RESUMEN

AIM(S): To assess barriers and facilitators to seeking inpatient psychiatric treatment among transgender and nonbinary people. DESIGN: Qualitative interview study. METHODS: Semi-structured interviews were conducted from March 2019 to June 2022 with transgender and nonbinary people admitted to an inpatient psychiatric hospital in the United States during the past 5 years. Data were analysed using thematic analysis and constructed within a modified social-ecological model of stigma. Standards for Reporting Qualitative Research were used for this study. RESULTS: Participants (N = 15) described barriers and facilitators across all three social-ecological levels. i) Individual themes included distrust of the mental healthcare system, feeling unsafe, loss of autonomy, minimizing one's own mental health needs, and feelings of accountability to others. ii) Interpersonal themes included: lack of support for transgender/nonbinary identity, limited transgender/nonbinary knowledge among mental healthcare professionals, and allyship. iii) Structural themes included: carceral setting, financial costs, and availability of non-profit treatment options. CONCLUSION: Multi-level themes were identified as barriers and facilitators to seeking inpatient psychiatric care for transgender and nonbinary people, providing opportunities among inpatient settings to improve care delivery and engagement. Greater health equity can be achieved by addressing barriers to care. IMPLICATIONS: Incorporating inclusive and affirming practices in inpatient psychiatric services presents an opportunity to reduce barriers to seeking care. IMPACT: The present study describes the experiences of transgender and nonbinary people as they determine whether to voluntarily seek inpatient psychiatric treatment. This perspective allows nurses, health systems, and policymakers to integrate transgender and nonbinary people's needs to improve healthcare delivery. PATIENT/PUBLIC CONTRIBUTION: Transgender and nonbinary participants were recruited in collaboration with community organizations. Members of the transgender and nonbinary community participated in study design development and analysis and were part of the study team.

RESUMEN

Dental epidemiological studies are essential for analysing and evaluating the population's health state and dental treatments provided, as well as for planning future oral health programme activities and interventions based on their findings. In order to determine the health condition of children and adolescents in connection to the prevalence of caries, caries indices (decayed and filled teeth (dft) for primary teeth and decayed, missing and filled teeth (DMFT) in permanent teeth) and periodontal indices (community periodontal index (CPI)), oral exams of children and adolescents aged 6, 12 and 15 from selected schools were conducted. To assess the achievement of the oral health objectives set for Spain in 2020, these data were compared with those acquired at the national level. At 6 years of age, 278 children were examined, the prevalence of caries was 55.6%, the dft index was 2.77 (±3.44), the DMFT was 0.19 (±0.16), the restorative index (RI) was 4.62%, and the significant caries (SiC) index was 8.40 (±2.07). At 12 years of age, 208 students were examined, the prevalence of caries found was 65.86%, the DMFT index was 1.85 (±2.22), the RI was 36.63%, the SiC index was 5.43 (±2.07), and children without the presence of periodontal pathology was 59.13%. At 15 years of age, 165 students were examined, the prevalence of caries was 70.06%, the DMFT was 3.08 (±3.39), the RI was 42.42%, the SiC index was 8.10 (±2.55), and adolescents without periodontal disease was 47.90%. Conclusions: Melilla-born children and adolescents had higher caries indicators and indices than the corresponding national averages for Spain. Teenagers under the age of 15 have a particularly high frequency of dental caries. The investigation of the children's origin is where there is the most disparity. Children of Berber descent have much higher values than children of European heritage.

