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1.
OTJR (Thorofare N J) ; 43(1): 90-97, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-35068261

RESUMO

Older African Americans with multimorbidity are at an especially high risk of adverse outcomes due to synergistic risks conferred by age, chronic disease burden and social determinants of health. Chronic condition self-management is one way older African Americans can use health management occupations and exercise agency to reduce their risk of becoming severely ill, and during the ongoing pandemic, of COVID-19 infection. The objective of this study was to understand how the COVID-19 pandemic shaped health management occupations of older African Americans. In-depth qualitative interviews were conducted with 30 African Americans aged 65 and older who reported having two or more chronic conditions. Data were analyzed using thematic analysis. Data suggest how key health management occupations (accessing care; managing medications, nutrition, and physical activity; and social and emotional health promotion and maintenance) were utilized and also shaped by the pandemic. Another key finding was perceived benefits of the pandemic on health and well-being.


Assuntos
COVID-19 , Humanos , Multimorbidade , Pesquisa Qualitativa , Pandemias , Doença Crônica , Ocupações
2.
Public Health Rep ; 138(1): 149-156, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36113138

RESUMO

OBJECTIVES: The COVID-19 pandemic has propelled the use of technology for health care services delivery. Because of inequities in health care and technology access, we investigated the use of telehealth services among racial and ethnic minority groups before and during the COVID-19 pandemic. METHODS: For this retrospective study, we examined the electronic health records of privately insured patients in the Healthjump database, provided by the COVID-19 Research Database Consortium. We examined 17.98 million unique visit records of 2.93 million patients from March through December 2019 and 22.17 million records of 3.55 million patients from March through December 2020. We conducted a descriptive analysis and used multiple logistic regression to examine differences in the use of telehealth services among 3 racial and ethnic groups: non-Hispanic White, non-Hispanic Black, and Hispanic people. RESULTS: Telehealth visits before and during COVID-19 accounted for 8.3% and 10.9% of total visits, respectively, with a peak of 15.5% in April 2020. Pre-COVID-19, Hispanic patients had a significantly lower monthly utilization rate (5.3%) than non-Hispanic White patients (8.4%, P < .001) and non-Hispanic Black patients (10.4%, P = .001). During the pandemic study period, Hispanic patients were 41% less likely than non-Hispanic White patients to have a telehealth visit, controlling for age and sex. CONCLUSIONS: The likelihood of using telehealth was lower among Hispanic patients than among non-Hispanic White and non-Hispanic Black patients during the pandemic. Culturally sensitive measures are needed to support telehealth use among the Hispanic population.


Assuntos
COVID-19 , Telemedicina , Estados Unidos/epidemiologia , Humanos , Etnicidade , Grupos Minoritários , COVID-19/epidemiologia , Pandemias , Estudos Retrospectivos , Minorias Étnicas e Raciais
3.
Public Health Rep ; 138(1): 164-173, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36113145

RESUMO

OBJECTIVES: Minimal research has assessed COVID-19's unique impact on the Native Hawaiian/Pacific Islander (NH/PI) population-an Indigenous-colonized racial group with social and health disparities that increase their risk for COVID-19 morbidity and mortality. To address this gap, we explored the scope of COVID-19 outcomes, vaccination status, and health in diverse NH/PI communities. METHODS: NH/PI staff at partner organizations collected survey data from April through November 2021 from 319 community-dwelling NH/PI adults in 5 states with large NH/PI populations: Arkansas, California, Oregon, Utah, and Washington. Data were analyzed with descriptive statistics, Pearson χ2 tests, independent and paired t tests, and linear and logistic regression analyses. RESULTS: During the COVID-19 pandemic, 30% of survey participants had contracted COVID-19, 16% had a close family member who died of the disease, and 64% reported COVID-19 vaccine uptake. Thirty percent reported fair/poor health, 21% currently smoked cigarettes, and 58% reported obesity. Survey participants reported heightened COVID-19-related psychosocial distress (mean score = 4.9 on 10-point scale), which was more likely when health outcomes (general health, sleep, obesity) were poor or a family member had died of COVID-19. Logistic regression indicated that age, experiencing COVID-19 distress, and past-year use of influenza vaccines were associated with higher odds of COVID-19 vaccine uptake (1.06, 1.18, and 7.58 times, respectively). CONCLUSIONS: Our empirical findings highlight the acute and understudied negative impact of COVID-19 on NH/PI communities in the United States and suggest new avenues for improving NH/PI community health, vaccination, and recovery from COVID-19.


