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1.
Lancet Psychiatry ; 6(11): 915-925, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31601530

RESUMO

BACKGROUND: Housing First is increasingly implemented for homeless adults with mental illness in large urban centres, but little is known about its long-term effectiveness. The At Home/Chez Soi randomised controlled trial done in five cities in Canada showed that Housing First improved housing stability and other select health outcomes. We extended the At Home/Chez Soi trial at the Toronto site to evaluate the long-term effects of the Housing First intervention on housing and health outcomes of homeless adults with mental illness over 6 years. METHODS: The At Home/Chez Soi Toronto study was a randomised, controlled trial done in Toronto (ON, Canada). Here, we present the results of an extension study done at the same site. Participants were homeless adults (aged ≥18 years) with a serious mental disorder with or without co-occurring substance use disorder. In phase 1, participants were stratified by level of need for mental health support services (high vs moderate), and randomly assigned (1:1) using adaptive randomisation procedures to Housing First with assertive community treatment (HF-ACT), Housing First with intensive case management (HF-ICM), or to treatment as usual (TAU). Participants with moderate support needs were further stratified by ethnoracial status. Considering the nature of the Housing First intervention, study participants and study personnel were not masked to group assignment. Phase 1 participants could choose to enrol in the extension study (phase 2). The primary outcome was the rate of days stably housed per year analysed in the modified intention-to-treat population, which included all randomly assigned participants who had at least one assessment for the primary outcome. Participants contributed data to the study up to the point of their last interview. Multilevel multiple imputation was used to handle missing data. The trial was registered with ISRCTN, ISRCTN42520374. FINDINGS: Between Oct 1, 2009, and March 31, 2013, 575 individuals participated in phase 1 of the Toronto Site At Home/Chez Soi study (197 [34%] participants with high support needs and 378 [66%] with moderate support needs). Of the 378 participants with moderate support needs, 204 were randomly assigned to receive the HF intervention with ICM or with ethnoracial-specific ICM services (HF-ER-ICM; HF-ICM or HF-ER-ICM groups) and 174 were randomly assigned to TAU. Of the 197 participants with high support needs, 97 were randomly assigned to receive the HF intervention with ACT (HF-ACT treatment group) and 100 were randomly assigned to TAU group. Between Jan 1, 2014, and March 31, 2017, 414 (81%) of 575 phase 1 participants participated in the extended phase 2 study. The median duration of follow-up was 5·4 years (IQR 2·1-5·9). Among phase 2 participants, 141 had high support needs (79 participants in the HF-ACT group; 62 participants in the TAU group), and 273 had moderate support needs (160 participants in the HF-ICM or HF-ER-ICM group; 113 participants in the TAU group). 187 high support needs participants (93 participants in the HF-ACT group, 94 participants in the TAU group), and 361 moderate support needs participants (201 participants in the HF-ICM or HF-ER-ICM group, 160 participants in the TAU group) were included in the modified intention-to-treat analysis for the primary outcome. The number of days spent stably housed was significantly higher among participants in the HF-ACT and HR-ICM or HF-ER-ICM groups than participants in the TAU groups at all timepoints. For participants with moderate support needs, the rate ratio (RR) of days stably housed in the Housing First group, compared with TAU, was 2·40 (95% CI 2·03-2·83) in year 1, which decreased to 1·13 (1·01-1·26) in year 6. The RR of days stably housed for participants with high support needs, compared with TAU, was 3·02 (2·43-3·75) in year 1 and 1·42 (1·19-1·69) in year 6. In year 6, high support needs participants in the Housing First group spent 85·51% of days stably housed compared with 60·33% for the TAU group, and moderate needs participants in the Housing First group spent 88·16% of days stably housed compared with 78·22% for the TAU group. INTERPRETATION: Rent supplements and mental health support services had an enduring positive effect on housing stability for homeless adults with mental illness in a large, resource-rich urban centre, with a larger impact on individuals with high support needs than moderate support needs. FUNDING: Mental Health Commission of Canada, Ontario Ministry of Health and Long-Term Care, and the Canadian Institute of Health Research.


