Financial Stressors Research Articles

Myeloproliferative Neoplasms and Depressive Symptoms, Diagnosis, and Associations

Patients with a myeloproliferative neoplasm (MPN) diagnosis experience a high systemic symptom burden and a spectrum of physical, financial, mental and emotional stressors. The impact of mood disturbances in MPN patient is not well understood. It was recently identified by our study team that symptoms of depression coexist with the prevalent and debilitating symptom of fatigue in patients with MPNs. The purpose of this study is to comprehensively describe the experience of depressive symptoms in MPN patients.Methods: A 70-item internet based national survey regarding fatigue and mood symptoms was developed by MPN investigators and patient/advocates and refined by the Mayo Clinic Survey Research Center. The Patient Health Questionnaire-2 (PHQ) was completed by all respondents and utilized to assess symptoms of depression. Survey responses were compared between those who endorsed having current symptoms of depression (defined as a PHQ-2 score ≥ 3) and those without symptoms of depression (defined as a PHQ-2 score < 3).Results:Demographics: 1389 patients across the country with MPNs completed the survey. The mean age was 59 years (standard deviation [SD] 11.7) with a predominance of female respondents (68%). Self-reported diagnoses included polycythemia vera (PV) (550/1389, 40%), essential thrombocythemia (ET) (445/1389, 32%), myelofibrosis (MF) (349/1389, 25%), and other (41/1389, 3%). There were 318 respondents (23%) with PHQ-2 scores ≥ 3 (122/550, 22% PV; 107/445, 24% ET; 80/349, 22% MF; other 8/41, 3%).MPN Related History: MPN diagnosis and gender frequency did not differ between depression symptom classification groups (P=0.86 and P=0.80, respectively). There were no differences in the use of particular MPN directed treatments between depression symptom groups (including phlebotomy 52% PHQ≥3, P=0.39; medications 87% PHQ≥3, P=0.38; JAK inhibitor use specifically 17% PHQ≥3, P=0.36; interferon use specifically 21% PHQ ≥3, P=0.19; or transfusions 18% PHQ≥3, P=0.10). However, a thrombosis history was more associated with depressive symptoms (23% vs 17%; P=0.008).A PHQ score of ≥3 was associated with younger age (mean 57.0 (SD 12.1) vs 59.5 (SD 11.5) years; P <0.001) and an overall more recent MPN diagnosis (P=0.02) (<1 year, 12% vs 7%; 1 to 3 years, 21% vs 20%; >3 years ago, 67% vs 73%).MPN Related Symptoms: A PHQ score ≥3 was associated with a higher MPN-SAF Total Symptom Score (mean 41.1 (SD 16.7) vs 24.7 (SD 15.9); P <0.001) with all 10 individual symptoms being statistically significantly higher including fatigue (mean 7.8 (SD 1.9) vs 5.8 (SD 2.7); P <0.001).Mood Treatment: Patients with PHQ≥3 more often utilized medication for mood problems (87% vs 77%; P=0.03), and used counseling/therapy at similar rates (38% vs 41%; P=0.63) compared to patients without symptoms of depression.Conclusion: The presence of significant depressive symptoms is not uncommon in patients with MPNs. Mood disturbances were not associated with MPN-related therapy options but were associated with worse systemic symptoms. These findings indicate depressive symptomatology may be intrinsic to the condition, and not a result of treatment side effects. Additionally, the association of depressive symptoms was impacted by time from diagnosis, suggesting that patients with recent diagnosis may have the highest risk for depression. Given that almost one-fourth of the patients endorsed having symptoms of depression better understanding of the mood disturbances impacting MPN patients is warranted. Comprehensive health care for patients with MPNs should include investigation into interventions targeting mood disturbances that may improve health related quality of life and may prove to mitigate the severity of MPN-related symptoms, specifically fatigue. DisclosuresGowin:Incyte: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Harrison:Celgene: Consultancy; Shire: Speakers Bureau; Gilead: Consultancy, Speakers Bureau; Novartis: Honoraria, Research Funding, Speakers Bureau; CTI: Speakers Bureau. Mesa:Ariad: Consultancy; Promedico: Research Funding; Incyte Corporation: Research Funding; Gilead Sciences, Inc.: Research Funding; CTI BioPharma Corp.: Research Funding; Celgene Corporation: Research Funding; Novartis Pharmaceuticals Corporation: Consultancy; Galena Biopharma, Inc.: Consultancy.

