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1.
Oncol Nurs Forum ; 48(3): 261-262, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33855999

RESUMO

As we enter the second year of the COVID-19 pandemic, there is much hope about the eventual containment of the virus, leading to some form of a new normalcy. Multiple COVID-19 vaccines have proven to be effective, and the vaccination of individuals in the United States has reached several million per day, with an ever-growing percentage of the population having been vaccinated. However, there are stark reminders of the continued disparities that have been highlighted by the COVID-19 pandemic, with different levels of vaccine accessibility across states and communities. In addition, multiple countries have not begun any vaccination implementation. Case and death rates continue to be unevenly distributed, with higher death rates in minority populations, particularly African American and Latinx individuals. This pandemic has raised to a higher level of awareness the ongoing and multiple forms of disparity associated with health and illness. For oncology nurses and scientists, how do we look to the issues so starkly presented by the pandemic and raise our awareness that the issues are not specific to COVID-19?


Assuntos
Afro-Americanos/estatística & dados numéricos , /mortalidade , Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermagem Oncológica , Pandemias/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Sindemia , Estados Unidos/epidemiologia
2.
Prev Chronic Dis ; 18: E33, 2021 04 08.
Artigo em Inglês | MEDLINE | ID: mdl-33830913

RESUMO

The Centers for Disease Control and Prevention (CDC) define chronic diseases as conditions that last 1 year or more and that require ongoing medical attention or limit activities of daily living, or both (1). Chronic diseases may be influenced by a combination of genetics, lifestyle and social behaviors, health care system factors, community influences, and environmental determinants of health (2). These risk factors often coexist and interact with each other. Therefore, a better understanding of determinants of chronic diseases such as tobacco use, unhealthy eating, and physical inactivity stands to benefit from effective strategies for improving primary, secondary, and tertiary disease prevention and management in diverse global settings (3). Strategies to prevent and manage chronic disease outcomes such as diabetes and cardiovascular diseases (CVDs) have global commonalities (4-7). The impact of chronic diseases is disproportionately evident in Black and Brown communities (8,9). Chronic disease prevention and management typically focus on behavioral interventions such as healthy eating, increased physical activity, and cessation of unhealthy practices such as tobacco and alcohol use (10-15). In 2020, the COVID-19 pandemic added to the fact that chronic diseases disproportionately affect low-resource communities, where many Black and Brown populations live (16,17). COVID-19 demonstrated that chronic disease disparities actually present as preexisting conditions in Black and Brown communities, who are disproportionately affected by COVID-19 outcomes. Although most of the articles in this Preventing Chronic Disease (PCD) collection were published before the pandemic, the insights they present, combined with the racial and ethnic data on the burden of COVID-19 thus far, support this reality. Many researchers and public health practitioners often consider the need to sufficiently address the relationships between chronic diseases and social, behavioral, and community factors (18). Global lessons in the prevention and management of chronic diseases, therefore, can help researchers and practitioners benefit from the shared lessons and experience derived from research and interventions conducted in different parts of the world. There are more than 7 billion people worldwide, who speak diverse languages and who have different nationalities, identities, and health systems. Yet, if we share challenges and opportunities for chronic disease prevention and management, many of the global adversities to improving health and well-being can be ameliorated, which is the purpose of this collection. The authors in this collection share lessons that represent experiences in diverse contexts across countries and regions of the world.


Assuntos
/epidemiologia , Doença Crônica , Saúde Global , Saúde Pública , Determinantes Sociais da Saúde , Causalidade , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Doença Crônica/terapia , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Disseminação de Informação , Estilo de Vida , Psicologia , Saúde Pública/normas , Saúde Pública/tendências , Determinantes Sociais da Saúde/etnologia , Determinantes Sociais da Saúde/estatística & dados numéricos
3.
PLoS One ; 16(3): e0248336, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33788848

RESUMO

Early reports indicate that the social determinants of health are implicated in COVID-19 incidence and outcomes. To inform the ongoing response to the pandemic, we conducted a rapid review of peer-reviewed studies to examine the social determinants of COVID-19. We searched Ovid MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials from December 1, 2019 to April 27, 2020. We also searched the bibliographies of included studies, COVID-19 evidence repositories and living evidence maps, and consulted with expert colleagues internationally. We included studies identified through these supplementary sources up to June 25, 2020. We included English-language peer-reviewed quantitative studies that used primary data to describe the social determinants of COVID-19 incidence, clinical presentation, health service use and outcomes in adults with a confirmed or presumptive diagnosis of COVID-19. Two reviewers extracted data and conducted quality assessment, confirmed by a third reviewer. Forty-two studies met inclusion criteria. The strongest evidence was from three large observational studies that found associations between race or ethnicity and socioeconomic deprivation and increased likelihood of COVID-19 incidence and subsequent hospitalization. Limited evidence was available on other key determinants, including occupation, educational attainment, housing status and food security. Assessing associations between sociodemographic factors and COVID-19 was limited by small samples, descriptive study designs, and the timeframe of our search. Systematic reviews of literature published subsequently are required to fully understand the magnitude of any effects and predictive utility of sociodemographic factors related to COVID-19 incidence and outcomes. PROSPERO: CRD4202017813.


