Regional inequalities in premature mortality in Great Britain

Premature mortality exhibits strong spatial patterns in Great Britain. Local authorities that are located further North and West, that are more distant from its political centre London and that are more urban tend to have a higher premature mortality rate. Premature mortality also tends to cluster among geographically contiguous and proximate local authorities. We develop a novel analytical research design that relies on spatial pattern recognition to demonstrate that an empirical model that contains only socio-economic variables can eliminate these spatial patterns almost entirely. We demonstrate that socioeconomic factors across local authority districts explain 81 percent of variation in female and 86 percent of variation in male premature mortality in 2012-14. As our findings suggest, policy-makers cannot hope that health policies alone suffice to significantly reduce inequalities in health. Rather, it requires strong efforts to reduce the inequalities in socio-economic factors, or living conditions for short, in order to overcome the spatial disparities in health, of which premature mortality is a clear indication

What are the living conditions and health status of those who don't report their migration status? a population-based study in Chile

BACKGROUND: Undocumented immigrants are likely to be missing from population databases, making it impossible to identify an accurate sampling frame in migration research. No population-based data has been collected in Chile regarding the living conditions and health status of undocumented immigrants. However, the CASEN survey (Caracterizacion Socio- Economica Nacional) asked about migration status in Chile for the first time in 2006 and provides an opportunity to set the base for future analysis of available migration data. We explored the living conditions and health of self-reported immigrants and respondents who preferred not to report their migration status in this survey. METHODS: Cross-sectional secondary analysis of CASEN survey in Chile in 2006. Outcomes: any disability, illness/accident, hospitalization/surgery, cancer/chronic condition (all binary variables); and the number of medical/emergency attentions received (count variables). Covariates: Demographics (age, sex, marital status, urban/rural, ethnicity), socioeconomic status (education level, employment status and household income), and material standard of living (overcrowding, sanitation, housing quality). Weighted regression models were estimated for each health outcome, crude and adjusted by sets of covariates, in STATA 10.0. RESULTS: About 1% of the total sample reported being immigrants and 0.7% preferred not to report their migration status (Migration Status - Missing Values; MS-MV). The MS-MV lived in more deprived conditions and reported a higher rate of health problems than immigrants. Some gender differences were observed by health status among immigrants and the MS-MV but they were not statistically significant. Regressions indicated that age, sex, SES and material factors consistently affected MS-MVs’ chance of presenting poor health and these patterns were different to those found among immigrants. Great heterogeneity in both the MS-MV and the immigrants, as indicated by wide confidence intervals, prevented the identification of other significantly associated covariates. CONCLUSION: This is the first study to look at the living conditions and health of those that preferred not to respond their migration status in Chile. Respondents that do not report their migration status are vulnerable to poor health and may represent undocumented immigrants. Surveys that fail to identify these people are likely to misrepresent the experiences of immigrants and further quantitative and qualitative research is urgently required

Acceso a salud en inmigrantes: identificando brechas para la protección social en salud

