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1.
West J Emerg Med ; 21(5): 1048-1053, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32970553

RESUMO

INTRODUCTION: The unfolding COVID-19 pandemic has predictably followed the familiar contours of well established socioeconomic health inequities, exposing and often amplifying preexisting disparities. People living in homeless shelters are at higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared to the general population. The purpose of this study was to identify shelter characteristics that may be associated with higher transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We conducted a cross-sectional assessment of five congregate shelters in Rhode Island. Shelter residents 18 years old and older were tested for SARS-CoV-2 from April 19-April 24, 2020. At time of testing, we collected participant characteristics, symptomatology, and vital signs. Shelter characteristics and infection control strategies were collected through a structured phone questionnaire with shelter administrators. RESULTS: A total of 299 shelter residents (99%, 299/302) participated. Thirty-five (11.7%) tested positive for SARS-CoV-2. Shelter-level prevalence ranged from zero to 35%. Symptom prevalence did not vary by test result. Shelters with positive cases of SARS-CoV-2 were in more densely populated areas, had more transient resident populations, and instituted fewer physical distancing practices compared to shelters with no cases. CONCLUSION: SARS-CoV-2 prevalence varies with shelter characteristics but not individual symptoms. Policies that promote resident stability and physical distancing may help reduce SARS-CoV-2 transmission. Symptom screening alone is insufficient to prevent SARS-CoV-2 transmission. Frequent universal testing and congregate housing alternatives that promote stability may help reduce spread of infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Disparidades nos Níveis de Saúde , Pessoas em Situação de Rua/estatística & dados numéricos , Habitação/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Estudos Transversais , Feminino , Política de Saúde , Inquéritos Epidemiológicos , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Prevalência , Rhode Island/epidemiologia , Adulto Jovem
2.
MMWR Morb Mortal Wkly Rep ; 69(33): 1139-1143, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32817597

RESUMO

Preventing coronavirus disease 2019 (COVID-19) in correctional and detention facilities* can be challenging because of population-dense housing, varied access to hygiene facilities and supplies, and limited space for isolation and quarantine (1). Incarcerated and detained populations have a high prevalence of chronic diseases, increasing their risk for severe COVID-19-associated illness and making early detection critical (2,3). Correctional and detention facilities are not closed systems; SARS-CoV-2, the virus that causes COVID-19, can be transmitted to and from the surrounding community through staff member and visitor movements as well as entry, transfer, and release of incarcerated and detained persons (1). To better understand SARS-CoV-2 prevalence in these settings, CDC requested data from 15 jurisdictions describing results of mass testing events among incarcerated and detained persons and cases identified through earlier symptom-based testing. Six jurisdictions reported SARS-CoV-2 prevalence of 0%-86.8% (median = 29.3%) from mass testing events in 16 adult facilities. Before mass testing, 15 of the 16 facilities had identified at least one COVID-19 case among incarcerated or detained persons using symptom-based testing, and mass testing increased the total number of known cases from 642 to 8,239. Case surveillance from symptom-based testing has likely underestimated SARS-CoV-2 prevalence in correctional and detention facilities. Broad-based testing can provide a more accurate assessment of prevalence and generate data to help control transmission (4).


Assuntos
Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/prevenção & controle , Programas de Rastreamento , Pneumonia Viral/epidemiologia , Prisões , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Habitação/estatística & dados numéricos , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prevalência , Estados Unidos/epidemiologia
3.
PLoS One ; 15(7): e0236078, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687527

