Family Foundation Research Articles

MH workers strike against Kaiser Permanente in Southern California

More than 2,000 unionized mental health workers in Southern California went on strike against Kaiser Permanente last week after the two sides failed to reach a new labor agreement, CNN reported Oct. 21. The National Union of Healthcare Workers (NUHW) — which represents 19,000 health care workers in California and Hawaii, including 4,700 mental health workers — picketed outside Kaiser facilities in Los Angeles, San Diego, Anaheim and Fontana, seeking an increase in salaries, restoration of pensions and increased staffing. When announcing the impending strike earlier this month, the union cited its 10‐week strike in Northern California in 2022, which resulted in higher wages, better working conditions to improve patient care and prevented rapid staff turnover (see “Kaiser agrees to historic settlement to overhaul its BH care system,” MHW, Oct. 25, 2023; https://doi.org/10.1002/mhw.33828). Union members on strike in Southern California have said their demands are in line in with what Kaiser has provided to the majority of its workforce. “Unless we strike, our coworkers are going to keep leaving and our patients are going to keep struggling in an underfunded, understaffed system that doesn't meet their needs,” Josh Garcia, a psychologist for Kaiser in San Diego, said in a press statement from the NUHW. The strike comes as employment in the mental health field — for psychiatrists, psychologists, therapists, counselors, psychiatric aides and social workers — is expected to grow three times faster than the average US job position, according to CNN's analysis of data released in September by the Bureau of Labor Statistics. A survey in 2022 from CNN in partnership with the Kaiser Family Foundation showed that nine out of 10 US adults believe the country has a mental health crisis.

The Changing Nature of Foundation Work: Advancing the Field by Understanding the Foundation Professional Experience

The nature of foundation work is underexplored with little attention to the internal dynamics of foundations. Focus has been on the organizational level describing foundations’ societal roles, but understanding the individual experiences of those working within foundations would remove much of the mystery of these institutions. This article focuses on the experiences of the individual foundation professional, by exploring the entry-to-exit of UK family foundation CEOs. This study demonstrates inherent tensions between amateur and emerging professional influences in foundation roles. In asking about the changing nature of foundation work, this article highlights three underexplored elements: competing expertise, inconsistent field formalization, and a professionalizing context. Understanding these elements are crucial for implementing effective and equitable field-level initiatives. Focusing on foundation professional experiences challenges the “black box” narrative by providing a greater understanding of foundation work and its evolution.

The evolving climate change investing strategies of asset owners

Asset owners will play a foundational role in how the financial system will respond to the immediate and long-term physical, transition, legal, and other risks and opportunities emerging from global climate change. We investigated how asset owners incorporated climate change in their investments using a process framework of organizational change. We conducted more than 50 interviews with asset owners with over $750B assets under management, and their stakeholders, including beneficiaries, lawyers, consultants, and asset managers. These asset owners included retail investors, high-net-worth family offices, pensions, foundations, endowments, trusts, and corporations. Interviewees discussed their investment strategies related to climate change, including mitigation, adaptation, profit, philanthropic finance, risks, and opportunities. We found that legal stakeholders sometimes drove conversations, that trustees gradually matured in their fiduciary identities, and that staff struggled to operationalize investment mandates. We summarize proposed interventions that will help asset owners better serve their commitments.

A new patient navigation model of care to support older adults in transitions of care: Key considerations for implementation for policy-makers and health system leaders.

A Patient Navigation (PN) model of care was introduced in a large metropolitan hospital in Ontario (Canada) to support transitions in care for older adults in 2019. The patient navigator is a community social worker or "community transitional lead" embedded in the hospital's in care teams to assist with discharge planning and provide follow-up care to older adults, their families, and/or care partners for up to 90 days. Initially, the PN program supported acute care patients and has since expanded in the Emergency Department and Reactivation Care Centre. In this cohort retrospective observational study, we described the new PN model of care by analyzing the clinical notes collected by the patient navigator. This article provides preliminary insights for health leaders who are interested in implementing this novel PN model to improve transitions of care in a hospital setting. Funding was provided by the SLAIGHT Family Foundation.

T cell responses and clinical symptoms among infants with congenital cytomegalovirus infection.

