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Drawing on the authors' own ethnographic research, this article discusses the importance of developing polymedia literacy as a key step toward ethical online research on social networking sites (SNS). Polymedia literacy entails the ability to critically analyze the vast landscape of SNS, their affordances, and users' social motivations for choosing specific SNS for their interactions. Internet researchers face several ethical challenges, including issues of informed consent, "public" and "private" online spaces, and data protection. Even when research ethics committees waive the need for a formal ethics approval process, researchers of online spaces need to ensure that their studies are conducted and presented in an ethical and responsible manner. This is particularly important in research contexts that pertain to vulnerable populations in online communities. [ABSTRACT FROM AUTHOR]

Purpose: This study examined demographic, practice, and area‐level characteristics associated with family physicians' (FP) provision of maternity care. Methods: Using the American Board of Family Medicine Certification examination application survey data, we investigated the relationship between FPs' maternity care service provision and (1) demographic (gender, years in practice, race/ethnicity), (2) practice characteristics (size, ownership, rurality), and (3) county‐level factors (percentage of reproductive‐age women, the number of obstetrician–gynecologists (OBGYNs) and certified nurse midwives (CNMs) per 100,000 reproductive‐age women). We performed summary statistics and multivariate logistic regression analyses. Results: Of the 59,903 FPs in the sample, 7.5% provided maternity care. FPs practicing in rural were 2.5 times more likely to provide maternity care than those practicing in urban areas. FPs in academic (odds ratio [OR] 4.6, 95% confidence interval [CI] 4.1–5.1) and safety‐net settings (OR 1.9, 1.7–2.1) had greater odds of providing maternity care. FPs in the bottom quintile with no or fewer OBGYNs and CNMs had a higher likelihood of maternity care provision (OR 2.1, 1.8–2.3) than those in the top quintile, with more OBGYNs and CNMs. Conclusions: FPs in high‐needs areas, such as rural and safety net settings, and areas with fewer CNMs or OBGYNs are more likely to provide maternity care, demonstrating the importance of FPs in meeting the needs of women with limited maternity care access. Our study findings highlight the importance of considering the contributions of FPs to maternity care as the organizations prioritize resource allocation to areas of highest need. [ABSTRACT FROM AUTHOR]

Objectives: The inJectable Antiretroviral feasiBility Study (JABS) aimed to evaluate the implementation of long‐acting regimens in a 'real world' Australian setting, with inclusion of participants with complex medical needs, social vulnerability and/or historical non‐adherence. Methods: JABS was a 12‐month, single‐centre, single‐arm, open‐label phase IV study of long‐acting cabotegravir 600 mg plus rilpivirine 900 mg administered intramuscularly every 2 months to adults with treated HIV‐1 infection. The primary endpoint was the proportion of attendances and administration of injections within a 14‐day dosing window over 12 months, out of the total prescribed doses. Secondary endpoints included proportions of missed appointments, use of oral bridging, discontinuations, virological failures, adverse events and participant‐reported outcomes. A multidisciplinary adherence programme embedded in the clinical service known as REACH provided support to JABS participants. Results: Of 60 participants enrolled by May 2022, 60% had one or more complexity or vulnerability factors identified, including absence of social supports (50%), mental health issues, alcohol or drug use (30%) and financial hardship or instability (13%), among others. Twenty‐seven per cent of participants had historical non‐adherence to antiretroviral therapy. Out of 395 prescribed doses, 97.2% of injections were administered within correct dosing windows at clinic visits. Two courses of short‐term oral bridging were required. The rate of injection site reactions was 29%, the majority being grade 1–2. There were no virological failures, no serious adverse events and only one injection‐related study discontinuation. High baseline treatment satisfaction and acceptability of injections increased by month 12. Those with vulnerability factors had similar adherence to injections as those without such factors. Ninety‐eight per cent of the participants who completed 12 months on the study have maintained long‐acting therapy, virological suppression and retention in care. Conclusions: Long‐acting cabotegravir plus rilpivirine was associated with very high adherence, maintenance of virological suppression, safety and treatment satisfaction in a diverse Australian clinic population, comparable to results of phase III randomized clinical trials. Individuals with vulnerability factors can achieve adherence to injections with individualized support. Long‐acting therapies in this group can increase the subsequent engagement in clinical care. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of weekly nurse facilitated 5000 m running at Parkrun on markers of health in vulnerable adolescents from a high deprivation area. Design: A matched pair randomized control trial. Sample: Twenty‐five adolescents aged 13–18, 90% identifying as Māori/Pasifika ethnicity. Intervention: The intervention (INT) group participated in 6–10 Parkruns within 10 weeks, and a control group (CON) participated in one Parkrun only. A nurse facilitated the intervention offering support and encouragement at each Parkrun. Measurements: Pre‐ and post‐intervention testing sessions for cardiorespiratory fitness (CRF), glycated hemoglobin, body mass index (BMI), skeletal muscle mass (SMM), body fat, and hand grip strength (STR) were conducted. Results: Parkrun improved CRF (F = 5.308, p = 0.035) and 5000 m time (t = 2.850, p = 0.019) by 5.5 ± 4.9 min (11.2%). Parkrun conferred a large beneficial effect on CRF (η2 = 0.249) a moderate beneficial effect on glycated hemoglobin levels (η2 = 0.119), and small beneficial effects upon SMM (η2 = 0.037) and body fat (η2 = 0.017). Conclusion: A weekly dose of nurse facilitated Parkrun can be recommended as a simple, accessible intervention that confers multiple beneficial effects on markers for health in adolescents from a high deprivation area. [ABSTRACT FROM AUTHOR]

Background: Completing high school enables access to educational and employment opportunities associated with better physical and mental health and improved quality of life. Identifying modifiable factors that promote optimal educational trajectories for youth experiencing disadvantage is an important research focus. Social inclusion has been theorised to play a role in promoting better educational outcomes for this priority population, however limited research has examined this relationship. Method: This study used three waves of data from the state‐representative Australian arm of the International Youth Development Study (IYDS) (youngest cohort, N = 733; 54% female, 95% Australian born) to examine the extent to which vulnerability in primary school (Grade 5; Mage = 10.97, SD = 0.38) and social inclusion in mid‐adolescence (Year 10; Mage = 15.50, SD = 0.53), were associated with school completion in young adulthood (post‐secondary; Mage = 19.02, SD = 0.43). Results: Regression models identified an interaction between social inclusion and vulnerability (OR = 1.37, 95% CI [1.06, 1.77], p =.016), indicating that the association between vulnerability and school completion varied as a student's level of social inclusion increased. Higher social inclusion was beneficial for youth with lower levels of vulnerability but did not appear to influence school completion for the most vulnerable students. Conclusions: For many young people, promoting social inclusion may support engagement in education and play a protective role. However, further research is needed to better understand the role of social inclusion for highly vulnerable youth, particularly the mechanisms via which social inclusion may have differential effects on school completion. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) causes significant mortality worldwide. HCV is highly curable but access to care is limited for many patients. The Grady Liver Clinic (GLC), a primary care‐based HCV clinic, utilizes a multidisciplinary team to provide comprehensive care for a medically underserved patient population in Atlanta, Georgia. The GLC added a telehealth option for HCV treatment at the start of the COVID‐19 pandemic. We describe the outcomes of utilizing telehealth in this population. We performed a retrospective chart review of patients who initiated HCV treatment from March 2019 to February 2020 (pre‐pandemic) and March 2020 to February 2021 (pandemic). Charts were abstracted for patient demographics and characteristics, treatment regimen, and treatment outcomes. Our primary outcome was HCV cure rate of the pre‐pandemic compared to the pandemic cohorts and within the different pandemic cohort visit types. We performed an intention‐to‐treat (ITT) analysis for all patients who took at least one dose of a direct‐acting antiviral (DAA) regardless of therapy completion, and a per‐protocol (PP) analysis of those who completed treatment and were tested for HCV cure. SVR12 rates were >95% on ITT analysis, with no significant difference between pre‐pandemic and pandemic cohorts. There was also no significant difference within the pandemic group when treatment was provided traditionally, via telehealth, or via a hybrid of these. Our findings support the use of telehealth as a tool to expand access to HCV treatment in a medically underserved patient population. [ABSTRACT FROM AUTHOR]

