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The ageing of Western societies is leading to a marked increase in mortality. Death and old age are now intertwined. This situation should be of particular concern to palliative care. But in reality, palliative care remains too inaccessible to the oldest sections of the population. Why this paradox? After reviewing the clinical and organisational reasons that are often given, we invite you to take a more global look, one that is both sociological and ethical.

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Heatwaves pose a serious threat and are projected to amplify with changing climate and social demographics. A comprehensive understanding of heatwave exposure to the communities is imperative for the development of effective strategies and mitigation plans. This study explores spatiotemporal characterization of heatwaves across the historically vulnerable communities in Mississippi, United States. We derive multiple heatwave metrics including frequency, duration, and magnitude based on temperature data for urban-specific daytime, nighttime, and day-night combined conditions. Our analysis depicts a rising heatwave trend across all counties, with the most extreme shifts observed in prolonged day-night events lacking overnight relief. We integrate physical heatwave hazards with a socioeconomic vulnerability index to develop an integrated urban heatwave risk index. Integrated metric identifies the counties in northwest Mississippi as heat-prone areas, exhibiting an urgent need to prioritize heat resilience and adaptive strategies in these regions. The compounding urban heatwave and vulnerability risks in these communities highlights an environmental justice imperative to implement equitable policies that protect disadvantaged populations. Although this study is focused on Mississippi, our framework is scalable and can be employed to urban regions globally. This study provides a solid foundation for developing timely heatwave preparedness and mitigation to avert preventable heat-related tragedies as extremes intensify with climate change.

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Through a quality improvement project, we developed an initiative that leveraged patient- and community-level data to address health disparities and social vulnerability among patients receiving outpatient dialysis, including both incenter and home modalities. Using the Area Deprivation Index, we identified patients living in areas with the highest levels of deprivation and developed targeted interventions to help address adverse social determinants of health to improve patient health outcomes. Our quality improvement project demonstrates the potential of data-driven ap - proaches to identify and address health disparities in outpatient dialysis, and highlights the importance of addressing social determinants of health in improving patient outcomes.

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Climate anxiety has a negative impact on the mental health and psychological wellbeing of the vulnerable population. The goal is to assess many factors that affect mental health and psychological wellbeing, as well as how climate change affects mental health in Pakistan's vulnerable population. This study provides evidence-based insights on the long- and medium-term impacts of extreme weather events on mental health. We conducted semi-structured interviews with a sample of 72 students aged 10-16 years, employing an exploratory qualitative design. The resulting process identified themes and questions for future research on climate change and its psychological effects on children's mental health. As a result, positive emotions embedded in children's climate strategic actions in parent and community contexts helped to mitigate children's perceptions of negative emotions (such as climate anxiety, phobias, fear, sleep disorders, depression, sadness, and substance abuse). Climate change's effects can have a significant impact on mental health. We will be discussing effective strategies to address the expected mental health issues among children caused by climate change. The discussion paper offers a set of recommendations for addressing the mental health impacts of climate change, including improving mental health support systems, integrating climate change education into services, and developing targeted interventions for vulnerable populations.

L'anxiété climatique a un impact négatif sur la santé mentale et le bien-être psychologique de la population vulnérable. L'objectif est d'évaluer de nombreux facteurs qui affectent la santé mentale et le bien-être psychologique, ainsi que la manière dont le changement climatique affecte la santé mentale de la population vulnérable du Pakistan. Cette étude fournit des informations fondées sur des données probantes sur les impacts à long et moyen terme des événements météorologiques extrêmes sur la santé mentale. Nous avons mené des entretiens semi-structurés avec un échantillon de 72 étudiants âgés de 10 à 16 ans, en utilisant une conception qualitative exploratoire. Le processus qui en a résulté a identifié des thèmes et des questions pour de futures recherches sur le changement climatique et ses effets psychologiques sur la santé mentale des enfants. En conséquence, les émotions positives intégrées dans les actions stratégiques climatiques des enfants dans les contextes parental et communautaire ont contribué à atténuer les perceptions des enfants concernant les émotions négatives (telles que l'anxiété climatique, les phobies, la peur, les troubles du sommeil, la dépression, la tristesse et la toxicomanie). Les effets du changement climatique peuvent avoir un impact significatif sur la santé mentale. Nous discuterons de stratégies efficaces pour résoudre les problèmes de santé mentale attendus chez les enfants causés par le changement climatique. Le document de travail propose un ensemble de recommandations pour faire face aux impacts du changement climatique sur la santé mentale, notamment en améliorant les systèmes de soutien en santé mentale, en intégrant l'éducation au changement climatique dans les services et en développant des interventions ciblées pour les populations vulnérables.

