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Abstract: The purpose of our integrative review was to synthesize the literature examining relationships between depressive symptoms, silencing the self (STS), sexual relationship power (SRP), and HIV vulnerability among women in the United States. Literature searches were conducted through CINAHL, MEDLINE, PsycINFO, SCOPUS, Sociological Abstracts, and SocINDEX. Integrative review methodology of Whittemore and Knafl guided the review process, and 37 articles met inclusion criteria. The Theory of Gender and Power, modified by Wingood and DiClemente, was the guiding framework to organize and synthesize findings. Primary findings suggest that depressive symptoms, STS, and SRP in relationships may individually influence women's vulnerability for acquiring HIV, yet research lags behind. Evidence documenting relationships between these factors is insufficient to draw generalizable conclusions. Findings suggest that the current literature on this topic does not reflect those women most highly affected by HIV and those who identify as African American or Black in the Southeast region of the United States., (Copyright © 2024 Association of Nurses in AIDS Care.)

Background: Although psychological interventions can be used to improve chronic pain management, underserved individuals (i.e., racially minoritized and socioeconomically disadvantaged) may be less likely to engage in such services. The purpose of this study was to examine whether offering a psychological intervention for chronic pain in a primary care clinic could be a method in which to successfully engage underserved patients., Methods: There were 220 patients with chronic pain in a primary care clinic located in a socioeconomically and racially diverse city who were approached to discuss enrolment in a pilot randomized controlled trial of a five-session psychological intervention for chronic pain. Patients were introduced to the study by their primary care provider using the warm handoff model. We compared whether there were sociodemographic differences between those who enrolled in the study and those who declined to enrol., Results: There were no differences between those who enrolled and those who declined enrolment with regard to race, age, insurance type, and household income. However, females were more likely to enrol in the study compared to males., Conclusions: Recruiting patients to participate in a trial of a psychological intervention for chronic pain in a primary care clinic appeared to be effective for engaging Black patients, patients with lower income, and those with government insurance. Thus, offering a psychological intervention for chronic pain in a primary care clinic may encourage engagement among racially minoritized individuals and those with lower socioeconomic status.

Objective: The aims of this article are (1) to evaluate the association between oral health-related quality of life (OHRQoL) and self-perceived job readiness and (2) to investigate changes in self-perceived job readiness following an oral health promotion intervention., Materials and Methods: The first aim was elucidated in a cross-sectional design, and the second through a prospective intervention study. A survey was administered among 273 unemployed vulnerable people in Copenhagen, Denmark. Participants were randomised to either control or intervention in 2018, and follow-up was conducted 7-15 months later. The intervention entailed support for dental care. OHRQoL was measured by the Oral Health Impact Profile (OHIP-14), and self-perceived job readiness was measured using the Employability Indicator Project (BIP) questionnaire., Results: The sample reported a high mean OHIP-14 score at baseline (26.9, SD 15.6) and poor OHRQoL was significantly associated with low self-perceived job readiness (rs = -0.15, p = 0.02). The control group reported better job readiness at follow-up compared to the intervention group. However, the effect sizes were small in both groups and no clear pattern was observed., Conclusions: The results indicate that OHRQoL is linked to self-perceived job readiness. However, the oral health promotion applied in this study did not lead to better self-perceived job readiness. Further research is needed on the effect of oral health promotion interventions on job readiness within socially vulnerable groups.

Introduction: Depression and anxiety are highly prevalent among individuals with inflammatory bowel disease (IBD); however, little is understood about how social determinants of health (SDOH) may impact mental health diagnoses in this population. The social vulnerability index (SVI) is a publicly available tool that can be used to study SDOH in IBD patients., Methods: Home addresses from a retrospective cohort of IBD patients at a single center were used to geocode patients to their individual census tract and corresponding SVI. We used multivariable logistic regression to examine the relationship between SVI and comorbid mental health diagnoses in patients with IBD. Secondarily, data from standardized health questionnaires were then used to determine if patients were adequately screened for depression and anxiety., Results: In all, 9644 patients were included; 18% had a diagnosis of depression, 21% anxiety, and 32% had a composite of "any mental health diagnosis." Depression (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.02-1.56) but not anxiety (OR, 0.87; 95% CI, 0.71-1.06) nor "any mental health diagnosis" (OR, 1.09; 95% CI, 0.92-1.30) was associated with higher levels of social vulnerability. However, overall rates of screening for depression and anxiety were low (15% and 8%, respectively), with the lowest screening rates among the most socially vulnerable (depression 8.2%, anxiety 6.3%)., Conclusions: Disparities in the diagnoses of depression and anxiety for socially vulnerable patients with IBD exist. Awareness of these inequities is the first step toward developing interventions to improve mental health screening, eliminate barriers and bias, and promote referrals for appropriate mental health management., (© The Author(s) 2023. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

It is widely recognised that children recovering from Severe Acute Malnutrition (SAM), remain vulnerable to risk of death following hospital discharge due to a wide range of biological and social factors. In light of this heightened risk, we report here on a qualitative study which aimed to better understand the caring contexts that children recovering from SAM were recuperating in within the high density urban and suburban districts of Harare, Zimbabwe. Undertaken with the mothers and other primary caregivers of 10 children enrolled on a large observational cohort study (HOPE-SAM), this paper identifies several dimensions of the women's lives that impede their caring capabilities. Given the country's status as a global 'hunger hotspot' (FAO/WFP, 2022), it should not be surprising that food insecurity featured prominently amongst these. Beyond this, the paper highlights the women's uneven access to informal social protection, experiences that are reflective of what recent scholarship refers to as examples of 'uncaring' or 'noncaring,' as well as their responses to discourses of shame and stigma within the community and hospital settings. The paper concludes by considering what this means for understanding of, and responses to, the bodies encountered in the place of global health research and interventions., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Early home visit programmes have been developed to help parents build an adequate relationship with their baby and to prevent child developmental delays and affective disorders. The "Appui Parental" programme is an intervention carried out by nursery nurses to provide intensive parental support to vulnerable families. Before extending this programme, it seemed necessary to evaluate its impact objectively., Objectives: The main aim is to determine the impact of the "Appui Parental" programme on the change in the child's symptoms. The secondary objectives are to evaluate its effects on mother-child interactions, self-assessed parental competence, perception of social support, primary caregiver's anxiety-depression symptoms, alliance with the nursery nurse, frequency of out-of-home placements, and nursery nurses' stress., Method: This non-randomized prospective multicentre study would include 44 families who receive the "Appui Parental" intervention for a one to 20-month-old child (intervention group) and 44 families with the same vulnerability criteria who receive care as usual by the maternal and child protection services (control group). The child, parents, mother-child interaction, nursery nurse-mother alliance, and nursery nurse's stress will be assessed at month one and month 18 after inclusion. Comparisons between groups will be performed., Conclusion: This study should provide the public authorities with objective data on this programme's impact and allow them to pursue its generalization. For professionals, the study should confirm the interest in close early parental support through home visits or should lead to rethinking some aspects of the programme., (Copyright © 2023 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: To improve our understanding of older informal caregivers' (ICs) health, this paper aimed to compare multidimensional frailty and sociodemographic and economic characteristics between (subgroups of) older ICs and non-caregivers., Methods: Using data originating from the Belgian Ageing studies ( n  = 6054), intergroup differences between older ICs and non-caregivers and between care-dependent and -independent older ICs/non-caregivers were conducted. In addition binary logistic regressions were carried out to determine which variables were related to caregiver status and need of assistance., Results: Among all respondents, 14.3% were ICs reporting care needs themselves. Informal and non-caregivers with care needs, relative to those without, more often only (partially) completed primary education, were significantly older, more likely to be female and widowed, found it more difficult to make ends meet, and reported higher levels of frailty in each domain. Moreover, environmental and psychological frailty were associated with an increase in the likelihood of reporting need of assistance among older non-caregivers and ICs, respectively., Conclusions: This study revealed a particular vulnerable subpopulation of older ICs with care needs., Clinical Implications: It is essential for clinicians to be observant for unrecognized frailty and care needs in older ICs and to develop targeted intervention and prevention strategies.