This study combined asset (i.e., strength) assessment, measured by the Search Institute's Asset Checklist, and humanistic counseling approaches to measure effects on self‐reported assets in two similar vulnerable adolescent populations in therapeutic residential treatment centers located in the rural Rocky Mountain West. Results indicated that seven of eight asset categories increased from baseline to follow‐up assessment, with four of those categories having statistically significant increases. Total Asset scores also indicated substantial overall asset building during treatment. Suggestions are included, especially for one concerning area, Constructive Use of Time. [ABSTRACT FROM AUTHOR]

Introduction: Refugees entering the United States are often unfamiliar with the healthcare system and have different medication beliefs. Since 2016, pharmacy students and faculty have been conducting medication literacy workshops to improve knowledge of medications for newly arriving refugees. Objectives: The primary study objective was to measure the newly arriving refugees' medication knowledge after a one‐time educational workshop. Methods: This was a retrospective quantitative and qualitative evaluation. Participants engaged in a student‐led 90‐min educational workshop utilizing interpreters, translated materials, and demonstrations. Topics included medical definitions, information on getting sick, medication use, and label reading. A translated, postworkshop evaluation included 22 questions grouped into the following categories: demographics (n = 4), medication use (n = 7), label reading (n = 6), access (n = 3), and cultural beliefs (n = 2). Three optional, free‐response questions regarding overall workshop feedback were included. Quantitative data was analyzed utilizing descriptive statistics. Thematic analysis was used to analyze qualitative data. Two independent coders reviewed each free‐response question and discussed any discrepancies for consensus. The study team developed key themes based on the codes. Results: Twenty‐one workshops were conducted with 419 participants from 42 countries. Correct responses were highest for medication beliefs (84%), label reading (78%), access (74%), and medication use (73%). Prescription label reading ability was high (86%), while preventative medicine understanding was lower (34%). Three major learning themes developed, including (1) Cultural differences impact medication habits, (2) Knowing provider roles and how to access different services in healthcare settings was important, and (3) Understanding how to read a label was useful. Researchers found that demonstrations were helpful in participants' learning and that additional education on prevention and specific disease states would be useful. Conclusion: Newly and recently arrived refugees were able to correctly identify basic medication health information through a medication literacy workshop. Additional classes exploring other topics, including preventative medicine and medications, should be considered. [ABSTRACT FROM AUTHOR]

Climate change disproportionately affects low‐income and minority populations. This study identified vulnerable populations to extreme heat, focusing on home air conditioning. State and municipal laws and regulations usually consider home air conditioning an amenity rather than a requirement for habitability such as heat, water, and electricity. Using the historical census data and the American Housing Survey data, this study identified the vulnerable populations to extreme heat and their spatial dynamic in Los Angeles County, CA. This study found that low‐income minority populations are more likely to live without home air conditioning, and they are more likely to be exposed to extreme heat in the coming years if their residential location patterns continue. Changing spatial patterns of low‐income and minority populations need to be incorporated into urban and regional planning for climate change. State regulations and municipal codes should require air conditioning as a habitability requirement for cooling equity. Also, cooling stations that provide immediate relief for those without home air conditioning need strategic placements based on the locational concentration of the vulnerable populations. [ABSTRACT FROM AUTHOR]

Innovative midwifery‐led collaborative care models have the potential to build on grassroots approaches to make transformative change within systems that work with families. Rainier Valley Midwives operates the Bundle Birth Project, a successful program that serves communities who are at higher risk for poor birth outcomes and face barriers to adequate medical, prenatal, and postpartum care, including Black, Indigenous, and persons of color. This project offers wraparound perinatal care services to provide a missing community of support to traditionally marginalized families before, during, and after birth while also bridging the gaps between midwives and physicians who attend births in different settings. By strengthening and formalizing the relationships between different types of perinatal providers including community‐based doulas and lactation support professionals, this midwifery‐led initiative improves the continuity and quality of care available to families including immigrant, refugee, and families of color in south Seattle, Washington. [ABSTRACT FROM AUTHOR]

Synopsis: Sudden‐onset climate events can have a significant impact on maternal health care systems, particularly in low‐ and middle‐income countries where resources are limited. We outline strategic policies that can help anticipate and plan for such disasters and help minimize negative maternal outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Safety net clinics (SNC) provide healthcare to vulnerable populations and SNC websites are an important information source. In North Carolina (NC), all 100 counties are Dental Health Professional Shortage Areas, yet 91 of 317 SNCs are non‐dental (ND‐SNC). Our goals were to: (1) assess the presence and type of oral health (OH) information on ND‐SNC websites; (2) develop and distribute an OH education webpage to ND‐SNCs and track its use. Methods: The website search function was used with common dental terms to evaluate the presence of OH content on each ND‐SNC website. Key representatives from ND‐SNCs were surveyed to assess patient care and willingness to implement an OH webpage. Webpage topics included oral hygiene and a map of NC dentists that provide services to low‐income patients. Google Analytics was used to track consumer webpage engagement including acquisition source (AS), average time on page (AT), and unique page views (UPV). Results: Of the 91 ND‐SNCs websites, none contained OH education; 15% had information about nearby dental providers. For the 40 ND‐SNCs using our webpage, January–December 2022, the primary AS for new webpage users was referrals; 72.5% of users visited directly from ND‐SNC websites. Statewide AT was 2 min and 30 s (SD = 58 s), 2.88 times longer than the 52‐s threshold marketing experts use to establish genuine user engagement. There were 1364 UPVs statewide for 2022. Conclusion: Our results suggest a need for OH education content on ND‐SNC websites, as users are searching for and engaging with this information. [ABSTRACT FROM AUTHOR]

How people pay is critically important to consumers and businesses alike. Many consumers are choosing to pay for goods and services from an increasing number of options. Tech‐savvy urbanites buy coffee by tapping their phone on a reader. Parents returning from a night out use peer‐to‐peer payment apps, such as Venmo, to pay the sitter. The recent explosion of financial innovations promises faster, more efficient, and cheaper transactions. These increasing digital payment options coincide with decreased number and volume of cash transactions. However, vulnerable populations face more constrained payment choices and often rely exclusively on cash. Without experience, devices, or acceptable credit histories, vulnerable populations may have little access to digital transactions. The advantages of falling digital costs and other benefits thus accrue to the digitally connected. At the same time, those who must transact in coins and paper money are likely to find their relative costs increasing. This paper highlights payment trends and the potential impact on vulnerable populations in the United States as we move toward a cashless society. This paper should stimulate discussions of public policy initiatives to mitigate digital payment issues for vulnerable people. [ABSTRACT FROM AUTHOR]

The coronavirus disease pandemic has highlighted significant gaps in community mental health services, placing vulnerable individuals at greater risk for mental health and substance use difficulties via disrupting their wellness journey. Guided by a wellness framework, a needs assessment was conducted among adult consumers of behavioral health services to understand their needs during the pandemic and to help develop and strengthen service delivery strategies. A team of three university researchers and four Consumer Researchers, who receive services at a publicly funded community mental health center, engaged in a community‐based participatory project in which 13 focus groups were conducted with 51 consumers. Several themes emerged from a thematic analysis of transcripts regarding consumer well‐being and healthcare needs, coping strategies employed, and the accessibility, benefits, and perception of clinical and support services during the pandemic. Results highlighted strengths in service delivery and areas in need of enhancement. Findings may inform similar community services that seek to enhance delivery of care among vulnerable populations. [ABSTRACT FROM AUTHOR]