Assuntos
COVID-19 , Havaiano Nativo ou Outro Ilhéu do Pacífico , Adulto , Estados Unidos/epidemiologia , Humanos , Vacinas contra COVID-19 , Pandemias , Hawaii , Obesidade
4.
Support Care Cancer ; 30(2): 1863-1872, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34613473

RESUMO

OBJECTIVES: The COVID-19 pandemic has adversely affected the caregivers of people with all chronic diseases, including people with cancer (PWC). This study was conducted to determine the impact of anxiety and spiritual well-being on the care burden of caregivers of PWC during the COVID-19 pandemic. DESIGN: This cross-sectional descriptive study included 250 caregivers of hematology and oncology patients registered with a cancer support association. All participants completed the following self-report questionnaires: the Spiritual Well-Being Scale (SWBS), Generalized Anxiety Disorder 7-item scale (GAD-7), and the Zarit Caregiver Burden Interview (ZBI). RESULTS: Most (82.4%) of the caregivers expressed fear that their patient may contract COVID-19, and 42.0% stated that they had difficulty getting to the hospital. The caregivers' mean ZBI score was 21.06 ± 14.64, their mean GAD-7 score was 14.51 ± 6.02, and their mean SWBS score was 111.50 ± 16.84. According to the results of regression analysis, SWBS and GAD-7 scores had a significant effect on the ZBI score (p < 0.05). CONCLUSION: In this study, anxiety explained most of the care burden during COVID-19. Therefore, during the COVID-19 pandemic, it may be beneficial to implement practices to promote spirituality and reduce anxiety in caregivers of PWC.


Assuntos
COVID-19 , Neoplasias , Ansiedade/epidemiologia , Transtornos de Ansiedade , Fardo do Cuidador , Cuidadores , Efeitos Psicossociais da Doença , Estudos Transversais , Humanos , Neoplasias/terapia , Pandemias , SARS-CoV-2 , Inquéritos e Questionários
5.
BMC Public Health ; 22(1): 2263, 2022 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-36463172

RESUMO

BACKGROUND: Historical vaccination coverage in economically disadvantaged, ethnic minority, non-affluent white and agricultural populations in the US has lagged coverage in more affluent urban and suburban white populations due to a variety of social and economic factors. In the current COVID-19 pandemic, sociocultural and economic challenges continue to present significant obstacles to achieving equitable uptake of COVID-19 vaccines. The goal of this study was to qualitatively assess perceptions of key US healthcare stakeholders of the most significant barriers to COVID-19 vaccine access and equity to better characterize their expected impact on US communities. METHODS: After conducting a targeted literature review (TLR), we hypothesized 20 high-impact barriers which included structural and logistical barriers, capturing systemic challenges to vaccine accessibility, and attitudinal and informational barriers, affecting patient willingness to pursue vaccination. We developed a qualitative discussion guide, which included both open-ended and closed-ended questions, and interview stimulus material to conduct one-on-one in-depth interviews to assess the expected prevalence, severity, and persistence of these 20 high-impact barriers, which were hypothesized based on TLR. As a part of this qualitative study, we conducted one-on-one in-depth interviews with a diverse set of 15 US healthcare stakeholders who were involved in the COVID-19 vaccine rollout in states with relatively disparate vaccination rates by ethnicity. These stakeholders were selected to reflect an array of roles in the COVID-19 vaccine rollout, including infectious disease specialists, pharmacists, community advocacy representatives, and partners of local governments involved in the COVID-19 vaccine rollout and community education. RESULTS: Respondents identified limited vaccination sites in rural settings and technology-related barriers as the most prevalent and severe structural and logistical barriers in US communities. Respondents assessed COVID-19 vaccine safety concerns and politically motivated skepticism to be the most prevalent and severe attitudinal and informational barriers. Respondents cited proliferation of mobile vaccination clinics and local community messaging to endorse vaccines as the most effective solutions to these top structural and attitudinal barriers. Respondents expected politically motivated skepticism to be the most significant and persistent barrier to broader vaccine uptake in the US. CONCLUSIONS: Our study suggests that attitudinal barriers, particularly politically motivated skepticism, are likely to remain the most persistent challenges to widespread vaccination against COVID-19 in the US.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Etnicidade , Pandemias/prevenção & controle , Grupos Minoritários , Vacinação
6.
Biomed Eng Online ; 21(1): 84, 2022 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-36463207

