Relação entre apoio social e sono de pessoas idosas cuidadoras em vulnerabilidade social / Relationship between social support and sleep of elderly caregivers in social vulnerability / Relación entre apoyo social y sueño de adultos mayores cuidadores con vulnerabilidad social

Objetivo: analisar a relação entre apoio social e qualidade do sono de pessoas idosas que cuidam de outros idosos em ambiente de vulnerabilidade social. Método: estudo transversal realizado com 65 cuidadores entrevistados por meio de instrumento de caracterização, Índice de Katz, Escala de Lawton e Brody, Índice de Qualidade do Sono de Pittsburgh e Escala de Apoio Social do Medical Outcomes Study, com dados analisados com testes de comparação e de correlação. Resultados: a maioria eram mulheres, cônjuges do idoso cuidado e possuíam sono de má qualidade. Observou-se correlação fraca e inversa entre má qualidade do sono e a dimensão interação social positiva (Rho=-0,27; p=0,028). Identificou-se relação significativa entre: apoio material e disfunção diurna (p=0,034); apoio afetivo e eficiência do sono (p=0,026); interação social positiva e qualidade subjetiva do sono (p=0,001) e disfunção diurna (p=0,008). Conclusão: Quanto maior a interação social positiva, melhor é a qualidade do sono.

Objective: to analyze the relationship between social support and sleep quality of elderly individuals who care for other elderly individuals in a socially vulnerable environment. Method: a cross-sectional study conducted with 65 caregivers interviewed using a characterization instrument, Katz Index, Lawton and Brody Scale, Pittsburgh Sleep Quality Index, and Medical Outcomes Study Social Support Scale, with data analyzed using comparison and correlation tests. Results: the majority were women, spouses of the elderly being cared for, and had poor sleep quality. A weak and inverse correlation was observed between poor sleep quality and the positive social interaction dimension (Rho=-0.27; p=0.028). Significant relationships were identified between: material support and daytime dysfunction (p=0.034); emotional support and sleep efficiency (p=0.026); positive social interaction and subjective sleep quality (p=0.001), as well as daytime dysfunction (p=0.008). Conclusion: The higher the positive social interaction, the better the sleep quality.

Objetivo: analizar la relación entre el apoyo social y la calidad del sueño de personas mayores que cuidan de otras personas mayores en entornos socialmente vulnerables. Método: estudio transversal realizado con 65 cuidadores entrevistados mediante un instrumento de caracterización, Índice de Katz, Escala de Lawton y Brody, Índice de Calidad del Sueño de Pittsburgh y Escala de Apoyo Social del Medical Outcomes Study, los datos fueron analizados mediante pruebas de comparación y correlación. Resultados: la mayoría eran mujeres, cónyuges del adulto mayor que recibe el cuidado y tenían mala calidad del sueño. Se observó una correlación débil e inversa entre la mala calidad del sueño y la dimensión de interacción social positiva (Rho=-0,27; p=0,028). Se identificó que había relación significativa entre: apoyo material y disfunción diurna (p=0,034); apoyo afectivo y eficiencia del sueño (p=0,026); interacción social positiva y calidad subjetiva del sueño (p=0,001) y disfunción diurna (p=0,008). Conclusión: Cuanto mayor sea la interacción social positiva, mejor será la calidad del sueño.

Social Phenotyping for Cardiovascular Risk Stratification in Electronic Health Registries.

PURPOSE OF REVIEW: Evaluation of social influences on cardiovascular care requires a comprehensive analysis encompassing economic, societal, and environmental factors. The increased utilization of electronic health registries provides a foundation for social phenotyping, yet standardization in methodology remains lacking. This review aimed to elucidate the primary approaches to social phenotyping for cardiovascular risk stratification through electronic health registries. RECENT FINDINGS: Social phenotyping in the context of cardiovascular risk stratification within electronic health registries can be separated into four principal approaches: place-based metrics, questionnaires, ICD Z-coding, and natural language processing. These methodologies vary in their complexity, advantages and limitations, and intended outcomes. Place-based metrics often rely on geospatial data to infer socioeconomic influences, while questionnaires may directly gather individual-level behavioral and social factors. Z-coding, a relatively new approach, can capture data directly related to social determinant of health domains in the clinical context. Natural language processing has been increasingly utilized to extract social influences from unstructured clinical narratives-offering nuanced insights for risk prediction models. Each method plays an important role in our understanding and approach to using social determinants data for improving population cardiovascular health. These four principal approaches to social phenotyping contribute to a more structured approach to social determinant of health research via electronic health registries, with a focus on cardiovascular risk stratification. Social phenotyping related research should prioritize refining predictive models for cardiovascular diseases and advancing health equity by integrating applied implementation science into public health strategies.

