Social Inequalities In Health Research Articles

Mortes maternas como desafio para a assistência obstétrica em tempos da Covid-19 no Brasil

Abstract Objectives: to describe the effects of the Covid-19 pandemic on maternal mortality in Brazil in 2021. Methods: it is an exploratory study with description of the excess maternal mortality in Brazil for 2021, considering different scenarios: (i) 2015-2019 linear trend; (ii) 2020 observed number of deaths; (iii) 2015-2019 linear trend corrected for general mortality excess; (iv) 2020 observed number of deaths corrected for general mortality excess. Results: compared to the trend of the previous five years, the year 2021 showed an excess mortality of 39% (n=3030). The maternal mortality ratio for 2021 drastically exceeded the SDG target for this indicator, reaching approximately 110 maternal deaths per 100,000 live births. In any scenario described, there will be excess maternal mortality in 2021 higher than general mortality and higher than level presented in 2020. Analysis stratified by region demonstrates subnational heterogeneity. Conclusion: Covid-19 pandemic had a considerable impact on maternal health, not only by leading to increased deaths but also by increasing social health inequality. The year 2021 was the most critical period of the pandemic regarding the magnitude of mortality. Barriers to accessing and using essential health services are challenging to achieving health-related Sustainable Development Goals.

Putting proportionate universalism into practice: challenges and tools

Proportionate universalism is a well-know strategy in the effort of reducing social health inequalities. It refers to the resourcing and delivering of universal services and interventions at a scale and intensity proportionate to the degree of the need of the target group. However, putting the principle of proportionate universalism into practice, is highly challenging. Applying proportionate universalism demands for a systematic thinking exercise about similarities, unique characteristics and differences of and between different subgroups, especially those most at risk, that are part of the broader target group (e.g. inhabitants of Flanders).
 Developing a well thought out strategy of proportionate universalism requires an answer to the following questions:
 -What are the high-risk subgroups that require special attention? 
 -Can the needs, interests, concerns, barriers, … of the high-risk groups be integrated in a universal approach that serves the entire target group?
 -What ‘proportionalities’ need to be added to the universal approach so that high-risk groups are definitely served?
 -Are there particular needs, barriers, concerns, … of high-risk groups that are very specific and different from those of other subgroups, which requires the development of a ‘categorical’ service, intervention,… targeting one specific subgroup?
 We developed a user guideline, ‘Determining your proportionate universalism strategy’, which supports professionals in the field of prevention and health promotion to reflect upon these questions and formulate answers to them.
 In addition to this guideline, we developed an inspirational guide including 10 methods that help professionals putting proportionate universalism into practice: ‘Health promotion for and with socially vulnerable populations: 10 methods for an inclusive approach’. These methods are well known for their potential in health promotion for and with underserved and socially vulnerable groups. The methods are visually presented and clustered in a ‘cake’ and divided into four categories: 1/ ‘getting to know’, 2/ reach, 3/work together and 4/empower and advocate. Each method is furnished with good practices from the field. During the months to come, focus will go to the implementation of both tools (the user guideline and the inspiration guide) in the sector of prevention and health promotion in Flanders.
 
 In this presentation, we will present both tools and focus on how they can be used to support the development and implementation of inclusive health promoting interventions that follow the principle of proportionate universalism. We will refer to multiple good practices to illustrate the tool’s added value for professionals and policy makers.

Unpacking the Public Health Triad of Social Inequality in Health, Health Literacy, and Quality of Life-A Scoping Review of Research Characteristics.

Social inequalities in health, health literacy, and quality of life serve as distinct public health indicators, but it remains unclear how and to what extent they are applied and combined in the literature. Thus, the characteristics of the research have yet to be established, and we aim to identify and describe the characteristics of research that intersects social inequality in health, health literacy, and quality of life. We conducted a scoping review with systematic searches in ten databases. Studies applying any design in any population were eligible if social inequality in health, health literacy, and quality of life were combined. Citations were independently screened using Covidence. The search yielded 4111 citations, with 73 eligible reports. The reviewed research was mostly quantitative and aimed at patient populations in a community setting, with a scarcity of reports specifically defining and assessing social inequality in health, health literacy, and quality of life, and with only 2/73 citations providing a definition for all three. The published research combining social inequality in health, health literacy, and quality of life is heterogeneous regarding research designs, populations, contexts, and geography, where social inequality appears as a contextualizing variable.

