Determinants of adult sedentary behavior and physical inactivity for the primary prevention of diabetes in historically disadvantaged communities: A representative cross-sectional population-based study from Reunion Island.

Populations undergoing extensive and rapid socio-economic transitions including historically disadvantaged communities face an increased risk of type-2 diabetes (T2D). In recent years, sedentary behavior and physical inactivity have been considered modifiable determinants when developing primary prevention programs to reduce T2D incidence. Reunion Island is a French overseas department with an increasing T2D population and a high level of socio-economic inequality. The objectives of our study were to identify the individual, social, and environmental factors associated with sedentary behavior and physical inactivity among the Reunion Island adult population, and to highlight these findings in order to propose T2D primary prevention strategies aiming at alleviating local social inequalities in health (SIH). In 2021, we conducted a population-based cross-sectional telephone survey using random sampling. Participants included adults over 15 years old living in ordinary accommodation on Reunion Island (n = 2,010). Using a sequential approach, multinomial logistic regression model (explaining 3 profiles of interest: sedentary/inactive, sedentary/active, non-sedentary/inactive), and sampling-design weighted estimates, we found that 53.9% [95% confidence interval: 51.1 to 56.7%] of participants had sedentary behavior and 20.1% [95% CI: 17.8 to 22.5%] were inactive. Abandoning physical activity due to the COVID-19 pandemic (p<0.001), final secondary school diploma or above (p = 0.005), student as professional status (p≤0.005) and living in fewer poor neighborhoods located far from city centers (p = 0.030) were four conditions independently associated with sedentary/inactive and/or sedentary/active profiles. Based on these findings, to help reduce SIH, we used a typology of actions based on the underlying theoretical interventions including four main action categories: strengthening individuals (using person-based strategies), strengthening communities, improving living and working conditions, and promoting health-based macro-policies. Our findings suggest several directions for reducing lifestyle risk factors and enhancing T2D primary prevention programs targeting psychosocial, behavioral, and structural exposures.

Mapping Vulnerability to Potential Crisis Events in Surabaya City: A GIS-Based Approach.

Background: This study aims to develop a vulnerability map for Surabaya using GIS-based Multi-Criteria Decision Analysis (MCDA) to assess the city's vulnerability to COVID-19. Methods: Six key factors influencing vulnerability were identified and their relative importance determined through the Analytic Hierarchy Process (AHP) pairwise comparison matrix. GIS was utilized to classify Surabaya's vulnerability into five levels: very low, low, medium, high, and very high. Results: The resulting vulnerability map provides essential insights for decision-makers, healthcare professionals, and disaster management teams. It enables strategic resource allocation, targeted interventions, and formulation of comprehensive response strategies tailored to specific needs of vulnerable districts. Conclusions: Through these measures, Surabaya can enhance its resilience and preparedness, ensuring the well-being of its residents in the face of potential emergency outbreaks.

How An Academic Direct Primary Care Clinic Served Patients from Vulnerable Communities.

PURPOSE: Direct primary care (DPC) critics are concerned that the periodic fee precludes participation from vulnerable populations. The purpose is to describe the demographics and appointments of a, now closed, academic DPC clinic and determine whether there are differences in vulnerability between census tracts with and without any clinic patients. METHODS: We linked geocoded data from the DPC's electronic health record with the social vulnerability index (SVI). To characterize users, we described their age, sex, language, membership, diagnoses, and appointments. Descriptive statistics included frequencies, proportions or medians, and interquartile ranges. To determine differences in SVI, we calculated a localized SVI percentile within Harris County. A t test assuming equal variances and Mann-Whitney U Tests were used to assess differences in SVI and all other census variables, respectively, between those tracts with and without any clinic patients. RESULTS: We included 322 patients and 772 appointments. Patients were seen an average of 2.4 times and were predominantly female (58.4%). More than a third (37.3%) spoke Spanish. There was a mean of 3.68 ICD-10 codes per patient. Census tracts in which DPC patients lived had significantly higher SVI scores (ie, more vulnerable) than tracts where no DPC clinic patients resided (median, 0.60 vs 0.47, p-value < 0.05). CONCLUSION: This academic DPC clinic cared for individuals living in vulnerable census tracts relative to those tracts without any clinic patients. The clinic, unfortunately, closed due to multiple obstacles. Nevertheless, this finding counters the perception that DPC clinics primarily draw from affluent neighborhoods.