BACKGROUNDCongenital cytomegalovirus (cCMV) infection can cause developmental impairment and sensorineural hearing loss (SNHL). To determine the relationship between immune responses to cCMV infection and neurologic sequelae, T cell responses were compared for their connection to clinical symptoms at birth and neurodevelopmental outcomes.METHODSThirty cCMV-infected and 15 uninfected infants were enrolled in a single-center prospective observational case-control study. T cell pp65-specific cytokine responses; CD57, CD28, and PD-1 expression; and memory subsets were compared.RESULTSInfected neonates (73% symptomatic at birth) lacked pp65-specific cytokine-secreting T cells, with elevated frequencies of CD57+, CD28-, and PD-1+CD8+ T cells and effector memory subsets. Though frequencies overlapped between cCMV symptom groups, asymptomatic infants had higher frequencies of CD57+PD-1+CD8+ T cells. Neonates with subsequent developmental delay lacked detectable CMV-specific T cell responses, with patterns resembling those of uninfected infants. Two children with progressive SNHL had high frequencies of PD-1+CD8+ T cells over the first year compared with children without progressive SNHL.CONCLUSIONSimilar to published reports, neonatal viral antigen-specific cytokine-secreting T cell responses were not detected, but overall patterns indicate that globally differentiated memory CD8+ T cell populations were induced by cCMV infection, with higher frequencies of terminally differentiated PD-1+CD8+ T cells potentially associated with asymptomatic infection. In this cohort, a lack of in utero T cell differentiation was associated with developmental delay, and high frequencies of PD-1+CD8+ T cells persisted only in children with progressive SNHL. Further work is needed to define the specificity of these T cells and their mechanistic connection to these outcomes.FUNDINGThis study was funded through an intramural research award at Nationwide Children's Hospital, the Pediatric Infectious Disease Society Fellowship Award funded by Stanley and Susan Plotkin and Sanofi Pasteur, the Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Pichichero Family Foundation Vaccines for Children Initiative Research Award from the Pediatric Infectious Diseases Society Foundation.

Abstract C024: Evaluation of PI3K/AKT/mTOR pathway signaling as a prognostic indicator in Hispanic Mexican women with breast cancer

Abstract Breast cancer (BC) is among the most commonly diagnosed cancer in women and a leading cause of cancer death worldwide. Hispanic/Latina women represent a heterogeneous group with diverse genetic backgrounds, including varying proportions of Native American, European, African and to a lesser extent Asian ancestry. In the US, Hispanic and African American women have lower BC incidence overall yet higher incidence of triple negative breast cancer (TNBC). Furthermore, African American and Hispanic women tend to present with more aggressive disease, at younger ages and worse survival compared to women of European ancestry. These disparities have been attributed to biologic and non-biologic socioeconomic factors. Genomic analyses of Hispanic Mexican (HM) women have revealed specific genetic signatures distinct from those of non-Hispanic women. These variations include AKT kinase mutations activating PI3K/AKT/mTOR signaling pathway and PI3KCA mutations which could potentially benefit from targeted therapies. 4EBP1 phosphorylation by mTORC1 is generally considered a marker of activated mTOR signaling and high levels in tumors associate with worse outcomes in different cancers. To evaluate clinical significance of PI3KCA expression and PI3K/AKT/mTOR signaling, we performed immunohistochemical (IHC) analyses of tissue microarrays (TMA) including 272 BC patient samples from HM women. Protein expression of PI3KCA and p4EBP1 were evaluated quantitatively by receiver operator characteristics (ROC) curves based on area under the curve (AUC) as well as sensibility and specificity. p4EBP1 levels were associated with clinicopathological characteristics. Chi-squared and Fisher’s Exact tests showed higher p4EBP1 expression correlated with estrogen (P=0.001) and progesterone receptor negative BC (P=0.003), TNBC (P<0.001), tumor size (P<0.090), and advanced stage (P<0.001). PI3KCA expression was positively correlated with 4EBP1 expression (P=0.044) as shown by Mann Whitney U tests; but PI3KCA lacked prognostic value after screening through ROC curves. However, uni- and multi-variate Cox regression analyses did show that increased 4EBP1 expression correlates with worse OS. Overall, our study indicates that higher p4EBP1 expression is an independent prognostic factor of worse OS in BC patients. The activation of 4EBP1 may result from several upstream oncogenic alterations or mutations, representing a potential therapeutic target and biomarker. Further research is necessary to better define biological differences in Hispanic women to advance understanding and targeting of health disparities. [Funded by California Breast Cancer Research Program Idea Award B27IB3869, JCCC Breast Cancer Award, Hickey Family Foundation, NCI U54 CA143930, Team Research Grant, UCLA TDG, CIRM DISC2-14166]. Citation Format: Mario Morales Martinez, Giovanny Soca-Chafre, Altagracias Maldonado-Valenzuela, Clara M Rivera-Pazos, Gabriela Antonio-Andres, Mayra Montecillo-Aguado, Georgina Rocha-Lopez, Berenice Alcala-Mota-Velazco, Anel Gomez-Garcia, Madhuri Wadehra1, Richard J Pietras, Sergio Gutierrez-Castro, Sara Huerta-Yepez, Diana Marquez-Garban. Evaluation of PI3K/AKT/mTOR pathway signaling as a prognostic indicator in Hispanic Mexican women with breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C024.