Impact of lockdown and school closure on children during the COVID-19 pandemic

This brief communication reports the conclusions of a narrative review study on the impact of Lockdown and School Closure on Children During the COVID-19 Pandemic. The objective was to analyze social inequalities in child health, before, during and after the pandemic, in a range of child health outcomes related to school closures and other lockdown measures.

Guide Development for eHealth Interventions Targeting People With a Low Socioeconomic Position: Participatory Design Approach.

People with a low socioeconomic position (SEP) are less likely to benefit from eHealth interventions, exacerbating social health inequalities. Professionals developing eHealth interventions for this group face numerous challenges. A comprehensive guide to support these professionals in their work could mitigate these inequalities. We aimed to develop a web-based guide to support professionals in the development, adaptation, evaluation, and implementation of eHealth interventions for people with a low SEP. This study consisted of 2 phases. The first phase involved a secondary analysis of 2 previous qualitative and quantitative studies. In this phase, we synthesized insights from the previous studies to develop the guide's content and information structure. In the second phase, we used a participatory design process. This process included iterative development and evaluation of the guide's design with 11 professionals who had experience with both eHealth and the target group. We used test versions (prototypes) and think-aloud testing combined with semistructured interviews and a questionnaire to identify design requirements and develop and adapt the guide accordingly. The secondary analysis resulted in a framework of recommendations for developing the guide, which was categorized under 5 themes: development, reach, adherence, evaluation, and implementation. The participatory design process resulted in 16 requirements on system, content, and service aspects for the design of the guide. For the system category, the guide was required to have an open navigation strategy leading to more specific information and short pages with visual elements. Content requirements included providing comprehensible information, scientific evidence, a user perspective, information on practical applications, and a personal and informal tone of voice. Service requirements involved improving suitability for different professionals, ensuring long-term viability, and a focus on implementation. Based on these requirements, we developed the final version of "the inclusive eHealth guide." The inclusive eHealth guide provides a practical, user-centric tool for professionals aiming to develop, adapt, evaluate, and implement eHealth interventions for people with a low SEP, with the aim of reducing health disparities in this population. Future research should investigate its suitability for different end-user goals, its external validity, its applicability in specific contexts, and its real-world impact on social health inequality.

Oral health, a public health issue in 2023: Reflections and actions of the ASPBD

The first Dental Public Health Day, in 2001, was not only the starting point for the creation of the Association des Acteurs de la Santé Publique Bucco-Dentaire (ASPBD), but also for the recognition of this specialty in France, even though it had already been recognized by the American Dental Association as early as 1950. Every year, the ASPBD organizes a national oral health day. The ASPBD brings together the vast majority of French odontologists and academic researchers in the field, as well as other French-speaking academics. Throughout the year, we work to bring together the dental and non-dental worlds, mainly the institutional and non-profit sectors with users, freelancers, and employees, the World Health Organization, and the French Public Health Society. This is in keeping with the partnership approach taken by the association for the past twenty-two years. Our aim is to bring together all the actors concerned to work toward integrating oral health into all health policies and health promotion and prevention schemes. We believe it is vital to provide oral health training for medical and paramedical staff, as well as for those working in education and outreach. Likewise, we are working to ensure that prevention is organized on a territorial level, involving local people as closely as possible and focusing on their needs. This is why we are actively involved in the fight against social and territorial inequalities in health, oral health being a strong indicator of these inequalities.

Improving Access to Safe Water in Rural Schools of Kenya: Qualitative Multisectoral Insights.

