scholarly journals Hereditary cancer panel testing challenges and solutions for the latinx community: costs, access, and variants

2021 ◽  
Author(s):  
Michael P. Douglas ◽  
Grace A. Lin ◽  
Julia R. Trosman ◽  
Kathryn A. Phillips
Keyword(s):  
San Francisco ◽  
Hereditary Cancer ◽  
Low Cost ◽  
Safety Net ◽  
Impact Testing ◽  
Structured Interviews ◽  
Financial Barriers ◽  
Assistance Programs ◽  
Cascade Testing ◽  
Out Of Pocket Expenses

Abstract Hereditary breast and ovarian cancers (HBOCs) are common among the Latinx population, and risk testing is recommended using multi-gene hereditary cancer panels (HCPs). However, little is known about how payer reimbursement and out-of-pocket expenses impact provider ordering of HCP in the Latinx population. Our objective is to describe key challenges and possible solutions for HCP testing in the Latinx population. As part of a larger study, we conducted semi-structured interviews with key provider informants (genetic counselors, oncologist, nurse practitioner) from safety-net institutions in the San Francisco Bay Area. We used a deductive thematic analysis approach to summarize themes around challenges and possible solutions to facilitating HCP testing in Latinx patients. We found few financial barriers for HCP testing for the Latinx population due to laboratory patient assistance programs that cover testing at low or no cost to patients. However, we found potential challenges related to the sustainability of low-cost testing and out-of-pocket expenses for patients, access to cascade testing for family members, and pathogenic variants specific to Latinx. Providers questioned whether current laboratory payment programs that decrease barriers to testing are sustainable and suggested solutions for accessing cascade testing and ensuring variants specific to the Latinx population were included in testing. The use of laboratories with payment assistance programs reduces barriers to HCP testing among the US population; however, other barriers are present that may impact testing use in the Latinx population and must be addressed to ensure equitable access to HCP testing for this population.

scholarly journals “You run out of hope:” An Exploration of Low-Income Parents’ Experiences with Food Insecurity using Photovoice

2021 ◽  
pp. 1-21
Author(s):  
Payge Lindow ◽  
Irene H. Yen ◽  
Mingyu Xiao ◽  
Cindy W. Leung
Keyword(s):  
Food Insecurity ◽  
San Francisco ◽  
Low Income ◽  
Eating Behaviors ◽  
Comparative Method ◽  
Well Being ◽  
Structured Interviews ◽  
Unhealthy Eating ◽  
Low Income Families ◽  
The Impact

ABSTRACT Objective: Using an adaption of the Photovoice method, this study explored how food insecurity affected parents’ ability to provide food for their family, their strategies for managing household food insecurity, and the impact of food insecurity on their well-being. Design: Parents submitted photos around their families’ experiences with food insecurity. Afterwards, they completed in-depth, semi-structured interviews about their photos. The interviews were transcribed and analyzed for thematic content using the constant comparative method. Setting: San Francisco Bay Area, California, USA. Subjects: 17 parents (14 mothers and 3 fathers) were recruited from a broader qualitative study on understanding the experiences of food insecurity in low-income families. Results: Four themes were identified from the parents’ photos and interviews. First, parents described multiple aspects of their food environment that promoted unhealthy eating behaviors. Second, parents shared strategies they employed to acquire food with limited resources. Third, parents expressed feelings of shame, guilt, and distress resulting from their experience of food insecurity. And finally, parents described treating their children to special foods to cultivate a sense of normalcy. Conclusions: Parents highlighted the external contributors and internal struggles of their experiences of food insecurity. Additional research to understand the experiences of the food-insecure families may help to improve nutrition interventions targeting this structurally vulnerable population.

scholarly journals Mapping Instructional Barriers during COVID-19 Outbreak: Islamic Education Context

Religions ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 50
Author(s):  
Akhmad Habibi ◽  
Amirul Mukminin ◽  
Lalu Nurul Yaqin ◽  
Lalu Parhanuddin ◽  
Rafiza Abdul Razak ◽  
...  
Keyword(s):  
Mother Tongue ◽  
Teaching Experience ◽  
Islamic Education ◽  
Educational Systems ◽  
Structured Interviews ◽  
Financial Barriers ◽  
Instructional Activities ◽  
Years Of Teaching Experience ◽  
Technological Barriers

