Sample records for identifying vulnerable populations

  1. Identifying Frailty Among Vulnerable Populations

    PubMed Central

    Salem, Benissa E.; Nyamathi, Adeline; Phillips, Linda R.; Mentes, Janet; Sarkisian, Catherine; Brecht, Lynn

    2014-01-01

    Frailty is a significant public health issue which is experienced by homeless and other vulnerable adults; to date, a frailty framework has not been proposed to guide researchers who study this hard-to-reach population. The Frailty Framework among Homeless and other Vulnerable Populations (FFHVP) has been developed from empirical research and consultation with frailty experts in an effort to characterize antecedents, i.e. situational, health-related, behavioral, resource, biological, and environmental factors which contribute to physical, psychological and social frailty domains and impact adverse outcomes. As vulnerable populations continue to age, a greater understanding of frailty will enable the development of nursing interventions. PMID:24469090

  2. Identifying vulnerable populations to death and injuries from residential fires.

    PubMed

    Gilbert, Stanley W; Butry, David T

    2017-08-03

    This study proposes and evaluates the theory that people who are susceptible to injury in residential fires are not susceptible to death in residential fires and vice versa. It is proposed that the population vulnerable to death in residential fires can be proxied by 'frailty', which is measured as age-gender adjusted fatality rates due to natural causes. This study uses an ecological approach and controls for exposure to estimate the vulnerability of different population groups to death and injury in residential fires. It allows fatalities and injuries to be estimated by different models. Frailty explains fire-related death in adults while not explaining injuries, which is consistent with the idea that deaths and injuries affect disjoint populations. Deaths and injuries in fire are drawn from different populations. People who are susceptible to dying in fires are unlikely to be injured in fires, and the people who are susceptible to injury are unlikely to die in fires. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. How Researchers Define Vulnerable Populations in HIV/AIDS Clinical Trials

    PubMed Central

    Lo, Bernard; Strauss, Ronald P.; Eron, Joseph; Gifford, Allen L.

    2010-01-01

    In this study, we interviewed researchers, asking them to define vulnerable populations in HIV/AIDS clinical trials, and provide feedback on the federal regulations for three vulnerable populations. Interview data informed a conceptual framework, and were content analyzed to identify acceptability or disagreement with the regulations. Beginning with several characteristics of vulnerable enrollees identified by researchers, the conceptual framework illustrates possible scenarios of how enrollees could be considered vulnerable in clinical research. Content analysis identified barriers affecting HIV/AIDS researchers’ ability to conduct clinical trials with pregnant women, prisoners, and children, for which the regulations specify additional protections. This study challenges current thinking about federal regulations’ group-based approach to defining vulnerable populations. PMID:20721614

  4. Identifying Population Vulnerable to Extreme Heat Events in San Jose, California.

    NASA Astrophysics Data System (ADS)

    Rivera, A. L.

    2016-12-01

    The extreme heat days not only make cities less comfortable for living but also they are associated with increased morbidity and mortality. Mapping studies have demonstrated spatial variability in heat vulnerability. A study conducted between 2000 and 2011 in New York City shows that deaths during heat waves was more likely to occur in black individuals, at home in census tracts which received greater public assistance. This map project intends to portray areas in San Jose California that are vulnerable to extreme heat events. The variables considered to build a vulnerability index are: land surface temperature, vegetated areas (NDVI), and people exposed to these area (population density).

  5. Population-focused nursing: advocacy for vulnerable populations in an RN-BSN program.

    PubMed

    Jones, Melissa; Smith, Paul

    2014-01-01

    The purpose of this article is to describe an innovative learning activity for online RN-BSN students designed to foster advocacy for vulnerable populations. The Vulnerable Population Advocacy Assignment, included as a component of the online Population-Focused Nursing class, provides students with the opportunity to identify and develop an awareness of issues impacting vulnerable populations and to advocate for policy changes that will influence the health of individuals, families, and populations. RN-BSN students build on previous knowledge and skills in professional communication and advocacy as they develop a policy statement designed to address health disparities impacting local, national, and global populations. © 2014 Wiley Periodicals, Inc.

  6. Vulnerable populations in healthcare.

    PubMed

    Waisel, David B

    2013-04-01

    This review is designed to update readers on recent discussions and research regarding vulnerable populations in medicine, including patients who are socioeconomically disadvantaged, queer, in prison or labeled with a stigmatizing complex medical disease. Recent studies have more closely examined the effects of being part of a vulnerable population. Greater societal income inequality impacts those at the lower end of the income curve by increasing mortality and heightening the importance of individual personal situations. Recommendations from an extensive WHO report on the social determinants of health may affect social policy and use of public resources in Europe. Clinicians are undereducated about the lives and concerns of vulnerable populations, including LGBTQI persons, immigrants, physicians, prisoners, and families of patients with diseases considered 'incompatible with life'. Greater understanding of the cause of the health effects of being socioeconomically disadvantaged or being a member of a vulnerable population may be the first steps toward specific policy recommendations. Professional medical organizations and advocacy groups should raise awareness, provide education, publish guidelines and define the goals for the medical care for certain vulnerable populations.Vulnerable populations are at risk for disparate healthcare access and outcomes because of economic, cultural, ethnic or health characteristics. Vulnerable populations include patients who are racial or ethnic minorities, children, elderly, socioeconomically disadvantaged, underinsured or those with certain medical conditions. Members of vulnerable populations often have health conditions that are exacerbated by unnecessarily inadequate healthcare.

  7. The representation of vulnerable populations in quality improvement studies.

    PubMed

    Rolnitsky, Asaph; Kirtsman, Maksim; Goldberg, Hanna R; Dunn, Michael; Bell, Chaim M

    2018-05-01

    A mapping review to quantify representation of vulnerable populations, who suffer from disparity and often inequitable healthcare, in quality improvement (QI) research. Studies published in 2004-2014 inclusive from Medline, Embase and Cochrane databases for English language research with the terms 'quality improvement' or 'quality control' or 'QI' and 'plan-do-study-act' or 'PDSA' in the years 2004-2014 inclusively. Published clinical research that was a QI-themed, as identified by its declared search terms, MESH terms, abstract or title. Three reviewers identified the eligible studies independently. Excluded were publications that were not trials, evaluations or analyses. Of 2039 results, 1660 were eligible for inclusion. There were 586 (33.5%) publications that targeted a specific vulnerable population: children (184, 10.54%), mental health patients (125, 7.16%), the elderly (100, 5.73%), women (57, 3.27%), the poor (30, 1.72%), rural residents (29, 1.66%), visible minorities (27, 1.55%), the terminally ill (17, 0.97%), adolescents (16, 0.92%) and prisoners (1 study). Seventy-four articles targeted two or more vulnerable populations, and 11 targeted three population categories. On average, there were 158 QI research studies published per year, increasing from 69 in 2004 to 396 in 2014 (R2 = 0.7, P < 0.001). The relative representation of vulnerable populations had a mean of 33.58% and was stable over the time period (standard deviation (SD) = 5.9%, R2 = 0.001). Seven countries contributed to over 85% of the publications targeting vulnerable populations, with the USA contributing 62% of the studies. Over 11 years, there has been a marked increase in QI publications. Roughly one-third of all published QI research is on vulnerable populations, a stable proportion over time. Nevertheless, some vulnerable populations are under-represented. Increased education, resources and attention are encouraged to improve the health of vulnerable populations through focused QI

  8. Identifying Frailty Levels and Associated Factors in a Population Living in the Context of Poverty and Social Vulnerability.

    PubMed

    Zazzetta, M S; Gomes, G A O; Orlandi, F S; Gratão, A C M; Vasilceac, F A; Gramani-Say, K; Ponti, M A; Castro, P C; Pavarini, S C I; Menezes, A L C; Nascimento, C M C; Cominetti, M R

    2017-01-01

    This study aimed to investigate a vulnerable population living in the context of poverty in a Brazilian municipality, in order to identify the factors that are associated with frailty syndrome in elderly people. From the total population living in the area, a random sample of 363 community-dwelling people, 60 years and older, age and gender-stratified, was selected to participate in the research. After losses, a sample of 304 older adults was classified as non-frail, pre-frail and frail. According to the Fried frailty criteria, the prevalence was 12.2% for non-frail individuals, 60.5% pre-frail and 27.3% frail. The main factors associated with frailty in the studied sample were low level of physical activity (OR: 5.2, 95%CI: 2.5-11.0), the occurrence of two or more falls within 12 months (OR: 3.1, 95%CI: 1.4-7.1), mobility deficits (OR: 3.0, 95%CI: 1.5-5.8), and depressive symptoms (OR: 1.9, 95%CI: 1.1-3.7). This study identified the most important factors that must be evaluated to identify frailty syndrome in a socially vulnerable population in the context of poverty. The data should help to encourage effective strategies concerning public health policies for this population.

  9. A GIS Approach to Identifying Socially and Medically Vulnerable Older Adult Populations in South Florida.

    PubMed

    Hames, Elizabeth; Stoler, Justin; Emrich, Christopher T; Tewary, Sweta; Pandya, Naushira

    2017-11-10

    We define, map, and analyze geodemographic patterns of socially and medically vulnerable older adults within the tri-county region of South Florida. We apply principal components analysis (PCA) to a set of previously identified indicators of social and medical vulnerability at the census tract level. We create and map age-stratified vulnerability scores using a geographic information system (GIS), and use spatial analysis techniques to identify patterns and interactions between social and medical vulnerability. Key factors contributing to social vulnerability in areas with higher numbers of older adults include age, large household size, and Hispanic ethnicity. Medical vulnerability in these same areas is driven by disease burden, access to emergency cardiac services, availability of nursing home and hospice beds, access to home health care, and available mental health services. Age-dependent areas of social vulnerability emerge in Broward County, whereas age-dependent areas of medical vulnerability emerge in Palm Beach County. Older-adult social and medical vulnerability interact differently throughout the study area. Spatial analysis of older adult social and medical vulnerability using PCA and GIS can help identify age-dependent pockets of vulnerability that are not easily identifiable in a populationwide analysis; improve our understanding of the dynamic spatial organization of health care, health care needs, access to care, and outcomes; and ultimately serve as a tool for health care planning. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. Prevalence in vulnerable population of liver fibrosis identified by transient elastography.

    PubMed

    Chávez-Tapia, Norberto; Torres-Sánchez, Jorge; Romero-Flores, Juan; Álvarez-Quiroz, Paulina; Ramírez-Álvarez, Sandra; Juárez-Hernández, Eva; Pérez-Jáuregui, José; Méndez-Sánchez, Nahum; Uribe, Misael

    2015-01-01

    Transient elastography (TE) is a useful tool for the assessment of hepatic fibrosis as an alternative to liver biopsy, but it has not been validated as a screening procedure in apparently healthy people. To determine the prevalence of advanced liver fibrosis diagnosed by TE in a socioeconomically challenged rural population. We enrolled 299 participants aged over 18 years old from a vulnerable population in Mexico who responded to an open invitation. All participants had their history recorded and underwent a general clinical examination and a liver stiffness measurement, performed by a single operator according to international standards. Overall, 7.35% participants were found to be at high risk for cirrhosis. Three variables correlated with a risk for a TE measure ≥ 9 kPa and significant fibrosis: history of alcohol intake [7.95 vs. 92.04%, odds ratio (OR) 4.47, 95% confidence interval (CI) 1.45-13.78, P = 0.0167], body mass index (BMI) ≥ 30 kg/m2 (30.87 vs. 69.12%, OR 4.25, 95%CI 1.04-6.10, P = 0.049), and history of diabetes mellitus (14.87 vs. 85.12%, OR 2.76, 95%CI 1.002-7.63, P = 0.0419). In the multivariate analyses BMI ≥ 30 kg/m2 was the only significant risk factor for advanced liver fibrosis or cirrhosis (OR 2.54, 95%CI 1.02-6.3, P = 0.0460). TE could be useful as a screening process to identify advanced liver fibrosis in the general and apparently healthy population.

  11. [The social vulnerability index regarding Medellín's disabled population].

    PubMed

    Cardona-Arango, Doris; Agudelo-Martínez, Alejandra; Restrepo-Molina, Lucas; Segura-Cardona, Angela M

    2014-01-01

    Constructing a social vulnerability index (SVI) for Medellín's disabled population during 2008 aimed at determining areas which were reducing opportunities for this population to use their tangible and intangible assets, thus impairing their quality of life. This descriptive cross-sectional study drew on a source of secondary information regarding people having some kind of limitation recorded in the Quality of Life Survey, 2008. Physical, human and social variables were grouped when constructing the SVI; the models were run in principal component analysis to determine their degree of vulnerability, defined by the number of negative factors identified (high category=4 or 5, medium=2 or 3 and low=1 or none). Such classification led to identifying non-causal relationships with demographic variables through Mann-Whitney, Chi-square and Kruskal-Wallis tests (5.0 % statistical significance level); multinomial logistic regression was used for calculating adjusted measures for epidemiological measurement, such as opportunity ratios and confidence intervals. A degree of medium vulnerability predominated in disabled people living in Medellín (60.3 %) followed by low vulnerability (28.7 %) and high vulnerability populations (11.0 %). The proposed ISV classified the city's communes according to high, medium or low vulnerability, supported by the use of statistical and spatial location techniques.

  12. Assessing vulnerability to drought: identifying underlying factors across Europe

    NASA Astrophysics Data System (ADS)

    Urquijo, Julia; Gonzalez Tánago, Itziar; Ballesteros, Mario; De Stefano, Lucia

    2015-04-01

    Drought is considered one of the most severe and damaging natural hazards in terms of people and sectors affected and associated losses. Drought is a normal and recurrent climatic phenomenon that occurs worldwide, although its spatial and temporal characteristics vary significantly among climates. In the case of Europe, in the last thirty years, the region has suffered several drought events that have caused estimated economic damages over a €100 billion and have affected almost 20% of its territory and population. In recent years, there has been a growing awareness among experts and authorities of the need to shift from a reactive crisis approach to a drought risk management approach, as well as of the importance of designing and implementing policies, strategies and plans at country and river basin levels to deal with drought. The identification of whom and what is vulnerable to drought is a central aspect of drought risk mitigation and planning and several authors agree that societal vulnerability often determines drought risk more than the actual precipitation shortfalls. The final aim of a drought vulnerability assessment is to identify the underlying sources of drought impact, in order to develop policy options that help to enhance coping capacity and therefore to prevent drought impact. This study identifies and maps factors underlying vulnerability to drought across Europe. The identification of factors influencing vulnerability starts from the analysis of past drought impacts in four European socioeconomic sectors. This analysis, along with an extensive literature review, led to the selection of vulnerability factors that are both relevant and adequate for the European context. Adopting the IPCC model, vulnerability factors were grouped to describe exposure, sensitivity and adaptive capacity. The aggregation of these components has resulted in the mapping of vulnerability to drought across Europe at NUTS02 level. Final results have been compared with

  13. Communicating effectively with vulnerable populations during water contamination events.

    PubMed

    Nsiah-Kumi, Phyllis A

    2008-01-01

    Water contamination events are a public health concern worldwide with significant potential to impact the global community. When communicating with the public during these crisis situations, it is vital to consider the multiple audiences who receive the messages. Before developing or delivering messages to a particular community, it is essential to be familiar with the community's characteristics, needs, concerns, and who is considered credible to that community. Vulnerable populations are those with difficulties in comprehension or accessibility that may limit their full understanding of risks and may mitigate the effectiveness of public health strategies. Vulnerable populations include, but are not limited to, the urban/rural poor, those who are mentally ill, intellectually disabled, medically vulnerable, at the extremes of age (children and the elderly), racial/ethnic minorities, and those with low literacy or limited English proficiency.A water contamination event poses a unique opportunity to work with diverse populations to effectively convey important health messages. Each population needs to receive appropriate public health messages. Becoming familiar with vulnerable populations and their needs prior to a water contamination event will help in identifying barriers and developing and refining effective messages in such a crisis. In water contamination crises, our publics' health depends on effective, targeted crisis communication.

  14. Assessing vulnerability of marine bird populations to offshore wind farms.

    PubMed

    Furness, Robert W; Wade, Helen M; Masden, Elizabeth A

    2013-04-15

    Offshore wind farms may affect bird populations through collision mortality and displacement. Given the pressures to develop offshore wind farms, there is an urgent need to assess population-level impacts on protected marine birds. Here we refine an approach to assess aspects of their ecology that influence population vulnerability to wind farm impacts, also taking into account the conservation importance of each species. Flight height appears to be a key factor influencing collision mortality risk but improved data on flight heights of marine birds are needed. Collision index calculations identify populations of gulls, white-tailed eagles, northern gannets and skuas as of particularly high concern in Scottish waters. Displacement index calculations identify populations of divers and common scoters as most vulnerable to population-level impacts of displacement, but these are likely to be less evident than impacts of collision mortality. The collision and displacement indices developed here for Scottish marine bird populations could be applied to populations elsewhere, and this approach will help in identifying likely impacts of future offshore wind farms on marine birds and prioritising monitoring programmes, at least until data on macro-avoidance rates become available. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. TB in Vulnerable Populations

    PubMed Central

    Ugarte-Gil, César; Caro, Godofredo; Aylas, Rula; Castro, César; Lema, Claudia

    2016-01-01

    Abstract This article analyzes the factors associated with vulnerability of the Ashaninka, the most populous indigenous Peruvian Amazonian people, to tuberculosis (TB). By applying a human rights-based analytical framework that assesses public policy against human rights standards and principles, and by offering a step-by-step framework for a full assessment of compliance, it provides evidence of the relationship between the incidence of TB among the Ashaninka and Peru’s poor level of compliance with its human rights obligations. The article argues that one of the main reasons for the historical vulnerability of the Ashaninka to diseases such as TB is a lack of political will on the part of the national government to increase public health spending, ensure that resources reach the most vulnerable population, and adopt and invest in a culturally appropriate health system. PMID:27780999

  16. Issues, considerations and recommendations on emergency preparedness for vulnerable population groups.

    PubMed

    Chen, Jing; Wilkinson, Diana; Richardson, Richard B; Waruszynski, Barbara

    2009-06-01

    The Workshop on Emergency Preparedness for Vulnerable Population Groups was held on 2 and 3 March 2009 in Ottawa, ON, Canada. The purpose of the workshop was to enhance communications within the emergency community response network and to identify the needs and gaps of emergency preparedness against chemical, biological, radiological, nuclear and explosives events for vulnerable population groups. The workshop was organised to enable extensive round-table discussions and provide a summary of key issues, considerations and recommendations for emergency response planners.

  17. Methamphetamine use and dependence in vulnerable female populations.

    PubMed

    Kittirattanapaiboon, Phunnapa; Srikosai, Soontaree; Wittayanookulluk, Apisak

    2017-07-01

    The study reviews recent publications on methamphetamine use and dependence women in term of their epidemic, physical health impact, psychosocial impacts, and also in the identified vulnerable issues. Studies of vulnerable populations of women are wide ranging and include sex workers, sexual minorities, homeless, psychiatric patients, suburban women, and pregnant women, in which amphetamine type stimulants (ATSs) are the most commonly reported illicit drug used among them. The prenatal exposure of ATS demonstrated the small for gestational age and low birth weight; however, more research is needed on long-term studies of methamphetamine-exposed children. Intimate partner violence (IPV) is commonly reported by female methamphetamine users as perpetrators and victims. However, statistics and gendered power dynamics suggest that methamphetamine-related IPV indicates a higher chance of femicide. Methamphetamine-abusing women often have unresolved childhood trauma and are introduced to ATS through families or partners. Vulnerable populations of women at risk of methamphetamine abuse and dependence. Impacts on their physical and mental health, IPV, and pregnancy have been reported continuing, which guide that empowering and holistic substance abuse are necessary for specific group.

  18. Tripartite Governance: Enabling Successful Implementations with Vulnerable Populations.

    PubMed

    Kennedy, Margaret Ann

    2016-01-01

    Vulnerable populations are often at a distinct disadvantage when it comes to the implementation of health information systems in an equitable, appropriate, and timely manner. The disadvantages experienced by vulnerable populations are innumerable and include lack of representation, lack of appropriate levels of funding, lack of resources and capacity, and lack of representation. Increasingly, models of representation for complex implementations involve a tripartite project governance model. This tripartite partnership distributes accountability across all partners, and ensures that vulnerable populations have an equitable contribution to the direction of implementation according to their needs. This article shares lessons learned and best practices from complex tripartite partnerships supporting implementations with vulnerable populations in Canada.

  19. Using standard clinical assessments for home care to identify vulnerable populations before, during, and after disasters.

    PubMed

    van Solm, Alexandra I T; Hirdes, John P; Eckel, Leslie A; Heckman, George A; Bigelow, Philip L

    Several studies have shown the increased vulnerability of and disproportionate mortality rate among frail community-dwelling older adults as a result of emergencies and disasters. This article will discuss the applicability of the Vulnerable Persons at Risk (VPR) and VPR Plus decision support algorithms designed based on the Resident Assessment Instrument-Home Care (RAI-HC) to identify the most vulnerable community-dwelling (older) adults. A sample was taken from the Ontario RAI-HC database by selecting unique home care clients with assessments closest to December 31, 2014 (N = 275,797). Statistical methods used include cross tabulation, bivariate logistic regression as well as Kaplan-Meier survival plotting and Cox proportional hazards ratios calculations. The VPR and VPR Plus algorithms, were highly predictive of mortality, long-term care admission and hospitalization in ordinary circumstances. This provides a good indication of the strength of the algorithms in identifying vulnerable persons at times of emergencies. Access to real-time person-level information of persons with functional care needs is a vital enabler for emergency responders in prioritizing and allocating resources during a disaster, and has great utility for emergency planning and recovery efforts. The development of valid and reliable algorithms supports the rapid identification and response to vulnerable community-dwelling persons for all phases of emergency management.

  20. GIS-Mapping and Statistical Analyses to Identify Climate-Vulnerable Communities and Populations Exposed to Superfund Sites

    EPA Science Inventory

    Climate change-related cumulative health risks are expected to be disproportionately greater for overburdened communities, due to differential proximity and exposures to chemical sources and flood zones. Communities and populations vulnerable to climate change-associated impacts ...

  1. Identifying Future Disease Hot Spots: Infectious Disease Vulnerability Index.

    PubMed

    Moore, Melinda; Gelfeld, Bill; Okunogbe, Adeyemi; Paul, Christopher

    2017-06-01

    Recent high-profile outbreaks, such as Ebola and Zika, have illustrated the transnational nature of infectious diseases. Countries that are most vulnerable to such outbreaks might be higher priorities for technical support. RAND created the Infectious Disease Vulnerability Index to help U.S. government and international agencies identify these countries and thereby inform programming to preemptively help mitigate the spread and effects of potential transnational outbreaks. The authors employed a rigorous methodology to identify the countries most vulnerable to disease outbreaks. They conducted a comprehensive review of relevant literature to identify factors influencing infectious disease vulnerability. Using widely available data, the authors created an index for identifying potentially vulnerable countries and then ranked countries by overall vulnerability score. Policymakers should focus on the 25 most-vulnerable countries with an eye toward a potential "disease belt" in the Sahel region of Africa. The infectious disease vulnerability scores for several countries were better than what would have been predicted on the basis of economic status alone. This suggests that low-income countries can overcome economic challenges and become more resilient to public health challenges, such as infectious disease outbreaks.

  2. Investigating Community Concerns Regarding HIV Prevention Organizations' Expertise in Serving HIV-Vulnerable Populations.

    PubMed

    Bellows, Denise; Howard, Donna; Boekeloo, Brad; Randolph, Suzanne

    2015-01-01

    People living with human immunodeficiency virus (HIV)/AIDS (PLWH/A) and others affected have expressed that cultural differences between patients and providers can create barriers to care and prevention. These barriers are exacerbated in the case of vulnerable populations who are often marginalized by society. During the formative phase of a community-based participatory research (CBPR) process, the researchers' community advisory committee (CAC) and HIV stakeholders shared anecdotes of incongruencies between needs of HIV-vulnerable populations and expertise of local providers. In response, researchers worked with the CAC to develop survey questions intended for providers of HIV prevention services in a region afflicted with some of the highest HIV prevalence rates in the country. The objective of this study was to identify and validate HIV stakeholders' perceptions about challenges to provision of HIV services through a sequential mixed methods study design. Thirty HIV prevention organizations (HPOs) were identified as local leaders in HIV prevention by community stakeholders and through community event attendance. Each HPO was invited to participate in an interviewer-assisted survey examining population-specific expertise and service for 15 HIV-vulnerable populations. Frequency analysis was used to compare HPOs' expertise relative to who they serve (n = 26). Although 13 of the HIV-vulnerable populations were served by more than 50% of the HPOs, only 2 of these 13 populations were served with high expertise by more than one half of the HPOs in the sample. These data give credence to the CAC's concern regarding misalliance between whom HPOs serve and with whom they have high expertise, a factor potentially influencing HIV outcomes among HIV-vulnerable populations.

  3. Interprofessional Graduate Students' Perspectives on Caring for Vulnerable Populations.

    PubMed

    Wright, Patricia Moyle; Hanson, Mary Jane S

    The purpose of this focus group study was to explore graduate students' clinical experiences with vulnerable populations, perceived barriers to care, and ethical issues related to caring for disenfranchised groups. Furthermore, based on their experiences, the students were asked to share suggestions for curricular changes that could enhance care for vulnerable populations through interdisciplinary collaboration and multidisciplinary projects. The responses of the participants add to what is known about the care of vulnerable populations, offering a first-hand description of students' preparation for work with vulnerable populations and the interdisciplinary team.

  4. Development of a frailty framework among vulnerable populations.

    PubMed

    Salem, Benissa E; Nyamathi, Adeline; Phillips, Linda R; Mentes, Janet C; Sarkisian, Catherine; Brecht, Mary-Lynn

    2014-01-01

    Frailty is a public health issue that is experienced by homeless and other vulnerable populations; to date, a frailty framework has not been proposed to guide researchers who study hard-to-reach populations. The Frailty Framework among Vulnerable Populations has been developed from empirical research and consultation with frailty experts in an effort to characterize antecedents, that is, situational, health-related, behavioral, resource, biological, and environmental factors that contribute to physical, psychological, and social frailty domains and impact adverse outcomes. As vulnerable populations continue to age, a greater understanding of frailty will enable the development of nursing interventions.

  5. Shared Decision Making With Vulnerable Populations in the Emergency Department.

    PubMed

    Castaneda-Guarderas, Ana; Glassberg, Jeffrey; Grudzen, Corita R; Ngai, Ka Ming; Samuels-Kalow, Margaret E; Shelton, Erica; Wall, Stephen P; Richardson, Lynne D

    2016-12-01

    The emergency department (ED) occupies a unique position within the healthcare system, serving as a safety net for vulnerable patients, regardless of their race, ethnicity, religion, country of origin, sexual orientation, socioeconomic status, or medical diagnosis. Shared decision making (SDM) presents special challenges when used with vulnerable population groups. The differing circumstances, needs, and perspectives of vulnerable groups invoke issues of provider bias, disrespect, judgmental attitudes, and lack of cultural competence, as well as patient mistrust and the consequences of their social and economic disenfranchisement. A research agenda that includes community-engaged approaches, mixed-methods studies, and cost-effectiveness analyses is proposed to address the following questions: 1) What are the best processes/formats for SDM among racial, ethnic, cultural, religious, linguistic, social, or otherwise vulnerable groups who experience disadvantage in the healthcare system? 2) What organizational or systemic changes are needed to support SDM in the ED whenever appropriate? 3) What competencies are needed to enable emergency providers to consider patients' situation/context in an unbiased way? 4) How do we teach these competencies to students and residents? 5) How do we cultivate these competencies in practicing emergency physicians, nurses, and other clinical providers who lack them? The authors also identify the importance of using accurate, group-specific data to inform risk estimates for SDM decision aids for vulnerable populations and the need for increased ED-based care coordination and transitional care management capabilities to create additional care options that align with the needs and preferences of vulnerable populations. © 2016 by the Society for Academic Emergency Medicine.

  6. Nursing Student Birth Doulas' Influence On the Childbearing Outcomes of Vulnerable Populations.

    PubMed

    Van Zandt, Shirley E; Kim, Soohyun; Erickson, Amanda

    2016-01-01

    Of 1,511 women served by nursing student birth doulas (Birth Companions) between 1998 and 2014, 34.5% were identified as vulnerable (refugees, non-English speakers, teens, low income, low education). This retrospective evaluation of the Birth Companions Program showed that vulnerable mothers had more epidurals and smaller babies, and attempted breastfeeding less frequently than nonvulnerable. There was no difference in the frequency of caesarean births, pitocin induction/augmentation, low birth weight, or preterm newborns among the vulnerable women. Birth Companion interventions may have a role in influencing these outcomes. The Birth Companions program will use this analysis to identify additional services for these populations.

  7. The Vulnerable Population of Teacher-Researchers; or, "Why I Can't Name My Coauthors"

    ERIC Educational Resources Information Center

    White, Brian

    2011-01-01

    Educational researchers are accustomed to institutional review board (IRB) requirements (e.g., protecting participants) with students often identified as the only "vulnerable population" for IRB purposes. However, as practitioner research has gained more prominence, the vulnerability of teacher-researchers themselves has begun to…

  8. Decline in Cancer Screening in Vulnerable Populations? Results of the EDIFICE Surveys.

    PubMed

    Morère, Jean-François; Eisinger, François; Touboul, Chantal; Lhomel, Christine; Couraud, Sébastien; Viguier, Jérôme

    2018-03-05

    We studied cancer screening over time and social vulnerability via surveys of representative populations. Individuals aged 50-75 years with no personal history of cancer were questioned about lifetime participation in screening tests, compliance (adherence to recommended intervals [colorectal, breast and cervical cancer]) and opportunistic screening (prostate and lung cancer). The proportion of vulnerable/non-vulnerable individuals remained stable between 2011 and 2016. In 2011, social vulnerability had no impact on screening participation, nor on compliance. In 2014, however, vulnerability was correlated with less frequent uptake of colorectal screening (despite an organised programme) and prostate cancer screening (opportunistic), and also with reduced compliance with recommended intervals (breast and cervical cancer screening). In 2016, the trends observed in 2014 were substantiated and even extended to breast, colorectal and cervical cancer screening uptakes. Social vulnerability has an increasingly negative impact on cancer screening attendance. The phenomenon was identified in 2014 and had expanded by 2016. Although organised programmes have been shown to ensure equitable access to cancer screening, this remains a precarious achievement requiring regular monitoring. Further studies should focus on attitudes of vulnerable populations and on ways to improve cancer awareness campaigns.

  9. Institutional facilitators and barriers to local public health preparedness planning for vulnerable and at-risk populations.

    PubMed

    Bevc, Christine A; Simon, Matthew C; Montoya, Tanya A; Horney, Jennifer A

    2014-01-01

    Numerous institutional facilitators and barriers to preparedness planning exist at the local level for vulnerable and at-risk populations. Findings of this evaluation study contribute to ongoing practice-based efforts to improve response services and address public health preparedness planning and training as they relate to vulnerable and at-risk populations. From January 2012 through June 2013, we conducted a multilevel, mixed-methods evaluation study of the North Carolina Preparedness and Emergency Response Research Center's Vulnerable & At-Risk Populations Resource Guide, an online tool to aid local health departments' (LHDs') preparedness planning efforts. We examined planning practices across multiple local, regional, and state jurisdictions utilizing user data, follow-up surveys, and secondary data. To identify potential incongruities in planning, we compared respondents' reported populations of interest with corresponding census data to determine whether or not there were differences in planning priorities. We used data collected from evaluation surveys to identify key institutional facilitators and barriers associated with planning for at-risk populations, including challenges to conducting assessments and lack of resources. Results identified both barriers within institutional culture and disconnects between planning priorities and evidence-based identification of vulnerable and at-risk populations, including variation in the planning process, partnerships, and perceptions. Our results highlight the important role of LHDs in preparedness planning and the potential implications associated with organizational and bureaucratic impediments to planning implementation. A more in-depth understanding of the relationships among public institutions and the levels of preparedness that contribute to the conditions and processes that generate vulnerability is needed.

  10. Community-based cardiovascular health interventions in vulnerable populations: a systematic review.

    PubMed

    Walton-Moss, Benita; Samuel, Laura; Nguyen, Tam H; Commodore-Mensah, Yvonne; Hayat, Matthew J; Szanton, Sarah L

    2014-07-01

    Although cardiovascular health has been improving for many Americans, this is not true of those in "vulnerable populations." To address this growing disparity, communities and researchers have worked for decades, and as a result of their work, a growing body of literature supports the use of community engagement as a component of successful interventions. However, little literature synthesizes community-based interventions that address this disparity among a wide range of vulnerable populations. This article provides a critical review of community-based cardiovascular disease interventions to improve cardiovascular health behaviors and factors among vulnerable populations based on the American Heart Association's 7 metrics of ideal cardiovascular health. In February 2011, 4 databases (PubMed, PsychInfo, CINAHL, and Scopus) were searched using the following keywords: vulnerable populations OR healthcare disparities AND cardiovascular disease AND clinical trials OR public health practice AND English. This search strategy resulted in the retrieval of 7120 abstracts. Each abstract was reviewed by at least 2 authors, and eligibility for the systematic review was confirmed after reading the full article. Thirty-two studies met eligibility criteria. Education was the most common intervention (41%), followed by counseling or support (38%) and exercise classes (28%). Half of the interventions were multicomponent. Healthcare providers were the most frequent interventionists. Interventions aimed at decreasing blood pressure were the most promising, whereas behavior change interventions were the most challenging. Almost all of the interventions were at the individual level and were proof-of-concept or efficacy trials. This analysis provides a step toward understanding the current literature on cardiovascular interventions for vulnerable population. The next step should be integrating the identified successful interventions into larger health systems and/or social policies.

  11. Vulnerability Risk Index Profile for Elder Abuse in Community-Dwelling Population

    PubMed Central

    Dong, XinQi; Simon, Melissa A.

    2013-01-01

    Objectives Elder abuse is associated with increased morbidity and mortality. This study aims to develop a vulnerability index for elder abuse in a community-dwelling population. Design Population-based study Setting Geographically defined community in Chicago. Participants A population-based study was conducted in Chicago of community-dwelling older adults who participated in the Chicago Health and Aging Project (CHAP). Of the 8,157 participants in the CHAP study, 213 participants were reported to social services agency for suspected elder abuse. Measurements A vulnerability index for elder abuse was constructed from sociodemographic, health-related, and psychosocial factors. The outcomes of interest were reported and confirmed elder abuse. Logistic regression models were used to determine the accuracy of the index with respect to elder abuse outcomes. Results Out of the selected risk index for elder abuse, every one point increase in the 9 item vulnerability index items, there was a two fold increase in the risk for reported elder abuse (OR, 2.19 (2.00–2.40) and confirmed elder abuse (OR, 2.19 (1.94–2.47). Compared to the reference group, older adults with 3–4 vulnerability index items had increased risk for reported elder abuse (OR, 2.98 (1.98–4.49) and confirmed elder abuse (OR, 3.90, (2.07–7.36); and older adults with 5 or more risk index items, there was an 18 fold increase in risk for reported elder abuse (OR, 18.46 (12.15–28.04) and confirmed elder abuse (OR, 26.79 (14.18–50.61). Receiver Operating Characteristic (ROC) statistically derived curves for identifying reported elder abuse ranged between 0.77–0.84 and for predicting confirmed elder abuse ranged between 0.79–0.86. Conclusion The vulnerability risk index demonstrates value for identifying individuals at risk for elder abuse. Additional studies are needed to validate this index in other community dwelling populations. PMID:25180376

  12. Community Based Cardiovascular Health Interventions in Vulnerable Populations: A Systematic Review

    PubMed Central

    Walton-Moss, Benita; Samuel, Laura; Nguyen, Tam H; Commodore-Mensah, Yvonne; Hayat, Matthew J.; Szanton, Sarah L.

    2013-01-01

    Background Although cardiovascular health has been improving for many Americans, this is not true of those in “vulnerable populations.” To address this growing disparity communities and researchers have worked for decades, and as a result of their work a growing body of literature supports the use of community engagement as a component of successful interventions. However, little literature synthesizes community-based interventions that address this disparity among a wide range of vulnerable populations. Objective This paper provides a critical review of community-based cardiovascular disease (CVD) interventions to improve cardiovascular health behaviors and factors among vulnerable populations based on the American Heart Association’s 7 metrics of ideal cardiovascular health. Methods In February 2011, four databases (PubMed, PsychInfo, CINAHL, and Scopus) were searched using the following keywords: vulnerable populations OR healthcare disparities AND cardiovascular disease AND clinical trials OR public health practice AND English. Results This search strategy resulted in the retrieval of 7,120 abstracts. Each abstract was reviewed by at least two authors and eligibility for the systematic review was confirmed after reading the full article. Thirty two studies met eligibility criteria. Education was the most common intervention (41%), followed by counseling or support (38%), and exercise classes (28%). Half of the interventions were multi-component. Health care providers were the most frequent interventionists. Interventions aimed at decreasing blood pressure were the most promising while behavior change interventions were the most challenging. Almost all of the interventions were at the individual level, and were proof of concept or efficacy trials. Conclusions This analysis provides a step towards understanding the current literature on cardiovascular interventions for vulnerable population. The next step should be integrating the identified successful

  13. Identifying Vulnerable Populations Using a Social Determinants of Health Framework: Analysis of National Survey Data across Six Asia-Pacific Countries

    PubMed Central

    Ward, Paul R.; Mamerow, Loreen; Meyer, Samantha B.

    2013-01-01

    Background In order to improve the health of the most vulnerable groups in society, the WHO called for research on the multiple and inter-linking factors shaping the social determinants of health (SDH). This paper analyses four key SDH (social cohesion, social inclusion, social empowerment and socioeconomic security) across six Asia-Pacific countries: Australia, Hong Kong, Japan, South Korea, Taiwan, and Thailand. Methods Population surveys were undertaken using a validated instrument in 2009-10, with sample sizes around 1000 in each country. The four SDH were analysed using multivariate binomial logistic regression to identify socio-demographic predictors in each country. Results Low socio-economic security was associated with low income in all six study countries and with poor subjective health in Japan, South Korea and Thailand and with being married or cohabiting in Australia and Hong Kong. Low social cohesion was associated with low income in all countries and with undertaking household duties in South Korea, Thailand and Taiwan. Low social inclusion was associated with low income in Australia, South Korea and Taiwan and with poor subjective health in Australia, Japan and South Korea. Older people had lower social inclusion in Taiwan (50-59 years) and Hong Kong (retired), younger people in Japan and South Korea (20-29 years in both countries) and younger and middle-aged people in Australia. Low social empowerment was associated with low income in Australia, Thailand and Taiwan, with being aged 60 years or over in Australia, Hong Kong and South Korea, and over 50 years in Thailand. Conclusions This paper provides baseline measures for identifying where and how policy should be altered to improve the SDH. Furthermore, these data can be used for future policy evaluation to identify whether changes in policy have indeed improved the SDH, particularly for marginalised and vulnerable populations. PMID:24349417

  14. Prevalence and predictors of food allergy in Canada: a focus on vulnerable populations.

    PubMed

    Soller, Lianne; Ben-Shoshan, Moshe; Harrington, Daniel W; Knoll, Megan; Fragapane, Joseph; Joseph, Lawrence; St Pierre, Yvan; La Vieille, Sebastien; Wilson, Kathi; Elliott, Susan J; Clarke, Ann E

    2015-01-01

    Studies suggest that individuals of low education and/or income, new Canadians (immigrated <10 years ago), and individuals of Aboriginal identity may have fewer food allergies than the general population. However, given the difficulty in recruiting such populations (hereafter referred to as vulnerable populations), by using conventional survey methodologies, the prevalence of food allergy among these populations in Canada has not been estimated. To estimate the prevalence of food allergy among vulnerable populations in Canada, to compare with the nonvulnerable populations and to identify demographic characteristics predictive of food allergy. By using 2006 Canadian Census data, postal codes with high proportions of vulnerable populations were identified and households were randomly selected to participate in a telephone survey. Information on food allergies and demographics was collected. Prevalence estimates were weighted by using Census data to account for the targeted sampling. Multivariable logistic regression was used to identify predictors of food allergy. Of 12,762 eligible households contacted, 5734 households completed the questionnaire (45% response rate). Food allergy was less common among adults without postsecondary education versus those with postsecondary education (6.4% [95% CI, 5.5%-7.3%] vs 8.9% [95% CI, 7.7%-10%]) and new Canadians versus those born in Canada (3.2% [95% CI, 2.2%-4.3%] vs 8.2% [95% CI, 7.4%-9.1%]). There was no difference in prevalence between those of low and of high income or those with and without Aboriginal identity. Analysis of our data suggests that individuals of low education and new Canadians self-report fewer allergies, which may be due to genetics, environment, lack of appropriate health care, or lack of awareness of allergies, which reduces self-report. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  15. Combining demographic and genetic factors to assess population vulnerability in stream species

    USGS Publications Warehouse

    Erin L, Landguth; Muhlfeld, Clint C.; Jones, Leslie W.; Waples, Robin S.; Whited, Diane; Lowe, Winsor H.; Lucotch, John; Neville, Helen; Luikart, Gordon

    2014-01-01

    Accelerating climate change and other cumulative stressors create an urgent need to understand the influence of environmental variation and landscape features on the connectivity and vulnerability of freshwater species. Here, we introduce a novel modeling framework for aquatic systems that integrates spatially explicit, individual-based, demographic and genetic (demogenetic) assessments with environmental variables. To show its potential utility, we simulated a hypothetical network of 19 migratory riverine populations (e.g., salmonids) using a riverscape connectivity and demogenetic model (CDFISH). We assessed how stream resistance to movement (a function of water temperature, fluvial distance, and physical barriers) might influence demogenetic connectivity, and hence, population vulnerability. We present demographic metrics (abundance, immigration, and change in abundance) and genetic metrics (diversity, differentiation, and change in differentiation), and combine them into a single vulnerability index for identifying populations at risk of extirpation. We considered four realistic scenarios that illustrate the relative sensitivity of these metrics for early detection of reduced connectivity: (1) maximum resistance due to high water temperatures throughout the network, (2) minimum resistance due to low water temperatures throughout the network, (3) increased resistance at a tributary junction caused by a partial barrier, and (4) complete isolation of a tributary, leaving resident individuals only. We then applied this demogenetic framework using empirical data for a bull trout (Salvelinus confluentus) metapopulation in the upper Flathead River system, Canada and USA, to assess how current and predicted future stream warming may influence population vulnerability. Results suggest that warmer water temperatures and associated barriers to movement (e.g., low flows, dewatering) are predicted to fragment suitable habitat for migratory salmonids, resulting in the loss

  16. Environmental Health Related Socio-Spatial Inequalities: Identifying “Hotspots” of Environmental Burdens and Social Vulnerability

    PubMed Central

    Shrestha, Rehana; Flacke, Johannes; Martinez, Javier; van Maarseveen, Martin

    2016-01-01

    Differential exposure to multiple environmental burdens and benefits and their distribution across a population with varying vulnerability can contribute heavily to health inequalities. Particularly relevant are areas with high cumulative burdens and high social vulnerability termed as “hotspots”. This paper develops an index-based approach to assess these multiple burdens and benefits in combination with vulnerability factors at detailed intra-urban level. The method is applied to the city of Dortmund, Germany. Using non-spatial and spatial methods we assessed inequalities and identified “hotspot” areas in the city. We found modest inequalities burdening higher vulnerable groups in Dortmund (CI = −0.020 at p < 0.05). At the detailed intra-urban level, however, inequalities showed strong geographical patterns. Large numbers of “hotspots” exist in the northern part of the city compared to the southern part. A holistic assessment, particularly at a detailed local level, considering both environmental burdens and benefits and their distribution across the population with the different vulnerability, is essential to inform environmental justice debates and to mobilize local stakeholders. Locating “hotspot” areas at this detailed spatial level can serve as a basis to develop interventions that target vulnerable groups to ensure a health conducive equal environment. PMID:27409625

  17. Vulnerable Population Challenges in the Transformation of Cancer Care.

    PubMed

    Meneses, Karen; Landier, Wendy; Dionne-Odom, J Nicholas

    2016-05-01

    To consider current trends and future strategies that will bring about change in cancer care delivery for vulnerable populations. Institute of Medicine reports, literature review, clinical practice observations and experiences. Vulnerable populations are older adults, both minorities and the underserved, children, and individuals at end of life. These groups pose unique challenges that require health system changes and innovative nursing models to assure access to patient-centered care in the future. In the future, attention to the needs of vulnerable populations, the growing aging cancer population and the improved outcomes in the pediatric and adolescent cancer population will all require new nursing services and models of care. System changes where nursing roles are critical to support the transition to earlier palliative care are projected. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Spatial vulnerability of Australian urban populations to extreme heat events

    NASA Astrophysics Data System (ADS)

    Loughnan, Margaret; Tapper, Nigel; Phan, Thu; Lynch, Kellie; McInnes, Judith

    2013-04-01

    Extreme heat events pose a risk to the health of all individuals, especially the elderly and the chronically ill, and are associated with an increased demand for healthcare services. In order to address this problem, policy makers' need information about temperatures above which mortality and morbidity of the exposed population is likely to increase, where the vulnerable groups in the community are located, and how the risks from extreme heat events are likely to change in the future. This study identified threshold temperatures for all Australian capital cities, developed a spatial index of population vulnerability, and used climate model output to predict changes in the number of days exceeding temperature thresholds in the future, as well as changes in risk related to changes in urban density and an ageing population. The study has shown that daily maximum and minimum temperatures from the Bureau of Meteorology forecasts can be used to calculate temperature thresholds for heat alert days. The key risk factors related to adverse health outcomes were found to be areas with intense urban heat islands, areas with higher proportions of older people, and areas with ethnic communities. Maps of spatial vulnerability have been developed to provide information to assist emergency managers, healthcare professionals, and ancillary services develop heatwave preparedness plans at a local scale that target vulnerable groups and address heat-related health risks. The numbers of days exceeding current heat thresholds are predicted to increase over the next 20 to 40 years in all Australian capital cities.

  19. Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations.

    PubMed

    Richard, Lauralie; Furler, John; Densley, Konstancja; Haggerty, Jeannie; Russell, Grant; Levesque, Jean-Frederic; Gunn, Jane

    2016-04-12

    Improving access to primary healthcare (PHC) for vulnerable populations is important for achieving health equity, yet this remains challenging. Evidence of effective interventions is rather limited and fragmented. We need to identify innovative ways to improve access to PHC for vulnerable populations, and to clarify which elements of health systems, organisations or services (supply-side dimensions of access) and abilities of patients or populations (demand-side dimensions of access) need to be strengthened to achieve transformative change. The work reported here was conducted as part of IMPACT (Innovative Models Promoting Access-to-Care Transformation), a 5-year Canadian-Australian research program aiming to identify, implement and trial best practice interventions to improve access to PHC for vulnerable populations. We undertook an environmental scan as a broad screening approach to identify the breadth of current innovations from the field. We distributed a brief online survey to an international audience of PHC researchers, practitioners, policy makers and stakeholders using a combined email and social media approach. Respondents were invited to describe a program, service, approach or model of care that they considered innovative in helping vulnerable populations to get access to PHC. We used descriptive statistics to characterise the innovations and conducted a qualitative framework analysis to further examine the text describing each innovation. Seven hundred forty-four responses were recorded over a 6-week period. 240 unique examples of innovations originating from 14 countries were described, the majority from Canada and Australia. Most interventions targeted a diversity of population groups, were government funded and delivered in a community health, General Practice or outreach clinic setting. Interventions were mainly focused on the health sector and directed at organisational and/or system level determinants of access (supply-side). Few innovations

  20. Political commitment for vulnerable populations during donor transition.

    PubMed

    Rodríguez, Daniela C; Whiteside, Alan; Bennett, Sara

    2017-02-01

    The responsibilities for the programmatic, technical and financial support of health programmes are increasingly being passed from external donors to governments. Programmes for family planning, human immunodeficiency virus, immunization, malaria and tuberculosis have already faced such donor transition, which is a difficult and often political process. Wherever programmes and services aimed at vulnerable populations are primarily supported by donors, the post-transition future is uncertain. Overreliance on donor support is often a reflection of limited domestic political commitment. Limited commitment, which is frequently expressed as the persecution of vulnerable groups, poses a risk to individuals as well as to the effectiveness and sustainability of health programmes. We argue that, for reasons linked to human rights, the social contract and the cost-effectiveness of health promotion, prevention and treatment programmes, it is critical that governments sustain health services for vulnerable populations during and after donor transition. Although civil society organizations could help by engaging with government stakeholders, pushing to change social norms and supporting mechanisms that demand accountability, they may be constrained by economic, political and social factors. Vulnerable populations need to be actively involved in the planning and implementation of donor transition - to ensure that their voice and needs are taken into account and to establish a platform that improves visibility and accountability. As transitions spread across all aspects of global health, transparent conversations about the building and sustainment of political commitment for health services for vulnerable populations become a critical human rights issue.

  1. Recruiting vulnerable populations into research: a systematic review of recruitment interventions.

    PubMed

    UyBico, Stacy J; Pavel, Shani; Gross, Cary P

    2007-06-01

    Members of vulnerable populations are underrepresented in research studies. To evaluate and synthesize the evidence regarding interventions to enhance enrollment of vulnerable populations into health research studies. Studies were identified by searching MEDLINE, the Web of Science database, personal sources, hand searching of related journals, and article references. Studies that contained data on recruitment interventions for vulnerable populations (minority, underserved, poor, rural, urban, or inner city) and for which the parent study (study for which recruitment was taking place) was an intervention study were included. A total of 2,648 study titles were screened and 48 articles met inclusion criteria, representing 56 parent studies. Two investigators extracted data from each study. African Americans were the most frequently targeted population (82% of the studies), while 46% targeted Hispanics/Latinos. Many studies assessed 2 or more interventions, including social marketing (82% of studies), community outreach (80%), health system recruitment (52%), and referrals (28%). The methodologic rigor varied substantially. Only 40 studies (71%) incorporated a control group and 21% used statistical analysis to compare interventions. Social marketing, health system, and referral recruitment were each found to be the most successful intervention about 35-45% of the studies in which they were attempted, while community outreach was the most successful intervention in only 2 of 16 studies (13%) in which it was employed. People contacted as a result of social marketing were no less likely to enroll than people contacted through other mechanisms. Further work with greater methodologic rigor is needed to identify evidence-based strategies for increasing minority enrollment in research studies; community outreach, as an isolated strategy, may be less successful than other strategies.

  2. Population vulnerability to storm surge flooding in coastal Virginia, USA.

    PubMed

    Liu, Hua; Behr, Joshua G; Diaz, Rafael

    2016-07-01

    This study aims to assess the vulnerability of populations to storm surge flooding in 12 coastal localities of Virginia, USA. Population vulnerability is assessed by way of 3 physical factors (elevation, slope, and storm surge category), 3 built-up components (road availability, access to hospitals, and access to shelters), and 3 household conditions (storm preparedness, financial constraints to recovering from severe weather events, and health fragility). Fuzzy analysis is used to generate maps illustrating variation in several types of population vulnerability across the region. When considering physical factors and household conditions, the most vulnerable neighborhoods to sea level rise and storm surge flooding are largely found in urban areas. However, when considering access to critical infrastructure, we find rural residents to be more vulnerable than nonrural residents. These detailed assessments can inform both local and state governments in catastrophic planning. In addition, the methodology may be generalized to assess vulnerability in other coastal corridors and communities. The originality is highlighted by evaluating socioeconomic conditions at refined scale, incorporating a broader range of human perceptions and predispositions, and employing a geoinformatics approach combining physical, built-up, and socioeconomic conditions for population vulnerability assessment. Integr Environ Assess Manag 2016;12:500-509. © 2015 SETAC. © 2015 SETAC.

  3. Antiretroviral drug diversion links social vulnerability to poor medication adherence in substance abusing populations.

    PubMed

    Tsuyuki, Kiyomi; Surratt, Hilary L

    2015-05-01

    Antiretroviral (ARV) medication diversion to the illicit market has been documented in South Florida, and linked to sub-optimal adherence in people living with HIV. ARV diversion reflects an unmet need for care in vulnerable populations that have difficulty engaging in consistent HIV care due to competing needs and co-morbidities. This study applies the Gelberg-Andersen behavioral model of health care utilization for vulnerable populations to understand how social vulnerability is linked to ARV diversion and adherence. Cross-sectional data were collected from a targeted sample of vulnerable people living with HIV in South Florida between 2010 and 2012 (n = 503). Structured interviews collected quantitative data on ARV diversion, access and utilization of care, and ARV adherence. Logistic regression was used to estimate the goodness-of-fit of additive models that test domain fit. Linear regression was used to estimate the effects of social vulnerability and ARV diversion on ARV adherence. The best fitting model to predict ARV diversion identifies having a low monthly income and unstable HIV care as salient enabling factors that promote ARV diversion. Importantly, health care need factors did not protect against ARV diversion, evidence that immediate competing needs are prioritized even in the face of poor health for this sample. We also find that ARV diversion provides a link between social vulnerability and sub-optimal ARV adherence, with ARV diversion and domains from the Behavioral Model explaining 25 % of the variation in ARV adherence. Our analyses reveal great need to improve engagement in HIV care for vulnerable populations by strengthening enabling factors (e.g. patient-provider relationship) to improve retention in HIV care and ARV adherence for vulnerable populations.

  4. Mobile population dynamics and malaria vulnerability: a modelling study in the China-Myanmar border region of Yunnan Province, China.

    PubMed

    Chen, Tian-Mu; Zhang, Shao-Sen; Feng, Jun; Xia, Zhi-Gui; Luo, Chun-Hai; Zeng, Xu-Can; Guo, Xiang-Rui; Lin, Zu-Rui; Zhou, Hong-Ning; Zhou, Shui-Sen

    2018-04-29

    The China-Myanmar border region presents a great challenge in malaria elimination in China, and it is essential to understand the relationship between malaria vulnerability and population mobility in this region. A community-based, cross-sectional survey was performed in five villages of Yingjiang county during September 2016. Finger-prick blood samples were obtained to identify asymptomatic infections, and imported cases were identified in each village (between January 2013 and September 2016). A stochastic simulation model (SSM) was used to test the relationship between population mobility and malaria vulnerability, according to the mechanisms of malaria importation. Thirty-two imported cases were identified in the five villages, with a 4-year average of 1 case/year (range: 0-5 cases/year). No parasites were detected in the 353 blood samples from 2016. The median density of malaria vulnerability was 0.012 (range: 0.000-0.033). The average proportion of mobile members of the study population was 32.56% (range: 28.38-71.95%). Most mobile individuals lived indoors at night with mosquito protection. The SSM model fit the investigated data (χ 2  = 0.487, P = 0.485). The average probability of infection in the members of the population that moved to Myanmar was 0.011 (range: 0.0048-0.1585). The values for simulated vulnerability increased with greater population mobility in each village. A high proportion of population mobility was associated with greater malaria vulnerability in the China-Myanmar border region. Mobile population-specific measures should be used to decrease the risk of malaria re-establishment in China.

  5. Recruiting Vulnerable Populations into Research: A Systematic Review of Recruitment Interventions

    PubMed Central

    UyBico, Stacy J.; Pavel, Shani

    2007-01-01

    Background Members of vulnerable populations are underrepresented in research studies. Objective To evaluate and synthesize the evidence regarding interventions to enhance enrollment of vulnerable populations into health research studies. Data sources Studies were identified by searching MEDLINE, the Web of Science database, personal sources, hand searching of related journals, and article references. Studies that contained data on recruitment interventions for vulnerable populations (minority, underserved, poor, rural, urban, or inner city) and for which the parent study (study for which recruitment was taking place) was an intervention study were included. A total of 2,648 study titles were screened and 48 articles met inclusion criteria, representing 56 parent studies. Two investigators extracted data from each study. Results African Americans were the most frequently targeted population (82% of the studies), while 46% targeted Hispanics/Latinos. Many studies assessed 2 or more interventions, including social marketing (82% of studies), community outreach (80%), health system recruitment (52%), and referrals (28%). The methodologic rigor varied substantially. Only 40 studies (71%) incorporated a control group and 21% used statistical analysis to compare interventions. Social marketing, health system, and referral recruitment were each found to be the most successful intervention about 35–45% of the studies in which they were attempted, while community outreach was the most successful intervention in only 2 of 16 studies (13%) in which it was employed. People contacted as a result of social marketing were no less likely to enroll than people contacted through other mechanisms. Conclusions Further work with greater methodologic rigor is needed to identify evidence-based strategies for increasing minority enrollment in research studies; community outreach, as an isolated strategy, may be less successful than other strategies. PMID:17375358

  6. Protecting vulnerable populations from pandemic influenza in the United States: a strategic imperative.

    PubMed

    Hutchins, Sonja S; Truman, Benedict I; Merlin, Toby L; Redd, Stephen C

    2009-10-01

    Protecting vulnerable populations from pandemic influenza is a strategic imperative. The US national strategy for pandemic influenza preparedness and response assigns roles to governments, businesses, civic and community-based organizations, individuals, and families. Because influenza is highly contagious, inadequate preparedness or untimely response in vulnerable populations increases the risk of infection for the general population. Recent public health emergencies have reinforced the importance of preparedness and the challenges of effective response among vulnerable populations. We explore definitions and determinants of vulnerable, at-risk, and special populations and highlight approaches for ensuring that pandemic influenza preparedness includes these populations and enables them to respond appropriately. We also provide an overview of population-specific and cross-cutting articles in this theme issue on influenza preparedness for vulnerable populations.

  7. A qualitative study into the perceived barriers of accessing healthcare among a vulnerable population involved with a community centre in Romania.

    PubMed

    George, Siân; Daniels, Katy; Fioratou, Evridiki

    2018-04-03

    Minority vulnerable communities, such as the European Roma, often face numerous barriers to accessing healthcare services, resulting in negative health outcomes. Both these barriers and outcomes have been reported extensively in the literature. However, reports on barriers faced by European non-Roma native communities are limited. The "Health Care Access Barriers" (HCAB) model identifies pertinent financial, structural and cognitive barriers that can be measured and potentially modified. The present study thus aims to explore the barriers to accessing healthcare for a vulnerable population of mixed ethnicity from a charity community centre in Romania, as perceived by the centre's family users and staff members, and assess whether these reflect the barriers identified from the HCAB model. Eleven community members whose children attend the centre and seven staff members working at the centre participated in face-to-face semi-structured interviews, exploring personal experiences and views on accessing healthcare. The interviews were transcribed and analysed using an initial deductive and secondary inductive approach to identify HCAB themes and other emerging themes and subthemes. Identified themes from both groups aligned with HCAB's themes of financial, structural and cognitive barriers and emergent subthemes important to the specific population were identified. Specifically, financial barriers related mostly to health insurance and bribery issues, structural barriers related mostly to service availability and accessibility, and cognitive barriers related mostly to healthcare professionals' attitudes and discrimination and the vulnerable population's lack of education and health literacy. A unique theme of psychological barriers emerged from both groups with associated subthemes of mistrust, hopelessness, fear and anxiety of this vulnerable population. The current study highlights healthcare access barriers to a vulnerable non-Roma native population involved with a

  8. Protecting Vulnerable Populations From Pandemic Influenza in the United States: A Strategic Imperative

    PubMed Central

    Truman, Benedict I.; Merlin, Toby L.; Redd, Stephen C.

    2009-01-01

    Protecting vulnerable populations from pandemic influenza is a strategic imperative. The US national strategy for pandemic influenza preparedness and response assigns roles to governments, businesses, civic and community-based organizations, individuals, and families. Because influenza is highly contagious, inadequate preparedness or untimely response in vulnerable populations increases the risk of infection for the general population. Recent public health emergencies have reinforced the importance of preparedness and the challenges of effective response among vulnerable populations. We explore definitions and determinants of vulnerable, at-risk, and special populations and highlight approaches for ensuring that pandemic influenza preparedness includes these populations and enables them to respond appropriately. We also provide an overview of population-specific and cross-cutting articles in this theme issue on influenza preparedness for vulnerable populations. PMID:19797737

  9. Availability of Advanced Breast Imaging at Screening Facilities Serving Vulnerable Populations.

    PubMed

    Lee, Christoph I; Bogart, Andy; Germino, Jessica C; Goldman, L Elizabeth; Hubbard, Rebecca A; Haas, Jennifer S; Hill, Deirdre A; Tosteson, Anna Na; Alford-Teaster, Jennifer A; DeMartini, Wendy B; Lehman, Constance D; Onega, Tracy L

    2016-03-01

    Among vulnerable women, unequal access to advanced breast imaging modalities beyond screening mammography may lead to delays in cancer diagnosis and unfavourable outcomes. We aimed to compare on-site availability of advanced breast imaging services (ultrasound, magnetic resonance imaging [MRI], and image-guided biopsy) between imaging facilities serving vulnerable patient populations and those serving non-vulnerable populations. 73 imaging facilities across five Breast Cancer Surveillance Consortium regional registries in the United States during 2011 and 2012. We examined facility and patient characteristics across a large, national sample of imaging facilities and patients served. We characterized facilities as serving vulnerable populations based on the proportion of mammograms performed on women with lower educational attainment, lower median income, racial/ethnic minority status, and rural residence.We performed multivariable logistic regression to determine relative risks of on-site availability of advanced imaging at facilities serving vulnerable women versus facilities serving non-vulnerable women. Facilities serving vulnerable populations were as likely (Relative risk [RR] for MRI = 0.71, 95% Confidence Interval [CI] 0.42, 1.19; RR for MRI-guided biopsy = 1.07 [0.61, 1.90]; RR for stereotactic biopsy = 1.18 [0.75, 1.85]) or more likely (RR for ultrasound = 1.38 [95% CI 1.09, 1.74]; RR for ultrasound-guided biopsy = 1.67 [1.30, 2.14]) to offer advanced breast imaging services as those serving non-vulnerable populations. Advanced breast imaging services are physically available on-site for vulnerable women in the United States, but it is unknown whether factors such as insurance coverage or out-of-pocket costs might limit their use. © The Author(s) 2015.

  10. Availability of Advanced Breast Imaging at Screening Facilities Serving Vulnerable Populations

    PubMed Central

    Lee, Christoph I.; Bogart, Andy; Germino, Jessica C.; Goldman, L. Elizabeth; Hubbard, Rebecca A.; Haas, Jennifer S.; Hill, Deirdre A.; Tosteson, Anna N.A.; Alford-Teaster, Jennifer A.; DeMartini, Wendy B.; Lehman, Constance D.; Onega, Tracy L.

    2015-01-01

    Objective Among vulnerable women, unequal access to advanced breast imaging modalities beyond screening mammography may lead to delays in cancer diagnosis and unfavorable outcomes. We aimed to compare on-site availability of advanced breast imaging services (ultrasound (US), magnetic resonance imaging (MRI), and image-guided biopsy) between imaging facilities serving vulnerable patient populations and those serving non-vulnerable populations. Setting 73 United States imaging facilities across five Breast Cancer Surveillance Consortium regional registries during calendar years 2011–2012. Methods We examined facility and patient characteristics across a large, national sample of imaging facilities and patients served. We characterized facilities as serving vulnerable populations based on the proportion of mammograms performed on women with lower educational attainment, lower median income, racial/ethnic minority status, and rural residence. We performed multivariable logistic regression to determine relative risks of on-site availability of advanced imaging at facilities serving vulnerable women versus facilities serving non-vulnerable women. Results Facilities serving vulnerable populations were as likely (RR for MRI = 0.71 [95% CI 0.42, 1.19]; RR for MRI-guided biopsy = 1.07 [0.61, 1.90]; RR for stereotactic biopsy = 1.18 [0.75, 1.85]) or more likely (RR for US = 1.38 [95% CI 1.09, 1.74]; RR for US-guided biopsy = 1.67 [1.30, 2.14]) to offer advanced breast imaging services as those serving non-vulnerable populations. Conclusions Advanced breast imaging services are physically available on-site for vulnerable women in the United States, but it is unknown whether factors such as insurance coverage or out-of-pocket costs might limit their use. PMID:26078275

  11. Patterns of health care utilization among vulnerable populations in Central Texas using data from a regional health information exchange.

    PubMed

    Schiefelbein, Emily L; Olson, Jerome A; Moxham, Jamie D

    2014-02-01

    Describe patterns of health care utilization among vulnerable subgroups of an underserved population and identify populations that could benefit from interventions to reduce health care costs and improve quality of care. Health Information Exchange data focused on underserved patients was used to estimate the risk of an emergency department (ED) or inpatient (IP) visit among vulnerable patients. Approximately 20.9% of the population was vulnerable, with behavioral health being the most predominant. Homeless, disabled, and severe behavioral health patients had an increased risk of ED utilization. Behavioral health, disabled, and near elderly patients had an increased risk of IP utilization. Inpatient risk was even greater for patients with multiple vulnerabilities. Improved primary care services are needed to address both the mental and physical needs of vulnerable populations, particularly people with severe behavioral health conditions. Improved access to services may help reduce the costly burden of providing hospital-based care.

  12. 59th Medical Wing Protection of Vulnerable Populations: Ombudsman Program

    DTIC Science & Technology

    2018-04-20

    REPORT TYPE 20/04/2018 poster 4. TITLE AND SUBTITLE 59th Medical Wing Protection of Vulnerable Populations: Ombudsman Program 6. AUTHOR(S...requirements that build upon protections provided by the common rule. The purpose of this poster is to 1) describe DoD vulnerable populations-BMT, students

  13. Catholic hospital services for vulnerable populations: are system values sufficient determinants?

    PubMed

    White, Kenneth R; Chou, Tiang-Hong; Dandi, Roberto

    2010-01-01

    Catholic hospitals and health systems comprise a substantial segment of nonprofit, mission-driven, health care services, with accountability to institutional pressures of the Roman Catholic Church as well as economic pressures for solvency. Values are the way in which the organization expresses its faith-based institutional identity, which may used to select services that represent those values. The purpose of this study was to identify whether Catholic health systems' explicit values of justice or compassion (and derivatives of those words, known to have similar meaning) were associated with a greater number of system member hospitals' services aimed at vulnerable populations. Using information from Web sites of 41 Catholic health systems in 2007 and data describing their 452 hospitals from the American Hospital Association Annual Survey, the relationship of health system values with hospital services for vulnerable populations was examined while controlling for organizational, market, and demand variables. Although Catholic hospitals as a whole are more likely to provide services to vulnerable populations than to other ownership types, the results show that among Catholic hospitals, values of justice or compassion are not associated with more services (defined in this study) that reflect those values. System hospitals likely to have more services that represent the values of justice and compassion are larger, have a higher Medicaid payer mix, are located in less dense urban areas, and are members of geographically dispersed systems. Hospitals select services that may represent symbolic system values, but community need and financial means are stronger determinants. To bolster community benefit to justify tax exempt status, Catholic hospitals and systems may benefit from further defining, analyzing, and reporting the impact of access to relatively unprofitable services for previously underserved vulnerable populations.

  14. Tuberculosis in vulnerable populations in Eastern Mediterranean Region-Implications for control.

    PubMed

    Shakoor, Sadia; Hasan, Rumina

    2016-12-01

    Socially and economically disadvantaged or "vulnerable" people are at high risk of tuberculosis (TB) and also contribute to active chains of TB transmission. Included in such vulnerable populations are children, women, prisoners, people living with human immunodeficiency virus, the homeless, and displaced people. The ongoing active transmission of TB among such populations is made more difficult to assess and control by difficult access, health inequities, poverty, and other chronic and debilitating health conditions at individual, domestic, and community levels. The 22 Eastern Mediterranean Region member states encompass diverse sociopolitical and socioeconomic situations with far-reaching effects on vulnerable populations in each country, thereby threatening the control of TB. Here, we examined the impact of these populations on the incidence and transmission of TB in light of these risks. Approximately 60% of the regional population comprises children and adolescents ⩽19years of age, increasing the population at risk. Additionally, up to 11% of the population suffers from mental- or substance-abuse disorders, while >50% of the world refugee populations live in the Eastern Mediterranean Region. TB control requires a strategic approach at the country level to access these vulnerable populations. Copyright © 2016.

  15. Clinical prediction model to identify vulnerable patients in ambulatory surgery: towards optimal medical decision-making.

    PubMed

    Mijderwijk, Herjan; Stolker, Robert Jan; Duivenvoorden, Hugo J; Klimek, Markus; Steyerberg, Ewout W

    2016-09-01

    Ambulatory surgery patients are at risk of adverse psychological outcomes such as anxiety, aggression, fatigue, and depression. We developed and validated a clinical prediction model to identify patients who were vulnerable to these psychological outcome parameters. We prospectively assessed 383 mixed ambulatory surgery patients for psychological vulnerability, defined as the presence of anxiety (state/trait), aggression (state/trait), fatigue, and depression seven days after surgery. Three psychological vulnerability categories were considered-i.e., none, one, or multiple poor scores, defined as a score exceeding one standard deviation above the mean for each single outcome according to normative data. The following determinants were assessed preoperatively: sociodemographic (age, sex, level of education, employment status, marital status, having children, religion, nationality), medical (heart rate and body mass index), and psychological variables (self-esteem and self-efficacy), in addition to anxiety, aggression, fatigue, and depression. A prediction model was constructed using ordinal polytomous logistic regression analysis, and bootstrapping was applied for internal validation. The ordinal c-index (ORC) quantified the discriminative ability of the model, in addition to measures for overall model performance (Nagelkerke's R (2) ). In this population, 137 (36%) patients were identified as being psychologically vulnerable after surgery for at least one of the psychological outcomes. The most parsimonious and optimal prediction model combined sociodemographic variables (level of education, having children, and nationality) with psychological variables (trait anxiety, state/trait aggression, fatigue, and depression). Model performance was promising: R (2)  = 30% and ORC = 0.76 after correction for optimism. This study identified a substantial group of vulnerable patients in ambulatory surgery. The proposed clinical prediction model could allow healthcare

  16. Isolating social influences on vulnerability to earthquake shaking: identifying cost-effective mitigation strategies.

    NASA Astrophysics Data System (ADS)

    Bhloscaidh, Mairead Nic; McCloskey, John; Pelling, Mark; Naylor, Mark

    2013-04-01

    Until expensive engineering solutions become more universally available, the objective targeting of resources at demonstrably effective, low-cost interventions might help reverse the trend of increasing mortality in earthquakes. Death tolls in earthquakes are the result of complex interactions between physical effects, such as the exposure of the population to strong shaking, and the resilience of the exposed population along with supporting critical infrastructures and institutions. The identification of socio-economic factors that contribute to earthquake mortality is crucial to identifying and developing successful risk management strategies. Here we develop a quantitative methodology more objectively to assess the ability of communities to withstand earthquake shaking, focusing on, in particular, those cases where risk management performance appears to exceed or fall below expectations based on economic status. Using only published estimates of the shaking intensity and population exposure for each earthquake, data that is available for earthquakes in countries irrespective of their level of economic development, we develop a model for mortality based on the contribution of population exposure to shaking only. This represents an attempt to remove, as far as possible, the physical causes of mortality from our analysis (where we consider earthquake engineering to reduce building collapse among the socio-economic influences). The systematic part of the variance with respect to this model can therefore be expected to be dominated by socio-economic factors. We find, as expected, that this purely physical analysis partitions countries in terms of basic socio-economic measures, for example GDP, focusing analytical attention on the power of economic measures to explain variance in observed distributions of earthquake risk. The model allows the definition of a vulnerability index which, although broadly it demonstrates the expected income-dependence of vulnerability to

  17. GIS model for identifying urban areas vulnerable to noise pollution: case study

    NASA Astrophysics Data System (ADS)

    Bilaşco, Ştefan; Govor, Corina; Roşca, Sanda; Vescan, Iuliu; Filip, Sorin; Fodorean, Ioan

    2017-04-01

    The unprecedented expansion of the national car ownership over the last few years has been determined by economic growth and the need for the population and economic agents to reduce travel time in progressively expanding large urban centres. This has led to an increase in the level of road noise and a stronger impact on the quality of the environment. Noise pollution generated by means of transport represents one of the most important types of pollution with negative effects on a population's health in large urban areas. As a consequence, tolerable limits of sound intensity for the comfort of inhabitants have been determined worldwide and the generation of sound maps has been made compulsory in order to identify the vulnerable zones and to make recommendations how to decrease the negative impact on humans. In this context, the present study aims at presenting a GIS spatial analysis model-based methodology for identifying and mapping zones vulnerable to noise pollution. The developed GIS model is based on the analysis of all the components influencing sound propagation, represented as vector databases (points of sound intensity measurements, buildings, lands use, transport infrastructure), raster databases (DEM), and numerical databases (wind direction and speed, sound intensity). Secondly, the hourly changes (for representative hours) were analysed to identify the hotspots characterised by major traffic flows specific to rush hours. The validated results of the model are represented by GIS databases and useful maps for the local public administration to use as a source of information and in the process of making decisions.

  18. Strategic use of communication to market cancer prevention and control to vulnerable populations.

    PubMed

    Kreps, Gary L

    2008-01-01

    There are significant challenges to communicating relevant cancer prevention and control information to health care consumers due both to the complexities of the health information to be communicated and the complexities of health communication, especially with vulnerable populations. The need for effective communication about cancer risks, early detection, prevention, care, and survivorship is particularly acute, yet also tremendously complex, for reaching vulnerable populations, those groups of people who are most likely to suffer significantly higher levels of morbidity and mortality from cancers than other segments of the population. These vulnerable populations, typically the poorest, lowest educated, and most disenfranchised members of modern society, are heir to serious cancer-related health disparities. Vulnerable populations often have health literacy difficulties, cultural barriers, and economic challenges to accessing and making sense of relevant health information. This paper examines these challenges to communicating relevant information to vulnerable populations and suggests strategies for effectively using different communication media for marketing cancer prevention and control to reduce health disparities and promote public health.

  19. Assessment of iodine status and associated factors in vulnerable populations in Henan Province, China, in 2012.

    PubMed

    Yang, Jin; Zheng, Heming; Li, Xiaofeng; Zhu, Lin; Hao, Zongyu; Chen, Gan; Liu, Yang; Wang, Yanli

    2014-01-01

    Iodine content in table salt was adjusted from 30-50 mg/kg to 21-39 mg/kg from March of 2012 in Henan Province, China. The vulnerable population may be at risk of iodine deficiency. To determine whether the iodine intake was sufficient in vulnerable populations and to investigate what factors may be associated with iodine status in these vulnerable populations in Henan Province, China. A cross-sectional survey was conducted in 17 cities in Henan Province, China, from April 2012 to December 2012 to assess the iodine status in vulnerable populations, including women of reproductive-age (n=2648), pregnant women (n=39684), lactating women (n=6859), infants <2 years of age (n=16481), and children aged 8-10 years (n=3198). Questionnaires (n=4865) related to demographic and dietary factors were collected from the investigated women to identify factors that were related to iodine intake and iodine status. The median urinary iodine concentrations (mUICs) were 205 μg/L, 198 μg/L, 167 μg/L, 205 μg/L and 200 μg/L, respectively, in reproductiveage, pregnant and lactating women, infants <2 years of age and children aged 8-10 years. Higher income, and consuming more poultry and fish in the diet had positive impact on UIC levels. Low salt intake, consuming more rice and vegetables in the diet were negative factors for UIC. Iodine status of the vulnerable populations was generally adequate in Henan Province, China, according to WHO criteria. But the mUICs were slightly above the adequate level in reproductive-age women and children aged 8-10 years. It's important to monitor the iodine status in vulnerable populations after the adjustment on iodine content in table salt.

  20. Multilevel Interventions Targeting Obesity: Research Recommendations for Vulnerable Populations

    PubMed Central

    Stevens, June; Pratt, Charlotte; Boyington, Josephine; Nelson, Cheryl; Truesdale, Kimberly P.; Ward, Dianne S.; Lytle, Leslie; Sherwood, Nancy E.; Robinson, Thomas N.; Moore, Shirley; Barkin, Shari; Cheung, Ying Kuen; Murray, David M.

    2017-01-01

    Introduction The origins of obesity are complex and multifaceted. To be successful, an intervention aiming to prevent or treat obesity may need to address multiple layers of biological, social, and environmental influences. Methods NIH recognizes the importance of identifying effective strategies to combat obesity, particularly in high-risk and disadvantaged populations with heightened susceptibility to obesity and subsequent metabolic sequelae. To move this work forward, the National Heart, Lung, and Blood Institute, in collaboration with the NIH Office of Behavioral and Social Science Research and NIH Office of Disease Prevention convened a working group to inform research on multilevel obesity interventions in vulnerable populations. The working group reviewed relevant aspects of intervention planning, recruitment, retention, implementation, evaluation, and analysis, and then made recommendations. Results Recruitment and retention techniques used in multilevel research must be culturally appropriate and suited to both individuals and organizations. Adequate time and resources for preliminary work are essential. Collaborative projects can benefit from complementary areas of expertise and shared investigations rigorously pretesting specific aspects of approaches. Study designs need to accommodate the social and environmental levels under study, and include appropriate attention given to statistical power. Projects should monitor implementation in the multiple venues and include a priori estimation of the magnitude of change expected within and across levels. Conclusions The complexity and challenges of delivering interventions at several levels of the social—ecologic model require careful planning and implementation, but hold promise for successful reduction of obesity in vulnerable populations. PMID:28340973

  1. Vulnerable populations in an American Red Cross shelter after Hurricane Katrina.

    PubMed

    Saunders, Judith M

    2007-02-01

    During Katrina, people suddenly encountered multiple losses, including homes, finances, medications, and death of loved ones. The Model of Vulnerable Populations illustrates how reduced resources placed individuals at greater risk for harm. Using vignettes and the Model of Vulnerable Populations, a psychiatric nurse discusses her experiences as an American Red Cross psychiatric/mental health nurse volunteer after the Katrina disaster at a Mississippi shelter. The role of the mental health nurse volunteer was demonstrated by assessment and interventions of advocacy, referral, crisis intervention, and general support and education. Using the Model of Vulnerable Populations, psychiatric nurses can improve mental health assessment and services by counseling, advocacy, triage, and teaching disease prevention strategies such as hand washing.

  2. Disaster planning for vulnerable populations: leveraging Community Human Service Organizations direct service delivery personnel.

    PubMed

    Levin, Karen L; Berliner, Maegan; Merdjanoff, Alexis

    2014-01-01

    Given the variability, complexities, and available resources for local vulnerable populations, it is clear that preparing effectively for catastrophic events cannot be accomplished with a single, simple template. Inclusion of Community Human Service Organizations' (CHSO's) direct service delivery personnel ensures that emergency disaster planning efforts for vulnerable populations are effective and responsive to unique needs and constraints. By leveraging existing local resources, it extends the preparedness system's reach to the whole community. CHSO personnel already perform community-based services and directly engage with vulnerable and special needs populations; typically they are on the front lines during an emergency event. Generally, however, the CHSOs, staff, and clients are neither adequately prepared for disasters nor well integrated into emergency systems. To address preparedness gaps identified during Hurricane Sandy, regional CHSO and local health department partners requested that the Columbia Regional Learning Center provide preparedness trainings for their agencies and staff responsible for vulnerable clients. Evaluation of this initiative was begun with a mixed-methods approach consisting of collaborative learning activities, a function-based assessment tool, and a 5 Steps to Preparedness module. Results from a survey were inclusive because of a low response rate but suggested satisfaction with the training format and content; increases in awareness of a client preparedness role; and steps toward improved personal, agency, and client preparedness. Direct service delivery personnel can leverage routine client interactions for preparedness planning and thus can contribute significantly to vulnerable population and community disaster readiness. Trainings that provide preparedness tools can help support this role. CHSO personnel are knowledgeable and have the expertise to assist clients in personal preparedness planning; yet, there are challenges

  3. Cost-effectiveness analysis of HPV vaccination: comparing the general population with socially vulnerable individuals.

    PubMed

    Han, Kyu-Tae; Kim, Sun Jung; Lee, Seo Yoon; Park, Eun-Cheol

    2014-01-01

    After the WHO recommended HPV vaccination of the general population in 2009, government support of HPV vaccination programs was increased in many countries. However, this policy was not implemented in Korea due to perceived low cost-effectiveness. Thus, the aim of this study was to analyze the cost-utility of HPV vaccination programs targeted to high risk populations as compared to vaccination programs for the general population. Each study population was set to 100,000 people in a simulation study to determine the incremental cost-utility ratio (ICUR), then standard prevalence rates, cost, vaccination rates, vaccine efficacy, and the Quality-Adjusted Life-Years (QALYs) were applied to the analysis. In addition, sensitivity analysis was performed by assuming discounted vaccination cost. In the socially vulnerable population, QALYs gained through HPV vaccination were higher than that of the general population (General population: 1,019, Socially vulnerable population: 5,582). The results of ICUR showed that the cost of HPV vaccination was higher for the general population than the socially vulnerable population. (General population: 52,279,255 KRW, Socially vulnerable population: 9,547,347 KRW). Compared with 24 million KRW/QALYs as the social threshold, vaccination of the general population was not cost-effective. In contrast, vaccination of the socially vulnerable population was strongly cost-effective. The results suggest the importance and necessity of government support of HPV vaccination programs targeted to socially vulnerable populations because a targeted approach is much more cost-effective. The implementation of government support for such vaccination programs is a critical strategy for decreasing the burden of HPV infection in Korea.

  4. Multilevel Interventions Targeting Obesity: Research Recommendations for Vulnerable Populations.

    PubMed

    Stevens, June; Pratt, Charlotte; Boyington, Josephine; Nelson, Cheryl; Truesdale, Kimberly P; Ward, Dianne S; Lytle, Leslie; Sherwood, Nancy E; Robinson, Thomas N; Moore, Shirley; Barkin, Shari; Cheung, Ying Kuen; Murray, David M

    2017-01-01

    The origins of obesity are complex and multifaceted. To be successful, an intervention aiming to prevent or treat obesity may need to address multiple layers of biological, social, and environmental influences. NIH recognizes the importance of identifying effective strategies to combat obesity, particularly in high-risk and disadvantaged populations with heightened susceptibility to obesity and subsequent metabolic sequelae. To move this work forward, the National Heart, Lung, and Blood Institute, in collaboration with the NIH Office of Behavioral and Social Science Research and NIH Office of Disease Prevention convened a working group to inform research on multilevel obesity interventions in vulnerable populations. The working group reviewed relevant aspects of intervention planning, recruitment, retention, implementation, evaluation, and analysis, and then made recommendations. Recruitment and retention techniques used in multilevel research must be culturally appropriate and suited to both individuals and organizations. Adequate time and resources for preliminary work are essential. Collaborative projects can benefit from complementary areas of expertise and shared investigations rigorously pretesting specific aspects of approaches. Study designs need to accommodate the social and environmental levels under study, and include appropriate attention given to statistical power. Projects should monitor implementation in the multiple venues and include a priori estimation of the magnitude of change expected within and across levels. The complexity and challenges of delivering interventions at several levels of the social-ecologic model require careful planning and implementation, but hold promise for successful reduction of obesity in vulnerable populations. Copyright © 2016. Published by Elsevier Inc.

