Face Additional Challenges Research Articles

Shared decision-making in Argentina in 2022

Argentina is an upper-middle income country located in South America with an estimated population of 46.2 million inhabitants. There is no unified research agenda or government initiatives encouraging the implementation and research of Shared Decision-Making (SDM). Our working group at the Family and Community Medicine Division of the Hospital Italiano de Buenos Aires is the leading centre for research and implementation of SDM in the country. The implementation strategy is articulated in undergraduate, postgraduate and continuous medical education. However, it is challenged by the professionals' perception that they are already doing it or lack time during consultations. We have advanced research to understand how to adapt tools to measure and implement SDM in our settings. Still, we face additional challenges related to funding, accessing diverse populations beyond the reach of our institution and incorporating patients in the co-production of research. While most of our efforts arise from the voluntary work of our healthcare professionals, we believe this is a strength since SDM research and implementation are then directly linked to patient care.

Etiology and Management of Dyslipidemia in Patients With Cancer.

Patients with cancer are now living longer than ever before due to the growth and expansion of highly effective antineoplastic therapies. Many of these patients face additional health challenges, of which cardiovascular disease (CVD) is the leading contributor to morbidity and mortality. CVD and cancer share common biological mechanisms and risk factors, including lipid abnormalities. A better understanding of the relationship between lipid metabolism and cancer can reveal strategies for cancer prevention and CVD risk reduction. Several anticancer treatments adversely affect lipid levels, increasing triglycerides and/or LDL-cholesterol. The traditional CVD risk assessment tools do not include cancer-specific parameters and may underestimate the true long-term CVD risk in this patient population. Statins are the mainstay of therapy in both primary and secondary CVD prevention. The role of non-statin therapies, including ezetimibe, PCSK9 inhibitors, bempedoic acid and icosapent ethyl in the management of lipid disorders in patients with cancer remains largely unknown. A contemporary cancer patient needs a personalized comprehensive cardiovascular assessment, management of lipid abnormalities, and prevention of late CVD to achieve optimal overall outcomes.

Perceived Health Care Needs of Amish Populations in Two Newly Established Districts

The Amish population in the United States is growing rapidly, leading to many new Amish communities. This mixed-methods study establishes the demographic characteristics within two newly formed Amish districts in New York State and determines the community's perceived health care needs. The study targeted married individuals within the two districts, utilizing informational meetings, individual meetings, and the creation of a Perceived Health Care Needs Questionnaire. The findings included baseline demographics, barriers to health care access, desired health care provider qualities, and perceptions related to health care costs. Conclusions: The Amish are an underserved population with significant barriers to health care, and newly established districts located in rural geographical areas where Amish communities previously did not exist face additional challenges. Opportunities exist for health care providers to help the newly established Amish districts meet their desired health care needs in a culturally competent manner.

Broadening the scope of social support, coping skills and resilience among caretakers of children with disabilities in Uganda: a sequential explanatory mixed-methods study

BackgroundMost caretakers of children with disabilities (CWDs) have adverse health outcomes. Approximately 31% of the caretakers have clinical depression in the world. In Sub-Saharan Africa, 42% of them face severe psychological distress. Caretakers in Africa face additional cultural challenges that undermine their coping skills, access to social support, and resilience.MethodsThis study used sequential explanatory mixed methods to examine the relationships of social support, coping skills and resilience among caretakers of CWDs in Uganda. A total of 621 caretakers were surveyed, and 43 of them participated in interviews. Hierarchical cluster analysis and binary logistic regression were conducted to determine coping patterns and predict caretakers’ likelihood of using them. Hierarchical linear regression and thematic analyses then explored the relationships and perceptions of coping skills and resilience related to social support. A joint display was used to integrate results and show the convergence and expansion of quantitative and qualitative results.ResultsQuantitative and qualitative findings converged that caretakers who received social support used adaptive coping skills and had higher resilience. Qualitative results expanded the finding that caretakers who received formal social support perceived it as a safer mode of care than informal social support.ConclusionsThe study expanded the scope of social support, coping skills, and resilience. Caretakers perceived formal social support from schools as a safe mode of care that enabled them to use adaptive coping skills and have high resilience. Therefore, enrolling children with disabilities in schools at an early age is beneficial for building the resilience of their caretakers.

