Understanding of Socially Vulnerable Individuals on Oral Health and Access to Dentist: A Brazilian Study

Social vulnerability experienced by collectors of recyclable materials has a strong influence on their understanding and confrontations health. This research aimed to explore the relationship between oral health and perception of subjects in a context of social disadvantage, in order to support concrete alternatives for action on (oral) health conference. This was a qualitative study carried out with representatives of an autonomous community of Brazilian collectors of recyclable materials. Data were collected through interviews and focus group treated with the technique of qualitative analysis. Respondents showed perceptions of etiology and care practices on oral health promoted beliefs and values collectively instituted in a social risk territory. Also, they associate the quality of their oral health and their difficulty of public access to the context of social vulnerability. This study suggests the adoption of protective, educational and interceptive in oral health practice in order to improve and enable the oral health status of this population.

Identification of the Profile of Vulnerable Population to Elaborate Efficient Employment Strategy:Proposition of a Quantitative-creative Approach

Brazilian public managers have been structuring and updating policies to support workers’employment and income strategies.However,when the vulnerable individual has social,emotional,or technical limitations,success in this operation becomes uncertain.This research aim was to propose a methodology to identify profiles in vulnerable populations,viewing to promote the efficient elaboration of employment and income strategies.The unit of analysis was vulnerable population of waste pickers,in a large city from South Brazil,in the scope of a municipal program named"All of us are Porto Alegre".A literature review allowed the identification of tools from marketing,economy and design adequate to profile analysis.A workshop with social educators responsible for giving support to the individuals.Insights from workshop and the literature allowed the proposition of a methodology including cluster analysis and the creative tool named personas.The methodological approach suggests it is adequate in confirming the differences in profiles.The theoretical contribution lies in the use of quantitative-creativity tools to support policymaking.The practical contribution is to provide consistent information for governmental decision-making at the labor access market.

The relationship between acceptance of illness and quality of life among men who have sex with men living with human immunodeficiency virus:A cross-sectional study

Objectives To explore the relationship between acceptance of illness and quality of life(QOL),and factors associated with acceptance of illness among men who have sex with men(MSM)living with human immunodeficiency virus(HIV).Methods Three hundred and one MSM were recruited from an HIV clinic between August and December 2018.The battery of measurements consisted of the Acceptance of Illness Scale,World Health Organization Quality of Life Questionnaire for HIV brief version,HIV Cognitive Appraisal Scale and a self-designed questionnaire used to collect general information.Pearson correlation test was used to examine the relationship between acceptance of illness and QOL.Univariate and multivariate ordinal logistic regression analyses were used to examine whether the general data(demographic and HIV-related clinical data)and HIV cognitive appraisal were associated with acceptance of illness levels.Results Descriptive analysis showed the acceptance level among MSM living with HIV was moderate(Mean=26.29,SD=5.28).Those with a better acceptance of illness had a better QOL(r=0.69,P<0.01).In the multivariate ordinal logistic regression model,education level,threat appraisals(OR:1.09;95%CI[1.06–1.13]),and controllability appraisals(OR:0.82;95%CI[0.71–0.94])were significantly associated with acceptance of illness.Conclusions Results showed acceptance level was moderate and had a positive correlation with QOL.High level of education,low threat appraisals and high controllability appraisals were related to high illness acceptance.This finding highlights the importance of focusing on HIV-infected MSM with low education and on their perceptions of threat and controllability about HIV-related issues when designing interventions to promote illness acceptance in this vulnerable population.

