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Washington; Organización Panamericana de la Salud; mayo 30, 2020.
Não convencional em Inglês, Espanhol | Coleciona SUS | ID: biblio-1096876


La pandemia de COVID-19 afecta de distintas maneras a los diferentes grupos de hombres y mujeres. Los riesgos y las consecuencias recaen de forma desproporcionada en ciertos grupos de la población, especialmente los que se encuentran en una situación de vulnerabilidad y los que sufren discriminación. Es fundamental que en su respuesta a la COVID-19 los países consideren la perspectiva de la equidad, el género, la etnicidad y los derechos humanos a fin de: - evitar un aumento de las desigualdades; - tener en cuenta la realidad cotidiana de cada uno de los diferentes grupos, pues esa realidad puede afectar el éxito de las medidas

The COVID­19 pandemic affects diverse groups of women and men differently. The risks and consequences are disproportionately felt by certain groups, especially those living in situations of vulnerability and those who experience discrimination. It is vital that country responses to COVID-19 consider equity, gender, ethnicity, and human rights perspectives to: • prevent the expansion of inequalities; • account for the everyday lived realities of different groups that may affect the success of measures. Objectives: • To function as a "first port of call" for national health policy makers to support their efforts to integrate and enhance equity, gender, ethnicity and human rights considerations and approaches into measures responding to COVID-19; • To provide links to sources of related information and guidelines, where available.

Humanos , Masculino , Feminino , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Equidade em Saúde , Populações Vulneráveis/etnologia , Pandemias/prevenção & controle , Betacoronavirus , Iniquidade de Gênero , Direitos Humanos
Infant Ment Health J ; 40(5): 640-658, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31335984


Latina immigrant women are vulnerable to traumatic stress and sexual health disparities. Without autonomy over their reproductive health and related decision-making, reproductive justice is elusive. We analyzed behavioral health data from 175 Latina immigrant participants (M age = 35; range = 18-64) of the International Latino Research Partnership (ILRP) study. We used descriptive and inferential statistics to compare immigrant mothers of minor children to those without, regarding their psychological and reproductive health, and correlates of past exposure to sexual trauma. Over one third (38%) of ILRP participants had minor children, and 58% had citizenship in their host country. The rate for sexual assault was 30 and 61%, respectively, for physical assault; these rates were similarly high for women with and without minor children. Women who reported sexual assault scored significantly higher for depression, posttraumatic stress disorder, and substance-abuse screens. Odds of experiencing sexual assault was highest for women who experienced physical assault (odds ratio = 10.74), and for those from the Northern Triangle (odds ratio = 8.41). Subgroups of Latina migrant mothers are vulnerable to traumatic stress and related sexual and mental health risks. Given these findings, we frame the implications in a reproductive justice framework and consider consequences for caregiver-child well-being.

Emigração e Imigração , Mães/psicologia , Saúde Sexual/etnologia , Transtornos Relacionados a Trauma e Fatores de Estresse , Adulto , Feminino , Hispano-Americanos/psicologia , Humanos , Lactente , Bem-Estar do Lactente , Saúde Mental/etnologia , Saúde Reprodutiva/etnologia , Fatores de Risco , Justiça Social , Transtornos Relacionados a Trauma e Fatores de Estresse/etnologia , Transtornos Relacionados a Trauma e Fatores de Estresse/psicologia , Estados Unidos , Populações Vulneráveis/etnologia , Populações Vulneráveis/psicologia
Trials ; 20(1): 439, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315685


BACKGROUND: Economic vulnerability, such as homelessness and unemployment, contributes to the HIV risk among racial minorities in the U.S., who are disproportionately infected. Yet, few economic-strengthening interventions have been adapted for HIV prevention in economically-vulnerable African-American young adults. Engaging Microenterprise for Resource Generation and Health Empowerment (EMERGE) is a feasibility randomized clinical trial of an HIV prevention microenterprise intervention with integrated text messages ("nudges") that are informed by behavioral economic principles. The trial aims to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors. METHODS/DESIGN: In total, 40 young adults who are African-American, aged 18-24, live in Baltimore City, have experienced at least one episode of homelessness in the last 12 months, are unemployed or underemployed (fewer than 10 h per week), are not enrolled in school, own a cell phone with text messaging, and report at least one episode of unprotected or unsafe sex in the prior 12 months will be recruited from two community-based organizations providing residential supportive services to urban youth. Participants will undergo a 3-week run-in period and thereafter be randomly assigned to one of two groups with active interventions for 20 weeks. The first group ("comparison") will receive text messages with information on job openings. The second group ("experimental") will receive text messages with information on job openings plus information on HIV prevention and business educational sessions, a mentored apprenticeship, and a start-up grant, and business and HIV prevention text messages based on principles from behavioral economics. The two primary outcomes relate to the feasibility of conducting a larger trial. Secondary outcomes relate to employment, sexual risk behaviors, and HIV preventive practices. All participants will be assessed using an in-person questionnaire at pre-intervention (prior to randomization) and at 3 weeks post-intervention. To obtain repeated, longitudinal measures, participants will be assessed weekly using text message surveys from pre-intervention up to 3 weeks post-intervention. DISCUSSION: This study will be one of the first U.S.-based feasibility randomized clinical trials of an HIV prevention microenterprise intervention for economically-vulnerable African-American young adults. The findings will inform whether and how to conduct a larger efficacy trial for HIV risk reduction in this population. TRIAL REGISTRATION:, NCT03766165 . Registered on 4 December 2018.

