Young African American men who have sex with men (AAMSM) are at greater risk of being infected with the human immunodeficiency virus (HIV) and less likely to seek HIV testing than are members of other demographic groups. This behavior results in a significant public health threat because young AAMSM with an unrecognized HIV infection are less likely to practice safer sex and, therefore, more likely to pass the infection on to their partners. This study is an examination of the social and personality factors that influence HIV testing rates among young AAMSM, using Aday's model of the social determinants of health and the Big Five model of personality as the theoretical frameworks. A cross-sectional design was employed, and social networks were used to recruit study respondents. Forty-three young AAMSM completed online questionnaires, and multiple regression techniques were used to examine relationships among the variables of interest. Statistical analysis indicated that neither the social risk factors derived from Aday's model nor the Big Five model predicted HIV testing. However, it is unknown whether these nonsignificant findings are attributable to a genuine lack of influence or the unique characteristics of the sample. Given the null results of this study and the mixed findings of prior research, further studies are required to draw conclusions regarding the influence of social and personality factors on HIV testing in this high-risk group. Additional research could be helpful in developing more effective strategies for encouraging HIV testing among young AAMSM. The potential for positive social change lies in slowing the spread of HIV through this vulnerable population and in engaging young AAMSM in the medical system to improve their long-term health prospects.

INTRODUÇÃO: O processo saúde-doença está intrinsecamente conectado com as condições concretas de vida e com as diversas realidades sociais, acarretando o forte vínculo entre a situação de saúde e os fatores históricos, sociais, econômicos, culturais e biológicos. A formulação sobre Determinantes Sociais da Saúde (DSS) busca ampliar o enfoque sobre as condições de vida e bem-estar, salientando a distribuição de renda, as condições de vida e trabalho, as redes de suporte social, entre outros, como fatores que afetam a qualidade de vida. Os DSS buscam, assim, evitar a análise fragmentada, englobando a concepção de Determinantes Estruturais. Estes procuram compreender as condições de distribuição de riqueza, poder e prestígio na origem dos problemas de saúde. Assim, a estrutura de classes sociais, a distribuição de renda e o preconceito de gênero e raça são considerados na proposição de políticas de saúde. OBJETIVO: Sistematizar o conhecimento a respeito dos DSS e seus componentes Estruturais e Intermediários, segundo o potencial para contribuir na elaboração de políticas sociais e de saúde. MÉTODO: Trata-se de uma pesquisa de revisão de escopo (Scoping Review), metodologia que amplia e aprofunda o mapeamento e a síntese do conhecimento. As etapas foram: identificação da questão de pesquisa e dos estudos relevantes; seleção dos estudos; extração de dados; separação, sumarização, relatório e comunicação dos resultados. Foram pesquisadas as seguintes bases de dados eletrônicas: Web of Science, CINAHL, Scopus, LILACS e Pub-Med, que engloba o MEDLINE. Adicionalmente, foi realizado levantamento específico nas revistas: International Journal of Epidemiology, Journal of Epidemiology and Community Health, American Journal of Public Health e American Journal of Epidemiology. RESULTADOS: Após a retirada das duplicatas, foram localizados 752 artigos; e após a triagem, 19 artigos foram analisados em profundidade. Dentre os países nos quais as pesquisas selecionadas foram desenvolvidas, destacaram-se Estados Unidos e Inglaterra com seis e quatro publicações respectivamente (31,6% e 21%) seguidos de três publicações no Canadá (15,7%), duas no Brasil (10,5%), duas na Nova Zelândia (10,5%), duas na Austrália (10,5%) e uma no México (5,2%). As discussões sobre os Determinantes Estruturais da saúde são mais recentes. A análise permitiu tratar das diferenças entre termos comumente utilizados, como desigualdade, disparidade e iniquidade. Os marcadores sociais da diferença mais problematizados na formulação dos DSS Estruturais foram: racismo gênero, classe social e situação migratória. Por serem os marcadores sociais mutuamente construídos, a perspectiva teórica da interseccionalidade foi apresentada como recurso metodológico para entender suas inter-relações. CONCLUSÃO: Foi possível identificar neste trabalho uma agenda síntese que