Socio-geographical factors and vulnerability to leptospirosis in South Brazil.

BACKGROUND: Leptospirosis, caused by the Leptospira bacteria, is an acute infectious disease that is mainly transmitted by exposure to contaminated soil or water, thereby presenting a wide range of subsequent clinical conditions. This study aimed to assess the distribution of cases and deaths from leptospirosis and its association with social vulnerability in the state of Rio Grande do Sul, Brazil, between 2010 and 2019. METHODS: The lethality rates and incidence of leptospirosis and their association with gender, age, education, and skin color were analyzed using chi-square tests. The spatial relationship between the environmental determinants, social vulnerability, and the incidence rate of leptospirosis in the different municipalities of Rio Grande do Sul was analyzed through spatial regression analysis. RESULTS: During the study period, a total of 4,760 cases of leptospirosis, along with 238 deaths, were confirmed. The mean incidence rate was 4.06 cases/100,000 inhabitants, while the mean fatality rate was 5%. Although the entire population was susceptible, white-colored individuals, males, people of the working-age group, along with less-educated individuals, were more affected by the disease. Lethality was higher in people with dark skin, and the prime risk factor associated with death was the direct contact of the patients with rodents, sewage, and garbage. The social vulnerability was positively associated with the incidence of leptospirosis in the Rio Grande do Sul, especially in municipalities located in the center of the state. CONCLUSIONS: It is evident that the incidence of the disease is significantly related to the vulnerability of the population. The use of the health vulnerability index showed great relevance in the evaluation of leptospirosis cases and can be used further as a tool to help municipalities identify disease-prone areas for intervention and resource allocation.

Satisfaction with oral health and associated factors among homeless people in Midwest Brazil.

BACKGROUND: Self-perceived oral health has been extensively investigated, but studies on homeless people are scarce, and there is currently no evidence from Latin America. OBJECTIVE: To investigate the prevalence and factors associated with satisfaction with the oral health of homeless individuals in one Brazilian capital of the Midwest region. SUBJECT AND METHODS: A cross-sectional study was carried out with 351 adult individuals attending a temporary public shelter who were interviewed about sociodemographic and psychosocial aspects, drugs use and oral health. The outcome was satisfaction with oral health (satisfied/dissatisfied). Pearson's chi-square test and Poisson regression with robust variance were used for statistical analysis. RESULTS: The prevalence of dissatisfaction with oral health was 68.9% (95% CI = 63.9-73.6). After adjusting for covariates, dissatisfaction was more frequent among individuals who were married/in a stable relationship (PR = 1.18; 95% CI = 1.02-1.36), with felt need for treatment (PR = 2.27; 95% CI = 1.23-4.17) or complete prosthesis (PR = 1.35; 95% CI = 1.18-1.55), and those who used illicit drugs in the past six months (PR = 1.22; 95% CI = 1.06-1.39). CONCLUSION: The prevalence of dissatisfaction with oral health in the homeless individuals studied was high and associated with their marital status, use of illicit drugs and self-reported need for dental treatment and complete prosthesis.

[Health equity and vulnerability in the access to COVID-19 vaccinesEquidad y vulnerabilidad en la salud respecto del acceso a las vacunas contra la COVID-19]. / Equidade e vulnerabilidade em saúde no acesso às vacinas contra a COVID-19.

The present article discusses the importance of equity in health care access with a focus on the acquisition and distribution of vaccines - strategic and essential inputs in the context of COVID-19. It also addresses aspects that increase the risk of transmission, reinfection, and emergence of new variants, such as fake news, pandemic denial, and the anti-vax movement, which perpetuate the epidemic cycle. The importance of planning and designing whole-of-society health policies to manage the pandemic, within a national and global context of joint control is underscored, considering the need to ensure universal and timely access to vaccines and inputs and to the logistics necessary for vaccination. Equity is examined as the global guiding principle in reducing COVID-19 vaccination vulnerability, with an emphasis on the Brazilian setting, where, despite a strong vaccination expertise, a scenario of decreasing investment in science and technology, precarious logistical infrastructure, and corruption endangers access to vaccines. Finally, possible paths that can be explored and transformed into initiatives to be performed by various sectors in society are presented - for example, the prioritization of regions or vulnerable social groups for vaccine distribution - to ensure that equity in health care access in terms of COVID-19 vaccine coverage is achieved.