Conceptualizing “Vulnerability” in the European Legal Space: Mixed Migration Flows and Human Trafficking as a Test

The article discusses the role of “vulnerability” in the legal and political discourse of today's Europe as a dual-mode dispositive. On the one hand, “vulnerability” allows the legal formalism to incorporate the precarious subjects that the traditional language of “rights” risks to exclude. Compared with the human rights language, “vulnerability” better articulates the relationship between legal categories and rapidly changing social and ecological landscapes. The “vulnerability language” captures intersectionality. On the other hand, however, through examples taken from the EU normative production on irregular and mixed migrations, with a focus on refugee “screening” and reception and on managing identification and referral procedures of persons victims of human trafficking, this article shows that the assignment of an individual to a “vulnerable group” has the effect not only of expanding and intensifying their protection under normative human rights regimes, but also of accentuating some risks already inherent in human rights discourse, namely paternalism and essentialism. Paradoxically, a possible outcome can be fragmentation of rights protection frameworks, and exclusion. Vulnerable migrants may have to face additional challenges stemming from their inability (coupled with objective difficulty) to decodify communications and instructions concerning their status. Divergent ways of conceiving vulnerability, depending on subjective assessments, public policy standards, the legal framework, and the political agenda on welfare, contribute to neutralizing the potentially emancipatory impact of the vulnerability language.

Marginalized and Misunderstood: How Anti-Rohingya Language Policies Fuel Genocide.

Language plays a role in the genocide of the Rohingya people in Myanmar and continues to shape their experiences in displacement, yet their linguistic rights are rarely discussed in relation to their human rights and humanitarian concerns. International human rights standards offer important foundations for conceptualizing the “right to language” and identifying how linguistic rights can be violated both in situ and in displacement. The Rohingya case highlights how language policies are weaponized to oppress unwanted minorities; their outsider status is reinforced by the country’s language education policy and they face additional rights challenges in displacement—including obstacles to effectively accessing humanitarian aid. Moving forward, norms associated with self-determination and language rights offer a conceptual foundation for shifting attitudes and altering negative perceptions of Rohingya identity.

LCRR Compliance Involves More Than Lead Service Lines

LCRR Compliance Involves More Than Lead Service Lines

Business Model Adaptation to the COVID-19 Crisis: Strategic Response of the Spanish Cultural and Creative Firms

Surviving in a humanitarian disaster such as the COVID-19 pandemic is a big challenge for micro, small, and medium-sized enterprises in all industries. Furthermore, cultural and creative firms face additional challenges. Many of those firms have survived the effects of the pandemic by proposing redesigned business models that have brought new added value in response to environmental hostility; they have strategically responded to the crises by adapting their business model. According to the extant literature, in VUCA (volatile, uncertain, complex and ambiguous) environments, dynamic capabilities are developed to detect and seize new opportunities and reconfigure the company’s assets. However, in very hostile environments, such as the COVID-19 crisis, the dynamic capabilities approach fails to explain the firm owners’ strategic decisions. A cross-case comparative analysis of ten micro and small firms in Spain’s cultural and creative industries has been conducted to examine how enterprises adapted to the COVID-19 crisis and the different organizational capabilities they implemented. This work proposes a new framework that postulates that business model adaptation is better understood under the emergency management theory and improvisational capability, instead of only under the dynamic capabilities lens. Organizational proximity in the diffusion of innovations under the open innovation paradigm is also critical to understanding the business model adaptation. From an academic perspective, this article enriches the current understanding of business model asdaptation by micro, small, and medium-sized enterprises in very hostile environments. The new framework intends to offer managers concrete guidelines about systematically adapting their business models in hostile situations.

Sustainable entrepreneurs: what drives them to engage in different crowdfunding types?