Background: Improving health equity and access to the highest possible standard of health care is a key issue of social accountability. Centretown Community Health Centre in Ottawa, Canada has iteratively developed a program to target and serve marginalized and complex populations since 1999. The program implementation was evaluated using a validated implementation framework., Methods: Quantitative and qualitative data were collected through a health records extraction (n = 570), a client complexity assessment tool (n = 74), semi-structured interviews with clients and key stakeholders (n = 41), and a structured client satisfaction survey (n = 30). Data were analyzed using descriptive statistics and inductive thematic analysis., Results: Five hundred and seventy unique clients were seen between November 1-30, 2021. A third of clients (34%) did not have a provincial health card for access to universal health care services, and most (68%) were homeless or a resident of rooming houses. Most clients who reported their income (92%) were at or below Canada's official poverty line. The total mean complexity score for clients seen over a one-month period (n = 74) was 16.68 (SD 6.75) where a total score of at least 13 of 33 is perceived to be a threshold for client biopsychosocial complexity. Clients gained the majority of their total score from the Social support assessment component of the tool. Clients (n = 31) and key informants (n = 10) highlighted the importance of building relationships with this population, providing wrap-around care, and providing low-barrier care as major strength to the Urban Health program (UH). Key areas for improvement included the need to: i) increase staff diversity, ii) expand program hours and availability, and iii) improve access to harm reduction services. Clients appeared to be highly satisfied with the program, rating the program an average total score of 18.50 out of 20., Conclusions: The program appears to serve marginalized and complex clients and seems well-received by the community. Our findings have relevance for other health care organizations seeking to better serve marginalized and medically and socially complex individuals and families in their communities., (© 2024. The Author(s).)

Roma living in marginalised communities are among the most disadvantaged groups in Slovakia. Socioeconomic disadvantage is associated with higher hair cortisol concentrations (HCC), including in parents. The aim of this study is therefore to assess differences in HCC, reflecting the levels of stress, between mothers living in MRCs and from the majority population, to assess the association of socioeconomic disadvantage with HCC, and whether disadvantage mediates the MRC/majority differences in HCC. Participants were mothers of children aged 15-18 months old living in MRCs (N=61) and from the Slovak majority population (N=90). During preventive paediatric visits, visits at community centres and home visits, hair samples and data by questionnaire were collected. HCC differed significantly between mothers living in MRCs and mothers from the majority population, with the mean HCC value being twice as high in mothers living in MRCs (22.98 (95% confidence interval, CI, 15.70-30.30) vs. 11.76 (8.34-15.20), p<0.05). HCC was significantly associated with education, household equipment and household overcrowding, but not with billing, socioeconomic stress and social support. The difference in HCC between mothers living in MRCs and mothers from the majority population was partially mediated by poor house equipment, such as no access to running water, no flushing toilet or no bathroom (the indirect effect of B=7.63 (95% CI: 2.12-13.92)). Practitioners and policymakers should be aware of high stress levels among mothers living in MRCs and aim at enhancing their living and housing conditions., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: There is evidence youth in foster care may be vulnerable to commercial and sexual exploitation of children (CSEC) in the U.S. Youth in care may show vulnerabilities such as running away, identifying as sexual/gender minorities, or exhibiting complex behavioral and mental health needs. However, the nature and nuances of the relationship between CSEC and foster care placements has been largely unexamined., Objectives: This review explores the literature on trafficking among foster care youth to establish what is known about risk factors, vulnerable populations, and leverage points for prevention and intervention., Methods: This scoping review was conducted using PRISMA-ScR guidelines. Eight databases were searched, and the screening process resulted in 16 final articles in the analysis., Results: Sixteen articles were screened into the current study. In reviewing the content, a few distinct themes emerged. First, the articles focused on three different populations of CSEC youth. Second, there was variability in the definitions of CSEC used by scholars. Third, there was a range of terms used to describe youth who were trafficked. Finally, there were broad differences in study methodology. This included the data sources used and the array of outcomes explored (e.g. substance use, mental health diagnoses, housing stability)., Conclusions: It is important for scholars to use common language and definitions when studying the sex trafficking of minors. Developing national databases and improving state and federal data sharing is needed to inform prevalence estimates and explore various pathways to youth experiencing CSEC., (Copyright © 2024. Published by Elsevier Ltd.)

Ethical Considerations of Including Minors in Clinical Trials Using the Example of the Indicated Prevention of Psychotic Disorders Abstract: As a vulnerable group, minors require special protection in studies. For this reason, researchers are often reluctant to initiate studies, and ethics committees are reluctant to authorize such studies. This often excludes minors from participating in clinical studies. This exclusion can lead to researchers and clinicians receiving only incomplete data or having to rely on adult-based findings in the treatment of minors. Using the example of the study "Computer-Assisted Risk Evaluation in the Early Detection of Psychotic Disorders" (CARE), which was conducted as an 'other clinical investigation' according to the Medical Device Regulation, we present a line of argumentation for the inclusion of minors which weighs the ethical principles of nonmaleficence (especially regarding possible stigmatization), beneficence, autonomy, and fairness. We show the necessity of including minors based on the development-specific differences in diagnostics and early intervention. Further, we present specific protective measures. This argumentation can also be transferred to other disorders with the onset in childhood and adolescence and thus help to avoid excluding minors from appropriate evidence-based care because of insufficient studies.

Background: Women in socially disadvantaged positions face increased risk of fear of birth, birth complications, and postpartum depression, highlighting the need for targeted interventions for this group. Doula support is associated with positive emotional and medical outcomes for mother and child. Experience of doula support for women in socially disadvantaged positions in Sweden remains unexplored., Aim: To describe experiences of doula support within a project for women in socially disadvantaged positions in Sweden., Methods: In-depth interviews with seven women and focus group discussions with twelve doulas in a Doula support project were conducted. Data was analysed with inductive content analysis., Results: Women and doulas described experiences of doula support as a significant relationship with challenges, due to unclear boundaries for the support, and the time and trust needed to establish the relationship. The support was perceived as comprehensive, far exceeding traditional doula support, with extensive assistance provided postpartum. The project was regarded as meaningful, and that it led to positive birth experiences., Conclusions: Women in socially disadvantaged positions may benefit from doula support during the perinatal period. The support fosters feelings of calmness, security and empowerment, and alleviates feelings of isolation, which is crucial for a positive birth experience. Support for these women is complex due to increased social needs, leading to unclear expectations of the doula's role. Support from colleagues is deemed crucial. Future projects should establish clear frameworks and a supportive structure for doulas., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: The term 'vulnerable' is often used to describe women facing psychosocial adversity during pregnancy, implying a heightened risk of experiencing suboptimal pregnancy outcomes. While this label might facilitate the pathway to appropriate care, it can be perceived as stigmatizing by the women it intends to help, which could deter their interaction with healthcare services. This study explores how women facing psychosocial adversity before, during and after pregnancy perceive the concept of vulnerability and experience being labeled as such., Methods: We conducted a thematic analysis of semi-structured, in-depth interviews. Through purposive sampling targeting maximum variation, ten women of diverse backgrounds were included., Results: Three central themes emerged: defining vulnerability, embracing vulnerability and the feeling of being stigmatized. Women perceived vulnerability as an inability to adequately care for themselves or their children, necessitating additional support alongside routine antenatal care. Acceptance of the 'vulnerable' label came when it also acknowledged their proactive efforts and strengths to improve their situation. Conversely, if discussions surrounding vulnerability failed to recognize women's agency - specifically, their personal journeys and the courage needed to seek support - the label was perceived as stigmatizing., Conclusions: Addressing vulnerability effectively in maternity care requires a nuanced, patient-centered approach, acknowledging both the challenges and strengths of women facing psychosocial adversities. Emphasizing personal narratives and their courage in seeking support can mitigate the stigmatizing effects of the 'vulnerable' label. Integrating these narratives into maternal healthcare practices can foster deeper connections with the women involved, enhancing the overall quality of care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

