Estimating Asymptomatic and Symptomatic Transmission of the COVID-19 First Few Cases in Selenge Province, Mongolia.

BACKGROUND: Following the first locally transmitted case in Sukhbaatar soum, Selenge Province, we aimed to investigate the ultimate scale of the epidemic in the scenario of uninterrupted transmission. METHODS: This was a prospective case study following the locally modified WHO FFX cases generic protocol. A rapid response team collected data from November 14 to 29, 2020. We created a stochastic process to draw many transmission chains from this greater distribution to better understand and make inferences regarding the outbreak under investigation. RESULTS: The majority of the cases involved household transmissions (35, 52.2%), work transmissions (20, 29.9%), index (5, 7.5%), same apartment transmissions (2, 3.0%), school transmissions (2, 3.0%), and random contacts between individuals transmissions (1, 1.5%). The posterior means of the basic reproduction number of both the asymptomatic cases R 0 Asy $$ {R}_0^{Asy} $$ and the presymptomatic cases R 0 Pre $$ {R}_0^{Pre} $$ (1.35 [95% CrI 0.88-1.86] and 1.29 [95% CrI 0.67-2.10], respectively) were lower than that of the symptomatic cases (2.00 [95% Crl 1.38-2.76]). CONCLUSION: Our study highlights the heterogeneity of COVID-19 transmission across different symptom statuses and underscores the importance of early identification and isolation of symptomatic cases in disease control. Our approach, which combines detailed contact tracing data with advanced statistical methods, can be applied to other infectious diseases, facilitating a more nuanced understanding of disease transmission dynamics.

Work productivity loss and work-related factors during the first wave of the COVID-19 pandemic: A cross-sectional web-based survey.

BACKGROUND: The COVID-19 pandemic could have led to a technological revolution however it has caused work productivity loss, especially among people working from home. OBJECTIVE: This study examined the frequency and related factors of work productivity loss, focusing on work-related factors, during the first wave of the COVID-19 pandemic in Japan. METHODS: We conducted a cross-sectional, web-based survey of Japanese workers. Questionnaires were distributed using snowball sampling through e-mail and social networking sites. RESULTS: Of the respondents, 708 non-medical workers reported subjective work productivity loss during the first wave of the pandemic, compared with before. A multiple regression analysis showed that living with preschool-age children, having poor mental health, not using video conferencing solutions, and increased e-mail communication were related to work productivity loss. A subgroup analysis of those working from home showed similar variables associated with work productivity loss. CONCLUSIONS: More than 70% of workers in Japan experienced work productivity loss during the first wave of the pandemic. Moreover, factors such as time-consuming tasks or background distractions might lead to operational inefficacy.

Family's socioeconomic and demographic factors on elements of children's dental and oral health: A scoping review.

BACKGROUND: Family plays a significant role in children's dental and oral health (DOH) elements, such as children's DOH knowledge and practice, the development of children's dental fear and anxiety (DFA), children's dental visits, and children's DOH status. The study aims to address the interrelationship of these elements based on individual and familial socioeconomic and demographic (SED) attributes. METHODS: Given the possibility that the COVID-19 epidemic might alter oral health and disrupt dental care, a systematic literature search from the Scopus and Web of Science library database was limited to the 2017-2019 peer-reviewed published literature, which includes quantitative studies that investigated at whether SED status contributed to children's DOH elements. Four sets of keywords are combined in both library database literature searches. Using the PRISMA-ScR Checklist as a reference, we conduct this scoping review. RESULTS: A total of 15 studies were included. Studies were from Brazil, Iran, China, India, Indonesia, Peru, Portugal, and UK. The socioeconomic characteristics include parental education, income, employment, assets and home ownership, type of residence, and health insurance coverage. The demographic characteristics include parent's age, children's age, the number of family members, and family type. There were 13 studies observing parent's education, seven examining family income, four identifying parental employment, three measuring family assets, six assessing the type of residence, and one recording health insurance coverage. Few studies assessed socioeconomic proxies such as school type, free school lunches, and social networks. In addition, race, the number of household members, the number of children, and family type were measured in at least one of the literature. CONCLUSION: Family SED characteristics may define a pathway to children's DOH elements.

