Social and Environmental Determinants of Health Among Family Caregivers of Older Adults.

BACKGROUND: Although the academic literature has focused on family caregivers' health outcomes, little is known about the social and environmental determinants of health and the extent to which they relate to health disparities among family caregivers caring for older adults. OBJECTIVES: The purpose of the study was to describe the prevalence of diseases and the association with social and environmental determinants of health among family caregivers caring for older adults in Finland. METHODS: A cross-sectional analysis was conducted. The study participants were interviewed on sociodemographic factors, comorbidity, and the World Health Organization Quality of Life Questionnaire. Independent-samples t-test, analysis of variance, and chi-square analyses were used to assess the social and environmental factors' association with health outcomes. RESULTS: A total of 126 family caregivers participated in this study. The mean age of study participants was 74.4 years, and most were female, married, and from an urban area. Family caregivers' older age and lower financial satisfaction were the main factors associated with the health inequalities. Older age was associated with age-related eye disorders, hearing impairment, coronary heart disease, and comorbidity. Family caregivers' lower financial satisfaction was associated with diabetes, depression, and higher body mass index. Other factors linked to health disparities were family caregivers' gender, educational attainment, and the municipality of living. DISCUSSION: This study provides evidence about family caregivers' social and environmental determinants of health. To enhance health equity, nurse-led interventions, a life course approach, and intersectional actions are required.

RWJF's future of nursing's campaign for action: A content analysis of social determinants of health activities.

The RWJF-sponsored 2010 report, The Future of Nursing: Leading Change, Advancing Health (FoN), fostered creation of the Campaign for Action (Campaign) as a mechanism to monitor and enact the FoN report's recommendations. Influenced by RWJF's Culture of Health initiative, Campaign efforts refocused to include the social determinants of health (SDOH), with an additional action area entitled "Building Healthier Communities" (BHC). This study describes nursing activities in the BHC action area relative to the six initial FoN core action areas and assesses the extent to which nursing actions in the BHC action area align with public health conceptions of the SDOH. A content analysis was conducted of the RWJF's Campaign issue blog posts on 51 state Action Coalition websites from January 2011 to August 2018. Results demonstrate a decline in blog posts among the six FoN action areas over time compared to an increase in the BHC action area. BHC blog posts of nursing activities included predominantly stories and events, with few interventions. Although the Campaign's definition of the SDOH aligns with definitions from public health, posted actions do not. Re-evaluation of the Campaign' tagging process is needed so system-level conceptualizations can be integrated into the Campaign's next iteration for categorizing SDOH-driven interventions.

Financial health as a measurable social determinant of health.

OBJECTIVES: Financial health, understood as one's ability to manage expenses, prepare for and recover from financial shocks, have minimal debt, and ability to build wealth, underlies all facets of daily living such as securing food and paying for housing, yet there is inconsistency in measurement and definition of this critical concept. Most social determinants research and interventions focus on siloed solutions (housing, food, utilities) rather than on a root solution such as financial health. In light of the paucity of public health research on financial health, particularly among low-income populations, this study seeks to: 1) introduce the construct of financial health into the domain of public health as a useful root term that underlies other individual measures of economic hardship and 2) demonstrate through outcomes on financial, physical and mental health among low-income caregivers of young children that the construct of financial health belongs in the canon of social determinants of health. MATERIALS AND METHODS: In order to extract features of financial health relevant to overall well-being, principal components analysis were used to assess survey data on banking and personal finances among caregivers of young children who participate in public assistance. Then, a series of logistic regressions were utilized to examine the relationship between components of financial health, depression and self-rated health. RESULTS: Components aligned with other measures of financial health in the literature, and there were strong associations between financial health and health outcomes. PRACTICE IMPLICATIONS: Financial health can be conceived of and measured as a key social determinant of health.

Moving Toward Health Equity by Addressing Social Determinants of Health.

