Vulnerable Individual Research Articles

Navigating Care Boundaries: Exploring the Limits between Compassionate Care and Neglect1

For over two decades in France, the concept of "bientraitance" has echoed within the walls of nursing homes. While recommendations for good professional practices stand as a beacon for the care of the elderly, aiming to prevent the indignity of mistreatment, they may not consistently guide daily care giving practices in these establishments. This study does not delve into the reasons for this discrepancy. Instead, it presents three situations extracted from the field, exploring the concepts of "bientraitance" and its antithesis. Employing a qualitative and reflective approach, the research seeks to examine the nuanced boundary between these two antagonistic modes of care. The caregiver's individual response becomes pivotal, signifying their positioning—whether to remain or contemplate a shift—while respecting the construction of their professional identity and the dignity of the vulnerable individual.

Clinical Psychopathology During Covid-19 Pandemic

The coronavirus disease 2019 (COVID-2019) pandemic and its consequences on individuals’ social, economic, and familial lives have negatively affected mental health of the general population especially in a vulnerable individual. In this case reports, we aim to highlight the role of such psychosocial stressors related to COVID pandemic resulting in development of Acute Psychosis. In the first case the stressor is associated with fear of getting infected while in the second case fear of being put into Quarantine. Thus health measures should be employed to address psychosocial stressors, particularly related to the use of isolation/quarantine, infection fear and vulnerability among the general population.

Definition and Evolution of the Term Osteoporosis.

Osteoporosis is a metabolic bone disease in which the loss of bone mineral density causes the bone to become weaker and more susceptible to fracture. In the vulnerable individual, osteoporosis develops as a result of a combination of hereditary and environmental risk factors. The definition of the term osteoporosis as a clinical syndrome has evolved with the improved understanding of the pathogenesis,diagnostic terminology and treatment directions both pharmacological and non-pharmacological, over the past few decades.

The Appropriate Adult: Their perspective working in the criminal justice system

Vulnerable individuals are increasingly coming into custody. One safeguard implemented by the Police and Criminal Evidence Act and Codes of Practice is the Appropriate Adult measure. However, little is known about how the Appropriate Adult constructs and understands their role and the implications this may have for the enactment of their role. The current study aimed to explore how Appropriate Adults and others experience and understand their role when working with vulnerable individuals. Semi-structured interviews were conducted with 14 Appropriate Adults and analysed using interpretative phenomenological analysis. Overall, two superordinate and six subordinate themes emerged from the data that highlighted the complex and confusing role of the Appropriate Adult. In addition, Appropriate Adults suggested that they may be less likely to perform their duties if faced with excessive conflict from others working in custody. The research raises implications regarding the understanding and utilisation of the Appropriate Adult role and for the treatment and outcome of the vulnerable adult in custody. That is, if the Appropriate Adult remains passive in their role, the vulnerable individual in custody is not being appropriately safeguarded and remains at risk of providing unreliable, self-incriminating information or even a false confession.

Improper communication starts arterial hypertension in a vulnerable individual

Background: People interact with or without words and sounds through their energy, and their appearance makes us think of them. People’s communication by terms represents a common and convenient channel to exchange ideas and deal with problems. Collaboration luxury relaxes and improves individual well-being; ill-mannered people interactions act in opposite directions. Provocative and scandalous debates go before various mental disturbs, following physical complaints according to existing fragile areas. Aim: To reveal the influence of communication skills on blood vessel control and how improper communication starts arterial hypertension in a vulnerable individual. Material& Method: A qualitative study was performed by the author in the community from 2008 to 2023, relating to the people’s interaction influence on their health. People’s inappropriate communication effects on the individual were noticed, then corrected. Findings: man, aged 68, occasionally experienced unpleasant cooperation with some members of his large family. Each time, after offensive attitudes and forceful disputes, he presented tachycardia and increased blood pressure: 155/90 to 167/95 mmHg. On November 2022, following a violent discussion with a family member, he presented headache, high blood pressure, 180/103 mm Hg, tachycardia, and vertigo. Patient’s family medical history: Parents, brothers, and sisters: arterial hypertension. Patient’s medical history: Transient arterial hypertension, from 2009; permanent arterial hypertension: 2022; atrial arrhythmia, 2022.

