1,174 results on '"Determinants of health"'
Search Results
2. Preparing Graduate Nursing Students to Lead Nursing Green Teams: Approach and Identified Greening Opportunities and Solutions.
- Author
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Jacobson Vann, Julie C.
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MEDICAL ethics , *GREENHOUSE gases , *MEDICAL care , *BUSINESS planning , *CLIMATE change & health , *INTERPROFESSIONAL education , *TEAM nursing - Abstract
This article discusses the importance of preparing graduate nursing students to address environmental health issues and lead nursing green teams. It emphasizes the need to integrate environmental health concepts into nursing school curricula and highlights the role of nurses in addressing climate change and pollution in healthcare settings. The article provides information on the impact of health services on climate change and the formation of nursing green teams to implement sustainability initiatives. It also discusses opportunities and solutions for greening healthcare workplaces, waste management, chemical use, and improving environmental sustainability in healthcare settings. The document includes a list of references and sources for further research on the topic. [Extracted from the article]
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- 2024
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3. Checkmating the Nutri-Score: Will Food Patriotism Prevent the Harmonization of Front-of-Pack Labeling Schemes within the EU?
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Ewert, Benjamin
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FOOD labeling laws , *FOOD quality , *NUTRITIONAL value , *PACKAGED foods , *DECISION making , *FOOD industry , *PRACTICAL politics , *FOOD preferences - Abstract
Front-of-pack labeling schemes are an effective but contested regulatory approach to nudge consumers toward healthy food choices. The Nutri-Score, being implemented by eight European countries, is one of the most elaborated and evidence-based examples. Therefore, the Nutri-Score has been deemed as the front-runner within the European Commission's attempt to harmonize front-of-pack labeling among European Union (EU) member states under its Farm-to-Fork strategy by the end of 2022. However, the endeavor is on the brink of failure because of massive resistance by Mediterranean member states and parts of the food industry capitalizing on patriotic narratives (e.g., "Made in Italy"). This article investigates the Nutri-Score saga from a political and commercial determinants of health lens. It argues that an EU-wide rollout of the label hinges on the specific interplay between political structures and stakeholder agency. As shown, the EU's weak decision-making power has been exploited by the No-Nutri-Score alliance. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Fifty Observations About the Health Promotion Discipline: Tributes, Cautions and a Call to Action (Part One).
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Terry, Paul E.
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HEALTH promotion , *TEXTBOOKS , *WELL-being , *READERSHIP , *LEADERSHIP - Abstract
In observance of having worked for going on five decades in the health promotion profession, this editorial shares fifty observations about the state of our field. In part one, I offer these first twenty five observations that focus on societal trends that have shifted how we frame our work and the movement from wellness to well-being. I reflect on why the wellness term fell out of favor, the roots of the well-being term and attendant definitions of health promotion. Seminal professional text books, popular readership books and key studies that have informed the health promotion discipline are reviewed. I summarize several conundrums that need solving for and conclude with calls to action for health promotion professionals. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Fifty Observations About the Health Promotion Discipline: Ambitions, Polemics and Inspiration (Part Two).
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Terry, Paul E.
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HEALTH promotion , *PRIVATE sector , *PUBLIC sector , *EFFECTIVE teaching , *POLEMICS - Abstract
In part one of this editorial covering fifty observations about the history and evolution of the health promotion discipline I shared twenty five observations relating to societal trends, definitional nuances and seminal studies and resources that have contributed to the trajectory of the field. In this, part two of the editorial, I list an additional twenty five observations focused on polemics and controversies and on the importance of effective teaching, research and writing. I reflect on the different approaches used by public sector and private sector health promotion experts respectively. I also share inspirational quotes that I consider closely aligned with the vision and mission of our profession. [ABSTRACT FROM AUTHOR]
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- 2024
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6. PROGRESS TOWARD EU SDG 3 THROUGH MULTIPURPOSE INDICATORS
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PÎRVU RAMONA, NACHE CIMPOERU MARIA, and NĂSTASE LUIZA LOREDANA
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sdg 3 ,multipurpose indicators ,determinants of health ,causes of death ,sustainable development ,Commercial geography. Economic geography ,HF1021-1027 ,Economics as a science ,HB71-74 - Abstract
Sustainable development is an important objective of European Union policies, being a responsibility at national, regional, and local level. In a prosperous Europe, addressing sustainable development and, above all, of the health and well-being of its citizens is essential. The EU expresses its concern for the approach of multifunctional indicators, which are relevant not only in the context of the 2030 Agenda, but also in relation to the objectives of the European Pillar of Social Rights, the objectives of the 8th environmental action program and the objectives of the European Green Deal. Growing obesity, noise exposure of individuals, incidence of fatal accidents at work, incidence of deaths in road traffic or exposure to fine particles are current problems of the European Union; these being found as indicators not only for tracking the progress of SDG 3, but also for tracking the progress of SDG 2, SDG 8 and SDG 11. In this regard, our paper aims at the progress of the third Sustainable Development Goal, by carrying out a multi-year statistical analysis of the multi-purpose indicators established by the European Union to track the achievement of the predetermined targets. The collection of quantitative data for analysis was carried out by consulting the Statistical Office of the European Union.
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- 2024
7. Interfaces of ‘being healthy and being Ill’: how is health being perceived by individuals with non-communicable chronic conditions?
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Nilanjan Bhor and P Omkar Nadh
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Determinants of health ,Health system ,Non-communicable chronic conditions ,Perception of health ,Urban health ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Accommodating chronic care into the everyday lives of individuals diagnosed with non-communicable chronic conditions often poses significant challenges. Several studies in public health literature that addressed the question of non-adherence to treatment by turning their gaze towards individual’s perception of their own health restricted the use of perception exploration to visceral states and corporeality without adequately acknowledging the mutual permeance of socio-biological worlds. This study explored the socio-economic genealogies of individuals, to understand the role of structural and intermediate factors that determine health perceptions, by attempting to answer the question ‘how do individuals with non-communicable chronic conditions perceive their health as healthy or ill’?. Methods This study was conducted in a low-income neighbourhood called Kadugondanahalli in India using qualitative research methods. A total of 20 in-depth interviews were conducted with individuals diagnosed with non-communicable chronic conditions. Individuals were recruited through purposive and snowball sampling. Results The participants predominantly perceived their health as being healthy and ill in an episodic manner while adhering to their treatment and medications for chronic conditions. This was strongly determined by the factors such as presence of family support and caregiving, changes in work and occupation, changes in lifestyle, psychological stress from being diagnosed, and care-seeking practices. This episodic perception of illness led to the non-adherence of prescribed chronic care. Conclusions Due to the episodic manner in which the participants experienced their illness, the paper recommends considering health and illness as two different entities while researching chronic conditions. It is important for the health system to understand and fix the healthy and ill episodes, which often lead to switching between controlled and uncontrolled states of diabetes and hypertension. To do so, it is important to consider the social, economic, behavioural and psychological factors in an individual’s health outcome. The interplay between these factors has socialized health perception and various related practices from the individual to the community level. Therefore, the health system needs to re-strategize its focus from individual to community level interventions to address the determinants of health and NCD risk factors by strengthening the NCD prevention approach.
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- 2024
- Full Text
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8. Barriers to preschool aged children's participation in swimming lessons in New South Wales, Australia.
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Ananthapavan, Vidthyany, Peden, Amy E., Angell, Blake, and Macniven, Rona
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SWIMMERS , *PRESCHOOL children , *INDIGENOUS Australians , *SWIMMING , *LOW-income parents - Abstract
Issue Addressed: To understand barriers to uptake of subsidised swimming lessons by children aged 3–6 years old ('preschool aged children'), including from priority populations, in New South Wales (NSW). Methods: A thematic analysis of 4191 qualitative responses from parents/carers of preschool aged children describing barriers that resulted in their child's non‐participation in subsidised swimming lessons in the past 12 months was conducted. Data, including parent/carer sociodemographic variables, were collected through registrations for the NSW Government's First Lap voucher program. Results: Seven overarching barriers to participation were identified: (1) child's disability or health needs; (2) swimming lesson affordability; (3) family or personal circumstances; (4) lack of or poor availability of swimming lessons; (5) parent/carer availability, including to fulfil participation requirements; (6) COVID‐19 and (7) deprioritisation of formal swimming lessons due to parent/carer perceptions relating to its importance. These may limit the uptake of swimming lessons in preschool aged children, particularly those who are Aboriginal and Torres Strait Islander, from culturally and linguistically diverse backgrounds, living with a disability, from low socioeconomic families and living in regional and remote areas. Conclusion: Structural barriers must be addressed to increase uptake of swimming lessons in preschool aged children, particularly in priority populations, to reduce drowning risk. So What?: Evidence‐based policy initiatives, with robust evaluation, should seek to address the availability and flexibility of swimming lessons, including for priority populations; complexities associated with supervision requirements; poor awareness of parents/carers of the importance of swimming for preschool aged children and the lack of continuity of swimming for children in out of home care. [ABSTRACT FROM AUTHOR]
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- 2024
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9. Evaluating the potential role of determinants of health on encephalocele patient outcomes — a combined retrospective study and systematic review.
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Escobar, Victoria A. Pinilla, Wyant, W. Austin, Debs, Luca H., Jamshidi, Aria, Kiehna, Erin N., and McCrea, Heather J.