Afro-Americanos , Emprego , Infecções por HIV/prevenção & controle , Serviços Preventivos de Saúde , Comportamento Sexual , Empresa de Pequeno Porte , Envio de Mensagens de Texto , Sexo sem Proteção/prevenção & controle , Populações Vulneráveis , Adolescente , Afro-Americanos/psicologia , Fatores Etários , Baltimore/epidemiologia , Emprego/psicologia , Estudos de Viabilidade , Feminino , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Comportamentos Relacionados com a Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Masculino , Fatores de Proteção , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores de Tempo , Sexo sem Proteção/etnologia , Sexo sem Proteção/psicologia , Populações Vulneráveis/etnologia , Populações Vulneráveis/psicologia , Adulto Jovem
Infant Ment Health J ; 40(5): 742-756, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31291015


Effecting a paradigm shift from "reproductive health" to "reproductive justice" within the perinatal field requires changes simultaneously at the levels of the individual healthcare provider and the system of care. The Infant-Parent Program at the University of California, San Francisco (UCSF) has extended its pioneering infant and early childhood mental health consultation to perinatal service systems applying an infant mental health approach to programs caring for expecting and new parents. In partnership with two nursing programs, UCSF consultants direct their efforts at supporting reflective practice capacities and use-of-self in patient-provider relationships. Both nursing programs serve vulnerable groups of expectant and new parents who grapple with challenges to health and well-being stemming from structural racism. As reflective capacities are supported within the consultation case conferences, providers spontaneously identify the need for tools to effectively address issues of race, class, and culture and to combat structural racism throughout the healthcare system. Policies and procedures that uphold structural racism cease to be tolerable to providers who bring their full selves to the work that they are trained to do. Using these nurse consultation partnerships as organizational case studies, this article describes a range of challenges that arise for providers and delineates steps to effective engagement toward reproductive justice.

Assistência à Saúde Culturalmente Competente , Pessoal de Saúde , Relações Profissional-Paciente/ética , Racismo/prevenção & controle , Encaminhamento e Consulta , Diversidade Cultural , Assistência à Saúde Culturalmente Competente/métodos , Assistência à Saúde Culturalmente Competente/organização & administração , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/normas , Humanos , Lactente , Saúde do Lactente/etnologia , Saúde Mental/etnologia , Pesquisa em Avaliação de Enfermagem , Gravidez , Encaminhamento e Consulta/ética , Encaminhamento e Consulta/normas , Estados Unidos , Populações Vulneráveis/etnologia
Rev Esc Enferm USP ; 53: e03451, 2019 May 30.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31166533


OBJECTIVE: Understanding the relationship of social determinants in the Health Promotion of quilombola women. METHOD: This was a participatory study developed through the Research Itinerary of Paulo Freire, which comprises three stages: thematic investigation, codification and decoding, and critical unveiling. These stages were developed in Culture Circles from April to June 2016. Twenty themes were investigated, coded and decoded into eight themes, revealing the theme of women and their relationship with the Social Determinants. RESULTS: Ten women from a quilombola community in Santa Catarina participated. The Health Promotion of this population and its interface with Social Determinants were understood. Health, religiosity, racial issues, social and community networks emerged as potentializing community empowerment and solidification. CONCLUSION: An accentuated correlation of racial issues and fragility combined with health care, education and information, and above all the distancing of vulnerable communities from comprehensive and equitable health was observed, highlighting the imminent need to strengthen Health Promotion strategies.

Promoção da Saúde/métodos , Determinantes Sociais da Saúde/etnologia , Populações Vulneráveis/etnologia , Adulto , Brasil , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem
Nat Hum Behav ; 3(3): 214-220, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30953016


Economic inequality can have a range of negative consequences for those in younger generations, particularly for those from lower-socioeconomic status (SES) backgrounds. Economists and psychologists, among other social scientists, have addressed this issue, but have proceeded largely in parallel. This Perspective outlines how these disciplines have proposed and provided empirical support for complementary theoretical models. Specifically, both disciplines emphasize that inequality weakens people's belief in socioeconomic opportunity, thereby reducing the likelihood that low-SES young people will engage in behaviours that would improve their chances of upward mobility (for example, persisting in school or averting teenage pregnancy). In integrating the methods and techniques of economics and psychology, we offer a cohesive framework for considering this issue. When viewed as a whole, the interdisciplinary body of evidence presents a more complete and compelling framework than does either discipline alone. We use this unification to offer policy recommendations that would advance prospects for mobility among low-SES young people.

