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1.
Acta Cir Bras ; 35(2): e202000207, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32320996

RESUMEN

PURPOSE: To develop a database with social, demographic and professional information of all graduates of the two post-graduate programs in Ophthalmology of EPM-UNIFESP, including their opinions on quality, application, and contribution of the courses received in their professional careers. METHODS: The survey was conducted in the digital and physical archives of the University and by telephone contact. When the graduates' e-mails were all collected, the electronic questionnaire was applied. The responses were compiled. Descriptive analysis of the results obtained in this cross-sectional study was performed, and analyzed by the authors and by statistical professionals, through Excel graphs. RESULTS: The database suggests that most graduates were born and work in the state of São Paulo. A significant fraction of 66.77% is dedicated to academic work, but only 36.2% hold management positions. Most of them receive amounts of one to 56 minimum wages monthly. The main motivation was to improve their professional careers. CONCLUSION: For post-graduate programs, a database with information of its graduates can elucidate whether the goals were achieved based on the proposed teaching, as well as can generate reflections to improve the quality, the courses expectations and the vision that students have of the University.


Asunto(s)
Bases de Datos Factuales , Oftalmología/educación , Estudiantes de Medicina , Adulto , Anciano , Estudios Transversales , Bases de Datos Factuales/normas , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oftalmología/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , Estudiantes de Medicina/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
2.
Rev Cardiovasc Med ; 21(1): 1-7, 2020 03 30.
Artículo en Inglés | MEDLINE | ID: mdl-32259899

RESUMEN

Approximately 90 days of the SARS-CoV-2 (COVID-19) spreading originally from Wuhan, China, and across the globe has led to a widespread chain of events with imminent threats to the fragile relationship between community health and economic health. Despite near hourly reporting on this crisis, there has been no regular, updated, or accurate reporting of hospitalizations for COVID-19. It is known that many test-positive individuals may not develop symptoms or have a mild self-limited viral syndrome consisting of fever, malaise, dry cough, and constitutional symptoms. However some individuals develop a more fulminant syndrome including viral pneumonia, respiratory failure requiring oxygen, acute respiratory distress syndrome requiring mechanical ventilation, and in substantial fractions leading to death attributable to COVID-19. The pandemic is evolving in a clustered, non-inform fashion resulting in many hospitals with preparedness but few or no cases, and others that are completely overwhelmed. Thus, a considerable risk of spread when personal protection equipment becomes exhausted and a large fraction of mortality in those not offered mechanical ventilation are both attributable to a crisis due to maldistribution of resources. The pandemic is amenable to self-reporting through a mobile phone application that could obtain critical information on suspected cases and report on the results of self testing and actions taken. The only method to understand the clustering and the immediate hospital resource needs is mandatory, uniform, daily reporting of hospital censuses of COVID-19 cases admitted to hospital wards and intensive care units. Current reports of hospitalizations are delayed, uncertain, and wholly inadequate. This paper urges all the relevant stakeholders to take up self-reporting and reporting of hospitalizations of COVID-19 as an urgent task in combating this devastating pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Recursos en Salud/provisión & distribución , Recursos en Salud/estadística & datos numéricos , Notificación Obligatoria , Aplicaciones Móviles/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Atención Ambulatoria/estadística & datos numéricos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/terapia , Cuidados Críticos/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Características de la Residencia/estadística & datos numéricos , Autoinforme/estadística & datos numéricos
3.
Cent Eur J Public Health ; 28(1): 33-39, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32228814

RESUMEN

OBJECTIVE: A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas. METHODS: The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used. RESULTS: Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies. CONCLUSIONS: The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised.


Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , Medicina Física y Rehabilitación/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Anciano , Humanos , Turquia
4.
Cent Eur J Public Health ; 28(1): 44-47, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32228816

RESUMEN

OBJECTIVES: The exposure of embryos or foetuses to ionising radiation can cause serious detriments to health. Thus, an enhanced incidence of spontaneous abortions and congenital anomalies might be expected in the vicinity of a uranium processing plant. We analysed the situation in the vicinity of MAPE Mydlovary, a facility about 20 km from Ceské Budejovice, South Bohemia, Czech Republic, which was in operation from 1963 to 1992. METHODS: No relevant data are available for the period of operation of the uranium processing plant. Statistical data have only been collected since 1994. As sanitation work in the area was initiated at around that time and has yet to be completed, we considered a study of possible prenatal effects in the vicinity of MAPE Mydlovary to still be of interest. Data were provided by the Institute of Health Information and Statistics of the Czech Republic for the years 1994-2013. RESULTS: We tested whether there are demonstrable, statistically significant differences between the microregions of the four closest villages (Mydlovary, Olesník, Zahájí, and Zliv), the District of Ceské Budejovice, the South-Bohemian Region, and the Czech Republic. CONCLUSIONS: No increase was found in the incidence of spontaneous abortions and congenital anomalies in the vicinity of this former uranium processing plant compared to the surrounding District of Ceské Budejovice, the South Bohemian Region, or the Czech Republic as a whole.