Assuntos
/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , /diagnóstico , Grupos de Populações Continentais/estatística & dados numéricos , Humanos , Incidência , Prognóstico
4.
J Am Board Fam Med ; 34(Suppl): S40-S47, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33622817

RESUMO

INTRODUCTION: Recent data demonstrated that socioeconomic, environmental, demographic, and health factors can contribute to vulnerability for coronavirus 2019 (COVID-19). The goal of this study was to assess association between severe acute respiratory syndrome coronavirus (SARS CoV-2) infection and demographic and socioeconomic factors in patients from a large academic family medicine practice to support practice operations. METHODS: Patients referred for SARS CoV-2 testing by practice providers were identified using shared patient lists in the electronic health records (Epic). The Health Information Exchange (CRISP) was used to identify additional practice-attributed patients receiving testing elsewhere. RESULTS: Compared with white non-Hispanic patients, the odds of COVID-19 detection were higher in black non-Hispanic (odds ratio [OR] = 1.75; 95% CI, 1.18-2.59, P = .0052) and Hispanic patients (OR = 5.40; 95% CI, 3.11-9.38, P < .0001). The latent class analysis revealed additional patterns in health disparities. Patients living in the areas with Area Deprivation Index 8-10 who were predominantly black had higher risk for SARS CoV-2 infection compared with patients living in less socioeconomically deprived areas who were predominantly white (OR = 1.68; 95% CI, 1.25-2.28; P = .0007). CONCLUSION: Our data provide insight into the association of COVID-19 with race/ethnic minority patients residing in highly socioeconomically deprived areas. These data could impact outreach and management of ambulatory COVID-19 in the future.


Assuntos
/estatística & dados numéricos , Medicina de Família e Comunidade/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Criança , Pré-Escolar , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Pandemias , Fatores Socioeconômicos , Adulto Jovem
5.
BMJ Open ; 11(2): e042034, 2021 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-33536319

RESUMO

OBJECTIVE: We aimed to identify the country-level determinants of the severity of the first wave of the COVID-19 pandemic. DESIGN: Ecological study of publicly available data. Countries reporting >25 COVID-19 related deaths until 8 June 2020 were included. The outcome was log mean mortality rate from COVID-19, an estimate of the country-level daily increase in reported deaths during the ascending phase of the epidemic curve. Potential determinants assessed were most recently published demographic parameters (population and population density, percentage population living in urban areas, population >65 years, average body mass index and smoking prevalence); economic parameters (gross domestic product per capita); environmental parameters (pollution levels and mean temperature (January-May); comorbidities (prevalence of diabetes, hypertension and cancer); health system parameters (WHO Health Index and hospital beds per 10 000 population); international arrivals; the stringency index, as a measure of country-level response to COVID-19; BCG vaccination coverage; UV radiation exposure; and testing capacity. Multivariable linear regression was used to analyse the data. PRIMARY OUTCOME: Country-level mean mortality rate: the mean slope of the COVID-19 mortality curve during its ascending phase. PARTICIPANTS: Thirty-seven countries were included: Algeria, Argentina, Austria, Belgium, Brazil, Canada, Chile, Colombia, the Dominican Republic, Ecuador, Egypt, Finland, France, Germany, Hungary, India, Indonesia, Ireland, Italy, Japan, Mexico, the Netherlands, Peru, the Philippines, Poland, Portugal, Romania, the Russian Federation, Saudi Arabia, South Africa, Spain, Sweden, Switzerland, Turkey, Ukraine, the UK and the USA. RESULTS: Of all country-level determinants included in the multivariable model, total number of international arrivals (beta 0.033 (95% CI 0.012 to 0.054)) and BCG vaccination coverage (-0.018 (95% CI -0.034 to -0.002)), were significantly associated with the natural logarithm of the mean death rate. CONCLUSIONS: International travel was directly associated with the mortality slope and thus potentially the spread of COVID-19. Very early restrictions on international travel should be considered to control COVID-19 outbreaks and prevent related deaths.


