Cash-Flow and Savings Practices of Low-Income Households: Evidence From a Follow-Up Study of IDA Participants

This study uses a survey of participants from an Individual Development Account (IDA) matched savings intervention to examine self-reported financial practices (cash flow and savings) five years after the intervention terminated. Latent class analysis produced three groups of financial practices - high, medium, and low functioning. Results showed that some low-income households are carefully managing their finances. Psychological sense of mastery was positively related to high functioning cash-flow and savings. The IDA intervention had no association with latent class membership. Antipoverty interventions should assess the financial practices of participants at the time of service enrollment. Further, social service providers should not assume that households are not already carefully managing their finances

Perceived Impact of Individual Development Account Participation Among Native Hawaiians

Indigenous peoples face many social development challenges and the lingering effects of colonization. Income transfer, a traditional social welfare approach designed to raise minimum living standards, has had limited beneficial effects on long-term social conditions. As a complement to income transfer, asset-based approaches to social welfare have resulted in positive effects in the short and long terms. Some Indigenous communities are exploring how asset-based interventions might enhance social development (Hicks, Edwards, Dennis, & Finsel, 2005), but only limited and scattered research describes how they experience asset-building programs. This qualitative descriptive study explores the perceived impact of a large Individual Development Account (IDA) program for Indigenous Native Hawaiians. Data consist of answers to open-ended questions about the impacts of participating in an IDA program. Participants felt that the culturally based program material was empowering and that they gained lasting, meaningful life skills. They attributed skills development, psychological changes, and tangible asset gains to the IDA program. Notably, participants who did not finish the program identified barriers to doing so, including a lack of flexibility in savings requirements and life events that forced an exit from the program

The case for asset-based interventions with indigenous peoples: Evidence from Hawai‘i

Two movements are shaping social work in Hawai’i in the era of globalization: (a) the Assets Movement, and (b) the Indigenous Peoples Movement. Data from an asset-based Individual Development Account (IDA) program for indigenous Hawaiians are analyzed. Findings suggest that, under certain conditions, asset-based interventions may promote social development among indigenous peoples

Homelessness among older people: Assessing strategies and frameworks across Canada

Homelessness among older people is expected to rise as a result of unmet need and demographic change. Yet, strategies and responses to homelessness across Canada tend to focus on younger groups, overlooking the circumstances and needs of older people (i.e., age 50+). This article reports the results of a content analysis of government planning documents on homelessness conducted in 2014. A total of 42 local, provincial, and federal strategies were reviewed to assess the extent to which they recognized and targeted the needs of older people. Our review resulted in three categories of documents: 1) documents with no discussion of homelessness among older people (n=16; 38%); 2) documents with a minimal discussion of homelessness among older people (n=22; 55%); and 3) documents with a significant discussion of homelessness among older people (n=4; 7%). Results indicate that while many strategies are beginning to consider older people as a subgroup with unique needs, little action has been taken to develop comprehensive services and supports for this group. We conclude with a call to integrate the needs of diverse groups of older people into strategies to end homelessness and to develop programs and responses that are suitable for older people. L’itinérance parmi les personnes âgées: Évaluations des stratégies et des structures à travers le Canada RésuméIl est prévu que l’itinérance chez les personnes âgées augmentera au cours des prochaines années, en raison des changements démographiques et des besoins non comblés que l’on observe actuellement.  Malgré cela, les stratégies et les réponses à l’itinérance au Canada tendent à être centrées sur les populations plus jeunes, ignorant les besoins et réalités des personnes âgées. Cet article présente les résultats d’une analyse de contenu des stratégies canadiennes sur l’itinérance effectuée en 2014. 42 stratégies ont été recensées afin d’évaluer dans quelle mesure elles reconnaissaient et ciblaient les besoins des personnes âgées. Notre analyse regroupe en trois catégories les documents recensés : 1) les documents qui n’abordent pas l’itinérance chez les personnes âgées (n=16; 38 pour cent); 2) les documents  abordent très brièvement l’itinérance des personnes âgées (n=22; 55 pour cent); 3) les documents abordant de façon substantielle l’itinérance des personnes âgées (n=4; 7 pour cent). Les résultats indiquent que bien que plusieurs stratégies commencent à prendre en considération le fait que les personnes âgées constituent un sous-groupe qui présente des besoins particuliers, peu d’actions ont été entreprises afin de  développer des services et un soutien adaptés à leur réalité. Nous concluons en rappelant l’importance d’intégrer les besoins de différents groupes de personnes âgées aux stratégies qui visent à mettre fin à  l’itinérance et de développer des programmes et réponses qui sont adaptées à une population âgée. Mots Clefs : politique; pratique; vieillissement; exclusion sociale; pauvreté; logemen

