Search

Intersectionality is a useful tool to address health inequalities, by helping us understand and respond to the individual and group effects of converging systems of power. Intersectionality rejects the notion of inequalities being the result of single, distinct factors, and instead focuses on the relationships between overlapping processes that create inequities. In this Series paper, we use an intersectional approach to highlight the intersections of racism, xenophobia, and discrimination with other systems of oppression, how this affects health, and what can be done about it. We present five case studies from different global locations that outline different dimensions of discrimination based on caste, ethnicity and migration status, Indigeneity, religion, and skin colour. Although experiences are diverse, the case studies show commonalities in how discrimination operates to affect health and wellbeing: how historical factors and coloniality shape contemporary experiences of race and racism; how racism leads to separation and hierarchies across shifting lines of identity and privilege; how racism and discrimination are institutionalised at a systems level and are embedded in laws, regulations, practices, and health systems; how discrimination, minoritisation, and exclusion are racialised processes, influenced by visible factors and tacit knowledge; and how racism is a form of structural violence. These insights allow us to begin to articulate starting points for justice-based action that addresses root causes, engages beyond the health sector, and encourages transnational solidarity.

The inclusion of social determinants of health offers a more comprehensive lens to fully appreciate and effectively address health. However, decision-makers across sectors still struggle to appropriately recognise and act upon these determinants, as illustrated by the ongoing COVID-19 pandemic. Consequently, improving the health of populations remains challenging. This paper seeks to draw insights from the literature to better understand decision-making processes affecting health and the potential to integrate data on social determinants. We summarised commonly cited conceptual approaches across all stages of the policy process, from agenda-setting to evaluation. Nine conceptual approaches were identified, including two frameworks, two models and five theories. From across the selected literature, it became clear that the context, the actors and the type of the health issue are critical variables in decision-making for health, a process that by nature is a dynamic and adaptable one. The majority of these conceptual approaches implicitly suggest a possible role for data on social determinants of health in decision-making. We suggest two main avenues to make the link more explicit: the use of data in giving health problems the appropriate visibility and credibility they require and the use of social determinants of health as a broader framing to more effectively attract the attention of a diverse group of decision-makers with the power to allocate resources. Social determinants of health present opportunities for decision-making, which can target modifiable factors influencing health—i.e. interventions to improve or reduce risks to population health. Future work is needed to build on this review and propose an improved, people-centred and evidence-informed decision-making tool that strongly and explicitly integrates data on social determinants of health. Supplementary Information The online version contains supplementary material available at 10.1007/s11524-021-00560-z.

Housing is a paradigmatic example of a social determinant of health, as it influences and is influenced by structural determinants, such as social, macroeconomic, and public policies, politics, education, income, and ethnicity/race, all intersecting to shaping the health and well-being of populations. It can therefore be argued that housing policy is critically linked to health policy. However, the extent to which this linkage is understood and addressed in public policies is limited and highly diverse across and within countries. This analysis seeks to describe the linkages between housing policies and health and well-being using examples from three countries at different levels of the wealth spectrum: Singapore, the UK, and Kenya. We conducted a comparative policy analysis across three country contexts (Singapore, the UK, and Kenya) to document the extent to which housing policies address health and well-being, highlighting commonalities and differences among them. To guide our analysis, we used the United Nations (UN) definition of adequate housing as it offers a broad framework to analyze the impact of housing on health and well-being. The anatomy of housing policies has a strong correlation to the provision of adequate housing across Singapore, the UK, and Kenya, especially for vulnerable groups. The paper demonstrates that contextual factors including population composition (i.e., aging versus youthful), political ideologies, legal frameworks (i.e., welfare versus market-based provision of housing), and presence (or absence) of adequate, quality, timely, reliable, robust data systems for decision-making, which are taken up by stakeholders/state, have strong implications of the type of housing policies developed and implemented, in turn directly and indirectly impacting the overall health and well-being of populations. This analysis demonstrates the value of viewing housing policies as public health policies that could significantly impact the health and well-being of populations, especially vulnerable groups. Moreover, the findings highlight the importance of the Health in All Policies approach to facilitate integrated policy responses to address social determinants of health such as housing. This is more critical than ever, given the context of the global pandemic that has led to worsening overall health and well-being.

