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OBJECTIVES: This study aimed to assess the impact of pay-for-performance (P4P) programmes on healthcare in Taiwan. STUDY DESIGN: This was a systematic review and meta-analysis. METHODS: A systematic literature search was performed using the PubMed, Medline, Embase, Cochrane review, Scopus, Web of Science and PsycINFO databases up to July 2023. Meta-analysis of the available outcomes was conducted using a random-effects model. RESULTS: The search yielded 85 studies, of which 58 investigated the programme for diabetes mellitus (DM), eight looked at the programme for chronic kidney disease (CKD), and the remaining studies examined programmes for breast cancer, tuberculosis, schizophrenia and chronic obstructive pulmonary disease. The DM P4P programme was a cost-effective strategy associated with reduced hospitalisation and subsequent complications. The CKD P4P was associated with a lower risk of dialysis initiation. The P4P programme also improved outcomes in breast cancer, cure rates in tuberculosis, reduced admissions for schizophrenia and reduced acute exacerbation in chronic obstructive pulmonary disease. The meta-analysis revealed that the P4P programme for DM (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.48-0.73) and CKD (OR = 0.73; 95% CI = 0.67-0.81) significantly reduced mortality risk. However, participation rate in the DM P4P programme was only 19% in 2014. CONCLUSIONS: P4P programmes in Taiwan improve quality of care. However, participation was voluntary and the participation rate was very low, raising the concern of selective enrolment of participants (i.e. 'cherry-picking' behaviour) by physicians. Future programme reforms should focus on well-designed features with the aim of reducing healthcare disparities.

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BACKGROUND: Reversing declining rates of people initiating and completing hepatitis C (HCV) treatment, observed in many countries, is needed to achieve global HCV elimination goals. Providing financial incentives to increase HCV testing and treatment uptake among people at-risk of or living with HCV infection could be an effective intervention. We conducted a systematic review to assess evidence regarding the effectiveness of financial incentives to improve engagement and progression through the HCV care cascade. METHODS: We searched MEDLINE, PubMed and EMBASE for studies published from January 2013 to January 2023 that evaluated financial incentives offered to people living with and at-risk of HCV to increase HCV antibody and or RNA testing, linkage to care, treatment initiation, treatment adherence, treatment completion, and sustained viral load (SVR) testing. Open-label randomised controlled trials (RCTs), controlled non-randomised studies, cohort or observation studies and mixed-methods studies were included, whereas literature reviews, case series and studies which did not report data were excluded. RESULTS: We identified 1,278 studies, with 21 included after full-text screening (14,913 participants); three randomised controlled trials and 18 non-randomised studies. Studies evaluated incentives aimed at improving test uptake (n = 11), engagement in care (n = 13), treatment initiation (n = 8), adherence (n = 3), completion (n = 3) and attainment of SVR (n = 5). Findings provided inconclusive evidence for the effectiveness of incentives in improving engagement in the HCV cascade of care. Determining incentive effectiveness to improve care cascade engagement was limited by low quality study designs, heterogeneity in type (cash or voucher), value (US$5 to $600) and cascade stage being incentivised. No randomised controlled trials assessed the effectiveness of incentives to promote HCV testing, and none showed an impact on treatment uptake. In non-randomised studies (observational comparative), some evidence suggested that incentives promoted HCV testing, but evidence of their role in promoting linkage to care, HCV treatment adherence and treatment completion were mixed. CONCLUSION: Currently, there lacks high-quality evidence evaluating whether financial incentives improve HCV testing and treatment outcomes. Future research should seek to standardise methodologies, compare incentive types and values to enhance engagement in HCV care, and determine factors that support incentives effectiveness.

