Clinical Experiences of Perinatal Palliative Care After a Stillbirth: A Narrative Therapy for Grief.

Narrative care for families suffering from perinatal loss is rarely provided by medical institutions in China Mainland. However, with the advancement of the Chinese narrative medicine theory and practice, the clinical significance of narrative care has been increasingly recognized. Based on the principles of Chinese narrative medicine, this narrative case study described traumatic narrative foreclosures occuring in a family suffering from stillbirth, and highlighted the multidisciplinary collaboration for practising narrative care in the process of supporting the bereaved in our hospital. Meanwhile, we advocate the establishment of a narrative care ecology by training more obsteticians and nurses with good narrative competence in purpose of helping the family experiencing perinatal losses to overcome their tramatic narrative foreclosures, increasing the chances of another successful pregnancy and childbirth as well as enhancing their quality of life.

Depressive-Like Effects of Foreclosing: A Cross-Sectional Study of Hair Cortisol Concentration.

INTRODUCTION: Foreclosing and home eviction have been associated with various negative health outcomes, probably due to exposure to such stressful circumstance, but there is no evidence about foreclosure and home eviction to elicit cortisol responses. METHODS: Participants who recently had received a court eviction notice were compared to subjects suffering a depressive disorder and to healthy controls in terms of hair cortisol concentrations. RESULTS: Subjects under the stressful circumstance of foreclosure and patients with depression showed comparable concentrations in most of the hair segments while healthy subjects displayed the lowest levels of cortisol. CONCLUSION: The findings show that foreclosure and home eviction are associated with increased cumulative hair cortisol and with depressive-like symptoms. Foreclosing procedures yielded to maintain high levels of cortisol which may increase the risk to develop major depression.

The Buffering Effect of State Eviction and Foreclosure Policies for Mental Health during the COVID-19 Pandemic in the United States.

The COVID-19 pandemic spurred an economic downturn that may have eroded population mental health, especially for renters and homeowners who experienced financial hardship and were at risk of housing loss. Using household-level data from the Census Bureau's Household Pulse Survey (n = 805,223; August 2020-August 2021) and state-level data on eviction/foreclosure bans, we estimated linear probability models with two-way fixed effects to (1) examine links between COVID-related financial hardship and anxiety/depression and (2) assess whether state eviction/foreclosure bans buffered the detrimental mental health impacts of financial hardship. Findings show that individuals who reported difficulty paying for household expenses and keeping up with rent or mortgage had increased anxiety and depression risks but that state eviction/foreclosure bans weakened these associations. Our findings underscore the importance of state policies in protecting mental health and suggest that heterogeneity in state responses may have contributed to mental health inequities during the pandemic.

Experiences with Eviction, House Foreclosure, and Homelessness Among COVID-19 Infected Adults and Their Relation to Mental Health in a Large U.S. City.

This study examined experiences with eviction, house foreclosures, and homelessness in a large U.S. city sample of adults with Coronavirus Disease-2019 (COVID-19). A total of 3595 adults with COVID-19 participated in an assessment of health and well-being after completing contact tracing activities. The sample had a 5.7% lifetime prevalence of eviction, 3.7% lifetime prevalence of house foreclosure, and 8.2% lifetime prevalence of homelessness. Relative importance analyses revealed drug use was the most important variable associated with any lifetime eviction, lifetime house foreclosure, lifetime homelessness, and being currently at-risk of eviction or recently evicted. Loneliness was also relatively strongly associated with any lifetime eviction or homelessness, while socioeconomic characteristics were the most importance variables associated with late mortgage payments in the past month. Treatment for addiction problems may be important for in the aftermath of the COVID-19 pandemic and adults with histories of housing instability may be particularly at risk.

Economic Hardship and Violence: A Comparison of County-Level Economic Measures in the Prediction of Violence-Related Injury.

Economic hardship may lead to a wide range of negative outcomes, including violence. However, existing literature on economic hardship and violence is limited by reliance on official reports of violence and conflation of different measures of economic hardship. The goals of this study are to measure how violence-related injuries are associated with five measures of county-level economic shocks: unemployment rate, male mass layoffs, female mass layoffs, foreclosure rate, and unemployment rate change, measured cross-sectionally and by a 1-year lag. This study measures three subtypes of violence outcomes (child abuse, elder abuse, and intimate partner violence). Yearly county-level data were obtained on violence-related injuries and economic measures from 2005 to 2012 for all 87 counties in Minnesota. Negative binomial models were run regressing the case counts of each violence outcome at the county-year level on each economic indicator modeled individually, with population denominator offsets to yield incidence rate ratios. Crude models were run first, then county-level socio-demographic variables and year were added to each model, and finally fully-adjusted models were run including all socio-demographic variables plus all economic indicators simultaneously. In the fully-adjusted models, a county's higher foreclosure rate is the strongest and most consistently associated with an increase in all violence subtypes. Unemployment rate is the second strongest and most consistent economic risk factor for all violence subtypes. Lastly, there appears to be an impact of gender specific to economic impacts on child abuse; specifically, male mass-lay-offs were associated with increased rates while female mass-lay-offs were associated with decreased rates. Understanding the associations of different types of economic hardship with a range of violence outcomes can aid in developing more holistic prevention and intervention efforts.

