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1.
East Mediterr Health J ; 27(10): 962-973, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34766322

RESUMO

Background: Financial hardships of out-of-pocket health expenditure (OPHE) is a growing concern for health policy makers in many low and middle-income countries. Spatiotemporal variation between Pakistan's four provinces over 2001-2015 is discussed, which would help comparing existing health services delivery and financial risk protection plans. Aims: In this paper, we estimate financial hardship of OPHE in Pakistan. Methods: We use the data sets of the household integrated economic surveys 2001-02, 2005-06, 2010-11 and 2015-16. We estimate OPHE share in household total and non-subsistence expenditure, catastrophic headcount at the threshold of OPHE ≥ 10% of total expenditure or OPHE ≥ 25% of non-subsistence expenditure. We estimate impoverishment of OPHE using national poverty lines. Finally, we explore socioeconomic factors of financial hardships of OPHE. Results: Over the years, catastrophic headcount and impoverishment of OPHE had decreased at national level (-1.3% points) and in the provinces of Sindh (-7.8% points) and Khyber Pukhtoonkhawa (KPK), (-2.8% points). The province of KPK and the year 2005-06 witnessed the highest incidence of financial catastrophe (26.89% points) and impoverishment (4.8% points) of OPHE. Households in rural areas, in the middle and rich quintiles and those headed by a male were more likely to encounter financial catastrophe and impoverishment due to OPHE. Conclusion: Inter-provincial variation in financial hardships of OPHE provide aide to provincial level priority setting. The high impact of OPHE in the non-poor, in rural areas, and in KPK calls for enhanced targeting of financial risk protection plans.


Assuntos
Estresse Financeiro , Gastos em Saúde , Humanos , Masculino , Paquistão , Pobreza , Fatores Socioeconômicos
2.
Artigo em Inglês | MEDLINE | ID: mdl-34639497

RESUMO

Based on the stimuli-organism-response framework, this study investigates how artistic stimuli (i.e., interior design) influence a person's mental responses (i.e., situational satisfaction and stress). Prior to checking the main analysis, demographic features were checked to determine whether they were significant precedents to the stimuli by using hierarchical linear modeling. As the main model, structural equation modeling was used to find (a) how stimuli (i.e., interior design) were associated with organisms (i.e., emotional perception) and (b) how organisms were associated with mental responses. The results showed that demographic features were not significantly associated with the stimuli. Stimuli were partially and significantly associated with organisms and the organisms were partially and significantly associated with the mental responses. The study has implications for practitioners in commercial fields who might recognize the importance of interior design and employ their utilities in practical applications.


Assuntos
Decoração de Interiores e Mobiliário , Satisfação Pessoal , Emoções , Estresse Financeiro , Humanos
3.
J Natl Cancer Inst Monogr ; 2021(57): 10-14, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34478512

RESUMO

Cancer-related financial hardship is highly prevalent and affects individuals in the setting of cancer care delivery across the survivorship trajectory. Mitigating financial hardship requires multi-level solutions at the policy, payer, health-care system, provider, and individual patient levels. At the highest level, strategies for intervention include enacting policies to improve price transparency and expand insurance coverage. Also needed are implementing systematic screening and financial navigation in cancer care delivery; improving cost communication by provider care teams; developing patient-reported measures that incorporate the multiple, complex dimensions of financial hardship, as reflected in the Economic Strain and Resilience in Cancer tool; and advancing electronic medical record infrastructure to manage data on patient financial hardship. For individual patients, activating their social networks, community resources, and employers provides patient-level support resources to enhance coping. The proposed multi-level approach is needed to overcome financial hardship in the setting of high-quality, high-value cancer care delivery.


Assuntos
Neoplasias , Sobrevivência , Atenção à Saúde , Estresse Financeiro , Humanos , Cobertura do Seguro , Neoplasias/terapia
4.
BMC Cancer ; 21(1): 1036, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530765

