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1.
PLOS Glob Public Health ; 4(3): e0002995, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38507404

RESUMO

Indigenous Peoples worldwide are experiencing a cascade of impacts on their health and wellbeing as a result of climate change and biodiversity loss. Existing literature at the interface of climate change, biodiversity loss, and Indigenous health tells us that Indigenous Peoples are among those most disproportionately and acutely affected by these impacts. Yet, a gap exists with respect to comprehensively and critically synthesizing the impacts reported across this literature and identifying Indigenous-led responses. Guided by an Indigenous advisory group, we employed a systematic umbrella review methodology, following PRISMA guidelines, to characterize the global secondary literature (PROSPERO registration #: CRD42023417060). In so doing, we identified the proximal, intermediate, distal, and gendered impacts of climate change and biodiversity loss on Indigenous health and wellbeing as well as Indigenous-led responses. Five databases were searched for published reviews, along with a grey literature search that focused on underrepresented geographic regions in the academic literature. Two independent reviewers conducted two-stage screening, data extraction, and quality assessment of retrieved records. Basic descriptive statistics were calculated. Qualitative data were analyzed thematically, using a constant comparative approach. A total of 38 review articles met the eligibility criteria and 37 grey literature records were retrieved and included in the review. Reviews were published between 2010-2023 and geographically clustered in the Circumpolar North. Intersecting proximal, intermediate, and distal impacts were characterized as place-based and specific, and linked to colonialism as an antecedent to and driver of these impacts. Gendered impacts were underexplored within reviews. Reviewed literature underscored the value of engaging diverse knowledge systems; platforming localized, community-led adaptation to climate change and biodiversity loss, while addressing sociopolitical constraints to these efforts; and applying a broader conceptualization of health that aligns with Indigenous frameworks. Going forward, we must foreground equity- and rights-based considerations within integrated responses to climate and biodiversity crises.

2.
Public Health Nutr ; 27(1): e92, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38454652

RESUMO

OBJECTIVE: The research objectives were to evaluate factors that influence Canadian secondary school students' milk and milk alternatives (MMA) consumption and to explore associations through age and gender lenses. DESIGN: A qualitative design was used, consisting of semi-structured interviews and photo-elicitation methods. Analysis was guided by the Theory of Planned Behaviour (TPB). Deductive and inductive thematic analyses were used to generate themes, charting data based on attributes such as gender and age. SETTING: Interviews were held virtually or via telephone. PARTICIPANTS: Participants were twenty-eight high school students from Ontario, Canada, diverse in terms of gender and age. RESULTS: Both desirable and undesirable beliefs about the health outcomes of consuming MMA were commonly discussed. These included health benefits such as strong bones, muscular strength, and growth, and health consequences like unwanted skin conditions, weight gain, and diseases. While boys and girls associated MMA consumption with muscular strength, boys predominantly considered this favourable, while girls discussed outcomes like unwanted skin conditions and weight gain more often. Adolescents' perspectives on taste/perceived enjoyment, environmentally friendly choices and animal welfare also influenced their MMA preferences. Parental influences were most cited among social factors, which appeared to be stronger during early adolescence. Factors involving cost, time and accessibility affected adolescents' beliefs about how difficult it was to consume MMA. CONCLUSIONS: Recommendations for shifting attitudes towards MMA are provided to address unfavourable beliefs towards these products. Interventions to increase MMA consumption among adolescents should include parents and address cost barriers.


Assuntos
Controle Comportamental , Leite , Masculino , Feminino , Adolescente , Animais , Humanos , Aumento de Peso , Estudantes , Instituições Acadêmicas , Ontário
3.
Syst Rev ; 13(1): 8, 2024 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-38167217

