bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coverage and inequalities in health interventions in Ecuador 1994- 2012
Authors: Rios-Quituizaca P , Gatica-Dominguez G , Santos J Ferreira , Nambiar D , Bruck S , Vidaletti L , Barros A 
Published: October 2020

Abstract
Several Latin American countries have reported significant reductions in inequalities and increases in coverage of essential health interventions across the continuum of reproductive, maternal, newborn and child health (RMNCH) care. Although Ecuador has had significant political and economic progress, few studies have evaluated the magnitude and trend of inequalities in RMNCH coverage interventions, a critical step in defining priorities for future health policies and strategies. This cross-sectional study used data from four national representative, standardized health surveys (1994, 1999, 2004 and 2012), analyzing coverage of seven interventions, stratifying by wealth quintile, urban-rural residence and geographic location. We used a variance-weighted least squares regression to calculate the average annual absolute change in coverage across interventions and mapped the results. Using the latest round of the survey, simple and complex measures of inequality were computed. Between 1994 and 2012, in almost all analyzed interventions the differences between rich and poor decreased, especially from 2004 to 2012, period in which primary health care policies were strengthened. In 2012, nevertheless, the most unequal intervention was improved sanitary facilities with 2.4-fold difference between rich and poor (ratio quintile 5:1; concentration index 15.4% 95% CI; 15.0-15.9%); and antenatal care, institutional delivery and improved drinking water kept significant inequality by economic status. While interventions related to the provision of health services showed reduction in inequality gaps, basic sanitation and drinking water had high gaps. Several provinces failed to improve coverage interventions over time, gaps which are masked by national averages and need additional intersectoral approaches to be addressed. Further analysis should focus on other dimensions of inequality such as ethnic group to identify gaps and generate strategies adapted to local realities.

Key messages
In Ecuador from 1994 to 2012 inequality gaps between rich and poor in most RMNCH coverage interventions declined, mainly from 2004 to 2012, but national means mask inequalities at the provincial level. Interventions related to the provision of health services showed reduction in socio-economic inequalities, while inequalities in basic sanitation and drinking water intervention coverage remained high.
Maternal Mortality in Paraguay tendencies and risk factors: 2004-2015
Authors: Villalba A , Sánchez M 
Published: October 2020

Abstract

Background
Maternal mortality remains a serious challenge worldwide, it being part of the Sustainable Development Goals. Progress is tracked through maternal mortality ratios (MMR), which demonstrate the current development of a health system. Our study describes tendencies and factors involved in the MMR in Paraguay, South America.

Methods
A retrospective cross-sectional study was undertaken. Data were extracted from the national system of vital statistics published by the Ministry of Public Health and Social Welfare. MMR was expressed as the number of maternal deaths per 100,000 live births. The causes of maternal deaths were classified according to the CIE-10. The tendency and fluctuations of the variables were analyzed through Pearson and Spearman correlations. A significance level of 5% was established.

Results
During the period of 2004-2015 in Paraguay there was a significant reduction in the tendency of the number of maternal deaths (r= -0.895; p &lt; 0.001) with a decrease of 37.1%; Accordingly, there is a decreased tendency of the MMR (r= -0.929; p &lt; 0.001) with a reduction of 45.4% and an annual mean decrease of 3.95%. It was observed that women aged 40 years and older and women characterized as single possessed a higher MMR, with each group showing 317.7/100 000 and 377.5/100 000, respectively. The 75% of death causes were Postpartum Hemorrhage, Eclampsia, Concurrent maternal deaths, Abortion and Puerperal Sepsis.

Conclusions
Our study showed significant decreased tendency of MMR, although remaining high compared to high income countries. More studies to support this result are recommended due to the difference with international estimates. The main causes of death showed the need to strengthen prenatal follow-up in primary care far from high-complexity hospitals.

Key messages
Our study describes the situation on Maternal Mortality in a developing country, showing the importance of health care access and prenatal follow up for preventable complications. Our work showed the urgent need for more studies about abortion prevalence and also to determine the cause of higher MMR on single women in our country.
Health and social needs of unprotected unaccompanied minors in Paris in the context of COVID-19
Authors: Gautier L , Quesnel-Vallée A 
Published: October 2020

Abstract

Background
Unaccompanied minors (UMs) are children under 18 settling in foreign countries without the care of a guardian. Host countries' governments are responsible for the care of UMs. In France, UMs theoretically receive child protection. However, assessment systems frequently deny their protection because of minority status rejection. As a result, they navigate through social precarity and have limited access to healthcare services. In Paris, the non-governmental organisation Médecins du Monde (MdM) offers them medico-psycho-social care. In March 2020, lockdown measures to contain COVID-19 further reduced unprotected UMs' access to social and healthcare services. This critical situation prompted MdM to adapt their care provision to the pandemic. In this research, we sought answers to the following research question: what were unprotected UMs' social and healthcare needs during lockdown and what was MdM's response?

