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1.
Expert Syst Appl ; 211: 118185, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35873111

RESUMO

To cater to the increasing demands, particularly during diseases such as Covid-19, the design and planning of home health care systems is of significant importance. The current study proposes a multi-objective mixed-integer linear model for a home health care network in two stages; the first is the opening of efficient health centres, and the second is the routing and scheduling considering corporate social responsibility and efficiency. There are multiple objectives that we consider, including minimization of total costs and inefficiency considerations, and maximization of social aspects. A novel aspect of this study is the consideration of social responsibility, which includes employment opportunities and regional economic development, and efficiency in terms of time, energy, and mismanagement of budgets. To measure efficiency, an augmented version of the data envelopment analysis approach is incorporated into the proposed optimization model. Additionally, the TH approach is developed as an interactive fuzzy method to deal with the proposed multi-objective model. Within the HHC problem, costs, social factors, and service time are inherently uncertain, and hence, to solve this problem, a robust-fuzzy approach is proposed. The ensuing model is applied to a real case study of Kermanshah in Iran. Moreover, several problem instances motivated by real cases are generated with different characteristics to measure the performance of the proposed model and approach. The results show that decision-makers' preferences play a key role in human resource planning and regional development. Furthermore, the results confirm the efficiency of the proposed approach in different instances within reasonable time frames.

2.
Rural Remote Health ; 22(1): 6740, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35130709

RESUMO

CONTEXT: In Australia, Aboriginal Community Controlled Health Organisations (ACCHOs) are geographically proximal to where Aboriginal and Torres Strait Islander People reside and are valued for providing holistic and culturally safe primary health care. Partnering with ACCHOs in research is appropriate for redressing health inequities experienced by Aboriginal and Torres Strait Islander People, which includes a high burden of chronic disease. Historically, some approaches to Aboriginal and Torres Strait Islander health research have been unethical. Greater accountability in the research process, transparency in reporting, and use of culturally appropriate research methodologies are key recommendations to improving the ethical integrity of research. The need for strengthening the reporting of health research involving Aboriginal and Torres Strait Islander People and Indigenous peoples globally led to the development of the CONSolIDated critERia for strengthening the reporting of health research involving Indigenous peoples (CONSIDER statement), which is a synthesis of international ethical guidelines. This project report uses the CONSIDER statement to critically reflect on participatory research undertaken in partnership with an ACCHO in the rural context and to identify lessons of value for future research. ISSUE: By using the CONSIDER statement as a tool for critical reflection, it was identified that processes used to establish a research partnership with an ACCHO were key to setting the research agenda, including identifying ethical issues, the needs of local Aboriginal and Torres Strait Islander People, and expectations from the research. The participation of Aboriginal community members throughout the entire research process was not only methodologically important but was also ethically appropriate. Research activities in this project included opportunities for Aboriginal community members to directly share their perspectives and experiences and develop local solutions to issues affecting them. Outcomes included evidence to support future funding applications, community-derived priorities that assisted with government reporting, and locally identified methods for addressing chronic disease management. Key to this was building the research capacity and capability of local Aboriginal community members, which also reflected the ethical principles of reciprocity and equity. This also provided opportunities for non-Indigenous researchers to learn from local Aboriginal community members and develop skills in culturally appropriate research. LESSONS LEARNED: Using the CONSIDER statement was beneficial in enabling researchers to critically reflect on a participatory research project undertaken in partnership with a rural ACCHO. Researchers identified that participatory approaches can be used to generate research of relevance to local Aboriginal community members and their ACCHOs, and to support health service reporting, and future funding applications. Research timelines and activities needed to be flexible and adaptable, to allow for staff turnover and unforeseen events of cultural significance. Similarly, it is important for researchers to be receptive to change and open to learning. Although research partnerships are established on trust and mutual respect, it is recommended that greater formal provisions are required to protect the intellectual property of Aboriginal and Torres Strait Islander communities involved in research. These lessons are likely to be transferrable to other settings and are of value to researchers seeking to partner with ACCHOs in research.


Assuntos
Serviços de Saúde do Indígena , Povos Indígenas , Pesquisa Participativa Baseada na Comunidade/métodos , Humanos , População Rural
3.
Health Aff (Millwood) ; 41(2): 158-162, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35130058

RESUMO

One large Massachusetts health system has ambitious plans for how it can become an antiracist institution.