Assuntos
Serviços Comunitários de Saúde Mental/métodos , Pessoas em Situação de Rua/psicologia , Pessoas em Situação de Rua/estatística & dados numéricos , Transtornos Mentais/terapia , Avaliação de Programas e Projetos de Saúde/métodos , Habitação Popular/estatística & dados numéricos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/psicologia , Ontário , Tempo , População Urbana/estatística & dados numéricos
2.
Can J Psychiatry ; 64(10): 718-725, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31248276

RESUMO

OBJECTIVE: We aimed to describe interactions between police and persons who experience homelessness and serious mental illness and explore whether housing status is associated with police interactions. METHOD: We conducted a secondary analysis of 2008 to 2013 data from the Toronto, Canada, site of the At Home/Chez Soi study. Using police administrative data, we calculated the number and types of police interactions, the proportion of charges for acts of living and administration of justice, and the proportion of occurrences due to victimization, involuntary psychiatric assessment, and suicidal behavior. Using generalized estimating equations, we estimated the odds of police interaction by housing status. RESULTS: This study included 547 adults with mental illness who were homeless at baseline. In the year prior to randomization, 55.8% of participants interacted with police, while 51.7% and 43.0% interacted with police in Study Years 1 and 2, respectively. Of 2,228 charges against participants, 12.6% were due to acts of living and 21.2% were for administration of justice. Of 518 occurrences, 41.1% were for victimization, 45.6% were for mental health assessment, and 22.2% were for suicidal behavior. The odds of any police interaction during the past 90 days was 47% higher for those who were homeless compared to those who were stably housed (95% CI 1.26 to 1.73). CONCLUSIONS: For people who experience homelessness and mental illness in Toronto, Canada, interactions with police are common. The provision of stable housing and changes in policy and practice could decrease harms and increase health benefits associated with police interactions for this population.

3.
Int J Obes (Lond) ; 42(11): 1853-1870, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29535453

RESUMO

BACKGROUND/OBJECTIVES: The role of smoking from the paternal line during the pre-conception period on grand-child's overweight/obesity and associated underlying pathways are uncertain. We examined whether the smoking status from the paternal line was associated with the grand-child's higher weight at birth, and overweight or obesity at 5 and 9 years of age. The grandparental smoking effect from the maternal line was also explored. SUBJECTS/METHODS: Participants were fathers and grandparents and grand-children from the Lifeways Cross Generational Cohort (N = 1021 for the analysis at birth; N = 562 and N = 284 for the analysis at 5 and 9 years, respectively). Paternal and grandparental smoking was defined as smoking versus non-smoking. Children's weight categories compared were high versus normal weight at birth, and overweight/obesity versus normal weight (based on BMI and waist circumference) at age of five and nine years. Logistic regression models were used to estimate the crude and adjusted associations. RESULTS: After adjustment for several child and parental factors, at age five there was an association between paternal smoking and offspring's overweight/obesity based on BMI (Adjusted Odds Ratio (AOR), and 95%CI: 1.76, 1.14-2.71, p-value: 0.010), most marked for boys (AOR: 2.05, 1.06-3.96, p-value: 0.032). These associations remained when confined to the children sample with biological fathers only (overall sample, AOR: 1.92, 1.22-3.02, p-value: 0.005; son, AOR: 2.09, 1.06-4.11, p-value: 0.033). At age 9, the paternal grandmothers' smoking was positively associated with their grandchild's overweight/obesity status based on waist circumference (AOR: 3.29, 1.29-8.37), and especially with that of her granddaughter (AOR: 3.44, 1.11-10.69). These associations remained when analysing only the children sample with biological fathers (overall sample, AOR: 3.22,1.25-8.29, p-value: 0.016; granddaughter, AOR: 3.55, 1.13-11.15, p-value: 0.030). CONCLUSION: The smoking habit from the paternal line is associated with grand-children's adiposity measures during their early childhood, which might be epigenetically transmitted through male-germline cells.


Assuntos
Adiposidade/efeitos dos fármacos , Linhagem da Célula/efeitos dos fármacos , Células Germinativas/efeitos dos fármacos , Avós , Obesidade Pediátrica/induzido quimicamente , Fumar , Fumar Tabaco/efeitos adversos , Adiposidade/genética , Adulto , Índice de Massa Corporal , Criança , Pai , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mães , Razão de Chances , Obesidade Pediátrica/patologia , Estudos Prospectivos , Fatores de Risco , Fumar/genética , Fumar/fisiopatologia , Fumar Tabaco/genética
4.
SSM Popul Health ; 4: 100-116, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29349279

