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1.
Enferm. actual Costa Rica (Online) ; (38): 282-291, Jan.-Jun. 2020.
Article in Spanish | LILACS, BDENF - Nursing | ID: biblio-1090102

ABSTRACT

Resumen En las últimas décadas se ha desarrollado una mayor conciencia acerca de cuán relevante es la paternidad activa en el desarrollo integral de los/as hijos/as y en la equidad de género. Sin embargo, a pesar de la amplia discusión e implementación de algunas estrategias, se observa una escasa participación en la crianza y cuidados de parte de los padres, situación por la que el presente ensayo tiene el propósito de reflexionar críticamente en torno al cuidado de la niñez desde la desigualdad de género, la masculinidad imperante y las estrategias para el fomento de la paternidad activa. Este escrito reflexiona sobre la paternidad activa desde la mirada de una sociedad adultocéntrica y su influencia en la incorporación de valores, actitudes y conductas durante la niñez. Además, analiza la construcción del cuidado del infante en el ámbito privado, tarea que es subvalorada por la comunidad y que recae principalmente en la mujer con las consecuencias de inequidad de género y problemas de salud que conlleva. Finalmente, se evidencia los esfuerzos realizados en Chile en la implementación para el fomento de una paternidad activa, así como los desafíos pendientes. Para avanzar a la paternidad activa se requiere de una mayor intervención con las familias y los distintos sectores de la sociedad, implementando estrategias desde un enfoque de equidad de género en cuanto a la distribución del cuidado en la niñez. Asimismo, se requiere de avances politicos importantes para dar sustento a una nueva formar de cuidar.


Abstract In recent decades, there has been a growing awareness of the importance of active fatherhood in the integral development of children and in gender inequality. Despite the extensive discussion and implementation of some strategies, there is a low participation in parenting and care of parents. For this reason, the present essay has the purpose of critically reflecting on the care of children from gender inequality, prevailing masculinity and strategies for the promotion of active parenthood. This paper reflects on active fatherhood from the perspective of an adult-centric society and its influence on the incorporation of values, attitudes and behaviors during childhood. In addition, it analyzes the construction of child care in the private sphere, a task that is undervalued by the community and that falls mainly on women with the consequences of gender inequity and health problems that it entails. Finally, the efforts made in Chile in the implementation for the promotion of active fatherhood and the pending challenges are visualized. To move towards active fatherhood requires a greater intervention with families and different sectors of society, implementing strategies from a gender equity perspective regarding the distribution of child care. It also requires important political advances to support a new way of caring.


Resumo Nas últimas décadas, tem havido uma crescente conscientização sobre a importância da paternidade ativa no desenvolvimento integral das crianças e na desigualdade de gênero. Apesar da extensa discussão e implementação de algumas estratégias, há uma baixa participação na parentalidade e no cuidado dos pais. Por este motivo, o presente ensaio tem como objetivo refletir criticamente em torno do cuidado das crianças da desigualdade de gênero, masculinidade prevalente e estratégias para a promoção da paternidade ativa. Este artigo reflete sobre a paternidade ativa a partir da perspectiva de uma sociedade adultocêntrica e sua influência na incorporação de valores, atitudes e comportamentos durante a infância. Além disso, analisa a construção da creche na esfera privada, uma tarefa que é subvalorizada pela comunidade e que recai principalmente sobre as mulheres com as conseqüências da desigualdade de gênero e dos problemas de saúde que ela acarreta. Finalmente, os esforços feitos no Chile na implementação para a promoção da paternidade ativa e os desafios pendentes são visualizados. Avançar para a paternidade ativa requer uma maior intervenção com as famílias e diferentes setores da sociedade, implementando estratégias a partir de uma perspectiva de equidade de gênero em relação à distribuição do cuidado infantil. Também requer avanços políticos importantes para apoiar uma nova maneira de cuidar.


