Financial Barriers Research Articles

AFFORDABLE VIRTUAL REALITY HAPTIC-FEEDBACK SURGICAL SIMULATOR: A PROOF OF CONCEPT

INTRODUCTIONSimulation plays an important role in surgical education and the ability to perfect surgical performance. Simulation can be enhanced by adding various layers of realism to the experience. Haptic feedback enhances the simulation experience by providing tactile responses and virtual reality imagery provides an immersive experience and allows for greater appreciation of three-dimensional structures. In this study, we present a proof-of-concept haptic simulator to replicate key steps of a cervical laminoplasty procedure. The technology uses affordable components and is easily modifiable so that it can be used from novice through to expert level. Custom models can be easily added ensuring the simulator can be used in a wide range of orthopaedic applications from baseline education through to day of surgery pre-operative simulation.METHODWe used the Unity Game Engine, the 3D Systems “Touch” Haptic Feedback Device (HFD), and a Meta Quest VR headset. Our system uses a number of complex algorithms to track the shape and provide haptic feedback of a virtual bone model. This allows for simulation of various tools including a high-speed burr, Kerrison rongeur and intraoperative X-rays.RESULTSOur simulator replicates the tactile sensations of bone-burring tasks. Although we focused on the cervical laminoplasty procedure, the system can load data from CT scans, enabling the simulation of multiple other procedures. The parts cost of our system, $10,000 NZD, is a fraction of the cost of traditional surgical simulators.DISCUSSIONOur simulator reduces financial barriers to accessing orthopaedic simulators. Trainees can perform hands-on practice without compromising patient safety. The immersive nature of VR, combined with realistic haptic feedback, enables trainees to develop the dexterity and three-dimensional understanding of detailed bony work. Further refinements are needed before we can perform validation studies on our system.CONCLUSIONSWe present an affordable surgical simulator capable of simulating bony surgical procedures in a VR environment using haptic feedback technology and consumer-grade components.ACKNOWLEDGEMENTSThis research was made possible by the generosity of the Wishbone Trust.

Eating Disorder Treatment Access in the United States: Perceived Inequities Among Treatment Seekers.

Although eating disorders are associated with high rates of psychological and physical impairments and mortality, only about 20% of individuals with eating disorders receive treatment. No study has comprehensively assessed treatment access for those with these disorders in the United States. The authors examined access to eating disorder treatments and how it might vary among some populations. Seekers of treatment for eating disorders (N=1,995) completed an online assessment of clinical demographic and anthropometric characteristics, barriers to eating disorder treatment access, and eating disorder symptomatology. Analyses were conducted to identify treatment access barriers, compare barriers to treatment access across demographic groups, and investigate relationships between barriers to treatment access and eating disorder symptoms. Financial barriers (e.g., lack of insurance coverage) were the most frequently reported barrier to treatment access. Participants with historically underrepresented identities and with a diagnosis of other specified feeding or eating disorder (OSFED) reported more barriers related to financial challenges, geographic location, eating disorder identification, sociocultural factors, and treatment quality compared with those with historically represented identities (e.g., White and cisgender persons). Higher frequencies of reported barriers to treatment access were associated with more severe eating disorder symptoms and poorer illness trajectories. Financial barriers were the most significant impediment to accessing treatment among individuals seeking eating disorder treatment. Barriers to treatment access disproportionally affected underrepresented groups and those with an OSFED diagnosis.

Does health voucher intervention increase antenatal consultations and skilled birth attendances in Cameroon? Results from an interrupted time series analysis

BackgroundLimited access to health services during the antenatal period and during childbirth, due to financial barriers, is an obstacle to reducing maternal and child mortality. To improve the use of health services in the three regions of Cameroon, which have the worst reproductive, maternal, neonatal, child and adolescent health indicators, a health voucher project aiming to reduce financial barriers has been progressively implemented since 2015 in these three regions. Our research aimed to assess the impact of the voucher scheme on first antenatal consultation (ANC) and skilled birth attendance (SBA).MethodsRoutine aggregated data by month over the period January 2013 to May 2018 for each of the 33 and 37 health facilities included in the study sample were used to measure the effect of the voucher project on the first ANC and SBA, respectively. We estimated changes attributable to the intervention in terms of the levels of outcome indicators immediately after the start of the project and over time using an interrupted time series regression. A meta-analysis was used to obtain the overall estimates.ResultsOverall, the voucher project contributed to an immediate and statistically significant increase, one month after the start of the project, in the monthly number of ANCs (by 26%) and the monthly number of SBAs (by 57%). Compared to the period before the start of the project, a statistically significant monthly increase was observed during the project implementation for SBAs but not for the first ANCs. The results at the level of health facilities (HFs) were mixed. Some HFs experienced an improvement, while others were faced with the status quo or a decrease.ConclusionsUnlike SBAs, the voucher project in Cameroon had mixed results in improving first ANCs. These limited effects were likely the consequence of poor design and implementation challenges.

