Objectives:This scoping review aims to methodically identify and analyse the determinants which influence maternal mortality and healthcare utilization in women of childbearing years in Nigeria.The review specifically...Objectives:This scoping review aims to methodically identify and analyse the determinants which influence maternal mortality and healthcare utilization in women of childbearing years in Nigeria.The review specifically addresses the difficulties faced in assessing medical care,and the ongoing initiatives to lower the maternal mortality ratio.Methods:Primary studies(published after year 2000)focused on maternal mortality,health determinants,and the utilization of maternal healthcare services in Nigeria were retrieved following a systematic search across multiple databases,including Scopus,PubMed,Google Scholar,and Web of Science.These were screened using defined inclusion and exclusion criteria.Data from these studies were extracted and thematically analysed to identify common themes and trends.Results:A total of 21 publications were included in this review comprising 2 qualitative,17 quantitative,and2 mixed study designs.Major health determinants identified in these studies include hypertensive disorders of pregnancy,haemorrhage,and sepsis/septicaemia,contributing as much as 29%,24%,and 14.2%of maternal deaths respectively in over 10%of the reviewed studies.Similarly,social-economic determinants including poverty,maternal education,health system issues and culture significantly impacted the utilization of maternal healthcare services,inadvertently impacting maternal mortality.Despite various maternal health interventions such as the"Abiye"Safe Motherhood Initiative,the Integrated Maternal,Newborn,and Child Health Strategy and strengthening emergency obstetric care by governmental and non-governmental agencies,early childbearing,unemployment,large family sizes,and dependence on male spouses continued to result in suboptimal utilization of services and adverse maternal outcomes.Conclusion:This scoping review comprehensively integrated existing data from published studies to provide a detailed picture of maternal mortality,its health determinants,and factors influencing care utilization among women of childbearing age in Nigeria and approaches to reduce maternal mortality in the country and possibly in the West African sub-region.展开更多
Objective To explore the health determinants of all-cancer mortality from a health-ecological perspective.Methods Using the health-ecological model,we identified 15 health determinants across five domains:personal inn...Objective To explore the health determinants of all-cancer mortality from a health-ecological perspective.Methods Using the health-ecological model,we identified 15 health determinants across five domains:personal innate,behavioral,interpersonal network,socioeconomic,and macroenvironmental characteristics.Data on cancer outcomes and health determinants from 185 countries,classified using the Human Development Index(HDI),were extracted from GLOBOCAN 2022,the World Health Organization Global Health Observatory,the Global Burden of Disease Study 2021,the United Nations,and the World Bank.A multivariate linear regression model was used to estimate the association between health determinants and cancer outcomes.Results A total of 153 countries with complete information on cancer outcomes and health determinants were enrolled in the study.A higher all-cancer age-standardized mortality rate(ASMR)was associated with current tobacco use,alcohol consumption,obesity,agricultural employment,and lag-distributed income.In women aged 15–49 years,being married or in a union was associated with a lower ASMR.Early-onset ASMR was positively associated with agricultural employment,lag-distributed income,and unsafe sanitation.Notable sex differences were observed,although tobacco use and obesity were identified as risk factors in both sexes.Conclusion We underscore the crucial need to incorporate cross-sectoral interventions within a resilient healthcare system to effectively mitigate the cancer mortality burden.展开更多
Preservation of teeth until old ages indicates oral health status. Improving life expectancy in developing countries makes teeth care an important topic. This study assessed reasons of tooth extraction (TE), oral heal...Preservation of teeth until old ages indicates oral health status. Improving life expectancy in developing countries makes teeth care an important topic. This study assessed reasons of tooth extraction (TE), oral health determinants and demographic factors of permanent TE in Iranian adults. Adult people who referred to dental clinic of Mashhad Medical University in 2012 for dental extraction and lived in Mashhad city, participated in this study by convenient sampling method after obtaining informed consent. Demographic characteristics, oral health status, health habit and reasons of TE of participants were assessed. Data were analyzed by SPSS11.5 by Chi-Square, T-Test, ANOVA, Mann-Whitney and Kruskall-Wallis tests. Totally 254 people participated (383 extracted teeth) that 55% were female. Mean age of participants was 39.3 years;females were 6.1 years younger than males. The main reason of TE was dental caries (55.1%), following by impaction. There was significant difference between average times of tooth brushing in both sexes, but difference was not shown in sugar intake. Except in people with college degrees that dental caries is the main cause of TE. With increase in life expectancy to more than 70 years old in Iranian, the age of TE especially in women is younger than expected. The most common cause of TE is dental caries that seem in spite of improving health indexes in Iran, poor oral hygiene remains as a problem. There is no significant difference between frequency of sugar intake and level of education that indicates unhealthy dietary habits related to tooth decay.展开更多
Rhegmatogenous retinal detachment(RRD)is a sight threatening condition in which the neurosensory retina separates from the underlying retinal pigment epithelium.With an incidence of 6.3 to 17.9 per 100,000 persons(1),...Rhegmatogenous retinal detachment(RRD)is a sight threatening condition in which the neurosensory retina separates from the underlying retinal pigment epithelium.With an incidence of 6.3 to 17.9 per 100,000 persons(1),RRD is a condition frequently encountered by vitreoretinal specialists.Because the fovea is responsible for central visual acuity,foveal detachment is associated with poor presenting vision and is the strongest prognostic factor predicting poor visual outcome after RRD repair(2).展开更多
