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Aim High-altitude mountaineering has become more and more popular, however if female alpinists show different injury pattern is not finally elucidated.Material and methods A retrospective analysis was therefore conducted from the central registry of the Swiss Alpine Club (SAC) during the observational period from 2009 to 2022 concerning intersex differences of emergencies specific while high-altitude mountaineering.Conclusions A total of 1252 female (22%) and 4347 male (78%) emergencies while high-altitude mountaineering were elucidated. A significant difference was detected in average NACA score as proxy for the severity of an event for falls, where female cases show a significant lower severity with NACA score 3.0 ± 1.5 as compared to male cases with NACA score 3.5 ± 2.0 (p

Suicide is a major public health issue and research in the field is numerous, but its fragmented state has made it quite impractical to summarise the body of research through systematic reviews and meta-analyses. We propose up to date scientometric methods (Bibliometrix R-package and CiteSpace) to assess how research on suicide has evolved over the past decades and identify future topics of interest based on emerging trends since 2020. We also measure research performance and relevance in terms of studies, countries, institutions, and journals. A comprehensive search for relevant terms in the titles, abstracts, and keywords of the Web of Science Core Collection was conducted in February 2024. Our study compiled 689,004 citations of 33,305 references published from 1966 to 2023 (28,579 original articles, 3288 reviews, 1047 editorials, and 238 early access articles). Three major research trends were identified: biology of suicide, mood disorder and suicide, a clinical and genetic framework of suicide. Most influential studies, countries, institutions, and journals were identified. Finally, the latest research trends were singled out, such as non-suicidal self-injury in adolescents, gaps in suicidology in low-and-middle income countries, machine learning and new pharmacological treatments. With this study, we aspire to facilitate the work of research groups striving to develop collaborations and we hope to provide useful information for grant applicants, funding agencies, and policymakers.

Homelessness is a complex and pervasive worldwide social crisis that profoundly affects a diverse range of individuals and communities. Adverse childhood events (ACEs) are traumatic events that can lead to significant negative effects during adulthood, including homelessness. In women who are mothers, the pathways to loss of housing include, but are not limited to: a history of ACEs, weak social networks, sexual violence, and intimate partner violence. This narrative review of the literature aimed at examining the evidence of adverse childhood experiences and homelessness in adult women who are mothers and to providing recommendations for practice. Across the eight articles included and analyzed, six common themes emerged: family fragmentation, out-of-family placement, abuse, learned substance abuse, a lack of formal and informal education, and normalization and internalization of ACEs. The results showed that children who experience ACEs and become mothers in adulthood might have increased chances of becoming homeless and repeating an intergenerational cycle of trauma onto their children.

AbstractSurveys were conducted on sociodemographic characteristics, family, home- and school-related factors, and sugar-sweetened beverage (SSB) intake to identify factors associated with SSB consumption in children. In total, 2700 valid questionnaires were returned. Mean age was 10.4 ± 2.23 years and 49.3% were male. Multivariate logistic analysis showed that the frequency of SSB dinking by fathers and peers, the frequency of SSB purchasing at home and school, and the duration of daily TV and video watching were significantly independent factors affecting SSB intake, suggesting that interventions targeting children’s SSB intake should incorporate government policies, educational programs and parental engagement.

Using the journal of the Dutch Diabetics Association (Nederlandse Vereniging van Suikerzieken), the article provides insight into the role of an early patient organisation in conceptualising the chronic disease diabetes and its management in the Netherlands between 1945 and 1970. The dual aims of discipline (steered by health professionals) and independence (steered by diabetics) were reconciled through the concept of balance during the 1940s and 1950s. Organised diabetics played a particularly large role, and independence got particular emphasis as a consequence. This made it possible for organised patients to reconfigure their disease and identity in terms of social health in relation to labour, family and society in the post-war reconstruction period. In the late 1960s, this social concept transformed into a personal concept of health in which the concept of balance lost its prominence, despite a short intermezzo of medicalisation in the early 1960s. [ABSTRACT FROM AUTHOR]

Background: Previous extreme heat and human health studies have investigated associations either over time (e.g. case-crossover or time series analysis) or across geographic areas (e.g. spatial models), which may limit the study scope and regional variation. Our study combines a case-crossover design and spatial analysis to identify: 1) the most vulnerable counties to extreme heat; and 2) demographic and socioeconomic variables that are most strongly and consistently related to heat-sensitive health outcomes (cardiovascular disease, dehydration, heat-related illness, acute renal disease, and respiratory disease) across 67 counties in the state of Florida, U. S over 2008-2012.Methods: We first used a case-crossover design to examine the effects of air temperature on daily counts of health outcomes. We employed a time-stratified design with a 28-day comparison window. Referent periods were extracted from ±7, ±14, or ± 21 days to address seasonality. The results are expressed as odds ratios, or the change in the likelihood of each health outcome for a unit change in heat exposure. We then spatially examined the case-crossover extreme heat and health odds ratios and county level demographic and socioeconomic variables with multiple linear regression or spatial lag models.Results: Results indicated that southwest Florida has the highest risks of cardiovascular disease, dehydration, acute renal disease, and respiratory disease. Results also suggested demographic and socioeconomic variables were significantly associated with the magnitude of heat-related health risk. The counties with larger populations working in farming, fishing, mining, forestry, construction, and extraction tended to have higher risks of dehydration and acute renal disease, whereas counties with larger populations working in installation, maintenance, and repair workers tended to have lower risks of cardiovascular, dehydration, acute renal disease, and respiratory disease. Finally, our results showed that high income counties consistently have lower health risks of dehydration, heat-related illness, acute renal disease, and respiratory disease.Conclusions: Our study identified different relationships with demographic/socioeconomic variables for each heat-sensitive health outcome. Results should be incorporated into vulnerability or risk indices for each health outcome. [ABSTRACT FROM AUTHOR]

