Prevalence and determinants of home delivery among pregnant women in Somaliland: Insights from SLDHS 2020 data.

OBJECTIVE: This cross-sectional study aimed to identify the determinants of home deliveries among women in Somaliland, with the objective of informing targeted interventions to improve maternal and child health outcomes. DESIGN: A cross-sectional study design was employed, utilizing data from a nationally representative sample of 3250 women in Somaliland. A multivariate logistic regression analysis was conducted to examine the factors influencing the likelihood of home delivery. SITE: The study was conducted in Somaliland, a region where home delivery remains prevalent. PARTICIPANTS: The study included 3250 women of reproductive age in Somaliland who had given birth. INTERVENTIONS: No specific interventions were administered as part of this study. The focus was on understanding the factors associated with home deliveries. MAIN MEASUREMENTS: Sociodemographic, economic, and regional factors were examined as potential determinants of home deliveries. Education levels of women and their husbands, maternal age at first marriage and first birth, and household wealth were among the main measurements analyzed. RESULTS: The analysis revealed that higher education levels were associated with a decreased likelihood of home delivery. Women with secondary (OR: 0.42, 95% CI: 0.32-0.55) or higher (OR: 0.21, 95% CI: 0.12-0.37) education were less likely to deliver at home than those with no education. Similarly, women whose husbands had a secondary (OR: 0.55, 95% CI: 0.41-0.73) or higher (OR: 0.43, 95% CI: 0.28-0.66) education were less likely to deliver at home. Increased maternal age at first marriage (OR: 1.04, 95% CI: 1.02-1.06) and first birth (OR: 1.03, 95% CI: 1.01-1.05) were significant predictors of home delivery. Lower household wealth was also associated with a higher likelihood of home delivery. Significant regional variations were observed, with certain regions showing higher rates of home deliveries compared to others. CONCLUSIONS: The findings highlight the importance of targeted interventions to address sociodemographic and regional disparities in the utilization of institutional delivery services in Somaliland. Strategies should focus on improving access to and quality of maternal healthcare services, empowering women's decision-making, and engaging men to address gender norms within households.

Social Determinants of Health and their Influence on the Homogeneity of Vaccination Coverage in Paraíba / Determinantes Sociais de Saúde e sua Influência na Homogeneidade da Cobertura Vacinal na Paraíba

The Homogeneity of Vaccination Coverage (HVC) is an important public health indicator for identifying pockets of susceptible individuals. To analyze the spatial distribution of HVC in the municipalities of Paraíba and its relation to social determinants of health. This is a mixed ecological study design, utilizing secondary and publicly available data for the period from 2016 to 2020. Spatial analysis techniques were employed to achieve the study's objective.  HVC was found to be heterogeneous across the state, with the formation of pockets of susceptible individuals. Adequate prenatal care coverage (OR=0.572; 95% CI: 0.409-0.799; p<0.001) was positively associated with adequate HVC. The proportion of individuals with inadequate water and sewage networks (OR=1.345; 95% CI: 1.007-1.796; p=0.045) and the proportion of women as heads of households (OR=1.512; 95% CI: 1.082-2.113; p=0.015) were inversely associated with adequate HVC. Our study highlights the importance of identifying geographic areas with susceptible individuals and the factors that individually and collectively interfere with HVC. This enables targeted and efficient actions, ensuring resolution.

 A Homogeneidade da Cobertura Vacinal (HCV) é um importante indicador de saúde pública para a identificação de bolsões de suscetíveis. Analisar a distribuição espacial da HCV nos municípios paraibanos e relacionar com os determinantes sociais de saúde. Trata-se de um estudo com delineamento ecológico do tipo misto, onde os dados usados são secundários e de domínio público para o período de 2016 a 2020. Para atingir o objetivo do estudo utilizou-se técnicas de análise espacial. A HCV mostrou-se heterogênea em todo o Estado com formação de bolsões de susceptíveis. Cobertura de pré-natal (OR=0,572; IC95%: 0,409-0,799; p<0,001) associou-se positivamente com HCV adequada. Proporção de indivíduos com rede de água e esgoto inadequada (OR=1,345; IC95%: 1,007-1,796; p=0,045) e proporção de mulheres como chefes de família (OR=1,512; IC95%: 1,082-2,113; p=0,015) associam-se inversamente com a HCV adequada. Nosso estudo, destaca a importância da identificação de áreas geográficas com indivíduos susceptíveis e dos fatores que interferem individualmente e em conjunto com a HCV, pois possibilita ações direcionadas e eficientes, assegurando a resolutividade.  

[How the individual characteristics and area of residence influence the request for virtual consultations?] / ¿Cómo influyen las características individuales y el área de residencia en la solicitud de interconsultas virtuales?

INTRODUCTION: The foundation of virtual consultation is to improve the cooperation and the coordination between Primary Care and other specialties. However, in its use inequities related to socioeconomic determinants have been described. The aim of this study was to identify individual and geographical factors affecting the likelihood of accessing this resource. MATERIAL AND METHODS: Descriptive study of virtual and non-virtual consultations requested by Primary Care doctors from other specialists doctors in Aragon between 1 January 2020 and 31 December 2022. Characteristics of the interconsultations and variables specific to the patient treated were recorded and analyzed; and the request rate for virtual consultations by specialty and the standardized rates by age by Basic Health Zone and stratified by sex were calculated. RESULTS: Progressive increase in the number of virtual consultations for the study period, being Traumatology, Neurology, Urology, General Surgery and Dermatology the specialties that received the most. The standardized rates by age and stratified by sex were higher in women and the Health Areas of Huesca, Calatayud and Alcañiz. The request was higher in 2022 and the specialized referral was the main type of response. Regarding variables of the patients treated, virtual consultations were requested more in urban and less dispersed areas, women, patients with lower adjusted morbidity and with free pharmacy, pensioners and active users with income less than €18,000/year. CONCLUSIONS: Despite the rise of telemedicine and its potential advantages, it is necessary to adapt it to the needs of the local population, to mitigate inequalities in access, and to integrate it with face-to-face care.

