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Coral reefs can mitigate flood damages by providing protection to tropical coastal communities whose populations are dense, growing fast, and have predominantly lower-middle income. This study provides the first fine-scale, regionally modeled valuations of how flood risk reductions associated with hybrid coral reef restoration could benefit people, property, and economic activity along Florida and Puerto Ricos 1005 kilometers of reef-lined coasts. Restoration of up to 20% of the regions coral reefs could provide flood reduction benefits greater than costs. Reef habitats with the greatest benefits are shallow, nearshore, and fronting low-lying, vulnerable communities, which are often where reef impacts and loss are the greatest. Minorities, children, the elderly, and those below the poverty line could receive more than double the hazard risk reduction benefits of the overall population, demonstrating that reef restoration as a nature-based solution can have positive returns on investment economically and socially by providing protection to the most vulnerable people.

BACKGROUND: Loneliness is a significant issue among older Asian Americans, exacerbated by the COVID-19 pandemic. Older age, lower income, limited education, and immigrant status heighten loneliness risk. Information communication technologies (ICTs) have been associated with decreased loneliness among older adults. However, older Asian Americans are less likely to use ICTs, particularly if they are immigrants, have limited English proficiency, or are low income. The Technology Acceptance Model posits that perceived usefulness (PU), and perceived ease of use (PEOU) are key factors in predicting technology use. OBJECTIVE: This study aimed to examine associations between PU, PEOU, ICT use, and loneliness among low-income, older Asian Americans. METHODS: Cross-sectional survey data were gathered from predominately older Asian Americans in affordable senior housing (N=401). Using exploratory factor analysis and Horn parallel analysis, we examined 12 survey items to identify factors accounting for variance in ICT use. We deployed structural equation modeling to explore relationships among the latent factors and loneliness, adjusting for demographic and cognitive factors. RESULTS: Exploratory factor analysis and Horn parallel analysis revealed 3 factors that accounted for 56.48% (6.78/12) total variance. PEOU combined items from validated subscales of tech anxiety and comfort, accounting for a 28.44% (3.41/12) variance. ICT use combined years of technological experience, computer, tablet, and smartphone use frequency, accounting for 15.59% (1.87/12) variance. PU combined 2 items assessing the usefulness of technology for social connection and learning and accounted for a 12.44% (1.49/12) variance. The 3-factor structural equation modeling revealed reasonable fit indexes (χ2133=345.132; P

BACKGROUND: Self-rated health is associated with information and communications technology (ICT) use among older adults. Non-US born, older Asian American individuals are more inclined to rate their health as fair or poor compared to individuals from other racial and ethnic backgrounds. This population is also less likely to use ICTs as compared to White older Americans. Furthermore, cognitive decline may impact technology acceptance. In a previous adaptation of the technology acceptance model for low-income, Asian American older adults, perceived usefulness (PU), perceived ease of use (PEOU), age, educational attainment, ethnicity, and English proficiency were significant predictors of ICT use. However, the association between health and technology acceptance has not been explored among Asian American older adults. OBJECTIVE: This study examined the role of self-rated health and subjective cognitive decline in the acceptance and use of ICTs among low-income, Asian American older adults. METHODS: This cross-sectional survey included Asian American individuals aged ≥62 years living in affordable housing for older adults (N=392). Using hierarchical multiple regression, we explored the association between self-rated health and ICT use and technology acceptance model mediators (PU and PEOU) while adjusting for demographics, English proficiency, and subjective cognitive decline. Contrast statements were used to estimate contrasts of interest. To further examine the separate and joint association between age and subjective cognitive decline and the dependent variables, we examined scatterplots with locally estimated scatterplot smoothing lines, revealing that the relationship between subjective cognitive decline and ICT use varied in 3 age segments, which led to updating our analysis to estimate differences in ICT use among age categories with and without subjective cognitive decline. RESULTS: Self-rated health was not significantly associated with ICT use (β=.087; P=.13), PU (β=.106; P=.10), or PEOU (β=.062; P=.31). However, the interaction terms of subjective cognitive decline and age significantly improved the model fit for ICT use (ΔR2=0.011; P=.04). In reviewing scatterplots, we determined that, in the youngest age group (62-74 years), ICT use increased with subjective cognitive decline, whereas in the older age groups (75-84 and ≥85 years), ICT use decreased with subjective cognitive decline, more so in the oldest age category. Through regression analysis, among participants with subjective cognitive decline, ICT use significantly decreased in the middle and older age groups as compared to the youngest age group. However, among participants without subjective cognitive decline, the difference in use among age groups was not significant. CONCLUSIONS: This study contributes to the understanding of the complex relationship between health and ICT acceptance among low-income, Asian American older adults and suggests the need for tailored interventions to promote digital engagement and quality of life for this population.

Water is an increasingly precious resource in California as years of drought, climate change, pollution, as well as an expanding population have all stressed the state's drinking water supplies. Currently, there are increasing concerns about whether regulated and unregulated contaminants in drinking water are linked to a variety of human-health outcomes particularly in socially disadvantaged communities with a history of health risks. To begin to address this data gap by broadly assessing contaminant mixture exposures, the current study was designed to collect tapwater samples from communities in Gold Country, the San Francisco Bay Area, two regions of the Central Valley (Merced/Fresno and Kern counties), and southeast Los Angeles for 251 organic chemicals and 32 inorganic constituents. Sampling prioritized low-income areas with suspected water quality challenges and elevated breast cancer rates. Results indicated that mixtures of regulated and unregulated contaminants were observed frequently in tapwater throughout the areas studied and the types and concentrations of detected contaminants varied by region, drinking-water source, and size of the public water system. Multiple exceedances of enforceable maximum contaminant level(s) (MCL), non-enforceable MCL goal(s) (MCLG), and other health advisories combined with frequent exceedances of benchmark-based hazard indices were also observed in samples collected in all five of the study regions. Given the current focus on improving water quality in socially disadvantaged communities, our study highlights the importance of assessing mixed-contaminant exposures in drinking water at the point of consumption to adequately address human-health concerns (e.g., breast cancer risk). Data from this pilot study provide a foundation for future studies across a greater number of communities in California to assess potential linkages between breast cancer rates and tapwater contaminants.

There are two dominant approaches to implementing permanent supportive housing (PSH), namely place-based (PB) and scattered-site (SS). Formal guidance does not distinguish between these two models and only specifies that PSH should be reserved for those who are most vulnerable with complex health needs. To consider both system- and self-selection factors that may affect housing assignment, this study applied the Gelberg-Anderson behavioral model for vulnerable populations to compare predisposing, enabling, and need factors among people experiencing homelessness (PE) by whether they were assigned to PB-PSH (n = 272) or SS-PSH (n = 185) in Los Angeles County during the COVID-19 pandemic. This exploratory, observational study also included those who were approved but did not receive PSH (n = 94). Results show that there are notable differences between (a) those who received PSH versus those who did not, and (b) those in PB-PSH versus SS-PSH. Specifically, PEH who received PSH were more likely to be white, US-born, have any physical health condition, and have lower health activation scores. PEH who received PB- versus SS-PSH were more likely to be older, Black, have any alcohol use disorder, and have higher health activation scores. These findings suggest that homeless service systems may consider PB-PSH more appropriate for PEH with higher needs but also raises important questions about how race may be a factor in the type of PSH that PEH receive and whether PSH is received at all.