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ENCEPHALOCELE , *CHILD health services , *MATERNAL age , *LITERATURE reviews , *PRENATAL diagnosis , *RELIGIOUS identity - Abstract
Introduction: To evaluate the outcomes and demographics of encephalocele patients who were born and received treatment in our neonatal ICU and conduct a PRISMA literature review. Methods: An Institutional Review Board (IRB)-approved retrospective cohort study was undertaken to investigate the results of treating encephalocele patients at Jackson Memorial Hospital (JMH) from 1998 to 2022. The study focused on assessing outcomes and the impact of maternal socioeconomic factors, such as religion, age, and education, along with the timing of diagnosis, in connection with a systematic review. Results: A total of 20 encephalocele patients were identified (13 females and 7 males), with 15 having available medical records for review. Most of these cases involved occipital encephaloceles (73.3%). Maternal ages at the time of delivery ranged from 15 to 42 years, with a mean age of 27.3 years. The average gestational age at birth was 37 weeks. Ten cases had a prenatal diagnosis documented, occurring between 12 and 24.5 weeks of gestation. Three of the surviving patients had records of prenatal counseling that included discussions about termination. No infections were reported. Among the 15 cases, 11 patients (73.3%) were alive at the last follow-up, with a mean age at follow-up of 4.12 years, ranging from 6 weeks to 15 years post-birth. Hydrocephalus was noted in 26.7%. Only 1 mother had completed high school. Most mothers were either on Medicaid (9 patients) or uninsured (3 patients), with only 3 having commercial insurance. Religious affiliations varied among the mothers, with 14 out of 15 identifying with a particular religion. The systematic review identified 22 articles from various countries, with 11 articles meeting the inclusion criteria for qualitative analysis. These articles revealed potential maternal risk factors for encephaloceles, including low-nutrient diets, inadequate folic acid intake, young maternal age, advanced maternal age, low socioeconomic status, and limited educational attainment. Conclusions: In the twenty-first century, there is a positive trend in the survival rates of children born with encephalocele. However, maternal factors such as low socioeconomic status and limited educational attainment remain prominent, affecting their ability to access timely prenatal care and impacting follow-up medical care for these children. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Outcomes and instruments used in social prescribing: a modified umbrella review.
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Ashe, Maureen C., dos Santos, Isis Kelly, Alfares, Hadil, Chudyk, Anna M., and Esfandiari, Elham
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PSYCHOSOCIAL factors ,PHYSICAL activity ,SOCIAL services ,UMBRELLAS ,DATABASE searching - Abstract
Introduction: Previous social prescribing work highlights a range in the types and number of outcomes used in published studies. We aimed to describe social prescribing outcome core areas and instruments to build capacity for future research and program evaluation. Methods: This was a modified umbrella review following standard guidelines. We registered the study and searched multiple databases (all languages and years); inclusion criteria were peer-reviewed publications containing outcomes for self-described social prescribing for adults aged 18 years and older. The last search date was 9 July 2023. From the included systematic reviews, we identified primary studies using the same inclusion criteria. For primary studies, we sorted extracted outcomes and instruments into six core areas using a published taxonomy. We located information on instruments' description and measurement properties and conducted two rating rounds for (1) the quality of systematic reviews and (2) reporting of instruments in primary studies. We conducted a narrative synthesis of reviews, primary studies and outcomes (PROSPERO 2023 CRD42023434061). Results: We identified 10 systematic reviews and 33 primary studies for inclusion in our review. Outcomes covered most core taxonomy areas, with an emphasis on psychosocial factors (e.g. well-being) and less emphasis on cognition, physical activity, and caregivers and volunteers. We noted few studies provided detailed information on demographic data of participants or measurement properties of instruments. Conclusion: This synthesis provides an overview and identifies knowledge gaps for outcomes and instruments used in social prescribing interventions. This work forms the basis of our next step of identifying social prescribing-related outcomes that matter most across interested parties, such as individuals providers and decision makers. [ABSTRACT FROM AUTHOR]
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- 2024
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11. Bridging the commercial determinants of Indigenous health and the legacies of colonization: A critical analysis.
- Author
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Eisenkraft Klein, Daniel and Shawanda, Amy
- Abstract
To date, there has been scarce effort to consider the intertwining of colonization and the commercial determinants of Indigenous health. This is a vital omission, and one that this paper proposes to address. We propose how four losses of tradition borne out of colonialism are intertwined with four respective commercial determinants of Indigenous health: 1) loss of traditional diets and the ultra-processed food industry; 2) loss of traditional ceremony and the tobacco industry; 3) loss of traditional knowledge and the infant formula industry; and 4) loss of traditional support networks and the alcohol industry. Building on Indigenous efforts to decolonize spaces and assert control over their own lives, we argue that analyzing the mechanisms through which industry activities intersect with colonial legacies will improve broader understandings of Indigenous health disparities. [ABSTRACT FROM AUTHOR]
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- 2024
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12. Evaluating the Environmental Impact of Anthropogenic Activities on Human Health: A Systematic Review.
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Cofone, Luigi, Sabato, Marise, Di Rosa, Enrico, Colombo, Chiara, and Paglione, Lorenzo
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ANTHROPOGENIC effects on nature ,ENVIRONMENTAL impact analysis ,HEALTH impact assessment ,URBAN planning ,ENVIRONMENTAL health ,INDUSTRIALIZATION - Abstract
Due to major global urbanisation, a careful evaluation of plans (town planning and mobility) and projects (industrial and development) is required in order to measure their impact on health and environmental matrices. In Italy, Legislative Decree No 152/06 introduced two procedures: the EIA (Environmental Impact Assessment) and SIA (Strategic Impact Assessment). Their focus, however, does not consider human health. Recently, the Integrated Environmental and Health Impact Assessment (IEHIA) was introduced; this defines the parameters necessary to provide an EIA that includes human health as a factor. This systematic review was conducted, including both the population impacted by new facilities and the method used to define their impact. Our database search produced 724 articles, of which 33 were eligible. Studies included landfill plans, manufacturing industries, mobility policies, energy production, and the environmental health of an area. All studies show how an approach encompassing multiple parameters can analyse the impact of a new facility in a comprehensive manner. This review shows that the use of health-related environmental impact parameters is essential for the integration of a project into a community, and can allow a wider understanding of the possible impacts on human health, both direct and indirect. [ABSTRACT FROM AUTHOR]
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- 2024
- Full Text
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13. Interfaces of ‘being healthy and being Ill’: how is health being perceived by individuals with non-communicable chronic conditions?
- Author
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Bhor, Nilanjan and Nadh, P Omkar
- Abstract
Background: Accommodating chronic care into the everyday lives of individuals diagnosed with non-communicable chronic conditions often poses significant challenges. Several studies in public health literature that addressed the question of non-adherence to treatment by turning their gaze towards individual’s perception of their own health restricted the use of perception exploration to visceral states and corporeality without adequately acknowledging the mutual permeance of socio-biological worlds. This study explored the socio-economic genealogies of individuals, to understand the role of structural and intermediate factors that determine health perceptions, by attempting to answer the question ‘how do individuals with non-communicable chronic conditions perceive their health as healthy or ill’?. Methods: This study was conducted in a low-income neighbourhood called Kadugondanahalli in India using qualitative research methods. A total of 20 in-depth interviews were conducted with individuals diagnosed with non-communicable chronic conditions. Individuals were recruited through purposive and snowball sampling. Results: The participants predominantly perceived their health as being healthy and ill in an episodic manner while adhering to their treatment and medications for chronic conditions. This was strongly determined by the factors such as presence of family support and caregiving, changes in work and occupation, changes in lifestyle, psychological stress from being diagnosed, and care-seeking practices. This episodic perception of illness led to the non-adherence of prescribed chronic care. Conclusions: Due to the episodic manner in which the participants experienced their illness, the paper recommends considering health and illness as two different entities while researching chronic conditions. It is important for the health system to understand and fix the healthy and ill episodes, which often lead to switching between controlled and uncontrolled states of diabetes and hypertension. To do so, it is important to consider the social, economic, behavioural and psychological factors in an individual’s health outcome. The interplay between these factors has socialized health perception and various related practices from the individual to the community level. Therefore, the health system needs to re-strategize its focus from individual to community level interventions to address the determinants of health and NCD risk factors by strengthening the NCD prevention approach. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
14. PROGRESS TOWARD EU SDG 3 THROUGH MULTIPURPOSE INDICATORS.
- Author
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RAMONA, PÎRVU, MARIA, NACHE CIMPOERU, and LOREDANA, NĂSTASE LUIZA
- Abstract
Sustainable development is an important objective of European Union policies, being a responsibility at national, regional, and local level. In a prosperous Europe, addressing sustainable development and, above all, of the health and well-being of its citizens is essential. The EU expresses its concern for the approach of multifunctional indicators, which are relevant not only in the context of the 2030 Agenda, but also in relation to the objectives of the European Pillar of Social Rights, the objectives of the 8th environmental action program and the objectives of the European Green Deal. Growing obesity, noise exposure of individuals, incidence of fatal accidents at work, incidence of deaths in road traffic or exposure to fine particles are current problems of the European Union; these being found as indicators not only for tracking the progress of SDG 3, but also for tracking the progress of SDG 2, SDG 8 and SDG 11. In this regard, our paper aims at the progress of the third Sustainable Development Goal, by carrying out a multi-year statistical analysis of the multi-purpose indicators established by the European Union to track the achievement of the predetermined targets. The collection of quantitative data for analysis was carried out by consulting the Statistical Office of the European Union. [ABSTRACT FROM AUTHOR]
- Published
- 2024
15. Ending violence against Indigenous peoples in Canada: a healthcare responsibility
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Jessica Kolopenuk
- Subjects
Indigenous health ,Colonial violence ,Critical Indigenous studies ,Self-determination ,Determinants of health ,Health equity ,Public aspects of medicine ,RA1-1270 - Abstract
Summary: By foregrounding the embodiment of colonial dispossession–how the body feels colonialism–this article theorises violence against Indigenous peoples in Canada, positioning it firmly within the purview of healthcare. The article critically questions the discourse of reconciliation currently shaping Indigenisation policies and Indigenous health research in the country’s public institutions. It contends that a narrow application of “closing the Indigenous health gap,” described more robustly by the Truth and Reconciliation Commission of Canada, falls short of addressing the root problem: “ending colonial violence.” Aligning with critical Indigenous studies scholarship, I redirect representations of Indigenous health away from the presumption of deficit. I argue that health care in Canada is responsible for recognising and confronting colonial violence as a matter of public health. As a starting point, this responsibility involves implementing the relevant Calls for Justice outlined in Reclaiming Power and Place: The Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls.
