RESUMO
OBJECTIVE: To examine the current evidence regarding health care disparities in pediatric rehabilitation after hospitalization with traumatic injury. STUDY DESIGN: This systematic review utilized both PubMed and EMBASE, and each was searched with key MESH terms. Studies were included in the systematic review if they (1) addressed social determinants of health including, but not limited to, race, ethnicity, insurance status, and income level; (2) focused on inpatient and outpatient rehabilitation services posthospital stay; (3) were based in the pediatric population; and (4) addressed traumatic injury requiring hospitalization. Only studies from within the US were included. RESULTS: From 10â169 studies identified, 455 abstracts were examined for full-text review, and 24 studies were chosen for data extraction. Synthesis of the 24 studies revealed 3 major themes: (1) access to services; (2) outcomes from rehabilitation; and (3) service provision. Patients with public insurance had decreased availability of service providers and had longer outpatient wait times. Non-Hispanic Black and Hispanic children were more likely to have greater injury severity and decreased functional independence after discharge. Lack of interpreter services was associated with decreased utilization of outpatient services. CONCLUSIONS: This systematic review identified significant effects of health care disparities on the rehabilitation process in pediatric traumatic injury. Social determinants of health must be thoughtfully addressed to identify key areas of improvement for the provision of equitable health care.
Assuntos
Disparidades em Assistência à Saúde , Determinantes Sociais da Saúde , Ferimentos e Lesões , Criança , Humanos , População Negra , Etnicidade , Hispânico ou Latino , Hospitalização , Determinantes Sociais da Saúde/economia , Determinantes Sociais da Saúde/etnologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Ferimentos e Lesões/reabilitação , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricosRESUMO
Introducción: La integración social es un proceso dinámico que mejora la inclusión de sujetos en riesgos de exclusión, requiriendo de estrategias especializadas, como pueden ser los programas aplicados de actividad física. Objetivo: Valorar los efectos de la actividad física en la integración social del adulto mayor jubilado de la Espoch. Métodos: Se estudian a 34 exservidores públicos jubilados de la Escuela Superior Politécnica de Chimborazo (Espoch), con un nivel moderado auto percibido de depresión/ansiedad, sometiéndolos a un proceso de intervención con actividades físico-recreativas que incluyen 7 unidades con sesiones de 90min. Los adultos mayores fueron evaluados con la Escala Auto Aplicada de Adaptación Social-SASS en dos momentos del proceso de intervención. Resultados: El pretest determinó una media de ï2.24puntos (≈2: Desadaptación social patente), incrementándose el puntaje promedio como parte del posttest a ï2.76 (≈3: Normalidad), existiendo diferencias significativas a favor del posttest (p=0.000). Conclusiones: Se demuestra un incremento de la adaptación social basada en un equilibrio de los niveles de integración con el entorno conocido (universidad), logrados con la implementación de la propuesta de intervención. En tal sentido, los programas físico-recreativo especializados pueden ser complementos efectivos para potenciar la integración de un grupo social determinado, como es el caso de adultos mayores jubilados de un centro de educación superior(AU)
Introduction: Social integration is a dynamic process that improves the subject's inclusion at exclusion risk, requiring specialized strategies, such as physical activity programs. Objective: to assess the physical activity effects on the social integration of the retired older adult from Espoch. Methods: 34 former retired public servants from the Escuela Superior Politécnica de Chimborazo (Espoch), with a self-perceived moderate level of depression/anxiety, were studied, subjecting them to an intervention process with physical-recreational activities that included 7 units with 90-min sessions. The older adults were evaluated with the Self-Applied Scale of Social Adaptation-SASS at two moments of the intervention process. Results: The pretest determined an average of ï2.24 points (≈2: patent social maladjustment), increasing the score as part of the posttest to ï2.76 (≈3: Normality), with significant differences in posttest favor (p=0.000). Conclusions: an increase in social adaptation is demonstrated based on a balance level of integration with the known environment (university), achieved with the implementation of the intervention proposal. In this sense, specialized physical-recreational programs can be effective complements to promote the integration of a specific social group, as is the case of older adults retired from a higher education center(AU)
Assuntos
Humanos , Pessoa de Meia-Idade , Ansiedade/psicologia , Exercício Físico/psicologia , Depressão/psicologia , Determinantes Sociais da Saúde/economiaRESUMO
This paper aims to perform a theoretical reflection on the historical-social foundations of the COVID-19 pandemic. The "capital worldization", "capital-imperialism", "space-time compression", and "structural crisis of capital" categories are conjured from the historical materialistic-theoretical matrix, outlining a course that transcends the limits of Health Sciences to understand global health, of which the COVID-19 pandemic is an expression. We then return to the field of health, when the category of "social determination of health" allows elucidating the bases of the pandemic studied. We show that, other elements typical of the current phase of contemporary capitalism have become universal besides the SARS-CoV-2 characteristics or the dynamics of the rapid movement of people and objects around the world, unifying the health social determination process.
