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3.
Pediatr Clin North Am ; 68(6): 1147-1155, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34736581

RESUMO

Social determinants of health (SDH) as outlined by Healthy People 2020 encompasses 5 key domains: economic, education, social and community context, health and health care, and neighborhood and built environment. This article emphasizes pediatric populations and some of the existing SDH and health care disparities seen in pediatric gastroenterology. We specifically review inflammatory bowel disease, endoscopy, bariatric surgery, and liver transplantation. We also examine the burgeoning role of telehealth that has become commonplace since the coronavirus disease 2019 era.


Assuntos
Proteção da Criança/estatística & dados numéricos , Gastroenterologia/organização & administração , Equidade em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde , Criança , Acesso aos Serviços de Saúde/organização & administração , Disparidades nos Níveis de Saúde , Humanos , Fatores Socioeconômicos , Estados Unidos
4.
Pediatr Clin North Am ; 68(6): 1157-1169, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34736582

RESUMO

Pediatric gastroenterologists took on a variety of challenges during the coronavirus disease 2019 pandemic, including learning about a new disease and how to recognize and manage it, prevent its spread among their patients and health professions colleagues, and make decisions about managing patients with chronic gastrointestinal and liver problems in light of the threat. They adapted their practice to accommodate drastically decreased numbers of in-person visits, adopting telehealth technologies, and instituting new protocols to perform endoscopies safely. The workforce pipeline was also affected by the impact of the pandemic on trainee education, clinical experience, research, and job searches.


Assuntos
COVID-19/epidemiologia , Proteção da Criança/estatística & dados numéricos , Gastroenterologia/organização & administração , Equidade em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde , Criança , Acesso aos Serviços de Saúde/organização & administração , Disparidades nos Níveis de Saúde , Humanos , Fatores Socioeconômicos , Estados Unidos
6.
Artigo em Inglês | MEDLINE | ID: mdl-34769781

RESUMO

This study examined the association between neighborhood-based social capital (NSC) and depressive symptoms in the context of urban neighborhoods in China, with special attention given to the association heterogeneity across socioeconomic groups. Drawing on cross-sectional data collected from 39 neighborhoods in Guangzhou, this research demonstrated that adults' depressive symptoms were higher among those with lower cognitive (trustworthiness, reciprocity, and cohesion within a neighborhood) and structural (social network and participation) dimensions of NSC. Further analysis showed that the negative association between NSC and depressive symptoms was significantly heterogeneous across socioeconomic groups. Specifically, this negative relationship was more prominent in the lower socioeconomic classes than in the upper socioeconomic classes, indicating that the lower accumulation of NSC among disadvantaged groups may aggravate depression unequally across social classes. In addition, the negative association between social participation and depressive symptoms was stronger for people who are older or unemployed. The findings of this study not only provide new evidence concerning the significance of the beneficial effects of NSC in the Chinese context, but also, more importantly, highlight that NSC plays a crucial role in creating mental health inequality across social classes. Thus, the relevant social interventions including fostering neighborhood relationships and social activities should be carefully tailored against the backdrop of community building during the urbanization process. The implications of our study for urban governance to promote healthy cities are discussed.


Assuntos
Depressão , Capital Social , Adulto , China/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Disparidades nos Níveis de Saúde , Humanos , Características de Residência , Apoio Social
7.
Int J Public Health ; 66: 595311, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744562

RESUMO

Objectives: Colombia's civil conflict and persistent socio-economic disparities have contributed to mental health inequalities in conflict-affected territories. We explore the magnitude of mental health inequalities, contributing socio-economic factors, and sociodemographic characteristics that explain these differences. Methods: The study draws on data collected in 2018, using the household survey Conflicto, Paz y Salud (CONPAS) applied to 1,309 households in Meta, Colombia. Logistic regression and decomposition analysis were used to analyze the risk of mental health disorders, measured with the Self-Reporting Questionnaire -20 (SRQ-20). Results: Individuals with lower socio-economic status are at a higher risk for mental health disorders. Forced displacement accounts for 31% of the measured mental health inequalities. Disparities in employment, education level, disability and conflict incidence between municipalities are other contributing factors. Women and people with disabilities are respectively 2.3 and 1.2 times more prone to present a mental health disorder. Conclusion: It is necessary to tackle the identified risk factors and sociodemographic circumstances that contribute to mental health inequalities in conflict-affected territories, as these hinder adequate/equitable access to mental health services.


