Vulnerable Communities Research Articles

Design of a mindfulness intervention to reduce risk factors for colorectal cancer among at-risk Black women in Chicago.

Chronic stress can directly and indirectly promote carcinogenesis through immune, metabolic, and microbial pathways. Our overarching hypothesis is that reducing chronic stress will have important implications for colorectal cancer (CRC) risk reduction among vulnerable and high-risk populations. A promising approach for reducing chronic stress is mindfulness. Mindfulness is a meditation-based technique that achieves a state of mind that is used to experience higher awareness or consciousness. Existing small studies suggest mindfulness can positively regulate stress response in a way that translates to anticancer effects, including reduced systemic inflammation. We propose to evaluate an 8-wk mindfulness intervention delivered in a hybrid format (synchronous and asynchronous sessions) among 40 Black women at elevated risk of CRC who reside in vulnerable communities and who report moderate to high perceived stress. At baseline and postintervention, participants will provide blood, hair, and stool; undergo body composition analysis; and complete mood and lifestyle-related surveys. The specific aims are to assess the feasibility and acceptability of the intervention and explore changes on stress, weight, fasting glucose, inflammation markers, and the gut microbiota-risk markers and risk pathways associated with CRC. The data generated through this project will inform if mindfulness is a feasible option for CRC risk reduction among high-risk individuals.NEW & NOTEWORTHY We propose to evaluate an 8-wk mindfulness intervention delivered in a hybrid format (synchronous and asynchronous sessions) among 40 Black women at elevated risk of CRC who reside in vulnerable communities and who report moderate to high perceived stress. The specific aims are to assess the feasibility and acceptability of the intervention and explore changes on stress, weight, fasting glucose, inflammation markers, and the gut microbiota-risk markers and risk pathways associated with CRC.

Reimagining maternal resilience: Incorporating the socioecological framework, lifecourse theory, and weathering hypothesis.

Women of color are at least twice as likely as non-Hispanic White women to die during the perinatal period or deliver infants who are low birthweight, preterm, or die within the first year of life. Maternal stress before and during pregnancy is associated with adverse obstetric outcomes. A growing body of literature has explored maternal resilience as protective factors contributing to healthy maternal and child health (MCH) outcomes. However, several gaps exist in how this construct has been conceptualized and operationalized. First, extant research has primarily conceptualized maternal resilience as individual attributes that enable women to "bounce back" after facing adversity during pregnancy, thereby failing to incorporate the broader systemic and environmental factors that contribute to chronic stress, particularly among vulnerable groups. Second, the literature has largely neglected to examine resilience in relation to maternal stress, therefore not acknowledging that women who experience greater stress will likely require more resources. Third, though resilience has been investigated at discrete life stages, longitudinal research has not been conducted to explore how it develops over the lifecourse. This article critically evaluates the resilience literature, expands upon the gaps described, and proposes a conceptual framework that reimagines material resilience using three population health theories, including Bronfenbrenner's socioecological framework, Elder's lifecourse theory, and Geronimus' weathering hypothesis. The proposed framework will inform future research that examines the development of multilevel resilience resources over the lifecourse as well as interventions to increase resilience and ultimately yield healthier MCH outcomes among vulnerable communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Assessment of Changes in the Composition and Distribution of Large and Medium-Sized Mammals in Xishuangbanna, Southwest China.

Given the vulnerability of large and medium-sized mammal communities to climate change and human disturbances, understanding the spatial-temporal dynamics of these communities is essential for effective conservation planning. However, in many biodiversity hotspots, precise biological community assessments are insufficient. From 2012 to 2022, we deployed 784 camera traps in eight nature reserves (including sub-reserves) and one State Forest Farm (SFF, less strictly protected than a reserve) to study the composition and distribution of large and medium-sized mammals in tropical Xishuangbanna. The findings revealed the following: (1) Forty-three species, encompassing six orders, 17 families, and 37 genera, were documented. Among the species in historical data, nine species were not detected in this survey. (2) Smaller and more fragmented reserves lacked larger body-sized predators and herbivores, and most common species showed lower relative population abundance. Conversely, the SFF exhibited high mammal diversity. (3) The community composition of large and medium-sized mammals varied significantly across the nine sites, particularly among threatened species. Our findings highlight the uneven distribution of these mammal communities in Xishuangbanna, with rare and large-sized species facing increased vulnerability to rapid environmental changes. Moreover, the findings demonstrate the importance of considering species specificity and uniqueness in conservation planning for maintaining regional-scale biodiversity.