Importance: In its mission to improve health, the US Preventive Services Task Force (USPSTF) recognizes the strong relationship between a person's health and social and economic circumstances as well as persistent inequities in health care delivery.Objective: To assess how social risks have been considered in USPSTF recommendation statements and identify current gaps in evidence needed to expand the systematic inclusion of social risks in future recommendations.Evidence: The USPSTF commissioned a technical brief that reviewed existing literature on screening and interventions for social risk factors and also audited the 85 USPSTF recommendation statements active as of December 2019 to determine how social risks were addressed in clinical preventive services recommendations.Findings: Among the 85 USPSTF recommendation statements reviewed, 14 were focused on preventive services that considered health-related social risks. Social risks were commonly referenced in parts of USPSTF recommendations, with 57 of 85 recommendations including some comment on social risks within the recommendation statement, although many comments were not separate prevention services. Social risks were commented on in USPSTF recommendations as part of risk assessment, as a marker of worse health outcomes from the condition of focus, as a consideration for clinicians when implementing the preventive service, and as a research need or gap on the topic.Conclusions and Relevance: This report identified how social risks have been considered in the USPSTF recommendation statements. It serves as a benchmark and foundation for ongoing work to advance the goal of ensuring that health equity and social risks are incorporated in USPSTF methods and recommendations. [ABSTRACT FROM AUTHOR]

Background: To reduce social inequities in health, the World Health Organization's Commission on Social Determinants of Health recommends acting as soon as life begins. In this context, parenting support is promoted as a major lever. The objective of the present research was to develop an intervention theory establishing the conditions for the success of interventions, policies, and organizations supporting parenting in terms of reducing or preventing social inequalities in health for both mother and child in the perinatal period.Methods: To meet these objectives, we conducted a realist evaluation based on a multiple-case study. The study evaluated two border towns in Europe. We collected data from three sources: documentary reviews, focus groups and interviews with professionals, and parental questionnaires.Results: The main results concerning the fight against social inequalities in health show a true willingness on the part of those involved to carry out universal actions, coordinated between professionals and institutions, in response to the demands of parents; however, the reality on the ground shows the complexity of their implementation and the multiplicity of results. Our middle-range theory showed that to be effective in tackling social inequalities in health, actions must address structural determinants at the macro-systemic level. However, the field of realist evaluation shows that it is first and foremost the actions focused on individual behavior that are implemented. While there is a general political desire to combat social inequalities in health in early childhood, the results show that the strategies in place are potentially not the most effective. Effective support actions would respond to individual strategies; however, current approaches target parents' behavior, aiming to empower them but without giving them the means to do so.Conclusions: This research constitutes a body of knowledge gathered for reflection and action. In particular, any perinatal policy should clearly state among its objectives the intention to reduce social inequalities in health. The policy should also state that it will be evaluated according to the criteria of proportionate universalism, interprofessional coordination, and actions based on the diversity of parents' needs. [ABSTRACT FROM AUTHOR]

Social determinants of health (SDOH) are circumstances in which people grow, live, work, and play. Unmet SDOH needs can adversely affect mental and physical health; however, to date, there are no comprehensive publications that highlight human services providers' (HSPs') role in addressing SDOH. This article defines SDOH, delineates HSPs' role in addressing SDOH, and provides conceptual frameworks that can be used by HSPs to promote SDOH in practice. Special consideration is given for a collective approach that incorporates multiple frameworks to promote holistic practice and health equity. The article concludes with implications for HSPs, administrators, and educators. [ABSTRACT FROM AUTHOR]

How can we keep people - wherever they live - healthy and safe? Among all global health initiatives, universal health coverage (UHC) has garnered most political attention. But can UHC (as important as it is) actually achieve the two fundamental aspirations of the right to health: keeping people healthy and safe, while leaving no one behind? There is a universal longing for health and security, but also a deep-seated belief in fairness and equity. Can UHC achieve both health and equity, or what I have called, "global health with justice?" What makes a population healthy and safe? Certainly, universal and affordable access to healthcare is essential, including clinical prevention, treatment, and essential medicines. But beyond medical care are public health services, including surveillance, clean air, potable water, sanitation, vector control, and tobacco control. The final and most important factor in good health are social determinants, including housing, employment, education, and equity. If we can provide everyone with these three essential conditions for good health (healthcare, public health and social determinants), it would vastly improve global health. But we also need to take measures to leave no one behind. To achieve equity, we need to plan for it, and here I propose national health equity programs of action. Society's highest obligation is to achieve global health, with justice. [ABSTRACT FROM AUTHOR]