Assuntos
Racismo , Humanos , Massachusetts , Racismo/prevenção & controle
4.
Health Aff (Millwood) ; 41(2): 195-202, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35130060

RESUMO

Few studies have illustrated how racism influences Black women's use of reproductive health care services. This article presents findings of a collaborative study conducted by a research team and a reproductive justice organization to understand Black women's concerns with sexual and reproductive health services. The qualitative research was conducted with Black women living in Georgia and North Carolina, using a community-based participatory research approach. Themes were developed from participant accounts that highlight how racism, both structural and individual, influenced their reproductive health care access, utilization, and experience. Structural racism affected participants' finances and led some to forgo care or face barriers to obtaining care. Individual racism resulted in some women electing to receive care only from same-race medical providers. These findings suggest a need for policies and practices that address structural barriers to reproductive health care access and improve the reproductive health experience of Black women.


Assuntos
Racismo , Serviços de Saúde Reprodutiva , Feminino , Acesso aos Serviços de Saúde , Humanos , Saúde Reprodutiva , Comportamento Sexual
5.
Health Aff (Millwood) ; 41(2): 179-186, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35130062

RESUMO

Antiracist health policy research requires methodological innovation that creates equity-centered and antiracist solutions to health inequities by centering the complexities and insidiousness of structural racism. The development of effective health policy and health equity interventions requires sound empirical characterization of the nature of structural racism and its impact on public health. However, there is a disconnect between the conceptualization and measurement of structural racism in the public health literature. Given that structural racism is a system of interconnected institutions that operates with a set of racialized rules that maintain White supremacy, how can anyone accurately measure its insidiousness? This article highlights methodological approaches that will move the field forward in its ability to validly measure structural racism for the purposes of achieving health equity. We identify three key areas that require scholarly attention to advance antiracist health policy research: historical context, geographical context, and theory-based novel quantitative and qualitative methods that capture the multifaceted and systemic properties of structural racism as well as other systems of oppression.


Assuntos
Equidade em Saúde , Transtornos Mentais , Racismo , Política de Saúde , Humanos , Racismo/prevenção & controle
6.
Health Aff (Millwood) ; 41(2): 247-255, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35130066

RESUMO

Patients receiving home health services from high-quality home health agencies often experience fewer adverse outcomes (for example, hospitalizations) than patients receiving services from low-quality agencies. Using administrative data from 2016 and regression analysis, we examined individual- and neighborhood-level racial, ethnic, and socioeconomic factors associated with the use of high-quality home health agencies. We found that Black and Hispanic home health patients had a 2.2-percentage-point and a 2.5-percentage-point lower adjusted probability of high-quality agency use, respectively, compared with their White counterparts within the same neighborhoods. Low-income patients had a 1.2-percentage-point lower adjusted probability of high-quality agency use compared with their higher-income counterparts, whereas home health patients residing in neighborhoods with higher proportions of marginalized residents had a lower adjusted probability of high-quality agency use. Some 40-77 percent of the disparities in high-quality agency use were attributable to neighborhood-level factors. Ameliorating these inequities will require policies that dismantle structural and institutional barriers related to residential segregation.


Assuntos
Agências de Assistência Domiciliar , Segregação Social , Humanos , Características de Residência , Fatores Socioeconômicos
7.
Health Aff (Millwood) ; 41(2): 157, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35130068
8.
Health Aff (Millwood) ; 41(2): 289-295, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35130069

RESUMO

Within the monolithic racial category of "Asian American," health determinants are often hidden within each subgroup's complex histories of indigeneity, colonialism, migration, culture, and socio-political systems. Although racism is typically framed to underscore the ways in which various institutions (for example, employment and education) disproportionately disadvantage Black/Latinx communities over White people, what does structural racism look like among Filipinx/a/o Americans (FilAms), the third-largest Asian American group in the US? We argue that racism defines who is visible. We discuss pathways through which colonialism and racism preserve inequities for FilAms, a large and overlooked Asian American subgroup. We bring to light historical and modern practices inhibiting progress toward dismantling systemic racial barriers that impinge on FilAm health. We encourage multilevel strategies that focus on and invest in FilAms, such as robust accounting of demographic data in heterogeneous populations, explicitly naming neocolonial forces that devalue and neglect FilAms, and structurally supporting community approaches to promote better self- and community care.


Assuntos
Racismo , Colonialismo , Humanos , Estados Unidos
9.
Health Aff (Millwood) ; 41(2): 237-246, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35130071

RESUMO

Examining how spatial access to health care varies across geography is key to documenting structural inequalities in the United States. In this article and the accompanying StoryMap, our team identified ZIP Code Tabulation Areas (ZCTAs) with the largest share of minoritized racial and ethnic populations and measured distances to the nearest hospital offering emergency services, trauma care, obstetrics, outpatient surgery, intensive care, and cardiac care. In rural areas, ZCTAs with high Black or American Indian/Alaska Native representation were significantly farther from services than ZCTAs with high White representation. The opposite was true for urban ZCTAs, with high White ZCTAs being farther from most services. These patterns likely result from a combination of housing policies that restrict housing opportunities and federal health policies that are based on service provision rather than community need. The findings also illustrate the difficulty of using a single metric-distance-to investigate access to care on a national scale.


