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JAMA ; 328(16): 1616-1623, 2022 10 25.
Artigo em Inglês | MEDLINE | ID: mdl-36282256


Importance: Bundled Payments for Care Improvement Advanced (BPCI-A) is a Centers for Medicare & Medicaid Services (CMS) initiative that aims to produce financial savings by incentivizing decreases in clinical spending. Incentives consist of financial bonuses from CMS to hospitals or penalties paid by hospitals to CMS. Objective: To investigate the association of hospital participation in BPCI-A with spending, and to characterize hospitals receiving financial bonuses vs penalties. Design, Setting, and Participants: Difference-in-differences and cross-sectional analyses of 4 754 139 patient episodes using 2013-2019 US Medicare claims at 694 participating and 2852 nonparticipating hospitals merged with hospital and market characteristics. Exposures: BPCI-A model years 1 and 2 (October 1, 2018, through December 31, 2019). Main Outcomes and Measures: Hospitals' per-episode spending, CMS gross and net spending, and the incentive allocated to each hospital. Results: The study identified 694 participating hospitals. The analysis observed a -$175 change in mean per-episode spending (95% CI, -$378 to $28) and an aggregate spending change of -$75.1 million (95% CI, -$162.1 million to $12.0 million) across the 428 670 episodes in BPCI-A model years 1 and 2. However, CMS disbursed $354.3 million (95% CI, $212.0 million to $496.0 million) more in bonuses than it received in penalties. Hospital participation in BPCI-A was associated with a net loss to CMS of $279.2 million (95% CI, $135.0 million to $423.0 million). Hospitals in the lowest quartile of Medicaid days received a mean penalty of $0.41 million; (95% CI, $0.09 million to $0.72 million), while those in the highest quartile received a mean bonus of $1.57 million; (95% CI, $1.09 million to $2.08 million). Similar patterns were observed for hospitals across increasing quartiles of Disproportionate Share Hospital percentage and of patients from racial and ethnic minority groups. Conclusions and Relevance: Among US hospitals measured between 2013 and 2019, participation in BPCI-A was significantly associated with an increase in net CMS spending. Bonuses accrued disproportionately to hospitals providing care for marginalized communities.

Custos Hospitalares , Medicare , Motivação , Pacotes de Assistência ao Paciente , Melhoria de Qualidade , Idoso , Humanos , Estudos Transversais , Etnicidade/estatística & dados numéricos , Hospitais/normas , Hospitais/estatística & dados numéricos , Medicare/economia , Medicare/normas , Grupos Minoritários/estatística & dados numéricos , Estados Unidos/epidemiologia , Pacotes de Assistência ao Paciente/economia , Pacotes de Assistência ao Paciente/normas , Pacotes de Assistência ao Paciente/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Melhoria de Qualidade/economia , Melhoria de Qualidade/normas , Melhoria de Qualidade/estatística & dados numéricos , Marginalização Social
BMJ Open ; 12(7): e060479, 2022 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-35798531


INTRODUCTION: Exposure to gender-based violence (GBV) has devastating psychological outcomes for victims/survivors. Particularly in conditions where GBV intersects with multiple forms of oppression, the negative impacts of violence are more challenging to overcome and potential pathways for recovery become less accessible. However, evidence regarding the availability and effectiveness of mental health interventions for GBV survivors from marginalised and disadvantaged communities has yet to be systematically integrated and synthesised. The proposed scoping review will examine the relevant literature regarding the availability and effectiveness of psychological interventions for survivors of GBV from marginalised and disadvantaged backgrounds. This review will (i) document what psychological interventions have been available and empirically established for marginalised and disadvantaged women and individuals with experiences of GBV, (ii) provide a narrative examination of the treatment outcomes of identified interventions regarding their effectiveness and (iii) examine the degree to which GBV interventions in selected sources are designed and applied with a recognition of the social determinants of mental health. METHODS AND ANALYSIS: The search for the proposed scoping review will include five electronic databases: PsycINFO, Scopus, Web of Science, Ovid Medline, and CINAHL. The database search will be completed in June 2022. An additional search will be conducted before the completion of the study in December 2022. The search will target research studies published after 2010. The primary eligibility criterion for study selection is having a focus on psychological interventions for GBV survivors from marginalised and disadvantaged groups. Two reviewers will conduct screening and data extraction. The data will be evaluated to map the treatment outcomes of interventions and their effectiveness. Implications for clinical services will be discussed. ETHICS AND DISSEMINATION: No ethical consideration is foreseen for this scoping review. The dissemination will be done through a publication in a top-tier open access journal and conference presentations.