RESUMO

BACKGROUND: Research that examines the intersections of Indigenous Peoples' health and wellbeing with climate change and biodiversity loss is abundant in the global scholarship. A synthesis of this evidence base is crucial in order to map current pathways of impact, as well as to identify responses across the global literature that advance Indigenous health and wellbeing, all while centering Indigenous voices and perspectives. This protocol details our proposed methodology to systematically conduct an umbrella review (or review of reviews) of the synthesized literature on climate change, biodiversity loss, and the health and wellbeing of Indigenous Peoples globally. METHODS: A multidisciplinary team of Indigenous and non-Indigenous scholars will conduct the review, guided by an engagement process with an Indigenous Experts group. A search hedge will be used to search PubMed®, Scopus®, Web of Science™, CINAHL (via EBSCOHost®), and Campbell Collaboration databases and adapted for use in grey literature sources. Two independent reviewers will conduct level one (title/abstract) and level two (full-text) eligibility screening using inclusion/exclusion criteria. Data will be extracted from included records and analyzed using quantitative (e.g., basic descriptive statistics) and qualitative methods (e.g., thematic analysis, using a constant comparative method). DISCUSSION: This protocol outlines our approach to systematically and transparently review synthesized literature that examines the intersections of climate change, biodiversity loss, and Indigenous Peoples' health and wellbeing globally. SYSTEMATIC REVIEW REGISTRATION: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on April 24, 2023 (registration number: CRD42023417060).


Assuntos
Mudança Climática , Povos Indígenas , Humanos , Revisões Sistemáticas como Assunto , Grupos Populacionais , Projetos de Pesquisa
4.
Lupus Sci Med ; 10(2)2023 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-38087643

RESUMO

OBJECTIVE: Lupus nephritis (LN) is one of the most severe manifestations of SLE; however, we know little about the lived experience of LN. This research investigates patient experiences and perspectives of (1) LN diagnosis; (2) living with LN; and (3) LN healthcare and treatment. METHODS: Patients aged ≥18 years with biopsy-proven pure or mixed International Society of Nephrology/Renal Pathology Society class III, IV or V LN were purposefully recruited from a Canadian lupus cohort to participate in semistructured in-depth interviews. RESULTS: Thirty patients with LN completed the interviews. The mean (SD) age was 42.1 (16.4) years, and 86.7% were female. Participants described challenges seeking, receiving and adjusting to a LN diagnosis, and some reported that their diagnosis process took weeks to years. While 16 participants were provided resources by healthcare providers to help them through the process of diagnosis, the need for accessible LN-specific information at diagnosis was highlighted (n=18). Participants also described the unpredictability of living with LN, particularly related to impacts on physical and mental health, relationships, leisure activities, employment and education, and family planning. While most (n=26) participants reported a positive impression of their care, the side effects of LN medications and the need to increase patient and societal awareness/understanding of LN were highlighted in the context of healthcare and treatment. CONCLUSIONS: The unpredictability of living with LN, the heavy treatment burden and a lack of patient/societal awareness substantially affect the lived experience of LN. These findings will inform the development of LN-specific patient resources to increase understanding of LN and improve well-being for patients.


Assuntos
Lúpus Eritematoso Sistêmico , Nefrite Lúpica , Humanos , Feminino , Adolescente , Adulto , Masculino , Nefrite Lúpica/tratamento farmacológico , Canadá , Lúpus Eritematoso Sistêmico/patologia , Rim/patologia , Avaliação de Resultados da Assistência ao Paciente
5.
Sex Reprod Health Matters ; 31(1): 2272762, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37955525

RESUMO

Deeply rooted cultural beliefs and norms relating to the position and the responsibilities assigned to men and women play a significant role in propagating intimate partner violence (IPV). It is yet to be understood in what ways experiences of IPV contribute to how people socially construct their health and wellbeing as they navigate the tensions created by the prevailing sociocultural systems. To address this knowledge gap, we employed a social constructionist perspective and the eco-social model to explore how Kenyans aged 25-49 years socially construct their health and wellbeing in relation to their experiences of IPV. We conducted nine in-depth interviews and ten focus group discussions in four counties in Kenya between January and April of 2017. Textual analysis of the narratives reveals that although men are usually framed as perpetrators of violence, they may also be victims of reciprocal aggression by women, as recently witnessed in cases where women retaliate through gang attacks, chopping of male genitalia, and scalding with water. However, women are still disproportionately affected by gender-based violence because of the deeply rooted gender imbalances in patriarchal societies. Women experience social stigma associated with such violence and when separated or divorced in situations of unsafe relationships, they are viewed as social misfits. As such, most women opt to stay in unhealthy relationships to avoid social isolation. These experiences are not only unhealthy for their psychological wellbeing but also for their physical health and socioeconomic status and that of their offspring.


