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2.
Soc Sci Med ; 247: 112812, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-32066015

RESUMO

The long-term care insurance (LTCI) has been implemented to help the government take responsibility for social prevention and protection measures to maintain and improve older adults' health and well-being since 2008. This study aimed to evaluate the effects of LTCI on mortality of elders in South Korea. The data used from the national representative Elderly Cohort Database for 2009 to 2013. We analyzed longitudinal panel data from 61,235 persons aged 65 years and older. We generated Kaplan-Meier survival curves and Cox proportional hazard models by use and type of long-term care services (LTCSs) (e.g., non-user, facility, and in-home benefits) and income level. The covariate-adjusted approximate mortality rates by LTCSs type for facility and in-home benefits group compared to non-LTCS users were 0.761 and 0.803, respectively. The approximate mortality rates were higher in the middle low- (Hazard Ratio [HR] = 1.131, p < .001), low- (HR = 1.125, p < .001), and middle- (HR = 1.122, p < .001) than the high income group. In particular, the disparities in mortality by income gap in in-home care users of LTCS was greater than that of facility care users in Korea. Consequently, these findings point to the need for program improvements to the quality and quantity of the in-home LTCSs for elderly Koreans. Ensuring a "continuum of care" through education for service providers and stronger relationships with the recipients' families could improve overall quality. There is a particular need to devote more attention to the needs of low-income elderly who currently lack sufficient the health coverage.

3.
J Epidemiol Community Health ; 74(3): 211-218, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31915239

RESUMO

BACKGROUND: Over the past several decades, governments have enacted far-reaching reforms aimed at reducing the generosity and coverage of welfare benefits. Prior literature suggests that these policy measures may have deleterious effects on the health of populations. In this study, we evaluate the impact of one of the largest welfare reforms in recent history-the 2005 Hartz IV reform in Germany-with a focus on estimating its effect on the health of the unemployed. METHODS: We employed a quasi-experimental difference-in-differences (DID) design using population-based data from the German Socio-Economic Panel Study, covering the period between 1994 and 2016. We applied DID linear probability modelling to examine the association between the Hartz IV reform and poor self-rated health, adjusting for a range of demographic and socioeconomic confounders. RESULTS: The Hartz IV reform was associated with a 3.6 (95% CI 0.9 to 6.2) percentage point increase in the prevalence of poor self-rated health among unemployed persons affected by the reform relative to similar but unaffected controls. This negative association appeared immediately following the implementation of the reform and has persisted over time. CONCLUSION: Governments in numerous European and North American jurisdictions have introduced measures to further diminish the generosity and coverage of welfare benefits. In line with growing concerns over the potential consequences of austerity and associated policy measures, our findings suggest that these reform efforts pose a threat to the health of socioeconomically disadvantaged populations.

4.
Alcohol ; 82: 71-79, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31082505

RESUMO

Risky alcohol consumption among adolescents has health and social consequences. Evidence identifying the school context that determines alcohol consumption among rural and urban adolescents is lacking. This study aimed to describe the contextual school and town factors determining risky alcohol consumption among rural and urban 10th-grade adolescents (15-17 years old) from Catalonia (northeastern Spain). The study had a cross-sectional design. Cluster sampling with the class as the sampling unit was used, and a total of 1268 10th-grade adolescents from Catalonia nested in 26 high schools participated in the study. A computerized and self-administrated questionnaire was used to collect individual variables. Contextual variables were collected from the Catalan police registers, geocoded sources, and governmental internet databases, and by aggregation of answers from the self-administrated questionnaire. The prevalence of risky alcohol consumption was calculated, and a multilevel Poisson regression analysis with robust variance was conducted with data from adolescents nested within high schools. The results show that risky alcohol consumption is higher among rural adolescents (59.3%) than among urban youth (51.1%) (p < 0.005). Positive expectancies, drunkenness of siblings and friends, and most of the variables indicating accessibility are associated with risky alcohol consumption at the individual level. At the contextual level, the sports center rate and the high school's percentage of risky student alcohol consumption are strongly associated with individual risky alcohol consumption. The town environment (rural or urban), the unemployment rate, and the number of pubs and nightclubs lost their significance after adjustment by the individual and mediating variables. In conclusion, individual factors, such as the influence of drinking patterns of siblings and friends, and more alcohol access opportunities, are associated with adolescents' risky alcohol consumption. The associated contextual factors are the sports center rate and the percentage of risky classmate alcohol consumers. Interventions targeting adolescents should focus at community and high school levels, trying to reduce adolescents' accessibility to alcohol.