Many working clients view retirement as the light at the end of the tunnel--the time when they not only stop working but can pursue their dreams, which have often been deferred for many years. If clients are not properly prepared for retirement, their retirement experiences can be much different from what they envisioned. Preparation for retirement involves much more than preparing financially. It also involves assessing current and future health, considering what to do in retirement, planning for health care costs, and evaluating how the client views himself or herself. [ABSTRACT FROM AUTHOR]

The seminal Consensus Study by the National Academies of Science, Engineering, and Medicine released in September 2019 describes the benefits of integrating health and social care service delivery, underscoring the central role of social determinants of health (SDOH) in health outcomes. Although the report's focus on the integration of health and social care contributes a much needed perspective to the national discourse on SDOH and offers a useful framework for organizing service delivery activities, the omission of prevention and health promotion throughout the report is a substantial limitation. We call for increased attention to and investment in prevention and health promotion in the proposed 5As framework. We contend that effectively addressing SDOH and improving alignment between health and social systems require reconceptualization of the traditional health care workforce and renewed state and national advocacy efforts. A paradigm shift encompassing a broader "workforce for health" that is well trained in prevention, health promotion, and advocacy is critical to addressing SDOH, improving population health outcomes, and achieving health equity. Given their professional mission, training, expertise, and scope of practice, social workers are well positioned to lead this effort. [ABSTRACT FROM AUTHOR]

Objectives. To examine effects of unmet social needs on adherence to pediatric weight management intervention (PWMI). Methods. We examined individual associations of positive screens for parental stress, parental depression, food insecurity, and housing insecurity with intervention adherence, and associations of 0, 1 or 2, and 3 or 4 unmet social needs with adherence, among children enrolled in a 2017–2019 comparative effectiveness trial for 2 high-intensity PWMIs in Massachusetts. Models were adjusted for child age, body mass index (BMI), parent BMI, and intervention arm. Results. Families with versus without housing insecurity received a mean of 5.3 (SD = 8.0) versus 8.3 (SD = 10.9) contact hours (P <.01). There were no statistically significant differences in adherence for families reporting other unmet social needs. Children with 3 to 4 unmet social needs versus without received a mean of 5.2 (SD = 8.1) versus 9.2 (SD = 11.8) contact hours (P <.01). In fully adjusted models, those with housing insecurity attended a mean difference of −3.14 (95% confidence interval [CI] = −5.41, −0.88) hours versus those without. Those with 3 or 4 unmet social needs attended −3.74 (95% CI = –6.64, −0.84) hours less than those with none. Conclusions. Adherence to PWMIs was lower among children with housing insecurity and in families with 3 or 4 unmet social needs. Addressing social needs should be a priority of PWMIs to improve intervention adherence and reduce disparities in childhood obesity. Trial Registration: ClinicalTrials.gov identifier: NCT03012126. [ABSTRACT FROM AUTHOR]

Many health care providers and systems are developing and implementing processes to screen patients for social determinants of health and to refer patients to appropriate nonclinical and community-based resources. The largest public health care system in the United States, New York City Health + Hospitals, piloted such a program in 2017. A qualitative evaluation yielded insights into the implementation and feasibility of such screening and referral programs in health care systems serving low-income, minority, immigrant, and underserved populations. [ABSTRACT FROM AUTHOR]

Medicaid is at the core of the opioid overdose epidemic. Both state and federal government reactions continue to shape the outcomes of this epidemic while death rates in some states continue to increase. There is a strong correlation between those suffering from opioid use disorder and those eligible for Medicaid. Most significantly, individuals with opioid use disorder enrolled in their state's Medicaid program experience greater positive health outcomes compared to those without coverage. Furthermore, states with expanded Medicaid coverage tend to positively impact social determinants of health for individuals with opioid use disorder. Notwithstanding these critical figures, the positive, ameliorative implementation of Medicaid programs is under attack as several states are erecting new work-requirement rules and the federal government is pushing for a block grant funding model, all of which will make access to health insurance more difficult for those suffering from opioid use disorder. [ABSTRACT FROM AUTHOR]

This study draws upon the social determinants of health framework to model and test the extent to which a community's social capital is health protective in the face of a substantial economic shock, namely the recent foreclosure crisis. U.S. county–level data are used to analyze potential moderating effects of social capital on health given a community's foreclosure risk. We rely upon established social capital measures for U.S counties and merge them with county level foreclosure risk scores constructed by the U.S. Department of Housing and Urban Development (HUD). While theorists suggest that social capital's effect on health and other outcomes may be durable over time there have been few empirical tests of this. We interact established social capital indicators measured at two points in time with foreclosure risk to predict overall self‐reported health. Our results provide strong support suggesting that high levels of social capital are health protective. Communities with high levels of social capital that are facing high foreclosure risks report significantly better aggregate health outcomes than comparable communities facing the same level of foreclosure risk, but lower levels of social capital. [ABSTRACT FROM AUTHOR]

