Greater Vulnerability Research Articles

ANÁLISE DAS REPERCUSSÕES FETAIS, NEONATAIS E OBSTÉTRICAS RELACIONADAS A IDADE MATERNA AVANÇADA E PRECOCE

In Brazil, pregnancy at extreme ages, whether in adolescence or advanced age, poses significant challenges to maternal and neonatal health. In a country where one in every seven babies is born to adolescent mothers, and there has been a 70% increase in pregnancies among women aged 35 to 38 over the last two decades, it becomes essential to understand the obstetric and neonatal repercussions of these pregnancies. This study aimed to analyze the fetal, neonatal, and obstetric complications associated with early and advanced maternal age. It is an epidemiological study with data collected from TabNet of DataSUS, covering the period from 1996 to 2020. The variations found included maternal and fetal deaths, as well as sociodemographic characteristics of the mothers. The results show that adolescent mothers have a higher risk of newborns with low birth weight and fetal mortality, especially in the Northeast region. On the other hand, older mothers show lower fetal mortality but a higher prevalence of obstetric complications, particularly in the Southeast region. The research highlights the need for public policies focused on reducing risks in pregnancies with greater vulnerability and on training health professionals for better monitoring.

Assessment of Mycotoxins in Infants and Children Cereal-Based Foods: Dietary Exposure and Potential Health Risks

AbstractPublic health concerns are rising regarding potential mycotoxin contamination in processed cereal-based products consumed by infants and young children. Due to their developing physiological systems and greater vulnerability, children are particularly susceptible to the adverse health effects of mycotoxins. This study investigated the presence of a wide range of mycotoxins (20 in total, encompassing various chemical classes, such as aflatoxins, ochratoxins, trichothecenes, zearalenones, fumonisins, citrinin and sterigmatocystin) in readily available processed cereal-based foods targeted towards infants and children in Portugal. Among the 148 analysed samples, 43% contained at least one of the targeted mycotoxins. Aflatoxin B1 (8.1%) and fumonisin B1 (10.8%) were the most commonly detected regulated mycotoxins, while emerging mycotoxins like enniatin B (14.9%) and beauvericin (10.1%) were also prevalent. The most commonly co-occurring mycotoxins were ENNB + BEA and FB1 + FB2. Although the Estimated Daily Intake of non-carcinogenic mycotoxins in most products was below their respective Tolerable Daily Intake (DONs and FBs (1 μg/kg bw/day), HT-2 and T-2 (0.02 μg/kg bw/day), ZEN (0.25 μg/kg bw/day), and CIT (0.2 μg/kg bw/day)), Hazard Quotient and Hazard Index values exceeded safe thresholds, indicating potential health risks.

Development and Application of an Environmental Vulnerability Index (EVI) for Identifying Priority Restoration Areas in the São Francisco River Basin, Brazil

The environmental vulnerability diagnosis of a river basin depends on a holistic analysis of its environmental aspects and degradation factors. Based on this diagnosis, the definition of priority areas where interventions for environmental recovery should be carried out is fundamental, since financial and natural resources are limited. In this study, we developed a methodology to assess these fragilities using an environmental vulnerability index (EVI) that combines physical and environmental indicators related to the natural sensitivity of ecosystems and their exposure to anthropogenic factors. The developed EVI was applied to the headwater region of the São Francisco River Basin (SFRB), Brazil. The proposed index was based on the AHP multicriteria analysis and was adapted to include four variables representative of the study area: Land Use Adequacy, Burned Area, Erosion Susceptibility, and quantitative water balance. The EVI analysis highlighted that the presence of easily erodible soils, associated with sloping areas and land use above their capacity, generate the most vulnerable areas in the headwaters of the SFRB. The highest EVI values are primarily linked to regions with shallow, easily erodible soils like Leptosols and Cambisols, found in steep areas predominantly used for pasture. In the SFBR, the greatest vulnerability was observed within a 5 km buffer around conservation units, covering approximately 32.4% of the total area. The results of this study indicate where resources should be applied for environmental preservation in the basin under study, directing the allocation of efforts to areas with lower resilience to maintain ecosystem services.