Asunto(s)
Aborto Espontáneo/epidemiología , Anomalías Congénitas/epidemiología , Centrales Eléctricas/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Uranio , República Checa/epidemiología , Femenino , Humanos , Incidencia , Embarazo
5.
PLoS One ; 15(2): e0228491, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32032390

RESUMEN

Latin Americans engage in physical activity (PA) in unique ways and use a wider range of places for PA than those commonly studied in high-income settings. We examined the contribution of a variety of places and domains of PA to meeting PA recommendations among a sample of adults (18-65 y) from all over Mexico. This was a cross-sectional study conducted in 2017 (n = 3 686). Overall and domain-specific PA was measured using the Global Physical Activity Questionnaire. Use of places for PA was self-reported. Places were classified as private or public. In 2018, associations between specific places and meeting PA recommendations (≥150 mins/week) were estimated using multivariate logistic regression models. In total 72.1% met PA recommendations. The proportion meeting recommendations through domain-specific PA was highest for leisure-time PA (50.0%), followed by travel-related (39.1%) and work-related (24.9%) PA. The most commonly reported places for PA were home (43%), parks (40.7%) and streets (39.4%) (public). Use of most public places was positively associated with meeting PA recommendations, mainly through travel-related PA (Streets OR 2.05 [95% CI 1.71-2.45]; Cycling paths OR 1.91 [1.37-2.68]). Using private places was more strongly associated with PA, mainly leisure-time PA (Gyms OR 9.66 [7.34-12.70]); Sports facilities OR 5.03 [3.27-7.74]). In conclusion, public and private places were important contributors to PA. While public places may be a powerful setting for PA promotion, increasing the equitable access for all to private places may also represent an effective strategy to increase PA among Mexican adults.


Asunto(s)
Planificación Ambiental , Ejercicio Físico/fisiología , Actividades Recreativas , Características de la Residencia , Adolescente , Adulto , Anciano , Ciclismo/fisiología , Estudios Transversales , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Parques Recreativos/estadística & datos numéricos , Instalaciones Privadas/estadística & datos numéricos , Instalaciones Públicas/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
6.
PLoS One ; 15(2): e0229087, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32045467

RESUMEN

Loneliness is a potent predictor of negative health outcomes, making it important to identify risk factors for loneliness. Though extant studies have identified characteristics associated with loneliness, less is known about the cumulative and relative importance of these factors, and how their interaction may impact loneliness. Here, 4,885 individuals ages 10-97 years from the US completed the three-item UCLA Loneliness Survey on TestMyBrain.org. Using census data, we calculated the population and community household income of participants' census area, and the proportion of individuals in the participant's census area that shared the participant's demographic characteristics (i.e., sociodemographic density). We evaluated the relative importance of three classes of variables for loneliness risk: those related to the person (e.g., age), place (e.g., community household income), and the interaction of person X place (sociodemographic density). We find that loneliness is highly prevalent and best explained by person (age) and place (community household income) characteristics. Of the variance in loneliness accounted for, the overwhelming majority was explained by age with loneliness peaking at 19 years and declining thereafter. The congruence between one's sociodemographic characteristics and that of one's neighborhood had no impact on loneliness. These data may have important implications for public health interventions.


Asunto(s)
Soledad/psicología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Internet , Masculino , Persona de Mediana Edad , Características de la Residencia/estadística & datos numéricos , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios/estadística & datos numéricos , Estados Unidos , Adulto Joven
7.
Lancet ; 395(10225): 698-708, 2020 02 29.
Artículo en Inglés | MEDLINE | ID: mdl-32050090

RESUMEN

BACKGROUND: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. METHODS: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). FINDINGS: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4-9) in the accelerated-surgery group and 24 h (10-42) in the standard-care group (p<0·0001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0·91 (95% CI 0·72 to 1·14) and absolute risk reduction (ARR) of 1% (-1 to 3; p=0·40). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0·97 (0·83 to 1·13) and an ARR of 1% (-2 to 4; p=0·71). INTERPRETATION: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care. FUNDING: Canadian Institutes of Health Research.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Intervención Médica Temprana/métodos , Fijación Interna de Fracturas/métodos , Hemiartroplastia/métodos , Fracturas de Cadera/cirugía , Complicaciones Posoperatorias/epidemiología , Tiempo de Tratamiento/estadística & datos numéricos , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/mortalidad , Comorbilidad , Delirio/epidemiología , Demencia/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Fracturas del Cuello Femoral/epidemiología , Fracturas del Cuello Femoral/cirugía , Fracturas de Cadera/epidemiología , Humanos , Infecciones/epidemiología , Internacionalidad , Masculino , Persona de Mediana Edad , Mortalidad , Isquemia Miocárdica/epidemiología , Casas de Salud , Reducción Abierta/métodos , Hemorragia Posoperatoria/epidemiología , Modelos de Riesgos Proporcionales , Características de la Residencia/estadística & datos numéricos , Sepsis/epidemiología , Resultado del Tratamiento
8.
Medicine (Baltimore) ; 99(8): e19167, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080095

