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2.
Nat Food ; 5(3): 251-261, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38486126

RESUMO

Food consumption contributes to the degradation of air quality in regions where food is produced, creating a contrast between the health burden caused by a specific population through its food consumption and that faced by this same population as a consequence of food production activities. Here we explore this inequality within China's food system by linking air-pollution-related health burden from production to consumption, at high levels of spatial and sectorial granularity. We find that low-income groups bear a 70% higher air-pollution-related health burden from food production than from food consumption, while high-income groups benefit from a 29% lower health burden relative to their food consumption. This discrepancy largely stems from a concentration of low-income residents in food production areas, exposed to higher emissions from agriculture. Comprehensive interventions targeting both production and consumption sides can effectively reduce health damages and concurrently mitigate associated inequalities, while singular interventions exhibit limited efficacy.


Assuntos
Poluição do Ar , Renda , Pobreza , Alimentos , Agricultura
3.
Health Aff (Millwood) ; 43(3): 424-432, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38437600

RESUMO

Hospital prices for commercially insured people are high and vary widely, prompting states to seek ways to control hospital price growth. In October 2019, the Oregon state employee health insurance plan instituted a cap on hospital payments. Using 2014-21 data from the Oregon All Payer All Claims Reporting Program database, we performed a difference-in-differences analysis to test the impact of the cap on hospital facility prices for Oregon's state employee plan enrollees. We found that the cap was not associated with a significant reduction in inpatient facility prices across the post period (-$901.9 per admission) but was associated with a significant reduction in the second year after implementation (-$2,774.20). The cap was associated with a significant reduction in outpatient facility prices over the course of the first twenty-seven months of the policy (-$130.50 per procedure). We estimated $107.5 million (or 4 percent of total plan spending) in savings to the state employee plan during the first two years. The hospital payment cap successfully reduced hospital prices for enrollees in that plan.


Assuntos
Hospitalização , Hospitais , Humanos , Oregon , Bases de Dados Factuais , Renda
4.
Health Aff (Millwood) ; 43(3): 398-407, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38437604

RESUMO

Sixteen states have used Section 1332 waivers to implement reinsurance programs that aim to reduce premiums and increase enrollment in the Affordable Care Act's health insurance Marketplaces. Although reinsurance programs have successfully reduced premiums for unsubsidized enrollees, little is known about how reinsurance affects Marketplace premiums, minimum cost of coverage, and enrollment for the large majority of Marketplace enrollees who receive premium subsidies. Using a difference-in-differences analysis of matched counties straddling Georgia's borders to examine Georgia's 2022 implementation of its reinsurance program, we found that reinsurance increased the minimum cost of enrolling in subsidized Marketplace coverage by approximately 30 percent and decreased enrollment by roughly a third for Marketplace enrollees with incomes of 251-400 percent of the federal poverty level. Marketplace reinsurance programs may have the unintended consequences of increasing the minimum cost of subsidized coverage and reducing enrollment. These outcomes are especially relevant in the present policy context of enhanced subsidies, which have substantially reduced the number of unsubsidized enrollees who would benefit most from reinsurance.


Assuntos
Trocas de Seguro de Saúde , Patient Protection and Affordable Care Act , Estados Unidos , Humanos , Georgia , Renda , Políticas
5.
Int J Public Health ; 69: 1606571, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38440080

RESUMO

Objective: This article aims to identify individual and community-contextual level factors associated with the wellbeing of older adults (50 years and older) in rural Zambia. Methods: Data from the nationally representative 2015 Living Conditions Monitoring Survey (LCMS) was used. Employing multilevel mixed effects, the individual and community-contextual factors on wellbeing were determined. Results: Overall, 31.7% of rural older adults perceived their wellbeing as good. Both individual and community-contextual level factors are associated with the wellbeing of older adults in rural communities. At the individual level, wellbeing was associated with higher education attainment. Community-contextual factors significantly associated with wellbeing included improved housing, access to piped tap water within the premises, own charcoal or income to purchase firewood. Conclusion: The findings foreground the imperative to analyse both individual and community-contextual level factors of wellbeing to generate and present evidence for investments in education across the life course and for the development of infrastructure towards increasing the wellbeing of rural older adults. Additionally, the results provide a basis for planning by devising policies and programmes for older people to thrive and for no one to be left behind regardless the setting.


