Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 190.581
Filtrar
1.
Rev. enferm. UERJ ; 28: e39222, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1116097

RESUMEN

Objetivo: desenvolver uma reflexão teórica-reflexiva acerca da vulnerabilidade e suas dimensões nos cuidados de enfermagem aos grupos humanos. Conteúdo: Trata-se de uma análise reflexiva, fundamentada no referencial de vulnerabilidade e direitos humanos, que promoveu uma reflexão acerca do tema proposto, com o propósito de uma aprendizagem prática- reflexiva a partir da imersão nos contextos práticos-teóricos sobre o tema, para tecer uma análise de como as dimensões da vulnerabilidade podem ser trabalhadas com os cuidados de enfermagem aos diversos grupos humanos. Considerações finais: Verifica-se, a partir desse estudo, que a vulnerabilidade envolve a combinação de elementos que refletem na dimensão individual, social e programática e estão associadas às experiências de facilidade e dificuldades impostas pelo processo saúdedoença relacionadas ao modo de vida de cada grupo e aos cuidados de enfermagem prestados.


Objective: to develop a reflective and theoretical discussion about vulnerability and its dimensions in nursing care for human groups. Content: this reflective analysis, framed by reference to vulnerability and human rights, conducted group thinking on the proposed theme, with a view to practical and theoretical learning through immersion in related practical and theoretical contexts, so as to build an analysis of how dimensions of vulnerability can be addressed by nursing care for diverse human groups. Final considerations: this study found that vulnerability involves a combination of components reflected in the individual, social and programmatic dimensions and associated with experiences of difficulties and solutions imposed by the health-disease process. related to the lifestyle of each group and the nursing care provided.


Objetivo: desarrollar una discusión reflexiva y teórica sobre la vulnerabilidad y sus dimensiones en el cuidado de enfermería para grupos humanos. Contenido: este análisis reflexivo, enmarcado en referencia a la vulnerabilidad y los derechos humanos, realizó un pensamiento grupal sobre el tema propuesto, con miras al aprendizaje práctico y teórico a través de la inmersión en contextos prácticos y teóricos relacionados, a fin de construir un análisis de cómo las dimensiones de La vulnerabilidad puede ser abordada por el cuidado de enfermería para diversos grupos humanos. Consideraciones finales: este estudio encontró que la vulnerabilidad implica una combinación de componentes reflejados en las dimensiones individuales, sociales y programáticas y asociados con experiencias de dificultades y soluciones impuestas por el proceso de salud-enfermedad. relacionado con el estilo de vida de cada grupo y la atención de enfermería brindada.


Asunto(s)
Humanos , Poblaciones Vulnerables , Vulnerabilidad en Salud , Relaciones Enfermero-Paciente , Atención de Enfermería/tendencias , Equidad en Salud , Acogimiento
2.
BMC Pediatr ; 20(1): 358, 2020 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-32731853

RESUMEN

BACKGROUND: Children with medical complexity (CMC) denotes the profile of a child with diverse acute and chronic conditions, making intensive use of the healthcare services and with special health and social needs. Previous studies show that CMC are also affected by the socioeconomic position (SEP) of their family. The aim of this study is to describe the pathologic patterns of CMC and their socioeconomic inequalities in order to better manage their needs, plan healthcare services accordingly, and improve the care models in place. METHODS: Cross-sectional study with latent class analysis (LCA) of the CMC population under the age of 15 in Catalonia in 2016, using administrative data. LCA was used to define multimorbidity classes based on the presence/absence of 57 conditions. All individuals were assigned to a best-fit class. Each comorbidity class was described and its association with SEP tested. The Adjusted Morbidity Groups classification system (Catalan acronym GMA) was used to identify the CMC. The main outcome measures were SEP, GMA score, sex, and age distribution, in both populations (CMC and non-CMC) and in each of the classes identified. RESULTS: 71% of the CMC population had at least one parent with no employment or an annual income of less than €18,000. Four comorbidity classes were identified in the CMC: oncology (36.0%), neurodevelopment (13.7%), congenital and perinatal (19.8%), and respiratory (30.5%). SEP associations were: oncology OR 1.9 in boys and 2.0 in girls; neurodevelopment OR 2.3 in boys and 1.8 in girls; congenital and perinatal OR 1.7 in boys and 2.1 in girls; and respiratory OR 2.0 in boys and 2.0 in girls. CONCLUSIONS: Our findings show the existence of four different patterns of comorbidities in CMC and a significantly high proportion of lower SEP children in all classes. These results could benefit CMC management by creating more efficient multidisciplinary medical teams according to each comorbidity class and a holistic perspective taking into account its socioeconomic vulnerability.

