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Wasser LM, Bear TM, Sommers M, Cassidy J, Muir KW, Williams AM. Barriers to Care Among Glaucoma Patients With a Missed Appointment and Interest in a Navigator Program. J Glaucoma 2024; 33:297-302. [PMID: 37974342 PMCID: PMC10954418 DOI: 10.1097/ijg.0000000000002330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/15/2023] [Indexed: 11/19/2023]
Abstract
PRCIS Most glaucoma patients with missed appointments report barriers to care and social risk factors. One third expressed interest in engaging with a patient navigator program. Most expressed interest in rescheduling. PURPOSE The purpose of this study was to identify barriers to care among glaucoma patients with missed appointments and to assess their interest in a patient navigator program. MATERIAL AND METHODS A cross-sectional study involving adult glaucoma patients from an academic eye center who missed their scheduled appointment between April 18 and July 25, 2022. Participants were surveyed about reasons for missed appointments, barriers to care, social risk factors, and interest in consulting with our patient navigator program. RESULTS Of 172 patients with a missed glaucoma appointment, 73% (126/172) were contacted, and 40% (51/126) of those completed the survey. Participant age averaged 67±14 years, half were female (25/51, 49%), and most identified as Black (27/51, 53%) or White (21/51, 40%). Barriers to seeing a doctor including difficulty scheduling appointments (13/51, 26%), transportation (12/51, 24%), and cost or insurance barriers (8/51, 16%). Twenty-eight (55%) respondents reported at least one social risk factor. A positive association was found between having at least one risk factor and expressing interest in consulting our patient navigator (odds ratio=6.7, P =0.009). Overall, a third of respondents expressed interest in engaging with our patient navigator program (17/51, 33%). Two thirds of participants reported awareness of missed appointments (34/51, 67%), of whom 35% (12/34) reported having already rescheduled, 41% (14/34) expressed interest in rescheduling, and 24% (8/34) did not wish to return. CONCLUSIONS Glaucoma patients with missed appointments report barriers to care and face social risk factors. Telephone outreach may help to re-engage them with care, and patients expressed interest in a patient navigator program to address social needs.
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Affiliation(s)
- Lauren M. Wasser
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Ophthalmology, Shaare Zedek Medical Center Affiliated with the Hebrew University, Hadassah School of Medicine, Jerusalem, Israel
| | - Todd M. Bear
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh; and Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew Sommers
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Julie Cassidy
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kelly W. Muir
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina; and Durham Veterans Affairs Medical Center, Health Services Research and Development, Durham, North Carolina
| | - Andrew M. Williams
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Li C, Mowery DL, Ma X, Yang R, Vurgun U, Hwang S, Donnelly HK, Bandhey H, Akhtar Z, Senathirajah Y, Sadhu EM, Getzen E, Freda PJ, Long Q, Becich MJ. Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions. medRxiv 2024:2024.02.04.24302242. [PMID: 38370703 PMCID: PMC10871446 DOI: 10.1101/2024.02.04.24302242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background Social determinants of health (SDoH) like socioeconomics and neighborhoods strongly influence outcomes, yet standardized SDoH data is lacking in electronic health records (EHR), limiting research and care quality. Methods We searched PubMed using keywords "SDOH" and "EHR", underwent title/abstract and full-text screening. Included records were analyzed under five domains: 1) SDoH screening and assessment approaches, 2) SDoH data collection and documentation, 3) Use of natural language processing (NLP) for extracting SDoH, 4) SDoH data and health outcomes, and 5) SDoH-driven interventions. Results We identified 685 articles, of which 324 underwent full review. Key findings include tailored screening instruments implemented across settings, census and claims data linkage providing contextual SDoH profiles, rule-based and neural network systems extracting SDoH from notes using NLP, connections found between SDoH data and healthcare utilization/chronic disease control, and integrated care management programs executed. However, considerable variability persists across data sources, tools, and outcomes. Discussion Despite progress identifying patient social needs, further development of standards, predictive models, and coordinated interventions is critical to fulfill the potential of SDoH-EHR integration. Additional database searches could strengthen this scoping review. Ultimately widespread capture, analysis, and translation of multidimensional SDoH data into clinical care is essential for promoting health equity.
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Affiliation(s)
- Chenyu Li
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Danielle L. Mowery
- University of Pennsylvania, Institute for Biomedical Informatics
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Xiaomeng Ma
- University of Toronto, Institute of Health Policy Management and Evaluations
| | - Rui Yang
- Duke-NUS Medical School, Centre for Quantitative Medicine
| | - Ugurcan Vurgun
- University of Pennsylvania, Institute for Biomedical Informatics
| | - Sy Hwang
- University of Pennsylvania, Institute for Biomedical Informatics
| | | | - Harsh Bandhey
- Cedars-Sinai Medical Center, Department of Computational Biomedicine
| | - Zohaib Akhtar
- Northwestern University, Kellogg School of Management
| | - Yalini Senathirajah
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Eugene Mathew Sadhu
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
| | - Emily Getzen
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Philip J Freda
- Cedars-Sinai Medical Center, Department of Computational Biomedicine
| | - Qi Long
- University of Pennsylvania, Institute for Biomedical Informatics
- University of Pennsylvania, Department of Biostatistics, Epidemiology and Informatics
| | - Michael J. Becich
- University of Pittsburgh School of Medicine Department of Biomedical Informatics
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Kirkbride JB, Anglin DM, Colman I, Dykxhoorn J, Jones PB, Patalay P, Pitman A, Soneson E, Steare T, Wright T, Griffiths SL. The social determinants of mental health and disorder: evidence, prevention and recommendations. World Psychiatry 2024; 23:58-90. [PMID: 38214615 PMCID: PMC10786006 DOI: 10.1002/wps.21160] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.
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Affiliation(s)
| | - Deidre M Anglin
- City College, City University of New York, New York, NY, USA
- Graduate Center, City University of New York, New York, NY, USA
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Praveetha Patalay
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Emma Soneson
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Thomas Steare
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Talen Wright
- Division of Psychiatry, University College London, London, UK
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Hicks PM, Simmons K, Newman-Casey PA, Woodward MA, Elam AR. Spatial Vision Inequalities: A Literature Review of the Impact of Place on Vision and Eye Health Outcomes. Transl Vis Sci Technol 2024; 13:22. [PMID: 38285463 PMCID: PMC10829826 DOI: 10.1167/tvst.13.1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
"Neighborhood and built environment" is one of the five domains of social determinants of health that has been outlined by Healthy People 2030, and this domain impacts an individual's well-being, health, and quality of life. Social risk factors (SRFs) in the neighborhood and built environment domain include unstable or unsafe housing, poor access to transportation, lack of green spaces, pollution, safety concerns, and neighborhood measures of inequity. In this narrative literature review, we assess the relationship between neighborhood and built environment SRFs and eye health and vision outcomes. We explain how mapping neighborhood-level SRFs may be used to advance health equity in the field of eye health and vision care.
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Affiliation(s)
- Patrice M. Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Kirsten Simmons
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Angela R. Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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5
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Hausmann LRM, Cohen AJ, Eliacin J, Gurewich DA, Lee RE, McCoy JL, Meterko M, Michaels Z, Moy EM, Procario GT, Russell LE, Schaefer JH. Developing a brief assessment of social risks for the Veterans Health Administration Survey of Healthcare Experiences of Patients. Health Serv Res 2023; 58:1209-1223. [PMID: 37674359 PMCID: PMC10622278 DOI: 10.1111/1475-6773.14220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE To determine whether a 6- or 12-month look-back period affected rates of reported social risks in a social risk survey for use in the Veterans Health Administration and to assess associations of social risks with overall health and mental health. STUDY DESIGN Cross-sectional survey of respondents randomized to 6- or 12-month look-back period. DATA SOURCES AND STUDY SETTING Online survey with a convenience sample of Veterans in June and July 2021. DATA COLLECTION/EXTRACTION METHODS Veteran volunteers were recruited by email to complete a survey assessing social risks, including financial strain, adult caregiving, childcare, food insecurity, housing, transportation, internet access, loneliness/isolation, stress, discrimination, and legal issues. Outcomes included self-reported overall health and mental health. Chi-squared tests compared the prevalence of reported social risks between 6- and 12-month look-back periods. Spearman correlations assessed associations among social risks. Bivariate and multivariable logistic regression models estimated associations between social risks and fair/poor overall and mental health. PRINCIPAL FINDINGS Of 3418 Veterans contacted, 1063 (31.10%) responded (87.11% male; 85.61% non-Hispanic White; median age = 70, interquartile range [IQR] = 61-74). Prevalence of most reported social risks did not significantly differ by look-back period. Most social risks were weakly intercorrelated (median |r| = 0.24, IQR = 0.16-0.31). Except for legal issues, all social risks were associated with higher odds of fair/poor overall health and mental health in bivariate models. In models containing all significant social risks from bivariate models, adult caregiving and stress remained significant predictors of overall health; food insecurity, housing, loneliness/isolation, and stress remained significant for mental health. CONCLUSIONS Six- and 12-month look-back periods yielded similar rates of reported social risks. Although most individual social risks are associated with fair/poor overall and mental health, when examined together, only adult caregiving, stress, loneliness/isolation, food, and housing remain significant.
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Affiliation(s)
- Leslie R. M. Hausmann
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System (VAPHS); Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Alicia J. Cohen
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System; Department of Health Services, Policy, and Practice, Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Johanne Eliacin
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, Massachusetts; Department of General Internal Medicine and Geriatrics, Indiana University School of MedicineIndianapolisIndianaUSA
- Department of Health Services ResearchRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Deborah A. Gurewich
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Section of General Internal Medicine, Boston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Richard E. Lee
- Veterans Rural Health Resource CenterWhite River JunctionVermontUSA
| | - Jennifer L. McCoy
- Center for Health Equity Research and Promotion and Office of Research and Development StatCore, VAPHSPittsburghPennsylvaniaUSA
| | - Mark Meterko
- Analytics and Performance Integration, Office of Quality and Patient SafetyDepartment of Veterans Affairs; Department of Health Law, Policy and Management, Boston University School of Public HealthBostonMassachusettsUSA
| | - Zachary Michaels
- Center for Health Equity Research and Promotion, VAPHSPittsburghPennsylvaniaUSA
| | - Ernest M. Moy
- Office of Health EquityVeterans Health AdministrationWashingtonDCUSA
| | - Gregory T. Procario
- Center for Health Equity Research and Promotion, VAPHSPittsburghPennsylvaniaUSA
| | - Lauren E. Russell
- Office of Health EquityVeterans Health AdministrationWashingtonDCUSA
| | - James H. Schaefer
- Analytics and Performance Integration, Office of Quality and Patient SafetyDepartment of Veterans AffairsDurhamNorth CarolinaUSA
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Russell LE, Cohen AJ, Chrzas S, Halladay CW, Kennedy MA, Mitchell K, Moy E, Lehmann LS. Implementing a Social Needs Screening and Referral Program Among Veterans: Assessing Circumstances & Offering Resources for Needs (ACORN). J Gen Intern Med 2023; 38:2906-2913. [PMID: 37165261 PMCID: PMC10171907 DOI: 10.1007/s11606-023-08181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/17/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND The Department of Veterans Affairs (VA) healthcare system routinely screens Veterans for food insecurity, housing instability, and intimate partner violence, but does not systematically screen for other health-related social needs (HRSNs). OBJECTIVES To (1) develop a process for systematically identifying and addressing Veterans' HRSNs, (2) determine reported prevalence of HRSNs, and (3) assess the acceptability of HRSN screening among Veterans. DESIGN "Assessing Circumstances and Offering Resources for Needs" (ACORN) is a Veteran-tailored HRSN screening and referral quality improvement initiative. Veterans were screened via electronic tablet for nine HRSNs (food, housing, utilities, transportation, legal needs, social isolation, interpersonal violence, employment, and education) and provided geographically tailored resource guides for identified needs. Two-week follow-up interviews with a purposive sample of Veterans explored screening experiences. PARTICIPANTS Convenience sample of Veterans presenting for primary care at a VA urban women's health clinic and suburban community-based outpatient clinic (October 2019-May 2020). MAIN MEASURES Primary outcomes included prevalence of HRSNs, Veteran-reported acceptability of screening, and use of resources guides. Data were analyzed using descriptive statistics, chi-square tests, and rapid qualitative analysis. KEY RESULTS Of 268 Veterans screened, 50% reported one or more HRSNs. Social isolation was endorsed most frequently (29%), followed by educational needs (19%), interpersonal violence (12%), housing instability (9%), and utility concerns (7%). One in five Veterans reported at least one form of material hardship. In follow-up interviews (n = 15), Veterans found screening acceptable and felt VA should continue screening. No Veterans interviewed had contacted recommended resources at two-week follow-up, although several planned to use resource guides in the future. CONCLUSION In a VA HRSN screening and referral program, Veterans frequently reported HRSNs, felt screening was important, and thought VA should continue to screen for these needs. Screening for HRSNs is a critical step towards connecting patients with services, identifying gaps in service delivery, and informing future resource allocation.