BACKGROUND Social determinants of health are social and economic factors that influence health intervention outcomes.Type 2 diabetes is a highly prevalent disease,primarily affecting individuals in low-to-middle-incom...BACKGROUND Social determinants of health are social and economic factors that influence health intervention outcomes.Type 2 diabetes is a highly prevalent disease,primarily affecting individuals in low-to-middle-income countries.However,the association between social determinants and cardiovascular complications in type 2 diabetes has not been widely studied.AIM To examine the relationship between social determinants of health and cardiovascular complications in individuals with type 2 diabetes.METHODS We conducted a retrospective cohort study with an analytical component at a national-level referral hospital for military personnel in Bogota,Colombia.Patients treated at the diabetes clinic between September 2021 and December 2022 who met the inclusion criteria were included.A total of 583 patients participated in the study.We performed descriptive,bivariate,and binary logistic regression analyses,adjusting for confounding variables.RESULTS Among the 583 patients included,urban residency[odds ratio(OR)=3.05,95%confidence interval(CI):1.01-9.20]and a middle or high educational level(OR=2.33,95%CI:1.14-4.72)were associated with an increased risk of coronary artery disease.Additionally,receiving diabetes education beyond that provided by the clinic(OR=2.15,95%CI:1.14-4.05)and lack of access to spaces for physical activity(OR=4.05,95%CI:1.31-12.5)were associated with a higher risk of diabetic nephropathy and cerebrovascular disease,respectively.CONCLUSION Programs for diabetes management should account for social determinants of health that contribute to cardiovascular complications and increased healthcare costs.Population-based studies are needed to guide targeted interventions and clarify causal relationships.展开更多
Social determinants of health (SDOH) contribute to cancer disparities among young Latina women (<50 years) residing in the counties along the US-Mexico border. These SDOH are particularly burdensome to young Latina...Social determinants of health (SDOH) contribute to cancer disparities among young Latina women (<50 years) residing in the counties along the US-Mexico border. These SDOH are particularly burdensome to young Latina mothers diagnosed with cancer while they are raising school-age children. Conexiones, a culturally adapted program designed to improve mother and child adjustment to maternal cancer, was piloted with diagnosed Latina mothers residing in border counties in New Mexico and Texas. The purpose of this case analysis was to highlight the SDOH affecting a young Latina mother’s cancer survivorship in the U.S.-Mexico border region. The participant’s Conexiones education sessions were recorded, transcribed, translated to English, back translated to Spanish to establish accuracy, and inductively coded. The participant’s baseline survey indicated she was a young (<50 years), married, Spanish-speaking Latina mother diagnosed with breast cancer while raising a teenage daughter. Seventeen SDOH themes affecting the participant’s cancer experience were identified in the cancer-related emotional triggers she reported across five Conexiones sessions. These themes were organized using Yanez’s conceptual model of determinants of cancer outcomes in Hispanics (i.e., socioeconomic, healthcare, cultural context, and psychosocial). Findings provide direction for cultural adaptations of evidence-based programs.展开更多
Social determinants of health(SDOH)affect quality of life.We investigated SDOH impacts on self-perceived resilience among people with adult congenital heart disease(ACHD).Secondary analysis of data from two com-plemen...Social determinants of health(SDOH)affect quality of life.We investigated SDOH impacts on self-perceived resilience among people with adult congenital heart disease(ACHD).Secondary analysis of data from two com-plementary studies:a survey study conducted May 2021–June 2022 and a qualitative study conducted June 2020–August 2021.Resilience was assessed through CD-RISC10 score(range 0–40,higher scores reflect greater self-perceived resilience)and interview responses.Sociodemographic and SDOH(education,employment,living situa-tion,monetary stability,financial dependency,area deprivation index)data were collected by healthcare record review and self-report.We used linear regression with robust standard errors to analyze survey data and performed a thematic analysis of interview data.Survey participants(N=127)mean age was 42±14 years;51%were female,87%white.ACHD was moderate(75%)or complex(25%);41%functional class C or D.Resilience(mean 30±7)varied by monetary stability:compared to people with difficulty paying bills,resilience was 15.0 points higher(95%CI:6.9–23.1,p<0.001)for people reporting having enough money and 14.2 points higher(95%CI:5.9–22.4,p=0.001)for those reporting just enough money.Interview participants’(N=25)mean age was 32 years(range 22–44);52%were female,72%white.ACHD was moderate(56%)or complex(44%);76%functional class C or D.Participants discussed factors affecting resilience aligned with each of the major SDOH,prominently,economic stability and healthcare access and quality.Financial stability may be important for supporting self-perceived resi-lience in ACHD.This knowledge can inform the development of resilience interventions for this population.展开更多
Increasingly international and national policies are being directed at actions for the social determinants of health and for an integrated approach to health care provision, not only in terms of institutional cooperat...Increasingly international and national policies are being directed at actions for the social determinants of health and for an integrated approach to health care provision, not only in terms of institutional cooperation but also stakeholder involvement. A key component of both these policies is the development of good governance principles in all health care agencies and organizations. A neglected dimension in these debates has been the role of the public hospital which remains a vital and expensive dimension of service provision. In a case study of a public hospital in South Africa, this paper charts the readiness of its management principles and activities to provide quality health care linked to population health and to contribute to the non-medical determinant of health. Using Taylor’s principles of good governance, we conclude that there is a mixture of good and not so good governance activity. The paper concludes by examining the external constraints on the public hospital and by providing suggestions for future activities.展开更多
Social determinants of health are some indicating factors such as income, education, class, gender, and race that influence the socio-economic status of people living in a society. Coronavirus affects the social, econ...Social determinants of health are some indicating factors such as income, education, class, gender, and race that influence the socio-economic status of people living in a society. Coronavirus affects the social, economic, and also political sectors of people all over the world. In Bangladesh, during the Covid-19 pandemic, people of all ages and classes have faced social and economic crises based on the social determinants of health. Higher-class families had the facility of advanced medical services rather than the lower and lower-middle classes. This article aims to show the relationship between the social determinants of health and the socio-economic impact of the Covid-19 pandemic in Bangladesh. This paper presents some secondary data to describe the socio-economic impact of Covid-19 and the functions of the social determinants of health in this case.展开更多