High risk of psychosis, condition or diagnosis? About a case.

IntroductionA person with “high-risk mental status (HRMS)” indicates that the person, usually young people between the ages of 14 and 25, is more likely to develop psychosis. These people have attenuated psychotic symptoms without reaching the intensity or frequency of a frank psychotic episode. It is suggested that psychological trauma could favor neurochemical and psychopathological changes in a vulnerable individual. It would be interesting to study the role of psychotherapeutic interventions in the course of high-risk mental states and their possible evolution to a psychotic disorder. We present the case of an 18-year-old adolescent whose diagnosis was high risk of psychosis.ObjectivesThis work has several objectives. On the one hand review current information on high-risk mental status (EMAR). On the other hand, develop a discussion about whether the EMAR category should be a diagnostic entity or just a condition.MethodsA bibliographic search has been carried out in the main sources of medical information such as pubmed, uptodate as well as in national and international journals. Likewise, the knowledge and clinical experience of the team has been reviewed in order to expose its own experience in this field, defining specific interventions as well as results.ResultsThe case presented is of an 18-year-old female patient.She states that the main reason for consultation is something that happened last Sunday, at which time he had “an identity crisis” in which he did not know if he was a girl or a boy. The reasoning behind this fact is that “as Pablo Alborán likes him, perhaps he is a boy”. Given the bizarreness of the explanation and the patient’s particular contact, I explore a previous psychopathological situation. She says that since last year she feels more insecure, with diffuse fear that it is difficult to specify or nominate something specific: “in class and that is very difficult for me, public presentations”, she says that “everything scares me”, she says that she has a non-specific fear that has been maintained even increasing over the months and that has led him to have greater anguish. Even though the patient dates the beginning of the picture on Sunday, it is noteworthy that the previous Thursday she had requested a consultation with psychology in the private circuit that although she does not know how to specify the reason “because of fears” it seems that the anguish resulting from this fear had been increasing, having greater difficulties for the presentations in class. The contact is psychotic and the situation that the patient describes is typical of a “treme” situation, cataloged in the current literature as a High-Risk Mental State.ConclusionsHigh-risk mental states are not a diagnostic category according to current classifications, although it is necessary to reach a consensus on what the diagnosis implies and what would be the way to proceed when a patient presents these symptoms.Disclosure of InterestNone Declared

Spatial clusters of diabetes: individual and neighborhood characteristics in the ELSA-Brasil cohort study.

This study identified spatial clusters of type 2 diabetes mellitus among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) residing in two cities and verified individual and neighborhood socioeconomic environmental characteristics associated with the spatial clusters. A cross-sectional study was conducted with 4,335 participants. Type 2 diabetes mellitus was defined as fasting blood glucose ≥ 126mg/dL (7.0mmol/L), oral glucose tolerance test ≥ 200mg/dL (11.1mmol/L), or glycated hemoglobin ≥ 6.5% (48mmol/L); by antidiabetic drug use; or by the self-reported medical diagnosis of type 2 diabetes mellitus. Neighborhood socioeconomic characteristics were obtained from the 2011 Brazilian census. A spatial data analysis was conducted with the SaTScan method to detect spatial clusters. Logistic regression models were fitted to estimate the magnitude of associations. In total, 336 and 343 participants had type 2 diabetes mellitus in Belo Horizonte, Minas Gerais State (13.5%) and Salvador, Bahia State (18.5%), respectively. Two cluster areas showing a high chance of type 2 diabetes mellitus were identified in Belo Horizonte and Salvador. In both cities, participants living in the high type 2 diabetes mellitus cluster area were more likely to be mixed-race or black and have a low schooling level and manual work; these were also considered low-income areas. On the other hand, participants in the low type 2 diabetes mellitus cluster area of Salvador were less likely to be black and have low schooling level (university degree) and live in a low-income area. More vulnerable individual and neighborhood socioeconomic characteristics were associated with living in clusters of higher type 2 diabetes mellitus occurrence , whereas better contextual profiles were associated with clusters of lower prevalence.