3.
Int J Equity Health ; 19(1): 47, 2020 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-32731870

RESUMEN

BACKGROUND: Given the persistence of Indigenous health inequities across national contexts, many countries have adopted strategies to improve the health of Indigenous peoples. Governmental recognition of the unique health needs of Indigenous populations is necessary for the development of targeted programs and policies to achieve universal health coverage. At the same time, the participation of Indigenous peoples in decision-making and program and policy design helps to ensure that barriers to health services are appropriately addressed and promotes the rights of Indigenous peoples to self-determination. Due to similar patterns of Indigenous health and health determinants across borders, there have been calls for greater global collaboration in this field. However, most international studies on Indigenous health policy link Anglo-settler democracies (Canada, Australia, Aotearoa/New Zealand and the United States), despite these countries representing a small fraction of the world's Indigenous people. AIM: This paper examines national-level policy in Australia, Brazil, Chile and New Zealand in relation to governmental recognition of differential Indigenous health needs and engagement with Indigenous peoples in health. The paper aims to examine how Indigenous health needs and engagement are addressed in national policy frameworks within each of the countries in order to contribute to the understanding of how to develop pro-equity policies within national health care systems. METHODS: For each country, a review was undertaken of national policies and legislation to support engagement with, and participation of, Indigenous peoples in the identification of their health needs, development of programs and policies to address these needs and which demonstrate governmental recognition of differential Indigenous health needs. Government websites were searched as well as the following databases: Google, OpenGrey, CAB Direct, PubMed, Web of Science and WorldCat. FINDINGS: Each of the four countries have adopted international agreements regarding the engagement of Indigenous peoples in health. However, there is significant variation in the extent to which the principles laid out in these agreements are reflected in national policy, legislation and practice. Brazil and New Zealand both have established national policies to facilitate engagement. In contrast, national policy to enable engagement is relatively lacking in Australia and Chile. Australia, Brazil and New Zealand each have significant initiatives and policy structures in place to address Indigenous health. However, in Brazil this is not necessarily reflected in practice and although New Zealand has national policies these have been recently reported as insufficient and, in fact, may be contributing to health inequity for Maori. In comparison to the other three countries, Chile has relatively few national initiatives or policies in place to support Indigenous engagement or recognise the distinct health needs of Indigenous communities. CONCLUSIONS: The adoption of international policy frameworks forms an important step in ensuring that Indigenous peoples are able to participate in the formation and implementation of health policy and programs. However, without the relevant principles being reflected in national legislature, international agreements hold little weight. At the same time, while a national legislative framework facilitates the engagement of Indigenous peoples, such policy may not necessarily translate into practice. Developing multi-level approaches that improve cohesion between international policy, national policy and practice in Indigenous engagement in health is therefore vital. Given that each of the four countries demonstrate strengths and weaknesses across this causal chain, cross-country policy examination provides guidance on strengthening these links.