Subject(s)
Humans , Male , Paternity , Child Care , Child Rearing , Essay , Masculinity
2.
Article in English | PAHO-IRIS | ID: phr-52154

ABSTRACT

[ABSTRACT]. Objective. To compare inequalities in full infant vaccination coverage at two different time points between 1992 and 2016 in Latin American and Caribbean countries. Methods. Analysis is based on recent available data from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and Reproductive Health Surveys conducted in 18 countries between 1992 and 2016. Full immunization data from children 12–23 months of age were disaggregated by wealth quintile. Absolute and relative inequalities between the richest and the poorest quintile were measured. Differences were measured for 14 countries with data available for two time points. Significance was determined using 95% confidence intervals. Results. The overall median full immunization coverage was 69.9%. Approximately one-third of the countries have a high-income inequality gap, with a median difference of 5.6 percentage points in 8 of 18 countries. Bolivia, Colombia, El Salvador, and Peru have achieved the greatest progress in improving coverage among the poorest quintiles of their population in recent years. Conclusion. Full immunization coverage in the countries in the study shows higher-income inequality gaps that are not seen by observing national coverage only, but these differences appear to be reduced over time. Actions monitoring immunization coverage based on income inequalities should be considered for inclusion in the assessment of public health policies to appropriately reduce the gaps in immunization for infants in the lowest-income quintile.


[RESUMEN]. Objetivo. Comparar las desigualdades en cuanto a la cobertura de la inmunización completa en los lactantes en países de América Latina y el Caribe. en dos puntos diferentes en el tiempo: 1992 y el 2016. Métodos. El análisis se basa en datos obtenidos recientemente a partir de las encuestas demográficas y de salud, las encuestas de grupos de indicadores múltiples y las encuestas de salud reproductiva realizadas en 18 países entre 1992 y el 2016. Los datos de la cobertura de la inmunización completa en lactantes (de 12 a 23 meses de edad) fueron desglosados por quintil de riqueza. Se midieron las desigualdades absolutas y relativas entre el quintil de ingresos más altos y el quintil de ingresos más bajos. Se midieron las diferencias en 14 países a partir de los datos disponibles para dos puntos en el tiempo. Se determinó la significación mediante intervalos de confianza del 95%. Resultados. La mediana general de los niveles de cobertura de inmunización total fue de 69,9%. Aproximadamente un tercio de los países presentan una brecha de desigualdad con respecto al quintil de ingresos más altos, con una diferencia entre medianas de 5,6 puntos porcentuales en 8 de 18 países. En los últimos años, Bolivia, Colombia, Perú y El Salvador han logrado el mayor avance en cuanto a la mejora de la cobertura en términos de la población correspondiente al quintil de ingresos más bajos. Conclusiones. En este estudio, la cobertura de inmunización completa en los países muestra brechas de desigualdad con respecto al quintil de ingresos más altos que no se evidencian con tan solo observar el nivel de cobertura a nivel nacional. Sin embargo, estas desigualdades parecen disminuir con el transcurso del tiempo. Debería considerarse la posibilidad de que las medidas de seguimiento de la cobertura de inmunización con base en las desigualdades de los ingresos sean incluidas en la evaluación de las políticas de salud pública. Esto permitiría reducir de manera apropiada las brechas en cuanto a la inmunización en los lactantes en el quintil de ingresos más bajos.


[RESUMO]. Objetivo. Comparar as desigualdades na cobertura vacinal completa infantil em dois momentos distintos entre 1992 e 2016 em países da América Latina e Caribe. Métodos. A análise se baseou em dados recentes provenientes de Pesquisas Nacionais de Demografia e Saúde, Inquéritos por Conglomerados de Múltiplos Indicadores e Pesquisas de Saúde Reprodutiva realizados em 18 países entre 1992 e 2016. Os dados de cobertura vacinal completa em crianças entre 12 e 23 meses de idade foram desagregados por quintis de renda. Foi mensurada a desigualdade absoluta e relativa entre os quintis de maior e menor renda. A magnitude destas diferenças foi avaliada em 14 países com dados disponíveis nos dois momentos considerados. O nível de significância foi determinado com o uso de intervalos de confiança de 95%. Resultados. A mediana global de cobertura vacinal completa foi de 69,9%. Cerca de um terço dos países apresenta alto nível de desigualdade de renda, com uma diferença mediana de 5,6 pontos percentuais em 8 dos 18 países. Bolívia, Colômbia, El Salvador e Peru obtiveram maior avanço nos últimos anos com o aumento do nível de cobertura na população nos quintis de menor renda destes países. Conclusões. A análise da cobertura vacinal completa infantil nos países estudados indica altos níveis de desigualdade de renda que não são evidentes quando se observa somente a cobertura nacional. No entanto, estas diferenças parecem que vêm diminuindo. Deve-se considerar incluir ações de monitoramento da cobertura vacinal com base nas desigualdades de renda ao se avaliar as políticas de saúde pública a fim de reduzir apropriadamente a disparidade na cobertura vacinal de lactentes pertencentes ao quintil de menor renda.


