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1.
Health Econ ; 32(1): 155-174, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36237151

RESUMO

Mental health problems impose substantial individual and societal costs over the life-cycle. The age-profile of mental health problems is, however, not well understood. Hence, we study the age-profile of mental health while introducing minimal bias to reach identification. Using mental health data from the United States Panel Study of Income Dynamics we apply first difference estimation to derive an unbiased estimate of the second derivative of the age effect as well as an estimate up to a linear period trend of the first derivative. Next, we use a battery of estimators with varying restrictions to approximate the first derivative. Our results suggest that the age profile of mental health in the US is not U-shaped and we find tentative evidence that the age-profile could follow an inverse U-shape where individuals experience a mental health high during their life course. Further analyses, using German and Dutch data, confirm that these results do not only apply to the US, but also to Germany and the Netherlands.


Assuntos
Renda , Saúde Mental , Humanos , Estados Unidos , Alemanha , Viés , Custos e Análise de Custo
2.
J Hazard Mater ; 442: 130042, 2023 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-36182890

RESUMO

The emergence of antimicrobial resistance (AMR) is a growing public health threat worldwide and antibiotic consumption is being increasingly recognized as the main selective pressure driving this resistance. However, global trend in antibiotic resistance in response to antibiotic consumption is not fully understood. In this study, we collected national resistance data on specific resistant pathogens considered by the World Health Organization (WHO) as priority and antibiotic consumption data for 61 countries to assess the global trends in antibiotic resistance of those common bacterial pathogens and their association with antibiotic consumption. The low- and middle-income countries (LMICs) represented the largest hotspots of resistance, which presented relatively higher resistance rates in common bacterial pathogens but lower antibiotic consumption rates compared to high-income countries (HICs). Specifically, we developed the Normalized Antibiotic Resistance/Consumption Index (NARCI) and produced global maps of NARCI to roughly assess the appropriateness of antibiotic consumption across countries and to indicate the potentially inappropriate antibiotic consumption in LMICs compared with HICs. Additionally, we linked antibiotic consumption rates and resistance rates of target pathogens, in conjunction with NARCI and the correlation analysis between antibiotic use and resistance, to inform strategies to alleviate the threat of antibiotic resistance worldwide.


Assuntos
Antibacterianos , Farmacorresistência Bacteriana , Antibacterianos/uso terapêutico , Bactérias , Renda
3.
J Environ Manage ; 325(Pt A): 116567, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36419285

RESUMO

With the increasing share of waste material recovery, household plastic waste is one of the biggest problems. In most countries, mainly manual sorting is used. Meanwhile, new automated technologies are being developed to expand the range of classifiable types to increase material recovery. The overall automation of the sorting process can help the EU's established recycling targets to be effectively met. However, the new technologies are feasible only in the case of large-capacity centers, which must be conveniently located in the existing infrastructure. This paper presents a two-stage model aiming to modernize the current sorting infrastructure for plastic waste. The approach uses multi-criteria optimization to minimize environmental impact at a reasonable price. The result is the optimal location of new automatic sorting centers, and waste stream flows using existing manual sorting facilities. The model is applied through an initial case study inspired by the Czech Republic data. Optimization output proposes four new automatic sorting lines with a total capacity of 158 kt per year. In most cases, manual sorting is used to reduce the transported weight of plastic waste, while automatic sorting lines separate the remaining, hardly recognized part. More than 60% of separately collected plastic is sorted and determined for material recovery.


Assuntos
Gases de Efeito Estufa , Plásticos , Renda , Resíduos , Reciclagem
4.
J Environ Manage ; 325(Pt A): 116464, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36242971

RESUMO

Income inequity and energy consumption have become important issues for sustainable development, and digitalization offers unlimited potential for bridging the income gap and decreasing energy consumption. Based on an international perspective, we confirm the impact of income inequality on energy consumption in 108 countries from 2000 to 2019 and then explore the moderating and threshold effects of digitalization on the impact of income inequality on energy consumption. The empirical results indicate that income inequality causes a surge in energy consumption, and the dynamic SYS-GMM results suggest that for every 1 unit increase in income inequality, energy consumption increases by 0.003 unit. The moderating effect suggests that digitalization helps mitigate the impact of a 3.654% surge in energy consumption caused by income inequality. In comparison, digitalization has a significant moderating effect on energy consumption in middle- and high-income countries (Europe, the Americas, and the Asia-Pacific region), and the moderating effect of digitalization is effective in both free and non-free economies. The dynamic SYS-GMM threshold panel models reveal a non-linear relationship between income inequality and energy consumption affected by digitalization. This provides international evidence that reveals the underlying mechanisms of digitalization, income inequality, and energy consumption. It will better guide countries in harnessing digital dividends to overcome the twin dilemmas of the income gap and energy poverty.


