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Aim: Quantify disparities and identify correlates and predictors of 'wellness' supplement use among nurses during the first year of the pandemic. Design: Longitudinal secondary analysis of Nurses' Health Studies 2 and 3 and Growing Up Today Study data. Methods: Sample included 36,518 total participants, 12,044 of which were nurses, who completed surveys during the first year of the COVID‐19 pandemic (April 2020 to April 2021). Analyses were conducted in March 2023. Modified Poisson models were used to estimate disparities in 'wellness' supplement use between nurses and non‐healthcare workers and, among nurses only, to quantify associations with workplace‐related predictors (occupational discrimination, PPE access, workplace setting) and psychosocial predictors (depression/anxiety, county‐level COVID‐19 mortality). Models included race/ethnicity, gender identity, age and cohort as covariates. Results: Nurses were significantly more likely to use all types of supplements than non‐healthcare workers. Lacking personal protective equipment and experiencing occupational discrimination were significantly associated with new immune supplement use. Depression increased the risk of using weight loss, energy and immune supplements. Conclusion: Nurses' disproportionate use of 'wellness' supplements during the COVID‐19 pandemic may be related to workplace and psychosocial stressors. Given well‐documented risks of harm from the use of 'wellness' supplements, the use of these products by nurses is of concern. Impact: 'Wellness' supplements promoting weight loss, increased energy, boosted immunity and cleansing of organs are omnipresent in today's health‐focused culture, though their use has been associated with harm. This is of added concern among nurses given their risk of COVID‐19 infection at work. Our study highlighted the risk factors associated with use of these products (lacking PPE and experiencing occupational discrimination). Findings support prior research suggesting a need for greater public health policy and education around the use of 'wellness' supplements. Reporting Method: STROBE guidelines were followed throughout manuscript. Patient or Public Contribution: No patient or public contribution was involved. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Implications for the Profession and/or Patient Care Impact Reporting Method Public Contribution To examine community nurses' experiences of caring for people with dark skin tones at high risk of developing a pressure injury.Qualitative descriptive design.Focus groups and individual semi‐structured interviews were conducted among registered nurses working in the community between November 2023 and March 2024. Thematic analysis was used.The findings reveal the lack of nurse education on diverse skin tones, how community nurses gain knowledge on skin tone diversity in the context of pressure injuries and the topics community nurses believe are crucial to improve the management of pressure injuries in patients with dark skin tones.The study highlights the gap in nurse education regarding diverse skin tones, revealing how community nurses acquire knowledge related to pressure injuries in patients with dark skin tones.This research could inform the development of targeted educational programmes and training initiatives, ultimately preventing patient harm and enhancing the quality of care and health outcomes for patients with dark skin tones.It provides valuable insights into key topics that community nurses consider essential for improving the early recognition and management of pressure injuries in people with darker skin tones.The research adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.A project steering group contributed to the concept of the study and checked the interview questions were relevant and suitable. [ABSTRACT FROM AUTHOR]

Background: The health state of a population can be measured in different ways. Common measures are life expectancy at birth or quality-adjusted life expectancy. However, the distribution of health may also be of interest to inform priority setting in health. Whereas there is a growing literature on the social distribution of health, knowledge of pure health inequalities may be useful to inform fair and equitable priority setting in both specialist and municipal health services. Method: We aimed to investigate the distribution of life years and quality-adjusted life years in Norway using recent mortality tables and population norms for health-related quality of life at different ages. We propose and contrast two alternative methods for estimating what we term expected quality-adjusted lifespans – the amount of quality-adjusted life years an individual who dies at a certain age will have achieved through their life. The first method assumes a relationship between increasing chronological age and decreasing health-related quality of life, and the second assumes that decreasing health-related quality of life is correlated with shorter remaining lifespan (time-to-death). The first method is similar to established methods to estimate quality-adjusted life expectancy, whereas the second is a novel approach. We estimate average, expected quality-adjusted lifespans in quintiles across a cohort of newborns in Norway in 2022. We further provide quality-adjusted life expectancies by age and sex. Results: Our results show that the gap in unweighted lifespans between individuals in the highest and lowest quintile is more than 30 years, whereas the gap in expected quality-adjusted lifespans is between 25 and 27 quality-adjusted life years, depending on the method used. We find that the time-to-death model yields lower estimates of expected quality-adjusted lifespans in the lower end of the distribution and higher estimates in the higher end, and thus higher inequality, compared to the chronological age model. Conclusion: Our estimates show that the expected distribution of both unweighted and quality-adjusted lifespans in Norway is uneven. While our results may be of relevance across all levels of priority setting in health, we argue that our study may be of particular interest to policy makers who wish to take distributive effects of priority setting in the municipal health sector into account. We argue that priority setting in the municipal health services should give higher priority to individuals and groups who are at risk of falling into the lower end of the expected quality-adjusted lifespan distribution. Examples include addiction and mental illness, severe disability, and chronic illness with early onset. We invite future research on this topic.

Aim Design Methods Results Conclusions Impact Reporting Method Patient or Public Contribution Compare the use and trend of a telemedicine tool for clinical advice among nurses and other Cameroonian healthcare providers and explore its feasibility and accessibility.A comparative observational descriptive study.The sample includes all telemedicine users who request advice from volunteer medical specialists in Spain on clinical cases through the telemedicine tool “diagnosis assistance” (DA). It consisted of a total of 296 Cameroonian health professionals (59% women), of whom 77 were nurses. The variables in which the trend was explored (2013–2022) were DAs entered by nurses versus other healthcare professionals, compared by primary specialty, comments and documents attached. Feasibility and accessibility were explored through an anonymous survey.There were 2527 DAs between 2013 and 2022, of which nurses introduced 68%. There is an increasing trend in the nurse/other healthcare providers ratio, with significant differences in the chi‐square of the linear trend between 2015 and 2022 (χ2 = 395.05; df = 7; p < .001). The probability that a DA was requested by nurses (PR >1) was observed in all years except for 2014, 2018 and 2019. The most tele‐counselling requested by nurses was in the specialties of internal medicine, obstetrics and gynaecology, and dermatology. The exchange of comments and attachments was mainly conducted among nurses (74.9% and 50.4%, respectively). The users surveyed considered the tool valuable for diagnosis, applicable, with limitations due to cost, Internet quality or lack of time and effective at reducing hospital referrals.Telemedicine for clinical advice has been used mostly and with increasing tendency by nurses, mainly in internal medicine, gynaecology and dermatology, being a useful and feasible resource that can contribute to improving clinical decision‐making by African nurses.The study addressed the problem of the shortage of health professionals in Central Africa and the search for alternatives that facilitate decision‐making in this context. Tele‐counselling tools through digital platforms that put Spanish specialists in contact with health professionals in Central Africa are mostly used by nurses working in rural health centres with a growing trend in their use. The research allows us to determine that tele‐counselling tools constitute a well‐accepted resource, which has a positive impact in environments with a shortage of human health resources, favouring the safety of both the nursing professional, through support in decision‐making, and the populations to whom they provide care, who benefit from a multidisciplinary approach to their processes.The study has adhered to STROBE guidelines.No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