perpassa ações na área econômica, propondo a redistribuição da riqueza; políticas públicas intersetoriais e mudanças no arcabouço jurídico, destacando que os determinantes sociais são mais bem compreendidos quando se reconhece a dialética entre contextos específicos e os macrodeterminantes políticos e econômicos, identificando os diferentes significados e consequências para a saúde / INTRODUCTION: The health-disease process is intrinsically connected with concrete conditions of life and with the diverse social realities, which brings about the strong ties between the health situation and historical, social, economical, cultural, and biological factors. The formulation of Social Determinants of Health (SDH) seeks to broaden the focus on conditions of life and well-being, emphasizing the distribution of income, the work and life conditions, the net of social support, among other factors that affected the quality of life. SDH seek, in this way, to avoid a fragmented analysis, embodying the conception of Structural Determinants, which seek to comprehend the conditions of distribution of wealth, power, and prestige in the origins of health problems. Thus, the structure of social classes, the distribution of income, and the prejudice of gender and race are taken into account in the proposition of health policies. OBJECTIVE: systematizing knowledge about the SDH and their structural components, according to the potential to contribute in the elaboration of social and health policies. METHODOLOGY: The following research employs the Scoping Review Methodology, which enlarges and deeps the mapping and the synthesis of knowledge. The phases of our work were the following: identification of the research issue and relevant studies; selection of the studies; extraction of data; division, summarization, reports, and communication of results. The following electronic databases were researched: Web of Science, CINAHL, Scopus, LILACS, and Pub-Med, which comprehends MEDLINE. Additionally, specific journals were surveyed: International Journal of Epidemiology, Journal of Epidemiology and Community Health, American Journal of Public Health, and American Journal of Epidemiology. OUTCOMES: After removing the duplicates, 752 articles were found, and after the screening 19 articles were analyzed in depth. Among the countries in which the selected researches were conducted, the following are noteworthy: England and the USA with four and five publications respectively (21% and 26,3%), followed by three publications in Canada (15,7%), two in Brazil (10,5%), two in New Zealand (10,5%), two in Australia (10,5%) and one in México (5,2%). The discussions on Structural Determinants of Health are more recent. The analysis allowed us to treat the differences among terms commonly used, such as inequality, disparity, and inequity. The social markers of difference more problematized in the formulation of the Structural SDH were racism, gender, social class, and migration situation. For being social markers mutually built, the theoretical perspective of intersectionality was presented as a methodological resource to understand its inter-relations. CONCLUSION: This work was able to identify a synthesis-agenda, which passes through actions in the economical field, proposing the redistribution of wealth, intersectoral public policies, and changes in the juridical frame, emphasizing that the social determinants are better comprehended when the dialectics between specific contexts and the political-economical macro-determinants are acknowledged, identifying the different meanings and consequences for Health

A partir do referencial teórico marxista e da centralidade do trabalho, estudamos como o campo da Saúde Coletiva e o Sistema Único de Saúde (SUS) vêm abordando a questão do trabalho. Partimos da hipótese de que o trabalho é fator central na determinação social da saúde, mas que a atuação estatal sobre essa questão é precária e insuficiente; ao mesmo tempo, entendemos que o campo da Saúde Coletiva vem se afastando do debate sobre o trabalho em uma perspectiva emancipatória. Realizamos revisão narrativa de 53 artigos publicados em três periódicos do campo, sendo 34 propriamente teóricos e 19 referentes a políticas públicas. Apresentamos o debate organizado por categorias, seguido de balanço crítico. Identificamos que é pouco abordada a relação entre o campo denominado Saúde do Trabalhador e o campo da Saúde Coletiva. Notamos a relativa ausência do debate sobre a determinação social da saúde, ao mesmo tempo que o termo determinantes sociais da saúde aparece com frequência. Constatamos que as obra de Marx e da Sociologia