RESUMEN

Compared to recent generations, workers today generally experience poorer quality employment across both contractual (e.g., wages, hours) and relational (e.g., participation in decision-making, power dynamics) dimensions within the worker-employer relationship. Recent research shows that women are more likely to experience poor-quality employment and that these conditions are associated with adverse health effects, suggesting employment relations may contribute to gender inequities in health. We analyzed data from the General Social Survey (2002-2018) to explore whether the multidimensional construct of employment quality (EQ) mediates the relationship between gender and health among a representative, cross-sectional sample of U.S. wage earners. Using a counterfactually-based causal mediation framework, we found that EQ plays a meaningful role in a gender-health relationship, and that if the distribution of EQ among women was equal to that observed in men, the probability of reporting poor self-reported health and frequent mental distress among women would be lower by 1.5% (95% Confidence Interval: 0.5-2.8%) and 2.6% (95% CI: 0.6-4.6%), respectively. Our use of a multidimensional, typological measure of EQ allowed our analysis to better account for substantial heterogeneity in the configuration of contemporary employment arrangements. Additionally, this study is one of the first mediation analyses with a nominal mediator within the epidemiologic literature. Our results highlight EQ as a potential target for intervention to reduce gender inequities in health.

Asunto(s)

RESUMEN

Infant mental health is interconnected with and affected by maternal mental health. A mother or birthing person's mental health before and during pregnancy and the postpartum period is essential for a child's development. During the first year of life, infants require emotional attachment and bonding to strive. Perinatal mood disorders are likely to hinder attachment and are associated with an increased risk of adverse mental health effects for children later in life. The Black community is faced with a crisis as Black mothers experience a higher prevalence of perinatal mood disorders, including postpartum depression and anxiety, compared to the United States national estimates. The aim of the research is to identify social, structural, and economic disparities of Black perinatal women and birthing people's experience to understand the impact of perinatal mental health on infants' mental health. Black mothers and birthing people may often face social and structural barriers that limit their opportunity to seek and engage with interventions and treatment that address the root causes of their perinatal mood disorder. To enhance understanding of racial disparities caused by social and structural determinants of health on Black mothers and birthing people's mental health and health care experiences that influence infant mental health, the study team conducted semi-structured interviews among self-identified cisgender Black women health professionals nationwide, who provide care to pregnant or postpartum Black women and birthing people. Our study attempted to identify themes, pathways, interventions, and strategies to promote equitable and anti-racist maternal and infant mental health care. Using a Rigorous and Accelerated Data Reduction (Radar) technique and a deductive qualitative analytic approach it was found that limited access to resources, lack of universal screening and mental health education, and the disjointed healthcare system serves as barriers, contribute to mental health issues, and put Black mothers and birthing people at a disadvantage in autonomous decision making. Our study concluded that instituting education on healthy and culturally appropriate ways to support infant development in parent education programs may support Black parents in establishing healthy attachment and bonds. Prioritizing strategies to improve maternal mental health and centering Black parents in developing these educational parenting programs may optimize parenting experiences.

RESUMEN

BACKGROUND: Comparing health inequalities between countries helps us to highlight some factors specific to each context that contribute to these inequalities, thus contributing to the identification of courses of action likely to reduce them. This paper compares the associations between socioeconomic status (SES) and 1) low birth weight (LBW) and 2) preterm birth, in Brussels and Montreal (in general population, natives-born mothers, and immigrant mothers). METHODS: A population-based study examining associations between SES and pregnancy outcomes was conducted in each city, using administrative databases from Belgian and Quebec birth records (N = 97,844 and 214,620 births in Brussels and Montreal, respectively). Logistic regression models were developed in order to estimate the relationship between SES (maternal education and income quintile) and pregnancy outcomes, in each region. The analyses were first carried out for all births, then stratified according to the mother's origin. RESULTS: For the general population, SES is associated with LBW and preterm birth in both regions, except for income and preterm birth in Brussels. The association is stronger for mothers born in Belgium and Canada than for those born abroad. The main difference between the two regions concerns the magnitude of inequalities in perintal health, which is greater in Montreal than in Brussels among the general population. For native-born mothers, the magnitude of inequalities in perinatal health is also greater for mothers born in Canada than for those born in Belgium, except for the association between income and preterm birth. The socioeconomic gradient in perinatal health is less marked among immigrant mothers than native mothers. CONCLUSION: Significant differences in inequalities in perinatal health are observed between Brussels and Montreal. These differences can be explained by : on the one hand, the existence of greater social inequalities in Montreal than in Brussels and, on the other hand, the lower vulnerability of immigrants with low SES in Brussels. Future studies seeking to understand the mechanisms that lead to inequalities in health in different contexts should take into account a comparison of immigration and poverty contexts, as well as the public policies related to these factors.