Assuntos
Violência por Parceiro Íntimo , Humanos , Masculino , Feminino , Quênia , Violência por Parceiro Íntimo/psicologia , Violência , Estigma Social , Política
6.
Soc Sci Med ; 338: 116343, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37924774

RESUMO

In many parts of the world access to adequate water, sanitation and hygiene (WASH) is entwined with gender relations. While there is emerging research on how gender relations intersect with socio-cultural practices and norms to produce gender-based violence in WASH, little is known about how these gender relations are intimately produced, reproduced and embodied in place. Drawing insights from feminist political ecology and gendered geographies of power, this paper uses retrospective narratives of Ghanaian migrants in Canada to advance this scholarship in three significant ways. First, the findings demonstrate how gender relations in WASH produce everyday vulnerabilities differently among women and men. Second, they highlight the complex ways women bargain with patriarchal structures to ensure their safety in WASH spaces. Finally, the findings show how gender relations and roles in WASH transform in transnational spaces in which gendered WASH roles and responsibilities are blurred. The findings draw policy attention to the interconnectedness of WASH and gender equality and the need for policy and practice change to advance gender equity in WASH.


Assuntos
Higiene , Saneamento , Masculino , Humanos , Feminino , Gana , Estudos Retrospectivos , Canadá
7.
Glob Public Health ; 18(1): 2256831, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-37700525

RESUMO

There has been a push for understanding gendered violence in WASH in recent times. Attention is therefore shifting to how these issues are conceptualised, considering their embeddedness in context. One step primarily is to understand how existing policies in WASH acknowledge the needs of women and girls in WASH. In doing this, we conducted a summative content analysis of selected policy documents on WASH: five at the international level and five each from Ghana, Uganda and Kenya. Findings suggest that existing policies inadequately acknowledge WASH related gender-based violence and pay little attention to the complex ways gender and WASH relations are intimately connected. Generally, a holistic policy approach for addressing gender-based violence in WASH is needed. The paper recommends a system policy approach to address the unique needs of women and girls in WASH in sub-Saharan Africa.


Assuntos
População Negra , Violência de Gênero , Humanos , Feminino , Gana , Quênia , Políticas
8.
Implement Sci Commun ; 4(1): 120, 2023 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-37759275

RESUMO

BACKGROUND: Integrated Knowledge Translation (IKT) and other forms of research co-production are increasingly recognized as valuable approaches to knowledge creation as a way to better facilitate the implementation of scientific findings. However, the nature of some scientific work can preclude direct knowledge to action as a likely outcome. Do IKT approaches have value in such cases? METHODS: This study used a qualitative case study approach to better understand the function of IKT in a non-traditional application: basic and clinical science investigating the causes and consequences of food allergy. Building off previous baseline findings, data were obtained through in-depth interviews with project scientists and steering committee members and complemented by researcher observation. Data were analyzed through an integrated approach to understand how well participants perceived the stipulated project IKT outcomes had been met and to better understand the relationship between different forms of IKT goals, outcomes, and impacts. RESULTS: We propose a conceptual model which builds temporal continuity into the IKT work and understands success beyond truncated timelines of any one project. The model proposes project IKT goals be conceptualized through three metaphorical tower blocks: foundational (changing the culture for both scientists and knowledge-users), laying the groundwork (building relationships, networks and sparking scientific inquiry), and putting scientific knowledge to action. Based on this model, this case study demonstrated notable success at the foundational and intermediate blocks, though did not turn basic and clinical research knowledge into actionable outcomes within the project timespan. CONCLUSIONS: We find that current IKT literature which situates success as filling a knowledge to action gap is conceptually inadequate for understanding the full contributions of IKT activities. This work highlights the need for building cultural and scientific familiarity with IKT in order to better enable knowledge to action translation. Improving understanding and communication of science and empowering knowledge-users to engage with the research agenda are long-term strategies to build towards knowledge implementation and lay the ground work for many future research projects.

