Cost of illness due to respiratory syncytial virus acute lower respiratory tract infection among infants hospitalized in Argentina.

BACKGROUND: Information is scarce regarding the economic burden of respiratory syncytial virus (RSV) disease in low-resource settings. This study aimed to estimate the cost per episode of hospital admissions due to RSV severe disease in Argentina. METHODS: This is a prospective cohort study that collected information regarding 256 infants under 12 months of age with acute lower respiratory tract infection (ALRTI) due to RSV in two public hospitals of Buenos Aires between 2014 and 2016. Information on healthcare resource use was collected from the patient's report and its associated costs were estimated based on the financial database and account records of the hospitals. We estimated the total cost per hospitalization due to RSV using the health system perspective. The costs were estimated in US dollars as of December 2022 (1 US dollar = 170 Argentine pesos). RESULTS: The mean costs per RSV hospitalization in infants was US$587.79 (95% confidence interval [CI] $535.24 - $640.33). The mean costs associated with pediatric intensive care unit (PICU) admission more than doubled from those at regular pediatric wards ($1,556.81 [95% CI $512.21 - $2,601.40] versus $556.53 [95% CI $514.59 - $598.48]). CONCLUSIONS: This study shows the direct economic impact of acute severe RSV infection on the public health system in Argentina. The estimates obtained from this study could be used to inform cost-effectiveness analyses of new preventive RSV interventions being developed.

Temporal assessment of disparities in California COVID-19 mortality by industry: a population-based retrospective cohort study.

PURPOSE: To assess changes in the COVID-19 mortality rate and disparities over variants or waves by industry. METHODS: We identified COVID-19 deaths that occurred between January 2020 and May 2022 among California workers aged 18-64 years using death certificates, and estimated Californians at risk using the Current Population Survey. The waves in deaths were wave 1: March-June 2020, wave 2: July-November 2020, wave 3/Epsilon and Alpha variants: December 2020-May 2021, wave 4/Delta variant: June 2021-January 2022, and wave 5/Omicron variant: February-May 2022. We used Poisson regression to generate wave-specific mortality rate ratios (MRR) and included an interaction term between industry and wave in different models to assess significance of the change in MRR. RESULTS: In all waves of the pandemic, healthcare, other services, manufacturing, transportation, and retail trade industries had higher mortality rates than the professional, scientific, and technical industry. The healthcare industry had the highest relative rate earlier in the pandemic, while other services, utilities, and accommodation and food services industries had substantial increases in MRR in later waves. CONCLUSIONS: Industries that consistently had disproportionate COVID-19 mortality may have benefitted from protections that consider workers' increased exposure and vulnerability to severe outcomes.

Exploring the use of digital technology to deliver healthcare services with explicit consideration of health inequalities in UK settings: A scoping review.

Objective: To map and explore existing evidence on the use of digital technology to deliver healthcare services with explicit consideration of health inequalities in UK settings. Methods: We searched six bibliographic databases, and the National Health Service (NHS) websites of each UK nation (England, Scotland, Wales, Northern Ireland). Restrictions were applied on publication date (2013-2021) and publication language (English). Records were independently screened against eligibility criteria by pairs of reviewers from the team. Articles reporting relevant qualitative and/or quantitative research were included. Data were synthesised narratively. Results: Eleven articles, reporting data from nine interventions, were included. Articles reported findings from quantitative (n = 5), qualitative (n = 5), and mixed-methods (n = 1) studies. Study settings were mainly community based, with only one hospital based. Two interventions targeted service users, and seven interventions targeted healthcare providers. Two studies were explicitly and directly aimed at (and designed for) addressing health inequalities, with the remaining studies addressing them indirectly (e.g. study population can be classed as disadvantaged). Seven articles reported data on implementation outcomes (acceptability, appropriateness, and feasibility) and four articles reported data on effectiveness outcomes, with only one intervention demonstrating cost-effectiveness. Conclusions: It is not yet clear if digital health interventions/services in the UK work for those most at risk of health inequalities. The current evidence base is significantly underdeveloped, and research/intervention efforts have been largely driven by healthcare provider/system needs, rather than those of service users. Digital health interventions can help address health inequalities, but a range of barriers persist, alongside a potential for exacerbation of health inequalities.