BACKGROUND: The homeless population are among the most vulnerable groups to experience suicide ideation and behavior. Several studies have shown that people who are homeless experience more significant suicidal ideation and behavior than the general population. However, there is limited information about what suicide interventions exist, to what extent they are grounded in robust research, and which intervention components effectively reduce suicidal ideation and behavior in the homeless community. This research aimed to characterise the current evidence base in the area of suicide prevention for homeless individuals. METHODS: A scoping review guided by Arksey and OMalleys five-stage framework was conducted and a narrative synthesis was performed. Pubmed, EMBASE, PsychInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Open Grey, and Bielefeld Academic Search Engine were searched up to 8 May 2020. RESULTS: A total of 3209 records were identified through database and grey literature searching. Three studies are included in this review. Key outcomes identify suicide intervention prevention programmes; similarities and differences across interventions, and examples of staff training. A quality review of the studies was completed. CONCLUSION: A stark gap in the evidence of suicide specific prevention interventions targeted at homeless populations.

IntroductionTo investigate the association between social deprivation and COVID-19 among hospitalized patients in an underprivileged department of the greater Paris area.MethodsIndividuals hospitalized for COVID-19 between March 1st and October 31, 2020, were included, matched on age and sex, and compared with patients hospitalized for any other reason with negative RT-PCR for SARS-CoV-2, through a case-control study. Clinical, socio-demographic characteristics, health literacy, and social deprivation, assessed by the EPICES score, were collected. Factors associated with COVID-19 in hospitalized patients were assessed using univariate and multivariate logistic regression models.Results69 cases and 180 controls were included. Participants were mostly men (N = 148: 59.4%) aged 65 or older (N = 109: 44.1%). Median EPICES score was 43.2 (IQR 29.4–62.9). EPICES score > 30.17 (precariousness threshold) was not significantly associated with COVID-19 in hospitalized patients (adjusted odds ratio (aOR) = 0.46; 95% Confidence Interval (CI) [0.21–1.01]). Advanced age, higher BMI, professional activity, home area of less than 25 m2 per person, and low health literacy, were significantly associated with COVID-19 in hospitalized patients.DiscussionThis study highlights probable risk factors for specific exposition in disadvantaged area: maintenance of professional activity, smaller home area, and low health literacy.

Aims: The aim of the study was to examine how female sex worker's motivations, desires, intentions and behaviours towards childbearing and childbearing avoidance inform their contraceptive decision‐making. We explored the influence of social determinants of health in the domains of social context (sexual partners and experiences of violence), healthcare access, economic instability on the contraceptive decision‐making process. Design: We conducted a qualitative descriptive study informed by Miller's Theory of Childbearing Motivations, Desires and Intentions through the lens of social determinants of health. Methods: Participants were recruited from a parent study, EMERALD, in July–September, 2020. Data were collected from 22 female sex workers ages 18–49 using semi‐structured 45 to 60‐min audio‐recorded interviews and transcribed verbatim. Theory guided the development of the study's interview guide and thematic analytic strategy. Results: Five themes emerged related to contraceptive decision‐making: Motivations (value of fatherhood), Desires (relationships with love), Intentions and Behaviours (drugs overpower everything, contraceptive strategies and having children means being a protector). Women's contraceptive decision‐making often included intentions to use contraception. However, social determinants such relationships with clients and intimate partners, interpersonal violence and challenges accessing traditional health care offering contraceptive services often interfered with these intentions and influenced contraceptive behaviours. Conclusion: Women's contraceptive decision‐making process included well‐informed desires related to childbearing and contraceptive use. However, social determinants across domains of health interfered with autonomous contraceptive decision‐making. More effort is needed to examine the influence of social determinants on the reproductive health of this population. Impact: Findings from this study build on existing research that examines social determinants impacting reproductive health among female sex workers. Existing theoretical frameworks may not fully capture the influence constrained reproductive autonomy has on contraceptive decision‐making. Future studies examining interpersonal and structural barriers to contraception are warranted. Patient or Public Contribution: The parent study, EMERALD, collaborated with community service providers in the study intervention. [ABSTRACT FROM AUTHOR]

Aim: To examine factors that influence intrapartum health outcomes among Black childbearing persons, including cisgender women, transmasculine and gender‐diverse birthing persons. Background: Black childbearing persons are three to four times (243%) more likely to die while giving birth than any other racial/ethnic group. Black birthing persons are not just dying from complications but also from inequitable care from healthcare providers compared to their white counterparts. Design: Discursive paper. Method: Searching national literature published between 2010 and 2021 in PubMed, CINAHL, Embase and SCOPUS, we explored factors associated with poor intrapartum health outcomes among Black childbearing persons. Discussion Several studies have ruled out social determinants of health as sufficient causative factors for poor intrapartum health outcomes among Black birthing persons. Recent research has shown that discrimination by race heavily influences whether a birthing person dies while childbearing. Conclusions: There is a historical context for obstetric medicine that includes harmful stereotypes, implicit bias and racism, all having a negative impact on intrapartum health outcomes. The existing health disparity among this population is endemic and requires close attention. Impact on Nursing Practice: Nurses and other healthcare professionals must understand their role in establishing unbiased care that promotes respect for diversity, equity and inclusion. No Patient or Public Contribution: There was no patient or public involvement in the design or drafting of this discursive paper. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the use of Indigenous philosophies and ways of knowing as a means to critique, understand and improve the care of Indigenous infants and families in the neonatal intensive care unit (NICU). Background: The ability of health professionals to provide culturally safe and equitable care to Indigenous infants and their families can affect infant development and long‐term health outcomes. Research suggests that family involvement in care benefits both the infant and their family, but there is limited research that addresses the experience of Indigenous families in the NICU and advances understanding of how nurses involve Indigenous families in their infants' care. Design: A discursive, critical review will be presented to outline the assumptions of Indigenous philosophies and to explore how the consideration and implementation of Indigenous ways of knowing can improve the nursing care of Indigenous infants and their families in the NICU. Method: First, our subjective positioning as Indigenous nurses and as health researchers is described. Second, our understanding of Indigenous philosophical frameworks and how these approaches fit in the context of the philosophy of science is defined. Third, the key elements of an Indigenous philosophical paradigm are described. Fourth, an application of Indigenous paradigms to supporting the care of Indigenous infants and families in the NICU context is made. Conclusions: An Indigenous philosophical approach to nursing is ideal for understanding and improving the experiences of Indigenous infants and families in the NICU. This approach allows nurses to critically analyse the history and legacy of colonialism and its impact on the health and wellbeing of Indigenous peoples. By prioritising the voices and concerns of Indigenous families in the clinical setting and in nursing research, nurses can better understand the experiences of these families in the NICU and use strengths‐based approaches to facilitate family involvement in care. Relevance to clinical practice: The application of Indigenous philosophies in the nursing context can be used to inform the care of Indigenous infants and families in the NICU. Potential benefits include improved therapeutic relationships between nurses and Indigenous families, and increased uptake of parent‐led interventions in nursing practice, which may lead to improved health outcomes for Indigenous infants in the NICU and throughout their subsequent development. [ABSTRACT FROM AUTHOR]

