Financial Problems Research Articles

Financial Inclusion and Climate Resilience: The Role for an AI-Enhanced Digital Wallet in Caribbean SIDS

Caribbean Small Island Developing States (SIDS) are highly vulnerable to extreme weather events and climate change. Caribbean SIDS climate vulnerability is worsened by their high level of financial exclusion. Many people do not have bank accounts and access to electronic fund transfer (EFT). As such, they cannot electronically receive funds before or after a natural disaster to cope with the effects. The financial exclusion problem can be addressed through a digital wallet. A digital wallet is a financial transaction application that securely stores a user’s banking and payment information on a cloud interface and allows the user to perform a transaction while hiding their banking information from a vendor. The biggest concern of users with regards to the use of digital wallets are its convenience and security. While digital wallets offer outstanding convenience of purchasing goods and services, data privacy and fraud risks deter people from adopting mobile payment. Potential fraud risk to digital wallets can be identified with anomaly detection techniques. The research problem investigated in this study is how the implementation of an artificial intelligence (AI) enhanced digital wallet can facilitate financial inclusion in the Caribbean, particularly in the context of disaster preparedness and recovery. Since security is an important aspect of a digital wallet, a sub-objective of this study is to derive an appropriate model for anomaly detection in financial transactions in a digital wallet. This study modifies Liu et al. [1] Gated Transformer Networks (GTN) architecture to allow for univariate time series classification. The corresponding new model is referred to as the Univariate Gated Transformer Network (UGTN). The UGTN is used for anomaly detection in financial data from a digital wallet. This study also provides policy recommendations for the implementation of a digital wallet to facilitate financial inclusion and climate resilience in Caribbean SIDS.

Prevalence and Impact of Stress in the Indian Population: A Retrospective Survey Analysis

Post-COVID-19 pandemic, individuals are experiencing various forms of stress. This study assessed the prevalence of stress among Indian adults, examined its physical and psychological impacts, and investigated stress management strategies, aiming to fill existing gaps in research. This retrospective observational study utilized an online survey from March 16, 2023, to July 30, 2023, using snowball sampling to target the Indian population. Respondents aged ≥18 years participated in the study. The survey collected data on demographic information, self-reported stress levels, and Perceived Stress Scale (PSS) scores. The chi-square test was applied for statistical analysis, and results with a p-value under 0.05 were considered significant. Among 1,479 respondents (638 males, 841 females; mean age: 23.7±7.7 years), 76.0% of respondents resided in Karnataka. Out of 1,479 respondents, 9.6% experienced mild stress, 84.9% experienced moderate stress, and 5.5% experienced severe stress according to the PSS. Females experienced significantly higher stress levels when compared with males (p=0.047), but both experienced moderate stress levels. Financial problems (20.7%) and studies (36.4%) were the most common stressors among respondents. They most frequently manage stress through personal strategies, such as sleeping and listening to music. The present study's findings indicate that, following the COVID-19 health crisis, moderate levels of stress are significantly prevalent in the Indian population, primarily due to academic and job-related pressures.

Stochastic Frontier Analysis of Technical Efficiency of Smallholder Maize Farmers in Morogoro Municipality: A Reflection from RIPAT Program

This study looks into the elements that influence maize production and technical efficiency among households participating in the RIPAT SUA Project in Morogoro Municipality, using stochastic frontier analysis for the 2022 – 2023 season. The focus was on socio-economic characteristics, land size, seed usage, use of fertilizer extension services, training from the project, and education. The primary objective was to examine the factors influencing maize production and efficiency by evaluating socioeconomic aspects and specific agricultural techniques. A total of 110 households were surveyed with standardized questionnaires. Socioeconomic data was collected, key variables were evaluated and key variables were analyzed using descriptive statistics and stochastic frontier analysis. The results reveal that land size harms productivity (β = -0.436, p < 0.001), whereas improved seed usage has a positive impact (β = 0.401, p = 0.016). Education level (β = -1.168, p = 0.002) and agriculture experience (β = -0.016, p = 0.049) considerably reduce technical inefficiency, insisting on the importance of education interventions. Additionally, 40% of households have access to VSLA, revealing financial problems. While 94.55% of households got training, only 18.18% received extension services which could hamper the best productivity. Every household reported owning land and using seeds highlighting that they had the necessary materials for maize production. Regarding technical efficiency, Magadu ward high score of 5%, while Kauzeni has the lowest at 1.9% suggesting significant disproportions in productivity among wards. These findings emphasize the importance of focused initiatives to improve agriculture productivity through enhancing farmer education and training, experience, and increased access to finance. These strategies are critical for improving maize productivity and addressing food security issues among households participating in programs like the RIPAT SUA initiative hence will increase agricultural efficiency and contribute to more farmer-sustainable farming methods throughout the region