Varieties of Financial Stressors and Midlife Health Problems.

Financial stressors such as wealth loss, indebtedness, and bankruptcy have gained the attention of public health scholars since the Great Recession. In this study, we extend this area of research by comparing the mental and physical impact of multiple financial stressors during midlife, a pivotal period in the life course for wealth accumulation and disease onset. With data from the National Longitudinal Survey of Youth 1979 (www.nlsinfo.org), an ongoing survey of adult men and women in the U.S., we used logistic regression to estimate the associations between financial stressors and the risk of a psychiatric disorder or high blood pressure diagnosis from ages 31-39 in 1996 to ages 50-59 in 2016 (N = 7,143). Financial stressors include multiple types of wealth loss, debt, and bankruptcy. Even after adjusting for a comprehensive set of confounders, many of the financial stressors we considered had similar associations with the risk of a psychiatric disorder, whereas only debt and bankruptcy were associated with the risk of high blood pressure. The best fitting models for both health outcomes included a simple indicator of indebtedness. Stock losses were not significantly associated with either health outcome. Given the recent volatility in the U.S. economy, our results highlight the potential loss of health that may occur if nothing is done to prevent economically vulnerable populations from sliding into financial crisis. Our results also emphasize the need for additional research to develop individual-level interventions to improve health among those already experiencing financial difficulties.

How we coordinate care for uninsured children with nonmalignant hematologic disorders.

Providing medical care for uninsured children with nonmalignant hematologic diagnoses presents unique challenges to medical providers and multidisciplinary staff. Financial and psychosocial stressors can hinder optimal care of the uninsured child. Maximizing coverage of medical costs through patient enrollment in state and charity care programs and capitalizing upon community partnerships can help providers achieve comprehensive care for these children. Collaboration between primary care providers, subspecialists, and multidisciplinary teams can be optimized to facilitate provision of hematology care for uninsured children. We detail our experience in establishing these collaborations to improve access to subspecialty care for children with nonmalignant hematologic disorders.

Trajectories of unsecured debt and health at midlife

BackgroundUnsecured debt — debt not tied to an asset — is a financial stressor that undermines health, but prior research has not investigated relationships between group-based trajectories of unsecured debt and pain and disability at midlife. MethodsUS respondents of the National Longitudinal Study of Youth-1979 cohort reported unsecured debt and income between ages 28–40. We used these measures to identify group-based trajectories of unsecured debt and unsecured debt-to-income ratio. We then used trajectory membership to predict three pain and disability-related health outcomes at age 50, adjusting for lagged health and other covariates. ResultsGroup-based trajectory models divided the sample of 7850 respondents into 6 unsecured debt trajectories and 5 unsecured debt-to-income trajectories. In fully adjusted unsecured debt models, compared to people with constant low debt, those who paid down debt over time, carried constant debt, experienced debt cycling, or accumulated debt later in life were more likely to report pain interference with activities or joint pain or stiffness at age 50 (pain interference ORs ranging from 1.33 to 1.76; joint pain or stiffness ORs ranging from 1.27 to 1.45). In fully adjusted unsecured debt-to-income models, compared to those with constant low debt, those with constant high debt or accumulating debt later in life were more likely to report pain interference or joint pain or stiffness (pain interference ORs ranging from 1.30 to 1.91; joint pain or stiffness ORs ranging from 1.19 to 1.33). ConclusionThe amount, timing, and duration of unsecured debt accumulation and repayment have important health implications and may exacerbate midlife health inequalities.