Abstract Background The positive effects of cardiac rehabilitation are well established. However, it has an inherent challenge, namely the low attendance rate among older vulnerable patients, which illustrates the need for effective interventions. Peer mentoring is a low-cost intervention that has the potential to improve cardiac rehabilitation attendance and improve physical and psychological outcomes among older patients. The aim of this study was to test the feasibility and acceptability of a peer-mentor intervention among older vulnerable myocardial infarction patients referred to cardiac rehabilitation. Methods The study was conducted as a single-arm feasibility study and designed as a mixed methods intervention study. Patients admitted to a university hospital in Denmark between September 2020 and December 2020 received a 24-week peer-mentor intervention. The feasibility of the intervention was evaluated based on five criteria by Orsmond and Cohn: (a) recruitment capability, (b) data-collection procedures, (c) intervention acceptability, (d) available resources, and (e) participant responses to the intervention. Data were collected through self-administrated questionnaires, closed-ended telephone interviews, semi-structured interviews, and document sheets. Results Twenty patients were offered the peer-mentor intervention. The intervention proved feasible, with a low dropout rate and high acceptability. However, the original inclusion criteria only involved vulnerable women, and this proved not to be feasible, and were therefore revised to also include vulnerable male patients. Peer mentors (n = 17) were monitored during the intervention period, and the findings indicate that their mentoring role did not cause any harm. The peer-mentor intervention showed signs of effectiveness, as a high rate of cardiac rehabilitation attendance was achieved among patients. Quality of life also increased among patients. This was the case for emotional, physical, and global quality of life measures at 24-week follow-up. Conclusion The peer-mentor intervention is a feasible and acceptable intervention that holds the potential to increase both cardiac rehabilitation attendance and quality of life in older vulnerable patients. This finding paves the way for peer-mentor interventions to be tested in randomized controlled trials, with a view toward reducing inequality in cardiac rehabilitation attendance. However, some of the original study procedures were not feasible, and as such was revised. Trial registration The feasibility study was registered at ClinicalTrials.gov ( ClinicalTrials.gov identification number: NCT04507529 ), August 11, 2020.

While race and ethnicity have been acknowledged as determinants of health, there remain gaps regarding their effects on experiences of paediatric care. This scoping review examines empirical literature regarding the state and experience of paediatric care provided to racially and ethnically diverse families in North America. We seek to clarify the needs of care administrators and recipients, as well as to conceptualize what paediatric care must look like to enable equitable practices and optimal health outcomes. Utilizing Arksey and O'Malley's framework, we reviewed literature published between 2005 and 2020, most of which was written within an American context. The literature reviewed featured quantitative, qualitative and mixed methods studies. Paediatric care administrators and recipients collectively identified the following as domains requiring an increased focus: (1) knowledge (awareness or training), (2) alignment of views and values, (3) resources and (4) communication. Findings suggest overall that despite there being merit in the cultural competency efforts underway, more patient-centric approaches are vital. This review concludes by encouraging the sustained development of cultural safety initiatives in paediatric care to ultimately promote patient comfort and provider-patient collaboration. [ABSTRACT FROM AUTHOR]

Background and purpose: There are regional disparities in access to stroke units in France. Several studies have shown that living in disadvantaged areas is associated with a higher frequency of stroke, worse severity at presentation, increased level of dependency and higher mortality rates. However, few studies have explored the association between an individual's socioeconomic characteristics and stroke care. Our study aimed to determine if living standards are associated with stroke unit access for patients admitted to hospital for acute ischaemic stroke. Methods: Using the EDP‐Santé French administrative database, all patients admitted to hospital for acute ischaemic stroke between 2014 and 2017 were selected. Acute ischaemic stroke corresponded to hospital stay with International Classification of Diseases 10th Revision codes I63 or I64 as the main diagnosis. Multivariate logistic regression was used to identify if standard of living was associated with likelihood of admission to a stroke unit. Results: In all, 14,123 acute care episodes were identified, corresponding to 335,273 episodes in the general population when appropriately weighted. Of these, 52.9% were admitted to a stroke unit. Being in the first (i.e., poorest) living standard quartile was associated with lower likelihood of admission to a stroke unit compared with the fourth (i.e., wealthiest) quartile, and was associated with a higher likelihood of paralysis and language disorder, and death at 1 year. Conclusion: A low living standard was associated with lower likelihood of admission to a stroke unit as well as a greater chance of paralysis and aphasia at the end of hospitalization and a higher possibility of death at 1 year after stroke. Greater access to stroke units for disadvantaged people should be promoted. [ABSTRACT FROM AUTHOR]

This commentary refers to the article by Fisher et al on lessons from Australian primary healthcare (PHC), which highlights the role of PHC to reduce non-communicable diseases (NCDs) and promote health equity. This commentary discusses important elements and features when aiming for health equity, including going beyond the healthcare system and focusing on the social determinants of health in public health policies, in PHC and in the healthcare system as a whole, to reduce NCDs. A wider biopsychosocial view on health is needed, recognizing the importance of social determinants of health, and inequalities in health. Public funding and universal access to care are important prerequisites, but regulation is needed to ensure equitable access in practice. An example of a PHC reform in Sweden indicates that introducing market solutions in a publicly funded PHC system may not benefit those with greater needs and may reduce the impact of PHC on population health.