Impact of Social Vulnerability Index on the Development of Severe Visual Impairment or Blindness from Glaucoma.

PURPOSE: To evaluate whether geocoded social risk factor data predict the development of severe visual impairment or blindness due to glaucoma during follow-up using a large electronic health record (EHR) database. DESIGN: Cohort study. METHODS: Patients diagnosed with open-angle glaucoma (OAG) at a tertiary care institution. All eyes had glaucomatous visual field defects at baseline. Sociodemographic and ocular data were extracted from EHR, including age, gender, self-reported race and ethnicity, insurance status, OAG type, prior glaucoma laser or surgery, baseline disease severity using Hodapp-Anderson-Parrish criteria, mean intraocular pressure (IOP) during follow-up, and central corneal thickness. Social vulnerability index (SVIndex) data at the census tract level were obtained using geocoded patient residences. Mixed-effects Cox proportional hazard models were completed to assess for the development of severe visual impairment or blindness during follow-up, defined as BCVA ≤20/200 at the last two clinic visits or standard automated perimetry (SAP) mean deviation (MD) ≤-22dB confirmed on two tests. RESULTS: A total of 4,046 eyes from 2,826 patients met inclusion criteria and were followed for an average of 4.3±2.2 years. Severe visual impairment or blindness developed in 79 eyes (2.0%) from 76 patients (2.7%) after an average of 3.4±1.8 years, leading to an incidence rate of severe visual impairment or blindness of 0.5% per year. Older age (adjusted hazards ratio (HR) 1.36 per decade, p=0.007), residence in areas with higher SVIndex (HR 1.56 per 25% increase, p<0.001), higher IOP during follow-up (HR 3.01 per 5 mmHg increase, p<0.001), and moderate or severe glaucoma at baseline (HR 7.31 and 26.87, p<0.001) were risk factors for developing severe visual impairment or blindness. Concordance index of the model was 0.87. Socioeconomic, minority status/language, and housing type/transportation SVIndex themes were key contributors to developing severe visual impairment or blindness. CONCLUSIONS: Risk factors for developing glaucoma-related severe visual impairment or blindness included older age, elevated IOP during follow-up, moderate or severe disease at baseline, and residence in areas associated with greater social vulnerability. In addition to ocular risk factors, geocoded EHR data regarding social risk factors could help identify patients at high risk of developing glaucoma-related visual impairment.

Beyond race: social vulnerability and access to metabolic and bariatric surgery.

BACKGROUND: Metabolic and bariatric surgery (MBS) is under-accessed by non-White patients, who are disproportionately affected by obesity. We hypothesized that unique barriers experienced by socially vulnerable patients drive disparate MBS utilization. OBJECTIVES: To determine whether socially vulnerable patients experience greater attrition and face more insurance-mandated medical weight management (MWM) requirements. SETTING: Urban, academic center. METHODS: This retrospective cohort study included adults evaluated for MBS in 2018. Social vulnerability was determined using the 2018 Social Vulnerability Index. Outcomes included attrition, or failure to undergo surgery within 1year, and the number and duration of MWM requirements. Multivariable logistic regression and negative binomial regression tested these associations. RESULTS: In 2018, 339 patients were evaluated for MBS (83% female, 70% Black). The attrition rate was 57%. On adjusted analyses, patients in the highest social vulnerability quartile had double the odds of attrition compared to their least vulnerable counterparts (OR 2.33, 95% CI 1.11-4.92, P = .03). Highly vulnerable patients had double the number (IRR 2.29, 95% CI 1.42-3.72, P = .001) and nearly quadruple the duration (IRR 3.90, 95% CI 1.93-7.86, P < .001) of MWM requirements compared to those with low social vulnerability. Odds of attrition increased by 11% and 20% for each additional MWM visit (OR 1.11, 95% CI 1.02-1.20, P = .02) and month (OR 1.20, 95% CI 1.08-1.33, P = .001), respectively. CONCLUSIONS: Patients with high social vulnerability were less likely to undergo MBS and faced more insurance-mandated preoperative requirements, which independently predicted attrition. Insurance-mandated MWM is inequitable and may contribute to disparate care of patients with severe obesity.

Social vulnerability and surgery outcomes: a cross-sectional analysis.

