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1.
Enferm. actual Costa Rica (Online) ; (38): 282-291, Jan.-Jun. 2020.
Artigo em Espanhol | LILACS, BDENF - Enfermagem | ID: biblio-1090102

RESUMO

Resumen En las últimas décadas se ha desarrollado una mayor conciencia acerca de cuán relevante es la paternidad activa en el desarrollo integral de los/as hijos/as y en la equidad de género. Sin embargo, a pesar de la amplia discusión e implementación de algunas estrategias, se observa una escasa participación en la crianza y cuidados de parte de los padres, situación por la que el presente ensayo tiene el propósito de reflexionar críticamente en torno al cuidado de la niñez desde la desigualdad de género, la masculinidad imperante y las estrategias para el fomento de la paternidad activa. Este escrito reflexiona sobre la paternidad activa desde la mirada de una sociedad adultocéntrica y su influencia en la incorporación de valores, actitudes y conductas durante la niñez. Además, analiza la construcción del cuidado del infante en el ámbito privado, tarea que es subvalorada por la comunidad y que recae principalmente en la mujer con las consecuencias de inequidad de género y problemas de salud que conlleva. Finalmente, se evidencia los esfuerzos realizados en Chile en la implementación para el fomento de una paternidad activa, así como los desafíos pendientes. Para avanzar a la paternidad activa se requiere de una mayor intervención con las familias y los distintos sectores de la sociedad, implementando estrategias desde un enfoque de equidad de género en cuanto a la distribución del cuidado en la niñez. Asimismo, se requiere de avances politicos importantes para dar sustento a una nueva formar de cuidar.


Abstract In recent decades, there has been a growing awareness of the importance of active fatherhood in the integral development of children and in gender inequality. Despite the extensive discussion and implementation of some strategies, there is a low participation in parenting and care of parents. For this reason, the present essay has the purpose of critically reflecting on the care of children from gender inequality, prevailing masculinity and strategies for the promotion of active parenthood. This paper reflects on active fatherhood from the perspective of an adult-centric society and its influence on the incorporation of values, attitudes and behaviors during childhood. In addition, it analyzes the construction of child care in the private sphere, a task that is undervalued by the community and that falls mainly on women with the consequences of gender inequity and health problems that it entails. Finally, the efforts made in Chile in the implementation for the promotion of active fatherhood and the pending challenges are visualized. To move towards active fatherhood requires a greater intervention with families and different sectors of society, implementing strategies from a gender equity perspective regarding the distribution of child care. It also requires important political advances to support a new way of caring.


Resumo Nas últimas décadas, tem havido uma crescente conscientização sobre a importância da paternidade ativa no desenvolvimento integral das crianças e na desigualdade de gênero. Apesar da extensa discussão e implementação de algumas estratégias, há uma baixa participação na parentalidade e no cuidado dos pais. Por este motivo, o presente ensaio tem como objetivo refletir criticamente em torno do cuidado das crianças da desigualdade de gênero, masculinidade prevalente e estratégias para a promoção da paternidade ativa. Este artigo reflete sobre a paternidade ativa a partir da perspectiva de uma sociedade adultocêntrica e sua influência na incorporação de valores, atitudes e comportamentos durante a infância. Além disso, analisa a construção da creche na esfera privada, uma tarefa que é subvalorizada pela comunidade e que recai principalmente sobre as mulheres com as conseqüências da desigualdade de gênero e dos problemas de saúde que ela acarreta. Finalmente, os esforços feitos no Chile na implementação para a promoção da paternidade ativa e os desafios pendentes são visualizados. Avançar para a paternidade ativa requer uma maior intervenção com as famílias e diferentes setores da sociedade, implementando estratégias a partir de uma perspectiva de equidade de gênero em relação à distribuição do cuidado infantil. Também requer avanços políticos importantes para apoiar uma nova maneira de cuidar.


