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1.
Rev. clín. esp. (Ed. impr.) ; 220(2): 79-85, mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-186416

RESUMO

Objetivo: Analizar si existen factores sociales que influyan en la estancia hospitalaria prolongada (EHP) de pacientes con agudización grave de EPOC (AEPOC), además de factores clínico-demográficos. Metodología: Estudio de cohortes prospectivo. Se incluyeron pacientes consecutivos que ingresaron por AEPOC en un servicio de Neumología. Se registraron variables demográficas, clínicas (tabaquismo, exacerbaciones e infecciones, disnea, impacto según cuestionario CAT, función pulmonar, comorbilidades, oxigenoterapia y ventilación no invasiva) y sociales (situación económica, disponibilidad y sobrecarga de cuidador, dependencia en actividades básicas e instrumentales, riesgo social y uso de servicios sociales), utilizando cuestionarios e índices como Barthel, Lawton-Brody, Zarit, Barber y Gijón. Se realizó un análisis univariante y multivariante mediante un modelo de regresión logística. Resultados: Se incluyeron 253 pacientes, y la edad media fue de 68,9+/-9,8años. El 77,1% fueron varones. En el modelo de regresión logística se incluyeron tabaquismo activo, valor del FEV1, puntuación en CAT >10, disnea 3-4 de la mMRC, presencia de gérmenes en cultivos de esputo, comorbilidad cardiovascular, anemia, oxigenoterapia domiciliaria, vivir solo, residencia en zona rural, sobrecarga del cuidador y la detección de riesgo/problema sociofamiliar. Las variables que se asociaron de forma independiente con la posibilidad de una EHP fueron la puntuación en cuestionario CAT >10 (OR=8,9; p=0,04) y la detección de riesgo/problema sociofamiliar (OR=2,6; p=0,04). Fumar activamente fue predictor de estancia más breve (OR=0,15; p=0,002). Conclusiones: Variables relacionadas con la esfera social juegan un papel relevante en la estancia hospitalaria, además del impacto de la enfermedad y la persistencia del tabaquismo en pacientes con AEPOC graves


Objective: To determine whether there are social factors that affect the prolonged hospital stay (PHS) of patients with severe chronic obstructive pulmonary disease exacerbation (COPDE), as well as clinical-demographic factors. Methodology: We conducted a prospective cohort study that consecutively included patients who were admitted to a Pneumology department for COPDE. We recorded demographic, clinical (tobacco use, exacerbations and infections, dyspnoea, impact according to CAT questionnaire, pulmonary function, comorbidities, oxygen therapy and noninvasive ventilation) and social (financial status, caregiver availability and overload, dependence for basic and instrumental activities, social risk and use of social services) variables, employing questionnaires and indices such as Barthel, Lawton-Brody, Zarit, Barber and Gijón. We performed a univariate and multivariate analysis using a logistic regression model. Results: The study included 253 patients, with a mean age of 68.9+/-9.8years; 77.1% of whom were men. The logistic regression model included active tobacco use, FEV1 value, CAT score >10, dyspnoea 3-4 on the MMRC, the presence of bacteria in sputum cultures, cardiovascular comorbidity, anaemia, home oxygen therapy, living alone, rural residence, caregiver overload and detecting social-family risks/problems. The variables independently associated with the possibility of PHS were a CAT score >10 (OR, 8.9; P=.04) and detecting a social-family risk/problem (OR, 2.6; P=.04). Active smoking was a predictor of shorter stays (OR, 0.15; P=.002). Conclusions: Variables related to the social sphere play a relevant role in hospital stays, as do the impact of the disease and the persistent use of tobacco by patients with severe COPD exacerbation


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Tempo de Internação/estatística & dados numéricos , Exacerbação dos Sintomas , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Testes de Função Respiratória/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Previsões , Tabagismo/epidemiologia
2.
JAMA Netw Open ; 3(1): e1919928, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995211

