Vulnerable Groups Research Articles

Status and Possible Further Development of the Prohibition of Starvation of Civilian Population in Armed Conflicts

The main objective of the research is to determine whether the legal rules of international law of armed conflict and international criminal law regarding the prohibition of starvation of civilians as a method of warfare are appropriate to the increasingly widespread practice of starvation in armed conflicts and what the main challenges are. The authors analyze the content and scope of relevant rules, including those that indirectly refer to the prohibition of starvation – for the protection of vulnerable groups, siege, blockade, evacuation, humanitarian relief operations, etc. They take a dynamic and critical approach to this issue. They dynamically analyze the evolution of the prohibition of starvation of civilians under international law from World War II to the present, drawing on relevant examples from international jurisprudence, the work of international bodies and the opinions of legal authors. The authors apply a critical approach to address the need for greater moral stigmatization of starving civilians in armed conflicts. As a part of the critical approach, they see the need for consistent use of the term "starvation", especially when opening new criminal proceedings against the order issuers and perpetrators. They point to the need for patient research and documentation in each case to gather evidence to the best possible extent. Regarding the existing international legal framework, they see the possibility of creating additional legal rules by introducing a distinction between the basic and qualified forms of a criminal offence.

Prior resilience to trauma & coping during the COVID-19 pandemic.

This study examined the potential influence of pre-pandemic psychological resilience on use of approach or avoidant coping styles and strategies to manage stress during the COVID-19 pandemic. We hypothesized that higher resilience would be associated with more approach coping and less avoidant coping. Longitudinal cohort data were from the Nurses' Health Study II, including 13,143 female current and former healthcare professionals with pre-pandemic lifetime trauma. Pre-pandemic resilience was assessed between 2018-2019 and current coping during the outbreak of the pandemic in the United States (May-August 2020). Multiple linear regression model results identified associations between continuous pre-pandemic resilience scores and use of approach and avoidant coping styles, as well as individual coping strategies, adjusting for relevant covariates. Greater resilience was associated with higher use of approach coping (ß = 0.06, 95% CI 0.05, 0.08) and lower use of avoidant coping styles (ß = -0.39, 95% CI -0.41, -0.38). Higher pre-pandemic resilience was also associated with use of eight (distraction [ß = -0.18, 95% CI -0.20, -0.16], substance use [ß = -0.15, 95% CI -0.17, -0.13], behavioral disengagement [ß = -0.29, 95% CI -0.30, -0.27], self-blame [ß = -0.44, 95% CI -0.45, -0.42], emotional support (ß = 0.03, 95% CI 0.01, 0.05), positive reframing [ß = 0.13, 95% CI 0.12, 0.15], humor [ß = 0.03, 95% CI 0.01, 0.05] and religion [ß = 0.06, 95% CI 0.04, 0.08]) of the nine coping strategies in expected directions. Findings have important implications for intervention or even prevention efforts to support vulnerable groups, such as women with prior trauma histories, during this and other immensely stressful times. Supporting or building psychological resilience following trauma may promote effective coping in times of future stress.

SHARIA MICROFINANCE MODELS: A GRAMEEN BANK APPROACH FOR SUSTAINABLE CONSTRUCTION AND WELFARE ENHANCEMENT

This research aims to build a model for strengthening Sharia microfinance through an adapted Grameen Bank replica based on the pillars of leadership, collaboration, spirituality, and women's freedom. This research used a quantitative method to analyze a Grameen Bank replica or build a model for strengthening Sharia microfinance. It provides an early description of the model's independent and dependent variables using Path Investigation and Structural Equation Modeling (SEM). Data were gathered through participatory observation methods, interview techniques, and the distribution of SEM questionnaires to MFI managers and beneficiary customers. The findings indicate a link between the influence of the Grameen Bank-based Islamic Microfinance Institution system on partners in terms of leadership, cooperation, economy, community, and spirituality, as well as alternative strategies for strengthening Grameen Bank-based MFIs in improving the welfare of women's microbusiness groups. This research encourages more attention and implementation of Islamic microfinance models in an effort to improve social and economic welfare, especially among vulnerable groups such as women micro-entrepreneurs.