Developing classroom ICT teaching techniques, principles and practice for teachers in rural Ghana without access to computers or internet: a framework based on literature review

PurposeThis paper aims to propose a conceptual framework for integrating information and communication technologies (ICT) into teaching practices for educators in rural Ghana lacking computer and internet access. Bridging the rural–urban digital divide is critical for equitable quality education. This research identifies distinct infrastructure, financial, human, and socio-cultural challenges of ICT adoption in underserved Ghanaian schools through an exhaustive literature review. The framework provides tailored strategies to empower teachers to leverage ICT for innovative pedagogy despite limitations. Ultimately, the goal is to offer pragmatic, evidence-based solutions to advance ICT-enabled instruction and digital equity in marginalized settings.Design/methodology/approachThis study utilizes a qualitative literature review methodology to develop a conceptual framework for ICT teaching techniques tailored to the rural Ghanaian context. Published empirical studies, theoretical papers, and reports focused on ICT education in developing countries, particularly sub-Saharan Africa, were systematically reviewed across multidisciplinary databases. Relevant theories and models, like TPACK and SAMR, were analyzed to determine appropriate modifications for the framework design. The proposed strategies emphasize affordable technologies, teacher training, localized content, and culturally relevant pedagogies selected based on evidence from literature to address the unique barriers and needs of the rural setting.FindingsThe literature review revealed profound infrastructure, financial, human, and socio-cultural barriers to ICT adoption in rural Ghanaian schools. These include lack of electricity, internet, hardware, and software alongside inadequate teacher training and support. The proposed conceptual framework offers solutions including leveraging low-cost technologies like mobile devices, prioritizing teacher professional development, developing localized digitally-enabled resources, and fostering community participation. Culturally relevant pedagogies are also emphasized. This tailored, evidence-based approach holds promise for enhancing ICT-enabled instruction and bridging digital divides to promote equitable quality education. Further findings will emerge through framework implementation and evaluation.Research limitations/implicationsThis conceptual framework requires implementation and evaluation to truly determine its impact and effectiveness in the intended rural Ghanaian context. As a literature review, primary data collection was not undertaken. Practical application of the framework in schools can yield direct insights through surveys, interviews, observations, and analysis of key educational outcomes pre and post-implementation. Comparisons with control groups may further illuminate its efficacy. Monitoring and adaptation over time is also essential. Ultimately, this research sets the foundation for praxis-oriented work transforming ICT integration in marginalized communities to advance digital equity and inclusion.Practical implicationsThis research provides an evidence-based, context-aware framework with pragmatic solutions to enhance ICT-enabled teaching and learning in underserved rural Ghanaian schools. It offers guidance to teachers, administrators, and policymakers on integrating technology despite infrastructure and resource constraints. The emphasis on cost-effective innovations, educator training, localized content, and community participation can inform planning and investments in ICT education. Broader applications include adapting the framework for other developing country contexts facing comparable challenges. Overall, this work promotes digital equity and quality education access, catalyzing social development and aligning with the UN Sustainable Development Goals.Social implicationsThis research highlights the urgent need to address digital divides exacerbating educational inequalities between rural and urban communities in Ghana. Lack of technology access and utilization in rural schools threatens to widen gaps in skills, capabilities, and opportunities for students. Strategic integration of ICT can promote social inclusion, cultivate digital literacy, and equip youth to participate in the global digital economy, thereby enhancing prospects. More broadly, advancing digital equity and ICT-enabled education empowers marginalized groups, fosters community empowerment, and drives progressive social change. This work underscores that localized, context-appropriate solutions are pivotal for promoting development and social justice.Originality/valueThis research fills a crucial gap by proposing a conceptual framework tailored specifically for integrating ICT in teaching practices in rural Ghanaian schools lacking digital access, responding to context-specific barriers and needs. While extensive literature examines ICT education models globally, few studies offer localized strategies for resource-constrained environments. This framework adapts established models based on a systematic literature review, emphasizing affordability, capacity building, and cultural relevance. By synthesizing evidence-based, pragmatic solutions to advance ICT-enabled instruction in marginalized settings, this work provides a valuable foundation for praxis transforming rural education. The localization approach could inform frameworks for other developing regions.