do Trabalho são relativamente pouco citadas, embora possam contribuir para a compreensão do trabalho em perspectiva emancipatória. Avaliamos que o debate sobre a Rede Nacional de Atenção Integral à Saúde do Trabalhador aparece nos artigos de forma descritiva, abordando pouco a precariedade e a insuficiência da atenção à saúde dos trabalhadores no SUS. O papel da Atenção Primária à Saúde é mencionado sem levar em conta que a população trabalhadora já é atendida por esses serviços, como se as questões de Saúde do Trabalhador constituíssem uma nova atribuição. Os desafios estruturais do SUS são abordados de forma fragmentada e superficial. A atuação desarticulada dos setores do Estado sobre a questão do trabalho é retratada, mas não se analisa as contradições de forma mais ampla. Consideramos que é necessário retomar a articulação entre a Reforma Sanitária Brasileira e a perspectiva revolucionária de superação do capitalismo, ao menos em termos teóricos. / Based on the Marxist theory and on the theoretical reference of the centrality of work, we study how the field of Collective Health and the Brazilian Unified Health System (UHS) have been approaching the issue of work. We start from the hypothesis that work is a central factor in the social determination of health, but that state action on this issue is precarious and insufficient. At the same time, we understand that the field of Collective Health has been moving away from the debate about work in an emancipatory perspective. We carried out a narrative review of 53 articles published in three journals of the field, 34 of which are theoretical and 19 are related to public policies. We present the debate organized by categories, followed by critical review. We identify that the relationship between the field called Occupational Health and the field of Collective Health is little discussed. We note the relative absence of the debate on the social determination of health, while the term social determinants of health appears frequently. We find that the work of Marx and the Sociology of Work are relatively little cited, although they may contribute to the understanding of work in an emancipatory perspective. We evaluate that the debate about the National Network of Integral Attention to Workers\' Health appears in the articles in a descriptive way, addressing little the precariousness and insufficiency of health care of workers in the UHS. The role of Primary Health Care is mentioned without taking into account that the working population is already served by these services, as if Workers\' Health issues constituted a new assignment. The structural challenges of UHS are addressed in a fragmented and superficial way. The disjointed performance of the state sectors on the issue of work is portrayed, but contradictions are not analyzed more broadly. We consider that it is necessary to resume the articulation between the Brazilian Sanitary Reform and the revolutionary perspective of overcoming capitalism, at least in theoretical terms.

OBJETIVO: Desenvolver e validar um instrumento de medida das percepções sobre discriminação racial interpessoal no contexto dos serviços de saúde brasileiros. METODOLOGIA: Estudo do tipo metodológico conduzido com base na Teoria Clássica dos Testes para elaboração e validação psicométrica de instrumento. Para o desenvolvimento do pool de itens inicial, três fontes foram utilizadas: revisão de literatura sobre escalas já existentes; estudo qualitativo; e, sugestões de especialistas sobre racismo/desigualdades em saúde. O instrumento inicialmente proposto (versão 1) constava de 50 itens. Buscou-se verificar as evidências de validade de conteúdo e constructo e, para isso, a coleta de dados foi dividida em duas etapas. A primeira etapa consistiu na avaliação do instrumento proposto junto ao comitê de especialistas e a segunda etapa consistiu no preenchimento do instrumento pela população-alvo. A análise dos dados foi realizada no R e Stata 14.2. RESULTADOS: Na validação de face e conteúdo, a versão 1 foi submetida à avaliação por comitê de especialistas composto por um metodologista, um profissional de língua portuguesa, três especialistas em relações étnico-raciais e três membros da população-alvo. Dos 50 itens elaborados originalmente, foram excluídos 28 e restaram 22 (versão 2). O CVR (razão de validade de conteúdo) médio dos itens que restaram foi 0,74. Com relação à concordância entre os especialistas, o PABAK foi 0,30, considerado razoável. Entretanto, dos 22 itens que compuseram a versão 2, dois foram desmembrados, o que gerou a versão 3, com 24 itens. A versão 3 foi construída na plataforma