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Affiliation(s)
- Lauren E Russell
- Office of Health Equity, Veterans Health Administration, Washington, DC, USA.
| | - Alicia J Cohen
- VA Health Services Research & Development (HSR&D) Center of Innovation in Long Term Services and Supports (LTSS-COIN), VA Providence Healthcare System, Providence, RI, USA
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Steven Chrzas
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Christopher W Halladay
- VA Health Services Research & Development (HSR&D) Center of Innovation in Long Term Services and Supports (LTSS-COIN), VA Providence Healthcare System, Providence, RI, USA
| | - Meaghan A Kennedy
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kathleen Mitchell
- New England Geriatric Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, MA, USA
| | - Ernest Moy
- Office of Health Equity, Veterans Health Administration, Washington, DC, USA
| | - Lisa Soleymani Lehmann
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
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7
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Shi S, Huang H, Huang Y, Zhong VW, Feng N. Lifestyle Behaviors and Cardiometabolic Diseases by Race and Ethnicity and Social Risk Factors Among US Young Adults, 2011 to 2018. J Am Heart Assoc 2023; 12:e028926. [PMID: 37608770 PMCID: PMC10547329 DOI: 10.1161/jaha.122.028926] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/20/2023] [Indexed: 08/24/2023]
Abstract
Background Cardiometabolic health has been worsening among young adults, but the prevalence of lifestyle risk factors and cardiometabolic diseases is unclear. Methods and Results Adults aged 18 to 44 years were included from the National Health and Nutrition Examination Survey, 2011 to 2018. Age-standardized prevalence of lifestyle risk factors and cardiometabolic diseases was estimated overall and by demographic and social risk factors. A set of multivariable logistic regressions was sequentially performed by adjusting for age, sex, social risk factors, and lifestyle factors to determine whether racial and ethnic disparities in the prevalence of cardiometabolic diseases may be attributable to differences in social risk factors and lifestyle factors. Appropriate weights were used to ensure national representativeness of the estimates. A total of 10 405 participants were analyzed (median age, 30.3 years; 50.8% women; 32.3% non-Hispanic White). The prevalence of lifestyle risk factors ranged from 16.3% for excessive drinking to 49.3% for poor diet quality. The prevalence of cardiometabolic diseases ranged from 4.3% for diabetes to 37.3% for dyslipidemia. The prevalence of having ≥2 lifestyle risk factors was 45.2% and having ≥2 cardiometabolic diseases was 22.0%. Racial and ethnic disparities in many cardiometabolic diseases persisted but were attenuated after adjusting for social risk factors and lifestyle factors. Conclusions The prevalence of lifestyle risk factors and cardiometabolic diseases was high among US young adults and varied by race and ethnicity and social risk factors. Racial and ethnic disparities in the prevalence of cardiometabolic diseases were not fully explained by differences in social risk factors and lifestyle factors.
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Affiliation(s)
- Shuxiao Shi
- Department of Epidemiology and Biostatistics, School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hengye Huang
- Department of Epidemiology and Biostatistics, School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yue Huang
- Department of Epidemiology and Biostatistics, School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Victor W. Zhong
- Department of Epidemiology and Biostatistics, School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Nannan Feng
- Department of Epidemiology and Biostatistics, School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
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Linfield GH, Patel S, Ko HJ, Lacar B, Gottlieb LM, Adler-Milstein J, Singh NV, Pantell MS, De Marchis EH. Evaluating the comparability of patient-level social risk data extracted from electronic health records: A systematic scoping review. Health Informatics J 2023; 29:14604582231200300. [PMID: 37677012 DOI: 10.1177/14604582231200300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Objective: To evaluate how and from where social risk data are extracted from EHRs for research purposes, and how observed differences may impact study generalizability. Methods: Systematic scoping review of peer-reviewed literature that used patient-level EHR data to assess 1 ± 6 social risk domains: housing, transportation, food, utilities, safety, social support/isolation. Results: 111/9022 identified articles met inclusion criteria. By domain, social support/isolation was most often included (N = 68/111), predominantly defined by marital/partner status (N = 48/68) and extracted from structured sociodemographic data (N = 45/48). Housing risk was defined primarily by homelessness (N = 39/49). Structured housing data was extracted most from billing codes and screening tools (N = 15/30, 13/30, respectively). Across domains, data were predominantly sourced from structured fields (N = 89/111) versus unstructured free text (N = 32/111). Conclusion: We identified wide variability in how social domains are defined and extracted from EHRs for research. More consistency, particularly in how domains are operationalized, would enable greater insights across studies.
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Affiliation(s)
- Gaia H Linfield
- School of Medicine, University of California, San Francisco, CA, USA
| | - Shyam Patel
- School of Medicine, University of California, San Francisco, CA, USA
| | - Hee Joo Ko
- School of Medicine, University of California, San Francisco, CA, USA
| | - Benjamin Lacar
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, CA, USA; Berkeley Institute for Data Science, University of California, Berkeley
| | - Laura M Gottlieb
- Department of Family & Community Medicine, University of California, San Francisco, CA, USA
| | - Julia Adler-Milstein
- School of Medicine, University of California, San Francisco, CA, USA; Center for Clinical Informatics and Improvement Research, University of California, San Francisco, CA, USA
| | - Nina V Singh
- California School of Professional Psychology, Alliant International University, Emeryvilla, CA, USA
| | - Matthew S Pantell
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Emilia H De Marchis
- Department of Family & Community Medicine, University of California, San Francisco, CA, USA
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9
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Hicks PM, Armstrong ML, Woodward MA. Current social determinants of health and social risk factors in conditions of the cornea: a scoping review. Curr Opin Ophthalmol 2023; 34:324-333. [PMID: 37097186 PMCID: PMC10247394 DOI: 10.1097/icu.0000000000000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
PURPOSE OF REVIEW To achieve health equity in eye health and vision care, social determinants of health (SDoH) and the associated social risk factors must be addressed. To address SDoH and social risk factors in ophthalmology, they must first be identified. The purpose of this review was to determine the SDoH and social risk factors in conditions of the cornea that have most recently been explored. RECENT FINDINGS This review identified social risk factors associated with all five domains of SDoH, as outlined by Healthy People 2030. The neighborhood and built environment was the domain identified the most for both exploration and observation. The social and community context domain was the least explored, and healthcare access and quality and social and community context domains were the least observed. The cornea condition explored the most in relation to SDoH was dry eye syndrome. SUMMARY The findings from this review can inform clinicians on the social risk factors that could be screened for in eye care facilities, so patients can be connected with services to minimize the impact of social risk factors on cornea conditions. Furthermore, the findings have identified cornea conditions and domains of SDoH that are understudied which can be an area for future studies by vision researchers.
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Affiliation(s)
- Patrice M. Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
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Boyd LM, Colavecchia AC, Townsend KA, Kmitch L, Broder L, Hegeman-Dingle RR, Ateya M, Lattimer A, Bosch R, Alvir J. Associations of Community and Individual Social Determinants of Health With Medication Adherence in Patients With Atrial Fibrillation: A Retrospective Cohort Study. J Am Heart Assoc 2023; 12:e026745. [PMID: 37026552 DOI: 10.1161/jaha.122.026745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Background Despite guideline-recommended use of oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF), OAC medication adherence among patients with AF in the United States ranges from 47% to 82%. To characterize potential causes of nonadherence, we analyzed associations between community and individual social risk factors and OAC adherence for stroke prevention in AF. Methods and Results A retrospective cohort analysis of patients with AF was conducted using the IQVIA PharMetrics Plus claims data from January 2016 to June 2020, and 3-digit ZIP code-level social risk scores were calculated using American Community Survey and commercial data. Logistic regression models evaluated associations between community social determinants of health, community social risk scores for 5 domains (economic climate, food landscape, housing environment, transportation network, and health literacy), patient characteristics and comorbidities, and 2 adherence outcomes: persistence on OAC for 180 days and proportion of days covered ≥0.80 at 360 days. Of 28 779 patients with AF included in the study, 70.8% of patients were male, 94.6% were commercially insured, and the average patient age was 59.2 years. Multivariable regression found that greater health literacy risk was negatively associated with 180-day persistence (odds ratio [OR]=0.80 [95% CI, 0.76-0.83]) and 360-day proportion of days covered (OR, 0.81 [95% CI, 0.76-0.87]). Patient age and higher AF stroke risk score and AF bleeding risk scores were positively associated with both 180-day persistence and 360-day proportion of days covered. Conclusions Social risk domains, such as health literacy, may affect OAC adherence among patients with AF. Future studies should explore associations between social risk factors and nonadherence with greater geographic granularity.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ryan Bosch
- Socially Determined Inc. Washington DC USA
| | - Jose Alvir
- Pfizer Inc, US Statistical Research and Data Science Center, Global Product Development New York NY USA
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11
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Jacobs MA, Kim J, Tetley JC, Schmidt S, Brimhall BB, Mika V, Wang CP, Manuel LS, Damien P, Shireman PK. Association of Insurance Type with Inpatient Surgical 30-day Readmissions, Emergency Department Visits/Observation Stays, and Costs. Ann Surg Open 2023; 4:e235. [PMID: 37588413 PMCID: PMC10427129 DOI: 10.1097/as9.0000000000000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/19/2022] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To assess the association of Private, Medicare, and Medicaid/Uninsured insurance type with 30-day Emergency Department visits/Observation Stays (EDOS), readmissions, and costs in a safety-net hospital (SNH) serving diverse socioeconomic status patients. SUMMARY BACKGROUND DATA Medicare's Hospital Readmission Reduction Program (HRRP) disproportionately penalizes SNHs. METHODS This retrospective cohort study used inpatient National Surgical Quality Improvement Program (2013-2019) data merged with cost data. Frailty, expanded Operative Stress Score, case status, and insurance type were used to predict odds of EDOS and readmissions, as well as index hospitalization costs. RESULTS The cohort had 1,477 Private; 1,164 Medicare; and 3,488 Medicaid/Uninsured cases with a patient mean age 52.1 years [SD=14.7] and 46.8% of the cases were performed on male patients. Medicaid/Uninsured (aOR=2.69, CI=2.38-3.05, P<.001) and Medicare (aOR=1.32, CI=1.11-1.56, P=.001) had increased odds of urgent/emergent surgeries and complications versus Private patients. Despite having similar frailty distributions, Medicaid/Uninsured compared to Private patients had higher odds of EDOS (aOR=1.71, CI=1.39-2.11, P<.001), and readmissions (aOR=1.35, CI=1.11-1.65, P=.004), after adjusting for frailty, OSS, and case status, while Medicare patients had similar odds of EDOS and readmissions versus Private. Hospitalization variable cost %change was increased for Medicare (12.5%) and Medicaid/Uninsured (5.9%), but Medicaid/Uninsured was similar to Private after adjusting for urgent/emergent cases. CONCLUSIONS Increased rates and odds of urgent/emergent cases in Medicaid/Uninsured patients drive increased odds of complications and index hospitalization costs versus Private. SNHs care for higher cost populations while receiving lower reimbursements and are further penalized by the unintended consequences of HRRP. Increasing access to care, especially for Medicaid/Uninsured patients, could reduce urgent/emergent surgeries resulting in fewer complications, EDOS/readmissions, and costs.
