Financial Consequences Research Articles

Moral Imperative or Economic Necessity? The Role of Institutional Investors in the Corporate Social Responsibility—Financial Performance Relationship

This study examines how institutional ownership concentration, quantified by the Herfindahl-Hirschman Index (HHI), influences the financial consequences of CSR initiatives within the U.S. restaurant industry. This study distinguishes between CSR activities that are integral to core operations (operation-related CSR) and those that are not (non-operation-related CSR), analyzing their impacts on both market-based (ROA) and accounting-based performance (Tobin’s q) measures. Employing panel regression analysis, findings reveal that higher institutional ownership concentration enhances the alignment of operation-related CSR with improved financial performance. Conversely, the institutional ownership concentration does not significantly moderate the impact of non-operation-related CSR on both performance measures. Given the restaurant industry’s high consumer visibility and operational reliance on social and environmental factors, this study fills gaps in CSR literature by offering insights for aligning CSR strategies with institutional owners’ expectations. The results provide actionable guidance for policymakers and industry practitioners to optimize organizational outcomes from CSR activities.

Effects of alcohol consumption on gambling warning message recall and recognition.

To understand the influence of acute alcohol consumption on the recall and recognition of warning messages. Participants (n = 82) were randomly assigned to a condition where they consumed alcoholic beverages (target blood alcohol concentrations of 0.06%-0.08%) or a condition where they consumed juice. Participants in both conditions then gambled on preprogrammed slot machines in a casino-themed room with four pop-up warning messages appearing twice each. After the gambling session, participants in both conditions completed a filler task followed by free recall and recognition assessments. Most participants (81%) recalled the gist, or the general idea, of the warning messages. However, participants in the alcohol condition underestimated the total number of messages they viewed to a significantly greater extent than those in the juice condition. Participants in the alcohol condition were also significantly less accurate in recognizing messages than participants in the juice condition. Participants in the juice condition were significantly more likely to recall the self-appraisal message than participants in the alcohol condition. There were no other significant differences in the recall of specific messages between conditions. Individuals who are moderately intoxicated are just as likely as nonintoxicated individuals to understand the general idea of warning messages but may have greater difficulty recalling specific details within those messages. Those who are intoxicated may have difficulties engaging in self-appraisal, indicating that messages that are focused on the financial consequences of gambling may be more impactful. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Firm Value Impact of Global Oil and Gas Mergers and Acquisitions: The Role of Environmental Policy Framework

The oil and gas (O&G) industry is under increasing pressure to decarbonize and adopt sustainable practices. While some firms are transitioning toward renewable energy, many continue to expand their traditional O&G operations. This study examines how financial markets perceive the value creation potential of business-as-usual mergers and acquisitions (M&As) by the world’s largest O&G companies from 2000 to 2021. Using an event study methodology, we focus on the role of home-country environmental policy stringency (EPS) in shaping market reactions. Our findings reveal that higher EPS in the acquirer’s home country is associated with a greater perceived loss in shareholder value upon the announcement of traditional O&G M&A deals, suggesting that EPS signals significant operational and financial risks related to hydrocarbon investments. However, when these deals are cross-border, the adverse impact of the acquirer’s home-market EPS diminishes, indicating that expanding beyond domestic markets may help O&G firms mitigate the financial consequences of stricter environmental regulations. JEL Classification: G11, G14, G34, Q40, Q58

Financial Consequences of Geopolitical Turmoil and Trade Restrictions

Financial Consequences of Geopolitical Turmoil and Trade Restrictions

Financial Toxicity in Older Adults With Cancer and Their Caregivers.