Health Promotion in Debate: The Role of Women Leaders in the Favelas of Rio de Janeiro, Brazil.

This study aimed to discuss the actions of women leaders in favelas in Rio de Janeiro, Brazil, regarding the health promotion of people residing in territories affected by urban violence and inequalities. The understanding of social determinants of health (SDH) is not unequivocal and challenges us to expand our practices in health promotion and equity. A mixed-methods study was conducted with 200 women living in 169 favelas of Rio de Janeiro between 2018 and 2022. Questionnaires and semi-structured face-to-face interviews followed by thematic analysis were conducted. The analysis focused on the socio-demographic profile, community activism, and health promotion strategies undertaken by these groups, expanding knowledge on the experiences of these leaders in confronting social injustices. Results showed that participants performed health promotion actions in their communities by 1. strengthening popular participation and human rights, 2. creating environments favorable to health, and 3. developing personal skills towards social participation in policy design through mobilizing health services and third-sector organizations. With the limited presence of government public agents in these spaces, participants assumed roles as managers of local demands, and, by means of resistance, intersectionality, and solidarity, they transformed this micro-power into the potential for social transformation.

[Gender perspectives in mental health plans in Spain: a pending task?] / Perspectiva de género en los planes de salud mental en España: ¿una asignatura pendiente?

OBJECTIVE: To develop a gender sensitivity index and analyse the regional mental health plans in force in 2021 in terms of their gender sensitivity. METHOD: We reviewed the regional mental health plans in force in 2021 using an ad hoc questionnaire design based on a review of documents and reports on gender sensitivity in health policies. We construct an index based on both the symbolic and operative sensibility of plans. RESULTS: Of the seven plans reviewed, four scored less than 13 out of 26. The maximum score was 18 and the minimum 2. Symbolic gender sensitivity was higher than operational sensitivity. CONCLUSIONS: Mental health plans have a low or very low degree of gender sensitivity. Not considering gender as a determinant of mental health in the formulation of specific health plans may reduce the effectiveness of interventions aimed at reducing gender inequalities in mental health.

Pilot Study for the Assessment of the Best Radiomic Features for Bosniak Cyst Classification Using Phantom and Radiologist Inter-Observer Selection.

Since the Bosniak cysts classification is highly reader-dependent, automated tools based on radiomics could help in the diagnosis of the lesion. This study is an initial step in the search for radiomic features that may be good classifiers of benign-malignant Bosniak cysts in machine learning models. A CCR phantom was used through five CT scanners. Registration was performed with ARIA software, while Quibim Precision was used for feature extraction. R software was used for the statistical analysis. Robust radiomic features based on repeatability and reproducibility criteria were chosen. Excellent correlation criteria between different radiologists during lesion segmentation were imposed. With the selected features, their classification ability in benignity-malignity terms was assessed. From the phantom study, 25.3% of the features were robust. For the study of inter-observer correlation (ICC) in the segmentation of cystic masses, 82 subjects were prospectively selected, finding 48.4% of the features as excellent regarding concordance. Comparing both datasets, 12 features were established as repeatable, reproducible, and useful for the classification of Bosniak cysts and could serve as initial candidates for the elaboration of a classification model. With those features, the Linear Discriminant Analysis model classified the Bosniak cysts in terms of benignity or malignancy with 88.2% accuracy.

Health and Social Care Inequalities: The Impact of COVID-19 on People Experiencing Homelessness in Brazil.

This article aims to reflect on the challenges affecting people experiencing homelessness in Rio de Janeiro, Brazil, due the COVID-19 pandemic. Participatory research was carried out to identify data related to sociodemographic profile; strategies for survival; health and social care support; and access to services during the pandemic. The research methodology was co-designed with NGOs and people with lived experience of homelessness and involved conducting semi-structured questionnaires with 304 participants in 2020. The results highlighted the worsening of the situation of extreme vulnerability and poverty already experienced by this population before the pandemic. Key strategies led by Third Sector organizations to reduce the spread of the virus, to minimize the financial impact of lockdown, and to increase emotional support and information on COVID-19 were presented. The conclusions show the complexity of issues affecting these groups and the need for urgent response from public policies and Government support to guarantee their rights, dignity, and respect during and after the COVID-19 pandemic.

