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Social cure model: testing the link between identity centrality and body appreciation in diverse sexual orientation and gender identity groups 社会治愈模式:测试不同性取向和性别认同群体的身份中心性与身体鉴赏之间的联系
IF 4.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-18 DOI: 10.1186/s12939-024-02268-3
Nikola Komlenac, Kristina Stockburger, Jennifer Birke, Margarethe Hochleitner
The level of experienced sociocultural pressure to have an idealized body can vary depending on a person’s gender identity and sexual orientation. The current study explored whether differences in levels of body appreciation among people with different sexual orientations and gender identities vary because of differing levels of experienced pressure by in-group members and varying levels of experienced hostile behaviors because of their looks or body. Thereby, the study tests the social cure model, according to which high levels of identity centrality are associated with better mental health. An online cross-sectional questionnaire study was conducted with 1,587 people (51.3% cisgender women, 39.3% cisgender men, 9.5% non-binary; 52.9% identified as heterosexual, 27.7% identified as bisexual/pansexual, 11.2% identified as gay/lesbian, 8.2% identified as asexual/demi/queer; Mage = 32.9, SD = 12.6) from German-speaking countries. Variables were assessed with German-language versions of the Multidimensional and Multicomponent Measure of Social Identification, Body Appreciation Scale-2, the Perceived Stigmatization Questionnaire, and the Sociocultural Attitudes Towards Appearance Questionnaire-4, revised. A manifest-path model was calculated. Non-binary persons reported lower levels of body appreciation than did cisgender men and sexual minority persons reported lower levels of body appreciation than did heterosexual persons. Furthermore, sexual minority persons experienced more hostile behaviors directed towards them because of their looks or body than did heterosexual persons. Similarly, non-binary persons experienced more hostile behaviors than did men. Non-binary persons were subjected to lower levels of in-group pressure than were men. Gay/lesbian persons and asexual persons were subjected to lower levels of in-group pressure than were heterosexual persons. More hostile behaviors and stronger in-group pressure were related to lower body appreciation. In cisgender women and men indirect links revealed associations between strong identity centrality and low levels of body appreciation through the mediator of high in-group pressure. Data in sexual minority individuals or non-binary persons supported the social cure model, according to which persons can find support and validation for their looks and body from in-group members. In cisgender women and men, strong identification as a woman or man can be related to stronger in-group pressure and in turn to lower body appreciation.
一个人的性别认同和性取向不同,其所承受的拥有理想化身材的社会文化压力也会不同。本研究探讨了不同性取向和性别认同的人在身体欣赏水平上的差异是否会因群体内成员施加压力的程度不同以及因长相或身体而遭受敌对行为的程度不同而不同。因此,该研究检验了社会治愈模型,根据该模型,高水平的身份中心性与更好的心理健康相关。我们对来自德语国家的 1587 人(51.3% 为顺性女性,39.3% 为顺性男性,9.5% 为非二元性;52.9% 为异性恋,27.7% 为双性恋/泛双性恋,11.2% 为同性恋/女同性恋,8.2% 为无性/半无性/同性恋;Mage = 32.9,SD = 12.6)进行了在线横截面问卷调查。研究人员使用德语版的社会认同多维和多成分测量表、身体鉴赏量表-2、感知鄙视问卷和社会文化外貌态度问卷-4(修订版)对各变量进行了评估。计算出了一个表现路径模型。非二元性别者对身体的欣赏水平低于顺性别男性,性少数群体者对身体的欣赏水平低于异性恋者。此外,与异性恋者相比,性少数群体的人因其长相或身体而遭受的敌意行为更多。同样,与男性相比,非二元人士遭受了更多的敌意行为。与男性相比,非二元人受到的群体内压力较低。同性恋者和无性恋者受到的群体内压力低于异性恋者。更多的敌对行为和更强的群体内压力与较低的身体欣赏水平有关。在双性恋女性和男性中,间接联系显示,通过高群体内压力这一中介,强身份中心性与低身体欣赏水平之间存在关联。性少数群体或非二元人群的数据支持社会治愈模式,根据该模式,人们可以从群体内成员那里找到对其容貌和身体的支持和肯定。在顺性别女性和男性中,强烈的女性或男性身份认同可能与较强的群体内压力有关,进而与较低的身体鉴赏力有关。
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引用次数: 0
Health disparities and inequalities in prevalence of diabetes in the Kingdom of Saudi Arabia 沙特阿拉伯王国糖尿病发病率的健康差距和不平等现象
IF 4.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-18 DOI: 10.1186/s12939-024-02265-6
Mohammed Khaled Al-Hanawi