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- 2024
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16. Short communication: Five ways UK European Capitals and cities of culture have connected cultural activities with nature and their impacts on health and wellbeing, wider determinants of health and inequality
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Amy Barnes, Kevin Brain, and Fiona Phillips
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Cultural mega-events ,City of culture ,Inequality ,Determinants of health ,Planetary health ,Culture-nature initiatives ,Public aspects of medicine ,RA1-1270 - Abstract
Objective: To rapidly synthesise evidence for local practice on what initiatives UK European Capitals and Cities of Culture (UKEUCoCs) have implemented connecting cultural activities with green, blue, or outdoor space (culture-nature initiatives) and their impacts on planetary health outcomes: personal health and wellbeing, wider determinants of health particularly the environment, and existing inequality. Study design: Rapid evidence review. Methods: A rapid review of published articles and evaluation reports. Published articles were identified through database searches (Proquest, OVID, Scopus, Web of Science, MEDLINE) in January–February 2024. Data was extracted directly into a table and findings synthesised narratively by theme. Results: Published evidence about UKEUCoC culture-nature initiatives was limited but five initiative types were identified: 1) growing-focused activities; 2) activities exploring human-nature relationships; 3) targeted nature-based wellbeing activities; 4) activities connecting cultural engagement with environmental activism; and 5) use of outdoor spaces for artworks, performances and festivals. UKEUCoC culture-nature initiatives may contribute to short-term improvements in mental health and wellbeing (confidence, self-esteem, subjective wellbeing), community health (community relations, civic pride), cultural participation, and local environmental quality and use, but risk widening existing inequalities. Co-creating initiatives at hyper-local levels with marginalised groups and trusted Community Champions, active involvement, and creating equitable access to livelihood opportunities may mitigate inequality risks. Conclusions: Evidence is limited but suggests UKEUCoC culture-nature initiatives could positively support planetary health outcomes in the short-term. Equity in these outcomes appears to rely however, on action to ensure the involvement of and sustainable livelihood creation for marginalised groups. It is unclear how outcomes are generated across the initiative types identified, including through interactions between them, where they are implemented. The five initiative types identified in this work could be targeted for further investigation in research and practice on culture-nature initiatives for health more generally, using a complex systems approach to evaluation.
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- 2024
- Full Text
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17. Allocation of Users of Mental Health Services to Needs-Based Care Clusters: An Italian Pilot Study.
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Barbato, Angelo, D'Avanzo, Barbara, Corrao, Giovanni, Di Fiandra, Teresa, Ferrara, Lucia, Gaddini, Andrea, Jarach, Carlotta Micaela, Monzio Compagnoni, Matteo, Saponaro, Alessio, Scondotto, Salvatore, Tozzi, Valeria D, and Lora, Antonio
- Subjects
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PERSONALITY disorders , *DECISION trees , *SOCIAL determinants of health , *SCHIZOPHRENIA , *MEDICAL personnel , *PUBLIC health , *COMMUNITY mental health service administration , *MEDICAL protocols , *RESEARCH funding , *MENTAL depression , *DESCRIPTIVE statistics , *NEEDS assessment , *CLUSTER analysis (Statistics) , *COMMUNITY mental health services , *BIPOLAR disorder , *MENTAL illness - Abstract
In Italy, despite strong community-based mental health services, needs assessment is unsatisfactory. Using the Mental Health Clustering Tool (MHCT) we adopted a multidimensional and non-diagnosis dependent approach to assign mental health services users with similar needs to groups corresponding to resources required for effective care. We tested the MHCT in nine Departments of Mental Health in four Italian regions. After a brief training, 318 professionals assessed 12,938 cases with a diagnosis of schizophrenia, depression, bipolar disorder and personality disorder through the MHCT. 53% of cases were 40–59 years, half were females, 51% had a diagnosis of schizophrenia, 48% of cases were clinically severe. Clusters included different levels of clinical severity and diagnostic groups. The largest cluster was 11 (ongoing recurrent psychosis), with 18.9% of the sample, followed by cluster 3 (non-psychotic disorders of moderate severity). The MHCT could capture a variety of problems of people with mental disorders beyond the traditional psychiatric assessment, therefore depicting service population from a different standpoint. Following a brief training, MHCT assessment proved to be feasible. The automatic allocation of cases made the attribution to clusters easy and acceptable by professionals. To what extent clustering provide a sound base for care planning will be the matter of further research. [ABSTRACT FROM AUTHOR]
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- 2024
- Full Text
- View/download PDF
18. Patterns of Socioeconomic Marginalization among People Who Use Drugs: A Gender-Stratified Repeated Measures Latent Class Analysis.
- Author
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Mitra, Sanjana, Kerr, Thomas, Cui, Zishan, Gilbert, Mark, Fleury, Mathew, Hayashi, Kanna, Milloy, M.-J., and Richardson, Lindsey
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DRUG utilization , *GENERALIZED estimating equations , *HEPATITIS C virus , *SOCIOECONOMIC factors , *HEALTH equity - Abstract
Socioeconomic factors are important correlates of drug use behaviors and health-related outcomes in people who use drugs (PWUD) residing in urban areas. However, less is known about the complex overlapping nature of socioeconomic conditions and their association with a range of individual, drug use, and health-related factors in men and women who use drugs. Data were obtained from two community-recruited prospective cohorts of PWUD. Using a gender-stratified approach, we conducted repeated measures latent class analyses (RMLCA) to identify discrete latent socioeconomic subgroups. Multivariable generalized estimating equations were then used to identify correlates of class membership. Between June 2014 and December 2018, RMLCA of 9844 observations from 1654 participants revealed five distinct patterns of socioeconomic status for both men and women. These patterns were primarily distinguished by variations in income, material and housing security, income generation activity, exposure to violence, criminal justice involvement, and police contact. Across gender, progressive increases in exposure to multiple dimensions of socioeconomic disadvantage were found to be associated with frequent use of opioids and stimulants, accessing social services, and being hepatitis C virus antibody-positive. Similar but less congruent trends across gender were observed for age, binge drug use, engagement with opioid agonist therapy, and living with HIV. Gendered patterns of multiple and overlapping dimensions of socioeconomic adversity aligned with patterns of frequent drug use and health-related concerns, highlighting priority areas for gender-inclusive, multilevel responses to mitigate health disparities and meet the diverse socioeconomic needs of urban-dwelling men and women who use drugs. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
19. Medication Adherence Barriers and Their Relationship to Health Determinants for Saudi Pediatric Dialysis Patients.
- Author
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Baghdadi, Leena R. and Alsaiady, Manar M.
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CLINICAL drug trials ,PATIENT compliance ,CROSS-sectional method ,PERITONEAL dialysis ,HEALTH services accessibility ,SOCIAL determinants of health ,DISEASE duration ,STATISTICAL sampling ,HEMODIALYSIS ,AGE distribution ,FAMILIES ,DESCRIPTIVE statistics ,SEVERITY of illness index ,TREATMENT duration ,SOCIODEMOGRAPHIC factors ,CONFIDENCE intervals ,DATA analysis software ,EDUCATIONAL attainment ,REGRESSION analysis - Abstract
Medication adherence is critical for the treatment and improved outcomes of chronic diseases. However, there is little research on the medication adherence of pediatric dialysis patients in Saudi Arabia. This study examines medication adherence barriers and their relationship to health determinants among Saudi children on dialysis, to enhance treatment success. We conducted a hospital-based, cross-sectional survey of pediatric dialysis patients using a simple random sampling technique. There is a trend of higher medication adherence for peritoneal dialysis patients compared with hemodialysis patients (36.1 ± 12.9 vs. 34.7 ± 8.3, p = 0.07). The leading barriers to medication adherence for all patients included being tired of taking the medication (score = 3.0256), not feeling like taking the medicine sometimes (score = 2.7436), bad taste (score = 2.5513), and forgetfulness (score = 2.41). Determinants of health were associated with medication adherence. Lack of education (56.4%) (some children underage for school) and chronic disease requirements (16.7%) were common barriers. After adjusting for the common confounders, the adherence scores increased significantly with increasing patient age (β = 2.378, p < 0.001), patients with working parents (β = 8.726, p = 0.011), and those living outside Riyadh (β = 19.198, p < 0.001). Medication adherence among pediatric dialysis patients is influenced by sociodemographic factors, health systems, and access to care. Evidence-based targeted interventions can increase medication adherence in this group on frequent dialysis. Future efforts should utilize systematic frameworks and digital health technologies to provide quality alternatives to improve medication adherence. [ABSTRACT FROM AUTHOR]
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- 2024
- Full Text
- View/download PDF
20. Socioeconomic status, diet, and recurrent severe asthma exacerbations in Puerto Rican youth
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Kristina Gaietto, MD MPH, Yueh-Ying Han, PhD, Franziska J. Rosser, MD, MPH, Edna Acosta-Pérez, PhD, Erick Forno, MD, MPH, Glorisa Canino, PhD, and Juan C. Celedón, MD, DrPH, FAAAAI
- Subjects
Asthma ,Puerto Rican ,recurrent exacerbations ,exacerbation-prone asthma ,determinants of health ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Background: Why Puerto Rican youths have higher rates of severe asthma exacerbations (SAEs) than their non-Hispanic White peers is unclear. Objective: We aimed to identify risk factors associated with recurrent SAEs in Puerto Rican youths with asthma. Methods: We performed cross-sectional and longitudinal analyses of recurrent SAEs in 209 Puerto Rican youths with asthma who participated in 2 cross-sectional studies approximately 5.2 years apart: the Puerto Rico Genetics of Asthma and Lifestyle study (visit 1, participants aged 6-14 years) and the Epigenetic Variation and Childhood Asthma in Puerto Ricans study (visit 2, participants aged 9-20 years). Recurrent SAEs were defined as at least 2 SAEs in the previous year. Results: Of the youths in our study, there were 80 (38.3%) and 47 (22.4%) with recurrent SAEs at visit 1 and visit 2, respectively, and 31 participants (14.8%) had persistent recurrent SAEs (ie, recurrent SAEs at both visits). In multivariable analyses, low household income was significantly associated with 2.4 to 12.3 times increased odds of recurrent SAEs in all analyses, with stronger longitudinal associations. Low parental education level, nonprivate or employer-based health insurance, overweight or obesity, residential proximity to a major road, and low or moderate level of outdoor activity were each significantly associated with recurrent SAEs in at least 1 analysis. Further, persistence of low parental numeracy level, low household income, and an unhealthy diet were each associated with persistent recurrent SAEs. Conclusion: In this study of Puerto Rican youths with asthma, persistence of low parental numeracy level, a low household income, and an unhealthy diet were associated with persistent recurrent SAEs. Our findings support policies promoting equity and healthy lifestyles for Puerto Rican children and their families.