RESUMO

Exposure to deprived socioeconomic conditions during the peri-conception and early childhood periods can have a negative long-term impact on individuals' health and that of their progeny. We aimed to examine whether relatives' birth period affected index-child (grand-child) birthweight status in the Lifeways Cross-Generation Cohort in the Republic of Ireland. Participants were 943 mothers and offspring, 890 fathers, 938 maternal grandmothers (MGM), 700 maternal grandfathers (MGF) 537 paternal grandmothers (PGM) and 553 paternal grandfathers (PGF). Index-child's birthweight was sex-for-gestational age standardised (UK1990 population), and then classified into low birthweight (≤10th percentile) and high-birthweight (≥90th percentile) and compared against normal-birthweight (>10th to <90th percentiles). Four adult birth periods were considered: The Free State (FS, 1916-1938); Emergency Act (EA, 1939-1946); Post-World War-II Baby-Boom (PWWII-BB, 1947-1964); and Modern Ireland (MI, 1964 onwards). Logistic regression was used to assess the crude and adjusted relationship between index-child's birthweight status and relatives' birth periods. Overall, there were 8.7% (n=82) index-children in the low-birthweight category, 77.9% (n=735) and 13.4% (n=126) within the normal and high birthweight groups respectively. Index-children whose mothers were born during the PWWII-BB had higher birthweight infants (Crude OR(COR)=1.81 (1.08-3.03) which remained the case only for male index-children when adjusted for co-variables (Adjusted OR(AOR)=4.61(1.71-12.42)). Parents' combined PWWII-BB birth period was positively associated with male index-child higher birthweight, even adjusted for maternal characteristics (AOR=4.60(1.69-12.50)). MGFs born during the EA were more likely to have grandchildren with low birthweight after adjustment for maternal characteristics (AOR=2.45(1.03-5.85)), particularly for female index-children (AOR=4.74(1.16-19.25)). Both PGMs and PGFs born during the FS period had higher birthweight grandchildren, adjusted for maternal-related co-variables (PGM, AOR=3.23(1.21-8.63); PGF, AOR=3.93(1.11-13.96)), with the effect of PGM more evident in her granddaughter (AOR=6.53(1.25-34.04)). In conclusion, there is some evidence that period of grandparental birth is associated with their grandchildren's birthweights, suggesting that transgenerational exposures may be particular to historical context, meriting further exploration.

5.
Am J Epidemiol ; 182(9): 763-74, 2015 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-26443417

RESUMO

Identifying preventable exposures that lead to asthma and associated allergies has proved challenging, partly because of the difficulty in differentiating phenotypes that define homogeneous disease groups. Understanding the socioeconomic patterns of disease phenotypes can help distinguish which exposures are preventable. In the present study, we identified disease phenotypes that are susceptible to socioeconomic variation, and we determined which life-course exposures were associated with these inequalities in a contemporary birth cohort. Participants included children from the Avon Longitudinal Study of Parents and Children, a population-based birth cohort in England, who were born in 1991 and 1992 and attended the clinic at 7-8 years of age (n = 6,378). Disease phenotypes included asthma, atopy, wheezing, altered lung function, and bronchial reactivity phenotypes. Combining atopy with a diagnosis of asthma from a doctor captured the greatest socioeconomic variation, including opposing patterns between phenotype groups: Children with a low socioeconomic position (SEP) had more asthma alone (adjusted multinomial odds ratio = 1.50, 95% confidence interval: 1.21, 1.87) but less atopy alone (adjusted multinomial odds ratio = 0.80, 95% confidence interval: 0.66, 0.98) than did children with high SEP. Adjustment for maternal exposure to tobacco smoke during pregnancy and childhood exposure to tobacco smoke reduced the odds of asthma alone in children with a low SEP. Current inequalities among children who have asthma but not atopy can be prevented by eliminating exposure to tobacco smoke. Other disease phenotypes were not socially patterned or had SEP patterns that were not related to smoke exposure.


Assuntos
Asma/epidemiologia , Hipersensibilidade/epidemiologia , Sons Respiratórios , Classe Social , Asma/fisiopatologia , Criança , Inglaterra/epidemiologia , Feminino , Humanos , Hipersensibilidade/fisiopatologia , Estudos Longitudinais , Masculino , Fenótipo , Testes de Função Respiratória , Sons Respiratórios/fisiopatologia , Fatores de Risco
6.
BMJ Open ; 5(6): e006928, 2015 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-26078307

