Objectives Out-of-pocket (OOP) costs and financial toxicity remain significant barriers to equitable cancer care globally. This review systematically identifies and compares survey-based approaches used to measure patient- and household-level OOP expenditures and financial burden across diverse cancer settings. Methods A systematic search (2021-2025) of PubMed, Embase, and EBSCO databases identified studies that used survey methodologies, including patient-reported outcome measure instruments to estimate OOP spending and financial toxicity among cancer patients. Two reviewers independently screened studies and extracted data on key methodological characteristics including instrument type, cost domains, recall periods, validation practices, and reporting conventions to compare measurement approaches across studies. Results Based on the eligibility criteria, 45 studies were included. Survey tools showed substantial heterogeneity in structure, terminology, and measurement practices. Studies differed widely in the cost domains captured (direct medical, direct nonmedical, and indirect costs) and used recall periods ranging from a few days to 156 months. Reporting of currency, cost year, and conversion methods was inconsistent. Most relied on bespoke, nonvalidated questionnaires to measure objective financial burden, whereas validated patient-reported outcome measures, such as the Comprehensive Score for Financial Toxicity (COST) measures, were used inconsistently for subjective financial distress. This methodological variation substantially limited comparability across studies and hindered synthesis of patient-level financial burden. Conclusions Survey-based methods for measuring OOP costs and financial burden in cancer care remain highly variable. Establishing minimum methodological and reporting standards for core cost domains, recall periods, and financial burden indicators may improve comparability of evidence while allowing context-specific adaptation across health systems.
The black soldier fly larvae (Hermetia Illucens L.) have gained increasing attention as a sustainable protein alternative source due to their high nutritional value and low environmental footprint. Despite growing interest, data rigorously assessing the combined in-vivo protein quality and acute toxicity of BSFL protein for human consumption remain scarce. This study evaluated the nutritional composition, including amino acid profile, in-vivo protein digestibility and acute toxicology of defatted BSFL protein. Amino acid analysis showed a comparable profile with conventional protein sources, with isoleucine identified as the first-limiting amino acid (AAS = 0.83) based on the reference pattern for preschool children (0.5–3 years). In-vivo digestibility assessment using a rat model showed a true ileal digestibility of 96.18
This study examines the interplay between environmental management (EM), environmental performance (EP), and corporate financial performance (CFP) within the global food and beverage (F&B) industry to advance the discourse on sustainable development. By leveraging the natural resource-based view (NRBV) and stakeholder theory, it investigates how internal environmental policy translates into financial outcomes and evaluates the moderating role of brand visibility in facilitating stakeholder engagement. Using system generalized method of moments (GMMs) on panel data from 540 firms spanning 2015 to 2023, the findings reveal that EM significantly improves market-based CFP (Tobin's Q), but has no direct effect on accounting-based measures (ROA and ROE). EP shows no direct financial impact, though EM positively influences EP. Brand visibility significantly moderates the EM-CFP and EP-CFP relationships, amplifying their effects. The study clarifies the distinct roles of EM and EP, addresses mixed findings in prior research, and highlights the strategic importance of integrating environmental and marketing capabilities to drive competitive advantage and enhance firm performance.
Risk perception is a key predictor of the preceptors' intention to evaluate risk, treat and reduce risks, and adopt protective behavior. Using the photovoice method, this study examines risk perception among junior and senior high school students in three schools regarding their experiences with disasters. The thematic analysis found that children experience affective responses such as trauma, fear when alone, and feeling secure when their parents are around during a disaster. Schools and disaster advocates need to understand children's risk perception to enhance existing disaster education and preparedness strategies.
Antimicrobial stewardship (AMS) programmes are central to tackling antimicrobial resistance. Comparative evidence on how barriers differ between high-income countries (HICs) and low-/middle-income countries (LMICs) in tertiary care hospitals is limited. The review aims to identify and compare multilevel barriers to implementing AMS programmes in tertiary care hospitals in HICs and LMICs. We conducted a systematic scoping review following PRISMA-ScR and Joanna Briggs Institute guidance. PubMed and Web of Science were searched for English-language primary studies from January 2015 to November 2025. Studies were considered eligible if they examined barriers to implementing AMS in adult inpatient services in tertiary care hospitals. Using a framework-based thematic approach, barriers were grouped into eight themes and mapped to individual, team, organizational, and system levels. Out of 2311 records, 57 studies met inclusion criteria (23 = HICs, 34 = LMICs). Knowledge, education, and confidence gaps were the most frequent barrier theme in both groups, reported in about three-quarters of studies. Staffing and resource constraints and organisational/governance barriers were also highly prevalent, particularly in LMIC hospitals. Workflow and documentation problems and data-system limitations were more prominent in HIC studies, whereas structural health system constraints were more prominent in LMICs. Qualitative and mixed-methods studies identified a broader range of barriers than surveys or observational designs. AMS implementation in tertiary hospitals is constrained by overlapping multilevel barriers that are broadly similar across income groups but differ in emphasis. Tailored strategies that jointly strengthen workforce capacity, infrastructure and governance are needed, with particular attention to system-level constraints in LMICs and workflow and data challenges in HICs.