Perceived Causes of Sleep Problems in Higher Education Students: An Exploratory Study

The major purpose of the present study was to explore higher education students’ perceptions of the causes of their sleep problems. The data were drawn from a previous cross-sectional online survey, from which only the questions relevant to this study were selected, including items on sleep disturbances and their causes. The participants included 1519 full-time students (76% women), aged 18–30 years ( M = 20.9, SD = 2.3); 95.3% were single and studying for a Bachelor’s degree (75.2%) across diverse fields of study. Overall, 30% of the students reported suffering from insomnia, 17.8% met the criteria for clinical insomnia (according to the Insomnia Severity Index), and 12.5% reported being dissatisfied with their sleep. The most significant perceived causes of sleep difficulties were stress (85%), academic problems (67%), and general worries (56.5%). Other causes included affective/love problems (28.4%), family issues (27.5%), changes in sleeping habits (25.9%), financial problems (13.7%), transition to higher education (10.4%), pain (7.1%), and general illness (5.5%). These findings may have important implications for interventions aimed at improving sleep health among higher education students.

High rates of violence and low police reporting amongst sex workers in the Netherlands during the COVID-19 pandemic

IntroductionDuring the COVID-19 pandemic, sex work in the Netherlands was forbidden for many months, yet most sex workers were not eligible for governmental financial support. Therefore, many were forced to continue working illegally, likely leading to unsafe work conditions. We determined sex workers’ experienced violence and police reporting during the COVID-19 pandemic.MethodsData were collected through an online, anonymous survey (N = 173) covering background characteristics, the financial impact of the COVID-19 control measures, experienced sexual and/or physical violence, and police reporting in relation to experienced violence in 2021. We analyzed the data through descriptive statistics and multiple logistic regression analysis. Contextualization was achieved through online focus group discussions (FGDs; N = 3 covering a total of 14 sex workers and 4 social/health workers).ResultsIn total, 41% (n/N = 71/173) of sex workers reported at least one form of violence, and those facing severe financial problems due to the COVID-19 containment measures were significantly more likely to report violence (adjusted OR: 2.7, CI 1.0–7.2, p = 0.049) compared to those without financial problems. Only 9% of those having reason to file charges officially did so. FGDs explained that violence was high due to the unsafe working conditions, and police reporting was low because police were more concerned with enforcing COVID-19 sex work restrictions rather than with prioritizing the safety and well-being of sex workers.DiscussionWe found high rates of reported violence and low police reporting among sex workers in The Netherlands during the COVID-19 pandemic, and COVID-19 control measures and enforcement likely contributed to these unsafe conditions. Safeguarding the safety of sex workers during future crises demands legislation grounded in human rights principles. This includes measures such as mitigating income loss during prohibition of sex work, and shifting police focus towards protecting rather than prosecuting sex workers engaged in illegal sex work.

Grey Relation System Applications in Multi-Attribute Decision-Making and Forecasting in Financial Management