RESUMO

OBJECTIVE: This study aimed to determine in detail the risk perception of sexually transmitted infections (STIs) and HIV, and the contextual circumstances, in Nigerian commercial sex workers (CSWs) in Barcelona. DESIGN: A qualitative study with a phenomenological approach. SETTING: Raval area in Barcelona. PARTICIPANTS: 8 CSWs working in Barcelona. METHODS: A phenomenological study was carried out with Nigerian CSWs in Barcelona. Sampling was theoretical, taking into account: different age ranges; women with and without a partner; women with and without children; and women participating or not in STI/HIV-prevention workshops. Information was obtained by means of eight semistructured individual interviews. An interpretative content analysis was conducted by four analysts. RESULTS: Illegal immigrant status, educational level, financial situation and work, and cultural context had mixed effects on CSW knowledge of, exposure to, and prevention and treatment of STI and HIV. CSWs were aware of the higher risk of STI associated with their occupation. They identified condoms as the best preventive method and used them during intercourse with clients. They also implemented other preventive behaviours such as personal hygiene after intercourse. Control of sexual services provided, health education and healthcare services had a positive effect on decreasing exposure and better management of STI/HIV. CONCLUSIONS: Nigerian CSWs are a vulnerable group because of their poor socioeconomic status. The perception of risk in this group and their preventive behaviours are based on personal determinants, beliefs and experiences from their home country and influences from the host country. Interventions aimed at CSWs must address knowledge gaps, risk behaviours and structural elements.


Assuntos
Emigrantes e Imigrantes , HIV , Conhecimentos, Atitudes e Prática em Saúde , Assunção de Riscos , Trabalho Sexual , Profissionais do Sexo , Doenças Sexualmente Transmissíveis , Adulto , Preservativos , Cultura , Emigração e Imigração , Feminino , Infecções por HIV/etiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/virologia , Educação em Saúde , Humanos , Nigéria/etnologia , Pesquisa Qualitativa , Comportamento Sexual , Doenças Sexualmente Transmissíveis/etiologia , Doenças Sexualmente Transmissíveis/prevenção & controle , Doenças Sexualmente Transmissíveis/virologia , Fatores Socioeconômicos , Espanha , Populações Vulneráveis , Adulto Jovem
7.
BMC Cardiovasc Disord ; 14: 135, 2014 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-25280390

RESUMO

BACKGROUND: Whilst it is well known that psychosocial determinants may contribute to cardiovascular diseases (CVD), data from specific groups are scarce. The present study aims to determine the contribution of psychosocial determinants in increasing the risk of cardiovascular events (myocardial infarction and stroke), and death from CVD, in a high risk adult population. METHODS: Longitudinal prospective study of 7263 patients (57.5% women), mean age 67.0 (SD 6.2) free from CVD but at high risk, with a median follow-up of 4.8 years (from October 2003 to December 2010). The Hazard Ratios (HRs) of cardiovascular events (myocardial infarction, stroke, and death from cardiovascular causes) related to educational attainment, diagnosed depression (based on medical records), and low social support (number of people living in the household) were estimated by multivariate Cox regression models. RESULTS: Stroke incidence was associated with low educational level in the whole population (HR: 1.83, 95% CI: 1.09-3.09), and especially in men (HR: 2.11, 95% CI 1.09-4.06). Myocardial infarction and CVD mortality were not associated with any of the psychosocial factors considered. CONCLUSION: Adults with low educational level had a higher risk of stroke. Depression and low social support were not associated with CVD incidence. TRIAL REGISTRATION: Clinical trial registration information unique identifier: ISRCTN35739639.


Assuntos
Escolaridade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/psicologia , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/psicologia , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Depressão/mortalidade , Depressão/psicologia , Feminino , Disparidades nos Níveis de Saúde , Habitação , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/diagnóstico , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Apoio Social , Espanha/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo
8.
BMC Cardiovasc Disord ; 14: 109, 2014 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-25160563

RESUMO

BACKGROUND: Hypertension and depression are both important risk factors for cardiovascular diseases. Nevertheless, the association of blood pressure on and depression has not been completely established. This study aims to analyze whether depression may influence the control of blood pressure in hypertensive individuals at high cardiovascular risk. METHODS: Cross-sectional study, embedded within the PREDIMED clinical trial, of 5954 hypertensive patients with high cardiovascular risk factor profiles. The relationship between blood pressure control and depression was analyzed. A multivariate analysis (logistic and log-linear regression), adjusting for potential confounders (socio-demographic factors, body mass index, lifestyle, diabetes, dyslipidemia, and antihypertensive treatment), was performed. RESULTS: Depressive patients, with and without antidepressant treatment, had better blood pressure control (OR: 1.28, CI 95%: 1.06-1.55, and OR: 1.30, CI 95%: 1.03-1.65, respectively) than non-depressive ones. Regarding blood pressure levels, systolic blood pressure values (mmHg) were found to be lower in both treated and untreated depressive patients (Log coefficient Beta: -1.59, 95% CI: -0.50 to -2.69 and Log coefficient Beta: -3.49, 95% CI: -2.10 to -4.87, respectively). CONCLUSIONS: Among hypertensive patients at high cardiovascular risk, the control of blood pressure was better in those diagnosed with depression. TRIAL REGISTRATION: Unique identifier: ISRCTN35739639.