Which are the intermediate determinants of gender inequalities in mental health?: A scoping review.

BACKGROUND: Gender segmentation in the labour market and women's greater burden of domestic work and caregiving increase their risk of developing mental health problems, especially in vulnerable social groups. AIMS: The objectives of this study were to identify and describe the role of working and labour conditions, domestic work and caregiving and social support in gender inequalities in mental health, as well as to assess whether studies have taken an intersectional approach, describing its role in gender inequalities in mental health. METHODS: We carried out a systematic review of scientific articles published between 2010 and 2019 in PubMed, Scopus, WoS and PsycInfo, in Spanish and English, conducted in the European Economic Area in populations aged between 25 and 65 years. Studies were excluded if they were qualitative, focused on sexual identity or factors based on biological differences, or considered use of medical services, medicalisation or suicide as the outcome variable. RESULTS: A total of 30 articles were included, of which only four concerned studies in which intersectional analysis had been performed. The mental health of men was seen to be more influenced by employment conditions and that of women by working conditions, the double presence and civil status. Further, depending on the size of the household (women) and unemployment (men), people in lower social classes had poorer mental health outcomes. CONCLUSIONS: The results may be useful for designing policies focused on reducing gender inequalities in mental health. Additionally, they show the need for taking an intersectional perspective.

Social Inequalities in Health Determinants in Spanish Children during the COVID-19 Lockdown.

The COVID-19 lockdown was imposed in a context of notable inequalities in the distribution of the social determinants of health. It is possible that the housing conditions in which children and their families experienced the confinement, and the adoption of healthy behaviors, may have followed unequal patterns. The aim was to describe social inequalities in housing conditions and in health-related behaviors among children during the lockdown in Spain. This cross-sectional study was based on data from an online survey collecting information on the child population (3-12 years) living in Spain (n = 10,765). The outcome variables used were several housing conditions and health-related behaviors. The socioeconomic variables used were financial difficulties and parents' educational level. Crude prevalence and prevalence ratios estimated using Poisson models were calculated. During lockdown, children from families with low educational levels and financial difficulties not only tended to live in poor housing conditions, but were also exposed to negative health determinants such as noise and tobacco smoke; they took less physical exercise, had a poorer diet, spent more time in front of screens and had less social contact. A notable social gradient was found in most of the variables analyzed. The results point to the need to incorporate the perspective of equity in the adoption of policies in order to avoid the increase of pre-existing social inequalities in the context of a pandemic.

Diagnosis and Treatment of Depression in Spain: Are There Gender Inequalities?

It is well known that women are more likely than men to be diagnosed with depression and to consume antidepressants. The factors related to the medicalisation of depression and their social distribution remain unclear. The aim of this study was to analyse gender inequalities in the medicalisation of depression from an intersectional perspective. This was a cross-sectional study based on data from the European Health Survey relating to Spain. Gender inequalities were calculated using prevalence ratios of women compared to men with a diagnosis of depression and antidepressant use, adjusted for age, depressive symptoms, primary care visits and diagnosis of depression in the case of antidepressant use. After adjustments, the diagnosis of depression and the use of antidepressants were more prevalent in women, especially of lower socioeconomic levels. Gender inequalities in the diagnosis of depression also increased with decreasing level of education. Regarding the use of antidepressants, gender inequalities were not significant in university graduates and people of higher social. The gender inequalities found in the diagnosis and treatment of depression cannot be completely attributed to a higher level of depressive symptoms in women or their greater frequency of visits to primary care. Inequalities are greater in more vulnerable social groups.

Google timeline accuracy assessment and error prediction.