En el presente artículo se aborda la importancia de la equidad en el acceso a los servicios de salud, reflexionando sobre la compra y la distribución de vacunas, que son insumos estratégicos y fundamentales en el contexto de la COVID-19. Se analizan también los aspectos que aumentan los riesgos de transmisión, reinfección y surgimiento de nuevas variantes, como son las noticias falsas, el negacionismo y el movimiento antivacunas, que perpetúan el ciclo epidémico. Se resalta la importancia de que todos los sectores de la sociedad elaboren planes y políticas de salud para el control de la pandemia en un contexto nacional y mundial de afrontamiento conjunto, considerando la necesidad de garantizar un acceso universal y oportuno a las vacunas y los insumos, así como los aspectos logísticos necesarios para su aplicación. Se examina la equidad como principio rector global para reducir la vulnerabilidad en el acceso a la vacunas contra la COVID-19, y se pone de relieve la situación de Brasil, donde, a pesar del amplio conocimiento experto sobre la vacunación, una situación en la que se observa un descenso de las inversiones en ciencia y tecnología, una logística precaria y la corrupción pone en riesgo el acceso a las vacunas. Por último, se presentan las vías que pueden explorarse y transformarse en acciones a emprender por parte de diversos sectores de la sociedad (por ejemplo, la priorización de regiones y grupos sociales vulnerables en la distribución de las vacunas) y que permitan alcanzar la equidad en el acceso a los servicios de salud en relación con la cobertura de la vacunación contra la COVID-19.

Impact of climate change on human health: evidence from riverine island dwellers of Bangladesh.

This study aims to explore the impact of climate change on health, including local adaptation strategies. A mixed-method approach has been used in this study. The results reveal that increasing the frequency of flooding, severity of riverbank erosion and drought, and rising disease outbreak are the highest indicators of climate change perceived by riverine island (char) dwellers, which is similar to the observed data. It also uncovers, approximately all respondents encounter several health-related issues during different seasons where prevailing cold and cough with fever, skin diseases, and diarrhoea are the leading ailments. Several adaptation strategies are accommodated by char inhabitants in order to enhance resilience against the climate change health impacts, but the paucity of money, disrupted communication, lack of formal health-care centre are the most obstacles to the sustainability of adaptation. This research recommends that healthcare-associated project should be performed through proper monitoring for exterminating char dwellers' health issues.

Dental vulnerability scale in primary health care: evidence of content and structure internal validity.

BACKGROUND: Access to oral health services remains a challenge in the Brazilian healthcare system, especially in the primary health care setting, where the use of a risk stratification tool that could identify individuals with higher dental vulnerability would be extremely valuable. However, there literature on this theme is scarce, and there is no validated instrument in Brazil that is capable of measuring dental vulnerability. Hence, this psychometric study aimed at the development and evaluation of content and internal structure validity of the Dental Vulnerability Scale for Primary Health Care (PHC). METHODS: The items were developed based on a qualitative exploratory analysis. A total of 172 items were prepared and submitted to a panel of specialists, with content validity analyzed with the Content Validity Ratio (CVR), resulting in an the initial version of the instrument composed by 41 items. Internal structure validity was analyzed by Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and by applying 3 reliability indicators (Cronbach's Alpha, McDonald's Omega and Greatest Lower Bound - GBL), with a sample of 1227 individuals. RESULTS: The final configuration indicated a scale of 15 items divided into 4 dimensions (overall health, oral health, infrastructure, and healthcare services) with explained variance of 72.11%. The factor loads varied from 0.37 to 0.96. The model adjustment indices were set at × 2/df(51) = 3.23, NNFI = 0.95, CFI = 0.98, GFI = 0.96, AGFI = 0.97, RMSEA = 0.04 and RMSR = 0.03. CONCLUSION: DVS presented satisfactory evidence of validity, indicating its suitability to be used by healthcare professionals, students and managers to plan oral health actions and services at PHC.

