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1.
Washington, D.C.; OPAS; 2021-04-07. (OPAS/EGC/COVID-19/21-0001).
en Portugués | PAHO-IRIS | ID: phr-53539

RESUMEN

Para continuar com a criação de espaços de diálogo e prosseguir com os compromissos da agenda de saúde universal para a resposta à COVID-19 nas populações indígenas, a OPAS organizou uma reunião de alto nível, realizada em 30 de outubro de 2020, com o objetivo de avançar na elaboração de um roteiro que fortaleça a resposta à COVID-19, dando ênfase às prioridades, necessidades e propostas apresentadas pelas populações indígenas, com uma abordagem intercultural e coordenada com os povos indígenas da Região. Este documento apresenta um resumo das principais perspectivas e oportunidades reconhecidas, tanto pelas próprias lideranças indígenas quanto por representantes de alguns ministérios da saúde da Região, durante a reunião de alto nível. Embora as esferas temáticas identificadas sejam largamente aplicáveis a todas as populações, as diferenças contextuais e culturais são de grande relevância, razão pela qual deveriam ser consideradas a partir de enfoques diferenciados e, ao mesmo tempo, com base nas particularidades econômicas, sociais, políticas e ambientais de cada população.


Asunto(s)
Infecciones por Coronavirus , Salud de las Minorías Étnicas , Salud de Poblaciones Indígenas , Género y Salud
2.
Biomed Environ Sci ; 34(2): 101-109, 2021 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-33685568

RESUMEN

Objective: To assess the association of socioeconomic status with the burden of cataract blindness in terms of year lived with disability (YLD) rates and to determine whether ultraviolet radiation (UVR) levels modify the effect of socioeconomic status on this health burden. Methods: National and subnational age-standardized YLD rates associated with cataract-related blindness were derived from the Global Burden of Disease (GBD) study 2017. The human development index (HDI) from the Human Development Report was used as a measure of socioeconomic status. Estimated ground-level UVR exposure was obtained from the Ozone Monitoring Instrument (OMI) dataset of the National Aeronautics and Space Administration (NASA). Results: Across 185 countries, socioeconomic status was inversely associated with the burden of cataract blindness. Countries with a very high HDI had an 84% lower age-standardized YLD rate [95% confidence interval ( CI): 60%-93%, P < 0.001] than countries with a low HDI; for high-HDI countries, the proportion was 76% (95% CI: 53%-88%, P < 0.001), and for medium-HDI countries, the proportion was 48% (95% CI: 15%-68%, P = 0.010; P for trend < 0.001). The interaction analysis showed that UVR exposure played an interactive role in the association between socioeconomic status and cataract blindness burden ( P value for interaction = 0.047). Conclusion: Long-term high-UVR exposure amplifies the association of poor socioeconomic status with the burden of cataract-related blindness. The findings emphasize the need for strengthening UVR exposure protection interventions in developing countries with high-UVR exposure.


Asunto(s)
Ceguera/epidemiología , Catarata/epidemiología , Carga Global de Enfermedades , Rayos Ultravioleta/efectos adversos , Ceguera/etiología , Catarata/etiología , Femenino , Carga Global de Enfermedades/estadística & datos numéricos , Humanos , Masculino , Años de Vida Ajustados por Calidad de Vida , Clase Social , Factores Socioeconómicos
3.
Value Health ; 24(3): 361-368, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33641770

RESUMEN

OBJECTIVES: Promoting patient involvement in managing co-occurring physical and mental health conditions is increasingly recognized as critical to improving outcomes and controlling costs in this growing chronically ill population. The main objective of this study was to conduct an economic evaluation of the Wellness Incentives and Navigation (WIN) intervention as part of a longitudinal randomized pragmatic clinical trial for chronically ill Texas Medicaid enrollees with co-occurring physical and mental health conditions. METHODS: The WIN intervention used a personal navigator, motivational interviewing, and a flexible wellness expense account to increase patient activation, that is, the patient's knowledge, skills, and confidence in managing their self-care and co-occurring physical and mental health conditions. Regression models were fit to both participant-level quality-adjusted life years (QALYs) and total costs of care (including the intervention) controlling for demographics, health status, poverty, Medicaid managed care plan, intervention group, and baseline health utility and costs. Incremental costs and QALYs were calculated based on the difference in predicted costs and QALYs under intervention versus usual care and were used to calculate the incremental cost-effectiveness ratios (ICERs). Confidence intervals were calculated using Fieller's method, and sensitivity analyses were performed. RESULTS: The mean ICER for the intervention compared with usual care was $12 511 (95% CI $8971-$16 842), with a sizable majority of participants (70%) having ICERs below $40 000. The WIN intervention also produced higher QALY increases for participants who were sicker at baseline compared to those who were healthier at baseline. CONCLUSION: The WIN intervention shows considerable promise as a cost-effective intervention in this challenging chronically ill population.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/organización & administración , Medicaid/estadística & datos numéricos , Afecciones Crónicas Múltiples/epidemiología , Adulto , Análisis Costo-Beneficio , Femenino , Promoción de la Salud/economía , Estado de Salud , Humanos , Estudios Longitudinales , Masculino , Medicaid/economía , Entrevista Motivacional/organización & administración , Navegación de Pacientes/organización & administración , Años de Vida Ajustados por Calidad de Vida , Autocuidado , Autoimagen , Factores Socioeconómicos , Texas/epidemiología , Estados Unidos , Adulto Joven
4.
J Prim Care Community Health ; 12: 21501327211000250, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33769122

