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Yang C, Mao Z, Wu S, Yin S, Sun Y, Cui D. Influencing factors, gender differences and the decomposition of inequalities in cognitive function in Chinese older adults: a population-based cohort study. BMC Geriatr 2024; 24:371. [PMID: 38664618 PMCID: PMC11045435 DOI: 10.1186/s12877-024-04857-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/04/2023] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Evidence remains limited and inconsistent for assessing cognitive function in Chinese older adults (CFCOA) and inequalities in cognitive function in Chinese older adults (ICFCOA) and exploring their influencing factors and gender differences. This study aimed to identify influencing factors and inequality in CFCOA to empirically explore the existence and sources of gender differences in such inequality and analyse their heterogeneous effects. METHODS Based on data from the China Health and Retirement Longitudinal Study (CHARLS) for three periods from 2011 to 2015, recentered influence function unconditional quantile regression (RIF-UQR) and recentered influence function ordinary least squares (RIF-OLS) regression were applied to assess influencing factors of CFCOA, while grouped treatment effect estimation, Oaxaca-Blinder decomposition, and propensity score matching (PSM) methods were conducted to identify gender differences in ICFCOA and influencing factors, respectively. RESULTS The results showed heterogeneous effects of gender, age, low BMI, subjective health, smoking, education, social interactions, physical activity, and household registration on CFCOA. Additionally, on average, ICFCOA was about 19.2-36.0% higher among elderly females than among elderly males, mainly due to differences in characteristic effects and coefficient effects of factors such as marital status and education. CONCLUSIONS Different factors have heterogeneous and gender-differenced effects on CFCOA and ICFCOA, while the formation and exacerbation of ICFCOA were allied to marital status and education. Considering the severe ageing and the increasing incidence of cognitive decline, there is an urgent need for the government and society to adopt a comprehensive approach to practically work for promoting CFCOA and reducing ICFCOA.
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Affiliation(s)
- Ciran Yang
- School of Public Health, Wuhan University, 115# Donghu Road, 430071, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Zongfu Mao
- School of Public Health, Wuhan University, 115# Donghu Road, 430071, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Shaotang Wu
- School of Public Health, Wuhan University, 115# Donghu Road, 430071, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Shicheng Yin
- School of Public Health, Wuhan University, 115# Donghu Road, 430071, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Yu Sun
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Dan Cui
- School of Public Health, Wuhan University, 115# Donghu Road, 430071, Wuhan, China.
- Global Health Institute, Wuhan University, Wuhan, China.
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Makins A, Hearing F, Taghinejadi N, Kiarie J, Kabra R, Arulkumaran SS, Steyn P. The impact of cascade training-A FIGO and WHO Department of Sexual and Reproductive Health and Research collaboration to improve access to quality family planning globally. Int J Gynaecol Obstet 2024; 164:75-85. [PMID: 37987203 DOI: 10.1002/ijgo.15230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
Globally, there are considerable barriers to accessing safe and effective contraceptive methods. Increased awareness and utilization among obstetricians and gynecologists (OB/GYNs) and allied health professionals of the WHO's tools and guidelines on contraception is a possible avenue to changing this. A cascade-training model, based on regional training-of-trainer workshops followed by national workshops, was used to share key WHO global family planning tools and guidelines among OB/GYNs in 29 countries across three regions-Anglophone Africa, Middle East and Mediterraean, and Francophone West Africa. Monitoring and evaluation was performed through pre- and post-knowledge questionnaires as well as in-depth interviews of key informants before and after the training was instituted. The training increased both participants' knowledge and understanding of the relevant guidelines, as well as their confidence in using them. Qualitative data suggested that this improved in-country clinical practice and influenced national policy through dissemination and engagement with country leadership. The cascade-training model was a practical, locally adaptable means of disseminating up-to-date WHO family planning guidelines and tools. It resulted in sustainable changes in many participating countries, including training curriculum updates, policy changes, and increased government engagement with family planning. Future iterations of the initiative would benefit from additional support for multidisciplinary training.