Social determinants of health-the conditions in which people are born, grow, work, live, and age that affect health and quality of life-are strongly associated with disparities in health status and life expectancy. Nurses require a comprehensive understanding of social determinants and their associations with health outcomes to provide patient-centered care. Nurses can be leaders and change agents in advancing health equity by screening for social determinants that affect women and by engaging in cross-sector collaboration to build partnerships outside the health care system to address complex social needs. Nurses can also use their experience and knowledge to advocate for system-level change, which is required to address the upstream factors influencing the health of women.

El género como determinante de la salud mental y su medicalización. Informe SESPAS 2020 / Gender as a determinant of mental health and its medicalization. SESPAS Report 2020

La peor salud mental de las mujeres ha sido demostrada tanto en encuestas de salud como en estudios de base clínica. La hipótesis acerca de una mayor vulnerabilidad biológica de las mujeres es inconsistente, lo que haría que las condiciones de vida desiguales entre hombres y mujeres, junto con los modelos imperantes de masculinidad y feminidad hegemónicos, puedan estar explicando estas desigualdades de género en la salud mental. El artículo muestra la existencia de desigualdades de género en la salud mental, la relevancia de la intersección de diferentes ejes de desigualdad y un posible proceso de sobrediagnóstico y medicalización de la salud mental de las mujeres, por el cual los/las profesionales de la salud están etiquetando con más frecuencia como depresión y ansiedad estados de salud mental similares en hombres y mujeres, y prescribiendo con mayor intensidad psicofármacos a las mujeres, a igualdad de necesidad. Esta realidad, además, parece ser desigual en función de la edad y del nivel socioeconómico de los/las pacientes. En los últimos años se están desarrollando diferentes experiencias dirigidas a afrontar la creciente medicalización de la salud mental desde una perspectiva de género. En la medida en que el fenómeno de las desigualdades de género es complejo, resulta necesario actuar y promover cambios en los sectores político-estructural, cultural y asistencial, que reviertan en su conjunto en la reducción de las desigualdades de género en las sociedades y en una atención sanitaria sin sesgos de género

Women's worse mental health has been shown using both health survey and clinical-based data. Considering that the hypothesis about a greater biological vulnerability of women is inconsistent, unequal living conditions between men and women, together with hegemonic models of hegemonic masculinity and femininity emerge as explain factors of these gender inequalities in mental health. The article shows that gender inequalities in mental health, the intersection of different axes of inequality, and the existence of a possible process of medicalization of women's mental health, by which health professionals are labeling women more frequently as depressed and anxious given similar mental health status in men and women. Prescription of psychotropic drugs is also of greater intensity in women, given equal need. This reality, moreover, seems to be unequal depending on the age and socioeconomic level of the patients. In recent years, different experiences are being developed aimed at addressing the growing medicalization of mental health from a gender perspective. Given that the phenomenon of medicalization is complex, it is necessary to act and promote changes at political-structural, cultural and health care levels that ultimately reverse gender inequalities in societies and promote non gender-biased healthcare

Determinantes sociales de la incidencia de la Covid-19 en Barcelona: un estudio ecológico preliminar usando datos públicos / Social determinants of the incidence of Covid-19 in Barcelona: a preliminary ecological study using public data