Assuntos
/mortalidade , Pandemias/estatística & dados numéricos , Adulto , África/epidemiologia , Fatores Etários , Idoso , Poluição do Ar/estatística & dados numéricos , América/epidemiologia , Ásia/epidemiologia , Índice de Massa Corporal , Diabetes Mellitus/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Densidade Demográfica , Fumar/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Temperatura , Viagem , Adulto Jovem
6.
PLoS Med ; 18(1): e1003490, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33428624

RESUMO

BACKGROUND: The COVID-19 epidemic in the United States is widespread, with more than 200,000 deaths reported as of September 23, 2020. While ecological studies show higher burdens of COVID-19 mortality in areas with higher rates of poverty, little is known about social determinants of COVID-19 mortality at the individual level. METHODS AND FINDINGS: We estimated the proportions of COVID-19 deaths by age, sex, race/ethnicity, and comorbid conditions using their reported univariate proportions among COVID-19 deaths and correlations among these variables in the general population from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). We used these proportions to randomly sample individuals from NHANES. We analyzed the distributions of COVID-19 deaths by race/ethnicity, income, education level, and veteran status. We analyzed the association of these characteristics with mortality by logistic regression. Summary demographics of deaths include mean age 71.6 years, 45.9% female, and 45.1% non-Hispanic white. We found that disproportionate deaths occurred among individuals with nonwhite race/ethnicity (54.8% of deaths, 95% CI 49.0%-59.6%, p < 0.001), individuals with income below the median (67.5%, 95% CI 63.4%-71.5%, p < 0.001), individuals with less than a high school level of education (25.6%, 95% CI 23.4% -27.9%, p < 0.001), and veterans (19.5%, 95% CI 15.8%-23.4%, p < 0.001). Except for veteran status, these characteristics are significantly associated with COVID-19 mortality in multiple logistic regression. Limitations include the lack of institutionalized people in the sample (e.g., nursing home residents and incarcerated persons), the need to use comorbidity data collected from outside the US, and the assumption of the same correlations among variables for the noninstitutionalized population and COVID-19 decedents. CONCLUSIONS: Substantial inequalities in COVID-19 mortality are likely, with disproportionate burdens falling on those who are of racial/ethnic minorities, are poor, have less education, and are veterans. Healthcare systems must ensure adequate access to these groups. Public health measures should specifically reach these groups, and data on social determinants should be systematically collected from people with COVID-19.


Assuntos
/mortalidade , Disparidades em Assistência à Saúde/normas , Saúde Pública , Determinantes Sociais da Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Idoso , Comorbidade , Grupos Étnicos/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Mortalidade , Saúde Pública/métodos , Saúde Pública/normas , Melhoria de Qualidade/organização & administração , Estados Unidos , Saúde dos Veteranos/estatística & dados numéricos
8.
Aten. prim. (Barc., Ed. impr.) ; 53(1): 36-42, ene. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-200087

RESUMO

OBJETIVO: Analizar si la utilización de códigos Z en la historia clínica electrónica (HCE) se correlaciona con la realidad socioeconómica de la población atendida en Atención Primaria (AP). DISEÑO: Estudio observacional, descriptivo, transversal, de tipo ecológico. Emplazamiento: 90 centros de salud de dos Direcciones Asistenciales de AP, Comunidad de Madrid. PARTICIPANTES: El total de pacientes atendidos durante el año 2016 fue de 1.920.124 (54,33% mujeres, 45,67% hombres). El 7,15% recibió algún código Z (67,29% mujeres, 32,71% hombres). Mediciones principales: Como variable dependiente se estableció la proporción de pacientes con registros de códigos Z en su HCE. Como variables independientes se seleccionaron dos indicadores socioeconómicos que reflejan de forma objetiva las diferencias entre zonas básicas de salud: renta media disponible per cápita y proporción de inmigrantes económicos. Para evaluar la correlación entre variable dependiente e independientes se recurrió a análisis multivariante de correlación-regresión. RESULTADOS: Se observó que a mayor renta disponible, menor proporción de registros de episodios Z en las HCE (coeficiente de correlación de Pearson: -0,56). Sin embargo, existe una gran variabilidad de registro de códigos Z y la codificación no consigue visibilizar las realidades socioeconómicas de las poblaciones atendidas (odds ratio diagnóstica: 0,12 [IC: 0,05-0,32]). CONCLUSIONES: Resulta relevante para una orientación comunitaria de la AP la utilización de distintas herramientas que faciliten visibilizar el impacto en la salud de las desigualdades sociales, así como su evaluación a través de diversas metodologías de investigación. Los códigos Z no visibilizan en la zona estudiada los determinantes sociales de la salud de la población atendida


