The Role of Health Inequality in the Maternal Health Services Provided by Public Institutions in Mexico

This work aims to determine the role of inequality in the provision of maternal health services among five regions in Mexico (northwest, northeast, central, the Mexico City-State of Mexico region and the south). We consider the most important service providers corresponding to the main health institutions in Mexico (IMSS, ISSSTE, SESAS, IMSS-Oportunidades). Therefore, a cross-sectional prospective study was conducted to analyze eight intervention packages (Prenatal Care, Syphilis, Influenza, Obstetric Urgent Care, HIV in pregnancy, delivery care, neonatal care and accessibility) offered by the Maternal and Perinatal Health (MPH) program. A quantitative analysis demonstrates low to marginal performance of the MPH program in three regions (South, Mexico City-State of Mexico and the Northwest) and marginal in two other regions (Central and Northeast). Furthermore, four of the intervention packages presented the lowest performance in the South (Prenatal Care, Syphilis, Influenza and Obstetric Urgent Care), as did the average of the total of the MPH packages. The performance of HIV in Pregnancy package was marginal in the Southern and Mexico City-State of Mexico regions and Neonatal Care was low in the Northwest. The assessment of the MPH intervention packages allows us to identify their strengths and weaknesses. This information allows us to identify similarities and differences among the geographical regions in order to describe and analyze the strengths, weaknesses, opportunities and threats in the current system and hence to improve the decision making regarding the Maternal and Perinatal Health Programs in Mexico. The results suggest that a homogenization has taken place in terms of the low quality of the services.

Health Inequalities during 20 Years of Rapid Economic Development in China (1980-2000):A Mortality Analysis

Objective To examine the influence of China＇s economic reforms on population health and regional mortality rates.Methods Longitudinal study measuring the mortality trends and their regional variations.Using data from the three most recent national censuses,we used the model life table to adjust the mortality levels within the population for each census,and to calculate life expectancy.We then examined the variation in patterns of mortality and population health by economic status,region and gender from 1980-2000.Results Life expectancy varied with economic status,province,and gender.Results showed that,although life expectancy in China had increased overall since the early 1980s,regional differences became more pronounced.Life expectancy for populations who live in the eastern coastal provinces are greater than those in the western regions.Conclusion Differences in life expectancy are primarily related to differences in regional economic development,which in turn exacerbate regional health inequalities.Therefore,it is necessary to improve economic development in less developed regions and to improve health policies and the public health system that address the needs of everyone.

Inequity in the global distribution of monkeypox vaccines

Monkeypox(mpox)has been a public health emergency of international concern that emerged in mid-2022 and has spread to 110 countries.The clinical findings of the disease vary according to the seriousness of the cases.Although its case fatality risk has not been high,a significant percentage of patients require hospitalization.In this context,local initiatives were taken to extend the limited supply of vaccines against the disease;however,such measures have not been sufficient to contain the spread of cases and ensure an equitable distribution of health resources.As a result,endemic regions of low-income countries continue to have insufficient access to mpox vaccination.Despite this and considering the global scope of the disease,there is still little discussion in the literature about the difficulties in achieving adequate vaccination coverage rates for the target population of interest.In this article,we briefly discussed general aspects of the disease,including its surveillance,the current global context of challenges for mpox vaccination,and issues on global allocation of health resources as well as proposed related recommendations.

Diabetes and COVID-19:Diseases of racial,social and glucose intolerance

Diabetes and coronavirus disease 2019(COVID-19)are worldwide pandemics that have had a major impact on public health throughout the globe.Risk factors for developing diabetes and having adverse outcomes of COVID-19 appear to be similar;metabolic factors(such as obesity),non-White ethnicity and poorer socioeconomic status appear to be risk factors for both.Diabetes and COVID-19 have a significant effect on populations adversely affected by health inequality.Whilst we hope that COVID-19 will be mitigated by widespread use of vaccines,no such prospect exists for mitigating the pandemic of diabetes.In this brief opinion review,I compare risk factors for diabetes and adverse outcomes of COVID-19 and argue that tackling health and social inequality is likely to play a major role in solving the global diabetes pandemic and improve outcomes of COVID-19.

A cross-sectional study of the relationships between ethnicity and occupational classes with mental wellbeing in the UK

Various aspects of a job (e.g. contract clauses, promotion, wages, job security and workplacehierarchy) are becoming increasingly complex and have some effect on an employee’s wellbeing. Simultaneously,research about an increase in mental health issues due to workplace obstacles for ethnic minorities is amassing butthere is a lack of policymaking to tackle this via accessible mental health support at the workplace. My study aimsto assess the effect of occupational class and ethnicity on wellbeing in the UK working population. Methods: Thestudy assessed 3,374 adult employees who participated in the Health Survey for England from 2014–2016 and werecategorised in 1/3 National Statistics Socio-economic Classification groups. The Warwick-Edinburgh MentalWellbeing Scale was used as a measure of mental wellbeing. I explored the relationship between occupational classand wellbeing score using linear regression, accounting for demographic and socioeconomic covariates: age, sex,income and education. My sample’s ethnicity breakdown was White: 3,051;Black: 83;Asian: 180;Mixed: 39;Other:21 adults. Results: Of the sample, 46.8% of adults belonged to managerial and professional occupations and 90.4%were of White ethnicity. Managerial and professional occupations had a higher mean wellbeing score (48.54;P <0.001) than routine and manual occupations (47.69;P < 0.05). Multiple ethnic background showed the highest meanwellbeing score (52.82;P < 0.05), compared to White adults with the lowest wellbeing score (48.57;P << 0.001).Unlike occupational class which had a small effect size (partial eta-squared = 0.02), when holding education, income,age and sex constant, ethnicity had a statistically significant association with wellbeing. Conclusion: White ethnicityand routine and manual occupations are high-risk groups for poor mental wellbeing. The impact of ethnicity andoccupational class on wellbeing scores remained after accounting for socioeconomic and demographic factors.