RESUMO

Importance: An association between social and neighborhood characteristics and health outcomes has been reported but remains poorly understood owing to complex multidimensional factors that vary across geographic space. Objectives: To quantify social determinants of health (SDOH) as multiple dimensions across the continental United States (the 48 contiguous states and the District of Columbia) at a small-area resolution and to examine the association of SDOH with premature mortality within Chicago, Illinois. Design, Setting, and Participants: In this cross-sectional study, census tracts from the US Census Bureau from 2014 were used to develop multidimensional SDOH indices and a regional typology of the continental United States at a small-area level (n = 71 901 census tracts with approximately 312 million persons) using dimension reduction and clustering machine learning techniques (unsupervised algorithms used to reduce dimensions of multivariate data). The SDOH indices were used to estimate age-adjusted mortality rates in Chicago (n = 789 census tracts with approximately 7.5 million persons) with a spatial regression for the same period, while controlling for violent crime. Main Outcomes and Measures: Fifteen variables, measured as a 5-year mean, were selected to characterize SDOH as small-area variations for demographic characteristics of vulnerable groups, economic status, social and neighborhood characteristics, and housing and transportation availability at the census-tract level. This SDOH data matrix was reduced to 4 indices reflecting advantage, isolation, opportunity, and mixed immigrant cohesion and accessibility, which were then clustered into 7 distinct multidimensional neighborhood typologies. The association between SDOH indices and premature mortality (defined as death before age 75 years) in Chicago was measured by years of potential life lost and aggregated to a 5-year mean. Data analyses were conducted between July 1, 2018, and August 30, 2019. Results: Among the 71 901 census tracts examined across the continental United States, a median (interquartile range) of 27.2% (47.1%) of residents had minority status, 12.1% (7.5%) had disabilities, 22.9% (7.6%) were 18 years and younger, and 13.6% (8.1%) were 65 years and older. Among the 789 census tracts examined in Chicago, a median (interquartile range) of 80.4% (56.3%) of residents had minority status, 10.2% (8.2%) had disabilities, 23.2% (10.9%) were 18 years and younger, and 9.5% (7.1%) were 65 years and older. Four SDOH indices accounted for 71% of the variance across all census tracts in the continental United States in 2014. The SDOH neighborhood typology of extreme poverty, which is of greatest concern to health care practitioners and policy advocates, comprised only 9.6% of all census tracts across the continental United States but characterized small areas of known public health crises. An association was observed between all SDOH indices and age-adjusted premature mortality rates in Chicago (R2 = 0.63; P < .001), even after accounting for violent crime and spatial structures. Conclusions and Relevance: The modeling of SDOH as multivariate indices rather than as a singular deprivation index may better capture the complexity and spatial heterogeneity underlying SDOH. During a time of increased attention to SDOH, this analysis may provide actionable information for key stakeholders with respect to the focus of interventions.


Assuntos
Nível de Saúde , Grupos Minoritários/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto , Idoso , Chicago , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Qualidade de Vida , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
3.
Rev Saude Publica ; 53: 97, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800910

RESUMO

OBJECTIVES: To develop a deprivation index to study health inequalities in 221 areas of Ecuador, to describe the pattern of deprivation in Ecuador, and to explore the applications of the index to study health inequalities by analysing the association between deprivation and mortality in the study areas. METHODS: We performed principal component analyses of available indicators of the 221 cantons of Ecuador. A set of 41 sociodemographic, social capital, and subjective well-being variables were obtained from the 2010 National Population Census and the National Living Conditions Survey 2013-2014. To explore the application of the index in public health, the association between the index and standardised mortality ratios was estimated through a Poisson regression model. RESULTS: The final index was constructed with 17 indicators. The first component explained 51.8% of the total variance of the data. A geographic pattern and a positive association of the index with the standardised mortality ratios of the cantons were observed in both men and women. CONCLUSIONS: We constructed a deprivation index that can identify disadvantaged areas in Ecuador. This index could be a valuable tool for the detection of vulnerabilised populations and the development of interventions and policies adapted to local needs.


Assuntos
Disparidades nos Níveis de Saúde , Indicadores Básicos de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Equador/epidemiologia , Feminino , Geografia Médica , Humanos , Masculino , Mortalidade , Áreas de Pobreza , Saúde Pública , Fatores Socioeconômicos
4.
PLoS Med ; 16(12): e1002978, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31846474