4.
Int J Equity Health ; 19(1): 98, 2020 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-32731871

RESUMEN

BACKGROUND: Understanding health financing reforms and means is key to evaluate how maternal health has improved. Problems related to health financing policies are contributing to inadequate quality of care and inequitable use of healthcare by pregnant women, resulting in poor maternal health outcomes. The purpose of the study was to measure socioeconomic and health financing related inequality in maternal mortality in Colombia as well as identifying potential epicenters of this inequality. METHODS: The data used was obtained from National Information of Social Protection (Sispro), the Department of Planning and National Statistics Department. Maternal mortality ratios were calculated by health insurance scheme and disaggregated by health spending per capita quintiles to allow for closer examination of inequality. The Slope Index of Inequality and Concentration Index were estimated to express absolute and relative inequality. We conducted interviews with key informants involved in the implementation of health financing and maternal health policies. RESULTS: The main finding shows inequality in maternal mortality across regions and in particular in the subsidized health insurance. The contributory health insurance scheme is closing gaps over time, but inequality in the subsidized scheme is significantly widening, which impacts the severity of overall measurements of inequality. 20% of territories with the lowest health spending per capita have reached 35% of maternal mortality, and it such rates are worsening. This means that there is a marginal exclusion in which most of maternal deaths still occur in the regions with lowest resources. CONCLUSIONS: Beyond the key issues in health financing, issues of quality of care must be addressed. The country must define its own approach to financing for maternal health coverage given its unique situation and starting point. Potential policy implications that emerged are: i) afro-Colombian, indigenous, poorer and migrant women must be put at the center of the maternal health care services; ii) better skills, Reproductive, Maternal, Newborn and Child Health RMNCH training and health worker retention strategies and training in rural, insular and remote geographical areas; ii) a better understanding of provider payment mechanisms and the incentives that influence provider behaviors; and iv) inequality prompt calls for a targeted approach, whereby care is directed toward the most disadvantaged regions.

5.
Int J Equity Health ; 19(1): 125, 2020 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-32731893

RESUMEN

BACKGROUND: Four Andean countries of Bolivia, Colombia, Ecuador, and Peru introduced national health-focused conditional cash transfer (CCT) programs in the 2000s. This study probes whether policymakers in these countries targeted CCT programs to subregions with the highest prevalence of ill-health or those with the lowest socioeconomic status (SES) to evaluate the equity of geographic targeting and means-testing, as well as the potential role of normative frames, bounded rationality, and clientelism as explanatory mechanisms for inequities in social spending. METHODS: The distribution of vaccination coverage, underweight, stunting, and child deaths is established both within and between subnational regions and SES quintiles from 1998 to 2012 using every available nationally representative household survey. The equity of CCT program targeting and strength of association with subregional SES and health outcomes are measured using generalized entropy index decomposition and meta-regression. Finally, simple predictive models for CCT targeting are created using lagged subregional SES, health outcomes, and concentration indices. RESULTS: Bolivia and Peru both effectively targeted at-risk subregions, but subregions in Peru with no CCT program coverage result in higher mistargeting rates for the country as a whole. Only Bolivia failed to attain CCT coverage concentration indices that are at least as large as the health inequalities they are targeting. Despite this insufficient progressivity, Bolivia has the most efficient subregional targeting, while the lowest rates of mistargeting for child deaths are found in Colombia and Ecuador. Finally, the simple predictive model performs as well or better than observed CCT coverage distribution for every country, year, and outcome. CONCLUSIONS: Both Peru and Ecuador have targeted programs to their poorest populations effectively, demonstrating that this is possible with both universal and geographic targeting. No clear evidence of clientelism was found, while the dominant normative frame underlying CCT program targeting decisions appears to be the relative SES of subregions, rather than absolute SES, prevalence of health outcomes, or health inequalities. To reduce the inequitable impacts of bounded rationality, policymakers can use simple predictive models to target CCT coverage effectively and without leaving behind the most vulnerable populations that happen to live in more affluent subregions.