Assuntos
Desenvolvimento Econômico , Renda , Pobreza , Ásia , Europa (Continente) , Dióxido de Carbono/análise
5.
Environ Res ; 216(Pt 2): 114575, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36252836

RESUMO

The COVID-19 pandemic has further increased income inequality. This work is aimed to explore the impact of income inequality on the environmental Kuznets curve (EKC) hypothesis. To this end, income inequality is set as the threshold variable, economic growth is set as the explanatory variable, while carbon emission is set as the explained variable, and the threshold panel model is developed using the data of 56 countries. The empirical results show that income inequality has changed the relationship between economic growth and carbon emissions from an inverted U-shaped to an N-shaped, which means that income inequality redefines the environmental Kuznets curve and increases the complexity of the decoupling of economic growth and carbon emissions. Specifically, economic growth significantly increases carbon emissions during periods of low income inequality, however, as income inequality increases, economic growth in turn suppresses carbon emissions. In the period of high income inequality, economic growth inhibits the increase of carbon emissions. However, with the increase of income inequality, the impact of economic growth on carbon emission changes from inhibiting to promoting. Panel regressions for robustness tests show that this phenomenon is more pronounced in high-income countries. We therefore contend that the excessive income inequality is bad for the win-win goal of economic growth without carbon emission growth, and the income distribution policy should be included in the carbon neutral strategy.


Assuntos
COVID-19 , Análise de Dados , Humanos , Dióxido de Carbono , Pandemias , COVID-19/epidemiologia , Desenvolvimento Econômico , Renda , Carbono
6.
Environ Pollut ; 316(Pt 2): 120605, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36347406

RESUMO

Evidence of the health impacts from environmental noise has largely been drawn from studies in high-income countries, which has then been used to inform development of noise guidelines. It is unclear whether findings in high-income countries can be readily translated into policy contexts in low-middle-income-countries (LMICs). We conducted this systematic review to summarise noise epidemiological studies in LMICs. We conducted a literature search of studies in Medline and Web of Science published during 2009-2021, supplemented with specialist journal hand searches. Screening, data extraction, assessment of risk of bias as well as overall quality and strength of evidence were conducted following established guidelines (e.g. Navigation Guide). 58 studies were identified, 53% of which were from India, China and Bulgaria. Most (92%) were cross-sectional studies. 53% of studies assessed noise exposure based on fixed-site measurements using sound level meters and 17% from propagation-based noise models. Mean noise exposure among all studies ranged from 48 to 120 dB (Leq), with over half of the studies (52%) reporting the mean between 60 and 80 dB. The most studied health outcome was noise annoyance (43% of studies), followed by cardiovascular (17%) and mental health outcomes (17%). Studies generally reported a positive (i.e. adverse) relationship between noise exposure and annoyance. Some limited evidence based on only two studies showing that long-term noise exposure may be associated with higher prevalence of cardiovascular outcomes in adults. Findings on mental health outcomes were inconsistent across the studies. Overall, 4 studies (6%) had "probably low", 18 (31%) had "probably high" and 36 (62%) had "high" risk of bias. Quality of evidence was rated as 'low' for mental health outcomes and 'very low' for all other outcomes. Strength of evidence for each outcome was assessed as 'inadequate', highlighting high-quality epidemiological studies are urgently needed in LMICs to strengthen the evidence base.