Malnutrition and Polypharmacy in Older Adult Patients Receiving Home Care Nursing Services: A Cross-sectional Study.

OBJECTIVE: We studied the nutritional status of older adult adults receiving home nursing care using demographic data, household category, polypharmacy, and potentially inappropriate medications (PIMs). DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Two Norwegian municipalities during 2017-2019; home nursing service clients aged ≥70 years. METHODS: Inclusion of patients and data collection were done by nurses working in the home services. Recorded data were participants' age, sex, living alone or with others, nutritional status (Mini Nutritional Assessment-Short Form and body mass index), regular prescription drugs, and potentially inappropriate medications (PIMs) according to the Norwegian General Practice Nursing home (NORGEP-NH) criteria. Descriptive statistics and logistic regression were used. RESULTS: Of the 270 patients (mean age 84.2 years; 64.8% females; 188 living alone), 25 (9.3%) were malnourished and 154 (57%) at risk of malnutrition; in addition, 14.8% had a BMI <21 and 27.8% had lost weight in the previous 3 months. The odds for being at malnutrition risk was higher if living with others vs living alone: adjusted odds ratio (OR) 2.23 (1.20-4.13). Female sex, older age, and better mobility was associated with living alone. The mean number of regular drugs was 7.3. Overall, 43.3% of the participants used at least 1 PIM. Using 0 to 5 drugs vs ≥6 drugs (polypharmacy) was associated with higher odds for malnutrition risk: adjusted OR 1.97 (1.04-3.75). Compared with well-nourished patients, those at risk for or who were malnourished used fewer cardiovascular and musculoskeletal drugs. Exposure to PIMs was not associated with nutritional status. CONCLUSIONS AND IMPLICATIONS: Two-thirds of home nurse clients were either malnourished or at risk for malnutrition. Living with others or using fewer daily drugs implied increased risk for malnourishment, probably reflecting differences in morbidity and possible inappropriateness of medication use. Future research on nutritional status and medication use should aim for including more clinical data than simple drug counts.

Family characteristics in adolescents with overweight or obesity: a network analysis.

Background: Rates of overweight and obesity continue to grow in adolescents. Overweight and obesity in adolescence are associated with numerous immediate and long-term adverse health conditions. Throughout adolescence, parents and the family have an important and central influence on adolescents' health and lifestyle. The home environment may be a major factor in shaping children's weight. However, our current understanding of the interplay between family-related variables in adolescents with overweight or obesity is limited and fragmented. This study aimed to assess the relationship between family-related variables in adolescents who are overweight or obese using network analysis and inform future health promotion for family-based intervention. Methods: Participants (n = 488) were recruited from middle schools in Nanjing from October 2022 to March 2023. Participants, together with their parents, completed a questionnaire at school about the family food environment, family size, family APGAR index, family physical activity facilities, parental mental health, rearing behavior, parental weight status, drinking history, marital satisfaction, and sociodemographic characteristics. Results: The network split into three distinct communities of items. Network analysis showed that parental mental health and paternal rearing styles-rejection were the most central nodes in the network. In contrast, maternal weight status was the most peripheral and least connected nodes. Conclusion: Family-related variables constituted a connected network in adolescents with overweight or obesity. The pattern of network node connections supports that interventions could prioritize targeting changing parental mental health and paternal rearing styles in adolescents with overweight or obesity.

Meaning of community activity participation for older adults in couple households.

Objective: Currently, 65.3% of older adults in Japan live in couple households. If one partner dies, the other may be unable to reconstruct their lifestyles, have health problems, or become isolated. Participation in community activities helps them maintain physical, mental, and social health. This study aimed to clarify the meaning of participation in community activities among older adults in couple households. Methods: Semi-structured individual interviews were used to collect data. In February 2019, six adults aged 65 and above who had lived with their spouses for at least one year and continuously participated in community activities were interviewed in Miyazaki City, Japan. Data were analyzed using the KJ method (a qualitative method that organizes ideas in a bottom-up fashion developed by Kawakita Jiro), supervised by a professional instructor. Results: The results revealed seven symbols using this method: 1) building a cooperative relationship with a spouse: respect the willingness to work hard for members; 2) consideration for relationships with other organizations: pay attention to every detail; 3) proactive attitude: don't leave everything to others, 4) attitude of questioning one's way of being: myself in connection to others, 5) connection among participants: increased awareness directed toward others, 6) spiritual fulfillment: time, place, and opportunity for outings, 7) physical and mental self-control for continued community activities: growing awareness of health care. Conclusions: For older adults in couple households, it is found that participation in community activities helps them receive support from their spouses and gain a proactive attitude, and the connection between participants contributes to physical and mental control and also improves their health.