Assuntos
Conflitos Armados , Disparidades nos Níveis de Saúde , Transtornos Mentais , Colômbia/epidemiologia , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Transtornos Mentais/epidemiologia , Fatores Socioeconômicos
8.
Int J Public Health ; 66: 609179, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744575

RESUMO

Objective: To describe the inequalities in the double burden of malnutrition (DBM) in the adult population. Methods: Study carried out with data from the VIGITEL study, conducted in 2019 in all Brazilian capitals. Underweight and excess weight were evaluated on the basis of years of schooling and age. Multi-level analysis was performed including Human Development Index of each capital and individual-level variables. The inequality slope index was used to assess the magnitude of the inequalities found. All analyses considered the svy command owing to the complexity of the sampling process. Results: 47.119 individuals were studied. Men with no education had 6 percentage points more underweight compared to those with higher education. Higher prevalence of excess weight was found among men with higher education and women with no education. In women, the difference was 18 percentage points between extreme categories. Elderly people with no education had 10 percentage points more excess weight than those with higher education. Conclusions: The findings suggest the need for intersectoral actions that can cope with the social inequalities and help confronting with the DBM in Brazil.


Assuntos
Disparidades nos Níveis de Saúde , Desnutrição , Adulto , Brasil/epidemiologia , Feminino , Humanos , Masculino , Desnutrição/epidemiologia , Fatores Socioeconômicos
9.
Int J Public Health ; 66: 645513, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744593

RESUMO

Objectives: To assess time trends in the social class inequalities and in total inequality in disability and self-rated health (SRH) in two oldest old populations. Methods: The data came from the Finnish Vitality 90+ Study (2001, 2003, 2007, 2010, 2014 and 2018; n = 5,440) and from the Swedish Panel Study of Living Conditions of the Oldest Old (2002, 2004, 2011 and 2014; n = 1,645). Inequalities in mobility and activities of daily living (ADL) disability and SRH were examined cross-sectionally and over time using relative and absolute measures. Results: Lower social classes had greater mobility and ADL disability and worse SRH than higher social classes and the inequalities tended to increase over time. Findings were remarkably similar in both studies and with absolute and relative measures. Total inequality, referring to the variance in health outcome in the total population, remained stable or decreased. Conclusion: The study suggests that the earlier findings of improved mobility and ADL are largely driven by the positive development in higher social classes while findings of decline in SRH are related to the worsening of SRH in lower social classes.


Assuntos
Autoavaliação Diagnóstica , Pessoas com Deficiência , Disparidades nos Níveis de Saúde , Classe Social , Atividades Cotidianas , Idoso de 80 Anos ou mais , Estudos Transversais , Pessoas com Deficiência/estatística & dados numéricos , Finlândia , Humanos , Suécia
11.
Artigo em Inglês | MEDLINE | ID: mdl-34770127

RESUMO

The relationship between child development and adolescent health, and how this may be modified by socio-economic conditions, is poorly understood. This limits cross-sector interventions to address adolescent health inequality. This review summarises evidence on the associations between child development at school starting age and subsequent health in adolescence and identifies factors affecting associations. We undertook a participatory systematic review, searching electronic databases (MEDLINE, PsycINFO, ASSIA and ERIC) for articles published between November 1990 and November 2020. Observational, intervention and review studies reporting a measure of child development and subsequent health outcomes, specifically weight and mental health, were included. Studies were individually and collectively assessed for quality using a comparative rating system of stronger, weaker, inconsistent or limited evidence. Associations between child development and adolescent health outcomes were assessed and reported by four domains of child development (socio-emotional, cognitive, language and communication, and physical development). A conceptual diagram, produced with stakeholders at the outset of the study, acted as a framework for narrative synthesis of factors that modify or mediate associations. Thirty-four studies were included. Analysis indicated stronger evidence of associations between measures of socio-emotional development and subsequent mental health and weight outcomes; in particular, positive associations between early externalising behaviours and later internalising and externalising, and negative associations between emotional wellbeing and later internalising and unhealthy weight. For all other domains of child development, although associations with subsequent health were positive, the evidence was either weaker, inconsistent or limited. There was limited evidence on factors that altered associations. Positive socio-emotional development at school starting age appears particularly important for subsequent mental health and weight in adolescence. More collaborative research across health and education is needed on other domains of development and on the mechanisms that link development and later health, and on how any relationship is modified by socio-economic context.