9.
Health Place ; 83: 103099, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37634303

RESUMO

The COVID-19 pandemic has heightened and made visible the embodied consequences of water, sanitation and hygiene (WASH) inequalities and the relationalities of health in place. This paper combines insights from relational geographies and embodied epidemiology to explore psychosocial concerns among Ghanaian migrants in Canada due to their multiple and simultaneous roles in the WASH space in Ghana, particularly during the COVID-19 pandemic. We explored this using narratives from in-depth interviews with 27 participants (16 women and 11 men) residing in Ontario, Canada. The case of Ghana offers insight into how social ties with home communities could provide a safety net during emergencies but could also affect the psychosocial wellbeing of migrants. Results revealed four interrelated psychosocial stressors, including social stressors, financial stressors, stressors related to perceived inequality and stressors related to the fear of infection during WASH access. The paper underscores the urgent need for research to move beyond local health implications of WASH inequalities and begin to prioritize how these social inequalities are embodied at distant locations.


Assuntos
COVID-19 , Água , Masculino , Humanos , Feminino , Abastecimento de Água , Gana , Saneamento , Emergências , Pandemias , Higiene , Ontário , Emoções
10.
BMC Public Health ; 23(1): 890, 2023 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-37189082

RESUMO

BACKGROUND: Collective agreement about the importance of centering equity in health research, practice, and policy is growing. Yet, responsibility for advancing equity is often situated as belonging to a vague group of 'others', or delegated to the leadership of 'equity-seeking' or 'equity-deserving' groups who are tasked to lead systems transformation while simultaneously navigating the violence and harms of oppression within those same systems. Equity efforts also often overlook the breadth of equity scholarship. Harnessing the potential of current interests in advancing equity requires systematic, evidence-guided, theoretically rigorous ways for people to embrace their own agency and influence over the systems in which they are situated. ln this article, we introduce and describe the Systematic Equity Action-Analysis (SEA) Framework as a tool that translates equity scholarship and evidence into a structured process that leaders, teams, and communities can use to advance equity in their own settings. METHODS: This framework was derived through a dialogic, critically reflective and scholarly process of integrating methodological insights garnered over years of equity-centred research and practice. Each author, in a variety of ways, brought engaged equity perspectives to the dialogue, bringing practical and lived experience to conversation and writing. Our scholarly dialogue was grounded in critical and relational lenses, and involved synthesis of theory and practice from a broad range of applications and cases. RESULTS: The SEA Framework balances practices of agency, humility, critically reflective dialogue, and systems thinking. The framework guides users through four elements of analysis (worldview, coherence, potential, and accountability) to systematically interrogate how and where equity is integrated in a setting or object of action-analysis. Because equity issues are present in virtually all aspects of society, the kinds of 'things' the framework could be applied to is only limited by the imagination of its users. It can inform retrospective or prospective work, by groups external to a policy or practice setting (e.g., using public documents to assess a research funding policy landscape); or internal to a system, policy, or practice setting (e.g., faculty engaging in a critically reflective examination of equity in the undergraduate program they deliver). CONCLUSIONS: While not a panacea, this unique contribution to the science of health equity equips people to explicitly recognize and interrupt their own entanglements in the intersecting systems of oppression and injustice that produce and uphold inequities.


Assuntos
Equidade em Saúde , Políticas , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Liderança
11.
Artigo em Inglês | MEDLINE | ID: mdl-37107789

RESUMO

Brazil experienced some of the highest rates of COVID-19 globally. This was complicated by the fact that 35 million of its citizens have limited access to water, a primary resource necessary to stem the spread of infectious diseases. In many cases, civil society organizations (CSOs) stepped into this void left by responsible authorities. This paper explores how CSOs in Rio de Janeiro helped populations struggling with access to water, sanitation, and hygiene (WASH) during the pandemic, and what coping strategies are transferable to similar contexts. In-depth interviews (n = 15) were conducted with CSO representatives in the metropolitan region of Rio de Janeiro. Thematic analysis of the interviews revealed that COVID-19 exacerbated pre-existing social inequities among vulnerable populations, undermining their ability to protect their health. CSOs provided emergency relief aid but faced the counterproductive actions of public authorities who promoted a narrative that diminished the risks of COVID-19 and the importance of non-pharmacological interventions. CSOs fought this narrative by promoting sensitization among vulnerable populations and partnering with other stakeholders in networks of solidarity, playing a vital role in the distribution of health-promoting services. These strategies are transferrable to other contexts where state narratives oppose public health understandings, particularly for extremely vulnerable populations.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , Brasil/epidemiologia , Organizações , Sociedades , Saúde Pública
12.
Soc Sci Med ; 317: 115621, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36542928