An investigation of the prevalence of stress among graduate and post-graduate Indian students during COVID 19 pandemic by means of factor analysis

Objective: Since December 2019, the COVID-19 pandemic has posed a considerable threat with its associated high mortality, infection, and hazard of physical, mental, emotional, financial, and spiritual stress (WHO, 2020). A large number of students are affected due to a chronic break from classroom academic activities, the pressure of being hired for an internship or final placement and staying at home. The main focus of this learning is to know the stressors of graduate and post-graduate Indian students and their major hurdles during the COVID-19 lockdown. Further, the study aims to facilitate a proposed model of training, by combining 7 psychosocial variables of emotional resilience which might empower the students to cater to stressors and improve personal, academic, and professional effectiveness (Chen et.al, 2020; Horesh et.al, 2020) Methods: Using a convenience method, an internet survey of the 6-item COVID-19 Student Stress Questionnaire (CSSQ) (modified version Zurlo et.al, 2020) was conducted on students across India. together with their demographic details, the participants also reported their study patterns and challenges during their confinement period. The statistical scores for the responses were calculated and also the demographic variables analyzed using the factor analysis technique. (Ahorsu et.al,2020) Findings, discussion, and implications: The findings suggest that self-awareness, self-regulation, mental agility, optimism, self-efficacy, sense of belonging and psychological safety may be the important emotional resilience to be developed among the Indian students to cope with physical, mental, emotional, financial, and spiritual stressors confronted by them during COVID 19 pandemic to increase personal and professional effectiveness (Maria et.al, 2020, Zurlo et.al. 2017) Conclusion: The study has several practical implications for counseling psychologists, academicians, parents, life coaches handling youth and mental health workers related to the graduate and post-graduate education sector (Taylor et.al, 2020; Sahu et.al, 2020).

Suicides in Barnsley – an IHBTT project

AimsWe wanted to see whether an increase in IHBTT(Intensive Home based treatment team) case load correlated with the recent increase in suicides. We also wanted to investigate the common factors between patients who died by suicide.BackgroundThis was a study completed by IHBTT in Barnsley (South Yorkshire), looking into recent suicides with the caseload from April 2009 to November 2019. There were a total of six suicides.MethodWe Calculated mean IHBTT caseload size from November 2008 to November 2019 . There were 6 suicides in this period. We plotted this against caseload, investigating if increase in caseload correlated with these. We also analysed the common themes and trends associates with these patients who died by suicide. We compared the trends we found locally against a National Survey. (National Confidential Inquiry into Suicide and Safety in Mental Health; Annual Report: England, Northern Ireland, Scotland, Wales October 2018 University of Manchester).ResultWe found that four out of six suicides occurred during periods of high activity.. Common themes we found around patients who had died by suicide included middle aged men who lived alone, with a diagnosis of adjustment disorder, recent financial stress and relationship breakdown, upcoming court case, abusing drugs or alcohol. This does compare somewhat to national trends, however alcohol and drug misuse, upcoming court case and financial stressors and relationship breakdown are higher in our patients who died by suicide compared to nationally.ConclusionWe acknowledge the small sample size and hence the need to take results cautiously. However there is a clear increase in suicides as caseload increases, we hypothesised this was due to the same levels of staff despite increase in caseload. We were also able to conclude the factors our patients who died by suicide had in common locally, and how this compared to national data. We wondered if this could be used to guide resource allocation, i.e. interventions to help patient manage their finances, accommodation and substance misuse. Consideration may need to be given to reviewing IHBTT staffing levels, given the significant decrease in inpatient bed numbers.

Program evaluation of a student-led peer support service at a Canadian university

BackgroundUniversity students often experience numerous financial, social and emotional stressors that can affect their mental health. The Peer Support Centre (PSC) is a pilot project that was established to provide peer support to students in these stressful conditions. We wanted to investigate whether peer support is a viable form of support that would benefit university students. The objective of this study is to determine whether the organization was indeed providing a beneficial service to students and if it was fulfilling the needs of the students that visited the service.MethodsAfter a support session, students and peer support providers completed an anonymous questionnaire regarding their self-reported mental wellbeing using the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7) metrics, and Outcome Rating Scale (ORS). They were also asked about their experience with previous professional mental health services as well as their experience at the PSC. With the data collected from 1043 students and 797 volunteers from September 2016–March 2020, a program evaluation was conducted for quality improvement purposes.ResultsThe PSC is used by students of different sexes, genders, and ethnicities. Students reported having a low ORS score, moderate anxiety as per the GAD-7 and moderate depression according to the PHQ-9. They find it easy to use and rely on it as an alternative form of support when they approach barriers that prevent them from accessing professional services. Lastly, the peer support providers feel very validated in their role and overall quite prepared and helpful when helping their fellow peers.ConclusionsThe establishment of a student service that provides peer support would be beneficial to the members of a university/college campus.