OBJECTIVE: Analyze whether the use of Z codes in the Electronic Health Record (EHR) correlates with the socioeconomic reality of the population attended. DESIGN: Observational, descriptive, cross-sectional, ecological study. LOCATION: 90 health centres of two Primary Health Care (PHC) Departments of the Community of Madrid. PARTICIPANTS: The total number of patients treated during 2016: 1,920,124 (54.33% women, 45.67% men). The 7.15% received some Z code (67.29% women, 32.71% men). MAIN MEASUREMENTS: As a dependent variable, the proportion of patients with Z code records in their EHRs was established. As independent variable, two socioeconomic indicators were selected that objectively reflect the differences between Basic Health Areas: Average Income Available per capita and Proportion of Economic Immigrants. To evaluate the correlation between dependent and independent variables, a multivariate correlation-regression analysis was used. RESULTS: It was observed that the higher the disposable income, the lower the proportion of Z code records in the EHRs (Pearson correlation coefficient: -0.56). However, there is a great variability in the registration of Z codes and the coding fails to make visible the socio-economic realities of the populations covered (Diagnostic Odds Ratio: 0.12. CI: 0.05-0.32). CONCLUSIONS: The use of different tools that facilitate the visualization of the health impact of social inequalities, as well as their evaluation through various research methodologies, is relevant for a community orientation of the PHC. The Z codes do not make visible in the studied area the social determinants of health of the population attended


Assuntos
Humanos , Masculino , Feminino , Atenção Primária à Saúde/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Estudos Transversais , Fatores Socioeconômicos , Valores de Referência , Disparidades nos Níveis de Saúde , Espanha
10.
Rev. Hosp. Ital. B. Aires (2004) ; 40(4): 185-190, dic. 2020.
Artigo em Espanhol | LILACS | ID: biblio-1145464

RESUMO

Esta revisión narrativa describe el daño colateral de la pandemia de COVID-19, tanto en aspectos de la salud, como también sociales, educativos o económicos. Comunicamos el impacto mundial y local. Consideramos que varias de estas consecuencias eran inevitables, especialmente las sucedidas durante los primeros meses de una pandemia que se difundió a gran velocidad y con graves consecuencias directas en la morbimortalidad de la población. Sin embargo, luego de seis meses de su llegada a la Argentina, es oportuno revaluar la situación y replantearse si no se debería cambiar el enfoque para balancear la minimización del impacto directo de COVID-19 junto con la del daño colateral que las medidas para paliarlo produjeron. Es un desafío que no debe limitarse al sistema de salud. Debe encararse con un abordaje intersectorial amplio y con participación activa de la sociedad. Así como aplanamos la curva de COVID-19, cuanto más nos demoremos en aplanar las otras curvas de problemas sanitarios y sociales que se están generando, mayor será su impacto, tanto en el corto como en el largo plazo. (AU)


This narrative review shows the collateral damage of the COVID-19 pandemic, whether in health, social, educational or economic aspects. We report on the impact at the global and local levels. Many of these consequences were inevitable, especially in the first months of a pandemic that spread at great speed and with serious direct consequences on the morbidity and mortality of the population. However, six months after the arrival in our country, it is an opportunity to reassess the situation and rethink whether the approach should not be changed to balance the minimization of the direct impact of COVID-19 with that of the collateral damage that mitigation measures produced. This is a challenge that should not be limited to the health system. It must be addressed with a broad intersectoral approach and active participation of society. Just as we flatten the COVID-19 curve, the longer we delay in flattening the other curves of health and social problems that are being generated, the greater the impact, both in the short and long term. (AU)


Assuntos
Humanos , Pneumonia Viral/economia , Infecções por Coronavirus/economia , Determinantes Sociais da Saúde/estatística & dados numéricos , Argentina , Pneumonia Viral/mortalidade , Pneumonia Viral/psicologia , Qualidade de Vida , Isolamento Social , Problemas Sociais/prevenção & controle , Problemas Sociais/estatística & dados numéricos , Estratégias Nacionais , Sistemas de Saúde/tendências , Indicadores de Morbimortalidade , Mortalidade , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/psicologia , Impactos na Saúde/estatística & dados numéricos , Equidade no Acesso aos Serviços de Saúde , Análise de Consequências , Comunicação em Saúde/métodos , Pandemias/estatística & dados numéricos
11.
Am J Emerg Med ; 38(9): 1904-1909, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32739860

