Low-income Populations Research Articles

Outpatient ATG-free hematopoietic transplantation for aplastic anemia in limited-resource environments offers excellent results: Data from a single LATAM center

ObjectiveTo document the results of outpatient hematopoietic stem cell transplantation (HSCT) from the peripheral blood (PB) of sibling donors without anti-thymocyte globulin (ATG) in the conditioning regimen. Material and methodsPatients from a low-income population with severe AA who received a PB, unmanipulated sibling HLA-identical HSCT between 2000 and 2020 at a single institution were studied. Survival was the primary outcome. ResultsForty-one transplants were performed. Time between diagnosis and transplant was five months (1–104). Median age was 37 (range, 4–61) years; 25 (61 %) recipients were males and 32 (78 %) had treatment failure, 9 (22 %) have not received treatment. ATG was administered in 5 (12.2 %) cases; the graft source was PB in 38 (92.7 %) transplants. Twenty-six (63.4 %) transplants were carried out in the outpatient setting. Infections developed in 14 (34.1 %) patients. Primary graft failure (GF) occurred in 3 (7.3 %) patients. The 15-year OS was 81 %, EFS was 77.4 %. Patients with high pre-HSCT transfusion burden had lower OS (p = 0.035) and EFS (p = 0.026). Previous treatment failure and age were not associated with lower OS (p = 0.115, p = 0.069) or EFS (p = 0.088, p = 0.5, respectively). ConclusionsHLA-identical T-cell replete outpatient HSCT from the PB of sibling donors for AA patients using ATG-free conditioning offers excellent long-term survival.

Food insecurity amongst asylum seekers and people without status in Israel

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

Economic and Social Impact Assessment of Chronic Diseases Among the Low-Income Population in Southern Punjab, Pakistan

Economic and Social Impact Assessment of Chronic Diseases Among the Low-Income Population in Southern Punjab, Pakistan

Cienciometric Analysis of Scientific Production on Hydatidosis/Echinococcosis in Latin America

Abstract Introduction: Hydatidosis/cystic echinococcosis (CE) is considered a neglected disease due to its preventive nature and impact on low-income populations. In Latin America, there is a high incidence, and in the high Andean regions, it is considered an endemic disease. The objective of this study was to quantify and analyze the scientific production of hydatidosis/echinococcosis through a bibliometric analysis in Latin America up to 2022. Methods: A bibliometric analysis study was conducted based on the scientific production of CE in the SCOPUS database until 2022 in Latin American countries. Information was collected through a systematic search. Frequencies and percentages were used to summarize the variables captured in the final database. Results: Scientific production showed growth over the years, with Argentina, Uruguay, and Chile having the highest production. In addition, there has been a trending use of the term “neglected disease” since 2018. The most cited articles were primarily narrative reviews, book chapters, and original articles in that order. Only 27% of the studies were funded by an institution in Latin America. Conclusion: Scientific production in Latin America regarding CE is on the rise, especially in countries with high incidence rates. Furthermore, these countries demonstrate a significant network of international collaboration.

Mild Traumatic Brain Injury by the Glasgow Coma Scale Score and Early CT-Brain Findings in Acute Alcohol Intoxication Patients: A Prospective Observational Study.

Introduction Traumatic brain injuries (TBI) in recent years have proved to be a significant public health problem, with potentially life-changing consequences for the individual and their family. Alcohol consumption is a regular, well-documented problem among persons sustaining TBIdue to road traffic accidents and accidental falls. The primary objective of this study was to find out the correlation between the Glasgow Coma Scale (GCS) score and CT brain findings among mild TBI patients under acute alcohol intoxication and determine if early CT-brain is indicated in this group. Methods A prospective observational study was conducted involving 111 alcohol-intoxicated patients with mild head injuries admitted to the surgical wards of Thanjavur Medical College Hospitalover a period of three months. The Glasgow Coma Scale was used to assess the patient'sneurological status and determine the severity of the brain injury. A semi-structured CT-brain findings chart and a severity of alcohol intoxication objective-based scoring system were developed and validated by experts. Descriptive statistics tools such as frequency, percentage, and mean were used, along with inferential statistics tools like the Chi-squared test, Fisher exact test, and Pearson's correlation coefficient test. Results The study findings showed that the comparison of GCS with early CT-brain was significant at a p-value of 0.012, and a negative correlation (r=-0.253) was found between GCS and CT-brain findings. A comparison of CT-brain findings with the severity of alcohol intoxication was non-significant at a p-value of 0.433. Conclusions Early CT-brain in intoxicated mild TBI patients may have a positive impact on early diagnosis and management, even in centers with limited resources catering to low-income population groups. The results of our short-term study show that early CT-Brain picks up lesions and helps initiate early management while it is up to the attending physician to keep in mind an adverse cost-benefit ratio in overuse of hospital resources and misdiagnosis leading to undertreatment causing long-term sequelae and morbidity before prescribing early CT-brain in this cohort of patients.

