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Crellin NE, Herlitz L, Sidhu MS, Ellins J, Georghiou T, Litchfield I, Massou E, Ng PL, Sherlaw‐Johnson C, Tomini SM, Vindrola‐Padros C, Walton H, Fulop NJ. Patient Characteristics Associated With Disparities in Engagement With and Experience of COVID-19 Remote Home Monitoring Services: A Mixed-Methods Evaluation. Health Expect 2024; 27:e14145. [PMID: 39092691 PMCID: PMC11295099 DOI: 10.1111/hex.14145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/29/2024] [Accepted: 06/27/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION The adoption of remote healthcare methods has been accelerated by the COVID-19 pandemic, but evidence suggests that some patients need additional support to engage remotely, potentially increasing health disparities if needs are not met. This study of COVID-19 remote home monitoring services across England explores experiences of and engagement with the service across different patient groups. METHODS This was a mixed-methods study with survey and interview data collected from 28 services across England between February and June 2021. Surveys were conducted with staff and patients and carers receiving the service. Interviews with staff service leads, patients and carers were conducted in 17 sites. Quantitative data were analysed using univariate and multivariate methods, and qualitative data were analysed using thematic analysis. FINDINGS Survey responses were received from 292 staff and 1069 patients and carers. Twenty-three staff service leads, 59 patients and 3 carers were interviewed. Many service leads reported that they had considered inclusivity when adapting the service for their local population; strategies included widening the eligibility criteria, prioritising vulnerable groups and creating referral pathways. However, disparities were reported across patient groups in their experiences and engagement. Older patients reported the service to be less helpful (p = 0.004), were more likely to report a problem (p < 0.001) and had more difficulty in understanding information (p = 0.005). Health status (p = 0.004), ethnicity (p < 0.001), gender (p < 0.001) and employment (p = 0.007) were associated with differential engagement with monitoring, and minority ethnic groups reported more difficulty understanding service information (p = 0.001). Qualitative data found illness severity to be an important factor in the support required, and patients' living situation and social network affected whether they found the service reassuring. CONCLUSION Addressing health disparities must be a key focus in the design and delivery of remote care. Services should be tailored to match the needs of their local population, encourage access through collaboration and referral pathways with other services and monitor their inclusiveness. Involving patients and staff in service design can illuminate the diversity of patients' needs and experiences of care. PATIENT OR PUBLIC CONTRIBUTION The study team met with service user and public members of the BRACE PPI group and patient representatives from RSET in a series of workshops. Workshops informed study design, data collection tools, data interpretation and dissemination activities. Study documents (such as consent forms, topic guides, surveys and information sheets) were reviewed by PPI members; patient surveys and interview guides were piloted, and members also commented on the manuscript.
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Affiliation(s)
| | - Lauren Herlitz
- NIHR Children and Families Policy Research UnitUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Manbinder S. Sidhu
- School of Social Policy, Health Services Management Centre, College of Social SciencesUniversity of BirminghamBirminghamUK
| | - Jo Ellins
- School of Social Policy, Health Services Management Centre, College of Social SciencesUniversity of BirminghamBirminghamUK
| | | | - Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Efthalia Massou
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Pei Li Ng
- Department of Applied Health ResearchUniversity College LondonGower StreetLondonUK
| | | | - Sonila M. Tomini
- Department of Applied Health ResearchUniversity College LondonGower StreetLondonUK
| | | | - Holly Walton
- Department of Applied Health ResearchUniversity College LondonGower StreetLondonUK
| | - Naomi J. Fulop
- Department of Applied Health ResearchUniversity College LondonGower StreetLondonUK
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Guerrero-López CM, Serván-Mori E, Jan S, Downey L, Heredia-Pi I, Orozco-Núñez E, Muradás-Troitiño MDLC, Norton R. Gender disparities in lost productivity resulting from non-communicable diseases in Mexico, 2005-2021. J Glob Health 2024; 14:04121. [PMID: 38818618 PMCID: PMC11140423 DOI: 10.7189/jogh.14.04121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
Background Non-communicable diseases (NCDs) cause long-term impacts on health and can substantially affect people's ability to work. Little is known about how such impacts vary by gender, particularly in low- and middle-income countries (LMICs), where productivity losses may affect economic development. This study assessed the long-term productivity loss caused by major NCDs among adult women and men (20-76 years) in Mexico because of premature death and hospitalisations, between 2005 and 2021. Methods We conducted an economic valuation based on the Human Capital Approach. We obtained population-based data from the National Employment Survey from 2005 to 2021 to estimate the expected productivity according to age and gender using a two-part model. We utilised expected productivity based on wage rates to calculate the productivity loss, employing Mexican official mortality registries and hospital discharge microdata for the same period. To assess the variability in our estimations, we performed sensitivity analyses under two different scenarios. Results Premature mortality by cancers, diabetes, chronic cardiovascular diseases (CVD), chronic respiratory diseases (CRD) and chronic kidney disease (CKD) caused a productivity loss of 102.6 billion international US dollars (Intl. USD) from 2.8 million premature deaths. Seventy-three percent of this productivity loss was observed among men. Cancers caused 38.3% of the productivity loss (mainly among women), diabetes 38.1, CVD 15.1, CRD 3.2, and CKD 5.3%. Regarding hospitalisations, the estimated productivity loss was 729.7 million Intl. USD from 54.2 million days of hospitalisation. Men faced 65.4 and women 34.6% of these costs. Cancers caused 41.3% of the productivity loss mainly by women, followed by diabetes (22.1%), CKD (20.4%), CVD (13.6%) and CRD (2.6%). Conclusions Major NCDs impose substantial costs from lost productivity in Mexico and these tend to be higher amongst men, while for some diseases the economic burden is higher for women. This should be considered to inform policymakers to design effective gender-sensitive health and social protection interventions to tackle the burden of NCDs.
