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4.
BMC Public Health ; 20(1): 1443, 2020 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-32967646

RESUMO

BACKGROUND: Client-Centered Representative Payee (CCRP) is an intervention modifying implementation of a current policy of the US Social Security Administration, which appoints organizations to serve as financial payees on behalf of vulnerable individuals receiving Social Security benefits. By ensuring beneficiaries' bills are paid while supporting their self-determination, this structural intervention may mitigate the effects of economic disadvantage to improve housing and financial stability, enabling self-efficacy for health outcomes and improved antiretroviral therapy adherence. This randomized controlled trial will test the impact of CCRP on marginalized people living with HIV (PLWH). We hypothesize that helping participants to pay their rent and other bills on time will improve housing stability and decrease financial stress. METHODS: PLWH (n = 160) receiving services at community-based organizations will be randomly assigned to the CCRP intervention or the standard of care for 12 months. Fifty additional participants will be enrolled into a non-randomized ("choice") study allowing participant selection of the CCRP intervention or control. The primary outcome is HIV medication adherence, assessed via the CASE adherence index, viral load, and CD4 counts. Self-assessment data for ART adherence, housing instability, self-efficacy for health behaviors, financial stress, and retention in care will be collected at baseline, 3, 6, and 12 months. Viral load, CD4, and appointment adherence data will be collected at baseline, 6, 12, 18, and 24 months from medical records. Outcomes will be compared by treatment group in the randomized trial, in the non-randomized cohort, and in the combined cohort. Qualitative data will be collected from study participants, eligible non-participants, and providers to explore underlying mechanisms of adherence, subjective responses to the intervention, and implementation barriers and facilitators. DISCUSSION: The aim of this study is to determine if CCRP improves health outcomes for vulnerable PLWH. Study outcomes may provide information about supports needed to help economically fragile PLWH improve health outcomes and ultimately improve HIV health disparities. In addition, findings may help to refine service delivery including the provision of representative payee to this often-marginalized population. This protocol was prospectively registered on May 22, 2018 with ClinicalTrials.gov (NCT03561103) .


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Marginalização Social , Previdência Social/economia , Humanos , Projetos de Pesquisa , Estados Unidos , United States Social Security Administration
5.
Psychiatry Res ; 292: 113369, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32795754

RESUMO

The world has endured over six months of the Coronavirus disease 2019 (COVID-19). Older adults are at disproportionate risk of severe infection and mortality. They are also vulnerable to loneliness and social exclusion during the pandemic. Age and ageism both can act as significant risk factors during this pandemic, increasing the physical as well as psychosocial burden on the elderly. A review was performed in relation to the psychosocial vulnerabilities of the older adults during the pandemic, with insights from the similar biological disasters in the past. Besides the physiological risk, morbidities, polypharmacy and increased case fatality rates, various social factors like lack of security, loneliness, isolation, ageism, sexism, dependency, stigma, abuse and restriction to health care access were identified as crucial in pandemic situation. Frailty, cognitive and sensory impairments added to the burden. Marginalization and human rights deprivation emerged as a common pathway of suffering for the elderly during COVID-19. The implications of the emergent themes are discussed in light of psychosocial wellbeing and impact on the quality of life. The authors suggest potential recommendations to mitigate this marginalization on lines of the World Health Organization (WHO)'s concept of Healthy Ageing and the United Nations (U.N.) Sustainable Development Goals.


Assuntos
Infecções por Coronavirus/psicologia , Direitos Humanos , Pneumonia Viral/psicologia , Qualidade de Vida , Marginalização Social/psicologia , Idoso , Envelhecimento , Betacoronavirus , Coronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Solidão , Pandemias , Pneumonia Viral/epidemiologia , Fatores de Risco , Estigma Social
9.
Ethn Dis ; 30(3): 421-424, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32742144

RESUMO

The COVID-19 pandemic is revealing the deeply entrenched structural inequities in health that exist in the United States. We draw parallels between the COVID-19 pandemic and our cardiovascular health equity research focused on physical activity and diabetes to highlight three common needs: 1) access to timely and disaggregated data; 2) how to integrate community-engaged approaches in telehealth; and 3) policy initiatives that explicitly integrate health equity and social justice principles and action. We suggest that a similar sense of urgency regarding COVID-19 should be applied to slow the burgeoning costs and suffering associated with cardiovascular disease overall and in marginalized communities specifically. We remain hopeful that the current crisis can serve as a guide for aligning our principles as a just and democratic society with a health agenda that explicitly recognizes that social inequities in health for some impacts all members of society.