New Findings: What is the topic of this review?Thermal extremes disproportionately affect populations with cardiovascular conditions. Preterm birth, across all gestational age ranges below 37 weeks, has been identified as a non‐modifiable risk factor for cardiovascular disease. The hypothesis is presented that individuals born preterm are at an increased risk of cardiovascular morbidity and mortality during thermal extremes.What advances does it highlight?Cardiovascular stress tests performed in preterm‐born populations, from infancy through adulthood, highlight a progression of cardiovascular dysfunction accelerating through adolescence and adulthood. This dysfunction has many similarities with populations known to be at risk in thermal extremes. Preterm‐born individuals are a uniquely vulnerable population. Preterm exposure to the extrauterine environment and the (mal)adaptations that occur during the transitional period can result in alterations to their macro‐ and micro‐physiological state. The physiological adaptations that increase survival in the short term may place those born preterm on a trajectory of lifelong dysfunction and later‐life decompensation. Cardiovascular compensation in children and adolescents, which masks this trajectory of dysfunction, is overcome under stress, such that the functional cardiovascular capacity is reduced and recovery impaired following physiological stress. This has implications for their response to thermal stress. As the Anthropocene introduces greater changes in our environment, thermal extremes will impact vulnerable populations as yet unidentified in the climate change context. Here, we present the hypothesis that individuals born preterm are a vulnerable population at an increased risk of cardiovascular morbidity and mortality during thermal extremes. [ABSTRACT FROM AUTHOR]

Purpose: There is little information as to how America's broadband infrastructure might impact recent efforts to expand access to virtual care for underserved communities. Objective: To examine potential and realized access to broadband internet services within Medically Underserved Areas (MUAs) that rely on community health care service providers for primary care. Methods: This cross‐sectional study included 214,946 US Census Block Group estimates from the 2017 and 2019 American Community Survey and the corresponding Federal Communications Commission database. Changes in household broadband subscription rates and Healthy People 2020 access thresholds within MUAs were assessed. Findings: In 2019, 24,304 MUA households (31.9%) met Healthy People 2020 targets for broadband subscription rates, compared to 64.4% of non‐MUA households (n = 89,285). On average, 74.7% of MUA households had a broadband internet subscription compared to 85.2% of non‐MUA households, whereas 61.1% (n = 46,635) of MUA households had access to broadband speeds of at least 25.0 Mbps, compared to 75.6% (n = 104,696) of non‐MUA households. Within urban households, there was a 0.8 to 1.3 to 1.6 annual percentage point convergence in MUA versus non‐MUA broadband disparities between across quintiles (P <.05). Rural MUA households showed little improvement in broadband access between 2017 and 2019. Conclusions: There has been an overall convergence of broadband access disparities between MUA and non‐MUA households over time, but less improvements in access among the most rural households. Reimbursement for audio‐only telehealth visits by state Medicaid agencies would help drive down barriers to virtual health care options for populations residing in MUAs. [ABSTRACT FROM AUTHOR]

Introduction: Key populations (sex workers, men who have sex with men, people who inject drugs, people in prisons and other closed settings, and trans and gender diverse individuals) are disproportionately affected by HIV, sexually transmitted infections (STIs) and viral hepatitis (VH). Counselling behavioural interventions are widely used, but their impact on HIV/STI/VH acquisition is unclear. Methods: To inform World Health Organization guidelines, we conducted a systematic review and meta‐analysis of effectiveness, values and preferences, and cost studies about counselling behavioural interventions with key populations. We searched CINAHL, PsycINFO, PubMed and EMBASE for studies published between January 2010 and December 2022; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials (RCTs) with HIV/STI/VH incidence outcomes; secondary review outcomes of unprotected sex, needle/syringe sharing and mortality were captured if studies also included primary review outcomes. We assessed the risk of bias using the Cochrane Collaboration tool, generated pooled risk ratios through random effects meta‐analysis and summarized findings in GRADE evidence profiles. Values and preferences and cost data were summarized descriptively. Results: We identified nine effectiveness, two values and preferences, and two cost articles. Meta‐analysis of six RCTs showed no statistically significant effect of counselling behavioural interventions on HIV incidence (1280 participants; combined risk ratio [RR]: 0.70, 95% confidence interval [CI]: 0.41–1.20) or STI incidence (3783 participants; RR: 0.99; 95% CI: 0.74–1.31). One RCT with 139 participants showed possible effects on hepatitis C virus incidence. There was no effect on secondary review outcomes of unprotected (condomless) sex (seven RCTs; 1811 participants; RR: 0.82, 95% CI: 0.66–1.02) and needle/syringe sharing (two RCTs; 564 participants; RR 0.72; 95% CI: 0.32–1.63). There was moderate certainty in the lack of effect across outcomes. Two values and preferences studies found that participants liked specific counselling behavioural interventions. Two cost studies found reasonable intervention costs. Discussion: Evidence was limited and mostly on HIV, but showed no effect of counselling behavioural interventions on HIV/VH/STI incidence among key populations. Conclusions: While there may be other benefits, the choice to provide counselling behavioural interventions for key populations should be made with an understanding of the potential limitations on incidence outcomes. [ABSTRACT FROM AUTHOR]

Few funding sources have explicitly supported systems‐wide research to identify mechanisms for improving access, service delivery, outcomes and wellbeing for autistic transition‐age youth and young adults. We aimed to integrate findings from research produced through a five‐year federal Autism Transition Research Project (ATRP) cooperative agreement. This capstone review sought to: (1) map the body of scientific evidence that emerged from this federal award, and (2) identify remaining evidence gaps to inform future autism transition services research. We used scoping review methods to assess 31 ATRP‐funded published scientific studies. We charted study characteristics, topical domains, socio‐ecological levels of variables, focus on equity, and inclusion of autistic participants. We evaluated how these topics were addressed across studies to identify continued gaps in the evidence base. Compared to prior published reviews and research agendas, we found improvements in characterization of study participants, broader examination of socio‐ecological correlates, and examination of multiple outcome domains. However, we also identified continued deficits in inclusion of autistic study participants, use of multisectoral data, and research with a strong focus on equity. Our recommended priorities for autism transition services research to facilitate healthy life outcomes and wellbeing included: continued analysis of population‐level data and improved data infrastructure; development of service delivery methods and interventions that target marginalized groups; expanded research to inform improvements in the performance and coordination of complex service ecosystems that interface with autistic youth; and bolstering the roles of autistic research participants. Lay Summary: There is little federal funding available for researching services, outcomes and wellbeing of autistic transition‐age youth and young adults. We reviewed 31 published studies produced through a historic federal investment in autism transitions research by the U.S. Health Resources and Services Administration. We discuss findings of these studies, gaps in research, and priorities for autism transition services research to facilitate healthy life outcomes and wellbeing for autistic youth and adults. [ABSTRACT FROM AUTHOR]

Low‐income populations are particularly susceptible to mental health problems, and the susceptibilities of family members may be interconnected. In particular, maternal factors are known to be linked to their children's outcomes. This study aims to investigate how maternal cognition, depression, and the mother–child relationship, as well as children's cognition, predict the mental health of children in low‐income families. Pairs of mothers and children from families receiving governmental assistance were surveyed between January 2018 and March 2019. Korean versions of the following instruments were used: Strengths and Difficulties Questionnaire (children's mental health problems), Cognitive Triad Inventory for Children (children's cognition), Kerns' Security Scale (mother–child relationship), Center for Epidemiologic Studies Depression Scale (maternal depression), and Automatic Thoughts Questionnaire–Negative (maternal cognition). A structural equation model was used to examine how maternal cognition, depression, the mother–child relationship, and children's cognition predict children's mental health. Maternal negative cognition and depression mediated by the children's relationships with their mothers negatively predicted their cognition and mental health problems. Enhancing maternal mental health and a mother–child relationship can help improve positive cognition and mental health of children from low‐income families. [ABSTRACT FROM AUTHOR]

Objective: Exploring how public health nurses (PHNs) provide community‐based support to women who are refugees and mothering. Design: A constructivist grounded theory (CGT) design was used where intersectionality as an analytical tool was applied. Varying data collection approaches including focus groups were used. Sample: Twelve PHNs from four public health units in Western Canada participated in this study. Results: Participants in this study described an overall process of creating safe relational space to address a basic social problem of establishing trust while managing structural forces. This overarching process was expressed through burning with passion, connecting while looking beyond, protecting from re‐traumatization, and fostering independence. Findings reveal strategies PHNs used to enhance health equity. This study extends critical caring theory to include sociopolitical and economic influences on public health nursing practice. Consequences of these influences on the mothering refugee women population are also revealed. Implications include structural integration of trauma‐and‐violence‐informed principles to support public health nursing practice. Conclusions: This study adds to an emerging body of knowledge on PHNs work with complex populations. Innovative application of intersectionality is demonstrated as an effective approach to analyzing impacts of broad sociopolitical priorities on communities that are systemically marginalized. [ABSTRACT FROM AUTHOR]