digital Research Eletronic Data Capture (REDCap) e foi divulgada entre setembro e dezembro de 2017 por meio de um link (via redes sociais como Facebook e Whatsapp) que direcionou os respondentes para o instrumento. Ao todo, 480 pessoas acessaram o link, mas apenas 158 finalizaram o preenchimento do instrumento. A maior parte dos respondentes foi do sexo feminino (87,0%), autoclassificada como de raça/cor preta ou parda (97,5%) e pertencente ao grupo econômico A e B (61,4%). Prosseguiu-se com a avaliação da validade de constructo por meio da análise fatorial exploratória. KMO (Kaiser-Meyer-Okin) foi 0,736; o teste de esfericidade de Bartlett foi p<0,001; todas as cargas fatorias estiveram entre 0,3 e 0,9; e as comunalidades abaixo de 0,4. A avaliação do índice de confiabilidade Ômega de Mcdonald total foi 0,87, valor considerado bom. Dessa forma, produziu-se a versão 4, denominada DRISS, com 19 itens no total e seis dimensões, que são: sintomas somáticos, preparo, expressão emocional, percepção social, reação, consequências emocionais. Não foi observada diferença estatisticamente significativa nas médias dos escores em relação à idade, escolaridade, grupo econômico e outras variáveis sociodemográficas. CONCLUSÕES: Este estudo produziu uma escala que mede a percepção sobre discriminação racial interpessoal no contexto dos serviços de saúde, denominada DRISS, que apresenta adequadas propriedades psicométricas. O DRISS é direcionado especificamente às/aos usuárias/os dos serviços de saúde. Em nível populacional, produzirá dados relevantes para a tomada de decisões programáticas com foco na redução da discriminação racial nos serviços de saúde e consequente diminuição das iniquidades raciais em saúde. / OBJECTIVE: To develop and validate an instrument to measure perceptions about interpersonal racial discrimination in Brazilian healthcare facilities context. METHODOLOGY: This is a methodological study based on Classical Theory of Tests. For the development of the initial items pool, three sources were used: literature review on existing scales; qualitative study; and, expert on racism health inequalities suggestions. Initially, the version 1 was composed by 50 items. In order to test content and construct validity evidence, data collection was divided into two steps. The first step consisted of the analysis of version 1 instrument to an expert committee and the second step consisted of the submission of the instrument to the target population. Data analysis was performed with R and Stata 14.2. RESULTS: Face and content validation of version 1 was performed by expert committee composed by a psychometrist, a Portuguese language expert, three experts in ethnic-racial relations and three members of the target population. From the 50 originally drafted items, 28 were excluded and 22 remained (version 2). The average CVR (content validity ratio) of the items was 0.74. Regarding the agreement among the experts, PABAK was 0.30, considered reasonable. Two items from version 2 were dismembered, which generated version 3, with 24 items. Version 3 was included on the Research Eletronic Data Capture (REDCap) digital platform and was released between September and December 2017 in a link (via social networks like Facebook and Whatsapp). Altogether, 480 people accessed the link, but only 158 completed the instrument. Most respondents were female (87.0%), self-classified as black or brown (97.5%) and were at economic group A and B (61.4%). We proceeded with the evaluation of construct validity through exploratory factorial analysis. KMO (Kaiser-Meyer-Okin) was 0.736; Bartlett Sphericity Test was p <0.001; all factor loads were between 0.3 and 0.9; and commonalities below 0.4. The McDonalds Omega Total reliability rating was 0.87, which is considered good. In this way, version 4, named DRISS, was produced with a total of 19 items and six dimensions, that are: somatic symptoms, preparation, emotional expression, social perception, reaction, and emotional consequences. No statistically significant difference was observed in the means of the DRISS scores in relation to age, schooling, economic group and other sociodemographic variables. CONCLUSIONS: This study produced a scale that measures the \'perception about interpersonal racial discrimination in the healthcare facilities context, called DRISS, with adequate psychometric properties. DRISS is specifically targeted to the health services users. At the population level, it may produce relevant data for programmatic decision-making focused on reducing racial discrimination in healthcare facilities, and as a consequence, racial inequities in health.