Assuntos
Saúde do Adolescente , Desenvolvimento Infantil , Adolescente , Criança , Disparidades nos Níveis de Saúde , Humanos , Saúde Mental , Instituições Acadêmicas
12.
Trials ; 22(1): 818, 2021 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-34789322

RESUMO

BACKGROUND: Positive Choices is a whole-school social marketing intervention to promote sexual health among secondary school students. Intervention comprises school health promotion council involving staff and students coordinating delivery; student survey to inform local tailoring; teacher-delivered classroom curriculum; student-run campaigns; parent information; and review of sexual/reproductive health services to inform improvements. This trial builds on an optimisation/pilot RCT study which met progression criteria, plus findings from another pilot RCT of the Project Respect school-based intervention to prevent dating and relationship violence which concluded such work should be integrated within Positive Choices. Young people carry a disproportionate burden of adverse sexual health; most do not report competence at first sex. Relationships and sex education in schools can contribute to promoting sexual health but effects are small, inconsistent and not sustained. Such work needs to be supplemented by 'whole-school' (e.g. student campaigns, sexual health services) and 'social marketing' (harnessing commercial marketing to social ends) approaches for which there is good review-level evidence but not from the UK. METHODS: We will conduct a cluster RCT across 50 schools (minimum 6440, maximum 8500 students) allocated 1:1 to intervention/control assessing outcomes at 33 months. Our primary outcome is non-competent first sex. Secondary outcomes are non-competent last sex, age at sexual debut, non-use of contraception at first and last sex among those reporting heterosexual intercourse, number of sexual partners, dating and relationship violence, sexually transmitted infections, and pregnancy and unintended pregnancy for girls and initiation of pregnancy for boys. We will recruit 50 school and undertake baseline surveys by March 2022; implement the intervention over the 2022-2024 school years and conduct the economic and process evaluations by July 2024; undertake follow-up surveys by December 2024; complete analyses, all patient and policy involvement and draft the study report by March 2025; and engage in knowledge exchange from December 2024. DISCUSSION: This trial is one of a growing number focused on whole-school approaches to public health in schools. The key scientific output will be evidence about the effectiveness, costs and potential scalability and transferability of Positive Choices. TRIAL REGISTRATION: ISRCTN No: ISRCTN16723909 . Trial registration summary: Date:. Funded by: National Institute for Health Research Public Health Research Programme (NIHR131487). SPONSOR: LSHTM. Public/scientific contact: Chris Bonell. Public title: Positive Choices trial. Scientific title: Phase-III RCT of Positive Choices: a whole-school social marketing intervention to promote sexual health and reduce health inequalities. Countries of recruitment: UK. INTERVENTION: Positive Choices. INCLUSION CRITERIA: Students in year 8 (age 12-13 years) at baseline deemed competent by schools to participate in secondary schools excluding pupil referral units, schools for those with special educational needs and disabilities, and schools with 'inadequate' Ofsted inspections. STUDY TYPE: interventional study with superiority phase III cluster RCT design. Enrollment: 1/9/21-31/3/22. SAMPLE SIZE: 50 schools and 6440-8500 students. Recruitment status: pending. PRIMARY OUTCOME: binary measure of non-competent first sex. SECONDARY OUTCOMES: non-competent last sex; age at sexual debut; non-use of contraception at first and last sex; number of sexual partners; dating and relationship violence (DRV) victimisation; sexually transmitted infections; pregnancy and unintended pregnancy for girls and initiation of pregnancy for boys using adapted versions of the RIPPLE measures. Ethics review: LSHTM research ethics committee (reference 26411). Completion data: 1/3/25. Sharing statement: Data will be made available after the main trial analyses have been completed on reasonable request from researchers with ethics approval and a clear protocol. Amendments to the protocol will be communicated to the investigators, sponsor, funder, research ethics committee, trial registration and the journal publishing the protocol. Amendments affecting participants' experience of the intervention or important amendments affecting the overall design and conduct of the trial will be communicated to participants.


Assuntos
Saúde Sexual , Adolescente , Criança , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Serviços de Saúde Escolar , Instituições Acadêmicas , Marketing Social
14.
Int J Public Health ; 66: 584916, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34616240

RESUMO

Objective: Much of the extensive quantitative research linking socio-economic position (SEP) and health utilizes three common indicators: income, occupation and education. Existing survey data may enable researchers to include indicators of additional forms of capital in their analyses, permitting more nuanced consideration of the relationship between SEP and health. Our objective was to identify the breadth of survey questions related to economic, cultural, and social capital available through Statistics Canada surveys, and the extent to which those surveys also include health measures. Methods: We compiled a list of all population-based Statistics Canada surveys, and developed a broad list of potential indicators of forms of capital. We systematically searched the surveys for those indicators and health measures, analyzing their co-occurrence. Results: Traditional SEP indicators were present in 73% of surveys containing health measures, while additional indicators of social and cultural capital were available in 57%. Conclusion: Existing national survey data represent an under-exploited opportunity for research examining the relationship between various forms of capital and health in Canada. Future empirical explorations of these data could enrich our theoretical understanding of health inequities.