RESUMO

BACKGROUND: Social determinants of health (SDH) are strong predictors of morbidity and mortality but health care systems struggle to integrate documentation of SDH into health records in ways that can be used for health services research. Given the impact of social factors on health, it is important to examine the relationship with emergency department (ED) utilization. OBJECTIVE: To examine the association between seven indicators of SDH and ED utilization using electronic health record (EHR) data from the Veterans Health Administration (VHA). METHODS: This cross-sectional analysis included data from all patients who had at least one health care visit in the Veterans Integrated Service Network region 4 from October 1, 2015 through September 30, 2016 (n=293,872). Seven categories of adverse SDH included violence, housing instability, employment or financial problems, legal problems, social or family problems, lack of access to care or transportation, and non-specific psychosocial needs identified through structured coding in EHR. Negative binomial regression was used to examine the association of the count of adverse SDH (0-7) with the count of ED visits, adjusting for socio-demographic and health-related factors. RESULTS: Approximately 18% of patients visited the ED during the observation period. After adjusting for covariates, adverse SDH were positively associated with VHA ED utilization. Each of the SDH indicators, other than legal issues, was positively associated with increased ED utilization. CONCLUSION: Even after accounting for several demographic and health-related factors, adverse SDH demonstrated strong positive associations with VHA ED utilization.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Serviços de Saúde para Veteranos Militares/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos , United States Department of Veterans Affairs/estatística & dados numéricos , Adulto Jovem
12.
Nutrients ; 12(9)2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32825251

RESUMO

The coronavirus disease (COVID-19) pandemic has increased unemployment and food insecurity in the United States (US). Prior to the pandemic, college students exhibited higher rates of food insecurity than nonstudent households. The objectives of this study were to assess the prevalence and determinants of food insecurity among college students during the COVID-19 pandemic. We administered an online survey to 651 students on three diverse campuses at a state-funded university in Texas, US, in May 2020. Food security was assessed using a multistep approach that included the 2-item Food Sufficiency Screener and 6-Item USDA Food Security Survey Module (FSSM). Overall, 34.5% of respondents were classified as food insecure within the last 30 days. The strongest predictors of food insecurity were change in current living arrangement (OR = 2.70, 95% CI: 2.47, 2.95), being furloughed (OR = 3.22, 95% CI: 2.86, 3.64), laid off (OR = 4.07, 95% CI: 3.55, 4.66), or losing part-time work (OR = 5.73, 95% CI: 5.09, 6.46) due to the COVID-19 pandemic. These findings highlight the high prevalence of food insecurity among college students during the COVID-19 pandemic, with students who experienced housing insecurity and/or loss of income due to the pandemic being impacted the most.


Assuntos
Infecções por Coronavirus/economia , Abastecimento de Alimentos/estatística & dados numéricos , Pandemias/economia , Pneumonia Viral/economia , Determinantes Sociais da Saúde/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Adulto , Betacoronavirus , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Prevalência , Texas/epidemiologia , Estados Unidos/epidemiologia , Universidades , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-32785046

RESUMO

The Health Opportunity Index (HOI) is a multivariate tool that can be more efficiently used to identify and understand the interplay of complex social determinants of health (SDH) at the census tract level that influences the ability to achieve optimal health. The derivation of the HOI utilizes the data-reduction technique of principal component analysis to determine the impact of SDH on optimal health at lower census geographies. In the midst of persistent health disparities and the present COVID-19 pandemic, we demonstrate the potential utility of using 13-input variables to derive a composite metric of health (HOI) score as a means to assist in the identification of the most vulnerable communities during the current pandemic. Using GIS mapping technology, health opportunity indices were layered by counties in Ohio to highlight differences by census tract. Collectively we demonstrate that our HOI framework, principal component analysis and convergence analysis methodology coalesce to provide results supporting the utility of this framework in the three largest counties in Ohio: Franklin (Columbus), Cuyahoga (Cleveland), and Hamilton (Cincinnati). The results in this study identified census tracts that were also synonymous with communities that were at risk for disparate COVID-19 related health outcomes. In this regard, convergence analyses facilitated identification of census tracts where different disparate health outcomes co-exist at the worst levels. Our results suggest that effective use of the HOI composite score and subcomponent scores to identify specific SDH can guide mitigation/intervention practices, thus creating the potential for better targeting of mitigation and intervention strategies for vulnerable communities, such as during the current pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Betacoronavirus , Censos , Mapeamento Geográfico , Humanos , Ohio/epidemiologia , Pandemias , Análise de Componente Principal , Fatores Socioeconômicos
14.
J Prev Med Public Health ; 53(4): 220-227, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32752590