Methods
First, we estimate the evolution of social and healthcare needs of a cohort of 58 unprotected UMs during the eight-week lockdown using secondary data. Second, using interview data with MdM volunteers and staff (n = 15) we further explore UMs' needs and document the experience of phone consultations with this cohort of UMs.

Preliminary Results
Time series show a constant increase of UMs' needs through time. MdM's new form of care provision may have contributed to alleviate their feeling of isolation. It also had unintended consequences.

Conclusions
In light of the alarming healthcare status of unprotected UMs, we recommend that France implements the public health authorities' recommendation to provide appropriate shelter to UMs regardless of their status, at least during health crises.

Key messages
This study fills a research gap related to a pressing political and public health issue. This study advances evidence-informed debates debates on the influence of models of care provision on UMs’ social and healthcare needs during health crises.
Burden of food insecurity in older adults from diverse global settings: policy recommendations
Authors: Pirkle C , Peltzer N , Câmara S , Gomes J , Ylli A 
Published: October 2020

Abstract
Food insecurity prevalence is highest in low and middle-income countries, yet there is a dearth of research on the burden in older adults in these settings. Food insecurity has long-term consequences for the health of older persons. We examined cross-sectional food security data from 1,482 participants in the 2016 wave of the longitudinal International Mobility in Aging Study (IMIAS) conducted in Canada, Albania, Colombia, and Brazil. These are community samples between 68 and 79 years. Food security was assessed with the Latin American and Caribbean Household Food Security Scale and recoded to yes/no. Covariates of interest included sex, site, income, living arrangement, and education. Descriptive statistics, with tests of statistical significance, were used. Responses to scale items varied from 10% of participants reporting worry about running out of food and being unable to eat healthy foods to 2% reporting not eating for a whole day or having to beg for food. Food insecurity in the sample was 17%. Few Canadian respondents (&lt;5%) were food insecure, compared to 30% in Tirana, 28% in Manizales, and 18% in Natal. Better educated and income sufficient respondents were significantly more food secure than lesser educated, lower income ones. Respondents living with spouses were significantly less likely to be food insecure than those living alone or in other arrangements (e.g. with children). The exception was Tirana; 25% of those in other arrangements were food insecure compared to 32% living with a spouse and 44% alone. Food insecurity did not differ significantly by age or sex. Site, income, living arrangement, and education were all associated with food insecurity status. Study findings contribute to a significant gap in literature about food security in older adults. Because food insecurity in older adults leads to negative health outcomes, results suggest specific interventions to improve health and reduce burden on healthcare systems is needed for elderly.

Key messages
Food insecurity has severe health consequences for elderly and location, income, education, and living arrangement contributes to health inequalities in this population across diverse settings. Little to no research has been done on food insecurity in elderly outside of North America and study findings contribute to significant gap in research in this population across global settings.
Retrospective study of the distribution of doctors in municipalities of extreme poverty in Brazil
Authors: Luizeti B L O , Massuda E M M , Garcia L F G 
Published: October 2020

Abstract
In view of the national scenario of scarcity of material and human resources in public health in Brazil, the survey verified the demographics of doctors who attend the Unified Health System (SUS) in municipalities of extreme poverty.
An observational, analytical and cross-sectional study was carried out, based on secondary quantitative data from the Department of Informatics of the SUS using the TABNET of December 2019. The care networks variable was restricted to infer the number of physicians who attend the SUS in extreme poverty municipalities in Brazil. Municipalities of extreme poverty are those that at least 20% of the population have a household income of up to 145 reais per capita monthly.
In Brazil, there are 1526 municipalities in extreme poverty, 27.4% of the country's total municipalities. 14,907 doctors linked to SUS work in this condition, 3.19% of the total of these professionals in Brazil. There is still disproportion between regions: North concentrates 11.2% of the municipalities in extreme poverty and 8.61% of the total number of doctors; Northeast, with 61.33% of these municipalities, for 61.5% of doctors; Southeast, with 15.46% of the municipalities in this condition, has 20.6% of doctors; South concentrates 10.87% of the municipalities under discussion with 5.61% of doctors and the Midwest, with 4.87% of these municipalities, has 3.54% of doctors. Between 2009 and 2018, there was a 39% increase in the number of doctors in these locations, however, for 2019, there was a decrease of 3.89%.
The medical demographic distribution in Brazil is uneven, especially in the North. There is also the vulnerability of this population in view of the observed reduction in the number of professionals between 2018 and 2019 in municipalities of extreme poverty, for political reasons. It is evident the need to restructure the health system to guarantee access to health for this population, through the attraction and fixation of doctors in needy regions in Brazil.