Accessibility to the winter cycling network in Montréal: A transport equity diagnosis

Recent studies have demonstrated the importance of a well-maintained and safe bicycle network to increase winter cycling. However, inequities in the access to cycling infrastructure in winter have not been documented yet. Based on the concept of equity in transport, this research aims to fill the gap and assess whether inequities are exacerbated during winter in the city of Montréal, Canada. The distance to the nearest cycling network section and kilometres of cycling network with 2.5 km and 5 km were computed in GIS. Two types of statistical analysis were then conducted to assess potential inequities for four population groups: weighted t-tests and seemingly unrelated regression (SUR) models. Our results demonstrate that the winter cycling network is more concentrated in central neighbourhoods and that accessibility issues are increasing in winter. Visible minorities face the most lack of accessibility, compared to the rest of the population. People under the age of 15 and over the age of 65 years old are also in unequal situations, while the low-income population has better access to winter cycling infrastructure than other groups. Our results innovate by incorporating measures of accessibility to the winter cycling network into the assessment of transport inequities.

Climate Justice Implications of Natech Disasters: Excess Contaminant Releases during Hurricanes on the Texas Gulf Coast.

Extreme weather events are becoming more severe due to climate change, increasing the risk of contaminant releases from hazardous sites disproportionately located in low-income communities of color. We evaluated contaminant releases during Hurricanes Rita, Ike, and Harvey in Texas and used regression models to estimate associations between neighborhood racial/ethnic composition and residential proximity to hurricane-related contaminant releases. Two-to-three times as many excess releases were reported during hurricanes compared to business-as-usual periods. Petrochemical manufacturing and refineries were responsible for most air emissions events. Multivariable models revealed sociodemographic disparities in likelihood of releases; compared to neighborhoods near regulated facilities without a release, a one-percent increase in Hispanic residents was associated with a 5 and 10% increase in the likelihood of an air emissions event downwind and within 2 km during Hurricanes Rita and Ike (odds ratio and 95% credible interval= 1.05 [1.00, 1.13], combined model) and Harvey (1.10 [1.00, 1.23]), respectively. Higher percentages of renters (1.07 [1.03, 1.11], combined Rita and Ike model) and rates of poverty (1.06 [1.01, 1.12], Harvey model) were associated with a higher likelihood of a release to land or water, while the percentage of Black residents (0.94 [0.89, 1.00], Harvey model) was associated with a slightly lower likelihood. Population density was consistently associated with a decreased likelihood of a contaminant release to air, land, or water. Our findings highlight social inequalities in the risks posed by natural-technological disasters that disproportionately impact Hispanic, renter, low-income, and rural populations.

Exploring Patterns and Disparities in E-Consult Referrals: An Analysis of Patient and Community Factors in Colorado Health Care.

