1
|
Bermudi PMM, Pellini ACG, Diniz CSG, Ribeiro AG, de Aguiar BS, Failla MA, Chiaravalloti Neto F. Clusters of high-risk, low-risk, and temporal trends of breast and cervical cancer-related mortality in São Paulo, Brazil, during 2000-2016. Ann Epidemiol 2023; 78:61-67. [PMID: 36586458 DOI: 10.1016/j.annepidem.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/11/2022] [Accepted: 12/18/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Studying breast and cervical cancers in space and time and verifying divergences of different territorially established socioeconomic profiles. METHODS Ecological study using spatial scanning (with socioeconomic characterization), space-time, and spatial variation of temporal trends, in order to identify significant clusters of high- and low-risk or temporal trends, of deaths from breast cancer and cervical cancer, in the city of São Paulo, Brazil, during 2000-2016. RESULTS High-risk spatial clusters were identified in the central areas, and low-risk clusters were identified in the peripheral areas, which were associated with better and worse socioeconomic conditions, respectively. As for cervical cancer, the pattern was the opposite. High-risk space-time clusters occurred in the early years of the study, whereas low-risk clusters occurred in the most recent years. For breast cancer, the central areas showed a temporal trend of decreasing mortality and the peripheral areas showed an increasing trend. While for cervical cancer, in general, the temporal trend was for the identified clusters to fall. CONCLUSIONS It is expected that this study will provide insights for the formulation of public policies to implement prevention and control measures, in order to reduce mortality and inequalities related to breast and cervical cancers.
Collapse
Affiliation(s)
- P M M Bermudi
- School of Public Health of University of São Paulo, São Paulo, Brazil.
| | - A C G Pellini
- Nove de Julho University - UNINOVE, São Paulo, Brazil and Sao Caetano do Sul Municipal University Sao Caetano do Sul, Brazil
| | - C S G Diniz
- School of Public Health of University of São Paulo, São Paulo, Brazil
| | - A G Ribeiro
- Educational and Research Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - B S de Aguiar
- Municipal Health Department of São Paulo, Coordination of Epidemiology and Information - São Paulo (SP), Brazil
| | - M A Failla
- Center for Geoprocessing and Socioenvironmental Information (GISA) of the Coordination of Epidemiology and Information (CEInfo) of the Municipal Health Department of São Paulo, São Paulo, Brazil
| | | |
Collapse
|
2
|
Tunali M, Radin AA, Başıbüyük S, Musah A, Borges IVG, Yenigun O, Aldosery A, Kostkova P, dos Santos WP, Massoni T, Dutra LMM, Moreno GMM, de Lima CL, da Silva ACG, Ambrizzi T, da Rocha RP, Jones KE, Campos LC. A review exploring the overarching burden of Zika virus with emphasis on epidemiological case studies from Brazil. Environ Sci Pollut Res Int 2021; 28:55952-55966. [PMID: 34495471 PMCID: PMC8500866 DOI: 10.1007/s11356-021-15984-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/11/2021] [Indexed: 05/13/2023]
Abstract
This paper explores the main factors for mosquito-borne transmission of the Zika virus by focusing on environmental, anthropogenic, and social risks. A literature review was conducted bringing together related information from this genre of research from peer-reviewed publications. It was observed that environmental conditions, especially precipitation, humidity, and temperature, played a role in the transmission. Furthermore, anthropogenic factors including sanitation, urbanization, and environmental pollution promote the transmission by affecting the mosquito density. In addition, socioeconomic factors such as poverty as well as social inequality and low-quality housing have also an impact since these are social factors that limit access to certain facilities or infrastructure which, in turn, promote transmission when absent (e.g., piped water and screened windows). Finally, the paper presents short-, mid-, and long-term preventative solutions together with future perspectives. This is the first review exploring the effects of anthropogenic aspects on Zika transmission with a special emphasis in Brazil.
Collapse
Affiliation(s)
- Merve Tunali
- Institute of Environmental Sciences, Boğaziçi University, Bebek, 34342 Istanbul, Turkey
| | | | - Selma Başıbüyük
- Institute of Environmental Sciences, Boğaziçi University, Bebek, 34342 Istanbul, Turkey
| | - Anwar Musah
- UCL Centre for Digital Public Health in Emergencies, Institute for Risk and Disaster Reduction, University College London, London, WC1E 6BT, London, UK
| | - Iuri Valerio Graciano Borges
- Departamento de Ciências Atmosféricas, Instituto de Astronomia, Geofísica e Ciências Atmosféricas, Universidade de São Paulo, São Paulo, SP 05508-090 Brazil
| | - Orhan Yenigun
- Institute of Environmental Sciences, Boğaziçi University, Bebek, 34342 Istanbul, Turkey
- School of Engineering, European University of Lefke, Lefke, North Cyprus, Turkey
| | - Aisha Aldosery
- UCL Centre for Digital Public Health in Emergencies, Institute for Risk and Disaster Reduction, University College London, London, WC1E 6BT, London, UK
| | - Patty Kostkova
- UCL Centre for Digital Public Health in Emergencies, Institute for Risk and Disaster Reduction, University College London, London, WC1E 6BT, London, UK
| | - Wellington P. dos Santos
- Department of Biomedical Engineering, Federal University of Pernambuco, Recife, PE 50740-550 Brazil
| | - Tiago Massoni
- Department Systems and Computing, Federal University of Campina Grande, Campina Grande, PB 58429-900 Brazil
| | - Livia Marcia Mosso Dutra
- Departamento de Ciências Atmosféricas, Instituto de Astronomia, Geofísica e Ciências Atmosféricas, Universidade de São Paulo, São Paulo, SP 05508-090 Brazil