RESUMO

BACKGROUND: The impact of the pandemic caused by the coronavirus (SARS-CoV-2), causing the disease COVID-19, has brought losses to the world in terms of deaths, economic and health problems. The expected return of the public to activities adapted to the new health situation led to discussions about the use of vaccination and its effects. However, the demand for proof of vaccination showed how inconsistent, unregistered, and uncontrolled this health process is with current technologies. Despite the proven effectiveness of vaccines in reducing infection rates, mortality, and morbidity, there are still doubts about their use in preventing certain infections and injuries, as well as the use of digital medical records for identification at public events and disease prevention. Therefore, this review aims to analyze the use of digital immunization cards in disease prevention in general. METHODS: A systematic review of Science, PubMed/MEDLINE, LILACS /BSV, CINALH, and IEEE and Xplore was performed using PRISMA guidelines. The authors summarized the studies conducted over the last decade on the impacts of prophylaxis by control through immunization cards. Studies were selected using the following terms: Vaccination; Mobile Applications; Health Smarts Cards; Immunization Programs; Vaccination Coverage. For data analysis, we used Mendeley, Excel, RStudio, and Bibliometrix software among others. RESULTS: A total of 1828 publications were found. After applying eligibility criteria (Articles published in Portuguese, Spanish or English in the last 10 years). Studies that only dealt with paper or physical records were excluded, as well as studies that were not linked to their country's health Department, as a possibility of bias exists with these types of information). After removing duplicates and applying filters 1 and 2, we included 18 studies in this review. This resulted in 18 papers that met our priori inclusion criteria; it was found that the most relevant sources were from the databases of the Institute of Electrical and Electronics Engineers (IEEE). CONCLUSIONS: Considering the selected studies, we found that scientific evidence and epidemiological surveillance are essential tools to characterize the efficiency and effectiveness of immunization passport protection intervention and to ethically justify them. Technological development of digital vaccine passports can assist in vaccination programs and positively impact disease prophylaxis.


Assuntos
COVID-19 , Vacinas , Humanos , SARS-CoV-2 , COVID-19/prevenção & controle , Pandemias , Clorexidina
7.
Int J Equity Health ; 21(Suppl 3): 172, 2022 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-36471346

RESUMO

BACKGROUND: The Sustainable Development Goals have helped to focus attention on the importance of reducing inequality and 'leaving no one behind'. Monitoring health inequalities is essential for providing evidence to inform policies, programmes and practices that can close existing gaps and achieve health equity. The Health Equity Assessment Toolkit (HEAT and HEAT Plus) software was developed by the World Health Organization to facilitate the assessment of within-country health inequalities. RESULTS: HEAT contains a built-in database of disaggregated health data, while HEAT Plus allows users to upload and analyze inequalities using their own datasets. Version 4.0 of the software incorporated enhancements to the toolkit's capacity for equity assessments. This includes a multilingual interface, interactive and downloadable visualizations, flexibility to analyze inequalities using any dataset of disaggregated data, and the built-in calculation of 19 summary measures of inequality. This paper outlines the improved features and functionalities of the HEAT and HEAT Plus software since their original release, highlighted through an example of how the toolkit can be used to assess inequalities in the COVID-19 pandemic era. CONCLUSIONS: The features of the HEAT and HEAT Plus software make it a valuable tool for analyzing and reporting inequalities related to the COVID-19 pandemic, as well as its indirect impacts on inequalities in other health and non-health areas, providing evidence to inform equity-oriented interventions and strategies.