RESUMO

Gender-based violence resulting from water, sanitation and hygiene (WASH) insecurity is a major public health problem. WaSH gender-based (WaSH-GBV) is a spatio-temporal experience and has disproportionate health and wellbeing impacts on women and girls. However, the global community of WaSH practitioners and policymakers is yet to adequately address women's vulnerability to violence in relation to WaSH access. Informed by the feminist political ecology of health framework, we conducted in-depth interviews (n = 27, 16 women and 11 men) with Ghanaian immigrants to Canada to explore perceptions of WaSH experiences over lifecourse. Results revealed that participants' perceptions and experiences of GBV are both socially and context dependent, organized around four dimensions: structural, physical, psychological, and sexual. These muti-scalar dimensions of diasporans' WaSH experiences and perceptions in Ghana are discussed along with their implications for policy and practice, specifically in enhancing health equity and water security.


Assuntos
Violência de Gênero , Saneamento , Masculino , Humanos , Feminino , Água , Gana , Abastecimento de Água , Higiene , Dor
13.
Lupus Sci Med ; 9(1)2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36283746

RESUMO

OBJECTIVE: We conducted an international survey of patients with SLE to assess their access, preference and trust in various health information sources pre-COVID-19 and during the COVID-19 pandemic. METHODS: Patients with SLE were recruited from 18 observational cohorts, and patients self-reporting SLE were recruited through five advocacy organisations. Respondents completed an online survey from June 2020 to December 2021 regarding the sources of health information they accessed in the 12 months preceding (pre-11 March 2020) and during (post-11 March 2020) the pandemic. Multivariable logistic regressions assessed factors associated with accessing news and social media post-11 March 2020, and self-reporting negative impacts from health information accessed through these sources. RESULTS: Surveys were completed by 2111 respondents; 92.8% were female, 76.6% had postsecondary education, mean (SD) age was 48.8 (14.0) years. Lupus specialists and family physicians were the most preferred sources pre-11 March 2020 and post-11 March 2020, yet were accessed less frequently (specialists: 78.5% pre vs 70.2% post, difference -8.3%, 95% CI -10.2% to -6.5%; family physicians: 57.1% pre vs 50.0% post, difference -7.1%, 95% CI -9.2% to -5.0%), while news (53.2% pre vs 62.1% post, difference 8.9%, 95% CI 6.7% to 11.0%) and social media (38.2% pre vs 40.6% post, difference 2.4%, 95% CI 0.7% to 4.2%) were accessed more frequently post-11 March 2020 vs pre-11 March 2020. 17.2% of respondents reported negative impacts from information accessed through news/social media. Those outside Canada, older respondents or with postsecondary education were more likely to access news media. Those in Asia, Latin America or younger respondents were more likely to access social media. Those in Asia, older respondents, males or with postsecondary education in Canada, Asia or the USA were less likely to be negatively impacted. CONCLUSIONS: Physicians, the most preferred and trusted sources, were accessed less frequently, while news and social media, less trusted sources, were accessed more frequently post-11 March 2020 vs pre-11 March 2020. Increasing accessibility to physicians, in person and virtually, may help reduce the consequences of accessing misinformation/disinformation.