  5. The ethics and regulatory landscape of including vulnerable populations in pragmatic clinical trials

    PubMed Central

    Welch, Mary Jane; Lally, Rachel; Miller, Jennifer E; Pittman, Stephanie; Brodsky, Lynda; Caplan, Arthur L; Uhlenbrauck, Gina; Louzao, Darcy M; Fischer, James H; Wilfond, Benjamin

    2015-01-01

    Policies have been developed to protect vulnerable populations in clinical research, particularly the US federal research regulations (45 CFR 46 subparts B, C, and D). These policies generally recognize vulnerable populations to include pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons. The aim has been to protect these populations from harm, often by creating regulatory and ethical checks that may limit their participation in many clinical trials. The recent increase in pragmatic clinical trials (PCTs) raises at least two questions about this approach. First, is exclusion itself a harm to vulnerable populations, as these groups may be denied access to understanding how health interventions work for them in clinical settings? Second, are groups considered vulnerable in traditional clinical trials also vulnerable in PCTs? We argue first, that excluding vulnerable subjects from participation in PCTs can be harmful by preventing acquisition of data to meaningfully inform clinical decision-making in the future. Second, we argue that protections for vulnerable subjects in traditional clinical trial settings may not be translatable, feasible, or even ethical to apply in PCTs. We conclude by offering specific recommendations for appropriately protecting vulnerable research subjects in PCTs, focusing on pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons. PMID:26374681

  6. The ethics and regulatory landscape of including vulnerable populations in pragmatic clinical trials.

    PubMed

    Welch, Mary Jane; Lally, Rachel; Miller, Jennifer E; Pittman, Stephanie; Brodsky, Lynda; Caplan, Arthur L; Uhlenbrauck, Gina; Louzao, Darcy M; Fischer, James H; Wilfond, Benjamin

    2015-10-01

    Policies have been developed to protect vulnerable populations in clinical research, including the US federal research regulations (45 Code of Federal Regulations 46 Subparts B, C, and D). These policies generally recognize vulnerable populations to include pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons. The aim has been to protect these populations from harm, often by creating regulatory and ethical checks that may limit their participation in many clinical trials. The recent increase in pragmatic clinical trials raises at least two questions about this approach. First, is exclusion itself a harm to vulnerable populations, as these groups may be denied access to understanding how health interventions work for them in clinical settings? Second, are groups considered vulnerable in traditional clinical trials also vulnerable in pragmatic clinical trials? We argue first that excluding vulnerable subjects from participation in pragmatic clinical trials can be harmful by preventing acquisition of data to meaningfully inform clinical decision-making in the future. Second, we argue that protections for vulnerable subjects in traditional clinical trial settings may not be translatable, feasible, or even ethical to apply in pragmatic clinical trials. We conclude by offering specific recommendations for appropriately protecting vulnerable research subjects in pragmatic clinical trials, focusing on pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons. © The Author(s) 2015.

  7. [Tuberculosis among the socially vulnerable populations; perspectives from human security concept].

    PubMed

    Ishikawa, Nobukatsu

    2009-07-01

    Tuberculosis (TB) has been and will continue to be the disease of the poor and the socially vulnerable. Current TB epidemiology in Japan shows increasing proportion of TB among the economically and socially poor or vulnerable populations. Though there is no universally recognized set of the definitions, the economically poor who are covered under the social security services including the homeless, foreign migrants, or the aged over 80 years may be considered as consisting the "socially vulnerable population" for TB in Japan. TB among the socially vulnerable has several characteristics, for example, patients are often detected with severe conditions due to delayed diagnosis, and have high defaulter rate during treatment, which causes immature death, or drug-resistant disease. Stop TB Strategy by WHO, responding to the Millennium Development Goals, proposes a new approach which focuses on empowering the patients and the community. Observations from various studies show that DOTS contributes to empowering the patients and the communities. Further effort will be needed to reorient TB programs towards the perspective of patients' empowerment. Solely relying on static analyses of TB among the socially vulnerable has its limitations. Dynamic approach, which utilizes human security concepts such as empowerment and patients' perspective, will be required not only to control TB among the socially vulnerable population but also to holistically tackle the problem of TB for Japan.

  8. Social network characteristics and HIV vulnerability among transgender persons in San Salvador: identifying opportunities for HIV prevention strategies.

    PubMed

    Barrington, Clare; Wejnert, Cyprian; Guardado, Maria Elena; Nieto, Ana Isabel; Bailey, Gabriela Paz

    2012-01-01

    The purpose of this study is to improve understanding of HIV vulnerability and opportunities for HIV prevention within the social networks of male-to-female transgender persons in San Salvador, El Salvador. We compare HIV prevalence and behavioral data from a sample of gay-identified men who have sex with men (MSM) (n = 279), heterosexual or bisexual identified MSM (n = 229) and transgender persons (n = 67) recruited using Respondent Driven Sampling. Transgender persons consistently reported higher rates of HIV risk behavior than the rest of the study population and were significantly more likely to be involved in sex work. While transgender persons reported the highest rates of exposure to HIV educational activities they had the lowest levels of HIV-related knowledge. Transgender respondents' social networks were homophilous and efficient at recruiting other transgender persons. Findings suggest that transgender social networks could provide an effective and culturally relevant opportunity for HIV prevention efforts in this vulnerable population.

  9. Social Network Characteristics and HIV Vulnerability Among Transgender Persons in San Salvador: Identifying Opportunities for HIV Prevention Strategies

    PubMed Central

    Barrington, Clare; Wejnert, Cyprian; Guardado, Maria Elena; Nieto, Ana Isabel; Bailey, Gabriela Paz

    2013-01-01

    The purpose of this study is to improve understanding of HIV vulnerability and opportunities for HIV prevention within the social networks of male-to-female transgender persons in San Salvador, El Salvador. We compare HIV prevalence and behavioral data from a sample of gay-identified men who have sex with men (MSM) (n = 279), heterosexual or bisexual identified MSM (n = 229) and transgender persons (n = 67) recruited using Respondent Driven Sampling. Transgender persons consistently reported higher rates of HIV risk behavior than the rest of the study population and were significantly more likely to be involved in sex work. While transgender persons reported the highest rates of exposure to HIV educational activities they had the lowest levels of HIV-related knowledge. Transgender respondents’ social networks were homophilous and efficient at recruiting other transgender persons. Findings suggest that transgender social networks could provide an effective and culturally relevant opportunity for HIV prevention efforts in this vulnerable population. PMID:21538082

  10. Secondary Surge Capacity: A Framework for Understanding Long-Term Access to Primary Care for Medically Vulnerable Populations in Disaster Recovery

    PubMed Central

    Brock-Martin, Amy; Karmaus, Wilfried; Svendsen, Erik R.

    2012-01-01

    Disasters create a secondary surge in casualties because of the sudden increased need for long-term health care. Surging demands for medical care after a disaster place excess strain on an overtaxed health care system operating at maximum or reduced capacity. We have applied a health services use model to identify areas of vulnerability that perpetuate health disparities for at-risk populations seeking care after a disaster. We have proposed a framework to understand the role of the medical system in modifying the health impact of the secondary surge on vulnerable populations. Baseline assessment of existing needs and the anticipation of ballooning chronic health care needs following the acute response for at-risk populations are overlooked vulnerability gaps in national surge capacity plans. PMID:23078479

  11. Collecting data to evaluate the effect of health policies on vulnerable populations.

    PubMed

    Bindman, A B; Grumbach, K; Keane, D; Lurie, N

    1993-02-01

    Public health policies often have disproportionate effects on the poor and other vulnerable groups. Standard survey techniques are often difficult to apply to these vulnerable populations, and many data bases systematically omit such individuals. The purpose of this paper is to review our experience in collecting primary survey data from public hospital, mentally ill, HIV-infected, and non-English-speaking patients. Important issues in conducting research on these populations include proper selection of subjects and comparison groups and difficulties involved in recruitment and enrollment of subjects. Maintaining longitudinal data on these populations is difficult and often requires tracking, secondary contacts, home visits and community outreach, and the use of organizations, institutions, and networks. Investigators must also pay careful attention to ethical issues involved in conducting research on vulnerable populations.

  12. Use of modeling to identify vulnerabilities to human error in laparoscopy.

    PubMed

    Funk, Kenneth H; Bauer, James D; Doolen, Toni L; Telasha, David; Nicolalde, R Javier; Reeber, Miriam; Yodpijit, Nantakrit; Long, Myra

    2010-01-01

    This article describes an exercise to investigate the utility of modeling and human factors analysis in understanding surgical processes and their vulnerabilities to medical error. A formal method to identify error vulnerabilities was developed and applied to a test case of Veress needle insertion during closed laparoscopy. A team of 2 surgeons, a medical assistant, and 3 engineers used hierarchical task analysis and Integrated DEFinition language 0 (IDEF0) modeling to create rich models of the processes used in initial port creation. Using terminology from a standardized human performance database, detailed task descriptions were written for 4 tasks executed in the process of inserting the Veress needle. Key terms from the descriptions were used to extract from the database generic errors that could occur. Task descriptions with potential errors were translated back into surgical terminology. Referring to the process models and task descriptions, the team used a modified failure modes and effects analysis (FMEA) to consider each potential error for its probability of occurrence, its consequences if it should occur and be undetected, and its probability of detection. The resulting likely and consequential errors were prioritized for intervention. A literature-based validation study confirmed the significance of the top error vulnerabilities identified using the method. Ongoing work includes design and evaluation of procedures to correct the identified vulnerabilities and improvements to the modeling and vulnerability identification methods. Copyright 2010 AAGL. Published by Elsevier Inc. All rights reserved.

  13. Humanitarian responses to mass violence perpetrated against vulnerable populations.

    PubMed Central

    Gellert, G. A.

    1995-01-01

    This multidisciplinary review links three areas of legitimate inquiry for practitioners of medicine and public health. The first is occurrences of mass violence or genocide perpetrated against vulnerable populations, with a focus on the failure of national and international mechanisms to prevent or predict such violence. The second is evolving concepts of national sovereignty and an emerging framework in which the imperative to assist vulnerable populations supersedes a state's right to self determination. The last is how medical, public health, and other systems of surveillance and rapid assessment of mass violence can accelerate public awareness and facilitate structured, consistent political decision making to prevent mass violence and to provide international humanitarian assistance. Images p1000-a PMID:7580643

  14. Identifying typical patterns of vulnerability: A 5-step approach based on cluster analysis

    NASA Astrophysics Data System (ADS)

    Sietz, Diana; Lüdeke, Matthias; Kok, Marcel; Lucas, Paul; Carsten, Walther; Janssen, Peter

    2013-04-01

    Specific processes that shape the vulnerability of socio-ecological systems to climate, market and other stresses derive from diverse background conditions. Within the multitude of vulnerability-creating mechanisms, distinct processes recur in various regions inspiring research on typical patterns of vulnerability. The vulnerability patterns display typical combinations of the natural and socio-economic properties that shape a systems' vulnerability to particular stresses. Based on the identification of a limited number of vulnerability patterns, pattern analysis provides an efficient approach to improving our understanding of vulnerability and decision-making for vulnerability reduction. However, current pattern analyses often miss explicit descriptions of their methods and pay insufficient attention to the validity of their groupings. Therefore, the question arises as to how do we identify typical vulnerability patterns in order to enhance our understanding of a systems' vulnerability to stresses? A cluster-based pattern recognition applied at global and local levels is scrutinised with a focus on an applicable methodology and practicable insights. Taking the example of drylands, this presentation demonstrates the conditions necessary to identify typical vulnerability patterns. They are summarised in five methodological steps comprising the elicitation of relevant cause-effect hypotheses and the quantitative indication of mechanisms as well as an evaluation of robustness, a validation and a ranking of the identified patterns. Reflecting scale-dependent opportunities, a global study is able to support decision-making with insights into the up-scaling of interventions when available funds are limited. In contrast, local investigations encourage an outcome-based validation. This constitutes a crucial step in establishing the credibility of the patterns and hence their suitability for informing extension services and individual decisions. In this respect, working at

  15. Promoting an egalitarian approach to research with vulnerable populations of women.

    PubMed

    Mkandawire-Valhmu, Lucy; Rice, Elizabeth; Bathum, Mary Elizabeth

    2009-08-01

    This paper is a presentation of issues that arise when conducting research with women from vulnerable populations. Conducting research with ethnic minority populations has accentuated the challenges inherent in research, particularly when the populations participating are considered 'vulnerable' due to additional variables such as low levels of income. The paper is based on the experiences of three authors using feminist methods in separate but similar research trajectories that include (a) low-income women in the Southern African country of Malawi, (b) women diagnosed with schizophrenia in the United States of America, and (c) rural, indigenous Aymara women of the highlands of Peru. The data forming the basis of this paper were collected over 3- to 6-month periods between 2005 and 2006. We examine the impact of the researcher's power on the research process. Our research provides examples that illuminate the limitations of informed consent in research with vulnerable populations of women. We offer critical questions about and recommendations for nursing and other health care researchers, both in the third world and the western world, regarding appropriate research methods with vulnerable populations: methods that acknowledge the oppressive realities of the participants, methods that deliberately avoid further marginalization of participants, and methods that have the potential to improve the life situations of the women who participate in our research. These examples show the need for new methods to ensure that participants in research understand their role and the benefits they may expect to receive from research.

  16. Cutaneous nodules in Irrawaddy dolphins: an emerging disease in vulnerable populations.

    PubMed

    Van Bressem, Marie-Francoise; Minton, Gianna; Sutaria, Dipani; Kelkar, Nachiket; Peter, Cindy; Zulkarnaen, Mohammad; Mansur, Rubaiyat M; Porter, Lindsay; Vargas, Luz H; Rajamani, Leela

    2014-01-16

    The presence of cutaneous nodules is reported in vulnerable populations of Irrawaddy dolphins Orcaella brevirostris from Malaysia (Kuching, Bintulu-Similajau, Kinabatangan-Segama and Penang Island), India (Chilika Lagoon) and Bangladesh (Sundarbans). Approximately 5700 images taken for photo-identification studies in 2004 to 2013 were examined for skin disorders. Nodules were detected in 6 populations. They appeared as circumscribed elevations of the skin and varied in size from 2 to >30 mm, were sparse or numerous and occurred on all visible body areas. In 8 photo-identified (PI) dolphins from India and Malaysia, the lesions remained stable (N = 2) or progressed (N = 6) over months but did not regress. The 2 most severely affected individuals were seen in Kuching and the Chilika Lagoon. Their fate is unknown. Cutaneous nodules were sampled in a female that died in a gillnet in Kuching in 2012. Histologically, the lesions consisted of thick collagen bundles covered by a moderately hyperplasic epithelium and were diagnosed as fibropapillomas. Whether the nodules observed in the other O. brevirostris were also fibropapillomas remains to be investigated. Disease prevalence ranged from 2.2% (N = 46; Bintulu-Similajau) to 13.9% (N = 72; Chilika) in 4 populations from Malaysia and India. It was not significantly different in 3 study areas in eastern Malaysia. In Chilika, prevalence was significantly higher (p = 0.00078) in 2009 to 2011 (13.9%) than in 2004 to 2006 (2.8%) in 72 PI dolphins. The emergence of a novel disease in vulnerable O. brevirostris populations is of concern.

  17. Tsunami survivors' perspectives on vulnerability and vulnerability reduction: evidence from Koh Phi Phi Don and Khao Lak, Thailand.

    PubMed

    Steckley, Marylynn; Doberstein, Brent

    2011-07-01

    This paper presents the results of primary research with 40 survivors of the 2004 Indian Ocean tsunami in two communities: Khao Lak (n=20) and Koh Phi Phi Don (n=20), Thailand. It traces tsunami survivors' perceptions of vulnerability, determines whether residents felt that the tsunami affected different communities differently, identifies the populations and sub-community groups that survivors distinguished as being more vulnerable than others, highlights community-generated ideas about vulnerability reduction, and pinpoints a range of additional vulnerability reduction actions. Tsunami survivors most consistently identified the 'most vulnerable' community sub-populations as women, children, the elderly, foreigners, and the poor. In Khao Lak, however, respondents added 'Burmese migrants' to this list, whereas in Koh Phi Phi Don, they added 'Thai Muslims'. Results suggest that the two case study communities, both small, coastal, tourism-dominated communities no more than 100 kilometres apart, have differing vulnerable sub-groups and environmental vulnerabilities, requiring different post-disaster vulnerability reduction efforts. © 2011 The Author(s). Disasters © Overseas Development Institute, 2011.

  18. Strategies for expanding health insurance coverage in vulnerable populations.

    PubMed

    Jia, Liying; Yuan, Beibei; Huang, Fei; Lu, Ying; Garner, Paul; Meng, Qingyue

    2014-11-26

    evaluated the effects of strategies on increasing health insurance coverage for vulnerable populations. We defined strategies as measures to improve the enrolment of vulnerable populations into health insurance schemes. Two categories and six specified strategies were identified as the interventions. At least two review authors independently extracted data and assessed the risk of bias. We undertook a structured synthesis. We included two studies, both from the United States. People offered health insurance information and application support by community-based case managers were probably more likely to enrol their children into health insurance programmes (risk ratio (RR) 1.68, 95% confidence interval (CI) 1.44 to 1.96, moderate quality evidence) and were probably more likely to continue insuring their children (RR 2.59, 95% CI 1.95 to 3.44, moderate quality evidence). Of all the children that were insured, those in the intervention group may have been insured quicker (47.3 fewer days, 95% CI 20.6 to 74.0 fewer days, low quality evidence) and parents may have been more satisfied on average (satisfaction score average difference 1.07, 95% CI 0.72 to 1.42, low quality evidence).In the second study applications were handed out in emergency departments at hospitals, compared to not handing out applications, and may have had an effect on enrolment (RR 1.5, 95% CI 1.03 to 2.18, low quality evidence). Community-based case managers who provide health insurance information, application support, and negotiate with the insurer probably increase enrolment of children in health insurance schemes. However, the transferability of this intervention to other populations or other settings is uncertain. Handing out insurance application materials in hospital emergency departments may help increase the enrolment of children in health insurance schemes. Further studies evaluating the effectiveness of different strategies for expanding health insurance coverage in vulnerable population are

  19. Animal Ownership Among Vulnerable Populations in Regional South Australia: Implications for Natural Disaster Preparedness and Resilience.

    PubMed

    Thompson, Kirrilly; Trigg, Joshua; Smith, Bradley

    Few studies have examined the prevalence of animal ownership among populations likely to be at greater risk from disaster events within a bushfire context. To investigate the proportion of vulnerable community members keeping animals and the types of animals kept, as well as perceived risk of harm to pets, and their inclusion in bushfire survival planning. Statewide anonymous online survey in 2014 of adult South Australian animal owners threatened by bushfire in January 2014. Respondents were asked about animal ownership, their bushfire risk perception, and household survival planning. Descriptive statistics are presented for 5 groups considered likely to contribute to increased risk of harm for households: linguistically diverse, older adults, families with young children, physically frail, and self-identifying disabled, as well as individuals with mental health considerations. An opt-in purposively targeted sample of anonymous South Australians living in high fire-risk locations. Adult South Australian animal owners threatened or directly impacted by bushfire events, including individuals matching 1 of the 5 vulnerable groups. Self-reported details of animal ownership, perceived fire risk, survival planning, and vulnerability characteristics. Animal ownership was found to be more prevalent in these 5 populations than in the wider South Australian population. Perceived risk to pets was low to moderately low in these individuals. Variation was observed in the role of animals generally and pets specifically as motivators for preparing bushfire survival plans. Emergency services and associated agencies need to consider how the unique needs of vulnerable populations that keep animals, and their potential differences in risk perception, relate to their bushfire survival planning and preparedness requirements.

  20. Defining Population Health Vulnerability Following an Extreme Weather Event in an Urban Pacific Island Environment: Honiara, Solomon Islands.

    PubMed

    Natuzzi, Eileen S; Joshua, Cynthia; Shortus, Matthew; Reubin, Reginald; Dalipanda, Tenneth; Ferran, Karen; Aumua, Audrey; Brodine, Stephanie

    2016-08-03

    Extreme weather events are common and increasing in intensity in the southwestern Pacific region. Health impacts from cyclones and tropical storms cause acute injuries and infectious disease outbreaks. Defining population vulnerability to extreme weather events by examining a recent flood in Honiara, Solomon Islands, can help stakeholders and policymakers adapt development to reduce future threats. The acute and subacute health impacts following the April 2014 floods were defined using data obtained from hospitals and clinics, the Ministry of Health and in-country World Health Organization office in Honiara. Geographical information system (GIS) was used to assess morbidity and mortality, and vulnerability of the health system infrastructure and households in Honiara. The April flash floods were responsible for 21 acute deaths, 33 injuries, and a diarrhea outbreak that affected 8,584 people with 10 pediatric deaths. A GIS vulnerability assessment of the location of the health system infrastructure and households relative to rivers and the coastline identified 75% of the health infrastructure and over 29% of Honiara's population as vulnerable to future hydrological events. Honiara, Solomon Islands, is a rapidly growing, highly vulnerable urban Pacific Island environment. Evaluation of the mortality and morbidity from the April 2014 floods as well as the infectious disease outbreaks that followed allows public health specialists and policy makers to understand the health system and populations vulnerability to future shocks. Understanding the negative impacts natural disaster have on people living in urban Pacific environments will help the government as well as development partners in crafting resilient adaptation development. © The American Society of Tropical Medicine and Hygiene.

  1. Defining Population Health Vulnerability Following an Extreme Weather Event in an Urban Pacific Island Environment: Honiara, Solomon Islands

    PubMed Central

    Natuzzi, Eileen S.; Joshua, Cynthia; Shortus, Matthew; Reubin, Reginald; Dalipanda, Tenneth; Ferran, Karen; Aumua, Audrey; Brodine, Stephanie

    2016-01-01

    Extreme weather events are common and increasing in intensity in the southwestern Pacific region. Health impacts from cyclones and tropical storms cause acute injuries and infectious disease outbreaks. Defining population vulnerability to extreme weather events by examining a recent flood in Honiara, Solomon Islands, can help stakeholders and policymakers adapt development to reduce future threats. The acute and subacute health impacts following the April 2014 floods were defined using data obtained from hospitals and clinics, the Ministry of Health and in-country World Health Organization office in Honiara. Geographical information system (GIS) was used to assess morbidity and mortality, and vulnerability of the health system infrastructure and households in Honiara. The April flash floods were responsible for 21 acute deaths, 33 injuries, and a diarrhea outbreak that affected 8,584 people with 10 pediatric deaths. A GIS vulnerability assessment of the location of the health system infrastructure and households relative to rivers and the coastline identified 75% of the health infrastructure and over 29% of Honiara's population as vulnerable to future hydrological events. Honiara, Solomon Islands, is a rapidly growing, highly vulnerable urban Pacific Island environment. Evaluation of the mortality and morbidity from the April 2014 floods as well as the infectious disease outbreaks that followed allows public health specialists and policy makers to understand the health system and populations vulnerability to future shocks. Understanding the negative impacts natural disaster have on people living in urban Pacific environments will help the government as well as development partners in crafting resilient adaptation development. PMID:27091867

  2. [Information hygiene and regulation of information for vulnerable groups of the population].

    PubMed

    Denisov, E I; Eremin, A L; Sivochalova, O V; Kurerov, N N

    2014-01-01

    Development of information society engenders the problem of hygienic regulation of information load for the population, first of all for vulnerable groups. There are presented international and Russian normative legal documents and experience in this area, there are described the negative effects of information (such as stress, depression, suicidal ideations). There are considered social-psychological characteristics of vulnerable groups that requires their best protection from loads of information, doing harm, particularly in terms of reproductive health, family relationships, children, etc. There was noted the desirability of improvement of sanitary, legislation on the regulation of the information load on the population, especially in vulnerable groups, in terms of optimization of parameters of the signal-carriers on volume, brightness and the adequacy of the volume and content of information in radio and television broadcasting, in an urban environment and at the plant to preserve the health and well-being of the population.

  3. Applying mixed reality to simulate vulnerable populations for practicing clinical communication skills.

    PubMed

    Chuah, Joon Hao; Lok, Benjamin; Black, Erik

    2013-04-01

    Health sciences students often practice and are evaluated on interview and exam skills by working with standardized patients (people that role play having a disease or condition). However, standardized patients do not exist for certain vulnerable populations such as children and the intellectually disabled. As a result, students receive little to no exposure to vulnerable populations before becoming working professionals. To address this problem and thereby increase exposure to vulnerable populations, we propose using virtual humans to simulate members of vulnerable populations. We created a mixed reality pediatric patient that allowed students to practice pediatric developmental exams. Practicing several exams is necessary for students to understand how to properly interact with and correctly assess a variety of children. Practice also increases a student's confidence in performing the exam. Effective practice requires students to treat the virtual child realistically. Treating the child realistically might be affected by how the student and virtual child physically interact, so we created two object interaction interfaces - a natural interface and a mouse-based interface. We tested the complete mixed reality exam and also compared the two object interaction interfaces in a within-subjects user study with 22 participants. Our results showed that the participants accepted the virtual child as a child and treated it realistically. Participants also preferred the natural interface, but the interface did not affect how realistically participants treated the virtual child.

  4. Developing an online tool for identifying at-risk populations to wildfire smoke hazards.

    PubMed

    Vaidyanathan, Ambarish; Yip, Fuyuen; Garbe, Paul

    2018-04-01

    Wildfire episodes pose a significant public health threat in the United States. Adverse health impacts associated with wildfires occur near the burn area as well as in places far downwind due to wildfire smoke exposures. Health effects associated with exposure to particulate matter arising from wildfires can range from mild eye and respiratory tract irritation to more serious outcomes such as asthma exacerbation, bronchitis, and decreased lung function. Real-time operational forecasts of wildfire smoke concentrations are available but they are not readily integrated with information on vulnerable populations necessary to identify at-risk communities during wildfire smoke episodes. Efforts are currently underway at the Centers for Disease Control and Prevention (CDC) to develop an online tool that utilizes short-term predictions and forecasts of smoke concentrations and integrates them with measures of population-level vulnerability for identifying at-risk populations to wildfire smoke hazards. The tool will be operationalized on a national scale, seeking input and assistance from several academic, federal, state, local, Tribal, and Territorial partners. The final product will then be incorporated into CDC's National Environmental Public Health Tracking Network (http://ephtracking.cdc.gov), providing users with access to a suite of mapping and display functionalities. A real-time vulnerability assessment tool incorporating standardized health and exposure datasets, and prevention guidelines related to wildfire smoke hazards is currently unavailable for public health practitioners and emergency responders. This tool could strengthen existing situational awareness competencies, and expedite future response and recovery efforts during wildfire episodes. Published by Elsevier B.V.

  5. Determinants of physician utilization, emergency room use, and hospitalizations among populations with multiple health vulnerabilities.

    PubMed

    Small, La Fleur F

    2011-09-01

    Understanding the factors that influence differing types of health care utilization within vulnerable groups can serve as a basis for projecting future health care needs, forecasting future health care expenditures, and influencing social policy. In this article the Behavioral Model for Vulnerable Populations is used to evaluate discretionary (physician visits) and non-discretionary (emergency room visits, and hospitalizations) health utilization patterns of a sample of 1466 respondents with one or more vulnerable health classification. Reported vulnerabilities include: (1) persons with substance disorders; (2) homeless persons; (3) persons with mental health problems; (4) victims of violent crime; (5) persons diagnosed with HIV/AIDS; (6) and persons in receipt of public benefits. Hierarchical logistic regression is used on three nested models to model factors that influence physician visits, emergency room visits, and hospitalizations. Additionally, bivariate logistic regression analyses are completed using a vulnerability index to evaluate the impact of increased numbers of vulnerability on all three forms of health care utilization. Findings from this study suggest the Behavioral Model of Vulnerable Populations be employed in future research regarding health care utilization patterns among vulnerable populations. This article encourages further research investigating the cumulative effect of health vulnerabilities on the use of non-discretionary services so that this behavior could be better understood and appropriate social policies and behavioral interventions implemented.

  6. A spatial analysis of population dynamics and climate change in Africa: potential vulnerability hot spots emerge where precipitation declines and demographic pressures coincide

    USGS Publications Warehouse

    López-Carr, David; Pricope, Narcisa G.; Aukema, Juliann E.; Jankowska, Marta M.; Funk, Christopher C.; Husak, Gregory J.; Michaelsen, Joel C.

    2014-01-01

    We present an integrative measure of exposure and sensitivity components of vulnerability to climatic and demographic change for the African continent in order to identify “hot spots” of high potential population vulnerability. Getis-Ord Gi* spatial clustering analyses reveal statistically significant locations of spatio-temporal precipitation decline coinciding with high population density and increase. Statistically significant areas are evident, particularly across central, southern, and eastern Africa. The highly populated Lake Victoria basin emerges as a particularly salient hot spot. People located in the regions highlighted in this analysis suffer exceptionally high exposure to negative climate change impacts (as populations increase on lands with decreasing rainfall). Results may help inform further hot spot mapping and related research on demographic vulnerabilities to climate change. Results may also inform more suitable geographical targeting of policy interventions across the continent.

  7. Effective Health Risk Communication About Pandemic Influenza for Vulnerable Populations

    PubMed Central

    Tinker, Timothy

    2009-01-01

    The consequences of pandemic influenza for vulnerable populations will depend partly on the effectiveness of health risk communications. Strategic planning should fully consider how life circumstances, cultural values, and perspectives on risk influence behavior during a pandemic. We summarize recent scientific evidence on communication challenges and examine how sociocultural, economic, psychological, and health factors can jeopardize or facilitate public health interventions that require a cooperative public. If ignored, current communication gaps for vulnerable populations could result in unequal protection across society during an influenza pandemic. We offer insights on communication preparedness gleaned from scientific studies and the deliberations of public health experts at a meeting convened by the Centers for Disease Control and Prevention, May 1 and 2, 2008. PMID:19797744

  8. Usability of a Novel Mobile Health iPad App by Vulnerable Populations.

    PubMed

    Miller, David P; Weaver, Kathryn E; Case, L Doug; Babcock, Donald; Lawler, Donna; Denizard-Thompson, Nancy; Pignone, Michael P; Spangler, John G

    2017-04-11

    Recent advances in mobile technologies have created new opportunities to reach broadly into populations that are vulnerable to health disparities. However, mobile health (mHealth) strategies could paradoxically increase health disparities, if low socioeconomic status individuals lack the technical or literacy skills needed to navigate mHealth programs. The aim of this study was to determine whether patients from vulnerable populations could successfully navigate and complete an mHealth patient decision aid. We analyzed usability data from a randomized controlled trial of an iPad program designed to promote colorectal cancer (CRC) screening. The trial was conducted in six primary care practices and enrolled 450 patients, aged 50-74 years, who were due for CRC screening. The iPad program included a self-survey and randomly displayed either a screening decision aid or a video about diet and exercise. We measured participant ability to complete the program without assistance and participant-rated program usability. Two-thirds of the participants (305/450) were members of a vulnerable population (limited health literacy, annual income < US $20,000, or black race). Over 92% (417/450) of the participants rated the program highly on all three usability items (90.8% for vulnerable participants vs 96.6% for nonvulnerable participants, P=.006). Only 6.9% (31/450) of the participants needed some assistance to complete the program. In multivariable logistic regression, being a member of a vulnerable population was not associated with needing assistance. Only older age, less use of text messaging (short message service, SMS), and lack of Internet use predicted needing assistance. Individuals who are vulnerable to health disparities can successfully use well-designed mHealth programs. Future research should investigate whether mHealth interventions can reduce health disparities. ©David P Miller Jr, Kathryn E Weaver, L Doug Case, Donald Babcock, Donna Lawler, Nancy Denizard

  9. Multi-dimensional flood vulnerability assessment using data envelopment analysis

    NASA Astrophysics Data System (ADS)

    Zahid, Zalina; Saharizan, Nurul Syuhada; Hamzah, Paezah; Hussin, Siti Aida Sheikh; Khairi, Siti Shaliza Mohd

    2017-11-01

    Malaysia has been greatly impacted by flood during monsoon seasons. Even though flood prone areas are well identified, assessment on the vulnerability of the disaster is lacking. Assessment of flood vulnerability, defined as the potential for loss when a disaster occurs, is addressed in this paper. The focus is on the development of flood vulnerability measurement in 11 states in Peninsular Malaysia using a non-parametric approach of Data Envelopment Analysis. Scores for three dimensions of flood vulnerability (Population Vulnerability, Social Vulnerability and Biophysical) were calculated using secondary data of selected input and output variables across an 11-year period from 2004 to 2014. The results showed that Johor and Pahang were the most vulnerable to flood in terms of Population Vulnerability, followed by Kelantan, the most vulnerable to flood in terms of Social Vulnerability and Kedah, Pahang and Terengganu were the most vulnerable to flood in terms of Biophysical Vulnerability among the eleven states. The results also showed that the state of Johor, Pahang and Kelantan to be most vulnerable across the three dimensions. Flood vulnerability assessment is important as it provides invaluable information that will allow the authority to identify and develop plans for flood mitigation and to reduce the vulnerability of flood at the affected regions.

  10. Navigator Approach to Improve Quality of Care for Vulnerable Populations in Mexico.

    PubMed

    Ramos, Rebeca; Ferreira-Pinto, João; Loza, Oralia

    2015-01-01

    For nearly 30 years, Programa Compañeros Inc (Compañeros) has worked in Ciudad Juarez, Chihuahua, Mexico, to ensure that vulnerable populations can exercise their rights to receive HIV and substance abuse prevention and treatment services. Compañeros staff has worked to ameliorate the negative results that limit access to care to the most vulnerable individuals: those who are poor, homeless, sex workers, addicted, and others whose life context put them at greater risk for being infected with HIV. With support from the MAC AIDS Foundation, Compañeros has expanded its capacity to deliver services to persons living with HIV/AIDS (PLWHA) and to HIV-vulnerable populations. This short communication describes findings from an internal evaluation conducted to investigate the effectiveness of the MAC AIDS-funded navigator-based program implemented at Compañeros. © The Author(s) 2015.

  11. Vulnerable Populations Perceive Their Health as at Risk from Climate Change.

    PubMed

    Akerlof, Karen L; Delamater, Paul L; Boules, Caroline R; Upperman, Crystal R; Mitchell, Clifford S

    2015-12-04

    Climate change is already taking a toll on human health, a toll that is likely to increase in coming decades. The relationship between risk perceptions and vulnerability to climate change's health threats has received little attention, even though an understanding of the dynamics of adaptation among particularly susceptible populations is becoming increasingly important. We demonstrate that some people whose health will suffer the greatest harms from climate change-due to social vulnerability, health susceptibility, and exposure to hazards-already feel they are at risk. In a 2013 survey we measured Maryland residents' climate beliefs, health risk perceptions, and household social vulnerability characteristics, including medical conditions (n = 2126). We paired survey responses with secondary data sources for residence in a floodplain and/or urban heat island to predict perceptions of personal and household climate health risk. General health risk perceptions, political ideology, and climate beliefs are the strongest predictors. Yet, people in households with the following characteristics also see themselves at higher risk: members with one or more medical conditions or disabilities; low income; racial/ethnic minorities; and residence in a floodplain. In light of these results, climate health communication among vulnerable populations should emphasize protective actions instead of risk messages.

  12. Vulnerable Populations Perceive Their Health as at Risk from Climate Change

    PubMed Central

    Akerlof, Karen L.; Delamater, Paul L.; Boules, Caroline R.; Upperman, Crystal R.; Mitchell, Clifford S.

    2015-01-01

    Climate change is already taking a toll on human health, a toll that is likely to increase in coming decades. The relationship between risk perceptions and vulnerability to climate change’s health threats has received little attention, even though an understanding of the dynamics of adaptation among particularly susceptible populations is becoming increasingly important. We demonstrate that some people whose health will suffer the greatest harms from climate change—due to social vulnerability, health susceptibility, and exposure to hazards—already feel they are at risk. In a 2013 survey we measured Maryland residents’ climate beliefs, health risk perceptions, and household social vulnerability characteristics, including medical conditions (n = 2126). We paired survey responses with secondary data sources for residence in a floodplain and/or urban heat island to predict perceptions of personal and household climate health risk. General health risk perceptions, political ideology, and climate beliefs are the strongest predictors. Yet, people in households with the following characteristics also see themselves at higher risk: members with one or more medical conditions or disabilities; low income; racial/ethnic minorities; and residence in a floodplain. In light of these results, climate health communication among vulnerable populations should emphasize protective actions instead of risk messages. PMID:26690184

  13. COORDINATING, COMMUNICATING AND PERFORMING COMPLEX RESEARCH THAT IDENTIFIES VULNERABLE STREAM ECOSYSTEM IN THE MID-ATLANTIC REGION

    EPA Science Inventory

    The USEPA's Regional Vulnerability Assessment (ReVA) program was created to advance the scientific basis for protecting vulnerable ecosystems at a regional scale. As a first step, the ReVa program will coordinate, communicate and perform complex research that will identify vulner...

  14. Staying cool in a changing climate: Reaching vulnerable populations during heat events

    PubMed Central

    Sampson, Natalie R.; Gronlund, Carina J.; Buxton, Miatta A.; Catalano, Linda; White-Newsome, Jalonne L.; Conlon, Kathryn C.; O’Neill, Marie S.; McCormick, Sabrina; Parker, Edith A.

    2017-01-01

    The frequency and intensity of hot weather events are expected to increase globally, threatening human health, especially among the elderly, poor, and chronically ill. Current literature indicates that emergency preparedness plans, heat health warning systems, and related interventions may not be reaching or supporting behavior change among those most vulnerable in heat events. Using a qualitative multiple case study design, we comprehensively examined practices of these populations to stay cool during hot weather (“cooling behaviors”) in four U.S. cities with documented racial/ethnic and socio-economic disparities and diverse heat preparedness strategies: Phoenix, Arizona; Detroit, Michigan; New York City, New York; and Philadelphia, Pennsylvania. Based on semi-structured in-depth interviews we conducted with 173 community members and organizational leaders during 2009–2010, we assessed why vulnerable populations do or do not participate in health-promoting behaviors at home or in their community during heat events, inquiring about perceptions of heat-related threats and vulnerability and the role of social support. While vulnerable populations often recognize heat’s potential health threats, many overlook or disassociate from risk factors or rely on experiences living in or visiting warmer climates as a protective factor. Many adopt basic cooling behaviors, but unknowingly harmful behaviors such as improper use of fans and heating and cooling systems are also adopted. Decision-making related to commonly promoted behaviors such as air conditioner use and cooling center attendance is complex, and these resources are often inaccessible financially, physically, or culturally. Interviewees expressed how interpersonal, intergenerational relationships are generally but not always protective, where peer relationships are a valuable mechanism for facilitating cooling behaviors among the elderly during heat events. To prevent disparities in heat morbidity and

  15. How Academic Health Systems Can Achieve Population Health in Vulnerable Populations Through Value-Based Care: The Critical Importance of Establishing Trusted Agency.

    PubMed

    Wesson, Donald E; Kitzman, Heather E

    2018-01-16

    Improving population health may require health systems to proactively engage patient populations as partners in the implementation of healthy behaviors as a shared value using strategies that incentivize healthy outcomes for the population as a whole. The current reactive health care model, which focuses on restoring the health of individuals after it has been lost, will not achieve the goal of improved population health. To achieve this goal, health systems must proactively engage in partnerships with the populations they serve. Health systems will need the help of community entities and individuals who have the trust of the population being served to act on behalf of the health system if they are to achieve this effective working partnership. The need for these trusted agents is particularly pertinent for vulnerable and historically underserved segments of the population. In this Invited Commentary, the authors discuss ways by which health systems might identify, engage, and leverage trusted agents to improve the health of the population through value-based care.

  16. Strategies for expanding health insurance coverage in vulnerable populations

    PubMed Central

    Jia, Liying; Yuan, Beibei; Huang, Fei; Lu, Ying; Garner, Paul; Meng, Qingyue

    2014-01-01

    ) studies and Interrupted time series (ITS) studies that evaluated the effects of strategies on increasing health insurance coverage for vulnerable populations. We defined strategies as measures to improve the enrolment of vulnerable populations into health insurance schemes. Two categories and six specified strategies were identified as the interventions. Data collection and analysis At least two review authors independently extracted data and assessed the risk of bias. We undertook a structured synthesis. Main results We included two studies, both from the United States. People offered health insurance information and application support by community-based case managers were probably more likely to enrol their children into health insurance programmes (risk ratio (RR) 1.68, 95% confidence interval (CI) 1.44 to 1.96, moderate quality evidence) and were probably more likely to continue insuring their children (RR 2.59, 95% CI 1.95 to 3.44, moderate quality evidence). Of all the children that were insured, those in the intervention group may have been insured quicker (47.3 fewer days, 95% CI 20.6 to 74.0 fewer days, low quality evidence) and parents may have been more satisfied on average (satisfaction score average difference 1.07, 95% CI 0.72 to 1.42, low quality evidence). In the second study applications were handed out in emergency departments at hospitals, compared to not handing out applications, and may have had an effect on enrolment (RR 1.5, 95% CI 1.03 to 2.18, low quality evidence). Authors' conclusions Community-based case managers who provide health insurance information, application support, and negotiate with the insurer probably increase enrolment of children in health insurance schemes. However, the transferability of this intervention to other populations or other settings is uncertain. Handing out insurance application materials in hospital emergency departments may help increase the enrolment of children in health insurance schemes. Further studies

  17. Attending to social vulnerability when rationing pandemic resources.

    PubMed

    Vawter, Dorothy E; Garrett, J Eline; Gervais, Karen G; Prehn, Angela Witt; DeBruin, Debra A

    2011-01-01

    Pandemic plans are increasingly attending to groups experiencing health disparities and other social vulnerabilities. Although some pandemic guidance is silent on the issue, guidance that attends to socially vulnerable groups ranges widely, some procedural (often calling for public engagement), and some substantive. Public engagement objectives vary from merely educational to seeking reflective input into the ethical commitments that should guide pandemic planning and response. Some plans that concern rationing during a severe pandemic recommend ways to protect socially vulnerable groups without prioritizing access to scarce resources based on social vulnerability per se. The Minnesota Pandemic Ethics Project (MPEP), a public engagement project on rationing scarce health resources during a severe influenza pandemic, agrees and recommends an integrated set of ways to attend to the needs of socially vulnerable people and avoid exacerbation of health disparities during a severe influenza pandemic. Among other things, MPEP recommends: 1. Engaging socially vulnerable populations to clarify unique needs and effective strategies; 2. Engaging socially vulnerable populations to elicit ethical values and perspectives on rationing; 3. Rejecting rationing based on race, socioeconomic class, citizenship, quality of life, length of life-extension and first-come, first-served; 4. Prioritizing those in the general population for access to resources based on combinations of risk (of death or severe complications from influenza, exposure to influenza, transmitting influenza to vulnerable groups) and the likelihood of responding well to the resource in question. 5. Protecting critical infrastructures on which vulnerable populations and the general public rely; 6. Identifying and removing access barriers during pandemic planning and response; and 7. Collecting and promptly analyzing data during the pandemic to identify groups at disproportionate risk of influenza-related mortality and

  18. Identifying the "vulnerables" in biomedical research: the vox populis from the Tuskegee Legacy Project.

    PubMed

    Chiu, Christopher T; Katz, Ralph V

    2011-01-01

    This report presents, for the first time, findings on the vox populis as to who constitutes the "vulnerables in biomedical research" The 3-City Tuskegee Legacy Project (TLP) study used the TLP questionnaire as administered via random-digit-dial telephone interviews to 1162 adult Black people, non-Hispanic White people, and two Puerto Rican (PR) Hispanic groups: Mainland United States and San Juan (SJ) in three cities. The classification schema was based upon respondents' answers to an open-ended question asking which groups of people were the most vulnerable when participating in biomedical research. Subjects provided 749 valid open-ended responses, which were grouped into 29 direct response categories, leading to a four-tier classification schema for vulnerability traits. Tier 1, the summary tier, had five vulnerability categories: (1) Race/ ethnicity; (2) Age; (3) SES; (4) Health; and, (5) Gender. Black people and Mainland United States PR Hispanics most frequently identified Race/Ethnicity as a vulnerability trait (42.1 percent of Black people and 42.6 percent of Mainland United States. PR Hispanics versus 15.4 percent of White people and 16.7 percent of SJ R Hispanics) (P < 0.007), while White people and SJ PR Hispanics most frequently identified Age (48.3 percent and 29.2 percent) as a vulnerability trait. The response patterns on "who was vulnerable" were similar for the two minority groups (Black people and Mainland US PR Hispanics), and notably different from the response patterns of the two majority groups (White people and SJ PR Hispanics). Further, the vox populis definition of vulnerables differed from the current official definitions as used by the U.S. federal government.

  19. Geographical Imbalance of Anesthesia Providers and its Impact On the Uninsured and Vulnerable Populations.

    PubMed

    Liao, C Jason; Quraishi, Jihan A; Jordan, Lorraine M

    2015-01-01

    The purpose of this study was to determine if there is a relationship between socioeconomic factors related to geography and insurance type and the distribution of anesthesia provider type. Using the 2012 Area Resource File, the correlation analyses illustrates county median income is a key factor in distinguishing anesthesia provider distribution. Certified registered nurse anesthetists (CRNAs) correlated with lower-income populations where anesthesiologists correlated with higher-income populations. Furthermore, CRNAs correlated more with vulnerable populations such as the Medicaid-eligible population, uninsured population, and the unemployed. Access to health care is multifactorial; however, assuring the population has adequate insurance is one of the hallmark achievements of the Affordable Care Act. Removing barriers to CRNA scope of practice to maximize CRNA services will facilitate meeting the demand by vulnerable populations after full implementation of the Affordable Care Act.

  20. Genetic analysis reveals demographic fragmentation of grizzly bears yielding vulnerably small populations

    PubMed Central

    Proctor, Michael F; McLellan, Bruce N; Strobeck, Curtis; Barclay, Robert M.R

    2005-01-01

    Ecosystem conservation requires the presence of native carnivores, yet in North America, the distributions of many larger carnivores have contracted. Large carnivores live at low densities and require large areas to thrive at the population level. Therefore, if human-dominated landscapes fragment remaining carnivore populations, small and demographically vulnerable populations may result. Grizzly bear range contraction in the conterminous USA has left four fragmented populations, three of which remain along the Canada–USA border. A tenet of grizzly bear conservation is that the viability of these populations requires demographic linkage (i.e. inter-population movement of both sexes) to Canadian bears. Using individual-based genetic analysis, our results suggest this demographic connection has been severed across their entire range in southern Canada by a highway and associated settlements, limiting female and reducing male movement. Two resulting populations are vulnerably small (≤100 animals) and one of these is completely isolated. Our results suggest that these trans-border bear populations may be more threatened than previously thought and that conservation efforts must expand to include international connectivity management. They also demonstrate the ability of genetic analysis to detect gender-specific demographic population fragmentation in recently disturbed systems, a traditionally intractable yet increasingly important ecological measurement worldwide. PMID:16243699

  1. Genetic analysis reveals demographic fragmentation of grizzly bears yielding vulnerably small populations.

    PubMed

    Proctor, Michael F; McLellan, Bruce N; Strobeck, Curtis; Barclay, Robert M R

    2005-11-22

    Ecosystem conservation requires the presence of native carnivores, yet in North America, the distributions of many larger carnivores have contracted. Large carnivores live at low densities and require large areas to thrive at the population level. Therefore, if human-dominated landscapes fragment remaining carnivore populations, small and demographically vulnerable populations may result. Grizzly bear range contraction in the conterminous USA has left four fragmented populations, three of which remain along the Canada-USA border. A tenet of grizzly bear conservation is that the viability of these populations requires demographic linkage (i.e. inter-population movement of both sexes) to Canadian bears. Using individual-based genetic analysis, our results suggest this demographic connection has been severed across their entire range in southern Canada by a highway and associated settlements, limiting female and reducing male movement. Two resulting populations are vulnerably small (< or =100 animals) and one of these is completely isolated. Our results suggest that these trans-border bear populations may be more threatened than previously thought and that conservation efforts must expand to include international connectivity management. They also demonstrate the ability of genetic analysis to detect gender-specific demographic population fragmentation in recently disturbed systems, a traditionally intractable yet increasingly important ecological measurement worldwide.

  2. Public health consequences on vulnerable populations from acute chemical releases.

    PubMed

    Ruckart, Perri Zeitz; Orr, Maureen F

    2008-07-09

    Data from a large, multi-state surveillance system on acute chemical releases were analyzed to describe the type of events that are potentially affecting vulnerable populations (children, elderly and hospitalized patients) in order to better prevent and plan for these types of incidents in the future. During 2003-2005, there were 231 events where vulnerable populations were within ¼ mile of the event and the area of impact was greater than 200 feet from the facility/point of release. Most events occurred on a weekday during times when day care centers or schools were likely to be in session. Equipment failure and human error caused a majority of the releases. Agencies involved in preparing for and responding to chemical emergencies should work with hospitals, nursing homes, day care centers, and schools to develop policies and procedures for initiating appropriate protective measures and managing the medical needs of patients. Chemical emergency response drills should involve the entire community to protect those that may be more susceptible to harm.

  3. Variations in population vulnerability to tectonic and landslide-related tsunami hazards in Alaska

    USGS Publications Warehouse

    Wood, Nathan J.; Peters, Jeff

    2015-01-01

    Effective tsunami risk reduction requires an understanding of how at-risk populations are specifically vulnerable to tsunami threats. Vulnerability assessments primarily have been based on single hazard zones, even though a coastal community may be threatened by multiple tsunami sources that vary locally in terms of inundation extents and wave arrival times. We use the Alaskan coastal communities of Cordova, Kodiak, Seward, Valdez, and Whittier (USA), as a case study to explore population vulnerability to multiple tsunami threats. We use anisotropic pedestrian evacuation models to assess variations in population exposure as a function of travel time out of hazard zones associated with tectonic and landslide-related tsunamis (based on scenarios similar to the 1964 M w9.2 Good Friday earthquake and tsunami disaster). Results demonstrate that there are thousands of residents, employees, and business customers in tsunami hazard zones associated with tectonically generated waves, but that at-risk individuals will likely have sufficient time to evacuate to high ground before waves are estimated to arrive 30–60 min after generation. Tsunami hazard zones associated with submarine landslides initiated by a subduction zone earthquake are smaller and contain fewer people, but many at-risk individuals may not have enough time to evacuate as waves are estimated to arrive in 1–2 min and evacuations may need to occur during earthquake ground shaking. For all hazard zones, employees and customers at businesses far outnumber residents at their homes and evacuation travel times are highest on docks and along waterfronts. Results suggest that population vulnerability studies related to tsunami hazards should recognize non-residential populations and differences in wave arrival times if emergency managers are to develop realistic preparedness and outreach efforts.

  4. US Vulnerability to Natural Disasters

    NASA Astrophysics Data System (ADS)

    van der Vink, G.; Apgar, S.; Batchelor, A.; Carter, C.; Gail, D.; Jarrett, A.; Levine, N.; Morgan, W.; Orlikowski, M.; Pray, T.; Raymar, M.; Siebert, A.; Shawa, T. W.; Wallace, C.

    2002-05-01

    Natural disasters result from the coincidence of natural events with the built environment. Our nation's infrastructure is growing at an exponential rate in many areas of high risk, and the Federal government's liability is increasing proportionally. By superimposing population density with predicted ground motion from earthquakes, historical hurricane tracks, historical tornado locations, and areas within the flood plain, we are able to identify locations of high vulnerability within the United States. We present a comprehensive map of disaster risk for the United States that is being produced for the Senate Natural Hazards Caucus. The map allows for the geographic comparison of natural disaster risk with past disaster declarations, the expenditure of Federal dollars for disaster relief, population increase, and variations of GDP. Every state is vulnerable to natural disasters. Although their frequency varies considerably, the annualized losses for disaster relief from hurricanes, earthquakes, and floods are approximately equivalent. While fast-growing states such as California and Florida remain highly vulnerable, changes in the occurrence of natural events combined with population increases are making areas such as Texas, North Carolina, and the East Coast increasingly vulnerable.

  5. Development of a heat vulnerability index for New York State.

    PubMed

    Nayak, S G; Shrestha, S; Kinney, P L; Ross, Z; Sheridan, S C; Pantea, C I; Hsu, W H; Muscatiello, N; Hwang, S A

    2017-12-01

    The frequency and intensity of extreme heat events are increasing in New York State (NYS) and have been linked with increased heat-related morbidity and mortality. But these effects are not uniform across the state and can vary across large regions due to regional sociodemographic and environmental factors which impact an individual's response or adaptive capacity to heat and in turn contribute to vulnerability among certain populations. We developed a heat vulnerability index (HVI) to identify heat-vulnerable populations and regions in NYS. Census tract level environmental and sociodemographic heat-vulnerability variables were used to develop the HVI to identify heat-vulnerable populations and areas. Variables were identified from a comprehensive literature review and climate-health research in NYS. We obtained data from 2010 US Census Bureau and 2011 National Land Cover Database. We used principal component analysis to reduce correlated variables to fewer uncorrelated components, and then calculated the cumulative HVI for each census tract by summing up the scores across the components. The HVI was then mapped across NYS (excluding New York City) to display spatial vulnerability. The prevalence rates of heat stress were compared across HVI score categories. Thirteen variables were reduced to four meaningful components representing 1) social/language vulnerability; 2) socioeconomic vulnerability; 3) environmental/urban vulnerability; and 4) elderly/ social isolation. Vulnerability to heat varied spatially in NYS with the HVI showing that metropolitan areas were most vulnerable, with language barriers and socioeconomic disadvantage contributing to the most vulnerability. Reliability of the HVI was supported by preliminary results where higher rates of heat stress were collocated in the regions with the highest HVI. The NYS HVI showed spatial variability in heat vulnerability across the state. Mapping the HVI allows quick identification of regions in NYS that could

  6. Accounting for vulnerable populations in rural hazard mitigation plans: results of a survey of emergency managers.

    PubMed

    Horney, Jennifer A; Nguyen, Mai; Cooper, John; Simon, Matthew; Ricchetti-Masterson, Kristen; Grabich, Shannon; Salvesen, David; Berke, Philip

    2013-01-01

    Rural areas of the United States are uniquely vulnerable to the impacts of natural disasters. One possible way to mitigate vulnerability to disasters in rural communities is to have a high-quality hazard mitigation plan in place. To understand the resources available for hazard mitigation planning and determine how well hazard mitigation plans in rural counties meet the needs of vulnerable populations, we surveyed the lead planning or emergency management official responsible for hazard mitigation plans in 96 rural counties in eight states in the Southeastern United States. In most counties, emergency management was responsible for implementing the county's hazard mitigation plan and the majority of counties had experienced a presidentially declared disaster in the last 5 years. Our research findings demonstrated that there were differences in subjective measures of vulnerability (as reported by survey respondents) and objective measures of vulnerability (as determined by US Census data). In addition, although few counties surveyed included outreach to vulnerable groups as a part of their hazard mitigation planning process, a majority felt that their hazard mitigation plan addressed the needs of vulnerable populations "well" or "very well." These differences could result in increased vulnerabilities in rural areas, particularly for certain vulnerable groups.

  7. Vulnerability of Coastal Communities from Storm Surge and Flood Disasters

    PubMed Central

    Bathi, Jejal Reddy; Das, Himangshu S.

    2016-01-01

    Disasters in the form of coastal storms and hurricanes can be very destructive. Preparing for anticipated effects of such disasters can help reduce the public health and economic burden. Identifying vulnerable population groups can help prioritize resources for the most needed communities. This paper presents a quantitative framework for vulnerability measurement that incorporates both socioeconomic and flood inundation vulnerability. The approach is demonstrated for three coastal communities in Mississippi with census tracts being the study unit. The vulnerability results are illustrated as thematic maps for easy usage by planners and emergency responders to assist in prioritizing their actions to vulnerable populations during storm surge and flood disasters. PMID:26907313

  8. Mapping Vulnerability to Disasters in Latin America and the Caribbean, 1900-2007

    USGS Publications Warehouse

    Maynard-Ford, Miriam C.; Phillips, Emily C.; Chirico, Peter G.

    2008-01-01

    The vulnerability of a population and its infrastructure to disastrous events is a factor of both the probability of a hazardous event occurring and the community's ability to cope with the resulting impacts. Therefore, the ability to accurately identify vulnerable populations and places in order to prepare for future hazards is of critical importance for disaster mitigation programs. This project created maps of higher spatial resolution of vulnerability to disaster in Latin America and the Caribbean from 1900 to 2007 by mapping disaster data by first-level administrative boundaries with the objective of identifying geographic trends in regional occurrences of disasters and vulnerable populations. The method of mapping by administrative level is an improvement on displaying and analyzing disasters at the country level and shows the relative intensity of vulnerability within and between countries in the region. Disaster mapping at the country level produces only a basic view of which countries experience various types of natural disasters. Through disaggregation, the data show which geographic areas of these countries, including populated areas, are historically most susceptible to different hazard types.

  9. [Measles vaccination campaign for vulnerable populations: lessons learned].

    PubMed

    Laurence, Sophie; Chappuis, Marielle; Lucas, Dorinela; Duteurtre, Martin; Corty, Jean-François

    2013-01-01

    Between 2008 and 2011, a measles epidemic raged in France. Immunization coverage in France, already insufficient in the general population, is even more worrying for deprived populations in whom exposure to the disease and the risk of complications are much higher. In this context, Medecins du Monde (MdM), the General Council of the Seine-Saint-Denis (CG93) and the Territorial Directorate of the Regional Health Agency (DTARS) implemented a measles vaccination campaign among the Rom population of the department. The objective was to improve coverage of this population by providing ambulatory services in collaboration between various field partners in a single public health project. Twenty-two of the known Rom settlements were selected to receive vaccination. MdM was in charge of logistics, mediation and vaccinations at 13 sites and the DTARS and CG93 were in charge of vaccination at another 9 sites with support from MdM for mediation and logistics. Between January and June 2012, 250 persons were vaccinated, 34.7% of the target population. Coverage of the population after the vaccination campaign was still very low. The partnership between MdM, DTARS and CG93 helped to create a positive mobile action experience and extended prevention actions towards the most vulnerable populations excluded from conventional health care structures.

  10. Dasymetric high resolution population distribution estimates for improved decision making, with a case study of sea-level rise vulnerability in Boca Raton, Florida

    NASA Astrophysics Data System (ADS)

    Ziegler, Hannes Moritz

    Planners and managers often rely on coarse population distribution data from the census for addressing various social, economic, and environmental problems. In the analysis of physical vulnerabilities to sea-level rise, census units such as blocks or block groups are coarse relative to the required decision-making application. This study explores the benefits offered from integrating image classification and dasymetric mapping at the household level to provide detailed small area population estimates at the scale of residential buildings. In a case study of Boca Raton, FL, a sea-level rise inundation grid based on mapping methods by NOAA is overlaid on the highly detailed population distribution data to identify vulnerable residences and estimate population displacement. The enhanced spatial detail offered through this method has the potential to better guide targeted strategies for future development, mitigation, and adaptation efforts.

  11. Population Vulnerability to Biannual Cholera Outbreaks and Associated Macro-Scale Drivers in the Bengal Delta

    PubMed Central

    Akanda, Ali Shafqat; Jutla, Antarpreet S.; Gute, David M.; Sack, R. Bradley; Alam, Munirul; Huq, Anwar; Colwell, Rita R.; Islam, Shafiqul

    2013-01-01

    The highly populated floodplains of the Bengal Delta have a long history of endemic and epidemic cholera outbreaks, both coastal and inland. Previous studies have not addressed the spatio-temporal dynamics of population vulnerability related to the influence of underlying large-scale processes. We analyzed spatial and temporal variability of cholera incidence across six surveillance sites in the Bengal Delta and their association with regional hydroclimatic and environmental drivers. More specifically, we use salinity and flood inundation modeling across the vulnerable districts of Bangladesh to test earlier proposed hypotheses on the role of these environmental variables. Our results show strong influence of seasonal and interannual variability in estuarine salinity on spring outbreaks and inland flooding on fall outbreaks. A large segment of the population in the Bengal Delta floodplains remain vulnerable to these biannual cholera transmission mechanisms that provide ecologic and environmental conditions for outbreaks over large geographic regions. PMID:24019441

  12. Public Health Consequences on Vulnerable Populations from Acute Chemical Releases

    PubMed Central

    Ruckart, Perri Zeitz; Orr, Maureen F.

    2008-01-01

    Data from a large, multi-state surveillance system on acute chemical releases were analyzed to describe the type of events that are potentially affecting vulnerable populations (children, elderly and hospitalized patients) in order to better prevent and plan for these types of incidents in the future. During 2003–2005, there were 231 events where vulnerable populations were within ¼ mile of the event and the area of impact was greater than 200 feet from the facility/point of release. Most events occurred on a weekday during times when day care centers or schools were likely to be in session. Equipment failure and human error caused a majority of the releases. Agencies involved in preparing for and responding to chemical emergencies should work with hospitals, nursing homes, day care centers, and schools to develop policies and procedures for initiating appropriate protective measures and managing the medical needs of patients. Chemical emergency response drills should involve the entire community to protect those that may be more susceptible to harm. PMID:21572842

  13. Ethical questions identified in a study of local and expatriate responders' perspectives of vulnerability in the 2010 Haiti earthquake.

    PubMed

    Durocher, Evelyne; Chung, Ryoa; Rochon, Christiane; Henrys, Jean-Hugues; Olivier, Catherine; Hunt, Matthew

    2017-09-01

    Situations of disaster that prompt international humanitarian responses are rife with ethical tensions. The 2010 Haiti earthquake caused great destruction and prompted a massive humanitarian response. The widespread needs experienced by the population and the scale of the response inevitably rendered priority-setting difficult, and gave rise to ethical challenges. This paper presents four ethical questions identified in the analysis of a study on vulnerability and equity in the humanitarian response to the 2010 Haiti earthquake. Using interpretive description methodology, the interdisciplinary research team analysed 24 semi-structured in-depth interviews conducted with expatriate and Haitian health workers and decision-makers involved in the response. Ethical questions identified through the analysis were: (1) How should limited resources be allocated in situations of widespread vulnerability and elevated needs? (2) At what point does it become ethically problematic to expend (considerable) resources to sustain expatriate disaster responders? (3) How ought rapid and reactive interventions be balanced with more deliberated and coordinated approaches? (4) What trade-offs are justified when interventions to address acute needs could contribute to long-term vulnerabilities? The questions arise in light of an immense gap between available resources and widespread and elevated needs. This gap is likely unavoidable in large-scale crises and may be a source of ethical distress for both local and international responders. The analysis of ethical questions associated with crisis response can advance discussions about how relief efforts can best be designed and implemented to minimise ethical distress and improve assistance to local populations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. Identifying Vulnerabilities and Hardening Attack Graphs for Networked Systems

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Saha, Sudip; Vullinati, Anil K.; Halappanavar, Mahantesh

    We investigate efficient security control methods for protecting against vulnerabilities in networked systems. A large number of interdependent vulnerabilities typically exist in the computing nodes of a cyber-system; as vulnerabilities get exploited, starting from low level ones, they open up the doors to more critical vulnerabilities. These cannot be understood just by a topological analysis of the network, and we use the attack graph abstraction of Dewri et al. to study these problems. In contrast to earlier approaches based on heuristics and evolutionary algorithms, we study rigorous methods for quantifying the inherent vulnerability and hardening cost for the system. Wemore » develop algorithms with provable approximation guarantees, and evaluate them for real and synthetic attack graphs.« less

  15. Adolescents from families of divorce: vulnerability to physiological and psychological disturbances.

    PubMed

    Thompson, P

    1998-03-01

    Multiple factors contribute to the vulnerability of adolescents to physiological and psychological disturbances following parental divorce. These include father absence, interparental conflict, economic distress, multiple life stressors, parent adjustment, and short-term crisis. Clinical and societal problems manifested in these vulnerable adolescents are discussed. Systems theory is used to explain this vulnerability of adolescents and to identify appropriate interventions and policies to promote health in this population. Policies recommended include required divorce mediation, early referrals for family and sibling therapy, and school programs to identify and support those most vulnerable.

  16. The effectiveness of tobacco control policies on vulnerable populations in the USA: a review.

    PubMed

    Vijayaraghavan, Maya; Schroeder, Steven A; Kushel, Margot

    2016-09-22

    Despite population-wide efforts to reduce tobacco use, low-income populations in the USA have much higher rates of tobacco use compared with the general population. The principal components of tobacco control policies in the USA include cigarette taxes, clean indoor air laws and comprehensive interventions to increase access to tobacco cessation services. In this review, we describe the effectiveness of these policies and interventions in reducing tobacco use among vulnerable populations, focusing on persons with mental health disorders and substance use disorders, persons who have experienced incarceration or homelessness, and low-income tenants of public housing. We discuss the challenges that evolving tobacco and nicotine products pose to tobacco control efforts. We conclude by highlighting the clinical implications of treating tobacco dependence in healthcare settings that serve vulnerable populations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. The use of incentives in vulnerable populations for a telephone survey: a randomized controlled trial.

    PubMed

    Knoll, Megan; Soller, Lianne; Ben-Shoshan, Moshe; Harrington, Daniel; Fragapane, Joey; Joseph, Lawrence; La Vieille, Sebastien; St-Pierre, Yvan; Wilson, Kathi; Elliott, Susan; Clarke, Ann

    2012-10-19

    Poor response rates in prevalence surveys can lead to nonresponse bias thereby compromising the validity of prevalence estimates. We conducted a telephone survey of randomly selected households to estimate the prevalence of food allergy in the 10 Canadian provinces between May 2008 and March 2009 (the SCAAALAR study: Surveying Canadians to Assess the Prevalence of Common Food Allergies and Attitudes towards Food LAbeling and Risk). A household response rate of only 34.6% was attained, and those of lower socioeconomic status, lower education and new Canadians were underrepresented. We are now attempting to target these vulnerable populations in the SPAACE study (Surveying the Prevalence of Food Allergy in All Canadian Environments) and are evaluating strategies to increase the response rate. Although the success of incentives to increase response rates has been demonstrated previously, no studies have specifically examined the use of unconditional incentives in these vulnerable populations in a telephone survey. The pilot study will compare response rates between vulnerable Canadian populations receiving and not receiving an incentive. Randomly selected households were randomly assigned to receive either a $5 incentive or no incentive. The between group differences in response rates and 95% confidence intervals (CIs) were calculated. The response rates for the incentive and non-incentive groups were 36.1% and 28.7% respectively, yielding a between group difference of 7.4% (-0.7%, 15.6%). Although the wide CI precludes definitive conclusions, our results suggest that unconditional incentives are effective in vulnerable populations for telephone surveys.

  18. Involving members of vulnerable populations in the development of patient decision aids: a mixed methods sequential explanatory study.

    PubMed

    Dugas, Michèle; Trottier, Marie-Ève; Chipenda Dansokho, Selma; Vaisson, Gratianne; Provencher, Thierry; Colquhoun, Heather; Dogba, Maman Joyce; Dupéré, Sophie; Fagerlin, Angela; Giguere, Anik M C; Haslett, Lynne; Hoffman, Aubri S; Ivers, Noah M; Légaré, France; Légaré, Jean; Levin, Carrie A; Menear, Matthew; Renaud, Jean-Sébastien; Stacey, Dawn; Volk, Robert J; Witteman, Holly O

    2017-01-19

    Patient decision aids aim to present evidence relevant to a health decision in understandable ways to support patients through the process of making evidence-informed, values-congruent health decisions. It is recommended that, when developing these tools, teams involve people who may ultimately use them. However, there is little empirical evidence about how best to undertake this involvement, particularly for specific populations of users such as vulnerable populations. To describe and compare the development practices of research teams that did and did not specifically involve members of vulnerable populations in the development of patient decision aids, we conducted a secondary analysis of data from a systematic review about the development processes of patient decision aids. Then, to further explain our quantitative results, we conducted semi-structured telephone interviews with 10 teams: 6 that had specifically involved members of vulnerable populations and 4 that had not. Two independent analysts thematically coded transcribed interviews. Out of a total of 187 decision aid development projects, 30 (16%) specifically involved members of vulnerable populations. The specific involvement of members of vulnerable populations in the development process was associated with conducting informal needs assessment activities (73% vs. 40%, OR 2.96, 95% CI 1.18-7.99, P = .02) and recruiting participants through community-based organizations (40% vs. 11%, OR 3.48, 95% CI 1.23-9.83, P = .02). In interviews, all developers highlighted the importance, value and challenges of involving potential users. Interviews with developers whose projects had involved members of vulnerable populations suggested that informal needs assessment activities served to center the decision aid around users' needs, to better avoid stigma, and to ensure that the topic truly matters to the community. Partnering with community-based organizations may facilitate relationships of trust and may

  19. The Medicare Hospital Readmissions Reduction Program: potential unintended consequences for hospitals serving vulnerable populations.

    PubMed

    Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

    2014-06-01

    To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. © Health Research and Educational Trust.

  20. The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations

    PubMed Central

    Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

    2014-01-01

    Objective To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Data Sources/Study Setting Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Study Design Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Principal Findings Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Conclusions Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. PMID:24417309

  1. Nursing care of vulnerable populations using a framework of cultural competence, social justice and human rights.

    PubMed

    Pacquiao, Dula F

    2008-04-01

    The article attempts to present a model linking cultural competence with advocacy for social justice and protection of human rights in caring for vulnerable groups such as refugees and asylum seekers. Using the human rights principle focuses the moral obligation to address social inequities and suffering of vulnerable populations. Cultural competent care and culturally-congruent actions place the universal principles of social justice and protection of human rights within the cultural contexts of people's lives and the environment in which they are situated. Compassion is identified as the key component for culturally-competent advocacy for social justice and human rights protection. Compassion compels actions advocating social justice and protection of human rights for marginalised and powerless groups. Educational strategies for developing compassion are centered on collaboration, partnership and advocacy. Integration of experiential and didactic learning relevant to cultural competent care for refugees and asylum seekers are recommended.

  2. Population structure of an endemic vulnerable species, the Jamaican boa (Epicrates subflavus).

    PubMed

    Tzika, Athanasia C; Koenig, Susan; Miller, Ricardo; Garcia, Gerardo; Remy, Christophe; Milinkovitch, Michel C

    2008-01-01

    The Jamaican boa (Epicrates subflavus; also called Yellow boa) is an endemic species whose natural populations greatly and constantly declined since the late 19th century, mainly because of predation by introduced species, human persecution, and habitat destruction. In-situ conservation of the Jamaican boa is seriously hindered by the lack of information on demographic and ecological parameters as well as by a poor understanding of the population structure and species distribution in the wild. Here, using nine nuclear microsatellite loci and a fragment of the mitochondrial cytochrome b gene from 87 wild-born individuals, we present the first molecular genetic analyses focusing on the diversity and structure of the natural populations of the Jamaican boa. A model-based clustering analysis of multilocus microsatellite genotypes identifies three groups that are also significantly differentiated on the basis of F-statistics. Similarly, haplotypic network reconstruction methods applied on the cytochrome b haplotypes isolated here identify two well-differentiated haplogroups separated by four to six fixed mutations. Bayesian and metaGA analyses of the mitochondrial data set combined with sequences from other Boidae species indicate that rooting of the haplotypic network occurs most likely between the two defined haplogroups. Both analyses (based on nuclear and mitochondrial markers) underline an Eastern vs. (Western + Central) pattern of differentiation in agreement with geological data and patterns of differentiation uncovered in other vertebrate and invertebrate Jamaican species. Our results provide important insights for improving management of ex-situ captive populations and for guiding the development of proper in-situ species survival and habitat management plans for this spectacular, yet poorly known and vulnerable, snake.

  3. Community vulnerability to health impacts of wildland fire ...

    EPA Pesticide Factsheets

    Identifying communities vulnerable to adverse health effects from exposure to wildfire smoke may help prepare responses, increase the resilience to smoke and improve public health outcomes during smoke days. We developed a Community Health-Vulnerability Index (CHVI) based on factors known to increase the risks of health effects from air pollution and wildfire smoke exposures. These factors included county prevalence rates for asthma in children and adults, chronic obstructive pulmonary disease, hypertension, diabetes, obesity, percent of population 65 years of age and older, and indicators of socioeconomic status including poverty, education, income and unemployment. Using air quality simulated for the period between 2008 and 2012 over the continental U.S. we also characterized the population size at risk with respect to the level and duration of exposure to fire-originated fine particulate matter (fire-PM2.5) and CHVI. We estimate that 10% of the population (30.5 million) lived in the areas where the contribution of fire-PM2.5 to annual average ambient PM2.5 was high (>1.5 µg m3) and that 10.3 million individuals experienced unhealthy air quality levels for more than 10 days due to smoke. Using CHVI we identified the most vulnerable counties and determined that these communities experience more smoke exposures in comparison to less vulnerable communities. We describe the development of an index of community vulnerability for the health effects of smoke based o

  4. Disability and chronic disease among older adults in India: detecting vulnerable populations through the WHO SAGE Study.

    PubMed

    Basu, Sanjay; King, Abby C

    2013-12-01

    Chronic noncommunicable diseases (NCDs) are now prevalent in many low- and middle-income countries and confer a heightened risk of disability. It is unclear how public health programs can identify the older adults at highest risk of disability related to NCDs within diverse developing country populations. We studied nationally representative survey data from 7,150 Indian adults older than 50 years of age who participated in the World Health Organization Study on Global Aging and Adult Health (2007-2010) to identify population subgroups who are highly disabled. Using machine-learning algorithms, we identified sociodemographic correlates of disability. Although having 2 or more symptomatic NCDs was a key correlate of disability, the prevalence of symptomatic, undiagnosed NCDs was highest among the lowest 2 wealth quintiles of Indian adults, contrary to prior hypotheses of increased NCDs with wealth. Women and persons from rural populations were also disproportionately affected by nondiagnosed NCDs, with high out-of-pocket health care expenditures increasing the probability of remaining symptomatic from NCDs. These findings also indicate that NCD prevalence surveillance studies in low- and middle-income countries should expand beyond self-reported diagnoses to include more extensive symptom- and examination-based surveys, given the likely high rate of surveillance bias due to barriers to diagnosis among vulnerable populations.

  5. County-level heat vulnerability of urban and rural residents in Tibet, China.

    PubMed

    Bai, Li; Woodward, Alistair; Cirendunzhu; Liu, Qiyong

    2016-01-12

    Tibet is especially vulnerable to climate change due to the relatively rapid rise of temperature over past decades. The effects on mortality and morbidity of extreme heat in Tibet have been examined in previous studies; no heat adaptation initiatives have yet been implemented. We estimated heat vulnerability of urban and rural populations in 73 Tibetan counties and identified potential areas for public health intervention and further research. According to data availability and vulnerability factors identified previously in Tibet and elsewhere, we selected 10 variables related to advanced age, low income, illiteracy, physical and mental disability, small living spaces and living alone. We separately created and mapped county-level cumulative heat vulnerability indices for urban and rural residents by summing up factor scores produced by a principal components analysis (PCA). For both study populations, PCA yielded four factors with similar structure. The components for rural and urban residents explained 76.5 % and 77.7 % respectively of the variability in the original vulnerability variables. We found spatial variability of heat vulnerability across counties, with generally higher vulnerability in high-altitude counties. Although we observed similar median values and ranges of the cumulative heat vulnerability index values among urban and rural residents overall, the pattern varied strongly from one county to another. We have developed a measure of population vulnerability to high temperatures in Tibet. These are preliminary findings, but they may assist targeted adaptation plans in response to future rapid warming in Tibet.

  6. Social identity and support for counteracting tobacco company marketing that targets vulnerable populations

    PubMed Central

    Baig, Sabeeh A.; Pepper, Jessica K.; Morgan, Jennifer C.; Brewer, Noel T.

    2017-01-01

    Rationale Tobacco companies use advertising to target vulnerable populations, including youth, racial/ethnic minorities, and sexual minorities. Objective We sought to examine how personal identity affects support for population-specific anti-smoking advertisements that could serve as countermeasures to industry practices. Methods In 2014–2015, we surveyed probability phone samples of adults and adolescents (n = 6,139) and an online convenience sample of adults (n = 4,137) in the United States. We experimentally varied the description of tobacco industry marketing practices (no description, general, or specific to a target group). The four prevention target groups were teens; African Americans; Latinos; and gays, lesbians, and bisexuals (GLBs). Participants were either members or non-members of their prevention target group. Results Support was highest for anti-smoking advertisements targeting teens, moderate for Latinos and African Americans, and lowest for GLBs. In-group members expressed higher support than out-group members when anti-smoking advertisements targeted African Americans, Latinos, and GLBs (all p < .05). However, when teens were the target prevention group, in-group members expressed lower support than out-group members (p < .05). The description of industry marketing practices did not have an effect. Results were similar across the phone and online studies. Conclusions Our findings suggest that the public strongly supports advertisements to prevent smoking among teens, but support for similar efforts among other vulnerable populations is comparatively low. Anti-smoking campaigns for vulnerable populations may benefit from a greater understanding of the role of social identity in shaping public support for such campaigns. PMID:28427731

  7. Status of vulnerable Cystoseira populations along the Italian infralittoral fringe, and relationships with environmental and anthropogenic variables.

    PubMed

    Mancuso, F P; Strain, E M A; Piccioni, E; De Clerck, O; Sarà, G; Airoldi, L

    2018-04-01

    We analyzed the occurrence and status of infralittoral fringe populations of Cystoseira spp. (Fucales) at thirteen rocky sites around the Italian coastline, and explored the relationships with relevant environmental and anthropogenic variables. We found Cystoseira populations at 11 sites: most were scattered and comprised monospecific stands of C. compressa, and only 6 sites also supported sparse specimens of either C. amentacea var. stricta or C. brachycarpa. Coastal human population density, Chlorophyll a seawater concentrations, sea surface temperature, annual range of sea surface temperature and wave fetch explained most of the variation of the status of C. compressa. We hypothesize a generally unhealthy state of the Italian Cystoseira infralittoral fringe populations and identify multiple co-occurring anthropogenic stressors as the likely drivers of these poor conditions. Extensive baseline monitoring is needed to describe how Cystoseira populations are changing, and implement a management framework for the conservation of these valuable but vulnerable habitats. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Temporal and spatial changes in social vulnerability to natural hazards

    PubMed Central

    Cutter, Susan L.; Finch, Christina

    2008-01-01

    During the past four decades (1960–2000), the United States experienced major transformations in population size, development patterns, economic conditions, and social characteristics. These social, economic, and built-environment changes altered the American hazardscape in profound ways, with more people living in high-hazard areas than ever before. To improve emergency management, it is important to recognize the variability in the vulnerable populations exposed to hazards and to develop place-based emergency plans accordingly. The concept of social vulnerability identifies sensitive populations that may be less likely to respond to, cope with, and recover from a natural disaster. Social vulnerability is complex and dynamic, changing over space and through time. This paper presents empirical evidence on the spatial and temporal patterns in social vulnerability in the United States from 1960 to the present. Using counties as our study unit, we found that those components that consistently increased social vulnerability for all time periods were density (urban), race/ethnicity, and socioeconomic status. The spatial patterning of social vulnerability, although initially concentrated in certain geographic regions, has become more dispersed over time. The national trend shows a steady reduction in social vulnerability, but there is considerable regional variability, with many counties increasing in social vulnerability during the past five decades. PMID:18268336

  9. Ambient high temperature and mortality in Jinan, China: A study of heat thresholds and vulnerable populations.

    PubMed

    Li, Jing; Xu, Xin; Yang, Jun; Liu, Zhidong; Xu, Lei; Gao, Jinghong; Liu, Xiaobo; Wu, Haixia; Wang, Jun; Yu, Jieqiong; Jiang, Baofa; Liu, Qiyong

    2017-07-01

    Understanding the health consequences of continuously rising temperatures-as is projected for China-is important in terms of developing heat-health adaptation and intervention programs. This study aimed to examine the association between mortality and daily maximum (T max ), mean (T mean ), and minimum (T min ) temperatures in warmer months; to explore threshold temperatures; and to identify optimal heat indicators and vulnerable populations. Daily data on temperature and mortality were obtained for the period 2007-2013. Heat thresholds for condition-specific mortality were estimated using an observed/expected analysis. We used a generalised additive model with a quasi-Poisson distribution to examine the association between mortality and T max /T min /T mean values higher than the threshold values, after adjustment for covariates. T max /T mean /T min thresholds were 32/28/24°C for non-accidental deaths; 32/28/24°C for cardiovascular deaths; 35/31/26°C for respiratory deaths; and 34/31/28°C for diabetes-related deaths. For each 1°C increase in T max /T mean /T min above the threshold, the mortality risk of non-accidental-, cardiovascular-, respiratory, and diabetes-related death increased by 2.8/5.3/4.8%, 4.1/7.2/6.6%, 6.6/25.3/14.7%, and 13.3/30.5/47.6%, respectively. Thresholds for mortality differed according to health condition when stratified by sex, age, and education level. For non-accidental deaths, effects were significant in individuals aged ≥65 years (relative risk=1.038, 95% confidence interval: 1.026-1.050), but not for those ≤64 years. For most outcomes, women and people ≥65 years were more vulnerable. High temperature significantly increases the risk of mortality in the population of Jinan, China. Climate change with rising temperatures may bring about the situation worse. Public health programs should be improved and implemented to prevent and reduce health risks during hot days, especially for the identified vulnerable groups. Copyright

  10. Prevalence of metabolic syndrome and cardiovascular risk level in a vulnerable population.

    PubMed

    Kim, Chun-Ja; Park, JeeWon; Kang, Se-Won

    2015-04-01

    This study examined the prevalence of metabolic syndrome and the risk level of cardiovascular disease (CVD) in a vulnerable population of 407 subjects in Korea. This descriptive study was a part of the Tailed Health Visiting Service Program, using baseline data from public health centres in Suwon, Korea. The definition of metabolic syndrome was based on the National Cholesterol Education Program criteria, and risk of CVD was estimated according to the Framingham study equation. This study demonstrated that the prevalence of metabolic syndrome was 40.8% higher and the risk of CVD was significantly 3.1 times higher among those with metabolic syndrome than among those without it. Of those with metabolic syndrome, 50.6% overall and 81.1% of men had a high risk for CVD. These findings suggest a need to screen and prevent the risk of CVD in vulnerable populations with metabolic syndrome. © 2014 Wiley Publishing Asia Pty Ltd.

  11. Effects of human population density and proximity to markets on coral reef fishes vulnerable to extinction by fishing.

    PubMed

    Brewer, T D; Cinner, J E; Green, A; Pressey, R L

    2013-06-01

    Coral reef fisheries are crucial to the livelihoods of tens of millions of people; yet, widespread habitat degradation and unsustainable fishing are causing severe depletion of stocks of reef fish. Understanding how social and economic factors, such as human population density, access to external markets, and modernization interact with fishing and habitat degradation to affect fish stocks is vital to sustainable management of coral reef fisheries. We used fish survey data, national social and economic data, and path analyses to assess whether these factors explain variation in biomass of coral reef fishes among 25 sites in Solomon Islands. We categorized fishes into 3 groups on the basis of life-history characteristics associated with vulnerability to extinction by fishing (high, medium, and low vulnerability). The biomass of fish with low vulnerability was positively related to habitat condition. The biomass of fishes with high vulnerability was negatively related to fishing conducted with efficient gear. Use of efficient gear, in turn, was strongly and positively related to both population density and market proximity. This result suggests local population pressure and external markets have additive negative effects on vulnerable reef fish. Biomass of the fish of medium vulnerability was not explained by fishing intensity or habitat condition, which suggests these species may be relatively resilient to both habitat degradation and fishing. © 2012 Society for Conservation Biology.