BACKGROUND: Post-operative complications present a challenge to the healthcare system due to the high unpredictability of their incidence. Socioeconomic conditions have been established as social determinants of health. However, their contribution relating to postoperative complications is still unclear as it can be heterogeneous based on community, type of surgical services, and sex and gender. Uncovering these relations can enable improved public health policy to reduce such complications. METHODS: In this study, we conducted a large population cross-sectional analysis of social vulnerability and the odds of various post-surgical complications. We collected electronic health records data from over 50,000 surgeries that happened between 2012 and 2018 at a quaternary health center in St. Louis, Missouri, United States and the corresponding zip code of the patients. We built statistical logistic regression models of postsurgical complications with the social vulnerability index of the tract consisting of the zip codes of the patient as the independent variable along with sex and race interaction. RESULTS: Our sample from the St. Louis area exhibited high variance in social vulnerability with notable rapid increase in vulnerability from the south west to the north of the Mississippi river indicating high levels of inequality. Our sample had more females than males, and females had slightly higher social vulnerability index. Postoperative complication incidence ranged from 0.75% to 41% with lower incidence rate among females. We found that social vulnerability was associated with abnormal heart rhythm with socioeconomic status and housing status being the main association factors. We also found associations of the interaction of social vulnerability and female sex with an increase in odds of heart attack and surgical wound infection. Those associations disappeared when controlling for general health and comorbidities. CONCLUSIONS: Our results indicate that social vulnerability measures such as socioeconomic status and housing conditions could affect postsurgical outcomes through preoperative health. This suggests that the domains of preventive medicine and public health should place social vulnerability as a priority to achieve better health outcomes of surgical interventions.

The association between social vulnerability and geriatric assessment impairments among older adults with gastrointestinal cancers-The CARE Registry.

BACKGROUND: Older adults comprise the majority of patients with gastrointestinal (GI) cancer. Geriatric assessments (GAs) are recommended for older adults with cancer in part to detect aging-related impairments (e.g., frailty) associated with early mortality. Social factors like social vulnerability may also influence aging-related impairments. However, the association between social vulnerability and aging outcomes among older adults with cancer is understudied. METHODS: The authors included 908 older adults aged 60 years and older who were recently diagnosed with GI cancer undergoing GA at their first prechemotherapy visit to the University of Alabama at Birmingham oncology clinic. The primary exposure of interest was the social vulnerability index (SVI). Outcomes were frailty (frail vs. robust/prefrail) and total number of GA impairments (range, 0-13). The authors examined the association between SVI and outcomes using Poisson regression with robust variance estimation and generalized estimating equations. RESULTS: The median age at GA was 69 years (interquartile range, 64-75 years), 58.2% of patients were male, 22.6% were non-Hispanic Black, 29.1% had colorectal cancer, 28.2% had pancreatic cancer, and 70.3% had stage III/IV disease. Adjusting for age, sex, cancer type, and disease stage, each decile increase in the SVI was associated with an 8% higher prevalence of frailty (prevalence ratio, 1.08; 95% confidence interval, 1.05-1.11) and a 4% higher average count of total GA impairments (risk ratio, 1.04; 95% confidence interval, 1.02-1.06). The results were attenuated after further adjustment for race and education. CONCLUSIONS: Greater social vulnerability was associated with a higher prevalence of frailty and an increasing average number of GA impairments among older adults with GI cancers before systemic treatment. Intervening on social vulnerability may be a target for improving the risk of frailty and GA impairments, but associations of race and education should be further evaluated.

Associations between Flood Risk and United States Census Tract-Level Health Outcomes.

Human-induced climate change has led to more frequent and severe flooding throughout the globe. We examined the association between flood risk and the prevalence of coronary heart disease, high blood pressure, asthma, and poor mental health in the UnitedStates, while taking into account different levels of social vulnerability. We aggregated flood risk variables from First Street Foundation by census tract and used principal component analysis to derive a set of five interpretable flood risk factors. The dependent variables were census-tract level disease prevalences generated by the Centers for Disease Control and Prevention. Bayesian spatial conditional autoregressive models were fit on this data to quantify the relationship between flood risk and health outcomes under different stratifications of social vulnerability. We showed that three flood risk principal components had small but significant associations with each of the health outcomes, across the different stratifications of social vulnerability. Our analysis gives the first United States-wide estimates of the associated effects of flood risk on specific health outcomes. We also show that social vulnerability is an important moderator of the relationship between flood risk and health outcomes. Our approach can be extended to other ecological studies that examine the health impacts of climate hazards.

Social Determinants of Health and Limitation of Life-Sustaining Therapy in Neurocritical Care: A CHoRUS Pilot Project.