Pooled prevalence of malaria and associated factors among vulnerable populations in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Malaria is a serious, fatal disease, and a high-risk determinant for human health globally. Children, pregnant women, and migrants are vulnerable groups for malaria infection in African regions. Recently, malaria is an endemic disease in Ethiopia. OBJECTIVES: This study aimed to determine the pooled prevalence of malaria and its determinant factors among the most vulnerable populations in Ethiopia. METHODS: Electronic databases, including PubMed, Google Scholar, Web of Science, Semantic Scholar, and Scopus were used for searching articles published since the 2020 Gregorian calendar and onwards. All peer-reviewed Ethiopian journals, health institutions, and Universities were considered for article searching. A PRISMA flow chart and Endnote software were used for article screening, and to remove duplications, respectively. The modified version of the Newcastle-Ottawa Scale was used for potential risk of bias assessments. The heterogeneity among the included studies was evaluated using the indicator of heterogeneity (I2). Egger's test and funnel plot were used to examine the possible publication bias. A random-effects analysis was used to assess the pooled prevalence of malaria, and its determinant factors with a 95% CI. The screening process, data extraction, and quality assessment were done independently, and any disagreements were resolved through discussions. RESULTS: A total of twelve studies were included in this study. The pooled malaria prevalence was 11.10% (95% CI: 6.10, 16.11). Stagnant water (AOR: 4.19, 95% CI: 2.47, 7.11), no insecticide-treated net utilization (AOR: 3.15, 95% CI: 1.73, 5.73), and staying outdoors at night (AOR: 5.19, 95% CI: 2.08, 12.94) were the pooled estimated statistically risk factors for malaria prevalence. Whereas, insecticide-treated bed net utilization (AOR: 1.59, 95% CI: 0.23, 10.95) reduces the risk of malaria infection. CONCLUSIONS: The pooled prevalence of malaria is high among vulnerable populations. Creating awareness regarding utilization of insecticide-treated bed nets, and draining stagnant water from the environment are possible interventions to reduce the prevalence of malaria.

Pediatric trauma during the COVID-19 lockdown: caregiver abuse and self-harm in a vulnerable population.

PURPOSE: This retrospective cohort study explores the impact of the COVID-19 pandemic on pediatric trauma cases in Singapore's National University Hospital from January 2015 to July 2021. The pandemic prompted unprecedented measures, altering societal dynamics. The study hypothesizes a reduction in major trauma incidents during the pandemic period. METHODS: This is a single-center retrospective study including all pediatric patients presenting with trauma-related ICD-9 codes, and an Injury Severity Score (ISS) greater than 8. Patients were stratified into two time periods: pre-pandemic (January 2015 to March 2020) and pandemic (April 2020 to July 2021) periods. RESULTS: Out of 254 pediatric trauma cases, 201 occurred pre-pandemic, and 53 during the pandemic. While overall trauma incidence remained similar, the pandemic period saw a shift in injury patterns. Home-based falls increased, vehicular accidents decreased, while deliberate self-harm and caregiver abuse rose significantly. The incidence of serious trauma attributed to non-accidental injury increased during the pandemic. CONCLUSION: The study reveals changing trauma patterns, emphasizing the importance of understanding societal impacts during pandemics. Notably cases of deliberate self-harm and caregiver abuse surged, echoing global concerns highlighted in other studies during the pandemic. The study underscores the need to preempt physical and psychological stressors in vulnerable populations during future pandemics.

Women's empowerment, household dietary diversity, and child anthropometry among vulnerable populations in Odisha, India.