Assuntos
Disparidades nos Níveis de Saúde , Canadá , Conjuntos de Dados como Assunto , Humanos , Capital Social , Fatores Socioeconômicos , Inquéritos e Questionários
15.
Int J Public Health ; 66: 1604004, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34630005

RESUMO

Objectives: To quantify the Black/Hispanic disparity in COVID-19 mortality in the United States (US). Methods: COVID-19 deaths in all US counties nationwide were analyzed to estimate COVID-19 mortality rate ratios by county-level proportions of Black/Hispanic residents, using mixed-effects Poisson regression. Excess COVID-19 mortality counts, relative to predicted under a counterfactual scenario of no racial/ethnic disparity gradient, were estimated. Results: County-level COVID-19 mortality rates increased monotonically with county-level proportions of Black and Hispanic residents, up to 5.4-fold (≥43% Black) and 11.6-fold (≥55% Hispanic) higher compared to counties with <5% Black and <15% Hispanic residents, respectively, controlling for county-level poverty, age, and urbanization level. Had this disparity gradient not existed, the US COVID-19 death count would have been 92.1% lower (177,672 fewer deaths), making the rate comparable to other high-income countries with substantially lower COVID-19 death counts. Conclusion: During the first 8 months of the SARS-CoV-2 pandemic, the US experienced the highest number of COVID-19 deaths. This COVID-19 mortality burden is strongly associated with county-level racial/ethnic diversity, explaining most US COVID-19 deaths.


Assuntos
Afro-Americanos , COVID-19 , Disparidades nos Níveis de Saúde , Hispano-Americanos , Pandemias , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , COVID-19/etnologia , COVID-19/mortalidade , Criança , Pré-Escolar , Hispano-Americanos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
16.
South Med J ; 114(10): 649-656, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34599344

RESUMO

OBJECTIVES: Although disparities in coronavirus disease 2019 (COVID-19) prevalence are known, knowledge of the recent surge of COVID-19 in Texas and factors affecting fatality rates is limited. Understanding the health disparities associated with COVID-19 can help healthcare professionals determine the populations that are most in need of COVID-19 preventive care and treatment. The aim of this study was to assess COVID-19-related case and mortality rates. METHODS: Our cross-sectional analysis used Texas Department of State Health Services COVID-19 case surveillance counts. Case, hospitalization, and mortality counts were obtained from March to July 2020. RESULTS: From March to July 2020, there were 420,397 COVID-19-related cases and 6954 deaths in Texas. There were 3277 new cases and 104 deaths in March, and 261,876 new cases and 3660 deaths in July. The number of new COVID-19 cases was the highest from March to April (relative risk 1.77, 95% confidence interval [CI] 1.76-1.78). Although the death rate in June was a 30% increase over the rate in May, death rates nearly tripled by the end of July, for a total of 3660 deaths. Of the 3958 deaths, demographic data were available for 753 deaths. Of these, 440 were male, 16 Asian, 95 Black, 221 Hispanic, 325 White, and 96 were "Other" or "Unknown." Males were associated with a slightly higher chance of acquiring COVID-19 than females (odds ratio [OR] 1.11, 95% CI 1.09-1.14) and nearly a 29% higher chance of dying of COVID-19 compared with females (OR 1.29, 95% CI 1.11-1.49). Bivariate analysis revealed that the probability of acquiring COVID-19 was 12% higher in older adults compared with individuals younger than 65 years old (OR 1.12, 95% CI 1.08-1.16), and older adults had an 18.8 times higher risk of death when compared with the rate of younger individuals (OR 18.79, 95% CI 15.93-22.15). Hispanics and Blacks were 70% and 48%, respectively, more likely to contract COVID-19 than Whites. All races had lower significant chance of death when compared with Whites. At the end of July, there was a total of 430,485 Texas COVID-19 cases and 6387 fatalities (8.8% of all cases and 4% of all deaths in the United States.). Case fatality ratios were the highest in older adults. As we continued to observe data, in contrast to previous study time points, we found that Asians and Hispanics had no significant difference in COVID mortality rates and were comparable in terms of mortality odds and death case ratios when compared with Whites. CONCLUSIONS: This time period represents the highest COVID-19 surge time in Texas. Although our data consist of a short time period of population-level data in an ongoing pandemic and are limited by information reported to the Texas Department of State Health Services, older age, male sex, Hispanics, and Blacks are currently associated with higher infection rates, whereas older age, male sex, and Whites are associated with higher mortality rates. Clinicians and decision makers should be aware of the COVID-19 health disparities and risk factors for mortality to better promote targeted interventions and allocate resources accordingly.