Assuntos
Renda , População Rural , Humanos , Idoso , Zâmbia , Escolaridade , Políticas
6.
Work ; 77(3): 721-729, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38457138

RESUMO

BACKGROUND: Customized employment (CE) is recognized in the Workforce Innovation and Opportunity Act (2014) as a strategy for promoting competitive integrated employment. However, the existing body of evidence supporting CE is mainly descriptive rather than experimental research. OBJECTIVE: This study examined the impact of CE on the employment outcomes, hours worked per week, and wages of transition-age youth with intellectual and developmental disabilities. METHOD: The outcomes of transition-age youth participating in a CE intervention were compared to those receiving treatment-as-usual using a randomized controlled trial design. RESULTS: Participants receiving CE were significantly more likely to secure competitive integrated employment than controls who received treatment-as-usual. Participants in the intervention and control conditions earned similar wages. Participants in the control condition worked more hours per week than those in CE. CONCLUSION: The findings from this study demonstrate the effectiveness of CE to assist transition-age youth with intellectual and developmental disabilities in obtaining competitive integrated employment, but future research is needed to examine factors impacting weekly hours and wages of participants in CE.


Assuntos
Readaptação ao Emprego , Criança , Humanos , Adolescente , Deficiências do Desenvolvimento , Reabilitação Vocacional , Renda , Salários e Benefícios
7.
BMC Public Health ; 24(1): 656, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38429749

RESUMO

BACKGROUND: Regular follow-up and medication can effectively reduce the risk of adverse outcomes for patients with hypertension. This study aimed to explore the temporal-spatial distribution characteristics and associated socioeconomic factors of visiting frequency for rural patients with hypertension in Fujian province from 2011 to 2016. METHODS: The medical records of patients with hypertension were abstracted from the database of New Rural Cooperative Medical Scheme. Geographically and temporally weighted regression model was used to analyze the associations between percentage of patients whose visiting frequency ≥ 4 times within a year and seven socioeconomic factors at the county level. RESULTS: The visiting rate of rural patients with hypertension was 0.79%, 1.27%, 1.87%, 2.29%, 2.78%, 3.43% over the six-year study period, respectively. The percentage of patients whose visiting frequency ≥ 4 times within a year gradually increased over time and the percentage ranged from 61 to 80% in a half of the counties by 2016. In general, there was positive association between Gross Domestic Product per capita and the percentage of patients whose visiting frequency ≥ 4 times within a year. The percentage of female patients, percentage of patients who aged ≥ 60 years, percentage of low-income patients, carbon emission intensity, percentage of savings and number of health technicians per 10,000 persons were negatively correlated with the percentage of patients whose visiting frequency ≥ 4 times within a year in most of counties of Fujian Province. In the sensitivity analysis, the percentage of outpatients whose visiting frequency ≥ 4 times within a year was higher than that of all patients. There was positive association between percentage of outpatients who aged ≥ 60 years and the percentage of outpatients whose visiting frequency ≥ 4 times. CONCLUSIONS: The visiting rate and the visiting frequency within a year for rural patients with hypertension in Fujian province need to be improved. Female and elderly patients should be the focus of health management. Effectively implementing the family doctor services, providing several kinds of free antihypertensive drugs, improving energy utilization efficiency and reasonably allocating the health resources may be the effective strategies to improve the follow-up compliance of patients.


Assuntos
Hipertensão , Idoso , Humanos , Feminino , Fatores Socioeconômicos , Hipertensão/epidemiologia , Renda , Pobreza , China/epidemiologia
8.
J Int AIDS Soc ; 27(3): e26232, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38494652