Lower entorhinal cortex thickness is associated with greater financial exploitation vulnerability in cognitively unimpaired older adults.

Research suggests that increased financial exploitation vulnerability due to declining decision making may be an early behavioral manifestation of brain changes occurring in preclinical Alzheimer's disease. One of the earliest documented brain changes during the preclinical phase is neurodegeneration in the entorhinal cortex. The objective of the current study was to examine the association between a measure of financial exploitation vulnerability and thickness in the entorhinal cortex in 97 cognitively unimpaired older adults. We also investigated financial exploitation vulnerability associations with frontal regions typically associated with decision making (e.g. dorsolateral and ventromedial prefrontal cortices), and additionally examined the interactive effect of age and cortical thickness on financial exploitation vulnerability. Results showed that greater financial exploitation vulnerability was associated with significantly lower entorhinal cortex thickness. There was a significant interaction between age and entorhinal cortex thickness on financial exploitation vulnerability, whereby lower entorhinal cortex thickness was associated with greater financial exploitation vulnerability in older participants. When the group was divided by age using a median split (70+ and <70years old), lower entorhinal cortex thickness was associated with greater vulnerability only in the older group. Collectively, these findings suggest that financial exploitation vulnerability may serve as a behavioral manifestation of entorhinal cortex thinning, a phenomenon observed in suboptimal brain aging and preclinical Alzheimer's disease.

Clinical and biochemical responses to treatment of uncomplicated severe acute malnutrition: a multicenter observational cohort from the OptiDiag study

BackgroundSevere acute malnutrition (SAM) can be diagnosed using weight-for-height Z-score (WHZ) and/or mid-upper arm circumference (MUAC). Although some favor using MUAC alone, valuing its presumed ability to identify children at greatest need for nutritional care, the functional severity and physiological responses to treatment in children with varying deficits in WHZ and MUAC remain inadequately characterized. ObjectiveWe aimed to compare clinical and biochemical responses to treatment in children with 1) both low MUAC and low WHZ, 2) low MUAC-only, and 3) low WHZ-only. MethodsA multicenter, observational cohort study was conducted in children aged 6–59 mo with nonedematous, uncomplicated SAM in Bangladesh, Burkina Faso, and Liberia. Anthropometric measurements and critical indicators were collected 3 times during treatment; metrics included clinical status, nutritional status, viability, and serum leptin, a biomarker of mortality risk in SAM. ResultsChildren with combined MUAC and WHZ deficits had greater increases in leptin levels during treatment than those with low MUAC alone, showing a 34.4% greater increase on the second visit (95% confidence interval [CI]: 7.6%, 43.6%; P = 0.02) and a 34.3% greater increase on the third visit (95% CI: 13.2%, 50.3%; P = 0.01). Similarly, weight gain velocity was higher by 1.56 g/kg/d in the combined deficit group (95% CI: 0.38, 2.75; P = 0.03) compared with children with low MUAC-only. Children with combined deficits had higher rates of iron deficiency and wasting while those with low WHZ alone and combined deficits had higher rates of tachypnea and pneumonia during treatment. ConclusionsGiven the comparable treatment responses of children with low WHZ alone and those with low MUAC alone, and the greater vulnerability at admission and during treatment in those with combined deficits, our findings support retaining WHZ as an independent diagnostic and admission criterion of SAM, alongside MUAC.This trial was registered at www.clinicaltrials.gov/study/NCT03400930 as NCT03400930.