This study bridges gaps in air pollution research by examining exposure dynamics in disadvantaged communities. Using cutting-edge machine learning and massive data processing, we produced high-resolution (100 meters) daily air pollution maps for nitrogen dioxide (NO2), fine particulate matter (PM2.5), and ozone (O3) across California for 2012-2019. Our findings revealed opposite spatial patterns of NO2 and PM2.5 to that of O3. We also identified consistent, higher pollutant exposure for disadvantaged communities from 2012 to 2019, although the most disadvantaged communities saw the largest NO2 and PM2.5 reductions and the advantaged neighborhoods experienced greatest rising O3 concentrations. Further, day-to-day exposure variations decreased for NO2 and O3. The disparity in NO2 exposure decreased, while it persisted for O3. In addition, PM2.5 showed increased day-to-day variations across all communities due to the increase in wildfire frequency and intensity, particularly affecting advantaged suburban and rural communities.

California faces several serious direct and indirect climate exposures that can adversely affect public health, some of which are already occurring. The public health burden now and in the future will depend on atmospheric greenhouse gas concentrations, underlying population vulnerabilities, and adaptation efforts. Here, we present a structured review of recent literature to examine the leading climate risks to public health in California, including extreme heat, extreme precipitation, wildfires, air pollution, and infectious diseases. Comparisons among different climate-health pathways are difficult due to inconsistencies in study design regarding spatial and temporal scales and health outcomes examined. We find, however, that the current public health burden likely affects thousands of Californians each year, depending on the exposure pathway and health outcome. Further, while more evidence exists for direct and indirect proximal health effects that are the focus of this review, distal pathways (e.g., impacts of drought on nutrition) are more uncertain but could add to this burden. We find that climate adaptation measures can provide significant health benefits, particularly in disadvantaged communities. We conclude with priority recommendations for future analyses and solution-driven policy actions.

Scalable models for result disclosure are needed to ensure large-scale access to genomics services. Research evaluating alternatives to genetic counseling suggests effectiveness; however, it is unknown whether these findings are generalizable across populations. We assessed whether a letter is non-inferior to telephone genetic counseling to inform participants with no personal or family history of cancer of their normal results. Data were collected via self-report surveys before and after result disclosure (at 1 and 6 months) in a study sample enriched for individuals from underserved populations. Primary outcomes were subjective understanding of results (global and aggregated) and test-related feelings, ascertained via three subscales (uncertainty, negative emotions, and positive feelings) of the Feelings About genomiC Testing Results (FACToR) measure. Secondary outcomes related to satisfaction with communication. Non-inferiority tests compared outcomes among disclosure methods. Communication by letter was inferior in terms of global subjective understanding of results (at 1 month) and non-inferior to telephoned results (at 6 months). Letter was non-inferior to telephone for aggregated understanding (at 6 months). Letter was superior (at 1 month) to telephone on the uncertainty FACToR subscale. Letter was non-inferior to telephone on the positive-feelings FACToR subscale (at 6 months). Letter was non-inferior to telephone for satisfaction with mode of result delivery and genetic test results. Communication via letter was inferior to telephone in communicating the right amount of information. The use of written communication to relay normal results to low-risk individuals is a promising strategy that may improve the efficiency of care delivery.

BackgroundSince the coronavirus disease 2019 (COVID-19) pandemic began, telemedicine use has transformed healthcare delivery. Yet there is concern that telemedicine may widen care disparities for vulnerable populations, and patient experience data are limited.AimsWe aimed to assess patient satisfaction with hepatology-related telemedicine (telehepatology) for delivery of fatty liver disease (FLD) care in a safety-net healthcare system.MethodsAdult patients with FLD were surveyed regarding satisfaction with telehepatology. Clinical, demographic, resources, and social determinants of health (SDoH) data were collected to identify factors associated with satisfaction through multivariable modeling.ResultsFrom June 2020 to March 2022, 220 participants were enrolled: the median age was 52 years, 37% were men, and 68% were Hispanic. One hundred nineteen (54%) had prior telehepatology experience. Overall, satisfaction was high; 70% reported being somewhat or very satisfied. On univariate analysis, Hispanic ethnicity (versus non-Hispanic, OR 0.34, 95% CI 0.1-0.9, p = 0.03) and limited access to personal cellphone/internet (OR 0.16, 95% CI 0.04-0.6, p = 0.01) were associated with lower satisfaction. On multivariable logistic regression modeling adjusted for pandemic duration, age, sex, severity of liver disease, and coexisting liver disease, Hispanic ethnicity and lack of personal cellphone/internet remained independently associated with lower telehepatology satisfaction (OR 0.24, 95% CI 0.07-0.9, p = 0.03 and OR 0.2, 95% CI 0.04-0.9, p = 0.04, respectively). The association remained statistically significant after inclusion of various SDoH in the multivariable model.ConclusionsSatisfaction with telehepatology among FLD patients in a safety-net clinical setting was high overall. However, Hispanic ethnicity and lack of personal cellphone/internet were independently associated with lower telehepatology satisfaction. A better understanding of patients' experience with telehepatology is needed to identify reasons for dissatisfaction, and in-person visits should remain an option for patients to ensure equitable care.

Background: Approximately 11 million immigrants without legal status live in the United States and many of these individuals live in areas that are prone to natural hazards. While there is sufficient literature to suggest that these individuals are more vulnerable to the impacts of disasters and are less prepared for disasters, there is limited understanding of natural disaster risk perception, behavioral intentions, and trust in disaster assistance among individuals or their immediate family members lacking legal status (IFLLS) in the United States. To address this gap, this study sought to describe and compare risk perception, barriers to evacuation, and trust in disaster assistance between legal citizens and IFLLS. Methods: A cross-sectional, online survey was conducted from April 24 to June 3, 2024. Survey respondents were asked about their demographic and socioeconomic characteristics, their risk perceptions and attitudes regarding natural hazards, reasons for not complying with evacuation orders, and their trust in assistance offered by various entities during the response to natural hazards. Pearson chi-square tests and Cramér's V were used to investigate the association between IFLLS and variables of interest. Results: 2,989 individuals completed the survey and 284 reported that they identified as IFLLS. Statistically significant relationships existed between IFLLS and residing in an area that experiences natural hazards, having been previously impacted by a disaster, anticipating being impacted by a natural hazard within the next 12 months, various reasons for noncompliance with evacuation orders, and trust in assistance offered during disaster response. There were not statistically significant relationships between IFLLS and the belief that preparedness for natural hazards is important or concern about natural hazards becoming more severe or frequent in the future. Conclusions: These results provide the first nationally representative examination of disaster risk faced by IFLLS in the United States, as well as the barriers to evacuation. These findings highlight the importance of developing disaster preparedness and response plans that incorporate the needs of IFLLS, as these groups face higher risk. Preparedness and response policies must consider and address the unique barriers faced by IFLLS. [ABSTRACT FROM AUTHOR]