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Affiliation(s)
- Carlos M Guerrero-López
- Center for Health Systems Research, The National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Edson Serván-Mori
- Center for Health Systems Research, The National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Stephen Jan
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, Scotland, UK
- Centre for Health Economics and Policy Innovation, Business School, Imperial College London, London
| | - Laura Downey
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, Scotland, UK
| | - Ileana Heredia-Pi
- Center for Health Systems Research, The National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Emanuel Orozco-Núñez
- Center for Health Systems Research, The National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Robyn Norton
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, Scotland, UK
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Teppo K, Airaksinen KEJ, Jaakkola J, Halminen O, Salmela B, Kouki E, Haukka J, Putaala J, Linna M, Aro AL, Mustonen P, Hartikainen J, Lip GYH, Lehto M. Ischaemic stroke in women with atrial fibrillation: temporal trends and clinical implications. Eur Heart J 2024; 45:1819-1827. [PMID: 38606837 PMCID: PMC11129795 DOI: 10.1093/eurheartj/ehae198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/19/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND AND AIMS Female sex has been linked with higher risk of ischaemic stroke (IS) in atrial fibrillation (AF), but no prior study has examined temporal trends in the IS risk associated with female sex. METHODS The registry-linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study included all patients with AF in Finland from 2007 to 2018. Ischaemic stroke rates and rate ratios were computed. RESULTS Overall, 229 565 patients with new-onset AF were identified (50.0% women; mean age 72.7 years). The crude IS incidence was higher in women than in men across the entire study period (21.1 vs. 14.9 events per 1000 patient-years, P < .001), and the incidence decreased both in men and women. In 2007-08, female sex was independently associated with a 20%-30% higher IS rate in the adjusted analyses, but this association attenuated and became statistically non-significant by the end of the observation period. Similar trends were observed when time with and without oral anticoagulant (OAC) treatment was analysed, as well as when only time without OAC use was considered. The decrease in IS rate was driven by patients with high IS risk, whereas in patients with low or moderate IS risk, female sex was not associated with a higher IS rate. CONCLUSIONS The association between female sex and IS rate has decreased and become non-significant over the course of the study period from 2007 to 2018, suggesting that female sex could be omitted as a factor when estimating expected IS rates and the need for OAC therapy in patients with AF.
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Affiliation(s)
- Konsta Teppo
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Jussi Jaakkola
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Olli Halminen
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Birgitta Salmela
- Department of Internal Medicine, Heart Center, Päijät-Häme Central Hospital, Lahti, Finland
| | - Elis Kouki
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Haukka
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Miika Linna
- Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Aapo L Aro
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pirjo Mustonen
- Heart Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Juha Hartikainen
- Heart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Mika Lehto
- Department of Internal Medicine, Jorvi Hospital, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Orozco-Núñez E, Ojeda-Arroyo E, Cerecer-Ortiz N, Guerrero-López CM, Ramírez-Pérez BM, Heredia-Pi I, Allen-Leigh B, Feeny E, Serván-Mori E. Gender and non-communicable diseases in Mexico: a political mapping and stakeholder analysis. Health Res Policy Syst 2024; 22:46. [PMID: 38605301 PMCID: PMC11007965 DOI: 10.1186/s12961-024-01125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/17/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Mexico and other low- and middle-income countries (LMICs) present a growing burden of non-communicable diseases (NCDs), with gender-differentiated risk factors and access to prevention, diagnosis and care. However, the political agenda in LMICs as it relates to health and gender is primarily focused on sexual and reproductive health rights and preventing violence against women. This research article analyses public policies related to gender and NCDs, identifying political challenges in the current response to women's health needs, and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care in Mexico. METHODS We carried out a political mapping and stakeholder analysis during July-October of 2022, based on structured desk research and interviews with eighteen key stakeholders related to healthcare, gender and NCDs in Mexico. We used the PolicyMaker V5 software to identify obstacles and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care, from the perspective of the political stakeholders interviewed. RESULTS We found as a political obstacle that policies and stakeholders addressing NCDs do not take a gender perspective, while policies and stakeholders addressing gender equality do not adequately consider NCDs. The gendered social and economic aspects of the NCD burden are not widely understood, and the multi-sectoral approach needed to address these aspects is lacking. Economic obstacles show that budget cuts exacerbated by the pandemic are a significant obstacle to social protection mechanisms to support those caring for people living with NCDs. CONCLUSIONS Moving towards an effective, equity-promoting health and social protection system requires the government to adopt an intersectoral, gender-based approach to the prevention and control of NCDs and the burden of NCD care. Despite significant resource constraints, policy innovation may be possible given the willingness among some stakeholders to collaborate, particularly in the labour and legal sectors. However, care will be needed to ensure the implementation of new policies has a positive impact on both gender equity and health outcomes. Research on successful approaches in other contexts can help to identify relevant learnings for Mexico.