Objective: Electronic consultations (e-consults) provide a strategic solution to address challenges in health care systems related to cost management and access to care. This study aims to investigate the multilevel patient characteristics associated with higher frequency of receiving e-consults and increased likelihood of completion. Materials and Methods: University of Colorado's electronic medical record were analyzed to study factors influencing referral types (e-consult vs. standard) and their completion rates from April 2018 to September 2023. Multivariate probit regression assessed the impact of patient-level and community-level factors (urban-rural classification, Social Vulnerability Index, and technology accessibility) on e-consult referrals and completion. Results: In 263,882 records, 92.5% were standard referrals, and 7.4% were e-consult referrals. Analysis showed that females were less likely than males (OR = 0.95, 95%CI[0.93, 0.96]), and Blacks were more likely than Whites (OR = 1.03, 95%CI[1.01,1.06]) to receive e-consult referrals. Medicaid patients had lower odds compared to those with Medicare only (OR = 1.04, 95%CI[1.00,1.07]), and rural residency was associated with lower odds (OR = 0.80, 95%CI[0.73,0.88]) of e-consult referral. Factors such as areas with higher population without internet subscription (OR = 1.03, 95%CI[1.01,1.04]) and higher social vulnerabilities (OR = 1.26, 95%CI[1.16,1.37]) increased e-consult odds. Black patients were less likely to have their referrals completed compared to Whites. Patients who resided in regions with limited computer and smartphone access, as well as higher social vulnerabilities, showed decreased odds of referral completion. Discussions and Conclusion: This study highlights the need for partnering with a variety of health care organizations, especially those serving low-income and disadvantaged populations, to enhance health care access equity through the use of e-consults.

Community Collaboration to Advance Racial/Ethnic Equity in Colorectal Cancer Screening: Protocol for a Multilevel Intervention to Improve Screening and Follow-up in Community Health Centers

IntroductionColorectal cancer (CRC) screening utilization is low among low-income, uninsured, and minority populations that receive care in community health centers (CHCs). There is a need for evidence-based interventions to increase screening and follow-up care in these settings. MethodsA multilevel, multi-component pragmatic cluster randomized controlled trial is being conducted at 8 CHCs in two metropolitan areas (Boston and Los Angeles), with two arms: (1) Mailed FIT outreach with text reminders, and (2) Mailed FIT-DNA with patient support. We also include an additional CHC in Rapid City (South Dakota) that follows a parallel protocol for FIT-DNA but is not randomized due to lack of a comparison group. Eligible individuals in participating clinics are primary care patients ages 45–75, at average-risk for CRC, and overdue for CRC screening. Participants with abnormal screening results are offered navigation for follow-up colonoscopy and CRC risk assessment. ResultsThe primary outcome is the completion rate of CRC screening at 90 days. Secondary outcomes include the screening completion rate at 180 days and the rate of colonoscopy completion within 6 months among participants with an abnormal result. Additional goals are to enhance our understanding of facilitators and barriers to CRC risk assessment in CHC settings. ConclusionsThis study assesses the effectiveness of two multilevel interventions to increase screening participation and follow-up after abnormal screening in under-resourced clinical settings, informing future efforts to address CRC disparities. Trial RegistrationNCT05714644

Connecting With Shosho: Assessing the Role of Grandmothers in a Low-Income Population in Nairobi, Kenya

Connecting With Shosho: Assessing the Role of Grandmothers in a Low-Income Population in Nairobi, Kenya

Impact of Third-Generation Antiseizure Medications on People with Epilepsy in a Low-Income Population: The Brivaracetam Experience in a Real-World Study.

Third-generation antiseizure medications, such as brivaracetam, are recognized for their superior safety, tolerability, and pharmacokinetic profiles. However, their potential benefits are often limited in low-income populations because of challenges related to availability and affordability. We aimed to evaluate the effectiveness and safety of brivaracetam for treating epilepsy in a low-income population, within a real-world setting. This retrospective cohort study included individuals with epilepsy from a low-income population in Bogotá, Colombia, who were treated with brivaracetam between January 2020 and July 2023. Effectiveness (mean seizure reduction and ≥ 50% seizure reduction) and safety (retention rate and adverse events) were evaluated. A total of 106 individuals were included, with a median age of 33 years (interquartile range: 24-44). Most had focal epilepsy with a median disease duration of 25.4 years (standard deviation: 13.6). The baseline seizure frequency was 4 seizures per month (interquartile range: 2-15) and individuals had previously received a mean of 4.4 (standard deviation: 1.8) antiseizure medications. The mean percentage seizure reduction at 3, 6, and 12 months was 55.3%, 66.9%, and 63.8%, respectively. Additionally, 60%, 63.8%, and 65.9% of individuals achieved a ≥ 50% seizure reduction at 3, 6, and 12 months, respectively. Retention rate at 3 months was 89% (n = 95) and 18.7% (n = 20) reported adverse effects. In a real-world setting, brivaracetam has been shown to be safe and effective for the treatment of epilepsy in individuals from a low-income population. This study suggests that people with epilepsy living in this context can significantly benefit from the use of third-generation antiseizure medications.