RESUMO

BACKGROUND: Optimising the care of individuals with cancer without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult. The American Society of Clinical Oncology (ASCO) has recommended clinicians discuss costs of cancer care with patients to enhance shared decision-making. We sought information to guide oncologists' discussions with patients about these costs. METHODS: We searched Medline, EMBASE and clinical practice guideline databases from January 2009 to 1 June 2019 for recommendations about discussing the costs of care and financial burden. Guideline quality was assessed with the AGREE-II instrument. RESULTS: Twenty-seven guidelines met our eligibility criteria, including 16 from ASCO (59%). 21 of 27 (78%) guidelines included recommendations about discussion or consideration of treatment costs when prescribing, with information about actual costs in four (15%). Recognition of the risk of financial burden or financial toxicity was described in 81% (22/27) of guidelines. However, only nine guidelines (33%) included information about managing the financial burden. CONCLUSIONS: Current clinical practice guidelines have little information to guide physician-patient discussions about costs of anticancer treatment and management of financial burden. This limits patients' ability to control costs of treatment, and for the healthcare team to reduce the incidence and severity of financial burden. Current guidelines recommend clinician awareness of price variability and high costs of treatment. Clinicians are recommended to explore cost concerns and address financial worries, especially in high risk groups. Future guidelines should include advice on facilitating cost transparency discussions, with provision of cost information and resources.


Assuntos
Comunicação , Efeitos Psicossociais da Doença , Neoplasias/economia , Oncologistas , Relações Médico-Paciente , Guias de Prática Clínica como Assunto/normas , Estresse Financeiro/diagnóstico , Estresse Financeiro/terapia , Custos de Cuidados de Saúde , Humanos , Neoplasias/terapia , Sociedades Médicas
5.
Am J Mens Health ; 15(5): 15579883211049605, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34587818

RESUMO

Pain associated with financial hardship among older men varies by race. The purpose of this study was to examine the association of financial hardship with the presence of pain in men 50 years and older by race. Using the Health and Retirement Study (HRS) 2010 wave, bivariate and multivariate logistic regression models were used to assess the association between four financial hardship indicators and total financial hardship as a composite score, and the presence of pain by race. Among White men, the association between the presence of pain and hardship controlling for demographic factors was statistically significant across four indicators and one composite score: ongoing financial hardship (OR = 1.29, 95% CI [1.02, 1.64]), food insecurity (OR = 2.55, 95% CI [1.51, 4.31]), taking less medication due to cost (OR = 2.12, 95% CI [1.40, 3.22]), difficulty paying bills (OR = 1.36, 95% CI [1.07, 1.73]), and total financial hardship (OR = 1.27, 95% CI [1.12, 1.44]). Among African American men, the association between the presence of pain and taking less medication due to cost (OR = 2.99, 95% CI [1.31, 6.85]) was significant. With increasing comorbidities among older adults, particularly African Americans, it is imperative to fully understand the mechanisms of this underexplored area in both the pain and financial hardship literature.


Assuntos
Estresse Financeiro , Aposentadoria , Idoso , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Dor , Estados Unidos/epidemiologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-34574463

RESUMO

BACKGROUND: Many patients on maintenance dialysis experience financial hardship. Existing studies are mainly cost analyses that quantify financial hardship in monetary terms, but an evaluation of its impact is also warranted. This review aims to explore the definition of financial hardship and its relationship with symptom burden among patients on dialysis. METHODS: A literature search was conducted in November 2020, using six electronic databases. Studies published in English that examined the associations between financial hardship and symptom burden were selected. Two reviewers independently extracted data and appraised the studies by using the JBI Critical Appraisal Checklists. RESULTS: Fifty cross-sectional and seven longitudinal studies were identified. Studies used income level, employment status, healthcare funding, and financial status to evaluate financial hardship. While relationships between decreased income, unemployment, and overall symptom burden were identified, evidence suggested that several symptoms, including depression, fatigue, pain, and sexual dysfunction, were more likely to be associated with changes in financial status. CONCLUSION: Our findings suggest that poor financial status may have a negative effect on physical and psychological well-being. However, a clear definition of financial hardship is warranted. Improving this assessment among patients on dialysis may prompt early interventions and minimize the negative impact of financial hardship.


