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1.

Development of the health literacy on social determinants of health questionnaire in Japanese adults.

Matsumoto, Masayoshi; Nakayama, Kazuhiro
| Idioma(s): Inglés
BACKGROUND: Health inequities are increasing worldwide, with mounting evidence showing that the greatest cause of which are social determinants of health. To reduce inequities, a lot of citizens need to be able to access, understand, appraise, and apply information on the social determinants; that is, they need to improve health literacy on social determinants of health. However, only a limited number of scales focus on these considerations; hence, we developed the Health Literacy on Social Determinants of Health Questionnaire (HL-SDHQ) and examined its psychometric properties. METHODS: We extracted domains of the social determinants of health from "the solid facts" and related articles, operationalizing the following ten domains: "the social gradient," "early life," "social exclusion," "work," "unemployment," "social support," "social capital," "addiction," "food," and "transport," Next, we developed the scale items in the ten extracted domains based on the literature and included four aspects of health literacy (ability to access, understand, appraise, and apply social determinants of health-related information) in the items. We also evaluated the ease of response and content validity. The self-administered questionnaire consisted of 33 items. The reliability and construct validity were verified among 831 Japanese adults in an internet survey. RESULTS: The scale items had high reliability with a Cronbach's alpha of 0.92, and also adequate results were obtained for the internal consistency of the information-processing dimensions (Cronbach's alpha values were 0.82, 0.91, 0.84, and 0.92 for accessing, understanding, appraising, and applying, respectively). The goodness of fit by confirmatory factor analysis based on the four dimensions was an acceptable value (comparative fit index = 0.901; root mean square error of approximation = 0.058). Furthermore, the bivariate relationship between HL-SDHQ and the frequency of participation in citizen's activities was similar to the theoretical results. CONCLUSIONS: HL-SDHQ clarifies the relationship between the ten domains of the social determinants of health and health in each domain and is able to measure whether it is possible to access, understand, appraise, and apply related information. The reliability and validity of the scale were adequate.
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3.

The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study.

Meddings, Jennifer; Reichert, Heidi; Smith, Shawna N; Iwashyna, Theodore J; Langa, Kenneth M; Hofer, Timothy P; McMahon, Laurence F
| Idioma(s): Inglés
BACKGROUND: Readmission rates after pneumonia, heart failure, and acute myocardial infarction hospitalizations are risk-adjusted for age, gender, and medical comorbidities and used to penalize hospitals. OBJECTIVE: To assess the impact of disability and social determinants of health on condition-specific readmissions beyond current risk adjustment. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of Medicare patients using 1) linked Health and Retirement Study-Medicare claims data (HRS-CMS) and 2) Healthcare Cost and Utilization Project State Inpatient Databases (Florida, Washington) linked with ZIP Code-level measures from the Census American Community Survey (ACS-HCUP). Multilevel logistic regression models assessed the impact of disability and selected social determinants of health on readmission beyond current risk adjustment. MAIN MEASURES: Outcomes measured were readmissions ≤30 days after hospitalizations for pneumonia, heart failure, or acute myocardial infarction. HRS-CMS models included disability measures (activities of daily living [ADL] limitations, cognitive impairment, nursing home residence, home healthcare use) and social determinants of health (spouse, children, wealth, Medicaid, race). ACS-HCUP model measures were ZIP Code-percentage of residents ≥65 years of age with ADL difficulty, spouse, income, Medicaid, and patient-level and hospital-level race. KEY RESULTS: For pneumonia, ≥3 ADL difficulties (OR 1.61, CI 1.079-2.391) and prior home healthcare needs (OR 1.68, CI 1.204-2.355) increased readmission in HRS-CMS models (N = 1631); ADL difficulties (OR 1.20, CI 1.063-1.352) and 'other' race (OR 1.14, CI 1.001-1.301) increased readmission in ACS-HCUP models (N = 27,297). For heart failure, children (OR 0.66, CI 0.437-0.984) and wealth (OR 0.53, CI 0.349-0.787) lowered readmission in HRS-CMS models (N = 2068), while black (OR 1.17, CI 1.056-1.292) and 'other' race (OR 1.14, CI 1.036-1.260) increased readmission in ACS-HCUP models (N = 37,612). For acute myocardial infarction, nursing home status (OR 4.04, CI 1.212-13.440) increased readmission in HRS-CMS models (N = 833); 'other' patient-level race (OR 1.18, CI 1.012-1.385) and hospital-level race (OR 1.06, CI 1.001-1.125) increased readmission in ACS-HCUP models (N = 17,496). CONCLUSIONS: Disability and social determinants of health influence readmission risk when added to the current Medicare risk adjustment models, but the effect varies by condition.
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4.

Introduction to the "Evaluating the Impact of Structural Policies on Health Inequalities and Their Social Determinants and Fostering Change" (SOPHIE) Project.

Borrell, Carme; Malmusi, Davide; Muntaner, Carles
| Idioma(s): Inglés
The SOPHIE Project (acronym for Structural Policies for Health Inequalities Evaluation) has focused on evaluating the impact of structural policies on health equity, considering as such all those policies that exert a powerful influence on the structural determinants of health (e.g., patterns of social stratification, living and working conditions) and thus on health-related exposures through intermediary determinants. In these sections of the International Journal of Health Services, we present some of the main findings of the SOPHIE Project. We include both articles that summarize all the evidence already published in the project on a thematic area (such as labor market, gender, or housing) and articles that present new, unpublished evidence on a specific health inequality or policy.
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6.