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Affiliation(s)
- Anita Makins
- FIGO (International Federation of Gynecology and Obstetrics), FIGO House, London, UK
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Francesca Hearing
- FIGO (International Federation of Gynecology and Obstetrics), FIGO House, London, UK
| | - Neda Taghinejadi
- FIGO (International Federation of Gynecology and Obstetrics), FIGO House, London, UK
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - James Kiarie
- UNDP/UNFPA, UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization Headquarters, Geneva, Switzerland
| | - Rita Kabra
- UNDP/UNFPA, UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization Headquarters, Geneva, Switzerland
| | | | - Petrus Steyn
- UNDP/UNFPA, UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization Headquarters, Geneva, Switzerland
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Barcellona C, Mariñas YB, Tan SY, Lee G, Ko KC, Chham S, Chhorvann C, Leerapan B, Pham Tien N, Lim J. Measuring health equity in the ASEAN region: conceptual framework and assessment of data availability. Int J Equity Health 2023; 22:251. [PMID: 38053205 PMCID: PMC10696689 DOI: 10.1186/s12939-023-02059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Existing research on health equity falls short of identifying a comprehensive set of indicators for measurement across health systems. Health systems in the ASEAN region, in particular, lack a standardised framework to assess health equity. This paper proposes a comprehensive framework to measure health equity in the ASEAN region and highlights current gaps in data availability according to its indicator components. METHODS A comprehensive literature review was undertaken to map out a core set of indicators to evaluate health equity at the health system level. Secondary data collection was subsequently conducted to assess current data availability for ASEAN states in key global health databases, national health accounts, and policy documents. RESULTS A robust framework to measure health equity was developed comprising 195 indicators across Health System Inputs and Processes, Outputs, Outcomes, and Contextual Factors. Total indicator data availability equated to 72.9% (1423/1950). Across the ASEAN region, the Inputs and Processes sub-component of Health Financing had complete data availability for all indicators (160/160, 100%), while Access to Essential Medicine had the least data available (6/30, 20%). Under Outputs and Outcomes, Coverage of Selected Interventions (161/270, 59.63%) and Population Health (350/350, 100%) respectively had the most data available, while other indicator sub-components had little to none (≤ 38%). 72.145% (384/530) of data is available for all Contextual Factors. Out of the 10 ASEAN countries, the Philippines had the highest data availability overall at 77.44% (151/195), while Brunei Darussalam and Vietnam had the lowest data availability at 67.18% (131/195). CONCLUSIONS The data availability gaps highlighted in this study underscore the need for a standardised framework to guide data collection and benchmarking of health equity in ASEAN. There is a need to prioritise regular data collection for overlooked indicator areas and in countries with low levels of data availability. The application of this indicator framework and resulting data availability analysis could be conducted beyond ASEAN to enable cross-regional benchmarking of health equity.
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Affiliation(s)
- Capucine Barcellona
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | | | - Si Ying Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Gabriel Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Savina Chham
- National Institute of Public Health Cambodia, Phnom Penh, Cambodia
| | - Chhea Chhorvann
- National Institute of Public Health Cambodia, Phnom Penh, Cambodia
| | - Borwornsom Leerapan
- Faculty of Medicine Ramathibodi Hospital, Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Jeremy Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Yakubu K, Campain A, Abimbola S, Bouckley T, Peiris D, Joshi R, Shanthosh J. Promoting equitable health workforce distribution through improved migration governance: A mixed methods study of African health professionals' perceptions in Australia. Int J Health Plann Manage 2023; 38:1789-1815. [PMID: 37674361 DOI: 10.1002/hpm.3704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 07/19/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND This study examined skilled health worker (SHW) migration governance in African countries and Australia, with an emphasis on areas of influence for achieving an equitable global health workforce distribution. METHODS We used a mixed-methods research design with African SHW migrants in Australia. An institutional and rights-based framing of governance guided thematic analysis of the interviews, which was mapped to survey findings from a Bayesian Exploratory Factor Analysis. RESULTS The findings imply that Australian state actors enforce laws that attract SHW migrants and promote safe clinical practice, but do not adequately address their integration concerns or role in health system strengthening. Non-state actors in Australia make donations to African health institutions but rarely promote health workforce equity. African state actors respond to increased SHW migration trends by increasing health worker training and limiting migration, but they lack a comprehensive governance framework for involving citizens and engaging foreign governments. There is limited evidence of a shared community definition of SHW migration governance in many African countries. CONCLUSION When stakeholders in both sending and receiving countries recognise the indivisibility of the rights at stake (for example, SHW rights as migrants and the right to health), support for an equity-focused SHW migration governance system may increase. Promoting these rights can result in policies that enhance health system strengthening in destination and source countries. Similarly, growing adoption of these rights in sending countries should help inspire a coordinated plan for strengthening health system and SHW migration governance.