Subject(s)
Immunization , Social Inequity , Infant , Latin America , Caribbean Region , Immunization , Social Inequity , Infant , Latin America , Caribbean Region
3.
Article in English | MEDLINE | ID: mdl-32415578

ABSTRACT

BACKGROUND: Racial minority populations face an increased burden relative to cancer interventions. Compared with Caucasians, the cancer screening rate is substantially lower among African American, Asian American, Latinx American, and American Indian/Alaska Native populations. Barriers such as low health literacy, lack of health insurance, and miscommunication between patients and providers have been identified as important factors that result in low screening rates among minority adults. This study was designed to identify interventions targeting racial minority adults 40 years of age or older that were effective in increasing cancer screening uptake rates. METHODS: A systematic review of articles published in and after January 2009 was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Twenty-six published studies of cancer screening intervention tested with minority adults were identified through the searches of CINAHL, Global Health, PsycINFO, PubMed, and Scopus databases. RESULTS: Thirteen (50%) of the studies utilized lay community health workers to increase cancer awareness and knowledge and to encourage screening. These methods took place over the telephone, at community education sessions, or within the context of personalized patient navigation support. The intervention programs utilized culturally relevant materials as well as spoken and written information in the targeted population's native language. Various intervention designs resulted in statistically significant increases in cancer screening adherence. However, we found no intervention that consistently elevated cancer screening rates across all racial/ethnic minority adults. CONCLUSIONS: The finding suggests that highly segmented interventions are needed in order to improve cancer screening among various racial/ethnic minority adults.

4.
Article in English | MEDLINE | ID: mdl-32357506

ABSTRACT

Promoting physical activity (PA) and eliminating health disparities among underserved minority children is a public health priority. The main purpose of this study was to examine the relationship of actual motor competence (a set of object control skills) and perceived motor competence with PA participation and health-related quality of life (HRQoL) among underserved Hispanic children who were born in the U.S. Guided by Stodden et al.'s conceptual model, we tested the direct and indirect effects (mediational model) of actual motor competence on health-related outcomes (PA and HRQoL) through perceived motor competence. Participants were 215 underserved Hispanic children (Mage = 10.55 years, SD = 0.53 [age range 10-12]; 51.6% boys), recruited from four elementary schools in the southwestern U.S., who completed validated questionnaires assessing their perceived motor competence, PA, and HRQoL. Their actual motor skills were assessed using PE MetricsTM. After examining the associations among the variables, we tested the hypothesized model using structural equation modeling (SEM; AMOS 25). The hypothesized model indicated a good fit (χ²/df = 38.427/24 = 1.60 < 5; non-normed fit index (NFI) = 0.93; comparative fit index (CFI) = 0.968; root mean square error of approximation (RMSEA) = 0.053 [0.016, 0.083]). The effect of actual motor competence on PA and HRQoL was fully mediated by perceived motor competence. The findings demonstrated the mediating role of perceived motor competence between actual motor competence and health-related outcomes (PA and HRQoL) among underserved Hispanic children. The results highlight that actual motor competence significantly predicted underserved Hispanic children' perceived motor competence, which in turn positively predicted their PA and HRQoL. These findings have significant practical implications for future intervention strategies of randomized clinical trials in schools aimed at promoting PA and HRQoL and eliminating health disparities among underserved Hispanic children.

5.
Cien Saude Colet ; 25(5): 1735-1750, 2020 May.
Article in English, Portuguese | MEDLINE | ID: mdl-32402040

ABSTRACT

This study analyzed the social and geographical inequalities in the performance of prenatal medical care in the Unified Health System (SUS) in the Metropolitan Region of Grande Vitória, Espírito Santo, Brazil. A cross-sectional study was carried out with 1,209 puerperae living in this region, admitted for childbirth from 2010 to 2011. Data about prenatal care and contextual, enabling, and social characteristics were collected, following the Andersen's Behavioral Model. The performance of prenatal care was classified into five levels, including information on the number of prenatal visits, initial and repetitive examinations, tetanus vaccination, gestational risk management, and participation in educational activities. The likelihood of different levels of prenatal care performance was analyzed using a multivariate multinomial model, according to maternal social variables. High prenatal coverage (98%) and 4.4% care adequacy were identified. The likelihood of access to prenatal care was increased by enabling, contextual, and social factors. The relationship between prenatal care quality and pregnant women's social and geographical conditions must be considered in the organization of services to achieve equity and reduce maternal and perinatal morbimortality.