Advancing the Science of Health Disparities Through Research on the Social Determinants of Health.

Fouad, Mona N; Oates, Gabriela R; Scarinci, Isabel C; Demark-Wahnefried, Wendy; Hamby, Bryant W; Bateman, Lori B; Estrada, John J; Payton, Marinelle; Sims, Mario; Miele, Lucio; Partridge, Edward E
| Idioma(s): Inglés
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7.

The Social Determinants of Health Core: Taking a Place-Based Approach.

Scribner, Richard A; Simonsen, Neal R; Leonardi, Claudia
| Idioma(s): Inglés
INTRODUCTION: There is growing recognition that health disparities research needs to incorporate social determinants in the local environment into explanatory models. In the transdisciplinary setting of the Mid-South Transdisciplinary Collaborative Center (TCC), the Social Determinants of Health (SDH) Core developed an approach to incorporating SDH across a variety of studies. This place-based approach, which is geographically based, transdisciplinary, and inherently multilevel, is discussed. METHODS: From 2014 through 2016, the SDH Core consulted on a variety of Mid-South TCC research studies with the goal of incorporating social determinants into their research designs. The approach used geospatial methods (e.g., geocoding) to link individual data files with measures of the physical and social environment in the SDH Core database. Once linked, the method permitted various types of analysis (e.g., multilevel analysis) to determine if racial disparities could be explained in terms of social determinants in the local environment. RESULTS: The SDH Core consulted on five Mid-South TCC research projects. In resulting analyses for all the studies, a significant portion of the variance in one or more outcomes was partially explained by a social determinant from the SDH Core database. CONCLUSIONS: The SDH Core approach to addressing health disparities by linking neighborhood social and physical environment measures to an individual-level data file proved to be a successful approach across Mid-South TCC research projects.
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8.

The Role of Urban Environment, Social and Health Determinants in the Tracking of Leisure-Time Physical Activity Throughout Adolescence.

Magalhães, Alexandre Pedro Tavares da Fonseca; Pina, Maria de Fátima Rodrigues Pereira de; Ramos, Elisabete da Conceição Pereira
| Idioma(s): Inglés
PURPOSE: Adolescence may be a period particularly relevant for acquisition of lifelong habits of physical activity (PA). We investigated the tracking of leisure-time PA from 13 to 17 years old and the influence of urban environment and other determinants. METHODS: As part of the EPITeen cohort (Portugal), we evaluated 969 adolescents living in the city of Porto. Participants were assembled in public and private schools at 13 years and reevaluated at 17 years. Leisure-time PA was evaluated by self-reported questionnaires. The shortest routes from residence to urban green spaces and open sports spaces were calculated using the street network within a Geographical Information System. Odds ratio (OR) and 95% confidence intervals were calculated by multinomial logistic regression. RESULTS: Among sedentary girls at 13 years, 33.1% were still sedentary at 17 years, 39.8% changed to low, 22.3% to moderate, and only 4.6% changed to vigorous PA. In boys, the respective values were 32.3%, 17.3%, 36.2%, and 14.2%. High PA levels were maintained by 19.5% of the girls and by 41.1% of the boys. After adjustment for parental education and body image at 13 years, practice of sports at 13 years was strongly associated with stable high PA at 17 years: in girls OR = 3.96 (2.21, 7.12); in boys OR = 6.81 (3.30, 14.07). Distance to urban green spaces or to open sports spaces was not associated to changes in leisure-time PA. CONCLUSION: Practice of sports in early adolescence may be important to promote maintenance of high PA. Urban environment in the vicinity of residence did not affect changes in the practice of leisure-time PA.
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9.

How unemployment and precarious employment affect the health of young people: A scoping study on social determinants.

Vancea, Mihaela; Utzet, Mireia
| Idioma(s): Inglés
BACKGROUND: The impact of unemployment and precarious employment on the health of young people is not well understood. However, according to social causation, higher socio-economic positions and thus better working conditions are beneficial to health in general. We tried to synthesize the results of studies that test this hypothesis in the case of young people. METHODS: We conducted a scoping study mapping all the academic articles published in the period 2006-2016 in Europe. The literature was searched in PubMed/Medline, Science Direct, Web of Science and Scopus. RESULTS: We identified 1770 studies, of which only 46 met the inclusion criteria. There are more studies that focus on the relationship between unemployment and health than between precarious employment and health (28 and 16, respectively). The vast majority of the studies (44) found support for the social causation hypothesis, the most common health outcomes being mental health disorders, health risk behaviour, poor quality of life and occupational injuries. The causal mechanisms behind this association relied mainly on the life-course perspective, the breadwinner model, and the lack of social and economic benefits provided by standard employment. CONCLUSIONS: There is evidence that young people are especially vulnerable to health problems when unemployed or working in precarious conditions. Active labour market and training programmes, inclusive social security measures, improved working conditions and targeted health programmes are important for addressing this vulnerability. Further research should strive to enhance the causal model by including a gender perspective, longitudinal data, more indicators on precariousness and third factor explanations.
Resultados  1-10 de 51.858