Coronavirus disease 2019 (COVID-19) is currently the most potent threat to educational systems, a crisis that may become disastrous. For the current study, a qualitative design within a case study tradition was implemented to investigate instructional barriers during COVID-19 faced by Indonesian teachers in Islamic boarding schools (Pesantren). Within this study, we applied a purposeful convenient sampling in which the access was obtained through communication with the principals of two Pesantren. Seven invited participants with more than ten years of teaching experience agreed to participate. Semi-structured interviews were addressed for data collection; each interview lasted from 40 to 50 min. The interviews were conducted in the participants’ mother tongue to provide an in-depth understanding of their perceptions, ideas, and arguments regarding instructional barriers during the COVID-19 outbreak. The thematic analysis revealed three major findings regarding the barriers; technological barriers, financial barriers, and pedagogical barriers affecting instructional activities in the two Pesantren. Based on the three themes, the development of a qualitative conceptual map of teachers’ instructional barriers was finalized. Recommendations are also proposed by the participants and the study for the betterment of Indonesian Islamic education facing future similar outbreaks.

scholarly journals Video-Based Intervention for Improving Maternal Retention and Adherence to HIV Treatment: Patient Perspectives and Experiences

2021 ◽  
Vol 18 (4) ◽  
pp. 1737
Author(s):  
Steven Masiano ◽  
Edwin Machine ◽  
Mtisunge Mphande ◽  
Christine Markham ◽  
Tapiwa Tembo ◽  
...  
Keyword(s):  
Positive Impact ◽  
Low Cost ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Structured Interviews ◽  
Convenience Sample ◽  
Long Term Conditions ◽  
Art Initiation ◽  
Retention In Hiv Care

VITAL Start is a video-based intervention aimed to improve maternal retention in HIV care and adherence to antiretroviral therapy (ART) in Malawi. We explored the experiences of pregnant women living with HIV (PWLHIV) not yet on ART who received VITAL Start before ART initiation to assess the intervention’s acceptability, feasibility, fidelity of delivery, and perceived impact. Between February and September 2019, we conducted semi-structured interviews with a convenience sample of 34 PWLHIV within one month of receiving VITAL Start. The participants reported that VITAL Start was acceptable and feasible and had good fidelity of delivery. They also reported that the video had a positive impact on their lives, encouraging them to disclose their HIV status to their sexual partners who, in turn, supported them to adhere to ART. The participants suggested using a similar intervention to provide health-related education/counseling to people with long term conditions. Our findings suggest that video-based interventions may be an acceptable, feasible approach to optimizing ART retention and adherence amongst PWLHIV, and they can be delivered with high fidelity. Further exploration of the utility of low cost, scalable, video-based interventions to address health counseling gaps in sub-Saharan Africa is warranted.

SYMBOLIC STRUGGLE FOR POLICY IMPLEMENTATION OF «ACTIVE AGING» IN THE RUSSIAN SOCIAL AND LABOR SPHERE

2021 ◽  
pp. 1050-1059
Author(s):  
И. Л. Сизова ◽  
Н. С. Орлова
Keyword(s):  
The Elderly ◽  
Work Behavior ◽  
Special Importance ◽  
Active Aging ◽  
Social Mechanisms ◽  
Structured Interviews ◽  
Aging Policy ◽  
Assistance Programs ◽  
The Social

В статье рассматриваются социальные процессы, сопровождающие реализацию политики «активного долголетия» в российской социальнотрудовой сфере. В первом разделе статьи кратко представляются основы концепции «активного долголетия» и обсуждаются возможные социальные механизмы ее применения. Особое место здесь отводится анализу социальных прав, которые формируют основу для разных моделей развития общественного благосостояния и качества жизни населения. Во втором разделе на базе парадигмы конструктивизма в социальных науках и теории символической власти П. Бурдьё предлагается авторский вариант изучения структур восприятия и оценивания населением реализованных государственных реформ. В третьем разделе представлены результаты эмпирического анализа серии полуструктурированных интервью с основными субъектами социально-трудовой сферы и текстов обращений граждан в органы государственной власти. В заключение интерпретируется символическая борьба вокруг восприятия политики «активного долголетия» в России. Авторы приходят к выводу о том, что ожидается новый всплеск программ социальной помощи пожилым и рост пассивности в их трудовом поведении. The article examines the social processes accompanying implementation of the policy «active aging» in the Russian social and labor spheres. The basic concepts of «active aging» are briefl y introduced and possible social mechanisms of its application are discussed in the first section of the article. Special importance is given to the analysis of social rights which form the basis for different models of the development of public welfare and the population’s quality of life. In the second section, author’s version of studying the perception and assessment structures by the population of the implemented reforms of the State are proposed on the basis of the paradigm of constructivism in the social sciences and the theory of symbolic power by P. Bourdieu. In the third section the results of an empirical analysis of a set of semi-structured interviews with the main subjects of the social and labor spheres and the texts of citizens’ appeals to government bodies are presented. In conclusion, the symbolic struggle around the perception of the «active aging» policy in Russia is interpreted. The authors conclude that a new surge in social assistance programs for the elderly and an increase in passivity in their work behavior are expected.