6.
J Natl Med Assoc ; 2020 Jul 27.
Artículo en Inglés | MEDLINE | ID: mdl-32732018

RESUMEN

PURPOSE: Outcome differences driven by variation in Blacks' biologic response to treatment may contribute to persistent racial disparities in asthma morbidity and mortality. This review assessed systematic variation in ß2 agonist treatment outcomes among Blacks compared to other groups. METHODS: We conducted a systematic review of studies reporting differential response to ß2 agonists among Blacks, including studies identifying pharmacogenetic variants. RESULTS: Of 3158 papers, 20 compared safety or efficacy of ß2 agonists among Blacks as compared with other subgroups. Six papers evaluating efficacy of short-acting ß2 agonists (SABA) found similar or improved results among Blacks compared with other groups, while one small study found reduced response to SABA therapy among Blacks. Reports of safety and efficacy of long-acting ß2 agonists (LABA) indicated similar results among Blacks in four papers, while four reports found reduced safety among Blacks, as compared with other groups. Four papers assessed genomic variation and relative treatment response in Blacks, with two finding significant effects of the p.Arg16Gly variant in ADRB2 on ß2 agonist response and one finding significant gene-gene IL6/IL6R interaction effects on albuterol response. CONCLUSIONS: Evidence suggests the potential for differences in ß2 agonist outcomes among Blacks compared with other groups. This literature, however, remains small and significantly underpowered for substantive conclusions. There are notable opportunities for adequately-powered investigations exploring safety and efficacy of ß2 agonists among Blacks, including pharmacogenomic modifiers of response.

7.
J Affect Disord ; 276: 752-764, 2020 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-32736185

RESUMEN

BACKGROUND: Emotional distress (defined as any negative mood state, including anxiety, depression, trauma symptoms and global distress) is common in people with multiple sclerosis (PwMS). To develop more integrated care for PwMS requires a better understanding of causal variables underlying persistent emotional distress. This systematic review critically appraised and synthesised the findings of prospective studies investigating predictors of emotional distress in PwMS. METHOD: CINAHL, Medline, and PsycINFO, were systematically searched for: i) prospective cohort studies with ≥1-month follow-up period, which; ii) evaluated baseline clinical and demographic, social and/or psychosocial predictors of emotional distress; iii) presented results for adults with MS; and iv) used validated measures to assess emotional distress. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Scale. RESULTS: Thirteen studies, reported in 17 papers, were included. A wide range of outcome measures and statistical methods were used. The most reliable finding was that baseline emotional distress and stress-coping variables predicted emotional distress. Less robust support was found for income, negative cognitive illness appraisals and poor social support. No other variables often predicted emotional distress. LIMITATIONS: Lack of consistency across included studies may limit confidence in the results obtained. CONCLUSIONS: Little is currently known about how or why some people become and remain distressed following a diagnosis of MS, whilst others do not. However, psychological and social factors such as emotional distress and stress-coping variables appear to be important. A better understanding of the psychological factors underpinning distress in PwMS is needed.

