Browsing by Subject "Vulnerable Populations"

Now showing 1 - 6 of 6
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    Adapting ethical guidelines for adolescent health research to street-connected children and youth in low- and middle-income countries: a case study from western Kenya
    (Springer (Biomed Central Ltd.), 2015-12-18) Embleton, L.; Ott, Mary A.; Wachira, J.; Naanyu, V.; Kamanda, A.; Makori, D.; Ayuku, D.; Braitstein, P.; Department of Epidemiology, Richard M. Fairbanks School of Public Health
    BACKGROUND: Street-connected children and youth (SCCY) in low- and middle-income countries (LMIC) have multiple vulnerabilities in relation to participation in research. These require additional considerations that are responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of adapting ethical guidelines for SCCY's specific vulnerabilities in LMIC. METHODS: As part of three interrelated research projects in western Kenya, we created procedures to address SCCY's vulnerabilities related to research participation within the local context. These consisted of identifying ethical considerations and solutions in relation to community engagement, equitable recruitment, informed consent, vulnerability to coercion, and responsibility to report. RESULTS: Substantial community engagement provided input on SCCY's participation in research, recruitment, and consent processes. We designed an assent process to support SCCY to make an informed decision regarding their participation in the research that respected their autonomy and their right to dissent, while safeguarding them in situations where their capacity to make an informed decision was diminished. To address issues related to coercion and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided access to care regardless of research participation. CONCLUSIONS: Although a vulnerable population, the specific vulnerabilities of SCCY can to some extent be managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in reducing inequities and advancing their health and human dignity.
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    Covid-19: Control Measures Must be Equitable and Inclusive
    (BMJ Publishing Group, 2020-03-20) Berger, Zackary D.; Evans, Nicholas G.; Phelan, Alexandra L.; Silverman, Ross D.; Health Policy and Management, School of Public Health
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    Pediatric assent for a study of antiretroviral therapy dosing for children in western Kenya: a case study in international research collaboration
    (Regents of the University of California, 2009-03) Vreeman, Rachel C.; Nyandiko, Winstone M.; Meslin, Eric M.
    Multinational collaborators in health research face particular ethical challenges when conducting studies involving vulnerable populations such as children. We use an example from our first attempt to implement pediatric assent in the context of a longstanding research and clinical partnership between Kenyan and American medical schools to highlight the ethical and procedural issues related to pediatric assent that must be considered for multinational, pediatric studies. We consider relevant domestic, professional, and international guidelines for assent in pediatric research subjects, and we discuss the particular ethical challenges related to pediatric assent in the Kenyan context. Finally, we propose a way forward for approaching pediatric assent within our collaborative research program in Kenya that may apply to other multinational research partnerships.
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    Reducing Physical Activity Disparities Among Vulnerable Minorities: Methods and Preliminary Outcomes
    (2023) Alamilla, Rafael A.; Georgiadis, Yanoula M.; Kaushal, Navin; Keith, NiCole R.
    INTRODUCTION: Vulnerable minorities experience high rates of chronic disease. Physical Activity (PA) is an effective preventive behavior to mitigate multiple diseases. Vulnerable minorities have low PA participation. Finding ways to engage vulnerable minorities in PA is imperative. PURPOSE: To describe preliminary data from a community-based wait-list pilot PA trial for vulnerable minorities. METHODS: Forty-five participants from a Midwest urban community were randomized to an experimental (EXP: N = 23; 15 F) or control (CON: N = 22; 15 F) group. Baseline measures are height = 168.5 ± 9.1cm (EXP), and 167.9 ± 7.0cm (CON); weight = 95.8 ± 26.4kg (EXP) and 85.0 ± 19.3kg (CON), age = 39.9 ± 9.7y (EXP) and 48.8 ± 13.2y (CON). EXP participants were counseled to engage in regular PA (>4d/wk for >30 mins). EXP participants received a fitness center membership, trainer, and on-site monthly education to help them develop exercise identity and habit formation. The CON group could engage in PA if desired but did not have the same research resources. Both groups completed monthly surveys assessing exercise identity, social support, and habit formation. Baseline data included one week of moderate-to-vigorous PA (MVPA) and health-related fitness (measured by accelerometry and fitness tests, respectively). RESULTS: Paired-samples T-test were used to make baseline comparisons. Study participants were 73.2% White, 67.4% employed full-time, 56.1% obtained a bachelor’s degree or higher, and 32.0% earned >300% of the federal poverty level. MVPA was 127.9 ± 69.8 min/wk (EXP) and 174.7 ± 103.1 min/wk (CON). Other non-significant outcomes included body fat % (EXP: 37.1 ± 10.9%; CON: 32.9 ± 12.0%), 8ft-up-and-go time (EXP: 5.01 ± 0.8s; CON: 5.05 ± 1.10s), and 30s chair stand (EXP: 15.3 ± 6.5; CON: 17.5 ± 5.2), 30s seated arm curl (EXP: R =18.9 ± 5.1, L = 19.2 ± 5.1; CON: R = 21.2 ± 5.7, L = 20.1 ± 5.4). Chair sit-and-reach scores for right (EXP: -0.1 ± 8.3cm; CON: 1.0 ± 12.2cm, p = 0.003 ) and left (EXP: -0.3 ± 8.2cm; CON: 0.1 ± 11.4cm, p = 0.01) legs were different. CONCLUSION: Data show baseline measures did not vary between groups and difficulty recruiting vulnerable minorities. Next steps include reporting final outcomes and developing refined recruitment methods.
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    Suicide Prevention
    (The Center for Health Policy, 2020-01-01) Gutta, Jyotsna; Heniff, Lauren; Greene, Marion S.
    Suicide, or intentional self-harm, is one of the leading causes of death in the United States. Suicide rates among Hoosiers have increased from 12.6 per 100,000 in 2008 to 16.3 per 100,000 in 2017, a nearly 30% increase over the 10-year period. One in ten Indiana high school students attempted and survived suicide; those who identified as gay, lesbian, or bisexual had significantly higher rates of suicide-related thoughts and behaviors compared to students who identified as heterosexual. A variety of factors contribute to a person’s likelihood to engage in suicidal thoughts and behaviors. Though anyone can be affected by suicide, there are some groups within the population that are at a particularly high risk due to the stresses they experience. The purpose of this report is to provide an overview of suicide risks, trends, and current interventions in Indiana. To accomplish this, we (1) reviewed the literature and existing data, (2) conducted key informant interviews with state experts, and (3) synthesized the information to provide recommendations for suicide prevention.
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    The vulnerabilities of orphaned children participating in research: a critical review and factors for consideration for participation in biomedical and behavioral research
    (University of California Press, 2012-10) Thompson, Rachel T.; Meslin, Eric M.; Braitstein, Paula K. A.; Nyandiko, Winstone M.; Ayaya, Samuel O.; Vreeman, Rachel C.; Department of Pediatrics, IU School of Medicine
    Orphans are a subpopulation with a unique set of additional vulnerabilities. Increasing focus on children's rights, pediatric global health, and pediatric research makes it imperative to recognize and address unique vulnerabilities of orphaned children. This paper describes the unique vulnerabilities of the orphaned pediatric population and offers a structured set of factors that require consideration when including orphans in biomedical research. Pediatric orphans are particularly vulnerable due to decreased economic resources, psychosocial instability, increased risk of abuse, and delayed/decreased access to healthcare. These vulnerabilities are significant. By carefully considering each issue in a population in a culturally specific and study-specific manner, researchers can make valuable contributions to the overall health and well-being of this uniquely vulnerable population.