Friendship as Medicine

Social isolation is a risk factor for many diseases and overall increased mortality. Alternatively human connection has been noted to lead to healthier lives and longevity. Medical clinicians need to be more aware of this condition and consider how to prescribe friendship. This is not just an issue for the elderly; many Americans are being ravaged by being alone. There are many organizations that we can refer our patients to in order to make connections. This lesson is one we as physicians need to embrace ourselves as loneliness during our busy days is affecting us too.

Facilitating discharge planning: the Risk Assessment of Complex Discharge Index

BACKGROUND

Untimely social interventions prolong hospitalizations, suggesting discharge planning should begin early. This study aimed to create a tool to identify, already in Emergency department, patients at risk of complex discharge for social reasons.

METHODS

We developed the Risk Assessment of Complex Discharge Index (RACDI). In Emergency department, we administered RACDI to patients destined to hospitalization. We calculated sensitivity and specificity of RACDI in identifying patients who need a social intervention. RACDI was compared with simplified BRASS. A multivariable logistic regression explored social intervention predictors (P-value < 0.05).

RESULTS

RACDI was administered to 296 patients. There were significant associations between classes of risk defined by RACDI or by simplified BRASS and social intervention. The sensitivity of RACDI and simplified BRASS was, respectively, 0.59 and 0.43; the specificity 0.81 and 0.83. Chances of social intervention were higher for patients at high risk with RACDI (adjOR:3.13, 95% CI: 1.23-8.00, P = 0.017).

CONCLUSIONS

The reduced items and mostly dichotomous answers made RACDI a tool easy to be used in daily practice. RACDI helps in classifying patients needing discharge planning for social care and is a starting point to standardize the evaluation of social context early in hospitalization. Further work is needed to overcome limitations and assess additional outcomes.

Patient Barriers to Accessing Referred Resources for Unmet Social Needs

INTRODUCTION

Many primary care clinics screen patients for their unmet social needs, such as food insecurity and housing instability, and refer them to community-based organizations (CBOs). However, the ability for patients to have their needs met is difficult to evaluate and address. This study explores patient-reported barriers to accessing referred resources using a conceptual framework that identifies opportunities for intervening to optimize success.

METHODS

Patients who participated in a social needs screening and referral intervention at a Federally Qualified Health Center (FQHC) were called 2 weeks after the clinic encounter. We conducted a directed content analysis across 6 domains of access to examine responses from patients who reported barriers.

RESULTS

Of the 462 patients that were reached for follow-up, 366 patients reported 537 total barriers. The most frequent challenges related to resource availability (24.6%, eg, patients waiting for submitted application to process) and approachability (23.8%, eg, patients lacking information needed to contact or access resources). Barriers in the domains of acceptability (21.6%, eg, competing life priorities such as medical issues, major life events, or caretaking responsibilities) and appropriateness (17.9%, eg, resource no longer needed) largely represented patient constraints expressed only after the clinical encounter. It was less common for patients to identify accommodation (eg, physical limitations, language barriers, transportation barriers, administrative complexity) or affordability of community resources as barriers (11.2% and 0.9%, respectively).

CONCLUSION

Findings suggest opportunities for improvement across the access continuum, from initial referrals from primary care staff during the clinical encounter to patients' attempts to accessing services in the community. Future efforts should consider increased collaboration between health and social service organizations, and advocacy for structural changes that mitigate system-level barriers related to resource availability and administrative complexity.

You Can Call Me "Doctor" and "Friend"

Despite interacting with a number of other people, doctors are at risk of social isolation. The author shares from his experiences how the use of professional titles may unintentionally hinder the development of meaningful relationships at and away from work. This may increase the risk for physicians to experience isolation, loneliness and burnout.

[Fragility and precariousness of people living with HIV]

Fragility and Precariousness of People living with hiv Living with hiv in 2021 means having a Chronic disease that is still not "like the Others". Stigma and discrimination persist. And the prognosis remains uncertain in the Countries of the south where access to care Can be problematic and the emergence of Resistance is a concern. Being treated during the covid-19 pandemic Represented a public health challenge, but Persons living with hiv (plwhiv), who were More precarious and psychologically fragile Than the general population, were more Affected by the difficulties in accessing Care. The population of plwhiv includes two main Groups in particular migrants and msm (men who have sex with men) as indicated By the figures for new infections in 2020. The migrant population affected is heterogeneous, With people who have been living in France for decades but also newcomers Whose migration path is often marked by Traumatic events. In addition to the weight Of the hiv infection itself, frequent aggressions And concerns for loved ones back Home, as well as the weight of exile, result In a high prevalence of psychological disorders. Even today, being homosexual is not always Self-evident, whether the stigma comes from Others or is integrated by the person himself (internalized stigma). Aging is globally depreciated In our society but particularly in The gay community. This community is also Affected by the practice of chemsex and Slam, use of psychoactive substances. All of these elements lead to a high prevalence Of psychological disorders and possible Social insecurity. The care of plwhiv Must be global, it requires taking into account All these aspects, medical, psychological And social, and associating the patients To the care.