More than a decade after the World Health Organization Commission on the Social Determinants of Health (SDoH), it is becoming widely accepted that social and economic factors, including but not limited to education, energy, income, race, ethnicity, and housing, are important drivers of health in populations. Despite this understanding, in most contexts, social determinants are not central to local, national, or global decision-making. Greater clarity in conceptualizing social determinants, and more specificity in measuring them, can move us forward towards better incorporating social determinants in decision-making for health. In this paper, first, we summarize the evolution of the social framing of health. Second, we describe how the social determinants are conceptualized and contextualized differently at the global, national, and local levels. With this, we seek to demonstrate the importance of analyzing and understanding SDoH relative to the contexts in which they are experienced. Third, we problematize the gap in data across contexts on different dimensions of social determinants and describe data that could be curated to better understand the influence of social determinants at the local and national levels. Fourth, we describe the necessity of using data to understand social determinants and inform decision-making to improve health. Our overall goal is to provide a path for our collective understanding of the foundational causes of health, facilitated by advances in data access and quality, and realized through improved decision-making.

Noncommunicable diseases (NCDs) represent a significant global public health burden. As more countries experience both epidemiologic transition and increasing urbanization, it is clear that we need approaches to mitigate the growing burden of NCDs. Large and growing urban environments play an important role in shaping risk factors that influence NCDs, pointing to the ineluctable need to engage sectors beyond the health sector in these settings if we are to improve health. By way of one example, the transportation sector plays a critical role in building and sustaining health outcomes in urban environments in general and in megacities in particular. We conducted a qualitative comparative case study design. We compared Bus Rapid Transit (BRT) policies in 3 megacities-Lagos (Africa), Bogotá (South America), and Beijing (Asia). We examined the extent to which data on the social determinants of health, equity considerations, and multisectoral approaches were incorporated into local politics and the decision-making processes surrounding BRT. We found that all three megacities paid inadequate attention to health in their agenda-setting, despite having considerable healthy transportation policies in principle. BRT system policies have the opportunity to improve lifestyle choices for NCDs through a focus on safe, affordable, and effective forms of transportation. There are opportunities to improve decision-making for health by involving more available data for health, building on existing infrastructures, building stronger political leadership and commitments, and establishing formal frameworks to improve multisectoral collaborations within megacities. Future research will benefit from addressing the political and bureaucratic processes of using health data when designing public transportation services, the political and social obstacles involved, and the cross-national lessons that can be learned from other megacities.

Background TNF-α and IL-6 are both pleiotropic cytokines playing major roles in cancer-associated cytokine networks. They have previously been investigated for their function in skin malignancies, mostly melanomas, and studies on non-melanoma skin cancer (NMSC) patients are relatively rara. In this study, we aimed to investigate the associations of serum levels of IL-6 and TNF-α with NMSCs and its clinicopathological features. Methods This cases-control study was carried out to assess the serum levels of TNF-α and IL-6 in 70 NMSC patients, in comparison with 30 healthy individuals, by means of flow cytometric bead-based immuneoassay. Results Serum levels of both TNF-α and IL-6 were significantly higher in NMSC patients (6.470 vs. 4.355 pg/ml; p = 0.0468, respectively), compared to healthy individuals (3.205 vs. 0.000 pg/ml; p = 0.0126, respectively). In the subgroup analysis, squamous cell carcinomas patients had higher serum levels of IL-6 compared to healthy individuals (3.445 vs. 0.000 pg/ml; p = 0.0432). No other significant differences were observed in the serum levels of these two cytokines among different clinicopathological subgroups of the patients. Conclusion The increased levels of TNF-α and IL-6 in NMSC patients can be introduced as an epiphenomenon of a complex cancer-induced cytokine cascade.

Background To strengthen health systems, the shortage of physicians globally needs to be addressed. However, efforts to increase the numbers of physicians must be balanced with controls on medical education imparted and the professionalism of doctors licensed to practise medicine. Methods We conducted a multi-country comparison of mandatory regulations and voluntary guidelines to control standards for medical education, clinical training, licensing and re-licensing of doctors. We purposively selected seven case-study countries with differing health systems and income levels: Canada, China, India, Iran, Pakistan, UK and USA. Using an analytical framework to assess regulations at four sequential stages of the medical education to relicensing pathway, we extracted information from: systematically collected scientific and grey literature and online news articles, websites of regulatory bodies in study countries, and standardised input from researchers and medical professionals familiar with rules in the study countries. Results The strictest controls we identified to reduce variations in medical training, licensing and re-licensing of doctors between different medical colleges, and across different regions within a country, include: medical education delivery restricted to public sector institutions; uniform, national examinations for medical college admission and licensing; and standardised national requirements for relicensing linked to demonstration of competence. However, countries analysed used different combinations of controls, balancing the strictness of controls across the four stages. Conclusions While there is no gold standard model for medical education and practise regulation, examining the combinations of controls used in different countries enables identification of innovations and regulatory approaches to address specific contextual challenges, such as decentralisation of regulations to sub-national bodies or privatisation of medical education. Looking at the full continuum from medical education to licensing is valuable to understand how countries balance the strictness of controls at different stages. Further research is needed to understand how regulating authorities, policy-makers and medical associations can find the right balance of standardisation and context-based flexibility to produce well-rounded physicians.