Violência de Gênero , Intervenção Psicossocial , Feminino , Humanos , Transtornos Mentais , Projetos de Pesquisa , Marginalização Social , Revisões Sistemáticas como Assunto , Populações Vulneráveis
J Behav Med ; 45(5): 760-770, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35688960


Medical avoidance is common among U.S. adults, and may be emphasized among members of marginalized communities due to discrimination concerns. In the current study, we investigated whether this disparity in avoidance was maintained or exacerbated during the onset of the COVID-19 pandemic. We assessed the likelihood of avoiding medical care due to general-, discrimination-, and COVID-19-related concerns in an online sample (N = 471). As hypothesized, marginalized groups (i.e., non-White race, Latinx/e ethnicity, non-heterosexual sexual orientation, high BMI) endorsed more general- and discrimination-related medical avoidance than majoritized groups. However, marginalized groups were equally likely to seek COVID-19 treatment as majoritized groups. Implications for reducing medical avoidance among marginalized groups are discussed.

COVID-19 , Disparidades em Assistência à Saúde , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , Marginalização Social , Populações Vulneráveis , Adulto , Índice de Massa Corporal , COVID-19/epidemiologia , COVID-19/terapia , Etnicidade/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Grupos Raciais/estatística & dados numéricos , Comportamento Sexual , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Estados Unidos/epidemiologia , Populações Vulneráveis/estatística & dados numéricos
Barbarói ; (61): 123-143, jan.-jun. 2022.
Artigo em Português | LILACS, Index Psicologia - Periódicos | ID: biblio-1397238


O presente texto apresenta reflexões teóricas que apontam para possibilidades de expressar identidades sexuais e de gênero em diversos espaços de sociabilidade, considerando os fatores relacionados à sublevação dos pensamentos conservadores. Em seguida, intentamos compreender o fenômeno dos discursos conservadores como sendo um movimento político e social que faz uso dos recursos da linguagem para encenar processos de exclusão, que potencializam a eliminação física do outro em sua diferença em termos reais. Posteriormente, trazemos a categoria social mulher para o centro do debate; nesta parte, objetivamos compreender os marcadores que acentuam a estigmatização e a marginalização da identidade feminina. Em complemento, desenvolvemos uma discussão acerca do protagonismo da mulher professora e filósofa e, para corroborar tal reflexão, pretendemos discorrer a respeito da decolonialidade como uma epistemologia que defende a retomada da representatividade, no campo do ser, do saber e do poder, de grupos que foram, através de um processo eurocêntrico/moderno de colonização, oprimidos, marginalizados e inferiorizados.(AU)

The present paper presents theoretical reflections that guide to possibilities of expressing sexual and gender identities in several spaces of sociability considering the factors related to the growth of conservative thoughts. We seek to understand the phenomenon of conservative discourses as a political and social movement that makes use of the resources of language to enact processes of exclusion that enhance the physical elimination of the other in their difference in real terms. Subsequently, we bring the social category to the center of the debate, in this part we aim to understand the markers that accentuate the stigmatization and marginalization of the feminine identity. In addition, we develop a discussion about the protagonism of the teacher and philosopher woman and, to corroborate this reflection, we intend to discuss about the decoloniality as an epistemology that defends the resumption of representativity, in the field of being, knowledge and power, groups which were, through a Eurocentric / modern process of colonization, oppressed, marginalized, and inferior.(AU)