Assuntos
Antidepressivos/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Depressão/tratamento farmacológico , Hipertensão/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Estudos Transversais , Depressão/diagnóstico , Depressão/psicologia , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Fatores de Risco , Resultado do Tratamento
9.
Rev. esp. cardiol. (Ed. impr.) ; 66(10): 803-811, oct. 2013.
Artigo em Espanhol | IBECS | ID: ibc-115596

RESUMO

Introducción y objetivos. Aunque se sabe que los determinantes sociales pueden ser causa de desigualdades en la salud, se ha evaluado escasamente si hay diferencias socioeconómicas relacionadas con el tratamiento preventivo. El objetivo de este estudio es analizar la relación entre el nivel socioeconómico de una población con alto riesgo cardiovascular y las desigualdades en el tratamiento cardiovascular recibido en un sistema sanitario gratuito y universal. Métodos. Estudio transversal de 7.447 pacientes con alto riesgo cardiovascular (el 57,5% mujeres; media de edad, 67 años) procedentes del estudio PREDIMED, un ensayo clínico de intervención nutricional para la prevención cardiovascular. El nivel educativo alcanzado se usó como indicador del nivel socioeconómico para evaluar las diferencias en el tratamiento farmacológico contra la hipertensión, la diabetes mellitus y la dislipemia. Resultados. Los participantes que con mayor frecuencia se encontraban en niveles socioeconómicos inferiores eran mujeres, ancianos, pacientes con sobrepeso y sedentarios y aquellos con peor patrón de adherencia a la dieta mediterránea; sin embargo, eran menos fumadores y consumidores habituales de alcohol. Asimismo, este subgrupo mostró mayor proporción de factores de riesgo cardiovascular. El análisis multivariable ajustado en la población general no mostró diferencias en el tratamiento de fármacos preventivos prescritos para los principales factores de riesgo cardiovascular en relación con el nivel socioeconómico (odds ratio [intervalo de confianza del 95%]): participantes hipertensos (0,75 [0,56-1,00] frente a 0,85 [0,65-1,10]); participantes diabéticos: (0,86 [0,61-1,22] frente a 0,90 [0,67-1,22]); participantes con dislipemia: (0,93 [0,75-1,15] frente a 0,99 [0,82-1,19]). Conclusiones. No se observaron diferencias en el tratamiento recibido en prevención cardiovascular primaria por los pacientes de edad avanzada en relación con el nivel socioeconómico. Un sistema de salud universal y gratuito basado en un modelo de atención primaria puede ser eficaz en la reducción de las desigualdades en la salud (AU)


Introduction and objectives. Although it is known that social factors may introduce inequalities in cardiovascular health, data on the role of socioeconomic differences in the prescription of preventive treatment are scarce. We aimed to assess the relationship between the socioeconomic status of an elderly population at high cardiovascular risk and inequalities in receiving primary cardiovascular treatment, within the context of a universal health care system. Methods. Cross-sectional study of 7447 individuals with high cardiovascular risk (57.5% women, mean age 67 years) who participated in the PREDIMED study, a clinical trial of nutritional interventions for cardiovascular prevention. Educational attainment was used as the indicator of socioeconomic status to evaluate differences in pharmacological treatment received for hypertension, diabetes, and dyslipidemia. Results. Participants with the lowest socioeconomic status were more frequently women, older, overweight, sedentary, and less adherent to the Mediterranean dietary pattern. They were, however, less likely to smoke and drink alcohol. This socioeconomic subgroup had a higher proportion of coexisting cardiovascular risk factors. Multivariate analysis of the whole population found no differences between participants with middle and low levels of education in the drug treatment prescribed for 3 major cardiovascular risk factors (odds ratio [95% confidence interval]): hypertension (0.75 [0.56-1.00] vs 0.85 [0.65-1.10]); diabetic participants (0.86 [0.61-1.22] vs 0.90 [0.67-1.22]); and dyslipidemia (0.93 [0.75-1.15] vs 0.99 [0.82-1.19], respectively). Conclusions. In our analysis, socioeconomic differences did not affect the treatment prescribed for primary cardiovascular prevention in elderly patients in Spain. Free, universal health care based on a primary care model can be effective in reducing health inequalities related to socioeconomic status (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Disparidades nos Níveis de Saúde , Classe Social , Fatores Socioeconômicos , Fatores de Risco , Estilo de Vida , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , Análise Socioeconômica , Estudos Transversais/métodos , Estudos Transversais/tendências , Estudos Transversais , Sobrepeso/complicações , Sobrepeso/diagnóstico , Obesidade/complicações , Razão de Chances
10.
BMJ Open ; 3(7)2013 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-23901029