Women's empowerment has been promoted by researchers and development practitioners as one of the most promising strategies to address widespread hunger and malnutrition. However, the relationship between women's empowerment and dietary diversity and child nutrition has rarely been studied among vulnerable populations or individuals at greater risk of poor physical and social health status. Moreover, the effects of different domains of women's empowerment on nutritional outcomes, including dietary diversity and child anthropometry, have rarely been examined, especially with panel data. Using two rounds of panel data from 1900 households and fixed effects regression models, we analyze the effect of women's empowerment on household dietary diversity score (HDDS) and child anthropometry among the particularly vulnerable tribal groups in Odisha, India. We also estimate the effects of various decision-making domains of women's empowerment on HDDS and child anthropometry to understand which empowerment domains matter for nutrition. Results show that women's empowerment is positively associated with HDDS (coef. 0.41 food groups; p < 0.1) and reduces the prevalence of underweight (coef. 39%; p < 0.05) and wasting (coef. 56%; p < 0.1) in children but has no effect on the prevalence of child stunting. Women's empowerment in agricultural input use; output sales; income; food purchases; and credit, group membership, and employment contribute to improved dietary diversity and child nutrition. We conclude that women's empowerment contributes to improved dietary diversity and child nutrition and is a promising strategy to improve farm household diets and child nutrition among vulnerable populations. Strengthening women's empowerment through the promotion of women's access to land and other agricultural inputs, market participation, access to information, capital, and credit is important.

Lessons from the COVID-19 pandemic: the unequal burden of COVID-19 on vulnerable populations in the Brazilian Central-West.

This study aimed to estimate the prevalence and identify social factors and preventive strategies associated with the coronavirus disease 2019 (COVID-19) in socio and economically vulnerable people (recyclable waste pikers, immigrants/refugees, and homeless people) in Goiânia, Goiás State, Central-Western Brazil. A cross-sectional study was conducted from July 2020 to October 2020. COVID-19 positivity was defined as a positive total anti-SARS-COV-2 antibody test and/or RNA test for SARS-COV-2. Univariable and multiple regression analyses were performed to identify the variables associated with COVID-19. Of the 594 participants, 47.3% were recyclable waste pickers, 29.6% were immigrants/refugees, and 23.1% were homeless people. The positivity for SARS-CoV-2 RNA was 14.1%, whereas for anti-SARS-CoV-2 a total of 30.8% were positive, and 39.4% were positive for at least one COVID-19 marker. Among the 541 individuals, being immigrants/refugees, not wearing a surgical mask, and having three or more people sleeping in the same room were associated with SARS-CoV-2 infection, while using TV news as the main source of information about the pandemic was a protective predictor of COVID-19. This study revealed ethnic and socioeconomic inequalities in the prevalence of COVID-19 among impoverished people in Brazil. Additionally, a high prevalence of COVID-19 was detected in all three groups. Developing new strategies to combat and prevent communicable diseases affecting this population is essential for mitigating future and ongoing pandemics.

How Community-Based Organizations Responded to the Covid-19 Crisis to Maintain HIV Services Among Vulnerable Populations in Burundi, Mauritania, and Lebanon: Qualitative Results From the Multicountry EPIC Program.

Little is known about the adaption of community-based organizations (CBOs) during the COVID-19 crisis. This study aimed to study how HIV CBOs and their community health workers (CHWs) faced the COVID-19 outbreak. Semi-structured interviews (n = 53) were conducted among CHWs in Burundi, Mauritania, and Lebanon in 2021. A thematic content analysis was performed. Results showed that CBOs had succeeded in maintaining HIV services and integrated COVID-19 prevention and awareness in their activities. COVID-19 led to innovation in terms of HIV services (eg, telemedicine and online psychosocial support) and to opportunities to try new modalities of antiretroviral therapy dispensation. Field workers (a specific group among CHWs) were negatively impacted by the COVID-19 crisis and showed resilience in their adaptation to ensure the continuity of their activities. Considering the essential role of field workers during the crisis, their status and the sustainability of their activities should be clearly supported by health policies and programs.