Assuntos
Acesso aos Serviços de Saúde , Feminino , Geografia , Hospitais , Humanos , Gravidez , Estados Unidos
10.
Health Aff (Millwood) ; 41(2): 304-308, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35130072

RESUMO

Shalon Irving's 2017 death brought national attention to maternal mortality among Black women in the US. This essay remembers her life and legacy.


Assuntos
Equidade em Saúde , Feminino , Humanos , Mortalidade Materna
11.
Health Aff (Millwood) ; 41(2): 219-227, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35130073

RESUMO

Theoretical research suggests that racialized felony disenfranchisement-a form of structural racism-is likely to undermine the health of Black people, yet empirical studies on the topic are scant. We used administrative data on disproportionate felony disenfranchisement of Black residents across US states, linked to geocoded individual-level health data from the 2016 Health and Retirement Study, to estimate race-specific regression models describing the relationship between racialized disenfranchisement and health among middle-aged and older adults, adjusting for other individual- and state-level factors. Results show that living in states with higher levels of racialized disenfranchisement is associated with more depressive symptoms, more functional limitations, more difficulty performing instrumental activities of daily living, and more difficulty performing activities of daily living among Black people. However, there are no statistically significant relationships between racialized disenfranchisement and health among White people. These findings suggest that policies aiming to mitigate disproportionate Black felony disenfranchisement not only are essential for political inclusion but also may be valuable tools for improving population health equity.


Assuntos
Equidade em Saúde , Saúde da População , Racismo , Atividades Cotidianas , Idoso , Humanos , Pessoa de Meia-Idade , Estados Unidos
12.
Health Aff (Millwood) ; 41(2): 163-170, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35130075

RESUMO

Research related to racism and health has evolved in recent decades, with a growing appreciation of the centrality of the social determinants of health, life-course approaches and structural racism, and other upstream factors as drivers of health inequities. Examining how race, class, and structural racism relate to each other and combine over the life course to affect health can facilitate a clearer understanding of the determinants of health. Yet there is ongoing discomfort in many public health and medical circles about research on racism, including opposition to the use of racial terminology. Similarly, most major national reports on racial and ethnic inequities in health have given limited attention to the role of racism. We conclude that there is a need to acknowledge the central role of racism in the national discourse on racial inequities in health, and paradigmatic shifts are needed to inform equity-driven policy and practice innovations that would tackle the roots of the problem of racism and dismantle health inequities.


Assuntos
Equidade em Saúde , Racismo , Humanos , Políticas
13.
Health Aff (Millwood) ; 41(2): 296-303, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35130076

RESUMO

The Asian American health narrative reflects a long history of structural racism in the US and the complex interplay of racialized history, immigrant patterns, and policies regarding Asians in the US. Yet owing to systematic issues in data collection including missing or misclassified data for Asian Americans and practices that lead to indiscriminate grouping of unlike individuals (for example, Chinese, Vietnamese, and Bangladeshi) together in data systems and pervasive stereotypes of Asian Americans, the drivers and experiences of health disparities experienced by these diverse groups remain unclear. The perpetual exclusion and misrepresentation of Asian American experiences in health research is exacerbated by three racialized stereotypes-the model minority, healthy immigrant effect, and perpetual foreigner-that fuel scientific and societal perceptions that Asian Americans do not experience health disparities. This codifies racist biases against the Asian American population in a mutually reinforcing cycle. In this article we describe the poor-quality data infrastructure and biases on the part of researchers and public health professionals, and we highlight examples from the health disparities literature. We provide recommendations on how to implement systems-level change and educational reform to infuse racial equity in future policy and practice for Asian American communities.


