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Abstract Background Colombia is one of the countries with the widest levels of socioeconomic and health inequalities. Bogotá, its capital, faces serious problems of poverty, social disparities and access to health services. A Primary Health Care (PHC) strategy was implemented in 2004 to improve health care and to address the social determinants of such inequalities. This study aimed to evaluate the contribution of the PHC strategy to reducing inequalities in child health outcomes in Bogotá. Methods An ecological analysis with localities as the unit of analysis was carried out. The variable used to capture the socioeconomic status and living standards was the Quality of Life Index (QLI). Concentration curves and concentration indices for four child health outcomes (infant mortality rate (IMR), under-5 mortality rate, prevalence of acute malnutrition in children under-5, and vaccination coverage for diphtheria, pertussis and tetanus) were calculated to measure socioeconomic inequality. Two periods were used to describe possible changes in the magnitude of the inequalities related with the PHC implementation (2003 year before - 2007 year after implementation). The contribution of the PHC intervention was computed by a decomposition analysis carried out on data from 2007. Results In both 2003 and 2007, concentration curves and indexes of IMR, under-5 mortality rate and acute malnutrition showed inequalities to the disadvantage of localities with lower QLI. Diphtheria, pertussis and tetanus (DPT) vaccinations were more prevalent among localities with higher QLI in 2003 but were higher in localities with lower QLI in 2007. The variation of the concentration index between 2003 and 2007 indicated reductions in inequality for all of the indicators in the period after the PHC implementation. In 2007, PHC was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-5 mortality (24%), IMR (19%) and acute malnutrition (7%). PHC also contributed approximately 20% to inequality in DPT coverage, favoring the poorer localities. Conclusion The PHC strategy developed in Bogotá appears to be contributing to reductions of the inequality associated with socioeconomic and living conditions in child health outcomes.

Abstract Background Colombia has a highly segmented and fragmented national health system that contributes to inequitable health outcomes. In 2004 the district government of Bogota initiated a Primary Health Care (PHC) strategy to improve health care access and population health status. This study aims to analyse the contribution of the PHC strategy to the improvement of health outcomes controlling for socioeconomic variables. Methods A longitudinal ecological analysis using data from secondary sources was carried out. The analysis used data from 2003 and 2007 (one year before and 3 years after the PHC implementation). A Primary Health Care Index (PHCI) of coverage intensity was constructed. According to the PHCI, localities were classified into two groups: high and low coverage. A multivariate analysis using a Poisson regression model for each year separately and a Panel Poisson regression model to assess changes between the groups over the years was developed. Dependent variables were infant mortality rate, under-5 mortality rate, infant mortality rate due to acute diarrheal disease and pneumonia, prevalence of acute malnutrition, vaccination coverage for diphtheria, pertussis, tetanus (DPT) and prevalence of exclusive breastfeeding. The independent variable was the PHCI. Control variables were sewerage coverage, health system insurance coverage and quality of life index. Results The high PHCI localities as compared with the low PHCI localities showed significant risk reductions of under-5 mortality (13.8%) and infant mortality due to pneumonia (37.5%) between 2003 and 2007. The probability of being vaccinated for DPT also showed a significant increase of 4.9%. The risk of infant mortality and of acute malnutrition in children under-5 years was lesser in the high coverage group than in the low one; however relative changes were not statistically significant. Conclusions Despite the adverse contextual conditions and the limitations imposed by the Colombian health system itself, Bogota’s initiative of a PHC strategy has successfully contributed to the improvement of some health outcomes.