Assuntos
Ruído , Pobreza , Ruído/efeitos adversos , Renda , Índia , China , Países em Desenvolvimento
7.
J Interpers Violence ; 38(1-2): NP1007-NP1039, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35298318

RESUMO

Introduction: Intimate partner violence (IPV) affects 1 in 3 women and poses a major human rights threat and public health burden, yet there is great variation in risk globally. Whilst individual risk factors are well-studied, less research has focussed on the structural and contextual drivers of IPV and how these co-occur to create contexts of high risk. Methods: We compiled IPV drivers from freely-accessible global country-level data sources and combined gender inequality, natural disasters, conflict, colonialism, socioeconomic development and inequality, homicide and social discrimination in a latent class analysis, and identified underlying 'risk contexts' based on fit statistics and theoretical plausibility (N=5,732 country-years; 190 countries). We used multinomial regression to compare risk contexts according to: proportion of population with disability, HIV/AIDS, refugee status, and mental health disorders; proportion of men with drug use disorders; men's alcohol consumption; and population median age (N=1,654-5,725 country-years). Finally, we compared prevalence of physical and/or sexual IPV experienced by women in the past 12 months across risk contexts (N=3,175 country-years). Results: Three distinct risk contexts were identified: 1) non-patriarchal egalitarian, low rates of homicide; 2) patriarchal post-colonial, high rates of homicide; 3) patriarchal post-colonial conflict and disaster-affected. Compared to non-patriarchal egalitarian contexts, patriarchal post-colonial contexts had a younger age distribution and a higher prevalence of drug use disorders, but a lower prevalence of mental health disorders and a smaller refugee population. IPV risk was highest in the two patriarchal post-colonial contexts and associated with country income classification. Conclusions: Whilst our findings support the importance of gender norms in shaping women's risk of experiencing IPV, they also point towards an association with a history of colonialism. To effectively address IPV for women in high prevalence contexts, structural interventions and policies are needed that address not only gender norms, but also broader structural inequalities arising from colonialism.


Assuntos
Violência por Parceiro Íntimo , Masculino , Feminino , Humanos , Análise de Classes Latentes , Violência por Parceiro Íntimo/psicologia , Homens , Prevalência , Renda , Fatores de Risco , Parceiros Sexuais/psicologia
9.
PLoS One ; 17(12): e0278275, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36454740

RESUMO

OBJECTIVE: To construct an individual socioeconomic status index (ISESI) with information available in the Population Information System of the Region of Valencia, Spain, and use it to analyse inequalities in a colorectal cancer screening programme (CRCSP). METHODS: Cross-sectional study of men and women aged between 50 and 75 at the time of the study (2020) that were selected from the target population of the Region of Valencia CRCSP. (study sample 1,150,684). First, a multiple correspondence analysis was performed to aggregate information from the Population Information System of the Region of Valencia into an ISESI. Second, data from the 2016 Region of Valencia Health Survey were used for validation, and finally the relationship between CRCSP participation and the ISESI was analysed by logistic regression models. RESULTS: The variables included in the index were nationality, employment status, disability, healthcare coverage, risk of vulnerability and family size. The most important categories for determining the highest socioeconomic status were being employed and not being at risk of social vulnerability, and being unemployed and at risk of social vulnerability for determining the lowest socioeconomic status. Index validation demonstrated internal and external coherence for measuring socioeconomic status. The relationship between CRCSP participation and the ISESI categorised by quartile (Q) showed that Q4 (the lowest socioeconomic status) was less likely to participate OR = 0.769 (0.757-0.782) than Q1 (the highest socioeconomic status), and the opposite was found for Q2 OR = 1.368 (1.347-1.390) and Q3 OR = 1.156 (1.137-1.175). CONCLUSIONS: An ISESI was constructed and validated using Population Information System data and made it possible to evaluate inequalities in colorectal cancer screening.


Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Estudos Transversais , Classe Social , Renda , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia
10.
PLoS One ; 17(12): e0277839, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36454902

RESUMO

INTRODUCTION: Cancer is the main cause of morbidity and mortality in every part of the world, regardless of human development. Cancer patients exhibit a wide range of signs and symptoms. Being diagnosed with cancer has a variety of consequences that can affect one's quality of life. The term "health-related quality of life" refers to a multidimensional concept that encompasses a person's whole health. The availability of data on the prevalence of poor quality of life among cancer patients in Ethiopia is critical in order to focus on early detection and enhance cancer treatment strategies. In Ethiopia, however, there is a scarcity of information. As a result, the aim of this study was to determine the pooled estimated prevalence of quality of life among cancer patients in Ethiopia. MATERIALS AND METHODS: This systematic review and meta-analysis were searched through MEDLINE, Pub Med, Cochrane Library, and Google Scholar by using different search terms on the prevalence of health-related quality of life of cancer patients and Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used for critical appraisal of studies. The analysis was done using STATA 14 software. The Cochran Q test and I2 test statistics were used to test the heterogeneity of studies. The funnel plot and Egger's test were used to show the publication bias. The pooled prevalence of health-related quality of life of cancer with a 95% confidence interval was presented using forest plots. RESULTS: A total of 12 studies with 3, 479 participants were included in this review and the overall pooled estimates mean score of health-related quality of life among cancer patients in Ethiopia was 57.91(44.55, 71.27, I2 = 98.8%, p≤0.001). Average monthly income (AOR:3.70;95%CI:1.31,6.10), Stage of cancer (AOR:4.92;95% CI:2.96,6.87), Physical functioning(AOR:4.11;95%CI:1.53,6.69), Social functioning(AOR:3.91;95% CI:1.68,6.14) were significantly associated with quality of life. Subgroup meta-analysis of health-related quality of life of cancer patients in Ethiopia done by region showed that a higher in Addis Ababa 83.64(78.69, 88.60), and lower in SNNP region16.22 (11.73, 20.71), and subgroup analysis done based on the type of cancer showed that higher prevalence of health-related quality of life among cancer patients was breast cancer 83.64(78.69, 88.60). CONCLUSION: This review showed that the overall health related quality of life was above an average. Furthermore, average monthly income, cancer stage, physical, and social functioning were all significant determinants in cancer patients' QOL.as a result, this review suggests that quality of life evaluation be incorporated into a patient's treatment routine, with a focus on linked components and domains, as it is a critical tool for avoiding and combating the effects of cancer and considerably improving overall health. In general, more research is needed to discover crucial determining elements utilizing more robust study designs.


Assuntos
Neoplasias da Mama , Qualidade de Vida , Humanos , Feminino , Etiópia/epidemiologia , Renda , Projetos de Pesquisa
11.
PLoS One ; 17(12): e0278091, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36454957

RESUMO

Most recipients of doctorates leave universities some years after graduation, while little is known about their future non-academic career prospects. I report results from a novel microlevel database that links information about doctoral dissertations completed in Germany with doctorate recipients' social security records. The results, based on graduates' individual careers for five broader subject groups, indicate that postdoctoral periods do not result in a wage premium when changing to the non-academic sector.


Assuntos
Emprego , Salários e Benefícios , Renda , Previdência Social , Universidades
12.
Semin Pediatr Neurol ; 44: 100996, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36456038

RESUMO

Childhood stroke is not as common as adult stroke, but it is underrecognized the world over. Diagnosis is often delayed due to lack of awareness not only by the lay public but also by emergency and front-line health care workers. Despite the relative rarity of childhood stroke, the impact on morbidity, mortality and the economic burden for families and society is high, especially in poorly resourced settings. The risk factors for stroke in children differ from the adult population where lifestyle factors play a more important role. The developmental aspects of the pediatric cerebral vasculature and hematological maturational biology affects the clinical presentation, investigation, management and outcomes of childhood stroke in a different way compared to adults. The management of childhood stroke is currently based on expert guidelines and evidence extrapolated from adult studies. Hyperacute therapies that have revolutionized the treatment of stroke in adults cannot be easily applied to children at this stage due to the diagnostic delays, diverse risk factors and developmental considerations mentioned above. Much has been achieved in the understanding of genetic, acquired, preventable and recurrent stroke risk factors in the past decade through international collaborative efforts like the International Pediatric Stroke Study. Evidence for the prevention and treatment of childhood stroke remains elusive. Even more elusive are relevant and achievable management guidelines for pediatric stroke in resource-limited settings. This narrative review focusses on the current management practices globally, emphasizing the challenges, and gaps in knowledge of pediatric stroke in low- and middle-income countries and other areas with limited resources. Priorities and some potential solutions at national and local level are suggested for these settings.


