Determinants Of Health Research Articles

Functional disability and disease activity are affected by social determinants ofhealth in patients with rheumatoid arthritis.

The relationship between social determinants of health (SDH) and disease outcomes in rheumatoid arthritis (RA) is not well documented. Data were extracted from the Ontario Best Practices Research Initiative (OBRI) registry for patients between January 2008 and April 2022. Adjusted mixed models analysis was used to investigate the effect of baseline SDH on disease activity (Clinical Disease Activity Index (CDAI)) and functional disability (Health Assessment Questionnaire-Disability Index (HAQ-DI)) 12months after enrollment. The analyses were completed on multiple imputed data. There were 2651 patients with a mean age of 58.1years (SD 12.9). The majority (77.8%) were female. Greater improvements in physical function were seen in patients who were full-time employed (difference = - 0.20; 95% CI - 0.28, - 0.11), part-time employed (difference = - 0.10; 95% CI - 0.19, - 0.02), or retired (difference = - 0.17; 95% CI - 0.25, - 0.08), compared to unemployed, those with highest income ($75,000 or more) (difference = - 0.23; 95% CI - 0.37, - 0.09). Caucasian was also associated with a positive impact on functional ability (difference = - 0.09; 95% CI - 0.17, - 0.02). In contrast, smokers had smaller improvements in physical function (difference = 0.07; 95% CI 0.002, 0.14). Interestingly, women had greater improvement in CDAI (difference = - 2.40; 95% CI - 3.29, - 1.51), while they reported less improving in their physical function (difference = 0.33; 95% CI 0.27-0.39). Achieving CDAI low disease activity/remission state was also more common in females. Our findings suggest that disease activity and functional disability are affected by different SDH factors. The effects of SDH should be better understood and addressed by rheumatologists to provide equitable healthcare for all patients with RA. Key points • This study explored a comprehensive panel of social determinants of health and their relationship to clinical outcomes. • Previously unreported factors such as employment status and income were found to influence clinical outcomes. • Our findings can help physicians to identify high-risk patients who may benefit from additional attention to their social background.

How do occupants experience the onset and triggering of building-related symptoms in damp Australian housing? An inductive-deductive content analysis

In recent years, occupants’ time spent in dwellings has increased concurrently with an increase in the duration and intensity of extreme weather events and the worsening of housing conditions. Indoor dampness and or mould (D/M) are risk factors for building-related symptoms (BRS), yet little is known about how symptoms start, thus hindering where to focus indoor air quality measurements and improvements in occupant safety. This study describes perceived symptom initiators, triggers and coinciding factors that explain what and how symptoms occurred from the perspectives of occupants living with indoor D/M. This study uses an inductive/deductive qualitative analysis, with purposive sampling (n = 154) from data collected via an online survey. Deductive content analysis utilises a framework driven by the Determinants of Health (DoH). Themes that emerged from the inductive analysis include: 1) when occupants or others interact with D/M; 2) when indoor D/M conditions change; and 3) a home full of D/M problems. From the deductive analysis, perceived exposure relating to D/M conditions differed between the initial onset of symptoms and the later triggering of symptoms. Additional coinciding factors relating to climate, socioeconomic, policy and individual factors along with a lack of knowledge, attitudes and beliefs, emerged. This study highlights the need to raise occupant awareness, enhance housing and occupancy regulations, and introduce safe work practices to address the lack of health awareness and health significance regarding indoor D/M housing conditions. It also outlines the need for targeted research measuring bioaerosol exposure related to actions, proximity-based exposure, and wet and repeatedly wet conditions.

