Vulnerable Population Groups Research Articles

Assessing public health implications of free trade agreements: The comprehensive and progressive Trans‐Pacific Partnership Agreement

AbstractIn 2016, the United Kingdom voted to exit the European Union, which was surrounded by political and social uncertainty. The United Kingdom now negotiates its own trade agreements, and in March 2023, it agreed to join the Comprehensive and Progressive Trans‐Pacific Partnership Agreement (CPTPP). A health impact assessment (HIA) was undertaken in 2022–23 to predict the potential impact of the CPTPP on the health and well‐being of the Welsh Population. This paper explores the HIA findings and highlights the value of the approach in engaging with stakeholders and informing policymakers. This HIA followed a standard five‐step approach which involved a literature review to identify potential health impacts, qualitative interviews with cross‐sectoral stakeholders and the development of a community health profile. The HIA identified potential impacts across the wider determinants of health and specific vulnerable population groups. Investor state dispute settlement mechanisms, economic uncertainty and loss of regulatory policy space were identified as key pathways for health impacts. The findings have been beneficial in informing decision‐makers to prepare for the CPTPP in Wales using an evidence‐informed approach. This work has demonstrated the value of a HIA approach that uses a transparent process to mobilise a wide range of evidence, resulting in transferrable learning.

Profiling population-wide exposure to environmental chemicals: A case study of naphthalene

Long-term exposure to environmental chemicals can detrimentally impact human health, and understanding the relationship between age distribution and levels of external and internal exposure is crucial. Nonetheless, existing methods for assessing population-wide exposure across age groups are limited. To bridge this research gap, we introduced a modeling approach designed to assess both chronic external and internal exposure to chemicals at the population level. The external and internal exposure assessments were quantified in terms of the average daily dose (ADD) and steady-state blood concentration of the environmental chemical, respectively, which were categorized by age and gender groups. The modeling process was presented within a spreadsheet framework, affording users the capability to execute population-wide exposure analyses across a spectrum of chemicals. Our simulation outcomes underscored a salient trend: younger age groups, particularly infants and children, exhibited markedly higher ADD values and blood concentrations of environmental chemicals compared to their older counterparts. This observation is due to the elevated basal metabolic rate per unit of body weight characteristic of younger individuals, coupled with their diminished biotransformation kinetics of xenobiotics within their livers. These factors collectively contribute to increased intake rates of environmental chemicals per unit of body weight through air and food consumption, along with heightened bioaccumulation of these chemicals within their bodies (e.g., blood). Furthermore, we augmented the precision of the external and internal exposure assessment by incorporating the age distribution across the population. The simulation outcomes unveiled that, to estimate the central tendency of the population's exposure levels, employing the baseline value group (age group 21–30) or the surrogate age of 25 serves as a simple yet dependable approach. However, for comprehensive population protection, our recommendation aligns with conducting exposure assessments for the younger age groups (age group 0–11). Future studies should integrate individual-level exposure assessment, analyze vulnerable population groups, and refine population structures within our developed model.

Status of Nutritional Services to Vulnerable Population in West Bengal and Their Hardship during COVID-19 Pandemic: A Community-based Qualitative Exploration

Introduction: In response to the COVID-19 pandemic, restrictions were imposed on various activities including nutritional services. This study was conducted with the objective to explore the status of the nutritional services and to identify the hardship and barriers faced by the vulnerable population and challenges for service providers and program managers during the initial phase of pandemic. Materials and Methods: A community-based cross-sectional qualitative study was conducted among three vulnerable population groups (slum dwellers, tribal population, and residents of disaster-prone area) in three districts of West Bengal, the reference period being April–September 2020. To assess the status of nutritional services and identify existing barriers or challenges, the study employed a mixed-methods approach utilizing focus group discussions (FGDs) as well as in-depth interviews (IDIs) conducted with beneficiaries, service providers and program managers. One habitation in each district was selected to obtain case scenarios on food insecurity and hardship. Descriptive analysis of household surveys and thematic analysis of FGDs and IDIs were done, and the findings were triangulated. Results: Different nutritional services (supplementary nutrition, micronutrient supplementation, growth monitoring, nutrition counseling, and nutrition rehabilitation) were disrupted. Shifting from hot-cooked meals to dry take-home ration was the most conspicuous change during restoration phase. Food security was absent in majority of the households. Reduction of income affected their affordability, which along with difficult accessibility to diverse food items contributed to their hardship. Service providers identified several challenges, including increased workload due to both COVID-19 activities and a rise in beneficiaries, transportation difficulties, and experiences of stigma and discrimination. Long administrative decision-making process, additional hurdles due to cyclone, and containment zones were identified as challenges by the program managers. Conclusion: As the hardship of vulnerable population was pervasive, it is necessary to formulate mitigating measures in light of the identified challenges and to combat similar crises in future.