Abstract Objective Few methodological studies address the prioritization of clinical topics for the development of Clinical Practice Guidelines (CPGs). The aim of this study was to validate a methodology for Priority Determination of Topics (PDT) of CPGs. Methods and results Firstly, we developed an instrument for PDT with 41 criteria that were grouped under 10 domains, based on a comprehensive systematic search. Secondly, we performed a survey of stakeholders involved in CPGs development, and end users of guidelines, using the instrument. Thirdly, a pilot testing of the PDT procedure was performed in order to choose 10 guideline topics among 34 proposed projects; using a multi-criteria analysis approach, we validated a mechanism that followed five stages: determination of the composition of groups, item/domain scoring, weights determination, quality of the information used to support judgments, and finally, topic selection. Participants first scored the importance of each domain, after which four different weighting procedures were calculated (including the survey results). The process of weighting was determined by correlating the data between them. We also reported the quality of evidence used for PDT. Finally, we provided a qualitative analysis of the process. The main domains used to support judgement, having higher quality scores and weightings, were feasibility, disease burden, implementation and information needs. Other important domains such as user preferences, adverse events, potential for health promotion, social effects, and economic impact had lower relevance for clinicians. Criteria for prioritization were mainly judged through professional experience, while good quality information was only used in 15% of cases. Conclusion The main advantages of the proposed methodology are supported by the use of a systematic approach to identify, score and weight guideline topics selection, limiting or exposing the influence of personal biases. However, the methodology was complex and included a number of quantitative and qualitative approaches reflecting the difficulties of the prioritization process.

Objective: Hypertensive disorders of pregnancy (HDP) are responsible for several maternal and fetal complications. This study investigated the occurrence of HDP, associated factors, and neonatal complications in women living in the Western Brazilian Amazon. Methods: This is a population‐based cross‐sectional study with 1521 mother–child pairs enrolled in the Maternal and Child Health and Nutrition in Acre birth cohort (MINA‐Brazil study). All parturients with HDP (registered in the medical records) were identified. Crude and adjusted prevalence ratios were calculated in Poisson regression models with robust variance. Results: The prevalence of HDP was 11.0% (95% CI: 9.5–12.7). Factors associated with the prevalence of HDP were maternal age ≥ 35 years (PR: 1.9; 95% CI: 1.3–3.0), primigravida status (PR: 2.0; 95% CI: 1.5–2.7), pre‐pregnancy obesity (PR: 2.7; 95% CI: 1.9–4.0), higher gestational weight gain (highest quartile RP: 2.5; 95% CI: 1.6–3.8), chronic hypertension (RP: 3.6; 95% CI: 2.7–4.9), and diabetes in pregnancy (RP: 1.9; 95% CI: 1.1–3.2). HDP was associated with risk for caesarean delivery (PR: 1.8; 95% CI: 1.6–2.0) and prematurity (PR: 2.0; 95% CI: 1.3–3.2). Gestational malaria was not associated with HDP in Amazonian pregnant women. Conclusions: Evaluating risk factors before pregnancy and during the prenatal period is essential for reducing adverse maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background: In socially vulnerable populations, evidence is needed regarding the role of maternal nutritional status on child weight during the first 2 years of life. Objectives: We aimed to assess the association of pre‐pregnancy body mass index (BMI) and gestational weight gain (GWG) with offspring BMI‐for‐age z‐scores (BAZs) during the first 2 years of life. Methods: A population‐based birth cohort study was conducted with 900 mother–child pairs. Pre‐pregnancy weight and weight at delivery were collected from medical records, and anthropometric data were measured at birth and at 6‐month, 1‐year and 2‐year follow‐up visits. Linear regression and linear mixed‐effect models assessed associations with pre‐pregnancy BMI, GWG and BAZ during the first 2 years of life. Results: Pre‐pregnancy overweight and obesity and excessive GWG were positively associated with BAZ at birth and at 1‐ and 2‐year follow‐up visits. There were no significant additional BAZ changes per year based on the exposures up to age 2 years. Conclusions: Elevated maternal pre‐pregnancy BMI and GWG were associated with a child's higher BAZ at birth, and these differences remained constant throughout the first 2 years of life in Amazonian children. These findings highlight the importance of promoting adequate maternal weight before pregnancy and during prenatal care also in socially vulnerable populations. Key points: Pre‐pregnancy overweight and obesity and excessive gestational weight gain were associated with child's higher BMI‐for‐age z at birth, and these differences remained constant throughout the first 2 years of life in Amazonian children.Strategies that promote adequate maternal weight before and during pregnancy are necessary in socially vulnerable populations. [ABSTRACT FROM AUTHOR]

