Unintended Burden Research Articles

"We don't do any of these things because we are a death-denying culture": Sociocultural perspectives of Black and Latinx cancer caregivers.

Cancer is an enormous public health burden among Black and Latinx cancer survivors, and they are at risk of facing barriers to accessing cancer treatment and support in the United States. This study explored the unique challenges and experiences faced by Black and Latinx cancer survivors through the lens of their caregivers, including the specific cultural, social, and systemic factors that influence cancer survivorship experience and quality of life within these communities in the United States. We used a qualitative descriptive design for the study, and conducted 6 focus group discussions (3 Latinx and 3 Black groups) with a total of 33 caregivers of cancer survivors, (Mean age = 63 years). Data were analyzed using inductive content analysis. We identified 3 main themes: (1) families as (un)stressors in survivorship such as the vitality of social connections and families as unintended burden; (2) responses after diagnosis specifically whether to conceal or accept a diagnosis, and (3) experiencing health care barriers including communication gaps, biased prioritizing of care, and issues of power, trust, and need for stewardship. The findings align with previous research, highlighting the complex interplay between cultural, familial, and healthcare factors in cancer survivorship experiences within underserved communities. The study reiterates the need for culturally tailored emotional, physical, financial, and informational support for survivors and their caregivers. Also, to improve quality of life, the study highlights a need to strengthen mental health and coping strategies, to help address psychological distress and improve resilience among survivors and their caregivers.

Meeting the promise and challenges of “Free College”: Research and practical insights from a community college scholarship program

AbstractThis chapter illustrates the potential promise and complexities of free college initiatives from the perspective of administrators, faculty, staff, and students who are involved in a scholarship program at a small Midwestern community college. Based on two waves of interviews conducted in 2019 and 2021 respectively, we found that, while largely supportive of the free college movement, the program participants shared clear reservations due to potential unintended burdens on the part of institutions, and compounding barriers for students that free tuition alone cannot solve. This chapter closes by presenting a series of implications to inform the implementation of “free college” to realize its full promise.

Hidden cost of conservation: A demonstration using losses from human-wildlife conflicts under a payments for ecosystem services program

As global efforts to protect ecosystems expand, there is increasing concern about conservation costs borne by rural communities. To date, these costs have often been narrowly estimated in terms of foregone livelihood opportunities directly caused by conservation, while unintended human burdens that accrue with ecological gains from conservation are often ignored. As a first attempt to quantify this previously hidden cost, we estimated the impact of converting cropland to forest under one of the world’s largest conservation policies, China’s Grain-to-Green Program (GTGP), on crop raiding in a demonstration site using the matching approach. We found that GTGP afforestation was responsible for 64 % of the crop damage by wildlife on remaining cropland, a cost worth 27 % of GTGP’s total payment to farmers. Our study highlights that the conservation cost to communities through influencing human-wildlife conflicts can be substantial, which should be quantified and considered in global conservation efforts to avoid unintended burdens on rural communities.