RESUMEN

To verify the validity of functional health literacy scale and analyze what influences functional health literacy.Using convenience sampling method based on cross-sectional data to select 589 left-behind senior high-school students in an ethnic minority area, using the functional health literacy scale.The scale results were relatively strong, and the absolute fitness index, value-added fitness index, and simple fitness index reached the fitness standards. The overall functional health literacy score was (0.65 ±â€Š0.12), which falls within the upper middle class. Gender(t = 2.40, P < .05), ethnicity (t = 4.28, P < .001), place of residence (t =  = 4.51, P < .001), mother's education level (F = 3.608, P < .05), self-assessment of grades for 1 year (F = 25.781, P < .001), and whether the participant liked the health education content (F = 9.416, P < .001) had impacts on overall functional health literacy.The study results show that relatively satisfactory reliability and validity and can be applied further analysis for improving students functional health literacy levels.


Asunto(s)
Grupos Étnicos/estadística & datos numéricos , Alfabetización en Salud/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Encuestas y Cuestionarios/normas , Éxito Académico , Adolescente , China/epidemiología , Estudios Transversales , Femenino , Educación en Salud/estadística & datos numéricos , Humanos , Masculino , Reproducibilidad de los Resultados , República de Corea/etnología , Características de la Residencia/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Factores Sexuales
9.
Health Qual Life Outcomes ; 18(1): 45, 2020 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-32103763

RESUMEN

BACKGROUND: The aim of this study was to measure differences in quality-adjusted life expectancy (QALE) by income in Korea at the national and district levels. METHODS: Mortality rates and EuroQol-5D (EQ-5D) scores were obtained from the National Health Information Database of the National Health Insurance Service and the Korea Community Health Survey, respectively. QALE and differences in QALE among income quintiles were calculated using combined 2008-2014 data for 245 districts in Korea. Correlation analyses were conducted to investigate the associations of neighborhood characteristics with QALE and income gaps therein. RESULTS: QALE showed a graded pattern of inequality according to income, and increased over time for all levels of income and in both sexes, except for low-income quintiles among women, resulting in a widened inequality in QALE among women. In all 245 districts, pro-rich inequalities in QALE were found in both men and women. Districts with higher QALE and smaller income gaps in QALE were concentrated in metropolitan areas, while districts with lower QALE and larger income gaps in QALE were found in rural areas. QALE and differences in QALE by income showed relatively close correlations with socioeconomic characteristics, but relatively weak correlations with health behaviors, except for smoking and indicators related to medical resources. CONCLUSIONS: This study provides evidence of income-based inequalities in health measured by QALE in all subnational areas in Korea. Furthermore, QALE and differences in QALE by income were closely associated with neighborhood-level socioeconomic characteristics.


Asunto(s)
Disparidades en el Estado de Salud , Renta/estadística & datos numéricos , Esperanza de Vida , Calidad de Vida , Adulto , Estatus Económico , Femenino , Encuestas Epidemiológicas , Humanos , Renta/clasificación , Masculino , Persona de Mediana Edad , República de Corea , Características de la Residencia/estadística & datos numéricos , Distribución por Sexo
10.
BMC Public Health ; 20(1): 172, 2020 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-32019508

RESUMEN

BACKGROUND: Policies to improve healthy food retail have been recognized as a potential means of reducing diet-related health disparities. The revised 2014 Minneapolis Staple Foods Ordinance instituted minimum stocking standards for healthy, staple foods. The objective of this study was to examine retailer compliance with the policy, and whether compliance varied by neighborhood and store characteristics. METHODS: In this natural experiment, audits were conducted annually pre- and post-ordinance (2014-2017) in 155 small/nontraditional stores in Minneapolis, MN and a comparison city (St. Paul, MN). Compliance measures for 10 product categories included: (1) met requirements for ≥8 categories; (2) 10-point scale (one point for each requirement met); and (3) carried any item in each category. Store characteristics included store size and ownership status. Neighborhood characteristics included census-tract socioeconomic status and low-income/low-access status. Analyses were conducted in 2018. RESULTS: All compliance measures increased in both Minneapolis and St. Paul from pre- to post-policy; Minneapolis increases were greater only for carrying any item in each category (p < 0.01). In Minneapolis, corporate (vs. independent) stores were generally more compliant. No differences were found by neighborhood characteristics. CONCLUSIONS: Overall trends suggest broad movement among Minneapolis stores towards providing a minimum level of staple foods. Increases were greater in corporate stores. Trends do not suggest neighborhood-level disparities in compliance. STUDY REGISTRATION: ClinicalTrials.gov NCT02774330, retrospectively registered May 17, 2016.