Comprehensive strategies in water, sanitation, and appropriate hygiene behaviors can improve school enrolment and improve gender parity disparities. Lack of safe drinking water negatively impacts the social capital of people, especially school-going children in rural areas. In this study, we systematically evaluated and documented evidence on the barriers and facilitators in the access and adoption of safe water practices in rural schools in Laikipia County, Kenya. An ethnographic formative, collaborative implementation research design was used in an iterative and participatory process to evaluate community, socio-economic, and health system-related factors affecting water, hygiene, and sanitation strategies. Qualitative data was collected using key informant interviews (n=5) and focus groups (n=3) from various multisectoral participants. Directed content analysis was used to develop codes, categories, and themes from textual data. Data was organized according to the Promoting Action on Research Implementation in Health Services framework. The findings were classified and described under three key elements: context, evidence, and facilitation. Contextual elements showed an association of diarrhea outbreaks with unsafe hygiene practices compounded by water scarcity. The evidence elements were indicative of the applicability of water backpacks in strengthening handwashing, storage, and transport of water. Facilitation elements indicated evidence of gaps in synergy between the school health and public health systems, necessitating multisectoral collaboration and social capital capacity building. The national and county governments play an imperative role in ensuring access and continuous supply of safe drinking water in schools. This is fundamental in efforts towards reducing social inequalities of health among school-going children and building their social capital. Participatory, collaborative, multisectoral interventions and decision-making are crucial, leveraging on creating local ownership, in meeting the water consumption needs of children and communities in water-scarce regions.

Utilization of a public subsidy scheme for dental care services among socially vulnerable citizens out of labor in Copenhagen, Denmark

Objective Addressing social inequality in oral health and access to dental care is a global concern. This study aims to describe the utilization of a public subsidy scheme targeting vulnerable individuals out of labor in Copenhagen municipality (2013–2018) and to identify key characteristics of individuals eligible to apply. Material and Methods Data from Copenhagen municipality were combined with data from population and health registers. Employing logistic regression analyses, we examined the association between demographic, socioeconomic, and health-related characteristics and (1) having applied, (2) being granted, and (3) using the subsidy. Results The study included 65,174 individuals aged 18–65. Of these 10,369 (15.9%) applied for subsidies, submitting a total of 18,529 applications. Overall, 83% of the applications were granted and 85% were used. Significantly increased odds of applying for subsidies were observed among individuals receiving social benefits non-stop over the past year versus none (odds ratio [OR] = 15.45, 95% confidence interval [CI] = 14.24–16.76), aged 50–65 versus 18–29 years (OR = 4.41, CI = 4.15–4.69), and having combined indicators of social vulnerability versus none (OR = 2.90, CI = 2.73–3.07). Conclusions While the utilization of the public subsidy scheme is low, individuals who apply are likely to be granted a subsidy and use it. Vulnerability was associated with greater utilization of the scheme, yet a substantial portion of those at risk of poor oral health did not take advantage of it.

Missed Appointments: Research Protocol for a mixed method study about the causes of patient non-attendance at medical appointments in Denmark.

Approximately one third of patient appointments in health care result in failures, leading to patient risk and sizable resource "waste". Existing interventions to alleviate the no-shows often target the patients. The underlying reason behind these interventions is a view that attendance/non-attendance is solely the patient's problem. However, these interventions often prove ineffective and can perpetuate social biases and health inequalities, leaving behind the more vulnerable or disadvantaged patients (in terms of social, economical, linguistic factors, etc.). A more holistic understanding of no-shows is needed to optimize processes, to reduce waste and support vulnerable patients. This study aims to gain a deeper and more comprehensive understanding of the causes, mechanisms and recurring patterns and elements contributing to non-attendance at Danish hospitals in the Region of Southern Denmark. It emphasizes the patient perspective and analyses the relational and organizational processes surrounding no-shows in healthcare. Additionally, the study aims to identify effective communicative strategies and organizational processes that can support development and implementation of successful interventions. The research employs mixed quantitative-qualitative methods, encompassing four analytical projects focusing on non-attendance patterns, patient knowledge and behaviour, management of hospital appointments, and in-situ communication. To address the complexity of no-shows in healthcare the study incorporates various data sources. The quantitative data sources include the electronic patient records, the Danish central registries, the Danish National Patient Registry, and the Register of Medicinal Product Statistics. Baseline characteristics of patients at different levels are compared using Chi2 and Kruskal-Wallis tests. The qualitative studies involve observational data, individual semi-structured interviews with patients and practitioners, and video recordings of patient consultations. This paper presents the protocol of the study, which was funded by the Novo Nordisk Foundation in July 2022. The study was registered with The Danish Data Protection Agency (Registry ID: 22/54791) and with The Open Patient Data Explorative Network (Registry ID: OP_1800) in January 2023. Recruitment started in February 2023. It is anticipated that the quantitative data analysis will be completed by the end of September 2023, with the qualitative investigation starting in October 2023. The first study findings are anticipated to be available by the end of 2024. The existing research on non-attendance in Danish healthcare is inadequate in addressing relational and organisational factors leading to hospital no-shows. Interventions have had limited effect, high-lighting the Danish healthcare system's failure to accommodate for vulnerable patients. Effective interventions require a qualitative approach and robust ethnographic data to supplement the description and categorization of no-shows at hospitals. Obtaining comprehensive knowledge about the causes of missed patient appointments will yield practical benefits, enhancing safety, coherence and quality of treatment in healthcare.