OBJETIVO: Los determinantes sociales tienen un gran impacto en la salud de las poblaciones. Es relevante estudiar su papel en la gestión de la epidemia de la Covid-19, especialmente en las ciudades, pues ciertas variables como el número de tests realizados o la disponibilidad de recursos sanitarios no se pueden asumir por igual. El objetivo de este trabajo fue estimar la relación de los determinantes sociales en la incidencia de la Covid-19 en Barcelona. MÉTODOS: Se realizó un estudio ecológico, observacional retrospectivo, con el barrio como unidad de población, basado en los datos publicados a fecha de 14 de mayo de 2020 sobre incidencia acumulada de Covid-19 confirmada por PCR. Se estimó la diferencia de incidencia de la Covid-19 en función de la renta de los barrios, la correlación lineal de Pearson de las distintas variables seleccionadas (edad, sexo, densidad neta, inmigrantes, comorbilidades, tabaquismo, Índice de Masa Corporal [IMC] e Índice de Renta Familiar Disponible [IRFD]) con la incidencia acumulada y se llevó a cabo un análisis multivariante mediante un Modelo Lineal Generalizado (GLM). RESULTADOS: Los barrios del quintil de menor renta presentaban un 42% más de incidencia que aquellos del quintil con más renta: 942 casos por cada 100.000 habitantes frente a los 545 casos por cada 100.000 habitantes. La correlación de Pearson se mostró estadísticamente significativa entre la incidencia de la Covid-19 y el porcentaje de población mayor de 75 años (r=0,487), el porcentaje de inmigrantes (r=-0,257) y el origen de dichos inmigrantes, el IRFD (r=-0,462), el porcentaje de fumadores (r=0,243) y de personas con un IMC mayor de 25 (r=0,483). En GLM las variables que más correlación tenían con la incidencia entre barrios eran el porcentaje de población mayor de 75 años (Z-score=0,258), el porcentaje de inmigrantes latinoamericanos (Z-score=0,19) y magrebíes (Z-score=-0,206), y el porcentaje de personas con IMC>25 (Z-score=0,334). Los resultados del GLM fueron estadísticamente significativos. CONCLUSIONES: Los determinantes sociales se correlacionan con una modificación de la incidencia de la Covid-19 en los barrios de Barcelona, con especial relevancia de la prevalencia de IMC>25 y del porcentaje de inmigrantes y de su origen

OBJECTIVE: Social determinants and health inequalities have a huge impact on health of populations. It is important to study their role in the management of the Covid-19 epidemic, especially in cities, as certain variables like the number of tests and the access to health system cannot be assumed as equal. The aim of this work was to determine the relation of social determinants in the incidence of Covid-19 in the city of Barcelona. METHODS: An observational retrospective ecological study was performed, with the neighbourhood as the population unit, based on data of cumulative incidence published at May 14th, 2020 by the Public Health Agency of Barcelona. Covid-19 incidence disparities depending on the income of the neighbourhoods, the Pearson linear correlation of the variables selected (age, sex, net density, immigrants, comorbidities, smokers, Body Mass Index [BMI] and Available Income per Family Index [AIFI]) with the incidence and the correlation with a multivariant Generalized Linear Model (GLM) were estimated. RESULTS: It was found that neighbourhoods belonging to the lowest quintile of income had a 42% more incidence than those belonging to the highest quintile: 942 cases per 100,000 inhabitants versus 545 per 100,000 inhabitants of the highest quintile. The Pearson correlation was statistically significative between the incidence of Covid-19 and the percentage of population over 75 (r=0.487), the percentage of immigration of the neighbourhood and the origin of the immigrants (r=-0.257), the AIFI (r=-0.462), the percentage of smokers (r=0.243) and the percentage of people with BMI over 25 (r=0.483). The GLM showed that the most correlated variables with the incidence are the percentage of people over 75 (Z-score=0.258), the percentage of people from Maghreb (Z-score=-0.206) and Latin America (Z-score=0.19) and the percentage of people with BMI over 25 (Z-score=0.334). The results of the GLM were significative. CONCLUSIONS: Social determinants are correlated with the modification of the incidence of Covid-19 in the neighbourhoods of Barcelona, with special relevance of the prevalence of BMI over 25 and the percentage of immigrants and its origin

Anticoncepción en la población gitana residente en dos barrios con bajo nivel de renta de Barcelona / Contraception in the Roma population living in two low-income neighborhoods of Barcelona (Spain)