Assuntos
Acidente Vascular Cerebral , Adulto , Criança , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Renda
13.
Semin Pediatr Neurol ; 44: 101000, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36456036

RESUMO

Rehabilitation for pediatric stroke survivors can maximize a child's potential through each developmental stage of life. Timely diagnosis and referral to a rehabilitation specialist may harness opportunities to maximize brain plasticity, to help children adapt and learn, and to participate in and enjoy daily life to their capability. The aim of this focused review is to explore current rehabilitation models and evidence-based interventions for pediatric stroke survivors in Low- and Middle- Income Countries (LMICs) and to provide recommendations for future research and focused areas of improvement.There are several published pediatric stroke guidelines from the American Heart Association (AHA), Canada, Australia, and the United Kingdom (UK) which provide specific recommendations for rehabilitation, although the suggested intervention and services vary. There are no current guidelines developed in or contextually adapted for LMICs, although the current pediatric stroke guidelines emphasize the need to develop interventions that fit the cultural and environmental contexts. The World Health Organization (WHO) Rehabilitation 2030 initiative acknowledges profound unmet rehabilitation needs around the world, especially in LMICs. According to the WHO, LMICs have less than ten skilled rehabilitation professionals per one million people. Enhancing the understanding of rehabilitation services in LMICs could lead to nationally supported workforce education initiatives targeted to expand the number of locally trained therapy providers. This could improve access to and delivery of quality rehabilitation interventions to pediatric stroke survivors in these settings.


Assuntos
Países em Desenvolvimento , Acidente Vascular Cerebral , Estados Unidos , Humanos , Criança , Renda , Pobreza , Acidente Vascular Cerebral/terapia , Organização Mundial da Saúde
14.
Zhonghua Liu Xing Bing Xue Za Zhi ; 43(10): 1619-1625, 2022 Oct 10.
Artigo em Chinês | MEDLINE | ID: mdl-36456494

RESUMO

Objective: To investigate the relationship between socioeconomic status (SES) and all-cause mortality in patients with type 2 diabetes. Methods: A total of 17 553 patients with type 2 diabetes were recruited under the National Basic Public Health Service Project in Changshu county, Qingjiangpu district, and Huai'an district in Huai'an city of Jiangsu province as participants. Latent class analysis was applied to classify the individuals based on five socioeconomic indicators. Then, Cox proportional hazards regression models were used to estimate the associations of different levels of SES with all-cause mortality, and stratified analysis was performed according to age and area. Results: Among 100 529.08 person-years of the fo1low-up, the median follow-up time was 5.7 years, and 1 829 deaths occurred during the follow-up period. According to the relevant results of the latent class model, the model of the "three classes" was the best. The related population was then divided into low SES (8 256 people, 47.0%), medium SES (4 427 people, 25.2%), and high SES groups (4 870 people, 27.8%). Compared to patients with high SES, the multivariate-adjusted hazard ratio (95%CI) of all-cause mortality associated with low SES for males and females were 1.84 (1.53-2.21) and 1.41 (1.51-1.72), respectively. Stratified analysis showed that the hazard ration (95%CI) of all-cause mortality associated with low SES for males and females were 1.99 (1.12-2.95) and 2.01 (1.20-3.23), respectively, in people younger than 60 years old, and were 1.90 (1.57-2.31) and 1.40 (1.13-1.73) in people over 60 years old. The HR values (95%CI) for all-cause mortality associated with low SES for the male and females were 1.54 (1.17-2.04) and 1.27 (1.02-1.59) in the urban population with 2.11 (1.55-2.85) and 2.64 (1.17-3.35) in rural population, respectively. Conclusions: Lower SES increased the risk of all-cause mortality in type 2 diabetic patients, which is more significant in younger and rural populations.


