Vulnerable Groups Research Articles

Economic challenges faced by migrant street vendors during a crisis: implications for social inclusion development

PurposeInformal migrant workers and street vendors have long been recognized as vulnerable groups in urban areas of Global South countries. However, limited studies exist on the economic challenges faced by migrant street vendors during crises. We aim to address this gap by shedding light on their livelihood and welfare losses during a public health crisis.Design/methodology/approachThis research uses descriptive and qualitative analyzes to triangulate the results. Data are derived from surveys and in-depth interviews with migrant street vendors in the two biggest cities in Vietnam during the COVID-19 pandemic.FindingsThe street vendors experienced significant business loss and consumption reduction during social distancing as well as encountered difficulties in recovering their businesses in the “new normal.” These adverse consequences were also found to disproportionately affect women vendors. Additionally, despite adopting various strategies and mitigation mechanisms to sustain their businesses and consumption, these efforts proved insufficient.Social implicationsThis research underscores the importance of short-term and long-term urban policies aimed at supporting and promoting the social inclusion of street vendors, particularly migrant and women vendors.Originality/valueThis research represents one of the early attempts to explore the adverse effects of a public health crisis on migrant street vendors and to examine whether the crisis disproportionately affected vendors from different genders and educational backgrounds. It also examines their business recovery in the “new normal.”

Exploring the associations between structural and functional aspects of social relationships and cognition in very old age.

Few studies have examined the associations between social relationships and cognition in very old adults (80+ years). Moreover, limited research has considered structural and functional aspects of social relationships together when exploring their associations with cognition. Therefore, the present study aimed to investigate the associations between structural and functional social aspects and cognition in very old age. The sample comprised 518 two-wave participants of the NRW80+ Study, who showed no indication of dementia and an average age of 85 years at baseline (range: 80-97 years). They were assessed twice over an approximate 2-year interval. Multilevel linear growth curve analysis was employed to model cognitive development over very old age and to examine the associations between structural and functional aspects of social relationships and cognitive development. It was controlled for demographic and health characteristics. A larger social network size (ß = 0.05, 95% CI [0.02, 0.08], p = 0.002) and frequent compared with occasional, seldom, and no contact with others (ß = 0.16, 95% CI [0.03, 0.28], p = 0.013) were associated with higher global cognition in the fully-controlled model. Model comparisons further revealed that structural aspects better predicted global cognition in very old age compared to functional aspects (χ2(2) = 16.17, p < 0.001). The findings underline the positive association between structural aspects of social relationships and global cognition in very old age. They also highlight the need for interventions promoting a socially active lifestyle to prevent cognitive decline in this vulnerable age group.

Hope in hardship: charting a new course for mental health in Afghanistan.

The long legacy of upheavals and deprivations in Afghanistan and the associated mental health impacts on its people are well documented. A systematic review undertaken by Alemi et al (2023) presents the most comprehensive synthesis to date on this topic. Drawing on their findings, this editorial examines the complex mental health and psychosocial challenges confronted by neglected vulnerable groups such as pregnant and postnatal women, LGBTQ individuals, older adults, ethnic minority groups and Afghan refugees living overseas. It explores the potential challenges in rebuilding a resilient mental health system following the mass exodus of Afghanis. It calls for a whole-of-society approach that extends beyond clinical interventions to address the broader sociocultural and economic factors influencing mental health.

Risk-Taking, Social Support, and Belongingness Contribute to the Risk for Cannabis Use Frequency in University Students.