Assuntos
Estresse Financeiro , Diálise Renal , Estudos Transversais , Emprego , Humanos , Desemprego
7.
CMAJ ; 193(31): E1203-E1212, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373268

RESUMO

BACKGROUND: The COVID-19 pandemic has exacerbated disparities in poverty and illness for people in vulnerable circumstances in ethnocultural communities. We sought to understand the evolving impacts of COVID-19 on ethnocultural communities to inform intersectoral advocacy and community action. METHODS: The Illuminate Project used participatory action research, with cultural health brokers as peer researchers, from Sept. 21 to Dec. 31, 2020, in Edmonton, Alberta. Twenty-one peer researchers collected narratives from members of ethnocultural communities and self-interpreted them as they entered the narratives into the SenseMaker platform, a mixed-method data collection tool. The entire research team analyzed real-time, aggregate, quantitative and qualitative data to identify emerging thematic domains, then visualized these domains with social network analysis. RESULTS: Brokers serving diverse communities collected 773 narratives. Identified domains illuminate the evolving and entangled impacts of COVID-19 including the following: COVID-19 prevention and management; care of acute, chronic and serious illnesses other than COVID-19; maternal care; mental health and triggers of past trauma; financial insecurity; impact on children and youth and seniors; and legal concerns. We identified that community social capital and cultural brokering are key assets that facilitate access to formal health and social system supports. INTERPRETATION: The Illuminate Project has illustrated the entangled, systemic issues that result in poor health among vulnerable members of ethnocultural communities, and the exacerbating effects of COVID-19, which also increased barriers to mitigation. Cultural brokering and community social capital are key supports for people during the COVID-19 pandemic. These findings can inform policy to reduce harm and support community resiliency.


Assuntos
COVID-19/etnologia , Serviços de Saúde Comunitária/organização & administração , Pandemias , Populações Vulneráveis/etnologia , Alberta/epidemiologia , COVID-19/prevenção & controle , COVID-19/terapia , Informação de Saúde ao Consumidor , Feminino , Estresse Financeiro , Pesquisa sobre Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Masculino , Pobreza , SARS-CoV-2 , Capital Social , Análise de Rede Social , Apoio Social
8.
Nutrients ; 13(8)2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34444851

RESUMO

The United States Department of Agriculture (USDA) National School Lunch and Breakfast Programs are critical for the health and food security of U.S. schoolchildren, but access to these programs was disrupted by COVID-19 pandemic-related school closures in spring 2020. While temporary policy changes to the programs enabled school food authorities (SFAs) to pivot towards distributing meals throughout their communities instead of within school buildings, SFAs faced complex challenges during COVID-19 with minimal external support. This mixed methods study investigates the implementation and financial challenges experienced by twelve of the largest urban SFAs in the U.S. during COVID-19. We conducted semi-structured interviews with SFA leaders and analyzed alongside quantitative financial data. We found that SFAs reconfigured their usual operations with nearly no preparation time while simultaneously trying to keep staff from contracting COVID-19, accommodate stakeholders with sometimes competing priorities, and remain financially solvent. Because student participation was much lower than during regular times, and revenue is tied to the number of meals served, SFAs saw drastic decreases in revenue even as they carried regular operating costs. For future crises, disaster preparedness plans that help SFAs better navigate the switch to financially viable community distribution methods are needed.


Assuntos
COVID-19/epidemiologia , Serviços de Alimentação/economia , COVID-19/economia , Criança , Estresse Financeiro , Insegurança Alimentar/economia , Serviços de Alimentação/estatística & dados numéricos , Humanos , Refeições , Pandemias , SARS-CoV-2/isolamento & purificação , Instituições Acadêmicas , Inquéritos e Questionários , Estados Unidos/epidemiologia , United States Department of Agriculture
9.
Artigo em Inglês | MEDLINE | ID: mdl-34444394

RESUMO

Several countries, including India, imposed mandatory social distancing, quarantine, and lockdowns to stop the spread of the SARS-CoV-2 virus. Although these measures were effective in curbing the spread of the virus, prolonged social distancing, quarantine, and the resultant economic disruption led to an increase in financial stress and mental health concerns. Prior studies established a link between the first lockdown and an increase in mental health issues. However, few studies investigated the association between post-lockdown financial hardship, job loss, and mental health. In this study, we examined the association between COVID-19-related financial hardship, job loss, and mental health symptoms approximately nine months after the end of the first nationwide lockdown in India. Job loss was associated with higher reporting of mental health symptoms among men (aIRR = 1.16) while financial hardship was associated with poor mental health symptoms among women (aIRR = 1.29). Conversely, social support and government aid were associated with better mental health symptoms among women. Our findings highlight the need for financial assistance and job creation programs to aid families in the recovery process. There is also an urgent need for improving the availability and affordability of mental health services in rural areas.