Family Caregivers' Experiences of Living with Hemodialysis Patients: A Descriptive Phenomenology.

Several challenges are experienced by caregivers of patients with chronic kidney disease undergoing hemodialysis treatment. These difficulties pertain to the patients, their hemodialysis treatment, and other caregiving responsibilities and concerns. Given the adverse effects of caring for individuals with such conditions on the lives of caregivers, this study aims to investigate the experiences of hemodialysis patients' family caregivers. A qualitative study with a descriptive, phenomenological approach was conducted in the hemodialysis department of a teaching hospital in Birjand, Iran, in 2022. Fourteen participants were selected through purposive sampling. The data were collected through semistructured interviews and analyzed using Colaizzi's method. The participants were caregivers of dialysis patients who had a 6-month history of caring for patients and were first-degree relatives of the patient. A total of 278 initial codes emerged, which were categorized into three overarching themes and eight subthemes based on the research purpose and question. The overarching themes comprised caregiver time and cost strain, social challenges faced by the caregiver, and life challenges faced by the caregiver. Caregivers of patients with chronic kidney disease face problems in multiple dimensions and are susceptible to developing new problems. The majority of caregivers in this study were extremely vulnerable women; if they experience difficulties, the family's foundation will be weakened. Therefore, caregivers should be included in patients' treatment plans. The expression of caregivers' experiences can help solve the problems they are facing and also helps hospital managers and health planners better plan to solve problems.

Assessing olaparib efficacy in U.S. Veterans with metastatic prostate cancer utilizing a time-indifferent g-rate method ideal for real-world analyses

We aimed to assess real-world efficacy of the PARP inhibitor, olaparib, in US Veterans with metastatic prostate cancer (mPC) by leveraging the national data repository and evaluate a novel approach to assess treatment efficacy in tumors considered rare or harboring rare mutations. Included Veterans had 1) mPC with somatic or germline alterations/mutations in genes involved in homologous recombination repair (HRR), 2) received olaparib monotherapy as well as a novel hormonal therapy/androgen receptor pathway inhibitors (NHT/ARPI), and/or chemotherapy, and 3) estimable rates of tumor growth (g-rate) using PSA values obtained while receiving treatment. Previous work has shown an excellent inverse correlation of g-rate with survival. Using g-rate, we determined tumor doubling time (DT) and DT ratios (DT on olaparib/DT on prior medication). We postulated that a DT ratio≥ 1 was associated with benefit. We identified 139 Veterans, including 42 Black males with tumors harboring mutations/alterations in HRR genes who received olaparib: BRCA2 (50), ATM (32), BRCA1 (10), other mutations (47). 62/139 (45%) of all and 21/42 (50%) of Black Veterans had DT ratios ≥1, including 31, 10, 2, and 19 with BRCA2, ATM, BRCA1, and other mutations, respectively (p=0.006). Median survival with DT ratios ≥1 was superior, being 24.5 vs. 11.4 months for DT ratio <1 (p=0.01, HR 0.50, 95% CI 0.29-0.85). Benefit from olaparib, defined as DT ratio ≥1, was not observed for germline status, starting PSA value, number of prior therapies, or immediate prior therapy. Compared to matched cohorts, tumors in the olaparib cohort had shorter DTs with enzalutamide in first line (367 vs. 884 days; p=0.0043). Using equations indifferent to timing of assessments ideal for real-world efficacy analyses, we showed DT ratio ≥1 representing slower tumor growth on olaparib relative to the prior therapy correlates with improved survival. Olaparib efficacy in Veterans with mPC harboring mutations/alterations in HRR genes emulates clinical trial results. Black men had comparable results. Compared to matched cohorts, in first line, enzalutamide was less efficacious in tumors harboring mutations/alterations in HRR genes. American Society of Clinical Oncology Conquer Cancer Foundation (ASCO CCF), the Blavatnik Family Foundation and the Prostate Cancer Foundation (PCF).

