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Background Traumatic brain injury (TBI) is disproportionately prevalent among individuals who intersect or are involved with the criminal justice system (CJS). In the absence of appropriate care, TBI-related impairments, intersecting social determinants of health, and the lack of TBI awareness in CJS settings can lead to lengthened sentences, serious disciplinary charges, and recidivism. However, evidence suggests that most clinical practice guidelines (CPGs) overlook equity and consequently, the needs of disadvantaged groups. As such, this review addressed the research question 'To what extent are (1) intersections with the CJS considered in CPGs for TBI, (2) TBI considered in CPGs for CJS, and (3) equity considered in CPGs for CJS?'. Methods and findings CPGs were identified from electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google Search, and reference lists of identified CPGs on November 2021 and March 2023 (CPGs for TBI) and May 2022 and March 2023 (CPGs for CJS). Only CPGs for TBI or CPGs for CJS were included. We calculated the proportion of CPGs that included TBI- or CJS-specific content, conducted a qualitative content analysis to understand how evidence regarding TBI and the CJS was integrated in the CPGs, and utilised equity assessment tools to understand if and how equity was considered. Fifty-seven CPGs for TBI and 6 CPGs for CJS were included in this review. Fourteen CPGs for TBI included information relevant to the CJS, but only 1 made a concrete recommendation to consider legal implications during vocational evaluation in the forensic context. Two CPGs for CJS acknowledged the prevalence of TBI among individuals in prison and one specifically recommended considering TBI during health assessments. Both CPGs for TBI and CPGs for CJS provided evidence specific to a single facet of the CJS, predominantly in policing and corrections. The use of equity best practices and the involvement of disadvantaged groups in the development process were lacking among CPGs for CJS. We acknowledge limitations of the review, including that our searches were conducted in English language and thus, we may have missed other non-English language CPGs in this review. We further recognise that we are unable to comment on evidence that is not integrated in the CPGs, as we did not systematically search for research on individuals with TBI who intersect with the CJS, outside of CPGs. Conclusions Findings from this review provide the foundation to consider CJS involvement in CPGs for TBI and to advance equity in CPGs for CJS. Conducting research, including investigating the process of screening for TBI with individuals who intersect with all facets of the CJS, and utilizing equity assessment tools in guideline development are critical steps to enhance equity in healthcare for this disadvantaged group., Author(s): Zoe Colclough 1, Maria Jennifer Estrella 2, Julie Michele Joyce 2, Sara Hanafy 3,4, Jessica Babineau 5,6, Angela Colantonio 2,3,4,7,8, Vincy Chan 3,4,7,* Introduction Traumatic brain injury (TBI) affects [...]

The overall purpose of the paper is to analyze the free supply of menstrual items to primary and secondary school girls in New Zealand using the substantive equality principle. The New Zealand government's incentive for free supply of the articles to menstruating girls was their worrying absenteeism at school due to menstrual poverty. Menstrual poverty limits school girls' equal access to their fundamental right to education. In my analysis, I adopt a human rights approach, employing the substantive equality principle to reflect on this rationale to provide menstrual products to school girls who need them. My research cites scholarly texts, organizational and media works from multidisciplinary literature to support the free supply of sanitary products. Using this research, I demonstrate that the supply satisfies the multiple interpretations of substantive equality for the attainment of menstruating girls' equal access to their right to education. The government program addresses menstrual poverty and facilitates the management of menstruation with dignity. Keywords: Menstrual poverty, School girls, Substantive equality, Right to education, New Zealand, Introduction Across most cultures and political settings, menstrual or sanitary articles are still a taboo subject (2) of secrecy. In other words, there is a menstrual taboo. Almost fifty percent [...]

Context: Before availability of COVID-19 vaccinations, rural counties with majority racial and ethnic minority populations were disproportionately impacted by COVID-19 compared to majority Non-Hispanic White (NHW) counties. Objective: Describe disparities in COVID-19 outcomes across majority NHW and minority NHW rural counties before and after the widespread availability of COVID-19 vaccinations. Study Design: Rural counties were categorized as, Presenters Anne Gaglioti, MD, FAAFP, MS, Robina Josiah Willock, PhD, MPH, Megan Douglas, JD, Lee Caplan, MD, PhD, MPH, Ashley Daniel, BS, MS, Peter Baltrus, PhD, Dominic Mack, MD, MBA, [...]