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Over the past several decades, citizenship status has become more important in immigrant lives and communities in the United States. Undocumented adults who arrived as children, the 1.5 generation, comprise a growing percentage of the immigrant population. Although they are similar to children of immigrants born in the United States (the second generation) they face a variety of barriers to integration due to their lack of legal status. Based on over five years of ethnographic fieldwork with mainly 1.5 and second generation Mexican-American men during a period of major healthcare reform, this paper addresses how citizenship status and embeddedness within multi-status communities impacts immigrant experiences in the healthcare domain. In particular, I argue that the Affordable Care Act (ACA) has contributed to an institutionalization of the status differences and a further differentiation in the social integration of these groups of children of immigrants. The novel methodological approach and the data which emerges through fieldwork reveals important insights into the process whereby healthcare reforms have consequences for immigrant communities which I show through highlighting the status-signaling event that is generated through various forms of direct and indirect interaction with the ACA. The implications of this extend beyond healthcare, and I discuss its impact on issues including ethnic identity and psychological well-being. This paper makes contributions to both our understanding of intergroup dynamics in immigrant integration and the health implications of immigration policies more generally. [ABSTRACT FROM AUTHOR]

Menstrual health and hygiene have become important parts of the human rights agenda in recent years. This article examines the ways in which human rights actors invoke the language of human dignity to illuminate and address the vulnerabilities menstruating individuals face. It argues that although the norms associated with conventional accounts of human dignity provide an important resource for this project, they can also present a stumbling block. To the extent that menstrual rights actors rely on conventional accounts of human dignity associated with bodily self-control they may unwittingly reinforce the period stigma at the heart of the problem. [ABSTRACT FROM AUTHOR]

This essay turns toward Carlos Bulosan's America Is in the Heart to reassess the cultural and political imperatives of US health intervention during the early twentieth century. Unlike other scholarship on this novel, my study gives sustained treatment to the diverse therapeutic histories and traditions that underwrite Bulosan's intensely transnational pathography. Ultimately, I argue that the novel challenges racialized clinical categories of health inequality and, in the process, elaborates new ways to contemplate and encounter illness, convalescence, and care. [ABSTRACT FROM AUTHOR]

Background: This study assessed the prevalence of physical inactivity and the influence of sociodemographic variables on physical activity categories, highlighting the correlates of physical inactivity in Nigerian young adults. Methods: A representative sample of young adults age 16 to 39 years (n = 1006) from a Nigerian University were categorized using the International Physical Activity Questionnaire as physically inactive, moderately active, and highly active. Prevalence rates were computed for the activity categories and the independent associations of sociodemographic correlates on each category were determined using the multinomial logistic regression. Results: Physical inactivity prevalence was 41%. More likely to be inactive were females (OR = 1.93; CI: I .49-2.49), those of Hausa ethnicity (OR = 2.29; CI: 1.08-5.84), having BMI> 30 kg/m2 (OR = 2.88; CI: 1.16-7.17), and those whose parents’ annual income was < 180,000 NAIRA (OR = 1.69; CI: 1.04-2.95). Less likely to be moderately active were females (OR = 0.71; CI: 0.61-0.95), those with BMI between 25.0 to 29.9 kg/m2 (OR = 0.46; CI: 0.23-0.92), and those of Hausa ethnicity (OR = 0.17; CI: 0.04-0.74). Conclusion: Important sociodemographic variables that can contribute to the preliminary analysis of correlates of physical inactivity among Nigerian young adults were identified. [ABSTRACT FROM AUTHOR]

This article extends postmodern theories of consumption-oriented microcultures by analyzing the natural health value system and the microcultural meanings through which it is constructed. We first compare our theoretical approach to the conventional, Rokeachian view of the consumer value system. Drawing from a range of cultural and postmodern theories, we argue that the Rokeachian view is not sufficiently attuned to the meaning-based aspects of consumer value systems. Furthermore, it largely ignores the intracultural diversity among consumer value systems that arises from the fragmentation of postmodern consumer culture into diverse consumption microcultures. Our analysis focuses on the narratives that natural health consumers use to articulate the values manifest in their wellness-oriented consumption outlooks and practices. These narratives reveal the meaning-based linkages between these articulated values and the consumption goals being pursued through natural health practices. We further contextualize the natural health value system by highlighting four higher-order postmodern orientations that are inflected in this microculture. We discuss the implications of our analysis for conceptualizations of the fragmented postmodern marketplace, means-end analyses of consumer values, and generative theories of consumer goal formation. [ABSTRACT FROM AUTHOR]

Focuses on primary-care-based physical activity interventions targeting older adults in health care settings in the U.S. Citation of related literature on primary-care-based physical activity interventions; Description of programs integrated into the context of primary care; Importance of socio-environmental influences on heath and health behaviors.