Google Location Timeline, once activated, allows to track devices and save their locations. This feature might be useful in the future as available data for evidence in investigations. For that, the court would be interested in the reliability of this data. The position is presented in the form of a pair of coordinates and a radius, hence the estimated area for tracked device is enclosed by a circle. This research focuses on the assessment of the accuracy of the locations given by Google Location History Timeline, which variables affect this accuracy and the initial steps to develop a linear multivariate model that can potentially predict the actual error with respect to the true location considering environmental variables. The determination of the potential influential variables (configuration of mobile device connectivity, speed of movement and environment) was set through a series of experiments in which the true position of the device was recorded with a reference Global Positioning System (GPS) device with a superior order of accuracy. The accuracy was assessed measuring the distance between the Google provided position and the de facto one, later referred to as Google error. If this Google error distance is less than the radius provided, we define it as a hit. The configuration that has the largest hit rate is when the mobile device has GPS available, with a 52% success. Then the use of 3G and 2G connection go with 38% and 33% respectively. The Wi-Fi connection only has a hit rate of 7%. Regarding the means of transport, when the connection is 2G or 3G, the worst results are in Still with a hit rate of 9% and the best in Car with 57%. Regarding the prediction model, the distances and angles from the position of the device to the three nearest cell towers, and the categorical (non-numerical) variables of Environment and means of transport were taking as input variables in this initial study. To evaluate the usability of a model, a Model hit is defined when the actual observation is within the 95% confidence interval provided by the model. Out of the models developed, the one that shows the best results was the one that predicted the accuracy when the used network is 2G, with 76% of Model hits. The second model with best performance had only a 23% success (with the mobile network set to 3G).

Mortality due to Respiratory Syncytial Virus. Burden and Risk Factors.

RATIONALE: Respiratory syncytial virus (RSV) is the most frequent cause of hospitalization and an important cause of death in infants in the developing world. The relative contribution of social, biologic, and clinical risk factors to RSV mortality in low-income regions is unclear. OBJECTIVES: To determine the burden and risk factors for mortality due to RSV in a low-income population of 84,840 infants. METHODS: This was a prospective, population-based, cross-sectional, multicenter study conducted between 2011 and 2013. Hospitalizations and deaths due to severe lower respiratory tract illness (LRTI) were recorded during the RSV season. All-cause hospital deaths and community deaths were monitored. Risk factors for respiratory failure (RF) and mortality due to RSV were assessed using a hierarchical, logistic regression model. MEASUREMENTS AND MAIN RESULTS: A total of 2,588 (65.5%) infants with severe LRTI were infected with RSV. A total of 157 infants (148 postneonatal) experienced RF or died with RSV. RSV LRTI accounted for 57% fatal LRTI tested for the virus. A diagnosis of sepsis (odds ratio [OR], 17.03; 95% confidence interval [CI], 13.14-21.16 for RF) (OR, 119.39; 95% CI, 50.98-273.34 for death) and pneumothorax (OR, 17.15; 95% CI, 13.07-21.01 for RF) (OR, 65.49; 95% CI, 28.90-139.17 for death) were the main determinants of poor outcomes. CONCLUSIONS: RSV was the most frequent cause of mortality in low-income postneonatal infants. RF and death due to RSV LRTI, almost exclusively associated with prematurity and cardiopulmonary diseases in industrialized countries, primarily affect term infants in a developing world environment. Poor outcomes at hospitals are frequent and associated with the cooccurrence of bacterial sepsis and clinically significant pneumothoraxes.

Late Diagnosis Due to Missed Opportunities and Inadequate Screening Strategies in HIV Infected Mexican Women.

Late diagnosis of HIV remains a public health issue in Mexico. Most national programs target high-risk groups, not including women. More data on factors associated with late diagnosis and access to care in women are needed. In 2012-2013, Mexican women recently diagnosed with HIV were interviewed. Socio-cultural background, household-dynamics and clinical data were collected. Of 301 women, 49 % had <200 CD4 cells/mm3, 8 % were illiterate, 31 % had only primary school. Physical/sexual violence was reported by 47/30 %; 75 % acquired HIV from their stable partners. Prenatal HIV screening was not offered in 61 %; 40 % attended consultation for HIV-related symptoms without being tested for HIV. Seeking medical care ≥3 times before diagnosis was associated with baseline CD4 <200 cells/mm3 (adjusted OR 3.74, 95 % CI 1.88-7.45, p < 0.001). There were missed opportunities during prenatal screening and when symptomatic women seeked medical care. Primary care needs to be improved and new strategies implemented for early diagnosis in women.