RESUMO

OBJECTIVES: The aim of this study was to assess how different social determinants of health (SDoH) may be related to variability in coronavirus disease 2019 (COVID-19) rates in cities and towns in Massachusetts (MA). METHODS: Data about the total number of cases, tests, and rates of COVID-19 as of June 10, 2020 were obtained for cities and towns in MA. The data on COVID-19 were matched with data on various SDoH variables at the city and town level from the American Community Survey. These variables included information about income, poverty, employment, renting, and insurance coverage. We compared COVID-19 rates according to these SDoH variables. RESULTS: There were clear gradients in the rates of COVID-19 according to SDoH variables. Communities with more poverty, lower income, lower insurance coverage, more unemployment, and a higher percentage of the workforce employed in essential services, including healthcare, had higher rates of COVID-19. Most of these differences were not accounted for by different rates of testing in these cities and towns. CONCLUSIONS: SDoH variables may explain some of the variability in the risk of COVID-19 across cities and towns in MA. Data about SDoH should be part of the standard surveillance for COVID-19. Efforts should be made to address social factors that may be putting communities at an elevated risk.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Massachusetts/epidemiologia , Pandemias , Pobreza/estatística & dados numéricos , Inquéritos e Questionários
15.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32753371

RESUMO

BACKGROUND AND OBJECTIVES: Although clinical settings are increasingly screening for social determinants of health, essential questions about optimal screening remain. We aimed to assess primary care contexts of individuals choosing not to answer questions about health-related social needs and to compare screening question response with subsequent use of resource information. METHODS: We compared caregiver responses to an electronic survey administered during a child's emergency department visit and through telephone follow-up 2 weeks later by responses to questions about health-related social needs (no social needs endorsed, ≥1 endorsed, none endorsed but ≥1 question not answered). RESULTS: Of 146 respondents, 42 (29%) endorsed ≥1 health-related social need. Additionally, 19 (13%) endorsed no social needs but did not answer ≥1 question. Compared with those denying all social needs and those endorsing ≥1 social need, respondents who did not answer social needs screening questions reported longer duration since their child's last primary care visit, lower perceptions of primary care, and less social support. For the 61 respondents participating in the 2-week follow-up survey, reported use of a community resource packet was 37% among those who had reported a social need, 26% among those who had denied all social needs, and 0% among those who had not answered ≥1 social needs questions. CONCLUSIONS: Clinicians and systems implementing screening for health-related social risks should plan for individuals who choose not to respond to specific items and may also wish to consider strategies that do not rely on screening and disclosure, particularly in communities known to have high prevalence of social needs.


Assuntos
Acesso à Informação , Cuidadores/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Adulto , Cuidadores/psicologia , Distribuição de Qui-Quadrado , Pré-Escolar , Feminino , Seguimentos , Abastecimento de Alimentos/estatística & dados numéricos , Recursos em Saúde/organização & administração , Humanos , Comportamento de Busca de Informação , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Apoio Social , Transportes/estatística & dados numéricos , Adulto Jovem
16.
Womens Health (Lond) ; 16: 1745506520949727, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842920

RESUMO

OBJECTIVES: maternal and neonatal mortality in Ethiopia is a major reproductive health problem. Obstructed labor is one of the leading causes of maternal, fetal, and neonatal morbidity in developing countries. The evidence regarding its determinants at the tertiary level of care is sparse. Therefore, this study aimed to study the determinants of obstructed labor among women attending intrapartum care in Amhara region referral hospitals. METHODS: A Hospital-based unmatched case-control study was conducted from March 1stto August 30, 2017. Cases were women whose labor was obstructed (n = 270), and controls were women whose labor was not obstructed (n = 540). Both cases and controls were selected randomly, and a proportional to size allocation was made to the referral hospitals selected for the study. A binary and a multivariable logistic regression model was computed to identify the determinant factors at 95% CI. RESULTS: The mean age of the study participants was 27.66 years (27.4 ± 5.44 for cases and 28.15 ± 6.16 for controls), ranging between 16 and 45 years. Relatively, higher proportions of cases than controls were unable to read and write (58.5%) and were urban residents (53.7%). Distance from hospital, distance from health center, mothers inability to read and write, mothers primary level of education, more than 28 weeks of gestation at the first visit of antenatal care, 37 to 42 weeks at admission, above 42 weeks at admission, women of a merchant spouse, and history of pregnancy-related complications were the positive determinants of obstructed labor. However, mothers whose gestational age was 16 to 28 weeks at the first antenatal care visit were 62% less likely to be exposed to obstructed labor. CONCLUSIONS: Obstetric, service-related, and system factors were predictors of obstructed labor. Improving women's literacy status, health service access, and utilization will help reduce obstructed labor.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , História Reprodutiva , Determinantes Sociais da Saúde/estatística & dados numéricos , Adolescente , Adulto , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Maternidades , Hospitais Estaduais , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Assistência Perinatal , Gravidez , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
17.
Am J Public Health ; 110(S2): S219-S221, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32663083