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Affiliation(s)
- Michael A. Jacobs
- From the Department of Surgery, University of Texas Health San Antonio, San Antonio, TX
| | - Jeongsoo Kim
- From the Department of Surgery, University of Texas Health San Antonio, San Antonio, TX
| | - Jasmine C. Tetley
- From the Department of Surgery, University of Texas Health San Antonio, San Antonio, TX
| | - Susanne Schmidt
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX
| | - Bradley B. Brimhall
- Department of Pathology and Laboratory Medicine, University of Texas Health San Antonio, San Antonio, TX
- University Health, San Antonio, TX
| | | | - Chen-Pin Wang
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX
| | - Laura S. Manuel
- Business Intelligence and Data Analytics, University of Texas Health Physicians, University of Texas Health San Antonio, San Antonio, TX
| | - Paul Damien
- Department of Information, Risk, and Operations Management, Red McCombs School of Business, University of Texas, Austin, TX
| | - Paula K. Shireman
- From the Department of Surgery, University of Texas Health San Antonio, San Antonio, TX
- University Health, San Antonio, TX
- Departments of Primary Care & Rural Medicine and Medical Physiology, School of Medicine, Texas A&M Health, Bryan, TX
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12
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Bunce A, Donovan J, Hoopes M, Gottlieb LM, Krancari M, Gold R. Patient-Reported Social Risks and Clinician Decision Making: Results of a Clinician Survey in Primary Care Community Health Centers. Ann Fam Med 2023; 21:143-150. [PMID: 36973053 PMCID: PMC10042556 DOI: 10.1370/afm.2953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/03/2022] [Accepted: 11/21/2022] [Indexed: 03/29/2023] Open
Abstract
PURPOSE To assess the extent that patients' social determinants of health (SDOH) influence safety-net primary care clinicians' decisions at the point of care; examine how that information comes to the clinician's attention; and analyze clinician, patient, and encounter characteristics associated with the use of SDOH data in clinical decision making. METHODS Thirty-eight clinicians working in 21 clinics were prompted to complete 2 short card surveys embedded in the electronic health record (EHR) daily for 3 weeks. Survey data were matched with clinician-, encounter-, and patient-level variables from the EHR. Descriptive statistics and generalized estimating equation models were used to assess relationships between the variables and the clinician reported use of SDOH data to inform care. RESULTS Social determinants of health were reported to influence care in 35% of surveyed encounters. The most common sources of information on patients' SDOH were conversations with patients (76%), prior knowledge (64%), and the EHR (46%). Social determinants of health were significantly more likely to influence care among male and non-English-speaking patients, and those with discrete SDOH screening data documented in the EHR. CONCLUSIONS Electronic health records present an opportunity to support clinicians integrating information about patients' social and economic circumstances into care planning. Study findings suggest that SDOH information from standardized screening documented in the EHR, combined with patient-clinician conversations, may enable social risk-adjusted care. Electronic health record tools and clinic workflows could be used to support both documentation and conversations. Study results also identified factors that may cue clinicians to include SDOH information in point-of-care decision-making. Future research should explore this topic further.
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Affiliation(s)
| | | | | | - Laura M Gottlieb
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | | | - Rachel Gold
- OCHIN Inc, Portland, Oregon
- Kaiser Center for Health Research, Portland, Oregon
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13
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Ngongo WM, Peterson J, Lipiszko D, Gard LA, Wright KM, Parzuchowski AS, Ravenna PA, Cooper AJ, Persell SD, O'Brien MJ, Goel MS. Examining How Social Risk Factors Are Integrated Into Clinical Settings Using Existing Data: A Scoping Review. Ann Fam Med 2023; 21:S68-S74. [PMID: 36849484 PMCID: PMC9970670 DOI: 10.1370/afm.2932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 03/01/2023] Open
Abstract
PURPOSE Integrating social care into clinical care requires substantial resources. Use of existing data through a geographic information system (GIS) has the potential to support efficient and effective integration of social care into clinical settings. We conducted a scoping literature review characterizing its use in primary care settings to identify and address social risk factors. METHODS In December 2018, we searched 2 databases and extracted structured data for eligible articles that (1) described the use of GIS in clinical settings to identify and/or intervene on social risks, (2) were published between December 2013 and December 2018, and (3) were based in the United States. Additional studies were identified by examining references. RESULTS Of the 5,574 articles included for review, 18 met study eligibility criteria: 14 (78%) were descriptive studies, 3 (17%) tested an intervention, and 1 (6%) was a theoretical report. All studies used GIS to identify social risks (increase awareness); 3 studies (17%) described interventions to address social risks, primarily by identifying relevant community resources and aligning clinical services to patients' needs. CONCLUSIONS Most studies describe associations between GIS and population health outcomes; however, there is a paucity of literature regarding GIS use to identify and address social risk factors in clinical settings. GIS technology may assist health systems seeking to address population health outcomes through alignment and advocacy; its current application in clinical care delivery is infrequent and largely limited to referring patients to local community resources.
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Affiliation(s)
- Wivine M Ngongo
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonna Peterson
- Galter Health Sciences Library & Learning Center, Northwestern University, Chicago, Illinois
| | - Dawid Lipiszko
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lauren A Gard
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katherine M Wright
- Department of Family and Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Paul A Ravenna
- Department of Family and Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew J Cooper
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen D Persell
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Center for Primary Care Innovation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew J O'Brien
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mita Sanghavi Goel
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Iglesias Martínez E, Yáñez Legaspi P, Agulló-Tomás E, Llosa JA. Psychosocial Risk in COVID Context: The Impact of Economic Factors and Labour Protection Policy (ERTEs) in Spain. Int J Environ Res Public Health 2023; 20:1824. [PMID: 36767191 PMCID: PMC9914205 DOI: 10.3390/ijerph20031824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
The pandemic and the current situation have caused working poverty and therefore social risk, which implies a deterioration in well-being, affecting mental health and anxiety. In this context, the employment situation tends to be regarded ignoring previous social differences, economic and mental components, which should be considered when establishing priorities to program a global action of various synergistic elements. The study involved 4686 people (3500 women and 1186 men). They all completed a questionnaire that evaluated their anxiety, employment situation, income, changes of working status, and fears of becoming infected at the workplace. The results show the need to take into account the social determinants of mental health in vulnerable groups due to socioeconomic factors, job changes, contractual changes, age, or gender, considering the need to generate strategies to manage mental health and deal with it at a structural level, therefore displacing individual focus policies and interventions. An example of these policies are ERTEs (record of temporary employment regulation), constituting a perceived measure of protection and acting as an effective buffer against the economic crisis, thus reducing anxiety.
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Affiliation(s)
| | - Pablo Yáñez Legaspi
- Faculty of Juridic Sciences, University Rovira i Virgili, 43002 Tarragona, Spain
| | | | - José Antonio Llosa
- Department of Social Education, Padre Ossó Faculty, University of Oviedo, 33008 Oviedo, Spain
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15
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Fuchs J, Gaertner B, Rommel A, Starker A. Informal caregivers in Germany - who are they and which risks and resources do they have? Front Public Health 2023; 11:1058517. [PMID: 36875417 PMCID: PMC9978811 DOI: 10.3389/fpubh.2023.1058517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023] Open
Abstract
Background The aim of this study is to describe the social characteristics, the health and living situation and the prevalence of behavioral risk factors of adult informal caregivers compared to non-caregivers in Germany. Methods We used data from the German Health Update (GEDA 2019/2020-EHIS survey) which is a cross-sectional population-based health interview survey conducted between 04/2019 and 09/2020. The sample comprised 22,646 adults living in private households. Three mutually exclusive groups of providing informal care or assistance were differentiated: intense caregivers (informal care ≥10 h/week), less-intense caregivers (informal care<10 h/week) and non-caregivers. For the three groups weighted prevalences of social characteristics, health status (self-perceived health, health-related activity limitations, chronic diseases, low back disorder or other chronic back defect, depressive symptoms), behavioral risk factors (at-risk drinking, current smoking, insufficient physical activity, non-daily fruit and vegetable consumption, obesity) and social risk factors (single household, low social support) were calculated and stratified by gender. Separate regression analyses adjusted for age-group were conducted to identify significant differences between intense and less-intense caregivers vs. non-caregivers, respectively. Results Overall, 6.5% were intense caregivers, 15.2% less-intense caregivers and 78.3% non-caregivers. Women provided care more often (23.9%) than men (19.3%). Informal care was most frequently provided in the age group of 45 to 64 years. Intense caregivers reported worse health status, were more often current smokers, physical inactive, obese and lived less often alone than non-caregivers. However, in age-group adjusted regression analyses only few significant differences were seen: Female and male intense caregivers had more often a low back disorder and lived less often alone compared to non-caregivers. In addition, male intense care-givers reported more often worse self-perceived health, health-related activity limitation, and the presence of chronic diseases. In contrast, less-intense caregivers and non-caregivers differed in favor of the less-intense caregivers. Discussion A substantial proportion of the adult German population provides informal care regularly, especially women. Intense caregivers are a vulnerable group for negative health outcomes, especially men. In particular measures to prevent low back disorder should be provided. As the necessity of providing informal care will probably increase in the future, this will be important for the society and public health.
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Affiliation(s)
- Judith Fuchs
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Beate Gaertner
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Alexander Rommel
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anne Starker
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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16
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Azan A, Stephens J, Xie X, Fiori K, Gover M. COVID-19 and Changes in Reported Social Risk Factors at a Primary Care Practice in the South Bronx. J Prim Care Community Health 2023; 14:21501319221147136. [PMID: 36625253 PMCID: PMC9834620 DOI: 10.1177/21501319221147136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Historically, Black and Hispanic patient populations in the Bronx Borough of New York City have experienced the highest rates of social risk factors, and associated poor health outcomes, in New York State. During the pandemic, Bronx communities disproportionately experienced high rates of COVID-19 illness and death. To date, little is known regarding the COVID-19 pandemic's impact on social risk factors in urban, at-risk communities. This study aimed to determine how social risk factors changed during the pandemic in a Bronx-based patient population. METHODS Study participants were adult patients seen at a Federally Qualified Health Center in the South Bronx. Using a paired longitudinal study design, 300 participants were randomly selected for telephonic outreach during the pandemic from a sample of 865 participants who had been offered a social risk factor screener in the year prior to the pandemic. The outreach survey used included the social risk factor screener and questions regarding COVID-19 illness burden and prior engagement in social services. The McNemar test was used to analyze trends in reported social risks. RESULTS Housing quality needs, food insecurity, and legal care needs significantly increased during the pandemic. Participants who reported COVID-19 illness burden were 1.47 times more likely to report a social risk factor (P = .02). No significant relationship was found between prior enrollment in clinic-based social services and degree of reported social risk (P = .06). CONCLUSION Housing quality needs, food insecurity, and legal care needs increased during the COVID-19 pandemic in a predominantly Black and Hispanic identifying urban patient population. Urgently addressing this increase is imperative to achieving health equity in ongoing COVID-19 mitigation efforts.
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Affiliation(s)
- Alexander Azan
- Montefiore Medical Center, NY,
USA
- NYU Langone Health, New York, NY,
USA
| | | | - Xianhong Xie
- Albert Einstein College of Medicine,
Bronx, NY, USA
| | - Kevin Fiori
- Montefiore Medical Center, NY,
USA
- Albert Einstein College of Medicine,
Bronx, NY, USA
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17
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Jennings D, List R, Bruschwein H, Compton M, Somerville L, Williamson L, Murray R, Evangelista B, Albon D. Social determinants of health screening and intervention: A cystic fibrosis quality improvement process. Pediatr Pulmonol 2022; 57:3035-3043. [PMID: 36039394 PMCID: PMC9826285 DOI: 10.1002/ppul.26131] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/09/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Lower socioeconomic status is associated with significantly poorer outcomes in weight, lung function, and pulmonary exacerbation rates in people with cystic fibrosis (PwCF). GLOBAL AIM We aim to reduce health disparities and inequities faced by PwCF by screening for and addressing unmet social needs. SPECIFIC AIMS We aimed to increase routine social determinants of health (SDoH) screening of eligible PwCF from 0% to 95% and follow-up within 2 weeks for those PwCF who screened positive and requested assistance from 0% to 95% by December 31, 2021. METHODS The Model for Improvement methodology was used. A process map and a simplified failure mode effects analysis chart were created for the screening and SDoH follow-up process. For those who screened positive for SDoH and requested assistance, follow-up contact was made to offer intervention. INTERVENTION Adult PwCF who had at least one UVA Clinic encounter in 2021 were screened for SDoH. The SDoH screening tool included eight domains: housing, food, transportation, utilities, health-care access, medication access, income/employment, and education. Follow-up was completed with all PwCF who screened positive for SDoH. RESULTS A total of 132 of 142 (93.0%) PwCF eligible for screening completed the SDoH screening. Of the PwCF who completed screening, 56 (42.4%) screened positive for SDoH. A follow-up rate of 100% was achieved in June 2021 and maintained through December 2021. CONCLUSION Implementing screening for SDOH and follow-up to mitigate social difficulties in adult PwCF at UVA was successful and could be reproduced at other CF care centers.