RESUMO

BACKGROUND: Gun violence has shortened the average life expectancy of Americans, and better knowledge about the root causes of gun violence is crucial to its prevention. While some empirical evidence exists regarding the impacts of social and economic factors on violence and firearm homicide rates, to the author's knowledge, there has yet to be a comprehensive and comparative lagged, multilevel investigation of major social determinants of health in relation to firearm homicides and mass shootings. METHODS AND FINDINGS: This study used negative binomial regression models and geolocated gun homicide incident data from January 1, 2015, to December 31, 2015, to explore and compare the independent associations of key state-, county-, and neighborhood-level social determinants of health-social mobility, social capital, income inequality, racial and economic segregation, and social spending-with neighborhood firearm-related homicides and mass shootings in the United States, accounting for relevant state firearm laws and a variety of state, county, and neighborhood (census tract [CT]) characteristics. Latitude and longitude coordinates on firearm-related deaths were previously collected by the Gun Violence Archive, and then linked by the British newspaper The Guardian to CTs according to 2010 Census geographies. The study population consisted of all 74,134 CTs as defined for the 2010 Census in the 48 states of the contiguous US. The final sample spanned 70,579 CTs, containing an estimated 314,247,908 individuals, or 98% of the total US population in 2015. The analyses were based on 13,060 firearm-related deaths in 2015, with 11,244 non-mass shootings taking place in 8,673 CTs and 141 mass shootings occurring in 138 CTs. For area-level social determinants, lag periods of 3 to 17 years were examined based on existing theory, empirical evidence, and data availability. County-level institutional social capital (levels of trust in institutions), social mobility, income inequality, and public welfare spending exhibited robust relationships with CT-level gun homicide rates and the total numbers of combined non-mass and mass shooting homicide incidents and non-mass shooting homicide incidents alone. A 1-standard deviation (SD) increase in institutional social capital was linked to a 19% reduction in the homicide rate (incidence rate ratio [IRR] = 0.81, 95% CI 0.73-0.91, p < 0.001) and a 17% decrease in the number of firearm homicide incidents (IRR = 0.83, 95% CI 0.73-0.95, p = 0.01). Upward social mobility was related to a 25% reduction in the gun homicide rate (IRR = 0.75, 95% CI 0.66-0.86, p < 0.001) and a 24% decrease in the number of homicide incidents (IRR = 0.76, 95% CI 0.67-0.87, p < 0.001). Meanwhile, 1-SD increases in the neighborhood percentages of residents in poverty and males living alone were associated with 26%-27% and 12% higher homicide rates, respectively. Study limitations include possible residual confounding by factors at the individual/household level, and lack of disaggregation of gun homicide data by gender and race/ethnicity. CONCLUSIONS: This study finds that the rich-poor gap, level of citizens' trust in institutions, economic opportunity, and public welfare spending are all related to firearm homicide rates in the US. Further establishing the causal nature of these associations and modifying these social determinants may help to address the growing gun violence epidemic and reverse recent life expectancy declines among Americans.


Assuntos
Homicídio/estatística & dados numéricos , Renda/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Adulto , Estudos Transversais , Coleta de Dados , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Estados Unidos
5.
BMC Public Health ; 19(1): 1330, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640635

RESUMO

BACKGROUND: To reduce the under-five mortality (U5M), fine-gained spatial assessment of the effects of health interventions is critical because national averages can obscure important sub-national disparities. In turn, sub-national estimates can guide control programmes for spatial targeting. The purpose of our study is to quantify associations of interventions with U5M rate at national and sub-national scales in Uganda and to identify interventions associated with the largest reductions in U5M rate at the sub-national scale. METHODS: Spatially explicit data on U5M, interventions and sociodemographic indicators were obtained from the 2011 Uganda Demographic and Health Survey (DHS). Climatic data were extracted from remote sensing sources. Bayesian geostatistical Weibull proportional hazards models with spatially varying effects at sub-national scales were utilized to quantify associations between all-cause U5M and interventions at national and regional levels. Bayesian variable selection was employed to select the most important determinants of U5M. RESULTS: At the national level, interventions associated with the highest reduction in U5M were artemisinin-based combination therapy (hazard rate ratio (HRR) = 0.60; 95% Bayesian credible interval (BCI): 0.11, 0.79), initiation of breastfeeding within 1 h of birth (HR = 0.70; 95% BCI: 0.51, 0.86), intermittent preventive treatment (IPTp) (HRR = 0.74; 95% BCI: 0.67, 0.97) and access to insecticide-treated nets (ITN) (HRR = 0.75; 95% BCI: 0.63, 0.84). In Central 2, Mid-Western and South-West, largest reduction in U5M was associated with access to ITNs. In Mid-North and West-Nile, improved source of drinking water explained most of the U5M reduction. In North-East, improved sanitation facilities were associated with the highest decline in U5M. In Kampala and Mid-Eastern, IPTp had the largest associated with U5M. In Central1 and East-Central, oral rehydration solution and postnatal care were associated with highest decreases in U5M respectively. CONCLUSION: Sub-national estimates of the associations between U5M and interventions can guide control programmes for spatial targeting and accelerate progress towards mortality-related Sustainable Development Goals.


Assuntos
Serviços de Saúde da Criança/organização & administração , Mortalidade da Criança/tendências , Bem-Estar da Criança/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Antimaláricos/uso terapêutico , Pré-Escolar , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Inseticidas/uso terapêutico , Modelos de Riscos Proporcionais , Fatores de Risco , Uganda
6.
Rev Bras Enferm ; 72(4): 1044-1051, 2019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432964

RESUMO

OBJECTIVE: To verify the association between Social Determinants of Health and birth control methods used by women of childbearing age. METHODS: Documentary and retrospective study, performed at a Brazilian Natural Birth Center with evaluation of the medical records of patients seen between 2003 and 2011 (n=2410). Data were collected on identification and general history, gynecological, sexual and obstetric. RESULTS: Hormone birth control methods were the most used among participants (25.0%); followed by barrier methods (21.5%) and surgical methods (19.3%). Statistical associations were observed regarding age, menarche, onset of sexual activity, pregnancy, miscarriage, smoking, hypertension, marital status, gynecological care and schooling with the choice of methods. CONCLUSION: The results confirm the importance of studies involving Social Determinants of Health, since they interfere in the way women choose birth control methods and the risks that this choice may pose to their health.


