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1.
BMC Health Serv Res ; 21(1): 643, 2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217287

RESUMO

BACKGROUND: Worldwide, socioeconomic differences in health and use of healthcare resources have been reported, even in countries providing universal healthcare coverage. However, it is unclear how large these socioeconomic differences are for different types of care and to what extent health status plays a role. Therefore, our aim was to examine to what extent healthcare expenditure and utilization differ according to educational level and income, and whether these differences can be explained by health inequalities. METHODS: Data from 18,936 participants aged 25-79 years of the Dutch Health Interview Survey were linked at the individual level to nationwide claims data that included healthcare expenditure covered in 2017. For healthcare utilization, participants reported use of different types of healthcare in the past 12 months. The association of education/income with healthcare expenditure/utilization was studied separately for different types of healthcare such as GP and hospital care. Subsequently, analyses were adjusted for general health, physical limitations, and mental health. RESULTS: For most types of healthcare, participants with lower educational and income levels had higher healthcare expenditure and used more healthcare compared to participants with the highest educational and income levels. Total healthcare expenditure was approximately between 50 and 150 % higher (depending on age group) among people in the lowest educational and income levels. These differences generally disappeared or decreased after including health covariates in the analyses. After adjustment for health, socioeconomic differences in total healthcare expenditure were reduced by 74-91 %. CONCLUSIONS: In this study among Dutch adults, lower socioeconomic status was associated with increased healthcare expenditure and utilization. These socioeconomic differences largely disappeared after taking into account health status, which implies that, within the universal Dutch healthcare system, resources are being spent where they are most needed. Improving health among lower socioeconomic groups may contribute to decreasing health inequalities and healthcare spending.


Assuntos
Gastos em Saúde , Renda , Adulto , Atenção à Saúde , Disparidades em Assistência à Saúde , Humanos , Países Baixos , Classe Social , Fatores Socioeconômicos
3.
JAMA Netw Open ; 4(7): e2117060, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34259847

RESUMO

Importance: Socioeconomic factors in the disparities in COVID-19 outcomes have been reported in studies from the US and other Western countries. However, no studies have documented national- or subnational-level outcome disparities in Asian countries. Objective: To assess the association between regional COVID-19 outcome disparities and socioeconomic characteristics in Japan. Design, Setting, and Participants: This cross-sectional study collected and analyzed confirmed COVID-19 cases and deaths (through February 13, 2021) as well as population and socioeconomic data in all 47 prefectures in Japan. The data sources were government surveys for which prefecture-level data were available. Exposures: Prefectural socioeconomic characteristics included mean annual household income, Gini coefficient, proportion of the population receiving public assistance, educational attainment, unemployment rate, employment in industries with frequent close contacts with the public, household crowding, smoking rate, and obesity rate. Main Outcomes and Measures: Rate ratios (RRs) of COVID-19 incidence and mortality by prefecture-level socioeconomic characteristics. Results: All 47 prefectures in Japan (with a total population of 126.2 million) were included in this analysis. A total of 412 126 confirmed COVID-19 cases (326.7 per 100 000 people) and 6910 deaths (5.5 per 100 000 people) were reported as of February 13, 2021. Elevated adjusted incidence and mortality RRs of COVID-19 were observed in prefectures with the lowest household income (incidence RR: 1.45 [95% CI, 1.43-1.48] and mortality RR: 1.81 [95% CI, 1.59-2.07]); highest proportion of the population receiving public assistance (1.55 [95% CI, 1.52-1.58] and 1.51 [95% CI, 1.35-1.69]); highest unemployment rate (1.56 [95% CI, 1.53-1.59] and 1.85 [95% CI, 1.65-2.09]); highest percentage of workers in retail industry (1.36 [95% CI, 1.34-1.38] and 1.45 [95% CI, 1.31-1.61]), transportation and postal industries (1.61 [95% CI, 1.57-1.64] and 2.55 [95% CI, 2.21-2.94]), and restaurant industry (2.61 [95% CI, 2.54-2.68] and 4.17 [95% CI, 3.48-5.03]); most household crowding (1.35 [95% CI, 1.31-1.38] and 1.04 [95% CI, 0.87-1.24]); highest smoking rate (1.63 [95% CI, 1.60-1.66] and 1.54 [95% CI, 1.33-1.78]); and highest obesity rate (0.93 [95% CI, 0.91-0.95] and 1.17 [95% CI, 1.01-1.34]) compared with prefectures with the most social advantages. Among potential mediating variables, higher smoking rate (RR, 1.54; 95% CI, 1.33-1.78) and obesity rate (RR, 1.17; 95% CI, 1.01-1.34) were associated with higher mortality RRs, even after adjusting for prefecture-level covariates and other socioeconomic variables. Conclusions and Relevance: This cross-sectional study found a pattern of socioeconomic disparities in COVID-19 outcomes in Japan that was similar to that observed in the US and Europe. National policy in Japan could consider prioritizing populations in socially disadvantaged regions in the COVID-19 response, such as vaccination planning, to address this pattern.


