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Indian J Med Ethics ; V(2): 1-3, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32393453


The lockdown of the country, imposed by the government of India, has resulted in additional suffering for the poor without any tangible benefit. The germ theory of disease is an important contribution to human welfare. However, disease has social determinants. Responses to infectious epidemics should be based on social conditions, not only from considerations of equity, but also because they are important for success. Advice from the World Health Organisation has to be tailored to the social realities in India. Current response by the government of India has confined the poor to ghettos. They have lost the means of livelihood without a proper social security net. It is not possible for them to practise social distancing or proper hygiene. The lockdown has the effect of making conditions worse for the poor. Keywords: Covid-19 pandemic, resource allocation, social origins of disease, unplanned lockdown, diversion of resources, lack of social security.

Infecciones por Coronavirus , Accesibilidad a los Servicios de Salud , Pandemias , Neumonía Viral , Pobreza , Cuarentena , Betacoronavirus , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Humanos , India/epidemiología , Pandemias/economía , Neumonía Viral/economía , Neumonía Viral/epidemiología , Aislamiento Social , Poblaciones Vulnerables
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud | ID: lis-LISBR1.1-47344


Elaborado pelo Departamento Científico de Aleitamento Materno, da Sociedade Brasileira de Pediatria - SBP. Amamentação: a base da vida, tema da 27ª Semana Mundial de Aleitamento Materno (SMAM-2018). O documento está organizado em duas seções que abordam as evidências dos efeitos positivos da amamentação na saúde física e mental. Uma terceira seção discute a amamentação como redutora da pobreza e promotora da equidade, haja vista a ênfase que a WABA dá ao papel fundamental do aleitamento materno na nutrição, segurança alimentar e redução da pobreza ao tratar do tema da SMAM2018.

Salud Mental , Pobreza/prevención & control , Equidad en Salud , Lactancia Materna , Promoción de la Salud , Seguridad Alimentaria y Nutricional
Nature ; 580(7804): 432, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32322084

Clima , Pobreza , Política
Epidemiol Psychiatr Sci ; 29: e113, 2020 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-32248873


AIMS: Psychotropic prescription rates continue to increase in the United States (USA). Few studies have investigated whether social-structural factors may play a role in psychotropic medication use independent of mental illness. Food insecurity is prevalent among people living with HIV in the USA and has been associated with poor mental health. We investigated whether food insecurity was associated with psychotropic medication use independent of the symptoms of depression and anxiety among women living with HIV in the USA. METHODS: We used cross-sectional data from the Women's Interagency HIV Study (WIHS), a nationwide cohort study. Food security (FS) was the primary explanatory variable, measured using the Household Food Security Survey Module. First, we used multivariable linear regressions to test whether FS was associated with symptoms of depression (Center for Epidemiologic Studies Depression [CESD] score), generalised anxiety disorder (GAD-7 score) and mental health-related quality of life (MOS-HIV Mental Health Summary score; MHS). Next, we examined associations of FS with the use of any psychotropic medications, including antidepressants, sedatives and antipsychotics, using multivariable logistic regressions adjusting for age, race/ethnicity, income, education and alcohol and substance use. In separate models, we additionally adjusted for symptoms of depression (CESD score) and anxiety (GAD-7 score). RESULTS: Of the 905 women in the sample, two-thirds were African-American. Lower FS (i.e. worse food insecurity) was associated with greater symptoms of depression and anxiety in a dose-response relationship. For the psychotropic medication outcomes, marginal and low FS were associated with 2.06 (p < 0.001; 95% confidence interval [CI] = 1.36-3.13) and 1.99 (p < 0.01; 95% CI = 1.26-3.15) times higher odds of any psychotropic medication use, respectively, before adjusting for depression and anxiety. The association of very low FS with any psychotropic medication use was not statistically significant. A similar pattern was found for antidepressant and sedative use. After additionally adjusting for CESD and GAD-7 scores, marginal FS remained associated with 1.93 (p < 0.05; 95% CI = 1.16-3.19) times higher odds of any psychotropic medication use. Very low FS, conversely, was significantly associated with lower odds of antidepressant use (adjusted odds ratio = 0.42; p < 0.05; 95% CI = 0.19-0.96). CONCLUSIONS: Marginal FS was associated with higher odds of using psychotropic medications independent of depression and anxiety, while very low FS was associated with lower odds. These complex findings may indicate that people experiencing very low FS face barriers to accessing mental health services, while those experiencing marginal FS who do access services are more likely to be prescribed psychotropic medications for distress arising from social and structural factors.