scholarly journals “In Today’s Society, It’s a Necessity”: Latino/a Postsecondary Plans in the College-for-all Era

2021 ◽  
Author(s):  
Sarah Ovink
Keyword(s):  
Higher Education ◽  
San Francisco ◽  
Low Income ◽  
Low Cost ◽  
College Completion ◽  
Socioeconomic Mobility ◽  
Bay Area ◽  
Large Numbers ◽  
East Bay ◽  
College Completion Rates

Latino/a enrollments at U.S. colleges are rapidly increasing. However, Latinos/as remain underrepresented at four-year universities, and college completion rates and household earnings lag other groups’. Yet, little theoretical attention has been paid to the processes that drive these trends, or to what happens when students not traditionally expected to attend college begin to enroll in large numbers. Longitudinal interviews with 50 Latino/a college aspirants in the San Francisco East Bay Area reveal near-universal college enrollment among these mostly low-income youth, despite significant barriers. East Bay Latino/a youth draw on a set of interrelated logics (economic, regional, family/group, college-for-all) supporting their enrollment, because they conclude that higher education is necessary for socioeconomic mobility. In contrast to the predictions of status attainment and rational choice models, these rationally optimistic college aspirants largely ignore known risks, instead focusing on anticipated gains. Given a postrecession environment featuring increasing costs and uncertain employment, this approach led many to enroll in low-cost, less supportive two-year institutions, resulting in long and winding pathways for some. Results suggest that without structural supports, access to college fails to meaningfully redress stratification processes in higher education and the postrecession economy that significantly shape possibilities for mobility.

scholarly journals Main Challenges to Concrete Recycling in Practice

2021 ◽  
Vol 13 (19) ◽  
pp. 11077
Author(s):  
Abdulmalek K. Badraddin ◽  
Rahimi A. Rahman ◽  
Saud Almutairi ◽  
Muneera Esa
Keyword(s):  
Construction Projects ◽  
Low Cost ◽  
Transportation Cost ◽  
Recycled Concrete ◽  
Structured Interviews ◽  
Project Cost ◽  
Main Challenge ◽  
Small Medium Enterprises ◽  
National Programs ◽  
Concrete Recycling

While concrete recycling is crucial to protecting the environment, its implementation in practice is low in many countries. This study aims to highlight challenges to concrete recycling. To achieve that aim, the study objectives are (1) to identify the main challenges to concrete recycling in construction projects; (2) to compare the main challenges between small–medium enterprises (SMEs) and large enterprises (LEs); and (3) to determine the underlying groups among the main challenges. Potential challenges were identified through a systematic literature review of journal articles and semi-structured interviews with fifteen industry practitioners. Then, the identified challenges were inserted into a questionnaire survey and distributed to industry practitioners. Eighty-nine valid responses were collected and analyzed using the mean score ranking, normalization, agreement analysis, and factor analysis techniques. The analyses show thirteen main challenges to concrete recycling. The main challenges include increased project duration, lack of national programs, lack of comprehensive rules and regulations, increased project cost, low demand for recycled concrete, low cost-effectiveness of concrete recycling, and increased transportation cost. However, there is no consensus on the criticality between SMEs and LEs. For example, increased project cost is the main challenge for SMEs but is only middlingly ranked for LEs. Finally, the main challenges can be categorized into three interrelated groups: people and technical, legal and environmental, and economic challenges. This study contributes to the literature by analyzing challenges that hinder concrete recycling in practice. The findings allow researchers and practitioners to develop strategies to reduce concrete recycling rejection.