RESUMEN

Nigeria recorded her first case of COVID 19 in Lagos State on 27th February 2019, and the number of confirmed cases of COVID 19 has risen to 59 287, with 1113 deaths as of 4th October 2020. The commentary highlighted the importance of a health and demographic surveillance system (HDSS) and its potential in addressing surveillance gap, and the inadequacy of existing sociodemographic database used for palliative administration. The authors examined the HDSS in the context of the COVID-19 pandemic response and learning from the Nahuche model. The Nahuche HDSS model has the potential of identifying poor households as it collects standard data on the socio-economic status of each of the households within the demographic surveillance area (DSA). Standard questionnaire in assessing the household socio-economic status adapted from standard surveys, such as Nigeria Health and Demographic Survey and Malaria Indicator Survey, was administered on the household heads of each household every 2 years to monitor socio-economic advancement of the households. Data on variables such as household possessions, including animals and livestock, were collected and analyzed using factor analysis to group the households into different wealth indices. HDSS provides an opportunity to ameliorate the challenges associated with halting the spread of the virus in the areas of surveillance and administration of palliatives in Nigeria, where there is a paucity of reliable demographic and household-level socio-economic data. This paper calls for the setting up of a functioning HDSS in each region of Nigeria to address the dearth of reliable data for planning health and socio-economic interventions.


Asunto(s)
Composición Familiar , Planificación en Salud , Pandemias , Política Pública , Clase Social , Encuestas y Cuestionarios , Demografía , Análisis Factorial , Programas de Gobierno , Humanos , Malaria , Nigeria , Propiedad , Salud Poblacional , Vigilancia de la Población , Pobreza , Factores Socioeconómicos
5.
Medicine (Baltimore) ; 100(8): e23718, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663038

RESUMEN

ABSTRACT: Pain as a result of cervical radiculopathy (CR) can be widespread, nondermatomal and individually specific, but the association between pain extent and other clinical features has never been explored. The objective of this study is to investigate whether pain extent relates to clinical variables including pain intensity in addition to health indicators including disability, general health, depression, somatic anxiety, coping strategies or self-efficacy.An observational cohort study was conducted. Participants were recruited from 4 hospital spinal centres in Sweden. Pain extent was quantified from the pain drawings of 190 individuals with cervical disc disease, verified with magnetic resonance imaging (MRI) and compatible with clinical findings (examined by a neurosurgeon), that show cervical nerve root compression. Pain extent was evaluated in relation to neck pain, arm pain, and headache intensity. Multiple linear regression analysis were then used to verify whether pain extent was associated with other health indicators including disability, health-related quality of life, depression, somatic anxiety, coping strategies and self-efficacy.Pain extent was directly related to neck, arm and headache pain intensity (all P < .01). Multiple linear regression revealed that pain extent was significantly associated only to the level of perceived disability (P < .01).Increased pain extent in people with CR is associated with higher headache, neck and arm pain intensity, and disability but not measures of general health, depression, somatic anxiety, coping strategies or self-efficacy.


Asunto(s)
Evaluación de la Discapacidad , Estado de Salud , Dolor/etiología , Dolor/psicología , Radiculopatía/complicaciones , Adaptación Psicológica , Adulto , Factores de Edad , Anciano , Vértebras Cervicales , Depresión/etiología , Personas con Discapacidad , Ejercicio Físico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Calidad de Vida , Autoeficacia , Factores Sexuales , Factores Socioeconómicos , Suecia , Evaluación de Capacidad de Trabajo , Adulto Joven
6.
Medicine (Baltimore) ; 100(10): e25089, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725900

RESUMEN

ABSTRACT: To investigate the health-related quality of life (HRQoL) and related factors, the symptoms of posttraumatic stress disorder (PTSD) among earthquake survivors in minority area 2 years after Jiuzhaigou earthquake.Two years after the Jiuzhaigou earthquake, a cross-sectional survey was conducted by a multi-stage sampling approach. HRQoL was measured by the short form 12 (SF-12), PTSD was measured by the PTSD Check List-Civilian Version (PCL-C), and social support was measured by the Multidimensional Scale of Perceived Social Support. Descriptive statistics, t-tests, ANOVA and multiple linear regression analysis were used for data analysis.Of the 561 participants, the mean scores on the physical component summary (PCS) and mental component summary (MCS) were 46.36 ±â€Š12.79 and 55.03 ±â€Š8.73, and 5.73% reported the symptoms of PTSD. Lower PCS and MCS after an earthquake were associated with elderly age, physical illness, and low level of social support (P < .05). Meanwhile, PTSD was significantly associated with MCS.These findings showed that physical disease and psychological symptoms can adversely affect the HRQoL of survivors. Moreover, providing higher social support to survivors should be considered as a way to improve the HRQoL outcomes of survivors.