In the Netherlands adverse perinatal outcomes are also associated with non-medical factors which vary across geographical locations. This study analyses the presence of non-medical vulnerabilities in pregnant women in two regions with high numbers of psychosocial adversity using the same definition for vulnerability in both regions. A register study was performed in 2 regions. Files from women in midwife-led care were analyzed using a standardized case report form addressing non-medical vulnerability based on the Rotterdam definition for vulnerability: measurement A in Groningen (n = 500), measurement B in South-Limburg (n = 538). Only in South-Limburg a second measurement was done after implementing an identification tool for vulnerability (C (n = 375)). In both regions about 10% of pregnant women had one or more urgent vulnerabilities and almost all of these women had an accumulation of several urgent and non-urgent vulnerabilities. Another 10% of women had an accumulation of three or more non-urgent vulnerabilities. This study showed that by using the Rotterdam definition of vulnerability in both regions about 20% of pregnant women seem to live in such a vulnerable situation that they may need psychosocial support. The definition seems a good tool to determine vulnerability. However, without considering protective factors it is difficult to establish precisely women's vulnerability. Research should reveal whether relevant women receive support and whether this approach contributes to better perinatal and child outcomes.

Climate anxiety has a negative impact on the mental health and psychological wellbeing of the vulnerable population. The goal is to assess many factors that affect mental health and psychological wellbeing, as well as how climate change affects mental health in Pakistan's vulnerable population. This study provides evidence-based insights on the long- and medium-term impacts of extreme weather events on mental health. We conducted semi-structured interviews with a sample of 72 students aged 10-16 years, employing an exploratory qualitative design. The resulting process identified themes and questions for future research on climate change and its psychological effects on children's mental health. As a result, positive emotions embedded in children's climate strategic actions in parent and community contexts helped to mitigate children's perceptions of negative emotions (such as climate anxiety, phobias, fear, sleep disorders, depression, sadness, and substance abuse). Climate change's effects can have a significant impact on mental health. We will be discussing effective strategies to address the expected mental health issues among children caused by climate change. The discussion paper offers a set of recommendations for addressing the mental health impacts of climate change, including improving mental health support systems, integrating climate change education into services, and developing targeted interventions for vulnerable populations., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Background: The COVID-19 pandemic caused massive disruptions globally, with food insecurity a primary concern amongst vulnerable communities. As one of the most marginalized and vulnerable groups in Israeli society asylum seekers and undocumented populations were amongst the first to be affected by the pandemic and the economic crisis that followed. The objective of the study was to evaluate the severity and causes of food insecurity among asylum seekers and other undocumented communities because of COVID-19., Methods: A multi method approach was used. The quantitative component included an online questionnaire regarding access to food, aid and choices, and the 6 item Household Food Security Survey Module (HFSSM) The qualitative component included 4 focus groups and thematic analysis. The study was conducted in November 2020, by the Ministry of Health's Nutrition Division and the Tel Aviv Municipality's foreign community assistance and information center (Mesila). The convenience sample was drawn from the low-income neighborhood population of South Tel Aviv. Logistic regression, multivariate analysis and content analysis, were performed., Results: Four hundred eighty-five people completed the quantitative survey, with average age 33.2 ± 5.4 years and 349 (72.0%) experienced food insecurity. In the multivariate analysis, being older (p = 0.04, Odds Ratio OR 1.1, Confidence Interval CI 1.05-1.15) and being single (unmarried) (p = 0.03, OR 2.1, CI 1.2, 3.5) predicted food insecurity. Qualitative findings identified three main themes: children preferring Israeli/ Western foods to traditional foods; financial stresses were compounded; a preference for receiving assistance with purchasing food (vouchers), rather than food handouts., Conclusion: In conclusion, vulnerable populations (asylum seekers and other undocumented communities) were severely affected and are in danger of food insecurity. Culturally relevant and contextualized solutions are needed to address the acute hunger within the community. These include establishment of a cross-ministerial forum, a social grocery store, increased liaison with food rescue bodies, complete nutritional support for children in educational settings and increased guidance regarding food choices and budgeting., (© 2024. The Author(s).)

Women's empowerment has been promoted by researchers and development practitioners as one of the most promising strategies to address widespread hunger and malnutrition. However, the relationship between women's empowerment and dietary diversity and child nutrition has rarely been studied among vulnerable populations or individuals at greater risk of poor physical and social health status. Moreover, the effects of different domains of women's empowerment on nutritional outcomes, including dietary diversity and child anthropometry, have rarely been examined, especially with panel data. Using two rounds of panel data from 1900 households and fixed effects regression models, we analyze the effect of women's empowerment on household dietary diversity score (HDDS) and child anthropometry among the particularly vulnerable tribal groups in Odisha, India. We also estimate the effects of various decision-making domains of women's empowerment on HDDS and child anthropometry to understand which empowerment domains matter for nutrition. Results show that women's empowerment is positively associated with HDDS (coef. 0.41 food groups; p < 0.1) and reduces the prevalence of underweight (coef. 39%; p < 0.05) and wasting (coef. 56%; p < 0.1) in children but has no effect on the prevalence of child stunting. Women's empowerment in agricultural input use; output sales; income; food purchases; and credit, group membership, and employment contribute to improved dietary diversity and child nutrition. We conclude that women's empowerment contributes to improved dietary diversity and child nutrition and is a promising strategy to improve farm household diets and child nutrition among vulnerable populations. Strengthening women's empowerment through the promotion of women's access to land and other agricultural inputs, market participation, access to information, capital, and credit is important., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ogutu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In this special issue, innovative research teams expanded work on the effects of the COVID-19 pandemic and lockdowns on child maltreatment by assessing these effects on treatment and service delivery following maltreatment, on the professionals responsible for identification and treatment, and on the systems responsible for oversight and instruction. One theme that emerged across these studies concerned challenges faced by professionals as they attempted to evaluate families and provide service and support. Organizational leadership was crucial in helping these professionals navigate challenges in a positive and productive manner. A second theme concerned remote service delivery. Findings suggested that remote maltreatment assessments, treatment, and court procedures all worked to some degree. Thus, despite the massive social disruption caused by the pandemic and lockdowns, parents, professionals, and systems were able to adapt and address core needs of children and families. In future work, it may be important to consider how these findings and their implications vary depending on the type of maltreatment children experienced. Doing so would allow for more nuanced understanding of the consequences of significant national and global crises on child maltreatment and would enable clearer recommendations regarding how best to protect children and support families during such events., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Unmet health care needs are considered a key indicator of equity in access to health care. For younger people, they can lead to poorer health outcomes in adulthood, for older people, they are associated with an increased risk of mortality. Unmet needs were therefore investigated as part of a research project on "Improving the health-related life situation of young and old people in the Ruhr area.", Method: Unmet health care needs were surveyed with the help of semi-structured guideline interviews with younger and older people in the Ruhr area (n=29). Due to the spatial and social structure of the study region, the aim was to recruit especially people with a low subjective social status (SSS) for the study. The interviews were recorded, transcribed, and subjected to a qualitative content analysis and a supplementary frequency analysis. The reporting is based on the Standards for Qualitative Research (SRQR)., Results: The respondents reported deficiencies in treatment and doctor-patient communication with GPs and specialists. The feeling of not being taken seriously due to age is cited several times by both age groups as a reason for unmet health care needs. Waiting times are particularly relevant in the case of specialist consultations, while co-payments for services mainly play a role in dentistry and orthodontics. Unmet needs are primarily reported by people with a medium SSS. Overall, almost two thirds of the respondents stated that they have or have had at least one unmet need. Participants with a low SSS report fewer unmet needs and do not mention any financial aspects as a cause. Explanations for this range from lower health literacy to the fear of being discredited., Conclusions: The results provide indications of deficits in regional health care provision for younger and older people in the Ruhr region. Corresponding fields of action result from the areas of care and reasons identified as relevant for unmet health care needs. The reported findings also provide a basis for differentiated quantitative surveys with representative samples., (Copyright © 2024. Published by Elsevier GmbH.)

