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.

This research contributes to the social work understanding of mental competency assessments with older adults in healthcare settings. Utilizing a narrative research methodology, this qualitative research study analysed nine face-to-face interviews with social workers with experience assessing competency of older adults in the following Winnipeg, Manitoba healthcare settings: hospitals, personal care homes, and a number of community settings (home care, geriatric specialty programs, and private practice). Drawing from systems and ecological theories, as well as the social determinants of health, the results of this study revealed several key concerns such as the motivation behind what triggers an assessment, the specific tests and methods used to determine competency, inequitable treatment of the patient throughout the assessment depending on their cultural or socioeconomic background, and depending on the setting whether the social worker felt their role on the assessment team was valued or dismissed. Recommendations outlined implications for: enhancing the quality of the competency assessment process; expanding the role of social work in interdisciplinary settings; examining the use of methods and tests for assessment; and exploring opportunities for change in legislation, education and early detection. Potential areas of further study are discussed.

Abstract Type 2 diabetes mellitus is a disease that has trebled in incidence over the last 25 years, affecting both adults and increasingly children. The rapid increase of the disease mirrors the gradients of social position and income distribution, and parallels the accelerated environmental changes witnessed with the rise of neoliberal capitalism. This research situates neoliberal capitalism as a collection of political and economic policies that form an ideology suited to protect discrete elite interests. The current ideology has permeated all social aspects of society, including education and healthcare. Therefore, it is argued that the practice of healthcare and the education of healthcare students are shaped by the sociopolitical environment in which they exist. Ten best-selling postsecondary textbooks in pathology, pathophysiology, and disease processes were selected for content analysis to determine if the interpretation of type 2 diabetes in pathophysiology textbooks reflects neoliberal thinking. The data were interpreted within the tradition of critical discourse analysis and theoretically enriched using Foucault’s descriptions of governmentality, biopolitics, and discursive formations. The results indicate that notions consistent with neoliberal capitalism permeate pathology textbooks in the understandings of type 2 diabetes. Consistent with how neoliberal thought embodies and explicates social conditions, type 2 diabetes is described in a way that stresses iii self-responsibility and culpability for falling ill. The texts also impart the importance of biomedical industry interventions for the treatment of the sick and the surveillance of the healthy. Finally, in a way that substantiates the degradation of the environment and retrenchment of social welfare policies, the textbooks fail to make any reference to the ecological factors that contribute to type 2 diabetes, including urbanisation and the propagation of food deserts, environmental toxins, income inequality, the steepening of the social gradient, and the deleterious effects of globalisation on human nutrition.

Abstract Type 2 diabetes mellitus is a disease that has trebled in incidence over the last 25 years, affecting both adults and increasingly children. The rapid increase of the disease mirrors the gradients of social position and income distribution, and parallels the accelerated environmental changes witnessed with the rise of neoliberal capitalism. This research situates neoliberal capitalism as a collection of political and economic policies that form an ideology suited to protect discrete elite interests. The current ideology has permeated all social aspects of society, including education and healthcare. Therefore, it is argued that the practice of healthcare and the education of healthcare students are shaped by the sociopolitical environment in which they exist. Ten best-selling postsecondary textbooks in pathology, pathophysiology, and disease processes were selected for content analysis to determine if the interpretation of type 2 diabetes in pathophysiology textbooks reflects neoliberal thinking. The data were interpreted within the tradition of critical discourse analysis and theoretically enriched using Foucault’s descriptions of governmentality, biopolitics, and discursive formations. The results indicate that notions consistent with neoliberal capitalism permeate pathology textbooks in the understandings of type 2 diabetes. Consistent with how neoliberal thought embodies and explicates social conditions, type 2 diabetes is described in a way that stresses iii self-responsibility and culpability for falling ill. The texts also impart the importance of biomedical industry interventions for the treatment of the sick and the surveillance of the healthy. Finally, in a way that substantiates the degradation of the environment and retrenchment of social welfare policies, the textbooks fail to make any reference to the ecological factors that contribute to type 2 diabetes, including urbanisation and the propagation of food deserts, environmental toxins, income inequality, the steepening of the social gradient, and the deleterious effects of globalisation on human nutrition.