Background: The positive effects of cardiac rehabilitation are well established. However, it has an inherent challenge, namely the low attendance rate among older vulnerable patients, which illustrates the need for effective interventions. Peer mentoring is a low-cost intervention that has the potential to improve cardiac rehabilitation attendance and improve physical and psychological outcomes among older patients. The aim of this study was to test the feasibility and acceptability of a peer-mentor intervention among older vulnerable myocardial infarction patients referred to cardiac rehabilitation. Methods: The study was conducted as a single-arm feasibility study and designed as a mixed methods intervention study. Patients admitted to a university hospital in Denmark between September 2020 and December 2020 received a 24-week peer-mentor intervention. The feasibility of the intervention was evaluated based on five criteria by Orsmond and Cohn: (a) recruitment capability, (b) data-collection procedures, (c) intervention acceptability, (d) available resources, and (e) participant responses to the intervention. Data were collected through self-administrated questionnaires, closed-ended telephone interviews, semi-structured interviews, and document sheets. Results: Twenty patients were offered the peer-mentor intervention. The intervention proved feasible, with a low dropout rate and high acceptability. However, the original inclusion criteria only involved vulnerable women, and this proved not to be feasible, and were therefore revised to also include vulnerable male patients. Peer mentors (n = 17) were monitored during the intervention period, and the findings indicate that their mentoring role did not cause any harm. The peer-mentor intervention showed signs of effectiveness, as a high rate of cardiac rehabilitation attendance was achieved among patients. Quality of life also increased among patients. This was the case for emotional, physical, and global quality of life measures at 24-week follow-up. Conclusion: The peer-mentor intervention is a feasible and acceptable intervention that holds the potential to increase both cardiac rehabilitation attendance and quality of life in older vulnerable patients. This finding paves the way for peer-mentor interventions to be tested in randomized controlled trials, with a view toward reducing inequality in cardiac rehabilitation attendance. However, some of the original study procedures were not feasible, and as such was revised. Trial registration: The feasibility study was registered at ClinicalTrials.gov (ClinicalTrials.gov identification number: NCT04507529), August 11, 2020. [ABSTRACT FROM AUTHOR]

The paper dwells on the results obtained via examining dependence between HIV-infection spread and factors related to social environmental and social structure of population in RF regions. These factors are considered to be potential health risk ones. The authors tested a hypothesis about influence exerted by demographic, economic, cultural and behavioral determinants and public healthcare availability on differences in territorial spread of the disease within social-epidemiologic approach. To solve the set task, data that characterized 85 RF regions were taken from official statistical reports. Descriptive statistic analysis was performed and regression models were built up; it allowed testing whether the analyzed factors had their influence in RF regions and selecting the most significant ones to be included into the overall regression model. The research revealed significant contextual differences in HIV-infection spread. Regression analysis showed that 22.0 % differences in a number of HIV-infected people detected in RF regions occurred due to differences in urban population numbers, provision with ambulatories and polyclinics, and unemployment rate. Moreover, a number of registered crimes committed by minors determined 32.5 % difference in a number of patients with the first diagnosed HIV-infection between the examined regions. These results allow assuming that the greatest influence on spread of the disease in RF regions is exerted by consequences of urbanization; this process is usually accompanied with a growth in a share of urban population in a given region, instability on the labor market there as well as related migration processes within the country and wider opportunities to pursue individual behavioral strategies including those that involve law violations and/or are destructive for people’s health

Background: The medicines are the most used and most effective therapeutic intervention for the treatment of various pathologies. The lack of access to medicines among groups with lower socioeconomic conditions represents an inequity in health care. In this sense, the public supply of medicines is free of charge by the public sector to promote equity. Objective: To evaluate the change, in time and prevalence of free access, by the Brazilian adult population, to medicines prescribed in the Unified Health System (SUS) over 10 years. Method: Data came from the National Household Sample Surveys (PNAD) conducted in Brazil in 1998, 2003 and 2008. The dependent variable was free access to prescribed medicines. Results: Free access to medicines in the SUS increased over time. Individuals with lower socioeconomic income had higher chance to access the medicines and this scenario remained constant over the years evaluated. Conclusion: The findings reveal the importance of SUS as an effective tool for promoting access to medicines, especially for the poorest individuals. However, reducing inequality in access to medicines remains a challenge. [ABSTRACT FROM AUTHOR]

Abstract Background Increasing mortality among men from drugs, alcohol and suicides is a growing public health concern in many countries. Collectively known as “deaths of despair”, they are seen to stem from unprecedented economic pressures and a breakdown in social support structures. Methods We use high-quality population wide Scottish data to calculate directly age-standardized mortality rates for men aged 15–44 between 1980 and 2018 for 15 leading causes of mortality. Absolute and relative inequalities in mortality by cause are calculated using small-area deprivation and the slope and relative indices of inequality (SII and RIIL) for the years 2001–2018. Results Since 1980 there have been only small reductions in mortality among men aged 15–44 in Scotland. In that period drug-related deaths have increased from 1.2 (95% CI 0.7–1.4) to 44.9 (95% CI 42.5–47.4) deaths per 100,000 and are now the leading cause of mortality. Between 2001 and 2018 there have been small reductions in absolute but not in relative inequalities in all-cause mortality. However, absolute inequalities in mortality from drugs have doubled from SII = 66.6 (95% CI 61.5–70.9) in 2001–2003 to SII = 120.0 (95% CI 113.3–126.8) in 2016–2018. Drugs are the main contributor to inequalities in mortality, and together with alcohol harm and suicides make up 65% of absolute inequalities in mortality. Conclusions Contrary to the substantial reductions in mortality across all ages in the past decades, deaths among young men are increasing from preventable causes. Attempts to reduce external causes of mortality have focused on a single cause of death and not been effective in reducing mortality or inequalities in mortality from external causes in the long-run. To reduce deaths of despair, action should be taken to address social determinants of health and reduce socioeconomic inequalities.

Abstract Aims To explore how maternal and child health nurses (MCHNs) working in a specific regionally located service perceive and experience delivering health care to a diverse population. Design Qualitative exploratory study. Methods Qualitative interviews were conducted with MCHNs (N = 6) working in a particular regionally located service. Data were selectively coded, categorized and interpreted through a process of argument writing influenced by poststructuralist thought and Foucauldian conceptualizations of power. Results The data analysed were interpreted into the following categories: (a) system‐level expectations of the maternal and child health role; (b) what these system‐level expectations mean for the role and practice of MCHNs; and (c) what MCHNs themselves report prioritizing in their work. The analysis suggests that a substantial hindrance to the development and support of culturally safe, inclusive and quality maternal and child health care lies in the very ways contemporary health institutions seek to discipline the routine practices of MCHNs.

The relationship between inequalities and health has been widely studied. Several theories have been proposed to define the role of the factors that act on the health levels, their strength and the determination profile. This review recalls the main theories and interpretation proposed by different fields of knowledge and highlights that there is not a single way to generate inequalities in health. Deprivation, disadvantage drift, empowerment, structure and social capital, status syndrome, and embodiment are some of the concepts recalled and explored. Some theories consolidate each other, and some remain more isolated. To increase the knowledge on the mechanisms to define the disease distributions among individuals in the population can help to define new and greater equity intervention policies.