Modern women have increased options for birth control with the development of Long Acting Reversible Contraceptives (LARCs). These methods are reliable, easy to use, and require less daily maintenance while providing ...Modern women have increased options for birth control with the development of Long Acting Reversible Contraceptives (LARCs). These methods are reliable, easy to use, and require less daily maintenance while providing contraception for an extended period of time. However, despite the surge of LARCs as contraceptive options, the prevalence of unintended pregnancies is still alarmingly high in the United States. As LARCs are the most effective reversible method of birth control at preventing pregnancy, and therefore the potential social, financial, and medical complications associated, we examined whether social determinants of health play a role in LARC usage. While parity and marriage do not seem to affect LARC utilization, increased research is needed to determine the effects of race. Age can affect the type of LARC implemented, as younger women prefer implants to intrauterine devices (IUDs). Insurance coverage was an apparent influencer of LARC usage, as low out-of-pocket costs translate to increased utilization. This is linked to socioeconomic status (SES), as lower SES is associated with decreased access to healthcare in general. Increased research is needed in order to draw conclusions about the effects of education, intimate partner violence, geographic location, and other SDH on LARC usage.展开更多
Background: Social determinants of health (SDOH) significantly influence diseases with environmental components, like vector-borne parasitic diseases. This study aims to examine how these factors influence vector-born...Background: Social determinants of health (SDOH) significantly influence diseases with environmental components, like vector-borne parasitic diseases. This study aims to examine how these factors influence vector-borne parasitic diseases (VBPDs) transmission in Chad and provide recommendations for policy improvements. Methods: The study adopts the WHO Conceptual Framework of SDOH to compare two regions in Southern Chad: Kouh-Est, which has an ongoing vector control program, and Grand-Sido, which lacks such a program. The study includes both nomadic and sedentary populations to provide a comprehensive understanding of the SDOH influencing VBPDs. Households were randomly selected. Data on sociodemographic characteristics, literacy, knowledge of VBPDs and protective measures, and access to education and health facilities were collected. Results: A total of 202 households from 17 villages, including 820 participants, were surveyed. Agriculture, livestock, and fishing were the main occupations, involving 84.1% of participants. Literacy was low, with 36.7% non-educated, 47.7% completing primary school, 14.5% secondary school, and only 0.3% reaching tertiary education. Most villages lacked schools beyond the primary level, and nomadic populations were significantly less educated than sedentary ones (p Conclusion: Educational deficiencies, lack of protective measures against vectors, inadequate healthcare resources, and lifestyle conditions aggravated by poor road infrastructure, limited transportation, and economic constraints contribute to worsened VBPDs outcomes in these rural populations. Addressing these systemic issues in the surveyed communities is essential for improving health equity and VBPDs outcomes in these regions specifically and in similar populations settings more broadly.展开更多
Chronic diseases,or NCDs(noncommunicable diseases),constitute a major global health challenge,causing millions of deaths and imposing substantial economic burdens annually.This paper introduces the Health Score,a comp...Chronic diseases,or NCDs(noncommunicable diseases),constitute a major global health challenge,causing millions of deaths and imposing substantial economic burdens annually.This paper introduces the Health Score,a comprehensive framework for assessing chronic disease risk by integrating diverse determinants of health,including social,economic,environmental,behavioral,treatment,culture,and nature factors.The Health Score,ranging from 0 to 850,quantifies indivi dual and population-level health risks while identifying protective factors through a structured methodology that supports targeted interventions at individual,corporate,and community scales.The paper highlights the rising prevalence of chronic diseases in the United States,projecting that nearly half of the population will be affected by 2030,alongside a global economic burden expected to reach trillions of dollars.Existing surveillance tools,such as the CDS(Chronic Disease Score)and CDIs(Chronic Disease Indicators),are examined for their roles in monitoring health disparities.The Health Score advances a holistic,proactive approach,emphasizing lifestyle modifications,equitable healthcare access,economic opportunities,social support,nature exposure,cu ltural awareness,and community engagement.By elucidating the complex interplay of health determinants,this framework equips stakeholders with actionable insights to implement effective prevention strategies,ultimately fostering healthier,more resi lient populations.展开更多
Tuberculosis(TB),one of the oldest infectious diseases caused by Mycobacterium tuberculosis,poses a considerable challenge to global public health.There are approximately 10 million new TB cases worldwide annually,and...Tuberculosis(TB),one of the oldest infectious diseases caused by Mycobacterium tuberculosis,poses a considerable challenge to global public health.There are approximately 10 million new TB cases worldwide annually,and TB claims the lives of nearly 3 million people each year,making it one of the leading causes of death from a single infectious disease[1].China ranks third globally in terms of TB burden,with approximately 733,000 TB cases reported in 2023[2].Based on the ecological model of health determinants developed by Whitehead and Dahlgren,health determinants can be classified into direct causes.展开更多
Language plays a central role in how gender and sexuality are described. In Bangla or Bengali, physicians, when educating and counseling women patients, do not have a socially acceptable word for “vagina”. If langua...Language plays a central role in how gender and sexuality are described. In Bangla or Bengali, physicians, when educating and counseling women patients, do not have a socially acceptable word for “vagina”. If language is missing for female genitalia or important female sexual functions, could this absence reflect on the position of women in society, reproductive rights, and access to healthcare? Is there a relationship between language and the high rates of the gender-based cervical and breast cancers in some low and middle-income countries? This commentary examines scholarship on the topic of language, the female body, gender-based violence, disparities of healthcare for women, and the consequences of language on sexual attitudes and health.展开更多
BACKGROUND A progressive decrease in exclusive breastfeeding(BF)is observed in Latin America and the Caribbean compared with global results.The possibility of being breastfed and continuing BF for>6 months is lower...BACKGROUND A progressive decrease in exclusive breastfeeding(BF)is observed in Latin America and the Caribbean compared with global results.The possibility of being breastfed and continuing BF for>6 months is lower in low birth weight than in healthy-weight infants.AIM To identify factors associated with BF maintenance and promotion,with particular attention to low-and middle-income countries,by studying geographic,socioeconomic,and individual or neonatal health factors.METHODS A scoping review was conducted in 2018 using the conceptual model of social determinants of health published by the Commission on Equity and Health Inequalities in the United States.The extracted data with common characteristics were synthesized and categorized into two main themes:(1)Sociodemographic factors and proximal determinants involved in the initiation and maintenance of BF in low-birth-weight term infants in Latin America;and(2)individual characteristics related to the self-efficacy capacity for BF maintenance and adherence in low-birth-weight term infants.RESULTS This study identified maternal age,educational level,maternal economic capacity,social stratum,exposure to BF substitutes,access to BF information,and quality of health services as mediators for maintaining BF.CONCLUSION Individual self-efficacy factors that enable BF adherence in at-risk populations should be analyzed for better health outcomes.展开更多