Justificativa: Internações por Condições Sensíveis à Atenção Primária (ICSAP) são utilizadas como medida da efetividade da atenção à saúde e menores taxas estão associadas ao maior acesso à Atenção Primária à Saúde (APS). Poucos estudos utilizam instrumentos que medem a qualidade da APS e seu efeito nas taxas de internações. Esse estudo buscou identificar fatores individuais, contextuais e dos atributos da APS, medidos nas Equipes de Saúde da Família (ESF), associados com a variação das ICSAP. Métodos: Estudo ecológico das taxas de ICSAP e sua associação com as variáveis preditoras na população de Belo Horizonte, Minas Gerais, entre 2010 e 2013, analisadas por um modelo multinível. Resultados: Do total de 447.500 internações, excluídos os partos, 85.211 foram ICSAP, correspondendo a 19% do total de Internações. Dessas, 50,8% ocorreram em mulheres, 33% em menores de 18 anos, 32% em adultos e 35% em maiores de 60 anos. As taxas padronizadas anuais de ICSAP entre 2010 e 2013, foram maior nos homens (114,5/10.000) que nas mulheres (107,1/10.000). A vulnerabilidade socioeconômica da população está fortemente associada com o comportamento das taxas de internação. O aumento de 10% na população de alto risco ampliou em 4 ICSAP por 10.000 mulheres e em 3 ICSAP por 10.000 homens. Enquanto um aumento de 10% na população de baixo risco, uma redução de 6 ICSAP em mulheres e 5 nos homens, em cada Unidade Básica de Saúde. Nas análises realizadas na população adulta e idosa, para os grupos de doenças agudas e crônicas mais prevalentes nessa faixa etária, o aumento de uma unidade a mais no escore de qualidade da APS, reduz a taxa de ICSAP em 4% ao ano nas mulheres idosas com doenças crônicas. Conclusão: A utilização das ICSAP como medida da efetividade da APS/SF deve ter seu escopo ampliado, incluindo, além das características individuais e dos serviços, as socioeconômicas. Os melhores escores de qualidade da APS tem efeito significativo na redução das taxas de internações por condições crônicas, em mulheres idosas, ao longo dos anos. Como a vulnerabilidade socioeconômica esteve fortemente relacionada ao comportamento das taxas de ICSAP, esses achados reforçam a importância da APS na redução das iniquidades, ao atender uma população idosa e vulnerável, em um contexto de grandes desigualdades, como é o caso dessa metrópole brasileira. / Introduction. Ambulatory Care Sensitive Conditions (ACSC) have been used as a measure of the effectiveness of Primary Health Care (PHC). Few studies have, however, analysed changes in the rates of these hospitalizations using instruments that measure the quality of PHC and its effect on admission rates. This study aimed to identify individual factors, with the variation of ACSC. Methods. Ecological study of ACSC rates and their association with the predictor variables in the population of Belo Horizonte, Minas Gerais, between 2010 and 2013, analyzed by a multilevel model. Results. Of the total 447,500 admissions, excluding births, 85,211 were ICSAP, corresponding to 19% of total admissions. Of these, 50.8% occurred in women, 33% under 18, 32% in adults and 35% over 60 years. The annual standardized rates ACSC between 2010 and 2013 were higher in men (114.5 /10,000) than in women (107.1/10,000). The socio-economic vulnerability of the population is strongly associated with the trends of hospitalization rates. The 10% increase in high-risk population expanded by 4 and 3 ACSC per 10,000 women and men, respectively. While an increase of 10% in low-risk population, a reduction of 6 and 5 ACSC per 10.000 in women and men in each Basic Health Unit. In the analyzes in adults and the elderly, for most prevalent acute and chronic diseases in this age group, the increase of one more unit in the APS quality score, reduces ICSAP rate of 4% per year in older women with chronic diseases. Conclusion. The PHC best quality scores have significant effect in reducing hospitalization rates for chronic conditions in elderly women over the years. As the socioeconomic vulnerability was strongly related to the behavior of ACSC rates, these findings reinforce the importance of PHC in reducing inequities, particularly in large inequalities contexts, as in the case of a Brazilian metropolis. And reinforce the need to expand the assessment of the scope to use ACSC as a mesure of effectiveness of PHC, considering the individual, services and socio-economic characteristics.