Trust and Psychosomatic Complaints in Adolescence: Findings From a Swedish Cohort Study.

Objectives: To examine the cross-sectional and longitudinal associations between generalised and institutional trust and psychosomatic complaints in mid and late adolescence. Methods: Data were derived from the Swedish cohort study Futura01, using survey information collected amongst 3,691 grade 9 students (∼15-16 years, t1) who were followed-up 2 years later (∼17-18 years, t2). Registry information on sociodemographic characteristics was linked to the data. Linear regression analyses were performed. The longitudinal analyses applied the first difference (FD) approach as well as the lagged dependent variable (LDV) approach. Covariates included gender, family type, parental education, parental country of birth, and upper secondary programme. Results: Higher levels of generalised and institutional trust were cross-sectionally associated with lower levels of psychosomatic complaints at both time points. The FD analyses showed that increases in generalised and in institutional trust between ages 15-16 and 17-18 years were associated with corresponding decreases in psychosomatic complaints. The LDV analyses demonstrated reciprocal temporal associations between trust and psychosomatic complaints. Conclusion: The findings indicate that trust is a social determinant of psychosomatic complaints in adolescents, but also that health may affect trust.

Implications of the COVID-19 Pandemic on the Family Structural Dimensions: A Correlational Study.

The COVID-19 pandemic caused changes in the families' social support network, employment status, and family income, which are the focus of attention of family health nurses. This study aims to describe the pandemic's repercussions in the areas of attention of the structural dimension of families according to the Dynamic Model of Family Assessment and Intervention, as perceived by Portuguese families, and to relate the changes in their employment status according to the variables of the structural dimension. A quantitative, descriptive, and correlational study was conducted using snowball sampling. A questionnaire of sociodemographic characterization and assessment of the family structural dimension according to the model's operational matrix was applied to 235 family members. Changes were found in their employment status; family income; intensity and frequency of contact with family, friends, and coworkers; frequency of contact with educational/health/religious institutions and community groups; cultural activities; and housing comfort conditions such as the use of heating/air conditioning, gas, and water consumption. Changes in employment status were related to family income, interaction with friends, frequency of cultural activities, and use of air conditioning and heating. Knowing the implications of the pandemic on the family's structural dimension results in a nursing intervention more focused on family needs.

Unwanted or Mistimed Pregnancy and Developmental Issues in Ecuadorian Children Aged 3 to 5: A Doubly Robust Estimate Using Data from the National Health and Nutrition Survey 2018.

BACKGROUND: Past studies in high-income countries have shown an association between unintended (unwanted or mistimed) pregnancy and child development; no national-level studies in low-and-middle-income countries have been conducted. Moreover, extant studies often adjust for potential mediators, underestimating the average population effect. METHODS: We aimed to estimate the effect of unintended pregnancy on early childhood development in Ecuadorian children aged 3 to 5, participating in the National Health and Nutrition Survey 2018. We used a design-based doubly robust estimate. First, we used propensity score matching (1:1) to identify a subsample equally likely to come from a desired vs. unintended pregnancy based on geographic area, household income, paternal intendedness, the mother's current marital status, age, ethnicity, and educational level, depressive symptoms, and the child's gender and age. Then, we used a logistic regression model to explore the relation of maternal pregnancy intentions with adequate development, as defined by the Early Childhood Development Index (ECDI). While exempt from review by an Institutional Review Board, this secondary research was conducted in accord with prevailing ethical principles. RESULTS: Among 1694 observations representing 162,285 Ecuadorian children, unintended pregnancy associated with inadequate development (odds ratio: 1.56; 95% confidence interval: 1.06; 2.29), after adjusting for all relevant confounders. Unintended pregnancy was also negatively associated with all four ECDI domains, socio-emotional development being the most affected. DISCUSSION: Our doubly robust design found evidence of the relation between the maternal perception of pregnancy and early child development. Addressing this relation to achieve reproductive justice entails considering a wide spectrum of population health and legal interventions to allow adequate access to education, contraception, and safe abortion. Moreover, pre- and post-natal check-ups could screen for unintended pregnancy and provide support accordingly.

