[Influence of the social deprivation index on outcomes during the COVID-19 pandemic]. / Influencia del índice de privación social en resultados durante la pandemia de COVID-19.

OBJECTIVE: To see the relationship between the population deprivation index and the use of the health services, adverse evolution and mortality during the COVID-19 pandemic. METHOD: Retrospective cohort study of patients with SARS-CoV-2 infection from March 1, 2020 to January 9, 2022. The data collected included sociodemographic data, comorbidities and prescribed baseline treatments, other baseline data and the deprivation index, estimated by census section. Multivariable multilevel logistic regression models were performed for each outcome variable: death, poor outcome (defined as death or intensive care unit), hospital admission, and emergency room visits. RESULTS: The cohort consists of 371,237 people with SARS-CoV-2 infection. In the multivariable models, a higher risk of death or poor evolution or hospital admission or emergency room visit was observed within the quintiles with the greatest deprivation compared to the quintile with the least. For the risk of being hospitalized or going to the emergency room, there were differences between most quintiles. It has also been observed that these differences occurred in the first and third periods of the pandemic for mortality and poor outcome, and in all due for the risk of being admitted or going to the emergency room. CONCLUSIONS: The groups with the highest level of deprivation have had worse outcomes compared to the groups with lower deprivation rates. It is necessary to carry out interventions that minimize these inequalities.

Vulnerabilidad e interdependencia ante la pandemia de la COVID-19

La pandemia de la COVID-19, declarada por la OMS en marzo de 2020, reclama una atención específica al fenómeno de la vulnerabilidad. La pandemia ha puesto de manifiesto la vulnerabilidad ontológica compartida por todos los seres humanos, pero también la forma en que las desigualdades socioeconómicas inciden en la distribución inequitativa de vulnerabilidades específicas o situacionales. Por otra parte, también ha hecho presente la profunda interdependencia que compartimos entre todas las personas, que se extiende también a agentes no humanos y al medio ambiente. En este artículo se presenta un análisis general de la vulnerabilidad en el contexto de la COVID-19, proponiendo, en concreto, que se trata de una categoría adecuada para analizar la esencial interdependencia del ser humano con sus congéneres, con los demás seres vivos y con el medio ambiente.Alternate : The COVID-19 pandemic, declared in March of 2020 by the WHO, requires specific attention to the phenomenon of vulnerability. The pandemic made the ontological vulnerability manifest that all human beings share. Still, it also made the ways apparent in which socio-economical inequalities result in the unequal distribution of specific or circumstantial vulnerabilities. On the other hand, it also showed the profound interdependency we share with all these persons, extending to no human agents and the environment. This article presents a general analysis of vulnerability in the context of COVID-19. It suggests in particular that it constitutes an adequate category for analysing the essential interdependency of the human being with his fellow human beings, the other living creatures and the environment.

Impact of the social determinants of health on the rate of infections by COVID-19 / Impacto de los determinantes sociales de la salud sobre la tasa de contagios por COVID-19

RESUMEN Objetivo Analizar el impacto entre los determinantes sociales en salud en México y la tasa de contagios por COVID-19. Método Estudio ecológico cuantitativo a nivel nacional y municipal. Las principales variables fueron tasa de contagios por COVID-19, población total no hablante de español, ingreso per cápita, pobreza e índice de desarrollo humano (IDH). La tasa media nacional de contagios fue de 2 880/100 000 habitantes. Se aplicó la prueba T-test y, para determinar la fuerza de asociación entre la tasa de contagios y las variables, se aplicó la prueba de correlación de Pearson. Resultados Las entidades con menos tasa de población no hablante de español tuvo la menor tasa de contagios por COVID-19. El análisis de correlación mostró que los estados con tasas de contagio por COVID-19 por arriba de la media nacional tienen mejores condiciones de desarrollo. Discusión En nuestros resultados se revela una correlación negativa entre las tasas contagios por COVID-19 y la variable pertenecer a población indígena. Es necesario analizar desde la perspectiva de las comunidades las necesidades para afrontar escenarios de pandemia.

