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Comparison results by malignancy status of subcutaneous nodules Malignant Comparison P-value No Yes Evolution No change Little change Change Significant change 77 (17.4%) 88 (19.9%) 270 (61.1%) 7 (1.6%) 4 (8.2%) 6 (12.2%) 24 (49.0%) 15 (30.6%)  < 0.001 (CA)* Itch/pain Itch No pain Pain 11 (1.9%) 325 (55.6%) 249 (42.6%) 2 (3.7%) 29 (53.7%) 23 (42.6%) 0.658 (C) Nodule type Fixed Mobile 9 (2.5%) 352 (97.5%) 10 (41.7%) 14 (58.3%)  < 0.001 (C)* Nodule size in millimeters 18.1 ± 13.0 (15.0) 41.0 ± 59.0 (20.5)  < 0.001 (W)* Duration length in months 39.1 ± 60.9 (24.0) 36.9 ± 45.1 (24.0) 0.933 (W) Total n = 859. CA Cochran-Armitage Trend Test; C Chi-Square Test; W Wilcoxon Rank Sum Test. *Statistically significant: p < 0.05 Further analysis of cases in which all five criteria were documented in the chart was included in subsequent analysis to determine malignancy score trends. Future research will aim at evaluating similar criteria across multiple institutions to further validate our results and assess variations in nodule characteristics among demographic subgroups.

Characteristics of SSc crowdfunding campaigns Characteristic N (%) N=652 Funding recipient Self (person with SSc) 203 (31.1) Another person with SSc 510 (78.2) SSc-related charitable organization 48 (7.4) Impact of SSc described in campaign Financial burden 539 (82.7) Functional impairment 468 (71.8) Psychosocial distress 253 (38.8) Unspecified impact on quality of life 102 (15.7) Sources of financial burden Loss or expected loss of income 218 (33.4) Lack of health insurance 13 (2) Incomplete insurance coverage 166 (25.4) Lack of insurance coverage for medications 30 (4.6) Lack of insurance coverage for procedures 54 (8.3) Fundraising goal (average, [range]) $21,627.83 [$100 - $300,000] Amount raised (average, [range]) $5,409.66 [$0 - $44,780] Campaigns meeting fundraising goal 96 (14.8) Abbreviation: SSc, systemic sclerosis [See PDF for image] Fig. 1 Categories to which SSc crowdfunding campaigns allocated their donations This study highlights the financial hardships experienced by individuals with SSc, as well as the limited effectiveness of crowdfunding in providing support. [...]our study highlights financial challenges confronting individuals with SSc. A.L. and D.M. oversaw data collection, data analysis, and preparation of the main manuscript.

Abstract People living with serious mental illnesses (SMI) continue to face a disproportionate burden of tobacco-related prevalence, morbidity, and mortality as compared to those without SMI. The risk of mortality related to cigarette smoking among those with SMI is six-times that for persons without SMI. Tobacco use undermines social determinants of health (SDoH) in general and the social determinants of mental health more specifically. Not only does tobacco use exacerbate mental health symptoms, it further impedes mental health recovery by reducing expendable income, sustaining poverty, hindering food security, and limiting job opportunities. Conversely, stopping tobacco use is associated with improved mental health and, possibly, substance use recovery outcomes. The purpose of this paper is to analyze the social determinants of tobacco smoking cessation as described by adults with SMI. We conducted semi-structured qualitative interviews with 17 middle aged and older adults (mean=52, sd=6.9) with SMI upon completion of a 12-week smoking cessation program. Grounded Theory methodology guided data collection and analysis. Participants described what contributed to their success with smoking cessation or reduction and pointed out how SDoH played a role in the process. Five broad categories of SDoH described were: 1. Support and sense of belonging; 2. Structure and meaningful activities; 3. Employment; 4. Role models; and 5. Access to green space. Our findings illustrate the importance of SDoH in health interventions and are a reminder to consider these SDoH as interventions are tailored to meet the unique needs of people living with SMI.