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Population-based payment in Medicare Advantage (MA) can foster innovation in care delivery by giving risk-bearing providers flexibility and strong incentives to enhance care and engage patients. This may particularly benefit historically underserved groups for whom payments often exceed costs. In this study, using data from Humana MA plans, we examined "senior-focused" primary care organizations that are supported predominantly by population-based payments in contracts with MA plans. We explored whether such organizations supported by such payment are associated with better care and improved equity compared with other primary care organizations receiving other forms of payment in MA. Analyses of data from 462,872 MA beneficiaries in 2021 showed that senior-focused primary care organizations served more Black and dually eligible beneficiaries than other primary care organizations serving MA beneficiaries, and regression-adjusted analysis showed that senior-focused primary care patients received 17 percent more primary care visits. Differences were largest among Black and dual-eligible beneficiaries. These findings suggest that risk-bearing organizations in MA are responding to current payment dynamics and providing enhanced care and access to patients, particularly historically underserved populations.

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Major power outages have risen over the last two decades, largely due to more extreme weather conditions. However, there is a lack of knowledge on the distribution of power outages and its relationship to social vulnerability and co-occurring hazards. We examined the associations between localized outages and social vulnerability factors (demographic characteristics), controlling for environmental factors (weather), in Washington State between 2018-2021. We additionally analyzed the validity of PowerOutage.us data compared to federal datasets. The population included 27 counties served by 14 electric utilities. We developed a continuous measure of daily outage burden using PowerOutage.us data and operationalized social vulnerability using four factors: poverty level, unemployment, disability, and limited English proficiency. We applied zero-altered lognormal generalized additive mixed-effects models to characterize the relationship between social vulnerability and daily power outage burden, controlling for daily minimum temperature, maximum wind speed, and precipitation, from 2018 to 2021 in Washington State. We found that social vulnerability factors have non-linear relationships with outages. Wind and precipitation are consistent drivers of outage occurrence and duration. There are seasonal effects that vary by county-utility area. Both PowerOutage.us and federal datasets have missing and inaccurate outage data. This is the first study evaluating differential exposure to localized outages as related to social vulnerability that has accounted for weather and temporal correlation. There is a lack of transparency into power outage distribution for those most vulnerable to climate impacts, despite known contributions by electric utilities to climate change. For effective public health surveillance of power outages and transparency, outage data should be made available at finer spatial resolution and temporal scales and/or utilities should be required to report differential exposure to power outages for socially vulnerable populations.

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Little is known about Voluntary Assisted Partner Notification (VAPN) in groups in sub-Saharan Africa that experience marginalisation, and whether its use is suitable for referral to HIV care pathways. We conducted semi-structured in-depth interviews with purposively selected medical and health professionals (N = 15) regarding their perspectives and experiences with VAPN policy and its implementation. Data were analysed following a Reflexive Thematic Analysis approach. Respondents highlighted the flexibility in VAPN policy implementation and described adjustments made by health workers. Women were seen as vulnerable and lacked access to support against gender-based violence. Men who have sex with men could face exclusion from important social networks. Age-appropriate VAPN assistance was also considered unavailable for sexually active children. Embedding understandings of identity, belonging, and safety into VAPN could address individual priorities and needs. Community support networks, tailored care for children, and family-orientated approaches to HIV notification may overcome issues relating to vulnerability and marginalisation.