Determinantes estructurales de la salud y resistencia a los antibióticos en América Latina: revisión sistemática

Objetivo: Determinar la influencia de los determinantes sociales de la salud en la resistencia antibiótica, en los países de América Latina. Metodología: Estudio documental de tipo revisión sistemática, con análisis interpretativo de la información, se incluyeron a artículos publicados entre 2018 y 2023 de las bases de datos: PubMed, ScienceDirect, Cochrane, Dialnet, Google académico, BVS, LilaCs, Scielo, Epistemonikos, CUIDEN, TripDatabase, BASE Search, Jurn, WorldWideScience, Refseek, Redalyc, EbscoHost y CONRICYT; en los idiomas español, inglés y portugués, que tuvieran como población comunidades y países de América Latina; se excluyeron aquellos con enfoque veterinario o agropecuario. Resultados: Se obtuvieron 4,625 en la búsqueda inicial y posterior a la aplicación de criterios de selección, se analizaron 28 artículos analizó la calidad metodológica, la bibliometría y el análisis temático a través de la interpretación de la información contenida. Conclusión: Los determinantes sociales de la salud estructurales asociados con la resistencia antimicrobiana fueron las políticas públicas, el género, los factores macroeconómicos, el nivel socioeconómico familiar, educativo y la gobernanza.

Objective: Determine the influence of social determinants of health on antibiotic resistance in Latin American countries. Methodology: Systematic review type documentary study with interpretive analysis of the information, articles published between 2018 and 2023 from the following databases were included: PubMed, ScienceDirect, Cochrane, Dialnet, Google scholar, BVS, LilaCs, SciELO, Epistemonikos, CUIDEN, TripDatabase, BASE Search, Jurn, WorldWideScience, Refseek, Redalyc, EbscoHost and CONRICYT; in the Spanish, English and Portuguese languages, which had Latin American communities and countries as their population; Those with a veterinary or agricultural focus were excluded. Results: 4,625 were obtained in the initial search and after the application of selection criteria, 28 articles were analyzed that analyzed the methodological quality, bibliometrics and thematic analysis through the interpretation of the information contained. Conclusion: The social determinants of structural health associated with antimicrobial resistance were public policies, gender, macroeconomic factors, family socioeconomic level, education, and governance.

Social determinants of health influencing the choice of dialysis modality in advanced chronic kidney disease: Need of an interdisciplinary approach.

INTRODUCTION: The influence of socioeconomic and cultural barriers in the choice of renal replacement therapy (RRT) techniques in advanced chronic kidney disease (ACKD) has been scarcely explored, which can generate problems of inequity, frequently unnoticed in health care. The aim of this study is to identify the "non-medical" barriers that influence the choice of RRT in an advanced chronic kidney disease (ACKD) consultation in Spain. MATERIAL AND METHODS: Retrospective analysis including the total number of patients seen in the ACKD consultation in a tertiary hospital from 2009 to 2020. Inclusion in the ACKD consultation began with an eligibility test and a decision-making process, conducted by a specifically trained nurse. The variables considered for the study were: age, sex, etiology of CKD, level of dependence for basic activities of daily living (Barthel Scale) and instrumental activities of daily living (Lawton and Brody Scale), Spanish versus foreign nationality, socioeconomic level and language barrier. The socioeconomic level was extrapolated according to home and health district by primary care center to which the patients belonged. RESULTS: A total of 673 persons were seen in the ACKD consultation during the study period, of whom 400 (59.4%) opted for hemodialysis (HD), 156 (23.1%) for peritoneal dialysis (PD), 4 (0.5%) for early living donor renal transplantation (LDRT) and 113 (16.7%) chose conservative care (CC). The choice of PD as the chosen RRT technique (vs. HD) was associated with people with a high socioeconomic level (38.7% vs. 22.5%) (p = 0.002), Spanish nationality (91% vs. 77.7%) (p < 0.001), to a lower language barrier (0.6% vs 10.5%) (p < 0.001), and to a higher score on the Barthel scale (97.4 vs 92.9) and on the Lawton and Brody scale (7 vs 6.1) (p < 0.001). Neither age nor sex showed significant differences in the choice of both techniques. Patients who opted for CC were significantly older (81.1 vs 67.7 years; p < 0.001), more dependent (p < 0.001), with a higher proportion of women (49.6% vs 35.2%; p = 0.006) and a higher proportion of Spaniards (94.7% vs 81%, p = 0.001) in relation to the choice of other techniques (PD and HD). Socioeconomic level did not influence the choice of CC. CONCLUSION: Despite a regulated decision-making process, there are factors such as socioeconomic status, migration, language barrier and dependency of the population that influence the type of RRT chosen. To address these aspects that may cause inequity, an intersectoral and multilevel intervention is required with interdisciplinary teams that include, among others, social workers, to provide a more holistic and person-centered assessment.

[Determinants of avoidable hospitalization for type2 diabetes. Narrative review]. / Factores determinantes de las hospitalizaciones evitables por diabetes tipo2. Revisión narrativa.