Objective: Excessive weight gain during childhood has been considered an early life risk factor for chronic disease in the long term. We examined the role of excessive gestational weight gain (GWG) and breastfeeding (BF) practices with the offspring's body mass index‐for‐age z‐score (zBMI) at 2 years. Methods: Data from 743 Amazonian young children of the MINA‐Brazil population‐based birth cohort study were used. Linear regression models were run to estimate the associations between excessive GWG and BF practices (exclusive breastfeeding, EBF <3 months of age and BF <1 year) with zBMI. Results: Excessive GWG and BF <1 year were associated with an adjusted 0.24 units (95% CI: 0.08, 0.41) and 0.28 units (95% CI: 0.12, 0.44) higher zBMI at age 2 years, respectively. Conclusions: Gain excessive weight during pregnancy and shorter BF duration (<1y) were associated with a higher body mass index at 2 years of age among Brazilian Amazonian children. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe the prevalence and factors associated with exclusive (EBF) and continued breastfeeding (BF) practices among Amazonian children. METHODS: Data from 1,143 mother-child pairs recorded on the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) birth cohort were used. Information on EBF and BF was collected after childbirth (July 2015-June 2016) and during the follow-up visits at 1 and 6 months postpartum, 1, 2, and 5 years of age. For longitudinal analysis, the outcomes were EBF and BF duration. Probability of breastfeeding practices were estimated by Kaplan-Meier survival analysis. Associations between baseline predictors variables and outcomes among children born at term were assessed by extended Cox regression models. RESULTS: EBF frequencies (95% confidence interval [95%CI]) at 3 and 6 months of age were 33% (95%CI: 30.2-36.0) and 10.8% (95%CI: 8.9-12.9), respectively. Adjusted hazard ratio for predictors of early EBF cessation were: being a first-time mother = 1.47 (95%CI: 1.19-1.80), feeding newborns with prelacteals = 1.70 (95%CI: 1.23-2.36), pacifier use in the first week of life = 1.79 (95%CI: 1.44-2.23) or diarrhea in the first two weeks of life = 1.70 (95%CI: 1.15-2.52). Continued BF frequency was 67.9% (95%CI: 64.9-70.8), 29.3% (95%CI: 26.4-32.4), and 1.7% (95%CI: 0.9-2.8) at 1, 2 and 5 years of age, respectively. Adjusted hazard ratio for predictors of early BF cessation were: male sex = 1.23 (95%CI: 1.01-1.49), pacifier use in the first week of life = 4.66 (95%CI: 2.99-7.26), and EBF less than 3 months = 2.76 (95%CI: 1.64-4.66). CONCLUSIONS: EBF and continued BF duration among Amazonian children is considerably shorter than recommendations from the World Health Organization. Significant predictors of breastfeeding practices should be considered for evaluating local strategies to achieve optimal breastfeeding practices. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To review observational studies on the association between breastfeeding (BF) practices and head circumference (HC) of children < 2 years old. METHODS: A systematic review was conducted using the following electronic databases of health sciences: PubMed, Latin American and Caribbean Literature in Health Sciences (Lilacs), Web of Science and Scopus. We selected observational studies published in any language from January 01, 2010 to November 19, 2021, from different populations that investigated the association between BF practice and HC among healthy children < 2 years old. Titles and abstracts were screened independently by two evaluators. RESULTS: From the 4,229 articles identified, 24 were included in this review: 6 cross-sectional, 17 longitudinal, and 1 case-control. The studies varied in their definition of the variables for BF and in reporting its practice, frequency, duration, and feeding method. Regarding HC, the authors analyzed the mean differences, abnormal values (z-score above + 2SD or below -2SD according to the World Health Organization (WHO) growth standards, 2007), and longitudinal growth parameters. The findings of this review suggest that BF may have a positive relationship with HC at the beginning of life. CONCLUSIONS: Our findings suggest that BF, especially exclusive BF, may play a protective role against abnormal HC values in young children. However, more robust evidence with standardized BF indicators and WHO growth standards (2007) are required. DESCRIPTORS: Head Circumference. Cephalometry. Anthropometry. Breastfeeding. Exclusive Breastfeeding. Formula Feeding. Child Growth. Child Development. Systematic review. [ABSTRACT FROM AUTHOR]

