Climate change and rising energy costs: a threat but also an opportunity for a healthier future?

Health problems caused by overconsumption, growing inequalities and diminished well-being are issues that have been attributed to the prioritization of economic growth as the central purpose of society. It is also known that climate change and rising energy prices will inevitably bring changes to the globe's economic models. Doctors and the wider public health community have campaigned successfully in the past on issues such as the threat of nuclear war. Is it now time for this constituency to make its distinctive contribution to these new threats to health

Padronização de uma bateria para a avaliação de fatores de risco psicossociais trabalhistas em trabalhadores colombianos

A battery of questionnaires to assess psychosocial risk factors at work was developed in 2010 in response to Resolution 2646 created by the Colombian Ministry of Social Protection. However, this battery presents some theoretical and practical limitations. A new battery of instruments has been designed and validated that includes instruments and risk indicators of the demand-control-social support and the effort-reward imbalance models. Other factors, not included in these models, but that Resolution 2646 suggests should be assessed, have also been added, and with this additional information, the new battery allows us to also calculate a “global indicator” of demand, control, and social support; family and social risk conditions, coping and personality; and health and wellbeing. The new battery was administered to a sample of 16,095 workers from different occupations and representative Colombian regions. An analysis of the various domains indicates that internal consistency of the various scales is high. The new battery has the following properties: it is simple to use in paper format or when administered by computer, it enables comparison between occupations, it offers unified scores for each variable, and provides information to assess the risk factors suggested by Resolution 2646. In addition, it will make it possible to compare the results obtained when analyzing Colombian workers with those obtained from studies of workers from other countries.Em 2010, desenvolveu-se uma bateria de instrumentos para avaliar fatores psicossociais trabalhistas de risco para a saúde, em resposta à Resolução 2 646 do Ministério da Proteção Social da Colômbia. Contudo, esta conta com algumas limitações que, a partir da construção e da validação de uma nova bateria, neste estudo se pretendem superar. Além disso, a nova bateria oferece recursos adicionais para a avaliação desses fatores: a presente bateria incorpora os instrumentos e os indicadores centrais dos modelos demanda-controle-apoio social e desiquilíbrio esforço-recompensa e os fatores internos do trabalho não considerados nesses modelos, mas que a Resolução considera necessários, mediram-se com testes preexistentes ou desenvolvidos pelos autores. Com os dados coletados, é possível calcular indicadores globais de demanda, controle e apoio social; além de condições familiares e sociais de risco, enfrentamento, personalidade e indicadores de saúde e bem-estar. Para a validação, a bateria foi aplicada a uma amostra de 16 095 trabalhadores de diferentes cargos e municípios colombianos. As anál i ses de consistência interna e validade permitem afirmar que a bateria é simples de aplicar em papel ou digital, permitirá comparar cargos, obter pontuações unificadas por variável, oferecer um diagnóstico de um número importante das variáveis sugeridas na Resolução bem como permitirá comparar os resultados dos trabalhadores colombianos com os de outros países. Palavras-chave: fatores trabalhistas de risco psicossocial, Resolução 2 646 de 2008, modelo demanda-controle-apoio social, modelo desiquilíbrio esforço-recompensa, estresse profissional, avaliação.En 2010 se desarrolló una batería de instrumentos para evaluar factores psicosociales laborales de riesgo para la salud, en respuesta a la Resolución 2646 de 2008 del Ministerio de la Protección Social de Colombia. Sin embargo, esta cuenta con algunas limitaciones que, a partir de la construcción y validación de una nueva batería, en el presente estudio se buscan superar. La nueva batería ofrece recursos adicionales para la evaluación de estos factores: incorpora los instrumentos e indicadores centrales de los modelos demanda-control-apoyo social y desequilibrio esfuerzo-recompensa, y los factores intralaborales no contemplados en dichos modelos, pero que la Resolución considera necesarios, se midieron con pruebas preexistentes o desarrolladas por los autores. Con los datos recolectados es posible calcular indicadores globales de demanda, control y apoyo social; además de condiciones familiares y sociales de riesgo, afrontamiento, personalidad e indicadores de salud y bienestar. Para la validación, la batería se aplicó a una muestra de 16.095 trabajadores de diferentes ocupaciones y municipios colombianos. Los análisis de consistencia interna y validez permiten afirmar que la batería es sencilla de aplicar en papel o por computador, permitirá comparar ocupaciones, obtener puntuaciones unificadas por variable, ofrecer un diagnóstico de un número importante de las variables sugeridas en la Resolución y comparar los resultados de los trabajadores colombianos con los de otros países

