Limited Financial Means Research Articles

Can local nutrient-circularity and erosion control increase yields of resource-constraint smallholder farmers? A case study in Kenya and Uganda

As many regions in sub-Saharan Africa, the border region of Kenya (KE) and Uganda (UG) has faced a declining soil fertility for decades, resulting from soil erosion, intensely managed agricultural soils due to population pressure and small inputs of mineral and organic fertilizers. With limited financial means, farmers need measures and/or technologies that effectively reduce nutrient losses or increase inputs at a low cost. In this study, four such measures are in focus, namely erosion reduction practices, vermicomposting of animal manure, collection of human urine in jerry cans and, collection of human excreta in urine-diverting dry toilets. Current soil nutrient balances in five districts in the Sio-Malaba-Malakisi River Basin and the potential of these measures to reduce the soil nutrient deficit are studied using the method of material flow analysis and the software STAN. Furthermore, crop-nutrient-response functions are used to determine their potential impact on maize harvests. Overall, results reveal that there exists a non-negligible and exploitable potential of local resources to reduce the soil nutrient deficit, improve harvests and in turn food security of the smallholder farmers in the region. Soil nutrient deficits could be reduced by 20–30%, 23–42% and 9–15% for nitrogen (N), phosphorus (P) and potassium (K), respectively. Subsequently, maize harvests could be increased by 8–40%, depending on the applied technology and area. This research provides useful insights for agricultural extension workers, politicians and researchers alike, highlighting that simple and easily available technologies can harness similar amounts of nutrients as more complex and expensive ones if all specific technology-constraints are adequately incorporated in the analyses.

English

This study investigates why postpartum women cannot or will not receive postpartum consultations at the maternity ward in Sokoura, Côte d’Ivoire. It aims to present the sociocultural, economic, infrastructural and organisational factors limiting new mothers’ access to postpartum care and to suggest ways to encourage them to seek out such care. A qualitative approach was adopted and data was collected from individual interviews with new mothers and midwives. The results have elucidated the factors hindering postpartum consultations at the maternity ward in Sokoura and the broader sociological context in which they need to be assessed. The relevant factors are deficient knowledge about the post-partum period, new mothers’ professional obligations, their spouses’ limited financial means, the distance of the maternity ward, unfavourable transport conditions, tensions between new mothers and midwives, and inadequate organisation and management of the postpartum consultation services at the maternity ward. These obstacles to postpartum care can be broadly categorised as insufficient education, scarce social support and unfavourable environmental and medical conditions. To remedy these issues, it is necessary to foster community action targeting new mothers and their spouses, to develop midwives’ cross-cultural skills, notably their capacity for anthropological observation, and to involve public authorities in the changes.   Key words: Postpartum women, accessibility, postpartum consultations, obstacles, social change, maternal and neonatal health.

An Examination of How People Appraise and Manage Health-Related Financial Uncertainty

ABSTRACT While health care is one of the largest stressors across all incomes and political affiliations, it is unclear how people with health-related financial uncertainty appraise and manage this ambiguity. Using the lens of Uncertainty Management Theory (UMT) and a thematic analysis of semi-structured, in-depth interviews with 17 individuals facing financial and health struggles, we uncovered how intersecting financial and medical uncertainty exacerbated participants’ medical worries, worsening and compromising their mental and physical health. Additionally, we revealed how participants managed health-related financial uncertainty through seeking social support, seeking information to reduce financial burden, enacting financial concessions, making health sacrifices, avoiding information and thoughts about health costs, and adapting to chronic financial uncertainty. This study extends UMT by foregrounding the ways individuals’ environmental resources (i.e., limited financial means) can jeopardize tending to their health, illustrating how uncertainty management is connected not only to communication strategies but also to health behaviors, such as tapering or skipping medications or procedures.

The State of Obesity in Kansas: A Community Based Approach to Chronic Care Management.