Do Financial Barrier Beliefs About Marriage Predict Building Wealth? Latent Growth Curves of Emerging Adults’ Financial Barrier Beliefs, Assets, and Debt

AbstractScholars have found that among emerging adults, financial barrier beliefs about marriage—like believing financial independence should be achieved prior to marriage—appear to be common. Despite the prevalence of beliefs about finances regarding marriage readiness, scholars have not established whether and how these financial barrier beliefs about marriage predict emerging adults’ debt and assets over time. Through the lens of marital paradigms theory, we sought to address this gap by examining whether and how the initial level and changes in financial barrier beliefs about marriage predict changes in young emerging adults’ debt and assets across four waves of data from 1,033 young U.S. emerging adults. We found that, on average, financial barrier beliefs about marriage increased, assets were relatively stable, and debt increased over the early years of emerging adulthood. We also found that increases in emerging adults’ agreement with financial barrier beliefs like ‘finances are a barrier to marriage’ over time were associated with a decrease in assets over time. However, neither the initial level nor changes in financial barrier beliefs about marriage predicted changes in debt over time. In short, our findings provide some evidence that beliefs like a certain amount of money should be saved before marriage, somewhat paradoxically, do not appear to help young emerging adults build their assets.

Low HBV knowledge is associated with low HBV vaccination uptake in general adult population despite incentivization of HBV vaccination

BackgroundHepatitis B virus (HBV) vaccination in Vietnamese adults remains low and unequally distributed. We conducted a study on HBV-naïve adults living in Ho Chi Minh City, Viet Nam, to determine barriers associated with HBV vaccination uptake after removing the financial barrier by providing free coupons for HBV vaccination.MethodsAfter being screened for HBsAg, anti-HBs, and anti-HBc, 284 HBV-naïve study participants aged 18 and over (i.e., negative for HBsAg, anti-HBs, and anti-HBc total) were provided free 3-dose HBV vaccine coupons. Next, study participants’ receipt of 1st, 2nd, and 3rd doses of HBV vaccine was documented at a pre-specified study healthcare facility, where HBV vaccines were distributed at no cost to the participants. Upon study entry, participants answered questionnaires on sociodemographics, knowledge of HBV and HBV vaccination, and related social and behavioral factors. The proportions of three doses of HBV vaccine uptake and their confidence intervals were analyzed. Associations of HBV vaccine initiation with exposures at study entry were evaluated using modified Poisson regression.Results98.9% (281 of 284) of study participants had complete data and were included in the analysis. The proportion of participants obtaining the 1st, 2nd, and 3rd doses of HBV vaccine was 11.7% (95% Confidence Interval [95% CI] 8.0-15.5%), 10.7% (95%CI 7.1–14.3%), and 8.9% (95%CI 5.6–12.2%), respectively. On the other hand, participants were more likely to initiate the 1st dose if they had adequate knowledge of transmission (adjusted relative risk [aRR] = 2.58, 95% CI 1.12–5.92), adequate knowledge of severity (aRR = 6.75, 95%CI 3.38–13.48), and annual health-checking seeking behavior (aRR = 2.04, 95%CI 1.07–3.87).ConclusionWe documented a low HBV vaccination uptake despite incentivization. However, increased vaccine initiation was associated with better HBV knowledge and annual health check-up adherence. When considering expanding HBV vaccination to the general adult population, we should appreciate that HBV knowledge is an independent predictor of vaccine uptake.

Abstract PO3-22-08: Impact of Zip Code-Based Income on Reconstructive Method and Outcomes in Mutation-Positive Breast Cancer Patients

