A review of equity issues in quantitative studies on health inequalities: the case of asthma in adults

<p>Abstract</p> <p>Background</p> <p>The term 'inequities' refers to avoidable differences rooted in injustice. This review examined whether or not, and how, quantitative studies identifying inequalities in risk factors and health service utilization for asthma explicitly addressed underlying inequities. Asthma was chosen because recent decades have seen strong increases in asthma prevalence in many international settings, and inequalities in risk factors and related outcomes.</p> <p>Methods</p> <p>A review was conducted of studies that identified social inequalities in asthma-related outcomes or health service use in adult populations. Data were extracted on use of equity terms (objective evidence), and discussion of equity issues without using the exact terms (subjective evidence).</p> <p>Results</p> <p>Of the 219 unique articles retrieved, 21 were eligible for inclusion. None used the terms equity/inequity. While all but one article traced at least partial pathways to inequity, only 52% proposed any intervention and 55% of these interventions focused exclusively on the more proximal, clinical level.</p> <p>Conclusions</p> <p>Without more in-depth and systematic examination of inequities underlying asthma prevalence, quantitative studies may fail to provide the evidence required to inform equity-oriented interventions to address underlying circumstances restricting opportunities for health.</p

Affirming life despite a poisoned fate : a grounded theory of reproductive decision-making among women living with HIV

The purpose of this qualitative research study was to investigate the cultural, psychological, and social processes of reproductive decision-making among women living with HIV. In using grounded theory method, the primary objective of this study was to generate a substantive theory. Audiotaped interviews were completed with 29 women living with HIV and nine of their primary support persons. Other sources of data included field notes about each interview, non-fictional literature, and articles in the popular press that described the experiences of reproductive decision-making for women living with HIV. Data were analyzed by using techniques of constant comparison for qualitative data. 'Affirming life despite a poisoned fate' was identified as the core process in reproductive decision-making by women living with HIV. This process consisted of two competing elements: 'struggling with vulnerability' and 'striving for longevity.' These elements interacted dialectically so that change in a woman's sense of her own vulnerability affected her capacity to strive to live longer. This interaction depended on the woman's experience of 'wanting to live,' 'managing fears of HIV,' 'awakening personal spirituality,' and 'yearning for connection.' A woman's sense of balance in 'struggling while striving' contributed to decisions about 'risking deadly connections,' i.e., whether she would risk possibly giving others HIV when having sex or giving birth. The women considered a range of practical, romantic, intellectual, and ethical determinants in deciding "how risky is risky?" This personal calculation of risk accounted for the diverse and sometimes contradictory feelings and thoughts described by women as they made these decisions, and allowed each woman consciously or unconsciously to justify their choices. Throughout the overarching process of 'affirming life despite a poisoned fate,' each turning point in the women's decision-making depended on their life context including their own sense of 'mothering capacity' and 'mothering anxiety,' and how they saw themselves in terms of the struggle with vulnerability and the striving for longevity. For these women, reproductive decision-making involved making sexual decisions about whether to protect others from getting HIV and to protect themselves from the potentially traumatic result of getting pregnant. Such decisions were heartbreaking emotionally as each woman confronted deep convictions about spirituality and morality, her many contradictory, changing desires, and the powerful, social forces that shape perceptions about motherhood. These decisions were not always well-informed because of the gaps in knowledge about the most effective treatments and best prevention practices for HIV-seropositive women. This grounded theory provides some insights about the realities of reproductive decision-making of women living with HIV. Health professionals must be sensitive to the effects of HIV stigma and be prepared to set aside their personal values, and encourage women to reflect on "what matters most" when faced with pregnancy decisions. Health professionals have a crucial role in assisting women living with HIV to optimize their health, by knowing available HIV prevention technologies, and informing them about current treatment options. Efforts must also be made to involve the primary support persons or sex partners and to assist couples in talking about sexual issues. Other important implications included new research directions to address the unique concerns of women living with HIV and policies to ensure the provision and accessibility of comprehensive health services for all those who must endure the terrible reality of this disease.Applied Science, Faculty ofNursing, School ofGraduat

The association between cardiorespiratory fitness and abdominal adiposity in postmenopausal, physically inactive South Asian women