Assuntos
COVID-19/economia , Grupos de Populações Continentais/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/etnologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Fatores de Risco , Governo Estadual , Texas/epidemiologia
17.
MMWR Morb Mortal Wkly Rep ; 70(41): 1447-1452, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34648483

RESUMO

Traumatic brain injuries (TBIs) have contributed to approximately one million deaths in the United States over the last 2 decades (1). CDC analyzed National Vital Statistics System (NVSS) mortality data for a 3-year period (2016-2018) to examine numbers and rates of TBI-related deaths, the percentage difference between each state's rate and the overall U.S. TBI-related death rate, leading causes of TBI, and the association between TBI and a state's level of rurality. During 2016-2018, a total of 181,227 TBI-related deaths (17.3 per 100,000 population per year) occurred in the United States. The percentage difference between state TBI-related death rates and the overall U.S. rate during this period ranged from 46.2% below to 101.2% above the overall rate. By state, the lowest rate was in New Jersey (9.3 per 100,000 population per year); the states with the highest rates were Alaska (34.8), Wyoming (32.6), and Montana (29.5). States in the South and those with a higher proportion of residents living in rural areas had higher rates, whereas states in the Northeast and those with a lower proportion of residents living in rural areas had lower TBI-related death rates. In 43 states, suicide was the leading cause of TBI-related deaths; in other states, unintentional falls or unintentional motor vehicle crashes were responsible for the highest numbers and rates of TBI-related deaths. Consistent with previous studies (2), differences in TBI incidence and outcomes were observed across U.S. states; therefore, states can use these findings to develop and implement evidence-based prevention strategies, based on their leading causes of TBI-related deaths. Expanding evidence-based prevention strategies that address TBI-related deaths is warranted, especially among states with high rates due to suicide, unintentional falls, and motor vehicle crashes.


Assuntos
Lesões Encefálicas Traumáticas/mortalidade , Disparidades nos Níveis de Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/etiologia , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Intenção , Pessoa de Meia-Idade , Fatores de Risco , População Rural/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-34682479

RESUMO

Previous research has confirmed a positive association between income and health, but there are still a lot of inconsistencies on how income affects health. Indeed, this impact is caused by overlaying of absolute income and relative income effects, and only by decomposing and comparing their relative importance within an integrated framework can suggestions be made for health inequalities and health intervention. To deal with this issue, using the panel data from the 2011, 2014, and 2017 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a well-designed research model is established to decompose and explore the impact. Our results indicate that relative income, rather than absolute income, has a significant negative impact on health performance, and that these associations may be causal in nature. The health inequity persists throughout the life cycle, but it remains relatively stable, without significant expansion or convergence. To some extent, the research-proposed models enrich the related literature on associations between income and health, and the empirical results suggest that as China moves to the stage of higher incomes and accelerated aging, the Chinese government should pay more attention to income inequality and be alert to the risks of "income-healthy poverty" traps.


Assuntos
Renda , Pobreza , China , Nível de Saúde , Disparidades nos Níveis de Saúde , Fatores Socioeconômicos
20.
Artigo em Inglês | MEDLINE | ID: mdl-34682626

RESUMO

Health inequities are systemic, avoidable, and unjust differences in health between populations. These differences are often determined by social and structural factors, such as income and social status, employment and working conditions, or race/racism, which are referred to as the social determinants of health (SDOH). According to public opinion, health is considered to be largely determined by the choices and behaviours of individuals. However, evidence suggests that social and structural factors are the key determinants of health. There is likely a lack of public understanding of the role that social and structural factors play in determining health and producing health inequities. Public opinion and priorities can drive governmental action, so the aim of this work was to determine the most impactful way to increase knowledge and awareness about the social determinants of health (SDOH) and health inequities in the province of Ontario, Canada. A study to test the effectiveness of four different messaging styles about health inequities and the SDOH was conducted with a sample of 805 adult residents of Ontario. Findings show that messages highlighting the challenges faced by those experiencing the negative effects of the SDOH, while still acknowledging individual responsibility for health, were the most effective for eliciting an empathetic response from Ontarians. These findings can be used to inform public awareness campaigns focused on changing the current public narrative about the SDOH toward a more empathetic response, with the goal of increasing political will to enact policies to address health inequities in Ontario.


Assuntos
Racismo , Determinantes Sociais da Saúde , Adulto , Disparidades nos Níveis de Saúde , Humanos , Renda , Ontário , Opinião Pública
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