OBJECTIVE: To identify the structural and intermediate determinants associated with avoidable hospitalizations (AH) of patients with type2 diabetes mellitus (T2DM). DESIGN: Literature review based on narrative synthesis. DATA SOURCES: Databases: PubMed, Science Direct, and Latin American and Caribbean Literature in Health Sciences (LILACS). STUDY SELECTION: Documents were selected and analyzed under a critical literature review, considering inclusion and exclusion criteria. DATA EXTRACTION: Information extracted from each selected article was synthesized based on the countries' income levels and the social determinants of health framework. RESULTS: A total of 4,166 articles were relevant, 36 were selected for review. From this selection, 21 were publications conducted in high-income countries, 14 in upper-middle-income countries, and one in lower-middle-income countries. The review identified that the coverage of health services -mainly primary health care- and health insurance contribute to reducing the risk of AH for T2DM, while social inequalities tend to increase the risk. CONCLUSIONS: The AH due to T2DM are susceptible to reduction through policies that contribute to increasing effective access to health services (availability, insurance), since they express social inequality, occurring to a greater extent in socioeconomically vulnerable populations. This review also provides evidence of the need to expand research on this topic in middle and low-income countries.

Estudio de prevalencia, conocimiento y control de la hipertensión arterial en barrios vulnerables de Argentina / Prevalence, knowledge and control of arterial hypertension in vulnerable neighborhoods of Argentina: A Cross-sectional Study

Introducción: La hipertensión arterial (HTA) representa el principal factor de riesgo individual, con mayor carga a nivel mundial de enfermedades cardiovasculares (ECV). En nuestro país, algunos trabajos epidemiológicos han mostrado marcadas diferencias en las prevalencias de estos factores de riesgo de acuerdo con la población evaluada. Sin embargo, no hay estudios epidemiológicos de evaluación de factores de riesgo cardiovascular exclusivos referentes a barrios vulnerables con muy bajos recursos económicos, socioculturales y poca accesibilidad a los sistemas de salud. Materiales y métodos: Estudio observacional de corte transversal multicéntrico en habitantes de comunas vulnerables de muy bajos recursos, como asentamientos populares y barrios carenciados con muestreo aleatorizado simple de casas. Se realizaron tomas de presión arterial (PA), medidas antropométricas, así como cuestionarios epidemiológicos, económicos y socioculturales. Se describen los hallazgos: prevalencia, conocimiento y control de la PA en las distintas regiones. Se efectuó una regresión logística para determinar las variables independientes a los resultados principales. Resultados: Se analizaron 989 participantes. La prevalencia de HTA global fue de 48,2%. Un total de 82% tenía un índice de masa corporal (IMC) >25 kg/m2. De estos pacientes, 45,3% tenían menos de seis años de educación. Este último aspecto se asoció a mayor prevalencia de HTA de forma independiente. De los hipertensos, 44% desconocían su padecimiento y solo en 17,2% estaba controlado, asociándose esto a tener obra social (OS) y mayor nivel educativo. Únicamente 24% estaban bajo tratamiento combinado. Conclusión: La prevalencia de HTA en barrios vulnerables es elevada, superando a la de otros estratos sociales con niveles de conocimiento, tratamiento y control de la HTA bajos, similar a otras poblaciones. Se detectó un uso insuficiente de la terapia combinada.

Introduction: Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access. Methods: A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes. Results: A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy. Conclusion: The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations... (AU)

FREE-FARE POLICY AND PHYSICAL ACTIVITY PROMOTION: ITINERARY AND INITIAL REFLECTIONS / POLÍTICA DE TARIFA ZERO E PROMOÇÃO DE ATIVIDADE FÍSICA: ITINERÁRIO E REFLEXÕES INICIAIS

In order to indicate interfaces between the Zero-Fare (ZF) public transport policy and the promotion of physical activity (PA), based on a broader view of health, the text contextualizes the ZF policy and PA in Brazil, discussing the circumstances of PA practiced as a commute, which can be optional or necessary. Recognizing the concern of readers of a newspaper article about the impacts of ZF on the reduction of commuting PA, based on the "PA paradox", reflections are made on its associations with direct and indirect benefits to people's health, so that public policies can prioritize, in addition to free time, commuting PA that is optional, with adequate safety and infrastructure. Alongside the points of convergence, considerations are also given to the consolidation of these interfaces, observing different contextual barriers. ZF is a policy that, in addition to directly and indirectly guaranteeing rights, also dialogues with the PA promotion, based on a broader vision of health. Contrary to the hegemonic model of financing public transportation, which is exclusionary, we understand that the ZF is an important achievement in the field of citizenship and should not be seen as an "enemy" of the PA practice.

Com objetivo de indicar interfaces entre a política de Tarifa Zero (TZ) e a promoção da atividade física (AF), a partir da visão ampliada de saúde, o texto contextualiza a política de TZ e da AF no Brasil, discutindo as circunstâncias das AF praticadas como deslocamento, que podem ser opcionais ou por necessidade. Ao reconhecer a preocupação de leitores de uma matéria jornalística sobre os impactos da TZ na diminuição da AF de deslocamento, com base no "paradoxo da AF", são trazidas reflexões sobre suas associações à benefícios diretos e indiretos à saúde das pessoas, de modo que as políticas públicas possam priorizar, para além do tempo livre, as AF de deslocamentos que são opcionais, com segurança e infraestrutura adequada. Junto aos pontos de convergência, também são feitas ponderações à consolidação dessas interfaces, observando-se distintas barreiras contextuais. A TZ é uma política que, para além da garantia direta e indireta de direitos, também dialoga com a promoção da AF, a partir da visão ampliada de saúde. Na contramão do modelo hegemônico de financiamento do transporte público, que é excludente, entendemos que a TZ é uma conquista importante no âmbito da cidadania e não deve ser vista como "inimiga" da prática de AF.