Copyright of Saúde e Sociedade is the property of Universidade de Sao Paulo, Faculdade de Saude Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article aims to examine agreement of pre-pregnancy weight, pregnancy weight, height and systolic (SBP) and diastolic (DBP) blood pressure measurements recorded on antenatal record cards with the same information obtained in the MINA-Brazil longitudinal study. 428 pregnant women who participated in the MINA-Brazil study and had an antenatal card at time of childbirth were selected. Concordance analysis of the data used Lin’s correlation coefficient and Bland-Altman analysis. There was moderate agreement on self-reported pre-pregnancy weight (0.935) and height (0.913) information, and substantial agreement on the pregnant women’s weight in the second (0.993) and third (0.988) trimesters of pregnancy. Little agreement was found on SBP and DBP measured in the second (SBP = 0.447; DBP = 0.409) and third (SBP = 0.436; DBP = 0.332) trimesters of pregnancy. Anthropometric measurements showed strong agreement. There was weak agreement between blood pressure measurements, which may relate both to the variability and the standardisation of these measurements, suggesting the need for continued training of antenatal teams in primary health care. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: to investigate the factors associated with continued breastfeeding (BF). Methods: All the parturients at a local maternity from July 2015 to June 2016 were invited to participate in a cohort study in Cruzeiro do Sul, Acre. Data on socioeconomic, demographic, obstetric and neonatal of the babies were obtained for the interview. Multiple Poisson regression models with robust variance were used to estimate the prevalence ratio (PR) and 95% confidence intervals (95%CI). Results: among the 1551 mothers contacted, 305 lived in the rural area, leaving 1,246 eligible mothers living in urban area. For the 1-year cohort follow-up, 74 non-twin babies were assessed. Most of the mothers reported to have mixed skin color (79%), are over 21 years old (72%), more than 10 years of schooling (72%) and with unpaying job (54%). The children’s age ranged from 10 to 15 months. The frequency of continued breastfeeding was 69,4% (95%CI=66.0-72.6). The factors negatively associated with continued breastfeeding were the use of bottle feeding (PR=1.44; CI95% =1,33-1.56) and pacifier (PR=2.54; CI95% =1.98-3.27), after adjusting for maternal age and socioeconomic variables. Conclusion: the frequency of continued breastfeeding in Cruzeiro do Sul was higher than the national estimates, but below the WHO recommendations for breastfeeding up to two years of age. [ABSTRACT FROM AUTHOR]