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Affiliation(s)
- Deirdre Jennings
- Department of Social Work, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Rhonda List
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Heather Bruschwein
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Martina Compton
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Lindsay Somerville
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Lauren Williamson
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Rachel Murray
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Brielle Evangelista
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Dana Albon
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Virginia Health System, Charlottesville, Virginia, USA
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18
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Tetley JC, Jacobs MA, Kim J, Schmidt S, Brimhall BB, Mika V, Wang CP, Manuel LS, Damien P, Shireman PK. Association of Insurance Type With Colorectal Surgery Outcomes and Costs at a Safety-Net Hospital: A Retrospective Observational Study. Ann Surg Open 2022; 3:e215. [PMID: 36590892 PMCID: PMC9780053 DOI: 10.1097/as9.0000000000000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/02/2022] [Indexed: 11/09/2022] Open
Abstract
Association of insurance type with colorectal surgical complications, textbook outcomes (TO), and cost in a safety-net hospital (SNH). Background SNHs have higher surgical complications and costs compared to low-burden hospitals. How does presentation acuity and insurance type influence colorectal surgical outcomes? Methods Retrospective cohort study using single-site National Surgical Quality Improvement Program (2013-2019) with cost data and risk-adjusted by frailty, preoperative serious acute conditions (PASC), case status and open versus laparoscopic to evaluate 30-day reoperations, any complication, Clavien-Dindo IV (CDIV) complications, TO, and hospitalization variable costs. Results Cases (Private 252; Medicare 207; Medicaid/Uninsured 619) with patient mean age 55.2 years (SD = 13.4) and 53.1% male. Adjusting for frailty, open abdomen, and urgent/emergent cases, Medicaid/Uninsured patients had higher odds of presenting with PASC (adjusted odds ratio [aOR] = 2.02, 95% confidence interval [CI] = 1.22-3.52, P = 0.009) versus Private. Medicaid/Uninsured (aOR = 1.80, 95% CI = 1.28-2.55, P < 0.001) patients were more likely to undergo urgent/emergent surgeries compared to Private. Medicare patients had increased odds of any and CDIV complications while Medicaid/Uninsured had increased odds of any complication, emergency department or observations stays, and readmissions versus Private. Medicare (aOR = 0.51, 95% CI = 0.33-0.88, P = 0.003) and Medicaid/Uninsured (aOR = 0.43, 95% CI = 0.30-0.60, P < 0.001) patients had lower odds of achieving TO versus Private. Variable cost %change increased in Medicaid/Uninsured patients to 13.94% (P = 0.005) versus Private but was similar after adjusting for case status. Urgent/emergent cases (43.23%, P < 0.001) and any complication (78.34%, P < 0.001) increased %change hospitalization costs. Conclusions Decreasing the incidence of urgent/emergent colorectal surgeries, possibly by improving access to care, could have a greater impact on improving clinical outcomes and decreasing costs, especially in Medicaid/Uninsured insurance type patients.
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Affiliation(s)
- Jasmine C. Tetley
- From the Department of Surgery, University of Texas Health San Antonio, San Antonio, TX
| | - Michael A. Jacobs
- From the Department of Surgery, University of Texas Health San Antonio, San Antonio, TX
| | - Jeongsoo Kim
- From the Department of Surgery, University of Texas Health San Antonio, San Antonio, TX
| | - Susanne Schmidt
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX
| | - Bradley B. Brimhall
- Department of Pathology and Laboratory Medicine, University of Texas Health San Antonio, San Antonio, TX
- University Health, San Antonio, TX
| | | | - Chen-Pin Wang
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX
| | - Laura S. Manuel
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX
| | - Paul Damien
- Department of Information, Risk, and Operations Management, Red McCombs School of Business, University of Texas, Austin, TX
| | - Paula K. Shireman
- From the Department of Surgery, University of Texas Health San Antonio, San Antonio, TX
- University Health, San Antonio, TX
- Departments of Primary Care & Rural Medicine and Medical Physiology, School of Medicine, Texas A&M Health, Bryan, TX
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Sharpe JA, Miller R, Cook CE, Hastings SN, Rethorn TJ, Allen KD, Rethorn ZD. Social Risk Factors Are Associated With Disability Prevalence - Results From 17 States in the 2017 Behavioral Risk Factor Surveillance System. Am J Health Promot 2022; 37:453-463. [PMID: 36194861 DOI: 10.1177/08901171221132390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Determine the association between incremental increases in the number of social risk factors and the prevalence of any disability and disability type. DESIGN The cross-sectional analysis was conducted using 2017 Behavioral Risk Factor Surveillance System data from states whose surveys included items about social risk factors. SETTING Respondents from 17 US states. SUBJECTS Respondents included 136 432 adults. MEASURES Dichotomized social risk factors included food, housing, and financial insecurity, unsafe neighborhood, and healthcare access hardship. ANALYSIS Weighted χ2 and logistic regression analyses adjusted for demographic characteristics, measures of socioeconomic position, and comorbid health conditions were used to examine differences in the prevalence of disability by social risk factor and via a social risk index created by summing the social risk factors. RESULTS Compared to those reporting 0 social risk factors, respondents reporting ≥4 had more than thrice the odds of reporting a cognition ((adjusted odds ratio [AOR]=3.37; 95%CI [2.75-4.13]), independent living (AOR=3.24 [2.52-4.15]), self-care (AOR=3.33 [2.55-4.34]), or any disability (AOR=3.90 [3.24-4.70]); more than twice the odds of reporting a vision (AOR=2.61 [1.93-3.52]) or mobility (AOR=2.72 [2.16-3.41]) disability; and more than 1.5 times the odds of reporting a hearing disability (AOR=1.59 [1.22-2.07]). CONCLUSIONS Incremental increases in the number of social risk factors were independently associated with higher odds of disability. Intervention efforts should address the social context of US adults with disabilities to improve health outcomes.
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Affiliation(s)
- Jason A Sharpe
- 584122VA Center of Innovation to Accelerate Discovery and Practice Transformation Medical Center, Durham, NC, USA
| | - Rachel Miller
- Doctor of Physical Therapy Division, 3065Duke University, Durham, NC, USA
| | - Chad E Cook
- Doctor of Physical Therapy Division, 3065Duke University, Durham, NC, USA.,Department of Population Health Sciences, 3065Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, 3065Duke University, Durham, NC, USA
| | - Susan N Hastings
- 584122VA Center of Innovation to Accelerate Discovery and Practice Transformation Medical Center, Durham, NC, USA.,Department of Population Health Sciences, 3065Duke University Medical Center, Durham, NC, USA.,Department of Medicine, 3065Duke University Medical Center, Durham, NC, USA.,Geriatrics Research Education and Clinical Center, 20054Durham VA Health Care System, Durham, NC, USA.,Center for the Study of Aging, 3065Duke University School of Medicine, Durham, NC, USA
| | - Timothy J Rethorn
- School of Health and Rehabilitation Sciences, 2647The Ohio State University, Columbus, OH, USA
| | - Kelli D Allen
- 584122VA Center of Innovation to Accelerate Discovery and Practice Transformation Medical Center, Durham, NC, USA.,Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Zachary D Rethorn
- 584122VA Center of Innovation to Accelerate Discovery and Practice Transformation Medical Center, Durham, NC, USA.,Doctor of Physical Therapy Division, 3065Duke University, Durham, NC, USA
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Rigdon J, Montez K, Palakshappa D, Brown C, Downs SM, Albertini LW, Taxter AJ. Social Risk Factors Influence Pediatric Emergency Department Utilization and Hospitalizations. J Pediatr 2022; 249:35-42.e4. [PMID: 35697140 DOI: 10.1016/j.jpeds.2022.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize the association of children's social risk factors with total number of emergency department (ED) visits or hospitalization and time to first subsequent ED or hospitalization. STUDY DESIGN This was a retrospective cohort study of patients seen at a general pediatric clinic between 2017 and 2021 with documented ≥1 social risk factors screened per visit. Negative binomial or Poisson regression modeled ED utilization and hospitalizations as functions of the total number of risk factors or each unique risk factor. Time-varying Cox models were used to evaluate differences between those who screened positive and those who screened negative, controlling for demographic and clinical covariates. RESULTS Overall, 4674 patients (mean age, 6.6 years; 49% female; 64% Hispanic; 21% Black) were evaluated across a total of 20 927 visits. Children with risk factors had higher rates of attention-deficit hyperactivity disorder, failure to gain weight, asthma, and prematurity compared with children with no risk (all P < .01). Adjusted models show a positive association between increased total number of factors and ED utilization (incidence rate ratio [IRR], 1.18; 95% CI, 1.12-1.23) and hospitalizations (IRR, 1.36; 95% CI, 1.26-1.47). There were no associations between a positive screen and time to first ED visit (hazard ratio [HR], 0.95; 95% CI, 0.85-1.06; P = .36) or hospitalization (HR, 1.15; 95% CI, 0.84-1.59; P = .40). CONCLUSIONS Social risk factors were associated with increased ED utilization and hospitalizations at the patient level but were not significantly associated with time to subsequent acute care use. Future research should evaluate the effect of focused interventions on health care utilization, such as those addressing food insecurity and transportation challenges.
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Affiliation(s)
- Joseph Rigdon
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kimberly Montez
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, NC; Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Deepak Palakshappa
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC; Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, NC; Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Callie Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC; Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stephen M Downs
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Laurie W Albertini
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Alysha J Taxter
- Department of Pediatric Rheumatology, Nationwide Children's Hospital, Columbus, OH; Department of Clinical Informatics, Nationwide Children's Hospital, Columbus, OH.
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21
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Oates GR, Schechter MS. Socioeconomic determinants of respiratory health in patients with cystic fibrosis: implications for treatment strategies. Expert Rev Respir Med 2022; 16:637-650. [PMID: 35705523 DOI: 10.1080/17476348.2022.2090928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Great variation exists in the progression and outcomes of cystic fibrosis (CF) lung disease, due to both genetic and environmental influences. Social determinants mediate environmental exposures and treatment success; people with CF from socioeconomically disadvantaged backgrounds have worse health and die younger than those in more advantaged positions. AREAS COVERED This paper reviews the literature on the mechanisms that are responsible for generating and sustaining disparities in CF health, and the ways by which social determinants translate into health advantages or disadvantages in people with CF. The authors make recommendations for addressing social risk factors in CF clinical practice. EXPERT OPINION Socioeconomic factors are not dichotomous and their impact is felt at every step of the social ladder. CF care programs need to adopt a systematic protocol to screen for health-related social risk factors, and then connect patients to available resources to meet individual needs. Considerations such as daycare, schooling options, living and working conditions, and opportunities for physical exercise and recreation as well as promotion of self-efficacy are often overlooked. In addition, advocacy for changes in public policies on health insurance, environmental regulations, social welfare, and education would all help address the root causes of CF health inequities.
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Affiliation(s)
- Gabriela R Oates
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael S Schechter
- Division of Pulmonary Medicine, Department of Pediatrics, Virginia Commonwealth University and Children's Hospital of Richmond at VCU, USA
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22
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Kausar K, Coffield E, Zak S, Raju R, Dlugacz Y. Clinically Screening Hospital Patients for Social Risk Factors Across Multiple Hospitals: Results and Implications for Intervention Development. J Gen Intern Med 2022; 37:1359-66. [PMID: 35296982 DOI: 10.1007/s11606-020-06396-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 12/03/2020] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hospitals are increasingly screening patients for social risk factors to help improve patient and population health. Intelligence gained from such screening can be used to inform social need interventions, the development of hospital-community collaborations, and community investment decisions. OBJECTIVE We evaluated the frequency of admitted patients' social risk factors and examined whether these factors differed between hospitals within a health system. A central goal was to determine if community-level social need interventions can be similar across hospitals. DESIGN AND PARTICIPANTS We described the development, implementation, and results from Northwell Health's social risk factor screening module. The statistical sample included patients admitted to 12 New York City/Long Island hospitals (except for maternity/pediatrics) who were clinically screened for social risk factors at admission from June 25, 2019, to January 24, 2020. MAIN MEASURES We calculated frequencies of patients' social needs across all hospitals and for each hospital. We used chi-square and Friedman tests to evaluate whether the hospital-level frequency and rank order of social risk factors differed across hospitals. RESULTS Patients who screened positive for any social need (n = 5196; 6.6% of unique patients) had, on average, 2.3 of 13 evaluated social risk factors. Among these patients, the most documented social risk factor was challenges paying bills (29.4%). The frequency of 12 of the 13 social risk factors statistically differed across hospitals. Furthermore, a statistically significant variance in rank orders between the hospitals was identified (Friedman test statistic 30.8 > 19.6: χ2 critical, p = 0.05). However, the hospitals' social need rank orders within their respective New York City/Long Island regions were similar in two of the three regions. CONCLUSIONS Hospital patients' social needs differed between hospitals within a metropolitan area. Patients at different hospitals have different needs. Local considerations are essential in formulating social need interventions and in developing hospital-community partnerships to address these needs.