Assuntos
Humanos , Masculino , Paternidade , Cuidado da Criança , Educação Infantil , Ensaio , Masculinidade
2.
Artigo em Inglês | MEDLINE | ID: mdl-32349383

RESUMO

Central-nervous-system (CNS) injuries constitute a significant cause of morbidity (often resulting in long-term disability) and mortality. This cross-sectional study compared the activity and participation of community-dwelling people with severe disability from acquired brain injuries (ABI) (n = 322) and spinal-cord injuries (SCI) (n = 183) to identify risk factors related to disability. Data were collected through a questionnaire survey of community-dwelling people with severe disability attending 65 healthcare centers. The survey included the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and sociodemographic factors. We categorized a registered grade of disability of 1 or 2 as severe disability. WHODAS 2.0 domain and summary scores were compared between the ABI and SCI groups, and risk factors associated with disability were identified through regression analysis. ABI participants had significantly higher disability in cognition and relationships, whereas patients with SCI had higher disability in mobility (p < 0.05). Onset duration was negatively correlated with cognition, relationships, participation, and summary scores in ABI participants (p < 0.05). Neither group's socioeconomic factors were associated with WHODA 2.0 scores. Understanding the different patterns of disability between SCI and ABI in community-dwelling people with severe disability helps establish future plans for the management of health resources.

3.
Arch Iran Med ; 23(4Suppl1): S60-S61, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32349512

RESUMO

This report describes an experience of the first international health for peace conference held in November 2018 in Shiraz University of Medical Sciences. This paper discusses the panel on peace education in medical and paramedical schools and the way for the future.

4.
Circulation ; : CIR0000000000000767, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32349541

RESUMO

Heart failure is a clinical syndrome that affects >6.5 million Americans, with an estimated 550 000 new cases diagnosed each year. The complexity of heart failure management is compounded by the number of patients who experience adverse downstream effects of the social determinants of health (SDOH). These patients are less able to access care and more likely to experience poor heart failure outcomes over time. Many patients face additional challenges associated with the cost of complex, chronic illness management and must make difficult decisions about their own health, particularly when the costs of medications and healthcare appointments are at odds with basic food and housing needs. This scientific statement summarizes the SDOH and the current state of knowledge important to understanding their impact on patients with heart failure. Specifically, this document includes a definition of SDOH, provider competencies, and SDOH assessment tools and addresses the following questions: (1) What models or frameworks guide healthcare providers to address SDOH? (2) What are the SDOH affecting the delivery of care and the interventions addressing them that affect the care and outcomes of patients with heart failure? (3) What are the opportunities for healthcare providers to address the SDOH affecting the care of patients with heart failure? We also include a case study (Data Supplement) that highlights an interprofessional team effort to address and mitigate the effects of SDOH in an underserved patient with heart failure.

5.
Inquiry ; 57: 46958020910305, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32349581

RESUMO

As pressure increases on public health systems globally, a potential consequence is that this is transferred to patients in the form of longer waiting times to receive care. In this review, we overview what waiting for health care encompasses, its measurement, and the data available in terms of trends and comparability. We also discuss whether waiting time is equally distributed according to socioeconomic status. Finally, we discuss the policy implications and potential approaches to addressing the burden of waiting time. Waiting time for elective surgery and emergency department care is the best described type of waiting time, and it either increases or remains unchanged across multiple developed countries. There are many challenges in drawing direct comparisons internationally, as definitions for these types of waiting times vary. There are less data on waiting time from other settings, but existing data suggest waiting time presents a significant barrier to health care access for a range of health services. There is also evidence that waiting time is unequally distributed to those of lower socioeconomic status, although this may be improving in some countries. Further work to better clarify definitions, identify driving factors, and understand hidden waiting times and identify opportunities for reducing waiting time or better using waiting time could improve health outcomes of our health services.