What is already known on this subject? Studies from developed countries have shown an association between unintended pregnancy and early child development. Such contexts are not transferable to developing economies and cultures.What this study adds? Using a doubly robust estimate and avoiding known mediators, we provide the first national-level average population effect estimation of unintended pregnancy on child development from low-and-middle-income countries. Ecuadorian children born from unintended pregnancies had a 42% increased risk of having inadequate development, as measured by the Early Childhood Development Index (ECDI), at ages 3 to 5 compared to wanted children. Inadequate development was found in each of the ECDI domains: numeracy and literacy, social-emotional development, physical development, and approaches to learning.

Gini index decomposition by deprivation in multidimensional poverty: evidence from Chad.

OBJECTIVE: This paper aims the decomposition of the multidimensional Gini coefficient by deprivation to investigate how aggregate multidimensional poverty inequality translates into inequality within each of its components. This approach provides a better understanding of the distribution of deprivations held, the standard of living of the population and makes recommendations on government policies. METHOD: We use the method of Lerman and Yitzhaki (1985), which allows us to identify the impact of marginal changes on multidimensional inequality (fuzzy poverty inequality). RESULTS: The data used come from the Household Budget and Consumption Surveys of 2003 of 6695 households, 2011 of 9259 households and 2018 of 7493 households. Empirical findings suggest that the Gini index in 2003 is 0.229, 0.215 in 2011 and 0.180 in 2018. CONCLUSIONS: The different social policies to reduce multi-inequalities must mainly be oriented towards health policies and access to drinking water, which are unequally distributed during the three periods. And social policies to reduce inequality in education, sanitation and housing are also to be taken into account.

My parent, myself, or my child: whose education matters most for trajectories of cognitive aging in middle age?

The growing body of evidence linking intergenerational education and late-life cognitive decline is almost exclusively from high-income countries, despite rapid intergenerational changes in education in low- and middle-income countries (LMICs). We used data from the Mexican Health and Aging Study (n = 8,822), a cohort of Mexican adults aged > 50 years (2001- 2018) to evaluate whether parental (none vs. any formal schooling), own (< primary school vs. primary completion), or adult child (< high school vs. high school completion) education was associated with verbal memory z-scores. We used linear mixed models with inverse probability of attrition weights. Educational attainment in all three generations was associated with baseline verbal memory scores, independent of the prior generation's education. Lower parental (ß= -0.005; 95% CI: -0.009, -0.002) and respondents' education (ß= -0.013; 95% CI: -0.017, -0.010) were associated with faster decline in delayed (not immediate) verbal memory z-scores. Associations between adult child education and respondent's verbal memory decline varied by exposure specification. Educational attainment of parents and adult children may influence the cognitive aging of middle-aged and older adults in LMICs. These results have important implications given recent structural shifts in educational attainment in many LMICs.

Smoking Behavior and Cigarette Expenditure in a Household: Evidence for Smoke-Free Houses Initiation in Indonesia.

Background: The household is considered as a private area that is untouched tobacco control policies in developing countries, especially in Indonesia, which has not ratified the Framework Convention on Tobacco Control (FCTC) treaty. Objectives: This study aims to identify smoking behavior and expenditure on cigarettes in the household, which are part of the initiation of a policy including a smoke-free home, so it assumes that the home is a public domain in Tegal Regency, Central Java Province, Indonesia. Methods: This research is an observational study with a quantitative descriptive design. A total of 225 subjects in the seven regions designated as smoke-free areas were all selected as samples in this study and were willing to be the subject of research. Results: The results found that 76.1% of smokers smoked with their nuclear family (wife/children/husband) present. Smoking behavior with the nuclear family inside the home (39.13%) and outside the home (36.96%) was more common than not smoking with the nuclear family. Expenditure for cigarettes per month was one-third of household revenue (IDR 607,521.74) based on the regency minimum wage (UMR) set by the local government. Conclusions: The study concludes that smokers who smoke with family still lack knowledge on smoking's impact on health and household economics. The smoke-free regulation that is initiated should include households as a parameter.