Spatial distribution of the "Mais Médicos (More Doctors) Program" and social vulnerability: an analysis of the Brazilian metropolitan regions.

BACKGROUND: The "Mais Médicos (More Doctors) Program" established in 2013 by the Brazilian Government aimed to reduce inequalities by means of an emergency provision of physicians, the improvement of medical care service in the Brazilian Unified Health System, and the expansion of medical education training in Brazil. In this context, equity should be considered when defining priorities and allocating resources. This study describes the distribution of physicians for the Program in five Brazilian metropolitan regions (MRs) and analyses whether the most vulnerable areas within each one of these regions had been prioritized in compliance with the legislation framework of the program. METHODS: This is a quantitative cross-sectional study. Official secondary data was analyzed to verify the relationship between the Index of Social Vulnerability, set up by the Institute of Applied Economic Research, and the physician allocation provided by the Program. The data were organized into categories and quintiles. For spatialization purposes, the QGIS 3.4 Madeira software was used. RESULTS: There are 2592 primary health care units, (in Portuguese, UBS), within the five MRs studied; 981 of these hosted at least one physician from the Program. In the Manaus, Recife, and the DF MRs, the 4th and 5th quintiles (the most vulnerable ones) hosted physicians in more significant proportions than the other quintiles, namely, 71.4%, 71.4%, and 52.2%, respectively, exceeding the national average (51.7%). It is worth mentioning that in the São Paulo MR, the units located in the most vulnerable quintiles (4th and 5th) also hosted physicians in proportions significantly higher than others (45.8%); however, this proportion did not reach 50%. There was no significant difference in the allocation of physicians in the Porto Alegre MR, indicating that there was no prioritization of the UBS according to vulnerability. CONCLUSIONS: These results appoint to the enormous gaps of vulnerability existing both between the analyzed MRs and internally in each one of them. It emphasizes the need for criteria for the allocation of physicians so as not to increase inequities. It also highlights the importance of the continuity of the "Mais Médicos (More Doctors) Program" in the metropolitan regions, above all, in areas of extreme vulnerabilities. On the other hand, they contribute to the national debate about the importance of public policies regarding constitutional rights related to access to health care and the relevance of primary care and the "Mais Médicos (More Doctors) Program" for the reduction of disparities regarding access to health care, especially for the citizens who live in regions of greater vulnerability, whether it is inside or outside large metropolitan regions.

Health vulnerabilities of readymade garment (RMG) workers: a systematic review.

BACKGROUND: There is a paucity of literature that addresses the health vulnerabilities of readymade garment (RMG) workers in South and Southeast Asian regions. Therefore, the aim of this systematic review is to identify the distinctive types of health vulnerabilities along with the causes and consequences of these vulnerabilities of the RMG workers in South and Southeast Asian regions. METHODS: Systematic review search methods were applied utilising the PRISMA protocol. Literature published between July 2007 to June 2017 on health vulnerabilities of the RMG workers of South and Southeast Asian countries were identified through electronic databases and manual searches. RESULTS: A total number of 19 studies (16 quantitative studies, 3 mixed-method studies) were included from the primary 17,001 papers identified. The quality of these studies was assessed by using the EPHPP (effective public health practice project) and the CASP (critical appraisal skills programme) tools. From the identified studies, 14 were considered 'strong,' with the remainder assessed as 'moderate' quality. The findings reported in these studies suggest that RMG workers of South and Southeast Asian countries are prone to several health vulnerabilities which include physical and psychological issues. Further, many of these health vulnerabilities arise from the nature of the RMG workplace, and include unhygienic and unsafe working environments, hazardous conditions of the factories, and lack of safety equipment. CONCLUSIONS: This systematic review suggests that RMG workers' health vulnerabilities are an emerging area of inquiry that needs to be better understood and solutions identified. Little is currently known about the distinctive types of health vulnerabilities of the RMG workers of these countries, other than Bangladesh and India, due to the lack of robust studies in other South and Southeast Asian countries. Although the health vulnerabilities of the Bangladeshi and Indian RMG workers have been previously highlighted, the health vulnerabilities arising from sudden disasters in the sector remain a neglected issue.