Communication campaigns can contribute to promoting physical activity (PA) among children. However, health inequalities can ensue from this type of public health intervention. Using a pre-test posttest design, we examined the effects of social disadvantage on the large-scale WIXX communication campaign and whether or not social disadvantage moderated WIXX’s impact on PA. Parents of youths were identified using random digit dialing procedures and asked permission for their child to participate in a telephone survey. Surveys were conducted each year between 2012 and 2016. Moderating effects of individual-level and area-based indicators of social disadvantage on campaign effectiveness were examined. Self-reported levels of PA and trying new PAs were the outcomes. Exposure was defined as a function of ads recall and brand awareness. Logistic regression analyses controlling for survey periods, screen time, language, school grade, and attitudes toward PA were performed in 2020. Among girls, no significant interaction effects were observed for household income, parental education, and material deprivation. A significant interaction effect was observed for minority group status on PA (OR = 2.4; 95%CIs: 1.2, 4.9) and trying of new activities (OR = 2.5; 95%CIs: 1.2, 5.1). A significant interaction effect between social deprivation and exposure was observed for trying new activities among girls (OR = 1.8; 95%CIs: 1.0, 3.2). Among boys, no significant interaction effects were observed for any indicators. Results suggest no clear evidence of communication inequalities as a result of the WIXX campaign but reveal positive impacts of the campaign among more socially disadvantaged girls.

Background: Homeless people are a socially excluded group whose health reflects exposures to intersecting social determinants of health. The aim of this study was to describe and compare the demographic composition, certain social determinants of health, and self-reported health among homeless people in Stockholm, Sweden, in 2006 and 2018.Methods: Analysis of data from face-to-face interviews with homeless people in Stockholm 2006 (n = 155) and 2018 (n = 148), based on a public health survey questionnaire adapted to the group, including the EQ-5D-3L instrument. The chi-squared test was employed to test for statistical significance between groups and the independent t-test for comparison of mean scores and values. Ordinary Least Squares (OLS) regression, with Robust Standard Errors (RSE) was performed on merged 2006 and 2018 data with mean observed EQ VAS score as outcome variable.Results: In 2018 more homeless people originated from countries outside Europe, had temporary social assistance than long-term social insurance, compared to in 2006. In 2018 more respondents reported lack of social support, exposure to violence, and refrained from seeking health care because of economic reasons. Daily smoking, binge drinking, and use of narcotic drugs was lower 2018 than 2006. In 2018 a higher proportion reported problems in the EQ-5D-3L dimensions, the mean TTO index value and the VAS index value was significantly lower than in 2006. In the regression analysis of merged data there was no significant difference between the years.Conclusions: Homeless people are an extremely disadvantaged group, have high rates of illness and disease and report poor health in all EQ-5D-3L dimensions. The EQ VAS score among the homeless people in 2018 is comparable to the score among persons aged 95–104 years in the general Swedish population 2017. The EQ-5D-3L instrument was easily administered to this group, its use allows comparison with larger population groups. Efforts are needed regarding housing, but also intensified collaboration by public authorities with responsibilities for homeless people's health and social welfare. Further studies should evaluate the impact of such efforts by health and social care services on the health and well-being of homeless people.

Part-time work is a common work arrangement in the United States that can be precarious, insecure, and lacking opportunities for advancement. In turn, part-time work, especially involuntary part-time work, tends to be associated with worse health outcomes. Although prior research documents heterogeneity in the health consequences of precarious work across countries, we do not know whether state-level institutional contexts shape the association between part-time work and self-rated health in the United States. Using data from the Current Population Survey (2009–2019; n = 813,077), the present study examined whether linkages between part-time work and self-rated health are moderated by state-level social policies and contexts. At the population level, we document differences in the prevalence of fair/poor health among part-time workers across states. For instance, 21% of involuntary part-time workers reported fair/poor health in West Virginia compared to 7% of involuntary part-time workers in Massachusetts. Findings also provide evidence that voluntary (β =.51) and involuntary (β=.57) part-time work is associated with greater odds of fair/poor health among individuals. Moreover, the association between voluntary part-time work and self-rated health is weaker for individuals living in states with higher amounts for maximum unemployment insurance, higher minimum wage, and lower income inequality. State-level policies did not moderate the association between involuntary part-time work and health. The present study points to the need to mitigate the health consequences of part-time work with social policies that enhance the health of workers.

Medical interventions that increase life expectancy of patients result in additional consumption of non‐medical goods and services in 'added life years'. This paper focuses on the distributional consequences across socio‐economic groups of including these costs in cost effectiveness analysis. In that context, it also highlights the role of remaining quality of life and household economies of scale. Data from a Dutch household spending survey was used to estimate non‐medical consumption and household size by age and educational attainment. Estimates of non‐medical consumption and household size were combined with life tables to estimate what the impact of including non‐medical survivor costs would be on the incremental cost effectiveness ratio (ICER) of preventing a death at a certain age. Results show that including non‐medical survivor costs increases estimated ICERs most strongly when interventions are targeted at the higher educated. Adjusting for household size (lower educated people less often live additional life years in multi‐person households) and quality of life (lower educated people on average spend added life years in poorer health) mitigates this difference. Ignoring costs of non‐medical consumption in economic evaluations implicitly favors interventions targeted at the higher educated and thus potentially amplifies socio‐economic inequalities in health. [ABSTRACT FROM AUTHOR]

Child- and family-centered care (CFCC) is being increasingly adopted internationally as a fundamental philosophical approach to the design, delivery, and evaluation of children's services in diverse primary and acute health care contexts. CFCC has yet to be explored in the context of families and children whose health and health care is likely to be compromised by multifaceted social and structural factors, including racialization, material deprivation, and historically entrenched power imbalances. To date, an equity orientation for CFCC has not been examined or developed. This is a critical area of inquiry, given the increasing evidence that children in families who face such inequities have poor health outcomes. This article examines dominant discourses on CFCC in the context of families and children who are at greater risk of health inequities in wealthy countries, drawing on Canada as a useful example. It outlines an evidence-based approach to equity-oriented care that the authors contend has the potential to orient CFCC toward equity and provide greater clarity in the conceptualization, implementation, measurement, and evaluation of CFCC in ways that can benefit all families and children including those who have typically been excluded from research. [ABSTRACT FROM AUTHOR]

Abstract Background Sweden has a long tradition of nationwide registers enabling population-based research of high quality and validity. We aimed to describe the content and validity of reported number of remaining and intact teeth in the Swedish Dental Health Register and report some descriptive data on dental health care utilization. Methods The Swedish Dental Health Register was initiated in July 1st 2008 and contains individual data on dental health care to the whole adult population of Sweden. The dental care given freely to children and young adults is not included. Descriptive data on remaining, intact teeth and dental health care utilization is presented by proportion of the population stratified by sex and age. We conducted a validation study, by manual review of randomly sampled 1500 dental health visits records, to assess reported number of teeth to the register with what was actually recorded in the dental health care record (gold standard), analyzed by positive predictive value (PPV) and Bland-Altman plots. Results Of the Swedish adult population 2014, 2.6 million (69%) men and 2.9 million (76%) women had at least one visit to a dentist during a two-year period 2013 to 2014. More than half of the population up to age 64 have all remaining teeth (28 teeth or more). Of the 1500 requested dental records 1131 (75%) were received. The positive predictive value for patients reported to the register as having at least 1 tooth up to 31 intact teeth was 91.5% (95% confidence interval 89.0–93.5, 567 manually reviewed to be correct out of 620 reported). Conclusions For patients coded as having less than 32 intact teeth but not being edentulous the reported number of remaining and intact teeth is to a very high degree correct. However, the correctness for those coded as edentulous or having 32 remaining intact teeth is low and varies substantially by age.