Effectiveness of Interventions to Improve Digital Health Literacy in Forced Migrant Populations: Protocol for a Mixed Methods Systematic Review

Background Digital health literacy is considered a health determinant that can influence improved health and well-being, health equity, and the reduction of social health inequalities. Therefore, it serves as an asset for individuals to promote their health. However, low digital health literacy is a major problem among forced migrant populations. They do not always have the capacity and skills to access digital health resources and use them appropriately. To our knowledge, no studies are currently available to examine effective interventions for improving digital health literacy among forced migrant populations. Objective This paper presents the protocol for a systematic review that aims to assess the effectiveness of digital health literacy interventions among forced migrant populations. With this review, our objectives are as follows: (1) identify interventions designed to improve digital health literacy among forced migrant populations, including interventions aimed at creating enabling conditions or environments that cater to the needs and expectations of forced migrants limited by low levels of digital health literacy, with the goal of facilitating their access to and use of eHealth resources; (2) define the categories and describe the characteristics of these interventions, which are designed to enhance the abilities of forced migrants or adapt digital health services to meet the needs and expectations of forced migrant populations. Methods A mixed methods systematic review will be conducted according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) checklist. The research will be conducted in an iterative process among the different authors. With the help of a medical information specialist, a specific search strategy will be formulated for the 6 most relevant databases (ie, MEDLINE, Embase, CINAHL, Web of Science, Academic Search Premier, PsycINFO, and the Google Scholar search engine). A literature search covering studies published between 2000 and 2022 has already been conducted. Two reviewers then proceeded, individually and independently, to conduct a double selection of titles, abstracts, and then full texts. Data extraction will be conducted by a reviewer and validated by a senior researcher. We will use the narrative synthesis method (ie, structured narrative summaries of key themes) to present a comprehensive picture of effective digital health literacy interventions among forced migrant populations and the success factors of these interventions. Results The search strategy and literature search were completed in December 2022. A total of 1232 articles were identified. The first selection was completed in July 2023. The second selection is still in progress. The publication of the systematic review is scheduled for December 2023. Conclusions This mixed methods systematic review will provide comprehensive knowledge on effective interventions for digital literacy among forced migrant populations. The evidence generated will further inform stakeholders and aid decision makers in promoting equitable access to and use of digital health resources for forced migrant populations and the general population in host countries. International Registered Report Identifier (IRRID) DERR1-10.2196/50798

Who consumes ultra-processed food? A systematic review of sociodemographic determinants of ultra-processed food consumption from nationally representative samples.

Ultra-processed food (UPF) intake is associated with increased non-communicable disease risks. However, systematic reports on sociodemographic predictors of UPF intake are lacking. This review aimed to understand UPF consumption based on sociodemographic factors, using nationally representative cohorts. The systematic review was pre-registered (PROSPERO:CRD42022360199), following PRISMA guidelines. PubMed/MEDLINE searches ('ultra-processed/ultraprocessed' and 'ultra-processing/ultraprocessing') until 07/09/2022 retrieved 1,131 results. Inclusion criteria included: observational, nationally representative adult samples, in English, in peer-reviewed journals, assessing the association between sociodemographics and individual-level UPF intake defined by the NOVA classification. Exclusion criteria included: not nationally representative, no assessment of sociodemographics and individual-level UPF intake defined by NOVA. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). 55 papers were included, spanning 32 countries. All 13 sociodemographic variables identified were significantly associated with UPF intake in ≥1 studies. Significant differences in UPF intake were seen across age, race/ethnicity, rural/urbanisation, food insecurity, income and region, with up to 10-20% differences in UPF intake (% total energy). Higher UPF intakes were associated with younger age, urbanisation, and being unmarried, single, separated or divorced. Education, income and socioeconomic status showed varying associations, depending on country. Multivariate analyses indicated that associations were independent of other sociodemographics. Household status and gender were generally not associated with UPF intake. NOS averaged 5.7/10. Several characteristics are independently associated with high UPF intake, indicating large sociodemographic variation in non-communicable disease risk. These findings highlight significant public health inequalities associated with UPF intake, and the urgent need for policy action to minimise social injustice-related health inequalities.