Structural Determinants of Health

This Invited Commentary focuses on a brief summary of how structural determinants of health (DoH) are framed in nursing and how a focus on the political economy of health can support identifying and addressing the ideological drivers of the structural DoH. Structural determinants focus on the politics and histories of enduring root causes of preventable injustices. There is a nascent literature in nursing regarding the structural DoH, which includes policy and governance processes, interlocking systems of oppression and discrimination, and social and economic structures that contribute to forces of power inherent in financial, legal, and governmental systems and policies. However, it is also crucially important to name and analyze their root ideological foundations because this is the space where structural change must be targeted. Various ideologies, intentionally or unintentionally, drive policy, politics, institutional governance and decision-making, and so on. The political economy of health is a foundational field that supports identifying these ideological drivers of the structural DoH. The invited commentary concludes with reflections and recommendations for nursing.

Digital determinants of health as a way to address multilevel complex causal model in the promotion of Digital health equity and the prevention of digital health inequities: A scoping review.

With the progressive digitization of health services and the current spread of Telemedicine and e-Health, it became clear that promoting Digital health equity (DHE) is necessary to support health potential, to avoid that some individuals can incur in unintended inequities. In this paper, we address the complex causal process(es) that may generate risk of inequities, considering the so-called "Digital Determinants of health" (DDoH) and their relationship with determinants of health (DoH). We conducted a scoping review, according to methodological framework proposed in PRISMA-ScR guidelines, on the definition of DDoH (Scopus, Pubmed and Web of Science electronic databases). Inclusion criteria: papers on the definition of DDoH, no time limits, all study designs eligible. There is an agreement on the link between DDoHs and "digital divide" and on their effects on a wide range of health, functioning outcomes, both as barriers and as facilitators. Authors proposed to modify or integrate with DDoHs the "Rainbow model" or other conceptual models on DoH. To promote DHE, authors suggest considering a multidimensional complex causal model, with interdependence among the different levels and the mutually reinforcing effects. To study DDoH and their relationship with main determinants of health could be a way to address the complex causal model in the promotion of DHE. However, as they act in a multidimensional causal context, any intervention may consider the interdependence among different involved levels, within them, and the mutually reinforcing effects. Further research is needed to gain a more complete picture of the field.

Kontrola zdrowia u dzieci w wieku szkolnym

The contemporary young generation is struggling with an increasing tendency to engage in anti-health behaviors. The process of health locus of control is influenced by many determinantsof health, both in physical and mental terms. The influence of all determinants, family and peer environment, or socio-economic status can contribute to positive or negative health behaviors, and thus shape internal or external health locus of control among children.

Spatial Patterns in the Association between the Prevalence of Asthma and Determinants of Health

The World Health Organization endorses the study of diseases from the perspective of the Determinants of Health (DH), that is, the circumstances in which people are born and raised, the environment in which they grow up and age and their lifestyle. The aim of this study is to analyze the spatial behavior of the prevalence of asthma in Aragon, a Mediterranean region in Spain, under the DH approach. The methodological process entailed building a spatial database collating asthma prevalence as dependent variable, and lifestyle, socioeconomic, and climate indicators as explanatory factors, and then evaluating the spatial variability of the relationships by combining the Principal Component Analysis (PCA), Multiscale Geographically Weighted Regression (MGWR) models and cartographic design techniques. MGWR evidenced spatially varying relationships operating at different scales. Lifestyles seem closely tied to the prevalence of asthma in most of the study area while urban functionality and local climate patterns seem to boost prevalence rates in some specific enclaves. Consequently, the social and environmental conditions that characterize the study area translate into several DH scenarios modulating the spatial distribution of asthma. This differential DH behavior detected by local regression models is relevant to guiding and refining public health decision‐making.

