Delivery methods of financial information and sources of financial education as indicators of perceived financial well-being in South Dakota

The purpose of this research was to identify factors that are related to the perceived financial well-being of adults in South Dakota, specifically delivery methods of financial information and sources of financial education. This quantitative study used the eight-question Personal Financial Wellness Scale (PFW scale, also known as the InCharge Financial Distress/Financial Well-Being Scale) to measure perceived financial well-being. A random sample of 3,000 individuals was mailed a survey that elicited 814 completed questionnaires. The survey consisted of the PFW Scale, demographics, delivery methods of financial information, and sources of informal and formal financial education. The PFW scale scores were calculated for all individuals, and the mean score was used as the dependent variable in all analysis. Independent variables included: demographic factors, delivery methods of financial information, sources of informal financial education, sources of formal financial education, and having formal or informal financial education. A block regression of the total sample was used with financial well-being as the dependent variable and all other items as independent variables to test for possible linear relationships. Reliability statistics of the sample were acceptable, and assumptions for the model were tested. An analysis of variance (ANOVA) with Bonferroni post-hoc test was used to identify pair-wise differences between mean perceived financial well-being for individual significant variables and for the variable of having formal or informal financial education. Data were analyzed using SPSS statistical software. The mean perceived financial well-being for adult South Dakotans in the study was 6.24 (SD=2.18) on a ten-point scale. Demographic variables as a group did have a significant association with perceived financial well-being, and five individual demographic variables emerged as being related to perceived financial well-being. Delivery methods of financial information as a group significantly impact the variance of perceived financial well-being, and one individual delivery method, television, was found to have a significant negative impact. Sources of informal or formal financial education variables as a group were not significant in explaining the variance in perceived financial well-being. However, individuals having neither informal nor formal financial education (M=6.06, SD=2.31) had significantly lower perceived financial well-being than individuals having both informal and formal financial education (M=6.67, SD=2.15). This study shows that there may be a positive relationship between individuals receiving financial education in both the informal and formal setting and PFW scale scores. The delivery method used to deliver financial information may have a significant impact on financial well-being and should be considered. Future research may consider including delivery methods of financial information into a conceptual model of financial well-being. Financial planners, counselors, educators, psychologists, and extension educators can use the information to better serve their clients by targeting those individuals that may have low perceived financial well being: female, younger age, with dependent children in the home, working, or lower income. Targeting financial education resources using appropriate delivery methods as described is especially true for South Dakota, to which these results are most appropriate

Risk of critical illness among patients with solid cancers: a population-based observational study of 118,541 adults

Importance: Critical illness may be a potential determinant of cancer outcomes and geographic variations, but its role has not been described before. Objective: To determine the incidence of admission to intensive care units (ICUs) within 2 years following cancer diagnosis. Design, Setting, and Participants: This was a retrospective observational study using cancer registry data in 4 datasets from 2000 to 2009 with linked ICU admission data from 2000 to 2011, in the West of Scotland region of the United Kingdom (population, 2.4 million; all 16 ICUs within the region). All 118 541 patients (≥16 years) diagnosed as having solid (nonhematological) cancers. Their median age was 69 years, and 52.0% were women. Main Outcomes and Measures: Demographic and clinical variables associated with admission to an ICU and death in an ICU. Results: A total of 118 541 patients met the study criteria. Overall, 6116 patients (5.2% [95% CI, 5.0%-5.3%]) developed a critical illness and were admitted to an ICU within 2 years. Risk of critical illness was highest at ages 60 to 69 years and higher in men. The cumulative incidence of critical illness was greatest for small intestinal (17.2% [95% CI, 13.3%-21.8%]) and colorectal cancers (16.5% [95% CI, 15.9%-17.1%]). The risk following breast cancer was low (0.8% [95% CI, 0.7%-1.0%]). The percentage who died in ICUs was 14.1% (95% CI, 13.3%-15.0%), and during the hospital stay, 24.6% (95% CI, 23.5%-25.7%). Mortality was greatest among emergency medical admissions and lowest among elective surgical patients. The risk of critical illness did not vary by socioeconomic circumstances, but mortality was higher among patients from deprived areas. Conclusions and Relevance: In this study, about 1 in 20 patients experienced a critical illness resulting in ICU admission within 2 years of cancer diagnosis. The associated high mortality rate may make a significant contribution to overall cancer outcomes

Mature Minor Eligibility for Medical Assistance in Dying (MAiD): An Ethical Analysis

Medical Assistance in Dying (MAiD) was legalized in Canada on June 17, 2016, following a landmark Supreme Court of Canada decision, Carter v. Canada (2015). Currently, the law controversially denies three groups access to MAiD: mature minors (capable children under 18), persons making advance directives, and persons with mental illness as a sole underlying condition. All three populations are excluded from access to MAiD on the grounds that they may lack the capacity to autonomously request and consent to the procedure. This Applied Philosophy Dissertation examines the prospect of extending MAiD eligibility to one of these vulnerable populations, mature minors. The question of MAiD presents conflicting legal and ethical obligations to children. One obligation is to child welfare. We have stronger duties – including legal duties – to protect children’s interests than those of adults, and we organize society such that children are treated differently to shield them as a vulnerable group. Yet we also have obligations to child self-determination. Children have a legal right to decision-making autonomy corresponding to their level of maturity. This tension between welfare and self-determination hinges in part on whether children can make genuinely autonomous choices, a source of considerable debate among child development experts. The dissertation argues that eligibility for MAiD should be calibrated according to maturity rather than age. It develops three key arguments for this conclusion. One is that an age criterion in Bill C-14 is an unjustifiable act of age discrimination. Children who are otherwise eligible for MAiD suffer to the same extent as adults, and are disadvantaged compared to adults where they cannot end this suffering on their own terms. Secondly, prohibiting mature minors from accessing MAiD does not protect their welfare, and may be harmful in cases where requests are motivated by severe pain and suffering, a low quality of life, and an unwillingness to endure continued indignities. Thirdly, the law treats mature minors inconsistently by permitting minors to refuse life-sustaining treatment, for example, a blood transfusion on religious grounds, yet prohibiting them from consenting to MAiD. This legal inconsistency is also an ethical inconsistency: mature minors are able to choose to die when they could otherwise live, yet they are unable to control how they die when their death is unavoidable