With advances in cancer treatment, long-term survival rates have improved in recent decades, resulting in extended life expectancies for many patients. This progress brings substantial challenges, however, particularly in terms of the costs associated with cancer care. The financial burden, often considerable, poses difficulties for older adults with cancer and their caregivers. Financial toxicity refers to the unintended financial consequences and distress that patients and families incur from cancer and its treatment. The prevalence of financial toxicity varies (some estimates with over half experiencing this challenge), and certain subgroups (eg, race other than White and those with lack of social support) are at greater risk. Although studies focusing on older adults are limited, existing research has shown that financial toxicity is associated with adverse outcomes, including delayed care, poorer physical, social, and psychological well-being, and lower overall quality of life. Moreover, financial toxicity may result in negative caregiver health outcomes, which can in turn affect patient outcomes. These negative caregiver effects may persist into the bereavement phase. Various methods are available to assess financial toxicity, and they consist of three domains: material, psychological, and behavioral. Available interventions focus on identifying those at risk and providing financial counseling, navigation, and literacy, as well as tangible assistance. Although the impact of financial toxicity is increasingly recognized, studies in older adults and their caregivers are lacking. A better understanding of their needs is important to develop interventions aimed at mitigating financial toxicity in older adults with cancer and their caregivers.

Exploring Aviation Accidents and Related Costs: A Critical Literature Review across Global and Greek Skies

Safety has a direct impact on the economic policy of an organization, especially when it concerns critical sectors such as military, commercial, and general aviation. It is apparent that such organizations prioritize aviation safety with great attention since even a single accident can cost not only human lives but also the financial survival of the respective company (Chance & Ferris, 1987). According to data from the National Transportation Safety Board (NTSB), the rate of accidents per 100,000 flight hours for U.S. air carriers has significantly declined over time, dropping from 1.77 in 1965 to 0.20 in 1990, and further decreasing to 0.13 in 2020 (NTSB, 2021). Also, the Massachusetts Institute of Technology (MIT) revealed a significant decline in airline passenger fatalities by considering the total number of passengers boardings. Specifically, this rate stood at one fatality for every 7.9 million passenger boardings in 2020, which is a notable improvement from one fatality per 2.7 million boardings between 1998 and 2007. Looking further back in history, the risk of fatality for commercial airline passengers was one death per 750,000 boardings during the period of 1978-1987 and one death per 350,000 boardings between 1968 and 1977 (Barnett, 2020). Nevertheless, despite aviation is currently safer than ever, accidents still occur globally. In this context, and by drawing on the literature, a critical review is conducted so as to analyze the financial consequences of aviation accidents and explore accident rates globally. Also, a special focus on Greece is attempted to facilitate comparison between worldwide and national accident rates. The aforementioned goals were pursued by discriminating between military, commercial and general aviation in order to pinpoint differences between these sectors. It is envisaged that through this process, additional knowledge will be built regarding the accident cost in aviation. By acknowledging that diagnosis is the initial response to overcoming challenges, it is envisioned that analyzing the current accident rates and costs will aid in the development of more advanced mitigation strategies aimed at safety optimization. Keywords: Transportation Safety, Aviation Industry, Cost Analysis, Regulation.

Differences in economic consequences of union dissolution across gender and ethnic groups in Belgium and Israel

ABSTRACT Given increased ethnic diversity in Europe and Israel in recent decades, coupled with high union dissolution rates, the study compares two case studies exemplifying diverse ethnic and immigrant societies – Belgium and Israel. We examine differences between ethnic, migrant, and gender groups in each country, and the intersections between them, regarding the economic outcome of union dissolution, as well as the effect of reemployment on these consequences. The study adds to the broad discussion on union dissolution and inequality in the dimensions of ethnicity, migration and gender and their intersections across countries. Growth models were applied to data from two longitudinal sources: the Data Warehouse on Labor Market and Social Security for Belgium and administrative data from tax authorities with the National Insurance Institute database for Israel. Results show that change in income upon separation is gendered and varies between ethnic/migrant groups in both countries. Cross-country differences were found in the effect of reemployment mainly among women, as it increases the income of minority-group women in Belgium but not Israel. The study emphasizes the importance of the intersectionality perspective in comparative studies, revealing the interplay between ethnicity, gender, and country in how ex-partners cope with the financial consequences of union dissolution.