Logro , Comportamento do Adolescente , Economia Comportamental , Modelos Psicológicos , Pobreza , Classe Social , Fatores Socioeconômicos , Populações Vulneráveis , Adolescente , Comportamento do Adolescente/etnologia , Comportamento do Adolescente/psicologia , Humanos , Pobreza/etnologia , Pobreza/psicologia , Pobreza/estatística & dados numéricos , Populações Vulneráveis/etnologia , Populações Vulneráveis/psicologia , Populações Vulneráveis/estatística & dados numéricos
Ethics Hum Res ; 41(2): 29-34, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30895754


The U.S. Public Health Service's sexually transmitted disease (STD) experiments in Guatemala are an important case study not only in human subjects research transgressions but also in the response to serious lapses in research ethics. This case study describes how individuals in the STD experiments were tested, exposed to STDs, and exploited as the source of biological specimens-all without informed consent and often with active deceit. It also explores and evaluates governmental and professional responses that followed the public revelation of these experiments, including by academic institutions, professional organizations, and the U.S. federal government, pushing us to reconsider both how we prevent such lapses in the future and how we respond when they are first revealed.

Ética em Pesquisa/história , Experimentação Humana não Terapêutica/ética , Experimentação Humana não Terapêutica/história , Sujeitos da Pesquisa , Doenças Sexualmente Transmissíveis/induzido quimicamente , Doenças Sexualmente Transmissíveis/história , United States Public Health Service/ética , Adulto , Criança , Coerção , Decepção , Feminino , Guatemala , História do Século XX , Humanos , Consentimento Livre e Esclarecido/ética , Masculino , Manejo de Espécimes/ética , Manejo de Espécimes/história , Estados Unidos , Populações Vulneráveis/etnologia
Arthritis Care Res (Hoboken) ; 71(7): 903-913, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30055088


OBJECTIVE: Adherence to hydroxychloroquine (HCQ) treatment in patients with systemic lupus erythematous (SLE) is suboptimal. Although individual-level factors, including younger age and non-white race/ethnicity, have been implicated, contextual factors have not been explored. The aim of this study was to investigate the effect of contextual factors, including racial composition, socioeconomic status, and the concentration of health care resources, on adherence to HCQ among SLE patients enrolled in Medicaid. METHODS: We identified SLE patients from 28 states in the US who enrolled in Medicaid (2000-2010) and in whom HCQ treatment was newly initiated (no use for ≥6 months). We required 12 months of continuous enrollment with complete drug dispensing data and measured adherence using the proportion of days covered (PDC). We identified individual-level variables from Medicaid, zip code-level, county-level and state-level sociodemographic variables from the American Community Survey, and health resources from Area Health Resources Files. We used 4-level hierarchical multivariable logistic regression models to examine the odds ratios (ORs) and 95% credible intervals (95% CrIs) of adherence (PDC ≥80%) versus nonadherence. RESULTS: Among 10,268 patients with SLE in whom HCQ treatment was initiated, 15% were adherent to treatment. After we adjusted for individual-level characteristics, we observed lower odds of adherence among patients living in zip code areas with a higher percentage of black individuals (highest tertile OR 0.81 [95% CrI 0.69-0.96] versus lowest tertile). This association persisted after controlling for area-level educational attainment, percent below federal poverty level (FPL), urbanicity, and health care resources. We did not observe statistically significant associations with zip code-level percent Hispanic, percent white, education, or percent below FPL. The odds of adherence were higher in counties with more hospitals (OR 1.30 [95% CrI 1.07-1.58]). CONCLUSION: Among Medicaid beneficiaries with SLE, we observed significant effects of racial composition and hospital concentration on HCQ adherence. Interventions that acknowledge and address contextual factors should be considered in order to reduce high rates of nonadherence in vulnerable populations.

Antirreumáticos/uso terapêutico , Hidroxicloroquina/uso terapêutico , Benefícios do Seguro , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Medicaid , Adesão à Medicação/etnologia , Características de Residência , Populações Vulneráveis/etnologia , Adolescente , Adulto , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/etnologia , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Fatores de Risco , Classe Social , Estados Unidos/epidemiologia , Adulto Jovem
Health Serv Res ; 54 Suppl 1: 226-233, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30394526


OBJECTIVE: To investigate mammography facilities' follow-up times, population vulnerability, system-based processes, and association with cancer stage at diagnosis. DATA SOURCES: Prospectively collected from San Francisco Mammography Registry (SFMR) 2005-2011, California Cancer Registry 2005-2012, SFMR facility survey 2012. STUDY DESIGN: We examined time to biopsy for 17 750 abnormal mammogram results (BI-RADS 4/5), categorizing eight facilities as short or long follow-up based on proportion of mammograms with biopsy at 30 days. We examined facility population vulnerability (race/ethnicity, language, education), and system processes. Among women with a cancer diagnosis, we modeled odds of advanced-stage (≥IIb) cancer diagnosis by facility follow-up group. DATA EXTRACTION METHODS: Merged SFMR, Cancer Registry and facility survey data. PRINCIPAL FINDINGS: Facilities (N = 4) with short follow-up completed biopsies by 30 days for 82% of mammograms compared with 62% for facilities with long follow-up (N = 4) (P < 0.0001). All facilities serving high proportions of vulnerable women were long follow-up facilities. The long follow-up facilities had fewer radiologists, longer biopsy appointment wait times, and less communication directly with women. Having the index abnormal mammogram at a long follow-up facility was associated with higher adjusted odds of advanced-stage cancer (OR 1.45; 95% CI 1.10-1.91). CONCLUSIONS: Providing mammography facilities serving vulnerable women with appropriate resources may decrease disparities in abnormal mammogram follow-up and cancer diagnosis stage.