Asunto(s)

RESUMEN

Physical activity benefits both physical and mental health. Specific events may augment participation in physical activity at a population level. Parkrun is a popular, free, weekly, timed 5 km run or walk in public spaces located in five continents. However, these events may be distributed inequitably, possibly reinforcing inequities in health. As a prelude to a comprehensive analysis of a larger dataset, we explore a hypothesis that participation in parkrun is influenced by the socio-economic characteristics of both parkrunners and their park. Two parkruns, 4.5 km apart, were selected in the city of Sheffield in the United Kingdom. Defined by indices of multiple deprivation, Castle parkrun is located in an economically deprived neighbourhood and Hallam parkrun is in a prosperous area of the city. Parkrunners were defined by applying these same indices to the neighbourhood of home registration. Results: (i) the prosperous Hallam catchment area produced over five times more parkrun participants than Castle; (ii) compared with Castle, Hallam parkrun attracted more participants from both catchment areas; (iii) consequently, Hallam parkrun had seven times more participants than Castle parkrun. Conclusion: establishing parkruns in deprived areas is a necessary but not sufficient prerequisite for equity of participation in this heath promoting activity.

Parkruns are popular, free, weekly, timed 5 km runs or walks in public places across the world. They contribute to both mental and physical health. But they could also increase health inequality. Participants may already have the better health generally associated with above average incomes and home life in attractive neighbourhoods. Our pilot study compares two parkruns in the British city of Sheffield; one located in the city's poorer East End, the other in the richer West End.

Asunto(s)

RESUMEN

OBJECTIVE: To describe the consequences of social inequalities on children's health as a global and persistent problem, demonstrating its historical and structural roots in different societies. DATA SOURCES: Relevant articles in the PubMed/MEDLINE database, in addition to those found in a manual search and in the bibliographic references of selected studies and consultation to the websites of international organizations to obtain relevant data and documents. DATA SYNTHESIS: To understand how inequities affect health, it is necessary to know the unequal distribution of their social determinants among population groups. In the case of children, the parental pathway of determinants is central. The non-equitable way in which many families or social groups live, determined by social and economic inequalities, produces unequal health outcomes, particularly for children. This is observed between and within countries. Children from the most vulnerable population groups consistently have worse health conditions. Interventions aimed at children's health must go beyond care and act in an integrated manner on poverty and on social and economic inequalities, aiming to end systematic and unfair differences. CONCLUSIONS: Despite the considerable advances observed in children's health in recent decades at a global level, the inequalities measured by different indicators show that they persist. This scenario deserves attention from researchers and decision-makers, especially in the context of the global health crisis caused by the COVID-19 pandemic, which has further intensified the situation of vulnerability and social inequalities in health around the world.

Asunto(s)

RESUMEN

Abstract Objective: To describe the consequences of social inequalities on children's health as a global and persistent problem, demonstrating its historical and structural roots in different societies. Data sources: Relevant articles in the PubMed/MEDLINE database, in addition to those found in a manual search and in the bibliographic references of selected studies and consultation to the websites of international organizations to obtain relevant data and documents. Data synthesis: To understand how inequities affect health, it is necessary to know the unequal distribution of their social determinants among population groups. In the case of children, the parental pathway of determinants is central. The non-equitable way in which many families or social groups live, determined by social and economic inequalities, produces unequal health outcomes, particularly for children. This is observed between and within countries. Children from the most vulnerable population groups consistently have worse health conditions. Interventions aimed at children's health must go beyond care and act in an integrated manner on poverty and on social and economic inequalities, aiming to end systematic and unfair differences. Conclusions: Despite the considerable advances observed in children's health in recent decades at a global level, the inequalities measured by different indicators show that they persist. This scenario deserves attention from researchers and decision-makers, especially in the context of the global health crisis caused by the COVID-19 pandemic, which has further intensified the situation of vulnerability and social inequalities in health around the world.