Asunto(s)
Terremotos , Calidad de Vida/psicología , Trastornos por Estrés Postraumático/epidemiología , Sobrevivientes/psicología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , China/epidemiología , Estudios Transversales , Femenino , Estado de Salud , Humanos , Entrevistas como Asunto , Masculino , Salud Mental , Persona de Mediana Edad , Factores de Riesgo , Factores Sexuales , Apoyo Social , Factores Socioeconómicos , Adulto Joven
7.
Isr J Health Policy Res ; 10(1): 28, 2021 03 23.
Artículo en Inglés | MEDLINE | ID: mdl-33757598

RESUMEN

BACKGROUND: Increased anxiety was frequently reported during the 2020 global COVID-19 pandemic. An association between anxiety and increased body weight has been documented. Identifying associations between diet quality and anxiety may facilitate the development of preventive dietary policy, particularly relevant since obesity appears to increase the risk of adverse COVID-19 outcomes. In this study we aim to examine associations between changes in diet pattern and body weight and anxiety levels during the COVID-19 pandemic among Israeli respondents to an international online survey. METHODS: Conducted between March 30-April 252,020, this was cross-sectional, international and online study. The questionnaire was developed and tested in Hebrew and translated into six other languages: English, Arabic, Spanish, French, Italian, and Russian. The survey was conducted on a Google Survey platform, the link to which was posted on several social media platforms. Adults aged 18 or older who saw and responded to the link on a social media site comprised the study population. RESULTS: Of the 3979 eligible respondents, 1895 indicated their current location as Israel. Most Israeli respondents completed the survey in Hebrew (83.2%) followed by Arabic (9.4%), though responses were recorded in all seven of the survey languages. The median age was 33 (IQ = 22) years, and 75.7% were female. Almost 60% indicated that their pre-pandemic diet was healthier than their current diet, and 25.2% indicated they had gained weight during the pandemic. The median Mediterranean diet score was 9 (IQ = 3). While the median General Anxiety Disorder (GAD-7) score was 5 (IQ = 8), only 37.3% of participants reported at least mild anxiety (a GAD-7 score of 5 or more), while 10.7% reported moderate anxiety or greater (a GAD-7 score of 10 or more). In a multivariate logistic regression model of at least mild anxiety, being male and completing the survey in Hebrew significantly reduced odds of at least mild anxiety, while a worsening of diet quality during the pandemic, weight gain, and isolation significantly increased odds of at least mild anxiety. CONCLUSIONS: During the COVID pandemic, changes in nutrition quality and habits were associated with greater anxiety. These findings suggest the need for routine and continuous surveillance of the nutritional and psychological consequences of outbreaks as part of healthcare preparedness efforts. Organizations responsible for community-based health services (such as Israeli health plans) should adopt specific interventions to improve case finding and support individuals at increased risk of anxiety and declining nutrition status within primary healthcare settings. These interventions should include the provision of appropriate diagnostic instruments, training of medical staff, feedback to physicians and nurses, and raising awareness among the relevant patient population and their caregivers. Primary care physicians should refer people with high anxiety or substantial weight gain during the pandemic to appropriate mental health and dietetic treatment, as needed. TRIAL REGISTRATION: NCT04353934 .


Asunto(s)
Ansiedad/epidemiología , Dieta/estadística & datos numéricos , Salud Global , Adulto , Estudios Transversales , Femenino , Conductas Relacionadas con la Salud , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Factores Socioeconómicos
8.
Rev Esp Salud Publica ; 952021 Mar 05.
Artículo en Español | MEDLINE | ID: mdl-33664220

RESUMEN

OBJECTIVE: The irruption of SARS-CoV-2 and its different incidence on the regional mortality rate could be revealing the effects of the change in the paradigm of health justice, initiated in Spain in 2010 and applied, more or less enthusiastically, by the different autonomous communities. The objective of this work was to look for if the socio-economic conditions and the policy of budgetary expenditure followed by the different Spanish autonomous communities have incidence, by themselves, on the mortality rate caused by the SARS-CoV-2. METHODS: Econometric research based on Multiple Linear Regression to determine the direct cause-effect relationship between the dependent variable, mortality associated with COVID-19, with explanatory variables of the health budget and socio-economic type. RESULTS: The number of deaths caused by COVID-19 has a positive relationship with the rate of GDP per capita and inversely with expenditure on hospital and specialized services, teaching and IRMs and with the resources allocated to health over the last nine years. A reduction in any of these health budget variables leads to an increase in mortality caused by COVID-19. CONCLUSIONS: The COVID-19 mortality rate has hit the wealthiest autonomous communities hardest but, above all, has hit those that, although richer, applied more restrictive budgetary measures in the period 2010-2018.