El presente artículo presenta reflexiones teóricas que abordan las posibilidades de expresar identidades sexuales y de género en diversos espacios de sociabilidad considerando factores relacionados con el crecimiento de los pensamientos conservadores. Comprendemos el fenómeno relativo a los discursos conservadores como parte de un movimiento político y social que utiliza los recursos del lenguaje para poner en escena procesos de exclusión potencializadores de la eliminación física del otro, en su diferencia, en términos reales. A continuación, traemos la categoría social mujer al centro del debate, en esta sección objetivamos comprender los marcadores que acentúan la estigmatización y la marginación de la identidad femenina. En complemento, desarrollamos una discusión acerca del protagonismo de la mujer profesora y filósofa. Para esta reflexión, pretendemos discurrir sobre la decolonialidad como una epistemología que defiende el rescate de la representatividad, en el campo del ser, del saber y del poder, de grupos que, a través de un proceso eurocéntrico / moderno de colonización, oprimidos, marginados tornados más inferior.(AU)

Humanos , Feminino , Sexualidade , Opressão Social , Identidade de Gênero , Isolamento Social , Estereotipagem , Marginalização Social , Papel de Gênero
Tog (A Coruña) ; 19(1): 36-43, mayo 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-207068


Objetivos: las Tecnologías de la Información y la Comunicación tienen un desarrollo exponencial, formando parte de nuestra vida cotidiana; no obstante, esta incorporación de las tecnologías al día a día se está produciendo a tal velocidad que genera desigualdades entre diferentes grupos de edad como las personas mayores. El objetivo fue indagar sobre el uso de las Tecnologías de la Información y Comunicación en personas mayores, en Porto do Son (La Coruña, España). Métodos: La muestra quedó formada por 237 personas, 57,8 % mujeres y 42,2 % hombres, con una edad media de 74,8 años (SD=6,85). Se empleó un cuestionario sociodemográfico y el Cuestionario Sobre el Uso de Tecnologías-Consumidor. Resultados: se encontraron como factores predictores de uso de tecnologías: el acercamiento a estas mediante cursos de alfabetización digital y a través de un amigo; la percepción por parte de las personas mayores de que las actividades que realizan les resultan satisfactorias y de que la tecnología les acerca a la gente, y usar tecnología concreta en la vida diaria. No se obtuvieron datos significativos con respecto a la influencia de las características personales/sociales. Se observó una relación directa entre el uso de tecnologías y el nivel cultural e inversa con la edad. Conclusiones: la mayor diferencia en la percepción del uso de tecnología por parte de la población adulta se produce a favor de los grupos con menor edad y un nivel cultural superior. (AU)

Objective: Information and Communication Technologies have an exponential development, forming part of our daily life; however, this incorporation of technologies into everyday life is taking place at such speed that it generates inequalities between different age groups such as the elderly. The objective was to investigate the use/non-use of Information and Communication Technologies in the elderly, in Porto do Son. Methods: The sample was made up of 237 people, 137 women and 100 men, with a mean age of 74.8 years (SD=6.85). A sociodemographic questionnaire and the Questionnaire on the Use of Technologies-Consumer were used.Results: The predictive results of the use of technologies were found: the approach to these through digital literacy courses and through a friend; the satisfactory perception of all their common activities and that technology brings them closer to people and the concrete use of technology in daily life. No significant data was obtained regarding the influence of personal/social characteristics on the use/non-use of Information and Communication Technologies.Conclusions: The greatest difference in the perception of the use of technology by the adult population occurs in favor of younger groups and a higher cultural level. (AU)

Humanos , Idoso , Idoso de 80 Anos ou mais , Tecnologia da Informação/tendências , Exclusão Digital , Marginalização Social , Epidemiologia Descritiva , Inquéritos e Questionários , Qualidade de Vida , Autonomia Pessoal
J Med Syst ; 46(5): 27, 2022 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-35396622


In this editorial, we further discuss the effects that health equity tourism has had on Black, Native, and Latinx marginalized communities. We identify the consequences of the resulting medical mistrust within these communities as well as implications for data collection in research. Throughout, solutions are proposed that may eventually empower these communities to become actively engaged with the research and initiatives that influence their health outcomes, as well as improve the quality and quantity of data extracted from these communities.