Over time, global health systems have witnessed significant improvements in the delivery and coverage of healthcare services. Nevertheless, the increasing prominence of non-communicable diseases remains a persistent challenge. Diabetes is one such non-communicable chronic disease that poses a threat with respect to both mortality and morbidity. This study investigated the socio-economic determinants and inequalities in the prevalence of diabetes in the Kingdom of Saudi Arabia according to data collected from the 2018 Saudi Family Health Survey conducted by the General Authority for Statistics. The analysis was limited to a sample of 11,528 respondents aged ≥ 18 years, selected across all 13 regions of Saudi Arabia, with complete responses for all variables of interest. Socio-economic determinants in diabetes prevalence were explored with univariate, bivariate, and multivariate logistic regression analyses. Furthermore, inequalities were visualised and quantitatively estimated according to construction of a concentration curve and calculation of the concentration index. The prevalence of diabetes among the 11,528 respondents was 11.20%. Age, education, income, and residence area were significant determinants of diabetes prevalence, with a greater risk of diabetes found in older participants (odds ratio [OR]: 12.262, 95% confidence interval [CI]: 9.820–15.313, p < 0.01) compared to younger participants. Inequality analysis showed a negative education-based concentration index (–0.235, p < 0.01), indicating that diabetes prevalence is concentrated among people with relatively less formal education. For males, the income-based concentration index was significantly positive, whereas the education-based concentration index was significantly negative, indicating a greater concentration of diabetes among Saudi men with higher incomes and less education. These findings emphasize the need to prioritize policies and strategies for diabetes prevention and control with considerations of the socio-economic inequalities in prevalence. Key areas of focus should include improving education levels across all regions, raising awareness about diabetes and implementing nutritional interventions.
随着时间的推移,全球卫生系统在医疗保健服务的提供和覆盖方面取得了显著改善。然而,非传染性疾病的日益突出仍然是一个持续的挑战。糖尿病就是这样一种对死亡率和发病率都构成威胁的非传染性慢性疾病。本研究根据统计总局开展的 2018 年沙特家庭健康调查收集的数据,调查了沙特阿拉伯王国糖尿病患病率的社会经济决定因素和不平等现象。分析仅限于在沙特阿拉伯所有 13 个地区选取的 11528 名年龄≥ 18 岁的受访者样本,这些受访者对所有相关变量都做出了完整回答。通过单变量、双变量和多变量逻辑回归分析,探讨了糖尿病患病率的社会经济决定因素。此外,根据浓度曲线的构建和浓度指数的计算,对不平等现象进行了可视化和定量估算。在 11528 名受访者中,糖尿病患病率为 11.20%。年龄、教育程度、收入和居住地区是糖尿病患病率的重要决定因素,年龄越大的受访者患糖尿病的风险越高(几率比 [OR]:与年轻参与者相比,老年参与者患糖尿病的风险更高(几率比 [OR]:12.262,95% 置信区间 [CI]:9.820-15.313,P < 0.01)。不平等分析显示,教育集中指数为负值(-0.235,p < 0.01),表明糖尿病发病率集中在正规教育程度相对较低的人群中。就男性而言,基于收入的集中指数呈显著正值,而基于教育的集中指数呈显著负值,这表明糖尿病更集中于收入较高、教育程度较低的沙特男性。这些发现强调,在制定糖尿病预防和控制的政策和战略时,需要优先考虑社会经济不平等的发病率。重点领域应包括提高所有地区的教育水平、提高对糖尿病的认识以及实施营养干预措施。
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引用次数: 0
Rural–urban differences in health service utilization in upper-middle and high-income countries: a scoping review 中上收入和高收入国家在医疗服务利用方面的城乡差异:范围界定审查
IF 4.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-18 DOI: 10.1186/s12939-024-02261-w
Talis Liepins, Garry Nixon, Tim Stokes
This scoping review aims to understand the extent and attributes of literature evaluating differences between rural and urban populations’ utilization of health services in upper-middle and high-income countries. The review was conducted in line with established scoping review methodology guidelines. We used the “Participants, Concept and Context” framework to guide the inclusion criteria and determination of the review’s scope. Studies published over a 15-year period (2008–2022) were identified using Embase, Medine, PubMed, and Scopus databases. Study attributes, areas of focus and findings were reviewed and extracted. The search identified 179 studies. The number of studies published looking at rural–urban differences in health service utilization has increased over time. The focus of these studies is relatively evenly split between primary and secondary sectors. The majority of studies observed less service utilization by rural populations than urban—especially so in primary-sector services. When higher rural utilization of secondary services was observed this was frequently attributed to poor access to other services that would have had the potential to mitigate the secondary demand. Studies were not commonly grounded in principles of equity or fairness and rarely offered value judgements on observed differences in utilization. There were limited system-level studies – the vast majority being disease- or service-specific analyses. We consider this a notable gap in the literature. This scoping review identifies key parameters of studies on rural–urban variation in health service utilization. The finding that most studies observed rural populations utilized comparatively less services is concerning, in the context of general evidence about high levels of health need in rural communities. Future system-level research considering the combined variations in need and utilization appears a priority.