9.
Milbank Q ; 99(1): 209-239, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33528047

RESUMEN

Policy Points Several intergovernmental organizations (Organisation for Economic Co-operation and Development, World Health Organization, United Nations) are urging countries to use well-being indicators (e.g., life satisfaction) in addition to traditional economic indicators when making important policy decisions. As the number of governments implementing this new approach grows, so does the need to continue evaluating the health and well-being outcomes we might observe from policies aimed at improving life satisfaction. The results of this study suggest that life satisfaction is a valuable target for policies aiming to enhance several indicators of psychosocial well-being, health behaviors, and physical health outcomes. CONTEXT: Several intergovernmental organizations (Organisation for Economic Co-operation and Development, World Health Organization, United Nations) are urging countries to use well-being indicators (e.g., life satisfaction) in addition to traditional economic indicators when making important policy decisions. As the number of governments implementing this new approach grows, so does the need to continue evaluating the health and well-being outcomes we might observe from policies aimed at improving life satisfaction. METHODS: We evaluated whether positive change in life satisfaction (between t0 ;2006/2008 and t1 ;2010/2012) was associated with better outcomes on 35 indicators of physical, behavioral, and psychosocial health and well-being (in t2 ;2014/2016). Data were from 12,998 participants in the University of Michigan's Health and Retirement Study-a prospective and nationally representative cohort of US adults over age 50. FINDINGS: Participants with the highest (versus lowest) life satisfaction had better subsequent outcomes on some physical health indicators (lower risk of pain, physical functioning limitations, and mortality; lower number of chronic conditions; and higher self-rated health) and health behaviors (lower risk of sleep problems and more frequent physical activity), and nearly all psychosocial indicators (higher positive affect, optimism, purpose in life, mastery, health mastery, financial mastery, and likelihood of living with spouse/partner; and lower depression, depressive symptoms, hopelessness, negative affect, perceived constraints, and loneliness) over the 4-year follow-up period. However, life satisfaction was not subsequently associated with many specific health conditions (i.e., diabetes, hypertension, stroke, cancer, heart disease, lung disease, arthritis, overweight/obesity, or cognitive impairment), other health behaviors (i.e., binge drinking or smoking), or frequency of contact with children, family, or friends. CONCLUSIONS: These results suggest that life satisfaction is a valuable target for policies aiming to enhance several indicators of psychosocial well-being, health behaviors, and physical health outcomes.


Asunto(s)
Conductas Relacionadas con la Salud , Estado de Salud , Satisfacción Personal , Anciano , Anciano de 80 o más Años , Femenino , Política de Salud , Indicadores de Salud , Encuestas Epidemiológicas , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Estudios Prospectivos , Salud Pública , Factores Socioeconómicos , Estados Unidos
10.
Value Health ; 24(2): 236-243, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33518030

RESUMEN

OBJECTIVES: Patients with atrial fibrillation (AF) have rapid and irregular heart rates, increasing the risk of comorbidities and mortality. Next to formal medical care, many patients receive informal care from their social environment. The objective of this study was to examine the well-being and economic burden of providing informal care to patients with AF in the UK, Italy, and Germany. METHODS: Caregivers of patients with AF completed an online survey based on the iMTA Valuation of Informal Care Questionnaire, with questions about their caregiving situation, perceived burden of caregiving, and absence from work due to health problems resulting from caregiving. Care-related quality-of-life utilities were calculated using the Care-related Quality of Life instrument and associated tariffs. Societal costs of caregiving were calculated based on the proxy good method. RESULTS: A total of 585 caregivers participated in this study. On average, caregivers provided 33 hours of informal care per week to patients (SD 29 hours). On a scale from 0 to 10, their self-rated burden was 5.4. The average Care-related Quality of Life utility was 72. Caregivers primarily indicated problems with daily activities, mental health, and physical health. Still, the vast majority of caregivers (87%) derived fulfillment from providing care. Weekly societal costs of caregiving were on average €636. Comorbidities contributed substantially to the caregiver time and burden. CONCLUSIONS: Caring for a patient with AF is associated with substantial objective and subjective burden, but also provides fulfillment from being able to care for a loved one.