The Impact of Referencing Academics Who Have Defended and Exercised Pederasty

The scientific literature has shown an increasing demand by citizens and society at large to stop using people who have committed sexual violence against children as a reference in academia. However, research has not explored the fact that in some sectors of society, the rejection of individuals who have exercised sexual abuse against children is entirely deliberate. This study analyzes, for the first time, the incoherence of many academics when it comes to their positioning regarding different renowned authors who commit sexual abuse against children, and the consequences of such incoherence according to several citizens. To that end, social media analytics and interviews with 16 individuals aged 27 to 70 years from different professions, including university professors, construction workers and retired lawyers, were conducted. The results show three main consequences of the incoherence of academics who use as a reference authors who have defended and exercised pederasty: promoting social mistrust toward those academics, as there is no coherence between what they say and do; normalizing and promoting pederasty and impunity toward abusers, creating a sense that “anything goes”; and silencing and revictimizing victims, which creates a context of great vulnerability to develop a healthy sexuality.

Adolescent health-risk behaviours in Uruguay: Patterns from national cross-sectional school surveys conducted in 2006, 2012 and 2019.

There are no trend studies on various health risk behaviours among adolescents in Uruguay. Therefore, this study looked at trends in a number of health-risky behaviours among adolescents in Uruguay from three separate surveys. Data from 9272 adolescents (age range: 11-16 years), who took part in three cross-sectional national in-school surveys in Uruguay in 2006, 2012 and 2019 were analysed. A self-administered survey was used to evaluate 24 health risk behaviours. By using logistic regression analyses to treat the study year as a categorical variable and adjusting food insecurity and age, linear trends were examined. We found a significant increase in the prevalence of being overweight, having obesity, inadequate fruit intake, sedentary behaviour in leisure-time, physical inactivity, bullying victimisation, loneliness, suicidal ideation, and sexual activity. We found a significant decrease in current cigarette use, physical fighting and current alcohol use. Among males, a significant increase of non-condom use, and a decrease in current other tobacco use (other than cigarettes), being physically attacked and the number of sexual partners. Among females, we found an increase in food insecurity, trouble from alcohol use, multiple sexual partners, and sleep problems. Overall, from 2006 to 2019, there was a decrease in seven health risk behaviours among boys and/or girls. Among boys, there was an increase in 10 health risk behaviours and among girls, 15 health risk behaviours increased, highlighting adolescent girls' greater vulnerability, thereby perpetuating further gendered health inequalities. In Uruguay, school health programmes for adolescents are recommended.

Vulnerability to Climate Change and Communal Conflicts: Evidence from Sub-Saharan Africa and South/South-East Asia

This paper examines the influence of climate change vulnerability on the likelihood and severity of communal violence, with a particular emphasis on delineating large-scale regional patterns. Specifically, the analysis centres on Sub-Saharan Africa and South/South-East Asia – both regions being predominantly characterised by rain-fed agriculture and climate-sensitive economic activities – spanning the years 1995 to 2021. Relying on the ND-GAIN Vulnerability Index as a multidimensional measure for propensity of societies to be negatively impacted by climate change, we found robust evidence that greater vulnerability is conducive to a higher likelihood and severity of communal violence in Sub-Saharan Africa. On the other hand, in South/South-East Asia, results suggest that current climate variability, measured as rainfall deviations within the period, exerts a greater effect on communal violence outbreak than overall vulnerability to climate change. In both regions, greater access to productive means is significantly associated to the reduction of communal violence.

The COVID-19 pandemic and the use of benzodiazepines and benzodiazepine-related drugs in Estonia: an interrupted time-series analysis