| | - Giselle Machado Magalhaes Moreno
- Departamento de Ciências Atmosféricas, Instituto de Astronomia, Geofísica e Ciências Atmosféricas, Universidade de São Paulo, São Paulo, SP 05508-090 Brazil
| | - Clarisse Lins de Lima
- Polytechnic School of Pernambuco, University of Pernambuco (Poli-UPE), Recife, PE 50720-001 Brazil
| | - Ana Clara Gomes da Silva
- Department of Biomedical Engineering, Federal University of Pernambuco, Recife, PE 50740-550 Brazil
| | - Tércio Ambrizzi
- Departamento de Ciências Atmosféricas, Instituto de Astronomia, Geofísica e Ciências Atmosféricas, Universidade de São Paulo, São Paulo, SP 05508-090 Brazil
| | - Rosmeri Porfirio da Rocha
- Departamento de Ciências Atmosféricas, Instituto de Astronomia, Geofísica e Ciências Atmosféricas, Universidade de São Paulo, São Paulo, SP 05508-090 Brazil
| | - Kate E. Jones
- Department of Genetics, Evolution and Environment, Centre for Biodiversity and Environment Research, University College London, WC1E 6BT, London, UK
| | - Luiza C. Campos
- Department of Civil, Environmental and Geomatic Engineering, University College London, WC1E 6BT, London, UK
| |
Collapse
|
3
|
May SY, Clara N, Khin OK, Mar WW, Han AN, Maw SS. Challenges faced by community health nurses to achieve universal health coverage in Myanmar: A mixed methods study. Int J Nurs Sci 2021; 8:271-278. [PMID: 34307775 PMCID: PMC8283707 DOI: 10.1016/j.ijnss.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
Objective This study aimed to identify the challenges of community health nurses (CHNs) in delivering effective community health care to achieve universal health coverage (UHC) in Myanmar. Methods A total of 30 CHNs from township health centers in the northeastern, southern, and western parts of Myanmar were purposefully recruited for quantitative and qualitative interviews. Quantitative data were processed using Microsoft Excel software, and qualitative data were analyzed using thematic analysis. This study is registered with researchregistry6201. Results Around the country, 30 CHNs uncovered their hardships in implementing primary health care to achieve UHC. Over 90% of the participants agreed to the problem of inadequate health infrastructure, while half of them felt unmotivated when they encountered role conflicts among various cadres of healthcare providers and poor opportunities for career promotion. Major problems arose from the lack of standard professional education at the entry point to community settings because most CHNs did not achieve specialized training in providing public health services. Complications are incapable of evaluating health services for policy-making and the inability to conduct health research to develop evidence-based practices. Insecure work and living conditions, unsupportive community relationships, and undereducation in professional practices were supportive major themes explored by CHNs to achieve a deeper understanding of the barriers to UHC. Not only the health system itself but also the population and other geographical factors have contributed to many challenges to CHNs. Conclusion Myanmar's CHNs face many challenges in achieving UHC. These challenges are not confined to the health sector. Some situations, such as geographical barriers and transportation problems, remain persistent challenges for healthcare providers. This study highlights the fact that current health systems should be strengthened by qualified healthcare providers and sufficient infrastructure. Meanwhile, public empowerment plays a critical role in promoting health development.
Collapse
|
4
|
Jiménez Carrillo M, Fernández Rodker J, Sastre Paz M, Alberquilla Menendez-Asenjo Á. [Does the Electronic Health Record reflect the social determinants of health from Primary Health Care?]. Aten Primaria 2021; 53:36-42. [PMID: 32417165 DOI: 10.1016/j.aprim.2020.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/03/2019] [Accepted: 01/09/2020] [Indexed: 11/23/2022] Open
Abstract
Objetivo Analizar si la utilización de códigos Z en la historia clínica electrónica (HCE) se correlaciona con la realidad socioeconómica de la población atendida en Atención Primaria (AP). Diseño Estudio observacional, descriptivo, transversal, de tipo ecológico. Emplazamiento 90 centros de salud de dos Direcciones Asistenciales de AP, Comunidad de Madrid. Participantes El total de pacientes atendidos durante el año 2016 fue de 1.920.124 (54,33% mujeres, 45,67% hombres). El 7,15% recibió algún código Z (67,29% mujeres, 32,71% hombres). Mediciones principales Como variable dependiente se estableció la proporción de pacientes con registros de códigos Z en su HCE. Como variables independientes se seleccionaron dos indicadores socioeconómicos que reflejan de forma objetiva las diferencias entre zonas básicas de salud: renta media disponible per cápita y proporción de inmigrantes económicos. Para evaluar la correlación entre variable dependiente e independientes se recurrió a análisis multivariante de correlación-regresión. Resultados Se observó que a mayor renta disponible, menor proporción de registros de episodios Z en las HCE (coeficiente de correlación de Pearson: −0,56). Sin embargo, existe una gran variabilidad de registro de códigos Z y la codificación no consigue visibilizar las realidades socioeconómicas de las poblaciones atendidas (odds ratio diagnóstica: 0,12 [IC: 0,05-0,32]). Conclusiones Resulta relevante para una orientación comunitaria de la AP la utilización de distintas herramientas que faciliten visibilizar el impacto en la salud de las desigualdades sociales, así como su evaluación a través de diversas metodologías de investigación. Los códigos Z no visibilizan en la zona estudiada los determinantes sociales de la salud de la población atendida.