RESUMO

INTRODUCTION: Pre-exposure prophylaxis (PrEP) is an effective medication to reduce the risk of acquiring HIV. PrEP is available free of charge in the UK from sexual health clinics. Expanding PrEP delivery to community pharmacies holds promise and aligns with UK government goals to eliminate new cases of HIV by 2030. The aim of this scoping review was to describe the existing evidence about the barriers to and facilitators of community pharmacy oral PrEP delivery, for pharmacists and pharmacy clients, as aligned with the Capacity Opportunity, Motivation Behaviour (COM-B) Model. METHODS: Five bibliographic and five review databases were searched from inception to August 2023. Literature of any study design was included if it discussed barriers and facilitators of community pharmacy PrEP delivery. Trial registrations, protocols and news articles were excluded. RESULTS: A total of 649 records were identified, 73 full texts were reviewed and 56 met the inclusion criteria, predominantly from high-income/westernized settings. Most of the included literature was original research (55%), from the United States (77%) conducted during or after the year 2020 (63%). Barriers to PrEP delivery for pharmacists included lack of knowledge, training and skills (capability), not having the necessary facilities (opportunity), concern about the costs of PrEP and believing that PrEP use could lead to risk behaviours and sexually transmitted infections (motivation). Facilitators included staff training (capability), time, the right facilities (opportunity), believing PrEP could be a source of profit and could reduce new HIV acquisitions (motivation). For clients, barriers included a lack of PrEP awareness (capability), pharmacy facilities (opportunity) and not considering pharmacists as healthcare providers (motivation). Facilitators included awareness of PrEP and pharmacist's training to deliver it (capability), the accessibility of pharmacies (opportunity) and having an interest in PrEP (motivation). DISCUSSION: To effectively enhance oral PrEP delivery in UK community pharmacies, the identified barriers and facilitators should be explored for UK relevance, addressed and leveraged at the pharmacy team, client and care pathway level. CONCLUSIONS: By comprehensively considering all aspects of the COM-B framework, community pharmacies could become crucial providers in expanding PrEP accessibility, contributing significantly to HIV prevention efforts.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Farmácias , Humanos , Estados Unidos , Infecções por HIV/prevenção & controle , Infecções por HIV/tratamento farmacológico , Motivação , Renda , Fármacos Anti-HIV/uso terapêutico
9.
Health Promot Int ; 39(2)2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38501311

RESUMO

Research on social innovations in health has increased in recent years. However, little training is geared toward enhancing social innovation research capacity. Most health training for low- and middle-income countries (LMICs) is developed by individuals in high-income countries, disregarding LMIC researchers' wisdom and insights and the communities' needs. Our team organized a multi-phase investigation involving a series of surveys and co-creation group discussions to assess individuals' training needs that directly informed a subsequent co-created training workshop series. We conducted a Hennessy-Hicks Training Needs Assessment among the Social Innovation in Health Initiative (SIHI) network and formed a co-creation group comprising SIHI fellows to design related training workshops. We ran a final evaluation survey and analyzed the workshop series' strengths, weaknesses and threats. Descriptive and thematic analysis were employed to analyze survey data and open-ended responses. The final evaluation survey captured data from 165 learners in 35 countries, including 26 LMICs. Most participants (67.3%, 111/165) rated the training workshop series as excellent, and 30.3% (50/165) rated it as good on a five-point scale. The need for writing research grants and manuscripts was rated the highest priority. Learners were interested in community-engaged research and diversity, equity and inclusion. This workshop illustrated how co-creation could be an effective tool for developing training materials tailored for LMIC researchers. We also offer a template for conducting a needs assessment and subsequent training workshops for LMICs. The ground-up, locally developed courses may be more effective than externally developed training programs intended for LMICs.


Assuntos
Países em Desenvolvimento , Renda , Humanos , Determinação de Necessidades de Cuidados de Saúde , Inquéritos e Questionários , Pesquisadores
10.
PLoS One ; 19(3): e0295333, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38483967