Introduction and objective One of the main factors determining the burden of breast cancer is the effectiveness of measures taken to combat this cancer including urban-rural differences. The aim of the study was to analyse the differences in breast cancer incidence and disease stage distribution among urban and rural women in the Świętokrzyskie Province as a part of a strategy for breast cancer control. Material and methods The study of disease stage distribution included 483 female residents of Świętokrzyskie Province who were diagnosed in 2013 with invasive breast cancer, and reported to Świętokrzyskie Office for Cancer Registration. Urban-rural differences in breast cancer incidence in 2002–2013 were presented using Range Ratio (RR). Changes in incidence trends in urban and rural areas were analysed using joinpoint models. Annual Percentage Change (APC) of the rates was calculated for each time trend. Results Breast cancer incidence rate in the urban female population was higher than in rural women with RR, amounting to 1.43. However, the analysis of trends showed that the pace and direction of change were developing negatively among inhabitants of rural areas. In 2002–2013, in rural women, the age-standardized rate (ASR) values increased by 2.8% per year (p

ABSTRACT Objective Understanding the individual and collective behavior of individuals about their oral health conditions is important to prevent and control of dental caries. This study aimed to seek evidence of the relationship between social capital and caries experience. Methods Using a systematic review with meta-analysis, we searched articles in PubMed, ISI Web of Knowledge, LILACS, IBECS, BBO, SCIELO, The Cochrane Library and MEDLINE databases. Studies with humans, of all ages and languages, published until July 2019, which related social capital to the caries experience, were included in this review. Results We identified 1163 articles evaluated considering inclusion and exclusion criteria, leaving 5 articles selected to compose the study sample, and only 3 included in the meta-analysis. In the final analysis p value was significant (p

This commentary refers to the article by Fisher et al on lessons from Australian primary healthcare (PHC), which highlights the role of PHC to reduce non-communicable diseases (NCDs) and promote health equity. This commentary discusses important elements and features when aiming for health equity, including going beyond the healthcare system and focusing on the social determinants of health in public health policies, in PHC and in the healthcare system as a whole, to reduce NCDs. A wider biopsychosocial view on health is needed, recognizing the importance of social determinants of health, and inequalities in health. Public funding and universal access to care are important prerequisites, but regulation is needed to ensure equitable access in practice. An example of a PHC reform in Sweden indicates that introducing market solutions in a publicly funded PHC system may not benefit those with greater needs and may reduce the impact of PHC on population health. [ABSTRACT FROM AUTHOR]

Copyright of RGO: Revista Gaúcha de Odontologia is the property of RGO: Revista Gaucha de Odontologia 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.)

Abstract The objective of this study is to assess the importance of municipal expenses executed with own-source revenues for the maintenance of the territorial inequalities between resources allocated by Brazilian municipalities in the health sector, in spite of the redistributive effects attributed to the vertical transfers of the Brazilian National Health System. The formation of municipal own-source revenues is strongly impacted by regional economic inequalities, corresponding to almost 60% of the resources allocated by municipalities to health in recent years. Based on the Tree Edge Removal method, the total expenditures and those executed with own-source revenues by the municipalities were spatially distributed, thereby enabling identification of clusters from 2005 to 2015 in both cases. Central and dispersion measures were calculated for the two types of expenditure in this interval for the clusters. In the end, we found municipal expenditures with own-source revenues show levels of inequality which are significantly higher than those of the total municipal health expenditure, and even more significant is that these inequalities increase in time with higher intensity in the case of the former. Since municipalities are the main implementers of public health policy, results suggest higher levels of territorial equity will necessarily require adjustments in fiscal federalism in this sector.

Background: To evaluate the changes of mortality among children aged 1–14 yr due to road traffic injury and related demographic and economic factors in an ecological study undertaken in 33 European countries. Methods: Information about mortality due to road traffic injury among children aged 1–14 yr in European countries was obtained from the WHO database. Changes in the mortality for the years 2000–2009 were estimated as linear regression. These deaths were correlated with demographic and economic factors. Results: The greatest burden of child mortality due to road traffic accidents was observed in Baltic States, three times lower mortality levels than that in Northern States. Between 2000 and 2009, there was a significant reduction (P

Background: Increasing mortality among men from drugs, alcohol and suicides is a growing public health concern in many countries. Collectively known as "deaths of despair", they are seen to stem from unprecedented economic pressures and a breakdown in social support structures. Methods: We use high-quality population wide Scottish data to calculate directly age-standardized mortality rates for men aged 15–44 between 1980 and 2018 for 15 leading causes of mortality. Absolute and relative inequalities in mortality by cause are calculated using small-area deprivation and the slope and relative indices of inequality (SII and RIIL) for the years 2001–2018. Results: Since 1980 there have been only small reductions in mortality among men aged 15–44 in Scotland. In that period drug-related deaths have increased from 1.2 (95% CI 0.7–1.4) to 44.9 (95% CI 42.5–47.4) deaths per 100,000 and are now the leading cause of mortality. Between 2001 and 2018 there have been small reductions in absolute but not in relative inequalities in all-cause mortality. However, absolute inequalities in mortality from drugs have doubled from SII = 66.6 (95% CI 61.5–70.9) in 2001–2003 to SII = 120.0 (95% CI 113.3–126.8) in 2016–2018. Drugs are the main contributor to inequalities in mortality, and together with alcohol harm and suicides make up 65% of absolute inequalities in mortality. Conclusions: Contrary to the substantial reductions in mortality across all ages in the past decades, deaths among young men are increasing from preventable causes. Attempts to reduce external causes of mortality have focused on a single cause of death and not been effective in reducing mortality or inequalities in mortality from external causes in the long-run. To reduce deaths of despair, action should be taken to address social determinants of health and reduce socioeconomic inequalities. [ABSTRACT FROM AUTHOR]

Copyright of Revista Daena: International Journal of Good Conscience is the property of Spenta University Mexico 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.)