Assuntos
COVID-19 , Equidade em Saúde , Humanos , COVID-19/epidemiologia , Temperatura Alta , Pandemias , Organização Mundial da Saúde , Fatores Socioeconômicos
8.
S Afr Med J ; 112(8b): 729-736, 2022 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-36458355

RESUMO

BACKGROUND: The incidence of diarrhoeal disease is closely linked to socioeconomic and environmental factors, household practices and access to health services. South African (SA) district health information and national survey data report wide variation in the incidence and prevalence of diarrhoeal episodes in children under 5 years of age. These differentials indicate potential for reducing the disease burden through improvements in provision of water and sanitation services and changes in hygiene behaviour. OBJECTIVES: To estimate the burden of disease attributed to unsafe water, sanitation and hygiene (WASH) by province, sex and age group for SA in 2000, 2006 and 2012. METHODS: Comparative risk assessment methodology was used to estimate the disease burden attributable to an exposure by comparing the observed risk factor distribution with a theoretical lowest possible population distribution. The study adapts the original World Health Organization scenario-based approach for estimating diarrhoeal disease burden from unsafe WASH, by assigning different standards of household water and sanitation-specific geographical classification to capture SA living conditions in rural, urban and informal settlements. RESULTS: SA experienced an improvement in water and sanitation supply in eight of the nine provinces between 2001 and 2011, with the exception of Northern Cape Province. In 2011, 41% of South Africans lived with poor water and sanitation conditions; however, wide provincial inequalities exist. In 2012, it was estimated that 84.1% of all deaths due to diarrhoeal disease were attributable to unsafe WASH; this equates to 13 757 deaths (95% uncertainty interval (UI) 13 015 - 14 300). Of these diarrhoeal disease deaths, 48.2% occurred in children under 5 years of age, accounting for 13.9% of all deaths in this age group (95% UI 13.1 - 14.4). Between 2000 and 2012, the proportion of deaths attributable to diarrhoea reduced from 3.6% to 2.6%. Gauteng and Western Cape provinces experienced much lower WASHattributable death rates than the more rural, poorer provinces. CONCLUSION: Unsafe WASH remains an important risk factor for disease in SA, especially in children. High priority needs to be given to the provision of safe and sustainable sanitation and water facilities and promoting safe hygiene behaviours. The COVID-19 pandemic has reinforced the critical importance of clean water for preventing and containing disease.


Assuntos
COVID-19 , Saneamento , Criança , Humanos , Pré-Escolar , África do Sul/epidemiologia , Água , Pandemias , Higiene , Diarreia/epidemiologia , Diarreia/etiologia , Efeitos Psicossociais da Doença
9.
BMC Health Serv Res ; 22(1): 1466, 2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36461119

RESUMO

BACKGROUND: The COVID-19 pandemic has overloaded the healthcare systems of many countries and reduced the population's access to treatment and prevention of other diseases. This study aims to assess whether the COVID-19 pandemic has negatively interfered with the trend and the direct costs of screening and chemotherapy treatment of breast cancer in a public and universal healthcare system. METHOD: This was an ecological time series study using an open database of a public and universal health system from 2017 to 2021. RESULTS: In 2020, there was a 41% reduction in the coverage rate of breast cancer screening in women aged 50 to 69 years (about 1 million mammograms missed). The total direct cost of breast cancer screening reduced proportionally to the number of tests (BRL 67 million). On the other hand, the cost of chemotherapy treatment was higher in 2020, both in advanced (BRL 465 million) and localized (BRL 113 million) diseases. In the time series, mammograms' trend and direct costs changed from stationary to decreasing after the COVID-19 pandemic. The trend of direct costs with chemotherapy treatment for the advanced disease has been increasing and has not changed after the COVID-19 pandemic. On the other hand, in the case of localized disease, there was a trend toward reducing direct costs after the pandemic. CONCLUSION: After COVID-19, there was a downward trend in breast cancer screening and its direct costs, an upward trend in chemotherapy costs for advanced disease, and a downward trend in chemotherapy costs for localized disease.