Assuntos
Doenças Cardiovasculares , Infecções por Coronavirus , Equidade em Saúde/organização & administração , Pandemias , Pneumonia Viral , Betacoronavirus , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Justiça Social , Marginalização Social , Estados Unidos
10.
BMC Public Health ; 20(1): 1023, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600303

RESUMO

BACKGROUND: Gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria experience social marginalization, discrimination and violence due to their sexual identity, which may negatively impact physical, mental, and sexual health outcomes. Studies on GBMSM in Africa utilize measurement scales developed largely for populations in the Global North. The validity and reliability of these instruments-to our knowledge-have never been thoroughly investigated among GBMSM in Nigeria. The aim of the current study was to determine the validity and reliability of the English versions of the Center for Epidemiologic Studies Depression Scale (CESD-R), Multidimensional Scale of Perceived Social Support (MSPSS), and LGBT Minority Stress Measure among a large multi-state sample of GBMSM Nigeria. METHODS: Between January and June 2019, we conducted cognitive interviews (N = 30) and quantitative assessments (N = 406) with GBMSM in Nigeria. The cognitive interviews assessed comprehension of scale items and elicited suggestions for scale modifications. The quantitative assessment was used to gather psychosocial health data and to evaluate psychometric properties and construct validity of the modified scales. We utilized confirmatory factor analysis to assess factor structure, correlation coefficients, and Cronbach's alpha to examine scale validity and internal consistency. RESULTS: Based on participant feedback from the cognitive interviews, we made slight modifications (i.e., culturally appropriate word substitutions) to all three scales. Results of quantitative analyses indicated good psychometric properties including high factor loadings, internal consistency and construct validity among the CESD-R, MSPSS, and LGBT Minority Stress Measure among GBMSM in Nigeria. CONCLUSION: These results suggests that modifying research scales to be more culturally relevant likely do not jeopardize their validity and reliability. We found that modified scales measuring depressive symptoms, perceived social support, and minority stress among GBMSM in Nigeria remained valid. More research is needed to explore whether the psychometric properties remain if the scales are translated into broken English (Pidgin) and other traditional Nigerian languages (Yoruba, Igbo and Hausa).


Assuntos
Depressão/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Minorias Sexuais e de Gênero/psicologia , Apoio Social , Estresse Psicológico/diagnóstico , Adulto , Depressão/psicologia , Análise Fatorial , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Nigéria , Psicometria , Reprodutibilidade dos Testes , Discriminação Social/psicologia , Marginalização Social/psicologia , Estresse Psicológico/psicologia
11.
Minerva Pediatr ; 72(3): 226-235, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32613821

RESUMO

Although medical literature shows that children are minimally susceptible to 2019-Corona virus disease (COVID-19), they are hit the hardest by psychosocial impact of this pandemic. Being quarantined in homes and institutions may impose greater psychological burden than the physical sufferings caused by the virus. School closure, lack of outdoor activity, aberrant dietary and sleeping habits are likely to disrupt children's usual lifestyle and can potentially promote monotony, distress, impatience, annoyance and varied neuropsychiatric manifestations. Incidences of domestic violence, child abuse, adulterated online contents are on the rise. Children of single parent and frontline workers suffer unique problems. The children from marginalized communities are particularly susceptible to the infection and may suffer from extended ill-consequences of this pandemic, such as child labor, child trafficking, child marriage, sexual exploitation and death etc. Parents, pediatricians, psychologists, social workers, hospital authorities, government and non-governmental organizations have important roles to play to mitigate the psychosocial ill-effects of COVID-19 on children and adolescents. To provide the basic amenities, social security, medical care, and to minimize the educational inequities among the children of the different strata of the society are foremost priorities.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Quarentena/psicologia , Estresse Psicológico/etiologia , Atividades Cotidianas , Adolescente , Criança , Maus-Tratos Infantis/psicologia , Socorristas/psicologia , Acesso aos Serviços de Saúde , Humanos , Deficiência Intelectual/psicologia , Acontecimentos que Mudam a Vida , Fatores de Risco , Instituições Acadêmicas , Isolamento Social/psicologia , Marginalização Social , Fatores Socioeconômicos , Estresse Psicológico/prevenção & controle , Populações Vulneráveis/psicologia
14.
Diabetes Metab Syndr ; 14(5): 779-788, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32526627