Ineffectiveness of information and access to health services: vulnerability to human papillomavirus.

AIM: To examine situations of vulnerability to human papillomavirus in the social representations of young women. BACKGROUND: Human papillomavirus is one of the most frequent sexually transmitted infections among women and constitutes a serious health problem among youth. This problem is embedded in psychosocial issues that promote situations of vulnerability and affect attitudes and behaviour in relation to prevention. METHODS: Qualitative study based on the theory of social representations, conducted among 64 female students in a high school in the city of Rio de Janeiro, Brazil. The study used personal semi-structured interviews, with a lexical analysis by Alceste 2010 software. FINDINGS: The inefficacy of information on the human papillomavirus pointed out individual and social vulnerabilities, and showed relationships between the difficulty of access and the perception of low quality in public health services, which also promotes institutional vulnerability. DISCUSSION: The representation of vulnerability to human papillomavirus infection is associated, not only with individual behaviours related to sexuality and gender identity but also to social and institutional conditions involving insufficient information and low quality of and ineffective access to public health services. CONCLUSION: Situations of vulnerability of young women to human papillomavirus infection influence ways of thinking and acting, when they generate feelings and behaviours that put them at risk. The social representations provided knowledge about how the participants appropriated consensual and reified universes in relation to vulnerability, influencing care and awareness of prevention. IMPLICATION FOR NURSING AND HEALTH POLICY: Situations of vulnerability, whether individual, social or institutional, warrant the attention of nurses and should be prioritized as public health policy goals to reduce the number of cases of human papillomavirus infection among younger women.

Assessing epidemiology of leprosy and socio-economic distribution of cases.

Leprosy still represents a serious health problem in a number of countries, including Brazil. Although leprosy has been associated with poverty for a long time, it is still difficult to accurately define this relationship. Here, we evaluated in an endemic municipality the progress from 1995 to 2015 of epidemiological indicators to establish if there were any strong associations between social indicators and the occurrence of leprosy. An ecological study was conducted using the SINAN database (Brazilian leprosy-national notifiable diseases information system) in combination with georeferencing of leprosy cases. The georeferencing used the ArcGis programme and occurrence of cases was evaluated in relation to the Health Vulnerability Index (HVI), an indicator that categorises socio-economic and sanitation factors. The data identified a marked decrease in the overall prevalence of leprosy, a reduction in the new case-detection rate and a reduction in the number of cases with grade 2 disabilities (albeit with transient peaks in 2007 and 2015). Logistic regression analysis showed association of detection rates with elevated HVI. Thus, while the epidemiological indicators point to the elimination of leprosy, there is evidence of hidden cases and an association between higher rates of leprosy detection and greater social vulnerability remain.

Female healthcare professionals' behaviour and attitudes in the context of the feminisation of HIV/AIDS: gender vulnerability analysis.

In only a few years, HIV/AIDS became a severe public health problem worldwide. More recently, the phenomenon of feminisation has substantially modified the epidemiological profile of the pandemic. Drawing on Grounded Theory, this qualitative, descriptive study examines the adoption of HIV/AIDS prevention measures and practices by women health professionals. Data were acquired by semi-structured interviews of 12 women working as health professionals providing care for HIV-seropositive women. Analysis of the results showed how, as women, the participants felt safe and protected against HIV in a so-called stable relationship, because they relied on factors such as trust in their companion, and perceived themselves as vulnerable and exposed to the risk of sexual contamination. As health professionals, they revealed concerns relating to care for women with HIV, ranging from speculations about how the women were contaminated, to the sensitivity, as women professionals, to put themselves in the place of the women with HIV and, also as professionals, expressed fear of contamination through accidents with biological material. It was concluded that, despite understanding the importance of adopting self-protective HIV-prevention measures and practices, they admitted the existence of vulnerability from occupational rather than sexual risk, and accordingly deployed protective measures against workplace accidents, but failed to use condoms and thus continued to be exposed to HIV in their sexual relations.

Assessing the Vulnerability and Adaptation Needs of Mozambique's Health Sector to Climate: A Comprehensive Study.