Assuntos
COVID-19 , Saúde Mental , Ansiedade , Controle de Doenças Transmissíveis , Estudos Transversais , Depressão , Feminino , Estresse Financeiro , Humanos , Índia/epidemiologia , Masculino , Quarentena , SARS-CoV-2
10.
Medicine (Baltimore) ; 100(31): e26877, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397865

RESUMO

ABSTRACT: High health care and medication expenditures pose a financial burden on Americans seeking care. It is imperative to determine the role of affordability in influencing access to health care and medications.To investigate the association between financial burden and health care access by comparing the effects of absolute and relative financial burdens, measured by total health care/medication expenditure (Expenditure) and health care/medication expenditure as a share of annual family income (Expenditure Share), respectively.Delay in receiving health care services and delay in obtaining prescription medications.A cross-sectional analysis of the 2017 Medical Expenditure Panel Survey using multivariate logistic regressions with Expenditure and Expenditure Share variables standardized to facilitate comparison.While both absolute and relative financial burdens were found to be positively associated with the outcomes, the relative measure had a significantly higher association that was about twice as much as the absolute one. For the outcome of delay in getting health care, the standardized odds ratios (OR) for health care expenditure and health care expenditure as a share of family income were 1.13 (95% confidence interval [CI] = 1.09-1.18) and 1.25 (95% CI = 1.20-1.32), respectively. For the outcome of delay in getting medications, the standardized OR for medication expenditure and medication expenditure as a share of family income were 1.11 (95% CI = 1.08-1.15) and 1.23 (95% CI = 1.18-1.29), respectively.The study illustrated the importance of including income in policy considerations intended to balance value, access, and affordability. Specifically, income should be included in measures assessing the value of medications.


Assuntos
Efeitos Psicossociais da Doença , Custos e Análise de Custo , Gastos em Saúde , Acesso aos Serviços de Saúde , Renda/estatística & dados numéricos , Medicamentos sob Prescrição/economia , Custos de Medicamentos/normas , Custos de Medicamentos/estatística & dados numéricos , Características da Família , Feminino , Estresse Financeiro , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
11.
Child Abuse Negl ; 121: 105258, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34419900

RESUMO

BACKGROUND: COVID-19 has exacerbated material hardship among grandparent-headed kinship families. Grandparent-headed kinship families receive financial assistance, which may mitigate material hardship and reduce child neglect risk. OBJECTIVE: This study aims to examine (1) the association between material hardship and child neglect risk; and (2) whether financial assistance moderates this association in a sample of kinship grandparent-headed families during COVID-19. PARTICIPANTS AND SETTING: Cross-sectional survey data were collected from a convenience sample of grandparent-headed kinship families (not necessarily child welfare involved) (N = 362) in the United States via Qualtrics Panels online survey. METHODS: Descriptive, bivariate, and negative binomial regression were conducted using STATA 15.0. RESULTS: Experiencing material hardship was found to be associated with an increased risk of child neglect, and receiving financial assistance was associated with a decreased risk of child neglect in the full sample and a subsample with household income > $30,000. Receiving financial assistance buffered the negative effect of material hardship on child neglect risk across analytic samples, and receiving SNAP was a significant moderator in the full sample. Among families with a household income ≤ $30,000, receiving SNAP and foster care payments was associated with a decreased risk of child neglect, while receiving TANF and unemployment insurance was associated with an increased risk of child neglect. Among families with household income > $30,000, only receiving SNAP was associated with a decreased risk of child neglect. CONCLUSIONS: This study suggests the potential importance of providing concrete financial assistance, particularly SNAP and foster care payments, to grandparent-headed kinship families in efforts to decrease child neglect risk during COVID-19.


Assuntos
COVID-19/psicologia , Maus-Tratos Infantis , Estresse Financeiro , Avós , COVID-19/epidemiologia , Criança , Criança Acolhida , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Estados Unidos/epidemiologia
12.
J Affect Disord ; 294: 889-896, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34375217