Asunto(s)
Comercio/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Política Nutricional , Características de la Residencia/estadística & datos numéricos , Humanos , Minnesota , Factores Socioeconómicos
11.
JAMA Netw Open ; 3(1): e1919928, 2020 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-31995211

RESUMEN

Importance: An association between social and neighborhood characteristics and health outcomes has been reported but remains poorly understood owing to complex multidimensional factors that vary across geographic space. Objectives: To quantify social determinants of health (SDOH) as multiple dimensions across the continental United States (the 48 contiguous states and the District of Columbia) at a small-area resolution and to examine the association of SDOH with premature mortality within Chicago, Illinois. Design, Setting, and Participants: In this cross-sectional study, census tracts from the US Census Bureau from 2014 were used to develop multidimensional SDOH indices and a regional typology of the continental United States at a small-area level (n = 71 901 census tracts with approximately 312 million persons) using dimension reduction and clustering machine learning techniques (unsupervised algorithms used to reduce dimensions of multivariate data). The SDOH indices were used to estimate age-adjusted mortality rates in Chicago (n = 789 census tracts with approximately 7.5 million persons) with a spatial regression for the same period, while controlling for violent crime. Main Outcomes and Measures: Fifteen variables, measured as a 5-year mean, were selected to characterize SDOH as small-area variations for demographic characteristics of vulnerable groups, economic status, social and neighborhood characteristics, and housing and transportation availability at the census-tract level. This SDOH data matrix was reduced to 4 indices reflecting advantage, isolation, opportunity, and mixed immigrant cohesion and accessibility, which were then clustered into 7 distinct multidimensional neighborhood typologies. The association between SDOH indices and premature mortality (defined as death before age 75 years) in Chicago was measured by years of potential life lost and aggregated to a 5-year mean. Data analyses were conducted between July 1, 2018, and August 30, 2019. Results: Among the 71 901 census tracts examined across the continental United States, a median (interquartile range) of 27.2% (47.1%) of residents had minority status, 12.1% (7.5%) had disabilities, 22.9% (7.6%) were 18 years and younger, and 13.6% (8.1%) were 65 years and older. Among the 789 census tracts examined in Chicago, a median (interquartile range) of 80.4% (56.3%) of residents had minority status, 10.2% (8.2%) had disabilities, 23.2% (10.9%) were 18 years and younger, and 9.5% (7.1%) were 65 years and older. Four SDOH indices accounted for 71% of the variance across all census tracts in the continental United States in 2014. The SDOH neighborhood typology of extreme poverty, which is of greatest concern to health care practitioners and policy advocates, comprised only 9.6% of all census tracts across the continental United States but characterized small areas of known public health crises. An association was observed between all SDOH indices and age-adjusted premature mortality rates in Chicago (R2 = 0.63; P < .001), even after accounting for violent crime and spatial structures. Conclusions and Relevance: The modeling of SDOH as multivariate indices rather than as a singular deprivation index may better capture the complexity and spatial heterogeneity underlying SDOH. During a time of increased attention to SDOH, this analysis may provide actionable information for key stakeholders with respect to the focus of interventions.


Asunto(s)
Estado de Salud , Grupos Minoritarios/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Determinantes Sociales de la Salud/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adulto , Anciano , Chicago , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Calidad de Vida , Factores de Riesgo , Factores Socioeconómicos , Adulto Joven
12.
JAMA Netw Open ; 3(1): e1920053, 2020 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-31995216

RESUMEN

Importance: Access to reproductive health services is a public health goal. It is unknown how geographic and health plan network availability of Catholic and non-Catholic hospitals may be associated with access to reproductive health services in the United States. Objective: To characterize the market share of Catholic hospitals in the United States, both overall and within Marketplace health insurance plans' hospital networks. Design, Setting, and Participants: This cross-sectional study of US counties used data on hospitals' Catholic affiliation and discharges, hospital networks in Marketplace health insurance plans, and US Census population data to construct a national, county-level data set. The Catholic hospital market share overall in each county and in Marketplace plans' hospital networks in each county were calculated. The study examined whether the Catholic hospital market share was different within Marketplace networks compared with the counties they served. Data analysis was conducted in May and June 2018. Main Outcomes and Measures: The overall Catholic hospital market share was calculated on the basis of the share of discharges in Catholic hospitals in a county compared with all hospital discharges. Overall market share was categorized as minimal (≤2%), low (>2% to ≤20%), high (>20% to ≤70%), or dominant (>70%). The Catholic hospital market share in Marketplace networks was calculated as the share of Catholic hospital discharges in each Marketplace network. Results: The sample included 4450 hospitals in 3101 counties. Overall, 26.1% of US counties had minimal Catholic hospital market share, 38.6% had low Catholic hospital market share, and 35.3% had high or dominant Catholic hospital market share; 38.7% of US reproductive-aged women resided in counties with high or dominant Catholic hospital market share. Among counties with Catholic hospital market share greater than 2%, the distribution of the median Marketplace network's Catholic hospital market share (median [interquartile range], 4.6% [0%-24.3%]) was lower than overall Catholic hospital market share (median [interquartile range], 18.5% [8.1%-36.5%]). The median Marketplace hospital network had a lower Catholic hospital market share than the county overall in 68.0% of US counties with Catholic hospital market share greater than 2%. Conclusions and Relevance: In this national study, 35.3% of counties had high or dominant Catholic hospital market share serving an estimated 38.7% of US women of reproductive age. Marketplace health insurance plans' hospital networks included a lower share of Catholic hospitals than the counties they serve.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitales Religiosos/organización & administración , Servicio de Ginecología y Obstetricia en Hospital/provisión & distribución , Servicios de Salud Reproductiva/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Catolicismo , Femenino , Humanos , Embarazo , Complicaciones del Embarazo/prevención & control , Calidad de la Atención de Salud/estadística & datos numéricos , Estados Unidos
13.
BMC Public Health ; 20(1): 123, 2020 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-31996184

