Contextual Vulnerabilities Research Articles

Understanding Ethical Concerns Involving Vulnerable Human Participant Populations in Medical Research: Mixed-Method Analysis of Liberian Ebola Survivors' Experiences in PREVAIL I-VII.

Background: As the number of large-scale outbreaks continues to rise worldwide, clinical trials are increasingly engaging disease-affected peoples within the Minority World (nations with over 80% poverty rates). Yet global health research inadequately addresses potential ethical issues of including impoverished, disease-affected populations and their contextual vulnerabilities in medical research. Objective: This paper presents a mixed-method analysis from our 2022 semi-structured survey capturing the experiences of Liberian Ebola Virus Disease (EVD) survivors serving as study participants in the Partnership for Research on Ebola Virus in Liberia (PREVAIL) clinical trials. Methods: Firstly, we conducted an extensive literature review of the scholarship related to biomedical research and ethical standards protecting study participants to inform our survey method and design. Applying a theoretical framework on vulnerability, we then qualitatively explored the survey responses of 19 EVD survivors' perceptions and experiences taking part in PREVAIL, including their expectations, treatment, delivered benefits, and quality of care. We further quantitatively codified their statements for underlying themes of reported negative experiences against standard ethical regulations in biomedical research, conducting a statistical analysis to inform generalizability. Most of the 19 survivors reported facing extreme ongoing vulnerabilities related to their disease status, including physical impairments, psychosocial stress, and socio-economic inequity. Results: Initially, the survivors tended to experience a sense of hope and pride in volunteering for PREVAIL. One in five participants reported benefiting from PREVAIL's regular medical diagnoses. However, most of their survey responses indicated prevalent negative shared experiences, including continually being confused or misinformed of their study participant rights, roles, and benefits; being burdened by heavy participation transaction costs; and repeated incidents of poor treatment and discrimination by PREVAIL staff after initial recruitment. PREVAIL participant satisfaction ranking is negatively correlated with receiving insufficient financial compensation (r = -0.51), extensive time requirements for each medical visit (-0.40), and being poorly treated by clinical staff (-0.67).

Individual and contextual factors associated with measles infection in Malaysia: a multilevel analysis.

Despite effective vaccination strategies, measles remains a global public health challenge. The study explored individual and contextual factors associated with measles infection in Malaysia from 2018 to 2022, informing the development of targeted public health interventions. This cross-sectional study utilised data from the Ministry of Health, the Department of Statistics, and the Department of Environment Malaysia. Multilevel logistic regression analysis was employed to examine individual-level factors, including age, sex, ethnicity, nationality, contact history, travel history, and vaccination status. Concurrently, contextual factors were assessed, encompassing district-level determinants such as population density, median household income, urbanisation, the number of health and rural clinics, vaccination rates, PM2.5 levels, relative humidity, and temperature, to determine their impact on measles infection risk. Measles infection was significantly associated with various individual factors. These included age (adjusted odds ratio [aOR], 1.02; 95% confidence interval [CI], 1.02-1.03), ethnicity, non-Malaysian nationality (aOR, 34.53; 95% CI, 8.42-141.51), prior contact with a measles case (aOR, 2.36; 95% CI, 2.07-2.69), travel history (aOR, 2.30; 95% CI, 1.13-4.70), and vaccination status (aOR, 0.76; 95% CI, 0.72-0.79). Among contextual factors, urbanisation (aOR, 1.56; 95% CI, 1.16-2.10) and the number of clinics (aOR, 0.98; 95% CI, 0.97-0.99) were significant determinants. This multilevel logistic regression analysis illuminates the complexities of measles transmission, advocating public health interventions tailored to individual and contextual vulnerabilities. The findings highlight the need for a synergistic approach that combines vaccination campaigns, healthcare accessibility improvements, and socioeconomic interventions to effectively combat measles.

The Global Impact of Multisystemic Vulnerabilities on Criminal Variety: A Cross-Continental Study in Young Adults.