RESUMO

BACKGROUNDS: Socioeconomic factors influence suicide risk but a systematic understanding of the role of financial hardship is unclear. We examined whether financial hardship had cumulative or contemporaneous impacts on suicide ideation and any gender and age differences in a large Korean sample. METHODS: Data of 67,728 observations from 14,321 individuals were extracted from seven waves of Korean Welfare Panel Study. The association of financial hardship at baseline and its change over two years with suicide ideation was investigated using generalized estimation equation to account for repeated measurements within an individual, adjusting for other socioeconomic factors. RESULTS: Financial hardship was associated with suicide ideation but the magnitude of association varied across age and gender groups. Specifically, the impact of financial hardship was persistent over two years presenting a cumulative effect among men aged 50-64 years and ≥65 years; e.g., adjusted OR (adjusted odds ratio) = 3.87, 95 % CI = 2.71-5.54 for emergent hardship group vs adjusted OR = 4.22, 95 %CI = 3.00-5.93 for persistent group in those aged ≥65 years. Financial hardship increased the risk of suicide ideation incrementally with age, although the pattern was less clear among women. LIMITATIONS: Financial hardship was identified as having changing nature, though it was assumed to occur over two years. CONCLUSION: In general, financial hardship plays a role in amplifying suicide ideation in a contemporaneous way but also in a cumulative way, predominantly among late-middle-aged and elderly men. Monitoring and intervention for financial hardship would be a promising strategy for suicide prevention.


Assuntos
Estresse Financeiro , Ideação Suicida , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos
14.
Am J Perinatol ; 38(11): 1201-1208, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34225372

RESUMO

OBJECTIVE: Limited data are available regarding family and financial well-being among parents whose infants were hospitalized during the 2019 coronavirus (COVID-19) pandemic. The study objective was to evaluate the family and financial well-being of parents whose infants were hospitalized in the neonatal intensive care unit (NICU) during COVID-19. STUDY DESIGN: Parents were recruited for this online, cross-sectional survey via support groups on social media. Data collection was completed between May 18, 2020 and July 31, 2020. The final sample consisted of 178 parents, who had an infant hospitalized in an NICU between February 1, 2020 and July 31, 2020. The primary outcomes were impact on family life and financial stability, as measured by the Impact on Family scale, an instrument that evaluates changes to family life as a result of infant or childhood illness. RESULTS: Of the 178 parent respondents, 173 (97%) were mothers, 107 (59.4%) were non-Hispanic White, and 127 (69.5%) of the infants were born prematurely. Parents reported significant family impact and greater financial difficulty. Extremely premature infants, lower household income, parent mental health, and lower parental confidence were predictive of greater impacts on family life. CONCLUSION: Parents reported significant family and financial impacts during their infant's hospitalization amid COVID-19. Further studies are needed to guide clinical practice and inform family-supportive resources that can mitigate consequences to family well-being. KEY POINTS: · Impact of infant hospitalization in the context of COVID-19 is largely unknown.. · In a cohort of NICU parents during COVID-19, they reported changes to family life and finances.. · Greater impacts were reported by parents with lower income, confidence, and very premature infants..


Assuntos
COVID-19 , Criança Hospitalizada/psicologia , Saúde da Família , Hospitalização/economia , Saúde Mental , Pais/psicologia , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Transversais , Saúde da Família/economia , Saúde da Família/estatística & dados numéricos , Feminino , Estresse Financeiro , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Terapia Intensiva Neonatal/psicologia , Masculino , SARS-CoV-2 , Estados Unidos/epidemiologia
15.
PLoS One ; 16(7): e0252083, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34329327

RESUMO

BACKGROUND: Economic strengthening (ES) interventions can address economic barriers to retention and adherence (R&A) to antiretroviral therapy in prevention of mother-to-child transmission (PMTCT) services. To inform tailoring of ES activities for PMTCT, we used financial diaries to understand the economic lives of women in PMTCT and examine associations between participants' finances and their R&A. METHODS: We collected financial data from a stratified sample (n = 241) of HIV-positive pregnant women and new mothers enrolled in PMTCT from three clinics in Zomba, Malawi. For 30 weeks, participants met with staff to record cash and in-kind inflows and outflows. We used clinical records to calculate a measure of R&A for each participant. We summarized diary data using R and used cox proportional hazard models to examine the relationship between R&A and participant characteristics and behavior. RESULTS: There were 68,097 cash transactions over 30 weeks, with 10% characterized as inflows. The median value of cash inflows was US$3.54 compared with US$0.42 for cash outflows. Fewer than 7% of total transactions were considered related to PMTCT, with the majority classified as food or drink. Participants in the rural site had the lowest hazard of non-adherence. Decreased hazard of non-adherence was also linked to having dependents and years on ART. There were significant differences in cash inflows and outflows between those who were always adherent and those who were not. CONCLUSIONS: Financial inflows were large and erratic, whereas outflows were small but consistent. PMTCT expenses comprised a small proportion of overall expenses and focused on proper nutrition. The influence of inflows and outflows on adherence was significant but small; however, always adherent participants demonstrated smoother inflows and outflows, indicating an association between greater adherence and economic stability. Participants would benefit from interventions that bolster and stabilize their economic lives, including income generating activities in the agricultural industry and inclusion in village banks.