Este artigo possui o objetivo de realizar uma reflexão teórica sobre os fundamentos histórico-sociais da pandemia de COVID-19. A partir da matriz teórica materialista histórica, evoca-se as categorias da "mundialização do capital", "capital-imperialismo", "compressão espaço-tempo" e "crise estrutural do capital" traçando um percurso que ultrapassa os limites das Ciências da Saúde a fim de entender a saúde global, da qual a pandemia de COVID-19 é expressão. Posteriormente, faz-se o retorno ao campo da saúde, quando a categoria da "determinação social da saúde" permite elucidar as bases da pandemia estudada. Demonstra-se que, para além das características próprias do SARS-CoV-2 ou da dinâmica de rápido trânsito de pessoas e objetos pelo mundo, há outros elementos típicos da atual fase do capitalismo contemporâneo que se tornaram universais, unificando o processo de determinação social da saúde.
Assuntos
Betacoronavirus , Capitalismo , Infecções por Coronavirus , Saúde Global , Pandemias , Pneumonia Viral , Determinantes Sociais da Saúde , COVID-19 , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/etiologia , Saúde Global/economia , Saúde Global/estatística & dados numéricos , Humanos , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Saúde Pública , SARS-CoV-2 , Determinantes Sociais da Saúde/economia , Fatores de TempoRESUMO
RESUMEN Objetivo Identificar las características de los estudios sobre desigualdades sociales, en la mortalidad de niños menores de cinco años; sus perspectivas teóricas, ejes de desigualdad, métodos y resultados. Método Revisión sistemática de la literatura. Se consultaron cuatro bases de datos electrónicas y Google Scholar; se incluyeron estudios entre 2010 y 2018. Resultados Se analizaron 126 artículos. En el 62,7%, se estudió el territorio como eje de desigualdad, seguido por los determinantes socioeconómicos (27,8%). La mortalidad neonatal, infantil y en la niñez fue analizada en el 19,0%, 49,2% y 32,3%, respectivamente. Predominaron los estudios ecológicos (62,7%) y longitudinales (50,0%). Se encontró una disminución considerable en las tasas de mortalidad; sin embargo, el descenso no fue homogéneo entre subpoblaciones. Conclusiones La literatura reporta una marcada disminución de la mortalidad en niños menores de cinco años; no obstante, las brechas entre distintos ejes de desigualdad continúan y en algunos lugares se han incrementado. Las brechas entre los estratificadores variaron de acuerdo con el tiempo, lugar, eje de desigualdad y tipo de mortalidad analizada.(AU)
ABSTRACT Objective To identify the characteristics of the published studies on social inequalities in under-five mortality, their theoretical perspectives, axes of inequality, methods and results. Method We carried out a systematic literature review. We consulted four electronic databases and Google Scholar, for studies published between 2010 and 2018. Results We analyzed 126 articles. In 62.7%, territory was studied as the axis of inequality, followed by socioeconomic determinants (27.8%). Neonatal, infant and under-five mortality was analyzed as an output in health in 19.0%, 49.2% and 32.3%, respectively. It predominated ecological (62.7%) and longitudinal (50.0%) studies. Significant reductions in mortality rates were found, however, the decline was not homogeneous among subpopulations. Conclusions The literature reports a marked decrease in under-five mortality; however, the gaps between different axes of inequality continue and in some cases they have increased. Gaps varied according to time, place, axis of inequality and type of mortality analyzed.(AU)
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Mortalidade Infantil , Disparidades nos Níveis de Saúde , Determinantes Sociais da Saúde/economia , Estratificadores de EquidadeRESUMO
