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Open Access Publications from the University of California

Scholarly Works (9 results)

  • Article
  • Peer Reviewed
UC Berkeley Previously Published Works (2005)

In 1994, after a year of intense activism by indigenous women and their urban supporters, indigenous women in the New Territories of Hong Kong were legally allowed to inherit land for the first time. In pushing for legislative change, the female inheritance movement adopted key ideas-gender equality, human rights and a critique of patriarchy-from a global vocabulary of feminism and human rights. This article examines this rights frame to understand how, if at all, activists modified international conceptions of discrimination and rights to fit Hong Kong. Overall, the ideology was not fundamentally altered or adapted, but indigenized by local activists through the use of local symbols. More deep-rooted change was not necessary for two reasons: First, in the pre-handover moment, rights arguments derived political currency from their association with an international community. Also, critical movement participants, here termed translators, helped encompass the indigenous women's individual kinship grievances within a broader movement based on rights.

    Cover page: Unpacking Adaptation: The Female Inheritance Movement in Hong Kong
    • Article
    • Peer Reviewed
    UC Berkeley Previously Published Works (2012)
    In this conceptual essay, the authors argue that one way to understand the Chinese state is to view it from below, from the perspective of people advocating change. The authors' "state reflected in society" approach is illustrated with accounts of Chinese lawyers, journalists, and NGO leaders who operate at the boundary of the acceptable and are attentive to signals about what the authorities will tolerate. Their experiences suggest that mixed signals about the limits of the permissible is a key feature of the Chinese state. Beyond a number of well-patrolled "forbidden zones," the Chinese state speaks with many voices and its bottom line is often unclear. At the border of the uncontroversial and the unacceptable, the Chinese state is both a highcapacity juggernaut capable of demarcating no-go zones and a hodgepodge of disparate actors ambivalent about what types of activism it can live with. Whether mixed signals are deliberate or accidental is hard to determine, but they do offer the authorities certain advantages by providing a low-cost way to contain dissent, gather information, and keep options open. © 2012 SAGE Publications.
      Cover page: Politics at the Boundary
      • Thesis
      • Peer Reviewed
      UC Berkeley Electronic Theses and Dissertations (2009)

      This is a dissertation about lawyers, judges, international NGOs and legal action in an authoritarian state. The state is contemporary China. The type of legal action is civil environmental lawsuits, as when herdsmen from Inner Mongolia sue a local paper factory over poisoned groundwater and dead livestock or a Shandong villager demands compensation from a nearby factory for the noise that allegedly killed 26 foxes on his farm. Empirically, this is a close-to-the-ground account of everyday justice and the factors that shape it. Drawing on fifteen months of field research in China, along with in-depth exploration of four cases, legal documents, government reports, newspaper articles and blog archives, this dissertation unpacks how law as litigation works: how judges make decisions, why lawyers take cases and how international influence matters.

      Conceptually, civil environmental lawsuits illustrate one pathway between litigation and social change in China and, by implication, possibly other illiberal states. With the exception of the first chapter, each chapter introduces a new actor's perspective on the interaction between state signals and legal professionals' response. The key theme, which cuts across chapters on the state, judges, lawyers and international NGOs, is what I call political ambivalence: conflicting official (or quasi-official) signals regarding the desirability of certain types of citizen action. Simultaneous impulses to promote law but control courts, to protect the environment and yet pursue economic growth, generate a medley of statements, cases and regulations that do not necessarily concord. For legal professionals on the ground, these mixed messages translate into a degree of opportunity. Without official sanction or intent, conflicting signals crack open enough political space to allow limited judicial innovation (chapter 3), legal activism (chapter 4), sustained international encouragement (chapter 5) and policy promotion (chapter 6). Even on tough terrain, political ambivalence over law can provide a limited opportunity to probe new roles and, in so doing, gently push the limitations of political tolerance.