Assuntos
COVID-19 , Disparidades nos Níveis de Saúde , Classe Social , Adulto , Idoso , COVID-19/epidemiologia , Estudos Transversais , Aglomeração , Escolaridade , Emprego , Características da Família , Feminino , Humanos , Renda , Japão , Masculino , Pessoa de Meia-Idade , Obesidade , Ocupações , Pandemias , Assistência Pública , SARS-CoV-2 , Fumar , Fatores Socioeconômicos , Adulto Jovem
5.
Transl Psychiatry ; 11(1): 360, 2021 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-34226496

RESUMO

Weight gain and metabolic complications are major adverse effects of many psychotropic drugs. We aimed to understand how socio-economic status (SES), defined as the Swiss socio-economic position (SSEP), is associated with cardiometabolic parameters after initiation of psychotropic medications known to induce weight gain. Cardiometabolic parameters were collected in two Swiss cohorts following the prescription of psychotropic medications. The SSEP integrated neighborhood-based income, education, occupation, and housing condition. The results were then validated in an independent replication sample (UKBiobank), using educational attainment (EA) as a proxy for SES. Adult patients with a low SSEP had a higher risk of developing metabolic syndrome over one year versus patients with a high SSEP (Hazard ratio (95% CI) = 3.1 (1.5-6.5), n = 366). During the first 6 months of follow-up, a significant negative association between SSEP and body mass index (BMI), weight change, and waist circumference change was observed (25 ≤ age < 65, n = 526), which was particularly important in adults receiving medications with the highest risk of weight gain, with a BMI difference of 0.86 kg/m2 between patients with low versus high SSEP (95% CI: 0.03-1.70, n = 99). Eventually, a causal effect of EA on BMI was revealed using Mendelian randomization in the UKBiobank, which was notably strong in high-risk medication users (beta: -0.47 SD EA per 1 SD BMI; 95% CI: -0.46 to -0.27, n = 11,314). An additional aspect of personalized medicine was highlighted, suggesting the patients' SES represents a significant risk factor. Particular attention should be paid to patients with low SES when initiating high cardiometabolic risk psychotropic medications.


Assuntos
Doenças Cardiovasculares , Ganho de Peso , Adulto , Índice de Massa Corporal , Estudos de Coortes , Humanos , Estudos Prospectivos , Psicotrópicos/efeitos adversos , Classe Social
6.
Artigo em Inglês | MEDLINE | ID: mdl-34204130

RESUMO

Although the relationship between environment and public depression has aroused heated debate, the empirical research on the relationship between environmental quality perception and public depression is still relatively insufficient. This paper aims to explore the influence of environmental quality perception on public depression and the mediating role of subjective social class between environmental quality perception and public depression. Using the China Family Panel Studies data of 2016 for empirical analysis, this study's results show that environmental quality perception has a significant effect on public depression and subjective social class also has a significant effect on public depression. In addition, we found that subjective social class can play a partial mediating role between environmental quality perception and public depression, and the intermediary effect only comes from the contribution of the perception of living environmental quality, not the perception of overall environmental quality. That is to say, the perception of living environment quality deeply affects the subjective social class, and then induces public depression. In order to alleviate the relationship between environmental quality and public depression, it is recommended that the state environmental protection department and civil affairs department strengthen the improvement of public living environment so as to promote individual subjective social class and reduce the risk of public depression. Moreover, it is suggested that research with longitudinal design and comprehensive indicators be undertaken in the future.