Recognizing Early Deterioration in Elderly Care Home Setting - a Snapshot

AimsOur aim is to measure the baseline physical and mental health early deterioration recognition of carers in the care home setting in Harrogate, North Yorkshire. This is part of a larger undergoing quality improvement project that looks at improving elderly care in care homes in the region by implementing a training package.MethodsThe approach was to contact local authorities, in this case, the NHS clinical commissioning group North Yorkshire to identify a struggling care home. We then engaged the care home and designated a leader to coordinate the project. We collected common themes by using focus groups with both carers and our professionals which led to the creation of a 16-item questionnaire covering deterioration literacy. Finally, we electronically and anonymously surveyed the carers (December 2021) and analysed the data via Google Forms.ResultsWe had 22 responses out of 30 possible. As an overview, 100% felt confident in recognizing deterioration, however, 31.8% don't feel confident in managing deterioration. 90.9% need tools to aid recognition, from which 45.5% find tools confusing. Only 50% feel confident to appropriately escalate the incident, from which 36.4% did not know when or to whom to escalate and 13.6% were not sure if escalation was needed but will refer to secondary care regardless. 27.3% think their escalation process needs improvement. When it comes to deterioration themes, 4.6% don't feel confident in identifying confusion, 13.6% feel their knowledge on confusion could be improved and 9.1% don't know how to identify, manage, or escalate confusion. 22.7% don't feel confident in identifying mobility decline and 9.1% don't know how to manage this accordingly. 9.1% feel like their knowledge of skin changes needs improvement. 22.7% feel that their confidence in identifying toilet habits could be improved and 4.5% don't know how to manage or escalate these changes. In terms of carers’ mental health, 50% and 13.6% have mild and moderate anxiety, respectively.ConclusionDeterioration recognition in the elderly is currently a hot topic. Recent studies highlight the need to improve deterioration management to minimize inappropriate referrals and admissions and unnecessary infection exposure of a vulnerable elderly individual. Our results show that besides improving the theoretical knowledge we also must think about a clear escalation process, an easy-to-read deterioration tool, and managing carers' anxiety as part of the training package.

Identification of the Profile of Vulnerable Population to Elaborate Efficient Employment Strategy: Proposition of a Quantitative-creative Approach

Brazilian public managers have been structuring and updating policies to support workers’ employment and income strategies. However, when the vulnerable individual has social, emotional, or technical limitations, success in this operation becomes uncertain. This research aim was to propose a methodology to identify profiles in vulnerable populations, viewing to promote the efficient elaboration of employment and income strategies. The unit of analysis was vulnerable population of waste pickers, in a large city from South Brazil, in the scope of a municipal program named "All of us are Porto Alegre". A literature review allowed the identification of tools from marketing, economy and design adequate to profile analysis. A workshop with social educators responsible for giving support to the individuals. Insights from workshop and the literature allowed the proposition of a methodology including cluster analysis and the creative tool named personas. The methodological approach suggests it is adequate in confirming the differences in profiles. The theoretical contribution lies in the use of quantitative-creativity tools to support policymaking. The practical contribution is to provide consistent information for governmental decision-making at the labor access market.

Common factors in serious case reviews of child maltreatment where there is a medical cause of death: qualitative thematic analysis

AimTo identify the common factors in serious case reviews (SCRs) where a child has died of a medical cause.DesignQualitative thematic analysis.BackgroundSCRs take place when neglect or abuse results in children...

Social workers’ perceptions of their peers’ unprofessional behavior

Summary This article explores social workers’ perceptions of their colleagues’ professional mistakes, and the influences of those opinions. Vignettes in a factorial survey helped to determine whether certain variables related to the social worker or the situation influenced the perception of others’ professional errors and ethical violations. The changed variables included personal characteristics of the offending social worker such as perceived race, gender, and sexual orientation of the social worker, and characteristics of the situation, such as the length of time involved in unprofessional behavior. Findings Licensed social workers in six U.S. states ( n = 5596) read vignettes based on real cases brought before licensing boards ( n = 22,127) and assigned levels of seriousness and importance to discipline. The vignettes rated most highly involved perceived harm to a client or other vulnerable individual. Those on the lower end of seriousness and importance to discipline were those violations against the profession of social work. Analysis of changed variables indicated respondents’ ratings were influenced by several situational factors, but not by personal characteristics of the social worker involved in the vignette. Applications Our findings provide some insight into the decision-making factors important to social workers. The results may be helpful to licensing boards considering the contextual factors of unprofessional behavior and whether to discipline certain actions.