  12. Population dynamics of Hawaiian seabird colonies vulnerable to sea-level rise

    USGS Publications Warehouse

    Hatfield, Jeff S.; Reynolds, Michelle H.; Seavy, Nathaniel E.; Krause, Crystal M.

    2012-01-01

    Globally, seabirds are vulnerable to anthropogenic threats both at sea and on land. Seabirds typically nest colonially and show strong fidelity to natal colonies, and such colonies on low-lying islands may be threatened by sea-level rise. We used French Frigate Shoals, the largest atoll in the Hawaiian Archipelago, as a case study to explore the population dynamics of seabird colonies and the potential effects sea-level rise may have on these rookeries. We compiled historic observations, a 30-year time series of seabird population abundance, lidar-derived elevations, and aerial imagery of all the islands of French Frigate Shoals. To estimate the population dynamics of 8 species of breeding seabirds on Tern Island from 1980 to 2009, we used a Gompertz model with a Bayesian approach to infer population growth rates, density dependence, process variation, and observation error. All species increased in abundance, in a pattern that provided evidence of density dependence. Great Frigatebirds (Fregata minor), Masked Boobies (Sula dactylatra), Red-tailed Tropicbirds (Phaethon rubricauda), Spectacled Terns (Onychoprion lunatus), and White Terns (Gygis alba) are likely at carrying capacity. Density dependence may exacerbate the effects of sea-level rise on seabirds because populations near carrying capacity on an island will be more negatively affected than populations with room for growth. We projected 12% of French Frigate Shoals will be inundated if sea level rises 1 m and 28% if sea level rises 2 m. Spectacled Terns and shrub-nesting species are especially vulnerable to sea-level rise, but seawalls and habitat restoration may mitigate the effects of sea-level rise. Losses of seabird nesting habitat may be substantial in the Hawaiian Islands by 2100 if sea levels rise 2 m. Restoration of higher-elevation seabird colonies represent a more enduring conservation solution for Pacific seabirds.

  13. Social identity and support for counteracting tobacco company marketing that targets vulnerable populations.

    PubMed

    Baig, Sabeeh A; Pepper, Jessica K; Morgan, Jennifer C; Brewer, Noel T

    2017-06-01

    Tobacco companies use advertising to target vulnerable populations, including youth, racial/ethnic minorities, and sexual minorities. We sought to examine how personal identity affects support for population-specific anti-smoking advertisements that could serve as countermeasures to industry marketing practices. In 2014-2015, we surveyed probability phone samples of adults and adolescents (n = 6,139) and an online convenience sample of adults (n = 4,137) in the United States. We experimentally varied the description of tobacco industry marketing practices (no description, general, or specific to a target group). The four prevention target groups were teens; African Americans; Latinos; and gays, lesbians, and bisexuals (GLBs). Participants were either members or non-members of their prevention target group. Support was highest for anti-smoking advertisements targeting teens, moderate for Latinos and African Americans, and lowest for GLBs. In-group members expressed higher support than out-group members when anti-smoking advertisements targeted African Americans, Latinos, and GLBs (all p < 0.05). However, when teens were the target prevention group, in-group members expressed lower support than out-group members (p < 0.05). The description of industry marketing practices did not have an effect. Results were similar across the phone and online studies. Our findings suggest that the public strongly supports advertisements to prevent smoking among teens, but support for similar efforts among other vulnerable populations is comparatively low. Anti-smoking campaigns for vulnerable populations may benefit from a greater understanding of the role of social identity in shaping public support for such campaigns. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Tsunami vulnerability assessment in the western coastal belt in Sri Lanka

    NASA Astrophysics Data System (ADS)

    Ranagalage, M. M.

    2017-12-01

    26th December 2004 tsunami disaster has caused massive loss of life, damage to coastal infrastructures and disruption to economic activities in the coastal belt of Sri Lanka. Tsunami vulnerability assessment is a requirement for disaster risk and vulnerability reduction. It plays a major role in identifying the extent and level of vulnerabilities to disasters within the communities. There is a need for a clearer understanding of the disaster risk patterns and factors contributing to it in different parts of the coastal belt. The main objective of this study is to investigate tsunami vulnerability assessment of Moratuwa Municipal council area in Sri Lanka. We have selected Moratuwa area due to considering urbanization pattern and Tsunami hazards of the country. Different data sets such as one-meter resolution LiDAR data, orthophoto, population, housing data and road layer were employed in this study. We employed tsunami vulnerability model for 1796 housing units located there, for a tsunami scenario with a maximum run-up 8 meters. 86% of the total land area affected by the tsunami in 8 meters scenarios. Additionally, building population has been used to estimate population in different vulnerability levels. The result shows that 32% of the buildings have extremely critical vulnerability level, 46% have critical vulnerability level, 22% have high vulnerability level, and 1% have a moderate vulnerability. According to the population estimation model results, 18% reside building with extremely critical vulnerability, 43% with critical vulnerability, 36% with high vulnerability and 3% belong to moderate vulnerability level. The results of the study provide a clear picture of tsunami vulnerability. Outcomes of this analysis can use as a valuable tool for urban planners to assess the risk and extent of disaster risk reduction which could be achieved via suitable mitigation measures to manage the coastal belt in Sri Lanka.

  15. Demography, vulnerabilities and right to health to Brazilian prison population.

    PubMed

    Soares, Marden Marques; Bueno, Paula Michele Martins Gomes

    2016-06-01

    This study investigates the latest research on the profile of the Brazilian prison population, its demography and current laws and regulations. It aims in the direction of ensuring the human right to health. Brazilian prison system is a complex universe in which state and federal criminal contexts keep more than 607,000 people in custody. This population is composed of 75% of young and black people, 67% poorly educated and 41% are pre-trial detainees, living in overcrowded prisons and architecturally vandalized, with population growth of around 575% in 24 years, making this environment a major focus of production of diseases. The prison becomes the object of differentiated intervention by public bodies linked to the executive and the judiciary - it is worth remarking that the data show the high level of inequalities and health vulnerabilities among the prison population, whose needs involve a set of cross-sector of transverse public policies actions towards penal execution.

  16. Access to genetic testing and genetic counseling in vulnerable populations: the d/Deaf and hard of hearing population.

    PubMed

    Cooke-Hubley, Sandra; Maddalena, Victor

    2011-09-01

    Genetic testing holds great potential for preventing morbidities and mortalities for a number of diseases through early detection and effective intervention. As the number of genetic tests expand, so will public demand for these services. Therefore, it is essential to evaluate access to genetic testing and genetic services to ensure that all Canadians, including vulnerable groups, have equitable access to all forms of health care, in keeping with the mandate of the Canadian Health Act. The purpose of this paper is to examine the literature to determine if and how the Deaf community, as a vulnerable group, is at an increased risk of inequitable access to genetic services in Canada and to discuss how those who are deaf and hard of hearing are subject to the same risks. First, we define vulnerability and describe why the Deaf community, as a social group, can be considered a vulnerable group, followed by a description of the benefits of genetic testing. Second, we describe the barriers to accessing genetic testing, and how the d/Deaf and hard of hearing population experience additional barriers. Third, we examine the difficulties incorporating genetic testing into medical practice, and how this creates additional barriers to those already at risk. Finally, we discuss the steps necessary to promote equitable access to genetic testing among the d/Deaf and hard of hearing populations within Canada, and provide recommendations for further research in this topic area. Lastly, we comment on how barriers to genetic testing vary among the d/Deaf and hard of hearing is dependent upon the type of health care system available (whether public or private).

  17. Business continuity, emergency planning and special needs: How to protect the vulnerable.

    PubMed

    Reilly, Daniel

    2015-01-01

    Emergencies and disasters affect all segments of the population. Some segments are more at risk during the emergency response and recovery efforts owing to vulnerabilities that increase the risk of harm. These vulnerabilities are due to individuals' disabilities, which must be incorporated into emergency and business continuity planning. Some disabilities are obvious, such as impaired vision, hearing or mobility, while other are less evident, but equally disabling, such as cognitive disorders, geographical or language isolation, and numerous age-related factors. Taken together when creating emergency or business continuity plans, the issues identified as disabilities can be grouped by functionality and termed as special needs. This paper will detail the identification of special needs populations, explain how these persons are vulnerable during the emergency or disaster response and recovery process, and provide examples of how to partner with individuals within identified special needs populations to improve the planning process.

  18. Extending Vulnerability Assessment to Include Life Stages Considerations

    PubMed Central

    Hodgson, Emma E.; Essington, Timothy E.; Kaplan, Isaac C.

    2016-01-01

    Species are experiencing a suite of novel stressors from anthropogenic activities that have impacts at multiple scales. Vulnerability assessment is one tool to evaluate the likely impacts that these stressors pose to species so that high-vulnerability cases can be identified and prioritized for monitoring, protection, or mitigation. Commonly used semi-quantitative methods lack a framework to explicitly account for differences in exposure to stressors and organism responses across life stages. Here we propose a modification to commonly used spatial vulnerability assessment methods that includes such an approach, using ocean acidification in the California Current as an illustrative case study. Life stage considerations were included by assessing vulnerability of each life stage to ocean acidification and were used to estimate population vulnerability in two ways. We set population vulnerability equal to: (1) the maximum stage vulnerability and (2) a weighted mean across all stages, with weights calculated using Lefkovitch matrix models. Vulnerability was found to vary across life stages for the six species explored in this case study: two krill–Euphausia pacifica and Thysanoessa spinifera, pteropod–Limacina helicina, pink shrimp–Pandalus jordani, Dungeness crab–Metacarcinus magister and Pacific hake–Merluccius productus. The maximum vulnerability estimates ranged from larval to subadult and adult stages with no consistent stage having maximum vulnerability across species. Similarly, integrated vulnerability metrics varied greatly across species. A comparison showed that some species had vulnerabilities that were similar between the two metrics, while other species’ vulnerabilities varied substantially between the two metrics. These differences primarily resulted from cases where the most vulnerable stage had a low relative weight. We compare these methods and explore circumstances where each method may be appropriate. PMID:27416031

  19. Extending Vulnerability Assessment to Include Life Stages Considerations.

    PubMed

    Hodgson, Emma E; Essington, Timothy E; Kaplan, Isaac C

    2016-01-01

    Species are experiencing a suite of novel stressors from anthropogenic activities that have impacts at multiple scales. Vulnerability assessment is one tool to evaluate the likely impacts that these stressors pose to species so that high-vulnerability cases can be identified and prioritized for monitoring, protection, or mitigation. Commonly used semi-quantitative methods lack a framework to explicitly account for differences in exposure to stressors and organism responses across life stages. Here we propose a modification to commonly used spatial vulnerability assessment methods that includes such an approach, using ocean acidification in the California Current as an illustrative case study. Life stage considerations were included by assessing vulnerability of each life stage to ocean acidification and were used to estimate population vulnerability in two ways. We set population vulnerability equal to: (1) the maximum stage vulnerability and (2) a weighted mean across all stages, with weights calculated using Lefkovitch matrix models. Vulnerability was found to vary across life stages for the six species explored in this case study: two krill-Euphausia pacifica and Thysanoessa spinifera, pteropod-Limacina helicina, pink shrimp-Pandalus jordani, Dungeness crab-Metacarcinus magister and Pacific hake-Merluccius productus. The maximum vulnerability estimates ranged from larval to subadult and adult stages with no consistent stage having maximum vulnerability across species. Similarly, integrated vulnerability metrics varied greatly across species. A comparison showed that some species had vulnerabilities that were similar between the two metrics, while other species' vulnerabilities varied substantially between the two metrics. These differences primarily resulted from cases where the most vulnerable stage had a low relative weight. We compare these methods and explore circumstances where each method may be appropriate.

  20. Identifying Novel Phenotypes of Vulnerability and Resistance to Activity-Based Anorexia in Adolescent Female Rats

    PubMed Central

    Barbarich-Marsteller, Nicole C.; Underwood, Mark D.; Foltin, Richard W.; Myers, Michael M.; Walsh, B. Timothy; Barrett, Jeffrey S.; Marsteller, Douglas A.

    2018-01-01

    Objective Activity-based anorexia is a translational rodent model that results in severe weight loss, hyperactivity, and voluntary self-starvation. The goal of our investigation was to identify vulnerable and resistant phenotypes of activity-based anorexia in adolescent female rats. Method Sprague-Dawley rats were maintained under conditions of restricted access to food (N = 64; or unlimited access, N = 16) until experimental exit, predefined as a target weight loss of 30–35% or meeting predefined criteria for animal health. Nonlinear mixed effects statistical modeling was used to describe wheel running behavior, time to event analysis was used to assess experimental exit, and a regressive partitioning algorithm was used to classify phenotypes. Results Objective criteria were identified for distinguishing novel phenotypes of activity-based anorexia, including a vulnerable phenotype that conferred maximal hyperactivity, minimal food intake, and the shortest time to experimental exit, and a resistant phenotype that conferred minimal activity and the longest time to experimental exit. Discussion The identification of objective criteria for defining vulnerable and resistant phenotypes of activity-based anorexia in adolescent female rats provides an important framework for studying the neural mechanisms that promote vulnerability to or protection against the development of self-starvation and hyperactivity during adolescence. Ultimately, future studies using these novel phenotypes may provide important translational insights into the mechanisms that promote these maladaptive behaviors characteristic of anorexia nervosa. PMID:23853140

  1. Identifying novel phenotypes of vulnerability and resistance to activity-based anorexia in adolescent female rats.

    PubMed

    Barbarich-Marsteller, Nicole C; Underwood, Mark D; Foltin, Richard W; Myers, Michael M; Walsh, B Timothy; Barrett, Jeffrey S; Marsteller, Douglas A

    2013-11-01

    Activity-based anorexia is a translational rodent model that results in severe weight loss, hyperactivity, and voluntary self-starvation. The goal of our investigation was to identify vulnerable and resistant phenotypes of activity-based anorexia in adolescent female rats. Sprague-Dawley rats were maintained under conditions of restricted access to food (N = 64; or unlimited access, N = 16) until experimental exit, predefined as a target weight loss of 30-35% or meeting predefined criteria for animal health. Nonlinear mixed effects statistical modeling was used to describe wheel running behavior, time to event analysis was used to assess experimental exit, and a regressive partitioning algorithm was used to classify phenotypes. Objective criteria were identified for distinguishing novel phenotypes of activity-based anorexia, including a vulnerable phenotype that conferred maximal hyperactivity, minimal food intake, and the shortest time to experimental exit, and a resistant phenotype that conferred minimal activity and the longest time to experimental exit. The identification of objective criteria for defining vulnerable and resistant phenotypes of activity-based anorexia in adolescent female rats provides an important framework for studying the neural mechanisms that promote vulnerability to or protection against the development of self-starvation and hyperactivity during adolescence. Ultimately, future studies using these novel phenotypes may provide important translational insights into the mechanisms that promote these maladaptive behaviors characteristic of anorexia nervosa. Copyright © 2013 Wiley Periodicals, Inc.

  2. Livestock and food security: vulnerability to population growth and climate change.

    PubMed

    Godber, Olivia F; Wall, Richard

    2014-10-01

    Livestock production is an important contributor to sustainable food security for many nations, particularly in low-income areas and marginal habitats that are unsuitable for crop production. Animal products account for approximately one-third of global human protein consumption. Here, a range of indicators, derived from FAOSTAT and World Bank statistics, are used to model the relative vulnerability of nations at the global scale to predicted climate and population changes, which are likely to impact on their use of grazing livestock for food. Vulnerability analysis has been widely used in global change science to predict impacts on food security and famine. It is a tool that is useful to inform policy decision making and direct the targeting of interventions. The model developed shows that nations within sub-Saharan Africa, particularly in the Sahel region, and some Asian nations are likely to be the most vulnerable. Livestock-based food security is already compromised in many areas on these continents and suffers constraints from current climate in addition to the lack of economic and technical support allowing mitigation of predicted climate change impacts. Governance is shown to be a highly influential factor and, paradoxically, it is suggested that current self-sufficiency may increase future potential vulnerability because trade networks are poorly developed. This may be relieved through freer trade of food products, which is also associated with improved governance. Policy decisions, support and interventions will need to be targeted at the most vulnerable nations, but given the strong influence of governance, to be effective, any implementation will require considerable care in the management of underlying structural reform. © 2014 The Authors. Global Change Biology Published by John Wiley & Sons Ltd.

  3. Livestock and food security: vulnerability to population growth and climate change

    PubMed Central

    Godber, Olivia F; Wall, Richard

    2014-01-01

    Livestock production is an important contributor to sustainable food security for many nations, particularly in low-income areas and marginal habitats that are unsuitable for crop production. Animal products account for approximately one-third of global human protein consumption. Here, a range of indicators, derived from FAOSTAT and World Bank statistics, are used to model the relative vulnerability of nations at the global scale to predicted climate and population changes, which are likely to impact on their use of grazing livestock for food. Vulnerability analysis has been widely used in global change science to predict impacts on food security and famine. It is a tool that is useful to inform policy decision making and direct the targeting of interventions. The model developed shows that nations within sub-Saharan Africa, particularly in the Sahel region, and some Asian nations are likely to be the most vulnerable. Livestock-based food security is already compromised in many areas on these continents and suffers constraints from current climate in addition to the lack of economic and technical support allowing mitigation of predicted climate change impacts. Governance is shown to be a highly influential factor and, paradoxically, it is suggested that current self-sufficiency may increase future potential vulnerability because trade networks are poorly developed. This may be relieved through freer trade of food products, which is also associated with improved governance. Policy decisions, support and interventions will need to be targeted at the most vulnerable nations, but given the strong influence of governance, to be effective, any implementation will require considerable care in the management of underlying structural reform. PMID:24692268

  4. Psychotropic medications for highly vulnerable children.

    PubMed

    McLaren, Jennifer L; Barnett, Erin R; Concepcion Zayas, Milangel T; Lichtenstein, Jonathan; Acquilano, Stephanie C; Schwartz, Lisa M; Woloshin, Steven; Drake, Robert E

    2018-04-01

    At least 20% of children in the U.S. are highly vulnerable because they lack healthcare and protection. Several factors produce vulnerability: trauma, disruptions of parenting, poverty, involvement in the juvenile justice and/or child welfare systems, residence in restrictive settings, and problems related to developmental disabilities. These children receive psychotropic medications at high rates, raising numerous concerns. Areas covered: The authors begin this review with a description of the population of highly vulnerable children. They then follow this with a review of the effectiveness and side effects of psychotropic medications for their most common diagnoses, using the highest-quality systematic reviews identified by multiple database searches. Expert opinion: Highly vulnerable children receive numerous psychotropic medications with high rates of polypharmacy, off-label use, and long-term use, typically in the absence of adjunctive psychosocial interventions. The current evidence contravenes these trends. Future studies of psychotropic medications in vulnerable children should include long-term effectiveness trials and polypharmacy in conjunction with evidence-based, family-centered, psychosocial treatments.

  5. Climate Risk and Vulnerability in the Caribbean and Gulf of Mexico Region: Interactions with Spatial Population and Land Cover Change

    NASA Astrophysics Data System (ADS)

    Chen, R. S.; Levy, M.; Baptista, S.; Adamo, S.

    2010-12-01

    Vulnerability to climate variability and change will depend on dynamic interactions between different aspects of climate, land-use change, and socioeconomic trends. Measurements and projections of these changes are difficult at the local scale but necessary for effective planning. New data sources and methods make it possible to assess land-use and socioeconomic changes that may affect future patterns of climate vulnerability. In this paper we report on new time series data sets that reveal trends in the spatial patterns of climate vulnerability in the Caribbean/Gulf of Mexico Region. Specifically, we examine spatial time series data for human population over the period 1990-2000, time series data on land use and land cover over 2000-2009, and infant mortality rates as a proxy for poverty for 2000-2008. We compare the spatial trends for these measures to the distribution of climate-related natural disaster risk hotspots (cyclones, floods, landslides, and droughts) in terms of frequency, mortality, and economic losses. We use these data to identify areas where climate vulnerability appears to be increasing and where it may be decreasing. Regions where trends and patterns are especially worrisome include coastal areas of Guatemala and Honduras.

  6. Evaluation of vulnerable PM2.5-exposure individuals: a repeated-measure study in an elderly population.

    PubMed

    Chu, Haiyan; Xin, Junyi; Yuan, Qi; Zhang, Xu; Pan, Wang; Zeng, Xinying; Chen, Yaoyao; Ma, Gaoxiang; Ge, Yuqiu; Du, Mulong; Tong, Na; Li, Xiaobo; Zhang, Zhengdong; Wang, Meilin

    2018-04-01

    Numerous studies have shown that elderly people are susceptible to high-level particles with aerodynamic diameter ≤ 2.5 μm (PM 2.5 ) exposure. However, not all elderly people exposed to PM 2.5 suffer from diseases. In this study, we aim to establish a method to predict the vulnerable PM 2.5 -exposure individuals among elderly population. Fourteen elderly people were recruited from May 8 to July 4, 2016, in Nanjing, China. Ten physiological indicators were repeatedly measured for 15 times. Liner mixed-effects model, principal component analysis (PCA), and PM 2.5 lag score were used to estimate the effects of PM 2.5 on blood pressure, pulse, and lung function. As a result, each quartile increase of ambient PM 2.5 was significantly associated with increased pulse (P < 0.05 for lag0, 1, 4, 0-1, 0-2, 0-3, and 0-5 days), decreased blood pressure (P < 0.05 for lag4 and 0-3 days), and decreased lung function (P < 0.05 for lag0, 1, 0-1, and 0-2 days) among the 14 elderly people. In terms of pulse or lung function, three elderly people were considered as vulnerable PM 2.5 -exposure individuals. No vulnerable individual was found for blood pressure. Blood pressure, pulse, and lung function could be affected by high-level PM 2.5 exposure in elderly people. This method for screening three elderly people may provide a new insight on identifying the vulnerable PM 2.5 -exposure individuals.

  7. Accessibility and utilization patterns of a mobile medical clinic among vulnerable populations.

    PubMed

    Gibson, Britton A; Ghosh, Debarchana; Morano, Jamie P; Altice, Frederick L

    2014-07-01

    We mapped mobile medical clinic (MMC) clients for spatial distribution of their self-reported locations and travel behaviors to better understand health-seeking and utilization patterns of medically vulnerable populations in Connecticut. Contrary to distance decay literature, we found that a small but significant proportion of clients was traveling substantial distances to receive repeat care at the MMC. Of 8404 total clients, 90.2% lived within 5 miles of a MMC site, yet mean utilization was highest (5.3 visits per client) among those living 11-20 miles of MMCs, primarily for those with substance use disorders. Of clients making >20 visits, 15.0% traveled >10 miles, suggesting that a significant minority of clients traveled to MMC sites because of their need-specific healthcare services, which are not only free but available at an acceptable and accommodating environment. The findings of this study contribute to the important research on healthcare utilization among vulnerable population by focusing on broader dimensions of accessibility in a setting where both mobile and fixed healthcare services coexist. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Assessment of the vulnerability and the resilience of the population at risk of multi-hazard: a support to geo-risk management in Central Africa

    NASA Astrophysics Data System (ADS)

    Michellier, Caroline; Kervyn, François; Tréfon, Théodore; Wolff, Eléonore

    2013-04-01

    GeoRisCA is a project which aims at studying the geo-risk in the Kivu region (DRC, Rwanda, Burundi), in order to support risk management. The approach developed in GeoRisCA combines methodologies from various disciplines, which will allow the analyses of seismic, volcanic and mass-movement hazards and the vulnerability assessment of the threatened elements. Vulnerability is a complex concept which is commonly defined as the susceptibility of the population, the infrastructures and the natural ecosystems to suffer from damages if a hazard occurs. The densely populated area extended from the North Kivu province in Democratic Republic of the Congo (DRC) to North Burundi and East Rwanda is vulnerable to several geohazards, such as landslides triggered by geodynamical processes (climate, seismicity, volcanism) and possibly worsen by anthropic actions. Located in the East African rift valley, the region is also characterized by a strong seismicity, with increasing people and infrastructure exposed. In addition, east DRC hosts the two most active African volcanoes: Nyiragongo and Nyamulagira. Their activity can have serious impacts, as in 2002 when Nyiragongo directly endangers the ~800.000 inhabitants of Goma city, located ~15 km to the south. Linked to passive volcanic degassing, SO2 and CO2 discharge may also increase the population vulnerability(morbidity, mortality). Focusing specifically on this region, the vulnerability assessment methodology developed in GeoRisCA takes into account "exposure to perturbations" and "adaptive capacity or resilience" of the vulnerable systems. On one hand, the exposure is identified as the potential degree of loss of a given element or set of elements at risk; i.e., the susceptibility of people, infrastructures and buildings with respect to a hazard (social vulnerability). It focuses mainly on land use, and on demographic and socio-economic factors that increase or attenuate the impacts of hazards events on local populations. On the

  9. Social Vulnerability and Ebola Virus Disease in Rural Liberia.

    PubMed

    Stanturf, John A; Goodrick, Scott L; Warren, Melvin L; Charnley, Susan; Stegall, Christie M

    2015-01-01

    The Ebola virus disease (EVD) epidemic that has stricken thousands of people in the three West African countries of Liberia, Sierra Leone, and Guinea highlights the lack of adaptive capacity in post-conflict countries. The scarcity of health services in particular renders these populations vulnerable to multiple interacting stressors including food insecurity, climate change, and the cascading effects of disease epidemics such as EVD. However, the spatial distribution of vulnerable rural populations and the individual stressors contributing to their vulnerability are unknown. We developed a Social Vulnerability Classification using census indicators and mapped it at the district scale for Liberia. According to the Classification, we estimate that districts having the highest social vulnerability lie in the north and west of Liberia in Lofa, Bong, Grand Cape Mount, and Bomi Counties. Three of these counties together with the capital Monrovia and surrounding Montserrado and Margibi counties experienced the highest levels of EVD infections in Liberia. Vulnerability has multiple dimensions and a classification developed from multiple variables provides a more holistic view of vulnerability than single indicators such as food insecurity or scarcity of health care facilities. Few rural Liberians are food secure and many cannot reach a medical clinic in <80 minutes. Our results illustrate how census and household survey data, when displayed spatially at a sub-county level, may help highlight the location of the most vulnerable households and populations. Our results can be used to identify vulnerability hotspots where development strategies and allocation of resources to address the underlying causes of vulnerability in Liberia may be warranted. We demonstrate how social vulnerability index approaches can be applied in the context of disease outbreaks, and our methods are relevant elsewhere.

  10. Vulnerable Populations in Hospital and Health Care Emergency Preparedness Planning: A Comprehensive Framework for Inclusion.

    PubMed

    Kreisberg, Debra; Thomas, Deborah S K; Valley, Morgan; Newell, Shannon; Janes, Enessa; Little, Charles

    2016-04-01

    As attention to emergency preparedness becomes a critical element of health care facility operations planning, efforts to recognize and integrate the needs of vulnerable populations in a comprehensive manner have lagged. This not only results in decreased levels of equitable service, but also affects the functioning of the health care system in disasters. While this report emphasizes the United States context, the concepts and approaches apply beyond this setting. This report: (1) describes a conceptual framework that provides a model for the inclusion of vulnerable populations into integrated health care and public health preparedness; and (2) applies this model to a pilot study. The framework is derived from literature, hospital regulatory policy, and health care standards, laying out the communication and relational interfaces that must occur at the systems, organizational, and community levels for a successful multi-level health care systems response that is inclusive of diverse populations explicitly. The pilot study illustrates the application of key elements of the framework, using a four-pronged approach that incorporates both quantitative and qualitative methods for deriving information that can inform hospital and health facility preparedness planning. The conceptual framework and model, applied to a pilot project, guide expanded work that ultimately can result in methodologically robust approaches to comprehensively incorporating vulnerable populations into the fabric of hospital disaster preparedness at levels from local to national, thus supporting best practices for a community resilience approach to disaster preparedness.

  11. The safety net medical home initiative: transforming care for vulnerable populations.

    PubMed

    Sugarman, Jonathan R; Phillips, Kathryn E; Wagner, Edward H; Coleman, Katie; Abrams, Melinda K

    2014-11-01

    Despite findings that medical homes may reduce or eliminate health care disparities among underserved and minority populations, most previous medical home pilot and demonstration projects have focused on health care delivery systems serving commercially insured patients and Medicare beneficiaries. To develop a replicable approach to support medical home transformation among diverse practices serving vulnerable and underserved populations. Facilitated by a national program team, convening organizations in 5 states provided coaching and learning community support to safety net practices over a 4-year period. To guide transformation, we developed a framework of change concepts aligned with supporting tools including implementation guides, activity checklists, and measurement instruments. Sixty-five health centers, homeless clinics, private practices, residency training centers, and other safety net practices in Colorado, Idaho, Massachusetts, Oregon, and Pennsylvania. We evaluated implementation of the change concepts using the Patient-Centered Medical Home-Assessment, and conducted a survey of participating practices to assess perceptions of the impact of the technical assistance. All practices implemented key features of the medical home model, and nearly half (47.6%) implemented the 33 identified key changes to a substantial degree as evidenced by level A Patient-Centered Medical Home-Assessment scores. Two thirds of practices that achieved substantial implementation did so only after participating in the initiative for >2 years. By the end of the initiative, 83.1% of sites achieved external recognition as medical homes. Despite resource constraints and high-need populations, safety net clinics made considerable progress toward medical home implementation when provided robust, multimodal support over a 4-year period.

  12. Nurses Need Not Be Guilty Bystanders: Caring for Vulnerable Immigrant Populations

    PubMed

    Fitzgerald, Elizabeth Moran; Myers, Judith G; Clark, Paul

    2016-12-01

    Nurses face many dilemmas when providing healthcare to immigrants, a vulnerable population. Racist, rancorous dialogue can create a hostile care environment that may place patients at risk for substandard care. This article presents a two part case study about a Hispanic patient to illustrate both examples of inappropriate dialogue (Part I) and potential nursing actions (Part 2). The authors review myths versus facts about Hispanic immigrants and introduce activist Thomas Merton’s concept of the guilty bystander, the nursing professional code of ethics, and Professor Joseph Badaracco’s concepts of quiet leadership as practical tools and approaches that nurses can use to advocate for safe, quality, ethical care of immigrant populations.

  13. Population dynamics of Hawaiian seabird colonies vulnerable to sea-level rise.

    PubMed

    Hatfield, Jeff S; Reynolds, Michelle H; Seavy, Nathaniel E; Krause, Crystal M

    2012-08-01

    Globally, seabirds are vulnerable to anthropogenic threats both at sea and on land. Seabirds typically nest colonially and show strong fidelity to natal colonies, and such colonies on low-lying islands may be threatened by sea-level rise. We used French Frigate Shoals, the largest atoll in the Hawaiian Archipelago, as a case study to explore the population dynamics of seabird colonies and the potential effects sea-level rise may have on these rookeries. We compiled historic observations, a 30-year time series of seabird population abundance, lidar-derived elevations, and aerial imagery of all the islands of French Frigate Shoals. To estimate the population dynamics of 8 species of breeding seabirds on Tern Island from 1980 to 2009, we used a Gompertz model with a Bayesian approach to infer population growth rates, density dependence, process variation, and observation error. All species increased in abundance, in a pattern that provided evidence of density dependence. Great Frigatebirds (Fregata minor), Masked Boobies (Sula dactylatra), Red-tailed Tropicbirds (Phaethon rubricauda), Spectacled Terns (Onychoprion lunatus), and White Terns (Gygis alba) are likely at carrying capacity. Density dependence may exacerbate the effects of sea-level rise on seabirds because populations near carrying capacity on an island will be more negatively affected than populations with room for growth. We projected 12% of French Frigate Shoals will be inundated if sea level rises 1 m and 28% if sea level rises 2 m. Spectacled Terns and shrub-nesting species are especially vulnerable to sea-level rise, but seawalls and habitat restoration may mitigate the effects of sea-level rise. Losses of seabird nesting habitat may be substantial in the Hawaiian Islands by 2100 if sea levels rise 2 m. Restoration of higher-elevation seabird colonies represent a more enduring conservation solution for Pacific seabirds. Conservation Biology ©2012 Society for Conservation Biology. No claim to original

  14. Pharmacologic studies in vulnerable populations: Using the pediatric experience.

    PubMed

    Zimmerman, Kanecia; Gonzalez, Daniel; Swamy, Geeta K; Cohen-Wolkowiez, Michael

    2015-11-01

    Historically, few data exist to guide dosing in children and pregnant women. Multiple barriers to inclusion of these vulnerable populations in clinical trials have led to this paucity of data. However, federal legislation targeted at pediatric therapeutics, innovative clinical trial design, use of quantitative clinical pharmacology methods, pediatric thought leadership, and collaboration have successfully overcome many existing barriers. This success has resulted in improved knowledge on pharmacokinetics, safety, and efficacy of therapeutics in children. To date, research in pregnant women has not been characterized by similar success. Wide gaps in knowledge remain despite the common use of therapeutics in pregnancy. Given the similar barriers to drug research and development in pediatric and pregnant populations, the route toward success in children may serve as a model for the advancement of drug development and appropriate drug administration in pregnant women. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Prioritizing vulnerable children: why should we address inequity?

    PubMed

    Joshua, P; Zwi, K; Moran, P; White, L

    2015-11-01

    Children and young people from vulnerable population groups, including Indigenous Australians, those in out of home care, those with disabilities and those from refugee families, have difficulties in accessing health services and are at high risk of adverse outcomes, driving population health inequity. Although heterogeneous, these groups face common disadvantage and shared challenges in health service utilization. This study aims to analyse the demographics of vulnerable child populations in NSW, the rationale for focussing on their health needs and strategies for addressing population health inequity. A literature review was undertaken on vulnerable child populations and successful strategies for improving their health outcomes. NSW data on vulnerable children were collated. Vulnerable children in NSW are estimated to comprise 10-20% of the childhood population. Efforts to improve their health and well-being can be justified based on child rights, a focus on equity and effectiveness of care, public opinion and the evidence base supporting such interventions. Targeted (subpopulation specific) interventions and delivery of universally applied (population wide) strategies that disproportionately benefit vulnerable populations have been shown to be effective in reducing healthcare disparities. Most available information relates to specific vulnerable population groups. However, some effective strategies and key principles are broadly applicable to the vulnerable child population as a whole. Vulnerable children should be a key focus of healthcare interventions if inequities are to be addressed. © 2015 John Wiley & Sons Ltd.

  16. Identifying counties vulnerable to diabetes from obesity prevalence in the United States: a spatiotemporal analysis.

    PubMed

    Li, Xiao; Staudt, Amanda; Chien, Lung-Chang

    2016-11-21

    Clinical and epidemiological research has reported a strong association between diabetes and obesity. However, whether increased diabetes prevalence is more likely to appear in areas with increased obesity prevalence has not been thoroughly investigated in the United States (US). The Bayesian structured additive regression model was applied to identify whether counties with higher obesity prevalence are more likely clustered in specific regions in 48 contiguous US states. Prevalence data adopted the small area estimate from the Behavioral Risk Factor Surveillance System. Confounding variables like socioeconomic status adopted data were from the American Community Survey. This study reveals that an increased percentage of relative risk of diabetes was more likely to appear in Southeast, Northeast, Central and South regions. Of counties vulnerable to diabetes, 36.8% had low obesity prevalence, and most of them were located in the Southeast, Central, and South regions. The geographic distribution of counties vulnerable to diabetes expanded to the Southwest, West and Northern regions when obesity prevalence increased. This study also discloses that 7.4% of counties had the largest average in predicted diabetes prevalence compared to the other counties. Their average diabetes prevalence escalated from 8.7% in 2004 to 11.2% in 2011. This study not only identifies counties vulnerable to diabetes due to obesity, but also distinguishes counties in terms of different levels of vulnerability to diabetes. The findings can provide the possibility of establishing targeted surveillance systems to raise awareness of diabetes in those counties.

  17. Peer-led Aboriginal parent support: Program development for vulnerable populations with participatory action research.

    PubMed

    Munns, Ailsa; Toye, Christine; Hegney, Desley; Kickett, Marion; Marriott, Rhonda; Walker, Roz

    2017-10-01

    Participatory action research (PAR) is a credible, culturally appropriate methodology that can be used to effect collaborative change within vulnerable populations. This PAR study was undertaken in a Western Australian metropolitan setting to develop and evaluate the suitability, feasibility and effectiveness of an Aboriginal peer-led home visiting programme. A secondary aim, addressed in this paper, was to explore and describe research methodology used for the study and provide recommendations for its implementation in other similar situations. PAR using action learning sets was employed to develop the parent support programme and data addressing the secondary, methodological aim were collected through focus groups using semi-structured and unstructured interview schedules. Findings were addressed throughout the action research process to enhance the research process. The themes that emerged from the data and addressed the methodological aim were the need for safe communication processes; supportive engagement processes and supportive organisational processes. Aboriginal peer support workers (PSWs) and community support agencies identified three important elements central to their capacity to engage and work within the PAR methodology. This research has provided innovative data, highlighting processes and recommendations for child health nurses to engage with the PSWs, parents and community agencies to explore culturally acceptable elements for an empowering methodology for peer-led home visiting support. There is potential for this nursing research to credibly inform policy development for Aboriginal child and family health service delivery, in addition to other vulnerable population groups. Child health nurses/researchers can use these new understandings to work in partnership with Aboriginal communities and families to develop empowering and culturally acceptable strategies for developing Aboriginal parent support for the early years. Impact Statement Child

  18. Communicating Pacific Rim Risk: A GIS Analysis of Hazard, Vulnerability, Population, and Infrastructure

    NASA Astrophysics Data System (ADS)

    Yurkovich, E. S.; Howell, D. G.

    2002-12-01

    Exploding population and unprecedented urban development within the last century helped fuel an increase in the severity of natural disasters. Not only has the world become more populated, but people, information and commodities now travel greater distances to service larger concentrations of people. While many of the earth's natural hazards remain relatively constant, understanding the risk to increasingly interconnected and large populations requires an expanded analysis. To improve mitigation planning we propose a model that is accessible to planners and implemented with public domain data and industry standard GIS software. The model comprises 1) the potential impact of five significant natural hazards: earthquake, flood, tropical storm, tsunami and volcanic eruption assessed by a comparative index of risk, 2) population density, 3) infrastructure distribution represented by a proxy, 4) the vulnerability of the elements at risk (population density and infrastructure distribution) and 5) the connections and dependencies of our increasingly 'globalized' world, portrayed by a relative linkage index. We depict this model with the equation, Risk = f(H, E, V, I) Where H is an index normalizing the impact of five major categories of natural hazards; E is one element at risk, population or infrastructure; V is a measure of the vulnerability for of the elements at risk; and I pertains to a measure of interconnectivity of the elements at risk as a result of economic and social globalization. We propose that future risk analysis include the variable I to better define and quantify risk. Each assessment reflects different repercussions from natural disasters: losses of life or economic activity. Because population and infrastructure are distributed heterogeneously across the Pacific region, two contrasting representations of risk emerge from this study.

  19. Community Vulnerability to Health Impacts of Wildland Fire Smoke Exposure.

    PubMed

    Rappold, Ana G; Reyes, Jeanette; Pouliot, George; Cascio, Wayne E; Diaz-Sanchez, David

    2017-06-20

    Identifying communities vulnerable to adverse health effects from exposure to wildfire smoke may help prepare responses, increase the resilience to smoke and improve public health outcomes during smoke days. We developed a Community Health-Vulnerability Index (CHVI) based on factors known to increase the risks of health effects from air pollution and wildfire smoke exposures. These factors included county prevalence rates for asthma in children and adults, chronic obstructive pulmonary disease, hypertension, diabetes, obesity, percent of population 65 years of age and older, and indicators of socioeconomic status including poverty, education, income and unemployment. Using air quality simulated for the period between 2008 and 2012 over the continental U.S. we also characterized the population size at risk with respect to the level and duration of exposure to fire-originated fine particulate matter (fire-PM 2.5 ) and CHVI. We estimate that 10% of the population (30.5 million) lived in the areas where the contribution of fire-PM 2.5 to annual average ambient PM 2.5 was high (>1.5 μg/m 3 ) and that 10.3 million individuals experienced unhealthy air quality levels for more than 10 days due to smoke. Using CHVI we identified the most vulnerable counties and determined that these communities experience more smoke exposures in comparison to less vulnerable communities.

  20. Linking degradation status with ecosystem vulnerability to environmental change

    USGS Publications Warehouse

    Angeler, David G.; Baho, Didier L.; Allen, Craig R.; Johnson, Richard K.

    2015-01-01

    Environmental change can cause regime shifts in ecosystems, potentially threatening ecosystem services. It is unclear if the degradation status of ecosystems correlates with their vulnerability to environmental change, and thus the risk of future regime shifts. We assessed resilience in acidified (degraded) and circumneutral (undegraded) lakes with long-term data (1988–2012), using time series modeling. We identified temporal frequencies in invertebrate assemblages, which identifies groups of species whose population dynamics vary at particular temporal scales. We also assessed species with stochastic dynamics, those whose population dynamics vary irregularly and unpredictably over time. We determined the distribution of functional feeding groups of invertebrates within and across the temporal scales identified, and in those species with stochastic dynamics, and assessed attributes hypothesized to contribute to resilience. Three patterns of temporal dynamics, consistent across study lakes, were identified in the invertebrates. The first pattern was one of monotonic change associated with changing abiotic lake conditions. The second and third patterns appeared unrelated to the environmental changes we monitored. Acidified and the circumneutral lakes shared similar levels and patterns of functional richness, evenness, diversity, and redundancy for species within and across the observed temporal scales and for stochastic species groups. These similar resilience characteristics suggest that both lake types did not differ in vulnerability to the environmental changes observed here. Although both lake types appeared equally vulnerable in this study, our approach demonstrates how assessing systemic vulnerability by quantifying ecological resilience can help address uncertainty in predicting ecosystem responses to environmental change across ecosystems.

  1. Central and rear-edge populations can be equally vulnerable to warming

    NASA Astrophysics Data System (ADS)

    Bennett, Scott; Wernberg, Thomas; Arackal Joy, Bijo; de Bettignies, Thibaut; Campbell, Alexandra H.

    2015-12-01

    Rear (warm) edge populations are often considered more susceptible to warming than central (cool) populations because of the warmer ambient temperatures they experience, but this overlooks the potential for local variation in thermal tolerances. Here we provide conceptual models illustrating how sensitivity to warming is affected throughout a species' geographical range for locally adapted and non-adapted populations. We test these models for a range-contracting seaweed using observations from a marine heatwave and a 12-month experiment, translocating seaweeds among central, present and historic range edge locations. Growth, reproductive development and survivorship display different temperature thresholds among central and rear-edge populations, but share a 2.5 °C anomaly threshold. Range contraction, therefore, reflects variation in local anomalies rather than differences in absolute temperatures. This demonstrates that warming sensitivity can be similar throughout a species geographical range and highlights the importance of incorporating local adaptation and acclimatization into climate change vulnerability assessments.

  2. Mapping human vulnerability to climate change in the Brazilian Amazon: The construction of a municipal vulnerability index

    PubMed Central

    Confalonieri, Ulisses; Madureira, Ana Paula; Duval, Isabela de Brito; dos Santos, Rhavena Barbosa; Margonari, Carina

    2018-01-01

    Vulnerability, understood as the propensity to be adversely affected, has attained importance in the context of climate change by helping to understand what makes populations and territories predisposed to its impacts. Conditions of vulnerability may vary depending on the characteristics of each territory studied—social, environmental, infrastructural, public policies, among others. Thus, the present study aimed to evaluate what makes the municipalities of the state of Amazonas, Brazil, vulnerable to climate change in the context of the largest tropical forest in the world, and which regions of the State are the most susceptible. A Municipal Vulnerability Index was developed, which was used to associate current socio-environmental characteristics of municipalities with climate change scenarios in order to identify those that may be most affected by climate change. The results showed that poor adaptive capacity and poverty had the most influence on current vulnerability of the municipalities of Amazonas with the most vulnerable areas being the southern, northern, and eastern regions of the state. When current vulnerability was related to future climate change projections, the most vulnerable areas were the northern, northeastern, extreme southern, and southwestern regions. From a socio-environmental and climatic point of view, these regions should be a priority for public policy efforts to reduce their vulnerability and prepare them to cope with the adverse aspects of climate change. PMID:29444086

  3. Mapping human vulnerability to climate change in the Brazilian Amazon: The construction of a municipal vulnerability index.

    PubMed

    Menezes, Júlia Alves; Confalonieri, Ulisses; Madureira, Ana Paula; Duval, Isabela de Brito; Santos, Rhavena Barbosa Dos; Margonari, Carina

    2018-01-01

    Vulnerability, understood as the propensity to be adversely affected, has attained importance in the context of climate change by helping to understand what makes populations and territories predisposed to its impacts. Conditions of vulnerability may vary depending on the characteristics of each territory studied-social, environmental, infrastructural, public policies, among others. Thus, the present study aimed to evaluate what makes the municipalities of the state of Amazonas, Brazil, vulnerable to climate change in the context of the largest tropical forest in the world, and which regions of the State are the most susceptible. A Municipal Vulnerability Index was developed, which was used to associate current socio-environmental characteristics of municipalities with climate change scenarios in order to identify those that may be most affected by climate change. The results showed that poor adaptive capacity and poverty had the most influence on current vulnerability of the municipalities of Amazonas with the most vulnerable areas being the southern, northern, and eastern regions of the state. When current vulnerability was related to future climate change projections, the most vulnerable areas were the northern, northeastern, extreme southern, and southwestern regions. From a socio-environmental and climatic point of view, these regions should be a priority for public policy efforts to reduce their vulnerability and prepare them to cope with the adverse aspects of climate change.

  4. Self-efficacy as a unifying construct in nursing-social work collaboration with vulnerable populations.

    PubMed

    Washington, Olivia G M; Moxley, David P

    2013-03-01

    The authors consider self-efficacy practice as an organizing construct guiding nursing-social work action research in partnership with older homeless and formerly homeless African-American women. The authors, both academics who together have worked with members of this vulnerable population for a decade and a half, report on their unifying action research perspective immersed in self-efficacy theory. We examine how our adaptations of Bandura's classic four sources of self-efficacy form a distinctive intervention practice designed to help older African-American women emerge from homelessness. We amplify the incorporation of the four sources (vicarious experience and exposure to powerful role models, emotional arousal and accompanying catharsis, verbal persuasion, and role performance) into a grand strategy useful in working collaboratively with members of vulnerable populations, so they can achieve outcomes that improve their functional health, well-being and ultimately their quality of life. © 2012 Blackwell Publishing Ltd.

  5. Identification of vulnerability within a child and family health service.

    PubMed

    Kimla, Katarina; Nathanson, Dania; Woolfenden, Susan; Zwi, Karen

    2017-11-21

    Objective The aims of the present study were to describe the prevalence of vulnerability in a cohort of newborns, identify the factors that increase the risk of vulnerability and examine whether those who are most vulnerable are receiving home visits. Methods A prospective cross-sectional study was performed using data collected from questionnaires completed by child and family health nurses and obstetric discharge summaries for each mother-baby dyad. Descriptive frequencies and percentages are used to describe the proportions of children who were vulnerable, offered services and had risk factors for vulnerability. Categorical data were compared using Pearson's Chi-squared analysis. Results In all, 1517 newborns were included in the present study. Of these, 40.5% were identified as vulnerable and 13.9% had two or more risk factors for vulnerability (95% confidence interval (CI) 12-16%). The most common risk factors were biological. Across all newborns, 33.7% were visited at home, and 74.6% of vulnerable newborns were offered a home visit. Children identified as vulnerable were more likely to have a home visit than those who were not (z for 95% CI=1.96; P<0.1). Conclusions Although the high reported prevalence of identified risk needs to be confirmed in further studies, identifying vulnerability allowed the offer of home visiting to be directed towards those most likely to benefit. What is known about the topic? Of the Australian child population, 10-20% are vulnerable to adverse health, developmental and wellbeing outcomes. Vulnerable infants are at a greater risk of becoming vulnerable children, adolescents and adults over the life course. Biological and psychosocial risk factors for vulnerability are well described. Families with the greatest need are often the least likely to access or receive support, and have lower utilisation of preventative health services despite evidence that support in the first few years of life can significantly improve long

  6. Identifying the world's most climate change vulnerable species: a systematic trait-based assessment of all birds, amphibians and corals.

    PubMed

    Foden, Wendy B; Butchart, Stuart H M; Stuart, Simon N; Vié, Jean-Christophe; Akçakaya, H Resit; Angulo, Ariadne; DeVantier, Lyndon M; Gutsche, Alexander; Turak, Emre; Cao, Long; Donner, Simon D; Katariya, Vineet; Bernard, Rodolphe; Holland, Robert A; Hughes, Adrian F; O'Hanlon, Susannah E; Garnett, Stephen T; Sekercioğlu, Cagan H; Mace, Georgina M

    2013-01-01

    Climate change will have far-reaching impacts on biodiversity, including increasing extinction rates. Current approaches to quantifying such impacts focus on measuring exposure to climatic change and largely ignore the biological differences between species that may significantly increase or reduce their vulnerability. To address this, we present a framework for assessing three dimensions of climate change vulnerability, namely sensitivity, exposure and adaptive capacity; this draws on species' biological traits and their modeled exposure to projected climatic changes. In the largest such assessment to date, we applied this approach to each of the world's birds, amphibians and corals (16,857 species). The resulting assessments identify the species with greatest relative vulnerability to climate change and the geographic areas in which they are concentrated, including the Amazon basin for amphibians and birds, and the central Indo-west Pacific (Coral Triangle) for corals. We found that high concentration areas for species with traits conferring highest sensitivity and lowest adaptive capacity differ from those of highly exposed species, and we identify areas where exposure-based assessments alone may over or under-estimate climate change impacts. We found that 608-851 bird (6-9%), 670-933 amphibian (11-15%), and 47-73 coral species (6-9%) are both highly climate change vulnerable and already threatened with extinction on the IUCN Red List. The remaining highly climate change vulnerable species represent new priorities for conservation. Fewer species are highly climate change vulnerable under lower IPCC SRES emissions scenarios, indicating that reducing greenhouse emissions will reduce climate change driven extinctions. Our study answers the growing call for a more biologically and ecologically inclusive approach to assessing climate change vulnerability. By facilitating independent assessment of the three dimensions of climate change vulnerability, our approach can

  7. Identifying the World's Most Climate Change Vulnerable Species: A Systematic Trait-Based Assessment of all Birds, Amphibians and Corals

    PubMed Central

    Foden, Wendy B.; Butchart, Stuart H. M.; Stuart, Simon N.; Vié, Jean-Christophe; Akçakaya, H. Resit; Angulo, Ariadne; DeVantier, Lyndon M.; Gutsche, Alexander; Turak, Emre; Cao, Long; Donner, Simon D.; Katariya, Vineet; Bernard, Rodolphe; Holland, Robert A.; Hughes, Adrian F.; O’Hanlon, Susannah E.; Garnett, Stephen T.; Şekercioğlu, Çagan H.; Mace, Georgina M.

    2013-01-01

    Climate change will have far-reaching impacts on biodiversity, including increasing extinction rates. Current approaches to quantifying such impacts focus on measuring exposure to climatic change and largely ignore the biological differences between species that may significantly increase or reduce their vulnerability. To address this, we present a framework for assessing three dimensions of climate change vulnerability, namely sensitivity, exposure and adaptive capacity; this draws on species’ biological traits and their modeled exposure to projected climatic changes. In the largest such assessment to date, we applied this approach to each of the world’s birds, amphibians and corals (16,857 species). The resulting assessments identify the species with greatest relative vulnerability to climate change and the geographic areas in which they are concentrated, including the Amazon basin for amphibians and birds, and the central Indo-west Pacific (Coral Triangle) for corals. We found that high concentration areas for species with traits conferring highest sensitivity and lowest adaptive capacity differ from those of highly exposed species, and we identify areas where exposure-based assessments alone may over or under-estimate climate change impacts. We found that 608–851 bird (6–9%), 670–933 amphibian (11–15%), and 47–73 coral species (6–9%) are both highly climate change vulnerable and already threatened with extinction on the IUCN Red List. The remaining highly climate change vulnerable species represent new priorities for conservation. Fewer species are highly climate change vulnerable under lower IPCC SRES emissions scenarios, indicating that reducing greenhouse emissions will reduce climate change driven extinctions. Our study answers the growing call for a more biologically and ecologically inclusive approach to assessing climate change vulnerability. By facilitating independent assessment of the three dimensions of climate change vulnerability

  8. Hydration, morbidity, and mortality in vulnerable populations.

    PubMed

    Maughan, Ronald J

    2012-11-01

    Both acute and chronic fluid deficits have been shown to be associated with a number of adverse health outcomes. At the extreme, deprivation of water for more than a few days inevitably leads to death, but even modest fluid deficits may precipitate adverse events, especially in young children, in the frail elderly and in those with poor health. Epidemiological studies have shown an association, although not necessarily a causal one, between a low habitual fluid intake and some chronic diseases, including urolithiasis, constipation, asthma, cardiovascular disease, diabetic hyperglycemia, and some cancers. Acute hypohydration may be a precipitating factor in a number of acute medical conditions in elderly persons. Increased mortality, especially in vulnerable populations, is commonly observed during periods of abnormally warm weather, with at least part of this effect due to failure to increase water intake, and this may have some important implications for those responsible for forward planning in healthcare facilities. © 2012 International Life Sciences Institute.

  9. The linear relationship between the Vulnerable Elders Survey-13 score and mortality in an Asian population of community-dwelling older persons.

    PubMed

    Wang, Jye; Lin, Wender; Chang, Ling-Hui

    2018-01-01

    The Vulnerable Elders Survey-13 (VES-13) has been used as a screening tool to identify vulnerable community-dwelling older persons for more in-depth assessment and targeted interventions. Although many studies supported its use in different populations, few have addressed Asian populations. The optimal scaling system for the VES-13 in predicting health outcomes also has not been adequately tested. This study (1) assesses the applicability of the VES-13 to predict the mortality of community-dwelling older persons in Taiwan, (2) identifies the best scaling system for the VES-13 in predicting mortality using generalized additive models (GAMs), and (3) determines whether including covariates, such as socio-demographic factors and common geriatric syndromes, improves model fitting. This retrospective longitudinal cohort study analyzed the data of 2184 community-dwelling persons 65 years old or older from the 2003 wave of the national-wide Taiwan Longitudinal Study on Aging. Cox proportional hazards models and Generalized Additive Models (GAMs) were used. The VES-13 significantly predicted the mortality of Taiwan's community-dwelling elders. A one-point increase in the VES-13 score raised the risk of death by 26% (hazard ratio, 1.26; 95% confidence interval, 1.21-1.32). The hazard ratio of death increased linearly with each additional VES-13 score point, suggesting that using a continuous scale is appropriate. Inclusion of socio-demographic factors and geriatric syndromes improved the model-fitting. The VES-13 is appropriate for an Asian population. VES-13 scores linearly predict the mortality of this population. Adjusting the weighting of the physical activity items may improve the performance of the VES-13. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Nutritional status and poverty assessment of vulnerable population groups in Armenia.

    PubMed

    Rossi, Laura; Mangasaryan, Nune; Branca, Francesco

    2005-01-01

    To produce estimates of main nutrition deficiencies to identify public health intervention priorities; to investigate the importance of urban-rural and resident-refugee differences; to validate the vulnerability indicators used for targeting humanitarian aid. Cross-sectional study with cluster design on a nationally representative sample of 2627 households (3390 children under five and 2649 mothers). Underweight was observed in 4% of the mothers, while more than one third of them showed different levels of overweight. Prevalence of anaemia in mothers was 15% with significant highest prevalence in rural areas. Stunting was detected in 12% of children with highest prevalence in rural zones. The overall prevalence of wasting was 4%. The prevalence of anaemia in children under five was 16% with highest prevalence in rural areas (22%). A vulnerability questionnaire was tested: it was only partially able to identify best potential beneficiaries of humanitarian aid. Armenian children and women were not affected by major energy problems, but followed inadequate diets that led them to a low micronutrient status. Drought in 2000s compromised the possibility of improving the general nutritional status.

  11. Promoting research partnerships to reduce health disparities among vulnerable populations: sharing expertise between majority institutions and historically black universities.

    PubMed

    Hutchinson, M Katherine; Davis, Bertha; Jemmott, Loretta Sweet; Gennaro, Susan; Tulman, Lorraine; Condon, Esther H; Montgomery, Arlene J; Servonsky, E Jane

    2007-01-01

    This chapter focuses on promoting cultural competence in research and the care of vulnerable populations by establishing inter-university nursing partnership centers for health disparities research between historically Black universities and minority-serving institutions and research-intensive majority institutions. The Hampton-Penn Center to Reduce Health Disparities (HPC), an inter-university collaborative center funded through the National Institutes of Health (NIH) National Institute of Nursing Research (NINR) P20 funding mechanism, is discussed as the exemplar. The mission of the Hampton-Penn Center is to promote culturally competent research on health promotion and disease prevention and the examination of how culture, race and ethnicity and their interactions with the health care system and the larger society influence health outcomes and the occurrence of health disparities. The history, goals, and conceptual model underlying this collaborative effort between the University of Pennsylvania and Hampton University Schools of Nursing are described as are the accomplishments and lessons learned to date. Based upon the Hampton-Penn experience, recommendations for similar collaborations to reduce health disparities among vulnerable populations are made in three major areas: (a) increasing the study of the multi-system level factors that contribute to health disparities among vulnerable populations, (b) promoting the development of culturally competent research on health disparities, and (c) promoting the recruitment and training of health researchers who are themselves members of vulnerable populations.

  12. Orphans and vulnerable children in Kenya: results from a nationally representative population-based survey.

    PubMed

    Lee, Veronica C; Muriithi, Patrick; Gilbert-Nandra, Ulrike; Kim, Andrea A; Schmitz, Mary E; Odek, James; Mokaya, Rose; Galbraith, Jennifer S

    2014-05-01

    In Kenya, it is estimated that there are approximately 3.6 million children aged <18 years who have been orphaned or who are vulnerable. We examined the data from the second Kenya AIDS Indicator Survey (KAIS 2012) to determine the number and profile of orphans and vulnerable children (OVC) in Kenya who were aged <18 years. KAIS 2012 was a nationally representative, population-based household survey. We analyzed the data for all the children from birth to age 17 years who resided in an eligible household so as to determine whether their parents were alive or had been very ill to define their OVC status. We estimated that there were 2.6 million OVC in Kenya in 2012, of whom 1.8 million were orphans and 750,000 were vulnerable. Among orphans, 15% were double orphans. Over one-third of all the OVC were aged between 10 and 14 years. Households with ≥1 OVC (12% of all households) were usually in the lowest 2 wealth quintiles, and 22% of OVC households had experienced moderate or severe hunger. Receipt of OVC support services was low for medical (3.7%), psychological (4.1%), social (1.3%), and material support (6.2%); educational support was slightly more common (11.5%). Orphanhood among children aged <15 years increased from 1993 to 2003 (P < 0.01) but declined from 2003 to 2012 (P < 0.01). The 2.6 million OVC constitute a significant proportion of Kenya's population aged <18 years. Special attention should be paid to OVC to prevent further vulnerability and ensure their well-being and development as they transition into adulthood.

  13. Orphans and Vulnerable Children in Kenya: Results From a Nationally Representative Population-Based Survey

    PubMed Central

    Lee, Veronica C.; Muriithi, Patrick; Gilbert-Nandra, Ulrike; Kim, Andrea A.; Schmitz, Mary E.; Odek, James; Mokaya, Rose; Galbraith, Jennifer S.

    2016-01-01

    Background In Kenya, it is estimated that there are approximately 3.6 million children aged <18 years who have been orphaned or who are vulnerable. We examined the data from the second Kenya AIDS Indicator Survey (KAIS 2012) to determine the number and profile of orphans and vulnerable children (OVC) in Kenya who were aged <18 years. Methods KAIS 2012 was a nationally representative, population-based household survey. We analyzed the data for all the children from birth to age 17 years who resided in an eligible household so as to determine whether their parents were alive or had been very ill to define their OVC status. Results We estimated that there were 2.6 million OVC in Kenya in 2012, of whom 1.8 million were orphans and 750,000 were vulnerable. Among orphans, 15% were double orphans. Over one-third of all the OVC were aged between 10 and 14 years. Households with ≥1 OVC (12% of all households) were usually in the lowest 2 wealth quintiles, and 22% of OVC households had experienced moderate or severe hunger. Receipt of OVC support services was low for medical (3.7%), psychological (4.1%), social (1.3%), and material support (6.2%); educational support was slightly more common (11.5%). Orphanhood among children aged <15 years increased from 1993 to 2003 (P < 0.01) but declined from 2003 to 2012 (P < 0.01). Conclusions The 2.6 million OVC constitute a significant proportion of Kenya’s population aged <18 years. Special attention should be paid to OVC to prevent further vulnerability and ensure their well-being and development as they transition into adulthood. PMID:24732824

  14. HIV and Mexican migrant workers in the United States: a review applying the vulnerable populations conceptual model.

    PubMed

    Albarrán, Cynthia R; Nyamathi, Adeline

    2011-01-01

    Mexican migrant workers residing in the United States are a vulnerable population at high risk for HIV infection. This article critically appraises the published data surrounding HIV prevalence in this vulnerable group, as seen through the lens of the Vulnerable Populations Conceptual Model. This model demonstrates how exposure to risk and resource availability affect health status. The health status of Mexican migrants in the United States is compromised by a number of factors that increase risk of HIV: limited access to health services, multiple sexual partners, low rates of condom use, men having sex with men, and lay injection practices. Migration from Mexico to the United States has increased the prevalence of HIV in rural Mexico, making this an issue of urgent binational concern. This review highlights the implications for further nursing research, practice, and policy. Copyright © 2011 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  15. Functional genomics identifies specific vulnerabilities in PTEN-deficient breast cancer.

    PubMed

    Tang, Yew Chung; Ho, Szu-Chi; Tan, Elisabeth; Ng, Alvin Wei Tian; McPherson, John R; Goh, Germaine Yen Lin; Teh, Bin Tean; Bard, Frederic; Rozen, Steven G

    2018-03-22

    -SSL patterns of activity in a large proportion of PTEN-deficient breast cancer cell lines and are potential specific vulnerabilities in PTEN-deficient breast cancer. Furthermore, the NUAK1 PTEN-SSL vulnerability identified by RNA interference techniques can be recapitulated and exploited using the small molecule kinase inhibitor HTH-01-015. Thus, NUAK1 inhibition may be an effective strategy for precision treatment of PTEN-deficient breast tumors.

  16. Targetable vulnerabilities in T- and NK-cell lymphomas identified through preclinical models.

    PubMed

    Ng, Samuel Y; Yoshida, Noriaki; Christie, Amanda L; Ghandi, Mahmoud; Dharia, Neekesh V; Dempster, Joshua; Murakami, Mark; Shigemori, Kay; Morrow, Sara N; Van Scoyk, Alexandria; Cordero, Nicolas A; Stevenson, Kristen E; Puligandla, Maneka; Haas, Brian; Lo, Christopher; Meyers, Robin; Gao, Galen; Cherniack, Andrew; Louissaint, Abner; Nardi, Valentina; Thorner, Aaron R; Long, Henry; Qiu, Xintao; Morgan, Elizabeth A; Dorfman, David M; Fiore, Danilo; Jang, Julie; Epstein, Alan L; Dogan, Ahmet; Zhang, Yanming; Horwitz, Steven M; Jacobsen, Eric D; Santiago, Solimar; Ren, Jian-Guo; Guerlavais, Vincent; Annis, D Allen; Aivado, Manuel; Saleh, Mansoor N; Mehta, Amitkumar; Tsherniak, Aviad; Root, David; Vazquez, Francisca; Hahn, William C; Inghirami, Giorgio; Aster, Jon C; Weinstock, David M; Koch, Raphael

    2018-05-22

    T- and NK-cell lymphomas (TCL) are a heterogenous group of lymphoid malignancies with poor prognosis. In contrast to B-cell and myeloid malignancies, there are few preclinical models of TCLs, which has hampered the development of effective therapeutics. Here we establish and characterize preclinical models of TCL. We identify multiple vulnerabilities that are targetable with currently available agents (e.g., inhibitors of JAK2 or IKZF1) and demonstrate proof-of-principle for biomarker-driven therapies using patient-derived xenografts (PDXs). We show that MDM2 and MDMX are targetable vulnerabilities within TP53-wild-type TCLs. ALRN-6924, a stapled peptide that blocks interactions between p53 and both MDM2 and MDMX has potent in vitro activity and superior in vivo activity across 8 different PDX models compared to the standard-of-care agent romidepsin. ALRN-6924 induced a complete remission in a patient with TP53-wild-type angioimmunoblastic T-cell lymphoma, demonstrating the potential for rapid translation of discoveries from subtype-specific preclinical models.

  17. Air pollution and vulnerability: solving the puzzle of prioritization.

    PubMed

    Wright, Caradee Y; Diab, Roseanne

    2011-01-01

    While ambient air pollution levels in excess of prescribed health standards are generally unacceptable, the exceedance is even more serious in areas where people reside. Vulnerability caused by poverty, disease, lack of education, and poor living conditions exacerbates the problem. Air quality management plans identify prioritized strategies for improved air quality independent of consideration of vulnerability. A population exposure and vulnerability risk prioritization framework comprising five themes (air pollution sources; air pollution levels; air pollution potential; community awareness, observations, perceptions, and actions; and vulnerability factors) was proposed and applied to the eThekwini Municipality (Durban, South Africa). Data were scored according to predetermined risk threshold values to ascertain at-risk communities. While those urban wards located in a known air pollution hotspot had the highest air pollution levels, a periurban ward with moderate exposure levels was most vulnerable. This framework will prove invaluable for the development of focused interventions to reduce vulnerability and air pollution-associated adverse health impacts.

  18. Assessing climate change and health vulnerability at the local level: Travis County, Texas.

    PubMed

    Prudent, Natasha; Houghton, Adele; Luber, George

    2016-10-01

    We created a measure to help comprehend population vulnerability to potential flooding and excessive heat events using health, built environment and social factors. Through principal component analysis (PCA), we created non-weighted sum index scores of literature-reviewed social and built environment characteristics. We created baseline poor health measures using 1999-2005 age-adjusted cardiovascular and combined diabetes and hypertension mortality rates to correspond with social-built environment indices. We mapped US Census block groups by linked age-adjusted mortality and a PCA-created social-built environment index. The goal was to measure flooding and excessive heat event vulnerability as proxies for population vulnerability to climate change for Travis County, Texas. This assessment identified communities where baseline poor health, social marginalisation and built environmental impediments intersected. Such assessments may assist targeted interventions and improve emergency preparedness in identified vulnerable communities, while fostering resilience through the focus of climate change adaptation policies at the local level. No claim to original US government works. Journal compilation © 2016 Overseas Development Institute.

  19. Third sector primary care for vulnerable populations.

    PubMed

    Crampton, P; Dowell, A; Woodward, A

    2001-12-01

    This paper aims to describe and explain the development of third sector primary care organisations in New Zealand. The third sector is the non-government, non-profit sector. International literature suggests that this sector fulfils an important role in democratic societies with market-based economies, providing services otherwise neglected by the government and private for-profit sectors. Third sector organisations provided a range of social services throughout New Zealand's colonial history. However, it was not until the 1980s that third sector organisations providing comprehensive primary medical and related services started having a significant presence in New Zealand. In 1994 a range of union health centres, tribally based Mäori health providers, and community-based primary care providers established a formal network -- Health Care Aotearoa. While not representing all third sector primary care providers in New Zealand, Health Care Aotearoa was the best-developed example of a grouping of third sector primary care organisations. Member organisations served populations that were largely non-European and lived in deprived areas, and tended to adopt population approaches to funding and provision of services. The development of Health Care Aotearoa has been consistent with international experience of third sector involvement -- there were perceived "failures" in government policies for funding primary care and private sector responses to these policies, resulting in lack of universal funding and provision of primary care and continuing patient co-payments. The principal policy implication concerns the role of the third sector in providing primary care services for vulnerable populations as a partial alternative to universal funding and provision of primary care. Such an alternative may be convenient for proponents of reduced state involvement in funding and provision of health care, but may not be desirable from the point of view of equity and social cohesion

  20. Assessing Household Economic Vulnerability in HIV-Affected Communities in Five Regions of Côte d'Ivoire

    PubMed Central

    Burke, Holly M.; Moret, Whitney; Field, Samuel; Chen, Mario; Zeng, Yanwu; Seka, Firmin M.

    2016-01-01

    The objective of this study was to identify and describe levels of household economic vulnerability in HIV-affected communities in Côte d’Ivoire, defined as those with a high prevalence of HIV and large numbers of orphans and vulnerable children. We conducted a cross-sectional survey of 3,749 households in five health regions of Côte d’Ivoire. Using principal component analysis, we attempted to identify sets of correlated vulnerabilities and derive a small number of composite scores to create an index for targeting interventions to vulnerable populations. The 65 vulnerability measures examined did not cluster in ways that would allow for the creation of a small number of composite measures. Instead, we found that households face numerous unique pathways to vulnerability. PMID:27655530

  1. Assessing mental health and violence on college campuses using the vulnerability model.

    PubMed

    Ponsford, Lisa R

    2016-04-01

    Violence on college campuses has become increasingly more common than in previous years. Nearly 73% of students with a mental health condition living on campus experience a mental health crisis. College students arriving on campuses today come with different needs, expectations for services, and with different risk factors than in previous years. Advanced practice registered nurses (APRNs) in college health settings have the ability to recognize these changing trends and assist with improving the mental health of this population. A critical analysis of an exemplar college campus is explored using the vulnerability model to assess risks that can lead to unnecessary and preventable violence on college campuses. The vulnerability model is a comprehensive approach utilized to guide an assessment to identify both individual and community risk factors influencing health and healthcare environments. The use of the vulnerability model illustrated in this article reveals its usefulness in identifying the risk and needs for this population. APRNs and student health centers are positioned well to utilize the vulnerability model in assessing the needs of college campuses to improve outcomes of students. ©2016 American Association of Nurse Practitioners.

  2. Topological Vulnerability Analysis

    NASA Astrophysics Data System (ADS)

    Jajodia, Sushil; Noel, Steven

    Traditionally, network administrators rely on labor-intensive processes for tracking network configurations and vulnerabilities. This requires a great deal of expertise, and is error prone because of the complexity of networks and associated security data. The interdependencies of network vulnerabilities make traditional point-wise vulnerability analysis inadequate. We describe a Topological Vulnerability Analysis (TVA) approach that analyzes vulnerability dependencies and shows all possible attack paths into a network. From models of the network vulnerabilities and potential attacker exploits, we compute attack graphs that convey the impact of individual and combined vulnerabilities on overall security. TVA finds potential paths of vulnerability through a network, showing exactly how attackers may penetrate a network. From this, we identify key vulnerabilities and provide strategies for protection of critical network assets.

  3. Protecting and respecting the vulnerable: existing regulations or further protections?

    PubMed

    Solomon, Stephanie R

    2013-02-01

    Scholars and policymakers continue to struggle over the meaning of the word "vulnerable" in the context of research ethics. One major reason for the stymied discussions regarding vulnerable populations is that there is no clear distinction between accounts of research vulnerabilities that exist for certain populations and discussions of research vulnerabilities that require special regulations in the context of research ethics policies. I suggest an analytic process by which to ascertain whether particular vulnerable populations should be contenders for additional regulatory protections. I apply this process to two vulnerable populations: the cognitively vulnerable and the economically vulnerable. I conclude that a subset of the cognitively vulnerable require extra protections while the economically vulnerable should be protected by implementing existing regulations more appropriately and rigorously. Unless or until the informed consent process is more adequately implemented and the distributive justice requirement of the Belmont Report is emphasized and operationalized, the economically disadvantaged will remain particularly vulnerable to the harm of exploitation in research.

  4. Who Is Vulnerable to Dengue Fever? A Community Survey of the 2014 Outbreak in Guangzhou, China

    PubMed Central

    Chen, Bin; Yang, Jun; Luo, Lei; Yang, Zhicong; Liu, Qiyong

    2016-01-01

    Unprecedented dengue fever (DF) outbreaks impel China to develop useful disease control strategies. Integrated vector management (IVM) focuses on identifying vulnerable populations and interrupting human–vector contact; however, vulnerable populations have not been clearly identified in China. We conducted a case-control study during the initial stage of the 2014 DF outbreak in Guangzhou, China to assess risk factors for DF infection. Cases were randomly sampled from the National Notifiable Infectious Disease Reporting Information System (NNIDRIS). Controls were healthy individuals recruited from 17 DF infected communities through cluster sampling. A structured questionnaire on demographics, knowledge, practices, and living environment was administered to participants (165 cases; 492 controls). Logistic regression models identified characteristics of vulnerable populations. Awareness of dengue (OR = 0.08, 95% CI = 0.04–0.17), removing trash and stagnant water from around the residence (OR = 0.02, 95% CI = 0.00–0.17), and using mosquito repellent oils (OR = 0.36, 95% CI = 0.16–0.81) were protective factors. Living in an old flat or shed (OR = 2.38, 95% CI = 1.18–4.79) was a risk factor. Coils and bed nets were not protective due to incorrect knowledge of use. Using mosquito repellent oils and other protective measures can reduce vulnerability to DF infection. PMID:27428986

  5. Protecting and Respecting the Vulnerable: Existing Regulations or Further Protections?

    PubMed Central

    Solomon, Stephanie R.

    2013-01-01

    Scholars and policymakers continue to struggle over the meaning of the word “vulnerable” in the context of research ethics. One major reason for the stymied discussions regarding vulnerable populations is that there is no clear distinction between accounts of research vulnerabilities that exist for certain populations and discussions of research vulnerabilities that require special regulations in the context of research ethics policies. I suggest an analytic process by which to ascertain whether particular vulnerable populations should be contenders for additional regulatory protections. I apply this process to two vulnerable populations: the cognitively vulnerable and the economically vulnerable. I conclude that a subset of the cognitively vulnerable require extra protections while the economically vulnerable should be protected by implementing existing regulations more appropriately and rigorously. Unless or until the informed consent process is more adequately implemented and the distributive justice requirement of the Belmont Report is emphasized and operationalized, the economically disadvantaged will remain particularly vulnerable to the harm of exploitation in research. PMID:23329228

  6. Immigrant workers in the United States: recent trends, vulnerable populations, and challenges for occupational health.

    PubMed

    McCauley, Linda A

    2005-07-01

    Immigrant workers are a rapidly growing segment of the U.S. work force, and these increasing numbers have resulted in a different ethnic mix in the work force than in previous decades. Immigrant workers are not a homogenous group, but are over-represented in low-paying occupations. Their diversity and vulnerability present distinct challenges for occupational health nurses. High-risk occupations in which a large proportion of immigrant workers are hired include agriculture, sweatshops, day laborers, and construction. Initiatives needed to improve the working conditions of this vulnerable population include improved surveillance and research, culturally competent care providers, improved health care access, advocacy, and changes in immigration and health policy.

  7. Identifying key features of early stressful experiences that produce stress vulnerability and resilience in primates

    PubMed Central

    Parker, Karen J.; Maestripieri, Dario

    2010-01-01

    This article examines the complex role of early stressful experiences in producing both vulnerability and resilience to later stress-related psychopathology in a variety of primate models of human development. Two types of models are reviewed: Parental Separation Models (e.g., isolate-rearing, peer-rearing, parental separations, and stress inoculation) and Maternal Behavior Models (e.g., foraging demands, variation in maternal style, and maternal abuse). Based on empirical evidence, it is argued that early life stress exposure does not increase adult vulnerability to stress-related psychopathology as a linear function, as is generally believed, but instead reflects a quadratic function. Features of early stress exposure including the type, duration, frequency, ecological validity, sensory modality, and developmental timing, within and between species, are identified to better understand how early stressful experiences alter neurobiological systems to produce such diverse developmental outcomes. This article concludes by identifying gaps in our current knowledge, providing directions for future research, and discussing the translational implications of these primate models for human development and psychopathology. PMID:20851145

  8. Social vulnerability from a social ecology perspective: a cohort study of older adults from the National Population Health Survey of Canada

    PubMed Central

    2014-01-01

    Background Numerous social factors, generally studied in isolation, have been associated with older adults’ health. Even so, older people’s social circumstances are complex and an approach which embraces this complexity is desirable. Here we investigate many social factors in relation to one another and to survival among older adults using a social ecology perspective to measure social vulnerability among older adults. Methods 2740 adults aged 65 and older were followed for ten years in the Canadian National Population Health Survey (NPHS). Twenty-three individual-level social variables were drawn from the 1994 NPHS and five Enumeration Area (EA)-level variables were abstracted from the 1996 Canadian Census using postal code linkage. Principal Component Analysis (PCA) was used to identify dimensions of social vulnerability. All social variables were summed to create a social vulnerability index which was studied in relation to ten-year mortality. Results The PCA was limited by low variance (47%) explained by emergent factors. Seven dimensions of social vulnerability emerged in the most robust, yet limited, model: social support, engagement, living situation, self-esteem, sense of control, relations with others and contextual socio-economic status. These dimensions showed complex inter-relationships and were situated within a social ecology framework, considering spheres of influence from the individual through to group, neighbourhood and broader societal levels. Adjusting for age, sex, and frailty, increasing social vulnerability measured using the cumulative social vulnerability index was associated with increased risk of mortality over ten years in a Cox regression model (HR 1.04, 95% CI:1.01-1.07, p = 0.01). Conclusions Social vulnerability has important independent influence on older adults’ health though relationships between contributing variables are complex and do not lend themselves well to fragmentation into a small number of discrete factors. A

  9. Health complaints and regulatory reform: Implications for vulnerable populations?

    PubMed

    Carney, Terry; Beaupert, Fleur; Chiarella, Mary; Bennett, Belinda; Walton, Merrilyn; Kelly, Patrick J; Satchell, Claudette S

    2016-03-01

    Complaints and disciplinary processes play a significant role in health professional regulation. Many countries are transitioning from models of self-regulation to greater external oversight through systems including meta-regulation, responsive (risk-based) regulation, and "networked governance". Such systems harness, in differing ways, public, private, professional and non-governmental bodies to exert influence over the conduct of health professionals and services. Interesting literature is emerging regarding complainants' motivations and experiences, the impact of complaints processes on health professionals, and identification of features such as complainant and health professional profiles, types of complaints and outcomes. This article concentrates on studies identifying vulnerable groups and their participation in health care regulatory systems.

  10. Maternal age and offspring developmental vulnerability at age five: A population-based cohort study of Australian children

    PubMed Central

    Banks, Emily; Lynch, John; Brownell, Marni; Eades, Sandra; Jorm, Louisa

    2018-01-01

    Background In recent decades, there has been a shift to later childbearing in high-income countries. There is limited large-scale evidence of the relationship between maternal age and child outcomes beyond the perinatal period. The objective of this study is to quantify a child’s risk of developmental vulnerability at age five, according to their mother’s age at childbirth. Methods and findings Linkage of population-level perinatal, hospital, and birth registration datasets to data from the Australian Early Development Census (AEDC) and school enrolments in Australia’s most populous state, New South Wales (NSW), enabled us to follow a cohort of 99,530 children from birth to their first year of school in 2009 or 2012. The study outcome was teacher-reported child development on five domains measured by the AEDC, including physical health and well-being, emotional maturity, social competence, language and cognitive skills, and communication skills and general knowledge. Developmental vulnerability was defined as domain scores below the 2009 AEDC 10th percentile cut point. The mean maternal age at childbirth was 29.6 years (standard deviation [SD], 5.7), with 4,382 children (4.4%) born to mothers aged <20 years and 20,026 children (20.1%) born to mothers aged ≥35 years. The proportion vulnerable on ≥1 domains was 21% overall and followed a reverse J-shaped distribution according to maternal age: it was highest in children born to mothers aged ≤15 years, at 40% (95% CI, 32–49), and was lowest in children born to mothers aged between 30 years and ≤35 years, at 17%–18%. For maternal ages 36 years to ≥45 years, the proportion vulnerable on ≥1 domains increased to 17%–24%. Adjustment for sociodemographic characteristics significantly attenuated vulnerability risk in children born to younger mothers, while adjustment for potentially modifiable factors, such as antenatal visits, had little additional impact across all ages. Although the multi

  11. Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review.

    PubMed

    Khanassov, Vladimir; Pluye, Pierre; Descoteaux, Sarah; Haggerty, Jeannie L; Russell, Grant; Gunn, Jane; Levesque, Jean-Frederic

    2016-10-10

    Access to community-based primary health care (hereafter, 'primary care') is a priority in many countries. Health care systems have emphasized policies that help the community 'get the right service in the right place at the right time'. However, little is known about organizational interventions in primary care that are aimed to improve access for populations in situations of vulnerability (e.g., socioeconomically disadvantaged) and how successful they are. The purpose of this scoping review was to map the existing evidence on organizational interventions that improve access to primary care services for vulnerable populations. Scoping review followed an iterative process. Eligibility criteria: organizational interventions in Organisation for Economic Cooperation and Development (OECD) countries; aiming to improve access to primary care for vulnerable populations; all study designs; published from 2000 in English or French; reporting at least one outcome (avoidable hospitalization, emergency department admission, or unmet health care needs). Main bibliographic databases (Medline, Embase, CINAHL) and team members' personal files. One researcher selected relevant abstracts and full text papers. Theory-driven synthesis: The researcher classified included studies using (i) the 'Patient Centered Access to Healthcare' conceptual framework (dimensions and outcomes of access to primary care), and (ii) the classification of interventions of the Cochrane Effective Practice and Organization of Care. Using pattern analysis, interventions were mapped in accordance with the presence/absence of 'dimension-outcome' patterns. Out of 8,694 records (title/abstract), 39 studies with varying designs were included. The analysis revealed the following pattern. Results of 10 studies on interventions classified as 'Formal integration of services' suggested that these interventions were associated with three dimensions of access (approachability, availability and affordability) and

  12. Vulnerability of pejerrey Odontesthes bonariensis populations to climate change in pampean lakes of Argentina.

    PubMed

    Kopprio, G A; Freije, R H; Strüssmann, C A; Kattner, G; Hoffmeyer, M S; Popovich, C A; Lara, R J

    2010-11-01

    The vulnerability of the pejerrey Odontesthes bonariensis population in Lake Chasicó was assessed under different climate change conditions. During the sampling period, the water temperature was adequate for fish reproduction and to sustain an adequate sex ratio. Climate-driven higher temperatures, however, may severely distort population structure and cause drastic reduction or local extinction of stocks. Lake Chasicó can be classified as eutrophic with clear waters and cyanobacteria that regularly cause fish mortality were identified as Nodularia spumigena and Oscillatoria sp. Global warming may strengthen the effects of eutrophication (e.g. toxic blooms or anoxia). Since many Cyanophyta species tolerate higher temperatures better than other algae, toxic blooms could increase. Furthermore, cyanobacteria have low nutritional value and could decouple the low-diversity food web. Lake Chasicó has currently the salinity optimum (c. 20) for the development of the early life-history stages of O. bonariensis. Climate change, however, is likely to amplify the intensity of droughts or inundations. Floods can endanger O. bonariensis development due to its sub-optimal growth at low salinity and droughts could increase lake salinity and also temperature and nutrient concentration. In order to reduce some of the effects of climate change on the O. bonariensis population in Lake Chasicó, integrated basin management based on an eco-hydrological approach is proposed. © 2010 The Authors. Journal of Fish Biology © 2010 The Fisheries Society of the British Isles.