The Social and Home Environment: Impacts of Determinants of Health on Atopic Dermatitis, Pathways Toward Solutions, and Unique Considerations for Rural and Remote North American Indigenous Populations

Disparities in environmental and social determinants of health (DOH) are associated with morbidity in atopic dermatitis (AD). The socioecological model (SEM) is a framework that can be applied to better understand how DOH impacts patients with AD. We include a case scenario of a remote Indigenous patient reflective of real-world situations of living with AD and examine relevant impact, gaps in knowledge, and further research needs. This review highlights a variety of social and environmental exposures as important DOH which must be addressed to achieve optimal management in AD. The "Rainbow model” is a modified framework to help illustrate how complex environmental and social forces impact both AD presentation and therapeutic success. However, practical applications and outcome metrics for health promotion are limited.1 An inter- and transdisciplinary approach is paramount to address the complex challenges associated with AD care, as well as multistakeholder approach integrating culturally-competent equitable health frameworks. This review underscores the importance of expanding the focus of AD management beyond basic science and clinical trials to recognize and address health disparities and to promote optimal health and well-being in patients with AD, and contributes a working approach to mapping the complex interventions and patient-oriented research needed using a focus on remote North American Indigenous patients affected by AD.

A Framework for Public Health Authorities to Evaluate Health Determinants for Wastewater-Based Epidemiology.

Wastewater-based epidemiology (WBE) is rapidly developing as a powerful public health tool. It can provide information about a wide range of health determinants (HDs), including community exposure to environmental hazards, trends in consumption of licit and illicit substances, spread of infectious diseases, and general community health. As such, the list of possible candidate HDs for WBE is almost limitless. Consequently, a means to evaluate and prioritize suitable candidates for WBE is useful, particularly for public health authorities, who often face resource constraints. We have developed a framework to assist public health authorities to decide what HDs may be appropriate for WBE and what biomarkers could be used. This commentary reflects the experience of the authors, who work at the interface of research and public health implementation. To be suitable for WBE, a candidate HD should address a public health or scientific issue that would benefit from better understanding at the population level. For HDs where information on individual exposures or stratification by population subgroups is required, WBE is less suitable. Where other methodologies are already used to monitor the candidate HD, consideration must be given to whether WBE could provide better or complementary information to the current approach. An essential requirement of WBE is a biomarker specific for the candidate HD. A biomarker in this context refers to any human-excreted chemical or biological that could act as an indicator of consumption or exposure to an environmental hazard or of the human health state. Suitable biomarkers should meet several criteria outlined in this commentary, which requires background knowledge for both the biomarker and the HD. An evaluation tree summarizing key considerations for public health authorities when assessing the suitability of candidate HDs for WBE and an example evaluation are presented. https://doi.org/10.1289/EHP11115.

Association between Structural Determinants of Health and Posttraumatic Stress Symptoms during the COVID-19 Pandemic

Background: Psychological problems, such as post-traumatic stress symptoms (PTSS), are among the most important complications associated with the COVID-19 pandemic in people. Studying the social determinants of health (SDH) and its impact on the populations during the crisis will help governments deal better with health emergencies so that every person can have an equal opportunity to stay healthy. Objective: To determine what factors affect PTSS, we conducted a study to investigate the association between structural determinants of health and PTSS during the COVID-19 pandemic. Methods: We conducted a cross-sectional study on 370 people referred to a selected laboratory between June and July 2020 in Karaj province, Iran. Post-traumatic stress disorder (PTSD) 8-item inventory was used to evaluate the PTSS and its subscales, including intrusion, avoidance, and hypervigilance in the participants. Results: Overall, 51.2% of participants were male, and 17.3% were positive for the IgM or IgG COVID-19 test. The most common symptoms in these patients were weakness, myalgia, cough, anosmia, and fever. The prevalence of total PTSS, intrusion, avoidance, and hypervigilance symptoms were 7.1%, 25.7%, 41.6%, and 16.2%, respectively. In univariable regression analysis, female gender (p-value=0.01, 95%CI (2.25-0.31)), un-employment (p-value=0.011, 95%CI (0.37-2.81)), having symptoms of COVID-19 disease (p-value=0.000, 95%CI (.82-2.75)), underlying chronic disease, were directly associated with PTSS. Conclusion: Results showed that sex and occupation as structural determinants of health could affect PTSS in the COVID-19 pandemic. However, in the multivariable model, having symptoms of the COVID-19 disease and underlying disease affected PTSS.