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23
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Wray C, Tang J, Byers A, Keyhani S. Digital Health Skillsets and Digital Preparedness: Comparison of Veterans Health Administration Users and Other Veterans Nationally. JMIR Form Res 2022; 6:e32764. [PMID: 35089147 PMCID: PMC8838565 DOI: 10.2196/32764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/03/2021] [Accepted: 12/13/2021] [Indexed: 02/06/2023] Open
Abstract
Background As health care systems shift to greater use of telemedicine and digital tools, an individual’s digital health literacy has become an important skillset. The Veterans Health Administration (VA) has invested resources in providing digital health care; however, to date, no study has compared the digital health skills and preparedness of veterans receiving care in the VA to veterans receiving care outside the VA. Objective The goal of the research was to describe digital health skills and preparedness among veterans who receive care within and outside the VA health care system and examine whether receiving care in the VA is associated with digital preparedness (reporting more than 2 digital health skills) after accounting for demographic and social risk factors. Methods We used cross-sectional data from the 2016-2018 National Health Interview Survey to identify veterans (aged over 18 years) who obtain health care either within or outside the VA health care system. We used multivariable logistic regression models to examine the association of sociodemographic (age, sex, race, ethnicity), social risk factors (economic instability, disadvantaged neighborhood, low educational attainment, and social isolation), and health care delivery location (VA and non-VA) with digital preparedness. Results Those who received health care within the VA health care system (n=3188) were younger (age 18-49 years: 33.3% [95% CI 30.7-36.0] vs 24.2% [95% CI 21.9-26.5], P<.01), were more often female (34.7% [95% CI 32.0-37.3] vs 6.6% [95% CI 5.5-7.6], P<.01) and identified as Black (13.1% [95% CI 11.2-15.0] vs 10.2% [95% CI 8.7-11.8], P<.01), and reported greater economic instability (8.3% [95% CI 6.9-9.8] vs 5.5% [95% CI 4.6-6.5], P<.01) and social isolation (42.6% [95% CI 40.3-44.9] vs 35.4% [95% CI 33.4-37.5], P<.01) compared to veterans who received care outside the VA (n=3393). Veterans who obtained care within the VA reported more digital health skills than those who obtained care outside the VA, endorsing greater rates of looking up health information on the internet (51.8% [95% CI 49.2-54.4] vs 45.0% [95% CI 42.6-47.3], P<.01), filling a prescription using the internet (16.2% [95% CI 14.5-18.0] vs 11.3% [95% CI 9.6-13.0], P<.01), scheduling a health care appointment on the internet (14.1% [95% CI 12.4-15.8] vs 11.6% [95% CI 10.1-13.1], P=.02), and communicating with a health care provider by email (18.0% [95% CI 16.1-19.8] vs 13.3% [95% CI 11.6-14.9], P<.01). Following adjustment for sociodemographic and social risk factors, receiving health care from the VA was the only characteristic associated with higher odds (adjusted odds ratio [aOR] 1.36, 95% CI 1.12-1.65) of being digitally prepared. Conclusions Despite these demographic disadvantages to digital uptake, veterans who receive care in the VA reported more digital health skills and appear more digitally prepared than veterans who do not receive care within the VA, suggesting a positive, system-level influence on this cohort.
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Affiliation(s)
- Charlie Wray
- Section of Hospital Medicine, San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Janet Tang
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Amy Byers
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Division of Mental Health Services, San Francisco Department of Veterans Affairs Medical Center, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Salomeh Keyhani
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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24
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Rethorn ZD, Cook CE, Park C, Somers T, Mummaneni PV, Chan AK, Pennicooke BH, Bisson EF, Asher AL, Buchholz AL, Bydon M, Alvi MA, Coric D, Foley KT, Fu KM, Knightly JJ, Meyer S, Park P, Potts EA, Shaffrey CI, Shaffrey M, Than KD, Tumialan L, Turner JD, Upadhyaya CD, Wang MY, Gottfried O. Social risk factors predicting outcomes of cervical myelopathy surgery. J Neurosurg Spine 2022; 37:1-8. [PMID: 35090132 DOI: 10.3171/2021.12.spine21874] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Combinations of certain social risk factors of race, sex, education, socioeconomic status (SES), insurance, education, employment, and one's housing situation have been associated with poorer pain and disability outcomes after lumbar spine surgery. To date, an exploration of such factors in patients with cervical spine surgery has not been conducted. The objective of the current work was to 1) define the social risk phenotypes of individuals who have undergone cervical spine surgery for myelopathy and 2) analyze their predictive capacity toward disability, pain, quality of life, and patient satisfaction-based outcomes. METHODS The Cervical Myelopathy Quality Outcomes Database was queried for the period from January 2016 to December 2018. Race/ethnicity, educational attainment, SES, insurance payer, and employment status were modeled into unique social phenotypes using latent class analyses. Proportions of social groups were analyzed for demonstrating a minimal clinically important difference (MCID) of 30% from baseline for disability, neck and arm pain, quality of life, and patient satisfaction at the 3-month and 1-year follow-ups. RESULTS A total of 730 individuals who had undergone cervical myelopathy surgery were included in the final cohort. Latent class analysis identified 2 subgroups: 1) high risk (non-White race and ethnicity, lower educational attainment, not working, poor insurance, and predominantly lower SES), n = 268, 36.7% (class 1); and 2) low risk (White, employed with good insurance, and higher education and SES), n = 462, 63.3% (class 2). For both 3-month and 1-year outcomes, the high-risk group (class 1) had decreased odds (all p < 0.05) of attaining an MCID score in disability, neck/arm pain, and health-related quality of life. Being in the low-risk group (class 2) resulted in an increased odds of attaining an MCID score in disability, neck/arm pain, and health-related quality of life. Neither group had increased or decreased odds of being satisfied with surgery. CONCLUSIONS Although 2 groups underwent similar surgical approaches, the social phenotype involving non-White race/ethnicity, poor insurance, lower SES, and poor employment did not meet MCIDs for a variety of outcome measures. This finding should prompt surgeons to proactively incorporate socially conscience care pathways within healthcare systems, as well as to optimize community-based resources to improve outcomes and personalize care for populations at social risk.
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Affiliation(s)
- Zachary D Rethorn
- 1Department of Orthopaedics, Duke University, Durham
- 19Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - Chad E Cook
- 1Department of Orthopaedics, Duke University, Durham
- 3Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Christine Park
- 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Tamara Somers
- 3Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Praveen V Mummaneni
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K Chan
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Erica F Bisson
- 6Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Anthony L Asher
- 7Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Avery L Buchholz
- 8Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Mohamad Bydon
- 9Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Mohammed Ali Alvi
- 9Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Domagoj Coric
- 7Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Kevin T Foley
- 10Department of Neurosurgery, University of Tennessee and Semmes-Murphey Clinic, Memphis, Tennessee
| | - Kai-Ming Fu
- 11Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
| | | | - Scott Meyer
- 12Altair Health Spine and Wellness, Morristown, New Jersey
| | - Paul Park
- 13Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Eric A Potts
- 14Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Christopher I Shaffrey
- 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | - Mark Shaffrey
- 8Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Khoi D Than
- 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
| | | | - Jay D Turner
- 16Barrow Neurological Institute, Phoenix, Arizona
| | | | - Michael Y Wang
- 18Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Oren Gottfried
- 15Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina
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25
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Beech BM, Dobbins J, Woodard L, Liaw W, Bruce MA. Multisector Partnerships and Service Colocation to Increase Adoption of Influenza Vaccines and Address Food Insecurity. Popul Health Manag 2021; 25:430-432. [PMID: 34882018 DOI: 10.1089/pop.2021.0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bettina M Beech
- Department of Health Systems and Population Health Science, University of Houston, Houston, Texas, USA
| | | | - LeChauncy Woodard
- Department of Health Systems and Population Health Science, University of Houston, Houston, Texas, USA.,Humana Integrated Health System Sciences Institute, University of Houston, Houston, Texas, USA
| | - Winston Liaw
- Department of Health Systems and Population Health Science, University of Houston, Houston, Texas, USA
| | - Marino A Bruce
- Department of Health Systems and Population Health Science, University of Houston, Houston, Texas, USA.,Program for Research on Faith, Justice, and Health, Department of Behavioral and Social Sciences, University of Houston, Houston, Texas, USA
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26
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Beckett MK, Martino SC, Agniel D, Mathews M, Hudson Scholle S, James C, Wilson-Frederick S, Orr N, Darabidian B, Elliott MN. Distinguishing neighborhood and individual social risk factors in health care. Health Serv Res 2021; 57:458-471. [PMID: 34596232 DOI: 10.1111/1475-6773.13884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 05/11/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate (a) the magnitude of the independent associations of neighborhood-level and person-level social risk factors (SRFs) with quality, (b) whether neighborhood-level SRF associations may be proxies for person-level SRF associations, and (c) how the association of person-level SRFs and quality varies by neighborhood-level SRFs. DATA SOURCES 2015-2016 Medicare Advantage HEDIS data, Medicare beneficiary administrative data, and 2016 American Community Survey (ACS). STUDY DESIGN Mixed effects linear regression models (1) estimated overall inequities by neighborhood-level and person-level SRFs, (2) compared neighborhood-level associations to person-level associations, and (3) tested the interactions of person-level SRFs with corresponding neighborhood-level SRFs. DATA COLLECTION/EXTRACTION METHODS Beneficiary-level SES and disability administrative data and five-year ACS neighborhood-level SRF information were each linked to HEDIS data. PRINCIPAL FINDINGS For all or nearly all HEDIS measures, quality was worse in neighborhoods lower in SES and in neighborhoods with higher proportions of residents with a disability. Quality by neighborhood racial and ethnic composition was mixed. Accounting for corresponding person-level SRFs reduced neighborhood SRF associations by 25% for disability, 43% for SES, and 74%-102% for racial and ethnic groups. Person-level SRF coefficients were not consistently reduced in models that added neighborhood-level SRFs. In 19 of 35 instances, there were significant (p < 0.05) interactions between neighborhood-level and corresponding person-level SRFs. Significant interactions were always positive for disability, SES, Black, and Hispanic, indicating more negative neighborhood effects for people with SRFs that did not match their neighborhood and more positive neighborhood effects for people with SRFs that matched their neighborhood. CONCLUSIONS Relying solely on neighborhood-level SRF models that omit similar person-level SRFs overattributes inequities to neighborhood characteristics. Neighborhood-level characteristics account for much less variation in these measures' scores than similar person-level SRFs. Inequity-reduction programs may be most effective when targeting neighborhoods with a high proportion of people with a given SRF.