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Affiliation(s)
- Emanuel Orozco-Núñez
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | - Enai Ojeda-Arroyo
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | - Nadia Cerecer-Ortiz
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | - Carlos M Guerrero-López
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | | | - Ileana Heredia-Pi
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | - Betania Allen-Leigh
- Center for Population Health Research, The National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Emma Feeny
- The George Institute for Global Health, Sidney, Australia
| | - Edson Serván-Mori
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico.
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de Jesus GM, Dias LA, Barros AKC, Araujo LDMDS, Schrann MMF. Do girls wash dishes and boys play sports? Gender inequalities in physical activity and in the use of screen-based devices among schoolchildren from urban and rural areas in Brazil. BMC Public Health 2024; 24:196. [PMID: 38229021 PMCID: PMC10792968 DOI: 10.1186/s12889-024-17672-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVE The aim of the study was to analyze gender inequalities in types of physical activity (PA) and in the use of screen-based devices among schoolchildren from both urban and rural areas in Brazil. METHODS Data from two population-based surveys conducted in 2019 (urban areas: n = 2,479; 52.6% girls; age = 9.2 ± 1.51 years) and 2022 (rural areas: n = 979; 42.6% girls; age = 9.4 ± 1.52 years) were used. PA (active play, nonactive play, home chores, and structured physical activities) and the use of screen-based devices (TV, cellphone, videogame, and computer) were self-reported in a previous-day-recall online questionnaire (Web-CAAFE). Absolute gender inequalities were evaluated and presented as equiplots. Relative gender inequalities were evaluated by the prevalence ratio (PR) and respective 95% confidence intervals (95% CI), which were estimated by Poisson regression, with adjustments for age and BMI z scores. RESULTS Girls from urban and rural areas presented a lower prevalence of active play and a higher prevalence of home chores. The prevalence of nonactive play among girls from urban areas was also lower; however, their prevalence of structured physical activities was higher, especially among girls aged seven to nine years. Girls in both urban and rural areas presented a higher prevalence of TV viewing and lower use of video games. CONCLUSION The gender inequalities observed in the types of physical activities and in the use of screen-based devices could be considered potential correlates of the likelihood of girls' and boys' compliance with the physical activity guidelines.
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Affiliation(s)
- Gilmar Mercês de Jesus
- Public Health Post-Graduate Program, State University of Feira de Santana, Travessa Pássaro Vermelho,32, Santa Mônica II, CEP: 44082- 320, Feira de Santana, Brazil.
| | - Lizziane Andrade Dias
- Public Health Post-Graduate Program, State University of Feira de Santana, Travessa Pássaro Vermelho,32, Santa Mônica II, CEP: 44082- 320, Feira de Santana, Brazil
| | - Anna Karolina Cerqueira Barros
- Public Health Post-Graduate Program, State University of Feira de Santana, Travessa Pássaro Vermelho,32, Santa Mônica II, CEP: 44082- 320, Feira de Santana, Brazil
| | - Lara Daniele Matos Dos Santos Araujo
- Public Health Post-Graduate Program, State University of Feira de Santana, Travessa Pássaro Vermelho,32, Santa Mônica II, CEP: 44082- 320, Feira de Santana, Brazil
| | - Mayva Mayana Ferreira Schrann
- Public Health Post-Graduate Program, State University of Feira de Santana, Travessa Pássaro Vermelho,32, Santa Mônica II, CEP: 44082- 320, Feira de Santana, Brazil
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Shen H, Zhao H, Wang B, Jiang Y. Women's status, empowerment, and utilization of skilled delivery services in Papua New Guinea: an empirical analysis based on structural equation modeling. Front Public Health 2024; 11:1192966. [PMID: 38269389 PMCID: PMC10807043 DOI: 10.3389/fpubh.2023.1192966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
Background Skilled birth attendants (SBA) facilitate identifying and overcoming labor problems and saving lives. With one of the highest maternal death rates in the Asia-Pacific area, SBA utilization during childbirth among Papua New Guinea (PNG) women remains low. Women's status and empowerment are important factors in maternal and child health services and critical to maternal and child health development. This study is intended to apply structural equation modeling based on data from the Demographic and Health Survey (DHS) to evaluate the causal relationship between women's status, empowerment, and SBA utilization in PNG and the mechanisms of their influence. Methods This study employed data from the 2016-2018 Papua New Guinea Demographic Health Survey (PNG DHS), which recruited 18,175 women aged 15-49 years. A multi-stage sample and a structured questionnaire were used to collect information on maternal health, women's empowerment, and related topics. STATA 17.0 was used to describe the data, while MPLUS 8.2 was employed for structural equation modeling and pathway analysis. Results The two empowerment dimensions of household decision-making (standardized path coefficient, β = 0.049, p < 0.05) and access to health services (β = 0.069, p < 0.01) were positively associated with SBA utilization, while the association between attitudes toward partner violence and SBA utilization was not statistically significant. In addition, mediation analysis revealed that education indirectly influenced SBA utilization through access to health services (β = 0.011, 95% CI: 0.002, 0.022). Conclusion The findings confirmed the direct and indirect effects of women's status and empowerment on SBA utilization in PNG. Therefore, a call for further evidence-based interventions in PNG and possibly Pacific Small Island Developing States (PSIDS) is needed to improve women's educational attainment, household decision-making, and access to health services to enhance maternal and newborn health and well-being.