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- 2024
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21. Equity in vaccine coverage in Uganda from 2000 to 2016: revealing the multifaceted nature of inequity
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Anthony Ssebagereka, Gatien de Broucker, Elizabeth Ekirapa-Kiracho, Rornald Muhumuza Kananura, Alfred Driwale, Joshua Mak, Aloysius Mutebi, and Bryan Nicholas Patenaude
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Vaccine equity ,Vaccine coverage ,Vaccine delivery ,Access to healthcare ,Uganda ,Determinants of health ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background This study analyses vaccine coverage and equity among children under five years of age in Uganda based on the 2016 Uganda Demographic and Health Survey (UDHS) dataset. Understanding equity in vaccine access and the determinants is crucial for the redress of emerging as well as persistent inequities. Methods Applied to the UDHS for 2000, 2006, 2011, and 2016, the Vaccine Economics Research for Sustainability and Equity (VERSE) Equity Toolkit provides a multivariate assessment of immunization coverage and equity by (1) ranking the sample population with a composite direct unfairness index, (2) generating quantitative measure of efficiency (coverage) and equity, and (3) decomposing inequity into its contributing factors. The direct unfairness ranking variable is the predicted vaccination coverage from a logistic model based upon fair and unfair sources of variation in vaccination coverage. Our fair source of variation is defined as the child’s age – children too young to receive routine immunization are not expected to be vaccinated. Unfair sources of variation are the child’s region of residence, and whether they live in an urban or rural area, the mother’s education level, the household’s socioeconomic status, the child’s sex, and their insurance coverage status. For each unfair source of variation, we identify a “more privileged” situation. Results The coverage and equity of the Diphtheria-Pertussis-Tetanus vaccine, 3rd dose (DPT3) and the Measles-Containing Vaccine, 1st dose (MCV1) – two vaccines indicative of the health system’s performance – improved significantly since 2000, from 49.7% to 76.8% and 67.8% to 82.7%, respectively, and there are fewer zero-dose children: from 8.4% to 2.2%. Improvements in retaining children in the program so that they complete the immunization schedule are more modest (from 38.1% to 40.8%). Progress in coverage was pro-poor, with concentration indices (wealth only) moving from 0.127 (DPT3) and 0.123 (MCV1) in 2000 to -0.042 and -0.029 in 2016. Gains in overall equity (composite) were more modest, albeit significant for most vaccines except for MCV1: concentration indices of 0.150 (DPT3) and 0.087 (MCV1) in 2000 and 0.054 and 0.055 in 2016. The influence of the region and settings (urban/rural) of residence significantly decreased since 2000. Conclusion The past two decades have seen significant improvements in vaccine coverage and equity, thanks to the efforts to strengthen routine immunization and ongoing supplemental immunization activities such as the Family Health Days. While maintaining the regular provision of vaccines to all regions, efforts should be made to alleviate the impact of low maternal education and literacy on vaccination uptake.
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- 2024
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22. Environmental Determinants of Health: NOVA National School of Public Health Research to Tackle Ongoing Threats and Challenges
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Carla Martins, Ana Margarida Alho, Fortunato Muquinapir, Francisco Madeira, José Durão, Lorena Falcão Lima, Mariana Corda, Marta Dias, Pedro Pena, Renata Cervantes, and Susana Viegas
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environmental health ,determinants of health ,occupational health ,burden of disease ,risk assessment ,Public aspects of medicine ,RA1-1270 - Published
- 2024
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23. Equity Matters: Introduction to a New Column.
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Marcellus, Lenora and Amundsen, Miranda
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HEALTH services accessibility ,DIVERSITY & inclusion policies ,SOCIAL determinants of health ,FAMILIES ,NURSING practice ,NEONATAL nursing ,HEALTH equity ,WELL-being - Abstract
"Equity Matters" is a new column for Neonatal Network designed to further explore and apply the concept of health equity as it relates to supporting neonatal health and family well-being. In this initial column, an overview of health equity and determinants of health is provided. Two frameworks—the Healthy People 2030 strategy (U.S. Department of Health and Human Services) and the American Hospital Association equity roadmap and health equity transformation model—are introduced. Five domains of determinants will be explored in future columns: economic stability, education, social and community context, health and health care, and neighborhood and built environment. The domains of each determinant will be described to provide theoretical and practical approaches to support integration into nursing practice. Neonatal nurses are positioned to recognize health inequities for new families, critically analyze their relationship with the determinants of health, and advocate for strategies to promote health and well-being. [ABSTRACT FROM AUTHOR]
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- 2024
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24. The Human Genome Organisation (HUGO) and a vision for Ecogenomics: the Ecological Genome Project
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Benjamin Capps, Ruth Chadwick, Zohar Lederman, Tamra Lysaght, Catherine Mills, John J. Mulvihill, William S. Oetting, Ingrid Winship, and HUGO Committee on Ethics, Law and Society
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Human Genome Organisation ,Ecogenomics ,Human Genome Project ,Determinants of health ,One Health ,Medicine ,Genetics ,QH426-470 - Abstract
Abstract Background The following outlines ethical reasons for widening the Human Genome Organisation’s (HUGO) mandate to include ecological genomics. Main The environment influences an organism’s genome through ambient factors in the biosphere (e.g. climate and UV radiation), as well as the agents it comes into contact with, i.e. the epigenetic and mutagenic effects of inanimate chemicals and pollution, and pathogenic organisms. Emerging scientific consensus is that social determinants of health, environmental conditions and genetic factors work together to influence the risk of many complex illnesses. That paradigm can also explain the environmental and ecological determinants of health as factors that underlie the (un)healthy ecosystems on which communities rely. We suggest that The Ecological Genome Project is an aspirational opportunity to explore connections between the human genome and nature. We propose consolidating a view of Ecogenomics to provide a blueprint to respond to the environmental challenges that societies face. This can only be achieved by interdisciplinary engagement between genomics and the broad field of ecology and related practice of conservation. In this respect, the One Health approach is a model for environmental orientated work. The idea of Ecogenomics—a term that has been used to relate to a scientific field of ecological genomics—becomes the conceptual study of genomes within the social and natural environment. Conclusion The HUGO Committee on Ethics, Law and Society (CELS) recommends that an interdisciplinary One Health approach should be adopted in genomic sciences to promote ethical environmentalism. This perspective has been reviewed and endorsed by the HUGO CELS and the HUGO Executive Board.
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- 2023
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25. A Comparative Analysis on the Social Determinants of COVID-19 Vaccination Coverage in Fragile and Conflict Affected Settings and Non-fragile and Conflict Affected Settings
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Sanjay Pattanshetty, Mantej Pardesi, and Nachiket Gudi
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covid-19 ,equity ,fragile and conflict ,determinants of health ,vaccine coverage ,Public aspects of medicine ,RA1-1270 - Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has coerced various resources of all the countries. While the high-income nations redirected financial and human resources to understand specific determinants of vaccination coverage, fragile and conflict-affected setting (FCS) nations were waiting for global bodies to cater to their ever-growing need for vaccines and other lifesaving drugs. This study aimed to determine various factors influencing vaccine coverage in the FCS context.Methods World Bank’s classification of FCS states was the primary source for country classification. The study utilized data from various other open sources. The study models cross-country inequities in COVID-19 vaccine coverage and we have employed multi-variate log-linear regressions to understand the relationship between COVID-19 vaccine coverage and cross-country macro-level determinants. The analysis was conducted on two samples, non-FCS Countries and the FCS countries.Results Socio-economic determinants such as gross domestic product (GDP) per capita, socioeconomic resilience; health system determinants such as density of human resources, government spending on health expenditure; and political determinants such as effective government, more power to regional governments, political stability and absence of violence play a pivotal role in vaccine coverage. We also found that FCS countries with a higher share of people strongly believing in the vaccine effectiveness have a positive association with COVID-19 vaccine coverage.Conclusion The study confirmed that political factors, government effectiveness and political stability are also important determinants of vaccine coverage. The result further draws attention to few policy implications such as promoting future research to explore the linkages between the perceived equality before the law and individual liberty and its effect on vaccination coverage in the FCS.
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- 2023
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26. Reducing intervention- and research-induced inequalities to tackle the digital divide in health promotion
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Laura M. König, Rebecca A. Krukowski, Emmanuel Kuntsche, Heide Busse, Laura Gumbert, Kathrin Gemesi, Efrat Neter, Nor Firdous Mohamed, Kathryn M. Ross, Yetunde O. John-Akinola, Rosie Cooper, Anila Allmeta, Anabelle Macedo Silva, Cynthia C. Forbes, and Max J. Western
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Digital technology ,Health inequalities ,Health inequity ,Internet-based intervention ,Determinants of health ,Public health ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Social inequalities are an important contributor to the global burden of disease within and between countries. Using digital technology in health promotion and healthcare is seen by some as a potential lever to reduce these inequalities; however, research suggests that digital technology risks re-enacting or evening widening disparities. Most research on this digital health divide focuses on a small number of social inequality indicators and stems from Western, educated, industrialized, rich, and democratic (WEIRD) countries. There is a need for systematic, international, and interdisciplinary contextualized research on the impact of social inequality indicators in digital health as well as the underlying mechanisms of this digital divide across the globe to reduce health disparities. In June 2023, eighteen multi-disciplinary researchers representing thirteen countries from six continents came together to discuss current issues in the field of digital health promotion and healthcare contributing to the digital divide. Ways that current practices in research contribute to the digital health divide were explored, including intervention development, testing, and implementation. Based on the dialogue, we provide suggestions for overcoming barriers and improving practices across disciplines, countries, and sectors. The research community must actively advocate for system-level changes regarding policy and research to reduce the digital divide and so improve digital health for all.