Tourism metagovernance and the role of the state: Insights from post-blast Beirut

This paper examines the institutionalised interests and values that underpin tourism governance (i.e., tourism metagovernance), to explain why certain governance arrangements appear and how they function. We examined the redevelopment of Beirut's tourism-dependent Mar Mikhael and Gemmayze neighbourhoods in the aftermath of the 2020 port blast. The chaotic post-disaster setting reflected and amplified the ineffectiveness of the already existing, strongly intertwined, metagovernance of urban development and urban tourism in Beirut. The state's absence resulted in enhanced community vulnerability, uncoordinated donor-led disaster responses, and limited strategic rebuilding of tourism and cultural activities. Even when the state as a key governance intermediary is absent, its relational and institutional roles affect tourism metagovernance and, therefore, influence the resilience of tourism governance and development.

Carbon Trading and Environmental Justice: A Juridical Examination of Fairness in Indonesia's Emissions Reduction Initiative

This paper provides a normative juridical analysis of Indonesia's carbon trading regulations, with a focus on environmental justice and fairness. It examines the legal framework established by Presidential Regulation No. 98 of 2021, which governs carbon pricing mechanisms, including carbon taxes and carbon credit trading. The analysis highlights key gaps in the regulation, particularly in terms of equitable benefit distribution and inclusion of vulnerable communities in decision-making processes. While Indonesia's carbon trading system aligns with global trends and its international obligations, significant improvements are needed to ensure that marginalized groups are not further disadvantaged. Recommendations include the redistribution of carbon trading revenues, enhanced public participation, stronger enforcement mechanisms, and alignment with international best practices.

FLOOD PROGNOSIS USING AGGREGATION MACHINE LEARNING STRUCTURE

Frequent and devastating floods in Lagos State pose a significant threat to people and property. Accurate and real-time forecasting of floods is essential to mitigate their impact. This thesis focuses on evaluating different machine-learning structures for flood prediction in Lagos State. The structures assessed include K-Nearest Neighbor (KNN), Support Vector Classifier (SVC), Binary Logistic Regression, and Stacked Generalization (Stacking). The researchers trained and tested these structures using a rainfall dataset. The results demonstrate the better results of the stacked generalization model than the others, achieving an impressive accuracy of 93.3 per cent with a standard deviation(sd) of 0.098. These findings highlight the potential of machine learning models to provide precise and timely flood predictions, empowering the local authorities, especially disaster management ones, to take necessary actions to avoid destruction and preferably save people. Floods pose significant threats to human life, infrastructure, and economic stability. Timely and accurate flood predictions are crucial for effective disaster management. This study proposes an innovative aggregation machine learning structure to enhance flood prognosis accuracy. By integrating multiple machines learning algorithms, including random forests, support vector machines, and artificial neural networks, our framework leverages the strengths of individual models to improve predictive performance. The proposed framework is evaluated using a comprehensive dataset of hydrological and meteorological factors. Results demonstrate significant improvements in flood prediction accuracy, with a reduction in false positives and false negatives. The aggregation structure outperforms individual models, achieving an accuracy of [insert percentage] and a mean absolute error of [insert value]. This research contributes to the development of reliable flood prediction systems, enabling proactive measures to mitigate flood risks and protect vulnerable communities.

Assessing the impacts of climate change on high mountain land-based livelihoods: An empirical investigation in District Nagar, Gilgit-Baltistan, Pakistan

Land-based livelihoods in Pakistan's high mountain regions are highly vulnerable to climate change due to the complex interactions between people and their natural environment. This study uses a mixed-method approach to explore how climate change affects land-based livelihoods in the high mountain Nagar District, Pakistan. Data were collected using a structured household survey of 430 randomly selected farmers, supplemented by focus group discussions and key informant interviews. The findings reveal that 87.7 % of farmers have observed negative impacts of climate change, such as increased crop diseases, reduced water for irrigation, and lower crop yields. Bivariate results indicate that factors related to farming practices, such as farming experience and cropping zones, significantly influence farmers' perceptions of impacts. The study emphasizes the urgent need for targeted government intervention and agricultural planning to boost the resilience of farmers in Nagar District. It calls for improved irrigation, crop disease management, and support tailored to high-mountain farming practices. The research highlights the importance of developing adaptation strategies to protect vulnerable farming communities from climate change impacts and supports the need for effective autonomous adaptation measures. This research contributes to a better understanding of climate change impacts on high-mountain agriculture and emphasizes the need to safeguard vulnerable farming communities.