RESUMO

Universal screenings for social determinants of health (SDOH) are feasible at the health system level and enable institutions to identify unmet social needs that would otherwise go undiscovered. NewYork-Presbyterian Hospital implemented SDOH screenings together with clinical screenings in four outpatient primary care sites. Aligning SDOH screening with clinical screening was crucial for establishing provider buy-in and ensuring sustainability of screening for SDOH. Despite some challenges, universal screening for SDOH has allowed NewYork-Presbyterian Hospital to identify unmet needs to improve population health.


Assuntos
Programas de Rastreamento/organização & administração , Atenção Primária à Saúde/organização & administração , Determinantes Sociais da Saúde/estatística & dados numéricos , Centros Médicos Acadêmicos , Instituições de Assistência Ambulatorial/organização & administração , Registros Eletrônicos de Saúde , Feminino , Letramento em Saúde , Humanos , Masculino , Grupos Minoritários , Cidade de Nova Iorque , Atenção Primária à Saúde/métodos
18.
BMC Infect Dis ; 20(1): 490, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32650738

RESUMO

BACKGROUND: In order to effectively combat Tuberculosis, resources to diagnose and treat TB should be allocated effectively to the areas and population that need them. Although a wealth of subnational data on TB is routinely collected to support local planning, it is often underutilized. Therefore, this study uses spatial analytical techniques and profiling to understand and identify factors underlying spatial variation in TB case notification rates (CNR) in Bangladesh, Nepal and Pakistan for better TB program planning. METHODS: Spatial analytical techniques and profiling was used to identify subnational patterns of TB CNRs at the district level in Bangladesh (N = 64, 2015), Nepal (N = 75, 2014) and Pakistan (N = 142, 2015). A multivariable linear regression analysis was performed to assess the association between subnational CNR and demographic and health indicators associated with TB burden and indicators of TB programme efforts. To correct for spatial dependencies of the observations, the residuals of the multivariable models were tested for unexplained spatial autocorrelation. Spatial autocorrelation among the residuals was adjusted for by fitting a simultaneous autoregressive model (SAR). RESULTS: Spatial clustering of TB CNRs was observed in all three countries. In Bangladesh, TB CNR were found significantly associated with testing rate (0.06%, p < 0.001), test positivity rate (14.44%, p < 0.001), proportion of bacteriologically confirmed cases (- 1.33%, p < 0.001) and population density (4.5*10-3%, p < 0.01). In Nepal, TB CNR were associated with population sex ratio (1.54%, p < 0.01), facility density (- 0.19%, p < 0.05) and treatment success rate (- 3.68%, p < 0.001). Finally, TB CNR in Pakistan were found significantly associated with testing rate (0.08%, p < 0.001), positivity rate (4.29, p < 0.001), proportion of bacteriologically confirmed cases (- 1.45, p < 0.001), vaccination coverage (1.17%, p < 0.001) and facility density (20.41%, p < 0.001). CONCLUSION: Subnational TB CNRs are more likely reflective of TB programme efforts and access to healthcare than TB burden. TB CNRs are better used for monitoring and evaluation of TB control efforts than the TB epidemic. Using spatial analytical techniques and profiling can help identify areas where TB is underreported. Applying these techniques routinely in the surveillance facilitates the use of TB CNRs in program planning.