Asunto(s)
Fibrilación Atrial/epidemiología , Cuidadores/economía , Cuidadores/psicología , Calidad de Vida , Actividades Cotidianas , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Costo de Enfermedad , Eficiencia , Europa (Continente) , Femenino , Estado de Salud , Humanos , Relaciones Interpersonales , Masculino , Salud Mental , Persona de Mediana Edad , Factores Sexuales , Factores Socioeconómicos
11.
Value Health ; 24(2): 274-280, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33518034

RESUMEN

OBJECTIVES: Health utility decrement estimates for diabetes and complications are needed for parametrization of simulation models that aim to assess the cost-utility of diabetes prevention and care strategies. This study estimates health utility decrements associated with diabetes and cardiovascular and microvascular complications from a population-based German study. METHODS: Data were obtained from the population based cross-sectional KORA (Cooperative Health Research in the Augsburg Region) health questionnaire 2016 and comprised n = 1072 individuals with type 2 diabetes and n = 7879 individuals without diabetes. Health utility was assessed through the EQ-5D-5L. We used linear regression models with interaction terms between type 2 diabetes and different cardiovascular and microvascular complications while adjusting for demographic and socio-economic factors and other comorbidities. RESULTS: Type 2 diabetes (ß = -0.028, standard error [SE] = 0.014), stroke (ß = -0.070, SE = 0.010), cardiac arrhythmia (ß = -0.031, SE = 0.006), heart failure (ß = -0.073, SE = 0.009), coronary heart disease (ß = -0.028, SE = 0.010), myocardial infarction (ß = -0.020, SE = 0.011, estimates of main effect), and neuropathy (ß = -0.067, SE = 0.020), diabetic foot (ß = -0.042, SE = 0.030), nephropathy (ß = -0.032, SE = 0.025), and blindness (ß = -0.094, SE = 0.056, estimates of interaction terms) were negatively associated with health utility. The interaction term for diabetes x stroke (ß = -0.052, SE = 0.021) showed that the utility decrement for stroke is significantly larger in people with type 2 diabetes than in people without diabetes. CONCLUSIONS: Diabetes, cardiovascular, and microvascular conditions are associated with significant health utility decrements. Utility decrements for some conditions differ between people with and without type 2 diabetes. These results are of high relevance for the parametrization of decision analytic simulation models and applied health economic evaluations in the field of prevention and management of type 2 diabetes in Germany.


Asunto(s)
Análisis Costo-Beneficio/métodos , Diabetes Mellitus Tipo 2/economía , Angiopatías Diabéticas/economía , Cardiomiopatías Diabéticas/economía , Factores de Edad , Anciano , Anciano de 80 o más Años , Pesos y Medidas Corporales , Comorbilidad , Estudios Transversales , Diabetes Mellitus Tipo 2/prevención & control , Femenino , Alemania , Conductas Relacionadas con la Salud , Promoción de la Salud/economía , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Factores Socioeconómicos
12.
Value Health ; 24(2): 281-290, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33518035

RESUMEN

BACKGROUND: There are increasing concerns about the appropriateness of generic preference-based measures to capture health benefits in the area of mental health. OBJECTIVES: The aim of this study is to estimate preference weights for a new measure, Recovering Quality of Life (ReQoL-10), to better capture the benefits of mental healthcare. METHODS: Psychometric analyses of a larger sample of mental health service users (n = 4266) using confirmatory factor analyses and item response theory were used to derive a health state classification system and inform the selection of health states for utility assessment. A valuation survey with members of the UK public representative in terms of age, sex, and region was conducted using face-to-face interviewer administered time-trade-off with props. A series of regression models were fitted to the data and the best performing model selected for the scoring algorithm. RESULTS: The ReQoL-Utility Index (UI) classification system comprises 6 mental health items and 1 physical health item. Sixty-four health states were valued by 305 participants. The preferred model was a random effects model, with significant and consistent coefficients and best model fit. Estimated utilities modeled for all health states ranged from -0.195 (state worse than dead) to 1 (best possible state). CONCLUSIONS: The development of the ReQoL-UI is based on a novel application of item response theory methods for generating the classification system and selecting health states for valuation. Conventional time-trade-off was used to elicit utility values that are modeled to enable the generation of QALYs for use in cost-utility analysis of mental health interventions.


Asunto(s)
Análisis Costo-Beneficio/métodos , Salud Mental/economía , Calidad de Vida/psicología , Encuestas y Cuestionarios/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estado de Salud , Esperanza , Humanos , Relaciones Interpersonales , Actividades Recreativas , Masculino , Persona de Mediana Edad , Autonomía Personal , Psicometría , Factores Socioeconómicos , Adulto Joven
13.
Soc Work Health Care ; 60(1): 30-48, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33550956

RESUMEN

For social work practitioners in healthcare settings, self-care can be an integral tool to assuaging stressors associated with COVID-19. However, research that examines the impact of public health crises, such as COVID-19, is nominal, at best. This exploratory study investigated the impact of COVID-19 on the self-care practices of self-identified healthcare social workers (N = 2,460) in one southeastern state. Primary data were collected via an electronic survey and assessed via a retrospective pre/post design. Analyses compared practices before and after COVID-19 was declared a pandemic. Overall, data suggest that participants experienced significant pre/post decreases in self-care practices across multiple domains. As well, findings indicate that participants who identified as married, financially stable, and working non-remotely, and in good physical/mental health engaged in significantly more self-care practices than other participants, at post. This study underscores the need to foster supportive professional cultures that include developing self-care practice skills, particularly during large-scale crisis, such as COVID-19.