The Relationship Between Social Determinants of Health and Functional Capacity in Adult Primary Care Patients With Multiple Chronic Conditions

PURPOSE

Social determinants of health (SDoH) including insecure access to food, housing, and financial resources are critical threats to overall health. We sought to examine this relationship among adult primary care patients with multiple chronic conditions.

METHODS

We obtained cross-sectional data on 2763 adults with chronic medical and behavioral conditions or greater than 2 chronic medical conditions from a survey of participants in Integrating Behavioral Health and Primary Care, a multicenter randomized trial.

RESULTS

The prevalence of 1 or more insecurities was reported in 29% of participants, including food (13%), housing (3%), or financial (25%). Functional capacity ranged from 2.74 to 9.89 metabolic equivalents (METs) (median, 6.05). The distribution of functional capacity was significantly lower for those with any 1 or more SDoH than for those without. Each insecurity independently affected the functional capacity in multivariable analysis.

CONCLUSIONS

Among primary care patients with chronic conditions, SDoH are associated with poorer functional capacity, independent of other social and demographic factors. Primary care offers a promising, if underused, opportunity to intervene in SDoH. There is a need for future studies to explore the role of screening and intervention by primary care providers to mitigate or prevent SDoH.

Impact of novel coronavirus (COVID-19) on daily routines and air environment: evidence from Turkey

Turkish people are facing several problems because of the novel coronavirus (COVID-19), as the pandemic has brought about drastic changes to their daily routines. This study mainly investigates the impact of this pandemic on the daily routines of Turkish. It also unveils how COVID-19 affects the air environment. The adopted methods for data collection are based on open-ended questions and Facebook interviews as per recommended by QSR-International (2012). The sample of this study comprises of Turkish students as well as professional workers. The findings of the research show that there are eighteen different results of COVID-19 that have been identified according to the Turkish people's daily routines. Results reveal that increasing unemployment, decrease in air contamination, high stress and depression, a slowdown in the economic growth, and the tourism industry are profoundly affected due to the COVID-19 in Turkey. Furthermore, on the one hand, the consequences of the pandemic are segregated into social problems and psychological issues in daily routines. On the other hand, they have shown a positive impact on the air environment. This study concludes that, amid the COVID-19 pandemic, the lives of the people in Turkey are subject to deterioration, while the air environment of Turkey is gradually improving.

Impact of novel coronavirus (COVID-19) on daily routines and air environment: evidence from Turkey

Turkish people are facing several problems because of the novel coronavirus (COVID-19), as the pandemic has brought about drastic changes to their daily routines. This study mainly investigates the impact of this pandemic on the daily routines of Turkish. It also unveils how COVID-19 affects the air environment. The adopted methods for data collection are based on open-ended questions and Facebook interviews as per recommended by QSR-International (2012). The sample of this study comprises of Turkish students as well as professional workers. The findings of the research show that there are eighteen different results of COVID-19 that have been identified according to the Turkish people's daily routines. Results reveal that increasing unemployment, decrease in air contamination, high stress and depression, a slowdown in the economic growth, and the tourism industry are profoundly affected due to the COVID-19 in Turkey. Furthermore, on the one hand, the consequences of the pandemic are segregated into social problems and psychological issues in daily routines. On the other hand, they have shown a positive impact on the air environment. This study concludes that, amid the COVID-19 pandemic, the lives of the people in Turkey are subject to deterioration, while the air environment of Turkey is gradually improving.

Soziale Probleme in der hausärztlichen Praxis

Social problems in primary care Objectives: Social problems appear in clinical work as well as in expert opinions for courts and insurances as a major factor in frequently chronic psychosomatic diseases, both in the professional and private environment. On the assumption that unemployed individuals show a higher risk for the development of mental and psychosomatic diseases, we investigated our hypothesis that mostly social issues lie at the center of patients' motivation for consultations.

METHODS

Our questionnaire was dispatched by the Medical Association of Mecklenburg-Vorpommern (MV) to all established general practitioners in that state (n = 1025). It collected information on how social problems were handled in primary-care practices.