Assuntos
Depressão , Qualidade de Vida , China , Depressão/epidemiologia , Percepção , Classe Social
7.
Front Public Health ; 9: 645376, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34268284

RESUMO

Introduction: Before the pandemic, mid-life women in Australia were among the "heaviest" female alcohol consumers, giving rise to myriad preventable health risks. This paper uses an innovative model of social class within a sample of Australian women to describe changes in affective states and alcohol consumption patterns across two time points during COVID-19. Methods: Survey data were collected from Australian mid-life women (45-64 years) at two time points during COVID-19-May 2020 (N = 1,218) and July 2020 (N = 799). We used a multi-dimensional model for measuring social class across three domains-economic capital (income, property and assets), social capital (social contacts and occupational prestige of those known socially), and cultural capital (level of participation in various cultural activities). Latent class analysis allowed comparisons across social classes to changes in affective states and alcohol consumption patterns reported at the two time points using alcohol consumption patterns as measured by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and its component items. Results: Seven social classes were constructed, characterized by variations in access to capital. Affective states during COVID-19 differed according to social class. Comparing between the survey time points, feeling fearful/anxious was higher in those with high economic and cultural capital and moderate social capital ("emerging affluent"). Increased depression was most prominent in the class characterized by the highest volumes of all forms of capital ("established affluent"). The social class characterized by the least capital ("working class") reported increased prevalence of uncertainty, but less so for feeling fearful or anxious, or depressed. Women's alcohol consumption patterns changed across time during the pandemic. The "new middle" class-a group characterized by high social capital (but contacts with low prestige) and minimal economic capital-had increased AUDIT-C scores. Conclusion: Our data shows the pandemic impacted women's negative affective states, but not in uniform ways according to class. It may explain increases in alcohol consumption among women in the emerging affluent group who experienced increased feelings or fear and anxiety during the pandemic. This nuanced understanding of the vulnerabilities of sub-groups of women, in respect to negative affect and alcohol consumption can inform future pandemic policy responses designed to improve mental health and reduce the problematic use of alcohol. Designing pandemic responses segmented for specific audiences is also aided by our multi-dimensional analysis of social class, which uncovers intricate differences in affective states amongst sub-groups of mid-life women.


Assuntos
Alcoolismo , COVID-19 , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Austrália/epidemiologia , Feminino , Humanos , SARS-CoV-2 , Classe Social
8.
Nat Commun ; 12(1): 4266, 2021 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253718

RESUMO

Does higher socioeconomic status predict decreased prosocial behavior? Methodological issues such as the reliance of survey studies on self-reported measures of prosociality, the insufficient control of relative incentives in experiments, and the use of non-random samples, have prevented researchers from ruling out that there is a negative association between socioeconomic status (SES) and prosociality. Here, we present results from a field experiment on the willingness of unaware individuals of different SES to undertake an effortful prosocial task-returning a misdelivered letter. Specifically, using the rental or sale value of homes as indicators of SES, we randomly selected households of high and low SES and misdelivered envelopes to them. Despite controlling for numerous covariates and performing a series of ancillary tests, we fail to find any evidence that higher SES predicts decreased prosocial behavior. Instead, we find that misdelivered letters are substantially more likely to be returned from high rather than low SES households.


Assuntos
Comportamento Social , Classe Social , Características da Família , Humanos
9.
Nat Commun ; 12(1): 4248, 2021 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253719

RESUMO

India has the world's highest number of undernourished children and the largest school feeding program, the Mid-Day Meal (MDM) scheme. As school feeding programs target children outside the highest-return "first 1000-days" window, they have not been included in the global agenda to address stunting. School meals benefit education and nutrition in participants, but no studies have examined whether benefits carry over to their children. Using nationally representative data on mothers and their children spanning 1993 to 2016, we assess whether MDM supports intergenerational improvements in child linear growth. Here we report that height-for-age z-score (HAZ) among children born to mothers with full MDM exposure was greater (+0.40 SD) than that in children born to non-exposed mothers. Associations were stronger in low socioeconomic strata and likely work through women's education, fertility, and health service utilization. MDM was associated with 13-32% of the HAZ improvement in India from 2006 to 2016.


Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Comportamento Alimentar , Programas Governamentais , Estado Nutricional , Instituições Acadêmicas , Viés , Criança , Estudos de Coortes , Características da Família , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , Índia/epidemiologia , Análise de Séries Temporais Interrompida , Masculino , Motivação , Prevalência , Análise de Regressão , Religião , Classe Social
10.
Chin Med J (Engl) ; 134(13): 1552-1560, 2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34250960

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common public health problem worldwide. Recent studies have reported that socioeconomic status (SES) is related to the incidence of COPD. This study aimed to investigate the association between SES and COPD among adults in Jiangsu province, China, and to determine the possible direct and indirect effects of SES on the morbidity of COPD. METHODS: A cross-sectional study was conducted among adults aged 40 years and above between May and December of 2015 in Jiangsu province, China. Participants were selected using a multistage sampling approach. COPD, the outcome variable, was diagnosed by physicians based on spirometry, respiratory symptoms, and risk factors. Education, occupation, and monthly family average income (FAI) were used to separately indicate SES as the explanatory variable. Mixed-effects logistic regression models were introduced to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for examining the SES-COPD relationship. A pathway analysis was conducted to further explore the pulmonary function impairment of patients with different SES. RESULTS: The mean age of the 2421 participants was 56.63 ±â€Š9.62 years. The prevalence of COPD was 11.8% (95% CI: 10.5%-13.1%) among the overall sample population. After adjustment for age, gender, residence, outdoor and indoor air pollution, body weight status, cigarette smoking, and potential study area-level clustering effects, educational attainment was negatively associated with COPD prevalence in men; white collars were at lower risk (OR: 0.60, 95% CI: 0.43-0.83) of experiencing COPD than blue collars; compared with those within the lower FAI subgroup, participants in the upper (OR: 0.68, 95% CI: 0.49-0.97) tertiles were less likely to experience COPD. Such negative associations between all these three SES indicators and COPD were significant among men only. Education, FAI, and occupation had direct or indirect effects on pulmonary function including post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC), FEV1, FVC, and FEV1 percentage of predicted. Education, FAI, and occupation had indirect effects on pulmonary function indices of all participants mainly through smoking status, indoor air pollution, and outdoor air pollution. We also found that occupation could affect post-bronchodilator FEV1/FVC through body mass index. CONCLUSIONS: Education, occupation, and FAI had an adverse relationship with COPD prevalence in Jiangsu province, China. SES has both direct and indirect associations with pulmonary function impairment. SES is of great significance for COPD morbidity. It is important that population-based COPD prevention strategies should be tailored for people with different SES.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fatores de Risco , Classe Social , Espirometria , Capacidade Vital
11.
Int J Equity Health ; 20(1): 154, 2021 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215274

RESUMO

BACKGROUND: Israel's containment of the first wave of Covid-19 was relatively successful. Soon afterwards, however, in the summer months, a harsher pandemic wave developed, resulting in many more seriously ill and dead Israelis. Israel was the world's first country to impose a second general lockdown. The present study outlines the early months of Israel's second pandemic wave, until the imposition of the second general lockdown, and their impact on various communities. The investigation is conducted in conjunction with five sociodemographic variables: population density, socioeconomic status, rate of elderly population, minority status (Jewish / Arab identity) and religiosity (Ultra-Orthodox vs. other Jewish communities). METHODS: The analysis is based on a cross sectional study of morbidity rates, investigated on a residential community basis. Following the descriptive statistics, we move on to present a multivariate analysis to explore associations between the five aforementioned sociodemographic variables and Covid-19 morbidity in Israel in the early second pandemic wave vs. the first Covid-19 outbreak. RESULTS: Both the descriptive statistics and regressions show morbidity rates to be significantly and positively associated with communities' population density and significantly and negatively associated with socioeconomic status (SES) and the size of elderly population. These results differ from Wave I morbidity, which was not significantly associated with SES. Another difference vis-a-vis Wave I is the rise of morbidity in Arab communities that led to the disappearance of the previously observed significant negative association of morbidity with minority (Arab) status. Exceptional morbidity was found in Ultra-Orthodox Jewish communities. CONCLUSION: The second wave of Covid-19 in Israel has profoundly affected marginalized communities characterized by high residential density, low SES and minority status. Other marginalized and disempowered communities have also been badly hit. While acknowledging the potential contribution of various possible causes, we highlight the policy response of Israel's government during the early weeks of the second Covid-19 outbreak, suggesting that the severe second wave might possibly be associated with belated, undecided government response during this period.