Cross-Sectional Evaluation of Health Insurance Knowledge and Self-Efficacy in Adolescents and Young Adults with Inflammatory Bowel Disease

ObjectiveTo evaluate the status of health insurance knowledge and self-efficacy among adolescents and young adults with inflammatory bowel disease (AYA-IBD). Study designEnglish-proficient AYA-IBD >15 years receiving care at an academic pediatric practice were invited to perform the Kaiser Family Foundation survey on health information knowledge and the Health Insurance Literacy Measure. Analyses of responses by demographic factors were performed using nonparametric analyses and agreement analyses were performed to compare survey responses. ResultsFifty AYA-IBD (60% 15-17 years old; 54% male; 76% white; 32% Hispanic) completed the surveys. Most AYA-IBD (58%) answered less than half the health insurance knowledge questions correctly. Reported ability and confidence in choosing and using health insurance was slight to moderate (median 2.8 on Likert scale of 1[not at all confident] to 4 [very confident]). While health insurance knowledge scores did not vary by demographic factors, total health insurance self-efficacy increased with disease duration, and Hispanic participants reported reduced ability to select health insurance than non-Hispanic counterparts. ConclusionsAYA-IBD demonstrated suboptimal health insurance knowledge and self-efficacy. Our findings identify an important opportunity to provide health insurance education to help prepare all AYA-IBD to manage the costs of medical care during the transition process to adulthood

Isbat Nikah Massal Pasirlangu: Langkah Nyata Mewujudkan Keluarga Sakinah

Unclear marital status remains a crucial issue in Pasirlangu Village, leading to family instability and hindered access to civil rights. This community service aims to solve this problem through the implementation of mass isbat nikah. The methods used include data collection of residents with nikah sirri status, socialization of the importance of isbat nikah, and cooperation with relevant agencies for the implementation of mass isbat nikah. The results showed that the implementation of mass isbat nikah succeeded in providing legal certainty to the marital status of Pasirlangu Village residents who previously had the status of nikah sirri to become legal in religion and the State. In addition, the number of couples who have been isbatized is at least 35 couples who have been successfully isbatized in this service activity. And this program also succeeded in increasing public awareness of the importance of marriage legality as the foundation of a sakinah family and the achievement of legal certainty for all Indonesian people.

(Battery Division Postdoctoral Associate Research Award Sponsored by MTI Corporation and the Jiang Family Foundation) Science of Multiphysics Behavior of Si/C Composite Anodes in High-Energy-Density Lithium-Ion Batteries