Using electronic health record data to link families: an illustrative example using intergenerational patterns of obesity.

OBJECTIVE: Electronic health record (EHR) data are a valuable resource for population health research but lack critical information such as relationships between individuals. Emergency contacts in EHRs can be used to link family members, creating a population that is more representative of a community than traditional family cohorts. MATERIALS AND METHODS: We revised a published algorithm: relationship inference from the electronic health record (RIFTEHR). Our version, Pythonic RIFTEHR (P-RIFTEHR), identifies a patient's emergency contacts, matches them to existing patients (when available) using network graphs, checks for conflicts, and infers new relationships. P-RIFTEHR was run on December 15, 2021 in the Northwestern Medicine Electronic Data Warehouse (NMEDW) on approximately 2.95 million individuals and was validated using the existing link between children born at NM hospitals and their mothers. As proof-of-concept, we modeled the association between parent and child obesity using logistic regression. RESULTS: The P-RIFTEHR algorithm matched 1 157 454 individuals in 448 278 families. The median family size was 2, the largest was 32 persons, and 247 families spanned 4 generations or more. Validation of the mother-child pairs resulted in 95.1% sensitivity. Children were 2 times more likely to be obese if a parent is obese (OR: 2.30; 95% CI, 2.23-2.37). CONCLUSION: P-RIFTEHR can identify familiar relationships in a large, diverse population in an integrated health system. Estimates of parent-child inheritability of obesity using family structures identified by the algorithm were consistent with previously published estimates from traditional cohort studies.

Family Background Issues as Predictors of Mental Health Problems for University Students.

Mental health problems are common among university students. Specific type of family background is one of the important factors contributing to these problems. This study aimed to evaluate the proportion of severe mental health problems and the associations between severity and types of problems and family backgrounds. This was a cross-sectional descriptive study. We reviewed the database and medical records of 125 university students aged over 18 years who attended the mental health consultation clinic for university students, 123 Primary Care Unit, Khon Kaen University, between 1 January and 31 December 2018. The characteristics of the participants were summarized using descriptive statistics. We performed an analysis using logistic regression to obtain the crude and adjusted odds ratio. The proportion of severe mental health problems was 50.4%. The most common problem was learning problems (54.4%). The severity of the problems reported by the students was associated with communication failure in the family (AOR = 3.30 [95% CI: 1.14-9.52], p = 0.027). All students who experienced domestic violence in their family had severe mental health problems. This study re-appraised the utility of the context of the family as a predictor of current problems of university students.

Fewer Children in Families Associated with Lower Odds of Early Childhood Caries: A Sample from Three Countries.

Childhood caries experience is influenced by family characteristics and oral health practices in the context of many social-commercial determinants. The aim of this study was to explore the relationship between families' number of children, oral health practices and child caries experience in a convenience sample of 1374 children aged 6 months through 6 years and their families from Ecuador, Nepal, and Vietnam. Data were collected by mother interviews and child dental exams. Multivariate logistic and Zero-Inflated-Poisson regression analyses assessed associations between number of children, oral health practices and decayed, missing or filled teeth (dmft). Families had a mean of 2.2 children (range 1-12); 72% of children had tooth decay, with mean dmft of 5.4. Adjusting for child age, sex, and urban/rural location, a greater number of children in the family was associated with significantly less likelihood of unhealthy bottle feeding practices, having a toothbrush/toothpaste and parent helping child brush, and being cavity-free; higher number of dmft, and greater likelihood of having a dental visit. Early childhood oral health promotion should include focus on oral hygiene and healthy feeding-particularly breastfeeding and healthy bottle feeding practices-as well as access to family planning services and support for childcare.

Caregiving Strain, family functioning, and effort to change diet for patients with gastrointestinal cancer: A cross-sectional descriptive study.