Social inequalities in trajectories of contacts with the healthcare system in adolescence and young adulthood

BackgroundUnderstanding of healthcare utilization of different populations is useful for prevention and prioritization of healthcare resources. This study aims to identify populations following different trajectories of contacts with the healthcare system and to describe social inequalities between the groups. MethodsIndividuals born 1980–2000 in Denmark were linked to national registers. Contacts with somatic hospitals, psychiatric hospitals, general practitioners, and redeemed prescriptions were counted for each year between 16 and 37 years of age. Trajectories of contacts with the four dimensions of healthcare use were identified using group-based multi-trajectory modeling. ResultsFive trajectory groups were identified. One group had low healthcare utilization over time (12% in women; 27% in men). The largest group had low healthcare utilization but more contacts with especially GP (39% in women; 43% in men). A third group had more contacts with most dimensions of the healthcare system (33% in women; 21% in men). The fourth group had many contacts with especially somatic hospitals and GP (7% in women; 4% in men). The fifth group had many contacts especially to psychiatric hospitals (8% in women; 5% in men). Shorter parental education, parental unemployment, family income below the poverty line, and cohabitation with one or no parent was more frequent in the two high utilization groups compared to the lower utilization groups. ConclusionThe observed trajectories of health service use and the social inequalities between trajectory groups highlight that prevention and treatment targeting the entire population will benefit from a complementary focus on social inequalities in health.

Influence of deprivation on hospital care pathways and costs for people with ischaemic stroke: A trajectory modelling study

BackgroundSocioeconomic characteristics have a strong impact on the incidence of stroke. The highest levels of morbidity and mortality are associated with the lowest socioeconomic positions. Moreover, the health insurance budget for stroke is significant. ObjectivesTo describe typical Hospital Care Pathways (HCPs) and their costs 1 year after acute stroke and to assess the impact of individuals’ socioeconomic characteristics on HCPs and costs. MethodsThis retrospective observational study used hospital data on people with primary ischaemic stroke in a region of France (Haute-Garonne).HCPs were identified by sequential analysis. Multinomial logistic regression was used to analyse the impact of socioeconomic characteristics on HCPs as measured using an ecological index of deprivation, and a gamma regression model was used to analyse costs. ResultsThe analysis identified 4 typical HCPs. The first HCP consisted exclusively of consultations, the second was composed of consultations and hospitalisations, the third included hospitalisations during the first 2 months after stroke followed by consultations, and the fourth included long-term hospitalisations.After adjustment, deprivation was associated with HCPs and determined its costs: a high level of social disadvantage determined the type of pathway and increased the costs. ConclusionsThis study is one of the first to assess the impact of social inequalities in health on post-stroke HCPs in France and their corresponding costs. Our results confirm the hypothesis that healthcare costs differ according to the level of deprivation.

Organising for health equality: assessing contexts for implementing integrated health access