BackgroundThe COVID-19 pandemic has posed challenges that worsened people’s mental health. We explored the impact of the COVID-19 pandemic on the mental well-being of the population, as indicated by the prevalence rates of benzodiazepine and benzodiazepine-related drug (BDZ) use.MethodsThis population‐based, time‐series analysis included all prescriptions of BDZs dispensed in Estonia between 2012 and 2021. The monthly prevalence rates of BDZ use were calculated. Autoregressive integrated moving average models with pulse and slope intervention functions tested for temporary and long-term changes in monthly prevalence rates after the onset of the COVID-19 pandemic.ResultsThroughout the 10-year study period, a total of 5,528,911 BDZ prescriptions were dispensed to 397,436 individuals. A significant temporary increase in the overall prevalence rate of BDZ use in March 2020 (2.698 users per 1000, 95% CI 1.408–3.988) was observed, but there was no statistically significant long-term change. This temporary increase affected all the examined subgroups, except for new users, individuals aged 15–29 years, and prescribing specialists other than general practitioners and psychiatrists. The long-term increase in BDZ use was confined to females aged 15–29 years (0.056 users per 1000 per month, 95% CI 0.033–0.079), while no significant change was observed among males of the same age (0.009 users per 1000 per month, 95% CI – 0.017 to 0.035). Among females aged 15–29 years, a significant long-term increase in BDZ use was observed for anxiety disorders (0.017 users per 1000 per month, 95% CI 0.010–0.023), depressive disorders (0.021 users per 1000 per month, 95% CI 0.012–0.030), and other mental and behavioral disorders (0.020 users per 1000 per month, 95% CI 0.010–0.030), but not for sleep disorders (– 0.008 users per 1000 per month, 95% CI – 0.018–0.002).ConclusionThe COVID-19 pandemic led to a short-term increase in BDZ use immediately after the pandemic was declared. In the long term, young females experienced a sustained increase in BDZ use. The prolonged effect on girls and young women suggests their greater vulnerability. These results underscore the need to effectively address the long-term effects of the pandemic among youth.

Census tract–level social determinants of health and variability in stage at diagnosis of bladder, breast, and non-small cell lung cancers.

11170 Background: Social determinants of health (SDOH) can identify underserved populations, inform the patient journey, and identify opportunities to improve outcomes. In cancer, SDOH may influence stage at diagnosis through exposure to risk factors for aggressive cancer and decreased access to care. However, privacy restrictions can limit research with SDOH in real world datasets, which often only know a patient’s broad location. Methods: Geocoding was undertaken on addresses of patients diagnosed between 1/1/17 and 9/30/22 with bladder (n=6078), breast (n=28,958), and non-small cell lung cancer (NSCLC, n=14,957) in the Syapse Learning Health Network of U.S. community health systems. Location was linked to five indicators of SDOH at the census tract level: the Social Vulnerability Index (SVI); percent (%) of tract spending &gt;30% of income on housing; % of tract with broadband internet; county designation as a primary care shortage area; and rural urban commuting area (RUCA). Nested multivariable ordinal logistic regression models estimated independent associations between demographic, clinical, and SDOH factors with stage at initial cancer diagnosis. The statistical significance of including SDOH variables was assessed using a likelihood ratio test (LRT) comparing the models before and after including SDOH. Results: After successful geocoding and linkage to census tracts, there were marginal differences in the distribution of the five SDOH across stages at diagnosis within the three tumor types. In multivariable models adjusted for year of diagnosis, age, sex, race, ethnicity, smoking, and primary payor, among the tested SDOH measures, county designated as primary care shortage (proportional odds ratios (OR): 1.31, 95% confidence interval (95% CI): 1.05-1.64), and non-metropolitan area (0.69, 0.50-0.94) were statistically significantly associated with stage at bladder cancer diagnosis. SVI (1.52, 1.31-1.76) was also statistically significantly associated and directly proportional with stage at breast cancer diagnosis. Among patients with NSCLC, broadband internet access (1.01, 1.00-1.01), primary care shortage (1.15, 1.03-1.27) and non-metropolitan area (0.85, 0.74-0.99) were statistically associated with stage at diagnosis. In all three tumors, LRTs found that models with SDOH were statistically significantly better at predicting stage at diagnosis than those without (p &lt;0.001). Conclusions: Using granular, census-tract geospatial resolution for geocoding of SDOH, we find that patients who live in greater vulnerability are diagnosed at later stages than those who live in areas of less vulnerability, suggesting that consideration of SDOH variables is important in assessing stage at diagnosis and identify patients with an unmet need for outreach and screening.

Sleep Disruption Precedes Forebrain Synaptic Tau Burden and Contributes to Cognitive Decline in a Sex-Dependent Manner in the P301S Tau Transgenic Mouse Model.