本范围界定综述旨在了解评估中上收入和高收入国家城乡居民利用医疗服务差异的文献的范围和属性。综述按照既定的范围界定综述方法指南进行。我们使用 "参与者、概念和背景 "框架来指导纳入标准和确定综述范围。我们使用 Embase、Medine、PubMed 和 Scopus 数据库确定了 15 年内(2008-2022 年)发表的研究。对研究属性、重点领域和研究结果进行了审查和提取。搜索共发现 179 项研究。随着时间的推移,有关城乡医疗服务利用率差异的研究发表数量有所增加。这些研究的重点相对平均地分布在第一产业和第二产业。大多数研究发现,农村人口对服务的利用率低于城市人口,尤其是在第一产业服务方面。当观察到农村人口对第二产业服务的利用率较高时,这往往被归因于他们难以获得其他服务,而这些服务本有可能缓解第二产业的需求。研究通常不以公平或公正原则为基础,也很少对观察到的利用率差异作出价值判断。系统层面的研究非常有限,绝大多数都是针对具体疾病或服务的分析。我们认为这是文献中的一个明显空白。本范围界定综述确定了有关城乡医疗服务利用差异研究的关键参数。大多数研究发现,农村人口使用的服务相对较少,这一发现令人担忧,因为有普遍证据表明,农村社区的健康需求水平较高。未来系统层面的研究应优先考虑需求和利用率的综合差异。
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引用次数: 0
"No Papers, No Treatment": a scoping review of challenges faced by undocumented immigrants in accessing emergency healthcare "无证件,无治疗":无证移民在获得紧急医疗服务方面所面临挑战的范围界定审查
IF 4.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-14 DOI: 10.1186/s12939-024-02270-9
Sezer Kisa, Adnan Kisa
Undocumented immigrants face many obstacles in accessing emergency healthcare. Legal uncertainties, economic constraints, language differences, and cultural disparities lead to delayed medical care and thereby exacerbate health inequities. Addressing the healthcare needs of this vulnerable group is crucial for both humanitarian and public health reasons. Comprehensive strategies are needed to ensure equitable health outcomes. This study aimed to identify and analyze the barriers undocumented immigrants face in accessing emergency healthcare services and the consequences on health outcomes. We used a scoping review methodology that adhered to established frameworks. Utilizing MEDLINE/PubMed, Embase, Web of Science, PsychoInfo, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), we identified 153 studies of which 12 focused on the specific challenges that undocumented immigrants encounter when accessing emergency healthcare services based on the inclusion and exclusion criteria. The results show that undocumented immigrants encounter significant barriers to emergency healthcare, including legal, financial, linguistic, and cultural challenges. Key findings were the extensive use of emergency departments as primary care due to lack of insurance and knowledge of alternatives, challenges faced by health professionals in providing care to undocumented migrants, increased hospitalizations due to severe symptoms and lack of healthcare access among undocumented patients, and differences in emergency department utilization between irregular migrants and citizens. The findings also serve as a call for enhanced healthcare accessibility and the dismantling of existing barriers to mitigate the adverse effects on undocumented immigrants' health outcomes. Undocumented immigrants' barriers to emergency healthcare services are complex and multifaceted and therefore require multifaceted solutions. Policy reforms, increased healthcare provider awareness, and community-based interventions are crucial for improving access and outcomes for this vulnerable population. Further research should focus on evaluating the effectiveness of these interventions and exploring the broader implications of healthcare access disparities.