A qualitative analysis of voluntary assisted partner notificationLittle is known about Voluntary Assisted Partner Notification (VAPN) in groups in sub-Saharan Africa that experience marginalisation. We conducted semi-structured in-depth interviews with purposively selected medical and health professionals (N = 15) regarding their perspectives and experiences with VAPN policy and implementation. Data were analysed following a Reflexive Thematic Analysis approach. Respondents highlighted flexibility in VAPN policy implementation and described adjustments made by health workers. Women were seen as vulnerable and lacked access to support against gender-based violence. Men who have sex with men could face exclusion from important social networks. Age-appropriate VAPN assistance was also considered unavailable for sexually active children. Embedding understandings of identity, belonging, and safety into VAPN could address individual priorities and needs. Community support networks, tailored care for children, and family-orientated approaches to HIV notification may overcome issues relating to vulnerability and marginalisation.

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The nation's child welfare system serves the most vulnerable youth and families and so has been impacted dramatically by the coronavirus disease 2019 pandemic with decreases of abuse reporting, delayed toward permanency, and increased disproportionality. Youth in foster care have increased likelihood of boarding in hospital emergency rooms or nontraditional placements. These issues are magnified in exceptional vulnerable populations such as American Indian and Alaska Native children. The child welfare response to the national mental health crisis offers opportunities to redress chronic gaps and vulnerabilities within the systems of care serving these youth.

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BACKGROUND: Child protective services (CPS) reports are spatially concentrated in disadvantaged neighborhoods and Black children are more likely than White children to reside in these neighborhoods. Entrenched patterns of racial residential segregation reflect the lasting impact of historical redlining - a racist practice spearheaded by the federally sponsored Home Owners' Loan Corporation (HOLC) in the 1930s that assigned worst risk grades to minoritized neighborhoods. Research has established links between historically redlined areas and the present-day wellbeing of children and families; however, little is known about the relationship between historical redlining and CPS report rates in neighborhoods. OBJECTIVE: Using census tracts as a proxy for neighborhood, this study examines the relationship between historical redlining and the number of CPS reports within neighborhoods. PARTICIPANTS, SETTING, AND METHOD: This study combines data on HOLC risk grades and sociodemographic data from the American Community Survey with the aggregate number of CPS reports per census tract in Los Angeles County, CA (n = 1137). RESULTS: We used Bayesian conditionally autoregressive models to examine the relationship between historical redlining score (A = 1, B = 2, C = 3, D = 4) and the number of CPS reports within neighborhoods. In the unadjusted model, each unit increase in redlining score is associated with a 21.6 % higher number of CPS reports (95 % CI; 1.140, 1.228). In adjusted models that included concentrated disadvantage, each unit increase in redlining score is associated with a 7.3 % higher number of CPS reports (95 % CI; 1.021, 1.136). CONCLUSION: Housing policy reforms through a racial equity lens should be considered as a part of a national strategy to prevent child maltreatment.

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OBJECTIVE: Considerable disparities exist in access to gastrointestinal (GI) care and digestive outcomes across gender, racial, and socioeconomic groups. We evaluated (1) whether adults with chronic GI symptoms from diverse demographic groups would use a digital digestive care programme and (2) the effects of participation on GI symptom severity and other patient-reported outcomes. METHODS: Access to a digital digestive chronic care programme was provided to participants regardless of prior digestive diagnoses or symptoms for 90 days. The intervention included GI symptom tracking, personalised medical nutrition therapy, GI-specific health coaching, and targeted education on common GI symptoms. We assigned a Social Vulnerability Index (SVI) score to each participant according to their home address and compared baseline and end-intervention symptoms and other patient-reported outcomes by gender, race/ethnicity, and SVI. RESULTS: Of the 1936 participants, mean age was 43.1 years; 67% identified as white/Caucasian, 11% Asian/Pacific Islander, 6% Hispanic/Latinx, 7% black/African American, and 7% of multiple races. Participants of all demographic groups used the app symptom logging, reviewed educational materials, and interacted with their care team and reported similar statistically significant improvements in GI symptoms (by the end of the intervention, 85% improved, p<0.05). Participants reported feeling greater control of their health (83%), better able to manage their digestive symptoms (83%), increased happiness (76%), and greater productivity at work (54%), with black/African Americans and Native Americans most likely to report these changes. CONCLUSION: We conclude that a digital GI disease management programme may be of value in reducing disparities in access to GI care.