Background: Cannabis use and misuse is known to be associated with a variety of negative health, academic, and work-related outcomes; therefore, it is important to study the factors that contribute to or moderate its use. Objectives: The aim of this study was to determine whether risky behavior, belongingness and social support as clustering variables play a role in cannabis use frequency. Method: In a university student sample, participant data on risky behavior, belongingness and social support were used to generate vulnerability profiles through cluster analysis (low vulnerability with low risk, low vulnerability with high belonging, moderate vulnerability, and high vulnerability). Using an analysis of variance, the vulnerability profiles were compared with respect to cannabis use frequency and quantity. Through chi-square tests we assessed whether these profiles are overrepresented in certain demographics. Results: The cluster analysis yielded four groups, which differed in their vulnerability for cannabis use. The most vulnerable cluster group had higher cannabis use frequency relative to the two least vulnerable groups. Low income vs. high income was also associated with high vulnerability group membership. International students were overrepresented in the low vulnerability with high belonging group relative to the low vulnerability with low-risk group. The opposite was observed for domestic students. Conclusions: This research adds to the expanding body of literature on cannabis use and misuse in Canada, which may contribute to public health policy and the prevention and treatment of cannabis addiction by providing new insight on who may be at risk.

Tobacco use, trauma exposure and PTSD: a systematic review.

Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets.

Safe and sustainable fish and seafood system and per- and poly-fluorinated substances occurrence: the role of PFAS toxicity in the assessment.

Fish and seafood are valuable sources of both nutrients and organic contaminants. The expansion of the analytical per- and polyfluoroalkyl substances (PFAS) panel with toxicological characterisation necessitates an update of PFAS intake assessment and management within the context of cumulative exposure. Benthic and demersal seafood, such as clams, squid, and cuttlefish, are more prone to contamination with C9-C14 perfluorocarboxylic acids, exhibiting the highest relative potency factors in terms of immunotoxicity, according to the grid recently proposed by the European Commission Scientific Committee on Health, Environment, and Emerging Risk. Based on the Italian food consumption database referring to demersal and benthic biota such as squid, cuttlefish, crustaceans, and clams, a toxicology-based intake scenario was drafted to highlight the relevant contribution of such wild species to PFAS intake, well above the provisional health-based guidance value of 4.4ng/kg body weight per week. Ensuring consistency between PFAS reduction and substitution policies, environmental quality standards for water bodies, and the issuance of advisories and regulations regarding safe and sustainable intake of fish and seafood is crucial. This is done to prevent a loss of accountability for institutional bodies, which aim to protect fragile (sensitive and vulnerable) groups from PFAS exposure and simultaneously promote 'blue growth' as a sustainable food production system.

Demographic and economic inequality of antenatal care coverage in 4 African countries with a high maternal mortality rate

BackgroundMaternal deaths are concentrated in low and middle-income countries, and Africa accounts for over 50% of the deaths. Women from socioeconomically disadvantaged households have higher morbidity and mortality rates and lower access to maternal health services. Understanding and addressing these inequalities is crucial for achieving the Sustainable Development Goals and improving maternal health outcomes. This study examines the demographic and economic disparities in the utilization of antenatal care (ANC) in four countries with high maternal mortality rates in Africa, namely Nigeria, Chad, Liberia, and Sierra Leone.MethodThe study utilised data from Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) from Nigeria, Chad, Liberia, and Sierra Leone. The data was obtained from the Health Equity Assessment Toolkit (HEAT) database. The study examined ANC service utilisation inequality in four dimensions such as economic status, education, place of residence, and subnational region across different subgroups by using four summary measures (Difference (D), Absolute Concentration Index (ACI), Population Attributable Risk (PAR), and Population Attributable Factor (PAF)).ResultA varying level of inequality in ANC coverage across multiple survey years was observed in Nigeria, Chad, Liberia, and Sierra Leone. Different regions and countries exhibit varying levels of inequality. Disparities were prominent based on educational attainment and place of residence. Higher level of inequality was generally observed among individuals with higher education and those residing in urban areas. Inequality in ANC coverage was also observed by economic status, subnational region, and other factors in Nigeria, Chad, Liberia, and Sierra Leone. ANC coverage is generally higher among the richest quintile subgroup, indicating inequality. Nigeria and Chad show the highest levels of inequality in ANC coverage across multiple measures. Sierra Leone displays some variation with higher coverage among the poorest quintile subgroup.Conclusion and recommendationInequalities in ANC coverage exist across age groups and survey years in Nigeria, Chad, Liberia, and Sierra Leone. Disparities are prominent based on education, residence, and economic status. Efforts should focus on improving access for vulnerable groups, enhancing education and awareness, strengthening healthcare infrastructure, and addressing economic disparities.