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Background: Social determinants of health (SDOH) significantly influence health behaviors, including tobacco use among youth. Adversities such as perceived discrimination, perceived neighborhood stress, life trauma, and financial strain are stressors that may mediate the relationship between various SDOH and youth tobacco use. This study aims to investigate whether multidimensional adversities mediate the effects of SDOH on tobacco use among youth. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) study were used to test our hypotheses. The sample included a diverse cohort of youth aged 9-10 years old followed until they were 15-16 years old. We examined the effects of baseline parental education, household income, neighborhood income, and family structure on subsequent youth tobacco use. Structural equation models were used to test if adversities (perceived discrimination, life trauma, financial strain) operate as potential mediators. Results: All ABCD participants were eligible for our analysis, regardless of race, ethnicity, or SDOHs (n = 11,878). The findings indicated that the effects of parental education, household income, neighborhood income, and family structure on youth tobacco use were partially mediated by adversities. Higher levels of parental education and household income were associated with lower tobacco use, and this relationship was weakened when accounting for adversities. Similarly, stable family structures and higher neighborhood income were linked to reduced tobacco use, with adversities playing a mediating role. Conclusions: Multidimensional adversities partially mediate the relationship between SDOH at baseline and subsequent youth tobacco use. Interventions aimed at reducing youth tobacco use should address both the social determinants and multiple adversities experienced by adolescents. Policies to improve the educational and economic situations of families, enhance neighborhood environments, and support stable family structures all reduce youth tobacco use, with lower exposure to adversities explaining this effect.

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The convergence of investing and gambling has accelerated with the proliferation of gamblified investment products characterized by high volatility. This case report examines a 42-year-old male commercial airline pilot who developed maladaptive engagement with high-risk financial instruments during the COVID-19 pandemic, resulting in significant financial losses. The patient's behavior, marked by an inability to adapt to market conditions and attempts to recoup losses through increasingly speculative investments, mirrors patterns observed in problem gambling. Notably, as demonstrated by proficient performance on the Big Three financial literacy assessment, the patient's elevated financial literacy level failed to serve as a protective factor against problematic speculative behavior. This case highlights potential risk factors in aviation professionals, including personality traits like high extraversion and elevated disposable income. Following cognitive behavioral therapy (CBT), the patient successfully transitioned to more conservative investment strategies, with improvements in psychometric scores. However, his posttreatment score on the National Opinion Research Center Diagnostic Screen for Gambling Problems, while improved, still indicated an at-risk status, necessitating ongoing monitoring. This case underscores the need for enhanced awareness, targeted screening protocols, and tailored interventions within occupational health settings, particularly in safety-critical professions like commercial aviation. Future research should focus on developing comprehensive screening instruments for the early identification of problematic financial behaviors, investigating the long-term efficacy of therapeutic modalities like CBT, and examining the prevalence and safety implications of high-risk financial behaviors among aviators.

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In the Romanian healthcare system, public hospitals' contract for the provision of healthcare services with the National Health Insurance Services (NHIS) is the main source of revenue in a hospital's income and expenditure budget. In Romania, for acute diseases, payment is made on a per-case basis for hospitals financed under the diagnostic-related groups (DRG) system, which is calculated according to the indicators achieved. The main objective of the study aimed at the quantitative and comparative analysis of hospital performance indicators used in the calculation of the contracted amount with NHIS, in order to quantify the results and evaluate the effectiveness of the measures taken in the surgical wards of the Emergency Clinical County Hospital of Oradea (ECCHO) compared to the annual average values at the national level, in the period 2012-2022. The indicators, such as the number of beds, number of cases, average length of hospitalization (LOH), and case complexity index (CCI), were analyzed at the level of the ECCHO, a tertiary care hospital in the surgical wards. Rehabilitation and modernization of wards, laboratories, operating theatres, and high-performance equipment have been made possible through efficient management and monthly monitoring of medical and financial activity. The average LOH actually carried out on the surgical wards has been decreasing over the 11 years analyzed, with a lower number of hospital days than at the national level. The CCI achieved by the hospital's surgical wards has had an increasing evolution throughout the period analyzed, higher than the national value. The maximum amount contracted and the amount contracted by the hospital is higher when the LOH and CCI indicators achieved by each section are included in the formula than the indicators established at the national level. A lower LOH and a higher CCI than the national values facilitated the contracting of a higher amount. Optimization of the indicators by hospital performance is correlated with improved funding by the NHIS. Increasing the contracted amount facilitates the contracting of an exponential annual number of cases, resulting in more efficient medical services in the surgical wards.