  13. Future Extreme Event Vulnerability in the Rural Northeastern United States

    NASA Astrophysics Data System (ADS)

    Winter, J.; Bowen, F. L.; Partridge, T.; Chipman, J. W.

    2017-12-01

    Future climate change impacts on humans will be determined by the convergence of evolving physical climate and socioeconomic systems. Of particular concern is the intersection of extreme events and vulnerable populations. Rural areas of the Northeastern United States have experienced increased temperature and precipitation extremes, especially over the past three decades, and face unique challenges due to their physical isolation, natural resources dependent economies, and high poverty rates. To explore the impacts of future extreme events on vulnerable, rural populations in the Northeast, we project extreme events and vulnerability indicators to identify where changes in extreme events and vulnerable populations coincide. Specifically, we analyze future (2046-2075) maximum annual daily temperature, minimum annual daily temperature, maximum annual daily precipitation, and maximum consecutive dry day length for Representative Concentration Pathways (RCP) 4.5 and 8.5 using four global climate models (GCM) and a gridded observational dataset. We then overlay those projections with estimates of county-level population and relative income for 2060 to calculate changes in person-events from historical (1976-2005), with a focus on Northeast counties that have less than 250,000 people and are in the bottom income quartile. We find that across the rural Northeast for RCP4.5, heat person-events per year increase tenfold, far exceeding decreases in cold person-events and relatively small changes in precipitation and drought person-events. Counties in the bottom income quartile have historically (1976-2005) experienced a disproportionate number of heat events, and counties in the bottom two income quartiles are projected to experience a greater heat event increase by 2046-2075 than counties in the top two income quartiles. We further explore the relative contributions of event frequency, population, and income changes to the total and geographic distribution of climate change

  14. Economic impact of using fesoterodine for the treatment of overactive bladder with urge urinary incontinence in a vulnerable elderly population in the United States.

    PubMed

    Qin, Lei; Luo, Xuemei; Zou, Kelly H; Snedecor, Sonya J

    2016-01-01

    To assess the costs of treating overactive bladder (OAB) with fesoterodine compared to no OAB pharmacotherapy among vulnerable elderly from the US payer perspective. A decision analytic cost model was developed to estimate the 52-week costs of a cohort of vulnerable elderly with OAB initiating treatment with fesoterodine or no OAB pharmacotherapy. Vulnerable elderly OAB patients were defined as those aged ≥65 years with self-reported urge urinary incontinence (UUI) symptoms for ≥3 months, 2-15 UUI episodes/day, and at risk of deteriorating health by a score of ≥3 on the Vulnerable Elders Survey (VES)-13. Patients were evaluated for fesoterodine treatment response (defined as no UUI episodes) and persistence at weeks 12, 26, and 52. The model included a hypothetical health plan with 100,000 elderly members. A total of 7096 vulnerable elderly subjects were identified as the model target population based on the percentage of vulnerable elderly and annual prevalence of OAB among vulnerable elderly. OAB-related costs included fesoterodine drug acquisition costs, healthcare resource use (inpatient hospitalization, outpatient visits, and physician office visits), and OAB-related co-morbidities (falls/fractures, urinary tract infections, depression, and nursing home admissions). All costs were inflated to 2013 US$ using the medical care component of the consumer price index (CPI). When 7096 vulnerable elderly OAB patients were treated with fesoterodine, US healthcare payers could save $11,463,981 per year, or $1616 per patient vs no OAB pharmacotherapy. Univariate one-way sensitivity analyses supported the robustness of the findings and showed results were most sensitive to changes in fesoterodine efficacy followed by annual costs of inpatient hospitalization. From a US payer perspective, treating vulnerable elderly OAB patients with fesoterodine was cost-saving compared to no OAB pharmacotherapy.

  15. A vulnerability paradox in the cross-national prevalence of post-traumatic stress disorder.

    PubMed

    Dückers, Michel L A; Alisic, Eva; Brewin, Chris R

    2016-10-01

    Determinants of cross-national differences in the prevalence of mental illness are poorly understood. To test whether national post-traumatic stress disorder (PTSD) rates can be explained by (a) rates of exposure to trauma and (b) countries' overall cultural and socioeconomic vulnerability to adversity. We collected general population studies on lifetime PTSD and trauma exposure, measured using the WHO Composite International Diagnostic Interview (DSM-IV). PTSD prevalence was identified for 24 countries (86 687 respondents) and exposure for 16 countries (53 038 respondents). PTSD was predicted using exposure and vulnerability data. PTSD is related positively to exposure but negatively to country vulnerability. Together, exposure, vulnerability and their interaction explain approximately 75% of variance in the national prevalence of PTSD. Contrary to expectations based on individual risk factors, we identified a paradox whereby greater country vulnerability is associated with a decreased, rather than increased, risk of PTSD for its citizens. © The Royal College of Psychiatrists 2016.

  16. A population-based study of cognitive impairment in socially vulnerable adults in Argentina. The Matanza Riachuelo study preliminary results

    PubMed Central

    Bartoloni, Leonardo; Blatt, Graciela; Insua, Iván; Furman, Mariano; González, María Agustina; Hermann, Bárbara; Kesselman, Mariana; Massautis, Alicia; Reinado, Alejandra; Senas, Patricia; Yavitz, Claudia; Lejarraga, Horacio; Nunes, Fernando; Arizaga, Raúl Luciano; Allegri, Ricardo F

    2014-01-01

    Population aging has taken place intensively worldwide, even in developing countries. These countries have population groups with low resources and basic unmet needs that are frequently omitted from epidemiological studies. Objective The purpose of this study was to determine the prevalence of cognitive impairment (CI) and dementia in an economic and socially vulnerable population from Argentina. Methods A door-to-door observational population-based survey among adults over 60 years of cognitive impairment and dementia in the social vulnerable area of the Matanza Riachuelo Basin, in the suburban area of Buenos Aires, Argentina was conducted. Trained psychologists interviewed subjects and a proxy informant. A standardized protocol including a socio-demographic questionnaire, the Mini-Mental State Examination, the Geriatric Depression Scale and a functional inventory for IADL and ADL was administered. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment-no dementia (CIND) and dementia. Results and Conclusions A total of 2437 elderly persons were assessed, of which 73.6% fulfilled inclusion criteria. The prevalence of CI among those over 60 was 26.4% (18.1% CIND and 8.3% dementia) with higher prevalence of dementia in younger individuals than rates reported in developed counties, probably due to low control of vascular risk factors. This information can help inform health public decisions in the generation of programs and plans for the prevention, diagnosis and treatment of cognitive impairment in this type of socially vulnerable population. PMID:29213923

  17. A population-based study of cognitive impairment in socially vulnerable adults in Argentina. The Matanza Riachuelo study preliminary results.

    PubMed

    Bartoloni, Leonardo; Blatt, Graciela; Insua, Iván; Furman, Mariano; González, María Agustina; Hermann, Bárbara; Kesselman, Mariana; Massautis, Alicia; Reinado, Alejandra; Senas, Patricia; Yavitz, Claudia; Lejarraga, Horacio; Nunes, Fernando; Arizaga, Raúl Luciano; Allegri, Ricardo F

    2014-01-01

    Population aging has taken place intensively worldwide, even in developing countries. These countries have population groups with low resources and basic unmet needs that are frequently omitted from epidemiological studies. The purpose of this study was to determine the prevalence of cognitive impairment (CI) and dementia in an economic and socially vulnerable population from Argentina. A door-to-door observational population-based survey among adults over 60 years of cognitive impairment and dementia in the social vulnerable area of the Matanza Riachuelo Basin, in the suburban area of Buenos Aires, Argentina was conducted. Trained psychologists interviewed subjects and a proxy informant. A standardized protocol including a socio-demographic questionnaire, the Mini-Mental State Examination, the Geriatric Depression Scale and a functional inventory for IADL and ADL was administered. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment-no dementia (CIND) and dementia. A total of 2437 elderly persons were assessed, of which 73.6% fulfilled inclusion criteria. The prevalence of CI among those over 60 was 26.4% (18.1% CIND and 8.3% dementia) with higher prevalence of dementia in younger individuals than rates reported in developed counties, probably due to low control of vascular risk factors. This information can help inform health public decisions in the generation of programs and plans for the prevention, diagnosis and treatment of cognitive impairment in this type of socially vulnerable population.

  18. Integrating social media and remote sensing data in a model framework to identify vulnerable areas in coastal cities after disasters

    NASA Astrophysics Data System (ADS)

    Gopalakrishnan, G.

    2013-12-01

    In the aftermath of man-made disasters such as oil spills or natural disasters such as hurricanes and floods, city planners and residents of affected areas are often concerned about future vulnerabilities and rebuilding the area to increase resilience. However, identifying locations in the affected area that are most impacted by the disaster, the associated human health risks and potential vulnerabilities often require a monitoring effort that is expensive, time-consuming and difficult to implement in disaster-hit areas using traditional monitoring techniques. This project presents a framework for identifying areas that are most likely to be impacted by disasters by integrating remote sensing data and information from social media networks, including Twitter streams. The framework was tested for New York, coastal New Jersey and Staten Island in the aftermath of Hurricane Sandy. Vulnerable areas were identified using anomaly detection and the results were mapped against measurements collected on the ground. A correlation coefficient of 0.78 was obtained. Uncertainty in model predictions was evaluated using Monte Carlo simulations.

  19. Mobile Phones and Psychosocial Therapies with Vulnerable People: a First State of the Art.

    PubMed

    Vázquez, Maria Yolanda García; Sexto, Carlos Ferrás; Rocha, Álvaro; Aguilera, Adrián

    2016-06-01

    Mobile phones are becoming a communication tool commonly used by people all over the world; and they are started to be adopted in psychosocial therapies involving vulnerable people. We are herein presenting the results of an academic literature review. We identified scientific papers published between 2006 and 2015 resorting to academic databases available on the Internet, applying a systematic selection method based on quality criteria. Secondly, we analysed contents, highlighting the scarcity of research involving vulnerable people. The available literature specialized in psychosocial therapies offers investigation results which involve mobile phones and patients in general, focusing particularly on the clinical psychology field and, to a lesser extent, on the social work field. Particularly significant are the investigation works developed in the United States. In the present paper we introduce a first "state of the art", identifying opportunities and also the limitations surrounding the use of mobile phones in psychosocial therapies targeting the vulnerable. Issues concerning privacy and data confidentiality, and the access of vulnerable people to mobile phones and how they use them, pose significant challenges; but they offer the opportunity to reach isolated or impoverished populations, or even to facilitate access to social and healthcare services. We close this paper formulating possible orientations, hypotheses and goals to design new investigation works involving vulnerable populations.

  20. Vulnerability of populations and man-made facilities to seismic hazards

    NASA Astrophysics Data System (ADS)

    Badal, J.; Vazquez-Prada, M.; Gonzalez, A.; Chourak, M.; Samardzhieva, E.; Zhang, Z.

    2003-04-01

    Earthquakes become major societal risks when they impinge on vulnerable populations. According to the available worldwide data during the twentieth century (NEIC Catalog of Earthquakes 1980-1999), almost half a thousand of earthquakes resulted in more than 1,615,000 human victims. Besides human casualty levels, destructive earthquakes frequently inflict huge economic losses. An additional problem of very different nature, but also worthy of being considered in a damage and loss analysis, is the direct cost associated with the damages derived from a strong seismic impact. We focus our attention on both aspects to their rapid quantitative assessment, and to lessen the earthquake disaster in areas affected by relatively strong earthquakes. Our final goal is the knowledge of potential losses from earthquakes to forward national programs in emergency management, and consequently the minimization of the life loss due to earthquakes, and to aid in response and recovery tasks. For this purpose we follow a suitable and comprehensible methodology for risk-based loss analysis, and simulate the occurence of a seismic event in densely populated areas of Spain.

  1. Storytelling: A Qualitative Tool to Promote Health Among Vulnerable Populations.

    PubMed

    Palacios, Janelle F; Salem, Benissa; Hodge, Felicia Schanche; Albarrán, Cyndi R; Anaebere, Ann; Hayes-Bautista, Teodocia Maria

    2015-09-01

    Storytelling is a basic cultural phenomenon that has recently been recognized as a valuable method for collecting research data and developing multidisciplinary interventions. The purpose of this article is to present a collection of nursing scholarship wherein the concept of storytelling, underpinned by cultural phenomena, is explored for data collection and intervention. A conceptual analysis of storytelling reveals key variables. Following a brief review of current research focused on storytelling used within health care, three case studies among three vulnerable populations (American Indian teen mothers, American Indian cancer survivors, and African American women at risk for HIV/AIDS) demonstrate the uses of storytelling for data collection and intervention. Implications for transcultural nursing regarding storytelling are discussed. © The Author(s) 2014.

  2. Modeling Coastal Vulnerability through Space and Time.

    PubMed

    Hopper, Thomas; Meixler, Marcia S

    2016-01-01

    Coastal ecosystems experience a wide range of stressors including wave forces, storm surge, sea-level rise, and anthropogenic modification and are thus vulnerable to erosion. Urban coastal ecosystems are especially important due to the large populations these limited ecosystems serve. However, few studies have addressed the issue of urban coastal vulnerability at the landscape scale with spatial data that are finely resolved. The purpose of this study was to model and map coastal vulnerability and the role of natural habitats in reducing vulnerability in Jamaica Bay, New York, in terms of nine coastal vulnerability metrics (relief, wave exposure, geomorphology, natural habitats, exposure, exposure with no habitat, habitat role, erodible shoreline, and surge) under past (1609), current (2015), and future (2080) scenarios using InVEST 3.2.0. We analyzed vulnerability results both spatially and across all time periods, by stakeholder (ownership) and by distance to damage from Hurricane Sandy. We found significant differences in vulnerability metrics between past, current and future scenarios for all nine metrics except relief and wave exposure. The marsh islands in the center of the bay are currently vulnerable. In the future, these islands will likely be inundated, placing additional areas of the shoreline increasingly at risk. Significant differences in vulnerability exist between stakeholders; the Breezy Point Cooperative and Gateway National Recreation Area had the largest erodible shoreline segments. Significant correlations exist for all vulnerability (exposure/surge) and storm damage combinations except for exposure and distance to artificial debris. Coastal protective features, ranging from storm surge barriers and levees to natural features (e.g. wetlands), have been promoted to decrease future flood risk to communities in coastal areas around the world. Our methods of combining coastal vulnerability results with additional data and across multiple time

  3. A new perspective: a vulnerable population framework to guide research and practice for persons with traumatic brain injury.

    PubMed

    Bay, Esther; Kreulen, Grace J; Shavers, Clarissa Agee; Currier, Connie

    2006-01-01

    Recovery from traumatic brain injury (TBI) can be a tumultuous lifelong and expensive process. Guided therapies for community integration within community systems are a focus of treating therapists around the world, yet there are no published discussions concerning the most fitting community context. We propose a theoretical approach for practice and research using Flaskerud and Winslow's conceptual model of vulnerable populations. Using the model constructs of health status, resource availability, and increased relative risk, we offer empirical support for proposed construct relationships applied to persons with traumatic brain injury. We then propose that interventions for health promotion, acute care, and rehabilitation or chronic disease management have a community focus, and we identify relevant goals for community-based practice and research.

  4. Resilience, Vulnerability and Residual Threat: An Assessment from Indian Sundarban

    NASA Astrophysics Data System (ADS)

    Ghosh, T.

    2016-12-01

    The estuarine islands within Indian Sundarban are extremely vulnerable due to climate change, erosion, flooding and increasing population pressure. Around 4.6 million people are living under constant threat of climatic shocks, affecting their farm based economy and dependency on forest resources for their livelihood. This paper attempts to focus on the dynamics of system's resilience in the backdrop of higher level of vulnerability. Globally the assessment of island vulnerability is generally more focused towards the climate change impacts, rather than taking into account other determining drivers with proper weightage. Three estuarine islands namely Sagar, Ghoramara and Mousani at the western part of Indian Sundarban Delta (ISD) have been chosen for this study to derive the indicator based scoring method using the household survey data from twenty seven (27) sampled `Mouza' (lowest administrative boundary; village) with cluster random sampling. Vulnerability and resilience of these islands have been calculated using the indicators like housing condition, electrification, population density, accretion, adult secondary education level, percentage of people `Below Poverty Line' (BPL) based on per capita income. Residual threats for these islands have been obtained by subtracting the score of resilience and vulnerability of the system. Result suggests that all these islands are in less resilient condition to combat the negative impact of the influencing factors. Sapkhali, Ghoramara, Bankimnagar, Shibpur and Baliara are becoming sensitive from excess residual threats. This study is an initiation for identifying the thrust areas need to address with effective policy adaptation, necessary to minimize the existing vulnerable conditions in these islands. Key words: Vulnerability, Resilience, Residual threat, Indian Sundarban

  5. [Aging and becoming vulnerable].

    PubMed

    Monod, Stéfanie; Sautebin, Annelore

    2009-11-18

    "The vulnerable are those whose autonomy, dignity and integrity are capable of being threatened". Based on this ethical definition of vulnerability, four risk factors of vulnerability might be identified among elderly persons, and are described in this article: the functional limitation, the loss of autonomy, the social precariousness and the restriction of access to medical care. A clinical case of elderly abuse is presented to illustrate vulnerability. Finally, some recommendations to lower the risk of vulnerability in elderly persons are proposed.

  6. A NATIONAL STUDY TO ASSESS SUSCEPTIBILITY, VULNERABILITY, AND EFFECT MODIFICATION OF AIR POLLUTION HEALTH RISKS

    EPA Science Inventory

    Identifying factors that explain heterogeneity of risks will help to identify: 1) the populations that are more susceptible/vulnerable to air pollution; and 2) the emission sources, pollutants and pollutant mixtures that are more toxic. The characterization of susceptibility f...

  7. Global health and local poverty: rich countries' responses to vulnerable populations.

    PubMed

    Simms, Chris D; Persaud, D David

    2009-01-01

    Poverty is an important determinant of ill health, mortality and suffering across the globe. This commentary asks what we can learn about poverty by looking at the way rich countries respond to the needs of vulnerable populations both within their own societies and those of low-income countries. Taking advantage of recent efforts to redefine child poverty in a way that is consistent with the World Health Organization's Commission on Social Determinants of Health, three sets of data are reviewed: levels of child well-being within 23 Organization of Economic Community Development countries; the amount of official development assistance these countries disburse to poor countries; and, government social transfers targeted at families as a percentage of GDP. Analysis shows that countries in Northern Europe tend to have lower levels of child poverty, and are the most generous with social transfers and providing development assistance to poor countries; in contrast, the non-European countries like Australia, Canada, Japan, and the United States, and generally, the G7 countries, are the least generous towards the vulnerable at home and abroad and tend to have the highest levels of child poverty. The findings suggest that nations' responses tend to be ideologically based rather than evidence or needs based and that poverty is neither inevitable nor intractable.

  8. Spatio-temporal earthquake risk assessment for the Lisbon Metropolitan Area - A contribution to improving standard methods of population exposure and vulnerability analysis

    NASA Astrophysics Data System (ADS)

    Freire, Sérgio; Aubrecht, Christoph

    2010-05-01

    The recent 7.0 M earthquake that caused severe damage and destruction in parts of Haiti struck close to 5 PM (local time), at a moment when many people were not in their residences, instead being in their workplaces, schools, or churches. Community vulnerability assessment to seismic hazard relying solely on the location and density of resident-based census population, as is commonly the case, would grossly misrepresent the real situation. In particular in the context of global (climate) change, risk analysis is a research field increasingly gaining in importance whereas risk is usually defined as a function of hazard probability and vulnerability. Assessment and mapping of human vulnerability has however generally been lagging behind hazard analysis efforts. Central to the concept of vulnerability is the issue of human exposure. Analysis of exposure is often spatially tied to administrative units or reference objects such as buildings, spanning scales from the regional level to local studies for small areas. Due to human activities and mobility, the spatial distribution of population is time-dependent, especially in metropolitan areas. Accurately estimating population exposure is a key component of catastrophe loss modeling, one element of effective risk analysis and emergency management. Therefore, accounting for the spatio-temporal dynamics of human vulnerability correlates with recent recommendations to improve vulnerability analyses. Earthquakes are the prototype for a major disaster, being low-probability, rapid-onset, high-consequence events. Lisbon, Portugal, is subject to a high risk of earthquake, which can strike at any day and time, as confirmed by modern history (e.g. December 2009). The recently-approved Special Emergency and Civil Protection Plan (PEERS) is based on a Seismic Intensity map, and only contemplates resident population from the census as proxy for human exposure. In the present work we map and analyze the spatio-temporal distribution of

  9. Cultivating the Role of Nurse Practitioners in Providing Primary Care to Vulnerable Populations in an Era of Health-Care Reform.

    PubMed

    Xue, Ying; Intrator, Orna

    2016-02-01

    The evolving role of nurse practitioners (NPs) as primary care providers, especially for vulnerable populations, is central to the debate regarding strategies to address the growing need for primary care services. The current article provides policy recommendations for leveraging and expanding the historic role of NPs in caring for vulnerable populations, by focusing on three key policy levers: NP scope-of-practice regulation, distribution of the NP workforce, and NP education. These policy levers must go hand in hand to build a sufficient and equitably distributed NP workforce, to help meet the escalating need for primary care in an era of health-care reform. © The Author(s) 2016.

  10. Climate Vulnerability and Human Migration in Global Perspective

    PubMed Central

    Grecequet, Martina; DeWaard, Jack; Hellmann, Jessica J.; Abel, Guy J.

    2018-01-01

    The relationship between climate change and human migration is not homogenous and depends critically on the differential vulnerability of population and places. If places and populations are not vulnerable, or susceptible, to climate change, then the climate–migration relationship may not materialize. The key to understanding and, from a policy perspective, planning for whether and how climate change will impact future migration patterns is therefore knowledge of the link between climate vulnerability and migration. However, beyond specific case studies, little is known about this association in global perspective. We therefore provide a descriptive, country-level portrait of this relationship. We show that the negative association between climate vulnerability and international migration holds only for countries least vulnerable to climate change, which suggests the potential for trapped populations in more vulnerable countries. However, when analyzed separately by life supporting sector (food, water, health, ecosystem services, human habitat, and infrastructure) and vulnerability dimension (exposure, sensitivity, and adaptive capacity), we detect evidence of a relationship among more, but not the most, vulnerable countries. The bilateral (i.e., country-to-country) migration show that, on average, people move from countries of higher vulnerability to lower vulnerability, reducing global risk by 15%. This finding is consistent with the idea that migration is a climate adaptation strategy. Still, ~6% of bilateral migration is maladaptive with respect to climate change, with some movement toward countries with greater climate change vulnerability. PMID:29707262

  11. Climate Vulnerability and Human Migration in Global Perspective.

    PubMed

    Grecequet, Martina; DeWaard, Jack; Hellmann, Jessica J; Abel, Guy J

    2017-05-01

    The relationship between climate change and human migration is not homogenous and depends critically on the differential vulnerability of population and places. If places and populations are not vulnerable, or susceptible, to climate change, then the climate-migration relationship may not materialize. The key to understanding and, from a policy perspective, planning for whether and how climate change will impact future migration patterns is therefore knowledge of the link between climate vulnerability and migration. However, beyond specific case studies, little is known about this association in global perspective. We therefore provide a descriptive, country-level portrait of this relationship. We show that the negative association between climate vulnerability and international migration holds only for countries least vulnerable to climate change, which suggests the potential for trapped populations in more vulnerable countries. However, when analyzed separately by life supporting sector (food, water, health, ecosystem services, human habitat, and infrastructure) and vulnerability dimension (exposure, sensitivity, and adaptive capacity), we detect evidence of a relationship among more, but not the most, vulnerable countries. The bilateral (i.e., country-to-country) migration show that, on average, people move from countries of higher vulnerability to lower vulnerability, reducing global risk by 15%. This finding is consistent with the idea that migration is a climate adaptation strategy. Still, ~6% of bilateral migration is maladaptive with respect to climate change, with some movement toward countries with greater climate change vulnerability.

  12. Mobile Phones and Psychosocial Therapies with Vulnerable People: a First State of the Art

    PubMed Central

    Sexto, Carlos Ferrás; Rocha, Álvaro; Aguilera, Adrián

    2017-01-01

    Mobile phones are becoming a communication tool commonly used by people all over the world; and they are started to be adopted in psychosocial therapies involving vulnerable people. We are herein presenting the results of an academic literature review. We identified scientific papers published between 2006 and 2015 resorting to academic databases available on the Internet, applying a systematic selection method based on quality criteria. Secondly, we analysed contents, highlighting the scarcity of research involving vulnerable people. The available literature specialized in psychosocial therapies offers investigation results which involve mobile phones and patients in general, focusing particularly on the clinical psychology field and, to a lesser extent, on the social work field. Particularly significant are the investigation works developed in the United States. In the present paper we introduce a first “state of the art”, identifying opportunities and also the limitations surrounding the use of mobile phones in psychosocial therapies targeting the vulnerable. Issues concerning privacy and data confidentiality, and the access of vulnerable people to mobile phones and how they use them, pose significant challenges; but they offer the opportunity to reach isolated or impoverished populations, or even to facilitate access to social and healthcare services. We close this paper formulating possible orientations, hypotheses and goals to design new investigation works involving vulnerable populations. PMID:27194134

  13. Geo-ethical dimension of community's safety: rural and urban population vulnerability analysis methodology

    NASA Astrophysics Data System (ADS)

    Kostyuchenko, Yuriy; Movchan, Dmytro; Kopachevsky, Ivan; Yuschenko, Maxim

    2016-04-01

    calculate a distribution of losses connected with decision making in land-use is demonstrated. Rural community's vulnerability determines by water availability, quality of soils, effectiveness of land use (including climate change adaptation), intensity of pollutions, crop productivity variations during the period of crop rotation, annual national distribution of crops output, and distance to city centres. It should noted here that "distance to city centres" is not comprehensive indicator of market accessibility in general case: quality and availability of transport infrastructure should be described more detailed on the next stages of analysis. Urban population vulnerability determines by distribution of urban fractures and quality urban environment: density, quality and availability of infrastructure, balance between industrial, residential and recreational zones, effectiveness of urban land use and landscape management, and social policy, particularly, employment. Population density is closely connected with social density, with communications and decision making. Social learning, as the function of social communications, is the way to increase sustainability. Also it possible to say that social sustainability is a function of intensity and efficiency of communications between interlinked and interacted networks in the heterogeneous environment. Therefore the results of study demonstrated that risk management study should includes issues of risk and threats perception, which should be described in framework of appropriate tools and approaches connected with ethical dimension of vulnerability. For instance, problems of accessibility and availability of safety resources in view of social fairness and socio-economic dynamics should be included into future studies in field of risk analysis.

  14. Modelling social vulnerability in sub-Saharan West Africa using a geographical information system

    PubMed Central

    Arokoyu, Samuel B.

    2015-01-01

    In recent times, disasters and risk management have gained significant attention, especially with increasing awareness of the risks and increasing impact of natural and other hazards especially in the developing world. Vulnerability, the potential for loss of life or property from disaster, has biophysical or social dimensions. Social vulnerability relates to societal attributes which has negative impacts on disaster outcomes. This study sought to develop a spatially explicit index of social vulnerability, thus addressing the dearth of research in this area in sub-Saharan Africa. Nineteen variables were identified covering various aspects. Descriptive analysis of these variables revealed high heterogeneity across the South West region of Nigeria for both the state and the local government areas (LGAs). Feature identification using correlation analysis identified six important variables. Factor analysis identified two dimensions, namely accessibility and socioeconomic conditions, from this subset. A social vulnerability index (SoVI) showed that Ondo and Ekiti have more vulnerable LGAs than other states in the region. About 50% of the LGAs in Osun and Ogun have a relatively low social vulnerability. Distribution of the SoVI shows that there are great differences within states as well as across regions. Scores of population density, disability and poverty have a high margin of error in relation to mean state scores. The study showed that with a geographical information system there are opportunities to model social vulnerability and monitor its evolution and dynamics across the continent.

  15. Vulnerability- and Diversity-Aware Anonymization of Personally Identifiable Information for Improving User Privacy and Utility of Publishing Data

    PubMed Central

    Majeed, Abdul; Ullah, Farman; Lee, Sungchang

    2017-01-01

    Personally identifiable information (PII) affects individual privacy because PII combinations may yield unique identifications in published data. User PII such as age, race, gender, and zip code contain private information that may assist an adversary in determining the user to whom such information relates. Each item of user PII reveals identity differently, and some types of PII are highly identity vulnerable. More vulnerable types of PII enable unique identification more easily, and their presence in published data increases privacy risks. Existing privacy models treat all types of PII equally from an identity revelation point of view, and they mainly focus on hiding user PII in a crowd of other users. Ignoring the identity vulnerability of each type of PII during anonymization is not an effective method of protecting user privacy in a fine-grained manner. This paper proposes a new anonymization scheme that considers the identity vulnerability of PII to effectively protect user privacy. Data generalization is performed adaptively based on the identity vulnerability of PII as well as diversity to anonymize data. This adaptive generalization effectively enables anonymous data, which protects user identity and private information disclosures while maximizing the utility of data for performing analyses and building classification models. Additionally, the proposed scheme has low computational overheads. The simulation results show the effectiveness of the scheme and verify the aforementioned claims. PMID:28481298

  16. Vulnerability- and Diversity-Aware Anonymization of Personally Identifiable Information for Improving User Privacy and Utility of Publishing Data.

    PubMed

    Majeed, Abdul; Ullah, Farman; Lee, Sungchang

    2017-05-08

    Personally identifiable information (PII) affects individual privacy because PII combinations may yield unique identifications in published data. User PII such as age, race, gender, and zip code contain private information that may assist an adversary in determining the user to whom such information relates. Each item of user PII reveals identity differently, and some types of PII are highly identity vulnerable. More vulnerable types of PII enable unique identification more easily, and their presence in published data increases privacy risks. Existing privacy models treat all types of PII equally from an identity revelation point of view, and they mainly focus on hiding user PII in a crowd of other users. Ignoring the identity vulnerability of each type of PII during anonymization is not an effective method of protecting user privacy in a fine-grained manner. This paper proposes a new anonymization scheme that considers the identity vulnerability of PII to effectively protect user privacy. Data generalization is performed adaptively based on the identity vulnerability of PII as well as diversity to anonymize data. This adaptive generalization effectively enables anonymous data, which protects user identity and private information disclosures while maximizing the utility of data for performing analyses and building classification models. Additionally, the proposed scheme has low computational overheads. The simulation results show the effectiveness of the scheme and verify the aforementioned claims.

  17. Community clusters of tsunami vulnerability in the US Pacific Northwest

    USGS Publications Warehouse

    Wood, Nathan J.; Jones, Jeanne M.; Spielman, Seth; Schmidtlein, Mathew C.

    2015-01-01

    Many coastal communities throughout the world are threatened by local (or near-field) tsunamis that could inundate low-lying areas in a matter of minutes after generation. Although the hazard and sustainability literature often frames vulnerability conceptually as a multidimensional issue involving exposure, sensitivity, and resilience to a hazard, assessments often focus on one element or do not recognize the hazard context. We introduce an analytical framework for describing variations in population vulnerability to tsunami hazards that integrates (i) geospatial approaches to identify the number and characteristics of people in hazard zones, (ii) anisotropic path distance models to estimate evacuation travel times to safety, and (iii) cluster analysis to classify communities with similar vulnerability. We demonstrate this approach by classifying 49 incorporated cities, 7 tribal reservations, and 17 counties from northern California to northern Washington that are directly threatened by tsunami waves associated with a Cascadia subduction zone earthquake. Results suggest three primary community groups: (i) relatively low numbers of exposed populations with varied demographic sensitivities, (ii) high numbers of exposed populations but sufficient time to evacuate before wave arrival, and (iii) moderate numbers of exposed populations but insufficient time to evacuate. Results can be used to enhance general hazard-awareness efforts with targeted interventions, such as education and outreach tailored to local demographics, evacuation training, and/or vertical evacuation refuges.

  18. Community clusters of tsunami vulnerability in the US Pacific Northwest.

    PubMed

    Wood, Nathan J; Jones, Jeanne; Spielman, Seth; Schmidtlein, Mathew C

    2015-04-28

    Many coastal communities throughout the world are threatened by local (or near-field) tsunamis that could inundate low-lying areas in a matter of minutes after generation. Although the hazard and sustainability literature often frames vulnerability conceptually as a multidimensional issue involving exposure, sensitivity, and resilience to a hazard, assessments often focus on one element or do not recognize the hazard context. We introduce an analytical framework for describing variations in population vulnerability to tsunami hazards that integrates (i) geospatial approaches to identify the number and characteristics of people in hazard zones, (ii) anisotropic path distance models to estimate evacuation travel times to safety, and (iii) cluster analysis to classify communities with similar vulnerability. We demonstrate this approach by classifying 49 incorporated cities, 7 tribal reservations, and 17 counties from northern California to northern Washington that are directly threatened by tsunami waves associated with a Cascadia subduction zone earthquake. Results suggest three primary community groups: (i) relatively low numbers of exposed populations with varied demographic sensitivities, (ii) high numbers of exposed populations but sufficient time to evacuate before wave arrival, and (iii) moderate numbers of exposed populations but insufficient time to evacuate. Results can be used to enhance general hazard-awareness efforts with targeted interventions, such as education and outreach tailored to local demographics, evacuation training, and/or vertical evacuation refuges.

  19. Community clusters of tsunami vulnerability in the US Pacific Northwest

    PubMed Central

    Wood, Nathan J.; Jones, Jeanne; Spielman, Seth; Schmidtlein, Mathew C.

    2015-01-01

    Many coastal communities throughout the world are threatened by local (or near-field) tsunamis that could inundate low-lying areas in a matter of minutes after generation. Although the hazard and sustainability literature often frames vulnerability conceptually as a multidimensional issue involving exposure, sensitivity, and resilience to a hazard, assessments often focus on one element or do not recognize the hazard context. We introduce an analytical framework for describing variations in population vulnerability to tsunami hazards that integrates (i) geospatial approaches to identify the number and characteristics of people in hazard zones, (ii) anisotropic path distance models to estimate evacuation travel times to safety, and (iii) cluster analysis to classify communities with similar vulnerability. We demonstrate this approach by classifying 49 incorporated cities, 7 tribal reservations, and 17 counties from northern California to northern Washington that are directly threatened by tsunami waves associated with a Cascadia subduction zone earthquake. Results suggest three primary community groups: (i) relatively low numbers of exposed populations with varied demographic sensitivities, (ii) high numbers of exposed populations but sufficient time to evacuate before wave arrival, and (iii) moderate numbers of exposed populations but insufficient time to evacuate. Results can be used to enhance general hazard-awareness efforts with targeted interventions, such as education and outreach tailored to local demographics, evacuation training, and/or vertical evacuation refuges. PMID:25870283

  20. Measuring vulnerability to disaster displacement

    NASA Astrophysics Data System (ADS)

    Brink, Susan A.; Khazai, Bijan; Power, Christopher; Wenzel, Friedemann

    2015-04-01

    Large scale disasters can cause devastating impacts in terms of population displacement. Between 2008 and 2013, on average 27 million people were displaced annually by disasters (Yonetani 2014). After large events such as hurricane Katrina or the Port-au-Prince earthquake, images of inadequate public shelter and concerns about large scale and often inequitable migration have been broadcast around the world. Population displacement can often be one of the most devastating and visible impacts of a natural disaster. Despite the importance of population displacement in disaster events, measures to understand the socio-economic vulnerability of a community often use broad metrics to estimate the total socio-economic risk of an event rather than focusing on the specific impacts that a community faces in a disaster. Population displacement is complex and multi-causal with the physical impact of a disaster interacting with vulnerability arising from the response, environmental issues (e.g., weather), cultural concerns (e.g., expectations of adequate shelter), and many individual factors (e.g., mobility, risk perception). In addition to the complexity of the causes, population displacement is difficult to measure because of the wide variety of different terms and definitions and its multi-dimensional nature. When we speak of severe population displacement, we may refer to a large number of displaced people, an extended length of displacement or associated difficulties such as poor shelter quality, risk of violence and crime in shelter communities, discrimination in aid, a lack of access to employment or other difficulties that can be associated with large scale population displacement. We have completed a thorough review of the literature on disaster population displacement. Research has been conducted on historic events to understand the types of negative impacts associated with population displacement and also the vulnerability of different groups to these impacts. We

  1. Identifying the Transgender Population in the Medicare Program

    PubMed Central

    Proctor, Kimberly; Haffer, Samuel C.; Ewald, Erin; Hodge, Carla; James, Cara V.

    2016-01-01

    Abstract Purpose: To identify and describe the transgender population in the Medicare program using administrative data. Methods: Using a combination of International Classification of Diseases ninth edition (ICD-9) codes relating to transsexualism and gender identity disorder, we analyzed 100% of the 2013 Centers for Medicare & Medicaid Services (CMS) Medicare Fee-For-Service (FFS) “final action” claims from both institutional and noninstitutional providers (∼1 billion claims) to identify individuals who may be transgender Medicare beneficiaries. To confirm, we developed and applied a multistage validation process. Results: Four thousand ninety-eight transgender beneficiaries were identified, of which ∼90% had confirmatory diagnoses, billing codes, or evidence of a hormone prescription. In general, the racial, ethnic, and geographic distribution of the Medicare transgender population tends to reflect the broader Medicare population. However, age, original entitlement status, and disease burden of the transgender population appear substantially different. Conclusions: Using a variety of claims information, ranging from claims history to additional diagnoses, billing modifiers, and hormone prescriptions, we demonstrate that administrative data provide a valuable resource for identifying a lower bound of the Medicare transgender population. In addition, we provide a baseline description of the diversity and disease burden of the population and a framework for future research. PMID:28861539

  2. Mining Bug Databases for Unidentified Software Vulnerabilities

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Dumidu Wijayasekara; Milos Manic; Jason Wright

    2012-06-01

    Identifying software vulnerabilities is becoming more important as critical and sensitive systems increasingly rely on complex software systems. It has been suggested in previous work that some bugs are only identified as vulnerabilities long after the bug has been made public. These vulnerabilities are known as hidden impact vulnerabilities. This paper discusses the feasibility and necessity to mine common publicly available bug databases for vulnerabilities that are yet to be identified. We present bug database analysis of two well known and frequently used software packages, namely Linux kernel and MySQL. It is shown that for both Linux and MySQL, amore » significant portion of vulnerabilities that were discovered for the time period from January 2006 to April 2011 were hidden impact vulnerabilities. It is also shown that the percentage of hidden impact vulnerabilities has increased in the last two years, for both software packages. We then propose an improved hidden impact vulnerability identification methodology based on text mining bug databases, and conclude by discussing a few potential problems faced by such a classifier.« less

  3. Electrophysiological activity is associated with vulnerability of Internet addiction in non-clinical population.

    PubMed

    Wang, Grace Y; Griskova-Bulanova, Inga

    2018-09-01

    This study investigated the electrophysiological activity associated with vulnerability of problematic Internet use in non-clinical population. The resting EEG spectrum of alpha (8-13 Hz) rhythm was measured in 22 healthy subjects who have used the Internet for recreational purpose. The vulnerability of Internet addiction was assessed using Young's Internet Addiction Test (IAT) and Assessment for Computer and Internet Addiction-Screener (AICA-S) respectively. Depression and impulsivity were also measured with Beck Depression Inventory (BDI) and Barratt Impulsiveness Scale 11(BIS-11) respectively. The IAT was positively correlated with alpha power obtained during eyes closed (EC, r = 0.50, p = 0.02) but not during eyes open (EO). This was further supported by a negative correlation (r = -0.48, p = 0.02) between IAT scores and alpha desynchronization (EO-EC). These relationships remained significant following correction for multiple comparisons. Furthermore, The BDI score showed positive correlation with alpha asymmetry at mid-lateral (r = 0.54, p = 0.01) and mid-frontal (r = 0.46, p = 0.03) regions during EC, and at mid-frontal (r = 0.53, p = 0.01) region during EO. The current findings suggest that there are associations between neural activity and the vulnerability of problematic Internet use. Understanding of the neurobiological mechanisms underlying problematic Internet use would contribute to improved early intervention and treatment. Copyright © 2018 Elsevier Ltd. All rights reserved.

  4. The collaborative edge: patient empowerment for vulnerable populations.

    PubMed

    Safran, Charles

    2003-03-01

    The problems with access to care and the special needs for educational outreach for disadvantage or vulnerable populations of patients require innovation. This paper describes Baby CareLink use of information technology to support communication, consultation, and collaboration among colleagues as well as with patients, their families, and community resources. In response to the educational, emotional and communication needs of parents of premature infants and the clinicians who care for the infants and support the families, we developed Baby CareLink, a secure collaborative environment. Baby CareLink provides a nurturing environment where parents, even though remote from the Neonatal Intensive Care Unit, can actively participate in decisions surrounding their baby's care. In a southeastern hospital serving a mostly Medicaid population in a rural setting, more than 300 parents have used Baby CareLink more than 11000 times during the past year. Despite the common wisdom that Medicaid families do not have access to the Internet, approximately 85% of the parents access Baby CareLink from home, at work, from the library or other public access point. The median use of Baby CareLinks from outside the hospital by parents is 17 separate sessions. In a city hospital in the midwestern US which exclusively serves a Medicaid population, experience has been equally encouraging. More than 70 parents have initiated more than 600 secure sessions with Baby CareLink. In contrast to the rural hospital, only 35% of sessions have been initiated outside the hospital. Experience with Baby CareLink suggests that families from all walks of life will use and benefit from collaborative tools that keep them informed and involved in the care of their children. The most significant barrier to wider deployment is bandwidth limitations into the homes of most families. The care of premature infants is a great example of an area where medical knowledge and ability has grown dramatically, and where

  5. Modeling Coastal Vulnerability through Space and Time

    PubMed Central

    2016-01-01

    Coastal ecosystems experience a wide range of stressors including wave forces, storm surge, sea-level rise, and anthropogenic modification and are thus vulnerable to erosion. Urban coastal ecosystems are especially important due to the large populations these limited ecosystems serve. However, few studies have addressed the issue of urban coastal vulnerability at the landscape scale with spatial data that are finely resolved. The purpose of this study was to model and map coastal vulnerability and the role of natural habitats in reducing vulnerability in Jamaica Bay, New York, in terms of nine coastal vulnerability metrics (relief, wave exposure, geomorphology, natural habitats, exposure, exposure with no habitat, habitat role, erodible shoreline, and surge) under past (1609), current (2015), and future (2080) scenarios using InVEST 3.2.0. We analyzed vulnerability results both spatially and across all time periods, by stakeholder (ownership) and by distance to damage from Hurricane Sandy. We found significant differences in vulnerability metrics between past, current and future scenarios for all nine metrics except relief and wave exposure. The marsh islands in the center of the bay are currently vulnerable. In the future, these islands will likely be inundated, placing additional areas of the shoreline increasingly at risk. Significant differences in vulnerability exist between stakeholders; the Breezy Point Cooperative and Gateway National Recreation Area had the largest erodible shoreline segments. Significant correlations exist for all vulnerability (exposure/surge) and storm damage combinations except for exposure and distance to artificial debris. Coastal protective features, ranging from storm surge barriers and levees to natural features (e.g. wetlands), have been promoted to decrease future flood risk to communities in coastal areas around the world. Our methods of combining coastal vulnerability results with additional data and across multiple time

  6. Evaluating the Characteristics of Social Vulnerability to Wildfire: Demographics, Perceptions, and Parcel Characteristics.

    PubMed

    Paveglio, Travis B; Prato, Tony; Edgeley, Catrin; Nalle, Darek

    2016-09-01

    A large body of research focuses on identifying patterns of human populations most at risk from hazards and the factors that help explain performance of mitigations that can help reduce that risk. One common concept in such studies is social vulnerability-human populations' potential exposure to, sensitivity from and ability to reduce negative impacts from a hazard. While there is growing interest in social vulnerability for wildfire, few studies have critically evaluated the characteristics that scholars often indicate influence social vulnerability to that hazard. This research utilizes surveys, wildfire simulations, and GIS data to test the relationships between select demographic, perceptual and parcel characteristics of property owners against empirically simulated metrics for wildfire exposure or wildfire-related damages and their performance of mitigation actions. Our results from Flathead County, MT, USA, suggest that parcel characteristics such as property value, building value, and the year structures were built explaining a significant amount of the variance in elements of social vulnerability. Demographic characteristics commonly used in social vulnerability analysis did not have significant relationships with measures of wildfire exposure or vulnerability. Part-time or full-time residency, age, perceived property risk, and year of development were among the few significant determinants of residents' performance of fuel reduction mitigations, although the significance of these factors varied across the levels of fuel reduction performed by homeowners. We use these and other results to argue for a renewed focus on the finer-scale characteristics that expose some populations to wildfire risk more than others.

  7. The perils of protection: vulnerability and women in clinical research.

    PubMed

    Schonfeld, Toby

    2013-06-01

    Subpart B of 45 Code of Federal Regulations Part 46 (CFR) identifies the criteria according to which research involving pregnant women, human fetuses, and neonates can be conducted ethically in the United States. As such, pregnant women and fetuses fall into a category requiring "additional protections," often referred to as "vulnerable populations." The CFR does not define vulnerability, but merely gives examples of vulnerable groups by pointing to different categories of potential research subjects needing additional protections. In this paper, I assess critically the role of this categorization of pregnant women involved in research as "vulnerable," both as separate entities and in combination with the fetuses they carry. In particular, I do three things: (1) demonstrate that pregnant women qua pregnancy are either not "vulnerable" according to any meaningful definition of that term or that such vulnerability is irrelevant to her status as a research participant; (2) argue that while a fetus may be vulnerable in terms of dependency, this categorization does not equate to the vulnerability of the pregnant woman; and (3) suggest that any vulnerability that appends to women is precisely the result of federal regulations and dubious public perceptions about pregnant women. I conclude by demonstrating how this erroneous characterization of pregnant women as "vulnerable" and its associated protections have not only impeded vital research for pregnant women and their fetuses, but have also negatively affected the inclusion of all women in clinical research.

  8. Awareness of Tobacco-Related Health Harms among Vulnerable Populations in Bangladesh: Findings from the International Tobacco Control (ITC) Bangladesh Survey.

    PubMed

    Driezen, Pete; Abdullah, Abu S; Nargis, Nigar; Hussain, A K M Ghulam; Fong, Geoffrey T; Thompson, Mary E; Quah, Anne C K; Xu, Steve

    2016-08-25

    This study assessed the knowledge of the harmful effects of tobacco use among vulnerable populations in Bangladesh and whether vulnerability was associated with the presence of complete home smoking bans. Data came from Wave 3 (2011-2012) of the International Tobacco Control (ITC) Bangladesh Survey, a nationally-representative survey of 3131 tobacco users and 2147 non-users. Socio-demographic measures of disadvantage were used as proxy measures of vulnerability, including sex, residential location, education and income. Outcome measures were awareness of the harmful effects of (a) cigarette smoking and (b) smokeless tobacco use and (c) whether respondents had complete smoking bans in their homes. Logistic regression was used to examine whether the adjusted prevalence of each outcome differed by socio-demographic proxies of vulnerability. Smaller percentages of women, the illiterate, urban slum residents and low-income Bangladeshis were aware of the health harms of tobacco. These vulnerable groups generally had lower odds of awareness compared to the least disadvantaged groups. Incomplete knowledge of tobacco's harms may prevent vulnerable groups from taking steps to protect their health. Development goals, such as increasing literacy rates and empowering women, can complement the goals of WHO's Framework Convention on Tobacco Control.

  9. Systematic review of mobile health behavioural interventions to improve uptake of HIV testing for vulnerable and key populations.

    PubMed

    Conserve, Donaldson F; Jennings, Larissa; Aguiar, Carolina; Shin, Grace; Handler, Lara; Maman, Suzanne

    2017-02-01

    Introduction This systematic narrative review examined the empirical evidence on the effectiveness of mobile health (mHealth) behavioural interventions designed to increase the uptake of HIV testing among vulnerable and key populations. Methods MEDLINE/PubMed, Embase, Web of Science, and Global Health electronic databases were searched. Studies were eligible for inclusion if they were published between 2005 and 2015, evaluated an mHealth intervention, and reported an outcome relating to HIV testing. We also reviewed the bibliographies of retrieved studies for other relevant citations. The methodological rigor of selected articles was assessed, and narrative analyses were used to synthesize findings from mixed methodologies. Results A total of seven articles met the inclusion criteria. Most mHealth interventions employed a text-messaging feature and were conducted in middle- and high-income countries. The methodological rigor was moderate among studies. The current literature suggests that mHealth interventions can have significant positive effects on HIV testing initiation among vulnerable and key populations, as well as the general public. In some cases, null results were observed. Qualitative themes relating to the use of mobile technologies to increase HIV testing included the benefits of having low-cost, confidential, and motivational communication. Reported barriers included cellular network restrictions, poor linkages with physical testing services, and limited knowledge of appropriate text-messaging dose. Discussion MHealth interventions may prove beneficial in reducing the proportion of undiagnosed persons living with HIV, particularly among vulnerable and key populations. However, more rigorous and tailored interventions are needed to assess the effectiveness of widespread use.

  10. Systematic review of mobile-health behavioral interventions to improve uptake of HIV testing for vulnerable and key populations

    PubMed Central

    Conserve, Donaldson F.; Jennings, Larissa; Aguiar, Carolina; Shin, Grace; Handler, Lara; Maman, Suzanne

    2016-01-01

    Objective This systematic narrative review examined the empirical evidence on the effectiveness of mobile health (mHealth) behavioral interventions designed to increase uptake of HIV testing among vulnerable and key populations. Methods MEDLINE/PubMed, Embase, Web of Science, and Global Health electronic databases were searched. Studies were eligible for inclusion if they were published between 2005 and 2015, evaluated an mHealth intervention, and reported an outcome relating to HIV testing. We also reviewed the bibliographies of retrieved studies for other relevant citations. The methodological rigor of selected articles was assessed, and narrative analyses were used to synthesize findings from mixed methodologies. Results A total of seven articles met the inclusion criteria. Most mHealth interventions employed a text-messaging feature and were conducted in middle- and high-income countries. The methodological rigor was moderate among studies. The current literature suggests that mHealth interventions can have significant positive effects on HIV testing initiation among vulnerable and key populations, as well as the general public. In some cases, null results were observed. Qualitative themes relating to use of mobile technologies to increase HIV testing included the benefits of having low-cost, confidential, and motivational communication. Reported barriers included cellular network restrictions, poor linkages with physical testing services, and limited knowledge of appropriate text-messaging dose. Conclusions MHealth interventions may prove beneficial in reducing the proportion of undiagnosed persons living with HIV, particularly among vulnerable and key populations. However, more rigorous and tailored intervention trials are needed to assess the effectiveness of widespread use. PMID:27056905

  11. The participatory vulnerability scoping diagram - deliberative risk ranking for community water systems

    USGS Publications Warehouse

    Howe, Peter D.; Yarnal, Brent; Coletti, Alex; Wood, Nathan J.

    2013-01-01

    Natural hazards and climate change present growing challenges to community water system (CWS) managers, who are increasingly turning to vulnerability assessments to identify, prioritize, and adapt to risks. Effectively assessing CWS vulnerability requires information and participation from various sources, one of which is stakeholders. In this article, we present a deliberative risk-ranking methodology, the participatory vulnerability scoping diagram (P-VSD), which allows rapid assessment and integration of multiple stakeholder perspectives of vulnerability. This technique is based on methods of deliberative risk evaluation and the vulnerability scoping diagram. The goal of the methodology is to engage CWS managers and stakeholders collectively to provide qualitative contextual risk rankings as a first step in a vulnerability assessment. We conduct an initial assessment using a case study of CWS in two U.S. counties, sites with broadly similar exposures but differences in population, land use, and other social sensitivity factors. Results demonstrate that CWS managers and stakeholders in the two case study communities all share the belief that their CWS are vulnerable to hazards but differ in how this vulnerability manifests itself in terms of the exposure, sensitivity, and adaptive capacity of the system.

  12. Barriers and Facilitators to Engagement of Vulnerable Populations in HIV Primary Care in New York City

    PubMed Central

    Remien, Robert H.; Bauman, Laurie J.; Mantell, Joanne; Tsoi, Benjamin; Lopez-Rios, Javier; Chhabra, Rosy; DiCarlo, Abby; Watnick, Dana; Rivera, Angelic; Teitelman, Nehama; Cutler, Blayne; Warne, Patricia

    2015-01-01

    Background Engagement in HIV care helps to maximize viral suppression, which, in turn, reduces morbidity and mortality and prevents further HIV transmission. With more HIV cases than any other US city, New York City reported in 2012 that only 41% of all persons estimated to be living with HIV (PLWH) had a suppressed viral load, while nearly three-quarters of those in clinical care achieved viral suppression. Thus, retaining PLWH in HIV care addresses this central goal of both the US National HIV/AIDS Strategy and Governor Cuomo's plan to end the AIDS epidemic in New York State. Methods We conducted 80 in-depth qualitative interviews with PLWH in four NYC populations that were identified as being inconsistently engaged in HIV medical care: African immigrants, previously incarcerated adults, transgender women, and young men who have sex with men. Results Barriers to and facilitators of HIV care engagement fell into three domains: (1) system factors (e.g., patient-provider relationship, social service agencies, transitions between penal system and community); (2) social factors (e.g., family and other social support; stigma related to HIV, substance use, sexual orientation, gender identity, and incarceration); and (3) individual factors (e.g., mental illness, substance use, resilience). Similarities and differences in these themes across the four populations as well as research and public health implications were identified. Conclusions Engagement in care is maximized when the social challenges confronted by vulnerable groups are addressed; patient-provider communication is strong; and coordinated services are available, including housing, mental health and substance use treatment, and peer navigation. PMID:25867774

  13. Flood hazard, vulnerability, and risk assessment for human life

    NASA Astrophysics Data System (ADS)

    Pan, T.; Chang, T.; Lai, J.; Hsieh, M.; Tan, Y.; Lin, Y.

    2011-12-01

    Flood risk assessment is an important issue for the countries suffering tropical cyclones and monsoon. Taiwan is located in the hot zone of typhoon tracks in the Western Pacific. There are three to five typhoons landing Taiwan every year. Typhoons and heavy rainfalls often cause inundation disaster rising with the increase of population and the development of social economy. The purpose of this study is to carry out the flood hazard, vulnerability and risk in term of human life. Based on the concept that flood risk is composed by flood hazard and vulnerability, a inundation simulation is performed to evaluate the factors of flood hazard for human life according to base flood (100-year return period). The flood depth, velocity and rising ratio are the three factors of flood hazards. Furthermore, the factors of flood vulnerability are identified in terms of human life that are classified into two main factors, residents and environment. The sub factors related to residents are the density of population and the density of vulnerable people including elders, youngers and disabled persons. The sub factors related to environment include the the number of building floors, the locations of buildings, the and distance to rescue center. The analytic hierarchy process (AHP) is adopted to determine the weights of these factors. The risk matrix is applied to show the risk from low to high based on the evaluation of flood hazards and vulnerabilities. The Tseng-Wen River watershed is selected as the case study because a serious flood was induced by Typhoon Morakot in 2009, which produced a record-breaking rainfall of 2.361mm in 48 hours in the last 50 years. The results of assessing the flood hazard, vulnerability and risk in term of human life could improve the emergency operation for flood disaster to prepare enough relief goods and materials during typhoon landing.

  14. E-Waste and Harm to Vulnerable Populations: A Growing Global Problem

    PubMed Central

    Heacock, Michelle; Kelly, Carol Bain; Asante, Kwadwo Ansong; Birnbaum, Linda S.; Bergman, Åke Lennart; Bruné, Marie-Noel; Buka, Irena; Carpenter, David O.; Chen, Aimin; Huo, Xia; Kamel, Mostafa; Landrigan, Philip J.; Magalini, Federico; Diaz-Barriga, Fernando; Neira, Maria; Omar, Magdy; Pascale, Antonio; Ruchirawat, Mathuros; Sly, Leith; Sly, Peter D.; Van den Berg, Martin; Suk, William A.

    2015-01-01

    Background: Electronic waste (e-waste) is produced in staggering quantities, estimated globally to be 41.8 million tonnes in 2014. Informal e-waste recycling is a source of much-needed income in many low- to middle-income countries. However, its handling and disposal in underdeveloped countries is often unsafe and leads to contaminated environments. Rudimentary and uncontrolled processing methods often result in substantial harmful chemical exposures among vulnerable populations, including women and children. E-waste hazards have not yet received the attention they deserve in research and public health agendas. Objectives: We provide an overview of the scale and health risks. We review international efforts concerned with environmental hazards, especially affecting children, as a preface to presenting next steps in addressing health issues stemming from the global e-waste problem. Discussion: The e-waste problem has been building for decades. Increased observation of adverse health effects from e-waste sites calls for protecting human health and the environment from e-waste contamination. Even if e-waste exposure intervention and prevention efforts are implemented, legacy contamination will remain, necessitating increased awareness of e-waste as a major environmental health threat. Conclusion: Global, national, and local levels efforts must aim to create safe recycling operations that consider broad security issues for people who rely on e-waste processing for survival. Paramount to these efforts is reducing pregnant women and children’s e-waste exposures to mitigate harmful health effects. With human environmental health in mind, novel dismantling methods and remediation technologies and intervention practices are needed to protect communities. Citation: Heacock M, Kelly CB, Asante KA, Birnbaum LS, Bergman AL, Bruné MN, Buka I, Carpenter DO, Chen A, Huo X, Kamel M, Landrigan PJ, Magalini F, Diaz-Barriga F, Neira M, Omar M, Pascale A, Ruchirawat M, Sly L, Sly PD

  15. E-Waste and Harm to Vulnerable Populations: A Growing Global Problem.

    PubMed

    Heacock, Michelle; Kelly, Carol Bain; Asante, Kwadwo Ansong; Birnbaum, Linda S; Bergman, Åke Lennart; Bruné, Marie-Noel; Buka, Irena; Carpenter, David O; Chen, Aimin; Huo, Xia; Kamel, Mostafa; Landrigan, Philip J; Magalini, Federico; Diaz-Barriga, Fernando; Neira, Maria; Omar, Magdy; Pascale, Antonio; Ruchirawat, Mathuros; Sly, Leith; Sly, Peter D; Van den Berg, Martin; Suk, William A

    2016-05-01

    Electronic waste (e-waste) is produced in staggering quantities, estimated globally to be 41.8 million tonnes in 2014. Informal e-waste recycling is a source of much-needed income in many low- to middle-income countries. However, its handling and disposal in underdeveloped countries is often unsafe and leads to contaminated environments. Rudimentary and uncontrolled processing methods often result in substantial harmful chemical exposures among vulnerable populations, including women and children. E-waste hazards have not yet received the attention they deserve in research and public health agendas. We provide an overview of the scale and health risks. We review international efforts concerned with environmental hazards, especially affecting children, as a preface to presenting next steps in addressing health issues stemming from the global e-waste problem. The e-waste problem has been building for decades. Increased observation of adverse health effects from e-waste sites calls for protecting human health and the environment from e-waste contamination. Even if e-waste exposure intervention and prevention efforts are implemented, legacy contamination will remain, necessitating increased awareness of e-waste as a major environmental health threat. Global, national, and local levels efforts must aim to create safe recycling operations that consider broad security issues for people who rely on e-waste processing for survival. Paramount to these efforts is reducing pregnant women and children's e-waste exposures to mitigate harmful health effects. With human environmental health in mind, novel dismantling methods and remediation technologies and intervention practices are needed to protect communities. Heacock M, Kelly CB, Asante KA, Birnbaum LS, Bergman AL, Bruné MN, Buka I, Carpenter DO, Chen A, Huo X, Kamel M, Landrigan PJ, Magalini F, Diaz-Barriga F, Neira M, Omar M, Pascale A, Ruchirawat M, Sly L, Sly PD, Van den Berg M, Suk WA. 2016. E-waste and harm to

  16. Factors Contributing to Exacerbating Vulnerabilities in Global Clinical Trials

    PubMed Central

    da Silva, Ricardo E.; Amato, Angélica A.; Guilhem, Dirce B.; de Carvalho, Marta R.; Lima, Elisangela da C.; Novaes, Maria Rita C. G.

    2018-01-01

    Background: Although policies and guidelines make use of the concept of vulnerability, few define it. The European Union's directive for clinical trials does not include explanations for or the reasoning behind the designation of certain groups as vulnerable. Emerging economies from lower middle-income countries have, in recent years, had the largest average annual growth rate, as well as increase, in number of clinical trials registered in the US government's database. Nevertheless, careful supervision of research activities has to be ensured. Objective: To describe and analyze the features of the clinical trials involving vulnerable populations in various countries classified by development status and geographic region. Methods: Retrospective study that involved analysis of data obtained from the International Clinical Trials Registry Platform (ICTRP) database between 01/2014 and 12/2014 from countries with (i) highest trial densities during 2005 to 2012, (ii) highest average growth rate in clinical trials, and (iii) greatest trial capabilities. Results: Statistical analysis of this study showed that patients incapable of giving consent personally are 11.4 times more likely to be vulnerable patients than patients who are capable, and that patients in upper-middle-income countries are 1.7 times more likely to be vulnerable patients than patients from high-income countries when participating in global clinical trials. Malaysia (21%), Egypt (20%), Turkey (19%), Israel (18%), and Brazil (17%) had the highest percentages of vulnerable populations involving children. Conclusions: Although the inability to provide consent personally was a factor associated with vulnerability, arbitrary criteria may have been considered when classifying the populations of clinical trials as vulnerable. The EU Clinical Trials Register should provide guidance regarding exactly what aspects or factors should be taken into account to frame given populations as vulnerable, because

  17. Factors Contributing to Exacerbating Vulnerabilities in Global Clinical Trials.

    PubMed

    da Silva, Ricardo E; Amato, Angélica A; Guilhem, Dirce B; de Carvalho, Marta R; Lima, Elisangela da C; Novaes, Maria Rita C G

    2017-01-01

    Background: Although policies and guidelines make use of the concept of vulnerability, few define it. The European Union's directive for clinical trials does not include explanations for or the reasoning behind the designation of certain groups as vulnerable. Emerging economies from lower middle-income countries have, in recent years, had the largest average annual growth rate, as well as increase, in number of clinical trials registered in the US government's database. Nevertheless, careful supervision of research activities has to be ensured. Objective: To describe and analyze the features of the clinical trials involving vulnerable populations in various countries classified by development status and geographic region. Methods: Retrospective study that involved analysis of data obtained from the International Clinical Trials Registry Platform (ICTRP) database between 01/2014 and 12/2014 from countries with (i) highest trial densities during 2005 to 2012, (ii) highest average growth rate in clinical trials, and (iii) greatest trial capabilities. Results: Statistical analysis of this study showed that patients incapable of giving consent personally are 11.4 times more likely to be vulnerable patients than patients who are capable, and that patients in upper-middle-income countries are 1.7 times more likely to be vulnerable patients than patients from high-income countries when participating in global clinical trials. Malaysia (21%), Egypt (20%), Turkey (19%), Israel (18%), and Brazil (17%) had the highest percentages of vulnerable populations involving children. Conclusions: Although the inability to provide consent personally was a factor associated with vulnerability, arbitrary criteria may have been considered when classifying the populations of clinical trials as vulnerable. The EU Clinical Trials Register should provide guidance regarding exactly what aspects or factors should be taken into account to frame given populations as vulnerable, because

  18. [Iodine nutritional status of the vulnerable population in Henan province in 2011].

    PubMed

    Yang, Jin; Zheng, He-ming; Chen, Gan

    2013-01-01

    To investigate the iodine nutritional status of the vulnerable population in Henan in 2011. From March to December 2011, 44 049 urinary samples of newly married women of childbearing age (363), pregnant women (31 874), lactating women (4893) and children under 2 years (6919) collected from hospitals, maternal and child care hospitals and outpatient department of family planning organizations from 8 cities of Henan province (only including the areas where water iodine was less than 100 µg/L) were tested for urine iodine concentration. The iodine nutritional status of different groups was analyzed. The median of urinary iodine for newly married women, pregnant women, lactating women and children under 2 years was 204.5, 190.9, 145.5 and 185.4 µg/L, respectively (χ(2) = 874.16, P < 0.01). The proportion of urinary iodine below 150 µg/L of pregnant women and below 100 µg/L of lactating women and children under 2 years was 33.0% (10 519/31 874), 24.9% (1218/4893) and 12.4% (855/6919), respectively. The proportion of urinary iodine above 300 µg/L of newly married women was 33.6% (122/363). The median of urinary iodine for pregnant women in the first, second and third trimester was 186.7, 193.8 and 182.5 µg/L, respectively (χ(2) = 55.19, P < 0.01). The median of urinary iodine for the breast-feeding, formula-feeding and mixed-feeding infant under the age of 1 year was 194.8, 85.6 and 176.0 µg/L, respectively (χ(2) = 179.25, P < 0.01). The overall iodine nutrient levels of the vulnerable population in Henan in 2011 were appropriate, but there were still some proportions of pregnant and lactating women with low iodine level. The iodine intake of the formula-feeding infants was not sufficient.

  19. Modelling homogeneous regions of social vulnerability to malaria in Rwanda.

    PubMed

    Bizimana, Jean Pierre; Kienberger, Stefan; Hagenlocher, Michael; Twarabamenye, Emmanuel

    2016-03-31

    Despite the decline in malaria incidence due to intense interventions, potentials for malaria transmission persist in Rwanda. To eradicate malaria in Rwanda, strategies need to expand beyond approaches that focus solely on malaria epidemiology and also consider the socioeconomic, demographic and biological/disease-related factors that determine the vulnerability of potentially exposed populations. This paper analyses current levels of social vulnerability to malaria in Rwanda by integrating a set of weighted vulnerability indicators. The paper uses regionalisation techniques as a spatially explicit approach for delineating homogeneous regions of social vulnerability to malaria. This overcomes the limitations of administrative boundaries for modelling the trans-boundary social vulnerability to malaria. The utilised approach revealed high levels of social vulnerability to malaria in the highland areas of Rwanda, as well as in remote areas where populations are more susceptible. Susceptibility may be due to the populations' lacking the capacity to anticipate mosquito bites, or lacking resilience to cope with or recover from malaria infection. By highlighting the most influential indicators of social vulnerability to malaria, the applied approach indicates which vulnerability domains need to be addressed, and where appropriate interventions are most required. Interventions to improve the socioeconomic development in highly vulnerable areas could prove highly effective, and provide sustainable outcomes against malaria in Rwanda. This would ultimately increase the resilience of the population and their capacity to better anticipate, cope with, and recover from possible infection.

  20. Assessing tsunami vulnerability, an example from Herakleio, Crete

    NASA Astrophysics Data System (ADS)

    Papathoma, M.; Dominey-Howes, D.; Zong, Y.; Smith, D.

    Recent tsunami have caused massive loss of life, destruction of coastal infrastructures and disruption to economic activity. To date, tsunami hazard studies have concentrated on determining the frequency and magnitude of events and in the production of simplistic flood maps. In general, such maps appear to have assumed a uniform vulnerability of population, infrastructure and business. In reality however, a complex set of factors interact to produce a pattern of vulnerability that varies spatially and temporally. A new vulnerability assessment approach is described, that incorporates multiple factors (e.g. parameters relating to the natural and built environments and socio-demographics) that contribute to tsunami vulnerability. The new methodology is applied on a coastal segment in Greece and, in particular, in Crete, westof the city of Herakleio. The results are presented within a Geographic Information System (GIS). The application of GIS ensures the approach is novel for tsunami studies, since it permits interrogation of the primary database by several different end-users. For example, the GIS may be used: (1) to determine immediate post-tsunami disaster response needs by the emergency services; (2) to preplan tsunami mitigation measures by disaster planners; (3) as a tool for local planning by the municipal authorities or; (4) as a basis for catastrophe modelling by insurance companies. We show that population density varies markedly with the time of the year and that 30% of buildings within the inundation zone are only single story thus increasing the vulnerability of their occupants. Within the high inundation depth zone, 11% of buildings are identified as in need of reinforcement and this figure rises to 50% within the medium inundation depth zone. 10% of businesses are located within the high inundation depth zone and these may need to consider their level of insurance cover to protect against primary building damage, contents loss and business interruption

  1. Epidemiology of paediatric burns in Lithuania: focus on a vulnerable population exposed to the risk of scalds at home without hot tap water supply.

    PubMed

    Kubilius, Darius; Smailytė, Giedrė; Rimdeikienė, Inesa; Malcius, Dalius; Kaikaris, Vygintas; Rimdeika, Rytis

    2014-05-01

    To describe the epidemiology of paediatric burns in Lithuania, identify the trends of burn occurrence, the vulnerable population and aetiology. This study was based on all inclusive national information obtained from the National Health Insurance database for the period of 2001-2010. Information on the burns aetiology was collected in the Hospital of Lithuanian University of Heath Sciences Kauno Klinikos. 7146 children in the age group of 0-14 were hospitalized in Lithuania and constituted 44% of all admissions due to burns. The incidence among boys was 149.8 and among girls 99.9 per 100,000. The highest risk of burns was observed from 11 to 15 months of age. Scalding in 0-1 years age group composed 96% of all burns in this age group. Children younger than 2 years of age are a vulnerable population of burns in Lithuania. Scalding was main cause of their burns. The aetiological subgroups of scalding were scalding with hot drinks/food and scalding with hot water meant for household. The major part of scalding with hot drinks was due to scalding with parents' drinks. Scalding with hot water meant for household is associated with the lack of hot water supply. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

  2. A comparison of data-driven groundwater vulnerability assessment methods

    USGS Publications Warehouse

    Sorichetta, Alessandro; Ballabio, Cristiano; Masetti, Marco; Robinson, Gilpin R.; Sterlacchini, Simone

    2013-01-01

    Increasing availability of geo-environmental data has promoted the use of statistical methods to assess groundwater vulnerability. Nitrate is a widespread anthropogenic contaminant in groundwater and its occurrence can be used to identify aquifer settings vulnerable to contamination. In this study, multivariate Weights of Evidence (WofE) and Logistic Regression (LR) methods, where the response variable is binary, were used to evaluate the role and importance of a number of explanatory variables associated with nitrate sources and occurrence in groundwater in the Milan District (central part of the Po Plain, Italy). The results of these models have been used to map the spatial variation of groundwater vulnerability to nitrate in the region, and we compare the similarities and differences of their spatial patterns and associated explanatory variables. We modify the standard WofE method used in previous groundwater vulnerability studies to a form analogous to that used in LR; this provides a framework to compare the results of both models and reduces the effect of sampling bias on the results of the standard WofE model. In addition, a nonlinear Generalized Additive Model has been used to extend the LR analysis. Both approaches improved discrimination of the standard WofE and LR models, as measured by the c-statistic. Groundwater vulnerability probability outputs, based on rank-order classification of the respective model results, were similar in spatial patterns and identified similar strong explanatory variables associated with nitrate source (population density as a proxy for sewage systems and septic sources) and nitrate occurrence (groundwater depth).

  3. Latent profiles of early developmental vulnerabilities in a New South Wales child population at age 5 years.

    PubMed

    Green, Melissa J; Tzoumakis, Stacy; Laurens, Kristin R; Dean, Kimberlie; Kariuki, Maina; Harris, Felicity; O'Reilly, Nicole; Chilvers, Marilyn; Brinkman, Sally A; Carr, Vaughan J

    2018-06-01

    Detecting the early emergence of childhood risk for adult mental disorders may lead to interventions for reducing subsequent burden of these disorders. We set out to determine classes of children who may be at risk for later mental disorder on the basis of early patterns of development in a population cohort, and associated exposures gleaned from linked administrative records obtained within the New South Wales Child Development Study. Intergenerational records from government departments of health, education, justice and child protection were linked with the Australian Early Development Census for a state population cohort of 67,353 children approximately 5 years of age. We used binary data from 16 subdomains of the Australian Early Development Census to determine classes of children with shared patterns of Australian Early Development Census-defined vulnerability using latent class analysis. Covariates, which included demographic features (sex, socioeconomic status) and exposure to child maltreatment, parental mental illness, parental criminal offending and perinatal adversities (i.e. birth complications, smoking during pregnancy, low birth weight), were examined hierarchically within latent class analysis models. Four classes were identified, reflecting putative risk states for mental disorders: (1) disrespectful and aggressive/hyperactive behaviour, labelled 'misconduct risk' ( N = 4368; 6.5%); (2) 'pervasive risk' ( N = 2668; 4.0%); (3) 'mild generalised risk' ( N = 7822; 11.6%); and (4) 'no risk' ( N = 52,495; 77.9%). The odds of membership in putative risk groups (relative to the no risk group) were greater among children from backgrounds of child maltreatment, parental history of mental illness, parental history of criminal offending, socioeconomic disadvantage and perinatal adversities, with distinguishable patterns of association for some covariates. Patterns of early childhood developmental vulnerabilities may provide useful indicators

  4. Heat Vulnerability Index Mapping for Milwaukee and Wisconsin.

    PubMed

    Christenson, Megan; Geiger, Sarah Dee; Phillips, Jeffrey; Anderson, Ben; Losurdo, Giovanna; Anderson, Henry A

    Extreme heat waves elevate the population's risk for heat-related morbidity and mortality, specifically for vulnerable groups such as older adults and young children. In this context, we developed 2 Heat Vulnerability Indices (HVIs), one for the state of Wisconsin and one for the Milwaukee metropolitan area. Through the creation of an HVI, state and local agencies will be able to use the indices as a planning tool for extreme heat events. Data used for the HVIs were grouped into 4 categories: (1) population density; (2) health factors; (3) demographic and socioeconomic factors; and (4) natural and built environment factors. These categories were mapped at the Census block group level. Unweighted z-score data were used to determine index scores, which were then mapped by quantiles ranging from "high" to "low" vulnerability. Statewide, Menominee County exhibited the highest vulnerability to extreme heat. Milwaukee HVI findings indicated high vulnerability in the city's inner core versus low vulnerability along the lakeshore. Visualization of vulnerability could help local public health agencies prepare for future extreme heat events.

  5. Health disparities among highly vulnerable populations in the United States: a call to action for medical and oral health care.

    PubMed

    Vanderbilt, Allison A; Isringhausen, Kim T; VanderWielen, Lynn M; Wright, Marcie S; Slashcheva, Lyubov D; Madden, Molly A

    2013-03-26

    Healthcare in the United States (US) is burdened with enormous healthcare disparities associated with a variety of factors including insurance status, income, and race. Highly vulnerable populations, classified as those with complex medical problems and/or social needs, are one of the fastest growing segments within the US. Over a decade ago, the US Surgeon General publically challenged the nation to realize the importance of oral health and its relationship to general health and well-being, yet oral health disparities continue to plague the US healthcare system. Interprofessional education and teamwork has been demonstrated to improve patient outcomes and provide benefits to participating health professionals. We propose the implementation of interprofessional education and teamwork as a solution to meet the increasing oral and systemic healthcare demands of highly vulnerable US populations.

  6. Health disparities among highly vulnerable populations in the United States: a call to action for medical and oral health care.

    PubMed

    Vanderbilt, Allison A; Isringhausen, Kim T; VanderWielen, Lynn M; Wright, Marcie S; Slashcheva, Lyubov D; Madden, Molly A

    2013-01-01

    Healthcare in the United States (US) is burdened with enormous healthcare disparities associated with a variety of factors including insurance status, income, and race. Highly vulnerable populations, classified as those with complex medical problems and/or social needs, are one of the fastest growing segments within the US. Over a decade ago, the US Surgeon General publically challenged the nation to realize the importance of oral health and its relationship to general health and well-being, yet oral health disparities continue to plague the US healthcare system. Interprofessional education and teamwork has been demonstrated to improve patient outcomes and provide benefits to participating health professionals. We propose the implementation of interprofessional education and teamwork as a solution to meet the increasing oral and systemic healthcare demands of highly vulnerable US populations.

  7. Functioning before and after a major depressive episode: pre-existing vulnerability or scar? A prospective three-wave population-based study.

    PubMed

    Bos, E H; Ten Have, M; van Dorsselaer, S; Jeronimus, B F; de Graaf, R; de Jonge, P

    2018-01-14

    The vulnerability hypothesis suggests that impairments after remission of depressive episodes reflect a pre-existing vulnerability, while the scar hypothesis proposes that depression leaves residual impairments that confer risk of subsequent episodes. We prospectively examined vulnerability and scar effects in mental and physical functioning in a representative Dutch population sample. Three waves were used from the Netherlands Mental Health Survey and Incidence Study-2, a population-based study with a 6-years follow-up. Mental and physical functioning were assessed with the Medical Outcomes Study Short Form (SF-36). Major depressive disorder (MDD) was assessed with the Composite International Diagnostic Interview 3.0. Vulnerability effects were examined by comparing healthy controls (n = 2826) with individuals who developed a first-onset depressive episode during first follow-up but did not have a lifetime diagnosis of MDD at baseline (n = 181). Scarring effects were examined by comparing pre- and post-morbid functioning in individuals who developed a depressive episode after baseline that was remitted at the third wave (n = 108). Both mental (B = -5.4, s.e. = 0.9, p < 0.001) and physical functioning (B = -8.2, s.e. = 1.1, p < 0.001) at baseline were lower in individuals who developed a first depressive episode after baseline compared with healthy controls. This effect was most pronounced in people who developed a severe episode. No firm evidence of scarring in mental or physical functioning was found. In unadjusted analyses, physical functioning was still lowered post-morbidly (B = -5.1, s.e. = 2.1, p = 0.014), but this effect disappeared in adjusted analyses. Functional impairments after remission of depression seem to reflect a pre-existing vulnerability rather than a scar.

  8. Ecosystem Vulnerability Review: Proposal of an Interdisciplinary Ecosystem Assessment Approach

    NASA Astrophysics Data System (ADS)

    Weißhuhn, Peter; Müller, Felix; Wiggering, Hubert

    2018-06-01

    To safeguard the sustainable use of ecosystems and their services, early detection of potentially damaging changes in functional capabilities is needed. To support a proper ecosystem management, the analysis of an ecosystem's vulnerability provide information on its weaknesses as well as on its capacity to recover after suffering an impact. However, the application of the vulnerability concept to ecosystems is still an emerging topic. After providing background on the vulnerability concept, we summarize existing ecosystem vulnerability research on the basis of a systematic literature review with a special focus on ecosystem type, disciplinary background, and more detailed definition of the ecosystem vulnerability components. Using the Web of ScienceTM Core Collection, we overviewed the literature from 1991 onwards but used the 5 years from 2011 to 2015 for an in-depth analysis, including 129 articles. We found that ecosystem vulnerability analysis has been applied most notably in conservation biology, climate change research, and ecological risk assessments, pinpointing a limited spreading across the environmental sciences. It occurred primarily within marine and freshwater ecosystems. To avoid confusion, we recommend using the unambiguous term ecosystem vulnerability rather than ecological, environmental, population, or community vulnerability. Further, common ground has been identified, on which to define the ecosystem vulnerability components exposure, sensitivity, and adaptive capacity. We propose a framework for ecosystem assessments that coherently connects the concepts of vulnerability, resilience, and adaptability as different ecosystem responses. A short outlook on the possible operationalization of the concept by ecosystem vulnerabilty indices, and a conclusion section complete the review.

  9. Ecosystem Vulnerability Review: Proposal of an Interdisciplinary Ecosystem Assessment Approach.

    PubMed

    Weißhuhn, Peter; Müller, Felix; Wiggering, Hubert

    2018-06-01

    To safeguard the sustainable use of ecosystems and their services, early detection of potentially damaging changes in functional capabilities is needed. To support a proper ecosystem management, the analysis of an ecosystem's vulnerability provide information on its weaknesses as well as on its capacity to recover after suffering an impact. However, the application of the vulnerability concept to ecosystems is still an emerging topic. After providing background on the vulnerability concept, we summarize existing ecosystem vulnerability research on the basis of a systematic literature review with a special focus on ecosystem type, disciplinary background, and more detailed definition of the ecosystem vulnerability components. Using the Web of Science TM Core Collection, we overviewed the literature from 1991 onwards but used the 5 years from 2011 to 2015 for an in-depth analysis, including 129 articles. We found that ecosystem vulnerability analysis has been applied most notably in conservation biology, climate change research, and ecological risk assessments, pinpointing a limited spreading across the environmental sciences. It occurred primarily within marine and freshwater ecosystems. To avoid confusion, we recommend using the unambiguous term ecosystem vulnerability rather than ecological, environmental, population, or community vulnerability. Further, common ground has been identified, on which to define the ecosystem vulnerability components exposure, sensitivity, and adaptive capacity. We propose a framework for ecosystem assessments that coherently connects the concepts of vulnerability, resilience, and adaptability as different ecosystem responses. A short outlook on the possible operationalization of the concept by ecosystem vulnerabilty indices, and a conclusion section complete the review.

  10. Response to varying the nicotine content of cigarettes in vulnerable populations: an initial experimental examination of acute effects.

    PubMed

    Higgins, Stephen T; Heil, Sarah H; Sigmon, Stacey C; Tidey, Jennifer W; Gaalema, Diann E; Stitzer, Maxine L; Durand, Hanna; Bunn, Janice Y; Priest, Jeff S; Arger, Christopher A; Miller, Mollie E; Bergeria, Cecilia L; Davis, Danielle R; Streck, Joanna M; Zvorsky, Ivori; Redner, Ryan; Vandrey, Ryan; Pacek, Lauren R

    2017-01-01

    The purpose of this study was to begin researching the effects of very low nicotine content cigarettes in smokers especially vulnerable to dependence to assess their potential as a less dependence-producing alternative to current commercial cigarettes. Participants were 26 adult, daily cigarette smokers from one of three populations: economically disadvantaged women of reproductive age (n = 9), opioid-dependent individuals (n = 11), and individuals with affective disorders (n = 6). Participants completed fourteen 2-4-h experimental sessions in a within-subjects research design. Sessions were conducted following brief smoking abstinence. Four research cigarettes varying in nicotine content (0.4, 2.4, 5.2, and 15.8 mg/g) were studied under double-blind conditions, assessing smoking topography, subjective effects, and relative reinforcing effects of varying doses in concurrent choice tests. Results were collapsed across vulnerable populations and analyzed using repeated measures ANOVA. No significant differences between doses were discernible in smoking topography. All doses were equi-effective at reducing nicotine withdrawal. Ratings of satisfaction from smoking were lower at the 0.4 compared to 15.8 mg/g dose. Participants preferred the 15.8 mg/g dose over the 0.4 and 2.4 but not the 5.2 mg/g doses in concurrent choice testing; no differences between the two lowest doses were noted. All cigarettes effectively reduced nicotine withdrawal with no differences in smoking topography, suggesting minimal compensatory smoking. Dependence potential was lowest at the 0.4 mg/g dose. These initial results are promising regarding the feasibility of lowering nicotine content in cigarettes to very low levels in vulnerable populations without untoward effects.