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Affiliation(s)
- Hao Shen
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Hang Zhao
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Baoqin Wang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Yi Jiang
- School of Public Health, Chongqing Medical University, Chongqing, China
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Comeau D, Johnson C, Bouhamdani N. Review of current 2SLGBTQIA+ inequities in the Canadian health care system. Front Public Health 2023; 11:1183284. [PMID: 37533535 PMCID: PMC10392841 DOI: 10.3389/fpubh.2023.1183284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
Gender identity and sexual orientation are determinants of health that can contribute to health inequities. In the 2SLGBTQIA+ community, belonging to a sexual and/or gender minority group leads to a higher risk of negative health outcomes such as depression, anxiety, and cancer, as well as maladaptive behaviors leading to poorer health outcomes such as substance abuse and risky sexual behavior. Empirical evidence suggests that inequities in terms of accessibility to health care, quality of care, inclusivity, and satisfaction of care, are pervasive and entrenched in the health care system. A better understanding of the current Canadian health care context for individuals of the 2SLGBTQIA+ community is imperative to inform public policy and develop sensitive public health interventions to make meaningful headway in reducing inequity. Our search strategy was Canadian-centric and aimed at highlighting the current state of 2SLGBTQIA+ health inequities in Canada. Discrimination, patient care and access to care, education and training of health care professionals, and crucial changes at the systemic and infrastructure levels have been identified as main themes in the literature. Furthermore, we describe health care-related disparities in the 2SLGBTQIA+ community, and present available resources and guidelines that can guide healthcare providers in narrowing the gap in inequities. Herein, the lack of training for both clinical and non-clinical staff has been identified as the most critical issue influencing health care systems. Researchers, educators, and practitioners should invest in health care professional training and future research should evaluate the effectiveness of interventions on staff attitudinal changes toward the 2SLGBTQIA+ community and the impact on patient outcomes.
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Affiliation(s)
- Dominique Comeau
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
| | - Claire Johnson
- School of Public Policy Studies, Université de Moncton, Moncton, NB, Canada
| | - Nadia Bouhamdani
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
- Medicine and Health Sciences Faculty, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Moncton, Moncton, NB, Canada
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Bartel D, Coile A, Zou A, Martinez Valle A, Nyasulu HM, Brenzel L, Orobaton N, Saxena S, Addy P, Strother S, Ogundimu M, Banerjee B, Kasungami D. Exploring system drivers of gender inequity in development assistance for health and opportunities for action. Gates Open Res 2023; 6:114. [PMID: 37593453 PMCID: PMC10427755 DOI: 10.12688/gatesopenres.13639.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/19/2023] Open
Abstract
Background : Deep-rooted and widespread gender-based bias and discrimination threaten achievement of the Sustainable Development Goals. Despite evidence that addressing gender inequities contributes to better health and development outcomes, the resources for, and effectiveness of, such efforts in development assistance for health (DAH) have been insufficient. This paper explores systemic challenges in DAH that perpetuate or contribute to gender inequities, with a particular focus on the role of external donors and funders. Methods: We applied a co-creation system design process to map and analyze interactions between donors and recipient countries, and articulate drivers of gender inequities within the landscape of DAH. We conducted qualitative primary data collection and analysis in 2021 via virtual facilitated discussions and visual mapping exercises among a diverse set of 41 stakeholders, including representatives from donor institutions, country governments, academia, and civil society. Results: Six systemic challenges emerged as perpetuating or contributing to gender inequities in DAH: 1) insufficient input and leadership from groups affected by gender bias and discrimination; 2) decision-maker blind spots inhibit capacity to address gender inequities; 3) imbalanced power dynamics contribute to insufficient resources and attention to gender priorities; 4) donor funding structures limit efforts to effectively address gender inequities; 5) fragmented programming impedes coordinated attention to the root causes of gender inequities; and 6) data bias contributes to insufficient understanding of and attention to gender inequities. Conclusions : Many of the drivers impeding progress on gender equity in DAH are embedded in power dynamics that distance and disempower people affected by gender inequities. Overcoming these dynamics will require more than technical solutions. Groups affected by gender inequities must be centered in leadership and decision-making at micro and macro levels, with practices and structures that enable co-creation and mutual accountability in the design, implementation, and evaluation of health programs.
