1
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Zhou X, Sun P, Wang B, Li M, Tong R. Capturing and quantifying the aggregate effects of multi-source factors affecting miners' health and well-being: Construction of Bayesian belief networks. Stress Health 2024; 40:e3336. [PMID: 37897699 DOI: 10.1002/smi.3336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/18/2023] [Accepted: 10/05/2023] [Indexed: 10/30/2023]
Abstract
Factors originating at the organizational, work, and individual levels are closely interrelated and intricately intertwined, affecting health rates. There was limited research on the interdependence and aggregate effects between multi-source factors and occupational health and well-being (OHW). It is challenging to achieve management goals. Therefore, considering cross-level factors and across the "work environment-stress-exposure-OHW" chain, individual vulnerability was considered. A Fuzzy Bayesian Belief Network (FBBN) driven by both domain knowledge and data was constructed to carve out the logic between multi-source factors and OHW. Workers from four coal mines were surveyed twice in 6 months. 714 valid samples were included in the analysis. The interdependencies among multi-source factors were identified by the Interpretive Structure Modeling method and the visual probability estimation was achieved based on FBBN. It revealed that the work and the organizational level were the root factors. Eight factors involved in work stress were mainly mediating, and actual exposure and individual vulnerability were direct factors. Pathway interventions and joint interventions were proposed. The prediction ability and scheme feasibility of FBBN were verified. The approach developed allows robust assessments of aggregate effects and obtains multi-source factor importance. This study provides vital insights and evaluation tools for understanding workplace stress and OHW management.
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Affiliation(s)
- Xiaofeng Zhou
- School of Emergency Management and Safety Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Pengyi Sun
- School of Emergency Management and Safety Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Biao Wang
- School of Emergency Management and Safety Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Ming Li
- School of Emergency Management and Safety Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Ruipeng Tong
- School of Emergency Management and Safety Engineering, China University of Mining and Technology-Beijing, Beijing, China
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2
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Juntunen ML, Sutela K. The effectiveness of music-movement integration for vulnerable groups: a systematic literature review. Front Psychol 2023; 14:1127654. [PMID: 37744587 PMCID: PMC10513045 DOI: 10.3389/fpsyg.2023.1127654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/24/2023] [Indexed: 09/26/2023] Open
Abstract
This systematic review synthesized the outcomes of previous intervention studies published from January 2000-October 2022 to evaluate the effectiveness of Dalcroze-based or similar music-movement integration among groups of individuals considered vulnerable (in relation to their abilities and health/wellbeing). The target groups addressed in previous intervention studies included individuals with special educational needs (such as disorders, disabilities, or impairments) or with a (risk of) decline in health and/or physical strength. Twenty articles met the review inclusion criteria. All studies showed beneficial outcomes for music-movement intervention except one that suffered from low adherence rates. In older adults, the benefits were cognitive, physical, social, and/or emotional, including improved postural stability, balance, gait safety, confidence in mobility, metamemory skills, dual-task performance, social and physical pleasure, autotelic/flow experience, enjoyment, health, and quality of life. In individuals with special educational needs, improvement was seen in relation to inclusion, reductions in compulsive and other problematic behaviors, self-regulation, perceptual and cognitive abilities and functions, linguistic and learning skills, auditory attention and phonological awareness, social interaction, engagement, and agency.
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Affiliation(s)
- Marja-Leena Juntunen
- Department of Music Education, Sibelius Academy, University of the Arts Helsinki, Helsinki, Finland
| | - Katja Sutela
- Faculty of Education, University of Oulu, Oulu, Finland
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3
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Zhou X, Sun N, Zhao X, Wang L, Tong R. Revealing the practical strategies for promoting Chinese migrant workers' health and well-being: Organizational empowerment perspective. Appl Psychol Health Well Being 2023; 15:1085-1109. [PMID: 36539304 DOI: 10.1111/aphw.12428] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
The health and well-being of migrant workers struggling to make ends meet are being compromised, especially with the uncertainty of the COVID-19 pandemic. The aim is to analyze how organizational empowerment promotes health and well-being from an applied psychological perspective, taking into account the shaping role of individual vulnerability. Links between theory and practice will be established to achieve equitable health and well-being. The underlying mechanism by which organizational empowerment mitigated workplace-induced adverse outcomes was validated in the analysis of construction workers (n = 966). In addition, individual characteristics, namely, excitability, low perceptual threshold, control, and knowledge, attitude, and practice, were identified as critical factors, as well-being consequences vary from person to person. Moderating effect analysis showed that high excitability enhanced the association between work environment exposure and health and well-being. Control and knowledge, attitude, and practice have opposite effects. Moreover, the dual effects of the low perception threshold are verified, that is, facing the work environment produces more negative consequences, whereas perceiving more resources stimulates more positive consequences. Overall, the research provides a clearer dialectical view of vulnerability, contributing wisdom toward accurate management based on empowerment theory, which lays a solid foundation for bridging gaps in health and well-being.