Abstract Background: In the United States, 13% of women develop invasive breast cancer, with certain genetic mutations increasing the risk. Genetic screening is costly and burdensome for patients, particularly those from lower socioeconomic backgrounds. Moreover, lower income (LI) patients face barriers in accessing healthcare and have lower rates of breast reconstruction. This study aims to examine the impact of socioeconomic status, as indicated by ZIP code median income, on the type of breast surgery, reconstructive technique, and perioperative outcomes among mutation-positive (M+) patients. Methods: A multicenter retrospective cohort study included patients with a genetic predisposition for breast cancer and undergoing breast and reconstructive surgery between January 2016 and October 2022. Patient demographics, history, operative details, and postoperative outcomes were collected. Patient ZIP codes were cross-referenced with the American Community Survey to determine the median household income, which served as a proxy for the patient-specific household income. Four distinct income quartiles were established: quartile 1 (Q1) = $37,045-$81,586 (“LI”); quartile 2 (Q2) = $81,587-$103,703; quartile 3 (Q3) = $103,704-$129,768; and quartile 4 (Q4) = $129,769-$213,724. Results: Among the 170 patients analyzed, 42 (24.7%) were in Q1, 42 (24.7%) in Q2, 44 (25.9%) in Q3, and 42 (24.7%) in Q4. Most patients had BRCA1 (n=73, 42.9%), BRCA2 (n=68, 40.0%), PALB2 (n=11,6.5%), or CHEK2 (n=8, 64.7%) mutations, and underwent prophylactic mastectomy without evidence of breast cancer (n=119, 70.0%). Mean age and body mass index (BMI) were 41±16 years and 25.0±7.5 kg/m2, respectively. There was a significant association between patient race and income (p< 0.0001), such that 30.1% of White patients were in Q4 (vs. 8.3% of Black patients), compared to 38.9% of Black patients in Q1 (vs.19.0% of White patients). LI was significantly associated with higher BMI (p=0.0083) and obesity rates (p=0.0080). Nipple-sparing mastectomy (NSM) (n=103, 60.6%) was the most frequent surgical approach, followed by skin-sparing mastectomy (SSM) (n=42, 24.7%), simple mastectomy (n=13, 7.6%), lumpectomy (n=4, 2.4%), and radical mastectomy (n=4, 2.4%). Patients in Q3 underwent NSM significantly more often than those in Q1 (p=0.0080). Tissue expander (n=73, 42.9%) was the most common reconstruction method. 34.7% of patients (n=59) experienced postoperative complications. Short-term (< 30 days postoperatively) complications included delayed wound healing (n=22, 12.9%), surgical site infection (n=16, 9.4%), dehiscence (n=12, 7.1%), cellulitis (n=10, 5.9%), seroma (n=9, 5.3%) and hematoma (n=9, 4.7%). Long term (≥30 days postoperatively) complications included mastectomy flap necrosis (n=22, 12.9%), total reconstructive failure (n=8, 4.7%), and red breast syndrome (n=2, 1.2%). There was no significant association between income level and incidence of complications (p >0.05). Income level significantly correlated with cancer recurrence, as patients in Q2 (n=0, 0.0%) and Q4 (n=1, 2.4%) had significantly lower recurrence rates compared to Q1 (n=6, 14.3%) (p=0.0140). Of the 30.0% of patients with diagnosis of cancer at DOS, 66.7% (n=34) of patients had ductal carcinoma in situ (DCIS). Eleven of these patients were in Q1, five in Q2, six in Q3, and twelve in Q4 (p=0.259). Conclusion: LI M+ patients had lower NSM rates than higher income patients, despite similar rates of prophylactic mastectomies, possibly due to perceived costs of increased follow-up care. Moreover, LI patients experienced higher cancer recurrence, despite similar incidences of equivalent cancer subtypes at presentation, likely reflecting differences in post-diagnostic care and morbidity. These findings highlight the need to address financial barriers and ensure equitable access to comprehensive care for M+ patients of all income strata. Citation Format: Jaytin Gupta, Shrayus Sortur, Christian Lava, Margaret Lee, Lauren Berger, Varsha Harish, Daisy Spoer, Lindy Rosal, Ian Greenwalt, Lucy De La Cruz, David Song, Kenneth Fan. Impact of Zip Code-Based Income on Reconstructive Method and Outcomes in Mutation-Positive Breast Cancer Patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-22-08.

Analyzing the nexus between Chinese industrial policy and cross-border M&As.

In recent years, as China experiences economic expansion and its corporations become more global, it has notably become a central hub for cross-border mergers and acquisitions (M&A) on the world stage. The Chinese government, in tandem, leverages these international M&A operations to drive industrial transformation and progress in technology. This research investigates the role of China's industrial policies in shaping cross-border M&A activities by examining recent instances. Findings indicate that relaxing financial barriers and applying specific industrial tactics bolster companies' abilities to secure funding, consequently energizing cross-border M&A initiatives. Several firms in these international mergers and acquisitions are intricately connected to political strategies, markedly affecting the formulation of industrial policies. This assertion is corroborated through the analysis of relevant statistical evidence. The study methodically collects and scrutinizes data to quantitatively depict the current landscape and influencing elements of cross-border M&A, thus providing concrete evidence for policy and business strategy formulation.

Mental health prevalence, healthcare use and access between 2018 and 2022 in Sri Lanka: an analysis of survey data