Based on the current prevalence of obesity and projected growth rates, approximately 50% of all adults ages 18 and older in the United States will be obese within the next 10 years.1 The state of Kansas is projected to have greater obesity rates than the national average during this timeframe at 55.6% of the population. Current estimates rank Kansas 12th in the nation for obesity prevalence, with 34.4% of adults ages 18 and older who are obese, and 39th in the nation for childhood obesity with 12.5% of the population ages 0 – 17 with obesity.2–4 The increasing prevalence of obesity is associated with a variety of factors including: socioeconomic status, ethnic and racial disparities, genetics, geographic location, age, disability status, pregnancy, associated comorbid medical conditions, access to food, cultural beliefs, and health behaviors.5–20 Socioeconomic factors including income level, education, ethnicity, race, unemployment, and geographic location have a significant influence on the development of obesity (Figure 1).1,5–10 Obesity prevalence is correlated negatively with income level, with increased rates of obesity noted in low income populations. Individuals with limited financial means often live in food deserts and gravitate toward convenient food sources that are highly processed, low in nutrient density, and high in caloric content with a long shelf life. Within the city of Wichita, there are 44 square miles of food deserts where individuals live more than 1 mile from a grocery store.12 With limited access to food, individuals within these neighborhoods increasingly utilize convenience stores that are located within walking distance. A study conducted by the Health and Wellness Coalition of Wichita in 2013 showed that convenience stores make up 40% of the retailers within Wichita, but only 44% offer fresh fruits and 9% offer fresh vegetables.12 The cost associated with fresh produce at these locations can be up to four times the cost of fresh produce purchased from grocery stores. Open in a separate window Figure 1 The impact of socioeconomic factors on the development of obesity rates within the state of Kansas. Rates reflect self-reported survey data and likely underestimate the true prevalence and the effect of demographics on the development of this disease. [Figure created with BioRender.com.]

Barierrs to Implementing the Concept of Green Human Resource Management: The Case of Poland

Purpose: The Green Human Resource Management concept is relatively new to Polish managers. There is a research gap with respect to investigating the reasons behind limited practical implementation of GHRM. The objective of the study is the identification of major barriers to the implementation of the GHRM concept in Polish companies. Design/Methodology/Approach: The study was conducted in 2018 on a random sample of 300 Polish enterprises. The respondents were managers responsible for HR policy development. The method used in the study was CATI. In the first stage of the analysis, an assessment of the level of implementation of the GHRM concept in 7 functional areas was carried out with the use of a 5-point Likert scale. The second stage involved identification of the main barriers impeding the implementation of green HR practices. Findings: Green Human Resource Management viewed as the latest research tendency plays a crucial role in the strategies of corporate sustainable development. However, studies demonstrate that the level of GHRM implementation in Polish companies is low. In the course of the analysis, it appeared that the primary barriers limiting GHRM implementation are: limited financial means, lack of incentives to engage in environmentally friendly activities, low competencies of the management with respect to sustainable HRM, no or low effectiveness of GHRM tools and a culture based on economic values. Practical Implications: If the major barriers to GHRM implementation are identified and Polish managers become aware of them, barrier removal may prove easier and, consequently, the scope of implementation of green practices within the HR function may be broadened. Originality/Value: This article is a pioneer attempt to identify the barriers to Green HRM implementation in Poland. The research enriches the still limited set of literature concerning environmental practice performance in the area of HR. The author believes that the results of the presented research may stimulate interest in GHRM concept’s implementation in Polish companies as a tool of corporate sustainable development.

Clinical mortality risk factors of variceal upper gastrointestinal bleeding in a Malagasy surgical intensive care unit.

BackgroundVariceal upper gastrointestinal bleeding is a dreadful complication of portal hypertension with a significant morbidity and mortality. Different prognostic scores can be used. However, in the local context of Madagascar, the completion of paraclinical investigations can be delayed by the limited financial means of patients. Hence, determining clinical mortality risk factors of variceal upper gastrointestinal bleeding could be interesting. The aim of the study was to evaluate the clinical mortality risk factors of variceal gastrointestinal bleeding (VUGIB).MethodAn observational, cohort retrospective study was conducted over an 8-year period (2010–2017), at the surgical intensive care unit of the J.R. Andrianavalona University Hospital, Antananarivo, in patients admitted for VUGIB confirmed by upper gastrointestinal endoscopy and whose clinical examination was performed at admission. The primary endpoint was intensive care unit (ICU) mortality. Univariate analysis and multivariate logistic regression analysis were performed to identify risk factors for ICU mortality, with OR defining odds ratio. A p value <0.05 was considered significant.Results1920 patients were admitted for gastrointestinal bleeding of any digestive causes; the source of bleeding was variceal in 269 patients (14%). The predominantly male population (sex ratio = 2.5), aged 47.1 ± 13.7 years was mostly American Society of Anesthesiologists (ASA) 1 classification (58.4%). In 56.5% of patients, the gastrointestinal bleeding had not occurred before. The mortality rate was 16.0%. Three major clinical factors of mortality were identified: previous endoscopic band variceal ligation (OR = 12.57 [2.18–72.58], p = 0.005), tachycardia >120 bpm (OR = 2.91 [1.04–8.14], p = 0.041), and ascites (OR = 3.80 [1.85–7.81], p < 0.001).ConclusionUpper gastrointestinal bleeding may be life-threatening. The mortality scores are certainly useful; however, the identification of clinical factors is interesting in countries like Madagascar, pending the results of paraclinical investigations.