On 30 July 2016, the Government Decree No. 272/2011 Coll., On health protection against adverse effects of noise and vibrations, became effective. The amendment in £ 12 still includes the possibility of granting a correction to the so-called “old noise load" and adjusts the conditions under which a +20 dB correction can be admitted to the baseline sound pressure level A LAeq,T 50 dB. Correction to the old noise load was introduced in 2000 as an analogy to the reduction of old ecological burdens in the environment. This paper deals with the analysis of problems that the “historical noise burdens" institute brings in practice 19 years after its introduction into the legal system in the field of public health protection against environmental noise. [ABSTRACT FROM AUTHOR]

Objectives. To examine whether the expansion of Medicaid under the Affordable Care Act (ACA) decreased the prevalence of severe food insecurity. Methods. With data on adult respondents to the Food Security Supplement to the Current Population Survey in US states for the years 2010 to 2013 and 2015 to 2016, I used a difference-in-difference design to compare trends in very low food security (VLFS) among low-income childless adults in states that did and did not expand Medicaid in 2014 under the ACA. Results. Among low-income, nonelderly childless adults, VLFS rose from 17.4% before ACA to 17.5% after ACA in nonexpansion states, and fell from 17.6% to 15.9% in expansion states. In difference-in-difference analysis, Medicaid expansion was associated with a significant adjusted 2.2-percentage-point decline in rates of VLFS, equivalent to a 12.5% relative reduction. Conclusions. The improvement in food security after the ACA's health insurance expansion suggests that health insurance provision has spillover effects that reduce other dimensions of poverty. Public Health Implications. Providing free or low-cost health insurance coverage may free up household funds, reducing food insecurity and improving this important social determinant of health. [ABSTRACT FROM AUTHOR]

There has been a burst of research on immigrant health in the United States and an increasing attention to the broad range of state and local policies that are social determinants of immigrant health. Many of these policies criminalize immigrants by regulating the "legality" of their day-to-day lives while others function to integrate immigrants through expanded rights and eligibility for health care, social services, and other resources. Research on the health impact of policies has primarily focused on the extremes of either criminalization or integration. Most immigrants in the United States, however, live in states that possess a combination of both criminalizing and integrating policies, resulting in distinct contexts that may influence their well-being. We present data describing the variations in criminalization and integration policies across states and provide a framework that identifies distinct but concurrent mechanisms of deportability and inclusion that can influence health. Future public health research and practice should address the ongoing dynamics created by both criminalization and integration policies as these likely exacerbate health inequities by citizenship status, race/ethnicity, and other social hierarchies. [ABSTRACT FROM AUTHOR]

Objective: This study examines the roles of parents, extended kin, and exchange networks in adolescent health‐seeking behavior in Ethiopia. Background: Prior studies highlight the role of mothers in children's health, whereas fathers, extended kin, and other network partners remain largely unexamined. The gender intensification hypothesis suggests that adolescents gravitate toward same‐gender parents for advice and assistance with health‐related issues. A more expansive view of the hypothesis suggests that other same‐gender adults may also be important sources of support. Method: Survey data were used from a random sample of 2,084 youth ages 13 to 17 collected in urban and rural communities in southwestern Ethiopia. Sources of advice, treatment, and accompaniment to get treatment were examined. Random intercept logistic regression models were used to identify factors associated with receipt of formal health care. Results: Fathers and mothers played an important role in all phases of adolescent health‐seeking behavior. Fathers' involvement was especially common in rural areas and more so with boys than girls. Extended kin and exchange networks also played a role and were even more important for boys in female‐headed households, suggesting that they may have substituted for absent fathers. Conclusion: Adolescents rely heavily on parents and other adults for health advice and treatment. Who children go to for assistance is highly gendered, especially in rural areas. Implications: Studies of adolescent health‐seeking and interventions designed to improve health services utilization need to recognize the important involvement of parents and other closely related adults in advising youth and accompanying them to get treatment. [ABSTRACT FROM AUTHOR]

Background and Aims: Identifying typologies of social determinants of health (SDoH) vulnerability influencing drug use practices among women living with HIV (WLWH) can help to address associated harms. This research aimed to explore the association of SDoH clusters with drug use among WLWH. Design Latent class analysis (LCA) was used to identify the distinct clusters of SDoH. Inverse probability weighting (IPW) was employed to account for confounding and potential selection bias. Associations were analyzed using generalized linear model with log link and Poisson distribution, and then weighted risk ratio (RR) and 95% confidence intervals (CI) were reported. Setting and Participants: Data from 1422 WLWH recruited at time‐point 1 of the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS, 2013–15), with 1252 participants at 18 months follow‐up (time‐point 2). Measurements: Drug use was defined as use of illicit/non‐prescribed opioids/stimulants in the past 6 months. SDoH indicators included: race discrimination, gender discrimination, HIV stigma, social support, access to care, food security, income level, employment status, education, housing status and histories of recent sex work and incarceration. Findings LCA identified four SDoH classes: no/least SDoH adversities (6.6%), discrimination/stigma (17.7%), economic hardship (30.8%) and most SDoH adversities (45.0%). Drug use was reported by 17.5% and 17.2% at time‐points 1 and 2, respectively. WLWH with no/least SDoH adversities were less likely to report drug use than those in economic hardship class (weighted RR = 0.13; 95% CIs = 0.03, 0.63), discrimination/stigma class (weighted RR = 0.15; 95% CIs = 0.03, 0.78), and most SDoH adversities class (weighted RR = 0.13; 95% CIs = 0.03, 0.58). Conclusions: Social determinants of health vulnerabilities are associated with greater likelihood of drug use, underscoring the significance of addressing interlinked social determinants and drug use through the course of HIV care and treatment. [ABSTRACT FROM AUTHOR]

The article argue that documented life-cycle cost analysis (LCCA) should be a required component of procurement planning for contingency operations. Topics discussed include the legal framework for overseas contingency operations, including U.S. environmental and government procurement regulations and international law considerations; the U.S. Department of Defense (DoD)practices and its impacts on the health of U.S.; and financial costs of the DoD's expeditionary operations.

