Search

We study the local effects of new market-rate housing in low-income areas using microdata on large apartment buildings, rents, and migration. New buildings decrease rents in nearby units by about 6% relative to units slightly farther away or near sites developed later, and they increase in-migration from low-income areas. We show that new buildings absorb many high-income households and increase the local housing stock substantially. If buildings improve nearby amenities, the effect is not large enough to increase rents. Amenity improvements could be limited because most buildings go into already-changing neighborhoods or buildings could create disamenities such as congestion.

BackgroundHousehold food insecurity persists in the United States and has important implications for health and well-being. Food insecurity in female-identified caregivers is particularly concerning, given its association with their mental health and adverse health outcomes for their children. Food insecurity is associated with disordered eating but, to our knowledge, no prior studies have examined an association between food insecurity and food addiction.ObjectiveOur aim was to examine whether food insecurity is associated with higher food addiction symptom endorsement in low-income female adults.DesignSecondary analysis of baseline data from a quasi-experimental study of a mindfulness-based intervention on gestational weight gain among low-income pregnant individuals and an observational study of low-income families.Participants/settingParticipants in study 1 (n= 208) were English-speaking, low-income pregnant individuals with overweight or obesity, recruited in California from 2011 to 2013. Participants in study 2 (n= 181) were English-speaking, low-income female caregivers for children aged 8 through 10 years, recruited in Michigan from 2018 to 2019. Both studies recruited participants from community health clinics, social service agencies, and online advertisements.Main outcome measuresThe primary outcome measure was food addiction symptoms, assessed by the Yale Food Addiction Scale.Statistical analysisMultivariate Poisson regression was used to examine the association between household food insecurity and food addiction symptoms in each sample, adjusted for sociodemographic characteristics.ResultsIn study 1, pregnant individuals in food-insecure households reported 21% higher food addiction symptoms than pregnant individuals in food-secure households (incidence rate ratio 1.21; 95% CI 1.00 to 1.47; P= .047). In study 2, caregivers in food-insecure households had 56% higher food addiction symptoms than caregivers in food-secure households (incidence rate ratio 1.56; 95% CI 1.01 to 2.40; P= .045).ConclusionsThese findings provide preliminary support for a relationship between household food insecurity and food addiction. Future research should examine potential mechanisms and whether interventions to reduce food insecurity lower risk of food addiction.

Pregnancy in women with sickle cell disease (SCD) is fraught with complications, some of which are life-threatening. Managing pregnancy in these women can be challenging, especially with poor resources, which is often the case in low-income countries. In Nigeria, for instance, up to 90% of patients pay out of pocket for medical care due to the poorly developed health insurance system, and this worsens the morbidity and mortality associated with this condition. We describe a pragmatic approach to routinely managing pregnant women with SCD in the antenatal period, showing the feasibility of effective management of these high-risk pregnancies in limited-resource settings. We also present the case of a pregnant Nigerian woman with SCD who has intrauterine growth restriction (IUGR) and acute chest syndrome (ACS), conditions that are life-threatening for the fetus and the mother, respectively, and require prompt intervention. We highlight how we successfully managed this woman in a cost-effective manner by employing relatively inexpensive tests for diagnosis and treating her effectively with oxygen, appropriate antibiotics and manual exchange blood transfusion for the ACS, and finger pulse oximeters to monitor oxygen saturation. We explore pathophysiological concepts to IUGR in women with SCD and briefly discuss the appropriate mode of delivery, including the options for pain relief in labor.

This paper presents the results of thermal comfort and air quality studies in naturally ventilated residential buildings in Kampala City, Uganda. Questionnaire surveys were used for obtaining occupant subjective thermal sensation votes. Indoor and outdoor measurements for air temperature (Ta), Mean Radiant Temperature (MRT), relative humidity, air speed, and air quality were done for seven buildings over fifteen days during the month of June 2019. DesignBuilder software was used to develop the reference building model and to simulate strategies for improvement of thermal comfort. Survey results showed that 67.8% of the respondents were comfortable with the indoor thermal environment. The indoor air temperature range was 22.7°C - 27.9°C which lies within the 80% acceptable limits set by ASHRAE 55. The measured indoor MRT range was 24.24°C - 25.57°C. Measured levels of indoor PM2.5 were double the World Health Organization recommended limits, while the levels of PM10 were thrice the recommended limits of ASHRAE 62.1. The CO2 concentrations were within the limits set by ASHRAE 62.1. The developed model predicted comfortable indoor conditions with a temperature range of 23.6°C - 25.3°C based on the 80% acceptable limits set by ASHRAE 55. The results show that majority of occupants preferred cooler temperatures during the day which is justified by the use of adaptive measures to obtain thermal comfort.

Particularly in low-income nations, infectious illnesses continue to be a significant global health burden. The interaction of stem cells with infectious diseases has become a fascinating field of study with bright therapeutic potential. This review article seeks to give readers an overview of how cells interact with one another in disease, with a particular focus on how stem cells interact with a few specific infectious diseases and their therapeutic potential in low-income nations. The definition and several types of stem cells are introduced at the outset of the review, with a focus on their capacity for regeneration and immunomodulation. The significance of stem cells in tissue repair and regeneration is next discussed, emphasizing their potential to lessen the damaging effects of infectious illnesses on host tissues.The article also examines the behaviour and function of stem cells as well as the direct and indirect effects of pathogens on stem cells. Examining the immune systems function in controlling the interaction between infections and stem cells helps to understand the intricate cellular cross-talk involved. The review examines the therapeutic potential of stem cell-based therapies for infectious diseases in the context of low-income nations. It addresses the potential of stem cell treatments for conditions like HIV, malaria, tuberculosis, and neglected tropical diseases while highlighting the developments and difficulties associated with applying these treatments in settings with limited resources.Overall, this review demonstrates the complex relationship between stem cells and infectious diseases and offers insights into the potential therapeutic applications of stem cell-based therapies in low-income nations. It emphasizes the requirement for additional study, teamwork, and the creation of affordable and widely available stem cell therapies to effectively combat infectious diseases and enhance healthcare outcomes in settings with limited resources. &nbsp

Although cancer survival rates have been improving in the United States over the past 30 years, cancer treatment facilities still struggle to achieve patient treatment volumes that match demand for their services. My capstone team and I studied the treatment workflow at UVA’s Cancer Center through a combination of interviews, observations, and statistical analysis. We discovered that there was significant room for process improvement at the center and determined that two strategies, a new drug pre-preparation approach and a novel scheduling approach, could increase chair utilization without subjecting nurses to additional strain. From a human factors standpoint, our research showed that increasing cancer treatment efficiency would improve patient experiences and decrease nurse workload. Indeed, future work at this cancer center and at cancer centers around the country must be evaluated holistically, from both a throughput and human impact perspective. Cancer care can also be viewed through an infrastructure lens. Susan Star’s infrastructure framework helps us understand that cancer care is embedded within pre-existing healthcare systems, learned as a part of membership by patients, and built on an installed base of other pieces of infrastructure. For my thesis project, I investigated the impact of the Affordable Care Act (ACA) on cancer outcomes for low-income patients using Star’s framework and statistical analysis. My study found that cancer mortality rates fell significantly in the decade following the ACA’s passage, but that cancer mortality rates in persistent poverty counties lagged rates in nonpersistent poverty counties by a decade. Moreover, the mortality rate gap between persistent and nonpersistent poverty counties only barely decreased during this time period. Unfortunately, the ACA was not significantly correlated with improvements in cancer treatment for low-income patients between 2010 and 2020. My capstone and thesis projects examine cancer care from different angles, but they are connected by their twin desires to understand and improve cancer treatment across the country. Together, these two projects help us understand how hospital-level and policy-level approaches can provide future cancer patients the cancer care they deserve.