5.
J Epidemiol Community Health ; 74(1): 3-6, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31615892

RESUMO

BACKGROUND: Disparities in mortality have been firmly established across occupational grades and the incomes they earn, but this line of research has failed to include individuals' relationships to capital, as suggested by class analysists. METHODS: According to Wright's classification, the research generated 10 mutually exclusive classes based on occupation and investment income: worker; capitalist worker; professional; capitalist professional; supervisor; capitalist supervisor; manager; capitalist manager; self-employed; and capitalist self-employed. The study participants (n=268 239) were randomly selected from the Statistics Finland population database and represent 33% of Finnish men aged 30-64 years. The mortality data were monitored over the 1995-2014 period. RESULTS: The sociodemographic-adjusted HRs for mortality were lowest for capitalist managers (HR 0.50; 95% CI 0.36 to 0.69) as compared with that for workers without a capitalist class advantage. A positive occupational class gradient was found from managers to supervisors to workers. The capitalist class advantage independently affected the disparities in mortality within this occupational hierarchy. CONCLUSION: Different occupational class locations protect against premature death differently, and the capitalist class advantage widens the premature-death disparities among the occupational classes. To monitor and explain social inequalities in health in a more nuanced way, future research on investment income as well as the operationalisation of the capitalist class advantage is encouraged.

6.
Artigo em Inglês | MEDLINE | ID: mdl-31817401

RESUMO

Nursing staff who provide care in the nursing homes of Catalonia have more precarious work conditions, including more demanding schedules and work overload, than those in other areas of care. This situation entails two major problems: Detrimental health results for nurses who face psychosocial and physical risks and a negative impact on the care provided to patients, with a decrease in the quality of care. This study aimed to describe the precarious employment situation of nursing staff in nursing homes. We carried out a descriptive study based on the employment precariousness scale (EPRES), which was administered to a sample of 239 nurses and nursing assistants working in public and private nursing homes in Catalonia. The highest level of job insecurity occurred among nursing assistants and in privately managed nursing homes. The precariousness of the working conditions of nursing staff poses a risk both to the workers themselves and to the people they tend to. For this reason, there is a need for greater knowledge on the scale of the problem and the implementation of appropriate legislative measures to alleviate it.

7.
Health Res Policy Syst ; 17(1): 102, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864364

RESUMO

BACKGROUND: Much of the research about Health in All Policies (HiAP) implementation is descriptive, and there have been calls for more evaluative evidence to explain how and why successes and failures have occurred. In this cross-case study of six state- and national-level governments (California, Ecuador, Finland, Norway, Scotland and Thailand), we tested hypotheses about win-win strategies for engaging policy-makers in HiAP implementation drawing on components identified in our previous systems framework. METHODS: We used two sources of data - key informant interviews and peer-reviewed and grey literature. Using a protocol, we created context-mechanism-outcome pattern configurations to articulate mechanisms that explain how win-win strategies work and fail in different contexts. We then applied our evidence for all cases to the systems framework. We assessed the quality of evidence within and across cases in terms of triangulation of sources and strength of evidence. We also strengthened hypothesis testing using replication logic. RESULTS: We found robust evidence for two mechanisms about how and why win-win strategies build partnerships for HiAP implementation - the use of shared language and the value of multiple outcomes. Within our cases, the triangulation was strong, both hypotheses were supported by literal and contrast replications, and there was no support against them. For the third mechanism studied, using the public-health arguments win-win strategy, we only found evidence from Finland. Based on our systems framework, we expected that the most important system components to using win-win strategies are sectoral objectives, and we found empirical support for this prediction. CONCLUSIONS: We conclude that two mechanisms about how and why win-win strategies build partnerships for HiAP implementation - the use of shared language and the value of multiple outcomes - were found as relevant to the six settings. Both of these mechanisms trigger a process of developing synergies and releasing potentialities among different government sectors and these interactions between sectors often work through sectoral objectives. These mechanisms should be considered when designing future HiAP initiatives and their implementation to enhance the emergence of non-health sector policy-makers' engagement.