Aim: The Danish Health Survey among Marginalized People is a nationwide health survey targeting people in marginalized life situations in Denmark. The aim of this paper is to present the study design, data collection methods and respondent characteristics of the survey, which was conducted in 2007, 2012, 2017 and 2022. Methods: The survey applies an outreach data collection approach which entails reaching out to social services (public and private) asking for their help with distributing self-administered paper questionnaires among their users. Themes include self-rated health, mental health, morbidity, pain, oral health, health behaviours, gambling problems, social relations, violence, sexual harassment and assault, suicide, and source of income. Results: The overall number of respondents has decreased slightly from 2007 (1290) to 2022 (1134). In all survey waves, men were overrepresented among the respondents. In 2007, women represented only 28%, which increased to 37% in 2022. There have been remarkable changes in the age distribution among respondents between 2007 and 2022. For example, the oldest age group (55–80 years) accounted for 15% of the respondents in 2007 and 40% in 2022. Conclusions: Conducting surveys among marginalized people entails methodological challenges and ethical considerations. However, continually attempting to reach marginalized people in surveys by tailoring data collection strategies to their specific life situation is essential to gain insight into their health and well-being. [ABSTRACT FROM AUTHOR]

Introduction: We examined COVID-19 trends and the socio-structural correlates of infections and vaccinations among people who inject drugs (PWID). Methods: We collected retrospective survey data from PWID (n = 472). We examined changes in COVID-19 testing, infection, and housing assistance for the first year of the pandemic, and then used multivariate logistic regression to examine factors with ever having an infection and receiving at least one vaccination from April 2020-March 2021. Results: The sample was mostly male, White and Latinx, and unhoused. Testing by quarter ranged from 46% to 33%. Housing assistance declined from 10% to 7% by the last quarter, while infections ranged from 6% to 4%. Ever being COVID-19 positive was associated with being male, having an income source, and being arrested in the last 3 months. Almost half of participants reported vaccination (47%). Receiving a vaccination was associated with prior U.S. armed forces service, older age, receiving substance use disorder treatment, and having ever received COVID-19 testing. Discussion: Efforts to vaccinate PWID fell short and housing assistance declined. Receiving targeted assistance, including better access to housing and medication treatments for opioid use disorder, could be important efforts to mitigate the heightened risks of COVID-19 and the ongoing harms PWID face that predate the pandemic. [ABSTRACT FROM AUTHOR]

Introduction: The digitalization of healthcare poses a risk of exacerbating health inequalities. Dutch public libraries offer freely accessible e-health courses given by trainers. However, there is limited knowledge on whether these libraries successfully reach and support those in need. This study aimed to explore trainers' perspectives on the challenges, successes, and potential improvements in digital health skill education in a library setting. Materials and methods: Trainers of the e-health course were interviewed. Topics included: the role of the library in digital health skills education, the successes and challenges in reaching groups with a low socioeconomic position, the perceived impact of the digital health skills education, and strategies for future improvement in digital health skills education. A deductive analysis based upon the interview guide topics was performed. A second inductive analysis was applied to identify underlying patterns. Coding was done independently and cross-checked. Codebooks and themes were determined in discussion with authors. Results: Three themes emerged. 1) Trainers' services, skills and expertise: Trainers identified older adults, youth, people with low (digital) literacy, the unemployed, and people from non-native cultural backgrounds as the groups most in need of support. Trainers felt equipped to address these groups' needs. 2) The libraries' reach: improving engagement, perceived accessibility, and clients' barriers: Despite trainers' efforts to adjust the course to the target groups' level of commitment, digital and literacy levels, and logistics, the digital health course predominantly engages older adults. Experienced barriers in reach: limited perceived accessibility of the public library and clients' personal barriers. 3) Collaborations with healthcare, welfare and community organizations: Trainers emphasized that collaborations could enhance the diversity and number of participants. Current partnerships provided: reach to target groups, teaching locations, and referral of clients. Discussion: Trainers in public libraries recognize a various target groups that need support in digital health skill development. The study identified three challenges: accessibility of the digital health course, reach of the public library, and clients' personal barriers. Public libraries have potential to support their target groups but need strategies to improve their engagement and reach. Collaborations with healthcare, welfare, and community organizations are essential to improve their reach to those most in need of support. [ABSTRACT FROM AUTHOR]

Portugal is commonly recognized as one of the best drug policy examples in the world. Nonetheless, contrasts between drug use risks in rural vs urban settings in the country is an understudied topic, even if its specific challenges are commonly affirmed, both by professionals and people who use drugs (PWUD). The aim of this study was to compare rural and urban environments concerning socio-sanitary services availability; illegal drugs availability; risk behaviors related to drug use; stigma associated with illicit drug use; and social support. Additionally, specific harm reduction challenges and recommendations for improvement were explored. A qualitative study with two focus groups involving people who use drugs, outreach workers and local decision-makers was conducted. Distinct scenarios and challenges in both settings were found: In large cities, a significantly higher specialized service coverage than in rural areas was described. In rural settings, a higher number of drug-related risks, higher levels of stigma and lower availability of human and material resources were mentioned, although being associated with higher levels of informal social support and more proximal relationships with harm reduction teams. This study emphasizes the need for a harm reduction paradigm strongly focused on environmental risk determinants, as much as in individual ones. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic was a global public health crisis with an unparalleled impact worldwide, presenting a significant challenge for both physical and mental health. The main objective of this study was to analyze the risk of depression during the COVID-19 pandemic and how this was affected by sociodemographic factors, pandemic fatigue, risk perception, trust in institutions, and perceived self-efficacy. Methods: A cross-sectional study was conducted in the Region of Murcia through two online surveys completed by 1000 people in June 2021 (Round 1) and March 2022 (Round 2). Risk of depression was measured using the 5-item World Health Organization Well-Being Index (WHO-5) questionnaire, and descriptive, bivariate, and multivariate regression analyses were performed to identify factors associated with the risk of depression. Results: In Round 1, 35.2% of the sample presented a risk of depression, which increased to 39.1% in Round 2. Those at greater risk were women, individuals with lower socioeconomic status, those with less family support, lower trust in institutions, higher perceived risk of contracting the disease, and higher levels of pandemic fatigue. Conclusions: Identifying vulnerable populations facing mental health issues can help the authorities and institutions that are responsible for managing public health crises to develop and implement inclusive strategies and interventions tailored to the population's needs. [ABSTRACT FROM AUTHOR]

