12. Invitation for the journey to the world of togetherness / 医学教育

This article is an account of a trans individual to share with the audience that transgender people are not a myth but ordinary humans living in Japan. I illustrated the real emotions and challenges a transgender person faces in a society that lacks sufficient understanding and support, including adequate legal and healthcare systems. I also want to tell readers what "coming out" and "transitions" mean to those who have had to hide their sexuality from a very young age, even from their parents.　Our society has been changing. However, there is still a number of enormous barriers in healthcare for someone who underwent gender-affirming therapy and finally started to live as their true self. I sincerely hope medical educators training future health professionals will recognize the hardships to improve the situations.

Difference of sociodemographic characteristics among the disabled population in Cambodia: a cross-sectional study of the demographic and health survey data / Journal of Rural Medicine

Objective: There is an urgent need to raise awareness of the significance of the social security system for vulnerable populations in developing countries and identify the widening disparities among people with disabilities. This study determined the sociodemographic characteristics of people with disabilities in Cambodia.Materials and Methods: This was a cross-sectional study. Data from the Cambodia Demographic and Health Survey were used to determine the association between disability and sociodemographic characteristics such as age, gender, number of family members, residence (rural/urban), and economic status.Results: The results showed that the proportion of people with disabilities greatly increased with age. The rural-urban residence difference affected the disability proportion in univariate analysis; however, the effect was not significant after adjusting for covariables in multivariate analysis. The odds of having a disability were 0.85 times lower for the high economic status group than for the low economic status group.Conclusion: Raising awareness to expand the capacity of social support for older adults with disabilities, especially those who do not receive care from their families, may be an urgent issue in Cambodia. Therefore, a well-designed and disease-specific study is required. This study was the first to determine the sociodemographic disparities among people with disabilities in Cambodia.

Determinantes sociales de salud y su relación con desnutrición infantil en dos comunidades étnicas colombianas / Social determinants and malnutrition of infants from two Colombian indigenous communities

RESUMEN Objetivo Identificar la relación entre los determinantes sociales de la salud y el estado nutricional de los niños pertenecientes a dos comunidades indígenas de la Costa Caribe colombiana, los wayús y los zenús. Métodos Estudio transversal que aborda el estado nutricional de los wayús y los zenús en edad preescolar y escolar. Incluyendo, además, estimación de determinantes sociales de la salud, referida por cuidadores de menores, que aborda algunos aspectos de ejes de desigualdad de tipo estructural (etnia, territorio, edad y sexo) e intermedios: vivienda, entorno y redes, mediante instrumentos de salud familiar. Se estandarizaron métricas de talla, peso e insumos de familiograma y ecomapa. Se estimaron medidas descriptivas de tipo frecuentistas y de medidas de tendencia central. Se estimó la odds ratio y su relación con variables independientes. Resultados La prevalencia de desnutrición global en la etnia Wayú fue del 59,1% IC (47,569,8) y en la etnia Zenú del 22,4% IC (15,9-30,4) para una p<0,001. Esta diferencia se relaciona con factores de riesgo intermediarios de saneamiento: inadecuadas excretas con OR=2.54; IC (1.42-4.53) p=0.002, la falta de empleo OR=1.94; IC (1.09-3.46) P=0.03 y falta de acceso a servicios de salud occidental OR=2.42; IC (1.34-4.40) p=0.005. Conclusiones La mejora en la nutrición requiere intervenir determinantes intermedios relacionados con saneamiento, modelo de salud, intersectorialidad de políticas en salud más enfoque étnico-cultural y territorial.

ABSTRACT Objetive To identify the relationship between the Health's Social Determinants and the nutritional status of children belonging to two indigenous communities on the Colombian Caribbean coast, the Wayú and the Zenú. Methods Cross-sectional study that addresses nutritional status in wayúes and zenúes at preschool and school age. Also including the estimation of health's social determinants, referred by minor's caregivers, which addresses some aspects of structural ¡nequality axes (ethnicity, territory, age, and sex) and intermediates: housing, environment, and networks, through health instruments family. Metrics for height, weight, and inputs for the familiogram and ecomap were standardized. Descriptive measures of frequencies and central tendency were estimated. Odds ratio and its relationship with ¡ndependent variables were estimated. Results The prevalence of global malnutrition in the Wayú ethnic group was 59.1% (47.5-69.8) and in the Zenú ethnic group 22.4% (15.9-30.4) for a p<0.001. This difference is related to intermedíate risk factors with sanitation: inadequate excreta with OR=2.54; CI (1.42-4.53) p=0.002, lack of employment OR=1.94; CI (1.09-3.46) P=0.03 and lack of access to western health services OR=2.42; IC (1.34-4.40) p=0.005. Conclusions Improvement in nutrition requires the intervention of intermediate determinants related to sanitation, health model, intersectoriality of health policies plus an ethnic-cultural and territorial focus.