RESUMEN

BACKGROUND: In 2017, about 20% of the world's children under 1 year of age with incomplete DPT vaccination lived in Nigeria. Fully-immunised child coverage (FIC), which is the percentage of children aged 12-23 months who received all doses of routine infant vaccines in their first year of life in Nigeria is low. We explored the associations between child, household, community and health system level factors and FIC, in particular focussing on urban formal and slum, and rural residence, using representative Nigeria Demographic Health Survey (NDHS) data from 2003, 2008 and 2013. METHOD: Multilevel logistic regression models were applied for quantitative analyses of NDHS 2003, 2008 and 2013 data, singly, pooled overall and stratified by rural/urban, and within urban by formal and slum. We also quantify Population Attributable Risk (PAR) of FIC. RESULTS: FIC for rural, urban formal and slum rose from 7.4, 25.6 and 24.9% respectively in 2003 to 15.8, 45.5 and 38.5% in 2013, and varied across sociodemographics. In pooled NDHS analysis, overall and stratified, final FIC adjusted odds (aOR) were: 1. Total population - delivery place (health facility vs home, aOR = 1.13, 95% CI = 0.73-1.73), maternal education (higher vs no education, aOR = 3.92, 95% CI = 1.79-8.59) and place of residence (urban vs rural, aOR = 1.69, 95% CI = 0.89-3.22). 2. Rural, urban formal and slum stratified: A.Rural - delivery place (aOR = 1.47, 95% CI = 1.12-1.94), maternal education (aOR = 4.99, 95% CI = 2.48-10.06). B.Urban formal - delivery place (aOR = 2.62, 95% CI = 1.43-4.79), maternal education level (aOR = 9.18, 95% CI = 3.05-27.64). C.Slums - delivery place (aOR = 5.39, 95% CI = 2.18-13.33), maternal education (aOR = 5.03, 95% CI = 1.52-16.65). The PAR revealed the highest percentage point increase in FIC would be achieved in all places of residence by maternal higher education: rural-38.15, urban formal-22.88 and slum 23.76, while non-attendance of antenatal care was estimated to lead to the largest reduction in FIC. CONCLUSION: Although low FIC in rural areas may be largely due to lack of health facilities and immunisation education, the intra-urban disparity is mostly unexplained, and requires further qualitative and interventional research. We show the FIC point increase that can be achieved if specific sociodemographic variable (risk) are addressed in the various communities, thus informing prioritisation of interventions.


Asunto(s)
Disparidades en Atención de Salud/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Cobertura de Vacunación/estadística & datos numéricos , Femenino , Encuestas de Atención de la Salud , Humanos , Lactante , Masculino , Nigeria
14.
BMC Public Health ; 20(1): 13, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31906992