Irritable Bowel Syndrome and Coping Strategies: A Cross-sectional Study for Identifying Psychological Alarms and Factors Related to Coping in Riyadh, Saudi Arabia.

Psychological alarms including severity of pain, functional impairment, depression, and impaired coping strategies have been correlated with (IBS); however, these attributes, particularly coping strategies, have not been well studied. The aim of this study was to assess psychological alarms, life stressors, and coping strategies of adults diagnosed with IBS. A total of 806 participants completed a self-administered survey consisting of socio-demographic data and life stressors, the Rome IV criteria to diagnose IBS, the Psychological Alarm Questionnaire, and the Coping Strategies Questionnaire (CSQ 24). IBS diagnosis was established among 372 (46.15%) participants. Anxiety (OR = 1.81; 95% CI: 1.35-2.45), severe pain (OR = 1.92; 95% CI: 1.42-2.63), financial life stressors (OR = 1.98; 95% CI: 1.33-2.40), and coping strategies such as reinterpretation (OR = 1.92; 95% CI: 1.39-2.68) and diversion (OR = 2.01; 95% CI: 1.05-3.89) were all significantly and independently associated with IBS diagnosis. Giving the chronic nature of IBS, future research should focus on coping as a potential treatment goal for IBS patients.

Distress screening for patients with a history of cancer during the COVID-19 pandemic.

e13537 Background: Although a diagnosis of cancer is widely accepted as resulting in significant levels of distress, distress itself cannot be considered benign and screening for distress is considered a best practice metric for patients receiving oncological care. Endorsed by NCCN, the Distress Thermometer (DT) considers a cutoff score of 4 or greater to identify patient with clinically relevant levels of distress. We hypothesized that the COVID-19 pandemic would manifest with higher levels of stress and anxiety in most persons by compounding the distress experienced by patients with a diagnosis of cancer. Methods: Patients with a new diagnosis of cancer underwent distress screening with the DT prior to a clinical appointment at a NCI-designated academic cancer center. Patients who scored 4 or higher were discussed at an Interprofessional Supportive Medicine patient conference or referred to oncology social work for appropriate evaluation and therapeutic care. By mid-March 2020, the SKCC catchment area was under a public health emergency with limited access to non-essential healthcare; therefore, we present data from 1/1-3/15/20 (pre-pandemic), 3/16-6/7/20 (pandemic peak with 2000+ daily cases in late April and peak daily deaths 300+ in May), and 6/8-8/30/20 (daily cases generally less than 700 except for occasional levels of 1000-in July and daily deaths less than 40 daily). Results: In the pre-pandemic time period, 60% of patients assessed reported a score of 4 or higher. During the subsequent periods—the first pandemic peak and the first post-pandemic period—the incidence of an elevated distress screen (4 or higher) was relatively stable at about 30%. Conclusions: Contrary to expectations, the DT screen identified less patient distress during the pandemic compared to pre-pandemic. Our results may be due to multiple factors—changes in processes and procedures to prioritize DT screening as pandemic risk became more apparent; an increased use of telemedicine; and the compounding of new, non-cancer related stressors resulting in the greater resiliency noted in disaster psychology. For example, during the first pandemic peak when the majority of patients were seen via telemedicine, the opportunity afforded by telemedicine for safety and decreased risk for COVID-19 infection may have reduced the overall distress experience. In addition, the compounding of stressors—the diagnosis of cancer, the risk of the pandemic, and its economic and financial stressors—may have influenced distress perception. Future work incorporating multiple distress assessment points may help better understand the impact of the layers of stress experienced by persons with cancer.[Table: see text]

Suicidal ideation and thoughts of self-harm during the COVID-19 pandemic: The role of COVID-19-related stress, social isolation, and financial strain.