This article takes a birds-eye view of equity in action, showcasing efforts to embed an equity lens in legislated and non-legislated policies and practices in three states. Authors from California, Colorado, and Minnesota provide state-specific examples of how equity has been advanced and operationalized in state-level governance. The article describes progress and lessons learned and offers guidance to others. [ABSTRACT FROM AUTHOR]

This article discusses (1) the ways in which law functions as a determinant of health, (2) historical collaborations between the health and legal professions, (3) the benefits of creating medical-public health-legal collaborations, and (4) how viewing law through a collaborative, population health lens can lead to health equity. [ABSTRACT FROM AUTHOR]

When Congress passed HIPAA, it did not intend to constrain public health's data sharing in the same way as clinical or payers. In fact, HIPAA recognizes data sharing with public health as a matter of national priority and shields this function from its reach. However, a health department may offer services that bring it within HIPAA's purview, such as running a Children's Health Insurance Program or a laboratory that bills electronically. When this is the case, HIPAA requires all information and departments be subject to HIPAA unless the public health authority chooses to hybridize. Health departments might re-assess their coverage and elect to become a hybrid entity, thereby restricting HIPAA to only where required and removing barriers to information sharing with communities. [ABSTRACT FROM AUTHOR]

This article discusses how advocacy can be taught to both law and public health students, as well as the role that public health law faculty can play in advocating for public health. Despite the central role that advocacy plans in translating public health research into law, policy advocacy skills are rarely explicitly taught in either law schools or schools of public health, leaving those engaged in public health practice unclear about whether and how to advocate for effective policies. The article explains how courses in public health law and health justice provide ideal opportunities to teach advocacy skills, and it discusses the work of the George Consortium, which seeks to engage public health law faculty in advocacy efforts. [ABSTRACT FROM AUTHOR]

Suicide is a public health problem which will require an integrated cross-sector approach to help reduce prevalence rates. One strategy is to include the legal system in a more integrated way with suicide prevention efforts. Caine (2013) explored a public health approach to suicide prevention, depicting risk factors across the socio-ecological model. The purpose of this paper is to examine laws that impact suicide prevention at the individual, relational, community, and societal levels. These levels are fluid, and some interventions will fall between two, such as a community-level approach to training that enhances provider-patient relationships. At the individual level, we will review laws to improve screening requirements across systems. At the relational level, we note interventions with couples having conflict, such as protection orders and access to attorney consultations, which have been known to be injury prevention mechanisms. At the community level, we discuss legislation that recommends suicide prevention efforts for key individuals working as frontline providers in the medical and educational systems. At the societal level, we explore public awareness campaigns that target stigma reduction for those suffering from mental health burden and enhance linkage to care. The article closes with the discussion that laws are good, but their implementation is essential. [ABSTRACT FROM AUTHOR]

Background: Physical violence against children and adolescents comprises a serious public health problem and often results in oral and maxillofacial traumas. Social determinants may favour the occurrence of these events, but few studies have critically evaluated the interaction between social and geographical risk factors. Aims: To investigate the spatiotemporal distribution of oral and maxillofacial traumas resulting from violence against children and adolescents through geostatistical techniques. Methods: This study was an ecological analysis of cases of trauma caused by violence against Brazilian children and adolescents using aggregated data from victims attended at a Center of Forensic Medicine and Forensic Dentistry between January 2012 and December 2015. Data were analysed through modelling based on geographic information system (GIS). Results: Two distinct patterns of longitudinal trajectory of oral and maxillofacial trauma related to violence against children and adolescents were identified (TP1 and TP2, P < 0.05). The spatial regression analysis revealed a statistically significant association between higher incidence of cases and areas with worse socioeconomic conditions (β = 0.047, SE = 0.020, P < 0.05). Conclusion: Neighbourhoods with considerable socio‐spatial vulnerability for violence against children and adolescents and maxillofacial traumas were identified. [ABSTRACT FROM AUTHOR]

The article discusses population health management in relation to a medicalization process involving patients' personal, behavioral, and social issues. An effort to understand the upstream (macro-level) and downstream (micro-level) social determinants of health and the limits of medical care in reducing health disparities in America is examined. Medical care spending in the U.S. is addressed, along with health care outcomes.

An editorial is presented which addresses the concept of food security as a social determinant of health for older adults, and it mentions how many older Americans do not receive an adequate amount of nutritious foods to sustain healthy lifestyles. Multimorbidity and chronic disease self-management are examined, along with the U.S. Supplemental Nutrition Assistance Program (SNAP) food support program and clinician-patient relations.