PURPOSE: Among patients with cancer, it has been found that the family system influences health-related behaviors and may promote a healthy diet. This study assessed the associations among cancer patients between family caregiver strain, family functioning, and efforts to change diet. METHODS: This cross-sectional descriptive study was conducted in gastrointestinal outpatient units at two tertiary university hospitals in South Korea. This study included 401 main family caregivers of patients with gastrointestinal cancer. The caregivers were evaluated using structured, face-to-face questionnaires measuring family strain, family functioning, and effort to change diet. RESULTS: Greater effort to change diet was associated with higher family functioning, having a spouse, and more caregiving time per week. Less effort to change diet was associated with greater levels of caregiving strain and with a son providing caregiving. CONCLUSION: The efforts of family caregivers to alter diet are influenced by family strain and family functioning, as well as family caregivers' characteristics, such as marital status, health problems due to caregiving, care time and duration, and relationship with the patient. This study suggested that reducing family strain and improving family functioning in clinical settings facilitate the success to change dietary strategies for cancer families.

Socioeconomic Status and Toothbrushing in Indigenous and Non-Indigenous Australian Children.

INTRODUCTION: Dental caries in children is a multifactorial and complex condition. Toothbrushing helps maintain good oral hygiene and delivers fluoride. However, determinants of toothbrushing could vary based on Indigenous status. OBJECTIVE: This study aimed to assess the association between socioeconomic status and adequate toothbrushing practice (brushing twice or more a day) in Indigenous and non-Indigenous Australian children. METHODS: Data were acquired from the National Child Oral Health Survey (NCOHS) 2012 to 2014. NCOHS administered questionnaires to parents of a representative sample of 24,215 Australian children aged 5 to 14 y recruited using a complex sampling method. Data on the frequency of toothbrushing and socioeconomic status were collected through the questionnaires. Statistical analysis was conducted progressively from bivariate to multivariable regression modeling, stratified by Indigenous status. RESULTS: Just over half of Indigenous children and over two-thirds of non-Indigenous children reported adequate toothbrushing. The prevalence of adequate brushing (twice or more a day) was 42% (95% confidence interval [CI], 1.10-1.84) higher among children with an overseas-born parent than those with Australian-born parents. Among non-Indigenous children, sex and age, parents' country of birth, number of children in the family, and other family socioeconomic indicators (education, income, private health insurance) were associated with adequate toothbrushing. The prevalence of adequate brushing was 1.09 (95% CI, 1.03-1.15) and 1.15 (95% CI, 1.10-1.21) times higher when their parent possessed vocational training and tertiary education, respectively, compared to those children whose parents had school-level education. CONCLUSIONS: There were differences in patterns of socioeconomic disparities for toothbrushing practices between Indigenous and non-Indigenous Australian children. KNOWLEDGE TRANSFER STATEMENT: To promote positive toothbrushing practices in children, dental clinicians and public health professionals must be aware of the determinants of toothbrushing practices. Socioeconomic disparities in toothbrushing frequency were more apparent in non-Indigenous children. These results will help develop population-specific interventions that tackle the determinants to help improve oral hygiene behavior in Indigenous and non-Indigenous children.

Links between early-life contextual factors and later-life cognition and the role of educational attainment.

OBJECTIVE: Educational attainment is a well-documented predictor of later-life cognition, but less is known about upstream contextual factors. This study aimed to identify which early-life contextual factors uniquely predict later-life global cognition and whether educational attainment mediates these relationships. METHOD: Participants were drawn from the Michigan Cognitive Aging Project (N = 485; Mage = 63.51; SDage = 3.13; 50% non-Hispanic Black). Early-life exposures included U.S. region of elementary school (Midwest, South, Northeast), average parental education, household composition (number of adults (1, 2, 3+), number of children), school racial demographics (predominantly White, predominantly Black, diverse), self-reported educational quality, and school type (public/private). Later-life global cognition was operationalized with a factor score derived from a comprehensive neuropsychological battery. Sequential mediation models controlling for sociodemographics estimated total, direct, and indirect effects of early-life contextual factors on cognition through educational attainment (years). RESULTS: Higher educational quality, higher parental education, and attending a private school were each associated with better cognition; attending a predominantly Black or diverse school and reporting three or more adults in the household were associated with lower cognition. After accounting for educational attainment, associations remained for educational quality, school type, and reporting three or more adults in the household. Indirect effects through educational attainment were observed for school region, educational quality, school racial demographics, and parental education. CONCLUSIONS: School factors appear to consistently predict later-life cognition more than household factors, highlighting the potential long-term benefits of school-level interventions for cognitive aging. Future research should consider additional mediators beyond educational attainment such as neighborhood resources and childhood adversity.