Neoplasias da Mama/diagnóstico por imagem , Diagnóstico Tardio/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Mamografia/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Neoplasias da Mama/etnologia , Feminino , Humanos , Grupos Minoritários , Estudos Prospectivos , Sistema de Registros , São Francisco , Fatores Socioeconômicos , Inquéritos e Questionários , Fatores de Tempo , Populações Vulneráveis/etnologia
J Immigr Minor Health ; 21(3): 439-442, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29959652


Between November 2015 and January 2017, the Government of Canada resettled over 40,000 Syrian refugees through different sponsorship programs (GAR and PSR). Timely access to healthcare is essential for good health and successful integration. However, refugee support differs depending on sponsorship program, which may lead to differences in healthcare service access and needs. A cross-sectional study with a sample of Syrian refugees was conducted to assess healthcare access, and perceived physical and mental health status. Results indicate demographic and healthcare access differences between GARs and PSRs. GARs reported significantly lower perceived physical and mental health, as well as, higher unmet healthcare needs than PSRs. GARs are among the most vulnerable refugees; they report higher needs, more complex medical conditions and tend to have more difficulty re-settling. These factors likely combine to help explain lower self-reported health and higher health needs in our sample compared to PSRs.

Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Saúde Mental/etnologia , Refugiados/estatística & dados numéricos , Adulto , Fatores Etários , Canadá/epidemiologia , Estudos Transversais , Feminino , Órgãos Governamentais/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Organizações/estatística & dados numéricos , Autorrelato , Fatores Sexuais , Fatores Socioeconômicos , Síria/etnologia , Populações Vulneráveis/etnologia
Cad Saude Publica ; 34(10): e00036318, 2018 10 11.
Artigo em Português | MEDLINE | ID: mdl-30328995


This article discusses the health needs and demands of trans men, a topic that has received little attention and frequently calls for the development of specific health care practices for this population. A qualitative study was performed, consisting of participant observation and semi-structured interviews with trans men residing in Salvador, Bahia State, Brazil, the majority of whom were black, heterosexual, and 20 to 43 years of age. The analysis was based on interpretative anthropology, linked to critique of the assumption of intersectionality and the decolonial perspective. The health needs and demands of trans men are organized in three aspects: de-pathologization, body modification, and outpatient care. These aspects are not universal among trans men and may result from situations that indicate group conflicts and pressures. The absence of transsexualization process in the state of Bahia and barriers to accessing the health care network intensify the commodification of trans men's health demands and especially body modifications. The study concludes that structural transphobia triggers a series of health issues, while limiting the possibilities for obtaining care. The de-pathologization of trans experiences constitutes the central basis for conceiving care, relating it to cultural, political, and social changes that involve the construction of a non-transphobic society and foster the well-being and recognition of trans men.

Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde para Pessoas Transgênero , Pessoas Transgênero , Adulto , Brasil , Humanos , Masculino , Preconceito , Pesquisa Qualitativa , Pessoas Transgênero/legislação & jurisprudência , Pessoas Transgênero/psicologia , Populações Vulneráveis/etnologia , Populações Vulneráveis/legislação & jurisprudência , Populações Vulneráveis/psicologia , Adulto Jovem
Cad. Saúde Pública (Online) ; 34(10): e00036318, oct. 2018.
Artigo em Português | LILACS | ID: biblio-952353


Resumo: Este artigo discute as necessidades e demandas de saúde de homens trans, tema pouco estudado que, com frequência, interpela a construção de práticas de cuidado em saúde para esta população. Foi realizada uma pesquisa qualitativa composta de observação participante e entrevistas semiestruturadas com dez homens trans residentes em Salvador, Bahia, Brasil, em sua maioria negros, heterossexuais e com idades entre 20 e 43 anos. A análise foi baseada na antropologia interpretativa, articulada às críticas do pressuposto da interseccionalidade e da perspectiva decolonial. As necessidades e demandas de saúde dos homens trans são organizadas em três aspectos: a despatologização, a modificação corporal e os atendimentos ambulatoriais. Esses não são universais entre todos os homens trans e podem ser decorrentes de situações que assinalam conflitos e pressões grupais. A ausência do processo transexualizador no estado e as barreiras no acesso à rede de atenção à saúde intensificam o processo de mercantilização das suas demandas de saúde, em especial, as modificações corporais. Conclui-se que a transfobia estrutural faz disparar uma série de questões de saúde, ao mesmo tempo em que limita as possibilidades de obtenção de cuidado. A despatologização das vivências trans constitui o eixo central com base no qual o cuidado deve ser pensado, relacionando-a a mudanças culturais, políticas e sociais que impliquem a construção de uma sociedade não transfóbica e incidam no bem-estar e reconhecimento dos homens trans.

