On risk-based poverty traps

World Development · 2026-01-17

Psychological barriers to participation in the labor market: Evidence from rural Ghana

Journal of Development Economics · 2026-02-06

Mental health conditions are strongly associated with reduced labor market participation, but the underlying channels through which such conditions impact labor supply remain unclear. We conduct a two-phase study decomposing this relationship by examining (i) job take-up decisions and (ii) labor supply, output, and earning conditional on job take-up, and (iii) quit rates. In Phase 1, women in rural Ghana are asked whether they would be willing to take-up a cash-for-work job during the lean season when alternative work is scarce. We find that individuals with depression and anxiety, which are common in this population, are much more likely to decline work offers outside the home but equally likely to accept work-from-home positions. In Phase 2, we randomly offer jobs at home to those who were willing to work from home, avoiding selection effects. Neither depression nor anxiety predict work completion, income, or quit rates when working from home. These findings suggest that poor mental health may harm labor market outcomes in traditional jobs outside of the home via reduced take-up, above and beyond the established negative impacts of mental health on productivity in work outside of the home. But, the results also suggest an alternative approach to improving labor market outcomes for those in poor mental health: work-from-home opportunities, which are not associated with lower take-up or lower productivity on the job for those in poor mental health. • Depression and anxiety reduce job take-up for outside-home work in rural Ghana. • No differences in take-up of home-based jobs by mental health status. • Mental health does not affect productivity, income, or quit rates in home-based work. • Work-from-home opportunities may mitigate labor market barriers from poor mental health.

CuddleCard: Protocol for a randomized controlled trial evaluating the effect of providing financial support to low-income mothers of preterm infants on parental caregiving in the neonatal intensive care unit (NICU)

BMC Pediatrics · 2025-05-15 · 1 citations

BACKGROUND: Preterm birth is a leading cause of childhood mortality and developmental disabilities, with persistent socioeconomic disparities in incidence and outcomes. Maternal presence during prolonged neonatal intensive care unit (NICU) hospitalization is critical for preterm infant health, enabling mothers to provide breast milk, directly breastfeed, and engage in skin-to-skin care-all of which promote infant physiological stability and neurodevelopment. Low-income mothers face significant barriers to visiting the NICU and participating in caregiving due to financial burdens and the psychological impact of financial stress. This randomized controlled trial aims to evaluate the effectiveness of financial transfers in promoting maternal caregiving behaviors that directly impact preterm infant health outcomes during NICU hospitalization. METHODS: We will conduct a two-arm, single-blinded randomized controlled trial with 420 Medicaid-eligible mothers of infants born between 24 weeks 0 days to 34 weeks 1 day gestation across four Level 3 NICUs in Georgia and Massachusetts. Mothers in the intervention arm will receive standard of care enhanced with weekly financial transfers and will be informed that these funds are intended to help them spend more time with their infants in the NICU. All participants will be provided with a hospital-grade breast pump and educational materials on the benefits of breast milk and skin-to-skin care. Participants will complete surveys during their infant's hospitalization and following discharge, capturing outcomes related to maternal mental and physical health, caregiving behaviors, cognitive function, financial and socioeconomic factors, infant health and growth, and perceptions of NICU care quality. Primary outcomes are the provision of breast milk and engagement in skin-to-skin care. Secondary outcomes include infant growth and health outcomes, NICU visitation, financial and socioeconomic hardship, maternal physical and mental health measures, cognitive function, and perception of NICU care quality. DISCUSSION: This study will provide evidence of the impact of financial transfers on maternal caregiving behaviors in the NICU, addressing critical gaps in our understanding of how financial stress affects low-income mothers. Findings may inform health policy, particularly regarding Medicaid coverage of non-medical services, and contribute to understanding how to address disparities in preterm infant care. TRIAL REGISTRATION: The trial was prospectively registered with the American Economic Association Trial Registry, the primary registry for academic economists conducting policy trials, on 16 April 2024 (AEARCTR-0013256). It was also registered on ClinicalTrials.gov (NCT06362798) on 10 April 2024.