Collapse
|
5
|
Sieber S, Cheval B, Orsholits D, Van der Linden BW, Guessous I, Gabriel R, Kliegel M, Aartsen MJ, Boisgontier MP, Courvoisier D, Burton-Jeangros C, Cullati S. Welfare regimes modify the association of disadvantaged adult-life socioeconomic circumstances with self-rated health in old age. Int J Epidemiol 2020; 48:1352-1366. [PMID: 30608584 DOI: 10.1093/ije/dyy283] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Welfare regimes in Europe modify individuals' socioeconomic trajectories over their life-course, and, ultimately, the link between socioeconomic circumstances (SECs) and health. This paper aimed to assess whether the associations between life-course SECs (early-life, young adult-life, middle-age and old-age) and risk of poor self-rated health (SRH) trajectories in old age are modified by welfare regimes (Scandinavian [SC], Bismarckian [BM], Southern European [SE], Eastern European [EE]). METHODS We used data from the longitudinal SHARE survey. Early-life SECs consisted of four indicators of living conditions at age 10. Young adult-life, middle-age, and old-age SECs indicators were education, main occupation and satisfaction with household income, respectively. The association of life-course SECs with poor SRH trajectories was analysed by confounder-adjusted multilevel logistic regression models stratified by welfare regime. We included 24 011 participants (3626 in SC, 10 256 in BM, 6891 in SE, 3238 in EE) aged 50 to 96 years from 13 European countries. RESULTS The risk of poor SRH increased gradually with early-life SECs from most advantaged to most disadvantaged. The addition of adult-life SECs differentially attenuated the association of early-life SECs and SRH at older age across regimes: education attenuated the association only in SC and SE regimes and occupation only in SC and BM regimes; satisfaction with household income attenuated the association across regimes. CONCLUSIONS Early-life SECs have a long-lasting effect on SRH in all welfare regimes. Adult-life SECs attenuated this influence differently across welfare regimes.
Collapse
Affiliation(s)
- Stefan Sieber
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland
| | - Boris Cheval
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland
| | - Dan Orsholits
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland
| | - Bernadette W Van der Linden
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland.,Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Rainer Gabriel
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland.,ZHAW School of Social Work, Institute of Diversity and Social Integration, Zurich, Switzerland
| | - Matthias Kliegel
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland.,Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Marja J Aartsen
- NOVA - Norwegian Social Research, Centre for Welfare and Labour Research, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Matthieu P Boisgontier
- Brain Behaviour Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.,Movement Control & Neuroplasticity Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium
| | - Delphine Courvoisier
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland.,Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Claudine Burton-Jeangros
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives", University of Geneva, Geneva, Switzerland.,Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| |
Collapse
|
6
|
Cruvinel VRN, Zolnikov TR, Takashi Obara M, Oliveira VTLD, Vianna EN, Santos FSGD, Oliveira KCD, Scott JA. Vector-borne diseases in waste pickers in Brasilia, Brazil. Waste Manag 2020; 105:223-232. [PMID: 32087540 DOI: 10.1016/j.wasman.2020.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/19/2019] [Accepted: 02/02/2020] [Indexed: 06/10/2023]
Abstract
Solid waste management is a challenge in developing countries. The Structural dump in Brasilia, Brazil, was the largest Latin American open-air dump until its closure in 2018. Thus, this study sought to investigate the prevalence of self-reported dengue, Zika and Chikungunya arbovirus infections in waste pickers who worked at the dumpsite and assess its association with the sanitary conditions in their residences and workplaces. This research used a mixed methods study using a questionnaire for the quantitative method and semi-structured interviews for the qualitative portion. A cross-sectional, observational, epidemiological study along with a phenomenological study were carried out to characterize socio environmental, occupational and health-related aspects to vector-borne diseases in Structural dumpsite in Brazil. Of the 1,025 respondents, 301 (29.2%) reported to have gotten sick from dengue, Zika or chikungunya fevers. We found significant associations between place of residence of waste pickers (p = 0,003) and the work conditions, use of personal protective equipment (p < 0.001) and weekly workload (p = 0.04) and occurrence of vector-borne disease. Results were confirmed by qualitative data and geo-referencing, in relation to location of their homes and proximity to the dumpsite, as well as through the vulnerability due to their working conditions. This research confirms that waste pickers are highly susceptible to vector-borne diseases; this situation that needs to be immediately addressed by interdisciplinary and intersectoral approaches in waste management and public health. This information confirms vulnerability of waste pickers to diseases transmitted by Ae. aegypti mosquito as a result of sanitary conditions at their residence and workplace.
Collapse
Affiliation(s)
| | | | | | | | - Elisa Neves Vianna
- General Coordination of National Programs for the Control and Prevention of Malaria and Diseases Transmitted by Aedes/CGPNCMD, Secretariat of Health Surveillance, Ministry of Health, Brazil
| | - Fabiana Sherine Ganem do Santos
- Universitat Autònoma de Barcelona, Spain; Facultat de Medicina; Doctorado em Metodología de La Investigación Biomédica y Salud Pública, Spain
| | - Kenia Cristina de Oliveira
- Secretariat of State for Health of the Federal District, Brasilia, Brazil; Master Student, University of Brasilia, Brazil
| | - James A Scott
- University of Toronto, Dalla Lana School of Public Health, Division of Occupational and Environmental Health, Canada.