8.
Am J Bioeth ; 19(2): 39-41, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31543026
9.
Int J Nurs Stud ; 99: 103388, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31493758

RESUMO

BACKGROUND: Nursing professionalization has substantial benefits for patients, health care systems, and the nursing workforce. Currently, however, there is limited understanding of the macro-level factors, such as policies and other country-level determinants, influencing both the professionalization process and the supply of nursing human resources. OBJECTIVES: Given the significance of gender to the development of nursing, a majority-female occupation, the purpose of this analysis was to investigate the relationship between gender regimes and gender equality policies, as macro-level determinants, and nursing professionalization indicators, in this case the regulated nurse and nurse graduate ratios. DESIGN: This cross-sectional, time-series analysis covered 16 years, from 2000 to 2015, and included 22 high-income countries, members of the Organisation for Economic Co-operation and Development. We divided countries into three clusters, using the gender policy model developed by Korpi, as proxy for gender regimes. The countries were grouped as follows: (a) Traditional family - Austria, Belgium, France, Germany, Greece, Italy, Netherlands, Portugal, and Spain; (b) Market-oriented - Australia, Canada, Ireland, Japan, New Zealand, South Korea, Switzerland, United Kingdom, and the United States; and (c) Earner-carer - Denmark, Finland, Norway, and Sweden. METHODS: We used fixed-effects linear regression models and ran Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction to examine the effect of gender equality policies on nursing professionalization indicators. Given the existence of missing observations, we devised and implemented a multiple imputation strategy, with the help of the Amelia II program. We gathered our data from open access secondary sources. RESULTS: Both the regulated nurse and nurse graduate ratios had averages that differed across gender regimes, being the highest in Earner-carer regimes and the lowest in Traditional family ones. In addition, we identified a number of indicators of gender equality policy in education, the labour market, and politics that are predictive of the regulated nurse and nurse graduate ratios. CONCLUSION: This study's findings could add to existing upstream advocacy efforts to strengthen nursing and the nursing workforce through healthy public policy. Given that the study consists of an international comparative analysis of nursing, it should be relevant to both national and global nursing communities.

10.
Am J Ind Med ; 62(11): 1007-1013, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31483067

RESUMO

BACKGROUND: Workers holding intermediate hierarchical positions in an institution may have a higher risk of occupational stress-related, ill health. This study examined the prevalence rates and odds ratios (ORs) of anxiety disorders among a hierarchical group of firefighters. METHODS: This cross-sectional study samples firefighters from Minas Gerais, Brazil, who answered a structured questionnaire in 2011 (survey completion rate = 89.5%). The outcome of interest was a medical diagnosis of anxiety disorder. Bivariate and multivariate analyses were conducted among five hierarchical occupational positions: privates (lowest position), corporals, sergeants (intermediate position), sub lieutenants, and officers (highest position). RESULTS: Overall, 8.4% of the sample reported an anxiety disorder, with the highest rate observed among intermediate workers (sergeants = 14.2%), followed by corporals (10%), privates (5.6%), sub lieutenants (5%), and officers (2.1%). Compared with privates, the unadjusted OR for sergeants was 2.49 (95% confidence interval, 1.35, 4.58). This finding remained statistically significant after adjustment for several control variables but was eliminated by age. CONCLUSION: The mental health of firefighters is affected by social class position. Mental health promotion efforts should focus on longitudinal research and work toward interventions aimed at modifying the hierarchical structure of workplaces.

11.
J Adv Nurs ; 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31396994

RESUMO

AIM: The aim of this study was to examine the relationship between welfare states and nursing professionalization indicators. DESIGN: We used a time-series, cross-sectional design. The analysis covered 16 years and 22 countries: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Netherlands, New Zealand, Norway, Portugal, South Korea, Spain, Sweden, Switzerland, United Kingdom, and the United States, allocated to five welfare state regimes: Social Democratic, Christian Democratic, Liberal, Authoritarian Conservative, and Confucian. METHODS: We used fixed-effects linear regression models and conducted Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction. We applied the Amelia II multiple imputation strategy to replace missing observations. Data were collected from March-December 2017 and subsequently updated from August-September 2018. RESULTS: Our findings highlight positive connections between the regulated nurse and nurse graduate ratios and welfare state measures of education, health, and family policy. In addition, both outcome variables had averages that differed among welfare state regimes, the lowest being in Authoritarian Conservative regimes. CONCLUSION: Additional country-level and international comparative research is needed to further study the impact of a wide range of structural political and economic determinants of nursing professionalization. IMPACT: We examined the effects of welfare state characteristics on nursing professionalization indicators and found support for the claim that such features affect both the regulated nurse and nurse graduate ratios. These findings could be used to strengthen nursing and the nursing workforce through healthy public policies and increase the accuracy of health human resources forecasting tools.