Abstract Background Social inequalities in health are complex and vulnerable people therefore need cross-sectoral initiatives that provides integrated access to different sectors of the health system. However, specialization makes systems fragmented, and health organization is an important but overlooked determinant of social inequalities in health. The Flexible Assertive Community Treatment (FACT) model offers integrated health access to people with severe mental illness, through interprofessional teams across health and social services. This study aimed to assess the organizational contexts that shape the implementation of this model of integrated care. Methods The study applied the theory of the Organizational Fields to identify the specific mechanisms by which organizational contexts influence the implementation of the FACT model. We analysed political and administrative documents at national, regional, and local levels to assess relevant contexts. We complemented with semi-structured interviews with managers and health professionals in three municipalities and the region in Denmark that implemented the model. Results Overall, this study found that the contexts for implementing FACT are highly complex both horizontally, between the health and social care sector, and vertically, between the national, regional, and local level. This leads to conflicting demands on the implementation of FACT in the municipalities. Local cultures of collaboration may nonetheless offer a lever to handle these demands, although this varies across municipalities. Conclusions For health systems, it is challenging to organize integrated health access as contexts are complex both horizontally and vertically. Assessing these contexts is therefore highly important to identify key determinants for successful implementation of models such as FACT. This may in turn reduce social inequalities in health through more coherent and accessible care. Key messages • Vulnerable people need integrated access to different sectors of health systems to secure health equity, but this is challenging to organise as health systems are complex horizontally and vertically. • Assessing the contexts of health sytems is key to identifying the determinants for successful implementation of initiatives to reduce health inequalities through more coherent and accessible care.

8.F. Workshop: SDG indicators: country scenarios and the way towards 2030

Abstract Background The UN 2030 Agenda for Sustainable Development is a global action plan aimed at achieving a better future for all. The 17 Sustainable Development Goals (SDGs) are at the core of this Agenda, balancing the economic, social and ecological dimensions of sustainable development. The 17 SDGs were adopted by the United Nations in 2015 as a blueprint for reducing inequalities, eliminating extreme poverty, rehabilitating the natural environment, ensuring access to justice for all, improving health and well-being, and building global partnerships supporting sustainable development. From the beginning, data availability was widely discussed. Previous have covered the issue of SDG data gaps; we will concentrate on SDG 3, Ensure healthy lives and promote well-being for all at all ages, though there are health-related indicators under other SDGs, e.g. 2.2.2 and 5.2.2. Developing SDG Indicators The UN General Assembly adopted the global indicator framework in 2017 with a set of 231 indicators, published in the UN SDG Reports, where countries are grouped according to geography. From the perspective of Europe, this makes sense, as i.e. neglected tropical diseases and births not attended by health personnel are uncommon. Indicators demonstrating social inequalities in health, or risk factors for non-communicable disease, such as insufficient physical activity and low fruit and vegetable consumption, are more relevant and demonstrate persistent threats to population health. In accordance with the UN's original mandate, some countries are therefore developing new local indicators. Addressing data gaps In the WHO European Region, the biggest challenge regarding SDG data is time lag. 6 of the 53 Member States (MS) in this region report mortality data from 2017 or earlier, and 39 MS have at least one year of missing mortality data, making it difficult to monitor demographic trends. Until MS are able to report timely and complete data, SDG reporting is unlikely to get better. Often flaws in the underlying health information systems (HISs) are the causes of the gaps. Major barriers to the optimal functioning of HISs are fragmentation of data sources, limited accessibility and unclear rules around use and reuse of data; barriers in the implementation of electronic health records; governance issues related to unclear responsibilities, including funding gaps and weak collaboration; legal gaps and misinterpretation of laws surrounding data protection, and limited number of skilled staff for implementation. These three abstracts show very different scenarios from three countries that illustrates how diverse the European Region is and how differently the countries work towards the SDGs, demonstrating what is currently happening in Europe regarding defining, collecting and reporting SDG indicators. Finally, WHO along with MS will offer some ideas for the best ways to optimize the years until the 2030 SDG achievement deadline. Key messages • Examples from three countries demonstrate challenges connected to SDG monitoring, including data gaps and reporting issues. • Flaws in HISs can lead to data gaps; WHO proposes some ways to alleviate this.