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Future viability depends on ensuring a sustainable society because green energy methods may efficiently reduce greenhouse gas emissions. Nevertheless, stakeholders, consumers, and developers continue to be notably ignorant of the financial incentives connected to green technology. Moreover, there is still a dearth of studies on the range of financial incentives offered by different authorities in India. Monetary incentives, such as tax breaks, indirect tax exemptions, and refunds, are crucial in encouraging the use of green technology in the modern world. This study explores the importance of financial incentives for green building technologies in India, which also looks at the wide range of incentives provided by federal, state, and local governments. Furthermore, the study highlights various state government programs such as goods subsidies, exemptions from local taxes, and fee waivers. Notably, several incentives aimed at consumers, developers, and other stakeholders have been implemented by the Indian Green Building Council (IGBC). This review study emphasizes the effectiveness of financial incentives in green construction projects and draws attention to a clear knowledge gap regarding the adoption of green technology. This study also provides insights into potential future directions. Studies and research results emphasize the importance of spreading the word about financial incentives as a key factor in determining the adoption of green technologies. Many parties, including governmental organizations, municipal governments, developers, and clients engaged in green building technology projects, stand to gain increased awareness.

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B-Corp certification is a fairly modern business phenomenon. Consequently, research on its relationship with key business strategy variables is still inconclusive, while longitudinal analyses of its link to financial performance are scarce. To determine whether business profit could be a robust argument to attract companies to assess and certify their social and environmental impact, in this research we explore the connection that exists between the B-Corp certification and corporate financial performance in the short-, medium- and long-term. For this purpose, we use an international sample of 103 B-Corp companies that have been certified in 2013-2020 and we use the S&P Capital IQ database to collect their economic data. A control sample of non-B-Corp companies is also collected to establish a comparison and avoid bias in the research. The findings show no differences in the performance of B-Corps and non-certified companies before the certification, so a selection effect does not seem to exist in B-Corp certification. Regarding the performance of companies after the certification, known as treatment effect, B-Corps have smaller economic return than pre- and non-certified companies during two years after certification. Nonetheless, after that and in the long run, differences in financial performance between pre-certified and B-Corps are not statistically significant. These findings set the basis for future studies aiming to understand the reasons behind the initial loss of profitability after the B-Corp certification.

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This study delves into the paradox of the financial resource curse, exploring how the abundance of natural resources in a country paradoxically constrains firms' accessibility to financing. Despite the potential economic boon natural resources represent, evidence suggests that they can lead to less diversified economies, making it challenging for firms outside the resource sector to access financing. Our research aims to dissect this phenomenon by analyzing microeconomic statistics on the financial accessibility of enterprises, juxtaposed with macroeconomic statistics across 170 countries, encompassing over 10,000 firms surveyed from 1990 to 2022. The panel regression analysis allows us to control for both time-invariant country characteristics and global economic trends, providing insights into the causal relationship between resource dependence and financial access for firms. The results are striking, revealing that, indeed, countries with significant natural resource wealth tend to exhibit reduced financial accessibility for firms outside the resource extraction sector. The panel regression models indicate a robust negative correlation between the extent of a country's resource wealth and the ease with which non-resource firms can access financial capital. This suggests that the financial resource curse is not only a real phenomenon but also one that has significant implications for economic diversification and sustainable development. Moreover, findings underscore the need for targeted policy interventions. Countries with abundant natural resources should implement strategies that foster economic diversification, enhance the financial infrastructure to support a broader range of industries, and encourage the development of financial instruments tailored to the needs of non-resource sectors.