Savings ownership and the use of maternal health services in Indonesia

In low- and middle-income countries (LMICs), many women of reproductive age experience morbidity and mortality attributable to inadequate access to and use of health services. Access to personal savings has been identified as a potential instrument for empowering women and improving access to and use of health services. Few studies, however, have examined the relation between savings ownership and use of maternal health services. In this study, we used data from the Indonesian Family Life Survey to examine the relation between women’s savings ownership and use of maternal health services. To estimate the effect of obtaining savings ownership on our primary outcomes, specifically receipt of antenatal care, delivery in a health facility and delivery assisted by a skilled attendant, we used a propensity score weighted difference-in-differences approach. Our findings showed that acquiring savings ownership increased the proportion of women who reported delivering in a health facility by 22 percentage points [risk difference (RD) = 0.22, 95%CI = 0.08–0.37)] and skilled birth attendance by 14 percentage points (RD = 0.14, 95%CI = 0.03–0.25). Conclusions were qualitatively similar across a range of model specifications used to assess the robustness of our main findings. Results, however, did not suggest that savings ownership increased the receipt of antenatal care, which was nearly universal in the sample. Our findings suggest that under certain conditions, savings ownership may facilitate the use of maternal health services, although further quasi-experimental and experimental research is needed to address threats to internal validity and strengthen causal inference, and to examine the impact of savings ownership across different contexts

Patterns of Shelter Use Among Men New to Homelessness in Later Life: Duration of Stay and Psychosocial Factors Related to Departure

People who become homeless for the first time in late life are a growing but understudied population. This study draws on administrative data from one shelter (N = 1,214 first-time homeless) to assess the extent to which age is related to shelter stay and, to examine psychosocial factors that may be associated with shelter departure. Our bivariate and survival analysis results suggest that older homeless men stay in the shelter 2 weeks longer than younger clients. Older men with pending legal issues and mobility concerns were more likely to leave the shelter than those without such concerns. Findings highlight the impact of age and other psychosocial variables on shelter stay, and provide direction from which to address homelessness among men who are new to homelessness in later life

One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke

BACKGROUND Previous studies conducted between 1997 and 2003 estimated that the risk of stroke or an acute coronary syndrome was 12 to 20% during the first 3 months after a transient ischemic attack (TIA) or minor stroke. The TIAregistry.org project was designed to describe the contemporary profile, etiologic factors, and outcomes in patients with a TIA or minor ischemic stroke who receive care in health systems that now offer urgent evaluation by stroke specialists. METHODS We recruited patients who had had a TIA or minor stroke within the previous 7 days. Sites were selected if they had systems dedicated to urgent evaluation of patients with TIA. We estimated the 1-year risk of stroke and of the composite outcome of stroke, an acute coronary syndrome, or death from cardiovascular causes. We also examined the association of the ABCD2 score for the risk of stroke (range, 0 [lowest risk] to 7 [highest risk]), findings on brain imaging, and cause of TIA or minor stroke with the risk of recurrent stroke over a period of 1 year. RESULTS From 2009 through 2011, we enrolled 4789 patients at 61 sites in 21 countries. A total of 78.4% of the patients were evaluated by stroke specialists within 24 hours after symptom onset. A total of 33.4% of the patients had an acute brain infarction, 23.2% had at least one extracranial or intracranial stenosis of 50% or more, and 10.4% had atrial fibrillation. The Kaplan–Meier estimate of the 1-year event rate of the composite cardiovascular outcome was 6.2% (95% confidence interval, 5.5 to 7.0). Kaplan–Meier estimates of the stroke rate at days 2, 7, 30, 90, and 365 were 1.5%, 2.1%, 2.8%, 3.7%, and 5.1%, respectively. In multivariable analyses, multiple infarctions on brain imaging, large-artery atherosclerosis, and an ABCD2 score of 6 or 7 were each associated with more than a doubling of the risk of stroke. CONCLUSIONS We observed a lower risk of cardiovascular events after TIA than previously reported. The ABCD2 score, findings on brain imaging, and status with respect to large-artery atherosclerosis helped stratify the risk of recurrent stroke within 1 year after a TIA or minor stroke. (Funded by Sanofi and Bristol-Myers Squibb.)Supported by an unrestricted grant from Sanofi and Bristol-Myers Squibb