Lecturas de Bioética: Las víctimas indirectas de la pandemia / Bioethics Readings: The Indirect Victims of the Pandemic

A 15 meses de la pandemia, todavía no conocemos los resultados del cierre de los servicios de salud ni las consecuencias de los manejos de muchas manos en ese plato. Nos preocupa, con razón, la alarmante serie de consecuencias negativas sobre la economía y sobre la educación, pero, en la marcha forzada, la pandemia desnudó las serias y crónicas falencias éticas del sistema de salud nacional

15 months after the pandemic, we still do not know the results of the closure of health services or the consequences of the handling of many hands on that plate. We are rightly concerned about the alarming series of negative consequences on the economy and on education, but, in the forced march, the pandemic exposed the serious and chronic ethical shortcomings of the national health system.

Teaching Social Determinants of Health before Graduation: the Learner's Perspective / 医学教育

In recent years, health disparity has become more obvious and people from diverse backgrounds suffer from various kinds of problems. It is crucial to foster doctors who can respond to social needs. I participated in a five-week elective course during his 3rd year of Juntendo University School of Medicine (2015). The course focused on health inequity and social determinants of health (SDH). As a student, I found it extremely important for medical students to learn about SDH. In this report, I will share my experiences as a junior doctor to reflect on what I learned then and how that affects my practice.

Health Status and Health Service Utilization: Barriers and Facilitators for Korea Medicaid Beneficiaries

PURPOSE: This study compares beneficiaries of Korean Medicaid with those under the National Health Insurance program, seeking to understand how each group utilizes their healthcare. METHODS: Data were obtained from a Health Promotion Survey in 2005. Health status was measured by the respondents' perception of health. Health service utilization included the availability of healthcare services, the type of healthcare institution, and intent to revisit. Predisposing and enabling factors, as well as health care needs were used for this study. RESULTS: Compared to National Health Insurance beneficiaries, Medicaid beneficiaries reported lower levels of health status and fewer enabling factors. They had more chronic diseases and disabilities. Education level, existence of chronic diseases, exercise patterns, and disabilities were associated with health status. CONCLUSION: We found that Medicaid beneficiaries had fewer resources and higher levels of health needs. As Medicaid is reformed, policy makers and administrators should understand healthcare utilization behaviors of Medicaid beneficiaries and the factors hindering access to care.

How to Improve Influenza Vaccination Rates in the U.S / 예방의학회지

Annual epidemics of seasonal influenza occur during autumn and winter in temperate regions and have imposed substantial public health and economic burdens. At the global level, these epidemics cause about 3-5 million severe cases of illness and about 0.25-0.5 million deaths each year. Although annual vaccination is the most effective way to prevent the disease and its severe outcomes, influenza vaccination coverage rates have been at suboptimal levels in many countries. For instance, the coverage rates among the elderly in 20 developed nations in 2008 ranged from 21% to 78% (median 65%). In the U.S., influenza vaccination levels among elderly population appeared to reach a "plateau" of about 70% after the late 1990s, and levels among child populations have remained at less than 50%. In addition, disparities in the coverage rates across subpopulations within a country present another important public health issue. New approaches are needed for countries striving both to improve their overall coverage rates and to eliminate disparities. This review article aims to describe a broad conceptual framework of vaccination, and to illustrate four potential determinants of influenza vaccination based on empirical analyses of U.S. nationally representative populations. These determinants include the ongoing influenza epidemic level, mass media reporting on influenza-related topics, reimbursement rate for providers to administer influenza vaccination, and vaccine supply. It additionally proposes specific policy implications, derived from these empirical analyses, to improve the influenza vaccination coverage rate and associated disparities in the U.S., which could be generalizable to other countries.

Necesidades de tratamiento en dentición primaria en niños de uno a cinco años con caries dental no tratada en una comunidad de bajos ingresos: Moravia, Medellín, 2006 / Treatment needs in primary dentition in 1-5 year old children with non treated dental caries in a low-income community Moravia, Medellín, 2006

Introducción: el objetivo fue establecer la prevalencia de caries dental no tratada y las necesidades de tratamiento en niños de uno a cinco años del barrio Moravia de Medellín. Métodos: se realizó un estudio descriptivo transversal, en 162 niños. Un examinador calibrado (Kappa 0.73) evaluó el estado de la dentición de los niños —según criterios de Pitts y Fyffe, que establecen niveles de avance delas lesiones de caries dental (D1-D4)— y con base en este se determinaron las necesidades de tratamiento, teniendo en cuenta lineamientos actuales de un enfoque más preventivo. Los datos se analizaron en el programa SPSS 15.0; se estimó la proporción de niños con caries dental no tratada y el promedio de dientes para los diferentes tipos de tratamiento y sus desviaciones estándar. Resultados: se encontróun 77,8% de los niños con caries dental no tratada, quienes tenían en promedio 5,8 ± 4,1 dientes que requerían tratamiento. El 47%de las lesiones de caries dental correspondían a lesiones iniciales en esmalte o con cavidad limitada al esmalte (D1 y D2), que pueden controlarse con tratamientos preventivos; el 53% comprometían dentina y pulpa (D3 y D4). Las necesidades de atención aumentan con la edad. Conclusiones: la alta prevalencia de niños con caries de la infancia temprana (ECC) y lesiones de caries dental no tratada reflejan el problema de necesidades de atención acumuladas en esta población, lo cual hace evidente la relación de la caries dental con la inequidady condiciones de vida que limitan el acceso a la atención odontológica oportuna y efectiva.

