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Sogbodjor LA, Razavi C, Williams K, Selman A, Pereira SMP, Davenport M, Moonesinghe SR. Risk factors for complications after emergency surgery for paediatric appendicitis: a national prospective observational cohort study. Anaesthesia 2024; 79:524-534. [PMID: 38387160 DOI: 10.1111/anae.16184] [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] [Accepted: 10/17/2023] [Indexed: 02/24/2024]
Abstract
Appendicectomy is a common procedure in children with a low risk of mortality, however, complication rates and risk factors are largely unknown. This study aimed to characterise the incidence and epidemiology of postoperative complications in children undergoing appendicectomy in the UK. This multicentre prospective observational cohort study, which included children aged 1-16 y who underwent surgery for suspected appendicitis, was conducted between November 2019 and January 2022. The primary outcome was 30-day postoperative morbidity. Data collected included: patient characteristics; comorbidities; and physiological status. Multivariable regression analysis was used to identify independent risk factors for poor outcomes. Data from 2799 children recruited from 80 hospitals were analysed, of which 185 (7%) developed postoperative complications. Children from black and 'other' minority ethnic groups were at significantly higher risk of poor outcomes: OR (95%CI) 4.13 (1.87-9.08), p < 0.001 and 2.08 (1.12-3.87), p = 0.021, respectively. This finding was independent of socio-economic status and type of appendicitis found on histology. Other risk factors for complications included: ASA physical status ≥ 3 (OR (95%CI) 4.05 (1.70-9.67), p = 0.002); raised C-reactive protein (OR 95%CI 1.01 (1.00-1.01), p < 0.001); pyrexia (OR (95%CI) 1.77(1.20-2.63), p = 0.004); and peri-operative oxygen supplementation (OR (95%CI) 4.20 (1.44-12.24), p = 0.009). In the UK NHS, which is a universally accessible healthcare system, ethnicity, but not socio-economic status, was associated with an increased risk of postoperative complications in children having surgery for acute appendicitis. Further evaluations and interventions are required to address this health inequality in keeping with NHS and international priorities.
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Affiliation(s)
- L A Sogbodjor
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Centre for Research and Improvement, Royal College of Anaesthetists, London, UK
| | - C Razavi
- Centre for Research and Improvement, Royal College of Anaesthetists, London, UK
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K Williams
- Centre for Research and Improvement, Royal College of Anaesthetists, London, UK
| | - A Selman
- Department of Anaesthesia, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S M Pinto Pereira
- Centre for Peri-operative Medicine, Research Department for Targeted Intervention, UCL Division of Surgery and Interventional Science, London, UK
| | - M Davenport
- Department of Paediatric Surgery, King's College London NHS Foundation Trust, London, UK
| | - S R Moonesinghe
- Centre for Peri-operative Medicine, Research Department for Targeted Intervention, UCL Division of Surgery and Interventional Science, London, UK
- Central London National Institute for Health Research Patient Safety Research Collaboration, London, UK
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Smith SM, Bais B, Ismaili M'hamdi H, Schermer MH, Steegers-Theunissen RP. Stimulating Preconception Care Uptake by Women With a Vulnerable Health Status Through a Mobile Health App (Pregnant Faster): Pilot Feasibility Study. JMIR Hum Factors 2024; 11:e53614. [PMID: 38648092 DOI: 10.2196/53614] [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: 10/12/2023] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND A low socioeconomic status is associated with a vulnerable health status (VHS) through the accumulation of health-related risk factors, such as poor lifestyle behaviors (eg, inadequate nutrition, chronic stress, and impaired health literacy). For pregnant women, a VHS translates into a high incidence of adverse pregnancy outcomes and therefore pregnancy-related inequity. We hypothesize that stimulating adequate pregnancy preparation, targeting lifestyle behaviors and preconception care (PCC) uptake, can reduce these inequities and improve the pregnancy outcomes of women with a VHS. A nudge is a behavioral intervention aimed at making healthy choices easier and more attractive and may therefore be a feasible way to stimulate engagement in pregnancy preparation and PCC uptake, especially in women with a VHS. To support adequate pregnancy preparation, we designed a mobile health (mHealth) app, Pregnant Faster, that fits the preferences of women with a VHS and uses nudging to encourage PCC consultation visits and engagement in education on healthy lifestyle behaviors. OBJECTIVE This study aimed to test the feasibility of Pregnant Faster by determining usability and user satisfaction, the number of visited PCC consultations, and the course of practical study conduction. METHODS Women aged 18-45 years, with low-to-intermediate educational attainment, who were trying to become pregnant within 12 months were included in this open cohort. Recruitment took place through social media, health care professionals, and distribution of flyers and posters from September 2021 until June 2022. Participants used Pregnant Faster daily for 4 weeks, earning coins by reading blogs on pregnancy preparation, filling out a daily questionnaire on healthy lifestyle choices, and registering for a PCC consultation with a midwife. Earned coins could be spent on rewards, such as fruit, mascara, and baby products. Evaluation took place through the mHealth App Usability Questionnaire (MAUQ), an additional interview or questionnaire, and assessment of overall study conduction. RESULTS Due to limited inclusions, the inclusion criterion "living in a deprived neighborhood" was dropped. This resulted in the inclusion of 47 women, of whom 39 (83%) completed the intervention. In total, 16 (41%) of 39 participants visited a PCC consultation, with their main motivation being obtaining personalized information. The majority of participants agreed with 16 (88.9%) of 18 statements of the MAUQ, indicating high user satisfaction. The mean rating was 7.7 (SD 1.0) out of 10. Points of improvement included recruitment of the target group, simplification of the log-in system, and automation of manual tasks. CONCLUSIONS Nudging women through Pregnant Faster to stimulate pregnancy preparation and PCC uptake has proven feasible, but the inclusion criteria must be revised. A substantial number of PCC consultations were conducted, and this study will therefore be continued with an open cohort of 400 women, aiming to establish the (cost-)effectiveness of an updated version, named Pregnant Faster 2. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/45293.
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Affiliation(s)
- Sharissa M Smith
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Babette Bais
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Hafez Ismaili M'hamdi
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Maartje Hn Schermer
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
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Choy MA, O'Brien K, Barnes K, Sturgiss EA, Rieger E, Douglas K. Evaluating the Digital Health Experience for Patients in Primary Care: Mixed Methods Study. J Med Internet Res 2024; 26:e50410. [PMID: 38602768 DOI: 10.2196/50410] [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: 07/03/2023] [Revised: 11/30/2023] [Accepted: 01/31/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged, who are already marginalized through reduced access to face-to-face health care, are additionally hindered through less access to patient-initiated digital health. A comprehensive understanding of how patients with socioeconomic disadvantage access and experience digital health is essential for improving the digital health divide. Primary care patients, especially those with chronic disease, have experience of the stages of initial help seeking and self-management of their health, which renders them a key demographic for research on patient-initiated digital health access. OBJECTIVE This study aims to provide comprehensive primary mixed methods data on the patient experience of barriers to digital health access, with a focus on the digital health divide. METHODS We applied an exploratory mixed methods design to ensure that our survey was primarily shaped by the experiences of our interviewees. First, we qualitatively explored the experience of digital health for 19 patients with socioeconomic disadvantage and chronic disease and second, we quantitatively measured some of these findings by designing and administering a survey to 487 Australian general practice patients from 24 general practices. RESULTS In our qualitative first phase, the key barriers found to accessing digital health included (1) strong patient preference for human-based health services; (2) low trust in digital health services; (3) high financial costs of necessary tools, maintenance, and repairs; (4) poor publicly available internet access options; (5) reduced capacity to engage due to increased life pressures; and (6) low self-efficacy and confidence in using digital health. In our quantitative second phase, 31% (151/487) of the survey participants were found to have never used a form of digital health, while 10.7% (52/487) were low- to medium-frequency users and 48.5% (236/487) were high-frequency users. High-frequency users were more likely to be interested in digital health and had higher self-efficacy. Low-frequency users were more likely to report difficulty affording the financial costs needed for digital access. CONCLUSIONS While general digital interest, financial cost, and digital health literacy and empowerment are clear factors in digital health access in a broad primary care population, the digital health divide is also facilitated in part by a stepped series of complex and cumulative barriers. Genuinely improving digital health access for 1 cohort or even 1 person requires a series of multiple different interventions tailored to specific sequential barriers. Within primary care, patient-centered care that continues to recognize the complex individual needs of, and barriers facing, each patient should be part of addressing the digital health divide.
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Affiliation(s)
- Melinda Ada Choy
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
- Academic Unit of General Practice, Office of Professional Leadership and Education, ACT Health Directorate, Canberra, Australia
| | - Kathleen O'Brien
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Katelyn Barnes
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
- Academic Unit of General Practice, Office of Professional Leadership and Education, ACT Health Directorate, Canberra, Australia
| | | | - Elizabeth Rieger
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Kirsty Douglas
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
- Academic Unit of General Practice, Office of Professional Leadership and Education, ACT Health Directorate, Canberra, Australia
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Hu B, Feng J, Wang Y, Hou L, Fan Y. Transnational inequities in cardiovascular diseases from 1990 to 2019: exploration based on the global burden of disease study 2019. Front Public Health 2024; 12:1322574. [PMID: 38633238 PMCID: PMC11021694 DOI: 10.3389/fpubh.2024.1322574] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Background To describe the burden and examine transnational inequities in overall cardiovascular disease (CVD) and ten specific CVDs across different levels of societal development. Methods Estimates of disability-adjusted life-years (DALYs) for each disease and their 95% uncertainty intervals (UI) were extracted from the Global Burden of Diseases (GBD). Inequalities in the distribution of CVD burdens were quantified using two standard metrics recommended absolute and relative inequalities by the World Health Organization (WHO), including the Slope Index of Inequality (SII) and the relative concentration Index. Results Between 1990 and 2019, for overall CVD, the Slope Index of Inequality changed from 3760.40 (95% CI: 3758.26 to 3756.53) in 1990 to 3400.38 (95% CI: 3398.64 to 3402.13) in 2019. For ischemic heart disease, it shifted from 2833.18 (95% CI: 2831.67 to 2834.69) in 1990 to 1560.28 (95% CI: 1559.07 to 1561.48) in 2019. Regarding hypertensive heart disease, the figures changed from-82.07 (95% CI: -82.56 to-81.59) in 1990 to 108.99 (95% CI: 108.57 to 109.40) in 2019. Regarding cardiomyopathy and myocarditis, the data evolved from 273.05 (95% CI: 272.62 to 273.47) in 1990 to 250.76 (95% CI: 250.42 to 251.09) in 2019. Concerning aortic aneurysm, the index transitioned from 104.91 (95% CI: 104.65 to 105.17) in 1990 to 91.14 (95% CI: 90.94 to 91.35) in 2019. Pertaining to endocarditis, the figures shifted from-4.50 (95% CI: -4.64 to-4.36) in 1990 to 16.00 (95% CI: 15.88 to 16.12) in 2019. As for rheumatic heart disease, the data transitioned from-345.95 (95% CI: -346.47 to-345.42) in 1990 to-204.34 (95% CI: -204.67 to-204.01) in 2019. Moreover, the relative concentration Index for overall CVD and each specific type also varied from 1990 to 2019. Conclusion There's significant heterogeneity in transnational health inequality for ten specific CVDs. Countries with higher levels of societal development may bear a relatively higher CVD burden except for rheumatic heart disease, with the extent of inequality changing over time.
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Affiliation(s)
- Ben Hu
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- The Fifth Clinical Medical School of Anhui Medical University, Hefei, Anhui, China
| | - Jun Feng
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Yuhui Wang
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Linlin Hou
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- The Fifth Clinical Medical School of Anhui Medical University, Hefei, Anhui, China
| | - Yinguang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
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Wu L, Liu Q, Li L. Can the household clean energy transition ameliorate health inequality? Evidence from China. Front Public Health 2024; 12:1348234. [PMID: 38590814 PMCID: PMC11000416 DOI: 10.3389/fpubh.2024.1348234] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/04/2024] [Indexed: 04/10/2024] Open
Abstract
China is actively encouraging households to replace traditional solid fuels with clean energy. Based on the Chinese Families Panel Survey (CFPS) data, this paper uses propensity scores matching with the difference-in-differences model to examine the impact of clean energy in the household sector on residents' health status, and whether such an energy transition promotes health equity by favoring relatively disadvantaged social groups. The results show that: (1) The use of cleaner cooking fuels can significantly improve residents' health status; (2) The older adult and women have higher health returns from the clean energy transition, demonstrating that, from the perspective of age and gender, the energy transition contributes to the promotion of health equity; (3) The clean energy transition has a lower or insignificant health impact on residents who cannot easily obtain clean energy or replace non-clean energy at an affordable price. Most of these individuals live in low-income, energy-poor, or rural households. Thus, the energy transition exacerbates health inequalities. This paper suggests that to reduce the cost of using clean energy and help address key issues in health inequality, Chinese government efforts should focus on improving the affordability, accessibility, and reliability of clean energy.