6.
Article in English | MEDLINE | ID: mdl-32399857

ABSTRACT

To design PARTNER-MH, a peer-led, patient navigation program for implementation in Veterans Health Administration (VHA) mental health care settings, we conducted a pre-implementation evaluation during intervention development to assess stakeholders' views of the intervention and to explore implementation factors critical to its future adoption. This is a convergent mixed-methods study that involved qualitative semi-structured interviews and survey data. Data collection was guided by the Consolidated Framework for Implementation Research (CFIR). We interviewed and administered the surveys to 23 peers and 10 supervisors from 12 midwestern VHA facilities. We used deductive and inductive approaches to analyze the qualitative data. We also conducted descriptive analysis and Fisher Exact Test to compare peers and supervisors' survey responses. We triangulated findings to refine the intervention. Overall, participants viewed PARTNER-MH favorably. However, they saw the intervention's focus on minority Veterans and social determinants of health framework as potential barriers, believing this could negatively affect the packaging of the intervention, complicate its delivery process, and impact its adoption. They also viewed clinic structures, available resources, and learning climate as potential barriers. Peers and supervisors' selections and discussions of CFIR items were similar. Our findings informed PARTNER-MH development and helped identify factors that could impact its implementation. This project is responsive to the increasing recognition of the need to incorporate implementation science in healthcare disparities research. Understanding the resistance to the intervention's focus on minority Veterans and the potential barriers presented by contextual factors positions us to adjust the intervention prior to testing, in an effort to maximize implementation success.

7.
J Travel Med ; 2020 May 15.
Article in English | MEDLINE | ID: mdl-32412064

ABSTRACT

We paired high-resolution travel-time metrics with a SARS-CoV-2 testing location database in the United States. Median travel time to testing sites is longer in counties with lower population density, and a higher percent of minority and uninsured individuals. Differential geographic accessibility to testing can recapitulate healthcare disparities and bias transmission estimates.

8.
PLoS One ; 15(4): e0232014, 2020.
Article in English | MEDLINE | ID: mdl-32352971

ABSTRACT

Despite being one of the most common measures of development, the Human Development Index [HDI] has been much criticized for its consistency, data requirements, difficulty of interpretation and trade-offs between indicators. The 'Human Life Indicator' [HLI] has been proposed as a 'simple effective means' of measuring development and, more specifically, as a viable alternative to the HDI. Reducing inequalities within countries is a core component of the Sustainable Development Goals; yet sub-national HDIs are subject to the same criticisms as national level indices (potentially more so). Our goal in this paper is to demonstrate 'proof of concept' in terms of the systematic application of the HLI to measure development at the subnational level. Using life tables for the United States of America, we calculate, for the first time, HLIs for each state for the period 1959-2016. This country was chosen for the comparatively long run of available sub-national life tables. We also calculate the extent to which mortality is distributed across the life course-a further measure of inequality and the role of the social determinants of health. The HLI clearly shows how striking regional inequalities exist across the United States. We find that HLI and HDI for the most recent time period are strongly correlated. The analysis demonstrates that HLI represents an effective means of measuring development at the sub-national level. Compared to HDI, HLIs are characterized by simpler calculation and interpretation; fewer data requirements; less measurement error; more consistency over time; and no trade-offs between components. A current challenge of producing sub-national HLIs is the lack of comprehensive civil registration and vital statistics systems in many parts of the Global South from which sub-national life tables can be generated. However, as more and more countries develop these systems the potential to produce HLIs will inevitably increase.

9.
N C Med J ; 81(3): 173-176, 2020.
Article in English | MEDLINE | ID: mdl-32366625

ABSTRACT

Place-a confluence of the social, economic, political, physical, and built environments-is fundamental to our understanding of health and health inequities among marginalized racial groups in the United States. Moreover, racism, defined as a system of structuring opportunity and assigning value based on the social interpretation of how one looks (i.e., race), has shaped the places people live in North Carolina. This problem is deeply imbedded in all of our systems, from housing to health care, affecting the ability of every resident of the state to flourish and thrive.