Asunto(s)
/epidemiología , Autocuidado/psicología , Trabajadores Sociales/psicología , Adulto , Agotamiento Profesional/epidemiología , Femenino , Estado de Salud , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Salud Laboral , Pandemias , Estudios Retrospectivos , Factores Socioeconómicos
14.
Lancet Public Health ; 6(3): e155-e163, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33571459

RESUMEN

BACKGROUND: Many patients prefer to avoid hospital-based care towards the end of life, yet hospitalisation is common and more likely for people with low socioeconomic position. The reasons underlying this socioeconomic inequality are not well understood. This study investigated health, service access, and social support as potential mediating pathways between socioeconomic position and receipt of hospital-based care towards the end of life. METHODS: For this observational cohort study, we included deceased participants from the nationally representative English Longitudinal Study of Ageing of people aged 50 years or older in England. We used a multiple mediation model with age-adjusted and gender-adjusted probit regression to estimate the direct effect of socioeconomic position (measured by wealth and education) on death in hospital and three or more hospital admissions in the last 2 years of life, and the indirect effects of socioeconomic position via three mediators: health and function, access to health-care services, and social support. FINDINGS: 737 participants were included (314 [42·6%] female, 423 [57·4%] male), with a median age at death of 78 years (IQR 71-85). For death in hospital, higher wealth had a direct negative effect (probit coefficient -0·16, 95% CI -0·25 to -0·06), which was not mediated by any of the pathways tested. For frequent hospital admissions, health and function mediated the effect of wealth (-0·04, -0·08 to -0·01), accounting for 34·6% of the total negative effect of higher wealth (-0·13, -0·23 to -0·02). Higher wealth was associated with better health and function (0·25, 0·18 to 0·33). Education was associated with the outcomes only indirectly via wealth. INTERPRETATION: Our findings suggest that worse health and function could partly explain why people with lower wealth have more hospital admissions, highlighting the importance of socioeconomically driven health differences in explaining patterns of hospital use towards the end of life. The findings should raise awareness about the related risk factors of low wealth and worse health for patients approaching the end of life, and strengthen calls for resource allocation to be made on the basis of health need and socioeconomic profile. FUNDING: Dunhill Medical Trust Fellowship Grant (RTF74/0116).


Asunto(s)
Utilización de Instalaciones y Servicios/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Clase Social , Anciano , Anciano de 80 o más Años , Inglaterra , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores Socioeconómicos
15.
Artículo en Inglés | MEDLINE | ID: mdl-33572977

RESUMEN

We assessed the perceived benefits and harms of COVID-19 on family and their associations with sociodemographic factors in Chinese adults in Hong Kong. We conducted an online population-based survey and collected 4891 responses in 6 days. Prevalence estimates were weighted by sex, age, and education of the general population, and associations were analyzed using logistic regression. Our results showed both perceived benefits: 19.0% for family physical health, 7.2% family mental health, and 13.5% family relationships; and harms: 2.3% for family physical health, 37.9% family mental health, 18.6% family relationships, and 37.8% decreased family income. More female or older respondents reported perceived benefits but fewer of them reported perceived harms. More respondents with higher than lower socioeconomic scores (SES) reported perceived benefits on family physical and mental health and family relationships, but more respondents with lower than higher SES reported perceived harm on family income. As the pandemic continues with uncertainties, further studies on the dynamics of benefits and harms are needed. Urgent and additional assistance to underprivileged families and at-risk individuals are needed to reduce the inequities amidst the COVID-19 pandemic.


Asunto(s)
Salud de la Familia , Salud Mental , Pandemias , Factores Socioeconómicos , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Estado de Salud , Hong Kong/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven
16.
JAMA Netw Open ; 4(2): e2036809, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33544146