Os Determinantes Sociais da Saúde no planejamento da testagem à covid-19 no Amazonas, Brasil / The Social Determinants of Health in the planning of COVID-19 testing in Amazonas, Brazil

RESUMO A sindemia da covid-19 afetou desproporcionalmente populações mais vulneráveis do ponto de vista social, como pessoas de baixa renda, populações indígenas e ribeirinhas. No estado do Amazonas, onde a geografia única e as disparidades sociais apresentam desafios significativos para o acesso e a equidade em saúde, os Determinantes Sociais da Saúde (DSS) desempenham um papel crucial. Este artigo analisa se e como os DSS foram considerados durante o planejamento de testes para a covid-19 no Amazonas. Para tal análise, realizou-se um estudo de caso qualitativo por meio de análise documental e entrevistas semiestruturadas com atores-chave envolvidos no planejamento e na implementação da testagem. Os documentos oficiais foram sistematizados usando TIDieR-PHP. Os dados foram analisados empregando a ferramenta REFLEX-ISS. Os DSS não foram considerados no planejamento de testes no Amazonas. Não houve consenso entre os entrevistados sobre a importância de considerar os DSS no planejamento da intervenção. Os testes foram restritos a pacientes com sintomas graves e a algumas categorias de trabalhadores em serviços considerados essenciais. Faz-se necessário, aos gestores de políticas de saúde, conhecimento sobre a importância de considerar os DSS no planejamento em intervenções populacionais para realizar uma política equânime.

ABSTRACT The COVID-19 syndemic has disproportionately affected socially vulnerable populations, such as low-income individuals, Indigenous peoples, and riverine communities. Social Determinants of Health (SDH) have played a crucial role in the state of Amazonas, where unique geography and social disparities pose significant challenges to health access and equity. This article examines whether and how SDH were considered during COVID-19 testing planning in Amazonas. For this analysis, we conducted a qualitative case study through document analysis and semi-structured interviews with key stakeholders involved in testing planning and implementation. Official documents were systematized using TIDieR-PHP, and data were analyzed using the REFLEX-ISS tool. SDH were not considered in testing planning in Amazonas. The respondents could not all agree on the importance of considering SDH in intervention planning. Testing was limited to patients with severe symptoms and specific categories of essential workers. Health policymakers need to understand the relevance of considering SDH in planning population interventions to ensure equitable policy implementation.

Itinerários terapêuticos de pessoas hospitalizadas por covid-19 no SUS: um estudo quantiqualitativo no Distrito Federal / Therapeutic itineraries of people hospitalized for COVID-19 in the SUS: quantitative and qualitative study in the Federal District

RESUMO Os estudos sobre itinerários terapêuticos revelam modelos de cuidado e decisões tomadas pelas pessoas em situações de adoecimento e podem contribuir para o planejamento de políticas e serviços de saúde mais efetivos, especialmente em emergências como a pandemia de covid-19. O objetivo desta pesquisa foi descrever os itinerários terapêuticos de pacientes hospitalizados por covid-19 em um hospital público do Distrito Federal e explorar associações com determinantes sociais da saúde. Trata-se de um estudo de caso integrado, com triangulação de evidências quantitativas e qualitativas obtidas a partir da análise do banco de dados de um estudo observacional transversal com 233 adultos internados entre maio/2020 e dezembro/2021. A maioria homens, idosos, pretos ou pardos, com baixo nível de renda e escolaridade e múltiplas comorbidades, que procuraram atendimento na atenção especializada e conseguiram acesso rápido ao sistema de saúde. Os fatores que influenciaram a escolha do primeiro serviço foram: ocupação, região de moradia, classe econômica e escolaridade. Já os determinantes da facilidade de acesso foram: tipo de serviço buscado primeiro, gravidade do caso e contexto socioeconômico. Os resultados confirmam a influência de determinantes sociais nas experiências de adoecimento e podem subsidiar reflexões relacionadas à organização do acesso ao SUS em emergências sanitárias.

ABSTRACT Studies on therapeutic itineraries reveal models of care and decisions taken by people in situations of illness and can contribute to the planning of effective health policies and services, especially in emergencies such as the COVID-19 pandemic. The aim of this research was to describe the itineraries of patients hospitalized for COVID-19 in a public hospital in the Federal District and explore associations with social determinants of health. This is an integrated case study, with triangulation of quantitative and qualitative evidence obtained from the analysis of raw data from a cross-sectional observational study with 233 adults hospitalized between May/2020 and December/2021. The majority were men, elderly, black or brown, with low income and education levels and multiple comorbidities, who sought care in specialized care and obtained quick access to the health system. The factors that influenced the choice of the first service sought were: occupation, region of residence, economic class and education. The determinants of ease of access were: type of service first sought, severity of the case and socioeconomic context. The results confirm the influence of social determinants on illness experiences and can support reflections related to the organization of access to the SUS in health emergencies.

Analysis of Madrid Primary Health-Care staff for the implementation of exercise prescription.

OBJECTIVE: To assess the self-perception of nurses and general practitioners (GPs) toward Physical Activity on Prescription (PAP) in Madrid Primary Health-Care (PHC). DESIGN: A survey-cohort study. SITE: Nurses and GPs of Madrid PHC System. PARTICIPANTS: A total of 319 GPs and 285 nurses' responders. MEASUREMENTS: Data were analyzed under a classification tree analysis by four predictor variables: (i) Health professional (Nurses/GPs); (ii) Exercise prescription collaboration with all health professionals: physicians, nurses, psychologists, physical therapists, sports medicine physicians, sports scientists, nutritionists, and teachers (Yes/No); (iii) PA promotion collaboration with Sports Scientists (Yes/No); and (iv) The stage of change of PHC staff to PA promotion (0-4 Likert scale). RESULTS: Regarding the predictor variable (i), responders without PA guidelines knowledge and positive attitude to collaborate with nurses in PA promotion are more GPs of female sex (nurses n=33 and GPs n=175) than male sex (nurses n=3 and GPs n=59) (p<.001). For the predictor variable (ii) only 9.30% of PHC staff with a positive attitude to collaborate with all health professionals in PA promotion and exercise prescription. For the predictor variable (iii) was shown low collaboration with sports physicians and sports scientists under a multidisciplinary PAP approach (26.50% responders). Finally, in the predictor variable (iv) Staff maintaining PAP for at least 6 months, self-considered active, and with PAP knowledge want to collaborate with Sports scientists (Yes=233; No=133). CONCLUSIONS: Nurses and GPs are conscious of health-related PA benefits despite the lack of PAP knowledge and lack of willingness to collaborate with other health personnel, exercise professionals, and community resources available.