BACKGROUND AND AIMS: To estimate the relationship between the price of ultra-processed foods and prevalence of obesity in Brazil and examine whether the relationship differed according to socioeconomic status. METHODS AND RESULTS: Data from the national Household Budget Survey from 2008/09 (n = 55 570 households, divided in 550 strata) were used. Weight and height of all individuals were used. Weight was measured by using portable electronic scales (maximum capacity of 150 kg). Height (or length) was measured using portable stadiometers (maximum capacity: 200 cm long) or infant anthropometers (maximum capacity: 105 cm long). Multivariate regression models (log-log) were used to estimate price elasticity. An inverse association was found between the price of ultra-processed foods (per kg) and the prevalence of overweight (Body mass index (BMI) ≥25 kg/m2) and obesity (BMI ≥30 kg/m2) in Brazil. The price elasticity for ultra-processed foods was -0.33 (95% CI: -0.46; -0.20) for overweight and -0.59 (95% CI: -0.83; -0.36) for obesity. This indicated that a 1.00% increase in the price of ultra-processed foods would lead to a decrease in the prevalence of overweight and obesity of 0.33% and 0.59%, respectively. For the lower income group, the price elasticity for price of ultra-processed foods was -0.34 (95% CI: -0.50; -0.18) for overweight and -0.63 (95% CI: -0.91; -0.36) for obesity. CONCLUSION: The price of ultra-processed foods was inversely associated with the prevalence of overweight and obesity in Brazil, mainly in the lowest socioeconomic status population. Therefore, the taxation of ultra-processed foods emerges as a prominent tool in the control of obesity.
Assuntos
Orçamentos , Fast Foods/efeitos adversos , Fast Foods/economia , Abastecimento de Alimentos/economia , Renda , Obesidade/economia , Obesidade/epidemiologia , Determinantes Sociais da Saúde/economia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Nutritivo , Obesidade/diagnóstico , Obesidade Infantil/economia , Obesidade Infantil/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Classe Social , Adulto JovemRESUMO
Resumo Este artigo possui o objetivo de realizar uma reflexão teórica sobre os fundamentos histórico-sociais da pandemia de COVID-19. A partir da matriz teórica materialista histórica, evoca-se as categorias da "mundialização do capital", "capital-imperialismo", "compressão espaço-tempo" e "crise estrutural do capital" traçando um percurso que ultrapassa os limites das Ciências da Saúde a fim de entender a saúde global, da qual a pandemia de COVID-19 é expressão. Posteriormente, faz-se o retorno ao campo da saúde, quando a categoria da "determinação social da saúde" permite elucidar as bases da pandemia estudada. Demonstra-se que, para além das características próprias do SARS-CoV-2 ou da dinâmica de rápido trânsito de pessoas e objetos pelo mundo, há outros elementos típicos da atual fase do capitalismo contemporâneo que se tornaram universais, unificando o processo de determinação social da saúde.
Abstract This paper aims to perform a theoretical reflection on the historical-social foundations of the COVID-19 pandemic. The "capital worldization", "capital-imperialism", "space-time compression", and "structural crisis of capital" categories are conjured from the historical materialistic-theoretical matrix, outlining a course that transcends the limits of Health Sciences to understand global health, of which the COVID-19 pandemic is an expression. We then return to the field of health, when the category of "social determination of health" allows elucidating the bases of the pandemic studied. We show that, other elements typical of the current phase of contemporary capitalism have become universal besides the SARS-CoV-2 characteristics or the dynamics of the rapid movement of people and objects around the world, unifying the health social determination process.