Key messages
Shortage of doctors in extreme poverty municipalities reinforces the health vulnerability of the population in Brazil. The uneven medical demography in Brazil requires restructuring in the public health system.
Addressing health inequities in Bologna: a mixed-method, multi stakeholder, action-research approach
Authors: Bodini C , Camplone I , Cavazza G , Di Girolamo C , Gentilini V , Marzaroli P , Pandolfi P , Perlangeli V , Pizzi L , Riccio M 
Published: October 2020

Abstract

Background
A large body of literature shows how lower socioeconomic classes have higher incidence of mortality and morbidity, and how worse health outcomes linked to barriers in accessing healthcare particularly affect the most vulnerable groups. Despite such evidence, in many a context health inequalities have continued to increase. Processes that better link knowledge with action are therefore needed.

Methods
An interdisciplinary, interprofessional, interinstitutional group was created involving the Public Health Department and the Center of International Health of Bologna. In 2017-19, the group carried out a project to document and tackle local health inequities, structured in two phases: a first one of quantitative analysis of health inequalities using routinely available data, and a second one of qualitative research in selected areas of the city. An action-research approach was embedded throughout the project, with periodic evaluations to ensure progress towards the intended results.

Results
Phase 1 results show significant differences in terms of disease burden and service use between the North, East and West periphery of the city compared to the center and South. These differences mirror the urban distribution of wealth/deprivation, measured through different indicators (education, income, presence of immigrant population). Results also show concentration of the worst health outcomes and healthcare access indicators in some areas of the city, which also have higher presence of social housing. Phase 2, started in January 2020, is using phase 1 results to inform both a qualitative analysis and a participatory process in 6 areas of the city selected among those with worst health indicators.

Conclusions
Our experience shows that addressing the issue of health inequities through a mixed-method, multi stakeholder and action-research approach may lead to greater integration of research findings and evidence into healthcare policy and practice, towards health equity.

Key messages
Working across disciplines, roles and institutions may bring added value to the complex field of health inequities, when approached with the aim of moving from knowledge to action. Relying on routinely available data may open a route for the replication of our experience and for its use to monitor the impact of interventions aimed at reducing health inequities.
Social inequalities in the consumption of beans and other legumes: a study with adults from Brazil
Authors: Medina L P B , Barros M B A , Barros Filho A A 
Published: October 2020

Abstract
Legumes have an effect on reducing risk factors for cardiometabolic diseases if consumed at least 4 times a week. In addition, they contribute to intestinal health, are a source of fiber and protein and represent an important instrument for the food safety of developing countries. It was intended to estimate the prevalence of consumption of beans and other legumes, in the diet of the adult population of a city in southeastern Brazil identifying inequalities of race, income and schooling. This is a cross-sectional study conducted in Campinas, São Paulo (ISACamp 2014/15) that evaluated 1889 people aged 18 years or older. Pearson's Chi-square test estimated the prevalence of bean consumption at least 4 days a week, as well as the prevalence of consumption of other legumes among those who stopped consuming beans in 3 days or more. The associations of these behaviors with the variables race, income and schooling were analyzed based on the prevalence ratios adjusted by gender and age. Among blacks and browns, in groups with incomes below 0.5 minimum wage and in those with up to 4 years of study, percentages higher than 66% were found in the prevalence of bean consumption in more than 4 days a week. Among those who stopped eating beans in at least 3 days, no more than 24% reported ingesting other legumes as a substitute. Among the whites, in the group of best income and in the best level of study the prevalence of bean consumption was lower and the intake of other legumes was more frequent. It is noteworthy, however, that the prevalence of bean replacement with another type of legumes did not exceed 34% even among the most favored strata. It is concluded that beans are strongly present in the diet of the less privileged groups of population and that the substitution of beans with other legumes, besides infrequent, can be considered a practice of whites and segments of better socioeconomic level.

Key messages
Beans are strongly present in the diet of the less privileged groups of population. The substitution of beans with other legumes can be considered a practice of whites and segments of better socioeconomic level.
Factors associated to functional outcome after total hip and knee arthroplasty
Authors: Kundisova L , Sanguineti I , Resani G , Lentino C , Nante N 
Published: October 2020

Abstract

Background
An individual rehabilitation plan should guarantee a personalized approach to each patient. Identifying patients at risk of slower progression could help to implement a targeted approach. Aim of this study was to analyse patients characteristics associated to worse Functional Outcome (FO).

Methods
A cross sectional study of patients after Total Hip Arthoplasty (THA) or Total Knee Artroplasty (TKA) recovered in a Rehabilitation Clinic from January 2017 to December 2018 was performed. Patients characteristic: Age, Gender, Body Mass Index (BMI), Pain at admission (expressed in Numeric Pain Rating Scale: NRS), Cumulative Illness Rating Scale (CIRS) and Length of Stay in surgical facility (SLOS). Outcome tested: Active Flexion (AF), Barthel index (BI), Tinetti scale (TS), Pain at Discharge (PD). Patients were divided into two groups in relation to the achievement of target values in eight day of rehabilitation (AF = 84°, BI = 90, TS = 19 and PD ≥ 5). Statistical analysis was realized using Stata12.