A highly sensitive and fairly selective spectrofluorimetric method has been developed for the determination of germanium with morin in tap water and health drink. The fluorescent reaction and optimal conditions of ger...A highly sensitive and fairly selective spectrofluorimetric method has been developed for the determination of germanium with morin in tap water and health drink. The fluorescent reaction and optimal conditions of germanium with morin in phosphoric acid medium were studied. The detection limits of germanium in tap water and health drink were found to be 0.2 and 0.7μd/L respectively.展开更多
BACKGROUND Sepsis and septic shock pose critical public health challenges with high mortality,particularly in critical care.While racial differences in sepsis incidence are documented,the impact of race on sepsis outc...BACKGROUND Sepsis and septic shock pose critical public health challenges with high mortality,particularly in critical care.While racial differences in sepsis incidence are documented,the impact of race on sepsis outcomes remains inconsistent.AIM To evaluate racial disparities in clinical outcomes among patients hospitalized with septic shock,focusing on in-hospital mortality,length of stay(LOS),and hospitalization costs.METHODS We conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2021.Patients diagnosed with septic shock were identified using ICD-10 code R65.21.The primary outcome was in-hospital mortality;secondary outcomes included trends in septic shock hospitalizations,mortality,length of stay,and cost of hospitalizations.RESULTS Among 3581504 hospitalizations for septic shock,the racial distribution was 67%Non-Hispanic White(NHW),15%Non-Hispanic Black(NHB),11%Hispanic,and 7%other groups,with a mean age of 66.3 years.In-hospital mortality was 33.6%,highest among other racial groups(36.7%).Mortality was stable across racial groups from 2016-2019 but rose sharply in 2020-2021,especially among Hispanic patients.Adjusted in-hospital mortality were higher for NHB and Hispanic compared to NHW patients.NHB patients had the longest LOS,while other racial groups incurred the highest cost of hospitalizations.CONCLUSION We found higher mortality among NHB,Hispanic,and other racial groups in septic shock patients,likely driven by higher risk of in-hospital complications among these racial groups.This highlights the need for future research to identify the factors contributing to the adverse outcomes in these populations.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)pandemic had a profound societal impact in the United States which was associated with a decrease in overall life expectancy and an increase in substance abuse and fire...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic had a profound societal impact in the United States which was associated with a decrease in overall life expectancy and an increase in substance abuse and firearm injury.Our under-standing of changes in mortality trends during the pandemic and its effect on organ availability for transplantation is limited.AIM To examine the trends of substance abuse and firearm injury fatalities during COVID-19 and a potential correlation with organ transplantation.METHODS Crude rates of population-based deaths among adults(18-75 years)from firearm injury and substance abuse from the period of 2014-2021 were obtained from centers of disease control wide-ranging online data for epidemiologic research database.Crude rates of causes of donor(18-75 years)deaths from 2014-2021 were obtained from the united network for organ sharing database.RESULTS Average annual percentage change(AAPC)deaths among the United States population were 16.4%from substance abuse and 3.4%from firearm injury.AAPC in cause of death among organ donors was 10.9%from drug intoxication and 2.1%from firearm injury.There was a significant(P<0.001)and progressive increase in mortality from both causes during the pandemic(2020-2021)and significant correlation(P<0.001)between population and donor causes of death.COVID-19 exacerbated trends in substance abuse and firearm mortality with a consequent increase in organ donation from donors who died from these two causes.CONCLUSION Identifying the socioeconomic and regional disparities associated with increase in deaths from substance abuse and firearms can help guide post-pandemic healthcare policies and mitigate their impact on organ transplantation.展开更多
Background:Grounded in intersectionality theory,this study examined the 6-year prevalence trend and correlates in meeting Canada’s 24-Hour Movement Guidelines(Guidelines hereafter)in a nationally representative adole...Background:Grounded in intersectionality theory,this study examined the 6-year prevalence trend and correlates in meeting Canada’s 24-Hour Movement Guidelines(Guidelines hereafter)in a nationally representative adolescent samples of South Korea(officially the Republic of Korea).Methods:Self-reported,annually repeated cross-sectional data collected between 2013 and 2018 were used(n=372,433,12-17 years old,47.9%females).Adolescents were categorized as meeting or not meeting different sets of physical activity,screen time(ST),and sleep recommendations within the Guidelines,separately for weekdays and weekend days.Intersectional correlates included sex and social class(i.e.,family economic status,parental education level,and academic performance).Multiple logistic regression analyses were performed.Results:Overall,the proportion of adolescents meeting physical activity,ST,and sleep recommendations were 5.3%,60.3%,and 10.2%on weekdays and 5.3%,28.2%,and 46.4%on weekend days,respectively.Between 2013 and 2018,no substantial changes were observed for meeting the physical activity or sleep recommendation,while meeting the ST recommendation was markedly lower in 2018.The proportion of meeting all 3 recommendations were 0.5%for weekdays and 0.8%for weekend days.Overall,compared to female adolescents,male adolescents were consistently associated with more favorable patterns of meeting different sets of recommendations,regardless of social class.Among females only,social class appeared to be not important or even detrimental in meeting different sets of recommendations.Being male,compounded with social class,was associated with meeting the ST recommendation.Conclusion:Less than 1%of Korean adolescents met the overall Guidelines.Intersectionality-based analysis and intervention may be important in promoting healthy active lifestyles among South Korean adolescents.展开更多