Integrated Geotechnical Modelling and Real-time Analysis for Predicting Earthquake-Induced Landslides and Rockfalls in the East African Fracture Zone

Background: The East African Fracture Zone (EAFZ) stands as a testament to the dynamic forces of Earth, marked by heightened seismic activity that frequently triggers geotechnical disasters such as landslides and rockfalls. Traditionally, the study of earthquake-induced geological risks has been reactive, with a focus on post-incident analysis. While significant advances have been made in spatial analysis and risk mapping, the capabilities for real-time prediction and proactive mitigation are still limited. Objectives: Current study presents an approach to predicting earthquake-induced landslides and rockfalls in the EAFZ. The aim is to change the perception of the problem by viewing disasters as manageable risks and informing decision-making in urban planning and disaster mitigation strategies. Methods: A combination of geotechnical engineering, remote sensing, artificial intelligence and machine learning, and socio-economic analysis were used to develop a holistic software framework that solves the complex problem of earthquake prediction without any problems. Results: A software model has been developed that includes a dynamic learning component that refines its predictions with new data, allowing for a deeper understanding of geological subtleties and socio-economic impacts. Considerable attention is paid to the tangible consequences of landslides and rockfalls, including human, property and economic losses. Despite the inevitable challenges of data accuracy and natural unpredictability, the proposed approach opens up new possibilities for proactive disaster management. The results demonstrate a transformational step in data-driven geotechnics and highlight the global applicability of the methods proposed in this work. Conclusion: In this investigation, was taken a pioneering stride in the realm of geotechnical hazard analysis and prediction, focusing on the complex terrains of the East African Fracture Zone (EAFZ). The results provided critical insights into the dynamics of geotechnical hazards in the EAFZ, laying the foundation for future innovations and enhanced safety measures in vulnerable communities.

Assessing building thermal resilience in response to heatwaves through integrating a social vulnerability lens

Major cities worldwide are increasingly experiencing intense heatwaves, which disproportionately affect vulnerable populations. This suggests the urgent need for focused attention and mitigation strategies to protect those most at risk from the impacts of heatwaves. The presence of vulnerable groups in buildings with varying thermal conditions can result in different outcomes during extreme heat events, making it crucial to evaluate the thermal resilience of buildings in conjunction with social vulnerability. This research advances the understanding of thermal vulnerability by integrating building thermal characteristics with social vulnerability. While previous studies have predominantly focused on socio-ethnic and economic dimensions of vulnerability, this study specifically investigates the relationship between social vulnerability and thermal resilience, with a focus on building thermal parameters. Datasets from Zillow and ResStock are used to capture the thermal properties of buildings, while social vulnerability data is obtained from the Center for Disease Control and Prevention. A Gaussian Naïve Bayes (GNB) model is applied to enhance building envelope attributes from Zillow, leveraging detailed information from ResStock data. Additionally, a Kolmogorov-Smirnov (KS) test is conducted to analyze diverse thermal attributes, such as age of buildings, room size, number of stories, building area, envelope characteristics, systems, infiltration, across differing levels of social vulnerability (high and low). Specifically, Philadelphia is selected as the analysis focus. The analysis reveals significant associations between thermal resilience and social vulnerability. Groups with higher social vulnerability are more likely to be exposed to elevated levels of thermal vulnerability compared to less vulnerable groups. This highlights the necessity for tailored interventions aimed at promoting the development of more resilient and equitable buildings, capable of reducing the impacts of heatwaves on vulnerable communities.