Introduction: The Birth Center model of care is a health care delivery innovation in its fourth decade of demonstration across the United States. The purpose of this research was to evaluate the model's potential for decreasing poverty‐related health disparities among childbearing families. Methods: Between 2013 and 2017, 26,259 childbearing people received care within the 45 Center for Medicare and Medicaid Innovation Strong Start birth center sites. Secondary analysis of the prospective American Association of Birth Centers Perinatal Data Registry was conducted. Descriptive statistics described sociobehavioral, medical risk factors, and core clinical outcomes to inform the logistic regression model. Privately insured consumers were independently compared with 2 subgroups of Medicaid beneficiaries: Strong Start enrollees (midwifery‐led care with peer counselors) and non‐Strong Start Medicaid beneficiaries (midwifery‐led care without peer counselors). Results: After controlling for medical risk factors, Strong Start Medicaid beneficiaries achieved similar outcomes to privately insured consumers with no significant differences in maternal or newborn outcomes between groups. Perinatal outcomes included induction of labor (adjusted odds ratio [aOR], 0.86; 95% CI 0.61‐1.13), epidural analgesia use (aOR, 1.00; 95% CI, 0.68‐1.48), cesarean birth (aOR, 1.16; 95% CI, 0.87‐1.53), exclusive breastfeeding on discharge (aOR, 1.11; 95% CI, 0.48‐2.56), low Apgar score at 5 minutes (aOR, 1.23; 95% CI, 0.86‐1.83), low birth weight (aOR, 1.12; 95% CI, 0.77‐1.64), and antepartum transfer of care after the first prenatal appointment (aOR, 1.53; 95% CI, 0.97‐2.40). Medicaid beneficiaries who were not enrolled in the Strong Start midwifery‐led, peer counselor program demonstrated similar results except for having higher epidural analgesia use (aOR, 1.30; 95% CI, 1.10‐1.53) and significantly lower exclusive breastfeeding on discharge (aOR, 0.57; 95% CI, 0.40‐0.81) than their privately insured counterparts. Discussion: The midwifery‐led birth center model of care complemented by peer counselors demonstrated a pathway to achieve health equity. [ABSTRACT FROM AUTHOR]

Background: Poor health outcomes amongst marginalized groups result in part from health inequities related to social and structural determinants of health. Marginalized people report higher incidences of comorbidities, chronic disease and adverse health behaviours than their nondisadvantaged peers. The objective of this review is to examine marginalized Australians' experiences of and access to community‐based primary health services in urban locations. Methods: A systematic search incorporating related MeSH terms and synonyms pertaining to marginalized Australian populations and their health‐seeking was conducted across seven databases. We included qualitative studies that reported experiences of health‐seeking within community‐based primary health care in metropolitan Australia. Participant populations experiencing marginalization due to social stigma and isolation, early‐life disadvantage, poor health and/or financial hardship were included. A meta‐ethnographic framework was used to synthesize themes across selected studies and researcher triangulation was employed to develop higher‐order themes. Results: Search results revealed 26 studies included for critical appraisal and synthesis. Seven higher‐order themes were developed describing experiences of health service engagement amongst marginalized groups: (1) Understanding the patient within the context of family and community, (2) Health and cultural beliefs influence health‐seeking, (3) Lack of information and poor cultural competence limit utilization of services, (4) Motivation for treatment influences health service engagement, (5) Accessing services, a spectrum of experience—from discrimination to validation, (6) Navigating a complex system in a complex society, (7) Preferences for health care and expectations for systemic change. Conclusion: Marginalized Australians experience health disadvantage across micro, meso and macro levels of health system navigation and commonalities in health‐seeking were identified across each of the distinct marginalized groups in our analysis. This review outlines important areas of consideration for health care provision and policy development essential to helping address health inequities for a diversity of marginalized populations. Patient or Public Contribution: Whilst patient voices were reported across all studies included within this review, no further patient or public contribution applies to this study. [ABSTRACT FROM AUTHOR]

Introduction: The global prevalence of diabetes in 2019 in adults was estimated to be 9.3%. This study developed in Ecuador, for the first time, instruments to assess patient‐reported outcomes and experiences. Methods: The Experiences of the Person with Diabetes (EPD) Questionnaire is a diabetes‐specific instrument. A mixed‐methods study was conducted. First, a qualitative item development phase that included four focus groups and six semi‐structured interviews with patients was conducted in different rural and urban areas of Ecuador to obtain information on culture, beliefs, demographics, diet and social perspectives. A second quantitative phase for psychometric validation was carried out in primary care settings of rural and urban areas of Ecuador. Results: Forty‐two and four hundred and eighty‐nine participants were included in each phase, respectively. The item development phase resulted in a questionnaire of 44 items (23 for perceived outcomes and 21 for experiences). In the validation study, most participants were women (58%) and from urban areas (57%). Exploratory factor analysis revealed three dimensions for each instrument. Outcomes instrument dimensions were symptoms and burnout, worries and fears and social limitations. Experiences instrument dimensions were information, patient‐centred care and care delivery. Cronbach's α values of the total score and dimensions were high, ranging between.81 and.93 in both instruments. Confirmatory factor analysis showed an acceptable fit of the data. Conclusion: The EPD Questionnaire is probably the first instrument developed to assess patient‐reported experiences and perceived outcomes in a middle‐income country that included patients to capture all dimensions relevant for the intended population. Its psychometric properties are robust and could provide valuable information for clinicians and policymakers in the region. Patient or Public Contribution: The development of these instruments has taken into consideration patients and the public since their conception. A qualitative approach gathered relevant information related to the cultural, social and economic burden of different populations in Ecuador. Before validation, a pilot test was carried out with users of the National Health Services to obtain their perspectives and insights of the developed instrument. Finally, during the data analysis, we have given special consideration to social variables such as rural and urban populations. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is the deadliest infectious disease across the world, with the greatest burden occurring in India. Pregnant women and children are especially vulnerable to adverse effects from infection, and they tend to have diminished ability to protect themselves. Malnutrition, HIV, and other causes of immune suppression such as exposure to air pollution make one more prone to serious illness or death from TB infection. Risk factors are influenced by maternal education, access to health care, poverty, nutrition, healthcare stigma, and sanitation, among others. Current literature is heavily clinical, lacking focus on upstream factors, with a skew toward secondary and tertiary prevention strategies (i.e., case finding and treatment), and less emphasis on primary prevention (e.g., wealth equity and environmental regulation). Given concerns with extremely drug resistant TB and because infectious diseases can permeate National borders, public health nurses, and other healthcare professionals must educate themselves and advocate on behalf of vulnerable populations such as children in India. Improved sanitation, air quality monitoring, women’s education, and increased access to health care are cost-effective and evidence-based strategies to address pediatric TB in India, a challenge which is grounded in human rights and justice. [ABSTRACT FROM AUTHOR]

Child abuse and neglect is an increasing international social issue. Specific challenges include the over‐representation of disadvantaged and marginalised populations, including First Nations communities. This document review explored how responses to child abuse and neglect are conceptualised in international policy and professional guidelines to identify the language that shapes strategies to address child abuse and neglect. In doing so, this review aimed to identify which approaches may be applicable to the Australian context to underpin population‐wide strategies to address child abuse and neglect and provide a shared language for professionals working with children. Twenty‐two policies and professional guidelines from 13 high and upper‐middle income countries were analysed inductively supported by NVivo software. Key findings showed that many policies and professional guidelines included blame, labelling and stigmatising language which may further marginalise children and families. One approach that minimised stigmatising language was safeguarding as practiced in the United Kingdom and Ireland. Safeguarding may be applicable to contexts like Australia to underpin inclusive approaches and provide a shared vision and language for all professionals working with children. However, further research is needed to explore whether safeguarding could be enacted in culturally safe ways in colonised countries with First Nations populations. [ABSTRACT FROM AUTHOR]

It is incumbent on dental educators to prepare students for careers in various practice settings and modalities. As the dental practice market continues to evolve away from a predominantly solo private practice model, schools are tasked with training future providers to deliver quality care to diverse patient populations in diverse settings. While no single health delivery model will solve access to care, exposing dental students to various practice environments prepares them to better understand and navigate nontraditional postgraduate practice opportunities. The University of California, Los Angeles (UCLA) School of Dentistry established a community-based clinical education (CBCE) program that has grown to include dental support organizations. By partnering with a more diverse portfolio of practice types, including large corporate entities, the UCLA CBCE program has strengthened its financial accountability while also delivering on the goal of enhancing dental education and improving access to care for vulnerable populations., (© 2024 The Author(s). Journal of Dental Education published by Wiley Periodicals LLC on behalf of American Dental Education Association.)