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Affiliation(s)
- Doris Bartel
- Independent, Washington, District of Columbia, USA
| | - Amanda Coile
- JSI Research and Training Institute, Inc., Arlington, Virginia, 22202, USA
| | - Annette Zou
- Global ChangeLabs, Portola Valley, California, 94028, USA
| | - Adolfo Martinez Valle
- Health Policy and Population Research Center (CIPPS), Universidad Nacional Autónoma de México, Mexico City, 04510, Mexico
| | | | - Logan Brenzel
- Bill & Melinda Gates Foundation, Seattle, Washington, 98109, USA
| | - Nosa Orobaton
- Bill & Melinda Gates Foundation, Seattle, Washington, 98109, USA
| | - Sweta Saxena
- U.S. Agency for International Development (USAID), Washington, District of Columbia, 20523, USA
| | - Paulina Addy
- Women in Agricultural Development, Ministry of Food and Agriculture, Accra, Ghana
| | - Sita Strother
- JSI Research and Training Institute, Inc., Arlington, Virginia, 22202, USA
| | | | - Banny Banerjee
- Global ChangeLabs, Portola Valley, California, 94028, USA
| | - Dyness Kasungami
- JSI Research and Training Institute, Inc., Arlington, Virginia, 22202, USA
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Fulop NJ, Walton H, Crellin N, Georghiou T, Herlitz L, Litchfield I, Massou E, Sherlaw-Johnson C, Sidhu M, Tomini SM, Vindrola-Padros C, Ellins J, Morris S, Ng PL. A rapid mixed-methods evaluation of remote home monitoring models during the COVID-19 pandemic in England. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-151. [PMID: 37800997 DOI: 10.3310/fvqw4410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Background Remote home monitoring services were developed and implemented for patients with COVID-19 during the pandemic. Patients monitored blood oxygen saturation and other readings (e.g. temperature) at home and were escalated as necessary. Objective To evaluate effectiveness, costs, implementation, and staff and patient experiences (including disparities and mode) of COVID-19 remote home monitoring services in England during the COVID-19 pandemic (waves 1 and 2). Methods A rapid mixed-methods evaluation, conducted in two phases. Phase 1 (July-August 2020) comprised a rapid systematic review, implementation and economic analysis study (in eight sites). Phase 2 (January-June 2021) comprised a large-scale, multisite, mixed-methods study of effectiveness, costs, implementation and patient/staff experience, using national data sets, surveys (28 sites) and interviews (17 sites). Results Phase 1 Findings from the review and empirical study indicated that these services have been implemented worldwide and vary substantially. Empirical findings highlighted that communication, appropriate information and multiple modes of monitoring facilitated implementation; barriers included unclear referral processes, workforce availability and lack of administrative support. Phase 2 We received surveys from 292 staff (39% response rate) and 1069 patients/carers (18% response rate). We conducted interviews with 58 staff, 62 patients/carers and 5 national leads. Despite national roll-out, enrolment to services was lower than expected (average enrolment across 37 clinical commissioning groups judged to have completed data was 8.7%). There was large variability in implementation of services, influenced by patient (e.g. local population needs), workforce (e.g. workload), organisational (e.g. collaboration) and resource (e.g. software) factors. We found that for every 10% increase in enrolment to the programme, mortality was reduced by 2% (95% confidence interval: 4% reduction to 1% increase), admissions increased by 3% (-1% to 7%), in-hospital mortality fell by 3% (-8% to 3%) and lengths of stay increased by 1.8% (-1.2% to 4.9%). None of these results are statistically significant. We found slightly longer hospital lengths of stay associated with virtual ward services (adjusted incidence rate ratio 1.05, 95% confidence interval 1.01 to 1.09), and no statistically significant impact on subsequent COVID-19 readmissions (adjusted odds ratio 0.95, 95% confidence interval 0.89 to 1.02). Low patient enrolment rates and incomplete data may have affected chances of detecting possible impact. The mean running cost per patient varied for different types of service and mode; and was driven by the number and grade of staff. Staff, patients and carers generally reported positive experiences of services. Services were easy to deliver but staff needed additional training. Staff knowledge/confidence, NHS resources/workload, dynamics between multidisciplinary team members and patients' engagement with the service (e.g. using the oximeter to record and submit readings) influenced delivery. Patients and carers felt services and human contact received reassured them and were easy to engage with. Engagement was conditional on patient, support, resource and service factors. Many sites designed services to suit the needs of their local population. Despite adaptations, disparities were reported across some patient groups. For example, older adults and patients from ethnic minorities reported more difficulties engaging with the service. Tech-enabled models helped to manage large patient groups but did not completely replace phone calls. Limitations Limitations included data completeness, inability to link data on service use to outcomes at a patient level, low survey response rates and under-representation of some patient groups. Future work Further research should consider the long-term impact and cost-effectiveness of these services and the appropriateness of different models for different groups of patients. Conclusions We were not able to find quantitative evidence that COVID-19 remote home monitoring services have been effective. However, low enrolment rates, incomplete data and varied implementation reduced our chances of detecting any impact that may have existed. While services were viewed positively by staff and patients, barriers to implementation, delivery and engagement should be considered. Study registration This study is registered with the ISRCTN (14962466). Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (RSET: 16/138/17; BRACE: 16/138/31) and NHSEI and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 13. See the NIHR Journals Library website for further project information. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.