IMPLEMENTING FLOOD-RESISTANT DESIGN STRATEGIES IN COASTAL REGIONS

This systematic review synthesizes findings from 85 articles to examine flood-resistant design strategies in coastal regions, emphasizing an integrated approach that combines traditional engineering solutions, nature-based strategies, green infrastructure, adaptive design, and predictive modeling. The review identifies a continuing reliance on engineered defenses, such as seawalls and automated floodgates, which have proven effective but are limited in addressing the escalating impact of climate change. Findings highlight the growing importance of nature-based solutions—wetlands, mangroves, and coral reefs—that not only mitigate flood risks but also enhance biodiversity and long-term sustainability. Green infrastructure, including permeable pavements and rain gardens, emerges as a valuable urban solution, although it faces implementation challenges in densely populated areas. The integration of predictive modeling and real-time data is transforming flood management by enabling proactive and adaptive responses, though these technologies remain financially inaccessible for many regions. Comparative analysis underscores that flood-resilient design is highly context-dependent, with successful practices varying based on local geography, resources, and socio-economic factors. This review concludes that future flood-resilient infrastructure must prioritize adaptable, sustainable, and region-specific solutions, highlighting the need for cross-disciplinary collaboration and continued policy support to enhance flood resilience and protect vulnerable coastal communities against the effects of climate change.

Exploring the impact of obesity and community health programs on enhancing endometrial cancer detection among low-income and native American women through a public health lens

This review examines the intricate relationship between obesity, endometrial cancer detection, and the role of community health programs, with a particular focus on low-income and Native American populations. Obesity is identified as a significant modifiable risk factor for endometrial cancer, disproportionately affecting vulnerable communities, which exacerbates existing health disparities. The paper explores the epidemiological link between obesity and endometrial cancer, highlighting disparities in detection and the compounded risks faced by underserved populations. It also reviews the effectiveness of public health initiatives aimed at improving cancer screening rates and obesity prevention among these groups. Despite the progress made through various community health programs, substantial gaps remain, particularly in ensuring culturally competent, accessible, and sustainable care. A lack of longitudinal studies evaluating the long-term impact of these programs on cancer detection and obesity management underscores the need for more robust research. Additionally, social, psychological, and systemic barriers continue to hinder screening uptake, further perpetuating health inequities. This review concludes by emphasizing the need for integrated public health approaches that combine obesity prevention with cancer screening, as well as policy reforms to enhance healthcare access and provider availability in underserved communities. Recommendations are provided for future research that addresses these gaps, with the goal of improving early detection and overall health outcomes for low-income and Native American women.

Psychological Impact Of Kidnapping On Social Reintegration And Academic Pursuits Of Female Undergraduates In Zamfara State

Although kidnapping and banditry are increasingly rampant in northern Nigeria, research on their psychological impact on female undergraduate students is lacking. To fill this gap, this study investigated the psychological impact of kidnapping on female undergraduate students in Zamfara State, Nigeria, focusing on their social reintegration and academic pursuits. Kidnapping and banditry have become pervasive in northern Nigeria, severely disrupting the lives of vulnerable communities including students in both pre-tertiary and tertiary institutions, particularly Zamfara State. The study adopted qualitative research design. Seven out of the female undergraduates of Federal University Gusau who had recently been released after prolonged captivity participated in the study. A combination of purposive and snowball sampling techniques was used to select participants based on availability, willingness, and ability to provide detailed accounts. Data was collected through structured interview. Thematic analysis revealed profound psychological trauma, including symptoms of Post-Traumatic Stress Disorder (PTSD), anxiety, and depression. Social reintegration challenges found in the study include stigmatization and alienation, while academic difficulties involved concentration, memory issues, and decreased motivation. The study recommends implementing comprehensive psychological support programmes within educational institutions located in high risk locations such as Zamfara State, including professional counseling and peer support groups, to address the long-term psychological effects and facilitate better social and academic reintegration of the victims

Sustainability of Small-Scale Capture Fisheries Based on Coastal Vulnerability in Pangpang Bay, Banyuwangi Regency, Indonesia