OBJECTIVE: To compare the access to and effective use of health services available among international migrants and Chileans. METHODS: Secondary analysis of the National Socioeconomic Characterization Survey (CASEN – Caracterización Socioeconómica Nacional), version 2017. Indicators of access to the health system (having health insurance) and effective use of health services (perceived need, appointment or coverage, barriers and need satisfaction) were described in immigrants and local population, self-reported. Gaps by immigrant status were estimated using logistic regressions, with complex samples. RESULTS: Immigrants were 7.5 times more likely to have no health insurance than local residents. Immigrants presented less perceived need than local residents, together with a greater lack of appointments (OR: 1.7 95%CI: 1.2–2.5), coverage (OR: 2.7 95%CI: 2.0–3.7) and unsatisfied need. The difference between immigrants and locals was not statistically significant in barriers to health care access (α = 0.005). CONCLUSIONS: Disadvantages persist regarding the access to and use of health services by immigrants as opposed to Chileans compared with information from previous years. It is necessary to reduce the gaps between immigrants and people born in Chile, especially in terms of health system access. This is the first barrier to effective use of services. The generation of concrete strategies and health policies that consider an approach of social participation of the immigrant community is suggested to bring the health system closer to this population.OBJETIVO: Comparar el acceso y uso efectivo de servicios de salud disponibles entre migrantes internacionales y chilenos. MÉTODOS: Análisis secundario de la encuesta poblacional de Caracterización Socioeconómica Nacional (CASEN), versión 2017. Se describieron indicadores de acceso al sistema de salud (tener previsión de salud) y uso efectivo de servicios de salud (necesidad sentida, consulta o cobertura, barreras y satisfacción de la necesidad) en inmigrantes y locales, autorreportados. Las brechas por condición de inmigrante se estimaron utilizando regresiones logísticas, con muestras complejas. RESULTADOS: Los inmigrantes presentaron 7,5 veces más chances de no tener previsión de salud que los locales. Los inmigrantes presentaron una menor necesidad sentida que los locales, en conjunto con una mayor falta de consulta (OR: 1,7 IC95%: 1,2–2,5), cobertura (OR: 2,7 IC95%: 2,0–3,7) e insatisfacción de necesidades. La diferencia entre inmigrantes y locales no fue estadísticamente significativa en barreras de acceso a atención en salud (α = 0,005). CONCLUSIONES: Persisten las desventajas en acceso y uso a servicios de salud en inmigrantes en comparación con los nacidos en Chile en contraste con información de años anteriores. Es necesario reducir las brechas entre inmigrantes y nacidos en Chile, sobre todo en cuanto a pertenencia a un sistema de salud. Esta es la primera barrera para un uso efectivo de servicios. Se sugiere generar estrategias concretas y políticas en salud que consideren un enfoque de participación social de la comunidad inmigrante y, adicionalmente, acerquen al sistema de salud a esta población

Effects of climate change on migration in Latin America and Caribbean: a scoping review

Climate change-induced natural disasters such as hurricanes, landslides, forest fires, and changes in precipitation directly affect rural sectors that depend on field production and other dimensions of everyday life. This generates the mobilization of people from their homes to safer places within the same country or across borders. There is a lack of information on the impacts of climate change on environmental migrants in Latin America and the Caribbean (LAC). This scoping review aims to describe the scientific evidence of the health effects of climate change on migrant in LAC. The review was conducted using databases from PubMed, Web of Science (WoS), and Google Scholar in English, Spanish and Portuguese. After screening the title, abstract, and full text of identified hits (n = 726), 31 records were finally included. Evidence indicates that climate change relates to health and healthcare, psychosocial and infrastructure dimensions among migrants in LAC. Health effects refer to limited access to healthcare, underdiagnosis, increased susceptibility to diseases and mental health conditions like stress and anxiety. Psychosocial dimensions refer to a heightened risk of sexual and gender-based violence, social marginalization, family separation, and loss of identity and culture. Infrastructure refers to environmental degradation and agricultural and urban infrastructure destruction. Multiple adaptations to these conditions are described among migrant populations in the region. Recommendations for improvements are presented. This scoping review suggests climate change’s significant health, psychosocial, and infrastructural associations with migrants in Latin America

Explaining infant feeding: the role of breastfeeding experience and vicarious experience of infant feeding on attitudes, subjective norms, self-efficacy and breastfeeding outcomes