During the summer of 2022, the Finance Platform team in an American banking firm headquartered in Virginia noticed that its data preview and download feature was malfunctioning. More specifically, miscommunication between the feature’s backend microservice and the frontend User Interface (UI) component caused erroneous behavior in the application when users attempted to preview larger and more complex datasets. Because this feature’s user base consisted primarily of the firm’s employees due to it comprising a portion of their internal application, my internship focused on replacing the existing feature with an improved version. My technical report details the steps that my internship team and I took to create an upgraded data preview and download backend service and its respective UI component. We hoped that doing so would rectify the previous feature’s shortcomings. My summer internship, which also served as my technical project, was managed using agile methodologies. Moreover, its technology stack included the Spring framework and Apache Spark for the backend, the Angular framework for the frontend, and Amazon Web Services (AWS) to satisfy data storage requirements. Utilizing the provided combination of tools and technologies allowed us to efficiently replace the existing service with one that incorporated a more comprehensive set of endpoints (e.g., preview, download, download zip) and a redesigned preview response object. To maintain consistency with the company’s coding practices, our team also created a UI component using Angular to facilitate a more user-friendly experience when previewing and downloading the selected datasets. Although the newly created service and UI component performed slower than we had originally anticipated, they allowed users to successfully preview and download a more diverse range of datasets with minimal challenges. However, potential next steps would include extensive regression and performance testing, improving performance time by leveraging newer technologies, and integrating this feature into the firm’s production environment. Despite my technical project focusing on modifying the existing data preview and download feature in the firm’s internal web application, this company also offers a myriad of other technological products and services to its customers. Even though I was only able to interact with a subset of the firm’s products, I was the most intrigued by Eno, its chatbot. Over the past few decades, advancements in fields including Artificial Intelligence (AI) and Machine Learning (ML) have helped revolutionize how businesses communicate with their customer base. More specifically, a majority of these companies across various industries have been rapidly transitioning away from customer support teams and into adopting chatbots. While chatbots have undoubtedly aided businesses by increasing productivity and minimizing cost, the STS paper investigates how generative chatbots in the banking industry impact the retention rate of low-income customers. Chatbots are merely computer programs that are designed with the intent of simulating and comprehending ordinary human conversation. Although earlier chatbots such as ELIZA, PARRY, and ALICE typically exhibited limited functionality because of their underlying rule-based technology, the progression of computer science has allowed the creation of generative chatbots such as Capital One’s Eno and Amazon’s Alexa among many others. In an attempt to narrow down the scope of the research topic, the STS paper solely focuses on generative chatbots. While chatbots have been widely popularized and even idolized in certain circumstances, this paper draws on various research (e.g., academic papers, research articles) to examine how aspects of a chatbot including functionality, credibility, and emotional objectivity are perceived by different social groups. Due to the nature of my topic, the social groups are stratified by both income and race. Moreover, a majority of the research focuses on the relationship between chatbots and the low-income community. To better understand the relationships between chatbots and the impacted social groups, the STS paper relies on the Social Construction of Technology (SCOT) framework. Given that this framework revolves around the concept that society shapes technology, it effectively supplements my analysis of how this technology is being continuously adapted in response to both the approvals and criticisms of different social groups such as the low-income population. Finally, a paper that concentrates on chatbots and their implications within communities would be incomplete without discussing the new chatbot that has taken the AI and ML fields by storm – ChatGPT. To acknowledge chatbots of this caliber, my research paper briefly examines how ChatGPT can potentially modify the banking landscape. Additionally, it touches on what this may mean when considering the ever-evolving relationship between the low-income population and this technology.

Background Patient navigation programs have shown promise for improving health but are not widely used in obstetric care. Our objective was to understand obstetric provider perspectives on how to implement patient navigation to optimize care during the postpartum period for low-income patients. Method Focus groups were conducted with obstetric physicians, nurses, and social workers who care for low-income pregnant and postpartum patients in an academic medical center. Semistructured interview guides were developed to elicit conversations about the potential value of patient navigators, recommendations for navigator training, and how navigators could be most effective in improving postpartum care. Analysis of themes was based on the constant comparative method. Results Twenty-six obstetric providers (six focus groups) discussed elements for a successful obstetric navigation program. Successful implementation themes included selecting navigators with appropriate interpersonal attributes, arranging navigator training, and identifying the most valuable services navigators could render. Desirable navigator attributes included persistence in patient advocacy, consistency, relatability, and a supportive manner. Training recommendations included learning the health care system, identifying where to obtain health system and community resources, and learning how be effective health educators. Suggested services were broad, ranging from traditional care coordination to specific educational and resource-driven tasks. Conclusions Obstetric providers perceive patient navigation to be a potentially beneficial resource to support low-income patients and offered recommendations for navigation implementation. These included suggestions for patient-centered navigators, with specific training and services focused on promoting care continuity and coordination.

In the context of successive global crises and rising household food insecurity in wealthy European countries there is renewed attention to the role of school meals as a welfare intervention. However, little is known about the extent to which school meals are a resource for low-income families living in different contexts. Drawing on a mixed methods study of food in low-income families in three European countries, this paper adopts a realist ontological stance and an embedded case study approach to address this question. The research concerns low-income families with children aged 11–15 years in the aftermath of the 2008 financial crisis in the UK, Portugal and Norway. Based on a comparative, multi-layered analysis of macro-, meso- and micro-level contexts, we argue that publicly funded, nutritious school meals protect children from the direct effects of poverty on their food security, whilst underfunded and weakly regulated school food provision compounds children’s experiences of disadvantage and exclusion. The paper concludes with recommendations for public policies that conceptualise school meals as a collective resource, like education, to which young people as bearers of the right to food are entitled.

Distinguishing profiles of trauma exposure among low-income adolescent females with depressive symptoms is important for understanding comorbidity, family relationships, and treatment. Specifically, child maltreatment is essential to examine in comparison to other traumas. Participants included 170 adolescent females (65.3% Black; 21.2% White; 13.5% other race; 14.1% Latina/x) with depressive symptoms and their primary caregiver from low-income families. Latent class analysis (LCA) identified three trauma classes. Probabilities of endorsing different subtypes of maltreatment (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse), number of subtypes of maltreatment, and non-maltreatment traumas (accident, experiencing or witnessing physical assault, death or injury of loved one, medical trauma) varied among groups. Higher levels of family dysfunction and traumatic stress symptoms were reported in both classes with maltreatment exposure as compared to the class with only non-maltreatment trauma exposure. Findings have implications for family-focused interventions for maltreated adolescent females with depressive symptoms from low-income contexts.

