Pathways to colorectal cancer screening in Hull : a complexity informed configurational approach

In terms of its colorectal cancer profile, Hull is among the worst cities in the UK. A considerable number of colorectal cancer cases in Hull are diagnosed in emergency departments and in their late stages. Several modalities of screening tests (e.g. Faecal Occult Blood Test (FOBT)) are offered in order to detect cancer cases in their early days of development when treatment is more feasible. However, the overall rate of screening is far from optimal and is even lower among people of lower socioeconomic status in Hull. Despite Hull having such an unacceptable profile of colorectal cancer, very few studies have investigated the reasons behind screening behaviour and its unequal distribution in Hull. This study, therefore, aimed to understand the reasons behind screening behaviour and its inequalities in this city. Unlike conventional research focusing on the impact of single psychosocial factors on screening, we used a complexity-informed configurational approach, called Qualitative Comparative Analysis (QCA), to understand the configurations of conditions that produce screening behaviour. Semi-structured interviews were conducted with 30 people from the most and least deprived neighbourhoods in Hull to gather the required data. A thematic content analysis was undertaken to discover the main themes (conditions) that were reported as the determinants of screening by participants. Various configurations of these conditions (complex solutions) were shown by QCA to be sufficient for production of outcome (screening) among the rich and poor. Interestingly, the number of configurations for production of outcome negation (lack of screening) was higher among the poor. Moreover, minimization of complex solutions showed that motivation is the most important (highly necessary and sufficient) condition influencing the screening decision in Hull, regardless of socioeconomic status. Therefore, motivation-focused interventions should be in the first line of interventions to increase screening rates and redress inequalities in this city. However, alongside specific attention to motivation and by taking a complex configurational approach, complex interventions should be designed to address the revealed configurations in each specific socioeconomic context within the city

Social determinants of spatial inequalities in COVID-19 outcomes across England: A multiscale geographically weighted regression analysis.

A variety of factors are associated with greater COVID-19 morbidity or mortality, due to how these factors influence exposure to (in the case of morbidity) or severity of (in the case of mortality) COVID-19 infections. We use multiscale geographically weighted regression to study spatial variation in the factors associated with COVID-19 morbidity and mortality rates at the local authority level across England (UK). We investigate the period between March 2020 and March 2021, prior to the rollout of the COVID-19 vaccination program. We consider a variety of factors including demographic (e.g. age, gender, and ethnicity), health (e.g. rates of smoking, obesity, and diabetes), social (e.g. Index of Multiple Deprivation), and economic (e.g. the Gini coefficient and economic complexity index) factors that have previously been found to impact COVID-19 morbidity and mortality. The Index of Multiple Deprivation has a significant impact on COVID-19 cases and deaths in all local authorities, although the effect is the strongest in the south of England. Higher proportions of ethnic minorities are associated with higher levels of COVID-19 mortality, with the strongest effect being found in the west of England. There is again a similar pattern in terms of cases, but strongest in the north of the country. Other factors including age and gender are also found to have significant effects on COVID-19 morbidity and mortality, with differential spatial effects across the country. The results provide insights into how national and local policymakers can take account of localized factors to address spatial health inequalities and address future infectious disease pandemics. [Abstract copyright: © 2024 The Authors.

Understanding determinants of socioeconomic inequality in mental health in Iran's capital, Tehran: a concentration index decomposition approach