| |
Collapse
|
7
|
D'Alonzo KT, Vilaró FM, Joseph ME, Oyeneye V, Garsman L, Rosas SR, Castañeda M, Vivar M. Using Concept Mapping within a Community-Academic Partnership to Examine Obesity among Mexican Immigrants. Prog Community Health Partnersh 2020; 14:173-185. [PMID: 33414692 PMCID: PMC7787540 DOI: 10.1353/cpr.2020.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Weight gain is common following migration to a new country. Mexican immigrants have a disparate prevalence of overweight/obesity and food insecurity. Social stressors, such as unemployment, discrimination, and the threat of deportation, may fuel both food insecurity and weight gain in this population. Objectives We sought to (1) examine community-defined causes and correlates of obesity among Mexican-Americans; (2) determine how current social stressors, policies, and programs impact food insecurity and obesity; and (3) identify community-defined priorities for preventive interventions. Methods Group concept mapping (GCM) was used in a community-academic partnership (CAP) to describe the factors contributing to weight gain and obesity among Mexican immigrant families. Activities included community brainstorming, sorting and rating, multivariate statistical analysis, and community interpretation of results. Results Eighty statements were generated in the brainstorming sessions. These statements were sorted into nine clusters, which were organized into three regions: (1) intrapersonal factors; (2) community-level factors; and (3) social policy-related barriers. Statements reflecting the impact of immigration-related stressors were found in all three regions, addressing participants' fears of deportation, and the prioritization of resources away from healthy eating, resulting in food insecurity. Community members identified five priority areas for intervention planning: (1) lack of exercise; (2) lack of knowledge of a healthy diet; (3) expense of healthy foods; (4) "junk" food; and (5) stress management. Conclusions Results suggest high levels of social stress are contributing to food insecurity and obesity among Mexican immigrant families. Areas identified for intervention planning reflect the need for a multifaceted approach toward obesity prevention.
Collapse
Affiliation(s)
| | | | - Maya E Joseph
- Rutgers, The State University of New Jersey, School of Nursing
| | | | | | | | | | | |
Collapse
|
8
|
Ingvorsen EB, Schnohr C, Andersen T, Lehrmann L, Funding E, Poulsen LH, Holm KB, Laursen AL, Gerstoft J, Bjorner JB. "Development in well-being and social function among Danish hemophilia patients with HIV: a three-wave panel study spanning 24 years". BMC Public Health 2019; 19:1714. [PMID: 31856778 PMCID: PMC6923887 DOI: 10.1186/s12889-019-8062-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/11/2019] [Indexed: 12/11/2022] Open
Abstract
Background Between 1975 and 1985 a total of 91 Danish patients with moderate and severe hemophilia (PWH) was infected with HIV constituting a major scandal in the Danish health care system. This study describes the burden of HIV infection among Danish PWH by evaluating changes from 1988 to 2012 in well-being, social function, experiencing stigma and openness about disease among Danish HIV+ PWH. Methods Three anonymous surveys were conducted in 1988, 2001 and 2012 targeting all Danish patients with moderate to severe hemophilia. Survey responses were received from 53, 21 and 18 HIV+ PWH respectively. A matched comparison sample of HIV− PWH was identified for each survey-year, using propensity score matching. Differences for each survey-year and trends over time were analyzed using ordinal logistic regression. Results In 1988, HIV+ PWH had more psychosomatic symptoms than HIV− PWH, but in 2001 life satisfaction was higher among HIV+ PWH than among HIV− PWH. Tests of differences in trend over time showed larger improvements in life satisfaction among HIV+ PWH than HIV− PWH, while HIV− PWH showed an increase in educational level compared to HIV+ PWH. Analysis restricted to HIV+ PWH showed an increase in perceived stigmatization. Conclusions Differences between Danish HIV+ and HIV− PWH regarding well-being and psychosomatic symptoms seem to have evened out between 1988 and 2012. However, results suggest that HIV+ PWH still experience stigmatization and lower levels of education.
Collapse
Affiliation(s)
- Emilie B Ingvorsen
- Department of Public Health Section of Social Medicine, University of Copenhagen, Oester Farimagsgade 5, 1014 K, Copenhagen, Denmark
| | - Christina Schnohr
- Department of Public Health Section of Social Medicine, University of Copenhagen, Oester Farimagsgade 5, 1014 K, Copenhagen, Denmark.
| | | | | | - Eva Funding
- Department of Hematology Rigshospitalet, Copenhagen, Denmark
| | - Lone H Poulsen
- Aarhus University Hospital, Centre for thrombosis and hemostasis, Aarhus, Denmark
| | - Karen B Holm
- The Danish Haemophilia Society, Copenhagen, Denmark
| | - Alex L Laursen
- Department of Infectious Diseases Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Rigshospitalet, Copenhagen Ø, Denmark
| | - Jakob B Bjorner
- Department of Public Health Section of Social Medicine, University of Copenhagen, Oester Farimagsgade 5, 1014 K, Copenhagen, Denmark.,Optum Patient Insights, Johnston, RI, USA
| |
Collapse
|
9
|
de Melo MMDC, de Souza WV, de Goes PSA. Increase in dental caries and change in the socioeconomic profile of families in a child cohort of the primary health care in Northeast Brazil. BMC Oral Health 2019; 19:183. [PMID: 31412837 PMCID: PMC6692952 DOI: 10.1186/s12903-019-0871-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 07/31/2019] [Indexed: 12/14/2022] Open
Abstract
Background Factors associated with increases in dental caries and changes in the family socioeconomic profile were investigated in a paediatric primary health care (PHC) cohort in Northeast Brazil during the implementation of social and income transfer programmes. Method A prospective analytical study compared data from two surveys on caries in primary dentition conducted in 2006 (age: 18–36 months, n = 1045) and 2010 (age: 5–7 years). Data from the sample recruited and re-examined in 2010 (n = 469) were analysed. Prevalences (P) and the mean primary decayed, missing and filled teeth (dmft) index, cumulative incidence and mean increase were calculated. Differences (p ≤ 0.05 and 95% CI) in dmft ≥1 were identified via McNemar’s test. Differences in the mean dmft were evaluated according to socioeconomic variables (Kruskal-Wallis test and p ≤ 0.05). Multivariate analysis with a negative binomial model was used for the risk factors associated with increasing dmft. In the univariate analyses, nonparametric methods (Kruskal-Wallis test) were used to compare subsamples. Variables with p ≤ 0.20 were included in the multivariate model and retained when p ≤ 0.05. Results The prevalence and mean dmft (18–36 months and 5–7 years: p = 28.6 and 68.9%, mean = 1.01 and 3.46, respectively) and variation in mean dmft changed significantly (p < 0.005) with the education level and occupation of the mother; the prevalence and mean dmft were lower for higher maternal education level and maternal participation in the labour market. The cumulative incidence and mean increase in dmft were 8.71% and 2.45, respectively. Common risk predictors for increases in caries were consumption of sweets (RR = 1.53, 95% CI 1.09–2.14) and attendance at public schools (RR = 1.49, 95% CI: 1.81–1.89). Use of private clinical services was a protective factor (RR = 0.68, 95% CI 0.54–0.87). Conclusion Increases in caries were observed despite positive changes in the distribution of socioeconomic indicators for the analysed children’s families. The risk factors identified for the increase in caries suggest ongoing problems regarding the effectiveness of intersectoral and health measures for controlling caries in populations exposed to PHC programmes.