BACKGROUND: Social determinants of health (SDOH) have been linked to neurocritical care outcomes. We sought to examine the extent to which SDOH explain differences in decisions regarding life-sustaining therapy, a key outcome determinant. We specifically investigated the association of a patient's home geography, individual-level SDOH, and neighborhood-level SDOH with subsequent early limitation of life-sustaining therapy (eLLST) and early withdrawal of life-sustaining therapy (eWLST), adjusting for admission severity. METHODS: We developed unique methods within the Bridge to Artificial Intelligence for Clinical Care (Bridge2AI for Clinical Care) Collaborative Hospital Repository Uniting Standards for Equitable Artificial Intelligence (CHoRUS) program to extract individual-level SDOH from electronic health records and neighborhood-level SDOH from privacy-preserving geomapping. We piloted these methods to a 7 years retrospective cohort of consecutive neuroscience intensive care unit admissions (2016-2022) at two large academic medical centers within an eastern Massachusetts health care system, examining associations between home census tract and subsequent occurrence of eLLST and eWLST. We matched contextual neighborhood-level SDOH information to each census tract using public data sets, quantifying Social Vulnerability Index overall scores and subscores. We examined the association of individual-level SDOH and neighborhood-level SDOH with subsequent eLLST and eWLST through geographic, logistic, and machine learning models, adjusting for admission severity using admission Glasgow Coma Scale scores and disorders of consciousness grades. RESULTS: Among 20,660 neuroscience intensive care unit admissions (18,780 unique patients), eLLST and eWLST varied geographically and were independently associated with individual-level SDOH and neighborhood-level SDOH across diagnoses. Individual-level SDOH factors (age, marital status, and race) were strongly associated with eLLST, predicting eLLST more strongly than admission severity. Individual-level SDOH were more strongly predictive of eLLST than neighborhood-level SDOH. CONCLUSIONS: Across diagnoses, eLLST varied by home geography and was predicted by individual-level SDOH and neighborhood-level SDOH more so than by admission severity. Structured shared decision-making tools may therefore represent tools for health equity. Additionally, these findings provide a major warning: prognostic and artificial intelligence models seeking to predict outcomes such as mortality or emergence from disorders of consciousness may be encoded with self-fulfilling biases of geography and demographics.

Effect of Social Vulnerability on Cocaine-Related Mortality Rates in U.S. Counties.

Cocaine-related mortality rates have risen sharply since 2013 and social vulnerability is a crucial indicator for drug-related mortality rates. Therefore, the purpose of this study was to investigate the relationship between social vulnerability and cocaine-related mortality rates in U.S. counties. The Data were collected from the CDC WONDER, CDC's Social Vulnerability Index (CDC's SVI), and American Community Survey (ACS). The Data were analyzed by spatial autoregression models. According to present results, first, counties with social vulnerability (socioeconomic) were positively related to higher rates of cocaine overdose death (spatial lag: B = 0.323, p < .05; spatial error: B = 0.513, p < .01). Second, counties with social vulnerability (minority status & language) were negatively related to higher rates of cocaine overdose death (spatial lag: B = -0.233, p < .05). Third, counties with social vulnerability (housing type & transportation) were positively related to higher rates of cocaine overdose death (spatial lag: B = 0.413, p < .001; spatial error: B = 0.378, p < .001). In conclusion, the spread of cocaine overdose on U.S. counties with social vulnerabilities demonstrated a disproportionate burden of cocaine-related mortality.

Food deserts, endometrial cancer survivors, and healthy food access: Is it equitable in rural America? - A geospatial analysis.

OBJECTIVE: To examine endometrial cancer survivors' access to healthy food resources recommended by the Society of Gynecologic Oncology (SGO) in relation to food deserts and social health determinants. METHODS: Participants included women seen for endometrial cancer treatment at an academic medical center in the Deep South from 2015 to 2020 who lived in South Carolina. Demographic and comorbidity data were abstracted from medical records. Food desert data were obtained from the United States Department of Agriculture (USDA). Each patient was assigned a socioeconomic (SES) score (SES-1 = low, SES-5 = high) using census data and a social vulnerability index (SVI) using Center for Disease Control and Prevention (CDC) data for neighborhood adverse health effects. Geospatial techniques assessed patients' driving distance from home to a healthy food resource. RESULTS: Of the 736 endometrial cancer survivors, 31% identified as African American, and 30% lived in low SES (SES-1, SES-2) census blocks. Most survivors had low grade disease (63%) and 76% with stage 1-2 disease. Seventy percent of patients were obese (BMI ≥30 kg/m2). Forty percent of survivors lived in a food desert. Survivors living in a food desert with low SES had significantly higher social vulnerability (p = 0.0001) and lower median income (p = 0.0001). Those with low SES and living in a food desert drove further (p = 0.05, range 0.017-12.0 miles). CONCLUSION: Obesity rates were high in endometrial cancer survivors living in the Deep South. Survivors with higher social vulnerability and lower SES were more likely to live in food deserts with decreased access to healthy food resources.