Prevalence and risk factors of depression and anxiety symptoms in intensive care unit patients with cardiovascular disease: A cross-sectional study.

To investigate the prevalence of anxiety and depression symptoms in intensive care unit (ICU) patients with cardiovascular disease (CVD) and to explore which elements are risk factors for the development of anxiety and depression symptoms. A cross-sectional study. A total of 1028 ICU patients with CVD were enrolled in this cross-sectional study. Logistic regression was used to assess risk factors and associations between anxiety and depression symptoms, and mediation analysis was used to explore the effect of risk factors on the association between anxiety and depression symptoms. Reporting of the study followed the STROBE checklist. The results showed that among ICU patients with CVD, 38.1% had anxiety symptoms, 28.7% had depression symptoms and 19.3% had both anxiety and depression symptoms, and there was a significant association between anxiety and depression symptoms. We also identified female gender, hypertension, hyperlipidemia and cardiac function class IV as independent risk factors for anxiety and depression symptoms. Importantly, these factors also mediated the association between anxiety and depression symptoms, emphasising their role in the psychological well-being of this patient group. ICU patients with CVD were prone to anxiety and depression symptoms. Female gender, hypertension, hyperlipidemia and cardiac function class IV were identified as independent risk factors that also served as mediators in the relationship between anxiety and depression symptoms. Especially, cardiac function class IV emerged as a critical factor in this association. It is imperative for critical care professionals to recognize the elevated risk of depression and anxiety among ICU patients with severe CVD, especially those with cardiac function class IV, hypertension, hyperlipidemia and females. Proactive and supportive measures are essential for this vulnerable group during their ICU stay to safeguard their mental health and prevent negative outcomes. No Patient or Public Contribution.

Obstetrical Complications in Venezuelan Refugee and Migrant Women: Analysis of Ecuadorian National Hospital Discharge Data, 2018-2021.

An estimated 7.7million Venezuelans have fled a severe humanitarian crisis in their country, most (70%) to other middle-income host countries in the same Andean region. Migration-related exposures during periconception and other critical gestational periods can adversely impact maternal-perinatal outcomes. Emerging evidence suggests that Venezuelan refugee and migrant women (VRMW) who migrate to Andean host countries are at-risk for delivering preterm and low birthweight infants and for Cesarean-sections. However, relatively few studies have examined obstetrical complications that could contribute to these or other short- and longer-term health outcomes of VRMW and/or their offspring. Our exploratory study analyzed four recent years of national hospital discharge data (2018-2021) from Ecuador to compare the primary discharge diagnoses of VRMW (n = 29,005) and Ecuadorian nationals (n = 1,136,796) for ICD-10 O code obstetrical complications related to or aggravated by pregnancy, childbirth, or the puerperium. Our findings indicated that VRMW were hospitalized for 0.5 days longer than Ecuadorian reference group women and they had higher adjusted odds (aOR) for a primary discharge diagnosis for obstetrical complications including preeclampsia (aOR:1.62, 95% CI:1.55,1.69), preterm labor (aOR:1.20, 95% CI:1.11,1.31), premature rupture of membranes (aOR: 1.72, 95% CI:1.63,1.83), oligohydraminos (aOR:1.24, 95% CI:1.12,1.36), obstructed labor (aOR: 1.39, 95% CI:1.31,1.47), perineal lacerations/other obstetric trauma (aOR:1.76, 95% CI:1.63, 1.91), STIs (aOR:2.59, 95% CI:1.29,2.92), anemia (aOR:1.33, 95% CI:1.24,1.42), and ectopic pregnancy (aOR:1.16 95% CI:1.04,1.28). They had similar aOR for diagnosed gestational diabetes and spontaneous abortion (SAB) compared to the reference group but a reduced aOR for genitourinary infections (aOR:0.79, 95% CI:0.74,0.84) and early pregnancy hemorrhage not ending in SAB (aOR:0.43, 95% CI:0.36,0.51). Our findings underscore the vulnerability of VRMW for a number of potentially serious obstetrical complications with the potential to adversely impact the short- and longer-term health of mothers and their offspring. Future studies should collect more detailed information on the migration status, experiences, and exposures of MRMW that influence their risk for obstetrical complications. These are needed to expand our findings to better understand why they have excess risk for these and to inform social and public health policies, programs and targeted interventions aimed at reducing the risk of this vulnerable refugee and migrant group.