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- 2023
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27. HIV in Three Groups of Young People from Medellín: General Population, Organizations for People with Socioeconomic Vulnerability, and Men Who Have Sex with Other Men
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Cardona-Arias JA, Narváez Moreno NN, and Higuita-Gutiérrez LF
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hiv ,youth ,determinants of health ,health system ,socioeconomic status ,men who have sex with men ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Jaiberth Antonio Cardona-Arias,1 Nicole Nahomy Narváez Moreno,1 Luis Felipe Higuita-Gutiérrez1,2 1Escuela de Microbiología, Universidad de Antioquia, Medellín, Antioquia, Colombia; 2Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín, Antioquia, ColombiaCorrespondence: Luis Felipe Higuita-Gutiérrez, Email Luis.higuita@campusucc.edu.coIntroduction: In Colombia, there are no studies that analyze the effect of socioeconomic vulnerability and belonging to the group of men who have sex with other men (MSM) on the prevalence of HIV in young people.Objective: To compare the prevalence of HIV in three groups of young people from Medellín-Colombia: general population, socioeconomic vulnerability and MSM.Methods: This cross-sectional analytical study included 2449 young people from the general population, 1736 from institutions that serve young people in situations of socioeconomic vulnerability, and 2269 MSM. The prevalence of infection in each group was determined, statistical differences were identified using Pearson’s Chi-square and Trend’s Chi-square, and crude and adjusted odds ratios were estimated using logistic regression with 95% confidence intervals. Analyses were performed in SPSS 29.0.Results: HIV prevalence was 0.8% in the general population group, 1.3% in young people with socioeconomic vulnerability, and 5.6% in MSM. The groups with the highest HIV were as follows: (i) in MSM it was 4.1 compared to the general population, (ii) between 25– 28 years of age it was 2.9 times compared to those under 20 years, (iii) in men it was 10 times that registered in women, (iv) in young people with primary, secondary, technical and university studies it was 7.1; 6.7; 11.0 and 14.5 times that found in those who did not register studies, (v) in affiliates of the subsidized health regime it was 2.2 times and in those without affiliation 2.4 times compared to the infection in affiliates of the contributory health regime.Conclusion: HIV prevalence was high, and explained by socioeconomic vulnerability, having sex between men, gender, age, education, and health affiliation, demonstrating the intersectionality of determinants of the health system, socioeconomic status, and determinants individuals in the occurrence of HIV in young people in Medellín.Keywords: HIV, youth, determinants of health, health system, socioeconomic status, men who have sex with men
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- 2023
28. Advocating for population health: The role of public health practitioners in the age of artificial intelligence
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Kamyabi, Alireza, Iyamu, Ihoghosa, Saini, Manik, May, Curtis, McKee, Geoffrey, and Choi, Alex
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- 2024
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29. Equity in vaccine coverage in Uganda from 2000 to 2016: revealing the multifaceted nature of inequity.
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Ssebagereka, Anthony, de Broucker, Gatien, Ekirapa-Kiracho, Elizabeth, Kananura, Rornald Muhumuza, Driwale, Alfred, Mak, Joshua, Mutebi, Aloysius, and Patenaude, Bryan Nicholas
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- *
VACCINATION coverage , *VACCINATION , *VACCINES , *DPT vaccines , *ECONOMIC research , *INSURANCE - Abstract
Background: This study analyses vaccine coverage and equity among children under five years of age in Uganda based on the 2016 Uganda Demographic and Health Survey (UDHS) dataset. Understanding equity in vaccine access and the determinants is crucial for the redress of emerging as well as persistent inequities. Methods: Applied to the UDHS for 2000, 2006, 2011, and 2016, the Vaccine Economics Research for Sustainability and Equity (VERSE) Equity Toolkit provides a multivariate assessment of immunization coverage and equity by (1) ranking the sample population with a composite direct unfairness index, (2) generating quantitative measure of efficiency (coverage) and equity, and (3) decomposing inequity into its contributing factors. The direct unfairness ranking variable is the predicted vaccination coverage from a logistic model based upon fair and unfair sources of variation in vaccination coverage. Our fair source of variation is defined as the child's age – children too young to receive routine immunization are not expected to be vaccinated. Unfair sources of variation are the child's region of residence, and whether they live in an urban or rural area, the mother's education level, the household's socioeconomic status, the child's sex, and their insurance coverage status. For each unfair source of variation, we identify a "more privileged" situation. Results: The coverage and equity of the Diphtheria-Pertussis-Tetanus vaccine, 3rd dose (DPT3) and the Measles-Containing Vaccine, 1st dose (MCV1) – two vaccines indicative of the health system's performance – improved significantly since 2000, from 49.7% to 76.8% and 67.8% to 82.7%, respectively, and there are fewer zero-dose children: from 8.4% to 2.2%. Improvements in retaining children in the program so that they complete the immunization schedule are more modest (from 38.1% to 40.8%). Progress in coverage was pro-poor, with concentration indices (wealth only) moving from 0.127 (DPT3) and 0.123 (MCV1) in 2000 to -0.042 and -0.029 in 2016. Gains in overall equity (composite) were more modest, albeit significant for most vaccines except for MCV1: concentration indices of 0.150 (DPT3) and 0.087 (MCV1) in 2000 and 0.054 and 0.055 in 2016. The influence of the region and settings (urban/rural) of residence significantly decreased since 2000. Conclusion: The past two decades have seen significant improvements in vaccine coverage and equity, thanks to the efforts to strengthen routine immunization and ongoing supplemental immunization activities such as the Family Health Days. While maintaining the regular provision of vaccines to all regions, efforts should be made to alleviate the impact of low maternal education and literacy on vaccination uptake. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
30. Environmental Determinants of Health: NOVA National School of Public Health Research to Tackle Ongoing Threats and Challenges.
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Martins, Carla, Alho, Ana Margarida, Muquinapir, Fortunato, Madeira, Francisco, Durão, José, Lima, Lorena Falcão, Corda, Mariana, Dias, Marta, Pena, Pedro, Cervantes, Renata, and Viegas, Susana
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- 2024
- Full Text
- View/download PDF
31. Reducing intervention- and research-induced inequalities to tackle the digital divide in health promotion.
- Author
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König, Laura M., Krukowski, Rebecca A., Kuntsche, Emmanuel, Busse, Heide, Gumbert, Laura, Gemesi, Kathrin, Neter, Efrat, Mohamed, Nor Firdous, Ross, Kathryn M., John-Akinola, Yetunde O., Cooper, Rosie, Allmeta, Anila, Silva, Anabelle Macedo, Forbes, Cynthia C., and Western, Max J.
- Subjects
- *
DIGITAL divide , *HEALTH services accessibility , *SOCIAL determinants of health , *INTERNET , *DIGITAL health , *WORLD health , *CONFERENCES & conventions , *MEDICAL care , *MEDICAL care research , *SOCIOECONOMIC factors , *HEALTH equity , *HEALTH promotion , *MEDICAL specialties & specialists - Abstract
Social inequalities are an important contributor to the global burden of disease within and between countries. Using digital technology in health promotion and healthcare is seen by some as a potential lever to reduce these inequalities; however, research suggests that digital technology risks re-enacting or evening widening disparities. Most research on this digital health divide focuses on a small number of social inequality indicators and stems from Western, educated, industrialized, rich, and democratic (WEIRD) countries. There is a need for systematic, international, and interdisciplinary contextualized research on the impact of social inequality indicators in digital health as well as the underlying mechanisms of this digital divide across the globe to reduce health disparities. In June 2023, eighteen multi-disciplinary researchers representing thirteen countries from six continents came together to discuss current issues in the field of digital health promotion and healthcare contributing to the digital divide. Ways that current practices in research contribute to the digital health divide were explored, including intervention development, testing, and implementation. Based on the dialogue, we provide suggestions for overcoming barriers and improving practices across disciplines, countries, and sectors. The research community must actively advocate for system-level changes regarding policy and research to reduce the digital divide and so improve digital health for all. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
32. Local government's roles in community health and wellbeing in Australia: Insights from Tasmania.
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Morgan, Michelle J., Stratford, Elaine, Harpur, Siobhan, and Rowbotham, Samantha
- Abstract
Issue Addressed Methods Results Conclusion So What? Local governments are well‐placed to respond to communities' health and wellbeing needs. However, in the Australian state of Tasmania, the sector's roles in that respect are unclear.We interviewed 10 municipal personnel in Tasmania to understand their views on local governments' community health and wellbeing functions.Participants had an integrative understanding of community health and wellbeing and recognised that collective effort from all tiers of government, community members, and other place‐based stakeholders would improve outcomes. They identified several roles local governments have to support and drive such improvements, including in relation to diverse place‐specific determinants of health and wellbeing. Capacity and capability to fulfil what is needed varied, with rural and remote councils generally less able than urban counterparts to respond consistently or comprehensively to community members' complex needs. However, in the presence of clear expectations and parameters, and appropriate support from other tiers of government, participants were eager for their councils to do more to improve their communities' health and wellbeing, including via a mandate in legislation.Local governments have the potential to do more to improve health and wellbeing outcomes in Tasmania, and the greatest gains could be made by addressing spatial inequalities faced by the sector. That insight is extensible to other comparable jurisdictions.We argue the need both for a shared societal goal of equitable wellbeing supported by all tiers of government and for actions proportionate to the needs of council areas. [ABSTRACT FROM AUTHOR]
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- 2023
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33. Burden of Social and Behavioral Determinants of Health on Infectious Complications in Emergency General Surgery.
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Lagazzi, Emanuele, Proaño-Zamudio, Jefferson A., Argandykov, Dias, Rafaqat, Wardah, Abiad, May, Romijn, Anne-Sophie, van Ee, Elaine P.X., Velmahos, George C., Kaafarani, Haytham M. A., and Hwabejire, John O.
