervention group; whereas for each unit of increase in pre‐hospital DBI score (HR: 1.08 and HR 1.16, respectively) was significantly associated with a higher hazard of 90‐day ED visit/readmission/death in the control group. Conclusions: The intervention and control groups had comparable time‐to‐first 90‐day ED visit/readmission/death during a deprescribing intervention. This finding suggests that deprescribing did not result in a higher risk of ED visit/readmission/death during the 90‐day period following hospital discharge. [ABSTRACT FROM AUTHOR]