PURPOSE: People who are transgender or gender diverse (PTGD) often experience difficulties navigating the health care system due to a variety of factors such as lack of knowledgeable and/or culturally competent clinicians, discrimination, and structural and/or socioeconomic barriers. We sought to determine whether a peer health navigator service in the Canadian province of Saskatchewan helped connect transgender and gender-diverse clients and health care practitioners (HCPs) to resources, and how this service changed their health care experiences. METHODS: Semistructured interviews were conducted with 9 clients and 9 HCPs. Interview transcripts were then analyzed by researchers using an interpretative phenomenological approach, with qualitative data analysis software. RESULTS: The most prevalent theme that emerged from interview data, from both clients and HCPs, was support for the navigators' work and a desire that the service should continue. It was reinforced by 3 subthemes: the importance that the navigators were PTGD, the ability of the navigators to connect people to services and reliable sources of information, and their skill in directly supporting clients. A fourth subtheme, primarily found among clients, was the navigators' ability to provide connections to affirming mental health care. CONCLUSIONS: Clients and HCPs alike emphasized that the navigator's lived experience was invaluable and allowed them to empathize with PTGD and provide support. Furthermore, the navigators acted as a direct connection to health care services, which helped improve access for clients. Our findings underscore the need for navigator positions to become permanent within the provincial health system to improve the health care experiences of PTGD in Saskatchewan. [ABSTRACT FROM AUTHOR]

Background: Knowledge of how different social groups in South Africa are affected by air quality is important for informing air quality regulations and determining the integrated social–environmental approach to adopt. This systematic review evaluates the impact of air pollution on these groups, investigates socio-economic factors that increase exposure, and assesses mitigation measures. Methods: The review followed the PRISMA guidelines and analyzed quantitative studies conducted in South Africa, which were published between 2014 and 2024. The studies' sources included databases such as Google Scholar, PubMed, and Scopus. Data from 47 eligible studies were analyzed using descriptive statistics. Results: Results show that women, children, and low-income communities tend to bear the brunt of poor air quality. Children are the most affected by poor air quality, with significant respiratory issues. Pregnant women are vulnerable to adverse birth outcomes. The results indicate that of the 47 studies reviewed, 51% focused on the effects of air pollution on children, whilst fewer studies (26%) focused on women. This may point to a gap in research on the specific impacts of air pollution on women. Low-income communities face increased exposure due to proximity to pollutant sources and substandard housing. The results further indicated that of the health impacts experienced by vulnerable populations, general health issues (96%) and respiratory health issues (89%) are the most prominent health impacts. Conclusions: The study underscores the need for stricter air quality regulations, public education, and an integrated social–environmental approach to mitigate exposure in vulnerable populations. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objective Design Results Conclusion Relevance to Clinical Practice Patient or Public Contribution Understanding ICU nurses' experiences in caring for patients with intellectual developmental disabilities is crucial. Insights can inform supportive measures and training programs to enhance nurse well‐being and patient population‐specific outcomes.The primary objective of this study was to explore and understand the lived experiences of nurses caring for patients with intellectual developmental disabilities.This narrative study employed a research design focusing on ICU nurse storytelling. Registered nurses from ICU settings (n = 49) in the United States participated. Data were collected from January 2024 through April 2024 via semi‐structured interviews over an online audiovisual recorded platform. Transcripts were analysed using Christopher Booker's theory of the seven basic plots (Overcoming the Monster, Rags to Riches, The Quest, Voyage and Return, Comedy, Tragedy, and Rebirth) to identify emerging themes in the data.Story arcs revealed each type of narrative arc apart from comedy, suggesting that ICU nurse experiences of caring for patients with IDD are widely varied and encompass a full range of human expression and experience. Themes spanning these arcs included (1) The Journey of Revisioning ICU Care and (2) Finding Strength to Champion Patient Rights. Findings suggest that ICU nurses consistently experienced the key elements in Finding Strength to Champion Patient Rights but that the key elements of The Journey of Revisioning ICU Care were less widely experienced.Tailored support and training programs can enhance nurses' ability to provide effective care to this patient population. Insights hold practical implications for nursing education, clinical practice, and policy development.Findings suggest additional training for nurses will benefit patient outcomes and nurse satisfaction. Through exploring unique challenges and emotional burdens faced by nurses, healthcare organisations can develop supportive measures that foster a more caring and effective healing environment. Policy changes can lead to improved patient outcomes, greater nurse satisfaction, and a more inclusive healthcare system that recognises and addresses the needs of vulnerable populations.No patient or public contribution. This study focused on the lived experiences of ICU nurses rather than direct patient or public involvement. The research design and data collection were centred on professional narratives from nursing staff, which did not necessitate input from patients or the public for the objectives set forth. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Data Source Methods Results Conclusion Implications Impact Reporting Method Patient or Public Contribution To synthesise literature on the aging characteristics of people with long‐term physical disabilities and inform future nursing research, education, practice and health policy.Scoping review.Literature searches were performed in the CINAHL, PubMed, and PsycINFO databases in April 2024.A systematic scoping review was conducted, beginning with the initial screening of titles and abstracts, followed by full‐text analysis. Eligibility criteria focused on the population (people with long‐term physical disabilities), concept (biopsychosocial characteristics of aging), context (individual/population‐level) and publications from 2000 to 2024. Selected articles underwent thematic analysis.Of the 814 identified articles, 31 met the inclusion criteria, from which 8 themes emerged. Physically, people with long‐term physical disabilities experience accelerated aging, increased secondary conditions and a heightened falls risk. Psychologically, they exhibit both negative affectivity and resilience, alongside psychological growth. Socially, they encounter persistent barriers, leading to socioeconomic disadvantages, notably in education, employment, income and transportation.This review provides a comprehensive understanding of the biopsychosocial aging characteristics of people with long‐term physical disabilities, elucidating their diverse experiences and adaptations throughout their life course.Future research should focus on understanding the multidimensional aging trajectory of this population longitudinally and identifying factors related to accelerated aging to develop tailored interventions at optimal time points to improve their aging experience. Increased attention to nursing education and training in disability‐cultural competence is required to alleviate attitudinal barriers in healthcare services. Policy efforts must enhance disability data justice and improve transportation accessibility.The study highlights that people with long‐term physical disabilities may have less optimal aging experiences, findings that could guide development of nursing interventions and changes to policy designed to enhance their well‐being.This review adheres to the PRISMA Extension for Scoping Reviews and the Joanna Briggs Institute's scoping reviews guideline.None. [ABSTRACT FROM AUTHOR]