  11. Awareness of Tobacco-Related Health Harms among Vulnerable Populations in Bangladesh: Findings from the International Tobacco Control (ITC) Bangladesh Survey

    PubMed Central

    Driezen, Pete; Abdullah, Abu S.; Nargis, Nigar; Hussain, A. K. M. Ghulam; Fong, Geoffrey T.; Thompson, Mary E.; Quah, Anne C. K.; Xu, Steve

    2016-01-01

    This study assessed the knowledge of the harmful effects of tobacco use among vulnerable populations in Bangladesh and whether vulnerability was associated with the presence of complete home smoking bans. Data came from Wave 3 (2011–2012) of the International Tobacco Control (ITC) Bangladesh Survey, a nationally-representative survey of 3131 tobacco users and 2147 non-users. Socio-demographic measures of disadvantage were used as proxy measures of vulnerability, including sex, residential location, education and income. Outcome measures were awareness of the harmful effects of (a) cigarette smoking and (b) smokeless tobacco use and (c) whether respondents had complete smoking bans in their homes. Logistic regression was used to examine whether the adjusted prevalence of each outcome differed by socio-demographic proxies of vulnerability. Smaller percentages of women, the illiterate, urban slum residents and low-income Bangladeshis were aware of the health harms of tobacco. These vulnerable groups generally had lower odds of awareness compared to the least disadvantaged groups. Incomplete knowledge of tobacco’s harms may prevent vulnerable groups from taking steps to protect their health. Development goals, such as increasing literacy rates and empowering women, can complement the goals of WHO’s Framework Convention on Tobacco Control. PMID:27571090

  12. Use of Mental Health Services among People with Co-Occurring Disorders and other Mental Health co-morbidities: Employing the Behavioral Model of Vulnerable Populations

    PubMed Central

    Small, La Fleur F.

    2010-01-01

    Background Persons with mental disorders frequently have other co-occurring problems such as substance related disorders and HIV/AIDS. Individuals with co-occurring medical and mental disorders encounter great obstacles to receiving mental health services. Aims This paper uses the Behavioral Model of Vulnerable Populations to evaluate use of mental health services among groups with co-occurring disorders (CODs) and other co-morbid relationships. The association between receipt of mental health treatment and traditional/vulnerable predisposing, enabling, and need factors are examined. Methods Bivariate analysis and two-stage hierarchical logistic regression were completed. Resutls A sample of 553 persons who reported mental health problems within the past year had one or more of the following vulnerabilities: (1) substance disorders; (2) homelessness; (3) victims of violent crime; (4) diagnosed with HIV/AIDS; (5) recipient of public benefits; and 31.3% reported having received some form of mental health treatment. Both traditional and vulnerable characteristics are significant predictors of receipt of mental health treatment. Vulnerable predictors indicated decreased odds of receiving mental health treatment were associated with injection and chronic drug use, (OR = .42, CI: .22 – .77) and (OR = .38, CI: .22 – .64) respectively. Conclusion The Behavioral Model of Vulnerable Populations could be employed in future research of CODs and other co-morbid group’s utilization of mental health treatment. PMID:20559416

  13. Mental Health Research in Correctional Settings: Perceptions of Risk and Vulnerabilities

    PubMed Central

    Johnson, Mark E.; Kondo, Karli K.; Brems, Christiane; Ironside, Erica F.; Eldridge, Gloria D.

    2015-01-01

    With over half of individuals incarcerated having serious mental health concerns, correctional settings offer excellent opportunities for epidemiological, prevention, and intervention research. However, due to unique ethical and structural challenges, these settings create risks and vulnerabilities for participants not typically encountered in research populations. We surveyed 1,224 researchers, IRB members, and IRB prisoner representatives to assess their perceptions of risks associated with mental health research conducted in correctional settings. Highest-ranked risks were related to privacy, stigma, and confidentiality; lowest-ranked risks were related to prisoners’ loss of privileges or becoming targets of violence due to having participated in research. Cognitive impairment, mental illness, lack of autonomy, and limited access to services emerged as the greatest sources of vulnerability; being male, being female, being over age of 60, being a minority, and being pregnant were the lowest-ranked sources of vulnerability. Researchers with corrections experience perceived lower risks and vulnerabilities than all other groups, raising the question whether these researchers accurately appraise risk and vulnerability based on experience, or if their lower risk and vulnerability perceptions reflect potential bias due to their vested interests. By identifying areas of particular risk and vulnerability, this study provides important information for researchers and research reviewers alike. PMID:27092025

  14. Global-scale river flood vulnerability in the last 50 years.

    PubMed

    Tanoue, Masahiro; Hirabayashi, Yukiko; Ikeuchi, Hiroaki

    2016-10-26

    The impacts of flooding are expected to rise due to population increases, economic growth and climate change. Hence, understanding the physical and spatiotemporal characteristics of risk drivers (hazard, exposure and vulnerability) is required to develop effective flood mitigation measures. Here, the long-term trend in flood vulnerability was analysed globally, calculated from the ratio of the reported flood loss or damage to the modelled flood exposure using a global river and inundation model. A previous study showed decreasing global flood vulnerability over a shorter period using different disaster data. The long-term analysis demonstrated for the first time that flood vulnerability to economic losses in upper-middle, lower-middle and low-income countries shows an inverted U-shape, as a result of the balance between economic growth and various historical socioeconomic efforts to reduce damage, leading to non-significant upward or downward trends. We also show that the flood-exposed population is affected by historical changes in population distribution, with changes in flood vulnerability of up to 48.9%. Both increasing and decreasing trends in flood vulnerability were observed in different countries, implying that population growth scenarios considering spatial distribution changes could affect flood risk projections.

  15. Global-scale river flood vulnerability in the last 50 years

    PubMed Central

    Tanoue, Masahiro; Hirabayashi, Yukiko; Ikeuchi, Hiroaki

    2016-01-01

    The impacts of flooding are expected to rise due to population increases, economic growth and climate change. Hence, understanding the physical and spatiotemporal characteristics of risk drivers (hazard, exposure and vulnerability) is required to develop effective flood mitigation measures. Here, the long-term trend in flood vulnerability was analysed globally, calculated from the ratio of the reported flood loss or damage to the modelled flood exposure using a global river and inundation model. A previous study showed decreasing global flood vulnerability over a shorter period using different disaster data. The long-term analysis demonstrated for the first time that flood vulnerability to economic losses in upper-middle, lower-middle and low-income countries shows an inverted U-shape, as a result of the balance between economic growth and various historical socioeconomic efforts to reduce damage, leading to non-significant upward or downward trends. We also show that the flood-exposed population is affected by historical changes in population distribution, with changes in flood vulnerability of up to 48.9%. Both increasing and decreasing trends in flood vulnerability were observed in different countries, implying that population growth scenarios considering spatial distribution changes could affect flood risk projections. PMID:27782160

  16. Vulnerability to temperature-related mortality in Seoul, Korea

    NASA Astrophysics Data System (ADS)

    Son, Ji-Young; Lee, Jong-Tae; Anderson, G. Brooke; Bell, Michelle L.

    2011-07-01

    Studies indicate that the mortality effects of temperature may vary by population and region, although little is known about the vulnerability of subgroups to these risks in Korea. This study examined the relationship between temperature and cause-specific mortality for Seoul, Korea, for the period 2000-7, including whether some subgroups are particularly vulnerable with respect to sex, age, education and place of death. The authors applied time-series models allowing nonlinear relationships for heat- and cold-related mortality, and generated exposure-response curves. Both high and low ambient temperatures were associated with increased risk for daily mortality. Mortality risk was 10.2% (95% confidence interval 7.43, 13.0%) higher at the 90th percentile of daily mean temperatures (25 °C) compared to the 50th percentile (15 °C). Mortality risk was 12.2% (3.69, 21.3%) comparing the 10th (-1 °C) and 50th percentiles of temperature. Cardiovascular deaths showed a higher risk to cold, whereas respiratory deaths showed a higher risk to heat effect, although the differences were not statistically significant. Susceptible populations were identified such as females, the elderly, those with no education, and deaths occurring outside of a hospital for heat- and cold-related total mortality. Our findings provide supportive evidence of a temperature-mortality relationship in Korea and indicate that some subpopulations are particularly vulnerable.

  17. Vulnerability assessment of urban ecosystems driven by water resources, human health and atmospheric environment

    NASA Astrophysics Data System (ADS)

    Shen, Jing; Lu, Hongwei; Zhang, Yang; Song, Xinshuang; He, Li

    2016-05-01

    As ecosystem management is a hotspot and urgent topic with increasing population growth and resource depletion. This paper develops an urban ecosystem vulnerability assessment method representing a new vulnerability paradigm for decision makers and environmental managers, as it's an early warning system to identify and prioritize the undesirable environmental changes in terms of natural, human, economic and social elements. The whole idea is to decompose a complex problem into sub-problem, and analyze each sub-problem, and then aggregate all sub-problems to solve this problem. This method integrates spatial context of Geographic Information System (GIS) tool, multi-criteria decision analysis (MCDA) method, ordered weighted averaging (OWA) operators, and socio-economic elements. Decision makers can find out relevant urban ecosystem vulnerability assessment results with different vulnerable attitude. To test the potential of the vulnerability methodology, it has been applied to a case study area in Beijing, China, where it proved to be reliable and consistent with the Beijing City Master Plan. The results of urban ecosystem vulnerability assessment can support decision makers in evaluating the necessary of taking specific measures to preserve the quality of human health and environmental stressors for a city or multiple cities, with identifying the implications and consequences of their decisions.

  18. Modelling the elements of country vulnerability to earthquake disasters.

    PubMed

    Asef, M R

    2008-09-01

    Earthquakes have probably been the most deadly form of natural disaster in the past century. Diversity of earthquake specifications in terms of magnitude, intensity and frequency at the semicontinental scale has initiated various kinds of disasters at a regional scale. Additionally, diverse characteristics of countries in terms of population size, disaster preparedness, economic strength and building construction development often causes an earthquake of a certain characteristic to have different impacts on the affected region. This research focuses on the appropriate criteria for identifying the severity of major earthquake disasters based on some key observed symptoms. Accordingly, the article presents a methodology for identification and relative quantification of severity of earthquake disasters. This has led to an earthquake disaster vulnerability model at the country scale. Data analysis based on this model suggested a quantitative, comparative and meaningful interpretation of the vulnerability of concerned countries, and successfully explained which countries are more vulnerable to major disasters.

  19. Anaemia of pregnancy, perinatal outcomes and children's developmental vulnerability: a whole-of-population study.

    PubMed

    Smithers, Lisa G; Gialamas, Angela; Scheil, Wendy; Brinkman, Sally; Lynch, John W

    2014-09-01

    There is limited longitudinal data from high-income countries on the sequelae of anaemia during pregnancy. The aim of this study is to examine whether anaemia of pregnancy is associated with adverse perinatal outcomes and with children's developmental vulnerability. We conducted a population-based study to link routinely collected government administrative data that involved all live births in the state of South Australia 1999-2005 (n = 124 061) and a subset for whom developmental data were collected during a national census of children attending their first year of school in 2009 (n = 13 654). Perinatal outcomes were recorded by midwives using a validated, standardised form. Development was recorded by schoolteachers using the Australian Early Development Index (AEDI). Children in the lowest 10% of AEDI scores are indicative of developmental vulnerability. There were 8764/124 061 (7.1%) cases of anaemia. After adjustment for a range of potentially confounding factors, anaemia of pregnancy was associated with a higher risk of fetal distress [incident rate ratio (IRR) 1.20 [95% CI 1.13, 1.27

  20. Chemical Proteomics Identifies Druggable Vulnerabilities in a Genetically Defined Cancer.

    PubMed

    Bar-Peled, Liron; Kemper, Esther K; Suciu, Radu M; Vinogradova, Ekaterina V; Backus, Keriann M; Horning, Benjamin D; Paul, Thomas A; Ichu, Taka-Aki; Svensson, Robert U; Olucha, Jose; Chang, Max W; Kok, Bernard P; Zhu, Zhou; Ihle, Nathan T; Dix, Melissa M; Jiang, Ping; Hayward, Matthew M; Saez, Enrique; Shaw, Reuben J; Cravatt, Benjamin F

    2017-10-19

    The transcription factor NRF2 is a master regulator of the cellular antioxidant response, and it is often genetically activated in non-small-cell lung cancers (NSCLCs) by, for instance, mutations in the negative regulator KEAP1. While direct pharmacological inhibition of NRF2 has proven challenging, its aberrant activation rewires biochemical networks in cancer cells that may create special vulnerabilities. Here, we use chemical proteomics to map druggable proteins that are selectively expressed in KEAP1-mutant NSCLC cells. Principal among these is NR0B1, an atypical orphan nuclear receptor that we show engages in a multimeric protein complex to regulate the transcriptional output of KEAP1-mutant NSCLC cells. We further identify small molecules that covalently target a conserved cysteine within the NR0B1 protein interaction domain, and we demonstrate that these compounds disrupt NR0B1 complexes and impair the anchorage-independent growth of KEAP1-mutant cancer cells. Our findings designate NR0B1 as a druggable transcriptional regulator that supports NRF2-dependent lung cancers. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. A comparative study of perceptions on tobacco in vulnerable populations between India and France.

    PubMed

    Stoebner-Delbarre, Anne; Aghi, Mira B

    2013-12-01

    Perceptions of tobacco are a relatively unexplored issue in disadvantaged populations in India and France. The objectives of this study included the following: obtain qualitative information on representations of tobacco use and cessation within two vulnerable populations; identify cultural factors that influence tobacco use and cessation; and acquire information for the development of effective tobacco cessation strategies. A total of 21 focus groups were conducted in India and France. All study participants were disadvantaged adults 18 years old or older. Sixty women resided in South Delhi in India and 163 adults with disabilities resided in the south of France. They were all current tobacco users. Data were collected by focus group and analysed with thematic coding. In both samples, the most relevant reasons of tobacco use were daily life circumstances, which were also a major barrier to quitting. None of the participants reported that quitting difficulties could be due to dependence or nicotine addiction. The data also suggested that whilst some participants wanted to stop, they also anticipated quitting would be extremely challenging. In addition, there were a number of cross-cultural differences between Indian and French disadvantaged people: level of information concerning the health risk related to tobacco use and level of demand for support to quit from health professionals were most often cited. Recommendations are made for a specific approach among disadvantaged people. The paper concludes that in order to facilitate cessation, tobacco control interventions need to focus on coping strategies to deal with feelings of distress, withdrawal symptoms, and the circumstances of everyday life experienced by disadvantaged tobacco users.

  2. Improving interprofessional practice for vulnerable older people: gaining a better understanding of vulnerability.

    PubMed

    Abley, Clare; Bond, John; Robinson, Louise

    2011-09-01

    A key focus for professionals working with older people in the community is on those who are vulnerable, although this vulnerability is not well defined. This study sought the views of health and social care professionals and older people on vulnerability, identifying significant differences between professional and older people's perspectives. It found that for older people, vulnerability is an emotional response to being in a specific situation, whereas for professionals, the vulnerability of those on their case loads relates to them having certain or a combination of characteristics (physical, psychological and social). The paper concludes that interprofessional care for older people in the community could be improved firstly by asking older people if they ever feel vulnerable and if so, in what situations and secondly by focusing team efforts on addressing the issues raised by older people in response to these questions.

  3. Relations between species rarity, vulnerability, and range contraction for a beetle group in a densely populated region in the Mediterranean biodiversity hotspot.

    PubMed

    Fattorini, Simone

    2014-02-01

    Rarity is often considered an indication of species extinction risk, and it is frequently used to obtain measures of species vulnerability. However, there is no strong evidence of a correlation between species vulnerability and threat. Moreover, there is no consensus about how rarity should be measured. I used a multidimensional characterization of species rarity to calculate a vulnerability index for tenebrionid beetles inhabiting an Italian region in the Mediterranean biodiversity hotspot. I used different metrics to examine 3 dimensions of rarity: species range, ecology, and population. Species with rarity values below the median were scored as rare for each dimension. I combined rarity scores into a vulnerability index. I then correlated species vulnerability with range trends (expanded vs. contracted). Different measures of the same rarity dimension were strongly correlated and produced similar vulnerability scores. This result indicates rarity-based vulnerability estimates are slightly affected by the way a certain rarity dimension is measured. Vulnerability was correlated with range trends; species with the highest vulnerability had the strongest range contraction. However, a large number of common species also underwent range contraction in the last 50 years, and there was no clear relation between range contraction and their ecology. This indicates that in general human-induced environmental changes affected species irrespective of their assumed vulnerability and that focusing only on rare species may severely bias perceptions of the extent of species decline. © 2013 Society for Conservation Biology.

  4. Children of Darfur: a vulnerable population.

    PubMed

    Chaikin, Jennifer

    2008-02-01

    Four years of intense war in Darfur has created an entire generation of children who might never recover. Children in this region are particularly vulnerable and suffer from issues including physical and psychological illness, malnutrition, rape and unlawful military recruitment. This international crisis is among the most important public health issues in the world. The responsibility of the international community to these children is significant and required to break this cycle. This paper will discuss the concerns surrounding these children, how current strategies are failing and proposed public health nursing interventions.

  5. Evaluating the Characteristics of Social Vulnerability to Wildfire: Demographics, Perceptions, and Parcel Characteristics

    NASA Astrophysics Data System (ADS)

    Paveglio, Travis B.; Prato, Tony; Edgeley, Catrin; Nalle, Darek

    2016-09-01

    A large body of research focuses on identifying patterns of human populations most at risk from hazards and the factors that help explain performance of mitigations that can help reduce that risk. One common concept in such studies is social vulnerability—human populations' potential exposure to, sensitivity from and ability to reduce negative impacts from a hazard. While there is growing interest in social vulnerability for wildfire, few studies have critically evaluated the characteristics that scholars often indicate influence social vulnerability to that hazard. This research utilizes surveys, wildfire simulations, and GIS data to test the relationships between select demographic, perceptual and parcel characteristics of property owners against empirically simulated metrics for wildfire exposure or wildfire-related damages and their performance of mitigation actions. Our results from Flathead County, MT, USA, suggest that parcel characteristics such as property value, building value, and the year structures were built explaining a significant amount of the variance in elements of social vulnerability. Demographic characteristics commonly used in social vulnerability analysis did not have significant relationships with measures of wildfire exposure or vulnerability. Part-time or full-time residency, age, perceived property risk, and year of development were among the few significant determinants of residents' performance of fuel reduction mitigations, although the significance of these factors varied across the levels of fuel reduction performed by homeowners. We use these and other results to argue for a renewed focus on the finer-scale characteristics that expose some populations to wildfire risk more than others.

  6. Volcanic risk assessment: Quantifying physical vulnerability in the built environment

    NASA Astrophysics Data System (ADS)

    Jenkins, S. F.; Spence, R. J. S.; Fonseca, J. F. B. D.; Solidum, R. U.; Wilson, T. M.

    2014-04-01

    This paper presents structured and cost-effective methods for assessing the physical vulnerability of at-risk communities to the range of volcanic hazards, developed as part of the MIA-VITA project (2009-2012). An initial assessment of building and infrastructure vulnerability has been carried out for a set of broadly defined building types and infrastructure categories, with the likelihood of damage considered separately for projectile impact, ash fall loading, pyroclastic density current dynamic pressure and earthquake ground shaking intensities. In refining these estimates for two case study areas: Kanlaon volcano in the Philippines and Fogo volcano in Cape Verde, we have developed guidelines and methodologies for carrying out physical vulnerability assessments in the field. These include identifying primary building characteristics, such as construction material and method, as well as subsidiary characteristics, for example the size and prevalence of openings, that may be important in assessing eruption impacts. At-risk buildings around Kanlaon were found to be dominated by timber frame buildings that exhibit a high vulnerability to pyroclastic density currents, but a low vulnerability to failure from seismic shaking. Around Fogo, the predominance of unreinforced masonry buildings with reinforced concrete slab roofs suggests a high vulnerability to volcanic earthquake but a low vulnerability to ash fall loading. Given the importance of agriculture for local livelihoods around Kanlaon and Fogo, we discuss the potential impact of infrastructure vulnerability for local agricultural economies, with implications for volcanic areas worldwide. These methodologies and tools go some way towards offering a standardised approach to carrying out future vulnerability assessments for populated volcanic areas.

  7. RESILIENCE IN VULNERABLE POPULATIONS WITH TYPE 2 DIABETES MELLITUS AND HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS

    PubMed Central

    Pesantes, M. Amalia; Lazo-Porras, María; Abu Dabrh, Abd Moain; Avila-Ramirez, Jaime R.; Caycho, Maria; Villamonte, Georgina Y.; Sanchez-Perez, Grecia P.; Málaga, Germán; Bernabé-Ortiz, Antonio; Miranda, J. Jaime

    2015-01-01

    Background Patients with chronic conditions and limited access to healthcare experience stressful challenges due to the burden of managing both their conditions and their daily life demands. Resilience provides a mechanism of adapting to stressful experiences. We conducted a systematic review and meta-analysis to synthesize the evidence about interventions to enhance resiliency in managing hypertension or type-2 diabetes in vulnerable populations, and to assess the efficacy of these interventions on clinical outcomes. Methods We searched multiple databases from early inception through February 2015 including randomized controlled trials that enrolled patients with type-2 diabetes or hypertension. All interventions that targeted resilience in vulnerable populations were included. Data were synthesized to describe the characteristics and efficacy of resilience interventions. We pooled the total effects by calculating standardized mean difference using the random-effects model. Results The final search yielded seventeen studies. All studies were conducted in the United States and generally targeted minority participants. Resiliency interventions used diverse strategies; discussion groups or workshops were the most common approach. Conclusions Interventions aimed at enhancing the resiliency of patients from vulnerable groups are diverse. Outcomes were not fully conclusive. There was some evidence that resilience interventions had a positive effect on HbA1c levels, but not blood pressure. The incorporation of resiliency-oriented interventions into the arsenal of prevention and management of chronic conditions appears to be an opportunity that remains to be better investigated and exploited, and there is need to pursue further understanding of the core components of any intervention that claims to enhance resilience. PMID:26239007

  8. African American adolescent perceptions of vulnerability and resilience to HIV.

    PubMed

    Glenn, Betty L; Wilson, Kathleen P

    2008-07-01

    HIV/AIDS is growing at a disproportional rate among African American adolescents. This trend has occurred despite the fact that 89% of schools have educational programs on HIV/AIDS. Barriers to effective HIV prevention may be related to a failure to develop educational programs based on the cultural competencies of vulnerable populations such as adolescents who are at risk for HIV. The purpose of this qualitative study was to explore African American adolescent perceptions of vulnerability and resilience to HIV/AIDS within a cultural competency paradigm. A group of 8 adolescents at an African American church participated in a focus group to discuss vulnerability and resilience to HIV. To facilitate discussion, the adolescents developed collages from pictures in African American magazines. Content analysis was used to identify themes. The themes revealed were confidence, safe social activities, innocence, image, music/drug culture, and peer pressure.

  9. Neighborhood Effects on Heat Deaths: Social and Environmental Predictors of Vulnerability in Maricopa County, Arizona

    PubMed Central

    Declet-Barreto, Juan H.; Stefanov, William L.; Petitti, Diana B.

    2012-01-01

    Background: Most heat-related deaths occur in cities, and future trends in global climate change and urbanization may amplify this trend. Understanding how neighborhoods affect heat mortality fills an important gap between studies of individual susceptibility to heat and broadly comparative studies of temperature–mortality relationships in cities. Objectives: We estimated neighborhood effects of population characteristics and built and natural environments on deaths due to heat exposure in Maricopa County, Arizona (2000–2008). Methods: We used 2000 U.S. Census data and remotely sensed vegetation and land surface temperature to construct indicators of neighborhood vulnerability and a geographic information system to map vulnerability and residential addresses of persons who died from heat exposure in 2,081 census block groups. Binary logistic regression and spatial analysis were used to associate deaths with neighborhoods. Results: Neighborhood scores on three factors—socioeconomic vulnerability, elderly/isolation, and unvegetated area—varied widely throughout the study area. The preferred model (based on fit and parsimony) for predicting the odds of one or more deaths from heat exposure within a census block group included the first two factors and surface temperature in residential neighborhoods, holding population size constant. Spatial analysis identified clusters of neighborhoods with the highest heat vulnerability scores. A large proportion of deaths occurred among people, including homeless persons, who lived in the inner cores of the largest cities and along an industrial corridor. Conclusions: Place-based indicators of vulnerability complement analyses of person-level heat risk factors. Surface temperature might be used in Maricopa County to identify the most heat-vulnerable neighborhoods, but more attention to the socioecological complexities of climate adaptation is needed. PMID:23164621

  10. Modelling farm vulnerability to flooding: A step toward vulnerability mitigation policies appraisal

    NASA Astrophysics Data System (ADS)

    Brémond, P.; Abrami, G.; Blanc, C.; Grelot, F.

    2009-04-01

    Recent catastrophic flood events such as Elbe in 2002 or Rhône in 2003 have shown limits of flood management policies relying on dykes protection: worsening of flood impacts downstream, increased damage by dykes rupture. Those events, among others, contributes to radical changes on the philosophy of flood prevention, with the promotion of new orientations for mitigating flood exposition. Two new trends may have a significant impact on rural areas: floodplain restoration and vulnerability mitigation. The Rhône River program, which is an contract of objectives signed between French Government and local collectivites, is highly illustrative of these new trends and their impact on agricultural sector. In this program, it appears that areas to be concerned by floodplain restoration are agricultural ones, because their supposed vulnerability to flood is expected to be less important to urban areas. As a consequence, agricultural sector is particularly concerned by planned actions on mitigation of assets vulnerability, an important part of the program (financial support of European Union of 7.5 Million euros). Mitigation of agricultural assets vulnerability reveals particularly interesting for two following reasons. Firstly, it is a way to maintain agricultural activities in floodplains yet existing, without promoting flood protection. Secondly, in case of floodplain restoration, vulnerability mitigation is a way for local authorities to compensate over-flooding impacts. In practice, local authorities may financially support farmers for implementing measures to mitigate their farm vulnerability. On the Rhône River, an important work has already been done to identify farm vulnerability to flooding, and propose measures to mitigate it. More than 3 000 farms exposed to flood risk have been identified representing 88 690 ha of agricultural areas which is estimated to generate damage between 400 and 800 Million euros depending on the season of occurrence for a catastrophic

  11. Temporal trends in human vulnerability to excessive heat

    NASA Astrophysics Data System (ADS)

    Sheridan, Scott C.; Allen, Michael J.

    2018-04-01

    Over recent decades, studies have examined various morbidity and mortality outcomes associated with heat exposure. This review explores the collective knowledge of the temporal trends of heat on human health, with regard to the hypothesis that humans are less vulnerable to heat events presently than in the past. Using Web of Science and Scopus, the authors identified all peer-reviewed articles that contained keywords on human impact (e.g. mortality, morbidity) and meteorological component (e.g. heat, heatwave). After sorting, a total of 71 articles, both case studies and epidemiological studies, contained explicit assessments of temporal trends in human vulnerability, and thus were used in this review. Most of the studies utilized mortality data, focused on the developed world, and showed a general decrease in heat sensitivity. Factors such as the implementation of a heat warning system, increased awareness, and improved quality of life were cited as contributing factors that led to the decreased impact of heat. Despite the overall recent decreases in heat vulnerability, spatial variability was shown, and differences with respect to health outcomes were also discussed. Several papers noted increases in heat’s impact on human health, particularly when unprecedented conditions occurred. Further, many populations, from outdoor workers to rural residents, in addition to the populations in much of the developing world, have been significantly underrepresented in research to date, and temporal changes in their vulnerability should be assessed in future studies. Moreover, continued monitoring and improvement of heat intervention is needed; with projected changes in the frequency, duration, and intensity of heat events combined with shifts in demographics, heat will remain a major public health issue moving forward.

  12. Threatened, endangered, and vulnerable species of terrestrial vertebrates in the Rocky Mountain Region

    Treesearch

    Deborah M. Finch

    1991-01-01

    This report describes the current status of 67 threatened, endangered, and vulnerable wildlife species in the Rocky Mountain Region of the U.S. Forest Service. Known or potential reasons for population declines and species susceptibility are identified; and distributions, habitats, specialized needs, and perceived threats of individual species are discusses.

  13. Iodine Status of Vulnerable Populations in Henan Province of China 2013-2014 After the Implementation of the New Iodized Salt Standard.

    PubMed

    Yang, Jin; Zhu, Lin; Li, Xiaofeng; Zheng, Heming; Wang, Zhe; Liu, Yang; Hao, Zongyu

    2016-09-01

    The standard of salt iodine content in China has been adjusted several times since implementation of the universal salt iodization (USI) in 1995. The new standard of iodized salt content was adjusted from 35 ± 15 to 30 ± 9 mg/kg in Henan province in 2012. We aimed to determine whether the vulnerable populations were iodine sufficient after the adjustment of salt iodine content and to provide a guideline for the adjustment of USI policy in China. Two cross-sectional surveys of iodine status in vulnerable populations, including reproductive-age, pregnant and lactating women, infants <2 years, and children aged 8-10 years, were conducted in Henan province in 2013 and 2014. In 2013, the median urinary iodine concentration (mUIC) of reproductive-age women was 200.1 μg/L and that of school children aged 8-10 years was 221.0 μg/L. These mUICs were considered as "more than adequate." The mUICs of reproductive-age women and school children in 2014 showed a significant decline compared to the mUICs in 2013 (P = 0.012 and P = 0.001, respectively). The mUICs of the pregnant women were 204.2 μg/L in 2013 and 202.5 μg/L in 2014, which both met the requirement level recommended by WHO. In 2013, the mUIC of lactating women was 169.1 μg/L and that of infants <2 years was 203.2 μg/L, which were significantly lower than that of 2014 (P < 0.001 and P < 0.001, respectively). The lactating women and infants in 2013 and 2014 were both regarded as "iodine adequate." Iodine status of the vulnerable populations is still adequate as a whole in Henan province after decreasing the salt iodine content. However, the mUIC of school children aged 8-10 years is slightly above the adequate level. To reduce the risk of iodine excess in the general population and prevent the possibility of iodine deficiency of the vulnerable population, it is necessary to explore the appropriate level of iodized salt content.

  14. Is a clean river fun for all? Recognizing social vulnerability in watershed planning.

    PubMed

    Cutts, Bethany B; Greenlee, Andrew J; Prochaska, Natalie K; Chantrill, Carolina V; Contractor, Annie B; Wilhoit, Juliana M; Abts, Nancy; Hornik, Kaitlyn

    2018-01-01

    Watershed planning can lead to policy innovation and action toward environmental protection. However, groups often suffer from low engagement with communities that experience disparate impacts from flooding and water pollution. This can limit the capacity of watershed efforts to dismantle pernicious forms of social inequality. As a result, the benefits of environmental changes often flow to more empowered residents, short-changing the power of watershed-based planning as a tool to transform ecological, economic, and social relationships. The objectives of this paper are to assess whether the worldview of watershed planning actors are sufficiently attuned to local patterns of social vulnerability and whether locally significant patterns of social vulnerability can be adequately differentiated using conventional data sources. Drawing from 35 in-depth interviews with watershed planners and community stakeholders in the Milwaukee River Basin (WI, USA), we identify five unique definitions of social vulnerability. Watershed planners in our sample articulate a narrower range of social vulnerability definitions than other participants. All five definitions emphasize spatial and demographic characteristics consistent with existing ways of measuring social vulnerability. However, existing measures do not adequately differentiate among the spatio-temporal dynamics used to distinguish definitions. In response, we develop two new social vulnerability measures. The combination of interviews and demographic analyses in this study provides an assessment technique that can help watershed planners (a) understand the limits of their own conceptualization of social vulnerability and (b) acknowledge the importance of place-based vulnerabilities that may otherwise be obscured. We conclude by discussing how our methods can be a useful tool for identifying opportunities to disrupt social vulnerability in a watershed by evaluating how issue frames, outreach messages, and engagement tactics

  15. Is a clean river fun for all? Recognizing social vulnerability in watershed planning

    PubMed Central

    Greenlee, Andrew J.; Prochaska, Natalie K.; Chantrill, Carolina V.; Contractor, Annie B.; Wilhoit, Juliana M.; Abts, Nancy; Hornik, Kaitlyn

    2018-01-01

    Watershed planning can lead to policy innovation and action toward environmental protection. However, groups often suffer from low engagement with communities that experience disparate impacts from flooding and water pollution. This can limit the capacity of watershed efforts to dismantle pernicious forms of social inequality. As a result, the benefits of environmental changes often flow to more empowered residents, short-changing the power of watershed-based planning as a tool to transform ecological, economic, and social relationships. The objectives of this paper are to assess whether the worldview of watershed planning actors are sufficiently attuned to local patterns of social vulnerability and whether locally significant patterns of social vulnerability can be adequately differentiated using conventional data sources. Drawing from 35 in-depth interviews with watershed planners and community stakeholders in the Milwaukee River Basin (WI, USA), we identify five unique definitions of social vulnerability. Watershed planners in our sample articulate a narrower range of social vulnerability definitions than other participants. All five definitions emphasize spatial and demographic characteristics consistent with existing ways of measuring social vulnerability. However, existing measures do not adequately differentiate among the spatio-temporal dynamics used to distinguish definitions. In response, we develop two new social vulnerability measures. The combination of interviews and demographic analyses in this study provides an assessment technique that can help watershed planners (a) understand the limits of their own conceptualization of social vulnerability and (b) acknowledge the importance of place-based vulnerabilities that may otherwise be obscured. We conclude by discussing how our methods can be a useful tool for identifying opportunities to disrupt social vulnerability in a watershed by evaluating how issue frames, outreach messages, and engagement tactics

  16. Surveys of environmental DNA (eDNA): a new approach to estimate occurrence in Vulnerable manatee populations

    USGS Publications Warehouse

    Hunter, Margaret; Meigs-Friend, Gaia; Ferrante, Jason; Takoukam Kamla, Aristide; Dorazio, Robert; Keith Diagne, Lucy; Luna, Fabia; Lanyon, Janet M.; Reid, James P.

    2018-01-01

    Environmental DNA (eDNA) detection is a technique used to non-invasively detect cryptic, low density, or logistically difficult-to-study species, such as imperiled manatees. For eDNA measurement, genetic material shed into the environment is concentrated from water samples and analyzed for the presence of target species. Cytochrome bquantitative PCR and droplet digital PCR eDNA assays were developed for the 3 Vulnerable manatee species: African, Amazonian, and both subspecies of the West Indian (Florida and Antillean) manatee. Environmental DNA assays can help to delineate manatee habitat ranges, high use areas, and seasonal population changes. To validate the assay, water was analyzed from Florida’s east coast containing a high-density manatee population and produced 31564 DNA molecules l-1on average and high occurrence (ψ) and detection (p) estimates (ψ = 0.84 [0.40-0.99]; p = 0.99 [0.95-1.00]; limit of detection 3 copies µl-1). Similar occupancy estimates were produced in the Florida Panhandle (ψ = 0.79 [0.54-0.97]) and Cuba (ψ = 0.89 [0.54-1.00]), while occupancy estimates in Cameroon were lower (ψ = 0.49 [0.09-0.95]). The eDNA-derived detection estimates were higher than those generated using aerial survey data on the west coast of Florida and may be effective for population monitoring. Subsequent eDNA studies could be particularly useful in locations where manatees are (1) difficult to identify visually (e.g. the Amazon River and Africa), (2) are present in patchy distributions or are on the verge of extinction (e.g. Jamaica, Haiti), and (3) where repatriation efforts are proposed (e.g. Brazil, Guadeloupe). Extension of these eDNA techniques could be applied to other imperiled marine mammal populations such as African and Asian dugongs.

  17. Targetable vulnerabilities in T- and NK-cell lymphomas identified through preclinical models. | Office of Cancer Genomics

    Cancer.gov

    T- and NK-cell lymphomas (TCL) are a heterogenous group of lymphoid malignancies with poor prognosis. In contrast to B-cell and myeloid malignancies, there are few preclinical models of TCLs, which has hampered the development of effective therapeutics. Here we establish and characterize preclinical models of TCL. We identify multiple vulnerabilities that are targetable with currently available agents (e.g., inhibitors of JAK2 or IKZF1) and demonstrate proof-of-principle for biomarker-driven therapies using patient-derived xenografts (PDXs).

  18. Identifying Multiple Populations in M71 using CN

    NASA Astrophysics Data System (ADS)

    Gerber, Jeffrey M.; Friel, Eileen D.; Vesperini, Enrico

    2018-01-01

    It is now well established that globular clusters (GCs) host multiple stellar populations characterized by differences in several light elements. While these populations have been found in nearly all GCs, we still lack an entirely successful model to explain their formation. A key constraint to these models is the detailed pattern of light element abundances seen among the populations; different techniques for identifying these populations probe different elements and do not always yield the same results. We study a large sample of stars in the GC M71 for light elements C and N, using the CN and CH band strength to identify multiple populations. Our measurements come from low-resolution spectroscopy obtained with the WIYN-3.5m telescope for ~150 stars from the tip of the red-giant branch down to the main-sequence turn-off. The large number of stars and broad spatial coverage of our sample (out to ~3.5 half-light radii) allows us to carry out a comprehensive characterization of the multiple populations in M71. We use a combination of the various spectroscopic and photometric indicators to draw a more complete picture of the properties of the populations and to investigate the consistency of classifications using different techniques.

  19. Food web structure and interaction strength pave the way for vulnerability to extinction.

    PubMed

    Karlsson, Patrik; Jonsson, Tomas; Jonsson, Annie

    2007-11-07

    This paper focuses on how food web structure and interactions among species affects the vulnerability, due to environmental variability, to extinction of species at different positions in model food webs. Vulnerability is here not measured by a traditional extinction threshold but is instead inspired by the IUCN criteria for endangered species: an observed rapid decline in population abundance. Using model webs influenced by stochasticity with zero autocorrelation, we investigate the ecological determinants of species vulnerability, i.e. the trophic interactions between species and food web structure and how these interact with the risk of sudden drops in abundance of species. We find that (i) producers fulfil the criterion of vulnerable species more frequently than other species, (ii) food web structure is related to vulnerability, and (iii) the vulnerability of species is greater when involved in a strong trophic interaction than when not. We note that our result on the relationship between extinction risk and trophic position of species contradict previous suggestions and argue that the main reason for the discrepancy probably is due to the fact that we study the vulnerability to environmental stochasticity and not extinction risk due to overexploitation, habitat destruction or interactions with introduced species. Thus, we suggest that the vulnerability of species to environmental stochasticity may be differently related to trophic position than the vulnerability of species to other factors. Earlier research on species extinctions has looked for intrinsic traits of species that correlate with increased vulnerability to extinction. However, to fully understand the extinction process we must also consider that species interactions may affect vulnerability and that not all extinctions are the result of long, gradual reductions in species abundances. Under environmental stochasticity (which importance frequently is assumed to increase as a result of climate change

  20. Fluctuations in wasting in vulnerable child populations in the Greater Horn of Africa.

    PubMed

    Chotard, Sophie; Mason, John B; Oliphant, Nicholas P; Mebrahtu, Saba; Hailey, Peter

    2010-09-01

    Malnutrition in preschool children, usually measured as wasting, is widely used to assess possible needs for emergency humanitarian interventions in areas vulnerable to drought, displacement, and related causes of food insecurity. The extent of fluctuations in wasting by season, year-to-year, and differential effects by livelihood group, need to be better established as a basis for interpretation together with ways of presenting large numbers of survey results to facilitate interpretation. To estimate levels of and fluctuations in wasting prevalences in children from surveys conducted in arid and semiarid areas of the Greater Horn of Africa according to livelihood (pastoral, agricultural, mixed, migrant), season or month, and year from 2000 to 2006. Results from around 900 area-level nutrition surveys (typical sample size, about 900 children) were compiled and analyzed. These surveys were carried out largely by nongovernmental organizations, coordinated by UNICEF, in vulnerable areas of Eritrea, Ethiopia, Kenya, Somalia, Southern Sudan, and Uganda. Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data were used for comparison. Data were taken from measurements of children 0 to 5 years of age (or less than 110 cm in height). Among pastoral child populations, the average prevalence of wasting (< -2 SD weight-for-height) was about 17%, 6-7 percentage points higher than the rates among agricultural populations or populations with mixed livelihoods. Fluctuations in wasting were greater among pastoralists during years of drought, with prevalences rising to 25% or higher; prevalences among agricultural populations seldom exceeded 15%. This difference may be related to very different growth patterns (assessed from DHS and UNICEF/MICS surveys), whereby pastoral children typically grow up thinner but taller than children of agriculturalists. Wasting peaks are seen in the first half of the year, usually during the dry or hunger season. In

  1. Identifying environmental health priorities in underserved populations: a study of rural versus urban communities

    PubMed Central

    Bernhard, M.C.; Evans, M.B.; Kent, S.T.; Johnson, E.; Threadgill, S.L.; Tyson, S.; Becker, S.M.; Gohlke, J.M.

    2013-01-01

    Objectives Understanding and effectively addressing persistent health disparities in minority communities requires a clear picture of members’ concerns and priorities. This study was intended to engage residents in urban and rural communities in order to identify environmental health priorities. Specific emphasis was placed on how the communities defined the term environment, their perceptions of environmental exposures as affecting their health, specific priorities in their communities, and differences in urban versus rural populations. Study design A community-engaged approach was used to develop and implement focus groups and compare environmental health priorities in urban versus rural communities. Methods A total of eight focus groups were conducted: four in rural and four in urban communities. Topics included defining the term environment, how the environment may affect health, and environmental priorities within their communities, using both open discussion and a predefined list. Data were analysed both qualitatively and quantitatively to identify patterns and trends. Results There were important areas of overlap in priorities between urban and rural communities; both emphasized the importance of the social environment and shared a concern over air pollution from industrial sources. In contrast, for urban focus groups, abandoned houses and their social and physical sequelae were a high priority while concerns about adequate sewer and water services and road maintenance were high priorities in rural communities. Conclusions This study was able to identify environmental health priorities in urban versus rural minority communities. In contrast to some previous risk perception research, the results of this study suggest prioritization of tangible, known risks in everyday life instead of rare, disaster-related events, even in communities that have recently experienced devastating damage from tornadoes. The findings can help inform future efforts to study

  2. [Vulnerability to depression in children and adolescents: update and perspectives].

    PubMed

    Purper-Ouakil, D; Michel, G; Mouren-Siméoni, M-C

    2002-01-01

    Depression in children and adolescents is associated with poor psychosocial functioning, high psychiatric comorbidity, risk of recurrent episodes or onset of bipolar disorder. These findings emphasize the importance of early identification of children and adolescents having elevated risk for future depression and further development, evaluation and greater availability of prevention strategies. Our review aims an update about depressive vulnerability in children and adolescents in the perspective of better identification of at-risk populations and targeting of prevention programs. Psychopathology, in particular anxiety and disruptive disorders are well identified risk-factors for later depression. Subclinical depressive symptomatology, also termed "demoralization", also identifies high-risk populations, likely to become incident cases of depression. It is still unclear whether this condition is prodromal depression, a specific clinical entity or the expression of biological and/or cognitive vulnerability. Familial risk for depressive disorders involves both genetic and psychosocial factors. Marital discord, poor communication and dysfunctional parenting practices are often present in families with affective disorders and can be implicated in increased depressive vulnerability in the offspring. Research on individual vulnerability in children and adolescents has focused on temperamental and cognitive characteristics. Temperament traits describe individual differences in reactivity and behavior. High emotionality, defined as the tendency to become upset easily and intensely has been associated with an increased risk for subsequent major depression. However, as the majority of high scorers will not become depressive cases, emotionality should not be the only criterion for selection of at-risk populations. Cognitive style including poor self esteem, low social competence and negative attributions are also associated with increased likelihood of depressive symptoms, but

  3. Resilience in Vulnerable Populations With Type 2 Diabetes Mellitus and Hypertension: A Systematic Review and Meta-analysis.

    PubMed

    Pesantes, M Amalia; Lazo-Porras, María; Abu Dabrh, Abd Moain; Ávila-Ramírez, Jaime R; Caycho, María; Villamonte, Georgina Y; Sánchez-Pérez, Grecia P; Málaga, Germán; Bernabé-Ortiz, Antonio; Miranda, J Jaime

    2015-09-01

    Patients with chronic conditions and limited access to health care experience stressful challenges resulting from the burden of managing both their conditions and their daily life demands. Resilience provides a mechanism of adapting to stressful experiences. We conducted a systematic review and meta-analysis to synthesize the evidence about interventions to enhance resiliency in managing hypertension or type 2 diabetes in vulnerable populations and to assess the efficacy of these interventions on clinical outcomes. We searched multiple databases from early inception through February 2015 including randomized controlled trials that enrolled patients with type 2 diabetes or hypertension. All interventions that targeted resilience in vulnerable populations were included. Data were synthesized to describe the characteristics and efficacy of resiliency interventions. We pooled the total effects by calculating standardized mean difference using the random-effects model. The final search yielded 17 studies. All studies were conducted in the United States and generally targeted minority participants. Resiliency interventions used diverse strategies; discussion groups or workshops were the most common approach. Interventions aimed at enhancing the resiliency of patients from vulnerable groups are diverse. Outcomes were not fully conclusive. There was some evidence that resiliency interventions had a positive effect on hemoglobin A1C levels but not blood pressure. The incorporation of resiliency-oriented interventions into the arsenal of preventing and managing chronic conditions appears to be an opportunity that remains to be better investigated and exploited, and there is need to pursue further understanding of the core components of any intervention that claims to enhance resilience. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  4. Do clinical standards for diabetes care address excess risk for hypoglycemia in vulnerable patients? A systematic review.

    PubMed

    Berkowitz, Seth A; Aragon, Katherine; Hines, Jonas; Seligman, Hilary; Lee, Sei; Sarkar, Urmimala

    2013-08-01

    To determine whether diabetes clinical standards consider increased hypoglycemia risk in vulnerable patients. MEDLINE, the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, and supplemental sources. Systematic review of clinical standards (guidelines, quality metrics, or pay-for-performance programs) for glycemic control in adult diabetes patients. The primary outcome was discussion of increased risk for hypoglycemia in vulnerable populations. Manuscripts identified were abstracted by two independent reviewers using prespecified inclusion/exclusion criteria and a standardized abstraction form. We screened 1,166 titles, and reviewed 220 manuscripts in full text. Forty-four guidelines, 17 quality metrics, and 8 pay-for-performance programs were included. Five (11 percent) guidelines and no quality metrics or pay-for-performance programs met the primary outcome. Clinical standards do not substantively incorporate evidence about increased risk for hypoglycemia in vulnerable populations. © Health Research and Educational Trust.

  5. Not the usual suspects: addressing layers of vulnerability.

    PubMed

    Luna, Florencia; Vanderpoel, Sheryl

    2013-07-01

    This paper challenges the traditional account of vulnerability in healthcare which conceptualizes vulnerability as a list of identifiable subpopulations. This list of 'usual suspects', focusing on groups from lower resource settings, is a narrow account of vulnerability. In this article we argue that in certain circumstances middle-class individuals can be also rendered vulnerable. We propose a relational and layered account of vulnerability and explore this concept using the case study of cord blood (CB) banking. In the first section, two different approaches to 'vulnerability' are contrasted: categorical versus layered. In the second section, we describe CB banking and present a case study of CB banking in Argentina. We examine the types of pressure that middle-class pregnant women feel when considering CB collection and storage. In section three, we use the CB banking case study to critique the categorical approach to vulnerability: this model is unable to account for the ways in which these women are vulnerable. A layered account of vulnerability identifies several ways in which middle-class women are vulnerable. Finally, by utilizing the layered approach, this paper suggests how public health policies could be designed to overcome vulnerabilities. © 2013 John Wiley & Sons Ltd.

  6. Obesity and diabetes in vulnerable populations: reflection on proximal and distal causes.

    PubMed

    Candib, Lucy M

    2007-01-01

    Around the world obesity and diabetes are climbing to epidemic proportion, even in countries previously characterized by scarcity. Likewise, people from low-income and minority communities, as well as immigrants from the developing world, increasingly visit physicians in North America with obesity, metabolic syndrome, or diabetes. Explanations limited to lifestyle factors such as diet and exercise are inadequate to explain the universality of what can be called a syndemic, a complex and widespread phenomenon in population health produced by multiple reinforcing conditions. Underlying the problem are complex factors-genetic, physiological, psychological, familial, social, economic, and political-coalescing to overdetermine these conditions. These interacting factors include events occurring during fetal life, maternal physiology and life context, the thrifty genotype, the nutritional transition, health impact of urbanization and immigration, social attributions and cultural perceptions of increased weight, and changes in food costs and availability resulting from globalization. Better appreciation of the complexity of causation underlying the worldwide epidemic of obesity and diabetes can refocus the work of clinicians and researchers to work at multiple levels to address prevention and treatment for these conditions among vulnerable populations.

  7. Fluctuation between grandiose and vulnerable narcissism.

    PubMed

    Gore, Whitney L; Widiger, Thomas A

    2016-10-01

    Current literature on narcissistic personality disorder has emphasized a distinction between grandiose and vulnerable narcissism. Some researchers have further suggested that narcissistic persons fluctuate between grandiose and vulnerable narcissism. However, this perception has been confined largely to clinical experience with no systematic research testing the hypothesis. Clinicians and clinical psychology professors in the current study identified 143 persons who fit a description of either a grandiose or a vulnerable narcissist and indicated the extent to which these persons ever demonstrated traits of the complementary variant. The results supported the fluctuation hypothesis, particularly for episodes of vulnerable narcissism in persons identified as a grandiose narcissist. Correlations of the grandiose and vulnerable narcissism traits with a brief five-factor model measure corroborated past trait descriptions of the 2 respective variants of narcissism. The results of the current study are compared with existing cross-sectional and longitudinal research, and suggestions for future research are provided. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  8. Climates Past, Present, and Yet-to-Come Shape Climate Change Vulnerabilities.

    PubMed

    Nadeau, Christopher P; Urban, Mark C; Bridle, Jon R

    2017-10-01

    Climate change is altering life at multiple scales, from genes to ecosystems. Predicting the vulnerability of populations to climate change is crucial to mitigate negative impacts. We suggest that regional patterns of spatial and temporal climatic variation scaled to the traits of an organism can predict where and why populations are most vulnerable to climate change. Specifically, historical climatic variation affects the sensitivity and response capacity of populations to climate change by shaping traits and the genetic variation in those traits. Present and future climatic variation can affect both climate change exposure and population responses. We provide seven predictions for how climatic variation might affect the vulnerability of populations to climate change and suggest key directions for future research. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. A cross-sectional, randomized cluster sample survey of household vulnerability to extreme heat among slum dwellers in ahmedabad, india.

    PubMed

    Tran, Kathy V; Azhar, Gulrez S; Nair, Rajesh; Knowlton, Kim; Jaiswal, Anjali; Sheffield, Perry; Mavalankar, Dileep; Hess, Jeremy

    2013-06-18

    Extreme heat is a significant public health concern in India; extreme heat hazards are projected to increase in frequency and severity with climate change. Few of the factors driving population heat vulnerability are documented, though poverty is a presumed risk factor. To facilitate public health preparedness, an assessment of factors affecting vulnerability among slum dwellers was conducted in summer 2011 in Ahmedabad, Gujarat, India. Indicators of heat exposure, susceptibility to heat illness, and adaptive capacity, all of which feed into heat vulnerability, was assessed through a cross-sectional household survey using randomized multistage cluster sampling. Associations between heat-related morbidity and vulnerability factors were identified using multivariate logistic regression with generalized estimating equations to account for clustering effects. Age, preexisting medical conditions, work location, and access to health information and resources were associated with self-reported heat illness. Several of these variables were unique to this study. As sociodemographics, occupational heat exposure, and access to resources were shown to increase vulnerability, future interventions (e.g., health education) might target specific populations among Ahmedabad urban slum dwellers to reduce vulnerability to extreme heat. Surveillance and evaluations of future interventions may also be worthwhile.

  10. An Extreme-Value Approach to Anomaly Vulnerability Identification

    NASA Technical Reports Server (NTRS)

    Everett, Chris; Maggio, Gaspare; Groen, Frank

    2010-01-01

    The objective of this paper is to present a method for importance analysis in parametric probabilistic modeling where the result of interest is the identification of potential engineering vulnerabilities associated with postulated anomalies in system behavior. In the context of Accident Precursor Analysis (APA), under which this method has been developed, these vulnerabilities, designated as anomaly vulnerabilities, are conditions that produce high risk in the presence of anomalous system behavior. The method defines a parameter-specific Parameter Vulnerability Importance measure (PVI), which identifies anomaly risk-model parameter values that indicate the potential presence of anomaly vulnerabilities, and allows them to be prioritized for further investigation. This entails analyzing each uncertain risk-model parameter over its credible range of values to determine where it produces the maximum risk. A parameter that produces high system risk for a particular range of values suggests that the system is vulnerable to the modeled anomalous conditions, if indeed the true parameter value lies in that range. Thus, PVI analysis provides a means of identifying and prioritizing anomaly-related engineering issues that at the very least warrant improved understanding to reduce uncertainty, such that true vulnerabilities may be identified and proper corrective actions taken.

  11. Mental vulnerability, Helicobacter pylori, and incidence of hospital-diagnosed peptic ulcer over 28 years in a population-based cohort.

    PubMed

    Levenstein, Susan; Jacobsen, Rikke Kart; Rosenstock, Steffen; Jørgensen, Torben

    2017-09-01

    To examine whether mental vulnerability, an enduring personality characteristic, predicts incident hospital-diagnosed ulcer over three decades. A population-based cohort study enrolled 3365 subjects with no ulcer history, ages 30-60, in 1982-3. Mental vulnerability, Helicobacter pylori IgG antibodies, socioeconomic status, and sleep duration were determined at baseline; non-steroidal antiinflammatory drug use, smoking, leisure time physical activity, and alcohol consumption both at baseline and in 1993-4. Hospital diagnoses of incident ulcer through 2011 were detected using the Danish National Patient Registry. Ulcers were diagnosed in 166 subjects, including 83 complicated by bleeding or perforation. Age-, gender-, and socioeconomic status-adjusted associations were significant for mental vulnerability (Hazard Ratio (HR) 2.0, 95% Confidence Interval 1.4-2.8), Helicobacter pylori (HR 1.7, CI 1.2-2.3), smoking (HR 2.0, CI 1.3-3.1), heavy drinking (HR 1.6, CI 1.1-2.4), abstinence (HR 1.6, CI 1.1-2.5), non-steroidal antiinflammatory drugs (HR 2.1, CI 1.5-3.0), and sedentary lifestyle (HR 1.9, CI 1.4-2.7). Adjusted for all behavioral mediators, the HR for mental vulnerability was 1.5 (CI 1.0-2.2, p = .04). Mental vulnerability raised risk in Helicobacter pylori seropositive subjects and those exposed to neither Helicobacter pylori nor non-steroidal antiinflammatory drugs; its impact was virtually unchanged when analysis was limited to complicated ulcers. A vulnerable personality raises risk for hospital-diagnosed peptic ulcer, in part because of an association with health risk behaviors. Its impact is seen in 'idiopathic' and Helicobacter pylori-associated ulcers, and in acute surgical cases.

  12. Mapping socio-environmentally vulnerable populations access and exposure to ecosystem services at the U.S.-Mexico borderlands

    USGS Publications Warehouse

    Norman, Laura M.; Villarreal, Miguel L.; Lara-Valencia, Francisco; Yuan, Yongping; Nie, Wenming; Wilson, Sylvia; Amaya, Gladys; Sleeter, Rachel

    2012-01-01

    Socio-environmental vulnerable populations are often unrepresented in land-use planning yet have great potential for loss when exposed to changes in ecosystem services. Administrative boundaries, cultural differences, and language barriers increase the disassociation between land-use management and marginalized populations living in the U.S.–Mexico borderlands. This paper describes the development of a Modified Socio-Environmental Vulnerability Index (M-SEVI), using determinants from binational census and neighborhood data that describe levels of education, access to resources, migratory status, housing, and number of dependents, to provide a simplified snapshot of the region's populace that can be used in binational planning efforts. We apply this index at the SCW, located on the border between Arizona, USA and Sonora, Mexico. For comparison, the Soil and Water Assessment Tool is concurrently applied to assess the provision of erosion- and flood control services over a 9-year period. We describe how this coupling of data can form the base for an ecosystem services assessment across political boundaries that can be used by land-use planners. Results reveal potential disparities in environmental risks and burdens throughout the binational watershed in residential districts surrounding and between urban centers. The M-SEVI can be used as an important first step in addressing environmental justice for binational decision-making.

  13. (Non-) robustness of vulnerability assessments to climate change: An application to New Zealand.

    PubMed

    Fernandez, Mario Andres; Bucaram, Santiago; Renteria, Willington

    2017-12-01

    Assessments of vulnerability to climate change are a key element to inform climate policy and research. Assessments based on the aggregation of indicators have a strong appeal for their simplicity but are at risk of over-simplification and uncertainty. This paper explores the non-robustness of indicators-based assessments to changes in assumptions on the degree of substitution or compensation between indicators. Our case study is a nationwide assessment for New Zealand. We found that the ranking of geographic areas is sensitive to different parameterisations of the aggregation function, that is, areas that are categorised as highly vulnerable may switch to the least vulnerable category even with respect to the same climate hazards and population groups. Policy implications from the assessments are then compromised. Though indicators-based approaches may help on identifying drivers of vulnerability, there are weak grounds to use them to recommend mitigation or adaptation decisions given the high level of uncertainty because of non-robustness. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Validation of a social vulnerability index in context to river-floods in Germany

    NASA Astrophysics Data System (ADS)

    Fekete, A.

    2009-03-01

    Social vulnerability indices are a means for generating information about people potentially affected by disasters that are e.g. triggered by river-floods. The purpose behind such an index is in this study the development and the validation of a social vulnerability map of population characteristics towards river-floods covering all counties in Germany. This map is based on a composite index of three main indicators for social vulnerability in Germany - fragility, socio-economic conditions and region. These indicators have been identified by a factor analysis of selected demographic variables obtained from federal statistical offices. Therefore, these indicators can be updated annually based on a reliable data source. The vulnerability patterns detected by the factor analysis are verified by using an independent second data set. The interpretation of the second data set shows that vulnerability is revealed by a real extreme flood event and demonstrates that the patterns of the presumed vulnerability match the observations of a real event. It comprises a survey of flood-affected households in three federal states. By using logistic regression, it is demonstrated that the theoretically presumed indications of vulnerability are correct and that the indicators are valid. It is shown that indeed certain social groups like the elderly, the financially weak or the urban residents are higher risk groups.

  15. Migration in the context of vulnerability and adaptation to climate change: insights from analogues

    PubMed Central

    McLeman, Robert A.; Hunter, Lori M.

    2011-01-01

    Migration is one of the variety of ways by which human populations adapt to environmental changes. The study of migration in the context of anthropogenic climate change is often approached using the concept of vulnerability and its key functional elements: exposure, system sensitivity, and adaptive capacity. This article explores the interaction of climate change and vulnerability through review of case studies of dry-season migration in the West African Sahel, hurricane-related population displacements in the Caribbean basin, winter migration of ‘snowbirds’ to the US Sun-belt, and 1930s drought migration on the North American Great Plains. These examples are then used as analogues for identifying general causal, temporal, and spatial dimensions of climate migration, along with potential considerations for policy-making and future research needs. PMID:22022342

  16. Social vulnerability and climate variability in southern Brazil: a TerraPop case study

    NASA Astrophysics Data System (ADS)

    Adamo, S. B.; Fitch, C. A.; Kugler, T.; Doxsey-Whitfield, E.

    2014-12-01

    Climate variability is an inherent characteristic of the Earth's climate, including but not limited to climate change. It affects and impacts human society in different ways, depending on the underlying socioeconomic vulnerability of specific places, social groups, households and individuals. This differential vulnerability presents spatial and temporal variations, and is rooted in historical patterns of development and relations between human and ecological systems. This study aims to assess the impact of climate variability on livelihoods and well-being, as well as their changes over time and across space, and for rural and urban populations. The geographic focus is Southern Brazil-the states of Parana, Santa Catarina and Rio Grande do Sul-- and the objectives include (a) to identify and map critical areas or hotspots of exposure to climate variability (temperature and precipitation), and (b) to identify internal variation or differential vulnerability within these areas and its evolution over time (1980-2010), using newly available integrated data from the Terra Populus project. These data include geo-referenced climate and agricultural data, and data describing demographic and socioeconomic characteristics of individuals, households and places.

  17. Do Clinical Standards for Diabetes Care Address Excess Risk for Hypoglycemia in Vulnerable Patients? A Systematic Review

    PubMed Central

    Berkowitz, Seth A; Aragon, Katherine; Hines, Jonas; Seligman, Hilary; Lee, Sei; Sarkar, Urmimala

    2013-01-01

    Objective To determine whether diabetes clinical standards consider increased hypoglycemia risk in vulnerable patients. Data Sources MEDLINE, the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, and supplemental sources. Study Design Systematic review of clinical standards (guidelines, quality metrics, or pay-for-performance programs) for glycemic control in adult diabetes patients. The primary outcome was discussion of increased risk for hypoglycemia in vulnerable populations. Data Collection/Extraction Methods Manuscripts identified were abstracted by two independent reviewers using prespecified inclusion/exclusion criteria and a standardized abstraction form. Principal Findings We screened 1,166 titles, and reviewed 220 manuscripts in full text. Forty-four guidelines, 17 quality metrics, and 8 pay-for-performance programs were included. Five (11 percent) guidelines and no quality metrics or pay-for-performance programs met the primary outcome. Conclusions Clinical standards do not substantively incorporate evidence about increased risk for hypoglycemia in vulnerable populations. PMID:23445498

  18. Identifying regions vulnerable to habitat degradation under future irrigation scenarios

    NASA Astrophysics Data System (ADS)

    Terrado, Marta; Sabater, Sergi; Acuña, Vicenç

    2016-11-01

    The loss and degradation of natural habitats is a primary cause of biodiversity decline. The increasing impacts of climate and land use change affect water availability, ultimately decreasing agricultural production. Areas devoted to irrigation have been increased to compensate this reduction, causing habitat and biodiversity losses, especially in regions undergoing severe water stress. These effects might intensify under global change, probably contributing to a decrease in habitat quality. We selected four European river basins across a gradient of water scarcity and irrigation agriculture. The habitat quality in the basins was assessed as a function of habitat suitability and threats under current and future global change scenarios of irrigation. Results revealed that the most threatened regions under future scenarios of global change were among those suffering of water scarcity and with bigger areas devoted to irrigation. Loss of habitat quality reached 10% in terrestrial and 25% in aquatic ecosystems under climate change scenarios involving drier conditions. The aquatic habitats were the most degraded in all scenarios, since they were affected by threats from both the terrestrial and the aquatic parts of the basin. By identifying in advance the regions most vulnerable to habitat and biodiversity loss, our approach can assist decision makers in deciding the conservation actions to be prioritized for mitigation and adaptation to the effects of climate change, particularly front the development of irrigation plans.

  19. Hydroclimatic drivers, Water-borne Diseases, and Population Vulnerability in Bengal Delta

    NASA Astrophysics Data System (ADS)

    Akanda, A. S.; Jutla, A. S.

    2012-04-01

    Water-borne diarrheal disease outbreaks in the Bengal Delta region, such as cholera, rotavirus, and dysentery, show distinct seasonal peaks and spatial signatures in their origin and progression. However, the mechanisms behind these seasonal phenomena, especially the role of regional climatic and hydrologic processes behind the disease outbreaks, are not fully understood. Overall diarrheal disease prevalence and the population vulnerability to transmission mechanisms thus remain severely underestimated. Recent findings suggest that diarrheal incidence in the spring is strongly associated with scarcity of freshwater flow volumes, while the abundance of water in monsoon show strong positive correlation with autumn diarrheal burden. The role of large-scale ocean-atmospheric processes that tend to modulate meteorological, hydrological, and environmental conditions over large regions and the effects on the ecological states conducive to the vectors and triggers of diarrheal outbreaks over large geographic regions are not well understood. We take a large scale approach to conduct detailed diagnostic analyses of a range of climate, hydrological, and ecosystem variables to investigate their links to outbreaks, occurrence, and transmission of the most prevalent water-borne diarrheal diseases. We employ satellite remote sensing data products to track coastal ecosystems and plankton processes related to cholera outbreaks. In addition, we investigate the effect of large scale hydroclimatic extremes (e.g., droughts and floods, El Nino) to identify how diarrheal transmission and epidemic outbreaks are most likely to respond to shifts in climatic, hydrologic, and ecological changes over coming decades. We argue that controlling diarrheal disease burden will require an integrated predictive surveillance approach - a combination of prediction and prevention - with recent advances in climate-based predictive capabilities and demonstrated successes in primary and tertiary prevention

  20. Construction of an integrated social vulnerability index in urban areas prone to flash flooding

    NASA Astrophysics Data System (ADS)

    Aroca-Jimenez, Estefania; Bodoque, Jose Maria; Garcia, Juan Antonio; Diez-Herrero, Andres

    2017-09-01

    Among the natural hazards, flash flooding is the leading cause of weather-related deaths. Flood risk management (FRM) in this context requires a comprehensive assessment of the social risk component. In this regard, integrated social vulnerability (ISV) can incorporate spatial distribution and contribution and the combined effect of exposure, sensitivity and resilience to total vulnerability, although these components are often disregarded. ISV is defined by the demographic and socio-economic characteristics that condition a population's capacity to cope with, resist and recover from risk and can be expressed as the integrated social vulnerability index (ISVI). This study describes a methodological approach towards constructing the ISVI in urban areas prone to flash flooding in Castilla y León (Castile and León, northern central Spain, 94 223 km2, 2 478 376 inhabitants). A hierarchical segmentation analysis (HSA) was performed prior to the principal components analysis (PCA), which helped to overcome the sample size limitation inherent in PCA. ISVI was obtained from weighting vulnerability factors based on the tolerance statistic. In addition, latent class cluster analysis (LCCA) was carried out to identify spatial patterns of vulnerability within the study area. Our results show that the ISVI has high spatial variability. Moreover, the source of vulnerability in each urban area cluster can be identified from LCCA. These findings make it possible to design tailor-made strategies for FRM, thereby increasing the efficiency of plans and policies and helping to reduce the cost of mitigation measures.

  1. How to communicate climate change 'impact and solutions' to vulnerable population of Indian Sundarbans? From theory to practice.

    PubMed

    Chowdhury, Abhiroop; Maiti, Subodh Kumar; Bhattacharyya, Santanu

    2016-01-01

    Global consciousness on climate change problems and adaptation revolves around the disparity of information sharing and communication gap between theoretical scientific knowledge at academic end and practical implications of these at the vulnerable populations' end. Coastal communities facing socio-economic stress, like densely populated Sundarbans, are the most affected part of the world, exposed to climate change problems and uncertainties. This article explores the successes of a socio-environmental project implemented at Indian Sundarbans targeted towards economic improvement and aims at communicating environmental conservation through organized community participation. Participatory rural appraisal (PRA) and the wealth rank tool (WRT) were used to form a "group based organization" with 2100 vulnerable families to give them knowledge about capacity building, disaster management, resource conservation and sustainable agriculture practices. Training was conducted with the selected group members on resource conservation, institution building, alternative income generation activities (AIGA) like, Poultry, Small business, Tricycle van, Organic farming and disaster management in a participatory mode. The climate change 'problems-solutions' were communicated to this socio-economically marginalized and ostracized community through participatory educational theater (PET). WRT revealed that 45 % of the population was under economic stress. Out of 2100 beneficiaries', 1015 beneficiaries' started organic farming, 133 beneficiaries' adopted poultry instead of resource exploitive livelihood and 71 beneficiaries' engaged themselves with small business, which was the success stories of this project. To mitigate disaster, 10-committees were formed and the endemic knowledge about climate change was recorded by participatory method validated through survey by structured questionnaire. As a part of this project 87 ha of naked deforested mudflat was reclaimed with endangered

  2. Identifying vulnerable Asian Americans under Health Care Reform: working in small businesses and health care coverage.

    PubMed

    Cook, Won Kim; Tseng, Winston; Ko Chin, Kathy; John, Iyanrick; Chung, Corina

    2014-11-01

    Working in small businesses has been identified as a key factor for low coverage rates in immigrant communities. In this study, we identify specific cultural and socioeconomic predictors of Asian Americans who work in small businesses to identify subgroups at a greater disadvantage than others in obtaining health insurance. Logistic regression models were fitted using a sample of 3,819 Asian American small business owners and employers extracted from pooled 2005–2012 California Health Interview Survey data. We found that individuals with low income levels, Korean Americans, U.S.-born South Asian and Southeast Asian (other than Vietnamese) Americans, immigrants without citizenship (particularly those lacking a green card), and individuals with limited English proficiency had higher odds of lacking coverage. The odds of being uninsured did not differ between small business owners and employees. Based upon these key findings, we propose several strategies to expand coverage for Asian Americans working in small businesses and their most vulnerable subgroups.

  3. [Late diagnosis and vulnerabilities of the elderly living with HIV/AIDS].

    PubMed

    Alencar, Rúbia Aguiar; Ciosak, Suely Itsuko

    2015-04-01

    To identify vulnerabilities of elderly people with HIV/AIDS and the trajectory that they follow until reaching the diagnosis of the disease. Qualitative research conducted in specialized clinics in the state of São Paulo, from January to June 2011. Semi-structured interviews were conducted with 11 elderly people who were found to be infected with the virus at the age of 60 years or older. The interviews were analyzed using content analysis. In this process four categories emerged, then analyzed with reference to the theoretical framework of vulnerability. Late diagnosis of HIV infection or AIDS among the elderly happens in the secondary or tertiary service. Issues related to sexual life of the elderly are only questioned by health professionals after the diagnosis, also the time that condom use becomes absolute. It is believed that the investigation of the vulnerability of the elderly to HIV/AIDS allows for carrying out appropriate interventions for this population.

  4. A Spatiotemporal Analysis of Extreme Heat Vulnerability Across the United States using Geospatial Techniques

    NASA Astrophysics Data System (ADS)

    Schoessow, F. S.; Li, Y.; Howe, P. D.

    2016-12-01

    Extreme heat events are the deadliest natural hazard in the United States and are expected to increase in both severity and frequency in the coming years due to the effects of climate change. The risks of climate change and weather-related events such as heat waves to a population can be more comprehensively assessed by coupling the traditional examination of natural hazards using remote sensing and geospatial analysis techniques with human vulnerability factors and individual perceptions of hazards. By analyzing remote-sensed and empirical survey data alongside national hazards advisories, this study endeavors to establish a nationally-representative baseline quantifying the spatiotemporal variation of individual heat vulnerabilities at multiple scales and between disparate population groups affected by their unique socioenvironmental factors. This is of immediate academic interest because the study of heat waves risk perceptions remains relatively unexplored - despite the intensification of extreme heat events. The use of "human sensors", georeferenced & timestamped individual response data, provides invaluable contextualized data at a high spatial resolution, which will enable policy-makers to more effectively implement targeted strategies for risk prevention, mitigation, and communication. As climate change risks are further defined, this cognizance will help identify vulnerable populations and enhance national hazard preparedness and recovery frameworks.

  5. An indoor air quality assessment for vulnerable populations exposed to volcanic vog from Kilauea Volcano.

    PubMed

    Longo, Bernadette M; Yang, Wei; Green, Joshua B; Longo, Anthony A; Harris, Merylin; Bibilone, Renwick

    2010-01-01

    The Ka'u District of Hawaii is exposed to sulfurous air pollution called vog from the ongoing eruption of Kilauea Volcano. Increased volcanic activity in 2008 prompted an indoor air quality assessment of the district's hospital and schools. All indoor sulfur dioxide concentrations were above the World Health Organization's average 24-hour recommendation. Indoor penetration ratios were up to 94% of ambient levels and dependent upon building construction or the use of air-conditioning. Health-promotion efforts for vulnerable populations at the hospital and schools are under way to improve indoor air quality and respond to those affected by vog exposure.

  6. Access to HIV community services by vulnerable populations: evidence from an enhanced HIV/AIDS surveillance system.

    PubMed

    Madden, H C E; Phillips-Howard, P A; Hargreaves, S C; Downing, J; Bellis, M A; Vivancos, R; Morley, C; Syed, Q; Cook, P A

    2011-05-01

    HIV disproportionately affects vulnerable populations such as black and minority ethnic groups, men who have sex with men (MSM) and migrants, in many countries including those in the UK. Community organisations in the UK are charitable non-governmental organisations with a proportion of the workforce who volunteer, and provide invaluable additional support for people living with HIV (PLWHIV). Information on their contribution to HIV care in vulnerable groups is relatively sparse. Data generated from an enhanced HIV surveillance system in North West England, UK, was utilised for this study. We aimed to determine the characteristics of individuals who chose to access community services in addition to clinical services (1375 out of 4195 records of PLWHIV in clinical services). Demographic information, risk factors including residency status, uniquely gathered in this region, and deprivation scores were examined. Multivariate logistic regression modelling was conducted to predict the relative effect of patient characteristics on attendance at community services. Attendance at community services was highest in those living in the most, compared with least, deprived areas (p<0.001), and was most evident in MSM and heterosexuals. Compared to white UK nationals attendance was significantly higher in non-UK nationals of uncertain residency status (Adjusted odds ratio [AOR] = 21.91, 95% confidence interval [CI] 10.48-45.83; p<0.001), refugees (AOR = 5.75, 95% CI 3.3-10.03; p<0.001), migrant workers (AOR = 5.48, 95% CI 2.22-13.51; p<0.001) and temporary visitors (AOR = 3.44, 95% CI 1.68-7.05; p<0.001). Community services, initially established predominantly to support MSM, have responded to the changing demography of HIV and reach the most vulnerable members of society. Consequent to their support of migrant populations, community services are vital for the management of HIV in black and minority groups. Paradoxically, this coincides with increasing funding pressures on these

  7. Arizona - Social Vulnerability Index

    EPA Pesticide Factsheets

    The Social Vulnerability Index is derived from the 2000 US Census data. The fields included are percent minority, median household income, age (under 18 and over 64), population without a high school diploma, linguistically isolated households, and single female head of households with own children under 18 (single moms). The data is at the block group level. Each field for each block group is assigned an index score of 0-3, based on whether the value of that dataset falls in the top quartile (score=3), second quartile (score=2), third quartile (score=1), or bottom quartile (score=0). The scores for each field are then added together to assign a comprehensive score to each block group (0-21). The highest scores are block groups that have the highest percentage of sensitive populations (highest percent minority, lowest per capita income, highest percent of population under 18 and over 64, highest percentage of population without a high school degree, highest percent of linguistically isolated households, and highest percent of single female head of households). Zoe Heller of the US EPA Region 9's Communities and Ecosystems Division, is responsible for the design and development of the Social Vulnerability Index data set.

  8. The use of audience response system technology with limited-english-proficiency, low-literacy, and vulnerable populations.

    PubMed

    Keifer, Matthew C; Reyes, Iris; Liebman, Amy K; Juarez-Carrillo, Patricia

    2014-01-01

    Audience response systems (ARS) have long been used to improve the interactivity of educational activities. Most studies of ARS have addressed education of literate trainees. How well these devices work with low-literacy subjects is not well studied. Information gathering on the training audience is an important use of ARS and helpful in improving the targeting of training information. However, obtaining demographic information from vulnerable populations with reasons to be concerned about divulging information about themselves has not been tested. In addition, a culturally competent method to effectively collect demographic and evaluation data of this growing population is essential. This project investigated the use of ARS to gather information from Hispanic immigrant workers, many of whom are socially vulnerable and have limited English proficiency (LEP) and low-literacy. Workers attended focus groups and were asked to use ARS devices or clickers to respond to questions. Questions were both categorical (multiple choice) and open-ended numerical (text entry), and varied from simple queries to more sensitive points regarding immigration. Most workers answered the one-key response categorical questions with little difficulty. In contrast, some participants struggled when responding to numerical questions, especially when the response required pressing multiple clicker keys. An overwhelming majority of participants reported that the clickers were comfortable and easy to use despite the challenges presented by the more complex responses. The error rate increased as question complexity increased and the trend across three ordered categories of response complexity reached statistical significance. Results suggest that ARS is a viable method for gathering dichotomous or higher-order categorical information from LEP and low-literacy populations in a group setting while assuring anonymity. However, it is recommended that clickers be developed and tested with fewer, bigger

  9. Psychosocial and Service Use Correlates of Health-Related Quality of Life Among a Vulnerable Population Living with HIV/AIDS.

    PubMed

    Mitchell, Mary M; Nguyen, Trang Q; Isenberg, Sarina R; Maragh-Bass, Allysha C; Keruly, Jeanne; Knowlton, Amy R

    2017-06-01

    Among people living with HIV/AIDS (PLHIV), health-related quality of life (HRQOL) is an important clinical metric of perceived well-being. Baseline data from the BEACON study (N = 383) were used to examine relationships between HRQOL and negative social support, HIV-related stigma, viral suppression, and physical and mental health service use among a vulnerable population of low-income, urban PLHIV who currently or formerly used substances, and were primarily African American. Factor analyses and structural equation modeling indicated that increases in negative social support, stigma, mental health care visits and HIV physician visits were associated with lower HRQOL, while viral suppression was associated with greater HRQOL. The association between negative social support and HRQOL suggests the importance of intervening at the dyad or network levels to shape the type of social support being provided to PLHIV. HIV-related stigma is another negative social factor that is prevalent in this sample and could be addressed by intervention. Results indicate that greater mental and physical health service use can be used to identify individuals with lower HRQOL. Therefore, findings increase an understanding of HRQOL in this understudied population and have implications for designing interventions to improve HRQOL among PLHIV.

  10. Economic vulnerability to sea-level rise along the northern U.S. Gulf Coast

    USGS Publications Warehouse

    Thatcher, Cindy A.; Brock, John C.; Pendleton, Elizabeth A.

    2013-01-01

    The northern Gulf of Mexico coast of the United States has been identified as highly vulnerable to sea-level rise, based on a combination of physical and societal factors. Vulnerability of human populations and infrastructure to projected increases in sea level is a critical area of uncertainty for communities in the extremely low-lying and flat northern gulf coastal zone. A rapidly growing population along some parts of the northern Gulf of Mexico coastline is further increasing the potential societal and economic impacts of projected sea-level rise in the region, where observed relative rise rates range from 0.75 to 9.95 mm per year on the Gulf coasts of Texas, Louisiana, Mississippi, Alabama, and Florida. A 1-m elevation threshold was chosen as an inclusive designation of the coastal zone vulnerable to relative sea-level rise, because of uncertainty associated with sea-level rise projections. This study applies a Coastal Economic Vulnerability Index (CEVI) to the northern Gulf of Mexico region, which includes both physical and economic factors that contribute to societal risk of impacts from rising sea level. The economic variables incorporated in the CEVI include human population, urban land cover, economic value of key types of infrastructure, and residential and commercial building values. The variables are standardized and combined to produce a quantitative index value for each 1-km coastal segment, highlighting areas where human populations and the built environment are most at risk. This information can be used by coastal managers as they allocate limited resources for ecosystem restoration, beach nourishment, and coastal-protection infrastructure. The study indicates a large amount of variability in index values along the northern Gulf of Mexico coastline, and highlights areas where long-term planning to enhance resiliency is particularly needed.

  11. Spatial-temporal analysis of dengue deaths: identifying social vulnerabilities.

    PubMed

    Silva, Maria do Socorro da; Branco, Maria Dos Remédios Freitas Carvalho; Aquino, José; Queiroz, Rejane Christine de Sousa; Bani, Emanuele; Moreira, Emnielle Pinto Borges; Medeiros, Maria Nilza Lima; Rodrigues, Zulimar Márita Ribeiro

    2017-01-01

    Currently, dengue fever, chikungunya fever, and zika virus represent serious public health issues in Brazil, despite efforts to control the vector, the Aedes aegypti mosquito. This was a descriptive and ecological study of dengue deaths occurring from 2002 to 2013 in São Luis, Maranhão, Brazil. Geoprocessing software was used to draw maps, linking the geo-referenced deaths with urban/social data at census tract level. There were 74 deaths, concentrated in areas of social vulnerability. The use of geo-technology tools pointed to a concentration of dengue deaths in specific intra-urban areas.

  12. Vulnerability to heatwaves and implications for public health interventions - A scoping review.

    PubMed

    Mayrhuber, Elisabeth Anne-Sophie; Dückers, Michel L A; Wallner, Peter; Arnberger, Arne; Allex, Brigitte; Wiesböck, Laura; Wanka, Anna; Kolland, Franz; Eder, Renate; Hutter, Hans-Peter; Kutalek, Ruth

    2018-05-31

    Heatwaves form a serious public health threat, especially for vulnerable groups. Interventions such as active outreach programs, exposure reduction measures and monitoring and mapping of at-risk groups are increasingly implemented across the world but little is known about their effect. To assess how vulnerable groups are identified and reached in heat health interventions, to understand the effectiveness and efficiency of those interventions, and to identify research gaps in existing literature. We performed a literature search in relevant scientific literature databases and searched with a four element search model for articles published from 1995 onward. We extracted data on intervention measures, target group and evaluation of effectiveness and efficiency. We identified 23 eligible studies. Patterns exist in type of interventions 1) to detect and 2) to influence extrinsic and intrinsic risk and protective factors. Results showed several intervention barriers related to the variety and intersection of these factors, as well as the self-perception of vulnerable groups, and misconceptions and unfavorable attitudes towards intervention benefits. While modest indications for the evidence on the effectiveness of interventions were found, efficiency remains unclear. Interventions entailed logical combinations of measures, subsumed as packages. Evidence for effective and efficient intervention is limited by the difficulty to determine effects and because single measures are mutually dependent. Interventions prioritized promoting behavioral change and were based on behavioral assumptions that remain untested and mechanisms not worked out explicitly. Multifaceted efforts are needed to tailor interventions, compiled in heat health warning systems and action plans for exposure reduction and protection of vulnerable populations, to fit the social, economic and geographical context. Besides adequately addressing relevant risk and protective factors, the challenge is to

  13. The etemic model of Gypsy Roma Traveller community vulnerability: is it time to rethink our understanding of vulnerability?