ABSTRACT Objective To analyze the impact between the social determinants in health and the rate of COVID-19 infection. Methods Quantitative ecological study at national and municipal levels. The main variables were COVID-19 infection rate, total non-Spanish-speaking population, per capita income, poverty, and human development index (HDI). The average national infection rate was 2 880/100 000 inhabitants. The T-test was applied, and Pearson's correlation test was performed to determine the strength of the association between the infection rate and the variables. Results Entities with the lowest rate of non-Spanish-speaking population had the lowest rate of COVID-19 infections. The correlation analysis showed that states with COVID-19 infection rates above the national average have better development conditions. Discussion Our results reveal a negative correlation between COVID-19 infection rates and the variable belonging to an indigenous population. It is necessary to analyze from the perspective of the communities the needs to face pandemic scenarios.

[Impact of COVID-19 lockdown on self-perceived health in Chile by gender]. / Impacto del confinamiento por la COVID-19 en la salud autopercibida en Chile según género.

OBJECTIVE: To analyse the social factors associated with self-perceived health during the COVID-19 lockdown in the Chilean resident population according to gender perspective. METHOD: Cross-sectional study conducted during the COVID-19 lockdown between May 17 and August 17, 2020 with an online survey. Self-perceived health was analysed in the population aged 18 years or older in relation to social variables. Multivariate logistic regression models were constructed to assess the association between independent variables with self-perceived health, through adjusted odds ratio (aOR). Analyses were stratified by sex (M: men; W: women). RESULTS: 5981 persons were analysed (women: 63.9%). 29.6% of women and 19.2% of men reported poor self-perceived health. In women it worsens with increasing age. Worse self-perceived health was mainly associated with lack of social support (ORa M: 2.05; ORa W: 2.34), concern about living together at home (ORa M: 1.66; ORa W: 1.38), perceived inadequate housing conditions (ORa M: 1.89; ORa W: 2.63), and disagreement with government measures (ORa M: 2.80; ORa W: 1.82). In women, it was also associated with informal work or being inactive in the labour market (ORa: 2.11). In men worse self-perceived health was associated with being self-employed (ORa: 1.65; confidence interval [CI]: 1.11-2.45) and has secondary education (ORa: 2.81; CI: 1.32-5.98). CONCLUSIONS: The social impact of lockdown in self-perceived health is related to gender, age, care work, and socioeconomic conditions, as well as, by disagreement with the measures implemented to manage the pandemic.

Inequities in the distribution of COVID-19: an adaptation of WHO's conceptual framework.

The COVID-19 pandemic currently affects populations worldwide. Although everyone is susceptible to the virus, there are numerous accounts of the pandemic having a greater impact on lower socioeconomic groups and minorities, which is a ubiquitous phenomenon. It is essential for public health administrations and governments to uncover and understanding these inequities to develop proper intersectoral policies to tackle this crisis. Therefore, developing a conceptual framework on this topic, describing the social mechanisms that explain the unjust distribution of the incidence and mortality of COVID-19, is a key task. The aim of this paper is to adapt the framework on social determinants of health from the World Health Organization to the specifics of COVID-19 pandemic. Thus, it identifies and explains the structural and intermediate determinants involved in this pandemic, and adds some new elements (such as the role of the oppression systems and communication) which may help to understand, and ultimately tackle, social inequities in COVID-19 distribution.

Social determinants of health associated with severity and mortality in patients with COVID-19.

INTRODUCTION: Historically, pandemics have resulted in higher mortality rates in the most vulnerable populations. Social determinants of health (SDH) have been associated with people morbidity and mortality at different levels. OBJECTIVE: To determine the relationship between SDH and COVID-19 severity and mortality. METHODS: Retrospective study, where data from patients with COVID-19 were collected at a public hospital in Chile. Sociodemographic variables related to structural SDH were classified according to the following categories: gender, age (< 65 years, ≥ 65 years), secondary education (completed or not), work status (active, inactive) and income (< USD 320, ≥ USD 320). RESULTS: A total of 1,012 laboratory-confirmed COVID-19 cases were included. Average age was 64.2 ± 17.5 years. Mortality of the entire sample was 14.5 %. Age, level of education, unemployment and income had a strong association with mortality (p < 0.001). CONCLUSIONS: The findings reinforce the idea that SDH should be considered a public health priority, which is why political efforts should focus on reducing health inequalities for future generations.