Características epidemiológicas, clínicas y funcionales de los pacientes mayores de 75 años ingresados en un hospital terciario durante la primera ola pandémica por SARS-CoV-2 / Epidemiological, clinical, and functional characteristics of patients older than 75 years admitted to a tertiary hospital during the first wave of the SARS-CoV-2 pandemic

Fundamento: Analizar las características epidemiológicas, clínicas y funcionales de los pacientes ingresados en el Hospital Universitario de Navarra por infección por SARS-CoV-2, así como los factores predictores de mortalidad, durante la primera ola de la pandemia provocada por este virus. Metodología: Estudio observacional y retrospectivo de todos los pacientes hospitalizados mayores de 75 años entre marzo y noviembre de 2020. Se ha obtenido información sobre múltiples variables, entre las que cabe destacar los síndromes geriátricos previos y que han aparecido durante la hospitalización, o los antecedentes médicos considerados relevantes en la infección por SARS-CoV-2. Se ha realizado un análisis descriptivo de los datos, comparaciones según diversos factores de interés y análisis multivariable para analizar los factores asociados a la mortalidad. Resultados: Se obtuvieron datos de un total de 426 pacientes cuya edad media fue de 83,2 años (52,6% varones). El 34,7% fallecieron en el hospital y el 4,5% antes de un mes tras el alta hospitalaria. Los factores relacionados con la mortalidad fueron: peor situación funcional basal, enfermedad renal crónica y fiebre o disnea como formas de presentación. Los síntomas típicos más frecuentes fueron: fiebre, disnea, tos, astenia e hiporexia. Hasta el 42,1% presentaron delirium como síntoma de inicio atípico. Se objetivó un deterioro funcional que no se recuperó al mes de seguimiento (índice de Barthel basal 81,12; 70,08 al alta; 75,55 al mes). Conclusiones: La infección por SARS-CoV-2 ha provocado elevadas tasas de mortalidad en las personas mayores. En este grupo etario, es frecuente la forma de presentación atípica de esta enfermedad y el deterioro funcional durante la hospitalización. En el presente estudio se ha identificado un peor estado funcional previo como predictor de mortalidad. Son necesarios más estudios que evalúen el impacto que la enfermedad y la hospitalización tienen en el paciente mayor...(AU)

Background: The objective of the present study is to analyze the epidemiological, clinical and functional characteristics of patients admitted to the University Hospital of Navarra due to SARS-CoV-2 infection, as well as the predictors of mortality, during the first wave of the pandemic caused by this virus. Methodology: An observational, retrospective study was performed, including all hospitalized patients older than 75 years. Information has been obtained on multiple variables, among which it is worth mentioning previous geriatric syndromes or those that have appeared during hospitalization, or past medical history considered relevant in SARS-CoV-2 infection. A descriptive analysis of the data, comparisons according to various factors of interest and multivariate analysis to analyze factors associated with mortality were carried out. Results: Data have been obtained from a total of 426 patients with a mean age of 83.2 years (52.6% men). 34.7% died in hospital and 4.5% within 1 month after hospital discharge. The factors related to mortality were: worse baseline functional status, chronic kidney disease, and fever or dyspnea as forms of presentation. The most frequent typical symptoms were: fever, dyspnea, cough, asthenia and hyporexia. Up to 42.1% presented delirium as a symptom of atypical onset. We observed a functional deterioration that was not recover after a month of follow-up (baseline Barthel index 81.12; 70.08 at discharge; 75.55 after a month). Conclusions: SARS-CoV-2 infection has caused high mortality rates in older adults. In this age group, the atypical presentation of this disease and functional deterioration during hospitalization are frequent. In the present study, a worse previous functional status has been identified as a predictor of mortality. More studies are needed to evaluate the impact that the disease and hospitalization have on the older patient...(AU)

Diferencias en la evolución del sobrepeso y la obesidad infantil en España en el periodo 2011-2019 por sexo, edad y nivel socioeconómico: resultados del estudio ALADINO / Differences in the temporal trends of childhood overweight and obesity in Spain in the 2011-2019 period by sex, age and socioeconomic level: Results of the ALADINO study

Introducción: El exceso de peso infantil es un problema de salud pública creciente. El objetivo del trabajo es estudiar la evolución de la prevalencia de sobrepeso, de obesidad y de obesidad central en escolares de 6 a 9años en España entre 2011 y 2019 según características demográficas y socioeconómicas.MetodologíaSe incluyeron las rondas 2011, 2015 y 2019 del estudio observacional, descriptivo y transversal ALADINO en escolares de ambos sexos de 6 a 9años. Se realizó un análisis descriptivo de la evolución de la prevalencia de sobrepeso y de obesidad según los criterios de la Organización Mundial de la Salud (OMS) y la International Obesity Task Force (IOTF), así como obesidad central, y las variables demográficas y socioeconómicas asociadas.ResultadosEntre 2011 y 2019 se redujo la prevalencia de sobrepeso (criterios OMS) en niños de 6, 7 y 8años (−5,4, −5,7 y −5,3 puntos porcentuales, respectivamente) y niños cuyos progenitores tenían estudios superiores (−5,3 puntos porcentuales). Por renta, el sobrepeso en niños se redujo en todos los niveles de ingresos. Sin embargo, entre 2011 y 2019 se mantuvieron estables tanto la prevalencia de sobrepeso en niñas como la prevalencia de obesidad según las referencias OMS e IOTF y la de obesidad central en ambos sexos.ConclusionesLas prevalencias de sobrepeso y de obesidad en escolares de 6 a 9años en España siguen siendo altas. Entre 2011 y 2019 disminuyó la prevalencia de sobrepeso en niños de 6 a 8años y aquellos cuyos progenitores tienen estudios universitarios, mientras que la obesidad en niños, el sobrepeso y la obesidad en niñas, y la obesidad central en ambos sexos han permanecido estables. (AU)