Assuntos
Comportamento de Escolha , Comportamento Contraceptivo/psicologia , Anticoncepcionais/uso terapêutico , Determinantes Sociais da Saúde/estatística & dados numéricos , Adolescente , Adulto , Centros de Assistência à Gravidez e ao Parto/organização & administração , Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Brasil , Comportamento Contraceptivo/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Estudos Retrospectivos
7.
Geriatr Gerontol Int ; 19(8): 711-716, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31257714

RESUMO

AIM: The present study used a deep learning model (recurrent neural network) for testing: (i) whether social determinants are major determinants of the association among cerebrovascular disease, hearing loss and cognitive impairment in a middle-aged or older population (hypothesis 1); and (ii) whether the association among the three diseases is very strong in the middle-aged or older population (hypothesis 2). METHODS: Data came from the Korean Longitudinal Study of Aging (2014-2016), with 6060 participants aged ≥53 years. The association among the three diseases was divided into eight categories: one category for having no disease, three categories for having one disease, three categories for having two diseases and one category for having three diseases. Variable importance, the effect of a variable on model performance, was used for evaluating the two hypotheses. Hypothesis 1 was based on whether family support, socioeconomic status and social activity in the year 2014 were the top 10 determinants of the association in the year 2016. Hypothesis 2 was based on whether cerebrovascular disease, hearing loss and cognitive impairment in the year 2014 were the top five determinants of the association in the year 2016. RESULTS: Based on variable importance from the recurrent neural network, cerebrovascular disease (0.0386), cognitive impairment (0.0151) and hearing loss (0.0092) in 2014 were the top three determinants of the association in 2016. Children alive (0.0072), education (0.0049), income (0.0075), friendship activity (0.0042) and marriage (0.0036) in 2014 were the top 10 determinants of the association in 2016. CONCLUSIONS: The findings of the present study support the two hypotheses, highlighting the importance of preventive measures, family support, socioeconomic status and friendship activity for managing the three diseases. Geriatr Gerontol Int 2019; 19: 711-716.


Assuntos
Envelhecimento , Transtornos Cerebrovasculares , Disfunção Cognitiva , Perda Auditiva , Comportamento Social , Determinantes Sociais da Saúde/estatística & dados numéricos , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/psicologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Aprendizado Profundo , Feminino , Avaliação Geriátrica/métodos , Perda Auditiva/epidemiologia , Perda Auditiva/psicologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , República da Coreia/epidemiologia , Classe Social , Apoio Social
8.
Med Care ; 57(8): 592-600, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31268954

RESUMO

BACKGROUND: Social determinants of health (SDH) at the area level are understood to influence the likelihood of having poor glycemic control for patients with type 2 diabetes mellitus (T2DM). OBJECTIVES: To develop a model for predicting whether a person with T2DM has uncontrolled diabetes (hemoglobin A1c ≥9%), incorporating individual and area-level (census tract) covariates. RESEARCH DESIGN: Development and validation of machine learning models. SUBJECTS: Total of N=1,015,808 privately insured persons in claims data with T2DM. MEASURES: C-statistic, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. RESULTS: A standard logistic regression model selecting among the available individual-level covariates and area-level SDH covariates (at the census tract level) performed poorly, with a C-statistic of 0.685, sensitivity of 25.6%, specificity of 90.1%, positive predictive value of 56.9%, negative predictive value of 70.4%, and accuracy of 68.4% on a 25% held-out validation subset of the data. By contrast, machine learning models improved upon risk prediction, with the highest performance from a random forest algorithm with a C-statistic of 0.928, sensitivity of 68.5%, specificity of 94.6%, positive predictive value of 69.8%, negative predictive value of 94.3%, and accuracy of 90.6%. SDH variables alone explained 16.9% of variation in uncontrolled diabetes. CONCLUSIONS: A predictive model developed through a machine learning approach may assist health care organizations to identify which area-level SDH data to monitor for prediction of diabetes control, for potential use in risk-adjustment and targeting.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Idoso , Diabetes Mellitus Tipo 2/terapia , Feminino , Hemoglobina A Glicada/análise , Humanos , Modelos Logísticos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Medição de Risco , Fatores de Risco
9.
Int J Equity Health ; 18(1): 108, 2019 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311553

RESUMO

BACKGROUND: Andalusia has been one of the regions most damaged by the economic crisis in Spain. A qualitative study of the effects of the economic crisis and austerity policies in this region has been conducted within the framework of the IMPACT-A project. This research seeks to analyse the perceived impact of the crisis upon the health of the Andalusian population through the first-hand discourses of professionals from the health and social sectors on the one hand, and citizens of different socioeconomic status (SES) on the other. METHODS: A total of five focus groups and ten semi-structured interviews were conducted and analysed following an inductive process based on Grounded Theory (GT). RESULTS: Our results show a general perception among professionals: the financial crisis has either directly or indirectly affected population health in Andalusia, though mostly impacting low-income individuals who were already at risk of social exclusion. Professionals' perceptions have been confirmed through the discourses of citizens of a lower SES, which differ from those of middle and upper SES. CONCLUSION: Findings reveal some of the most salient consequences on the socially vulnerable groups and people at risk of social exclusion. In particular, our study highlights the importance of addressing three areas of priority action: mental health, unmet (basic and medical) needs, and decline in the health system.


