Greater Economic Stress Research Articles

β-Thalassemia gene editing therapy: Advancements and difficulties.

β-Thalassemia is the world's number 1 single-gene genetic disorder and is characterized by suppressed or impaired production of β-pearl protein chains. This results in intramedullary destruction and premature lysis of red blood cells in peripheral blood. Among them, patients with transfusion-dependent β-thalassemia face the problem of long-term transfusion and iron chelation therapy, which leads to clinical complications and great economic stress. As gene editing technology improves, we are seeing the dawn of a cure for the disease, with its reduction of ineffective erythropoiesis and effective prolongation of survival in critically ill patients. Here, we provide an overview of β-thalassemia distribution and pathophysiology. In addition, we focus on gene therapy and gene editing advances. Nucleic acid endonuclease tools currently available for gene editing fall into 3 categories: zinc finger nucleases, transcription activator-like effector nucleases, and regularly interspaced short palindromic repeats (CRISPR-Cas9) nucleases. This paper reviews the exploratory applications and exploration of emerging therapeutic tools based on 3 classes of nucleic acid endonucleases in the treatment of β-thalassemia diseases.

30,000 Feet Overview of Lifestyle Medicine

Chronic diseases account for the highest morbidity and mortality among adults and, increasingly, adolescents and young adults in the United States. This imposes great economic stress on the healthcare system. Chronic diseases can largely be attributed to several key harmful lifestyle behaviors, including poor diet, low physical activity, substance abuse, and stress, to mention just a few. Recent research demonstrates that sustained healthy lifestyle behaviors can not only prevent and treat but may even reverse many of these chronic diseases. The American College of Lifestyle Medicine (ACLM) defines Lifestyle Medicine (LM) as "the use of evidence-based lifestyle therapeutic intervention—including a whole-food, plant-predominant eating pattern, regular physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection—as a primary modality, delivered by clinicians trained and certified in this specialty, to prevent, treat, and often reverse chronic disease.” ACLM has worked to establish and update LM core competencies over the last decade. Many training programs have adopted evidence-based LM didactic and clinical training across various health professions students to ensure trainees meet these competencies. We aim to provide a brief overview of LM, discuss the six pillars of LM: nutrition, physical activity, avoidance of risky substances, restorative sleep, stress reduction, and positive social connection, and discuss their significance in wellness from the patient’s and the physician’s perspectives.

Establishment and validation of a nomogram for progression to diabetic foot ulcers in elderly diabetic patients.

Many diabetic patients develop and progress to diabetic foot ulcers, which seriously affect health and quality of life and cause great economic and psychological stress, especially in elderly diabetic patients who often have various underlying diseases, and the consequences of their progression to diabetic foot ulcers are more serious and seriously affect elderly patients in surgery. Therefore, it is particularly important to analyze the influencing factors related to the progression of elderly diabetic patients to diabetic foot, and the column line graph prediction model is drawn based on regression analysis to derive the influencing factors of the progression of elderly diabetic patients to diabetic foot, and the total score derived from the combination of various influencing factors can visually calculate the probability of the progression of elderly diabetic patients to diabetic foot. The influencing factors of progression deterioration to diabetic foot in elderly diabetic patients based on LASSO regression analysis and logistics regression analysis, and the column line graph prediction model was established by statistically significant risk factors. The clinical data of elderly diabetic patients aged 60 years or older in the orthopedic ward and endocrine ward of the Third Hospital of Shanxi Medical University from 2015-01-01 to 2021-12-31 were retrospectively analyzed and divided into a modeling population (211) and an internal validation population (88) according to the random assignment principle. Firstly, LASSO regression analysis was performed based on the modeling population to screen out the independent influencing factors for progression to diabetic foot in elderly diabetic patients; Logistics univariate and multifactor regressions were performed by the screened influencing factors, and then column line graph prediction models for progression to diabetic foot in elderly diabetic patients were made by these influencing factors, using ROC (subject working characteristic curve) and AUC (their area under the curve), C-index validation, and calibration curve to initially evaluate the model discrimination and calibration. Model validation was performed by the internal validation set, and the ROC curve, C-index and calibration curve were used to further evaluate the column line graph model performance. Finally, using DCA (decision curve analysis), we observed whether the model could be used better in clinical settings. (1) LASSO (Least absolute shrinkage and selection operator) regression analysis yielded a more significant significance on risk factors for progression to diabetic foot in elderly diabetic patients, such as age, presence of peripheral neuropathy, history of smoking, duration of disease, serum lactate dehydrogenase, and high-density cholesterol; (2) Based on the influencing factors and existing theories, a column line graph prediction model for progression to diabetic foot in elderly diabetic patients was constructed. The working characteristic curves of subjects in the training group and their area under the curve (area under the curve = 0.840) were also analyzed simultaneously with the working characteristic curves of subjects in the external validation population and their area under the curve (area under the curve = 0.934), which finally showed that the model was effective in predicting column line graphs; (iii) the C-index in the modeled cohort was 0.840 (95%CI: 0.779-0.901) and the C-index in the validation cohort was 0.934 (95%CI: 0.887-0.981), indicating that the model had good predictive accuracy; the calibration curve fit was good; (iv) the results of the decision curve analysis showed that the model would have good results in clinical use; (v) it indicated that the established predictive model for predicting progression to diabetic foot in elderly diabetic patients had good test efficacy and helped clinically screen the possibility of progression to diabetic foot in elderly diabetic patients and give personalized interventions to different patients in time.