BackgroundThere are significant concerns about mental health problems occurring due to the coronavirus disease 2019 (COVID‐19) pandemic. To date, there has been limited empirical investigation about thoughts of suicide and self‐harm during the COVID‐19 pandemic.MethodsA national survey was conducted May 2020 to investigate the association between mental health symptoms, social isolation, and financial stressors during the COVID‐19 pandemic and thoughts of suicide and self‐harm. A total of 6607 US adults completed an online survey; survey criteria included an age minimum of 22 years old and reported annual gross income of $75,000 or below. Statistical raking procedures were conducted to more precisely weight the sample using US Census data on age, geographic region, sex, race, and ethnicity.ResultsCOVID‐19‐related stress symptoms, loneliness, and financial strain were associated with thoughts of suicide/self‐harm in multivariable logistic regression analyses, as were younger age, being a military veteran, past homelessness, lifetime severe mental illness, current depressive symptoms, alcohol misuse, and having tested positive for COVID‐19. Greater social support was inversely related to thoughts of suicide/self‐harm whereas running out of money for basic needs (e.g., food), housing instability (e.g., delaying rent), and filing for unemployment or disability were positively related.ConclusionsPublic health interventions to decrease risk of suicide and self‐harm in the wake of the COVID‐19 pandemic should address pandemic‐related stress, social isolation, and financial strain experienced including food insecurity, job loss, and risk of eviction/homelessness.

Buoyancy Amid the Pandemic: Resilience in Rough Waters

Buoyancy Amid the Pandemic: Resilience in Rough Waters

Financial Stressors During the Great Recession and Subsequent Risk of Early Mortality.

The Great Recession in 2008 was a period of severe economic upheaval and myriad financial stressors. Financial stress is associated with poorer health, but for whom is this stress the most health-relevant? The current study examined the association between financial stressors and mortality, as well as whether this association varied based on people's financial status. Participants from the Midlife in the United States study (n = 2760) were assessed before (2004-2005) and after (2013-2014) the Great Recession (2008). Mortality status was then tracked from 2013 to 2017. People who experienced more financial stressors during the Great Recession were at greater risk of early mortality over the 4-year follow-up (hazard ratio [HR] = 1.14 [1.00-1.29], p = .046). This association was moderated by the importance of financial security (B = 0.34 [0.08-0.59], p = .009). Financial stressors were more strongly associated with mortality among people who reported that financial security was important to their well-being (HR = 1.29 [1.08-1.54], p = .006) compared with people who reported it was not (HR = 1.02 [0.82-1.26], p = .89). Household income and subjective financial status did not moderate the association between financial stressors and mortality. Experiencing financial stressors during the Great Recession was associated with increased mortality over the 4-year follow-up period, particularly for people who reported financial security was important to their well-being. Interventions designed to reduce financial stress to improve health may benefit from targeting people for whom such stressors are particularly important.

“The sky is the limit; I am going there”: experiences of hope among young women receiving a conditional cash transfer in rural South Africa

Young women in South Africa face elevated risk of HIV infection compared to male peers. Cash transfers may mitigate their risk for HIV; however, there is limited understanding of mechanisms of impact. We explored hope as one potential mechanism. Longitudinal qualitative analysis was used to explore how cash transfer recipients in the HPTN 068 study conceptualised hope and how the intervention influenced their hope over time. We found the intervention increased confidence, alleviated financial stressors and instilled in young women the belief that a better life, defined as being educated, independent and supportive to family, was attainable. Findings support hope as a critical outcome of cash transfer and other economic strengthening interventions.

Perceived Financial Insecurity Impacts Healthcare Decision-Making Among Patients With Sinusitis.

The economic burden of sinusitis is significant, and socioeconomic factors can impact patient decision-making. The purpose of this study was to examine the impact of perceived financial insecurity on healthcare decision-making and treatment compliance among sinusitis patients. Cross-sectional study using the 2018 National Health Interview Survey. Survey responses to nine questions regarding financial stressors and nine questions regarding cost-saving healthcare actions were recorded, which included seeking lower cost medication, medication noncompliance, and avoiding care visits due to costs. There was a total weighted sample size of 28.9 million patients who self-reported a diagnosis of sinusitis (12% of the U.S. population). Sinusitis patients who reported cost-saving actions had an increased severity of perceived financial insecurity than those without cost-saving actions (P < .001). Sinusitis patients with perceived financial insecurity had the highest odds of at least one cost-saving action (odds ratio [OR]=5.94, 95% CI=5.911-5.970, P < .001), followed by lack of health insurance (OR=5.13, 95% CI=5.107-5.159, P < .001), and poor self-reported health status (OR=2.81, 95% CI=2.792-2.822, P < .001). Increasing the number of financial stressors increased the odds of at least one cost-saving action (P < .001). Across all financial stressors, the most commonly performed cost-saving action was asking for lower cost medication. Perceived financial insecurity is associated with cost-saving healthcare actions among sinusitis patients, including treatment noncompliance. Interventions to assess financial insecurity among sinusitis patients may facilitate shared decision-making for optimal, individualized treatment plans that may lead to improved outcomes and quality of life. NA Laryngoscope, 131:2403-2412, 2021.