Adversities during childhood such as experiences of neglect, parental mental illness, substance use, financial stress, unstable housing and racism/discrimination have cumulative and harmful lifelong impacts. Early identification, intervention and support for parents, families and communities experiencing adversity can enhance their capacity to provide environments where children can thrive and reach their full potential. However, parents experience many barriers to seeking support including experiences of judgement, blame and discrimination when accessing services. This systematic review of qualitative evidence aimed to explore parents' experiences of interactions with health, welfare and educational professionals when accessing support for adversities that impact parental capacity and children's health, development or wellbeing in the early years (0–5 years). In doing so, we specifically aimed to explore elements of professionals' interactions that parents viewed either positively or negatively to inform future policy, practice, education and research. After the screening process, 16 studies were included in the synthesis. Key findings highlighted that although health and welfare services should be promoting parental capacity to raise thriving children, parents frequently experienced professionals who were unwilling to listen, disrespectful and restricted parents' participation. Furthermore, parents felt the complexity of their lives was not acknowledged and felt blamed for broader socioeconomic circumstances and intergenerational patterns of marginalisation. Conversely, positive experiences came from professionals who engaged in genuine relationships that provided emotional and practical supports that empowered parents to change. These findings highlight the need for change across all levels of service delivery, inclusive of individual professionals through to the systems and policies underpinning the structure and provision of services for parents and families. Further work is needed to explore how to implement and sustain effective change across multiple sectors to inform consistent, empathetic and therapeutic approaches to supporting parents, so children can grow and thrive within their own families and communities. [ABSTRACT FROM AUTHOR]

Since 1979, The Belmont Report has served as a guidebook for ensuring that basic standards for ethical research are upheld. The Belmont Report calls for special protections of vulnerable research participants, such as people who are incarcerated and economically and educationally disadvantaged individuals who are deemed susceptible to exploitation. With a growing focus on health equity and community‐engaged approaches in health equity research, efforts to involve vulnerable participants are increasing. Yet there is little understanding of what matters most to vulnerable populations. This study sought to understand, from participant perspectives, ethical considerations when conducting research with two vulnerable populations: women experiencing homelessness and women who are incarcerated. Health care professionals and staff that work closely with homeless and incarcerated populations were also interviewed. The findings from semistructured interviews with these populations underscore the sustained importance of respect for persons, beneficence, and justice, and further highlight the need for self‐determination; privacy/confidentiality; continuous consent; fair treatment; benefit‐burden balance; nonauthoritarian relationships; and fair access to research participation. Although The Belmont Report durably serves to ethically guide standard conventional research, the Report's original concepts should be extended to include specific considerations when vulnerable populations are involved in community‐engaged research. [ABSTRACT FROM AUTHOR]

Homelessness among older individuals is increasing and women experiencing homelessness have been previously shown to have poorer health outcomes than their male counterparts. To address these concerns, the Bridges to Elders (BTE) program was developed to improve health and social outcomes for older women experiencing or at risk for homelessness. BTE consisted of a nurse practitioner (NP) and community health worker (CHW) dyad who provided intensive case management services for women 55+ with housing instability. This evaluation used a pretest/posttest design to examine three main outcomes from BTE: change in housing status, enrollment with a primary care provider (PCP), and diagnosis of uncontrolled chronic condition. The sample included 96 BTE participants enrolled from January 2017 to December 2018. The average age of participants was 66 years and had a mean BTE enrollment time of 7.6 months. Statistically significant improvements were achieved in all three outcomes measured: 17% (p <.009) increase in stable housing, 35% (p <.001) increase in PCP enrollment, and 47% (p <.001) decrease in the diagnosis of an uncontrolled chronic condition. The results indicated an NP/CHW dyad improved housing status, primary care access, and targeted health outcomes for older women who are experiencing or at risk for homelessness. Future studies examining the impact of NP/CHW dyads on additional social determinants of health and their impact on health outcomes are recommended. [ABSTRACT FROM AUTHOR]

Background and Objectives: The Youth Engagement Network (YEN) was a three-year project focused on strengthening meaningful youth engagement in sexual health programs. It sought to answer the question, "What is a useful framework for meaningful youth engagement of vulnerable populations in sexual health programming?" Methods: The YEN chose Group Concept Mapping (GCM) as the approach to answer their learning question. GCM is a mixed-methods process that can be used to integrate the unique perspectives of a group of individuals. The approach entails 1) brainstorming ideas related to a prompt, 2) individual sorting and rating of the ideas, and 3) the application of multi-dimensional scaling (MDS) and hierarchical cluster analysis to integrate the individual sorting information and develop a series of concept maps. Results: Seventy-four young people and adults generated 141 responses to our prompt. These were pared down to 82 statements that were then sorted and/or rated on importance by 113 participants. Our final cluster map focused on 9 concepts: Facilitators, Diversity, Relevance, Access, Connection, Comprehensive Sex Ed, Co-development, and Space. Conclusions: We found GCM to be useful for identifying potential components of a framework to move the field toward more meaningful engagement of young people in sexual health programming. [ABSTRACT FROM AUTHOR]

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The Department of Veterans Affairs (VA) is the largest provider of integrated health care services in the United States and its mission is to honor veterans by providing timely, effective, and high-quality health care that improves individuals' health and functionality. The VA provides comprehensive primary and specialty care, including colorectal surgery services, to eligible veterans who suffer from a disproportionately high burden of medical comorbidities and often belong to vulnerable populations, including individuals of low socioeconomic status, those who identify as lesbian, gay, bisexual, transgender, and questioning, racial minorities, and those suffering from severe mental health illness. There are many challenges to caring for a population of veterans with benign and malignant colorectal disease due to both patient and system level factors. Despite these challenges, the VA has demonstrated a commitment to ensuring culturally competent, equitable, and inclusive care and to conducting research that establishes evidence-based best practices in the management of colorectal diseases. These efforts have led to outcomes for patients undergoing care for colorectal diseases within the VA that are par with or better than civilian outcomes. The VA is uniquely positioned on a system level to provide nationwide efforts that improve care delivery and serve those who served. [ABSTRACT FROM AUTHOR]

Background: Maternal smoking during pregnancy carries significant health risks for both mothers and infants, especially in vulnerable regions like rural and Appalachian areas with high smoking rates. Understanding the causes of high smoking rates in vulnerable areas is crucial for designing effective interventions to promote smoking cessation and reduce preventable health disparities. Methods: Data from the Virginia Pregnancy Risk Assessment Monitoring System (PRAMS; years 2009–2020) comprised of 7,861 women aged over 18 were used in this cross-sectional observational study. Pregnant individuals were categorized as smoking if they reported smoking during the last trimester. A multi-level logistic regression was employed to examine the association of individual sociodemographic factors, rurality, Appalachian status, and county socioeconomic status (SES) proxied by Yost Index quintiles with smoking behaviors during pregnancy. The county of residence was considered as a random factor in the analysis. Trend analysis were also conducted. Results: Out of the overall sample, 92.8% (n = 7,292) were non-smokers, while 7.2% (n = 569) were smokers. The multi-level logistic regression analysis showed pregnant individuals aged 18–24 had 1.06 times higher odds of smoking compared to those over 35 (95% CI [1.02–1.10]). Those with a college education or higher had significantly reduced odds (OR: 0.10, 95% CI [0.10, 0.10]), as did racially minoritized individuals (OR: 0.59, 95% CI [0.51–0.68]) and Hispanic individuals (OR: 0.14, 95% CI [0.09–0.21]). Living in rural areas was associated with a 26% higher likelihood of smoking during pregnancy compared to urban areas (OR: 1.26, 95% CI [1.21–1.31]), while residing in Appalachian regions led to a 25% higher probability of smoking. Additionally, lower SES quintiles were linked to higher odds of smoking, with the lowest quintile at OR: 2.10 (95% CI [1.67–2.65]) and the second quintile at OR: 1.64 (95% CI [1.53–1.76]) as compared with the most affluent quintile. Trend analsysis shows smoking has declined across all quintiles, but a substantial gap persists between lowest and highest SES regions. Conclusions: Smoking rates during pregnancy have dropped overall but remain alarmingly high in specific rural and Appalachian areas. As smoking during pregnancy poses significant health risks, targeted interventions and resources for tobacco cessation programs are needed in these highly vulnerable regions. Trial registration: Not Applicable. [ABSTRACT FROM AUTHOR]

