6,291 research outputs found

    How Equity-Oriented Health Care Affects Health: Key Mechanisms and Implications for Primary Health Care Practice and Policy

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    Policy Points A consensus regarding the need to orient health systems to address inequities is emerging, with much of this discussion targeting population health interventions and indicators. We know less about applying these approaches to primary health care. This study empirically demonstrates that providing more equity-oriented health care (EOHC) in primary health care, including trauma- and violence-informed, culturally safe, and contextually tailored care, predicts improved health outcomes across time for people living in marginalizing conditions. This is achieved by enhancing patients’ comfort and confidence in their care and their own confidence in preventing and managing health problems. This promising new evidence suggests that equity-oriented interventions at the point of care can begin to shift inequities in health outcomes for those with the greatest need. Context: Significant attention has been directed toward addressing health inequities at the population health and systems levels, yet little progress has been made in identifying approaches to reduce health inequities through clinical care, particularly in a primary health care context. Although the provision of equity-oriented health care (EOHC) is widely assumed to lead to improvements in patients’ health outcomes, little empirical evidence supports this claim. To remedy this, we tested whether more EOHC predicts more positive patient health outcomes and identified selected mediators of this relationship. Methods: Our analysis uses longitudinal data from 395 patients recruited from 4 primary health care clinics serving people living in marginalizing conditions. The participants completed 4 structured interviews composed of self-report measures and survey questions over a 2-year period. Using path analysis techniques, we tested a hypothesized model of the process through which patients’ perceptions of EOHC led to improvements in self-reported health outcomes (quality of life, chronic pain disability, and posttraumatic stress [PTSD] and depressive symptoms), including particular covariates of health outcomes (age, gender, financial strain, experiences of discrimination). Findings: Over a 24-month period, higher levels of EOHC predicted greater patient comfort and confidence in the health care patients received, leading to increased confidence to prevent and manage their health problems, which, in turn, improved health outcomes (depressive symptoms, PTSD symptoms, chronic pain, and quality of life). In addition, financial strain and experiences of discrimination had significant negative effects on all health outcomes. Conclusions: This study is among the first to demonstrate empirically that providing more EOHC predicts better patient health outcomes over time. At a policy level, this research supports investments in equity-focused organizational and provider-level processes in primary health care as a means of improving patients’ health, particularly for those living in marginalizing conditions. Whether these results are robust in different patient groups and across a broader range of health care contexts requires further study

    The cell envelope subtilisin-like proteinase is a virulence determinant for Streptococcus suis

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    <p>Abstract</p> <p>Background</p> <p><it>Streptococcus suis </it>is a major swine pathogen and zoonotic agent that mainly causes septicemia, meningitis, and endocarditis. It has recently been suggested that proteinases produced by <it>S. suis </it>(serotype 2) are potential virulence determinants. In the present study, we screened a <it>S. suis </it>mutant library created by the insertion of Tn<it>917 </it>transposon in order to isolate a mutant deficient in a cell surface proteinase. We characterized the gene and assessed the proteinase for its potential as a virulence factor.</p> <p>Results</p> <p>Two mutants (G6G and M3G) possessing a single Tn<it>917 </it>insertion were isolated. The affected gene coded for a protein (SSU0757) that shared a high degree of identity with <it>Streptococccus thermophilus </it>PrtS (95.9%) and, to a lesser extent, with <it>Streptococcus agalactiae </it>CspA (49.5%), which are cell surface serine proteinases. The SSU0757 protein had a calculated molecular mass of 169.6 kDa and contained the catalytic triad characteristic of subtilisin family proteinases: motif I (Asp<sub>200</sub>), motif II (His<sub>239</sub>), and motif III (Ser<sub>568</sub>). SSU0757 also had the Gram-positive cell wall anchoring motif (Leu-Pro-X-Thr-Gly) at the carboxy-terminus, which was followed by a hydrophobic domain. All the <it>S. suis </it>isolates tested, which belonged to different serotypes, possessed the gene encoding the SSU0757 protein. The two mutants devoid of subtilisin-like proteinase activity had longer generation times and were more susceptible to killing by whole blood than the wild-type parent strain P1/7. The virulence of the G6G and M3G mutants was compared to the wild-type strain in the CD1 mouse model. Significant differences in mortality rates were noted between the P1/7 group and the M3G and G6G groups (<it>p </it>< 0.001).</p> <p>Conclusion</p> <p>In summary, we identified a gene coding for a cell surface subtilisin-like serine proteinase that is widely distributed in <it>S. suis</it>. Evidences were brought for the involvement of this proteinase in <it>S. suis </it>virulence.</p

    Lack of Mutual Respect in Relationship The Endangered Partner

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    Violence in a relationship and in a family setting has been an issue of concern to various interest groups and professional organizations. Of particular interest in this article is violence against women in a relationship. While there is an abundance of knowledge on violence against women in general, intimate or partner femicide seems to have received less attention. Unfortunately, the incidence of violence against women, and intimate femicide in particular, has been an issue of concern in the African setting. This article examines the trends of intimate femicide in an African setting in general, and in Botswana in particular. The increase in intimate femicide is an issue of concern, which calls for collective effort to address. This article also examines trends offemicide in Botswana, and the antecedents and the precipitating factors. Some studies have implicated societal and cultural dynamics as playing significant roles in intimate femicide in the African setting. It is believed that the patriarchal nature of most African settings and the ideology of male supremacy have relegated women to a subordinate role. Consequently, respect for women in any relationship with men is lopsided in favor of men and has led to abuse of women, including intimate femicide. Other militating factors in intimate femicide ,are examined and the implications for counseling to assist the endangered female partner are discussed