Budget impact analysis of cenobamate for epilepsy patients with drug-resistant focal onset seizures in the Netherlands

Objective The objective of this study was to explore the financial consequences of adopting cenobamate as a treatment alternative in epilepsy patients with drug-resistant focal onset seizures (FOS) from a societal perspective in the Netherlands. Methods A previous budget impact model with a 5-year time horizon was adapted to the Dutch setting accounting for the eligible population, real-world market shares, treatment effectiveness and resource use in two scenarios: cenobamate with constant market share versus cenobamate with linearly increased market share up to 20%. Clinical inputs included treatment response, seizure reduction and adverse events. Costs consisted of drugs, medical and non-medical costs. One-way sensitivity analysis and scenario analysis were conducted to test the robustness of our results. Results 14,723 patients were eligible for cenobamate in 2022. Although cenobamate adds a gross budget impact of €12,686,30, the displacement of other drugs yields a total impact on the drug budget of €3,722,596 over 5 years. Adopting cenobamate resulted in a medical cost savings of €13,499,498 due to less resource use, and non-medical cost savings of €22,144,054 due to reduced productivity losses. Overall, savings generated at medical and non-medical cost level offset the gross drug budget impact of cenobamate, resulting in a saving of €31,920,955 over 5 years. Results were robust in the sensitivity/scenario analyses. Conclusion Treatment with cenobamate is associated with both medical and non-medical cost savings, which offset the increase in drug budget and result in a significant potential budget saving. The higher the market share of cenobamate, the larger the budget savings. We acknowledge several limitations; Complex scenarios such as drug interactions, stopping/switching drugs, and multiple drug use were not taken into account. The long-term efficacy and safety of cenobamate and its comparators remains uncertain. Future real-world data are needed to confirm our findings.

“Whenever I think about this, I feel like killing myself, because life has no meaning to me anymore”: an exploration of the consequences of rape victimization for men

ABSTRACT Background and purpose Rape is one of the most common human violations, with devastating consequences for the victims and their families. Although this scourge affects everyone, regardless of gender, studies on rape victimization have largely focused on women and children as the victims. Studies on rape victimization of men are therefore limited and little is known about the consequences of rape victimization for men. Accordingly, this study sought to fill this gap by exploring the consequences of rape victimization for men in the City of Tshwane Metropolitan Municipality, Gauteng Province, South Africa Method A qualitative research approach underpinned by interpretative phenomenological analysis (IPA) was used to collect data from a purposive sample of eleven participants. Data was collected using semi-structured face-to-face individual interviews and analysed using the IPA framework. Trustworthiness and validity of study findings was ensured by following Lincoln and Guba criteria, and the study followed ethical principles outlined in the Declaration of Helsinki on conducting research with human participants. Results Six superordinate themes emerged from the data as consequences of rape victimization for men, namely physical, psychological, emotional, social, spiritual and financial consequences. Conclusion The study provides a comprehensive description of the effects of rape on the overall well-being of men. The findings underscore the need for the development of holistic clinical care management guidelines and psychosocial interventions that are specifically tailored for men post-rape. Furthermore, longitudinal studies on the long-term impact of rape on men should be conducted.

Environmental Protection Tax (EPT) and Its Influence on Firms’ Financial Health and Innovation Capabilities: Evidence from Chinese Listed Companies

This study examines the impact of the environmental protection tax (EPT) on the liquidity and green technological innovation of listed companies in China from 2013 to 2023. Using a difference-in-differences (DID) approach, we analyze the short-term financial consequences of the EPT, focusing on liquidity ratios while also examining its effects on innovation through research and development investments. The results suggest that the EPT significantly reduces corporate liquidity, particularly in industries with high environmental compliance costs, thereby placing financial pressure on firms. Although the EPT stimulates innovation, the inherent time lag in realizing financial returns from R&D investments exacerbates short-term liquidity problems. This research offers important insights for policymakers seeking to balance sustainability goals with corporate financial health.

امكانية تحسين فعالية الرقابة الداخلية باستخدام اشارات خطر التدقيق للحد من حالات الغش والاحتيال: دراسة نظرية