Exclusive Breastfeeding Factors at 6 Months Postpartum in Low-Income Populations: An Integrative Review

Exclusive Breastfeeding Factors at 6 Months Postpartum in Low-Income Populations: An Integrative Review

Reviewing the impact of climate change on global food security: Challenges and solutions

This review examines the intricate relationship between climate change and global food security, elucidating the challenges posed by climate variability and exploring potential solutions to mitigate its adverse effects. Climate change presents formidable obstacles to food security worldwide, disrupting agricultural productivity, exacerbating food shortages, and deepening malnutrition. Shifts in temperature and precipitation patterns, coupled with the increasing frequency of extreme weather events, threaten crop yields, livestock health, and food distribution networks, particularly in vulnerable regions. The review identifies key challenges confronting global food security in the context of climate change, including diminished agricultural productivity, heightened food price volatility, and heightened risks of food insecurity and malnutrition. It underscores the disproportionate impact of climate change on marginalized communities, smallholder farmers, and low-income populations, who bear the brunt of environmental degradation and lack the resources to adapt. In response to these challenges, the review explores a range of solutions and strategies aimed at enhancing food security resilience in a changing climate. It discusses the importance of climate-smart agricultural practices, such as agroforestry, crop diversification, and soil conservation, in bolstering the resilience of agricultural systems and improving resource efficiency. Additionally, the review highlights the significance of enhancing access to climate information, investing in sustainable infrastructure, and promoting gender equity in agriculture to foster inclusive and adaptive food systems. Furthermore, the review underscores the critical role of policy interventions, international collaboration, and community engagement in addressing climate-related food security challenges and advancing sustainable development goals. By integrating climate adaptation and mitigation measures into agricultural policies, promoting research and innovation, and fostering multi-stakeholder partnerships, it is possible to build more resilient and equitable food systems that can withstand the impacts of climate change and ensure food security for all. In conclusion, the review emphasizes the urgency of concerted action to address the complex interplay between climate change and global food security. Through collective efforts and targeted interventions, it is feasible to mitigate the adverse effects of climate change on food systems and pave the way for a more sustainable and food-secure future. Keywords: Impact, Climate Change, Global, Food Security, Challenges.

An Algorithm for the Estimation of Hemoglobin Level from Digital Images of Palpebral Conjunctiva Based in Digital Image Processing and Artificial Intelligence

Anemia is a common problem that affects a significant part of the world’s population, especially in impoverished countries. This work aims to improve the accessibility of remote diagnostic tools for underserved populations. Our proposal involves implementing algorithms to estimate hemoglobin levels using images of the eyelid conjunctiva and a calibration label captured with a mid-range cell phone. We propose three algorithms: one for calibration label segmentation, another for palpebral conjunctiva segmentation, and the last one for estimating hemoglobin levels based on the segmented images from the previous algorithms. Experiments were performed using a data set of children’s eyelid images and calibration stickers. An L1 norm error of 0.72 g/dL was achieved using the SLIC-GAT model to estimate the hemoglobin level. In conclusion, the integration of these segmentation and regression methods improved the estimation accuracy compared to current approaches, considering that the source of the images was a mid-range commercial camera. The proposed method has the potential for mass screening in low-income rural populations as it is non-invasive, and its simplicity makes it feasible for community health workers with basic training to perform the test. Therefore, this tool could contribute significantly to efforts aimed at combating childhood anemia.

Can carbon tax revenue recycling coordinate climate mitigation and energy poverty alleviation?