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Affiliation(s)
- Naomi J Fulop
- Department of Applied Health Research, University College London, UK
| | - Holly Walton
- Department of Applied Health Research, University College London, UK
| | | | | | - Lauren Herlitz
- Department of Applied Health Research, University College London, UK
| | - Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Efthalia Massou
- Department of Public Health and Primary Care, University of Cambridge, UK
| | | | - Manbinder Sidhu
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Sonila M Tomini
- Department of Applied Health Research, University College London, UK
| | | | - Jo Ellins
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Pei Li Ng
- Department of Applied Health Research, University College London, UK
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10
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Rifà‐Ros MR, Rodríguez‐Monforte M, Carrillo‐Alvarez E, Silva LB, Pallarés‐Marti A, Gasch‐Gallen A. Analysis of gender perspective in the use of NANDA-I nursing diagnoses: A systematic review. Nurs Open 2023; 10:1305-1326. [PMID: 36322639 PMCID: PMC9912414 DOI: 10.1002/nop2.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/07/2022] [Accepted: 10/02/2022] [Indexed: 02/11/2023] Open
Abstract
AIM To identify, describe and analyse the gender perspective in the use of the diagnoses contained in the NANDA-I taxonomy in observational studies published in the scientific literature. DESIGN AND METHODS A systematic review has been conducted spanning from 2002 to 2020. The most frequent NANDA-I nursing diagnoses in care plans reported in observational studies, and the defining characteristics and related factors identified for men and women have been described. The Preferred Reporting Items for Systematic Reviews (PRISMA-P) have guided our research. The main findings have been summarized using a descriptive narrative synthesis approach. RESULTS Forty-one articles were included in our study. With regard to gender analysis, the percentage of men and women that make up the sample were not specified in all articles, and half of the studies did not identify gender either in the diagnosis label or in their defining characteristics or related factors. Based on the reviewed articles, gender perspectives are not systematically incorporated in the use of the NANDA-I diagnosis. Therefore, gender biases in its use in the scientific literature may exist. This situation poses barriers to determine the health responses that are different and unequal between women and men.
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Affiliation(s)
- Mª Rosa Rifà‐Ros
- Blanquerna School of Health SciencesRamon Llull UniversityBarcelonaSpain
- Global Research on Wellbeing (GRoW) Research GroupBarcelonaSpain
| | - Míriam Rodríguez‐Monforte
- Blanquerna School of Health SciencesRamon Llull UniversityBarcelonaSpain
- Global Research on Wellbeing (GRoW) Research GroupBarcelonaSpain
| | - Elena Carrillo‐Alvarez
- Blanquerna School of Health SciencesRamon Llull UniversityBarcelonaSpain
- Global Research on Wellbeing (GRoW) Research GroupBarcelonaSpain
| | | | - Angela Pallarés‐Marti
- Blanquerna School of Health SciencesRamon Llull UniversityBarcelonaSpain
- Global Research on Wellbeing (GRoW) Research GroupBarcelonaSpain
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11
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Pinho-Gomes AC, Peters SAE, Woodward M. Gender equality related to gender differences in life expectancy across the globe gender equality and life expectancy. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001214. [PMID: 36963039 PMCID: PMC10021358 DOI: 10.1371/journal.pgph.0001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/13/2023] [Indexed: 03/08/2023]
Abstract
Life expectancy (LE) depends on the wider determinants of health, many of which have gendered effects worldwide. Therefore, this study aimed to investigate whether gender equality was associated with LE for women and men and the gender gap in LE across the globe. Gender equality in 156 countries was estimated using a modified global gender gap index (mGGGI), based on the index developed by the World Economic Forum between 2010 and 2021. Linear regression was used to investigate the association between the mGGGI and its economic, political, and education subindices and the gender gap in LE and women and men's LE. Overall, the mGGGI increased from 58% in 2010 to 62% in 2021. Globally, changes in the mGGGI and its economic and political subindexes were not associated with changes in the gender gap in LE or with LE for women and men between 2010 and 2020. Improvements in gender equality in education were associated with a longer LE for women and men and widening of the gender gap in LE. In 2021, each 10% increase in the mGGGI was associated with a 4.3-month increase in women's LE and a 3.5-month increase in men's LE, and thus with an 8-month wider gender gap. However, the direction and magnitude of these associations varied between regions. Each 10% increase in the mGGGI was associated with a 6-month narrower gender gap in high-income countries, and a 13- and 16-month wider gender gap in South and Southeast Asia and Oceania, and in Sub-Saharan Africa, respectively. Globally, greater gender equality is associated with longer LE for both women and men and a widening of the gender gap in LE. The variation in this association across world regions suggests that gender equality may change as countries progress towards socioeconomic development and gender equality.