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Background: Hotel housekeepers constitute an important occupational group in the Balearic Islands (Spain). Housekeeping is considered low-skilled and precarious and typically involves high physical demands and time pressure. The aim of this study is to analyze the association between the socioeconomic determinants of health and hotel housekeepers' self-rated health. Methods: This is a cross-sectional study conducted in Primary Health Care in the Balearic Islands (November 2018-February 2019). Hotel housekeepers over 18 years of age with free access to the Balearic Public Health System who had been employed during 2018 were eligible. Results: We enrolled 1,043 hotel housekeepers; the mean score of health perceived status was 72.4/100 (SD 19.0). Those with a lower self-perceived health were statistically significant older, had Spanish nationality, lower level of studies, permanent or recurring seasonal contract, financial difficulties, a higher level of occupational stress, an external locus of control, reported work-life balance difficulties, were former smokers, insufficiently physical active and obese. We found lower scores in self-perceived health status score of -7.159 (CI95% -10.20- -4.12) among hotel housekeepers with osteoarthritis; -6.858 (CI95% -11.89- -1.82) among those with chronic depression; -3.697 (CI95% -6.08- -1.31) among those who reported difficulties in work-life balance; -2.414 (CI95% -4.69- -0.13) among participants who performed insufficient physical activity; -2.107 (CI% -4.44- -0.23) among those who reported financial strain. Lower self-rated health was also associated to a higher perceived stress, -1.440 (CI95% -2.09- -0.79); BMI (kg/m2), -0.299 (CI95% -0.53- -0.07); and longer time working as HH -0.177 (CI95% -0.33- -0.03). Conclusion: Our results underscore the importance of psychosocial (such as difficulties in work-life balance and occupational stress) and material factors (such as financial difficulties) when explaining differences in self-perceived health. Public health interventions aimed at improving health status must consider inequalities in material and working conditions.

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BACKGROUND: Anaemia among women of reproductive age (WRA) remains persistently high in Ghana, affecting 41% in 2022. Women in low-income communities in Ghana engaged in fish processing activities are at increased risk of anaemia due to inadequate diets, exposure to infectious pathogens, and pollutants. The Invisible Fishers (IFs) project was implemented among women fish processors in their reproductive age in Central and Volta regions of Ghana to mitigate anaemia. Despite the efficacy, feasibility and scalability of the intervention, the cost of implementing the intervention is unknown. The objective of this study was to estimate the costs of implementing the IFs project in Ghana. METHODS: We used micro-costing approach to analyse the costs of implementing the IFs project. Data were collected as part of a pilot randomized control trial with three interventions: Behaviour Change Communication (BCC), Strengthening Market Engagement of fish processors plus Behaviour Change Communication (SME + BCC), and Fish Smoking Technology and Practices plus Behaviour Change Communication (FST + BCC). The interventions were delivered to 60 women fish processors in the Central region and 60 in Volta region. The cost of the intervention was estimated from the societal perspective. Economic costs were categorized as direct costs (i.e. personnel, transportation, meetings, training, and monitoring) and indirect cost (i.e. value of productive time lost due to women and community volunteers' participation in the activities of the IFs project). RESULTS: The FST + BCC had the highest average cost per beneficiary (US$11898.62), followed by the SME + BCC (US8962.93). The least expensive was the BCC (US$4651.93) over the intervention period of 18 months. Recurrent costs constituted the largest component of economic costs (98%). Key drivers of direct costs were personnel (58%), administrative expenses (14%), and transportation (7%). CONCLUSION: There is a high cost for implementing interventions included in the IFs project. Planning and scaling -up of the interventions across larger populations could bring about economies of scale to reduce the average cost of the interventions.

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In dairy farming, the uncertainty of cow calving date often imposes waiting costs for days on farmers. Improving the accuracy of calving date prediction would mitigate these costs, specifically before a few days of the event. We monitored and analyzed the heart rate patterns of eight pregnant cows in the days leading up to calving using a dedicated monitoring device. We decomposed the heart rate data into three distinct components: trend, daily cycle, and the remainder, and discovered that the heart rate trend exhibited a sharp decline more than 40 h before the calving event via the trend turning point. To detect the turning point, we applied common financial technical indicators traditionally used to identify turning points of asset prices in trading markets for the extracted heart rate trend. This study remains a feasibility study because of the limited observations, but it indicates that these indicators can effectively capture the trend's turning point in real time, offering a promising approach for enhanced calving prediction. In addition to discussing the practical implications for cow management, we also contemplate the broader utility of these technical indicators in the context of various dynamic scientific data analyses.