Background: Unaccompanied refugee children are one of the most vulnerable categories within the refugee population. They face inexhaustible risks from the start of their journey until its conclusion; being exposed to various forms of violence, assault, and exploitation during the transit phase., Objective: This study was aimed to discern the challenges faced by unaccompanied refugee children in Jordan, as perceived by social workers. Additionally, to uncover the role of the social work profession in helping these children in confronting and alleviating these challenges., Participants and Setting: Ten social workers working with unaccompanied refugee children in the International Medical Corps in Jordan were selected to take part in the study., Methods: The study adopted a qualitative research approach to achieve its aims. Semi-structured interviews served as the primary method for data collection. Data analysis used inductive thematic analysis, and ethical considerations were consistently observed throughout the study process., Results: The study revealed significant social challenges, including strained alternative familial relationships and difficulties in social integration. Psychological struggles were clear in enduring loss, separation, and suicidal thoughts. Economic hardships manifested in meeting basic needs and child labor. School dropouts appeared as a prominent educational issue. Social workers are primarily engaged in case management, providing psychosocial support, and easing referrals., Conclusions: Adverse living conditions profoundly affect children, affecting their psychological, physical, and social development. This leads to the emergence of deep psychological traits such as sadness, hostility, anxiety, and behavioral disintegration. Consequently, many children experience social disconnection and struggle to adapt to their environment effectively., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: The purpose of the study was to examine financial well-being among a diverse population of individuals with and without diabetes., Methods: Data from the Understanding America Survey, a nationally representative, longitudinal panel, were utilized to identify adults with self-reported diabetes diagnoses between 2014 and 2020. We used longitudinal mixed effects regression models to assess the association between diabetes and financial well-being score (FWBS) among racial and ethnic population subgroups. Models included sex, age, marital status, household size, income, education, race/ethnicity, insurance, body mass index, employment, and health insurance, incorporating individual- and household-level fixed effects. Racial and ethnic differentials were captured using group-condition interactions., Results: Black participants (17.06%) had the highest prevalence of diabetes, followed by White participants (12.2%), "other" racial groups (10.7%), and Hispanic participants (10.0%). In contrast, White participants (M = 67.66, SD = 22.63) and other racial groups (M = 67.99, SD = 18.45) had the highest FWBSs, followed by Hispanic participants (M = 59.31, SD = 22.78) and Black participants (M = 55.86, SD = 25.67). Compared to White participants, Black participants (β = -5.49, SE = 0.71) and Hispanic participants (β = -2.06, SE = 0.63) have significantly lower FWBSs. Compared to males, females (β = -3.25, SE = 0.41) had lower FWBSs among individuals with diabetes. FWBSs of individuals with diabetes was 2.71 points lower (SE = 0.52), on average, than those without diabetes. Education, household size, age, marital status, and income were also significantly associated with FWBSs., Conclusions: Findings suggest potential disparities in the financial ramifications of diabetes among socially marginalized populations., Competing Interests: DisclosuresThe authors have no relevant financial or nonfinancial interests to disclose.

Purpose: This study aimed to examine the double-edged effect of social mobility belief on socioeconomically disadvantaged adolescents' mental and physical health and further explore whether intentional self-regulation is the common psychological mechanism of social mobility belief affecting physical and mental health., Method: A total of 469 adolescents ( M age = 13.96 years, 49.3% boys) from two rural public schools in China were included in this study. Adolescents completed questionnaires measuring social mobility belief and mental health (life satisfaction, self-esteem, and depression). Physical health (allostatic load) was reflected by six indicators (resting diastolic and systolic blood pressure, body mass index, epinephrine, norepinephrine, and cortisol)., Results: Social mobility belief was positively correlated with adolescents' life satisfaction and self-esteem but negatively correlated with depression. Intentional self-regulation mediated the relationships between social mobility belief and mental health. In addition, the results showed that intentional self-regulation mediated the relationship between social mobility belief and adolescents' physical health., Conclusions: Social mobility belief may be a "skin-deep" resilience resource positively related to mental health but negatively correlated with physical health through intentional self-regulation among socioeconomically disadvantaged adolescents. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Exposure to childhood adversity is increasingly recognized as an important topic in pediatric medicine and a powerful driver of adult disease burden. While significant evidence exists that early intervention is critical for children exposed to adversities, few models have been established for addressing the complex medical, psychological, and social needs of these patients in a holistic manner., Method: La Linterna is an interdisciplinary clinical initiative providing trauma-informed primary care, mental health treatment, immigration legal counsel, and comprehensive case management to children (and their families) exposed to adversities throughout the migration process. Started in 2019, the clinic serves immigrant families throughout the city of Los Angeles. Described as the process of implementing an interdisciplinary, trauma-informed practice to meet the medical, mental health, social care needs of this uniquely vulnerable patient population., Results: Strong evidence exists in the medical literature arguing for the implementation of a holistic, trauma-informed model of patient care. We describe "principles" and "lessons learned" during implementation, as well as detail an approach to improving services to immigrant families who have experienced adversities via an interactive, patient-centered process., Conclusions: Trauma-informed care is critical for meeting the needs of vulnerable children and their families. La Linterna represents an innovative and effective way to enhance care for one of the most vulnerable United States populations, immigrant and refugee families. Implementation of all or some of the program's components is possible throughout the United States and would mark an improvement over current practice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objectives: 1) To compare the effect of the self-report distress tool (DT) and rapid mental health referral process (MH) on vocational training program attendance. 2) To compare the effect of the DT and MH on vocational training program completion. 3) To compare the effect of the DT an MH on post-vocational training program employment., Design: Pragmatic, multi-centre, 2x2 factorial, cluster randomized, superiority study with 4 parallel groups and primary endpoints of vocational program attendance and completion at 12 weeks and post-program employment at 24 months. Cluster randomization of each training cohort will be performed with a 1:1:1:1 allocation ratio using a site stratified, permuted-block group schema. Final sample size is expected to be 400 participants (100 per group)., Participants: Students enrolled in Community Builder's Trades & Diversity Training Program in either the city of Barrie or Sudbury (in Ontario, Canada) will be eligible for enrollment if they have an active Ontario Health Insurance Plan number and Canadian Social Insurance Number and provide written informed consent prior to Training program commencement., Outcomes: The primary outcome includes: 1) Difference in proportion of absence-free program days from date of randomization, where absence-free days are defined as being present in class or work setting for ≥ 8 hours from Monday to Thursday during the 12-week program duration., Trial Registration: ClinicalTrials.gov NCT05626374 (November 23, 2022)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bailey et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To describe the possibility of applying Fuzzy Logic in analyzing the vulnerability of Women Who Have Sex with Women to Sexually Transmitted Infections/HIV/AIDS., Methods: We developed a Fuzzy Logic system with 17 input variables and one output variable, using data related to vulnerability in a municipality located in the Midwest region of the State of São Paulo, Brazil., Results: The factor with the greatest positive impact was the confirmation that a low understanding of Sexually Transmitted Infections/HIV/AIDS is associated with higher vulnerability. Conversely, the statement "Not disclosing sexual activity to healthcare professionals," where individuals do not admit to having sex with women, had the least impact., Conclusions: Fuzzy Logic facilitates the identification of vulnerability, expressed through the analysis of interaction between variables in each dimension. This makes it a promising method to assist in analyzing the vulnerability of specific populations.