It is estimated that up to 70% of the health workforce are women; however, this pattern is not reflected in the leadership of health systems where women are under-represented. In this review, Zeinali et al. explore the literature around women’s leadership in the health sector in low- and middle-income countries using an intersectionality lens. The authors uncover four main intersecting themes across the reviewed studies and call for looking beyond gender and taking other intersecting social identities that create unique positionalities of privilege and/or disadvantage into account. This approach should be adopted across a diverse range of health systems programs and policies in an effort to strengthen gender equity in health and specifically human resources for health, and improve health systems governance, functioning and outcomes.

Phenylketonuria (PKU) is an inborn error of amino acid metabolism caused by mutations in the phenylalanine hydroxylase (PAH) gene, characterized by intellectual deficit and neuropsychiatric complications in untreated patients with estimated frequency of about one in 10,000 to 15,000 live births. PAH deficiency can be detected by neonatal screening in nearly all cases with hyperphenylalaninemia on a heel prick blood spot. Molecular testing of the PAH gene can then be performed in affected family members. Herein, we report molecular study of 635 patients genetically diagnosed with PKU from all ethnicities in Iran. The disease-causing mutations were found in 611 (96.22%) of cases. To the best of our knowledge, this is the most comprehensive molecular genetics study of PKU in Iran, identifying 100 distinct mutations in the PAH gene, including 15 previously unreported mutations. Interestingly, we found unique cases of PKU with uniparental disomy, germline mosaicism, and coinheritance with another Mendelian single-gene disorder that provides new insights for improving the genetic counseling, prenatal diagnosis (PND), and/or pre-implantation genetic diagnosis (PGD) for the inborn error of metabolism group of disorders.

There has been a welcome emphasis on gender issues in global health in recent years in the discourse around human resources for health. Although it is estimated that up to 75% of health workers are female (World Health Organization, Global strategy on human resources for health: Workforce 2030, 2016), this gender ratio is not reflected in the top levels of leadership in international or national health systems and global health organizations (Global Health 50/50, The Global Health 50/50 report: how gender responsive are the world’s leading global health organizations, 2018; Clark, Lancet, 391:918–20, 2018). This imbalance has led to a deeper exploration of the role of women in leadership and the barriers they face through initiatives such as the WHO Global Strategy on Human Resources for Health: Workforce 2030, the UN High Level Commission on Health Employment and Economic Growth, the Global Health 50/50 Reports, Women in Global Health, and #LancetWomen. These movements focus on advocating for increasing women’s participation in leadership. While efforts to reduce gender imbalance in global health leadership are critical and gaining momentum, it is imperative that we look beyond parity and recognize that women are a heterogeneous group and that the privileges and disadvantages that hinder and enable women’s career progression cannot be reduced to a shared universal experience, explained only by gender. Hence, we must take into account the ways in which gender intersects with other social identities and stratifiers to create unique experiences of marginalization and disadvantage.

The essential work of fracture (EWF) method is gaining attention for the toughness evaluation of ductile polymers. However its establishment as a toughness criteria requires that the parameters influencing it and their extent of influence be identified. In the current study the effect of the loading rate on the EWF of pure polypropylene (PP) is investigated. Tensile tests are performed at room temperature on DENT samples with ligament lengths of 7 to 15 mm at loading rates of 2 to 32 mm/min. The results confirm the dependency of the EWF on the loading rate, though a regular trend is not observed. The nonregularity of the EWF on the loading rate is explained by the ligament dependency of the loading rate effect on the specific work of fracture. This study reveals that the similarity of the ligament lengths and loading rate are necessities to yielding comparable values of the EWF.

Thermal conductivity of silicon nanowires (SiNWs) is evaluated using the reverse nonequilibrium molecular dynamics simulation. The Stillinger–Weber (SW) and Tersoff interatomic potentials are employed to simulate thermal conductivity of SiNWs. In this work, the influence of random vacancy defects, axial strain, temperature and length on thermal conductivity and effective mean free path of SiNWs is investigated. It is found that by raising the percent of random vacancy defects, thermal conductivity of SiNWs decreases linearly for the results obtained form SW potential and nonlinearly for those obtained from Tersoff interatomic potential. Dependence of the thermal conductivity on axial strain is also studied. Results show that thermal conductivity increases as compressive strain increases and decreases as tensile strain increases. Influence of temperature is also predicted. It is found that the thermal conductivity of SiNWs decreases with increasing the mean temperature. Most of the simulations are performed for 4 UC×4 UC×40 UC silicon nanowires using ssp boundary condition.