The article focuses on the limitations of current bruxism assessment criteria, particularly in evaluating vulnerable groups. Topics include the need for consistent definitions to streamline assessment guidelines, the challenges in defining bruxism for vulnerable populations with significant communication impairments and comorbidities, and the importance of publishing observational data to address the dearth of comprehensive oral health data for underserved and rare disease populations.

The aim of this study was to assess college students' food and housing insecurity risk amidst the pandemic. Data were collected through an online survey in the summer of 2020 from 1956 graduate and undergraduate students attending a large, private, urban university in the Midwest, U.S. Food insecurity among students increased (25% before; 29% during COVID) with housing insecurity staying roughly the same (34% before; 36% during COVID). Results indicate certain student groups were at greater risk of basic needs insecurity during the pandemic compared to their counterparts. Results also suggest changes in food and housing insecurity trends. College students are burdened with basic needs insecurity, exacerbated during the pandemic. Institutions need to work toward solutions to address the needs of vulnerable populations disproportionately affected by basic needs insecurity. Recommendations on addressing the basic needs of college students are also provided. [ABSTRACT FROM AUTHOR]

Sexual assault advocates provide support to survivors as they navigate medical, legal, housing, and other complex systems. However, social distancing measures enacted in response to coronavirus disease 2019 (COVID‐19) forced changes to traditional advocacy services. The current study aimed to understand how the COVID‐19 pandemic transformed survivors' engagement with sexual assault advocacy services. Semi‐structured interviews were conducted with 12 sexual assault advocates from a community‐based advocacy organization in Detroit. Thematic analysis was employed to uncover emergent themes reflecting COVID‐19's impact on survivors' engagement with advocacy services. Three themes were identified: (1) Disruption to advocacy services; (2) difficulty obtaining tangible resources; and (3) desire for COVID‐related support, information, and resources. This study highlights the needs of sexual assault survivors during the COVID‐19 pandemic and explores how public health emergencies have the potential to exacerbate the needs of this vulnerable population. Implications and future directions for service provision and research are considered. [ABSTRACT FROM AUTHOR]

The haor landscape is a wetland ecosystem in northeast Bangladesh, comprising shallow depressions that undergo large changes in water inundation between the monsoon and dry seasons. Sediment is supplied to the haor from rivers originating in the adjacent Shillong Plateau, and can adversely affect these largely arable agricultural lands. The critical adverse effects of changing hydrology and enhanced sedimentation due to anthropogenic change include the reduction of natural water storage capacity, changes in the timing and magnitude of floods, and increasing loss and damage to crops, which consequently affect the livelihoods of wetland dwellers. This study employs a mixed‐methods approach to investigate how sedimentation has affected the livelihoods of the residents and the pressures they experience. Cross‐sectional surveys and interviews were conducted with 180 respondents in Lubar and Pochashul Haors (LPH), Sunamganj District, and allied with an analysis of satellite images that reveals the nature of landscape change over the past 56 years. Our findings confirm that sedimentation has been promoted through both natural processes of alluvial fan progradation and anthropogenic forcings. Enhanced sedimentation threatens the agriculture of the region and affects the livelihood of local inhabitants, leading to other societal issues related to income, education, employment, health, displacement, and sexual harassment. The mixed methods employed herein are essential tools to reveal these effects. In order to reduce the vulnerability of the local population, a transboundary dialog between India and Bangladesh is needed to realize measures to protect wetland resources and achieve progress towards environmental sustainability. Key Points: Sedimentation has fostered a new pattern of local disasters in wetland areasBoth natural and anthropogenic factors cause accelerated sedimentationEnhanced sedimentation can lead to societal issues related to income, education, employment, health, displacement, and sexual harassment [ABSTRACT FROM AUTHOR]

Aims: To examine how weekly rates of emergency department (ED) visits for drug overdoses changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the pre‐pandemic, peak, and re‐opening periods of the first wave of the COVID‐19 pandemic, using corresponding weeks in 2019 as a historical control. Design Population‐based retrospective cohort study conducted between September 30, 2018 and September 26, 2020. Setting: Ontario, Canada. Participants: A total of 38 617 IRHH, 15 022 369 housed individuals, and 186 858 low‐income housed individuals matched on age, sex, rurality, and comorbidity burden. Measurements ED visits for drug overdoses of accidental and undetermined intent. Findings Average rates of ED visits for drug overdoses between January and September 2020 were higher among IRHH compared with housed individuals (rate ratio [RR], 148.0; 95% CI, 142.7–153.5) and matched housed individuals (RR, 22.3; 95% CI, 20.7–24.0). ED visits for drug overdoses decreased across all groups by ~20% during the peak period (March 17 to June 16, 2020) compared with corresponding weeks in 2019. During the re‐opening period (June 17 to September 26, 2020), rates of ED visits for drug overdoses were significantly higher among IRHH (RR, 1.56; 95% CI, 1.44–1.69), matched housed individuals (RR, 1.25; 95% CI, 1.08–1.46), and housed individuals relative to equivalent weeks in 2019 (RR, 1.07; 95% CI, 1.02–1.11). The relative increase in drug overdose ED visits among IRHH was larger compared with both matched housed individuals (P = 0.01 for interaction between group and year) and housed individuals (P < 0.001) during this period. Conclusions: Recently homeless individuals in Ontario, Canada experienced disproportionate increases in ED visits for drug overdoses during the re‐opening period of the COVID‐19 pandemic compared with housed people. [ABSTRACT FROM AUTHOR]

Background and Aims: Homelessness is one of the most significant harms associated with gambling and appears to affect older adults disproportionately, but the relationship has received little research attention. This exploratory study investigated how gambling and homelessness is linked in older adults. Methods: Using qualitative research methods, we undertook in‐depth semi structured face‐to‐face individual and group interviews to gather data from a purposive sample (n = 48) of key informants working in service provision for older adults (aged 50+ years) experiencing gambling‐related harm and/or homelessness in Victoria, Australia. Thematic analysis of data focused on evaluating mechanisms and identifying contextual conditions that activate pathways between gambling and homelessness. Results: The relationship between gambling and homelessness in older adults is often indirect and non‐linear, and can represent a reflexive cycle. Experiencing periods of homelessness into older age can contribute to gambling, often because the adverse impacts of homelessness on older adults' mental and material wellbeing increase the appeal of gambling. Additionally, comorbidities (e.g. substance use, mental illness, past trauma) and structural conditions (e.g. gambling accessibility, poverty, housing insecurity) can activate gambling. Furthermore, because gambling in the older homeless adult population is frequently hidden and regularly overlooked by service providers, it often continues unabated. Gambling in older adults can also contribute to the onset of first‐time homelessness. Large and rapid losses from high‐intensity gambling frequently characterize this route to homelessness. Such gambling is often triggered by major life events and changes (e.g. bereavement, job loss, relationship difficulties), and the outcomes are often worsened by the conduct of gambling operators and creditors. Conclusions: The link between gambling and homelessness in older adults is complex, with connecting mechanisms often contingent upon individual, interpersonal and structural conditions and contexts. There is potential for preventative and ameliorative action given many of the underlying conditions appear modifiable through policy intervention. [ABSTRACT FROM AUTHOR]