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Utilizing renewable energy is a necessity for accomplishing global agendas, including combating climate change and promoting sustainable development programs. Although much literature has investigated the nexus between energy sources and their affected regressors during the last few years, no appreciable emphasis is available in the previous studies respecting the influence of the energy trilemma index and economic expansion on the influence of the energy trilemma index and economic the renewables in N11 economies. Therefore, the current study analyzes the crucial influencing factors, including the energy trilemma, economic growth, economic complexity, financial development, and urban population, as drivers of renewable energy in N11 economics from 1990 to 2021 by utilizing a panel quantile regression approach. The empirical outcomes certify that renewable energy is positively connected with the energy trilemma, economic growth, financial development, and urban population, but not with economic complexity, which has the inverse result. As a result, legislators responsible for monitoring the deployment of renewables should stimulate their attempts to consider the energy trilemma dimensions into account when determining energy structural policies, increase the use of greener energy subsidies, pose high-carbon taxes, promote green financial innovation, and improve energy efficiency.

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BACKGROUND: Although diagnostic markers in cerebrospinal fluid (CSF) have become a rapidly growing research field, they have not as yet been investigated in relation to capacities that are of interest to geriatric psychiatry and neuropsychology, such as financial capacity. The aim of this study was to assess whether CSF biomarkers can predict financial capacity in patients with a diagnosis of major neurocognitive disorder due to Alzheimer's disease (AD). METHODS: Participants were examined with a number of neuropsychological tests, with an emphasis on the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS-15), and the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS) and CSF tests. RESULTS: Amyloid ß peptide 1-42 (Aß42), total tau, and phosphorylated tau were not found to predict financial capacity performance in AD, but MMSE shows a strong positive correlation with LCPLTAS. CONCLUSIONS: These preliminary findings indicate that complex cognitive functions, such as financial capacity, may not be directly linked to CSF concentrations of the abovementioned biomarkers. Further studies with larger numbers of patients will be required to assess the reproducibility of these findings and to determine whether this approach can assist not only in diagnosis but also in neuropsychological assessment.

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A thriving literature exists about the role of financial inclusion in socio-economic development. Nevertheless, the environmental effects of financial inclusion are largely unknown in the literature, especially in sub-Saharan African countries. Therefore, this study explores the association between financial inclusion and CO2 emissions utilizing data from 23 sub-Saharan Africa for the period 2004-2019. Based on different estimation methods such as dynamic ordinary least squares (DOLS), fully modified ordinary least squares (FMOLS), canonical correlation regression (CCR), and an instrumental variable generalized-method of moment (IV-GMM), the results show that financial inclusion is responsible for a substantial increase in CO2 emissions. In addition, financial inclusion moderates economic growth, resulting in higher CO2 emissions. Alternatively, financial inclusion moderates renewable energy use to lower CO2 emissions. The outcomes also verify the presence of the Environmental Kuznets Curve hypothesis (EKC). This study proposes uniting financial inclusion and environmental policies as a strategy for reducing CO2 emissions in sub-Saharan Africa.