Disciplinary Inequality, Collective Agency, and Interprofessional Collaboration in Health Care

In this thesis, I apply collective responsibility theory to the problem of health care inequality between physicians and nurses. This analysis is conducted in the context of physician-nurse interprofessional collaboration (IPC) – a teamwork-focused approach to health care which improves nurse job satisfaction, and the quality of patient care. Specifically, I suggest that portraying actions undertaken by an IPC team as being guided by both individual and collective intentions uncovers dynamics governing nurse marginalization that would not be present in an analysis of an aggregate of health professionals. Using this argument, I conclude that nurses are discouraged from engaging in decision-making about patient care formally, through organizational structure, and informally, through professional culture. Although hierarchy in the health care system seems to re-enforce these issues, a rational authority model of hierarchy can be understood to decentralize authority from physicians to nurses

A randomized trial of an Asthma Internet Self-management Intervention (RAISIN): study protocol for a randomized controlled trial

<b>Background</b><p></p> The financial costs associated with asthma care continue to increase while care remains suboptimal. Promoting optimal self-management, including the use of asthma action plans, along with regular health professional review has been shown to be an effective strategy and is recommended in asthma guidelines internationally. Despite evidence of benefit, guided self-management remains underused, however the potential for online resources to promote self-management behaviors is gaining increasing recognition. The aim of this paper is to describe the protocol for a pilot evaluation of a website 'Living well with asthma' which has been developed with the aim of promoting self-management behaviors shown to improve outcomes.<p></p> <b>Methods</b><p></p> The study is a parallel randomized controlled trial, where adults with asthma are randomly assigned to either access to the website for 12 weeks, or usual asthma care for 12 weeks (followed by access to the website if desired). Individuals are included if they are over 16-years-old, have a diagnosis of asthma with an Asthma Control Questionnaire (ACQ) score of greater than, or equal to 1, and have access to the internet. Primary outcomes for this evaluation include recruitment and retention rates, changes at 12 weeks from baseline for both ACQ and Asthma Quality of Life Questionnaire (AQLQ) scores, and quantitative data describing website usage (number of times logged on, length of time logged on, number of times individual pages looked at, and for how long). Secondary outcomes include clinical outcomes (medication use, health services use, lung function) and patient reported outcomes (including adherence, patient activation measures, and health status).<p></p> <b>Discussion</b><p></p> Piloting of complex interventions is considered best practice and will maximise the potential of any future large-scale randomized controlled trial to successfully recruit and be able to report on necessary outcomes. Here we will provide results across a range of outcomes which will provide estimates of efficacy to inform the design of a future full-scale randomized controlled trial of the 'Living well with asthma' website

Women’s responses to changes in U.S. preventive task force’s mammography screening guidelines: results of focus groups with ethnically diverse women

Background: The 2009 U.S. Preventive Services Task Force (USPSTF) changed mammography guidelines to recommend routine biennial screening starting at age 50. This study describes women’s awareness of, attitudes toward, and intention to comply with these new guidelines. Methods: Women ages 40–50 years old were recruited from the Boston area to participate in focus groups (k = 8; n = 77). Groups were segmented by race/ethnicity (Caucasian = 39%; African American = 35%; Latina = 26%), audio-taped, and transcribed. Thematic content analysis was used. Results: Participants were largely unaware of the revised guidelines and suspicious that it was a cost-savings measure by insurers and/or providers. Most did not intend to comply with the change, viewing screening as obligatory. Few felt prepared to participate in shared decision-making or advocate for their preferences with respect to screening. Conclusions: Communication about the rationale for mammography guideline changes has left many women unconvinced about potential disadvantages or limitations of screening. Since further guideline changes are likely to occur with advances in technology and science, it is important to help women become informed consumers of health information and active participants in shared decision-making with providers. Additional research is needed to determine the impact of the USPSTF change on women’s screening behaviors and on breast cancer outcomes

A systematic review of digital interventions for improving the diet and physical activity behaviors of adolescents

Many adolescents have poor diet and physical activity behaviors, which can lead to the development of noncommunicable diseases in later life. Digital platforms offer inexpensive means of delivering health interventions, but little is known about their effectiveness. This systematic review was conducted to synthesize evidence on the effectiveness of digital interventions to improve diet quality and increase physical activity in adolescents, to effective intervention components and to assess the cost-effectiveness of these interventions. Following a systematic search, abstracts were assessed against inclusion criteria, and data extraction and quality assessment were performed for included studies. Data were analyzed to identify key features that are associated with significant improvement in behavior. A total of 27 studies met inclusion criteria. Most (n = 15) were Web site interventions. Other delivery methods were text messages, games, multicomponent interventions, emails, and social media. Significant behavior change was often seen when interventions included education, goal setting, self-monitoring, and parental involvement. None of the publications reported cost-effectiveness. Due to heterogeneity of studies, meta-analysis was not feasible.It is possible to effect significant health behavior change in adolescents through digital interventions that incorporate education, goal setting, self-monitoring, and parental involvement. Most of the evidence relates to Web sites and further research into alternate media is needed, and longer term outcomes should be evaluated. There is a paucity of data on the cost-effectiveness of digital health interventions, and future trials should report these data