Results
In total 1857 patients, 58% females, 56% after THA. Average age was 70.5±10.4, higher for females (72±9.7 vs. 68.3±11), average BMI 27.2±4.3, average SLOS 5.2±2.8. Regarding AF: 48% did not reach target value (38%THA; 55%TKA), for THA more likely older (OR 1.01) and females (OR 1.5) and for both THA and TKA higher NRS (OR 1.2). As for the BI target value was not reached by 24% patients (24.4%THA; 23.4%TKA); more likely older patients (OR 1.05), females (THA OR 2.1; TKA OR1.5), those with higher NRS (OR 1.13) and higher SLOS (THA OR 1.16; TKA OR 1.14). As for TS, 7% did not reached target (6.5%THA; 6.8%TKA), association with age (TKA OR 1.08; THA OR 1.04) and for THA also with SLOS (OR 1.13), pain (OR 1.16) and female sex (OR 2.16) was observed. As for the PD 17% not reached target (9.78%THA; 25.59%TKA), for TKA an association with BMI was observed (OR 1.08).

Conclusions
Worse FO was associated to not modifiable variables as age and gender but also with NRS, BMI and SLOS.

Key messages
Analysing patients characteristics associated to worse Functional Outcome allow to identify patients at risk of slower progression. The aim is to implement a targeted and personalized approach. The worse FO was associated to not modifiable variables as age and sex but also to higher NRS, prolonged SLOS and high BMI. Those conclusions help to manage an Individual Rehabilitation plan.
The impact of homeopathy in the treatment of bruxism in a Brazilian school
Authors: Simóes pires Gallois Ficht S , Thaise Unbehaum E 
Published: October 2020

Abstract
Description of the result achieved by homeopathy in a pilot project in the treatment of schoolchildren with bruxism in public health in Blumenau, SC (Santa Catarina - Brazil). In parallel with the treatment of the main complaint of the dental patient, we sought to list other benefits obtained during the course of this project. The children were selected through a questionnaire addressed to the parents of students at the Adelaide Starke Municipal School, verifying cases of tightening and / or involuntary grinding of their children's teeth. Thereafter, their treatment started and lasted four months. It was a process of monthly consultations accompanied by homeopathic prescriptions according to the needs verified at the time. At the end of the period proposed in this study, favorable results were found in all children involved in the process, in addition to a remarkable influence of treatment on the quality of life of these patients. The data showed that homeopathy in school dentistry, in addition to solving or minimizing cases of bruxism, improved the relationship of children with their environment: school, social and domestic. Most respondents reported additional benefits such as improved sleep quality, the elimination of phobic crises, improved self-esteem and students' school report cards.

Key messages
Description of research carried out with children and adolescents attending a dental practice at a Brazilian public school submitted for four months to homeopathic treatment for bruxism. Benefits that homeopathic therapy.
Prescription of physical activity: knowledge and needs among general practitioners of Ile-de-France
Authors: Astruc A , Blanchard J C 
Published: October 2020

Abstract

Background
Physical inactivity is the fourth leading cause of death in the world. The concept of medical prescription of physical activity (PA) adapted now appears in a law, which specifies the central role of the family physician. The needs of the general practitioners (GP) about prescription of PA have not been studied.

Aim
To assess the knowledge and needs of GPs regarding the medical prescription of PA.

Methods
This is a transversal observational epidemiological study of GPs working in the departments of Hauts-de-Seine (92) and Val-de-Marne (94) near Paris. A questionnaire was sent by mail or email.

Results
One hundred and fifty-eight physicians were included. A total of 72.2% of GPs rated their knowledge in PA as average to very poor. The initial training in PA is estimated as unsatisfactory by 84.2% of GPs. A total of 81.6% haven't done a postgraduate additional training in PA. A specific skill in sports medicine, the individual practice of PA as well as the speaking about PA in more than 50% of consultations are significantly associated with a feeling of competence in PA prescription (P &lt; 0.01). Among the measures favoring the prescription of PA, GPs told that they need information brochures to give to the patient (60.8%), a website of help to the prescription of PA which can be used in consultation (60.1%), or the organization of a specific training on the medical prescription of AP (50.6%).

Conclusions
The lack of training seems to be the major obstacle to the generalization of prescription of PA. The organization of training or the creation of specific tools for the attending physician seems to be promising solutions.

Key messages
The lack of training seems to be the major obstacle to the generalization of prescription of PA. Organization of training or the creation of specific tools for the attending physician seems to be promising solutions.