Early life feeding practices can directly affect the growth, development, and survival of a child. This study aimed to estimate the frequency of and factors associated with exclusive breastfeeding (EBF) in the first month of life among Amazonian infants. We used data of 1,523 mother-child pairs of the MINA-Brazil birth cohort study. Mothers were interviewed soon after delivery at baseline and by telephone at 30–45 days postpartum (n = 962, 63.2% of those eligible). Kaplan-Meier survival analysis and accelerated failure-time (AFT) models were used to estimate the probability of EBF and the factors associated with EBF duration in the first month. At 30 days of age, 36.7% of the studied population (95% confidence interval [CI] 33.6–39.8) were exclusively breastfed, with a median duration of 16 days. Considering all eligible children for follow-up, the probability of EBF in the first month was 43.7% (95% CI 40.4–46.8), and the median duration was 30 days. The duration of EBF (time-ratio, TR) was 28% longer among multiparous mothers (TR 1.28; 95% CI 1.11–1.48). The use of a pacifier and the occurrence of wheezing were associated with a reduced EBF duration by 33% (TR 0.67; 95% CI 0.58–0.77) and 19% (TR 0.80; 95% CI 0.70–0.93), respectively. These results highlight that EBF among children in the Brazilian Amazon is considerably below international recommendations, and indicate the immediate need to plan and implement actions to promote and support breastfeeding early in life. [ABSTRACT FROM AUTHOR]

Background Three main explanations of the relationship between income and population health have been identified: the absolute, the contextual and the relative income hypotheses. The evidence about their relevance particularly in egalitarian societies is, however, inconsistent. This study aimed to test the three hypotheses in relation to psychological distress in northern Sweden. Methods Data come from the 2014 cross-sectional survey from the four northern-most counties in Sweden, and included people aged 25–84 years (n = 21 004). Psychological distress was measured by the General Health Questionnaire-12 and income information came from population registers. Absolute income was operationalized by individual disposable income, contextual income as the municipal-level Gini coefficient and relative income by the Yitzhaki index. Prevalence ratios (PR) were calculated from log-binomial regression analyses. Results A gradient in poor mental health was observed across quintiles of individual income, with the poorest substantially more likely to report poor health compared with the highest quintile (PR = 1.56; 95% CI = 1.19, 2.04). Second, municipalities in the quintiles 2–3 of the Gini coefficient had a better mental health compared with those in the most equal municipalities. Third, a gradient in poor mental health across quintiles of relative deprivation was also found, with the most deprived quintile the most likely to report poor health (PR = 1.37; 95% CI = 1.06, 1.76). Conclusion This study suggests a strong, moderate and lack of support for the absolute, relative and contextual income effect hypotheses, respectively. Interventions targeting a reduction in the individual income gap may be necessary in order to reduce psychosocial distress differences in northern Sweden. [ABSTRACT FROM AUTHOR]

Background: The Swedish health care system has successively moved toward increased market-orientation, which has raised concerns as to whether Sweden still offers health on equal terms. To explore this issue, this study aimed (i) to assess if the principles of horizontal equity (equal access for equal need regardless of socio-economic factors) are met in Northern Sweden 2006-14; and (ii) to explore the contribution of different factors to the inequalities in access along the same period. Methods: Data came from cross sectional surveys known in 2006, 2010 and 2014 targeting 16-84-year-old residents in the four northern-most counties in Sweden. The horizontal inequity index was calculated based on variables representing (i) the individual socioeconomic status, (ii) the health care needs, (iii) non-need factors as well as (iv) health care utilization: general practitioner (GP), specialist doctors, hospitalization. Decomposition analysis of the concentration index for need-standardized health care utilization was applied. Results: Adjusting for needs, there was a higher use of GP services by rich people during the two last surveys, a roughly equal use of specialists, and hospitalization concentrated among the poor but with a clear time trend toward equality. The pro-rich inequalities in GP use were to a large part explained by the income gap. Conclusion: While health care utilization can be considered equitable regarding specialist and hospital use, the increasing pro-rich trend in the use of GP is a concern. Further studies are required to investigate the reasons and a constant monitoring of socioeconomic differences in health care access is recommended. [ABSTRACT FROM AUTHOR]