Investigating the effects of spatial scales on social vulnerability index: A hybrid uncertainty and sensitivity analysis approach combined with remote sensing land cover data.

Investigating the effects of spatial scales on the uncertainty and sensitivity analysis of the social vulnerability index (SoVI) model output is critical, especially for spatial scales finer than the census block group or census block. This study applied the intelligent dasymetric mapping approach to spatially disaggregate the census tract scale SoVI model into a 300-m grids resolution SoVI map in Davidson County, Nashville. Then, uncertainty analysis and variance-based global sensitivity analysis were conducted on two scales of SoVI models: (a) census tract scale; (b) 300-m grids scale. Uncertainty analysis results indicate that the SoVI model has better confidence in identifying places with a higher socially vulnerable status, no matter the spatial scales in which the SoVI is constructed. However, the spatial scale of SoVI does affect the sensitivity analysis results. The sensitivity analysis suggests that for census tract scale SoVI, the indicator transformation and weighting scheme are the two major uncertainty contributors in the SoVI index modeling stages. While for finer spatial scales like the 300-m grid's resolution, the weighting scheme becomes the uttermost dominant uncertainty contributor, absorbing uncertainty contributions from indicator transformation.

Examining social vulnerability to multi-hazards in North-Western Himalayas, India.

The enhancing risk from human action and multi-hazard interaction has substantially complicated the hazard-society relationship. The underlying vulnerabilities are crucial in predicting the probable impact to be caused by multi-hazards. Thus, the evaluation of social vulnerability is decisive in inferring the driving factor and preparing for mitigation strategies. The Himalayan landscape is prone to multiple hazards as well as possesses a multitude of vulnerabilities owing to changing human landscape. Thus, an attempt has been made to inquire into the underlying socioeconomic factors enhancing the susceptibility of the region to multi-hazards. The social vulnerability index (SVIent) has been introduced, consisting of 13 indicators and 33 variables. The variables have been standardized using the maximum and minimum normalization method and the relative importance for each indicator has been determined using Shannon entropy methods to compute SVIent. The findings revealed that female population, population above 60 years old, net irrigated area, migrant population, dilapidated house, nonworkers, bank, and nonworkers seeking jobs were found to be relatively significant contributors to the vulnerability. The western part of the study area was classified as the highly vulnerable category (SVI > 0.40628), attributed to high dependence, and higher share of unemployed workers and high poverty. The SVIent was shown to have positive correlation between unemployment, socioeconomic status, migration, dependency, and household structure significant at two-tailed test. The study's impact can be found in influencing the decision of policymakers and stakeholders in framing the mitigation strategies and policy documents.

Provider-to-provider telemedicine for sepsis is used less frequently in communities with high social vulnerability.

PURPOSE: Sepsis disproportionately affects patients in rural and socially vulnerable communities. A promising strategy to address this disparity is provider-to-provider emergency department (ED)-based telehealth consultation (tele-ED). The objective of this study was to determine if county-level social vulnerability index (SVI) was associated with tele-ED use for sepsis and, if so, which SVI elements were most strongly associated. METHODS: We used data from the TELEmedicine as a Virtual Intervention for Sepsis in Rural Emergency Department study. The primary exposures were SVI aggregate and component scores. We used multivariable generalized estimating equations to model the association between SVI and tele-ED use. FINDINGS: Our study cohort included 1191 patients treated in 23 Midwestern rural EDs between August 2016 and June 2019, of whom 326 (27.4%) were treated with tele-ED. Providers in counties with a high SVI were less likely to use tele-ED (adjusted odds ratio [aOR] = 0.51, 95% confidence interval [CI] 0.31‒0.87), an effect principally attributable to the housing type and transportation component of SVI (aOR = 0.44, 95% CI 0.22-0.89). Providers who treated fewer sepsis patients (1‒10 vs. 31+ over study period) and therefore may have been less experienced in sepsis care, were more likely to activate tele-ED (aOR = 3.91, 95% CI 2.08‒7.38). CONCLUSIONS: Tele-ED use for sepsis was lower in socially vulnerable counties and higher among providers who treated fewer sepsis patients. These findings suggest that while tele-ED increases access to specialized care, it may not completely ameliorate sepsis disparities due to its less frequent use in socially vulnerable communities.