6.
New Solut ; : 1048291120920571, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349618

RESUMO

Children as young as ten are legally hired for farm work. In North Carolina, many of these hired children are Latinx; they often work long hours during hot and humid summer conditions. Heat-related illness occurs along a continuum of severity ranging from heat cramps and rashes to heat exhaustion and heat stroke, which can be fatal. The literature on the negative health effects of occupational heat exposure is growing; however, few studies have examined this exposure and health outcomes among child agricultural workers. To understand Latinx child farmworkers' experiences of working in heat, we conducted in-depth interviews (n = 30). To estimate the prevalence of heat-related illness symptoms and associated factors, we conducted survey interviews (n = 165). Heat-related illness is common among these child farmworkers. While children often understand the dangers of working in heat, work organization often prevents their taking precautions. Formal workplace protections to prevent heat-related illness are limited.

7.
CNS Spectr ; : 1-20, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32349833

RESUMO

Secure settings are not queer because lesbian, gay, bisexual, transgender, queer, questioning, Two Spirit, and asexual (LGBTQ+) people populate them, and neither are LGBTQ+ people inherently criminal because they are found in those spaces. Queer people bear disproportionate health, mental health, and social inequities that have had, historically and currently, the effect to criminalize them. This review discusses effective language and ideologies when working with LGBTQ+ people in secure settings. Major health, mental health, and social inequities are reviewed, along with the applied framework of minority stress. Then, the process of criminalization is diagrammed across the phases of predetainment, being in the system, and through re-entering the community. Finally, multilevel strategies are offered to decriminalize LGBTQ+ people ideologically and in practice.

9.
BMJ Mil Health ; 2020 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-32349987

RESUMO

BACKGROUND: Access to screening, brief intervention and referral to treatment programmes for alcohol use have been shown to be effective; however, little is known about access to these services among service members and veterans. We examined the association of service member or veteran rural-dwelling area and the following outcomes: recent general health check-up, alcohol screening and alcohol brief intervention. METHODS: Data on 5080 military service members and veterans were obtained from the 2017 Behavioural Risk Factor Surveillance System of the USA. We estimated rural-urban disparities in the receipt of a recent voluntary general health check-up, as well as the receipt of alcohol screening and brief intervention, using a mixed logit model. RESULTS: Of the 5080 participants in the study, a total of 4666 (90.49%, 95% CI 89.39% to 91.48%) reported a general health check-up in the last 2 years. Results showed 7.48% of the sample (95% CI 6.64% to 8.41%) exhibited heavy alcohol consumption patterns. Of the 414 participants who did not undergo a general health check-up, 13.80% (95% CI 9.63% to 19.41%) exhibited a pattern of heavy alcohol consumption. Rural individuals were less likely to report a recent health check-up (adjusted OR=0.82, 95% CI 0.79 to 0.87). Rurality was also independently associated with decreased likelihood of receiving an alcohol screening and brief intervention. CONCLUSION: Greater access to telehealth or other geographically flexible screening and brief intervention programmes is needed in rural areas for service members and veterans.

10.
Jpn J Infect Dis ; 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32350219

RESUMO

Emergence and spread of multidrug-resistant organisms (MDRO) is an urgent social problem. We carried out an epidemiological survey to clarify the geographic characteristics and factors influencing the prevalence of MDRO. Data regarding the prevalence of MDRO in 47 prefectures in Japan was extracted from the Japanese Nosocomial Infection Surveillance, a nationwide database for infection control. Potential factors influencing MDRO were selected from pharmacological, medical service-, infection control-, food-related, environmental and social categories considering the characteristics of each organism, and correlations between them and MDRO prevalence were analyzed. Statistics for potential factors were data from public domains. The use of antibiotics correlated with the prevalence of PRSP, 3 rd- generation cephalosporin- and fluoroquinolone-resistant E. coli and MRSA. Negative correlations between the consumption of foods that facilitate the growth of lactic acid bacteria such as kelp and fermented soy beans and the prevalence of 3 rd-generation cephalosporin- and fluoroquinolone-resistant E. coli suggested an association between intestinal microflora and MDRO colonization. In addition to the use of antibiotics, lifestyle, food culture and social factors such as tobacco smoking, average temperature, prevalence of three-generation households, ratio of elderlies, average length of tourist stay, chicken consumption, fermented bean consumption, and medical service conditions could modify MDRO prevalence.