8.
BMC Med Educ ; 20(1): 244, 2020 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-32736559

RESUMEN

BACKGROUND: To build a consensus about learning objectives in the operating room, the aim of the study was to evaluate both surgical teacher and learner perspectives on perioperative teaching and learning in Taiwan. METHODS: Twelve main technical and non-technical learning objectives in the operating room were evaluated by learners and surgical teachers in Kaohsiung Medical University Hospital. The learners included postgraduate year (PGY) 1-3 residents (junior learner, JL) and PGY 4-7 residents (senior learner, SL). The definition of learning preferences were recommended learning objectives, and learning load was defined as demands of learning preferences. During the survey, surgical teachers evaluated the learning preferences for the learner, and learners evaluated their learning preferences. The learners also evaluated the learning preferences that the surgical teachers should teach. RESULTS: Response rate of the questionnaire was 65.4%. A total of 31 learners and 39 surgical teachers completed the survey. The consensus was that the need to increase the learning loads and ethical issues were the learning preferences for SL, and indications, details of procedure, and teamwork were important to both JL and SL. The teachers intended to set specific learning objectives for different learner levels, including (i) indications, details of procedure, teamwork, and postoperative care for both JL and SL; (ii) preoperative preparation, surgical anatomy, and instrument handling for JL (P = 0.022, 0.021 and 0.006); and (iii) surgical technique, independent practice, clinical reasoning, complications, and ethical issues for SL (P = 0.010, < 0.001, < 0.001, 0.001, 0.011). Resident perspective on learning objectives differed between JL and SL, and there was discrepancy between resident's learning as perceived by teachers, particularly in the JL. CONCLUSIONS: Our study revealed significant disparity of perspectives between teachers and learners on perioperative teaching and learning. Surgical teachers should set specific learning objectives for different learner levels, since junior and senior residents have different learning preferences even though both scrub in the same case. Effective communication between teachers and learners has the potential to improve learning experience and create a positive environment in the operating room.

9.
BMC Public Health ; 20(1): 1190, 2020 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-32736615

RESUMEN

BACKGROUND: Great growth inequalities between urban and rural areas have been reported in China over the past years. By examining urban/rural inequalities in physical growth among children < 7 years old over the past three decades from 1985 to 2015 in Guangzhou, we analyzed altering trends of anthropometric data in children and their association with economic development during the period of rapid urbanization in Guangzhou. METHODS: The height, body weight and nutrition status of children under 7 years old were obtained from two successive cross-sectional surveys and one health surveillance system. Student's t-test, Spearman's rank-order correlation and polynomial regression were used to assess the difference in physical growth between children in urban and rural areas and the association between socioeconomic index and secular growth changes. RESULTS: A height and weight difference was found between urban and rural children aged 0-6 years during the first two decades of our research (1985-2005), which gradually narrowed in both sex groups over time. By the end of 2015, elder boys (age group ≥5 year) and girls (age group ≥4 year) in rural areas were taller than their counterparts in urban areas (p < 0.05).The same trend could be witnessed in the weight of children aged 6 years, with a - 1.30 kg difference (P = 0.03) for boys, and a - 0.05 difference (P = 0.82) for girls. When GDP increased, the gap in boys' weight-for-age z-score (WAZ from 0.25 to 0.01) and height-for-age z-score (HAZ from 0.55 to 0.03) between urban and rural areas diminished, and disappeared when the GDP per capita (USD) approached 25,000. In either urban or rural areas, the urbanization rate and GDP were positively associated with the prevalence of obesity (all R > 0.90 with P < 0.05) and negatively correlated with the prevalence of stunted growth (all R < -0.87 with P < 0.05). CONCLUSION: Growth inequalities gradually decreased with economic development and urbanization, while new challenges such as obesity emerged. To eliminate health problems due to catch-up growth among rural children, comprehensive intervention programs for early child growth should be promoted in rural areas.