11.
BMJ Open ; 10(5): e033356, 2020 May 15.
Article in English | MEDLINE | ID: mdl-32414818

ABSTRACT

OBJECTIVE: Despite the huge financial investment in the free maternal healthcare policy (FMHCP) by the Governments of Ghana and Burkina Faso, no study has quantified the impact of FMHCP on the relative reduction in neonatal and infant mortality rates using a more rigorous matching procedure with the difference in differences (DID) analysis. This study used several rounds of publicly available population-based complex survey data to determine the impact of FMHCP on neonatal and infant mortality rates in these two countries. DESIGN: A quasi-experimental study to evaluate the FMHCP implemented in Burkina Faso and Ghana between 2007 and 2014. SETTING: Demographic and health surveys and maternal health surveys conducted between 2000 and 2014 in Ghana, Burkina Faso, Nigeria and Zambia. PARTICIPANTS: Children born 5 years preceding the survey in Ghana, Burkina Faso, Nigeria and Zambia. PRIMARY OUTCOME MEASURES: Neonatal and infant mortality rates. RESULTS: The Propensity Score Kernel Matching coupled with DID analysis with modified Poisson showed that the FMHCP was associated with a 45% reduction in the risk of neonatal mortality rate in Ghana and Burkina Faso compared with Nigeria and Zambia (adjusted relative risk (aRR)=0.55, 95% CI: 0.40 to 0.76, p<0.001). In addition, infant mortality rate has reduced significantly in both Ghana and Burkina Faso by approximately 54% after full implementation of FMHCP compared with Nigeria and Zambia (aRR=0.46, 95% CI: 0.36 to 0.59, p<0.001). CONCLUSION: The FMHCP had a significant impact and still remains relevant in achieving Sustainable Development Goal 3 and could provide lessons for other sub-Saharan countries in the design and implementation of a similar policy.

12.
World J Surg ; 2020 Apr 09.
Article in English | MEDLINE | ID: mdl-32274536

ABSTRACT

BACKGROUND: Since long travel times to reach health facilities are associated with worse outcomes, geographic accessibility is one of the six core global surgery indicators; this corresponds to the second of the "Three Delays Framework," namely "delay in reaching a health facility." Most attempts to estimate this indicator have been based on geographical information systems (GIS) algorithms. The aim of our study was to compare GIS derived estimates to self-reported travel times for patients traveling to a district hospital in rural Rwanda for emergency obstetric care. METHODS: Our study includes 664 women who traveled to undergo a Cesarean delivery in Kirehe, Rwanda. We compared self-reported travel time from home to the hospital (excluding waiting time) with GIS estimated travel times, which were computed using the World Health Organization tool AccessMod, using linear regression. RESULTS: The majority of patients used multiple modes of transportation (walking = 48.5%, public transport = 74.2%, private transport = 2.9%, and ambulance 70.6%). Self-reported times were longer than GIS estimates by a factor of 1.49 (95% CI 1.40-1.57). Concordance was higher when the GIS model took into account that all patients in Rwanda are referred via their health center (ß = 1.12; 95% CI 1.05-1.18). CONCLUSIONS: To our knowledge, in this largest to date GIS validation study for geographical access to healthcare in low- and middle-income countries, a standard GIS model was found to significantly underestimate real travel time, which likely is in part because it does not model the actual route patients are travelling. Therefore, previous studies of 2-h access to surgery will need to be interpreted with caution, and future studies should take local travelling conditions into account.