RESUMO

INTRODUCTION: Sexually transmitted infections (STIs) and HIV are a serious global public health issue. These diseases are largely preventable, as they are directly and indirectly associated with potentially modifiable factors, including socioeconomic conditions. Sexual transmission is responsible for over 75% of new HIV infections worldwide. Moreover, commercial sex workers and their clients are two of the groups at the highest risk of acquiring and transmitting these infectious diseases, due to an extensive number of sexual encounters and the various factors related to commercial sex situations. This qualitative study aims to deepen the understanding of the risk perception of STIs and HIV and their associated factors in Nigerian commercial sex workers in the city of Barcelona. METHODS AND ANALYSIS: This is a qualitative, descriptive, interpretive study based on a social constructivist and phenomenological perspective conducted on a saturated sample of Nigerian commercial sex workers in the city of Barcelona. Data will be collected through semistructured individual and triangular group interviews. Information will be examined using a sociological discourse analysis, allowing us to understand the social and individual factors related to the risk perception of STIs and HIV in commercial sex workers. DISCUSSION: Qualitative studies are an important element in identifying individual, social and contextual factors directly or indirectly related to the health/disease process. This qualitative study will provide essential knowledge to improve health promotion, prevention strategies and effective management of STIs both for commercial sex workers and their clients. ETHICS: This study has been approved by the clinical research ethics committee (CEIC) of IDIAP Jordi Gol in Barcelona, 2012.

11.
Rev Esp Cardiol (Engl Ed) ; 66(10): 803-11, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24773861

RESUMO

INTRODUCTION AND OBJECTIVES: Although it is known that social factors may introduce inequalities in cardiovascular health, data on the role of socioeconomic differences in the prescription of preventive treatment are scarce. We aimed to assess the relationship between the socioeconomic status of an elderly population at high cardiovascular risk and inequalities in receiving primary cardiovascular treatment, within the context of a universal health care system. METHODS: Cross-sectional study of 7447 individuals with high cardiovascular risk (57.5% women, mean age 67 years) who participated in the PREDIMED study, a clinical trial of nutritional interventions for cardiovascular prevention. Educational attainment was used as the indicator of socioeconomic status to evaluate differences in pharmacological treatment received for hypertension, diabetes, and dyslipidemia. RESULTS: Participants with the lowest socioeconomic status were more frequently women, older, overweight, sedentary, and less adherent to the Mediterranean dietary pattern. They were, however, less likely to smoke and drink alcohol. This socioeconomic subgroup had a higher proportion of coexisting cardiovascular risk factors. Multivariate analysis of the whole population found no differences between participants with middle and low levels of education in the drug treatment prescribed for 3 major cardiovascular risk factors (odds ratio [95% confidence interval]): hypertension (0.75 [0.56-1.00] vs 0.85 [0.65-1.10]); diabetic participants (0.86 [0.61-1.22] vs 0.90 [0.67-1.22]); and dyslipidemia (0.93 [0.75-1.15] vs 0.99 [0.82-1.19], respectively). CONCLUSIONS: In our analysis, socioeconomic differences did not affect the treatment prescribed for primary cardiovascular prevention in elderly patients in Spain. Free, universal health care based on a primary care model can be effective in reducing health inequalities related to socioeconomic status.


Assuntos
Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Disparidades em Assistência à Saúde/estatística & dados numéricos , Prevenção Primária/métodos , Qualidade da Assistência à Saúde , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Doenças Cardiovasculares/terapia , Intervalos de Confiança , Estudos Transversais , Escolaridade , Feminino , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevenção Primária/tendências , Medição de Risco , Fatores Sexuais , Classe Social , Fatores Socioeconômicos , Espanha , Análise de Sobrevida
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