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Affiliation(s)
- Megan K Beckett
- Division of Health Care, RAND Corporation, Santa Monica, California, USA
| | - Steven C Martino
- Division of Health Care, RAND Corporation, Pittsburgh, Pennsylvania, USA
| | - Denis Agniel
- Division of Health Care, RAND Corporation, Santa Monica, California, USA
| | - Megan Mathews
- Division of Health Care, RAND Corporation, Arlington, Virginia, USA
| | - Sarah Hudson Scholle
- Research and Analysis, National Committee for Quality Assurance, Washington, DC, USA
| | - Cara James
- Grantmakers In Health, Washington, DC, USA
| | | | - Nate Orr
- Division of Health Care, RAND Corporation, Santa Monica, California, USA
| | - Biayna Darabidian
- Division of Health Care, RAND Corporation, Santa Monica, California, USA
| | - Marc N Elliott
- Division of Health Care, RAND Corporation, Santa Monica, California, USA
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27
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Agniel D, Martino SC, Burkhart Q, Hambarsoomian K, Orr N, Beckett MK, James C, Scholle SH, Wilson-Frederick S, Ng J, Elliott MN. Incentivizing Excellent Care to At-Risk Groups with a Health Equity Summary Score. J Gen Intern Med 2021; 36:1847-57. [PMID: 31713030 DOI: 10.1007/s11606-019-05473-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/12/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Social risk factors (SRFs) such as minority race-and-ethnicity or low income are associated with quality-of-care, health, and healthcare outcomes. Organizations might prioritize improving care for easier-to-treat groups over those with SRFs, but measuring, reporting, and further incentivizing quality-of-care for SRF groups may improve their care. OBJECTIVE To develop, as a proof-of-concept, a Health Equity Summary Score (HESS): a succinct, easy-to-understand score that could be used to promote high-quality care to those with SRFs in Medicare Advantage (MA) health plans, which provide care for almost twenty million older and disabled Americans and collect extensive quality measure and SRF data. DESIGN We estimated, standardized, and combined performance scores for two sets of quality measures for enrollees in 2013-2016 MA health plans, considering both current levels of care, within-plan improvement, and nationally benchmarked improvement for those with SRFs (specifically, racial-and-ethnic minority status and dual-eligibility for Medicare and Medicaid). PARTICIPANTS All MA plans with publicly reported quality scores and 500 or more 2016 enrollees. MAIN MEASURES Publicly reported clinical quality and patient experience measures. KEY RESULTS Almost 90% of plans measured for MA Star Ratings received a HESS; plans serving few patients with SRFs were excluded. The summary score was moderately positively correlated with publicly reported overall Star Ratings (r = 0.66-0.67). High-scoring plans typically had sizable enrollment of both racial-and-ethnic minorities (38-42%) and dually eligible beneficiaries (29-38%). CONCLUSIONS We demonstrated the feasibility of developing and estimating a HESS that is intended to promote and incentivize excellent care for racial-and-ethnic minorities and dually eligible MA enrollees. The HESS measures SRF-specific performance and does not simply duplicate overall plan Star Ratings. It also identifies plans that provide excellent care to large numbers of those with SRFs. Our methodology could be extended to other SRFs, quality measures, and settings.
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28
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Wang A, Kho AN, Black B, French DD. Determining the feasibility of an index of the social determinants of health using data from public sources. Inform Health Soc Care 2021; 46:205-217. [PMID: 33632053 DOI: 10.1080/17538157.2021.1880413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Examining the feasibility of developing an index measure for the social determinants of health using public data is needed. We examined these characteristics at the ZIP code in California and New York using public data extracted from the US Census, American Community Survey, the USDA Food Research Access Atlas, and the Dartmouth Atlas. We conducted a retrospective study from 2000 to 2017. The main outcome was a novel index measure representing six domains (economic stability, neighborhood and physical environment, education, community and social context, food access, and health care) and encompassing 13 items. The index measure at the ZIP code was created using principal component analysis, normalized to "0" worse and "1" better in California (ZIP codes n = 1,447 to 1,515) and New York (ZIP codes n = 1,211 to 1,298). We assessed the reliability and conducted a nonparametric comparison to the Robert Wood Johnson Foundation County Health Rankings, Area Deprivation Index, Social Deprivation Index, and GINI Index. These measures shared similarities and differences with the novel measure. Mapping of this novel measure showed regional variation. As a result, developing a universal social determinants of health measure is feasible and more research is needed to link it to health outcomes.
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Affiliation(s)
- Andrew Wang
- Institute for Public Health and Medicine, Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Institute for Public Health and Medicine, Center for Health Information Partnerships, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Abel N Kho
- Institute for Public Health and Medicine, Center for Health Information Partnerships, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bernard Black
- Pritzker School of Law, Northwestern University, Chicago, Illinois, USA.,Kellogg School of Management, Northwestern University, Chicago, Illinois, USA
| | - Dustin D French
- Institute for Public Health and Medicine, Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,U.S. Department of Veterans Affairs, Health Services Research and Development, Hines, Illinois, USA
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29
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Nash DB, Dobbins J, Cockerell T, Woodard L. Multi-Sector Partnerships and Networks to Support Social Health, Medical Education, and Return on Investment. Popul Health Manag 2020; 24:161-163. [PMID: 32639191 DOI: 10.1089/pop.2020.0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David B Nash
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | | | | | - LeChauncy Woodard
- College of Medicine, University of Houston, Houston, Texas, USA.,Houston Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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30
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Abstract
OBJECTIVE To identify patient social risk factors associated with Continuity of Care (COC) index. DATA SOURCES/STUDY SETTING Medicare Current Beneficiary Survey (MCBS), the Dartmouth Institute, and Area Resource File for 2006-2013. STUDY DESIGN We use regression methods to assess the effect of patient social risk factors on COC after adjusting for medical complexity. In secondary analyses, we assess the effect of social risk factors on annual utilization of physicians and specialists for evaluation and management (E&M). DATA COLLECTION/EXTRACTION METHODS We retrospectively identified 59 499 patient years for Medicare beneficiaries with one year of enrollment and three or more E&M visits. PRINCIPAL FINDINGS After adjustment for medical complexity, individual-level social risk factors such as lack of education, low income, and living alone are all associated with better patient COC (P < .05). Similarly, area-level social risk factors such as living in areas that are nonurban or high poverty, as well as in areas with low specialist or high primary care physician supply, are all associated with better patient COC (P < .05). We found the opposite pattern of associations between these same risk factors and annual patient utilization of physicians and specialists (P < .05). CONCLUSIONS Medicare patients with multiple social risk factors have consistently better COC; these same social risk factors are associated with reduced patient-realized access to specialist physician care.
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Affiliation(s)
- Kenton J Johnston
- Department of Health Management and Policy and Center for Outcomes Research, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Jessica Mittler
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia
| | - Jason M Hockenberry
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Abstract
Background: Posting on social media can have lasting consequences in one's social life and career. Research has not yet focused on social media or more modern forms of communication as social risk factors for individuals high on drugs. This study aims to examine prevalence and correlates of engaging in social media posting and related behavior while high. Methods: We examined data from 872 adults (39.8% female) who were surveyed entering electronic dance music (EDM) parties in New York City and reported lifetime illegal drug use. Participants were asked whether they were ever high on a drug while (1) posting on social media, (2) calling or texting someone, and (3) being in a photo. Those answering affirmatively were also asked whether they later regretted the behavior. We examined demographic and drug-related correlates of these behaviors. Results: Of the participants, 34.3% posted on social media while high (with 21.4% regretting it), 55.9% had texted or called someone while high (with 30.5% regretting it), and 47.6% had been in a photo while high (with 32.7% regretting it). Females and young adults (ages 18-24) were at high risk for posting on social media while high and at higher risk for engaging in more of these behaviors. Past-month marijuana users in particular were at increased risk for engaging in each of these behaviors. Conclusion: Engaging in these behaviors while high on drugs appears to be prevalent, and prevention and harm reduction efforts should seek to prevent or reduce likelihood of social harm that can result from such situations.
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Affiliation(s)
- Joseph J Palamar
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Austin Le
- Department of Population Health, New York University School of Medicine, New York, New York, USA.,New York University College of Dentistry, New York, New York, USA
| | - Patricia Acosta
- Department of Population Health, New York University School of Medicine, New York, New York, USA
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Wray CM, Vali M, Abraham A, Zhang A, Walter LC, Keyhani S. Validation of Administrative Measures of Social and Behavioral Risk in Veterans Affairs Medical Records. J Gen Intern Med 2019; 34:796-798. [PMID: 30604115 PMCID: PMC6544671 DOI: 10.1007/s11606-018-4792-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Charlie M Wray
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. .,Division of Hospital Medicine, San Francisco Veterans Affairs Medical Center, Clement Street, San Francisco, CA, USA.
| | - Marzieh Vali
- Northern California Institute for Research and Education, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Ann Abraham
- Northern California Institute for Research and Education, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Alysandra Zhang
- Northern California Institute for Research and Education, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Louise C Walter
- Division of Geriatrics, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Salomeh Keyhani
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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Chen J, Chun D, Tijani-Eniola O. Risk Adjustment in Clinical Quality Measures: What Is Needed Next? Popul Health Manag 2019; 22:374-376. [PMID: 31063030 DOI: 10.1089/pop.2019.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Junqiao Chen
- Evolent Health, Clinical Informatics, Arlington, Virginia
| | - David Chun
- George Mason University, College of Health and Human Services, Fairfax, Virginia
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Tung EL, Johnson TA, O'Neal Y, Steenes AM, Caraballo G, Peek ME. Experiences of Community Violence Among Adults with Chronic Conditions: Qualitative Findings from Chicago. J Gen Intern Med 2018; 33:1913-1920. [PMID: 30076574 PMCID: PMC6206331 DOI: 10.1007/s11606-018-4607-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 06/06/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Community violence is an important social determinant of health in many high-poverty, urban communities. OBJECTIVE The purpose of this study was to explore and characterize self-described experiences of community violence among adults with chronic health conditions. DESIGN Qualitative study design was implemented in 2017 using in-depth, semi-structured focus groups and interviews; data were collected from two clinical sites located in geographic epicenters of high violent crime in Chicago. PARTICIPANTS Adult patients, ages 35 years and older, who had at least one chronic condition. APPROACH Data were analyzed using grounded theory and the constant comparison method. KEY RESULTS The overall sample (N = 51) was predominantly female (67%) and black non-Hispanic (75%); a large proportion had hypertension (65%), arthritis (55%), obesity (53%), and/or diabetes (45%). The majority reported that a close friend or family member was seriously injured or killed due to community violence (71%); a similar proportion had never discussed their experiences of community violence with a healthcare provider (73%). Several major themes emerged: (1) perceived risk of being targeted, (2) chronic stress and worry, (3) hypervigilance, (4) social breakdown, (5) chronic isolation, (6) constrained choice (loss of freedom), (7) limited access to material resources, and (8) inadequate healthcare responses. CONCLUSIONS Patients often struggled to balance the challenges imposed by community violence with the demands of living with and managing their chronic conditions. Emergent themes may inform practical targets for addressing community violence as a social determinant of health in vulnerable populations.
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Affiliation(s)
- Elizabeth L Tung
- Section of General Internal Medicine, Department of Medicine, Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, IL, USA. .,The Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA. .,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
| | - Tyrone A Johnson
- Section of General Internal Medicine, Department of Medicine, Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Yolanda O'Neal
- Section of General Internal Medicine, Department of Medicine, Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, IL, USA
| | - Althera M Steenes
- Section of General Internal Medicine, Department of Medicine, Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, IL, USA
| | - Graciela Caraballo
- Section of General Internal Medicine, Department of Medicine, Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, IL, USA
| | - Monica E Peek
- Section of General Internal Medicine, Department of Medicine, Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
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Gaskin DJ, Zare H, Vazin R, Love D, Steinwachs D. Racial and Ethnic Composition of Hospitals' Service Areas and the Likelihood of Being Penalized for Excess Readmissions by the Medicare Program. Med Care 2018; 56:934-943. [PMID: 30256281 PMCID: PMC6185808 DOI: 10.1097/mlr.0000000000000988] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Hospital Readmission Reduction Program (HRRP) disproportionately penalizes hospitals serving minority communities. The National Academy of Science, Engineering, and Medicine has recommended that the Centers for Medicare and Medicaid Services (CMS) consider adjusting for social risk factors in their risk adjustment methodology. This study examines the association between the racial and ethnic composition of a hospital market and the impact of other social risk factors on the probability of a hospital being penalized under the HRRP. RESEARCH METHODS AND DATA This study analyzes data from CMS, the American Hospital Association, and the American Community Survey for 3168 hospitals from 2013 to 2017. We used logistic regression models to estimate the association between the penalty status under HRRP and the racial and ethnic composition of a hospital market, and explored whether this association was moderated by other social risk factors. RESULTS Our results indicate that the probability of being penalized increases with the percentage of black and Asian residents in the hospital service area (HSA) and decreased with the percentage of Hispanic residents in the HSA. This association was reduced and became statistically insignificant when we controlled for other social risk factors. The strongest predictors of penalty status were the hospital's share of Medicaid patients and the percent of persons without a high school diploma in the HSA. CONCLUSIONS By incorporating relevant social risk factors in the reimbursement methodology, CMS could mitigate the negative effects of HRRP on hospitals serving minority communities.