Socioeconomic status as a risk factor for dementia death:individual participant meta-analysis of 86 508 men and women from the UK

Background Life-course socioeconomic factors may have a role in dementia aetiology but there is a current paucity of studies. Meta-analyses of individual participant data would considerably strengthen this evidence base. Aims To examine the association between socioeconomic status in early life and adulthood with later dementia death. Method Individual participant meta-analysis of 11 prospective cohort studies (1994-2004, n = 86 508). Results Leaving full-time education at an earlier age was associated with an increased risk of dementia death in women (fully adjusted hazard ratio (HR) for age ⩽14 v. age ⩾16: HR = 1.76, 95% CI 1.23-2.53) but not men. Occupational social class was not statistically significantly associated with dementia death in men or women. Conclusions Lower educational attainment in women was associated with an increased risk of dementia-related death independently of common risk behaviours and comorbidities

Subjective social status and mortality: the English Longitudinal Study of Ageing

Self-perceptions of own social position are potentially a key aspect of socioeconomic inequalities in health, but their association with mortality remains poorly understood. We examined whether subjective social status (SSS), a measure of the self-perceived element of social position, was associated with mortality and its role in the associations between objective socioeconomic position (SEP) measures and mortality. We used Cox regression to model the associations between SSS, objective SEP measures and mortality in a sample of 9972 people aged ≥ 50 years from the English Longitudinal Study of Ageing over a 10-year follow-up (2002-2013). Our findings indicate that SSS was associated with all-cause, cardiovascular, cancer and other mortality. A unit decrease in the 10-point continuous SSS measure increased by 24 and 8% the mortality risk of people aged 50-64 and ≥ 65 years, respectively, after adjustment for age, sex and marital status. The respective estimates for cardiovascular mortality were 36 and 11%. Adjustment for all covariates fully explained the association between SSS and cancer mortality, and partially the remaining associations. In people aged 50-64 years, SSS mediated to a varying extent the associations between objective SEP measures and all-cause mortality. In people aged ≥ 65 years, SSS mediated to a lesser extent these associations, and to some extent was associated with mortality independent of objective SEP measures. Nevertheless, in both age groups, wealth partially explained the association between SSS and mortality. In conclusion, SSS is a strong predictor of mortality at older ages, but its role in socioeconomic inequalities in mortality appears to be complex

Misdiagnosis, Mistreatment, and Harm - When Medical Care Ignores Social Forces.

The Case Studies in Social Medicine demonstrate that when physicians use only biologic or individual behavioral interventions to treat diseases that stem from or are exacerbated by social factors, we risk harming the patients we seek to serve

Comparison of physical, public and human assets as determinants of socioeconomic inequalities in contraceptive use in Colombia - moving beyond the household wealth index

Background: Colombia is a lower-middle income country that faces the challenge of addressing health inequalities. This effort includes the task of developing measures of socioeconomic position (SEP) to describe and analyse disparities in health and health related outcomes. This study explores the use of a multidimensional approach to SEP, in which socioeconomic inequalities in contraceptive use are investigated along multiple dimensions of SEP. We tested the hypothesis that provision of Public capital compensated for low levels of Human capital.Methods: This study used the 2005 Colombian Demographic and Health Survey (DHS) dataset. The outcome measures were 'current non-use' and 'never use' of contraception. Inequalities in contraceptive behaviour along four measures of SEP were compared: the Household wealth index (HWI), Physical capital (housing, consumer durables), Public capital (publicly provided services) and Human capital (level of education). Principal component analysis was applied to construct the HWI, Physical capital and Public capital measures. Logistic regression models were used to estimate relative indices of inequality (RII) for each measure of SEP with both outcomes.Results: Socio-economic inequalities among rural women tended to be larger than those among urban women, for all measures of SEP and for both outcomes. In models mutually adjusted for Physical, Public and Human capital and age, Physical capital identified stronger gradients in contraceptive behaviour in urban and rural areas (Current use of contraception by Physical capital in urban areas RII 2.37 95% CI (1.99-2.83) and rural areas RII 3.70 (2.57-5.33)). The impact of women's level of education on contraceptive behaviour was relatively weak in households with high Public capital compared to households with low Public capital (Current use of contraception in rural areas, interaction p = < 0.001). Reduced educational inequalities attributable to Public capital were partly explained by differences in household wealth but not at all by health insurance cover.Conclusions: A multidimensional approach provides a framework for disentangling socioeconomic inequalities in contraceptive behaviour. We provide evidence that material circumstances indexed by Physical capital are important socioeconomic determinants while higher provision of Public capital may compensate for low levels of Human capital with respect to modern contraceptive behaviour