Background: Early life is thought of as a foundation for health inequalities in adulthood. However, research directly examining the contribution of childhood circumstances to the integrated phenomenon of adult social inequalities in health is absent. The present study aimed to examine whether, and to what degree, social conditions during childhood explain income inequalities in metabolic syndrome in mid-adulthood. Methods: The sample (N =12 481) comprised all 40- and 50-year-old participants in the Vasterbotten Intervention Program in Northern Sweden 2008, 2009 and 2010. Measures from health examinations were used to operationalize metabolic syndrome, which was linked to register data including socioeconomic conditions at age 40-50 years, as well as childhood conditions at participant age 10-12 years. Income inequality in metabolic syndrome in middle age was estimated by the concentration index and decomposed by childhood and current socioeconomic conditions using decomposition analysis. Results: Childhood conditions jointed explained 7% (men) to 10% (women) of health inequalities in middle age. Adding mid-adulthood sociodemographic factors showed a dominant contribution of chiefly current income and educational level in both gender. In women, the addition of current factors slightly attenuated the contribution of childhood conditions, but with paternal income and education still contributing. In contrast, the corresponding addition in men removed all explanation attributable to childhood conditions. Conclusions: Despite that the influence of early life conditions to adult health inequalities was considerably smaller than that of concurrent conditions, the study suggests that early interventions against social inequalities potentially could reduce health inequalities in the adult population for decades to come. [ABSTRACT FROM AUTHOR]

Background: Despite the goal of the Swedish health system to offer health care according to the principle of horizontal equity, little is known about the equality in access to health care use among young people. To explore this issue, the present study aimed i) to assess horizontal inequity in health care utilization among young people in Northern Sweden; and ii) to explore the contribution of different factors to explain the observed inequalities. Methods: Participants (N = 3016 youths aged 16-25 years) came from the "Health on Equal terms" survey conducted in 2014 in the four northernmost counties in Sweden. Concentration indices (C) and horizontal inequity indices (HI) were calculated to measure inequalities in the utilization of two health care services (general practitioners (GP) and youth clinics). The HI was calculated based on health care utilization and variables representing socioeconomic status (household income), health care needs factors and non-need factors affecting health care use. A decomposition analysis was carried out to explain the income-related inequalities. Results: Results showed a significant positive income-related inequality for youth clinic utilization in women (C = 0.166) and total sample (C = 0.097), indicating that services were concentrated among the better-off. In contrast, general practitioner visits showed inequality pointing toward a higher utilization among less affluent individuals; significant in women (C = -0.079), men (C = -0.101) and pooled sample (C = -0.097). After taking health care needs into consideration, the utilization of youth clinics remained significantly pro-rich in women (HI = 0.121) and total sample (HI = 0.099); and consistently pro-poor for the GP visits in the pooled sample (HI = -0.058). The decomposition analyses suggest that socioeconomic inequalities explain a considerable portion of the pro-rich utilization of youth clinics services among young women. The corresponding analyses for GP visits showed that need factors and socioeconomic conditions accounted for the pro-poor concentration of GP visits. Conclusion: The distribution of GP visits among young people in Northern Sweden slightly favored the low-income group, and thus seems to meet the premises of horizontal equity. In contrast, the findings suggest substantial pro-rich horizontal inequity in the utilization of youth clinics among young women, which are largely rooted in socioeconomic inequalities. [ABSTRACT FROM AUTHOR]

Background: Studies from Sweden and abroad have established health inequalities between heterosexual and non-heterosexual people. Few studies have examined the underpinnings of such sexual orientation inequalities in health. To expand this literature, the present study aimed to employ decomposition analysis to explain health inequalities between people with heterosexual and non-heterosexual orientation in Sweden, a country with an international reputation for heeding the human rights of non-heterosexual people. Methods: Participants (N = 23,446) came from a population-based cross-sectional survey in the four northernmost counties in Sweden in 2014. Participants completed self-administered questionnaires, covering sexual orientation, mental and general physical health, social conditions and unmet health care needs, and sociodemographic data was retrieved from total population registers. Sexual orientation inequalities in health were decomposed by Blinder-Oaxaca decomposition analysis. Results: Results showed noticeable mental and general health inequalities between heterosexual and non-heterosexual orientation groups. Health inequalities were partly explained (total explained fraction 64-74%) by inequalities in degrading treatment (24-26% of the explained fraction), but to a considerable degree also by material conditions (38-45%) and unmet care needs (25-43%). Conclusions: Psychosocial experiences may be insufficient to explain and understand health inequalities by sexual orientation in a reputedly 'gay-friendly' setting. Less overt forms of structural discrimination may need to be considered to capture the pervasive material discrimination that seems to underpin the embodiment of sexual minority inequalities. This ought to be taken into consideration in research, policy-making and monitoring aiming to work towards equity in health across sexual orientations. [ABSTRACT FROM AUTHOR]