Graphical Abstract Highlight Research Climate change impacts on coastal vulnerability. Low coastal vulnerability in Pangpang Bay, Banyuwangi Regency. Sustainability of small-scale capture fisheries based on vulnerability. Sustainable small-scale fisheries management. Abstract Teluk Pangpang is one of the water areas that has considerable capture fisheries potential in Banyuwangi Regency, Indonesia. On the other hand, climate change impacts the vulnerability of coastal areas and coastal communities, especially small-scale fishers. This study aims to analyse the coastal vulnerability of Pangpang Bay and formulate a sustainable development of small-scale capture fisheries in Pangpang Bay. The research method used a descriptive method with a quantitative approach. Data collection techniques used geographic information systems and focus group discussions (FGDs). The data analysis used was Coastal Vulnerability Index (CVI) analysis with spatial approach and Participatory Prospective Analysis (PPA). From the CVI analysis, through the assessment of geomorphological parameters, erosion/accretion, coastal slope, distance of plants from the beach, wave height, and average tide range, the level of coastal vulnerability of Teluk Pangpang is included in the low category. Meanwhile, the PPA analysis resulted in seven variables that most influence the sustainability of small-scale capture fisheries, namely climate change, coastal vulnerability, coral reef area and density, number of small-scale fishers, catches, human resources of small-scale fishers, and management of small-scale fisheries resources. Furthermore, for the formulation of the sustainability scenario of small-scale capture fisheries in Pangpang Bay, is to minimise the impact of climate change and conduct disaster mitigation, improve the human resources of small-scale fishers, and equalise perceptions as outlined in the commitment between all interested parties and small-scale fishing communities.

Quantitating SARS-CoV-2 neutralizing antibodies from human dried blood spots.

In the earliest days of the COVID-19 pandemic, the collection of dried blood spots (DBS) enabled public health laboratories to undertake population-scale seroprevalence studies used to estimate rates of SARS-CoV-2 exposure. With SARS-CoV-2 seropositivity levels now estimated to exceed 94% in the United States, attention has turned to using DBS to assess neutralizing antibodies within cohorts of interest. With this goal in mind, we generated contrived DBS (cDBS) and whole blood-derived DBS from convalescent and vaccinated individuals and subjected DBS eluates to a battery of assays, including a SARS-CoV-2 multiplexed microsphere immunoassay (MIA), a receptor binding domain (RBD)-human ACE2 inhibition assay (iACE2), a cell-based pseudovirus neutralization assay, and real-time PCR-based surrogate neutralization assay (NAB-Sure). The DBS results were benchmarked against paired serum samples tested in a clinically validated SARS-CoV-2 plaque reduction neutralization titer (PRNT) assay. The results of an 8-plex MIA and NAB-Sure assays demonstrated highly significant correlations with PRNT values when evaluated with a panel of 86 paired serum-DBS samples. Both the MIA and NAB-Sure are adaptable to automated liquid handlers for high-throughput capacity. While neutralizing assays were limited to the ancestral SARS-CoV-2 WA1, this study nonetheless represents an important proof of concept demonstrating the potential utility of DBS as a biospecimen type for use in assessing immunity to SARS-CoV-2 at the community and population levels.IMPORTANCESARS-CoV-2 variants of concern continue to circulate globally and remain a serious health threat to large segments of the population. From a public health standpoint, identifying vulnerable communities based on immune status is critical in terms of vaccine booster recommendations. In this report, we investigated the utility of dried blood spots (DBS) as a biospecimen type from which to estimate SARS-CoV-2 neutralizing antibody titers. Using contrived and whole blood-derived DBS, we demonstrate that SARS-CoV-2 neutralizing antibodies are readily measurable in DBS eluates and correlate with plaque reduction neutralization titer (PRNT) values from paired serum samples. Moreover, several of the methods used to estimate SARS-CoV-2 neutralizing antibodies in DBS eluates are adaptable to high-throughput platforms.

Housing situation of older adults in a vulnerable neighborhood in Santiago de Cuba. Differences based on skin color, gender and age

PurposeThe Cuban population is going through a process of demographic change and accelerated aging, which, together with a difficult economic situation, places the older adults in a complex economic reality, especially in the most vulnerable communities. This paper aims to analyze the housing situation of the older adults in a vulnerable community in Santiago de Cuba during a period of particular economic difficulty.Design/methodology/approachThe study analyzes the housing situation of a sample of people over 60 years of age (n = 325) in a vulnerable community in the city of Santiago de Cuba. A structured interview was used for data collection.FindingsThe results show that most of the people over 60 years of age interviewed considered their homes to be in a poor state of repair. A significant part of the homes were built with precarious materials and had cracked walls, leaks, problems with the functioning of the toilet, broken pipes, etc. In addition, most of the houses were poorly equipped, with a large number of them lacking refrigerators, cell phones or computers or other electrical appliances (heater, shower, stove, etc.). Women, people with black skin and people over 75 years of age were in a particularly precarious housing situation.Social implicationsDemographic changes and the expected aging of the population in Cuba mean that meeting the needs of the older adults is expected to become increasingly complex. The design of public policies and administrative management should take into consideration the housing needs of people over 60 years of age in vulnerable communities, with special attention to women, racialized people and older adults.Originality/valueThe research was conducted based on the information provided by a particularly vulnerable group in Cuba (older adults), about which there is limited information available, and the data were collected during a particularly challenging time for the Cuban economy: the post-COVID-19 pandemic period. The challenges of conducting research of this nature in Cuba and the period during which data collection took place form the basis of the originality of this manuscript.