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Affiliation(s)
- Xiaofeng Zhou
- School of Emergency Management and Safety Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Ninghao Sun
- School of Emergency Management and Safety Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Xu Zhao
- School of Emergency Management and Safety Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Leyao Wang
- School of Emergency Management and Safety Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Ruipeng Tong
- School of Emergency Management and Safety Engineering, China University of Mining and Technology-Beijing, Beijing, China
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4
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Macdonald ME, Muirhead V, Doughty J, Freeman R. Critically engaging vulnerability: Rethinking oral health with vulnerabilized populations. Community Dent Oral Epidemiol 2022; 50:469-475. [PMID: 34751455 DOI: 10.1111/cdoe.12703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/08/2021] [Accepted: 10/08/2021] [Indexed: 01/27/2023]
Abstract
This paper is the third in a series of narrative reviews challenging core concepts in oral health research and practice. Our series started with a framework for Inclusion Oral Health. Our second review explored one component of this framework, looking at how intersectionality adds important complexity to oral public health. This current manuscript drills into a second component of Inclusion Oral Health, exploring how labels can lead to 'othering' thereby misrepresenting populations and (re)producing harms. Specifically, we address a common oral public health label: vulnerable populations. This term is commonly used descriptively: an adjective (vulnerable) is used to modify a noun (population). What this descriptor conceals is the 'how,' 'why,' and 'therefore' that leads to and from vulnerability: How and why is a population made vulnerable; to what are they vulnerable; what makes them 'at risk,' and to what are they 'at risk'? In concealing these questions, we argue our conventional approach unwittingly does harm. Vulnerability is a term that implies a population has inherent characteristics that make them vulnerable; further, it casts populations as discrete, homogenous entities, thereby misrepresenting the complexities that people live. In so doing, this label can eclipse the strengths, agency and power of individuals and populations to care for themselves and each other. Regarding oral public health, the convention of vulnerability averts our research gaze away from social processes that produce vulnerability to instead focus on the downstream product, the vulnerable population. This paper theorizes vulnerability for oral public health, critically engaging its production and reproduction. Drawing from critical public health literature and disability studies, we advance a critique of vulnerability to make explicit hidden assumptions and their harmful outcomes. We propose solutions for research and practice, including co-engagement and co-production with peoples who have been vulnerabilized. In so doing, this paper moves forward the potential for oral public health to advance research and practice that engages complexity in our work with vulnerabilized populations.
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Affiliation(s)
- Mary Ellen Macdonald
- Faculty of Dentistry, and Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Vanessa Muirhead
- Centre for Dental Public Health and Primary Care, Institute of Dentistry, Barts and The London, School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Janine Doughty
- Pathway Homelessness and Inclusion Oral Health Fellow, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ruth Freeman
- Dental Health Services Research Unit, School of Dentistry, University of Dundee, Dundee, UK
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5
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Molenaar J, Van Praag L. Migrants as 'vulnerable groups' in the COVID-19 pandemic: A critical discourse analysis of a taken-for-granted label in academic literature. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100076. [PMID: 35529889 PMCID: PMC9052635 DOI: 10.1016/j.ssmqr.2022.100076] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 01/12/2023]
Abstract
The COVID-19 pandemic affects different people unequally, and migrants are frequently among the groups considered particularly vulnerable. However, conceptualizations of 'vulnerability' are often ambiguous and poorly defined. Using critical discourse analysis methods, this article analyses the academic use of the term 'vulnerable' applied to migrants in the context of the COVID-19 pandemic across public health and social science disciplines. Our findings indicate that the concept of vulnerability is frequently applied to migrants in the COVID-19 context as a descriptor with seemingly taken-for-granted applicability. Migrants are considered vulnerable for a wide variety of reasons, most commonly relating to exposure to and risk of contracting COVID-19; poverty or low socio-economic status; precarity; access to healthcare; discrimination; and language barriers. Drivers of migrants' vulnerability were frequently construed as immutable societal characteristics. Additionally, our analysis revealed widespread generalization in the use of the notion of vulnerability, with limited consideration of the heterogeneity among and between diverse groups of migrants. Conceptualizations of migrants' vulnerability in the COVID-19 pandemic were sometimes used to advance seemingly contradictory policy implications or conclusions, and migrants' own views and lived experiences were often marginalized or excluded within these discourses. Our analysis highlights that although some definable groups of people are certainly more likely to suffer harm in crisis situations like the COVID-19 pandemic, the use of 'vulnerable' as a fixed descriptor has potentially negative implications. As an alternative, we suggest thinking about vulnerability as the dynamic outcome of a process of 'vulnerabilisation' shaped by social order and power relations.
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Affiliation(s)
- Jil Molenaar
- Centre for Migration and Intercultural Studies (CeMIS), University of Antwerp, Stadscampus, S.LN55.202, Lange Nieuwstraat 55, B-2000, Antwerp, Belgium
| | - Lore Van Praag
- Centre for Migration and Intercultural Studies (CeMIS), University of Antwerp, Stadscampus, S.LN55.202, Lange Nieuwstraat 55, B-2000, Antwerp, Belgium
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6
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Jeleff M, Lehner L, Giles-Vernick T, Dückers MLA, Napier AD, Jirovsky-Platter E, Kutalek R. Vulnerability and One Health assessment approaches for infectious threats from a social science perspective: a systematic scoping review. Lancet Planet Health 2022; 6:e682-e693. [PMID: 35932788 DOI: 10.1016/s2542-5196(22)00097-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/08/2022] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
Vulnerability assessments identify vulnerable groups and can promote effective community engagement in responding to and mitigating destabilising events. This scoping review maps assessments for local-level vulnerabilities in the context of infectious threats. We searched various databases for articles written between 1978 and 2019. Eligible documents assessed local-level vulnerability, focusing on infectious threats and antimicrobial resistance. Since few studies provided this dual focus, we included tools from climate change and disaster risk reduction literature that engaged the community in the assessment. We considered studies using a One Health approach as essential for identifying vulnerability risk factors for zoonotic disease affecting humans. Of the 5390 records, we selected 36 articles for review. This scoping review fills a gap regarding vulnerability assessments by combining insights from various approaches: local-level understandings of vulnerability involving community perspectives; studies of social and ecological factors relevant to exposure; and integrated quantitative and qualitative methods that make generalisations based on direct observation. The findings inform the development of new tools to identify vulnerabilities and their relation to social and natural environments.