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Affiliation(s)
- Kenneth Yakubu
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Sydney, Australia
| | - Anna Campain
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Sydney, Australia
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tristan Bouckley
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Sydney, Australia
| | - Rohina Joshi
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Sydney, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Sydney, Australia
- The George Institute for Global Health India, New Delhi, India
| | - Janani Shanthosh
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, New South Wales, Sydney, Australia
- Australian Human Rights Institute, Faculty of Law and Justice, University of New South Wales, Sydney, New South Wales, Australia
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Blanchard AK, Jacobs C, Musukuma M, Chooye O, Sikapande B, Michelo C, Boerma T, Wehrmeister FC. Going deeper with health equity measurement: how much more can surveys reveal about inequalities in health intervention coverage and mortality in Zambia? Int J Equity Health 2023; 22:109. [PMID: 37268969 DOI: 10.1186/s12939-023-01901-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/27/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Although Zambia has achieved notable improvements in reproductive, maternal, newborn and child health (RMNCH), continued efforts to address gaps are essential to reach the Sustainable Development Goals by 2030. Research to better uncover who is being most left behind with poor health outcomes is crucial. This study aimed to understand how much more demographic health surveys can reveal about Zambia's progress in reducing inequalities in under-five mortality rates and RMNCH intervention coverage. METHODS Using four nationally-representative Zambia Demographic Health Surveys (2001/2, 2007, 2013/14, 2018), we estimated under-five mortality rates (U5MR) and RMNCH composite coverage indices (CCI) comparing wealth quintiles, urban-rural residence and provinces. We further used multi-tier measures including wealth deciles and double disaggregation between wealth and region (urban residence, then provinces). These were summarised using slope indices of inequality, weighted mean differences from overall mean, Theil and concentration indices. RESULTS Inequalities in RMNCH coverage and under-five mortality narrowed between wealth groups, residence and provinces over time, but in different ways. Comparing measures of inequalities over time, disaggregation with multiple socio-economic and geographic stratifiers was often valuable and provided additional insights compared to conventional measures. Wealth quintiles were sufficient in revealing mortality inequalities compared to deciles, but comparing CCI by deciles provided more nuance by showing that the poorest 10% were left behind by 2018. Examining wealth in only urban areas helped reveal closing gaps in under-five mortality and CCI between the poorest and richest quintiles. Though challenged by lower precision, wealth gaps appeared to close in every province for both mortality and CCI. Still, inequalities remained higher in provinces with worse outcomes. CONCLUSIONS Multi-tier equity measures provided similarly plausible and precise estimates as conventional measures for most comparisons, except mortality among some wealth deciles, and wealth tertiles by province. This suggests that related research could readily use these multi-tier measures to gain deeper insights on inequality patterns for both health coverage and impact indicators, given sufficient samples. Future household survey analyses using fit-for-purpose equity measures are needed to uncover intersecting inequalities and target efforts towards effective coverage that will leave no woman or child behind in Zambia and beyond.
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Affiliation(s)
- Andrea K Blanchard
- Institute for Global Public Health, University of Manitoba, R070-771 McDermot Ave, Winnipeg, R3E 0T6, Canada.