Background/Objectives This study determined time trends in the prevalence of malnutrition and its socioeconomic inequality among children under five at a national level and by urbanity in Thailand. Subjects/Methods This study compared malnutrition prevalence and inequality among children under five by wealth index score and urbanity using three Multiple Indicator Cluster Surveys for 2005-06, 2012, and 2015-16. The magnitude of inequality was measured on absolute (slope index of inequality) and relative scales (relative index of inequality). Results National prevalence of stunting decreased substantially (16% in 2005-06 and 2012 and 10% in 2015-16), whereas overweight prevalence did not meaningfully change. Inequalities in stunting and overweight by wealth decreased over time nationally on both absolute and relative scales (p-trend < 0.001). Similar decreasing patterns in inequalities were seen in both rural and urban areas, though substantial inequalities persisted. Poor children remained stunted (11.6% in the rural poor and 14.8% in the urban poor), wasted (6.6% in the rural poor), and, strikingly, also overweight (from 5.5% in 2005-06 to 9% in 2015-16 for the rural poor and 8% over time for the urban poor). Conclusion Despite favorable time trends in socioeconomic inequality, this study showed the existence of a double burden of malnutrition (under-nutrition and overweight) in young Thai children with persistent inequalities at the national level. Different patterns of this double burden were seen between urban and rural areas. Public health policies should target both under-nutrition and overweight and consider urbanity in this rapidly developing society., Author(s): Seo Ah Hong [sup.1] [sup.2] , Pattanee Winichagoon [sup.3] , Young-Ho Khang [sup.4] Author Affiliations: (1) ASEAN Institute for Health Development, Mahidol University, Phutthamonthon District, Thailand (2) Institute for [...]

A growing body of research emphasises the role of 'social determinants of health' in generating inequalities in health outcomes. How, if at all, should primary care providers respond? In this paper, I want to shed light on this issue by focusing on the role that 'big data' might play in allowing primary care providers to respond to the social determinants that affect individual patients' health. The general idea has been proposed and endorsed by the Institute of Medicine, and the idea has been developed in more detail by Bazemore et al. (2016 (See CR3)). In Bazemore et al.'s proposal, patients' addresses are used to generate information about the patients' neighbourhood; this information is then included in patients' health care records and made available to providers. This allows primary care providers to take this information into account when interacting with, and providing care to, patients. I explore three issues arising from this proposal. First, while questions of privacy have been central to discussions about big data, Bazemore et al.'s proposal also allows us to see that there might be costs to not making certain information available. Second, I consider some of the questions arising for primary care from the influence of social factors on health outcomes: given that we know these factors to be significant contributors to social inequalities in health, what precisely should be done about this in the primary care context? Finally, I address problems arising from the use of population level data when dealing with individuals., Author(s): Kristin Voigt [sup.1] Author Affiliations: (Aff1) 0000 0004 1936 8649, grid.14709.3b, Institute for Health and Social Policy & Department of Philosophy, McGill University, , 1130 Pine Ave W, H3A [...]

Never in our lifetime has it been so evident that leaders in health and human services must be 'navigators in hope'--charting a course for the future through the global COVID-19 [...]

Background We aimed to estimate multimorbidity trajectories and quantify socioeconomic inequalities based on childhood and adulthood socioeconomic position (SEP) in the risks and rates of multimorbidity accumulation across adulthood. Methods and findings Participants from the UK 1946 National Survey of Health and Development (NSHD) birth cohort study who attended the age 36 years assessment in 1982 and any one of the follow-up assessments at ages 43, 53, 63, and 69 years (N = 3,723, 51% males). Information on 18 health conditions was based on a combination of self-report, biomarkers, health records, and prescribed medications. We estimated multimorbidity trajectories and delineated socioeconomic inequalities (based on childhood and adulthood social class and highest education) in multimorbidity at each age and in longitudinal trajectories. Multimorbidity increased with age (0.7 conditions at 36 years to 3.7 at 69 years). Multimorbidity accumulation was nonlinear, accelerating with age at the rate of 0.08 conditions/year (95% CI 0.07 to 0.09, p < 0.001) at 36 to 43 years to 0.19 conditions/year (95% CI 0.18 to 0.20, p < 0.001) at 63 to 69 years. At all ages, the most socioeconomically disadvantaged had 1.2 to 1.4 times greater number of conditions on average compared to the most advantaged. The most disadvantaged by each socioeconomic indicator experienced an additional 0.39 conditions (childhood social class), 0.83 (adult social class), and 1.08 conditions (adult education) at age 69 years, independent of all other socioeconomic indicators. Adverse adulthood SEP was associated with more rapid accumulation of multimorbidity, resulting in 0.49 excess conditions in partly/unskilled compared to professional/intermediate individuals between 63 and 69 years. Disadvantaged childhood social class, independently of adulthood SEP, was associated with accelerated multimorbidity trajectories from age 53 years onwards. Study limitations include that the NSHD cohort is composed of individuals of white European heritage only, and findings may not be generalizable to the non-white British population of the same generation and did not account for other important dimensions of SEP such as income and wealth. Conclusions In this study, we found that socioeconomically disadvantaged individuals have earlier onset and more rapid accumulation of multimorbidity resulting in widening inequalities into old age, with independent contributions from both childhood and adulthood SEP., Author(s): Amal R. Khanolkar 1,2, Nishi Chaturvedi 1, Valerie Kuan 3, Daniel Davis 1, Alun Hughes 1, Marcus Richards 1, David Bann 4, Praveetha Patalay 1,4,* Introduction The management of [...]