Gender-specific associations of short sleep duration with prevalent and incident hypertension : the Whitehall II Study

Sleep deprivation (5 hour per night) was associated with a higher risk of hypertension in middle-aged American adults but not among older individuals. However, the outcome was based on self-reported diagnosis of incident hypertension, and no gender-specific analyses were included. We examined cross-sectional and prospective associations of sleep duration with prevalent and incident hypertension in a cohort of 10 308 British civil servants aged 35 to 55 years at baseline (phase 1: 1985-1988). Data were gathered from phase 5 (1997-1999) and phase 7 (2003-2004). Sleep duration and other covariates were assessed at phase 5. At both examinations, hypertension was defined as blood pressure 140/90 mm Hg or regular use of antihypertensive medications. In cross-sectional analyses at phase 5 (n5766), short duration of sleep (5 hour per night) was associated with higher risk of hypertension compared with the group sleeping 7 hours, among women (odds ratio: 2.01; 95% CI: 1.13 to 3.58), independent of confounders, with an inverse linear trend across decreasing hours of sleep (P0.003). No association was detected in men. In prospective analyses (mean follow-up: 5 years), the cumulative incidence of hypertension was 20.0% (n740) among 3691 normotensive individuals at phase 5. In women, short duration of sleep was associated with a higher risk of hypertension in a reduced model (age and employment) (6 hours per night: odds ratio: 1.56 [95% CI: 1.07 to 2.27]; 5 hour per night: odds ratio: 1.94 [95% CI: 1.08 to 3.50] versus 7 hours). The associations were attenuated after accounting for cardiovascular risk factors and psychiatric comorbidities (odds ratio: 1.42 [95% CI: 0.94 to 2.16]; odds ratio: 1.31 [95% CI: 0.65 to 2.63], respectively). Sleep deprivation may produce detrimental cardiovascular effects among women. (Hypertension. 2007;50:694-701.) Key Words: sleep duration blood pressure hypertension gender differences confounders comorbiditie

Sociedades justas: Una nueva visión para la equidad en la salud en la Región de las Américas después de la COVID19

Objective. Determine patterns of tuberculosis (TB) incidence indicators and number of deaths from TB within the framework of target 3.3 of the Sustainable Development Goals (SDGs) and their correlation with social determinants. Methods. Ecological study methodology was used, in which the population is the unit of analysis. Social determinants were analyzed using a negative binomial regression model and strength of association. Results. In the Americas, there was an average annual reduction in the TB incidence rate of 0.3% from 2009 to 2018; however, from 2015 to 2018, the rate increased, from 27.6 to 28.8 per 100,000 population. With regard to social determinants, the groups of countries with the lowest human development index (HDI) and gross domestic product (GDP) have a higher incidence of TB. TB risk in the country with the lowest HDI is six times that of the country with the highest HDI. Conclusions. At the current rate of reduction in the incidence rate and number of deaths from TB, the Region of the Americas will not meet the targets in the SDGs and in the End TB Strategy. Rapid implementation and expansion of interventions for TB prevention and control are required to attain the targets. This involves, among other actions, reducing access barriers to diagnosis and treatment and strengthening initiatives to address social determinants

Diabetes status and post-load plasma glucose concentration in relation to site-specific cancer mortality: findings from the original Whitehall study

ObjectiveWhile several studies have reported on the relation of diabetes status with pancreatic cancer risk, the predictive value of this disorder for other malignancies is unclear. Methods: The Whitehall study, a 25year follow-up for mortality experience of 18,006 men with data on post-challenge blood glucose and self-reported diabetes, allowed us to address these issues. Results: There were 2158 cancer deaths at follow-up. Of the 15 cancer outcomes, diabetes status was positively associated with mortality from carcinoma of the pancreas and liver, while the relationship with lung cancer was inverse, after controlling for a range of potential covariates and mediators which included obesity and socioeconomic position. After excluding deaths occurring in the first 10years of follow-up to examine the effect of reverse causality, the magnitude of the relationships for carcinoma of the pancreas and lung was little altered, while for liver cancer it was markedly attenuated. Conclusions: In the present study, diabetes status was related to pancreatic, liver, and lung cancer risk. Cohorts with serially collected data on blood glucose and covariates are required to further examine this area