Understanding the Pathogenesis of Gestational Hypothyroidism.

Pregnancy is a complex state with many endocrinological challenges to a woman’s physiology. Gestational Hypothyroidism (GHT) is an emerging condition where insufficiency of the thyroid gland has developed during pregnancy in a previously euthyroid woman. It is different to overt hypothyroidism, where marked elevation of thyroid-stimulating hormone with corresponding reduction in free thyroxine levels, is well known to cause detrimental effects to both the mother and the baby. During the past couple of decades, it has been shown that GHT is associated with multiple adverse maternal and fetal outcomes such as miscarriage, pre-eclampsia, placental abruption, fetal loss, premature delivery, neurocognitive and neurobehavioral development. However, three randomized controlled trials and a prospective cohort study performed within the last decade, show that there is no neurodevelopmental improvement in the offspring of mothers who received levothyroxine treatment for GHT. Thus, the benefit of initiating treatment for GHT is highly debated within the clinical community as there may also be risks associated with over-treatment. In addition, regulatory mechanisms that could possibly lead to GHT during pregnancy are not well elucidated. This review aims to unravel pregnancy induced physiological challenges that could provide basis for the development of GHT. During pregnancy, there is increased renal clearance of iodine leading to low iodine state. Also, an elevated estrogen level leading to an increase in circulating thyroglobulin level and a decrease in free thyroxine level. Moreover, placenta secretes compounds such as human chorionic gonadotropin (hCG), placental growth factor (PIGF) and soluble FMS-like tyrosine kinase-1 (s-Flt1) that could affect the thyroid function. In turn, the passage of thyroid hormones and iodine to the fetus is highly regulated within the placental barrier. Together, these mechanisms are hypothesized to contribute to the development of intolerance of thyroid function leading to GHT in a vulnerable individual.

Assessment of personal exposure to infectious contaminant under the effect of indoor air stability.

The objective of this study is to understand the effect of indoor air stability on personal exposure to infectious contaminant in the breathing zone. Numerical simulations are carried out in a test chamber with a source of infectious contaminant and a manikin (Manikin A). To give a good visual illustration of the breathing zone, the contaminant source is visualized by the mouth of another manikin. Manikin A is regarded as a vulnerable individual to infectious contaminant. Exposure index and exposure intensity are used as indicators of the exposure level in the breathing zone. The results show that in the stable condition, the infectious contaminant proceeds straightly towards the breathing zone of the vulnerable individual, leading to a relatively high exposure level. In the unstable condition, the indoor air experiences a strong mixing due to the heat exchange between the hot bottom air and the cool top air, so the infectious contaminant disperses effectively from the breathing zone. The unstable air can greatly reduce personal exposure to the infectious contaminant in the breathing zone. This study demonstrates the importance of indoor air stability on personal exposure in the indoor environment and provides a new direction for future study of personal exposure reduction in the indoor environment.

Emotions, Feelings, and Experiences of Social Workers While Attending to Vulnerable Groups: A Qualitative Approach.

Social workers in the community setting are in constant contact with the suffering experienced by the most vulnerable individual. Social interventions are complex and affect social workers’ emotional well-being. The aim of this study was to identify the emotions, feelings, and experiences social workers have while attending to individuals in situations of vulnerability and hardship. A qualitative methodology based on hermeneutic phenomenology was used. Six interviews and two focus group sessions were conducted with social workers from the community social services and health services of the Andalusian Public Health System in the province of Almería (Spain). Atlas.ti 8.0 software was used for discourse analysis. The professionals highlighted the vulnerability of certain groups, such as the elderly and minors, people with serious mental problems, and people with scarce or no economic resources. Daily contact with situations of suffering generates a variety of feelings and emotions (anger, sadness, fear, concern). Therefore, more attention should be paid to working with the emotions of social workers who are exposed to tense and threatening situations. Peer support, talking, and discussions of experiences are pointed out as relevant by all social workers. Receiving training and support (in formal settings) in order to learn how to deal with vulnerable groups could be positive for their work and their professional and personal quality of life.