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Affiliation(s)
- Darrell J Gaskin
- Johns Hopkins Bloomberg School of Public Health, William C. and Nancy F. Richardson Professor in Health Policy, Department of Health Policy and Management, Director of the Johns, Hopkins Center for Health Disparities Solutions, 624 North Broadway Ave, Hampton, House, Suite #441, Baltimore, Maryland, 21205, United States,
| | - Hossein Zare
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Johns Hopkins Center for Health Disparities Solutions, University of Maryland University College, Health Services Management, 624 North Broadway Ave, Hampton House, Room #310, Baltimore, Maryland, 21205, United States., Phone: +1 410-614-7246,
| | - Roza Vazin
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 North Broadway Ave, Hampton House, Room #307, Baltimore, Maryland, 21205, United States.,
| | | | - Donald Steinwachs
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 North Broadway Ave, Hampton House, Baltimore, Maryland, 21205, United States.,
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Naidoo K, Dookie N, Naidoo K, Yende-Zuma N, Chimukangara B, Bhushan A, Govender D, Gengiah S, Padayatchi N. Recurrent tuberculosis among HIV-coinfected patients: a case series from KwaZulu-Natal. Infect Drug Resist 2018; 11:1413-1421. [PMID: 30233220 PMCID: PMC6130302 DOI: 10.2147/idr.s150644] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Recurrent tuberculosis (TB) following TB treatment completion in HIV-infected individuals remains a major public health burden. We assessed the role of various risk factors in mediating the development of recurrent TB and subsequent resistance to antiretroviral therapy and anti-TB drugs. Patients and methods We analyzed secondary demographic, clinical, and laboratory data from medical records of five HIV-infected TB patients enrolled between 2009 and 2014 in a prospective observational study investigating TB recurrence. Paired clinical isolates of Myco-bacterium tuberculosis were typed by IS6110 restriction fragment length polymorphism analysis to determine the mechanism of TB recurrence. Plasma samples were genotyped to determine acquisition of HIV drug resistance mutations on antiretroviral treatment (ART). Results All five patients were HIV-coinfected, with a previous history of TB infection and prior exposure to anti-TB treatment, and residual lung damage, and demonstrated poor treatment adherence – significant risk factors linked to the development of recurrent TB disease. Furthermore, three of the five patients had multiple episodes of drug-susceptible TB infection with subsequent drug-resistant TB infection. Genotyping of the initial and recurrent M. tuberculosis isolates demonstrated three cases of recurrent TB because of relapse and two because of reinfection. All five patients had no mutations at ART initiation; however, by the end of the study follow-up, all patients developed dual class resistance. Conclusion This series demonstrates the complexity of recurrent TB in HIV coinfection. We highlight the challenges of managing coinfected patients and the increased propensity for the development of drug resistance. We report on the role of various risk factors mediating the development of resistance and subsequent clinical impact. This report underscores the need for structural clinical and adherence interventions for the management of complex treatment and dosing.
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Affiliation(s)
- Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa, .,South African Medical Research Council (SAMRC) - CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa,
| | - Navisha Dookie
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa, .,KwaZulu Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa
| | - Kasavan Naidoo
- South African Medical Research Council (SAMRC) - CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa,
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa,
| | - Benjamin Chimukangara
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa, .,KwaZulu Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa.,Department of Virology, National Health Laboratory Service, University of KwaZulu-Natal, Durban, South Africa
| | - Ambika Bhushan
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa,
| | - Dhineshree Govender
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa,
| | - Santhanalakshmi Gengiah
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa,
| | - Nesri Padayatchi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa, .,South African Medical Research Council (SAMRC) - CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa,
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Yun M, Kim E, Park WS. A Test of an Integrative Model Using Social Factors and Personality Traits: Prediction on the Delinquency of South Korean Youth. Int J Offender Ther Comp Criminol 2017; 61:1262-1287. [PMID: 26758207 DOI: 10.1177/0306624x15619615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
To more fully comprehend juvenile delinquency, it is necessary to take an integrative approach, with consideration of both personality traits of social risk factors. Many scholars argue the necessity and strength of integrative approach on the ground that juvenile delinquency is an outcome of interplay of individual and social factors. The present study examines the general applicability of an integrative model of personal traits and social risk factors to youth delinquency in the South Korean context. The empirical results show that the delinquency predictors in the current South Korean sample are closely aligned to Loeber and Farrington's theoretical propositions and that found in Western nations. Perhaps this is because South Korea has undergone rapid Westernization for the last decades. Because the correlates in this sample and Western theoretical propositions and studies overlap, an integrative model of personality trait and social risk factors is indeed generally applicable to South Korea. This finding also depicts the extent of Westernization in the South Korean society at least among adolescents. Limitations of the present study and directions for the future study are discussed.
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Affiliation(s)
- Minwoo Yun
- 1 Gachon University, Kyonggi, South Korea
| | - Eunyoung Kim
- 2 Catholic Kwandong University, Gangwon, South Korea
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Smith CM, Trienekens SCM, Anderson C, Lalor MK, Brown T, Story A, Fry H, Hayward AC, Maguire H. Twenty years and counting: epidemiology of an outbreak of isoniazid-resistant tuberculosis in England and Wales, 1995 to 2014. ACTA ACUST UNITED AC 2017; 22:30467. [PMID: 28251890 PMCID: PMC5356435 DOI: 10.2807/1560-7917.es.2017.22.8.30467] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/19/2016] [Indexed: 11/24/2022]
Abstract
An outbreak of isoniazid-resistant tuberculosis first identified in London has now been ongoing for 20 years, making it the largest drug-resistant outbreak of tuberculosis documented to date worldwide. We identified culture-confirmed cases with indistinguishable molecular strain types and extracted demographic, clinical, microbiological and social risk factor data from surveillance systems. We summarised changes over time and used kernel-density estimation and k-function analysis to assess geographic clustering. From 1995 to 2014, 508 cases were reported, with a declining trend in recent years. Overall, 70% were male (n = 360), 60% born in the United Kingdom (n = 306), 39% white (n = 199), and 26% black Caribbean (n = 134). Median age increased from 25 years in the first 5 years to 42 in the last 5. Approximately two thirds of cases reported social risk factors: 45% drug use (n = 227), 37% prison link (n = 189), 25% homelessness (n = 125) and 13% alcohol dependence (n = 64). Treatment was completed at 12 months by 52% of cases (n = 206), and was significantly lower for those with social risk factors (p < 0.05), but increased over time for all patients (p < 0.05). The outbreak remained focused in north London throughout. Control of this outbreak requires continued efforts to prevent and treat further active cases through targeted screening and enhanced case management.
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Affiliation(s)
- Catherine M Smith
- Farr Institute of Health Informatics Research, Department of Infectious Disease Informatics, University College London, London, United Kingdom.,These authors contributed equally to this work
| | - Suzan C M Trienekens
- These authors contributed equally to this work.,Field Epidemiology Service, Liverpool, United Kingdom.,Field Epidemiology Training Programme, Public Health England, London, United Kingdom.,European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Charlotte Anderson
- Field Epidemiology Service - South East and London, Public Health England, London, United Kingdom
| | - Maeve K Lalor
- Public Health England TB Section, Centre for Infectious Disease Surveillance and Control, Colindale, London, United Kingdom.,Research Department Infection and Population Health, Centre for Infectious Disease Epidemiology, University College London, London, United Kingdom
| | - Tim Brown
- Public Health England National Mycobacterium Reference Laboratory, Whitechapel, London, United Kingdom
| | - Alistair Story
- Farr Institute of Health Informatics Research, Department of Infectious Disease Informatics, University College London, London, United Kingdom.,Find and Treat, University College Hospitals NHS Foundation Trust, London, United Kingdom
| | - Hannah Fry
- Centre for Advanced Spatial Analysis, University College London, London, United Kingdom
| | - Andrew C Hayward
- Farr Institute of Health Informatics Research, Department of Infectious Disease Informatics, University College London, London, United Kingdom
| | - Helen Maguire
- Field Epidemiology Service - South East and London, Public Health England, London, United Kingdom.,Research Department Infection and Population Health, Centre for Infectious Disease Epidemiology, University College London, London, United Kingdom
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Kohli A, Kerrigan D, Brahmbhatt H, Likindikoki S, Beckham J, Mwampashi A, Mbwambo J, Kennedy CE. Social and structural factors related to HIV risk among truck drivers passing through the Iringa region of Tanzania. AIDS Care 2017; 29:957-960. [PMID: 28107796 DOI: 10.1080/09540121.2017.1280127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Truck drivers and their assistants have been identified as groups at higher risk for HIV infection. We sought to identify and describe the social and structural factors that may contribute to HIV risk among truck drivers who visit rest stops in Iringa, Tanzania, a region characterized by high levels of migration and mobility. This analysis was part of a comprehensive strategic assessment to examine HIV risk factors in Iringa. This analysis focuses on 11 in-depth interviews with truck drivers and a transport owner. A semi-structured interview guide was developed to elicit open-ended responses and enable probing. Interviews were conducted in Swahili, transcribed, and translated into English. Data analysis followed thematic analysis procedures that included initial reading of transcripts, development of a codebook and identification of themes through in-depth reading of transcripts. Drivers described structural risk factors for HIV including work conditions, the power imbalance between male drivers and their sexual partners and minimal perceived HIV risk with certain partners (e.g., regular partners and women selling sex). Multiple and inter-related social norms associated with truck stop environments influenced HIV risk, including peer influence and expectations, presence of sex workers, ability to purchase sex throughout their travel and alcohol consumption. These distinct social norms in truck stops and other rest points facilitated behavior that many participants said they would not engage in elsewhere. HIV prevention strategies with truck drivers should address individual, social and structural barriers to HIV prevention through partnerships with the health and transportation sectors, local government and local communities. HIV prevention services should be adapted to drivers' times and places of availability, for example, condom provision where/when drivers make decisions about or have sex. A focus on positive messaging and addressing specific challenges including the continual challenge of re-choosing and reinforcing decisions to engage in safer sexual behaviors is important.
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Affiliation(s)
- Anjalee Kohli
- a Johns Hopkins University School of Nursing , Baltimore , MD , USA
| | - Deanna Kerrigan
- b Department of Health, Behavior and Society , Johns Hopkins University , Baltimore , MD , USA
| | - Heena Brahmbhatt
- b Department of Health, Behavior and Society , Johns Hopkins University , Baltimore , MD , USA
| | - Samuel Likindikoki
- c Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Justin Beckham
- d CIEE and Ruaha Catholic University , Iringa , Tanzania
| | - Ard Mwampashi
- c Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Jessie Mbwambo
- c Muhimbili University of Health and Allied Sciences , Dar es Salaam , Tanzania
| | - Caitlin E Kennedy
- b Department of Health, Behavior and Society , Johns Hopkins University , Baltimore , MD , USA
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Patra KC, Shirolkar MS, Ghane VR. Acute disseminated encephalomyelitis: Extremely rare presentation of pediatric human immunodeficiency virus infection. J Pediatr Neurosci 2014; 9:150-3. [PMID: 25250073 PMCID: PMC4166840 DOI: 10.4103/1817-1745.139326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acquired human immunodeficiency virus (HIV) infection in a 10-year-old child, presenting with monoparesis, progressing to triplegia over 4 weeks is an extremely rare feature. The child had left upper motor neurone facial palsy with left hemiplegia, paralyzed right lower limb, grade zero power, exaggerated deep tendon reflexes and bilateral extensor plantars. Child tested positive for HIV by ELISA. CD3(+) absolute count was 431. CD3(+) CD4 count was 28, and CD45 absolute count was 478. Magnetic resonance imaging of brain and spine showed multiple ill-defined foci of hyperintensity in white matter suggestive of ADEM. Acute demyelinating encephalomyelitis (ADEM) is an extremely rare presenting feature of perinatally acquired HIV infection in paediatrics. Clinically child remained same even with methylprednisolone, intravenous immunoglobulin, antituberculosis therapy, trimethoprim-sulfamethoxazole prophylaxis and supportive therapy. Child had sudden clinical deterioration and death before antiretroviral therapy could be initiated. This case emphasizes that pediatricians and neurophysicians should suspect HIV as an etiology of ADEM in cases with atypical clinical presentation and social risk factors, in spite of its very rare occurrence.