RESUMO

BACKGROUND: The disruptive potential of mobile phones in catalyzing development is increasingly being recognized. However, numerous gaps remain in access to phones and their influence on health care utilization. In this cross-sectional study from India, we assess the gaps in women's access to phones, their influencing factors, and their influence on health care utilization. METHODS: Data drawn from the 2015 National Family Health Survey (NFHS) in India included a national sample of 45,231 women with data on phone access. Survey design weighted estimates of household phone ownership and women's access among different population sub-groups are presented. Multilevel logistic models explored the association of phone access with a wide range of maternal and child health indicators. Blinder-Oaxaca (BO) decomposition is used to decompose the gaps between women with and without phone access in health care utilization into components explained by background characteristics influencing phone access (endowments) and unexplained components (coefficients), potentially attributable to phone access itself. FINDINGS: Phone ownership at the household level was 92·8% (95% CI: 92·6-93·0%), with rural ownership at 91·1% (90·8-91·4%) and urban at 97.1% (96·7-97·3%). Women's access to phones was 47·8% (46·7-48·8%); 41·6% in rural areas (40·5-42·6%) and 62·7% (60·4-64·8%) in urban. Phone access in urban areas was positively associated with skilled birth attendance, postnatal care and use of modern contraceptives and negatively associated with early antenatal care. Phone access was not associated with improvements in utilization indicators in rural settings. Phone access (coefficient components) explained large gaps in the use of modern contraceptives, moderate gaps in postnatal care and early antenatal care, and smaller differences in the use of skilled birth attendance and immunization. For full antenatal car, phone access was associated with reducing gaps in utilization. INTERPRETATION: Women of reproductive age have significantly lower phone access use than the households they belong to and marginalized women have the least phone access. Existing phone access for rural women did not improve their health care utilization but was associated with greater utilization for urban women. Without addressing these biases, digital health programs may be at risk of worsening existing health inequities.


Assuntos
Telefone Celular/estatística & dados numéricos , Nível de Saúde , Inquéritos Epidemiológicos , Adulto , Feminino , Habitação/estatística & dados numéricos , Humanos , Índia , Serviços de Saúde Materna/estatística & dados numéricos , Análise Multivariada , Propriedade/estatística & dados numéricos
4.
PLoS One ; 15(7): e0235626, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32658895

RESUMO

BACKGROUND: Approximately 20.5 million infants were born weighing <2500 g (defined as low birthweight or LBW) in 2015, primarily in low- and middle-income countries (LMICs). Infants born LBW, including those born preterm (<37 weeks gestation), are at increased risk for numerous consequences, including neonatal mortality and morbidity as well as suboptimal health and nutritional status later in life. The objective of this study was to identify predictors of LBW and preterm birth among infants in rural Uganda. METHODS: Data were derived from a prospective birth cohort study conducted from 2014-2016 in 12 districts across northern and southwestern Uganda. Birth weights were measured in triplicate to the nearest 0.1 kg by trained enumerators within 72 hours of delivery. Gestational age was calculated from the first day of last menstrual period (LMP). Associations between household, maternal, and infant characteristics and birth outcomes (LBW and preterm birth) were assessed using bivariate and multivariable logistic regression with stepwise, backward selection analyses. RESULTS: Among infants in the study, 4.3% were born LBW (143/3,337), and 19.4% were born preterm (744/3,841). In multivariable analysis, mothers who were taller (>150 cm) (adjusted Odds Ratio (aOR) = 0.42 (95% CI = 0.24, 0.72)), multigravida (aOR = 0.62 (95% CI = 0.39, 0.97)), or with adequate birth spacing (>24 months) (aOR = 0.60 (95% CI = 0.39, 0.92)) had lower odds of delivering a LBW infant Mothers with severe household food insecurity (aOR = 1.84 (95% CI = 1.22, 2.79)) or who tested positive for malaria during pregnancy (aOR = 2.06 (95% CI = 1.10, 3.85)) had higher odds of delivering a LBW infant. In addition, in multivariable analysis, mothers who resided in the Southwest (aOR = 0.64 (95% CI = 0.54, 0.76)), were ≥20 years old (aOR = 0.76 (95% CI = 0.61, 0.94)), with adequate birth spacing (aOR = 0.76 (95% CI = 0.63, 0.93)), or attended ≥4 antenatal care (ANC) visits (aOR = 0.56 (95% CI = 0.47, 0.67)) had lower odds of delivering a preterm infant; mothers who were neither married nor cohabitating (aOR = 1.42 (95% CI = 1.00, 2.00)) or delivered at home (aOR = 1.25 (95% CI = 1.04, 1.51)) had higher odds. CONCLUSIONS: In rural Uganda, severe household food insecurity, adolescent pregnancy, inadequate birth spacing, malaria infection, suboptimal ANC attendance, and home delivery represent modifiable risk factors associated with higher rates of LBW and/or preterm birth. Future studies on interventions to address these risk factors may be warranted.