RESUMO

Status or relative concerns (as in the idiom 'keeping up with the Joneses') can lead to negative feelings such as stress and anxiety. One key question is whether these concerns relate to daily smoking behaviour. The conjecture is that status concerns and the accompanying stress and anxiety might be associated with a higher likelihood of smoking and a higher number of cigarettes smoked, generating a higher instant physical reward and reducing the stress and anxiety. The literature aiming to identify this relationship focuses mostly on a single cross section of individuals, ignoring potential differences in unobserved characteristics of smokers and non-smokers (e.g., genetic factors, personality differences, parental smoking during childhood). This paper investigates the role of unobserved individual characteristics on this relationship, which has not been done in previous studies. Using a long panel data of smoking information in Germany and a variety of panel data model specifications, we show that there is no statistically significant association between relative income concerns and the likelihood of smoking or the number of cigarettes smoked among the overall population. We find a positive and significant relationship only among people who smoked at least one cigarette in the past. A 10% appreciation in the income of comparable other individuals relates to about 3.5 more cigarettes per month among these people. Importantly, failing to allow for the unobserved influences of smoking leads to three times larger estimates than when using models with unobserved factors correlating to the income and smoking behaviour. The results are robust with respect to alternative assumptions and specifications where we use different functional forms of unobserved heterogeneity, definitions of relative concerns, incomes, and reference groups.


Assuntos
Abandono do Hábito de Fumar , Produtos do Tabaco , Humanos , Fumar/epidemiologia , Fumar Tabaco , Fumantes , Renda
11.
JAMA Health Forum ; 5(3): e240126, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38488778

RESUMO

Importance: The Medicare Shared Savings Program (MSSP) includes more than 400 accountable care organizations (ACOs) and is among the largest and longest running value-based payment efforts in the US. However, given recent program reforms and other changes in the health care system, the experiences and perspectives of ACO leaders remain incompletely characterized. Objective: To understand the priorities, strategies, and challenges of ACO leaders in MSSP. Design, Setting, and Participants: In this qualitative study, interviews were conducted with leaders of 49 ACOs of differing sizes, leadership structures, and geographies from MSSP between September 29 and December 29, 2022. Participants were asked about their clinical and care management efforts; how they engaged frontline clinicians; the process by which they distributed shared savings and added or removed practices; and other factors that they believed influenced their success or failure in the program. Main Outcomes and Measures: Leader perspectives on major themes related to ACO initiatives, performance improvement, and the recruitment, engagement, and retention of clinicians. Results: Of the 49 ACOs interviewed, 34 were hospital-associated ACOs (69%), 35 were medium or large (>10 000 attributed beneficiaries) (71%), and 17 were rural (35%). The ACOs had a mean (SD) tenure of 8.1 (2.1) years in MSSP. Five major themes emerged: (1) ACO leaders reported a focus on annual wellness visits, coding practices, and care transitions; (2) leaders used both relationship-based and metrics-based strategies to promote clinician engagement; (3) ACOs generally distributed half or more of shared savings to participating practices; (4) ACO recruitment and retention efforts were increasingly influenced by market competition; and (5) some hospital-associated ACOs faced misaligned incentives. Conclusions and Relevance: In this study, the ACO leaders reported varied approaches to promoting clinician alignment with ACO goals, an emphasis on increasing annual wellness visits, and new pressures related to growth of other care models. Policymakers hoping to modify or expand the program may wish to incorporate these perspectives into future reforms.


Assuntos
Organizações de Assistência Responsáveis , Idoso , Humanos , Estados Unidos , Medicare , Hospitais , Pesquisa Qualitativa , Renda
12.
Support Care Cancer ; 32(3): 207, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38436749

RESUMO

PURPOSE: Children with leukemia may experience a range of chemotherapy-related symptoms. Identifying subgroups and their distinct characteristics of symptoms may improve symptom management. We aimed to identify subgroups and their distinct characteristics of chemotherapy-related symptoms in children with leukemia. METHODS: A cross-sectional survey was conducted among 500 children with leukemia, who completed questionnaires that assessed their demographic and clinical characteristics, as well as the Memorial Symptom Assessment Scale. Latent profile analysis was conducted to identify subgroups of symptoms. Additionally, multiple regression analysis and network analysis were utilized to reveal the characteristics of each subgroup. RESULTS: Four subgroups were identified: "Profile 1: low symptom burden subgroup" (26.2%), "Profile 2: moderate symptom burden subgroup in transitional period" (14.8%), "Profile 3: moderate psychological symptom burden subgroup" (35.6%), and "Profile 4: high symptom burden subgroup" (23.4%). Multiple logistic regression analysis indicated that lower primary caregiver's education level, lower family monthly income, self-paid medical expenses, induction remission period, and consolidation enhancement period were associated with more severe symptoms of subgroups. Network analysis further revealed that nausea was the core symptom in Profiles 1 and 2, while the core symptom in Profile 3 was "I don't look like myself." Additionally, worrying was the core symptom in Profile 4. CONCLUSION: There exists heterogeneity in chemotherapy-related symptoms. Four subgroups and their corresponding characteristics of children with varying symptom severity were identified. Identifying these subgroups will facilitate personalized care, maximize intervention effectiveness, and alleviate symptom burden.