Associations of neighborhood sociodemographic environment with mortality and circulating metabolites among low-income black and white adults living in the southeastern United States.

BACKGROUND: Residing in a disadvantaged neighborhood has been linked to increased mortality. However, the impact of residential segregation and social vulnerability on cause-specific mortality is understudied. Additionally, the circulating metabolic correlates of neighborhood sociodemographic environment remain unexplored. Therefore, we examined multiple neighborhood sociodemographic metrics, i.e., neighborhood deprivation index (NDI), residential segregation index (RSI), and social vulnerability index (SVI), with all-cause and cardiovascular disease (CVD) and cancer-specific mortality and circulating metabolites in the Southern Community Cohort Study (SCCS). METHODS: The SCCS is a prospective cohort of primarily low-income adults aged 40-79, enrolled from the southeastern United States during 2002-2009. This analysis included self-reported Black/African American or non-Hispanic White participants and excluded those who died or were lost to follow-up ≤ 1 year. Untargeted metabolite profiling was performed using baseline plasma samples in a subset of SCCS participants. RESULTS: Among 79,631 participants, 23,356 deaths (7214 from CVD and 5394 from cancer) were documented over a median 15-year follow-up. Higher NDI, RSI, and SVI were associated with increased all-cause, CVD, and cancer mortality, independent of standard clinical and sociodemographic risk factors and consistent between racial groups (standardized HRs among all participants were 1.07 to 1.20 in age/sex/race-adjusted model and 1.04 to 1.08 after comprehensive adjustment; all P < 0.05/3 except for cancer mortality after comprehensive adjustment). The standard risk factors explained < 40% of the variations in NDI/RSI/SVI and mediated < 70% of their associations with mortality. Among 1110 circulating metabolites measured in 1688 participants, 134 and 27 metabolites were associated with NDI and RSI (all FDR < 0.05) and mediated 61.7% and 21.2% of the NDI/RSI-mortality association, respectively. Adding those metabolites to standard risk factors increased the mediation proportion from 38.4 to 87.9% and 25.8 to 42.6% for the NDI/RSI-mortality association, respectively. CONCLUSIONS: Among low-income Black/African American adults and non-Hispanic White adults living in the southeastern United States, a disadvantaged neighborhood sociodemographic environment was associated with increased all-cause and CVD and cancer-specific mortality beyond standard risk factors. Circulating metabolites may unveil biological pathways underlying the health effect of neighborhood sociodemographic environment. More public health efforts should be devoted to reducing neighborhood environment-related health disparities, especially for low-income individuals.

Feeling hot is being hot? Comparing the mapping and the surveying paradigm for urban heat vulnerability in Vienna.

With rising global temperatures, cities increasingly need to identify populations or areas that are vulnerable to urban heat waves; however, vulnerability assessments may run into ecological fallacy if data from different scales are misconstrued as equivalent. We assess the heat vulnerability of 1983 residents in Vienna by measuring heat impacts, exposure, sensitivity and adaptive capacity with mirrored indicators in the mapping paradigm (i.e. census tract data referring to the geographic regions where these residents live) and the surveying paradigm (i.e. survey data referring to the residents' individual households). Results obtained in both paradigms diverge substantially: meteorological indicators of hot days and tropical nights are virtually unrelated to self-reported heat strain. Meteorological indicators are explained by mapping indicators (R2 of 15-40 %), but mostly not by surveying indicators. Vice versa, experienced heat stress and subjective heat burden are mostly unassociated with mapping indicators but are partially explained by surveying indicators (R2 of 2-4 %). The results suggest that the two paradigms do not capture the same components of vulnerability; this challenges whether studies conducted in the respective paradigms can complement and cross-validate each other. Policy interventions should first define which heat vulnerability outcome they target and then apply the paradigm that best captures the specific drivers of this outcome.

Examining the role of social vulnerability, neighborhood characteristics, and geospatial patterns of firearm-related injuries and clinical outcomes in Milwaukee county.