Assuntos
COVID-19/epidemiologia , Disparidades nos Níveis de Saúde , Pandemias , Idoso , Idoso de 80 Anos ou mais , Árabes/estatística & dados numéricos , COVID-19/prevenção & controle , Estudos Transversais , Feminino , Humanos , Israel/epidemiologia , Judeus/estatística & dados numéricos , Masculino , Grupos Minoritários/estatística & dados numéricos , Morbidade/tendências , Densidade Demográfica , Religião , Classe Social
12.
Anticancer Res ; 41(7): 3607-3613, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34230157

RESUMO

BACKGROUND/AIM: We evaluated timeliness of care at a safety-net hospital after implementation of a multidisciplinary breast program. PATIENTS AND METHODS: A prospective database of patients with breast cancer was created after multidisciplinary breast program initiation in 2018. Patients were tracked to obtain time to completion of diagnostic imaging, biopsy, and treatment initiation. Patients with breast cancer diagnosed from 2015-2017 were reviewed for comparison. RESULTS: A total of 102 patients were identified. There was no statistical difference in time to completion of imaging, biopsy, and initial treatment between the 2018 and the 2015-2017 cohorts (p>0.05). No statistical difference was observed in time to completion of imaging, biopsy, and initial treatment between different races (p>0.05). CONCLUSION: Within the same socioeconomic status, there was no differential delivery of screening, work-up, and treatment by race. Despite protocol implementations, efficiency of care remained limited in a safety-net hospital with lack of financial resources.


Assuntos
Neoplasias da Mama/diagnóstico , Idoso , Biópsia , Mama/patologia , Neoplasias da Mama/patologia , Gerenciamento de Dados/métodos , Feminino , Equidade em Saúde , Humanos , Programas de Rastreamento/métodos , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Classe Social
13.
PLoS One ; 16(7): e0254580, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34270604

RESUMO

Patients hospitalized with COVID-19 infection are at a high general risk for in-hospital mortality. A simple and easy-to-use model for predicting mortality based on data readily available to clinicians in the first 24 hours of hospital admission might be useful in directing scarce medical and personnel resources toward those patients at greater risk of dying. With this goal in mind, we evaluated factors predictive of in-hospital mortality in a random sample of 100 patients (derivation cohort) hospitalized for COVID-19 at our institution in April and May, 2020 and created potential models to test in a second random sample of 148 patients (validation cohort) hospitalized for the same disease over the same time period in the same institution. Two models (Model A: two variables, presence of pneumonia and ischemia); (Model B: three variables, age > 65 years, supplemental oxygen ≥ 4 L/min, and C-reactive protein (CRP) > 10 mg/L) were selected and tested in the validation cohort. Model B appeared the better of the two, with an AUC in receiver operating characteristic curve analysis of 0.74 versus 0.65 in Model A, but the AUC differences were not significant (p = 0.24. Model B also appeared to have a more robust separation of mortality between the lowest (none of the three variables present) and highest (all three variables present) scores at 0% and 71%, respectively. These brief scoring systems may prove to be useful to clinicians in assigning mortality risk in hospitalized patients.