无证移民在获得紧急医疗服务方面面临许多障碍。法律上的不确定性、经济上的限制、语言上的差异以及文化上的差异,都会导致医疗服务的延误,从而加剧健康方面的不平等。出于人道主义和公共卫生的原因,满足这一弱势群体的医疗保健需求至关重要。需要采取综合战略来确保公平的医疗结果。本研究旨在确定和分析无证移民在获得紧急医疗保健服务时面临的障碍及其对健康结果的影响。我们采用了符合既定框架的范围审查方法。我们利用 MEDLINE/PubMed、Embase、Web of Science、PsychoInfo 和《护理和专职医疗文献累积索引》(CINAHL),根据纳入和排除标准,确定了 153 项研究,其中 12 项研究关注无证移民在获得急诊医疗服务时遇到的具体挑战。研究结果表明,无证移民在获得急诊医疗服务时遇到了巨大障碍,包括法律、经济、语言和文化方面的挑战。主要发现包括:由于缺乏保险和对其他选择的了解,人们广泛使用急诊科作为初级医疗服务;医疗专业人员在为无证移民提供医疗服务时面临挑战;无证病人因症状严重和缺乏医疗途径而住院治疗的人数增加;以及非正常移民和公民在使用急诊科方面的差异。研究结果还呼吁加强医疗保健的可及性,消除现有障碍,以减轻对无证移民健康结果的不利影响。无证移民获得急诊医疗服务的障碍是复杂和多方面的,因此需要多方面的解决方案。政策改革、提高医疗服务提供者的认识以及基于社区的干预措施对于改善这一弱势群体的就医途径和结果至关重要。进一步的研究应侧重于评估这些干预措施的有效性,并探索医疗服务获取差异的更广泛影响。
{"title":"\"No Papers, No Treatment\": a scoping review of challenges faced by undocumented immigrants in accessing emergency healthcare","authors":"Sezer Kisa, Adnan Kisa","doi":"10.1186/s12939-024-02270-9","DOIUrl":"https://doi.org/10.1186/s12939-024-02270-9","url":null,"abstract":"Undocumented immigrants face many obstacles in accessing emergency healthcare. Legal uncertainties, economic constraints, language differences, and cultural disparities lead to delayed medical care and thereby exacerbate health inequities. Addressing the healthcare needs of this vulnerable group is crucial for both humanitarian and public health reasons. Comprehensive strategies are needed to ensure equitable health outcomes. This study aimed to identify and analyze the barriers undocumented immigrants face in accessing emergency healthcare services and the consequences on health outcomes. We used a scoping review methodology that adhered to established frameworks. Utilizing MEDLINE/PubMed, Embase, Web of Science, PsychoInfo, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), we identified 153 studies of which 12 focused on the specific challenges that undocumented immigrants encounter when accessing emergency healthcare services based on the inclusion and exclusion criteria. The results show that undocumented immigrants encounter significant barriers to emergency healthcare, including legal, financial, linguistic, and cultural challenges. Key findings were the extensive use of emergency departments as primary care due to lack of insurance and knowledge of alternatives, challenges faced by health professionals in providing care to undocumented migrants, increased hospitalizations due to severe symptoms and lack of healthcare access among undocumented patients, and differences in emergency department utilization between irregular migrants and citizens. The findings also serve as a call for enhanced healthcare accessibility and the dismantling of existing barriers to mitigate the adverse effects on undocumented immigrants' health outcomes. Undocumented immigrants' barriers to emergency healthcare services are complex and multifaceted and therefore require multifaceted solutions. Policy reforms, increased healthcare provider awareness, and community-based interventions are crucial for improving access and outcomes for this vulnerable population. Further research should focus on evaluating the effectiveness of these interventions and exploring the broader implications of healthcare access disparities.","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
“Economic exclusion and the health and wellbeing impacts of the oil industry in the Niger Delta region: a qualitative study of Ogoni experiences” "尼日尔三角洲地区的经济排斥以及石油工业对健康和福祉的影响:对奥戈尼人经历的定性研究"
IF 4.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-12 DOI: 10.1186/s12939-024-02248-7
Augusta C. Nkem, Susan Devine, Daprim S. Ogaji, Stephanie M. Topp
When managed effectively, oil wealth can drive economic development and improve wellbeing. Conversely, as has been the experience in Ogoniland in the Niger Delta, the presence of the oil industry can lead to environmental degradation and social and economic vulnerabilities with negative impacts on health and wellbeing. Few studies have explored the experiences and perceptions of these impacts among residents of host communities themselves. This qualitative study explored Ogoni residents’ experiences and perceptions of oil-industry related economic exclusion and associated impacts on health and wellbeing. In-depth interviews with 22 participants from four Local Government Areas (LGAs) were analyzed with open (inductive) coding. Guided by constructivist philosophy, interpretation of emerging themes was informed by the concept of social exclusion which recognizes that multi-dimensional processes can deprive individuals or groups of resources, rights, goods, and services, thus limiting broader societal participation. Findings highlight the exclusionary impacts of the oil industry at the intersection of i) damaged livelihoods and family income, that increased economic vulnerability and reduced participants’ ability to meet basic needs including ability to pay for healthcare; ii) lack of progress on environmental remediation and non-transparent benefit sharing schemes that exacerbate economic displacement and contribute to ongoing exposures to air and water pollution; and iii) insufficient of investment in economic development and essential health services, limiting employment opportunities and ability to access adequate healthcare. Addressing these issues requires integrated policy interventions focusing on equitable resource distribution, environmental restoration, and inclusive economic development to promote sustainable community resilience.