Collapse
Affiliation(s)
- Márcia Maria Dantas Cabral de Melo
- Department of Clinical and Preventive Dentistry, Federal University of Pernambuco, Av. Professor Moraes Rego, s/n. Cidade Universitária, Recife, PE, CEP: 50,670-420, Brazil.
| | - Wayner Vieira de Souza
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Av. Moraes Rego, s/n. Cidade Universitária, Recife, PE, CEP: 50670-420, Brazil
| | - Paulo Sávio Angeiras de Goes
- Department of Clinical and Preventive Dentistry, Federal University of Pernambuco
- , Av. Professor Moraes Rego, s/n. Cidade Universitária, Recife, PE, CEP: 50,670-420, Brazil
| |
Collapse
|
10
|
Cruvinel VRN, Marques CP, Cardoso V, Novaes MRCG, Araújo WN, Angulo-Tuesta A, Escalda PMF, Galato D, Brito P, da Silva EN. Health conditions and occupational risks in a novel group: waste pickers in the largest open garbage dump in Latin America. BMC Public Health 2019. [PMID: 31096940 DOI: 10.1186/s12889-019-6879-x/tables/2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND The inadequate management of solid waste impacts populations' health and quality of life, and disproportionately affects developing countries. This study aims to describe a protocol for epidemiological diagnosis, the purpose being to estimate the prevalence of chronic and communicable and non communicable diseases in waste pickers, and the occupational and environmental risk factors to which these are exposed. METHODS This is a cross-sectional study, based on survey design in an area of extreme social vulnerability - the largest garbage dump in Latin America. Using a multidimensional research protocol, divided in three stages: 1- The identification of the subjects, and the scheduling of tests; 2- Situational diagnosis through interviews, anthropometric evaluation, measuring blood pressure, collecting hair and nail samples to detect exposure to heavy metals and undertaking laboratory tests; 3- The return of the waste pickers to receive the test results, followed by referral to the health team and to report occupational accidents. RESULTS One thousand twenty-five waste pickers undertook tests and interviews. The majority were women (67.0%), with 36-45 years old (45.7%), and 96.0% had children. In total, 27.3% of the participants did not attend to any school and 47.7% were educated only up to primary level. The majority of waste pickers (68.70%) reported accidents and most of them (89.69%) were related to sharp objects. The mean time working in this open dump was 15 years. According the anthropometric measure, 32.6% were overweight and 21.1% were obese. The most common reported diseases were: osteomuscular disorders (78.7%); arboviruses (28.6%); episodic diarrhea (24.9%); hypertension (24.2%); bronchitis (14.3%); intestinal worms (12.6%) and diabetes (10.1%). According to the blood tests, the values outside the reference limits were: Uric acid (23.89%); creatinine (54.06%); GGT range (16.04%); SGOT - Serum Glutamic Oxaloacetic Transaminase (5.29%); SGPT - serum Glutamic-Pyruvic Transaminase (35.52%). CONCLUSIONS This study is the first to evaluate multiple risks and diseases in the majority of waste pickers working in the largest garbage dump of a continent. These findings highlight the importance to address urgently the environmental, social and health impacts related to the management of solid waste in developmental countries to protect these workers and their families.
Collapse
Affiliation(s)
| | | | - Vanessa Cardoso
- School of Health Sciences and State Secretariat of Health of the Federal District, Brasília, Brazil
| | | | | | | | | | - Dayani Galato
- University of Brasília, Faculty of Ceilandia, Brasília, Brazil
| | - Petruza Brito
- School of Health Sciences and State Secretariat of Health of the Federal District, Brasília, Brazil
| | | |
Collapse
|
11
|
Cruvinel VRN, Marques CP, Cardoso V, Novaes MRCG, Araújo WN, Angulo-Tuesta A, Escalda PMF, Galato D, Brito P, da Silva EN. Health conditions and occupational risks in a novel group: waste pickers in the largest open garbage dump in Latin America. BMC Public Health 2019; 19:581. [PMID: 31096940 PMCID: PMC6521552 DOI: 10.1186/s12889-019-6879-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 04/22/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The inadequate management of solid waste impacts populations' health and quality of life, and disproportionately affects developing countries. This study aims to describe a protocol for epidemiological diagnosis, the purpose being to estimate the prevalence of chronic and communicable and non communicable diseases in waste pickers, and the occupational and environmental risk factors to which these are exposed. METHODS This is a cross-sectional study, based on survey design in an area of extreme social vulnerability - the largest garbage dump in Latin America. Using a multidimensional research protocol, divided in three stages: 1- The identification of the subjects, and the scheduling of tests; 2- Situational diagnosis through interviews, anthropometric evaluation, measuring blood pressure, collecting hair and nail samples to detect exposure to heavy metals and undertaking laboratory tests; 3- The return of the waste pickers to receive the test results, followed by referral to the health team and to report occupational accidents. RESULTS One thousand twenty-five waste pickers undertook tests and interviews. The majority were women (67.0%), with 36-45 years old (45.7%), and 96.0% had children. In total, 27.3% of the participants did not attend to any school and 47.7% were educated only up to primary level. The majority of waste pickers (68.70%) reported accidents and most of them (89.69%) were related to sharp objects. The mean time working in this open dump was 15 years. According the anthropometric measure, 32.6% were overweight and 21.1% were obese. The most common reported diseases were: osteomuscular disorders (78.7%); arboviruses (28.6%); episodic diarrhea (24.9%); hypertension (24.2%); bronchitis (14.3%); intestinal worms (12.6%) and diabetes (10.1%). According to the blood tests, the values outside the reference limits were: Uric acid (23.89%); creatinine (54.06%); GGT range (16.04%); SGOT - Serum Glutamic Oxaloacetic Transaminase (5.29%); SGPT - serum Glutamic-Pyruvic Transaminase (35.52%). CONCLUSIONS This study is the first to evaluate multiple risks and diseases in the majority of waste pickers working in the largest garbage dump of a continent. These findings highlight the importance to address urgently the environmental, social and health impacts related to the management of solid waste in developmental countries to protect these workers and their families.