RESUMEN

@#Inequity and inequality in accessing primary healthcare services can be created by systemic and structural barriers in a health system. A recent review of Papua New Guinea’s (PNG) health system revealed that there are inequities and inequalities in primary healthcare service access. This disparity is magnified in the rural and remote regions of the country. One of the main reasons for this has been the chronic shortage in government funding. This paper presents an overview of inequities and inequalities in health and suggests some public health approaches that may improve primary healthcare service access in PNG

RESUMEN

BACKGROUND: In Italy an important contribution to the spread of global health education (GHE) grew from the establishment and work of the Italian Network for Global Health Education (INGHE). INGHE gave a national shared definition of global health (GH), grounded in the theory of determinants of health, inspired by a vision of social justice, and committed to reduce health inequities. The aim of this article is to share with the international community INGHE's point of view on Medical Education. METHODS: To express its view of medical education at the national level, INGHE established a dedicated commission, which elaborated a first draft of the document and then shared and discussed it with all other members. RESULTS: INGHE elaborated a paper where it explained the need to change medical education in order to prepare future health professionals for the challenges of the globalized and unequal world. In this article the authors summarize the experience of INGHE and share with the international community its document. CONCLUSIONS: The authors believe it is necessary now, more than ever, to insert this new approach to health at social and academic levels. Students should play a fundamental role in the spread of GHE, and activities related with GHE could be considered an important part of the third mission of universities to promote social justice.

Asunto(s)

RESUMEN

RESUMEN Las Inequidades Sociales en Salud (ISS) continúan representando un gran reto para la salud pública en los diferentes países del mundo. Por su parte, el estudio, análisis y generación de conocimiento en esta materia ha sido reconocida como prioritaria para la Organización Mundial de la Salud desde 1991. La investigación de las ISS debe basarse en fundamentos teóricos y conceptuales sólidos, pues son estos las que guiarán las decisiones metodológicas en términos de diseño de investigaciones, formulación de intervenciones y políticas públicas en salud. En Latinoamérica, los estudios realizados se han basado primordialmente en experiencias que se han llevado a cabo en países industrializados. Esto ha fomentado que el análisis de las ISS reproduzca posturas teóricas y metodologías, sin necesariamente presentar una perspectiva crítica de los posibles estratificadores sociales que aproximan de la mejor forma los determinantes sociales de la salud en los contextos particulares. Por esta razón, se expone que las aproximaciones teórico-metodológicas deben ajustarse a los contextos específicos de los países; que la estratificación social de la salud debe ser evaluada de forma prioritaria; que los determinantes de la salud individuales y estructurales deben ser considerados dentro de las mediciones; y que la justificación teórica de las decisiones metodológicas realizadas en los estudios y las medidas seleccionadas deben ser explícitas y responder a hipótesis concretas. Esto con el fin de proveer un análisis crítico y herramientas útiles tanto para la investigación como para la toma de decisiones en salud. Este estudio inicia con una síntesis de los principales antecedentes históricos que han permitido la evolución del concepto de ISS. Seguidamente, se presentan los principales conceptos subyacentes relativos a la definición de ISS (determinantes sociales, equidad, justicia, estratificación y gradiente social en salud) y cómo estos deben guiar las decisiones prácticas y metodológicas. Finalmente, se concluye con algunas recomendaciones para la generación de esta evidencia científica para Latinoamérica.

ABSTRACT Social health inequalities (or inequities) continue to represent a great challenge for public health research worldwide. Since 1991, the World Health Organization established that the study and analysis of health inequalities represented a priority for all countries. To better guide methodological and practical implications of health inequalities, research on this topic should present a solid theoretical model, able to impact future public health policies. Previous studies of health inequalities in Latin America are often inspired from abroad experiences, encouraging the reproduction of mainly European theoretical positions and methodologies. However, especially when it comes to this topic, it is known the important role of the social context and culture, playing an important role in promoting differences in health outcomes. From this perspective, to operationalize the different social determinants in health, a critical perspective and thoughtful analysis of the context is mandatory. In order to provide a critical analysis and useful tools for both research and health decision making, we recommend that the theoretical and methodological approaches used in social health inequalities research must be well adapted to the specific contexts; that health social stratification must be assessed as a priority; that individual and the wider health determinants must be well characterized; and that the theoretical justification of the methodological decisions made in the studies and the selected measures must be explicit and should answer specific hypotheses. This research provides a brief historical background, to share the basis for the conceptual evolution of social health inequalities; the main underlying concepts related to the definition of health inequalities (social determinants, equity, justice, stratification and social gradient in health); and some recommendations for the future perspectives of health inequalities research in Latin America.