Equidade em Saúde , Turismo Médico , Racismo , Marginalização Social , Humanos , Confiança
Gac. sanit. (Barc., Ed. impr.) ; 36(2): 118-126, mar./abr. 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-209190


Objetivo: El objetivo del presente estudio es crear capacidad de abogacía entre un grupo de vecinos/as gitanos/as que viven en contextos de riesgo de exclusión social. Método: Se ha utilizado un diseño de Investigación Acción Participativa Basada en la Comunidad, en el que el que 4 miembros de la comunidad participaron en el proceso de recogida de evidencias mediante fotovoz, análisis de estas siguiendo el método ReACT y diseminación de los resultados. Resultados: Se recogieron un total de 96 evidencias que fueron analizadas para el análisis de datos cualitativos. Estas fueron categorizadas atendiendo a (a) el tipo de condiciones insalubres y (b) la zona del barrio donde se encontraban. La posterior agrupación temática permitió identificar como causas: (a) El abandono de los servicios públicos; (b) la discriminación y (c) la falta de presencia de población gitana en los espacios comunitarios. Las consecuencias señaladas fueron (a) problemas de salud mental y física y (b) normalización de condiciones de vida indignas. El plan diseñado tuvo por objetivo abogar por la presencia gitana en los espacios comunitarios. Conclusiones: Nuestro estudio puso en evidencia la pertinencia del fotovoz para trascender la perspectiva biomédica y desarrollar acciones de abogacía basadas en el conocimiento creado por la comunidad. Futuras investigaciones deberían profundizar en el impacto de la abogacía para la salud en la reducción de las desigualdades y considerar la importancia de implicar a investigadores/as, profesionales de salud pública y la comunidad en su abordaj. (AU)

Objective: The objective of this study is to build advocacy capacity among a group of gipsy Roma neighbours living in contexts of risk of social exclusion. Methods: A Community Based Participatory Action Research design was used, in which 4 members of the community participated in the process of collecting evidence by photovoice, analysing it using the ReACT method and disseminating the results. Results: A total of 96 pieces of evidence were collected and analysed for qualitative data analysis. These were categorised according to (a) the type of unhealthy conditions and (b) the area of the neighbourhood where they were located. The subsequent thematic grouping made it possible to identify the causes: (a) the abandonment of public services; (b) discrimination; and (c) the lack of Roma presence in community spaces. The consequences identified were (a) mental and physical health problems and (b) the normalisation of undignified living conditions. The plan was designed to advocate for the presence of Roma in community spaces. Conclusions: Our study highlighted the relevance of the photovoice to transcend the biomedical perspective and develop advocacy actions based on the knowledge created by the community. Future research should look more deeply into the impact of health advocacy on reducing inequalities and consider the importance of involving researchers, public health professionals and the community in addressing it. (AU)

Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Roma (Grupo Étnico) , Disparidades nos Níveis de Saúde , Serviços de Saúde , Saúde Pública , Determinantes Sociais da Saúde , Marginalização Social
Artigo em Inglês | MEDLINE | ID: mdl-35162133


The goal of the present study is to examine the psychology of working framework/theory with a sample of Korean workers. This study examined the structural model of sociocultural factors (i.e., economic constraints and social marginalization), psychological variables (i.e., work volition and career adaptability), and outcomes of decent work based on the psychology of working framework. This study assumed that decent work helps all workers attain a sense of self-respect, dignity, experience freedom and security in the work environment and provides an opportunity for workers to contribute to society. Data were collected from 420 Korean workers, with an average age of 39.13 years (SD = 9.26). We used a hypothesis model that did not assume a direct path from economic constraints and social marginalization to decent work and work volition and career adaptation to job satisfaction and life satisfaction. We also employed an alternative model that assumed all of its paths and compared the models' goodness of fit based on prior studies. Results indicated that alternative models have higher goodness of fit than hypothesis models. All path coefficients were significant except for the direct path from social marginalization to work volition and career adaptability to life satisfaction. Additionally, work volition and career adaptability mediated both the relationship between social marginalization and job satisfaction and between marginalization and life satisfaction. This study enabled the comprehensive examination of the relevance of various social environments and psychological and occupational characteristics that should be considered when exploring job or life satisfaction in the process of career counseling.