Assuntos
Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , População Rural/estatística & dados numéricos , Adolescente , Adulto , Estudos de Coortes , Feminino , Habitação/estatística & dados numéricos , Humanos , Lactente , Masculino , Mães , Gravidez , Uganda/epidemiologia , Adulto Jovem
5.
Environ Health Prev Med ; 25(1): 28, 2020 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-32652952

RESUMO

BACKGROUND: Sick building syndrome (SBS) refers to the combination of symptoms experienced by occupants of specific building characteristics. This study investigated the associations of children's lifestyle behaviors, allergies, home, and school environment with SBS symptoms. METHODS: A total of 4408 elementary school children living in Sapporo City, Japan participated in this study. SBS was determined on parental answers to MM080 standardized school questionnaires on symptoms that were weekly experienced by these children, and if the symptom is attributed to their home or school environment. The Japanese version of the International Study of Asthma and Allergies in Childhood questionnaire was used to assess wheeze, rhino-conjunctivitis, and eczema. A logistic regression analysis was conducted to evaluate the associations between SBS symptoms and variables by controlling the potential confounders (gender, grade, school, and parental history of allergies). A stepwise backward elimination was conducted to assess independent variables related to SBS. RESULTS: Participants revealed mucosal (6.9%), skin (2.0%), and general (0.8%) symptoms. The presence of one or more allergy was associated with increased mucosal and skin symptoms. Children who skipped breakfast, displayed faddiness (like/dislike of food), had constipation, have insufficient sleep, did not feel refreshed after sleep, and lacked deep sleep showed significantly high odds ratios with SBS symptoms. The stepwise analysis showed faddiness for mucosal symptoms and not feeling refreshed after sleep for mucosal and skin symptoms, whereas constipation and lacking deep sleep for general symptoms were independent variables in increasing the symptoms. We found no significant relationship between SBS in children and schools. Considering children's home, old building, no ventilation, wall-to-wall carpet, and heavy nearby traffic were associated with elevated mucosal symptom, while living in a multifamily home increased general symptoms. Home dampness was an independent variable in increasing all SBS symptoms. CONCLUSIONS: Allergies and lifestyle behaviors were associated with increased SBS in children, including skipping breakfast, displaying faddiness, constipation, insufficient sleep, not feeling refreshed after sleep, and the lack of deep sleep. Further, dampness at home was associated with increase in all SBS symptoms. Lifestyle (e.g., eating and sleeping habits) and home (i.e., dampness) improvements might alleviate SBS symptoms in children.


Assuntos
Meio Ambiente , Hipersensibilidade/epidemiologia , Estilo de Vida , Síndrome do Edifício Doente/epidemiologia , Estudantes/estatística & dados numéricos , Criança , Estudos Transversais , Habitação/estatística & dados numéricos , Humanos , Hipersensibilidade/etiologia , Japão , Prevalência , Instituições Acadêmicas/estatística & dados numéricos , Síndrome do Edifício Doente/etiologia
7.
PLoS One ; 15(6): e0234324, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32511267

RESUMO

OBJECTIVE: Low individual socioeconomic status (SES) is known to be associated with a higher risk of type 2 diabetes mellitus (T2DM), but the extent to which the local context in which people live may influence T2DM rates remains unclear. This study examines whether living in a low property value neighbourhood is associated with higher rates of T2DM independently of individual SES. RESEARCH DESIGN AND METHODS: Using cross-sectional data from the Maastricht Study (2010-2013) and geographical data from Statistics Netherlands, multilevel logistic regression was used to assess the association between neighbourhood property value and T2DM. Individual SES was based on education, occupation and income. Of the 2,056 participants (aged 40-75 years), 494 (24%) were diagnosed with T2DM. RESULTS: Individual SES was strongly associated with T2DM, but a significant proportion of the variance in T2DM was found at the neighbourhood level (VPC = 9.2%; 95% CI = 5.0%-16%). Participants living in the poorest neighbourhoods had a 2.38 times higher odds ratio of T2DM compared to those living in the richest areas (95% CI = 1.58-3.58), independently of individual SES. CONCLUSIONS: Neighbourhood property value showed a significant association with T2DM, suggesting the usefulness of area-based programmes aimed at improving neighbourhood characteristics in order to tackle inequalities in T2DM.