Assuntos
Neoplasias da Mama , COVID-19 , Feminino , Humanos , Pandemias , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/epidemiologia , Detecção Precoce de Câncer , Análise de Séries Temporais Interrompida , COVID-19/epidemiologia
10.
Natl Med J India ; 35(3): 172-176, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36461865

RESUMO

Background The Covid-19 pandemic has posed a challenge to organizing a safe clinical assessment for postgraduate degree candidates completing the residency programmes in various specialties. Although minimizing the risk of Covid-19 transmission is a priority, fulfilling the objectives of the assessment is equally important. Methods We conducted this study in the Department of Internal Medicine at our institute. Instead of physically examining patients, case scenarios that included history, clinical and investigational data of the cardiovascular system (CVS) were presented to the candidates. Performance was scored by both the conventional and the CVS objective-structured clinical examination (CVS-OSCE) method and compared. Results Clinical assessment examination of 27 candidates for the degree of Doctor of Medicine showed that the median cumulative score gained in narrating and analysing various differential diagnoses was lower compared to the mean cumulative score gained in arriving at a single correct diagnosis (50% [interquartile range-IQR 39%-64%] v. 79% [IQR 64%-100%], p<0.01). Most of the candidates agreed that case scenarios were good alternatives to the conventional physical examination amidst the pandemic. Conclusion CVS-OSCE-based assessment using structured case scenarios is a feasible and effective alternative for clinical skill assessment in high-stake examinations.


Assuntos
COVID-19 , Sistema Cardiovascular , Internato e Residência , Humanos , COVID-19/epidemiologia , Pandemias/prevenção & controle , Exame Físico
12.
J Glob Health ; 12: 05051, 2022 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-36462207

RESUMO

Background: During the COVID-19 pandemic, health systems rapidly introduced in-home telehealth to maintain access to care. Evidence is evolving regarding telehealth's impact on health disparities. Our objective was to evaluate associations between socioeconomic factors and rurality with access to ambulatory care and telehealth use during the COVID-19 pandemic. Methods: We conducted a retrospective study at an academic medical centre in midwestern United States. We included established and new patients who received care during a one-year COVID-19 period vs pre-COVID-19 baseline cohorts. The primary outcome was the occurrence of in-person or telehealth visits during the pandemic. Multivariable analyses identified factors associated with having a health care provider visit during the COVID-19 vs pre-COVID-19 period, as well as having at least one telehealth visit during the COVID-19 period. Results: All patient visit types were lower during the COVID-19 vs the pre-COVID-19 period. During the COVID-19 period, 125 855 of 255 742 established patients and 53 973 new patients had at least one health care provider visit, with 41.1% of established and 23.5% of new patients having at least one telehealth visit. Controlling for demographic and clinical characteristics, established patients had 30% lower odds of having any health care provider visit during COVID-19 vs pre-COVID-19 (adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.698-0.71) period. Factors associated with lower odds of having a telehealth visit during COVID-19 period for established patients included older age, self-pay or other insurance vs commercial insurance, Black or Asian vs White race and non-English preferred languages. Female patients, patients with Medicare or Medicaid coverage, and those living in lower income zip codes were more likely to have a telehealth visit. Living in a zip code with higher average internet access was associated with telehealth use but living in a rural zip code was not. Factors affecting telehealth visit during the COVID-19 period for new patients were similar, although new patients living in more rural areas had a higher odds of telehealth use. Conclusion: Healthcare inequities existed during the COVID-19 pandemic, despite the availability of in-home telehealth. Patient-level solutions targeted at improving digital literacy, interpretive services, as well as increasing access to stable high-speed internet are needed to promote equitable health care access.


Assuntos
COVID-19 , Telemedicina , Estados Unidos/epidemiologia , Humanos , Idoso , Feminino , COVID-19/epidemiologia , Pandemias , Estudos Retrospectivos , Medicare
13.
Front Public Health ; 10: 1018060, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36466448

RESUMO

Background: The emergence of the COVID-19 has disrupted the health and socioeconomic sectors, particularly in resource-poor settings such as Guinea. Like many sub-Saharan countries, Guinea is facing shortcomings related to its fragile health system and is further affected by the passage of the Ebola virus disease. The pandemic has worsened the socio-economic situation of the poorest people, leading to their exclusion from health care. To promote access to care for the most vulnerable populations, a system was set up to provide care for these people who are victims of health marginalization to promote their access to care. This study aimed to analyze access to health services by vulnerable populations during the COVID-19 pandemic in Guinea through the establishment of a health indigent fund (HIF). Methods: This was a qualitative study to assess the project implementation process. A total of 73 in-depth individual interviews were conducted with beneficiaries, health workers, community health workers and members of the HIF management committee, and a few informal observations and conversions were also conducted in the project intervention areas. The data collected were transcribed and coded using the deductive and inductive approaches with the Nvivo software before applying the thematic analysis. Results: A total of 1,987 indigents were identified, of which 1,005 were cared for and 64 referred to all 38 intervention health facilities within the framework of the HIF. All participants appreciated the project's social action to promote access to equitable and quality health care for this population excluded from health care services. In addition, the project has generated waves of compassion and solidarity toward these "destitute" people whose main barrier to accessing health care remains extreme poverty. A state of poverty that leads some to sell their assets (food or animal reserves) or to go into debt to ensure access to care for their children, considered the most at risk. Conclusion: The HIF can be seen as an honest attempt to provide better access to health care for the most vulnerable groups. Some challenges need to be addressed including the current system of acquiring funds before the attempt can be considered scalable.


