Financial toxicity is of increasing concern in the United States. The Comprehensive Score for Financial Toxicity (COST) is a validated measure; however, it has not been widely utilized among low-income patients and may not fully capture financial toxicity in this population. Furthermore, the relationships between financial toxicity, quality of life (QOL), and patient well-being are poorly understood. We describe the experience of financial toxicity among low-income adults receiving cancer care. We hypothesized that higher financial toxicity would be associated with less income and lower quality of life. Qualitative interviews focused on the financial impact of cancer treatment.

This study was conducted at a cancer clinic in Central Texas. Quantitative and qualitative data were collected in Fall and Spring 2018, respectively. The quantitative sample (N = 115) was dichotomized by annual income (<$15,000 vs. >$15,000). Outcomes included financial toxicity (COST), quality of life (FACT-G), and patient well-being (PROMIS measures: Anxiety, Depression, Fatigue, Pain Interference, and Physical Function). Associations between quality of life, patient well-being, and financial toxicity were evaluated using linear regression. Sequential qualitative interviews were conducted with a subsample of 12 participants.

Patients with <$15k had significantly lower levels of QOL and patient well-being such as depression and anxiety compared to patients with >$15k across multiple measures. A multivariate linear regression found QOL (Β = 0.17, 95% CI = 0.05, 0.29, p = 0.008) and insurance status (Β = −3.79, 95% CI = −7.42, −0.16, p = 0.04), but not income, were significantly associated with financial toxicity. Three qualitative themes regarding patient's access to cancer care were identified: obtaining healthcare coverage, maintaining financial stability, and receiving social support.

Low-income patients with cancer face unique access barriers and are at risk for forgoing treatment or increased symptom burdens. Comprehensive assessment and financial navigation may improve access to care, symptom management, and reduce strain on social support systems.

The World Health Organization (WHO; Geneva, Switzerland) recommends lay first responder (LFR) programs as a first step toward establishing formal Emergency Medical Services (EMS) in low- and middle-income countries (LMICs) to address injury. There is a scarcity of research investigating LFR program development in predominantly rural settings of LMICs.

A pilot LFR program was launched and assessed over 12 months to investigate the feasibility of leveraging pre-existing transportation providers to scale up prehospital emergency care in rural, low-resource settings of LMICs.

An LFR program was established in rural Chad to evaluate curriculum efficacy, using a validated 15-question pre-/post-test to measure participant knowledge improvement. Pre-/post-test score distributions were compared using a Wilcoxon Signed-Rank test. For test evaluation, each pre-test question was mapped to its corresponding post-test analog and compared using McNemar’s Chi-Squared Test to examine knowledge acquisition on a by-question basis. Longitudinal prehospital care was evaluated with incident reports, while program cost was tracked using a one-way sensitivity analysis. Qualitative follow-up surveys and semi-interviews were conducted at 12 months, with initial participants and randomly sampled motorcycle taxi drivers, and used a constructivist grounded theory approach to understand the factors motivating continued voluntary participation to inform future program continuity. The consolidated criteria for reporting qualitative research (COREQ) checklist was used to guide design, analysis, and reporting the qualitative results.

A total of 108 motorcycle taxi participants demonstrated significant knowledge improvement (P <.001) across three of four curricular categories: scene safety, airway and breathing, and bleeding control. Lay first responders treated 71 patients over six months, encountering five deaths, and provided patient transport in 82% of encounters. Lay first responders reported an average confidence score of 8.53/10 (n = 38). In qualitative follow-up surveys and semi-structured interviews, the ability to care for the injured, new knowledge/skills, and the resultant gain in social status and customer acquisition motivated continued involvement as LFRs. Ninety-six percent of untrained, randomly sampled motorcycle taxi drivers reported they would be willing to pay to participate in future training courses.

Lay first responder programs appear feasible and cost-effective in rural LMIC settings. Participants demonstrate significant knowledge acquisition, and after 12 months of providing emergency care, report sustained voluntary participation due to social and financial benefits, suggesting sustainability and scalability of LFR programs in low-resource settings.

