Impact of Social Determinants of Health on Self-Perceived Resilience: An Exploratory Study of Two Cohorts of Adults with Congenital Heart Disease

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.

“I Felt Defeated. I Felt Helpless”: Social Determinants of Health Influencing the Cancer Survivorship of a Young Latina Mother

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.

The Social Determinants of Health and the Role of the Health Care System: A Case Study of the Significance of Good Governance in Public Hospitals in South Africa

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.

Impact of Social Determinants of Health on the Choice and Use of Long Acting Reversible Contraceptives

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.

Social Determinants of Health in Understanding the Socio-Economic Impacts of Covid-19 Pandemic in Bangladesh

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.

Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico

BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly described.This observational study analyzes the impact of place of residence,referring institution,and transplant cost coverage(out-of-pocket vs government-funded vs private insurance)on outcomes after allogeneic hematopoietic stem cell transplantation(alloHSCT)in two of Mexico's largest public and private institutions.AIM To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico.METHODS In this retrospective cohort study,we included adolescents and adults≥16 years who received a matched sibling or haploidentical transplant from 2015-2022.Participants were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in Mexico.Three payment groups were compared:Out-of-pocket(OOP),private insurance,and a federal Universal healthcare program“Seguro Popular”.Outcomes were compared between referred and institution-diagnosed patients,and between residents of Nuevo Leon and out-of-state.Primary outcomes included overall survival(OS),categorized by residence,referral,and payment source.Secondary outcomes encompassed early mortality,event-free-survival,graft-versus-host-relapse-free survival,and non-relapse-mortality(NRM).Statistical analyses employed appropriate tests,Kaplan-Meier method,and Cox proportional hazard regression modeling.Statistical software included SPSS and R with tidycmprsk library.RESULTS Our primary outcome was overall survival.We included 287 patients,n=164 who lived out of state(57.1%),and n=129 referred from another institution(44.9%).The most frequent payment source was OOP(n=139,48.4%),followed by private insurance(n=75,26.1%)and universal coverage(n=73,25.4%).No differences in OS,event-free-survival,NRM,or graft-versus-host-relapse-free survival were observed for patients diagnosed locally vs in another institution,nor patients who lived in-state vs out-of-state.Patients who covered transplant costs through private insurance had the best outcomes with improved OS(median not reached)and 2-year cumulative incidence of NRM of 14%than patients who covered costs OOP(Median OS and 2-year NRM of 32%)or through a universal healthcare program active during the study period(OS and 2-year NRM of 19%)(P=0.024 and P=0.002,respectively).In a multivariate analysis,payment source and disease risk index were the only factors associated with overall survival.CONCLUSION In this Latin-American multicenter study,the site of residence or referral for alloHSCT did not impact outcomes.However,access to healthcare coverage for alloHSCT was associated with improved OS and reduced NRM.

Sociodemographic determinants associated with breastfeeding in term infants with low birth weight in Latin American countries

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.

Oral health of adolescents in West Africa:prioritizing its social determinants

Oral health is a major public health issue in West Africa,yet it has gotten little attention.Individual and group disparities in health status are influenced by social determinants of health(SDH),which also affect oral health.Adolescence is a significant transition into adulthood,a time when the SDH can contribute to lifelong health status.This article explored the SDH associated with oral health behaviour,perception,and oral health development amongst adolescents in West Africa.This article engaged articles published in peer-reviewed journals relating to adolescents’oral health and West Africa.The authors undertook this desk review to determine the social determinants of adolescents’oral health in West Africa.The literacy levels and oral health awareness of adolescents,family and social circle influences,socioeconomic status,nutritional levels,and cultural and environmental factors have been identified as important social determinants.Adequate policy implementation with the integration of oral health in schools’curriculum,health systems reorientation with the adoption of oral health delivery in primary health care and expansion in oral health research with the assessment of cultural influences on oral health development have been recommended as interventions to reduce oral health inequalities in West Africa.

Use of Social Cognitive Theory to Assess Salient Clinical Research in Chronic Disease Self-Management for Older Adults: An Integrative Review

The purpose of this integrative review is to evaluate research pertaining to self-management programs for older adults with chronic diseases using Albert Bandura’s Social Cognitive Theory (SCT) for behavior change. The focus is application of the SCT domains to self-management programs. The exploration of the current chronic disease self-management research provides an understanding of the Social Cognitive Theory concepts studied in interventional self-management research. The integrative review explicated two areas related to the theory in need of further research. First, social support has not been thoroughly explored as a mechanism for enhancing self-management interventions. Second, moral disengagement was not identified as a focus within chronic disease research raising the question about the impact of moral disengagement on long-term adherence and behavior change.

Six-year trends and intersectional correlates of meeting 24-Hour Movement Guidelines among South Korean adolescents:Korea Youth Risk Behavior Surveys,2013-2018

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.