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Affiliation(s)
- Lili Wu
- School of Economics and Management, China University of Petroleum, Beijing, China
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Nie P, Lin X, Ding L. The Role of Childhood Circumstances in Healthy Aging Inequalities Among Older Adults - China, 2011-2020. China CDC Wkly 2024; 6:208-212. [PMID: 38532747 PMCID: PMC10961217 DOI: 10.46234/ccdcw2024.042] [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: 09/02/2023] [Accepted: 02/07/2024] [Indexed: 03/28/2024] Open
Abstract
What is already known about this topic? Addressing health disparities is a worldwide priority, with a well-established acknowledgment of the influence of childhood circumstances on these discrepancies. In China, particularly among the elderly, health inequalities are a notable concern. What is added by this report? The inequality in healthy aging has increased from 2011 to 2020, both in general and concerning childhood factors. Nevertheless, the impact of early-life healthcare access and parental health behaviors on healthy aging gaps has reduced among older adults in better health within the top segment of healthy aging. What are the implications for public health practice? Efforts towards reducing regional health disparities and improving healthcare access for children, along with promoting the health and well-being of parents, especially in economically disadvantaged households, are crucial policy considerations.
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Affiliation(s)
- Peng Nie
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
- Global Health Institute, Xi'an Jiaotong University Health Science Center, Xi'an City, Shaanxi Province, China
| | - Xili Lin
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
| | - Lanlin Ding
- National School of Development, Peking University, Beijing, China
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Perales-Puchalt J, Peltzer J, Fracachan-Cabrera M, Perez GA, Ramírez M, Greiner KA, Burns JM. Authors' Response to Peer Reviews of "Impact of the COVID-19 Pandemic on Latino Families With Alzheimer Disease and Related Dementias: Qualitative Interviews With Family Caregivers and Primary Care Providers". JMIRx Med 2024; 5:e56439. [PMID: 38509604 PMCID: PMC11004510 DOI: 10.2196/56439] [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] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Jaime Perales-Puchalt
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
| | - Jill Peltzer
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Monica Fracachan-Cabrera
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - G Adriana Perez
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Mariana Ramírez
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jeffrey Murray Burns
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
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Perales-Puchalt J, Peltzer J, Fracachan-Cabrera M, Perez GA, Ramírez M, Greiner KA, Burns JM. Impact of the COVID-19 Pandemic on Latino Families With Alzheimer Disease and Related Dementias: Qualitative Interviews With Family Caregivers and Primary Care Providers. JMIRx Med 2024; 5:e42211. [PMID: 38488740 PMCID: PMC11004515 DOI: 10.2196/42211] [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] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/11/2023] [Accepted: 01/13/2024] [Indexed: 03/19/2024]
Abstract
Background Latino individuals experience disparities in the care of Alzheimer disease and related dementias (ADRD) and have disproportionately high COVID-19 infection and death outcomes. Objective We aimed to gain an in-depth understanding of the impact of the COVID-19 pandemic among Latino families with ADRD in the United States. Methods This was a qualitative study of 21 informal caregivers of Latino individuals with ADRD and 23 primary care providers who serve Latino patients. We recruited participants nationwide using convenience and snowball sampling methods and conducted remote interviews in English and Spanish. We organized the transcripts for qualitative review to identify codes and themes, using a pragmatic approach, a qualitative description methodology, and thematic analysis methods. Results Qualitative analysis of transcripts revealed eight themes, including (1) the pandemic influenced mental and emotional health; (2) the pandemic impacted physical domains of health; (3) caregivers and care recipients lost access to engaging activities during the confinement; (4) the pandemic impacted Latino caregivers' working situation; (5) the pandemic impacted health care and community care systems; (6) health care and community care systems took measures to reduce the impact of the pandemic; (7) Latino families experienced barriers to remote communication during the pandemic; and (8) caregiver social support was critical for reducing social isolation and its sequalae. Conclusions Latino families with ADRD experienced similar but also unique impacts compared to those reported in the general population. Unique impacts may result from Latino individuals' underserved status in the United States, commonly held cultural values, and their intersectionality with ADRD-related disability. Family caregiver social support was crucial during this time of adversity. These findings suggest the need for more equitable access, culturally appropriate and trustworthy content and delivery of health care and community services, as well as stronger financial and social supports for family caregivers.
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Affiliation(s)
- Jaime Perales-Puchalt
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
| | - Jill Peltzer
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Monica Fracachan-Cabrera
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - G Adriana Perez
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Mariana Ramírez
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jeffrey Murray Burns
- Department of Neurology, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States
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Alfani G, Bonetti M, Fochesato M. Pandemics and socio-economic status. Evidence from the plague of 1630 in northern Italy. Popul Stud (Camb) 2024; 78:21-42. [PMID: 37161858 DOI: 10.1080/00324728.2023.2197412] [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: 09/24/2021] [Accepted: 11/22/2022] [Indexed: 05/11/2023]
Abstract
This paper investigates the biological, socio-economic, and institutional factors shaping the individual risk of death during a major pre-industrial epidemic. We use a micro-demographic database for an Italian city (Carmagnola) during the 1630 plague to explore in detail the survival dynamics of the population admitted to the isolation hospital (lazzaretto). We develop a theoretical model of admissions to the lazzaretto, for better interpretation of the observational data. We explore how age and sex shaped the individual risk of death, and we provide a one-of-a-kind study of the impact of socio-economic status. We report an inversion of the normal mortality gradient by status for those interned at the lazzaretto. The rich enjoyed a greater ability to make decisions about their hospitalization, but this backfired. Instead, the poor sent to the lazzaretto faced a relatively low risk of death because they enjoyed better conditions than they would have experienced outside the hospital.
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Mebratie AD. Receipt of core antenatal care components and associated factors in Ethiopia: a multilevel analysis. Front Glob Womens Health 2024; 5:1169347. [PMID: 38463748 PMCID: PMC10921939 DOI: 10.3389/fgwh.2024.1169347] [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: 06/12/2023] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
Background Despite recent promising progress, maternal morbidity and mortality are still unacceptably high in Ethiopia. This is partly attributed to the lack of quality health services. Pregnant women may not receive adequate services that are essential to protect the health of women and their unborn children. This study aimed to examine the extent of receiving prenatal care components and associated factors in Ethiopia. It also assessed prenatal service use inequality between urban and rural residents. Methods The analysis was carried out using the 2016 Ethiopian Demographic and Health Survey (EDHS), which is nationally representative survey data. A weighted sample of 4,772 women nested within 595 communities who had live births five years preceding the survey was included in the study. Necessary adjustments were made to account for the design of the survey, and sampling weights were used to adjust for nonproportional allocation of the sample to strata. Bivariate and multivariable multilevel ordered logit models were used to analyze factors associated with receiving comprehensive ANC contents. Statistically significant predictors were identified at p value ≤ 0.05. Results Among those women who had at least one ANC visit, only 15% (95% CI: 13, 16) received six core elements of antenatal care. The proportion of mothers who had essential prenatal components in rural areas was less than 13 percentage points. Approximately 43% of women did not receive at least two doses of tetanus toxoid vaccines to protect them and newborn infants against this life-threatening disease. Moreover, the majority of them, particularly those in rural Ethiopia, were not informed about pregnancy danger signs. Mothers who had at least four ANC visits received more types of prenatal components compared to those who had fewer ANC visits. The multilevel regression analysis revealed that receiving adequate ANC content is positively associated with having more frequent ANC visits, attaining a higher education level, being a member of a household in the highest wealth quintile and residing in urban areas. Conclusion The evidence implies that the quality of maternal health services needs to be improved. Health programs and interventions should also give priority to rural areas where the majority of Ethiopian women reside.
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Smith A, Leach G, Rossouw L. The timing of antenatal care access for adolescent pregnancies in Cape Town, South Africa. Afr J Prim Health Care Fam Med 2024; 16:e1-e10. [PMID: 38426770 PMCID: PMC10913161 DOI: 10.4102/phcfm.v16i1.4192] [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: 06/13/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Late antenatal care (ANC)-seeking among pregnant adolescents threatens their health outcomes, and the health outcomes of their new-borns. South Africa has experienced a rapid increase in adolescent pregnancies during the COVID-19 pandemic, adding to the existing concerns around adolescent pregnancy care-seeking behaviour. AIM The main aim of this study was to investigate the causes and covariates of late ANC access among adolescents in the Cape Town Metropole, South Africa. SETTING Three public healthcare facilities in the Cape Town Metropole, 2018-2019. METHODS A retrospective, cross-sectional study on ANC seeking behaviour was conducted, surveying 202 adolescents. Late attendance was defined as attending ≥ 3 months. For this study, adolescents were defined as women aged 16-18 years. The sample was restricted to adolescents who used public healthcare facilities or who did not attend at all. Data were analysed using univariate, bivariate and multivariate methods. RESULTS A total of 50.8% (n = 99/195) of the pregnant adolescents in the sample had their first ANC visit 3 months. 14.9% (n = 29/195) did not attend at all. Major contributors to delayed care-seeking include poor pregnancy identification (n = 45/99, 45.5%), and a lack of information about ANC. Age, education, and alcohol consumption were significant predictors of delayed care-seeking. CONCLUSION Delayed ANC attendance contributes to negative long-term health outcomes for pregnant adolescents and their new-borns. Improving access to pregnancy tests in the public sector could benefit adolescents with earlier pregnancy identification. Adolescents need to be made aware of their care seeking options.Contribution: There is evidence of long-term health impacts of late ANC attendance by pregnant adolescents, but there is an absence of evidence on the timing and barriers of late care-seeking behaviour. In this study, late ANC attendance among adolescents was associated with late pregnancy identification and poor knowledge of care options.
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Affiliation(s)
- Anja Smith
- Department of Economics, Faculty of Economic Management and Business Sciences, Stellenbosch University, Stellenbosch.
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Toorang F, Amiri P, Djazayery A, Pouraram H, Takian A. Worse becomes the worst: obesity inequality, its determinants and policy options in Iran. Front Public Health 2024; 12:1225260. [PMID: 38384892 PMCID: PMC10880032 DOI: 10.3389/fpubh.2024.1225260] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
Background This tracked obesity inequality and identified its determinants among the population of Iran. In addition, it examined the impact of implemented policies on these inequalities. Methods This study was performed in two phases. First, we conducted a rapid review of the disparity in obesity prevalence in Iran. Then we investigated the main determinants of this inequality in a qualitative study. In addition, we examined Iran's policies to deal with obesity from the perspective of equality. We conducted 30 Semi-structured interviews with various obesity stakeholders selected through a purposive snowball sampling method between November 25, 2019, and August 5, 2020. In the inductive approach, we used the content analysis method based on the Corbin and Status framework to analyze the data using MAXQDA-2020. The consolidating criteria for reporting a Qualitative Study (COREQ-32) were applied to conduct and report the study. Results Inequalities in the prevalence of obesity in terms of place of residence, gender, education, and other socioeconomic characteristics were identified in Iran. Participants believed that obesity and inequality are linked through immediate and intermediate causes. Inequality in access to healthy foods, physical activity facilities, and health care are the immediate causes of this inequality. Intermediate factors include inequality against women, children, and refugees, and inequality in access to information, education, and financial resources. Policymakers should implement equity-oriented obesity control policies such as taxing unhealthy foods, subsidizing healthy foods, providing healthy and free meals in schools, especially in disadvantaged areas, and providing nutrient-rich foods to low-income families. Also, environmental re-engineering to increase opportunities for physical activity should be considered. Of course, for the fundamental reduction of these inequalities, the comprehensive approach of all statesmen is necessary. Conclusion Obesity inequality is a health-threatening issue in Iran that can prevent achieving human development goals. Targeting the underlying causes of obesity, including inequalities, must be considered.