Introduction: Vulnerably housed individuals access emergency departments (EDs) more frequently than the general population. Despite Canada's universal public health care system, vulnerably housed persons face structural barriers to care and experience discrimination from healthcare providers. This study examines how vulnerably housed persons perceive their experience of care in the ED and Urgent Care Center (UCC) in Kingston, Ontario and aims to develop strategies for improving care for this group., Methods: As part of a larger mixed-methods study, narratives were collected from participants attending the ED/UCC as well as community-based partner organizations, asking them to describe an experience of a recent ED visit (< 24 months). Participants could identify as members of up to three equity-deserving groups (EDGs) (for example homeless, part of an ethnic minority, having a disability, experiencing mental health issues). Coding and thematic analysis were completed for the experiences of participants who identified as being vulnerably housed (n = 171). Results were presented back to individuals with lived experience and service providers working with clients with unstable housing., Results: Participants reported judgement related to a past or presumed history of mental health or substance use and based on physical appearance. They also often felt unheard and that they were treated as less than human by healthcare providers. Lack of effective communication about the ED process, wait times, diagnosis, and treatment led to negative care experiences. Participants reported positive experiences when their autonomy in care-decision making was respected. Furthermore, having a patient-centered approach to care and addressing specific patient needs, identities and priorities led to positive care experiences., Conclusions: The ED care experiences of vulnerably housed persons may be improved through healthcare provider training related to trauma-informed and patient-centered care and communication strategies in the ED. Another potential strategy to improve care is to have advocates accompany vulnerably housed persons to the ED. Finally, improving access to primary care may lead to reduced ED visits and better longitudinal care for vulnerably housed persons., (© 2024. The Author(s).)

In the UK people living in disadvantaged communities are less likely than those with higher socio-economic status to have a healthy diet. To address this inequality, it is crucial scientists, practitioners and policy makers understand the factors that hinder and assist healthy food choice in these individuals. In this scoping review, we aimed to identify barriers and facilitators to healthy eating among disadvantaged individuals living in the UK. Additionally, we used the Theoretical Domains Framework (TDF) to synthesise results and provide a guide for the development of theory-informed behaviour change interventions. Five databases were searched, (CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science) for articles assessing healthy dietary intake of disadvantaged adults living in the UK. A total of 50 papers (34 quantitative; 16 qualitative) were included in this review. Across all studies we identified 78 barriers and 49 facilitators found to either impede and/or encourage healthy eating. Both barriers and facilitators were more commonly classified under the Environmental, Context and Resources TDF domain, with 74% of studies assessing at least one factor pertaining to this domain. Results thus indicate that context related factors such as high cost and accessibility of healthy food, rather than personal factors, such as lack of efficiency in healthy lifestyle drive unhealthy eating in disadvantaged individuals in the UK. We discuss how such factors are largely overlooked in current interventions and propose that more effort should be directed towards implementing interventions that specifically target infrastructures rather than individuals., (© 2024. The Author(s).)

Healthcare providers (HP) work in high-stress situations, interacting with patients and families who are often in crisis. HPs who work in safety net clinics, which provide care to uninsured, Medicaid recipients and other vulnerable populations, interact with patients who are frequently frustrated by long wait times, extensive paperwork, short appointments, and have generally lower health literacy. Many patients have chronic conditions and substance use disorders which has been associated with higher likelihood to be perceived as verbally aggressive and/or perpetrate workplace violence (WPV). Using interviews with 26 HPs at safety net clinics, we investigated how HPs manage interactions with aggressive patients and avoid burnout. Findings are based on emotional labor constructs describing why and how workers use emotion management strategies to smooth communication and relationships with clients/patients. According to our participants, HPs perform emotional labor to de-escalate interactions, prevent WPV, and to develop relationships with patients who might become regular clinic patients. We found that HPs perceive an influence of the clinic context on patient aggression management, hold initial perceptions that shape engagement with aggressive patients, and report emotional labor and burnout that came from interacting with aggressive patients to prevent WPV. We offer implications that extend research on emotional labor and burnout, provide guidance to healthcare organizations, and offer directions for future theory and research.

The early coronavirus disease 2019 (COVID-19) outbreak inflicted vulnerability on individuals and societies on a completely different scale than we have seen previously. The pandemic developed rapidly from 1 day to the next, and both society and individuals were put to the test. Older people's experiences of the early outbreak were no exception. Using an abductive analytical approach, the study explores the individual experiences of vulnerability as described by older people hospitalised with COVID-19 in the early outbreak. In these older people, we found that the societal context and the individual experiences of vulnerability were inextricable linked. The study demonstrates that despite significant individual stress, informants displayed an interesting ability to also view their situation to reorient their perspective. The experience of vulnerability is both conditional and individual, which imposes a degree of unpredictability that neither they nor others were able to negotiate. The article discusses the phenomenon of unpredictability in light of a modern society with regard to how individuals and society may encounter unexpected events in the future where the potential to reorient will be vital., (© 2024 The Authors. Nursing Inquiry published by John Wiley & Sons Ltd.)

Narrative gerontology considers how people age biographically as well as socially and biologically. Vulnerability as a process category and state of being remains undertheorized in the context of narratives of later life. It is argued that the narrative space for stories from old age privilege backward-looking stories that focus on positive milestones and support cultural narratives of a "life well lived." Sad, emotionally laden or uncertain/unfinished stories that reveal vulnerabilities are rejected and potentially viewed as problematic. Using an illustrative case example of a study of resilience narratives and aging, this paper considers how the study authors position and identify resilience. Some interpretative judgements used in the research regarding who is resilient based on expressions of vulnerability are highlighted. Overall, the tensions between cultural and personal narratives that position older people as vulnerable subjects are considered and it is argued that vulnerability can be a great source of strength and meaning in later life., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: The ageing female body is particularly exposed to the social gaze. While it should remain fit and durable as well as attractive and desirable, there is the danger of ridicule through supposedly too youthful or too outlandish performance. Women's clothing practices can conform to social expectations, can circumvent them, can actively protest against them, and possibly change social demands. In every part of the process, i.e., the experience of bodily changes, the experience of social expectations, consumer choices, the practices of clothing and reactions to clothing choices, the body and getting dressed becomes a site of new feelings of vulnerability., Objective: This article asks how these vulnerabilities are presented in the clothing practices of older women, are expressed in the materiality of clothes and in the practices of getting dressed., Material and Methods: Data from a study that followed a situational analysis methodology and used semi-structured interviews and photo elicitation, were re-examined through the lens of vulnerability., Results: Different aspects to vulnerability are presented in this article. Interviewees had to come to terms with bodily changes and made arrangement to the way they dressed that in turn could collide with subjective and social expectations of normative femininity. In this process of acquiescing, new vulnerabilities were produced; however, interviewees developed clothing strategies that provided them with experiences of their own attractiveness. They also had to adapt to changing circumstances to present themselves as fashionable and attractive due to age., Conclusion: Practitioners can address feelings of vulnerabilities when talking about gendered clothing practices, for example through biographical work., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

There is emerging evidence that a significant proportion of migrants acquire HIV after arrival in Europe. Thus, to strengthen prevention efforts, it is crucial to understand migrants' vulnerability to HIV/AIDS. This article contributes to this understanding by analysing the perspectives of prevention actors and migrants. Data were collected through a qualitative and participative research study conducted in Switzerland. Twenty prevention actors and 28 migrants participated in in-depth interviews. Results show that migrants' difficulties in accessing and adopting measures to prevent HIV are related to three types of situational vulnerability that increase their vulnerability to HIV/AIDS: social vulnerability, which refers to social inequalities in access to care; relational vulnerability, which refers to unequal distribution of power within intimate relationships; and sexual vulnerability, which refers to stigmatization of sexualities that some people may consider as socially nonconforming. For HIV/AIDS prevention to be successful among migrants, power structures such as sexism, heterosexism, cisgenderism, ethnocentrism, and racism need to be addressed. Reducing stigma related to HIV among migrants requires a struggle against these power structures as well as health inequities.