A Training-of-Trainers program for health facilitators fighting malaria in a vulnerable community

Abstract Background When Public Health is challenged by issues related to migrant and vulnerable populations, health facilitators’ profiles are crucial to accessing communities and increasing intervention effectiveness and acceptability. The French overseas region, French Guiana, is concerned with a migrant population living in vulnerable conditions far from healthcare and being a major reservoir of malaria. Curema is an intervention implemented to fight malaria in this population by distributing RDTs, and treatments after an appropriate training of participants. Facilitators from the community are employed to provide health education and enroll participants. Objectives An intensive theoretical-practical training program was realized to enable facilitators to master procedures related to the intervention. The training was designed using the CDC Training-of-Trainers (ToT) framework and adult learning principles. It was composed of initial and on-the-field training, both based on bidirectional, participative, and dynamic working spaces. A mixed-method evaluation was carried out to assess training effectiveness and quality. Results Group dynamics and adaptations driven by facilitators’ needs were key elements of a high-quality training program. Satisfaction was elevated for training format and learning results. Statistically significant improvements in knowledge level demonstrated good effectiveness. During the initial training, difficulties persisted regarding some tasks to be performed during the intervention: further on-the-job training addressed them, improving facilitators’ practices in the field. Conclusions High-quality, effective, and appropriate training programs are required for intervention involving facilitators’ profiles. Training design is crucial to achieve it. ToT model has been shown to allow high satisfaction, learning results, and good implementation in the field. Initial and on-the-job training are an indispensable continuum to sustain good practices and motivation. Key messages • If health facilitators from the community are actors in public health interventions, appropriate training is necessary to ensure good implementation. • ToT seems an optimal model for training health facilitators.

Rheumatic heart disease: an ongoing public health concern in vulnerable communities

Abstract Background Acute rheumatic fever (ARF) results from an autoimmune response triggered by group A streptococcus (GAS) infection (1). Severe or recurrent ARF episodes can cause permanent heart valve damage, leading to complications including heart failure, stroke, arrhythmias, carditis, and decompensation during pregnancy (2). Purpose Rheumatic fever (RF) remains a public health concern in Australia, particularly among Indigenous, migrant populations and socioeconomically disadvantaged communities. Europe and various regions worldwide have experienced significant migration from areas with a high prevalence of RHD (3). Amongst the more than 1 million asylum seekers who arrived in Europe in 2015, an estimated 1% could potentially be affected by RHD (3). This migration influx underscores the pressing need for the implementation of strategies in health policy and practice. We aimed to outline the attributes of our RF-RHD cohort to aid in the formulation of a Model of Care (MoC). Methods Cases were identified on a quarterly basis either through the NSW Public Health Rapid, Emergency, Disease, and Syndromic Surveillance (PHREDSS) system or via clinical diagnoses reported to the Public Health Unit (PHU) from January 2015 to June 2023. Demographic profiles, clinical particulars, and patient outcomes were collected from patients in the South Western Sydney Local Health District (SWSLHD), NSW, Australia. Results A total of 45 cases were reported (Table 1). This consisted predominantly of females with an average age at diagnosis of 14 years. A majority were obese (69%). Most were in the Maori and Pacific Islander populations (62%), while a smaller portion of patients were of Aboriginal or Torres Strait Islander descent (9%) (Australian Indigenous community). Notably, 84% of patients diagnosed with ARF subsequently progressed to RHD. Among the reported cases, 16 patients underwent valvular surgery, 2 patients progressed to end-stage heart failure, and there was 1 mortality. 39% (11) of female patients were pregnant during the study period, with 6 (55%) of these patients decompensating during their pregnancy (Table 2). Conclusion Rheumatic fever persists as a public health concern on a global scale. Our findings emphasize the need for a high index of clinical awareness in considering RF/RHD in socioeconomically disadvantaged communities. In our setting, there is a disproportionate burden of disease among the Pacific Islander population. The high occurrence of cardiac decompensation during pregnancy, underscores the need for close monitoring in this demographic. Despite the prevalence of rheumatic fever predominantly affecting young patients in vulnerable groups, we found a significant proportion of individuals lost to follow-up or not connected with Cardiology services. Addressing rheumatic fever requires a comprehensive approach that encompasses improved healthcare accessibility, targeted health education initiatives, and socioeconomic interventions.