11.
Nature ; 580(7805): 636-639, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32350468

RESUMO

Education is a key dimension of well-being and a crucial indicator of development1-4. The Sustainable Development Goals (SDGs) prioritize progress in education, with a new focus on inequality5-7. Here we model the within-country distribution of years of schooling, and use this model to explore educational inequality since 1970 and to forecast progress towards the education-related 2030 SDG targets. We show that although the world is largely on track to achieve near-universal primary education by 2030, substantial challenges remain in the completion rates for secondary and tertiary education. Globally, the gender gap in schooling had nearly closed by 2018 but gender disparities remained acute in parts of sub-Saharan Africa, and North Africa and the Middle East. It is predicted that, by 2030, females will have achieved significantly higher educational attainment than males in 18 countries. Inequality in education reached a peak globally in 2017 and is projected to decrease steadily up to 2030. The distributions and inequality metrics presented here represent a framework that can be used to track the progress of each country towards the SDG targets and the level of inequality over time. Reducing educational inequality is one way to promote a fairer distribution of human capital and the development of more equitable human societies.

12.
Artigo em Inglês | MEDLINE | ID: mdl-32350800

RESUMO

Incarceration may be an overlooked reason for treatment non-completion experienced disproportionately by African Americans. This study utilized multilevel logistic regression to model treatment non-completion due to incarceration using the 2015-2016 Treatment Episode Dataset-Discharges. Among a sample restricted to treatment non-completers (n = 306,008), 5% terminated treatment because they became incarcerated (n = 13,082), which varied widely by demographics and by state. In Idaho, 46% of African Americans terminated treatment because they became incarcerated. Women had lower odds of treatment non-completion than men, and the effect of sex was strongest among African Americans (adjusted odds ratio [aOR] = 0.30, 95% confidence interval [95% CI] = 0.26-0.34). Among men, all racial/ethnic minority groups demonstrated significantly higher odds of treatment non-completion due to incarceration compared with Whites, and the strongest effect was among African Americans (aOR = 1.37, 95% CI = 1.29-1.44). Incarceration as a reason for treatment non-completion disproportionately affects African Americans and men and varies by state. Interventions targeting incarceration alternatives should be availed to racial/ethnic minorities already participating in treatment.

13.
MedEdPORTAL ; 16: 10893, 2020 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-32352030

RESUMO

Introduction: Microaggressions, subtle slights related to characteristics such as race, gender, or sexual orientation, in a clinical setting can sabotage the therapeutic alliance. Curricula tailored specifically towards medical students that raise awareness of microaggressions and aim to change behavior are absent. Methods: We created a 2-hour workshop to prepare preclinical medical and dental students to recognize and respond to microaggressions in clinical practice. The workshop consisted of a didactic portion describing microaggressions and strategies for responding to them and a case-based small-group portion to practice strategies. Participants completed electronic pre- and postworkshop surveys. Results: Of 163 students participating in the workshop, 121 (74%) completed the preworkshop survey, 105 (64%) completed the postworkshop survey, and 81 (50%) completed both. Preworkshop, 48% reported female gender, and 36% reported underrepresented in medicine status. The majority (77%) had witnessed or experienced microaggressions in the clinical setting, and 69% reported very good or excellent familiarity with the concept of microaggressions. The curriculum appeared to significantly mitigate challenges associated with microaggressions, including reductions in perceived difficulty in identifying microaggressions (p < .001), being unsure what to do or say (p < .001), improvements in familiarity with institutional support systems (p < .001), and awareness of the clinical relevance of microaggressions (p < .001). Discussion: Given the high self-reported prevalence of microaggressions in the clinical setting, students need the skills to respond. This innovative session improves readiness to address microaggressions by helping participants build and practice these skills in a supportive environment.

14.
Gerontologist ; 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32352144

RESUMO

Since 1997, the Resource Centers for Minority Aging Research Program at the National Institute on Aging has been the model for training social and behavioral scientists in minority aging and health disparities research. The latest cycle of these Centers implemented a new structure for the analytic training of junior investigators and for advancing methodologic work relevant to improving the rigor of minority aging research. In this article, we describe the conceptual framework, logistical approaches, challenges, and lessons learned from our experience training junior investigators in methodology through the Michigan Center for Urban African American Aging Research over the past 20 years, with the goal of informing future analytic training efforts for the next generation of scholars focused on minority aging issues.