Abastecimiento de Alimentos/estadística & datos numéricos , Infecciones por VIH/psicología , Trastornos Mentales/tratamiento farmacológico , Psicotrópicos/uso terapéutico , Calidad de Vida , Trastornos Relacionados con Sustancias/psicología , Adulto , Antidepresivos/uso terapéutico , Antipsicóticos/uso terapéutico , Ansiedad/tratamiento farmacológico , Ansiedad/psicología , Estudios de Cohortes , Estudios Transversales , Depresión/tratamiento farmacológico , Depresión/psicología , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Hipnóticos y Sedantes/uso terapéutico , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Salud Mental , Pobreza , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/complicaciones , Estados Unidos/epidemiología
Br J Community Nurs ; 25(4): 162-166, 2020 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-32267767


Nurses in primary care are often the first point of access for those seeking health care, and it is well known that accessing health services can be difficult for some, especially those on a low income. A charity initiative has been developed in a low-income area in England to help such individuals, wherein volunteers help local residents to access local services and support. This study explores the experiences of service users in order to understand their perceptions and feelings about the service, using an instrumental case study method with semi-structured interviews. Qualitative data were collected from six service users and transcribed by the researcher for subsequent thematic analysis. The participants' experiences were characterised by reduced social isolation, reduced emotional distress, improved mobility and transport options, improved confidence and control over life, and effective management of memory issues. Various aspects of advocacy and empowerment were also observed. Further, the coping strategies used by the participants while facing the challenges of social isolation and ageing were highlighted. The findings provide important insight into the support needs of populations on low income, the ways in which they access healthcare and how the volunteer service can best support them.

Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Defensa del Paciente , Pobreza/estadística & datos numéricos , Atención Primaria de Salud , Inglaterra , Humanos , Enfermería de Atención Primaria , Investigación Cualitativa , Voluntarios
Medwave ; 20(2): e7833, 2020 Mar 19.
Artículo en Español | MEDLINE | ID: mdl-32225131


Background: Out-of-pocket spending on medicines and supplies can lead to a heavy financial burden in households. Objective: To determine the out-of-pocket spending on medicines and supplies in Peru and the population groups with the highest out-of-pocket spending on medicines and supplies in 2007 and 2016. Methods: We conducted an analytical cross-sectional study of the Peruvian National Household Survey on Living and Poverty Conditions for the years 2007 and 2016. Mean and median out-of-pocket spending on medicines and supplies are reported in USD for the general population, and according to the presence or not of factors described in the literature as associated with out-of-pocket spending on medicines and supplies. Results: 92 148 and 130 296 participants from 2007 and 2016 were included. In 2007, a median of 3.19 (interquartile range: 0.96 to 7.99) and an average of 8.14 (95% confidence interval: 7.80 to 8.49) were found for the out-of-pocket spending on medicines and supplies. In 2016, the median and mean out-of-pocket spending on medicines and supplies were 3.55 (interquartile range: 1.48 to 8.88) and 9.68 (95% confidence interval: 9.37 to 9.99), respectively. For 2016, higher out-of-pocket spending on medicines and supplies was found in women, children under five and over 60 years of age, people of higher educational level, having private or armed forces insurance, living in the coastal region, and being in one of the highest per capita quintile of expenditure. Between 2007 and 2016, the out-of-pocket spending on medicines and supplies was significantly increased in children under five (p < 0.001), uninsured persons (p < 0.001), insured to the Seguro Integral de Salud (p < 0.001) or the Armed Forces (p = 0.035), for the urban and rural area (both p < 0.001), and in people without chronic diseases (p < 0.001). Conclusions: An increase in out-of-pocket spending on medicines and supplies was found in the study period. There were population groups with significant increases in out-of-pocket spending on medicines and supplies. It is necessary to explore further the factors associated with out-of-pocket spending on medicines and supplies in groups of greater economic vulnerability regarding direct health spending in Peru.