Sleep disruption and impaired synaptic processes are common features in neurodegenerative diseases, including Alzheimer's disease (AD). Hyperphosphorylated Tau is known to accumulate at neuronal synapses in AD, contributing to synapse dysfunction. However, it remains unclear how sleep disruption and synapse pathology interact to contribute to cognitive decline. Here, we examined sex-specific onset and consequences of sleep loss in AD/tauopathy model PS19 mice. Using a piezoelectric home-cage monitoring system, we showed PS19 mice exhibited early-onset and progressive hyperarousal, a selective dark-phase sleep disruption, apparent at 3 months in females and 6 months in males. Using the Morris water maze test, we report that chronic sleep disruption (CSD) accelerated the onset of decline of hippocampal spatial memory in PS19 males only. Hyperarousal occurs well in advance of robust forebrain synaptic Tau burden that becomes apparent at 6-9 months. To determine whether a causal link exists between sleep disruption and synaptic Tau hyperphosphorylation, we examined the correlation between sleep behavior and synaptic Tau, or exposed mice to acute or chronic sleep disruption at 6 months. While we confirm that sleep disruption is a driver of Tau hyperphosphorylation in neurons of the locus ceruleus, we were unable to show any causal link between sleep loss and Tau burden in forebrain synapses. Despite the finding that hyperarousal appears earlier in females, female cognition was resilient to the effects of sleep disruption. We conclude sleep disruption interacts with the synaptic Tau burden to accelerate the onset of cognitive decline with greater vulnerability in males.

Decent Work Profiles of Korean Workers: Antecedents and Outcomes of Profile Membership

Recent research has explored profiles of decent work based on the Psychology of Working Theory. However, such investigations have rarely been attempted in Korea. This study applied latent profile analysis to discover decent work profiles and their relationships with antecedents and outcomes. Among 605 Korean workers, five distinct profiles emerged: indecent (7.9%), low safety and healthcare access (34.9%), average (38.1%), decent (13.7%), and value-dominant but low rest (5.4%). Higher subjective social status and work volition were associated with the decent work group, whereas women and individuals with less education were linked to work characterized by greater vulnerability. Furthermore, satisfaction with work needs, job, and life varied significantly across these profiles. The decent work group generally exhibited the highest satisfaction, whereas the indecent work group had the lowest. The low-safety and healthcare access work group tended to exhibit higher satisfaction levels than the indecent work group, but lower levels than the average work group. The v alue-dominant but low-rest work group exhibited life satisfaction comparable to the decent work group. The findings of this study highlight the distinctive characteristics of the working conditions in South Korea. Based on these results, we discuss theoretical and practical implications.

Intérêt de la psychothérapie d’acceptation et d’engagement et de la thérapie fondée sur la compassion pour soutenir le maintien de l’abstinence dans les polyaddictions