People with disabilities experiencing low socioeconomic position are priority populations when considering access to veterinary care. In this population, intersectional inequities lead to adverse health outcomes for both those individuals and the companion animals they care for. Community-based veterinary clinics provide an opportunity to target these inequities from a culturally sensitive lens, intending to improve human and animal outcomes. We conducted a process evaluation of a student-led community-based clinic for this population to better understand client satisfaction, assess learning outcomes among veterinary students, and improve program delivery and services. During academic year 2020–2021, the monthly clinics had 162 appointments in total with a median 15 DVM candidates volunteering at each clinic. Clients and volunteers responded to survey questionnaires designed to elicit information about their experiences with the clinic, including open-ended questions for further elucidation of measurable indicators of client-, patient-, and student-level impact. Clients attributed enrollment in the clinic with improved quality-of-life and reduction of financial burden; the program saved clients approximately $2,050 per pet during the evaluation year. Furthermore, the clinic widely facilitated completion of the college's core Primary Care and Dentistry learning outcomes. Beyond curriculum-standard learning objectives, students also reported positive attitude changes and increased readiness to provide care to people with disabilities and people experiencing low socioeconomic position. The results of this evaluation have significant implications for both veterinary and public health pedagogy. Especially, they highlight the significance of community health practice in veterinary trainee education.

Background: Parent mentors are a potential community-based mechanism for delivering behavioral interventions. For communities at a higher risk of obesity and challenges with access to care, such as migrant and seasonal farm workers, this may be an effective intervention for obesity. This study examined the effect of parent mentors on weight outcomes. Methods: This randomized clinical trial assigned parents of 2- to 5 year-old children enrolled in Head Start 1:1:1 to control, a parent mentor teaching We Can!, or a parent mentor teaching an intervention derived from positive deviance methods. The parent mentor arms were designed to have weekly interactions and monthly community meetings over 6 months. The primary outcome was change in adiposity, as measured by body mass indices. Results: We randomized 188 parents, and 155 completed the 6-month visit. Most parents, 107 (58%), had less than a high school education, and 170 (90%) reported Latino ethnicity. In the intention-to-treat analysis, no difference between the groups was observed for change in percent distance from the median or BMI z-score. The median number of interactions was 14 (IQR 10-20) over 6 months for those who did engage, though 24 of 118 (20%) had no interaction. Those with no interactions in We Can! had a mean increase in change from median of 6.7 [standard deviation (SD) = 8.2]; those with higher participation experienced a 0.4 (SD = 9.2) change, p = 0.04. Conclusions: Parent mentors were not effective in changing the adiposity indices in this study overall, with some evidence of efficacy after accounting for participation. Clinicaltrials.gov registration number: NCT03330743.

Pharmaceuticals are widely used in Africa due to the high burden of human and animal diseases. However, a review of the current practices and pollution risks arising from the disposal of pharmaceuticals in low-income settings in Africa is still lacking. Therefore, the present review examined the literature to address the following questions: (1) what are the key factors driving the accumulation of unused and expired pharmaceuticals?, (2) what are the current disposal practices for unused and expired pharmaceuticals, and wastewater (feces and urine) containing excreted pharmaceuticals?, (3) what are the potential environmental and human health hazards posed by current disposal practices?, and (4) what are the key research needs on the disposal of pharmaceuticals in low-income settings? Evidence shows that, in low-income settings, wastewater comprising predominantly of feces and urine containing excreted pharmaceuticals often end up in on-site sanitation systems such as pit latrines, septic tanks, and the environment in the case of open defecation. Unused and expired pharmaceuticals are disposed of in pit latrines, household solid waste, and/or burned. The pollution risks of current disposal practices are poorly understood, but pharmaceutical pollution of groundwater sources, including those used for drinking water supply, may occur via strong hydrological connectivity between pit latrines and groundwater systems. Potential high-risk pollution and human exposure hotspots are discussed. However, compared to other environmental compartments, the occurrence, dissemination, fate, and human health risks of pharmaceuticals in the pit latrine-groundwater continuum are still understudied. Future research directions are discussed to address these gaps using the Source-Pathway-Receptor-Impact-Mitigation (SPRIM) continuum as an organizing framework.

This study aimed to establish the prevalence of underweight, overweight and obesity, the level of moderate-to-vigorous physical activity (MVPA) and the association thereof among vulnerable children from low-income communities in South Africa. Cross-sectional data were collected from 916 children (467 boys and 449 girls) aged 8–13 years (x̄ = 10.4 ± 1.2 years) attending eight low-income schools in Gqeberha, South Africa. Measured outcomes included accelerometery-measured physical activity (PA), weight, height and body mass index (BMI). Analysis of variance was used to determine the mean difference of total MVPA stratified by sex and BMI classification. Overall, 13% of the cohort were underweight, 19% were overweight/obese and 64% engaged in 60 min of MVPA per day. Girls presented nearly twice the odds of being overweight or obese than boys (95% CI: 1.40–2.77). Underweight to normal-weight children (boys: OR = 3.89, 95% CI: 2.18–6.93; girls: OR = 1.78, 95% CI: 1.13–2.80) were more likely to engage in 60 min/day of MVPA than overweight to obese children. There is an inverse association between BMI categories and theduration of MVPA achieved per day. Special attention should be aimed at increasing awareness of healthy nutrition and promoting a variety of PA, especially among girls and children with excess weight.

BACKGROUND: Low-income and middle-income countries (LMICs) face a double burden of malnutrition (DBM), whereby overnutrition and undernutrition coexist within the same individual, household, or population. This analysis investigates global inequalities in household-level DBM, expressed as a stunted child with an overweight mother, and its association with economic, social, and political globalisation across country income and household wealth. METHODS: We pooled anthropometric and demographic data for 1 132 069 children (aged

Rapid urbanization pressure and poverty have created a push for affordable housing within the global south. The design of affordable housing can have consequences on the thermal (dis)comfort and behaviour of the occupants, hence requiring an occupant-centric approach to ensure sustainability. This paper investigates occupant behaviour within the urban poor households of Mumbai, India and its impact on their thermal comfort and energy use. This study is a first-of-its-kind attempt to explore the socio-demographic characteristics and energy-related behaviour of low-income occupants within Indian context. Three occupant archetypes, Indifferent Consumers; Considerate Savers; and Conscious Conventionals, were identified from the behavioural and psychographic characteristics gathered through a transverse field survey. A two-step clustering approach was adopted for occupant segmentation that highlighted considerable diversity in occupants’ adaptation measures, energy knowledge, energy habits, and their pro-environmental behaviour within similar socio-economic group. Building energy simulation of the representative archetype behaviour estimated up to 37% variations for air-conditioned and up to 8% variation for fan-assisted naturally ventilated housing units during peak summer months. The results from this study establish the significance of occupant factors in shaping energy demand and thermal comfort within low-income housing and pave way for developing occupant-centric building design strategies to serve this marginalized population. The developed low-income occupant archetypes would be useful for architects and energy modelers to generate realistic energy use profiles and improve building performance simulation results.

Previous research shows that low-income and first-generation college students are less likely to obtain the benefits associated with attending graduate school. No-loan programs, which typically administer financial aid through institutional grants, are designed to improve access and success among students from low-income backgrounds, but we know very little about the influence of no-loan programs after students enroll and eventually graduate from college. This study examines the impact of no-loan program participation on graduate school enrollment by leveraging a novel institutional dataset and applying regression discontinuity, difference-in-differences, and propensity score weighting approaches. Results indicate that no-loan program participation has a positive and relatively consistent impact on graduate school enrollment among low-income and first-generation students.