Geographical inequality in health: results from a population-based health survey

Abstract Background The greatest public health concern is social inequality in health, which also includes a geographic dimension. Residents of less resourceful areas are often disproportionately exposed to health risks, and the negative health effects of both low social position and unhealthy surroundings can exacerbate each other. This study aims to explore the relationship between sociodemographic characteristics of local areas, health behavior and mental health. Methods The study used self-reported data from the ‘How are you? 2021’ health survey conducted in the Central Denmark Region (N = 33,925), and parish-level data from Statistics Denmark. Latent Profile Analysis was used to group parishes into five socio-geographic groups based on social composition, where deprived areas were characterized by low income, high unemployment, and low education. Health behavior and mental health were compared across socio-geographic groups using linear regression, contrasts and linear hypothesis tests. Results Citizens in less resourceful areas exhibit higher prevalence rates of daily smoking, physical inactivity, unhealthy diet, and obesity, alongside higher levels of perceived stress and depressive symptoms, as compared to citizens in more affluent areas. However, a higher proportion of individuals in affluent areas exceeded the Danish Health Authority's low-risk recommendations for alcohol consumption. Conclusions The health outcomes of citizens living in less resourceful areas are inferior to those of citizens in more affluent areas. Residents in less resourceful areas exhibit poorer health outcomes across health behaviors and mental health. Based on the study's findings, implementing health promotion initiatives at the local level and addressing the underlying social inequality through structural efforts are necessary. This could potentially help to reduce the disparities in health outcomes in citizens in less resourceful areas compared to those in more affluent areas. Key messages • Health outcomes of citizens in less resourceful areas are inferior to those living in affluent areas. • Local health promotion initiatives and structural efforts addressing social inequality is needed.

Quality Improvement Process in Childcare Facilities: Results of a Qualitative Study

Abstract Introduction Access to quality educational facilities is a major determinant of children's well-being and a means to tackle social health inequalities. In France, ‘Accompagne-moi...!’ (AM) intervention, tested in a pilot study, was adapted from evidence-based interventions developed in Quebec. The objective of AM was to improve professional practices allowing children to develop their social and emotional skills. This research aimed to assess viable validity of AM. Viable validity “refers to stakeholders’ views and experience regarding whether an intervention program is practical, affordable, suitable, evaluable and helpful in the real-world” (Chen, 2010). Methods A qualitative study was realised in 13 childcare facilities from 4 French deprived areas (2019-22). Eight exploratory interviews, 33 semi-structured interviews with professionals were conducted. A comprehensive thematic analysis was performed. Results Childcare facilities were systems characterised by involved professionals evolving in difficult working conditions amplified in times of health crisis. The interviews showed the potential of the approach to address needs (e.g. professional training, increased awareness of children's emotions) and perceived positive effects (e.g. support for management in implementing change in the facilities, perceived effects on children). Professionals expressed a negative experience of AM (e.g. sense of failure, insufficient appropriation of the approach by the group) linked to the challenges of deploying an intervention in highly stressed environments. Conclusions This study highlights: i) potential of AM, ii) that children's well-being cannot be separated from the professional's well-being, iii) inflluence of certain structural determinants on educational practices and the quality of childcare facilities, iv) need to address these structural determinants prior to the intervention implementation. Prior to the deployment of AM on a larger scale, adaptations were proposed. Key messages • The well-being of children and professionals in childcare facilities are interdependent. • Structural determinants are key determinants of the quality of childcare facilities.

Access to health care for migrants in French Guiana in 2022: a qualitative study of health care system actors.

Access to health care is a major public health issue. The social determinants of health have a role in accessing health care and in meeting the health needs of populations. With 281 million international migrants around the world, population movements are another major issue. Migrants are particularly exposed to precariousness during their migratory journey and after their settlement. These vulnerabilities may have deleterious effects on their health status and on their social conditions. In French Guiana, 36% of the population is of foreign origin. The objective of this study is to explore the barriers and the facilitators to accessing health care for migrants in French Guiana in 2022, from the perspective of health care professionals, social workers and local NGO actors. This research is an exploratory qualitative study based on the experiential knowledge of health care professionals, social workers and local NGO actors in French Guiana. 25 semi-structured interviews were conducted with these professionals and actors between April and June 2022, using an interview guide to explore their practices, representations and beliefs of access to health care and accompaniment of migrants in their patient journey. The interviews were transcribed and analyzed using the thematic analysis method. A total of 25 health care professionals, social workers and local NGO actors were included in the study. Participants highlighted that migrants are exposed to many factors hindering their access to health care in French Guiana (administrative complexity, language barriers, financial barriers, mobility issues, etc.). With the situations of great precariousness and the inadequacies of the public authorities, associative support (social, health and legal accompaniment process provided by NGOs and associations) has an important role in providing close support to migrants. Moreover, health mediation supports migrants in their social and health care journey to lead them toward empowerment. Health mediators contribute to promote a better understanding between professionals and migrants. In French Guiana, associative support and health mediation promote access to health care and social accompaniment for migrants. This article highlights the issues surrounding access to health care, associative support and health mediation in the Guianese context, which is marked by significant socio-cultural diversity and precariousness. Considering the benefits of associative support and health mediation, as well as social inequalities in health, is essential for health care professionals, social workers, local NGO actors, associations, public health authorities and political decision-makers to initiate concrete and suitable actions in favor of access to health care and social support for migrants in French Guiana.