13.
PLoS One ; 15(4): e0232126, 2020.
Article in English | MEDLINE | ID: mdl-32320458

ABSTRACT

OBJECTIVE: China is emerging as an increasingly important player in the global development space, but may be less bound to compacts that aim to curb political preferencing and therefore may produce less yield in terms of impact toward Sustainable Development Goals. This research tests the hypothesis that the disproportionate aid allocation to the birth regions of the current African political leaders that applies to some sectors more than others. DESIGN: We applied a two-part model to first estimate the probability that a region receives an aid project. Then when at least one aid project is present in a leader's birth region, we estimated the mean amount of aid the region received. SETTING: This analysis covers 699 subnational units (first administrative level) across 44 African countries over 2000-2014. These administrative units were compiled into a region year panel resulting in 10,485 observations. RESULTS: Birth regions of the current political leader are significantly more likely than the average of all of the regions to receive education (1.3 percentage points), social infrastructure and services (1.2 percentage points), and energy aid (1.7 percentage points). No significant association was found between aid flows to the birth region of the current political leader in the agriculture, communication, education, government, health or transportation sectors. Within the education sector, the coefficients for birth region are positive in both parts and statistically significant. Both the probability of aid allocation and the amount of aid conditional on any projects increase in the birth region of the current political leader. CONCLUSIONS: This sector-specific analysis provides a more nuanced picture of Chinese aid than previous analyses that determine the presence of political preference according to aggregate aid flows. The sectors where political preferencing exists are also those sectors that are typically associated with limited counterfactual-based program evaluation. We present evidence that demonstrates the importance of disaggregating aid flows in order to support a new policy framework designed to target the Sustainable Development Goals.

14.
Article in English | MEDLINE | ID: mdl-32231108

ABSTRACT

A food tradition not only corresponds to the vital need to be nourished every day, but is part of the particularity of a territory as a consequence of its history, traditions, natural heritage, and capacity for ecological and social resilience. In the search for culinary identity, a valorization of a rural territory of high identity potential is carried out, such as in the environmental protection area "Sierra Grande de Hornachos" (Extremadura, Spain), and specifically the town of Hornachos. For this purpose, a series of workshops and interviews were held for men and women who had lived most of their lives in Hornachos and who were older than 70. Information on the food uses of wild and cultivated plants, as determined by the Cultural Significance Index (CSI) for 79 species, was extracted from the interpretation of the data collected. In addition, new uses were collected in Extremadura for 16 plants and in Spain for 3, with some of these data being of particular significance in the culinary culture of Hornachega. We conclude that the area "Sierra Grande de Hornachos" forms an environment of great culinary identity that must be preserved, not only for its heritage interests but also for its agroecological ones, which could be translated into measures of wealth creation and development.

16.
Article in English | MEDLINE | ID: mdl-32295177

ABSTRACT

Action on the Sustainable Development Goals (SDGs) needs to become real and impactful, taking a "whole systems" perspective on levers for systems change. This article reviews what we have learned over the past century about the large-scale outcome of health inequality, and what we know about the behaviour of complex social systems. This combined knowledge provides lessons on the nature of inequality and what effective action on our big goals, like the SDGs, might look like. It argues that economic theories and positivist social theories which have dominated the last 150 years have largely excluded the nature of human connections to each other, and the environment. This exclusion of intimacy has legitimatised arguments that only value-free economic processes matter for macro human systems, and only abstract measurement constitutes valuable social science. Theories of complex systems provide an alternative perspective. One where health inequality is viewed as emergent, and causes are systemic and compounding. Action therefore needs to be intensely local, with power relationships key to transformation. This requires conscious and difficult intervention on the intolerable accumulation of resources; improved reciprocity between social groups; and reversal of system flows, which at present ebb away from the local and those already disadvantaged.

17.
Pediatr Blood Cancer ; : e28263, 2020 Apr 23.
Article in English | MEDLINE | ID: mdl-32323913

ABSTRACT

INTRODUCTION: Indications for hematopoietic stem cell transplantation (HSCT) in pediatric acute myeloid leukemia (AML) are primarily dependent on risk stratification at diagnosis and relapse status. We sought to determine whether access to HSCT is influenced by regional and socioeconomic factors. METHODS: Children with newly diagnosed AML aged < 15 years between 2001 and 2015 were identified using the Cancer in Young People in Canada national population-based registry. Factors potentially associated with the receipt of HSCT were studied using univariate and multivariable logistic regression models. RESULTS: Overall, 568 children with newly diagnosed AML were included and 262 (46%) received HSCT. A greater proportion of patients, 103/157 (65.6%), underwent HSCT after first or subsequent relapse compared to 159/411 (38.7%) patients who underwent transplant before relapse. Among patients for whom HSCT would be considered before relapse, factors associated with higher odds of HSCT in a multivariable analysis were: poor versus good-risk cytogenetics (Odds ratio [OR]: 30.0, 95% confidence interval [CI]: 7.7-117.0), diagnosis during 2012-2015 versus 2001-2006 (OR: 3.2, 95% CI: 1.6-6.3), diagnosis in eastern Canada versus central Canada (OR: 3.7, 95% CI: 1.9-7.3), and age 10-14 years versus age < 1 year (OR: 5.4, 95% CI: 2.3-12.8). Among patients for whom HSCT would be considered after first relapse, higher odds of HSCT was associated with diagnosis at a HSCT center (OR: 2.1, 95% CI: 1.1-4.1). CONCLUSION: Patients diagnosed at a HSCT performing center and patients from eastern Canada had higher odds of receiving HSCT. This may suggest preferential access to HSCT for certain patients.