Asunto(s)

RESUMEN

Primary care is generally perceived by the public as an inefficient, low-quality source of health care in the Philippines. Taking a toll on local health policies, the repercussions of these views warrant a more holistic approach in understanding patient experience. This paper evaluates the impact of strengthening primary care services on patient satisfaction at the University of the Philippines Health Service (UPHS). A prevalidated 16-item, 5-scale questionnaire was distributed to 200 eligible patients at the start of the study in 2016 and then again in 2017. A significant increase of highly satisfied patients in 13 of 16 questionnaire items was recorded after primary care services in the facility were strengthened. The highest satisfaction scores were reported for overall wait times, coordination of care, and health advice. Our findings suggest that improvements in primary care services through digitalizing health records, financing laboratory and pharmaceutical services, and retraining staff accounts for significant improvements in patient satisfaction. This ultimately bears potential for better clinical outcomes in form of patient retention and long-term care.

Asunto(s)

RESUMEN

Purpose Documents articulating public health nurses' (PHNs') roles, including Canadian standards and competencies, depict a broad focus working at multiple levels to improve population outcomes through the promotion of health equity. Conversely, Canadian experts depict a looming crisis, based on the rising disconnect between daily activities and ideal practice. While perfectly positioned, PHNs' skills and abilities are under-utilized and largely invisible. The intention of this study was to develop a model to support the full scope of equity-focused PHN practice. Method A participatory action research approach was used. Qualitative data were gathered using semistructured interview guides during audio-recorded meetings. The data were coded into central themes using content analysis and constant comparison. A researcher reflexive journal and field notes were kept. A significant feature was full participant involvement. Results The outcome was a professional practice model to reframe the PHN role to focus on population health and equity. The model was imperative in promoting full scope of practice, dealing with workload pressures, and describing PHNs' value within the organization and broader health system. Conclusion Professional practice models hold promise as frameworks to depict autonomous practice activities, situated within organizations and healthcare systems, and underpinned by nursing knowledge.

Asunto(s)

RESUMEN

With solid evidence that free healthcare increases the utilization of health services, Burkina Faso recently exempted all children under five and pregnant women from direct payment at health facilities. However, there is little insight into the capacity to maintain the gains attributable to free healthcare under routine conditions of implementation at the national scale. In particular, the repercussions of its interruption are unknown. The objective is to assess the effects of a sequence of natural interventions including the introduction, interruption and reintroduction of free healthcare on health-seeking practices and utilization of healthcare facilities by children under five. This is an embedded mixed methods study conducted in Kaya district, Burkina Faso. The quantitative component is based on a reversal longitudinal design. Pooled interrupted time-series analysis was performed to assess changes in the monthly number of visits from January 2005 to March 2015. Qualitative data were collected through in-depth interviews with health personnel and mothers to better understand the quantitative results. The results show that visits to health centres dropped immediately and significantly when free healthcare was interrupted (-146, CI95% [-255; -37]). They increased again when free healthcare was reintroduced (+89, CI95% [-11; 187]). Both urban and rural centres were affected. Self-medication and visits to traditional healers were reported more frequently during the withdrawal of free healthcare, and tensions between the population and health personnel increased. Implementation problems other than insufficient funding limited the coverage or intensity of free healthcare. While removing user fees could potentially improve mothers and children's health in Burkina Faso, this study shows that demand for healthcare remains highly sensitive to price changes. Gains in utilization attributable to free healthcare may vanish rapidly if user fees are reintroduced. It is essential to support an effective and sustainable implementation of this ambitious initiative.