Community factors and animal shelter outcomes

ABSTRACT This research explores connections between the nature of a community, the type of animal shelter it has, how animals arrive at the shelter, and outcomes for the animals in terms of adoption or euthanasia. Based on data from Shelter Animals Count, the study concludes that the nature of the local community is related to the type of shelter it is served by, how dogs arrive at the shelter, and directly to outcomes. Areas with greater economic stress and lower educational attainment are more likely to have a municipal shelter, which increases stray intake, and ultimately euthanasia. Community economic stress is also directly associated with lower adoption and higher euthanasia rates. The findings of the study suggest a multi-pronged strategy to increase adoptions and reduce euthanasia focusing on both animal shelters but also using a One Health approach to improve the welfare of both humans and non-human animals.

Number of Children, Partnership Status, and Later-life Depression in Eastern and Western Europe.

ObjectivesTo investigate associations between number of children and partnership with depressive symptoms among older Europeans and assess whether associations are greater in Eastern than Western countries. We further analyze whether associations are mediated by provision and receipt of emotional and financial support.MethodsUsing cross-sectional data for five Eastern (Bulgaria, Czech Republic, Georgia, Romania, and Russia) and four Western European countries (Belgium, France, Norway, and Sweden) (n = 15,352), we investigated variation in depressive symptoms using linear regression. We fitted conditional change score models for depressive symptoms using longitudinal data for four countries (Bulgaria, Czech Republic, Georgia, and France) (n = 3,978).ResultsUnpartnered women and men had more depressive symptoms than the partnered. In Eastern, but not Western, European countries childlessness and having one compared with two children were associated with more depressive symptoms. Formal tests indicated that partnership and number of children were more strongly associated with depressive symptoms in Eastern than Western Europe.DiscussionAvailability of close family is more strongly associated with older people’s depressive symptoms in Eastern than Western Europe. The collapse of previous state supports and greater economic stress in Eastern Europe may mean that having a partner and children has a greater psychological impact than in Western countries.

Self-Regulation and Economic Stress in Children of Hispanic Immigrants and Their Peers: Better Regulation at a Cost?

ABSTRACTResearch Findings: Although there is a well-established relationship between economic stress and children’s self-regulation, few studies have examined this relationship in children of Hispanic immigrants (COHIs), a rapidly growing population. In a sample of preschool children (N = 165), we examined whether economic stress predicted teacher evaluations of children’s self-regulation, whether economic stress predicted children’s physiological reactivity (via cortisol levels), and whether economic stress had a similar effect on self-regulation and children’s cortisol for COHI versus nonimmigrant children. Greater economic stress was associated with poorer child self-regulation and heightened physiological reactivity across a challenging classroom task for the sample as a whole. However, when we examined children by group, greater economic stress was associated with poorer teacher-reported self-regulation for nonimmigrant children only. In contrast, greater economic stress was related to greater cortisol reactivity across a challenge task for COHIs but not for nonimmigrants. Practice or Policy: Results demonstrate the importance of considering physiological indices of self-regulation (heightened stress physiology), in addition to traditional external indices (teacher report), when assessing self-regulation or risk more generally among preschool samples that are diverse in terms of ethnicity, economic risk, and parents’ nativity.

Economic stress and cigarette smoking: Evidence from the United States

This paper uses pooled data on U.S. states for the post-MSA period to estimate the demand for cigarettes, with the main contribution lying in considering the effects of economic stress/uncertainty. Different measures of economic stress – standard deviations and averages of unemployment and property prices – are considered. Greater economic stress is found to lower cigarette smoking across various specifications. Other findings largely support the literature on cigarette demand — price effects are negative, border price effects are positive and the effect of income is negative.