RESUMO

BACKGROUND: Along with its high infectivity and fatality rates, the 2019 Corona Virus Disease (COVID-19) has caused universal psychosocial impact by causing mass hysteria, economic burden and financial losses. Mass fear of COVID-19, termed as "coronaphobia", has generated a plethora of psychiatric manifestations across the different strata of the society. So, this review has been undertaken to define psychosocial impact of COVID-19. METHODS: Pubmed and GoogleScholar are searched with the following key terms- "COVID-19", "SARS-CoV2", "Pandemic", "Psychology", "Psychosocial", "Psychitry", "marginalized", "telemedicine", "mental health", "quarantine", "infodemic", "social media" and" "internet". Few news paper reports related to COVID-19 and psychosocial impacts have also been added as per context. RESULTS: Disease itself multiplied by forced quarantine to combat COVID-19 applied by nationwide lockdowns can produce acute panic, anxiety, obsessive behaviors, hoarding, paranoia, and depression, and post-traumatic stress disorder (PTSD) in the long run. These have been fueled by an "infodemic" spread via different platforms of social media. Outbursts of racism, stigmatization, and xenophobia against particular communities are also being widely reported. Nevertheless, frontline healthcare workers are at higher-risk of contracting the disease as well as experiencing adverse psychological outcomes in form of burnout, anxiety, fear of transmitting infection, feeling of incompatibility, depression, increased substance-dependence, and PTSD. Community-based mitigation programs to combat COVID-19 will disrupt children's usual lifestyle and may cause florid mental distress. The psychosocial aspects of older people, their caregivers, psychiatric patients and marginalized communities are affected by this pandemic in different ways and need special attention. CONCLUSION: For better dealing with these psychosocial issues of different strata of the society, psychosocial crisis prevention and intervention models should be urgently developed by the government, health care personnel and other stakeholders. Apt application of internet services, technology and social media to curb both pandemic and infodemic needs to be instigated. Psychosocial preparedness by setting up mental organizations specific for future pandemics is certainly necessary.


Assuntos
Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Ansiedade/epidemiologia , Ansiedade/etiologia , Betacoronavirus/fisiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Pessoal de Saúde/psicologia , Humanos , Saúde Mental/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Psiquiatria/organização & administração , Psiquiatria/normas , Psiquiatria/tendências , Marginalização Social/psicologia , Fatores Socioeconômicos , Telemedicina/métodos , Telemedicina/organização & administração , Telemedicina/tendências
15.
Diabetes Metab Syndr ; 14(5): 817-823, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32540735

RESUMO

BACKGROUND AND AIMS: 2019-coronavirus disease (COVID-19) is causing insurmountable psychosocial impact on the whole mankind. Marginalized community, particularly those with substance use disorders (SUD), are particularly vulnerable to contract the infection and also likely to suffer from greater psychosocial burden. This article analyses the intricate bi-directional relationship between COVID-19 and addiction. METHODS: Pubmed and Google Scholar are searched with the following key terms- "COVID-19", "SARS-CoV2", "Pandemic", "Addiction", "Opioid", "Alcohol", "Smoking", "Addiction Psychiatry", "Deaddiction", "Substance use disorders", "Behavioral addiction". Few newspaper reports related to COVID-19 and addiction have also been added as per context. RESULTS: People with SUD are at greater risk of worse COVID-19 outcome. There is surge of addictive behaviors (both new and relapse) including behavioral addiction in this period. Withdrawal emergencies and death are also being increasingly reported. Addicted people are especially facing difficulties in accessing the healthcare services which are making them prone to procure drugs by illegal means. CONCLUSION: COVID-19 and addiction are the two pandemics which are on the verge of collision causing major public health threat. While every effort must be taken to make the public aware of deleterious effects of SUD on COVID-19 prognosis, the resumption of deaddiction services and easier accessibility of prescription drugs are needs of the hour.