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Affiliation(s)
- Maren Jeleff
- Depart6ment of Social and Preventive Medicine, Medical Anthropology and Global Health Unit, Medical University of Vienna, Center for Public Health, Vienna, Austria.
| | - Lisa Lehner
- Depart6ment of Social and Preventive Medicine, Medical Anthropology and Global Health Unit, Medical University of Vienna, Center for Public Health, Vienna, Austria
| | - Tamara Giles-Vernick
- The Pasteur Institute, Anthropology and Ecology of Disease Emergence Unit, Paris, France
| | - Michel L A Dückers
- Netherlands Institute for Health Services Research, Utrecht, Netherlands; Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, Netherlands
| | - A David Napier
- Department of Anthropology, Science, Medicine, and Society Network, University College London, London, UK
| | - Elena Jirovsky-Platter
- Depart6ment of Social and Preventive Medicine, Medical Anthropology and Global Health Unit, Medical University of Vienna, Center for Public Health, Vienna, Austria
| | - Ruth Kutalek
- Depart6ment of Social and Preventive Medicine, Medical Anthropology and Global Health Unit, Medical University of Vienna, Center for Public Health, Vienna, Austria
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7
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Substance and Behavioral Addictions, and Their Consequences among Vulnerable Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106163. [PMID: 35627700 PMCID: PMC9141345 DOI: 10.3390/ijerph19106163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 02/01/2023]
Abstract
"Vulnerable populations" in health behavior research, practice and policy is generally used to refer to groups that, due to their life circumstances, may require extra consideration, reasonable accommodation, and legitimized protection [...].
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8
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Evidence of the Relationship between Social Vulnerability and the Spread of COVID-19 in Urban Spaces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095336. [PMID: 35564729 PMCID: PMC9104638 DOI: 10.3390/ijerph19095336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/21/2022] [Accepted: 04/23/2022] [Indexed: 02/04/2023]
Abstract
Modeling the social-spatial structure of urban spaces can facilitate the development of guidelines aimed at curbing the spread of the COVID-19 pandemic while also acting as an instrument that helps decision-making concerning mitigation policies. The modeling process starts with categorization of urban spaces based on the concept of social vulnerability. A model is created based on this concept and the theory of analysis of social areas. Statistical techniques of factor analysis and geostatistics are applied. This generates a map of social differentiation that, when related to data on the evolution of the contagion, generates a multidimensional model of social vulnerability. The application of this model towards people (social structure) and the environment where they live (spatial structure) is specified. Our model assumes the uniqueness of cities, and it is intended to be a broadly applicable model that can be extrapolated to other urban areas if pertinent revisions are made. Our work demonstrates that aspects of the social and urban structures may be validly used to analyze and explain the spatial spread of COVID-19.
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9
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Community engagement and vulnerability in infectious diseases: A systematic review and qualitative analysis of the literature. Soc Sci Med 2021; 284:114246. [PMID: 34311391 DOI: 10.1016/j.socscimed.2021.114246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 11/20/2022]
Abstract
The global response to infectious diseases has seen a renewed interest in the use of community engagement to support research and relief efforts. From a perspective rooted in the social sciences, the concept of vulnerability offers an especially useful analytical frame for pursuing community engagement in a variety of contexts. However, few have closely examined the concept of vulnerability in community engagement efforts, leading to a need to better understand the various theories that underline the connections between the two. This literature review searched four databases (covering a total of 537 papers), resulting in 15 studies that analyze community engagement using a framing of vulnerability, broadly defined, in the context of an infectious disease, prioritizing historical and structural context and the many ways of constituting communities. The review identified historical and structural factors such as trust in the health system, history of political marginalization, various forms of racism and discrimination, and other aspects of vulnerability that are part and parcel of the main challenges faced by communities. The review found that studies using vulnerability within community engagement share some important characteristics (e.g., focus on local history and structural factors) and identified a few theoretical avenues from the social sciences which integrate a vulnerability-informed approach in community engagement. Finally, the review proposes an approach that brings together the concepts of vulnerability and community engagement, prioritizing participation, empowerment, and intersectoral collaboration.
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10
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McLaren L, Masuda J, Smylie J, Zarowsky C. Unpacking vulnerability: towards language that advances understanding and resolution of social inequities in public health. Canadian Journal of Public Health 2021; 111:1-3. [PMID: 31994015 DOI: 10.17269/s41997-019-00288-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Janet Smylie
- University of Toronto and St. Michael's Hospital, Toronto, ON, Canada
| | - Christina Zarowsky
- Université de Montréal, Montréal, QC, Canada.,University of the Western Cape, Cape Town, South Africa
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11
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Filipe AM, Lloyd S, Larivée A. Troubling Neurobiological Vulnerability: Psychiatric Risk and the Adverse Milieu in Environmental Epigenetics Research. FRONTIERS IN SOCIOLOGY 2021; 6:635986. [PMID: 33912612 PMCID: PMC8072338 DOI: 10.3389/fsoc.2021.635986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
In post-genomic science, the development of etiological models of neurobiological vulnerability to psychiatric risk has expanded exponentially in recent decades, particularly since the neuromolecular and biosocial turns in basic research. Among this research is that of McGill Group for Suicide Studies (MGSS) whose work centers on the identification of major risk factors and epigenetic traits that help to identify a specific profile of vulnerability to psychiatric conditions (e.g., depression) and predict high-risk behaviors (e.g., suicidality). Although the MGSS has attracted attention for its environmental epigenetic models of suicide risk over the years and the translation of findings from rodent studies into human populations, its overall agenda includes multiple research axes, ranging from retrospective studies to clinical and epidemiological research. Common to these research axes is a concern with the long-term effects of adverse experiences on maladaptive trajectories and negative mental health outcomes. As these findings converge with post-genomic understandings of health and also translate into new orientations in global public health, our article queries the ways in which neurobiological vulnerability is traced, measured, and profiled in environmental epigenetics and in the MGSS research. Inspired by the philosophy of Georges Canguilhem and by literature from the social studies of risk and critical public health, we explore how the epigenetic models of neurobiological vulnerability tie into a particular way of thinking about the normal, the pathological, and the milieu in terms of risk. Through this exploration, we examine how early life adversity (ELA) and neurobiological vulnerability are localized and materialized in those emerging models while also considering their broader conceptual and translational implications in the contexts of mental health and global public health interventions. In particular, we consider how narratives of maladaptive trajectories and vulnerable selves who are at risk of harm might stand in as a "new pathological" with healthy trajectories and resilient selves being potentially equated with a "new normal" way of living in the face of adversity. By troubling neurobiological vulnerability as a universal biosocial condition, we suggest that an ecosocial perspective may help us to think differently about the dynamics of mental health and distress in the adverse milieu.