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SURGERY , *SOCIAL determinants of health , *SURGICAL emergencies , *URINARY tract infections , *OPIOID abuse - Abstract
Background: Infectious complications lead to worse post-operative outcomes and are used to compare hospital performance in pay-for-performance programs. However, the impact of social and behavioral determinants of health on infectious complication rates after emergency general surgery (EGS) remains unclear. Patients and Methods: All patients undergoing EGS in the 2019 Nationwide Readmissions Database were included. The primary outcome of the study was the rate of infectious complications within 30 days, defined as a composite outcome including all infectious complications occurring during the index hospitalization or 30-day re-admission. Secondary outcomes included specific infectious complication rates. Multivariable regression analyses were used to study the impact of patient characteristics, social determinants of health (insurance status, median household income in the patient's residential zip code), and behavioral determinants of health (substance use disorders, neuropsychiatric comorbidities) on post-operative infection rates. Results: Of 367,917 patients included in this study, 20.53% had infectious complications. Medicare (adjusted odds ratio [aOR], 1.3; 95% confidence interval [CI], 1.26–1.34; p < 0.001), Medicaid (aOR, 1.24; 95% CI,1.19–1.29; p < 0.001), lowest zip code income quartile (aOR, 1.17; 95% CI, 1.13–1.22; p < 0.001), opioid use disorder (aOR,1.18; 95% CI,1.10–1.29; p < 0.001), and neurodevelopmental disorders (aOR, 2.16; 95% CI, 1.90–2.45; p < 0.001) were identified as independent predictors of 30-day infectious complications. A similar association between determinants of health and infectious complications was also seen for pneumonia, urinary tract infection (UTI), methicillin-resistant Staphylococcus aureus (MRSA) sepsis, and catheter-association urinary tract infection (CAUTI). Conclusions: Social and behavioral determinants of health are associated with a higher risk of developing post-operative infectious complications in EGS. Accounting for these factors in pay-for-performance programs and public reporting could promote fairer comparisons of hospital performance. [ABSTRACT FROM AUTHOR]
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- 2023
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- View/download PDF
34. Permanent Supportive Housing Receipt and Health Care Use Among Adults With Disabilities.
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Grove, Lexie R., Berkowitz, Seth A., Cuddeback, Gary, Pink, George H., Stearns, Sally Clark, Stürmer, Til, and Domino, Marisa Elena
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MEDICAL care use , *PEDIATRIC emergency services , *PEOPLE with disabilities , *ADULTS , *MEDICAL care , *PRIMARY care , *DISABILITIES , *INSTITUTIONALIZED persons - Abstract
This study assessed whether permanent supportive housing (PSH) participation is associated with health service use among a population of adults with disabilities, including people transitioning into PSH from community and institutional settings. Our primary data sources were 2014 to 2018 secondary data from a PSH program in North Carolina linked to Medicaid claims. We used propensity score weighting to estimate the average treatment effect on the treated of PSH participation. All models were stratified by whether individuals were in institutional or community settings prior to PSH. In weighted analyses, among individuals who were institutionalized prior to PSH, PSH participation was associated with greater hospitalizations and emergency department (ED) visits and fewer primary care visits during the follow-up period, compared with similar individuals who largely remained institutionalized. Individuals who entered PSH from community settings did not have significantly different health service use from similar comparison group members during the 12-month follow-up period. [ABSTRACT FROM AUTHOR]
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- 2023
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35. Setting the scene: a scoping review of gambling research in Ghana.
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Badu, Emmanuel, Hallett, Jonathan, Vujcich, Daniel, Crawford, Gemma, and Bellringer, Maria E
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PSYCHIATRY , *PROFESSIONAL peer review , *PSYCHOLOGY information storage & retrieval systems , *ONLINE information services , *CINAHL database , *LEISURE , *MEDICAL information storage & retrieval systems , *SYSTEMATIC reviews , *RESEARCH methodology , *INDUSTRIES , *GAMBLING , *RISK assessment , *BUSINESS , *RESEARCH funding , *LITERATURE reviews , *MEDLINE , *DATA analysis software , *FINANCIAL management - Abstract
Ghana, like many other African countries, has seen a rapid expansion in gambling industry activity in the last decade with sports betting becoming a popular pastime among young Ghanaian males. The proliferation of land based, and online gambling operations presents a significant public health threat to the citizenry. Yet little is known about gambling participation and harms, the size of the gambling market and the role of the gambling industry in influencing and perpetuating gambling behaviour in Ghana. The aim of this study was to contribute to understanding the extent of gambling research in Ghana by mapping out what the current literature indicates. Six databases were searched for peer-reviewed journal articles that focused on gambling in Ghana. The findings from this review demonstrate gambling research in Ghana is in a nascent state with a predominant focus on individual factors and limited consideration of public health. The implications for future research are highlighted, including the requirement for a nationally representative study to understand the prevalence of gambling participation and harm, and the role of the gambling industry. Public health action grounded in sound evidence is urgently required to address the individual and community level problems associated with this harmful commodity. [ABSTRACT FROM AUTHOR]
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- 2023
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36. Student success strategies: Approaches to navigating and understanding the determinants of health outside the classroom.
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Terry, Daniel, Peck, Blake, Smith, Andrew, and Gazula, Swapnali
- Abstract
Research approaches to better engage student learning regarding the determinants of health are somewhat limited. The present study highlights the evolution of an authentic fieldwork assessment and the strategies nursing students used as they navigated the assessment for learning activity outside the classroom, and how these impacted student’s performance. A cross-sectional study examined learning strategies, assessment challenges and concept understanding according to academic performance among students over a 2-year period. Among the 282 (19.7% response rate) students, success encapsulated making time, planning, good organisation, checking in and making time. Being less successful centred on being busy with other courses or employment. Poorer performing students were less likely to understand the assessment requirements or just ran out of time. Performance-based assessments remain relevant to nursing student learning. However, students must explicitly understand their benefits, be motivated to engage, have the capacity to persevere and seek clarification if understanding is not achieved. [ABSTRACT FROM AUTHOR]
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- 2023
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37. Corrigendum: Prioritizing determinants of cognitive function in healthy middle-aged and older adults: insights from a machine learning regression approach in the Canadian longitudinal study on aging
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Sarah Singh, Shiran Zhong, Kem Rogers, Vladimir Hachinski, and Stephanie Frisbee
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cognitive function ,determinants of health ,dementia prevention ,machine learning ,CLSA ,Public aspects of medicine ,RA1-1270 - Published
- 2024
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38. Identifying key factors for successful formulation and implementation of healthcare policies on non-communicable diseases: a multinational analysis
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Abdulfatai Olamilekan Babaita, Yasmin Jahan, Ryota Nakamura, and Michiko Moriyama
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health policy ,non-communicable disease ,prevention ,multisector ,determinants of health ,health equity ,Public aspects of medicine ,RA1-1270 - Abstract
ObjectivesNon-communicable diseases (NCDs) are a major public health concern that accounts for 74% of global deaths each year. The increasing burden of NCDs exhausts public health resources and threatens the achievement of the 2030 agenda for sustainable development. The purpose of this study is to thematically analyze the contributory factors in the health policy process and reforms to strengthen the prevention of NCDs across borders, as well as the milestones achieved through the process of policy-making, change, and implementation.MethodThis study informs and draws on the findings of contributory factors in the health policy process for preventing NCDs across borders: United States, England, Sweden, Bangladesh, Singapore, South Korea, and Thailand. Ten experts from the seven countries were recruited purposively for a semi-structured interview (e-Interview) on the NCD policy-making process in their countries, either through health ministries or the authors’ network. This descriptive qualitative study design is guided by the “Three I’s” framework of public policy (institutions, ideas, and interests). In addition to the information obtained from the interviewee, data were also sourced from relevant documents and homepages suggested by the interviewee, as well as health homepages of the countries.ResultThe following themes were generated: (1) environmental policies and social determinants, (2) multistakeholder involvement, (3) interministerial collaboration, (4) independent evidence and review institution, (5) integrated health data, and (6) primary care system. There was a shift from individual-targeted policies to environmental policies and social determinants. Notably, national campaigns were developed through non-governmental organizations (NGOs) for the primary prevention of NCDs.ConclusionThe shift from behavioral modification and treatment to social determinants is important. NCDs are broad and require a multisector and multilevel approach. Establishing an organization or hierarchical body to overlook NCDs could result in increased awareness, focus, and surveillance and enhance the policy process.
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- 2024
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39. A holistic model of health inequalities for health policy and state administration: a case study in the regions of the Czech Republic
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Dana Hübelová, Jan Caha, Lenka Janošíková, and Alice Kozumplíková
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Determinants of health ,Regional disparities in health ,Spatial differentiation of health ,Health promotion and prevention ,Healthcare system optimization ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Health inequities exist within and between societies at different hierarchical levels. Despite overall improvements in health status in European Union countries, disparities persist among socially, economically, and societally disadvantaged individuals. This study aims to develop a holistic model of health determinants, examining the complex relationship between various determinants of health inequalities and their association with health condition. Methods Health inequalities and conditions were assessed at the territorial level of Local Administrative Units (LAU1) in the Czech Republic. A dataset of 57 indicators was created, categorized into seven determinants of health and one health condition category. The necessary data were obtained from publicly available databases. Comparisons were made between 2001–2003 and 2016–2019. Various methods were employed, including composite indicator creation, correlation analysis, the Wilcoxon test, aggregate index calculation, cluster analysis, and data visualization using the LISA method. Results The correlation matrix revealed strong relationships between health inequality categories in both periods. The most significant associations were observed between Economic status and social protection and Education in the first period. However, dependencies weakened in the later period, approaching values of approximately 0.50. The Wilcoxon test confirmed variations in determinant values over time, except for three specific determinants. Data visualization identified persistently adverse or worsening health inequalities in specific LAU1, focusing on categories such as Economic status and social protection, Education, Demographic situation, Environmental status, Individual living status, and Road safety and crime. The health condition indices showed no significant change over time, while the aggregate index of health inequalities improved with widened differences. Conclusion Spatial inequalities in health persist in the Czech Republic, influenced by economic, social, demographic, and environmental factors, as well as local healthcare accessibility. Both inner and outer peripheries exhibit poor health outcomes, challenging the assumption that urban areas fare better. The combination of poverty and vulnerabilities exacerbates these inequalities. Despite the low rates of social exclusion and poverty, regional health inequalities persist in the long term. Effectively addressing health inequalities requires interdisciplinary collaboration and evidence-based policy interventions. Efforts should focus on creating supportive social and physical environments, strengthening the healthcare system, and fostering cooperation with non-medical disciplines.