15.
J Burn Care Res ; 2020 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-32352522

RESUMO

Social determinants of health (SDoH) influence risk of injury. We conducted a population-based, case-control study to identify which social determinants influence burn injury in children. Children (≤16 years of age) admitted to a Canadian regional burn center between January 1, 1999 and March 30, 2017 were matched based on age, sex, and geographic location 1:5 with an uninjured control cohort from the general population. Population-level administrative data describing the SDoH at the Manitoba Center for Health Policy (MCHP) were compared between the cohorts. Specific SDoH were chosen based on a published systematic review conducted by the research team. In the final multivariable model, children from a low-income household odds ratio (OR) (95% confidence interval) 1.97 (1.46, 2.65), in care 1.57 (1.11, 2.21), from a family that received income assistance 1.71 (1.33, 2.19) and born to a teen mother 1.43 (1.13, 1.81) were significantly associated with an increased risk of pediatric burn injury. This study identified SDoH that are associated with an increased risk of burn injury. This case-control study supports the finding that children from a low-income household, children in care, from a family that received income assistance, and children born to a teen mother are at an elevated risk of burn injury. Identifying children at increased potential risk allows targeting of burn risk reduction and home safety programs.

16.
Artigo em Inglês | MEDLINE | ID: mdl-32352635

RESUMO

INTRODUCTION: The purpose of this integrative review was to synthesize the literature on women's perceived barriers and facilitators to achieving a vaginal birth after cesarean. METHODS: A search of Scopus and PubMed databases and relevant citations from 2000 to 2018 was conducted to identify resources meeting inclusion criteria. Conclusion drawing and verification were completed using data displays, data analysis, and comparison. RESULTS: Sixteen resources met inclusion criteria. Factors identified by women with a history of cesarean that act as facilitators or barriers to achieving a vaginal birth after cesarean included (1) individual factors (knowledge, body, and psychological), (2) social factors (culture and social support), and (3) systemic factors (perinatal care provider, health system, and financial). Some factors related to barriers and facilitators reflected opposing aspects of the same phenomenon on a continuum. DISCUSSION: Enhancing facilitators identified by women, while addressing perceived barriers, may increase access to labor after cesarean for women in the United States. Increasing access to labor after cesarean may subsequently improve women's experiences of care and decrease the US cesarean rate, positively affecting individual health outcomes and overall health of childbearing women in the United States.

17.
Artigo em Inglês | MEDLINE | ID: mdl-32352650

RESUMO

Health inequities exist throughout the life course, resulting in racial/ethnic and socioeconomic disparities in obesity and obesity-related health complications. Obesity and its co-morbidities appear linked to COVID-19 mortality. Approaches to reduce obesity in the time of COVID-19 closures are urgently needed and should start early in life. In New York City, we developed a telehealth pediatric weight management collaborative spanning NewYork-Presbyterian, Columbia University Vagelos College of Physicians and Surgeons, and Weill Cornell Medicine during COVID-19 with show rates 76-89%. To stave off the impending exacerbation of health disparities related to obesity risk factors in the aftermath of the COVID-19 pandemic, effective interventions that can be delivered remotely are urgently needed among vulnerable children with obesity. Challenges in digital technology access, social and linguistic differences, privacy security, and reimbursement must be overcome to realize the full potential of telehealth for pediatric weight management among low-income and racial/ethnic minority children.