Assuntos
Humanos , Pneumonia Viral/economia , Pneumonia Viral/etiologia , Pneumonia Viral/epidemiologia , Saúde Global/economia , Saúde Global/estatística & dados numéricos , Infecções por Coronavirus/economia , Infecções por Coronavirus/etiologia , Infecções por Coronavirus/epidemiologia , Capitalismo , Pandemias/economia , Determinantes Sociais da Saúde/economia , Betacoronavirus , Fatores de Tempo , Saúde Pública , Infecções por CoronavirusRESUMO
RESUMEN El objetivo del trabajo es explorar el posible efecto que la crisis económica ha tenido sobre la salud de la población nacida en España en edad adulta previa a la jubilación (entre 30 y 59 años). Específicamente, a partir de los datos de la European Union Statistics on Income and Living Conditions (EU-SILC) para los años 2006, 2010 y 2014 analizamos diferencias en la salud autopercibida según su perfil socioeconómico y la posición que ocupan en el hogar. Nuestros resultados muestran que la salud de los hombres y las mujeres tienen niveles de asociación similares con ciertos factores (por ejemplo, nivel educativo) y diferenciados con otros (la salud de la mujer es ligeramente más sensible al nivel de los ingresos del hogar, mientras la salud de los hombres a su propio estado de empleo). Finalmente, mientras que en el primer periodo se observan mejoras sustanciales en la salud autopercibida en casi todos los grupos socioeconómicos, en el segundo periodo no hay casi ningún cambio e incluso, para algunos hombres con un perfil más desfavorecido (inactivos con educación baja), la salud empeoró.
ABSTRACT The objective of this study is to explore the possible impact of the economic crisis on the health of the Spanish-born population not of retirement age (between 30 and 59 years). Specifically, using data from the European Union Statistics on Income and Living Conditions (EU-SILC) for the years 2006, 2010 and 2014, we analyze differences in self-perceived health by socioeconomic profile and position occupied in the household. According to our results, the health of men and women show similar levels of association with certain factors (such as education) and different levels with others (women's health is more sensitive to household income level while men's is more sensitive to employment status). Finally, while substantial improvements in self-perceived health were observed during the first period in almost all socioeconomic groups, during the second period there was almost no change, and for the most disadvantaged men (inactive in the labor market and with low educational levels), health worsened.
Assuntos
Humanos , Masculino , Feminino , Adulto , Nível de Saúde , Escolaridade , Emprego , Recessão Econômica , Determinantes Sociais da Saúde/economia , Classe Social , Espanha , Análise Multivariada , Inquéritos Epidemiológicos , Autorrelato , Saúde da PopulaçãoRESUMO
The objective of this study is to explore the possible impact of the economic crisis on the health of the Spanish-born population not of retirement age (between 30 and 59 years). Specifically, using data from the European Union Statistics on Income and Living Conditions (EU-SILC) for the years 2006, 2010 and 2014, we analyze differences in self-perceived health by socioeconomic profile and position occupied in the household. According to our results, the health of men and women show similar levels of association with certain factors (such as education) and different levels with others (women's health is more sensitive to household income level while men's is more sensitive to employment status). Finally, while substantial improvements in self-perceived health were observed during the first period in almost all socioeconomic groups, during the second period there was almost no change, and for the most disadvantaged men (inactive in the labor market and with low educational levels), health worsened.
El objetivo del trabajo es explorar el posible efecto que la crisis económica ha tenido sobre la salud de la población nacida en España en edad adulta previa a la jubilación (entre 30 y 59 años). Específicamente, a partir de los datos de la European Union Statistics on Income and Living Conditions (EU-SILC) para los años 2006, 2010 y 2014 analizamos diferencias en la salud autopercibida según su perfil socioeconómico y la posición que ocupan en el hogar. Nuestros resultados muestran que la salud de los hombres y las mujeres tienen niveles de asociación similares con ciertos factores (por ejemplo, nivel educativo) y diferenciados con otros (la salud de la mujer es ligeramente más sensible al nivel de los ingresos del hogar, mientras la salud de los hombres a su propio estado de empleo). Finalmente, mientras que en el primer periodo se observan mejoras sustanciales en la salud autopercibida en casi todos los grupos socioeconómicos, en el segundo periodo no hay casi ningún cambio e incluso, para algunos hombres con un perfil más desfavorecido (inactivos con educación baja), la salud empeoró.