Editorial Comment

Dr. Albertson has been a leader in delineating the natural history of prostate cancer and warning us about overdetection and treatment. This review article 1 Albertsen PC. The unintended burden of increased prostate cancer detection associated with prostate cancer detection associated with prostate cancer screening and diagnosis. Urology, in press. Google Scholar enhances this reputation; it is complete and clearly written. He reminds us again that we are picking up too much prostate cancer, we are treating too many of them at significant morbidities, and although the death rate is declining in many western countries and the best controlled randomized trial (ie, the European ESRPC) suggests survival benefit, there is an alarmingly high rate of overdiagnosis. One estimate suggests that almost 1500 cases need to be screened for 50 cancers to be detected to cure 1 man. It is no wonder that the U.S. Preventive Task Force (References 5 Lange P.H. A philosophical reflection on PSA screening What should we now think and do. in: Thomsan I.A. Resnick M.I. Klein E.A. Prostate Cancer Screening. Humana Press, Totowa, NJ2001: 97-104 Crossref Google Scholar and 6 Lange P.H. Schellhammer P.F. Views from the “other side”: personal reflections about prostate cancer from two urological oncologists. in: Kirby R. Partin A.W. Feneley M. Prostate Cancer: Principles and Practice. 2006: 617-624 Google Scholar in the article) and maybe the American Cancer Society 2 American Cancer SocietyProstate Cancer Screening Recommendation. http://www.cancer.org/docroot/ped/content/ped_2_3x_acs_cancer_detection_guidelines_36.asp Google Scholar are going on record against widespread early detection and all concerned organizations recommend careful education of the patient before testing. Yet we all know that a true orientation can be time prohibitive and much of the time these men say, “what would you do and what do you recommend I do?” 3 Smith Jr, J.A. What would you do, doctor?. J Urol. 2009; 182: 421-422 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar The Unintended Burden of Increased Prostate Cancer Detection Associated With Prostate Cancer Screening and DiagnosisUrologyVol. 75Issue 2PreviewThe increasing incidence of prostate cancer is associated with the intensity of screening for prostate-specific antigen. Although some men may benefit from the early detection of prostate cancer through screening, all men diagnosed with prostate cancer experience an effect on their mental and physical well-being and that of their families. In light of the recent publication of the United States Preventive Services Task Force recommendations concerning prostate-specific antigen testing, this article reviews the quality-of-life implications of prostate cancer screening and diagnosis, and explores risk reduction in screened men as a potential strategy to manage these issues. Full-Text PDF ReplyUrologyVol. 75Issue 2PreviewI appreciate Dr. Lange's kind words and agree with his conclusions. We cannot embrace a “no screening” policy. The ERSPC study has shown that screening can reduce prostate cancer mortality within 8 years of diagnosis.1 Furthermore, this benefit may increase as we follow patients for a longer duration. There are major differences however, in the way PSA testing is practiced in the United States and that described in the ERSPC study. Full-Text PDF

The Fiscal Crisis of National Health Insurance in the Republic of Korea: In Search of a New Paradigm

Abstract In 2001, National Health Insurance (NHI) in Korea, the social insurance system for health care with universal population coverage, experienced a serious fiscal crisis as its accumulated surplus was depleted. This fiscal crisis is attributed to its chronic imbalance: health care expenditure has increased more rapidly than have insurance contributions. The recent failure in implementing pharmaceutical reform was a further blow to the deteriorating fiscal status of the NHI. Although the NHI has since recovered from the immediate fiscal crisis, this has mainly been because of a temporary increase in government subsidy into the NHI. The strong influence of the medical profession in health policy‐making remains a major barrier to the introduction of policy changes, such as a reform of the payment system to strengthen the fiscal foundations of the NHI. Korea also has to restructure its national health insurance in an era of very rapid population ageing. A new paradigm is called for in the governance of the NHI: to empower groups of consumers and payers in the policy and major decision‐making process of the NHI. The fiscal crisis in Korean national health insurance sheds light on the vulnerability of the social health insurance system to financial instability, the crucial role of provider payment schemes in health cost containment, the importance of governance in health policy, and the unintended burdens of health care reform on health care financing systems.

Economic compulsion and Christian ethics

General editor's preface Preface Part I. The Nature and Dynamics of Economic Compulsion: 1. Markets and coercive pecuniary externalities 2. The regressive incidence of unintended burdens Part II. Setting the Moral Baseline and Shaping Expectations: 3. Economic security as God's twofold gift 4. Retrieving the biblical principle of restoration Part III. Contemporary Appropriation: 5. Economic rights-obligations as diagnostic framework 6. Application: the case of agricultural protectionism 7. Summary and conclusions References Index.

Multilateral assistance and sustainable development: The case of an IFAD project in the pastoral region of China

Multilateral aid agencies aim to fund projects which will contribute to sustained development in the Third World. The pastoral areas of China present major challenges in relation to sustainable development. A major multilateral aid project designed to meet these challenges, the IFAD North China Pasture and Animal Development project, is described and evaluated using new survey data. A number of problems with this project which are common to many multilateral aid projects are discussed. In particular, the analysis supports the argument that multilateral aid agencies should place more emphasis on projects which facilitate the development of new institutions and policy reforms than on projects which concentrate on investment in new technology. The case study also illustrates the point that financial arrangements adopted by agencies such as IFAD can impose potentially serious unintended burdens on the recipient country.