A comprehensive review on nutritional interventions and nutritive elements: Strengthening immunity for effective defense mechanism during pandemic

AbstractThe pandemic has brought attention to the importance of a healthy immune system in preventing infectious diseases. In this in‐depth review, the process by which nutritional interventions and fundamental nutrients affect immune function has been discussed with the goal of enhancing the body's natural defenses against viral infections. We explored the complex interplay between diet and immunology, highlighting the essential nutrients, vitamins, minerals, and bioactive substances that are crucial for enhancing immune response. We also investigated the effect of dietary patterns and supplementation methods on immune function. We assessed the effectiveness and potential mechanisms of action of various nutritional therapies in modifying immune responses through a thorough examination of scientific literature. Additionally, we go through the significance of individualized nutrition and highlight possible factors to consider for vulnerable groups, such as the elderly and people with chronic conditions. This review attempts to provide a thorough understanding of the role of diet in boosting immunity by synthesizing available research. It also offers insights into practical methods for enhancing the immune function during the current epidemic and in the future.

Exclusive breastfeeding among Indonesian working mothers: does early initiation of breastfeeding matter?

BackgroundEarly initiation of breastfeeding (EIBF) is a starting point that lays the foundation for breastfeeding and bonding between mother and baby. Meanwhile, working mothers are one of the vulnerable groups for the success of exclusive breastfeeding (EBF). The study analyzed the role of EIBF on EBF among Indonesian working mothers.MethodsThe cross-sectional study examined secondary data from the 2021 Indonesian National Nutritional Status Survey. The study analyzed 4,003 respondents. We examined EBF practice as an outcome variable and EIBF as an exposure variable. We included nine control variables (residence, maternal age, marital, education, prenatal classes, wealth, infant age, sex, and birth weight). All variables were assessed by questionnaire. The study employed a binary logistic regression test in the last stage.ResultsThe result showed that the proportion of EBF among working mothers in Indonesia in 2021 was 51.9%. Based on EIBF, Indonesian working mothers with EIBF were 2.053 times more likely than those without to perform EBF (p < 0.001; AOR 2.053; 95% CI 2.028–2.077). Moreover, the study also found control variables related to EBF in Indonesia: residence, maternal age, marital, education, prenatal classes, wealth, infant age, sex, and birth weight.ConclusionThe study concluded that EIBF was related to EBF. Indonesian working mothers with EIBF were two times more likely than those without to perform EBF. The government needs to release policies that strengthen the occurrence of EIBF in working mothers to increase EBF coverage.

Feasibility and Acceptability of a Meditation Mobile App Intervention for Adolescent and Young Adult Survivors of Childhood Cancer

Background: Adolescent and young adult (AYA) survivors of childhood cancer are increasingly recognized as a vulnerable group with unique emotional, social, and practical needs due to the intersection of cancer survivorship and normal developmental processes. Mindfulness meditation has shown early efficacy in improving psychological distress among cancer patients. However, the overall scientific study of app-based mindfulness-based interventions is still in its early stages. The goal of this study was to evaluate the feasibility and acceptability of a commercially available mindfulness mobile app intervention “Ten Percent Happier” among AYA survivors of childhood cancer. Methods: We conducted a single-arm pilot intervention with 25 AYA survivors of childhood cancer ages 18–29 years. Results: A total of 108 potentially eligible individuals were initially identified for screening. Of the 45 individuals reached (contact rate = 41.67%), 20 declined to participate; 25 were enrolled in the study and completed the baseline survey (enrollment rate = 55.56%). Twenty-one participants completed the study (retention rate = 84%). Changes in several outcomes were promising, with medium to large effect sizes: Mindfulness (d = 0.74), Negative Emotion (d = 0.48), Perceived Stress (d = 0.52), and Mental Health (d = 0.45). Furthermore, results suggested that participants with consistent app usage showed greater improvement in reported outcomes than those who stopped their usage (e.g., Mindfulness: d = 0.74, Perceived Stress: d = 0.83, Mental Health: d = 0.51; Meaning and Purpose: d = 0.84; and Sleep Disturbance: d = 0.81). Qualitative feedback indicated high satisfaction, but participants suggested adding group or individual peer support to improve their experience with the app. Conclusions: AYA survivors can be difficult to reach, but a mindfulness app was feasible and acceptable to this group. In particular, the robust retention rate and high satisfaction ratings indicate that the meditation mobile app was well received. Preliminary results suggest positive changes in health-related quality of life outcomes, warranting a larger efficacy trial.