Abstract The contemporary business environment is always fraught with risks, uncertainties and uncertainties, including errors and fraud, which can have serious financial consequences for an organization's reputation. Despite the implementation of internal control systems in these institutions, these risks still exist and recur as the business and operations are completed. This is where the research problem of ineffectiveness arisesInternal controls in mitigating the occurrence of errors and cases of fraud within institutions. This motivates auditors to take a proactive approach to identifying and addressing weaknesses. This approach is to use the potential of audit risk signals as a means of enhancing the effectiveness of internal control measures. This study aimed to increase the auditor's efficiency in detecting financial fraud by studying and analyzing the impact of using audit risk signals in improving the effectiveness of internal control, and evaluating internal control systems and the extent of reliance on it. The study relied on the descriptive approach through the use of theses, letters, periodicals, books and websites that dealt with the subject of the study, especially those related to the topics of audit risk signals and internal control. The study concluded several conclusions, the most important of which are: that the availability and use of audit risk signals by the auditor helps to achieve savings in the time and cost allocated to the audit process, and to direct attention to citizens who have the possibility of fraud, which achieves the effectiveness of the audit process in general, and the high efficiency of the audit in particular, there is a lack of access to sufficient and reliable information before starting the audit, and this indicates that there are obstacles that limit the importance of good communication with employees and the collection of information necessary to understand the situation accurately. The study also included several recommendations, the most important of which are: the need for auditors to be distinguished by the ability to analyze the causes and search for the real roots of the problem instead of relying only on apparent signals. Auditors should adhere to strong and transparent audit practices such as audit risk signals to ensure the correctness and reliability of employees' transactions, management, assets and financial reports in order to improve the effectiveness of internal control.

Effect of factory reliability on bagasse usage and surplus

Poor factory reliability increases season length, reduces sugar production and reduces the supply of bagasse available for cogeneration and the production of by-products. The financial justification for capital expenditure, maintenance and control system upgrades usually account for the extended season length and lost sugar production associated with stoppages. However, the extra bagasse use due to stoppages is often harder to quantify, and, therefore, the resulting financial consequences are often not considered. This work attempts to quantify the effects of stoppages on bagasse use in factories so that the true costs of factory stoppages can be more accurately determined. Factory data have been used to predict the effects of long and short factory stops on bagasse consumption and surpluses. Calculations were carried out for a factory data set with a relatively small number of short stops and a factory data set with a large number of short stops. For both data sets, far more bagasse was lost due to short stops than long stops, and the quantity of bagasse consumed due to short stops represents a significant loss of revenue. Stops disrupt and increase the bagasse consumption of the boiler station in ways that are difficult to model, so it is likely that the calculations in this work underestimate the bagasse consumption and, therefore, revenue lost due to stops.

Behavioral risk assessment of work-related musculoskeletal disorders among workers of petrochemical industries: protocol of a mixed method study

BackgroundMusculoskeletal disorders (MSDs) are one of the most common occupational diseases and the main cause of disability worldwide. Work-related musculoskeletal disorders (WMSDs) are one of the common health risks and the most important cause of absenteeism due to disability in various industries, including the petrochemical industry, in developed and developing countries. These disorders have important social economic, and significant financial consequences due to direct and hidden costs. Health behaviors play a role in both creating and preventing musculoskeletal disorders in employees. Therefore, by identifying the influencing factors on these behaviors, it is possible to strengthen and improve the preventive behaviors of musculoskeletal disorders through educational intervention programs. This study aims to assess the behavioral risk of work-related musculoskeletal disorders, and design and implement an educational intervention to teach effective behaviors in the prevention of musculoskeletal disorders in petrochemical industry workers.MethodsThis study is a mixed-method study implemented in four stages involving the qualitative study, the design and evaluation of an instrument, the design of an experimental randomized clinical trial, and the psychometric evaluation of the instrument and the evaluation of the program. The research community consists of employees working in the petrochemical industry. The volume of samples in the qualitative study with the purposeful sampling method, in the instrument design stage based on the available sampling method, and also in the experimental study, the samples are employees suffering from work-related musculoskeletal disorders, who were selected based on a simple random method from among the employees of the petrochemical industry. Then they will be divided into intervention and control groups. The instruments of this research include a demographic questionnaire, a researcher-made questionnaire for measuring behavior, and two auxiliary instruments including the visual analog scale (VAS) and the Quebec Disability Scale. Evaluation is done in 4 stages: pre-test, immediately, 3, and 6 months after the intervention of both groups. The obtained data will be analyzed using SPSS software.DiscussionMusculoskeletal disorders related (WMSDs) to work can harm employees’ health in various industries, including the petrochemical industry. This study attempts to evaluate the behavioral risk of work-related musculoskeletal disorders among petrochemical industry workers and design and implement an appropriate educational intervention program.Trial registrationIranian Registry of Clinical Trial (IRCT20240321061346N1). Registered on 2024–04-10.Ethics Status: Ethics code: IR.MODARES.REC.1402.251.