Assuntos
Recessão Econômica , Escolaridade , Emprego , Nível de Saúde , Determinantes Sociais da Saúde/economia , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Análise Multivariada , Saúde da População , Autorrelato , Classe Social , EspanhaRESUMO
The Texas-Mexico border incidence rate of tuberculosis (TB) is 10 times the rate of TB in the United States. Additionally, this area is plagued by antibiotic-resistant TB at a rate that is 70% higher among those living along the border than among nonborder residents. Both the high rate of TB and the emergence of drug-resistant TB increases the importance of controlling TB along the U.S.-Mexico border. Men have higher rates of TB than women, which can be attributed to biological differences and increased environmental exposure. The purpose of this article is to describe the experience of TB for Mexican American men living on the Texas-Mexico border. This a qualitative descriptive study, using participants from a larger study. A purposeful sample was recruited through two south Texas TB clinics. Interviews were audio recorded, transcribed, and translated into English. Data analysis consisted of line-by-line coding, labeling, organizing, and discovering common codes to describe participants' experience of TB and TB treatment. The participants include 13 Mexican American men. Ages ranged from 22 to 76 years. Only one participant was employed during treatment. Years of education ranged from no school to an associate's degree. Five themes were discovered: misinformation, delayed diagnosis, stigma, depression, and loss of community. Participants without social support were further isolated and felt a greater burden of treatment. Two participants contemplated suicide and two others told their families to leave them because they were a burden and infectious. The burden of treatment on the patient is great, especially for Hispanic men.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Americanos Mexicanos/psicologia , Determinantes Sociais da Saúde/etnologia , Isolamento Social/psicologia , Estigma Social , Tuberculose/etnologia , Adulto , Idoso , Diagnóstico Tardio , Depressão/etiologia , Humanos , Incidência , Entrevistas como Assunto , Masculino , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Determinantes Sociais da Saúde/economia , Texas/epidemiologia , Tempo para o Tratamento , Tuberculose/diagnóstico , Tuberculose/psicologia , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/etnologia , Tuberculose Resistente a Múltiplos Medicamentos/psicologia , Adulto JovemRESUMO
OBJECTIVE: To establish the relationship between socioeconomic inequality and health problems amongst Mexican population reviewing studies with national or regional representation. METHODS: A literature search was performed at national and international databases using the following keywords: health, disease, mental disorders, nutrition, food, social class, social status, unemployment, employment, occupation, income, wage, poverty and socioeconomic status. Reports of national or regional surveys conducted from the nineties were included. RESULTS: Mostly, diseases events were more common among people from low socioeconomic status: anencephaly, viral infections, anemia, transit accidents by run over, metabolic syndrome, hypertension, affective disorder, anxiety and substances abuse; some malignancies, difficulties to perform activities of daily living, and poor perceived health status. On the opposite, as it goes down in the social scale, are less frequent some protective factors (e.g. fruits or vegetables intake and physical activity) and there is less access to medical aid and preventive interventions (e.g. condom use or diagnosis and treatment for HIV infection, hypertension or obesity). CONCLUSIONS: Socioeconomic status affects all living conditions; therefore, its effects are not confined to certain diseases, but a general precarious state of health. The conceptual and public policy implications related with social inequalities in health are discussed.
Objetivo: establecer la relación entre la desigualdad socioeconómica y los problemas de salud en la población mexicana a partir de la revisión de estudios con representatividad nacional o regional. Métodos: la revisión bibliohemerográfica se realizó consultando bases de datos nacionales e internacionales, mediante el uso de las siguientes palabras clave: salud, enfermedad, trastornos mentales, nutrición, alimentación, clase social, estrato social, desempleo, empleo, ocupación, ingreso, salario, pobreza, nivel socioeconómico y estatus socioeconómico. Se incluyeron los reportes de encuestas nacionales y regionales realizados a partir de la década de los noventa. Resultados: la mayoría de los eventos de enfermedad fueron más comunes entre las personas de baja posición socioeconómica. Asimismo, conforme se desciende de la escala social, son menos frecuentes los factores protectores y es menor el acceso a la atención médica y a las medidas preventivas. Conclusiones: la posición socioeconómica afecta la totalidad de las condiciones de vida de las personas, por lo que sus efectos no se reducen únicamente a ciertas enfermedades, sino que condiciona un estado de salud precario. Las implicaciones conceptuales y en política pública de las desigualdades en salud son ampliamente discutidas.