RESULTS

The large majority of social problems in MV arise from unemployment and job-related conflicts. Doctors often evaluate these problems using pathological dimensions (medicalization) and provide certificates of disability as a "dysfunctional" approach to the problem.

CONCLUSIONS

The medicalization of social problems indicates a lack of alternatives in our medical system and highlights the inadequate handling up to early retirement based on dysfunctional behavior (incorrect diagnosis, certificate of disability).

Building a Foundation to Reduce Health Inequities: Routine Collection of Sociodemographic Data in Primary Care

INTRODUCTION

Detailed data on social determinants of health can facilitate the identification of inequities in access to health care. We report on a sociodemographic data collection tool used in a family medicine clinic.

METHODS

Four major health organizations in Toronto collaborated to identify a set of 14 questions that covered a range of social determinants of health. These were translated into 13 languages. This survey was self-administered using an electronic tablet to a convenience sample of 407 patients in the waiting room of a primary care clinic. Data were uploaded directly to the electronic medical record.

RESULTS

The rate of valid responses provided for each question was high, ranging from 84% to 100%. The questions with the highest number of patients selecting "do not know" and "prefer not to answer" pertained to disabilities and income. Patients reported finding the process acceptable. In subsequent implementation across 5 clinics, 10,536 patients have been surveyed; only 724 (6.9%) declined to participate.

CONCLUSION

Collecting data on social determinants of health through a self-administered survey, and linking them to a patient's chart, is feasible and acceptable. A modified survey is now administered to all patients. Such data are already being used to identify health inequities, develop novel interventions, and evaluate their impact on health outcomes.

Addressing Social Determinants of Health in a Clinic Setting: The WellRx Pilot in Albuquerque, New Mexico

Although it is known that the social determinants of health have a larger influence on health outcomes than health care, there currently is no structured way for primary care providers to identify and address nonmedical social needs experienced by patients seen in a clinic setting. We developed and piloted WellRx, an 11-question instrument used to screen 3048 patients for social determinants in 3 family medicine clinics over a 90-day period. Results showed that 46% of patients screened positive for at least 1 area of social need, and 63% of those had multiple needs. Most of these needs were previously unknown to the clinicians. Medical assistants and community health workers then offered to connect patients with appropriate services and resources to address the identified needs. The WellRx pilot demonstrated that it is feasible for a clinic to implement such an assessment system, that the assessment can reveal important information, and that having information about patients' social needs improves provider ease of practice. Demonstrated feasibility and favorable outcomes led to institutionalization of the WellRx process at a university teaching hospital and influenced the state department of health to require managed care organizations to have community health workers available to care for Medicaid patients.

Depression screening and treatment in uninsured urban patients

BACKGROUND

Depression has been widely studied in primary care settings, yet studies of medically uninsured populations are lacking. We sought to determine whether depression screening and treatment improved depression scores of a medically uninsured, mostly African American primary care population.

METHODS

The study was a prospective repeated-measures design that recruited uninsured patients. Patients were screened for depression, and the rate of depression diagnosis was compared with baseline. Patients who were diagnosed and accepted treatment were randomized to 1 of 4 treatment arms: (1) usual care; (2) usual care and psychotherapy; (3) usual care and education and psychotherapy; and (4) usual care and education. Patients were then reevaluated at 8, 12, and 24 weeks.

RESULTS

A total of 674 patients participated. Depression prevalence was significantly higher among those screened (38%) than at baseline (16%). All treatment groups showed a significant reduction in depression scores over a 6-month period, from a mean score of 15 at baseline to 8.3 at 24 weeks (P < .005). All treatment interventions were equally effective.

CONCLUSION

Screening improves the rate of diagnosis of depression in an uninsured, primarily African American population, and subsequent treatment significantly reduces the burden of depression.

Maternal depressive symptoms, employment, and social support

OBJECTIVE

The purpose of this study was to characterize the relationship between maternal depressive symptoms and employment and whether it is mediated by social support.

METHODS

We used data from a nationally representative sample of 700 US women who gave birth in 2005 and completed 2 surveys in the Listening to Mothers series, the first in early 2006, an average of 7.3 months postpartum, and the second an average of 13.4 months postpartum. A dichotomous measure of depressive symptoms was calculated from the 2-item Patient Health Questionnaire, and women reported their employment status and levels of social support from partners and others. We modeled the association between maternal employment and depressive symptoms using multivariate logistic regression, including social support and other control variables.

RESULTS

Maternal employment and high support from a nonpartner source were both independently associated with significantly lower odds of depressive symptoms (adjusted odds ratio [AOR], 0.35 and P = .011, and AOR, 0.40, P = .011, respectively). These relationships remained significant after controlling for mothers' baseline mental and physical health, babies' health, and demographic characteristics (AOR, 0.326 and P = .015, and AOR, 0.267 and P = .025, respectively).