Assuntos
Infecções por HIV/economia , Mães/psicologia , Gestantes/psicologia , Adolescente , Adulto , Antirretrovirais/uso terapêutico , Feminino , Estresse Financeiro , Infecções por HIV/tratamento farmacológico , Humanos , Renda , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Entrevistas como Assunto , Malaui , Adesão à Medicação , Pessoa de Meia-Idade , Gravidez , Modelos de Riscos Proporcionais , População Rural , Inquéritos e Questionários , Adulto Jovem
16.
Cancer ; 127(21): 4072-4080, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34292583

RESUMO

BACKGROUND: As the coronavirus disease 2019 (COVID-19) pandemic continues to spread, it remains unclear how vulnerable populations with preexisting health conditions like cancer have been affected. METHODS: Between July and September of 2020, the authors conducted a cross-sectional study that surveyed 2661 patients with breast cancer who were registered in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort and received 1300 responses (71.5% White patients and 22.4% Black patients). The survey measured the psychosocial well-being of participants before and during the COVID-19 pandemic and examined whether they experienced any type of financial challenges or treatment disruption. RESULTS: The results indicated that feelings of isolation increased significantly during the pandemic. Meanwhile, the overall median isolation/stress score was 1.2 on a scale from 0 (never) to 4 (always), which was not significantly different between White patients and Black patients. One-third of patients experienced some type of financial challenge during this time. Medicaid recipients, of whom almost 80% were Black, were more likely to experience financial challenges. In addition, approximately one-fourth of patients experienced difficulty getting treatment. CONCLUSIONS: This study indicates that the quality of life of patients with breast cancer and their scheduled treatments have been adversely affected during the COVID-19 pandemic. These findings suggest that more support should be provided by hospital centers and the medical research community to patients with cancer during this challenging pandemic. LAY SUMMARY: The authors surveyed patients with breast cancer in Chicago using a questionnaire to examine how their lives have been affected during the coronavirus disease 2019 (COVID-19) pandemic. The results indicate that the lives of patients with breast cancer and their scheduled treatments have been adversely affected during the pandemic. In addition, patients who were covered by Medicaid, most of whom were Black, were more likely to experience financial challenges. The findings suggest that hospital centers and the medical research community should reach out and provide more information to support patients with cancer during this challenging pandemic.


Assuntos
Neoplasias da Mama/terapia , COVID-19/epidemiologia , Pandemias , Qualidade de Vida , Suspensão de Tratamento , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Idoso , Nativos Estadunidenses/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Neoplasias da Mama/etnologia , Chicago/epidemiologia , Chicago/etnologia , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Estresse Financeiro/epidemiologia , Estresse Financeiro/etnologia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Prevalência , Isolamento Social/psicologia , Estados Unidos
17.
Cancer Causes Control ; 32(10): 1173-1183, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34283327

RESUMO

PURPOSE: Cancer screening uptake differs between groups in ways that cannot be explained by socioeconomic status alone. This study examined associations between material, psychosocial, and behavioral aspects of financial hardship and cancer screening behaviors. METHODS: Surveys were mailed to 7,979 people ages 18-75 who were seen in the statewide health system in Indiana. Participants reported SES, feelings about finances, and whether they had to forgo medical care due to cost. This was compared to uptake of mammogram, colonoscopy/sigmoidoscopy, and Pap testing in best-fit multivariable logistic regression analyses controlling for demographic and healthcare characteristics. RESULTS: A total of 970 surveys were returned; the majority of respondents were female (54%), non-Hispanic White (75%), and over 50 years old (76%). 15% reported forgoing medical care due to cost; this barrier was higher among Black than White participants (24% vs. 13%; p = 0.001). In a best fit regression model for colonoscopy/sigmoidoscopy, those who reported they had to forgo medical care due to cost had lower odds of screening (aOR 0.41; 95% CI 0.22-0.74). Forgoing medical care due to cost was not significantly associated with Pap testing in bivariate analyses. For mammogram, forgoing medical care due to cost was significant in bivariate analyses (OR 0.44; 95% CI 0.22-0.88), but was not significant in the multivariable model. CONCLUSION: Associations between financial hardship and cancer screening suggest the need to reduce barriers to cancer screening even among patients who have access to healthcare. Future research should explore barriers related to both healthcare and personal costs.