Assuntos
Recessão Econômica/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Nível de Saúde , Determinantes Sociais da Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Saúde Mental , Pesquisa Qualitativa , Classe Social , Espanha/epidemiologia
10.
BMC Public Health ; 19(1): 699, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170953

RESUMO

BACKGROUND: The majority of empirical studies focus on a single Social Determinant of Health (SDH) when analysing health inequalities. We go beyond this by exploring how the combination of education (micro level) and household arrangements (mezzo level) is associated with self-perceived health. METHODS: Our data source is the 2014 cross-sectional data from the European Survey of Living Conditions (EU-SILC). We calculate the predicted probabilities of poor self-perceived health for the middle-aged European population (30-59 years) as a function of the combination of the two SDHs. This is done separately for five European country groups (dual-earner; liberal; general family support; familistic; and post-socialist transition) and gender. RESULTS: We observe a double health gradient in all the country groups: first, there is a common health gradient by education (the higher the education, the lower the probability of poor health); second, household arrangements define a health gradient within each educational level according to whether or not the individual lives with a partner (living with a partner is associated with a lower probability of poor health). We observe some specificity in this general pattern. Familistic and post-socialist transition countries display large differences in the predicted probabilities according to education and household arrangements when compared with the other three country groups. Familistic and post-socialist transition countries also show the largest gender differences. CONCLUSIONS: Health differences in European populations seem to be defined, first, by education and, second, by living or not living with a partner. Additionally, different social contexts (gender inequalities, educational profile, etc.) in European countries change the influences on health of both the SDHs for both women and men.


Assuntos
Escolaridade , Características da Família , Disparidades nos Níveis de Saúde , Fatores Sexuais , Determinantes Sociais da Saúde/estatística & dados numéricos , Adulto , Estudos Transversais , Autoavaliação Diagnóstica , Europa (Continente)/epidemiologia , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Condições Sociais
11.
Rev. Asoc. Esp. Neuropsiquiatr ; 39(135): 177-191, ene.-jun. 2019.
Artigo em Espanhol | IBECS | ID: ibc-186387

RESUMO

La prevención sanitaria del sufrimiento psíquico, ya sea primaria, secundaria o terciaria, no trata únicamente de que los profesionales intenten evitar anticipadamente su aparición de manera bienintencionada, hagan un diagnóstico precoz o reduzcan las consecuencias negativas del problema mental. Detrás de las actividades clínicas preventivas, se encuentra una particular conceptualización de los problemas mentales, una práctica contextualizada sociopolíticamente, una relación terapéutica a menudo condicionada por una omnipotencia profesional que propicia una dinámica paternalista y unas intervenciones que, como todas las de carácter sanitario, también provocan daños. Frente a esta perspectiva, la prevención cuaternaria nos da las claves científicas y éticas para limitar el daño que realizan las intervenciones sanitarias preventivas en un contexto de medicalización e individualización de los problemas sociales. Igualmente, la promoción de la salud mental, entendida como una actividad de carácter fundamentalmente político, colectivo e intersectorial en la que los profesionales de la salud mental somos otros nudos dentro de la red de agentes comunitarios, nos proporciona un quehacer profesional fuera de la consulta en el marco de la salud pública y la medicina social que ayuda a mejorar el bienestar psíquico de la población


Health prevention of mental suffering, regardless of being done In primary, secondary or tertiary care, is not just professionals trying to prevent its happening in advance in a well-meant way, making an early diagnosis or reducing the negative consequences of mental problems. Behind preventive measures, there is a particular conceptualization of mental problems, a socio-politically contextualized practice, a therapeutic relationship very often conditioned by professional omnipotence that fosters a paternalistic dynamic, and interventions that, as it always happens in the health field, also cause damage. Against this perspective, quaternary care prevention gives us the scientific and ethical keys to limit the damage done by preventive health interventions in a context of medicalization and individualization of social problems. Likewise, mental health promotion, understood as an activity with a fundamentally political, collective and intersectoral nature in which mental health professionals are other knots within the network of community agents, provides us with a professional task outside the clinical practice and in a public health and social medicine framework, which helps improve mental well-being in the population