Energy poverty is a key dimension of multidimensional poverty and a major challenge for climate action. This study examines how climate policies affect energy poverty, especially the role of carbon tax revenue recycling in coordinating climate mitigation and energy poverty alleviation. Using an integrated Climate-Economy-Energy Poverty (RICE-EP) model that incorporates inequality aspects of energy poverty, the study analyzes the effects of climate policies on household energy consumption. The study simulates various scenarios of climate actions and carbon tax revenue recycling and finds that: i) Carbon tax revenue recycling can simultaneously advance climate change mitigation and energy poverty reduction goals, it can promote climate mitigation and enhance equity by lowering the abatement costs borne by low-income populations; ii) However, the interactions between stringent climate targets and energy affordability are complex. Modeling suggests that even optimal revenue recycling fails to prevent exacerbated energy poverty among disadvantaged groups under ambitious 2 °C climate targets; iii) Analysis indicates that an emissions reduction rate approaching 43 %, enabled by a carbon tax calibrated to incentivize an equitable transition, could maximize alleviation of energy poverty by directing subsidy support to low-income groups. The study methodology and findings offer valuable, actionable insights into coordinating equitable climate and economic policies.

The impact of primary health care on AIDS incidence and mortality: A cohort study of 3.4 million Brazilians.

Primary Health Care (PHC) is essential for effective, efficient, and more equitable health systems for all people, including those living with HIV/AIDS. This study evaluated the impact of the exposure to one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality. A retrospective cohort study carried out in Brazil from January 1, 2007 to December 31, 2015. We conducted an impact evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the impact of FHS on AIDS incidence and mortality and compared outcomes between residents of municipalities with low or no FHS coverage (unexposed) with those in municipalities with 100% FHS coverage (exposed). We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated the FHS impact by sex and age and performed a wide range of sensitivity and triangulation analyses; 100% FHS coverage was associated with lower AIDS incidence (rate ratio [RR]: 0.76, 95% CI: 0.68 to 0.84) and mortality (RR: 0.68, 95%CI: 0.56 to 0.82). FHS impact was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR: 0.62, 95% CI: 0.53 to 0.72) and mortality (RR: 0.56, 95% CI: 0.43 to 0.72). The absence of important confounding variables (e.g., sexual behavior) is a key limitation of this study. AIDS should be an avoidable outcome for most people living with HIV today and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030.

A districting problem with data reliability constraints for equity analysis

While data plays an important role in transportation research, sampled data is not always reliable. Data reliability issue is significant especially for minority groups. In this study, a districting approach is proposed which improves data reliability through aggregation of basic spatial units (BSU), adapted from a max-p-regions problem. The model generates as many aggregated zones as possible that minimize intrazonal heterogeneity while minimizing data margin of error (MOE) of all aggregated zones using a controlling MOE threshold. The problem is first formulated as an integer programming which selects optimal set of zones from a pre-generated set of candidate zones. The difficulty of solving the formulation lies in the generation of the candidate set, so a heuristic solution algorithm is proposed. Two case studies are provided to illustrate the method and validate its performance by evaluating the resulting data quality in an example subsequent planning model. First is an area in Downtown Manhattan with 62 census tracts, comparing the aggregated zones with Neighborhood Tabulation Areas (NTAs) and Taxi Zones. Second is the generation of the New York City Equitable Zoning (NYCEZ), which generated 574 Equitable Zones that reduce the average MOE% of demographic data by 48% for seniors, 75% for low-income population, and 46% for long commuters, all with a district number that is higher than NTAs (221) and Taxi Zones (263). NYCEZ and census tracts are then compared in a subsequent model, synthetic population generation, showing an improvement of 6.2% in standard deviation across simulated populations under the proposed zone design. NYCEZ showed smaller variation in the generated population data. The algorithm can help the decision making of public agencies and the service design of mobility providers by producing reliable and equitable data. The algorithm can also be applied to data-sharing between mobility providers and agencies to alleviate privacy concerns.

Consumer Protection Frameworks by Enhancing Market Fairness, Accountability and Transparency (FAT) for Ethical Consumer Decision-Making: Integrating Circular Economy Principles and Digital Transformation in Global Consumer Markets

This research explores the evolving role of consumer protection laws for enhancing market fairness, accountability, and transparency (FAT) to facilitate informed consumer decision-making within the digital economy. Exploring international standards by The United Nations Guidelines for Consumer Protection (UNGCP), the Organisation for Economic Co-operation and Development (OECD), and the United Nations on Trade and Development (UNCTAD), as well as regional initiatives like the European Commission's, the study investigates circular economy principles for consumer resilience and marginalized groups such as low-income populations and rural communities. Utilizing a normative and exploratory research approach, data is gathered from global policy documents and scholarly sources. Comparative qualitative analysis is conducted to identify standard practices. The significance of adopting consumer protection frameworks to study the intricacies of digital transactions and environmental sustainability and its impact on consumer protection law, which will help citizens make informed decisions. This study highlights innovative strategies, such as the OECD’s guidelines for e-commerce and national policies promoting circular economy principles. By exploring case studies from countries like Germany, the Netherlands, China, Japan, India and Oman for circular economy practices and Sweden, the United States, Armenia, Australia and Oman for financial sector improvements, the research provides the framework for improving consumer protection policies globally.