Assuntos
Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/epidemiologia , Habitação/economia , Características de Residência , Adulto , Idoso , Estudos Transversais , Feminino , Habitação/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Pobreza/economia , Pobreza/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Fatores de Risco , Classe Social
8.
Chemosphere ; 257: 127119, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32497835

RESUMO

Radon-based radiation from natural soil building materials is an important factor likely influencing residents' health as a contributing source of natural radiation. This survey aims to quantify the nuclide-specific α-radiation of isotopes 222Rn and 220Rn in common types of houses in a region of northern Vietnam, Dong Van karst plateau, to preliminarily (i) evaluate the total annual effective dose rates and (ii) assess the relative risk of cancer induction from indoor α-radiation for inhabitants. The average 222Rn concentrations in all house types were lower than 100 Bq m-3, but 220Rn abundances were far higher than 222Rn, even up to >1000 Bq m-3 in air close to a wall of unfired-soil bricks. The estimated total annual effective dose rates from indoor 222Rn and 220Rn and their progenies to residents with daily exposure of 13 h in the various types of houses range from 3.1 to 4.3 mSv a-1 for houses constructed with modified materials, but up to higher than 6 mSv a-1 in houses with raw building materials. The average risk of developing lung cancer as a consequence of a lifetime exposure to indoor α-radiation in affected homes ranges from 3.9% to 14.6%. 220Rn and its metallic progenies contribute more than 80% of the total average lung cancer risk from total radon, being responsible for a range of 2.7-14.6% of the risk of developing lung cancer.


Assuntos
Poluentes Radioativos do Ar/análise , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Monitoramento de Radiação , Radônio/análise , Poluição do Ar em Ambientes Fechados/análise , Radiação de Fundo , Materiais de Construção , Habitação/estatística & dados numéricos , Humanos , Solo , Vietnã
10.
MMWR Morb Mortal Wkly Rep ; 69(17): 521-522, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: covidwho-101898

RESUMO

In the United States, approximately 1.4 million persons access emergency shelter or transitional housing each year (1). These settings can pose risks for communicable disease spread. In late March and early April 2020, public health teams responded to clusters (two or more cases in the preceding 2 weeks) of coronavirus disease 2019 (COVID-19) in residents and staff members from five homeless shelters in Boston, Massachusetts (one shelter); San Francisco, California (one); and Seattle, Washington (three). The investigations were performed in coordination with academic partners, health care providers, and homeless service providers. Investigations included reverse transcription-polymerase chain reaction testing at commercial and public health laboratories for SARS-CoV-2, the virus that causes COVID-19, over approximately 1-2 weeks for residents and staff members at the five shelters. During the same period, the team in Seattle, Washington, also tested residents and staff members at 12 shelters where a single case in each had been identified. In Atlanta, Georgia, a team proactively tested residents and staff members at two shelters with no known COVID-19 cases in the preceding 2 weeks. In each city, the objective was to test all shelter residents and staff members at each assessed facility, irrespective of symptoms. Persons who tested positive were transported to hospitals or predesignated community isolation areas.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pessoas em Situação de Rua/estatística & dados numéricos , Habitação/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Boston/epidemiologia , Cidades , Georgia/epidemiologia , Humanos , Pandemias , Prevalência , São Francisco/epidemiologia , Washington/epidemiologia
11.
MMWR Morb Mortal Wkly Rep ; 69(17): 523-526, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: covidwho-101802

RESUMO

On March 30, 2020, Public Health - Seattle and King County (PHSKC) was notified of a confirmed case of coronavirus disease 2019 (COVID-19) in a resident of a homeless shelter and day center (shelter A). Residents from two other homeless shelters (B and C) used shelter A's day center services. Testing for SARS-CoV-2, the virus that causes COVID-19, was offered to available residents and staff members at the three shelters during March 30-April 1, 2020. Among the 181 persons tested, 19 (10.5%) had positive test results (15 residents and four staff members). On April 1, PHSKC and CDC collaborated to conduct site assessments and symptom screening, isolate ill residents and staff members, reinforce infection prevention and control practices, provide face masks, and advise on sheltering-in-place. Repeat testing was offered April 7-8 to all residents and staff members who were not tested initially or who had negative test results. Among the 118 persons tested in the second round of testing, 18 (15.3%) had positive test results (16 residents and two staff members). In addition to the 31 residents and six staff members identified through testing at the shelters, two additional cases in residents were identified during separate symptom screening events, and four were identified after two residents and two staff members independently sought health care. In total, COVID-19 was diagnosed in 35 of 195 (18%) residents and eight of 38 (21%) staff members who received testing at the shelter or were evaluated elsewhere. COVID-19 can spread quickly in homeless shelters; rapid interventions including testing and isolation to identify cases and minimize transmission are necessary. CDC recommends that homeless service providers implement appropriate infection control practices, apply physical distancing measures including ensuring resident's heads are at least 6 feet (2 meters) apart while sleeping, and promote use of cloth face coverings among all residents (1).