The Athletic Identity of Collegiate Athletic Trainers: A Descriptive Study.

CONTEXT: Empirical and anecdotal evidence suggests that many athletic trainers (ATs) are former athletes and selected the profession because of its affiliation with sport. Qualitative research has indicated that collegiate ATs may have a strong athletic identity, but the concept of athletic identity has not been quantified in this population. OBJECTIVE: To quantitatively assess the athletic identity of collegiate ATs and determine if group differences exist. DESIGN: Cross-sectional observational study. SETTING: Collegiate clinical setting. PATIENTS OR OTHER PARTICIPANTS: A total of 255 (n = 93 men [36%], n = 162 women [63%]; n = 2 did not indicate sex [1%]) ATs employed in the collegiate setting. MAIN OUTCOME MEASURE(S): Data were collected via a web-based survey platform that was designed to measure athletic identity. Demographic information was analyzed for frequency and distribution. Mann-Whitney U tests and Kruskal-Wallis tests were calculated to determine if group differences existed. RESULTS: The large majority of respondents (90%) self-identified as having participated in organized sport and yet scored moderately on the Athletic Identity Measurement Scale (22.9 ± 7.9). No sex differences were present in overall athletic identity (P = .446), but women had higher levels of negative affectivity (P = .045) than men. Testing also revealed group differences based on current employment setting for social identity (P = .020), with scores for those in National Collegiate Athletic Association (NCAA) Division I less than those in Division II, Division III, and the National Association of Intercollegiate Athletics. Exclusivity in NCAA Division III was lower (P = .030) than that in NCAA Division II and National Association of Intercollegiate Athletics ATs. CONCLUSIONS: Components of athletic identity appeared to vary based on the employment setting of collegiate ATs and may be related to the number of hours worked in the summer. The moderate athletic identity scores of collegiate ATs were comparable with those of former athletes who selected career paths outside of sport. This may indicate adaptive career decision processes.

Financial indebtedness and suicide: A 1-year follow-up study of a population registered at the Swedish Enforcement Authority.

BACKGROUND: Economic hardship is an established suicidogenic factor. However, very little is known about whether financial difficulties in terms of debt problems, specifically, is related to suicide. This would seem to be an important research gap, not least at a time when the repercussions of the global financial crisis are still being felt by many people. AIMS: This study sets out to examine whether experiencing financial indebtedness is related to suicide. METHODS: For this purpose, people aged between 18 and 64 with a registration date for a debt in the Swedish Enforcement Authority register between 2015 and 2017 (n = 180,842) are followed up for a 1-year period for death by suicide and compared with a sample from the general Swedish population (n = 928,265). The analysis is based on penalized maximum likelihood logistic regressions. RESULTS: Those who had experienced financial indebtedness were two and a half times more likely to commit suicide than those who had not lived through this experience (OR = 2.50), controlling for several demographic, socio-economic, and mental health conditions prior to the date of the registration at the Enforcement Authority. CONCLUSION: Debt repayment problems have a significant and detrimental impact on individuals' risk of committing suicide, even when several other socioeconomic risk factors are controlled for. The results reinforce the importance of ongoing attempts to remove the issue of debt problem from its status as a rather hidden suicidogenic risk factor.

Property Tax Foreclosure, Spatial Effects, and Neighborhood Racial Demographic Change: Examining Data From Detroit.

In recent decades, the city of Detroit has experienced the greatest population loss of any major American city. Applying Event History Analysis methodology to a large dataset containing information on all properties in Detroit between 2002 and 2013, I examine how Property Tax Foreclosure spatially perpetuated itself in Detroit, finding evidence that the number of past but recent Property Tax Foreclosures in a localized area significantly predicts the likelihood of a future foreclosure. I extrapolate these findings to mathematical simulations and find evidence that suggests that initial Property Tax Foreclosures played a significant role in cascading many later on. Finally, building off past research that suggests neighborhood blight disproportionally affects white residential preferences and patterns, I perform an empirical analysis that examines how the initial distribution of Property Tax Foreclosures in Detroit neighborhoods played some role in determining how those neighborhoods have experienced racial demographic change.