10.
Harm Reduct J ; 17(1): 53, 2020 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-32736624

RESUMEN

BACKGROUND: People who inject drugs (PWID) are a medically and socially vulnerable population with a high incidence of overdose, mental illness, and infections like HIV and hepatitis C. Existing literature describes social and economic correlations to increased health risk, including stigma. Injection drug use stigma has been identified as a major contributor to healthcare disparities for PWID. However, data on this topic, particularly in terms of the interface between enacted, anticipated, and internalized stigma, is still limited. To fill this gap, we examined perspectives from PWID whose stigmatizing experiences impacted their views of the healthcare system and syringe service programs (SSPs) and influenced their decisions regarding future medical care. METHODS: Semi-structured interviews conducted with 32 self-identified PWID in New York City. Interviews were audio recorded and transcribed. Interview transcripts were coded using a grounded theory approach by three trained coders and key themes were identified as they emerged. RESULTS: A total of 25 participants (78.1%) reported at least one instance of stigma related to healthcare system engagement. Twenty-three participants (71.9%) reported some form of enacted stigma with healthcare, 19 participants (59.4%) described anticipated stigma with healthcare, and 20 participants (62.5%) reported positive experiences at SSPs. Participants attributed healthcare stigma to their drug injection use status and overwhelmingly felt distrustful of, and frustrated with, medical providers and other healthcare staff at hospitals and local clinics. PWID did not report internalized stigma, in part due to the availability of non-stigmatizing medical care at SSPs. CONCLUSIONS: Stigmatizing experiences of PWID in formal healthcare settings contributed to negative attitudes toward seeking healthcare in the future. Many participants describe SSPs as accessible sites to receive high-quality medical care, which may curb the manifestation of internalized stigma derived from negative experiences in the broader healthcare system. Our findings align with those reported in the literature and reveal the potentially important role of SSPs. With the goal of limiting stigmatizing interactions and their consequences on PWID health, we recommend that future research include explorations of mechanisms by which PWID make decisions in stigmatizing healthcare settings, as well as improving medical care availability at SSPs.

11.
Acta Psychol (Amst) ; 209: 103140, 2020 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-32738451

RESUMEN

The display of synchronous behaviour can be both an engaging spectacle and a source of important social information. When understood as a dynamical system, interpersonal synchrony has specific kinematic qualities that have been shown to shape social perceptions. Little research, however, has examined the converse relationship - are perceptions of the kinematics of interpersonal synchrony influenced by socially relevant, but task-irrelevant, information? To provide further insight to this question we conducted a pre-registered replication of Lumsden, Miles, and Macrae (2012). Participants (n = 191) rated the level of coordination present in dyads made up of individuals with either similar or dissimilar skin tones. Faithful to the original study, the results indicated that perceivers were sensitive to differing levels of interpersonal coordination, and judged dissimilar dyads to be less coordinated than dyads with a similar skin tone despite actual coordination levels being objectively equivalent. Extending Lumsden et al., the results also revealed a negative relationship between subclinical variation in social anxiety and the degree of perceived coordination. This work is discussed with respect to the perceptual and social factors that underlie judgements of interpersonal coordination.

12.
Am J Emerg Med ; 38(9): 1904-1909, 2020 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-32739860

RESUMEN

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

13.
Artículo en Inglés | MEDLINE | ID: mdl-32731614

RESUMEN

With China's rapid development, urban air pollution problems occur frequently. As one of the principal components of haze, fine particulate matter (PM2.5) has potential negative health effects, causing widespread concern. However, the causal interactions and dynamic relationships between socioeconomic factors and ambient air pollution are still unclear, especially in specific regions. As an important industrial base in Northeast China, Liaoning Province is a representative mode of social and economic development. Panel data including PM2.5 concentration and three socio-economic indicators of Liaoning Province from 2000 to 2015 were built. The data were first-difference stationary and the variables were cointegrated. The Granger causality test was used as the main method to test the causality. In the results, in terms of the causal interactions, economic activities, industrialization and urbanization processes all showed positive long-term impacts on changes of PM2.5 concentration. Economic growth and industrialization also significantly affected the variations in PM2.5 concentration in the short term. In terms of the contributions, industrialization contributed the most to the variations of PM2.5 concentration in the sixteen years, followed by economic growth. Though Liaoning Province, an industry-oriented region, has shown characteristics of economic and industrial transformation, policy makers still need to explore more targeted policies to address the regional air pollution issue.