Intrahousehold empowerment patterns, gender power relations, and food security in Uganda

AbstractThis study examined (a) the relationship between women's empowerment, men's empowerment, and food security within households and (b) the effect of gender power in households on the food security status of women and men in Uganda's fishing villages using NutriFish project data (N = 762). An inaugural intersectional gender analysis approach applied the project‐level Women's Empowerment in Agriculture Index (pro‐WEAI), categorizing indicators into five domains: decision making, labor sharing, resource access, norms and beliefs, and gender parity within households. Binary logit models were computed, including interactions between the empowerment of women and men, controlling for individual‐ and household‐level characteristics, and stratified by gender and occupation (i.e., fishing vs. non‐fishing) to account for context differences. Results showed that empowering women in non‐fishing groups enhanced food security for both genders, regardless of men's empowerment. In fishing groups, women's food security improved most when their partners were already empowered, while men's empowerment remained relatively unaffected. Notably, the norms and beliefs domain was strongly linked to food security, except for non‐fishing men. Context‐specific gender interventions and analyses are vital to address food security disparities and critical to informing project implementers and policymakers in gender‐ and nutrition‐sensitive development projects to target the most vulnerable groups.

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.

Development of a disaster preparedness training program for community leaders: Evidence from Taiwan

Community leaders are vital in enhancing community disaster preparedness through empowerment, consensus-building, and public engagement. Despite existing programs, Taiwan lacks essential elements like disaster risk perception and healthcare responses. There is an urgent need for a comprehensive training program that incorporates community leaders' perspectives to address these gaps. This study utilized a mixed-methods approach in a two-step process to develop a theory-based training program for community leaders. The first step involved developing a disaster preparedness training program, identifying core elements through literature reviews on the contents and the protection motivation theory, and conducting qualitative interviews with community leaders to assess their training needs. In the second step, the content of the developed training program was validated. Suggestions from five male community leaders were integrated into program development, resulting in four major themes: community resource linkage, protection and assistance for vulnerable groups, evacuation and sheltering, and health care. The developed disaster preparedness training program was named the R3_SAF3E training program. Content validity was assessed by five experts, with item-level content validity indexes (I-CVI) and scale-level content validity index/averaging (S-CVI/Ave) both were 1, and scale-level content validity index/universal agreement (S-CVI/UA) was 0.94. This is the first study in Taiwan to integrate the protection motivation theory based on community leaders’ disaster preparedness needs. The training program demonstrate strong content validity. The results of this study can be used to plan disaster preparedness training for other programs to assist residents in enhancing their disaster preparedness.

Representations of alcohol and drug use in the Finnish reform of social and health care service users’ rights

BackgroundA growing body of research has analysed the representations of alcohol and other drugs (AOD) in policy-making, but few studies have focused on the representations reproduced in law-making processes, especially in the context of the regulation of the rights of social and health care service users. This study examined what kind of representations of AOD use are reproduced in the legislative reform of social and health care service users’ rights in Finland. The purpose of the reform is to strengthen social and health care service users’ rights to self-determination and to reduce the use of restrictive measures. MethodsAs its data, the study used a draft of the bill and stakeholder opinions regarding the reform. ‘What's the problem represented to be?’ approach as a methodological framework. ResultsThe study discovered three AOD-related discourses: the Control, Welfare, and Rights and Legality discourses. The Control discourse represented people who use AOD as risky individuals and called for ways to manage risks in treatment situations. The Welfare discourse portrayed people who use AOD as a vulnerable group whose problems should be addressed by the welfare system. The Rights and Legality discourse represented the vague legal definitions of AOD use as the main regulatory problem. The discourses differed in terms of their definitions of self-determination. ConclusionsThe study illustrated how the right to self-determination as a legal concept is contested and can be interpreted in different ways depending on the representations of AOD use. The differing representations highlight the tensions involved in improving the rights of people who use AOD.

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