Assuntos
Leucemia , Criança , Humanos , Estudos Transversais , Leucemia/tratamento farmacológico , Escolaridade , Renda , Náusea
13.
Ned Tijdschr Geneeskd ; 1682024 03 04.
Artigo em Holandês | MEDLINE | ID: mdl-38451168

RESUMO

OBJECTIVE: Differences in payment between men and women are common. The goal of this study was to assess differences in payment in a large Dutch university hospital. METHODS: The Human Resource Management & Organizational BehaviorCenter, University of Groningen conducted the study. Anonymous monthly data from UMCG employees from 2012-2020 (13,212 employees with a permanent appointment and a minimum size of 0.2 Full Time Equivalent (FTE)), were used regarding salary, function, leadership position, department, age, gender, FTE, bonuses and allowances. The total salary consisted of gross salary, bonuses and allowances. Medical specialists were further divided in surgical, medical and support groups. RESULTS: Female employees earned on average less than their male colleagues throughout the entire period. In 2020, female medical specialists received an average of 6.1% less salary than male colleagues; for non-medical staff this was 3.2%. A breakdown by salary components showed that for the medical specialists the difference in total salary was not due to differences in gross salary (-0.5%), but to the difference in allowances and bonuses. Female medical specialists received up to 7.1% less in bonuses and up to 5.4% less in allowances and for non-medical staff, in addition to a significant difference in gross salary in 2020 (average -1.7%), a similar pattern was seen. Among medical specialists, the difference was greatest for surgical specialists: 9.9%, compared to 3.0% and 0.4% for medical and support specialists respectively. CONCLUSION: We showed a gender payment gap within one of the largest university hospitals of the Netherlands, which is systematic, in time and throughout the institution. The most striking differences are due to bonuses and gratifications.


Assuntos
Renda , Salários e Benefícios , Feminino , Humanos , Masculino , Países Baixos , Hospitais Universitários , Etnicidade
14.
Sci Rep ; 14(1): 6575, 2024 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-38503779

RESUMO

Free riders, who benefit from collective efforts to mitigate climate change but do not actively contribute, play a key role in shaping behavioral climate action. Using a sample of 2096 registered American voters, we explore the discrepancy between two groups of free riders: cynics, who recognize the significance of environmental issues but do not adopt sustainable behaviors, and doubters, who neither recognize the significance nor engage in such actions. Through statistical analyses, we show these two groups are different. Doubters are predominantly male, younger, with lower income and education, exhibit stronger conspiracy beliefs, lower altruism, and limited environmental knowledge, are more likely to have voted for Trump and lean towards conservative ideology. Cynics are younger, religious, higher in socioeconomic status, environmentally informed, liberal-leaning, and less likely to support Trump. Our research provides insights on who could be most effectively persuaded to make climate-sensitive lifestyle changes and provides recommendations to prompt involvement in individual sustainability behaviors. Our findings suggest that for doubters, incentivizing sustainability through positive incentives, such as financial rewards, may be particularly effective. Conversely, for cynics, we argue that engaging them in more community-driven and social influence initiatives could effectively translate their passive beliefs into active participation.


Assuntos
Altruísmo , Motivação , Masculino , Humanos , Estados Unidos , Feminino , Renda , Classe Social , Mudança Climática
15.
PLoS One ; 19(3): e0298794, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38498475