Suicide: The pandemic inside the pandemic

IntroductionCovid-19 was declared a pandemic by the WHO on March 11th and efforts have been made to minimize the impact that this new disease can produce. The mental health effects of this pandemic can be severe considering that each year close to 800.000 people die by suicide. This pandemic could increase those numbers, although this is not inevitable.ObjectivesThis work reviewed the current available data on possible causes for a suicide rate increase and to try to understand if suicide is already increasing worldwide.MethodsNon-systematic review of the literature with selection of scientific articles published in the past 6 months; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: Covid-19; suicide; SARS-Cov2; pandemic.Results Multiple factors can account for an increase in suicide rates such as isolation with a sense of decreased belongingness and increased burdensomeness. A synergy with known suicide precipitants can also occur such as domestic violence, intra-familiar conflicts, alcohol consumption and access to means. Media communication can represent a danger with constant reports about the crisis. And lastly the loss of employment and financial stressors can produce an important impact.ConclusionsIn conclusion, Covid-19 will produce an important impact in many spheres of society, one of which will be mental health. If at the start of this crisis a widespread sense of solidarity was present with the maintenance of precipitant factors for suicide we expect to see an increase in suicide rates.

114 The Patient’s Perspective: Burn Reconstructive Surgery During the Pandemic

IntroductionThe novel Coronavirus disease 2019 (COVID-19) has created profound challenges in healthcare delivery. Hospital systems have delayed or shut down elective surgeries and outpatient care. These measures resulted in profound disruptions to burn treatment regarding reconstructive care from surgery to therapy. This study aims to characterize burn patients’ perspectives on elective reconstructive surgery during COVID-19.MethodsAs part of a quality improvement initiative, a 12-component questionnaire to burn patients awaiting reconstructive surgery at a single ABA verified Burn Center during COVID-19 was conducted. Responses regarding willingness to undergo reconstruction during COVID-19, perceived medical and personal impacts of COVID-19, and perspectives on telehealth were gathered. Surveys were administered over the phone in English and Spanish to burn patients or to primary caregivers in the case of pediatric patients.ResultsWe surveyed 23 participants who met our inclusion criteria. Average age was 23 and 43% were male. We found 22 (96%) patients were willing to undergo reconstruction during the COVID-19 pandemic. Table 1 outlines the responses to questions regarding telehealth and being a burn patient during COVID-19. Examples of stressors experienced by patients and their families due to COVID-19 included: inability to communicate with healthcare providers in person, increased anxiety in public places, delayed surgical care, and interruption of physical or occupational therapy. Family members in 5 out of the 8 Spanish speaking households lost their job due to COVID-19, resulting in financial stress for the burn patient.ConclusionsThe majority of patients expressed strong desires to return to surgical and therapy care delayed by COVID-19. Patients reported feeling especially vulnerable as burn patients and cited receiving healthcare and financial stressors as a result of the COVID-19 pandemic as the main causes.

Bundled Payment Models in Spine Surgery.