Introduction: Childhood excess weight is a growing public health problem. The aim of this study was to assess temporal trends in the prevalence of overweight, obesity and central obesity in schoolchildren aged 6 to 9years in Spain between 2011 and 2019 based on demographic and socioeconomic characteristics.MethodologyThe analysis included data from the 2011, 2015 and 2019 rounds of the cross-sectional observational and descriptive ALADINO study in schoolchildren of both sexes aged 6 to 9years. We conducted a descriptive analysis of the trends in the prevalence of overweight and obesity (defined according to the criteria of the World Health Organization [WHO] and the International Obesity Task Force [IOTF]) and of central obesity, in addition to associated demographic and socioeconomic variables.ResultsBetween 2011 and 2019, the prevalence of overweight (WHO criteria) decreased in boys aged 6, 7 and 8years (by −5.4%, −5.7% and −5.3%, respectively) and boys whose parents had a higher educational attainment (by −5.3%). In relation to the socioeconomic level, overweight in boys declined at all income levels. However, between 2011 and 2019, both the prevalence of overweight in girls and the prevalence of obesity (applying the WHO and IOTF criteria) and the prevalence of central obesity in both sexes remained stable.ConclusionsThe prevalence of overweight and the prevalence of obesity in schoolchildren aged 6 to 9years in Spain remain high. Between 2011 and 2019, the prevalence of overweight in children aged 6 to 8years and in children whose parents had university degrees decreased, whereas obesity in boys, overweight and obesity in girls and central obesity in both sexes remained stable. (AU)

RISKY BEHAVIORS AMONG SCHOOL-AGED ADOLESCENTS AND SOCIAL DETERMINANTS OF HEALTH / CONDUCTAS DE RIESGO ENTRE ADOLESCENTES EN EDAD ESCOLAR Y DETERMINANTES SOCIALES DE LA SALUD / COMPORTAMENTOS DE RISCO ENTRE ADOLESCENTES ESCOLARES E DETERMINANTES SOCIAIS DA SAÚDE

This study aimed to identify the association between the occurrence of risk behaviors among school adolescents and the Social Determinants of Health of both the students and their families. This is a descriptive, correlational, cross-sectional study, with a quantitative approach, carried out with adolescents enrolled in elementary school (final years) and high school, in public schools in the metropolitan region and the agrestic region of Pernambuco, between June and August 2023. Two instruments were used: a sociodemographic questionnaire prepared by the researchers and the Risk Behavior Index. The data was analyzed using Epi info and SPSS software. The results revealed that aspects such as age, gender, religion, marital status, physical activity and family structure were related to the behaviors assessed and could act as risk or protective factors. When considering ways of conducting actions to protect, prevent and mitigate risk behaviors among school adolescents, it is imperative to include the involvement of health and education professionals in the development of strategies that facilitate the development of dialogical spaces. It is also important to encourage responsible protagonism and active participation by adolescents in making decisions about their lives and health.

Este estudio tuvo como objetivo identificar la asociación entre la ocurrencia de comportamientos de riesgo entre adolescentes escolares y los Determinantes Sociales de la Salud tanto de los alumnos como de sus familias. Se trata de un estudio descriptivo, correlacional, transversal, con abordaje cuantitativo, realizado entre adolescentes matriculados en la enseñanza fundamental (años finales) y secundaria en escuelas públicas de las regiones metropolitana y agreste de Pernambuco, entre junio y agosto de 2023. Se utilizaron dos instrumentos: un cuestionario sociodemográfico elaborado por los investigadores y el Índice de Comportamiento de Riesgo. Los datos fueron analizados utilizando los softwares Epi info y SPSS. Los resultados mostraron que aspectos como la edad, el sexo, la religión, el estado civil, la actividad física y la estructura familiar estaban relacionados con los comportamientos evaluados y podían actuar como factores de riesgo o de protección. Al pensar en formas de conducir acciones para proteger, prevenir y mitigar las conductas de riesgo entre los adolescentes escolarizados, es fundamental considerar la participación de los profesionales de la salud y de la educación en el desarrollo de estrategias que faciliten la construcción de espacios dialógicos. También es importante fomentar el protagonismo responsable y la participación activa de los adolescentes en la toma de decisiones sobre sus vidas y su salud.

Este estudo objetivou identificar a associação entre a ocorrência de comportamentos de risco entre adolescentes escolares e os Determinantes Sociais de Saúde tanto dos estudantes quanto de suas famílias. Trata-se de um uma pesquisa descritiva, correlacional, de delineamento transversal, com abordagem quantitativa, realizada ao público de adolescentes matriculados no Ensino Fundamental II e Médio, em escolas públicas da região metropolitana e do agreste de Pernambuco, durante o período de junho a agosto de 2023. Foram aplicados 2 instrumentos: um questionário sociodemográfico elaborado pelos pesquisadores e o Índice de Comportamentos de Risco. Os dados foram analisados com suporte dos softwares Epi info e SPSS. Os resultados evidenciaram que aspectos como idade, gênero, religião, estado civil dos adolescentes, prática de atividades físicas e estrutura familiar obtiveram relações com os comportamentos avaliados, podendo agir como fatores de risco ou protetivos. Ao pensar formas de conduzir ações de proteção, prevenção e mitigação de comportamentos de risco entre adolescentes escolares, é crucial considerar o envolvimento de profissionais da saúde e da educação no desenvolvimento de estratégias que facilitem a criação de espaços dialógicos. Ademais, o estímulo ao protagonismo responsável e participação ativa dos adolescentes na tomada de decisões relacionadas às suas vidas e saúde.