The Genetic Diagnostics of Hemochromatosis: Disparities in Low- Versus High-Income Countries.

This study provides a comprehensive overview of hereditary hemochromatosis (HH), a genetic condition characterized by iron overload due to excessive iron absorption. It elucidates diverse inheritance patterns and clinical manifestations by exploring mutations in critical genes such as HFE (hemochromatosis), HJV (hemojuvelin), HAMP (hepcidin antimicrobial peptide), TfR2 (transferrin receptor 2), and FP (ferroportin). The significance of early screening, diagnosis, and personalized management strategies based on genetic classification is emphasized, particularly in terms of high-income vs. low-income countries. Addressing challenges in diagnosis, genetic testing accessibility, and healthcare disparities, the study highlights the importance of early detection, cost-effective screening strategies, and enhancing healthcare outcomes globally. Advanced genetic testing in high-income countries facilitates early diagnosis and management, reducing complications such as liver disease and cardiomyopathy. In contrast, low-income populations face several barriers, including limited access to genetic testing, high costs, and inadequate healthcare infrastructure. Cost-effective serum ferritin (SF) and transferrin saturation (TS) tests and emerging point-of-care (POC) tests offer affordable diagnostic options for low-resource settings. Additionally, the ongoing development of hepcidin measurement methods holds promise for enhancing diagnostic capabilities. Implementing these strategies can aid healthcare providers in improving global HH management and reducing the burden of iron overload complications. Furthermore, the study underscores the need for public health initiatives to raise awareness about HH, promote routine screenings, and advocate for equitable healthcare policies. Collaborative efforts between governments, healthcare organizations, and research institutions are crucial in addressing the global burden of HH. By fostering international cooperation and resource-sharing, it is possible to bridge the gap between high-income and low-income countries, ensuring all individuals have access to the necessary diagnostic and treatment options. This holistic approach can ultimately lead to better health outcomes and improved quality of life for individuals affected by HH worldwide. This comprehensive examination of HH not only illuminates the genetic and clinical aspects of the condition but also provides a roadmap for addressing the multifaceted challenges associated with its diagnosis and management.

Who are marginalized in accessing urban ecosystem services? A systematic literature review

Urban ecosystems provide many crucial services to cities and their residents, particularly in adapting to the effects of climate change. Extensive research has been conducted in this field, covering various aspects of ecosystem services. However, little is known about issues related to the limited access to these ecosystem services, particularly among marginalized populations. This review systematically screened 3961 papers and synthesized findings from 98 papers to identify groups that are marginalized in terms of access to urban ecosystem services and provide policy measures to address the issue. We conducted an inductive content analysis and thematic analysis to review the literature comprehensively. Our findings revealed that marginalization is more prevalent in cultural ecosystem services (51 %) than in other ecosystem service types. The results also show that vulnerable populations, including minorities, low-income populations, physically challenged people, children/young people/students, older people, and migrants, are particularly marginalized. Among these groups, minorities (24 %) emerged as the most extensively studied category. Additionally, we identified a marginalized group labeled as 'generic,' consisting of individuals whose identities did not neatly fit within the previously defined groups or were mentioned across multiple groups simultaneously.The marginalization across all these groups stems from income disparities, cultural norms, racial and ethnic considerations, willingness to visit, age-related disparities, physical disabilities, and geographical location. Importantly, our study underscores the adverse effects of marginalization on these groups, leading to health disparities, lower quality of life, and reduced resilience to climate change. In light of these findings, we also spotlight policies from the literature such as inclusive urban planning, community engagement initiatives, and financial support aimed at ensuring more equitable access to urban ecosystem services.