Assuntos
Humanos , Estresse Psicológico/prevenção & controle , Intervenção na Crise/organização & administração , Prevenção Quaternária , Transtornos Mentais/prevenção & controle , Estresse Psicológico/psicologia , Avaliação de Resultado de Ações Preventivas , Determinantes Sociais da Saúde/estatística & dados numéricos , Gradiente Socioeconômico de Saúde/tendências
12.
Rev Bras Epidemiol ; 22: e190032, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31038613

RESUMO

INTRODUCTION: The social determinants of health (SDH) are factors that can influence the distribution of rates for acquired immunodeficiency syndrome (AIDS) in a given region. The objective of this study was to analyze SDHs related to AIDS. METHOD: Ecological study, using spatial analyses techniques. 7,896 disease case reports were analyzed over a period of 11 years. Subjects were 13 years or older and residents of the state of Ceará, in the northeast of Brazil. The area of analysis was the municipality, calculating both the average rate of AIDS and the Freeman-Tukey transformed average rate for measuring softening. We used the Simple Linear Regression Model to make the spatial correlation between AIDS detection rates and SDH. A Geographic Information Systems (GIS) was used to manipulate georeferenced data. RESULTS: High rates of AIDS could be found in cities with better living conditions. Additionally, there was a significant relationship between primary health care coverage and lower rates of the disease in Ceará. CONCLUSION: Socioeconomic indicators with statistically significant correlation to the distribution of AIDS should be targeted by strategies policies in the fight against the disease.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Adolescente , Adulto , Brasil/epidemiologia , Características da Família , Feminino , Humanos , Modelos Lineares , Masculino , Análise Multivariada , Fatores Socioeconômicos , Análise Espacial , Adulto Jovem
14.
Artigo em Inglês | MEDLINE | ID: mdl-31083298

RESUMO

African Americans, other minorities and underserved populations are consistently under- represented in clinical trials. Such underrepresentation results in a gap in the evidence base, and health disparities. The ABC Cardiovascular Implementation Study (CVIS) is a comprehensive prospective cohort registry that integrates social determinants of health. ABC CVIS uses real world clinical practice data to address critical gaps in care by facilitating robust participation of African Americans and other minorities in clinical trials. ABC CVIS will include diverse patients from collaborating ABC member private practices, as well as patients from academic health centers and Federally Qualified Health Centers (FQHCs). This paper describes the rationale and design of the ABC CVIS Registry. The registry will: (1) prospectively collect socio-demographic, clinical and biospecimen data from enrolled adults, adolescents and children with prioritized cardiovascular diseases; (2) Evaluate the safety and clinical outcomes of new therapeutic agents, including post marketing surveillance and pharmacovigilance; (3) Support National Institutes of Health (NIH) and industry sponsored research; (4) Support Quality Measures standards from the Center for Medicare and Medicaid Services (CMS) and Commercial Health Plans. The registry will utilize novel data and technology tools to facilitate mobile health technology application programming interface (API) to health system or practice electronic health records (EHR). Long term, CVIS will become the most comprehensive patient registry for underserved diverse patients with cardiovascular disease (CVD) and co morbid conditions, providing real world data to address health disparities. At least 10,000 patients will be enrolled from 50 sites across the United States.


Assuntos
Afro-Americanos/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Georgia , Humanos , Estudos Prospectivos , Sistema de Registros
15.
An Bras Dermatol ; 94(2): 182-191, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31090823

RESUMO

BACKGROUND: Leprosy is a neglected disease caused by Mycobacterium leprae. Brazil has the second largest number of cases in the world. OBJECTIVES: To analyze the spatial distribution of leprosy in the state of BAHIA, Brazil, and the association between his occurrence and the synthetic indicators of municipal socioeconomic performance, social vulnerability and income inequality. METHODS: An ecological study with secondary data obtained from the National System of Notifiable Diseases. Dependent variables: coefficient of detection in the general population and in the population under 15 years old and the rate of grade II of physical disability. Independent variables: Synthetic indicators of socioeconomic performance, social vulnerability and income inequality. RESULTS: The highest coefficients of detection of new cases in the general population and in children under 15 years old are concentrated in the north-west axis and in the southern region of the state. On the other hand, the highest rates of degree II of physical incapacity are concentrated in the north, northeast and south regions. Only the Index of Social and Economic Performance(IPESE)-Economy and Finance composed the final regression model of the general detection coefficients and in children under 15 years old. The municipalities with the highest indexes had the highest detection coefficients, reflecting the capacity to diagnose new cases. STUDY LIMITATIONS: The use of synthetic indicators is a limitation of the study. CONCLUSIONS: Leprosy presents a heterogeneous spatial pattern in the state of BAHIA, and the IPESE-Economics and Finance indicator is the only one with explanatory potential of the disease.