The lost years of potential life under cancer of neck of uterus in the Kyrgyz Republic

One of modern methods of estimating health losses under malignant neoplasms in economic terms, characterizing number of deaths and age of death are lost years of potential life. The cumulative losses from premature cancer mortality made up to 29 217.5 man-years in 2013 and 39 710 man-years in 2021. The number of years lost over 9 years increased by 10 492.5 man-years despite decreasing of mortality across all ages. The rate of lost years of potential life during this period increased from 5.3 to 6.2 years. The maximal contribution to lost years of potential life was made by population groups 45-59 years old. Total losses from premature mortality from cervical cancer were 2682.5 man-years and 2411 man-years in 2013 in 2021. The number of years lost decreased by 271.5 man-years. The rate of lost years of potential life during this period increased from 0.5 to 3.7 years. The greatest contribution to lost years of potential life was made by population groups 60-64 and 40-49 years old. The calculation demonstrated that there are significant reserves for reducing population mortality from malignant neoplasms in most vulnerable age population groups that is important for organization of oncological care and planning of target prevention programs.

The impact of COVID -19 on the rights of some vulnerable groups of population

The topicality of the theme is determined by the remark of the need for the real analysis of the right to health in the context and period of the pandemic of vulnerable people as beneficiaries of public health services at national and international level, regarding the implementation of the protection of the health rights. And the practical aspects highlight the problems that these people and their families face, being marginalized and excluded from society. In the same way, the extent of the action of socio-economic life on the health of people around the world would be analyzed, with reflections in which minors and disabled people were mentioned, especially in the context of the COVID-19 pandemic.

Inequalities in caregiving strain during the COVID-19 pandemic: conceptual framework and review of the empirical evidence

The COVID-19 pandemic poses specific risks to vulnerable population groups. Informal carers for older adults are especially at risk of increased strain, as support from social networks and professional care services is no longer available or in short supply. Already before the pandemic, caring was unequally distributed within societies, with women and people in lower socio-economic status groups bearing a higher risk of caring strain. In this article, we propose a conceptual framework of (unequal) caring strain during the pandemic. We then summarise the state of empirical research, suggest questions for future studies and outline implications for social policy.

Environmental sustainability of diets among children and adolescents in the German DONALD cohort study: age and time trends, and nutrient adequacy

BackgroundIdentifying diets beneficial for both human and planetary health has become increasingly important. However, to date, there is limited research on sustainable diets for children and adolescents, a vulnerable population group with specific nutritional needs. ObjectivesWe aimed to identify 1) the main determinants; 2) age and time trends of greenhouse gas emissions (GHGE), land use (LU), and water use (WU) of diets of children and adolescents; and 3) analyze the associations of dietary GHGE, LU, and WU with nutrient adequacy. MethodsA total of 5510 3-d-weighted dietary records (n = 856; 6–17 y; 48% ♀) of the DONALD (DOrtmund Nutritional and Anthropometric Longitudinally Designed) study between 2000 and 2021 were analyzed. Values of GHGE (kgCO2eq), LU (m2 × year), and WU (L) determined by life cycle assessment were assigned to all recorded foods. For nutrient adequacy, the mean adequacy ratio (MAR = ∑(nutrient intake / recommended intake) / number of nutrients) was used. Data were analyzed using polynomial mixed-effects regression models. ResultsThe main contributors to GHGE and LU were meat products (GHGE: 25.6%; LU: 32.8%), dairy products (22.2%; 17.7%), and sweets and pastries (14.0%; 14.3%); to WU, nonalcoholic beverages (24.3%), meat products (18.9%), and vegetables and fruits (17.7%). GHGE, LU, and WU per 1000 kcal increased with age (P < 0.01). GHGE and LU per 1000 kcal increased between 2000 and 2010 and decreased after that in females (P < 0.01) and males (GHGE only: P = 0.02). No significant time trend was found for WU (P > 0.05). A higher MAR was directly associated with GHGE/1000 kcal (MAR: β: 0.011, 95% CI: 0.008, 0.013, P < 0.0001), LU/1000 kcal (MAR: β: 0.009, 95%CI: 0.005, 0.013, P < 0.0001), and WU/1000 kcal (MAR: β: 0.429, 95% CI: 0.325, 0.533, P < 0.0001). ConclusionsOur findings underscore the further need and the capacity for change toward more environmentally sustainable diets. Yet, the tradeoff between environmental sustainability and nutrient adequacy in the diets of children and adolescents requires specific attention to dietary composition.