Neighborhood predictors of short sleep duration and bedtime irregularity among children in the United States: results from the 2019-2020 National Surveyof Children's Health

Background Environmental factors may contribute to short sleep duration and irregular bedtime in children.Neighborhood factors and children's sleep duration and bedtime regularity remain a less investigated area.The aim of this study was to investigate the national and state-level proportions of children with short sleep duration and irregular bedtime and their neighborhood predictors.Methods A total of 67,598 children whose parents completed the National Survey of Children's Health in 2019-2020 were included in the analysis.Survey-weighted Poisson regression was used to explore the neighborhood predictors of children's short sleep duration and irregular bedtime.Results The prevalence of short sleep duration and irregular bedtime among children in the United States(US)was 34.6%[95%confidence interval(CI)=33.8%-35.4%]and 16.4%(95%CI=15.6%-17.2%)in 2019-2020,respectively.Safe neighborhoods,supportive neighborhoods,and neighborhoods with amenities were found to be protective factors against children's short sleep duration,with risk ratios ranging between 0.92 and 0.94,P<0.05.Neighborhoods with detracting elements were associated with an increased risk of short sleep duration[risk ratio(RR)=1.06,95%CI=1.00-1.12]and irregular bedtime(RR=1.15,95%CI=1.03-1.28).Child race/ethnicity moderated the relationship between neighborhood with amenities and short sleepduration.Conclusions Insufficient sleep duration and irregular bedtime were highly prevalent among US children.A favorable neighborhood environment can decrease children's risk of short sleep duration and irregular bedtime.Improving the neighborhood environment has implications for children's sleep health,especially for children from minority racial/ethnic groups.

Cardiovascular diseases in European ethnic minorities: Beyond the traditional cardiovascular risk factors

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.

Epidemiology of coal miners’pneumoconiosis and its social determinants:An ecological study from 1949 to 2021 in China

Background:Pneumoconiosis is the most widely distributed occupational disease worldwide.China is currently the largest coal producer and consumer and the country with the most coal miners and cases of coal workers’pneumoconiosis(CWP).Despite more than 70 years of effort,the problem of CWP and silicosis remains serious.There is a lack of analysis of direct data on coal miners’pneumoconiosis from all over the country.This study aimed to describe the epidemiology of coal miners’pneumoconiosis and reveal some important clues regarding its social determinants.Methods:The annual incidence rate,20-year prevalence rate,and incidence rate of coal miners’pneumoconiosis per million tons in China from 1949 to 2021 were calculated by using the data of annual number of coal miners’pneumoconiosis diagnosed and reported from the coal mining and dressing industry,the number of coal miners,and the raw coal production,and the relationship between the incident cases of coal miners’pneumoconiosis and the death toll from coal mine safety accidents was analyzed using Pearson correlation analysis,with the aim of exploring the relationship between the incident cases of coal miners’pneumoconiosis and its social determinants with an ecological study.Results:From 1949 to 2021,there have been more than 462,000 patients with coal miners’pneumoconio-sis in China,showing double U-shaped distributions with an increasing trend,accounting for about 50.5%(462,000/915,000)of all diagnosed pneumoconiosis in China,while the incidencet rate of coal miners’pneu-moconiosis presents a large W shaped distribution with three peaks over a time span of more than 50 years.From 1949 to 1986,there was a strong correlation between the incident cases of coal miners’pneumoconiosis and raw coal production,the number of coal miners,and the number of deaths from coal mine accidents(r=0.849,P<0.001;r=0.817,P<0.001;r=0.697,P<0.001,respectively),but there was no such correlation found from 1987 to 2006.It was estimated that the annual incidence rate of coal miners’pneumoconiosis in China from 2016 to 2020 was 3.4‰(95%CI:2.6-4.3‰),and the prevalence rate across the recent 20-year observation period was 4.8%(95%CI:4.6-4.9%),both measured at the peak or around the peak over the 70 years.In particular,1963,1986,2006,and 2009 were the four important turning points in time.Conclusion:There was a sustained high level of incident cases of coal miners’pneumoconiosis with double U-shaped curve in China,which may be affected by a variety of social determinants and risk factors.

In Bangla There Is No Word for Vagina —Reflections on Language, Sexual Health, and Women’s Access to Healthcare in Resource-Limited Countries

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.