Assuntos
COVID-19 , Lúpus Eritematoso Sistêmico , Mídias Sociais , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , COVID-19/epidemiologia , Pandemias , Lúpus Eritematoso Sistêmico/epidemiologia , Meios de Comunicação de Massa
14.
Infect Dis Poverty ; 11(1): 88, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35932055

RESUMO

BACKGROUND: Neglected tropical diseases (NTDs) affect poor populations with little or no 'political voice' to influence control activities. While most NTDs have interventions that work, the biggest challenge remains in delivering targeted interventions to affected populations residing in areas experiencing weak health systems. Despite the upward development trends in most countries of sub-Saharan Africa (SSA), the healthcare worker to population ratio remains exceptionally low, with some areas not served at all; thus, there is a need to involve other personnel for school and community-based healthcare approaches. Nonetheless, the current community-based programs suffer from inconsistent community participation due to a lack of coordinated response, and an expanded intervention agenda that lacks context-specific solutions applicable to rural, urban, and marginalized areas. METHODS: This research investigated the capacity of local communities to address the burden of NTDs. Informed by the social theory of human capability, the research collected primary qualitative data by conducting key informant interviews and focus group discussions of people infected or affected by NTDs. The interview data were collected and transcribed verbatim for thematic analysis using Nvivo version 12. RESULTS: Our findings reveal, first, a need for intersectoral collaboration between governments and affected populations for inclusive and sustainable NTD solutions. Second, a 'bottom-up' approach that enhances capacity building, sensitization, and behaviour change for improved uptake of NTD interventions. Third, the enforcement of Public Health Legislative Acts that mandates the reporting and treatment of NTDs such as leprosy. Fourth, the establishment of support groups and counseling services to assist persons suffering from debilitating and permanent effects of NTDs. CONCLUSIONS: Our research demonstrates the importance of human agency in encouraging new forms of participation leading to the co-production of inclusive and sustainable solutions against NTDs.


Assuntos
Doenças Negligenciadas , Medicina Tropical , Fortalecimento Institucional , Serviços de Saúde Comunitária , Humanos , Quênia , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/prevenção & controle , Saúde Pública
15.
Health Place ; 76: 102841, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35667223

RESUMO

The devastating effects of inadequate basic utilities such as water, sanitation, hygiene, waste management and environmental cleaning (WASH) is underscored by the current global pandemic declared on March 11, 2020. This paper explores the experiences of key informants (n = 15) ie government and non-government organization officials on the impacts of the COVID-19 pandemic in health care facilities (HCFs) and the role of WASH in emergency preparedness in health settings and the communities they serve using Kisumu, Kenya as a case study. The results from interviews with the key informants indicate socioecological challenges shaping access to hygiene services in HCFs and related disparities in social determinants of health such as WASH that serve as barriers to the pandemic response. All participants indicated the healthcare system was ill-prepared for the pandemic. Health care workers experienced such severe psychosocial impacts due to the lack of preparedness that they subsequently embarked on strikes in protest. These situations influenced citizens' perceptions of the COVID-19 pandemic as a hoax and resulted in a surge in other population health indicators (e.g., increased maternal mortality; decreased vaccination rates for other illnesses such as measles). We recommend authentic partnerships among all stakeholders to develop and implement context-driven sustainable solutions that integrate WASH and emergency preparedness in HCFs and the communities they serve across all spatial scales, from the global to the local.


Assuntos
COVID-19 , Defesa Civil , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Quênia/epidemiologia , Pandemias/prevenção & controle , Saneamento , Abastecimento de Água
16.
Health Promot Chronic Dis Prev Can ; 42(6): 229-237, 2022 Jun.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-35766912

RESUMO

INTRODUCTION: High levels of income inequality and increased opioid-related harm across Canada bring into question the role of socioeconomic status (SES) in the opioid epidemic. Only a few studies have examined this association, and most of those have analyzed this issue on a provincial level. This study examined the association between opioid-related health outcomes and SES, and investigated rate ratios over time. METHODS: Administrative databases were used to identify opioid-related mortality, hospitalization and emergency department visits between 2000 and 2017. Patient's postal code was linked to the quintile of median household income at the forward sortation area level. Crude rates and age- and sex-adjusted rates in each quintile were calculated, as well as the adjusted rate ratio of average annual rates between the lowest and highest quintiles. The significance of the time trend of rate ratios for all outcomes was examined using linear regression. RESULTS: A stepped gradient of opioid-related outcomes across all income quintiles emerged from these data. For mortality, hospitalization and emergency department visits, the average annual rate ratio between lowest quintile and highest quintile was 3.8, 4.3 and 4.9, respectively. These ratios were generally stable and consistent over the study period, albeit the opioid-related mortality SES gap decreased gradually (p < 0.01). CONCLUSION: Area income quintile was found to be highly associated with opioid outcomes. Psychosocial factors (stress, unemployment, housing insecurity) that are typically concentrated in low SES areas may play a significant role in the opioid epidemic. Health policies should address these factors in order to provide effective solutions.