Fundraising In Difficult Economic Times: Best Practices

Christian institutions of higher education, as with other American nonprofits, are under considerable financial stress. The purpose of this research, which included both a survey of development officers and conversations with a sample of CCCU presidents, vice presidents of development, or provosts, was to identify best practices in fundraising. Several factors were hypothesized as impacting institutional effectiveness in fundraising: First, we hypothesized that organizations that operated on transformational approaches to fundraising have fared significantly better during the recession than those which operate on a more transactional basis. Secondly, we hypothesized that the greater proximity of the donor base of an organization would positively impact fundraising. Thirdly, we hypothesized that regional economic stress patterns would impact fundraising effectiveness with greater economic stress leading to decreases in fundraising effectiveness. Our research suggests that macroeconomic conditions, the number of development staff, and the size of development budget do not predict performance. Performance is related to a transformational approach to development work built on a compelling vision that is communicated clearly. The core challenge for Christian higher education is the development of visions and programs that speak to the realities of the 21st century, and the development of the broad-based leadership to take us there.

The Global Financial Crisis: Implications for China's South-South Cooperation

How the global financial crisis affects China has implications that extend well beyond its own borders. This article examines the impact of the crisis on China and considers how this might affect China's relations with low income economies, particularly in Africa. The crisis provides an opportunity for China to extend its economic and political interests in Africa and to secure access to resources at a time when other countries are under greater economic stress. Beyond the immediate impacts of the crisis, therefore, a subtle power shift may be underway in relation to Africa. African leaders need to find ways to use this to their advantage in managing relations with both China and the ‘traditional’ donors.

Commitment to Care for the Community

ONCE AGAIN HEALTH CARE REFORM IS A NATIONAL priority, and President Obama has made a commitment that his administration will work to ensure health care for all US citizens. It is assumed that this includes the 47 million individuals who are currently uninsured and the other millions who have inadequate insurance because they lack the financial means to purchase adequate health care. The United States has assiduously opted not to join other developed nations by enacting a national health service, a national health insurance, or any single-payer health system, and there is little likelihood that this will occur now. Why is this the case? The United States is a nation built on commitment, certainly to freedom and to capitalism. But what has happened to the entreaty “Give me your tired, your poor, your huddled masses yearning to breathe free . . . ,” inscribed on a bronze plaque currently located inside the Statue of Liberty exhibit? Perhaps US citizens have become too tired and there are too many poor, huddled masses yearning, so the sense of community has dramatically changed. Certainly, especially in current times of great economic stress, few if any want to provide for those who can provide for themselves but will not. Commitment to community means all doing whatever they can to provide for themselves and family and then providing whatever they can to help those who, for legitimate reasons, simply do not have enough. Perhaps it is unrealistic to believe that there are enough resources in the United States to ensure that no citizen should go hungry or without shelter or health care. But knowing how the United States has prospered despite great stresses such as wars and financial depressions, it seems logical to hope that the nation can once again prosper and share that prosperity with all deserving Americans. One aspect of health care can serve as an example of how commitment to community could work. There has been a maldistribution of US physicians by specialty and geography for many decades. The solution for maldistribution by specialty rests primarily on eliminating the lack of primary care physicians and perhaps the lack of general surgeons. In 2008, only 16.9% of medical students chose the primary care specialties of general internal medicine (5.1%), family medicine (6.1%), and general pediatrics (5.7%), and only 6% chose general surgery. In addition, 87.6% of medical students graduate with loans, and 79.3% graduate with loans of more than $50 000. The mean educational debt for indebted medical school graduates is $139 517. With that degree of indebtedness, and considering the current salaries of generalist physicians, the likelihood is low that more medical school graduates will choose primary care. One peculiarity is that this is not true for general pediatricians. In this issue of JAMA, Freed and Stockman report that, over the past 3 decades, there has been a steady increase in the ratio of generalist pediatricians from 32 per 100 000 children aged 0 to 17 years to 78 per 100 000 in 2005. However, although the number of generalist pediatricians does not appear to be a problem, their geographic maldistribution remains. The current lack of primary care physicians, at least for adults, especially in underserved areas, is not a new phenomenon, and several solutions to alleviate this problem have been proposed. One attempted solution to the primary care problem was to increase the number of medical schools in the United States. A total of 41 new medical schools were opened in the United States between 1970, when there were 85 schools, and 1990, when there were 126 schools. The majority (27) of these new schools were opened in the 1970s (Henry M. Sondheimer, MD, Association of American Medical Colleges; oral communication). Graduating more physicians from more medical schools clearly did not solve the issue of specialty or geographic maldistribution. Another proposed solution centered primarily on the relatively low reimbursements to primary care physicians when compared with subspecialists. In this issue of JAMA, Baron proposes that a more substantial problem affecting primary care is the lack of capacity for generalist physicians to perform well despite their intentions. This problem is a function of both the mental models of primary care (ie, taking responsibility for advocating for and supporting patients) and the available funding to support that care. This problem is exemplified by Wu, also in this issue of JAMA, who writes about his experience with one patient in A Piece of My Mind.