Assuntos
COVID-19/mortalidade , Adulto , Fatores Etários , Idoso , Proteína C-Reativa/análise , COVID-19/epidemiologia , Doenças Cardiovasculares/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigenoterapia/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Classe Social , Análise de Sobrevida , Taxa de Sobrevida/tendências
14.
Artigo em Inglês | MEDLINE | ID: mdl-34299665

RESUMO

The COVID-19 pandemic impacted on academic routine because of the social distancing measures. This study examined the relationships of sociodemographic characteristics, social distancing aspects and psychosocial factors on psychosocial well-being among undergraduate students during the social distancing period due to COVID-19. A web-based survey was conducted of undergraduate students at a public university in Brazil (n = 620). Demographics, socioeconomic status (SES), social distancing factors, negative affectivity (DASS-21), sense of coherence (SOC-13), social support and psychosocial well-being (GHQ-12) were measured. The direct and indirect links between was variables was tested using structural equation modelling. The estimated model showed that greater social support, higher sense of coherence and lower negative affectivity were directly associated with better psychological well-being. Female gender, higher SES, not working during the social distancing period and availability of online modules were indirectly associated with psychological well-being through psychosocial factors. Working during the social distancing period and availability of online modules mediated the link of age, gender, SES with psychological well-being. Our findings suggest the need to provide psychological support, online teaching and financial aid to undergraduate students during the social distancing period due to COVID-19 pandemic to improve their psychological well-being.


Assuntos
COVID-19 , Pandemias , Brasil , Demografia , Feminino , Humanos , Distanciamento Físico , SARS-CoV-2 , Classe Social , Estudantes
15.
Artigo em Inglês | MEDLINE | ID: mdl-34072902

RESUMO

Due to the wishes of the elderly and the traditional family culture in China, family care is the main way of providing for the aged, and women's care is the main way. This is not conducive to the protection of women's employment rights and the realization of self-worth under the background of increasing women's autonomy. Based on the latest data of the China Health and Nutrition Survey Database (CHNS), this paper uses ordinary least squares (OLS) and the instrumental variable method of control endogeneity to analyze the influence of family care activities on the labor participation rate of married women. The innovation of this paper is to introduce family bargaining power into this kind of model for the first time, and further analyze the heterogeneity from the perspective of bargaining power differences. The empirical results show that the family elderly care activities have an obstacle effect on married women's participation in employment, and the family members with strong bargaining power will significantly hinder employment, so this paper puts forward policy recommendations in line with the actual situation, hoping to provide theoretical support for the improvement of the social security system for the elderly.


Assuntos
Características da Família , Classe Social , Idoso , China , Países em Desenvolvimento , Economia , Emprego , Feminino , Humanos , Fatores Socioeconômicos , Direitos da Mulher
16.
BMC Public Health ; 21(1): 1197, 2021 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-34162349

RESUMO

BACKGROUND: Non-communicable disease (NCD) multimorbidity is associated with impaired functioning, lower quality of life and higher mortality. Susceptibility to accumulation of multiple NCDs is rooted in social, economic and cultural contexts, with important differences in the burden, patterns, and determinants of multimorbidity across settings. Despite high prevalence of individual NCDs within the Caribbean region, exploration of the social epidemiology of multimorbidity remains sparse. This study aimed to examine the social determinants of NCD multimorbidity in Jamaica, to better inform prevention and intervention strategies. METHODS: Latent class analysis (LCA) was used to examine social determinants of identified multimorbidity patterns in a sample of 2551 respondents aged 15-74 years, from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008. Multimorbidity measurement was based on self-reported presence/absence of 11 chronic conditions. Selection of social determinants of health (SDH) was informed by the World Health Organization's Commission on SDH framework. Multinomial logistic regression models were used to estimate the association between individual-level SDH and class membership. RESULTS: Approximately one-quarter of the sample (24.05%) were multimorbid. LCA revealed four distinct profiles: a Relatively Healthy class (52.70%), with a single or no morbidity; and three additional classes, characterized by varying degrees and patterns of multimorbidity, labelled Metabolic (30.88%), Vascular-Inflammatory (12.21%), and Respiratory (4.20%). Upon controlling for all SDH (Model 3), advancing age and recent healthcare visits remained significant predictors of all three multimorbidity patterns (p < 0.001). Private insurance coverage (relative risk ratio, RRR = 0.63; p < 0.01) and higher educational attainment (RRR = 0.73; p < 0.05) were associated with lower relative risk of belonging to the Metabolic class while being female was a significant independent predictor of Vascular-Inflammatory class membership (RRR = 2.54; p < 0.001). Material circumstances, namely housing conditions and features of the physical and neighbourhood environment, were not significant predictors of any multimorbidity class. CONCLUSION: This study provides a nuanced understanding of the social patterning of multimorbidity in Jamaica, identifying biological, health system, and structural determinants as key factors associated with specific multimorbidity profiles. Future research using longitudinal designs would aid understanding of disease trajectories and clarify the role of SDH in mitigating risk of accumulation of diseases.