Assuntos
Analgésicos Opioides , Epidemia de Opioides , Canadá/epidemiologia , Serviço Hospitalar de Emergência , Hospitalização , Humanos , Classe Social , Fatores Socioeconômicos
17.
Ann Allergy Asthma Immunol ; 129(2): 220-230.e6, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35500863

RESUMO

BACKGROUND: Limited data exist on the economic burden of food allergy (FA). OBJECTIVE: To assess FA-related direct (healthcare and out-of-pocket) and indirect (lost productivity) costs and their determinants in Canadian children and adults self-reporting FA. METHODS: FA-individuals self-reporting a convincing history or physician diagnosis were recruited through FA registries, an anaphylaxis registry, and advocacy associations, and electronically surveyed regarding FA-related healthcare use, out-of-pocket expenditures, and time lost from paid and unpaid labor. Direct and indirect costs (2020 Canadian dollars [CAD]) were stratified on severe reaction vs mild, moderate or no reaction, and children vs adults; multivariate regressions assessed the association between costs and sociodemographic and disease characteristics. RESULTS: Between May 2018 and July 2019, 2692 eligible individuals responded (2189 convincing history and 503 physician diagnosis only); 1020 experienced a severe reaction; 1752 were children. Per FA-individual, annual healthcare, out-of-pocket, and indirect costs were $1267, $2136, and $7950. Those with a severe reaction had higher healthcare and out-of-pocket costs than those with mild, moderate or no reaction. FA-children vs FA-adults had higher healthcare and out-of-pocket costs, and lower indirect costs. Multivariate results showed that lower age, a severe reaction ever, multiple FAs, and fair or poor general health were associated with higher healthcare and out-of-pocket costs. Higher age, lower household education and income, and fair or poor general health were associated with higher indirect costs. CONCLUSION: The economic burden of FA in Canada is substantial, particularly for those with a severe reaction ever, multiple FAs, and fair or poor general health. It is crucial that those most adversely affected are allocated appropriate resources to support disease management.


Assuntos
Efeitos Psicossociais da Doença , Hipersensibilidade Alimentar , Adulto , Canadá/epidemiologia , Estresse Financeiro , Hipersensibilidade Alimentar/epidemiologia , Custos de Cuidados de Saúde , Gastos em Saúde , Humanos
18.
Can J Public Health ; 113(2): 175-177, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35297023

Assuntos
Saúde Global , Humanos
20.
J Allergy Clin Immunol Glob ; 1(2): 67-72, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-37780589

RESUMO

Background: Evidence suggests a mental health impact of food allergy on affected children and their families; however, little is known about health care professionals' understanding of these impacts and the resources available to patients and their families. Objective: Our aim was to conduct a pilot study examining health care professionals' perceptions of the psychosocial and financial burden of food allergy to identify gaps in education and resources and thus better support families with food allergy moving forward. Methods: Between February 20 and November 19, 2020, we conducted audiorecorded interviews (n = 6) and profession-specific focus groups (n = 2 [representing 7 individuals]). The participants included pediatric allergists, allergy nurse educators, and clinical dietitians who were directly involved in pediatric food allergy care. The interviews were recorded and transcribed verbatim. Thematic analysis was subsequently applied to identify the main themes. Results: Our study consisted of an interdisciplinary group of Manitoban health care providers (N = 13) who were directly involved with pediatric food allergy care. We identified 3 main themes from these interviews: anxiety among families with food allergy, which is a common comorbidity; limited resources available within current public infrastructure; and empowerment through education. These themes describe issues surrounding access to information and resources and how this can affect anxiety and parenting styles among families with food allergy. Conclusions: Health care professionals perceive that many families experience anxiety as a result of their child's food allergy. They further advocate that access to information and suitability of public resources be considered when planning for related programs.

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