Assuntos
COVID-19 , Administração Financeira , Animais , Humanos , COVID-19/epidemiologia , Pandemias , Guiné/epidemiologia , Pobreza , Agentes Comunitários de Saúde , Continuidade da Assistência ao Paciente
14.
Front Public Health ; 10: 986273, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36466527

RESUMO

This study aims to analyze the inter-provincial variation in the increase of attack rates in the third wave of the COVID-19 outbreak in Turkey and to determine their relationship with potential urban health indicators. In this ecological study, dependent variables were selected as the COVID-19 attack rates of provinces before the third wave and during the third peak and the attack rate increase ratio. Urban health indicators that can function as determinants of health were calculated for each province under five headings: demographic, health capacity, economic, environmental, and socio-cultural. The epidemiologic maps were produced to show the spatial distribution of COVID-19 attack rates pre- and during the third wave. The associations with urban indicators were conducted using bivariate analysis, including Pearson or Spearman correlation analysis. A multiple linear regression model was run with variables significantly associated with increased attack rates. The results of our study show significant regional variations in COVID-19 attack rates both at the beginning and during the third wave of the COVID-19 pandemic in Turkey. Among the provinces, the attack rate increase ratio has only shown significant correlations to education level and some economic indicators, such as income, employment, industrial activity measured by electric consumption, and economic activity in the manufacturing industry. The multivariate analysis determined that the indicator of economic activity in the manufacturing industry is related to the increase of the attack rate in the third wave. Our results show that the COVID-19 cases are higher in more developed cities with more manufacturing sector activity. It makes us think that it is mainly related to inequalities arising from access to health institutions and testing. It can be determined that the partly lockdown strategy, which excluded the industrial activity in the country, concluded the higher increase in the attack rates in highly industrialized provinces.


Assuntos
COVID-19 , Saúde da População Urbana , Humanos , Incidência , COVID-19/epidemiologia , Turquia/epidemiologia , Pandemias , Controle de Doenças Transmissíveis , Surtos de Doenças
15.
Perspect Biol Med ; 65(4): 586-595, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36468386

RESUMO

The relationship between equality and equity has been theorized and described in many ways. Recently, this relationship has been popularly illustrated via a meme depicting three people watching a baseball game while standing on boxes. The meme's analogy, that achieving health equity is the ability to view a spectator sport, is a neoliberal account of health. The analogy defines equality at the expense of equity, characterizes health as individualistic, describes health equity as a static outcome, and implies that the bioethical questions for achieving health equity are about the distribution and redistribution of resources. As the SARS CoV-2 pandemic vividly reminded us, health equity is no spectator sport. Health equity is the intentional removal of obstacles to health and the enabling of human flourishing to assure that everyone has fair and just opportunities for health. That relational and radical account of health equity requires different analogies. This article reimagines and re-illustrates the relationship between equality and equity using an organic analogy of three plants. The analogy calls for bioethics to nurture communal relationships and engage community leaders in pursuit of communal flourishing.