<p>Abstract</p> <p>Background</p> <p>Mental health is of special importance regarding socioeconomic inequalities in health. On the one hand, mental health status mediates the relationship between economic inequality and health; on the other hand, mental health as an "end state" is affected by social factors and socioeconomic inequality. In spite of this, in examining socioeconomic inequalities in health, mental health has attracted less attention than physical health. As a first attempt in Iran, the objectives of this paper were to measure socioeconomic inequality in mental health, and then to untangle and quantify the contributions of potential determinants of mental health to the measured socioeconomic inequality.</p> <p>Methods</p> <p>In a cross-sectional observational study, mental health data were taken from an Urban Health Equity Assessment and Response Tool (Urban HEART) survey, conducted on 22 300 Tehran households in 2007 and covering people aged 15 and above. Principal component analysis was used to measure the economic status of households. As a measure of socioeconomic inequality, a concentration index of mental health was applied and decomposed into its determinants.</p> <p>Results</p> <p>The overall concentration index of mental health in Tehran was -0.0673 (95% CI = -0.070 - -0.057). Decomposition of the concentration index revealed that economic status made the largest contribution (44.7%) to socioeconomic inequality in mental health. Educational status (13.4%), age group (13.1%), district of residence (12.5%) and employment status (6.5%) also proved further important contributors to the inequality.</p> <p>Conclusions</p> <p>Socioeconomic inequalities exist in mental health status in Iran's capital, Tehran. Since the root of this avoidable inequality is in sectors outside the health system, a holistic mental health policy approach which includes social and economic determinants should be adopted to redress the inequitable distribution of mental health.</p

Changes in Socio-Economic Inequality in Neonatal Mortality in Iran Between 1995-2000 and 2005-2010: An Oaxaca Decomposition Analysis

Background: Exploring changes in health inequality and its determinants over time is of policy interest. Accordingly, this study aimed to decompose inequality in neonatal mortality into its contributing factors and then explore changes from 1995-2000 to 2005-2010 in Iran. Methods: Required data were drawn from two Iran’s demographic and health survey (DHS) conducted in 2000 and 2010. Normalized concentration index (CI) was used to measure the magnitude of inequality in neonatal mortality. The contribution of various determinants to inequality was estimated by decomposing concentration indices in 1995- 2000 and 2005-2010. Finally, changes in inequality were investigated using Oaxaca-type decomposition technique. Results: Pro-rich inequality in neonatal mortality was declined by 16%, ie, the normalized CI dropped from -0.1490 in 1995-2000 to -0.1254 in 2005-2010. The largest contribution to inequality was attributable to mother’s education (32%) and household’s economic status (49%) in 1995-2000 and 2005-2010, respectively. Changes in mother’s educational level (121%), use of skilled birth attendants (79%), mother’s age at the delivery time (25-34 years old) (54%) and using modern contraceptive (29%) were mainly accountable for the decrease in inequality in neonatal mortality. Conclusion: Policy actions on improving households’ economic status and maternal education, especially in rural areas, may have led to the reduction in neonatal mortality inequality in Ira

Mapping the flows and stocks of permanent magnets rare earth elements for powering a circular economy in the UK

A transition towards renewable energy and transport electrification requires a high demand for rare earth elements (REE). China's dominance in REE makes the supply chains vulnerable for REE-consuming countries. The UK is one of the only three major refining plants outside of China, and it has, therefore, an active role in the global REE supply chain. In addition, the UK recycling capacity of REE permanent magnets is in development. Understanding REE flows and stocks is required both for scaling up upstream refining capacity and for the recycling projects that are currently in commercial development. This study developed a material flow model of REE in NdFeB magnets used in electric vehicles and wind turbines, taking the UK (2017–2021) as a case. Results show that the UK is a net importer (1238 t of REE in REE compounds, 7787 t of REE in NdFeB magnets) and has a highly fragmented value chain. A significant amount of the REE remains in stocks, whilst most end-of-life REE-containing components were not recovered. Substantial data challenges cause a lack of traceability across the global REE supply chain. This needs to be addressed in order to enhance knowledge of how these REE are utilised. The proposed model and policy interventions can be applied to other countries to improve traceability and circularity

An exploration of young people's, parent/carers', and professionals' experiences of a voluntary sector organisation operating a Youth Information, Advice, and Counselling (YIAC) model in a disadvantaged area