In South Asians, a unique obesity phenotype of high abdominal fat is associated with increased cardiovascular risk. Low cardiorespiratory fitness (CRF) is associated with abdominal fat and an increased risk of cardiovascular disease. The purpose of this paper is to determine whether CRF as assessed by VO2 peak, in post-menopausal South Asian women, was associated with body fat distribution and abdominal fat. Physically inactive post-menopausal South Asian women (n = 55) from the Greater Vancouver area were recruited and assessed from January to August 2014. At baseline, VO2 peak was measured with the Bruce Protocol, abdominal fat with CT imaging, and body composition with dual energy X-ray absorptiometry. ANOVA was used to assess differences in subcutaneous abdominal adipose tissue (SAAT), visceral adipose tissue (VAT) and total abdominal adipose tissue (TAAT) between tertiles of CRF. Bivariate correlation and multiple linear regression analyses explored the association between VO2 peak with SAAT, VAT, TAAT and body composition. Models were further adjusted for body fat and body mass index (BMI). Compared to women in the lowest tertile of VO2 peak (13.8–21.8 mL/kg/min), women in the highest tertile (25.0–27.7 mL/kg/min) had significantly lower waist circumference, BMI, total body fat, body fat percentage, lean mass, SAAT, VAT and TAAT (p < 0.05). We found VO2 peak to be negatively associated with SAAT, VAT and TAAT, independent of age and body fatness but not independent of BMI. Further research is necessary to assess whether exercise and therefore improvements in CRF would alter SAAT, VAT and TAAT in post-menopausal South Asian women

Differences and similarities in the perception of caring between Spanish and UK nurses

The aim of the present paper was to compare and contrast perceptions of caring in nursing between Spanish and UK nurses. There are no previous studies comparing directly the perceptions of caring across cultures in nursing. A survey method was used employing the 25-item Caring Dimensions Inventory. Data were Mokken scaled for comparison with data from a previous study and scores for common items on the 25-item Caring Dimension Inventory for Spanish and UK nurses were correlated. There were similarities and differences between Spanish and UK nurses' perceptions of caring: many similar items were incorporated into Mokken scales but the endorsement of items did not correlate. The present work demonstrates that it is possible to measure differences and similarities in perceptions of caring. The study design could be improved and such work could be valuable in cross-cultural work with nurses

Association between exercise-induced change in body composition and change in cardio-metabolic risk factors in post-menopausal South Asian women

The South Asian (SA) population suffers from a high prevalence of type 2 Diabetes and cardiovascular disease (CVD). A unique obesity phenotype of elevated visceral adipose tissue (VAT) is associated with CVD risk among SA. Exercise-induced reduction in VAT and body fat is an effective mechanism to improve cardio-metabolic risk factors but this has not been shown in SA. Whether exercise-induced changes in measurements such as waist circumference (WC) are independently related to changes in cardio-metabolic risk factors in SA is unknown. Multi-slice computed tomography scanning was used to assess VAT, cardio-metabolic risk factors through a fasting blood sample and body fat using dual energy x-ray absorptiometry. Forty- nine post-menopausal South Asian women who participated in two 12-week aerobic exercise programs were included. Bivariate correlations were used to assess associations between change in cardio-metabolic risk factors and change in body composition. Regression analyses were conducted with change in glucose, insulin and homeostatic model assessment of insulin resistance (HOMA-IR) as dependent variables and change in body composition as independent variables of interest. There were significant associations between changes in fasting insulin, glucose and HOMA-IR with change in VAT. The association between change in VAT and these cardio-metabolic risk factors was independent of change in other body composition variables of interest. South Asian women should be encouraged to engage in aerobic activity to reduce their risk of type 2 diabetes and CVD, and physicians should be aware of improvements in glucose regulation with exercise training not observed through reductions in WC.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Beliefs and practices of complementary and alternative medicine (CAM) among HIV/AIDS patients: A qualitative exploration

Introduction Complementary and alternative medicine (CAM) is often used within the sphere of chronic disease management. Exploring the beliefs and practices of CAM use among People Living with HIV/AIDS (PLWHA) could be vital, since some of these therapies may adversely affect the outcomes of the conventional HIV treatment. Methods A phenomenological methodology was adopted. In depth patient interviews were performed with Malaysian patients over the age of 18 diagnosed with HIV/AIDS using a semi structured topic guide. Prior to each interview both written and verbal consents were taken. Saturation was reached after the 13th interview, with no further newly emerging information. All interviews were audio-recorded and subjected to a thematic content analysis framework. Results Beliefs in the effectiveness of CAM, types of CAM and reasons for CAM use emerged from the data as themes. A majority of the participants had a strong faith in the effectiveness and safety of CAM due to their natural origin. Perceived immune boosting effects, devoid of any toxicities and strong cultural influences appeared to be vital driving forces towards CAM use. Remarkably, participants were generally of the view that CAM can always be used either with conventional HIV medicines or until one’s CD4 cell counts drop significantly. Conclusions Despite the possible underlying adherence and therapeutic challenges towards taking ARTs; CAM use in contemporary HIV-care may provide a proactive means of engaging PLWHA, and generate self-care practises that promote positive health behaviours, including proper use of ARTs. Therefore, patient-healthcare provider communications are critical