Asunto(s)

RESUMEN

El debate sobre la justicia global, es decir, sobre la transformación de las relaciones económicas y políticas entre las sociedades más ricas y las más pobres es de vital importancia para la salud pública por dos motivos. Primero, porque se encuentra bien documentado un aumento de las desigualdades en salud como efecto del proceso de globalización económica; y segundo, porque para el manejo de estas desigualdades en salud se han hecho visibles especialmente dos enfoques que tienen total relación con el campo de trabajo de la salud pública: el enfoque de determinantes sociales de la salud de la oms y el enfoque de la determinación social de la salud de la medicina social latinoamericana. En tal sentido, el propósito de este artículo es analizar las perspectivas de justicia global que asume cada uno de estos enfoques y las propuestas para el manejo de las inequidades en salud que en cada caso se generan. Se concluye de dicho análisis que en los textos de la Comisión de Determinantes de la Salud de la oms no se cuestiona ni se demanda un cambio en las relaciones económicas y políticas globales, mientras que, por el contrario, para la medicina social latinoamericana el propósito de avanzar en la eliminación de las desigualdades globales pasa obligatoriamente por un cuestionamiento tico y una re-estructuración de las relaciones de poder a escala global.

The discussion on global justice, namely, on the transformation of economic and political relations among the richest societies and the poorest becomes vital for public health today due to two reasons. First, because its well documented an increase in health inequities as an effect of economic globalization process; and second, because to manage these health inequalities, have become visible especially two approaches that have full regard with the public health field of work: social determinants of health approach of the WHO, and Latin American Social Medicine approach. In this sense, the purpose of this article is to analyze the prospects for global justice that assumes each of these approaches, and proposals for management of health inequities that are generated in each case. We concluded, that texts of the Committee on Health Determinants of WHO don´t question nor demand a change in the global economic and political relationships, while in contrast, Latin American Social Medicine considers that to advance in global inequalities elimination involves ethical questions and to restructure power relationship globally.

RESUMEN

Norwegian national policies have been distinguished by their focus on equity, contributing to comprehensive policies to reduce the social inequities in health (SIH). The newly adopted Public health act, which aims at reducing the SIH, endorses these acknowledgements while highlighting the importance of municipalities as the key actors in public health. Municipal obligations include inter-sectoral policies for health, health impact assessments (HIA), and the development of local health overviews. Against the background of a system of local autonomy in Norway, this article illuminates whether, and how, municipal public health policies reflect national priorities. Our data are based on one qualitative study, combining document content analysis and expert interviews conducted in 2011, and one quantitative questionnaire sent to municipal chief administrative officers in 2011. Our findings indicate a divide between national and municipal public health strategies. Many municipalities focus on life-style and health-care related measures. Only few municipalities acknowledge the social determinants of health and have implemented HIA and health overviews. Arguing for the importance of concerted multi-level action to reduce the SIH, we need to better understand the gap between national and municipal approaches. We thus suggest further research to illuminate the challenges and success factors faced at local levels.

Asunto(s)

RESUMEN

Ao reconhecer a relevância dos estudos sobre as desigualdades sociais em saúde, o presente trabalho propõe uma análise que articula essa temática à questão das práticas corporais e sua institucionalização no campo público. Inicia resgatando as perspectivas ético-políticas legitimadoras do ideário da Atenção Primária à saúde e da Promoção da saúde e alguns elementos pontuais do vasto debate teórico sobre as desigualdades e iniquidades sociais em saúde. A partir desses pressupostos problematiza o modo como as práticas corporais têm sido "posicionadas" no universo da Atenção Primária no Brasil, uma vez que sua implementação vem ocorrendo de forma medicalizadora e fragmentada. Para tanto, debruça-se sobre o exame contextual de duas iniciativas públicas existentes no Espírito Santo (ES) que fomentam práticas corporais/atividades físicas. O empreendimento analítico foi subsidiado pelo cotejamento de informações relativas às condições de vida em alguns bairros da cidade de Vitória e às características de tais programas. Finaliza apontando algumas reflexões, com base no quadro empírico-conceitual produzido.

Asunto(s)

Asunto(s)