RESUMEN

BACKGROUND: Persons with low socioeconomic status may be disproportionately at risk for multimorbidity. METHODS: Adults aged ≥20 years on 4/1/2015 from 7 counties in Minnesota were identified using the Rochester Epidemiology Project (population-based sample). A composite measure of neighborhood socioeconomic disadvantage, the area deprivation index (ADI), was estimated at the census block group level (n = 251). The prevalence of 21 chronic conditions was obtained to calculate the proportion of persons with multimorbidity (≥2 chronic conditions) and severe multimorbidity (≥5 chronic conditions). Hierarchical logistic regression was used to estimate the association of ADI with multimorbidity and severe multimorbidity using odds ratios (OR). RESULTS: Among 198,941 persons (46.7% male, 30.6% aged ≥60 years), the age- and sex-standardized (to the United States 2010 census) median prevalence (Q1, Q3) was 23.4% (21.3%, 25.9%) for multimorbidity and 4.8% (4.0%, 5.7%) for severe multimorbidity. Compared with persons in the lowest quintile of ADI, persons in the highest quintile had a 50% increased risk of multimorbidity (OR 1.50, 95% CI 1.39-1.62) and a 67% increased risk of severe multimorbidity (OR 1.67, 95% CI 1.51-1.86) after adjusting for age, sex, race, and ethnicity. Associations were stronger after further adjustment for individual level of education; persons in the highest quintile had a 78% increased risk of multimorbidity (OR 1.78, 95% CI 1.62-1.96) and a 92% increased risk of severe multimorbidity (OR 1.92, 95% CI 1.72-2.13). There was evidence of interactions between ADI and age, between ADI and sex, and between ADI and education. After age 70 years, no difference in the risk of multimorbidity was observed across quintiles of ADI. The pattern of increasing multimorbidity with increasing ADI was more pronounced in women. Finally, there was less variability across quintiles of ADI for the most highly educated group. CONCLUSIONS: Higher ADI was associated with increased risk of multimorbidity, and the associations were strengthened after adjustment for individual level of education, suggesting that neighborhood context plays a role in health above and beyond individual measures of socioeconomic status. Furthermore, associations were more pronounced in younger persons and women, highlighting the importance of interventions to prevent chronic conditions in younger women, in particular.


Asunto(s)
Enfermedad Crónica/epidemiología , Disparidades en el Estado de Salud , Multimorbilidad , Áreas de Pobreza , Características de la Residencia/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Minnesota/epidemiología , Prevalencia , Factores de Riesgo , Adulto Joven
15.
BMC Public Health ; 20(1): 26, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31914967

RESUMEN

BACKGROUND: From 2000 to 2008, in urban areas in Spain, adolescent fertility and abortion rates underwent unprecedented increases, consecutive to intensive immigration from developing countries. To address unmet needs for contraception information and services, a community-based, gender-sensitive and culturally adapted brief counselling intervention (SIRIAN program) was launched in some deprived neighbourhoods with a high proportion of immigrants in Barcelona. Once a randomized controlled trial demonstrated its effectiveness in increasing the use of contraceptives, we aim to examine its population impact on adolescent fertility rates. METHODS: Quasi-experimental study with comparison group, using population data from 2005 to 2016. Five neighbourhoods in the lowest tercile of Disposable Household Income were intervened in 2011-13. The comparison group included the three neighbourhoods which were in the same municipal district and in the lowest Disposable Household Income tercile, and displayed the highest adolescent fertility rates. Generalized linear models were fitted to assess absolute adolescent fertility rates and adjusted by immigrant population between pre-intervention (2005-10) and post-intervention periods (2011-16); Difference in Differences and relative pre-post changes analysis were performed. RESULTS: In 2005-10 the intervention group adolescent fertility rate was 27.90 (per 1000 women 15-19) and 21.84 in the comparison group. In 2011-16 intervention areas experienced great declines (adolescent fertility rate change: - 12.30 (- 12.45 to - 12.21); p < 0.001), while comparison neighbourhoods remained unchanged (adolescent fertility rate change: 1.91 (- 2.25 to 6.07); p = 0.368). A reduction of - 10.97 points (- 13.91 to - 8.03); p < 0.001) is associated to the intervention. CONCLUSION: Adolescent fertility rate significantly declined in the intervention group but remained stable in the comparison group. This quasi-experimental study provide evidence that, in a country with universal health coverage, a community counselling intervention that increases access to contraception, knowledge and sexual health care in hard-to-reach segments of the population can contribute to substantially reduce adolescent fertility rates. Reducing adolescent fertility rates could become a feasible goal in cities with similar conditions.


Asunto(s)
Tasa de Natalidad/tendencias , Servicios de Salud Comunitaria , Anticoncepción/psicología , Consejo , Adolescente , Ciudades , Anticoncepción/estadística & datos numéricos , Anticonceptivos/administración & dosificación , Emigrantes e Inmigrantes/psicología , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Áreas de Pobreza , Embarazo , Evaluación de Programas y Proyectos de Salud , Características de la Residencia/estadística & datos numéricos , España , Adulto Joven
16.
BMC Public Health ; 20(1): 52, 2020 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-31937271