Making vulnerable groups able to connect socially and digitally—opportunities and pitfalls

IntroductionThis article addresses digital and social inclusion of adults with potential low digital skills. The article presents a case study of how digital learning activities (DLAs) as a service to refugees, immigrants, senior citizens, and young adults neither in education, employment, or training (NEETs), are delivered outside the formal educational system by two libraries and one civic organization in Norway, Denmark, and Belgium. Through the theoretical lenses of social capital building, co-creation and co-producing, the article analyzes how the DLA’s were organized and tailored for the participant’s needs, with an emphasis on cooperation efforts with local sub-partners and representatives from the target groups.MethodsA multiple case-design was applied using a process tracing method combining qualitative and quantitative techniques. To measure the partner organizations’ experiences from the project, we conducted participant observation, personal and focus group interviews, in addition to self-reporting schemas about how they organized the DLA’s. Surveys were conducted to measure the participants’ experiences.ResultsBy combining literature and theoretical approaches from several fields; digital inclusion, public and civil organization research—with a particular focus on libraries, and their role in educating refugees and other vulnerable groups, the article provides new insights on how public and non-public organizations in local communities can work together to tailor-make DLAs and contribute to the promotion of digital inclusion.DiscussionLibraries and civic organizations have potential to reach out to vulnerable people in local communities, to provide innovative DLA’s and to connect both people and organizations. Vital for recruitment of participants and to find the right level of digital/technical ambition is to closely co-create and co-produce with representatives from other local organizations in both civil and public sector during the whole process. Co-creating activities with actors representing the target group in the planning phase as well as co-producing them in the implementation phase, are important prerequisites. The article discusses the challenges of trust-building, of finding the right level of digital ambition as well as developing long-term digital activities as important factors for the promotion of digital inclusion.

Multidrug-resistant Organisms: The Silent Plight of Burn Patients.

The global increasing spread of multidrug-resistant organisms (MRDOs) is threatening the control of various infections in vulnerable populations and patient groups. One of the most affected groups is burn patients, who are prone to hyperinfection as they suffer from a hypermetabolic state and weakened immune barriers. Those patients also share the infection risk of patients hospitalized for a long time, including ventilator-associated pneumonia and urinary tract infections. While some preventative and therapeutic management styles are still controversial, there are some consensuses that we discuss here. In this review, we aim to present the current knowledge on multidrug-resistance with a special focus on burn patients, discuss various causative organisms and their treatment options, and highlight the importance of antibiotic stewardship and teamwork in responding to an outbreak of MDROs.

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.