        Cover page: Navigating the Boundaries of Political Tolerance: Environmental Litigation in China
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2018)

        Patients and caregivers play a central role in health care safety in the hospital, ambulatory care setting, and community. Despite this, interventions to promote patient engagement in safety are still underexplored. We conducted an overview of review articles on patient engagement interventions in safety to examine the current state of the evidence. Of the 2,795 references we evaluated, 52 articles met our full-text inclusion criteria for synthesis in 2018. We identified robust evidence supporting patients' self-management of anticoagulation medications and mixed-quality evidence supporting patient engagement in medication and chronic disease self-management, adverse event reporting, and medical record accuracy. Promising modes of patient engagement in safety, such as anticoagulation management and patient portal access, are not widely implemented. We discuss major implementation priorities and propose directions for future research and policy to enhance patient partnership within safety efforts.

          Cover page: Patient Engagement In Health Care Safety: An Overview Of Mixed-Quality Evidence.
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2012)

          Background

          The Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set assesses patient perceptions of aspects of the cultural competence of their health care.

          Objective

          To determine characteristics of patients who identify the care they receive as less culturally competent.

          Research design

          Cross-sectional survey consisting of face-to-face interviews.

          Subjects

          Safety-net population of patients with type 2 diabetes (n=600) receiving ongoing primary care.

          Measures

          Participants completed the Consumer Assessment of Healthcare Providers and Systems Cultural Competency and answered questions about their race/ethnicity, sex, age, education, health status, depressive symptoms, insurance coverage, English proficiency, duration of relationship with primary care provider, and comorbidities.

          Results

          In adjusted models, depressive symptoms were significantly associated with poor cultural competency in the Doctor Communication--Positive Behaviors domain [odds ratio (OR) 1.73, 95% confidence interval, 1.11-2.69]. African Americans were less likely than whites to report poor cultural competence in the Doctor Communication--Positive Behaviors domain (OR 0.52, 95% CI, 0.28-0.97). Participants who reported a longer relationship (≥ 3 y) with their primary care provider were less likely to report poor cultural competence in the Doctor Communication--Health Promotion (OR 0.35, 95% CI, 0.21-0.60) and Trust domains (OR 0.4, 95% CI, 0.24-0.67), whereas participants with lower educational attainment were less likely to report poor cultural competence in the Trust domain (OR 0.51, 95% CI, 0.30-0.86). Overall, however, sociodemographic and clinical differences in reports of poor cultural competence were insignificant or inconsistent across the various domains of cultural competence examined.

          Conclusions

          Cultural competence interventions in safety-net settings should be implemented across populations, rather than being narrowly focused on specific sociodemographic or clinical groups.
            Cover page: Risk factors for reporting poor cultural competency among patients with diabetes in safety net clinics.
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2012)

            Background

            Providing culturally competent care shows promise as a mechanism to reduce health care inequalities. Until the recent development of the Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set (CAHPS-CC), no measures capturing patient-level experiences with culturally competent care have been suitable for broad-scale administration.

            Methods

            We performed confirmatory factor analysis and internal consistency reliability analysis of CAHPS-CC among patients with type 2 diabetes (n=600) receiving primary care in safety-net clinics. CAHPS-CC domains were also correlated with global physician ratings.

            Results

            A 7-factor model demonstrated satisfactory fit (χ²₂₃₁=484.34, P<0.0001) with significant factor loadings at P<0.05. Three domains showed excellent reliability-Doctor Communication-Positive Behaviors (α=0.82), Trust (α=0.77), and Doctor Communication-Health Promotion (α=0.72). Four domains showed inadequate reliability either among Spanish speakers or overall (overall reliabilities listed): Doctor Communication-Negative Behaviors (α=0.54), Equitable Treatment (α=0.69), Doctor Communication-Alternative Medicine (α=0.52), and Shared Decision-Making (α=0.51). CAHPS-CC domains were positively and significantly correlated with global physician rating.