Assuntos
Diabetes Mellitus Tipo 2 , Estados Unidos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Classes Latentes , Estudos Prospectivos , Classe Social , Renda
15.
Popul Health Metr ; 20(1): 21, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36456956

RESUMO

BACKGROUND: Concentration index-based measures are one of the most popular tools for estimating socioeconomic-status-related health inequalities. In recent years, several variants of the concentration index have been developed that are designed to correct for deficiencies of the standard concentration index and which are increasingly being used. These variants, which include the Wagstaff index and the Erreygers index, have important technical and normative differences. MAIN BODY: In this study, we provide a non-technical review and critical assessment of these indices. We (i) discuss the difficulties that arise when measurement tools intended for income are applied in a health context, (ii) describe and illustrate the interrelationship between the technical and normative properties of these indices, (iii) discuss challenges that arise when determining whether index estimates are large or of policy significance, and (iv) evaluate the alignment of research practice with the properties of the indices used. Issues discussed in parts (i) and (ii) include the different conceptions of inequality that underpin the indices, the types of changes to a distribution which leave inequality unchanged and the importance of the measurement scale and range of the outcome variable. These concepts are illustrated using hypothetical examples. For parts (iii) and (iv), we reviewed 44 empirical studies published between 2015 and 2017 and find that researchers often fail to provide meaningful interpretations of the index estimates. CONCLUSION: We propose a series of questions to facilitate further sensitivity analyses and provide a better understanding of the index estimates. We also provide a guide for researchers and policy analysts to facilitate the critical assessment of studies using these indices, while helping applied researchers to choose inequality measures that have the normative properties they seek.


Assuntos
Disparidades nos Níveis de Saúde , Nível de Saúde , Humanos , Renda , Classe Social
16.
BMC Med Ethics ; 23(1): 122, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36457067

RESUMO

Population-based genomics studies have proven successful in identifying genetic variants associated with diseases. High-quality biospecimens linked with informative health data from diverse segments of the population have made such research possible. However, the success of biobank research depends on the willingness of the public to participate in this type of research. We aimed to explore the factors associated with the willingness of the public to participate in biobank research from four low- and middle-income countries in the Arab region (Egypt, Jordan, Morocco, and Sudan). We used a previously validated questionnaire to assess several constructs that included the public's perceptions, attitudes, and willingness to participate in biobank research. We recruited 967 participants. More than half did not have prior awareness of biobanks. Participants' willingness to donate biospecimens and health data was less than 10%. Our results also showed that participants harbored concerns with trust, privacy, and with data-sharing involving international researchers. Predictors of willingness to participate in biobank research included no previous involvement in research and positive attitudes toward biobanks. Finally, our study showed several differences between the four countries regarding several of the investigated constructs. We conclude there should be additional efforts to raise public awareness and enhance perceptions of the public in biobanking research to enhance trust. We further recommend qualitative research to explore the underlying factors that contribute to the public's concerns with international data sharing that would enhance global health.


Assuntos
Árabes , Bancos de Espécimes Biológicos , Humanos , Países em Desenvolvimento , Renda , Confiança
17.
PLoS One ; 17(11): e0277441, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36378655

RESUMO

Socioeconomic factors have exacerbated the impact of COVID-19 worldwide. Brazil, already marked by significant economic inequalities, is one of the most affected countries, with one of the highest mortality rates. Understanding how inequality and income segregation contribute to excess mortality by COVID-19 in Brazilian cities is essential for designing public health policies to mitigate the impact of the disease. This paper aims to fill in this gap by analyzing the effect of income inequality and income segregation on COVID-19 mortality in large urban centers in Brazil. We compiled weekly COVID-19 mortality rates from March 2020 to February 2021 in a longitudinal ecological design, aggregating data at the city level for 152 Brazilian cities. Mortality rates from COVID-19 were compared across weeks, cities and states using mixed linear models. We estimated the associations between COVID-19 mortality rates with income inequality and income segregation using mixed negative binomial models including city and week-level random intercepts. We measured income inequality using the Gini index and income segregation using the dissimilarity index using data from the 2010 Brazilian demographic census. We found that 88.2% of COVID-19 mortality rates variability was between weeks, 8.5% between cities, and 3.3% between states. Higher-income inequality and higher-income segregation values were associated with higher COVID-19 mortality rates before and after accounting for all adjustment factors. In our main adjusted model, rate ratios (RR) per 1 SD increases in income inequality and income segregation were associated with 17% (95% CI 9% to 26%) and 11% (95% CI 4% to 19%) higher mortality. Income inequality and income segregation are long-standing hallmarks of large Brazilian cities. Risk factors related to the socioeconomic context affected the course of the pandemic in the country and contributed to high mortality rates. Pre-existing social vulnerabilities were critical factors in the aggravation of COVID-19, as supported by the observed associations in this study.