RESUMEN

Importance: Studying long-term changes in neighborhood socioeconomic status (SES) may help to better understand the associations between neighborhood exposure and weight outcomes and provide evidence supporting neighborhood interventions. Little previous research has been done to examine associations between neighborhood SES and weight loss, a risk factor associated with poor health outcomes in the older population. Objective: To determine whether improvements in neighborhood SES are associated with reduced likelihoods of excessive weight gain and excessive weight loss and whether declines are associated with increased likelihoods of these weight outcomes. Design, Study, and Participants: This cohort study was conducted using data from the National Institutes of Health-AARP (formerly known as the American Association of Retired Persons) Diet and Health study (1995-2006). The analysis included a cohort of 126 179 adults (aged 50-71 years) whose neighborhoods at baseline (1995-1996) were the same as at follow-up (2004-2006). All analyses were performed from December 2018 through December 2020. Exposures: Living in a neighborhood that experienced 1 of 8 neighborhood SES trajectories defined based on a national neighborhood SES index created using data from the US Census and American Community Survey. The 8 trajectory groups, in which high, or H, indicated rankings at or above the sample median of a specific year and low, or L, indicated rankings below the median, were HHH (ie, high in 1990 to high in 2000 to high in 2010), or stable high; HLL, or early decline; HHL, or late decline; HLH, or transient decline; LLL, or stable low; LHH, or early improvement; LLH, or late improvement; and LHL, or transient improvement. Main Outcomes and Measures: Excessive weight gain and loss were defined as gaining or losing 10% or more of baseline weight. Results: Among 126 179 adults, 76 225 (60.4%) were men and the mean (SD) age was 62.1 (5.3) years. Improvements in neighborhood SES were associated with lower likelihoods of excessive weight gain and weight loss over follow-up, while declines in neighborhood SES were associated with higher likelihoods of excessive weight gain and weight loss. Compared with the stable low group, the risk was significantly reduced for excessive weight gain in the early improvement group (odds ratio [OR], 0.87; 95% CI, 0.79-0.95) and for excessive weight loss in the late improvement group (OR, 0.89; 95% CI, 0.80-1.00). Compared with the stable high group, the risk of excessive weight gain was significantly increased for the early decline group (OR, 1.19; 95% CI, 1.08-1.31) and late decline group (OR, 1.13; 95% CI, 1.04-1.24) and for excessive weight loss in the early decline group (OR, 1.15; 95% CI, 1.02-1.28). The increases in likelihood were greater when the improvement or decline in neighborhood SES occurred early in the study period (ie, 1990-2000) and was substantiated throughout the follow-up (ie, the early decline and early improvement groups). Overall, we found a linear association between changes in neighborhood SES and weight outcomes, in which every 5 percentile decline in neighborhood SES was associated with a 1.2% to 2.4% increase in the risk of excessive weight gain or loss (excessive weight gain: OR, 1.01; 95% CI, 1.00-1.02 for women; OR, 1.02; 95% CI, 1.01-1.03 for men; excessive weight loss: OR, 1.02; 95% CI, 1.01-1.03 for women; OR, 1.02; 95% CI, 1.01-1.03 for men; P for- trend < .0001). Conclusions and Relevance: These findings suggest that changing neighborhood environment was associated with changes in weight status in older adults.


Asunto(s)
Trayectoria del Peso Corporal , Características de la Residencia/estadística & datos numéricos , Clase Social , Anciano , Escolaridad , Grupos Étnicos , Femenino , Vivienda/tendencias , Humanos , Renta/tendencias , Masculino , Persona de Mediana Edad , Asistencia Pública/tendencias , Familia de Padres Solteros , Factores Socioeconómicos , Desempleo/tendencias , Estados Unidos , Aumento de Peso , Pérdida de Peso
17.
Hist Philos Life Sci ; 43(1): 19, 2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-33566205

RESUMEN

As cases of COVID-19 continue to rise, some countries, including the US, Chile, and Germany, have considered issuing "immunity passports." This possibility has raised concerns and debate regarding their potential social, political and economic ramifications, especially for marginalized communities. This paper contributes to that debate by exposing that ways in which immunoprivilege already exists and operates within our present system of structural inequalities.


Asunto(s)
/virología , Disparidades en Atención de Salud/estadística & datos numéricos , Inmunidad , Clase Social , Factores Socioeconómicos , Chile , Alemania , Humanos , Estados Unidos
18.
Am J Epidemiol ; 190(2): 295-304, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33524122

RESUMEN

Socioeconomic status has been associated with cardiovascular disease risk factors. However, few studies have examined this relationship among populations in the US Gulf Coast region. We assessed neighborhood deprivation in relation to obesity and diabetes in 9,626 residents participating in the Gulf Long-Term Follow-Up Study (2011-present) who completed a home visit (2011-2013) with height, weight, waist, and hip measurements. Obesity was categorized as body mass index of at least 30, and diabetes was defined by doctor's diagnosis or prescription medication. Participant home addresses were linked to an established Area Deprivation Index and categorized into 4 levels (1 = least deprived). In adjusted, modified Poisson regression models, participants with greatest deprivation were more likely to have obesity compared with those with least deprivation (adjusted prevalence ratio (aPR) = 1.21, 95% confidence interval (CI): 1.08, 1.35), central obesity (aPR = 1.11, 95% CI: 1.04, 1.19), and diabetes (aPR = 1.49, 95% CI: 1.03, 2.14). Repeated analyses among a subgroup of participants (n = 3,016) whose hemoglobin A1C values were measured 3 years later indicated the association with diabetes (defined as diagnosis, medications, or hemoglobin A1C ≥ 6.5) was similar (aPR = 1.46, 95% CI: 1.14, 1.86). Results suggest neighborhood deprivation is associated with obesity and diabetes in a US region with high baseline prevalence.