Collapse
Affiliation(s)
| | | | - Vanessa Cardoso
- School of Health Sciences and State Secretariat of Health of the Federal District, Brasília, Brazil
| | | | | | | | | | - Dayani Galato
- University of Brasília, Faculty of Ceilandia, Brasília, Brazil
| | - Petruza Brito
- School of Health Sciences and State Secretariat of Health of the Federal District, Brasília, Brazil
| | | |
Collapse
|
12
|
Kane JB, Margerison-Zilko C. Theoretical Insights into Preconception Social Conditions and Perinatal Health: The Role of Place and Social Relationships. Popul Res Policy Rev 2017; 36:639-69. [PMID: 29398741 DOI: 10.1007/s11113-017-9430-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recent efforts to explain the stark social and racial disparities in adverse birth outcomes that have persisted for decades in the U.S. have looked beyond prenatal factors, to explore preconception social conditions that may influence perinatal health via dysregulation of physiologic processes. The extant evidence supporting this link however remains limited, both due to a lack of data and theory. To address the latter, this manuscript generates a structured set of theoretical insights that further develop the link between two preconception social conditions - place and social relationships - and perinatal health. The insights propose the following. PLACE necessarily encompasses all social contexts to which females are exposed from infancy through young adulthood; encompasses a variety of related exposures that, when possible, should be jointly considered; and may compound the effect of poverty-in childhood, adolescence, or young adulthood-on perinatal health. Social relationships: span relationships from early life through adulthood, and extend to intergenerational associations; often involve (or induce) major changes in the lives of individuals and should be examined with an emphasis on the developmental stage in which the change occurred; and necessarily encompass a lack of social integration, or, social isolation. We also identify potential biological and social-structural mechanisms linking these preconception social conditions to perinatal health, and conclude by identifying promising directions for future research.
Collapse
|
13
|
Abstract
To take up the AJCP editor's call to think forward in this article, I offer up three challenges that revolve around further contextualizing our understandings of diversity, i.e., reconsidering the notion of "difference" between discrete categories; more fully emphasizing diversity as socially situated; and further delving into local, setting-specific practices that shape the meanings of diversity. Enhanced attention to these three challenges can transform theory, research, and action about diversity as we move into community psychology's next 50 years.
Collapse
Affiliation(s)
- Meg A Bond
- Department of Psychology and Center for Women & Work, University of Massachusetts Lowell, Lowell, MA, USA
| |
Collapse
|
14
|
Niedzwiedz CL, Richardson EA, Tunstall H, Shortt NK, Mitchell RJ, Pearce JR. The relationship between wealth and loneliness among older people across Europe: Is social participation protective? Prev Med 2016; 91:24-31. [PMID: 27471027 DOI: 10.1016/j.ypmed.2016.07.016] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/09/2016] [Accepted: 07/23/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE 1. Examine the relationship between household wealth, social participation and loneliness among older people across Europe. 2. Investigate whether relationships vary by type of social participation (charity/volunteer work, sports/social clubs, educational/training course, and political/community organisations) and gender. 3. Examine whether social participation moderates the association between wealth and loneliness. METHODS Data (N=29,795) were taken from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), which was collected during 2013 from 14 European countries. Loneliness was measured using the short version of the Revised-University of California, Los Angeles (R-UCLA) Loneliness Scale. We used multilevel logistic models stratified by gender to examine the relationships between variables, with individuals nested within countries. RESULTS The risk of loneliness was highest in the least wealthy groups and lowest in the wealthiest groups. Frequent social participation was associated with a lower risk of loneliness and moderated the association between household wealth and loneliness, particularly among men. Compared to the wealthiest men who often took part in formal social activities, the least wealthy men who did not participate had greater risk of loneliness (OR=1.91, 95% CI: 1.44 to 2.51). This increased risk was not observed among the least wealthy men who reported frequent participation in formal social activities (OR=1.12, 95% CI: 0.76 to 1.67). CONCLUSION Participation in external social activities may help to reduce loneliness among older adults and potentially acts as a buffer against the adverse effects of socioeconomic disadvantage.