Previous research has shown a robust association between different childhood and adolescent vulnerabilities and youth offending. However, these investigations have primarily focused on youths from high-income Western countries. Consequently, the generalizability of these findings to better inform global justice policies remains uncertain. This study aimed to address this gap by examining the relationship between individual, familial, and contextual vulnerabilities and criminal versatility during young adulthood, accounting for sociodemographic factors and cross-national differences. Data were derived from a diverse sample of 4,182 young adults (67% female; mean age = 18.96; SD = 0.81) residing in 10 countries across 5 continents who participated in the International Study of Pro/Antisocial Behavior in Young Adults. The Psychosocial and Family Vulnerability Questionnaire and the Adverse Childhood Experiences questionnaire were used to assess social and family adversity, and past-year criminal diversity was measured with the Criminal Variety Index. Results indicate that child maltreatment, substance abuse, and delinquent peers are global risk factors for criminal variety. Moreover, they are independent across males and females and among youths living in countries that are ranked differently on the Human Development Index (HDI). In addition, some childhood vulnerabilities showed different predictive ability across sexes (e.g., school failure), and across countries ranked differently on the HDI (e.g., family dysfunction). These findings suggest that certain childhood factors contribute to criminal behavior through transcultural mechanisms. Moreover, they highlight the importance of developing evidence-based policies that focus on transcultural risk factors to globally prevent criminal behavior.

She Shores

Abstract This study delves into the lives of women from the Koli fishing community in Mumbai, aiming to illuminate their unique life experiences and the daily struggles that often remain hidden beneath their prosperous facade. It endeavours to examine their agency and adaptive strategies employed to navigate these challenges. The research was conducted in Pachubandar, Vasai, located in the western suburbs of Mumbai, which stands as one of the prominent Koli settlements in the city. Employing a qualitative research approach coupled with an exploratory research design, the study engaged ten participants, comprising seven Koli women and three key informants from the community. Additionally, an observational analysis of four retail and wholesale fish markets in Mumbai was conducted to gain insight into the working conditions of Koli fisherwomen. This study adopts a gender-focused perspective to scrutinise the contextual vulnerabilities that shape the lives of Koli women. It underscores the paradox wherein, despite playing a pivotal role in sustaining both their families and the traditional fishing occupation, their contributions often go unnoticed. The Koli women face severe deprivation due to their limited access to property and decision-making authority. They find themselves entangled within traditional norms and patriarchal structures, which impede their access to essential assets and diverse livelihood resources. Although they significantly contribute to the fishery sector, their struggles, needs, and aspirations are frequently disregarded due to their lack of representation and involvement in decision-making bodies. The majority of these women work under precarious conditions, devoid of proper infrastructure, resources, and security. Furthermore, the evolving dynamics within the fishery sector, driven by rapid urbanisation and modernisation, have a profound impact on the lives and traditional livelihoods of Koli women. They now confront issues such as dwindling fish catches due to environmental degradation, heightened market competition, reduced livelihood spaces brought about by shifting urban and coastal landscapes, altered labour relations, and technological advancements. Consequently, they find themselves caught between the conflicting forces of tradition and modernity. The research also sheds light on the strategies devised by Koli women to resist and adapt to the uncertainties and challenges they encounter, ultimately safeguarding their livelihoods through self-organisation. The study emphasises the imperative to acknowledge their contributions as ‘visible work’ and advocates for the incorporation of gender considerations when formulating policies and development strategies within the fisheries sector.

Socioeconomic inequalities in contraceptive use among Brazilian women: A multilevel analysis stratified by parity