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Affiliation(s)
- Fatemeh Toorang
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Science, Tehran, Iran
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolghassem Djazayery
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Pouraram
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Departments of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department Health Management, Policy, and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
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13
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Yaver M. Rationing by Inconvenience: How Insurance Denials Induce Administrative Burdens. J Health Polit Policy Law 2024:11186111. [PMID: 38324347 DOI: 10.1215/03616878-11186111] [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: 02/08/2024]
Abstract
CONTEXT How does the practice of health coverage denials keep care out of reach for American patients through the imposition of unevenly distributed administrative burdens? Despite increased discussion about wrongful coverage denials and prior authorization requirements in Medicare Advantage plans, little work has examined the impact of these denials for patients enrolled in different types of public and private insurance. I argue that the process of appealing insurers' denials imposes administrative burdens on patients in ways that are not equitable, deepening the divide between those with meaningful access to health coverage and those for whom benefits are kept out of reach. METHODS I conducted a nationwide survey of 1,340 U.S. adults on their experiences with coverage denials, supplemented with 110 semi-structured interviews with patients, physicians, and former health insurance executives. FINDINGS I find that those who are less affluent are significantly less likely than their wealthier counterparts to appeal denials of coverage. Patients who underestimated the rate at which patients prevail in insurance appeals are less likely to appeal their own denials. Black Medicaid patients and those who are in worse health are significantly less likely to prevail in the appeals they pursue. Many un-appealed denials are attributable to the significant administrative burdens associated with appeal, including the learning costs of navigating their insurance plan and the psychological costs of getting denials reversed amid time commitments and confusion about the denial. CONCLUSIONS Administrative burdens associated with appealing denials of coverage can deepen health inequities along class and race lines, suggesting a need for policy interventions to make more accessible the navigation of the health insurance bureaucracy.
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Chung SY, Lee RG, Park SY, Oh IH. Disability-Related Mortality Inequity in South Korea: Comparison in Terms of Seoul Metropolitan/Non-Metropolitan Areas and Income Levels. Healthcare (Basel) 2024; 12:293. [PMID: 38338178 PMCID: PMC10855041 DOI: 10.3390/healthcare12030293] [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: 11/17/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
Despite the improved living standards in South Korea, people with disabilities still experience health disparities. Therefore, we analyzed differences in mortality rates among people with disabilities according to income level and residential area using representative data from the National Health Insurance Service in South Korea. Descriptive statistics and Cox proportional risk models were used to identify the risk factors for mortality affecting people with disabilities stratified by income level and residential area. Those living in non-metropolitan areas and low-income households had high mortality risks, suggesting that income level and residential area were related to mortality risk. The mortality risk of those with a high-income level was 1.534 times higher in non-metropolitan areas than in Seoul metropolitan areas (95% confidence interval [CI] = 1.44-1.63). Among people with low income living in non-metropolitan areas, the crude hazard ratios of mortality risk were 1.26 (95% CI = 1.14-1.39), 1.44 (95% CI = 1.34-1.54), and 1.39 (95% CI = 1.20-1.61) for those with brain lesions, sensory impairment (visual/hearing/speech impairment), and kidney failure, respectively. No significant differences were observed between people with autism in non-metropolitan and Seoul metropolitan areas and those with low- and high-income levels. Health issues and countermeasures are crucial to reduce mortality risk among people with disabilities.
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Affiliation(s)
- Seo-Yeon Chung
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (S.-Y.C.); (R.-G.L.)
| | - Ru-Gyeom Lee
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (S.-Y.C.); (R.-G.L.)
| | - So-Youn Park
- Department of Medical Education and Humanities, School of Medicine, Kyung Hee University, Seoul 02453, Republic of Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea; (S.-Y.C.); (R.-G.L.)
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15
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Yang J, Zhong Q, Liao Z, Pan C, Fan Q. Socioeconomic deprivation, medical services accessibility, and income-related health inequality among older Chinese adults: evidence from a national longitudinal survey from 2011 to 2018. Fam Pract 2023; 40:671-681. [PMID: 36928561 DOI: 10.1093/fampra/cmad018] [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] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Health inequality poses a challenge to improving the quality of life of older adults as well as the service system. The literature rarely explores the moderating role of medical services accessibility in the association between socioeconomic deprivation and health inequality. OBJECTIVE This study examines the socioeconomic deprivation and medical services accessibility associated with health inequality among older Chinese adults, which will contribute to the medical policy reform. METHODS Using data from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we analyse 14,232 older adults. This paper uses a concentration index (CI) to measure the income-related health inequality among the target population and employs a recentered influence function-concentration index-ordinary least squares (RIF-CI-OLS) model to empirically analyse the correlation between socioeconomic deprivation and health inequality among older Chinese adults. Based on the correlation analysis, we discuss the moderating effect of medical services accessibility. RESULTS We find that health inequality exists among older Chinese adults and that the relative deprivation in socioeconomic status (SES) is significantly associated with health inequality (β∈ [0.1109, 0.1909], P < 0.01). The correlation between socioeconomic deprivation and health inequality is moderated by medical services accessibility, which means that an increase in medical services accessibility can weaken the correlation between socioeconomic deprivation and health inequality. CONCLUSION China needs an in-depth reform of its medical services accessibility system to promote the equitable distribution of medical services resources, strengthen medical costs and quality management, and ultimately mitigate the SES reason for health inequality among older Chinese adults.
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Affiliation(s)
- Jing Yang
- Research Institute of Public Health and Social Security, School of Public Administration, Hunan University, Changsha, China
| | - Qiao Zhong
- Research Institute of Public Health and Social Security, School of Public Administration, Hunan University, Changsha, China
| | - Zangyi Liao
- School of Political Science and Public Administration, China University of Political Science and Law, Beijing, China
| | - Changjian Pan
- Economic Research Office, Tea Research Institute of Chinese Academy of Agricultural Sciences, Hangzhou, China
| | - Qiuyan Fan
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
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16
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Westrop SJ, Thomas A, Williams A, Johnson F, Liao H, Edlin K, Burgess K, Kearins O, Maclean R. Impact of changes to invite methodology on equality of access to the National Breast Screening Programme in the South of England. J Med Screen 2023:9691413231219934. [PMID: 38105465 DOI: 10.1177/09691413231219934] [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] [Indexed: 12/19/2023]
Abstract
In response to the COVID-19 pandemic, a temporary change in policy was implemented in 2020. Breast screening services in England were advised to change from timed appointments to an open invitation for invitees to contact the service and arrange an appointment. This change to invitation methodology had potential benefits and risks including impacting inequalities in uptake. Qualitative data were collected by online questionnaire from 23 service providers and routinely collected quantitative uptake data were analysed to investigate the impact of open invitations on the National Programme in the South of England. Office for National Statistics and general practitioner (GP) practice profile data enabled the modelling of sociodemographic characteristics of breast screening invitees at each GP practice. Most services changed to open invitations (17/23), 82% of which altered administrative capacity and/or procedures to accommodate this change. Logistic benefits were reported including a more consistent flow of participants, fewer long gaps and fewer wasted slots. The change to open invitations was associated with a 7.2% reduction in the percentage of participants screened, accounting for participant sociodemographics and historical screening provider uptake. The inequality in screening uptake experienced by participants of minority ethnic background was exacerbated by the change to open invitations. Open invitations, whilst affording logistic benefits in an unprecedented pandemic era, were associated with reduced overall uptake and exacerbation of existing health inequality experienced by women of minority ethnic background. The broader impact on services highlighted the need for sustainability of measures taken to accommodate such operational changes.
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Affiliation(s)
| | | | | | - Fiona Johnson
- Screening Quality Assurance Service, NHS England, UK
| | - Hui Liao
- Screening Quality Assurance Service, NHS England, UK
| | - Kirsty Edlin
- South West Public Health Commissioning Team, NHS England, UK
| | - Karen Burgess
- South East Public Health Commissioning Team, NHS England, UK
| | - Olive Kearins
- Screening Quality Assurance Service, NHS England, UK
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Abstract
Kamila Hawthorne, chair of the Royal College of General Practioners Council, and Bola Owolabi, director of the National Healthcare Inequalities Improvement Programme, offer a personal perspective on how their professional experiences have led them to see health inequality as urgent priority, and introduce initiatives that can help general practitioners make a difference individually and collectively.
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Affiliation(s)
| | - Bola Owolabi
- National Healthcare Inequalities Improvement Programme, UK
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18
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Gallagher T, Choi JS, Garcia E, Chambers T, Ference E. Telemedicine in an Otolaryngology Clinic Serving the Incarcerated Population. Ann Otol Rhinol Laryngol 2023; 132:1321-1329. [PMID: 36647259 DOI: 10.1177/00034894221149547] [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] [Indexed: 01/18/2023]
Abstract
OBJECTIVE There is a paucity of data investigating the effect of implementation of telehealth on vulnerable populations, particularly the incarcerated. Our objective is to evaluate patient and physician satisfaction with telehealth (telephone visits) used in an outpatient otolaryngology clinic serving the incarcerated population. METHODS Incarcerated patients who were served by otolaryngologists via telephone visits from a large tertiary care center from June 2021 to January 2022 were included (n = 20) in this pilot study. Patient and physician satisfaction with the encounters were evaluated using the Telehealth Satisfaction Questionnaire and a modified physician satisfaction questionnaire, respectively. RESULTS Consultations for various otolaryngological complaints were completed via telephone for incarcerated patients including hearing loss, tinnitus, facial fracture, dysphonia, and tonsillitis. Mean patient and physician satisfaction scores were high at 4.25 ± 0.12 and 4.65 ± 0.13 respectively (score range 1-5). Patient satisfactions subdomain scores were 3.92 ± 0.13 for quality of care provided, 3.99 ± 0.13 for similarity to face-to-face encounter, and 4.2 ± 0.17 for perception of the interaction. Imaging or audiogram was available prior to appointment in 60% of cases, with labs, imaging, or audiogram ordered after in 40% of cases and initial pharmaceutical treatment provided to 10% of patients. 45% of patients required follow up in-person, while 40% were discharged pro re nata, and 15% were followed up with another phone visit. There was no statistically significant association between demographic or clinical characteristics and patient or physician satisfaction scores. CONCLUSIONS Consultations for various otolaryngological complaints were completed via telephone with high patient and physician satisfaction within an incarcerated population in this pilot study. Telephone visit is likely a feasible alternative format that can advance otolaryngological care. Studies with larger sample sizes are required to ensure quality of care and advance social justice for this chronically underserved population.
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Affiliation(s)
- Tyler Gallagher
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Janet S Choi
- Department of Otolaryngology, University of Minnesota, Minneapolis, MN, USA
| | - Erick Garcia
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Tamara Chambers
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Elisabeth Ference
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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19
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Abstract
There has been a reticence to introduce universal varicella zoster virus (VZV) vaccines in the UK because of a theoretical concern of increased herpes zoster infections. However, this has not been borne out in real-world data. Here, I argue that, in reality, many parents are vaccinating their children privately and, thus, we do not know the degree of inequity that this creates. The fairest option going forward is to introduce universal VZV vaccination in the UK.
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20
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McKenzie K, Murray G, Metcalfe D, Robson R, Kaczmar M, Shirley A. Using the learning disability screening questionnaire to help identify people with an intellectual disability in homeless services. J Appl Res Intellect Disabil 2023; 36:1319-1325. [PMID: 37635318 DOI: 10.1111/jar.13150] [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: 01/24/2023] [Revised: 04/29/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND We explored the accuracy of using the learning disability screening questionnaire (LDSQ) in services for people experiencing homelessness in the United Kingdom. METHOD We examined the concordance between the LDSQ outcomes and assessments of intellectual disability. Seventy adults experiencing homelessness completed the LDSQ. Staff completed the LDSQ and a measure of adaptive functioning for 38 of this group. Nine participants received an intellectual assessment. RESULTS Sensitivity and specificity for the LDSQ when completed by staff was 83% and 96% respectively and 50% and 92% when completed by the individual. Seven people had intellectual and adaptive functioning in the intellectual disability range. CONCLUSION The results suggest that the LDSQ would be an appropriate and beneficial screening tool to use within services for people experiencing homelessness. More accurate results would be likely if it were completed by staff.