Assuntos
Americanos Asiáticos , Emigrantes e Imigrantes , Confiabilidade dos Dados , Humanos , Grupos Minoritários
14.
J. Health Biol. Sci. (Online) ; 10(1): 1-9, 01/jan./2022. tab
Artigo em Português | LILACS | ID: biblio-1378520

RESUMO

Objetivos: avaliar a cobertura e os fatores associados à não realização do exame citopatológico do colo do útero entre mulheres de 18 a 39 anos no Brasil. Métodos: estudo transversal, de base populacional, com dados de inquérito domiciliar com 2.002 mulheres alfabetizadas de áreas urbanas, selecionadas por amostragem aleatória por conglomerados em 2016. Foram avaliados a prática do exame nos três anos anteriores e os fatores associados à não realização, com cálculo de razão de prevalência ajustada (RPaj) e intervalos de confiança de 95% (IC95%) por regressão de Poisson. Resultados: a cobertura do exame entre mulheres de 18-39 anos foi de 66,5%, sendo mais elevada naquelas de 35-39 anos (76,8%). Mulheres com renda familiar até 1 salário-mínimo (RPaj=2,08;IC95% 1,72-2,54), que estudaram até a 4a série (RPaj=2,30;IC95% 1,22-2,67), residentes na região Nordeste (RPaj=1,79;IC95% 1,34-2,09) e em municípios com até 20.000 habitantes (RPaj=3,15;IC95% 2,33-3,96) apresentaram maior prevalência de não realização do exame. Conclusão: a cobertura do exame citopatológico esteve abaixo do recomendado, com disparidades socioeconômicas e geográficas. Os dados sugerem necessidade de oportunizar o rastreamento entre mulheres jovens de maior risco para o câncer do colo do útero.


Objectives: to evaluate the coverage and factors associated with non-performing Pap smear test among women aged 18-39 years in Brazil. Methods: cross-sectional, population-based study with household survey data with 2,002 literate women from urban areas, selected by random sampling by clusters in 2016. The practice of Pap test in the previous three years and associated factors with non-participation were evaluated, with calculation of adjusted prevalence ratio (PRad) and 95% confidence intervals (95%CI) by Poisson regression. Results: coverage of Pap tests among women 18-39 years was 66.5%, being higher in those aged 35-39 years (76.8%). Women with a family income up to 01 minimum wage (PRad=2.08; 95%CI 1.72-2.54), who studied up to 4th grade (PRad=2.30; 95%CI 1.22-2.67) and residents in the Northeast region (PRad=1.79; 95%CI 1.34-2.09) and in municipalities up to 20,000 inhabitants (PRad=3.15; 95%CI 2.33-3.96) had a higher prevalence of non-participation in screening. Conclusions: the coverage of the Pap smear test was below recommended, with socioeconomic and geographical disparities. The data suggest the need to provide screening among young women at higher risk for cervical cancer.


Assuntos
Teste de Papanicolaou , Mulheres , Neoplasias do Colo do Útero , Colo do Útero , Programas de Rastreamento , Inquéritos Epidemiológicos
15.
Prim Health Care Res Dev ; 23: e49, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-36047002

RESUMO

Strong primary care does not develop spontaneously but requires a well-developed organizational planning between levels of care. Primary care-oriented health systems are required to effectively tackle unmet health needs of the population, and efficient primary care organization (PCO) is crucial for this aim. Via strong primary care, health delivery, health outcomes, equity, and health security could be improved. There are several theoretical models on how primary care can be organized. In this position paper, the key aspects and benchmarks of PCO will be explored based on previously mentioned frameworks and domains. The aim of this position paper is to assist primary care providers, policymakers, and researchers by discussing the current context of PCO and providing guidance for implementation, development, and evaluation of it in a particular setting. The conceptual map of this paper consists of structural and process (PC service organization) domains and is adapted from frameworks described in literature and World Health Organization resources. Evidence we have gathered for this paper shows that for establishing a strong PCO, it is crucial to ensure accessible, continuous, person-centered, community-oriented, coordinated, and integrated primary care services provided by competent and socially accountable multiprofessional teams working in a setting where clear policy documents exist, adequate funding is available, and primary care is managed by dedicated units.


Assuntos
Grupos Populacionais , Atenção Primária à Saúde , Humanos
17.
Diabet Med ; : e14951, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36054775