Introduction and objectivesAddiction concerns people suffering from great psychological vulnerability due to early trauma and attachment disorders. Although several forms of therapeutic management have been shown to be effective, the relapse rate remains high, and the effects are short-lived. Therefore, the first objective of this study was to integrate the tenets and concepts of compassion-based therapy with acceptance and commitment therapies for the treatment of patients with polyaddictions by conceptualizing a therapeutic program aimed at support for maintaining abstinence. The interest in such an integration has been raised by several authors. The central concept of that integrative approach was the “compassionate flexibility”. Our second objective was to explore the feasibility, acceptability, and therapeutic effects of this intervention for patients with polyaddictions and psychiatric comorbidities, who are particularly resistant to psychotherapies. Material and methodTwelve patients (8 men and 4 women) with polyaddictions (alcohol, cocaine, tobacco, cannabis) of the 24 referred for the study, followed the MyActaddiction program. The A-B multiple-case-series protocol combined qualitative and quantitative measures to monitor feasibility, acceptability, clinical (OCDS, EADS-21) and psychological (AAQ-II, EAC) progress, patient narrative feedback (perception, connection, sense of presence), complemented by follow-up observations on abstinence maintenance. ResultsResults show moderate feasibility, with only 50 % of study referrals accessing psychotherapy, good accessibility, with 66 % of patients completing all sessions, high satisfaction levels and positive qualitative feedback. Pre- and post-treatment assessments showed a significant clinical improvement in craving (obsessive thoughts and OCDS total score) at group level, and these changes were clinically significant at individual level by Reliable Change Index measures, for 70 % of participants. On the EDAS-21 scale, patients who had pathological scores prior to therapy improved their scores to non-pathological thresholds for anxiety, stress and depression. The Reliability Change Index (RCI) showed that the resulting change was clinically significant at the individual level for 83 % of patients on anxiety level, for 58.33 % of patients on depression, and 50 % of patients on the stress level. In terms of the psychological processes targeted by the therapeutic practices, we observed an improvement in psychological flexibility, with a clinically significant reduction in AAQ-II scores after the intervention compared to the pre-treatment score. The RCI indicated that the observed clinical change was significant. There was also a significant increase in post-test versus pre-test for two dimensions of self-compassion: “common humanity” and “mindfulness”, with a high Cohen's d. Regarding individual scores, the scores for “self-compassion” and “common humanity” were below the expected average scores usually observed in the general population. According to the RCI, the increase in post-test scores was robust for 41 % of the patients on “common humanity” dimension, for only on patient on the “mindfulness” dimension, and on patient on the “self-kindness” dimension. The RCI shows that changes are clinically reliable for 50 % of patients for the “common humanity” and “mindfulness” sub-dimensions of self-compassion. Follow-up showed that 66 % of patients-maintained abstinence at one year, while 25 % relapsed, while one patient experienced both variations in consumption and periods of abstinence. ConclusionThe present program combines TFC and ACT for abstinence maintenance in the treatment of addiction. This study could demonstrate the value of process-based approaches to the treatment of complex pathologies such as polyaddiction. These findings suggest that compassion-based psychological interventions and psychological flexibility could be a transdiagnostic protective factor encouraging abstinence maintenance in people with polyaddictions. These results call for further research to explore the active mechanisms of compassion-related components.

Association Between Social Vulnerability and Streptococcus pneumoniae Antimicrobial Resistance in US Adults.

Growing evidence indicates antimicrobial resistance disproportionately affects individuals living in socially vulnerable areas. This study evaluated the association between the CDC/ATSDR Social Vulnerability Index (SVI) and Streptococcus pneumoniae (SP) antimicrobial resistance (AMR) in the United States. Adult patients ≥18 years with 30-day nonduplicate SP isolates from ambulatory/hospital settings from January 2011 to December 2022 with zip codes of residence were evaluated across 177 facilities in the BD Insights Research Database. Isolates were identified as SP AMR if they were non-susceptible to ≥1 antibiotic class (macrolide, tetracycline, extended-spectrum cephalosporins, or penicillin). Associations between SP AMR and SVI score (overall and themes) were evaluated using generalized estimating equations with repeated measurements within county to account for within-cluster correlations. Of 8008 unique SP isolates from 574 US counties across 39 states, the overall proportion of AMR was 49.9%. A significant association between socioeconomic status (SES) theme and SP AMR was detected with higher SES theme SVI score (indicating greater social vulnerability) associated with greater risk of AMR. On average, a decile increase of SES, indicating greater vulnerability, was associated with a 1.28% increased risk of AMR (95% confidence interval [CI], .61%, 1.95%; P = .0002). A decile increase of household characteristic score was associated with a 0.81% increased risk in SP AMR (95% CI, .13%, 1.49%; P = .0197). There was no association between racial/ethnic minority status, housing type and transportation theme, or overall SVI score and SP AMR. SES and household characteristics were the SVI themes most associated with SP AMR.