Bakgrund: Statistik och forskningsrapporter från bland annat Världshälsoorganisationen visar att hälsan världen över är ojämlikt fördelad och att socioekonomisk status, socialt kapital och health literacy är bidragande faktorer. Föräldrars utbildningsnivå och inkomst kan påverka barns hälsa och uppväxtvillkor och barn tillhörande riskgrupper har sämre förutsättningar till hälsa. Samhället har möjlighet att genom politiska insatser på olika nivåer och i olika sektorer påverka individers möjligheter att i sin tur vidta hälsofrämjande åtgärder. Syfte: Syftet med studien var att undersöka föräldrars syn på kopplingen mellan ekonomi och hälsa, och hur det påverkar familjen att leva ett gott liv. Metod: En kvalitativ ansats valdes och sju föräldrar från tre olika kommuner i Värmland intervjuades i enskilda semistrukturerade intervjuer. Samtliga intervjuer spelades in, transkriberades och analyserades därefter enligt kvalitativ innehållsanalys. Resultat: Analysen resulterade i två kategorier: ”Hinder och möjligheter” som består av subkategorierna: Socialt kapital och Tid och utrymme, och vidare av ”Prioritering och investering” som består av subkategorierna: Samhällets roll, Levnadsvanor och livsstil och Uppväxtvillkor. Slutsats: Det framkom att hälsa är ett komplext begrepp som handlar om både fysiskt och psykiskt välbefinnande. Enligt informanterna har individer möjlighet att påverka sin hälsa genom prioriteringar och investeringar. Vidare beskrevs att förutsättningarna för hälsa är ojämlikt fördelade i samhället och de ekonomiskt svagare kan ha svårare att vidta hälsofrämjande åtgärder. Informanterna ansåg att det finns en koppling mellan ekonomi och hälsa och att god ekonomi förbättrar individers möjligheter till hälsa och ett gott liv. Individers kunskap, intressen och vilja styr individers val i livet. Tidsbrist och för lite utrymme för återhämtning och tid med familjen har beskrivits kunna utgöra en begränsande faktor för bättre hälsa. Hälsa beskrevs också vara en resurs för ett produktivt liv. Barns hälsa påverkas bara till viss del av familjens ekonomi samtidigt som en trygg miljö och god föräldrarelation ansågs vara betydelsefulla. / Background: Statistics and reports from among others the World Health Organization show that inequity in health exists all over the world and that socioeconomic status, social capital and health literacy are contributing factors. Parental education and income have an effect on children’s health and development and children in risk groups have lower chances to develop good health. The society has the opportunity to affect individuals to take actions to promote their own health by political actions on different levels and in different sectors. Aim: The aim of this study was to examine parental view on the connection between economics and health, and its effects on living a good family life. Method: A qualitative approach was used to collect data. Seven parents from three different municipalities in Wermland were interviewed using a semi-structured interview guide. The interviews were recorded and transcribed. The data was analyzed using qualitative content analysis. Results: The analysis of the material resulted in two categories: ”Obstacles and opportunities” which further consists of two subcategories: Social capital and Time and capacity. The other category “Priority and investment” consists of three subcategories: Society’s role, Lifestyle factors and Childhood conditions. Conclusion: This study showed that health is a complex concept about physical and psychological well-being. According to the informants individuals have the opportunity to affect their health by their priorities and investments. Furthermore, the opportunities for reaching good health are being described as unequal throughout the society and it seems to be harder to take health promoting actions for those who are economically weaker. The informants felt that there is a connection between economics and health and that good economy improves individuals’ possibilities to be healthy and live a good life. Individuals’ interests, knowledge and will affect their choices in life. Lack of time and capacity for recovery and to spent time with their families is thought to be a limiting factor for better health. Health is also being described as a resource for a productive life. Children’s health is only partly being affected by families’ economy. A safe environment and good parental relationship seems to be important.