This editorial is intended to be a reflection on cardiovascular disease(CVD)burden in European ethnic minorities.In some European countries,ethnic minority realities,due to their recent appearance,are still to be stud...This editorial is intended to be a reflection on cardiovascular disease(CVD)burden in European ethnic minorities.In some European countries,ethnic minority realities,due to their recent appearance,are still to be studied in depth.The experience of several European countries,where the migration processes started earlier,even more than a century ago,can help by being an example.Many studies have shown that major differences in CVD burden exist not only between countries,but also within the same country when considering different social strata and ethnic groups.The CV risk factors underlying heart disease have been well established.Important epidemiological studies have helped us understand that the underlying causes of heart disease as well as the behaviors that can help prevent them are the same.We are now well aware that CVD should be treated by considering a holistic approach.This is why the social determinants(SDs)of health that may worsen the disease burden or that,vice versa,may improve the treatment,and even more significantly,the prognosis of a patient’s illness should be taken into consideration.For ethnic minority patients,this holistic,hermeneutic approach is of importance.Several SDs of health that influence CVDs have been identified but their relevance for the health of ethnic minorities has not yet been clearly defined.In some European countries,most ethnic minorities are largely also religious minorities.Only a few studies have evaluated the role of religion,which is an important SD that affects the probability of having CV risk factors and diseases.Adolescents,particularly those belonging to the second generation,seem to be the weak link.If we believe that these young people are really citizens of their country of birth,then a way of recognizing their belonging to the community starts from a will to better understand their condition,in order to assist them while they grow physically and mentally.Thinking about safeguarding the health of this population should be more than a health task,rather a goal of social justice.展开更多
文摘Objectives:This scoping review aims to methodically identify and analyse the determinants which influence maternal mortality and healthcare utilization in women of childbearing years in Nigeria.The review specifically addresses the difficulties faced in assessing medical care,and the ongoing initiatives to lower the maternal mortality ratio.Methods:Primary studies(published after year 2000)focused on maternal mortality,health determinants,and the utilization of maternal healthcare services in Nigeria were retrieved following a systematic search across multiple databases,including Scopus,PubMed,Google Scholar,and Web of Science.These were screened using defined inclusion and exclusion criteria.Data from these studies were extracted and thematically analysed to identify common themes and trends.Results:A total of 21 publications were included in this review comprising 2 qualitative,17 quantitative,and2 mixed study designs.Major health determinants identified in these studies include hypertensive disorders of pregnancy,haemorrhage,and sepsis/septicaemia,contributing as much as 29%,24%,and 14.2%of maternal deaths respectively in over 10%of the reviewed studies.Similarly,social-economic determinants including poverty,maternal education,health system issues and culture significantly impacted the utilization of maternal healthcare services,inadvertently impacting maternal mortality.Despite various maternal health interventions such as the"Abiye"Safe Motherhood Initiative,the Integrated Maternal,Newborn,and Child Health Strategy and strengthening emergency obstetric care by governmental and non-governmental agencies,early childbearing,unemployment,large family sizes,and dependence on male spouses continued to result in suboptimal utilization of services and adverse maternal outcomes.Conclusion:This scoping review comprehensively integrated existing data from published studies to provide a detailed picture of maternal mortality,its health determinants,and factors influencing care utilization among women of childbearing age in Nigeria and approaches to reduce maternal mortality in the country and possibly in the West African sub-region.
基金supported by the National Natural Science Foundation of China(No.82273722)Noncommunicable Chronic Diseases-National Science and Technology Major Project(2024ZD0520000)(2024ZD0520005)Central University Basic Research Fund of Peking Union Medical College(3332024216)。
文摘Objective To explore the health determinants of all-cancer mortality from a health-ecological perspective.Methods Using the health-ecological model,we identified 15 health determinants across five domains:personal innate,behavioral,interpersonal network,socioeconomic,and macroenvironmental characteristics.Data on cancer outcomes and health determinants from 185 countries,classified using the Human Development Index(HDI),were extracted from GLOBOCAN 2022,the World Health Organization Global Health Observatory,the Global Burden of Disease Study 2021,the United Nations,and the World Bank.A multivariate linear regression model was used to estimate the association between health determinants and cancer outcomes.Results A total of 153 countries with complete information on cancer outcomes and health determinants were enrolled in the study.A higher all-cancer age-standardized mortality rate(ASMR)was associated with current tobacco use,alcohol consumption,obesity,agricultural employment,and lag-distributed income.In women aged 15–49 years,being married or in a union was associated with a lower ASMR.Early-onset ASMR was positively associated with agricultural employment,lag-distributed income,and unsafe sanitation.Notable sex differences were observed,although tobacco use and obesity were identified as risk factors in both sexes.Conclusion We underscore the crucial need to incorporate cross-sectoral interventions within a resilient healthcare system to effectively mitigate the cancer mortality burden.
文摘Preservation of teeth until old ages indicates oral health status. Improving life expectancy in developing countries makes teeth care an important topic. This study assessed reasons of tooth extraction (TE), oral health determinants and demographic factors of permanent TE in Iranian adults. Adult people who referred to dental clinic of Mashhad Medical University in 2012 for dental extraction and lived in Mashhad city, participated in this study by convenient sampling method after obtaining informed consent. Demographic characteristics, oral health status, health habit and reasons of TE of participants were assessed. Data were analyzed by SPSS11.5 by Chi-Square, T-Test, ANOVA, Mann-Whitney and Kruskall-Wallis tests. Totally 254 people participated (383 extracted teeth) that 55% were female. Mean age of participants was 39.3 years;females were 6.1 years younger than males. The main reason of TE was dental caries (55.1%), following by impaction. There was significant difference between average times of tooth brushing in both sexes, but difference was not shown in sugar intake. Except in people with college degrees that dental caries is the main cause of TE. With increase in life expectancy to more than 70 years old in Iranian, the age of TE especially in women is younger than expected. The most common cause of TE is dental caries that seem in spite of improving health indexes in Iran, poor oral hygiene remains as a problem. There is no significant difference between frequency of sugar intake and level of education that indicates unhealthy dietary habits related to tooth decay.