BACKGROUND: The present evaluation explored young people’s, parents/carers, and healthcare professionals’ perceptions of the Youth Information, Advice and Counselling (YIAC) model operated by a voluntary sector organisation in North West England. With an aim to understand the key components that contribute to enhancing the success of the YIAC model. METHOD: Semi-structured interviews and focus groups with young people, parents/carers, and healthcare professionals were conducted. Data were analysed using thematic analysis. RESULTS: Five main themes were identified from the data: 1) Accessibility and flexibility; 2) Non-clinical model and environment; 3) Staff; 4) Partnership working; and 5) Promotion of positive mental health and wellbeing. CONCLUSION: Findings highlight the importance of non-clinical, community-based, ‘one-stop-shop’ hubs for young people in disadvantaged areas. The key components highlighted as facilitating access and engagement include: opportunity to self-refer, choice of location, timely provision of support, non-clinical environment, age appropriate services, a non-hierarchical workforce, inclusive support for family and carers, a focus on wider, often social, issues, and collaboration with partner organisations. These findings suggest that early support hubs for young people’s mental health should have consistent, long-term funding and should exist in every local area. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-07800-1

Social Health Status in Iran: An Empirical Study

Background: As social health is a condition-driven, dynamic and fluid concept, it seems necessary to construct and obtain a national and relevant concept of it for every society. Providing an empirical back up for Iran’s concept of social health was the aim of the present study.Methods: This study is an ecologic study in which available data for 30 provinces of Iran in 2007 were analyzed. In order to prove construct validity and obtain a social health index, an exploratory factor analysis was conducted on six indicators of population growth, willful murder, poverty, unemployment, insurance coverage and literacy.Results: Following the factor analysis, two factors of Diathesis (made up of high population growth, poverty, low insurance coverage and illiteracy) and Problem (made up of unemployment and willful murder) were extracted. The diathesis and problem explained 48.6 and 19.6% of social health variance respectively. From provinces, Sistan & Baluchistan had the highest rate of poverty and violence and the lowest rate of literacy and insurance coverage. In terms of social health index, Tehran, Semnan, Isfahan, Bushehr and Mazandaran had the highest ranks while Sistan and Baluchistan, Lurestan, Kohkiloyeh and Kermanshah occupied the lowest ones.Conclusion: There are some differences and similarities between Iranian concept of social health and that of other societies. However, a matter that makes our concept special and different is its attention to population. The increase in literacy rate and insurance coverage along with reduction of poverty, violence and unemployment rates can be the main intervention strategies to improve social health status in Iran

An Investigation of Environmental Inequality in a Metropolitan Area

Introduction: Inequalities in urban environment are a significant concern. Socioeconomic level plays an important role in these inequalities. Inequality in environmental hazards is recognized as potential determinants of health disparities. Materials & Methods: In this study, we used individual and cumulative environmental hazard inequality indices to compare the inequality among 379 neighborhoods in the city. Inequality indices were calculated based on unequal shares of environmental hazards for socioeconomic status (SES). The hazards include ambient concentrations of PM10 and NO2 in 2011. Results: Results revealed that inequalities from cumulative hazards (additive and multiplicative) and individual PM10 in different education rates were significant (P0.05). Conclusion: Findings of this research can be useful for policymakers and managers to investigate environmental justice especially in mega cities

Investigating the Status of Social Capital in Tehran in 2008

Abstract Introduction: Today, the role of social capital has been proved to be undeniable in the health . The World Health Organization (WHO) in 2000 declared that almost 60% of the causes of disease and mortality were related to the social factors. Therefore, this study aimed to investigate the status of social capital as one of the social determinants of health in Tehran, capital of Iran. Methods: &nbsp;&nbsp;The study participants, who aged over 18 years, lived in 22 districts of Tehran in 2010. The study data were collected on social capital and socioeconomic variables in Iran. Different dimensions of social capital as well as the mean score of social capital was measured in various groups using the SC-IQ. The study data were analyzed using Stata statistical software: release 13.0. Results: In this study, 2.484 participants were selected via multistage random sampling. The mean age of participants was 41.38&plusmn;17.7, and the mean score of social capital was slightly more in men (31.18) than women (30.41). Social capital was demonstrated to be lower within poor participants than other groups. In terms of marital status, the divorced had the lowest social capital (26.50). The mean social capital in those with university education was higher compared to individuals with other levels of education. Conclusion: Social capital is regarded as one of the factors affecting health. To promote the level of this valuable capital, the factors affecting the&nbsp; social capital level should be identified and all appropriate measures should be taken into account in order to ultimately enhance the level of public health