12.
Glob Health Action ; 12(1): 1651017, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31431145

RESUMO

Background: The current approach to global health has significantly contributed to improving it, as evidenced by the progress made toward the Millennium Development Goals (MDGs). However, the health gains achieved are often highly unequitable, and the current approach is expected to be insufficient to meet the future health equity challenges. There is an urgent need to re-think and expand the scope of research and programmatic strategies. Objective: This paper aims to assess the ideological underpinnings of the currently dominant norms in global health, with the goal of highlighting the research and programmatic areas that are marginalized and warrant greater efforts in order to resolve persistent health inequity and achieve the UN Sustainable Development Goals (SDGs). Methods: We have conducted a critical review of the literature that traces the historical origins of global health to the period between the mid-19th century and the end of the 20th century. Results: Critical review of the historical origins of global health reveals a set of dominant norms in global health that are ideological in character, and profoundly shape the current practice. We identified key manifestations of the ideological underpinnings as 1) Democratic deficit, 2) Depoliticization of the discourse, 3) Marginalization of the scholarship that interrogates the relations of power. Conclusion: Examination of the dominant norms that shape the foundation of our knowledge and action in global health is required to solve persistent health inequity challenges and meet the SDGs. Inversion of the key manifestations of the dominant norms can serve as guiding principles to elaborate alternative frameworks that have the theoretical and programmatic potential for a fundamental rather than an incremental change in the practice of global health.


Assuntos
Saúde Global/história , Saúde Global/normas , Equidade em Saúde/organização & administração , Objetivos Organizacionais , História do Século XIX , História do Século XX , História do Século XXI , Humanos
14.
Glob Health Action ; 12(1): 1621007, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31315521

RESUMO

Background: In recent decades, global health scholars and policymakers have highlighted the burgeoning role of South-South cooperation (SSC) in health, claiming it constitutes a more just and even-handed approach to health cooperation. But the assertion that SSC inherently challenges power asymmetries and pursues egalitarian agendas and forms of interaction merits interrogation. Here we explore a transformative, counter-hegemonic, solidarity-oriented form of SSC - social justice-oriented South-South cooperation (SJSSC) - as differentiated from other types of health aid. Objective: The objectives of this scoping review are: 1) to determine what is known and discussed through peer-reviewed and grey literature about SJSSC in health; and 2) to identify the different features and principles of SJSSC. This review seeks to inform research agendas and identify implications for policy and practice around SJSSC. Methods: We conducted a search for relevant peer-reviewed and grey literature in eight languages and screened abstracts that met inclusion criteria. We carried out a full-text review and data extraction on included pieces and conducted a thematic analysis identifying a set of repeated themes related to the features and principles of SJSSC. Results: We identified 188 publications meeting our criteria. Through an iterative process, we developed two overarching categories: values and strategies. Each comprises four themes that allowed us to map the ideas and practices of SJSSC depicted in the literature. The values mapped are: an anti-hegemonic world view; equity-oriented and redistributive political values; egalitarian terms of cooperation; and reciprocity. The strategies encompass: solidarity-building; health justice approaches; mutual exchange and collective justice; and challenging interests of dominant classes in the health arena. Conclusion: This review rectifies ungrounded claims about SSC by identifying and mapping the research literature on SJSSC and has relevance for the conceptualization, policy development, and practice of equitable health cooperation.


Assuntos
Saúde Global , Justiça Social , Comportamento Cooperativo , Equidade em Saúde , Humanos , Relações Interpessoais , Formulação de Políticas , Pesquisa/organização & administração
16.
PLoS One ; 14(5): e0217055, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31095637