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Affiliation(s)
- Ana-Catarina Pinho-Gomes
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Sanne A E Peters
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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12
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Bartel D, Coile A, Zou A, Martinez Valle A, Nyasulu HM, Brenzel L, Orobaton N, Saxena S, Addy P, Strother S, Ogundimu M, Banerjee B, Kasungami D. Exploring system drivers of gender inequity in development assistance for health and opportunities for action. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13639.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Deep-rooted and widespread gender-based bias and discrimination threaten achievement of the Sustainable Development Goals. Despite evidence that addressing gender inequities contributes to better health and development outcomes, the resources for, and effectiveness of, such efforts in development assistance for health (DAH) have been insufficient. This paper explores systemic challenges in DAH that perpetuate or contribute to gender inequities, with a particular focus on the role of external donors and funders. Methods: We applied a co-creation system design process to map and analyze interactions between donors and recipient countries, and articulate drivers of gender inequities within the landscape of DAH. We conducted qualitative primary data collection and analysis in 2021 via virtual facilitated discussions and visual mapping exercises among a diverse set of 41 stakeholders, including representatives from donor institutions, country governments, academia, and civil society. Results: Six systemic challenges emerged as perpetuating or contributing to gender inequities in DAH: 1) insufficient input and leadership from groups affected by gender bias and discrimination; 2) decision-maker blind spots inhibit capacity to address gender inequities; 3) imbalanced power dynamics contribute to insufficient resources and attention to gender priorities; 4) donor funding structures limit efforts to effectively address gender inequities; 5) fragmented programming impedes coordinated attention to the root causes of gender inequities; and 6) data bias contributes to insufficient understanding of and attention to gender inequities. Conclusions: Many of the drivers impeding progress on gender equity in DAH are embedded in power dynamics that distance and disempower people affected by gender inequities. Overcoming these dynamics will require more than technical solutions. Groups affected by gender inequities must be centered in leadership and decision-making at micro and macro levels, with practices and structures that enable co-creation and mutual accountability in the design, implementation, and evaluation of health programs.
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13
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Wandschneider L, Miani C, Razum O. Decomposing intersectional inequalities in subjective physical and mental health by sex, gendered practices and immigration status in a representative panel study from Germany. BMC Public Health 2022; 22:683. [PMID: 35392864 PMCID: PMC8991479 DOI: 10.1186/s12889-022-13022-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 03/16/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The mapping of immigration-related health inequalities remains challenging, since immigrant populations constitute a heterogenous socially constructed group whose health experiences differ by social determinants of health. In spite of the increasing awareness that population mobility and its effects on health are highly gendered, an explicit gender perspective in epidemiology is often lacking or limited. METHODS To map inequalities in self-reported physical and mental health in Germany at the intersections of sex, gendered practices and immigration status, we used data from the German Socioeconomic Panel (SOEP) and applied an intercategorical intersectional approach conducting multilevel linear regression models. We differentiated between sex (male/female) as reported in the survey and gendered social practices, quantified through a gender score (on a femininity-masculinity continuum). RESULTS We included 20,897 participants in our analyses. We saw an intersectional gradient for physical and mental health. Compared to the reference group, i.e. non-immigrant males with masculine gendered practices, physical and mental health steadily decreased in the intersectional groups that did not embody one or more of these social positions. The highest decreases in health were observed in the intersectional group of immigrant females with feminine gendered practices for physical health (-1,36; 95% CI [-2,09; -0,64]) and among non-immigrant females with feminine practices for mental health (-2,51; 95% CI [-3,01; -2,01]). CONCLUSIONS Patterns of physical and mental health vary along the intersectional axes of sex, gendered practices and immigration status. These findings highlight the relevance of intersections in describing population health statuses and emphasise the need to take them into account when designing public health policies aiming at effectively reducing health inequalities.
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Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitaetsstr. 25, 33615, Bielefeld, Germany.
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitaetsstr. 25, 33615, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitaetsstr. 25, 33615, Bielefeld, Germany
- Research Institute Social Cohesion (RISC), Bielefeld University, Bielefeld, Germany
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14
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Daher M, Al Rifai M, Kherallah RY, Rodriguez F, Mahtta D, Michos ED, Khan SU, Petersen LA, Virani SS. Gender disparities in difficulty accessing healthcare and cost-related medication non-adherence: The CDC behavioral risk factor surveillance system (BRFSS) survey. Prev Med 2021; 153:106779. [PMID: 34487748 PMCID: PMC9291436 DOI: 10.1016/j.ypmed.2021.106779] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/21/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
Ensuring healthcare access is critical to maintain health and prevent illness. Studies demonstrate gender disparities in healthcare access. Less is known about how these vary with age, race/ethnicity, and atherosclerotic cardiovascular disease. We utilized cross-sectional data from 2016 to 2019 CDC Behavioral Risk Factor Surveillance System (BRFSS), a U.S. telephone-based survey of adults (≥18 years). Measures of difficulty accessing healthcare included absence of healthcare coverage, delay in healthcare access, absence of primary care physician, >1-year since last checkup, inability to see doctor due to cost, and cost-related medication non-adherence. We studied the association between gender and these variables using multivariable-adjusted logistic regression models, stratifying by age, race/ethnicity, and atherosclerotic cardiovascular disease status. Our population consisted of 1,737,397 individuals; 54% were older (≥45 years), 51% women, 63% non-Hispanic White, 12% non-Hispanic Black,17% Hispanic, 9% reported atherosclerotic cardiovascular disease. In multivariable-adjusted models, women were more likely to report delay in healthcare access: odds ratio (OR) and (95% confidence interval): 1.26 (1.11, 1.43) [p < 0.001], inability to see doctor due to cost: 1.29 (1.22, 1.36) [p < 0.001], cost-related medication non-adherence: 1.24 (1.01, 1.50) [p = 0.04]. Women were less likely to report lack of healthcare coverage: 0.71 (0.66, 0.75) [p < 0.001] and not having a primary care physician: 0.50 (0.48, 0.52) [p < 0.001]. Disparities were pronounced in younger (<45 years) and Black women. Identifying these barriers, particularly among younger women and Black women, is crucial to ensure equitable healthcare access to all individuals.