Assuntos
COVID-19 , Segregação Social , Humanos , Brasil/epidemiologia , COVID-19/epidemiologia , Renda , Fatores Socioeconômicos , Mortalidade
19.
Nutrients ; 14(21)2022 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-36364750

RESUMO

Women's nutrition has been highlighted as a global priority to ensure the health and well-being of both them and future generations. This systematic review summarises the available literature on the integration of nutrition services for girls and women of reproductive age (GWRA) into existing public health systems across low- and middle-income countries, as well as any barriers to integration. We searched PubMed and Cochrane Database of Systematic Reviews for articles published since 2011 according to eligibility criteria. A total of 69 articles were included. Evidence suggested that several services for GWRA are well integrated into public health systems, including antenatal care services, nutrition education and counselling, and micronutrient supplementation programmes. However, there was limited evidence on the integration of family planning, adolescent health, and reproductive health services. Barriers to integration fell into five main themes: lack of training and capacity building, poor multisectoral linkages and coordination, weak advocacy, lack of M&E systems, and inequity. We identified a lack of evidence and services for non-pregnant GWRA and for women postpartum. Addressing barriers to integration and gaps in nutrition services for GWRA would increase service coverage and contribute to improving health outcomes for GWRA and future generations.


Assuntos
Países em Desenvolvimento , Estado Nutricional , Adolescente , Feminino , Humanos , Gravidez , Renda , Cuidado Pré-Natal , Revisões Sistemáticas como Assunto
20.
JAMA Netw Open ; 5(11): e2240519, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36342718

RESUMO

Importance: In the US, Black individuals die younger than White individuals and have less household wealth, a legacy of slavery, ongoing discrimination, and discriminatory public policies. The role of wealth inequality in mediating racial health inequities is unclear. Objective: To assess the contribution of wealth inequities to the longevity gap that exists between Black and White individuals in the US and to model the potential effects of reparations payments on this gap. Design, Setting, and Participants: This cohort study analyzed the association between wealth and survival among participants in the Health and Retirement Study, a nationally representative panel study of community-dwelling noninstitutionalized US adults 50 years or older that assessed data collected from April 1992 to July 2019. Participants included 7339 non-Hispanic Black (hereinafter Black) and 26 162 non-Hispanic White (hereinafter White) respondents. Data were analyzed from January 1 to September 17, 2022. Exposures: Household wealth, the sum of all assets (including real estate, vehicles, and investments), minus the value of debts. Main Outcomes and Measures: The primary outcome was all-cause mortality by the end of survey follow-up in 2018. Using parametric survival models, the associations among household wealth, race, and survival were evaluated, adjusting for age, sex, number of household members, and marital status. Additional models controlled for educational level and income. The survival effects of eliminating the current mean wealth gap with reparations payments ($828 055 per household) were simulated. Results: Of the 33 501 individuals in the sample, a weighted 50.1% were women, and weighted mean (SD) age at study entry was 59.3 (11.1) years. Black participants' median life expectancy was 77.5 (95% CI, 77.0-78.2) years, 4 years shorter than the median life expectancy for White participants (81.5 [95% CI, 81.2-81.8] years). Adjusting for demographic variables, Black participants had a hazard ratio for death of 1.26 (95% CI, 1.18-1.34) compared with White participants. After adjusting for differences in wealth, survival did not differ significantly by race (hazard ratio, 1.00 [95% CI, 0.92-1.08]). In simulations, reparations to close the mean racial wealth gap were associated with reductions in the longevity gap by 65.0% to 102.5%. Conclusions and Relevance: The findings of this cohort study suggest that differences in wealth are associated with the longevity gap that exists between Black and White individuals in the US. Reparations payments to eliminate the racial wealth gap might substantially narrow racial inequities in mortality.


Assuntos
Negros , Etnicidade , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Masculino , Estudos de Coortes , Fatores Socioeconômicos , Renda
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