RESUMO

We investigate the factors that influence the selection and productivity of informal service-oriented family enterprises in Nigeria. Using nationally representative micro-data from the Nigerian General Household Survey (2010-2015), we employed random-effect probit and selectivity-adjusted regression models to estimate and analyze the results. The findings reveal that the location of informal Non-Farm Household Enterprises (NFHEs)-whether home-based or non-home-based-significantly impacts the wholesale, retail, personal, and consultancy service sectors operated by informal NFHEs. This impact remains significant even after accounting for variations in individuals, households, or locational characteristics. Furthermore, when considering selectivity in the earnings equation, we found that home-based informal enterprises exhibit lower productivity compared to non-home-based enterprises, a difference that varies across sectors. Overall, factors such as the gender of business owners, educational levels, geopolitical zones, infrastructure, and business characteristics play a crucial role in determining the locational and productivity disparities among service-oriented enterprises in Nigeria. Key recommendations stemming from this study include addressing gender-based segregation and economic disparities, prioritising financial inclusion for small business development, bridging infrastructure gaps, and implementing policies that acknowledge and bolster the informal sector.


Assuntos
Características da Família , Renda , Humanos , Inquéritos e Questionários , Escolaridade , Nigéria
16.
BMC Public Health ; 24(1): 836, 2024 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-38500120

RESUMO

BACKGROUND: Hemodialysis patients require a reasonable dietary intake to manage their disease progression effectively. However, there is limited research on these patients' overall dietary knowledge, attitude, and practice (KAP) status. This study aimed to investigate the dietary KAP status and latent profiles in hemodialysis patients and identify sociodemographic and disease-related factors associated with these profiles and dietary practice. METHODS: A multicenter cross-sectional study involving 425 hemodialysis patients was conducted. A dietary KAP questionnaire in hemodialysis patients was used to evaluate the dietary KAP of the patients. A structural equation model was employed to analyze the correlations between dietary knowledge, attitude, and practice. Multiple linear regression analysis was used to identify factors associated with dietary practice scores. Latent profile analysis was conducted to determine the latent profiles of dietary KAP, and binary logistic regression was used to explore the sociodemographic and disease-related characteristics associated with each KAP profile in hemodialysis patients. RESULTS: The normalized average scores for dietary knowledge, attitude, and practice in hemodialysis patients were 0.58, 0.82, and 0.58, respectively. The structural equation model revealed significant positive correlations between dietary knowledge and attitude, and attitude and practice. Attitude played an indirect effect between knowledge and practice. Gender, cerebrovascular disease, and dietary attitude scores were identified as independent influencing factors for dietary practice scores. Two dietary KAP profiles were developed: a profile with general knowledge and attitude but low practice (40.2%) and a profile with general knowledge and attitude and high practice (59.8%). Binary logistic regression analysis indicated gender and monthly income per household significantly predicted membership in each KAP profile. CONCLUSIONS: The dietary practice of hemodialysis patients requires improvement. It is necessary to develop more individualized dietary interventions for these patients. Further exploration is needed to understand the motivation of patients to change their dietary behavior.


Assuntos
Dieta , Estado Nutricional , Humanos , Estudos Transversais , Renda , Características da Família , Conhecimentos, Atitudes e Prática em Saúde
17.
Int J Equity Health ; 23(1): 63, 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38504240

RESUMO

BACKGROUND: Oral health in Sweden is good at the population level, but seemingly with persisting or increasing inequities over the last decades. In 2008, a major Swedish reform introduced universal partial subsidies to promote preventive care and reduce the treatment cost for patients with extensive care needs. This study aimed to apply an intersectional approach to assess the impact of the 2008 subsidization reform on inequities in self-rated oral health among adults in Sweden over the period 2004-2018. METHODS: Data from 14 national surveys conducted over 2004-2018 were divided into three study periods: pre-reform (2004-2007), early post-reform (2008-2012) and late post-reform (2013-2018). The final study population was 118,650 individuals aged 24-84 years. Inequities in self-rated oral health were examined by intersectional analysis of individual heterogeneity and discriminatory accuracy across 48 intersectional strata defined by gender, age, educational level, income, and immigrant status. RESULTS: Overall, the prevalence of poor self-rated oral health decreased gradually after the reform. Gender-, education- and income-related inequities increased after the reform, but no discernible change was seen for age- or immigration-related inequities. The majority of intersectional strata experienced patterns of persistently or delayed increased inequities following the reform. CONCLUSIONS: Increased inequities in self-rated oral health were found in most intersectional strata following the reform, despite the seemingly positive oral health trends at the population level. Applying an intersectional approach might be particularly relevant for welfare states with overall good oral health outcomes but unsuccessful efforts to reduce inequities.