Climate change poses severe consequences, particularly in sub-Saharan Africa, where poverty rates may escalate by 2050 without significant climate and development action. The health impacts are diverse, encompassing communicable and non-communicable diseases. Mozambique, a climate-vulnerable nation, has experienced significant natural disasters in the past 42 years, impacting its health system. This study aims to assess Mozambique's health sector's vulnerability and adaptation needs to climate change. Following a methodology proposed by the World Health Organization and the Intergovernmental Panel for Climate Change, a six-step vulnerability and adaptation assessment was conducted to conduct the Health Vulnerability Index (HVI) for Mozambique's regions (n=161). The HVI integrates historical climate, epidemiological, and socio-economic data at the district level, and was computed using exposure, sensitivity, and adaptive capacity dimensions. The results revealed spatial patterns in exposure to climate variables, extreme weather events, and variations in sensitivity and adaptive capacity across the country. The HVI mirrored the exposure findings. Notably, high vulnerability was observed in several districts, while major urban centers displayed lower vulnerability. These findings highlight the country's vulnerability to climate change and underscore the potential for adverse impacts on livelihoods, the economy, and human health. The study provides a foundation for developing strategies and adaptation actions.

Association between the health vulnerability of family members and concern about the contagion of COVID-19 in Peruvian residents after the pandemic.

Background: The COVID-19 pandemic has created additional challenges for family health. Worry, fear, and anxiety associated with this disease can affect the perception of family health. The study's objective was to analyze the factors associated with health vulnerability of family members in the Peruvian population after pandemic. Methods: Observational, cross-sectional, and analytical study. Sampling was nonprobabilistic. The sample consisted of 519 residents who met the following inclusion criteria: Peruvian resident, of both genders, over 18 years of age, who lives with their family, and who agrees to participate in the study. For data collection, the "SALUFAM" and "PRE-COVID-19" scales were used, which measure the health vulnerability of family members and concern about the contagion of COVID-19, respectively. Data collection was done between January and March, 2023. Results: Living in the Coast region increases by 3.299 times (95% CI = 1.55-9.28; p = 0.003) the probability of lower family health vulnerability compared to residents from the Jungle region. In the same way, having a low concern about the contagion of COVID-19 increases 2.77 times (95% CI = 1.02-7.53; p = 0.044) the probability of less vulnerability to family health, unlike participants who are highly concerned about the contagion of COVID-19. Conclusions: It should be necessary to design prevention and family health promotion strategies according to the geographical region; it is also essential to provide education on the risks and the importance of prevention measures for COVID-19, regardless of their initial level of concern.

Primary Health Care and Tuberculosis Detection during the COVID-19 Pandemic: Crucial Actions for Intensifying Efforts.

BACKGROUND: Tuberculosis has been considered a global emergency since 1993, and controlling it has become even more challenging since 2020 due to the health and social crisis resulting from the COVID-19 pandemic. This study aimed to identify the impact of the COVID-19 pandemic on tuberculosis case detection activities within primary health Care in the largest city in Brazil. METHODS: This is a cross-sectional and analytical study on the provision of tuberculosis detection actions in primary healthcare units during the pandemic period. A descriptive analysis was performed for characterization, and Generalized Mixed Models were used for evaluating associations, with a Bonferroni post hoc test applied. RESULTS: The study sample comprised 80 health units in the municipality. There was a moderate alteration level in the provision of consultations for individuals with signs and symptoms of tuberculosis in 2020 (13.8%) and in 2021 (15.1%). Statistical significance (p < 0.05) was found between the pandemic period and detection actions, with a lower alteration level in 2022. CONCLUSIONS: Tuberculosis detection activities underwent changes due to the COVID-19 pandemic, mainly in 2020, which was associated with alterations in consultation and case notification provision.

Method and process towards developing a Health Vulnerability Index (HVI) for Extreme Weather Events (EWEs) for local residents in South Africa.