Digitization of healthcare post COVID-19: Reimagining the role of health education and promotion

The digitization of health promotion and communication has become a major discourse in healthcare. This paper synthesizes my understanding of the role of health literacy, promotion, education and communication in ensuring effective digitization of healthcare and presents four key findings from a mental health promotion project. First, the pandemic has shown us more than ever how fragile we all are – health-seeking behaviour will increasingly take centre stage over the next decade. Second, why do people refuse to wear masks even though it increases the risk of mortality? Why are individuals not motivated to exercise despite downloading free health apps? Why do people keep eating unhealthy food even when they can afford healthier options? Why? The numbers cannot tell the whole story. Similarly, the proliferation of digital health technology cannot convince people to modify their behaviours nor promote meaningful use of e/m-health apps. Third, deliberate digital health promotion and communication is needed to leverage opportunities in health technology. Fourth, the world needs researchers and experts who understand the broader determinants of health attitudes and are knowledgeable in synthesizing valid health information across various technological platforms, in support of health system needs. I address the implications of my findings and discuss future directions for policy and practitioners.

Culture, Ethnic, Lifestyle, and Diabetes

Diabetes is a social health problem that is large with special attention in the community and amongindividuals. Nevertheless, the efforts to spread paradigm of health society to inputsocial determinant ofhealth including analysis and contextual of social factors that are considered out of the scope of the healthresearch is seldom conducted. As a result, the conceptualization of dynamic health inequality of diabetesis superficial. By using a holistic anthropologist lens has the potency to offer insight intothe character ofsocialdeterminer which is wider. The individual factor that is traditionally focused on the health of society andqualitative exploration structural, deeply local context, social environment, and culture, and their interactionand intersexuality, as the key factors, while considering how to reach alterations. The systematic study aimsto describe that culture, ethnicity, and lifestyle have much impacton the patients of diabetes mellitus. Themethod of the systematic study is the article’s investigations which are listed by PubMed with the keywords“culture, ethnic, lifestyle, and diabetes”. Twenty-nine articles are got from the result of an investigation andafter a selection has been done and got five articles to be analyzed furthermore. The result of the review ofthe literature study shows that culture, ethnicity, and lifestyle are able to influence the case of diabetes illnessto the individual or group. On a certain ethnic group besides economic problem, the characteristic ofcertainbody starts from size and shape of the body make someone can suffer from diabetes, in addition,the motoricactivity of the body and physical activity can influence the case of diabetes.

Preventing Child Drowning in the Philippines: The Need to Address the Determinants of Health.

Drowning is a public health issue in the Philippines, with children at significantly increased risk. Determinants of health (DoH) such as education, socio-economic status, ethnicity, and urbanization are factors that impact drowning risk. As drowning is a multisectoral issue, a national drowning prevention plan can drive collaboration with relevant stakeholders. This study reports trends in unintentional child (0–14 years) drowning in the Philippines (incidence, rates, and trends over time for fatal and non-fatal (years lived with a disability (YLDs) and disability adjusted life years (DALYs) from 2008–2017 and conducts an analysis of the Philippines’ Multisector Action Plan (MSAP) on Drowning Prevention. From 2008–2017, 27,928 (95%UI [Uncertainty Interval]: 22,794–33,828) children aged 0–14 years died from drowning (52.7% aged 5–14 years old). Rates of drowning have declined among both age groups, with greater reductions seen among 0–4 year olds (y = −0.3368x + 13.035; R2 = 0.9588). The MSAP has 12 child drowning-specific activities and 20 activities were identified where DoH will need to be considered during development and implementation. The MSAP activities, and work done to prevent drowning more generally, must consider DoH such as education, urbanization, water and sanitation health, and safe water transportation. A national drowning surveillance system and investment in research in the Philippines are recommended.

Hackensack Meridian School of Medicine at Seton Hall University.

Hackensack Meridian School of Medicine at Seton Hall University.

Physical fitness and physical activity in women with obesity: short term effects of sleeve gastrectomy.