Assuntos
Renda , Saúde Bucal , Adulto , Humanos , Suécia , Escolaridade , Reforma dos Serviços de Saúde
19.
Trials ; 25(1): 206, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38515150

RESUMO

BACKGROUND: There is little evidence on how to support ultra-poor people with disabilities to adopt sustainable livelihoods. The Disability-Inclusive Graduation (DIG) programme targets ultra-poor people with disabilities and/or women living in rural Uganda. The programme is an adaptation of an ultra-poor graduation model that has been shown to be effective in many contexts but not evaluated for people with disabilities. METHODS: The DIG programme works with project participants over a period of 18 months. Participants receive unconditional cash transfers for 6 months, training, access to savings-and-loans groups, and a capital asset that forms the basis of their new livelihood. The programme is also adapted to address specific barriers that people with disabilities face. Eligible households are clustered by geographical proximity in order to deliver the intervention. Eligibility is based on household screening to identify the 'ultra-poor' based on proxy means testing-both households with and without people with disabilities are included in the programme. Clusters are randomly selected prior to implementation, resulting in 96 intervention and 89 control clusters. The primary outcome of the trial is per-capita household consumption. Before the start of the intervention, a baseline household survey is conducted (November 2020) among project participants and those not offered the programme, a similar endline survey is conducted with participants with disabilities at the end of programme implementation in July 2022, and a second endline survey for all participants in October 2023. These activities are complemented by a process evaluation to understand DIG programme implementation, mechanisms, and context using complementary qualitative and quantitative methods. Ethical approval for the research has been received from Mildmay Uganda Research Ethics Committee and London School of Hygiene and Tropical Medicine. DISCUSSION: DIG is a promising intervention to evaluate for people with disabilities, adapted to be disability inclusive across programme components through extensive consultations and collaboration, and has proven efficacy at reducing poverty in other marginalised groups. However, evaluating a well-evidenced intervention among a new target group poses ethical considerations. TRIAL REGISTRATION: Registry for International Development Impact Evaluations, RIDIE-STUDY-ID-626008898983a (20/04/22). ISRCTN registry, ISRCTN78592382 . Retrospectively registered on 17/08/2023.


Assuntos
Pessoas com Deficiência , Instituições Acadêmicas , Humanos , Feminino , Uganda , Renda , Inquéritos e Questionários , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Hum Resour Health ; 22(1): 20, 2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38475844

RESUMO

BACKGROUND: Pay-for-performance (P4P) schemes are commonly used to incentivize primary healthcare (PHC) providers to improve the quality of care they deliver. However, the effectiveness of P4P schemes can vary depending on their design. In this study, we aimed to investigate the preferences of PHC providers for participating in P4P programs in a city in Shandong province, China. METHOD: We conducted a discrete choice experiment (DCE) with 882 PHC providers, using six attributes: type of incentive, whom to incentivize, frequency of incentive, size of incentive, the domain of performance measurement, and release of performance results. Mixed logit models and latent class models were used for the statistical analyses. RESULTS: Our results showed that PHC providers had a strong negative preference for fines compared to bonuses (- 1.91; 95%CI - 2.13 to - 1.69) and for annual incentive payments compared to monthly (- 1.37; 95%CI - 1.59 to - 1.14). Providers also showed negative preferences for incentive size of 60% of monthly income, group incentives, and non-release of performance results. On the other hand, an incentive size of 20% of monthly income and including quality of care in performance measures were preferred. We identified four distinct classes of providers with different preferences for P4P schemes. Class 2 and Class 3 valued most of the attributes differently, while Class 1 and Class 4 had a relatively small influence from most attributes. CONCLUSION: P4P schemes that offer bonuses rather than fines, monthly rather than annual payments, incentive size of 20% of monthly income, paid to individuals, including quality of care in performance measures, and release of performance results are likely to be more effective in improving PHC performance. Our findings also highlight the importance of considering preference heterogeneity when designing P4P schemes.


Assuntos
Renda , Reembolso de Incentivo , Humanos , Salários e Benefícios , China , Atenção Primária à Saúde
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