An increase in incidence and amplitude of extreme weather events (EWEs) linked to climate change, has resulted in greater human exposure and vulnerability to weather-related health effects. Increases in the occurrence of EWEs, including storms, flooding, extreme heat and wildfires, will impact health globally, with poor and vulnerable populations disproportionately affected. Vulnerability to EWEs, and the ability to adapt to these weather shocks, are influenced by existing physical, social and political limitations of a given region. As such, developing context-specific health vulnerability indices to inform planning and decision-making for policy makers and citizens alike, should be prioritized. The existence and development of health vulnerability indices in South Africa are limited, therefore, this study provides a foundation from which future indices can build. Mixed methods approaches including evidence and data analysis/synthesis and focus groups are used to understand the interconnections between extreme weather events and human health, including citizens' understanding of emergent vulnerabilities linked to these events. The methods employed in this study include: •A rapid evidence review (RER) including data extraction identifying health impacts and indicators.•Development of a draft health vulnerability index (HVI) framework.•Focus groups and individual interviews testing the draft HVI for citizen input and framework refinement.

Moderating the role of social progress with greenhouse gases to determine the health vulnerability in developing countries.

Human activities have compelled massive environmental degradation, which causes climate vulnerability and that has emerged as a significant health issue. The present study assesses the role of social progress with greenhouse gases to determine the health vulnerability in 77 developing countries from 2011 to 2020. The empirical results are estimated by using the panel ARDL econometric approach. The study found that greenhouse gas emission proposes a U-shaped relationship to determine health vulnerability. In this study, social progress is used as the moderator variable, which shifts the turning point of the U-shaped curve. For this purpose, the interaction term of social progress with greenhouse gases shifts the turning point to the left side of the U-shaped curve and further flattens it. Furthermore, this study explores that urbanization, export openness, and government education expenditure negatively impact health vulnerability while industrialization increases health vulnerability. The study recommends that government should pay special attention to declining greenhouse gases and rising social progress to improve health vulnerability.Graphical abstact.

Public opinion in vaccine allocation priority: who comes first?

OBJECTIVE: We investigated people's preferences in COVID-19 vaccine allocation priority, comparing different social categories based on age and occupation. Vaccine allocation preferences were related to perceived health vulnerability and economic backlash (economic negative consequences) endured by the different social groups during the pandemic. In-group favoritism in vaccine allocation preferences was analyzed. DESIGN: Data were collected through an online survey in Italy (n = 506) before the start of the vaccination campaign. MAIN OUTCOME MEASURES: Vaccine allocation preferences, health vulnerability, and economic backlash due to COVID-19, measured through ranking tasks. RESULTS: The healthcare workers category was placed at the top of the ranking in vaccine allocation priority by 65% of the respondents. Vaccine allocation priority was related to perceived health vulnerability and not economic difficulties. Limited self-preference effects emerged. People who did not consider healthcare workers a priority (1/5 of the sample) had a lower education level, were more worried about COVID-19 infection risk, and did not trust vaccines. CONCLUSIONS: A consensus emerged on who should be vaccinated first. Governments and policymakers should be aware of these preferences when designing and communicating vaccine allocation plans to predict and foster the public's acceptance of the COVID-19 vaccination programs created by experts.

Mapping health vulnerability to short-term summer heat exposure based on a directional interaction network: Hotspots and coping strategies.

Health risk resulting from non-optimal temperature exposure, referred to as "systematic risk", has been a sustainable-development challenge in the context of global warming. Previous studies have recognized interactions between and among system components while assessing the vulnerability to climate change, but have left open the question of indicator directional interactions. The question is important, not least because indicator directional association analysis provides guidance to address climate risks by revealing the key nodes and pathways. The purpose of this work was to assess health vulnerability to short-term summer heat exposure based on a directional interaction network. Bayesian network model and network analysis were used to conduct a directional interaction network. Using indicator directional associations as weights, a weighted technique for the order of preference by similarity to ideal solution method was then proposed to assess heat-related health vulnerability. Finally, hotspots and coping strategies were explored based on the directional interaction network and health vulnerability assessments. The results showed that (1) indicator directional interactions were revealed in the health vulnerability framework, and the interactions differed between northern and southern China; (2) there was a dramatic spatial imbalance of health vulnerability in China, with the Beijing-Tianjin-Hebei Region and the Yangtze River Basin identified as hotspots; (3) particulate matter and ozone were recognized as priority indicators in the most vulnerable cities of northern China, while summer heat exposure level and variation were priority indicators in southern China; and (4) adaptive capacity could alter the extent of risk; thus, mitigation and adaptation should be implemented in an integrated way. Our study has important implications for strengthening the theoretical basis for the vulnerability assessment framework by providing indicator directional associations and for guiding policy design in dealing with heat-related health vulnerability in China.