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Pessoas em Situação de Rua/estatística & dados numéricos , Habitação/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Washington/epidemiologia
12.
MMWR Morb Mortal Wkly Rep ; 69(17): 523-526, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32352954

RESUMO

On March 30, 2020, Public Health - Seattle and King County (PHSKC) was notified of a confirmed case of coronavirus disease 2019 (COVID-19) in a resident of a homeless shelter and day center (shelter A). Residents from two other homeless shelters (B and C) used shelter A's day center services. Testing for SARS-CoV-2, the virus that causes COVID-19, was offered to available residents and staff members at the three shelters during March 30-April 1, 2020. Among the 181 persons tested, 19 (10.5%) had positive test results (15 residents and four staff members). On April 1, PHSKC and CDC collaborated to conduct site assessments and symptom screening, isolate ill residents and staff members, reinforce infection prevention and control practices, provide face masks, and advise on sheltering-in-place. Repeat testing was offered April 7-8 to all residents and staff members who were not tested initially or who had negative test results. Among the 118 persons tested in the second round of testing, 18 (15.3%) had positive test results (16 residents and two staff members). In addition to the 31 residents and six staff members identified through testing at the shelters, two additional cases in residents were identified during separate symptom screening events, and four were identified after two residents and two staff members independently sought health care. In total, COVID-19 was diagnosed in 35 of 195 (18%) residents and eight of 38 (21%) staff members who received testing at the shelter or were evaluated elsewhere. COVID-19 can spread quickly in homeless shelters; rapid interventions including testing and isolation to identify cases and minimize transmission are necessary. CDC recommends that homeless service providers implement appropriate infection control practices, apply physical distancing measures including ensuring resident's heads are at least 6 feet (2 meters) apart while sleeping, and promote use of cloth face coverings among all residents (1).


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Pessoas em Situação de Rua/estatística & dados numéricos , Habitação/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Washington/epidemiologia
13.
MMWR Morb Mortal Wkly Rep ; 69(17): 521-522, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32352957

RESUMO

In the United States, approximately 1.4 million persons access emergency shelter or transitional housing each year (1). These settings can pose risks for communicable disease spread. In late March and early April 2020, public health teams responded to clusters (two or more cases in the preceding 2 weeks) of coronavirus disease 2019 (COVID-19) in residents and staff members from five homeless shelters in Boston, Massachusetts (one shelter); San Francisco, California (one); and Seattle, Washington (three). The investigations were performed in coordination with academic partners, health care providers, and homeless service providers. Investigations included reverse transcription-polymerase chain reaction testing at commercial and public health laboratories for SARS-CoV-2, the virus that causes COVID-19, over approximately 1-2 weeks for residents and staff members at the five shelters. During the same period, the team in Seattle, Washington, also tested residents and staff members at 12 shelters where a single case in each had been identified. In Atlanta, Georgia, a team proactively tested residents and staff members at two shelters with no known COVID-19 cases in the preceding 2 weeks. In each city, the objective was to test all shelter residents and staff members at each assessed facility, irrespective of symptoms. Persons who tested positive were transported to hospitals or predesignated community isolation areas.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pessoas em Situação de Rua/estatística & dados numéricos , Habitação/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Boston/epidemiologia , Cidades , Georgia/epidemiologia , Humanos , Pandemias , Prevalência , São Francisco/epidemiologia , Washington/epidemiologia
15.
Am J Public Health ; 110(7): 1046-1053, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32437270

RESUMO

Objectives. To assess if historical redlining, the US government's 1930s racially discriminatory grading of neighborhoods' mortgage credit-worthiness, implemented via the federally sponsored Home Owners' Loan Corporation (HOLC) color-coded maps, is associated with contemporary risk of preterm birth (< 37 weeks gestation).Methods. We analyzed 2013-2017 birth certificate data for all singleton births in New York City (n = 528 096) linked by maternal residence at time of birth to (1) HOLC grade and (2) current census tract social characteristics.Results. The proportion of preterm births ranged from 5.0% in grade A ("best"-green) to 7.3% in grade D ("hazardous"-red). The odds ratio for HOLC grade D versus A equaled 1.6 and remained significant (1.2; P < .05) in multilevel models adjusted for maternal sociodemographic characteristics and current census tract poverty, but was 1.07 (95% confidence interval = 0.92, 1.20) after adjustment for current census tract racialized economic segregation.Conclusions. Historical redlining may be a structural determinant of present-day risk of preterm birth.Public Health Implications. Policies for fair housing, economic development, and health equity should consider historical redlining's impacts on present-day residential segregation and health outcomes.