Throughout history, poets, scholars, and scientists have acknowledged the profound link between sleep and psychological well-being. The wisdom of "sleep on it", ingrained in both Western and Eastern traditions, highlights the crucial role sleep plays in restoring and enhancing cognitive functions. In today's fast-paced, highly-interconnected, technology-driven world, where cognitive demands are ever-growing, quality sleep has become both more vital and more elusive. This collection delves into the evolving role of sleep in maintaining psychological well-being amidst contemporary challenges. It brings together a diverse array of behavioral and brain imaging studies from researchers across the globe, focusing on three key areas: the beneficial effects of sleep on learning and education, the detrimental consequences of sleep disruption on mental health, and the rising prevalence of sleep disruption in vulnerable populations. These studies offer compelling insights, revealing, for instance, how sleep consolidates conceptual networks of knowledge, how sleep disruption can signal suicidal tendencies a month before suicide attempts, and how heatwaves negatively affect infant sleep. This body of work not only underscores the cognitive benefits of sleep but also illuminates how contemporary challenges—such as climate change, poverty, and shift work—undermine sleep health. It calls for targeted interventions to improve sleep health and psychological well-being in response to these contemporary challenges, urging scholars and policymakers to prioritize sleep health as a foundational element in building a healthier, more resilient society. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Methods Result Conclusion Implications for the Profession Impact Patient and Public Contribution Health equity is actualized when all individuals can attain the highest level of health. Youth who identify as LGBTQ+ experience health disparities and scarce access to culturally congruent mental healthcare. Our nurse‐led research team recognized evidence‐based practice guidance gaps and prioritized a systematic inquiry into the lived experiences of LGBTQ+ identifying youth who needed emergency care for suicidality. Concurrently, we translated new findings into practice. The purpose of this endeavor is to implement a nimble evidence‐based practice adoption process for nursing staff to effectively address LGBTQ+ population health needs.Informed by Purnell's Cultural Competence Theory, qualitative findings from a prospective study and available literature, we developed an LGBTQ+ sensitive care curriculum for nursing staff using the American Nurses Credentialing Center's (ANCC) Nursing Continuing Education Professional Development (NCPD) Framework to address the intersectionality of cultural awareness and care provision. The curriculum was delivered and formally evaluated longitudinally with a focus on communication confidence and knowledge.The curriculum was delivered in one session to nursing staff during a 6‐month period. Program evaluations indicated curriculum acceptability and effectiveness. Participants reported improved ability to use appropriate language when communicating with patients who identify as LGBTQ+ and their families and a moderate to high change in confidence when providing care to LGBTQ+ identifying patients.Concurrent, evidence‐based efforts to uncover and apply new knowledge relevant to nursing communication with youth who identify as LGBTQ+ is possible and yield effective, positive change in nursing knowledge and confidence in providing care for these youth. Implementation science is essential to advance evidence‐based nursing practice or the full positive impact of research on patient outcomes is not likely. When the implementation science program is not incorporated early in the research process, research excellence is at risk. Evolving evidence‐based practices that enhance individualized holistic patient care delivery for LGBTQ+ individuals are strengthened when primary research, implementation science, and scaling research co‐occurrence is achievable.This implementation strategy demonstrates that early translation of health equity research on culturally congruent care for individuals identifying as LGBTQ+ can be done effectively and replicated across practice settings. Further, this work validates the importance of the relationship between nurse scientists, translational scientists, and clinical practice and education experts in the early dissemination and adoption of new knowledge. Evidence‐based practice adoption improves healthcare professionals' propensity to positively impact public health patient care outcomes.Nursing staff are equipped with the knowledge and skills to deliver equitable care. Dissemination of early research findings as an implementation science strategy supports concurrent adoption in clinical practice to advance health equity outcomes with urgency.No patient or public contribution. [ABSTRACT FROM AUTHOR]

In radiological disasters, evacuating institutionalized individuals such as hospitalized patients and nursing home residents presents complex challenges. The Fukushima Daiichi Nuclear power plant (FDNPP) accident, triggered by the Great East Japan Earthquake (GEJE), exposed critical issues in evacuation planning. This case series investigates the evacuation difficulties encountered by three hospitals situated 20 to 30 km from the FDNPP following the GEJE and FDNPP accident. Data collection involved reviewing records, stakeholder interviews and analyzing publicly available resources. Six key challenges emerged: acute phase influx—hospitals faced an abrupt surge in patients, including trauma victims and vulnerable individuals; initial discharge and transfers—coordinating patient discharges and transfers during the chaotic aftermath proved daunting; staff shortages—evacuation and personal factors lead to reduced staffing levels and strained hospital capabilities; infrastructure damage and logistics suspension—infrastructure issues, such as burst water pipes, halted gas supplies, and heavy oil shortage disrupted hospital operations; unclear evacuation criteria—ad hoc evacuation decisions underscored the lack of clear criteria; and limited preparation time—minimal preparation time hindered communication and planning. These findings underscore the need for robust disaster planning, resource management, and communication strategies to ensure the safety of patients and staff during radiological emergencies. Government interventions, early patient discharge, and improved medical record communication may alleviate the burden of evacuation. The lessons learned emphasize the importance of maintaining hospital functions in disaster-prone areas, particularly for vulnerable populations, and highlight the necessity for comprehensive community-wide disaster prevention planning. [ABSTRACT FROM AUTHOR]

Family involvement has been identified as a mechanism that explains the differences in academic performance and well-being between students from different socioeconomic backgrounds. The implications of family involvement in students' non-academic outcomes have often been overshadowed by a focus on the academic domain. This study focuses on one type of non-academic attributes which is currently most critical to navigate in school and beyond: social-emotional development. In addition to that, the potential mediating role of school engagement in the association between family involvement and students' social-emotional development remains to be explored. This study aimed to investigate whether family involvement was associated with students' school engagement and social-emotional development and to clarify the underlying mechanism in the relationship. The sample consisted of 170 students from 8 to 17 years old and their parents who live in economically vulnerable situations and experience social exclusion. The analyses were performed using Jamovi statistical software and a GLM Mediation Model module. To address the research objectives, a series of mediation analysis were performed to fit the hypothesized relations among the study variables. The mediational analysis suggested that home-based family involvement could not predict students' social-emotional development, and that the effect of home-based family involvement on students' social-emotional development was fully mediated by school engagement, a variable not included in previous research. The results suggest that families who are actively engaged in their child's education at home positively influence students' level of participation in school, which, in turn, promotes the development of students' social-emotional competences. [ABSTRACT FROM AUTHOR]