Eligibility and benefits for anti-poverty income transfers in the U.S. are based on both the means and the household characteristics of applicants, such as their filing status, living arrangement, and marital status. In this paper we develop a dynamic structural model to study the effects of the U.S. tax-transfer system on the decisions of non-college-educated workers with children. In our model workers face uninsurable idiosyncratic risks and make decisions on savings, labor supply, living arrangement, and marital status. We find that the U.S. anti-poverty policy distorts the cohabitation/marriage decision of single mothers, providing incentives to cohabit. We also find quantitatively important effects on savings, and on the labor supply of husbands and wives. Namely, the model yields a U-shaped relationship between the earnings of one spouse and the labor supply of the other spouse, a result that we also find in the data. We show that these U-shaped relationships stem in part from the current design of anti-poverty income programs, and that the introduction of an EITC deduction on the earnings of secondary earners—as proposed in the 21st Century Worker Tax Cut Act—would increase the employment rate of the spouses of workers earning between $15K and $35K, especially of female spouses.

Menstrual Hygiene Management (MHM) is typically a constant reality for post menarche and premenopausal females globally. However, unlike other natural routine physiological experiences, a healthy monthly MHM comes with considerable financial implications. Hence, this study examines the financial ability of girls and women in a Nigerian low-income community to access materials needed for MHM monthly. The possible implication of the COVID-19 pandemic was also considered. Semi-structured questionnaires were administered to 130 respondents selected via systematic-random sampling. Data were analyzed using SPSS version 20. The respondents’ age ranged between 14 to 40 years, while 82.3% worked informal jobs. Half of the respondents reported they were unable to purchase sanitary pads and other items required for monthly MHM. Over 65% of the respondents revealed they suffered anxiety thinking about the financial burden associated with monthly MHM, while about one-third of the respondents were more financially capable before the pandemic. Common alternatives to sanitary pads used were tissue paper, cloth napkins, old sanitary towels, and newspapers. Moreover, 64% of the respondents reported had at least a form of vaginal/urinary tract infection in the past 3 months. The results clearly show that period poverty remains a barrier to achieving gender equality. The fact that 1 out of every 2 females in the study area reportedly suffered period poverty shows the dire need for socio-economic interventions. Local and State Governments must consider subsidizing products required for MHM to improve and maintain the health of girls and women in low-income communities.

Informal financial support is a vital yet under-examined source of welfare for people on low incomes. This thesis explores why and how people draw on networks of family, friends and neighbours for financial support to cover their basic living costs and considers the significant practical and emotional implications the practice has for individuals, their relationships and wider support networks. It takes as its starting point Robert Pinker’s (1971, 1979) view of social policy as a discipline that should take into account how ordinary people go about enhancing their own welfare and the welfare of their family members and friends in their everyday lives. The findings are based on unstructured interviews with fifty working-age social housing tenants living in the South West of England centred around a support network mapping exercise. The research identifies informal financial support as a distinctive form of support among the broad range of informal help and care people engage in on a daily basis. It highlights the significant work involved in providing and navigating informal financial support within a context of poverty, as well as the often challenging clash participants experienced between societal norms of independence and support, and the reality of their interdependent lives. For many participants, informal financial support was “the ultimate safety net”, but the research finds that the practice exposed people and their networks to multiple negative impacts and associated risks, including relationship breakdown, isolation and financial insecurity. The study concludes by arguing for a social policy based on an ethic of care that recognises and supports people's interdependence across households, while also working to prevent and mitigate the negative effects of informal financial support.

Although international guidelines exist for the prevention of surgical site infections, their implementation in diverse clinical contexts, especially in low and middle-income countries, is challenging due to the lack of available resources and organizational structure of facilities. The goal of this project was to develop a series of video training aids to highlight best practices in surgical infection prevention in hospitals with limited resources and to provide practical solutions to common challenges faced in these settings. Using the validated Clean Cut education framework for infection prevention developed by Lifebox, a charity devoted to improving surgical and anesthetic safety, we partnered with clinicians in one Ethiopian hospital to create six educational videos giving practical guidelines for infection prevention under resource variable conditions. These include: 1) proper use of the WHO Surgical Safety Checklist, 2) hand and skin antisepsis, 3) confirming instrument sterility, 4) maintaining the sterile field, 5) antibiotic prophylaxis, and 6) gauze counting. Gaps in available online educational materials were identified in each of the six areas. Videos were created providing setting-specific education and addressing gaps in existing materials for each of the infection prevention topics. These videos are now integrated into infection prevention curricula through Lifebox in Ethiopia and ongoing data collection to evaluate acceptability and efficacy is ongoing. Surgical education videos on infection prevention topics addressing location-specific resources and workarounds can be useful to hospitals operating in resource-limited settings for training staff and supporting quality and safety efforts in surgery.

Many low-income households in rich countries have very little wealth, but the role of intergenerational wealth transmission in underpinning this deficit is not known. This article seeks to fill that gap by investigating patterns of past wealth transfer receipt for low-income versus other households in seven rich countries and assessing the contribution that these transfers, or their absence, make to current wealth levels. We find that households on low incomes are relatively disadvantaged in terms of intergenerational transfers received in the past, both in terms of the likelihood of having received any and the amounts received by those who do benefit from such transfers. The role that this disadvantage plays in the linkage between current low-income and low wealth is assessed and evidence presented that it is significant. Simulation of a universal wealth transfer scheme or ‘capital endowment’ on reaching adulthood for two countries shows that such a policy could lead to a marked decline in the proportion of low-income adults with negative or no wealth. This and alternative or complementary policy responses to these wealth deficits merit the most serious attention.

This study examined characteristics and planned expenses of U.S. adults who received the economic impact payment (EIP) during the COVID-19 pandemic.Using a nationally representative sample of 6,607 middle- and low-income U.S. adults, the authors examined the proportion and correlates of EIP receipt among eligible adults and the associations among planned EIP-financed expenses, challenges with paying expenses, and clinical characteristics.Of the sample, 78.8% reported that they received the EIP, and 82.3% of EIP recipients reported that it had a positive impact on their life. Being a veteran (odds ratio [OR]=2.59), being married (OR=1.82), having a history of schizophrenia spectrum disorder (OR=1.74) or posttraumatic stress disorder (OR=1.51), and screening negative for recent suicidal ideation (OR=0.49) were associated with EIP receipt. Planned expenses with the EIP were savings, paying debt, and rent and accounted for 63.4% of the total amount. Screening positive for mental health or drug use problems was positively associated with greater planned expenses for substances and gambling. EIP receipt also was associated with fewer problems paying daily expenses, but participants who screened positive for mental health or alcohol use problems were more likely to report problems paying past-month daily expenses.Unconditional cash transfers such as the EIP may be important for sustaining the living situation of middle- and low-income populations. The management of funds is important to consider, especially among adults experiencing mental health and substance abuse problems, and such cash transfers may represent opportunities for financial literacy and money management interventions.