RESUMO

The perspectives of social selection and causation have long been debated. Social selection theory is as "social" as social causation theory, since all diseases are social and no biological process occurs outside society. To identify the social selection pathway and historical juncture affected by socioeconomic and political changes, we investigated the reciprocal impact of suffering from tuberculosis (TB) on the current socioeconomic position (SEP), stratified by childhood SEP. We also examined the extent to which the social consequences of ill health changed since the East Asian economic downturn. Data were collected for 2007-2012 from the Korea National Health and Nutritional Examination Survey. To identify associations between TB history and current household income (HHI), we constructed an ordinal logistic regression model adjusted for covariates, including age, gender, educational attainment, and job status. We adopted a recursive regression model to examine trend changes in this association from 1980-2012 to 2003-2012. Of 28,136 participants, 936 had experienced TB. In the first ordinal logistic regression, the TB group was more likely to have lower HHI than the non-TB group. The odds ratios (ORs) increased from 1.30 (1980-2012) to 1.86 (2003-2012) for the TB group, increasing their probability of having low HHI. Among the low childhood SEP group, the TB group's probability of having low HHI was 1.35 (95% confidence interval [CI]: 1.16-1.57) during 1980-2012, which increased to 2.01 (95% CI: 1.37-2.95) during 2003-2012. For the high childhood SEP group, the TB group's OR range fluctuated, similar to that for the non-TB group. The results support the social selection pathway from TB history to adverse impact on current SEP. Our study identified downward social mobility due to TB history among the low childhood SEP group. Moreover, negative social consequences deteriorated since the East Asian economic crisis.


Assuntos
Efeitos Psicossociais da Doença , Classe Social , Tuberculose/economia , Tuberculose/epidemiologia , Adulto , Idoso , Controle de Doenças Transmissíveis , Economia , Escolaridade , Emprego/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , História do Século XX , História do Século XXI , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Probabilidade , Análise de Regressão , República da Coreia/epidemiologia , Fatores Socioeconômicos , Tuberculose/história
18.
Soc Sci Med ; 226: 198-206, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30861433

RESUMO

In the wake of the Great Recession, an expanding body of research has highlighted the role of social protection policies in mitigating the deleterious effects of adverse socioeconomic experiences. In this paper, we examine whether unemployment benefits - a key pillar of national social protection systems - can offset the negative health consequences of unemployment. Using cross-sectional nationally representative data from the Canadian Community Health Survey covering the period between 2009 and 2014, we employed propensity score matching to estimate the effect of receiving unemployment benefits on self-rated health among the unemployed. After matching benefit recipients to comparable non-recipient 'controls', we found that receiving unemployment benefits was associated with better health outcomes. In our main analyses, benefit recipiency reduced the probability of reporting poor self-rated health among the unemployed by up to 4.9% (95% CI -7.3, -2.5). Sensitivity analyses stratified by socioeconomic position revealed stronger treatment effects among lower income and less educated individuals. By contrast, treatment effects were small or negligible among higher income and more educated individuals. Our findings provide evidence that unemployment benefits can play an important role in offsetting the negative health consequences of unemployment among the socioeconomically disadvantaged. These findings lend support to recent calls, including many from within the field of public health, for governments to respond to current labor market trends by expanding the generosity and scope of social protection policies.

19.
Int J Health Serv ; 49(1): 102-107, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30798685

RESUMO

The field of social inequalities in health has been dominated by an individual attributes approach with a small number of indicators, namely occupation, income, and education. We review the weakness of this approach and detail the emergence of sociological alternatives tied to the writings of Bourdieu, Marx, and Weber. A particularly rich theoretical development stems from the integration of Weberian and Marxian approaches, associated with sociologists Melvin Kohn, Carmi Schooler, and Erik Olin Wright.


Assuntos
Disparidades nos Níveis de Saúde , Política , Classe Social , Determinantes Sociais da Saúde , Sociologia Médica , Humanos
20.
Glob Public Health ; 14(6-7): 817-834, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29468938

RESUMO

Latin American social medicine efforts are typically understood as national endeavours, involving health workers, policymakers, academics, social movements, unions, and left-wing political parties, among other domestic actors. But Latin America's social medicine trajectory has also encompassed considerable between-country solidarity, building on early twentieth century interchanges among a range of players who shared approaches for improving living and working conditions and instituting protective social policies. Since the 1960s, Cuba's country-to-country solidarity has stood out, comprising medic exchanges, training, and other forms of support for the health and social struggles of oppressed peoples throughout Latin America and around the world, recently via Misión Barrio Adentro in Venezuela. These efforts strive for social justice-oriented health cooperation based on horizontal power relations, shared political values, a commitment to social and economic redistribution, bona fide equity, and an understanding of the societal determination of health that includes, but goes well beyond, public health and medical care. With Latin America's left-wing surge now receding, this article traces the provenance, dynamics, impact, challenges, and legacy of health solidarity across Latin American borders and its prospects for continuity.


Assuntos
Política de Saúde , Cooperação Internacional , Medicina Social , Cuba , Humanos , América Latina , Política , Saúde Pública , Justiça Social , Venezuela
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