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BACKGROUND: There is evidence youth in foster care may be vulnerable to commercial and sexual exploitation of children (CSEC) in the U.S. Youth in care may show vulnerabilities such as running away, identifying as sexual/gender minorities, or exhibiting complex behavioral and mental health needs. However, the nature and nuances of the relationship between CSEC and foster care placements has been largely unexamined. OBJECTIVES: This review explores the literature on trafficking among foster care youth to establish what is known about risk factors, vulnerable populations, and leverage points for prevention and intervention. METHODS: This scoping review was conducted using PRISMA-ScR guidelines. Eight databases were searched, and the screening process resulted in 16 final articles in the analysis. RESULTS: Sixteen articles were screened into the current study. In reviewing the content, a few distinct themes emerged. First, the articles focused on three different populations of CSEC youth. Second, there was variability in the definitions of CSEC used by scholars. Third, there was a range of terms used to describe youth who were trafficked. Finally, there were broad differences in study methodology. This included the data sources used and the array of outcomes explored (e.g. substance use, mental health diagnoses, housing stability). CONCLUSIONS: It is important for scholars to use common language and definitions when studying the sex trafficking of minors. Developing national databases and improving state and federal data sharing is needed to inform prevalence estimates and explore various pathways to youth experiencing CSEC.

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OBJECTIVE: People living in socioeconomically disadvantaged neighbourhoods in Sweden engage less in physical activity compared with the general population, contributing to an elevated risk of cardiometabolic diseases. To inform targeted and effective public health interventions, understanding residents' lived experiences is essential. This study sought to understand the values and priorities associated with physical activity by people living in a socioeconomically disadvantaged neighbourhood in Region Uppsala, Sweden, informing a public health intervention to prevent cardiometabolic diseases and promote healthy and active living. DESIGN: The study employed a photo-elicitation methodology, combining participants' photographs with semistructured interviews. Data were analysed using reflexive thematic analysis. SETTING: A socioeconomically disadvantaged neighbourhood in the city of Uppsala, Sweden, characterised by a large proportion of households with low income, a large percentage of individuals living on economic aid, high unemployment rates, low educational attainment and high levels of poor health. PARTICIPANTS: A total of 15 participants (8 women and 7 men) were purposively sampled between February and August 2023 and recruited via fieldwork, social media and local stakeholders. RESULTS: Participants described challenging conditions for physical activity, including conflicting values and priorities between themselves and the local authorities. Four main areas emerged as sources of tension; difficulties influencing decision-making processes affecting the neighbourhood, unmet needs of gender-separated physical activity spaces, discrepancy between the perceived pressure and individual motivation to be active, and their perception of health being solely an individualised responsibility, but their need of support. CONCLUSIONS: This study underscores the importance of understanding and navigating the values and priorities influencing physical activity among residents in a socioeconomically disadvantaged neighbourhood, when designing public health interventions. Findings reveal that residents' needs for being physically active are not met by the authorities who are perceived to have different priorities, and that the lack of influence of citizen voices undermines trust in the local authorities.