            Conclusions

            Select CAHPS-CC domains are suitable for broad-scale administration among safety-net patients. Those domains may be used to target quality-improvement efforts focused on providing culturally competent care in safety-net settings.
              Cover page: Advances in measuring culturally competent care: a confirmatory factor analysis of CAHPS-CC in a safety-net population.
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2023)

              Background

              Shelter-in-place orders during the COVID-19 pandemic created unmet health-related and access-related needs among older adults. We sought to understand the prevalence of these needs among community-dwelling older adults.

              Methods

              We performed a retrospective chart review of pandemic-related outreach calls to older adults between March and July 2020 at four urban, primary care clinics: a home-based practice, a safety net adult medicine clinic, an academic geriatrics practice, and a safety net clinic for adults living with HIV. Participants included those 60 or older at three sites, and those 65 or older with a chronic health condition at the fourth. We describe unmet health-related needs (the need for medication refills, medical supplies, or food) and access-related needs (ability to perform a telehealth visit, need for a call back from the primary care provider). We performed bivariate and multivariate analyses to examine the association between unmet needs and demographics, medical conditions, and healthcare utilization.

              Results

              Sixty-two percent of people had at least one unmet need. Twenty-six percent had at least one unmet health-related need; 14.0% needed medication refills, 12.5% needed medical supplies, and 3.0% had food insecurity. Among access-related needs, 33% were not ready for video visits, and 36.4% asked for a return call from their provider. Prevalence of any unmet health-related need was the highest among Asian versus White (36.4% vs. 19.1%) and in the highest versus lowest poverty zip codes (30.8% vs. 18.2%). Those with diabetes and COPD had higher unmet health-related needs than those without, and there was no change in healthcare utilization.

              Conclusions

              During COVID, we found that disruptions in access to services created unmet needs among older adults, particularly for those who self-identified as Asian. We must foreground the needs of this older population group in the response to future public health crises.
                Cover page: Unmet health‐related needs of community‐dwelling older adults during COVID‐19 lockdown in a diverse urban cohort
                • Article
                • Peer Reviewed
                UC San Francisco Previously Published Works (2021)
                  Cover page: Concentrating Vaccines in Neighborhoods with High Covid-19 Burden
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2023)

                  Introduction

                  Heart failure (HF) is a frequent cause of readmissions. Despite caring for underresourced patients and dependence on government funding, safety net hospitals frequently incur penalties for failing to meet pay-for-performance readmission metrics. Limited research exists on the causes of HF readmissions in safety net hospitals. Therefore, we sought to investigate predictors of 30-day all-cause readmission in HF patients in the safety net setting.

                  Methods

                  We performed a retrospective chart review of patients admitted for HF from October 2018 to April 2019. We extracted data on demographics and medical comorbidities and performed patient-specific review of social determinants and mental health in 4 domains: race/ethnicity, housing status, substance use, and mental illness. Multivariable Poisson regression modeling was employed to evaluate associations with 30-day all-cause readmission.

                  Results

                  The study population included 290 patients, among whom the mean age was 59 years and 71% (n = 207) were male; 42% (120) were Black/African American (AA), 22% (64) were Hispanic/Latino, and 96% (278) had public insurance; 28% (79) were not housed, 19% (56) had a diagnosis of mental illness, and active substance use was common. The 30-day readmission rate was 25.5% (n = 88). Factors that were associated with increased risk of readmission included self-identifying as Black/AA (relative risk 2.28, 95% confidence interval 1.00-5.20) or Hispanic/Latino (2.53, 1.07-6.00), experiencing homelessness (2.07, 1.21-3.56), living in a shelter (3.20, 1.27-8.02), or intravenous drug use (IVDU) (2.00, 1.08-3.70).

                  Conclusion

                  Race/ethnicity, housing status, and substance use were associated with increased risk of 30-day all-cause readmission in HF patients in a safety net hospital. In contrast to prior studies, medical comorbidities were not associated with increased risk of readmission.
                    Cover page: Predictors of All-Cause 30-Day Readmissions in Patients with Heart Failure at an Urban Safety Net Hospital: The Importance of Social Determinants of Health and Mental Health
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