Role of community health workers during the COVID-19 pandemicThis study explores how HIV community-based organizations (CBOs) and their community health workers (CHWs) adapted during the COVID-19 pandemic. We conducted interviews with 53 CHWs from Burundi, Mauritania, and Lebanon in 2021 to understand their experiences. We found that despite the challenges posed by COVID-19, CBOs managed to continue providing essential HIV services. They also incorporated COVID-19 prevention and awareness efforts into their work. The pandemic prompted innovation, such as the use of telemedicine and online psychosocial support, and provided opportunities to explore new ways of dispensing antiretroviral therapy (ART). However, field workers, a specific group of CHWs, faced significant negative impacts due to the pandemic. Despite these challenges, they showed remarkable resilience and adapted to ensure the continuity of their services. Given the critical role of field workers during the crisis, it is important for health policies and programs to support their status and ensure the sustainability of their activities.

Food insecurity amongst asylum seekers and people without status in Israel.

BACKGROUND: The COVID-19 pandemic caused massive disruptions globally, with food insecurity a primary concern amongst vulnerable communities. As one of the most marginalized and vulnerable groups in Israeli society asylum seekers and undocumented populations were amongst the first to be affected by the pandemic and the economic crisis that followed. The objective of the study was to evaluate the severity and causes of food insecurity among asylum seekers and other undocumented communities because of COVID-19. METHODS: A multi method approach was used. The quantitative component included an online questionnaire regarding access to food, aid and choices, and the 6 item Household Food Security Survey Module (HFSSM) The qualitative component included 4 focus groups and thematic analysis. The study was conducted in November 2020, by the Ministry of Health's Nutrition Division and the Tel Aviv Municipality's foreign community assistance and information center (Mesila). The convenience sample was drawn from the low-income neighborhood population of South Tel Aviv. Logistic regression, multivariate analysis and content analysis, were performed. RESULTS: Four hundred eighty-five people completed the quantitative survey, with average age 33.2 ± 5.4 years and 349 (72.0%) experienced food insecurity. In the multivariate analysis, being older (p = 0.04, Odds Ratio OR 1.1, Confidence Interval CI 1.05-1.15) and being single (unmarried) (p = 0.03, OR 2.1, CI 1.2, 3.5) predicted food insecurity. Qualitative findings identified three main themes: children preferring Israeli/ Western foods to traditional foods; financial stresses were compounded; a preference for receiving assistance with purchasing food (vouchers), rather than food handouts. CONCLUSION: In conclusion, vulnerable populations (asylum seekers and other undocumented communities) were severely affected and are in danger of food insecurity. Culturally relevant and contextualized solutions are needed to address the acute hunger within the community. These include establishment of a cross-ministerial forum, a social grocery store, increased liaison with food rescue bodies, complete nutritional support for children in educational settings and increased guidance regarding food choices and budgeting.

Fuzzy Logic: vulnerability of women who have sex with women to sexually transmitted infections.

OBJECTIVE: To describe the possibility of applying Fuzzy Logic in analyzing the vulnerability of Women Who Have Sex with Women to Sexually Transmitted Infections/HIV/AIDS. METHODS: We developed a Fuzzy Logic system with 17 input variables and one output variable, using data related to vulnerability in a municipality located in the Midwest region of the State of São Paulo, Brazil. RESULTS: The factor with the greatest positive impact was the confirmation that a low understanding of Sexually Transmitted Infections/HIV/AIDS is associated with higher vulnerability. Conversely, the statement "Not disclosing sexual activity to healthcare professionals," where individuals do not admit to having sex with women, had the least impact. CONCLUSIONS: Fuzzy Logic facilitates the identification of vulnerability, expressed through the analysis of interaction between variables in each dimension. This makes it a promising method to assist in analyzing the vulnerability of specific populations.

Mass Incarceration, Maternal Vulnerability, and Birth Outcomes Across U.S. Counties.