Objetivo: Describir el conocimiento y el uso de anticonceptivos y de servicios sanitarios en la población gitana de dos barrios de renta baja de Barcelona (2011-2015). Método: Estudio de metodología mixta en el ámbito comunitario. 1) Estudio cuantitativo descriptivo transversal. Entrevista con cuestionario a una muestra de residentes en edad fértil. Comparación del conocimiento y el uso de anticonceptivos y de servicios según etnia y sexo con modelos ajustados de regresión logística para obtener odds ratios ajustadas (ORa) y sus intervalos de confianza del 95% (IC95%). 2) Estudio cualitativo descriptivo con método etnográfico. Entrevista a 10 residentes de etnia gitana y tres profesionales de salud para explorar aspectos de anticoncepción, familia y roles. Análisis narrativo de discurso de los textos. Resultados: Participaron 834 personas, de las que un 11,8% se autoidentificaron como gitanas. Las mujeres gitanas utilizaban más que las no gitanas la ligadura tubárica (ORa: 3,0; IC95%: 1,3-7) y el implante (ORa: 4,9; IC95%: 3,1-72), y conocían mejor el dispositivo intrauterino (ORa: 2,4; IC95%: 1,4-4,1), la obstrucción tubárica (ORa: 3,3; IC95%: 1,1-9,9) y los inyectables (ORa: 2,4; IC95%: 1,3-4,4). Los hombres gitanos utilizaban más frecuentemente la retirada (ORa: 3,6; IC95%: 1,3-10), práctica corroborada en el estudio cualitativo. Ambas poblaciones utilizaban similarmente la anticoncepción de emergencia y los servicios sanitarios. En la población gitana, la anticoncepción y la reproducción son responsabilidad de las mujeres. Aunque el aborto está culturalmente penalizado en la comunidad gitana, las mujeres gitanas lo utilizan, pero lo afrontan en soledad. Conclusiones: El género emergió como un determinante transversal en los aspectos explorados. En la población gitana el control reproductivo sigue siendo una responsabilidad femenina. Una vez completada la familia, las mujeres gitanas usan anticonceptivos de larga duración. Ambas poblaciones utilizan los servicios sanitarios

Objective: To describe the knowledge and use of contraceptive methods and health services in the Roma population (Kale/Spanish Gitanos) of two low-income neighbourhoods of Barcelona (2011-2015). Method: Mixed. Community setting. 1) Descriptive cross-sectional study. We interviewed with a questionnaire a sample of residents of childbearing age. We compared the knowledge and use of contraception and services by ethnic self-identification and sex with adjusted logistic regression models to obtain adjusted odds ratio (ORa) and 95% confidence interval (95%CI). 2) Qualitative descriptive study with ethnographic method. We interviewed 10 Roma residents and three health professionals to explore aspects of contraception, family and roles. We performed a narrative analysis of discourse from the recorded texts. Results: 834 people participated, with an 11.8% self-identified Roma population. With regard to the non-Roma population, more Roma women used tubal ligation (ORa: 3.0; 95%CI: 1.3-7)] and implant (ORa:4.9; 95%CI: 3.1-72), and had better knowledge of IUD (ORa: 2,4; 95%CI: 1,4-4,1), tubal obstruction (ORa: 3,3; 95%CI: 1,1-9,9) and injectables (ORa: 2,4; 95%CI: 1.3-4.4). Roma men used withdrawal more frequently (ORa: 3.6; 95%CI: 1.3-10), a practice confirmed in the qualitative study. Both communities used emergency contraception and health services. In the Roma population, contraception and reproduction are in the hands of women. As abortion is culturally penalized in the Roma population, women use it, but they face it alone. Conclusions: Gender emerged as a cross-cutting determinant in all issues explored. In the Roma population reproductive control and contraception remain the responsibility of women. Once the family is complete, Roma women use long-term contraception. Both populations use health services

Higher experience of caries and lower income trajectory influence the quality of restorations: A multilevel analysis in a birth cohort.