Violence against pregnant and postpartum individuals is a major public health problem. Homicides during the perinatal period have recently increased, yet these deaths reflect only the most extreme manifestation of violence. Far less is known about trends and disparities in pregnancy-associated violence morbidity. Examining emergency department (ED) utilization for violence-related injuries in this population can shed light on overall incidence and patterns of risk. We used longitudinal, all-payer, statewide data from California, comprising all individuals with a live-birth hospital delivery in each year from 2010–2018 (N = 3068,921). We followed annual cohorts of women before and after their delivery hospitalizations to identify ED visits for violent injury. We analyzed trends and disparities in annual incidence rates. The cumulative incidence of any pregnancy-associated ED visit for violence was 0.84 % overall; incidence increased slightly over the study period (annual OR adj = 1.01, 95 % CI = 1.01,1.02). The highest risk of pregnancy-associated violence was observed in younger individuals, non-Hispanic Black individuals, and Medicaid users. Our findings suggest risk of pregnancy-associated violence morbidity has increased over the past decade and is amplified for structurally vulnerable populations. The emergency department may be a critical opportunity for screening and providing resources to at-risk individuals. [ABSTRACT FROM AUTHOR]

Introduction Monitoring tobacco use during pregnancy is critical for achieving the United Nations Sustainable Development Goals. We examined changes between 2013 and 2019 in the relative differences in smoking prevalence rates between pregnant and nonpregnant women aged 18–49 years. Aims and Methods We used data from a nationally representative health survey conducted in Brazil in 2013 and 2019. A generalized linear model with binomial family and logarithmic link function was used to estimate, for each year of analysis, the crude and adjusted (by age group, educational attainment, place of residence, and status of protection from passive smoking at home) relative differences. Results In 2013, the proportion point estimate of tobacco use among pregnant women was lower than that observed among nonpregnant women (4.7% vs. 9.6%). However, in 2019 proportion point estimates were virtually the same (8.5% vs. 8.4%). After adjustment for selected variables, in 2013, smoking prevalence among pregnant women was 42% (p -value ≤ .05) lower than that observed among nonpregnant women. On the other hand, in 2019, maternal smoking prevalence was 13% (p -value > .05) higher than that found among nonpregnant women. Conclusions Ongoing tobacco industry interference and the marketing of tobacco products to vulnerable populations pose serious threats to public health and likely contribute to increasing maternal smoking prevalence. The fact that women smoke in such an important phase of their and their unborn children's lives reinforces the need to strengthen the implementation of concurrent tobacco control actions, including tobacco excise tax policy and prenatal tobacco prevention and cessation interventions as part of health professionals' routine consultation. Implications The decline in smoking prevalence among nonpregnant women between 2013 and 2019 was accompanied by an increase in maternal smoking prevalence. Monitoring tobacco use during pregnancy is critical for achieving the United Nations Sustainable Development Goals. Ongoing tobacco industry interference and the marketing of tobacco products to vulnerable populations in Brazil pose serious threats to public health. The fact that women smoke in such an important phase of their and their unborn children's lives reinforces the need to strengthen the implementation of concurrent tobacco control actions, including tobacco excise tax policy and primary healthcare professionals´ tobacco-related assistance during interaction with their patients. [ABSTRACT FROM AUTHOR]

Background: Top-down implementation strategies led by researchers often generate limited or tokenistic community engagement. Co-creation, a community engagement methodology, aims to create a shared leadership role of program beneficiaries in the development and implementation of programs, and encourages early and deep involvement of community members. We describe our experience using a four-stage co-creation approach to adapt and implement a sexually transmitted diseases (STD) testing intervention among men who have sex with men (MSM) in China. Methods: We adapted a four-stage approach to co-creation. First, we conducted a needs assessment based on our prior work and discussions with community members. Second, we planned for co-creation by establishing co-creator roles and recruiting co-creators using both stratified convenience and opportunistic sampling. Third, we conducted co-creation via hybrid online/in-person focus groups (four multistakeholder groups and four MSM-only groups). Finally, we evaluated validity of the co-creation process through qualitative observations by research staff, analyzed using rapid qualitative analysis, and evaluated co-creator experience through post-discussion survey Likert scales and open-ended feedback. Results: Needs assessment identified the needs to adapt our STD intervention to be independently run at community-based and public clinics, and to develop explanations and principles of co-creation for our potential co-creators. In total, there were 17 co-creation members: one co-creation lead (researcher), two co-chairs (one gay influencer and one research assistant), eight MSM community members, four health workers (two health professionals and two lay health workers) and two research implementers and observers. Co-created contents for the trial included strategies to decrease stigma and tailor interventions to MSM at public STD clinics, strategies to integrate STD testing services into existing community-led clinics, and intervention components to enhance acceptability and community engagement. Our evaluation of validity identified three main themes: challenges with representation, inclusivity versus power dynamics and importance of leadership. Surveys and free responses suggested that the majority of co-creators had a positive experience and desired more ownership. Conclusion: We successfully adapted a structured co-creation approach to adapt and implement an STD testing intervention for a vulnerable population. This approach may be useful for implementation, and further research is needed in other contexts and populations. Co-creation is a community engagement methodology that aims to create a shared leadership role of program beneficiaries in the development and implementation of programs. We conducted a co-creation process to develop a community-engaged implementation strategy to enhance service uptake among a sexual minority sub-population in China. This paper describes the co-creation process and may help inform future co-creation practices in generating contextually appropriate public health solutions. [ABSTRACT FROM AUTHOR]

Background: People with multimorbidity (>2 long-term conditions) have poorer outcomes in areas of high socioeconomic deprivation (SED). High-quality person-centred care (PCC) is important in those with multimorbidity, but socially vulnerable populations have not, to our knowledge, informed current PCC models. Aim: To explore how wider community factors influence management of multimorbidity in the context of high SED, how high-quality PCC is defined by patients, and whether this influences healthcare management. Design and setting: Ethnographically informed case study in a community experiencing high SED in Scotland. Method: Participant observation (138 h) was undertaken within four community groups who also took part in two participatory workshops. There were 25 in-depth interviews with people with multimorbidity, recruited from local general practices; emerging findings were discussed with interviewees in one focus group. Field notes/transcripts were analysed using inductive thematic analysis. Results: Key aspects of PCC were 'patient as person', 'strong therapeutic relationship', 'coordination of care', and 'power sharing'; power sharing was particularly enabling but rarely happened (barriers often unseen by practitioners). Shared community experiences of 'being known', 'stigma', and 'none of the systems working' influenced how people approached health services and healthcare decisions. High-quality PCC may have been particularly effective in this setting because of its influence on ameliorating wider shared negative community experiences. Conclusion: In a high SED setting PCC is important and can enhance engagement. Wider community factors have a critical influence on engagement with health care in areas of high SED and PCC may be particularly important in this context because of its influence ameliorating these. Policymakers should prioritise and resource PCC. [ABSTRACT FROM AUTHOR]