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Affiliation(s)
- Angela Marques Filipe
- Department of Sociology and Centre for Research on Children & Families, McGill University, Montréal, QC, Canada
- Centre for Biomedicine, Self & Society, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Stephanie Lloyd
- Department of Anthropology, Université Laval, Québec, QC, Canada
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12
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Colmenares-Roa T, Figueroa-Perea JG, Pelcastre-Villafuerte B, Cervantes-Molina L, Juárez-Ramirez C, Guadarrama J, Ramirez-Hernández N, Pérez Zepeda MU, Peláez-Ballestas I. Vulnerability as a palimpsest: Practices and public policy in a Mexican hospital setting. Health (London) 2021; 26:753-776. [PMID: 33467946 DOI: 10.1177/1363459320988879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vulnerability is a concept associated with the effects of social inequities to access health care services. On a hospital level, vulnerable populations must be identified and favored over others. The aims of this study were the analysis of the conceptions and practices of social workers regarding vulnerable patients, and the identification of theoretical elements of vulnerability given by academics. Hospital ethnography and a focus group were implemented. Social workers related vulnerability to the social needs of each patient; however, they state that they have dilemmas to identify a person in a vulnerable condition; these dilemmas are related to social differences and deservingness. Academics indicated that the vulnerability should refer to the lack of access to health services offered by the institution. Academics agree with social workers regarding the importance of considering the overlapped social and individual circumstances in each patient to recognize their vulnerable condition, regardless of belonging to any of the pre-established vulnerable groups. Finally, taking into account the way of conceptualizing vulnerability and how public policy on the identification of vulnerable patients in the hospital has been implemented, these two elements are explained using the palimpsest model, which is a figure of thought that can be applied to analyze the sociocultural significance of this complex issue, as well as other social dynamics.
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13
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Mac-Seing M, Zinszer K, Oga Omenka C, de Beaudrap P, Mehrabi F, Zarowsky C. Pro-equity legislation, health policy and utilisation of sexual and reproductive health services by vulnerable populations in sub-Saharan Africa: a systematic review. Glob Health Promot 2020; 27:97-106. [PMID: 32748728 PMCID: PMC7750661 DOI: 10.1177/1757975920941435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 06/12/2020] [Indexed: 11/15/2022]
Abstract
Twenty-five years ago, the International Conference on Population and Development highlighted the need to address sexual and reproductive health (SRH) rights on a global scale. The sub-Saharan Africa region continues to have the highest levels of maternal mortality and HIV, primarily affecting the most vulnerable populations. Recognising the critical role of policy in understanding population health, we conducted a systematic review of original primary research which examined the relationships between equity-focused legislation and policy and the utilisation of SRH services by vulnerable populations in sub-Saharan Africa. We searched nine bibliographic databases for relevant articles published between 1994 and 2019. Thirty-two studies, conducted in 14 sub-Saharan African countries, met the inclusion criteria. They focused on maternal health service utilisation, either through specific fee reduction/removal policies, or through healthcare reforms and insurance schemes to increase SRH service utilisation. Findings across most of the studies showed that health-related legislation and policy promoted an increase in service utilisation, over time, especially for antenatal care, skilled birth attendance and facility-based delivery. However, social health inequalities persisted among subgroups of women. Neither the reviewed studies nor the policies specifically addressed youth, people living with HIV and people with disabilities. In the era of the sustainable development goals, addressing health inequities in the context of social determinants of health becomes unavoidable. Systematic and rigorous quantitative and qualitative research, including longitudinal policy evaluation, is required to understand the complex relationships between policy addressing upstream social determinants of health and health service utilisation.
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Affiliation(s)
- Muriel Mac-Seing
- Department of Social and
Preventive Medicine, School of Public Health, Université de Montréal,
Montreal, Canada
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - Kate Zinszer
- Department of Social and
Preventive Medicine, School of Public Health, Université de Montréal,
Montreal, Canada
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - Charity Oga Omenka
- Department of Social and
Preventive Medicine, School of Public Health, Université de Montréal,
Montreal, Canada
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - Pierre de Beaudrap
- Centre Population et Développement
(CEPED), Institut de recherche pour le développement, Paris, France
| | - Fereshteh Mehrabi
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
- Department of Health Management,
Evaluation and Health Policy, School of Public Health, Université de
Montréal, Montreal, Canada
| | - Christina Zarowsky
- Department of Social and
Preventive Medicine, School of Public Health, Université de Montréal,
Montreal, Canada
- Centre de recherche en santé
publique, Université de Montréal et CIUSSS du
Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
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14
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Wardrop R, Crilly J, Ranse J, Chaboyer W. Vulnerability: A concept synthesis and its application to the Emergency Department. Int Emerg Nurs 2020; 54:100936. [PMID: 33188947 DOI: 10.1016/j.ienj.2020.100936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 07/18/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
AIM The aim of this concept synthesis was to add clarity to the concept of vulnerability with application to the Emergency Department (ED) by critiquing, analysing and amalgamating published concept analyses. BACKGROUND The concept of vulnerability has been used widely, however it has various meanings. A clearer understanding of vulnerability and application to the ED may help healthcare professionals provide high quality care responsive to the needs of vulnerable individuals. METHOD Nine concept analyses of vulnerability were retrieved using Medline, CINAHL, and PsycINFO databases. After extracting data on each analysis, Walker and Avant's concept synthesis method was used to structure this synthesis, with a thematic synthesis approach used in the analysis. FINDINGS Four themes associated with vulnerability emerged from the synthesis. The first theme, vulnerability as a journey, reflected elements within an individual's life that perpetuate and exacerbate vulnerability. The second theme, vulnerability as susceptibility and risk, highlighted intrinsic and extrinsic elements that contribute to a state of risk. The third theme, positive and negative repercussions, emphasised lessons that can be learned from experience, with the fourth theme of a shared understanding indicating the importance of understanding the concept of vulnerability for patient care. CONCLUSION Findings from this synthesis highlight the multiple elements associated with a vulnerable state, evident in the context of the ED. With multiple ED-specific elements contributing to vulnerability, clarity of the term is important to inform ED-specific interventions designed to meet the needs of vulnerable populations.