Abstract: This article discusses the health needs and demands of trans men, a topic that has received little attention and frequently calls for the development of specific health care practices for this population. A qualitative study was performed, consisting of participant observation and semi-structured interviews with trans men residing in Salvador, Bahia State, Brazil, the majority of whom were black, heterosexual, and 20 to 43 years of age. The analysis was based on interpretative anthropology, linked to critique of the assumption of intersectionality and the decolonial perspective. The health needs and demands of trans men are organized in three aspects: de-pathologization, body modification, and outpatient care. These aspects are not universal among trans men and may result from situations that indicate group conflicts and pressures. The absence of transsexualization process in the state of Bahia and barriers to accessing the health care network intensify the commodification of trans men's health demands and especially body modifications. The study concludes that structural transphobia triggers a series of health issues, while limiting the possibilities for obtaining care. The de-pathologization of trans experiences constitutes the central basis for conceiving care, relating it to cultural, political, and social changes that involve the construction of a non-transphobic society and foster the well-being and recognition of trans men.

Resumen: Este artículo discute las necesidades y demandas de salud de hombres transexuales, tema poco estudiado que, con frecuencia, requiere la construcción de prácticas de cuidado de salud para esta población. Se realizó una investigación cualitativa, compuesta de diez hombres transexuales residentes en Salvador, Bahia, Brasil, en su mayoría negros, heterosexuales y con edades entre 20 y 43 años. El análisis se basó en la antropología interpretativa, vinculada a críticas del presupuesto de la interseccionalidad y desde una perspectiva decolonial. Las necesidades y demandas de salud de los hombres transexuales se organizan en torno a tres aspectos: despatologización, modificación corporal y atención ambulatoria. Estos no son universales entre todos los hombres transexuales y pueden derivarse de situaciones que indican conflictos y presiones grupales. La ausencia del proceso transexualizador en el estado y las barreras en el acceso a la red de atención de la salud intensifican el proceso de mercantilización de sus demandas de salud, en especial, las modificaciones corporales. Se concluye que la transfobia estructural dispara una serie de cuestiones de salud, al mismo tiempo que limita las posibilidades de obtención de cuidado. La despatologización de las vivencias trans constituye el eje central, en base al cual se debe pensar el cuidado, relacionándolo con cambios culturales y políticas sociales que impliquen la construcción de una sociedad no transfóbica e incidan en el bienestar y reconocimiento de los hombres transexuales.

Humanos , Masculino , Adulto , Adulto Jovem , Pessoas Transgênero/legislação & jurisprudência , Pessoas Transgênero/psicologia , Serviços de Saúde para Pessoas Transgênero , Necessidades e Demandas de Serviços de Saúde , Preconceito , Brasil , Pesquisa Qualitativa , Populações Vulneráveis/etnologia , Populações Vulneráveis/legislação & jurisprudência , Populações Vulneráveis/psicologia
Syst Rev ; 7(1): 143, 2018 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-30223895


BACKGROUND: A key determinant of survival after out-of-hospital cardiac arrest (OHCA) is bystander cardio pulmonary resuscitation (CPR) which can more than double an individual's chances of surviving to discharge from hospital. The experience of other international OHCA survival programmes has shown that increasing bystander CPR is strongly associated with an increase in overall survival. However, existing data suggest that the more economically deprived an area is the higher the incidence of cardiac arrest. At the same time, rates of bystander CPR in the same areas are lower, which could result in lower survival rates. High-profile awareness raising campaigns that are generic focus have not specifically targeted people living in deprived communities who may require more tailored campaigns and interventions to change attitudes and improve confidence to administer bystander CPR. Therefore, this systematic review will explore the facilitators and barriers to engaging with bystander CPR which exist in deprived communities The secondary objective is to identify existing bystander OHCA social marketing and social network intervention campaigns that could inform future activities to improve the rate of bystander CPR in deprived communities. METHODS: Systematic review searching the following databases: CINAHL, MEDLINE, PsycINFO, and Web of Science Core Collection Citation Indexes. Unpublished 'grey' literature will also be sourced through web searches, stakeholder interviews, and an advisory group. The reference lists of any relevant reviews will also be checked for additional studies. References will be restricted to those published in 2000 onwards. Authors will independently screen, assess data quality, and extract data for synthesis. A narrative synthesis of study findings will be conducted, with findings presented thematically. DISCUSSION: This review will focus on all studies that seek to examine the barriers and facilitators to the delivery of bystander CPR in deprived communities and identify examples of previous interventions or activities that could inform the design of a future theory-based intervention to improve the rate of bystander CPR in deprived communities. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017081944.