An introduction is presented in which the editor discusses articles in the issue on topics including understanding of the dynamics of social and biographical aspects of health; discussions on the economic and cultural threat for immigration control in Switzerland.

Purpose: Social determinants may influence health-related quality of life (HRQOL) among women with ovarian cancer, potentially creating disparities in clinical outcomes. We investigated the relationship between HRQOL and social determinants of health, including travel distance to access cancer care and health insurance type, among women participating in a randomized trial of primary adjuvant treatment for advanced ovarian cancer.Methods: The Functional Assessment of Cancer Therapy-Ovarian (FACT-O) questionnaire captured HRQOL (physical well-being, functional well-being, ovarian-specific, and trial outcome index [TOI]) prior to chemotherapy (baseline), during the trial, and 84 weeks after initiation of chemotherapy for women with advanced epithelial ovarian, primary peritoneal, or fallopian tube cancer. We constructed bivariate and multivariable linear mixed effects models examining the associations of social determinants of health (individual-level and contextual factors) with HRQOL scores at 84 weeks, clustering participants (n = 993) within treatment centers, and Census regions and controlling for baseline HRQOL.Results: Most individual-level (race, age, cancer stage, adverse events) and contextual (travel distance to treatment center, community socioeconomic status) factors were not statistically significantly associated with HRQOL. Compared to participants with private health insurance, other participants had lower mean HRQOL (physical well-being: public insurance, - 1.00 (standard error[SE] = 0.49) points, uninsured, - 1.93 (SE = 0.63) points; functional well-being: public, - 1.29 (SE = 0.59), uninsured, - 1.98 (SE = 0.76); ovarian cancer-specific: public, - 1.60 (SE = 0.59), uninsured, - 1.66 (SE = 0.75); TOI: public, - 3.81 (SE = 1.46), uninsured, - 5.51 (SE = 1.86); all p < .05).Conclusions: Private health insurance was associated with improved HRQOL at the completion of treatment for advanced stage ovarian cancer. Implications of health insurance on HRQOL should be further investigated, particularly among women with ovarian cancer who receive standard of care treatment. [ABSTRACT FROM AUTHOR]

Introduction. Factors associated with drug use are defined in terms of their proximity to the phenomenon and can be classified as individual, microsocial, and macrosocial. Macrosocial factors include variables of a geographic, economic, demographic, and social nature, which can be compiled from population censuses and surveys. Objective. To determine the levels of risk for drug use in municipalities in Mexico based on macro- social indicators. Method. Retrospective cross-sectional study, based on the analysis of population data, weighted by the Delphi method. Results. Sixty-four municipalities with a high or very high risk of drug use were identified. Factors such as the volume of drug seizures, prevalence of student use, alcohol supply, and inequality among the population were weighted as the factors with greatest risk for drug use. Discussion and conclusion. These data serve as a benchmark for guiding the efficient, rational administration of resources assigned for dealing with the problem of addictions, since they make it possible to identify localities with a greater need for care services. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to describe the relationships between personal and environmental factors and health behaviors in persons with hypertension. Methods: This was a cross-sectional study carried out using a convenient sample of individuals with hypertension from three community health centers in Yangon, Myanmar. Data were collected using a standardized interviewer-administered questionnaire consisting of six sections: demographic characteristics, Self-efficacy to manage Hypertension Scale, Health Behavior Questionnaire, Barriers to Health Promoting Activities Scale, Hypertension Knowledge Questionnaire, and Social Support Questionnaire. The data were analyzed using descriptive statistics, Chi-square, and Pearson's correlation coefficient. Results: Participants had a high level of perceived self-efficacy (42.13 ± 7.58), a low level of perceived barriers (35.32 ± 19.63), a poor social support (49.64 ± 8.51), a good level of hypertension knowledge (10.63 ± 1.90) and a moderate level of health behaviors (70.59 ± 12.39). Health behaviors had significant relationship with income, social support, hypertension knowledge and perceived barriers (r = -0.28, p = 0.004; r = 0.23, p = 0.019; r = 0.27, p = 0.006; r = -0.21, p = 0.034), respectively. Conclusions: These findings suggest that health behaviors in persons with hypertension can be improved using hypertension knowledge, social support, and decrease in perceived barriers. [ABSTRACT FROM AUTHOR]

In this article, we propose the conceptualization of family structure as an important socially stratified grouping within a social determinants of health (SDOH) framework. We explore how family science literature supports this conceptualization of family structure through evidence of inequity in health outcomes across structurally diverse families that can and ought to be addressed; social stratification across family structures in which some family forms have greater prestige and power than others; and internalized, personally mediated, and institutional prejudices and discriminations that operate on the basis of these social stratifications. Ultimately, we contend that conceptualizing family structure as a socially stratified grouping within an SDOH framework can help enhance family science scholarship and assist family professionals in more effectively serving contemporary families. [ABSTRACT FROM AUTHOR]

This article discusses the philosophy behind the image of health as seen through the lens of sport. The author discusses the body existing as not only healthy in and of itself, but as a symbol of a larger "healthy" existence. This symbolism, seen in health advertising, has been created to direct cultural thought to a specific sign or ideal representation. The athletic body functions as a static physical display of health, as well as being an action-oriented icon. This dualism allows it to function on multiple levels as a cultural symbol.