    PubMed

    Heaslip, Vanessa; Hean, Sarah; Parker, Jonathan

    2016-08-09

    To present a new etemic model of vulnerability. Despite vulnerability being identified as a core consequence of health and health experiences, there has been little research exploring the meaning of vulnerability as a concept. Yet, being vulnerable is known to have dire physical/mental health consequences. It is therefore a fundamental issue for nurses to address. To date, the meaning of the term vulnerability has been influenced by the work of Spiers (Journal of Advanced Nursing, 31, 2000, 715, The Essential Concepts of Nursing: Building Blocks for Practice, 2005, Elsevier, London). Spiers identified two aspects of vulnerability: the etic (external judgment of another persons' vulnerability) and the emic (internal lived experience of vulnerability). This approach has led to a plethora of research which has explored the etic (external judgment) of vulnerability and rendered the internal lived (or emic) experience invisible. Consequences of this, for marginalised communities such as Gypsy Roma Travellers include a lack of culturally sensitive services compounding health inequalities. Position paper. Drawing upon a qualitative phenomenological research study exploring the lived experience of vulnerability from a Gypsy Roma Travelling community (published previously), this paper presents a new model of vulnerability. This etemic model of vulnerability values both external and internal dimensions of vulnerability and argues for a fusion of these two opposing perspectives. If nurses and other health- and social care professionals wish to develop practice that is successful in engaging with Gypsy Roma Travellers, then there is a need to both understand and respect their community. This can be achieved through an etemic approach to understanding their vulnerability achieved by eliciting lived experience alongside the appreciation of epidemiological studies. If nurses and health practitioners used this etemic approach to practice then it would enable both the development

  14. African American Female Offender's Use of Alternative and Traditional Health Services After Re-Entry: Examining the Behavioral Model for Vulnerable Populations.

    PubMed

    Oser, Carrie B; Bunting, Amanda M; Pullen, Erin; Stevens-Watkins, Danelle

    2016-01-01

    This is the first known study to use the Gelberg-Andersen Behavioral Model for Vulnerable Populations to predict African American women's use of three types of health services (alternative, hospitalization, and ambulatory) in the 18 months after release from prison. In the multivariate models, the most robust predictors of all three types of service utilization were in the vulnerable theoretical domains. Alternative health services were predicted by ethnic community membership, higher religiosity, and HIV/HCV. Hospitalizations were predicted by the lack of barriers to health care and disability. Ambulatory office visits were predicted by more experiences of gendered racism, a greater number of physical health problems, and HIV/HCV. Findings highlight the importance of cultural factors and HIV/HCV in obtaining both alternative and formal health care during community re-entry. Clinicians and policymakers should consider the salient role that the vulnerable domain plays in offender's accessing health services.

  15. Vulnerability-based evaluation of water supply design under climate change

    NASA Astrophysics Data System (ADS)

    Umit Taner, Mehmet; Ray, Patrick; Brown, Casey

    2015-04-01

    Long-lived water supply infrastructures are strategic investments in the developing world, serving the purpose of balancing water deficits compounded by both population growth and socio-economic development. Robust infrastructure design under climate change is compelling, and often addressed by focusing on the outcomes of climate model projections ('scenario-led' planning), or by identifying design options that are less vulnerable to a wide range of plausible futures ('vulnerability-based' planning). Decision-Scaling framework combines these two approaches by first applying a climate stress test on the system to explore vulnerabilities across many traces of the future, and then employing climate projections to inform the decision-making process. In this work, we develop decision scaling's nascent risk management concepts further, directing actions on vulnerabilities identified during the climate stress test. In the process, we present a new way to inform climate vulnerability space using climate projections, and demonstrate the use of multiple decision criteria to guide to a final design recommendation. The concepts are demonstrated for a water supply project in the Mombasa Province of Kenya, planned to provide domestic and irrigation supply. Six storage design capacities (from 40 to 140 million cubic meters) are explored through a stress test, under a large number climate traces representing both natural climate variability and plausible climate changes. Design outcomes are simulated over a 40-year planning period with a coupled hydrologic-water resources systems model and using standard reservoir operation rules. Resulting performance is expressed in terms of water supply reliability and economic efficiency. Ensemble climate projections are used for assigning conditional likelihoods to the climate traces using a statistical distance measure. The final design recommendations are presented and discussed for the decision criteria of expected regret, satisficing, and

  16. Tobacco Retail Outlets and Vulnerable Populations in Ontario, Canada

    PubMed Central

    Chaiton, Michael O.; Mecredy, Graham C.; Cohen, Joanna E.; Tilson, Melodie L.

    2013-01-01

    Interest has been increasing in regulating the location and number of tobacco vendors as part of a comprehensive tobacco control program. The objective of this paper is to examine the distribution of tobacco outlets in a large jurisdiction, to assess: (1) whether tobacco outlets are more likely to be located in vulnerable areas; and (2) what proportion of tobacco outlets are located close to schools. Retail locations across the Province of Ontario from Ministry of Health Promotion data were linked to 2006 Census data at the neighbourhood level. There was one tobacco retail outlet for every 1,000 people over age 15 in Ontario. Density of outlets varied by public health unit, and was associated with the number of smokers. Tobacco outlets were more likely to be located in areas that had high neighbourhood deprivation, in both rural and urban areas. Outlets were less likely to be located in areas with high immigrant populations in urban areas, with the reverse being true for rural areas. Overall, 65% of tobacco retailers were located within 500 m of a school. The sale of tobacco products is ubiquitous, however, neighbourhoods with lower socio-economic status are more likely to have easier availability of tobacco products and most retailers are located within walking distance of a school. The results suggest the importance of policies to regulate the location of tobacco retail outlets. PMID:24351748

  17. Recognizing Risk and Vulnerability in Research Ethics: Imagining the "What Ifs?"

    PubMed

    Peter, Elizabeth; Friedland, Judith

    2017-04-01

    Research ethics committees (RECs) may misunderstand the vulnerability of participants, given their distance from the field. What RECs identify as the vulnerabilities that were not adequately recognized in protocols and how they attempt to protect the perceived vulnerability of participants and mitigate risks were examined using the response letters sent to researchers by three university-based RECs. Using a critical qualitative method informed by feminist ethics, we identified an overarching theme of recognizing and responding to cascading vulnerabilities and four subthemes: identifying vulnerable groups, recognizing potentially risky research, imagining the "what ifs," and mitigating perceived risks. An ethics approach that is up-close, as opposed to distant, is needed to foster closer relationships among participants, researchers, and RECs and to understand participant vulnerability and strength better.

  18. Timeliness of abnormal screening and diagnostic mammography follow-up at facilities serving vulnerable women

    PubMed Central

    Goldman, L. Elizabeth; Walker, Rod; Hubbard, Rebecca; Kerlikowske, Karla

    2013-01-01

    Background Whether timeliness of follow-up after abnormal mammography differs at facilities serving vulnerable populations such as women with limited education or income, in rural areas, and racial/ethnic minorities is unknown. Methods We examined receipt of diagnostic evaluation following abnormal mammography using 1998-2006 Breast Cancer Surveillance Consortium-linked Medicare claims. We compared whether time to recommended breast imaging or biopsy depended on whether women attended facilities serving vulnerable populations. We characterized a facility by the proportion of mammograms performed on women with limited education or income, in rural areas, or racial/ethnic minorities. Results We analyzed 30,874 abnormal screening examinations recommended for follow-up imaging across 142 facilities and 10,049 abnormal diagnostic examinations recommended for biopsy across 114 facilities. Women at facilities serving populations with less education or more racial/ethnic minorities had lower rates of follow-up imaging (4-5% difference, p<0.05), and women at facilities serving more rural and low income populations had lower rates of biopsy (4-5% difference, p<0.05). Women undergoing biopsy at facilities serving vulnerable populations had longer times until biopsy than those at facilities serving non-vulnerable populations (21.6 days vs. 15.6 days; 95% CI for mean difference 4.1-7.7). The proportion of women receiving recommended imaging within 11 months and biopsy within 3 months varied across facilities (interquartile range 85.5%-96.5% for imaging and 79.4%-87.3% for biopsy). Conclusions Among Medicare recipients, follow-up rates were slightly lower at facilities serving vulnerable populations, and among those women who returned for diagnostic evaluation, time to follow-up was slightly longer at facilities that served vulnerable population. Interventions should target variability in follow-up rates across facilities, and evaluate effectiveness particularly at facilities

  19. Participatory design of ehealth solutions for women from vulnerable populations with perinatal depression.

    PubMed

    Gordon, Mara; Henderson, Rebecca; Holmes, John H; Wolters, Maria K; Bennett, Ian M

    2016-01-01

    Cultural and health service obstacles affect the quality of pregnancy care that women from vulnerable populations receive. Using a participatory design approach, the Stress in Pregnancy: Improving Results with Interactive Technology group developed specifications for a suite of eHealth applications to improve the quality of perinatal mental health care. We established a longitudinal participatory design group consisting of low-income women with a history of antenatal depression, their prenatal providers, mental health specialists, an app developer, and researchers. The group met 20 times over 24 months. Applications were designed using rapid prototyping. Meetings were documented using field notes. The group achieved high levels of continuity and engagement. Three apps were developed by the group: an app to support high-risk women after discharge from hospital, a screening tool for depression, and a patient decision aid for supporting treatment choice. Longitudinal participatory design groups are a promising, highly feasible approach to developing technology for underserved populations. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. Vulnerability to the transmission of human visceral leishmaniasis in a Brazilian urban area

    PubMed Central

    de Toledo, Celina Roma Sánchez; de Almeida, Andréa Sobral; Chaves, Sergio Augusto de Miranda; Sabroza, Paulo Chagastelles; Toledo, Luciano Medeiros; Caldas, Jefferson Pereira

    2017-01-01

    ABSTRACT OBJECTIVE To analyze the determinants for the occurrence of human visceral leishmaniasis linked to the conditions of vulnerability. METHODS This is an ecological study, whose spatial analysis unit was the Territorial Analysis Unit in Araguaína, State of Tocantins, Brazil, from 2007 to 2012. We have carried out an analysis of the sociodemographic and urban infrastructure situation of the municipality. Normalized primary indicators were calculated and used to construct the indicators of vulnerability of the social structure, household structure, and urban infrastructure. From them, we have composed a vulnerability index. Kernel density estimation was used to evaluate the density of cases of human visceral leishmaniasis, based on the coordinates of the cases. Bivariate global Moran’s I was used to verify the existence of spatial autocorrelation between the incidence of human visceral leishmaniasis and the indicators and index of vulnerability. Bivariate local Moran’s I was used to identify spatial clusters. RESULTS We have observed a pattern of centrifugal spread of human visceral leishmaniasis in the municipality, where outbreaks of the disease have progressively reached central and peri-urban areas. There has been no correlation between higher incidences of human visceral leishmaniasis and worse living conditions. Statistically significant clusters have been observed between the incidences of human visceral leishmaniasis in both periods analyzed (2007 to 2009 and 2010 to 2012) and the indicators and index of vulnerability. CONCLUSIONS The environment in circumscribed areas helps as protection factor or increases the local vulnerability to the occurrence of human visceral leishmaniasis. The use of methodology that analyzes the conditions of life of the population and the spatial distribution of human visceral leishmaniasis is essential to identify the most vulnerable areas to the spread/maintenance of the disease. PMID:28513764

  1. Coastal vulnerability assessment of Puducherry coast, India using analytical hierarchical process

    NASA Astrophysics Data System (ADS)

    Mani Murali, R.; Ankita, M.; Amrita, S.; Vethamony, P.

    2013-03-01

    Increased frequency of natural hazards such as storm surge, tsunami and cyclone, as a consequence of change in global climate, is predicted to have dramatic effects on the coastal communities and ecosystems by virtue of the devastation they cause during and after their occurrence. The tsunami of December 2004 and the Thane cyclone of 2011 caused extensive human and economic losses along the coastline of Puducherry and Tamil Nadu. The devastation caused by these events highlighted the need for vulnerability assessment to ensure better understanding of the elements causing different hazards and to consequently minimize the after-effects of the future events. This paper advocates an Analytical Hierarchical Process (AHP) based approach to coastal vulnerability studies as an improvement to the existing methodologies for vulnerability assessment. The paper also encourages the inclusion of socio-economic parameters along with the physical parameters to calculate the coastal vulnerability index using AHP derived weights. Seven physical-geological parameters (slope, geomorphology, elevation, shoreline change, sea level rise, significant wave height and tidal range) and four socio-economic factors (population, Land-use/Land-cover (LU/LC), roads and location of tourist places) are considered to measure the Physical Vulnerability Index (PVI) as well as the Socio-economic Vulnerability Index (SVI) of the Puducherry coast. Based on the weights and scores derived using AHP, vulnerability maps are prepared to demarcate areas with very low, medium and high vulnerability. A combination of PVI and SVI values are further utilized to compute the Coastal Vulnerability Index (CVI). Finally, the various coastal segments are grouped into the 3 vulnerability classes to obtain the final coastal vulnerability map. The entire coastal extent between Muthiapet and Kirumampakkam as well as the northern part of Kalapet is designated as the high vulnerability zone which constitutes 50% of the

  2. Accessible Neurobehavioral Anger-Related Markers for Vulnerability to Post-Traumatic Stress Symptoms in a Population of Male Soldiers

    PubMed Central

    Lin, Tamar; Gilam, Gadi; Raz, Gal; Or-Borichev, Ayelet; Bar-Haim, Yair; Fruchter, Eyal; Hendler, Talma

    2017-01-01

    Identifying vulnerable individuals prone to develop post-traumatic stress symptoms (PTSS) is of paramount importance, especially in populations at high risk for stress exposure such as combat soldiers. While several neural and psychological risk factors are known, no post-traumatic stress disorder (PTSD) biomarker has yet progressed to clinical use. Here we present novel and clinically applicable anger-related neurobehavioral risk markers for military-related PTSS in a large cohort of Israeli soldiers. The psychological, electrophysiological and neural (Simultaneous recording of scalp electroencephalography [EEG] and functional magnetic resonance imaging [fMRI]) reaction to an anger-inducing film were measured prior to advanced military training and PTSS were recorded at 1-year follow-up. Limbic modulation was measured using a novel approach that monitors amygdala modulation using fMRI-inspired EEG, hereafter termed amygdala electrical fingerprint (amyg-EFP). Inter-subject correlation (ISC) analysis on fMRI data indicated that during movie viewing participants’ brain activity was synchronized in limbic regions including the amygdala. Self-reported state-anger and amyg-EFP modulation successfully predicted PTSS levels. State-anger significantly accounted for 20% of the variance in PTSS, and amyg-EFP signal modulation significantly accounted for additional 15% of the variance. Our study was limited by the moderate PTSS levels and lack of systematic baseline symptoms assessment. These results suggest that pre-stress neurobehavioral measures of anger may predict risk for later PTSS, pointing to anger-related vulnerability factors that can be measured efficiently and at a low cost before stress exposure. Possible mechanisms underlying the association between the anger response and risk for PTSS are discussed. PMID:28326027

  3. Spatial-explicit modeling of social vulnerability to malaria in East Africa

    PubMed Central

    2014-01-01

    Background Despite efforts in eradication and control, malaria remains a global challenge, particularly affecting vulnerable groups. Despite the recession in malaria cases, previously malaria free areas are increasingly confronted with epidemics as a result of changing environmental and socioeconomic conditions. Next to modeling transmission intensities and probabilities, integrated spatial methods targeting the complex interplay of factors that contribute to social vulnerability are required to effectively reduce malaria burden. We propose an integrative method for mapping relative levels of social vulnerability in a spatially explicit manner to support the identification of intervention measures. Methods Based on a literature review, a holistic risk and vulnerability framework has been developed to guide the assessment of social vulnerability to water-related vector-borne diseases (VBDs) in the context of changing environmental and societal conditions. Building on the framework, this paper applies spatially explicit modeling for delineating homogeneous regions of social vulnerability to malaria in eastern Africa, while taking into account expert knowledge for weighting the single vulnerability indicators. To assess the influence of the selected indicators on the final index a local sensitivity analysis is carried out. Results Results indicate that high levels of malaria vulnerability are concentrated in the highlands, where immunity within the population is currently low. Additionally, regions with a lack of access to education and health services aggravate vulnerability. Lower values can be found in regions with relatively low poverty, low population pressure, low conflict density and reduced contributions from the biological susceptibility domain. Overall, the factors characterizing vulnerability vary spatially in the region. The vulnerability index reveals a high level of robustness in regard to the final choice of input datasets, with the exception of the

  4. Safer stops for vulnerable customers

    DOT National Transportation Integrated Search

    2003-03-01

    This synthesis report presents a brief synopsis of the current literature and technologies being used in the development of safer and more secure bus stops. While the focus is more specifically with regard to vulnerable populations - women, children,...

  5. Groundwater vulnerability mapping in Guadalajara aquifers system (Western Mexico)

    NASA Astrophysics Data System (ADS)

    Rizo-Decelis, L. David; Marín, Ana I.; Andreo, Bartolomé

    2016-04-01

    some monitoring wells, which have been related to anthropogenic activity. Vulnerability maps were produced using different parametric methods (e.g.: DRASTIC, GOD, DISCO, AVI), then the results are compared and assessed. Since each one of these methods use different number of parameters and weights, relatively different results were obtained, although the results have been evaluated with common cartographic inputs. The comparison between selected methods shows that the GOD method results are more correlated with the other methods and produces vulnerability maps comparable with them. Even though groundwater vulnerability is a critical issue around the world, no protection zones have been delineated in Guadalajara city, one of the biggest in Latin America. The groundwater contamination in the study area poses a serious risk for a large population and the environment. This work aims to propose an approach for groundwater protection cartography, based on the application and the comparison of results from different contamination vulnerability methods. These outcomes may assist water authorities to identify the higher vulnerable zones of the aquifers, in order to improving and adapting the land planning and management according to the protection of the own water resources.

  6. Demographic and health attributes of the Nahua, initial contact population of the Peruvian Amazon.

    PubMed

    Culqui, Dante R; Ayuso-Alvarez, Ana; Munayco, Cesar V; Quispe-Huaman, Carlos; Mayta-Tristán, Percy; Campos, Juan de Mata Donado

    2016-01-01

    We present the case of the Nahua population of Santa Rosa de Serjali, Peruvian Amazon's population, considered of initial contact. This population consists of human groups that for a long time decided to live in isolation, but lately have begun living a more sedentary lifestyle and in contact with Western populations. There are two fully identified initial contact groups in Peru: the Nahua and the Nanti. The health statistics of the Nahua are scarce. This study offers an interpretation of demographic and epidemiological indicators of the Nahua people, trying to identify if a certain degree of health vulnerability exists. We performed a cross sectional study, and after analyzing their health indicators, as well as the supplemental qualitative analysis of the population, brought us to conclude that in 2006, the Nahua, remained in a state of health vulnerability.

  7. Tsunami vulnerability assessment mapping for the west coast of Peninsular Malaysia using a geographical information system (GIS)

    NASA Astrophysics Data System (ADS)

    Najihah, R.; Effendi, D. M.; Hairunnisa, M. A.; Masiri, K.

    2014-02-01

    The catastrophic Indian Ocean tsunami of 26 December 2004 raised a number of questions for scientist and politicians on how to deal with the tsunami risk and assessment in coastal regions. This paper discusses the challenges in tsunami vulnerability assessment and presents the result of tsunami disaster mapping and vulnerability assessment study for West Coast of Peninsular Malaysia. The spatial analysis was carried out using Geographical Information System (GIS) technology to demarcate spatially the tsunami affected village's boundary and suitable disaster management program can be quickly and easily developed. In combination with other thematic maps such as road maps, rail maps, school maps, and topographic map sheets it was possible to plan the accessibility and shelter to the affected people. The tsunami vulnerability map was used to identify the vulnerability of villages/village population to tsunami. In the tsunami vulnerability map, the intensity of the tsunami was classified as hazard zones based on the inundation level in meter (contour). The approach produced a tsunami vulnerability assessment map consists of considering scenarios of plausible extreme, tsunami-generating events, computing the tsunami inundation levels caused by different events and scenarios and estimating the possible range of casualties for computing inundation levels. The study provides an interactive means to identify the tsunami affected areas after the disaster and mapping the tsunami vulnerable village before for planning purpose were the essential exercises for managing future disasters.

  8. Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review.

    PubMed

    Kim, Kyounghae; Choi, Janet S; Choi, Eunsuk; Nieman, Carrie L; Joo, Jin Hui; Lin, Frank R; Gitlin, Laura N; Han, Hae-Ra

    2016-04-01

    Community-based health workers (CBHWs) are frontline public health workers who are trusted members of the community they serve. Recently, considerable attention has been drawn to CBHWs in promoting healthy behaviors and health outcomes among vulnerable populations who often face health inequities. We performed a systematic review to synthesize evidence concerning the types of CBHW interventions, the qualification and characteristics of CBHWs, and patient outcomes and cost-effectiveness of such interventions in vulnerable populations with chronic, noncommunicable conditions. We undertook 4 electronic database searches-PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane-and hand searched reference collections to identify randomized controlled trials published in English before August 2014. We screened a total of 934 unique citations initially for titles and abstracts. Two reviewers then independently evaluated 166 full-text articles that were passed onto review processes. Sixty-one studies and 6 companion articles (e.g., cost-effectiveness analysis) met eligibility criteria for inclusion. Four trained research assistants extracted data by using a standardized data extraction form developed by the authors. Subsequently, an independent research assistant reviewed extracted data to check accuracy. Discrepancies were resolved through discussions among the study team members. Each study was evaluated for its quality by 2 research assistants who extracted relevant study information. Interrater agreement rates ranged from 61% to 91% (average 86%). Any discrepancies in terms of quality rating were resolved through team discussions. All but 4 studies were conducted in the United States. The 2 most common areas for CBHW interventions were cancer prevention (n = 30) and cardiovascular disease risk reduction (n = 26). The roles assumed by CBHWs included health education (n = 48), counseling (n = 36), navigation assistance (n

  9. Multiple perspective vulnerability analysis of the power network

    NASA Astrophysics Data System (ADS)

    Wang, Shuliang; Zhang, Jianhua; Duan, Na

    2018-02-01

    To understand the vulnerability of the power network from multiple perspectives, multi-angle and multi-dimensional vulnerability analysis as well as community based vulnerability analysis are proposed in this paper. Taking into account of central China power grid as an example, correlation analysis of different vulnerability models is discussed. Then, vulnerabilities produced by different vulnerability metrics under the given vulnerability models and failure scenarios are analyzed. At last, applying the community detecting approach, critical areas of central China power grid are identified, Vulnerable and robust communities on both topological and functional perspective are acquired and analyzed. The approach introduced in this paper can be used to help decision makers develop optimal protection strategies. It will be also useful to give a multiple vulnerability analysis of the other infrastructure systems.

  10. Using experiments and demographic models to assess rare plant vulnerability to utlity-scale solar energy development

    NASA Astrophysics Data System (ADS)

    Moore, K. A.

    2015-12-01

    Pressing challenges for the implementation of solar energy are the effects of construction and operation on protected animal and plant species. Siting and mitigation of solar energy often requires understanding of basic biology and distributions of rare species that are unknown. How can we rapidly collect the information necessary on species- and site-specific population dynamics to effectively design mitigation and conservation measures? We have developed an integrated approach to assessing the vulnerability of a suite of representative rare plant species in the region. We implemented a prioritized series of demographic and experimental studies over the past four years to identify the types of species, populations, and life stages most vulnerable to impact or prone to conservation efforts. We have found substantial variation in vegetative and sexual reproduction between study populations for several rare plants, including between populations that vary in putative impact by development and/or effects of experimental solar arrays. For a subset of species, we designed population viability analysis and applied them to identify sensitive vital rates and compare quasi-extinction probabilities under different climate and impact scenarios. By utilizing practical experiments to test for the effects of real or simulated impacts, we found differences in vital rates between natural and disturbed populations adjacent to and within solar installations. We draw conclusions from our work to guide the analysis of benefits, permitting, and design of utility-scale solar energy facilities.

  11. Global Vulnerability Assessment in Santa María Tixmadeje, Estado de México, México

    NASA Astrophysics Data System (ADS)

    Monroy Salazar, S.; Novelo-Casanova, D. A.

    2010-12-01

    Santa María Tixmadejé (SMT), Estado de México, Mexico is a town located very close to the Acambay-Tixmadejé fault. This fault is located in the middle of the Trans Volcanic Belt in the center of the Mexican territory and generated a large seismic event in 1912 with magnitude 6.9 which combined with the local vulnerability, caused a disaster. In this work we measure the different vulnerabilities of the SMT community: structural, economical, social and educational. In addition, we determinate the total vulnerability, by summing all estimated vulnerabilities, for the critical facilities identified in this town. Vulnerability was determined using the methodology proposed by National Oceanic Atmospheric Administration (NOAA) and by Disaster Prevention National Center (CENAPRED). Besides, we considered a minimum sample statistically significant of the total houses with a random sampling for our survey. Our results indicate that 50% of the critical facilities have high and very high and the other 50% between low and moderate level of total vulnerability. The results for independent vulnerabilities are as follows: (1) Near to 75% of the community has high and very high level of social vulnerability and the range for the another 25% is between low and moderate; (2) About 43% of the community has high and very high economical vulnerability and 57% low and moderate; (3) Approximately 38% of the population has high and very high educational vulnerability. The 62% present low and moderate vulnerability; and (4) About 42% of the community has very high structural vulnerability and 58% between low and moderate.

  12. Identifying Vulnerable Plaques with Acoustic Radiation Force Impulse Imaging

    NASA Astrophysics Data System (ADS)

    Doherty, Joshua Ryan

    The rupture of arterial plaques is the most common cause of ischemic complications including stroke, the fourth leading cause of death and number one cause of long term disability in the United States. Unfortunately, because conventional diagnostic tools fail to identify plaques that confer the highest risk, often a disabling stroke and/or sudden death is the first sign of disease. A diagnostic method capable of characterizing plaque vulnerability would likely enhance the predictive ability and ultimately the treatment of stroke before the onset of clinical events. This dissertation evaluates the hypothesis that Acoustic Radiation Force Impulse (ARFI) imaging can noninvasively identify lipid regions, that have been shown to increase a plaque's propensity to rupture, within carotid artery plaques in vivo. The work detailed herein describes development efforts and results from simulations and experiments that were performed to evaluate this hypothesis. To first demonstrate feasibility and evaluate potential safety concerns, finite- element method simulations are used to model the response of carotid artery plaques to an acoustic radiation force excitation. Lipid pool visualization is shown to vary as a function of lipid pool geometry and stiffness. A comparison of the resulting Von Mises stresses indicates that stresses induced by an ARFI excitation are three orders of magnitude lower than those induced by blood pressure. This thesis also presents the development of a novel pulse inversion harmonic tracking method to reduce clutter-imposed errors in ultrasound-based tissue displacement estimates. This method is validated in phantoms and was found to reduce bias and jitter displacement errors for a marked improvement in image quality in vivo. Lastly, this dissertation presents results from a preliminary in vivo study that compares ARFI imaging derived plaque stiffness with spatially registered composition determined by a Magnetic Resonance Imaging (MRI) gold standard

  13. Overactive bladder in the vulnerable elderly

    PubMed Central

    Wolff, Gillian F; Kuchel, George A; Smith, Phillip P

    2014-01-01

    Overactive bladder (OAB) is a common problem that may occur in individuals of all ages. It has a considerable impact on patient quality of life, and although moderately effective management strategies do exist, this condition often remains undiagnosed and untreated. OAB needs to be viewed as a symptom complex. Its presentation and management are complicated in the vulnerable elderly by the presence of baseline frailty and multiple coexisting chronic conditions. Furthermore, and beyond a simple understanding of symptomatology, providers must address patient goals and motivations as well as the expectations of caretakers. These multiple levels of perception, function, expectations, and treatment efficacy/risks must be tailored to the individual patient. While the vulnerable elderly patient may often have evidence of urinary tract dysfunction, OAB and urge urinary incontinence in this population must be understood as a multifactorial geriatric syndrome and viewed in the context of medical and functional baseline and precipitating risk factors. Expectations and goals must be tailored to the resources of vulnerable elderly patients and their caregivers, and care must be coordinated with other medical care providers. The management of OAB in the vulnerable elderly often poses significant management challenges. Nonetheless, with a thoughtful approach and an aim towards future research specifically for this population, significant reductions in morbidity and mortality long with enhancement in health-related quality of life are possible. PMID:25328867

  14. Physician Participation In ACOs Is Lower In Places With Vulnerable Populations Compared To More Affluent Communities

    PubMed Central

    Yasaitis, Laura C.; Pajerowski, William; Polsky, Daniel; Werner, Rachel M.

    2016-01-01

    Early evidence suggested that accountable care organizations (ACOs) could improve health care quality while constraining costs, and ACOs are expanding throughout the United States. However, if disadvantaged patients have unequal access to physicians who participate in ACOs, that expansion may exacerbate health care disparities. We examined the relationship between physician participation in both Medicare and commercial ACOs across the country and the sociodemographic characteristics of their likely patient populations. Physician participation in ACOs varied widely across hospital referral regions, from nearly 0 percent to over 85 percent. After we adjusted for individual physician and practice characteristics, we found that physicians who practiced in ZIP Code Tabulation Areas where a higher percentage of the population was black, living in poverty, uninsured, or disabled or had less than a high school education—compared to other areas—had significantly lower rates of ACO participation than other physicians. Our findings suggest that vulnerable populations may not have as great access as other groups to physicians participating in ACOs, which could exacerbate existing disparities in health care quality. PMID:27503961

  15. The association between dental, general, and mental health status among underserved and vulnerable populations served at health centers in the US.

    PubMed

    Nguyen, Vy H; Lin, Sue C; Cappelli, David P; Nair, Suma

    2018-12-01

    Vulnerable populations in underserved communities are disproportionately at high risk for multiple medical, dental, and behavioral health conditions. This study aims to: a) examine the occurrence of acute dental needs and b) investigate the association of acute dental needs and self-rated general and mental health status among the adult dentate health center population. This cross-sectional study analyzed data on adult patients (n = 5,035) from the 2014 Health Center Patient Survey, a nationally representative survey of health center patients. Multivariate logistic regression was used to assess the association of acute dental needs and a) self-rated general health status and b) mental health status. Approximately, two thirds of adult dentate heath center patients reported having an acute dental need. After adjusting for confounding factors, not having or having had health insurance that pays for dental care, general health status of fair or poor, and ever having a mental illness were associated with higher odds of having an acute dental need. The results highlight the role of health centers in addressing oral health disparities among vulnerable populations and the importance of a team-based multidisciplinary approach to ensuring the integration and coordination of oral health services within a comprehensive primary care delivery system. © 2017 American Association of Public Health Dentistry.

  16. The role of the general dental practitioner (GDP) in the management of abuse of vulnerable adults.

    PubMed

    Moore, Roisin; Newton, J Tim

    2012-10-01

    Abuse of vulnerable adults is largely under reported. The most common forms of abuse amongst this group are neglect and financial abuse, although an individual may be at risk of any or all forms of abuse. Certain individuals are at an increased risk of abuse due to their domestic environment and any physical or mental disability they may have. Vulnerable adults constitute a significant proportion of the population. GDPs should be aware of the signs of abuse, to be able to identify those individuals at risk, and how and when to raise concerns of abuse to social services.

  17. Developing a Vulnerability Mapping Methodology: Applying the Water-Associated Disease Index to Dengue in Malaysia

    PubMed Central

    Dickin, Sarah K.; Schuster-Wallace, Corinne J.; Elliott, Susan J.

    2013-01-01

    The Water-associated Disease Index (WADI) was developed to identify and visualize vulnerability to different water-associated diseases by integrating a range of social and biophysical determinants in map format. In this study vulnerability is used to encompass conditions of exposure, susceptibility, and differential coping capacity to a water-associated health hazard. By assessing these conditions, the tool is designed to provide stakeholders with an integrated and long-term understanding of subnational vulnerabilities to water-associated disease and contribute to intervention strategies to reduce the burden of illness. The objective of this paper is to describe and validate the WADI tool by applying it to dengue. A systemic ecohealth framework that considers links between people, the environment and health was applied to identify secondary datasets, populating the index with components including climate conditions, land cover, education status and water use practices. Data were aggregated to create composite indicators of exposure and of susceptibility in a Geographic Information System (GIS). These indicators were weighted by their contribution to dengue vulnerability, and the output consisted of an overall index visualized in map format. The WADI was validated in this Malaysia case study, demonstrating a significant association with dengue rates at a sub-national level, and illustrating a range of factors that drive vulnerability to the disease within the country. The index output indicated high vulnerability to dengue in urban areas, especially in the capital Kuala Lumpur and surrounding region. However, in other regions, vulnerability to dengue varied throughout the year due to the influence of seasonal climate conditions, such as monsoon patterns. The WADI tool complements early warning models for water-associated disease by providing upstream information for planning prevention and control approaches, which increasingly require a comprehensive and

  18. Differential neuronal vulnerability identifies IGF-2 as a protective factor in ALS

    PubMed Central

    Allodi, Ilary; Comley, Laura; Nichterwitz, Susanne; Nizzardo, Monica; Simone, Chiara; Benitez, Julio Aguila; Cao, Ming; Corti, Stefania; Hedlund, Eva

    2016-01-01

    The fatal disease amyotrophic lateral sclerosis (ALS) is characterized by the loss of somatic motor neurons leading to muscle wasting and paralysis. However, motor neurons in the oculomotor nucleus, controlling eye movement, are for unknown reasons spared. We found that insulin-like growth factor 2 (IGF-2) was maintained in oculomotor neurons in ALS and thus could play a role in oculomotor resistance in this disease. We also showed that IGF-1 receptor (IGF-1R), which mediates survival pathways upon IGF binding, was highly expressed in oculomotor neurons and on extraocular muscle endplate. The addition of IGF-2 induced Akt phosphorylation, glycogen synthase kinase-3β phosphorylation and β-catenin levels while protecting ALS patient motor neurons. IGF-2 also rescued motor neurons derived from spinal muscular atrophy (SMA) patients from degeneration. Finally, AAV9::IGF-2 delivery to muscles of SOD1G93A ALS mice extended life-span by 10%, while preserving motor neurons and inducing motor axon regeneration. Thus, our studies demonstrate that oculomotor-specific expression can be utilized to identify candidates that protect vulnerable motor neurons from degeneration. PMID:27180807

  19. Consequences of rapid ice sheet melting on the Sahelian population vulnerability

    PubMed Central

    Ramstein, Gilles; Charbit, Sylvie; Vrac, Mathieu; Famien, Adjoua Moïse; Sultan, Benjamin; Swingedouw, Didier; Dumas, Christophe; Gemenne, François; Alvarez-Solas, Jorge; Vanderlinden, Jean-Paul

    2017-01-01

    The acceleration of ice sheet melting has been observed over the last few decades. Recent observations and modeling studies have suggested that the ice sheet contribution to future sea level rise could have been underestimated in the latest Intergovernmental Panel on Climate Change report. The ensuing freshwater discharge coming from ice sheets could have significant impacts on global climate, and especially on the vulnerable tropical areas. During the last glacial/deglacial period, megadrought episodes were observed in the Sahel region at the time of massive iceberg surges, leading to large freshwater discharges. In the future, such episodes have the potential to induce a drastic destabilization of the Sahelian agroecosystem. Using a climate modeling approach, we investigate this issue by superimposing on the Representative Concentration Pathways 8.5 (RCP8.5) baseline experiment a Greenland flash melting scenario corresponding to an additional sea level rise ranging from 0.5 m to 3 m. Our model response to freshwater discharge coming from Greenland melting reveals a significant decrease of the West African monsoon rainfall, leading to changes in agricultural practices. Combined with a strong population increase, described by different demography projections, important human migration flows could be potentially induced. We estimate that, without any adaptation measures, tens to hundreds million people could be forced to leave the Sahel by the end of this century. On top of this quantification, the sea level rise impact over coastal areas has to be superimposed, implying that the Sahel population could be strongly at threat in case of rapid Greenland melting. PMID:28584113

  20. Consequences of rapid ice sheet melting on the Sahelian population vulnerability.

    PubMed

    Defrance, Dimitri; Ramstein, Gilles; Charbit, Sylvie; Vrac, Mathieu; Famien, Adjoua Moïse; Sultan, Benjamin; Swingedouw, Didier; Dumas, Christophe; Gemenne, François; Alvarez-Solas, Jorge; Vanderlinden, Jean-Paul

    2017-06-20

    The acceleration of ice sheet melting has been observed over the last few decades. Recent observations and modeling studies have suggested that the ice sheet contribution to future sea level rise could have been underestimated in the latest Intergovernmental Panel on Climate Change report. The ensuing freshwater discharge coming from ice sheets could have significant impacts on global climate, and especially on the vulnerable tropical areas. During the last glacial/deglacial period, megadrought episodes were observed in the Sahel region at the time of massive iceberg surges, leading to large freshwater discharges. In the future, such episodes have the potential to induce a drastic destabilization of the Sahelian agroecosystem. Using a climate modeling approach, we investigate this issue by superimposing on the Representative Concentration Pathways 8.5 (RCP8.5) baseline experiment a Greenland flash melting scenario corresponding to an additional sea level rise ranging from 0.5 m to 3 m. Our model response to freshwater discharge coming from Greenland melting reveals a significant decrease of the West African monsoon rainfall, leading to changes in agricultural practices. Combined with a strong population increase, described by different demography projections, important human migration flows could be potentially induced. We estimate that, without any adaptation measures, tens to hundreds million people could be forced to leave the Sahel by the end of this century. On top of this quantification, the sea level rise impact over coastal areas has to be superimposed, implying that the Sahel population could be strongly at threat in case of rapid Greenland melting.

  1. The vulnerabilities in childhood and adolescence and the Brazilian public policy intervention.

    PubMed

    Fonseca, Franciele Fagundes; Sena, Ramony Kris R; dos Santos, Rocky Lane A; Dias, Orlene Veloso; Costa, Simone de Melo

    2013-06-01

    To review and discuss childhood and adolescence vulnerabilities, as well as Brazilian public policies of intervention. A narrative review was performed, considering studies published between 1990 and 2012, found in the Virtual Health Library databases (Biblioteca Virtual em Saúde - BVS). A combination of the following descriptors was used in the search strategy: "Adolescent Health", "Child Health", "Health Public Politics" and "Vulnerability". In addition, Brazilian official documents, the Statute of the Child and the Adolescent, Guardianship Council, Bolsa Família and Saúde na Escola Programs were evaluated. The results were divided into five categories of analysis: Vulnerability of Children and Adolescents in Brazil, Public Politics of Intervention to Risk Factors in Childhood and Adolescence, the Statute of the Child and the Adolescent and Guardianship Council, Bolsa Família Program and Saúde na Escola Program. The studies show that children and adolescents are vulnerable to environmental and social situations. Vulnerabilities are exhibited in daily violence within families and schools, which results in the premature entrance of children and adolescents in the work environment and/or in the drug traffic. To deal with these problems, the Brazilian Government established the Statute of the Child and the Adolescent as well as social programs. Literature exposes the risks experienced by children and adolescents in Brazil. In the other hand, a Government endeavor was identified to eliminate or minimize the suffering of those in vulnerable situations through public policies targeted to this population group.

  2. Comparing plasma and X-ray exposure and identifying vulnerable cell parts

    NASA Astrophysics Data System (ADS)

    Graham, Bill

    2012-10-01

    Here two issues in plasma medicine that are being addressed in a collaboration between the Centre of Plasma Physics and the School of Pharmacy at Queen's University Belfast and the Plasma Institute at York University UK will be discussed. Recent measurements of the interaction of plasmas created directly in DMEM cell medium and MDAMB-231, a human breast cancer cell line, showed evidence of reduced cell viability and of DNA damage. The same set of experiments were undertaken but with X-ray exposure. A correlation of the dependence on plasma exposure time and X-ray dose was observed which might point the way to dose definition in plasma medicine. We have also been working to identify the cell parts most vulnerable to plasma exposure. In this study a 10 kHz atmospheric pressure non-thermal plasma jet, operating in He/0.5%O2 and characterized to determine the behavior of many of the plasma species, was incident onto the surface of media containing either bacterial strains, in their planktonic and biofilm forms, or isolated bacterial plasmid DNA. The results of measurements to look for changes in plasmid structural conformation, rates of single and double strand breaks, the catalytic activity of certain bacterial enzymes, the peroxidation of lipid content of the bacterial cells, the leakage of ATP and Scanning Electron Microscope (SEM) images will be discussed.

  3. Region 9 - Social Vulnerability Index

    EPA Pesticide Factsheets

    The Social Vulnerability Index is derived from the 2000 US Census data. The fields included are percent minority, median household income, age (under 18 and over 64), population without a high school diploma, linguistically isolated households, and single female head of households with own children under 18 (single moms). The data is at the block group level. Each field for each block group is assigned an index score of 0-3, based on whether the value of that dataset falls in the top quartile (score=3), second quartile (score=2), third quartile (score=1), or bottom quartile (score=0). The scores for each field are then added together to assign a comprehensive score to each block group (0-21). The highest scores are block groups that have the highest percentage of sensitive populations (highest percent minority, lowest per capita income, highest percent of population under 18 and over 64, highest percentage of population without a high school degree, highest percent of linguistically isolated households, and highest percent of single female head of households). Zoe Heller of the US EPA Region 9's Communities and Ecosystems Division, is responsible for the design and development of the Social Vulnerability Index data set.

  4. Lack of evidence on mental health and well-being impacts of individual-level interventions for vulnerable adolescents: systematic mapping review.

    PubMed

    Vojt, G; Skivington, K; Sweeting, H; Campbell, M; Fenton, C; Thomson, H

    2018-05-30

    To review empirical evaluations of individual-level interventions intended to improve mental health or well-being for vulnerable adolescents. This is a systematic mapping review. Thirteen databases covering academic and gray literature were searched for published reviews and randomised controlled trials, and gray literature (2005-2016) and the results quality-assessed to prioritise best available evidence. We aimed to identify well-conducted systematic reviews and trials that evaluated individual-level interventions, for mental health/well-being outcomes, where the population was adolescents aged 10-24 years in any of 12 vulnerable groups at high risk of poor health outcomes (e.g. homeless, offenders, 'looked after', carers). Thirty systematic reviews and 16 additional trials were identified. There was insufficient evidence to identify promising individual-level interventions that improve the mental health/well-being of any of the vulnerable groups. Despite Western policy to promote health and well-being among vulnerable young people, the dearth of evidence suggests a lack of interest in evaluating interventions targeting these groups in respect of their mental health/well-being outcomes. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  5. Timeliness of abnormal screening and diagnostic mammography follow-up at facilities serving vulnerable women.

    PubMed

    Goldman, L Elizabeth; Walker, Rod; Hubbard, Rebecca; Kerlikowske, Karla

    2013-04-01

    Whether timeliness of follow-up after abnormal mammography differs at facilities serving vulnerable populations, such as women with limited education or income, in rural areas, and racial/ethnic minorities is unknown. We examined receipt of diagnostic evaluation after abnormal mammography using 1998-2006 Breast Cancer Surveillance Consortium-linked Medicare claims. We compared whether time to recommended breast imaging or biopsy depended on whether women attended facilities serving vulnerable populations. We characterized a facility by the proportion of mammograms performed on women with limited education or income, in rural areas, or racial/ethnic minorities. We analyzed 30,874 abnormal screening examinations recommended for follow-up imaging across 142 facilities and 10,049 abnormal diagnostic examinations recommended for biopsy across 114 facilities. Women at facilities serving populations with less education or more racial/ethnic minorities had lower rates of follow-up imaging (4%-5% difference, P<0.05), and women at facilities serving more rural and low-income populations had lower rates of biopsy (4%-5% difference, P<0.05). Women undergoing biopsy at facilities serving vulnerable populations had longer times until biopsy than those at facilities serving nonvulnerable populations (21.6 vs. 15.6 d; 95% confidence interval for mean difference 4.1-7.7). The proportion of women receiving recommended imaging within 11 months and biopsy within 3 months varied across facilities (interquartile range, 85.5%-96.5% for imaging and 79.4%-87.3% for biopsy). Among Medicare recipients, follow-up rates were slightly lower at facilities serving vulnerable populations, and among those women who returned for diagnostic evaluation, time to follow-up was slightly longer at facilities that served vulnerable population. Interventions should target variability in follow-up rates across facilities, and evaluate effectiveness particularly at facilities serving vulnerable populations.

  6. Transplant recipients are vulnerable to coverage denial under Medicare Part D.

    PubMed

    Potter, Lisa M; Maldonado, Angela Q; Lentine, Krista L; Schnitzler, Mark A; Zhang, Zidong; Hess, Gregory P; Garrity, Edward; Kasiske, Bertram L; Axelrod, David A

    2018-02-15

    Transplant immunosuppressants are often used off-label because of insufficient randomized prospective trial data to achieve organ-specific US Food and Drug Administration (FDA) approval. Transplant recipients who rely on Medicare Part D for immunosuppressant drug coverage are vulnerable to coverage denial for off-label prescriptions, unless use is supported by Centers for Medicare & Medicaid Services (CMS)-approved compendia. An integrated dataset including national transplant registry data and 3 years of dispensed pharmacy records was used to identify the prevalence of immunosuppression use that is both off-label and not supported by CMS-approved compendia. Numbers of potentially vulnerable transplant recipients were identified. Off-label and off-compendia immunosuppression regimens are frequently prescribed (3-year mean: lung 66.5%, intestine 34.2%, pancreas 33.4%, heart 21.8%, liver 16.5%, kidney 0%). The annual retail cost of these at-risk medications exceeds $30 million. This population-based study of transplant immunosuppressants vulnerable to claim denials under Medicare Part D coverage demonstrates a substantial gap between clinical practice, current FDA approval processes, and policy mandates for pharmaceutical coverage. This coverage barrier reduces access to life-saving medications for patients without alternative resources and may increase the risk of graft loss and death from medication nonadherence. © 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.

  7. Vulnerability analysis methods for road networks

    NASA Astrophysics Data System (ADS)

    Bíl, Michal; Vodák, Rostislav; Kubeček, Jan; Rebok, Tomáš; Svoboda, Tomáš

    2014-05-01

    steps can be taken in order to make it more resilient. Performing such an analysis of network break-ups requires consideration of the network as a whole, ideally identifying all the cases generated by simultaneous closure of multiple links and evaluating them using various criteria. The spatial distribution of settlements, important companies and the overall population in the nodes of the network are several factors, apart from the topology of the network which could be taken into account when computing vulnerability indices and identifying the weakest links and/or weakest link combinations. However, even for small networks (i.e., hundreds of nodes and links), the problem of break-up identification becomes extremely difficult to resolve. The naive approaches of the brute force examination consequently fail and more elaborated algorithms have to be applied. We address the problem of evaluating the vulnerability of road networks in our work by simulating the impacts of the simultaneous closure of multiple roads/links. We present an ongoing work on a sophisticated algorithm focused on the identification of network break-ups and evaluating them by various criteria.

  8. African American Female Offender’s Use of Alternative and Traditional Health Services After Re-Entry: Examining the Behavioral Model for Vulnerable Populations

    PubMed Central

    Oser, Carrie B.; Bunting, Amanda M.; Pullen, Erin; Stevens-Watkins, Danelle

    2016-01-01

    This is the first known study to use the Gelberg-Andersen Behavioral Model for Vulnerable Populations to predict African American women’s use of three types of health services (alternative, hospitalization, and ambulatory) in the 18 months after release from prison. In the multivariate models, the most robust predictors of all three types of service utilization were in the vulnerable theoretical domains. Alternative health services were predicted by ethnic community membership, higher religiosity, and HIV/HCV. Hospitalizations were predicted by the lack of barriers to health care and disability. Ambulatory office visits were predicted by more experiences of gendered racism, a greater number of physical health problems, and HIV/HCV. Findings highlight the importance of cultural factors and HIV/HCV in obtaining both alternative and formal health care during community re-entry. Clinicians and policy makers should consider the salient role that the vulnerable domain plays in offender’s accessing health services. PMID:27133515

  9. Folate and Vitamin B12 Deficiency Among Non-pregnant Women of Childbearing-Age in Guatemala 2009-2010: Prevalence and Identification of Vulnerable Populations.

    PubMed

    Rosenthal, Jorge; Lopez-Pazos, Eunice; Dowling, Nicole F; Pfeiffer, Christine M; Mulinare, Joe; Vellozzi, Claudia; Zhang, Mindy; Lavoie, Donna J; Molina, Roberto; Ramirez, Nicte; Reeve, Mary-Elizabeth

    2015-10-01

    Information on folate and vitamin B12 deficiency rates in Guatemala is essential to evaluate the current fortification program. The objectives of this study were to describe the prevalence of folate and vitamin B12 deficiencies among women of childbearing age (WCBA) in Guatemala and to identify vulnerable populations at greater risk for nutrient deficiency. A multistage cluster probability study was designed with national and regional representation of nonpregnant WCBA (15-49 years of age). Primary data collection was carried out in 2009-2010. Demographic and health information was collected through face-to-face interviews. Blood samples were collected from 1473 WCBA for serum and red blood cell (RBC) folate and serum vitamin B12. Biochemical concentrations were normalized using geometric means. Prevalence rate ratios were estimated to assess relative differences among different socioeconomic and cultural groups including ethnicity, age, education level, wealth index and rural versus urban locality. National prevalence estimates for deficient serum [<10 nmol per liter (nmol/L)] and RBC folate (<340 nmol/L) concentrations were 5.1 % (95 % CI 3.8, 6.4) and 8.9 % (95 % CI 6.7, 11.7), respectively; for vitamin B12 deficiency (<148 pmol/L) 18.5 % (95 % CI 15.6, 21.3). Serum and RBC folate deficiency prevalences were higher for rural areas than for urban areas (8.0 vs. 2.0 % and 13.5 vs. 3.9 %, respectively). The prevalence of RBC folate deficiency showed wide variation by geographic region (3.2-24.9 %) and by wealth index (4.1-15.1 %). The prevalence of vitamin B12 deficiency also varied among regions (12.3-26.1 %). In Guatemala, folate deficiency was more prevalent among indigenous rural and urban poor populations. Vitamin B12 deficiency was widespread among WCBA. Our results suggest the ongoing need to monitor existing fortification programs, in particular regarding its reach to vulnerable populations.

  10. Folate and Vitamin B12 Deficiency Among Nonpregnant Women of Childbearing Age in Guatemala 2009–2010: Prevalence and Identification of Vulnerable Populations

    PubMed Central

    Rosenthal, Jorge; Lopez-Pazos, Eunice; Dowling, Nicole F.; Pfeiffer, Christine M.; Mulinare, Joe; Vellozzi, Claudia; Zhang, Mindy; Lavoie, Donna J; Molina, Roberto; Ramirez, Nicte; Reeve, Mary-Elizabeth

    2015-01-01

    Introduction Information on folate and vitamin B12 deficiency rates in Guatemala is essential to evaluate the current fortification program. The objectives of this study were to describe the prevalence of folate and vitamin B12 deficiencies among women of childbearing age (WCBA) in Guatemala and to identify vulnerable populations at greater risk for nutrient deficiency. Methods A multistage cluster probability study was designed with national and regional representation of nonpregnant WCBA (15–49 years of age). Primary data collection was carried out in 2009–2010. Demographic and health information was collected through face-to-face interviews. Blood samples were collected from 1,473 WCBA for serum and red blood cell (RBC) folate and serum vitamin B12. Biochemical concentrations were normalized using geometric means. Prevalence rate ratios were estimated to assess relative differences among different socioeconomic and cultural groups including ethnicity, age, education level, wealth index and rural versus urban locality. Results National prevalence estimates for deficient serum (<10 nanomoles per liter [nmol/L]) and RBC folate (<340 nmol/L) concentrations were 5.1% (95% CI 3.8, 6.4) and 8.9% (95% CI 6.7, 11.7), respectively; for vitamin B12 deficiency (<148 pmol/L) 18.5% (95% CI 15.6, 21.3). Serum and RBC folate deficiency prevalences were higher for rural areas than for urban areas (8.0% vs. 2.0% and 13.5% vs. 3.9%, respectively). The prevalence of RBC folate deficiency showed wide variation by geographic region (3.2%–24.9%) and by wealth index (4.1%–15.1%). The prevalence of vitamin B12 deficiency also varied among regions (12.3% –26.1%). Conclusions In Guatemala, folate deficiency was more prevalent among indigenous rural and urban poor populations. Vitamin B12 deficiency was widespread among WCBA. Our results suggest the ongoing need to monitor existing fortification programs, in particular regarding its reach to vulnerable populations. PMID:26002178

  11. [Elderlies in street situation or social vulnerability: facilities and difficulties in the use of computational tools].

    PubMed

    Frias, Marcos Antonio da Eira; Peres, Heloisa Helena Ciqueto; Pereira, Valclei Aparecida Gandolpho; Negreiros, Maria Célia de; Paranhos, Wana Yeda; Leite, Maria Madalena Januário

    2014-01-01

    This study aimed to identify the advantages and difficulties encountered by older people living on the streets or social vulnerability, to use the computer or internet. It is an exploratory qualitative research, in which five elderlies, attended on a non-governmental organization located in the city of São Paulo, have participated. The discourses were analyzed by content analysis technique and showed, as facilities, among others, to clarify doubts with the monitors, the stimulus for new discoveries coupled with proactivity and curiosity, and develop new skills. The mentioned difficulties were related to physical or cognitive issues, lack of instructor, and lack of knowledge to interact with the machine. The studies focusing on the elderly population living on the streets or in social vulnerability may contribute with evidence to guide the formulation of public policies to this population.

  12. Enhancing the relevance of new scenarios for climate change impacts, adaptation and vulnerability research

    NASA Astrophysics Data System (ADS)

    van Ruijven, B. J.

    2013-12-01

    Over the past three decades, scenario analyses have occupied a central role in assessments of the potential impacts of climate change on natural and human systems at different scales during the 21st century. Here, we discuss the role and relevance of new scenarios using shared socioeconomic pathways (SSPs) and representative concentration pathways (RCPs) for climate change impacts, adaptation, and vulnerability (IAV) research. It first provides an overview of uses of social-environmental scenarios in IAV studies and identifies the main shortcomings of earlier such scenarios. Second, the paper elaborates on two aspects of new scenarios needing to be improved in order to enhance their usefulness for IAV studies: the ability to work coherently across spatial scales and adding indicators of importance to projections of vulnerability and adaptive capacity in addition to standard indicators of population and gross domestic product. This paper presents a research agenda to add income distribution, spatial population, human health projections, and governance indicators to the new scenarios.

  13. Evaluating County-Level Heat Vulnerability and Social Inequity in the United States through Climate and Socioeconomic Indices

    NASA Astrophysics Data System (ADS)

    Gannon, C.

    2016-12-01

    Climate change will have many impacts on human health, perhaps most directly through extreme heat. High temperature and humidity combinations inhibit the body's ability to cool through physiological responses such as sweating. In conjunction with extended periods of extreme heat and shifted seasonality, these conditions are particularly dangerous. Current research and literature can be used to show where dangerous heat and humidity conditions are likely to be most prevalent, or where populations vulnerable to heat stress reside. To provide a better assessment of overall heat vulnerability, however, many complex factors, such as relative changes in temperature patterns or local socioeconomic conditions, must also be considered. Here, we utilize a multivariate approach to establish county-level risk scores by combining the most relevant indicators for heat vulnerability with climate model projections of wet bulb globe temperature, a metric useful for understanding how the human body will respond to conditions of high heat and humidity. We present our findings as an ESRI ArcOnline Story Map with data aggregated at the county-level in the continental United States. This format allows users to access maps showing each county's score in four categories related to heat vulnerability: heat and humidity hazards, population vulnerability, medical access, and physical infrastructure. A final map showcases a composite heat vulnerability score for each county, with comparisons to state and national averages. Our tool, part of the White House's Climate Data Initiative, is presented as a series of maps with a normalized scoring system to provide clear and easy access to the indicators most relevant to evaluating heat vulnerability at a local level. Ultimately, this readily available tool with general indices helps community decision makers communicate heat vulnerability and identify which resilience factors are most critical to improving local resilience.

  14. Assessing the security vulnerabilities of correctional facilities

    NASA Astrophysics Data System (ADS)

    Spencer, Debra D.; Morrison, G. Steve

    1998-12-01

    The National Institute of Justice has tasked their satellite facility at Sandia National Laboratories and their Southeast Regional Technology Center in Charleston, South Carolina to devise new procedures and tools for helping correctional facilities to assess their security vulnerabilities. Thus, a team is visiting selected correctional facilities and performing vulnerability assessments. A vulnerability assessment helps identify the easiest paths for inmate escape, for introduction of contraband such as drugs or weapons, for unexpected intrusion from outside of the facility, and for the perpetration of violent acts on other inmates and correctional employees. In addition, the vulnerability assessment helps to quantify the security risks for the facility. From these assessments will come better procedures for performing vulnerability assessments in general at other correctional facilities, as well as the development of tools to assist with the performance of such vulnerability assessments.

  15. Hydrologic Variability Governs Population Dynamics of a Vulnerable Amphibian in an Arid Environment

    PubMed Central

    Zylstra, Erin R.; Steidl, Robert J.; Swann, Don E.; Ratzlaff, Kristina

    2015-01-01

    Dynamics of many amphibian populations are governed by the distribution and availability of water. Therefore, understanding the hydrological mechanisms that explain spatial and temporal variation in occupancy and abundance will improve our ability to conserve and recover populations of vulnerable amphibians. We used 16 years of survey data from intermittent mountain streams in the Sonoran Desert to evaluate how availability of surface water affected survival and adult recruitment of a threatened amphibian, the lowland leopard frog (Lithobates yavapaiensis). Across the entire study period, monthly survival of adults ranged from 0.72 to 0.99 during summer and 0.59 to 0.94 during winter and increased with availability of surface water (Z = 7.66; P < 0.01). Recruitment of frogs into the adult age class occurred primarily during winter and ranged from 1.9 to 3.8 individuals/season/pool; like survival, recruitment increased with availability of surface water (Z = 3.67; P < 0.01). Although abundance of frogs varied across seasons and years, we found no evidence of a systematic trend during the 16-year study period. Given the strong influence of surface water on population dynamics of leopard frogs, conservation of many riparian obligates in this and similar arid regions likely depends critically on minimizing threats to structures and ecosystem processes that maintain surface waters. Understanding the influence of surface-water availability on riparian organisms is particularly important because climate change is likely to decrease precipitation and increase ambient temperatures in desert riparian systems, both of which have the potential to alter fundamentally the hydrology of these systems. PMID:26030825

  16. Different preventions methods lead to different choices? Questions on HIV/AIDS prevention for men who have sex with men and other vulnerable populations.

    PubMed

    Terto, Veriano

    2015-09-01

    On the basis of an ethnographic narrative on sexual interactions observed in urban parks in large Brazilian cities, the article discusses the adoption of new strategies and methods for AIDS prevention in vulnerable populations, especially in men who have sex with men (MSM). By following some guiding questions, the text debates when, why, with whom, and in which context the new prevention methods should be adopted. It emphasizes, in agreement to the initial narrative, the importance of taking into account the prevention strategies created by the population itself to manage HIV risk infection. It also addresses how prevention practices and messages are adapted and recreated by individuals and groups in an attempt to suit them to their sexual desires, practices, and choices. In this perspective, the article recommends the inclusion of the experiences and voices of individuals and groups considered vulnerable in the new AIDS prevention methods and programs targeted to them.

  17. Considering Time-Dependency of Social Vulnerability in Crisis Modeling and Management

    NASA Astrophysics Data System (ADS)

    Aubrecht, C.; Steinnocher, K.; Freire, S.; Loibl, W.; Peters-Anders, J.; Ungar, J.

    2012-04-01

    and emergency management. The vulnerability of each relevant element at risk, including human beings and society in general and its time-dependent variation is characterized both by its pre-event status and by its possible evolution during a crisis. Particularly in metropolitan areas, the spatial distribution of population is highly time-dependent due to human activities and mobility. Identifying distinct day-/nighttime population distribution characteristics is a major improvement compared to standard residence-based models, but does however only display part of reality. New technologies and data processing capabilities allow moving into the field of real-time representation of human movement. The focus of this contribution will be on illustrating, through project examples and by putting it in an emergency and crisis management context, two main categories, (1) the mapping of cell phone user activity, and (2) the use of volunteered geographic information (VGI).

  18. Mapping malaria risk and vulnerability in the United Republic of Tanzania: a spatial explicit model.

    PubMed

    Hagenlocher, Michael; Castro, Marcia C

    2015-01-01

    Outbreaks of vector-borne diseases (VBDs) impose a heavy burden on vulnerable populations. Despite recent progress in eradication and control, malaria remains the most prevalent VBD. Integrative approaches that take into account environmental, socioeconomic, demographic, biological, cultural, and political factors contributing to malaria risk and vulnerability are needed to effectively reduce malaria burden. Although the focus on malaria risk has increasingly gained ground, little emphasis has been given to develop quantitative methods for assessing malaria risk including malaria vulnerability in a spatial explicit manner. Building on a conceptual risk and vulnerability framework, we propose a spatial explicit approach for modeling relative levels of malaria risk - as a function of hazard, exposure, and vulnerability - in the United Republic of Tanzania. A logistic regression model was employed to identify a final set of risk factors and their contribution to malaria endemicity based on multidisciplinary geospatial information. We utilized a Geographic Information System for the construction and visualization of a malaria vulnerability index and its integration into a spatially explicit malaria risk map. The spatial pattern of malaria risk was very heterogeneous across the country. Malaria risk was higher in Mainland areas than in Zanzibar, which is a result of differences in both malaria entomological inoculation rate and prevailing vulnerabilities. Areas of high malaria risk were identified in the southeastern part of the country, as well as in two distinct "hotspots" in the northwestern part of the country bordering Lake Victoria, while concentrations of high malaria vulnerability seem to occur in the northwestern, western, and southeastern parts of the mainland. Results were visualized using both 10×10 km(2) grids and subnational administrative units. The presented approach makes an important contribution toward a decision support tool. By decomposing malaria

  19. Current & future vulnerability of sarasota county Florida to hurricane storm surge & sea level rise

    USGS Publications Warehouse

    Frazier, T.; Wood, N.; Yarnal, B.

    2008-01-01

    Coastal communities in portions of the United States are vulnerable to storm-surge inundation from hurricanes and this vulnerability will likely increase, given predicted rises in sea level from climate change and growing coastal development. In this paper, we provide an overview of research to determine current and future societal vulnerability to hurricane storm-surge inundation and to help public officials and planners integrate these scenarios into their long-range land use plans. Our case study is Sarasota County, Florida, where planners face the challenge of balancing increasing population growth and development with the desire to lower vulnerability to storm surge. Initial results indicate that a large proportion of Sarasota County's residential and employee populations are in areas prone to storm-surge inundation from a Category 5 hurricane. This hazard zone increases when accounting for potential sea-level-rise scenarios, thereby putting additional populations at risk. Subsequent project phases involve the development of future land use and vulnerability scenarios in collaboration with local officials. Copyright ASCE 2008.

  20. Assessing the social vulnerability to malaria in Rwanda.

    PubMed

    Bizimana, Jean-Pierre; Twarabamenye, Emmanuel; Kienberger, Stefan

    2015-01-07

    Since 2004, malaria interventions in Rwanda have resulted in substantial decline of malaria incidence. However, this achievement is fragile as potentials for local malaria transmissions remain. The risk of getting malaria infection is partially explained by social conditions of vulnerable populations. Since vulnerability to malaria is both influenced by social and environmental factors, its complexity cannot be measured by a single value. The aim of this paper is, therefore, to apply a composite indicator approach for assessing social vulnerability to malaria in Rwanda. This assessment informs the decision-makers in targeting malaria interventions and allocating limited resources to reduce malaria burden in Rwanda. A literature review was used to conceptualize the social vulnerability to malaria and to select the appropriate vulnerability indicators. Indicators used in the index creation were classified into susceptibility and lack of resilience vulnerability domains. The main steps followed include selection of indicators and datasets, imputation of missing values, descriptive statistics, normalization and weighting of indicators, local sensitivity analysis and indicators aggregation. Correlation analysis helped to empirically evidence the association between the indicators and malaria incidence. The high values of social vulnerability to malaria are found in Gicumbi, Rusizi, Nyaruguru and Gisagara, and low values in Muhanga, Nyarugenge, Kicukiro and Nyanza. The most influential susceptibility indicators to increase malaria are population change (r = 0.729), average number of persons per bedroom (r = 0.531), number of households affected by droughts and famines (r = 0.591), and area used for irrigation (r = 0.611). The bed net ownership (r = -0.398) and poor housing wall materials (0.378) are the lack of resilience indicators that significantly correlate with malaria incidence. The developed composite index social vulnerability to malaria

  1. Exploring spatial patterns of vulnerability for diverse biodiversity descriptors in regional conservation planning.

    PubMed

    Vimal, Ruppert; Pluvinet, Pascal; Sacca, Céline; Mazagol, Pierre-Olivier; Etlicher, Bernard; Thompson, John D

    2012-03-01

    In this study, we developed a multi-criteria assessment of spatial variability of the vulnerability of three different biodiversity descriptors: sites of high conservation interest by virtue of the presence of rare or remarkable species, extensive areas of high ecological integrity, and landscape diversity in grid cells across an entire region. We assessed vulnerability in relation to (a) direct threats in and around sites to a distance of 2 km associated with intensive agriculture, building and road infrastructure and (b) indirect effects of human population density on a wider scale (50 km). The different combinations of biodiversity and threat indicators allowed us to set differential priorities for biodiversity conservation and assess their spatial variation. For example, with this method we identified sites and grid cells which combined high biodiversity with either high threat values or low threat values for the three different biodiversity indicators. In these two classes the priorities for conservation planning will be different, reduce threat values in the former and restrain any increase in the latter. We also identified low priority sites (low biodiversity with either high or low threats). This procedure thus allows for the integration of a spatial ranking of vulnerability into priority setting for regional conservation planning. Copyright © 2011 Elsevier Ltd. All rights reserved.

  2. Physicians' Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities.

    PubMed

    Yasaitis, Laura C; Pajerowski, William; Polsky, Daniel; Werner, Rachel M

    2016-08-01

    Early evidence suggested that accountable care organizations (ACOs) could improve health care quality while constraining costs, and ACOs are expanding throughout the United States. However, if disadvantaged patients have unequal access to physicians who participate in ACOs, that expansion may exacerbate health care disparities. We examined the relationship between physicians' participation in both Medicare and commercial ACOs across the country and the sociodemographic characteristics of their likely patient populations. Physicians' participation in ACOs varied widely across hospital referral regions, from nearly 0 percent to over 85 percent. After we adjusted for individual physician and practice characteristics, we found that physicians who practiced in ZIP Code Tabulation Areas where a higher percentage of the population was black, living in poverty, uninsured, or disabled or had less than a high school education-compared to other areas-had significantly lower rates of ACO participation than other physicians. Our findings suggest that vulnerable populations' access to physicians participating in ACOs may not be as great as access for other groups, which could exacerbate existing disparities in health care quality. Project HOPE—The People-to-People Health Foundation, Inc.

  3. Mapping vulnerability to climate change and its repercussions on human health in Pakistan

    PubMed Central

    2012-01-01

    Background Pakistan is highly vulnerable to climate change due to its geographic location, high dependence on agriculture and water resources, low adaptive capacity of its people, and weak system of emergency preparedness. This paper is the first ever attempt to rank the agro-ecological zones in Pakistan according to their vulnerability to climate change and to identify the potential health repercussions of each manifestation of climate change in the context of Pakistan. Methods A climate change vulnerability index is constructed as an un-weighted average of three sub-indices measuring (a) the ecological exposure of each region to climate change, (b) sensitivity of the population to climate change and (c) the adaptive capacity of the population inhabiting a particular region. The regions are ranked according to the value of this index and its components. Since health is one of the most important dimensions of human wellbeing, this paper also identifies the potential health repercussions of each manifestations of climate change and links it with the key manifestations of climate change in the context of Pakistan. Results The results indicate that Balochistan is the most vulnerable region with high sensitivity and low adaptive capacity followed by low-intensity Punjab (mostly consisting of South Punjab) and Cotton/Wheat Sindh. The health risks that each of these regions face depend upon the type of threat that they face from climate change. Greater incidence of flooding, which may occur due to climate variability, poses the risk of diarrhoea and gastroenteritis; skin and eye Infections; acute respiratory infections; and malaria. Exposure to drought poses the potential health risks in the form of food insecurity and malnutrition; anaemia; night blindness; and scurvy. Increases in temperature pose health risks of heat stroke; malaria; dengue; respiratory diseases; and cardiovascular diseases. Conclusion The study concludes that geographical zones that are more exposed

  4. Mapping vulnerability to climate change and its repercussions on human health in Pakistan.

    PubMed

    Malik, Sadia Mariam; Awan, Haroon; Khan, Niazullah

    2012-09-03

    Pakistan is highly vulnerable to climate change due to its geographic location, high dependence on agriculture and water resources, low adaptive capacity of its people, and weak system of emergency preparedness. This paper is the first ever attempt to rank the agro-ecological zones in Pakistan according to their vulnerability to climate change and to identify the potential health repercussions of each manifestation of climate change in the context of Pakistan. A climate change vulnerability index is constructed as an un-weighted average of three sub-indices measuring (a) the ecological exposure of each region to climate change, (b) sensitivity of the population to climate change and (c) the adaptive capacity of the population inhabiting a particular region. The regions are ranked according to the value of this index and its components. Since health is one of the most important dimensions of human wellbeing, this paper also identifies the potential health repercussions of each manifestations of climate change and links it with the key manifestations of climate change in the context of Pakistan. The results indicate that Balochistan is the most vulnerable region with high sensitivity and low adaptive capacity followed by low-intensity Punjab (mostly consisting of South Punjab) and Cotton/Wheat Sindh. The health risks that each of these regions face depend upon the type of threat that they face from climate change. Greater incidence of flooding, which may occur due to climate variability, poses the risk of diarrhoea and gastroenteritis; skin and eye Infections; acute respiratory infections; and malaria. Exposure to drought poses the potential health risks in the form of food insecurity and malnutrition; anaemia; night blindness; and scurvy. Increases in temperature pose health risks of heat stroke; malaria; dengue; respiratory diseases; and cardiovascular diseases. The study concludes that geographical zones that are more exposed to climate change in ecological and

  5. Assessment of Vulnerability to Coccidioidomycosis in Arizona and California.

    PubMed

    Shriber, Jennifer; Conlon, Kathryn C; Benedict, Kaitlin; McCotter, Orion Z; Bell, Jesse E

    2017-06-23

    Coccidioidomycosis is a fungal infection endemic to the southwestern United States, particularly Arizona and California. Its incidence has increased, potentially due in part to the effects of changing climatic variables on fungal growth and spore dissemination. This study aims to quantify the county-level vulnerability to coccidioidomycosis in Arizona and California and to assess the relationships between population vulnerability and climate variability. The variables representing exposure, sensitivity, and adaptive capacity were combined to calculate county level vulnerability indices. Three methods were used: (1) principal components analysis; (2) quartile weighting; and (3) percentile weighting. Two sets of indices, "unsupervised" and "supervised", were created. Each index was correlated with coccidioidomycosis incidence data from 2000-2014. The supervised percentile index had the highest correlation; it was then correlated with variability measures for temperature, precipitation, and drought. The supervised percentile index was significantly correlated ( p < 0.05) with coccidioidomycosis incidence in both states. Moderate, positive significant associations ( p < 0.05) were found between index scores and climate variability when both states were concurrently analyzed and when California was analyzed separately. This research adds to the body of knowledge that could be used to target interventions to vulnerable counties and provides support for the hypothesis that population vulnerability to coccidioidomycosis is associated with climate variability.

  6. Assessment of Vulnerability to Coccidioidomycosis in Arizona and California

    PubMed Central

    Conlon, Kathryn C.; Benedict, Kaitlin; McCotter, Orion Z.; Bell, Jesse E.

    2017-01-01

    Coccidioidomycosis is a fungal infection endemic to the southwestern United States, particularly Arizona and California. Its incidence has increased, potentially due in part to the effects of changing climatic variables on fungal growth and spore dissemination. This study aims to quantify the county-level vulnerability to coccidioidomycosis in Arizona and California and to assess the relationships between population vulnerability and climate variability. The variables representing exposure, sensitivity, and adaptive capacity were combined to calculate county level vulnerability indices. Three methods were used: (1) principal components analysis; (2) quartile weighting; and (3) percentile weighting. Two sets of indices, “unsupervised” and “supervised”, were created. Each index was correlated with coccidioidomycosis incidence data from 2000–2014. The supervised percentile index had the highest correlation; it was then correlated with variability measures for temperature, precipitation, and drought. The supervised percentile index was significantly correlated (p < 0.05) with coccidioidomycosis incidence in both states. Moderate, positive significant associations (p < 0.05) were found between index scores and climate variability when both states were concurrently analyzed and when California was analyzed separately. This research adds to the body of knowledge that could be used to target interventions to vulnerable counties and provides support for the hypothesis that population vulnerability to coccidioidomycosis is associated with climate variability. PMID:28644403

  7. Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review

    PubMed Central

    Kim, Kyounghae; Choi, Janet S.; Choi, Eunsuk; Nieman, Carrie L.; Joo, Jin Hui; Lin, Frank R.; Gitlin, Laura N.

    2016-01-01

    Background. Community-based health workers (CBHWs) are frontline public health workers who are trusted members of the community they serve. Recently, considerable attention has been drawn to CBHWs in promoting healthy behaviors and health outcomes among vulnerable populations who often face health inequities. Objectives. We performed a systematic review to synthesize evidence concerning the types of CBHW interventions, the qualification and characteristics of CBHWs, and patient outcomes and cost-effectiveness of such interventions in vulnerable populations with chronic, noncommunicable conditions. Search methods. We undertook 4 electronic database searches—PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane—and hand searched reference collections to identify randomized controlled trials published in English before August 2014. Selection. We screened a total of 934 unique citations initially for titles and abstracts. Two reviewers then independently evaluated 166 full-text articles that were passed onto review processes. Sixty-one studies and 6 companion articles (e.g., cost-effectiveness analysis) met eligibility criteria for inclusion. Data collection and analysis. Four trained research assistants extracted data by using a standardized data extraction form developed by the authors. Subsequently, an independent research assistant reviewed extracted data to check accuracy. Discrepancies were resolved through discussions among the study team members. Each study was evaluated for its quality by 2 research assistants who extracted relevant study information. Interrater agreement rates ranged from 61% to 91% (average 86%). Any discrepancies in terms of quality rating were resolved through team discussions. Main results. All but 4 studies were conducted in the United States. The 2 most common areas for CBHW interventions were cancer prevention (n = 30) and cardiovascular disease risk reduction (n = 26). The roles assumed by

  8. Vulnerability

    NASA Technical Reports Server (NTRS)

    Taback, I.

    1979-01-01

    The discussion of vulnerability begins with a description of some of the electrical characteristics of fibers before definiting how vulnerability calculations are done. The vulnerability results secured to date are presented. The discussion touches on post exposure vulnerability. After a description of some shock hazard work now underway, the discussion leads into a description of the planned effort and some preliminary conclusions are presented.

  9. Psychiatric Residents' Needs for Education about Informed Consent, Principles of Ethics and Professionalism, and Caring for Vulnerable Populations: Results of a Multisite Survey

    ERIC Educational Resources Information Center

    Jain, Shaili; Lapid, Maria I.; Dunn, Laura B.; Roberts, Laura Weiss

    2011-01-01

    Objective: The authors examined psychiatric residents' perceived needs for education in informed consent, principles of ethics and professionalism, and treating vulnerable populations. Method: A written survey was distributed to psychiatric residents (N = 249) at seven U.S. residency programs in 2005. The survey contained 149 questions in 10…

  10. Assessing species vulnerability to climate change

    NASA Astrophysics Data System (ADS)

    Pacifici, Michela; Foden, Wendy B.; Visconti, Piero; Watson, James E. M.; Butchart, Stuart H. M.; Kovacs, Kit M.; Scheffers, Brett R.; Hole, David G.; Martin, Tara G.; Akçakaya, H. Resit; Corlett, Richard T.; Huntley, Brian; Bickford, David; Carr, Jamie A.; Hoffmann, Ary A.; Midgley, Guy F.; Pearce-Kelly, Paul; Pearson, Richard G.; Williams, Stephen E.; Willis, Stephen G.; Young, Bruce; Rondinini, Carlo

    2015-03-01

    The effects of climate change on biodiversity are increasingly well documented, and many methods have been developed to assess species' vulnerability to climatic changes, both ongoing and projected in the coming decades. To minimize global biodiversity losses, conservationists need to identify those species that are likely to be most vulnerable to the impacts of climate change. In this Review, we summarize different currencies used for assessing species' climate change vulnerability. We describe three main approaches used to derive these currencies (correlative, mechanistic and trait-based), and their associated data requirements, spatial and temporal scales of application and modelling methods. We identify strengths and weaknesses of the approaches and highlight the sources of uncertainty inherent in each method that limit projection reliability. Finally, we provide guidance for conservation practitioners in selecting the most appropriate approach(es) for their planning needs and highlight priority areas for further assessments.

  11. Density-dependent vulnerability of forest ecosystems to drought

    USGS Publications Warehouse

    Bottero, Alessandra; D'Amato, Anthony W.; Palik, Brian J.; Bradford, John B.; Fraver, Shawn; Battaglia, Mike A.; Asherin, Lance A.

    2017-01-01

    1. Climate models predict increasing drought intensity and frequency for many regions, which may have negative consequences for tree recruitment, growth and mortality, as well as forest ecosystem services. Furthermore, practical strategies for minimizing vulnerability to drought are limited. Tree population density, a metric of tree abundance in a given area, is a primary driver of competitive intensity among trees, which influences tree growth and mortality. Manipulating tree population density may be a mechanism for moderating drought-induced stress and growth reductions, although the relationship between tree population density and tree drought vulnerability remains poorly quantified, especially across climatic gradients.2. In this study, we examined three long-term forest ecosystem experiments in two widely distributed North American pine species, ponderosa pine Pinus ponderosa (Lawson & C. Lawson) and red pine Pinus resinosa (Aiton), to better elucidate the relationship between tree population density, growth and drought. These experiments span a broad latitude and aridity range and include tree population density treatments that have been purposefully maintained for several decades. We investigated how tree population density influenced resistance (growth during drought) and resilience (growth after drought compared to pre-drought growth) of stand-level growth during and after documented drought events.3. Our results show that relative tree population density was negatively related to drought resistance and resilience, indicating that trees growing at lower densities were less vulnerable to drought. This result was apparent in all three forest ecosystems, and was consistent across species, stand age and drought intensity.4. Synthesis and applications. Our results highlighted that managing pine forest ecosystems at low tree population density represents a promising adaptive strategy for reducing the adverse impacts of drought on forest growth in coming decades

  12. Estimating population extinction thresholds with categorical classification trees for Louisiana black bears

    USGS Publications Warehouse

    Laufenberg, Jared S.; Clark, Joseph D.; Chandler, Richard B.

    2018-01-01

    Monitoring vulnerable species is critical for their conservation. Thresholds or tipping points are commonly used to indicate when populations become vulnerable to extinction and to trigger changes in conservation actions. However, quantitative methods to determine such thresholds have not been well explored. The Louisiana black bear (Ursus americanus luteolus) was removed from the list of threatened and endangered species under the U.S. Endangered Species Act in 2016 and our objectives were to determine the most appropriate parameters and thresholds for monitoring and management action. Capture mark recapture (CMR) data from 2006 to 2012 were used to estimate population parameters and variances. We used stochastic population simulations and conditional classification trees to identify demographic rates for monitoring that would be most indicative of heighted extinction risk. We then identified thresholds that would be reliable predictors of population viability. Conditional classification trees indicated that annual apparent survival rates for adult females averaged over 5 years () was the best predictor of population persistence. Specifically, population persistence was estimated to be ≥95% over 100 years when , suggesting that this statistic can be used as threshold to trigger management intervention. Our evaluation produced monitoring protocols that reliably predicted population persistence and was cost-effective. We conclude that population projections and conditional classification trees can be valuable tools for identifying extinction thresholds used in monitoring programs.

  13. Estimating population extinction thresholds with categorical classification trees for Louisiana black bears.

    PubMed

    Laufenberg, Jared S; Clark, Joseph D; Chandler, Richard B

    2018-01-01

    Monitoring vulnerable species is critical for their conservation. Thresholds or tipping points are commonly used to indicate when populations become vulnerable to extinction and to trigger changes in conservation actions. However, quantitative methods to determine such thresholds have not been well explored. The Louisiana black bear (Ursus americanus luteolus) was removed from the list of threatened and endangered species under the U.S. Endangered Species Act in 2016 and our objectives were to determine the most appropriate parameters and thresholds for monitoring and management action. Capture mark recapture (CMR) data from 2006 to 2012 were used to estimate population parameters and variances. We used stochastic population simulations and conditional classification trees to identify demographic rates for monitoring that would be most indicative of heighted extinction risk. We then identified thresholds that would be reliable predictors of population viability. Conditional classification trees indicated that annual apparent survival rates for adult females averaged over 5 years ([Formula: see text]) was the best predictor of population persistence. Specifically, population persistence was estimated to be ≥95% over 100 years when [Formula: see text], suggesting that this statistic can be used as threshold to trigger management intervention. Our evaluation produced monitoring protocols that reliably predicted population persistence and was cost-effective. We conclude that population projections and conditional classification trees can be valuable tools for identifying extinction thresholds used in monitoring programs.

  14. [Social vulnerability is more frequent in victims of interpersonal violence: value of the EPICES score].

    PubMed

    Sass, Catherine; Belin, Sébastien; Chatain, Carine; Moulin, Jean-Jacques; Debout, Michel; Duband, Sébastien

    2009-06-01

    To evaluate social vulnerability of victims of interpersonal violence having consulted a service of forensic medicine with an individual index of social vulnerability. The population of victims of interpersonal violence was composed of 275 subjects having consulted the service of forensic medicine of the CHU of Saint Etienne. The social data were collected by questionnaire. Social vulnerability was measured by an individual index (EPICES) calculated on the basis of 11 weighted questions related to material and social deprivation. This population was compared with a reference population; the reference population was people, aged more than 16, living in the Rhône-Alpes region and examined in 2005 in one of the Health examination Centres (HECs) of the French General Health Insurance System, that is 7553 men and 6002 women. The comparisons between the two populations were made after redressing the population of the HECs on various socio-demographic data of the Rhône-Alpes region. The relations between violence and the variables studied were measured by odds ratios adjusted on age and sex. The population of the victims of violence is younger than the reference population (p<0.001). It is characterized by a lower level of education (p<0.001, 15% in the higher education level vs 23%) and the categories Employees and Manual workers are more frequent (p<0.001). The situation with respect to employment is also different between the two populations, unemployment rate is higher (OR=2.25) and the retired are fewer (OR=0.41). Subjects in social vulnerability are more frequent in the victims (57% vs 36%). All these differences persist after adjustment on age and sex. The context in which the aggression took place (family, public area or at work) varies significantly according to social vulnerability. On the other hand, the majority of the other medico-legal characteristics are not different according to the level of social vulnerability. The population of the victims of

  15. A Heat Vulnerability Index and Adaptation Solutions for Pittsburgh, Pennsylvania.

    PubMed

    Bradford, Kathryn; Abrahams, Leslie; Hegglin, Miriam; Klima, Kelly

    2015-10-06

    With increasing evidence of global warming, many cities have focused attention on response plans to address their populations' vulnerabilities. Despite expected increased frequency and intensity of heat waves, the health impacts of such events in urban areas can be minimized with careful policy and economic investments. We focus on Pittsburgh, Pennsylvania and ask two questions. First, what are the top factors contributing to heat vulnerability and how do these characteristics manifest geospatially throughout Pittsburgh? Second, assuming the City wishes to deploy additional cooling centers, what placement will optimally address the vulnerability of the at risk populations? We use national census data, ArcGIS geospatial modeling, and statistical analysis to determine a range of heat vulnerability indices and optimal cooling center placement. We find that while different studies use different data and statistical calculations, all methods tested locate additional cooling centers at the confluence of the three rivers (Downtown), the northeast side of Pittsburgh (Shadyside/Highland Park), and the southeast side of Pittsburgh (Squirrel Hill). This suggests that for Pittsburgh, a researcher could apply the same factor analysis procedure to compare data sets for different locations and times; factor analyses for heat vulnerability are more robust than previously thought.