To examine trends from 2015 to 2017 in dietary behaviours and diet quality among low-income mothers, teenagers and children.

Cross-sectional telephone surveys using a validated 24 h dietary assessment.

Randomly sampled households with incomes ≤185 % of the US federal poverty level across California.

Survey participants were 13 247 mothers (≥18 years), 3293 teenagers (12–17 years) and 6043 children (5–11 years). Respondents were mostly Latino.

Over the 3-year study period, consumption of fruits and vegetables with and without 100 % fruit juice increased (P ≤ 0·05) by at least 0·3 cups/d for mothers, teenagers and children. Intake of water also increased (P ≤ 0·001) by more than 1 cup/d for mothers and children and 2 cups/d for teenagers. Sugar-sweetened beverage (SSB) consumption was unchanged over the 3 years. Overall diet quality, as assessed by the Healthy Eating Index-2015, improved (P ≤ 0·01) for mothers, teenagers and children. Covariates for the fifteen regression models (three age groups by five outcome variables) included race/ethnicity, age, education for mothers, and gender for teenagers and children.

The observed increases in fruit and vegetable intake and improvements in overall diet quality during the 3-year period suggest that low-income Californians may have lowered their risk of preventable diseases. However, more intense or strategic SSB-reduction interventions are required. Regional- or state-level, population-based surveillance of dietary behaviours is useful for public health nutrition policy and programme decision making, and can be used to assess potential trends in future negative health outcomes and related costs associated with poor dietary behaviours within at-risk populations.

To use cognitive interviewing and pilot testing to develop a survey instrument feasible for administering in the food pantry setting to assess daily intake frequency from several major food groups and dietary correlates (e.g. fruit and vegetable barriers) – the FRESH Foods Survey.

New and existing survey items were adapted and refined following cognitive interviews. After piloting the survey with food pantry users in the USA, preliminary psychometric and construct validity analyses were performed.

Three US food banks and accompanying food pantries in Atlanta, GA, San Diego, CA, and Buffalo, NY.

Food pantry clients (n 246), mostly female (68 %), mean age 54·5 (sd 14·7) years.

Measures of dietary correlates performed well psychometrically: Cronbach’s α range 0·71–0·90, slope (α) parameter range 1·26–6·36, and threshold parameters (β) indicated variability in the ‘difficulty’ of the items. Additionally, all scales had only one eigenvalue above 1·0 (range 2·07–4·71), indicating unidimensionality. Average (median, Q1–Q3) daily intakes (times/d) across six dietary groups were: fruits and vegetables (2·87, 1·87–4·58); junk foods (1·16, 0·58–2·16); fast foods and similar entrées (1·45, 0·58–2·03); whole-grain foods (0·87, 0·58–1·71); sugar-sweetened beverages (0·58, 0·29–1·29); milk and milk alternatives (0·71, 0·29–1·29). Significant correlations between dietary groups and dietary correlates were largely in the directions expected based on the literature, giving initial indication of convergent and discriminant validity.

The FRESH Foods Survey is efficient, tailored to food pantry populations, can be used to monitor dietary behaviours and may be useful to measure intervention impact.

To describe infant feeding practices and predictors of exclusive breast-feeding among women attending a local Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programme.

Cross-sectional survey. Outcomes included reported infant feeding practices at 3 and 6 months, timing and reasons for introduction of formula. Descriptive statistics, χ2 tests and logistic regression were used describe the sample and explore relationships between variables.

Loudoun County, VA, USA.

A sample of 190 predominantly Hispanic women attending local WIC clinics.

Overall, 84 % of women reported ever breast-feeding and 61 % of infants received formula in the first few days of life. Mothers who reported on infant feeding practices were less likely to exclusively breast-feed (34 v. 45 %) and more likely to provide mixed feeding (50 v. 20 %) at 3 months compared with 6 months, respectively. Significant (P<0·05) predictors of exclusive breast-feeding at 3 months included setting an exclusive breast-feeding goal and completing some high school (compared with completing high school or more). Only education remained a significant predictor of exclusive breast-feeding at 6 months.