Background: Early language delay is exacerbated by social disadvantage. Factors such as parents' low levels of literacy, confidence and self-perception can affect the capacity to act on advice received, critical to empowerment. Methods used to achieve successful health outcomes in socially disadvantaged clinical populations may need enhancing., Aims: To compare the impact of standard parent-based intervention (PBI) to enhanced PBI for young children with speech, language and communication needs (SCLN) and their families living in more socially disadvantaged populations., Methods and Procedures: A multicentre clustered blind randomised controlled trial was used to compare the effect of parent-based group interventions to improve early language development with children (mean age 27.5 months) from more socially disadvantaged populations with an expressive vocabulary of 40 or less single words. Intervention sessions were delivered by a speech and language therapist, over a 20-week period. Participants received one of two interventions: (1) Standard Care - indirect group PBI - (PBI) (2) Enhanced Care: indirect group enhanced PBI - (EPBI). Both standardised and non-standardised measures were used as outcomes. Parent engagement in the intervention was captured through analysis of attendance and the Parent Activation Measure - Speech & Language Therapy (PAM-SLT) (Insignia Health, 2014). The PAM measures a person's knowledge, skills and confidence to manage their own health and well-being (NHS England, 2018). In this study, activation referred to parents' knowledge, skills and confidence to manage their child's language development., Outcomes and Results: One hundred fifty-five participants were randomised at baseline. Children in both groups made significant improvements in the outcome on MacArthur-Bates Communicative Development Inventories Sentence Length, from pre-intervention to post-intervention and 6 months post-intervention (p < 0.05). Changes in vocabulary and expressive language skills were more equivocal, showing wide variation in confidence intervals for both groups. Where parents attended at least one intervention session almost all effect sizes were in favour of the EPBI intervention. Parents' activation levels significantly increased for both groups (EPBI p < 0.001, PBI p = 0.003), with a moderate effect size in favour of EPBI (Hedges' G 0.37, confidence interval -0.02 to 0.76), although wide variation was found., Conclusions and Implications: This trial provides some evidence of facilitating the language development of children with SLCN from more socially disadvantaged areas through supporting caregivers. However, we found variation in outcomes; some children made excellent progress, whilst others did not. Further exploration of parent engagement and its relationship to child language outcomes will be valuable to understanding more about mechanisms of change in interventions that involve parents., What This Paper Adds: What is already known on the subject Speech, language and communication needs (SLCN) have a knock-on effect on emotional well-being, school readiness, literacy and school attainment, putting children at increased risk of long-term consequences such as poor literacy, mental health problems and unemployment. In disadvantaged areas, the prevalence of language difficulties is higher than elsewhere. Factors such as parents' low levels of literacy, confidence and self-perception can affect the capacity to act on advice received, critical to empowerment. What this paper adds to existing knowledge Children with SLCN from more socially disadvantaged areas can make improvements in their language development through parent intervention, although wide individual variation was found. There was some evidence that children achieve better outcomes with EPBI, which employed an interagency collaborative approach. Parent's engagement (activation levels) increased significantly over time with intervention, with the increase twice as big for EPBI. What are the potential or actual clinical implications of this work? This trial provides some evidence that it is possible to facilitate the language development of children from more socially disadvantaged areas through supporting their caregivers. Further research would be useful to determine whether increases in parent engagement are related to adherence to intervention and change in child outcomes., (© 2024 Royal College of Speech and Language Therapists.)

Background: Older migrants are considered a vulnerable population group in many ways. Marginalization and social exclusion lead to unequal opportunities for social participation., Aim: In order to break down barriers for older migrants, the perspectives of people with migration biographies should be given greater consideration., Material and Methods: To this end, the results of an explorative intersectional ethical analysis of care narratives of older migrants are discussed in the light of aging studies research. The focus is on the ethical analysis of five guided interviews with older migrants between 65 and 80 years old, who have migrated from different countries in southeastern Europe., Results and Discussion: In contrast to the prevalent expert perspective, the narratives of the older migrants interviewed revealed not only resistance to vulnerabilization but also multiple negotiations of autonomy and dependency. By making ambivalent narrative and action strategies visible and linking them to narratives of intergenerational care relationships, the significance of care-ethical interpretations of vulnerability and characterization of vulnerability as "a universal, inevitable, and anthropological feature of humanity resulting from the embodied, finite, and socially contingent structure of human existence" [4] can be demonstrated., (© 2024. The Author(s).)

Increased maternal mental health during the perinatal period has been widely associated with a variety of positive outcomes for both mothers and infants. However, no studies in Peru have yet focused on studying maternal mental health and related psychological variables during this stage. Thus, the aim of this study was to test a model to associate a mother's parental stress with infant socioemotional difficulties and maternal mental health. The sample included 988 mothers of infants aged 6 to 18 months from Peru, all from socioeconomically vulnerable settings. The findings showed that infant socioemotional difficulties were associated with poorer maternal mental health through the mother's parental stress ( χ 2 (7) = 28.89, p < 0.001, CFI = 0.98, RMSEA = 0.06, SRMR = 0.03). These results provide a better understanding of the key elements associated with maternal mental health during the perinatal period in Peru and offer valuable insights for developing interventions and support strategies for socioeconomically vulnerable mothers and their young children.

Objectives: to analyze the risk areas for tuberculosis and the influences of social protection on the development of treatment for the disease in the municipality of São Luís, Maranhão., Methods: this is explanatory sequential mixed method research. In the quantitative phase, the data were obtained from the Notifiable Diseases Information System from 2010 to 2019, with georeferencing being carried out to identify areas vulnerable to tuberculosis. In the qualitative phase, semi-structured interviews were carried out with individuals who received social benefits., Results: 7,381 cases were geocoded, and, from the purely spatial scanning analysis, it was possible to identify 13 spatial clusters of risk. As for the interviews, there was a positive relationship between patient improvement and receiving benefits., Conclusions: geographic space and social determinants are relevant for reorienting monitoring actions for the conditions that generate the health-disease process.

Background: Despite the increasing need for digital services to support geriatric mental health, the development and implementation of digital mental health care systems for older adults have been hindered by a lack of studies involving socially vulnerable older adult users and their caregivers in natural living environments., Objective: This study aims to determine whether digital sensing data on heart rate variability, sleep quality, and physical activity can predict same-day or next-day depressive symptoms among socially vulnerable older adults in their everyday living environments. In addition, this study tested the feasibility of a digital mental health monitoring platform designed to inform older adult users and their community caregivers about day-to-day changes in the health status of older adults., Methods: A single-arm, nonrandomized living lab pilot study was conducted with socially vulnerable older adults (n=25), their community caregivers (n=16), and a managerial social worker over a 6-week period during and after the COVID-19 pandemic. Depressive symptoms were assessed daily using the 9-item Patient Health Questionnaire via scripted verbal conversations with a mobile chatbot. Digital biomarkers for depression, including heart rate variability, sleep, and physical activity, were measured using a wearable sensor (Fitbit Sense) that was worn continuously, except during charging times. Daily individualized feedback, using traffic signal signs, on the health status of older adult users regarding stress, sleep, physical activity, and health emergency status was displayed on a mobile app for the users and on a web application for their community caregivers. Multilevel modeling was used to examine whether the digital biomarkers predicted same-day or next-day depressive symptoms. Study staff conducted pre- and postsurveys in person at the homes of older adult users to monitor changes in depressive symptoms, sleep quality, and system usability., Results: Among the 31 older adult participants, 25 provided data for the living lab and 24 provided data for the pre-post test analysis. The multilevel modeling results showed that increases in daily sleep fragmentation (P=.003) and sleep efficiency (P=.001) compared with one's average were associated with an increased risk of daily depressive symptoms in older adults. The pre-post test results indicated improvements in depressive symptoms (P=.048) and sleep quality (P=.02), but not in the system usability (P=.18)., Conclusions: The findings suggest that wearable sensors assessing sleep quality may be utilized to predict daily fluctuations in depressive symptoms among socially vulnerable older adults. The results also imply that receiving individualized health feedback and sharing it with community caregivers may help improve the mental health of older adults. However, additional in-person training may be necessary to enhance usability., Trial Registration: ClinicalTrials.gov NCT06270121; https://clinicaltrials.gov/study/NCT06270121., (©Sunmi Song, YoungBin Seo, SeoYeon Hwang, Hae-Young Kim, Junesun Kim. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 17.06.2024.)