Assuntos
Demografia/métodos , Doenças Endêmicas/estatística & dados numéricos , Hanseníase/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Adolescente , Distribuição por Idade , Teorema de Bayes , Brasil/epidemiologia , Cidades/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Indicadores Básicos de Saúde , Humanos , Análise Espacial , Populações Vulneráveis/estatística & dados numéricos
16.
BMC Musculoskelet Disord ; 20(1): 215, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092222

RESUMO

BACKGROUND: Back pain is one of the most common causes for disability in the working population. Some risk factors for back pain are well known, however little is known about factors uniquely associated with acute or chronic back pain. This study aimed to elucidate patterns uniquely associated with acute or chronic back pain. METHODS: This study performed secondary analysis of data from the Welsh Health Survey 2012, a nationwide cross-sectional survey. A multivariable analysis was carried out for risk factors found to be significantly associated with acute and chronic back pain. RESULTS: We found that increased BMI (aOR 1.20, 95% Cis 1.08, 1.33; BMI > 30), mental health score below average (aOR 1.59, 95% CIs 1.47, 1.72), having a degree (aOR 1.28, 95% CIs 1.12, 1.47) and being older than 24 years (P < 0.001) were associated with increased prevalence of acute back pain. Higher prevalence of chronic back pain was seen in individuals characterised by increased deprivation (WIMD) (aOR 1.61, 95% CIs 1.32, 1.96); increased age (aOR 7.34, 95% CIs 5.25, 10.26; for 65+); being female (aOR = 1.43, 95% CIs 1.27, 1.61); lower educational attainment (aOR 0.44, 95% CIs 0.36, 0.55) higher BMI (aOR = 1.60 95% CIs 1.38, 1.85; BMI > 30); poorer mental health score (aOR = 3.11 95% CIs 2.76, 3.51), and a sedentary lifestyle (aOR = 0.58, 95% CIs 0.49, 0.69; 3-5 days of light exercise). CONCLUSION: Increased deprivation, female gender, and little exercise were uniquely associated with chronic back pain. These characteristics may help clinicians to intervene to prevent acute backpain resulting in chronic cases.


Assuntos
Dor Aguda/epidemiologia , Dor nas Costas/epidemiologia , Dor Crônica/epidemiologia , Adolescente , Adulto , Idoso , Estudos Transversais , Exercício/fisiologia , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Características de Residência/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Determinantes Sociais da Saúde/estatística & dados numéricos , Fatores Socioeconômicos , País de Gales/epidemiologia , Adulto Jovem
17.
Public Health Rep ; 134(4): 354-362, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31095451

RESUMO

INTRODUCTION: We describe the California Healthy Places Index (HPI) and its performance relative to other indexes for measuring community well-being at the census-tract level. The HPI arose from a need identified by health departments and community organizations for an index rooted in the social determinants of health for place-based policy making and program targeting. The index was geographically granular, validated against life expectancy at birth, and linked to policy actions. MATERIALS AND METHODS: Guided by literature, public health experts, and a positive asset frame, we developed a composite index of community well-being for California from publicly available census-tract data on place-based factors linked to health. The 25 HPI indicators spanned 8 domains; weights were derived from their empirical association with tract-level life expectancy using weighted quantile sums methods. RESULTS: The HPI's domains were aligned with the social determinants of health and policy action areas of economic resources, education, housing, transportation, clean environment, neighborhood conditions, social resources, and health care access. The overall HPI score was the sum of weighted domain scores, of which economy and education were highly influential (50% of total weights). The HPI was strongly associated with life expectancy at birth (r = 0.58). Compared with the HPI, a pollution-oriented index did not capture one-third of the most disadvantaged quartile of census tracts (representing 3 million Californians). Overlap of the HPI's most disadvantaged quartile of census tracts was greater for indexes of economic deprivation. We visualized the HPI percentile ranking as a web-based mapping tool that presented the HPI at multiple geographies and that linked indicators to an action-oriented policy guide. PRACTICE IMPLICATIONS: The framing of indexes and specifications such as domain weighting have substantial consequences for prioritizing disadvantaged populations. The HPI provides a model for tools and new methods that help prioritize investments and identify multisectoral opportunities for policy action.


Assuntos
Política de Saúde , Estilo de Vida Saudável , Vigilância da População , Saúde Pública/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , California , Humanos
18.
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-31050642