Dental consideration and management of cancer patients before initiation of IV bisphosphonates

Purpose Osteonecrosis of the jaw (ONJ) related to intravenous bisphosphonates (IVBP) is characterized by exposed necrotic bone in the maxillofacial region in patients who have received or are receiving treatment with IVBP and have no history of radiation therapy of the jaws.1 The risk of complication of using IVBP for oncologic purposes can be reduced with effective management of cancer patients. Therefore, it is imperative for practitioners to follow patient-specific guidelines for the dental management of patients who will be treated with IVBP. The purpose of this article was to provide a patient-specific, individualized approach for the dental management of patients before initiation of IVBP to prevent ONJ. This guideline will focus on 3 separate factors: the cancer, the patient, and the dentition. Methods A systematic literature review was conducted via PubMed using the following medical subject headings and terms: “bisphosphonates,” “avascular necrosis,” “bisphosphonate-related osteonecrosis of the jaw,” and “medication-related osteonecrosis of the jaw.” We then cross-referenced the same terms with the terms “multiple myeloma (MM),” “breast cancer,” “prostate cancer,” “jaw disease,” and “metastatic cancer” to identify publications that can provide evidence to develop pretreatment dental guidelines in cancer patients treated with IVBP. Articles were reviewed as a result of the PubMed literature search. The cancer types evaluated included breast cancer, prostate cancer, and MM. Relevant studies regarding patient- and dentition-related factors and their relation to IVBP treatment of the said cancers, survival, or comorbidities were evaluated. Results Upon review of articles, 137 articles met our inclusion criteria. No association was found between development of ONJ and the primary tumor site. The hazard of developing ONJ was significantly higher in patients who received zoledronic acid alone compared to those who received pamidronate alone or in combination with zoledronic acid. Our review also concluded that time of exposure to IVBP is strongly associated with development of ONJ, with exposure beyond 4 years of IVBP treatment increasing the incidence of ONJ significantly.2 Our literature search indicated that the risk of development of ONJ after IVBP treatment in cancer patient is also dose dependent, with higher doses being associated with higher risk of ONJ. This suggests that not only does the type of IVBP treatment positively correlate with the likelihood of developing ONJ, the dose and duration of IVBP therapy is also a significant factor. Our analysis identified several unique patient characteristics, including motivation, presence of a support system, socioeconomic status, nutrition, and race, which have all been found to affect the outcomes of IVBP therapy. Dental disease and available supportive dental management was found to significantly impact treatment and quality of life in this patient population. Conclusion Complications from IVBP treatment in cancer patients can have a lifelong impact on quality of life. Dentists and oral and maxillofacial surgeons can play a major role in preventing and minimizing these complications. The cancer, the patient, and the dentition should be analyzed thoroughly to assemble an effective pre-IVBP dental treatment plan. A pre-IVBP extraction-based dental treatment plan is warranted for patients with history of noncompliance, limited financial means, lack of motivation, and presence of tooth factors that decrease the prognosis of dentition. Use of zoledronic acid, IVBP for extended period of 4+ years, and dosage of 22.6 doses or higher are associated with significantly higher chance of developing ONJ and a more aggressive dental treatment (e.g., extraction vs restoration) should be utilized in treatment of these patients.

Looming threat of COVID-19 infection in Africa: act collectively, and fast

Because of the high volume of air traffic and trade between China and Africa,1 Africa is at a high risk for the introduction and spread of the novel coronavirus disease 2019 (COVID-19); although only Egypt has reported the first case, from a non-national.2 The greatest concern for public health experts is whether COVID-19 will become a pandemic, with sustained year-round transmission, similar to influenza, as is now being observed in several countries.3 What might happen to Africa—where most countries have weak health-care systems, including inadequate surveillance and laboratory capacity, scarcity of public health human resources, and limited financial means—if a pandemic occurs? With neither treatment nor vaccines, and without pre-existing immunity, the effect might be devastating because of the multiple health challenges the continent already faces: rapid population growth and increased movement of people; existing endemic diseases, such as human immunodeficiency virus, tuberculosis, and malaria; remerging and emerging infectious pathogens such as Ebola virus disease, Lassa haemorrhagic fever, and others; and increasing incidence of non-communicable diseases.

Vietnam and Disability Rights: Perspectives at the Time of Ratification of the UN Convention on the Rights of Persons with Disabilities

ABSTRACT Vietnam ratified the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in 2015, signalling a commitment to the basic human rights of citizens with disabilities. Previous research has shown people with disabilities in Vietnam to be marginalised in society, often with limited educational or work opportunity, and with limited financial means. Using in-depth semi-structured interviews conducted in Vietnam and a thematic analysis approach to data interpretation, this article examines the current status of people with disabilities in Vietnam in relation to the core elements of the CRPD, from the perspectives of people with disabilities, their families, and professionals who support them. Findings suggest that, while Vietnamese society has made strides supporting people with disabilities, work remains to be done for the country to comply with the CRPD’s core principles. Suggestions for future action are offered, including ways to support human rights of people with disabilities within cultural contexts.

Abstract 157: Assessment of Financial Hardship From Medical Bills Across the Spectrum of Diabetes Mellitus and Atherosclerotic Cardiovascular Disease Among Non-Elderly Adults in the United States

Background: Diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD) both increase the risk for experiencing an adverse cardiac event and affected individuals often have large medical expenditures. While prior research has evaluated financial burden associated with acute cardiovascular events and comparative healthcare expenditures between DM and ASCVD, less is known about the expressed financial hardship and inability to pay medical bills for individuals with families on the basis of ASCVD and DM status. Methods: Using data from the National Information Survey between 2013 and 2017, we examined ASCVD/DM status, financial hardship from medical bills, and an inability to pay medical bills at all for a nationally representative sample of non-elderly adults in the United States between 18-64 years of age. Results: Our study population consisted of 121,672 individuals. Approximately 3.1% of the weighted population had ASCVD alone, 5.6% had diabetes alone, and 1.3% had both ASCVD and diabetes mellitus. Nearly 50% of individuals with both ASCVD and DM reported having financial hardship from medical bills (23% being unable to pay medical bills at all) as compared to 28% of those without ASCVD and DM reported financial hardship from medical bills (8% being unable to pay medical bills at all). Individuals having ASCVD concurrently with DM had higher odds of expressing inability to pay medical bills at all when compared to those with DM alone (OR 2.69, 95% CI [2.21, 3.28] vs OR 1.70, 95% CI [1.52, 1.91]) whereas it was not significant when compared to those with ASCVD alone (OR 1.97, 95% CI [1.72, 2.25]). Conclusion: Patients with ASCVD and concurrent DM have much higher risk of financial hardship from medical bills compared to individuals with neither ASCVD nor DM. These findings provide strong evidence for clinicians to address these co-morbidities concurrently, particularly among vulnerable populations with limited financial means, emphasizing the importance of primary and secondary prevention along with appropriate lifestyle and therapeutic management.

Work and School in Young Adulthood: The Role of Personal Financial Responsibilities and Parental Social Support

Combining work while attending college is a common strategy for youth with limited financial means to pursue postsecondary education. However, we know relatively little about the socioeconomic contexts behind the different work and school decisions and whether the meaning of each work and school experience vary by different socioeconomic backgrounds. Following a national sample of young adults, this study explored how personal financial responsibilities and parental social support are associated with employment or enrollment in college and youths’ perceived relevance of them for their prospective careers. Youths’ personal financial responsibilities were associated with higher odds of working only and combining school and work, compared to attending college only. Youths’ personal financial responsibilities were positively linked to the career relevance of their work and school experiences, but only when they were experiencing low parental social support.