14.
JDR Clin Trans Res ; : 2380084420939040, 2020 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-32731782

RESUMEN

INTRODUCTION: Our ability to address child oral health inequalities would be greatly facilitated by a more nuanced understanding of whether underlying disease experience or treatment opportunities account for a larger share of differences between social groups. This is particularly relevant in the context of population subgroups who are socially marginalized, such as Australia's Indigenous population. The decayed, missing, and filled (dmf) surfaces index is at once a reflection of dental caries experience (d) and its management (m and f). OBJECTIVES: To 1) describe socioeconomic inequalities in dental caries experience and its management among Indigenous and non-Indigenous children and 2) compare these inequalities using absolute and relative measures. METHODS: Data were from the Australian National Child Oral Health Study 2012-2014. Absolute and relative income inequalities were assessed for overall dmfs and its individual components (ds, ms, fs) using adjusted means and health disparity indices (Slope Index of Inequality [SII] and Relative Index of Inequality [RII]). RESULTS: Mean dmfs among Indigenous children aged 5 to 10 y was 6.4 (95% confidence interval [CI], 5.4-7.4), ranging from 2.3 in the highest to 9.1 in the lowest income group. Mean dmfs among non-Indigenous children was 2.9 (95% CI, 2.8-3.1), ranging from 1.9 in the highest to 4.2 in the lowest income group. Age- and gender-adjusted social gradients for Indigenous children were evident across all dmfs components but were particularly notable for ds (SII = -4.6, RII = -1.7) and fs (SII = -3.2, RII = -1.5). The social gradients for non-Indigenous children were much lower in magnitude: ds (SII = -1.8, RII = -1.6) and fs (SII = -0.7, RII = -0.5). CONCLUSION: Our findings suggest that socioeconomic disadvantage may translate into both higher disease experience and increased use of dental services for both Indigenous and non-Indigenous groups, with the social gradients being much more amplified among Indigenous children. KNOWLEDGE TRANSFER STATEMENT: The findings of this study demonstrate the magnitude of disparities in dental caries among children by population groups in Australia. Our results suggest that the relationship between socioeconomic disadvantage and poor oral health is more deleterious among Indigenous than non-Indigenous children. Tackling upstream determinants of health might not only affect population patterns of health and disease but also mitigate the overwhelming racial inequalities in oral health between Indigenous and non-Indigenous Australians.

15.
Int Q Community Health Educ ; : 272684X20916624, 2020 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-32731797

RESUMEN

Community-based interventions are crucial to reducing health-care disparities throughout the world. CARE, an international development nongovernmental organization (NGO), is a global leader in using a community-based approach in public health. This qualitative study sought to understand the processes through which community organizing functions to effectively facilitate change and improve health among underserved populations in three programs in Sri Lanka and Bangladesh. Sixteen in-depth interviews and two focus groups were conducted with NGO staff, partner organization staff, and community change agents. Programs are assessed through Ganz's community-organizing model, which includes (a) leadership development, (b) storytelling strategies, and (c) team building. Our findings confirm existing literature showing that public health approaches can be augmented by using community organizing to develop local engagement. Results show that program success relates to developing community members' understanding of social inequality and its impact on society. Other important strategies include systems strengthening, political engagement, coalition building, and government outreach. Empowered communities were created through recruiting, activating, and investing in community members, their stories, and their collaborative potential, at least in the sites studied here. Collectively, these programs have begun to create empowered communities among some of the most marginalized people in Sri Lanka and Bangladesh.

16.
Emerg Infect Dis ; 26(11)2020 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-32731911

RESUMEN

Using a novel recruitment method and paired molecular and antibody testing for severe acute respiratory syndrome coronavirus 2 infection, we determined seroprevalence in a racially diverse municipality in Louisiana, USA. Infections were highly variable by ZIP code and differed by race/ethnicity. Overall census-weighted seroprevalence was 6.9%, and the calculated infection fatality ratio was 1.63%.