Osteoarthritis (OA) is the leading cause of disability in North American and has major economic consequences for society. People with knee OA experience the worst quality of life, among musculoskeletal conditions, with function and mobility being influenced by symptoms such as pain and stiffness. However, the impact of OA symptoms varies due to intrinsic and extrinsic factors, leading many researchers to employ biopsychosocial and other population health frameworks to study the disease. These population health approaches have not been adopted when studying knee OA outcomes in bioarchaeology, where a limited biological lens prevails due to the sole reliance on skeletal remains. The purpose of this research was to explore methods for identifying the impairment potential of knee OA in archaeological populations using a clinical sample and population health approaches. Clinical studies have the advantage of assessing not only the biological implications of knee OA but also the functional outcomes. By creating a knee OA grading system applicable for both MRI and dry bone femora samples (Clinical Archaeological Osteoarthritis Score) a link between clinical and archaeological populations was proposed. Using this link to infer functional deficits onto archaeological populations using population health frameworks, a theoretical analysis was performed with two populations; the 17th century Huron and the 19th century Inuit from the Igloolik region of Nunavut. The results demonstrated the increased impairment potential of knee OA in the Inuit population versus the Huron population, produced by contrasting factors captured by the determinants of health, including social and physical environments.

There are unequivocal health disparities, both physical and mental, between the Indigenous and non-Indigenous peoples of Canada. Utilizing narrative inquiry, a qualitative methodology, 15 néhiyawak (Plains Cree people) between 18 and 71 years of age from Thunderchild First Nation were interviewed to explore what improved their mental health and well-being and what they needed to attain optimal mental health and well-being. The néhiyawak interviewed for this study responded with descriptions of strength and resilience. By posing questions that focused on the positive, the strengths, and resilience of the néhiyawak in this study came to the forefront. Narrative thematic analysis of the interviews conducted with the néhiyawak from Thunderchild First Nation consistently revealed four overarching themes that highlighted what positively impacted their mental health and well-being and their perceived needs to attain optimal mental health and well-being: relationships; spiritual beliefs and cultural practices; tānisīsi wāpahtaman pimātisiwin (worldview); and ēkwa ōhi kikwaya piko ka-ispayiki kīspin ka-nohtē-miyo-mahcihoyān (these are the things that need to happen if I want to be healthy). The néhiyawak in this study described holistic health determinants that could best be associated with the medicine wheel and the determinants of health as making a positive difference to their mental health and as necessary for them to obtain optimal mental health and well-being. These results suggest that mental health programming and intervention should be harmonious with Indigenous culture; utilize a holistic approach that takes physical, emotional, mental, and spiritual well-being into consideration; and address the existing mental health disparities using the determinants of health as a framework, with an increased focus on the current socio-economic status of Indigenous peoples in Canada.