Serum free light chains in a racially diverse population including African Americans and populations from South Africa

Detection of light chain (LC) monoclonal gammopathies (MG) traditionally relies on serum free LC (FLC) κ, λ, and their ratio (κ/λ) reference ranges based on a mostly White population. We investigated FLC values in a racially diverse population by screening 10,035 individuals for heavy chain MG, identifying 9,028 negative cases whose FLC were measured. Participants included 4,149 from the PROMISE Study (US, n=2,383; South Africa, n=1,766) and 4,879 from the Mass General Brigham Biobank, with 44% self-identifying as Black. Using standard FLC reference ranges, 1,074 out of 10,035 individuals (10.7%) were diagnosed with LC-MGUS, with 99% being κ-restricted. In the US, 14.8% of Black and 4% of White individuals were diagnosed (p<0.01). Among US participants of African (AFR) and European (EUR) genetic ancestry, 14.4% AFR and 2.9% EUR were diagnosed (p<0.01). Among South Africans (100% Black), 27.8% were diagnosed using standard ranges. To avoid overdiagnosis, we propose a new κ/λ ratio reference range (0.686 to 2.10) for populations of African descent with normal renal function, with standard values for κ and λ being 7.97 to 77.50 mg/L and 6.20 to 49.20 mg/L, respectively. This reduces LC-MGUS overdiagnosis by 91% (10.7% vs. 0.97%). Using the new reference, LC-MGUS accounts for 8.8% of MGUS cases, with 74% being κ-restricted, consistent with LC myeloma rates. These findings highlight the importance of basing disease definitions, such as MGUS, on diverse populations. Adopting our proposed FLC reference values would reduce MGUS overdiagnosis among Black individuals, avoiding unnecessary financial, psychological, and medical consequences.

Effect of age on susceptibility to the attraction effect in sequential risky decision-making

Abstract Our study aims to contribute to the existing body of research on age-related changes in decision-making by investigating susceptibility to the attraction effect across adulthood. Prior studies have produced inconsistent conclusions regarding the decision-making abilities of older individuals, with some portraying them as easily manipulated and risk-averse, while others suggest the opposite. To address this issue, we conducted two experiments using a novel paradigm of the roulette task: (1) in an online environment with 357 participants and (2) in a laboratory setting with 173 participants. The results were consistent and demonstrated the robustness of the attraction effect. However, no age differences in susceptibility to the attraction effect as a common decision bias were found. As predicted, older adults were more likely to commit simple decision-making mistakes, especially in the preliminary trials, which could have serious financial or societal consequences. Additionally, older adults exhibited more risk-seeking behaviours. Furthermore, we observed that the dynamics of decision competence (as indicated by a decrease in the selection of erroneous decoy options and an increase in decision fluency) were similar for both younger and older adults, suggesting preservation of the ability to optimise decision-making while becoming familiar with new tasks. These findings provide insight into the cognitive functioning of older adults and indicate that decision-making abilities in late adulthood may be more complex than commonly assumed.

Trends in Overactive Bladder Therapy: Associations Between Clinical Care Pathways, Practice Guidelines, and Therapy Utilization Patterns.