The rapidly growing demands on energy storage technologies over the last decade have imposed further requirements for the high energy/power density, safety, and durability of lithium-ion batteries (LIBs). Si/C composite materials have attracted enormous research interest as the most promising candidates for the anodes of next-generation lithium-ion batteries, owing to their high energy density and mechanical buffering property. However, the major disadvantage of materials with ultra-high capacities, such as Si-based materials, is the significant volume change during cycling, which further leads to mechanical and electrochemical degradation. However, a sophisticated and quantitative understanding of the highly electrochemical-mechanical coupling behaviors is still lacking.A comprehensive computational model is indispensable in the developing process of the excellent performance of anode material due to the low-realizability, inconvenience, and high-cost of experiments, which also provides powerful tools for fabrication guidance of novel Si/C composites designs. Hence, a multiphysics modeling framework is established with a detailed geometric description to quantitatively reveal the underlying governing mechanisms of Si/C composite anode behaviors. We studied the effects of the Si weight percentage, the Si-related particle distribution, the Si-related particle size, the mechanical constraint, and the binder domain gradient on the battery performance regarding the potential behavior, capacity delivery, mechanical stress/strain, Li plating, and polarization evolution. In our study, we used silicon monoxide (SiO) as the Si element source and graphite (Gr) as the C element source. Results discover that an 8-10 wt% of SiO would be an optimal choice regarding capacity delivery and minimizing Li plating under 1C constant current charging condition. Positioning SiO particles near the separator and reducing the sizes of SiO particles are also demonstrated to be beneficial for electrochemical performance with trivial influence on mechanical mismatch. In addition, the mechanical constraint demonstrates a balanced effect on the overall performance of cells and the local behaviors of particles. Our findings also indicate that reducing the proportion of carbon-binder domain (CBD) in the upper domain (near the anode surface) compared to the lower domain (near the current collector) positively influences electrochemical performance, particularly in terms of capacity and Li plating. However, such an arrangement introduces potential risks of mechanical failures and we recommend to incorporate a higher proportion of CBD alongside the SiO particles. Finally, an anode design with a lower CBD proportion in the upper domain exhibits superior rate performance.This study explores the multiphysics behavior of Si/C anodes material using a comprehensive methodology combining experimental and FEA techniques, systematically revealing the coupling mechanism among various physical fields, as well as providing efficient and powerful tools in the design, development, and evaluation of high energy density lithium-ion batteries.

The oocyte microenvironment is altered in adolescents compared to oocyte donors.

Do the molecular signatures of cumulus cells (CCs) and follicular fluid (FF) of adolescents undergoing fertility preservation differ from that of oocyte donors? The microenvironment immediately surrounding the oocyte, including the CCs and FF, is altered in adolescents undergoing fertility preservation compared to oocyte donors. Adolescents experience a period of subfecundity following menarche. Recent evidence suggests that this may be at least partially due to increased oocyte aneuploidy. Reproductive juvenescence in mammals is associated with suboptimal oocyte quality. This was a prospective cohort study. Adolescents (10-19 years old, n = 23) and oocyte donors (22-30 years old, n = 31) undergoing ovarian stimulation and oocyte retrieval at a single center between 1 November 2020 and 1 May 2023 were enrolled in this study. Patient demographics, ovarian stimulation, and oocyte retrieval outcomes were collected for all participants. The transcriptome of CCs associated with mature oocytes was compared between adolescents (10-19 years old, n = 19) and oocyte donors (22-30 years old, n = 19) using bulk RNA-sequencing. FF cytokine profiles (10-19 years old, n = 18 vs 25-30 years old, n = 16) were compared using cytokine arrays. RNA-seq analysis revealed 581 differentially expressed genes in CCs of adolescents relative to oocyte donors, with 361 genes downregulated and 220 upregulated. Genes enriched in pathways involved in cell cycle and cell division (e.g. GO: 1903047, P = 3.5 × 10-43; GO: 0051983, P = 4.1 × 10-30; GO: 0000281, P = 7.7 × 10-15; GO: 0044839, P = 5.3 × 10-13) were significantly downregulated, while genes enriched in several pathways involved in cellular and vesicle organization (e.g. GO: 0010256, P = 1.2 × 10-8; GO: 0051129, P = 6.8 × 10-7; GO: 0016050, P = 7.4 × 10-7; GO: 0051640, P = 8.1 × 10-7) were upregulated in CCs of adolescents compared to oocyte donors. The levels of nine cytokines were significantly increased in FF of adolescents compared to oocyte donors: IL-1 alpha (2-fold), IL-1 beta (1.7-fold), I-309 (2-fold), IL-15 (1.6-fold), TARC (1.9-fold), TPO (2.1-fold), IGFBP-4 (2-fold), IL-12-p40 (1.7-fold), and ENA-78 (1.4-fold). Interestingly, seven of these cytokines have known pro-inflammatory roles. Importantly, neither the CC transcriptomes nor FF cytokine profiles were different in adolescents with or without cancer. Original high-throughput sequencing data have been deposited in Gene Expression Omnibus (GEO) database with the accession number GSE265995. This study aims to gain insights into the associated gamete quality by studying the immediate oocyte microenvironment. The direct study of oocytes is more challenging due to sample scarcity, as they are cryopreserved for future use, but would provide a more accurate assessment of oocyte reproductive potential. Our findings have implications for the adolescent fertility preservation cycles. Understanding the expected quality of cryopreserved eggs in this age group will lead to better counseling of these patients about their reproductive potential and may help to determine the number of eggs that is recommended to be banked to achieve a reasonable chance of future live birth(s). This project was supported by Friends of Prentice organization SP0061324 (M.M.L. and E.B.), Gesualdo Family Foundation (Research Scholar: M.M.L.), and NIH/NICHD K12 HD050121 (E.B.). The authors have declared that no conflict of interest exists.