Reanimação Cardiopulmonar/métodos , Assistência à Saúde/métodos , Serviços Médicos de Emergência/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Populações Vulneráveis/etnologia , Reanimação Cardiopulmonar/educação , Hospitais , Humanos , Incidência , Parada Cardíaca Extra-Hospitalar/mortalidade , Alta do Paciente , Taxa de Sobrevida
Am Ann Deaf ; 163(3): 328-355, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30100590


The authors examine parenting stress and coping strategies and their relation to satisfaction with family quality of life in a unique population: hearing Bedouin parents of children born with partial or total hearing loss in southern Israel. Could variables previously shown to predict families' quality of life in other populations with children with hearing loss also predict it in this underserved population? The study participants were 84 parents who responded to questionnaires. It was found that parenting stress affects satisfaction with the family's everyday functioning and that parents cope mainly by obtaining familial and social support and redefining the crisis situation. The latter strategy appears to improve the family's overall quality of life, whereas, surprisingly, cochlear implants do not. Thus, for such parents in traditional, marginalized societies, enhancing effective coping mechanisms may help reduce parenting stress and increase satisfaction with the family's quality of life.

Adaptação Psicológica , Árabes/psicologia , Crianças com Deficiência/psicologia , Perda Auditiva/psicologia , Pais/psicologia , Pessoas com Deficiência Auditiva/psicologia , Qualidade de Vida , Estresse Psicológico/psicologia , Populações Vulneráveis/psicologia , Adolescente , Comportamento do Adolescente/etnologia , Fatores Etários , Criança , Comportamento Infantil/etnologia , Pré-Escolar , Implante Coclear/instrumentação , Implante Coclear/psicologia , Implantes Cocleares/psicologia , Crianças com Deficiência/reabilitação , Feminino , Perda Auditiva/diagnóstico , Perda Auditiva/etnologia , Perda Auditiva/reabilitação , Humanos , Lactente , Israel/epidemiologia , Masculino , Relações Pais-Filho/etnologia , Poder Familiar/etnologia , Poder Familiar/psicologia , Pessoas com Deficiência Auditiva/reabilitação , Apoio Social , Estresse Psicológico/diagnóstico , Estresse Psicológico/etnologia , Inquéritos e Questionários , Populações Vulneráveis/etnologia
J Gerontol Soc Work ; 61(7): 719-734, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29979948


This study investigated to what extent income status and race/ethnicity in old age interplayed with disaster preparedness. Data came from the 2010 Health and Retirement Study, a nationally representative panel survey of older Americans over 51 years old. Our sample was restricted to respondents who participated in a special survey about disaster preparedness (N=1,711). Disaster preparedness was measured as a score, which includes 13 variables. Race/ethnicity was categorized by White, Black, and Hispanic. Low income was defined as below 300% of the federal poverty line. OLS regression was used to examine the main and interaction effects of race/ethnicity and lower income status on disaster preparedness scores. We found that older adults in lower income status had lower preparedness level than those in higher income (Coef. =-0.318, p<.01). Hispanics tend to be less prepared compared to White and Blacks (Coef. =-0.608, p<.001). Preparedness of Black elders was not significantly different from that of Whites. However, interestingly, Black elders in lower income status were significantly less prepared for disaster than other groups (Coef. =- 0.622, p<.05). This study identified vulnerable subgroups of older adults for disaster preparedness and suggests that preparedness programs should target minority and low income elders.

Defesa Civil/normas , Grupos de Populações Continentais/estatística & dados numéricos , Renda/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Defesa Civil/estatística & dados numéricos , Grupos de Populações Continentais/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos/etnologia , Populações Vulneráveis/etnologia , Populações Vulneráveis/estatística & dados numéricos
Rev. bioét. derecho ; (43): 211-223, jul. 2018.
Artigo em Português | IBECS | ID: ibc-176774


Este artigo discute as questões em torno do acesso à saúde dos grupos étnicos denominados quilombolas. Os quilombos contemporâneos são grupos tradicionais com organização política-econômica-histórica-cultural, que ao longo do tempo lutam pela inclusão social por meio das políticas públicas e ações de atenção integral. O Sistema Único de Saúde (SUS) defende que efetivar o direito humano à saúde da população é estabelecer padrões de equidade na política de saúde do país. Nessa perspectiva, a Bioética torna-se um instrumento de inclusão social pautando discussões democráticas acerca dos problemas que reduzem à população ao acesso equitativo e as melhores condições de vida, saúde e bem-viver

Este artículo discute las cuestiones en torno al acceso a la salud de los grupos étnicos denominados quilombolas. Los quilombos contemporáneos son grupos tradicionales con organización político-económica-histórica-cultural, que a lo largo del tiempo luchan por la inclusión social por medio de las políticas públicas y acciones de atención integral. El Sistema Único de Salud (SUS) de Brasil defiende que el derecho humano a la salud de la población es establecer estándares de equidad en la política de salud del país. En esta perspectiva, la Bioética se convierte en un instrumento de inclusión social que guía las discusiones democráticas acerca los problemas para el acceso equitativo y las mejores condiciones de vida, salud y bienestar de la población

This article discusses the issues related to access to healthcare of ethnic groups called quilombolas. Contemporary quilombos are traditional groups with political-economic-historical-cultural organization, which over time struggle for social inclusion through public policies and actions of comprehensive care. The Unified Health System (SUS) states that implementing the human right to health of the population is establishing equity standards in the health policy of the country. In this perspective, Bioethics becomes a social inclusion instrument guiding democratic discussions about the problems that reduce equitable access and better living, health and good living conditions of the population