Chicken anaemia virus evades host immune responses in transformed lymphocytes

Chicken anaemia virus (CAV) is a lymphotropic virus that causes anaemia and immunosuppression in chickens. Previously, we proposed that CAV evades host antiviral responses in vivo by disrupting T-cell signalling, but the precise cellular targets and modes of action remain elusive. In this study, we examined gene expression in Marek’s disease virus-transformed chicken T-cell line MSB-1 after infection with CAV using both a custom 5K immune-focused microarray and quantitative realtime PCR at 24, 48 and 72 h post-infection. The data demonstrate an intricate equilibrium between CAV and the host gene expression, displaying subtle but significant modulation of transcripts involved in the T-cell, inflammation and NF-kB signalling cascades. CAV efficiently blocked the induction of type-I interferons and interferon-stimulated genes at 72 h. The cell expression pattern implies that CAV subverts host antiviral responses and that the transformed environment of MSB-1 cells offers an opportunistic advantage for virus growth

Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study):a prospective, randomised, open-label, blinded-endpoint clinical trial

Background: Studies have suggested that evening dosing with antihypertensive therapy might have better outcomes than morning dosing. The Treatment in Morning versus Evening (TIME) study aimed to investigate whether evening dosing of usual antihypertensive medication improves major cardiovascular outcomes compared with morning dosing in patients with hypertension. Methods: The TIME study is a prospective, pragmatic, decentralised, parallel-group study in the UK, that recruited adults (aged ≥18 years) with hypertension and taking at least one antihypertensive medication. Eligible participants were randomly assigned (1:1), without restriction, stratification, or minimisation, to take all of their usual antihypertensive medications in either the morning (0600–1000 h) or in the evening (2000–0000 h). Participants were followed up for the composite primary endpoint of vascular death or hospitalisation for non-fatal myocardial infarction or non-fatal stroke. Endpoints were identified by participant report or record linkage to National Health Service datasets and were adjudicated by a committee masked to treatment allocation. The primary endpoint was assessed as the time to first occurrence of an event in the intention-to-treat population (ie, all participants randomly assigned to a treatment group). Safety was assessed in all participants who submitted at least one follow-up questionnaire. The study is registered with EudraCT (2011-001968-21) and ISRCTN (18157641), and is now complete. Findings: Between Dec 17, 2011, and June 5, 2018, 24 610 individuals were screened and 21 104 were randomly assigned to evening (n=10 503) or morning (n=10 601) dosing groups. Mean age at study entry was 65·1 years (SD 9·3); 12 136 (57·5%) participants were men; 8968 (42·5%) were women; 19 101 (90·5%) were White; 98 (0·5%) were Black, African, Caribbean, or Black British (ethnicity was not reported by 1637 [7·8%] participants); and 2725 (13·0%) had a previous cardiovascular disease. By the end of study follow-up (March 31, 2021), median follow-up was 5·2 years (IQR 4·9–5·7), and 529 (5·0%) of 10 503 participants assigned to evening treatment and 318 (3·0%) of 10 601 assigned to morning treatment had withdrawn from all follow-up. A primary endpoint event occurred in 362 (3·4%) participants assigned to evening treatment (0·69 events [95% CI 0·62–0·76] per 100 patient-years) and 390 (3·7%) assigned to morning treatment (0·72 events [95% CI 0·65–0·79] per 100 patient-years; unadjusted hazard ratio 0·95 [95% CI 0·83–1·10]; p=0·53). No safety concerns were identified. Interpretation: Evening dosing of usual antihypertensive medication was not different from morning dosing in terms of major cardiovascular outcomes. Patients can be advised that they can take their regular antihypertensive medications at a convenient time that minimises any undesirable effects. Funding: British Heart Foundation