ObjectiveTo investigate if individual and contextual socioeconomic factors are associated with contraceptive use in Brazilian women from 18 to 49 years old, stratified by parity. MethodsCross-sectional, population-based study that analyzed data from 16,879 women from 18 to 49 years old, respondents of the 2013 National Health Survey. Individual factors such as reproductive history, access to health services, and sociodemographic characteristics were considered; and as contextual factors, Human Development Index (HDI), Sociodemographic Index (SDI) Primary Health Care Coverage (PHC coverage) and Average Monthly Income were included. Multilevel logistic regression models were estimated, stratified by parity, with women being level 1 and States and Federal District of level 2 units. ResultsNulliparous women had lower prevalence of contraceptive use (77.9 %) when compared with primiparous and multiparous (88.7 %), as well as greater variability in the chance of using contraception (ICC = 2.1 vs. ICC = 1.1, respectively). Women who lived in States with higher levels of HDI, average monthly income and SDI were more likely to use contraception. The greater PHC coverage was positively associated with the use of contraceptives for primiparous/multiparous women and negatively for the nulliparous. Furthermore, higher education increased the chances of using contraception, both for nulliparous and primiparous/multiparous women. ConclusionsThe high contraceptive coverage in Brazil hides important inequities in access, highlighting contextual characteristics associated with the use of contraceptives, in addition to individual factors. The lower prevalence and chance of using contraceptives for nulliparous women with greater social vulnerability reveal inequity and priority in public policies. Implications for practiceThe need to improve access to contraception is highlighted, considering both the individual and contextual vulnerabilities of women, which implies ensuring timely and qualified access to contraceptive methods, especially for young and nulliparous women who are more socially vulnerable.

Abstract 2494: RAS-Bio a unique pan-cancer biobank for RAS-driven tumors

Abstract Background: RAS-driven cancers represent a significant unmet clinical need, while breakthroughs in treatments targeting KRASG12C driven-NSCLC have invigorated drug-development for other RAS mutant cancers. Most RAS mutant cancers are not driven by KRASG12C, leaving an enormous amount of work needed to establish the contextual treatment vulnerabilities of cancers driven by different RAS mutant subtypes. RAS-Bio was pioneered within The Cancer Research UK Lung Cancer Centre of Excellence in Manchester. RAS-Bio is a uniquely curated resource of unparalleled clinical, genomic, translational and biological detail. RAS-Bio was established with the aim of generating novel model systems along with clinical observation to facilitate RAS precision medicine breakthroughs. Method: RAS-Bio recruits patients affected by epithelial cancers with RAS pathway mutations, aiming to i) optimize sample collection & processing protocols (FFPE/fresh/frozen) for multi-omic profiling, ii) validate preclinical hypothesis-generating findings in a clinical cohort, iii) generate novel RAS-mutant organoid, PDX and other models for analyses and drugging experiments, iv) foster academic/industry collaboration using a unique dataset including demographics, pathology/imaging details, treatment types and survival outcomes. Results: In two years, we have recruited 190 cancer patients with cancers harboring KRASG12C (n=71), KRASG12D(17), KRASG12V(23), KRASG12A (8), KRASG12S (2), KRASG12F (3), KRASG12R (1) and KRASG12E (1). A further 20 harboring KRAS codon 13 mutations and 12 KRASQ61 cancers and an additional 32 patients with mutations in other key signaling nodes of the MAPK pathway have been recruited. Seventeen PDX models have been attempted; lung cancer (14) and colorectal cancer (3). Four lung cancer cases are currently growing (KRASG12C treatment naïve, KRASG12C inhibitor resistance, KRASG12C inhibitor refractory, KRASG13C treatment naïve) and two colorectal cancer cases (KRASG12C and KRASG12V). We will present two deep-dive lung patient cases i) KRASG12C ‘OFF’ state inhibitor (sotorasib) resistance where multiple tissue samples, CTCs and a successful PDX were derived, and ii) sotorasib resistance where paired biopsies and PDXs were derived pre- and post-treatment. Both cases demonstrate the clinical utility of longitudinal sampling in understanding clinically relevant resistance mechanisms to targeted treatment. Conclusion: RAS-Bio represents a comprehensive biobank of clinical, pathological, and genomic detail in RAS-mutant lung cancers. Optimizing collaborative potential with academia/industry to facilitate prospective sampling of patients at different timepoints and integrating colorectal and pancreas cancers in our protocol. Citation Format: Mathew Carter, Katherine D. Brown, Helen Adderley, George Morrissey, Laura Woodhouse, Jamie Weaver, Kathryn Simpson, Jordan Roebuck, Jane Rogan, Joseph Mercer, Anshuman Chaturvedi, David Wedge, Claus Jorgensen, Angeliki Malliri, Caroline Dive, Colin R. Lindsay. RAS-Bio a unique pan-cancer biobank for RAS-driven tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2494.