Background Sri Lanka has suffered four decades of violent conflict, a tsunami, terrorist attacks and an economic crisis, with unknown mental health consequences. People living with mental health difficulties may experience individual, interpersonal, social or structural barriers to help-seeking. These may include stigma, lack of knowledge, denial, fear of societal repercussions, language, acceptability/appropriateness of care, lack of family support, availability of medication, lack of transport and financial barriers. It is possible that several of these factors may have manifested during the challenging time period for Sri Lankans at which this study took place. Methods Using a sample of 4030 respondents from two waves of a nationally representative survey, this study assessed the changes in the prevalence of mental health conditions, and subsequent changes in rates of healthcare usage and access, among adults in Sri Lanka between 2018 and 2022. This spanned a period of crisis and unrest, inclusive of the Easter Sunday attacks in 2019, anti-Muslim riots, the coronavirus disease 2019 pandemic and lockdown measures, as well as the current economic crisis that started in late 2021. Descriptive analyses were conducted to assess the demographic and socioeconomic characteristics of the cohort, and to quantify the prevalence of mental health difficulties within the cohort at each wave. Regression analyses examined the changes in prevalence of mental health difficulties over time. Cross-sectional descriptive analyses examined rates of healthcare use and access among those experiencing mental health difficulties, and regression analyses compared use and access for those experiencing different levels of mental health difficulties, adjusting for age, sex, education, socioeconomic status, ethnicity, religion, region and language. Results We found that 2.9% of Sri Lankans experienced high mental health difficulties during 2018–9 and 6.1% in 2021–2. There was a statistically significant increase in prevalence between 2018–9 and 2021–2 (β = 0.23, 95% confidence interval 0.20 to 0.26; p < 0.05). This rise was disproportionately higher amongst older adults, those in the lowest socioeconomic classes, and those not from a minority ethnic group. The gap between inpatient use for those living with the highest and lowest levels of mental health difficulties widened across the study period, though the outpatient use gap remained stable. Finally, while those with high mental health difficulties reported high levels of unmet need for health care, when compared to those with the lowest levels of mental health difficulty, the difference was not found to be significant, likely due to a restricted sample size. Future work and limitations It would be beneficial for future studies to investigate issues with measuring mental health, applicability and the cultural safety of mental health measures. Conclusions We explored mental health in Sri Lankans during critical time periods when the country experienced various traumatic events. The lessons learnt from how mental health and healthcare access and use were measured in this study allows us to strengthen methods for future studies, allowing for robust longitudinal analyses of healthcare use and access for those experiencing common mental health difficulties. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 17/63/47. A plain language summary of this article is available on the NIHR Journals Library website https://doi.org/10.3310/HJWA5078.

Entrepreneurial Barriers among Rural Women in Badin, Pakistan

Women’s entrepreneurship has emerged as a catalyst for economic growth and social progress in developing economies. However, despite their potential, women face multifaceted barriers that hinder their entrepreneurial aspirations and business success. So, the purpose of this research is to explore the barriers to a woman’s intention to starting a new business in the rural context. Using a quantitative approach, primary data is to be collected through self-administered questionnaires from a sample of 385 women from two administrative districts of rural Sindh, Pakistan. For aspiring women entrepreneurs this research has the potential to provide insights into the opportunities and obstacles that women business owners in Pakistan encounter, as well as for policy makers and NGOs, it can provide direction for the development of specific interventions to overcome these obstacles. This paper focuses on examining the relationship between the four barriers, family support, patriarchal culture, entrepreneurship education, and financial barriers, and entrepreneurial intention of rural women of Badin, Pakistan, with mediating effects of self-efficacy and moderating effect of marital status, which have not been studied before, making it original and valuable to the existing literature.

Potential Health Disparities in the Early Detection and Prevention of Pancreatic Cancer.

Pancreatic cancer remains one of the deadliest cancers in the United States. Some types of pancreatic cysts, which are being detected more frequently and often incidentally on imaging, have the potential to develop into pancreatic cancer and thus provide a valuable window of opportunity for cancer interception. Although racial disparity in pancreatic cancer has been described, little is known regarding health disparities in pancreatic cancer prevention. In the present study, we investigate potential health disparities along the continuum of care for pancreatic cancer. The racial and ethnic composition of pancreatic patients at high-volume centers in Indiana were evaluated, representing patients undergoing surgery for pancreatic cancer (n=390), participating in biobanking (972 pancreatic cancer patients and 1984 patients with pancreatic disease), or being monitored for pancreatic cysts at an early detection center (n=1514). To assess racial disparities and potential differences in decision-making related to pancreatic cancer prevention and early detection, an exploratory online survey was administered through a volunteer registry (n=708). Results: We show that despite comprising close to 10% or 30% of the Indiana or Indianapolis population, respectively, African Americans make up only about 4-5% of our study cohorts consisting of patients undergoing pancreatic surgery or participating in biobanking and early detection. Analysis of online survey results revealed that given the hypothetical situation of being diagnosed with a pancreatic cyst or pancreatic cancer, the vast majority of respondents (>90%) would agree to undergo surveillance or surgery, respectively, regardless of race.Only a minority (3-12%) acknowledged any significant transportation, financial, or emotional barriers that would impact a decision to undergo surveillance or surgery. This suggests that the observed racial disparities may be due in part to the existence of other barriers that lie upstream of this decision point. Racial disparities exist not only for pancreatic cancer but also at earlier points along the continuum of care such as prevention and early detection. To our knowledge, this is the first study to document racial disparity in the management of patients with pancreatic cysts who are at risk of developing pancreatic cancer. Our results suggest that improving access to information and care for such at-risk individuals may lead to more equitable outcomes.