Primary care clinicians’ strategies to overcome financial barriers to specialty health care for uninsured patients

Objective:This study describes strategies used by federally qualified health centers(FQHCs)to assist medically uninsured patients in obtaining specialty health care services.Methods:Qualitative methods were used to study strategies for obtaining specialty health care for uninsured patients.Data were gathered from 10 primary care clinicians at three FQHC clinics by means of 10 semistructured interviews,23 brief interviews,and 45 h of direct observations.We captured additional data by studying cases of referred uninsured patients.Results:The following six strategies were identified:(1)quid pro quo-a specialist accept-ing the clinic’s medically uninsured patients was rewarded with referrals of the clinic’s insured patients;(2)over referral-clinicians referred insured patients whose needs could have been met at the FQHC;(3)brief hospitalization-when a specialist could not be obtained,high-risk patients were briefly hospitalized;(4)case building-diagnostic tests were conducted at the FQHC to justify a referral;(5)direct communication-communication between clinicians and specialists was neces-sary when requesting a referral;(6)specialty clinics-in return for conducting a specialty clinic at the FQHC,the specialist received all referrals of insured patients.Conclusion:Uninsured FQHC patients encountered difficulties accessing specialty health care,and in response,clinicians developed a range of innovative strategies.

Disparities in chiropractic utilization by race,ethnicity and socioeconomic status:A scoping review of the literature

Background Chiropractic is the largest complementary and alternative medicine profession in the United States,with increasing global growth.A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles.Objective There have been no prior studies to comprehensively integrate the literature on chiropractic utilization rates by race,ethnicity,and socioeconomic status.The purpose of this scoping review is to identify and describe the current state of knowledge of chiropractic utilization by race,ethnicity,education level,employment status,and income and poverty level.Search strategy Systematic searches were conducted in PubMed,Ovid MEDLINE,Cumulative Index of Nursing and Allied Health Literature(CINAHL),Cochrane Database of Systematic Reviews,and Index to Chiropractic Literature from inception to May 2021.Inclusion criteria Articles that reported race or ethnicity,education level,employment status,income or poverty level variables and chiropractic utilization rates for adults(≥18 years of age)were eligible for this review.Data extraction and analysis Data extracted from articles were citation information,patient characteristics,race and ethnicity,education level,employment status,income and poverty level,and chiropractic utilization rate.A descriptive numerical summary of included studies is provided.This study provides a qualitative thematic narrative of chiropractic utilization with attention to race and ethnicity,education level,income and poverty level,and employment status.Results A total of 69 articles were eligible for review.Most articles were published since 2003 and reported data from study populations in the United States.Of the race,ethnicity and socioeconomic categories that were most commonly reported,chiropractic utilization was the highest for individuals identifying as European American/White/non-Hispanic White/Caucasian(median 20.00%;interquartile range 2.70%-64.60%),those with employment as a main income source(median utilization 78.50%;interquartile range 77.90%-79.10%),individuals with an individual or household/family annual income between$40,001 and$60,000(median utilization 29.40%;interquartile range 25.15%-33.65%),and individuals with less than or equal to(12 years)high school diploma/general educational development certificate completion(median utilization 30.70%;interquartile range 15.10%-37.00%).Conclusion This comprehensive review of the literature on chiropractic utilization by race,ethnicity and socioeconomic status indicates differences in chiropractic utilization across diverse racial and ethnic and socioeconomic populations.Heterogeneity existed among definitions of key variables,including race,ethnicity,education level,employment status,and income and poverty level in the included studies,reducing clarity in rates of chiropractic utilization for these populations.

跨界PM_(2.5)污染健康影响及其不平等性的历史演化

大气传输导致的PM;跨界输送会引起重大的跨境健康影响.在过去几十年间,各区域人为源污染物排放发生了巨大且不同的变化,但是,由此产生的全球跨界健康影响及其中隐含的健康不平等性问题仍不清楚.本研究发现,在1950~2014年间,全球人为源PM_(2.5)累计导致了1.86(95%CI:1.16~2.56)亿例过早死亡,其中约14%是跨界PM;所致.在四个不同富裕程度的地区中,从对跨界PM;过早死亡的人均贡献的角度来说,越富裕的地区所造成的累计跨界健康影响越严重,而最贫穷的地区承受着最严重的跨界健康负担.这意味着,大气输送所造成的跨界健康影响不平等性问题十分严峻.并且,跨界健康效应及其不平等性随时间的变化也十分显著.降低PM;跨界污染需要全球紧密合作,而合作的基础应当将历史责任以及健康不平等性问题考虑在内.