Assuntos
Notificação de Doenças/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Tuberculose/epidemiologia , Bangladesh/epidemiologia , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Mortalidade , Nepal/epidemiologia , Paquistão/epidemiologia , Densidade Demográfica , Razão de Masculinidade , Análise Espacial , Resultado do Tratamento , Tuberculose/tratamento farmacológico , Cobertura Vacinal/estatística & dados numéricos
19.
Ann Epidemiol ; 48: 36-42.e3, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32651047

RESUMO

PURPOSE: The purpose of this study was to understand why a housing mobility experiment caused harmful effects on adolescent boys' risky behaviors. METHODS: Moving to Opportunity (MTO) (1994-2010) randomly assigned volunteer families to a treatment group receiving a Section 8 rental voucher or a public housing control group. Our outcome was a global risky behavior index (RBI; measured in 2002, n = 750 boys) measuring the fraction of 10 items the youth engaged in, 6 measuring past 30-day substance use and 4 measuring recent risky sexual behavior. Potential mediators (measured in 2002) included peer social relationships (e.g., peer drug use, peer gang membership). RESULTS: The voucher treatment main effect on boys' RBI was harmful (B (SE) = 0.05 (0.02), 95% CI 0.01, 0.08), and treatment marginally increased having friends who used drugs compared to controls (B (SE) = 0.67 (0.23), 95% CI 0.22, 1.12). Having friends who used drugs marginally mediated the MTO treatment effect on RBI (indirect effect: B (SE) = 0.02(.01), 95% CI -0.002, 0.04), reducing the total treatment effect by 39%. CONCLUSIONS: Incorporating additional supports into housing voucher programs may help support teenage boys who experience disruptions to their social networks, to buffer potential adverse consequences of residential mobility.


Assuntos
Comportamento do Adolescente/psicologia , Relações Interpessoais , Grupo Associado , Habitação Popular , Características de Residência , Comportamento Sexual/psicologia , Determinantes Sociais da Saúde/economia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Características da Família , Humanos , Masculino , Dinâmica Populacional , Pobreza , Habitação Popular/economia , Habitação Popular/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Fatores de Risco , Assunção de Riscos , Determinantes Sociais da Saúde/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos
20.
BMC Public Health ; 20(1): 1125, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32680488

RESUMO

BACKGROUND: Anaemia is a global health problem and women in reproductive age (WRA) are amongst the most affected population. Its consequences include low birth weight and maternal mortality. This study aimed to assess the prevalence of anaemia and to identify its determinants in Sudanese women in reproductive age. METHODS: A population-based cross-sectional study was conducted in Sudan in 2016. A multi-stage stratified cluster sampling design was executed with consideration of rural population, urban population, and internally displaced persons/refugees camps residents. All women in reproductive age (15-49 years), classified by pregnancy status, in the targeted households were surveyed and personal characteristic data were collected. Their haemoglobin level and malaria infection (using rapid diagnostic test, RDT) were assessed. The World Health Organization (WHO) haemoglobin level cut-off for defining anaemia and severe anaemia in pregnant and non-pregnant women was used. Logistic regression analyses were performed. RESULTS: A total of 4271 women (WRA) of which 421 (9.9%) pregnant women (PW) were included in the study. The overall anaemia prevalence in WRA was 35.6%. It was 36.0 and 35.5% in PW and non-pregnant women (NPW), respectively. The average haemoglobin level was found to be 113.9 g/L (SD 16.3) and 123.2 g/L (SD 15.7) for PW and NPW respectively. Severe anaemia prevalence was 1.2% in each group. In the logistic regression model, anaemia was associated with malaria infection in PW (aOR 4.100, 95%CI 1.523-11.039, p = 0.003), NPW (aOR 2.776, 95%CI 1.889-4.080, p < 0.001), and WRA (aOR 2.885, 95%CI 2.021-4.119, p < 0.001). Other identified determinants of anaemia in NPW was living in camps (aOR 1.499, 95%CI 1.115-2.017, p = 0.007) and in WRA was being in the poorest economic class (aOR 1.436, 95%CI 1.065-1.936, p = 0.018). CONCLUSIONS: Anaemia is a public health problem in Sudan. The study supported the association between malaria infection and anaemia, but not with low and moderate malaria transmission areas. Resources need to be allocated for all anaemic populations with special attention for the populations in most need and interventions need to be implemented based on local variations. Malaria control interventions, specifically case management, may have a major impact in reducing anaemia prevalence in low to moderate malaria transmission areas.


Assuntos
Anemia/epidemiologia , Complicações na Gravidez/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adolescente , Adulto , Anemia/etiologia , Análise por Conglomerados , Estudos Transversais , Características da Família , Feminino , Hemoglobinas/análise , Humanos , Modelos Logísticos , Malária/epidemiologia , Pobreza/estatística & dados numéricos , Gravidez , Complicações na Gravidez/etiologia , Prevalência , Refugiados/estatística & dados numéricos , Fatores de Risco , População Rural/estatística & dados numéricos , Sudão/epidemiologia , Inquéritos e Questionários , População Urbana/estatística & dados numéricos , Adulto Jovem
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