‘Secrecy, Trust, Safety’: a Multi-stakeholder Situation Assessment of Gendered and Contextual Vulnerabilities and Service Level Responsiveness to the Needs of Women Who Use Drugs in Egypt

AbstractWomen account for one in every three people who use drugs worldwide and tend to progress to drug use disorders in a shorter time than men. There is limited understanding of the situation of women who use drugs in the Middle East and North Africa. A multi-stakeholder rapid situation assessment (RSA) was conducted which aimed to investigate gendered and contextual vulnerabilities and service level responsiveness to the needs of women who use drugs (WWUD) in Egypt. An updated profile of female service user characteristics was sought via mapping of addiction and harm reduction services in the National Drug Observatory system. In-depth interviews were conducted with a purposive sample of representatives of UN agencies and health professionals providing treatment/harm reduction (government, private, community) (n = 21). Focus groups were facilitated with a convenience sample of women in treatment, accessing HIV services and community harm reduction services (n = 75). Thematic analysis and triangulation across data sources occurred. Eight themes emerged: profile of women who use drugs; access to drugs and settings for female drug use; dimensions of stigma; trauma and drivers of female drug use; networks and intimate partner relationships; high-risk behaviours and harms; barriers to help-seeking and accessing services; and enhancing gender-responsive and gender-transformative evidence-based services. This RSA yields a contemporary insight into the vulnerabilities, traumas, discrimination and stigma-related challenges experienced by WWUD in Egypt. Recommendations are made to enhance harm reduction awareness and uptake and to integrate gender-responsive care within existing maternal, addiction and harm reduction service structures.

Eating, heating or taking the bus? Lived experiences at the intersection of energy and transport poverty

Experiences of poverty can manifest in multiple aspects of everyday life, often in interlinking ways. One example is ‘double energy vulnerability’, where a household faces both energy poverty and transport poverty simultaneously. This can result in trade-offs, where prioritising one essential need (e.g., transport) makes accessing another impossible (e.g., heating). Such decisions are not easily made, and they can have distinct spatio-temporal characteristics. They can vary between space and time and across different household members, and result in stark inter- as well as intra-household differences. People with socio-demographic and contextual vulnerabilities are particularly at risk of experiencing double energy vulnerability. Based on 59 household interviews across the four nations of the United Kingdom, we provide novel, multi-nation empirical evidence on the lived experiences of double energy vulnerability, drawing on our themes; ‘being locked into infrastructure’, ‘facing high costs and low incomes’, ‘choosing between energy and transport’, and ‘missing out’. A cross-national lived-experiences approach sheds light on double energy vulnerability as a relational, contingent and ongoing phenomena, attending to everyday experiences and capacities. We provide suggestions for further research, such as further study of double energy vulnerability amongst refugees and migrants. We also highlight that the study of lived experiences can aid the recognition of how different forms of poverty intersect and how they need to be taken into account in the design of Net Zero policies.

Drug behaviors, sexually transmitted infection prevention, and sexual consent during chemsex: insights generated in the Budd app after each chemsex session.

Chemsex refers to the intentional use of drugs before or during sex in a specific context, typically involving prolonged sex sessions with multiple partners. Engaging in chemsex is associated with a wide range of health risks and related risk behaviors. We developed a mobile phone application ('Budd-app') to support and inform chemsex participants, reduce potential negative impacts associated with chemsex (e.g., physical, psychological and social health harms), and encourage more reasoned participation. During Budd's development process, 11 participants completed a survey after each chemsex session they attended. This data collection approach provided precise experiences on drug related behavior, prevention measures for sexually transmitted infection and sexual consent on 63 chemsex sessions. The mean duration of chemsex sessions was 17.5 h. Polydrug use was reported during 95% of chemsex sessions with an average of 3.5 agents per session. Unsafe dosing occurred at 49% of chemsex sessions, and 9/11 participants dosed unsafely at least once. Seven participants did not consistently take measures to prevent STI transmission. Nine had experienced peer pressure, both regarding drug use and sexual health. The same number reported sex without consent, not respecting others' boundaries as well as their own boundaries not being respected. Many participants experienced negative impact of their chemsex behavior during (7/9) and after (8/9) chemsex. Through participants' behavior assessment during multiple chemsex sessions, 'within-person' variability can be clarified. This clarification provides valuable insights in personal, emotional and contextual vulnerabilities. These insights can direct an individualized care and support trajectory aimed at addressing those vulnerabilities.