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Several individual-based social deprivation and vulnerability indices have been developed to measure the negative impact of low socioeconomic status on health outcomes. However, their variables and measurable characteristics have not been unequivocally assessed. A comprehensive database literature scoping review was performed to identify all individual-based social deprivation and vulnerability indices. Area-based indices and those developed for pediatric populations were excluded. Data were extracted from all eligible studies and their methodology was assessed with quality criteria. A total of 14 indices were identified, of which 64% (9/14) measured social deprivation and 36% (5/14) measured socioeconomic vulnerability. Sum of weights was the most common scoring system, present in 43% (6/14) of all indices, with no exclusive domains to either vulnerability or deprivation indices. A total of 83 different variables were identified; a very frequent variable (29%; 5/14) related to an individual's social relationships was "seen any family or friends or neighbors." Only five deprivation indices reported a specific internal consistency measure, while no indices reported data on reproducibility. This is the first scoping review of individual-based deprivation and vulnerability indices, which may be used interchangeably when measuring the impact of SES on health outcomes.

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BACKGROUND: Despite the decline in tuberculosis (TB) incidence across many regions worldwide, including Ethiopia, the disease remains highly concentrated among vulnerable or socially marginalized populations and in high-risk settings. This systematic review and meta-analysis aims to estimate the pooled prevalence of pulmonary tuberculosis (PTB) among key and vulnerable populations (KVPs) residing in hotspot settings in Ethiopia. METHODS: Potential papers were searched systematically in PubMed, Scopus, ScienceDirect databases, Google Scholar search engine, and institutional electronic repositories/registrars. A total of 34 potential articles that provide necessary information on the prevalence of PTB were reviewed and data were analyzed to determine the pooled prevalence of PTB among KVPs. The relevant data were recorded and analyzed using STATA 17.0. Cohen's kappa was computed to determine the agreement between reviewers, the Inverse of variance (I2) to evaluate heterogeneity across studies, and Egger's test to identify publication bias. A random effect model was used to determine the pooled prevalence of PTB, subgroup analysis was computed by types of hotspot settings and year of publication. RESULTS: This meta-analysis demonstrates that the pooled prevalence of PTB among populations residing in hotspot settings in Ethiopia was 11.7% (95% confidence interval (95CI): 7.97-15.43) with an I2 of 99.91% and a p< 0.001. Furthermore, the subgroup analysis unveiled the pooled prevalence of PTB among KVPs residing in different hotspot settings as follows: Prison inmates 8.8% (95CI: 5.00-12.55%), University students 23.1% (95CI: 15.81-30.37%), Refugees 28.4% (95CI: -1.27-58.15%), Homeless peoples 5.8% (95CI: -0.67-12.35%), Healthcare settings 11.1% (95CI: 0.58-21.63%), Spiritual holy water sites attendees 12.3% (95CI: -6.26-30.80%), and other high-risk settings 4.3% (95CI: 0.47-8.09%). Besides, the subgroup analysis revealed that the pooled prevalence of PTB post-2015 was 10.79% (95CI: 5.94-15.64%), whereas it stood at 14.04% (95CI: 10.27-17.82%) before 2015. CONCLUSION: The prevalence of PTB among KVPs residing in the hotspot settings in Ethiopia remains significant, with a weighted pooled prevalence of 11.7%. Thus, the national TB control programs should give due attention and appropriate control measures should be instituted that include regular systematic TB screening, compulsory TB testing for presumptive TB cases among KVPs, and tightened infection control at hotspot settings.

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Ethics standards reference the need for special consideration of vulnerable populations, such as pregnant women, incarcerated individuals, and minors. The concept of vulnerability is poorly conceptualized in the medical sciences where it originated, and its application to the social sciences is even more challenging. Social science researchers may unwittingly fail to appreciate preexisting vulnerabilities and indeed may be responsible for inducing new research-related vulnerability. In this paper, we present the first comprehensive coding of country-level vulnerability designations. Specifically, we coded all 355 official documents governing social/behavioral human subjects research for the 107 countries with such regulations and identified 68 distinct vulnerability categories. The data reveal substantial regional variation, overemphasis of categories derived from medical sciences, neglect of critical categories such as displacement, and likely heterogeneity within and across groups. The article provides a conceptual framework that shifts the problem away from static, enumerated categories toward emphasis on research-induced vulnerability. Based on our conceptualization and coding, we present a framework for assessing vulnerability and implementing appropriate protections.