Life stressors, mastery, and perceived partner engagement in HIV-Risk behavior

The relationships among level of personal mastery, economic stress, number of sexual partners, pregnancy status, and perceived partner engagement in HIV-risk behaviors (i.e., intravenous drug use, imprisonment, and sex with other partners) were studied in a sample of 1069 single, inner-city women. African American and European Americans were equally represented. We predicted that greater economic stress, a lower sense of personal mastery, and more sexual partners would be associated with greater perceptions of partner engagement in HIV-risk behavior. We also predicted that personal mastery would serve as a moderating variable in the presence of life stressors (e.g., being pregnant, having multiple sexual partners). The findings supported the hypotheses. Women with more economic stress, multiple sexual partners, and lower personal mastery reported higher perceived partner engagement in HIV-risk behavior than women with lower economic stress, one sexual partner, and higher personal mastery. Personal mastery had a greater impact for women with multiple sexual partners and for those who were pregnant. These findings were qualified by women's ethnicity. © 2001 John Wiley & Sons, Inc.

Writing Public Philosophy: Canada’s Royal Commissions on Everything

This article explores the contributions to Canadian policy development and policy thought of three royal commissions of political-economic inquiry: the 1940 Royal Commission on Dominion-Provincial Relations; the 1958 Royal Commission on Canada's Economic Prospects; and the 1985 Royal Commission on the Economic Union and Development Prospects for Canada. Each commission is examined through three areas of concern: the context for its appointment, the content of its report and the nature of its subsequent influence. Revealing similarities and differences across the three inquiries, the article highlights the importance of the commission process in renewing Canada's National Policy tradition in periods of great economic stress and policy uncertainty. The significance of Canada's “commissions on everything” is related to the deficiencies in innovation of other representational institutions and policy development channels in the Canadian political system.

Brief Communication

SUMMARY Although several descriptive epidemiologic studies have been conducted on injuries to farm youth, few analytical studies that examine causal associations have been reported. Anecdotal case studies conducted suggest that inappropriate child supervision may be a risk factor. To investigate supervision and other potential risk factors, we conducted a pilot case-control study of farm youth injuries in Iowa. During 1993, 139 children under the age of nine were injured or killed in Iowa due to farm injuries, as reported by the Iowa Department of Public Health. Pre-tested questionnaires were distributed to these families requesting information relating to supervision and other risk factors with 22 families agreeing to participate in the study. Matched controls were recruited from farm families where no child injuries occurred. Compared to controls, the farms with injured children had (1) greater economic stress, (2) less off-farm employ-ment, (3) greater participation of children in farm work activities, and (4) none of the children were reported to be alone at the time of the injury. The concern, however, is the degree of supervision and the pressure of multiple workplace hazards. Effective injury prevention must focus on child and parental education, environmental modifications, and alternative rural child care programs. With the high percentage of parents employed off the farm, care alternatives should be made attractive both economically and conveniently. Future research should include a more extensive case-control study for tailoring intervention programs to appropriate groups.

Radiology systems of the nineties: meeting the challenge of change.

Digital imaging technology, particularly reconstructed images such as computed tomography and magnetic resonance imaging, has fueled the increased demand for radiologic services but has intensified storage and communications problems. Today more than 25% of radiologic examinations are digital in origin and, with progressive replacing of film images by digital images likely through the introduction of imaging plate technology, the radiology profession is undertaking the massive effort of evolving a new system where digital images will be transmitted, stored, retrieved and displayed by a multicomponent system connected by a local area network. Through this system, images will be nearly instantly accessible to anyone who needs them. A leading hypothesis is that when the volume of digital examinations reaches 50% of the whole, cost and efficiency considerations will lead to a massive conversion to the digital image management system, which will progress spontaneously. This conversion, unless planned for in today's equipment acquisitions, could lead to great economic stress in hospitals. The 50% point may be reached by the early 1990s.