Mortality in people with a diabetes foot ulcer: An update from the Salford podiatry clinic follow‐up study

Diabetic Medicine · 2024-04-09 · 2 citations

In a clinic-based prospective study, we previously reported a very high long-term mortality rate in individuals with diabetic foot ulcer (DFU),1 greater for those with a hind foot ulcer and described a close relation between risk of sepsis/renal failure and DFU mortality. We highlighted the importance of addressing all risk factors as soon as people present with a DFU in order to mitigate the longer-term health consequences. The findings mirror the conclusions of a recent review which reported that the mortality rate for people with DFUs is 231 deaths per 1000 person-years, compared with 182 deaths per 1000 person-years in people with diabetes without foot ulcer.2 More recently in 2023, in a 10-year follow-up study,3 we highlighted the observation that an elevated urinary albumin/creatinine ratio or low-estimated glomerular filtration rate (eGFR) was commoner in those with a foot complication and elevated the odds ratio of death in those with an established foot complication. Other work has supported this observation.4 We here have updated mortality outcome findings from our single-site follow-up study at Salford Royal Hospital in the United Kingdom which recruited consecutive patients from April to June 2016. We previously reported on the 4 years up to the end of 2019 on 98 individuals, 17 had type 1 diabetes (T1D), and 81 had type 2 diabetes (T2D). Thirty-one were women. The mean age (range) in 2016 was 63.6 (28–90) years with range of diabetes duration from 1 to 45 years. In this latest analysis we applied the annual expected mortality rate for the general population by age and sex as published by the Office of National Statistics5 to generate the total number of expected deaths each year and divided that into the actual recorded deaths to give the age and sex standardised mortality rate (SMR). This was compared across the PERIOD 1 = 2016–2019 and PERIOD 2 = 2020–2023 study periods. The influence of the patient recorded status at the start of the study including sex, age duration with condition, type of diabetes, glycated haemoglobin (HbA1c), eGFR and body mass index (BMI), when linked to foot ulcers was analysed to see which showed the largest association with mortality rate. Position of ulcer continued to play a role in PERIOD 1. The 25 patients with a hind foot ulcer had SMR 6.3 while the 63 patients with a forefoot ulcer had SMR 5.4; in PERIOD 2 the 14 patients with a hind foot ulcer had SMR 13.0, while 39 patients with a forefoot ulcer had SMR 9.2. Weight difference in relation to 2016 BMI <30 kg/m2 or ≥30 kg/m2 did not associate strongly with difference in SMR during each period, nor did duration of diabetes <10 years or ≥10 years. That more than two-thirds of participants died only 7 years following presentation with a foot ulcer and the very high SMR in younger individuals (<65 years old), and in people with T1D, highlights the critical importance of bringing all relevant indices of risk to target in people who have developed a foot ulcer, wherever this is possible. The SMR remained higher for hind foot versus forefoot ulcers in the second period although the Kaplan–Meier plot which does not take into account age or sex and only looks at the unadjusted mortality rate, did not show a difference in mortality rate in the later stages of follow-up. Calibration of mortality for people with diabetes foot ulceration, against the general population for age and sex to estimate SMR, affords to patients and clinicians greater clarity of the inherent risks of diabetes foot ulceration for those with this condition and in relation to specific subgroups as defined here. Future identification of putative risk factors could enable better identification of people with diabetes who are at the greatest risk of shortened life expectancy in relation to the context of their health profile and related comorbidities, while screening and management of cardiovascular risk factors should remain a focus of health promotion policies at all levels of diabetes care.6 A. Heald prepared all drafts of the paper with the assistance of H. Rashid and A. Robinson. Extraction and validation of patient data was undertaken by H. Schofield. Data analysis was performed by M. Stedman and W. Lu with contributions from J. M. Gibson and M. B. Whyte. E. Jude provided ongoing input to the manuscript with senior review by G. Dunn and M. Edmonds. No external funding was received. None. No author has any conflict of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abstract 4441: The epigenetic factor BMI1 regulates metabolism and tumorigenesis in human pancreatic cancer cells