Overactive bladder (OAB) is a chronic condition with significant financial and health-related consequences. Guidelines and treatment pathways were created to optimize care and provide a clinical framework for diagnosing and managing OAB. However, the impact of these efforts and patterns of medical treatment for OAB are poorly understood. Therefore, we sought to evaluate overall trends in therapy utilization before and after the 2014 American Urological Association (AUA)/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) OAB guideline amendment and publication of the OAB clinical care pathway in 2016. In this retrospective cohort study, we analyzed data from Optum, a national administrative health and pharmacy claims database, between 2013 and 2018. All adult patients diagnosed with idiopathic OAB were identified by the International Classification of Diseases 9th and 10th Revision codes. Oral OAB therapies were identified using National Drug Codes, while third-line therapy procedures, onabotulinumtoxinA (BTX), sacral neuromodulation (SNM), and percutaneous tibial nerve stimulation (PTNS), were identified using Current Procedural Terminology (CPT) codes. The study's primary outcome was the annual number of OAB prescriptions filled by pharmacotherapy class and the number of minimally invasive therapies performed during the study period. The secondary outcome was the association between OAB therapy utilization and various clinical and sociodemographic factors. Patterns of care were analyzed from 2013 to 2018, and initial treatment with each therapy was collected, excluding repeat procedures from the analysis. 1 825 782 patients were included in the study. The mean age was 61.1 ± 16.7 years, and 1 071 420 patients were female (58.7%). The number of new OAB diagnoses increased by 369% from 2013 to 2017. During the 6-year study period, 347 052 (19%) patients were treated with oral and/or third-line therapies. The overall number of oral medications prescribed peaked in 2016, followed by a 17% decline between 2016 and 2018. In 2013, the two most prescribed oral medications were oxybutynin (46%) and solifenacin (31.8%). By 2018, mirabegron (18.5%) surpassed solifenacin (16.5%), with oxybutynin still accounting for most prescriptions written (55%). Eighty percent of all initial mirabegron prescriptions were filled by patients over the age of 65. The rate of third-line therapy procedures almost doubled between 2013 and 2018 (9-17 procedures per 1000 OAB patients, p < 0.001). Following the publication of the first OAB guidelines, there was an increase in OAB diagnoses, followed by a decrease in anticholinergic medication use, and a rise in beta-3 agonist utilization in patients over 65 years old. Additionally, there was greater adoption of third-line OAB therapies. These trends indicate that OAB therapy guidelines and clinical practice pathways may influence treatment patterns. Given the recent publication of the OAB guidelines, further studies are necessary to assess their impact on therapy utilization patterns.

Climate and health: a path to strategic co-financing?

Leveraging the co-benefits of investments in health and climate can be best achieved by moving away from isolated financing approaches and adopting co-financing strategies, which aim to improve the outcomes of both sectors. We propose a framework for studying co-financing for health and climate that considers the degree of integration between sector funding, and whether arrangements are 'passive', when cross-sectoral goals are indirectly affected, or 'strategic', when they are pre-emptively supported to build resilience and sustainability. We conducted a rigorous, evidence-focused review to describe co-financing mechanisms according to a framework, including the context in which they have been employed, and to identify enablers and barriers to implementation. We searched the international literature using Pubmed and Web of Science from 2013 to 2023, the websites of key health and climate agencies for grey literature and consulted with stakeholders. Our review underscores the significant impact of climate change and related hazards on government, health insurance and household health-related costs. Current evidence primarily addresses passive co-financing, reflecting the financial consequences of inaction. Strategic co-financing is under explored, as are integrative co-financing models demanding cross-sectoral coordination. Current instances of strategic co-financing lack sufficient funding to demonstrate their effectiveness. Climate finance, an under used resource for health, holds potential to generate additional revenue for health. Realizing these advantages necessitates co-benefit monitoring to align health, climate mitigation and adaptation goals, alongside stronger advocacy for the economic and environmental benefits of health investments. Strategic co-financing arrangements are vital at all system levels, demanding increased cross-sectoral collaboration, additional funding and skills for climate integration within health sector plans and budgets, and mainstreaming health into climate adaptation and mitigation plans. Supporting persistent health needs post-disasters, promoting adaptive social protection for health and climate risks, and disseminating best practices within and among countries are crucial, supported by robust evaluations to enhance progress.

Evolution of financial intermediation and performance consequences in China’s commercial banks

PurposeThis study evaluates the evolution from traditional to nontraditional financial intermediation (NTFI) in Chinese commercial banks from 2006 to 2021, analysing its impact on bank performance and risk.Design/methodology/approachAccounting measures are used to construct granular activity data, and factor analysis is employed to develop a financial intermediation evolution (FIE) index. The fully modified OLS (FMOLs) estimator is used for nonstationary data analysis, and difference-in-differences (DID) analysis is used for robustness check.FindingsChinese banks exhibit unique evolution in financial intermediation compared to developed economies, with greater inter-bank variations over time than intra-bank differences. From 2006 to 2017, three paths were identified: Investment, Fee and Repo models, with a fourth path (the Investment2 model) emerging post-2017. Only the Repo model enhances bank returns (ROA &amp; ROE), while shifts towards NTFI increase liquidity and leverage risks across all models. The evolution of bank business models and their consequent implications on performance and risks are influenced by regulatory objectives and banks’ endeavours in regulatory arbitrage.Practical implicationsMajor stakeholders in the banking sector can gain a better understanding of financial intermediation and associated market behaviour, performance and risks, with significant implications for banking regulations and crisis management.Originality/valueThis study provides the first comprehensive overview of the evolution of Chinese commercial banks’ financial intermediation activities over an extended period, uncovering the unique characteristics distinct from the developed economies.