Environment-dependent behavioral traits and experiential factors shape addiction vulnerability.

The transition from controlled drug use to drug addiction depends on an interaction between a vulnerable individual, their environment and a drug. Here we tested the hypothesis that conditions under which individuals live influence behavioral vulnerability traits and experiential factors operating in the drug taking environment to determine the vulnerability to addiction. The role of behavioral vulnerability traits in mediating the influence of housing conditions on the tendency to acquire cocaine self-administration was characterized in 48 rats housed in either an enriched (EE) or a standard (SE) environment. Then, the influence of these housing conditions on the individual vulnerability to develop addiction-like behavior for cocaine or alcohol was measured in 72 EE or SE rats after several months of cocaine self-administration or intermittent alcohol drinking, respectively. The determining role of negative experiential factors in the drug taking context was further investigated in 48 SE rats that acquired alcohol drinking to self-medicate distress in a schedule-induced polydipsia procedure. The environment influenced the acquisition of drug intake through its effect on behavioral markers of resilience to addiction. In contrast, the initiation of drug taking as a coping strategy or in a negative state occasioned by the contrast between enriched housing conditions and a relatively impoverished drug taking setting, facilitated the development of compulsive cocaine and alcohol intake. These data indicate that addiction vulnerability depends on environmentally determined experiential factors, and suggest that initiating drug use through negative reinforcement-based self-medication facilitates the development of addiction in vulnerable individuals. SIGNIFICANCE STATEMENT: The factors that underlie an individual's vulnerability to switch from controlled, recreational drug use to addiction are not well understood. We showed that in individuals housed in enriched conditions, the experience of drugs in the relative social and sensory impoverishment of the drug taking context, and the associated change in behavioral traits of resilience to addiction, exacerbate the vulnerability to develop compulsive drug intake. We further demonstrated that the acquisition of alcohol drinking as a mechanism to cope with distress increases the vulnerability to develop compulsive alcohol intake. Together these results demonstrate that experiential factors in the drug taking context shape the vulnerability to addiction.

State Complicity and Religious Extremism: Failing the Vulnerable Individual

Religious extremism—especially when unhindered by the state—can result in unimaginable harm to individuals. That is not to suggest that the only extremism is religious extremism. That would be patently incorrect and a profound misrepresentation of history; secular extremism - Communism, Fascism, Nazism, Pol Pot, Mao to name but the most obvious - has exacted an unimaginable price on hundreds of millions of people over the ages. While our examination will focus exclusively on religious extremism that is not intended - in any way - to minimize the extraordinary harm inflicted on innocent individuals by extremism not based on religion. To suggest otherwise would be an unacceptable combination of revisionist history, disrespectful of the memories of millions of victims. As we move forward, it is important to recall that in this chapter our focus is religious extremism and its impact on the individual. In doing so, we analyze the cost to the individual impacted by extremism and argue that state complicity in the face of extremism exacerbates individual vulnerability. In focusing on individual vulnerability, the working assumption is that the state fails to protect the individual member of a closed religious extremist group. The obligation, and the consistent failure, to protect individuals in the face of religious extremism - particularly in the context of “closed communities” - has significant consequences. This chapter will focus specifically on the effect specific closed communities have on vulnerable individuals. Not only does it put individuals “at risk”, it manifests state complicity in the face of extremism, the consequences of which are profound. While religious extremism is harmful to greater society, it is especially harmful to vulnerable individuals. With respect to the impact on larger society, specific examples will be provided illuminating the consequences of state complicity, regardless of its motivation or cause.

Pandemic Compassionate Release and the Case for Improving Judicial Discretion over Early Release Decisions

After decades of Bureau of Prisons’ maladministration of the sentence reduction authority authorized by 18 U.S.C. § 3582, Congress passed the First STEP Act of 2018 with the intention of expanding the use and transparency of compassionate release. Although the COVID-19 pandemic was not among the considerations when the First Step Act became law, it contains several important modifications that may protect thousands of federal prisoners from severe sickness and premature death while in custody. First, its procedural modification allowing federal prisoners to circumvent the often-artificial strictures of the Bureau of Prisons allows for a timely and proactive release decision from the sentencing court before a vulnerable individual is stricken with the deadly virus. Second, district courts are now permitted to grant release decisions to deserving individuals who were previously blocked from petitioning their sentencing court by the Bureau of Prisons. Importantly, courts are empowered to find grounds for release beyond those specifically enumerated in the now-outdated Sentencing Commission policy statement that formerly restricted compassionate release decisions. After observing the potential of the new compassionate release process as modified by the First Step Act, Congress should avoid concurrent systems of release and judicial discretion over early release should be expanded by statute or via an updated Sentencing Commission policy statement.