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Affiliation(s)
- Karen McKenzie
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | | | - Dale Metcalfe
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
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21
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Dicken SJ, Qamar S, Batterham RL. Who consumes ultra-processed food? A systematic review of sociodemographic determinants of ultra-processed food consumption from nationally representative samples. Nutr Res Rev 2023:1-41. [PMID: 37905428 DOI: 10.1017/s0954422423000240] [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] [Indexed: 11/02/2023]
Abstract
Ultra-processed food (UPF) intake is associated with increased non-communicable disease risks. However, systematic reports on sociodemographic predictors of UPF intake are lacking. This review aimed to understand UPF consumption based on sociodemographic factors, using nationally representative cohorts. The systematic review was pre-registered (PROSPERO:CRD42022360199), following PRISMA guidelines. PubMed/MEDLINE searches (‘ultra-processed/ultraprocessed’ and ‘ultra-processing/ultraprocessing’) until 7 September 2022 retrieved 1131 results. Inclusion criteria included: observational, nationally representative adult samples, in English, in peer-reviewed journals, assessing the association between sociodemographics and individual-level UPF intake defined by the NOVA classification. Exclusion criteria included: not nationally representative, no assessment of sociodemographics and individual-level UPF intake defined by NOVA. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS). Fifty-five papers were included, spanning thirty-two countries. All thirteen sociodemographic variables identified were significantly associated with UPF intake in one or more studies. Significant differences in UPF intake were seen across age, race/ethnicity, rural/urbanisation, food insecurity, income and region, with up to 10–20% differences in UPF intake (% total energy). Higher UPF intakes were associated with younger age, urbanisation and being unmarried, single, separated or divorced. Education, income and socioeconomic status showed varying associations, depending on country. Multivariate analyses indicated that associations were independent of other sociodemographics. Household status and gender were generally not associated with UPF intake. NOS averaged 5·7/10. Several characteristics are independently associated with high UPF intake, indicating large sociodemographic variation in non-communicable disease risk. These findings highlight significant public health inequalities associated with UPF intake, and the urgent need for policy action to minimise social injustice-related health inequalities.
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Affiliation(s)
- Samuel J Dicken
- Centre for Obesity Research, Department of Medicine, University College London (UCL), London WC1E 6JF, UK
| | - Sulmaaz Qamar
- Centre for Obesity Research, Department of Medicine, University College London (UCL), London WC1E 6JF, UK
- Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital (UCLH), London NW1 2BU, UK
- National Institute for Health Research, Biomedical Research Centre, University College London Hospital (UCLH), London W1T 7DN, UK
| | - Rachel L Batterham
- Centre for Obesity Research, Department of Medicine, University College London (UCL), London WC1E 6JF, UK
- Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital (UCLH), London NW1 2BU, UK
- National Institute for Health Research, Biomedical Research Centre, University College London Hospital (UCLH), London W1T 7DN, UK
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22
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Wang X, Guo Y, Qin Y, Nicholas S, Maitland E, Liu C. Regional catastrophic health expenditure and health inequality in China. Front Public Health 2023; 11:1193945. [PMID: 37927884 PMCID: PMC10624124 DOI: 10.3389/fpubh.2023.1193945] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/15/2023] [Indexed: 11/07/2023] Open
Abstract
Background Catastrophic health expenditures (CHE) can trigger illness-caused poverty and compound poverty-caused illness. Our study is the first regional comparative study to analyze CHE trends and health inequality in eastern, central and western China, exploring the differences and disparities across regions to make targeted health policy recommendations. Methods Using data from China's Household Panel Study (CFPS), we selected Shanghai, Henan and Gansu as representative eastern-central-western regional provinces to construct a unique 5-year CHE unbalanced panel dataset. CHE incidence was measured by calculating headcount; CHE intensity was measured by overshoot and CHE inequality was estimated by concentration curves (CC) and the concentration index (CI). A random effect model was employed to analyze the impact of household head socio-economic characteristics, the household socio-economic characteristics and household health utilization on CHE incidence across the three regions. Results The study found that the incidence and intensity of CHE decreased, but the degree of CHE inequality increased, across all three regions. For all regions, the trend of inequality first decreased and then increased. We also revealed significant differences across the eastern, central and western regions of China in CHE incidence, intensity, inequality and regional differences in the CHE influencing factors. Affected by factors such as the gap between the rich and the poor and the uneven distribution of medical resources, families in the eastern region who were unmarried, use supplementary medical insurance, and had members receiving outpatient treatment were more likely to experience CHE. Families with chronic diseases in the central and western regions were more likely to suffer CHE, and rural families in the western region were more likely to experience CHE. Conclusions The trends and causes of CHE varied across the different regions, which requires a further tilt of medical resources to the central and western regions; improved prevention and financial support for chronic diseases households; and reform of the insurance reimbursement policy of outpatient medical insurance. On a regional basis, health policy should not only address CHE incidence and intensity, but also its inequality.
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Affiliation(s)
- Xinyue Wang
- School of Management, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yan Guo
- School of Management, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yang Qin
- Dispatching and Operation Department, Construction and Management Bureau of the North Hu Bei Water Transfer Project, Wuhan, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia
- School of Economics and School of Management, Tianjin Normal University, Tianjin, China
- Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China
- Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW, Australia
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, United Kingdom
| | - Cai Liu
- School of Management, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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23
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Steuwer B, Eyal N. Ethical and legal race-responsive vaccine allocation. Bioethics 2023; 37:814-821. [PMID: 37448097 DOI: 10.1111/bioe.13203] [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] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 01/31/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023]
Abstract
In many countries, the COVID-19 pandemic varied starkly between different racial and ethnic groups. Before vaccines were approved, some considered assigning priority access to worse-hit racial groups. That debate can inform rationing in future pandemics and in some of the many areas outside COVID-19 that admit of racial health disparities. However, concerns were raised that "race-responsive" prioritizations would be ruled unlawful for allegedly constituting wrongful discrimination. This legal argument relies on an understanding of discrimination law as demanding color-blindness. We argue that a, color-blind understanding of discrimination would be hostile only to one of two rationales for prioritizing the relevant racial minorities in settings of racial health disparities. We also propose a method for incorporating appropriate race-responsive concerns that is in many ways ethically and legally superior to ones suggested thus far. That method turns artificial intelligence, thanks precisely to its artificial and "black box" nature (features that underlie recent concerns about artificial intelligence's discriminatory potential), into an instrument of social justice.
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Affiliation(s)
- Bastian Steuwer
- Department of Political Science, Ashoka University, Sonipat, HR, India
| | - Nir Eyal
- Center for Population-Level Bioethics, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Department of Philosophy, Rutgers University, New Brunswick, New Jersey, USA
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Ahmed S, Mahapatro SR. Examining the Effectiveness of Financial Protection Schemes in Reducing Health Inequality. Int J Soc Determinants Health Health Serv 2023; 53:444-454. [PMID: 37272016 DOI: 10.1177/27551938231179046] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Health protection schemes such as health insurance and financial assistance provide immense help and support to access health care services, especially to the poor and marginalized section of society. India is witness to low health-related expenditure, and the society's socioeconomic and demographic structure further drops health care access to the new bottom. Consequently, inequality in health care access is highly observed across many socioeconomic attributes. The condition of Bihar, the poorest state of India, is more alarming. The analysis suggests that financial support in terms of universal health insurance coverage considerably reduces out-of-pocket expenditure and thus health inequality. Further, the low health insurance coverage is not solely due to a lack of institutional commitment and implementation process; the cognitive behavior and attitude of people are equally responsible for low health care access. An intensive awareness program to show the benefit of the health insurance scheme and sensitization of people against the social stigma is important to provide better health care access and reduce health inequality.
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Affiliation(s)
- Shakeel Ahmed
- Department of Economics, A. N. Sinha Institute of Social Studies, Patna, India
| | - Sandhya R Mahapatro
- Department of Economics, A. N. Sinha Institute of Social Studies, Patna, India
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25
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Caton E, Sharma S, Vilar E, Farrington K. Measures of treatment burden in dialysis: A scoping review. J Ren Care 2023. [PMID: 37697889 DOI: 10.1111/jorc.12480] [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: 01/26/2023] [Revised: 08/16/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Dialysis is a life-sustaining treatment for patients with advanced kidney failure, but it is extremely burdensome. Despite this, there are very few tools available to assess treatment burden within the dialysis population. OBJECTIVE To conduct a scoping review of generic and disease-specific measures of treatment burden in chronic kidney disease, and assess their suitability for use within the dialysis population. DESIGN We searched CINAHL, MEDLINE and the Cochrane Library for kidney disease-specific measures of treatment burden. Studies were initially included if they described the development, validation or use of a treatment burden measure or associated concept (e.g., measures of treatment satisfaction, quality of life, illness intrusiveness, disease burden etc.) in adult patients with chronic kidney disease. We also updated a previous scoping review exploring measures of treatment burden in chronic disease to identify generic treatment burden measures. RESULTS One-hundred and two measures of treatment burden or associated concepts were identified. Four direct measures and two indirect measures of treatment burden were assessed, using adapted established criteria, for suitability for use within the dialysis population. The researchers outlined eight key dimensions of treatment burden: medication, financial, administrative, lifestyle, health care, time/travel, dialysis-specific factors, and health inequality. None of the measures adequately assessed all dimensions of treatment burden. CONCLUSION Current measures of treatment burden in dialysis are inadequate to capture the spectrum of issues that matter to patients. There is a need for dialysis-specific burdens and health inequality to be assessed when exploring treatment burden to advance patient care.
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Affiliation(s)
- Emma Caton
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - Shivani Sharma
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - Enric Vilar
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
- Department of Renal Medicine, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Ken Farrington
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
- Department of Renal Medicine, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
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Shoemaker HE, Thorpe A, Stevens V, Butler JM, Drews FA, Burpo N, Scherer LD, Fagerlin A. Telehealth Use During the COVID-19 Pandemic Among Veterans and Nonveterans: Web-Based Survey Study. JMIR Form Res 2023; 7:e42217. [PMID: 37527547 PMCID: PMC10494868 DOI: 10.2196/42217] [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: 08/30/2022] [Revised: 03/15/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND In the first year of the COVID-19 pandemic, studies reported delays in health care usage due to safety concerns. Delays in care may result in increased morbidity and mortality from otherwise treatable conditions. Telehealth provides a safe alternative for patients to receive care when other circumstances make in-person care unavailable or unsafe, but information on patient experiences is limited. Understanding which people are more or less likely to use telehealth and their experiences can help tailor outreach efforts to maximize the impact of telehealth. OBJECTIVE This study aims to examine the characteristics of telehealth users and nonusers and their reported experiences among veteran and nonveteran respondents. METHODS A nationwide web-based survey of current behaviors and health care experiences was conducted in December 2020-March 2021. The survey consisted of 3 waves, and the first wave is assessed here. Respondents included US adults participating in Qualtrics web-based panels. Primary outcomes were self-reported telehealth use and number of telehealth visits. The analysis used a 2-part regression model examining the association between telehealth use and the number of visits with respondent characteristics. RESULTS There were 2085 participants in the first wave, and 898 (43.1%) reported using telehealth since the pandemic began. Most veterans who used telehealth reported much or somewhat preferring an in-person visit (336/474, 70.9%), while slightly less than half of nonveterans (189/424, 44.6%) reported this preference. While there was no significant difference between veteran and nonveteran likelihood of using telehealth (odds ratio [OR] 1.33, 95% CI 0.97-1.82), veterans were likely to have more visits when they did use it (incidence rate ratio [IRR] 1.49, 95% CI 1.07-2.07). Individuals were less likely to use telehealth and reported fewer visits if they were 55 years and older (OR 0.39, 95% CI 0.25-0.62 for ages 55-64 years; IRR 0.43, 95% CI 0.28-0.66) or lived in a small city (OR 0.63, 95% CI 0.43-0.92; IRR 0.71, 95% CI 0.51-0.99). Receiving health care partly or primarily at the Veterans Health Administration (VA) was associated with telehealth use (primarily VA: OR 3.25, 95% CI 2.20-4.81; equal mix: OR 2.18, 95% CI 1.40-3.39) and more telehealth visits (primarily VA: IRR 1.5, 95% CI 1.10-2.04; equal mix: IRR 1.57, 95% CI 1.11-2.24). CONCLUSIONS Telehealth will likely continue to be an important source of health care for patients, especially following situations like the COVID-19 pandemic. Some groups who may benefit from telehealth are still underserved. Telehealth services and outreach should be improved to provide accessible care for all.