Background: Mobile health (mHealth) interventions that promote healthy behaviors or mindsets are a promising avenue to reach vulnerable or at-risk groups. In designing such mHealth interventions, authentic representation of intended participants is essential. The COVID-19 pandemic served as a catalyst for innovation in remote user-centered research methods. The capability of such research methods to effectively engage with vulnerable participants requires inquiry into practice to determine the suitability and appropriateness of these methods., Objective: In this study, we aimed to explore opportunities and considerations that emerged from involving vulnerable user groups remotely when designing mHealth interventions. Implications and recommendations are presented for researchers and practitioners conducting remote user-centered research with vulnerable populations., Methods: Remote user-centered research practices from 2 projects involving vulnerable populations in Norway and Australia were examined retrospectively using visual mapping and a reflection-on-action approach. The projects engaged low-income and unemployed groups during the COVID-19 pandemic in user-based evaluation and testing of interactive, web-based mHealth interventions., Results: Opportunities and considerations were identified as (1) reduced barriers to research inclusion; (2) digital literacy transition; (3) contextualized insights: a window into people's lives; (4) seamless enactment of roles; and (5) increased flexibility for researchers and participants., Conclusions: Our findings support the capability and suitability of remote user methods to engage with users from vulnerable groups. Remote methods facilitate recruitment, ease the burden of research participation, level out power imbalances, and provide a rich and relevant environment for user-centered evaluation of mHealth interventions. There is a potential for a much more agile research practice. Future research should consider the privacy impacts of increased access to participants' environment via webcams and screen share and how technology mediates participants' action in terms of privacy. The development of support procedures and tools for remote testing of mHealth apps with user participants will be crucial to capitalize on efficiency gains and better protect participants' privacy., (©Ingjerd J Straand, Kimberley A Baxter, Asbjørn Følstad. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 14.06.2024.)

Objective: The family system is important for children's development. Previous research has demonstrated that some families are able to maintain good adaptability or resilience in the face of stressors. This study aimed to develop the revised Chinese version of the Family Resilience Assessment Scale and examine the psychometric properties of the scale among children disadvantaged in adversity due to family migration., Methods: A total of 1487 children (47.6 % girls) from disadvantaged families participated in this study, whom completed the revised Chinese version of the Family Resilience Assessment Scale, the Chinese version of the Connor-Davidson Resilience Scale, and the Center for Epidemiologic Studies Depression Scale for Children., Results: (1) Good language equivalency was found (Intraclass Correlation Coefficient = 0.96); (2) Item analysis indicated that the critical ratio values of all 45 items were above 0.30 (p < 0.001), except for 7 items that were dropped from further analysis; (3) The exploratory factor analysis indicated that the best model was four-factor model; (4) The confirmatory factor analysis showed that the four-factor model had good model fit; (5) Family resilience was significantly correlated with personal resilience and depression; (6) The internal consistency reliability of the scale was 0.95., Conclusions: This study confirmed that the revised Chinese version of the Family Resilience Assessment Scale was a reliable and valid instrument to assess family resilience of Chinese children who are disadvantaged., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Shared decision-making allows older people to discuss and change their care with informal caregivers and healthcare professionals. When opinions differ, an older person's decision-making ability can be compromised by many factors. The objective of this qualitative pilot study was to study the dynamics of shared decision-making in home care support for vulnerable older people. Observations were carried out at the older people's homes during appointments with the network's healthcare professionals. Semi structured interviews were then conducted with older people, caregivers and healthcare professionals observed. When opinions differ, negotiation dynamics then develop between older people, caregivers and healthcare professionals. Using a dedicated negotiation framework, we identified four types of negotiation between the stakeholders in home care decision-making, influenced by various articulations of individual, collective and environmental factors.

Health researchers have had increasing calls to include vulnerable populations in research to tailor inclusive evidence-based practice interventions. The inclusion of vulnerable populations in research is sensitive and complex. Sensitive topics such as dating and sexual violence are especially complex, with emerging adults the highest risk group for all forms of sexual violence and an especially hard-to-reach population for inclusion in research. Impacts of trauma, including physiological and psychological, complex needs of survivors, and potential for revictimization during interactions when participating in research must be considered. Researchers must be equipped with specialized, trauma-informed skills to safely and ethically conduct all aspects of research. Using the trauma-informed framework, the purpose of this paper is to discuss the complexities of conducting research with emerging adult survivors of sexual violence and to explore evidence-based approaches that can safely include this vulnerable population through the application of trauma-informed approaches. The use of evidence-based, trauma-informed research approaches tailored to engage this population in research can further help to develop effective interventions that are context-sensitive to emerging adults., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Emergency departments are a last resort for some socially vulnerable patients without an acute medical illness (colloquially known as "socially admitted" patients), resulting in their occupation of hospital beds typically designated for patients requiring acute medical care. In this study, we aimed to explore the perceptions of health care providers regarding patients admitted as "social admissions.", Methods: This qualitative study was informed by grounded theory and involved semistructured interviews at a Nova Scotia tertiary care centre. From October 2022 to July 2023, we interviewed eligible participants, including any health care clinician or administrator who worked directly with "socially admitted" patients. Virtual or in-person individual interviews were audio-recorded and transcribed, then independently and iteratively coded. We mapped themes on the 5 domains of the Quintuple Aim conceptual framework., Results: We interviewed 20 nurses, physicians, administrators, and social workers. Most identified as female ( n = 11) and White ( n = 13), and were in their mid to late career ( n = 13). We categorized 9 themes into 5 domains: patient experience (patient description, provision of care); care team well-being (moral distress, hierarchy of care); health equity (stigma and missed opportunities, prejudices); cost of care (wait-lists and scarcity of alternatives); and population health (factors leading to vulnerability, system changes). Participants described experiences caring for "socially admitted" patients, perceptions and assumptions underlying "social" presentations, system barriers to care delivery, and suggestions of potential solutions., Interpretation: Health care providers viewed "socially admitted" patients as needing enhanced care but identified individual, institutional, and system challenges that impeded its realization. Examining perceptions of the people who care for "socially admitted" patients offers insights to guide clinicians and policy-makers in caring for socially vulnerable patients., Competing Interests: Competing interests:: Jasmine Mah receives scholarships supporting her PhD research from the Department of Medicine at Dalhousie University, Dalhousie Medical Research Foundation, Dr. Patrick Madore Traineeship, and the Pierre Elliott Trudeau Foundation. Kenneth Rockwood has asserted copyright of the Clinical Frailty Scale through Dalhousie University’s Industry, Liaison, and Innovation Office. In addition to academic and hospital appointments, Kenneth Rockwood is cofounder of Ardea Outcomes, which (as DGI Clinical) in the last 3 years has contracts with pharmaceutical and device manufacturers (Danone, Hollister, INmune, Novartis, Takeda) on individualized outcome measurement. In 2020, he attended an advisory board meeting with Nutricia on dementia and chaired a Scientific Workshop & Technical Review Panel on frailty for the Singapore National Research Foundation. He is associate director of the Canadian Consortium on Neurodegeneration in Aging, itself funded by the Canadian Institutes for Health Research, the Alzheimer Society of Canada, and several other charities. He holds the Kathryn Allen Weldon Chair in Alzheimer Research, funded by the Dalhousie Medical Research Foundation. Kenneth Rockwood also reports personal fees from Ardea Outcomes, the Chinese Medical Association, Wake Forest University Medical School Centre, the University of Nebraska Omaha, the Australia and New Zealand Society for Geriatric Medicine, Atria Institute, Fraser Health Authority, McMaster University, and EpiPharma. In addition, Dr. Rockwood has licensed the Clinical Frailty Scale to Enanta Pharmaceuticals, Synairgen Research, Faraday Pharmaceuticals, KCR S.A., Icosavax, BioAge Labs, Biotest AG, Qu Biologics, AstraZeneca UK, Cellcolabs AB, Pfizer, W.L. Gore & Associates, pending to Cook Research Incorporated, Renibus Therapeutics, and, as part of Ardea Outcomes, has a pending patent for Electronic Goal Attainment Scaling. He also reports permission for the Pictorial Fit-Frail Scale licensed to Congenica. Use of both the Clinical Frailty Scale and Pictorial Fit-Frail Scale is free for education, research, and nonprofit health care with completion of a permission agreement stipulating users will not change, charge for, or commercialize the scales. For-profit entities pay a licensing fee, 15% of which is is retained by the Dalhousie University Office of Commercialization and Industry Engagement. The remainder of the licence fees are donated to the Dalhousie Medical Research Foundation. Melissa Andrew reports grants from Sanofi, grants and support to attend meetings from GSK, grants from Pfizer, grants from Canadian Frailty Network, personal fees from Sanofi, personal fees from Pfizer, personal fees from Seqirus, grants from Merck, grants from Public Health Agency of Canada, and grants from Canadian Institutes of Health Research, outside the submitted work. Dr. Andrew is a volunteer board member for the Alzheimer Society of Nova Scotia and the National Advisory Committee on Immunization. Sheliza Khan declares leadership in the patient flow department at Queen Elizabeth II Hospital. No other competing interests were declared., (© 2024 CMA Impact Inc. or its licensors.)