Towards an integrated perinatal care pathway for vulnerable women: The development and validation of quality indicators

ObjectiveDevelopment and validation of a set of quality indicators for vulnerable women during the perinatal period. DesignA three-phase method was used. Phase 1 consisted of a literature review to identify publications for the development of care domains and potential QIs, as well as a quality assessment by the research team. In phase 2 an expert panel assessed the set of concept QIs in a modified three-round Delphi survey. Finally, semi-structured interviews with vulnerable women were conducted as a final quality assessment of a set of indicators (phase 3). Ethical approval was obtained from the ethics committee of the University Hospital Brussels and from the Ethics Committees of all the participating hospitals. SettingThe Flemish Region and the Brussels Capital Region in Belgium. ParticipantsHealthcare and social care professionals (n = 40) with expertise in the field of perinatal care provision for vulnerable families. Vulnerable women (n = 11) who gave birth in one of the participating hospitals. FindingsThe literature review resulted in a set of 49 potential quality indicators in five care domains: access to healthcare, assessment and screening, informal support, formal support and continuity of care. After assessment by the expert panel and vulnerable women, a final set of 21 quality indicators in five care domains was identified. First of all, organisation of care must involve an integrated multidisciplinary approach taking account of financial, administrative and social barriers (care domain 1: access to healthcare). Second, qualitative care includes the timely initiation of care, a general screening of the various aspects of vulnerability (biological, psychological, social and cognitive) and a risk assessment for all women (care domain 2: assessment and screening). Vulnerable women benefit from intensive formal and informal support taking account of individual needs and strengths (care domain 3: formal support; care domain 4: informal support). Finally, continuity of care needs to be guaranteed in line with vulnerable woman's individual needs (care domain 5: continuity of care). Key conclusions and implications for practiceImplementing quality indicators in existing and new care pathways offers an evidence-based approach facilitating an integrated view promoting a healthy start for woman and child. These quality indicators can assist healthcare providers, organisations and governmental agencies to improve the quality of perinatal care for vulnerable women.

Compound sibling caregivers of individuals with intellectual and developmental disabilities.

Given the increasing lifespans of individuals with intellectual and developmental disabilities (IDD), siblings may fulfil multiple caregiving roles simultaneously for their ageing parents, their offspring, and their brother or sister with IDD. Yet, little is known about compound sibling caregivers. The purpose of this study was to compare the perspectives of compound, single and non-caregiving siblings of adults with IDD. This study investigated 332 adult siblings of individuals with IDD in the United States via a national web-based survey. Participants included: 152 non-caregivers, 94 single caregivers (i.e., caregivers only for their brothers and sisters with IDD), and 86 compound caregivers (i.e., caregivers for their brothers and sisters with IDD and at least one other vulnerable individual). Single and compound sibling caregivers (versus non-caregivers) had more positive relationships and conducted greater advocacy and future planning activities. Given the potential for compound sibling caregiving, further investigation is warranted.

A Feminist Perspective for Forensic Practice.

Despite recent social movements and increasing public awareness, gender disparities persist. These affect daily forensic and clinical practice by providing unexpected obstacles to women professionals and evaluees who face centuries of established bias. State laws may conflict with professional ethics, women experts may be sidelined in important cases, pregnant substance users are prosecuted aggressively, and fetal personhood laws challenge the autonomy of competent adults. Such inequities call for a review of professional ethics and the common male-centered lens of traditional theory. Feminist thinking has played a key role in highlighting the way traditional views of autonomy and rights undervalue the narratives and perspectives of disadvantaged populations. Applying the cultural formulation, telling the full story, and taking a default position in favor of the vulnerable individual, this article advances intersectionality, positionality (narrative), and credibility for understanding the profession's interaction with women.