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Affiliation(s)
- Holly E Shoemaker
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
| | - Alistair Thorpe
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Vanessa Stevens
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Jorie M Butler
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
- Geriatrics Research, Education, and Clinical Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
- Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Frank A Drews
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
- Department of Psychology, College of Social and Behavioral Science, University of Utah, Salt Lake City, UT, United States
| | - Nicole Burpo
- Research Operations, American Heart Association, Dallas, TX, United States
| | - Laura D Scherer
- University of Colorado School of Medicine, Aurora, CO, United States
- VA Denver Center for Innovation, Denver, CO, United States
| | - Angela Fagerlin
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, United States
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Thomas M, Moore JB, Onuselogu DA, Dalton A, Rains T, Lowry E, Sritharan N, Morris MA. Supermarket top-up of Healthy Start vouchers increases fruit and vegetable purchases in low-income households. NUTR BULL 2023; 48:353-364. [PMID: 37501220 DOI: 10.1111/nbu.12627] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023]
Abstract
Stark, widening health and income inequalities in the United Kingdom underpin the need for increased support for low-income families to access affordable and nutritious foods. Using anonymised supermarket loyalty card transaction records, this study aimed to assess how an additional Healthy Start voucher (HSV) top-up of £2, redeemable only against fruit and vegetables (FVs), was associated with FV purchases among at-risk households. Transaction and redemption records from 150 loyalty card-holding households, living in northern England, who had engaged with the top-up scheme, were analysed to assess the potential overall population impact. Using a pre-post study design, 133 of these households' records from 2021 were compared with equivalent time periods in 2019 and 2020. Records were linked to product, customer and store data, permitting comparisons using Wilcoxon matched-pairs sign-ranked tests and relationships assessed with Spearman's Rho. These analyses demonstrated that 0.9 more portions of FV per day per household were purchased during the scheme compared to the 2019 baseline (p = 0.0017). The percentage of FV weight within total baskets also increased by 1.6 percentage points (p = 0.0242), although the proportional spend on FV did not change. During the scheme period, FV purchased was higher by 0.4 percentage points (p = 0.0012) and 1.6 percentage points (p = 0.0062) according to spend and weight, respectively, in top-up redeeming baskets compared to non-top-up redeeming baskets with at least one FV item and was associated with 5.5 more HSV 'Suggested' FV portions (p < 0.0001). The median weight of FV purchased increased from 41.83 kg in 2019 to 54.14 kg in 2021 (p = 0.0017). However, top-up vouchers were only redeemed on 9.1% of occasions where FV were purchased. In summary, this study provides novel data showing that safeguarding funds exclusively for FV can help to increase access to FV in low-income households. These results yield important insights to inform public policy aimed at levelling up health inequalities.
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Affiliation(s)
- Madeleine Thomas
- School of Food Sciences and Nutrition, University of Leeds, Leeds, UK
| | | | | | - Alexandra Dalton
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | | | | | | | - Michelle A Morris
- School of Food Sciences and Nutrition, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
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Lonnie M, Hunter E, Stone RA, Dineva M, Aggreh M, Greatwood H, Johnstone AM. Food insecurity in people living with obesity: Improving sustainable and healthier food choices in the retail food environment-the FIO Food project. NUTR BULL 2023; 48:390-399. [PMID: 37461154 DOI: 10.1111/nbu.12626] [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: 02/10/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 08/19/2023]
Abstract
At both UK and global level, dietary consumption patterns need to change to address environmental, health and inequality challenges. Despite considerable policy interventions, the prevalence of overweight and obesity in the United Kingdom has continued to rise with obesity now a leading cause of mortality and morbidity. Obesity prevalence is greater among those on lower incomes and the current UK food system, including government policy, does not effectively address this. Current behavioural approaches, without the support of structural changes in the system, may even widen the inequalities gap. Hence, using behavioural insights from those living with obesity and food insecurity, the project will explore potential avenues that can be applied in the food system to promote healthier choices in the food retail environment. The National Food Strategy report recommends that the UK food system should ensure "safe, healthy, affordable food; regardless of where people live or how much they earn". However, the association between food insecurity and the development of obesity is not well understood in relation to purchasing behaviours in the UK retail food environment, nor is the potential effectiveness of interventions that seek to prevent and reduce the impact of diet-induced health harms. The FIO Food (Food insecurity in people living with obesity - improving sustainable and healthier food choices in the retail food environment) project provides a novel and multi-disciplinary collaborative approach with co-development at the heart to address these challenges. Using four interlinked work packages, the FIO Food project will combine our knowledge of large-scale population data with an understanding of lived experiences of food shopping for people living with obesity and food insecurity, to develop solutions to support more sustainable and healthier food choices in the UK retail food environment.
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Affiliation(s)
- Marta Lonnie
- The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Emma Hunter
- The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - Rebecca A Stone
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Mariana Dineva
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
| | - Modupe Aggreh
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
| | | | - Alexandra M Johnstone
- The Rowett Institute, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Smith SM, Bais B, Ismaili M'hamdi H, Schermer MHN, Steegers-Theunissen RPM. Stimulating the Uptake of Preconception Care by Women With a Vulnerable Health Status Through mHealth App-Based Nudging (Pregnant Faster): Cocreation Design and Protocol for a Cohort Study. JMIR Res Protoc 2023; 12:e45293. [PMID: 37556197 PMCID: PMC10448288 DOI: 10.2196/45293] [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: 12/23/2022] [Revised: 04/22/2023] [Accepted: 05/03/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Women with a low socioeconomic status often have a vulnerable health status due to an accumulation of health-deteriorating factors such as poor lifestyle behaviors, including inadequate nutrition, mental stressors, and impaired health literacy and agency, which puts them at an unnecessary high risk of adverse pregnancy outcomes. Adequately preparing for pregnancy through preconception care (PCC) uptake and lifestyle improvement can improve these outcomes. We hypothesize that nudging is a successful way of encouraging engagement in PCC. A nudge is a behavioral intervention that changes choice behavior through influencing incentives. The mobile health (mHealth) app-based loyalty program Pregnant Faster aims to reward women in an ethically justified way and nudges to engage in pregnancy preparation by visiting a PCC consultation. OBJECTIVE Here, we first describe the process of the cocreation of the mHealth app Pregnant Faster that aims to increase engagement in pregnancy preparation by women with a vulnerable health status. Second, we describe the cohort study design to assess the feasibility of Pregnant Faster. METHODS The content of the app is based on the eHealth lifestyle coaching program Smarter Pregnancy, which has proven to be effective in ameliorating preconceptional lifestyle behaviors (folic acid, vegetables, fruits, smoking, and alcohol) and an interview study pertaining to the preferences of the target group with regard to an mHealth app stimulating PCC uptake. For moral guidance on the design, an ethical framework was developed based on the bioethical principles of Beauchamp and Childress. The app was further developed through iterative cocreation with the target group and health care providers. For 4 weeks, participants will engage with Pregnant Faster, during which opportunities will arise to earn coins such as reading informative blogs and registering for a PCC consultation. Coins can be spent on small fun rewards, such as folic acid, fruits, and mascara. Pregnant Faster's feasibility will be tested in a study including 40 women aged 18 to 45 years, who are preconceptional or <8 weeks pregnant, with a low educational level, and living in a deprived neighborhood. The latter 2 factors will serve as a proxy of a low socioeconomic status. Recruitment will take place through flyers, social media, and health care practices. After finalization, participants will evaluate the app through the "mHealth App Usability Questionnaire" and additional interviews or questionnaires. RESULTS Results are expected to be published by December 2023. CONCLUSIONS Pregnant Faster has been designed through iterative cocreation with the target group and health care professionals. With the designed study, we will test Pregnant Faster's feasibility. If overall user satisfaction and PCC uptake is achieved, the app will be further developed and the cohort will be continued with an additional 400 inclusions to establish effectiveness. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45293.
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Affiliation(s)
- Sharissa M Smith
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Babette Bais
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Hafez Ismaili M'hamdi
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Maartje H N Schermer
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
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Assebe LF, Norheim O. Distributional impact of infectious disease interventions in the Ethiopian Essential Health Service Package: a modelling study. BMJ Open 2023; 13:e067658. [PMID: 37460265 DOI: 10.1136/bmjopen-2022-067658] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES Reducing inequalities in health and financial risk are key goals on the path toward universal health coverage, particularly in low-income and middle-income countries. The design of the health benefit package creates an opportunity to select interventions through established criteria. The aim of this study is to examine the health equity and financial protection impact of selected interventions, along with their costs, at the national level in Ethiopia. DESIGN Distributional cost-effectiveness analysis. POPULATION The eligible population for all selected interventions is assumed to be 10 million. DATA SOURCES Data on disease prevalence and population size were gathered from the Global Burden of Disease database, and average health benefits and program costs are sourced from the Ethiopian Essential Health Service Package (EHSP) database, national surveys and other publicly available sources. INTERVENTION A total of 30 interventions were selected from the latest EHSP revision and analysed over a 1-year period. OUTCOME MEASURES Health benefits, social welfare indices and financial protection metrics across income quintiles were reported. RESULTS We found 23 interventions that improve population health and reduce health inequality and four interventions reduce both population health and health inequality. Additionally, three interventions improve population health while increasing health inequality. Overall, the EHSP interventions provide a 0.021 improvement in health-adjusted life expectancy (HALE) per person, with a positive distributional equity impact: 0.029 (26.9%) HALE gained in the poorest and 0.015 (14.0%) in the richest quintile. Similarly, a total of 1 79 475 cases of catastrophic health expenditure were averted, including 82 100 (46.0%) cases in the poorest and 17 900 (10.0%) in the richest quintile. CONCLUSION Increasing access to the EHSP improves health equity and financial protection. Improved access to selected EHSP interventions also has the potential to provide greater benefits to the poorest and thereby improve social welfare.
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Affiliation(s)
- Lelisa Fekadu Assebe
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Ole Norheim
- Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Richardson-Parry A, Silva M, Valderas JM, Donde S, Woodruff S, van Vugt J. Interactive or tailored digital interventions to increase uptake in cervical, breast, and colorectal cancer screening to reduce health inequity: a systematic review. Eur J Cancer Prev 2023; 32:396-409. [PMID: 37144585 PMCID: PMC10249608 DOI: 10.1097/cej.0000000000000796] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Significant health inequities exist in screening uptake for certain types of cancer. The review question was to identify and describe interactive, tailored digital, computer, and web-based interventions to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates versus usual care. METHODS We searched four medical literature databases for randomized control trials (RCTs) published until 12 January 2023 that evaluated interventions aimed at increasing the percentage of breast, prostate, cervical, or colorectal cancer screening uptake. Meta-analysis was not conducted due to heterogeneity among studies. RESULTS After screening 4200 titles and abstracts, 17 studies were included. Studies focused on colorectal ( n = 10), breast ( n = 4), cervical ( n = 2), and prostate ( n = 1) cancer screening. All were based in the USA except two. Most studies focused on ethnicity/race, while some included low-income populations. Intervention types were heterogeneous and used computer programs, apps, or web-based methods to provide tailored or interactive information to participants about screening risks and options. Some studies found positive effects for increasing cancer screening uptake in the intervention groups compared to usual care, but results were heterogeneous. CONCLUSION Interventions that use individual and cultural tailoring of cancer screening educational material should be further developed and investigated outside of the USA. Designing effective digital intervention strategies, with components that can be adapted to remote delivery may be an important strategy for reducing health inequities in cancer screening during the coronavirus disease 2019 pandemic.
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Affiliation(s)
| | | | - Jose M. Valderas
- Department of Family Medicine, National University Health System and Yong Loo Lin School of Medicine, Centre for Research in Health Systems Performance, Singapore, Singapore
| | - Shaantanu Donde
- European Developed Markets Medical Affairs Viatris, Hatfield, UK
| | - Seth Woodruff
- North America Medical Affairs, Viatris, New York, USA
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Chaianant N, Tussanapirom T, Kettratad M, Prasertsom P, Vejvithee W, Niyomsilp K, Leelasithorn S, Gaewkhiew P. Inequalities in dental service utilization among Thai adults from 2000 to 2017. Community Dent Oral Epidemiol 2023. [PMID: 37350457 DOI: 10.1111/cdoe.12884] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES The Universal Coverage Health Scheme (UCS) was implemented in Thailand in 2002 to increase access to health services among the Thai population. This study aimed to evaluate socioeconomic inequalities in dental service utilization (DU) before and after UCS implementation and to assess factors associated with DU among Thai adults. METHODS This study is based on secondary data from four Thai national oral health surveys in 2000-2001, 2006-2007, 2012 and 2017. Whether an individual from a nationally representative sample of Thai adults aged 35-44 went to see the dentist during the past year was used to define DU. The slope index of inequality (SII) and relative index of inequality (RII) were used to assess and compare education and income-related inequalities in DU. Poisson regression was used to assess factors associated with DU. Income inequalities were not reported for the year 2001 (Income data not available). RESULTS Although DU increased after UCS implementation, socioeconomic inequalities persisted. DU was concentrated among high-education and income groups. Absolute educational inequalities were 0.16 (95% CI: 0.09-0.22), 0.21 (95% CI: 0.10-0.32), 0.26 (95% CI: 0.14-0.38) and 0.25 (95% CI: 0.18-0.32) in 2001, 2007, 2012 and 2017, respectively. Absolute income inequalities were 0.15 (95% CI: 0.04-0.26), 0.07 (95% CI: -0.04-0.18) and 0.12 (95% CI: 0.05-0.19) in 2007, 2012 and 2017, respectively. Occupation, type of health insurance scheme, sex and oral health-related behaviour were associated with DU. CONCLUSION UCS has improved accessibility to dental services, but UCS alone might not narrow the inequalities gap for Thai adults.