Collapse
Affiliation(s)
- Claire L Niedzwiedz
- Centre for Research on Environment, Society and Health (CRESH), University of Edinburgh, Edinburgh, Scotland EH8 9XP, UK.
| | - Elizabeth A Richardson
- Centre for Research on Environment, Society and Health (CRESH), University of Edinburgh, Edinburgh, Scotland EH8 9XP, UK.
| | - Helena Tunstall
- Centre for Research on Environment, Society and Health (CRESH), University of Edinburgh, Edinburgh, Scotland EH8 9XP, UK.
| | - Niamh K Shortt
- Centre for Research on Environment, Society and Health (CRESH), University of Edinburgh, Edinburgh, Scotland EH8 9XP, UK.
| | - Richard J Mitchell
- Centre for Research on Environment, Society and Health (CRESH), University of Glasgow, Glasgow, Scotland G12 8RZ, UK.
| | - Jamie R Pearce
- Centre for Research on Environment, Society and Health (CRESH), University of Edinburgh, Edinburgh, Scotland EH8 9XP, UK.
| |
Collapse
|
15
|
Pinzón-Rondón ÁM, Aguilera-Otalvaro P, Zárate-Ardila C, Hoyos-Martínez A. Acute respiratory infection in children from developing nations: a multi-level study. Paediatr Int Child Health 2016; 36:84-90. [PMID: 25936959 DOI: 10.1179/2046905515y.0000000021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Worldwide, acute respiratory infections (ARI) are the leading cause of death of children under 5 years of age. AIM To assess the accomplishment of the Millennium Development Goal on under-5 mortality particularly related to ARI in developing countries, and to explore the associations between country characteristics and ARI in children under 5 taking into account child, mother and household attributes. METHODS The study included a representative sample of 354,633 children under 5 years from 40 developing nations. A multilevel analysis of data from the Demographic and Health Surveys and the World Bank was conducted. RESULTS The prevalence of ARI was 13%. Country inequalities were associated with the disease - GINI index (95% CI 1.01-1.04). The country's per capita gross domestic product (GDP) (95% CI 1.00-1.01) and health expenditure (95% CI 1.01-1.01) affected the relationship between immunization and ARI, while inequalities influenced the relationship between household wealth (95% CI 0.99-0.99) and the disease. Other factors positively associated with ARI were male gender, low birthweight, working mothers and a high-risk indoor environment. Factors associated with ARI reduction were older children, immunization, breastfeeding for more than 6 months, older maternal age, maternal education and planned pregnancy. CONCLUSIONS In developing countries, public health campaigns to target ARI should consider the country's macro characteristics. At country level, inequalities but not health expenditure or GDP were associated with the disease and were independent of child, family and household characteristics. The effect of immunization on reducing ARI is greater in countries with a higher GDP and health expenditure. The effect of household wealth on ARI is less in countries with fewer inequalities. Reduction of inequalities is an important measure to decrease ARI in developing countries.
Collapse
Affiliation(s)
| | | | - Carol Zárate-Ardila
- a Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario , Bogotá , Colombia
| | - Alfonso Hoyos-Martínez
- a Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario , Bogotá , Colombia
| |
Collapse
|
16
|
Duarte-Gómez MB, Núñez-Urquiza RM, Restrepo-Restrepo JA, Richardson-López-Collada VL. [Social determinants of infant mortality in socioeconomic deprived rural areas in Mexico]. Bol Med Hosp Infant Mex 2015; 72:181-189. [PMID: 29421500 DOI: 10.1016/j.bmhimx.2015.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/01/2015] [Accepted: 06/15/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study was to identify determinants of infant mortality in rural areas in Mexico and recommend strategies for its decrease. METHODS A study was conducted in a sample of 16 municipalities among those with the lowest index of human development. Infant deaths were identified through official data, records and through interviews with civil authorities, health workers and community leaders. Mothers of children who died were also interviewed. RESULTS In most cases, deaths were related with intermediate social determinants (living conditions and health services converged). The most important critical factors were the prevention programs and delays in receiving healthcare. Deficiencies in intersectorial policies to guarantee effective access to health services were found. CONCLUSIONS To decrease infant mortality in rural areas of Mexico, geographic access has to be improved as well as investment in resources and training health personnel in intercultural competence and primary health care skills.
Collapse
|
17
|
Martín Gordo O, Martín Moreno V, Agüero Orgaz D, Martín Fernández A, Coaquira Condori ER, Duce Tello S. [Management of time used to treat the chronic patient: a new approach to improve quality of health care]. Rev Calid Asist 2014; 29:270-277. [PMID: 25305054 DOI: 10.1016/j.cali.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 08/27/2014] [Accepted: 09/02/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Chronic disease is the main epidemic of the 21st century. It takes up a large part of the social-health budgets that are dedicated to its care. The aim of this study is to analyze if the welfare quality in the management of the chronic patients improves by implementing non-contact care time. MATERIAL AND METHODS Intervention study conducted in the health care center of Orcasitas (January 2012 - September 2013) in patients with hypertension (357), diabetes (180) and/or ischemic heart disease (60). Health care quality was analyzed through the effectiveness in the program, Tracking Objectives in Primary Care. The intervention group had four physical 10minute consultations/year and three non-physical 10minute consultations/year. The patients in the control group were seen as usual. The data were compared using the McNemar test, chi-square and Cochran's Q test. RESULTS In the intervention group, the effectiveness increased in the analyzed period by 46%, 54% and 55.9%, respectively, for processes of hypertension, diabetes and dyslipidemia control in ischemic heart disease, whereas in the control group (community of Madrid) it was 2.54%, 1.78%, and 5.44%, respectively, for these processes (statistically significant differences [χ(2)=24.78; χ(2)=39.9 y χ(2)=67.3, P<.0001]). CONCLUSIONS Thirty minutes/year of non-presential care represents a significant change in the level of control of chronic patients. These results should be considered in the approach strategies to chronic diseases.