Introduction: the increase on prevalence of obesity has been linked to a higher number of bariatric surgeries, being sleeve gastrectomy (SG) the most frequent bariatric procedures in the world. However, there are few studies that determine the impact of SG on health's determinants such as physical fitness (PF) and physical activity (PA). Objectives: to describe the changes in PF and PA of patients after SG. Methods: twenty-three women with obesity (mean 36.1 ± 11.1 years old and body mass index [BMI] of 35.1 ± 3.4 kg/m2) were evaluated preoperatively to SG and at one and three months after surgery. An assessment of PF was conducted, including handgrip (HGS) and quadriceps muscle strength (QMS) with dynamometers and cardiorespiratory fitness (CRF) with an ergospirometer. PA was assessed with a three-axis accelerometer. Results: the absolute VO2 peak decreased after the first and third month (p < 0.001) post SG. The VO2 peak relative to body weight showed an increase from baseline after the SG (p = 0.002). After SG, there was a reduction in absolute values for HGS and QMS (p < 0.001) and an increase in relative HGS after three months post-surgery compared to preoperative (p = 0.011), without changes in relative QMS (p = 0.596). No changes in PA were observed. Conclusions: after SG, there is a short term decline on PF when it is expressed on absolute values. However, when it is expressed in relative terms to body weight, some components of PF improve, while others showed no change. There was no modification in PA levels of the participants.

Digital Infrastructure as a Determinant of Health Equity: An Australian Case Study of the Implementation of the National Broadband Network

AbstractInequities in access to fast and reliable internet connections, essential for digital access to services and information that are important for health, can exacerbate social inequalities in health. We evaluated the social equity of the rollout of the National Broadband Network (NBN) in Australia based on the type of digital infrastructure delivered to areas of varying socioeconomic status. We found that areas of greater socioeconomic disadvantage were significantly less likely to receive the highest quality infrastructure, controlling for level of remoteness. These social inequities in provision of quality infrastructure will shape and possibly exacerbate inequities in health. In our discussion we consider how political decisions have obstructed equitable implementation of the policy. Lessons from the Australian case study may be valuable for other countries investing in public digital infrastructure who want to ensure equity of provision and can also inform Australian policy in the NBN's remaining rollout.

The Relationship between Structural Social Determinants of Health and Food Insecurity among Pregnant Women

Background: Food insecurity, as a major public health concern, is a useful indicator of an individual’s health and wellbeing. Objectives: This study aimed to identify the relationship between the structural social determinants of health and food insecurity among pregnant women. Methods: This cross sectional study was conducted on 837 pregnant women, using stratified cluster sampling. The number of samples from each city of Ilam Province was determined, based on the proportion of women at reproductive age in every city. Urban healthcare centers were selected from each city, and eligible samples were recruited at 24 - 28 weeks of gestation, based on the inclusion criteria. Data were collected on women’s demographic and obstetric characteristics, socioeconomic status, and food security status. Data were analyzed using SPSS version 19. Results: The results showed that the mean age of women was 28.734.41 years. Overall, 35.1% of samples had food insecurity (mild, moderate, and severe insecurity: 24.9%, 7.5%, and 2.9%, respectively). Food insecurity had a significant relationship with the structural social determinants of health (P < 0.001). The logistic regression analysis revealed that the structural social determinants of health were protective factors against food insecurity, as the probability of household food insecurity was lower in women with college education, employees, and high-income households (OR, 0.118, 0.411, and 0.050, respectively). Conclusions: Food insecurity is a common problem, associated with the social determinants of health. Therefore, establishment of food security requires access to the necessary nutrients for all family members, especially the vulnerable ones.