RESUMEN

BACKGROUND: Perceived neighborhood characteristics, including satisfaction with one's neighborhood as a place to live, are associated with lower obesity rates and more favorable cardiovascular risk factor profiles. Yet, few studies have evaluated whether changes in perceived neighborhood characteristics over time may be associated with cardiometabolic health indicators. METHODS: Changes in perception of one's neighborhood (2013-2016) were determined from a cohort of residents who lived in one of two low-income urban neighborhoods. Changes were categorized into the following: improvement vs. no change or worsening over the three-year time-period. Multivariable linear regression was used to measure the association between perceived improvement in each of the neighborhood characteristics with cardiometabolic outcomes (BMI, SBP, DBP, HbA1c, HDL-c) that were assessed in 2016, and compared with those who perceived no change or worsening of neighborhood characteristics. Models were adjusted for age, sex, income, education, marital status, physical function, neighborhood, and years spent in neighborhood. To examine potential sex differences, follow-up models were conducted and stratified by sex. RESULTS: Among the 622 individuals who remained in the same neighborhood during the time period, 93% were African American, 80% were female, and the mean age was 58 years. In covariate-adjusted models, those who perceived improvement in their neighborhood safety over the time period had a significantly higher BMI (kg/m2) than those who perceived no improvement or worsening (ß = 1.5, p = 0.0162); however, perceived improvement in safety was also significantly associated with lower SBP (mmHg) (ß = - 3.8, p = 0.0361). When results were stratified by sex, the relationship between improved perceived neighborhood safety and BMI was only evident in females. CONCLUSIONS: These findings suggest that perceived neighborhood characteristics may impact cardiometabolic outcomes (BMI, SBP), but through differing pathways. This highlights the complexity of the associations between neighborhood characteristics and underscores the need for more longitudinal studies to confirm the associations with cardiometabolic health in African American populations.


Asunto(s)
Afroamericanos/psicología , Enfermedades Cardiovasculares/etnología , Características de la Residencia , Afroamericanos/estadística & datos numéricos , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción Personal , Áreas de Pobreza , Características de la Residencia/estadística & datos numéricos , Población Urbana/estadística & datos numéricos
17.
Am J Public Health ; 110(3): 407-415, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31944851

RESUMEN

Objectives. To characterize health and health-related resources in the new qualified opportunity zones (QOZs) relative to tracts not selected or not eligible for this federal investment incentive.Methods. We used tract-level data from the 498 largest cities in the contiguous United States (n = 24 409), categorized using designations from the Department of Treasury. We compiled data on population characteristics, health-related resources, and health from the American Community Survey, the National Establishment Time Series, the National Land Cover Dataset, and the US Small-Area Life Expectancy Estimates Project and the 500 Cities projects. We calculated means and SDs for ineligible, eligible (but not designated), and designated QOZ tracts.Results. In general, designated QOZ tracts had lower access to health care facilities, physical activity resources, and healthy food. They had a higher prevalence of unhealthy behaviors and worse health outcomes across most measures.Conclusions. By benchmarking conditions, we facilitate tracking and assessment of QOZ impacts.Public Health Implications. QOZ could spur unprecedented neighborhood change with substantial influence on health resources and outcomes. Public health collaboration and strategic local governance of QOZ will be crucial for yielding health benefits for existing residents.


Asunto(s)
Instituciones de Salud/estadística & datos numéricos , Recursos en Salud/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Ejercicio Físico , Abastecimiento de Alimentos , Conductas Relacionadas con la Salud , Humanos , Esperanza de Vida , Factores Socioeconómicos , Estados Unidos
18.
PLoS One ; 15(1): e0227798, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31935262

RESUMEN

BACKGROUND: The World Health Organization recommends a minimum of 33 months between two consecutive live births to reduce the risk of adverse maternal and child health outcomes. However, determinants of short birth interval have not been well understood in Ethiopia. OBJECTIVE: The aim of this study was to assess individual- and community-level determinants of short birth interval among women in Ethiopia. METHODS: A detailed analysis of the 2016 Ethiopian Demographic and Health Survey data was performed. A total of 8,448 women were included in the analysis. A two-level multilevel logistic regression analysis was used to identify associated individual- and community-level factors and estimate between-community variance. RESULTS: At the individual-level, women aged between 20 and 24 years at first marriage (AOR = 1.37; 95% CI: 1.18-1.60), women aged between 25 and 29 years at first marriage (AOR = 1.65; 95% CI: 1.20-2.25), having a husband who attended higher education (AOR = 1.32; 95% CI: 1.01-1.73), being unemployed (AOR = 1.16; 95% CI: 1.03-1.31), having an unemployed husband (AOR = 1.23; 95% CI: 1.04-1.45), being in the poorest wealth quintile (AOR = 1.82; 95% CI: 1.39-2.39), being in the poorer wealth quintile (AOR = 1.58; 95% CI: 1.21-2.06), being in the middle wealth quintile (AOR = 1.61; 95% CI: 1.24-2.10), being in the richer wealth quintile (AOR = 1.54; 95% CI: 1.19-2.00), increased total number of children born before the index child (AOR = 1.07; 95% CI: 1.03-1.10) and death of the preceding child (AOR = 1.97; 95% CI: 1.59-2.45) were associated with increased odds of short birth interval. At the community-level, living in a pastoralist region (AOR = 2.01; 95% CI: 1.68-2.39), being a city dweller (AOR = 1.75; 95% CI: 1.38-2.22), high community-level female illiteracy (AOR = 1.23; 95% CI: 1.05-1.45) and increased distance to health facilities (AOR = 1.32; 95% CI: 1.11-1.56) were associated with higher odds of experiencing short birth interval. Random effects showed significant variation in short birth interval between communities. CONCLUSION: Determinants of short birth interval are varied and complex. Multifaceted intervention approaches supported by policy initiatives are required to prevent short birth interval.