Assuntos
Multimorbidade , Qualidade de Vida , Região do Caribe , Estudos Transversais , Feminino , Humanos , Jamaica/epidemiologia , Análise de Classes Latentes , Classe Social , Determinantes Sociais da Saúde
17.
Medicine (Baltimore) ; 100(25): e26435, 2021 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160434

RESUMO

ABSTRACT: The aim of this study was to evaluate the association between sociodemographic factors and noncavitated and cavitated caries lesions in Mexican schoolchildren.This cross-sectional study was conducted in 2020 on 8-to-12-year-old schoolchildren of different socioeconomic status (SES). The caries was evaluated using ICDAS II, SES was evaluated using three categories---a high, middle, or low-income level---of the CONAPO. Multinomial logistic regression analyses were performed in order to ascertain the associations between socioeconomic factors and noncavitated and cavitated caries lesions.The prevalence of noncavitated lesions was 38.0% and cavitated lesions was 43.4% in permanent dentition. In all the samples, 50.6% of schoolchildren had poor oral hygiene. About 52.5% of the mothers and 64.7% of the fathers had less than 9 years of education. Schoolchildren with a low-income level have more cavitated lesions (ICDAS II 4-6) than schoolchildren with high-income level (56.3% vs 15.8%, P = .009). The multinomial logistic regression models showed that mother's level of education <9 years and low-income level were significantly associated with cavitated caries lesions (ICDAS II 4-6), [odds ratio = 1.79 (1.17 - 2.75); P = .007], [OR = 2.21 (1.23 - 3.97); P = .008], respectively. The socioeconomic level was not associated with noncavitated caries lesions (ICDAS II 1-3).An association was found between the presence of cavitated caries lesions and the subject's mother's level of education and a low-income level. Socioeconomic factors were found to be associated with inequalities in caries distribution in the age group studied.


Assuntos
Cárie Dentária/epidemiologia , Exposição da Polpa Dentária/epidemiologia , Criança , Estudos Transversais , Cárie Dentária/complicações , Cárie Dentária/diagnóstico , Exposição da Polpa Dentária/diagnóstico , Exposição da Polpa Dentária/etiologia , Escolaridade , Feminino , Humanos , Renda , Masculino , México/epidemiologia , Mães/educação , Mães/estatística & dados numéricos , Prevalência , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Classe Social
18.
Syst Rev ; 10(1): 187, 2021 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-34172084

RESUMO

BACKGROUND: Many studies have evaluated the effects that a lack of resources has in children's physical and cognitive development. Although there are reviews that have focused on applied interventions from different perspectives, there is still a need for a comprehensive review of what has been attempted with these children from the cognitive intervention field. The aim of this paper is to present a protocol for a systematic review collecting randomized controlled trials (RCTs) studies whose purpose was to enhance cognitive development through the implementation of cognitive interventions in children and adolescents (< 18 years old) from low socioeconomic Status (SES) settings. METHODS: The following databases will be searched: Web of Science (WoS core collection), PsycINFO, Cochrane Central Register of Controlled Trial, ERIC, PubMed, ICTRP and Opengrey Register (System for Information of Grey Literature in Europe). Searches will be adapted for each database. Additionally, the reference list of articles included in the review will also be searched. As part of this process, two reviewers will determine, independently, the suitability of each article taking into account predefined inclusion/exclusion criteria. Pertinent data will then be extracted, including sample characteristics, specifics of the intervention, and outcomes, as well as follow-up measures. Internal validity will be assessed using the Cochrane Risk of Bias Tool. A quantitative synthesis of results will be conducted using a meta-analysis. However, if a meta-analysis is difficult to implement due to the diversity of the studies (for example, in terms of measures used to estimate the effect size, intervention types, outcomes, etc.), the technique synthesis without meta-analysis (SWiM) will be used. A description of outcome measures will be provided, as measured by validated neuropsychological instruments of any cognitive function. DISCUSSION: The systematic review will offer a framework based on evidence to organisations, institutions, and experts who want to implement or promote interventions aimed at enhancing cognitive domains in children and adolescents who live in disadvantaged contexts. SYSTEMATIC REVIEW REGISTRATION: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 16 March 2020 (registration number: CDR42020150238).