  16. A Heat Vulnerability Index and Adaptation Solutions for Pittsburgh, Pennsylvania

    NASA Astrophysics Data System (ADS)

    Klima, K.; Abrahams, L.; Bradford, K.; Hegglin, M.

    2015-12-01

    With increasing evidence of global warming, many cities have focused attention on response plans to address their populations' vulnerabilities. Despite expected increased frequency and intensity of heat waves, the health impacts of such events in urban areas can be minimized with careful policy and economic investments. We focus on Pittsburgh, Pennsylvania and ask two questions. First, what are the top factors contributing to heat vulnerability and how do these characteristics manifest geospatially throughout Pittsburgh? Second, assuming the City wishes to deploy additional cooling centers, what placement will optimally address the vulnerability of the at risk populations? We use national census data, ArcGIS geospatial modeling, and statistical analysis to determine a range of heat vulnerability indices and optimal cooling center placement. We find that while different studies use different data and statistical calculations, all methods tested locate additional cooling centers at the confluence of the three rivers (Downtown), the northeast side of Pittsburgh (Shadyside/ Highland Park), and the southeast side of Pittsburgh (Squirrel Hill). This suggests that for Pittsburgh, a researcher could apply the same factor analysis procedure to compare datasets for different locations and times; factor analyses for heat vulnerability are more robust than previously thought.

  17. An atmospheric vulnerability assessment framework for environment management and protection based on CAMx.

    PubMed

    Zhang, Yang; Shen, Jing; Li, Yu

    2018-02-01

    This paper presents an atmospheric vulnerability assessment framework based on CAMx that should be helpful to assess potential impacts of changes in human, atmospheric environment, and social economic elements of atmospheric vulnerability. It is also a useful and effective tool that can provide policy-guidance for environmental protection and management to reduce the atmospheric vulnerability. The developed framework was applied to evaluate the atmospheric environment vulnerability of 13 cities in the Beijing-Tianjin-Hebei (BTH) region for verification. The results indicated that regional disparity of the atmospheric vulnerability existed in the study site. More specifically, the central and southern regions show more atmospheric environment vulnerability than the northern regions. The impact factors of atmospheric environment vulnerability in the BTH region mainly derived from increasing population press, frequently unfavorable meteorological conditions, extensive economic growth of secondary industry, increased environmental pollution, and accelerating population aging. The framework shown in this paper is an interpretative and heuristic tool for a better understanding of atmospheric vulnerability. This framework can also be replicated at different spatial and temporal scales using context-specific datasets to straightly support environmental managers with decision-making. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. The impact of legal vulnerability on environmental inequalities. A case study of coastal populations in Guadeloupe (French Antilles)

    NASA Astrophysics Data System (ADS)

    Claeys, Cécilia; Arnaud, Aurélie; Lambert, Marie-Laure

    2017-10-01

    This paper draws on sociology, geography and law to analyse the exposure of populations to coastal multihazards in a postcolonial and overseas context. The research is based on a case study conducted in two municipalities in Guadeloupe (French Antilles): Deshaies and Capesterre-Belle-Eau. The corpus of data consists of 52 interviews conducted with inhabitants and institutional actors, as well as a set of spatialized data and a regulatory corpus. The analysis underscores how public policies must contend with a complex territorial reality that is still bound to the postcolonial past and legacy of slavery in Guadeloupe. The potential contradictions between regularization policies, hazard prevention policies and policies to curb insalubrious housing tend to expose the most fragile populations to what we refer to here as legal vulnerability.

  19. Assessing local population vulnerability to wind energy development with branching process models: an application to wind energy development

    USGS Publications Warehouse

    Erickson, Richard A.; Eager, Eric A.; Stanton, Jessica C.; Beston, Julie A.; Diffendorfer, James E.; Thogmartin, Wayne E.

    2015-01-01

    Quantifying the impact of anthropogenic development on local populations is important for conservation biology and wildlife management. However, these local populations are often subject to demographic stochasticity because of their small population size. Traditional modeling efforts such as population projection matrices do not consider this source of variation whereas individual-based models, which include demographic stochasticity, are computationally intense and lack analytical tractability. One compromise between approaches is branching process models because they accommodate demographic stochasticity and are easily calculated. These models are known within some sub-fields of probability and mathematical ecology but are not often applied in conservation biology and applied ecology. We applied branching process models to quantitatively compare and prioritize species locally vulnerable to the development of wind energy facilities. Specifically, we examined species vulnerability using branching process models for four representative species: A cave bat (a long-lived, low fecundity species), a tree bat (short-lived, moderate fecundity species), a grassland songbird (a short-lived, high fecundity species), and an eagle (a long-lived, slow maturation species). Wind turbine-induced mortality has been observed for all of these species types, raising conservation concerns. We simulated different mortality rates from wind farms while calculating local extinction probabilities. The longer-lived species types (e.g., cave bats and eagles) had much more pronounced transitions from low extinction risk to high extinction risk than short-lived species types (e.g., tree bats and grassland songbirds). High-offspring-producing species types had a much greater variability in baseline risk of extinction than the lower-offspring-producing species types. Long-lived species types may appear stable until a critical level of incidental mortality occurs. After this threshold, the risk of

  20. Vulnerability of dynamic systems

    NASA Technical Reports Server (NTRS)

    Siljak, D. D.

    1976-01-01

    Directed graphs are associated with dynamic systems in order to determine in any given system if each state can be reached by at least one input (input reachability), or can each state reach at least one output (output reachability). Then, the structural perturbations of a dynamic system are identified as lines or points removals from the corresponding digraph, and a system is considered vulnerable at those lines or points of the digraph whose removal destroys its input or output reachability. A suitable framework is formulated for resolving the problems of reachability and vulnerability which applies to both linear and nonlinear systems alike.

  1. Community perspectives on research consent involving vulnerable children in Western Kenya.

    PubMed

    Vreeman, Rachel; Kamaara, Eunice; Kamanda, Allan; Ayuku, David; Nyandiko, Winstone; Atwoli, Lukoye; Ayaya, Samuel; Gisore, Peter; Scanlon, Michael; Braitstein, Paula

    2012-10-01

    Involving vulnerable pediatric populations in international research requires culturally appropriate ethical protections. We sought to use mabaraza, traditional East African community assemblies, to understand how a community in western Kenya viewed participation of children in health research and informed consent and assent processes. Results from 108 participants revealed generally positive attitudes towards involving vulnerable children in research, largely because they assumed children would directly benefit. Consent from parents or guardians was understood as necessary for participation while gaining child assent was not. They felt other caregivers, community leaders, and even community assemblies could participate in the consent process. Community members believed research involving orphans and street children could benefit these vulnerable populations, but would require special processes for consent.

  2. Responses of a vulnerable Hispanic population in New Jersey to Hurricane Sandy: Access to care, medical needs, concerns and ecological ratings

    PubMed Central

    Burger, Joanna; Gochfeld, Michael; Pittfield, Taryn; Jeitner, Christian

    2017-01-01

    Recent increases in hurricanes led to a need to evaluate access to medical care, medical needs, and personal and community impact on vulnerable populations, particularly elderly, low income, and minority communities. This article examines access to care, interruptions in medical services, personal impact from Hurricane Sandy, and agreement with ecological statements related to storms, flooding and damages in Hispanic/Latino patients receiving health care at Federally Qualified Health Centers in New Jersey. Only 10 % of 335 Hispanic interviewees were U.S. born. Self-identified personal impact was a better indicator of effects from Sandy, health center use, and medical issues, than was a community impact rating. Respondents who gave a high personal impact rating were more likely to have evacuated, had longer power outage, were more likely to need medical care, had more trouble getting to centers, and had more medical interruptions during Sandy. A higher percentage of respondents who evacuated, needed the center, had trouble getting there, and had more “medical need” than those who did not evacuate. The greatest impacts were on respondents who were told to evacuate before the storm, but did not (46 % had “medical need”). The respondents had high agreement ratings for “storms are due to climate change”, followed by “frequent and stronger storms will come more often”, “flooding is due to sea level rise”, and “changing climate is due mainly to human activity and not natural causes”. These ratings will aid public policy makers and planners in developing resiliency strategies for vulnerable coastal communities. PMID:28644717

  3. Responses of a vulnerable Hispanic population in New Jersey to Hurricane Sandy: Access to care, medical needs, concerns, and ecological ratings.

    PubMed

    Burger, Joanna; Gochfeld, Michael; Pittfield, Taryn; Jeitner, Christian

    2017-01-01

    Recent increases in hurricanes led to a need to evaluate access to medical care, medical needs, and personal and community impact on vulnerable populations, particularly elderly, low income, and minority communities. This investigation examined (1) access to care, (2) interruptions in medical services, (3) personal impact from Hurricane Sandy, and (4) agreement with ecological statements related to storms, flooding, and damages in Hispanic/Latino patients receiving health care at Federally Qualified Health Centers in New Jersey. Only 10% of 335 Hispanic interviewees were US born. Self-identified personal impact was a better indicator of effects from Sandy, health center use, and medical issues, than community impact rating. Respondents who provided a high personal impact rating were more likely to have evacuated, had longer power outage, were more likely to need medical care, displayed more trouble getting to centers, and exhibited more medical interruptions during Sandy. A higher % respondents who evacuated, needed the center, had trouble getting there, and had more "medical need" than those who did not evacuate. The greatest impacts were on respondents who were told to evacuate before the storm, but did not (46% had "medical need"). The respondents had high agreement ratings for "storms are due to climate change," followed by "frequent and stronger storms will come more often," "flooding is due to sea level rise," and "changing climate is due mainly to human activity and not natural causes". These ratings may aid public policymakers and planners in developing resiliency strategies for vulnerable coastal communities.

  4. [Predisposition to alcohol and drug consumption in schizophrenia-vulnerable people].

    PubMed

    Fumero, A; Santamaría, C; Navarrete, G

    A large amount of current schizophrenia research has been centered on the understanding of its etiological mechanisms and the detection of vulnerability markers in people at risk. This vulnerability called schizotypy can be identified in people not affected by the illness at the clinical level. To check if the schizotypic personality disorder as a vulnerability marker of the disorders in the schizophrenic spectrum predicts the presence of psychopathologic symptoms and alcohol and drugs intake. From a population of 442 university students tested with the Schizotypy Personality Questionnaire (SPQ), it was selected a sample including people scoring on the 20% superior and inferior for the characteristic factors of schizophrenia corresponding to positive symptoms (cognitive-perceptual), negative symptoms (interpersonal) and thought disorder (disorganized). Furthermore, it was evaluated the presence of psychopathological problems and symptoms. Also, the participants gave information about alcohol and drugs intake as a passive coping strategy with stress. Compared with the low scored, subjects with high scores in the schizotypic personality disorder showed a significant increase in the presence of psychopathological problems and symptoms and a higher alcohol and drugs intake. That occurs mainly when those scores are found in symptoms associated to thought disorder and negative symptoms as lack of interest in social activities and emotional flattening. The schizotypic personality disorder, in accordance with its role as vulnerability factor, seems to co-occur with a higher volume of somatic and psychopathologic symptoms, and alcohol and drugs intake.

  5. Empirical Estimates of 0Day Vulnerabilities in Control Systems

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Miles A. McQueen; Wayne F. Boyer; Sean M. McBride

    2009-01-01

    We define a 0Day vulnerability to be any vulnerability, in deployed software, which has been discovered by at least one person but has not yet been publicly announced or patched. These 0Day vulnerabilities are of particular interest when assessing the risk to well managed control systems which have already effectively mitigated the publicly known vulnerabilities. In these well managed systems the risk contribution from 0Days will have proportionally increased. To aid understanding of how great a risk 0Days may pose to control systems, an estimate of how many are in existence is needed. Consequently, using the 0Day definition given above,more » we developed and applied a method for estimating how many 0Day vulnerabilities are in existence on any given day. The estimate is made by: empirically characterizing the distribution of the lifespans, measured in days, of 0Day vulnerabilities; determining the number of vulnerabilities publicly announced each day; and applying a novel method for estimating the number of 0Day vulnerabilities in existence on any given day using the number of vulnerabilities publicly announced each day and the previously derived distribution of 0Day lifespans. The method was first applied to a general set of software applications by analyzing the 0Day lifespans of 491 software vulnerabilities and using the daily rate of vulnerability announcements in the National Vulnerability Database. This led to a conservative estimate that in the worst year there were, on average, 2500 0Day software related vulnerabilities in existence on any given day. Using a smaller but intriguing set of 15 0Day software vulnerability lifespans representing the actual time from discovery to public disclosure, we then made a more aggressive estimate. In this case, we estimated that in the worst year there were, on average, 4500 0Day software vulnerabilities in existence on any given day. We then proceeded to identify the subset of software applications likely to be used

  6. An integrated chemical biology approach identifies specific vulnerability of Ewing's sarcoma to combined inhibition of Aurora kinases A and B.

    PubMed

    Winter, Georg E; Rix, Uwe; Lissat, Andrej; Stukalov, Alexey; Müllner, Markus K; Bennett, Keiryn L; Colinge, Jacques; Nijman, Sebastian M; Kubicek, Stefan; Kovar, Heinrich; Kontny, Udo; Superti-Furga, Giulio

    2011-10-01

    Ewing's sarcoma is a pediatric cancer of the bone that is characterized by the expression of the chimeric transcription factor EWS-FLI1 that confers a highly malignant phenotype and results from the chromosomal translocation t(11;22)(q24;q12). Poor overall survival and pronounced long-term side effects associated with traditional chemotherapy necessitate the development of novel, targeted, therapeutic strategies. We therefore conducted a focused viability screen with 200 small molecule kinase inhibitors in 2 different Ewing's sarcoma cell lines. This resulted in the identification of several potential molecular intervention points. Most notably, tozasertib (VX-680, MK-0457) displayed unique nanomolar efficacy, which extended to other cell lines, but was specific for Ewing's sarcoma. Furthermore, tozasertib showed strong synergies with the chemotherapeutic drugs etoposide and doxorubicin, the current standard agents for Ewing's sarcoma. To identify the relevant targets underlying the specific vulnerability toward tozasertib, we determined its cellular target profile by chemical proteomics. We identified 20 known and unknown serine/threonine and tyrosine protein kinase targets. Additional target deconvolution and functional validation by RNAi showed simultaneous inhibition of Aurora kinases A and B to be responsible for the observed tozasertib sensitivity, thereby revealing a new mechanism for targeting Ewing's sarcoma. We further corroborated our cellular observations with xenograft mouse models. In summary, the multilayered chemical biology approach presented here identified a specific vulnerability of Ewing's sarcoma to concomitant inhibition of Aurora kinases A and B by tozasertib and danusertib, which has the potential to become a new therapeutic option.

  7. Bayesian distributed lag interaction models to identify perinatal windows of vulnerability in children's health.

    PubMed

    Wilson, Ander; Chiu, Yueh-Hsiu Mathilda; Hsu, Hsiao-Hsien Leon; Wright, Robert O; Wright, Rosalind J; Coull, Brent A

    2017-07-01

    Epidemiological research supports an association between maternal exposure to air pollution during pregnancy and adverse children's health outcomes. Advances in exposure assessment and statistics allow for estimation of both critical windows of vulnerability and exposure effect heterogeneity. Simultaneous estimation of windows of vulnerability and effect heterogeneity can be accomplished by fitting a distributed lag model (DLM) stratified by subgroup. However, this can provide an incomplete picture of how effects vary across subgroups because it does not allow for subgroups to have the same window but different within-window effects or to have different windows but the same within-window effect. Because the timing of some developmental processes are common across subpopulations of infants while for others the timing differs across subgroups, both scenarios are important to consider when evaluating health risks of prenatal exposures. We propose a new approach that partitions the DLM into a constrained functional predictor that estimates windows of vulnerability and a scalar effect representing the within-window effect directly. The proposed method allows for heterogeneity in only the window, only the within-window effect, or both. In a simulation study we show that a model assuming a shared component across groups results in lower bias and mean squared error for the estimated windows and effects when that component is in fact constant across groups. We apply the proposed method to estimate windows of vulnerability in the association between prenatal exposures to fine particulate matter and each of birth weight and asthma incidence, and estimate how these associations vary by sex and maternal obesity status in a Boston-area prospective pre-birth cohort study. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Using Population Density and Size Class Frequency to Identify Recruitment Limitation and Saturation in Shellfishes

    NASA Astrophysics Data System (ADS)

    Bennett, B.

    2016-02-01

    Many fisheries are threatened due to overfishing, changing climate, and anthropogenic activities. Benthic marine organisms can be especially vulnerable to these pressures because of their inability to flee, and some of these organisms comprise the most threatened fisheries. Providing predictive tools to managers is key to reestablishing populations and sustainability in threatened or crashed fisheries. Here we examine the demographics of Cellana spp., culturally and culinarily important intertidal shellfishes in Hawai'i, in populations that are naturally recruitment limited and those that are recruitment saturated. We focus on variation in two demographic parameters: population density and size class frequency. From 2009 to 2015, yearly transect surveys were conducted on four isolated and uninhabited islands within the Papahānaumokuākea Marine National Monument (PMNM), a massive marine protected area. Two islands exhibit classic signs of recruitment limitation with several absent intertidal species and low population densities while two larger islands have a relative abundance of species and high population densities. The population density of C. exarata in the recruitment-saturated populations exhibit much higher variability, than in the recruitment-limited populations, that is driven by a massive recruitment peak in May-June. An inverted age pyramid characterized the recruitment-limited populations, which display a more stable adult-dominated population. The recruitment-saturated populations were characterized by a traditional age pyramid, which exhibit a less stable juvenile-dominated population. These results are being used to model and predict population dynamics in the intensely harvested populations of the main Hawaiian Islands for the purposes of management decision-making.

  9. Environmental and social determinants of population vulnerability to Zika virus emergence at the local scale.

    PubMed

    Rees, Erin E; Petukhova, Tatiana; Mascarenhas, Mariola; Pelcat, Yann; Ogden, Nicholas H

    2018-05-08

    Zika virus (ZIKV) spread rapidly in the Americas in 2015. Targeting effective public health interventions for inhabitants of, and travellers to and from, affected countries depends on understanding the risk of ZIKV emergence (and re-emergence) at the local scale. We explore the extent to which environmental, social and neighbourhood disease intensity variables influenced emergence dynamics. Our objective was to characterise population vulnerability given the potential for sustained autochthonous ZIKV transmission and the timing of emergence. Logistic regression models estimated the probability of reporting at least one case of ZIKV in a given municipality over the course of the study period as an indicator for sustained transmission; while accelerated failure time (AFT) survival models estimated the time to a first reported case of ZIKV in week t for a given municipality as an indicator for timing of emergence. Sustained autochthonous ZIKV transmission was best described at the temporal scale of the study period (almost one year), such that high levels of study period precipitation and low mean study period temperature reduced the probability. Timing of ZIKV emergence was best described at the weekly scale for precipitation in that high precipitation in the current week delayed reporting. Both modelling approaches detected an effect of high poverty on reducing/slowing case detection, especially when inter-municipal road connectivity was low. We also found that proximity to municipalities reporting ZIKV had an effect to reduce timing of emergence when located, on average, less than 100 km away. The different modelling approaches help distinguish between large temporal scale factors driving vector habitat suitability and short temporal scale factors affecting the speed of spread. We find evidence for inter-municipal movements of infected people as a local-scale driver of spatial spread. The negative association with poverty suggests reduced case reporting in poorer

  10. Assessment of vulnerability of forest ecosystems to climate change and adaptation planning in Nepal

    NASA Astrophysics Data System (ADS)

    Matin, M. A.; Chitale, V. S.

    2016-12-01

    Understanding ecosystem level vulnerability of forests and dependence of local communities on these ecosystems is a first step towards developing effective adaptation strategies. As forests are important components of livelihoods system for a large percentage of the population in the Himalayan region, they offer an important basis for creating and safeguarding more climate-resilient communities. Increased frequency, duration, and/or severity of drought and heat stress, changes in winter ecology, and pest and fire outbreaksunder climate change scenarios could fundamentally alter the composition, productivity and biogeography of forests affecting the potential ecosystem services offered and forest-based livelihoods. Hence, forest ecosystem vulnerability assessment to climate change and the development of a knowledgebase to identify and support relevant adaptation strategies is identified as an urgent need. Climate change vulnerability is measured as a function of exposure, sensitivity and the adaptive capacity of the system towards climate variability and extreme events. Effective adaptation to climate change depends on the availability of two important prerequisites: a) information on what, where, and how to adapt, and b) availability of resources to implement the adaptation measures. In the present study, we introduce the concept of two way multitier approach, which can support effective identification and implementation of adaptation measures in Nepal and the framework can be replicated in other countries in the HKH region. The assessment of overall vulnerability of forests comprises of two components: 1) understanding the relationship between exposure and sensitivity and positive feedback from adaptive capacity of forests; 2) quantifying the dependence of local communities on these ecosystems. We use climate datasets from Bioclim and biophysical products from MODIS, alongwith field datasets. We report that most of the forests along the high altitude areas and few

  11. Examining social, physical, and environmental dimensions of tornado vulnerability in Texas.

    PubMed

    Siebeneck, Laura

    2016-01-01

    To develop a vulnerability model that captures the social, physical, and environmental dimensions of tornado vulnerability of Texas counties. Guided by previous research and methodologies proposed in the hazards and emergency management literature, a principle components analysis is used to create a tornado vulnerability index. Data were gathered from open source information available through the US Census Bureau, American Community Surveys, and the Texas Natural Resources Information System. Texas counties. The results of the model yielded three indices that highlight geographic variability of social vulnerability, built environment vulnerability, and tornado hazard throughout Texas. Further analyses suggest that counties with the highest tornado vulnerability include those with high population densities and high tornado risk. This article demonstrates one method for assessing statewide tornado vulnerability and presents how the results of this type of analysis can be applied by emergency managers towards the reduction of tornado vulnerability in their communities.

  12. Assessing influences on social vulnerability to wildfire using surveys, spatial data and wildfire simulations.

    PubMed

    Paveglio, Travis B; Edgeley, Catrin M; Stasiewicz, Amanda M

    2018-05-01

    A growing body of research focuses on identifying patterns among human populations most at risk from hazards such as wildfire and the factors that help explain performance of mitigations that can help reduce that risk. Emerging policy surrounding wildfire management emphasizes the need to better understand such social vulnerability-or human populations' potential exposure to and sensitivity from wildfire-related impacts, including their ability to reduce negative impacts from the hazard. Studies of social vulnerability to wildfire often pair secondary demographic data with a variety of vegetation and wildfire simulation models to map potential risk. However, many of the assumptions made by those researchers about the demographic, spatial or perceptual factors that influence social vulnerability to wildfire have not been fully evaluated or tested against objective measures of potential wildfire risk. The research presented here utilizes self-reported surveys, GIS data, and wildfire simulations to test the relationships between select perceptual, demographic, and property characteristics of property owners against empirically simulated metrics for potential wildfire related damages or exposure. We also evaluate how those characteristics relate to property owners' performance of mitigations or support for fire management. Our results suggest that parcel characteristics provide the most significant explanation of variability in wildfire exposure, sensitivity and overall wildfire risk, while the positive relationship between income or property values and components of social vulnerability stands in contrast to typical assumptions from existing literature. Respondents' views about agency or government management helped explain a significant amount of variance in wildfire sensitivity, while the importance of wildfire risk in selecting a residence was an important influence on mitigation action. We use these and other results from our effort to discuss updated

  13. Research on vulnerability assessments of the Huanghe (Yellow River) delta

    NASA Astrophysics Data System (ADS)

    qiao, shuqing; shi, xuefa

    2014-05-01

    Coastal zone located at the juncture of the sea, river and land, and under the influence of both land and ocean (including atmosphere), especially the sea-level rise and human activities, are vulnerable to environment and ecology. At highest risk are coastal zone of South, Southeast and East Asia with dense populations, low elevations and inadequate adaptive capacity. In China, more than 40% of the population live on the 15% of the land in coastal area and more than 70% cities located around the coastal area. The Chinese coastal region, especially river delta area has been experienced erosion, seawater intrusion and decrease in biodiversity under the combined influence of sea-level rise, tectonic subsidence and flooding. Furthermore, some kinds of human activity, such as land use, building, dam construction, reclamation from the sea and waste dumping strengthen the vulnerability of environment and ecosystem in coastal region. The coastal hazards (e.g. coastal erosion, seawater intrusion, land subsidence) and vulnerability of the Huanghe (Yelllow River) delta area are studied during the past several years. A systematic coastal assessment index is built and an evaluation model is developed using the development platform of Visual studio.Net 2005. The assessment index system includes two parts, inherent (sea level rise rate, elevation, morphology, water and sediment discharge, mean tidal range, mean wave height etc) and specific vulnerability index (population density, GDP, land utilization, protection structures etc). The assessment index are determined the weight using Analytic hierarchy process (AHP) method. Based on the research results, we better understand the current status and future change of coastal vulnerability and hazards, discuss the impact of the natural possess and human activities. Furthermore, we provide defending strategies for coastal zone vulnerability and typical coastal hazards.

  14. Assessing intrinsic and specific vulnerability models ability to indicate groundwater vulnerability to groups of similar pesticides: A comparative study

    USGS Publications Warehouse

    Douglas, Steven; Dixon, Barnali; Griffin, Dale W.

    2018-01-01

    With continued population growth and increasing use of fresh groundwater resources, protection of this valuable resource is critical. A cost effective means to assess risk of groundwater contamination potential will provide a useful tool to protect these resources. Integrating geospatial methods offers a means to quantify the risk of contaminant potential in cost effective and spatially explicit ways. This research was designed to compare the ability of intrinsic (DRASTIC) and specific (Attenuation Factor; AF) vulnerability models to indicate groundwater vulnerability areas by comparing model results to the presence of pesticides from groundwater sample datasets. A logistic regression was used to assess the relationship between the environmental variables and the presence or absence of pesticides within regions of varying vulnerability. According to the DRASTIC model, more than 20% of the study area is very highly vulnerable. Approximately 30% is very highly vulnerable according to the AF model. When groundwater concentrations of individual pesticides were compared to model predictions, the results were mixed. Model predictability improved when concentrations of the group of similar pesticides were compared to model results. Compared to the DRASTIC model, the AF model more accurately predicts the distribution of the number of contaminated wells within each vulnerability class.

  15. Reduced population size does not affect the mating strategy of a vulnerable and endemic seabird

    NASA Astrophysics Data System (ADS)

    Nava, Cristina; Neves, Verónica C.; Andris, Malvina; Dubois, Marie-Pierre; Jarne, Philippe; Bolton, Mark; Bried, Joël

    2017-12-01

    Bottleneck episodes may occur in small and isolated animal populations, which may result in decreased genetic diversity and increased inbreeding, but also in mating strategy adjustment. This was evaluated in the vulnerable and socially monogamous Monteiro's Storm-petrel Hydrobates monteiroi, a seabird endemic to the Azores archipelago which has suffered a dramatic population decline since the XVth century. To do this, we conducted a genetic study (18 microsatellite markers) in the population from Praia islet, which has been monitored over 16 years. We found no evidence that a genetic bottleneck was associated with this demographic decline. Monteiro's Storm-petrels paired randomly with respect to genetic relatedness and body measurements. Pair fecundity was unrelated to genetic relatedness between partners. We detected only two cases of extra-pair parentage associated with an extra-pair copulation (out of 71 offspring). Unsuccessful pairs were most likely to divorce the next year, but genetic relatedness between pair mates and pair breeding experience did not influence divorce. Divorce enabled individuals to improve their reproductive performances after re-mating only when the new partner was experienced. Re-pairing with an experienced partner occurred more frequently when divorcees changed nest than when they retained their nest. This study shows that even in strongly reduced populations, genetic diversity can be maintained, inbreeding does not necessarily occur, and random pairing is not risky in terms of pair lifetime reproductive success. Given, however, that we found no clear phenotypic mate choice criteria, the part played by non-morphological traits should be assessed more accurately in order to better understand seabird mating strategies.

  16. Online patient websites for electronic health record access among vulnerable populations: portals to nowhere?

    PubMed

    Tieu, Lina; Schillinger, Dean; Sarkar, Urmimala; Hoskote, Mekhala; Hahn, Kenneth J; Ratanawongsa, Neda; Ralston, James D; Lyles, Courtney R

    2017-04-01

    With the rapid rise in the adoption of patient portals, many patients are gaining access to their personal health information online for the first time. The objective of this study was to examine specific usability barriers to patient portal engagement among a diverse group of patients and caregivers. We conducted interviews using performance testing and think-aloud methods with 23 patients and 2 caregivers as they first attempted to use features of a newly launched patient portal. In navigating the portal, participants experienced basic computer barriers (eg, difficulty using a mouse), routine computer barriers (eg, mistyping, navigation issues), reading/writing barriers, and medical content barriers. Compared to participants with adequate health literacy, participants with limited health literacy required 2 additional minutes to complete each task and were more likely to experience each type of navigational barrier. They also experienced more inaccuracies in interpreting a test result and finding a treatment plan within an after-visit summary. When using a patient portal for the first time, participants with limited health literacy completed fewer tasks unassisted, had a higher prevalence of encountering barriers, took longer to complete tasks, and had more problems accurately interpreting medical information. Our findings suggest a strong need for tailored and accessible training and support to assist all vulnerable patients and/or caregivers with portal registration and use. Measuring the health literacy of a patient population might serve as a strong proxy for identifying patients who need the most support in using health technologies. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  17. Integrating socio-economic and infrastructural dimension to reveal hazard vulnerability of coastal districts

    NASA Astrophysics Data System (ADS)

    Mazumdar, Jublee; Paul, Saikat

    2015-04-01

    Losses of life and property due to natural hazards have intensified in the past decade, motivating an alteration of disaster management away from simple post event resettlement and rehabilitation. The degree of exposure to hazard for a homogeneous population is not entirely reliant upon nearness to the source of hazard event. Socio-economic factors and infrastructural capability play an important role in determining the vulnerability of a place. This study investigates the vulnerability of eastern coastal states of India from tropical cyclones. The record of past hundred years shows that the physical vulnerability of eastern coastal states is four times as compared to the western coastal states in terms of frequency and intensity of tropical cyclones. Nevertheless, these physical factors played an imperative role in determining the vulnerability of eastern coast. However, the socio-economic and infrastructural factors influence the risk of exposure exponentially. Inclusion of these indicators would provide better insight regarding the preparedness and resilience of settlements to hazard events. In this regard, the present study is an effort to develop an Integrated Vulnerability Model (IVM) based on socio-economic and infrastructural factors for the districts of eastern coastal states of India. A method is proposed for quantifying the socio-economic and infrastructural vulnerability to tropical cyclone in these districts. The variables included in the study are extracted from Census of India, 2011 at district level administrative unit. In the analysis, a large number of variables are reduced to a smaller number of factors by using principal component analysis that represents the socio-economic and infrastructure vulnerability to tropical cyclone. Subsequently, the factor scores in socio-economic Vulnerability Index (SeVI) and Infrastructure Vulnerability Index (InVI) are standardized from 0 to 1, indicating the range from low to high vulnerability. The factor

  18. Community Perspectives on Research Consent Involving Vulnerable Children in Western Kenya

    PubMed Central

    Vreeman, Rachel; Kamaara, Eunice; Kamanda, Allan; Ayuku, David; Nyandiko, Winstone; Atwoli, Lukoye; Ayaya, Samuel; Gisore, Peter; Scanlon, Michael; Braitstein, Paula

    2013-01-01

    Involving vulnerable pediatric populations in international research requires culturally appropriate ethical protections. We sought to use mabaraza, traditional East African community assemblies, to understand how a community in western Kenya viewed participation of children in health research and informed consent and assent processes. Results from 108 participants revealed generally positive attitudes towards involving vulnerable children in research, largely because they assumed children would directly benefit. Consent from parents or guardians was understood as necessary for participation while gaining child assent was not. They felt other caregivers, community leaders, and even community assemblies could participate in the consent process. Community members believed research involving orphans and street children could benefit these vulnerable populations, but would require special processes for consent. PMID:23086047

  19. [The assessment of vulnerability to floods in Guangdong province at district level].

    PubMed

    Zhu, Qi; Liu, Tao; Zhang, Yong-hui; Luo, Yuan; Wei, Yao; Xiao, Jian-peng; Zeng, Si-qing; Ma, Wen-jun

    2012-11-01

    To evaluate the vulnerability to floods in Guangdong province at district level. Data were collected from the sixth census, the 2010 Statistical Yearbook of Guangdong, the 2010 Health Statistics Yearbook of Guangdong and China Disease Prevention and Control information systems, etc. The weight of each indicator was determined based on subjective method and objective method respectively; and finally the results of the two methods were compared. 13 indicators were selected for the assessment of vulnerability to floods, including 6 sensitivity indicators, 5 adaptability indicators and 2 exposure indicators. Indicators with large weight (subjective weight/objective weight) were the proportion of population older than 65 years old (0.31/0.30), the proportion of population older than 65 years old (0.16/0.23), infant mortality rate (0.18/0.20), the total Gross Domestic Product (GDP) per capita (0.33/0.21), the proportion of illiterate in the population older than 15 years old (0.19/0.28), history frequency of floods (0.75/0.75). The mean vulnerability index (VI) calculated by subjective method was 0.35 with the standard deviation of 0.10; the mean vulnerability index calculated by objective method was 0.31 with the standard deviation of 0.08. The two weighting methods showed consistent results of vulnerability index (ICC = 0.975, P < 0.01). VI of most districts dropped in the interval of 0.30 - 0.39. Districts with subjective VI > 0.50 or objective VI > 0.40 should pay more attention to floods, including parts of the coastal areas, Beijiang River Basin, the eastern tributary area of Dongjiang River and the northern part of Pearl River Delta. Dapu district of Meizhou (0.55/0.45), Dianbai district and Maogang district of Maoming (0.54/0.48) were most vulnerable. Districts of Heyuan, Dongguan, Zhaoqing and Huizhou were less vulnerable, Yuancheng district of Heyuan showed least vulnerable to floods (0.15/0.12) followed by Dongguan (0.18/0.16), Duanzhou district (0

  20. Landslide vulnerability criteria: a case study from Umbria, central Italy.

    PubMed

    Galli, Mirco; Guzzetti, Fausto

    2007-10-01

    Little is known about the vulnerability to landslides, despite landslides causing frequent and widespread damage to the population and the built-up environment in many areas of the world. Lack of information about vulnerability to landslides limits our ability to determine landslide risk. This paper provides information on the vulnerability of buildings and roads to landslides in Umbria, central Italy. Information on 103 landslides of the slide and slide-earth flow types that have resulted in damage to buildings and roads at 90 sites in Umbria is used to establish dependencies between the area of the landslide and the vulnerability to landslides. The dependencies obtained are applied in the hills surrounding the town of Collazzone, in central Umbria, an area for which a detailed landslide inventory map is available. By exploiting the landslide inventory and the established vulnerability curves, the geographical distribution of the vulnerability to landslides is mapped and statistics of the expected damage are calculated. Reliability and limits of the vulnerability thresholds and of the obtained vulnerability assessment are discussed.

  1. Spatial-temporal eco-environmental vulnerability assessment and its influential factors based on Landsat data

    NASA Astrophysics Data System (ADS)

    Anh, N. K.; Liou, Y. A.; Ming-Hsu, L.

    2016-12-01

    Regional land use/land cover (LULC) changes lead to various changes in ecological processes and, in turn, alter regional micro-climate. To understand eco-environmental responses to LULC changes, eco-environmental evaluation is thus required with aims to identify vulnerable regions and influential factors, so that practical measures for environmental protection and management may be proposed. The Thua Thien - Hue Province has been experiencing urbanization at a rapid rate in both population and physical size. The urban land, agricultural land, and aquaculture activities have been invasively into natural space and caused eco-environment deterioration by land desertification, soil erosion, shrinking forest resources,…etc. In this study, an assessment framework that is composed by 11 variables with 9 of them constructed from Landsat time series is proposed to serve as basis to examine eco-environmental vulnerability in the Thua Thien - Hue Province in years 1989, 2003, and 2014. An eco-environmental vulnerability map is assorted into six vulnerability levels consisting of potential, slight, light, medium, heavy, and very heavy vulnerabilities. Result shows that there is an increasing trend in eco-environmental vulnerability in general with expected evolving distributions in heavy and very heavy vulnerability levels, which mainly lying on developed land, bare land, semi bare land, agricultural land, and poor and recovery forests. In contrast, there is a significant decline in potential vulnerability level. The contributing factors of an upward trend in medium, heavy, and very heavy levels include: (i) a large natural forest converted to plantation forest and agriculture land; and (ii) significant expansion of developed land leading to difference in thermal signatures in urban areas as compared with those of the surrounding areas. It is concluded that anthropogenic processes with transformation on LULC has amplified the vulnerability of eco-environment in the study

  2. Vulnerability Management for an Enterprise Resource Planning System

    NASA Astrophysics Data System (ADS)

    Goel, Shivani; Kiran, Ravi; Garg, Deepak

    2012-09-01

    Enterprise resource planning (ERP) systems are commonly used in technical educational institutions(TEIs). ERP systems should continue providing services to its users irrespective of the level of failure. There could be many types of failures in the ERP systems. There are different types of measures or characteristics that can be defined for ERP systems to handle the levels of failure. Here in this paper, various types of failure levels are identified along with various characteristics which are concerned with those failures. The relation between all these is summarized. The disruptions causing vulnerabilities in TEIs are identified .A vulnerability management cycle has been suggested along with many commercial and open source vulnerability management tools. The paper also highlights the importance of resiliency in ERP systems in TEIs.

  3. Social vulnerability to climate change in primary producers: A typology approach

    USDA-ARS?s Scientific Manuscript database

    Adaptation in agro-ecological systems will be important for moderating the impacts of climate change. Vulnerability assessments provide the basis for developing strategies to reduce social vulnerability and plan for climate adaptation. Primary industries have been identified as the most vulnerable i...

  4. Subsidized health insurance coverage of people in the informal sector and vulnerable population groups: trends in institutional design in Asia.

    PubMed

    Vilcu, Ileana; Probst, Lilli; Dorjsuren, Bayarsaikhan; Mathauer, Inke

    2016-10-04

    Many low- and middle-income countries with a social health insurance system face challenges on their road towards universal health coverage (UHC), especially for people in the informal sector and vulnerable population groups or the informally employed. One way to address this is to subsidize their contributions through general government revenue transfers to the health insurance fund. This paper provides an overview of such health financing arrangements in Asian low- and middle-income countries. The purpose is to assess the institutional design features of government subsidized health insurance type arrangements for vulnerable and informally employed population groups and to explore how these features contribute to UHC progress. This regional study is based on a literature search to collect country information on the specific institutional design features of such subsidization arrangements and data related to UHC progress indicators, i.e. population coverage, financial protection and access to care. The institutional design analysis focuses on eligibility rules, targeting and enrolment procedures; financing arrangements; the pooling architecture; and benefit entitlements. Such financing arrangements currently exist in 8 countries with a total of 14 subsidization schemes. The most frequent groups covered are the poor, older persons and children. Membership in these arrangements is mostly mandatory as is full subsidization. An integrated pool for both the subsidized and the contributors exists in half of the countries, which is one of the most decisive features for equitable access and financial protection. Nonetheless, in most schemes, utilization rates of the subsidized are higher compared to the uninsured, but still lower compared to insured formal sector employees. Total population coverage rates, as well as a higher share of the subsidized in the total insured population are related with broader eligibility criteria. Overall, government subsidized health

  5. CALTRANS CLIMATE CHANGE VULNERABILITY ASSESSMENTS

    DOT National Transportation Integrated Search

    2018-01-01

    The following report was developed for the California Department of Transportation (Caltrans) to summarize a vulnerability assessment conducted for assets in Caltrans District 4. The assessment was developed to specifically identify the potential eff...

  6. Vulnerability to cavitation, hydraulic efficiency, growth and survival in an insular pine (Pinus canariensis)

    PubMed Central

    López, Rosana; López de Heredia, Unai; Collada, Carmen; Cano, Francisco Javier; Emerson, Brent C.; Cochard, Hervé; Gil, Luis

    2013-01-01

    Background and Aims It is widely accepted that hydraulic failure due to xylem embolism is a key factor contributing to drought-induced mortality in trees. In the present study, an attempt is made to disentangle phenotypic plasticity from genetic variation in hydraulic traits across the entire distribution area of a tree species to detect adaptation to local environments. Methods A series of traits related to hydraulics (vulnerability to cavitation and hydraulic conductivity in branches), growth performance and leaf mass per area were assessed in eight Pinus canariensis populations growing in two common gardens under contrasting environments. In addition, the neutral genetic variability (FST) and the genetic differentiation of phenotypic variation (QST) were compared in order to identify the evolutionary forces acting on these traits. Key Results The variability for hydraulic traits was largely due to phenotypic plasticity. Nevertheless, the vulnerability to cavitation displayed a significant genetic variability (approx. 5 % of the explained variation), and a significant genetic × environment interaction (between 5 and 19 % of the explained variation). The strong correlation between vulnerability to cavitation and survival in the xeric common garden (r = –0·81; P < 0·05) suggests a role for the former in the adaptation to xeric environments. Populations from drier sites and higher temperature seasonality were less vulnerable to cavitation than those growing at mesic sites. No trade-off between xylem safety and efficiency was detected. QST of parameters of the vulnerability curve (0·365 for P50 and the slope of the vulnerability curve and 0·452 for P88) differed substantially from FST (0·091), indicating divergent selection. In contrast, genetic drift alone was found to be sufficient to explain patterns of differentiation for xylem efficiency and growth. Conclusions The ability of P. canariensis to inhabit a wide range of ecosystems seemed to be associated

  7. Nested archetypes of vulnerability in African drylands: where lies potential for sustainable agricultural intensification?

    NASA Astrophysics Data System (ADS)

    Sietz, D.; Ordoñez, J. C.; Kok, M. T. J.; Janssen, P.; Hilderink, H. B. M.; Tittonell, P.; Van Dijk, H.

    2017-09-01

    Food production is key to achieving food security in the drylands of sub-Saharan Africa. Since agricultural productivity is limited, however, due to inherent agro-ecological constraints and land degradation, sustainable agricultural intensification has been widely discussed as an opportunity for improving food security and reducing vulnerability. Yet vulnerability determinants are distributed heterogeneously in the drylands of sub-Saharan Africa and sustainable intensification cannot be achieved everywhere in cost-effective and efficient ways. To better understand the heterogeneity of farming systems’ vulnerability in order to support decision making at regional scales, we present archetypes, i.e. socio-ecological patterns, of farming systems’ vulnerability in the drylands of sub-Saharan Africa and reveal their nestedness. We quantitatively indicated the most relevant farming systems’ properties at a sub-national resolution. These factors included water availability, agro-ecological potential, erosion sensitivity, population pressure, urbanisation, remoteness, governance, income and undernourishment. Cluster analysis revealed eight broad archetypes of vulnerability across all drylands of sub-Saharan Africa. The broad archetype representing better governance and highest remoteness in extremely dry and resource-constrained regions encompassed the largest area share (19%), mainly indicated in western Africa. Moreover, six nested archetypes were identified within those regions with better agropotential and prevalent agricultural livelihoods. Among these patterns, the nested archetype depicting regions with highest erosion sensitivity, severe undernourishment and lower agropotential represented the largest population (30%) and area (28%) share, mainly found in the Sahel region. The nested archetype indicating medium undernourishment, better governance and lowest erosion sensitivity showed particular potential for sustainable agricultural intensification, mainly in

  8. Vulnerability to cavitation, hydraulic efficiency, growth and survival in an insular pine (Pinus canariensis).

    PubMed

    López, Rosana; López de Heredia, Unai; Collada, Carmen; Cano, Francisco Javier; Emerson, Brent C; Cochard, Hervé; Gil, Luis

    2013-06-01

    It is widely accepted that hydraulic failure due to xylem embolism is a key factor contributing to drought-induced mortality in trees. In the present study, an attempt is made to disentangle phenotypic plasticity from genetic variation in hydraulic traits across the entire distribution area of a tree species to detect adaptation to local environments. A series of traits related to hydraulics (vulnerability to cavitation and hydraulic conductivity in branches), growth performance and leaf mass per area were assessed in eight Pinus canariensis populations growing in two common gardens under contrasting environments. In addition, the neutral genetic variability (FST) and the genetic differentiation of phenotypic variation (QST) were compared in order to identify the evolutionary forces acting on these traits. The variability for hydraulic traits was largely due to phenotypic plasticity. Nevertheless, the vulnerability to cavitation displayed a significant genetic variability (approx. 5 % of the explained variation), and a significant genetic × environment interaction (between 5 and 19 % of the explained variation). The strong correlation between vulnerability to cavitation and survival in the xeric common garden (r = -0·81; P < 0·05) suggests a role for the former in the adaptation to xeric environments. Populations from drier sites and higher temperature seasonality were less vulnerable to cavitation than those growing at mesic sites. No trade-off between xylem safety and efficiency was detected. QST of parameters of the vulnerability curve (0·365 for P50 and the slope of the vulnerability curve and 0·452 for P88) differed substantially from FST (0·091), indicating divergent selection. In contrast, genetic drift alone was found to be sufficient to explain patterns of differentiation for xylem efficiency and growth. The ability of P. canariensis to inhabit a wide range of ecosystems seemed to be associated with high phenotypic plasticity and some degree of local

  9. Locating Spatial Variation in the Association Between Wildland Fire Risk and Social Vulnerability Across Six Southern States

    NASA Astrophysics Data System (ADS)

    Poudyal, Neelam C.; Johnson-Gaither, Cassandra; Goodrick, Scott; Bowker, J. M.; Gan, Jianbang

    2012-03-01

    Wildland fire in the South commands considerable attention, given the expanding wildland urban interface (WUI) across the region. Much of this growth is propelled by higher income retirees and others desiring natural amenity residential settings. However, population growth in the WUI increases the likelihood of wildfire fire ignition caused by people, as humans account for 93% of all wildfires fires in the South. Coexisting with newly arrived, affluent WUI populations are working class, poor or otherwise socially vulnerable populations. The latter groups typically experience greater losses from environmental disasters such as wildfire because lower income residents are less likely to have established mitigation programs in place to help absorb loss. We use geographically weighted regression to examine spatial variation in the association between social vulnerability (SOVUL) and wildfire risk. In doing so, we identify "hot spots" or geographical clusters where SOVUL varies positively with wildfire risk across six Southern states—Alabama, Arkansas, Florida, Georgia, Mississippi, and South Carolina. These clusters may or may not be located in the WUI. These hot spots are most prevalent in South Carolina and Florida. Identification of these population clusters can aid wildfire managers in deciding which communities to prioritize for mitigation programming.

  10. Health related vulnerability due to chronic diseases: Impact on clinical services across emergency shelters in mass disasters

    NASA Astrophysics Data System (ADS)

    Koleva, Yordanka Nikolova

    Chronic diseases are increasingly recognized as major contributors to the global burden of disease. Individuals with chronic disease are particularly vulnerable during mass emergencies as they may suffer an interruption in their therapeutic programs, leading to life-threatening conditions and complications. Based on the individual and community risk factors framework, three categories are defined as the most vulnerable to extreme natural events: physically, psychologically, and socially vulnerable. Complex emergencies that occurred in the recent decade have provided evidence that these groups suffer more pronounced effects than others. Individuals seeking community support during emergencies have been predominantly medically dependent, elderly, children, people with chronic health conditions, and lower socioeconomic status. The purpose of this study was to investigate the effect of health-related vulnerability on shelter operations, and to estimate the burden of chronic disease on community resources following catastrophic events. A comprehensive survey data collection conducted by the United States Public Health Service in 2005 was used to evaluate clinical services for populations with health conditions accommodated by Louisiana temporary disaster shelters. Correlation and multiple regression analyses determined the relationship between shelter characteristics and the factors predicting shelters' needs for short-term assistance. Significant predictors were identified in all three explored domains: structural shelter characteristics (sponsor, interpreter needed); clinical characteristics (access to health providers, clinic on site, staff had no days off); population characteristics (census, compromised mental health alone, or in combination with chronic conditions and diseases with epidemic potential). Shelters sponsored by faith-based organizations were less likely to be in risk of rapid resource depletion. Shelters with large census demonstrated association with

  11. Heat Wave Vulnerability Mapping for India.

    PubMed

    Azhar, Gulrez; Saha, Shubhayu; Ganguly, Partha; Mavalankar, Dileep; Madrigano, Jaime

    2017-03-30

    Assessing geographic variability in heat wave vulnerability forms the basis for planning appropriate targeted adaptation strategies. Given several recent deadly heatwaves in India, heat is increasingly being recognized as a public health problem. However, to date there has not been a country-wide assessment of heat vulnerability in India. We evaluated demographic, socioeconomic, and environmental vulnerability factors and combined district level data from several sources including the most recent census, health reports, and satellite remote sensing data. We then applied principal component analysis (PCA) on 17 normalized variables for each of the 640 districts to create a composite Heat Vulnerability Index (HVI) for India. Of the total 640 districts, our analysis identified 10 and 97 districts in the very high and high risk categories (> 2SD and 2-1SD HVI) respectively. Mapping showed that the districts with higher heat vulnerability are located in the central parts of the country. On examination, these are less urbanized and have low rates of literacy, access to water and sanitation, and presence of household amenities. Therefore, we concluded that creating and mapping a heat vulnerability index is a useful first step in protecting the public from the health burden of heat. Future work should incorporate heat exposure and health outcome data to validate the index, as well as examine sub-district levels of vulnerability.

  12. Synthetic Lethal Screens Identify Vulnerabilities in GPCR Signaling and Cytoskeletal Organization in E-Cadherin-Deficient Cells.

    PubMed

    Telford, Bryony J; Chen, Augustine; Beetham, Henry; Frick, James; Brew, Tom P; Gould, Cathryn M; Single, Andrew; Godwin, Tanis; Simpson, Kaylene J; Guilford, Parry

    2015-05-01

    The CDH1 gene, which encodes the cell-to-cell adhesion protein E-cadherin, is frequently mutated in lobular breast cancer (LBC) and diffuse gastric cancer (DGC). However, because E-cadherin is a tumor suppressor protein and lost from the cancer cell, it is not a conventional drug target. To overcome this, we have taken a synthetic lethal approach to determine whether the loss of E-cadherin creates druggable vulnerabilities. We first conducted a genome-wide siRNA screen of isogenic MCF10A cells with and without CDH1 expression. Gene ontology analysis demonstrated that G-protein-coupled receptor (GPCR) signaling proteins were highly enriched among the synthetic lethal candidates. Diverse families of cytoskeletal proteins were also frequently represented. These broad classes of E-cadherin synthetic lethal hits were validated using both lentiviral-mediated shRNA knockdown and specific antagonists, including the JAK inhibitor LY2784544, Pertussis toxin, and the aurora kinase inhibitors alisertib and danusertib. Next, we conducted a 4,057 known drug screen and time course studies on the CDH1 isogenic MCF10A cell lines and identified additional drug classes with linkages to GPCR signaling and cytoskeletal function that showed evidence of E-cadherin synthetic lethality. These included multiple histone deacetylase inhibitors, including vorinostat and entinostat, PI3K inhibitors, and the tyrosine kinase inhibitors crizotinib and saracatinib. Together, these results demonstrate that E-cadherin loss creates druggable vulnerabilities that have the potential to improve the management of both sporadic and familial LBC and DGC. ©2015 American Association for Cancer Research.

  13. Assessing the vulnerability of human and biological communities to changing ecosystem services using a GIS-based multi-criteria decision support tool

    USGS Publications Warehouse

    Villarreal, Miguel; Norman, Laura M.; Labiosa, William B.

    2012-01-01

    In this paper we describe an application of a GIS-based multi-criteria decision support web tool that models and evaluates relative changes in ecosystem services to policy and land management decisions. The Santa Cruz Watershed Ecosystem Portfolio (SCWEPM) was designed to provide credible forecasts of responses to ecosystem drivers and stressors and to illustrate the role of land use decisions on spatial and temporal distributions of ecosystem services within a binational (U.S. and Mexico) watershed. We present two SCWEPM sub-models that when analyzed together address bidirectional relationships between social and ecological vulnerability and ecosystem services. The first model employs the Modified Socio-Environmental Vulnerability Index (M-SEVI), which assesses community vulnerability using information from U.S. and Mexico censuses on education, access to resources, migratory status, housing situation, and number of dependents. The second, relating land cover change to biodiversity (provisioning services), models changes in the distribution of terrestrial vertebrate habitat based on multitemporal vegetation and land cover maps, wildlife habitat relationships, and changes in land use/land cover patterns. When assessed concurrently, the models exposed some unexpected relationships between vulnerable communities and ecosystem services provisioning. For instance, the most species-rich habitat type in the watershed, Desert Riparian Forest, increased over time in areas occupied by the most vulnerable populations and declined in areas with less vulnerable populations. This type of information can be used to identify ecological conservation and restoration targets that enhance the livelihoods of people in vulnerable communities and promote biodiversity and ecosystem health.

  14. Identifying signatures of positive selection in pigmentation genes in two South Asian populations.

    PubMed

    Jonnalagadda, Manjari; Bharti, Neeraj; Patil, Yatish; Ozarkar, Shantanu; K, Sunitha Manjari; Joshi, Rajendra; Norton, Heather

    2017-09-10

    Skin pigmentation is a polygenic trait showing wide phenotypic variations among global populations. While numerous pigmentation genes have been identified to be under positive selection among European and East populations, genes contributing to phenotypic variation in skin pigmentation within and among South Asian populations are still poorly understood. The present study uses data from the Phase 3 of the 1000 genomes project focusing on two South Asian populations-GIH (Gujarati Indian from Houston, Texas) and ITU (Indian Telugu from UK), so as to decode the genetic architecture involved in adaptation to ultraviolet radiation in South Asian populations. Statistical tests included were (1) tests to identify deviations of the Site Frequency Spectrum (SFS) from neutral expectations (Tajima's D, Fay and Wu's H and Fu and Li's D* and F*), (2) tests focused on the identification of high-frequency haplotypes with extended linkage disequilibrium (iHS and Rsb), and (3) tests based on genetic differentiation between populations (LSBL). Twenty-two pigmentation genes fall in the top 1% for at least one statistic in the GIH population, 5 of which (LYST, OCA2, SLC24A5, SLC45A2, and TYR) have been previously associated with normal variation in skin, hair, or eye color. In comparison, 17 genes fall in the top 1% for at least one statistic in the ITU population. Twelve loci which are identified as outliers in the ITU scan were also identified in the GIH population. These results suggest that selection may have affected these loci broadly across the region. © 2017 Wiley Periodicals, Inc.

  15. A pragmatic analysis of vulnerability in clinical research.

    PubMed

    Wendler, David

    2017-09-01

    Identifying which subjects are vulnerable, and implementing safeguards to protect them, is widely regarded as essential to clinical research. Commentators have endorsed a number of responses to these challenges and have thereby made significant progress in understanding vulnerability in clinical research. At the same time, this literature points to a central contradiction which calls into question its potential to protect vulnerable subjects in practice. Specifically, analysis suggests that all human subjects are vulnerable and vulnerability in clinical research is comparative and context dependent, in the sense that individuals are vulnerable relative to others and in some contexts only. Yet, if everyone is vulnerable, there seems to be no point in citing the vulnerability of some individuals. Moreover, the conclusion that everyone is vulnerable seems inconsistent with the claims that vulnerability is comparative and context dependent, raising concern over whether it will be possible to develop a comprehensive account of vulnerability that is internally consistent. The solution to this dilemma lies in recognition of the fact that the practical significance of claims regarding vulnerability depends on the context in which they are used. The claims that appear to lead to the central contradiction are in fact accurate conclusions that follow from different uses of the term 'vulnerability'. The present manuscript describes this 'pragmatic' approach to vulnerability in clinical research and considers its implications for ensuring that subjects receive appropriate protection. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

  16. Microbiological Food Safety for Vulnerable People

    PubMed Central

    Lund, Barbara M.

    2015-01-01

    Foodborne pathogens are more likely to cause infection and to result in serious consequences in vulnerable people than in healthy adults. People with some increase in susceptibility may form nearly 20% of the population in the UK and the USA. Conditions leading to increased susceptibility are listed. The main factors leading to foodborne disease caused by major pathogens are outlined and examples are given of outbreaks resulting from these factors. Measures to prevent foodborne disease include procedures based on Hazard Analysis Critical Control Point principles and prerequisite programmes and, especially for vulnerable people, the use of lower-risk foods in place of higher-risk products. PMID:26308030

  17. Groundwater Pollution and Vulnerability Assessment.

    PubMed

    Kurwadkar, Sudarshan

    2017-10-01

    Groundwater is a critical resource that serve as a source of drinking water to large human population and, provide long-term water for irrigation purposes. In recent years; however, this precious resource being increasingly threatened, due to natural and anthropogenic activities. A variety of contaminants of emerging concern such as pharmaceuticals and personal care products, perfluorinated compounds, endocrine disruptors, and biological agents detected in the groundwater sources of both developing and developed nations. In this review paper, various studies have been included that documented instances of groundwater pollution and vulnerability to emerging contaminants of concern, pesticides, heavy metals, and leaching potential of various organic and inorganic contaminants from poorly managed residual waste products (biosolids, landfills, latrines, and septic tanks etc.). Understanding vulnerability of groundwater to pollution is critical to maintain the integrity of groundwater. A section on managed artificial recharge studies is included to highlight the sustainable approaches to groundwater conservation, replenishment and sustainability. This review paper is the synthesis of studies published in last one year that either documented the pollution problems or evaluated the vulnerability of groundwater pollution.

  18. Spatial vulnerability units - expert-based spatial modelling of socio-economic vulnerability in the Salzach catchment, Austria

    NASA Astrophysics Data System (ADS)

    Kienberger, S.; Lang, S.; Zeil, P.

    2009-05-01

    The assessment of vulnerability has moved to centre-stage of the debate between different scientific disciplines related to climate change and disaster risk management. Composed by a combination of social, economical, physical and environmental factors the assessment implies combining different domains as well as quantitative with qualitative data and makes it therefore a challenge to identify an integrated metric for vulnerability. In this paper we define vulnerability in the context of climate change, targeting the hazard "flood". The developed methodology is being tested in the Salzach river catchment in Austria, which is largely prone to floods. The proposed methodology allows the spatial quantification of vulnerability and the identification of vulnerability units. These units build upon the geon concept which acts as a framework for the regionalization of continuous spatial information according to defined parameters of homogeneity. Using geons, we are capable of transforming singular domains of information on specific systemic components to policy-relevant, conditioned information. Considering the fact that vulnerability is not directly measurable and due to its complex dimension and social construction an expert-based approach has been chosen. Established methodologies such as Multicriteria Decision Analysis, Delphi exercises and regionalization approaches are being integrated. The method not only enables the assessment of vulnerability independent from administrative boundaries, but also applies an aggregation mode which reflects homogenous vulnerability units. This supports decision makers to reflect on complex issues such as vulnerability. Next to that, the advantage is to decompose the units to their underlying domains. Feedback from disaster management experts indicates that the approach helps to improve the design of measures aimed at strengthening preparedness and mitigation. From this point of view, we reach a step closer towards validation of the

  19. Vulnerability related to oral health in early childhood: a concept analysis.

    PubMed

    Mattheus, Deborah J

    2010-09-01

    This article is a report of the analysis of the concept of vulnerability and its relationship to oral health in early childhood. Poor oral health is a continued problem for children worldwide. Vulnerability increases the probability of poor oral health outcomes. The lack of clarity of the concept of vulnerability creates difficulty in understanding this multi-factoral condition. Data source included 34 articles covering the period 2000-2009 from a variety of disciplines, including nursing, dentistry, medicine and public health. The concept analysis was conducted using Rodgers' evolutionary method. The literature was analysed and a social ecology model was used to frame the discussion, recognizing family and community influences on children's oral health. The context of oral health in early childhood contributes to the changes in the concept vulnerability. The attributes are closely related to family and community factors and identified as limited parental income, parental education, community-based services and fluoride; and exposure to poor parental habits, parental neglect and harmful toxins. The primary antecedent is identified as a form of limited protection from exposure to various circumstances. Children with limited protection have increased vulnerability and greater probability of poor health outcomes. Nurses who understand the concept of vulnerability related to oral health and can identify factors that create protection and are capable of decreasing vulnerability through parent education, community awareness and policy changes that support children and families.

  20. Vulnerability of schools to floods in Nyando River catchment, Kenya.

    PubMed

    Ochola, Samuel O; Eitel, Bernhard; Olago, Daniel O

    2010-07-01

    This paper assesses the vulnerability of schools to floods in the Nyando River catchment (3,600 km(2)) in western Kenya and identifies measures needed to reduce this vulnerability. It surveys 130 schools in the lower reaches, where flooding is a recurrent phenomenon. Of the primary schools assessed, 40% were vulnerable, 48% were marginally vulnerable and 12% were not vulnerable. Of the secondary schools, 8% were vulnerable, 73% were marginally vulnerable and 19% were not vulnerable. Vulnerability to floods is due to a lack of funds, poor building standards, local topography, soil types and inadequate drainage. The Constituencies Development Fund (CDF), established in 2003, provides financial support to cover school construction and reconstruction costs; CDF Committees are expected to adopt school building standards. In an effort to promote safe and resilient construction and retrofitting to withstand floods, this paper presents vulnerability reduction strategies and recommendations for incorporating minimum standards in the on-going Primary School Infrastructure Programme Design.

  1. A Preliminary Assessment of Social Vulnerability in Ganga-Brahmaputra-Meghna Delta

    NASA Astrophysics Data System (ADS)

    Hazra, Sugata; Islam, Nabiul

    2017-04-01

    The Ganga-Brahmaputra-Meghna (GBM) Delta has a high population density and is exposed to rapid environmental changes making it one of the most stressed deltas in the world. The low-lying coastal areas of the Ganga-Brahmaputra-Meghna (GBM) Delta comprise 19 coastal districts of Bangladesh and two districts in India with significant land areas within 5 meters of sea level has a population of more than 50 million people at an average population density of 1100 people/km2. This population is exposed to a range of hazards such as severe cyclones, coastal erosion, and salinization, exacerbated by climate change and subsidence which imply severe stress on the resource dependent community of this region. This situation is further complicated by poverty and limited social well-being such as poor access to education/ health/ drinking water/ sanitation facilities, and lack of food and energy security. Thus assessing social vulnerability can help to understand which communities are susceptible to environmental change and guide adaptation actions to address these threats. This preliminary study aims to construct a socio-economic index by assessing the social vulnerability of coastal communities of GBM Delta taking consistent and common secondary data from the Census of India and the Bangladesh Bureau of Statisticsand applyinga Principle Component Analysis(PCA) methodology. Several statistical tests like Kaiser-Meyer-Olkin (KMO) have also been used to assess the appropriateness of using PCA. Among the selected common indicators, five major components are found to explain majority of the total variation of social vulnerability across the delta: (1) poverty, (2) dependency ratio, (3) agriculture dependency, (4) lack of sanitation and (5) existence of mud houses. The most important observation is the existence of a social vulnerability gradient across the coast. In other words, socially marginalised and vulnerable communities are found on the Delta margin in both India and

  2. An alternative model for postdoctoral education of nurses engaged in research with potentially vulnerable populations.

    PubMed

    Gennaro, Susan; Deatrick, Janet A; Dobal, May T; Jemmott, Loretta Sweet; Ball, Katherine R

    2007-01-01

    Post-doctoral education has become a necessity for new nursing doctoral graduates. However, post-doctoral positions are limited and nurse scientists may face barriers that make non-traditional programs necessary. This study describes the outcomes of the Summer Nursing Research Institute (SNRI), an alternative post-doctoral educational program, reports formative perceptions of SNRI participants, and illustrates the efficacy and limitations of the model with selected summative research related outcomes. Participants between 1997 and 2006 were asked to evaluate the experience while attending the Institute (formative evaluation) and an overall summative evaluation was also conducted. Evaluations indicate that participants gained knowledge, skills, and networking abilities in terms of conducting research with vulnerable populations. A program like the SNRI can be successful in widening the research pipeline, in imparting knowledge, and in fostering positive attitudes as well as in improving research skills.

  3. A synthesized biophysical and social vulnerability assessment for Taiwan

    NASA Astrophysics Data System (ADS)

    Lee, Yung-Jaan

    2017-11-01

    Taiwan, located in the Western Pacific, is a country that is one of the most vulnerable to disasters that are associated with the changing climate; it is located within the Ring of Fire, which is the most geologically active region in the world. The environmental and geological conditions in Taiwan are sensitive and vulnerable to such disasters. Owing to increasing urbanization in Taiwan, floods and climate-related disasters have taken an increasing toll on human lives. As global warming accelerates the rising of sea levels and increasing of the frequency of extreme weather events, disasters will continue to affect socioeconomic development and human conditions. Under such circumstances, researchers and policymakers alike must recognize the importance of providing useful knowledge concerning vulnerability, disaster recovery and resilience. Strategies for reducing vulnerability and climate-related disaster risks and for increasing resilience involve preparedness, mitigation and adaptation. In the last two decades, extreme climate events have caused severe flash floods, debris flows, landslides, and other disasters and have had negative effects of many sectors, including agriculture, infrastructure and health. Since climate change is expected to have a continued impact on socio-economic development, this work develops a vulnerability assessment framework that integrates both biophysical and social vulnerability and supports synthesized vulnerability analyses to identify vulnerable areas in Taiwan. Owing to its geographical, geological and climatic features, Taiwan is susceptible to earthquakes, typhoons, droughts and various induced disasters. Therefore, Taiwan has the urgent task of establishing a framework for assessing vulnerability as a planning and policy tool that can be used to identify not only the regions that require special attention but also hotspots in which efforts should be made to reduce vulnerability and the risk of climate-related disaster. To

  4. The Lipid-Rich Plaque Study of vulnerable plaques and vulnerable patients: Study design and rationale.

    PubMed

    Waksman, Ron; Torguson, Rebecca; Spad, Mia-Ashley; Garcia-Garcia, Hector; Ware, James; Wang, Rui; Madden, Sean; Shah, Priti; Muller, James

    2017-10-01

    It has been hypothesized that the outcome post-PCI could be improved by the detection and subsequent treatment of vulnerable patients and lipid-rich vulnerable coronary plaques (LRP). A near-infrared spectroscopy (NIRS) catheter capable of detecting LRP is being evaluated in The Lipid-Rich Plaque Study. The LRP Study is an international, multicenter, prospective cohort study conducted in patients with suspected coronary artery disease (CAD) who underwent cardiac catheterization with possible ad hoc PCI for an index event. Patient level and plaque level events were detected by follow-up in the subsequent 2 years. Enrollment began in February 2014 and was completed in March 2016; a total of 1,562 patients were enrolled. Adjudication of new coronary event occurrence and de novo culprit lesion location during the 2-year follow-up is performed by an independent clinical end-points committee (CEC) blinded to NIRS-IVUS findings. The first analysis of the results will be performed when at least 20 de novo events have occurred for which follow-up angiographic data and baseline NIRS-IVUS measurements are available. It is expected that results of the study will be announced in 2018. The LRP Study will test the hypotheses that NIRS-IVUS imaging to detect LRP in patients can identify vulnerable patients and vulnerable plaques. Identification of vulnerable patients will assist future studies of novel systemic therapies; identification of localized vulnerable plaques would enhance future studies of possible preventive measures. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Measuring the consequences of wildfires in a Bayesian network with vulnerability and exposure indicators

    NASA Astrophysics Data System (ADS)

    Papakosta, Panagiota; Botzler, Sebastian; Krug, Kai; Straub, Daniel

    2013-04-01

    Mediterranean climate type areas have always been experiencing fire events. However, population growth and expansion of urban centers into wildland areas during the 20th century (expansion of wildland-urban interface) has increased the threat to humans and their activities. Life and property losses, damage on infrastructure and crops, and forest degradation are some of the damages caused by wildfires. Although fires repeatedly occur along the Mediterranean basin, not all areas have experienced severe consequences. The extent of damage by wildfires is influenced by several factors, such as population density, vegetation type, topography, weather conditions and social preparedness [1]. Wildfire consequence estimation by means of vulnerability and exposure indicators is an essential part of wildfire risk analysis. Vulnerability indicators express the conditions that increase the susceptibility of a site to the impact of wildfires and exposure indicators describe the elements at risk [2],[3]. Appropriate indicators to measure wildfire vulnerability and exposure can vary with scale and site. The consequences can be classified into economic, social, environmental and safety, and they can be tangible (human life losses, buildings damaged) or intangible (damage of cultural heritage site). As a consequence, a variety of approaches exist and there is a lack of generalized unified easy-to-implement methodologies. In this study we present a methodology for measuring consequences of wildfires in a Mediterranean area in the mesoscale (1 km² spatial resolution). Vulnerability and exposure indicators covering all consequence levels are identified and their interrelations are stressed. Variables such as building materials, roofing type, and average building values are included in the economic vulnerability level. Safety exposure is expressed by population density, demographic structure, street density and distance to closest fire station. Environmental vulnerability of protected

  6. Climate change and health: Indoor heat exposure in vulnerable populations

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    White-Newsome, Jalonne L., E-mail: jalonne@umich.edu; Sanchez, Brisa N., E-mail: brisa@umich.edu; Jolliet, Olivier, E-mail: ojolliet@umich.edu

    2012-01-15

    Introduction: Climate change is increasing the frequency of heat waves and hot weather in many urban environments. Older people are more vulnerable to heat exposure but spend most of their time indoors. Few published studies have addressed indoor heat exposure in residences occupied by an elderly population. The purpose of this study is to explore the relationship between outdoor and indoor temperatures in homes occupied by the elderly and determine other predictors of indoor temperature. Materials and methods: We collected hourly indoor temperature measurements of 30 different homes; outdoor temperature, dewpoint temperature, and solar radiation data during summer 2009 inmore » Detroit, MI. We used mixed linear regression to model indoor temperatures' responsiveness to weather, housing and environmental characteristics, and evaluated our ability to predict indoor heat exposures based on outdoor conditions. Results: Average maximum indoor temperature for all locations was 34.85 Degree-Sign C, 13.8 Degree-Sign C higher than average maximum outdoor temperature. Indoor temperatures of single family homes constructed of vinyl paneling or wood siding were more sensitive than brick homes to outdoor temperature changes and internal heat gains. Outdoor temperature, solar radiation, and dewpoint temperature predicted 38% of the variability of indoor temperatures. Conclusions: Indoor exposures to heat in Detroit exceed the comfort range among elderly occupants, and can be predicted using outdoor temperatures, characteristics of the housing stock and surroundings to improve heat exposure assessment for epidemiological investigations. Weatherizing homes and modifying home surroundings could mitigate indoor heat exposure among the elderly.« less

  7. Vulnerability analysis in terms of food insecurity and poverty using GIS and remote sensing technology applied to Sri Lanka

    NASA Astrophysics Data System (ADS)

    Shahriar, Pervez M.; Ramachandran, Mahadevan; Mutuwatte, Lal

    2003-03-01

    It is becoming increasingly recognized that computer methods such as models and Geographic Information Systems (GIS) can be valuable tools for analyzing a geographical area in terms of it's hazards vulnerability, Vulnerability is an important aspect of households' experience of poverty. The measurement and analysis of poverty, inequality and vulnerability are crucial for cognitive purposes (to know what the situation is), for analytical purposes (to understand the factors determining this situation), for policy making purposes (to design interventions best adapted to the issues), and for monitoring and evaluation purposes (to assess whether current policies are effective, and whether the situation is changing). Here vulnerability defined as the probability or risk today of being in poverty - or falling deeper into poverty - in the future. Vulnerability is a key dimension of well being since it affects individuals' behavior (in terms of investment, production patterns, coping strategies) and their perception of their own situation. This study has been conducted with the joint collaboration of World Food Programme (WFP) and International Water Management Institute (IWMI) in Sri Lanka for identifying regions and population which are food insecure, for analyzing the reasons for vulnerability to food insecurity in order to provide decision-makers with information to identify possible sectors of intervention and for identifying where and for whom food aid can be best utilized in Sri Lanka. This new approach integrates GIS and Remote sensing with other statistical packages to allow consideration of more spatial/physical parameters like accessibility to economic resources, particularly land and the assets of the built environment, creating employment, and attracting investment in order to improve the quality and quantity of goods and services for the analysis which leads the analysis to represent the real scenario. For this study a detailed topographic data are being used

  8. Addiction Potential of Cigarettes With Reduced Nicotine Content in Populations With Psychiatric Disorders and Other Vulnerabilities to Tobacco Addiction.

    PubMed

    Higgins, Stephen T; Heil, Sarah H; Sigmon, Stacey C; Tidey, Jennifer W; Gaalema, Diann E; Hughes, John R; Stitzer, Maxine L; Durand, Hanna; Bunn, Janice Y; Priest, Jeff S; Arger, Christopher A; Miller, Mollie E; Bergeria, Cecilia L; Davis, Danielle R; Streck, Joanna M; Reed, Derek D; Skelly, Joan M; Tursi, Lauren

    2017-10-01

    A national policy is under consideration to reduce the nicotine content of cigarettes to lower nicotine addiction potential in the United States. To examine how smokers with psychiatric disorders and other vulnerabilities to tobacco addiction respond to cigarettes with reduced nicotine content. A multisite, double-blind, within-participant assessment of acute response to research cigarettes with nicotine content ranging from levels below a hypothesized addiction threshold to those representative of commercial cigarettes (0.4, 2.3, 5.2, and 15.8 mg/g of tobacco) at 3 academic sites included 169 daily smokers from the following 3 vulnerable populations: individuals with affective disorders (n = 56) or opioid dependence (n = 60) and socioeconomically disadvantaged women (n = 53). Data were collected from March 23, 2015, through April 25, 2016. After a brief smoking abstinence, participants were exposed to the cigarettes with varying nicotine doses across fourteen 2- to 4-hour outpatient sessions. Addiction potential of the cigarettes was assessed using concurrent choice testing, the Cigarette Purchase Task (CPT), and validated measures of subjective effects, such as the Minnesota Nicotine Withdrawal Scale. Among the 169 daily smokers included in the analysis (120 women [71.0%] and 49 men [29.0%]; mean [SD] age, 35.6 [11.4] years), reducing the nicotine content of cigarettes decreased the relative reinforcing effects of smoking in all 3 populations. Across populations, the 0.4-mg/g dose was chosen significantly less than the 15.8-mg/g dose in concurrent choice testing (mean [SEM] 30% [0.04%] vs 70% [0.04%]; Cohen d = 0.40; P < .001) and generated lower demand in the CPT (α = .027 [95% CI, 0.023-0.031] vs α = .019 [95% CI, 0.016-0.022]; Cohen d = 1.17; P < .001). Preference for higher over lower nicotine content cigarettes could be reversed by increasing the response cost necessary to obtain the higher dose (mean [SEM], 61% [0

  9. Statistics of software vulnerability detection in certification testing

    NASA Astrophysics Data System (ADS)

    Barabanov, A. V.; Markov, A. S.; Tsirlov, V. L.

    2018-05-01

    The paper discusses practical aspects of introduction of the methods to detect software vulnerability in the day-to-day activities of the accredited testing laboratory. It presents the approval results of the vulnerability detection methods as part of the study of the open source software and the software that is a test object of the certification tests under information security requirements, including software for communication networks. Results of the study showing the allocation of identified vulnerabilities by types of attacks, country of origin, programming languages used in the development, methods for detecting vulnerability, etc. are given. The experience of foreign information security certification systems related to the detection of certified software vulnerabilities is analyzed. The main conclusion based on the study is the need to implement practices for developing secure software in the development life cycle processes. The conclusions and recommendations for the testing laboratories on the implementation of the vulnerability analysis methods are laid down.

  10. Vulnerability survival analysis: a novel approach to vulnerability management

    NASA Astrophysics Data System (ADS)

    Farris, Katheryn A.; Sullivan, John; Cybenko, George

    2017-05-01

    Computer security vulnerabilities span across large, enterprise networks and have to be mitigated by security engineers on a routine basis. Presently, security engineers will assess their "risk posture" through quantifying the number of vulnerabilities with a high Common Vulnerability Severity Score (CVSS). Yet, little to no attention is given to the length of time by which vulnerabilities persist and survive on the network. In this paper, we review a novel approach to quantifying the length of time a vulnerability persists on the network, its time-to-death, and predictors of lower vulnerability survival rates. Our contribution is unique in that we apply the cox proportional hazards regression model to real data from an operational IT environment. This paper provides a mathematical overview of the theory behind survival analysis methods, a description of our vulnerability data, and an interpretation of the results.

  11. Extinction vulnerability of coral reef fishes.

    PubMed

    Graham, Nicholas A J; Chabanet, Pascale; Evans, Richard D; Jennings, Simon; Letourneur, Yves; Aaron Macneil, M; McClanahan, Tim R; Ohman, Marcus C; Polunin, Nicholas V C; Wilson, Shaun K

    2011-04-01

    With rapidly increasing rates of contemporary extinction, predicting extinction vulnerability and identifying how multiple stressors drive non-random species loss have become key challenges in ecology. These assessments are crucial for avoiding the loss of key functional groups that sustain ecosystem processes and services. We developed a novel predictive framework of species extinction vulnerability and applied it to coral reef fishes. Although relatively few coral reef fishes are at risk of global extinction from climate disturbances, a negative convex relationship between fish species locally vulnerable to climate change vs. fisheries exploitation indicates that the entire community is vulnerable on the many reefs where both stressors co-occur. Fishes involved in maintaining key ecosystem functions are more at risk from fishing than climate disturbances. This finding is encouraging as local and regional commitment to fisheries management action can maintain reef ecosystem functions pending progress towards the more complex global problem of stabilizing the climate. © 2011 Blackwell Publishing Ltd/CNRS.

  12. Extinction vulnerability of coral reef fishes

    PubMed Central

    Graham, Nicholas A J; Chabanet, Pascale; Evans, Richard D; Jennings, Simon; Letourneur, Yves; Aaron MacNeil, M; McClanahan, Tim R; Öhman, Marcus C; Polunin, Nicholas V C; Wilson, Shaun K

    2011-01-01

    With rapidly increasing rates of contemporary extinction, predicting extinction vulnerability and identifying how multiple stressors drive non-random species loss have become key challenges in ecology. These assessments are crucial for avoiding the loss of key functional groups that sustain ecosystem processes and services. We developed a novel predictive framework of species extinction vulnerability and applied it to coral reef fishes. Although relatively few coral reef fishes are at risk of global extinction from climate disturbances, a negative convex relationship between fish species locally vulnerable to climate change vs. fisheries exploitation indicates that the entire community is vulnerable on the many reefs where both stressors co-occur. Fishes involved in maintaining key ecosystem functions are more at risk from fishing than climate disturbances. This finding is encouraging as local and regional commitment to fisheries management action can maintain reef ecosystem functions pending progress towards the more complex global problem of stabilizing the climate. PMID:21320260

  13. History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow.

    PubMed

    Walsh, D; McCartney, G; Collins, C; Taulbut, M; Batty, G D

    2017-10-01

    High levels of excess mortality (i.e. that not explained by deprivation) have been observed for Scotland compared with England & Wales, and especially for Glasgow in comparison with similar post-industrial cities such as Liverpool and Manchester. Many potential explanations have been suggested. Based on an assessment of these, the aim was to develop an understanding of the most likely underlying causes. Note that this paper distils a larger research report, with the aim of reaching wider audiences beyond Scotland, as the important lessons learnt are relevant to other populations. Review and dialectical synthesis of evidence. Forty hypotheses were examined, including those identified from a systematic review. The relevance of each was assessed by means of Bradford Hill's criteria for causality alongside-for hypotheses deemed causally linked to mortality-comparisons of exposures between Glasgow and Liverpool/Manchester, and between Scotland and the rest of Great Britain. Where gaps in the evidence base were identified, new research was undertaken. Causal chains of relevant hypotheses were created, each tested in terms of its ability to explain the many different aspects of excess mortality. The models were further tested with key informants from public health and other disciplines. In Glasgow's case, the city was made more vulnerable to important socioeconomic (deprivation, deindustrialisation) and political (detrimental economic and social policies) exposures, resulting in worse outcomes. This vulnerability was generated by a series of historical factors, processes and decisions: the lagged effects of historical overcrowding; post-war regional policy including the socially selective relocation of population to outside the city; more detrimental processes of urban change which impacted on living conditions; and differences in local government responses to UK government policy in the 1980s which both impacted in negative terms in Glasgow and also conferred protective

  14. Measuring Road Network Vulnerability with Sensitivity Analysis

    PubMed Central

    Jun-qiang, Leng; Long-hai, Yang; Liu, Wei-yi; Zhao, Lin

    2017-01-01

    This paper focuses on the development of a method for road network vulnerability analysis, from the perspective of capacity degradation, which seeks to identify the critical infrastructures in the road network and the operational performance of the whole traffic system. This research involves defining the traffic utility index and modeling vulnerability of road segment, route, OD (Origin Destination) pair and road network. Meanwhile, sensitivity analysis method is utilized to calculate the change of traffic utility index due to capacity degradation. This method, compared to traditional traffic assignment, can improve calculation efficiency and make the application of vulnerability analysis to large actual road network possible. Finally, all the above models and calculation method is applied to actual road network evaluation to verify its efficiency and utility. This approach can be used as a decision-supporting tool for evaluating the performance of road network and identifying critical infrastructures in transportation planning and management, especially in the resource allocation for mitigation and recovery. PMID:28125706

  15. Vulnerability of a killer whale social network to disease outbreaks

    NASA Astrophysics Data System (ADS)

    Guimarães, Paulo R., Jr.; de Menezes, Márcio Argollo; Baird, Robin W.; Lusseau, David; Guimarães, Paulo; Dos Reis, Sérgio F.