Introduction: The Chronic Disease Self‐Management Programme (CDSMP) has resulted in improved health outcomes for patients. However, research has focused mainly on those with chronic conditions and has not extensively explored prevention programmes targeting individuals with specific vulnerability profiles. Aim: This study aimed to understand the effects of the CDSMP on the lived experience of vulnerable patients included in the EFFICHRONIC project in France, based on their needs and expectations before and after participation. Methods: We conducted a qualitative phenomenological semio‐pragmatic study based on 37 in‐depth interviews with 20 patients (20 before/17 after CDSMP). Results: By transforming existential dimensions (identity, relationship with others and bodily experience), chronic illness generates new needs in the vulnerable person. By resonating with the expectations and needs of participants, the CDSMP induces motivation and a sense of belonging to a community of peers. It has enabled the participants to become actors of their own health until empowerment. Although some limitations are reported, the programme has awakened a desire in the participants to take better care of their health and to develop personal skills with, for some, a desire to become involved in health education. Conclusion: Our phenomenological approach highlighted the resonance between the programme (its design and implementation) and the lived experience of patients, as an effective element of empowerment. This necessitates training the facilitators to elicit the lived experience of patients. Furthermore, as a patient‐centred approach is required, the facilitators need to learn how to adapt the design of the programme to the singularity of the patient. Patient or Public Contribution: Patients provided the data that were collected through in‐depth interviews, and their experiences before and after the programme were analysed. [ABSTRACT FROM AUTHOR]

Sexual and gender minorities, for example, lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth, are overrepresented in the child welfare system and an increasing number of LGBTQ people are becoming foster parents. The objective of this scoping review is to provide an overview of the existing empirical research on the practices of child welfare services towards LGBTQ individuals (i.e., youth, carers and foster parents). The review followed the methodology framework outlined by the Joanna Briggs Institute (JBI). The electronic databases MEDLINE, Embase, PsycINFO, Web of Science, PubMed and Idunn were searched to identify studies appropriate for inclusion. There were 45 studies that met the inclusion criteria; 24 concerned LGBTQ youth, 10 encompassed foster parents, while nine had the service perspective as the primary focus. The studies originated from the USA (k = 34), the UK (k = 6), Australia (k = 2) and the Netherlands (k = 1). Of the included studies, 28 were qualitative, 14 were quantitative, and three studies used mixed method approach. The findings indicate that LGBTQ youth are overrepresented in the child welfare system and that LGBTQ youth and foster parents often face stigma and discrimination. The results reveal a gap in the current knowledge about social workers' attitudes, knowledge and experiences regarding working with LGBTQ individuals. [ABSTRACT FROM AUTHOR]

Introduction: The perceived unmet service needs of acute care‐seeking people who use illegal drugs (PWUD) have been poorly documented, despite evidence of frequent hospital utilisation. This study applies the Behavioral Model for Vulnerable Populations to investigate correlates of unmet service needs in this subpopulation. Methods: Survey data from 285 PWUD at three urban Canadian acute care centres were examined. The survey included the Perceived Need for Care Questionnaire, which measured service seeking and care satisfaction for mental health and substance use concerns across seven types of services, as well as barriers to having care needs met. The Behavioral Model for Vulnerable Populations was applied in hierarchical setwise logistic regression to examine associations between high unmet service need and socio‐structural predictors (i.e. predisposing, enabling and need factors). Results: Almost half (46%) of participants reported a high level of unmet service need, despite seeking services during the past year. Participants reporting recent criminal activity, adverse childhood experiences, transitory sleeping, having no community support worker, and meeting screening criteria for depression were more likely to report a high level of unmet service needs. Structural barriers to care (57%) were more commonly reported than motivational barriers (43%). Discussion and Conclusions: Acute care‐seeking PWUD experience high rates of unmet service needs for their mental health and substance use problems. Strategies that can help overcome structural barriers to care are necessary to help address the service needs of this population. [ABSTRACT FROM AUTHOR]

There is a robust body of research that examines problems women with criminal‐legal system involvement face, the support they need, how they get it, from whom, and how they use it. Rarely do we pause to consider what resources such women already have, the support they give, or what those experiences teach us about how to support them. In this study, my purpose was to reflect on the phenomenon of giving as experienced by women who have few material resources and whose lives have been disrupted by repeat incarcerations. I analyzed four lived experience descriptions of giving from interviews conducted in 2016–2017 with 10 women who had significant histories of criminal‐legal system involvement, unstable housing, and little or no income. Using concepts from hermeneutic phenomenology and the practice of phenomenological study described by Max Van Manen, I analyzed giving wholistically, selectively, and in detail. I discerned that the women's experience of giving was relationally structured as exchange, with both past and future aspects. In selective and detailed analysis, themes of "taking in" and "being there" and a gem or essential feature of automaticity/personhood presented themselves. Women found meaning, value, and a sense of belonging in giving to others even when they struggled to meet their own needs. The findings suggest potential directions for nursing practice, research, and advocacy, including work to recognize, build on, and remunerate women's affiliative care‐giving and support—while also putting pressure on community health and social services delivery systems to better serve those in need. [ABSTRACT FROM AUTHOR]

The development and implementation of a multicancer early detection (MCED) test that is effective and affordable has the potential to change cancer care systems around the world. However, careful consideration is needed within the context of different health care settings (both low- and middle-income countries and high-income countries) to roll out an MCED test and promote equity in access. [ABSTRACT FROM AUTHOR]

Aims: To identify factors asociated with early and sustained cessation of heavy drinking. Design Retrospective cohort study over 5 years. Setting: Kaiser Permanente Northern California, United States. Participants: Adults reporting heavy drinking during primary care‐based alcohol screening between 1 June 2013 and 31 May 2014. The sample (n = 85 434) was 40.7% female and 33.8% non‐white; mean age was 50.3 years (standard deviation = 18.1). Measurements: Following US guidelines, early and sustained cessation of heavy drinking was defined as reporting lower‐risk drinking or abstinence at 1 year and to 5 years after achieving early cessation, respectively. Associations between patient characteristics and service use and cessation outcomes were examined using logistic regression with inverse probability weights addressing attrition. Findings Nearly two‐thirds of participants achieved early cessation of heavy drinking. Women [odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.35, 1.44], middle‐age (35–64 years: ORs = 1.16–1.19), non‐white race/ethnicity (ORs = 1.03–1.57), medical conditions (OR = 1.05, 95% CI = 1.04, 1.06), psychiatric (OR = 1.10, 95% CI = 1.06, 1.15) and drug use disorders (OR = 1.35, 95% CI = 1.17, 1.56) and addiction treatment (OR = 1.19, 95% CI = 1.09, 1.30) were associated with higher odds of early cessation, while older age (≥ 65 years: OR = 0.91, 95% CI = 0.86, 0.96), smoking (OR = 0.81, 95% CI = 0.77, 0.84), higher index drinking levels (exceeding both daily and weekly limits: OR = 0.30, 95% CI = 0.29, 0.32) and psychiatric treatment (OR = 0.91, 95% CI = 0.84, 0.99) were associated with lower odds. Among those who achieved early cessation (n = 19 200), 60.0% sustained cessation. Associations between patient factors and sustained cessation paralleled those observed in analyses of early cessation. Additionally, routine primary care (OR = 1.57, 95% CI = 1.44, 1.71) and addiction treatment post‐1 year (OR = 1.41, 95% CI = 1.19, 1.66) were associated with higher odds of sustained cessation. Lower‐risk drinking versus abstinence at 1 year was associated with lower odds of sustained cessation (OR = 0.62, 95% CI = 0.57, 0.66). Conclusions: Nearly two‐thirds of a large, diverse sample of patients who reported heavy drinking in a Californian health‐care system achieved early and sustained cessation of heavy drinking. Vulnerable subgroups (i.e. non‐white patients and those with psychiatric disorders), patients who received routine primary care and those who received addiction treatment were more likely to sustain cessation of heavy drinking than other participants. [ABSTRACT FROM AUTHOR]