Small retail businesses' social media adoption amid a crisis

PurposeWhen retail businesses, especially small businesses with greater vulnerability, could not meet consumers in person during the recent pandemic crisis, how did they adapt to the situation? This study examined how small business practitioners (SBPs’) perceptions, trust and adoption intention levels for social media, as well as the relationships among these variables, changed before and during the crisis based on the integration of the contingency theory and the diffusion of innovation theory (DIT).Design/methodology/approachOnline surveys were conducted with USA SBPs before (n = 175) and during (n = 225) the recent pandemic. The hypotheses were tested using structural equation modeling (SEM), multivariate analysis of variance (MANOVA) and multiple-group SEM analysis.FindingsThe results confirmed significant sequential positive relationships between SBPs’ perceived external pressure and perceived benefits of adopting social media, which in turn led to their trust in and then adoption intentions for social media. Further, the comparisons between the pre- and in-pandemic samples revealed that SBPs’ perceptions and adoption intentions all became significantly higher during (vs before) the pandemic, but the structural relationships among these variables weakened during the pandemic.Originality/valueThis study uses a novel approach to integrate the contingency theory with the DIT to propose small businesses' perceptions, trust and adoption intentions for social media during the innovation decision process under rapid contingency changes. Our findings also offer practical implications including recommendations for small businesses’ innovation management as well as training programs.

Kadınların Güçlendirilmesi ve Göç Etme Niyeti Üzerine Hanehalkı Düzeyinde Bir Araştırma: Afganistan Örneği

This study investigates the relationship between two important concerns, which are migration intentions of households and women empowerment in the case of Afghanistan where migration is a process that continues from its history to the present, and international indicators shows a quite bad picture on women empowerment or gender equality. It is obvious that women in this country presents a great vulnerability and they need to be empowered. However, it is not that obvious whether their empowerment is associated with migration intention of households. Therefore, this paper questions how and in which way the empowerment of women as a vulnerable group within different segments of Afghan society influence migration intention of households. Findings show that women empowerment measures, that are Women_leader, Women_support, Women_job, and Girls_edu, do not significantly influence migration intentions of households when they exist separately. However, it significantly influence migration intentions when they are allowed to interact together. It might be said that empowerment of women from political, social, and economic aspects that are presented by four of abovementioned measures is important to explain potential movements of population. Besides, there is significant regional differences to explain migration intentions. These findings are expected to be useful for policy makers on migration policies.

Connection between El Niño Deep Convection and Precipitation in Northeast Brazil

The indices reflecting the warm or cold phases of the El Ni&amp;ntilde;o-Southern Oscillation (ENSO) phenomenon are commonly based on sea surface temperature (SST) anomalies in cleverly chosen sectors in the Tropical Pacific Ocean. These climate indices, used as predictors of remote climate oscillations, have been successful in most studies of the effects of ENSO forcings on drought anomalies or unexpected floods worldwide. However, there is one difficulty that bothers researchers: the diversity of these remote effects. One of the regions of the world that has attracted the attention of scholars of the remote effects of ENSO oscillations is Northeast Brazil. The main reason for this interest is the great vulnerability of this region to droughts due to the social and economic fragilities that have persisted there for more than two centuries. This study proposes the experimental use of essential atmospheric indices, such as convective instability, as indicators of the presence of cumulonimbus in the Tropical Pacific in response to El Ni&amp;ntilde;o episodes. It is well known that the remote effects of El Ni&amp;ntilde;o events occur due to cumulonimbus formation in the Tropical Pacific in response to the additional supply of heat and humidity in areas with warm surface waters. However, these tropical cumulus clusters respond not only to surface heating but also to other forces associated with atmospheric circulation. This study has shown that such cumulonimbi can form in areas that are slightly apart from the sectors with the greatest surface heating.