Health inequality can have a profound impact on a child's life. Maternal mental health challenges can hinder bonding, leading to impaired functioning and poorer child outcomes. To provide extra support for vulnerable pregnant women, the FACAM intervention offers the services of a health nurse or family therapist from pregnancy until the child starts school. This study examined the effects of FACAM intervention on pregnant women in vulnerable positions and their children until the child turned two years old. We randomly assigned 331 pregnant women to either FACAM intervention or care as usual and assessed them at baseline and when the infant was 3-6, 12-13.5, and 24 months old. The primary outcome was maternal sensitivity measured by Coding Interactive Behavior (CIB). Secondary outcomes included the parent-child relationship, child social-emotional development, child developmental progress, parent-child interaction, and child development. Our findings indicate that care-as-usual children were significantly more involved than FACAM children when the child was 4-6 months old (b = -0.25, [-0.42; -0.08] d = -0.42). However, we suspect this result is due to a biased dropout. We did not find any significant differences in any other outcomes. Therefore, the study suggests that the FACAM intervention is not superior to care as usual regarding child development and parent-child interaction outcomes.

Background: Adolescence is a stage of transition with multiple changes and transformations. It is a critical phase to potentiate or disrupt the life course of human beings. In Latin America, adolescents and young adults from countries like Colombia have unequal access to socioeconomic resources, education, and the job market. This may generate social disadvantages and vulnerability., Aim: We aimed to identify conditions of social vulnerability and psychosocial resilience in the life course of adolescents and young adults from a community art network in Bogota, Colombia., Methods: We conducted a qualitative study with a multivocal design supported by the ethnic-social life history construction. The data were collected using narrative interviews. The interviews were transcribed, coded, categorized, and triangulated according to the principles of grounded theory as an analytical method. We adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist., Results: Eight adolescents and young adults between the ages of 12 and 24 years participated in the study. Five categories emerged: social vulnerability, social environment, artistic processes, psychosocial resilience, and life course., Conclusions: Social vulnerability and psychosocial resilience coexist during the life course of adolescents and young adults. Social support networks and community art processes have the potential to promote psychosocial resilience in adolescents and young adults., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Male engagement in pregnancy care can be beneficial for maternal and child health outcomes. In Tanzania, pregnant women are strongly encouraged to present to their first antenatal care (ANC) appointment with a male partner, where they jointly test for HIV. For some, this presents a barrier to ANC attendance. The objectives of this study were to identify factors associated with presenting to ANC with a male partner using a cross-sectional design and to assess whether women presenting without partners had significantly delayed presentation., Methods: Pregnant women (n = 1007) attending a first ANC appointment in Moshi, Tanzania were surveyed. Questions captured sociodemographic characteristics and measures of psychosocial constructs., Results: Just over half (54%) of women presented to care with a male partner. Women were more likely to present with a male partner if they were younger than 25 years old, married, Muslim, attending ANC for their first pregnancy, and testing for HIV for the first time. Women presenting to ANC with a male partner were significantly more likely to attend ANC earlier in their pregnancy than those presenting without male partners., Conclusion: Policy change allowing women to present to care with other supportive family members could promote earlier presentation to first ANC. Unmarried women may be at a disadvantage in presenting to ANC when policies mandate attendance with a male partner. Male partners of multiparous women should be encouraged to provide pregnancy support even after first pregnancies, and a wholistic emphasis (beyond HIV testing) on first ANC could encourage male engagement beyond the initial appointment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Recent research has emphasized the importance of addressing specific victim-related factors to reduce victims' vulnerability and prevent future revictimization experiences. This study aimed to analyze the vulnerability profiles of women who were victims of intimate partner violence, including those who had experienced a single incident of violence and those who had endured revictimization. Participants were 338 women with active judicial protection measures registered in the system of support for victims of gender violence (VioGén) in Madrid, Spain. The analysis considered sociodemographic characteristics, victimization history, perceived triggers of violence, women's responses and feelings, as well as clinical outcomes linked to revictimization history. The study revealed that many victims faced socioeconomic vulnerability. Furthermore, the findings underscored the intricate link between the likelihood of enduring chronic violence and women's awareness of early indicators of violence risk, their initial responses to aggression, communication skills, and recurrent behaviors in the context of an established violent dynamic. This study offers valuable insights for law enforcement to identify the risk of revictimization. Furthermore, findings raise awareness about the particularly vulnerable situation of some women to repeated victimization experiences and provide relevant information for clinical intervention., Competing Interests: Conflict of Interest: The authors of this article declare no conflict of interest., (Copyright © 2023, Colegio Oficial de la Psicología de Madrid.)

Adult safeguarding legislation is contentious because it seeks to protect 'vulnerable' adults who fall between the borderlands of social care, mental health and mental capacity law. As a new and complex area of law and practice, further research on adult safeguarding legislation is required, in particular to consider it efficacy and human rights implications. Utilising a narrative literature review approach this article explores current research evidence on the Adult Support and Protection (Scotland) Act 2007 to consider whether safeguarding powers and duties can achieve a proportionate balance between individual autonomy and the state's duties to protect adults at risk of harm and, if so, how. The findings demonstrate there is a wide range of people who can fall into these borderland areas. For a majority, the use of the Act has made significant positive differences to their lives. However, while supported decision-making was identified it was not found to be consistently applied. In addition, concerns emerged around the adequacy of some professionals' legal knowledge, the consistent upholding of adults' will and preferences, and the commitment to and resourcing of supported decision-making. Notwithstanding these drawbacks, it is concluded that this Act provides vital functions but amendments would enhance alignment with the CRPD., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: This study validated the Vietnamese version of the Disaster Adaptation and Resilience Scale (DARS) for use in vulnerable communities in Vietnam., Methods: This was a cross-sectional study involving 595 adults from 2 identified communities. The original DARS assessment tool was translated, and the validity and reliability of the Vietnamese version of DARS (V-DARS) were assessed. The internal consistency of the overall scale and its subscales was evaluated using Cronbach's alpha and McDonald's omega reliability coefficients. Confirmatory factor analysis (CFA) was employed to evaluate its construct validity, building upon the factor structure identified in exploratory factor analysis (EFA). Construct validity was assessed based on convergent and discriminant validity., Results: Following the established criteria for EFA, 8 items were removed, resulting in a refined V-DARS structure comprising 35 items distributed across 5 distinct factors. Both alpha and omega reliability coefficients indicated strong internal consistency for the overall scale (α=0.963, ω=0.963) and for each of the 5 sub-scales (all>0.80). The CFA model also retained the 5-factor structure with 35 items. The model fit indices showed acceptable values (RMSEA: 0.072; CFI: 0.912; TLI: 0.904; chi-square test: <0.01). Additionally, the convergent and discriminant validity of the V-DARS were deemed appropriate and satisfactory for explaining the measurement structure., Conclusions: Our findings suggest that the V-DARS is a valid and reliable scale for use within vulnerable communities in Vietnam to assess adaptive responses to natural disasters. It may also be considered for use in other populations.