Seeking an expanded, multidimensional conceptual approach to health literacy and health disparities research

This chapter compares the conceptual foundations of health literacy and health disparities. It details some of the conceptual differences between health literacy and health disparities and explains some similarities that suggest the need for increased research collaboration. The chapter is among the first to address the structural and social determinants of health together and explain that future research needs to assess their interactions. Overall, the chapter creates a conceptual foundation as well as challenges future scholars/practitioners to take more multidimensional approaches to assess health's determinants. The chapter also attempts to demonstrate there is nothing more practical than good theory, or clear conceptual foundations. The chapter is divided into four sections that address the following topics: three conceptual frameworks about the determinants of health; opportunities in health disparities and health literacy research; seeking an expanded, multidimensional conceptual approach to health literacy and health disparities research; as well as a conclusion. The chapter suggests there are vacuums in current research knowledge that need future attention - especially regarding the integration of health literacy and health disparities research.

Functional liver stress in dairy sheep

The aim of this study was to investigate liver function in dairy sheep during summer and consequences made by heat stress. The experiment was performed on 117 Pramenka sheep at two different locations (Travnik and Livno) during summer grazing period (July, August and September). Levels of serum enzymes were determined for alanine aminotransferase (ALT), aspartate aminotransferase (AST)), gamma-glutamyl transferase (GGT), alkaline phosphatase (AP) and lactate dehydrogenase (LDH). Enzyme activities resulted in significant (P<0.05) variation except GCT and a moderate increase followed by dcrease in activity, which is likely to be correlated with the energy balance of animals. Values of serum profile above reference range may indicate intense metabolic processesasaliver response toa negative energy balance. The results of this research couldbeused for the determination ofhealth status.

Considering disparities: How do nurse practitioner regulatory policies, access to care, and health outcomes vary across four states?

BackgroundHealth disparities persist among morbidity and mortality rates in the United States. Contributing significantly to these disparities are the ability to pay for health care (largely, access to health insurance) and access to, and capacity of, the primary care health workforce. PurposeThis article examines key determinants of health (DOH) including demographics, public and regulatory policies, health workforce capacity, and primary health outcomes of four states of the United States. The context of this study is the potential association among health care disparities and myriad DOH, among them, the restrictive nurse practitioner (NP) scope of practice (SOP) regulatory environment, which are documented to influence access to care and health outcomes. MethodsThis descriptive study explores current NP SOP regulations, access to primary care, and health outcomes of key chronic disease indicators—diabetes, hypertension, and obesity in Alabama, Colorado, Mississippi, and Utah. These states represent both the greatest disparity in chronic disease health outcomes (obesity, diabetes, and hypertension) and the greatest difference in modernization of their NP SOP laws. The Affordable Care Act has greatly expanded access to health care. However, it is estimated that 23 million Americans, 7% of its total population, will remain uninsured by 2019. DiscussionRestrictive and inconsistent NP SOP policies may continue to contribute to health workforce capacity and population health disparities across the country, with particular concern for primary care indicators. The study findings bring into question whether states with more restrictive NP SOP regulations impact access to primary care, which may in turn influence population health outcomes. These findings suggest the need for further research. NPs are essential for meeting the increasing demands of primary care in the United States, and quality-of-care indicator research supports their use.

Hospital Community Benefit Spending: Leaning In on the Social Determinantsof Health

The Milbank QuarterlyVolume 94, Issue 2 p. 251-254 Op-Ed Hospital Community Benefit Spending: Leaning In on the Social Determinantsof Health SARA ROSENBAUM, Corresponding AuthorAddress correspondence to: Sara Rosenbaum, George Washington University School of Public Health and Health Services, 2021 K St, NW, Washington, DC 20006 (email: sarar@gwu.edu).Search for more papers by this author SARA ROSENBAUM, Corresponding AuthorAddress correspondence to: Sara Rosenbaum, George Washington University School of Public Health and Health Services, 2021 K St, NW, Washington, DC 20006 (email: sarar@gwu.edu).Search for more papers by this author First published: 06 June 2016 https://doi.org/10.1111/1468-0009.12191Citations: 14Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Citing Literature Volume94, Issue2June 2016Pages 251-254 RelatedInformation