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Affiliation(s)
- Rachel Wardrop
- School of Nursing and Midwifery, Griffith University, Australia.
| | - Julia Crilly
- School of Nursing and Midwifery, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia; Department of Emergency Medicine, Gold Coast Hospital and Health Service, Australia.
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia; Department of Emergency Medicine, Gold Coast Hospital and Health Service, Australia.
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia.
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What Is Still Necessary for Supporting the SDG7 in the Most Vulnerable Contexts? SUSTAINABILITY 2020. [DOI: 10.3390/su12177184] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The common agreement of the United Nation members pushes the 2030 Agenda ahead to alleviate poverty and ensure wellbeing for all, recognizing energy as a crucial pathway to achieving this goal under three core dimensions: human development, sustainable economic growth, and environmental sustainability. Affordable and clean energy is represented by the Sustainable Development Goal 7 (SDG7). This great scope represents a multifaceted challenge for all countries, especially for the most disadvantaged environments such as small islands and rural areas from developing countries. Both small islands and rural areas experience a scarcity of goods and services such as energy and are isolated from markets, have lack of human resources, difficulties in deploying economies of scale, and other issues that affect their development. Along the same line, their energy security is limited by their dependence on imported fuels, increasing electricity prices or making it infeasible to access electricity. This research builds the state of the art of off-grid energy systems for both contexts based on an extensive review of literature. The evidence shows that moving sustainable energy systems forward requires getting more people involved, the application of several business models, prevalent technological innovations, and the application of technical quality procedures. This perspective would really help to address the vulnerabilities of fragile locations. Here, auctions, the Energy Service Company, community, and Pay-As-You-Go (PAYG) models and renewable energy projects based on mature technology present a great opportunity for a sustainable future, powering a nexus among energy, environment, and society.
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Oga-Omenka C, Tseja-Akinrin A, Sen P, Mac-Seing M, Agbaje A, Menzies D, Zarowsky C. Factors influencing diagnosis and treatment initiation for multidrug-resistant/rifampicin-resistant tuberculosis in six sub-Saharan African countries: a mixed-methods systematic review. BMJ Glob Health 2020; 5:e002280. [PMID: 32616481 PMCID: PMC7333807 DOI: 10.1136/bmjgh-2019-002280] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Drug-resistant tuberculosis burdens fragile health systems in sub-Saharan Africa (SSA), complicated by high prevalence of HIV. Several African countries reported large gaps between estimated incidence and diagnosed or treated cases. Our review aimed to identify barriers and facilitators influencing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in SSA, which is necessary to develop effective strategies to find the missing incident cases and improve quality of care. METHODS Using an integrative design, we reviewed and narratively synthesised qualitative, quantitative and mixed-methods studies from nine electronic databases: Medline, Global Health, CINAHL, EMBASE, Scopus, Web of Science, International Journal of Tuberculosis and Lung Disease, PubMed and Google Scholar (January 2006 to June 2019). RESULTS Of 3181 original studies identified, 55 full texts were screened, and 29 retained. The studies included were from 6 countries, mostly South Africa. Barriers and facilitators to DR-TB care were identified at the health system and patient levels. Predominant health system barriers were laboratory operational issues, provider knowledge and attitudes and information management. Facilitators included GeneXpert MTB/RIF (Xpert) diagnosis and decentralisation of services. At the patient level, predominant barriers were patients being lost to follow-up or dying due to lengthy diagnostic and treatment delays, negative public sector care perceptions, family, work or school commitments and using private sector care. Some patient-level facilitators were HIV positivity and having more symptoms. CONCLUSION Case detection and treatment for DR -TB in SSA currently relies on individual patients presenting voluntarily to the hospital for care. Specific interventions targeting identified barriers may improve rates and timeliness of detection and treatment.
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Affiliation(s)
- Charity Oga-Omenka
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique, Université de Montréal (CReSP), Montréal, Quebec, Canada
- McGill International TB Centre, Montreal, Quebec, Canada
| | | | - Paulami Sen
- McGill International TB Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Muriel Mac-Seing
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique, Université de Montréal (CReSP), Montréal, Quebec, Canada
| | | | - Dick Menzies
- McGill International TB Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Christina Zarowsky
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique, Université de Montréal (CReSP), Montréal, Quebec, Canada
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Jeleff M, Lehner L, Giles-Vernick T, Dückers MLA, Napier AD, Jirovsky E, Kutalek R. Vulnerability assessment tools for infectious threats and antimicrobial resistance: a scoping review protocol. BMJ Open 2019; 9:e031944. [PMID: 31740471 PMCID: PMC6886976 DOI: 10.1136/bmjopen-2019-031944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This protocol will guide and explain the working process of a systematic scoping review on vulnerability assessment tools in the field of infectious disease outbreaks and antimicrobial resistance (AMR) crises. The scoping review will appraise existing tools or methodologies to identify local level vulnerabilities in the context of infectious disease outbreaks and AMR. Due to this focus on infectious threats and AMR, the review also considers articles using a 'One Health' approach to assess the vulnerability of individuals, groups and practices in human-animal-environment interactions. Given the broad nature of vulnerability, we aim to allocate studies discerning the process of identifying vulnerable or at-risk groups during a crisis, instead of studies taking vulnerability only as a starting point. Because considerable research has been conducted on vulnerability, disasters and climate change, we will also assemble tools developed from these fields. To our knowledge, this is the first planned systematic scoping review of vulnerability assessment tools for disease outbreaks and AMR, taking into account practices at the human-animal-environment interface that can lead to increased risk of exposure of individuals to infections, pathogen spillovers or epidemics. METHODS AND ANALYSIS To develop the protocol, we used the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist (PRISMA-P 2015) in compliance with the PRISMA Extension for Scoping Reviews Explanation and Elaboration. With the assistance of an experienced research librarian, we developed the search strategy, which targeted the following databases: Medline, Global Health database, Web of Science and Embase. A second strategy was developed for Epistemonikos, African Journals Online and Global Index Medicus because these databases do not provide the infrastructure for an advanced search. We consider studies published between 1978 and 2019 and include articles, book chapters, websites and grey literature from selected non-governmental organisations and non-profit organisations working in the health field. We contact them directly regarding whether they are working with or have developed a vulnerability assessment tool. To address the dynamic nature of our investigation, we develop a flow diagram which we continually update to reflect the selection process. Two reviewers (MJ and LL) independently screen the literature and resolve conflicts through discussion rounds. Data extraction will be conducted by four researchers (MJ, LL, EJ and RK) through inductive and deductive coding. Extracted data will be systematically compared and divergences highlighted. ETHICS AND DISSEMINATION Ethical approval is not required because this study does not involve collection of primary data. The purpose of this review is to disseminate a catalogue of vulnerability assessment tools and a brief summary of key results and recommendations for SoNAR-Global partners in Bangladesh, Ukraine and Uganda. The catalogue will be made publicly available. On the basis of our results, SoNAR-Global partners will pilot one of these tools.