Objective: The objective of the paper is to verify the Grey relation analysis methods and compare them with known models in financial management. The first part is devoted to MADM (multi-attribute decision methods) and the second one to grey forecasting methods. Method: Localization GRA and globalization GRA multi-criteria models are described and compared with the TOPSIS method. The forecasting GRA(1,1) model based on cumulative data is described, derived and compared with the linear growth model. The models are verified on the data set. Results and Discussion: The globalisation model based on a pair-wise comparison of alternatives is different, and the ranking of alternatives is fully different in comparison with the TOPSIS model. It was found that the localisation GRA model and TOPSIS, both constructed on similarity measures, present similar and comparable results. So, the grey relation approach considers the uncertainty of input data. The forecasting model GRA(1,1) is computed and compared with the growth model. Results show that the growth model is the trendy model, and the non-trendy series is overestimated or underestimated, so the GRA model looks more robust. Research Implications: The problem of imprecise data is investigated. And it is a realistic condition for practical decision-making. The problem of lack of data is often a phenomenon in decision-making. Traditional statistical methods cannot be applied. Therefore, grey relation methodology is one approach to overcoming the problem of imprecise data and lack of data. Uncertainty and lack of data problems are topics important for research and the managerial community. Originality/Value: Sometimes, in financial decision-making, high-quality data or long-term time series is not at our disposal, and on the other hand, decisions have to be made. This problem is often neglected and solved by not-relevant traditional statistical models. Therefore, methods that allow the solving of such problems are useful. It was shown that a grey relation methodology for multicriteria financial performance evaluation and forecasting shows more robust and stable results and could be more relevant for imprecise data or short time series data in financial decision-making problems.

The Influence of Employment Stress On the Academic Performance of Working Students: Perspectives from Pakistan

One must grasp stress's intricacy to develop and implement stress-reduction strategies. Employment-related stress on academic performance is becoming an acute concern for psychological and mental health in Pakistan. The current research focuses on how employment-related stress interferes with graduate students' academic performance in Parachinar, District Kurram Khyber Pakhtunkhwa, Pakistan. This investigation applies quantitative methods—the Govt. Postgraduate College Parachinar, District Kurram, Khyber Pakhtunkhwa Pakistan, completed a standardized questionnaire to 180 students from various academic disciplines. The findings illuminate stress's intricacy. It may be utilized to establish and encourage more efficient and achievable strategies or techniques that improve academics and job satisfaction, inspiration, and effectiveness at the individual and organizational levels. The research study concluded that 81.67% of male students suffered from employment stress. Student stressors include workload (31.67%), lack of time management (9.44%), interpersonal conflicts (20.00%), high study load (21.11%), and financial problems (17.78%), and the coping strategies being adopted by these students; Moral support (13.89%), Social support (30.00%), Financial support (45.00%), and Job enrichment (11.11%). The research concludes that addressing the highlighted concerns, counselling, and other successful coping strategies may alleviate academic and employment stress.

Evaluating the financial credibility of third-party logistic providers through a novel frank operators-driven group decision-making model with dual hesitant linguistic q-rung orthopair fuzzy information

In the relevant literature, there is no study dealing with the financial credibility of third-party logistic providers with the help of decision-making frames. Further, there are no criteria to evaluate the third-party logistics providers' creditworthiness in practice, and decision-makers in the banks consider their judgments and experiences to assess the demand of the logistics firms. This study proposes a multi-criteria group decision-making framework through a dual hesitant linguistic q-rung orthopair fuzzy (DHLq-ROF) set to manage uncertainties more effectively and make a theoretical contribution to the academic literature. For ranking, the score function and accuracy function are defined. Additionally, some novel operational laws based on Frank t-norms and t-conorms are defined for DHLq-ROF numbers. A wide range of generalized aggregation operators, such as DHLq-ROF Frank weighted averaging, DHLq-ROF Frank weighted geometric, DHLq-ROF Frank generalized weighted averaging, and DHLq-ROF Frank generalized weighted geometric operators, are also investigated. Beyond that, several prominent characteristics of the proposed operators are studied. It is applied to a financial credibility problem for a multinational organization to demonstrate the introduced model's applicability. Considering the results obtained regarding the importance of the criteria, the most crucial criterion is market indebtedness, followed by fleet vehicle structure and current rate criteria, respectively. The results indicate that UPS, Kuhne & Nagel and DHL Deutsche Post are the best third-party logistic providers. The sensitivity analysis shows that the framework possesses favourable flexibility and effectiveness. Thanks to the framework's ability to produce practical solutions to challenging decision-making problems, it can be reliably preferred in engineering and other fields.