如果管理得当,石油财富可以推动经济发展,改善人们的福祉。相反,正如尼日尔三角洲奥戈尼兰德的经验一样,石油工业的存在可能导致环境退化以及社会和经济脆弱性,对健康和福祉产生负面影响。很少有研究探讨东道社区居民自身对这些影响的体验和看法。本定性研究探讨了奥戈尼居民对与石油工业相关的经济排斥以及对健康和福祉的相关影响的体验和看法。对来自四个地方政府辖区(LGAs)的 22 名参与者进行了深入访谈,并对访谈内容进行了开放式(归纳式)编码分析。在建构主义哲学的指导下,对新出现的主题进行了解释,并借鉴了社会排斥的概念,即多维过程可能会剥夺个人或群体的资源、权利、商品和服务,从而限制更广泛的社会参与。研究结果凸显了石油工业在以下方面产生的排斥性影响:i) 生计和家庭收入受损,增加了经济脆弱性,降低了参与者满足基本需求的能力,包括支付医疗费用的能力;ii) 环境修复缺乏进展,利益分享计划不透明,加剧了经济流离失所现象,导致持续暴露于空气和水污染中;iii) 经济发展和基本医疗服务投资不足,限制了就业机会和获得适当医疗服务的能力。要解决这些问题,就必须采取综合政策干预措施,重点关注资源的公平分配、环境恢复和包容性经济发展,以促进社区的可持续恢复能力。
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引用次数: 0
Equity considerations for the implementation of health insurance benefit package in Ethiopia: result of expert Delphi exercise 埃塞俄比亚实施一揽子医疗保险福利的公平考虑因素:专家德尔菲活动的结果
IF 4.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-11 DOI: 10.1186/s12939-024-02226-z
Solomon Tessema Memirie, Muluken Argaw, Mieraf Taddesse Tolla, Frehiwot Abebe, Wubaye Walelgne Dagnaw, Ole F. Norheim, Amanuel Yigezu
Efficiency, equity and financial risk protection are key health systems objectives. Equitable distribution of health care is among the priority strategic initiative of the government of Ethiopia. However, data on the distribution of interventions benefits or on disease burden disaggregated by subpopulations to guide health care priority setting is not available in Ethiopia. Aligned with policy documents, we identified the following groups to be the worse off in the Ethiopian context: under-five children, women of reproductive age, the poor, and rural residents. We used the Delphi technique by a panel of 28 experts to assign a score for 253 diseases/conditions over a period of two days, in phases. The expert panel represented different institutes and professional mix. Experts assigned a score 1 to 4; where 4 indicates disease/condition predominantly affecting the poor and rural residents and 1 indicates a condition more prevalent among the wealthy and urban residents. Subsequently, the average equity score was computed for each disease/condition. The average scores ranged from 1.11 (for vitiligo) to 3.79 (for obstetric fistula). We standardized the scores to be bounded between 1 and 2; 1 the lowest equity score and 2 the highest equity score. The scores for each disease/condition were then assigned to their corresponding interventions. We used these equity scores to adjust the CEA values for each of the interventions. To adjust the CEA values for equity, we multiplied the health benefits (the denominator of the cost-effectiveness value) of each intervention by the corresponding equity scores, resulting in equity adjusted CEA values. The equity adjusted CEA was then used to rank the interventions using a league table. The Delphi method can be useful in generating equity scores for prioritizing health interventions where disaggregated data on the distribution of diseases or access to interventions by subpopulation groups are not available.