文摘Rhegmatogenous retinal detachment(RRD)is a sight threatening condition in which the neurosensory retina separates from the underlying retinal pigment epithelium.With an incidence of 6.3 to 17.9 per 100,000 persons(1),RRD is a condition frequently encountered by vitreoretinal specialists.Because the fovea is responsible for central visual acuity,foveal detachment is associated with poor presenting vision and is the strongest prognostic factor predicting poor visual outcome after RRD repair(2).
文摘BACKGROUND Social determinants of health are social and economic factors that influence health intervention outcomes.Type 2 diabetes is a highly prevalent disease,primarily affecting individuals in low-to-middle-income countries.However,the association between social determinants and cardiovascular complications in type 2 diabetes has not been widely studied.AIM To examine the relationship between social determinants of health and cardiovascular complications in individuals with type 2 diabetes.METHODS We conducted a retrospective cohort study with an analytical component at a national-level referral hospital for military personnel in Bogota,Colombia.Patients treated at the diabetes clinic between September 2021 and December 2022 who met the inclusion criteria were included.A total of 583 patients participated in the study.We performed descriptive,bivariate,and binary logistic regression analyses,adjusting for confounding variables.RESULTS Among the 583 patients included,urban residency[odds ratio(OR)=3.05,95%confidence interval(CI):1.01-9.20]and a middle or high educational level(OR=2.33,95%CI:1.14-4.72)were associated with an increased risk of coronary artery disease.Additionally,receiving diabetes education beyond that provided by the clinic(OR=2.15,95%CI:1.14-4.05)and lack of access to spaces for physical activity(OR=4.05,95%CI:1.31-12.5)were associated with a higher risk of diabetic nephropathy and cerebrovascular disease,respectively.CONCLUSION Programs for diabetes management should account for social determinants of health that contribute to cardiovascular complications and increased healthcare costs.Population-based studies are needed to guide targeted interventions and clarify causal relationships.
文摘Social determinants of health (SDOH) contribute to cancer disparities among young Latina women (<50 years) residing in the counties along the US-Mexico border. These SDOH are particularly burdensome to young Latina mothers diagnosed with cancer while they are raising school-age children. Conexiones, a culturally adapted program designed to improve mother and child adjustment to maternal cancer, was piloted with diagnosed Latina mothers residing in border counties in New Mexico and Texas. The purpose of this case analysis was to highlight the SDOH affecting a young Latina mother’s cancer survivorship in the U.S.-Mexico border region. The participant’s Conexiones education sessions were recorded, transcribed, translated to English, back translated to Spanish to establish accuracy, and inductively coded. The participant’s baseline survey indicated she was a young (<50 years), married, Spanish-speaking Latina mother diagnosed with breast cancer while raising a teenage daughter. Seventeen SDOH themes affecting the participant’s cancer experience were identified in the cancer-related emotional triggers she reported across five Conexiones sessions. These themes were organized using Yanez’s conceptual model of determinants of cancer outcomes in Hispanics (i.e., socioeconomic, healthcare, cultural context, and psychosocial). Findings provide direction for cultural adaptations of evidence-based programs.
基金This study is supported by K23HL15180(NIH/NHLBI,Steiner)a grant from the American College of Cardiology Foundation.
文摘Social determinants of health(SDOH)affect quality of life.We investigated SDOH impacts on self-perceived resilience among people with adult congenital heart disease(ACHD).Secondary analysis of data from two com-plementary studies:a survey study conducted May 2021–June 2022 and a qualitative study conducted June 2020–August 2021.Resilience was assessed through CD-RISC10 score(range 0–40,higher scores reflect greater self-perceived resilience)and interview responses.Sociodemographic and SDOH(education,employment,living situa-tion,monetary stability,financial dependency,area deprivation index)data were collected by healthcare record review and self-report.We used linear regression with robust standard errors to analyze survey data and performed a thematic analysis of interview data.Survey participants(N=127)mean age was 42±14 years;51%were female,87%white.ACHD was moderate(75%)or complex(25%);41%functional class C or D.Resilience(mean 30±7)varied by monetary stability:compared to people with difficulty paying bills,resilience was 15.0 points higher(95%CI:6.9–23.1,p<0.001)for people reporting having enough money and 14.2 points higher(95%CI:5.9–22.4,p=0.001)for those reporting just enough money.Interview participants’(N=25)mean age was 32 years(range 22–44);52%were female,72%white.ACHD was moderate(56%)or complex(44%);76%functional class C or D.Participants discussed factors affecting resilience aligned with each of the major SDOH,prominently,economic stability and healthcare access and quality.Financial stability may be important for supporting self-perceived resi-lience in ACHD.This knowledge can inform the development of resilience interventions for this population.
文摘Increasingly international and national policies are being directed at actions for the social determinants of health and for an integrated approach to health care provision, not only in terms of institutional cooperation but also stakeholder involvement. A key component of both these policies is the development of good governance principles in all health care agencies and organizations. A neglected dimension in these debates has been the role of the public hospital which remains a vital and expensive dimension of service provision. In a case study of a public hospital in South Africa, this paper charts the readiness of its management principles and activities to provide quality health care linked to population health and to contribute to the non-medical determinant of health. Using Taylor’s principles of good governance, we conclude that there is a mixture of good and not so good governance activity. The paper concludes by examining the external constraints on the public hospital and by providing suggestions for future activities.
文摘Social determinants of health are some indicating factors such as income, education, class, gender, and race that influence the socio-economic status of people living in a society. Coronavirus affects the social, economic, and also political sectors of people all over the world. In Bangladesh, during the Covid-19 pandemic, people of all ages and classes have faced social and economic crises based on the social determinants of health. Higher-class families had the facility of advanced medical services rather than the lower and lower-middle classes. This article aims to show the relationship between the social determinants of health and the socio-economic impact of the Covid-19 pandemic in Bangladesh. This paper presents some secondary data to describe the socio-economic impact of Covid-19 and the functions of the social determinants of health in this case.