OBJECTIVES: To examine the associations among mass incarceration, maternal vulnerability, and disparities in birth outcomes across U.S. counties, utilizing an ecological model and reproductive justice perspective was used. This study tests whether mass incarceration is associated with infant mortality and low birthweight across U.S. counties, and whether maternal vulnerability explains the relationship between mass incarceration and birth disparities. METHODS: Data were derived from a variety of public sources and were merged using federal FIPS codes. Outcomes from the CDC Vitality Statistics include percent low birth weight births (births below 2499 g divided by singleton births to women aged 20 to 39) and infant mortality (infant deaths per 1000 live births). Black-White rate ratios were calculated for the birth outcomes to specifically examine the large Black-White disparity in birth outcomes. The analysis controlled for urbanicity, income inequality, median household income, residential segregation, and southern region, as well as a fixed effect for state level differences. RESULTS: Findings show that counties with higher rates of incarceration have higher prevalence of infant mortality and low birthweight, as well as greater Black-White disparity in infant mortality. Mass incarceration is associated with increases in adverse birth outcomes and maternal vulnerability partially mediates this relationship. CONCLUSIONS: Findings provide evidence that heightened levels of incarceration affect birth outcomes for all residents at the county-level. It is imperative to address the overuse of mass incarceration in order to support adequate reproductive healthcare of vulnerable populations in the United States.

Climate change and public health in California: A structured review of exposures, vulnerable populations, and adaptation measures.

California faces several serious direct and indirect climate exposures that can adversely affect public health, some of which are already occurring. The public health burden now and in the future will depend on atmospheric greenhouse gas concentrations, underlying population vulnerabilities, and adaptation efforts. Here, we present a structured review of recent literature to examine the leading climate risks to public health in California, including extreme heat, extreme precipitation, wildfires, air pollution, and infectious diseases. Comparisons among different climate-health pathways are difficult due to inconsistencies in study design regarding spatial and temporal scales and health outcomes examined. We find, however, that the current public health burden likely affects thousands of Californians each year, depending on the exposure pathway and health outcome. Further, while more evidence exists for direct and indirect proximal health effects that are the focus of this review, distal pathways (e.g., impacts of drought on nutrition) are more uncertain but could add to this burden. We find that climate adaptation measures can provide significant health benefits, particularly in disadvantaged communities. We conclude with priority recommendations for future analyses and solution-driven policy actions.

Exploring psychosocial vulnerability among Dutch pregnant women: a register study.

In the Netherlands adverse perinatal outcomes are also associated with non-medical factors which vary across geographical locations. This study analyses the presence of non-medical vulnerabilities in pregnant women in two regions with high numbers of psychosocial adversity using the same definition for vulnerability in both regions. A register study was performed in 2 regions. Files from women in midwife-led care were analyzed using a standardized case report form addressing non-medical vulnerability based on the Rotterdam definition for vulnerability: measurement A in Groningen (n = 500), measurement B in South-Limburg (n = 538). Only in South-Limburg a second measurement was done after implementing an identification tool for vulnerability (C (n = 375)). In both regions about 10% of pregnant women had one or more urgent vulnerabilities and almost all of these women had an accumulation of several urgent and non-urgent vulnerabilities. Another 10% of women had an accumulation of three or more non-urgent vulnerabilities. This study showed that by using the Rotterdam definition of vulnerability in both regions about 20% of pregnant women seem to live in such a vulnerable situation that they may need psychosocial support. The definition seems a good tool to determine vulnerability. However, without considering protective factors it is difficult to establish precisely women's vulnerability. Research should reveal whether relevant women receive support and whether this approach contributes to better perinatal and child outcomes.

Provision of Stroke Care Services by Community Disadvantage Status in the US, 2009-2022.