Maintenance of lift systems affecting resident satisfaction in low-cost high-rise residential buildings

2018 ◽  
Vol 16 (1) ◽  
pp. 17-25 ◽  
Author(s):  
Cheong Peng Au-Yong ◽  
Nur Farhana Azmi ◽  
Nur Aaina Mahassan
Keyword(s):  
Residential Buildings ◽  
Low Cost ◽  
Housing Quality ◽  
Resident Satisfaction ◽  
Structured Interviews ◽  
Contributing Factors ◽  
Breakdown Rate ◽  
Content Type ◽  
High Rise ◽  
Poor Households

Purpose Providing quality low-cost high-rise residential housing for poor households remains a major concern worldwide and especially in Malaysia. Despite government effort to maintain the quality of the housing through the Housing Maintenance Program and 1Malaysia Maintenance Fund Program (TP1M), the maintenance industry is still faced with serious housing quality problems in terms of facilities, one of which is the lift system. As the most expensive and important transportation system in a high-rise building, a lift system requires regular maintenance and inspection to provide safe and effective service to occupants. Unfortunately, most lift systems in Malaysia are not effectively maintained. The purpose of this paper is to examine contributing factors to the breakdown of lift systems, which greatly affect resident satisfaction in low-cost high-rise residential buildings. Design/methodology/approach Semi-structured interviews were conducted with three stakeholders involved in maintenance management to identify the common causes of lift breakdown. Subsequently, a questionnaire survey was used to investigate resident satisfaction with the system. Findings The results demonstrate vandalism as the most common cause for the frequent breakdown of lift system in low-cost housing. The study also reveals that there is a significant relationship between system breakdown rate and residents’ satisfaction. Originality/value The paper concludes with the recommendation that stakeholders, including both maintenance personnel and residents, should commit themselves to ensuring that the use and care of lift system are correct

A place to work: examining workplace location attributes that appeal to generation Y and Z talent

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Wasuthon Wisuchat ◽  
Viriya Taecharungroj
Keyword(s):  
Generation Y ◽  
Low Cost ◽  
Rapid Development ◽  
Traffic Density ◽  
Structured Interviews ◽  
Content Type ◽  
Work Activities ◽  
Development Plans ◽  
The City ◽  
Practical Implications

Purpose This paper aims to identify and to compare workplace location attributes that appealed to Generation Y and Z talent. Design/methodology/approach Semi-structured interviews were conducted with 12 participants to identify workplace location attributes. Choice-based conjoint surveys were collected from 750 Generation Y and Z individuals in the talent pool of Bangkok, Thailand to compare the importance of attributes. Findings The most important workplace location attribute was the availability and diversity of restaurants followed by place appearance, traffic density, availability of public workspaces, public transport and after-work activities. Transport-related attributes were more important for older generations, whereas public workspaces and place appearance were more important for younger talent. Practical implications To attract talent, the Bangkok Metropolitan Administration (BMA) should address the weaknesses of potential workplace locations through efficient, low-cost and rapid development plans. Although Bangkok is known for street food, BMA policies that promote restaurants as the most important attribute are limited. The BMA should initiate plans to promote the availability and diversity of restaurants. Innovation districts in Bangkok should connect to restaurants and food networks in their vicinity. Originality/value The existing literature explored factors that attract talent at the city level, but no study has investigated attractiveness at the workplace location level. Despite some similarities, workplace location attributes identified in this study were more specific than city-level attributes.

Abstract 16520: Predictors of Thirty Day Readmission in a Vulnerable and Underserved Urban Heart Failure Population

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Alexandra B Steverson ◽  
Paul Marano ◽  
Caren Chen ◽  
Yifei Ma ◽  
Rachel Stern ◽  
...  
Keyword(s):  
Heart Failure ◽  
Substance Use ◽  
San Francisco ◽  
Chart Review ◽  
Safety Net ◽  
Housing Status ◽  
Medical Comorbidities ◽  
Increased Risk ◽  
Safety Net Hospital ◽  
Icd 10