Assuntos
Habitação/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Racismo , Segregação Social , Feminino , Humanos , Recém-Nascido , Cidade de Nova Iorque/epidemiologia , Pobreza , Gravidez , Características de Residência/classificação
16.
Am J Public Health ; 110(7): 1060-1067, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32437286

RESUMO

Objectives. To examine the association between residence in different housing typologies and all-cause and cause-specific mortality, and to compare with the 25 × 25 risk factors defined by the World Health Organization.Methods. We used data from EPIPorto cohort (Porto, Portugal; n = 2485). We georeferenced and matched participants to a housing type-conventional, affordable, social, or substandard housing (locally called ilhas). We used Poisson regression models to estimate mortality rates and associations.Results. Age- and sex-adjusted mortality rates (per 100 000 person-years) were 713 (95% confidence interval [CI] = 584, 863) for individuals residing in conventional housing, and 1019 (95% CI = 637, 1551), 1200 (95% CI = 916, 1551), and 1239 (95% CI = 839, 1772) for individuals residing in affordable housing, social housing, and ilhas, respectively. After further adjustment, the associations between mortality and residence in social housing (rate ratio [RR] = 1.59; 95% CI = 1.22, 2.06) and in ilhas (RR = 1.64; 95% CI = 1.12, 2.33) remained. The association between disadvantaged housing and mortality was stronger than that observed for well-established risk factors such as hypertension, sedentariness, heavy drinking, manual occupation, or obesity.Conclusions. Disadvantaged housing is a major risk factor for mortality that should be accounted for by health policies and surveillance systems.


Assuntos
Habitação/estatística & dados numéricos , Mortalidade , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Habitação Popular/estatística & dados numéricos , Fatores de Risco , População Urbana/estatística & dados numéricos
18.
PLoS One ; 15(4): e0231779, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298364

RESUMO

BACKGROUND: Theories of health outcomes often hypothesize that living in more socially and economically disadvantaged neighbourhoods will lead to worse health. Multiple measures of neighbourhood disadvantage are available to researchers, which may serve as better or worse proxies for each other across time. To inform longitudinal study design and interpretation we investigated how perceived and objective measures of neighbourhood disadvantage vary over time and the factors underlying this variation. METHODS: Data were from 8,918 mothers with at least three time-points of neighbourhood data in the Avon Longitudinal Study of Parents and Children in the UK. We analyzed measures of objective (Indices of Multiple Deprivation) and perceived (neighbourhood quality, social cohesion, and stress) exposure to neighbourhood disadvantage at 10 time-points over 18 years. We used group-based trajectory modelling to determine the overlap in participants' trajectories on the different measures and evaluated the baseline factors associated with different perceived trajectories over time. RESULTS: There was evidence of heterogeneity in both perceived and objective measures of neighbourhood disadvantage over time (e.g., on the objective measure, 5% of participants moved to more deprived neighbourhoods, 11% moved to less deprived neighbourhoods, 20% consistently lived in deprived neighbourhoods, and 64% consistently lived in non-deprived neighbourhoods). Perceived social cohesion showed the weakest relationship with exposure to objective neighbourhood deprivation: most participants in each trajectory group of objective neighbourhood deprivation followed non-corresponding trajectories of perceived social cohesion (61-80%). Accounting for objective deprivation exposure, poorer socioeconomic and psychosocial indicators at baseline were associated with following more negative perceived neighbourhood trajectories (e.g., high neighbourhood stress) over time. CONCLUSION: Trajectories of perceived and objective measures of neighbourhood disadvantage varied over time, with the extent of variation depending on the time point of measurement and individual-level social factors. Researchers should be mindful of this variation when choosing and determining the timing of measures of neighbourhood disadvantage in longitudinal studies and when inferring effect mechanisms.