Exploring the benefits of Smile4life training: Findings from a pilot study.

Smile4life is Scotland's national oral health improvement programme for people experiencing homelessness. Following an oral health and psychosocial needs assessment of 853 homeless people across Scotland, the Smile4life intervention was developed and rolled out across all NHS boards. Dental health and health and social care practitioners were invited to attend a training event at the launch of the Smile4life: Guide for Trainers - a training guide for practitioners working with homeless people. This paper presents results from HoPSCOTCH, a pilot study that took place in four NHS boards to examine the benefits of training for practitioners regarding their awareness of homelessness and the oral health needs of homeless people. Dental health (baseline: 10; follow-up: 8) and health and social care practitioners (baseline: 13; follow-up: 12) completed questionnaires about their knowledge, attitudes and behaviours. The results showed that there were increases in practitioner knowledge, confidence and motivation to help service users access dental care, to provide oral health education and to use motivational interviewing. The authors recommend that future training for practitioners who work with homeless people should include communication skills and advice on how to deliver tailored interventions, with the aim of strengthening practitioners' confidence and motivation to deliver the Smile4life intervention.

Life-course socioeconomic position and change in quality of life among older adults: evidence for the role of a critical period, accumulation of exposure and social mobility.

BACKGROUND: This study evaluates the influence of socioeconomic position (SEP) over the life course on change in health-related quality of life (HRQoL) in older adults. METHODS: A prospective cohort of 2117 individuals aged 60 years and over. In 2001, SEP was measured over the life course as social class in childhood (approximated by father's occupation), as educational level completed and as adult social class (occupation of household head). HRQoL was measured with the SF-36 health questionnaire. Changes from 2001 to 2003 in the scores for the physical component summary (PCS) and the mental component summary (MCS) of the SF-36 were calculated, and individuals were classified into three categories: decline (decrease of >5 points), no change (change of -5 to +5 points) and improvement (increase of >5 points) in HRQoL. RESULTS: After adjustment for baseline HRQoL, lifestyle, chronic illness, educational level and adult social class, low childhood social class was associated with a higher risk of both a decline and an improvement in the SF-36 PCS and MCS. The risk of decline in PCS and MCS and of improvement in MCS increased with the cumulative number of adverse SEP over the life course. Subjects who rose in social class from childhood to adulthood showed the greatest improvement on the SF-36 PCS and MCS. CONCLUSION: These results on the relation between SEP and changes in HRQoL in older adults support the three models proposed to explain health inequalities over the life course: the existence of critical periods, the accumulation of adverse SEP and social mobility.

Change in health-related quality of life as a predictor of mortality in the older adults.

PURPOSE: We examined whether changes in health-related quality of life (HRQL) predict subsequent mortality among the Spanish elderly. METHODS: Prospective cohort study of 2,373 persons, representative of the Spanish population aged 60 and older. HRQL was measured in 2001 and 2003 using the SF-36 health questionnaire. Cox regression models were used to examine the association of changes in the physical and mental component summary (PCS and MCS) scores of HRQL from 2001 to 2003 with all-cause mortality through 2007. RESULTS: Two hundred twelve deaths were ascertained from 2003 to 2007. The hazard ratios for mortality across categories of PCS change were as follows: 2.12 (95% confidence interval [CI] 1.39-3.24) for a > 10-point decline; 1.51 (1.01-2.28) for a 6- to 10-point decline; 1 for the reference category, a change of -5 to +5 points; 0.83 (0.51-1.34) for a 6- to 9-point improvement and 0.68 (0.42-1.09) for a > 10-point improvement; P for linear trend <0.001. The associations between changes in the MCS and mortality showed the same direction, but were of a lower magnitude and attained statistical significance (P < 0.05) only for a > 10-point decline in MCS. CONCLUSIONS: Changes in HRQL predict mortality in the older adults. A decline in HRQL should alert to a worse vital prognosis and stimulate the search for the possible determinants of such decline.