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Affiliation(s)
- Maren Jeleff
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Lisa Lehner
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | | | - Michel L A Dückers
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - A David Napier
- Department of Anthropology, Centre for Applied Global Citizenship, University College London, London, UK
| | - Elena Jirovsky
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Ruth Kutalek
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
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Mac-Seing M, Zarowsky C. [A meta-synthesis on gender, disability and reproductive health in sub-Saharan Africa]. SANTE PUBLIQUE 2018; 29:909-919. [PMID: 29473405 DOI: 10.3917/spub.176.0909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Reproductive health remains a major global health issue. People with disabilities face additional discrimination and barriers to access which need to be better understood. To contribute to future interventions, we examined the intersections between gender and disability related to reproductive health in sub-Saharan Africa in the qualitative literature. METHODS We conducted a meta-synthesis, using a taxonomic analysis. An inductive and iterative approach was adopted to allow exploration of new and emergent semantic variations in themes. NVivo 11 Plus was used to code themes. RESULTS Ten qualitative studies from six sub-Saharan African countries were analysed. Two main thematic areas emerged from the analysis: 1) gendered roles of people with disabilities are programmed by sociocultural normativity, including perceptions about sexuality. They are exacerbated by the hegemony of ableism and influenced by the type of reproductive health issues experienced by people with disabilities; and 2) experiences of disability in interaction with a reproductive health issue are exacerbated by the type of disability, influenced by the type of barriers to access, and perceived differently depending upon the actors involved. DISCUSSION The intersections between gender and disability embodied by people with disabilities are multiple and complex. Not only do imposed gendered roles influence the lives of people with disabilities, but their experiences of disability are also intricately linked to gender. An intersectional analysis is proposed as a useful support to developing future perspectives.
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Vijayasingham L, Jogulu U, Allotey P. Challenges for accessing and financing high-cost medicines in multipayer systems: case studies of multiple sclerosis in Malaysia. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1403011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lavanya Vijayasingham
- Jeffrey Cheah School of Medicine, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Uma Jogulu
- School of Law and Business, Edith Cowan University, Joondalup, Australia
| | - Pascale Allotey
- Jeffrey Cheah School of Medicine, Monash University Malaysia, Bandar Sunway, Malaysia
- International Institute for Global Health (IIGH), United Nations University (UNU), Federal Territory of Kuala Lumpur, Malaysia
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Bond V, Chiti B, Hoddinott G, Reynolds L, Schaap A, Simuyaba M, Ndubani R, Viljoen L, Simwinga M, Fidler S, Hayes R, Ayles H, Seeley J. "The difference that makes a difference": highlighting the role of variable contexts within an HIV Prevention Community Randomised Trial (HPTN 071/PopART) in 21 study communities in Zambia and South Africa. AIDS Care 2017; 28 Suppl 3:99-107. [PMID: 27421057 DOI: 10.1080/09540121.2016.1178958] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This paper explores contextual heterogeneity within a community randomised trial HPTN 071 (Population Effects of Antiretroviral Treatment to Reduce HIV Transmission) carried out in 21 study communities (12 Zambian, 9 South African). The trial evaluates the impact of a combination HIV prevention package (including household-based HIV counselling and testing and anti-retroviral treatment (ART) eligibility regardless of CD4-count) on HIV incidence. The selection, matching and randomisation of study communities relied on key epidemiological and demographic variables and community and stakeholder support. In 2013, following the selection of study communities, a "Broad Brush Survey" (BBS) approach was used to rapidly gather qualitative data on each study community, prior to the implementation of the trial intervention. First-year process indicator intervention data (2014-2015) were collected during the household-based intervention by community lay workers. Using an open/closed typology of urban communities (indicating more or less heterogeneity), this qualitative inquiry presents key features of 12 Zambian communities using a list of four meta-indicators (physical features, social organisation, networks and community narratives). These indicators are then compared with four intervention process indicators in a smaller set of four study communities. The process indicators selected for this analysis indicate response to the intervention (uptake) amongst adults. The BBS qualitative data are used to interpret patterns of similarity and variability in the process indicators across four communities. We found that meta-indicators of local context helped to interpret patterns of similarity and variability emerging across and within the four communities. Features especially significant for influencing heterogeneity in process indicators include proportion of middle-class residents, proximity to neighbouring communities and town centre, the scale of the informal economy, livelihood-linked mobility, presence of HIV stakeholders over time and commitment to community action. Future interdisciplinary analysis is needed to explore if these patterns of difference continue to hold up over the full intervention period and all intervention communities.