Costos de los Medicamentos , Financiación Personal , Gastos en Salud , Adolescente , Adulto , Niño , Estudios Transversales , Composición Familiar , Femenino , Financiación Personal/economía , Gastos en Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Perú , Pobreza , Adulto Joven
Artículo en Inglés | MEDLINE | ID: mdl-32236387


Giardia duodenalis is one of the most important and widespread gastrointestinal parasites in the world. Despite its relevance as a causative agent of diarrhea, asymptomatic giardiasis occurs frequently, especially in low resources settings in which children are exposed to many risk factors. Based on microscopic examination and the polymerase chain reaction (PCR) amplification and sequencing of beta-giardin (bg), triose phosphate isomerase (tpi) and glutamate dehydrogenase (gdh) genes, we assessed G. duodenalis occurrence and genetic diversity in isolates of children attending a daycare center and living in low income families, in an economically successful region. Considering both, microscopic examination and PCR/sequencing methods, the overall prevalence of Giardia infection was 51.4%, with the highest frequency in children aged 1-4 years old (p<0.05). Genotyping of 50 isolates revealed that the assemblage A was found in 60% of the samples (30/50), followed by the assemblage B in 38% (19/50) and 2% of mixed-assemblage infections (1/50). At the sub-assemblage level, isolates genotyped as A were AII and among isolates B, BIII and BIV were identified. Both assemblages A and B were detected in children of all age groups, however assemblage A was more prevalent. The detection of anthroponotic assemblages and sub-assemblages (AII, BIII and BIV) reinforces human-to-human transmission, mainly in children of all age groups when they have not yet received toilet training, making them more vulnerable to infection.

Variación Genética/genética , Giardia lamblia/genética , Giardiasis/parasitología , Parasitosis Intestinales/parasitología , Animales , Brasil/epidemiología , Jardines Infantiles , Preescolar , Heces/parasitología , Femenino , Genotipo , Giardia lamblia/aislamiento & purificación , Giardiasis/diagnóstico , Giardiasis/epidemiología , Humanos , Lactante , Parasitosis Intestinales/diagnóstico , Parasitosis Intestinales/epidemiología , Masculino , Tipificación de Secuencias Multilocus , Reacción en Cadena de la Polimerasa , Pobreza , Prevalencia
Orthop Clin North Am ; 51(2): 177-188, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138856


There exists an unmet need for locally relevant and sustainable orthopedic research in low- and middle-income countries. Partnerships between high-income countries and low- and middle-income countries can bridge gaps in resources, knowledge, infrastructure, and skill. This article presents a select list of models for high-income countries/low- and middle-income countries research partnerships including academic partnerships, international research consortia, professional society-associated working groups, and nongovernmental organization partnerships. Models that produce research with lasting legacy are those that promote mutually beneficial partnerships over individual gains.

Academias e Institutos/organización & administración , Investigación Biomédica/organización & administración , Países en Desarrollo , Ortopedia/organización & administración , Investigación Biomédica/economía , Países en Desarrollo/economía , Salud Global , Relaciones Interinstitucionales , América del Norte , Organizaciones/economía , Organizaciones/organización & administración , Ortopedia/economía , Pobreza
West Afr J Med ; 37(2): 107-112, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32150627