RESUMO

CONTEXT: Kaiser Permanente commissioned a health and well-being (HWB) survey of adult members and nonmembers in its 8 Regions. OBJECTIVE: To estimate the prevalence of HWB indicators and evaluate differences in prevalence of excellent/very good (E/VG) health and thriving overall in life (thriving) by race/ethnicity, age group, sex, education, and financial situation. DESIGN: Cross-sectional survey conducted by email and phone during Winter 2016-2017 with a racial/ethnic group-stratified quota sample. Participants (N = 26,304) provided sociodemographic characteristics and ratings for 6 HWB indicators. Using population-weighted data, we estimated the prevalence of HWB indicators and used logistic regression models to test for differences in E/VG health and thriving by sociodemographic factors. MAIN OUTCOME MEASURES: Overall health and overall life evaluation. RESULTS: Of adults, 52% were in E/VG health and 63% were thriving. Blacks were less likely to be in E/VG health than whites, Hispanics, and Asian/Pacific Islanders, but there was little racial/ethnic variation in those who were thriving. E/VG health and thriving varied significantly by level of education and financial situation. Across all racial/ethnic groups, large differences in percentages were observed in E/VG health and thriving between the lowest and highest levels of education and financial situation but little racial/ethnic variation within education and financial situation strata. CONCLUSION: Differences in health status and life evaluation are associated very strongly with financial situation and educational attainment, and these social determinants partially explain racial/ethnic disparities in HWB. The lack of strong correlation of health status and life evaluation suggests these are different domains of well-being.


Assuntos
Nível de Saúde , Determinantes Sociais da Saúde/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Grupos de Populações Continentais/estatística & dados numéricos , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
19.
J Affect Disord ; 252: 382-393, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31003107

RESUMO

BACKGROUND: There is a paucity of epidemiological studies of depression in war-free Arab countries. This study estimated the prevalence and potential determinants of Subthreshold (SUBDE) and Major Depressive Episode (MDE) in migrants and non-migrants typical of Qatar and neighboring Gulf countries. METHODS: A telephone survey of a probability-based sample of 2,424 participants was conducted in February 2017. The sample was divided based on nationality and income: Low-Income Migrants (LIMs), High Income Migrants (HIMs), and non-migrants or Qatari Nationals (QNs). Participants completed the nine-item Physician Health Questionnaire (PHQ-9). Ethnicity, sociodemographics, health- and work-related information was collected. Bivariate and multinomial logistic regression analyses were used. RESULTS: Overall prevalence of any depression ranged between 4.2% (95% CI: 3.3-5.3) and 6.6% (95% CI: 5.4-7.9) for a cut-off of 12 and 10, respectively. The diagnostic algorithm for SUBDE and MDE resulted in estimates of 5.5% (95% CI: 4.4-6.8) and 3.6% (95% CI: 2.8-4.5), respectively. SUBDE, but not MDE rates, were significantly increased in LIMs (OR=2.96, p = 0.004) and HIMs (OR = 2.00, p = 0.014) compared with non-migrants. Arab ethnicity was significantly associated with SUBDE: relative to South Asians (OR = 3.77, p < 0.001) and other ethnicities (OR = 3.61, p = 0.029). Arab ethnicity was significantly associated with MDE: relative to South Asians (OR = 10.42, p < 0.001) and South East Asians (OR = 3.54, p = 0.007). LIMITATIONS: Clinical diagnostic interviews for depression were not included. CONCLUSION: Using the PHQ-9, depression prevalence in Qatar was comparable to general population estimates from Western countries. Migrant status and ethnicity were associated with SUBDE and MDE with implications for early screening and community intervention.


Assuntos
Árabes/estatística & dados numéricos , Transtorno Depressivo Maior/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Adulto , Árabes/psicologia , Transtorno Depressivo Maior/etnologia , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Prevalência , Catar/epidemiologia , Determinantes Sociais da Saúde/etnologia , Inquéritos e Questionários , Migrantes/psicologia
20.
Res Dev Disabil ; 89: 105-113, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30974258

RESUMO

OBJECTIVE: Individuals with developmental disabilities (DD) experience significant health disparities. An overlooked risk factor for health disparities in the DD population is adverse childhood experiences (ACEs). The purpose of this study was to generate population prevalence data about level of adverse experiences among children with DD in comparison to children without DD and the extent to which potential confounders may influence observed associations between adversity and child DD status. METHODS: Data from the 2011-12 National Survey of Child Health (NSCH) were analyzed to estimate prevalence of adversity among families of children with and without DD, age 3-17 years (N = 62,428; DD = 2622). Level of adversity was assessed via parent response to the Adverse Family Experiences questionnaire. Bivariate and multinomial logistic regressions were utilized to investigate the relationship between adverse family experiences (AFEs) and child DD status, adjusting for covariates. RESULTS: Child DD status was significantly and independently associated with higher probability of reporting 1-2 AFEs (RRR = 1.28, 95% CI 1.06, 1.5) and 3+ AFEs (RRR = 1.60, 95% CI 1.16, 2.21). CONCLUSION: This study documents significant disparities in adversity among children with DD using a population-based sample. These adversities potentially compromise successful transition to adulthood and overall health outcomes.


Assuntos
Experiências Adversas da Infância , Deficiências do Desenvolvimento , Adolescente , Experiências Adversas da Infância/estatística & dados numéricos , Criança , Pré-Escolar , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/psicologia , Características da Família , Relações Familiares/psicologia , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Determinantes Sociais da Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos/epidemiologia
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