Asunto(s)
Diabetes Mellitus/epidemiología , Obesidad/epidemiología , Características de la Residencia/estadística & datos numéricos , Adulto , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Índice de Masa Corporal , Fumar Cigarrillos/epidemiología , Femenino , Hemoglobina A Glucada , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Clase Social , Factores Socioeconómicos , Sudeste de Estados Unidos/epidemiología , Texas/epidemiología
19.
Medicine (Baltimore) ; 100(5): e24419, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592890

RESUMEN

ABSTRACT: Childhood malnutrition is a serious public health problem in Yemen. However, there is a limited information regarding association of malnutrition with different socio-economic factors. This study examines the correlates of socioeconomic and maternal behavioral factors on malnutrition in Yemeni children under 5 years of age.Our study focuses on the nutritional status of children under 5 years of age, and uses the data provided by the cross-sectional study namely Yemen National Demographic and Health Survey. Three anthropometric indicators: stunting, wasting, and underweight were selected for the evaluation of malnutrition. Independent variables include personal and maternal characteristics, socioeconomic and behavioral factors, and illness conditions. The study used the Chi-Squared test to test the significant association between independent variables and logistic regression to estimate the odds of being malnourished.A total of 13,624 Yemeni children under 5 years of age were included in the study. The results show the high malnutrition level - the prevalence of stunting was 47%, wasting was 16%, and underweight was 39%. There is a statistically significant association between socioeconomic status, behavioral factors, and child malnutrition. The odds of malnutrition decreased with the increase in the level of mother's education, economic status, and frequency of prenatal visits. The odds of malnutrition were least for children whose mothers had highest level of education (OR = 0.64; 95%CI = 0.55-0.76), who belonged to highest wealth index (OR = 0.41; 95%CI = 0.36-0.47). Moreover, the likelihood of malnutrition was less among the children whose mother had highest number of prenatal visits during the pregnancy (OR = 0.67; 95%CI = 0.59-0.76).The high prevalence of stunting, wasting, and undernutrition were found in Yemeni children. Different factors such as regional variations, socio-economic disparities, and maternal education and health care utilization behavior are found to be associated with high malnutrition. These findings provide important policy implications to improving childhood malnutrition in Yemen.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Trastornos del Crecimiento/epidemiología , Delgadez/epidemiología , Síndrome Debilitante/epidemiología , Antropometría , Preescolar , Estudios Transversales , Demografía , Femenino , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Estado Nutricional , Prevalencia , Factores de Riesgo , Clase Social , Factores Socioeconómicos , Yemen/epidemiología
20.
Epidemiol Psychiatr Sci ; 30: e6, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33416045

RESUMEN

AIMS: There is compelling evidence for gradient effects of household income on school readiness. Potential mechanisms are described, yet the growth curve trajectory of maternal mental health in a child's early life has not been thoroughly investigated. We aimed to examine the relationships between household incomes, maternal mental health trajectories from antenatal to the postnatal period, and school readiness. METHODS: Prospective data from 505 mother-child dyads in a birth cohort in Singapore were used, including household income, repeated measures of maternal mental health from pregnancy to 2-years postpartum, and a range of child behavioural, socio-emotional and cognitive outcomes from 2 to 6 years of age. Antenatal mental health and its trajectory were tested as mediators in the latent growth curve models. RESULTS: Household income was a robust predictor of antenatal maternal mental health and all child outcomes. Between children from the bottom and top household income quartiles, four dimensions of school readiness skills differed by a range of 0.52 (95% Cl: 0.23, 0.67) to 1.21 s.d. (95% CI: 1.02, 1.40). Thirty-eight percent of pregnant mothers in this cohort were found to have perinatal depressive and anxiety symptoms in the subclinical and clinical ranges. Poorer school readiness skills were found in children of these mothers when compared to those of mothers with little or no symptoms. After adjustment of unmeasured confounding on the indirect effect, antenatal maternal mental health provided a robust mediating path between household income and multiple school readiness outcomes (χ2 126.05, df 63, p < 0.001; RMSEA = 0.031, CFI = 0.980, SRMR = 0.034). CONCLUSIONS: Pregnant mothers with mental health symptoms, particularly those from economically-challenged households, are potential targets for intervention to level the playing field of their children.


Asunto(s)
Desarrollo Infantil , Renta , Salud Materna/estadística & datos numéricos , Salud Mental/estadística & datos numéricos , Madres/psicología , Conducta Social , Adulto , Niño , Preescolar , Estudios de Cohortes , Emociones , Femenino , Humanos , Trastornos Mentales/psicología , Madres/estadística & datos numéricos , Embarazo , Estudios Prospectivos , Singapur , Clase Social , Factores Socioeconómicos
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