Transcultural skills for early childhood professionals.

Transcultural skills are especially useful for those involved in the perinatal period, when parents and babies must adapt to one another in a setting of migration a long a focus of transcultural clinical practice. The aim of this article is to provide useful transcultural skills for any health care worker (e.g., psychologists, child psychiatrists, midwives, family doctors, pediatricians, specialized child-care attendants, and social workers) who provide care or support to families during the perinatal period. It highlights the cultural aspects requiring attention in relation to representations of pregnancy, children's needs, obstetric complications, and postnatal problems. Taking into account the impact of culture on clinical evaluation and treatment can enable professionals to distinguish what involves cultural representations of pregnancy, babies, and sometimes of disease from what is associated with interaction disorders or maternal psychopathology. After explaining the relevance of transcultural clinical practices to provide migrant mothers with better support, we describe 9 themes useful to explore from a transcultural perspective. This choice is based on the transcultural clinical practice in our specialized department. The description of these 9 themes is intended to aid in their pragmatic application and is illustrated with short clinical vignettes for specific concepts. We describe situations that are extreme but often encountered in liaison transcultural clinical practice for maternity wards: perinatal mourning with cultural coding, mediation in refusal of care, cultural misunderstandings, situations of complex trauma and of multiple contextual vulnerabilities, and difficulties associated with acculturation. The transcultural levers described here make it possible to limit cultural misunderstandings and to promote the therapeutic alliance. It presupposes the professionals will concomitantly analyze their cultural countertransference and acquire both the knowledge and know-how needed to understand the elements of cultural, political, and social issues needed to develop clinical finesse. This combined theoretical-clinical article is intended to be pedagogical. It provides guidelines for conducting transcultural child psychiatry/psychological interviews in the perinatal period aimed at both assessment and therapy.

Contextual Vulnerability Should Guide Fair Subject Selection in Xenotransplantation Clinical Trials

Contextual Vulnerability Should Guide Fair Subject Selection in Xenotransplantation Clinical Trials

The impact of social violence on HIV risk for women in Colombia: A concurrent mixed methods study.

Gender, violence, and migration structurally impact health. The Venezuelan humanitarian crisis comprises the largest transnational migration in the history of the Americas. Colombia, a post-conflict country, is the primary recipient of Venezuelans. The Colombian context imposes high levels of violence on women across migration phases. There is little information on the relationship between violence and HIV risk in the region and how it impacts these groups. Evidence on how to approach the HIV response related to Venezuela's humanitarian crisis is lacking. Our study seeks to 1) understand how violence is associated with newly reported HIV/AIDS case rates for women in Colombian municipalities; and 2) describe how social violence impacts HIV risk, treatment, and prevention for Venezuelan migrant and refugee women undergoing transnational migration and resettlement in Colombia. We conducted a concurrent mixed-methods design. We used negative binomial models to explore associations between social violence proxied by Homicide Rates (HR) at the municipality level (n = 84). The also conducted 54 semi-structured interviews with Venezuelan migrant and refugee women and key informants in two Colombian cities to expand and describe contextual vulnerabilities to HIV risk, prevention and care related to violence. We found that newly reported HIV cases in women were 25% higher for every increase of 18 homicides per 100,000, after adjusting for covariates. Upon resettlement, participants cited armed actors' control, lack of government accountability, gender-based violence and stigmatization of HIV as sources of increased HIV risk for VMRW. These factors impose barriers to testing, treatment and care. Social violence in Colombian municipalities is associated with an increase in newly reported HIV/AIDS case rates in women. Violence hinders Venezuelan migrant and refugee women's access and engagement in available HIV prevention and treatment interventions.