Coronavirus Dynamics:The Undulating Playing Field

The goal of the paper is to conduct an exploratory review and analyses of the dynamics of the pandemic focusing on two themes:pandemic morbidity and vulnerable populations.Method:Review of literature,anecdotal evidence,and reports on the morbidity of COVID-19;including scope of its devastating effects in selected countries.Findings:The devastating effects of the coronavirus are felt across different vulnerable populations.These include the elderly,front line workers,marginalized communities,visible minorities,and more.Inadequate and sometimes conflicting remarks by“experts”have only contributed in exacerbating the confusion in the general population.However,compassion and empathy from different communities have had positive effects on mitigating some of the health outcomes like mental health and other health-related effects of the pandemic.Institutional support needs to be strengthened,especially with regard to individual risks and supply chain coordination:personal protection equipment(PPE),masks,swabs,reagents,etc.The challenge in Africa is especially daunting,because of limited and inadequate financial resources and infrastructure,as confirmed by the health budget allocations as a percentage of their respective GDP(gross domestic product).Discussion:The effects of the COVID-19 are producing unprecedented and catastrophic outcomes in many countries.These have been exacerbated by the level of unpreparedness and inadequate degrees of prevention and intervention strategies.With a few exceptions,the common and current intervention approach is driven by many unknowns including compilation of relevant reliable and compelling data sets.Vulnerable communities continue to suffer most:a situation that is highlighted in this essay as one attempt to remind institutions of their duty to provide appropriate support,including compassion and empathy to these populations.The repercussions of no or inadequate action are numerous,significant,and mind-boggling with unpredictable future outcomes and possible dire consequences.The continuous carnage caused by COVID-19 is a wake-up call reminding all stakeholders(public and private institutions)that once again the inequality infiltrating vulnerable populations needs to be effectively addressed with emphasis on affordability,improved quality of life,and an inclusive long-term strategic plan.Ubiquitous and inadequate supply chain coordination mechanisms have been a major deterrent towards mitigating the effects of this coronavirus pandemic.

Current status of nitrous oxide use in pediatric patients

Nitrous oxide is one of the most commonly used inhalational anesthetic agents used in practice.It is a cost-effective,pleasant,safe,and versatile anesthetic agent with many desirable properties like good quality analgesia,decreased awareness,accelerated induction and recovery from anesthesia,and reduced utilization of other expensive inhalational agents with potential cost savings.The use of nitrous oxide has been questioned by a lot of studies and case reports perceiving its adverse systemic,hematological,immune,and neurologic adverse effects.However,the literature in the recent past has tried to resolve the controversies related to its use.The concerns over an increase in cardiovascular complications and mortality following nitrous oxide use have been negated by recent data.However,its use in certain vulnerable populations like children with cobalamin and folate deficiency or defects in their metabolic pathways remains a cause of concern for its toxic effects.In this narrative review,we aim to discuss the pharmacological properties of nitrous oxide,the potential advantages and drawbacks of the use of nitrous oxide in children,address the neurodevelopmental and other systemic effects,and throw light on the evidence regarding the safety of nitrous oxide use and its current role in pediatric procedural sedation and anesthesia practice.The literature related to its use in the pediatric population for painful procedures and surgeries has been summarized.

Health risks from non-optimal temperatures in different populations and regions in China:Tailored intervention strategies are needed

Identifying temperature-sensitive diseases,vulnerable populations and attributable disease burden is crucial for the development and implementation of tailored climate change adaptation strategies in the context of climate change,especially through both mortality and morbidity analysis by using the data from same regions and populations.We re-analyzed and outlined the whole picture of the impacts of extreme temperatures on both mortality and morbidity among various populations and regions,based on the researches from a well-planned national project of Scientific Survey of Regional Meteorological Sensitive Diseases(SRMSD)with consistent methodology in China.The twenty-four representative regions of the SRMSD project cover all eleven geographical meteorological divisions in the country,including urban and rural areas.In addition to circulatory and respiratory diseases,we found that neurological diseases,injuries,digestive diseases,endocrine diseases,genitourinary diseases,skin and subcutaneous tissue diseases were sensitive to extreme heat,while digestive diseases were sensitive to extreme cold.The extreme temperature-sensitive diseases and the attributable disease burden varied by region.Females and the elderly people(65 years old and above)were more vulnerable to extreme heat when using mortality as a health outcome,whereas males and the young and middle-aged adults were more vulnerable to morbidity risk from heat.Our findings provide important scientific evidence for regional distribution of temperature-sensitive diseases and identification of vulnerable populations in China.It provides evidence and implications of developing regional heat/cold-exposure intervention policies,especially for hospital emergency departments and ambulance services during hot seasons.