A high proportion of women reported giving formula in the first few days of life and many changed from mixed to exclusive breast-feeding or formula by 6 months, suggesting possibly modifiable factors. Further investigation can help drive direct service- as well as policy and systems-based interventions to improve exclusive breast-feeding.

Surgery for chronic suppurative otitis media performed in low- and middle-income countries creates specific challenges. This paper describes the equipment and a variety of techniques that we find best suited to these conditions. These have been used over many years in remote areas of Nepal.

Extensive chronic suppurative otitis media is frequently encountered, with limited pre-operative investigation or treatment possible. Techniques learnt in better-resourced settings with good follow up need to be modified. The paper describes surgical methods suitable for resource-poor conditions, with rationales. These include methods of tympanoplasty for subtotal wet perforations, hearing reconstruction in wet ears and open cavities, large aural polyps, and canal wall down mastoidectomy with cavity obliteration. Various types of autologous ossiculoplasty are described in detail for use in the absence of prostheses. The following topics are discussed: decision-making for surgery on wet or best hearing ears, children, bilateral surgery, working with local anaesthesia, and obtaining adequate consent in this environment.

To better understand low-income adults’ attitudes towards participating in farmers’ markets, community-supported agriculture (CSA) and nutrition education programming.

Focus groups were held with a diverse sample of adults. Interviews were transcribed verbatim and analysed using thematic analysis.

Three affordable housing communities in Washington, DC, USA.

Participants included twenty-eight residents of the three affordable housing communities.

Four major themes emerged across groups, along with several sub-themes within each theme. These included: (i) perceptions of farmers’ markets (benefits, barriers, current participation and knowledge); (ii) perceptions of CSA (benefits, barriers and questions/concerns); (iii) need/interest in additional programming (nutrition education, non-nutrition education, qualities of programming and perceived barriers); and (iv) current health knowledge and behaviours (dietary behaviours, health recommendations and health concerns).

Adults living in urban, affordable housing communities desire access to healthy foods, but are limited by cost. Programmes could have a higher likelihood of success if they accept benefits like SNAP (the Supplemental Nutrition Assistance Program), are heavily marketed and incorporate culturally relevant nutrition education components.

To determine whether a community-based, multidisciplinary team consisting of home-based caregivers and supervised students could improve the functional status and quality of life of patients living with chronic obstructive pulmonary disease (COPD) in a low-income, peri-urban setting in South Africa.

This was a quasi-experimental study conducted over three months. Attention was paid to health literacy, inhaler technique, respiratory conditioning and nutrition.

Health literacy was poor and most patients were not using their inhalers correctly. Five of 12 patients found exercising challenging and withdrew from the study early. In the remaining seven patients, statistically significant improvements in FEV1%, and quality of life scores were seen at three months. Improvements in exercise tolerance and BODE prognostic index did not reach statistical significance.

A home-based multidisciplinary student team can improve the functional status and the quality of life in patients living with COPD in a low-income setting. This approach offers a suitable model for community-based service learning.

Recent research on access to food among low-income populations in industrialised countries has begun to focus on neighbourhood food availability as a key determinant of dietary behaviour. This study examined the relationship between various measures of food store access and household fruit and vegetable use among participants in the Food Stamp Program, America's largest domestic food assistance programme.

A secondary data analysis was conducted using the 1996–97 National Food Stamp Program Survey. The survey employed a 1-week food inventory method, including two at-home interviews, to determine household food use. Separate linear regression models were developed to analyse fruit and vegetable use. Independent variables included distance to store, travel time to store, ownership of a car and difficulty of supermarket access. All models controlled for a full set of socio-economic variables.

A nationally representative sample of participants (n = 963) in the Food Stamp Program.

After controlling for confounding variables, easy access to supermarket shopping was associated with increased household use of fruits (84 grams per adult equivalent per day; 95% confidence interval 5, 162). Distance from home to food store was inversely associated with fruit use by households. Similar patterns were seen with vegetable use, though associations were not significant.

Environmental factors are importantly related to dietary choice in a nationally representative sample of low-income households, reinforcing the importance of including such factors in interventions that seek to effect dietary improvements.