Gini index decomposition by deprivation in multidimensional poverty: evidence from Chad / Descomposición del índice de Gini por privación en la pobreza multidimensional: evidencia de Chad

Objective: This paper aims the decomposition of the multidimensional Gini coefficient by deprivation to investigate how aggregate multidimensional poverty inequality translates into inequality within each of its components. This approach provides a better understanding of the distribution of deprivations held, the standard of living of the population and makes recommendations on government policies. Method: We use the method of Lerman and Yitzhaki (1985), which allows us to identify the impact of marginal changes on multidimensional inequality (fuzzy poverty inequality). Results: The data used come from the Household Budget and Consumption Surveys of 2003 of 6695 households, 2011 of 9259 households and 2018 of 7493 households. Empirical findings suggest that the Gini index in 2003 is 0.229, 0.215 in 2011 and 0.180 in 2018. Conclusions: The different social policies to reduce multi-inequalities must mainly be oriented towards health policies and access to drinking water, which are unequally distributed during the three periods. And social policies to reduce inequality in education, sanitation and housing are also to be taken into account. (AU)

Objetivo: Este trabajo busca la descomposición del coeficiente de Gini multidimensional por privación para investigar cómo la desigualdad de pobreza multidimensional agregada se traduce en desigualdad dentro de cada uno de sus componentes. Este enfoque permite comprender mejor la distribución de las privaciones y el nivel de vida de la población, y formular recomendaciones sobre las políticas gubernamentales. Método: Utilizamos el método de Lerman y Yitzhaki (1985), que permite identificar el impacto de los cambios marginales sobre la desigualdad multidimensional (desigualdad difusa de la pobreza). Resultados: Los datos utilizados provienen de las Encuestas de Presupuesto y Consumo de Hogares de 2003 en 6695 hogares, de 2011 en 9259 hogares y de 2018 en 7493 hogares. Los hallazgos empíricos sugieren que el índice de Gini en 2003 es 0,229, en 2011 es 0,215 y en 2018 es 0,180. Conclusiones: Las diferentes políticas sociales para reducir las desigualdades múltiples deben orientarse principalmente hacia las políticas de salud y acceso al agua potable, que se distribuyen de manera desigual durante los tres periodos. También deben tenerse en cuenta las políticas sociales para reducir la desigualdad en la educación, el saneamiento y la vivienda. (AU)

Conhecimento e aplicabilidade da classificação familiar como estratégia de enfrentamento às iniquidades: a experiência do trabalhador da saúde / Knowledge and applicability of family classification as a strategy for coping with inequities: the worker's health experience

Resumo Modelo de estudo: Estudo descritivo qualitativo. Objetivo: analisar o conhecimento e a aplicabilidade da classificação familiar pelos trabalhadores da Estratégia Saúde da Família como estratégia de enfrentamento das iniquidades em saúde. Metodologia: Foram entrevistados 35 trabalhadores e realizada análise temática. Resultados: A maioria (91%) conhecia as Classificações das Famílias, utilizava alguma estratégia de priorização da assistência e 52% as aplicavam na prática. Cinco núcleos de sentido formaram o Grande Tema "A experiência dos profissionais de saúde na utilização da Classificação das Famílias". As principais vantagens foram a identificação de vulnerabilidades favorecendo a priorização do cuidado e do acesso e as dificuldades relacionadas à falta de tempo, desconhecimento e inexperiência em sua utilização. Conclusão: As Classificações das Famílias facilitam a identificação de famílias vulneráveis e favorecem uma atenção mais equânime.

Abstract Study model: Qualitative descriptive study. Objective: to analyze the knowledge and applicability of family classifications by the workers of the Family Health Strategy as a strategy to face health inequities. Methodology: 35 workers were interviewed, and thematic analysis was carried out. Results: The majority (91%) knew the Family Classifications, used some assistance prioritization strategy and 52% applied them in practice. Five centers of meaning formed the Great Theme "The experience of health professionals in the use of the Family Classification". The main advantages were the identification of vulnerabilities favoring the prioritization of care and access and the difficulties were related to lack of time, ignorance, and inexperience in its use. Conclusion: The Family Classifications facilitate the identification of vulnerable families and favoring more equitable attention.