International Journal for Equity in Health最新文献

Background: Asylum seekers and refugees in Switzerland face major barriers to oral health care services, often limited to urgent treatments like tooth extractions. Access depends largely on legal status, canton of residence and duration in the country, whereby it is largely unclear for those affected as to which treatments are actually covered.

Methods: Sixteen interviews and three in-clinic observations were conducted with Arabic-speaking asylum seekers and refugees in Basel-Stadt and Basel-Landschaft, two German-speaking Swiss cantons.

Results: It was documented that financial constraints, permit restrictions, communication challenges, and limited autonomy often led participants to delay or avoid dental care, worsening their oral health. While frameworks like Levesque's model help explain access challenges, they do not fully capture how systemic barriers shape asylum seekers and refugees' abilities to recognize needs, seek care, and participate in their own health decisions. If these deeper structural issues are not addressed, there is a risk that efforts to improve care will fall short.

Conclusion: The current findings point to the need for systemic reforms to improve coverage, communication, and preventive care, while promoting equitable, tooth-preserving treatment options for asylum seekers and refugees.

Introduction: Lower limb amputation has a significant impact on an individual's overall quality of life, with prosthetic devices serving as essential tools for rehabilitation and mobility restoration. In Syria, where access to advanced medical care remains constrained, identifying the key factors affecting the well-being of prosthesis users is crucial for enhancing rehabilitation strategies. This study examines the sociodemographic and health-related determinants influencing the quality of life among lower-limb amputees who rely on prosthetic devices in Syria.

Methods: This research employed a cross-sectional design at a highly specialized disability care facility within a tertiary hospital. A total of 233 individuals with lower limb amputations, all of whom had been using prosthetic limbs for at least five years, participated in the study. The sample was drawn from patients receiving treatment at the same medical institution. Data collection encompassed sociodemographic details, health status, and pain-related experiences. The SF-12 questionnaire was utilized to assess health-related quality of life (HrQoL), categorizing scores above 50 as indicative of good HrQoL in both the Mental Component Summary (MCS) and Physical Component Summary (PCS), while scores below 50 denoted poor HrQoL. Statistical analysis involved the Chi-square (χ²) test, applied with a 95% confidence level to examine associations among the study variables.

Results: The study assessed health-related quality of life among individuals with lower limb amputations, indicating that 62.23% had high mental health scores, while 66.09% demonstrated high physical health scores. Analysis revealed significant links between age and marital status with both the MCS and PCS. Furthermore, the cause of amputation and the occurrence of phantom pain were associated with MCS. Several pain-related factors, including residual limb pain treatment, its perceived effectiveness, and residual residual limb pain, showed significant associations with both MCS and PCS. Additionally, extremity dominance and actions taken to manage residual limb pain were notably linked to PCS. Lastly, a significant relationship was observed between the level of amputation and the treatment of phantom pain.

Conclusion: These findings emphasize the significant impact of age, marital status, limb dominance, cause of amputation, and residual limb pain treatment on the quality of life of lower limb amputees. They highlight the need for comprehensive rehabilitation programs that prioritize effective pain management, social support, and personalized care tailored to the unique demographic and clinical needs of each individual.

Background: Neonatal disorders remain a leading cause of loss of healthy life years worldwide, second only to COVID-19 in 2021, although most neonatal deaths are preventable. The neonatal mortality rate (NMR), a key indicator of the 2030 Sustainable Development Agenda, varies widely within and between countries, reflecting social conditions that shape neonatal survival. This study examined the magnitude and temporal trends of ecosocial inequalities in Peru's NMR from 2007 to 2021, their relationship with selected social determinants, and changes in the epidemiological profile of neonatal deaths.

Methods: An ecological study was conducted using data from Peru's 25 regions (2007-2021). Temporal trends in NMR and inequalities along a social gradient defined by monetary poverty, unmet basic needs, and food insecurity were analyzed. Absolute and relative inequalities were measured using the slope index of inequality (SII) and concentration index (CIx). Inflection points in trends were identified with joinpoint regression, and monotonic associations between NMR (and its inequalities) and contextual variables were assessed using Spearman's rank correlation. Changes in the epidemiological profile of neonatal deaths were evaluated with the Chi-square test.

Results: Peru's NMR declined from 10.3 to 8.8 deaths per 1,000 live births between 2007 and 2021, with the steepest reduction around 2010-2014. Most regions experienced decreases, except Huancavelica, Pasco, and Puno. Cross-regional inequalities showed a persistent pro-rich pattern, indicating survival disadvantages in regions with higher unmet basic needs. National NMR trends correlated positively with unmet basic needs and monetary poverty and negatively with current health expenditure per capita. During the COVID-19 years, inequalities narrowed as NMR fell in poorer regions and rose in richer ones. The epidemiological profile shifted toward a higher proportion of deaths from extreme prematurity and low birth weight.

Conclusions: From 2007 to 2021, Peru achieved a decline in neonatal mortality, but pro-rich regional inequalities persisted, and the burden remained concentrated in highland regions. During the COVID-19 period, the downward trend continued while inequalities narrowed, in parallel with reductions in poverty and increases in health expenditure. These ecological findings highlight the importance of monitoring health inequalities alongside national averages to support accountability toward the SDG commitment to "leave no one behind."