Treatment discontinuation in adults with atypical hemolytic uremic syndrome (aHUS): a qualitative study of international experts’ perspectives with associated cost-consequence analysis

BackgroundAtypical hemolytic uremic syndrome (aHUS) is a rare, life-threatening thrombotic microangiopathy (TMA) related to congenital mutations impeding control of the alternative pathway of complement. Following approval of the complement C5 inhibitor eculizumab by the European Medicines Agency and the US Food and Drug Administration, initial guidelines suggested lifelong therapy. Yet, growing evidence indicates that discontinuation of eculizumab, or its long-acting form ravulizumab, is possible for many patients. This mixed-methods study sought to explore international experts’ perspectives and experiences related to treatment duration in adult patients with aHUS, while also estimating the financial and potential health consequences of early discontinuation.MethodsBetween January and December 2023, we conducted 10 qualitative interviews with experts in the treatment of aHUS, based upon which we constructed a quantitative decision tree, designed to estimate time on treatment and treatment- and disease-related adverse events.ResultsThematic analysis of the interview data identified four main themes: (1) Concerns and prior experience; (2) High-risk vs. low-risk groups; (3) Patient preference and adherence; and (4) Funding for monitoring and re-treatment. Although most interviewees were in favour of considering treatment discontinuation for many patients (citing the high cost, burden, and potential side effects of lifelong treatment as key reasons), a prior negative experience of discontinuation seemed to make others more reluctant to stop. Deciding which patients required lifelong treatment and which not involved consideration of a wide range of factors, including patient- and system-related factors. Cost-consequence analysis demonstrated the financial savings associated with early treatment discontinuation at the expense of increased risk of recurrent TMA events. Close monitoring for these events had the potential to minimise any long-term injury, primarily renal, with an estimated one event per 100 patient years. For patients at high risk of TMA and with poor adherence to monitoring, rates of renal injury rose to three events per 100 patient years.ConclusionsaHUS treatment protocols are changing globally in response to new clinical evidence. Against this backdrop, our mixed-methods study provides compelling evidence on the complexity of factors influencing treatment discontinuation decisions in aHUS, as well as the financial and health consequences of early discontinuation.

Exploring problems Dutch transgender and gender diverse people experience during transition

Background and Aim During transition transgender and gender diverse (TGD) people may experience various problems. This research aimed to identify the problems Dutch TGD people face during transition, to examine how frequently they encounter these problems, and to create an overview of the main problems. Method The concept mapping method was used to inventory problems TGD people experience during the transition process. A focus group, consisting of TGD people and care providers, formulated seventy-four such problems. Subsequently, a new group of 124 TGD participants reported how often they perceived these problems. We analyzed the frequencies of the experienced problems and the differences between groups based on gender identity and transition phase using MANOVA. The influence of age was examined with multiple regression analyses. Results Principal component and cluster analysis, based on these problems, revealed five clusters: problems arising from the care process, consequences of the transition in relation to yourself, consequences of the transition in relation to others, problems arising from society, and financial consequences of the transition. The most frequently experienced problems were the long waiting lists, confrontation with one’s body, and the energy the transition takes. The MANOVAs revealed that frequency scores varied with identity and phase of transition. For example, trans men and nonbinary people reported a higher frequency of experiencing problems related to body satisfaction than trans women. The frequency scores were correlated with age; younger participants scored higher on many experienced problems. Discussion We highlighted the problems that emerge during transition. The observed differences between groups showed that TGD people vary widely in their experiences during transition. This inventory can provide useful input for supporting TGD people during their transition and serve as a guide for the development of more TGD-inclusive policies.