    The epidemiology of excess mortality in people with mental illness

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    Objective: To investigate the burden of excess mortality among people with mental illness in developed countries, how it is distributed, and whether it has changed over time. Method: We conducted a systematic search of MEDLINE, restricting our attention to peer-reviewed studies and reviews published in English relating to mortality and mental illness. Because of the large number of studies that have been undertaken during the last 30 years, we have selected a representative cross-section of studies for inclusion in our review. Results: There is substantial excess mortality in people with mental illness for almost all psychiatric disorders and all main causes of death. Consistently elevated rates have been observed across settings and over time. The highest numbers of excess deaths are due to cardiovascular and respiratory diseases. With life expectancy increasing in the general population, the disparity in mortality outcomes for people with mental illness is increasing. Conclusions: Without the development of alternative approaches to promoting and treating the physical health of people with mental illness, it is possible that the disparity in mortality outcomes will persist

    Metabolic Modulation Predicts Heart Failure Tests Performance

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    The metabolic changes that accompany changes in Cardiopulmonary testing (CPET) and heart failure biomarkers (HFbio) are not well known. We undertook metabolomic and lipidomic phenotyping of a cohort of heart failure (HF) patients and utilized Multiple Regression Analysis (MRA) to identify associations to CPET and HFBio test performance (peak oxygen consumption (Peak VO2), oxygen uptake efficiency slope (OUES), exercise duration, and minute ventilation-carbon dioxide production slope (VE/VCO2 slope), as well as the established HF biomarkers of inflammation C-reactive protein (CRP), beta-galactoside-binding protein (galectin-3), and N-terminal prohormone of brain natriuretic peptide (NT-proBNP)). A cohort of 49 patients with a left ventricular ejection fraction \u3c 50%, predominantly males African American, presenting a high frequency of diabetes, hyperlipidemia, and hypertension were used in the study. MRA revealed that metabolic models for VE/VCO2 and Peak VO2 were the most fitted models, and the highest predictors’ coefficients were from Acylcarnitine C18:2, palmitic acid, citric acid, asparagine, and 3-hydroxybutiric acid. Metabolic Pathway Analysis (MetPA) used predictors to identify the most relevant metabolic pathways associated to the study, aminoacyl-tRNA and amino acid biosynthesis, amino acid metabolism, nitrogen metabolism, pantothenate and CoA biosynthesis, sphingolipid and glycerolipid metabolism, fatty acid biosynthesis, glutathione metabolism, and pentose phosphate pathway (PPP). Metabolite Set Enrichment Analysis (MSEA) found associations of our findings with pre-existing biological knowledge from studies of human plasma metabolism as brain dysfunction and enzyme deficiencies associated with lactic acidosis. Our results indicate a profile of oxidative stress, lactic acidosis, and metabolic syndrome coupled with mitochondria dysfunction in patients with HF tests poor performance. The insights resulting from this study coincides with what has previously been discussed in existing literature thereby supporting the validity of our findings while at the same time characterizing the metabolic underpinning of CPET and HFBio

    Multifuncionalidad y Sistemas Agroalimentarios locales: prioridades de investigación e innovación en medio ambiente, territorio y desarrollo rural en el sector español del aceite de oliva

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    Los sistemas agroalimentarios locales (SIAL) de aceite de oliva en España son un buen ejemplo del comportamiento multifuncional y de su contribución potencial a la gobernanza territorial. Se detectan cambios significativos en la geografía del olivar español, derivados, por una parte, de la expansión de nuevas superficies de olivar en regadío de cultivo intensivo y superintensivo y, por otra, de la creciente marginalización a la que se ve abocado el olivar español de media y alta pendiente. Por otra parte, el olivar español produce un fuerte grado de externalidades ambientales negativas, como la erosión o la contaminación difusa de suelos y acuíferos. El principal objetivo del trabajo es detectar las relaciones que se establecen entre la definición de los principales problemas que atañen a los SIAL de aceite de oliva en España y las prioridades de investigación e innovación en materia de territorio y medio ambiente, desde una óptica multidisciplinar que integre enfoques procedentes de las Ciencias Sociales y de las Ciencias Agronómicas y Ambientales. El marco teórico procede de las teorías sobre la multifuncionalidad de los espacios rurales y sobre los SIAL. La metodología utiliza información cualitativa y cuantitativa procedente de dos fuentes primarias: i) un grupo de discusión integrado en un panel presencial de expertos sobre innovación en olivicultura, sostenibilidad y aprovechamiento de residuos; ii) un análisis Delphi dirigido a un conjunto amplio de expertos sobre medio ambiente, territorio y desarrollo rural sostenible en el sector oleícola. En cuanto al análisis de resultados, el grupo de discusión ha tenido como misión categorizar las grandes tipologías de olivicultura en España y sintetizar sus respectivos problemas ambientales y territoriales. Estos resultados sirven como marco de referencia del análisis Delphi, que tiene un doble objetivo: por una parte, el análisis de los principales problemas ambientales y territoriales de los SIAL oleícolas en España; por otra, el estudio de las prioridades en materia de programas y de grupos de líneas de investigación sobre la materia, así como las relaciones entre dichas líneas de investigación y los problemas a los que se enfrentan los SIAL oleícolas.prioridades de investigación e innovación, medio ambiente y territorio, análisis Delphi., Agribusiness, Agricultural and Food Policy, Community/Rural/Urban Development, Food Consumption/Nutrition/Food Safety, Labor and Human Capital,
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