| | - Choolwe Jacobs
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Mwiche Musukuma
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Ovost Chooye
- Monitoring and Evaluation Division, Ministry of Health, Lusaka, Zambia
| | - Brivine Sikapande
- Monitoring and Evaluation Division, Ministry of Health, Lusaka, Zambia
| | - Charles Michelo
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Ties Boerma
- Institute for Global Public Health, University of Manitoba, R070-771 McDermot Ave, Winnipeg, R3E 0T6, Canada
| | - Fernando C Wehrmeister
- Institute for Global Public Health, University of Manitoba, R070-771 McDermot Ave, Winnipeg, R3E 0T6, Canada
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
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Defining Success: Establishing Clarity of Purpose and a Measurement Framework to Advance Health Equity. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:559-561. [PMID: 35867505 PMCID: PMC9311459 DOI: 10.1097/phh.0000000000001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Exploring effort–reward imbalance and professional quality of life among health workers in Cape Town, South Africa: a mixed-methods study. Glob Health Res Policy 2022; 7:7. [PMID: 35227327 PMCID: PMC8885139 DOI: 10.1186/s41256-022-00242-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background In the context of a growing appreciation for the wellbeing of the health workforce as the foundation of high-quality, sustainable health systems, this paper presents findings from two complementary studies to explore occupational stress and professional quality of life among health workers that were conducted in preparation for a task-shifting intervention to improve antenatal mental health services in Cape Town. Methods This mixed-methods, cross-sectional study was conducted in public sector Midwife Obstetric Units and associated Non-Profit Organisations in Cape Town. Semi-structured interviews and a quantitative survey were conducted among facility-and community-based professional and lay health workers. The survey included demographic as well as effort–reward imbalance (ERI) and professional quality of life (PROQOL) questionnaires to examine overall levels of work-related psychosocial stress and professional quality of life, as well as differences between lay and professional health workers. Qualitative data was analysed using a thematic content analysis approach. Quantitative data was analysed using STATA 12. Results Findings from 37 qualitative interviews highlighted the difficult working conditions and often limited reward and support structures experienced by health workers. Corroborating these findings, our quantitative survey of 165 professional and lay health workers revealed that most health workers experienced a mismatch between efforts spent and rewards gained at work (61.1% of professional and 70.2% of lay health workers; p = 0.302). There were few statistically significant differences in ERI and PROQOL scores between professional and lay health workers. Although Compassion Satisfaction was high for all health worker groups, lay health workers also showed elevated levels of burnout and compassion fatigue, with community-based health workers particularly affected. Conclusions Findings of this study add to the existing evidence base on adverse working conditions faced by South African public-sector health workers that should be taken into consideration as national and local governments seek to ‘re-engineer’ South Africa’s Primary Health Care system. Furthermore, they also highlight the importance of taking into consideration the wellbeing of health workers themselves to develop interventions that can sustainably foster resilient and high-quality health systems. Supplementary Information The online version contains supplementary material available at 10.1186/s41256-022-00242-6.
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Maingi S, Radix A, Candrian C, Stein GL, Berkman C, O'Mahony S. Improving the Hospice and Palliative Care Experiences of LGBTQ Patients and Their Caregivers. Prim Care 2021; 48:339-349. [PMID: 33985709 DOI: 10.1016/j.pop.2021.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primary care providers often express a desire to be more involved with their patients as they transition to hospice care. Given that these providers have a central role in the care of their patients, they have the potential to significantly improve the experiences of lesbian, gay, bisexual, transgender, and queer patients who face serious illnesses. This article discusses the barriers to quality hospice and palliative care experienced by many sexual and gender minorities, as well as specific ways in which primary care physicians can promote equitable end-of-life care.
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Affiliation(s)
- Shail Maingi
- Department of Medical Oncology, St Peter's Health Partners Cancer Care, 315 South Manning Boulevard, Albany, NY 12208, USA.
| | - Asa Radix
- Callen-Lorde Community Health Center, NYU School of Medicine, 356 West 18th Street, New York, NY 10011, USA
| | - Carey Candrian
- University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, USA. https://twitter.com/CandrianCarey
| | - Gary L Stein
- Wurzweiler School of Social Work, Yeshiva University, 2495 Amsterdam Avenue, New York, NY 10033, USA
| | - Cathy Berkman
- Graduate School of Social Service, Fordham University, 113 West 60 Street, New York, NY 10023, USA
| | - Sean O'Mahony
- Section of Palliative Medicine, Department of Internal Medicine, Rush Medical College, 1725 West Harrison Street, Suite 955, Chicago, IL 60612, USA
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