European patterns of local adaptation planning—a regional analysis

While European regions face a range of different climate hazards, little is known about how these differences affect local climate adaptation planning. We present an analytical framework for evaluating local climate adaptation plans (LCAPs) and apply it to 327 cities in 28 countries across different European regions. To do this, we use statistical methods to identify regional clusters based on overall plan quality, impacts, vulnerable population groups, and sectors addressed by LCAPs. By comparing both geographic and statistical clusters, we found (1) significant spatial heterogeneity across European cities but (2) higher average plan quality scores and more consistent strategies across cities in Central and Eastern Europe. Notably, we found no regional differences regarding (a) the climate impacts and vulnerable communities identified in plans: (b) the most commonly addressed impacts, which were urban temperature and changing precipitation patterns; and (c) the residents that cities identified as most vulnerable, namely older people, women, infants, and the sick. Our study provides a spatial analysis of European LCAPs to uncover regional policy perspectives on local climate adaptation issues. Such approaches can effectively inform broader EU, national and regional strategies that aim to support local adaptation planning in a context of multi-level governance.

From State Developmentalism to Financial Populism: The ‘Bank of Welfare' and Mexico’s Moral Economy

ABSTRACT The Mexican state-owned bank Banco del Bienestar (BB) — Bank of Welfare — has received a lot of attention for its role in the current Government’s ambitious political project to create an ‘alternative to neoliberalism’ and turn Mexico into a ‘moral economy’. This article analyzes the activities of Banco del Bienestar, with special attention to the recent economic crisis induced by the Covid-19 pandemic. We conclude that BB has followed a path from a state developmentalist-corporatist, to a neoliberal, to a postneoliberal, ‘financial populist’ model, under changing political cultures and with an increasing historical importance for state-society relations. The BB currently operates as a government-funded public entity serving the distribution of non-repayable social benefits to large, vulnerable population groups, while maintaining links with financial markets. We interpret this shift from the neoliberal to the financial populist era of public banking as consolidation of a ‘fix’ of neoliberalism’s failures, which is based on the definitive acceptance of the reality of development perspectives of the Global South. ‘Public purpose’ in this context becomes based on a social imaginary where the ‘public’ is comprised of those that are permanently taken care of by the paternalistic state.

DETERMINANTS OF THE DEVELOPMENT OF THE INCLUSIVE LABOR MARKET IN UKRAINE

The article examines the modern determinants of the development of the inclusive labor market in Ukraine, which are determined by a complex of specific factors that affect the process of integration of people from socially vulnerable population groups. It has been proven that one of the key components of the inclusive labor market are socio-economic conditions that form the foundation for the development of an inclusive economy. It was determined that the degree of economic development, the level of unemployment and the availability of financial resources directly affect the formation of an inclusive labor market. In addition, an important role in the formation of an inclusive environment is also played by legal regulation, including the interaction of national public administration bodies with the international labor organization. It has been proven that normative acts aimed at protecting the rights of socially vulnerable persons create the necessary conditions for their active participation in economic activity on the labor market. It was determined that the development and improvement of such normative legal acts is a strategic task for ensuring the sustainable development of the inclusive labor market in Ukraine. Socio-cultural factors that determine society's attitude towards socially vulnerable persons and shape openness and tolerance in the working environment are considered. It was determined that an effective policy of differentiation and acceptance of diversity can contribute to the creation of a positive climate for inclusive employment, promoting the development of diverse talents and skills among employees in order to strengthen the relevance of their qualifications to the demands of employers. It has been proven that educational opportunities for persons with disabilities play a key role in their integration into the inclusive labor market. It was found that the system of providing high-quality education and professional training, as well as the implementation of special support programs in general, contribute to the growth of the competitiveness of this group of workers in the labor market. It was determined that organizational aspects, such as the creation of specialized employment centers, functional support of enterprises that implement inclusive practices, as well as the development of corporate responsibility, contribute to the effective solution of the problems of integration of socially vulnerable persons in the field of work. It is proved that all the mentioned determinants are closely interrelated and interact with each other, forming a complex system of factors that influence the development of the inclusive labor market in Ukraine.