Maternal capital predicts investment in infant growth and development through lactation.

Maternal capital (MC) is a broad term from evolutionary biology, referring to any aspects of maternal phenotype that represent resources available for investment in offspring. We investigated MC in breastfeeding mothers of late preterm and early term infants, examining its relationship with infant and breastfeeding outcomes. We also determined whether MC modified the effect of the relaxation intervention on these outcomes. The data was collected as part of a randomized controlled trial investigating breastfeeding relaxation in 72 mothers of late preterm and early term infants. Indicators of MC (socioeconomic, social, somatic, reproductive, psychological, and cognitive) were collected at baseline at 2-3 weeks post-delivery. Principal Component Analysis was conducted for the MC measures and two components were identified: 1."Subjective" maternal capital which included stress and depression scores, and 2."Objective" maternal capital which included height, infant birth weight, and verbal memory. Univariate linear regression was conducted to assess the relationship between objective and subjective MC (predictors) and infant growth, infant behavior, maternal behavior, and infant feeding variables (outcomes) at 6-8 weeks. The interaction of MC and intervention assignment with outcomes was assessed. Higher objective MC was significantly associated with higher infant weight (0.43; 95%CI 0.21,0.66) and length z-scores (0.47; 95%CI 0.19,0.76), shorter duration of crying (-17.5; 95%CI -33.2,-1.9), and lower food (-0.28; 95%CI -0.48,-0.08) and satiety responsiveness (-0.17; 95%CI -0.31,-0.02) at 6-8 weeks. It was also associated with greater maternal responsiveness to infant cues (-0.05, 95%CI -0.09,-0.02 for non-responsiveness). Greater subjective maternal capital was significantly associated with higher breastfeeding frequency (2.3; 95%CI 0.8,3.8) and infant appetite (0.30; 95%CI 0.07,0.54). There was a significant interaction between the intervention assignment and objective MC for infant length, with trends for infant weight and crying, which indicated that the intervention had greater effects among mothers with lower capital. Higher MC was associated with better infant growth and shorter crying duration. This was possibly mediated through more frequent breastfeeding and prompt responsiveness to infant cues, reflecting greater maternal investment. The findings also suggest that a relaxation intervention was most effective among those with low MC, suggesting some reduction in social inequalities in health.

Lifestyle patterns in European preschoolers: Associations with socio-demographic factors and body mass index.

Energy balance-related behaviours (EBRBs), that is, dietary intake, screen, outdoor play and sleep, tend to combine into 'lifestyle patterns', with potential synergistic influences on health. To date, studies addressing this theme mainly focused on school children and rarely accounted for sleep, with a cross-country perspective. We aimed at comparing lifestyle patterns among preschool-aged children across Europe, their associations with socio-demographic factors and their links with body mass index (BMI). Harmonized data on 2-5-year-olds participating in nine European birth cohorts from the EU Child Cohort Network were used (EBRBs, socio-demographics and anthropometrics). Principal component analysis and multivariable linear and logistic regressions were performed. The most consistent pattern identified across cohorts was defined by at least three of the following EBRBs: discretionary consumption, high screen time, low outdoor play time and low sleep duration. Consistently, children from low-income households and born to mothers with low education level had higher scores on this pattern compared to their socioeconomically advantaged counterparts. Furthermore, it was associated with higher BMI z-scores in the Spanish and Italian cohorts (β = 0.06, 95% CI = [0.02; 0.10], both studies). These findings may be valuable in informing early multi-behavioural interventions aimed at reducing social inequalities in health at a European scale.