The Resilience of Recently Graduated and Unemployed Dutch Academics in Coping with the Economic Crisis

Some years after the world-wide crisis starting in 2008, also many recently graduated Dutch academics were confronted with the problem of how to cope with getting a job. This article focuses on the coping strategies they use when searching after a job, spending the day, and coping with limited financial means. 91 graduated academics completed a survey and twelve more were interviewed. They exposed remarkable resilience in coping with their situation by using emotional and problem oriented coping strategies. Emotional oriented coping strategies resulted in the graduates being able to put their situation of being without a regular job into perspective, structuring their days rather easily, and being pleased with how they did it. Their problem oriented coping strategies showed willingness to look for a job outside their field of study and below an academic level. Some respondents were willing to do unpaid work to get enrolled in the job market. The rather constructive way of coping can be explained partly by their relatively favourable financial position, mostly due to their temporary or side jobs, which also gave them a way to spend their days. Thus, the recently graduated academic job seekers perceived their economic situation in a rather positive way. Whether this was influenced by their level of education should be an important subject for more research.

Increasing International Students’ Tuition Fees: The Two Sides of the Coin

While higher tuition fees contribute to better funded tertiary education systems, they also put a burden on families whose children enroll in tertiary education, especially those with limited financial means. This article explores this dilemma and identifies key questions.

Increasing International Students’ Tuition Fees: The Two Sides of the Coin

While higher tuition fees contribute to better funded tertiary education systems, they also put a burden on families whose children enroll in tertiary education, especially those with limited financial means. This article explores this dilemma and identifies key questions.

The Princely Houses of Edward, Duke of Kent

The younger sons of King George III personify fundamental change in the British monarchy. Unlike their predecessors, they were able to break free from the rigidity and etiquette of court life to establish independent public profiles. They often aligned themselves with radical political trends and supported charitable causes in a way which has become a readily identifiable characteristic of the modern Royal Family. The King’s fourth son, Edward, duke of Kent (1767–1820), the father of Queen Victoria, is a key example of how a prince with no real prospects of the succession, without land or fortune, nonetheless successfully positioned himself in society and maintained his rank. Despite limited financial means, he reinforced his outward status through architectural patronage and the creation of magnificence in three London residences. His efforts represent a preoccupation which brought him to the edge of bankruptcy, yet have been little studied. Two of the houses have disappeared without trace, while his apartment at Kensington Palace has been subsumed within the public exhibition areas and is now largely anonymous. This paper will attempt to retrieve and describe these residences through newly discovered documentary sources and physical analysis. They provide a rare insight into the domestic environment of a lesser member of the late Georgian royal family, while suggesting that the Duke reflected the modernity of his personal convictions with similarly advanced domestic tastes.

A cost-effective proposal for an RFID-based system for agri-food traceability

Agri-food companies, operating in the packaging, storage and distribution of fruit and vegetables, need to be provided with information systems able to meet the requirements imposed by the current European regulations in terms of traceability. This paper evaluates the benefits and drawbacks of a semi-automated information management tracking system for awarehouse specialised in the fruit market. It is targeted to small and medium-sized companies, with limited financial means for investments and without technical support in their premises. These requirements are met by using a personal digital assistant (PDA) equipped with an radio frequency identification (RFID) reader: the information collected throughout the production process are locally stored in the PDA and occasionally sent to a server. In this way the proposed system does not rely neither on a widespread wireless network, nor on fixed RFID readers, which can increase automation, but need more investment and assistance.

Nonregular Employment in a Society with a Decreasing Birthrate: Workers' Marriage, Childbirth, and Childcare

In this paper, we examine the trend in Japan towards nonregular employment and its effects on marriage, childbirth, and childcare from the viewpoint of a decreasing societal birthrate. Although the decision to marry includes personal values and preferences, socioeconomic status factors such as income and employment type are also associated with the determinants of marriage. Nonregular employment workers have a lower rate and motivation for marriage than regular workers. Thus, socioeconomic disparity caused by employment needs to be minimized through governmental measures and policies. Nonregular employment is increasing among younger generations, and for them, maternity and childcare leave are especially vital. Employee insurance coverage should be expanded to function as a form of income security during these leaves of absence, such that nonregular workers are also covered. During the childcare period, which lasts more than 10 years, it is necessary to cover childrearing costs and also the time required to spend with children. If a single working parent is involved in childcare alone, there is the burden of both work and childcare. Additionally, long work hours can also impact workers that are not involved in childcare. This is a dilemma: a stable and regular employment is often necessary to achieve a higher education; however, it is difficult for nonregular employees to take care of and prepare children for higher education owing to limited financial means. Properly designed measures and policies are necessary to break this chain. Importantly, considerations about life and work are important for all workers, including nonregular workers, who are especially affected in terms of marriage, childbirth, and childcare.