Body of Mine, Yours, and Everyone in Between: Communicating Gender Dysphoria Through Immersive Storytelling

<div><span>This article explores the potential of new, immersive realities to convey the complex experiences of gender dysphoria and body dissatisfaction, using the innovative and multi-award-winning experience <em>Body of Mine</em> as a case study. Recognizing a gap in understanding and empathy towards gender-queer communities, <em>Body of Mine</em> employs an innovative full-body tracking solution to place users into the body of someone else, combined with first-person documentary interviews and interactive elements aimed at fostering a deeper connection and insight into the transgender experience. Initial feedback from users indicates a heightened awareness and emotional connection to the challenges faced by individuals with gender dysphoria, as well as an increase in self-body positivity, based on a study conducted in collaboration with the University of Tübingen’s Department of Psychology. This project underscores the power of immersive storytelling in fostering embodied understanding, while also acknowledging the ethical complexities and voyeuristic risks when sharing narratives from vulnerable communities, and explores innovative methods for tackling social issues through emerging technology. It concludes by contemplating the implications of immersive technologies for the concept of identity in a world that increasingly transcends the physical body, suggesting a future where the notion of self is not confined to physical form but is fluid, multifaceted, and continually redefined within boundless digital horizons.</span></div>

Organization of Vaccination Sites in Quebec: Perception of Users, Employees and managers

Abstract Since late 2020, vaccination sites have emerged rapidly in order to protect the population against COVID-19. Health services in Montérégie (Québec) are provided by three organizations. Each adopted a different approach to immunization. The Regional Public Health Department took this opportunity to describe, compare, and explain these three approaches. A mixed methods design through a multiple case study was conducted. Users, employees and managers were interviewed at the end of 2021 on several performance-related topics. Individual interviews with employees and managers in mid-2022 further explored these topics. 38 managers, 360 employees, and 946 users participated in the survey. 9 managers and 10 employees were interviewed. Most participants were satisfied with vaccination organization regardless of the model used, mainly because of high geographic and temporal accessibility of the sites. Further signage to indicate directions could optimize accessibility. High adaptability was essential for managers and employees. Training strategies such as people to refer to and pairing allowed to better deal with frequent changes and staff rotation. The addition of ongoing training could be beneficial. Rapid changes in employee schedules were identified as a challenge. The use of technology-based scheduling tools, accessible to all, brought added flexibility, which was appreciated. Several ideas were used to communicate updates on a daily basis. However, timely implementation of new recommendations remained an ongoing challenge. Dedicated clinics for specific clienteles were successful. Community partnerships were generally beneficial, although establishing more of them could potentially reach other vulnerable communities. To improve accessibility and minimize health social inequities, a greater investment in local partnerships might reach more vulnerable clienteles. Regular communication and innovative employee support are key elements to improve fluidity of operations. Key messages • Reaching out for vulnerable clienteles is essential to minimize health social inequities. • Rapid changes in services needs underlign fluidity communication importance.

Charting water sanitation concerns within vulnerable communities and international contexts on X

This study used a computational exploratory approach to examine X discourse on water sanitation challenges in the Black Belt region in the United States and compared it with larger international contexts. The research sought to uncover themes that impact salient environmental health issues and support future interventions. A two-part research question addressing the nature of water issues in a local and global context, resulted in a data set (n = 12,472 observations) analyzed using computational text analysis. Findings indicated that there was limited attention of issues discussed in the Black Belt region. On the other hand, global communication resulted in a greater discussion surrounding community-level problems and the very public nature of concerns, despite both issues being public-facing. Study findings contribute to the body of knowledge on social media discourse that develops as environmental health challenges develop into broader issues that emerge as global health risks.