A community engaged exploratory study investigating the risk of elder abuse and neglect in two refugee communities in Greensboro, North Carolina

ABSTRACT Elder abuse and neglect (EAN) are serious health and human rights issues. Less is known about EAN in refugee communities. University researchers and leaders of a refugee services nonprofit partnered to conduct an exploratory community engaged study on EAN risks in two refugee communities in North Carolina. A convenience sample of 17 Nepali-speaking Bhutanese and 13 Congolese self-identified older adults filled short surveys and participated in Focus Group Discussions (FGDs). Descriptive survey findings showed EAN risk, isolation, economic insecurity, and family dependency, more among Congolese. FGDs yielded no reports of EAN, but showed dependence on family, and difficulties with language, transportation, and economic insecurity in both groups. These factors indicate individual and contextual vulnerabilities for EAN in these communities. An EAN awareness event was conducted for participants by a family violence nonprofit. Refugee older adults need culturally appropriate coordinated services including EAN information, English classes, job skills, income, and transportation.

Perceptions, views and practices regarding antibiotic prescribing and stewardship among hospital physicians in Jakarta, Indonesia: a questionnaire-based survey

ObjectivesAntibiotic overuse is one of the main drivers of antimicrobial resistance (AMR), especially in low-income and middle-income countries. This study aimed to understand the perceptions and views towards AMR, antibiotic...

Economic, social and demographic impacts of drought on treatment adherence among people living with HIV in rural South Africa: A qualitative analysis

The 2015 El Niño-triggered drought in Southern Africa caused widespread economic and livelihood disruption in South Africa, imposing multiple physical and health challenges for rural populations including people living with HIV (PLHIV). We examined the economic, social and demographic impacts of drought drawing on 27 in-depth interviews in two cohorts of PLHIV in Hlabisa, uMkhanyakude district, KwaZulu-Natal. Thematic analysis revealed how drought-enforced soil water depletion, dried-up rivers, and dams culminated in a continuum of events such as loss of livestock, reduced agricultural production, and insufficient access to water and food which was understood to indirectly have a negative impact on HIV treatment adherence. This was mediated through disruptions in incomes, livelihoods and food systems, increased risk to general health, forced mobility and exacerbation of contextual vulnerabilities linked to poverty and unemployment. The systems approach, drawn from interview themes, hypothesises the complex pathways of plausible networks of impacts from drought through varying socioeconomic factors, exacerbating longstanding contextual precarity, and ultimately challenging HIV care utilisation. Understanding the multidimensional relationships between climate change, especially drought, and poor HIV care outcomes through the prism of contextual vulnerabilities is vital for shaping policy interventions.

Class and Vulnerability to Debt in Rural India: A Statistical Overview*

AbstractRural indebtedness is a major development challenge confronting India. In 2018, scores of farmers protested rising household debt, and the popular coverage of the time asserted that farmers were under crushing debt. Combining data from the All‐India Debt and Investment Survey with other sources and using a class analysis, I interrogate this “crushing debt” narrative. Rural households, depending on the socioeconomic and contextual vulnerabilities that they experience, are indebted in different ways. The rural elite borrow more loans and have higher loan amounts, while asset‐poor households are more dependent on informal credit sources and also pay higher rates of interest. Households from the wage worker class are more likely to be over‐indebted relative to others. I further find that petty commodity producers bear less debt burden and are less likely to be over‐indebted relative to other classes. These findings underscore the fact that rural indebtedness is a nuanced problem that manifests in a multitude of ways across India.

Nursing violent patients: Vulnerability and the limits of the duty to provide care.