Previous studies documented the health disparities in smoking among sexual minority populations, including men who have sex with men (MSM). However, smoking behaviors have never been examined among Malaysian MSM, a sexual minority group in a predominantly Muslim country. A total of 622 Malaysian MSM completed an anonymous online survey in 2017. Data on the demographics, smoking and substance use behaviors, psychosocial factors, and attitudes toward smoking cessation were collected and analyzed. The mean age was 28 years and 67% of participants were of Malay ethnicity. The prevalence of current smoking was 23% (n = 143), while former smokers were 9% (n = 59). Current smoking status was associated with HIV-positive status and risk behaviors, such as suicidality, alcohol use, and illicit drug use (P =.001). Almost two thirds of current smokers had attempted to quit in the past year. Hence, comprehensive smoking cessation interventions addressing the psychosocial needs of MSM should be prioritized. [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.)

The main purpose of our research was to examine the relationship among various indicators of educational habitus, subjective health and substance use and the moderating role of gender. The results indicated that 1) over one third of bivariate correlation coefficients between habitus and health outcome measures were statistically significant; 2) the most consistent correlate of subjective health was satisfaction with the Slovenian educational system, while school adjustment most consistently correlated with substance use; 3) when controlling for several socioeconomic and parenting confounders in multivariate analyses, only in two out of twelve examined cases did habitus predictors remain significant (only for substance use); 4) gender moderated the impact of two indicators of educational habitus on overall substance use, but not on overall subjective health. [ABSTRACT FROM AUTHOR]

Aim and objective: This paper reports on the proceedings of the second Australasian International Learning Collaborative conference and summit. Background: In December 2019, over a hundred people attended the second Australasian International Learning Collaborative Conference and Summit. This was the first to be held in Aotearoa New Zealand, the land where cultural safety was developed, its origins being in nursing education. Perhaps not surprisingly, culture, cultural safety and the context of care featured highly in the presentations and workshops. Design and methods: Discussion paper. Results: A key outcome of the conference proceedings and workshops was the call for nurses and the International Learning Collaborative to work in partnership with indigenous groups to iterate the importance of the Fundamentals of Care framework and evaluate the impact of that on health equity. Other essential messages were to value establishing relationships, to continue to talk about the fundamentals of care, to research and to own them. Nurses were reminded to use their humanity to create a climate and culture in which patients and staff feel valued, safe and trusted. Conclusions: Future iterations of the Fundamentals of Care framework must incorporate indigenous worldviews, which emphasise the importance of relationships, family and spirituality on wellbeing. Such additions will provide an opportunity for the International Learning Collaborative to optimally respond and direct nursing practice. Relevance to clinical practice: International Learning Collaborative members and conference attendees learned, listened and worked on meeting the challenges of consistently implementing and applying the fundamentals of care in practice and its importance to education, research and policy. The takeaway message is, when this does not happen, nurses must speak up. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to estimate indirect costs associated with losses in productivity due to sickness absence among registered workers in Poland. Material and Methods: Data on sick leave durations in 2013 was obtained from the Social Insurance Institution (SII) (Zakład Ubezpieczeń Społecznych – ZUS). Based on the number of assumptions, this data was used for calculating absence durations. The costs of lost productivity were estimated on the basis of the measure of gross value added. Results: Estimated losses in productivity due to absenteeism in 2013 together accounted for 4.33% of gross domestic product (GDP) (17.09 billion euro). In the female population, the total value of losses amounted to 9.66 billion euro, but excluding the costs of pregnancy, childbirth, and puerperium (2.96 billion euro), it was 6.7 billion euro. In the male population, the loss amounted to 7.43 billion euro. The highest overall costs of sickness absence based on age were found in the age group of 30–39 years (5.14 billion euro, including pregnancy, childbirth, and puerperium – 1.474 billion euro; respiratory diseases – 0.632 billion euro, injuries and poisonings – 0.62 billion euro). In the group of people aged > 40 years, the highest cost was generated by bone-muscular diseases (1.553 billion euro) and injuries and poisoning (1.251 billion euro). Higher losses in the productivity of women in addition to pregnancy, childbirth, and puerperium were due to mental and behavioral disorders (0.71 billion euro), diseases of the genitourinary system (0.38 billion euro), and neoplasms (0.35 billion euro). At the same time, in men, compared to women, we observed higher losses due to injuries and poisoning (1.65 billion euro), and diseases of musculoskeletal (1.26 billion euro), nervous (0.79 billion euro), circulatory (0.65 billion euro), and digestive (0.41 billion euro) systems. Conclusions: Improvement and further development of effective strategies for prevention of complications of pregnancy and chronic diseases in the workplace are necessary. Policies aimed at reduction of sickness absence could potentially increase prosperity and the socioeconomic situation in Poland. Int J Occup Med Environ Health 2017;30(6):917–932

Abstract Purpose To evaluate the coverage of the Papanicolaou test in Brazil and the associated factors. Methods Cross-sectional study based on data from the Brazilian Health Survey 2013 comprising the proportion of 25- to 64-year-old women who had undergone a Papanicolaou test within the previous 3 years, categorized by sociodemographic variables and access to healthcare services. Results The screening coverage in Brazil was of 79.4% (95% confidence interval [95%CI]: 78.4-80.3), showing significant differences between the different states of the country, with the highest rate in the state of Roraima (86.5; 95%CI: 83.5-89.4), and the lowestone in the state ofMaranhão (67.7; 95%CI: 61.3-74.0).Undergoing the test was significantlymore frequent amongmarriedwomen (83.6%; 95%CI: 82.4-84.8), those with higher educational levels (88.7%; 95%CI: 87.0-90.5), of white ethnicity (82.6%; 95%CI: 81.3-83.9) and who reside in urban areas (80.1%; 95%CI: 79.1-81.2). Those who had undergone the test more than three years prior to the survey and the ones who had never undergone it were associated with a lower level of education, being of black or brown ethnicity, single or divorced, and rural dwellers. Conclusions The coverage of cervical cancer screening in Brazil is below the recommended rate and presents regional and sociodemographic disparities.

Objective: To analyse trends in dental pain prevalence among Brazilian adolescent students over 6 years, focusing on inequalities by maternal education. Methods: Data from the National Adolescent School‐Based Health Survey (PeNSE) carried out in 2009 (n = 45 239), 2012 (n = 46 482) and 2015 (n = 35 592) were analysed, including ninth grade students from the 27 state capitals in Brazil who were of ages 11‐17 years or older. Variables analysed were dental pain within the last 6 months (yes/no) and the following sociodemographic factors: age, sex, race, type of school and maternal schooling (years of study: ≤8; 9‐11; ≥12). The prevalence of dental pain in the 3 years was compared using the Rao‐Scott test. Relative and absolute measures of socioeconomic (maternal education) inequalities in dental pain were applied using the slope index of inequality (SII) and the relative concentration index (RCI). Results: The prevalence of dental pain increased from 17.5% (95% CI = 16.9‐18.2) in 2009 to 20.4% (95% CI = 19.7‐21.1) in 2012, then to 21.8% (95% CI = 21.1‐22.5) in 2015. All sociodemographic factors investigated were associated with dental pain in all survey years. There was an increasing proportion of the outcome in all categories of maternal education over the years studied. Absolute (SII) and relative (RCI) inequalities regarding of maternal education were found; these indicate higher levels of dental pain in the lower socioeconomic group in each study year. However, no significant changes in inequalities were found from 2009 to 2015. Conclusions: The prevalence of dental pain increased in the 2009‐2012 and 2012‐2015 periods, and social inequalities were found. Higher levels of dental pain persisted in the lower maternal education group. Inequalities remained stable over time. Broader actions to reduce the existing inequalities are needed and should be a priority for public policies. [ABSTRACT FROM AUTHOR]