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- 2023
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40. Evaluating the Environmental Impact of Anthropogenic Activities on Human Health: A Systematic Review
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Luigi Cofone, Marise Sabato, Enrico Di Rosa, Chiara Colombo, and Lorenzo Paglione
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Environmental Impact Assessment ,Health Impact Assessment ,determinants of health ,Geography. Anthropology. Recreation ,Social Sciences - Abstract
Due to major global urbanisation, a careful evaluation of plans (town planning and mobility) and projects (industrial and development) is required in order to measure their impact on health and environmental matrices. In Italy, Legislative Decree No 152/06 introduced two procedures: the EIA (Environmental Impact Assessment) and SIA (Strategic Impact Assessment). Their focus, however, does not consider human health. Recently, the Integrated Environmental and Health Impact Assessment (IEHIA) was introduced; this defines the parameters necessary to provide an EIA that includes human health as a factor. This systematic review was conducted, including both the population impacted by new facilities and the method used to define their impact. Our database search produced 724 articles, of which 33 were eligible. Studies included landfill plans, manufacturing industries, mobility policies, energy production, and the environmental health of an area. All studies show how an approach encompassing multiple parameters can analyse the impact of a new facility in a comprehensive manner. This review shows that the use of health-related environmental impact parameters is essential for the integration of a project into a community, and can allow a wider understanding of the possible impacts on human health, both direct and indirect.
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- 2024
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41. Nutritional, health and socio-demographic determinants of anaemia in adolescent girls in Kumbungu District, Ghana
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Anthony Wemakor, Matilda Kwaako, and Adinan Abdul-Rahman
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Anemia ,Adolescents, female ,Nutrition determinants ,Determinants of Health ,Social Determinants of Health ,Kumbungu ,Nutrition. Foods and food supply ,TX341-641 ,Food processing and manufacture ,TP368-456 ,Medicine (General) ,R5-920 - Abstract
Abstract Background Anaemia is a serious health problem among adolescent girls in Ghana. The aims of this study were to measure the prevalence and identify the nutritional, health, and socio-demographic determinants of anaemia in adolescent girls in Kumbungu District, Northern Region, Ghana. Method An analytical cross-sectional study involving 370 adolescent girls residing in Kumbungu district, selected using multi-stage sampling procedure, was conducted. A semi-structured questionnaire, 24-hr dietary recall, food frequency questionnaire, Food Insecurity Experience scale, and anthropometry were used to gather information on socio-demographic characteristics, nutrition knowledge, dietary diversity score, food consumption score, food consumption frequency, household food insecurity, and waist and hip circumferences. Haemoglobin was measured using a portable HemoCue hg 301 + Analyzer. Anaemia in the adolescent girls was defined as haemoglobin concentration less than 12 g/dl. Chi-square test and binary logistic regression analysis were used to identify the determinants of anaemia. Results The mean (± SD) age was 13.95 (± 2.94) years, and the majority of the girls were in school (79.5%) and lived in a rural area (81.1%). The mean (± SD) haemoglobin was 11.27 (± 1.19) g/dl, and 74.6% of the respondents had anaemia, with 1.6% having severe anaemia. The health determinant of anaemia was frequency of feeling nervous in the past 6 months [Adjusted Odds Ratio (AOR): 2.12: 95% Confidence Interval (CI): 1.17–3.89; p: 0.014], and the socio-demographic determinants were residential community status (AOR: 0.42; 95% CI: 0.24–0.75; p: 0.003), and fathers’ educational qualification (AOR: 2.57, 95% CI: 1.17–5.65, p: 0.019). No nutritional determinants of anaemia were identified for this study population. Conclusion The prevalence of anaemia was very high and the frequency of feeling nervous in the past 6 months, residential community status, and fathers’ educational qualification were associated with anaemia among adolescent girls in Kumbungu district, Ghana. The prevalence of anaemia measured highlights the need for intensification of anaemia prevention and management interventions in the district.
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- 2023
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42. Connections associated with a healthy spirituality: are these unrecognized intermediary determinants that shape health inequities in Canadian young people?
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Valerie Michaelson, Nathan King, Karen A. Patte, Pauli Gardner, and William Pickett
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Health equity ,Spiritual health ,Determinants of health ,Child and adolescent health ,Epidemiology ,Mental health ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background The health of adolescents is determined by structural and intermediary factors. Such factors operate through pathways that foster different opportunities to achieve health and wellbeing, contributing to inequities. Past analyses of cross-national adolescent health data show that measures of child spirituality, conceptualized as the strength of the connections in our lives, may operate as intermediary determinants in some Western countries. Inspired by this idea, the current analysis provides an in-depth exploration of such pathways among Canadian adolescents. Our objectives were to confirm the existence of relationships between economic position and seven indicators of adolescent health status, then explore whether any observed inequities could be explained by the strength of connections afforded by a healthy spirituality. Methods Cycle 8 of the Canadian Health Behaviour in School-aged Children (HBSC) study was conducted in 2017–18. A school-based sample (n = 18,962) of adolescents was obtained from across Canada following a standard cross-national protocol. Eligible participants completed a general survey about their health, health behaviours and their determinants. Survey data were used to model the potential effect of perceived levels of relative affluence on each of seven health indicators. Comparison of crude and adjusted relative risks estimates from weighted log-binomial regression models provided evidence of indirect mediating effects attributable to each of four domains of spirituality. Results As perceived levels of family affluence increased, the percentages of young people who reported each (7/7) of the negative health outcomes decreased. The spiritual health domain “connections to self” (i.e., the importance of meaning, purpose, joy and happiness in life) mediated the strength of relationships between relative affluence and each (7/7) of the outcomes in boys and girls. “Connections to others” (the importance of kindness, respect and forgiveness) mediated the strength of relationships between relative affluence and each (7/7) of the outcomes among girls. Inconsistent evidence of possible mediation was identified for connections to others in boys, as well as the other two domains of spirituality (connections to nature, then connections to the transcendent) in boys and girls. Conclusion Specific connections afforded by a healthy spirituality could be intermediary determinants of health in Canadian adolescent populations.
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- 2023
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43. Indigenous adaptation of a model for understanding the determinants of ethnic health inequities
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Elana Curtis, Rhys Jones, Esther Willing, Anneka Anderson, Sarah-Jane Paine, Sarah Herbert, Belinda Loring, Gulay Dalgic, and Papaarangi Reid
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Indigenous ,Health inequities ,Colonisation ,Racism ,Privilege ,Determinants of health ,Public aspects of medicine ,RA1-1270 ,Social Sciences - Abstract
Abstract Examining the pathways and causes of ethnic inequities in health is integral to devising effective interventions. Explanations set the scope for solutions. Understandings of ethnic health inequities are often situated in victim blaming and cultural deficit explanations, rather than in the root causes. For Indigenous populations, colonisation and racism are fundemental determinants of health inequities. Using a conceptual framework can support understanding of the fundamental causes of Indigenous health inequities. This article presents an Indigenous adaptation of the ‘Williams model’ for understanding the causes of racial/ethnic disparities in health. The Te Kupenga Hauora Māori modified model foregrounds colonisation as a critical determinant of health inequities, underpinning all levels from basic to surface causes. The modified model also attempts to reflect the dynamic interplay between causes at different levels, rather than a simple unidirectional relationship. We include the influence of worldviews/positioning as a cause and emphasise that privilege alongside racism plays a causative role in Indigenous health inequities. We also critique some of the limitations of this framework in reflecting the complex pathways of causation for ethnic health inequities, and indicate areas for further strengthening.
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- 2023
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44. Prioritizing determinants of cognitive function in healthy middle-aged and older adults: insights from a machine learning regression approach in the Canadian longitudinal study on aging
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Sarah Singh, Shiran Zhong, Kem Rogers, Vladimir Hachinski, and Stephanie Frisbee
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cognitive function ,determinants of health ,dementia prevention ,machine learning ,CLSA ,Public aspects of medicine ,RA1-1270 - Abstract
IntroductionThe preservation of healthy cognitive function is a crucial step toward reducing the growing burden of cognitive decline and impairment. Our study aims to identify the characteristics of an individual that play the greatest roles in determining healthy cognitive function in mid to late life.MethodsData on the characteristics of an individual that influence their health, also known as determinants of health, were extracted from the baseline cohort of the Canadian Longitudinal Study of Aging (2015). Cognitive function was a normalized latent construct score summarizing eight cognitive tests administered as a neuropsychological battery by CLSA staff. A higher cognitive function score indicated better functioning. A penalized regression model was used to select and order determinants based on their strength of association with cognitive function. Forty determinants (40) were entered into the model including demographic and socioeconomic factors, lifestyle and health behaviors, clinical measures, chronic diseases, mental health status, social support and the living environment.ResultsThe study sample consisted mainly of White, married, men and women aged 45–64 years residing in urban Canada. Mean overall cognitive function score for the study sample was 99.5, with scores ranging from 36.6 to 169.2 (lowest to highest cognitive function). Thirty-five (35) determinants were retained in the final model as significantly associated with healthy cognitive functioning. The determinants demonstrating the strongest associations with healthy cognitive function, were race, immigrant status, nutritional risk, community belongingness, and satisfaction with life. The determinants demonstrating the weakest associations with healthy cognitive function, were physical activity, greenness and neighborhood deprivation.ConclusionGreater prioritization and integration of demographic and socioeconomic factors and lifestyle and health behaviors, such greater access to healthy foods and enhancing aid programs for low-income and immigrant families, into future health interventions and policies can produce the greatest gains in preserving healthy cognitive function in mid to late life.
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- 2023
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45. Multi-Level Correlates of the Nutritional Status of Nigerian Women of Reproductive Age.
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Ezeama, Nkiru N., Okunna, Nene, and Ezeama, Chukwuemeka O.