Outcomes for high-risk young people referred to secure children’s homes for welfare reasons: a population record linkage study in England

Purpose Secure children’s homes (SCHs) restrict the liberty of young people considered to be a danger to themselves or others. However, not all young people referred to SCHs find a placement, and little is known about the outcomes of the young person after an SCH or alternative placement. The purpose of this paper is to understand which characteristics most likely predict allocation to an SCH placement, and to explore the outcomes of the young people in the year after referral. Design/methodology/approach A retrospective electronic cohort study was conducted using linked social care data sets in England. The study population was all young people from England referred to SCHs for welfare reasons between 1st October 2016 to 31st March 2018 (n = 527). Logistic regression tested for differences in characteristics of SCH placement allocation and outcomes in the year after referral. Findings In total, 60% of young people referred to an SCH were allocated a place. Factors predicting successful or unsuccessful SCH allocation were previous placement in an SCH (OR = 2.12, p = 0.01); being female (OR = 2.26, p = 0.001); older age (OR = 0.75, p = 0.001); and a history of challenging behaviour (OR = 0.34, p = 0.01). In the year after referral, there were little differences in outcomes between young people placed in a SCH versus alternative accommodation. Originality/value The study raised concerns about the capacity of current services to recognise and meet the needs of this complex and vulnerable group of young people and highlights the necessity to explore and evaluate alternatives to SCHs.

Extreme temperatures, birth outcomes, and social inequalities: Evidence from South China

Abstract The impacts of climate change on health are a critical public health issue, but the association between extreme temperatures and birth outcomes remains poorly understood. This paper links over 1 million birth records from Dongguan, China, between 2004 and 2013, to meteorological data. We investigate the relationship between extreme temperatures and birth outcomes and explore the heterogeneity among different demographic and socioeconomic factors, including maternal migrant status, education level, and mode of delivery. We find that one percentage increase in the number of days exposed to extreme heat during pregnancy is associated with a reduction in birth weight of 2.31 grams and a 2% increase in odds of LBW, while exposure to extreme cold temperatures is associated with a reduction in birthweight (0.66 g) and an increase in risk of LBW (1%). The association between extreme high temperatures and adverse birth outcomes is stronger for groups with disadvantaged social status. Specifically, the migrant group (for extreme heat exposure, local residents, −0.37 g, intra-provincial migrants, −2.75 g, out-of-province migrants, −2.49 g), the less-educated group (for extreme heat exposure, middle school or below, −2.47 g, high school or above, −1.66 g), and the group with vaginal birth (for extreme heat exposure, C-sections, −1.56 g, vaginal birth, −2.62 g) are more sensitive to extreme weather conditions. Our study provides further evidence about the association of extreme temperatures with birth outcomes and for vulnerable groups of pregnant women.

Active Case-Finding: An Effective Solution for Tuberculosis Detection in Vulnerable Groups – The Romanian Experience

Active Case-Finding: An Effective Solution for Tuberculosis Detection in Vulnerable Groups – The Romanian Experience

Assessing Accessible Travel Satisfaction in Old Communities: A SEM Study

China faces a significant population of individuals with disabilities, and the aging demographic exacerbates this challenge. There is an urgent need for accessible environments for vulnerable groups such as persons with disabilities, the elderly, and pregnant women. Consequently, this study aimed to explore the factors influencing satisfaction with accessible travel in old communities in Nanchang City. Adopting a perspective encompassing vulnerabilities across all age groups, we employed interviews, on-site surveys, questionnaires, and literature reviews to construct a model of satisfaction with accessible travel. This model comprises five evaluation dimensions: pedestrian pathways, public spaces, signage guidance, social support, and software provision, encompassing twenty-seven influencing factors. Structural equation modeling (SEM) was utilized to validate the model. The research findings indicated that social support (0.697), pedestrian pathways (0.480), and public spaces (0.291) exerted a significant overall effect on satisfaction within the model, whereas the influence of software provision (0.225) and signage guidance (0.249) was comparatively smaller. Vulnerable groups within the community prioritized operational maintenance (0.818) and cultural advocacy (0.791) within social support. They also emphasized aspects of pedestrian pathways such as elevation treatment (0.809) and pavement design (0.803), as well as rest facilities (0.804) and service facilities (0.790) within public spaces. Finally, based on the weighted ranking of factors among latent variables, we propose corresponding optimization strategies and development proposals. This paper contributes to providing theoretical, practical, and technical support for the design of community accessibility that caters to socially vulnerable groups across “universal and all-ages” groups. It plays a proactive role in enhancing the quality of life for these vulnerable groups and promoting the improvement of accessibility environments in old communities.