BACKGROUND: Previous work has shown socioenvironmental factors can influence firearm injury. Milwaukee County, Wisconsin is a diverse midwestern county with historic disinvestment in marginalized communities yielding stark segregation along racial and ethnic lines. It is also one of the many U.S. counties burdened by surging firearm injuries. The differences among communities within Milwaukee County provides a unique opportunity to explore the intersection of socioenvironmental factors that may affect clinical outcomes and geospatial patterns of firearm injury. METHODS: The trauma registry from the regional adult level 1 trauma center was queried for patients who sustained a firearm-related injury from 2015 to 2022 (N = 2402). The Social Vulnerability Index (SVI) ranking was derived using patient residence addresses to evaluate its association with traumatic injury clinical outcomes (i.e., in-hospital mortality, length of hospital stay, ICU or ventilator treatment, or injury severity score) and risk screening results for alcohol use disorder (AUD), posttraumatic stress disorder (PTSD), and depression. We evaluated hotspots of firearm injury density over time for patient residences and injury locations and distances between locations. A spatially lagged regression model tested the association between firearm injury density and SVI domains, alcohol outlet types, and park coverage. RESULTS: Most firearm injury patients were younger, male, racial or ethnic minorities from disadvantaged neighborhoods (SVI total; M = 0.86, SD = 0.15). SVI was not associated with any clinical outcomes. Of those screened, 12.9% screened positive for AUD and 44.5% screened at risk for PTSD, depression, or both. Hotspot analysis indicated consistent concentrations of firearm injury density. There were no differences in clinical outcomes between those injured inside or outside the home. Census tracts with lower socioeconomic status, greater off-premises and lower on-premises alcohol outlet density were associated with greater firearm injury density. CONCLUSIONS: In Milwaukee County, firearm injury patients are injured in and often return to the same disadvantaged neighborhoods that may hamper recovery. Results replicate and expand previous work and implicate specific socioenvironmental factors for intervention and prevention of firearm injury.

Socioeconomic Disparities and the Prevalence of Antimicrobial Resistance.

BACKGROUND: The increased prevalence of antimicrobial resistant (AMR) infections is a significant global health threat, resulting in increased morbidity, mortality, and costs. The drivers of AMR are complex and potentially impacted by socioeconomic factors. We investigated the relationships between geographic and socioeconomic factors and AMR. METHODS: We collected select patient bacterial culture results from 2015 to 2020 from electronic health records (EHR) of two expansive healthcare systems within the Dallas-Fort Worth, TX (DFW) metropolitan area. Among individuals with EHR records who resided in the four most populus counties in DFW, culture data were aggregated. Case counts for each organism studied were standardized per 1,000 persons per area population. Using residential addresses, the cultures were geocoded and linked to socioeconomic index values. Spatial autocorrelation tests identified geographic clusters of high and low AMR organism prevalence and correlations with established socioeconomic indices. RESULTS: We found significant clusters of AMR organisms in areas with high levels of deprivation, as measured by the Area Deprivation Index (ADI). We found a significant spatial autocorrelation between ADI and the prevalence of AMR organisms, particularly for AmpC and MRSA with 14% and 13%, respectively, of the variability in prevalence rates being attributable to their relationship with the ADI values of the neighboring locations. CONCLUSIONS: We found that areas with a high ADI are more likely to have higher rates of AMR organisms. Interventions that improve socioeconomic factors such as poverty, unemployment, decreased access to healthcare, crowding, and sanitation in these areas of high prevalence may reduce the spread of AMR.

O contexto de pessoas em situação de rua que vivem com estomias / The context of homeless people who live with ostomies

Objective: To understand the context experienced by homeless people, with ostomies, in a municipality in southern Brazil. Method: A qualitative ethnographic study, whose sample consisted of four individuals. Data collection took place from May to June 2022. Participant observation, field diary, data from medical records, and interviews were used. Results: Regarding the participants' profile, the majority are young adults, male, and drug users. All participants had children and received government assistance. The average duration of living with an ostomy was two years and the primary reason was gunshot wounds. The aim was to understand the characteristics and health conditions of these individuals, viewed within the context of the Brazilian healthcare system and the way services are organized to provide care. Conclusion: It was found that in addition to the vulnerability of being homeless, their life context leads to social and mental consequences, and the invisibility of these individuals within society and the healthcare network is remarkable.

Objetivo: Conhecer o contexto vivenciado por pessoas em situação de rua com estomias em um município do Sul do Brasil. Método: Estudo qualitativo etnográfico, cuja amostra foi constituída por quatro pessoas e cuja coleta de dados ocorreu de maio a junho de 2022, por meio de observação participante, diário de campo, dados de prontuários e entrevistas. Resultados: Em relação ao perfil dos participantes, a maioria deles é adultos jovens, do sexo masculino e usuários de drogas. Todos os participantes possuíam filhos e recebiam auxílio do governo. A média de tempo com estomia é de dois anos, e o motivo principal foi ferimento por arma de fogo. Buscou-se conhecer e entender as características e as condições de saúde dessas pessoas, visualizadas a partir do contexto do sistema de saúde brasileiro e na forma como os serviços se organizam para atendimentos. Conclusão: Constatou-se que, além da situação de vulnerabilidade por estarem na rua, o contexto de vida dessas pessoas acarreta consequências sociais e mentais, e é marcante sua invisibilidade na sociedade e na rede de atenção à saúde.