Introduction: the purpose was to establish non treated dental caries prevalence and treatment needs in 1 to 5 year old children living in a low-income neighborhood in Medellin. Methods: a cross-sectional study was performed in 162 children. A calibrated (Kappa0.73) examiner assessed dental status according to Pitts & Fyffe criteria. Based on caries lesions advance (D1-D4), treatment needs were defined, according to current guidelines promoting a preventive and less invasive approach. The proportion of non treated dental caries was estimated, as well as the average and standard deviation of teeth per child requiring different treatment categories. Results: from the total 162 children, 77.8% had non treated dental caries, each child having 5.8 ± 4.1 teeth needing some kind of treatment. From all dental caries lesions, 47% correspond to initial enamel lesions or small cavity confined to enamel (D1 - D2), potentially controlled by preventive treatment, and 53% compromise dentin and pulp (D3 - D4). Treatment needs increased with age. Conclusions: high prevalence of Early Childhood Caries and non treated dental caries lesions reflects cumulated treatment needs in this low income population and support a relationship between dental caries, inequalities and living conditions, limiting access to effective and opportune dental care.

Tuberculose nas populações indígenas de Rondônia (1997-2006), Amazônia Ocidental – Brasil: uma análise com base no SINAN / Tuberculosis in indigenous populations of Rondônia (1997-2006), Western Amazon - Brazil: an analysis based on SINAN

A tuberculose (TB) permanece como um importante problema de saúde pública no Brasil, especialmente nos povos indígenas da Região Amazônica, destacando-se os elevados coeficientes de morbidade e mortalidade descritos entre os Suruí e Warí de Rondônia (RO). O presente estudo analisou comparativamente, indicadores clínicos, epidemiológicos e operacionais da TB sobre os casos indígenas e não-indígenas e entre os Distritos Sanitários Especiais Indígenas (DSEI) de RO, com base nos dados disponíveis no período de dez anos (1997-2006) junto ao Sistema de Informação de Agravos de Notificação (SINAN) da Secretaria de Estado da Saúde (SESAU/RO). A estratégia de identificação dos casos indígenas através de seus sobrenomes (etnias) contornou as dificuldades relacionadas à ausência de preenchimento da variável raça/cor no SINAN/TB, possibilitando que os indicadores utilizados fossem calculados entre indígenas e não-indígenas e por DSEI (Porto Velho e Vilhena). No decênio foram analisados 6.407 casos, dos quais 6,5 por cento (420) foram reclassificados como indígenas e 93,5 por cento grupados como não-indígenas. Do total de casosindígenas, 55,7 por cento pertenciam ao DSEI Porto Velho e 44,3 por cento do DSEI Vilhena, com destaque para a elevada concentração de casos nas etnias Suruí, Warí e Karitiana. Os casos não-indígenas eram, em sua maioria (80,0 por cento), residentes de áreas urbanas do Estado, ao contrário dos indígenas que provinham de áreas rurais (81,9 por cento), especialmente os que pertenciam ao território do DSEI Vilhena(91,4 por cento)...

Tuberculosis (TB) remains an important public health problem in Brazil, especially among indigenous people of Rondônia - RO (Western Amazon - Brazil), for presenting one of the highestlevels of incidence in the country. This study sought to analyze the epidemiology of TB among theindigenous and non-indigenous populations of RO, comparing the indicators, using data of reportedcases in the ten-year period (1997-2006), along with the Sistema de Informação de Agravos deNotificação (SINAN - System of Reporting Aggravation Information) from Secretaria de Estadoda Saúde SESAU/RO – (State Secretary of Health/RO). The strategy used for the identification of the cases outlined the difficulties observed by the inconsistency of the filling out of theidentification variable of race/color in SINAN/TB, observing that in Rondônia, in general, the indigene’s surname is that which identifies the ethnic group to which he/she belongs to. During thestudy period, 6.631 cases were reported from which 6.407 were analyzed. From this amount, 6,5%(420) were classified as indigenes and 93,5% (5.987) as non-indigenes. In distribution by the variable zone of residency, it was observed that 75,8% of all reported cases were located in theurban area of the state. However, among the indigenes it was verified that 81,9% of the reports were located in rural areas. In relation to the variable-type of entering in the system, the indigenes corresponded to 81,7% of new cases, 12,6% of relapsing cases, 2,4% of post-desertion reentry, 1,9% of transferences and in 1,2% there was no defined situation. Among the classified as nonindigenous, the new cases consisted in 83,2% of the reports, the relapsing cases were 6,1%,reentries were 4,7% and transferences were 4,8% and the non-informed cases about the type of entry were 0,8%...