This study aims to analyze the association between social inequalities and gestational risk in administrative regions of the state of Espírito Santo. This is a cross-sectional study based on two administrative regions of the state of Espírito Santo. The sample consisted of 1,777 women who underwent prenatal care in the municipalities of the Greater Vitória Metropolitan Region (RMGV -ES) and São Mateus Microregion (MRSM) and were admitted to the public health facilities at the time of delivery between 2010 and 2012/2013. The multivariate logistic regression was performed to test the association between social and gestational risk variables. Variables with a significance level < 0.20 in the Chi-square test were adopted for the final model, and only those variables with a p-value < 0.05 remained. An association was found between high gestational risk and women's dwelling place in the RMGV-ES (OR = 1.74; CI95% 1.32-2.28), women as head of households (OR = 3.03; CI95% 1.64-5.61), head of household with less than five years of schooling (OR = 1.58; CI95% 1.14-2.20) and receipt of social benefit "Bolsa Família" (Family Grant) (OR = 1.46; CI95% 1.04-2.03). While some social variables underpin the classification of gestational risk, other social factors have been shown to produce this risk. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore how marginalised women perceive and rate equity‐oriented health care at a primary care clinic using items that evaluate patients' experiences of care. Background: Despite an increased recognition of the importance of health care that is equity‐oriented, and that understands the patient within the context of the broader social determinants of health, inequities in health remain prevalent around the world. Design: Items from the "EQUIP Primary Health Care" research programme were used to explore patients' experiences of equity‐oriented health care. Women were invited to complete the questionnaire with the explicit aim of gaining their input to improve quality of care at the clinic. The Strengthening the Reporting of Observational Studies in Epidemiology Statement was followed for the study. Methods: Sixty‐seven women who experienced significant health and social inequities, and were seeking care at a women's only nurse practitioner primary health care clinic in Canada, were invited to complete the questionnaire. For quality improvement purposes, correlational analyses were used to explore women's experiences of care. Results: Women's responses showed that Promote Emotional Safety and Trust and Overall Quality of Care were the most highly correlated domains, indicating the importance of the health care team in establishing trusting relationships, particularly for women who experience stigma and negative judgement when seeking care. Conclusion: Seeking feedback from patients on their experiences of care using items developed to explicitly tap into equity issues is useful in understanding how patients experience equity‐oriented health care. Responses from the women highlight the importance of understanding not only the what of equity‐oriented care but also the how. Relevance to clinical practice: The results of this study illustrate the importance of establishing trusting relationships, tailoring care, and using a nondiscriminatory approach when working with women who experience negative judgements when seeking care. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are linked to increased utilization of health care among adults; however, the impact of ACEs on nonmental health specialist care has been largely overlooked. To address this, data from the 2011–2012 National Survey of Children's Health (n = 89,357) were used to assess the health of children aged 0–17 living with a parent or guardian. Use of specialist care among children in the past 12 months was the outcome of interest and experiencing any one of nine ACEs was the independent variable of interest. After adjusting for confounders in logistic regression modeling, children who experience specific ACEs had higher odds of receiving specialist care. All ACEs were associated with higher unmet need of specialist care, and each additional ACE was independently associated with higher odds of needing specialist care among those who had not received it. This study provides evidence of that experiencing specific ACEs lead to increased demand of nonmental health specialist services among children and adds to the growing body of research indicating that individual ACE items may be differentially associated with health-care utilization or not associated with health-care utilization at all [ABSTRACT FROM AUTHOR]

Backgrounds: The empirical evidence shows discordant results regarding the role of local contexts on individual health. This article considers the role of the municipal socio-economic contexts on self-rated health in Italy, taking into account some individual variables.Methods: Multilevel model software (MlwiN) is used to fit multilevel linear regression models of perceived health. Individual data are from the Italian surveys on "Aspects of Daily Life" 2010, 2011 and 2012, collected by the Italian National Institute of Statistics (Istat). In addition, municipality-level social, demographic and economic characteristics are from the 2011 Census and the database "Atlas of Italian Municipalities" (Istat).Results: The main findings of this study confirm that, controlling for age and gender at the individual level, poor health is influenced by socio-economic positions: lower education, not working or looking for employment and disadvantaged family social class predict higher perceived health. The individual level explains the 70.1% heterogeneity in self-assessed health, the family level 25.6% and the municipality level only 4.3%. The additional influence of the socio-economic context is, conversely, of little substantive importance.Conclusions: Finally, by showing that variability in health relates mainly to individual characteristics, this study suggests that intervention to mitigate social inequalities in health should focus on structural factors, such as education and the labour market. [ABSTRACT FROM AUTHOR]

Introduction and objective. One of the main factors determining the burden of breast cancer is the effectiveness of measures taken to combat this cancer including urban-rural differences. The aim of the study was to analyse the differences in breast cancer incidence and disease stage distribution among urban and rural women in the Świętokrzyskie Province as a part of a strategy for breast cancer control. Materials and method. The study of disease stage distribution included 483 female residents of Œwiêtokrzyskie Province who were diagnosed in 2013 with invasive breast cancer, and reported to Œwiêtokrzyskie Office for Cancer Registration. Urban-rural differences in breast cancer incidence in 2002-2013 were presented using Range Ratio (RR). Changes in incidence trends in urban and rural areas were analysed using joinpoint models. Annual Percentage Change (APC) of the rates was calculated for each time trend. Results. Breast cancer incidence rate in the urban female population was higher than in rural women with RR, amounting to 1.43. However, the analysis of trends showed that the pace and direction of change were developing negatively among inhabitants of rural areas. In 2002-2013, in rural women, the age-standardized rate (ASR) values increased by 2.8% per year (p<0.05). The course of ASR trends showed statistically significant urban-rural differences (p=0.004). Analysis of urban-rural differences in disease stage distribution revealed a non-significantly higher proportion of cases with localised stage in urban than in rural areas, amounting to 51.0% and 43.9%, respectively. Conclusions. Existing health inequalities indicate the need to intensify activities in rural areas and should be the starting point for making key decisions in combating breast cancer. [ABSTRACT FROM AUTHOR]