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Copyright of Revista da Associação Brasileira de Nutrição is the property of Associacao Brasileira de Nutricao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Salud Pública is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Intersectionality has received increased interest within population health research in recent years, as a concept and framework to understand entangled dimensions of health inequalities, such as gender and socioeconomic inequalities in health. However, little attention has been paid to the intersectional middle groups, referring to those occupying positions of mixed advantage and disadvantage. Objective: This article aimed to 1) examine mental health inequalities between intersectional groups reflecting structural positions of gender and economic affluence and 2) decompose any observed health inequalities, among middle groups, into contributions from experiences and conditions representing processes of privilege and oppression. Design: Participants (N = 25,585) came from the cross-sectional 'Health on Equal Terms' survey covering 16- to 84-year-olds in the four northernmost counties of Sweden. Six intersectional positions were constructed from gender (woman vs. men) and tertiles (low vs. medium vs. high) of disposable income. Mental health was measured through the General Health Questionnaire-12. Explanatory variables covered areas of material conditions, job relations, violence, domestic burden, and healthcare contacts. Analysis of variance (Aim 1) and Blinder-Oaxaca decomposition analysis (Aim 2) were used. Results: Significant mental health inequalities were found between dominant (high-income women and middle-income men) and subordinate (middle-income women and low-income men) middle groups. The health inequalities between adjacent middle groups were mostly explained by violence (mid-income women vs. men comparison); material conditions (mid- vs. low-income men comparison); and material needs, job relations, and unmet medical needs (high- vs. mid-income women comparison). Conclusions: The study suggests complex processes whereby dominant middle groups in the intersectional space of economic affluence and gender can leverage strategic resources to gain mental health advantage relative to subordinate middle groups. [ABSTRACT FROM AUTHOR]

Background: The high segmentation and fragmentation in the provision of services are some of the main problems of the Colombian health system. In 2004 the district government of Bogota decided to implement a Primary Health Care (PHC) strategy through the Home Health program. PHC was conceived as a model for transforming health care delivery within the network of the first-level public health care facilities. This study aims to evaluate the performance of the essential dimensions of the PHC strategy in six localities geographically distributed throughout Bogotá city. Methods: The rapid assessment tool to measure PHC performance, validated in Brazil, was applied. The perception of participants (users, professionals, health managers) in public health facilities where the Home Health program was implemented was compared with the perception of participants in private health facilities not implementing the program. A global performance index and specific indices for each primary care dimension were calculated. A multivariate logistic regression analysis was conducted to determine possible associations between the performance of the PHC dimensions and the self-perceived health status of users. Results: The global performance index was rated as good for all participants interviewed. In general, with the exception of professionals, the differences in most of the essential dimensions seemed to favor public health care facilities where the Home Health program was implemented. The weakest dimensions were the family focus and community orientation-rated as critical by users; the distribution of financial resources-rated as critical by health managers; and, accessibility-rated as intermediate by users. Conclusions: The overall findings suggest that the Home Health program could be improving the performance of the network of the first-level public health care facilities in some PHC essential dimensions, but significant efforts to achieve its objectives and raise its visibility in the community are required. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Salud Pública is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Salud Pública is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)