Factors influencing the ability of family caregivers of Alzheimer’s patients within Iranian families to continue and persist in their caregiving roles: a qualitative study

BackgroundUnderstanding the motivations driving family members to continue caring for individuals with Alzheimer’s disease is crucial for enhancing social support programs within community health systems. This study specifically explores the factors influencing Iranian family caregivers’ ability to persist in their caregiving roles.MethodsThis qualitative study was conducted using conventional content analysis with 22 participants in 2022 in Babol (a city in northern Iran). The inclusion criteria for the study included caregivers of Alzheimer’s patients who had been the primary caregivers for at least one year for patients with a confirmed diagnosis of Alzheimer’s disease. The sampling method was purposive, ensuring maximum variation in social position, demographic status, and stages of Alzheimer’s disease after the onset of symptoms. In this research, data were collected from caregivers of Alzheimer’s patients through semi-structured interviews and in-depth individual interviews. The data were analyzed using MAXQDA software.ResultsOne category and four subcategories were identified to explain the continuity of the caring role in family caregivers of Alzheimer’s patients. The category was “on the Fence of the Caring Role.” The subcategories included Commitment to Care (Being Determined, Being Indebted, Feeling Dutiful), Coercion to Care (Giving in to the Caring Role Due to Family Requirements, Patient Care Due to Financial Problems), Socio-Cultural Beliefs and Concerns (Spiritual and Religious Tendencies, Social Stigma and Social Fears), and Attachment and Love for the Patient (Feeling Pity, Feeling Nostalgia for Kinship).ConclusionFamily caregivers are deeply engaged in their roles, often feeling trapped by various pressures. Recognizing these dimensions can inform policymakers and health practitioners in developing targeted interventions, such as respite care programs, financial support, and community resources, aimed at alleviating caregiver burden and enhancing the quality of care for patients. By addressing the complexities of the caregiver experience, effective strategies can be implemented to support both patients and their caregivers, ultimately improving health outcomes within the community.

Manajemen Risiko Bisnis BMT di Tengah Pandemi COVID-19

The economic contraction in the MSME (Micro Small and Medium Enterprises) sector during the Covid pandemic directly impacted financial business performance. On a micro scale, BMT (Baitul Maal wat Tamwil) as a sharia microfinance institution is affected by the weakening of economic activity in the MSME sector. This is understandable because in its activities, BMT makes MSMEs its business partners. From a business aspect, the impact experienced by BMT is the emergence of various risks; increasing problematic financing, liquidity and operational risks. The results of this qualitative research show that; Firstly, business risks that arise at BMT NU Jawa timur Balung Branch and BMT UGT Nusantara Rambipuji Jember include financing risk, operational risk and liquidity risk. Financing risk is characterized by a high number of problematic financing. Meanwhile, operational risks are characterized by restrictions on access to the office, physical distancing, and increased operational costs. Meanwhile, liquidity risk is characterized by an abundance of funds in cash. Second, risk management at BMT NU Jatim Balung Branch and BMT UGT Nusantara Rambipuji Jember is carried out sequentially starting from risk identification, measurement, analysis and control activities. Based on this process, tactical steps are then developed to handle each aspect of risk. Financing risks include financing moratorium steps, intensive collection, restructuring and creating reserves for losses. Operational risks are approached by the issuance of new rules regarding office operating systems and rules related to the implementation of Health procedures.

Teenage pregnancy in rural Ethiopia : The case of Jima Arjo District, East Wallaga, Western Ethiopia

ABSTRACT Background : Teenage pregnancy is a major public health concern in developing nations like Ethiopia. Many psychological, financial, and health problems are associated with it. Objective : To determine the magnitude and associated factors of teenage pregnancy among teenagers visiting public health facilities in Jima Arjo district, East wallaga, Western Ethiopia, 2022. Methods: A facility-based cross-sectional study was conducted on 421 teenage females(10 to 19 years) in Jima Arjo District from February 15 to May 30, 2022. Data were collected , cleaned and analayzed using Epidata version 3.1. Level of significance of association was determined at a P- value?<?0.05. Results: In this study, the magnitude of teenage pregnancy was 17.1%. Married participants, attending secondary school, no awareness on family planning, not living with parents, and having a sister with the history of teenage pregnancy were significantly associated with teenage pregnancy. Conclusion: This study found that the magnitude of teenage pregnancy was high. Key stakeholders should work on prevention of early marriage, raise awareness on family planning, and encourage females’ education. Keywords: magnitude, associated factors, teenage pregnancy, Jima Arjo, East Wallaga

An Urgent Call for Suicide Prevention in Indonesia: The Clinicians’ Role in Preventing Suicide