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Affiliation(s)
- Nichamon Chaianant
- Research Unit in Mineralized Tissue Reconstruction and Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
| | - Teerawat Tussanapirom
- Department of Community Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Matana Kettratad
- Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
| | - Piyada Prasertsom
- Bureau of Dental Health, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Warangkana Vejvithee
- Bureau of Dental Health, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Kornkamol Niyomsilp
- Bureau of Dental Health, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Srisuda Leelasithorn
- Bureau of Dental Health, Department of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Piyada Gaewkhiew
- Department of Community Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Quayle G, Jones B, Atkins J, Shannon C, Smith R, Tabor D, Bałabuch Z, Cox C, Horsell S, John M, McGrail White T, Vickers S, Whittinger S, Bannister N, Raleigh V, Mateen B, Drummond R. Qualitative interviews to understand methods and systems used to collect ethnicity information in health administrative data sources in England. Wellcome Open Res 2023; 8:265. [PMID: 37766853 PMCID: PMC10521056 DOI: 10.12688/wellcomeopenres.19262.1] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 09/29/2023] Open
Abstract
Background: This article is one of a series aiming to inform analytical methods to improve comparability of estimates of ethnic health disparities based on different sources. This article explores the quality of ethnicity data and identifies potential sources of bias when ethnicity information is collected in three key NHS data sources. Future research can build on these findings to explore analytical methods to mitigate biases. Methods: Thematic analysis of semi-structured qualitative interviews to explore potential sources of error and bias in the process of collecting ethnicity information across three NHS data sources: General Practice Extraction Service (GPES) Data for Pandemic Planning and Research (GDPPR), Hospital Episode Statistics (HES) and Improving Access to Psychological Therapies (IAPT). The study included feedback from 22 experts working on different aspects of health admin data collection for England (including staff from NHS Digital, IT system suppliers and relevant healthcare service providers). Results: Potential sources of error and bias were identified across data collection, data processing and quality assurance processes. Similar issues were identified for all three sources. Our analysis revealed three main themes which can result in bias and inaccuracies in ethnicity data recorded: data infrastructure challenges, human challenges, and institutional challenges. Conclusions: Findings highlighted that analysts using health admin data should be aware of the main sources of potential error and bias in health admin data, and be mindful that the main sources of error identified are more likely to affect the ethnicity data for ethnic minority groups. Where possible, analysts should describe and seek to account for this bias in their research.
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Affiliation(s)
- Gemma Quayle
- Office for National Statistics, Newport, NP10 8XG, UK
| | - Bethan Jones
- Office for National Statistics, Newport, NP10 8XG, UK
| | | | | | - Roxanne Smith
- Office for National Statistics, Newport, NP10 8XG, UK
| | - David Tabor
- Office for National Statistics, Newport, NP10 8XG, UK
| | | | - Courtney Cox
- Office for National Statistics, Newport, NP10 8XG, UK
| | - Sarah Horsell
- Office for National Statistics, Newport, NP10 8XG, UK
| | - Marie John
- Office for National Statistics, Newport, NP10 8XG, UK
| | | | | | | | | | - Veena Raleigh
- The King's Fund, London, England, W1G 0AN, UK
- Nuffield Trust, London, England, UK
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Ali S, Thind A, Stranges S, Campbell MK, Sharma I. Investigating Health Inequality Using Trend, Decomposition and Spatial Analyses: A Study of Maternal Health Service Use in Nepal. Int J Public Health 2023; 68:1605457. [PMID: 37332772 PMCID: PMC10272384 DOI: 10.3389/ijph.2023.1605457] [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: 10/05/2022] [Accepted: 05/10/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives: (a) To quantify the level and changes in socioeconomic inequality in the utilization of antenatal care (ANC), institutional delivery (ID) and postnatal care (PNC) in Nepal over a 20-year period; (b) identify key drivers of inequality using decomposition analysis; and (c) identify geographical clusters with low service utilization to inform policy. Methods: Data from the most recent five waves of the Demographic Health Survey were used. All outcomes were defined as binary variables: ANC (=1 if ≥4 visits), ID (=1 if place of delivery was a public or private healthcare facility), and PNC (=1 if ≥1 visits). Indices of inequality were computed at national and provincial-level. Inequality was decomposed into explanatory components using Fairile decomposition. Spatial maps identified clusters of low service utilization. Results: During 1996-2016, socioeconomic inequality in ANC and ID reduced by 10 and 23 percentage points, respectively. For PND, the gap remained unchanged at 40 percentage points. Parity, maternal education, and travel time to health facility were the key drivers of inequality. Clusters of low utilization were displayed on spatial maps, alongside deprivation and travel time to health facility. Conclusion: Inequalities in the utilization of ANC, ID and PNC are significant and persistent. Interventions targeting maternal education and distance to health facilities can significantly reduce the gap.
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Affiliation(s)
- Shehzad Ali
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Interfaculty Program in Public Health, Western University, London, ON, Canada
- WHO Collaborating Centre for KT and HTA in Health Equity, Ottawa, ON, Canada
- Department of Health Sciences, University of York, York, United Kingdom
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Interfaculty Program in Public Health, Western University, London, ON, Canada
- Departments of Family Medicine and Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Departments of Family Medicine and Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - M. Karen Campbell
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Obstetrics & Gynecology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Children’s Health Research Institute, Lawson Health Research Institute, London, ON, Canada
| | - Ishor Sharma
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
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Carrino E, Flatt R, Pawar P, Sanzari C, Tregarthen J, Argue S, Thornton L, Bulik C, Watson H. Sociodemographic and Clinical Characteristics of Treated and Untreated Adults with Bulimia Nervosa and/or Binge-eating Disorder Recruited for a Large-Scale Research Study. Res Sq 2023:rs.3.rs-2899349. [PMID: 37214840 PMCID: PMC10197743 DOI: 10.21203/rs.3.rs-2899349/v1] [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] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Background: Eating disorders affect millions of people worldwide, but most never receive treatment. The majority of clinical research on eating disorders has focused on individuals recruited from treatment settings, which may not represent the broader population of people with eating disorders. This study compared the characteristics of individuals with eating disorders based on whether they self-reported accessing treatment or not, to identify potential differences and contribute to a better understanding of the diverse needs and experiences of individuals with eating disorders. Methods: The study population included 762 community-recruited individuals (85% female, M ± SD age = 30 ± 7 y) with bulimia nervosa and/or binge eating disorder (BN/BED) enrolled in the Binge-Eating Genetics Initiative (BEGIN) United States study arm. Participants completed self-report surveys on demographics, treatment history, past and current eating disorder symptoms, weight history, and current mental health and gastrointestinal comorbidity. Untreated participants ( n = 291, 38%) were compared with treated participants ( n = 471, 62%) who self-reported accessing BN/BED treatment at some point in their lives. Results: Untreated participants disproportionately self-identified as male and as a racial or ethnic minority compared with treated participants. Treated participants reported a more severe illness history, specifically, an earlier age at onset, more longstanding and frequent ED symptoms over their lifetime, and higher body dissatisfaction and comorbid mental health symptoms (i.e., depression, anxiety, ADHD) at the time of the study. Those who reported a history of inpatient or residential treatment displayed the most severe illness history, whereas those who reported outpatient treatment had a less severe illness history, and untreated individuals had the mildest illness history. Conclusions: Individuals from historically overlooked or marginalized populations were less likely to access treatment. Those who accessed treatment had more severe ED and comorbid symptoms, which may have motivated them to seek treatment. Clinic-based recruitment samples may not accurately represent all individuals with EDs, particularly those with milder symptoms and those with gender or racial/ethnic diversity. The results of this study indicate that community-based recruitment is crucial for improving the ability to apply research findings to broader populations and to reduce disparities in medical research. Trial Registration : ClinicalTrials.gov NCT04162574 (https://clinicaltrials.gov/ct2/show/NCT04162574).
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Conneely M, Packer KC, Bicknell S, Janković J, Sihre HK, McCabe R, Copello A, Bains K, Priebe S, Spruce A, Jovanović N. Exploring Black and South Asian women's experiences of help-seeking and engagement in perinatal mental health services in the UK. Front Psychiatry 2023; 14:1119998. [PMID: 37077277 PMCID: PMC10109459 DOI: 10.3389/fpsyt.2023.1119998] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/06/2023] [Indexed: 04/21/2023] Open
Abstract
Background and aims In the United Kingdom (UK), Black and South Asian women are less likely than White British women to access support from perinatal mental health services, despite experiencing similar, or higher, levels of distress. This inequality needs to be understood and remedied. The aim of this study was to answer two questions: how do Black and South Asian women experience (1) access to perinatal mental health services and (2) care received from perinatal mental health services? Method Semi-structured interviews were conducted with Black and South Asian women (n = 37), including four women who were interviewed with an interpreter. Interviews were recorded and transcribed line-by-line. Data were analyzed using framework analysis, by an ethnically diverse multidisciplinary team of clinicians, researchers and people with lived experience of perinatal mental illness. Results Participants described a complex interplay of factors that impacted on seeking, and receiving help, and benefiting from services. Four themes emerged that captured the highly varied experiences of individuals: (1) Self-identity, social expectations and different attributions of distress deter help-seeking; (2) Hidden and disorganized services impede getting support; (3) The role of curiosity, kindness and flexibility in making women feel heard, accepted and supported by clinicians; (4) A shared cultural background may support or hinder trust and rapport. Conclusion Women described a wide range of experiences and a complex interplay of factors impacting access to, and experience of, services. Women described services as giving them strength and also leaving them disappointed and confused about where to get help. The main barriers to access were attributions related to mental distress, stigma, mistrust and lack of visibility of services, and organizational gaps in the referral process. These findings describe that many women feel heard, and supported by services, reporting that services provide a high quality of care that was inclusive of diverse experiences and understandings of mental health problems. Transparency around what PMHS are, and what support is available would improve the accessibility of PMHS.
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Affiliation(s)
- Maev Conneely
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Katy C. Packer
- Camden and Islington NHS Foundation Trust, London, United Kingdom
- North East London NHS Foundation Trust, London, United Kingdom
| | - Sarah Bicknell
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
| | - Jelena Janković
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Harpreet Kaur Sihre
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Rosemarie McCabe
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Alex Copello
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Kiren Bains
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Amy Spruce
- Action on Postpartum Psychosis, London, United Kingdom
| | - Nikolina Jovanović
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
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Carmen Koschollek, Katja Kajikhina, Charbel El Bcheraoui, Lothar H. Wieler, Niels Michalski, Claudia Hövener. SARS-CoV-2 infections in migrant populations in Germany: results from the COVID-19 Snapshot Monitoring Survey. Public Health 2023. [PMID: 37098323 PMCID: PMC10030330 DOI: 10.1016/j.puhe.2023.03.015] [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: 12/08/2022] [Accepted: 03/16/2023] [Indexed: 03/24/2023]
Abstract
Objectives Research shows that there is an increased risk of SARS-CoV-2 infection in migrants and ethnic minorities. However, increasing evidence indicates that socio-economic factors, such as employment, education and income, contribute to the association between migrant status and SARS-CoV-2 infection. This study aimed to examine the association between migrant status and the risk of SARS-CoV-2 infection in Germany, and to discuss potential explanations for these associations. Study design Cross-sectional study. Methods Data from the German COVID-19 Snapshot Monitoring online survey were analysed and hierarchical multiple linear regression models were used to calculate the probabilities of self-reported SARS-CoV-2 infection. Predictor variables were integrated in a stepwise method as follows: (1) migrant status (defined by own or parental country of birth other than Germany); (2) gender, age and education; (3) household size; (4) household language; and (5) occupation in the health sector, including an interaction term of migrant status (yes) and occupation in the health sector (yes). Results Of 45,858 participants, 3.5% reported a SARS-CoV-2 infection and 16% were migrants. Migrants, participants in large households, those speaking a language other than German in their household and those working in the health sector were more likely to report SARS-CoV-2 infection. The probability of reporting SARS-CoV-2 infection was 3.95 percentage points higher for migrants than non-migrants; this probability decreased when integrating further predictor variables. The strongest association of SARS-CoV-2 infection was observed for migrants working in the health sector. Conclusions Migrants and health sector employees, especially migrant health workers, are at an increased risk of SARS-CoV-2 infection. Results show that the risk of SARS-CoV-2 infection is determined by living and working conditions rather than migrant status.