Mortality risk factors in the dependent population of Castilla-La Mancha (Spain) before and during the first COVID-19 wave

The coronavirus disease pandemic has had an important impact worldwide. The population aged over 65 years and aged dependent persons are the population groups which have suffered in a highest level the consequences of the pandemic in terms of cases and death. In Spain, the situation is similar to other countries, but regional studies are needed because competencies on long-term care depend on regional public administration. Thus, the aim of this work is to analyse social and individual factors associated with the risk of mortality of legally recognised dependent people during the pandemic compared to a non-pandemic period. The data were extracted from the administrative database on individuals included in Castilla-La Mancha's long-term care system and it was merged with the information from the Spanish National Death Index administered by the Ministry of Health, Consumption and Social Welfare. The results show that the risk of mortality between March and June 2020 was positively associated with being male; being older than 65, with an especially high impact in the group aged over 90; having a higher level of dependency; living in a nursing home; and living in a place with more population density. Intraregional differences related to health areas also exists in both pandemic and non-pandemic periods. These findings are critical with a view to enhancing protocols for the care of the most vulnerable population groups.

Characterize and Address Mental health Problems in University Students (CAMPUS Study): preliminary results

Introduction The transition phase from late adolescence to early adulthood, which corresponds with the period of university life, is a time that offers important opportunities for personal growth. However, this developmental phase also concurs with the peak period of risk for the onset of mental health disorders. For this reason, the literature clearly identifies university students as a vulnerable population group for psychogical distress and mental problems. Digital psychological interventions and e-mental health solutions are emerging as a promising solution for university students, particularly appealing due to their anonymity, portability and ease of access. Hence, the World Health Organisation has developed several psychosocial e-mental health tools including Doing What Matters in Times of Stress (DWM), which has been consistently shown effective in various vulnerable populations. These data provide the framework for the CAMPUS study that is intended for students attending the University of Verona.Objectives The main objective of this project is to adapt the WHO psychological intervention called “Doing What Matters in Times of Stress” (DWM) to this target population and to evaluate the effectiveness, feasibility, and acceptability of WHO’s DWM as a psychological strategy for effective mental health prevention and promotion, and for reducing psychological symptoms and distress in university students. Secondary objectives of the project include to evaluate the fidelity of DWM, to assess factors associated with its implementation and effectiveness and to co-create the necessary local conditions for implementation and up-scaling of DWM.MethodsThe CAMPUS study is a prospective non-randomized follow-up study. The target population is composed by university students of University of Verona, Italy. The online assessments, which are collected pre and post intervention, consist of an ad-hoc sociodemographic information page, and four self-administered questionnaires assessing psychological distress, depression and anxiety symptoms, and psychological well-being. In addition, implementation checklists will be administered to assess the acceptability, appropriateness and feasibility of the intervention.ResultsPreliminary results on a sample of 300 students attending University of Verona show that the adapted DWM intervention promote students’ psychological well-being and reduce the level of psychological distress as well as the risk for the later development of a psychopathology. Moreover we expect that future results would include data on the effectiveness, feasibility, and acceptability of the adapted DWM intervention among university studentsConclusionsThese results provide valuable information for mental health promotion and support programs for university students, as well as insights into factors influencing its implementation and suggestions for future scaling of the intervention.Disclosure of InterestNone Declared

Soil zinc application decreases arsenic and increases zinc accumulation in grains of zinc-biofortified wheat cultivars