INTRODUCCIÓN: Históricamente, las pandemias han tenido como resultado tasas de mortalidad más altas en las poblaciones más vulnerables. Los determinantes sociales de la salud (DSS) se han asociado a la morbimortalidad de las personas en diferentes niveles. OBJETIVO: Determinar la relación entre los DSS, la severidad de COVID-19 y la mortalidad por esta enfermedad. MÉTODOS: Estudio retrospectivo en el que se recolectaron datos de pacientes con COVID-19 en un hospital público de Chile. Las variables sociodemográficas relacionadas con los DSS estructurales se clasificaron según las siguientes categorías: sexo, edad (< 65 años, ≥ 65 años), educación secundaria (completada o no), condición de trabajo (activo, inactivo) e ingreso económico (< USD 320, ≥ USD 320). RESULTADOS: Fueron incluidos 1012 casos con COVID-19 confirmados por laboratorio. La edad promedio fue de 64.2 ± 17.5 años. La mortalidad de la muestra total fue de 14.5 %. La edad, nivel educativo, desempleo e ingresos tuvieron fuerte asociación con la mortalidad (p < 0.001). CONCLUSIONES: Los hallazgos refuerzan la idea de que los DSS deben considerarse una prioridad de salud pública, por lo que los esfuerzos políticos deben centrarse en reducir las desigualdades en salud para las generaciones futuras.

[COVID-19 on migrants and ethnic minorities]. / COVID-19 en migrantes y minorías étnicas.

There are still few publications that analyse the effects on migrants or ethnic minorities of COVID-19 or of measures taken to curb this pandemic, although early studies point to a greater impact on black, asian and ethnic minority populations in the UK or on migrants in Mexico. In addition to barriers to access to information and health services, we consider it a priority to focus on their living conditions, particularly those in situations of vulnerability or social exclusion. People who are unemployed or with precarious jobs, without social benefits, in overcrowded conditions, may be more at risk of infection and not receiving adequate treatment. Confinement has predictably more negative impact on migrants in irregular administrative situations, victims of gender-based violence and those unable to comply with physical estrangement measures, such as refugees in camps or migrants under-living and settlements, without adequate hygienic conditions. Recommendations such as suspending deportations, extending or facilitating residence and work permits, closing detention centres for foreign persons, evacuating those in prisons and refugee camps or settlements have been applied unequally in different countries. Only a strong political commitment to global health equity can ensure the health of migrant populations and ethnic minorities, as well as their access to protection measures, information, medical testing and health services.Keywords: Migrants, COVID-19, Minority Groups, Vulnerable Populations, Social Determinants of Health.

Gyms and exercising in the fight against covid-19: reflections on the social determination of the health-disease process / Academias de ginástica e exercícios físicos no combate à covid-19: reflexões a partir da determinação social do processo saúde-doença / Gimnasios y ejercicios físicos en la lucha contra el covid-19: reflexiones a partir de la determinación social del proceso salud-enfermedad

Resumo O objetivo deste artigo é explicitar as contradições da defesa dos serviços oferecidos pelas academias de ginástica como essenciais à saúde em momentos de intensificação de casos da Covid-19. Analisou-se o modo como a concepção hegemônica que relaciona exercício físico e saúde é utilizada para justificar a reabertura destes estabelecimentos em momento de ascensão de casos e óbitos. Buscamos evidenciar como esse discurso assume um caráter ideológico. Apesar de ser uma necessidade, o exercício físico, produzido como mercadoria, apresenta seu valor de uso subsumido ao valor de troca, ou seja, é produzido prioritariamente para responder à necessidade de acumulação de capital. Reiteramos nossa concordância com a importância do exercício físico à saúde, mas problematizamos que deve ser considerado como uma necessidade historicamente produzida, portanto, articulada à particularidade de determinado momento histórico.

Abstract The purpose of this article is to explain the contradictions when services provided by gyms are advocated as essential to health in times of the COVID-19 pandemic. We analyzed how the hegemonic conception that links exercise and health was used to justify the reopening of these establishments when cases and deaths are on the rise. We seek to show how this discourse takes on an ideological character. While exercising is necessary, as a commodity its value is subsumed under its exchange value, that is, it is produced primarily to respond to capital accumulation needs. We reiterate our agreement with the importance of exercising to health, but we question the universal character ascribed to it without considering it as a historically produced need and therefore linked to the specifics of a given historical time.