A total number of 149 individuals from Iran (Persians, Lurs and Kurds) were analyzed for 49 autosomal SNPs using PCR, SBE and capillary electrophoresis. No deviation from Hardy–Weinberg expectations was observed. One SNP pair (rs1015250–rs251934) showed significant linkage disequilibrium in Kurds. However, this was most likely due to chance. High intrapopulation variability and no significant population structure were observed among the three ethnic groups from Iran. Pairwise F ST values obtained from the mean numbers of pairwise differences between SNP profiles were calculated for Persians, Lurs, Kurds and eighteen other worldwide populations. For each of the three Iranian ethnic groups, the lowest F ST values calculated between an Iranian and non-Iranian populations were observed between Iranians and populations in Iraq and Turkey. The three Iranian ethnic groups grouped together with other West Asian populations in the MDS plot drawn from the F ST values. Statistical parameters of forensic interest calculated for the Iranian ethnic groups showed values of the same order of magnitudes as those obtained for Asians. The mean match probability calculated for the 49 SNPs ranged from 1.7x10 −18 for Kurds to 1.3x10 −19 for Persians. Despite the low level of genetic structure observed among Persians, Lurs and Kurds, a single autosomal SNP database should be used with care when extending its forensic application to other Iranian ethnic groups.

Objective: Determination of parents to avoid giving birth to a child with any anomalies has increased the demand for prenatal diagnosis. Two most important criteria of any prenatal diagnosis procedure are accuracy, and speed. They have to minimize burden and anxiety for families. One of the main tests requested during pregnancies is testing for chromosomal abnormalities. This study was carried out with the aim of investigating the use of a rapid diagnosis test for detecting chromosomal numerical aneuploidy in blood and fetal samples, and also to compare the outcomes with cytogenetic method. Materials and methods: In this study, 100 samples from high risk pregnancies or affected individuals, comprising 12 chorionic villi (CV), 43 amniotic fluids (AF) and 45 blood samples were analyzed by QF-PCR. The samples were amplified using the specific microsatellite markers (STRs) for chromosomes X, Y, 13, 18 and 21. The sample analysis was performed based on the peak type of the PCR products, and the results were compared with the cytogenetic findings. Results: In total 26 samples were normal and 74 were diagnosed as aneuploids. Eight sex chromosome aberrations (three 45, X; three 47, XXY; one 47, XXX and one 46, XY (female phenotype), 65 numerical aberrations of X, Y, 13, 18 and 21 chromosomes and one triploidy were recognized. The QF-PCR data were compared with the karyotype results and showed complete concordance. Conclusion: This study showed that QF-PCR method is definitely superior, due to its advantages and few drawbacks in diagnosis of numerical chromosomal aberrations. Low costs and high speed of analysis as well as its automaticity are among the most important advantages of this method. Considering more than 99.4% accuracy of the QF-PCR method (compared with cytogenetics) and the time required to do cytogenetic analysis, QF-PCR is the method of choice for aneuploidy testing.

Goals: IORT is an accepted standard treatment for early stages of breast cancer in selected cases. This is proven in two large trials: ELIOTandTARGIT-AbasedonelectronhighvoltagebeamandlowkV X-ray energy respectively. Methods: Published results of the two trials aimed to evaluating local recurrence as the final outcome. In this study these results were compared with each other. Results: In the ELIOT study the local recurrence rate is 4/4% versus 0.4% in patients who received IORT and EBRT, in comparison to 3.2% and 1.3% in the TARGIT-A trial; these differences needs to be under more consideration regarding the efficacy and beneficenceofIORT.Herebywearegoingtoanalyzethedataofthese two trials to confirm the strategy of IORT in breast cancer as boost or radical modalities. Patient selection according to classification of ASTRO or ESTRO guidelines confirmed the local recurrence rate of IOERT (ELIOT) in low risk patients similar to TARGIT decrease to less than 1.9%. Conclusion: Statistical analysis revealed that in patients of both trials with matching clinical, pathological and biological profile for both methods, the radical IORT using electron and low kV X-ray are effective and acceptable. It seems in patients with low risk factors, IORT is more effective than EBRT. We compared ELIOT and TARGIT-A trial documents and found all of similarity and difference and referred to these two trials recommending using IORT for selected cases of breast cancer with at least non inferiority in DFS, OS, with superiority in cosmetic, non breast death and more.

The aim of this paper is to investigate the relationship of innovation control factors such as total quality management (TQM) with innovation performance in a manufacturing company. For this purpose, a survey-based investigation has been conducted in Isfahan Steel Company, in which 63 managers and supervisors have participated. House of quality (HoQ) has been used for analysing the relationship between TQM and innovation performance. The findings imply that among TQM factors, continuous improvement and team working have the first and the last priorities, respectively regarding their major influences on innovation performance.