Hepatitis Aguda Grave de Origen Desconocido en Población Pediátrica Durante la Pandemia de Covid 19

This research aims to conduct an updated bibliographic review focused on the comparison of clinical cases in pediatric patients who presented with severe acute hepatitis of unknown etiology in order to evaluate the severity that may occur in this risk group, characterized by gastrointestinal symptoms, elevated liver enzyme values (greater than 500 IU/L), monitoring of liver function should be considered (5). For this study, scientific literature was consulted between January 2021 and June 2022 using platforms such as PubMed, Scopus, Elsiever, The Lancet, Web of Science, Medline. The total population analyzed consists of 18 pediatric patients who tested negative for hepatitis virus (A-E). Of which 4 patients are negative for SARS VOC 2, while the rest are confirmed positive cases, surprisingly 5 patients tested positive for adenovirus. Of the five hypotheses raised in this study, the one that had the greatest impact was that of adenovirus, which caused greater vulnerability, resulting from the reduced circulation of this virus in the last two years. It is still necessary to collect data on this disease, it is important to notify them in order to know their etiopathogenesis and subsequent therapeutic management.

Association Between Social Vulnerability and Gastrointestinal Cancer Mortality in the United States Counties

Social determinants of health contribute to disparities in gastrointestinal (GI) cancer mortality between individuals in the US. Their effects on count-level mortality rates remain uncertain. We aimed to assess the association between county social vulnerability and GI cancer mortality. In this ecological study (2016-2020), we obtained US county Social Vulnerability Index (SVI) from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry and age-adjusted mortality rates (AAMRs) for GI cancers from Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiological Research). SVI ranges from 0 to 1, with higher indices indicating greater vulnerability. We presented AAMRs by quintiles of SVIs. We used Poisson regression through generalized estimating equation to calculate rate ratios (RRs) and 95% confidence intervals (CIs) for GI cancer mortality by quintiles of SVI. There were 799,968 deaths related to GI cancers from 2016 to 2020, resulting in an AAMR (95% CI) of 39.9 (41.4-51.2) deaths per 100,000 population. The largest concentration of counties with greater SVI and GI cancer mortality was clustered in the southern US. Counties with greater SVI had higher mortality related to all GI cancers (RRQ5 vs Q1, 1.19 [95% CI, 1.14-1.24]), gastric cancer (1.58 [1.48-1.69]), liver cancer (1.54 [1.36-1.73]), and colorectal cancer (RRQ5 vs Q1, 1.23 [95% CI, 1.15-1.31]). RRs for overall GI cancers were greater among individuals <45 years (1.24 [1.15-1.32]), men (1.22 [1.16-1.27]), Hispanic individuals (1.33 [1.18-1.50]), and rural counties (1.21 [1.14-1.27]) compared with their counterparts. Socially disadvantaged counties face a disproportionately high burden of GI cancer mortality in the US. Targeted public health interventions should aim to address social inequities faced by underserved communities.

Perspectives of Women with Intellectual Disabilities Regarding Affective Sexual Relationships: a Systematic Literature Review

IntroductionDespite the recognition of the right to sexual identity and expression for all people, individuals with intellectual disabilities continue to face significant restrictions in these aspects of their lives. The prevailing myths and stereotypes surrounding their sexual-affective relationships place people with intellectual disabilities—especially women—in a position of great vulnerability.MethodsA systematic literature review was conducted, examining the content of the following databases: BASE, Dialnet, ERIC, La Referencia, Microsoft Academic, Redalyc, REDIB, Redined, Science Direct, Scopus, Web of Science, and World Wide Science. A total of 178 potentially relevant articles were identified, out of which 11 met the eligibility criteria. Finally, the themes covered in the articles were identified and analyzed.ResultsThe results obtained were classified into six categories: perceptions regarding sex and sexuality, experiences of abuse, views and experiences of relationships between couples, the LGTBIQ + community, knowledge about contraception and related experiences, and, finally, beliefs regarding gender scripts.ConclusionsThis study offers valuable insights into the knowledge (or lack thereof) and beliefs regarding sex and sexuality, experiences of abuse among women with intellectual disabilities, the lack of independence and external intervention, and the influence of traditional gender scripts. Furthermore, this research also establishes a theoretical foundation for future support resources and initiatives, as well as social and public implications.