PurposeSustainable entrepreneurs face additional challenges in fundraising. Crowdfunding is emerging as a compelling alternative to traditional sources of capital with a growing body of research outlining its characteristics and discussing mainly its antecedents. Yet little is known about the crowdfunding behaviour of sustainable entrepreneurs. The purpose of this paper is to explore sustainable entrepreneurs' crowdfunding landscape namely the relation between motivation and different crowdfunding types.Design/methodology/approachBased on a unique dataset of French sustainable entrepreneurs, this paper adopts a qualitative case study approach by conducting in-depth interviews with the entrepreneurs. This was complemented by secondary data collected from company websites and crowdfunding platforms.FindingsThis study presents a conceptual framework that outlines and maps the drivers that lead sustainable entrepreneurs to engage with different crowdfunding types (donation, reward, mixed and equity) by unravelling a more granular understanding of the key and condition-based additional drivers within the context of sustainable entrepreneurial crowdfunding.Originality/valueEntrepreneurs are taking advantage of crowdfunding in order to raise funds. This manuscript offers empirical insights into the under-investigated question of what drives sustainable entrepreneurs to engage in crowdfunding and to what ends. This research also adds texture to prior findings about general motivations of entrepreneurs to seek crowdfunding. These insights inform research and practice on sustainable entrepreneurial crowdfunding, and entrepreneurial crowdfunding in general.

Social Networking and Romantic Relationships: When Mental Illness Enters the Mix

Social networking sites (SNS) are increasingly becoming integrated in our daily lives. (N=184, female=138) We surveyed 184 spouses (female =138) to explore whether there is an association between partner’s perception of the quality of available alternatives and SNS infidelity related behaviors. We also explored if mental illness moderated this association. Those with mental and/or emotional illness reported higher levels of SNS infidelity than those without, however, we did not find between-group differences in perceived quality of alternatives or relationship satisfaction. Perceived quality of available alternatives predicted social media infidelity behaviors and this association was moderated by mental illness status. Therefore, users about their both partners have Implications for family therapy practice are discussed.

Help-Seeking Behaviors Among Older Adults: A Scoping Review.

Although older adults may experience health challenges requiring increased care, they often do not ask for help. This scoping review explores the factors associated with the help-seeking behaviors of older adults, and briefly discusses how minority ethnic populations can face additional challenges in help-seeking, due to factors such as language barriers and differing health beliefs. Guided by Arksey and O’Malley’s scoping review framework and the Preferred Reporting Items for Systematic Reviews and Meta-AnalysesScoping Review guidelines, a systematic search of five databases was conducted. Using a qualitative meta-synthesis framework, emergent themes were identified. Data from 52 studies meeting inclusion criteria were organized into five themes: formal and informal supports, independence, symptom appraisal, accessibility and awareness, and language, alternative medicine and residency. Identifying how factors, including independence and symptom appraisal, relate to older adults’ help-seeking behaviors may provide insights into how this population can be supported to seek help more effectively.

HIV-Positive and HIV-Negative Women with Medicaid Have Similar Rates of Stillbirth and Preterm Birth.

Introduction: Women living with human immunodeficiency virus (WLHIV) may face additional challenges and differential birth outcomes when compared with women without human immunodeficiency virus (HIV). There is limited research to date studying birth outcomes among a nationally representative sample of WLHIV. This study compares stillbirth and prematurity rates between HIV-positive (HIV+) and HIV-negative (HIV−) mothers in the Medicaid program.Methods: We used 12 years (2001–2012) of Medicaid Analytic eXtract data. We included Medicaid claims from the 14 states with the highest prevalence of HIV: California, Florida, Georgia, Illinois, Louisiana, Massachusetts, Maryland, North Carolina, New Jersey, New York, Ohio, Pennsylvania, Texas, and Virginia. Primary outcomes were stillbirth and preterm birth. We used logistic regression models adjusting for age, race, Medicaid coverage, eligibility, substance use, rurality, comorbidities, and state fixed effects to compare differences in rates for women with and without HIV.Results: Our study included a total of 33,078 HIV+ and 7,663,758 HIV− pregnancies from Medicaid enrollees between 2001 and 2012. The proportions of stillbirths and preterm births were higher for HIV+ when compared with HIV− mothers (0.9% vs. 0.7% and 8.0% vs. 6.6%, p < 0.0001). After adjusting for covariates, being HIV+ was not significantly associated with both stillbirth (odds ratio [OR]: 1.05) or prematurity (OR: 1.01). Black race was a strong independent predictor of both stillbirth and prematurity (OR: 1.99 and 1.51, p < 0.01). Rurality and substance abuse were not associated with either outcome.Conclusions: After adjustment for relevant covariates, maternal HIV infection was not associated with increased rates of stillbirth or preterm birth in the Medicaid program in the United States. It is imperative that we understand and eliminate the clinical, social, and contextual factors that are responsible for the strong association between black race and poor perinatal outcomes that we observe.