Assuntos
Bioética , COVID-19 , Equidade em Saúde , Humanos , Pandemias , COVID-19/epidemiologia , SARS-CoV-2
16.
PLoS One ; 17(12): e0278274, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36454871

RESUMO

Infrastructure construction related to the new generation of information technology and 5G technology is an important measure taken by the Chinese government to promote regional economic development. Large-scale infrastructure investment is being carried out simultaneously in China's core and peripheral regions. The COVID-19 pandemic has dealt a severe blow to China's tourism industry, and the application of new technologies seems to blur the spatial boundaries of the tourism industry. Therefore, it is debatable whether the zealous development of large investment projects can really improve the competitiveness of the regional tourism industry. This paper discusses this topical issue by empirically analyzing data from 31 Chinese provinces and cities from 2008-2019 and draws the following conclusions (1) The continuous expansion of new infrastructure investment in China indeed has a positive effect on improving China's overall tourism competitiveness. However, the inverted U-shaped relationship between the two shows that China should not blindly expand the scale of infrastructure construction and make appropriate investment according to the regional industrial development level. (2) Although convergent infrastructure plays an important role in regional industrial competitiveness, the marginal effect has begun to weaken, so the problem of scale inefficiency needs to be addressed. In contrast, the input of innovation infrastructure is insufficient to enhance industrial competitiveness and can be moderately increased to achieve better results. (3) China's core economic areas have a good driving effect on new infrastructure investment, but the original technological innovation and transformation-type facilities are still the key to limiting the improvement of industrial competitiveness. Peripheral areas are more passive recipients with strong demand. Therefore, investment in various types of infrastructure can drive regional development.


Assuntos
COVID-19 , Turismo , Humanos , Pandemias , COVID-19/epidemiologia , Indústrias , China
17.
Hu Li Za Zhi ; 69(6): 6-11, 2022 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-36455908

RESUMO

Many studies from around the world demonstrate that COVID-19 has had significantly higher rates of infection, hospitalization, and mortality among indigenous and other vulnerable groups than among mainstream population groups. This situation has exposed and reinforced pre-existing health inequalities. This article investigates the rates of infection and mortality among different cultural groups during the COVID-19 pandemic, and then deconstructs the key elements related to systemic or structural racism. The impacts on the human rights and health of indigenous peoples and issues of policy formulation and resource equity during the epidemic are also mentioned. Based on the identified root causes of health inequality, suggestions for reducing health inequality for Taiwanese indigenous peoples are proposed. Further, during epidemics, policymakers must design and implement culturally appropriate epidemic prevention policies, systems, and strategies for indigenous and other disadvantaged populations.


Assuntos
COVID-19 , Direito à Saúde , Humanos , Povos Indígenas , Disparidades nos Níveis de Saúde , Direitos Humanos , Acesso aos Serviços de Saúde , Pandemias , Políticas
18.
BMJ Open ; 12(12): e066288, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36456017

RESUMO

OBJECTIVES: To quantify the effect of the COVID-19 pandemic on the timeliness of, and geographical and sociodemographic inequalities in, receipt of first measles, mumps and rubella (MMR) vaccination. DESIGN: Longitudinal study using primary care electronic health records. SETTING: 285 general practices in North East London. PARTICIPANTS: Children born between 23 August 2017 and 22 September 2018 (pre-pandemic cohort) or between 23 March 2019 and 1 May 2020 (pandemic cohort). MAIN OUTCOME MEASURE: Receipt of timely MMR vaccination between 12 and 18 months of age. METHODS: We used logistic regression to estimate the ORs (95% CIs) of receipt of a timely vaccination adjusting for sex, deprivation, ethnic background and Clinical Commissioning Group. We plotted choropleth maps of the proportion receiving timely vaccinations. RESULTS: Timely MMR receipt fell by 4.0% (95% CI: 3.4% to 4.6%) from 79.2% (78.8% to 79.6%) to 75.2% (74.7% to 75.7%) in the pre-pandemic (n=33 226; 51.3% boys) and pandemic (n=32 446; 51.4%) cohorts, respectively. After adjustment, timely vaccination was less likely in the pandemic cohort (0.79; 0.76 to 0.82), children from black (0.70; 0.65 to 0.76), mixed/other (0.77; 0.72 to 0.82) or with missing (0.77; 0.74 to 0.81) ethnic background, and more likely in girls (1.07; 1.03 to 1.11) and those from South Asian backgrounds (1.39; 1.30 to 1.48). Children living in the least deprived areas were more likely to receive a timely MMR (2.09; 1.78 to 2.46) but there was no interaction between cohorts and deprivation (Wald statistic: 3.44; p=0.49). The proportion of neighbourhoods where less than 60% of children received timely vaccination increased from 7.5% to 12.7% during the pandemic. CONCLUSIONS: The COVID-19 pandemic was associated with a significant fall in timely MMR receipt and increased geographical clustering of measles susceptibility in an area of historically low and inequitable MMR coverage. Immediate action is needed to avert measles outbreaks and support primary care to deliver timely and equitable vaccinations.