The Role of Islamic Religious Counselors in Providing Premarital Guidance at the Religious Affairs Office of Sultan Daulat District, Subulussalam City, Aceh Province

This study aims to analyze the implementation of premarital guidance at the Religious Affairs Office of Sultan Daulat District, the materials provided in premarital guidance at the Religious Affairs Office of Sultan Daulat District, and the SWOT analysis of premarital guidance at the Religious Affairs Office of Sultan Daulat District. The study used a nautical qualitative approach with data collection techniques in the form of observation, interviews and documentation studies. This study revealed several important findings regarding premarital guidance at the Religious Affairs Office of Sultan Daulat District. The implementation of this guidance follows the requirements for marriage registration in accordance with the latest regulations. Participants were very satisfied with the ease and flexibility of time provided during the guidance, which was arranged according to the agreement between the presenter and participants. Religious counselors showed responsibility and consistency in their duties, making positive contributions to the community by being active in discussions and question and answer sessions. The guidance material was delivered by two groups of presenters: Islamic religious counselors and representatives from the National Population and Family Planning Agency and health agencies. The material covered the management of psychology and family dynamics, reproductive health, and the foundations of a harmonious family. Religious counselors used an independent method in delivering their material. The SWOT analysis shows that religious counselors play a role in reducing the divorce rate in the area. They are also effective in reducing the spread of hoax news about premarital counseling. The guidance methods applied and the flexibility of implementation time help simplify the process and overcome the negative stigma that is often associated with premarital counseling at the Sultan Daulat Religious Affairs Office.

Homoharringtonine synergizes with venetoclax in early Tcell progenitor acute lymphoblastic leukemia: Bench and bed.

Early Tcell precursor acute lymphoblastic leukemia (ETP-ALL) is a distinct subtype of T-ALL with a poor prognosis. To find a cure, we examined the synergistic effect of homoharringtonine (HHT) in combination with the BCL-2 inhibitor venetoclax (VEN) in ETP-ALL. Using invitro cellular assays and ETP-ALL xenograft models, we first investigated the synergistic activity of HHT and VEN in ETP-ALL. Next, to explore the underlying mechanism, we employed single-cell RNA sequencing of primary ETP-ALL cells treated with HHT or VEN alone or in combination and validated the results with western blot assays. Based on the promising preclinical results and given that both drugs have been approved for clinical use, we then assessed this combination in clinical practice. Our results showed that HHT synergizes strongly with VEN both invitro and invivo in ETP-ALL. Mechanistic studies demonstrated that the HHT/VEN combination concurrently downregulated key anti-apoptotic proteins, i.e., MCL1, leading to enhanced apoptosis. Importantly, the clinical results were very promising. Six patients with ETP-ALL with either refractory/relapsed (R/R) or newly diagnosed disease were treated with an HHT/VEN-based regimen. All patients achieved complete remission (CR) after only one cycle of treatment. Our findings demonstrate that a combination of HHT/VEN is effective on ETP-ALL and represents the "backbone" of a promising and safe regimen for newly diagnosed and R/R patients with ETP-ALL. This work was funded by the National Cancer Institute, Gehr Family Foundation, George Hoag Family Foundation, National Natural Science Foundation of China, and Key Research and Development Program of Zhejiang Province of China.

Medical Students' Efforts to Address COVID-19 Vaccine Hesitancy Through Motivational Interviewing.