There are unequivocal health disparities, both physical and mental, between the Indigenous and non-Indigenous peoples of Canada. Utilizing narrative inquiry, a qualitative methodology, 15 néhiyawak (Plains Cree people) between 18 and 71 years of age from Thunderchild First Nation were interviewed to explore what improved their mental health and well-being and what they needed to attain optimal mental health and well-being. The néhiyawak interviewed for this study responded with descriptions of strength and resilience. By posing questions that focused on the positive, the strengths, and resilience of the néhiyawak in this study came to the forefront. Narrative thematic analysis of the interviews conducted with the néhiyawak from Thunderchild First Nation consistently revealed four overarching themes that highlighted what positively impacted their mental health and well-being and their perceived needs to attain optimal mental health and well-being: relationships; spiritual beliefs and cultural practices; tānisīsi wāpahtaman pimātisiwin (worldview); and ēkwa ōhi kikwaya piko ka-ispayiki kīspin ka-nohtē-miyo-mahcihoyān (these are the things that need to happen if I want to be healthy). The néhiyawak in this study described holistic health determinants that could best be associated with the medicine wheel and the determinants of health as making a positive difference to their mental health and as necessary for them to obtain optimal mental health and well-being. These results suggest that mental health programming and intervention should be harmonious with Indigenous culture; utilize a holistic approach that takes physical, emotional, mental, and spiritual well-being into consideration; and address the existing mental health disparities using the determinants of health as a framework, with an increased focus on the current socio-economic status of Indigenous peoples in Canada.

At present there is a reliance on behavioral interventions that have been limited in their effectiveness to reduce the public health burden of chronic disease, partly because the effects of social context on the initiation and maintenance of health behaviors is not incorporated into public health policy and practice. Yet current research indicates that there are macro-level structural and contextual influences on population health that cannot be reduced to individual or compositional effects. This study investigated the associations between social structural factors, community social context, individual characteristics, and self-reported correlates of disease. Distal influences included social structural inequalities such as income inequality and absolute deprivation or poverty. Pertinent mechanisms through which these influences might have operated on disease included social contextual factors, such as social capital. Both political economy and the ecosocial perspective were selected to inform this study and to provide the theoretical framework from which hypotheses were derived.The design was a multilevel, retrospective, nonexperimental study using secondary data. The study linked three data sources (2001 Behavioral Risk Factor Surveillance System, Social Capital Community Benchmark Study, and U.S. Census) by Federal Information Processing Standards codes in order for individuals to be placed in their community or state contexts. Results provided mixed evidence of the direct role of structural and contextual inequalities on self-rated health. Any direct effects of social structural inequalities on the health outcomes disappeared once individual factors were included in the models. Findings demonstrated that one dimension of social capital, organizational activism, retained its significant direct effect on general health status, once individual characteristics were considered. Conclusions suggested indirect associations whereby the negative influence of social structural inequalities on health was mediated by the erosion of social trust, which in turn was associated with engaging in risk behavior, thus increasing the odds of reporting hypertension, fair/poor general health, and mental distress. Although results were inconsistent, this study contributed to advancing Healthy People 2010 goals of increasing quality of life and reducing health disparities by advancing understanding of the multilevel nature of perceived health and the chronic diseases they predict.

No description available.

Osteoarthritis (OA) is the leading cause of disability in North American and has major economic consequences for society. People with knee OA experience the worst quality of life, among musculoskeletal conditions, with function and mobility being influenced by symptoms such as pain and stiffness. However, the impact of OA symptoms varies due to intrinsic and extrinsic factors, leading many researchers to employ biopsychosocial and other population health frameworks to study the disease. These population health approaches have not been adopted when studying knee OA outcomes in bioarchaeology, where a limited biological lens prevails due to the sole reliance on skeletal remains. The purpose of this research was to explore methods for identifying the impairment potential of knee OA in archaeological populations using a clinical sample and population health approaches. Clinical studies have the advantage of assessing not only the biological implications of knee OA but also the functional outcomes. By creating a knee OA grading system applicable for both MRI and dry bone femora samples (Clinical Archaeological Osteoarthritis Score) a link between clinical and archaeological populations was proposed. Using this link to infer functional deficits onto archaeological populations using population health frameworks, a theoretical analysis was performed with two populations; the 17th century Huron and the 19th century Inuit from the Igloolik region of Nunavut. The results demonstrated the increased impairment potential of knee OA in the Inuit population versus the Huron population, produced by contrasting factors captured by the determinants of health, including social and physical environments.