Satisfação no Emprego , Ocupações , Adulto , Humanos , República da Coreia , Marginalização Social/psicologia , Local de Trabalho/psicologia
PLoS One ; 17(2): e0263450, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35171929


BACKGROUND: Due to the circumstances of their early lives, young refugees are at risk of experiencing adverse labour market and health outcomes. The post-settlement environment is thought to play a decisive role in determining how this vulnerability plays out. This study compared trends in labour market marginalisation in young refugees and their majority peers during early adulthood in two national contexts, Denmark and Sweden, and explored the mediating role of common mental disorders and secondary school completions. METHODS: Using registry data, 13,390/45,687 refugees were included in Denmark/Sweden and 1:5 matched to majority peers. Inequalities in labour market marginalisation were investigated during 2012-2015 in each country using linear probability models and mediation analysis. Country trends were standardised to account for differences in observed population characteristics. RESULTS: The risk of marginalisation was 2.1-2.3 times higher among young refugees compared with their majority peers, but the risk decreased with age in Sweden and increased in Denmark for refugees. Birth-cohort differences drove the increase in Denmark, while trends were consistent across birth-cohorts in Sweden. Differences in population characteristics did not contribute to country differences. Common mental disorders did not mediate the inequality in either country, but secondary school completions did (77-85% of associations eliminated). CONCLUSIONS: The findings document both the vulnerability of young refugees to labour market marginalisation and the variability in this vulnerability across post-settlement contexts. While the contrast in policy climates in Denmark and Sweden sharpened over time, the risk of marginalisation appeared more similar in younger cohorts, pointing to the importance of factors other than national immigration and integration policies. Institutional efforts to assist young refugees through secondary education are likely to have long-lasting consequences for their socio-economic trajectories.

Transtornos Mentais/epidemiologia , Refugiados/psicologia , Sistema de Registros/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Marginalização Social/psicologia , Fatores Socioeconômicos , Desemprego/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Refugiados/estatística & dados numéricos , Adulto Jovem
Sportis (A Coruña) ; 8(1): 107-135, Ene. 2022. ilus
Artigo em Inglês, Espanhol | IBECS | ID: ibc-207464


Cambios físicos, psicológicos y sociales se experimenta en la etapa adolescente, algunos de estos cambios se muestran en la búsqueda de la identidad personal y la autonomía, mayor intimidad con los pares, alejamiento del vínculo parental-familiar, y desarrollo tanto de la sexualidad como el desarrollo cognitivo. A todo lo anterior, hay que considerar que, el adolescente se encuentra en una etapa psicoevolutiva donde urge propiciar espacios para la Integración Social. Con el fin de dar respuesta a estos cambios, se crea la Sesión Dialógica de Educación Física (SDEF) que es una metodología didáctica que tiene como objetivo modificar comportamientos y actitudes en adolescentes en riesgo de exclusión social. Esta sesión se divide en cinco partes: (1.) Planteamiento de los objetivos de la sesión; (2.) Activación; (3.) Confrontación; (4.) Reflexión y Debate; (5.) Transferencia a otros ámbitos de la vida y la sociedad. Existe muy poca evidencia científica que aborde el tema de la Integración Social y la Educación Física, menos aún, si realizamos una búsqueda de la utilización de Sesiones Dialógica de Educación Física para la inclusión de menores en riesgo. Por tanto, se coloca este ámbito como un elemento de investigación de referencia, para facilitar la formación de la integración social en sectores vulnerables como son los adolescentes. (AU)