A probability sample survey (n = 1,041) explored the relationship of both work-related and extra-workplace variables to four subjective quality of life measures: life satisfaction, life satisfaction over time, job satisfaction, and evaluation of health. The interrelationships among these four measures were also examined. A conceptual model relating job satisfaction to life satisfaction was offered. [ABSTRACT FROM AUTHOR]

See related Editorial by Salzman et al. in this issue. [ABSTRACT FROM AUTHOR]

Universal screenings for social determinants of health (SDOH) are feasible at the health system level and enable institutions to identify unmet social needs that would otherwise go undiscovered. NewYork-Presbyterian Hospital implemented SDOH screenings together with clinical screenings in four outpatient primary care sites. Aligning SDOH screening with clinical screening was crucial for establishing provider buy-in and ensuring sustainability of screening for SDOH. Despite some challenges, universal screening for SDOH has allowed NewYork-Presbyterian Hospital to identify unmet needs to improve population health. [ABSTRACT FROM AUTHOR]

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Background: Patient support during tuberculosis treatment is expected to be more often available and more customized in low tuberculosis incidence, high-resource settings than in lower-resource settings. The aim of this systematic review is to provide an overview of tuberculosis patient support interventions implemented in low-incidence countries and an evaluation of their effects on treatment-related outcomes as well as their acceptability by patients and providers. Methods: PubMed, Social Science Citation Index and Cumulative Index to Nursing and Allied Health and Literature were searched for the period 01.2006–05.2016 on publications describing tuberculosis patient support interventions in low-incidence countries (<20 patients per 100,000 population). Results: Through our search strategy, 1875 unique publications were identified. Forty publications were included: 17 evaluated patient support quantitatively, 9 qualitatively and 14 only described the patient support. Nineteen publications assessed treatment supervision options only, 21 assessed (combinations of) treatment supervision, socio-economic, psycho-emotional, health-educational and other support. Of eight studies quantitatively evaluating the effects of support with a control group, four showed positive effects: two out of three that used combinations of patient support and two out of five that compared treatment supervision options. Heterogeneity of interventions precluded pooling of results. Qualitative and descriptive studies showed that patients appreciated individualized support including treatment supervision, psycho-emotional and socio-economic support; and digital health interventions. Conclusion: Our review shows that a variety of patient support interventions is implemented in low-incidence countries. Although only a few interventions were evaluated quantitatively, we identified potential best practices. The scarcity of evidence on effectiveness, however, indicates the need for further research to evaluate potential best practices. [ABSTRACT FROM AUTHOR]

Objective: To identify challenges that disadvantaged adults with asthma face in mitigating social and environmental factors associated with poor symptom control. Methods: Using a community-engaged approach, we partnered with a community health center in New Haven, CT to conduct in-person interviews and a written survey of asthmatic adults with poor symptom control. Using the constant comparative method, we analyzed participant interviews to establish emerging themes and identify common barriers to improved outcomes. Through a written survey utilizing clinically validated questions, we assessed information on access to medical care, asthma control, and selected social and environmental risk factors. Results: Twenty-one patients (mean age 47, 62% female, 71% Black, 95% insured by Medicaid) participated. The average Asthma Control Test (ACT) score was 11.6. Seventy-six percent of participants were currently employed and of those, 75% reported work-related symptoms. Among participants currently in housing, 59% reported exposure to domiciliary mice and 47% to mold. We identified three themes that summarize the challenges the study participants face: 1) Lack of knowledge about home and workplace asthma triggers; 2) Lack of awareness of legal rights or resources available to mitigate adverse conditions in the home or work environment; and 3) Fear of retaliation from landlords or employers, including threats of eviction, sexual assault, and job loss. Conclusion: Patients with poorly controlled asthma in a disadvantaged urban northeast community identified common barriers in both the domestic and work environments that impeded attainment of symptom control. These challenges may be best addressed through legal advocacy for those most at risk. [ABSTRACT FROM AUTHOR]

In this paper, we consider personalized periodontics from a public health perspective. Periodontitis is an under-acknowledged and important public health problem, and there has long been interest in identifying and treating those who are at high risk of developing this disease. Although susceptibility/risk-assessment tools in periodontology are currently in their early stages of development, personalized periodontics is increasingly becoming a realistic approach. At the population level, however, personalized periodontics is not an effective way of improving periodontal health because it would target only those who seek help or are able to access care. The occurrence of periodontitis in populations is socially patterned, with those of lower socio-economic position having poorer periodontal health and being far less likely to seek care. There is the potential for social inequalities actually to worsen as a result of personalized periodontics. In most health systems, personalized periodontics is likely to be accessible only to the social strata for whom it is affordable, and those with the greatest need for such an intervention will remain the least likely to be able to get it. Thus, personalized periodontics is likely to be a niche service for a small proportion of the adult population. This is at odds with the public health approach. [ABSTRACT FROM AUTHOR]