Racial Differences in Germline Genetic Testing Completion Among Males With Pancreatic, Breast, or Metastatic Prostate Cancers.

Germline genetic testing is a vital component of guideline-recommended cancer care for males with pancreatic, breast, or metastatic prostate cancers. We sought to determine whether there were racial disparities in germline genetic testing completion in this population. This retrospective cohort study included non-Hispanic White and Black males with incident pancreatic, breast, or metastatic prostate cancers between January 1, 2019, and September 30, 2021. Two nationwide cohorts were examined: (1) commercially insured individuals in an administrative claims database, and (2) Veterans receiving care in the Veterans Health Administration. One-year germline genetic testing rates were estimated by using Kaplan-Meier methods. Cox proportional hazards regression was used to test the association between race and genetic testing completion. Causal mediation analyses were performed to investigate whether socioeconomic variables contributed to associations between race and germline testing. Our cohort consisted of 7,894 males (5,142 commercially insured; 2,752 Veterans). One-year testing rates were 18.0% (95% CI, 16.8%-19.2%) in commercially insured individuals and 14.2% (95% CI, 11.5%-15.0%) in Veterans. Black race was associated with a lower hazard of testing among commercially insured individuals (adjusted hazard ratio [aHR], 0.73; 95% CI, 0.58-0.91; P=.005) but not among Veterans (aHR, 0.99; 95% CI, 0.75-1.32; P=.960). In commercially insured individuals, income (aHR, 0.90; 95% CI, 0.86-0.96) and net worth (aHR, 0.92; 95% CI, 0.86-0.98) mediated racial disparities, whereas education (aHR, 0.98; 95% CI, 0.94-1.01) did not. Overall rates of guideline-recommended genetic testing are low in males with pancreatic, breast, or metastatic prostate cancers. Racial disparities in genetic testing among males exist in a commercially insured population, mediated by net worth and household income; these disparities are not seen in the equal-access Veterans Health Administration. Alleviating financial and access barriers may mitigate racial disparities in genetic testing.

Barriers to accessing hepatitis B medication: a qualitative study from the USA and Canada

ObjectivesTo collect and document the numerous barriers that people living with hepatitis B (PLHB) encounter when trying to access their hepatitis B virus (HBV) medications.DesignResearchers collected qualitative data through 24...

Listening to Black Women's Perspectives of Birth Centers and Midwifery Care: Advocacy, Protection, and Empowerment.

Black women in Texas experience high rates of adverse maternal outcomes that have been linked to health inequities and structural racism in the maternal care system. Birth centers and midwifery care are highlighted in the literature as contributing to improved perinatal care experiences and decreased adverse outcomes for Black women. However, compared with White women, Black women underuse birth centers and midwifery care. Black women's perceptions in Texas of birth center and midwifery care are underrepresented in research. Thus, this study aimed to highlight the views of Black women residing in Texas on birth centers and midwifery care to identify their needs and explore ways to increasing access to perinatal care. Semistructured interviews were conducted with 10 pregnant and postpartum Black women residing in Texas. Questions focused on the women's access, knowledge, and use of birth centers and midwifery care in the context of their lived maternal care experiences. Interview transcripts were reviewed and analyzed using inductive, qualitative content analysis. The Black women interviewed all shared experiences of discrimination and bias while receiving obstetric care that affected their interest in and overall perceptions of birth center and midwifery care. Participants also discussed financial and institutional barriers that impacted their ease of access to birth center and midwifery care services. Additionally, participants highlighted the need for culturally sensitive and respectful perinatalhealth care. The Black women interviewed in this study emphasized the prevalence of racism and discrimination in perinatal health care encounters, a reflection consistent with current literature. Black women also expressed a desire to use birth centers and midwifery care but identified the barriers in Texas that impede access. Study findings highlight the need to address barriers to promote equitable perinatal health care access for Black women.