Context Arsenic (As) is a noxious metalloid for plants, animals and humans. Elevated levels of As in soils may cause it to accumulate to above-permissible levels in wheat grains, posing a threat to human health. Moreover, vulnerable population groups in developing countries have inadequate dietary zinc (Zn) linked to cereal-based diets. Aims The present study evaluated the effect of soil Zn application on accumulation of As and Zn in grains of two Zn-biofortified wheat (Triticum aestivum L.) cultivars (Akbar-2019 and Zincol-2016). Methods Wheat plants were grown on an alkaline calcareous soil spiked with three levels of As (0, 5 and 25 mg kg−1). Before sowing, two rates of Zn (0 and 8 mg kg−1) were also applied to the soil. Key results Arsenic spiking in soil decreased plant dry matter yield, chlorophyll pigments, and phosphorus (P) and Zn accumulation, and increased As accumulation in wheat. By contrast, soil Zn application enhanced crop yield and increased P and Zn accumulation, with a simultaneous decrease in As accumulation in both cultivars. Compared with the Zn control, soil Zn application decreased grain As concentration by 26%, 30% and 32% for plants grown in soil spiked with 0, 5 and 25 mg As kg−1, respectively. Conclusions Applying Zn to As-spiked soil mitigates the harmful effects of As by increasing Zn and decreasing As concentrations in wheat, resulting in improved grain quality for human consumption. Implications Zinc application to crop plants should be recommended for addressing the health implications associated with As-contaminated crops and human Zn deficiency.

«ВРАЗЛИВІ ГРУПИ НАСЕЛЕННЯ» ЯК ОЦІНОЧНА КАТЕГОРІЯ ПРАВА СОЦІАЛЬНОГО ЗАБЕЗПЕЧЕННЯ

The article examines the phenomenon of evaluative categories in jurisprudence, reveals their concept and features. It is concluded that the term “evaluative concepts” is given a different meaning by scientists representing various branches of law. The author comes to the conclusion that “vulnerability” as a characteristic of the category of the population receiving individual types of social protection is of an evaluative nature. Through the prism of various social relations, it can be considered as a situation in which the risk of discrimination or violations of human rights increases, the probability of being “excluded” from society, as a result of which the social or material situation of a person may suffer, a threat to life or health and other negative consequences may arise. It is proven that it is most expedient to associate vulnerability with the possibility of encountering a certain social risk, and therefore – to claim social protection. The term “vulnerable stratum of the population” is used in international legal acts and in national legislation. At the international level, the traditional contractual approach to assessing persons as vulnerable prevails, states are given the opportunity to independently decide which means of protection such social groups will be supported with reference to the standards established in international legal acts. “Vulnerability” as a status can be directly enshrined in an international treaty or be presented abstractly. The definition of “vulnerable population groups” has relatively recently found expression at the level of national legislation and is revealed due to a number of factors, the influence of which can determine the state of vulnerability. It is proved that the circle of those factors fixed in Art. 1 of the Law of Ukraine “On Social Services” is limited and therefore needs to be expanded. This is explained by the existence of certain social risks, which were already established at the level of separate special legislative acts earlier, but were not reflected in the above-mentioned article (for example, homelessness, internal displacement, drug addiction, presence of HIV/AIDS, etc.). Moreover, it is necessary to take into account the dynamism of social risks in general, which may mean the appearance in the future of new ones not foreseen today, and therefore this fact should also be taken into account when forming the text of the article. Keywords: vulnerable population groups, risk groups, social security, social protection, evaluative categories, low-income families, people living with HIV/AIDS, social risks, factors that can lead to difficult life circumstances.

How to assess the needs of vulnerable population groups towards heat-sensitive routing?