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In September 2020, the National Institutes of Health acted in response to the COVID-19 pandemic, recognizing the critical need to combat misinformation, particularly in communities disproportionately affected by the crisis. The Community Engagement Alliance (CEAL) emerged as an initiative dedicated to fostering reliable, science-based information, diversity, and inclusion; aiming to implement effective strategies to mitigate the spread of COVID-19 nationwide. One of the teams participating in this initiative is Puerto Rico-CEAL (PR-CEAL). Our whose goal was to raise awareness about the coronavirus disease and advance research, mainly focusing on vulnerable and underserved populations. This concept paper seeks to outline PR-CEAL's infrastructure during its initial two cycles, providing insights into the research and community engagement activities designed to enhance prevention, counter misinformation, and foster awareness and uptake of COVID-19 vaccines. Ultimately, our objective is to reflect on the strengths and challenges encountered thus far as we endeavor to sustain this robust infrastructure, addressing ongoing public health issues with a forward-looking approach.

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BACKGROUND: COVID-19 protective behaviors are key interventions advised by the World Health Organization (WHO) to prevent COVID-19 transmission. However, achieving compliance with this advice is often challenging, particularly among socially vulnerable groups. OBJECTIVE: We developed a social vulnerability index (SVI) to predict individuals' propensity to adhere to the WHO advice on protective behaviors against COVID-19 and identify changes in social vulnerability as Omicron evolved in African countries between January 2022 and August 2022 and Asia Pacific countries between August 2021 and June 2022. METHODS: In African countries, baseline data were collected from 14 countries (n=15,375) during the first Omicron wave, and follow-up data were collected from 7 countries (n=7179) after the wave. In Asia Pacific countries, baseline data were collected from 14 countries (n=12,866) before the first Omicron wave, and follow-up data were collected from 9 countries (n=8737) after the wave. Countries' socioeconomic and health profiles were retrieved from relevant databases. To construct the SVI for each of the 4 data sets, variables associated with COVID-19 protective behaviors were included in a factor analysis using polychoric correlation with varimax rotation. Influential factors were adjusted for cardinality, summed, and min-max normalized from 0 to 1 (most to least vulnerable). Scores for compliance with the WHO advice were calculated using individuals' self-reported protective behaviors against COVID-19. Multiple linear regression analyses were used to assess the associations between the SVI and scores for compliance to WHO advice to validate the index. RESULTS: In Africa, factors contributing to social vulnerability included literacy and media use, trust in health care workers and government, and country income and infrastructure. In Asia Pacific, social vulnerability was determined by literacy, country income and infrastructure, and population density. The index was associated with compliance with the WHO advice in both time points in African countries but only during the follow-up period in Asia Pacific countries. At baseline, the index values in African countries ranged from 0.00 to 0.31 in 13 countries, with 1 country having an index value of 1.00. The index values in Asia Pacific countries ranged from 0.00 to 0.23 in 12 countries, with 2 countries having index values of 0.79 and 1.00. During the follow-up phase, the index values decreased in 6 of 7 African countries and the 2 most vulnerable Asia Pacific countries. The index values of the least vulnerable countries remained unchanged in both regions. CONCLUSIONS: In both regions, significant inequalities in social vulnerability to compliance with WHO advice were observed at baseline, and the gaps became larger after the first Omicron wave. Understanding the dimensions that influence social vulnerability to protective behaviors against COVID-19 may underpin targeted interventions to enhance compliance with WHO recommendations and mitigate the impact of future pandemics among vulnerable groups.

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