This article summarizes findings from the literature on the emotional and birth outcomes of women with low income receiving different types of prenatal care. This literature review included studies published between 2015 and 2020. The results indicated that women with low income have challenging experiences in traditional models of prenatal care. Evidence of improved birth outcomes with nontraditional prenatal care is mixed, but qualitative findings indicate that it is associated with better emotional outcomes for women with low income when compared to traditional prenatal care. Future research should investigate ways to improve the negative interpersonal and structural dimensions that can characterize prenatal care for women with low income.

Socioeconomic status is one of the personal factors contributing to positive well-being among disadvantaged groups. However, many studies in different countries have found that low socioeconomic status leads to negative well-being in work and non-work domains. Unfortunately, evidence on this issue from the Malaysian context is scarce. Therefore, this paper aims to investigate the influence of socioeconomic status on life and job satisfaction among low-income employees working in the public sector. A quantitative research design was employed, using a self-report questionnaire as the tool to gather the data. A total of 265 respondents from eight Johor local authorities in Malaysia were obtained using the convenience sampling technique. SPSS version 26.0 and SmartPLS version 3.0 structural equation modeling were used for the descriptive and inferential analysis respectively. The findings indicate that socioeconomic status has a positive influence on life and job satisfaction. Therefore, the study contributes insights into the socioeconomic status factors which determine well-being, specifically life satisfaction and job satisfaction, with respect to low-income employees working in the Malaysian public sector.

PurposeLack of access to supermarkets and fresh produce continues to be a problem for low income consumers in many countries. The purpose of this research was to identify the shopping preferences and needs of such consumers in the Eastern U.S. Additionally, the research sought to determine the interest and preferences of low income consumers in a mobile grocery intervention which would provide neighborhoods with a consistent, convenient shopping experience.Design/methodology/approachA mixed methods approach included conducting focus groups in low-income neighborhoods in Philadelphia, Pennsylvania, U.S.A. and a quantitative survey (n = 202) administered via Survey Monkey to low-income consumers. Thematic analysis was conducted on focus group data and surveys were administered and analyzed to assess applicability of themes identified to consumers over a larger geographic area.FindingsResults indicated that consumers in food desert neighborhoods reported an interest in purchasing a wide range of food staples, household goods, and personal items from any shopping intervention. Participants indicated a need for a more convenient overall shopping experience for a range of foods and goods in addition to fresh food choices. Findings indicate that mobile interventions to increase food access may benefit from expanding products available through the intervention beyond fresh produce and perishable goods.Originality/valueThis research explored purchasing preferences with low income consumers living in food deserts. It identifies products and goods they would prefer to see in an intervention to increase food access and is unique in that it explores the wants and preferences of consumers living in food deserts.

BACKGROUND. The objective of this study is to understand the effect of Medicaid expansion under the Affordable Care Act (ACA) on patterns of surgical care among low-income breast cancer patients. Emerging literature suggests cancer patients in Medicaid expansion states are presenting with earlier stages of disease. However, less is known regarding the implications of Medicaid expansion on patterns of surgical care in low-income women. PATIENTS AND METHODS. We compared nonmetastatic 30–64-year-old uninsured or Medicaid-insured Ohio breast cancer patients diagnosed 4 years before and 4 years after the state’s 2014 Medicaid expansion (study group); the control group was the privately insured. Time-to-surgery (TTS) was defined as days from diagnosis to surgery. Demographic and treatment variables before and after expansion were examined in multivariate analysis. RESULTS. There was a 10.4% point increase in breast conservation therapy (BCT) in the study group (pre-ACA 26.3%, post-ACA 36.7%; p < 0.01) compared with a 5.8% point increase in the control group (pre-ACA 36.0%, post-ACA 41.8%; p < 0.01). Disparities in reconstruction narrowed between the study (pre-ACA 21.4%, post-ACA 34.5%; p < 0.01) and the control (37.0% pre-ACA, 44.1% post-ACA group p < 0.01) groups. There was no statistically significant change in mean TTS in the study group (pre-ACA 42.1 days, post-ACA 43.1 days p = 0.18) but there was an increase in TTS in the control group (pre-ACA 35.0 days, post ACA 37.0 days; p < 0.01). CONCLUSIONS. Medicaid expansion appears to have narrowed disparities in the utilization of BCT and reconstruction in low-income women. However, there was no improvement in surgical delay.

Community-supported agriculture (CSA) is an alternative food marketing model in which community members subscribe to receive regular shares of a farm's harvest. Although CSA has the potential to improve access to fresh produce, certain features of CSA membership may prohibit low-income families from participating. A ‘cost-offset’ CSA (CO-CSA) model provides low-income families with purchasing support with the goal of making CSA more affordable. As a first step toward understanding the potential of CO-CSA to improve access to healthy foods among low-income households, we interviewed 24 CSA farmers and 20 full-pay CSA members about their experiences and perceptions of the cost-offset model and specific mechanisms for offsetting the cost of CSA. Audio recordings were transcribed verbatim and coded using a thematic approach. Ensuring that healthy food was accessible to everyone, regardless of income level, was a major theme expressed by both farmers and members. In general, CSA farmers and CSA members favored member donations over other mechanisms for funding the CO-CSA. The potential time burden that could affect CSA farmers when administering a cost-offset was a commonly-mentioned barrier. Future research should investigate various CO-CSA operational models in order to determine which models are most economically viable and sustainable.

The Coronavirus disease 2019 (COVID-19) pandemic has helped expose and exacerbate individuals’ and households’ financial vulnerability worldwide. Meanwhile, behavioral elements affecting low-income populations’ ability to save and become more financially resilient have yet to receive sufficient academic attention. This exploratory study aims at the beginning to help elucidate the determinants of low-income individuals’ real-life savings behavior by utilizing laboratory performance measures (to characterize participants’ risk preferences by using the Balloon Analog Risk Task – BART, in study 1), as well as self-report surveys (to characterize participants’ personality traits, in study 2). Combining results from both studies, latent personality traits (i.e., attitude towards risk, perseverance, distractibility, and state anxiety) are found to affect the risk preferences of low-income individuals (captured using a novel BART performance measure indicative of an individual’s strategic risk preference adaptation), which in turn impact their ability to successfully complete matched savings programs and, thus, their ability to save and enhance their financial resilience.

Purpose We compared the Risk subtest of the Diagnostic Evaluation of Language Variation–Screening Test (DELV–Screening Test Risk) with two other screeners when administered to low-income prekindergartners (pre-K) who spoke African American English (AAE) in the urban South. Method Participants were 73 children (six with a communication disorder and 67 without) enrolled in Head Start or a publicly funded pre-K in an urban Southern city. All children completed the DELV–Screening Test Risk, the Fluharty Preschool Speech and Language Screening Test–Second Edition (FLUHARTY-2), and the Washington and Craig Language Screener (WCLS). Test order was counterbalanced across participants. Results DELV–Screening Test Risk error scores were higher than those reported for its standardization sample, and scores on the other screeners were lower than their respective standardization/testing samples. The 52% fail rate of the DELV–Screening Test Risk did not differ significantly from the 48% rate of the WCLS. Fail rates of the FLUHARTY-2 ranged from 34% to 75%, depending on the quotient considered and whether scoring was modified for dialect. Although items and subtests assumed to measure similar constructs were correlated to each other, the three screeners led to inconsistent pass/fail outcomes for 44% of the children. Conclusions Like other screeners, the DELV–Screening Test Risk subtest may lead to high fail rates for low-income pre-K children who speak AAE in the urban South. Inconsistent outcomes across screeners underscore the critical need for more study and development of screeners within the field.