Introduction: Since suicide is a complicated matter, multiple sectors must be involved. Globally, there were 703,000 suicide cases in 2019. Over the past three years, there has been a rise in suicide instances in Indonesia. Treating those who are at risk of suicide is difficult since suicide situations, like mental health illnesses, continue to carry stigma. To provide a statistical overview of suicide cases and the role of clinicians in preventing suicide cases. Methods: Searching for statistical data in Indonesia, we used Pubmed with the keyword “statistics”, “suicide”, “Indonesia”. Searching for data regarding risk factors and prevention of suicide, we also used Pubmed with the keywords “risk factor”, “prevention”, “screening”, “suicide”. Results: Globally, in 2019 the average rate of suicide cases was around 9.0 cases per 100,000 population. In Indonesia, exact data regarding the prevalence of suicide cases is still unknown. A person committing suicide can be caused by many factors such as previous mental disorders, relationship conflicts, legal problems, violence, financial problems, social exclusion, and low socioeconomic status. In addition to providing appropriate management, a clinician must provide education and outreach to the public regarding warning signs and risk factors for suicide, restrictions on tools for suicide, screening, and also remind every patient, especially patients with mental disorders, to continue to pray to be given health. Conclusion: A clinician has a role ranging from education and related outreach, screening, and also pharmacological and non-pharmacological management of someone at risk of suicide

Research on the Application of Mathematics in Finance

Abstract. Mathematics is a fundamental science and a problem-solving method that plays an important role in revealing the essential laws of the development of certain things. It has rigorous logic, high abstractness, and wide applicability. This brings great difficulties to enterprises, especially high school mathematics because it involves a wide range of knowledge points and complex calculations. Among them, the formation of financial mathematics has greatly promoted the development of China's financial industry. Moreover, in solving financial problems, relevant knowledge and theories of mathematics can be used to analyze and explore financial laws, and the application effect is significant, for example, using deterministic mathematical method and nondeterministic mathematical method to solving question about financial investment and returns; building securities investment portfolio model or asset valuation model to calculating and expressing some economic models. Based on this, this article discusses the application of mathematical knowledge to several financial problems, analyzes the current problems, and looks forward to the future of financial mathematics.

The Experiences of Iranian Middle and Lower Class Living in Inflationary Conditions

One of the most important economic problems in Iran is inflation. The aim of this study was to explore the social consequences of inflation in the lives of middle-class and lower-class people. Some of the questions addressed in this study are: how do participants experience inflation? How do they make a living? What problems are they facing? what are the consequences of inflation for participants? We used a constructivist qualitative approach and grounded theory method. Participants were sampled purposively with different social groups. A total of 27 interviews with participants who belong to the middle-class and lower-class in three cities in Iran in Isfahan, Yazd and Tehran were performed. Data collection was performed through semi-structured interviews. The interview transcripts were analyzed using grounded theory coding. After analyzing the data, 8 main categories were explored which include: Limitations in relationships, Mental Threat, Frustration, make ends meet, Early Adulthood, Family quarrel, profit-making and Anomy. According to the results, participants are in a bad situation in terms of economy. Inflation and financial problems have had the pervasive impact on the people, especially those who have had a steady and low income.

Budaya Organisasi Penanganan Pembiayaan Murabahah Bermasalah

This research examines the factors that cause problematic murabahah financing at BMD Syariah Barat Magetan, and discusses the organizational work culture that is effective in finding solutions to resolve them. This research is field research using qualitative methods. The results of the research show that there are 2 factors that cause financing problems, namely internal factors originating from managerial and governance from the institution, and external factors originating from the customer's economic conditions. This research explains that there is an effective organizational work culture model to reduce the number of problematic murabahah financing, namely rescheduling and the most dominant one is billing customers' homes outside of working hours

Assessment of the Viability of Community-Based Health Insurance Schemes in the Ziguinchor Department from 2016 to 2018 in the Context of Universal Health Coverage (Senegal)