Purpose: To determine what is known about climate change health effects for gender diverse (GD) populations, and identify gaps in research, practice, education, and policy. Design/Methods: A scoping review was conducted. Findings: Twenty‐seven information sources met inclusion criteria. Natural disasters and inadequate disaster relief responses were identified as an overarching health threat for GD populations. Within this theme, four sub‐themes emerged. No other climate‐related health impacts for GD populations were mentioned in the sources reviewed. Conclusions: There are major gaps in knowledge about health implications of climate change for GD populations. Gender‐sensitive data must be collected in order to better understand these threats and detect disparities. Currently most practice and policy recommendations focus on disaster relief. More research on the broad effects of climate change on GD populations is urgently needed to inform practice and policy. Clinical relevance: Climate change amplifies existing risks of adverse health outcomes. Because of discrimination, stigma, and violence, gender diverse individuals are particularly vulnerable. [ABSTRACT FROM AUTHOR]

Objective: Eating disorders (ED) are associated with adverse pregnancy outcome and pregnancy is associated with both relapse and remission of ED. Knowledge is lacking on the risk of ED relapse during pregnancy and the postpartum period for women in stable remission. This study examined the occurrence of perinatal ED relapse as well as obstetric and postpartum outcome in women with at least a 6‐month ED remission before pregnancy. Method: A total of 122 women in stable remission before pregnancy were included in a prospective longitudinal study. Changes in ED symptoms based on the Eating Disorder Examination were systematically evaluated at each antenatal visit and in the postpartum period. Results: A total of 30 (25%) women relapsed. Twenty women relapsed within the first 20 weeks of pregnancy and eight in the early weeks postpartum. Severe postpartum depression symptoms (33%) were frequent in women with ED relapse; hyperemesis gravidarum (30%) was frequently present independent of the woman's relapse status. Discussion: To prevent relapse of ED and possible consequences, attention to relapse in women in stable remission is especially important in early pregnancy and in the postpartum period. [ABSTRACT FROM AUTHOR]

The nursing community in the United States polarized in September 2020 between Dawn Wooten's whistleblowing about forced hysterectomies at an immigration center in Georgia and the American Nurses Association's refusal to endorse a presidential candidate despite the Trump administration's mounting failures to address the public health crisis posed by the COVID‐19 pandemic. This reveals a need for more attention to political aspects of health outcome inequities. As advocates for health equity, nurses can join in recent scholarship and activism concerning the political determinants of health. In this paper, we examine recent work on the political determinants of health with an aim to add two things. First, we seek to build further on the notion of "political" determinants of health by distinguishing policy and governance structures from dynamics of politicization through appeal to critical disabilities studies. Second, we seek to apply this further nuanced approach to challenge rhetorical uses of "vulnerable populations," where this phrase serves to misrecognize systemic institutionalized forces that actively exploit and marginalize people and groups. By refocusing attention to political systems organized around and perpetuating inequitable health outcomes, nurses and other health care professionals—as well as those whom they serve—can concentrate their effort and power to act on political determinants of health in bringing about more equitable health outcomes. [ABSTRACT FROM AUTHOR]

Background: Due to immunological susceptibility, close contact with the environment and way of life, indigenous communities are in a highly vulnerable condition to be affected by zoonoses, such as bartonellosis. Methods: Seventy three paired serum samples were collected from indigenous people from a region of the Brazilian Legal Amazon, in cohorts carried out in 2014 and 2015, with the performance of serological tests by indirect immunofluorescence to detect anti‐Bartonella IgG antibodies. The interviews and laboratory results were double entered in the EpiInfo 7 software, and the data processing was performed in the MiniTab 17 software. Results: 5.47% of the indigenous people were seroreagent. The female gender was predominant (65.75%), aged between 20 and 39 years old (39.73%) with complete elementary school (42.47%). As for housing, wooden residences predominated (50.68%). Rodents were seen by 46.58% of the interviewees, and 55.88% of them reported that the animal was close to or inside the house. It was identified that each indigenous family, in its majority, had four to six cats, for the function of hunters of rodents. Conclusion: The high concentration of domestic cats, the close contact of indigenous people with wild rodents and the lack of care and poor hygiene of both are aspects that imply the possibility of infection by Bartonella sp. Health surveillance through seroepidemiological studies is essential to find evidence of the circulation of bartonellosis in these populations. [ABSTRACT FROM AUTHOR]

Background: Community academic partnerships (CAPs) connect students to interprofessional collaborations and expand clinical experiences beyond traditional settings. Serious and persistent mental health problems represent an important action area within population health. Mental health disorders across the lifespan are often co‐morbid with substance use, poverty, and community violence. Aims: This article describes CAPs in a community course where students impact vulnerable populations while learning new roles and responsibilities. The process explains student engagement with the community, and using best practices for care of community, population health concerns, and mental health and well‐being. Methods: We initiate and maintain collaborative relationships that guide culturally sensitive responses to health and illness. Four well‐established CAPs' exemplars describe the interventions and outcomes. Results: Students successfully integrated a variety of health promotion and mental health interventions within the CAPS clinical environments. The Socio‐Ecological framework is used to articulate student outcomes. Conclusion: The CAPs are a dynamic system requiring ongoing maintenance and response to evolving epidemiological issues, such as increased incidence of alterations in mental health. The educational innovation provides an opportunity for students to understand aspects of holistic health in a community environment as they intervene at individual, relationship, community, and societal levels. [ABSTRACT FROM AUTHOR]

Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated‐measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population‐appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population‐specific reports found in the extant literature and underscore their cross‐cutting nature, with adaptations based on participant and community partner needs and preferences. [ABSTRACT FROM AUTHOR]

The desire to ensure that the benefits of successful small‐scale social innovation are more widely available has led to a plethora of frameworks that seek to scale such innovations. We review 20 extant frameworks for scaling and distinguished four directions: up (producing changes in laws, policies, institutions or norms), down (resource allocation to support implementation), in (ensuring organizations have the capacity to deliver the type and number of good practices required) and out (geographically replicating or broadening the range or scope of good practices). In addition to these directions of scaling a generic pathway, or process, to achieve scaling is also discernible across many of the frameworks reviewed. This involves five phases: identifying, planning, implementing, learning and adapting. We stress the need for a more dynamic and systemic approach to scaling, as well as one which anticipates, addresses and assesses the extent to which scaling is inclusive of marginalized groups. [ABSTRACT FROM AUTHOR]