Background The coronavirus disease 2019 (COVID-19) pandemic reaffirmed health disparities in the United States (US) and highlighted the need for public health strategies to combat vaccine hesitancy, especially amongst vulnerable populations. The Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP) at Florida International University (FIU) serves a predominantly uninsured population, making it a critical area of opportunity for addressing vaccine hesitancy. Motivational interviewing (MI), a technique that supports individuals in making autonomous health decisions, has shown promise in encouraging vaccine acceptance.Medical students at FIU's Herbert Wertheim College of Medicine (HWCOM) are involved in the longitudinal care of the individuals in NeighborhoodHELP and receive training in MI within their clinical skills curriculum, making them optimally positioned to conduct outreach to encourage COVID-19 vaccination. Project goals There were two primary goals of this project: first, to systematically track and improve COVID-19 vaccination rates among individuals in NeighborhoodHELP, andsecond, to equip future physicians with hands-on experience in MI. Methods The COVID-19 Vaccination Promotion Initiative recruited medical students previously trained in MI to conduct outreach to unvaccinated individuals within NeighborhoodHELP. Students engaged in discussions about the COVID-19 vaccine with NeighborhoodHELP members, assisted in scheduling vaccination appointments, and updated medical records. The student team regularly met with faculty advisors to discuss changes in vaccine and public health data and to discuss challenges and successes with outreach efforts. To incentivize participation and enhance vaccine uptake, $25 gift cards were offered to individuals who agreed to receive the vaccine following the outreach conversations. Results From June 2021 to January 2023, the team made an estimated 720-1516 phone calls to NeighborhoodHELP individuals. The team encountered a challenge of low answering rates, with 35% of individuals being unreachable despite multiple attempts. Among those reached, 20% expressed no interest in receiving the vaccine, while 50% were interested in receiving the vaccine or had already been vaccinated. Vaccination rates among NeighborhoodHELP adults rose from 15.2% to 44.3% during this time. Student experiences with MI were generally positive, with many noting success in engaging hesitant individuals. However, the team also encountered challenges, such as growing vaccine apathy within the community and difficulties in reaching patients via cold calls, which limited the overall impact of their outreach efforts. Conclusions By using MI techniques,medical students engaged with community members in meaningful conversations about the importance and safety of COVID-19 vaccination.However,the initiative fell short of the 50% vaccination target, facing challenges such asreliance on unsolicited phone calls and the complexities of incentivizing vaccinations through this outreach method. Future initiatives could benefit from exploring alternative outreach methods, such as in-person engagement at community events or through partnerships with local organizations, to overcome the limitations of phone-based outreach. Additionally, investigating the relative efficacy of in-person versus telephone-based communication in promoting vaccination could provide valuable insights.

Health insurance literacy among patients receiving outpatient cancer treatment.

This study examines patients' understanding of health insurance terms and concepts and quantifies health insurance literacy (HIL) levels by key sociodemographic factors. This study included 393 adult patients with cancer (>18 years old) receiving treatment in two ambulatory infusion centers: Mayo Clinic in Phoenix, Arizona and the University of Mississippi Medical Center in Jackson, Mississippi. Respondents' perceptions of their HIL were assessed using the Health Insurance Literacy Measure (HILM), a validated 21-item measure of a consumer's ability to select and use health insurance (HIL self-efficacy). Respondents' knowledge of health insurance concepts (HIL knowledge) was measured using 10 items created by the Kaiser Family Foundation. The number of correct answers was categorized into three levels: 0-4 (low knowledge), 5-6 (moderate knowledge), and 7-10 (high knowledge). Multivariable logistic regressions were used to compare correct answers to HIL knowledge questions by HIL self-efficacy. Nearly three-quarters of patients had high HIL self-efficacy and high HIL knowledge (70.5%), understanding basic insurance terms, such as premiums and deductibles. Relatively low percentages of patients correctly answered questions about the meaning of provider networks, health insurance formularies, and calculating out-of-pocket spending in scenarios when insurers pay a portion of allowed charges. Lower HIL knowledge was more common among patients with less educational attainment (<college: 15.2%; ≥college: 4.7%), lower household income (<$4999: 11.8%; ≥$5000: 6.1%), and low HIL self-efficacy scores (low: 24.8%; high: 5.2) (all p values <.05). Efforts to improve HIL and navigation of health insurance plan features are required, especially for socioeconomically vulnerable patients.