The duty to provide care is foundational to the nursing profession and the work of nurses. Unfortunately, violence against nurses at the hands of recipients of care is increasingly common. While employers, labor unions, and professional associations decry the phenomenon, the decision to withdraw care, even from someone who is violent or abusive, is never easy. The scant guidance that exists suggests that the duty to care continues until the risk of harm to the nurse is unreasonable, however, “reasonableness” remains undefined in the literature. In this paper, I suggest that reasonable risk, and the resulting strength of the duty to provide care in situations where violence is present, hinge on the vulnerability of both nurse and recipient of care. For the recipient, vulnerability increases with the level of dependency and incapacity. For the nurse, vulnerability is related to the risk and implications of injury. The complex interplay of contextual vulnerabilities determines whether the risk a nurse faces at the hands of a violent patient is reasonable or unreasonable. This examination will enhance our understanding of professional responsibilities and can help to clarify the strengths and limitations of the nurse's duty to care.

Business management education in the African context of (post-)Covid-19: Applying a proximity framework

ABSTRACT What happens when Covid-19 meets Africa? To find answers, this article examines tertiary management education delivered by the continent’s business schools in the context of Africa’s susceptibilities to the pandemic. The concept of proximity is applied as an axiomatic analytic complement to Covid’s transmission pathways impacting on the psychosocial foundation of human relations, people’s spatial distribution and their time perspectives. Taking management literature into account, proximity is applied to Africa’s business schools in terms of their immediate and long-term responses to the pandemic, suggesting practical post-Covid reforms considered from a humanistic management approach to management education and scholarship. A theme throughout this article is that Covid-19’s exposure of contextual vulnerabilities presents an opportunity and imperative for business schools’ re-missioning and renewal to enhance relevance, quality and building post-Covid resilience. The article provides a framework for the study of other Covid-sensitive sectors or organizations and theory development and testing using different proximity conceptualizations, frames and combinations thereof. Limitations of the study are discussed.

Combating the COVID-19 pandemic in a resource-constrained setting: insights from initial response in India

The low-and-middle-income country (LMIC) context is volatile, uncertain and resource-constrained. India, an LMIC, has put up a complex response to the COVID-19 pandemic. Using an analytic approach, we have described...

Differences in adolescent activity and dietary behaviors across home, school, and other locations warrant location-specific intervention approaches

BackgroundInvestigation of physical activity and dietary behaviors across locations can inform “setting-specific” health behavior interventions and improve understanding of contextual vulnerabilities to poor health. This study examined how physical activity, sedentary time, and dietary behaviors differed across home, school, and other locations in young adolescents.MethodsParticipants were adolescents aged 12–16 years from the Baltimore-Washington, DC and the Seattle areas from a larger cross-sectional study. Participants (n = 472) wore an accelerometer and Global Positioning Systems (GPS) tracker (Mean days = 5.12, SD = 1.62) to collect location-based physical activity and sedentary data. Participants (n = 789) completed 24-h dietary recalls to assess dietary behaviors and eating locations. Spatial analyses were performed to classify daily physical activity, sedentary time patterns, and dietary behaviors by location, categorized as home, school, and “other” locations.ResultsAdolescents were least physically active at home (2.5 min/hour of wear time) and school (2.9 min/hour of wear time) compared to “other” locations (5.9 min/hour of wear time). Participants spent a slightly greater proportion of wear time in sedentary time when at school (41 min/hour of wear time) than at home (39 min/hour of wear time), and time in bouts lasting ≥30 min (10 min/hour of wear time) and mean sedentary bout duration (5 min) were highest at school. About 61% of daily energy intake occurred at home, 25% at school, and 14% at “other” locations. Proportionately to energy intake, daily added sugar intake (5 g/100 kcal), fruits and vegetables (0.16 servings/100 kcal), high calorie beverages (0.09 beverages/100 kcal), whole grains (0.04 servings/100 kcal), grams of fiber (0.65 g/100 kcal), and calories of fat (33 kcal/100 kcal) and saturated fat (12 kcal/100 kcal) consumed were nutritionally least favorable at “other” locations. Daily sweet and savory snacks consumed was highest at school (0.14 snacks/100 kcal).ConclusionsAdolescents’ health behaviors differed based on the location/environment they were in. Although dietary behaviors were generally more favorable in the home and school locations, physical activity was generally low and sedentary time was higher in these locations. Health behavior interventions that address the multiple locations in which adolescents spend time and use location-specific behavior change strategies should be explored to optimize health behaviors in each location.