Background: Social needs are actionable mediators of social determinants of health. Along with distress, they affect quality of life and survival in patients with cancer. The objectives of this study were to identify the most common social needs and distress in a largely immigrant gynecologic oncology patient population at a public safety‐net hospital and to evaluate for specific needs associated with distress and poor outcomes. Methods: This was a prospective, survey‐based cohort study of patients who participated in a performance‐improvement initiative offering social needs assessment and distress screening. Patients provided sociodemographic information and completed validated surveys adapted from the Health Leads Social Needs Screening Toolkit, the National Comprehensive Cancer Network Distress Thermometer, and the Emotion Thermometers Tool. Associations between social needs, distress, and treatment outcomes were analyzed. Results: In total, 135 women were included. Of these, 65.2% had at least 1 unmet social need, and 36.3% screened positive for distress. Help reading hospital materials (30.4%) was the most frequently reported need. Social isolation (odds ratio [OR], 3.65; 95% CI, 1.35‐9.9; P =.01) and lack of safety at home (OR, 4.90; 95% CI, 2.23‐10.62; P =.0001) were associated with distress. Perceived lack of finances for medical care (OR, 5.69; 95% CI, 1.12‐28.9; P =.036) and lack of transportation (OR, 20.5; 95% CI, 2.69‐156.7; P =.004) were associated with nonadherence‐related treatment interruption, whereas positive distress scores were associated with interruption because of comorbidities or treatment‐related toxicities (OR, 20.5; 95% CI, 1.5‐268.6; P =.02). Conclusions: Systematically identifying social needs and developing interventions aimed at mitigating them may lead to more actionable health care disparities research and affect treatment outcomes. Lay Summary: Social needs are individual‐level social conditions that drive health disparities.In this survey‐based study, the objective was to identify common social needs and how these relate to distress and poor health outcomes in a largely immigrant and underserved gynecologic oncology patient population.The authors found that greater than one‐third of patients screened positive for distress, nearly two‐thirds had at least 1 unmet social need, and these factors were associated with emergency room visits, hospital admissions, and treatment interruptions.These findings suggest that screening for universal social needs allows providers to identify unrecognized needs and implement interventions to mitigate distress and improve health outcomes. Health care disparities research must pivot from simply describing the poor outcomes associated with the social determinants of health to identifying and targeting actionable mediators of inequitable medical outcomes. This study provides evidence for the feasibility of universal social needs assessment in a low‐resource setting and offers examples of interventions with the potential for large downstream effects on treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Advance care planning (ACP) is low among older adults with cancer. In a secondary analysis of randomized trial data, the authors compared the efficacy of the PREPARE for Your Care (PREPARE) website plus an easy‐to‐read advance directive (AD) with an AD only among older adults with and without cancer. Methods: Safety net, primary care patients in San Francisco were included if they were 55 years old or older, were English‐ or Spanish‐speaking, and had 2 or more chronic conditions. The authors determined cancer diagnoses by using International Classification of Diseases,Ninth Revision/Tenth Revision codes. The primary outcome was new ACP documentation in the medical record at 15 months; the secondary outcomes were self‐reported ACP engagement, ease of use, satisfaction, and depression/anxiety. The authors used mixed effects logistic and linear regression adjusted for prior ACP, health literacy, and clinician, including a cancer interaction term. Results: Of 986 participants, 220 (22%) had cancer. The mean age was 63 years (SD, 6 years), 61% were women, 81% were of a minority race/ethnicity, 45% were Spanish‐speaking, 39% had limited health literacy, and 27% had prior ACP. New ACP documentation was higher in the PREPARE arm versus the AD‐only arm among participants with cancer (62% vs 43%; P =.01) and without cancer (38% vs 28%; P =.01), as was ACP engagement in both arms (P <.001), with no interactions by cancer. Ease of use and satisfaction were high, and depression/anxiety was low, with no differences by study arm or by cancer/no cancer. Conclusions: PREPARE plus an easy‐to‐read AD increased ACP documentation and engagement among diverse older adults with cancer more than an AD alone, with no increase in depression or anxiety between study arms or by cancer. PREPARE may help to decrease ACP disparities among patients with cancer. Lay Summary: Advance care planning (ACP) is the process of sharing values, goals, and preferences for medical care, but engagement in ACP is low among older adults with cancer.Among 986 English‐ and Spanish‐speaking older adults from a safety net hospital, an interactive, multimedia, web‐based ACP program (PREPARE for Your Care at https://prepareforyourcare.org/) plus an easy‐to‐read advance directive increased ACP documentation and engagement more than an advance directive alone.There were no differences in this increase in ACP between older adults with cancer and older adults without cancer. Also, engaging in ACP did not result in increased depression or anxiety. The PREPARE for Your Care (PREPARE) program plus an easy‐to‐read advance directive significantly increases new advance care planning (ACP) documentation and engagement among diverse older adults with cancer in a safety net setting in comparison with an advance directive alone. PREPARE may help reduce ACP disparities among patients with cancer. [ABSTRACT FROM AUTHOR]

Almost half of all pregnancies (45%) in the United States (US) are unintended, with the highest concentration in women with low incomes. Targeted research is warranted to identify risk and protective factors that influence pregnancy intention to improve maternal/child health. Purpose: To identify individual and interpersonal level associations to pregnancy intention to use as leverage points to build resilience. Method: A cross‐sectional, secondary analysis of Medicaid eligible pregnant women in Kentucky (n = 309). Results: Sixty‐two percent reported their current pregnancy was unintended. Older age, partnered, negative drug screen, and increased social support were associated with decreased odds of unintended pregnancy. For every 1 unit increase of belonging and tangible social support, women were 13% and 14% (respectively) less likely to have an unintended pregnancy (OR = 0.87, 95% CI = 0.78–0.97, p =.011, OR = 0.86, 95% CI = 0.77–0.95, p =.005). A positive drug screen was associated with an almost three‐fold increase in the odds of unintended pregnancy (OR = 2.88, 95% CI = 1.49–5.58, p =.002). Conclusion: Public health nurses can play a critical role in reducing unintended pregnancy rates by promoting social support, inclusion, and acceptance. There remains a critical need to identify barriers and facilitators to pregnancy planning for persons who use illicit drugs. [ABSTRACT FROM AUTHOR]

Limited access to medications and devices relevant to the care of low-risk childbearing families acts as a barrier to the successful integration of high-quality midwifery care into health care systems. Families who live in clinically underserved areas, whether urban or rural, are particularly in need of perinatal professionals who can provide comprehensive care. This article reviews existing US laws that impact whether families who choose community-based care with direct entry midwives have access, through their chosen provider, to the medications and devices relevant to their normal perinatal and postpartum care. Scope of practice and practice authority are considered as they relate to access to medications and devices primarily for certified professional midwives and state-licensed midwives. These professionals are the primary health care providers offering community-based care and birth at home and in freestanding birth centers. Washington state laws are compared and contrasted with laws from other states and jurisdictions, with the aim of identifying ways to improve service delivery for families who choose community-based midwifery care. Recent and historical efforts to expand Washington state's midwifery drugs and devices formulary are described. This discussion outlines the Washington context for direct entry community midwifery practice, highlights relevant legal examples, and describes current and future efforts around quality improvement. Information from a midwifery clinic serving some of Washington's most vulnerable pregnant and postpartum families allows for an exploration of the role that access to essential medications and devices might play in supporting midwives to address health inequities. Ideal statutory and regulatory language, lessons learned from an analysis of Washington's experience, and strategies to overcome barriers are described to aid and inspire midwifery advocates in other jurisdictions who want to increase access and enhance their ability to offer current evidence-based care. Policy makers can improve health, health equity, consumer choice, and access to evidence-based care by using ideal legal language for midwifery practice authority. [ABSTRACT FROM AUTHOR]

Background/objectives: Advance care planning (ACP) rates are low in diverse, vulnerable older adults, yet little is known about the unique barriers they face and how these barriers impact ACP documentation rates. Design: Validated questionnaires listing patient, family/friend, and clinician/system‐level ACP barriers and an open‐ended question on ACP barriers. Setting: Two San Francisco public/Department of Veterans Affairs hospitals. Participants: One thousand two hundred and forty‐one English and Spanish‐speaking patients, aged 55 and older, with two or more chronic conditions. Measurements: The open‐ended question on ACP barriers was analyzed using content analysis. We conducted chart review for prior ACP documentation. We used chi‐square/Wilcoxon rank‐sum tests and logistic regression to assess associations between ACP barriers and demographic characteristics/ACP documentation. Results: Participant mean age was 65 ± 7.4 years; they were 74% from racial/ethnic minority groups, 36% Spanish‐speaking, and 36% with limited health literacy. A total of 26 barriers were identified (15 patient, 4 family/friend, 7 clinician/system‐level), and 91% reported at least one ACP barrier (mean: 5.6 ± 4.0). The most common barriers were: (patient‐level) discomfort thinking about ACP (60%), wanting to leave health decisions to "God" (44%); (family/friend‐level) not wanting to burden friends/family (33%), assuming friends/family already knew their preferences (31%); (clinician/system‐level) assuming doctors already knew their preferences (41%), and mistrust (37%). Compared with those with no barriers, participants with at least one reported barrier were more likely to be from a racial/ethnic minority group (76% vs 53%), Spanish‐speaking (39% vs 6%), with fair‐to‐poor health (48% vs 34%), and limited health literacy (39% vs 9%) (p < 0.001 for all). Participants who reported barriers were less likely to have ACP documentation (adjusted odds ratio = 0.64, 95% confidence interval [0.42, 0.98]). Conclusion: English‐ and Spanish‐speaking older adults reported 26 unique barriers to ACP, with higher barriers among vulnerable populations, and barriers were associated with lower ACP documentation. Barriers must be considered when developing customized ACP interventions for diverse older adults. [ABSTRACT FROM AUTHOR]