Heat poses a significant risk to human health, particularly for vulnerable populations, such as pregnant women, older individuals, young children and people with pre-existing medical conditions. In view of this, we formulated a heat stress-avoidant routing approach in Heidelberg, Germany, to ensure mobility and support day-to-day activities in urban areas during heat events. Although the primary focus is on pedestrians, it is also applicable to cyclists. To obtain a nuanced understanding of the needs and demands of the wider population, especially vulnerable groups, and to address the challenge of reducing urban heat stress, we used an inter- and transdisciplinary approach. The needs of vulnerable groups, the public, and the city administration were identified through participatory methods and various tools, including interactive city walks. Solution approaches and adaptation measures to prevent heat stress were evaluated and integrated into the development of a heat-avoiding route service through a co-design process. The findings comprise the identification of perceived hotspots for heat (such as large public spaces in the city centre with low shading levels), the determination of commonly reported symptoms resulting from severe heat (e.g., fatigue or lack of concentration), and the assessment of heat adaptation measures that were rated positively, including remaining in the shade and delaying errands. Additionally, we analysed and distinguished between individual and community adaptation strategies. Overall, many respondents did not accurately perceive the risk of heat stress in hot weather, despite severe limitations. As a result, the heat-sensitive routing service (available in prototype form during publication) that has been created serves as a readily available and accessible source of assistance to combat the effects of heat stress in individuals' daily lives during periods of intense heat. The findings served as input for the calibration of heat stress-avoidant routing and supported the development of local heat protection plans without investing in large-scale adaptation of the built environment. It is crucial to involve the population, particularly vulnerable groups, in the development of the tool to ensure it meets their needs. This study employed a transdisciplinary multi-method approach, which considers practical framework conditions by involving the city administration.

Impacts of COVID-19 on Food Access: An Examination of People’s Food Shopping Methods Change

The COVID-19 pandemic has exacerbated the food insecurity issue across the nation, especially for vulnerable population groups. As an important way to access food, online grocery shopping has gained substantial popularity during COVID-19. However, it is not clear how COVID-19 impacted both the in-store and online grocery shopping simultaneously and how the impacts varied among different population groups. To gain a comprehensive understanding of the impacts of COVID-19 on food access, we conducted two rounds of online survey during the initial and middle stages of COVID-19 in Maricopa County, Arizona, United States. In addition to the factors that have been examined in the literature, we examined how travel behavior, food environment, and lifestyle change affected both in-store and online shopping during COVID-19 when compared with before COVID-19. Analysis results suggest that the methods people used for grocery shopping varied with different stages of COVID-19 and among different population groups. Changes of people’s daily life and travel behavior during COVID-19 are found to be associated with people’s grocery shopping method selection. While people with better food environment were more likely to keep in-store grocery shopping, as the pandemic progressed, food environment became less important as a factor influencing the adoption of online grocery shopping. Food assistance program participants had a higher demand for the online grocery shopping service. However, the barriers associated with redeeming their benefits online prohibited them from becoming new online grocery shoppers during COVID-19. The study provides important insights into planning of food provision and formulating effective intervention strategies during future shocks.

Walkable and Safe Route to Transit for Pedestrians in Greater Montréal: An Environmental Justice Approach

The experience of walking to transit stops plays a critical role in the use of public transportation. Having a safe and walkable environment for this part of the trip is even more important for vulnerable population groups, who depend more heavily on public transportation. The aim of this paper was to evaluate first mile/last mile walkability and road risks in the Montréal metropolitan area using an environmental justice approach. Using a spatially sound method, we determined that areas where more people identify as visible minorities are disadvantaged as far as walking-to-transit routes are concerned and that areas with higher proportions of people on low incomes and people aged 65 and over have more walkable environments but also have to deal with more road risk.

Кластерный подход в изучении рисков здоровью населения, обусловленных контаминацией пищевых продуктов тяжелыми металлами

Food products are a source of energy and essential substances but also of anthropogenic contaminants such as heavy metals. The aim of the study was to assess population health risks posed by contamination of food products with heavy metals, taking into account peculiarities of food preferences. An epidemiological study of actual nutrition of adult population of Samara region was conducted, the sample size was 1,856 people. At the first stage, using factor analysis, respondents' adherence to a certain model of food preferences was established; at the second stage, 5 homogeneous groups (clusters) of people with similar types of nutrition were formed using cluster analysis. The first cluster included individuals with maximum commitment to a high level of consumption of all studied foods; the second cluster was characterized by commitment to consumption of high-calorie foods such as baked goods, confectionery, sausages, potatoes, eggs, and cheese. Individuals from the cluster 3 showed a distinct preference for consumption of vegetables, fruit and dairy products. Individuals from the cluster 4 had no special preferences for any of the studied foods. The fifth cluster included people who had maximum preference for meat and meat products, smoked meats, pickles and salted fish. The content of cadmium, mercury, lead, and arsenic in food products was assessed via atomic absorption and photometric methods. The study relied on using social and hygienic monitoring data from the Samara Regional Rospotrebnadzor (Federal Service for Surveillance on Consumer Rights and Human Wellbeing) collection. Risk assessment of carcinogenic and non-carcinogenic effects was carried out in each of the five formed clusters taking into account modern methodological approaches. It was found that in all food clusters, the hazard coefficients for intake of contaminants in median concentrations and in the 90th percentile did not exceed permissible levels. In all clusters, the endocrine system was most at risk (HI = 1.68 ÷ 1.25). For all clusters, carcinogenic risk (for median concentrations) was created by arsenic both at the individual and the population level. The risk was the highest for people whose diets were characterized by high levels of consumption of high-calorie products. Cluster approach makes it possible to identify the most vulnerable groups of population in terms of risk burden for making managerial decisions and carrying out preventive measures.