Family planning decision-making in relation to psychiatric disorders in women: a qualitative focus group study

BackgroundRecent studies revealed an elevated likelihood of unintended pregnancies among women with psychiatric disorders compared to their counterparts without such vulnerability. Despite the importance of understanding family planning decision-making in this group, qualitative inquiries are lacking. This study explored family planning decisions among women with psychiatric disorders.MethodsUtilizing a qualitative approach, three focus group discussions were conducted with purposive sampling: women with a history of unintended pregnancies (N = 3), women without children (N = 5), and women with a history of intended pregnancies (N = 9), all of whom had self-reported psychiatric disorders. Using thematic framework analysis, we investigated the themes “Shadow of the past,” reflecting past experiences, and “Shadow of the future,” reflecting future imaginaries, building upon the existing “Narrative Framework.”ResultsThe Narrative Framework formed the foundation for understanding family planning among women with psychiatric disorders. The retrospective dimension of focus group discussions provided opportunities for reflective narratives on sensitive topics, revealing emotions of regret, grief and relief. Childhood trauma, adverse events, and inadequate parenting enriched the "Shadow of the past". The “Shadow of the present” was identified as a novel theme, addressing awareness of psychiatric disorders and emotions toward psychiatric stability. Social influences, stigma, and concerns about transmitting psychiatric disorders shaped future imaginaries in the shadow of the future.ConclusionsThis study enlightens how family planning decision-making in women with psychiatric disorders might be complex, as marked by the enduring impact of past experiences and societal influences in this sample. These nuanced insights underscore the necessity for tailored support for women with psychiatric disorders.

Poland: Tax labyrinths and legal landscapes—the odyssey of family foundations in Poland

Abstract The Polish Family Foundation Law, introduced in May 2023, was designed to facilitate the preservation and management of family wealth. Its success has exceeded expectations with over 1,500 foundations established in its first year. This article examines the law’s impact, its reception, and the practicalities of establishing a Polish foundation. It also explores the implications for existing foreign foundations, analyzing the challenges posed by the exit tax regulations, Controlled Foreign Corporation rules and withholding tax developments. The article further discusses potential legal adjustments needed to align the law with European Union principles and the opportunities for foreign foundations related to it.

Strong isolation by distance and evidence of population microstructure reflect ongoing Plasmodium falciparum transmission in Zanzibar.

The Zanzibar archipelago of Tanzania has become a low-transmission area for Plasmodium falciparum. Despite being considered an area of pre-elimination for years, achieving elimination has been difficult, likely due to a combination of imported infections from mainland Tanzania and continued local transmission. To shed light on these sources of transmission, we applied highly multiplexed genotyping utilizing molecular inversion probes to characterize the genetic relatedness of 282 P. falciparum isolates collected across Zanzibar and in Bagamoyo district on the coastal mainland from 2016 to 2018. Overall, parasite populations on the coastal mainland and Zanzibar archipelago remain highly related. However, parasite isolates from Zanzibar exhibit population microstructure due to the rapid decay of parasite relatedness over very short distances. This, along with highly related pairs within shehias, suggests ongoing low-level local transmission. We also identified highly related parasites across shehias that reflect human mobility on the main island of Unguja and identified a cluster of highly related parasites, suggestive of an outbreak, in the Micheweni district on Pemba island. Parasites in asymptomatic infections demonstrated higher complexity of infection than those in symptomatic infections, but have similar core genomes. Our data support importation as a main source of genetic diversity and contribution to the parasite population in Zanzibar, but they also show local outbreak clusters where targeted interventions are essential to block local transmission. These results highlight the need for preventive measures against imported malaria and enhanced control measures in areas that remain receptive to malaria reemergence due to susceptible hosts and competent vectors. This research was funded by the National Institutes of Health, grants R01AI121558, R01AI137395, R01AI155730, F30AI143172, and K24AI134990. Funding was also contributed from the Swedish Research Council, Erling-Persson Family Foundation, and the Yang Fund. RV acknowledges funding from the MRC Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 program supported by the European Union. RV also acknowledges funding by Community Jameel.

Switzerland: The Swiss Family Foundation—revival for family wealth and estate planning?

Switzerland: The Swiss Family Foundation—revival for family wealth and estate planning?