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BACKGROUND: Bovine fascioliasis is a parasitic disease that affects cattle. It leads to direct and indirect great economic loss due to animal mortalities, growth retardation and expenditure on anthelmintics, reduction livestock productivity and essentially condemnation of infected liver by inspection service. The study was carried out to determine the seasonal prevalence and estimated financial losses of fascioliasis in cattle in the Western Highlands of Cameroon. METHODOLOGY: A total of 2167 cattle were selected. Later, the cattle, have being the carcasses, were dissected, and the livers were dissected and carefully examined for adult liver flukes. Faeces were collected immediately after the cattle were killed and examined using the formol-ether concentration technique. Condemned livers were weighted to estimate the financial losses using the average price of a kilogram of liver. RESULTS: A total 428 of cattle were found with infected livers or egg in the faeces giving a total prevalence of 19.75%. Among the infected carcass, 18.64% had both the Fasciola eggs in the faeces and flukes in the liver while 1.10% had only flukes in the liver. Results revealed that prevalence of Fasciola spp. was significantly higher during the rainy season (23.48%) than 16% in the dry season (p = 0.00). A significantly (p = 0.000) higher prevalence was also observed in females (33.9%) than in males (13.1%). Age range showed significant (p = 0.000) influence with the animals of 8-10 years old recorded the highest prevalence of 39.3%. Furthermore, 433.1 kg of liver was condemned giving a direct financial loss of 1221,550 FCFA (2049.64 USD) and an annual financial loss due to liver condemnation estimated to 1814,775 (3045.01 USD). CONCLUSION: Findings of this study indicated that bovine fascioliasis is prevalent in cattle in the Western Highlands of Cameroon, and it leads to an important financial loss particularly in the rainy season.

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Objectives: While extensive research has focused on patient outcomes in skilled nursing facilities, a critical gap remains in understanding factors influencing their managerial performance, particularly occupancy rates. This study examines the occupancy rates of skilled nursing facilities and assesses the significance of two important drivers of managerial performance that have not received sufficient attention-the influence of payer mix and total profit margin. Specifically, we focused on the role played by a nursing home's financial performance (as assessed by profit margin) in influencing the relationship between payer mix and occupancy rate among skilled nursing facilities. Methods: Data were extracted from the 2019 to 2020 Joint Annual Report of Nursing Homes for a sample of 612 skilled nursing facilities in Tennessee, USA. Regression analysis was performed by fitting a generalized estimating equation of occupancy rate. Results: Compared to skilled nursing facilities in the lowest quartile of profit margin, for example, those in the highest quartile had approximately 18 percentage points higher occupancy rates per unit increase in resident days of care covered by traditional Medicare (ß = 0.18, p = 0.0028). Similarly, skilled nursing facilities in the second highest quartile of profit margin had a higher occupancy rate by approximately 23 percentage points per unit increase in Medicare Advantage (ß = 0.23, p = 0.0375) when compared to those in the lowest quartile of profit margin. Conclusions: Skilled nursing facilities with stronger financial performance generally have higher occupancy rates, particularly notable in relation to an upswing in payer sources such as traditional Medicare and Medicare Advantage, when compared to skilled nursing facilities with weaker profitability. Given the increasingly larger role of Medicare in long-term care funding, policymakers and nursing home managers may find it useful to consider our findings when evaluating opportunities to enhance managerial performance of skilled nursing facilities.

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This study investigated the impact of family financial status on Chinese children's health-related traits and their behavior in controlling COVID-19. When the children were 7 years old, their guardians provided information on family financial status. When the children reached 10 years old, they completed questionnaires concerning their own health consciousness and health status. At age 11, during the COVID-19 pandemic in 2020, they filled out questionnaires on perceived vulnerability to disease and disease control behavior. The findings revealed that higher health consciousness is associated with better health, particularly among children from financially challenged families. Additionally, a greater perception of vulnerability to disease is linked to increased COVID-19 control behaviors, particularly in children with high health consciousness in affluent families. These results contribute to our understanding of how children's personal health-related traits and family financial status interact to shape their response to the COVID-19 pandemic.

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Environmental regulations restricting the use of a natural resource or species often have unintended consequences. One example is prohibitions on the international trade in culturally important endangered wildlife. Trade restrictions may artificially increase scarcity and, consequently, value. In China, international trade restrictions may trigger bouts of speculative investment that have the opposite effect of the restrictions' intent. We examined how China's speculative economy and cultural history have together led to unintended consequences when regulating wildlife trade. In China, wildlife markets occupy a legal gray area that can make regulations ineffectual or even counterproductive. In extreme cases, prohibiting trade can provoke market booms. Further unintended consequences include potential cultural backlash. In China and across the Global South, international trade restrictions are sometimes considered a continuation of a longstanding history of Western intervention and thus may not be enforced as strongly or may generate resentment. This pushback has contributed to rising calls to decolonialize conservation and may lead to growing alliances between China and other Global South countries when negotiating international wildlife trade restrictions in the future.