Assuntos
Comportamento Aditivo/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Comportamento Aditivo/complicações , Comportamento Aditivo/psicologia , Betacoronavirus/fisiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/tendências , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/tendências , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Prognóstico , Marginalização Social/psicologia , Transtornos Relacionados ao Uso de Substâncias/complicações
16.
Fam Process ; 59(3): 832-846, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32589267

RESUMO

The COVID-19 pandemic brings to the forefront the complex interconnected dilemmas of globalization, health equity, economic security, environmental justice, and collective trauma, severely impacting the marginalized and people of color in the United States. This lack of access to and the quality of healthcare, affordable housing, and lack of financial resources also continue to have a more significant impact on documented and undocumented immigrants. This paper aims at examining these critical issues and developing a framework for family therapists to address these challenges by focusing on four interrelated dimensions: cultural values, social determinants of health, collective trauma, and the ethical and moral responsibility of family therapists. Given the fact that family therapists may unwittingly function as the best ally of an economic and political system that perpetuates institutionalized racism and class discrimination, we need to utilize a set of principles, values, and practices that are not just palliative or after the fact but bring forth into the psychotherapeutic and policy work a politics of care. Therefore, a strong call to promote and advocate for the broader continuum of health and critical thinking preparing professionals to meet the challenges of health equity, as well as economic and environmental justice, is needed. The issues discussed in this paper are specific to the United States despite their relevance to family therapy as a field. We are mindful not to generalize the United States' reality to the rest of the world, recognizing that issues discussed in this paper could potentially contribute to international discourse.


Assuntos
Terapia Familiar/ética , Disparidades nos Níveis de Saúde , Pandemias/ética , Política , Racismo/ética , Betacoronavirus , Mudança Climática , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/psicologia , Disparidades em Assistência à Saúde , Humanos , Princípios Morais , Pneumonia Viral/etnologia , Pneumonia Viral/psicologia , Racismo/psicologia , Determinantes Sociais da Saúde , Marginalização Social , Valores Sociais , Estados Unidos/epidemiologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-32512750

RESUMO

Nutrient deficiencies are a public health problem in Sri Lanka. Achieving food security is a major challenge due to unhealthy eating patterns. The nutritional status of a woman and her knowledge is a powerful indicator of the nutritional security of her children and household food security. Nutrition-related knowledge and attitude are necessary for dietary changes towards a healthier dietary pattern. For that reason, food and nutrition-related Knowledge, Attitude and Practice (KAP) is one of the key factors to achieving household food and nutritional security. The main objective of this study is to assess the food and nutrition-related KAP among reproductive-age women and understanding of household food and nutritional security in Sri Lanka as an example for marginalized societies. Thus, a cross-sectional survey was conducted using the KAP model questionnaire administered on 400 reproductive age women (18-49 Years) in marginalized areas in Sri Lanka. Data were collected using a random sampling method. The research results clearly showed that the reproductive age women have a low level of nutritional knowledge in the areas being investigated. Most women have a positive attitude towards receiving nutritional knowledge but have low-level practice about a healthy diet. Furthermore, knowledge, practices, and attitudes of women largely affect their BMI status, as well as household food security. Multiple linear regression analysis was used to analyze the influential factors. There was a highly significant positive correlation between nutritional knowledge, attitude score, and BMI level and a significant difference was found in the area, age, family size, monthly income, educational level, attitudes towards nutrition, food and nutrition practices across the reproductive women (R2:467, p < 0.01). The research results showed that KAP largely determines women's nutrition and household food security. Based on the results of this research, there is a need to enhance nutritional education in reproductive-age women in marginalized areas in Sri Lanka.


Assuntos
Características da Família , Alimentos , Conhecimentos, Atitudes e Prática em Saúde , Estado Nutricional , Marginalização Social , Adolescente , Adulto , Estudos Transversais , Feminino , Educação em Saúde , Humanos , Pessoa de Meia-Idade , Sri Lanka , Adulto Jovem
19.
N C Med J ; 81(3): 173-176, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32366625

RESUMO

Place-a confluence of the social, economic, political, physical, and built environments-is fundamental to our understanding of health and health inequities among marginalized racial groups in the United States. Moreover, racism, defined as a system of structuring opportunity and assigning value based on the social interpretation of how one looks (i.e., race), has shaped the places people live in North Carolina. This problem is deeply imbedded in all of our systems, from housing to health care, affecting the ability of every resident of the state to flourish and thrive.


Assuntos
Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Características de Residência/estatística & dados numéricos , Equidade em Saúde , Disparidades em Assistência à Saúde/etnologia , Humanos , North Carolina , Fatores Raciais , Racismo/prevenção & controle , Marginalização Social , Estados Unidos
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