The paradox of sustainable innovation: The ‘Eroom’ effect (Moore’s law backwards)

Innovation has been widely acknowledged as a key mechanism for addressing sustainable development concerns. However, less attention has focused on downstream commercialization challenges such as achieving increasingly complex and stringent regulatory approval. Such challenges may hinder the development of more sustainable technologies, especially those coming from smaller or publically funded institutes. As well, they may obstruct the development of applications that could provide societal benefits, but may only have limited commercial viability due to small market niches or applicability to customers with limited financial means. We explore this apparent paradox using the concept of the Eroom effect (Moore’s Law backwards), i.e. where improved price performance due to technological advances are outweighed by increasing costs of regulatory approval and other commercialization costs. We illustrate this phenomenon with two cases of publically funded institutes, one developing transgenic cotton, and the other lignin transformation technology that can replace petroleum-based feedstocks in a number of industrial applications. We discuss the unintended consequences of the Eroom effect and conclude with implications for industry, policy and NGOs.

A state-wide initiative to promote genetic testing in an underserved population.

Genetic testing for cancer susceptibility has been widely studied and utilized clinically. Access to genetic services in research and practice is largely limited to well‐insured, Caucasian individuals. In 2009, the Cancer Resource Foundation (CRF) implemented the Genetic Information for Treatment Surveillance and Support (GIFTSS) program to cover the out‐of‐pocket expenses associated with cancer genetic testing, targeting high‐risk individuals with limited financial means and limited health insurance coverage. Here, we (i) describe the characteristics of participants in the Massachusetts (MA) GIFTSS program and (ii) evaluate mutations found in this diverse sample. A secondary retrospective data analysis was performed using de‐identified demographic data obtained from laboratory requisition forms and cancer genetic testing result information from the laboratory source. Eligible participants were those who utilized the MA GIFFTS program from 2009 through December of 2014. Data were summarized using descriptive measures of central tendency. Participants were residents of Massachusetts who had health insurance and had a reported income within 250–400% of the federal poverty level. Genetic testing results were categorized following clinical guidelines. Overall, 123 (13%) of participants tested positive for a mutation in a cancer susceptibility gene. For those with a cancer diagnosis, 65 (12%) were found to have a positive result and 20 (7%) had a variant of uncertain significance (VUS). For those unaffected patients, 58 (15%) had a positive result and 10 (3%) were found to have a VUS. The results from this study are useful in describing genetic testing outcomes in this high‐risk underserved community. Repeatedly, the literature reports that individuals from diverse or limited resource settings are less likely to access genetic testing. Continued research efforts should be devoted to promoting the access of genetic testing in the high‐risk, underserved community.

How to build a low-cost underwater camera housing for aquatic research

Remote cameras are an increasingly important tool in field-based biological research. Terrestrial researchers can purchase inexpensive off-the-shelf cameras, but aquatic researchers face challenges in adopting similar systems for underwater science. Although technology allows researchers to deploy cameras in any aquatic environment, high procurement costs are often a barrier, particularly for studies that require the collection of lengthy videos. In this note, we provide a detailed guide explaining how to assemble an underwater camera system for less than $425 USD. We focus especially on the construction of the underwater housing, which is typically the most expensive component of an underwater camera system. As described, this system can record 13 h full high-definition videos in depths up to 100 m. It can be constructed and assembled with limited technical background using tools available in most workshops. The guide includes a general overview of the system, a full list of components, detailed instructions on constructing the camera housing, and suggestions on how to mount and use the camera in fieldwork. Our goal for this note is to promote the wider use of remote underwater cameras in aquatic research by making them accessible to those with limited financial means.