文摘Modern women have increased options for birth control with the development of Long Acting Reversible Contraceptives (LARCs). These methods are reliable, easy to use, and require less daily maintenance while providing contraception for an extended period of time. However, despite the surge of LARCs as contraceptive options, the prevalence of unintended pregnancies is still alarmingly high in the United States. As LARCs are the most effective reversible method of birth control at preventing pregnancy, and therefore the potential social, financial, and medical complications associated, we examined whether social determinants of health play a role in LARC usage. While parity and marriage do not seem to affect LARC utilization, increased research is needed to determine the effects of race. Age can affect the type of LARC implemented, as younger women prefer implants to intrauterine devices (IUDs). Insurance coverage was an apparent influencer of LARC usage, as low out-of-pocket costs translate to increased utilization. This is linked to socioeconomic status (SES), as lower SES is associated with decreased access to healthcare in general. Increased research is needed in order to draw conclusions about the effects of education, intimate partner violence, geographic location, and other SDH on LARC usage.
文摘Background: Social determinants of health (SDOH) significantly influence diseases with environmental components, like vector-borne parasitic diseases. This study aims to examine how these factors influence vector-borne parasitic diseases (VBPDs) transmission in Chad and provide recommendations for policy improvements. Methods: The study adopts the WHO Conceptual Framework of SDOH to compare two regions in Southern Chad: Kouh-Est, which has an ongoing vector control program, and Grand-Sido, which lacks such a program. The study includes both nomadic and sedentary populations to provide a comprehensive understanding of the SDOH influencing VBPDs. Households were randomly selected. Data on sociodemographic characteristics, literacy, knowledge of VBPDs and protective measures, and access to education and health facilities were collected. Results: A total of 202 households from 17 villages, including 820 participants, were surveyed. Agriculture, livestock, and fishing were the main occupations, involving 84.1% of participants. Literacy was low, with 36.7% non-educated, 47.7% completing primary school, 14.5% secondary school, and only 0.3% reaching tertiary education. Most villages lacked schools beyond the primary level, and nomadic populations were significantly less educated than sedentary ones (p Conclusion: Educational deficiencies, lack of protective measures against vectors, inadequate healthcare resources, and lifestyle conditions aggravated by poor road infrastructure, limited transportation, and economic constraints contribute to worsened VBPDs outcomes in these rural populations. Addressing these systemic issues in the surveyed communities is essential for improving health equity and VBPDs outcomes in these regions specifically and in similar populations settings more broadly.
文摘Chronic diseases,or NCDs(noncommunicable diseases),constitute a major global health challenge,causing millions of deaths and imposing substantial economic burdens annually.This paper introduces the Health Score,a comprehensive framework for assessing chronic disease risk by integrating diverse determinants of health,including social,economic,environmental,behavioral,treatment,culture,and nature factors.The Health Score,ranging from 0 to 850,quantifies indivi dual and population-level health risks while identifying protective factors through a structured methodology that supports targeted interventions at individual,corporate,and community scales.The paper highlights the rising prevalence of chronic diseases in the United States,projecting that nearly half of the population will be affected by 2030,alongside a global economic burden expected to reach trillions of dollars.Existing surveillance tools,such as the CDS(Chronic Disease Score)and CDIs(Chronic Disease Indicators),are examined for their roles in monitoring health disparities.The Health Score advances a holistic,proactive approach,emphasizing lifestyle modifications,equitable healthcare access,economic opportunities,social support,nature exposure,cu ltural awareness,and community engagement.By elucidating the complex interplay of health determinants,this framework equips stakeholders with actionable insights to implement effective prevention strategies,ultimately fostering healthier,more resi lient populations.
基金supported by the National Natural Science Foundation of China(82574173,82003516)Jiangsu Provincial Natural Science Foundation(BK20251958)+2 种基金Jiangsu Provincial Medical Key Discipline(ZDXK202250)Top Talent Awards Project Fund(RDF-TP-0023,RDF-TP-0030)Postgraduate Research Fund(PGRS2112022)at Xi'an Jiaotong-Liverpool University.
文摘Tuberculosis(TB),one of the oldest infectious diseases caused by Mycobacterium tuberculosis,poses a considerable challenge to global public health.There are approximately 10 million new TB cases worldwide annually,and TB claims the lives of nearly 3 million people each year,making it one of the leading causes of death from a single infectious disease[1].China ranks third globally in terms of TB burden,with approximately 733,000 TB cases reported in 2023[2].Based on the ecological model of health determinants developed by Whitehead and Dahlgren,health determinants can be classified into direct causes.
文摘Language plays a central role in how gender and sexuality are described. In Bangla or Bengali, physicians, when educating and counseling women patients, do not have a socially acceptable word for “vagina”. If language is missing for female genitalia or important female sexual functions, could this absence reflect on the position of women in society, reproductive rights, and access to healthcare? Is there a relationship between language and the high rates of the gender-based cervical and breast cancers in some low and middle-income countries? This commentary examines scholarship on the topic of language, the female body, gender-based violence, disparities of healthcare for women, and the consequences of language on sexual attitudes and health.
文摘BACKGROUND A progressive decrease in exclusive breastfeeding(BF)is observed in Latin America and the Caribbean compared with global results.The possibility of being breastfed and continuing BF for>6 months is lower in low birth weight than in healthy-weight infants.AIM To identify factors associated with BF maintenance and promotion,with particular attention to low-and middle-income countries,by studying geographic,socioeconomic,and individual or neonatal health factors.METHODS A scoping review was conducted in 2018 using the conceptual model of social determinants of health published by the Commission on Equity and Health Inequalities in the United States.The extracted data with common characteristics were synthesized and categorized into two main themes:(1)Sociodemographic factors and proximal determinants involved in the initiation and maintenance of BF in low-birth-weight term infants in Latin America;and(2)individual characteristics related to the self-efficacy capacity for BF maintenance and adherence in low-birth-weight term infants.RESULTS This study identified maternal age,educational level,maternal economic capacity,social stratum,exposure to BF substitutes,access to BF information,and quality of health services as mediators for maintaining BF.CONCLUSION Individual self-efficacy factors that enable BF adherence in at-risk populations should be analyzed for better health outcomes.