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Affiliation(s)
- Virginia Bond
- a Zambart Project, University of Zambia, School of Medicine , Lusaka , Zambia.,b Department of Global Health and Development, Faculty of Public Health and Policy , London School of Hygiene and Tropical Medicine , London , UK
| | - Bwalya Chiti
- a Zambart Project, University of Zambia, School of Medicine , Lusaka , Zambia
| | - Graeme Hoddinott
- c Desmond Tutu TB Centre, Department of Paediatrics and Child Health , University of Stellenbosch , Cape Town , South Africa
| | - Lindsey Reynolds
- d Department of Sociology and Social Anthropology , Stellenbosch University , Matieland , South Africa.,e Population Studies and Training Center , Brown University , Providence , RI , USA
| | - Ab Schaap
- a Zambart Project, University of Zambia, School of Medicine , Lusaka , Zambia.,f Department of Infectious Disease Epidemiology , London School of Hygiene and Tropical Medicine , London , UK
| | - Melvin Simuyaba
- a Zambart Project, University of Zambia, School of Medicine , Lusaka , Zambia
| | - Rhoda Ndubani
- a Zambart Project, University of Zambia, School of Medicine , Lusaka , Zambia
| | - Lario Viljoen
- c Desmond Tutu TB Centre, Department of Paediatrics and Child Health , University of Stellenbosch , Cape Town , South Africa
| | - Musonda Simwinga
- a Zambart Project, University of Zambia, School of Medicine , Lusaka , Zambia
| | - Sarah Fidler
- g Department of Medicine , Imperial College London , London , UK
| | - Richard Hayes
- f Department of Infectious Disease Epidemiology , London School of Hygiene and Tropical Medicine , London , UK
| | - Helen Ayles
- a Zambart Project, University of Zambia, School of Medicine , Lusaka , Zambia.,h Department of Clinical Research , London School of Hygiene and Tropical Medicine , London , UK
| | - Janet Seeley
- b Department of Global Health and Development, Faculty of Public Health and Policy , London School of Hygiene and Tropical Medicine , London , UK.,i MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda
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Vergunst R, Swartz L, Mji G, Kritzinger J, Braathen SH. Beyond the checklist: understanding rural health vulnerability in a South African context. Glob Health Action 2016; 9:33272. [PMID: 27914191 PMCID: PMC5134832 DOI: 10.3402/gha.v9.33272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 11/15/2022] Open
Abstract
Background Vulnerability in the past has sometimes been measured and understood in terms of checklists or common understanding. It is argued here that vulnerability is a more complex issue than this. Although checklists of vulnerable groups are important, they do not capture the essence and dynamics of vulnerability. Objective The case of rural health vulnerability in South Africa is discussed to show that classifying people into vulnerable groups does not portray the complexity and intricacies of what it means to have vulnerability. We also wish to show that there are different kinds of vulnerabilities, and the difference between access vulnerability and illness vulnerability is highlighted. Methods As part of a larger study, this case study is presented to show how vulnerability in a poor rural community in South Africa has to be understood in a contextual and dynamic manner as opposed to a static manner. Results Family and social dynamics can influence health. For example, fractured families were seen as a vulnerable issue within the community, while being a person with a disability can lead to isolation and callous attitudes towards them. It is these family and social dynamics that lead proximally to vulnerability to ill health. Conclusions A contextual approach can assist in giving a more layered understanding of vulnerability than a checklist approach can do. Interventions to change health cannot be addressed simply by medical means. Social conditions need to be changed, and part of changing social conditions is the process of assisting those who are isolated or experience themselves as vulnerable to reconnect with others in the community. Poverty leads to social exclusion; social and family inclusion may be key to well-being.
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Affiliation(s)
- Richard Vergunst
- Department of Psychology, University of Stellenbosch, Stellenbosch, South Africa;
| | - Leslie Swartz
- Department of Psychology, University of Stellenbosch, Stellenbosch, South Africa
| | - Gubela Mji
- Centre for Rehabilitation Studies, University of Stellenbosch, Stellenbosch, South Africa
| | - Janis Kritzinger
- Department of Psychology, University of Stellenbosch, Stellenbosch, South Africa
| | - Stine Hellum Braathen
- Department of Psychology, University of Stellenbosch, Stellenbosch, South Africa.,SINTEF Technology and Society, Department of Health, PB 124 Blindern, 0314 Oslo, Norway
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O’Neill S, Dierickx S, Okebe J, Dabira E, Gryseels C, d’Alessandro U, Peeters Grietens K. The Importance of Blood Is Infinite: Conceptions of Blood as Life Force, Rumours and Fear of Trial Participation in a Fulani Village in Rural Gambia. PLoS One 2016; 11:e0160464. [PMID: 27525652 PMCID: PMC4985146 DOI: 10.1371/journal.pone.0160464] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 07/19/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Clinical trials require high levels of participation and low drop-out rates to be successful. However, collecting blood samples from individuals recruited into clinical trials can be challenging when there is reticence about blood-taking. In addition to concerns regarding the feasibility of medical research, fears of 'blood-stealing' and 'blood-selling' have ethical implications related to cultural sensitivity and informed consent. This study explores anxieties around blood-taking during a malaria treatment trial in the Gambia. METHODS This case study is based on ethnographic research in one theoretically selected village due to the high reticence to screening for the clinical trial 'Primaquine's gametocytocidal efficacy in malaria asymptomatic carriers treated with dihydroartemisinin-piperaquine' carried out in the Gambia between 2013 and 2014. Data collection tools included in-depth interviews, participant observation, informal conversations and group discussions. RESULTS In total only 176 of 411 habitants (42%) in the village accepted having a bloodspot taken to screen for malaria. Although trial recruitment was initially high in the village, some families refused screening when rumours started spreading that the trial team was taking too much blood. Concerns about 'loss of blood' were equated to loss of strength and lack of good food to replenish bodily forces. Families in the study village were concerned about the weakness of their body while they had to harvest their crops at the time of recruitment for the trial. CONCLUSION A common recommendation to prevent and avoid rumours against public health interventions and trials is the provision of full and consistent information during the consent procedure, which is assumed to lead to more accurate knowledge of the purpose of the intervention and increased trial participation. However, even when information provision is continuous, the emergence of rumours can be related to times of uncertainty and perceptions of vulnerability, which are often a reflection of structural inequalities and diverging value orientations between communities and public health institutions.