    2007-10-01

    Emerging infectious diseases are among the main threats to conservation of biological diversity. A crucial task facing epidemiologists is to predict the vulnerability of populations of endangered animals to disease outbreaks. In this context, the network structure of social interactions within animal populations may affect disease spreading. However, endangered animal populations are often small and to investigate the dynamics of small networks is a difficult task. Using network theory, we show that the social structure of an endangered population of mammal-eating killer whales is vulnerable to disease outbreaks. This feature was found to be a consequence of the combined effects of the topology and strength of social links among individuals. Our results uncover a serious challenge for conservation of the species and its ecosystem. In addition, this study shows that the network approach can be useful to study dynamical processes in very small networks.

  16. Limited access to hepatitis B/C treatment among vulnerable risk populations: an expert survey in six European countries.

    PubMed

    Falla, Abby M; Veldhuijzen, Irene K; Ahmad, Amena A; Levi, Miriam; Hendrik Richardus, Jan

    2017-04-01

    To investigate access to treatment for chronic hepatitis B/C among six vulnerable patient/population groups at-risk of infection: undocumented migrants, asylum seekers, people without health insurance, people with state insurance, people who inject drugs (PWID) and people abusing alcohol. An online survey among experts in gastroenterology, hepatology and infectious diseases in 2012 in six EU countries: Germany, Hungary, Italy, the Netherlands, Spain and the UK. A four-point ordinal scale measured access to treatment (no, some, significant or complete restriction). From 235 recipients, 64 responses were received (27%). Differences in access between and within countries were reported for all groups except people with state insurance. Most professionals, other than in Spain and Hungary, reported no or few restrictions for PWID. Significant/complete treatment restriction was reported for all groups by the majority in Hungary and Spain, while Italian respondents reported no/few restrictions. Significant/complete restriction was reported for undocumented migrants and people without health insurance in the UK and Spain. Opinion about undocumented migrants in Germany and the Netherlands was divergent. Although effective chronic hepatitis B/C treatment exists, limited access among vulnerable patient populations was seen in all study countries. Discordance of opinion about restrictions within countries is seen, especially for groups for whom the health care system determines treatment access, such as undocumented migrants, asylum seekers and people without health insurance. This suggests low awareness, or lack, of entitlement guidance among clinicians. Expanding treatment access among risk groups will contribute to reducing chronic viral hepatitis-associated avoidable morbidity and mortality. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association.

  17. Feasibility of portable sleep monitors to detect obstructive sleep apnea (OSA) in a vulnerable urban population.

    PubMed

    Nickerson, Jillian; Lee, Euny; Nedelman, Michael; Aurora, R Nisha; Krieger, Ana; Horowitz, Carol R

    2015-01-01

    Portable sleep monitors may offer a convenient method to expand detection of obstructive sleep apnea (OSA), yet few studies have evaluated this technology in vulnerable populations. We therefore aimed to assess the feasibility and acceptability of portable sleep monitors for detection of OSA in a prediabetic, urban minority population. We recruited a convenience sample of participants at their 12-month follow-up for a community-partnered, peer-led lifestyle intervention aimed to prevent diabetes in prediabetic and overweight patients in this prospective mixed-methods pilot study. All participants wore portable sleep monitors overnight at home. We qualitatively explored perceptions about OSA and portable monitors in a subset of participants. We tested 72 people, predominantly non-White, female, Spanish speaking, uninsured, and of low income. Use of portable sleep monitors was feasible: 100% of the monitors were returned and all participants received results. We detected OSA in 49% (defined as an Apnea-Hypopnea Index [AHI] >5) and moderate-severe OSA in 14% (AHI >15) requiring treatment in 14%. In 21 qualitative interviews, participants supported increased use of portable sleep monitors in their community, were appropriately concerned that OSA could cause progression to diabetes, and thought weight loss could prevent or improve OSA. Portable sleep monitors may represent a feasible method for detecting OSA in high-risk urban minority populations. © Copyright 2015 by the American Board of Family Medicine.

  18. Using ancestry-informative markers to identify fine structure across 15 populations of European origin.

    PubMed

    Huckins, Laura M; Boraska, Vesna; Franklin, Christopher S; Floyd, James A B; Southam, Lorraine; Sullivan, Patrick F; Bulik, Cynthia M; Collier, David A; Tyler-Smith, Chris; Zeggini, Eleftheria; Tachmazidou, Ioanna

    2014-10-01

    The Wellcome Trust Case Control Consortium 3 anorexia nervosa genome-wide association scan includes 2907 cases from 15 different populations of European origin genotyped on the Illumina 670K chip. We compared methods for identifying population stratification, and suggest list of markers that may help to counter this problem. It is usual to identify population structure in such studies using only common variants with minor allele frequency (MAF) >5%; we find that this may result in highly informative SNPs being discarded, and suggest that instead all SNPs with MAF >1% may be used. We established informative axes of variation identified via principal component analysis and highlight important features of the genetic structure of diverse European-descent populations, some studied for the first time at this scale. Finally, we investigated the substructure within each of these 15 populations and identified SNPs that help capture hidden stratification. This work can provide information regarding the designing and interpretation of association results in the International Consortia.

  19. How to Assess Vulnerabilities of Water Policies to Global Change?

    NASA Astrophysics Data System (ADS)

    Kumar, A.; Haasnoot, M.; Weijs, S.

    2017-12-01

    Water managers are confronted with uncertainties arising from hydrological, societal, economical and political drivers. To manage these uncertainties two paradigms have been identified: top-down and bottom-up approaches. Top-down or prediction-based approaches use socio-economic scenarios together with a discrete set of GCM projections (often downscaled) to assess the expected impact of drivers and policies on water resource system through various hydrological and social systems models. Adaptation strategies to alleviate these impacts are then identified and tested against the scenarios. To address GCM and downscaling uncertainties, these approaches put more focus on climate predictions, rather than the decision problem itself. Triggered by the wish to have a more scenario-neutral approach and address downscaling uncertainties, recent analyses have been shifted towards vulnerability-based (bottom-up or decision-centric) approaches. They begin at the local scale by addressing socio-economic responses to climate, often involving stakeholder's input; identify vulnerabilities under a larger sample of plausible futures and evaluate sensitivity and robustness of possible adaptation options. Several bottom-up approaches have emerged so far and are increasingly recommended. Fundamentally they share several core ideas, however, subtle differences exist in vulnerability assessment, visualization tools for exploring vulnerabilities and computational methods used for identifying robust water policies. Through this study, we try to identify how these approaches are progressing, how the climate and non-climate uncertainties are being confronted and how to integrate existing and new tools. We find that choice of a method may depend on the number of vulnerability drivers identified and type of threshold levels (environmental conditions or policy objectives) defined. Certain approaches are suited well for assessing adaptive capacities, tipping points and sequencing of decisions

  20. Vulnerability of networks of interacting Markov chains.

    PubMed

    Kocarev, L; Zlatanov, N; Trajanov, D

    2010-05-13

    The concept of vulnerability is introduced for a model of random, dynamical interactions on networks. In this model, known as the influence model, the nodes are arranged in an arbitrary network, while the evolution of the status at a node is according to an internal Markov chain, but with transition probabilities that depend not only on the current status of that node but also on the statuses of the neighbouring nodes. Vulnerability is treated analytically and numerically for several networks with different topological structures, as well as for two real networks--the network of infrastructures and the EU power grid--identifying the most vulnerable nodes of these networks.

  1. Integrated intravascular ultrasound and optical coherence tomography technology: a promising tool to identify vulnerable plaques [INVITED PAPER

    PubMed Central

    Li, Jiawen; Chen, Zhongping

    2017-01-01

    Heart attack is mainly caused by the rupture of a vulnerable plaque. IVUS-OCT is a novel medical imaging modality that provides opportunities for accurate assessment of vulnerable plaques in vivo in patients. IVUS provides deep penetration to image the whole necrotic core while OCT enables accurate measurement of the fibrous cap of a plaque owing to its high resolution. In this paper, the authors describe the fundamentals, the technical designs and the applications of IVUS-OCT technology. Results from cadaver specimens are summarized, which indicated the complementary nature of OCT and IVUS for assessment of vulnerable plaques, plaque composition, and stent-tissue interactions. Furthermore, previously reported in vivo animal experiments are reviewed to assess the clinical adaptability of IVUS-OCT. Future directions for this technology are also discussed in this review. PMID:28966987

  2. Approaches to improving the contribution of the nursing and midwifery workforce to increasing universal access to primary health care for vulnerable populations: a systematic review.

    PubMed

    Dawson, A J; Nkowane, A M; Whelan, A

    2015-12-18

    Despite considerable evidence showing the importance of the nursing and midwifery workforce, there are no systematic reviews outlining how these cadres are best supported to provide universal access and reduce health care disparities at the primary health care (PHC) level. This review aims to identify nursing and midwifery policy, staffing, education and training interventions, collaborative efforts and strategies that have improved the quantity, quality and relevance of the nursing and midwifery workforce leading to health improvements for vulnerable populations. We undertook a structured search of bibliographic databases for peer-reviewed research literature using a focused review question and inclusion/exclusion criteria. The quality of retrieved papers was appraised using standard tools. The characteristics of screened papers were described, and a deductive qualitative content analysis methodology was applied to analyse the interventions and findings of included studies using a conceptual framework. Thirty-six papers were included in the review, the majority (25) from high-income countries and nursing settings (32). Eleven papers defined leadership and governance approaches that had impacted upon the health outcomes of disadvantaged groups including policies at the national and state level that had led to an increased supply and coverage of nursing and midwifery staff and scope of practice. Twenty-seven papers outlined human resource management strategies to support the expansion of nurse's and midwives' roles that often involved task shifting and task sharing. These included approaches to managing staffing supply, distribution and skills mix; workloads; supervision; performance management; and remuneration, financial incentives and staffing costs. Education and training activities were described in 14 papers to assist nurses and midwives to perform new or expanded roles and prepare nurses for inclusive practice. This review identified collaboration between

  3. MEASURING COERCION TO PARTICIPATE IN RESEARCH WITHIN A DOUBLY VULNERABLE POPULATION: INITIAL DEVELOPMENT OF THE COERCION ASSESSMENT SCALE

    PubMed Central

    Dugosh, Karen Leggett; Festinger, David S.; Croft, Jason R.; Marlowe, Douglas B.

    2011-01-01

    Despite many efforts aimed to ensure that research participation is autonomous and not coerced, there exists no reliable and valid measure of perceived coercion for the doubly vulnerable population of substance-abusing offenders. The current study describes the development and initial validation of an instrument measuring perceived coercion to participate in research among substance-abusing offenders. The results indicated that a substantial number of individuals report feeling coerced to participate in the study. In addition, the instrument has adequate levels of internal consistency, a one-dimensional factor structure, and evidence of discriminative validity. This study provides initial support for the instrument’s validity and clinical utility. PMID:20235867

  4. An Analysis of Botnet Vulnerabilities

    DTIC Science & Technology

    2007-06-01

    Definition Currently, the primary defense against botnets is prompt patching of vulnerable systems and antivirus software . Network monitoring can identify...IRCd software , none were identified during this effort. AFIT iv For my wife, for her caring and support throughout the course of this...are software agents designed to automatically perform tasks. Examples include web-spiders that catalog the Internet and bots found in popular online

  5. Unified communication to reach vulnerable mothers.

    PubMed

    Tezcan, B; Von Rege, I; Henkson, H; Oteng-Ntim, E

    2011-01-01

    The feasibility of using a mobile text to reach vulnerable patient groups was assessed in this study. A total of 121 pregnant or postnatal women were randomly asked to complete a questionnaire. The questionnaire was given to them in the antenatal clinic, postnatal ward, antenatal ward or in the day assessment unit at St Thomas' Hospital, London. The forms were collected and analysed using an Excel database. The results of this survey show that mobile technology is readily available for 97% of the obstetric population. In mothers from vulnerable groups and in mothers from deprived areas, 61% possessed 3rd generation mobile technology. The majority of mothers surveyed wanted their care supplemented by the use of their mobile phones.

  6. Report: Results of Technical Network Vulnerability Assessment: EPA’s Erlanger Building

    EPA Pesticide Factsheets

    Report #10-P-0211, September 7, 2010. Vulnerability testing of EPA’s Erlanger Building network conducted in June 2010 identified Internet Protocol addresses with numerous high-risk and medium-risk vulnerabilities.

  7. Report: Results of Technical Network Vulnerability Assessment: EPA’s Region 4

    EPA Pesticide Factsheets

    Report #10-P-0213, September 7, 2010. Vulnerability testing of EPA’s Region 4 network conducted in June 2010 identified Internet Protocol addresses with numerous high-risk and medium-risk vulnerabilities.

  8. Forest climate change Vulnerability and Adaptation Assessment in Himalayas

    NASA Astrophysics Data System (ADS)

    Chitale, V. S.; Shrestha, H. L.; Agarwal, N. K.; Choudhurya, D.; Gilani, H.; Dhonju, H. K.; Murthy, M. S. R.

    2014-11-01

    Forests offer an important basis for creating and safeguarding more climate-resilient communities over Hindu Kush Himalayan region. The forest ecosystem vulnerability assessment to climate change and developing knowledge base to identify and support relevant adaptation strategies is realized as an urgent need. The multi scale adaptation strategies portray increasing complexity with the increasing levels in terms of data requirements, vulnerability understanding and decision making to choose a particular adaptation strategy. We present here how such complexities could be addressed and adaptation decisions could be either directly supported by open source remote sensing based forestry products or geospatial analysis and modelled products. The forest vulnerability assessment under climate change scenario coupled with increasing forest social dependence was studied using IPCC Landscape scale Vulnerability framework in Chitwan-Annapurna Landscape (CHAL) situated in Nepal. Around twenty layers of geospatial information on climate, forest biophysical and forest social dependence data was used to assess forest vulnerability and associated adaptation needs using self-learning decision tree based approaches. The increase in forest fires, evapotranspiration and reduction in productivity over changing climate scenario was observed. The adaptation measures on enhancing productivity, improving resilience, reducing or avoiding pressure with spatial specificity are identified to support suitable decision making. The study provides spatial analytical framework to evaluate multitude of parameters to understand vulnerabilities and assess scope for alternative adaptation strategies with spatial explicitness.

  9. Comparison of independent screens on differentially vulnerable motor neurons reveals alpha-synuclein as a common modifier in motor neuron diseases.

    PubMed

    Kline, Rachel A; Kaifer, Kevin A; Osman, Erkan Y; Carella, Francesco; Tiberi, Ariana; Ross, Jolill; Pennetta, Giuseppa; Lorson, Christian L; Murray, Lyndsay M

    2017-03-01

    The term "motor neuron disease" encompasses a spectrum of disorders in which motor neurons are the primary pathological target. However, in both patients and animal models of these diseases, not all motor neurons are equally vulnerable, in that while some motor neurons are lost very early in disease, others remain comparatively intact, even at late stages. This creates a valuable system to investigate the factors that regulate motor neuron vulnerability. In this study, we aim to use this experimental paradigm to identify potential transcriptional modifiers. We have compared the transcriptome of motor neurons from healthy wild-type mice, which are differentially vulnerable in the childhood motor neuron disease Spinal Muscular Atrophy (SMA), and have identified 910 transcriptional changes. We have compared this data set with published microarray data sets on other differentially vulnerable motor neurons. These neurons were differentially vulnerable in the adult onset motor neuron disease Amyotrophic Lateral Sclerosis (ALS), but the screen was performed on the equivalent population of neurons from neurologically normal human, rat and mouse. This cross species comparison has generated a refined list of differentially expressed genes, including CELF5, Col5a2, PGEMN1, SNCA, Stmn1 and HOXa5, alongside a further enrichment for synaptic and axonal transcripts. As an in vivo validation, we demonstrate that the manipulation of a significant number of these transcripts can modify the neurodegenerative phenotype observed in a Drosophila line carrying an ALS causing mutation. Finally, we demonstrate that vector-mediated expression of alpha-synuclein (SNCA), a transcript decreased in selectively vulnerable motor neurons in all four screens, can extend life span, increase weight and decrease neuromuscular junction pathology in a mouse model of SMA. In summary, we have combined multiple data sets to identify transcripts, which are strong candidates for being phenotypic modifiers

  10. Community vulnerability to health impacts of wildland fire smoke exposure

    EPA Science Inventory

    Identifying communities vulnerable to adverse health effects from exposure to wildfire smoke may help prepare responses, increase the resilience to smoke and improve public health outcomes during smoke days. We developed a Community Health-Vulnerability Index (CHVI) based on fact...

  11. An allometric approach to quantify the extinction vulnerability of birds and mammals.

    PubMed

    Hilbers, J P; Schipper, A M; Hendriks, A J; Verones, F; Pereira, H M; Huijbregts, M A J

    2016-03-01

    Methods to quantify the vulnerability of species to extinction are typically limited by the availability of species-specific input data pertaining to life-history characteristics and population dynamics. This lack of data hampers global biodiversity assessments and conservation planning. Here, we developed a new framework that systematically quantifies extinction risk based on allometric relationships between various wildlife demographic parameters and body size. These allometric relationships have a solid theoretical and ecological foundation. Extinction risk indicators included are (1) the probability of extinction, (2) the mean time to extinction, and (3) the critical patch size. We applied our framework to assess the global extinction vulnerability of terrestrial carnivorous and non-carnivorous birds and mammals. Irrespective of the indicator used, large-bodied species were found to be more vulnerable to extinction than their smaller counterparts. The patterns with body size were confirmed for all species groups by a comparison with IUCN data on the proportion of extant threatened species: the models correctly predicted a multimodal distribution with body size for carnivorous birds and a monotonic distribution for mammals and non-carnivorous birds. Carnivorous mammals were found to have higher extinction risks than non-carnivores, while birds were more prone to extinction than mammals. These results are explained by the allometric relationships, predicting the vulnerable species groups to have lower intrinsic population growth rates, smaller population sizes, lower carrying capacities, or larger dispersal distances, which, in turn, increase the importance of losses due to environmental stochastic effects and dispersal activities. Our study is the first to integrate population viability analysis and allometry into a novel, process-based framework that is able to quantify extinction risk of a large number of species without requiring data-intensive, species

  12. Grid Transmission Expansion Planning Model Based on Grid Vulnerability

    NASA Astrophysics Data System (ADS)

    Tang, Quan; Wang, Xi; Li, Ting; Zhang, Quanming; Zhang, Hongli; Li, Huaqiang

    2018-03-01

    Based on grid vulnerability and uniformity theory, proposed global network structure and state vulnerability factor model used to measure different grid models. established a multi-objective power grid planning model which considering the global power network vulnerability, economy and grid security constraint. Using improved chaos crossover and mutation genetic algorithm to optimize the optimal plan. For the problem of multi-objective optimization, dimension is not uniform, the weight is not easy given. Using principal component analysis (PCA) method to comprehensive assessment of the population every generation, make the results more objective and credible assessment. the feasibility and effectiveness of the proposed model are validated by simulation results of Garver-6 bus system and Garver-18 bus.

  13. Determining What We Stand for Will Guide What We Do: Community Priorities, Ethical Research Paradigms, and Research With Vulnerable Populations

    PubMed Central

    Treadwell, Henrie M.

    2009-01-01

    Prisoners, ex-offenders, and the communities they belong to constitute a distinct and highly vulnerable population, and research must be sensitive to their priorities. In light of recent suggestions that scientific experimentation involving prisoners be reconsidered, community-based participatory research can be a valuable tool for determining the immediate concerns of prisoners, such as the receipt of high-quality and dignified health care inside and outside prisons. In building research agendas, more must be done to ensure the participation of communities affected by the resulting policies. PMID:19141599

  14. Vulnerability of eco-environmental health to climate change: the views of government stakeholders and other specialists in Queensland, Australia.

    PubMed

    Strand, Linn B; Tong, Shilu; Aird, Rosemary; McRae, David

    2010-07-28

    There is overwhelming scientific evidence that human activities have changed and will continue to change the climate of the Earth. Eco-environmental health, which refers to the interdependencies between ecological systems and population health and well-being, is likely to be significantly influenced by climate change. The aim of this study was to examine perceptions from government stakeholders and other relevant specialists about the threat of climate change, their capacity to deal with it, and how to develop and implement a framework for assessing vulnerability of eco-environmental health to climate change. Two focus groups were conducted in Brisbane, Australia with representatives from relevant government agencies, non-governmental organisations, and the industry sector (n = 15) involved in the discussions. The participants were specialists on climate change and public health from governmental agencies, industry, and non-governmental organisations in South-East Queensland. The specialists perceived climate change to be a threat to eco-environmental health and had substantial knowledge about possible implications and impacts. A range of different methods for assessing vulnerability were suggested by the participants and the complexity of assessment when dealing with multiple hazards was acknowledged. Identified factors influencing vulnerability were perceived to be of a social, physical and/or economic nature. They included population growth, the ageing population with associated declines in general health and changes in the vulnerability of particular geographical areas due to for example, increased coastal development, and financial stress. Education, inter-sectoral collaboration, emergency management (e.g. development of early warning systems), and social networks were all emphasised as a basis for adapting to climate change. To develop a framework, different approaches were discussed for assessing eco-environmental health vulnerability, including literature

  15. Vulnerability of eco-environmental health to climate change: the views of government stakeholders and other specialists in Queensland, Australia

    PubMed Central

    2010-01-01

    Background There is overwhelming scientific evidence that human activities have changed and will continue to change the climate of the Earth. Eco-environmental health, which refers to the interdependencies between ecological systems and population health and well-being, is likely to be significantly influenced by climate change. The aim of this study was to examine perceptions from government stakeholders and other relevant specialists about the threat of climate change, their capacity to deal with it, and how to develop and implement a framework for assessing vulnerability of eco-environmental health to climate change. Methods Two focus groups were conducted in Brisbane, Australia with representatives from relevant government agencies, non-governmental organisations, and the industry sector (n = 15) involved in the discussions. The participants were specialists on climate change and public health from governmental agencies, industry, and non-governmental organisations in South-East Queensland. Results The specialists perceived climate change to be a threat to eco-environmental health and had substantial knowledge about possible implications and impacts. A range of different methods for assessing vulnerability were suggested by the participants and the complexity of assessment when dealing with multiple hazards was acknowledged. Identified factors influencing vulnerability were perceived to be of a social, physical and/or economic nature. They included population growth, the ageing population with associated declines in general health and changes in the vulnerability of particular geographical areas due to for example, increased coastal development, and financial stress. Education, inter-sectoral collaboration, emergency management (e.g. development of early warning systems), and social networks were all emphasised as a basis for adapting to climate change. To develop a framework, different approaches were discussed for assessing eco-environmental health

  16. The Vulnerabilities of Orphaned Children Participating in Research: A Critical Review and Factors for Consideration for Participation in Biomedical and Behavioral Research

    PubMed Central

    Thompson, Rachel T.; Meslin, Eric M.; Braitstein, Paula K. A.; Nyandiko, Winstone M.; Ayaya, Samuel O.; Vreeman, Rachel C.

    2013-01-01

    Orphans are a subpopulation with a unique set of additional vulnerabilities. Increasing focus on children’s rights, pediatric global health, and pediatric research makes it imperative to recognize and address unique vulnerabilities of orphaned children. This paper describes the unique vulnerabilities of the orphaned pediatric population and offers a structured set of factors that require consideration when including orphans in biomedical research. Pediatric orphans are particularly vulnerable due to decreased economic resources, psychosocial instability, increased risk of abuse, and delayed/decreased access to healthcare. These vulnerabilities are significant. By carefully considering each issue in a population in a culturally specific and study-specific manner, researchers can make valuable contributions to the overall health and well-being of this uniquely vulnerable population. PMID:23086048

  17. A climate change vulnerability assessment of California's at-risk birds.

    PubMed

    Gardali, Thomas; Seavy, Nathaniel E; DiGaudio, Ryan T; Comrack, Lyann A

    2012-01-01

    Conservationists must develop new strategies and adapt existing tools to address the consequences of anthropogenic climate change. To support statewide climate change adaptation, we developed a framework for assessing climate change vulnerability of California's at-risk birds and integrating it into the existing California Bird Species of Special Concern list. We defined climate vulnerability as the amount of evidence that climate change will negatively impact a population. We quantified climate vulnerability by scoring sensitivity (intrinsic characteristics of an organism that make it vulnerable) and exposure (the magnitude of climate change expected) for each taxon. Using the combined sensitivity and exposure scores as an index, we ranked 358 avian taxa, and classified 128 as vulnerable to climate change. Birds associated with wetlands had the largest representation on the list relative to other habitat groups. Of the 29 state or federally listed taxa, 21 were also classified as climate vulnerable, further raising their conservation concern. Integrating climate vulnerability and California's Bird Species of Special Concern list resulted in the addition of five taxa and an increase in priority rank for ten. Our process illustrates a simple, immediate action that can be taken to inform climate change adaptation strategies for wildlife.

  18. A model for identifying and ranking need for trauma service in nonmetropolitan regions based on injury risk and access to services.

    PubMed

    Schuurman, Nadine; Bell, Nathaniel; Hameed, Morad S; Simons, Richard

    2008-07-01

    Timely access to definitive trauma care has been shown to improve survival rates after severe injury. Unfortunately, despite development of sophisticated trauma systems, prompt, definitive trauma care remains unavailable to over 50 million North Americans, particularly in rural areas. Measures to quantify social and geographic isolation may provide important insights for the development of health policy aimed at reducing the burden of injury and improving access to trauma care in presently under serviced populations. Indices of social deprivation based on census data, and spatial analyses of access to trauma centers based on street network files were combined into a single index, the Population Isolation Vulnerability Amplifier (PIVA) to characterize vulnerability to trauma in socioeconomically and geographically diverse rural and urban communities across British Columbia. Regions with a sufficient core population that are more than one hour travel time from existing services were ranked based on their level of socioeconomic vulnerability. Ten regions throughout the province were identified as most in need of trauma services based on population, isolation and vulnerability. Likewise, 10 communities were classified as some of the least isolated areas and were simultaneously classified as least vulnerable populations in province. The model was verified using trauma services utilization data from the British Columbia Trauma Registry. These data indicate that including vulnerability in the model provided superior results to running the model based only on population and road travel time. Using the PIVA model we have shown that across Census Urban Areas there are wide variations in population dependence on and distances to accredited tertiary/district trauma centers throughout British Columbia. Many of the factors that influence access to definitive trauma care can be combined into a single quantifiable model that researchers in the health sector can use to predict

  19. Assessment of human-natural system characteristics influencing global freshwater supply vulnerability

    NASA Astrophysics Data System (ADS)

    Padowski, Julie C.; Gorelick, Steven M.; Thompson, Barton H.; Rozelle, Scott; Fendorf, Scott

    2015-10-01

    Global freshwater vulnerability is a product of environmental and human dimensions, however, it is rarely assessed as such. Our approach identifies freshwater vulnerability using four broad categories: endowment, demand, infrastructure, and institutions, to capture impacts on natural and managed water systems within the coupled human-hydrologic environment. These categories are represented by 19 different endogenous and exogenous characteristics affecting water supply vulnerability. By evaluating 119 lower per capita income countries (<10 725), we find that every nation experiences some form of vulnerability. Institutional vulnerability is experienced most commonly, occurring in 44 nations, and 23 countries suffer deficiencies in all four categories. Of these highly vulnerable countries, Jordan is the most vulnerable, reporting the greatest number of characteristics (5 of 19) at critical vulnerability levels, with Yemen and Djibouti nearly as vulnerable. Surprising similarities in vulnerability were also found among geographically disparate nations such as Vietnam, Sri Lanka, and Guatemala. Determining shared patterns of freshwater vulnerability provides insights into why water supply vulnerabilities are manifested in human-water systems at the national scale.

  20. The influence of selection for vulnerability to angling on foraging ecology in largemouth bass Micropterus salmoides.

    PubMed

    Nannini, M A; Wahl, D H; Philipp, D P; Cooke, S J

    2011-10-01

    Several traits related to foraging behaviour were assessed in young-of-the-year produced from largemouth bass Micropterus salmoides that had been exposed to four generations of artificial selection for vulnerability to angling. As recreational angling may target foraging ability, this study tested the hypothesis that selection for vulnerability to angling would affect behaviours associated with foraging ecology and prey capture success. Fish selected for low vulnerability to angling captured more prey and attempted more captures than high vulnerability fish. The higher capture attempts, however, ultimately resulted in a lower capture success for low vulnerability fish. Low vulnerability fish also had higher prey rejection rates, marginally shorter reactive distance and were more efficient at converting prey consumed into growth than their high vulnerability counterparts. Selection due to recreational fishing has the potential to affect many aspects of the foraging ecology of the targeted population and highlights the importance of understanding evolutionary effects and how these need to be considered when managing populations. © 2011 The Authors. Journal of Fish Biology © 2011 The Fisheries Society of the British Isles.

  1. Methodology for the Detection of Residential Vulnerable Areas - the Case of Barcelona

    NASA Astrophysics Data System (ADS)

    Cornado, Cossima; Garcia-Almirall, Pilar; Vima, Sara; Vila Busqued, Gemma; Uzqueda, Angel

    2017-10-01

    In a context of a shifting environmental, economic and social paradigm, European cities face a situation that is at the same time challenge and opportunity: the need for urban rehabilitation of the vulnerable degraded socio residential fabric. Public administrations in big cities and metropolitan areas are confronted with both the undercurrent need of actualization of the built stock and the rise of urban residential vulnerability. The city of Barcelona, as many others, is the result of multiple phenomena with high urban and social consequences. The socio spatial integration of immigrant population, the touristic rise and gentrification processes are current situations simultaneously taking place in the city. In parallel, a framework of economic crisis in which public investments in urban and social matters decrease, provides a temporal juncture that results into an increase of social polarization and socio economic inequality that becomes evident and expressed in the territory. This research focuses in the case of Barcelona, and presents a methodology based on a system of indicators elaborated through the exploitation of statistical data complemented with very specific data supplied by the Barcelona City Council. The accurate knowledge of socio demographic, socioeconomic and residential and urban characteristics is crucial in order to define the very complex urban dynamics that describe in the city neighbourhoods and areas. Residential vulnerability is defined as an assembly of objective conditions that relate to residential space and indicate situations of social discrimination and structural disadvantage of the population, related to a specific time and context. Thus, it is relevant to analyse the concentration of certain indicators of vulnerability in specific places or neighbourhoods, to contrast its effect on the socio-residential situation and its temporal evolution in order to identify tendencies. The present study contributes to the identification of data

  2. Spatial Supermarket Redlining and Neighborhood Vulnerability: A Case Study of Hartford, Connecticut

    PubMed Central

    Zhang, Mengyao

    2015-01-01

    The disinclination of chain supermarkets to locate or pull out existing stores from impoverished neighborhoods is termed as “supermarket redlining”. This paper attempts to map and understand the spatial effects of potential supermarket redlining on food vulnerability in urban disadvantaged neighborhoods of Hartford, Connecticut. Using a combination of statistical and spatial analysis functions, we first, built a Supermarket Redlining Index (SuRI) from five indicators such as sales volume, employee count, accepts food coupons from federally assisted programs, and size and population density of the service area to rank supermarkets in the order of their importance. Second, to understand the effect of redlining, a Supermarket Redlining Impact Model (SuRIM) was built with eleven indicators describing both the socioeconomic and food access vulnerabilities. The interaction of these vulnerabilities would identify the final outcome: neighborhoods where the impact of supermarket redlining would be critical. Results mapped critical areas in the inner-city of Hartford where if a nearby supermarket closes or relocates to a suburb with limited mitigation efforts to gill the grocery gap, a large number of minority, poor, and disadvantaged residents will experience difficulties to access healthy food leading to food insecurity or perhaps a food desert. We also suggest mitigation efforts to reduce the impact of large supermarket closures. PMID:27034615

  3. Spatial Supermarket Redlining and Neighborhood Vulnerability: A Case Study of Hartford, Connecticut.

    PubMed

    Zhang, Mengyao; Debarchana, Ghosh

    2016-02-01

    The disinclination of chain supermarkets to locate or pull out existing stores from impoverished neighborhoods is termed as "supermarket redlining". This paper attempts to map and understand the spatial effects of potential supermarket redlining on food vulnerability in urban disadvantaged neighborhoods of Hartford, Connecticut. Using a combination of statistical and spatial analysis functions, we first, built a Supermarket Redlining Index (SuRI) from five indicators such as sales volume, employee count, accepts food coupons from federally assisted programs, and size and population density of the service area to rank supermarkets in the order of their importance. Second, to understand the effect of redlining, a Supermarket Redlining Impact Model (SuRIM) was built with eleven indicators describing both the socioeconomic and food access vulnerabilities. The interaction of these vulnerabilities would identify the final outcome: neighborhoods where the impact of supermarket redlining would be critical. Results mapped critical areas in the inner-city of Hartford where if a nearby supermarket closes or relocates to a suburb with limited mitigation efforts to gill the grocery gap, a large number of minority, poor, and disadvantaged residents will experience difficulties to access healthy food leading to food insecurity or perhaps a food desert. We also suggest mitigation efforts to reduce the impact of large supermarket closures.

  4. Vulnerabilities to Health Disparities and Statin Use in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study.

    PubMed

    Schroff, Praful; Gamboa, Christopher M; Durant, Raegan W; Oikeh, Asikhame; Richman, Joshua S; Safford, Monika M

    2017-08-28

    Statins may be underutilized in certain vulnerable populations, but the effect of cumulative vulnerabilities within 1 individual is not well described. We sought to determine the likelihood of receiving statins with an increasing number of vulnerabilities in an individual, after controlling for factors known to influence health services utilization. We identified 18 216 participants from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study who had a statin indication or who were taking statins, as verified by pill bottle review. Statin use was assessed with respect to 5 major vulnerability domains alone and in combination: older age, black race, female sex, high area-level poverty, and lack of health insurance. The study included 5286 white men, 4180 black men, 2791 white women, and 4194 black women; 5.6% of the sample had no vulnerabilities, 20.6% had 1 vulnerability, 29.2% had 2 vulnerabilities, 27.3% had 3 vulnerabilities, and 17.3% had 4 or 5 vulnerabilities. All race-sex groups were less likely than white men to use statins; prevalence of use was 0.80 in black women with reference to white men ( P <0.0001). In both unadjusted and adjusted models, as the number of vulnerabilities increased, statin use steadily decreased. After adjusting for factors that influence health services utilization, compared with those without any vulnerabilities, statin use prevalence was 0.91, 0.83, 0.74 and 0.68 ( P <0.0001) in those with 1, 2, 3, and 4 or 5 vulnerabilities, respectively. Participants with more simultaneously occurring vulnerabilities experienced the greatest disparities in statin use. Black women and those without health insurance were at particularly high risk of underutilization. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  5. Comparative studies of groundwater vulnerability assessment

    NASA Astrophysics Data System (ADS)

    Maria, Rizka

    2018-02-01

    Pollution of groundwater is a primary issue because aquifers are susceptible to contamination from land use and anthropogenic impacts. Groundwater susceptibility is intrinsic and specific. Intrinsic vulnerability refers to an aquifer that is susceptible to pollution and to the geological and hydrogeological features. Vulnerability assessment is an essential step in assessing groundwater contamination. This approach provides a visual analysis for helping planners and decision makers to achieve the sustainable management of water resources. Comparative studies are applying different methodologies to result in the basic evaluation of the groundwater vulnerability. Based on the comparison of methods, there are several advantages and disadvantages. SI can be overlaid on DRASTIC and Pesticide DRASTIC to extract the divergence in sensitivity. DRASTIC identifies low susceptibility and underestimates the pollution risk while Pesticide DRASTIC and SI represents better risk and is recommended for the future. SINTACS method generates very high vulnerability zones with surface waters and aquifer interactions. GOD method could be adequate for vulnerability mapping in karstified carbonate aquifers at small-moderate scales, and EPIK method can be used for large scale. GOD method is suitable for designing large area such as land management while DRASTIC has good accuracy and more real use in geoenvironmental detailed studies.

  6. Mapping the Decadal Spatio-temporal Variation of Social Vulnerability to Hydro-climatic Extremes over India

    NASA Astrophysics Data System (ADS)

    H, V.; Karmakar, S.; Ghosh, S.

    2015-12-01

    Human induced global warming is unequivocal and observational studies shows that, this has led to increase in the intensity and frequency of hydro-climatic extremes, most importantly precipitation extreme, heat waves and drought; and also is expected to be increased in the future. The occurrence of these extremes have a devastating effects on nation's economy and on societal well-being. Previous studies on India provided the evidences of significant changes in the precipitation extreme from pre- to post-1950, with huge spatial heterogeneity; and projections of heat waves indicated that significant part of India will experience heat stress conditions in the future. Under these circumstance, it is necessary to develop a nation-wide social vulnerability map to scrutinize the adequacy of existing emergency management. Yet there has been no systematic past efforts on mapping social vulnerability to hydro-climatic extremes at nation-wide for India. Therefore, immediate efforts are required to quantify the social vulnerability, particularly developing country like India, where major transformations in demographic characteristics and development patterns are evident during past decades. In the present study, we perform a comprehensive spatio-temporal social vulnerability analysis by considering multiple sensitive indicators for three decades (1990-2010) which identifies the hot-spots, with higher vulnerability to hydro-climatic extremes. The population datasets are procured from Census of India and the meteorological datasets are obtained from India Meteorological Department (IMD). The study derives interesting results on decadal changes of spatial distribution of risk, considering social vulnerability and hazard to extremes.

  7. Integrated flash flood vulnerability assessment: Insights from East Attica, Greece

    NASA Astrophysics Data System (ADS)

    Karagiorgos, Konstantinos; Thaler, Thomas; Heiser, Micha; Hübl, Johannes; Fuchs, Sven

    2016-10-01

    In the framework of flood risk assessment, vulnerability is a key concept to assess the susceptibility of elements at risk. Besides the increasing amount of studies on flash floods available, in-depth information on vulnerability in Mediterranean countries was missing so far. Moreover, current approaches in vulnerability research are driven by a divide between social scientists who tend to view vulnerability as representing a set of socio-economic factors, and natural scientists who view vulnerability in terms of the degree of loss to an element at risk. Further, vulnerability studies in response to flash flood processes are rarely answered in the literature. In order to close this gap, this paper implemented an integrated vulnerability approach focusing on residential buildings exposed to flash floods in Greece. In general, both physical and social vulnerability was comparable low, which is interpreted as a result from (a) specific building regulations in Greece as well as general design principles leading to less structural susceptibility of elements at risk exposed, and (b) relatively low economic losses leading to less social vulnerability of citizens exposed. The population show high risk awareness and coping capacity to response to natural hazards event and in the same time the impact of the events are quite low, because of the already high use of local protection measures. The low vulnerability score for East Attica can be attributed especially to the low physical vulnerability and the moderate socio-economic well-being of the area. The consequence is to focus risk management strategies mainly in the reduction of the social vulnerability. By analysing both physical and social vulnerability an attempt was made to bridge the gap between scholars from sciences and humanities, and to integrate the results of the analysis into the broader vulnerability context.

  8. Identifying psychosocial stressors of well-being and factors related to substance use among Latino day laborers.

    PubMed

    Nalini Junko Negi

    2011-08-01

    Day labor is largely comprised of young Latino immigrant men, many of who are undocumented, and thus vulnerable to a myriad of workers' rights abuses. The difficult work and life conditions of this marginalized population may place them at heightened risk for mental health problems and substance use and abuse. However, factors related to Latino day laborers' well-being and substance misuse are largely unknown. This article utilizes ethnographic and focus group methodology to elucidate participant identified factors associated to well-being and substance use and abuse. This study has implications for informing public health and social service programming as it provides thick description regarding the context and circumstances associated to increased vulnerability to substance abuse and lack of well-being among this hard-to-reach population of Latino immigrants.

  9. Identifying Psychosocial Stressors of Well-Being and Factors Related to Substance Use Among Latino Day Laborers

    PubMed Central

    2012-01-01

    Day labor is largely comprised of young Latino immigrant men, many of who are undocumented, and thus vulnerable to a myriad of workers’ rights abuses. The difficult work and life conditions of this marginalized population may place them at heightened risk for mental health problems and substance use and abuse. However, factors related to Latino day laborers’ well-being and substance misuse are largely unknown. This article utilizes ethnographic and focus group methodology to elucidate participant identified factors associated to well-being and substance use and abuse. This study has implications for informing public health and social service programming as it provides thick description regarding the context and circumstances associated to increased vulnerability to substance abuse and lack of well-being among this hard-to-reach population of Latino immigrants. PMID:21107694

  10. Can Tobacco Control Be Transformative? Reducing Gender Inequity and Tobacco Use among Vulnerable Populations

    PubMed Central

    Greaves, Lorraine

    2014-01-01

    Tobacco use and exposure is unequally distributed across populations and countries and among women and men. These trends and patterns reflect and cause gender and economic inequities along with negative health impacts. Despite a commitment to gender analysis in the preamble to Framework Convention on Tobacco Control there is much yet to be done to fully understand how gender operates in tobacco control. Policies, program and research in tobacco control need to not only integrate gender, but rather operationalize gender with the goal of transforming gender and social inequities in the course of tobacco control initiatives. Gender transformative tobacco control goes beyond gender sensitive efforts and challenges policy and program developers to apply gender theory in designing their initiatives, with the goal of changing negative gender and social norms and improving social, economic, health and social indicators along with tobacco reduction. This paper outlines what is needed to progress tobacco control in enhancing the status of gendered and vulnerable groups, with a view to reducing gender and social inequities due to tobacco use and exposure. PMID:24402065

  11. Targeting LKB1 in cancer – exposing and exploiting vulnerabilities

    PubMed Central

    Momcilovic, M; Shackelford, D B

    2015-01-01

    The LKB1 tumour suppressor is a serine/threonine kinase that functions as master regulator of cell growth, metabolism, survival and polarity. LKB1 is frequently mutated in human cancers and research spanning the last two decades have begun decoding the cellular pathways deregulated following LKB1 inactivation. This work has led to the identification of vulnerabilities present in LKB1-deficient tumour cells. Pre-clinical studies have now identified therapeutic strategies targeting this subset of tumours that promise to benefit this large patient population harbouring LKB1 mutations. Here, we review the current efforts that are underway to translate pre-clinical discovery of therapeutic strategies targeting LKB1 mutant cancers into clinical practice. PMID:26196184

  12. Food Vulnerability and Alluvial Farming for Food Security in Central Dry Zone Area of Myanmar

    NASA Astrophysics Data System (ADS)

    Boori, M. S.; Choudhary, K.; Evers, M.; Kupriyanov, A.

    2017-10-01

    The central dry zone area of Myanmar is the most water stressed and also one of the most food insecure regions in the country. In the Dry Zone area, the total population is 10.1 million people in 54 townships, in which approximately 43 % live in below poverty line and 40-50 % of the rural population is landless. Agriculture is the most important economic sector in Myanmar as it is essential for national food security and a major source of livelihood for its people. In this region the adverse effects of climate change such as late or early onset of monsoon season, longer dry spells, erratic rainfall, increasing temperature, heavy rains, stronger typhoons, extreme spatial-temporal variability of rainfall, high intensities, limited rainfall events in the growing season, heat stress, drought, flooding, sea water intrusion, land degradation, desertification, deforestation and other natural disasters are believed to be a major constraint to food insecurity. For food vulnerability, we use following indicators: slope, precipitation, vegetation, soil, erosion, land degradation and harvest failure in ArcGIS software. The erosion is influenced by rainfall and slope, while land degradation is directly related to vegetation, drainage and soil. While harvest failure can be generate by rainfall and flood potential zones. Results show that around 45 % study area comes under very high erosion danger level, 70 % under average harvest failure, 59 % intermediate land degradation area and the overall around 45 % study area comes under insecure food vulnerability zone. Our analysis shows an increase in alluvial farming by 1745.33 km2 since 1988 to reduce the insecure food vulnerability. Food vulnerability map is also relevant to increased population and low income areas. The extreme climatic events are likely increase in frequency and magnitude of serious drought periods and extreme floods. Food insecurity is an important thing that must

  13. Hierarchical population monitoring of greater sage-grouse (Centrocercus urophasianus) in Nevada and California—Identifying populations for management at the appropriate spatial scale

    USGS Publications Warehouse

    Coates, Peter S.; Prochazka, Brian G.; Ricca, Mark A.; Wann, Gregory T.; Aldridge, Cameron L.; Hanser, Steven E.; Doherty, Kevin E.; O'Donnell, Michael S.; Edmunds, David R.; Espinosa, Shawn P.

    2017-08-10

    Population ecologists have long recognized the importance of ecological scale in understanding processes that guide observed demographic patterns for wildlife species. However, directly incorporating spatial and temporal scale into monitoring strategies that detect whether trajectories are driven by local or regional factors is challenging and rarely implemented. Identifying the appropriate scale is critical to the development of management actions that can attenuate or reverse population declines. We describe a novel example of a monitoring framework for estimating annual rates of population change for greater sage-grouse (Centrocercus urophasianus) within a hierarchical and spatially nested structure. Specifically, we conducted Bayesian analyses on a 17-year dataset (2000–2016) of lek counts in Nevada and northeastern California to estimate annual rates of population change, and compared trends across nested spatial scales. We identified leks and larger scale populations in immediate need of management, based on the occurrence of two criteria: (1) crossing of a destabilizing threshold designed to identify significant rates of population decline at a particular nested scale; and (2) crossing of decoupling thresholds designed to identify rates of population decline at smaller scales that decouple from rates of population change at a larger spatial scale. This approach establishes how declines affected by local disturbances can be separated from those operating at larger scales (for example, broad-scale wildfire and region-wide drought). Given the threshold output from our analysis, this adaptive management framework can be implemented readily and annually to facilitate responsive and effective actions for sage-grouse populations in the Great Basin. The rules of the framework can also be modified to identify populations responding positively to management action or demonstrating strong resilience to disturbance. Similar hierarchical approaches might be beneficial

  14. Social vulnerability assessment: a growing practice in Europe?

    NASA Astrophysics Data System (ADS)

    Tapsell, S.; McC arthy, S.

    2012-04-01

    country policy and the particular risk management focus to the smaller scale risk management perceptions of the analysis techniques employed being to resource expensive, difficult to interpret or to operationalise. This paper will provide a context with some empirical examples to perhaps explain the growing popularity of concepts such as resilience and capacity building which lie more comfortably with policy makers and risk managers as concepts which focus on the solution rather than identifying a problem by assessing social vulnerability.

  15. Integrated assessment of urban vulnerability and resilience. Case study: Targu Ocna town, Romania

    NASA Astrophysics Data System (ADS)

    Grozavu, Adrian; Bănică, Alexandru

    2015-04-01

    Vulnerability assessment frequently emphasizes the internal fragility of a system in relation to a given hazard, when compared to similar systems or to a reference standard. This internal fragility, either biophysical or structural, may affect the ability to predict, to prepare for and cope with or to recover from the manifestation of a risk phenomenon. Thus, the vulnerability is highly related to resilience and adaptability. There is no single methodology for vulnerability and resilience analysis, their assessment can only be made by identifying and integrating indicators which are compatible with the analysis level and the geographic, economic and social features of a certain area. An integrated model of evaluating vulnerability and resilience capacity is being proposed in this paper for Targu Ocna, a small mining settlement in the Eastern Carpathians of Romania, that became in the last years a tourist town and acts within the surrounding territory as a dynamic local pole. Methodologically, the following steps and operations were considered: identifying potential hazards, identifying elements at risk, identifying proper indicators and integrating them in order to evaluate the general vulnerability and resilience. The inventory of elements at risk (the number of people potentially affected, residential or other functionalities buildings, roads and other infrastructure elements etc.) was made based on General Urban Plan, topographic maps (scale 1:5000), ortophotos from 2003 and 2008 and field mapping and researches. Further on, several vulnerability indicators were identified and included within the analytical approach: dependency ratio, income, quality of the habitat and technical urban facilities, environment quality showing differentiated sensitivity. Issues such as preparedness and preventive measures (priority areas within the risk prevention plans), coping ability (networks' geometry and connectivity, emergency utilities and services accessibility) and the

  16. Analysis of economic vulnerability to flash floods in urban areas of Castilla y León (Spain)

    NASA Astrophysics Data System (ADS)

    Aroca-Jimenez, Estefanía; Bodoque, Jose Maria; García, Juan Antonio; Diez-Herrero, Andres

    2017-04-01

    The growth of exposed population to floods, the expansion in allocation of economical activities to flood-prone areas and the rise of extraordinary event frequency over the last few decades, have resulted in an increase of flash flood-related casualties and economic losses. The increase in these losses at an even higher rate than the increase of magnitude and frequency of extreme events, underline that the vulnerability of societies exposed is a key aspect to be considered. Vulnerability is defined as the conditions determined by physical, social, economic and environmental factors or processes which increase the susceptibility of a community to the impact of hazards such as floods, being flash floods one of the natural hazards with the greatest capacity to generate risk. In recent years, numerous papers have deal with the assessment of the social dimension of vulnerability. However, economic factors are often a neglected aspect in traditional risk assessments which mainly focus on structural measures and flood damage models. In this context, the aim of this research is to identify those economic characteristics which render people vulnerable to flash flood hazard, and consider whether these characteristics are identifiable as local patterns at regional level. The result of this task is an Economic Vulnerability Index (EVI) based on susceptibility profiles of the population per township. These profiles are obtained by Hierarchical Segmentation and Latent Class Cluster Analysis of economic information provided by different public institutional databases. The methodology proposed here is implemented in the region of Castilla y León (94,230 km2), placed in Central-Northern Spain. Townships included in this study meet two requirements: i) urban areas are potentially affected by flash floods (i.e. villages are crossed by rivers or streams with a longitudinal slope higher than 0.01 m m-1); ii) urban areas are affected by an area with low or exceptional probability of

  17. Contexts of vulnerability and the acceptability of new biomedical HIV prevention technologies among key populations in South Africa: A qualitative study.

    PubMed

    Atujuna, Millicent; Newman, Peter A; Wallace, Melissa; Eluhu, Megan; Rubincam, Clara; Brown, Ben; Bekker, Linda-Gail

    2018-01-01

    New biomedical prevention technologies (NPTs) may contribute to substantially reducing incident HIV infections globally. We explored acceptability and preferences for NPTs among key and other vulnerable populations in two South African townships. We conducted six focus groups and 12 in-depth interviews with adolescents, and adult heterosexual men, women, and men who have sex with men (MSM) (n = 48), and eight in-depth interviews with key informant healthcare workers. The interview guide described pre-exposure prophylaxis (PrEP), vaginal rings, rectal microbicides and HIV vaccines, and explored acceptability and product preferences. Focus groups and in-depth interviews (45-80 minutes) were conducted in Xhosa, audiotaped, and transcribed and translated into English. Data were coded and reviewed using framework analysis with NVivo software. Overall, initial enthusiasm and willingness to use NPTs evolved into concerns about how particular NPTs might affect or require alterations in one's everyday lifestyle and practices. Different product preferences and motivations emerged by population based on similarity to existing practices and contexts of vulnerability. Adult women and female adolescents preferred a vaginal ring and HIV vaccine, motivated by longer duration of protection to mitigate feared repercussions from male partners, including threats to their marriage and safety, and a context of ubiquitous rape. Male adolescents preferred an HIV vaccine, seen as protection in serodiscordant relationships and convenient in obviating the HIV stigma and cost involved in buying condoms. Adult men preferred PrEP, given familiarity with oral medications and mistrust of injections, seen as enabling serodiscordant couples to have a child. MSM preferred a rectal microbicide given familiarity with gel-based lubricants, with concerns about duration of protection in the context of unplanned consensual sex and rape. Biomedical interventions to prevent HIV transmission, rather than

  18. [Vulnerability and health problems while traveling: the viewpoint of the tourist in the city of Rio de Janeiro].

    PubMed

    Matos, Vanina; Barcellos, Christovam; Camargo, Luiz Octávio de Lima

    2013-01-01

    This article examines how a group of tourists perceives health issues related to safety, prevention and health care during their travels. Interviews were conducted with Brazilian tourists visiting the city of Rio de Janeiro, as well as local residents leaving the city on trips. The interviews were analyzed in accordance with the dimensions of vulnerability, information, prevention and health care, from which vulnerability emerged as a category of analysis. The reports of the trajectory of the tourists made it possible to identify problems and opportunities that could be used by the health sector for actions of prevention and promotion. The means of transport determines the trajectory of tourists and their security alternatives. Traveling in groups and visiting tourist attractions are seen as protective factors, which reinforces the role of information and social support networks as resources used by tourists in the absence of specific policies geared to this highly mobile and vulnerable population group.

  19. Identifying populations sensitive to environmental chemicals by simulating toxicokinetic variability.

    PubMed

    Ring, Caroline L; Pearce, Robert G; Setzer, R Woodrow; Wetmore, Barbara A; Wambaugh, John F

    2017-09-01

    The thousands of chemicals present in the environment (USGAO, 2013) must be triaged to identify priority chemicals for human health risk research. Most chemicals have little of the toxicokinetic (TK) data that are necessary for relating exposures to tissue concentrations that are believed to be toxic. Ongoing efforts have collected limited, in vitro TK data for a few hundred chemicals. These data have been combined with biomonitoring data to estimate an approximate margin between potential hazard and exposure. The most "at risk" 95th percentile of adults have been identified from simulated populations that are generated either using standard "average" adult human parameters or very specific cohorts such as Northern Europeans. To better reflect the modern U.S. population, we developed a population simulation using physiologies based on distributions of demographic and anthropometric quantities from the most recent U.S. Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES) data. This allowed incorporation of inter-individual variability, including variability across relevant demographic subgroups. Variability was analyzed with a Monte Carlo approach that accounted for the correlation structure in physiological parameters. To identify portions of the U.S. population that are more at risk for specific chemicals, physiologic variability was incorporated within an open-source high-throughput (HT) TK modeling framework. We prioritized 50 chemicals based on estimates of both potential hazard and exposure. Potential hazard was estimated from in vitro HT screening assays (i.e., the Tox21 and ToxCast programs). Bioactive in vitro concentrations were extrapolated to doses that produce equivalent concentrations in body tissues using a reverse dosimetry approach in which generic TK models are parameterized with: 1) chemical-specific parameters derived from in vitro measurements and predicted from chemical structure; and 2) with

  20. Climate change vulnerability to agrarian ecosystem of small Island: evidence from Sagar Island, India

    NASA Astrophysics Data System (ADS)

    Mandal, S.; Satpati, L. N.; Choudhury, B. U.; Sadhu, S.

    2018-04-01

    The present study assessed climate change vulnerability in agricultural sector of low-lying Sagar Island of Bay of Bengal. Vulnerability indices were estimated using spatially aggregated biophysical and socio-economic parameters by applying principal component analysis and equal weight method. The similarities and differences of outputs of these two methods were analysed across the island. From the integration of outputs and based on the severity of vulnerability, explicit vulnerable zones were demarcated spatially. Results revealed that life subsistence agriculture in 11.8% geographical area (2829 ha) of the island along the western coast falls under very high vulnerable zone (VHVZ VI of 84-99%) to climate change. Comparatively higher values of exposure (0.53 ± 0.26) and sensitivity (0.78 ± 0.14) subindices affirmed that the VHV zone is highly exposed to climate stressor with very low adaptive capacity (ADI= 0.24 ± 0.16) to combat vulnerability to climate change. Hence, food security for a population of >22 thousands comprising >3.7 thousand agrarian households are highly exposed to climate change. Another 17% area comprising 17.5% population covering 20% villages in north-western and eastern parts of the island also falls under high vulnerable (VI= 61%-77%) zone. Findings revealed large spatial heterogeneity in the degree of vulnerability across the island and thus, demands devising area specific planning (adaptation and mitigation strategies) to address the climate change impact implications both at macro and micro levels.

  1. Climate change vulnerability for species-Assessing the assessments.

    PubMed

    Wheatley, Christopher J; Beale, Colin M; Bradbury, Richard B; Pearce-Higgins, James W; Critchlow, Rob; Thomas, Chris D

    2017-09-01

    Climate change vulnerability assessments are commonly used to identify species at risk from global climate change, but the wide range of methodologies available makes it difficult for end users, such as conservation practitioners or policymakers, to decide which method to use as a basis for decision-making. In this study, we evaluate whether different assessments consistently assign species to the same risk categories and whether any of the existing methodologies perform well at identifying climate-threatened species. We compare the outputs of 12 climate change vulnerability assessment methodologies, using both real and simulated species, and validate the methods using historic data for British birds and butterflies (i.e. using historical data to assign risks and more recent data for validation). Our results show that the different vulnerability assessment methods are not consistent with one another; different risk categories are assigned for both the real and simulated sets of species. Validation of the different vulnerability assessments suggests that methods incorporating historic trend data into the assessment perform best at predicting distribution trends in subsequent time periods. This study demonstrates that climate change vulnerability assessments should not be used interchangeably due to the poor overall agreement between methods when considering the same species. The results of our validation provide more support for the use of trend-based rather than purely trait-based approaches, although further validation will be required as data become available. © 2017 The Authors. Global Change Biology Published by John Wiley & Sons Ltd.

  2. Identifying consumer-resource population dynamics using paleoecological data.

    PubMed

    Einarsson, Árni; Hauptfleisch, Ulf; Leavitt, Peter R; Ives, Anthony R

    2016-02-01

    Ecologists have long been fascinated by cyclic population fluctuations, because they suggest strong interactions between exploiter and victim species. Nonetheless, even for populations showing high-amplitude fluctuations, it is often hard to identify which species are the key drivers of the dynamics, because data are generally only available for a single species. Here, we use a paleoecological approach to investigate fluctuations in the midge population in Lake Mývatn, Iceland, which ranges over several orders of magnitude in irregular, multigeneration cycles. Previous circumstantial evidence points to consumer-resource interactions between midges and their primary food, diatoms, as the cause of these high-amplitude fluctuations. Using a pair of sediment cores from the lake, we reconstructed 26 years of dynamics of midges using egg remains and of algal groups using diagnostic pigments. We analyzed these data using statistical methods that account for both the autocorrelated nature of paleoecological data and measurement error caused by the mixing of sediment layers. The analyses revealed a signature of consumer-resource interactions in the fluctuations of midges and diatoms: diatom abundance (as inferred from biomarker pigment diatoxanthin) increased when midge abundance was low, and midge abundance (inferred from egg capsules) decreased when diatom abundance was low. Similar patterns were not found for pigments characterizing the other dominant primary producer group in the lake (cyanobacteria), subdominant algae (cryptophytes), or ubiquitous but chemically unstable biomarkers of total algal abundance (chlorophyll a); however, a significant but weaker pattern was found for the chemically stable indicator of total algal populations (β-carotene) to which diatoms are the dominant contributor. These analyses provide the first paleoecological evaluation of specific trophic interactions underlying high amplitude population fluctuations in lakes.

  3. Water availability and vulnerability of 225 large cities in the United States

    NASA Astrophysics Data System (ADS)

    Padowski, Julie C.; Jawitz, James W.

    2012-12-01

    This study presents a quantitative national assessment of urban water availability and vulnerability for 225 U.S. cities with population greater than 100,000. Here, the urban assessments account for not only renewable water flows, but also the extracted, imported, and stored water that urban systems access through constructed infrastructure. These sources represent important hydraulic components of the urban water supply, yet are typically excluded from water scarcity assessments. Results from this hydraulic-based assessment were compared to those obtained using a more conventional method that estimates scarcity solely based on local renewable flows. The inclusion of hydraulic components increased the mean availability to cities, leading to a significantly lower portion of the total U.S. population considered "at risk" for water scarcity (17%) than that obtained from the runoff method (47%). Water vulnerability was determined based on low-flow conditions, and smaller differences were found for this metric between at-risk populations using the runoff (66%) and hydraulic-based (54%) methods. The large increase in the susceptible population between the scarcity measures evaluated using the hydraulic method may better reconcile the seeming contradiction in the United States between perceptions of natural water abundance and widespread water scarcity. Additionally, urban vulnerability measures developed here were validated using a media text analysis. Vulnerability assessments that included hydraulic components were found to correlate with the frequency of urban water scarcity reports in the popular press while runoff-based measures showed no significant correlation, suggesting that hydraulic-based assessments provide better context for understanding the nature and severity of urban water scarcity issues.

  4. Social vulnerability and the natural and built environment: a model of flood casualties in Texas.

    PubMed

    Zahran, Sammy; Brody, Samuel D; Peacock, Walter Gillis; Vedlitz, Arnold; Grover, Himanshu

    2008-12-01

    Studies on the impacts of hurricanes, tropical storms, and tornados indicate that poor communities of colour suffer disproportionately in human death and injury.(2) Few quantitative studies have been conducted on the degree to which flood events affect socially vulnerable populations. We address this research void by analysing 832 countywide flood events in Texas from 1997-2001. Specifically, we examine whether geographic localities characterised by high percentages of socially vulnerable populations experience significantly more casualties due to flood events, adjusting for characteristics of the natural and built environment. Zero-inflated negative binomial regression models indicate that the odds of a flood casualty increase with the level of precipitation on the day of a flood event, flood duration, property damage caused by the flood, population density, and the presence of socially vulnerable populations. Odds decrease with the number of dams, the level of precipitation on the day before a recorded flood event, and the extent to which localities have enacted flood mitigation strategies. The study concludes with comments on hazard-resilient communities and protection of casualty-prone populations.

  5. Synergistic vulnerabilities: antiretroviral treatment among women in Uganda.

    PubMed

    Winchester, Margaret S

    2015-01-01

    Despite being an early success story in the reduction of HIV infection rates, Uganda faces myriad challenges in the recent era of accelerated antiretroviral treatment (ARV) scale-up. For those able to access treatment, ongoing vulnerabilities of poverty and violence compound treatment-related costs and concerns. This paper explores experiences of one particularly vulnerable population - women on ARVs who have also experienced intimate partner violence (IPV). Data were collected over 12 months in Uganda. They include ethnographic interviews (n = 40) drawn from a larger sample of women on ARV and semi-structured interviews with policy-makers and service providers (n = 42), examining the intersection of experiences and responses to treatment from multiple perspectives. Women's narratives show that due to treatment, immediate health concerns take on secondary importance, while other forms of vulnerability, including IPV and poverty, can continue to shape treatment experiences and the decision to stay in violent relationships. Providers likewise face difficulties in overburdened clinics, though they recognise women's concerns and the importance of considering other forms of vulnerability in treatment. This analysis makes the case for integrating treatment with other types of social services and demonstrates the importance of understanding the ways in which synergistic and compounding vulnerabilities confound treatment scale-up efforts.

  6. A Climate Change Vulnerability Assessment of California's At-Risk Birds

    PubMed Central

    Gardali, Thomas; Seavy, Nathaniel E.; DiGaudio, Ryan T.; Comrack, Lyann A.

    2012-01-01

    Conservationists must develop new strategies and adapt existing tools to address the consequences of anthropogenic climate change. To support statewide climate change adaptation, we developed a framework for assessing climate change vulnerability of California's at-risk birds and integrating it into the existing California Bird Species of Special Concern list. We defined climate vulnerability as the amount of evidence that climate change will negatively impact a population. We quantified climate vulnerability by scoring sensitivity (intrinsic characteristics of an organism that make it vulnerable) and exposure (the magnitude of climate change expected) for each taxon. Using the combined sensitivity and exposure scores as an index, we ranked 358 avian taxa, and classified 128 as vulnerable to climate change. Birds associated with wetlands had the largest representation on the list relative to other habitat groups. Of the 29 state or federally listed taxa, 21 were also classified as climate vulnerable, further raising their conservation concern. Integrating climate vulnerability and California's Bird Species of Special Concern list resulted in the addition of five taxa and an increase in priority rank for ten. Our process illustrates a simple, immediate action that can be taken to inform climate change adaptation strategies for wildlife. PMID:22396726

  7. Vulnerability assessment at a national level in Georgia

    NASA Astrophysics Data System (ADS)

    Tsereteli, N.; Arabidze, V.; Varazanashvili, O.; Gugeshashvili, T.

    2012-04-01

    Vulnerability assessment at a national level in Georgia Nino Tsereteli, Vakhtang Arabidze, Otar Varazanashvili, Tengiz Gugeshashvili The risk always exists when cities are built on. Population growth in cities and urbanization in natural hazard-prone zones leads to infrastructure expansion. The goal of the society is to construct natural hazards resistant infrastructure and minimize the expected losses. This is a complicated task as there is always knowledge deficiency on real seismic hazard and vulnerability. Assessment of vulnerability is vital in risk analysis, as vulnerability is defined in many different ways. Work presented here mostly deals with assessment of infrastructure's and population vulnerability at national level in Georgia. This work was initiated by NATO SFP project "seismic Hazard and Risk Assessment for Southern Caucasus - Eastern Turkey Energy Corridors" and the two work packages WP4 (seismic risk) and WP5 (city scenarios) of risk module of EMME (Earthquake Model of the Middle East Region) project. First step was creation databases (inventory) of elements at risk in GIS. Element at risk were the buildings, population, pipelines. The inventories was studied and Created in GIS for the following categories: Building material, number of stories, number of entrances, condition of building, building period. For pipelines pipe tipe (continous or segmented), material, pipe diameter. Very important is to estimate the initial cost of building for assessment of economic losses. From this purpose the attempt was done and the algorithm of this estimation were prepared taking into account obtained the inventory. Build quality, reliability and durability are of special importance to corresponding state agencies and include different aesthetic, engineering, practical, social, technological and economical aspects. The necessity that all of these aspects satisfy existing normative requirements becomes evident as the building and structures come into exploitation

  8. Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries.

    PubMed

    Jagsi, Reshma; Pottow, John A E; Griffith, Kent A; Bradley, Cathy; Hamilton, Ann S; Graff, John; Katz, Steven J; Hawley, Sarah T

    2014-04-20

    To evaluate the financial experiences of a racially and ethnically diverse cohort of long-term breast cancer survivors (17% African American, 40% Latina) identified through population-based registries. Longitudinal study of women diagnosed with nonmetastatic breast cancer in 2005 to 2007 and reported to the SEER registries of metropolitan Los Angeles and Detroit. We surveyed 3,133 women approximately 9 months after diagnosis and 4 years later. Multivariable models evaluated correlates of self-reported decline in financial status attributed to breast cancer and of experiencing at least one type of privation (economically motivated treatment nonadherence and broader hardships related to medical expenses). Among 1,502 patients responding to both surveys, median out-of-pocket expenses were ≤ $2,000; 17% of respondents reported spending > $5,000; 12% reported having medical debt 4 years postdiagnosis. Debt varied significantly by race: 9% of whites, 15% of blacks, 17% of English-speaking Latinas, and 10% of Spanish-speaking Latinas reported debt (P = .03). Overall, 25% of women experienced financial decline at least partly attributed to breast cancer; Spanish-speaking Latinas had significantly increased odds of this decline relative to whites (odds ratio [OR], 2.76; P = .006). At least one privation was experienced by 18% of the sample; blacks (OR, 2.6; P < .001) and English-speaking Latinas (OR, 2.2; P = .02) were significantly more likely to have experienced privation than whites. Racial and ethnic minority patients appear most vulnerable to privations and financial decline attributable to breast cancer, even after adjustment for income, education, and employment. These findings should motivate efforts to control costs and ensure communication between patients and providers regarding financial distress, particularly for vulnerable subgroups.

  9. Climate challenges, vulnerabilities, and food security

    PubMed Central

    Nelson, Margaret C.; Ingram, Scott E.; Dugmore, Andrew J.; Streeter, Richard; Peeples, Matthew A.; McGovern, Thomas H.; Hegmon, Michelle; Arneborg, Jette; Brewington, Seth; Spielmann, Katherine A.; Simpson, Ian A.; Strawhacker, Colleen; Comeau, Laura E. L.; Torvinen, Andrea; Madsen, Christian K.; Hambrecht, George; Smiarowski, Konrad

    2016-01-01

    This paper identifies rare climate challenges in the long-term history of seven areas, three in the subpolar North Atlantic Islands and four in the arid-to-semiarid deserts of the US Southwest. For each case, the vulnerability to food shortage before the climate challenge is quantified based on eight variables encompassing both environmental and social domains. These data are used to evaluate the relationship between the “weight” of vulnerability before a climate challenge and the nature of social change and food security following a challenge. The outcome of this work is directly applicable to debates about disaster management policy. PMID:26712017

  10. Climate challenges, vulnerabilities, and food security.

    PubMed

    Nelson, Margaret C; Ingram, Scott E; Dugmore, Andrew J; Streeter, Richard; Peeples, Matthew A; McGovern, Thomas H; Hegmon, Michelle; Arneborg, Jette; Kintigh, Keith W; Brewington, Seth; Spielmann, Katherine A; Simpson, Ian A; Strawhacker, Colleen; Comeau, Laura E L; Torvinen, Andrea; Madsen, Christian K; Hambrecht, George; Smiarowski, Konrad

    2016-01-12

    This paper identifies rare climate challenges in the long-term history of seven areas, three in the subpolar North Atlantic Islands and four in the arid-to-semiarid deserts of the US Southwest. For each case, the vulnerability to food shortage before the climate challenge is quantified based on eight variables encompassing both environmental and social domains. These data are used to evaluate the relationship between the "weight" of vulnerability before a climate challenge and the nature of social change and food security following a challenge. The outcome of this work is directly applicable to debates about disaster management policy.

  11. Kernel Density Surface Modelling as a Means to Identify Significant Concentrations of Vulnerable Marine Ecosystem Indicators

    PubMed Central

    Kenchington, Ellen; Murillo, Francisco Javier; Lirette, Camille; Sacau, Mar; Koen-Alonso, Mariano; Kenny, Andrew; Ollerhead, Neil; Wareham, Vonda; Beazley, Lindsay

    2014-01-01

    The United Nations General Assembly Resolution 61/105, concerning sustainable fisheries in the marine ecosystem, calls for the protection of vulnerable marine ecosystems (VME) from destructive fishing practices. Subsequently, the Food and Agriculture Organization (FAO) produced guidelines for identification of VME indicator species/taxa to assist in the implementation of the resolution, but recommended the development of case-specific operational definitions for their application. We applied kernel density estimation (KDE) to research vessel trawl survey data from inside the fishing footprint of the Northwest Atlantic Fisheries Organization (NAFO) Regulatory Area in the high seas of the northwest Atlantic to create biomass density surfaces for four VME indicator taxa: large-sized sponges, sea pens, small and large gorgonian corals. These VME indicator taxa were identified previously by NAFO using the fragility, life history characteristics and structural complexity criteria presented by FAO, along with an evaluation of their recovery trajectories. KDE, a non-parametric neighbour-based smoothing function, has been used previously in ecology to identify hotspots, that is, areas of relatively high biomass/abundance. We present a novel approach of examining relative changes in area under polygons created from encircling successive biomass categories on the KDE surface to identify “significant concentrations” of biomass, which we equate to VMEs. This allows identification of the VMEs from the broader distribution of the species in the study area. We provide independent assessments of the VMEs so identified using underwater images, benthic sampling with other gear types (dredges, cores), and/or published species distribution models of probability of occurrence, as available. For each VME indicator taxon we provide a brief review of their ecological function which will be important in future assessments of significant adverse impact on these habitats here and

  12. Kernel density surface modelling as a means to identify significant concentrations of vulnerable marine ecosystem indicators.

    PubMed

    Kenchington, Ellen; Murillo, Francisco Javier; Lirette, Camille; Sacau, Mar; Koen-Alonso, Mariano; Kenny, Andrew; Ollerhead, Neil; Wareham, Vonda; Beazley, Lindsay

    2014-01-01

    The United Nations General Assembly Resolution 61/105, concerning sustainable fisheries in the marine ecosystem, calls for the protection of vulnerable marine ecosystems (VME) from destructive fishing practices. Subsequently, the Food and Agriculture Organization (FAO) produced guidelines for identification of VME indicator species/taxa to assist in the implementation of the resolution, but recommended the development of case-specific operational definitions for their application. We applied kernel density estimation (KDE) to research vessel trawl survey data from inside the fishing footprint of the Northwest Atlantic Fisheries Organization (NAFO) Regulatory Area in the high seas of the northwest Atlantic to create biomass density surfaces for four VME indicator taxa: large-sized sponges, sea pens, small and large gorgonian corals. These VME indicator taxa were identified previously by NAFO using the fragility, life history characteristics and structural complexity criteria presented by FAO, along with an evaluation of their recovery trajectories. KDE, a non-parametric neighbour-based smoothing function, has been used previously in ecology to identify hotspots, that is, areas of relatively high biomass/abundance. We present a novel approach of examining relative changes in area under polygons created from encircling successive biomass categories on the KDE surface to identify "significant concentrations" of biomass, which we equate to VMEs. This allows identification of the VMEs from the broader distribution of the species in the study area. We provide independent assessments of the VMEs so identified using underwater images, benthic sampling with other gear types (dredges, cores), and/or published species distribution models of probability of occurrence, as available. For each VME indicator taxon we provide a brief review of their ecological function which will be important in future assessments of significant adverse impact on these habitats here and elsewhere.

  13. Report: Results of Technical Network Vulnerability Assessment: EPA’s Ronald Reagan Building

    EPA Pesticide Factsheets

    Report #10-P-0212, September 7, 2010. Vulnerability testing of EPA’s Ronald Reagan Building network conducted in June 2010 identified Internet Protocol addresses with numerous high-risk and medium-risk vulnerabilities.

  14. Retooling CalEnviroScreen: Cumulative Pollution Burden and Race-Based Environmental Health Vulnerabilities in California.

    PubMed

    Liévanos, Raoul S

    2018-04-16

    The California Community Environmental Health Screening Tool (CalEnviroScreen) advances research and policy pertaining to environmental health vulnerability. However, CalEnviroScreen departs from its historical foundations and comparable screening tools by no longer considering racial status as an indicator of environmental health vulnerability and predictor of cumulative pollution burden. This study used conceptual frameworks and analytical techniques from environmental health and inequality literature to address the limitations of CalEnviroScreen, especially its inattention to race-based environmental health vulnerabilities. It developed an adjusted measure of cumulative pollution burden from the CalEnviroScreen 2.0 data that facilitates multivariate analyses of the effect of neighborhood racial composition on cumulative pollution burden, net of other indicators of population vulnerability, traffic density, industrial zoning, and local and regional clustering of pollution burden. Principal component analyses produced three new measures of population vulnerability, including Latina/o cumulative disadvantage that represents the spatial concentration of Latinas/os, economic disadvantage, limited English-speaking ability, and health vulnerability. Spatial error regression analyses demonstrated that concentrations of Latinas/os, followed by Latina/o cumulative disadvantage, are the strongest demographic determinants of adjusted cumulative pollution burden. Findings have implications for research and policy pertaining to cumulative impacts and race-based environmental health vulnerabilities within and beyond California.

  15. Retooling CalEnviroScreen: Cumulative Pollution Burden and Race-Based Environmental Health Vulnerabilities in California

    PubMed Central

    2018-01-01

    The California Community Environmental Health Screening Tool (CalEnviroScreen) advances research and policy pertaining to environmental health vulnerability. However, CalEnviroScreen departs from its historical foundations and comparable screening tools by no longer considering racial status as an indicator of environmental health vulnerability and predictor of cumulative pollution burden. This study used conceptual frameworks and analytical techniques from environmental health and inequality literature to address the limitations of CalEnviroScreen, especially its inattention to race-based environmental health vulnerabilities. It developed an adjusted measure of cumulative pollution burden from the CalEnviroScreen 2.0 data that facilitates multivariate analyses of the effect of neighborhood racial composition on cumulative pollution burden, net of other indicators of population vulnerability, traffic density, industrial zoning, and local and regional clustering of pollution burden. Principal component analyses produced three new measures of population vulnerability, including Latina/o cumulative disadvantage that represents the spatial concentration of Latinas/os, economic disadvantage, limited English-speaking ability, and health vulnerability. Spatial error regression analyses demonstrated that concentrations of Latinas/os, followed by Latina/o cumulative disadvantage, are the strongest demographic determinants of adjusted cumulative pollution burden. Findings have implications for research and policy pertaining to cumulative impacts and race-based environmental health vulnerabilities within and beyond California. PMID:29659481

  16. Bioenergetic status modulates motor neuron vulnerability and pathogenesis in a zebrafish model of spinal muscular atrophy

    PubMed Central

    Boyd, Penelope J.; Shorrock, Hannah K.; Carter, Roderick N.; Powis, Rachael A.; Thomson, Sophie R.; Thomson, Derek; Graham, Laura C.; Motyl, Anna A. L.; Highley, J. Robin; Becker, Thomas; Becker, Catherina G.; Heath, Paul R.

    2017-01-01

    Degeneration and loss of lower motor neurons is the major pathological hallmark of spinal muscular atrophy (SMA), resulting from low levels of ubiquitously-expressed survival motor neuron (SMN) protein. One remarkable, yet unresolved, feature of SMA is that not all motor neurons are equally affected, with some populations displaying a robust resistance to the disease. Here, we demonstrate that selective vulnerability of distinct motor neuron pools arises from fundamental modifications to their basal molecular profiles. Comparative gene expression profiling of motor neurons innervating the extensor digitorum longus (disease-resistant), gastrocnemius (intermediate vulnerability), and tibialis anterior (vulnerable) muscles in mice revealed that disease susceptibility correlates strongly with a modified bioenergetic profile. Targeting of identified bioenergetic pathways by enhancing mitochondrial biogenesis rescued motor axon defects in SMA zebrafish. Moreover, targeting of a single bioenergetic protein, phosphoglycerate kinase 1 (Pgk1), was found to modulate motor neuron vulnerability in vivo. Knockdown of pgk1 alone was sufficient to partially mimic the SMA phenotype in wild-type zebrafish. Conversely, Pgk1 overexpression, or treatment with terazosin (an FDA-approved small molecule that binds and activates Pgk1), rescued motor axon phenotypes in SMA zebrafish. We conclude that global bioenergetics pathways can be therapeutically manipulated to ameliorate SMA motor neuron phenotypes in vivo. PMID:28426667

  17. Collision and displacement vulnerability among marine birds of the California Current System associated with offshore wind energy infrastructure

    USGS Publications Warehouse

    Adams, Josh; Kelsey, Emily C.; Felis, Jonathan J.; Pereksta, David M.

    2016-10-27

    With growing climate change concerns and energy constraints, there is an increasing need for renewable energy sources within the United States and globally. Looking forward, offshore wind-energy infrastructure (OWEI) has the potential to produce a significant proportion of the power needed to reach our Nation’s renewable energy goal. Offshore wind-energy sites can capitalize open areas within Federal waters that have persistent, high winds with large energy production potential. Although there are few locations in the California Current System (CCS) where it would be acceptable to build pile-mounted wind turbines in waters less than 50 m deep, the development of technology able to support deep-water OWEI (>200 m depth) could enable wind-energy production in the CCS. As with all human-use of the marine environment, understanding the potential impacts of wind-energy infrastructure on the marine ecosystem is an integral part of offshore wind-energy research and planning. Herein, we present a comprehensive database to quantify marine bird vulnerability to potential OWEI in the CCS (see https://doi.org/10.5066/F79C6VJ0). These data were used to quantify marine bird vulnerabilities at the population level. For 81 marine bird species present in the CCS, we created three vulnerability indices: Population Vulnerability, Collision Vulnerability, and Displacement Vulnerability. Population Vulnerability was used as a scaling factor to generate two comprehensive indicies: Population Collision Vulnerability (PCV) and Population Displacement Vulnerability (PDV). Within the CCS, pelicans, terns (Forster’s [Sterna forsteri], Caspian [Hydroprogne caspia], Elegant [Thalasseus elegans], and Least Tern [Sternula antillarum]), gulls (Western [Larus occidentalis] and Bonaparte’s Gull [Chroicocephalus philadelphia]), South Polar Skua (Stercorarius maccormicki), and Brandt’s Cormorant (Phalacrocorax penicillatus) had the greatest PCV scores. Brown Pelican (Pelicanus occidentalis

  18. [Health inequality among vulnerable groups in Mexico: older adults, indigenous people, and migrants].

    PubMed

    Juárez-Ramírez, Clara; Márquez-Serrano, Margarita; Salgado de Snyder, Nelly; Pelcastre-Villafuerte, Blanca Estela; Ruelas-González, María Guadalupe; Reyes-Morales, Hortensia

    2014-04-01

    Health vulnerability refers to a lack of protection for specific population groups with specific health problems, as well as the disadvantages they face in solving them in comparison with other population groups. This major public health problem has multiple and diverse causes, including a shortage of trained health care personnel and the lack of family, social, economic, and institutional support in obtaining care and minimizing health risks. Health vulnerability is a dynamic condition arising from the confluence of multiple social determinants. This article attempts to describe the health situation of three vulnerable groups in Mexico-older adults, indigenous people, and migrants-and, after defining the needs of each, explore measures that could contribute to the design and implementation of public health policies better tailored to their respective needs.

  19. Vulnerability to alcohol consumption, spiritual transcendence and psychosocial well-being: test of a theory 1

    PubMed Central

    Heredia, Luz Patricia Díaz; Sanchez, Alba Idaly Muñoz

    2016-01-01

    Abstract Objective: to demonstrate the relations among vulnerability, self-transcendence and well-being in the young adult population and the effect of each of these variables on the adoption of low-risk consumption conducts. Method: quantitative and cross-sectional correlation study using structural equations analysis to test the relation among the variables. Results: an inverse relation was evidenced between vulnerability to alcohol consumption and spiritual transcendence (β-0.123, p 0.025) and a direct positive relation between spiritual transcendence and psychosocial well-being (β 0.482, p 0.000). Conclusions: the relations among the variables spiritual transcendence, vulnerability to alcohol consumption and psychosocial well-being, based on Reed's Theory, are confirmed in the population group of young college students, concluding that psychosocial well-being can be achieved when spiritual transcendence is enhanced, as the vulnerability to alcohol consumption drops. PMID:27276017

  20. World-wide satellite night-light data as a proxy of society-hydrology interaction and vulnerability to flood risk

    NASA Astrophysics Data System (ADS)

    Ceola, S.; Laio, F.; Montanari, A.

    2013-12-01

    The study and the analysis of the interactions and feedbacks between hydrology and society constitute the main issue of socio-hydrology. Recent flood events, which occurred across the globe, highlighted once again that mitigation strategies are needed to reduce flood risk. In particular, quick procedures for the identification of vulnerable human settlements and flood prone areas are a necessary tool to identify priorities for flood risk management. To this aim, a 19-year long period of world-wide night light data, as a proxy of human population, and the global river network have been examined. The spatio-temporal evolution of artificial luminosity depending on the distance from the river network has been assessed in order to quantitatively identify the likelihood for a populated pixel to be reached by water. The analysis focuses both on a global and on a local scale. Hotspots, such as highly illuminated areas and developing regions, have been also examined. The analysis shows an increment of yearly-averaged artificial luminosity from 1992 to 2010 (i.e. the time period of satellite data availability), whereas light intensity tends to decrease with increasing distance from the river network. The results thus reveal an increased vulnerability of human settlements to flooding events. A nearly 70-year long period of peace and the economic development after the Second World War could reasonably explain the observed enhancement of human population proximity to water bodies.