Summary Background Childhood immunisation is one of the most cost-effective health interventions. However, despite its known value, global access to vaccines remains far from complete. Although supply-side constraints lead to inadequate vaccine coverage in many health systems, there is no comprehensive analysis of the funding for immunisation. We aimed to fill this gap by generating estimates of funding for immunisation disaggregated by the source of funding and the type of activities in order to highlight the funding landscape for immunisation and inform policy making. Methods For this financial modelling study, we estimated annual spending on immunisations for 135 low-income and middle-income countries (as determined by the World Bank) from 2000 to 2017, with a focus on government, donor, and out-of-pocket spending, and disaggregated spending for vaccines and delivery costs, and routine schedules and supplementary campaigns. To generate these estimates, we extracted data from National Health Accounts, the WHO–UNICEF Joint Reporting Forms, comprehensive multi-year plans, databases from Gavi, the Vaccine Alliance, and the Institute for Health Metrics and Evaluation's 2019 development assistance for health database. We estimated total spending on immunisation by aggregating the government, donor, prepaid private, and household spending estimates. Findings Between 2000 and 2017, funding for immunisation totalled US$112·4 billion (95% uncertainty interval 108·5–118·5). Aggregated across all low-income and middle-income countries, government spending consistently remained the largest source of funding, providing between 60·0% (57·7–61·9) and 79·3% (73·8–81·4) of total immunisation spending each year (corresponding to between $2·5 billion [2·3–2·8] and $6·4 billion [6·0–7·0] each year). Across income groups, immunisation spending per surviving infant was similar in low-income and lower-middle-income countries and territories, with average spending of $40 (38–42) in low-income countries and $42 (39–46) in lower-middle-income countries, in 2017. In low-income countries and territories, development assistance made up the largest share of total immunisation spending (69·4% [64·6–72·0]; $630·2 million) in 2017. Across the 135 countries, we observed higher vaccine coverage and increased government spending on immunisation over time, although in some countries, predominantly in Latin America and the Caribbean and in sub-Saharan Africa, vaccine coverage decreased over time, while spending increased. Interpretation These estimates highlight the progress over the past two decades in increasing spending on immunisation. However, many challenges still remain and will require dedication and commitment to ensure that the progress made in the previous decade is sustained and advanced in the next decade for the Immunization Agenda 2030. Funding Bill & Melinda Gates Foundation.

This study describes the public policies of the DKI Jakarta Provincial Government on housing assistance for law-Income Communities. DKI Jakarta as the center of Government and economy attract people to come to the city. The scarcity and the high price of land in DKI Jakarta factors into the number of Low-Income Communities in the city who struggle to own housing/ property. The study aims to analyze the policy formulation of DKI Jakarta Provincial Government on the assistance in providing decent housing needs the policy formulation of the DKI Jakarta Provincial Government for assistance in providing decent housing needs for Low-Income Communities. The research uses descriptive qualitative methods by using primary and secondary data. Data and information are obtained through interviews with the actors involved in the process of policy formulation, surveys and taking photographs related to the Zero Rupiah Down Payment House and document that can support research. From the analysis, it is found in the formulation of the Zero Rupiah Down Payment House Program policy that there should be stronger legal basis and a set of wage margin for Low-Income Communities in DKI Jakarta as well as supervision in the implementation of the program so that it is targeted to the Low- Income community by paying attention to aspects of alignments to the community need.

Intergenerational poverty and scarce financial resources can create and sustain detrimental behaviors and outcomes among adolescents. Efforts to increase financial literacy and job-related skills, however, can offer youth from low-income households knowledge, skills, and opportunities otherwise unavailable to them. Targeted interventions that combine financial literacy and job-readiness components may help adolescents disrupt the cycle of intergenerational poverty by increasing economic awareness, adaptive financial behaviors, and work-related skills. Drawing on career construction and asset theory, the present study examined changes in financial knowledge and labor skills among youth from low-income households (N = 111) over the course of their participation in the Road to Success curriculum as well as how changes varied across demographic characteristics of participants. Data analysis included descriptive statistics, t-test analyses, and MANCOVA. Results indicated several improvements from Wave 1 to Wave 2 as students developed job-readiness and financial literacy knowledge. Potential educational and policy implications are discussed.

PURPOSE Children in low-income, urban areas are at a greater risk of poor physical activity (PA) and academic outcomes. The purpose of this study was to examine feasibility, acceptability, and engagement of a pilot implementation of the Active Science (AS) exer-learning program in 3rd grade physical education (PE) classes to inform potential upscaling after efficacy evaluation. METHODS AS was implemented within PE at five public schools serving low-income, urban neighborhoods, using a phased implementation approach. A mixed methods approach was utilized; feasibility and engagement were measured using quantitative dose and fidelity measures, students were surveyed regarding acceptability, and PE teachers were interviewed pre/post-intervention regarding perceptions of the program. RESULTS N = 638 students in k = 25 PE classes across five schools averaged 8.8 weeks of AS implementation with nearly universal inclusivity. Students averaged 1468 steps/session; an average of 15% of available PE class time was spent in MVPA. Semi-structured interviews revealed high staff perceptions of feasibility, as well as specific improvements that should be implemented before upscaling. CONCLUSIONS Process and PA measures indicate high feasibility, with excellent engagement across all five schools. Together with high acceptability reported by students and staff, these results show that AS can feasibly integrate into PE classes low-income, urban schools to improve student engagement in both PA and science learning.

Low-income government provided housing has been continually transformed by its beneficiaries, especially women. The transformations are a major sign that there is discontentment about the houses since low-income households are excluded from the design process of these houses. By transforming the houses, the low-income households are trying to fit their houses or environments to their ways of living. This paper intends to review the housing transformations at the Masese Women’s Self-Help Housing Project at Masese, Jinja, in Uganda to understand how women practice space. Studying the spatial alterations can help guide architects towards finding inclusive housing design approaches that can benefit the low-income households and prevent governments and donors from spending finances on futile housing prototypes that get eventually abandoned. The paper adopts a qualitative methodology comprising of precedent studies at Masese, and a literature review to analyse the various housing transformations in an attempt to address the problem of inadequate housing for low-income households.

Purpose The conceptualization of the Base of Pyramid (BOP) proposes that low-income markets can lead to profitable opportunities for businesses. The purpose of this study is to identify key success factors of a BOP business strategy based on a case study of the discount retailer, Dollar General, in the USA. Design/methodology/approach The research design used in this research is an in-depth case study of Dollar General in the USA. Qualitative methods are applied in both the primary and secondary data collection and during the follow-on data analysis of Dollar General. Findings Dollar General’s strategic profile is achieved through the combination of the following four actions which are tailored to compete effectively at the BOP in the USA: creating the neighborhood discounter, raising aspirational appeal, reducing service and eliminating internationalization. Research limitations/implications The case is specific to Dollar General in a US cultural context. Practical implications The case of Dollar General demonstrates how a discounter retailer should not only follow a low-cost strategy to compete at the BOP. Its ability to craft a distinctive strategy is coherent with meeting the logistical, rational and emotional needs of the low-income consumer in the USA. Social implications Many businesses have neglected rural areas of the USA as being unprofitable. The ability for businesses such as Dollar General to serve the BOP segment can foster the socio-economic well-being of communities. Originality/value The overwhelming body of the BOP literature is based on emerging markets. To the best of the authors’ knowledge, this is one of the few studies to investigate BOP business strategy in the USA.