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Affiliation(s)
- Sarah O’Neill
- Unit of Medical Anthropology, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Susan Dierickx
- Unit of Medical Anthropology, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
- RHEA, Centre of Expertise on Gender, Diversity and Intersectionality, Vrije Universiteit Brussels, Brussels, Belgium
| | - Joseph Okebe
- Medical Research Council Gambia, Fajara, The Gambia
- University of Antwerp, Antwerp, Belgium
| | | | - Charlotte Gryseels
- Unit of Medical Anthropology, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Umberto d’Alessandro
- Unit of Medical Anthropology, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Medical Research Council Gambia, Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Koen Peeters Grietens
- Unit of Medical Anthropology, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Partners for Applied Social Sciences (PASS) International, Tessenderlo, Belgium
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Briscoe L, Lavender T, McGowan L. A concept analysis of women's vulnerability during pregnancy, birth and the postnatal period. J Adv Nurs 2016; 72:2330-45. [DOI: 10.1111/jan.13017] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Lesley Briscoe
- SL Midwifery Education; Edge Hill University; Lancashire UK
| | - Tina Lavender
- Centre for Global Women's Health, University of Manchester; UK
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Carey G, Malbon E, Carey N, Joyce A, Crammond B, Carey A. Systems science and systems thinking for public health: a systematic review of the field. BMJ Open 2015; 5:e009002. [PMID: 26719314 PMCID: PMC4710830 DOI: 10.1136/bmjopen-2015-009002] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 10/23/2015] [Accepted: 11/11/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This paper reports on findings from a systematic review designed to investigate the state of systems science research in public health. The objectives were to: (1) explore how systems methodologies are being applied within public health and (2) identify fruitful areas of activity. DESIGN A systematic review was conducted from existing literature that draws on or uses systems science (in its various forms) and relates to key public health areas of action and concern, including tobacco, alcohol, obesity and the social determinants of health. DATA ANALYSIS 117 articles were included in the review. An inductive qualitative content analysis was used for data extraction. The following were systematically extracted from the articles: approach, methodology, transparency, strengths and weaknesses. These were then organised according to theme (ie, commonalities between studies within each category), in order to provide an overview of the state of the field as a whole. The assessment of data quality was intrinsic to the goals of the review itself, and therefore, was carried out as part of the analysis. RESULTS 4 categories of research were identified from the review, ranging from editorial and commentary pieces to complex system dynamic modelling. Our analysis of each of these categories of research highlighted areas of potential for systems science to strengthen public health efforts, while also revealing a number of limitations in the dynamic systems modelling being carried out in public health. CONCLUSIONS There is a great deal of interest in how the application of systems concepts and approach might aid public health. Our analysis suggests that soft systems modelling techniques are likely to be the most useful addition to public health, and align well with current debate around knowledge transfer and policy. However, the full range of systems methodologies is yet to be engaged with by public health researchers.
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Affiliation(s)
- Gemma Carey
- Regulatory Institutions Network Australian National University, Canberra, Australia
| | - Eleanor Malbon
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia
| | - Nicole Carey
- Self-organizing Systems Research Group School of engineering and applied sciences Harvard University
| | - Andrew Joyce
- Centre for Social Impact, Swinburne University, Melbourne, Victoria, Australia
| | - Brad Crammond
- Centre for Epidemiology and Preventive Health. Monash University, Melbourne, Australia
| | - Alan Carey
- Maths Science Institute Australian National University
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Mbalinda SN, Nakimuli A, Nakubulwa S, Kakaire O, Osinde MO, Kakande N, Kaye DK. Male partners' perceptions of maternal near miss obstetric morbidity experienced by their spouses. Reprod Health 2015; 12:23. [PMID: 25884387 PMCID: PMC4384277 DOI: 10.1186/s12978-015-0011-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe obstetric complications have potential negative impact on the family and household of the survivors, with potential negative effects during (and in the aftermath of) the traumatic obstetric events. The objective was to gain deeper understanding of how severe obstetric complications are perceived by male partners, and their impact on the livelihoods of the family and community. METHODS Data was collected through 25 in-depth narrative interviews with male partners of women with severe obstetric morbidity. The interviews occurred 4-12 months after the traumatic childbirth events. To gain a deeper understanding of the meanings and spouses attach to the experiences, we employed the notions of social capital and resilience. RESULTS Male partners' perceptions and experiences were mostly characterized by losses, dreams and dilemmas, disempowerment and alienation, seclusion and self isolation or reliance on the social networks. During the aftermath of the events, there was disruption of the livelihoods of the partners and the whole family. CONCLUSION While a maternal near miss obstetric event might appear as a positive outcome for the survivors, partners and caregivers of women who experience severe obstetric morbidity are deeply affected by the experiences of this life-threatening episode.
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Affiliation(s)
- Scovia N Mbalinda
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Annettee Nakimuli
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Sarah Nakubulwa
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Othman Kakaire
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Michael O Osinde
- Department of Obstetrics and Gynecology, Jinja Regional Hospital, Jinja, Uganda.
| | - Nelson Kakande
- Clinical, Operations and Health Services Research Program, Joint Clinical Research Centre, P. O. Box 10005, Kampala, Uganda.
| | - Dan K Kaye
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
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Survivors’ understanding of vulnerability and resilience to maternal near-miss obstetric events in Uganda. Int J Gynaecol Obstet 2014; 127:265-8. [DOI: 10.1016/j.ijgo.2014.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 05/28/2014] [Accepted: 07/10/2014] [Indexed: 11/23/2022]
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