Analysis of Risk Factors Sociodemographic for the Functional Dependence of Adults with Spinal Cord Injury

Objective: To evaluate the odds ratio of risk factors of sociodemographic and functional capacity of adults with spinal cord injury. Methods: Analytical, cross-sectional, quantitative study accomplished with a group of 47 people with spinal cord injury in hospitals and 27 in the household. The data were collected through a structured instrument composed of independent variables related to epidemiological and clinical data on spinal cord injury and dependent variables corresponding to the scale of the Barthel Index (BI). The data were analysed with the two-tailed chi-square or Fisher’s exact tests using the Statistical Package for the Social Sciences version 20.0 (SPSS Inc., USA). Odds ratio (OR) and 95% confidence intervals (CI) were used as an estimate of the risk. The level of significance was set at a p value ≤0.05. Results: It was found that males (OR = 4.804, p = 0.041), the education less than ten years (OR = 3.000, p = 0.036), the hospital care (OR = 5.250, p = 0.002) and injury time less than six months (OR = 5.250, p = 0.002) are sociodemographic factors that are associated with the functional capacity of individuals with spinal cord injury. Moreover, the total dependence (p < 0.001) and severe dependence (p = 0.019) are associated with quadricplegia. It was found that males (p = 0.041), the education less than ten years (p = 0.036), attention to hospital health (p = 0.002) and minor injury time less than six months (p = 0.002) are sociode-mographic factors associated with functional capacity of subjects. Conclusion: As a result, it was found that knowing the epidemiological and clinical factors of people with spinal cord injury is relevant to plan the nursing care. In other words, knowing the epidemiological and clinical factors of people with spinal cord injury is relevant to achieve the functional independence of these people, and it was demonstrated that the social determinants of health are interrelated and interdependent of chronic health conditions, as evidenced by the Care Model for Chronic Conditions.

Addressing neglected tropical diseases in Africa:a health equity perspective

Africa accounts for over one-third of the global burden of neglected tropical diseases(NTDs).Although continental efforts have been made to combat these diseases,there still exists a significant gap in the fight,ranging from a lack of data to multisectoral participation and,most critically,health inequity.Here,we assess the effort made to combat challenges caused by health disparities to prevent and control neglected tropical diseases.This article engages a health equity view to addressing the need for inclusion in achieving universal health coverage towards eradicating NTDs and outlines strategies to achieve such.Health disparities exist,and there is substantial and irrefutable evidence for them.Inequitable distribution and limited access to basic and essential life resources such as water,housing,toilets,soap,and literacy continue to facilitate the existence of NTDs such as Schistosomiasis,soil-transmitted helminths,and trachoma,the occurrence of which can be avoided if affected populations have better access to those resources.To eradicate NTDs,health disparities must be addressed to provide excellent health care to all populations and adequate universal health coverage for long-term sustainability.NTD programmes need to be data-driven to ensure better decision-making and ensure the inclusion of diverse population groups including women,children,and youths.This will ensure that no one is left behind,drawing upon the sustainable development goals.Community participation and engagement should also be considered as an essential approach to ensure people are at the centre of health programmes and their implementation.

Priority setting towards achieving underfive mortality target in Africa in context of sustainable development goals:an ordinary least squares(OLS)analysis

Background:Africa reduced its under-5 mortality rate(U5MR)by more than 50%during the MDGs era.However,it still has by far the highest average U5MR in the world-81 deaths compared to a global average of 43 deaths per 1000 births,with eight of the ten countries in the world with the highest child mortality rates.The primary objective of our study was to examine the socioeconomic,healthcare,and environmental determinants that most account for U5MR disparities between African countries.Methods:We used a series of ordinary least squares(OLS)regression models to assess the effects of 14 distinct socioeconomic,environmental and healthcare variables that account for the high U5MR differentials that persist between African countries.We conducted our analysis on 43 countries for which data were available.Using a dummy variable,we also emphasized factors that may be accounting for the disparity between the eight worstperforming countries and the remainder of the continent.Results:Among all the determinants analyzed in our study,the results reveal that the factors that most account for the inequities observed are,in order,expenditure on healthcare(p<0.01),total fertility rate(p<0.01),income per capita(p<0.05),and access to clean water(p<0.1).Conclusions:Our results show that the gap between the best and worst performing countries in Africa can be significantly narrowed if government and donor interventions will target downstream factors such as improving education for mothers and sensitising them about birth control since fertility rate differences play a critical role.Improving accessibility to clean water sources to reduce outbreaks of diarrhea diseases is also observed as a critical factor.

Socioeconomic status and anterior epistaxis in adult population

Objective:Little was known about the role of socioeconomic status as a risk factor for epistaxis in adult population.The objective of this study was to determine whether socioeconomic status influences the presentation to emergency department for anterior epistaxis in an adult population.Methods:Retrospective review of emergency department visits from January 2012 to May 2014.The setting is in an emergency department of a Canadian tertiary care centre.Adult patients with primary diagnosis of anterior epistaxis in the emergency department were included in this study.The main outcome was emergency department visits for anterior epistaxis visits.Results:A total of 351 cases of anterior epistaxis were included.The mean age was 70 years and 51%of patients were male.The patients were stratified into two groups based on whether their age was equal to and above,or below 75 years.Our analysis indicated that those 75 years or older in higher income quintiles have an increased risk of anterior epistaxis compared to the subjects in the lower income quintiles(P<0.05).This association did not hold true for those younger than 75 years or for all age groups combined.Conclusion:There is an association between higher socioeconomic status and the presentation to the emergency department with anterior epistaxis in the population older than 75 years but not in younger patients.