Objectives: This study sought to: 1) under­stand how the perceived food environment (availability, accessibility, and affordability) is associated with cardiometabolic health outcomes in predominately low-income Black residents in urban neighborhoods with limited healthy food access; and 2) examine the association of shopping at specific store types with cardiometabolic health outcomes. Methods: We report on cross-sectional data from 459 individuals participating in the Pittsburgh, PA Hill/Homewood Research on Neighborhoods and Health (PHRESH) study. Mean participant age was 60.7 (SD=13.9); 81.7% were female. We used logistic regression to examine associations between three factors (perceived fruit and vegetable availability, quality, and price; primary food shopping store characteristics; and frequency of shopping at stores with low or high access to healthy foods) and cardiometabolic and self-rated health. Results: Adjusting for sociodemographic characteristics, participants with higher perceived fruit and vegetable accessibility (AOR:.47, 95%CI: .28-.79, P=.004) and affordability (AOR:.59, 95%CI: .36-.96, P=.034) had lower odds of high blood pres­sure. Shopping often (vs rarely) at stores with low access to healthy foods was associated with higher odds of high total cholesterol (AOR:3.52, 95%CI: 1.09-11.40, P=.035). Finally, primary food shopping at a discount grocery (vs full-service supermarket) was as­sociated with lower odds of overweight/obe­sity (AOR:.51, 95%CI: .26-.99, P=.049). Conclusions: These results suggest that both perceived accessibility and affordability of healthy foods are associated with reduced cardiometabolic risk factors in this urban, low-income predominantly Black population. Additionally, discount grocery stores may be particularly valuable by providing access and affordability of healthy foods in this population. Ethn Dis. 2021;31(4):537-546; doi:10.18865/ed.31.4.537

Smartphones play an increasingly large role in the professional lives of teachers in low-income contexts, creating an urgent need to better understand the role of technology-related stress (technostress) in teachers' smartphone use for work. We contribute a mixed methods study analyzing the impact of smartphone use on teachers' work lives in low-income Indian schools. Findings from 70 interviews and 1,361 survey responses suggest that although smartphones aid teaching and administrative functions, smartphone use also significantly predicts burnout among teachers, with technostress providing a major explanation for this relationship. We reveal how teachers' work is constantly surveilled and monitored via technology and how teachers' personal smartphones were controlled and repurposed through socio-technical structures by the higher management to serve management's goals, substantially increasing the work teachers were required to perform outside of work hours. Our work extends technostress research to HCI4D contexts and highlights the need to develop better support structures for teachers and rethink how smartphones are used in their work.

Conduct problems are associated with numerous negative long-term psychosocial sequelae and are among the most frequent referrals for children's mental health services. Youth residing in low-income, urban communities are at increased risk for conduct problems, but not all youth in these environments develop conduct problems, suggesting heterogeneity in risk and resilience processes and developmental pathways. The present study used a developmental psychopathology- and Research Domain Criteria (RDoC)-informed approach for conceptualizing risk and resilience for conduct problems among children from low-income, urban neighborhoods. Participants were 104 children (M = 9.93 ± 1.22 years; 50% male; 96% African American, 4% Latinx). We assessed four constructs reflecting cognitive and neurobiological processes associated with conduct problems using multiple levels of analysis and informants: autonomic nervous system reactivity, limbic system/orbitofrontal cortical functioning, dorsolateral prefrontal cortical functioning, and conduct problems. Latent profile analysis identified four profiles: typically developing (TD, n = 34); teacher-reported conduct problems (TCP, n = 14); emotion processing (EP, n = 27); and emotion expression recognition (EER, n = 29). External validation analyses demonstrated that profiles differed on various indices of conduct problems in expected ways. The EP profile exhibited lower levels of emotional lability and callous–unemotional behaviors, and higher levels of prosocial behavior. The TD profile demonstrated elevated emotional lability. Implications for etiological and intervention models are presented.

Poverty has a negative impact on parenting patterns that can reduce the subjective well-being) of childhood. This study aims to reveal the parenting skill of low-income families to improve the subjective well-being of childhood. This type of descriptive research with 119 parents in Pekanbaru comes from low-income families who live in Pekanbaru. Results of the study revealed parenting skills respondents (41%) require information about good parenting to develop the potential of children for the child's positive development, the child's goodness, and independence. While 22% want their children to be successful and have a better future, they do not use the correct method, and 18% of respondents want their children to be more normative, more obedient, have good habits, and be accepted by society. About 14% of respondents want their children to achieve better academic performance, and 5% want their children to be happy and happy later. The conclusion is Parenting skills of low-income families in improving subjective well-being of early childhood is not optimal.

Web-based relationship programs are effective in improving low-income couples' relationship functioning. However, little is known about: (a) whether parenting couples presenting for relationship help also have difficulties in coparenting and parenting, (b) whether relationship-focused programs can improve these two domains, and (c) whether program effects differ across baseline levels of those domains. We examined these questions in a parenting subsample (Nindividuals = 934) and a coparenting subsample (Ndyads = 342) of low-income couples participating in a randomized controlled trial of two web-based relationship education programs-the OurRelationship (OR) program and the ePREP program. Although the majority of participants were relationally distressed at baseline, most coparents (83%) reported parenting well together. Parents "often" engaged in nurturing behaviors and "hardly ever" or "sometimes" felt overwhelmed by their parenting responsibilities. Among parents who had engaged in the harsh verbal discipline (59%) and physical discipline (28%) in the past month, the average frequency was 4.08 and 5.50 times per month, respectively. Moreover, compared to waitlist control parents, parents in OR but not ePREP reported significantly greater improvements in parental nurturance and harsh verbal discipline during the program. There was no evidence of program effects on coparenting, physical discipline, or parenting stress for OR or ePREP, nor was there any evidence of baseline functioning moderating program effects. Findings suggested that most low-income parents seeking relationship help did not have severe problems in coparenting or parenting and that effective relationship programs without a focus on coparenting and/or parenting had somewhat limited effects on these domains. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

STUDY OBJECTIVES: Black individuals and individuals of low socioeconomic status are at increased risk for obstructive sleep apnea (OSA). The Berlin Questionnaire is one of the most widely used screening tools for OSA; however, there is limited research on its diagnostic accuracy in low-income Black populations. METHODS: This study analyzed data from an ongoing study taking place among a cohort from 2 predominantly Black neighborhoods in Pittsburgh, Pennsylvania (96.3% Black, 79.6% female). The sample included 269 individuals without a prior diagnosis of OSA who completed the Berlin Questionnaire and also participated in a home sleep apnea test. An apnea-hypopnea index ≥ 15 events/h was used to identify individuals with moderate or severe OSA. RESULTS: 19.3% of individuals met criteria for moderate to severe OSA based on home sleep apnea test, while 31.2% of participants screened as high risk for OSA based on the overall Berlin index. Using apnea-hypopnea index ≥ 15 events/h as the reference standard, the Berlin Questionnaire had a sensitivity of 46.2%, specificity of 72.4%, positive predictive value of 28.6%, and negative predictive value of 84.9% among this sample. Analyses stratified by sex suggested that the Berlin Questionnaire had better diagnostic validity in women than men. CONCLUSIONS: The Berlin Questionnaire has lower sensitivity and positive predictive value in our sample than those observed in general population samples. The measure performed better among women, though a higher proportion of men fell into the moderate or severe OSA range based on the home sleep apnea test. Given the significant downstream consequences of OSA, utilizing screening tools that better detect OSA in Black communities is key. CITATION: Holliday SB, Haas A, Dong L, et al. Examining the diagnostic validity of the Berlin Questionnaire in a low-income Black American sample. J Clin Sleep Med. 2021;17(10):1987–1994.