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Affiliation(s)
- Marilyne Daher
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Riyad Y Kherallah
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Research Institute, Stanford University, Stanford, CA, United States of America
| | - Dhruv Mahtta
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Erin D Michos
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, United States of America
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Laura A Petersen
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States of America; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Salim S Virani
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States of America; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America.
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15
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Chilet-Rosell E, Hernández-Aguado I. Solving gender gaps in health, what else is missing? GACETA SANITARIA 2021; 36:45-47. [PMID: 34763942 PMCID: PMC8754416 DOI: 10.1016/j.gaceta.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/27/2021] [Accepted: 10/02/2021] [Indexed: 11/25/2022]
Abstract
In recent years, a great deal of attention has been paid to gender inequities in health. However, while we have a good body of evidence on the impact of gender on the health and vulnerability of women and men, we have not yet been able to generate sufficient evidence on effective interventions that can transform this situation or can influence public health policy making. Only a limited number of educational interventions on gender-sensitivity, gender bias in clinical practice and policies to tackle gender inequalities in health have been formulated, implemented and evaluated. Even in the current pandemic situation caused by SARS-CoV2, we have seen the lack of gender mainstreaming reflected in the global response. This happens even when we have tools that facilitate the formulation and implementation of actions to reduce gender inequities in health. We consider that the current initiatives organized to carry out advocacy activities on gender inequity in health to be very positive. In the same line of these initiatives, we propose that while academic and institutional research on gender and health remains essential, we need to shift the focus towards action. In order to move forward, we need public health researchers questioning what public health practice need to do to address gender inequities and shake structural and social power inequities in order to increase the gender equity in health.
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Affiliation(s)
- Elisa Chilet-Rosell
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Sant Joan d'Alacant, Alacant, Spain.
| | - Ildefonso Hernández-Aguado
- Department of Public Health, History of Science and Gynaecology, School of Medicine, University Miguel Hernández, Sant Joan d'Alacant, Alacant, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
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16
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Llorente-Marrón M, Fontanil-Gómez Y, Díaz-Fernández M, Solís García P. Disasters, Gender, and HIV Infection: The Impact of the 2010 Haiti Earthquake. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7198. [PMID: 34281135 PMCID: PMC8293795 DOI: 10.3390/ijerph18137198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 12/14/2022]
Abstract
Although disasters threaten all people who experience them, they do not affect all members of society in the same way. Its effects are not solely restricted to the economic sphere; they also affect the physical and mental health of those who suffer from them, having a particular impact on women and limiting their life chances. The aim of this study was to examine the impact the 2010 Haiti earthquake had on the seropositivity of female survivors. METHOD Using data from the Demographic and Health Survey, this study examines the impact of the 2010 Haiti earthquake on gender relations associated with the probability of being HIV positive through the differences-in-differences strategy. RESULTS A differential of four percentage points is observed in the probability of HIV seropositivity between men and women, favoring men. Additionally, it is observed that the probability of seropositivity intensifies when the cohabitation household is headed by a woman. CONCLUSION Disasters are not indifferent to the gender of the people affected. In the second decade of the 21st century, the conclusions obtained show, once again, the need for incorporating the gender perspective into the management of natural hazards in the field of health. This is the case of the differential exposure to HIV after the earthquake in Haiti.
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Affiliation(s)
- Mar Llorente-Marrón
- Quantitative Economics Department, University of Oviedo, 33006 Oviedo, Spain;
| | | | | | - Patricia Solís García
- Psychology Department, University of Oviedo, 33003 Oviedo, Spain; (Y.F.-G.); (P.S.G.)
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17
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Evagora-Campbell M, Borkotoky K, Sharma S, Mbuthia M. From routine data collection to policy design: sex and gender both matter in COVID-19. Lancet 2021; 397:2447-2449. [PMID: 34118998 PMCID: PMC8192088 DOI: 10.1016/s0140-6736(21)01326-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 12/17/2022]
Affiliation(s)
| | | | - Sneha Sharma
- International Center for Research on Women, New Delhi, India
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