Introduction: Heart failure (HF) readmission quality metrics disproportionately impact reimbursement in safety net hospitals. Prior research has demonstrated the effect of medical comorbidities on readmission, however, there is a paucity of data on predictors of readmission in vulnerable and underserved HF patients. We sought to evaluate the effect of demographics, medical and social comorbidities on risk of 30 day readmission in an academic safety net hospital in San Francisco. Methods: We performed a retrospective chart review from 2018 to 2020. Patients were included if treated for HF while on inpatient cardiology or medicine services and were assigned an ICD-10 discharge code for HF. Patients less than 21 years old were excluded. Demographics and comorbidities were obtained through evaluation of ICD-10 discharge codes and chart review. Multivariate modeling was used to determine predictors of 30 day readmission. Results: The study population included 383 patients in which the mean age was 60±13 years and 73% (n=282) were male. 44% (170) were Black, 23% (88) were Latinx, 33% (127) were not housed, 97% (371) had public insurance, and 21% (81) had a diagnosis of mental illness. 46% (177) had CAD, 76% (291) hypertension, and 36% (177) DM. Substance use was common with 30% (114) using methamphetamines, 36% (138) cocaine, 18% (69) opioids, and 35% (135) alcohol. On multi-variate analysis, EF less than 40% (75%, 285) was the only medical comorbidity associated with an increased risk of readmission (OR 1.86, 1.1-3.1, p= 0.018). Social variables associated with increased risk of readmission included identifying as Black (OR 2.26, 1.03-5.0, p= 0.043) or Latinx (OR 3.43, 1.41-7.59, p= 0.006), homelessness (OR 3.02, 1.76-5.18, p=<0.001), and specific substance use: methamphetamine (OR 2.23, 1.39-3.57, p=0.001), cocaine (OR 1.63, 1.03-2.57, p= 0.037), opioids (OR 1.81, 1.05-3.13, p= 0.033), and alcohol (OR 2.26, 1.43-3.58, p= 0.001). Conclusion: Race, housing status and substance use were more strongly associated with readmission risk than medical comorbidities in a population of urban, vulnerable and underserved HF patients. Interventions to improve HF readmission metrics should consider addressing racial and social disparities in similar populations.

Abstract 16247: Methamphetamine Use Predicts Worse Prognosis in a Safety Net Heart Failure Population

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anjali B Thakkar ◽  
Yifei Ma ◽  
Teresa Wang ◽  
Alexandra Teng ◽  
Rebecca Scherzer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
San Francisco ◽  
Cox Regression ◽  
Bypass Graft ◽  
Safety Net ◽  
High Risk Population ◽  
Age And Gender ◽  
Safety Net Hospital ◽  
And Gender

Background: Methamphetamine (MA) use is rising, and overdose deaths have increased by 500% in San Francisco since 2008. MA use is associated with heart failure (HF); yet, cardiovascular (CV) outcomes in this population have not been described. Methods: We performed a retrospective case-control study of HF patients at a safety net hospital in San Francisco. Between January 2001-June 2019, 1771 HF patients with MA use were matched by age and gender to 3542 HF patients without MA use. We examined age and gender-adjusted associations of MA use with likelihood of index HF admission and 30-day readmission (HF and all-cause), and used demographic-adjusted Cox regression model with competing risks to compare hazard rates associated with MA use over the 18-year study period. Results: At time of HF diagnosis, mean age was 52 years and 77% were male. Patients with MA use were significantly more likely than non-MA users to be black (49.1% vs 33.0%), and to have comorbid conditions including HIV (14.5% vs 4.7%), pulmonary hypertension (11.1% vs 7.7%), hypertension (82.0% vs 77.6%), and cocaine use (58.0% vs 14.7%). Despite similar rates of coronary artery disease, myocardial infarction, and diabetes, HF patients with MA use were less likely to have percutaneous coronary intervention (6.1% vs 8.2%) or coronary artery bypass graft (0.8% vs 1.4%), p<0.05 for all. Compared to HF patients without MA use, HF patients with MA use had higher rates of index HF hospitalizations (36.0% vs 21.7%, adjusted odds ratio 2.04, 95% CI 1.80-2.32, p<0.01), 30-day HF readmission (12.2% vs 6.4%, adjusted hazard ratio (aHR) 1.87, 95% CI 1.31-2.67, p<0.01) and 30-day all cause readmission (20.9% vs 14.3%, aHR 1.46, 95% CI 1.14-1.88, p<0.01). Exposure to MA was associated with higher likelihood of death during the study period, regardless of hospitalizations (22.4% vs 15.1%, aHR=1.17, 95% CI 1.03-1.33, p<0.01). Conclusions: In our study, HF patients with MA use were more likely to be admitted for an index HF admission; subsequently, they were also more likely to be readmitted within 30 days. Regardless of hospitalization risk, individuals with MA use had higher likelihood of death. Further study to understand the clinical and socioeconomic factors driving worse outcomes in this high-risk population is needed.

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