Aquest article discuteix les qüestions entorn de l'accés a la salut dels grups ètnics anominats quilombolas. Els quilombos contemporanis són grups tradicionals amb una organització polític-econòmica-històrica-cultural pròpia que al llarg del temps lluiten per la inclusió social per mitjà de les polítiques públiques i accions d'atenció integral. El Sistema Únic de Salut de Brasil defensa que el dret humà a la salut de la població exigeix que s’ estableixin estàndards d'equitat en la política de salut del país. Des d’aquesta perspectiva, la Bioètica es converteix en un instrument d'inclusió social que guia les discussions democràtiques sobre els problemes per a l'accés equitatiu i les millors condicions de vida, salut i benestar de la població

Humanos , Populações Vulneráveis/etnologia , Populações Vulneráveis/legislação & jurisprudência , Bioética , Grupos Étnicos/legislação & jurisprudência , Política Pública/legislação & jurisprudência , Equidade em Saúde/ética , Equidade em Saúde/legislação & jurisprudência , Brasil
MCN Am J Matern Child Nurs ; 43(5): 245-251, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29944478


OBJECTIVE: Black women are more likely to live in disadvantaged neighborhoods and experience racial discrimination and psychological stress compared with White women. These factors have been related to preterm birth (PTB). However, research is limited on the associations of disadvantaged neighborhoods, racial discrimination, and psychological stress among expectant Black fathers and PTB. This review focuses on what is known about psychosocial factors in relation to PTB among Black parents. METHODS: The Scopus database was used to search for studies using keywords of adverse childhood experiences, neighborhood environment, racial discrimination, psychological stress, depressive symptoms/depression, coping, locus of control, social support, and mother-father relationship. Each of these keywords was combined with the term preterm birth. This review focused on the associations of these psychosocial factors collected during the prenatal period and risk for PTB. However, due to lack of data for some of these factors during the prenatal period, studies conducted in the immediate period after birth were included. The focus of this review was on research conducted with Black expectant fathers given the limited data on the association between paternal psychosocial factors and PTB. This review only highlights studies that examined the associations of maternal psychosocial factors and PTB. It does not present a comprehensive review of studies on maternal factors given the extent of the studies that examined these associations. RESULTS: Pregnant Black women are more likely to report living in disadvantaged neighborhoods; experiencing racial discrimination, psychological stress, and depressive symptoms; using avoidance coping; and reporting lower levels of social support compared with White women. Limited data suggest that Black expectant fathers experience higher rates of everyday unfair treatment because of race/ethnicity compared with White fathers. Research suggests that these psychosocial factors have been related to PTB among pregnant Black women; however, research is limited on examining these associations among expectant Black fathers. CLINICAL IMPLICATIONS: Maternal-child nurses are in the position to assess these psychosocial factors among expectant parents. Nurses should also assess risk factors for PTB for both expectant parents and provide support to couples who are at risk for PTB.

Pais/psicologia , Nascimento Prematuro/psicologia , Psicologia , Adulto , Grupo com Ancestrais do Continente Africano/etnologia , Grupo com Ancestrais do Continente Africano/psicologia , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/etnologia , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Pai/psicologia , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Mães/psicologia , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etnologia , Fatores de Risco , Estados Unidos/epidemiologia , Estados Unidos/etnologia , Populações Vulneráveis/etnologia , Populações Vulneráveis/psicologia , Populações Vulneráveis/estatística & dados numéricos
Ann Pharmacother ; 52(12): 1218-1223, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29871511


BACKGROUND: Diabetes and its complications disproportionately affect Hispanic patients, many of whom receive care at federally qualified health centers (FQHCs) and prefer to receive care in a language other than English. There is little published data on clinical pharmacy diabetes services in this setting. OBJECTIVE: This study aims to measure the impact of a Collaborative Drug Therapy Management-driven bilingual clinical pharmacy service on diabetes outcomes in an FQHC that primarily serves Hispanic patients, many of whom prefer to receive their care in Spanish. METHODS: Patients were included if they had a diagnosis of diabetes and initial pharmacy visit between July 1, 2015, and March 31, 2016. Individual charts were analyzed for changes in hemoglobin A1C (A1C), changes in blood pressure (BP), number of visits, ethnicity, and primary language preference. Data for these patients were collected through September 30, 2016. RESULTS: The median preintervention A1C was 10.5%; the median postintervention A1C was 9.1% (n = 211; P < 0.0001). Statistically significant BP reductions were also found in patients with uncontrolled hypertension at baseline. There were no statistically significant differences in A1C improvement based on ethnicity or language preference. Conclusion and Relevance: Patients with diabetes managed by Spanish-speaking clinical pharmacists had significant improvement in their A1C. Hispanic and non-Hispanic patients, as well as patients who preferred their care in Spanish, had similar improvements in A1C. Clinical pharmacists who speak Spanish may help reduce diabetes-related health disparities in this population. This collaborative care model could be replicated at other institutions to help underserved patients.