17.
Soc Sci Med ; : 113218, 2020 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-32732096

RESUMEN

Integrating intersectionality theory and employing a quantitative design, the current study explores how migration-related health inequalities in Europe interact with migrant generation, occupational status and gender. Multilevel logistic regression analyses are conducted using pooled data from six waves of the European Social Survey (2004-2014), from 27 countries for two subjective health measures (general self-reported health and hampering conditions). The results reveal multiple relationships of health inequality that operate simultaneously and the complexity through which the combination of social privilege and disadvantage can have a particularly negative impact on individual health. The 'healthy migrant effect' seems to apply particularly for first-generation immigrants working as manual employees, and within occupational categories, in certain cases non-migrant women are more susceptible to poor health than migrant men. This evidence highlights how the health impact of migration is subject to additional dimensions of social positioning as well as the importance of an intersectional perspective for the monitoring of health inequalities in Europe.

18.
Artículo en Inglés | MEDLINE | ID: mdl-32732666

RESUMEN

PURPOSE: This pilot study investigated the level of cognition that physician assistant (PA) students achieved through adoption of an innovative blended learning model that connects the classroom, clinicians, and community clinics through electronic-learning (e-learning) technologies (C4Tech) used in a PA course. This education intervention aimed to facilitate authentic learning collaborations between PA students and practicing clinicians that would result in higher-order cognition related to the manifestations of social determinants of health and health disparities. METHODS: A case study approach was adopted to assess levels of cognition and changes in those levels resulting from application of an innovative blended learning model. Content analysis using Bloom's taxonomy of cognitive domains facilitated determination levels of cognition and changes in those levels. The sample of 8 groups comprised 70 PA students and 8 clinical instructors from community clinics with underrepresented patient populations. RESULTS: Analysis of 2 course assignments revealed that application of the C4Tech model yields high levels of cognition. By the course's end, all 8 groups achieved at least the "evaluate" level of cognition and half of the groups achieved the highest level of cognition, the "create" level. A wide variation in the level of cognition was demonstrated between the first and second assignments in each group and among groups. CONCLUSION: Our findings suggest that e-learning technologies can be effective in blending classrooms and work environments for authentic and collaborative learning. Adoption of the C4Tech model yielded higher-order cognition related to course content.

19.
Prof Case Manag ; 2020 Jul 23.
Artículo en Inglés | MEDLINE | ID: mdl-32732705

RESUMEN

Social justice, inclusion and equity are everyone's responsibility. We achieve these values when we recognize and accept the characteristics of every person as a unique individual. Professional case managers, or other healthcare practitioners and leaders, have an obligation to advance the health, human and social outcomes of the people they serve, regardless of the social group they belong to and irrespective of their determinants of diversity. It is time to address social justice, inclusion and equity as ethical principles of practice for the professional case manager.

20.
Artículo en Inglés | MEDLINE | ID: mdl-32732742

RESUMEN

OBJECTIVE: This study aims to investigate factors related to paretic upper limb use within first 4-weeks post-stroke. DESIGN: Sixty inpatients within 4-weeks of first-time stroke were stratified by severity defined by Fugl Meyer upper limb score: severe=0-22, moderate=23-50, mild=51-66. All wore a wrist accelerometer on the paretic upper limb (24hours). Factors investigated were measures of: upper limb motor impairment; mobility; balance; functional independence; sensory impairment; cognitive function; social factors; environmental restriction and knowledge. Individual and multivariate quantile regression analysis were performed. RESULTS: Upper limb motor impairment, mobility, balance, functional independence, self-efficacy and knowing how to use the paretic upper limb were significantly related to upper limb use across three impairment groups (pseudo R2= 0.079-0.492, p<0.02). Multivariate regression showed the only significant factor in moderate and mild group was Fugl Meyer Upper Limb score (moderate pseudo R2= 0.55; mild pseudo R2=0.54; p<0.001). For severe group, Fugl Meyer upper limb score and step count were significant (severe pseudo R2=0.47; p≤0.030). CONCLUSIONS: Upper limb motor impairment is significantly associated with paretic upper limb use across three impairment groups, and step count with severe group. Strategies to improve upper limb motor impairment and increase mobility may be required to increase upper limb use.

SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA