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Kaneri P, Lima do Vale M, Harding S, Molokhia M. A scoping review of the evidence available for the use of salons as health promotion environments, for the prevention and management of non-communicable diseases in women from different ethnic backgrounds. Front Public Health 2023; 11:1161645. [PMID: 37529433 PMCID: PMC10390218 DOI: 10.3389/fpubh.2023.1161645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/19/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Women from different ethnic backgrounds are disproportionately affected by non-communicable diseases (NCDs). Underpinned by the community capital they harness, hairdressers have successfully delivered NCD prevention programmes, particularly for African-American women in disadvantaged areas. Integrating community organisations and networks into existing primary care pathways can provide a sustainable process to address inequalities in access to health care. This scoping review aimed to map the evidence about interventions based in beauty salons, particularly formative research phases, including co-development, community participation, theoretical or conceptual underpinnings, as well as aspects related to training and incentivisation of salon staff, evaluation and equity. Methods The methodological framework was based on the seminal guidance of Arksey and O'Malley, using the 'PCC' (participants, concept, context) structure with incorporation of other relevant materials. Studies eligible for inclusion were salon-based health interventions (concept) focused on NCDs prevention (context), targeting women (participants) from different ethnic backgrounds and published in English. The searches were conducted across PubMed, Web of Science and OVID in June 2020 and updated in January 2023, with reference lists also screened. The Reach, Effectiveness, Adoption, Implementation, and Maintenance RE-AIM framework was used to explore the potential public health impact. Results 419 titles and abstracts were screened, with eight (2%) meeting the inclusion criteria, all based in the United States of America. Two used formative phases to inform intervention development, three described evidence of co-development with key stakeholders or experts within the community and five studies referred to theoretical or conceptual frameworks. Incentivisation was provided to salon staff in five of the studies, and to clients in three of the studies. Four of the investigations collated data on socioeconomic characteristics of the target population. Discussion Formative research in the scoped studies was weakly reported upon. Community participation was implicit in each of the scoped studies, yet its application varied considerably. Theoretical and conceptual frameworks were not consistently used, and there was inadequate process evaluation to ensure equitable reach and retention of targeted groups, suggesting a more concerted effort to address health equity is needed for future interventions.
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Tinner L, Holman D, Ejegi-Memeh S, Laverty AA. Use of Intersectionality Theory in Interventional Health Research in High-Income Countries: A Scoping Review. Int J Environ Res Public Health 2023; 20:6370. [PMID: 37510601 PMCID: PMC10379482 DOI: 10.3390/ijerph20146370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/12/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Intersectionality theory posits that considering a single axis of inequality is limited and that considering (dis)advantage on multiple axes simultaneously is needed. The extent to which intersectionality has been used within interventional health research has not been systematically examined. This scoping review aimed to map out the use of intersectionality. It explores the use of intersectionality when designing and implementing public health interventions, or when analysing the impact of these interventions. METHODS We undertook systematic searches of Medline and Scopus from inception through June 2021, with key search terms including "intersectionality", "interventions" and "public health". References were screened and those using intersectionality and primary data from high-income countries were included and relevant data synthesised. RESULTS After screening 2108 studies, we included 12 studies. Six studies were qualitative and focused on alcohol and substance abuse (two studies), mental health (two studies), general health promotion (one study) and housing interventions (one study). The three quantitative studies examined mental health (two studies) and smoking cessation (one study), while the three mixed-method studies examined mental health (two studies) and sexual exploitation (one study). Intersectionality was used primarily to analyse intervention effects (eight studies), but also for intervention design (three studies), and one study used it for both design and analysis. Ethnicity and gender were the most commonly included axes of inequality (11 studies), followed by socio-economic position (10 studies). Four studies included consideration of LGBTQ+ and only one considered physical disability. Intersectional frameworks were used by studies to formulate specific questions and assess differences in outcomes by intersectional markers of identity. Analytical studies also recommended intersectionality approaches to improve future treatments and to structure interventions to focus on power and structural dynamics. CONCLUSIONS Intersectionality theory is not yet commonly used in interventional health research, in either design or analysis. Conditions such as mental health have more studies using intersectionality, while studies considering LGBTQ+ and physical disability as axes of inequality are particularly sparse. The lack of studies in our review suggests that theoretical and methodological advancements need to be made in order to increase engagement with intersectionality in interventional health.
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Affiliation(s)
- Laura Tinner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
| | - Daniel Holman
- Department of Sociological Studies, The University of Sheffield, The Wave, 2 Whitham Road, Sheffield S10 2AH, UK
| | - Stephanie Ejegi-Memeh
- Department of Sociological Studies, The University of Sheffield, The Wave, 2 Whitham Road, Sheffield S10 2AH, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation, School of Public Health, Imperial College London, London SW7 2BX, UK
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Banaschak H, Bartolini F, Salman R, Bethge M. Increasing the use of medical rehabilitation by children and adolescents with migrant background through a multimodal information campaign: protocol of a trend study and accompanying process evaluation (MiMi-Reha-Kids, DRKS00019090). Front Public Health 2023; 11:1089685. [PMID: 37522008 PMCID: PMC10379645 DOI: 10.3389/fpubh.2023.1089685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Background Chronic illnesses can have an unfavorable impact on the participation opportunities of children and adolescents. The German health care system offers medical rehabilitation in order to prevent negative effects, however, migrant children and adolescents make use of this option less frequently than their peers without a migrant background. A multimodal information campaign was developed to increase the use of medical rehabilitation by children and adolescents with a migrant background, and to reduce disparities in health care. Methods The process evaluation will examine the implementation of a multimodal information campaign intended to increase the use of medical rehabilitation by migrant children and adolescents. The information campaign follows a low-threshold participatory approach. In a first step, persons from different migrant communities in Berlin and Hamburg are trained to become transcultural health mediators. These mediators then share their knowledge about chronic illnesses and medical rehabilitation with other families at information events held in their native language. The transcultural mediators also support migrant families in applying for medical rehabilitation. The effectiveness of the intervention will be tested by a trend study with repeated cross-sectional surveys. For this purpose, all families in the project regions of Berlin and Hamburg whose child has received medical rehabilitation are surveyed annually in order to be able to map changes in the proportions of children and adolescents with a migrant background over the course of the project. Discussion The study protocol describes a complex intervention to increase the use of medical rehabilitation by migrant children and adolescents, and the accompanying process evaluation and trend study. The intervention is intended to contribute to reducing health inequalities in Germany. Conclusion The study described in this protocol will provide extensive data on the multimodal information campaign and can thus help organizations and institutions adapt or further develop similar measures for other regions. Clinical trial registration German Clinical Trials Register (DRKS00019090).
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Affiliation(s)
- Hannes Banaschak
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | | | | | - Matthias Bethge
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
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Moirano G, Pizzi C, Rusconi F, Maule M, Richiardi L, Popovic M. Family socioeconomic position and changes in planned health care for children with chronic diseases during the COVID-19 pandemic in Italy. Front Public Health 2023; 11:1174118. [PMID: 37521970 PMCID: PMC10372358 DOI: 10.3389/fpubh.2023.1174118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction In this study, we aimed at evaluating whether, during the COVID-19 pandemic, children affected by chronic diseases were impacted by the deferral of planned healthcare caused by the restriction measures. Design This study was conducted using data from the Italian NINFEA birth cohort, which include children born between 2005 and 2016. Women who completed the 4-year NINFEA follow-up questionnaire before November 2020 (N = 5,307) were invited to complete a questionnaire targeted at evaluating the impacts of the pandemic on their children's health. The questionnaire asked mothers to report whether their children had a chronic disease or condition that required one or more regular health checks by a doctor in 2019 (used as a reference period) and whether the children had problems getting routine health checks after March 2020. Results We obtained information on 3,721 children. Out of 353 children with a chronic disease that required at least one medical visit in 2019, 130 (36.8%) experienced problems during the pandemic. Lower family income was associated with a higher risk of experiencing health access problems. We observed that children living in families at lower income tertiles had more chance of experiencing healthcare access problems than children living in families at the highest income tertiles (prevalence rate ratio for a tertile decrease in family income: 1.22; 95% CIs: 1.02-1.49). Conclusion Our study underlines that the COVID-19 pandemic may have caused healthcare access problems for children with prevalent chronic diseases, especially among those living in households with a low socioeconomic position.
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Affiliation(s)
- Giovenale Moirano
- Cancer Epidemiology Unit and CPO-Piemonte, Department of Medical Sciences, University of Torino, Torino, Italy
- Department of Public Health and Paediatrics, Post Graduate School of Medical Statistics, University of Torino, Torino, Italy
| | - Costanza Pizzi
- Cancer Epidemiology Unit and CPO-Piemonte, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Franca Rusconi
- Department of Mother and Child Health, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Milena Maule
- Cancer Epidemiology Unit and CPO-Piemonte, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit and CPO-Piemonte, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Maja Popovic
- Cancer Epidemiology Unit and CPO-Piemonte, Department of Medical Sciences, University of Torino, Torino, Italy
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Karácsony I, Bertókné Tamás R, Árváné Egri C, Fürtös VD, Szőllősi GJ, Surján O. [Summary of the Hungarian Mobile Health Screening Program data for 2021]. Orv Hetil 2023; 164:1070-1076. [PMID: 37422886 DOI: 10.1556/650.2023.32763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/13/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION In Hungary, significant regional and social inequalities in health status exist. In addition, this is exacerbated by health care inequalities between West and East Hungary. OBJECTIVE The aim of our study was to summarize the results of the 2021 Hungarian Mobile Health Screening Program, in order to determine the rates of detected cases and to assess the health status differences between different regions. METHOD A cross-sectional retrospective study was executed to analyze the screening results (n = 5185) of the Hungarian Mobile Health Screening Program. RESULTS 9% of screening attendees had higher than normal blood glucose level, 25% had abnormal cholesterol levels and 20% had elevated blood pressure. Of those screened, 35% had a not-negative result at the neurological examination, 44% at the dermatological examination, 42% at the cardiological examination, 20% at the spirometry function test, and 4% at the ankle-brachial index measurement. Newly detected gynaecological problems affected 1 in 5 women (21%) and 3 women were diagnosed with malignant tumors. Of those attending oral screening (n = 1836), 90% were directed to different levels of the health care system. CONCLUSION The results of the Hungarian Mobile Health Screening Program have also demonstrated the health inequalities in our country. The data confirmed the need for the continuation of the Program under the current structure. The aim for the future screening period is to increase the attendance of several examinations and preventive/health promotion advices. Orv Hetil. 2023; 164(27): 1070-1076.
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Affiliation(s)
- Ilona Karácsony
- 1 Nemzeti Népegészségügyi Központ, Szűrésirányítási Főosztály Budapest Magyarország
- 3 Pécsi Tudományegyetem, Egészségtudományi Kar, Szombathelyi Képzési Központ Szombathely, Jókai u. 14., 9700 Magyarország
| | | | - Csilla Árváné Egri
- 1 Nemzeti Népegészségügyi Központ, Szűrésirányítási Főosztály Budapest Magyarország
| | | | - Gergő József Szőllősi
- 1 Nemzeti Népegészségügyi Központ, Szűrésirányítási Főosztály Budapest Magyarország
- 4 Debreceni Egyetem, Egészségtudományi Kar Debrecen Magyarország
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Huijts T, Gage Witvliet M, Balaj M, Andreas Eikemo T. Assessing the long-term health impact of COVID-19: The importance of using self-reported health measures. Scand J Public Health 2023; 51:645-647. [PMID: 37382292 DOI: 10.1177/14034948221143421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
It is estimated that at least one out of 10 people who contracted COVID-19 continue to experience health problems long after the clearance of the acute infection. These belong to the growing group of people who have post-acute sequelae of SARS CoV-2 infection or long COVID, a multifaceted condition involving multiple organ systems. Given the lack of clear definition and diagnosis, this marked increase in the number of people who have long COVID might not be fully reflected in data on population health in the years to come. In this editorial, we argue that the use of self-reported health measures is vital for fully assessing the long-term impact of the COVID-19 pandemic on health and health inequalities. After briefly introducing self-reported health measures, we discuss strengths and limitations of specific measures that capture direct self-reports of long COVID. We then outline how the impact of long COVID may also be reflected in response patterns to more general self-reported health measures and give suggestions on how these can be used to examine the long-term health impact of the COVID-19 pandemic.
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Affiliation(s)
- Tim Huijts
- Research Centre for Education and the Labour Market (ROA), Maastricht University, The Netherlands
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology, Norway
| | | | - Mirza Balaj
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology, Norway
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology, Norway
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107
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Zhang A, Gagné T, Walsh D, Ciancio A, Proto E, McCartney G. Trends in psychological distress in Great Britain, 1991-2019: evidence from three representative surveys. J Epidemiol Community Health 2023; 77:468-473. [PMID: 37188500 PMCID: PMC10313989 DOI: 10.1136/jech-2022-219660] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/14/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Previously improving UK mortality trends stalled around 2012, with evidence implicating economic policy as the cause. This paper examines whether trends in psychological distress across three population surveys show similar trends. METHODS We report the percentages reporting psychological distress (4+ in the 12-item General Health Questionnaire) from Understanding Society (Great Britain, 1991-2019), Scottish Health Survey (SHeS, 1995-2019) and Health Survey for England (HSE, 2003-2018) for the population overall, and stratified by sex, age and area deprivation. Summary inequality indices were calculated and segmented regressions fitted to identify breakpoints after 2010. RESULTS Psychological distress was higher in Understanding Society than in SHeS or HSE. There was slight improvement between 1992 and 2015 in Understanding Society (with prevalence declining from 20.6% to 18.6%) with some fluctuations. After 2015 there is some evidence of a worsening in psychological distress across surveys. Prevalence worsened notably among those aged 16-34 years after 2010 (all three surveys), and aged 35-64 years in Understanding Society and SHeS after 2015. In contrast, the prevalence declined in those aged 65+ years in Understanding Society after around 2008, with less clear trends in the other surveys. The prevalence was around twice as high in the most deprived compared with the least deprived areas, and higher in women, with trends by deprivation and sex similar to the populations overall. CONCLUSION Psychological distress worsened among working-age adults after around 2015 across British population surveys, mirroring the mortality trends. This indicates a widespread mental health crisis that predates the COVID-19 pandemic.
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Affiliation(s)
- Anwen Zhang
- Adam Smith Business School, University of Glasgow, Glasgow, UK
| | - Thierry Gagné
- International Centre for Lifecourse Studies in Society and Health, London, UK
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - David Walsh
- Glasgow Centre for Population Health, Glasgow, UK
| | - Alberto Ciancio
- Adam Smith Business School, University of Glasgow, Glasgow, UK
| | - Eugenio Proto
- Adam Smith Business School, University of Glasgow, Glasgow, UK
| | - Gerry McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
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Harper LJ, Kidambi P, Kirincich JM, Thornton JD, Khatri SB, Culver DA. Health Disparities: Interventions for Pulmonary Disease - A Narrative Review. Chest 2023; 164:179-189. [PMID: 36858172 PMCID: PMC10329267 DOI: 10.1016/j.chest.2023.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023] Open
Abstract
There is expansive literature documenting the presence of health disparities, but there are disproportionately few studies describing interventions to reduce disparity. In this narrative review, we categorize interventions to reduce health disparity in pulmonary disease within the US health care system to support future initiatives to reduce disparity. We identified 211 articles describing interventions to reduce disparity in pulmonary disease related to race, income, or sex. We grouped the studies into the following four categories: biologic, educational, behavioral, and structural. We identified the following five main themes: (1) there were few interventional trials compared with the breadth of studies describing health disparities, and trials involving patients with asthma who were Black, low income, and living in an urban setting were overrepresented; (2) race or socioeconomic status was not an effective marker of individual pharmacologic treatment response; (3) telehealth enabled scaling of care, but more work is needed to understand how to leverage telehealth to improve outcomes in marginalized communities; (4) future interventions must explicitly target societal drivers of disparity, rather than focusing on individual behavior alone; and (5) individual interventions will only be maximally effective when specifically tailored to local needs. Much work has been done to catalog health disparities in pulmonary disease. Notable gaps in the identified literature include few interventional trials, the need for research in diseases outside of asthma, the need for high quality effectiveness trials, and an understanding of how to implement proven interventions balancing fidelity to the original protocol and the need to adapt to local barriers to care.
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Affiliation(s)
- Logan J Harper
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
| | - Pranav Kidambi
- Michigan State University College of Human Medicine, Grand Rapids, MI; Division of Pulmonary and Critical Care Medicine, Corewell Health Medical Group, Grand Rapids, MI
| | - Jason M Kirincich
- Department of Internal Medicine, Community Care Institute, Cleveland Clinic, Cleveland, OH
| | - J Daryl Thornton
- Center for Reducing Health Disparities, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH
| | - Sumita B Khatri
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
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Yfantopoulos J, Chantzaras A, Yfantopoulos P. The health gap and HRQoL inequalities in Greece before and during the economic crisis. Front Public Health 2023; 11:1138982. [PMID: 37342272 PMCID: PMC10277562 DOI: 10.3389/fpubh.2023.1138982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/29/2023] [Indexed: 06/22/2023] Open
Abstract
Objective The aim of this study was twofold: (i) to assess the health gap among young socio-economic groups generated by the economic crisis in Greece and (ii) to investigate HRQoL (Health Related Quality of Life) inequalities using the Theil index. Methods The EQ-5D-5L instrument was administered to a sample of 4,177 young individuals in Greece, mean age 22.3 (±SD 4.8) and 53.8% males, and 46.2% females. The Greek version of the EQ-5D-5L instrument was used in a web-based questionnaire to collect data. Subjects were asked to assess their subjective health status during the economic crisis of 2016 using the EQ-5D-5L instrument, and to recall their health before the crisis of 2009. The health gap was assessed on a Visual Analogue Scale (EQ-VAS), the EQ-5D-5L Index, and the five dimensions of the EQ-5D-5L instrument. Regression analysis was employed to measure the effects of the economic crisis on age, sex, education, and income on the EQ-VAS and EQ-5D-5L. Theil index was used to assess HRQoL inequalities. Results The economic crisis brought a significant deterioration in the HRQoL of young Greeks. The EQ-VAS was reduced during the crisis by -10.05% (p < 0.001) and the EQ-5D-5L index declined by -19.61% (p < 0.001). The prevalence of the health gap in each dimension of the EQ-5D-5L was also significant in terms of deterioration of Mobility [change by 66.8% (p < 0.001)], Self-care [change by 61.0% (p < 0.001)], Usual activities [change by 97.1% (p < 0.001)], Pain/discomfort [change by 65.0% (p < 0.001)], and Anxiety/depression [change by 70.5% (p < 0.001)]. Significant reductions in EQ-5D-5L indices were also associated with greater inequalities in the distribution of health among age, gender, income, and educational groups. The EQ-5D-5L health gap among the poor was much greater (0.198), in comparison to richer (0.128) classes. Similar gaps were also found in terms of educational inequalities. The EQ-5D-5L health gap among those with primary education was 0.211, whereas for those with tertiary education it was 0.16. The Theil index indicated an increase in income-related HRQoL inequalities by 222.3% for the EQ-5D-5L index and by 124.2% for the EQ-VAS. The effects of demographic and socioeconomic variables on the EQ-VAS were found statistically significant: sex (p < 0.05), age (p < 0.001), education (p < 0.001), and income (p < 0.001). Conclusion The EQ-5D-5L instrument appears to be a powerful tool in assessing the health gap and the HRQoL inequalities among young people in Greece. The findings indicate the importance of developing effective health policies to combat inequalities and mitigate the impact of austerity measures on the quality of life of the young.
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Affiliation(s)
- John Yfantopoulos
- IPOKE Research Institute, MBA National and Kapodistrian University of Athens, Athens, Greece
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110
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Wood RM. With much of England's NHS under severe pressure, should health inequalities be a priority? Int J Qual Health Care 2023:7190134. [PMID: 37279533 DOI: 10.1093/intqhc/mzad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 05/17/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Richard M Wood
- National Health Service, Bristol, United Kingdom
- School of Management, University of Bath, Bath, United Kingdom
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111
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Yfantopoulos J. Editorial: Health related quality of life inequalities. Front Public Health 2023; 11:1214899. [PMID: 37304088 PMCID: PMC10251305 DOI: 10.3389/fpubh.2023.1214899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/12/2023] [Indexed: 06/13/2023] Open
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Cicha-Mikołajczyk A, Piwońska A, Borowiec A, Aranowska A, Drygas W. Disparities in knowledge of cardiovascular risk factors and prevention methods related to cardiovascular status and functional health literacy in Poland, 2020-2021. Kardiol Pol 2023; 81:700-707. [PMID: 37222248 DOI: 10.33963/kp.a2023.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 05/14/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Numerous studies have reported a significant role of health literacy (HL) in the prevention or treatment of various diseases. However, in Poland, there was no scientific research involving simultaneously the status of cardiovascular disease (CVD) and HL in assessment of health knowledge; therefore, it became the objective of our study. AIMS We aimed to evaluate the level of CVD knowledge depending on CVD status and functional HL in the Polish population. METHODS The study population consisted of 2827 participants from the WOBASZ II Survey aged 20-89 years: 2266 were CVD-free (non-CVD), 361 were hospitalized for CVD (CVDH[+]), and 200 were diagnosed with CVD but not hospitalized (CVDH[-]). The Newest Vital Sign test (NVS) was applied to determine functional HL. Self-reported knowledge of CVD risk factors (RFs) and prevention methods (PMs) in participants with different CVD status depending on HL was estimated. Multivariable ordinal and binary logistic regression analyses were performed to find predictors of RFs and PMs knowledge. RESULTS The knowledge of CVD RFs and/or PMs was strictly related to HL and CVD status. Inadequate HL decreased the satisfactory (≥5 RFs/PMs) knowledge of RFs (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.40-0.62) and PMs (OR, 0.56; 95% CI, 0.45-0.71). CVDH(-) participants were more likely to have satisfactory PMs knowledge (OR, 1.49; 95% CI, 1.02-2.16), while CVDH(+) participants satisfactory RFs knowledge (OR, 1.85; 95% CI, 1.35-2.53). CONCLUSIONS HL and CVD status are the key determinants of CDV RFs/PMs knowledge. Functional HL significantly affects health knowledge; therefore, HL screening should be recommended in primary care to increase the effectiveness of primary CVD prevention.
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Affiliation(s)
- Alicja Cicha-Mikołajczyk
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warszawa, Poland.
| | - Aleksandra Piwońska
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warszawa, Poland
| | - Agnieszka Borowiec
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warszawa, Poland
| | - Anita Aranowska
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warszawa, Poland
| | - Wojciech Drygas
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warszawa, Poland
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Sharp L, Dodlek N, Willis D, Leppänen A, Ullgren H. Cancer Prevention Literacy among Different Population Subgroups: Challenges and Enabling Factors for Adopting and Complying with Cancer Prevention Recommendations. Int J Environ Res Public Health 2023; 20:ijerph20105888. [PMID: 37239613 DOI: 10.3390/ijerph20105888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
It is estimated that 40% of the cancer cases in Europe could be prevented if people had better information and tools to make healthier choices and thereby reduce some of the most important cancer risk factors. The aim of this study is to gain knowledge and understanding about cancer prevention literacy among people with intellectual disabilities, immigrants, young people and young cancer survivors. In this qualitative study, we conducted six online focus-group interviews, including forty participants, to explore the cancer prevention literacy of four population subgroups and determine how cancer prevention recommendations according to the European Code Against Cancer (ECAC) were perceived. The analysis resulted in the following main categories: current health beliefs and their impacts on how the ECAC recommendations were perceived, communication strategies and sources benefiting or hindering cancer prevention information from reaching out, and how vulnerabilities in these subgroups impact cancer prevention literacy. To improve cancer prevention literacy in Europe, more attention is needed this topic to overcome barriers among different population subgroups. Recommendations include improved and adapted cancer prevention information, support to individuals, as well as societal support, such as easy-access screening and vaccination programmes and regulations related to tobacco, alcohol, and diet.
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Affiliation(s)
- Lena Sharp
- Regional Cancer Centre, Stockholm-Gotland, SE-10425 Stockholm, Sweden
- Department of Nursing, Umeå University, SE-90187 Umeå, Sweden
| | - Nikolina Dodlek
- Department for Oncology, University Hospital Center Osijek, 31000 Osijek, Croatia
- Department of Nursing, Cyprus University of Technology, Limassol 3036, Cyprus
- Nursing and Palliative Care, Faculty for Medicine and Dental Health, 31000 Osijek, Croatia
| | - Diane Willis
- School of Health & Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK
| | - Arja Leppänen
- Regional Cancer Centre, Stockholm-Gotland, SE-10425 Stockholm, Sweden
| | - Helena Ullgren
- Department of Nursing, Umeå University, SE-90187 Umeå, Sweden
- ME Head & Neck, Lung & Skin Cancer, Karolinska Comprehensive Cancer Center, SE-17176 Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska Institutet, SE-17177 Stockholm, Sweden
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Aguilar-Latorre A, Oliván-Blázquez B, Porroche-Escudero A, Serrano-Ripoll MJ, Magallón-Botaya R. Editorial: Mental health in primary health care. Front Psychol 2023; 14:1190410. [PMID: 37265950 PMCID: PMC10230021 DOI: 10.3389/fpsyg.2023.1190410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/02/2023] [Indexed: 06/03/2023] Open
Affiliation(s)
- Alejandra Aguilar-Latorre
- Aragonese Primary Care Research Group (GAIAP), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute, Madrid, Spain
| | - Bárbara Oliván-Blázquez
- Aragonese Primary Care Research Group (GAIAP), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute, Madrid, Spain
| | - Ana Porroche-Escudero
- Centre for Health Inequalities Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - María J. Serrano-Ripoll
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute, Madrid, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
| | - Rosa Magallón-Botaya
- Aragonese Primary Care Research Group (GAIAP), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute, Madrid, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
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Marshall D, Perez M, Wang X, Matone M, Montoya-Williams D. Exploring Prenatal Care Quality and Access During the COVID-19 Pandemic Among Pregnant Immigrants in Philadelphia Through the Lens of Community-Based Organizations. Womens Health Rep (New Rochelle) 2023; 4:241-250. [PMID: 37284484 PMCID: PMC10240328 DOI: 10.1089/whr.2022.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/08/2023]
Abstract
Background The peak of the COVID-19 pandemic led to decreased maternal and child health care engagement, especially among marginalized populations. Existing disparities in prenatal care access and quality faced by pregnant immigrant people are likely to be amplified by the pandemic. Materials and Methods We conducted a study with direct service providers (DSPs) at community-based organizations (CBOs) serving pregnant immigrant families in the Philadelphia region. Semistructured interviews addressed barriers and facilitators to prenatal health care access and engagement among immigrant families both before and then after the onset of the pandemic in March 2020. Additional questions elicited context about the demographics of service populations, organizational connectedness to health care providers, and pandemic-related operational changes. Results Between June and November 2021, 10 interviews were conducted in English and Spanish with DSPs at 5 CBOs. Primary themes included diminished access and quality of care received due to decreased language accessibility, increased restrictions around support persons, shifts to telemedicine, and changes to appointment scheduling. Additional themes included heightened hesitancy engaging with services due to documentation status, confusion around legal rights, financial strain, and health insurance status. Interviewees provided suggestions for improving service access during and postpandemic for immigrant pregnant people, including implementation of culturally responsive group prenatal care, institutional policies to improve understanding of legal rights, and increased financial supports. Conclusions Understanding emergent and exacerbated barriers to prenatal care access and quality during the COVID-19 pandemic provides context for how to improve health equity for immigrant pregnant people through public health and health care policies as the pandemic continues, and once it has subsided.
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Affiliation(s)
- Deanna Marshall
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mikaela Perez
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Xi Wang
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Meredith Matone
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diana Montoya-Williams
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Ali NIM, Marhazlinda J. Geo-Mapping of the Spatial Accessibility to Public Oral Health Facilities among Schoolchildren in Selangor, Malaysia. Healthcare (Basel) 2023; 11:healthcare11101405. [PMID: 37239694 DOI: 10.3390/healthcare11101405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Spatial accessibility to health services influences service utilisation and eventually impacts the disease burden. This cross-sectional study analysed the spatial accessibility of schoolchildren to public oral health facilities and school dental services (SDS) and vice versa in Selangor. Overlay and proximity analysis from geo-mapping software was employed to map the primary dental clinics with SDS, the public schools, and the proximity between primary dental clinics with SDS and public schools by travelling distance (5 km, 10 km, 20 km) and travelling time (15 min, 30 min). Over half of the schoolchildren in Selangor are within 5 km of accessibility to primary dental clinics and SDS teams. Meanwhile, nearly half of the primary and secondary schools, particularly in rural areas, are located within a more than 5 km service area of public oral health facilities. The SDS teams have a travel burden of more than 20 km to the public schools in Selangor's northern and north-western districts of large geographical areas. Simultaneously, most public primary and secondary schools are within 15 min of driving time from primary dental clinics. Geo-mapping highlights the inequalities in spatial accessibility to public oral health facilities with SDS among schoolchildren in Selangor. It is time to prioritise the resources, SDS, and preventive programmes to reduce inequalities in oral health accessibility among schoolchildren in Selangor.
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Affiliation(s)
- Nurul Izzati Mohamad Ali
- Department of Community Oral Health & Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Oral Health Program, Ministry of Health, Putrajaya 62590, Malaysia
| | - Jamaludin Marhazlinda
- Department of Community Oral Health & Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Community Oral Health Research Group, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
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Domaradzki J, Koźlenia D, Kochan-Jacheć K, Szkudlarek P, Fugiel J. Socioeconomic inequalities in health-related fitness gradient shifts between 2001 and 2022 in young Polish adults. Front Public Health 2023; 11:1163215. [PMID: 37228712 PMCID: PMC10203652 DOI: 10.3389/fpubh.2023.1163215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/06/2023] [Indexed: 05/27/2023] Open
Abstract
Background This study aimed to assess the importance of socioeconomic status (SES) on health-related fitness (H-RF) measurements in young adults and determine the impact of SES over 20 years of substantial social and economic changes in Poland. Material and methods The study compared H-RF differences between 2001 (P1) and 2022 (P2) in 252 volunteers aged 18 to 28 years who were grouped into quartiles based on SES and gender. The variables measured included height, weight, body mass index, body fat mass, hand strength (hand grip), abdomen strength (sit-ups), flexibility (sit and reach), and leg power (standing long jump), with a synthetic motor performance index (MPSI) calculated for each participant. Results Health-related differences based on social inequalities included body fat mass and MPSI, and two-way analysis of variance (ANOVA) revealed an interaction between SES and period on motor performance (F = 2.73, p = 0.045). In addition, post-hoc tests revealed differences in P1 between SES quartiles one and two (p = 0.028). Over the last 20 years, physical fitness decreased and body fat increased. The regression slope showed decreased motor performance with higher amounts of body fat in P2 subjects compared to their P1 peers. Conclusion The observed trends may be associated with lifestyle changes shaped by technology development, high-energy and low-quality food access, and increased physical inactivity.
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Cloke J, Hassan S, Goodall M, Ring A, Saini P, Tahir N, Gabbay M. Tapping into the power of coproduction and knowledge mobilisation: Exploration of a facilitated interactive group learning approach to support equity-sensitive decision-making in local health and care services. Health Expect 2023. [PMID: 37154125 DOI: 10.1111/hex.13774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND We report on a study of a facilitated interactive group learning approach, through Collaborative Implementation Groups (CIGs), established to enhance capacity for equity-sensitive evaluation of healthcare services to inform local decision-making: (1) What was the experience of participants of the CIGs? (2) How was knowledge mobilisation achieved? (3) What are the key elements that enhance the process of coproducing equity-sensitive evaluations? METHODS A thematic analysis of qualitative data obtained from focus group (FG) discussions and semistructured interviews exploring the experiences of participants. All FGs included representation of participants from different projects across the programme. Interviews were conducted with a member from each of the teams participating in the first cohort after their final workshop. RESULTS We identified four themes to illustrate how the approach to delivering intensive and facilitated training supported equity-sensitive evaluations of local healthcare services: (1) Creating the setting for coproduction and knowledge mobilisation; (2) establishing a common purpose, meaning and language for reducing health inequalities; (3) making connections and brokering relationships and (4) challenging and transforming the role of evaluation. CONCLUSION We report on the implementation of a practical example of engaged scholarship, where teams of healthcare staff were supported with resources, interactive training and methodological advice to evaluate their own services, enabling organisations to assemble timely practical and relevant evidence that could feed directly into local decision-making. By encouraging mixed teams of practitioners, commissioners, patients, the public and researchers to work together to coproduce their evaluations, the programme also aimed to systematise health equity into service change. The findings of our study illustrate that the approach to delivering training gave participants the tools and confidence to address their organisation's stated aims of reducing health inequalities, coproduce evaluations of their local services and mobilise knowledge from a range of stakeholders. PATIENT OR PUBLIC CONTRIBUTION The research question was developed collaboratively with researchers, partner organisations and public advisers (PAs). PAs were involved in meetings to agree on the focus of this research and to plan the analysis. N. T. is a PA and coauthor, contributing to the interpretation of findings and drafting of the paper.
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Affiliation(s)
- Jane Cloke
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Shaima Hassan
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Mark Goodall
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Adele Ring
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Pooja Saini
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Naheed Tahir
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- NIHR ARC NWC, Liverpool, UK
| | - Mark Gabbay
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Vestesson EM, De Corte KLA, Crellin E, Ledger J, Bakhai M, Clarke GM. Consultation Rate and Mode by Deprivation in English General Practice From 2018 to 2022: Population-Based Study. JMIR Public Health Surveill 2023; 9:e44944. [PMID: 37129943 DOI: 10.2196/44944] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/03/2023] [Accepted: 03/14/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a significant impact on primary care service delivery with an increased use of remote consultations. With general practice delivering record numbers of appointments and rising concerns around access, funding, and staffing in the UK National Health Service, we assessed contemporary trends in consultation rate and modes (ie, face-to-face versus remote). OBJECTIVE This paper describes trends in consultation rates in general practice in England for key demographics before and during the COVID-19 pandemic. We explore the use of remote and face-to-face consultations with regard to socioeconomic deprivation to understand the possible effect of changes in consultation modes on health inequalities. METHODS We did a retrospective analysis of 9,429,919 consultations by general practitioners, nurses, or other health care professionals between March 2018 and February 2022 for patients registered at 397 general practices in England. We used routine electronic health records from Clinical Practice Research Datalink Aurum with linkage to national data sets. Negative binomial models were used to predict consultation rates and modes (ie, remote versus face-to-face) by age, sex, and socioeconomic deprivation over time. RESULTS Overall consultation rates increased by 15% from 4.92 in 2018-2019 to 5.66 in 2021-2022 with some fluctuation during the start of the COVID-19 pandemic. The breakdown into face-to-face and remote consultations shows that the pandemic precipitated a rapid increase in remote consultations across all groups, but the extent varies by age. Consultation rates increased with increasing levels of deprivation. Socioeconomic differences in consultation rates, adjusted for sex and age, halved during the pandemic (from 0.36 to 0.18, indicating more consultations in the most deprived), effectively narrowing relative differences between deprivation quintiles. This trend remains when stratified by sex, but the difference across deprivation quintiles is smaller for men. The most deprived saw a relatively larger increase in remote and decrease in face-to-face consultation rates compared to the least deprived. CONCLUSIONS The substantial increases in consultation rates observed in this study imply an increased pressure on general practice. The narrowing of consultation rates between deprivation quintiles is cause for concern, given ample evidence that health needs are greater in more deprived areas.
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Affiliation(s)
- Emma Maria Vestesson
- The Health Foundation, London, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | | | | | - Jean Ledger
- National Health Service England, London, United Kingdom
| | - Minal Bakhai
- National Health Service England, London, United Kingdom
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120
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Lord E. Green space for public mental health: an ethnographic study of ecotherapy in Wales. Perspect Public Health 2023; 143:173-178. [PMID: 37132020 DOI: 10.1177/17579139231170777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
AIMS In recent years, there has been a growing interest in the ways that human health intersects with exposure to nature. This article reports the findings of a research study investigating the experiences of people in South and West Wales who were engaged in a specific type of nature and health intervention: ecotherapy. METHODS Ethnographic methods were used to develop a qualitative account of the experiences of participants in four specific ecotherapy projects. Data collected during fieldwork included notes from participant observations, interviews with both individuals and small groups, and documents produced by the projects. RESULTS Findings were reported using two themes: 'smooth and striated bureaucracy' and 'escape and getting away'. The first theme focused on how participants negotiated tasks and systems related to gatekeeping, registration, record keeping, rule compliance, and evaluation. It was argued that this was experienced differently along a spectrum between striated, in which it was disruptive to time and space, and smooth, in which it was much more discrete. The second theme reported on an axiomatic perception that natural spaces represented an escape or refuge; in terms of both reconnecting with something beneficial in nature, and also disconnecting from pathological aspects of everyday life. In bringing the two themes into dialogue, it could be seen that bureaucratic practices often undermined the therapeutic sense of escape; and that this was more acutely experienced by participants from marginalised social groups. CONCLUSIONS This article concludes by reasserting that the role of nature in human health is contested and arguing for a greater emphasis on inequities in access to good quality green and blue space. Specific interventions like ecotherapy need funding models that avoid striated bureaucratic processes, and the stress associated with these. Inclusive models of ecotherapy practice could contribute to public health goals related to population engagement with healthy environments.
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Affiliation(s)
- E Lord
- Swansea University, Glyndwr 214, Swansea SA2 8PP, UK
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121
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Egede LE, Walker RJ, Campbell JA, Linde S, Hawks LC, Burgess KM. Modern Day Consequences of Historic Redlining: Finding a Path Forward. J Gen Intern Med 2023; 38:1534-1537. [PMID: 36746831 PMCID: PMC9901820 DOI: 10.1007/s11606-023-08051-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Abstract
There is emerging evidence that structural racism is a major contributor to poor health outcomes for ethnic minorities. Structural racism captures upstream historic racist events (such as slavery, black code, and Jim Crow laws) and more recent state-sanctioned racist laws in the form of redlining. Redlining refers to the practice of systematically denying various services (e.g., credit access) to residents of specific neighborhoods, often based on race/ethnicity and primarily within urban communities. Historical redlining is linked to increased risk of diabetes, hypertension, and early mortality due to heart disease with evidence suggesting it impacts health through suppressing economic opportunity and human capital, or the knowledge, skills, and value one contributes to society. Addressing structural racism has been a rallying call for change in recent years-drawing attention to the racialized impact of historical policies in the USA. Unfortunately, the enormous scope of work has also left people feeling incapable of effecting the very change they seek. This paper highlights a path forward by briefly discussing the origins of historical redlining, highlighting the modern-day consequences both on health and at the societal level, and suggest promising initiatives to address the impact.
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Affiliation(s)
- Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sebastian Linde
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laura C Hawks
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kaylin M Burgess
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
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McCartan C, Davidson G, Bradley L, Greer K, Knifton L, Mulholland A, Webb P, White C. 'Lifts your spirits, lifts your mind': A co-produced mixed-methods exploration of the benefits of green and blue spaces for mental wellbeing. Health Expect 2023. [PMID: 37128668 DOI: 10.1111/hex.13773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/03/2023] Open
Abstract
INTRODUCTION Mental health problems are a considerable public health issue and spending time in nature has been promoted as a way to access a range of psychological benefits leading to the development of nature-based interventions for people with severe and enduring mental health problems. Less, however, is understood about the potential benefits and efficacy of day-to-day routine access to outdoor green and blue spaces for mental health service users. METHODS Using a mixed-methods design between April and October 2021, we explored the benefits and barriers to spending time outdoors with a purposive sample of mental health service users (N = 11) using qualitative interviews and an online general population survey (N = 1791). Qualitative evidence highlighted the restorative benefits of nature and identified a number of barriers associated with fears around personal safety, social anxiety, fatigue and lack of motivation. COVID-19 had also restricted access to green and blue spaces. Having social contact and support encouraged people to spend time outdoors. In the quantitative survey, self-report and standardised measures (the Patient Health Questionnaire and the Warwick-Edinburgh Wellbeing Scale) were used to assess past and current mental wellbeing. FINDINGS Statistically significant differences were found between wellbeing and the use of green and blue spaces. Those with mental health problems spent time outdoors because they: felt guilty; wanted to reduce their anxiety; or rely on someone for encouragement. Those without mental health problems endorsed more positively framed reasons including relaxation, improving physical health or getting exercise. Barriers for people with mental health problems involved safety concerns, feeling anxious and having a poor self-image. These findings give insight into motivations for an outdoor activity to help inform the design of public mental health interventions. CONCLUSION Further work is required to improve access and safety to promote the benefits of green and blue spaces for everyone. PATIENT OR PUBLIC CONTRIBUTION The research team included expert experienced researchers with a mental health service provider (Praxis Care) and they were involved in the development of the research idea, funding application, design, data collection, analysis, writing up and dissemination activities.
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Affiliation(s)
- Claire McCartan
- Regional Trauma Network, IMPACT Research Centre, Northern Health and Social Care Trust, Antrim, UK
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Gavin Davidson
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
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Picha KJ, Welch Bacon CE, Bay RC, Lewis JH, Snyder Valier AR. Athletic Trainers' Perceptions of and Experience with Social Determinants of Health. Int J Environ Res Public Health 2023; 20:ijerph20085602. [PMID: 37107884 PMCID: PMC10138865 DOI: 10.3390/ijerph20085602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
The role that social determinants of health (SDHs) play in athletic healthcare is gaining attention, yet little is known about athletic trainers' (ATs) perceptions of and encounters with the impact of SDHs. The purpose of this study was to evaluate ATs' perceptions of various SDHs and their experience treating patients whose health and well-being were influenced by SDHs. This was a cross-sectional, web-based survey completed by 1694 ATs (completion rate = 92.6%; 61.1% female; age = 36.6 ± 10.8 years). The survey consisted of several multipart questions focusing on specific SDHs. Descriptive statistics were used to report frequencies and percentages. Results indicated widespread agreement that SDHs matter to patient health and are of concern in athletic healthcare. The SDHs that ATs most commonly reported encountering included lifestyle choices (n = 1306/1406; 93.0%), social support (n = 1185/1427; 83.0%), income (n = 1167/1502; 77.7%), and access to quality and timely healthcare (n = 1093/1420, 77.0%). The SDHs that ATs least commonly reported having experience with was governmental policy (n = 684/1411; 48%). The perceived importance of SDHs among ATs and their commonly reported experiences managing patient cases in which SDHs negatively influence patients' health and healthcare suggest that efforts to assess these factors are needed so that strategies to address their influence on athletic healthcare can be identified.
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Affiliation(s)
- Kelsey J. Picha
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ 85206, USA
- Correspondence:
| | - Cailee E. Welch Bacon
- Department of Athletic Training, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ 85206, USA
- Department of Basic Science Education, School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA
| | - R. Curt Bay
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ 85206, USA
| | - Joy H. Lewis
- Department of Public Health, School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA
| | - Alison R. Snyder Valier
- Department of Athletic Training, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ 85206, USA
- Department of Basic Science Education, School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA
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Schrecker T. Downing the Master's Tools? New Research Strategies to Address Social Determinants of Health Inequalities. Int J Soc Determinants Health Health Serv 2023:27551938231161932. [PMID: 37032455 DOI: 10.1177/27551938231161932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
A dramatic increase in the volume of research literature referencing social determinants of health (SDH) since the report of the World Health Organization Commission on the topic in 2008 has not been matched by expansion of policies and interventions to reduce health inequalities by way of SDH. This article argues that familiar hierarchies of evidence that privilege clinical epidemiology as used in evidence-based medicine are inappropriate to address SDH. They misunderstand both the range of relevant evidence and the value-based nature of standards of proof. A richer conceptual armamentarium is available; it includes several applications of the concepts of epidemiological worlds and the lifecourse, which are explained in the article. A more appropriate evidentiary approach to SDH and health inequalities requires "downing the master's tools," to adapt Audre Lorde's phrase, and instead applying a multidisciplinary approach to assessing the evidence that adequately reflects the complexity of the relevant causal pathways. Doing so is made more difficult by the power structures that shape research priorities, yet it is essential.
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Affiliation(s)
- Ted Schrecker
- Emeritus Professor of Global Health Policy, Faculty of Medical Sciences, Newcastle University, Population Health Sciences Institute, Newcastle upon Tyne, UK
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Beth Capper, John Ford, Mike Kelly. Has the pandemic resulted in a renewed and improved focus on heath inequalities in England? A discourse analysis of the framing of health inequalities in national policy ☆. Public Health Pract (Oxf) 2023:100382. [PMID: 37131506 PMCID: PMC10077814 DOI: 10.1016/j.puhip.2023.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Objectives The COVID-19 pandemic rapidly exacerbated health inequalities in England. Policy makers sought to ameliorate its impact. This paper aims to identify how health inequalities were framed in national policy documents published in England during the pandemic and how this impacts the framing of policy solutions. Study design Discourse analysis of selected national policy documents. Methods First, we identified relevant national policy documents through a broad search and eligibility criteria to identify illustrative policy documents. Second, we undertook a discourse analysis to understand the framing and constitution of health inequalities and consequent solutions within them. Third, we used existing health inequalities literature to critique the findings. Results Based on analysis of six documents, we found evidence of the idea of lifestyle drift with a marked disjunction between the acknowledgement of the wider determinants of heath and the policy solutions advocated. The target population for interventions is predominantly the worst off, rather than the whole social gradient. Repeated appeals to behaviour change indicate an inherent individualist epistemology. Responsibility and accountability for health inequalities appears delegated locally without the power and resource required to deliver. Conclusion Policy solutions are unlikely to address health inequalities. This could be done though through (i) shifting interventions towards structural factors and wider determinants of health, (ii) a positive vision of a health equitable society, (iii) a proportional universalism in approach and (iv) a delegation of power and resource alongside responsibility for delivering on health inequalities. These possibilities currently remain outside of the policy language of health inequalities.
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Qureshi S, Boily G, Boulanger J, Pagé É, Strumpf E. Inequalities in survival and care across social determinants of health in a cohort of advanced lung cancer patients in Quebec (Canada): A high-resolution population-level analysis. Cancer Med 2023. [PMID: 37017510 DOI: 10.1002/cam4.5897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/27/2023] [Accepted: 03/23/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Advanced lung cancer patients exposed to breakthrough therapies like EGFR tyrosine kinase inhibitors (EGFR-TKI) may experience social inequalities in survival, partly from differences in care. This study examined survival by neighborhood-level socioeconomic and sociodemographic status, and geographical location of advanced lung cancer patients who received gefitinib, an EGFR-TKI, as first-line palliative treatment. Differences in the use and delay of EGFR-TKI treatment were also examined. METHODS Lung cancer patients receiving gefitinib from 2001 to 2019 were identified from Quebec's health administrative databases. Accounting for age and sex, estimates were obtained for the median survival time from treatment to death, the probability of receiving osimertinib as a second EGFR-TKI, and the median time from biopsy to receiving first-line gefitinib. RESULTS Among 457 patients who received first-line treatment with gefitinib, those living in the most materially deprived areas had the shortest median survival time (ratio, high vs. low deprivation: 0.69; 95% CI: 0.47-1.04). The probability of receiving osimertinib as a second EGFR-TKI was highest for patients from immigrant-dense areas (ratio, high vs. lowdensity: 1.95; 95% CI: 1.26-3.36) or from Montreal (ratio, other urban areas vs. Montreal: 0.39; 95% CI: 0.16-0.71). The median wait time for gefitinib was 1.27 times longer in regions with health centers peripheral to large centers in Quebec or Montreal in comparison to regions with university-affiliated centers (95% CI: 1.09-1.54; n = 353). CONCLUSION This study shows that real-world variations in survival and treatment exist among advanced lung cancer patients in the era of breakthrough therapies and that future research on inequalities should also focus on this population.
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Affiliation(s)
- Samia Qureshi
- Department of Epidemiology, Biostatistics and Occupational Health (EBOH), McGill University, H3A 1G1, Montreal, Quebec, Canada
| | - Gino Boily
- Institut national d'excellence en santé et services sociaux (INESSS), H3A 2S9, Montreal, Quebec, Canada
| | - Jim Boulanger
- Institut national d'excellence en santé et services sociaux (INESSS), H3A 2S9, Quebec, Quebec, Canada
| | - Élisabeth Pagé
- Institut national d'excellence en santé et services sociaux (INESSS), H3A 2S9, Montreal, Quebec, Canada
| | - Erin Strumpf
- Department of Epidemiology, Biostatistics and Occupational Health (EBOH), McGill University, H3A 1G1, Montreal, Quebec, Canada
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Albert A, Islam S, Haklay M, McEachan RRC. Nothing about us without us: A co-production strategy for communities, researchers and stakeholders to identify ways of improving health and reducing inequalities. Health Expect 2023; 26:836-846. [PMID: 36683204 PMCID: PMC10010091 DOI: 10.1111/hex.13709] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Co-production with communities is increasingly seen as best practice that can improve the quality, relevance and effectiveness of research and service delivery. Despite this promising position, there remains uncertainty around definitions of co-production and how to operationalize it. The current paper describes the development of a co-production strategy to guide the work of the ActEarly multistakeholder preventative research programme to improve children's health in Bradford and Tower Hamlets, UK. METHODS The strategy used Appreciative Inquiry (AI), an approach following a five-step iterative process: to define (Step 1) scope and guide progress; to discover (Step 2) key issues through seven focus groups (N = 36) and eight in-depth interviews with key stakeholders representing community groups, and the voluntary and statutory sectors; to dream (Step 3) best practice through two workshops with AI participants to review findings; to design (Step 4) a co-production strategy building on AI findings and to deliver (Step 5) the practical guidance in the strategy. RESULTS Nine principles for how to do co-production well were identified: power should be shared; embrace a wide range of perspectives and skills; respect and value the lived experience; benefits should be for all involved parties; go to communities and do not expect them to come to you; work flexibly; avoid jargon and ensure availability of the right information; relationships should be built for the long-term; co-production activities should be adequately resourced. These principles were based on three underlying values of equality, reciprocity and agency. CONCLUSION The empirical insights of the paper highlight the crucial importance of adequate resources and infrastructure to deliver effective co-production. This documentation of one approach to operationalizing co-production serves to avert any misappropriations of the term 'co-production' by listening to service users, stakeholders and other relevant groups, to develop trust and long-term relationships, and build on the learning that already exists amongst such groups. PATIENT OR PUBLIC CONTRIBUTION The work was overseen by a steering group (N = 17) of individuals, both professional and members of the public with experience in undertaking co-production, and/or with some knowledge of the context of the two ActEarly field sites, who provided regular oversight and feedback on the AI process.
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Affiliation(s)
- Alexandra Albert
- Extreme Citizen Science Research Group, Geography Department, University College London, London, UK
| | - Shahid Islam
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Muki Haklay
- Extreme Citizen Science Research Group, Geography Department, University College London, London, UK
| | - Rosemary R C McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Chan J, Blane D, Choudhary P, Chowdhury TA, Goyal A, Hanif W, Jacca J, Mathur R, Misra S, Ocran N, Rutter MK, Studley R, Treweek S, Valabhji J, Khunti K. Addressing health inequalities in diabetes through research: Recommendations from Diabetes UK's 2022 health inequalities in diabetes workshop. Diabet Med 2023; 40:e15024. [PMID: 36508339 DOI: 10.1111/dme.15024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
AIMS To develop a position statement which identifies research priorities to address health inequalities in diabetes and provides recommendations to researchers and research funders on how best to conduct research in these areas. METHODS A two-day research workshop was conducted bringing together research experts in diabetes, research experts in health inequalities, healthcare professionals and people living with diabetes. RESULTS The following key areas were identified as needing increased focus: How can we improve patient and public involvement and engagement to make diabetes research more inclusive of and relevant to diverse communities? How can we improve research design so that the people who could benefit most are represented? How can we use theories from implementation science to facilitate the uptake of research findings into routine practice to reach the populations with highest need? How can we collate and evaluate local innovation projects and disseminate best practice around tackling health inequalities in diabetes? How can we best collect and use data to address health inequalities in diabetes, including the harnessing of real-world and routinely collected data? How could research funders allocate funds to best address health inequalities in diabetes? How do we ensure the research community is representative of the general population? CONCLUSIONS This position statement outlines recommendations to address the urgent need to tackle health inequalities in diabetes through research and calls on the diabetes research community to act upon these recommendations to ensure future research works to eliminate unfair and avoidable disparities in health.
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Affiliation(s)
- Jodie Chan
- Diabetes UK, Wells Lawrence House, London, UK
| | - David Blane
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Pratik Choudhary
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
| | | | - Aaliya Goyal
- Black Country Integrated Care Board, Wolverhampton, UK
| | - Wasim Hanif
- University Hospital Birmingham, Birmingham, UK
| | - Joyce Jacca
- North Lewisham Primary Care Network, London, UK
| | - Rohini Mathur
- Centre for Primary Care, Wolfson Institute for Population Health, Queen Mary University of London, London, UK
| | - Shivani Misra
- Division of Metabolism, Digestion & Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Department of Diabetes, Endocrinology & Metabolism, Imperial College Healthcare NHS Trust, London, UK
| | - Nana Ocran
- Diabetes Research Steering Group Member, London, UK
| | - Martin K Rutter
- Division of Endocrinology, Diabetes and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jonathan Valabhji
- Division of Metabolism, Digestion & Reproduction, Faculty of Medicine, Imperial College London, London, UK
- NHS England, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
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ÓhAiseadha C, Quinn GA, Connolly R, Wilson A, Connolly M, Soon W, Hynds P. Unintended Consequences of COVID-19 Non-Pharmaceutical Interventions (NPIs) for Population Health and Health Inequalities. Int J Environ Res Public Health 2023; 20:5223. [PMID: 37047846 PMCID: PMC10094123 DOI: 10.3390/ijerph20075223] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
Since the start of the COVID-19 pandemic in early 2020, governments around the world have adopted an array of measures intended to control the transmission of the SARS-CoV-2 virus, using both pharmaceutical and non-pharmaceutical interventions (NPIs). NPIs are public health interventions that do not rely on vaccines or medicines and include policies such as lockdowns, stay-at-home orders, school closures, and travel restrictions. Although the intention was to slow viral transmission, emerging research indicates that these NPIs have also had unintended consequences for other aspects of public health. Hence, we conducted a narrative review of studies investigating these unintended consequences of NPIs, with a particular emphasis on mental health and on lifestyle risk factors for non-communicable diseases (NCD): physical activity (PA), overweight and obesity, alcohol consumption, and tobacco smoking. We reviewed the scientific literature using combinations of search terms such as 'COVID-19', 'pandemic', 'lockdowns', 'mental health', 'physical activity', and 'obesity'. NPIs were found to have considerable adverse consequences for mental health, physical activity, and overweight and obesity. The impacts on alcohol and tobacco consumption varied greatly within and between studies. The variability in consequences for different groups implies increased health inequalities by age, sex/gender, socioeconomic status, pre-existing lifestyle, and place of residence. In conclusion, a proper assessment of the use of NPIs in attempts to control the spread of the pandemic should be weighed against the potential adverse impacts on other aspects of public health. Our findings should also be of relevance for future pandemic preparedness and pandemic response teams.
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Affiliation(s)
- Coilín ÓhAiseadha
- Department of Public Health, Health Service Executive, D08 W2A8 Dublin, Ireland
| | - Gerry A. Quinn
- Centre for Molecular Biosciences, Ulster University, Coleraine BT52 1SA, UK
| | - Ronan Connolly
- Independent Scientist, D08 Dublin, Ireland
- Center for Environmental Research and Earth Sciences (CERES), Salem, MA 01970, USA
| | - Awwad Wilson
- National Drug Treatment Centre, Health Service Executive, D02 NY26 Dublin, Ireland
| | - Michael Connolly
- Independent Scientist, D08 Dublin, Ireland
- Center for Environmental Research and Earth Sciences (CERES), Salem, MA 01970, USA
| | - Willie Soon
- Center for Environmental Research and Earth Sciences (CERES), Salem, MA 01970, USA
- Institute of Earth Physics and Space Science (ELKH EPSS), H-9400 Sopron, Hungary
| | - Paul Hynds
- SpatioTemporal Environmental Epidemiology Research (STEER) Group, Environmental Sustainability & Health Institute, Technological University, D07 H6K8 Dublin, Ireland
- Irish Centre for Research in Applied Geoscience, University College Dublin, D02 FX65 Dublin, Ireland
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Shearer JC, Nava O, Prosser W, Nawaz S, Mulongo S, Mambu T, Mafuta E, Munguambe K, Sigauque B, Cherima YJ, Durosinmi-Etti O, Okojie O, Hadejia IS, Oyewole F, Mekonnen DA, Kanagat N, Hooks C, Fields R, Richart V, Chee G. Uncovering the Drivers of Childhood Immunization Inequality with Caregivers, Community Members and Health System Stakeholders: Results from a Human-Centered Design Study in DRC, Mozambique and Nigeria. Vaccines (Basel) 2023; 11:vaccines11030689. [PMID: 36992273 DOI: 10.3390/vaccines11030689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The importance of immunization for child survival underscores the need to eliminate immunization inequalities. Few existing studies of inequalities use approaches that view the challenges and potential solutions from the perspective of caregivers. This study aimed to identify barriers and context-appropriate solutions by engaging deeply with caregivers, community members, health workers, and other health system actors through participatory action research, intersectionality, and human-centered design lenses. METHODS This study was conducted in the Demographic Republic of Congo, Mozambique and Nigeria. Rapid qualitative research was followed by co-creation workshops with study participants to identify solutions. We analyzed the data using the UNICEF Journey to Health and Immunization Framework. RESULTS Caregivers of zero-dose and under-immunized children faced multiple intersecting and interacting barriers related to gender, poverty, geographic access, and service experience. Immunization programs were not aligned with needs of the most vulnerable due to the sub-optimal implementation of pro-equity strategies, such as outreach vaccination. Caregivers and communities identified feasible solutions through co-creation workshops and this approach should be used whenever possible to inform local planning. CONCLUSIONS Policymakers and managers can integrate HCD and intersectionality mindsets into existing planning and assessment processes, and focus on overcoming root causes of sub-optimal implementation.
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Affiliation(s)
| | - Olivia Nava
- Independent Consultant, Oakland, CA 94608, USA
| | - Wendy Prosser
- JSI Research and Training Institute USA, Arlington, VA 22202, USA
| | | | - Salva Mulongo
- PATH DRC, Kinshasa 7525, Democratic Republic of the Congo
| | - Thérèse Mambu
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa 11, Democratic Republic of the Congo
| | - Eric Mafuta
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa 11, Democratic Republic of the Congo
| | - Khatia Munguambe
- Community Health Department, Eduardo Mondlane University, Maputo 1102, Mozambique
| | - Betuel Sigauque
- JSI Research and Training Institute Mozambique, Maputo, Mozambique
| | | | | | - Obehi Okojie
- Department of Community Health, University of Benin, Benin City 300271, Nigeria
| | | | - Femi Oyewole
- Consultant Public Health Physician, Lagos, Nigeria
| | | | - Natasha Kanagat
- JSI Research and Training Institute USA, Arlington, VA 22202, USA
| | | | - Rebecca Fields
- JSI Research and Training Institute USA, Arlington, VA 22202, USA
| | - Vanessa Richart
- JSI Research and Training Institute USA, Arlington, VA 22202, USA
| | - Grace Chee
- JSI Research and Training Institute USA, Arlington, VA 22202, USA
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Isherwood KR, Kyle RG, Gray BJ, Davies AR. Challenges to self-isolation among contacts of cases of COVID-19: a national telephone survey in Wales. J Public Health (Oxf) 2023; 45:e75-e86. [PMID: 35135013 PMCID: PMC8903426 DOI: 10.1093/pubmed/fdac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 11/17/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Self-isolation is challenging and adherence is dependent on a range of psychological, social and economic factors. We aimed to identify the challenges experienced by contacts of coronavirus disease 2019 (COVID-19) cases to better target support and minimize the harms of self-isolation. METHODS The Contact Adherence Behavioural Insights Study (CABINS) was a 15-minute telephone survey conducted with confirmed contacts of COVID-19 (N = 2027), identified through the NHS Wales Test Trace Protect (TTP) database. RESULTS Younger people (aged 18-29 years) were three times more likely to report mental health concerns (adjusted odds ratio [aOR]: 3.16, 95% confidence interval [CI]: 2.05-4.86) and two times more likely to report loneliness (aOR: 1.96, CI: 1.37-2.81) compared to people aged over 60 years. Women were 1.5 times more likely to experience mental health concerns (aOR: 1.51, 95% CI: 1.20-1.92) compared to men. People with high levels of income precarity were eight times more likely to report financial challenges (aOR: 7.73, CI: 5.10-11.74) and three times more likely to report mental health concerns than their more financially secure counterparts (aOR: 3.08, CI: 2.22-4.28). CONCLUSION Self-isolation is particularly challenging for younger people, women and those with precarious incomes. Providing enhanced support is required to minimize the harms of self-isolation.
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Affiliation(s)
| | - Richard G Kyle
- Research and Evaluation Division, Public Health Wales, Cardiff, Wales CF10 4BZ, UK
| | - Benjamin J Gray
- Research and Evaluation Division, Public Health Wales, Cardiff, Wales CF10 4BZ, UK
| | - Alisha R Davies
- Research and Evaluation Division, Public Health Wales, Cardiff, Wales CF10 4BZ, UK
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132
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Dunlea T, Richards S, Lembo T. Healthcare provider-focused antimicrobial stewardship in sub-Saharan Africa: opportunities and challenges. Trends Microbiol 2023; 31:215-218. [PMID: 36759308 DOI: 10.1016/j.tim.2022.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/29/2022] [Accepted: 12/27/2022] [Indexed: 02/10/2023]
Abstract
To address the antimicrobial resistance (AMR) crisis, governments around the world have created action plans to optimize antimicrobial use (AMU). These plans include antimicrobial stewardship (AMS) that encompasses educational programs for healthcare workers. We discuss these programs in sub-Saharan Africa, including the opportunities and challenges arising from a highly constrained healthcare environment.
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Affiliation(s)
- Torre Dunlea
- School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK.
| | - Shauna Richards
- Animal and Human Health, International Livestock Research Institute, Nairobi, Kenya
| | - Tiziana Lembo
- School of Biodiversity, One Health & Veterinary Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
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Aaltonen K. Austerity, economic hardship and access to medications: a repeated cross-sectional population survey study, 2013-2020. J Epidemiol Community Health 2023; 77:160-167. [PMID: 36693717 PMCID: PMC9933171 DOI: 10.1136/jech-2022-219706] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND In Finland, austerity measures included an increase in medication and healthcare copayments and a decrease in many social security allowances. This study examines whether austerity coincided with an increase in socioeconomic inequality in access to medications (going short of medications because of lack of money) and whether medication access problems increased more than other forms of economic hardship (going short of food or physician visits). METHODS Pooled cross-sectional population surveys collected in 2013-2015, 2018 and 2020 (n=139 324) and multinomial logistic regression, with interaction between study year and economic activity (EA) (full-time work vs part-time work/retirement; old age retirement; unemployment; disability/illness; family; student), were used to estimate the effect of EA on the probability of experiencing economic hardship (no hardship/hardship including medication problems/hardship excluding medication problems) and how it varies across years. RESULTS Working-age adults outside full-time employment have a higher risk of economic hardship than full-time workers, and old age retirees have a lower risk. In 2018, when austerity was most pronounced, economic hardship including medication problems increased for the disabled/ill (women and men), unemployed (women) and part-time workers/retirees (men), significantly more than for full-time workers. Hardship excluding medication access problems either decreased or remained unchanged. CONCLUSION Austerity coincided with increasing economic hardship among vulnerable groups, thus exacerbating socioeconomic inequalities. Strengthening the role for medication access problems suggests that medication copayment increases contributed to this accumulating disadvantage.
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Affiliation(s)
- Katri Aaltonen
- INVEST Research Flagship Center, University of Turku, Turku, Finland .,Kela Research, The Social Insurance Institution of Finland, Helsinki, Finland
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134
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Maharani A, Sinclair DR, Chandola T, Bower P, Clegg A, Hanratty B, Nazroo J, Pendleton N, Tampubolon G, Todd C, Wittenberg R, O'Neill TW, Matthews FE. Household wealth, neighbourhood deprivation and frailty amongst middle-aged and older adults in England: a longitudinal analysis over 15 years (2002-2017). Age Ageing 2023; 52:7093109. [PMID: 36995138 PMCID: PMC10061942 DOI: 10.1093/ageing/afad034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND frailty is a condition of reduced function and health due to ageing processes and is associated with a higher risk of falls, hospitalisation, disability and mortality. OBJECTIVE to determine the relationship between household wealth and neighbourhood deprivation with frailty status, independently of demographic factors, educational attainment and health behaviours. DESIGN population-based cohort study. SETTING communities in England. SUBJECTS in total 17,438 adults aged 50+ from the English Longitudinal Study of Ageing. METHODS multilevel mixed-effects ordered logistic regression was used in this study. Frailty was measured using a frailty index. We defined small geographic areas (neighbourhoods) using English Lower layer Super Output Areas. Neighbourhood deprivation was measured by the English Index of Multiple Deprivation, grouped into quintiles. Health behaviours included in this study are smoking and frequency of alcohol consumption. RESULTS the proportion of respondents who were prefrail and frail were 33.8% [95% confidence interval (CI) 33.0-34.6%] and 11.7 (11.1-12.2)%, respectively. Participants in the lowest wealth quintile and living in the most deprived neighbourhood quintile had 1.3 (95% CI = 1.2-1.3) and 2.2 (95% CI = 2.1-2.4) times higher odds of being prefrail and frail, respectively, than the wealthiest participants living in the least deprived neighbourhoods Living in more deprived neighbourhood and poorer wealth was associated with an increased risk of becoming frail. Those inequalities did not change over time. CONCLUSIONS in this population-based sample, living in a deprived area or having low wealth was associated with frailty in middle-aged and older adults. This relationship was independent of the effects of individual demographic characteristics and health behaviours.
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Affiliation(s)
- Asri Maharani
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - David R Sinclair
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE4 5PL, UK
| | - Tarani Chandola
- Faculty of Social Sciences, The University of Hong Kong, Pokfulam Road, Hong Kong 999077, Hong Kong
| | - Peter Bower
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Andrew Clegg
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Barbara Hanratty
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE4 5PL, UK
| | - James Nazroo
- Cathie Marsh Institute for Social Research, School of Social Sciences, Faculty of Humanities, University of Manchester, Manchester M13 9PL, UK
| | - Neil Pendleton
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Gindo Tampubolon
- Global Development Institute, School of Environment, Education and Development, School of Social Sciences, Faculty of Humanities, University of Manchester, Manchester M13 9PL, UK
| | - Chris Todd
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Raphael Wittenberg
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Care Policy and Evaluation Centre, London School of Economics and Political Science, London WC2A 2AE, UK
| | - Terence W O'Neill
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Fiona E Matthews
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE4 5PL, UK
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Cullen AE, Lindsäter E, Rahman S, Taipale H, Tanskanen A, Mittendorfer-Rutz E, Helgesson M. Patient factors associated with receipt of psychological and pharmacological treatments among individuals with common mental disorders in a Swedish primary care setting. BJPsych Open 2023; 9:e40. [PMID: 36852532 PMCID: PMC10044006 DOI: 10.1192/bjo.2023.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Psychological and pharmacological therapies are the recommended first-line treatments for common mental disorders (CMDs) but may not be universally accessible or utilised. AIMS To determine the extent to which primary care patients with CMDs receive treatment and the impact of sociodemographic, work-related and clinical factors on treatment receipt. METHOD National registers were used to identify all Stockholm County residents aged 19-64 years who had received at least one CMD diagnosis (depression, anxiety, stress-related) in primary care between 2014 and 2018. Individuals were followed from the date of their first observed CMD diagnosis until the end of 2019 to determine treatment receipt. Associations between patient factors and treatment group were examined using multinomial logistic regression. RESULTS Among 223 271 individuals with CMDs, 30.6% received pharmacotherapy only, 16.5% received psychological therapy only, 43.1% received both and 9.8% had no treatment. The odds of receiving any treatment were lower among males (odds ratio (OR) range = 0.76 to 0.92, 95% CI[minimum, maximum] 0.74 to 0.95), individuals born outside of Sweden (OR range = 0.67 to 0.93, 95% CI[minimum, maximum] 0.65 to 0.99) and those with stress-related disorders only (OR range = 0.21 to 0.51, 95% CI[minimum, maximum] 0.20 to 0.53). Among the patient factors examined, CMD diagnostic group, prior treatment in secondary psychiatric care and age made the largest contributions to the model (R2 difference: 16.05%, 1.72% and 1.61%, respectively). CONCLUSIONS Although over 90% of primary care patients with CMDs received pharmacological and/or psychological therapy, specific patient groups were less likely to receive treatment.
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Affiliation(s)
- Alexis E Cullen
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; and Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Elin Lindsäter
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Syed Rahman
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Heidi Taipale
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Helgesson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden; and Department of Public Health and Caring Sciences, Health Equity and Working Life, Uppsala University, Uppsala, Sweden
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136
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Wanis HA, Møller H, Ashkan K, Davies EA. The Influence of Ethnicity on Survival from Malignant Primary Brain Tumours in England: A Population-Based Cohort Study. Cancers (Basel) 2023; 15. [PMID: 36900254 DOI: 10.3390/cancers15051464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND In recent years, the completeness of ethnicity data in the English cancer registration data has greatly improved. Using these data, this study aims to estimate the influence of ethnicity on survival from primary malignant brain tumours. METHODS Demographic and clinical data on adult patients diagnosed with malignant primary brain tumour from 2012 to 2017 were obtained (n = 24,319). Univariate and multivariate Cox proportional hazards regression analyses were used to estimate hazard ratios (HR) for the survival of the ethnic groups up to one year following diagnosis. Logistic regressions were then used to estimate odds ratios (OR) for different ethnic groups of (1) being diagnosed with pathologically confirmed glioblastoma, (2) being diagnosed through a hospital stay that included an emergency admission, and (3) receiving optimal treatment. RESULTS After an adjustment for known prognostic factors and factors potentially affecting access to healthcare, patients with an Indian background (HR 0.84, 95% CI 0.72-0.98), Any Other White (HR 0.83, 95% CI 0.76-0.91), Other Ethnic Group (HR 0.70, 95% CI 0.62-0.79), and Unknown/Not Stated Ethnicity (HR 0.81, 95% CI 0.75-0.88) had better one-year survivals than the White British Group. Individuals with Unknown ethnicity are less likely be diagnosed with glioblastoma (OR 0.70, 95% CI 0.58-0.84) and less likely to be diagnosed through a hospital stay that included an emergency admission (OR 0.61, 95% CI 0.53-0.69). CONCLUSION The demonstrated ethnic variations associated with better brain tumour survival suggests the need to identify risk or protective factors that may underlie these differences in patient outcomes.
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137
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Doetsch JN, Almendra R, Severo M, Leão T, Pilot E, Krafft T, Barros H. 2008 economic crisis impact on perinatal and infant mortality in Southern European countries. J Epidemiol Community Health 2023; 77:305-314. [PMID: 36813545 DOI: 10.1136/jech-2022-219639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession's impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems' response to the protection of the health of the most vulnerable groups. OBJECTIVE To assess time trends and international disparities in perinatal mortality rates (PMR) and infant mortality rates (IMR), following the Great Recession, and their association with socioeconomic indicators in Portugal, Greece, Italy and Spain. METHODS Associations were assessed through generalised linear models for all four countries. A Poisson joinpoint regression model was applied to explore PMR and IMR trend changes between 2000 and 2018. Country disparities were analysed using mixed-effects multilevel models. RESULTS IMR and PMR have decreased overall in the four selected countries between 2000 and 2018. Still, whereas in Spain, Italy and Portugal the decreasing pace was attenuated after 2009, in Greece a positive trend was found after the 2008 crisis. IMR and PMR were significantly associated with socioeconomic indicators in all four countries. National disparities in the evolution of IMR and PMR were significantly associated with most socioeconomic indicators between 2000 and 2018. CONCLUSION Our results confirm the impact of the Great Recession on PMR and IMR trends in all four countries, taking recurring associations between macroeconomic cycles, variations in mortality trends, macroeconomic volatility and stagnation of IMR and PMR into account. The association with socioeconomic indicators stresses the need to strengthen social protection and healthcare systems to better protect the population's health from the earliest days.
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Affiliation(s)
- Julia Nadine Doetsch
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal .,Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Ricardo Almendra
- CEGOT-Centre of Studies on Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal
| | - Milton Severo
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Teresa Leão
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal.,Predictive Medicine and Public Health Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
| | - Eva Pilot
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University (UM), Maastricht, Netherlands
| | - Thomas Krafft
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University (UM), Maastricht, Netherlands
| | - Henrique Barros
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal.,Predictive Medicine and Public Health Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
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138
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Ochoa LB, Bijlsma MJ, Steegers EAP, Been JV, Bertens LCM. Does Neighbourhood Crime Mediate the Relationship between Neighbourhood Socioeconomic Status and Birth Outcomes? An Application of the Mediational G-Formula. Am J Epidemiol 2023:7043827. [PMID: 36799563 DOI: 10.1093/aje/kwad037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
While the link between living in low socioeconomic status (SES) neighbourhoods and a higher risk of adverse birth outcomes has been well established, the underlying mechanisms remain poorly understood. Using the parametric g-formula, we assess the role of neighbourhood crime as potential mediator for the relationship between neighbourhood SES and birth outcomes using data on singleton births occurring in the Netherlands between 2010 and 2017 (n = 1,219,470). We estimated total and mediated effects of neighbourhood SES on small for gestational age (SGA), low birthweight (LBW), and preterm birth (PTB) via three types of crime (violent crimes, crimes against property and crimes against public order). The g-formula intervention settings correspond to a hypothetical improvement in neighbourhood SES. The hypothetical improvement in neighbourhood SES resulted in a 6.6% (95%CI=5.6,7.5) reduction in the proportion of SGA, a 9.1% (95%CI=7.6,10.6) reduction in LBW, and a 5.8% (95%CI=5.7,6.2) decrease in PTB. Neighbourhood crime jointly accounted for 28.1% and 8.6% of the total effect on SGA and LBW, respectively. For PTB, we found no evidence of mediation. The most relevant pathways were crimes against property and crimes against public order. The results indicate that neighbourhood crime mediates a meaningful share of the relationship between neighbourhood SES and birth outcomes.
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Affiliation(s)
- Lizbeth Burgos Ochoa
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Maarten J Bijlsma
- Unit PharmacoTherapy, -Epidemiology, and -Economics (PTEE), Groningen Research Institute of Pharmacy, University of Groningen, The Netherlands.,Max Planck Institute for Demographic Research, Rostock, Germany
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jasper V Been
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Division of Neonatology, Department of Paediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Udoh II, Mpofu E, Prybutok G. Dementia and COVID-19 among Older African American Adults: A Scoping Review of Healthcare Access and Resources. Int J Environ Res Public Health 2023; 20:3494. [PMID: 36834189 PMCID: PMC9967955 DOI: 10.3390/ijerph20043494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
African American/Black communities comprise 12.2% of the U.S. population, with a COVID-19 infection rate of more than 18% and marginal access to healthcare services. This scoping review synthesizes the emerging evidence on healthcare accessibility among older African American adult communities with dementia and COVID-19, as well as the resource requirements for this population during the pandemic. Searches of different databases for empirical studies and other sources on dementia and COVID-19 among older African American adults yielded 13 studies that met the following inclusion criteria: (a) focus on dementia and COVID-19, (b) sampled older African American adults, (c) investigated healthcare accessibility and resources, and (d) published between 2019 and 2022. Following the initial selection of the studies, eight were selected for relevance based on the Population, Concept, and Context (PCC) inclusion and exclusion criteria. Thematic analysis indicated that older African Americans with dementia and COVID-19 experienced longer delays in accessing timely healthcare, including transportation, intensive care units (ICUs), and mechanical ventilation. They also had reduced healthcare resources associated with a lack of health insurance, low financial resources, and an increased length of hospital stay, which further aggravated the negative effects of comorbid dementia and COVID-19 infections. Evidence showed that racial and age disparities affected older African American adults with dementia and COVID-19, resulting in lower healthcare access and marginal resources. This is consistent with historical and systemic inequities in meeting the healthcare needs of people of color in the United States, which was compounded for older African Americans during the COVID-19 pandemic.
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Affiliation(s)
- Idorenyin Imoh Udoh
- Rehabilitation and Health Services, University of North Texas, Chilton Hall, 410 Avenue C, Suite 289, Denton, TX 76201, USA
| | - Elias Mpofu
- Rehabilitation and Health Services, University of North Texas, Chilton Hall, 410 Avenue C, Suite 289, Denton, TX 76201, USA
- School of Health Sciences, University of Sydney, Camperdown, NSW 2050, Australia
- Educational Psychology, University of Johannesburg, Johannesburg 2000, South Africa
| | - Gayle Prybutok
- Rehabilitation and Health Services, University of North Texas, Chilton Hall, 410 Avenue C, Suite 289, Denton, TX 76201, USA
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140
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Romero I, Díez J, Del Cura I, Franco M, Gullón P. Diet Quality Changes by Educational Level among Adults in Spain from 2017 to 2021. Nutrients 2023; 15:nu15040858. [PMID: 36839216 PMCID: PMC9961002 DOI: 10.3390/nu15040858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Despite increasing attention on addressing socioeconomic disparities in diet quality, longitudinal studies are scarce. Furthermore, the effects of the COVID-19 pandemic on diet-related outcomes are yet to be fully understood. We examined changes in diet quality by educational level among adults in Madrid, Spain. We used data from recruitment (in 2017) and from 2021. At baseline, our sample included 1358 adults aged 40-75 years who were free of cardiovascular disease and completed a validated diet quality screener. Of them, 931 answered the survey in the follow-up visit in 2021. We used participants' diet quality index scores (range: 18-54; higher scores indicate better diet quality) as the dependent variable. As our independent variable, we assessed participants' educational levels (low, medium, and high). We fitted a multinomial regression using the categories of educational level as the main predictor, adjusting for age, sex, country of origin, and household composition. During the study period, 78.0% of participants sustained their diet quality, 11.6% improved it, and 10.4% moved away from a healthier dietary pattern. In descriptive analyses, we observed an increase in diet quality among less-educated females. Unadjusted multinomial models showed that a lower educational level predicted both increases and decreases in diet quality over the period. Even though the median diet quality scores did not change significantly, we observed heterogeneous changes over the four years. Variability within diet, with some improving and some worsening, seems to have increased among participants with lower educational levels. Future studies should look at the determinants of change in these population subgroups.
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Affiliation(s)
- Isabel Romero
- Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Aragón, Spain
| | - Julia Díez
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain
- Correspondence:
| | - Isabel Del Cura
- Primary Care Research Unit, Madrid Health Service, 28035 Madrid, Spain
- Department of Preventive Medicine and Public Health, Universidad Rey Juan Carlos, 28933 Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC) & Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Institute of Health Carlos III, 28029 Madrid, Spain
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, 17165 Stockholm, Sweden
| | - Manuel Franco
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Pedro Gullón
- Public Health and Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain
- Center for Urban Research, RMIT University, Melbourne 3004, Australia
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141
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Oude Groeniger J, Houweling TAJ, Jansen PW, Horoz N, Buil JM, van Lier PAC, van Lenthe FJ. Social inequalities in child development: the role of differential exposure and susceptibility to stressful family conditions. J Epidemiol Community Health 2023; 77:74-80. [PMID: 36428086 PMCID: PMC9872228 DOI: 10.1136/jech-2022-219548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Stressful family conditions may contribute to inequalities in child development because they are more common among disadvantaged groups (ie, differential exposure) and/or because their negative effects are stronger among disadvantaged groups (ie, differential impact/susceptibility). We used counterfactual mediation analysis to investigate to what extent stressful family conditions contribute to inequalities in child development via differential exposure and susceptibility. METHODS We used data from the Generation R Study, a population-based birth cohort in the Netherlands (n=6842). Mother's education was used as the exposure. Developmental outcomes, measured at age 13 years, were emotional and behavioural problems (Youth Self-Report), cognitive development (Wechsler Intelligence Scale for Children) and secondary education entry level. Financial and social stress at age 9 years were the putative mediators. RESULTS Differential exposure to financial stress caused a 0.07 (95% CI -0.12 to -0.01) SD worse emotional and behavioural problem -score, a 0.05 (95% CI -0.08 to -0.02) SD lower intelligence score and a 0.05 (95% CI -0.05 to -0.01) SD lower secondary educational level, respectively, among children of less-educated mothers compared with children of more-educated mothers. This corresponds to a relative contribution of 54%, 9% and 6% of the total effect of mother's education on these outcomes, respectively. Estimates for differential exposure to social stress, and differential susceptibility to financial or social stress, were much less pronounced. CONCLUSION Among children of less-educated mothers, higher exposure to financial stress in the family substantially contributes to inequalities in socioemotional development, but less so for cognitive development and educational attainment.
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Affiliation(s)
- Joost Oude Groeniger
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands .,Department of Public Administration and Sociology, Erasmus University, Rotterdam, Netherlands
| | - Tanja AJ Houweling
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Pauline W Jansen
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Nil Horoz
- Dept of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - J. Marieke Buil
- Dept of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Amsterdam, Netherlands,Research Centre Urban Talent, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | - Pol AC van Lier
- Dept of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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Bull E, Young D, Etchebarne A, Malpus Z. Understanding ethnic minority service user experiences of being invited to and attending group pain programmes: A qualitative service evaluation. Br J Pain 2023; 17:58-70. [PMID: 36815070 PMCID: PMC9940249 DOI: 10.1177/20494637221129196] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Health inequalities continue to exist for individuals from an ethnic minority background who live with chronic pain. There is a growing recognition that an individual's experience of pain is shaped by their cultural beliefs, which may influence their decisions about managing their pain. Aims This service evaluation aimed to (a) understand experiences of service users from a Black, Asian or other ethnic minority background of being invited to and attending a group pain programme in one secondary care pain rehabilitation service. (b) Provide recommendations to develop culturally grounded services to better meet the diverse needs of all service users living with chronic pain. Method Semi-structured interviews were conducted with five service users who had been offered a place on a group pain programme within the last 3 years. The interviews were recorded and transcribed verbatim. An interpretative phenomenological analysis was used to identify themes in the data. Results The analysis produced three themes (1) Pain, Ethnicity and Coping: Perceptions of pain and coping in relation to ethnicity and intersectional factors, alignment to a self-management approach. (2) Communication for Decisions: Experiences of ethnicity and culture in relation to health professional communication about group pain programmes, participants' expectations and fears. (3) Feeling Included: Experiences of feeling included or excluded in group pain programme, relationships and empowerment during the group pain programme. Discussion The five service users shared a range of perspectives on how they felt ethnicity shaped their experience of the group pain programme. The findings suggest that adaptations to group pain programmes can make a meaningful difference for service users from ethnic minority backgrounds. 10 recommendations are suggested, including greater exploration of cultural beliefs during assessment, improving accessibility of information about the service and engaging more diverse attendees and facilitators.
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Affiliation(s)
- Eleanor Bull
- PRIMO Community MSK Pain Team | Withington Community Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Dore Young
- Back Pain Programme Lead, University of Manchester, Manchester, UK
| | - Andre Etchebarne
- Trafford Community MSK Pain Team, Manchester University NHS Foundation Trust, Manchester, UK
| | - Zoey Malpus
- Inpatient Pain Team, Oxford Road Campus, Manchester University NHS Foundation Trust, Manchester, UK
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143
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Bloomberg M, Dugravot A, Sommerlad A, Kivimäki M, Singh-Manoux A, Sabia S. Comparison of sex differences in cognitive function in older adults between high- and middle-income countries and the role of education: a population-based multicohort study. Age Ageing 2023; 52:7049632. [PMID: 36821646 PMCID: PMC9949595 DOI: 10.1093/ageing/afad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The extent to which education explains variations in sex differences in cognitive function between countries at different levels of economic development is unknown. We examined the role of education in sex differences in four cognitive domains in high- and middle-income countries. METHODS Analyses were based on 70,846 participants, aged 60 years and older, in cohort studies from a high-income (United States) and four middle-income countries (Mexico, Brazil, China, and India). We used weighted linear models to allow nationally-representative comparisons of sex differences in orientation, memory, attention, and fluency using the United States as the reference, before and after adjustment for education, and after stratification by education. RESULTS Females had lower levels of education than males in all countries, particularly in India. Before adjustment for education, sex differences in orientation and attention in all middle-income countries, memory in Brazil, China, and India, and fluency in India were less favourable to females than in the United States (P < 0.010). For example, females outperformed males in memory in the United States (mean difference [male-female scores] = -0.26 standard deviations [95% CI -0.30, -0.22]) but not in China (0.15 [0.09, 0.21]) or India (0.16 [0.13, 0.19]). Adjustment for education attenuated these sex differences. In analyses stratified by education, there were minimal sex differences in the high education group in all countries. CONCLUSION Education contributes to larger female disadvantages in cognitive function at older ages in middle-income countries compared with the United States. Gender equity in education is an important target to reduce sex disparities in cognitive function globally.
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Affiliation(s)
- Mikaela Bloomberg
- Department of Epidemiology and Public Health, University College London, UK
| | - Aline Dugravot
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France
| | | | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, UK.,Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France
| | - Séverine Sabia
- Department of Epidemiology and Public Health, University College London, UK.,Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France
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Tsakos G, Watt RG, Guarnizo-Herreño CC. Reflections on oral health inequalities: Theories, pathways and next steps for research priorities. Community Dent Oral Epidemiol 2023; 51:17-27. [PMID: 36744970 DOI: 10.1111/cdoe.12830] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 02/07/2023]
Abstract
Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.
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Affiliation(s)
- Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
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Ochoa LB, van der Meer L, Waelput AJM, Been JV, Bertens LCM. Neighbourhood-related socioeconomic perinatal health inequalities: An illustration of the mediational g-formula and considerations for the big data context. Paediatr Perinat Epidemiol 2023; 37:341-349. [PMID: 36717678 DOI: 10.1111/ppe.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Advances in computing power have enabled the collection, linkage and processing of big data. Big data in conjunction with robust causal inference methods can be used to answer research questions regarding the mechanisms underlying an exposure-outcome relationship. The g-formula is a flexible approach to perform causal mediation analysis that is suited for the big data context. Although this approach has many advantages, it is underused in perinatal epidemiology and didactic explanation for its implementation is still limited. OBJECTIVE The aim of this was to provide a didactic application of the mediational g-formula by means of perinatal health inequalities research. METHODS The analytical procedure of the mediational g-formula is illustrated by investigating whether the relationship between neighbourhood socioeconomic status (SES) and small for gestational age (SGA) is mediated by neighbourhood social environment. Data on singleton births that occurred in the Netherlands between 2010 and 2017 (n = 1,217,626) were obtained from the Netherlands Perinatal Registry and linked to sociodemographic national registry data and neighbourhood-level data. The g-formula settings corresponded to a hypothetical improvement in neighbourhood SES from disadvantaged to non-disadvantaged. RESULTS At the population level, a hypothetical improvement in neighbourhood SES resulted in a 6.3% (95% confidence interval [CI] 5.2, 7.5) relative reduction in the proportion of SGA, that is the total effect. The total effect was decomposed into the natural direct effect (5.6%, 95% CI 5.1, 6.1) and the natural indirect effect (0.7%, 95% CI 0.6, 0.9). In terms of the magnitude of mediation, it was observed the natural indirect effect accounted for 11.4% (95% CI 9.2, 13.6) of the total effect of neighbourhood SES on SGA. CONCLUSIONS The mediational g-formula is a flexible approach to perform causal mediation analysis that is suited for big data contexts in perinatal health research. Its application can contribute to providing valuable insights for the development of policy and public health interventions.
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Affiliation(s)
- Lizbeth Burgos Ochoa
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Lindsey van der Meer
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Adja J M Waelput
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jasper V Been
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Division of Neonatology, Department of Paediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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146
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Thompson S, Meyer JC, Burnett RJ, Campbell SM. Mitigating Vaccine Hesitancy and Building Trust to Prevent Future Measles Outbreaks in England. Vaccines (Basel) 2023; 11. [PMID: 36851166 DOI: 10.3390/vaccines11020288] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
Measles, a highly infectious respiratory viral infection associated with severe morbidity and mortality, is preventable when coverage with the highly effective measles, mumps and rubella vaccine (MMR) is ≥95%. Vaccine hesitancy is responsible for measles outbreaks in countries where measles had previously been eliminated, including in England, and is one of the ten threats to global public health identified by the World Health Organization (WHO). Official administrative 2012-2021 data on measles incidence and MMR coverage in England were reviewed alongside a scoping literature review on factors associated with MMR uptake in England. Whilst measles incidence has reduced significantly since 2012, sporadic measles outbreaks in England have occurred with geographic disparities and variations in MMR coverage. Over the last decade, MMR uptake has fallen across all regions with no area currently reaching the WHO target of 95% coverage of both doses of MMR necessary for herd immunity. Factors associated with MMR coverage overlap with the 3C (convenience, complacency and confidence) model of vaccine hesitancy. The COVID-19 pandemic has reinforced pre-existing vaccine hesitancy. Increasing MMR uptake by reducing vaccine hesitancy requires allocated funding for area-based and targeted domiciliary and community-specific immunisation services and interventions, public health catch-up campaigns and web-based decision aid tools.
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147
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Leung DSY, Ku BHB. Health-seeking, intercultural health communication, and health outcomes: An intersectional study of ethnic minorities' lived experiences. J Adv Nurs 2023; 79:1856-1867. [PMID: 36703289 DOI: 10.1111/jan.15568] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 01/28/2023]
Abstract
AIMS To explore ethnic minorities' lived experiences of health-seeking and healthcare utilization in Hong Kong, and to examine the impact of intersectionality of sociocultural identities on intercultural health communication. DESIGN Qualitative exploratory design. METHODS Data collection methods were semi-structured interviews, unstructured observations, and unstructured informal group discussions. Twenty-five informants, including eight Pakistanis, seven Nepalese, five Indians, four Bangladeshis and one Sri Lankan, were recruited using the snowball sampling method and individually interviewed between 25th June and 23rd September 2019. RESULTS Sixteen females and nine males, aged 21-76 years, were in the study. Two-thirds could communicate in English, but eight required interpreters. Thematic analysis reveals four factors affecting intercultural health communication: healthcare professionals' cultural insensitivity, red-tapism and ethnic minorities' language improficiency and/or deficiency in medical knowledge. Health professionals' workplace stress and cultural insensitivity prompt ineffective intercultural communication, making ethnic minority patients feel disrespected despite having adopted the Hong Kong culture. The intersectionality of sociocultural identities plus health professionals' blocking behaviours results in health inequalities. CONCLUSION The unequal power relationship between health professionals and ethnic minority patients may lead to dehumanizing and depersonalized experiences for patients, as humanity is the heart and soul of medicine. Therefore, the government should raise healthcare providers' cultural sensitivity and diversity awareness, and offer ethno-specific care and more interpretation services. IMPACT The study addresses health inequalities among Hong Kong ethnic minority patients with different sociocultural identities. About the impact of ineffective intercultural health communication on health inclusion and health outcomes, policies and practices should ameliorate health professionals' cultural sensitivity, awareness of the unequal power relationship and respect for diversity. PATIENT OR PUBLIC CONTRIBUTION Referred by organizations serving ethnic minorities, the minority patients shared their lived experiences in health-seeking.
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Affiliation(s)
- Dion Sik-Yee Leung
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Ben Hok-Bun Ku
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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148
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Szende A, Janssen MF, Cabases J, Ramos-Goni JM, Burström K. Socio-demographic indicators of self-reported health based on EQ-5D-3L: A cross-country analysis of population surveys from 18 countries. Front Public Health 2023; 10:959252. [PMID: 36684894 PMCID: PMC9853521 DOI: 10.3389/fpubh.2022.959252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/25/2022] [Indexed: 01/07/2023] Open
Abstract
Background Generic health-related quality of life instruments, such as the EQ-5D, are increasingly used by countries to monitor population health via general population health surveys. Our aim was to demonstrate analytic options to measure socio-demographic differences in self-reported health using the EuroQol Group's archive of EQ-5D-3L population surveys that accumulated over the past two decades. Methods Analyses captured self-reported EQ-5D-3L data on over 100,000 individuals from 18 countries with nationally representative population surveys. Socio-demographic indicators employed were age, sex, educational level and income. Logistic regression odds ratios and the health concentration index methodology were used in the socio-demographic analysis of EQ-5D-3L data. Results Statistically significant socio-demographic differences existed in all countries (p < 0.01) with the EQ VAS based health concentration index varying from 0.090 to 0.157 across countries. Age had generally the largest contributing share, while educational level also had a consistent role in explaining lower levels of self-reported health. Further analysis in a subset of 7 countries with income data showed that, beyond educational level, income itself had an additional significant impact on self-reported health. Among the 5 dimensions of the EQ-5D-3L descriptive system, problems with usual activities and pain/discomfort had the largest contribution to the concentration of overall self-assessed health measured on the EQ VAS in most countries. Conclusion The EQ-5D-3L was shown to be a powerful multi-dimensional instrument in the analyses of socio-demographic differences in self-reported health using various analytic methods. It offered a unique insight of inequalities by health dimensions.
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Affiliation(s)
- Agota Szende
- Global Health Economics and Outcomes Research, Labcorp, Leeds, United Kingdom
| | - Mathieu F. Janssen
- Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, Netherlands
- EuroQol Group, Rotterdam, Netherlands
| | - Juan Cabases
- Department of Economics, Public University of Navarra, Pamplona, Spain
| | | | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Gough Courtney M, Roberts J, Godde K. Structural Inequity and Socioeconomic Status Link to Osteoporosis Diagnosis in a Population-Based Cohort of Middle-Older-Age Americans. Inquiry 2023; 60:469580231155719. [PMID: 36789725 PMCID: PMC9932766 DOI: 10.1177/00469580231155719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 02/16/2023]
Abstract
Socioeconomic status (SES) is an important social determinant of health inequities that has been linked to chronic conditions, including osteoporosis, but research tends to focus on socioeconomic disadvantage rather than how socioeconomic advantage may facilitate these inequities. This study accounts for structural inequities and assesses the relationship between early-life and later-life SES, and risk of osteoporosis diagnosis. Data come from the nationally representative, population-based cohort Health and Retirement Study and include individuals ages 50 to 90. The outcome variable is osteoporosis diagnosis. Logistic regression models of the relationship between SES and osteoporosis diagnosis are estimated, accounting for demographic, health, and childhood variables. Higher levels of childhood and adult SES link to lower odds of osteoporosis diagnosis. Structural inequities in income and underdiagnosis of osteoporosis among persons identifying as Black/African American were detected. Accounting for bone density scan access, inequities in osteoporosis diagnosis appear to stem from barriers to accessing health care due to financial constraints. The important role of SES and evidence of structural inequities leading to underdiagnosis suggest the critical importance of clinicians receiving Diversity, Equity, and Inclusion training to reduce health inequities.
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150
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Lai ETC, Chau PH, Cheung K, Kwan M, Lau K, Woo J. Perception of extreme hot weather and the corresponding adaptations among older adults and service providers-A qualitative study in Hong Kong. Front Public Health 2023; 11:1056800. [PMID: 36875383 PMCID: PMC9980346 DOI: 10.3389/fpubh.2023.1056800] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/09/2023] [Indexed: 02/12/2023] Open
Abstract
Background Extreme hot weather events are happening with increasing frequency, intensity and duration in Hong Kong. Heat stress is related to higher risk of mortality and morbidity, with older adults being particularly vulnerable. It is not clear whether and how the older adults perceive the increasingly hot weather as a health threat, and whether community service providers are aware and prepared for such future climate scenario. Methods We conducted semi-structure interviews with 46 older adults, 18 staff members of community service providers and two district councilors of Tai Po, a north-eastern residential district of Hong Kong. Transcribed data were analyzed using thematic analysis until data saturation was reached. Results It was agreed upon among the older adult participants that the weather in recent years has become increasingly hot and this led to some health and social problems for them, although some participants perceived that hot weather did not have any impact in their daily lives and they were not vulnerable. The community service providers and district councilors reported that there is a lack of relevant services in the community to support the older adults in hot weather; and there is generally a lack of public education regarding the heat-health issue. Conclusions Heatwaves are affecting older adults' health in Hong Kong. Yet, discussions and education effort regarding the heat-health issue in the public domain remain scarce. Multilateral efforts are urgently needed to co-create a heat action plan to improve community awareness and resilience.
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Affiliation(s)
- Eric T C Lai
- Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Pui Hing Chau
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ken Cheung
- Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Michelle Kwan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kevin Lau
- Department of Civil, Environmental and Natural Resources Engineering, Luleå Tekniska Universitet, Luleå, Sweden
| | - Jean Woo
- Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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