效率、公平和财务风险保护是卫生系统的主要目标。公平分配医疗保健是埃塞俄比亚政府的优先战略举措之一。然而,埃塞俄比亚并没有关于干预措施收益分配的数据,也没有按亚人群分类的疾病负担数据来指导医疗保健优先事项的制定。根据政策文件,我们确定了埃塞俄比亚情况最差的以下群体:五岁以下儿童、育龄妇女、贫困人口和农村居民。我们使用德尔菲技术,由 28 位专家组成的专家小组在两天时间内分阶段对 253 种疾病/病症进行了评分。专家小组代表了不同的机构和专业组合。专家们给出了 1 至 4 分;其中 4 分表示主要影响穷人和农村居民的疾病/病症,1 分表示在富人和城市居民中更为普遍的疾病/病症。随后,计算出每种疾病/状况的平均公平得分。平均得分从 1.11(白癜风)到 3.79(产科瘘)不等。我们将得分标准化,使其介于 1 和 2 之间;1 代表最低公平得分,2 代表最高公平得分。然后将每种疾病/状况的得分分配给相应的干预措施。我们使用这些公平性得分来调整每个干预措施的 CEA 值。为了根据公平性调整 CEA 值,我们将每种干预措施的健康效益(成本效益值的分母)乘以相应的公平性得分,得出公平性调整后的 CEA 值。然后使用公平调整后的 CEA 值对干预措施进行排名。在没有关于疾病分布或次人口群体获得干预措施的分类数据的情况下,德尔菲法可用于生成公平分数,以确定卫生干预措施的优先次序。
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引用次数: 0
Building a healthy generation together: parents’ experiences and perceived meanings of a family-based program delivered in ethnically diverse neighborhoods in Sweden 共建健康的下一代:在瑞典不同种族社区开展的家庭计划的父母经验和感知意义
IF 4.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-11 DOI: 10.1186/s12939-024-02271-8
Lisette Farias, Mai-Lis Hellenius, Gisela Nyberg, Susanne Andermo
Ethnically diverse neighborhoods encounter pronounced inequalities, including housing segregation and limited access to safe outdoor spaces. Residents of these neighborhoods face challenges related to physical inactivity, including sedentary lifestyles and obesity in adults and children. One approach to tackling health inequalities is through family-based programs tailored specifically to these neighborhoods. This study aimed to investigate parents’ experiences and perceptions of the family-based Open Activities, a cost-free and drop-in program offered in ethnically diverse and low socioeconomic neighborhoods in Sweden. Researchers’ engagement in 15 sessions of the Open Activities family-based program during the spring of 2022, and individual interviews with 12 participants were held. Data were analyzed using reflexive thematic analysis. The analysis resulted in three main themes and seven sub-themes representing different aspects of the program’s meaning to the participants as parents, their families, and communities. The main themes describe how parents feel valued by the program, which actively welcomes and accommodates families, regardless of cultural differences within these neighborhoods. The themes also show how cultural norms perceived as barriers to participation in physical activity can be overcome, especially by mothers who express a desire to break these norms and support girls’ physical activity. Additionally, the themes highlight the importance of parents fostering safety in the area and creating a positive social network for their children to help them resist criminal gang-related influences. The program’s activities allowed parents to connect with their children and other families in their community, and (re)discover physical activity by promoting a sense of community and safety. Implications for practice include developing culturally sensitive activities that are accessible to and take place in public spaces for ethnically diverse groups, including health coordinators that can facilitate communication between groups. To enhance the impact of this program, it is recommended that the public sector support the creation of cost-free and drop-in activities for families who are difficult to reach in order to increase their participation in physical activity, outreach, and safety initiatives.
种族多元化社区面临着明显的不平等,包括住房隔离和获得安全户外空间的机会有限。这些社区的居民面临着缺乏运动的挑战,包括久坐不动的生活方式以及成人和儿童肥胖症。解决健康不平等问题的方法之一是为这些社区量身定制基于家庭的计划。这项研究旨在调查家长对基于家庭的 "开放活动 "的体验和看法。"开放活动 "是一项免费的随到随学计划,在瑞典的种族多元化和社会经济水平较低的社区开展。研究人员在 2022 年春季参与了 15 次以家庭为基础的 "开放活动 "项目,并对 12 名参与者进行了个别访谈。研究人员采用反思性主题分析法对数据进行了分析。分析得出了三个主要主题和七个次主题,分别代表了该计划对参与者作为父母、其家庭和社区的不同方面的意义。主主题描述了家长如何感受到该计划的价值,该计划积极欢迎和接纳家庭,而不考虑这些社区的文化差异。这些主题还表明,被视为参加体育锻炼障碍的文化规范是如何被克服的,尤其是那些表示希望打破这些规范并支持女孩参加体育锻炼的母亲。此外,这些主题还强调了家长促进地区安全和为孩子创造一个积极的社会网络以帮助他们抵制与犯罪团伙有关的影响的重要性。该计划的活动让家长们能够与孩子和社区中的其他家庭建立联系,并通过增强社区感和安全感来(重新)发现体育锻炼的重要性。该计划对实践的启示包括:开展文化敏感性活动,让不同种族的群体都能参与到活动中来,并在公共场所开展活动,包括可以促进群体间交流的健康协调员。为提高该计划的影响力,建议公共部门支持为难以接触到的家庭开展免费和随到随学的活动,以提高他们对体育活动、外联和安全倡议的参与度。
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引用次数: 0
Consideration of inequalities in effectiveness trials of mHealth applications – a systematic assessment of studies from an umbrella review 考虑移动保健应用有效性试验中的不平等问题--对总体审查中的研究进行系统评估
IF 4.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-11 DOI: 10.1186/s12939-024-02267-4
Nancy Abdelmalak, Jacob Burns, Laura Suhlrie, Michael Laxy, Anna-Janina Stephan