Collapse
|
18
|
Bojorquez I, Rentería D, Unikel C. Trajectories of dietary change and the social context of migration: a qualitative study. Appetite 2014; 81:93-101. [PMID: 24911619 DOI: 10.1016/j.appet.2014.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 05/18/2014] [Accepted: 06/03/2014] [Indexed: 11/18/2022]
Abstract
The aim of this article was to explore the influence of migration on changes in dietary practices, relating these changes to the social contexts in which they occur. Numerous studies have described how migration from poor countries and regions to more developed ones leads migrants to adopt a modern diet associated to the risk of acquiring chronic diseases. However, different contexts might influence dietary change in migrants in diverse ways. For this purpose, 28 semi-structured interviews were conducted with adult, female internal migrants to a border city in Mexico. The interviews were analyzed using thematic analysis. The results showed trajectories of dietary change to be associated to social position before and after migration. For the participants from rural areas, migration was accompanied by an increase in the consumption of processed foods, and also changes in food insecurity. Migrants who came from urban areas reported a decrease in the perceived quality of food available to them, but their eating pattern was modified only slightly. For some interviewees, migration resulted in the possibility to choose what to eat in a more autonomous way. We discuss how the effect of migration on dietary changes can be manifold, and the necessity to delve into how social context influences these changes.
Collapse
Affiliation(s)
| | | | - Claudia Unikel
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México
| |
Collapse
|
19
|
Hackenhaar AA, Albernaz EP, da Fonseca TM. Preterm premature rupture of the fetal membranes: association with sociodemographic factors and maternal genitourinary infections. J Pediatr (Rio J) 2014; 90:197-202. [PMID: 24184300 DOI: 10.1016/j.jped.2013.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/10/2013] [Accepted: 06/10/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE this study aimed to investigate the incidence of premature rupture of fetal membranes in preterm singleton pregnancies and its association with sociodemographic factors and maternal self-reported genitourinary infections. METHODS this was a population-based cross-sectional study, which included all mothers of newborns of singleton deliveries that occurred in 2010, with birth weight ≥ 500 grams, who resided in the city of Rio Grande. Women were interviewed in the two maternity hospitals. Cases were women who had lost amniotic fluid before hospitalization and whose gestational age was less than 37 weeks. Statistical analysis was performed by levels to control for confounding factors using Poisson regression. RESULTS of the 2,244 women eligible for the study, 3.1% had preterm premature rupture of fetal membranes, which was more frequent, after adjustment, in women of lower socioeconomic status, (prevalence ratio [PR]=1.94), with lower level of schooling (PR=2.43), age > 29 years (PR=2.49), and smokers (PR=2.04). It was also associated with threatened miscarriage (PR=1.68) and preterm labor, (PR=3.40). There was no association with maternal urinary tract infection or presence of genital discharge. CONCLUSIONS the outcome was more common in puerperal women with lower level of schooling, lower socioeconomic status, older, and smokers, as well as those with a history of threatened miscarriage and premature labor. These factors should be considered in the prevention, diagnosis, and therapy approach.
Collapse
|
20
|
Schrecker T. Can health equity survive epidemiology? Standards of proof and social determinants of health. Prev Med 2013; 57:741-4. [PMID: 23994154 DOI: 10.1016/j.ypmed.2013.08.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 07/12/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This article examines how epidemiological evidence is and should be used in the context of increasing concern for health equity and for social determinants of health. METHOD A research literature on use of scientific evidence of "environmental risks" is outlined, and key issues compared with those that arise with respect to social determinants of health. RESULTS The issue sets are very similar. Both involve the choice of a standard of proof, and the corollary need to make value judgments about how to address uncertainty in the context of "the inevitability of being wrong," at least some of the time, and to consider evidence from multiple kinds of research design. The nature of such value judgments and the need for methodological pluralism are incompletely understood. CONCLUSION Responsible policy analysis and interpretation of scientific evidence require explicit consideration of the ethical issues involved in choosing a standard of proof. Because of the stakes involved, such choices often become contested political terrain. Comparative research on how those choices are made will be valuable.
Collapse
Affiliation(s)
- Ted Schrecker
- School of Medicine, Pharmacy and Health, Durham University, UK; Department of Epidemiology and Community Medicine, University of Ottawa, Canada.
| |
Collapse
|
21
|
Trejo Amador U, Granados Cosme JA, Ortiz Hernández L, Delgado Sánchez G. [Social Differences in Proper Detection of Cervical Uterine Cancer among Employees at a University in Mexico City]. Rev Esp Salud Publica 2005; 79:403-414. [PMID: 28272388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Accepted: 05/10/2005] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE In Mexico, cervical uterine cancer (CUC) is one of the leading causes of death among women, however a low degree of participation in the early detection programs has been found. This study is aimed at describing the social determinants of knowledge related to cervical uterine cancer and proper testing being conducted by establishing the social differences with regard thereto among a population of female employees at a public university in Mexico. METHODS An analytical cross-sectional study was made. During the March-April 2003 period, a survey was conducted of a representative sample of the female employees who were working at a public university (n=228), 110 of whom were professors (PF) and 118 administrative staff (AS). This population was chosen due to the major socioeconomic differentiation thereof in terms of their job positions (PF versus AS), thus affording the possibility of evaluating the bearing social inequality has on health-related behavior. The survey explored three aspects: living conditions, knowledge of CUC and of proper cervical uterine cancer detection testing. RESULTS The female professors showed higher levels of income,schooling and knowledge of CUC and of cervical uterine cancer detection testing than the administrative staff. Income and schooling were positively related to the knowledge regarding cervical uterine cancer, cervical uterine cancer detection testing being related to the latter. CONCLUSIONS Socioeconomic inequality among the women studied was reflected in differences in the degree of knowledge and in cervical uterine cancer detection testing being undergone. These differences are associated, above all, to the differences in the level of schooling.
Collapse
|