OBJECTIVES: This study aimed to evaluate the quality of posterior restorations (amalgam or composite) placed in adults from a birth cohort and its association with clinical and socioeconomic determinants experienced during their life course. METHODS: A representative sample (n=539) of all 5914 births occurring in Pelotas (Brazil) in 1982 was prospectively investigated. Quality of posterior restorations (satisfactory or unsatisfactory) was assessed at 31 yrs-old, using modified USPHS criteria. Trained and calibrated dentists performed clinical examination. Explanatory variables included demographic and socioeconomic, oral health and dental service utilization patterns during the life course. Tooth related variables (type of tooth, material, size of cavity) were also analyzed. Untreated caries and socioeconomic status were assessed by group-based trajectories analyses. Multilevel Regression models were used to determine factors associated with restoration outcomes. RESULTS: In total 2123 restorations (53% composite) were evaluated of which 107 (5%) were assessed as failed. The main reasons for failure were tooth/restoration fracture (50.5%) and secondary caries (30.7%). Failures in posterior restorations showed a significant association with socioeconomic aspects (lower tertile of income at age 30 - prevalence ratio (PR) 2.21 [95% CI 1.19-4.09]), clinical variables (trajectory of higher untreated caries - PR 2.11 [95% CI 1.23-3.61]) and also with tooth-related factors (Restorations involving three or more surfaces - PR 5.51 [95% CI 3.30-9.19]) after adjustment for each other. CONCLUSIONS: These findings suggest that, although tooth-related variables have an important role in restoration longevity, patient-related factors, such as socioeconomic variables and untreated caries are also associated with failure and should be taken into account when evaluating longevity of posterior restorations. CLINICAL SIGNIFICANCE: This was the first study assessing long-term trajectory of untreated caries, showing an association between higher experience of caries during the life-course and unsatisfactory restorations. The findings suggest that individual related factors should be considered when planning treatment and in future research evaluating the longevity of dental restorations.

Implementación del mapa de la vulnerabilidad en salud en la Comunidad de Madrid / Health vulnerability mapping in the Community of Madrid (Spain)

Desde el modelo de los determinantes sociales de la salud y el enfoque de equidad, la Dirección General de Salud Pública de Madrid ha desarrollado la metodología de los mapas de la vulnerabilidad en salud para facilitar a los equipos sociosanitarios la planificación, la priorización y la intervención en salud en un territorio. A partir de la selección de las zonas básicas de salud con peores indicadores de vulnerabilidad en salud, se inicia un proceso de relación con los actores clave del territorio a fin de identificar conjuntamente áreas prioritarias de intervención y desarrollar un plan de acción consensuado. Se presentan el desarrollo de esta experiencia y su conexión con los modelos teóricos del mapeo en activos, los sistemas de georreferenciación integrados en salud y las intervenciones de salud comunitaria (AU)

The Public Health General Directorate of Madrid has developed a health vulnerability mapping methodology to assist regional social health teams in health planning, prioritisation and intervention based on a model of social determinants of health and an equity approach. This process began with the selection of areas with the worst social indicators in health vulnerability. Then, key stakeholders of the region jointly identified priority areas of intervention and developed a consensual plan of action. We present the outcomes of this experience and its connection with theoretical models of asset-based community development, health-integrated georeferencing systems and community health interventions (AU)

Determinantes sociales y mortalidad por cáncer en Comunas de la Ciudad de Buenos Aires: Quinquenio 2011-2015 / Social determinants and cancer mortality in Communes of the City of Buenos Aires: 2011-2015 Period