The Socio-political Roots of Boris Hessen: Soviet Marxism and the History of Science

One of the most famous papers ever presented at a history of science meeting was `The Socio-Economic Roots of Newton's Principia', given by the Soviet physicist Boris Hessen at the Second International Congress of the History of Science, held in London in 1931. Although many scholars at the congress were impressed by Hessen's thesis that intellectual achievements such as Newton's are best explained by examining the social context out of which they arose, oddly enough no one thought to apply this sort of analysis to Hessen's achievement. An examination of Soviet Russia in 1931, a time of great political and economic stress, shows that both Soviet physics and Hessen personally were under very unusual pressures. Hessen's main concern in previous months had been to protect Einstein's relativity theory from attacks by vulgar Marxist ideologists. Hessen's paper on Newton was carefully crafted to support this defensive effort and simultaneously was aimed at strengthening Hessen's own political situation.

Family Stress and Organization Following Parental Divorce or Death

This study examines whether children of separation/divorce experience more associated family disorganization and stress than those from homes broken by parental death or from intact families. Ratings of childrens' levels and types of parental attention, family problems, and economic hardship were obtained on three independent samples. The findings indicate that divorce per se, and not the more general case of family dissolution, is significantly related to increased levels of family stressors for the child. Children with histories of parental separation/divorce were seen to be experiencing significantly lower levels of educational stimulation from parents, as well as greater parental rejection, economic stress, and general family problems than those from homes broken by parental death or from intact families. This relationship was consistent across independent year samples, referred and normal populations, and urban/suburban and rural samples. The implications of these findings for previously demonstrated...

The shadow of death over aging.

The twentieth century has been a time of great economic and social stress during which people have experienced war, economic depression, and the failure of philosophical sustenance. Technological discoveries, which have prolonged life, have also presented older people with problems of adjustment for which they are ill prepared. Only their remarkable capacities for adaptation, relearning, and renewal have armed them to withstand the onslaught of diminishing physiological, cultural, and social attacks.

Hydraulic development as a process of response

The relationship between political organization and hydraulic development is discussed, using illustrations from the Valley of Oaxaca, Mexico. It is suggested that change in political organization toward greater or lesser centralization of control over local water resource use may be part of a social response to environmental degradation (in this case, a receding water table) resulting from the effects of change in resource use (in this case, intensified water extraction). Economic stress due to environmental degradation varies in duration and intensity; such variations must be taken into account in understanding shifts in response patterns. Small-scale hydraulic development which places pressure on the availability of water for irrigation may elicit an initial response of centralization of control over its use to correct for the disturbance, water shortage. However, this response itself tends to exacerbate the disturbance through reducing previously existing homeostatic controls on the extraction of water and hence leads to greater economic stress, up to the point at which new responses must take place. Other kinds of environmental disturbance resulting from initial development attempts appear to have similar feedback effects which contribute to potential systemic instability.

The Logical Structure of Analytic Induction

under greater economic stress in our society exhibit a higher rate of divorce. Additional clarification of these points can be achieved by research which is pointed toward these problems: (1) Specification of the further sociological dimensions of economic factors in familial relations; (2) Determination of the relative economic pressures on various strata in the population, as felt by those strata;28 and (3) Separation of the socio-economic from the occupational factors in marital relationships. The present suggestions are presented, then, as tentative steps in these directions.

Local Residents and Married Women as Teachers

Arguments Concerning Local and Nonresident Teachers Cooke (281) summarized the arguments usually presented in favor of local teachers as follows: (a) local teachers through knowledge many times avoid blunders made by the foreign teachers; (b) local teachers live at home and are able to maintain better health due to better living conditions; (c) superior teachers will remain in the system to be at home; and (d) local teachers are not absent from the city and the school as much as the foreign teachers. Wimbish and Lafferty (315) reported that schoolboards claim local teachers are an intelligent and economical investment and an insurance against teacher transiency. Young (316) stated that the home girl argues that she belongs to a permanent family which pays taxes and as a result she deserves first consideration. Arguments usually presented against local teachers as given by Cooke (281) are: (a) an excessive number of local teachers makes the danger of greater; (b) low salary schedules as a result of local teachers will not attract the best teachers; and (c) local teachers are many times promoted regardless of efficiency. Wimbish and Lafferty (315) stated that schoolboards discriminate against local teachers: (a) to minimize the influence of local politics; (b) to facilitate dismissals in case of unsatisfactory teachers; and (c) to insure the selection of properly qualified and adequately trained teachers. According to Young (316) local teachers have an unfair advantage as they can live at home and shift part of their expense to their parents. Coulbourn (284) is of the opinion that even though there may be justifiable reasons for employing a large number of local teachers in times of great economic stress, sound administration requires that the dangers of too much inbreeding be avoided.