Study Design:The following is a narrative discussion of bundled payments in spine surgery.Objective:The cost of healthcare in the United States has continued to increase. To lower the cost of healthcare, reimbursement models are being investigated as potential cost saving interventions by driving incentives and quality improvement in fields such a spine surgery.Methods:Narrative overview of literature pertaining to bundled payments in spine surgery synthesizing findings from computerized databases and authoritative texts.Results:Spine surgery is challenging to define payment modes because of high cost variability and surgical decision-making nuances. While implementing bundled care payments in spine surgery, it is important to understand concepts such as value-based purchasing, episodes of care, prospective versus retrospective payment models, one versus two-sided risk, risk adjustment, and outlier protection. Strategies for implementation underscore the importance of risk stratification and modeling, adoption of evidence based clinical pathways, and data collection and dissemination. While bundled care models have been successfully implemented, challenges facing institutions adopting bundled care payment models include financial stressors during adoption of the model, distribution of risks, incentivization of treating only low risk patients, and nuanced variation in procedures leading to variation in costs.Conclusion:An alternative for fee for service payments, bundled care payments may lead to higher cost savings and surgeon accountability in a patient’s care.

Congenital Heart Disease in Syrian Refugee Children: The Experience at a Tertiary Care Center in a Developing Country.

The influx of Syrian refugees to Lebanon that began in 2012 created new health-care and financial stressors on the country with an increase in communicable and non-communicable diseases. This study aims to describe the presentations, diagnoses, management, financial burden, and outcomes among Syrian refugees with congenital heart disease (CHD) in Lebanon. This is a retrospective study that was conducted through reviewing the charts of all Syrian pediatric patients referred to the Children's Heart Center at the American University of Beirut Medical Center for evaluation between the years 2012 and 2017. We reviewed the charts of 439 patients. The mean age at presentation was 3.97years, and 205 patients (46.7%) were females. 99 Patients (22.6%) were found to have no heart disease, 69 (15.7%) had simple, 146 (33.3%) had moderate, and 125 (28.5%) had complex heart diseases. 176 (40.1%) Patients underwent interventional procedures, with a surgical mortality rate of 10.1%, compared to a rate of 2.9% among non-Syrian children. The average cost per surgical procedure was $15,160. CHD poses a significant health and financial burden on the Syrian refugee population in Lebanon, a small country with very limited resources. The Syrian cohort had a higher frequency of complex cardiac lesions, presented late with additional comorbidities, and had a strikingly elevated surgical mortality rate. Securing appropriate funds can improve the lives of this population, ease the financial burden on the hosting country, provide adequate health-care services, and improve morbidity and mortality.

Mexican-Origin College Students’ Stress, Sibling Relationships, Academic Motivation, and Depressive Symptoms

The current study investigated associations among interpersonal, academic, financial, and ethnicity-related stressors and college students’ academic motivation and depressive symptoms, as well as the moderating role of positive sibling relationships on these associations. Participants included 171 Mexican-origin college students (80.7% female; M = 21.6 years). Data were collected using an online survey and analyzed with path analysis. Under conditions of more positive sibling relationships, there was a positive association between interpersonal stress and academic motivation, a negative association between ethnicity-related social stress and academic motivation, and a positive association between financial stress and depressive symptoms. Under conditions of less positive sibling relationships, there was a positive association between interpersonal stress and depressive symptoms. Findings suggest that sibling relationships may only be protective for certain types of stress.

Risk factors, physical and mental health burden of male and female pathological gamblers in the German general population aged 40\u201380

BackgroundGambling Disorder (GD) has been associated with considerable mental and physical health risks in clinical samples. The paper determines risk factors, mental and physical health burden of probable GD for both men and women in the general population.MethodsIn the Gutenberg Health Study, a population-based sample of N = 11,875 aged 40–80 years was analyzed regarding lifetime probable GD prevalence (measured with the Lie/ Bet Questionnaire) and a wide array of health variables including standardized measures of depression, anxiety, and somatic symptoms.ResultsProbable GD lifetime prevalence was 2.1%, with higher rates among 1st generation migrants (5.5%; vs. non-migrants 1.6%), men (3.0%; vs. women 1.2%), and the sample’s youngest age decade (40–49 y., 3.1%). Lifetime probable GD was associated with current work-related, family and financial stressors as well as unhealthy behavior (smoking, extended screen time), and lifetime legal offenses. In men, but not in women, increased rates of imprisonment, mental and somatic symptoms were found.ConclusionsGD is a major public health problem with serious social, mental and physical health burden. Epidemiological findings underscore the preponderance of GD among 1st generation migrants and men. Findings are consistent with a vicious cycle of family, work related and financial stress factors, and mental and physical burden, particularly in men. Demographic risk factors may help to target specific prevention and treatment efforts.