CONCLUSIONS

Maternal employment and strong social support, particularly nonpartner support, were independently associated with fewer depressive symptoms. Clinicians should encourage mothers of young children who are at risk for depression to consider ways to optimize their employment circumstances and "other" social support.

Early lessons and challenges from the healthy Mendocino community of solution

Northern California's Mendocino County is joining the national movement to upgrade the quantity and quality of local data available for assessing and improving local health. A broad-based coalition in the county has successfully engaged 20 community partners in funding a web-based tool for this purpose. HealthyMendocino.org, launched in January 2013, is designed to support setting local priorities, planning and evaluating the program, and building community by giving easy access to timely data on 90 indicators of local health and its determinants compiled from a range of state and federal sources. This article, written before the site's launch by the Chair of the Healthy Mendocino Steering Committee, describes the community of solution that came together to envision, publicize, raise support for, and bring to fruition this new resource. Mendocino is a rural county with limited financial capacity but rich social assets, including a strong collaborative tradition and an infrastructure of dynamic coalitions. This article outlines the anticipated benefits, early lessons, and challenges of the initiative and explains how the organizers leveraged connections with other communities of solution that already are working to improve the quality of life in the area. The article also notes ways in which this local initiative illustrates and aligns with several of the grand challenges outlined in the modern Folsom Report-specifically, challenges 7, 8, 11, 12, and above all 13, which concerns the use of health information technology to enable the flow of knowledge to the community of solution.

Regional Law No. 51, 18 November 1987

This Law establishes a center for the realization of equality and equal opportunity between men and women. The center is to promote investigations and research on the condition of women, promote institutional initiatives, and plan projects and give opinions in order to verify whether existing laws on equality are being applied; to promote the access of women to jobs and increase the opportunities for the instruction and professional advancement for women, and to encourage the real possibility of the insertion of women in social life, while supporting an adequate social services policy. Commissions having the same objective were established in 1987 in Calabria (Regional Law No. 4, 26 January 1987; Gazzetta Ufficiale, 3rd Special Series. No. 14, 4 April 1987, p. 31); Tuscany (Regional Law No. 14, 23 February 1987; Gazzetta Ufficiale, 3rd Special Series, No. 18, 9 May 1987, pp. 28-29); and Piemonte (Regional Law No. 46, 12 November 1986; Gazzetta Ufficiale, 3rd Special Series, No. 9, 28 February 1987, pp. 26).

Evidence Act 1983

Among other things, this Act provides that only male witnesses are judicious witnesses. It also provides that one way the offence of fornication may be proved when there are not witnesses is by the husband repeating his testimony as to the fact of adultery five times, on the fifth time calling for Allah to curse him if he is lying. Criminal Court Circular 97/83 of 24 November 1983 specifically requires that witnesses be male Muslims.

Vera Mia Beets-Proper v. F. van Lanschot Bankiers NV, 21 November 1986

The Supreme Court of the Netherlands held that a provision of a contract stipulating that a female employee was entitled to a pension at age 60 and a male employee at age 65 was void and in violation of European Community Council Directive of 9 September 1976. It reached this decision following a similar decision by the European Court of Justice.

United Kingdom. Court of Appeal. Pickstone v. Freemans plc, 25 March 1987

The applicants, female warehouse operatives for the defendant, challenged the defendant's policy of paying warehouse checkers more than they were being paid. They claimed that both groups were engaged in work of equal value and should be given equal pay. The case was dismissed by a lower court because the defendant employed men in both positions at the same pay as women in those positions and the Equal Pay Act 1970 prohibited suits in such circumstances. The Court of Appeal reversed this decision, holding that Article 119 of the EEC Treaty authorized the suit and overrode conflicting national legislation. It remanded the case for determination whether the pay differential between the two jobs was due to reasons other than sex discrimination.

Couple formation and fertility outside marriage in Great Britain: differences and similarities with the French situation

"In this paper, we shall attempt to give a detailed presentation of the recent evolution of the mechanisms of family formation in Great Britain. Basing our investigations on an original use of retrospective longitudinal data, we shall, in effect, explore the changes in the behaviours of successive generations and, as far as possible, relate these to comparable data on the French situation. This study aims at a more specific analysis of the respective evolutions in the two countries in order to show how, despite similarities in trends, these evolutions remain profoundly marked by their own socio-political and cultural traits. This will also bring to light the differences and similarities between France and Great Britain in family formation and, more specifically, in the evolution of extra-marital births and cohabitation."