Hospital Pricing Following Integration with Physician Practices.

The past decade has witnessed a new wave of hospital-physician integration, with the fraction of hospitals owning any office-based physician practice increasing from 28% in 2009 to 53% in 2015 nationwide. We offer one of the first hospital-level longitudinal analyses in examining how hospital-physician integration affects hospital prices in the modern healthcare environment. We find a robust 3-5% increase in hospital prices following integration. There is little indication that hospital quality is commensurately higher or that patient mix has changed following integration. Our supplementary analyses point to stronger bargaining leverage and foreclosure of rival hospitals as potential mechanisms for the estimated price effects.

Histories, Traumas, and Emotional Foreclosure from Manhattan to Dublin and Back.

The present paper begins with the particulars of clinical practice in Ireland. Through clinical example, it examines the emotion of shame, widely paired with blame, as a socially acceptable admission of psychological functioning, both in exercising and in denying the communication of more profound feeling. As a necessary emotional outlet, shame authorizes aggressions both large and small. Shame demands that certain acts, often seemingly random and subjective, are to be judged disgraceful in others. Shame demands that someone, everyone, endures hurt, at least through social judgement. Passing through the armoring of shame as social defense, clinical examples focus on the defensive action of foreclosure as an interpersonal act of nihilation, reducing another to no-thing, while at the same time diminishing one's own sense of inadequacy. Discerning this clinical pattern, the author generalizes from practice in a particular place to similar observable patterns, both with different populations, and in different contexts.

Forced to move: Patterns and predictors of residential displacement during an era of housing insecurity.

Recent work on residential displacement-being forced out of one's home-hints that its nature and prevalence have changed during the early twenty-first century. We evaluate this supposition against the backdrop of past displacement research. Reason-for-move data from seven waves of the American Housing Survey (2001-2013) are used to construct displacement measures that range from narrow (limited to forced moves prompted by government or private action or disaster loss) to broad (also including eviction and foreclosure). Our analysis shows that, regardless of measure, no consistent upward trend over time is apparent in the small percentage of mobile households experiencing displacement, although as many as 3.6 million individuals may be affected biennially. We also find that longstanding socioeconomic, racial, and other disparities in displacement persist but tend to be of modest magnitude. Such patterns could contribute to a perception of displacement as socially unpredictable, further heightening public concern about the issue.

'It's like they make it difficult for you on purpose': Barriers to property tax relief and foreclosure prevention in Detroit, Michigan.

All U.S. states permit local governments to recover unpaid property taxes through a tax lien foreclosure process. Tax relief policies can reduce household tax burdens and prevent the foreclosure of owner-occupied homes, but little is known about their use and effectiveness. Like other cities, Detroit, Michigan, experienced a rise in tax foreclosures following the 2008 deep recession. Michigan law requires cities to exempt low-income homeowners from some or all of their property tax obligation. Implementation of this policy, the Poverty Tax Exemption, nevertheless failed to protect many low-income homeowners from dispossession through tax foreclosure. State-mandated and locally-determined procedures placed the burden of learning about and applying for the exemption on financially stressed homeowners, restricting widespread access to this critical tax relief. Eliminating institutional barriers to tax relief can prevent many owner-occupied tax foreclosures, especially in cities where a high need for tax relief occurs under local conditions of fiscal austerity.

The foreclosure of the name of the father: logic of the significant and topology of the borromean knot / A foraclusão do nome-do-pai: lógica do significante e topologia dos nós

RESUMO: O artigo objetiva estabelecer uma discussão acerca do conceito de foraclusão extraído por Lacan da obra freudiana. O percurso teórico acompanha o ensino de Lacan desde a formulação do conceito de foraclusão, definido a partir da lógica da exclusão do significante do Nome-do-Pai. O desenvolvimento da topologia borromeana faz do Nome-do-Pai um sinthome que amarra os três registros - simbólico, imaginário e real. No final de seu ensino, Lacan concede novo relevo teórico ao conceito de foraclusão, compreendido como sinal da desamarração do nó borromeano.

Abstract: The present article aims to establish a discussion regarding the foreclosure concept, extracted by Lacan from the Freudian work. The theoretical path accompanies Lacan's teaching since the formulation of the foreclosure's concept, defined from the exclusion of the significant of the Name of the Father's logic. The development of the borromean topology makes the Name of the Father a sinthome that ties the three orders symbolic, imaginary and real. At the end of his teachings, Lacan grants a new theoretical relief to the concept of foreclosure, understood as sign of the untying of the borromean knot.