Abstract Background Despite advancements in reducing cardiovascular disease, it remains a major health concern. Cardiac rehabilitation (CR) has a positive impact on morbidity, mortality, and functioning, but faces high dropout rates especially among vulnerable patients, due to social inequalities and insufficiently tailored interventions. To address this, we developed the Heart Priority Programme targeting and supporting cardiac patients at risk of dropout. This study outlines the development of the Heart Priority Programme and share findings from a feasibility test. Methods An iterative three-stage process involving cardiac patients and healthcare professionals from three community healthcare services, guided the development of the programme. Stage 1 included reviewing evidence, consulting stakeholders, and observing practice. In stage 2, a project-group of researchers and healthcare professionals was established to co-produce the programme. Stage 3 included field-testing and local adaptions. Subsequently, the programme was feasibility tested in a single-arm follow-up study across two community healthcare services. Over six months, process data on implementation, acceptability, and mechanism of impact were gathered. Results The Heart Priority Programme was development from January 2023 to June 2023, comprising two main parts: 1) an evidence-based identification form with 13 risk factors to identify patients at risk of dropout (referred to as priority patients), and 2) an add-on intervention targeted these patients with three core elements—assigning a contact person, systematic communication, and follow-up. During a six-month feasibility phase, 260 patients were included. Of these, 91 (35%) were identified as priority patients. CR teams found that the programme was relevant, easy to integrate into daily workflow, and applicable in practice. Patient consultations yielded positive feedback on the three core elements of the add-on intervention. Conclusions This paper outlines the development and feasibility test of the Heart Priority Programme, co-produced to identify, and support priority patients. The programme, developed through a three-stage iterative co-production process, was found relevant and easy to implement in community healthcare services. CR teams valued its structured approach to supporting priority patients, and patients found it aligned with their needs. Although initial results are promising, further research is needed to evaluate the programme's effectiveness and suitability for widespread implementation. Trial registration ClinicalTrials.gov NCT06575764, registered retrospectively on 28 August 2024.

This integrative review assessed the efficacy of 5% fluoride varnish (FV) and 38% silver diamine fluoride (SDF) in preventing and treating caries in children and deciduous teeth, particularly in public health and socioeconomically disadvantaged settings. We searched PubMed and Google Scholar databases based on their relevance in evaluating the effectiveness of FV and SDF against caries in deciduous teeth. Joanna Briggs Institute’s Critical Appraisal Tools were employed to select the studies. Some studies showed no significant differences in efficacy between FV and SDF, suggesting that both could be equally effective, depending on the clinical scenario. Other studies have highlighted SDF’s superior performance of SDF in arresting caries in dentin and advanced decay and its antibacterial properties, while FV seems to be particularly effective in enamel remineralization during the early stages of caries. Both FV and SDF are effective in managing caries in children and deciduous teeth and offer significant benefits in the public health context by providing minimally invasive and cost-effective treatment options. The choice between FV and SDF should be tailored to the severity of caries and the specific needs of the child, ensuring that interventions are both practical and accessible, especially for the most vulnerable.

BACKGROUND: Wildfire smoke exposure has become a growing public health concern, as megafires and fires at the wildland urban interface increase in incidence and severity. Smoke contains many pollutants that negatively impact health and is linked to a number of health complications and chronic diseases. Communicating effectively with the public, especially at-risk populations, to reduce their exposure to this environmental pollutant has become a public health priority. Although wildfire smoke risk communication research has also increased in the past decade, best practice guidance is limited, and most health communications do not adhere to health literacy principles: readability, accessibility, and actionability. This scoping review identifies peer-reviewed studies about wildfire smoke risk communications to identify gaps in research and evaluation of communications and programs that seek to educate the public. METHODS: Four hundred fifty-one articles were identified from Web of Science and PubMed databases. After screening, 21 articles were included in the final sample for the abstraction process and qualitative thematic analysis. Ten articles were based in the US, with the other half in Australia, Canada, Italy, and other countries. Fifteen articles examined communication materials and messaging recommendations. Eight papers described communication delivery strategies. Eleven articles discussed behavior change. Six articles touched on risk communications for vulnerable populations; findings were limited and called for increasing awareness and prioritizing risk communications for at-risk populations. RESULTS: This scoping review found limited studies describing behavior change to reduce wildfire smoke exposure, characteristics of effective communication materials and messaging, and communication delivery strategies. Literature on risk communications, dissemination, and behavior change for vulnerable populations was even more limited. CONCLUSIONS: Recommendations include providing risk communications that are easy-to-understand and adapted to specific needs of at-risk groups. Communications should provide a limited number of messages that include specific actions for avoiding smoke exposure. Effective communications should use mixed media formats and a wide variety of dissemination strategies. There is a pressing need for more intervention research and effectiveness evaluation of risk communications about wildfire smoke exposure, and more development and dissemination of risk communications for both the general public and vulnerable populations.

PURPOSE: The impact of digital health on medically underserved patients is unclear. This study aimed to determine the early impact of a digital innovation to grow quality care through an interprofessional care team (DIG IT) on the blood pressure (BP) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk score of medically underserved patients. METHODS: This was a 3-month, prospective intervention study that included patients aged 40 years or more with BP of 140/90 mmHg or higher who received care from DIG IT from August through December 2021. Sociodemographic and clinical outcomes of DIG IT were compared with historical controls (controls) whose data were randomly extracted by the University of California Data Warehouse and matched 1:1 based on age, ethnicity, and baseline BP of the DIG IT arm. Multiple linear regression was performed to adjust for potential confounding factors. RESULTS: A total of 140 patients (70 DIG IT, 70 controls) were included. Both arms were similar with an average age (SD) of 62.8 (9.7) years. The population was dominated by Latinx (79.3%) persons, with baseline mean BP of 163/81 mmHg, and mean ASCVD risk score of 23.9%. The mean (SD) reduction in systolic BP at 3 months in the DIG IT arm was twice that of the controls (30.8 [17.3] mmHg vs 15.2 [21.2] mmHg; P

BackgroundA major challenge in epidemiology is knowing when an exposure effect is large enough to be clinically important, in particular how to interpret a difference in mean outcome in unexposed/exposed groups. Where it can be calculated, the proportion/percentage beyond a suitable cut-point is useful in defining individuals at high risk to give a more meaningful outcome. In this simulation study we compute differences in outcome means and proportions that arise from hypothetical small effects in vulnerable sub-populations.MethodsData from over 28,000 mother/child pairs belonging to the Environmental influences on Child Health Outcomes Program were used to examine the impact of hypothetical environmental exposures on mean birthweight, and low birthweight (LBW) (birthweight

BackgroundSmartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps.ObjectiveThis study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups.MethodsWe conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria.ResultsThe included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users' objective engagement.ConclusionsDespite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in "real-world" settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached.Trial registrationPROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254241.