<i>Introduction</i>: This study examines the viability of community-based health insurance schemes in the Ziguinchor department of Senegal from 2016 to 2018, within the context of universal health coverage. Health insurance schemes have emerged as a promising solution to extend social health protection to informal sector workers and rural populations. However, despite political support, these structures face persistent challenges in terms of enrollment, member retention, and management. The study aims to assess the viability of these schemes, as well as the perceptions of various stakeholders on mutual health insurance. <i>Methodology</i>: The study adopted a mixed approach, combining quantitative and qualitative methods, based on the theoretical framework developed with the support of the International Labor Office (ILO). This framework evaluates the viability of health insurance schemes according to four dimensions: institutional, technical, functional, and financial/economic. A questionnaire with 87 questions was used to collect quantitative data on these aspects from the seven health insurance schemes in the Ziguinchor department. For the qualitative component, focus groups and individual interviews were conducted with various actors, including beneficiaries, non-beneficiaries, community leaders, scheme managers, and healthcare providers. <i>Results</i>: The study's findings reveal a complex situation for the health insurance schemes in the Ziguinchor department. Institutionally, the schemes have a solid foundation with legal status, internal regulations, and affiliation to a departmental union. Technically, membership is voluntary and family-based, with control mechanisms in place, although their effectiveness is limited. Functional viability shows positive signs with a membership growth rate of 20.18%, but the overall penetration rate remains low at 16.99%, and the premium collection rate is very low, averaging 26.78%. The financial situation is particularly of concern: no scheme can meet its short or long-term debts, and the average claims ratio is excessively high at 282%. As for stakeholder perceptions, they are mixed: while the schemes are generally considered beneficial, significant practical difficulties are identified, including lack of information, funding problems, and procedural complexity. <i>Conclusion</i>: The study highlights the complexity of the role of health insurance schemes in the quest for universal health coverage. Despite undeniable strengths, the schemes face considerable challenges in terms of functional and financial viability. Corrective measures are necessary, including strengthening management capacities, innovating premium collection methods, and improving communication. An evolution of the model is also suggested, potentially towards greater integration into a national social protection system or the development of innovative public-private partnerships.

A systematic review of the financial issues of higher education institutions (HEIs) and possible strategies to cope with them

The field of higher education has not only been for elites since the last three decades. It has also included the general masses in it. That’s why the transformation of the socio-economic status and general awareness in the present age owes to higher education. On the other hand, challenges have also emerged and set conditions on the path to sustainability. Thus, higher education has faced problems, especially financial problems. These issues further give birth to some other issues. This study is an attempt to understand the issues caused by financial issues. The study also aimed to propose strategies to deal with these issues. Based on the systematic literature review, the problems have been categorized as lack of internet, digitalization, and online teaching; underdeveloped infrastructure for STEAM; lack of priorities; and quality issues. These findings create hurdles in achieving the quality of HEIs. To cope with these issues, clear policy and setting priorities were proposed as the top most important strategies to bring about quality and achieve HEIs’ organizational objectives. It can be concluded that HEIs need appropriate strategic and financial managers and administrators who can align their strategy with the vision and mission of the institutions.

Suicide in young and middle-aged individuals: lessons from a psychosocial autopsy study

Abstract Background Sociodemographic characteristics of suicides are available from Statistics Netherlands. To improve suicide prevention, it is not only necessary to know who dies but also why people die. A psychosocial autopsy was conducted in the Netherlands to investigate differences in psychosocial characteristics and precipitating factors of suicides of young (<30) and middle-aged (40-70) suicide decedents. Methods Data were collected from bereaved individuals. A questionnaire detailed sociodemographic and psychosocial characteristics of the decedents. We reconstructed the suicidal process in the months preceding the suicide in an interview. Findings from the questionnaire and interview were integrated. An independent expert committee formulated recommendations for suicide prevention. Results 162 suicides were investigated. Young decedents showed high levels of substance use and academic pressure. Young adults with developmental disorders were vulnerable in the transition to adulthood. Young males reached out less to support and care. By contrast, suicides of young females were distinguished by comorbidity of psychiatric disorders, frequent suicidal behaviours, high levels of care use, wait lists and a loss of (treatment) perspective, harmful social media use and bullying. Work and financial problems were common in middle-aged decedents. Physical disability and pain were frequently mentioned for middle-aged females. Suicide in middle-aged males was characterized by financial distress, interpersonal conflicts such as divorce, high levels of binge drinking and addiction. Conclusions Our data provide a topology of the needs of individuals at risk for suicide. Suicide prevention strategies can be improved by better transition support and explicit suicide monitoring in young adults with a developmental disorder, active waitlist policies in mental healthcare, and improved collaboration between debt counsellors and mental care professionals based on shared accountability. Key messages • Bereaved individuals elucidated a wide range of psychosocial problems in suicide decedents. • Suicide prevention should adhere to a needs-based approach.