The emerging role of selenium metabolic pathways in cancer: New therapeutic targets for cancer.

Selenium (Se) is incorporated into the body via the selenocysteine (Sec) biosynthesis pathway, which is critical in the synthesis of selenoproteins, such as glutathione peroxidases and thioredoxin reductases. Selenoproteins, which play a key role in several biological processes, including ferroptosis, drug resistance, endoplasmic reticulum stress, and epigenetic processes, are guided by Se uptake. In this review, we critically analyze the molecular mechanisms of Se metabolism and its potential as a therapeutic target for cancer. Sec insertion sequence binding protein 2 (SECISBP2), which is a positive regulator for the expression of selenoproteins, would be a novel prognostic predictor and an alternate target for cancer. We highlight strategies that attempt to develop a novel Se metabolism-based approach to uncover a new metabolic drug target for cancer therapy. Moreover, we expect extensive clinical use of SECISBP2 as a specific biomarker in cancer therapy in the near future. Of note, scientists face additional challenges in conducting successful research, including investigations on anticancer peptides to target SECISBP2 intracellular protein.

‘I’m kind of in a dilemma’: the challenges of non-standard work schedules and childcare

ABSTRACT Canada has long been criticized for its patchwork of childcare policies and programmes. In this context, parents who work non-standard hours face additional challenges finding, affording, and maintaining stable childcare. Drawing on a purposive sample of twenty Canadian parents of young children who have non-standard work schedules, we explore the challenges these parents face, the strategies they use, and the impacts of current childcare policies, especially for mothers. We draw on qualitative findings to show how childcare services, labour standards and employment practices must adapt to better serve Canadian families. In the context of the COVID pandemic, it is more critical than ever that policy makers and service providers appreciate that non-standard work results in extremely limited access to childcare services, even as childcare is increasingly recognized as essential to economic recovery, women’s equality, and child and family well-being.

The Gender Disparity of Refugee Earnings in the United States

The refugee crisis impacts both low and high-income countries alike, and the question of refugee assimilation receives much attention worldwide. While all refugees face various challenges in assimilating to their host countries, female refugees face additional challenges. This paper focuses on the earnings of refugees upon arrival to their host countries. The 2018 Annual Survey of Refugees was used to study the earnings trajectory of male and female refugees who arrive in the United States. Results reveal a significant earnings gap of approximately $1.70 an hour, which is equivalent in pay to male refugees receiving almost eight more years of schooling. To examine the underlying mechanism behind this result, this paper studies how the predicted earnings trajectory varies when including the UNDP Human Development Index and the World Economic Forum Global Gender Gap variable, using refugees’ country of birth. Findings indicate robust results that female refugees do not benefit from increases in human development, while both male and female refugees benefit from increases in gender equality. These results have important implications for refugee policy in the form of cash assistance or vocational training.

Secondary failure: immune responses to approved protein therapeutics.

Recombinant therapeutic proteins are a broad class of biological products used to replace dysfunctional human proteins in individuals with genetic defects (e.g., factor VIII for hemophilia) or, in the case of monoclonal antibodies, bind to disease targets involved in cancers, autoimmune disorders, or other conditions. Unfortunately, immunogenicity (immune response to the drug) remains a key impediment, potentially affecting the safety and efficacy of these therapeutics. Immunogenicity risk is routinely evaluated during the licensure of therapeutic proteins. However, despite eliciting anti-drug immune responses in at least some patients, most protein drugs are nevertheless licensed as they address unmet medical needs. The pre-licensure immunogenicity assessments of therapeutic proteins are the subject of numerous reviews and white papers. However, observation and clinical management of the immunogenicity of approved therapeutic proteins face additional challenges. We survey the immunogenicity of approved therapeutic proteins, discuss the clinical management of immunogenicity, and identify the challenges to establishing clinically relevant immunogenicity assays for use in routine clinical practice.