Risk of suicide in households threatened with eviction: the role of banks and social support.

BACKGROUND: One of the greatest effects of the financial crisis in Spain has been the enormous increase in the number of evictions. Several studies have shown the association of evictions with different aspects of the physical and mental health. Furthermore, evictions have been associated with an increased risk of suicide. Our objective was to evaluate the risk of suicide among victims of eviction and investigate whether it is associated with specific characteristics of households and interviewees, the eviction process and social support, and health needs. METHODS: A total of 205 participants from households threatened with eviction in Granada, Spain, and 673 being the total number of members of these households, were interviewed in one-on-one sessions between April 2013 and May 2014. Through a questionnaire, information was obtained on physical and mental health, characteristics of their eviction process and support networks, and the use of health services. RESULTS: Almost half of the sample (46.7%) were at low (11.8%), moderate (16.9%), or high suicide risk (17.9%). Household and interviewee features had a limited association with suicide risk. On the contrary, the risk of suicide is greater with a longer exposure to the eviction process. In addition, threatening phone calls from banks increased significantly the risk of suicide, especially among men. Suicide risk was also associated with low social support, especially among women. Interviewees at risk of suicide received more help from nongovernmental organizations than those who were not at risk. In interviewees at risk, the main unmet needs were emotional and psychological help, especially in men. A high percentage of those at risk of suicide declare having large unmeet health needs. Finally, there was a tendency among the evicted at risk of suicide to visit emergency room and primary care more often than those not at risk, especially among women. CONCLUSIONS: To our knowledge, this is the first study showing that when banks adopt a threatening attitude, suicide risk increases among the evicted. As hypothesized, when the evicted felt socially supported, suicide risk decreased. Emotional help was the main mediator of suicide risk and the main unmet need, especially among men.

Subprime Babies: The Foreclosure Crisis and Initial Health Endowments.

The subprime mortgage crisis was a devastating financial shock for many homeowners. This research uses a probabilistic matching strategy to link foreclosure records with birth certificate records from 2006 to 2010 in California to identify birth parents who experienced a foreclosure. Among mothers who did, those issued a loan during the peak of subprime lending from 2005 to 2007 were more Hispanic and socioeconomically disadvantaged than mothers with loans originating before 2005. We use a mother fixed-effects analyses of ever-foreclosed mothers issued a loan during 2006 and 2007 and find that infants in gestation during or after the foreclosure had a lower birth weight for gestational age than those born earlier, suggesting that the foreclosure crisis was a plausible contributor to disparities in initial health endowments.

Our lives in boxes: perceived community mediators between housing insecurity and health using a PHOTOVOICE approach.

BACKGROUND: While the negative effects of housing insecurity on health are well known, the mechanisms and mediators of these effects have been less well studied. The aim of this study is to identify perceived mediators involved in the relationship between housing insecurity and health. METHODS: We used a participatory action research approach, the Photovoice methodology. It promotes a reflective process where participants critically discuss housing insecurity and human health and make recommendations to find solutions for the issues identified. This study was conducted with 18 members of the Platform for People Affected by Mortgages who were living in a situation of housing insecurity in Barcelona during the first half of 2017. RESULTS: Participants took 990 photographs, of which 147 were printed for analysis in discussion sessions. 109 of these photographs were then selected for categorization by the participants. 11 major categories emerged, representing various factors related to housing insecurity and health. Most categories were acknowledged as possible mediators of the housing/health problem, including: psychological changes; housing-related material aspects; health-related behaviors; eviction; harassment by financial institutions; and family, neighbors and social network. Others were considered as modifiers that could alter the effects of housing insecurity on health. Co-existing determinants may interact with housing insecurity, thereby increasing negative effects on health. CONCLUSIONS: Through this participatory approach, the Photovoice project gives insight into the mechanisms underlying the relationship between housing insecurity and human health, and provides valuable recommendations to combat this serious public health issue.

Local Health Departments Addressing the Social Determinants of Health: A National Survey on the Foreclosure Crisis.

Purpose: To examine local health department (LHD) engagement in addressing the social determinants of health by using the foreclosure crisis as an example. Methods: National survey of 166 LHD staff on the foreclosure crisis (2006-2014). Results: About one quarter (28%) of respondents reported that their LHD had engaged in work related to the foreclosure crisis, 7% planned to engage, and 65% did not or were not planning to engage. Views about the role of LHDs in addressing the foreclosure crisis varied: 30% stated that LHDs should work on foreclosure. Conclusions: A substantial number of respondents reported that their LHD addressed foreclosure, or supported engagement, yet there are divergent perceptions of appropriate LHD roles. LHDs follow a pattern described by the diffusion of innovations theory: Innovative LHDs can share their work on foreclosure and housing, early adopters are poised to act, and others may follow if they have support.