The growing use of mobile health applications (apps) for managing diabetes and hypertension entails an increased need to understand their effectiveness among different population groups. It is unclear if efficacy and effectiveness trials currently provide evidence of differential effectiveness, and if they do, a summary of such evidence is missing. Our study identified to what extent sociocultural and socioeconomic inequalities were considered in effectiveness trials of mobile health apps in diabetic and hypertensive patients and if these inequalities moderated app effectiveness. We built on our recent umbrella review that synthesized systematic reviews (SRs) of randomized controlled trials (RCTs) on the effectiveness of health apps. Using standard SR methodologies, we identified and assessed all primary RCTs from these SRs that focused on diabetes and/or hypertension and reported on health-related outcomes and inequality-related characteristics across intervention arms. We used the PROGRESS-Plus framework to define inequality-related characteristics that affect health opportunities and outcomes. We used harvest plots to summarize the subgroups (stratified analyses or interaction terms) on moderating effects of PROGRESS-Plus. We assessed study quality using the Risk of Bias 2 tool. We included 72 published articles of 65 unique RCTs. Gender, age, and education were the most frequently described PROGRESS-Plus characteristics at baseline in more than half of the studies. Ethnicity and occupation followed in 21 and 15 RCTs, respectively. Seven trials investigated the moderating effect of age, gender or ethnicity on app effectiveness through subgroup analyses. Results were equivocal and covered a heterogenous set of outcomes. Results showed some concerns for a high risk of bias, mostly because participants could not be blinded to their intervention allocation. Besides frequently available gender, age, and education descriptives, other relevant sociocultural or socioeconomic characteristics were neither sufficiently reported nor analyzed. We encourage researchers to investigate how these characteristics moderate the effectiveness of health apps to better understand how effect heterogeneity for apps across different sociocultural or socioeconomic groups affects inequalities, to support more equitable management of non-communicable diseases in increasingly digitalized systems. https://osf.io/89dhy/ .
随着管理糖尿病和高血压的移动医疗应用程序(Apps)的使用日益增多,人们越来越需要了解这些应用程序在不同人群中的有效性。目前尚不清楚疗效和有效性试验是否提供了不同有效性的证据,如果提供了,也缺少对这些证据的总结。我们的研究确定了针对糖尿病和高血压患者的移动医疗应用程序的有效性试验在多大程度上考虑了社会文化和社会经济的不平等,以及这些不平等是否会调节应用程序的有效性。最近,我们对有关健康应用程序有效性的随机对照试验(RCT)进行了系统性综述(SR),在此基础上,我们对这些综述进行了综合。利用标准的系统综述方法,我们确定并评估了这些系统综述中所有以糖尿病和/或高血压为研究对象、报告了健康相关结果和干预措施间不平等相关特征的主要 RCTs。我们使用 PROGRESS-Plus 框架来定义影响健康机会和结果的不平等相关特征。我们使用收获图来总结亚组(分层分析或交互项)对 PROGRESS-Plus 的调节作用。我们使用 Risk of Bias 2 工具评估了研究质量。我们共纳入了 72 篇已发表的文章,其中 65 篇为 RCT。在半数以上的研究中,性别、年龄和教育程度是最常描述的 PROGRESS-Plus 基线特征。其次是种族和职业,分别有 21 项和 15 项研究数据。七项试验通过亚组分析研究了年龄、性别或种族对应用程序有效性的调节作用。结果模棱两可,涵盖的结果也不尽相同。研究结果表明,存在较高的偏倚风险,这主要是因为无法对参与者的干预分配进行盲法处理。除了常见的性别、年龄和教育程度描述外,其他相关的社会文化或社会经济特征既没有得到充分报告,也没有得到充分分析。https://osf.io/89dhy/。
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引用次数: 0
A realist impact evaluation of a tool to strengthen equity in local government policy-making 对加强地方政府决策公平性的工具进行现实主义影响评估
IF 4.8 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-10 DOI: 10.1186/s12939-024-02266-5
Schultz Sally, Beissmann Felicity, Zorbas Christina, Yoong Serene, Peeters Anna, Backholer Kathryn
Local governments have a critical role to play in addressing health inequities. Health equity impact assessments are recommended to help governments apply an equity lens to the development and implementation of policies and programs. Despite evidence of equity-positive benefits of such tools, adoption remains limited, prompting calls for evaluations to assess their impact and identify factors that will promote uptake across various contexts. We conducted a mixed method study to evaluate the impact of an equity impact assessment (EIA) tool and process on policies and organisational capacity in a local government in Victoria, Australia, and identify factors that influenced this impact. We analysed 33 documents related to 18 EIAs, and conducted surveys (n = 40) and in-depth interviews (n = 17) with staff involved in EIAs. Almost all (17 of 18) EIAs resulted in equity-positive changes to policies and programs, most frequently addressing individual-level factors, such as making community communications and consultations more accessible to under-represented or under-served groups. Structural-level recommendations from one EIA, such as increasing diversity in decision-making panels, were found to impact both the current policy and a broad range of future, related projects and services. Improvements in equity-centric organisational culture and capacity (including staff awareness, skills and confidence) and increased engagement with under-represented communities were also reported. Factors perceived to influence the impact of EIA’s related to organisational commitment and capacity to prioritise equity, process-level factors related to the type and timing of EIAs, and extent of implementation support. Our study supports wider uptake of health equity impact assessments in local government policies and programs. Legislation, leadership and resources from upper-tiers of government can help increase the adoption of equity tools to reduce disparities in population health.