Perceptions and barriers to the annual influenza vaccine compared with the coronavirus disease 2019 vaccine in an urban underserved population

BackgroundFor a vaccine to be successful, communities must perceive it as important, safe, effective, and necessary. However, there are many barriers and hesitancies to vaccination. Underserved patient populations may face additional challenges related to access and cost. Because community pharmacists improve vaccine access and increase vaccination rates, it is beneficial for pharmacists to understand perceptions and barriers to vaccinations in their community to increase vaccine confidence. ObjectivesThis study aims to assess and compare barriers and perceptions of the annual influenza to the coronavirus disease 2019 (COVID-19) vaccine for underserved patients of a charitable pharmacy. MethodsPatients who qualified to receive medications from an outpatient charitable pharmacy took an electronic survey when receiving medications. The survey incorporated questions developed by the World Health Organization’s Strategic Advisory Group of Experts on Vaccine Hesitancy on a 5-point Likert scale. Questions about the influenza and COVID-19 vaccines mirrored one another. Demographic data such as age, race, sex, and education level were also collected. ResultsOf the 189 patients surveyed at the charitable pharmacy, 71.7% were 55 years old and older and 58.9% were female. Of note, 78% and 77% of participants agreed or strongly agreed that the influenza and COVID-19 vaccines, respectively, were important for the health of others in their community. Adverse effects and the cost of the COVID-19 vaccine were noted to be statistically significantly more of a concern with the COVID-19 vaccine than that of the influenza vaccine (P < 0.001). ConclusionEnsuring equitable vaccine access, promoting the COVID-19 vaccine as free, and eliciting and addressing individual persons’ concerns related to vaccine safety and adverse effects are all important ways pharmacists and other health care providers and community stakeholders can help promote vaccine confidence within the populations they serve.

Parent Perceptions of Online School Support for Children with Disabilities

ABSTRACT Students with disabilities and their parents face additional challenges in any educational environment, but little previous research maps these challenges in a online schools. The purpose of this study was to understand parent perceptions of IDEA implementation for children with disabilities during the transition to fully online schooling. Specifically, the study focused on special education services and the preparation parents received for their new roles as on-site mentors. Multiple research strategies were used, including a survey of 58 parents and individual interviews with 15 respondents of those surveys. Findings of this study suggest that a generally welcoming demeanor of online school staff is integral to parent perceptions of the quality of the transition. However, two issues from the findings of this study raise concerns about state policies and local providers. First, students are losing many special education services without replacements appropriate to the online setting and, second, parents lack understandings about their changing roles when they enroll their children in online schools.

Portable Archives: Using Mobile Technology for Archival Education and Outreach in a Campus Community

Off-campus college and university archives face additional challenges when implementing educational and outreach initiatives. Travel difficulties for patrons, transportation issues for fragile materials, even inclement weather can play significant roles in whether a repository's materials can be used in an educational session in an on-campus classroom. This article explores the challenges an off-campus university archives encounters in incorporating its materials into the campus curriculum. In addition, this article discusses a technology-based solution devised by the university archivist to bring greater access to materials and engage the campus community in interactive archival education.

Experience of Medical Students on Appearing in First Sub Stage of Anatomy

Background: Higher level of stress experienced by medical students has been found to have a negative effect on their cognitive learning. The first year MBBS student have to face the challenge of higher standards of course work and examination as compared to his previous school and college coursework. Moreover, student from rural background and living in hostel has to face additional challenges of coping with homesickness, hostel related and many financial problems. Aim: To determine the experience and feelings amongst First year MBBS students to the first sub stage in anatomy in different public and private medical colleges of Punjab. Method: A descriptive cross-sectional study was conducted at Allama Iqbal Medical College, Lahore. A sample of 275 students of First year MBBS class were selected from both public and private sector of medical colleges in various cities of Punjab through convenience sampling technique. A self-administered structured questionnaire was prepared for data collection and distributed amongst First Year MBBS students. Data was entered and analyzed using SPSS 21. Results: The result of the study showed that 53.8% of First Year MBBS students were nervous before the first substage. Results of the study also showed that hostelites and females students were more nervous and these findings were statistically significant. Also our study showed that government medical college students were better prepared for their substage as compared to private college students and there is statistically significant difference between them (p &lt; 0.00). Conclusion: Majority of First year MBBS students (58%) are facing increase level of stress during their first substage. Statistically significant higher stress levels are observed among females, hostellites. Keywords: First Year MBBS, Experience, Stress, First substage