BACKGROUND: There are few reports on socioeconomic status (SES) of patients with chronic kidney disease (CKD) in Nigeria and indeed Africa, South of the Sahara. Identifying SES as an important factor for disability in people with CKD would provide a means for early identification of those at risk and, possible intervention. OBJECTIVE: To determine the SES of CKD patients attending renal clinic in the University of Nigeria Teaching Hospital. METHODS: Cross-sectional descriptive design was adopted using pretested questionnaire to elicit data on SES (age, place of residence, household asset ownership, source of drinking water; source of cooking energy; and type of toilet facility) from one hundred and forty-five (145) CKD patients attending renal clinic in the University of Nigeria Teaching Hospital. Principal component analysis was used to classify the SES into five quintiles. RESULTS: Majority of the respondents (patients) in stages 4 and 5 CKD, constituting 17.2% and 39.3% respectively were from the lower SES. There was significant correlation between SES and age of the patients; place of residence; hypertension history; ownership of some household assets; source of drinking water; source of cooking energy; and type of toilet facility. CONCLUSION: This study demonstrated that many of our patients were from the lower SES. It is recommended that both governmental and non-governmental agencies should help these patients with some form of health insurance to alleviate their healthcare cost burden.

Enfermedades Renales/epidemiología , Insuficiencia Renal Crónica , Características de la Residencia , Clase Social , Estudios Transversales , Hospitales de Enseñanza , Humanos , Enfermedades Renales/diagnóstico , Enfermedades Renales/etiología , Nigeria/epidemiología , Pobreza/estadística & datos numéricos , Factores Socioeconómicos
Rev. Univ. Ind. Santander, Salud ; 52(1): 9-19, ene.-mar. 2020. tab, graf
Artículo en Español | LILACS | ID: biblio-1092269


Resumen Introducción: Red Unidos es la política colombiana para la reducción de la pobreza extrema. Promueve el acceso de los hogares a servicios de salud, educación y a mejorar sus condiciones de habitabilidad, nutrición, ingresos y trabajo. El acceso a servicios, como los promovidos por la Red Unidos puede cambiar en el tiempo el comportamiento de indicadores sociales y de salud. Objetivo: Valorar el comportamiento de indicadores sociales y de salud a partir de la implementación de Red Unidos en Bogotá entre 2002-2017. Materiales y métodos: Se realizó un estudio longitudinal con información retrospectiva. Se tomaron registros de indicadores sociales y de salud para Bogotá durante el periodo 2002 - 2017. Se realizó un análisis de series de tiempo interrumpida para analizar el cambio de tendencia y de nivel de los indicadores sociales y de salud a partir de la implementación de Red Unidos. Resultados: Se presentaron reducciones significativas en el comportamiento de los indicadores de salud por cada año de observación para el periodo de estudio, excepto para la prevalencia de desnutrición crónica. La razón de mortalidad materna y la prevalencia de desnutrición global presentaron cambios significativos de nivel, pero no de tendencia. De manera similar, los indicadores sociales presentaron reducciones significativas por cada año de observación durante el periodo de estudio, a excepción de la tasa global de participación laboral. Los cambios de nivel para este grupo de indicadores no fueron persistentes en el tiempo. Conclusiones: Los cambios en el comportamiento de los indicadores posterior a la implementación de la Red no fueron sostenidos en el tiempo. Sin embargo, estos cambios son producto de múltiples factores, no sólo de la Red Unidos.

Abstract Introduction: Red Unidos is the Colombian policy aimed to reduce extreme poverty. Promote the access of households in extreme poverty to health, education and to improve its habitability, nutrition, income and work. Access to services, such as those promoted can change the performance of social and health indicators. Objective: To assess the performance of social and health indicators since Red Unidos implementation in Bogotá 2002-2017. Materials and methods: Longitudinal study with retrospective information was carry out. Health and social indicators from Bogota between 2002 - 2017 were collected. Interrupted Time Series were used to analyze the change of trend and level of social and health indicators since Red Unidos implementation. Results: Health indicators show significative reductions, but no chronic malnutrition prevalence. Maternal mortality ratio and global prevalence of malnutrition showed significant changes of level, but no trend. Similarly, social indicators showed significant reductions for each year of observation, but no overall participation rate. The level changes of this indicators were not persistent over time. Conclusions: Changes in the post-intervention performance of the indicators were not held. However, its increase or reduction depend on other circumstances that affect their performance but not exclusively result since Red Unidos implementation in Bogotá.

Humanos , Indicadores de Desigualdad en Salud , Pobreza , Política Pública , Condiciones Sociales , Análisis de Series de Tiempo Interrumpido