Objectives Breastfeeding confers important health benefits to both infants and their mothers, but rates are low in the United Kingdom and other developed countries despite widespread promotion. This study examined the relationships between personal and vicarious experience of infant feeding, self-efficacy, the theory of planned behaviour variables of attitudes and subjective norm, and the likelihood of breastfeeding at 6–8 weeks post-natally. Design A prospective questionnaire study of both first-time mothers (n = 77) and experienced breastfeeders (n = 72) recruited at an antenatal clinic in South East England. Methods Participants completed a questionnaire at 32 weeks pregnant assessing personal and vicarious experience of infant feeding (breastfeeding, formula-feeding, and maternal grandmother’s experience of breastfeeding), perceived control, self-efficacy, intentions, attitudes (to breastfeeding and formula-feeding), and subjective norm. Infant feeding behaviour was recorded at 6–8 weeks post-natally. Multiple linear regression modelled the influence of vicarious experience on attitudes, subjective norm, and self-efficacy (but not perceived control) and modelled the influence of attitude, subjective norm, self-efficacy, and past experience on intentions to breastfeed. Logistic regression modelled the likelihood of breastfeeding at 6–8 weeks. Results Previous experience (particularly personal experience of breastfeeding) explained a significant amount of variance in attitudes, subjective norm, and self-efficacy. Intentions to breastfeed were predicted by subjective norm and attitude to formula-feeding and, in experienced mothers, self-efficacy. Breastfeeding at 6 weeks was predicted by intentions and vicarious experience of formula-feeding. Conclusion Vicarious experience, particularly of formula-feeding, has been shown to influence the behaviour of first-time and experienced mothers both directly and indirectly via attitudes and subjective norm. Interventions that reduce exposure to formula-feeding (perhaps by limiting advertising) or cushion mothers from its effects may enable more mothers to meet their breastfeeding goals

Citizenship or repression? Coca, eradication and development in the Andes

For over two decades the US has funded repressive forced coca eradication in Peru, Colombia and Bolivia to reduce the illegal cocaine trade. These policies have never met their stated goals and have generated violence and poverty. In 2006 Bolivia definitively broke with the US anti-narcotics model, replacing the militarized eradication of coca crops with a community-based coca control strategy. The program substantially reduced the coca crop while simultaneously respecting human rights and allowing farmers to diversify their livelihoods. This article outlines the elements of the Bolivian initiative that ensure its continued successful functioning. It explores to what extent this model can be translated to other Andean contexts

Estilos de apego y dependencia emocional de pareja en estudiantes de medicina de una universidad privada de Trujillo

La investigación tuvo como propósito examinar la relación entre los estilos de apego y la dependencia emocional en las relaciones de pareja entre estudiantes de medicina de una universidad privada en Trujillo. Por esta razón, se llevó a cabo un estudio de tipo descriptivo-correlacional con un diseño no experimental. La muestra consistió en 359 estudiantes de la facultad de medicina de dicha universidad, seleccionados mediante un muestreo no probabilístico según la conveniencia del investigador. Para evaluar el estilo de apego se utilizó la Escala de Estilos de Apego en Vínculos Románticos, mientras que para medir la dependencia emocional se empleó el Cuestionario de Dependencia Emocional. Los resultados indicaron una correlación inversa y moderada (-0,392) entre el estilo de apego evitativo y la dependencia emocional en la pareja. Además, se halló una correlación directa y alta (0,544) entre el estilo de apego ansioso y la dependencia emocional en la pareja, y una correlación directa y baja (0,114) entre el estilo de apego seguro y la dependencia emocional en la pareja en estudiantes de medicina de una universidad privada de TrujilloThe purpose of the research was to examine the relationship between attachment styles and emotional dependence in romantic relationships among medical students at a private university in Trujillo. Consequently, a descriptive-correlational study with a non-experimental design was conducted. The sample consisted of 359 medical students from the university, selected through non-probabilistic sampling at the researcher's convenience. The Attachment Styles in Romantic Relationships Scale was used to assess attachment styles, while the Emotional Dependence Questionnaire was employed to measure emotional dependence. The findings indicated a moderate inverse correlation (-0.392) between the avoidant attachment style and emotional dependence in relationships. Additionally, a high direct correlation (0.544) was found between the anxious attachment style and emotional dependence, and a low direct correlation (0.114) was observed between the secure attachment style and emotional dependence among medical students at a private university in TrujilloTesi