Cancer Research · 2024-03-22

Abstract Dysregulation of epigenetic factors is a key component of tumorigenesis. BMI1, a member of the polycomb repressor complex 1 (PRC1), is an oncogenic factor studied in many types of cancer, including pancreatic ductal adenocarcinoma (PDAC). PDAC is the third most common cause of cancer-related death in the United States and investigation of the biology involved in transformation is critical for improving outcomes in this devastating disease. In PDAC, BMI1 is required for initiation of pancreatic cancer in mice and enhances in vitro growth of human and murine tumor cell lines. CRISPR-mediated knock out of BMI1 results in reduced subcutaneous and orthotopic tumor growth in mice and decreased expression of genes related to metabolism, specifically glycolysis, and cell proliferation. BMI1 has also been implicated in regulation of metabolism in other epithelial tumor types, including ovarian cancer. Given these preliminary findings, we hypothesized that loss of BMI1 in multiple human PDAC cell lines would result in altered metabolic activity, reducing the growth and tumorigenic properties of these cells. We demonstrated that BMI1 expression is higher in PDAC cell lines compared to normal pancreatic epithelial cells and normal human donor pancreatic tissue. Following CRISPR-mediated BMI1 knock out in human PDAC cell lines, we investigated the alterations to metabolism using metabolic flux analysis. Loss of BMI1 resulted in lower basal and compensatory rates of glycolysis and increased oxygen consumption rates compared to wild-type cells. Metabolomic analysis demonstrated reduction in all the enzymes involved in the glycolysis pathway with loss of BMI1. Cell growth was reduced by loss of BMI1 in vitro, and orthotopic injection into mice of human cells with BMI1 knock out resulted in decreased tumor size compared to wild-type, recapitulating these findings in vivo. Together, these data identify a role of BMI1 in promotion of tumor growth through regulation of metabolism in pancreatic cancer. Experiments are ongoing to determine the underlying mechanism of this regulation and implications on therapeutic targeting with BMI1/PRC1 complex inhibitors in conjunction with traditional chemotherapy. Citation Format: Jamie N. Mills, Dominik Awad, Heather K. Schofield, Joyce K. Thompson, Hannah Watkoske, Damien Sutton, Nicholas Nedzesky, Donovan Drouillard, Zeribe Nwosu, Carlos Espinoza, Yaqing Zhang, Annachiara Del Vecchio, Christopher J. Halbrook, Marina Pasca di Magliano, Costas A. Lyssiotis, Filip Bednar. The epigenetic factor BMI1 regulates metabolism and tumorigenesis in human pancreatic cancer cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4441.

Cognitive Endurance as Human Capital

The Quarterly Journal of Economics · 2024-12-16 · 2 citations

Abstract Schooling may build human capital not only by teaching academic skills but by expanding the capacity for cognition. We focus specifically on cognitive endurance: the ability to sustain effortful mental activity over a continuous stretch of time. As motivation, we document that globally and in the United States, the poor exhibit cognitive fatigue more quickly than the rich do across field settings; they also attend schools that offer fewer opportunities to practice thinking for continuous stretches. Using a field experiment with 1,600 Indian primary school students, we randomly increase the amount of time students spend in sustained cognitive activity during the school day—using either math problems (mimicking good schooling) or nonacademic games (providing a pure test of our mechanism). Each approach markedly improves cognitive endurance: students show 22% less decline in performance over time when engaged in intellectual activities—listening comprehension, academic problems, or IQ tests. They also exhibit increased attentiveness in the classroom and score higher on psychological measures of sustained attention. Moreover, each treatment improves students’ school performance by 0.09 standard deviations. This indicates that the experience of effortful thinking itself—even when devoid of any subject content—improves general cognitive capacity. Finally, we complement these results with quasi-experimental variation indicating that an additional year of schooling improves cognitive endurance, but only in higher-quality schools. Our findings suggest that schooling disparities may further disadvantage poor children by hampering the development of a core mental capacity.

Supplementary Figure 7 from Canonical Wnt Signaling Is Required for Pancreatic Carcinogenesis

2023-03-30

&lt;p&gt;PDF file - 6752K, Supplemental Figure 7. Inhibition of Wnt/β-catenin signaling by Dkk1 reduces epithelial cell proliferation.&lt;/p&gt;

Supplementary Methods from Canonical Wnt Signaling Is Required for Pancreatic Carcinogenesis

2023-03-30

&lt;p&gt;PDF file - 191K, Detailed experimental procedures including tables for the antibodies and primers used in our study, as well as additional references.&lt;/p&gt;

Supplementary Figure 5 from Canonical Wnt Signaling Is Required for Pancreatic Carcinogenesis

2023-03-30

&lt;p&gt;PDF file - 4422K, Supplemental Figure 5. Survival curve of KC and KDC mice. PDA in KC and KDC mice.&lt;/p&gt;

Supplementary Figure 2 from Canonical Wnt Signaling Is Required for Pancreatic Carcinogenesis

2023-03-30

&lt;p&gt;PDF file - 6297K, Supplemental Figure 2. Pancreatic histology in DKK1 mice on doxy; KC and KDC mice without doxy.&lt;/p&gt;