Assuntos
Características de Residência/estatística & dados numéricos , Meio Social , Fatores Socioeconômicos , Adolescente , Adulto , Criança , Pré-Escolar , Crime/estatística & dados numéricos , Demografia , Educação/estatística & dados numéricos , Emprego/estatística & dados numéricos , Feminino , Saúde/estatística & dados numéricos , Habitação/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Lactente , Recém-Nascido , Estudos Longitudinais , Modelos Estatísticos , Gravidez , Estudos Prospectivos , Fatores de Tempo , Reino Unido
19.
PLoS One ; 15(4): e0231758, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298388

RESUMO

BACKGROUND: Homelessness is one of the most disabling and precarious living conditions. The objective of this Delphi consensus study was to identify priority needs and at-risk population subgroups among homeless and vulnerably housed people to guide the development of a more responsive and person-centred clinical practice guideline. METHODS: We used a literature review and expert working group to produce an initial list of needs and at-risk subgroups of homeless and vulnerably housed populations. We then followed a modified Delphi consensus method, asking expert health professionals, using electronic surveys, and persons with lived experience of homelessness, using oral surveys, to prioritize needs and at-risk sub-populations across Canada. Criteria for ranking included potential for impact, extent of inequities and burden of illness. We set ratings of ≥ 60% to determine consensus over three rounds of surveys. FINDINGS: Eighty four health professionals and 76 persons with lived experience of homelessness participated from across Canada, achieving an overall 73% response rate. The participants identified priority needs including mental health and addiction care, facilitating access to permanent housing, facilitating access to income support and case management/care coordination. Participants also ranked specific homeless sub-populations in need of additional research including: Indigenous Peoples (First Nations, Métis, and Inuit); youth, women and families; people with acquired brain injury, intellectual or physical disabilities; and refugees and other migrants. INTERPRETATION: The inclusion of the perspectives of both expert health professionals and people with lived experience of homelessness provided validity in identifying real-world needs to guide systematic reviews in four key areas according to priority needs, as well as launch a number of working groups to explore how to adapt interventions for specific at-risk populations, to create evidence-based guidelines.


Assuntos
Pessoas em Situação de Rua/estatística & dados numéricos , Habitação/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Problemas Sociais/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Canadá/epidemiologia , Consenso , Técnica Delfos , Demografia , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Pessoal de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Povos Indígenas/psicologia , Povos Indígenas/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Refugiados/estatística & dados numéricos , Fatores de Risco , Problemas Sociais/psicologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Inquéritos e Questionários , Migrantes/estatística & dados numéricos , Adulto Jovem
20.
Geriatr Gerontol Int ; 20(6): 615-620, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32212236

RESUMO

AIM: Subjective happiness is an important marker of successful aging, and is associated with housing tenure status and household structure. However, the associations between subjective happiness and combinations of housing tenure status and household structure have not yet been clarified. Therefore, we examined which combinations of housing tenure status and household structure are associated with high or low subjective happiness among community-dwelling elderly people. METHODS: Subjects were enrolled by stratified random sampling, and comprised of 1602 elderly persons aged ≥65 years as of January 2017 in Fukushima Prefecture, Japan. The subjects' data were collected via a self-completed questionnaire (effective response rate: 53.4%), and the associations between subjective happiness and combinations of housing tenure status and household structure were analyzed by chi-squared test and logistic regression analysis, controlling the confounding variables such as care support needs, subjective economic status and health status. RESULTS: The subjects reported significantly decreased subjective happiness when they were a renter living alone (odds ratio [OR] = 0.427 and 95% confidence interval [CI] = 0.249, 0.732) and with others (OR = 0.420 and 95% CI = 0.256, 0.687) after adjustment for confounding variables, compared with owner-occupier living with others (referent). CONCLUSIONS: The results of the current study revealed significantly decreased subjective happiness when the subjects were renters regardless of household structure. Therefore, housing tenure status may be a stronger determinant of subjective happiness among community-dwelling elderly people than household structure. Geriatr Gerontol Int 2020; ••: ••-••.


Assuntos
Características da Família , Felicidade , Habitação/economia , Habitação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Vida Independente , Japão , Masculino , Razão de Chances , Qualidade de Vida , Distribuição Aleatória , Fatores Socioeconômicos , Inquéritos e Questionários
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