文摘A highly sensitive and fairly selective spectrofluorimetric method has been developed for the determination of germanium with morin in tap water and health drink. The fluorescent reaction and optimal conditions of germanium with morin in phosphoric acid medium were studied. The detection limits of germanium in tap water and health drink were found to be 0.2 and 0.7μd/L respectively.
文摘BACKGROUND Sepsis and septic shock pose critical public health challenges with high mortality,particularly in critical care.While racial differences in sepsis incidence are documented,the impact of race on sepsis outcomes remains inconsistent.AIM To evaluate racial disparities in clinical outcomes among patients hospitalized with septic shock,focusing on in-hospital mortality,length of stay(LOS),and hospitalization costs.METHODS We conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2021.Patients diagnosed with septic shock were identified using ICD-10 code R65.21.The primary outcome was in-hospital mortality;secondary outcomes included trends in septic shock hospitalizations,mortality,length of stay,and cost of hospitalizations.RESULTS Among 3581504 hospitalizations for septic shock,the racial distribution was 67%Non-Hispanic White(NHW),15%Non-Hispanic Black(NHB),11%Hispanic,and 7%other groups,with a mean age of 66.3 years.In-hospital mortality was 33.6%,highest among other racial groups(36.7%).Mortality was stable across racial groups from 2016-2019 but rose sharply in 2020-2021,especially among Hispanic patients.Adjusted in-hospital mortality were higher for NHB and Hispanic compared to NHW patients.NHB patients had the longest LOS,while other racial groups incurred the highest cost of hospitalizations.CONCLUSION We found higher mortality among NHB,Hispanic,and other racial groups in septic shock patients,likely driven by higher risk of in-hospital complications among these racial groups.This highlights the need for future research to identify the factors contributing to the adverse outcomes in these populations.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic had a profound societal impact in the United States which was associated with a decrease in overall life expectancy and an increase in substance abuse and firearm injury.Our under-standing of changes in mortality trends during the pandemic and its effect on organ availability for transplantation is limited.AIM To examine the trends of substance abuse and firearm injury fatalities during COVID-19 and a potential correlation with organ transplantation.METHODS Crude rates of population-based deaths among adults(18-75 years)from firearm injury and substance abuse from the period of 2014-2021 were obtained from centers of disease control wide-ranging online data for epidemiologic research database.Crude rates of causes of donor(18-75 years)deaths from 2014-2021 were obtained from the united network for organ sharing database.RESULTS Average annual percentage change(AAPC)deaths among the United States population were 16.4%from substance abuse and 3.4%from firearm injury.AAPC in cause of death among organ donors was 10.9%from drug intoxication and 2.1%from firearm injury.There was a significant(P<0.001)and progressive increase in mortality from both causes during the pandemic(2020-2021)and significant correlation(P<0.001)between population and donor causes of death.COVID-19 exacerbated trends in substance abuse and firearm mortality with a consequent increase in organ donation from donors who died from these two causes.CONCLUSION Identifying the socioeconomic and regional disparities associated with increase in deaths from substance abuse and firearms can help guide post-pandemic healthcare policies and mitigate their impact on organ transplantation.
文摘Background:Grounded in intersectionality theory,this study examined the 6-year prevalence trend and correlates in meeting Canada’s 24-Hour Movement Guidelines(Guidelines hereafter)in a nationally representative adolescent samples of South Korea(officially the Republic of Korea).Methods:Self-reported,annually repeated cross-sectional data collected between 2013 and 2018 were used(n=372,433,12-17 years old,47.9%females).Adolescents were categorized as meeting or not meeting different sets of physical activity,screen time(ST),and sleep recommendations within the Guidelines,separately for weekdays and weekend days.Intersectional correlates included sex and social class(i.e.,family economic status,parental education level,and academic performance).Multiple logistic regression analyses were performed.Results:Overall,the proportion of adolescents meeting physical activity,ST,and sleep recommendations were 5.3%,60.3%,and 10.2%on weekdays and 5.3%,28.2%,and 46.4%on weekend days,respectively.Between 2013 and 2018,no substantial changes were observed for meeting the physical activity or sleep recommendation,while meeting the ST recommendation was markedly lower in 2018.The proportion of meeting all 3 recommendations were 0.5%for weekdays and 0.8%for weekend days.Overall,compared to female adolescents,male adolescents were consistently associated with more favorable patterns of meeting different sets of recommendations,regardless of social class.Among females only,social class appeared to be not important or even detrimental in meeting different sets of recommendations.Being male,compounded with social class,was associated with meeting the ST recommendation.Conclusion:Less than 1%of Korean adolescents met the overall Guidelines.Intersectionality-based analysis and intervention may be important in promoting healthy active lifestyles among South Korean adolescents.
文摘This editorial is intended to be a reflection on cardiovascular disease(CVD)burden in European ethnic minorities.In some European countries,ethnic minority realities,due to their recent appearance,are still to be studied in depth.The experience of several European countries,where the migration processes started earlier,even more than a century ago,can help by being an example.Many studies have shown that major differences in CVD burden exist not only between countries,but also within the same country when considering different social strata and ethnic groups.The CV risk factors underlying heart disease have been well established.Important epidemiological studies have helped us understand that the underlying causes of heart disease as well as the behaviors that can help prevent them are the same.We are now well aware that CVD should be treated by considering a holistic approach.This is why the social determinants(SDs)of health that may worsen the disease burden or that,vice versa,may improve the treatment,and even more significantly,the prognosis of a patient’s illness should be taken into consideration.For ethnic minority patients,this holistic,hermeneutic approach is of importance.Several SDs of health that influence CVDs have been identified but their relevance for the health of ethnic minorities has not yet been clearly defined.In some European countries,most ethnic minorities are largely also religious minorities.Only a few studies have evaluated the role of religion,which is an important SD that affects the probability of having CV risk factors and diseases.Adolescents,particularly those belonging to the second generation,seem to be the weak link.If we believe that these young people are really citizens of their country of birth,then a way of recognizing their belonging to the community starts from a will to better understand their condition,in order to assist them while they grow physically and mentally.Thinking about safeguarding the health of this population should be more than a health task,rather a goal of social justice.