Asunto(s)
Intervalo entre Nacimientos , Adulto , Intervalo entre Nacimientos/estadística & datos numéricos , Etiopía , Femenino , Humanos , Masculino , Análisis Multivariante , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , Adulto Joven
19.
BMC Public Health ; 20(1): 60, 2020 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-31937292

RESUMEN

BACKGROUND: Marked disparities by socioeconomic status in the risk of potentially avoidable hospitalization for chronic illnesses have been observed in many contexts, including those with universal health coverage. Less well known is how gender mediates such differences. We conducted a population-based cohort study to describe associations between household and community-level income and rehospitalizations for types 1 and 2 diabetes mellitus among Canadian women and men. METHODS: Our cohorts were drawn from respondents to the 2006 mandatory long-form census linked longitudinally to 3 years of nationally standardized hospital records. We included adults 30-69 years hospitalized with diabetes at least once during the study period. We used logistic regressions to estimate odds ratios for 12-month diabetes rehospitalization associated with indicators of household and community-level income, with separate models by gender, and controlling for a range of other sociodemographic characteristics. Since diabetes may not always be recognized as the main reason for hospitalization, we accounted for disease progression through consideration of admissions where diabetes was previously identified as a secondary diagnosis. RESULTS: Among persons hospitalized at least once with diabetes (n = 41,290), 1.5% were readmitted within 12 months where the initial admission had diabetes as the primary diagnosis, and 1.8% were readmitted where the initial admission had diabetes as a secondary diagnosis. For men, being in the lowest household income quintile was associated with higher odds of rehospitalization in cases where the initial admission listed diabetes as either the primary diagnosis (OR = 2.21; 95% CI = 1.38-3.51) or a secondary diagnosis (OR = 1.51; 95% CI = 1.02-2.24). For women, we found no association with income and rehospitalization, but having less than university education was associated with higher odds of rehospitalization where diabetes was a secondary diagnosis of the initial admission (OR = 1.88; 95% CI = 1.21-2.92). We also found positive, but insignificant associations between community-level poverty and odds of rehospitalization. CONCLUSIONS: Universal health coverage remains insufficient to eliminate socioeconomic inequalities in preventable diabetes-related hospitalizations, as illustrated in this Canadian context. Decision-makers should tread cautiously with gender-blind poverty reduction actions aiming to enhance population health that may inadequately respond to the different needs of disadvantaged women and men with chronic illness.


Asunto(s)
Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Disparidades en el Estado de Salud , Renta/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Adulto , Anciano , Canadá , Estudios de Cohortes , Composición Familiar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Características de la Residencia/estadística & datos numéricos , Factores de Riesgo , Factores Sexuales
20.
PLoS One ; 15(1): e0226098, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31914137

RESUMEN

The chikungunya East/Central/South/Africa virus lineage (CHIKV-ECSA) was first detected in Brazil in the municipality of Feira de Santana (FS) by mid 2014. Following that, a large number of CHIKV cases have been notified in FS, which is the second-most populous city in Bahia state, northeastern Brazil, and plays an important role on the spread to other Brazilian states due to climate conditions and the abundance of competent vectors. To better understand CHIKV dynamics in Bahia state, we generated 5 complete genome sequences from a local outbreak raised in Serraria Brasil, a neighbourhood in FS, by next-generation sequencing using Illumina approach. Phylogenetic reconstructions revealed that the new FS genomes belongs to the ECSA genotype and falls within a single strongly supported monophyletic clade that includes other older CHIKV sequences from the same location, suggesting the persistence of the virus during distinct epidemic seasons. We also performed minor variants analysis and found a small number of SNPs per sample (b_29L and e_45SR = 16 SNPs, c_29SR = 29 and d_45PL and f_45FL = 21 SNPs). Out of the 93 SNPs found, 71 are synonymous, 21 are non-synonymous and one generated a stop codon. Although those mutations are not related to the increase of virus replication and/or infectivity, some SNPs were found in non-structural proteins which may have an effect on viral evasion from the mammal immunological system. These findings reinforce the needing of further studies on those variants and of continued genomic surveillance strategies to track viral adaptations and to monitor CHIKV epidemics for improved public health control.


Asunto(s)
Fiebre Chikungunya/epidemiología , Virus Chikungunya/genética , Virus Chikungunya/fisiología , Brotes de Enfermedades , Genotipo , Características de la Residencia/estadística & datos numéricos , Clase Social , Adulto , Brasil/epidemiología , Virus Chikungunya/clasificación , Femenino , Humanos , Masculino , Filogenia , Adulto Joven
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