Social determinants, symptoms and mental problems in adults internally displaced by armed conflict. Soacha, Colombia, 2019.

OBJECTIVE: To characterise social determinants of health, mental health problems and potentially problematic symptoms in the adult population displaced by internal armed conflict in Colombia. METHODS: Cross-sectional descriptive study with a random sample of 98 adults forcefully displaced to Soacha, Colombia, due to internal armed conflict. The Self Report Questionnaire to detect potentially problematic mental health problems and symptoms, and a structured questionnaire on social determinants of health were applied. RESULTS: The median age was 38 [interquartile range, 28-46] years, and women predominated (69.39%). The median time since displacement was 36 [16-48] months, and time since settlement in Soacha, 48 [5-48] months. 86.32% survived on less than the minimum wage per month and 93.87% did not have an employment contract. 42.86% and 7.14% reported being owners of their homes before and after displacement, respectively. Upon arriving in Soacha, 79.60% went to primary support networks and 3% to institutions. Before displacement, 16.33% lacked health insurance and 27.55% afterwards. Regarding mental health problems; there were possible depressive or anxious disorders in 57.29%; possible psychosis in 36.73%; and potentially problematic symptoms in 91.66%, being more prevalent and serious in women (p = 0.0025). CONCLUSIONS: A deterioration in living conditions and a higher prevalence of potentially problematic mental health problems and symptoms was reported in displaced adult populations settled in Soacha compared to other regions of the country. Analyses with complementary perspectives are required to evaluate these differences.

Unpacking gender-specific risk and protective factors for mental health status among Congolese refugees in Uganda.

Background: Research indicates refugees from the Democratic Republic of Congo (DRC), particularly females, have a higher incidence of mental health problems compared to the global norm for conflict-affected populations.Objective: This study aimed to unpack gender differences in the mental health of Congolese refugees by examining specific risk (trauma exposure, adaptation challenges, and discrimination) and protective factors (marital status, literacy, and social resources) in relation to posttraumatic stress symptoms (PTSS) and depression. Method: Utilizing systematic random sampling, we surveyed 667 adult refugees (370 females, 297 males) in the Kyaka II refugee settlement in Western Uganda. A multi-group path analysis was conducted, initially allowing for variance between genders and subsequently comparing a constrained model, where paths were set equal across groups.Results: The unconstrained model presented an excellent fit to the data. When paths were set to be equal across groups, the decline in model fit, confirmed by a chi-square difference test, indicated differences in the model for males and females. A series of Z-tests were used to compare individual paths. Experiencing discrimination was a stronger risk factor for depression among men, whereas a history of rape was more strongly associated with depression for females. Being literate and a member of a social group in the settlement were stronger protective factors for depression among men, whereas living with a partner and a felt sense of connection to their community was more important for women. Associations between risk and protective factors and PTSS were more similar across groups, only membership in a group was significantly moderated by gender; with group membership being more impactful for males.Conclusion: The results highlight similarities and differences in predictors of distress for male and female Congolese refugees and point to potential avenues for tailoring programming to be gender sensitive.

This research identified key differences in how specific traumatic experiences and social factors correlate with psychological distress for male and female Congolese refugees, underscoring the need for tailored support strategies.The study reveals that while discrimination is a stronger predictor of depression in men, experiences of rape are more closely linked to depression in women. Conversely, social factors like literacy and group membership offer more protection to men, whereas relationship status and community connection are more protective for women.The findings shed light on the importance of gender-sensitive mental health and psychosocial support interventions.

[Homelessness as a determinant of health and its impact on quality of life]. / Sinhogarismo como determinante de la salud y su impacto en la calidad de vida.

OBJECTIVE: To determine the health status of the homeless population who spend the night on the streets and in shelters (extreme residential exclusion), with reference to their quality of life, self-perceived health, comorbidity and access to health resources. METHOD: A cross-sectional descriptive study was carried out on a sample of 263 homeless people in the city of Valencia by means of a nocturnal count and using the EQ-5D-3L Health Related Quality of Life questionnaire and questions from the European Quality of Life Survey for Spain. RESULTS: Of the people who participated in the study, 129 of them slept outdoors, 49% (62.79% men, 19.37% women and 17.84% unidentified), while 134 slept in hostels, i.e. 51% (67.16% men and 32.84% women) with an estimated average age of 41.53 years and 55% had been living on the street for less than 12 months. People staying overnight on the streets presented worse quality of life and more than a quarter of the sample lacked a health card. CONCLUSIONS: There is a relationship between homelessness and poor health conditions in terms of quality of life, perceived health, comorbidity and accessibility to health to resources. The inverse care law is evidenced.

Differences in the temporal trends of childhood overweight and obesity in Spain in the 2011-2019 period by sex, age and socioeconomic level: results of the ALADINO study.