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OBESITY complications ,OBESITY ,ENERGY metabolism ,WOMEN ,COMMUNITIES ,SOCIOECONOMIC factors ,SURVEYS ,LEANNESS ,DESCRIPTIVE statistics ,MALNUTRITION ,LOGISTIC regression analysis ,DATA analysis software ,NUTRITIONAL status ,REPRODUCTIVE health ,SECONDARY analysis - Abstract
Poor nutrition compromises the capacity of women to perform their vital roles as mothers and productive workers in their families, communities and society. Using a conceptual framework developed by the United Nations Children's Fund, this study determines individual-, household- and community-level factors associated with the nutritional status of Nigerian women of reproductive age. A secondary analysis of pooled data from the Nigeria Demographic and Health Survey (NDHS) for 2003, 2008, 2013 and 2018 was conducted involving 82,734 non-pregnant women aged 15–49 years. Multinomial logistic regression was used to determine predictors of nutritional status. Study results show that a significant proportion of the women had poor nutritional status; the prevalence of underweight, overweight and obesity were 12.1%, 16.8% and 7.2% respectively. Statistically significant factors associated with poor nutritional status were found at all three levels, highlighting the need for effective multidimensional, multisectoral policy interventions to address the double burden of malnutrition among women in Nigeria. [ABSTRACT FROM AUTHOR]
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- 2023
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46. A scoping review of frameworks utilized in the design and evaluation of courses in health professional programs to address the role of historical and ongoing colonialism in the health outcomes of Indigenous Peoples.
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Melro, Carolyn M., Landry, Jyllenna, and Matheson, Kimberly
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MEDICAL personnel ,INDIGENOUS peoples ,COLONIES ,HEALTH programs ,SOCIAL attitudes - Abstract
Indigenous education curriculum has been implemented in health professional programs as a potential solution to addressing commonly held false beliefs, as well as negative social attitudes and behaviours. As such it is important to map and analyze the current literature on educational initiatives that teach about historical and ongoing colonialism as a determinant of health to identify commonly used theoretical frameworks and outcomes assessed, as well as the intended and unintended short- and long-term outcomes on health professional learner's beliefs, attitudes and behaviours. This scoping review follows the framework by (Peters et al., JBI Evidence Synthesis 18:2119–2126, 2020). Six databases (MEDLINE, CINAHL, PsychInfo, Sociological Abstracts, ERIC, and ProQuest Dissertations and Theses) were searched with grey literature included through hand-searching of Indigenous journals and citation searching for papers published up until 2022 based on an established search criterion. Two reviewers independently screened articles. In total, 2731 records were identified and screened; full text was assessed for 72 articles; 14 articles were identified as meeting all the inclusion criteria and included in the final review. Commonly- used theoretical frameworks were transformative learning and cultural safety, with a variety of evaluation tools used and post-intervention outcomes measured across the studies (e.g., knowledge, beliefs, attitudes, behaviour and general learner feedback). Indigenous education interventions require longitudinal evaluation studies to address shortcomings in the design and evaluation of outcomes associated with teaching about colonialism as a structural determinant of health. It is critical that we identify and monitor the intended and unintended consequences of such curriculum as we look to develop solutions to changing health professional learners' false beliefs and attitudes, in hopes to inform their future care practices. [ABSTRACT FROM AUTHOR]
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- 2023
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47. A holistic model of health inequalities for health policy and state administration: a case study in the regions of the Czech Republic.
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Hübelová, Dana, Caha, Jan, Janošíková, Lenka, and Kozumplíková, Alice
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HEALTH policy , *SOCIAL determinants of health , *HEALTH services accessibility , *ECONOMIC status , *HEALTH status indicators , *MANN Whitney U Test , *POPULATION geography , *COMPARATIVE studies , *SOCIAL context , *QUALITY assurance , *RESEARCH funding , *SOCIOECONOMIC disparities in health , *HEALTH equity , *CLUSTER analysis (Statistics) , *POVERTY , *HEALTH promotion , *EDUCATIONAL attainment - Abstract
Background: Health inequities exist within and between societies at different hierarchical levels. Despite overall improvements in health status in European Union countries, disparities persist among socially, economically, and societally disadvantaged individuals. This study aims to develop a holistic model of health determinants, examining the complex relationship between various determinants of health inequalities and their association with health condition. Methods: Health inequalities and conditions were assessed at the territorial level of Local Administrative Units (LAU1) in the Czech Republic. A dataset of 57 indicators was created, categorized into seven determinants of health and one health condition category. The necessary data were obtained from publicly available databases. Comparisons were made between 2001–2003 and 2016–2019. Various methods were employed, including composite indicator creation, correlation analysis, the Wilcoxon test, aggregate index calculation, cluster analysis, and data visualization using the LISA method. Results: The correlation matrix revealed strong relationships between health inequality categories in both periods. The most significant associations were observed between Economic status and social protection and Education in the first period. However, dependencies weakened in the later period, approaching values of approximately 0.50. The Wilcoxon test confirmed variations in determinant values over time, except for three specific determinants. Data visualization identified persistently adverse or worsening health inequalities in specific LAU1, focusing on categories such as Economic status and social protection, Education, Demographic situation, Environmental status, Individual living status, and Road safety and crime. The health condition indices showed no significant change over time, while the aggregate index of health inequalities improved with widened differences. Conclusion: Spatial inequalities in health persist in the Czech Republic, influenced by economic, social, demographic, and environmental factors, as well as local healthcare accessibility. Both inner and outer peripheries exhibit poor health outcomes, challenging the assumption that urban areas fare better. The combination of poverty and vulnerabilities exacerbates these inequalities. Despite the low rates of social exclusion and poverty, regional health inequalities persist in the long term. Effectively addressing health inequalities requires interdisciplinary collaboration and evidence-based policy interventions. Efforts should focus on creating supportive social and physical environments, strengthening the healthcare system, and fostering cooperation with non-medical disciplines. [ABSTRACT FROM AUTHOR]
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- 2023
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48. Frontline work and racial disparities in social and economic pandemic stressors during the first COVID‐19 surge.
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Haro‐Ramos, Alein Y., Brown, Timothy T., Deardorff, Julianna, Aguilera, Adrian, Pollack Porter, Keshia M., and Rodriguez, Hector P.
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COVID-19 pandemic , *WORKING class white people , *RACIAL inequality , *PANDEMICS , *SICK leave - Abstract
Objective: To assess the magnitude of racial–ethnic disparities in pandemic‐related social stressors and examine frontline work's moderating relationship on these stressors. Data Sources: Employed Californians' responses to the Institute for Governmental Studies (IGS) poll from April 16–20, 2020, were analyzed. The Pandemic Stressor Scale (PSS) assessed the extent to which respondents experienced or anticipated problems resulting from the inability to pay for basic necessities, job instability, lacking paid sick leave, unavailability of childcare, and reduced wages or work hours due to COVID‐19. Study Design: Mixed‐effects generalized linear models estimated (1) racial–ethnic disparities in pandemic stressors among workers during the first COVID‐19 surge, adjusting for covariates, and (2) tested the interaction between race–ethnicity and frontline worker status, which includes a subset of essential workers who must perform their job on‐site, to assess differential associations of frontline work by race–ethnicity. Data Collection: The IGS poll data from employed workers (n = 4795) were linked to the 2018 Centers for Disease Control and Prevention Social Vulnerability Index at the zip code level (N = 1068). Principal Findings: The average PSS score was 37.34 (SD = 30.49). Whites had the lowest PSS score (29.88, SD = 26.52), and Latinxs had the highest (50.74, SD = 32.61). In adjusted analyses, Black frontline workers reported more pandemic‐related stressors than White frontline workers (PSS = 47.73 vs. 36.96, p < 0.001). Latinxs reported more pandemic stressors irrespective of frontline worker status. However, the 5.09‐point difference between Latinx frontline and non‐frontline workers was not statistically different from the 4.6‐point disparity between White frontline and non‐frontline workers. Conclusion: Latinx workers and Black frontline workers disproportionately reported pandemic‐related stressors. To reduce stress on frontline workers during crises, worker protections like paid sick leave, universal access to childcare, and improved job security are needed, particularly for those disproportionately affected by structural inequities, such as racially minoritized populations. [ABSTRACT FROM AUTHOR]
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- 2023
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49. Political Barriers to Abortion Access in New Brunswick: A Qualitative Exploration of a Political Hot Potato.
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Johnson, Claire and Naam, Sara
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ABORTION , *BIRTH control , *HOSPITALS , *STAKEHOLDERS , *POLITICIANS , *MEDICAL care - Abstract
New Brunswick has been an outlier concerning abortion access for decades. In 2015, the Liberal government under Premier Brian Gallant made significant legislative changes to regulation 84–20 to make abortions more easily accessible in the province. Despite these changes, the Liberal government fell short of publicly funding community-based abortions outside hospitals. This qualitative study aimed to examine the political dynamic and pressures explaining why New Brunswick remains behind on abortion access compared to other Canadian provinces. From September until November 2020, we conducted semi-structured in-depth interviews with 22 participants. Participants were a mix of past and present politicians, health care leaders, and high-ranking public officials identified as key stakeholders in the abortion debate in New Brunswick. Some participants shared their challenges separating their personal views on abortions and admitted wanting to limit access to make it difficult for people to get an abortion. At the same time, other participants described concern for the most vulnerable segments of the New Brunswick population who may struggle with accessing abortions, leading to undue stress and anxiety levels. Ultimately, this article describes the challenges politicians face with power dynamics within their parties and the balance between managing political risks to maintain popularity within the New Brunswick electorate without infringing on people's right to medical care. [ABSTRACT FROM AUTHOR]
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- 2023
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50. The Structures of Caring.
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Lewis-Hunstiger, Marty
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IMPLICIT bias , *SOCIAL determinants of health , *NURSING , *DIGITAL divide , *NEUROBIOLOGY , *SERIAL publications , *CREATIVE ability , *EMOTIONAL trauma , *UNIVERSITIES & colleges , *HEALTH equity - Abstract
The World Health Organization defines social determinants of health as "the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life." This current journal issue has the theme of structural determinants of health. In 2016 (Creative Nursing Vol. 22), we published 49 articles in four issues addressing Determinants of Health: Social Determinants, Structural Determinants, Caregiver Determinants, and Global Determinants. This editorial presents the highlights of those four journal issues, then connects each of the articles in this current issue to the theme; these articles reveal the systems and structures that support our caring from many angles, levels, and perspectives. Readers are challenged to recognize the potential, embedded in every system and structure, for disparities in the provision of our care. [ABSTRACT FROM AUTHOR]
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- 2023
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