18.
J Nurs Educ ; 59(5): 293-296, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32352547

RESUMO

BACKGROUND: The assessment of a patient's social determinants of health (SDOH) may uncover potentially modifiable factors that each contribute to or detract from the health and wellness of individuals, families, and groups. A concept-based curriculum may offer advantages for introducing SDOH assessment to nursing students. METHOD: The concept of SDOH was threaded throughout a baccalaureate concept-based curriculum using innovative and team-based learning strategies. RESULTS: A concept-based curriculum provides an effective platform for introducing SDOH topics in nursing education, but many of the learning activities also could be incorporated into traditional curricula. CONCLUSION: Nursing education should incorporate teaching about SDOH to prepare students for high-quality nursing practice and better patient advocacy. Assessment of SDOH also allows treatment plans to be tailored to the needs of that patient or population, which in turn may improve health outcomes. [J Nurs Educ. 2020;59(5):293-296.].

19.
Lancet Planet Health ; 4(4): e131-e132, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32353288
20.
Lancet Glob Health ; 8(5): e699-e710, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32353317

RESUMO

BACKGROUND: Surgical, anaesthetic, and obstetric (SAO) health-care system strengthening is needed to address the emergency and essential surgical care that approximately 5 billion individuals lack globally. To our knowledge, a complete, non-modelled national situational analysis based on the Lancet Commission on Global Surgery surgical indicators has not been done. We aimed to undertake a complete situation analysis of SAO system preparedness, service delivery, and financial risk protection using the core surgical indicators proposed by the Commission in Colombia, an upper-middle-income country. METHODS: Data to inform the six core surgical system indicators were abstracted from the Colombian national health information system and the most recent national health survey done in 2007. Geographical access to a Bellwether hospital (defined as a hospital capable of providing essential and emergency surgery) within 2 h was assessed by determining 2 h drive time boundaries around Bellwether facilities and the population within and outside these boundaries. Physical 2 h access to a Bellwether was determined by the presence of a motor vehicle suitable for individual transportation. The Department Administrativo Nacional de Estadística population projection for 2016 and 2018 was used to calculate the SAO provider density. Total operative volume was calculated for 2016 and expressed nationally per 100 000 population. The total number of postoperative deaths that occurred within 30 days of a procedure was divided by the total operative volume to calculate the all-cause, non-risk-adjusted postoperative mortality. The proportion of the population subject to impoverishing costs was calculated by subtracting the baseline number of impoverished individuals from those who fell below the poverty line once out-of-pocket payments were accounted for. Individuals who incurred out-of-pocket payments that were more than 10% of their annual household income were considered to have experienced catastrophic expenditure. Using GIS mapping, SAO system preparedness, service delivery, and cost protection were also contextualised by socioeconomic status. FINDINGS: In 2016, at least 7·1 million people (15·1% of the population) in Colombia did not have geographical access to SAO services within a 2 h driving distance. SAO provider density falls short of the Commission's minimum target of 20 providers per 100 000 population, at an estimated density of 13·7 essential SAO health-care providers per 100 000 population in 2018. Lower socioeconomic status of a municipality, as indicated by proportion of people enrolled in the subsidised insurance regime, was associated with a smaller proportion of the population in the municipality being within 2 h of a Bellwether facility, and the most socioeconomically disadvantaged municipalities often had no SAO providers. Furthermore, Colombian providers appear to be working at or beyond capacity, doing 2690-3090 procedures per 100 000 population annually, but they have maintained a relatively low median postoperative mortality of 0·74% (IQR 0·48-0·84). Finally, out-of-pocket expenses for indirect health-care costs were a key barrier to accessing surgical care, prompting 3·1 million (6·4% of the population) individuals to become impoverished and 9·5 million (19·4% of the population) individuals to incur catastrophic expenditures in 2007. INTERPRETATION: We did a non-modelled, indicator-based situation analysis of the Colombian SAO system, finding that it has not yet met, but is working towards achieving, the targets set by the Lancet Commission on Global Surgery. The observed interdependence of these indicators and correlation with socioeconomic status are consistent with well recognised factors and outcomes of social, health, and health-care inequity. The internal consistency observed in Colombia's situation analysis validates the use of the indicators and has now informed development of an early national SAO plan in Colombia, to set a data-informed stage for implementation and evaluation of timely, safe, and affordable SAO health care, within the National Public Health Decennial Plan, which is due in 2022. FUNDING: Zoll Medical.

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