The impact of discontinuing proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors on clinical outcomes

Abstract Background/Introduction Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors have demonstrated efficacy in lowering low-density lipoprotein cholesterol (LDL-C) levels and reducing the risk of cardiovascular events. Despite these advantages, some patients are unable to continue the use of PCSK9 inhibitors due to financial or other reasons. Limited clinical studies have been conducted to investigate the clinical outcomes of patients discontinuing PCSK9 inhibitors for various reasons. Purpose This study aims to specifically investigate patients who were unable to continue PCSK9 inhibitors, with a particular focus on those discontinuing due to financial or other reasons. The primary objective is to assess the impact of discontinuation on major adverse cardiovascular events (MACE). Methods This study focused on 205 Japanese patients who received PCSK9 inhibitors between July 2016 and December 2023. The clinical outcomes of patients who continued or discontinued PCSK9 inhibitors were comprehensively compared. The primary endpoint was major adverse cardiovascular events (MACE), encompassing cardiovascular death, coronary revascularization, target lesion revascularization (TLR), and fatal or non-fatal myocardial infarction (MI). Results Among 205 patients (median age: 69 years; interquartile range [IQR]: 60-76 years 68% male), the median follow-up was 413 days (IQR, 49-1148 days). At one year, the median LDL-C was 43mg/dL, and 158 patients (77%) achieved LDL-C <70 mg/dL. During the follow-up, 64% (131 patients) continued PCSK9 inhibitors, while 36% (74 patients) discontinued. Of the discontinuation group, 30% (22 patients) cited financial problems, 24% (18 patients) clinical stability, and 12% (9 patients) patient preference. Multivariate Cox regression analysis revealed that the group discontinuing PCSK9 inhibitors had a higher incidence of MACE than the group that continued (hazard ratio: 1.84; 95% confidence interval: 1.02 to 3.55; p=0.05). Conclusions This study suggests an increased risk of MACE when PCSK9 inhibitors are discontinued for financial or other reasons. This insight is vital for healthcare management and decision-making among medical practitioners.PCSK9: continuation vs discontinuation

Gambling disorder and its associated factors in university students

Abstract Background Gambling disorder (GD) is defined as persistent and uncontrollable gambling behaviour that has negative effects on an individual’s life. This can lead to financial problems, poor academic performance, and health problems. GD has been associated with psychological disorders like depression, anxiety, and attention-deficit hyperactivity disorder (ADHD). We aimed to examine the gambling disorder and its associated factors in university students. Methods We conducted a cross-sectional study among students at a university in Eskisehir (Türkiye) in 2024. A stratified random sample design was used. Five faculties were randomly selected. A total of 1,201 students were included according to the stratum weight of the faculties. A questionnaire including sociodemographic characteristics, South Oaks Gambling Screen (SOGS), and Adult ADHD Self-Report Scale (ASRS) was applied. Data were analysed through descriptive statistical analyses and multivariate logistic regression models. Results The mean age was 21.5±2.8 years, and 46.8% were male. While 48.7% of the students stated that they had gambled at least once, 2.2% had a gambling disorder. The three most common types of gambling played by students were stock market (28.2%), bet on sports (22.0%), and scratch cards (18.2%). In multivariate analysis, being male (Odds ratio-OR:6.5, 95%CI:1.4-29.8), having lost years during education (OR:2.7, 1.1-6.8), having relatives with gambling problems (OR:8.0, 1.8-36.2), investing greater amounts of money in gambling (OR:3.7, 1.0-13.0), and having a high probability of ADHD (OR:4.3, 1.4-12.8) were found to be predictors for GD. Conclusions Although about half of the students had engaged in gambling activities, only a small proportion showed signs of GD. We can conclude that being male, having lost years in education, having relatives with gambling problems, investing larger amounts of money in gambling, and having a higher probability of ADHD are predictors of GD among students. Key messages • Implementing educational campaigns at universities to raise awareness of the potential risks and consequences associated with GD could be beneficial. • It may be helpful if mental health services at the university were equipped to consider mental health conditions such as ADHD, that contribute to GD.