Physical, psychological and social changes are experienced in the adolescent stage, some of these changes are shown in the search for personal identity and autonomy, greater intimacy with peers, distance from the parental-family bond, and development of both sexuality and cognitive development. To all the above, it must be considered that the adolescent is in a psych evolutional stage where it is urgent to promote spaces for Social Integration. In order to respond to these changes, the Dialogic Session of Physical Education (SDEF) is created, which is a didactic methodology that aims to modify behaviors and attitudes in adolescents at risk of social exclusion. This session is divided into five parts: (1.) Approach to the objectives of the session; (2.) Activation; (3.) Confrontation; (4.) Reflection and Debate; (5.) Transfer to other areas of life and society. There is very little scientific evidence that addresses the issue of Social Integration and Physical Education, even less, if we carry out a search for the use of Dialogic Sessions of Physical Education for the inclusion of minors at risk. Therefore, this area is placed as a reference research element, to facilitate the formation of social integration in vulnerable sectors such as adolescents. (AU)

Humanos , Masculino , Feminino , Adolescente , Esportes , Adolescente , Atitude , Comportamento , Educação Física e Treinamento , Desejabilidade Social , Socialização , Marginalização Social
Index enferm ; 31(1): 10-13, Ene-Mar. 2022. tab
Artigo em Espanhol | IBECS | ID: ibc-208861


Objetivo: Explorar los factores de la estigmatización social de las enfermeras de cuidados intensivos al inicio de la pandemia por Covid-19. Método: Estudio observacional exploratorio para comprobar los factores de la estigmatización social en enfermeras de cuidados intensivos que atendieron a pacientes con Covid-19 al inicio de la pandemia mediante muestreo no probabilístico. Se empleó el Cuestionario de Estigma Referenciado para Enfermeras en Cuidados Intensivos. Resultados: Participaron 135 enfermeras, 82,2 % mujeres, 85,9 % entre 25 y 44 años. Manifestaron como sintomatología asociada estrés (36,3 %), insomnio (32,6 %) y ansiedad (31,8 %). La escala mostró un coeficiente α Cronbach 0,866, un índice Kaiser Mayer Olkin 0,886, y Bartlett <0,001, con tres esferas de estigma social que alcan-zaron el 61,71 % de la variabilidad del constructo: Aislamiento Social, Exposición a SARS-Cov-2 y Vulnerabilidad profesional. Conclusiones: La vulnerabilidad profesional se asienta sobre el estrés, la sensación de fragilidad o la preocupación por el contagio, presentándose sentimientos ambivalentes. El aislamiento social estaría causado por las actitudes negativas sociales que provocan estereotipos. El estigma social se presenta en el contexto de atención a pacientes con enfermedades infectocontagiosas emergentes.(AU)

Aim: Explore the factors of social stigmatization of intensive care nurses at the start of the Covid-19 pandemic. Method: Exploratory observational study to verify the factors of social stigmatization in intensive care nurses who cared for patients with Covid-19 at the beginning of the pandemic using non-probabilistic sampling. The Referenced Stigma Questionnaire for Intensive Care Nurses was used. Results: 135 nurses participated, 82,2 % women, 85,9 % between 25 and 44 years old. They manifested stress (36,3 %), insomnia (32,6 %) and anxiety (31,8 %) as associated symptoms. The scale showed a α Cronbach coefficient 0.866, a Kaiser Mayer Olkin index of 0.886, and Bartlett´s test <0.001, with three areas of social stigma that reached 61,71 % of the variability of the construct: Social Isolation, Exposure to SARS-Cov-2 and Professional vulnerability. Conclusions: Professional vulnerability is based on stress, the feeling of fragility or concern about contagion, presenting ambivalent feelings. Social isolation would be caused by negative social attitudes that stereotypes cause. Social stigma occurs in the context of care for patients with emerging infectious-contagious diseases.(AU)

Humanos , Feminino , Pessoa de Meia-Idade , Pandemias , Betacoronavirus , Vírus da SARS , Infecções por Coronavirus/epidemiologia , Estereotipagem , Unidades de Terapia Intensiva , Enfermeiras Especialistas , Enfermeiras e Enfermeiros , Estresse Psicológico , Esgotamento Profissional , Enfermagem , Inquéritos e Questionários , Espanha , Reprodutibilidade dos Testes , Análise Fatorial , Marginalização Social , Ansiedade , Distúrbios do Início e da Manutenção do Sono , Estigma Social