19.
Reprod Health ; 17(1): 55, 2020 Apr 19.
Article in English | MEDLINE | ID: mdl-32306969

ABSTRACT

BACKGROUND: The Sustainable Development Goals (SDGs) include specific targets for family planning (SDG 3.7) and birth attendance (SDG 3.1.2), and require analyses disaggregated by age and other dimensions of inequality (SDG 17.18). We aimed to describe coverage with demand for family planning satisfied with modern methods (DFPSm) and institutional delivery in low- and middle-income countries across the reproductive age spectrum. We attempted to identify a typology of patterns of coverage by age and compare their distribution according to geographic regions, World Bank income groups and intervention coverage levels. METHODS: We used Demographic and Health Survey and Multiple Indicator Cluster Surveys. For DFPSm, we considered the woman's age at the time of the survey, whereas for institutional delivery we considered the woman's age at birth of the child. Both age variables were categorized into seven groups of 5 year-intervals, 15-19 up to 45-49. Five distinct patterns were identified: (a) increasing coverage with age; (b) similar coverage in all age groups; (c) U-shaped; (d) inverse U-shaped; and (e) declining coverage with age. The frequency of the five patterns was examined according to UNICEF regions, World Bank income groups, and coverage at national level of the given indicator. RESULTS: We analyzed 91 countries. For DFPSm, the most frequent age patterns were inverse U-shaped (53%, 47 countries) and increasing coverage with age (41%, 36 countries). Inverse-U shaped patterns for DFPSm was the commonest pattern among lower-middle income countries, while low- and upper middle-income countries showed a more balanced distribution between increasing with age and U-shaped patterns. In the first and second tertiles of national coverage of DFPSm, inverse U-shaped was observed in more than half of countries. For institutional delivery, declining coverage with age was the prevailing pattern (44%, 39 countries), followed by similar coverage across age groups (39%, 35 countries). Most (79%) upper-middle income countries showed no variation by age group while most low-income countries showed declining coverage with age (71%). CONCLUSION: Large inequalities in DFPSm and institutional delivery were identified by age, varying from one intervention to the other. Policy and programmatic approaches must be tailored to national patterns, and in most cases older women and adolescents will require special attention due to lower coverage and because they are at higher risk for maternal mortality and other poor obstetrical outcomes.

20.
Obes Surg ; 2020 Apr 23.
Article in English | MEDLINE | ID: mdl-32328879

ABSTRACT

BACKGROUND: In New Zealand (NZ), Indigenous Maori and Pacific peoples experience a higher burden of obesity and obesity-related disease. Counties Manukau Health (CMH) provides the largest public bariatric service in NZ housing a higher proportion (64%) of non-European groups (Asian, Pacific and Maori). This study investigated whether ethnic disparities in the receipt of bariatric surgery exist within one of the most ethnically diverse populations in NZ. METHODS: All patients accepted on to the CMH bariatric programme between 1 January 2011 and 31 December 2017 were identified through hospitalisation records. Logistic regression modelling with multivariate adjustment was utilised to assess the likelihood (odds ratio) of receipt of bariatric surgery by ethnicity. RESULTS: A total of 2519 referrals were received, of which 1051 proceeded to surgery. The proportion of patients referred who eventually underwent bariatric surgery was significantly higher for Other Europeans (68%) and NZ Europeans (63%) compared to Asian (42%), Maori (41%) and Pacific peoples (28%, p < 0.05). The likelihood of receipt of bariatric surgery was significantly lower for Maori (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.42-0.68) and Pacific (OR, 0.3; 95%CI, 0.23-0.40). These disparities were not explained by differences in socio-demographics, comorbidity or attrition. CONCLUSIONS: Ethnic disparities in the receipt of publicly funded bariatric surgery exist where NZ European and Other European patients are more likely to gain access to publicly funded bariatric surgery. These findings challenge current selection criteria and prompt discussion around whether equity targets based on ethnicity need to be established.

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