La loi du 04 mars 2002 relative aux droits des malades et à la qualité et à la qualité du système de santé et la loi HPST (Hôpital, Patients, Santé et Territoires) de 2009 qui accorde un cadre légal à l’éducation thérapeutique ont promu l’autonomie du patient en favorisant sa participation aux décisions médicales. L’autogestion de la maladie chronique voulue par les pouvoirs publics en fournissant ces outils juridiques pour améliorer la qualité de soins, a suscité notre intérêt pour programme d’éducation thérapeutique destiné à des patients insuffisants rénaux en pré-dialyse. L’un des objectifs est de favoriser la liberté des patients à choisir une méthode de dialyse. Dans notre travail de thèse, nous avons voulu montrer comment les déterminants sociaux des décisions médicales et ceux liés aux choix d’une méthode de dialyse sont construits. Si en France, les patients semblent davantage se tourner vers une prise en charge à l’hôpital, dans certains pays, c’est le pluralisme médical qui est de mise. L’exercice de l’auto-analyse a montré le poids de l’économique, de la culture, de la famille dans les choix de santé.Par ailleurs, la place de l’éducation thérapeutique dans le processus décisionnel n’est pas figée : l’éducation thérapeutique peut être complémentaire à la pratique médicale, être un outil d’aide à la décision pour certains patients insuffisants rénaux ou être utilisée par les médecins pour favoriser l’observance décisionnelle des patients. Nous avons montré que les patients et les médecins se basent sur plusieurs facteurs qui peuvent influencer la nature de la délibération.Cette étude a montré que le choix est réseauté et que les décisions sont construites car elles sont basées sur des interactions et des stratégies médicales. Ces déterminants permettent également de comprendre comment la confiance est construite dans le processus décisionnel. Tantôt distribuée, tantôt déplacée, la confiance est explicative du type d’information que le patient priorise. Le choix réseauté du patient amène finalement à la relativisation du modèle de décision médicale partagée qui semble de plus en plus avoir un caractère normatif dans la relation entre professionnels de santé et patients. / The law of March 04th, 2002 on the rights of patients and the quality of the health system and the law HPST (Hôpital, Patients, Santé et Territoires) of 2009 that grants legal framework for patients’ education, have promoted the patient’s autonomy by encouraging his participation in medical decisions. Self-management of chronic illness as favoured by public authorities in providing the legal tools to improve the quality of care has aroused our interest in patient education programs for patients with renal failure in pre-dialysis. One of the objectives of this program is to allow patients free choice when deciding on the method of dialysis.Our thesis aims to underline how the social determinants at work in medical decisions and those involved in the choice of a dialysis method are constructed.In France, patients seem to favor hospital patient care, but in some countries, medical pluralism is more frequent. The exercise of self-analysis has revealed the significant part played by economy, culture and family in health choices.Moreover, the part played by patient education in the decision-making process is neither fixed nor pre-determined: patient education can complement medical practice, can be a decision support tool for some kidney patients or be used by doctors to promote patient decision-making compliance.We have shown that patients and physicians rely on several factors that may influence the nature of the discussion.This study reveals that the choice is networked and that the decisions that are made are the outcome of several interactions and medical strategies. These determinants also help to understand how trust develops and leads to decision-making.Sometimes distributed, sometimes shifted, trust accounts for the type of information prioritized by the patient. The networked choice of the patient finally puts the shared decision-making model into perspective as it increasingly seems to have a normative character in the relationship between health professionals and patients.

This Master's thesis called "Labour as a Social Determinant and its Influence on the Health of Medical Staff in Selected Hospitals" is divided into two main sections. The first section summarizes current knowledge from both Czech and world literature from the field of social determinants related to health and labour. The second part of this work deals with the aim of the research, data collection and data processing methods as well as with the very evaluation of the output information and a discussion of the results elicited. The theoretical part is divided into four chapters and consists of basic issues related to the aim of this Master's thesis. The first chapter describes social determinants of health from various points of view. One of the chapter's components is a description of a current conception of these determinants. The second chapter deals with the construct of health, its definition and its conception. Last but not least it treats health as a determiner. The third chapter summarizes a social determinant of labour and labour-related terms. The author is further concerned with the importance of work for humans and with labour safety and hygiene. The fourth and last chapter is dedicated to public health of the Czech republic, its history, the system of health care and further focuses on the structure and services of Ostrov hospital and Sokolov hospital. The aim of this Master's thesis is proposed in the empirical part of this work. The aim was to map the influence of labour as a social determinant of the health of medical staff in selected hospitals. Next, constitutive objectives were established. Their purpose was to map the impact of workplace relationships and their influence on the overall health of medical staff as well as the impact of working environment including salary, working hours, work agenda and workplace security on the overall health of medical staff. The following hypotheses were assessed in connection with the objectives of this work: H1: Workplace relations of medical staff affects their overall health. H2: Salary affects the overall health of medical staff. H3: Working hours affects the overall health of medical staff. H4: Work agenda affects the overall health of medical staff. H5: Workplace safety affects the overall health of medical staff. Based on the statistical testing hypotheses 1, 3 and 4 were confirmed. Hypotheses 2 and 5 were not confirmed. The enquiry within the framework of this Master's thesis was conducted using a quantitative research. The interviewing method and the technique of questionnaire were used for data acquirement. The questionnaire was composed from questions regarding the matter of inquiry, questions evaluating subjective health of the respondents, questions related to the occupation of the people addressed. The round of questions was finally targeted at the issue of respondents' health vs. their work. The questionnaire was anonymous. The research distribution was accomplished via Deputy Minister of health care in both hospitals. The research file was formed by a medical staff who work in Sokolov hospital and Ostrov hospital. The resulting data were entered and processed using SPPS program vision 16.0 and 23.0 (Statistical Package for Social Science). The data were further evaluated and processed via graphs and tables in absolute numbers and percentages. After the evaluation of all questions in the questionnaire I reached a conclusion that labour as a social determinant of health has impact on the health of medical staff. I shall also assume that the majority of respondents were quite positive while rating the overall complacence with their jobs. Their complacence appears despite the mental rather than physical demand which undoubtedly goes with medical careers as well as despite their work conditions and workplace relationship which all impact their overall health.