“Do my Roma and non-Roma patients need different care?” A brief step-by-step guideline for clinical practitioners

Improving the mental health of Roma through research and policies that cross multiple social sectors

The integration of primary care and public health to improve population health: tackling the complex issue of multimorbidity

Romani maternal and child health: moving from documenting disparities to testing progress and interventions to achieve equity

How community resources mitigate the association between household poverty and the incidence of adverse childhood experiences Abstract Objectives To assess what proportion of the association between household low income and incidence of adverse childhood experiences (ACE) would be eliminated if all households had access to housing, transportation and childcare services, breastfeeding counselling, and parks. Methods Using Growing Up in Scotland birth cohort data (N = 2816), an inverse probability-weighted regression-based mediation technique was applied to assess associations between low-income status (< £11,000 in 2004/5), resource access, and cumulative 8-year ACE incidence (≥ 1, ≥ 3 ACEs). Resource access was measured based on households’ self-reported difficulties (yes/no) in accessing housing, transportation, childcare, and breastfeeding counselling, and park proximity (within 10 min from the residence). Results The protective effects of resources were heterogeneous. Only access to transportation was associated with lower ACE incidence in both low- and higher-income households. If all had access to transportation, 21% (95% CI 3%, 41%) of the income-based inequality in incidence of 3 or more ACEs could be eliminated. Conclusions While second best to the elimination of child poverty, measures to improve families’ access to community resources such as transportation may mitigate the effects of poverty on ACE incidence.

Excess burden of a chronic disabling condition: life lost due to traumatic spinal cord injury in a Swiss population-based cohort study Abstract Objectives To estimate excess mortality and life years lost in a Swiss cohort of individuals with traumatic spinal cord injury (TSCI). Methods This study uses population-based data collected in the Swiss Spinal Cord Injury Cohort (SwiSCI) study, which covers all specialized rehabilitation centres. Flexible parametric survival models were used to model life years remaining (LYR), potential years life lost (PYLL), relative survival and excess hazard ratios. Results Men and women with TSCI and an attained age of 30 were estimated to have 42 LYR (95% CI = 37.9–45.5) and 43 LYR (95% CI = 40.1–45.5), respectively; this equates to a life expectancy (LE) of 80.6 and 76.9% of that of the Swiss general population. With respect to lesion level and completeness, persons with incomplete paraplegia had 45.1 LYR at an attained age of 30, whereas individuals with complete tetraplegia only had 28.7 LYR. This pattern was similar for PYLL. Conclusions The extended LE following TSCI, even for the most severe lesions, underscores the need for sustained follow-up to support functioning and health for individuals ageing with SCI.

Mammographic densities of Aboriginal and non-Aboriginal women living in Australia’s Northern Territory Abstract Objectives To compare the mammographic densities and other characteristics of Aboriginal and non-Aboriginal women screened in Australia. Methods Population screening programme data of Aboriginal (n = 857) and non-Aboriginal women (n = 3236) were used. Mann–Whitney U test compared ages at screening and Chi-square tests compared personal and clinical information. Logistic regression analysis was used for density groupings. OR and 95% CI were calculated for multivariate association for density. Results Mammographic density was lower amongst Aboriginal women (P < 0.001). For non-Aboriginal women, higher density was associated with younger age (OR 2.4, 95% CI 2.1–2.8), recall to assessment (OR 2.2, 95% CI 1.6–3.0), family history of breast cancer (OR 1.4, 95% CI 1.2–1.6), English-speaking background (OR 1.4, 95% CI 1.2–1.6), and residence in remote areas (OR 1.2, 95% CI 1.1–1.4). For Aboriginal women, density was associated with younger age (OR 2.7, 95% CI 2.0–3.5; P < 0.001), and recall to assessment (OR 2.3, 95% CI 1.4–3.9; P < 0.05). Conclusions Significant differences between Aboriginal and non-Aboriginal women were found. There were more significant associations for dense breasts for non-Aboriginal women than for Aboriginal women.

Are socio-economic inequalities in diet and physical activity a matter of social distinction? A cross-sectional study Abstract Objectives To explore whether ‘distinction’, a well-known mechanism that produces and reproduces social inequalities, can explain the socio-economic gradient in healthy diet and physical activity in contemporary obesogenic environments. If this is the case, we would expect a well-established indicator of distinction, ‘highbrow’ cultural participation, to be associated with a healthy diet and physical activity, while adjusting for education and income. Methods Data from participants (25–75 years) of the 2014 wave of the Dutch GLOBE study (N = 2812) were used to analyse the association between ‘highbrow’ cultural participation (e.g. annual frequency of visits to museums, ballet, concerts, theatre) and sports participation, leisure-time walking and cycling, and fruit and vegetable intake, adjusted for education, income and other confounders. Results Both highbrow cultural participation and healthy behaviours were more prevalent among high educational groups. Cultural participation was strongly associated with all health behaviours, even when adjusted for education and income. Conclusions Our findings suggest that health behaviours, similar to highbrow cultural participation, are adopted as an expression of social distinction. This distinction mechanism may be an important determinant of health behaviour inequalities.

Behavioral interventions promoting HIV serostatus disclosure to sex partners among HIV-positive men who have sex with men: a systematic review Abstract Objectives This review aimed to identify intervention components which were effective to promote disclosure of HIV status among men have sex with men (MSM) living with HIV, particularly from a theoretical perspective. Methods A systematic review was performed through searching electronic databases, HIV-related conferences websites, and registered ongoing randomized controlled trials. Studies were included if they reported intervention evaluation results related to HIV disclosure and published before December 31, 2017. Two independent reviewers collected studies and extracted data. Results Eight studies met the inclusion criteria and were summarized. Interventions appeared effective in promoting HIV disclosure to their sex partners among MSM living with HIV if they were theory based (e.g., consequence theory and social cognitive theory). Key elements of effective interventions consisted of increasing disclosure self-efficacy, highlighting disclosure benefits, assisting risk assessment, developing disclosure strategy, and using messages under social influence. Conclusions Findings of this review imply that future interventions are more likely to succeed if they apply consequence theory, social cognitive theory, and trans-theoretical model of behavior change and include multiple key intervention components.

Variation in colorectal cancer testing between primary care physicians: a cross-sectional study in Switzerland Abstract Objectives To determine the proportion of 50–75-year-old patients who visit a primary care physician’s (PCP) office and were tested for colorectal cancer (CRC) by either colonoscopy within 10 years or fecal occult blood testing (FOBT) within 2 years. To describe the variation in care between PCPs and factors associated with these proportions. Methods Cross-sectional data collected between April and December 2017. Participants: PCPs reporting for the Swiss Sentinel Surveillance Network. Each PCP collected demographic data and CRC testing status from 40 consecutive patients. Measurements: proportions of patients up to date with CRC screening and method used (colonoscopy/FOBT/Other); variation in the outcome measures between PCPs; association of physician-level factors with main outcomes. Results 91/129 PCPs collected data from 3451 patients; 45% had been tested for CRC within recommended intervals (41% colonoscopy, 4% FOBT). The proportions of patients tested and testing with colonoscopy versus FOBT varied widely between PCPs. Language region was associated with PCPs’ rate of FOBT prescription. Conclusions Less than half of patients who visited PCPs in Switzerland were tested for CRC within recommended intervals. PCPs varied widely in their testing practices.