Relationship between area mortgage foreclosures, homeownership, and cardiovascular disease risk factors: The Hispanic Community Health Study/Study of Latinos.

BACKGROUND: The risk of mortgage foreclosure disproportionately burdens Hispanic/Latino populations perpetuating racial disparities in health. In this study, we examined the relationship between area-level mortgage foreclosure risk, homeownership, and the prevalence of cardiovascular disease risk factors among participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). METHODS: HCHS/SOL participants were age 18-74 years when recruited from four U.S. metropolitan areas. Mortgage foreclosure risk was obtained from the U.S. Department of Housing and Urban Development. Homeownership, sociodemographic factors, and cardiovascular disease risk factors were measured at baseline interview between 2008 and 2011. There were 13,856 individuals contributing to the analysis (median age 39 years old, 53% female). RESULTS: Renters in high foreclosure risk areas had a higher prevalence of hypertension and hypercholesterolemia but no association with smoking status compared to renters in low foreclosure risk areas. Renters were more likely to smoke cigarettes than homeowners. CONCLUSION: Among US Hispanic/Latinos in urban cities, area foreclosure and homeownership have implications for risk of cardiovascular disease.

O Sujeito e a Fala em Psicopatologia: Aportes Sobre a Foraclusão / The Subject and the Speech in Psychopathology: Intakes About the Foreclosure / El Sujeto y el Habla en Psicopatología: Aportes Sobre la Forclusión

Neste trabalho apresentamos uma contribuição ao estudo da especificidade da escuta psicanalítica na prática clínica. Iniciamos com uma análise histórica do termo foraclusão e da leitura que Lacan fez da concepção freudiana do processo de Verwerfung. Interessa mostrar a aproximação entre o sujeito foracluído da ciência, a constituição do sujeito na fala e o modelo topológico do corte. Trata-se de indagar sobre a estrutura na qual o sujeito está simbolicamente representado, e na qual, ao mesmo tempo, ele faz parte. Nesse sentido, o termo indiscriminado sujet responde tanto ao uso gramatical quanto ao topológico. Trabalhamos através de um caso clínico a diferença entre uma clínica do fenômeno e uma clínica da escuta, cujo efeito é um sujeito.(AU)

In this work we present a contribution to the study of the specificity of the psychoanalytical listening in clinical practice. We begin with a historical analysis of the term ";forclusion"; [rejection] and Lacan's interpretation of the freudian concept of the process of Verwerfung. This article deals with the relation among the rejected subject of the science, the constitution of the subject in speech and the topological model of the cut. We inquire about the structure in which the subject is symbolically represented and, at the same time, it is part of. In this way, the indiscriminate term sujet recovers both the grammatical and topological use. Through a clinical case we work the differences between a clinical practice of the phenomenon and a clinical practice of listening whose effect is a subject.(AU)

En este trabajo presentamos una contribución al estudio de la especificidad de la escucha psicoanalítica en la práctica clínica. Iniciamos con un análisis histórico del término forclusión y de la lectura que hace Lacan de la concepción freudiana del proceso de Verwerfung. Nos interesa mostrar la aproximación entre el sujeto forcluído de la ciencia, la constitución del sujeto en el habla y el modelo topológico del corte. Tratamos de indagar sobre la estructura en la que el sujeto se encuentra simbólicamente representado y, de la que, al mismo tiempo, es parte. En este sentido, el término indiscriminado sujet responde tanto al uso gramatical como al topológico. Trabajamos a través de un caso clínico, la diferencia entre una clínica del fenómeno y una clínica de la escucha, cuyo efecto es el sujeto.(AU)

Financially Overextended: College Attendance as a Contributor to Foreclosures During the Great Recession.

Although subprime mortgage lending and unemployment were largely responsible for the wave of foreclosures during the Great Recession, additional sources of financial risk may have exacerbated the crisis. We hypothesize that many parents sending children to college were financially overextended and vulnerable to foreclosure as the economy contracted. With commuting zone panel data from 2006 to 2011, we show that increasing rates of college attendance across the income distribution in one year predict a foreclosure rate increase in subsequent years, net of fixed characteristics and changes in employment, refinance debt, house prices, and 19-year-old population size. We find similar evidence of college-related foreclosure risk using longitudinal household data from the Panel Study of Income Dynamics. Our findings uncover a previously overlooked dimension of the foreclosure crisis, and highlight mortgage insecurity as an inadvertent consequence of parental investment in higher education.