Identifying Optimal Locations for Potential Temporary Community Clinics During Public Health Emergencies.

OBJECTIVES: This article argues that community healthcare clinics managed by dedicated medical professionals who are familiar with the special needs of the local community may serve as effective alternatives to centralized hospitals and medical facilities, which may be disconnected from these local communities. BACKGROUND: The literature indicates that socioeconomic factors that affect an individual's ability to seek medical help when needed can cause vulnerability to public health emergencies. These factors include belonging to lower income populations, being African American, being dependent due to age (below 18 or above 65) or disability, being an immigrant, English-language ability, access to transportation means, and the strength of an individual's social network. METHOD: This study aims at developing a multifaceted methodology to identify optimal locations for deployment of temporary healthcare clinics to address health disparity issues among socially vulnerable populations, especially during pandemics and public health crises. This case study looks at the Health Enterprise Zone (HEZ) in Baltimore and ranks Census tracts based on their vulnerability, using two novel health vulnerability indices and considering their locations. RESULTS: Using the proposed methodology, the optimal tracts within the HEZ are identified as potential locations for deploying temporary healthcare clinics. CONCLUSION: The analysis of vulnerabilities to public health emergencies based on socioeconomic factors can assist in identifying potential locations for setting up temporary healthcare clinics with the goal of assisting socially vulnerable populations during outbreaks and pandemics.

Loss of Muscle Mass and Vulnerability in Institutionalized Older Adults.

This study aimed to evaluate the association between muscle mass and vulnerability in institutionalized older adults. A cross-sectional study was carried out in eight philanthropic Long-Term Care Facilities (LTCF) located in the metropolitan area of Natal, Rio Grande do Norte, Brazil. The participants were individuals aged 60 years or older who were present in the institutions at the time of data collection. To assess muscle mass, the calf circumference was categorized into loss of muscle mass (<31 cm) and preserved muscle mass (≥31 cm). The vulnerability was assessed by The Vulnerable Elders Survey (VES-13). Of the 250 older adults evaluated, 46.1% presented loss of muscle mass, which was associated with the presence of physical limitation, vulnerability, and age group (p < 0.05). The presence of vulnerability was the main factor contributing to loss of muscle mass (R2 = 8.8%; B = 0.781; 95% CI 0.690−0.884; p < 0.001). Loss of muscle mass is associated with disability in institutionalized older adults.

Sociodemographic profile of motorcyclists and their vulnerabilities in traffic.

Introduction: Violence has acquired an endemic character in society; traffic violence stands out, particularly considering the upward trend in deaths among motorcyclists. Objectives: To describe the sociodemographic profile and analyze the vulnerabilities of motorcyclists from their experiences in traffic. Methods: This is an exploratory descriptive study with a quantitative approach, performed through interviews with three groups of motorcyclists: those who used motorcycles for recreation, transportation, and for work. Results: Most participants were male (> 80%), mainly young adults in the transportation and work groups (p < 0.001); with higher schooling and income levels in the recreation group (p < 0.001); and with lightweight motorcycles in the transportation and work groups (p < 0.001). Similar experiences fragilizing all three groups include alcohol consumption, disregard of traffic rules, and acts of aggression. With a different experience from the transportation and work groups, the recreation group experienced circumstances that were favorable to traffic safety. Overall, the pattern of answers in the transportation and work groups associated them with higher susceptibility; the work group, represented by motorcycle couriers, was marked by accidents and poor working conditions. Conclusions: Contextual variables inflict a higher traffic vulnerability on motorcyclists of the transportation and work groups. We advocate that further exploration of the analysis of road traffic accidents be a social construct, and advances in the knowledge of risks and margins for implementing safety measures will only be possible when the approaches consider social, economic, and cultural aspects.