Cluster approach to the study of population health risks posed by contamination of food products with heavy metals

Food products are a source of energy and essential substances but also of anthropogenic contaminants such as heavy metals. The aim of the study was to assess population health risks posed by contamination of food products with heavy metals, taking into account peculiarities of food preferences. An epidemiological study of actual nutrition of adult population of Samara region was conducted, the sample size was 1,856 people. At the first stage, using factor analysis, respondents' adherence to a certain model of food preferences was established; at the second stage, 5 homogeneous groups (clusters) of people with similar types of nutrition were formed using cluster analysis. The first cluster included individuals with maximum commitment to a high level of consumption of all studied foods; the second cluster was characterized by commitment to consumption of high-calorie foods such as baked goods, confectionery, sausages, potatoes, eggs, and cheese. Individuals from the cluster 3 showed a distinct preference for consumption of vegetables, fruit and dairy products. Individuals from the cluster 4 had no special preferences for any of the studied foods. The fifth cluster included people who had maximum preference for meat and meat products, smoked meats, pickles and salted fish. The content of cadmium, mercury, lead, and arsenic in food products was assessed via atomic absorption and photometric methods. The study relied on using social and hygienic monitoring data from the Samara Regional Rospotrebnadzor (Federal Service for Surveillance on Consumer Rights and Human Wellbeing) collection. Risk assessment of carcinogenic and non-carcinogenic effects was carried out in each of the five formed clusters taking into account modern methodological approaches. It was found that in all food clusters, the hazard coefficients for intake of contaminants in median concentrations and in the 90th percentile did not exceed permissible levels. In all clusters, the endocrine system was most at risk (HI = 1.68 ÷ 1.25). For all clusters, carcinogenic risk (for median concentrations) was created by arsenic both at the individual and the population level. The risk was the highest for people whose diets were characterized by high levels of consumption of high-calorie products. Cluster approach makes it possible to identify the most vulnerable groups of population in terms of risk burden for making managerial decisions and carrying out preventive measures.

Association between social vulnerability index and admission urgency for transcatheter aortic valve replacement

BackgroundTranscatheter aortic valve replacement (TAVR) are not offered equitably to vulnerable population groups. Adequate levels of insurance may narrow gaps among patients with higher social vulnerability index (SVI). Among a national population of individuals with commercial or Medicare insurance, we sought to determine whether SVI was associated with urgency of receipt of TAVR for aortic stenosis. Methods and resultsUsing Optum's de-identified Clinformatics Data Mart Database (CDM), we identified admissions for TAVR with aortic stenosis between January 2018 and March 2022. Admission urgency was identified by CDM claims codes. SVI was cross-referenced to patient zip codes and grouped into quintiles. Generalized linear mixed effects models were used to predict the probability of a TAVR admission being urgent based on SVI quintiles, adjusting for patient and hospital-level covariates. ResultsAmong 6680 admissions for TAVR [median age 80 years (interquartile range 75–85), 43.9 % female], 8.5 % (n = 567) were classified as urgent. After adjusting for patient and hospital-level variables, there were no significant differences in the odds of urgent admission for TAVR according to SVI quintiles [OR 5th (greatest social vulnerability) vs 1st quintile (least social vulnerability): 1.29 (95 % CI: 0.90–1.85)]. ConclusionsAmong commercial or Medicare beneficiaries with aortic stenosis, SVI was not associated with admission urgency for TAVR. To clarify whether cardiovascular care delivery is improved across SVI with higher paying beneficiaries, future investigation should identify whether relationships between SVI and TAVR urgency vary for Medicaid beneficiaries compared to commercial beneficiaries.