INTRODUCTION: Childhood excess weight is a growing public health problem. The aim of this study was to assess temporal trends in the prevalence of overweight, obesity and central obesity in schoolchildren aged 6-9 years in Spain between 2011 and 2019 based on demographic and socioeconomic characteristics. METHODOLOGY: The analysis included data from the 2011, 2015 and 2019 rounds of the cross-sectional observational and descriptive ALADINO study in schoolchildren of both sexes aged 6-9 years. We conducted a descriptive analysis of the trends in the prevalence of overweight and obesity (defined according to the criteria of the World Health Organization and the International Obesity Task Force) and of central obesity, in addition to associated demographic and socioeconomic variables. RESULTS: Between 2011 and 2019, the prevalence of overweight (WHO criteria) decreased in boys aged 6, 7 and 8 years (by -5.4%, -5.7% and -5.3%, respectively) and boys whose parents had a higher educational attainment (by -5.3%). In relation to the socioeconomic level, overweight in boys declined at all income levels. However, between 2011 and 2019, both the prevalence of overweight in girls and the prevalence of obesity (applying the WHO and IOTF criteria) and the prevalence of central obesity in both sexes remained stable. CONCLUSIONS: The prevalence of overweight and the prevalence of obesity in schoolchildren aged 6-9 years in Spain remain high. Between 2011 and 2019, the prevalence of overweight in children aged 6-8 years and in children whose parents had university degrees decreased, whereas obesity in boys, overweight and obesity in girls and central obesity in both sexes remained stable.

Vulnerabilidade social no contexto da pandemia de COVID-19: uma discussão bioética / Social vulnerability in the context of the COVID-19 pandemic: a bioethical discussion / Vulnerabilidad social en el contexto de la pandemia del COVID-19: una discusión bioética

Objetivo: analisar, sob um olhar bioético, a vulnerabilidade social referente à saúde durante o contexto da pandemia de COVID-19. Metodologia: foram incluídas publicações de 1º de janeiro a 31 de dezembro de 2020, revisadas por pares, identificadas nas bases de dados Pubmed, SciELO e LILACS. Foram utilizados para realizar a busca na base Pubmed o termo MESH "COVID-19" conjugado com os termos: "vulnerable population", "population groups", "social determinants of health", "health equity". Os descritores DECS equivalentes em português e em espanhol dos termos MESH foram utilizados na busca nas outras duas bases. Resultados: de um total de 132 artigos, após a aplicação dos critérios de inclusão e exclusão, foram identificados 21 artigos elegíveis. Os temas mais abordados na amostra foram: vulnerabilidades referentes a pessoas idosas, raça, minorias étnicas, condições socioeconômicas precárias, gênero feminino, pessoas com deficiência e condições crônicas de saúde. Observou-se artigos abordando mais de uma temática, integrando aspectos diversos de populações vulneráveis. Com base nos dados encontrados foram feitas análise e discussão com foco em vulnerabilidade como conceito bioético, além de conexões com discriminação e determinação social da saúde. Conclusão: os resultados apontam para a violação de direitos explicitados na Declaração Universal de Bioética e Direitos Humanos. Ao aumentar a disparidade da morbimortalidade por COVID-19 de grupos populacionais já impactados pela determinação social da saúde, constata-se uma violação do direito à saúde, indicando que governos e sociedades falham em respeitar a vulnerabilidade de grupos sociais no contexto pandêmico.

Objective: to analyze, from a bioethical perspective, social vulnerability in relation to health during the context of the COVID-19 pandemic. Methods: The study included peer-reviewed publications from January 1st until December 31st 2020, identified in Pubmed, SciELO and LILACS data basis. Mesh terms were utilized for research in Pubmed as follows: "COVID-19" conjugated with the terms: "vulnerable population", "population groups", "social determinants of health", "health equity". Portuguese and Spanish equivalents DECS terms were used for searching in the other two databases. Results: a total of 132 articles were found. After applied inclusion and exclusion criteria, were 21 eligible articles. The most recurrent themes were: racial, ethnic and social-economics, gender, age, disability and chronic health conditions. Articles addressing more than one theme were observed, integrating different aspects of vulnerable populations. A bioethical discussion with focus in vulnerability based in the data retrieved took place and connections with discrimination and social determinants of health were made. Conclusion: results point to the violation of rights explained in the Universal Declaration of Bioethics and Human Rights. By increasing the disparity in morbidity and mortality from COVID-19 of population groups already impacted by the social determination of health, there is a violation of the right to health, indicating that governments and societies fail to respect the vulnerability of social groups in the pandemic context.

Objetivo: analizar desde un punto de vista bioético, la vulnerabilidad social relacionada con la salud durante el contexto de la pandemia de la COVID-19. Metodología: se incluyeron publicaciones revisadas por pares del 1 de enero al 31 de diciembre de 2020, identificadas en las bases de datos Pubmed, SciELO y LILACS. Se utilizó el término MESH "COVID-19" para buscar en la base de datos Pubmed junto con los términos: "población vulnerable", "grupos de población", "determinantes sociales de la salud", "equidad en salud". Los descriptores DECS equivalentes en portugués y español de los términos MESH fueron utilizados en la búsqueda en las otras bases.Resultados: de un total de 132 artículos, tras aplicar los criterios de inclusión y exclusión, se identificaron 21 artículos. Los temas más discutidos fueron: vulnerabilidades relacionadas con los adultos mayores, raza (énfasis en personas negras), minorías étnicas, condiciones socioeconómicas precarias, género femenino, personas con discapacidad y condiciones crónicas de salud. Se observaron artículos que abordaban más de un tema, integrando diferentes aspectos de las poblaciones vulnerables. A partir de los datos encontrados, se realizó análisis y discusión con foco en la vulnerabilidad como concepto bioético, así como las conexiones con la discriminación y la determinación social de la salud. Conclusión: los resultados apuntan a la violación de los derechos explícitos en la Declaración Universal de Bioética y Derechos Humanos. Al aumentar la disparidad en la morbimortalidad por COVID-19 de grupos poblacionales ya impactados por la determinación social de la salud, se vulnera el derecho a la salud, indicando que los gobiernos y las sociedades no respetan la vulnerabilidad de los grupos sociales ante la pandemia.