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Grimes T, Marcilly R, Bonnici West L, Cordina M. Medication-Related Outcomes and Health Equity: Evidence for Pharmaceutical Care. Pharmacy (Basel) 2023; 11:pharmacy11020060. [PMID: 36961038 PMCID: PMC10037618 DOI: 10.3390/pharmacy11020060] [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: 02/01/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/25/2023] Open
Abstract
Marginalised people experience diminished access to pharmaceutical care and worse medication-related outcomes than the general population. Health equity is a global priority. This article explores the key evidence of health inequity and medication use, structures the causes and contributory factors and suggests opportunities that can be taken to advance the pharmaceutical care agenda so as to achieve health equity. The causes of, and contributors to, this inequity are multi-fold, with patient- and person-related factors being the most commonly reported. Limited evidence is available to identify risk factors related to other aspects of a personal medication use system, such as technology, tasks, tools and the internal and the external environments. Multiple opportunities exist to enhance equity in medication-related outcomes through pharmaceutical care research and practice. To optimise the effects and the sustainable implementation of these opportunities, it is important to (1) ensure the meaningful inclusion and engagement of members of marginalised groups, (2) use a person-centred approach and (3) apply a systems-based approach to address all of the necessary components of a system that interact and form a network as work processes that produce system outcomes.
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Affiliation(s)
- Tamasine Grimes
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, D02PN40 Dublin, Ireland
| | - Romaric Marcilly
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
- Inserm, CIC-IT 1403, F-59000 Lille, France
| | - Lorna Bonnici West
- Applied Research and Innovation Centre, Malta College of Arts, Science and Technology, PLA9032 Paola, Malta
| | - Maria Cordina
- Department of Clinical Pharmacology & Therapeutics, WHO Collaborating Centre for Health Professionals Education and Research, Faculty of Medicine and Surgery, University of Malta, 2080 Msida, Malta
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Maani N, Abdalla SM, Ettman CK, Parsey L, Rhule E, Allotey P, Galea S. Global Health Equity Requires Global Equity. Health Equity 2023; 7:192-196. [PMID: 36960163 PMCID: PMC10029999 DOI: 10.1089/heq.2022.0169] [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] [Accepted: 02/05/2023] [Indexed: 03/24/2023] Open
Abstract
Many global health challenges are characterized by the inequitable patterning of their health and economic consequences, which are etched along the lines of pre-existing inequalities in resources, power, and opportunity. These links require us to reconsider how we define global health equity, and what we consider as most consequential in its pursuit. In this article, we discuss the extent to which improving underlying global equity is an essential prerequisite to global health equity. We conclude that if we are to improve global health equity, there is a need to focus more on foundational—rather than proximal—causes of ill health and propose ways in which this can be achieved.
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Affiliation(s)
- Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
- Rockefeller Foundation/Boston University Commission on Data, Determinants and Decision-making, Boston, Massachusetts, USA
| | - Salma M. Abdalla
- Rockefeller Foundation/Boston University Commission on Data, Determinants and Decision-making, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, USA
| | - Catherine K. Ettman
- Rockefeller Foundation/Boston University Commission on Data, Determinants and Decision-making, Boston, Massachusetts, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lily Parsey
- International Longevity Centre UK (ILC), London, United Kingdom
| | - Emma Rhule
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Pascale Allotey
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Sandro Galea
- Rockefeller Foundation/Boston University Commission on Data, Determinants and Decision-making, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, USA
- Address correspondence to: Sandro Galea, MD, MPH, DrPH, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.
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Zhao Y. Socioeconomic Positions and Midlife Health Trajectories in a Changing Social Context: Evidence from China, 1991-2006. J Health Soc Behav 2023; 64:39-61. [PMID: 36789677 DOI: 10.1177/00221465221150381] [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] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Cumulative (dis)advantage theory posits that socioeconomic disparities in health may increase with age. This study examines individuals' midlife health trajectories, taking account of how their life courses are embedded within changing social contexts. Using the China Health and Nutrition Survey (1991-2006), it examines the health gap between Chinese rural peasants and urban nonpeasants in three adjacent time periods, during which a rapid process of social change increased the inequalities between rural and urban areas. Findings show that the health gap increases more rapidly in the more recent time periods, with higher levels of inequality, indicating that health inequalities between the two groups are contingent upon the social contexts in which individuals' lives unfold. To better understand the differences observed over these time periods, further analysis will examine the roles of two structural factors: income inequality and differential access to medical care.
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Abstract
This article discusses the social harms arising out of stigma experienced by people who use drugs (PWUD), and how stigmatisation compromises 'human flourishing' and constrains 'life choices'. Drawing on Wellcome Trust qualitative research using in-depth, semi-structured interview data (N = 24) with people who use heroin, crack cocaine, spice and amphetamine, this article firstly provides insight into how stigma is operationalised relationally between people via a lens of class talk and drug use predicated on normative ideas of 'valued personhood'. Secondly, it turns to how stigma is weaponised in social relations to keep people 'down', and thirdly, it shows how stigma is internalised as blame and shame and felt deeply 'under the skin' as 'ugly feelings'. Findings from the study show that stigma harms mental health, inhibits access to services, increases feelings of isolation, and corrodes a person's sense of self-worth as a valued human being. These relentless negotiations of stigma are painful, exhausting and damaging for PWUD, culminating in, as I argue, everyday acts of social harm that come to be normalised.
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Weiler HA, Sarafin K, Martineau C, Daoust JL, Esslinger K, Greene-Finestone LS, Loukine L, Dorais V. Vitamin D Status of People 3 to 79 Years of Age from the Canadian Health Measures Survey 2012-2019. J Nutr 2023; 153:1150-1161. [PMID: 36848989 DOI: 10.1016/j.tjnut.2023.02.026] [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: 12/09/2022] [Revised: 02/09/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Vitamin D is recognized in bone health and the prevention of rickets and osteomalacia. OBJECTIVE This study aimed to assess vitamin D status of people in Canada and to identify factors associated with vitamin D inadequacy and deficiency. METHODS Serum 25-hydroxyvitamin D (25(OH)D) from the Canadian Health Measures Survey (cycles 3-6, n = 21,770, 3-79 y) were evaluated for geometric means and proportions <40 (inadequate) and <30 (risk of deficiency) nmol/L. Factors associated with inadequacy or deficiency were tested using logistic regression. RESULTS Mean serum 25(OH)D was 57.9 (95% CI: 55.4, 60.5) nmol/L; the prevalence of inadequacy was 19.0% (95% CI: 15.7, 22.3) and risk of deficiency was 8.4% (95% CI: 6.5, 10.3). Prominent dietary factors associated with inadequacy in adults included: not consuming fish compared with ≥1/wk (adjusted ORadj: 1.60; 95% CI: 1.21, 2.11), none compared with ≥1/d for cow's milk (ORadj: 1.41; 95% CI: 1.02, 1.94) or margarine (ORadj: 1.42; 95% CI: 1.08, 1.88); or nonuser compared with user of vitamin D supplements (ORadj: 5.21; 95% CI: 3.88, 7.01). Notable demographic factors included: younger adults compared with 71 to 79 y (19-30 y ORadj: 2.33; 95% CI: 1.66, 3.29); BMI ≥30 compared with <25 kg/m2 (ORadj: 2.30; 95% CI: 1.79, 2.95); lower household income quartile 1 compared with 4 (ORadj: 1.46; 95% CI: 1.00, 2.15); and self-reported Black (ORadj: 8.06; 95% CI: 4.71, 13.81), East/Southeast Asian (ORadj: 3.83; 95% CI: 2.14, 6.85), Middle Eastern (ORadj: 4.57; 95% CI: 3.02, 6.92), and South Asian (ORadj: 4.63; 95% CI: 2.62, 8.19) race compared with White. Similar factors were observed in children and for deficiency. CONCLUSIONS Most people in Canada have adequate vitamin D status; nonetheless, racialized groups have an elevated prevalence of inadequacy. Further research is required to evaluate if current strategies to improve vitamin D status, including increasing vitamin D in fortified foods and supplements, and dietary guidance to include a source of vitamin D every day help to reduce health inequality in Canada.
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Affiliation(s)
- Hope A Weiler
- Nutrition Research Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada.
| | - Kurtis Sarafin
- Nutrition Research Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Chantal Martineau
- Nutrition Regulations and Standards Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Janice L Daoust
- Nutrition Regulations and Standards Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Krista Esslinger
- Office of Nutrition Policy and Promotion, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | | | - Lidia Loukine
- Bureau of Food Surveillance and Science Integration, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Veronique Dorais
- Bureau of Food Surveillance and Science Integration, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
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Slater M, Bartlett S. Climate change: What healthcare professionals can do. J R Coll Physicians Edinb 2023; 53:7-8. [PMID: 36825785 DOI: 10.1177/14782715231158878] [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] [Indexed: 02/25/2023] Open
Abstract
Climate change is the biggest threat to global health. The National Health Service (NHS) has committed to 'net zero' and significant inroads have been made into reducing the carbon footprint of some areas of healthcare. The Royal College of Physicians of Edinburgh (RCPE) has produced a resource outlining steps we can all take. It is incumbent on us all to act as doctors and citizens of the planet.
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Basurko C, Dupart O, Savy M, Obert-Marby C, Mvogo A, Gonzalez A, Trepont A, Cann L, Boceno C, Osei L, Creton PM, Dufit V, Thelusme L, Adenis A, Van-Melle A, Huber F, Nacher M. Hunger in French Guiana's Vulnerable Urban Neighborhoods: A Neglected Consequence of COVID-19. Food Nutr Bull 2023; 44:3-11. [PMID: 36824041 DOI: 10.1177/03795721231156641] [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] [Indexed: 02/25/2023]
Abstract
BACKGROUND In French Guiana, restrictions to control the spread of SARS-CoV-2 were put in place between March 2020 and March 2022. In vulnerable urban neighborhoods, during this period, requests for food assistance increased and fear of hunger overtook fear of being affected by COVID-19. OBJECTIVE The objective of this survey was to describe food security during the COVID-19 pandemic in French Guiana and to study the relationship between the socioeconomic conditions of the study households and household hunger. METHODS A multicenter survey was therefore conducted in mobile clinics and fixed structures providing care to at-risk urban populations. In a face-to-face interview, a community health worker asked participants questions about the sociodemographic and economic profile of the household, and about household food security (food consumption score, coping strategies in the face of food shortages, and household hunger index). Two hundred and seventy-seven households were recruited in February 2021. RESULTS According to the household hunger scale, 42.6% of households experienced moderate hunger and 23.8% of households experienced severe hunger in the month preceding the survey. Lack of residence permit, lack of social support, water insecurity, small housing, and lack of access to an urban garden were determinants related to the risk of household hunger. CONCLUSIONS Food insecurity have affected a large majority of the households in this survey, and the immediate consequences for children's health were already apparent. These results draw attention to a neglected health problem in a socioeconomically vulnerable population during the COVID-19 pandemic.
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Affiliation(s)
- Celia Basurko
- Centre d'Investigation Clinique Antilles Guyane, CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Ophélie Dupart
- Permanence d'accès aux soins de santé, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Mathilde Savy
- MoISA, Université de Montpellier, Cirad, Ciheam-IAMM, Inrae, Institut Agro, IRD, Montpellier, France
| | - Camille Obert-Marby
- Permanence d'accès aux soins de santé, Centre Hospitalier de l'ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Alexandra Mvogo
- Permanence d'accès aux soins de santé, Centre Hospitalier de l'ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | | | | | - Lisa Cann
- Médecins du Monde, Cayenne, French Guiana
| | - Claire Boceno
- Permanence d'accès aux soins de santé, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Lindsay Osei
- Centre d'Investigation Clinique Antilles Guyane, CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana.,Service de pédiatrie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | | | - Valentin Dufit
- Centre d'Investigation Clinique Antilles Guyane, CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Liliane Thelusme
- Unité transversale de nutrition, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Antoine Adenis
- Centre d'Investigation Clinique Antilles Guyane, CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Astrid Van-Melle
- Centre d'Investigation Clinique Antilles Guyane, CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | | | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles Guyane, CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
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Yan F, Zuo A, Qi W, Zhou Z. The Effect of Ecological Management on Regional Health Inequality. Int J Environ Res Public Health 2023; 20:3037. [PMID: 36833731 PMCID: PMC9966462 DOI: 10.3390/ijerph20043037] [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: 12/21/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Ecological management has been implemented to improve individual well-being. However, it remains unclear whether this management has improved health inequality over time. Aiming to examine whether health inequality is caused by ecological management in China, we harnessed a macro-level dataset from 2001 to 2019 across 31 Chinese provinces-combined with gene and dietary culture data-and utilized a bilateral approach to pair provincial data. Empirical results of system Generalized Method of Moments (sys-GMM) estimations in benchmark and extensive models which suggest a negative and statistically significant causal effect of ecological management on health inequality. Specifically, ecological management contributes to decreasing the inequality in the population death rate, the death rate among pregnant women, the underweight newborn rate, the child malnutrition rate, and the infectious disease mortality. The results are robust to weak instruments in the sys-GMM setting and a delayed effect of ecological management. Additionally, the heterogeneity analysis shows that the causal effect of ecological management on decreasing regional health inequality is more significant and higher for subsamples in identical regions than in different regions.