Assuntos
Neoplasias Colorretais , Neoplasias do Colo do Útero , Adolescente , Adulto , Idoso , Colonoscopia , Detecção Precoce de Câncer , Feminino , Estresse Financeiro , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/diagnóstico , Adulto Jovem
19.
Psychol Addict Behav ; 35(4): 377-390, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34096760

RESUMO

Objective: The COVID-19 pandemic has been an unprecedented event for the entire world. Stay-at-home orders, many children being taught at home, health anxieties, and the subsequent economic downturn have collectively resulted in significant stress. Recent work has established that some individuals report drinking more in response to experiencing pandemic-related stress, but data has largely been limited to individuals and to psychological stress. Methods: This research investigated how own (actor) and partner psychological and financial stress about the pandemic were associated with alcohol consumption, high-intensity drinking frequency, coping motives, and alcohol-related problems in a sample of 118 couples during the month of July 2020. We also explored whether own (actor) and partner effects were moderated by gender. Results: Results using indistinguishable Actor-partner interdependence models (APIMs) demonstrated that own psychological stress was associated with higher scores on all drinking indices, and own financial stress was associated with higher coping motives and alcohol-related problems. Partner psychological and financial stress was related to own greater endorsement of coping motives, and partner financial stress was related to own greater endorsement of alcohol-related problems. In APIMs with mixed-sex couples, men's psychological and financial stress were positively related to both his own and his partner's drinks per week, high-intensity drinking, and coping motives. Men's financial stress was also positively related to his own and his partner's alcohol-related problems. Conclusions: Results provide considerable insight into couple dynamics related to pandemic stress and have direct implications for alcohol prevention and treatment efforts as we navigate this serious crisis. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , COVID-19 , Estresse Financeiro/psicologia , Relações Interpessoais , Pandemias , Parceiros Sexuais/psicologia , Estresse Psicológico/psicologia , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Relacionados ao Uso de Álcool/psicologia , Ansiedade/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Poder Familiar/psicologia , Adulto Jovem
20.
Bull Cancer ; 108(7-8): 705-717, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34127254

RESUMO

Cancer is a disease with multidimensional consequences accompanied by new challenges in order to guarantee optimal care involving physical, psychological and social consequences of the disease and his treatments. The objective of this study is to identify the main challenges encountered by different stakeholders around cancer, including patients, in Brussels. This qualitative study was carried out with various stakeholders in the field of oncology. The semi-structured interviews and focus groups were transcribed directly and the data collected was analysed manually. Healthcare professionals and patients face many challenges in the current context of oncology care. Communication difficulties can affect the therapeutic relationship and the sharing of complex information. The increasing complexity of therapeutic strategies complicates interprofessional collaborations and care coordination. In a context of early return home and home hospitalization in particular, continuity in care and collaboration between the different lines of care are crucial. Patients face a variety of challenges, such as managing long-term side effects and post-cancer difficulties, including redefining their social and professional identities. Finally, cancer involves financial toxicity and social inequalities in health are particularly marked. Cancer is a complex disease which management involves a growing number of caretakers. It is also frequently synonymous with disruption in the personal, social and professional life of patients. The emerging themes of this study are closely interconnected and communication seems to occupy a central place. A holistic approach to the individual and inter-professional interactions could guide future prospects for the overall management of this constantly changing field.


Assuntos
Comunicação , Oncologia , Neoplasias/terapia , Participação dos Interessados , Bélgica , Continuidade da Assistência ao Paciente/organização & administração , Feminino , Estresse Financeiro , Grupos Focais , Humanos , Relações Interprofissionais , Masculino , Neoplasias/economia , Alta do Paciente , Pesquisa Qualitativa , Qualidade de Vida , Fatores Socioeconômicos , Sobrevivência
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