This study was carried out to determine the composition of solid wastes generated by some households in low-income areas of Jos Plateau State. Point source daily collection of household wastes from selected homes that were initially identified and categorized as low-income households were carried out for one week. The collected waste samples were weighed and sorted into food, ash/unburnt wood, plastic film/bags, fines, miscellaneous combustible, papers/cards, textiles, waste from electrical and electronic equipment (WEEE), glass, metals, dense plastic, garden waste and others. The components of these solid wastes were further classified into biodegradable (65.2%), recyclable (13.2%) and residual (21.6%). Biodegradable materials in the waste stream per household ranged from 1.7 kg to 18.3 kg per week. The recyclable materials produced by households varied from 0.4 kg to 2.9 kg and residual waste ranged from 0.6 kg to 6.0 kg per week. Urbanization and population growth are solely responsible for high increasing rate of solid wastes. The average household size found in the study area is 6.3 compared to an average household size of 4.6 Nigeria Demographic and Health Survey and 5.5 for Jos – Bukuru metropolis.

Background: One in eight people with heart disease has poor medication adherence that, in part, is related to copayment costs. This study tested whether eliminating copayments for high-value medications among low-income older adults at high cardiovascular risk would improve clinical outcomes. Methods: This randomized 2×2 factorial trial studied 2 distinct interventions in Alberta, Canada: eliminating copayments for high-value preventive medications and a self-management education and support program (reported separately). The findings for the first intervention, which waived the usual 30% copayment on 15 medication classes commonly used to reduce cardiovascular events, compared with usual copayment, is reported here. The primary outcome was the composite of death, myocardial infarction, stroke, coronary revascularization, and cardiovascular-related hospitalizations over a 3-year follow-up. Rates of the primary outcome and its components were compared using negative binomial regression. Secondary outcomes included quality of life (Euroqol 5-dimension index score), medication adherence, and overall health care costs. Results: A total of 4761 individuals were randomized and followed for a median of 36 months. There was no evidence of statistical interaction ( P =0.99) or of a synergistic effect between the 2 interventions in the factorial trial with respect to the primary outcome, which allowed us to evaluate the effect of each intervention separately. The rate of the primary outcome was not reduced by copayment elimination, (521 versus 533 events, incidence rate ratio 0.84 [95% CI, 0.66–1.07], P =0.162). The incidence rate ratio for nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death (0.97 [95% CI, 0.67–1.39]), death (0.94 [95% CI, 0.80 to 1.11]), and cardiovascular-related hospitalizations (0.78 [95% CI, 0.57 to 1.06]) did not differ between groups. No significant between-group changes in quality of life over time were observed (mean difference, 0.012 [95% CI, –0.006 to 0.030], P =0.19). The proportion of participants who were adherent to statins was 0.72 versus 0.69 for the copayment elimination versus usual copayment groups, respectively (mean difference, 0.03 [95% CI, 0.006–0.06], P =0.016). Overall adjusted health care costs did not differ ($3575 [95% CI, –605 to 7168], P =0.098). Conclusions: In low-income adults at high cardiovascular risk, eliminating copayments (average, $35/mo) did not improve clinical outcomes or reduce health care costs, despite a modest improvement in adherence to medications. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02579655.

In Chile, low-income women who are mothers are confronted daily with a normative ideal that exacerbates them as caregivers, together with public demands and social policies that value their hyper-rationality and hyper-austerity in the management of their families. This emphasis on their reproductive roles obliterates their emerging sense of intimacy and significant relations. Based on three case studies, in this article, we reflect on urban low-income women’s sense of and desire for intimacy that exceeds but does not exclude their maternal self. We present our findings based on three heuristic aspects of intimacy: rooted strategies for a renovated desire for intimacy; the desire to enjoy; and life outside the house and the desire for meaningful relations. We observe that these women’s efforts in their search for intimacy require them to orchestrate various strategies involving time and space management, money and relationships while resisting the normative pressures that place them mainly as caregivers.

We investigate whether the Affordable Care Act's Medicaid expansion, implemented in 2014, improved the mental health of young children whose parents are in the policy's target population. We study children ages 2 to 3 in families with incomes less than 138% of the federal poverty level.We use restricted National Health Interview Survey data covering the United States from 2010 to 2018 to conduct an event study-a flexible version of difference-in-differences-of the Medicaid expansion's effects on Mental Health Indicator values for young children. We estimate effects using ordered logit regression.Children's mental health was statistically significantly better in Medicaid expansion states, compared with non-expansion states, in 3 of 4 post-expansion years. There were no differences between expansion and non-expansion states in the pre-expansion period, lending support to the causal interpretation that the expansion improved children's mental health.While Medicaid expansion targets low-income adults, our evidence indicates it improves low-income children's mental health. The expansion is a two-generation investment in prevention. It helps lay a foundation for strong mental health in children's early years and beyond.

Objective:In 2016, a Whole Foods Market© opened in the Englewood community of Chicago, IL – a predominately low-income African American community. This study aimed to examine changes to food and beverage availability and marketing in Englewood’s existing food stores after the opening of this supermarket.Design:Quasi-experimental study.Setting:Two low-income African American communities in Chicago, IL.Participants:Fieldworkers audited all small grocery and limited service stores (e.g. convenience stores, liquor stores and dollar/discount stores) located within one-square mile of the new supermarket and a one-square mile area of a demographically comparable community that also lacked a supermarket. Stores were audited before (2016) and after (2017 and 2018) the supermarket opened.Results:Of the 78 stores audited at baseline, 71·8 % were limited service stores and 85·9 % accepted Supplemental Nutrition Assistance Program (SNAP) benefits. Overall, the availability of healthy food and beverage options in nearby small stores was low at baseline and both follow-up periods. Difference-in-difference regression models revealed a significant increase in: (1) the percentage of stores in the intervention community (i.e. Englewood) offering regular cheese and promoting salty snacks at check-out from 2016 to 2017; and (2) the percentage of stores in the comparison community with interior store promotions for other sweetened beverages from 2016 to 2018.Conclusions:Minimal changes in food and beverage availability and marketing occurred 1 and 2 years after the opening of a new supermarket. However, the wide range of staple food items offered by the supermarket expanded healthy food retail in Chicago’s Englewood community.