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Affiliation(s)
- Kailash Chandra Patra
- Department of Pediatrics, ESI PGIMSR, ESIC Model Hospital, Andheri, Mumbai, Maharashtra, India
| | - Mukund S Shirolkar
- Department of Pediatrics, ESI PGIMSR, ESIC Model Hospital, Andheri, Mumbai, Maharashtra, India
| | - Vaishali R Ghane
- Department of Pediatrics, ESI PGIMSR, ESIC Model Hospital, Andheri, Mumbai, Maharashtra, India
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Abstract
Sociological research on mental health focuses on a multitude of dynamic processes, including changes in psychological symptoms or the onset of a mental disorder, the course and outcome of mental health problems, and the associations of mental health with a wide variety of time-varying social risk and protective factors. I argue that scholars studying mental health have, thus far, only scratched the surface of the temporal dynamics upon which mental health and illness rest. Two broad research issues are reviewed to illustrate important temporal issues that have been neglected or understudied in mental health research: (1) specific dimensions of temporality, which focus on dynamic processes at the individual level, and (2) the age-period-cohort model, which focuses on mental health at the population level. Priority topics for future research that takes time seriously are recommended.
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Abstract
Epidemiological studies have suggested that the association between city upbringing and minority status with risk for schizophrenia can be explained by social mechanisms. Neuroimaging approaches hold promise for investigating this claim. Recent studies have shown that in healthy individuals, city upbringing and minority status are associated with increased activity in brain circuits involved in emotion regulation during social evaluative processing. These findings support the hypothesis that changes in the ability to regulate social stress contribute to the mechanism of risk. This is in accordance with a body of evidence demonstrating the sensitivity of the human brain to social stress, based on observational studies investigating the neurological sequelae of interpersonal trauma and experimental studies manipulating exposure to interpersonal distress. In this report, we summarize these initial findings, discuss methodological and conceptual challenges of pursuing this line of inquiry in schizophrenia, and suggest an outline for future research.
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Affiliation(s)
- Lydia Krabbendam
- *To whom correspondence should be addressed; tel: +31-20-5983606, fax: +31-20-5983346, e-mail:
| | | | - André Aleman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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ABDEL RAHMAN A, AL HASHIM B, AL HIJI N, AL-ABBAD Z. Stress among medical Saudi students at College of Medicine, King Faisal University. J Prev Med Hyg 2013; 54:195-9. [PMID: 24779279 PMCID: PMC4718324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sources of student stress can be academic pressures, social or personal issues and medical students have to face the challenge of rigorous curriculum and also have to learn how to deal with emotionally difficult experiences. AIM OF WORK Determination of the prevalence of stress and to identify the risk factors of stress among Saudi medical students at Faculty of Medicine, King Faisal University, Saudi Arabia. METHODS A survey study design was conducted among medical students at Faculty of Medicine, King Faisal University, Al Ahsaa Governorate, Eastern Province from February-May, 2013. Both male and female students were invited to participate in our study. The total number of students was 650 Saudi medical students, out of them 244 medical students were participated in the current study. All participants were provided a self administered questionnaire. A likert scale with 3 points for responses was used. Questionnaires were given to participants 2 month before end-semester examinations, to minimize the extra stress symptoms A score of stress was calculated. RESULTS Prevalence of stress was 53% among Saudi students. Gender has no role in stress among medical students (p > 0.05). Logistic regression analysis revealed the most important risk factors of stress, having places for recreation at the University showed a relationship with stress among medical students with a p value = 0.000, there is a statistically significant relationship between stress and having optimal place for studying outside the university p = 0.001, while, comparing number of sleeping hours with stress, we could not find a statistically significant relationship among medical students, p = 0.744. Medical students who had close friends to share with them their stresses and concerns showed a highly statistically significant relationship between stressed and unstressed students p = 0.001. CONCLUSION Medical students reported high levels of stress. The most frequently occurring stressors among the students were related to academic and psychosocial domains. The associations between stressed cases and gender, occurrence of academic and psychosocial stressors need to be further tested by prospective studies.
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Affiliation(s)
- A.G. ABDEL RAHMAN
- Department of Community, Environmental and Occupational Medicine-Faculty of Medicine, Suez Canal University, Ismailia, Egypt;, Faculty of Medicine, King Faisal University, Saudi Arabia,Correspondence: A.G. Abdel Rahman, Faculty of Medicine, Community, Environmental and Occupational Medicine Department, Suez Canal University - E-mail:
| | - B.N. AL HASHIM
- Faculty of Medicine, King Faisal University, Saudi Arabia
| | - N.K. AL HIJI
- Faculty of Medicine, King Faisal University, Saudi Arabia
| | - Z. AL-ABBAD
- Faculty of Medicine, King Faisal University, Saudi Arabia
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Abstract
OBJECTIVES Noma is a gangrenous affliction that destroys the soft and hard tissue of the face. It affects exclusively young children from developing countries. Although the risk factors (malnutrition and debilitating diseases) are known, the cause remains a topic of debate. Etiological studies have tried to identify bacterial or viral agents responsible for the illness. We examine for the first time the possibility of a link between this illness and the social practices surrounding childbirth. METHODS This study took place in Niger, where we conducted 18 ethnographic interviews with mothers from four villages. Noma was known in two villages, but unknown in the other two. RESULTS Our results show that inadequate practices related to breastfeeding, weaning, and nutritional supplementation practices are by themselves insufficient to initiate the disease, insofar as most of these practices, paradoxically, were found in the villages not affected by the disease. CONCLUSION The results indicate that these practices are not sufficient to explain noma. They suggest, however, that poor maternal health and nutritional status before and during pregnancy may have an irreversible negative impact on the child's overall health.
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Cornblatt BA, Carrión RE, Addington J, Seidman L, Walker EF, Cannon TD, Cadenhead KS, McGlashan TH, Perkins DO, Tsuang MT, Woods SW, Heinssen R, Lencz T. Risk factors for psychosis: impaired social and role functioning. Schizophr Bull 2012; 38:1247-57. [PMID: 22080497 PMCID: PMC3494064 DOI: 10.1093/schbul/sbr136] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Risk for psychosis is currently defined primarily on the basis of attenuated positive symptoms (APS), with no inclusion of the functional deficits characteristic of schizophrenia. Impaired social and role functioning have been of interest for reflecting poor outcome but far less is known about the developmental impact of these deficits as vulnerability or risk factors. METHODS Age-appropriate social and role functioning were prospectively assessed in 100 individuals at clinical high risk (CHR) for psychosis included in the 8-site North American Prodromal Longitudinal Study database. A nested case-control design was used to compare changes in social and role functioning in 26 individuals converting to psychosis shortly after baseline assessment and 24 converting over a year later. Individuals in each converter subgroup were directly matched to a non-converter at the same site, controlling for time to conversion, age, gender, and severity of baseline symptoms. RESULTS At baseline, CHR subjects who later became psychotic were significantly more likely to be impaired socially than matched non-converters. Onset of psychosis did not further disrupt social difficulties. Role functioning showed some of the same trends, but the overall pattern was not as consistent as for the social domain. Controlling for neurocognition did not change the pattern of group differences. CONCLUSIONS Early impaired social functioning appears to be a risk factor for psychosis and, added to APS, could potentially contribute to accurate identification of CHR individuals and provide a new direction for early intervention to reduce long-term disability.
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Affiliation(s)
- Barbara A. Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore—Long Island Jewish Health System, 75-59 263rd Street, Glen Oaks, NY 11004,Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY,Center for Psychiatric Neuroscience,The Feinstein Institute for Medical Research, North Shore—Long Island Jewish Health System, Manhasset, NY,To whom correspondence should be addressed; tel: 718-470-8133, fax: 718-470-8131, e-mail:
| | - Ricardo E. Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore—Long Island Jewish Health System, 75-59 263rd Street, Glen Oaks, NY 11004,Center for Psychiatric Neuroscience,The Feinstein Institute for Medical Research, North Shore—Long Island Jewish Health System, Manhasset, NY
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Larry Seidman
- Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Boston, MA,Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | | | | | | | | | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ming T. Tsuang
- Center for Behavioral Genomics, Department of Psychiatry, University of California, San Diego, La Jolla, CA,Department of Psychiatry, Harvard Institute of Psychiatric Epidemiology and Genetics, Boston, MA
| | - Scott W. Woods
- Department of Psychiatry,School of Medicine, Yale University, New Haven, CT
| | - Robert Heinssen
- Division of Adult Translational Research and Treatment Development, National Institute of Mental Health, Bethesda, MD
| | - Todd Lencz
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore—Long Island Jewish Health System, 75-59 263rd Street, Glen Oaks, NY 11004,Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY,Center for Psychiatric Neuroscience,The Feinstein Institute for Medical Research, North Shore—Long Island Jewish Health System, Manhasset, NY
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Abstract
OBJECTIVES The goal of this study was to examine the relationship between cumulative social adversity and childhood obesity among preschool-aged children (N = 1605) in the Fragile Families and Child Wellbeing Study. METHODS Maternal reports of intimate partner violence, food insecurity, housing insecurity, maternal depressive symptoms, maternal substance use, and father's incarceration were obtained when the child was 1 and 3 years of age. Two cumulative social risk scores were created by summing the 6 factors assessed at ages 1 and 3 years. Child height and weight were measured at 5 years of age. Logistic regression models stratified according to gender were used to estimate the association between cumulative social risk and obesity, adjusting for sociodemographic factors. RESULTS Seventeen percent of children were obese at age 5 years, and 57% had at least 1 social risk factor. Adjusting for sociodemographic factors, girls experiencing high cumulative social risk (≥2 factors) at age 1 year only (odds ratio [OR]: 2.1 [95% confidence interval [CI]: 1.1-4.1]) or at 3 years only (OR: 2.2 [95% CI: 1.2-4.2]) were at increased odds of being obese compared with girls with no risk factors at either time point. Those experiencing high cumulative risk at age 1 and 3 years were not at statistically significant odds of being obese (OR: 1.9 [95% CI: 0.9-4.0]). No significant associations were noted among boys. CONCLUSIONS There seems to be gender differences in the effects of cumulative social risk factors on the prevalence of obesity at 5 years of age. Understanding the social context of families could make for more effective preventive efforts to combat childhood obesity.
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Affiliation(s)
| | - Cristiane S. Duarte
- Division of Child and Adolescent Psychiatry, Columbia University, New York, New York
| | - Earle C. Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York; and
| | - Renée Boynton-Jarrett
- Division of General Pediatrics, Boston University School of Medicine, Boston, Massachusetts
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Raven MC, Billings JC, Goldfrank LR, Manheimer ED, Gourevitch MN. Medicaid patients at high risk for frequent hospital admission: real-time identification and remediable risks. J Urban Health 2009; 86:230-41. [PMID: 19082899 PMCID: PMC2648879 DOI: 10.1007/s11524-008-9336-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 11/12/2008] [Indexed: 12/01/2022]
Abstract
Patients with frequent hospitalizations generate a disproportionate share of hospital visits and costs. Accurate determination of patients who might benefit from interventions is challenging: most patients with frequent admissions in 1 year would not continue to have them in the next. Our objective was to employ a validated regression algorithm to case-find Medicaid patients at high-risk for hospitalization in the next 12 months and identify intervention-amenable characteristics to reduce hospitalization risk. We obtained encounter data for 36,457 Medicaid patients with any visit to an urban public hospital from 2001 to 2006 and generated an algorithm-based score for hospitalization risk in the subsequent 12 months for each patient (0 = lowest, 100 = highest). To determine medical and social contributors to the current admission, we conducted in-depth interviews with high-risk hospitalized patients (scores >50) and analyzed associated Medicaid claims data. An algorithm-based risk score >50 was attained in 2,618 (7.2%) patients. The algorithm's positive predictive value was equal to 0.67. During the study period, 139 high-risk patients were admitted: 60 met inclusion criteria and 50 were interviewed. Fifty-six percent cited the Emergency Department as their usual source of care or had none. Sixty-eight percent had >1 chronic medical conditions, and 42% were admitted for conditions related to substance use. Sixty percent were homeless or precariously housed. Mean Medicaid expenditures for the interviewed patients were $39,188 and $84,040 per patient for the years immediately prior to and following study participation, respectively. Findings including high rates of substance use, homelessness, social isolation, and lack of a medical home will inform the design of interventions to improve community-based care and reduce hospitalizations and associated costs.
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Affiliation(s)
- Maria C Raven
- Department of Emergency Medicine, NYU School of Medicine, New York, NY 10016, USA.
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