地方政府在解决健康不公平问题方面发挥着至关重要的作用。建议进行健康公平影响评估,以帮助政府在制定和实施政策和计划时采用公平视角。尽管有证据表明此类工具具有积极的公平效益,但其采用仍然有限,这促使人们呼吁对其影响进行评估,并确定在不同情况下促进采用的因素。我们开展了一项混合方法研究,以评估公平影响评估(EIA)工具和流程对澳大利亚维多利亚州地方政府的政策和组织能力的影响,并确定影响这种影响的因素。我们分析了与 18 项 EIA 相关的 33 份文件,并对参与 EIA 的工作人员进行了调查(n = 40)和深入访谈(n = 17)。几乎所有的环境影响评估(18 项中的 17 项)都对政策和计划进行了积极的公平改革,其中最常见的是针对个人层面的因素,例如让代表人数不足或服务不足的群体更容易获得社区沟通和咨询。一项环境影响评估提出的结构层面的建议,如增加决策小组的多样性,被认为既影响了当前的政策,也影响了未来广泛的相关项目和服务。此外,还报告了以公平为中心的组织文化和能力(包括工作人员的意识、技能和信心)的改善情况,以及与代表人数不足的群体接触的增加情况。被认为影响环境影响评估影响的因素涉及组织承诺和优先考虑公平的能力、与环境影响评估的类型和时间有关的过程层面因素以及实施支持的程度。我们的研究支持在地方政府政策和计划中更广泛地采用健康公平影响评估。上层政府的立法、领导力和资源可帮助更多地采用公平工具来减少人口健康方面的差异。
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引用次数: 0
Temporal trends in lower extremity amputation in Middle East and North Africa (MENA) region: analysis of the GBD dataset 1990-2019. 中东和北非地区下肢截肢的时间趋势:1990-2019 年 GBD 数据集分析。
IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-03 DOI: 10.1186/s12939-024-02264-7
Yazan A Al-Ajlouni, Mohamed Abouzid, Mohammad Tanashat, Ahmed Ahmed Basheer, Omar Al Ta'ani, Naciye Bilgin-Badur, Mohammad Islam

Background: Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019.

Methods: The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time.

Results: From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region.

Conclusion: The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region.

背景:下肢截肢(LEAs)是导致死亡率和发病率的重要原因,通常由外周动脉疾病和糖尿病(DM)引起。外伤也是许多下肢截肢的原因。尽管造成了全球负担,但对 LEAs 的流行病学,尤其是中东和北非地区(MENA)的 LEAs 流行病学仍未进行充分探索。本研究利用全球疾病负担(GBD)数据集,分析中东和北非地区从1990年到2019年LEAs的时间趋势:该研究利用了 2019 年的 GBD 数据集,其中包括 369 种疾病的发病率、流行率和残疾调整生命年(DALYs)的估计值。提取了 21 个中东和北非国家的 LEA 年龄标准化发病率 (ASIR)。使用百分比变化计算和联结点回归分析趋势,以确定 LEA 发病率随时间的显著变化:从 1990 年到 2019 年,男性的 LEA 发生率普遍下降,而女性的发生率则有所上升。叙利亚、也门和阿富汗的 LEA 率显著上升,与冲突和不稳定时期相关。相反,伊拉克、巴勒斯坦、苏丹、黎巴嫩、伊朗和科威特等国的 LEA 率则明显下降。研究强调了社会政治因素、自然灾害和慢性疾病(如 DM)在影响整个地区 LEA 趋势方面复杂的相互作用:这项研究揭示了中东和北非地区受冲突、自然灾害和慢性疾病影响的不同 LEA 趋势。这些发现突出表明,有必要采取有针对性的公共卫生干预措施,改善医疗服务的可及性,并建立强大的数据收集系统,以减轻中东和北非地区的 LEA 负担,改善患者的治疗效果。
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引用次数: 0
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International Journal for Equity in Health
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