Serviços de Saúde Comunitária/tendências , Diabetes Mellitus/etnologia , Hispano-Americanos , Multilinguismo , Farmacêuticos/tendências , Serviço de Farmácia Hospitalar/tendências , Adulto , Serviços de Saúde Comunitária/métodos , Diabetes Mellitus/tratamento farmacológico , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Conduta do Tratamento Medicamentoso/tendências , Pessoa de Meia-Idade , Serviço de Farmácia Hospitalar/métodos , Populações Vulneráveis/etnologia
Ann Hepatol ; 17(3): 413-418, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29735789


INTRODUCTION AND AIM: Adherence to hepatitis C (HCV) care was suboptimal in the interferon era among underserved African Americans (AA), but adherence data in the era of direct acting antivirals (DAA) is lacking in this population. We aimed to evaluate the impact of DAA on HCV care in underserved AA. MATERIAL AND METHODS: Clinical records of AAs undergoing HCV evaluation attending a safety net health system liver clinic were reviewed from 2006 to 2011 (pre-DAA), and January 1, 2014 to December 31, 2016 (post-DAA). RESULTS: 291 patients were identified (129 pre-DAA, and 162 post-DAA). Median age was 58, 66% were male, 91% had HCV genotype 1, and 70% had fibrosis ≥ stage 2. Post-DAA patients were older (60 vs. 53 years; p < 0.001), had higher rates of insurance (98 vs. 88%; p < 0.001), liver fibrosis ≥ stage 2 (77 vs. 61%; p = 0.048), ≥ 2 medical comorbidities (19 vs. 0.8%; p < 0.001), and median baseline log10 HCV RNA (6.07 vs. 5.81 IU/mL; p < 0.001), but lower median ALT (46 vs. 62 U/L; p < 0.001). Post-DAA, fewer patients were treatment ineligible (5.6 vs. 39%; p < 0.001) and more initiated therapy (71 vs. 8.5%; < 0.001), were adherent to HCV care (82 vs. 38%; p < 0.001), and achieved cure (95.7 vs. 63.6%, p < 0.001). Availability of DAA was independently associated with improved adherence to HCV care (OR 10.3, 95% CI 4.84-22.0). CONCLUSION: Availability of DAA is associated with increased treatment eligibility, initiation, adherence to HCV care, and cure in HCV-infected underserved AAs; highlighting the critical role of access to DAA in this population.

Afro-Americanos , Antivirais/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hepatite C/tratamento farmacológico , Adesão à Medicação/etnologia , Provedores de Redes de Segurança , Populações Vulneráveis/etnologia , Antivirais/efeitos adversos , Antivirais/provisão & distribução , Feminino , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/etnologia , Hepatite C/diagnóstico , Hepatite C/etnologia , Hepatite C/virologia , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Indução de Remissão , Estudos Retrospectivos , São Francisco , Fatores de Tempo , Resultado do Tratamento
Alcohol Alcohol ; 53(5): 578-585, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-29846496


Background and aims: Given ongoing community concern about high rates of alcohol-related crimes (ARCs) experienced by disadvantaged populations, a more specific and nuanced understanding of factors associated with ARCs would help inform the development of more sophisticated programs and policies aimed at reducing ARCs. This study estimates rates of ARCs across all communities in New South Wales (NSW), Australia, using routinely collected police data; investigates whether there are differences between communities; and identifies individual and community characteristics that are significantly associated with higher rates of ARCs. Short summary: This study analysed routinely collected police data in New South Wales, Australia, to identify individual and community characteristics associated with alcohol-related crimes. Young people, Aboriginal Australians, socio-economically disadvantaged communities, remote and regional communities and communities with higher per capita rate of on-venue liquor licenses are at risk of alcohol-related crimes. Methods: Age standardized rates of ARCs were calculated. A multi-level Poisson regression analysis was conducted to investigate the individual and community factors that were statistically significantly associated with higher rates of ARC, separately for Aboriginal and non-Aboriginal Australians. Results: Rates of ARCs were statistically significantly higher for Aboriginal Australians, young people (aged 13-37 years) and on weekends. ARCs varied significantly across communities, and were significantly higher in remote or regional communities, in communities with a higher per capita rate of on-venue licences, and for socio-economically disadvantaged communities for non-Aboriginal Australians, but not for Aboriginal females. Conclusion: This analysis shows that the impact of national-level and jurisdictional-level legislation and policies is uneven across communities and defined populations, leaving young people, socio-economically disadvantaged communities and Aboriginal Australians at increased risk of ARCs. To more equitably reduce the exposure of all Australians to ARC, mechanisms that effectively engage vulnerable communities and defined populations, need to be developed in consultation with them, implemented and evaluated.

Consumo de Bebidas Alcoólicas/etnologia , Consumo de Bebidas Alcoólicas/tendências , Crime/tendências , Coleta de Dados/tendências , Polícia/tendências , Populações Vulneráveis/etnologia , Adolescente , Adulto , Fatores Etários , Idoso , Crime/estatística & dados numéricos , Coleta de Dados/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales/etnologia , Grupo com Ancestrais Oceânicos/etnologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Política Pública/tendências , Características de Residência/estatística & dados numéricos , Adulto Jovem