Resumen El propósito de este artículo es explicitar las contradicciones existentes en la postura de defender los servicios que ofrecen los gimnasios como esenciales para la salud en momentos de intensificación de los casos de COVID-19. Se analizó la forma en que la concepción hegemónica que relaciona ejercicio físico y salud es utilizada para justificar la reapertura de estos establecimientos en momentos de aumento de casos y fallecimientos. Buscamos mostrar que este discurso adquiere un carácter ideológico. A pesar de ser una necesidad, el ejercicio físico, producido en forma de mercancía, presenta su valor de uso subsumido en el valor de cambio, es decir, se produce prioritariamente para responder a la necesidad de acumulación de capital. Reiteramos que estamos de acuerdo con la importancia del ejercicio físico para la salud, pero problematizamos que debe ser considerado como una necesidad históricamente producida y, por tanto, vinculada a la particularidad de un determinado momento histórico.

Pandemic and immigration: haitian families facing COVID-19 in Brazil / Pandemia e imigração: famílias haitianas no enfrentamento da COVID-19 no Brasil / Pandemia e inmigración: familias haitianas que enfrentan COVID-19 en Brasil

Objetivo: compreender a vivência do enfrentamento e repercussões da COVID-19 na perspectiva das famílias de imigrantes haitianos no Brasil. Método: estudo qualitativo, do tipo ação-participante, fundamentado no Itinerário de Pesquisa de Paulo Freire, que possui três fases: Investigação Temática; Codificação e Descodificação; Desvelamento Crítico. Foi realizado Círculo de Cultura Virtual em maio de 2020, com 10 famílias de imigrantes haitianos, residentes no oeste de Santa Catarina. Resultados: os participantes discutiram preocupações geradas no enfrentamento da pandemia: trabalho e subsistência da família no Brasil e no Haiti; incerteza do futuro; risco de contaminação e de morrer no Brasil; cancelamento das aulas dos filhos; desânimo e solidão. Desvelaram oportunidades na vivência da pandemia: ajuda recebida; força pessoal e familiar; repensar a vida; confiança em Deus e esperança. Conclusões e implicações para a prática: os imigrantes haitianos se encontram em situação de vulnerabilidade social, econômica e de saúde mental no enfrentamento da COVID-19. A identificação dessa vulnerabilidade, considerando fatores sociais, econômicos e culturais é fundamental à proposição de políticas públicas e adoção de estratégias efetivas de enfrentamento da situação. O Círculo de Cultura Virtual amplia possibilidades para a enfermagem, pois possibilita as interações necessárias à promoção da saúde, mesmo diante da pandemia

Objective: to understand the experience of coping and repercussions of COVID-19 from the perspective of Haitian immigrant families in Brazil. Method: qualitative, action-participant study, based on Paulo Freire's Research Itinerary, which has three phases: Thematic Research; Encoding and Decoding; Critical Unveiling. A Virtual Culture Circle was held in May 2020, with 10 families of Haitian immigrants residing in western Santa Catarina. Results: the participants discussed concerns generated in facing the pandemic: work and family subsistence in Brazil and Haiti; uncertainty of the future; risk of contamination and dying in Brazil; cancellation of children's classes; discouragement and loneliness. They revealed opportunities in experiencing the pandemic: help received; personal and family strength; rethinking life; trust in God and hope. Conclusions and implications for practice: Haitian immigrants are in a situation of social, economic and mental health vulnerability when facing COVID-19. The identification of this vulnerability considering social, economic and cultural factors is fundamental to the proposition of public policies and the adoption of effective strategies to face the situation. The Virtual Culture Circle expands possibilities for nursing, as it enables the interactions necessary for health promotion, even in the face of the pandemic