En la actualidad, las enfermedades crónicas no transmisibles (ECNT) constituyen la principal causa de mortalidad mundial. Las enfermedades crónicas se caracterizan por su larga duración, progresividad y curación no previsible, pudiendo requerir tratamiento y control durante una extensa e indeterminada cantidad de años. El cáncer forma parte del grupo de las enfermedades crónicas no transmisibles (ECNT), junto con las enfermedades cardiovasculares, respiratorias crónicas y diabetes. Estas enfermedades, se encuentran entre los problemas más comunes y más costosos para la salud pública de la población. En Argentina y en la Ciudad Autónoma de Buenos Aires, el cáncer constituye la segunda causa de muerte, después de las enfermedades del sistema circulatorio. Existe amplia evidencia de la relación existente entre las condiciones en que la gente nace, vive, se educa, trabaja y envejece con la situación de salud de las poblaciones.Estas condiciones se relacionan con aspectos sociales, económicos, políticos, culturales y medioambientales, llamados en conjunto "Determinantes sociales de la Salud".Adoptando como base conceptual este modelo de Determinantes Sociales de la Salud, se realizó el presente estudio, con el propósito de describir la forma en que se distribuye la mortalidad por cáncer entre las comunas de la Ciudad de Buenos Aires y conocer las potenciales disparidades entre dichas jurisdicciones, según las características socioeconómicas de las mismas. (AU) .

Enrich classifications in psychiatry with textual data: an ontology for psychiatry including social concepts.

We propose a modular approach to develop an ontology of psychiatry, ONTOPSYCHIA, based on Patient Discharges Summaries (PDS) and divided into three modules (i.e. social, mental disorders and treatments). We decided to take into account the social aspects of the patient life described in PDS to consider information such as family history, social environment or education.

A randomized trial on screening for social determinants of health: the iScreen study.

BACKGROUND: There is growing interest in clinical screening for pediatric social determinants of health, but little evidence on formats that maximize disclosure rates on a wide range of potentially sensitive topics. We designed a study to examine disclosure rates and hypothesized that there would be no difference in disclosure rates on face-to-face versus electronic screening formats for items other than highly sensitive items. METHODS: We conducted a randomized trial of electronic versus face-to-face social screening formats in a pediatric emergency department. Consenting English-speaking and Spanish-speaking adult caregivers familiar with the presenting child's household were randomized to social screening via tablet computer (with option for audio assist) versus a face-to-face interview conducted by a fully bilingual/bicultural researcher. RESULTS: Almost all caregivers (96.8%) reported at least 1 social need, but rates of reporting on the more sensitive issues (household violence and substance abuse) were significantly higher in electronic format, and disclosure was marginally higher in electronic format for financial insecurity and neighborhood and school safety. There was a significant difference in the proportion of social needs items with higher endorsement in the computer-based group (70%) than the face-to-face group (30%). CONCLUSIONS: Pediatric clinical sites interested in incorporating caregiver-reported socioeconomic, environmental, and behavioral needs screening should consider electronic screening when feasible, particularly when assessing sensitive topics such as child safety and household member substance use.

Do socioeconomic determinants affect the quality of posterior dental restorations? A multilevel approach.

OBJECTIVES: This study aimed to evaluate posterior restorations placed in young adults, investigating the association between social determinants experienced during the life course and the quality of tooth fillings. METHODS: A representative sample (n=720) of all 5914 individuals who were born in Pelotas in 1982 was prospectively investigated, and posterior restorations were assessed at 24 years of age. Exploratory variables included demographic and socioeconomic, oral health and dental service payment mode during the life course. Tooth-related variables (type of tooth, material and size of cavity) were also analysed. RESULTS: Multilevel logistic regression models showed that individuals who were always poor from birth to age 23 [odds ratio (OR) 2.35 (1.38-4.00)] and whose mothers had less years of education at their birth (OR 2.60 (1.44-4.68)) were with unsatisfactory restorations in posterior teeth more often. In addition, caries presence at age 15 (high decayed, missing, filled teeth (DMFT) tertile) (OR 1.95 (1.25-3.03)) and cavities with four or more surfaces (OR 18.67 (9.25-37.68)) were associated with the outcome. CONCLUSIONS: These results show that socioeconomic characteristics of the individuals play an important role in restoration failures, reinforcing the need for preventive dental strategies and public policies to reduce inequalities as a major topic of oral health. In addition, the size of cavity appears as the most important determinant for restoration failure. CLINICAL SIGNIFICANCE: Individual socioeconomic characteristics were associated with failure in posterior restorations in detriment of other clinical variables such as restorative material and type of tooth.