INVESTIGATING BARRIERS IN GREEN SUPPLY CHAIN MANAGEMENT

The Green Supply Chain Management (GSCM) has emerged in today’s scenario in response to the growing concern of environmental sustainability. Green Supply Chain is a term that has it’s importance in the entire supply chain starting from the designing of the product to raw material procurement to manufacturing of the product to distribution and until the end-of-life of the product. It’s main aim is to minimize the negative impact of the supply chain activities and also to maximize the efficiency of resources along with reduction of the waste generation. There are a number of challenges in implementing green practices in the organization, which include the need for cooperation, collaboration and coordination among the partners of supply chain and also the need to identify the cost-effective green practices and technologies. There are a number of strategies which have been proposed to address the challenges faced. These include packaging which is eco-friendly, the concept of reverse logistics etc. The organizations which adopt the green supply chain practices in their organizations, gain various types of benefits from it. These benefits include savings in the costs as there is reduction in the consumption and also waste generation. The brand image of the organization is enhanced by the adoption of green practices and there is increase in the customer loyalty etc. Companieswhich use green supply chain management in their supply chain include Johnson and Johnson, Ford, Adidas, Nestle, Coca-Cola, Tesla etc. The adoption of green supply chain management (GSCM) faces multiple challenges including financial barriers, lack of awareness and supplier engagement, and regulatory complexity, while cultural resistance and technological limitations also impede its implementation. Success relies on top management support and overcoming these hurdles to develop sustainable practices across the entire supply chain.

Analysis of interplay between food safety systems and halal standards in Indonesia

The present work aimed to develop a comprehensive certification process for halal food products within the Indonesian agribusiness, which integrates food safety and halal standards. The objective was to reduce financial barriers, certification burden, and workforce shortages currently impeding the establishment of quality halal food supply chains. To achieve this aim, Interpretive Structural Modelling (ISM) was used to elucidate the complex relationships between decision variables in the halal certification process. Data collection included interviews with sectoral experts overseeing food safety and halal compliance. The present work identified 17 strategic variables crucial to integrating the Halal Assurance System (HAS) with food safety using ISM analysis. The findings of the ISM model showed 11 hierarchical levels of integration between the HAS and food safety, identifying key factors influencing produce security mechanisms. Additionally, the present work emphasised the significance of transparency, proper handling of produce, and efficient certification processes for businesses operating in the global food sector. This proposed framework not only offers practical guidance for enhancing food security, but also correlated certification processes with supply chain objectives, thereby bridging the gap between theory and practice.

Addressing the Challenges of PD-1 Targeted Immunotherapy in Cancer Treatment

Background: Immune checkpoint inhibitors targeting the programmed cell death protein 1 (PD-1)/PD-ligand 1 (PD-L1) axis have revolutionized cancer treatment, demonstrating remarkable clinical efficacy across multiple malignancies. However, their broader applicability and therapeutic potential remain constrained by several challenges. Objective: This review aims to provide a comprehensive overview of the current challenges associated with PD-1 targeted immunotherapy, encompassing resistance mechanisms, patient selection, toxicity management, and the development of novel combination strategies. Methods: A comprehensive literature search was conducted across PubMed, Embase, and Web of Science databases to identify and critically analyze studies investigating the challenges and limitations of PD-1 targeted immunotherapy in cancer treatment. Results: The primary challenges identified include: (1) Intrinsic and acquired resistance mechanisms, such as alterations in antigen presentation, tumor microenvironment factors, and immune cell dysfunction; (2) Lack of reliable predictive biomarkers for patient selection and response monitoring; (3) Immune-related adverse events and their effective management; (4) Optimization of combination regimens with other immunotherapies, targeted therapies, or conventional treatments; (5) Financial and accessibility barriers limiting the broader implementation of immunotherapy. Conclusion: PD-1 targeted immunotherapy has transformed cancer treatment, addressing the current challenges is imperative to maximize its therapeutic potential and broaden its applicability. Ongoing research efforts focused on elucidating resistance mechanisms, developing predictive biomarkers, managing toxicities, and exploring novel combination strategies hold promise for overcoming these limitations. Interdisciplinary collaborations and continued investment in immunotherapy research are essential to ensure that the benefits of these groundbreaking therapies are accessible to a wider patient population.

Is private insurance enough to address barriers to accessing dental care? Findings from a Canadian population-based study

BackgroundIn Canada, as in many other countries, private dental insurance addresses financial barriers to a great extent thereby facilitating access to dental care. That said, insurance does not guarantee affordability, as there are issues with the quality and level of coverage of insurance plans. As such, individuals facing barriers to dental care experience poorer oral health. Therefore, it is important to examine more keenly the socio-demographic attributes of people with private insurance to particularly identify those, who despite having insurance, face challenges in accessing dental care and experience poorer oral health.MethodsThis study is a secondary data analysis of the most recent available cycle (2017-18) of the Canadian Community Health Survey (CCHS), a national cross-sectional survey. Univariate analysis was conducted to determine the characteristics of Ontarians with private insurance (n = 17,678 representing 6919,814 Ontarians)—bivariate analysis to explore their financial barriers to dental care, and how they perceive their oral health. Additionally, logistic regressions were conducted to identify relationships between covariates and outcome variables.ResultsAnalysis shows that the majority of those with private insurance do not experience cost barriers to dental care and perceive their oral health as good to excellent. However, specific populations, including those aged 20–39 years, and those earning less than $40,000, despite having private dental insurance, face significantly more cost barriers to access to care compared to their counterparts. Additionally, those with the lowest income (earning less than $20,000 annually) perceived their oral health as “fair to poor” more than those earning more. Adjusted estimates revealed that respondents aged 20–39 were six times more likely to report cost barriers to dental care and ten times more likely to visit the dentist only for emergencies than those aged 12–19. Additionally, those aged 40–59 were two times more likely to report poorer oral health status compared to those aged 12–19.ConclusionGiven the upcoming implementation of the Canadian Dental Care Plan, the results of this study can support in identifying vulnerable populations who currently are ineligible for the Plan but can be benefitted from the coverage.