Temperature change between neighboring days and hospital admissions in China

The short-term temperature fluctuation caused by global climate change is one of the risk factors affecting public health.Exploring the association between temperature fluctuation and diseases,which has received relatively limited research attention,can contribute to enhancing awareness of health risks and taking timely measures for health risk alert and management.Therefore,this study aims to investigate the relationship between temperature change between neighboring days(TCN)and hospitalizations,identify diseases sensitive to extreme TCN,and evaluate the related disease burden.We collected meteorological and hospitalization data from 2014 to 2019 in 23 sites of China to explore the impact of TCN on hospitalizations.We first quantified site-specific associations between TCN and hospitalizations and then conducted meta-analysis to pool the results,to assess the relative risk of extreme TCN for susceptible diseases,and to estimate the related disease burden attributed to TCN.Stratified analyses were undertaken by age,sex,and disease type.Results showed that all-cause hospital admission was significantly linked to TCN.A negative TCN(below-1.9℃)in the cool season and a positive TCN(above 1.0℃)in the warm season increased the risk of hospitalization.People aged 15-64 years,men,and patients with musculoskeletal system or connective tissue diseases were more sensitive to extremely negative TCN during the cool season.People aged over 65 years,men,and patients with respiratory diseases were more sensitive to extremely positive TCN during the warm season.The attributable fraction to all-cause hospitalization from negative TCN in the cool season was 2.05%(95%CI:-0.90%,4.53%)and from positive TCN in the warm season was 5.79%(95%CI:2.98%,8.31%).Circulatory diseases in the cool season and respiratory diseases in the warm season had the highest disease burden.Our findings indicate that awareness of TCN and its health risks should be promoted and evidence-informed policies are needed to reduce the risk of TCN.

The main and added effects of heat on mortality in 33 Chinese cities from 2007 to 2013

Increases in ambient temperatures and the frequency of extreme heat events constitute important burdens on global public health.However,evidence on their effects on public health is limited and inconclusive in China.In this study,data on daily deaths recorded in 33 Chinese cities from 2007 to 2013 was used to evaluate the effect of heat on mortality in China.In addition to the definition of a heatwave established by the China Meteorological Administration,we combined four city-specific relative thresholds(90th,92.5th,95th,and 97.5th percentiles)of the daily mean temperature during the study period and three durations of≽2,≽3,and≽4 days,from which 13 heatwave definitions were developed.Then,we estimated the main and added effects of heat at the city level using a quasi-Poisson generalized additive model combined with a distributed lag nonlinear model.Next,the estimates for the effects were pooled at the national level using a multivariable meta-analysis.Subgroup analysis was performed according to sex,age,educational attainment,and spatially stratified heterogeneity.The results showed that the mortality risk increased from 22.3%to 37.1%due to the effects of the different heatwave definitions.The added effects were much lower,with the highest increase of 3.9%(95%CI:1.7%–6.1%)in mortality risk.Females,the elderly,populations with low educational levels,and populations living inland in China were found to be the most vulnerable to the detrimental effects of heat.These findings have important implications for the improvement of early warning systems for heatwaves.

Evaluation of Climatic Comfort of Living Environment based on Age Differentials in Beijing-Tianjin-Hebei Area

Somatosensory comfort is mainly determined by the Temperature and Humidity Index(THI)with Wind Efficiency Index(WEI),but this conventional usage of these indicators does not capture the age-related differentials.Here we resolved this gap with a modification of the climatic comfort definition and method in a national standard,denoted as the Relative Climate Sensitive Index(RCSI),which incorporated the age-related vulnerability scores determined through online questionnaires with a scoring method,for each of the age-related and adaptive climatic comfort responses to changes in residence with Beijing-Tianjin-Hebei(BTH)region as an example.First,the result showed that the human comfort of living environment decreased with age in the BTH region,implicating age obviously impacted comfort,and weak adaptability made the elderly the relatively most high-risk group-their suitable region was less than a quarter of the whole study region.Second the adverse effects of persistent hot weather on comfort,indicating global warming as the leading driver of dwindling comfort over recent years.As the warming was more significant in the southeastern part,all these forces combined had there a hotspot,appealing for extra attention.Last this improved evaluation accorded with actual situation to captured high-risk groups with their distributions.