Especulación financiera y herencia cultural en los mercados de fauna de China Resumen Las regulaciones ambientales que restringen el uso de un recurso natural o una especie suelen tener consecuencias accidentales. Un ejemplo son las prohibiciones para el mercado internacional de fauna en peligro con importancia cultural. Las restricciones pueden incrementar de manera artificial la escasez y, como consecuencia, el valor. En China, las restricciones internacionales del mercado pueden detonar episodios de inversión especulativa que tienen el efecto opuesto a lo que se pretende con las restricciones. Analizamos cómo la economía especulativa y la historia cultural de China han, en conjunto, derivado en consecuencias accidentales cuando se regula el mercado de fauna. En este país, los mercados de fauna ocupan un área legal gris que puede volver ineficaces a las regulaciones o incluso contraproducentes. En casos extremos, prohibir el mercado puede provocar un auge de este. Otra consecuencia accidental es el potencial rechazo cultural. En China y en todo el Sur Global, algunas veces se consideran las restricciones del mercado internacional como una continuación de la historia de intervenciones occidentales y por lo tanto puede que no se apliquen con tanta fuerza o que generen resentimiento. Esta resistencia ha contribuido al incremento de llamados para descolonizar la conservación y podría llevar al aumento de alianzas entre China y otros países del Sur Global cuando se negocien restricciones para el mercado internacional de fauna en el futuro.

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BACKGROUND: Pancreatoduodenectomy (PD) for pancreatic cancer has a profound impact on patients' lives. However, the long-term financial implications are poorly understood. OBJECTIVE: Assess the financial burden of long-term survivors who underwent PD. METHODS: Patients who underwent PD between January 2011 and June 2019 were identified. To evaluate the long-term financial burden, patients surviving ≥ 3 years post-resection were prospectively surveyed using the Comprehensive Score for financial Toxicity (COST-FACIT) and a customized institutionally developed questionnaire. A logistic regression model predicting high financial toxicity was used to identify predictive factors. RESULTS: Among 238 eligible patients, 137 (57.6%) responded. Responders had a median age of 66 (59-73) years, with 86.7% identifying as financial prosperous or comfortable. However, 33.3% experienced financial distress due to treatment costs, 27.3% demonstrated high financial toxicity on the COST-FACIT survey, and 37.2% made sacrifices to afford treatment. Only 8.9% stated that the treatment costs influenced their decisions, and the majority (85.9%) did not discuss financial implications with healthcare providers. Multivariable analysis identified younger age as a risk factor for high financial toxicity. CONCLUSION: One in three long-term survivors experienced high financial toxicity, with younger age being a predictor. This emphasizes the need for efforts to provide comprehensive support and guidance to patients to navigate their oncological journey.

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Hospitals are complex organizations which provide a wide array of health care services. This complexity creates challenges for stakeholders who wish to use financial accounting statements to make inferences about the productive choices made by a hospital's management. These challenges are especially salient when using data reported at the department (or cost center) level, or where the provision of care is coordinated across hospital departments. This study applies information entropy-based comparability analysis techniques to overall and department-level hospital financial data to identify hospital peer groups. Hospitals peer groups not only exhibit similar financial positions overall, but are also likely to exhibit operational similarities at the department level. Data for this analysis are drawn from the financial statements of Washington State critical access hospitals in the fiscal year 2019. The medical laboratory and pharmacy departments were specifically assessed because their services impact or support virtually every other revenue-producing department in the hospital. Findings suggest both departments significantly impact the formation of peer groups, with the pharmacy department contributing the largest impact.