Assuntos
COVID-19 , Sarampo , Caxumba , Rubéola (Sarampo Alemão) , Masculino , Criança , Feminino , Humanos , Caxumba/epidemiologia , Caxumba/prevenção & controle , Pandemias , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Longitudinais , Registros Eletrônicos de Saúde , Londres/epidemiologia , Rubéola (Sarampo Alemão)/epidemiologia , Rubéola (Sarampo Alemão)/prevenção & controle , Sarampo/epidemiologia , Sarampo/prevenção & controle , Vacinação
19.
Washington, D.C.; OPS; 2022-12-28. (OPS/HSS/SF/COVID-19/22-0039).
em Espanhol | PAHOIRIS | ID: phr-56956

RESUMO

Las emergencias de salud recientes como la pandemia de gripe por A/H1N1 y la epidemia del zika visibilizaron la importancia de una inversión urgente por parte de los países y territorios de la Región de las Américas en la seguridad regional en el ámbito de la salud. La pandemia de COVID-19 demostró que los brotes de enfermedades a menudo exacerban las brechas crónicas en materia de salud pública. Debido a la falta de resiliencia de los sistemas de salud, las cadenas de suministro se tornaron frágiles produciendo desabastecimientos y disrupciones en los servicios de atención primaria. La inequidad en materia de salud generó acceso desigual a las medidas de contención y limitó el apoyo disponible para comunidades vulnerables y marginadas. La preparación y respuesta ante pandemias se ha convertido en una prioridad a la hora de fortalecer la seguridad nacional y económica, y la Región de las Américas no es la excepción. Dado que muchas brechas en la seguridad en el ámbito de la salud se centran en el acceso continuo a tecnologías sanitarias que salvan vidas, los fondos rotatorios de la OPS, es decir, el Fondo Rotatorio Regional para Suministros Estratégicos de Salud Pública (el Fondo Estratégico) y el Fondo Rotatorio para el Acceso a Las Vacunas (el Fondo Rotatorio), pueden aprovecharse como mecanismos esenciales y un enfoque útil para fortalecer la resiliencia y equidad del sistema de salud.


Assuntos
Pandemias , COVID-19 , Atenção Primária à Saúde , Vacinas , Imunização , Defesa Civil , Emergências
20.
Washington, D.C.; OPAS; 2022-12-28. (OPAS/HSS/SF/COVID-19/22-0039).
em Português | PAHOIRIS | ID: phr-56955

RESUMO

Recentes emergências de saúde, como o vírus H1N1 e a epidemia de zika, destacaram a importância de os países e territórios das Américas investirem urgentemente em segurança sanitária regional. Como a pandemia de COVID-19 mostrou ainda mais claramente, os surtos de doenças frequentemente exacerbam lacunas crônicas na saúde pública. A resiliência inadequada dos sistemas de saúde levou a fragilidade das cadeias de suprimentos, quebras de estoque e disrupções nos serviços de atenção primária à saúde. As falhas da equidade em saúde favoreceram a desigualdade no acesso a contramedidas médicas e limitaram o apoio a comunidades vulneráveis e marginalizadas. Preparação e resposta a pandemias (PRP) tornou-se uma prioridade para fortalecer a segurança nacional e econômica, e a Região das Américas não é exceção. Dado que muitas lacunas em segurança sanitária se concentram no acesso contínuo a tecnologias médicas que salvam vidas, os Fundos Rotatórios da OPAS – compostos pelo Fundo Rotatório Regional para Provisões Estratégicas de Saúde Pública (Fundo Estratégico) e o Fundo Rotatório para Acesso a Vacinas – podem ser alavancados como mecanismos vitais e enfoques úteis para fortalecer a resiliência dos sistemas de saúde e obter a equidade em saúde.


Assuntos
Pandemias , COVID-19 , Atenção Primária à Saúde , Vacinas , Imunização , Defesa Civil , Emergências
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