Assuntos
Cognição , Classe Social , Adolescente , Criança , Europa (Continente) , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Literatura de Revisão como Assunto , Revisões Sistemáticas como Assunto
19.
J Laryngol Otol ; 135(7): E3, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34137368

RESUMO

I wish to thank the Semon Committee for inviting me to deliver the 2020 Semon lecture. This is a very special honour, as is evidenced by the list of distinguished lecturers dating back to the inaugural lecture delivered at University College London in 1913. I am not the first South African to deliver the Semon lecture, having been preceded by my previous chairman Sean Sellars in 1993, and by Jack Gluckman in 2001, who was South African raised and educated and who subsequently became the chairman of otolaryngology in Cincinnati, USA.


Assuntos
Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Complicações Pós-Operatórias/prevenção & controle , Traqueostomia/métodos , Pesquisa Biomédica , Fístula Cutânea/prevenção & controle , Nutrição Enteral/métodos , Recursos em Saúde , Humanos , Laringe Artificial , Recidiva Local de Neoplasia/epidemiologia , Tratamentos com Preservação do Órgão , Otolaringologia , Doenças Faríngeas/prevenção & controle , Cuidados Pós-Operatórios/métodos , Inibidores da Bomba de Prótons/uso terapêutico , Qualidade de Vida , Radioterapia , Classe Social , África do Sul , Voz Esofágica , Estomas Cirúrgicos , Tireoidectomia
20.
Reprod Health ; 18(Suppl 1): 116, 2021 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-34134700

RESUMO

BACKGROUND: The use of modern contraception has increased in much of sub-Saharan Africa (SSA). However, the extent to which changes have occurred across the wealth spectrum among adolescents is not well known. We examine poor-rich gaps in demand for family planning satisfied by modern methods (DFPSm) among sexually active adolescent girls and young women (AGYW) using data from national household surveys. METHODS: We used recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys to describe levels of wealth-related inequalities in DFPSm among sexually active AGYW using an asset index as an indicator of wealth. Further, we used data from countries with more than one survey conducted from 2000 to assess DFPSm trends. We fitted linear models to estimate annual average rate of change (AARC) by country. We fitted random effects regression models to estimate regional AARC in DFPSm. All analysis were stratified by marital status. RESULTS: Overall, there was significant wealth-related disparities in DFPSm in West Africa only (17.8 percentage points (pp)) among married AGYW. The disparities were significant in 5 out of 10 countries in Eastern, 2 out of 6 in Central, and 7 out of 12 in West among married AGYW and in 2 out of 6 in Central and 2 out of 9 in West Africa among unmarried AGYW. Overall, DFPSm among married AGYW increased over time in both poorest (AARC = 1.6%, p < 0.001) and richest (AARC = 1.4%, p < 0.001) households and among unmarried AGYW from poorest households (AARC = 0.8%, p = 0.045). DPFSm increased over time among married and unmarried AGYW from poorest households in Eastern (AARC = 2.4%, p < 0.001) and Southern sub-regions (AARC = 2.1%, p = 0.030) respectively. Rwanda and Liberia had the largest increases in DPFSm among married AGYW from poorest (AARC = 5.2%, p < 0.001) and richest (AARC = 5.3%, p < 0.001) households respectively. There were decreasing DFPSm trends among both married (AARC = - 1.7%, p < 0.001) and unmarried (AARC = - 4.7%, p < 0.001) AGYW from poorest households in Mozambique. CONCLUSION: Despite rapid improvements in DFPSm among married AGYW from the poorest households in many SSA countries there have been only modest reductions in wealth-related inequalities. Significant inequalities remain, especially among married AGYW. DFPSm stalled in most sub-regions among unmarried AGYW.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Disparidades em Assistência à Saúde , Renda , Casamento , Pessoa Solteira , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Classe Social , Adulto Jovem
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