Objetivo: comprender la experiencia de afrontamiento y las repercusiones de COVID-19 desde la perspectiva de las familias de inmigrantes haitianos en Brasil. Método: estudio cualitativo, de tipo acción-participante, basado en el Itinerario de Investigación de Paulo Freire, que tiene tres fases: Investigación temática; Codificación y decodificación; Revelación crítica. En mayo de 2020 se realizó un Círculo de Cultura Virtual, con 10 familias de inmigrantes haitianos que residen en el oeste de Santa Catarina. Resultados: los participantes discutieron las preocupaciones generadas al enfrentar la pandemia: el trabajo y la subsistencia familiar en Brasil y Haití; la incertidumbre del futuro; el riesgo de contaminación y muerte en Brasil; la cancelación de las clases infantiles; el desánimo y la soledad. Revelaron oportunidades en la experiencia de la pandemia: la ayuda recibida; fortaleza personal y familiar; el repensar la vida; la confianza en Dios y la esperanza. Conclusiones e implicaciones para la práctica: los inmigrantes haitianos se encuentran en una situación de vulnerabilidad social, económica y de salud mental en la confrontación de COVID-19. La identificación de esta vulnerabilidad, considerando los factores sociales, económicos y culturales es fundamental para la propuesta de políticas públicas y la adopción de estrategias efectivas para enfrentar la situación. El Círculo de Cultura Virtual amplía las posibilidades de la enfermería, ya que permite las interacciones necesarias para la promoción de la salud, incluso ante la pandemia

COVID-19 Interconnectedness: Health Inequity, the Climate Crisis, and Collective Trauma.

The COVID-19 pandemic brings to the forefront the complex interconnected dilemmas of globalization, health equity, economic security, environmental justice, and collective trauma, severely impacting the marginalized and people of color in the United States. This lack of access to and the quality of healthcare, affordable housing, and lack of financial resources also continue to have a more significant impact on documented and undocumented immigrants. This paper aims at examining these critical issues and developing a framework for family therapists to address these challenges by focusing on four interrelated dimensions: cultural values, social determinants of health, collective trauma, and the ethical and moral responsibility of family therapists. Given the fact that family therapists may unwittingly function as the best ally of an economic and political system that perpetuates institutionalized racism and class discrimination, we need to utilize a set of principles, values, and practices that are not just palliative or after the fact but bring forth into the psychotherapeutic and policy work a politics of care. Therefore, a strong call to promote and advocate for the broader continuum of health and critical thinking preparing professionals to meet the challenges of health equity, as well as economic and environmental justice, is needed. The issues discussed in this paper are specific to the United States despite their relevance to family therapy as a field. We are mindful not to generalize the United States' reality to the rest of the world, recognizing that issues discussed in this paper could potentially contribute to international discourse.

La pandemia de la COVID-19 ha puesto en primer plano los dilemas complejos e interconectados de la globalización, la equidad sanitaria, la seguridad económica, la justicia ambiental y el trauma colectivo, afectando gravemente a las personas marginadas y de color de los Estados Unidos. Esta falta de acceso a asistencia sanitaria de calidad, a viviendas asequibles, y la falta de recursos económicos también continúan teniendo un efecto más significativo en los inmigrantes documentados e indocumentados. Este artículo tiene como finalidad analizar estas cuestiones críticas y desarrollar un marco para que los terapeutas familiares aborden estas dificultades centrándose en cuatro dimensiones interrelacionadas: valores culturales, determinantes sociales de salud, trauma colectivo, y responsabilidad ética y moral de los terapeutas familiares. Teniendo en cuenta el hecho de que los terapeutas familiares pueden funcionar inconscientemente como los mejores aliados de un sistema económico y político que perpetúa el racismo institucionalizado y el clasismo, necesitamos utilizar un conjunto de principios, valores y prácticas que no sea solo paliativo o a posteriori, sino que genere en el trabajo político y psicoterapéutico una política de asistencia. Por lo tanto, es necesario un reclamo firme de promover y abogar por un continuo más amplio de la salud y un pensamiento crítico que prepare a los profesionales para responder a las dificultades de la equidad sanitaria, así como de la justicia económica y ambiental, si fuera necesario. Las cuestiones tratadas en este artículo son específicas de los Estados Unidos a pesar de su relevancia para la terapia familiar como área. Somos conscientes de no generalizar la realidad de los Estados Unidos para el resto del mundo, y reconocemos que las cuestiones tratadas en este artículo podrían contribuir al discurso internacional.