Importance: Stroke center certification is granted to facilities that demonstrate distinct capabilities for treating patients with stroke. A thorough understanding of structural discrimination in the provision of stroke centers is critical for identifying and implementing effective interventions to improve health inequities for socioeconomically disadvantaged populations. Objective: To determine whether (1) hospitals in socioeconomically disadvantaged communities (defined using the Area Deprivation Index) are less likely to adopt any stroke certification and (2) adoption rates differ between entry-level (acute stroke-ready hospitals) and higher-level certifications (primary, thrombectomy capable, and comprehensive) by community disadvantage status. Design, Setting, and Participants: This cohort study used newly collected stroke center data merged with data from the American Hospital Association, Healthcare Cost Report Information datasets, and the US Census. All general acute hospitals in the continental US between January 1, 2009, and December 31, 2022, were included. Data analysis was conducted from July 2023 to May 2024. Main Outcomes and Measures: The primary outcome was the likelihood of hospitals adopting stroke care certification. Cox proportional hazard and competing risk models were used to estimate the likelihood of a hospital becoming stroke certified based on the socioeconomic disadvantage status of the community. Results: Among the 5055 hospitals studied from 2009 to 2022, 2415 (47.8%) never achieved stroke certification, 602 (11.9%) were certified as acute stroke-ready hospitals, and 2038 (40.3%) were certified as primary stroke centers or higher. When compared with mixed-advantage communities, adoption of any stroke certification was most likely to occur near the most advantaged communities (hazard ratio [HR], 1.24; 95% CI, 1.07-1.44) and least likely near the most disadvantaged communities (HR, 0.43; 95% CI, 0.34-0.55). Adoption of acute stroke-ready certification was most likely in mixed-advantage communities, while adoption of higher-level certification was more likely in the most advantaged communities (HR,1.41; 95% CI, 1.22-1.62) and less likely for the most disadvantaged communities (HR, 0.31; 95% CI, 0.21-0.45). After adjusting for population size and hospital capacity, compared with mixed-advantage communities, stroke certification adoption hazard was still 20% lower for relatively disadvantaged communities (adjusted HR, 0.80; 95% CI, 0.73-0.87) and 42% lower for the most disadvantaged communities (adjusted HR, 0.58; 95% CI, 0.45-0.74). Conclusions and Relevance: In this cohort study examining hospital adoption of stroke services, when compared with mixed-advantage communities, hospitals located in the most disadvantaged communities had a 42% lower hazard of adopting any stroke certification and relatively disadvantaged communities had a 20% lower hazard of adopting any stroke certification. These findings suggest that there is a need to support hospitals in disadvantaged communities to obtain stroke certification as a way to reduce stroke disparities.

Built Environment and Gender-Based Vulnerability as Key Drivers of Food Insecurity in Allegheny County.

Food insecurity is pervasive in Allegheny County, as one in five residents experiences food insecurity. Food insecurity is linked to chronic health conditions like heart disease and hypertension and disproportionately affects women in the United States, particularly women who are head of household. There are multiple dimensions used to measure regional disparities in food accessibility. Prior research has examined the linkages between food access and food insecurity, and this study aims to explore further the relationship between equitable access to sustainable and affordable food sources. This study examines food outlets in Allegheny County to determine if there is a significant relationship between food outlet availability and food insecurity. Both the presence and accessibility of these food outlets were examined. To measure accessibility, the walking distance to the nearest public transportation stop was calculated for each public transportation stop. The minimum distance to each food outlet was compared to food insecurity rates on a census tract level. Results showed that communities without grocery stores had lower access to healthy and affordable food sources. Also, communities with a higher proportion of female-headed households experienced greater food insecurity, regardless of access to food outlets. There was no statistically significant relationship between the distance from public transportation stops to grocery stores and rates of food insecurity overall and in low-income communities. However, communities with inaccessible grocery stores, either absent in the census tract or without close public transport stops, did have even greater average rates of food insecurity if there was an above-average proportion of female-headed households. Based on these findings, it is evident there exist structural elements of the built environment that correspond with disproportionate rates of food insecurity experienced by communities with households that are predominately female headed. In addition to resource support for these marginalized groups, we suggest that sole reliance on distance as an indicator of food insecurity can be misleading. There should be a greater focus on walkability aggregated on a household or individual level within the community instead of physical distance alone at a general scale.