RESUMO

OBJECTIVE: Diabetes-related foot ulceration (DFU) is a common limb-threatening condition, which is complex and subsequently challenging to manage. The aim of this study was to determine the contribution of a range of clinical and social factors to the healing of diabetes-related foot ulceration in an Australian population. RESEARCH DESIGN AND METHODS: This was a prospective cohort study of individuals with diabetes-related foot ulceration (DFU). Age, sex, medical history, medications, dietary supplementation (e.g. vitamin C intake) and smoking history were elicited at baseline. The index of relative socio-economic disadvantage (IRSD) was calculated. The Australian Eating Survey and International Physical Activity Questionnaire-short were administered. Wound history, size, grade, time to healing and infection were captured and monitored over 6 months. Logistic regression was performed to determine the relationship between healing and diet quality, toe systolic pressure, wound size at, IRSD, infection and previous amputation. RESULTS: A total of 117 participants were included. The majority were male n = 96 (82%), socio-economically disadvantaged (mean IRSD 965, SD 60), and obese (BMI 36 kg/m2 , SD 11) with a long history of diabetes (20 years, SD 11). Wounds were predominantly neuropathic (n = 85, 73%) and classified 1A (n = 63, 54%) on the University of Texas wound classification system with few infections (n = 23, 16%). Dietary supplementation was associated with 4.36 increased odds of healing (95% 1.28-14.84, p = 0.02), and greater levels of socio-economic advantage were also associated with increased odds of healing (OR 1.01, 95% CI 1.01-1.02, p = 0.03). CONCLUSIONS: In this cohort study of predominantly neuropathic, non-infected DFU, individuals who had greater levels of socio-economic advantage had significantly greater odds of DFU healing. Diet quality was poor in most participants, with individuals taking supplementation significantly more likely to heal.

18.
Nephrol Nurs J ; 49(4): 313-327, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36054804

RESUMO

The Nephrology Nursing Scope and Standards of Practice, 9th Edition, published by the American Nephrology Nurses Association, defines the scope of nephrology nursing and provides standards of practice, standards of professional performance, and competencies for registered nurses and graduate-level prepared registered nurses (e.g., advanced practice registered nurses, clinical nurse specialists) in an approach consistent with the American Nurses Association's Nursing Scope and Standards of Practice, published in 2021. Discussions addressing respect, equity, inclusion, and social justice have been included in the 9th edition. A new section related to altered/crisis standards has been added to assist nephrology nurses in developing strategies for implementing those standards. The section on how to use the standards has been updated with forms that organizations can download and individualize. This article provides an overview of the scope, standards, competencies, and strategies for implementing them in clinical practice.


Assuntos
Enfermagem em Nefrologia , Nefrologia , American Nurses' Association , Humanos , Estados Unidos
19.
Am J Public Health ; : e1-e11, 2022 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-36075009

RESUMO

Objectives. To assess whether cannabis control policies that may protect public health were adopted evenly across California localities with differing sociodemographic compositions. Methods. From November 2020 to January 2021, we measured cannabis control policies for 241 localities across California and linked them to data on the characteristics of the communities affected by these policies. We evaluated whether disadvantaged communities were more likely to allow cannabis businesses and less likely to be covered by policies designed to protect public health. Results. Localities with all-out bans on cannabis businesses (65% of localities) were disproportionately high-education (55.8% vs 50.5% with any college) and low-poverty (24.3% vs 34.2%), with fewer Black (4.4% vs 6.9%) and Latinx (45.6% vs 50.3%) residents. Among localities that allowed retail cannabis businesses (28%), there were more cannabis control policies in localities with more high-income and Black residents, although the specific policies varied. Conclusions. Cannabis control policies are unequally distributed across California localities. If these policies protect health, inequities may be exacerbated. Public Health Implications. Uniform adoption of recommended cannabis control policies may help limit any inequitable health impacts of cannabis legalization. (Am J Public Health. Published online ahead of print September 8, 2022:e1-e11. https://doi.org/10.2105/AJPH.2022.307041).

20.
Obstet Gynecol ; 2022 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-36075061

RESUMO

OBJECTIVE: To establish a sustainable and trackable process to delineate the role of social determinants of health, bias, and racism in adverse gynecologic events. METHODS: The existing process entails monthly reviews of adverse events. Each case is assessed for preventability, harm, and standards of care. The equity-focused process consists of: 1) creation of a standardized health equity checklist; 2) application of the checklist to each gynecologic adverse event beginning on September 1, 2020; 3) collection of event review data in a secure central digital repository; 4) review of the cases to understand apparent causes of the event; 5) exploration of areas for improvement by using standard fields; and 6) identification of specific ideas for change. RESULTS: Within 15 months, 46 safety events were identified by standard criteria. Twenty-four of the cases were deemed preventable. Of the 24, there were 12 cases in which social determinants of health or bias or both social determinants of health and bias were identified playing a role. Diagnostic delays and care delays were attributed to social determinants of health and implicit bias. Our process has mapped areas of infrastructure as well as the need for culture improvement and has also highlighted the need for restorative work on addressing implicit bias and improving approaches to shared decision making. CONCLUSION: Through the use of a health equity checklist, we have illustrated the feasibility of creating a systematic and trackable process to begin delineating the role of social determinants of health, bias, and racism in adverse gynecologic events.

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