Ambiente alimentar em um território de vulnerabilidade social em Piraquara-PR / Food environment in a socially vulnerable territory in Piraquara-PR

RESUMO O ambiente alimentar é um conceito fundamental para compreender como o contexto social influencia os comportamentos alimentares. Ele se refere ao conjunto de fatores físicos, econômicos e sociais que afetam o acesso e a disponibilidade de alimentos em uma determinada região. O objetivo deste estudo foi avaliar o ambiente alimentar em uma região de vulnerabilidade social no município de Piraquara, região metropolitana de Curitiba-PR. O ambiente alimentar foi mapeado a partir de busca ativa, virtual e no território, de todo e qualquer dos 122 estabelecimentos de venda de alimentos nas áreas de abrangência das unidades de saúde. Constatou-se a predominância de estabelecimentos de alimentos não saudáveis (62,2%), pequeno número de estabelecimentos que comercializam alimentos saudáveis (9,8%) e alta concentração de qualquer tipo de estabelecimento no entorno de duas das principais vias da região, deixando grandes áreas com maior dificuldade de acesso. Nesse contexto, destaca-se a importância da criação de equipamentos de Segurança Alimentar e Nutricional no município que promovam a garantia de acesso físico e econômico a uma alimentação adequada e saudável para as famílias, especialmente em áreas de vulnerabilidade socioeconômica.

ABSTRACT The concept of the food environment plays a crucial role in comprehending how the social context influences eating behaviors. It encompasses a combination of physical, economic, and social factors that impact food access and availability within a specific region. This study aimed to assess the food environment in a socially vulnerable area within the municipality of Piraquara, located in the metropolitan region of Curitiba-PR. The food environment was charted through an active virtual search within the territories covered by health units, leading to the identification of 122 establishments. The analysis revealed a prevalence of unhealthy food vendors in the region (62.2%), a limited number of establishments offering healthy food options (9.8%), and a notable concentration of various types of establishments around two main roads, creating significant access challenges in other areas. In this context, the significance of establishing Food and Nutrition Security facilities in the municipality is underscored. Such initiatives aim to ensure both physical and economic access to suitable and nutritious food, particularly for families residing in socioeconomically vulnerable regions.

Wildfires and climate justice: future wildfire events predicted to disproportionally impact socioeconomically vulnerable communities in North Carolina.

Wildfire events are becoming increasingly common across many areas of the United States, including North Carolina (NC). Wildfires can cause immediate damage to properties, and wildfire smoke conditions can harm the overall health of exposed communities. It is critical to identify communities at increased risk of wildfire events, particularly in areas with that have sociodemographic disparities and low socioeconomic status (SES) that may exacerbate incurred impacts of wildfire events. This study set out to: (1) characterize the distribution of wildfire risk across NC; (2) implement integrative cluster analyses to identify regions that contain communities with increased vulnerability to the impacts of wildfire events due to sociodemographic characteristics; (3) provide summary-level statistics of populations with highest wildfire risk, highlighting SES and housing cost factors; and (4) disseminate wildfire risk information via our online web application, ENVIROSCAN. Wildfire hazard potential (WHP) indices were organized at the census tract-level, and distributions were analyzed for spatial autocorrelation via global and local Moran's tests. Sociodemographic characteristics were analyzed via k-means analysis to identify clusters with distinct SES patterns to characterize regions of similar sociodemographic/socioeconomic disparities. These SES groupings were overlayed with housing and wildfire risk profiles to establish patterns of risk across NC. Resulting geospatial analyses identified areas largely in Southeastern NC with high risk of wildfires that were significantly correlated with neighboring regions with high WHP, highlighting adjacent regions of high risk for future wildfire events. Cluster-based analysis of SES factors resulted in three groups of regions categorized through distinct SES profiling; two of these clusters (Clusters 2 and 3) contained indicators of high SES vulnerability. Cluster 2 contained a higher percentage of younger (<5 years), non-white, Hispanic and/or Latino residents; while Cluster 3 had the highest mean WHP and was characterized by a higher percentage of non-white residents, poverty, and less than a high school education. Counties of particular SES and WHP-combined vulnerability include those with majority non-white residents, tribal communities, and below poverty level households largely located in Southeastern NC. WHP values per census tract were dispersed to the public via the ENVIROSCAN application, alongside other environmentally-relevant data.