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Affiliation(s)
- Fafa Yan
- Lingnan College, Sun Yat-Sen University, Guangzhou 510275, China
| | - Alec Zuo
- Centre for Global Food and Resources, School of Economics and Public Policy, University of Adelaide, Adelaide, SA 5000, Australia
| | - Wen’e Qi
- College of Economics and Management, South China Agricultural University, Guangzhou 510642, China
| | - Zhimin Zhou
- School of Finance and Economics, Guangdong Polytechnic Normal University, Guangzhou 510665, China
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Wang S, Ren Z, Liu X. Spatiotemporal trends in neonatal, infant, and child mortality (1990-2019) based on Bayesian spatiotemporal modeling. Front Public Health 2023; 11:996694. [PMID: 36844832 PMCID: PMC9947283 DOI: 10.3389/fpubh.2023.996694] [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: 07/18/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Background Neonatal mortality rate (NMR), infant mortality rate (IMR), and child mortality rate (CMR) show a huge difference across countries, which has been posing challenges for public health policies and medical resource allocation. Methods Bayesian spatiotemporal model is applied to assess the detailed spatiotemporal evolution of NMR, IMR, and CMR from a global perspective. Panel data from 185 countries from 1990 to 2019 are collected. Results The continuously decreasing trend of NMR, IMR, and CMR indicated a great improvement in neonatal, infant, and child mortality worldwide. Further, huge differences in the NMR, IMR, and CMR still exist across countries. In addition, the gap of NMR, IMR, and CMR across the countries presented a widening trend from the perspective of dispersion degree and kernel densities. The spatiotemporal heterogeneities demonstrated that the decline degree among these three indicators could be observed as CMR > IMR > NMR. Countries such as Brazil, Sweden, Libya, Myanmar, Thailand, Uzbekistan, Greece, and Zimbabwe showed the highest values of b1i , indicating a weaker downward trend compared to the overall downward trend in the world. Conclusions This study revealed the spatiotemporal patterns and trends in the levels and improvement of NMR, IMR, and CMR across countries. Further, NMR, IMR, and CMR show a continuously decreasing trend, but the differences in improvement degree present a widening trend across countries. This study provides further implications for policy in newborns, infants, and children's health to reduce health inequality worldwide.
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Affiliation(s)
- Shaobin Wang
- Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Zhoupeng Ren
- Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China,State Key Laboratory of Resources and Environmental Information System, Beijing, China,*Correspondence: Zhoupeng Ren ✉
| | - Xianglong Liu
- Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China,State Key Laboratory of Resources and Environmental Information System, Beijing, China
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Martyn E, Eisen S, Longley N, Harris P, Surey J, Norman J, Brown M, Sultan B, Maponga TG, Iwuji C, Flanagan S, Ghosh I, Story A, Matthews PC. The forgotten people: Hepatitis B virus (HBV) infection as a priority for the inclusion health agenda. eLife 2023; 12:e81070. [PMID: 36757862 PMCID: PMC9910830 DOI: 10.7554/elife.81070] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 07/01/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023] Open
Abstract
Hepatitis B virus (HBV) infection represents a significant global health threat, accounting for 300 million chronic infections and up to 1 million deaths each year. HBV disproportionately affects people who are under-served by health systems due to social exclusion, and can further amplify inequities through its impact on physical and mental health, relationship with stigma and discrimination, and economic costs. The 'inclusion health' agenda focuses on excluded and vulnerable populations, who often experience barriers to accessing healthcare, and are under-represented by research, resources, interventions, advocacy, and policy. In this article, we assimilate evidence to establish HBV on the inclusion health agenda, and consider how this view can inform provision of better approaches to diagnosis, treatment, and prevention. We suggest approaches to redress the unmet need for HBV interventions among excluded populations as an imperative to progress the global goal for the elimination of viral hepatitis as a public health threat.
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Affiliation(s)
- Emily Martyn
- The Francis Crick InstituteLondonUnited Kingdom
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Sarah Eisen
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Nicky Longley
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Hospital for Tropical Diseases, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Philippa Harris
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Julian Surey
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Institute of Global Health, University College LondonLondonUnited Kingdom
- Universidad Autonoma de Madrid, Ciudad Universitaria de CantoblancoMadridSpain
| | - James Norman
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Michael Brown
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
| | - Binta Sultan
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Tongai G Maponga
- Stellenbosch University, Faculty of Medicine and Health SciencesTygerbergSouth Africa
| | - Collins Iwuji
- Department of Global Health, Brighton and Sussex Medical School, University of SussexBrightonUnited Kingdom
- Africa Health Research InstituteDurban, KwaZulu-NatalSouth Africa
| | - Stuart Flanagan
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Indrajit Ghosh
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
| | - Alistair Story
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Collaborative Centre for Inclusion Health, University College LondonLondonUnited Kingdom
| | - Philippa C Matthews
- The Francis Crick InstituteLondonUnited Kingdom
- Department of Infectious Diseases, University College London Hospitals NHS Foundation TrustLondonUnited Kingdom
- Mortimer Market Centre, Central and North London NHS Foundation TrustLondonUnited Kingdom
- Division of Infection and Immunity, University College LondonLondonUnited Kingdom
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Pechdin W, Sarnkhaowkhom C, Kanthanetr S, Willemse MP. Retelling social inequalities in the era of market competition: Review and discussion for sustainable welfare development. Front Sociol 2023; 8:1085278. [PMID: 36824224 PMCID: PMC9941533 DOI: 10.3389/fsoc.2023.1085278] [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] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
As the prevalence of social inequalities has become increasingly evident, the implementation of social welfare policies in countries across the globe has faced considerable obstacles and has not yielded the desired results. In spite of the fact that social welfare policies are formulated to reduce inequalities in society, the recent increase in inequalities has raised questions about whether or not welfare implementation is appropriate to the social context where resource distributions are dominated by economic structure. Inspired by this, the aim of this paper is to echo contemporary perspectives on social inequality and challenges that have contributed to its development under the economic system of market competition. The contemporary matters arising from social inequalities, which include intergenerational inequality, gender-based inequality, health inequality, and education inequality, are examined in accordance with the context of market competition. This would hopefully enable academicians to timely recognize and address ideological and paradoxical social inequalities and welfare development within their society.
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Affiliation(s)
- Watchara Pechdin
- Thammasat University Research Unit in Social Equity, Faculty of Social Administration, Thammasat University, Bangkok, Thailand
| | - Chawapon Sarnkhaowkhom
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Sudarat Kanthanetr
- College of Population Studies, Chulalongkorn University, Bangkok, Thailand
| | - Martin Pieter Willemse
- Faculty of Information and Communication Technology, Mahidol University, Nakhon Pathom, Thailand
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Aurelius T, Maheshwari A, Ken-Dror G, Sharma SD, Amlani S, Gunathilagan G, Cohen DL, Rajkumar C, Maguire S, Ispoglou S, Balogun I, Parry A, Sekaran L, Syed H, Lawrence E, Singh R, Hassan A, Wharton C, Javaid K, Goorah N, Carr P, Sami EA, Sharma SR, Sylaja PN, Prasad K, Sharma P. Ischaemic stroke in South Asians: The BRAINS study. Eur J Neurol 2023; 30:353-361. [PMID: 36260058 PMCID: PMC10098949 DOI: 10.1111/ene.15605] [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: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Studies on stroke in South Asian populations are sparse. The aim of this study was to compare differences in age of onset of ischaemic stroke in South Asian patients living in the United Kingdom and South Asian patients living in India versus White British stroke patients. METHODS We studied the UK and Indian arms of the ongoing BRAINS study, an international prospective hospital-based study of South Asian stroke patients. The BRAINS study includes 4038 South Asian and White British patients with first-ever ischaemic stroke, recruited from sites in the United Kingdom and India. RESULTS Of the included patients, 1126 were South Asians living in India (ISA), while 1176 were British South Asian (BSA) and 1736 were White British (WB) UK residents. Patients in the ISA and BSA groups experienced stroke 19.5 years and 7.2 years earlier than their WB counterparts, respectively (mean [interquartile range] age: BSA 64.3 [22] years vs. ISA 52.0 [18] years vs. WB 71.5 [19] years; p < 0.001). Patients in the BSA group had higher rates of hypertension, diabetes mellitus and hypercholesterolaemia than those in the ISA and WB groups. After adjustment for traditional stroke risk factors, an earlier age of stroke onset of 18.9 years (p < 0.001) and 8.9 years (p < 0.001) was still observed in the ISA and BSA groups, respectively. In multivariable stepwise linear regression analysis, ethnicity accounted for 24.7% of the variance in early age onset. CONCLUSION Patients in the BSA and ISA groups experienced ischaemic stroke approximately 9 and 19 years earlier, respectively, than their WB counterparts. Ethnicity is an independent predictor of early age of stroke onset. Our study has considerable implications for public health policymakers in countries with sizable South Asian populations.
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Affiliation(s)
- Taylor Aurelius
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Ankita Maheshwari
- Departments of Neurology, All India Institute of Medical Sciences, New Delhi & Rajendra Institute of Medical Sciences, Ranchi, India
| | - Gie Ken-Dror
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Sapna D Sharma
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
| | - Sageet Amlani
- BARTS and the London NHS Trust/ Royal London Hospital, London, UK
| | | | | | - Chakravarthi Rajkumar
- Brighton and Sussex University Hospitals NHS Trust & Brighton and Sussex Medical School, University of Sussex, Sussex, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | - Peter Carr
- Birmingham Heartlands Hospital, Birmingham, UK
| | | | - Shri Ram Sharma
- North Eastern Indira Gandhi Regional Institute for Health and Medical Sciences, Shillong, India
| | - Padmavathy N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Kameshwar Prasad
- Departments of Neurology, All India Institute of Medical Sciences, New Delhi & Rajendra Institute of Medical Sciences, Ranchi, India
| | - Pankaj Sharma
- Institute of Cardiovascular Research Royal Holloway, University of London (ICR2UL), London, UK
- Ashford & St Peter's NHS Foundation Trust, Surrey, UK
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK
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Lightner J, Eighmy K, Valleroy E, Wray B, Grimes A. The Effectiveness of an After-school Sport Sampling Intervention on Urban Middle School Youth in the Midwest: Posttest-Only Study. JMIR Pediatr Parent 2023; 6:e42265. [PMID: 36696161 PMCID: PMC9909513 DOI: 10.2196/42265] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/18/2022] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Effective and scalable interventions are needed to combat chronic low levels of youth physical activity. After-school sport sampling programs may be vital interventions for teaching sports and increasing physical literacy and physical activity, which result in healthy lifelong habits that are maintained into adulthood. OBJECTIVE The purpose of this study was to test the effectiveness of an after-school sport sampling intervention among underserved youth in the Midwest. METHODS Youth (n=81) in 3 middle schools within a large Midwest city participated in an 8-month, after-school physical activity intervention that aimed to increase moderate- and vigorous-intensity physical activity, improve physical literacy, and decrease BMI. Difference scores for this 2-group, posttest-only design were calculated. A series of 2-tailed t tests were conducted to assess between-group differences. RESULTS The intervention group had significantly better physical literacy (t115=7.57; P=.004) and engaged in more moderate- and vigorous-intensity physical activity minutes per week (t115=4.28; P=.04) and steps per day (t115=4.29; P=.03). CONCLUSIONS An after-school sport sampling program may be an effective solution for combating youth physical inactivity. Future research should assess the scalability of this intervention with larger populations and in different areas. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/37126.
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Affiliation(s)
- Joseph Lightner
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Katlyn Eighmy
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, United States.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Ella Valleroy
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, United States.,Department of Population Health, University of Kansas Medical Center, Kansas City, KS, United States
| | - Bridget Wray
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Amanda Grimes
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, United States
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