Financing climate adaptation in Flemish cities: Unpacking financial strategies and policy dynamics for nature-based solutions

As climate change continues to impact cities, nature-based solutions (NBS) are being advanced as important adaptation strategies for mitigating these negative effects. As is the case throughout Europe, Flemish cities have enacted adaptation policies and plans outlining the importance of NBS. Nevertheless, the implementation of NBS has been slow. Local governments identify financing as an important barrier. Although private financing is often proposed as a solution, few studies have applied a public-financing perspective to generate insight into and remedies for such issues. In this article, we examine how four Flemish cities are financing NBS implemented in public spaces as climate adaptation strategies. Based on a multiple case study approach, our results uncover that different financing strategies are employed during the design, implementation and maintenance phase of developing NBS projects. Additionally, we learn that the interplay between policy and financing becomes an important catalyst for investments in public NBS. We identified three approaches administrations use to secure (public) resources. During the design phase, support is developed within the administration and politically through (1) fostering internal collaboration by developing integrated spatial NBS designs. In the implementation phase resources are attracted by (2) putting the developed spatial designs to work and seizing available funding opportunities. During the maintenance phase (3) strategic partnerships are established with NBS beneficiaries to alleviate costs for municipalities. We conclude that, in the absence of more long-term forms of public financing, these approaches offer smaller cities tools to overcome the financial barrier.

Who is most at risk of digital exclusion within healthcare?

Abstract Introduction There has been a rapid growth in the use of digital technologies in healthcare to improve population health. However, due to digital exclusion (DE) (the unfair differences in motivation, access and use of these technologies), some demographic groups are unable to harness the health benefits of these technologies. Various frameworks have been designed to highlight groups vulnerable to health inequities, but none focus on DE. To provide better support for digitally excluded individuals, we must start by identifying demographic groups most at risk of DE. Aim Review the literature to identify demographic groups most at risk of DE within healthcare. Methods PubMed, Google Scholar and Scopus were searched on 22nd October 2022 in a non-systematic way to scope and examine emerging evidence surrounding groups at risk of DE within healthcare. English-language peer-reviewed articles and grey literature (e.g., government reports and regulatory organisation documents) identifying demographic groups at risk of DE and possible factors influencing exclusion were included. Search terms included words associated with DE and health inequity. Data extracted from the included articles included the different demographic groups highlighted and reasons for DE. Results Analysis of twenty-two included articles highlighted six common sociodemographic factors associated with DE that we compiled into six groups. These groups include Culture (ethnicity, language, religion), Limiting conditions (visual and hearing impairments), Education, Age, Residence (rural, deprived areas, homeless), and Socioeconomic status, forming the CLEARS framework. Cultural factors associated with DE included bias in artificial intelligence models used in healthcare technologies, low sensitivity in sensors when used across different ethnic backgrounds, and lack of consideration for different religious groups. Limiting conditions may make it difficult to use the technology, such as reading health information on small screens if visually impaired. Low educational attainment and old age (over 65) were frequently associated with poor digital literacy skills and poor understanding of the benefit of health technologies, thus reducing motivation and use of health technologies. Residential factors centred around barriers to accessing infrastructure to support connectivity (e.g. WiFi) and socioeconomic factors, including financial barriers to compatible devices and connectivity. Individuals who identify with two or more of these groups (intersectionality) are at even greater risk of DE. Conclusion This review identified six groups at risk of DE, the contributing reasons for exclusion, and the role of intersectionality. The CLEARS framework generated from this review can guide researchers and health technology developers in identifying groups that need to be involved in the co-design of digital health technologies to support inclusion. During the development of the CLEARS framework, groups in previous health inequities frameworks, such as the LGBTQ+ community, were considered, but later excluded due to the lack of representation within the literature. However, it is also important to recognise underserved groups are less likely to appear in the literature. Further work is needed to design tailored guidelines to support the development of inclusive digital health technologies that meet the needs of underserved groups.