scholarly journals Influence of the COVID-19 pandemic on social determinants of health among an inner-city obstetric population

2022 ◽  
Vol 226 (1) ◽  
pp. S378
Author(s):  
Leah M. Hefelfinger ◽  
Braxton Forde ◽  
Katlynn V. McFarland ◽  
Christina Mendez ◽  
Elizabeth Kelly ◽  
...  
2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e56-e56
Author(s):  
Pamela Ng ◽  
Justine Cohen-Silver ◽  
Heather Yang ◽  
Aparna Swaminathan ◽  
Anne Wormsbecker

Abstract BACKGROUND Paediatric School Outreach (PSO) clinic is a school-based health centre housed in a Kindergarten-Grade 8 public school. It serves an inner-city community impacted by the social determinants of health, such as language and income, which are barriers to accessing health care. This clinic focuses on developmental/behavioural, mental health and educational concerns. OBJECTIVES To characterize demographics, social determinants of health and some clinical characteristics of patients accessing services at PSO. By gaining a better understanding of the challenges of patients, services may be tailored to better suit patient/family needs. DESIGN/METHODS We conducted a retrospective chart review of children enrolled at PSO from November 2015 to March 2017. Data were obtained from demographic questionnaires and the electronic medical record. Analyses were performed in Microsoft Excel and SPSS (version 23) and are primarily descriptive. This work was funded by a faculty of medicine student research program and approved by research ethics boards at our hospital and school board. RESULTS 138 children, between the ages of 2 and 15 years (average birth year 2008) enrolled at PSO during the study period. 73% were male. 70% of patients were in Grade 1 or above at enrolment. Children tended to be Canadian born to immigrant mothers; 74% of children were born in Canada but only 34% of mothers were also Canadian-born. After Canada, Hungary was the second common maternal place of birth (12%). English was the most common language spoken by patients (71%), followed by Hungarian, Tibetan, Portuguese and Spanish. 58% of patients’ families had a household annual income (HAI) of <$30,000 and 18% a HAI of $30,000–49,999. 84% of 138 patients reported having a family physician. Referrals were made by school support team (54%), teacher (36%) or principal (28%). The common presenting concerns were behaviour (81%), school performance (60%), followed by social communication (51%) and emotional presentation (49%). Among 132 patients with clinical records, 13% were on any medication at enrolment; and 3% (4/132) on psychostimulants. 14% of patients were started on medication during the study period, most frequently psychostimulants (11%, 15/132). CONCLUSION PSO patients are culturally diverse and at least three quarters have HAIs below our city’s median of $65,829 (2015). The majority reported having a family physician but accessed our clinic for educational/behavioural concerns, suggesting PSO may be a stream-lined approach. With knowledge of maternal languages, we can begin to translate questionnaires and clinic materials. Further data analyses will better describe diagnoses and referrals made at the clinic.


2019 ◽  
Vol 101 (4) ◽  
pp. 357-395 ◽  
Author(s):  
Saty Satya-Murti ◽  
Jennifer Gutierrez

The Los Angeles Plaza Community Center (PCC), an early twentieth-century Los Angeles community center and clinic, published El Mexicano, a quarterly newsletter, from 1913 to 1925. The newsletter’s reports reveal how the PCC combined walk-in medical visits with broader efforts to address the overall wellness of its attendees. Available records, some with occasional clinical details, reveal the general spectrum of illnesses treated over a twelve-year span. Placed in today’s context, the medical care given at this center was simple and minimal. The social support it provided, however, was multifaceted. The center’s caring extended beyond providing medical attention to helping with education, nutrition, employment, transportation, and moral support. Thus, the social determinants of health (SDH), a prominent concern of present-day public health, was a concept already realized and practiced by these early twentieth-century Los Angeles Plaza community leaders. Such practices, although not yet nominally identified as SDH, had their beginnings in the late nineteenth- and early twentieth-century social activism movement aiming to mitigate the social ills and inequities of emerging industrial nations. The PCC was one of the pioneers in this effort. Its concerns and successes in this area were sophisticated enough to be comparable to our current intentions and aspirations.


Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 648-P
Author(s):  
DOROTA CARPENEDO ◽  
SONJA TYSK ◽  
MELISSA HOUSE ◽  
JESSIE FERNANDES ◽  
MARCI K. BUTCHER ◽  
...  

2019 ◽  
Vol 24 (2) ◽  
pp. 159-165
Author(s):  
Jillian M. Berkman ◽  
Jonathan Dallas ◽  
Jaims Lim ◽  
Ritwik Bhatia ◽  
Amber Gaulden ◽  
...  

OBJECTIVELittle is understood about the role that health disparities play in the treatment and management of brain tumors in children. The purpose of this study was to determine if health disparities impact the timing of initial and follow-up care of patients, as well as overall survival.METHODSThe authors conducted a retrospective study of pediatric patients (< 18 years of age) previously diagnosed with, and initially treated for, a primary CNS tumor between 2005 and 2012 at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Primary outcomes included time from symptom presentation to initial neurosurgery consultation and percentage of missed follow-up visits for ancillary or core services (defined as no-show visits). Core services were defined as healthcare interactions directly involved with CNS tumor management, whereas ancillary services were appointments that might be related to overall care of the patient but not directly focused on treatment of the tumor. Statistical analysis included Pearson’s chi-square test, nonparametric univariable tests, and multivariable linear regression. Statistical significance was set a priori at p < 0.05.RESULTSThe analysis included 198 patients. The median time from symptom onset to initial presentation was 30.0 days. A mean of 7.45% of all core visits were missed. When comparing African American and Caucasian patients, there was no significant difference in age at diagnosis, timing of initial symptoms, or tumor grade. African American patients missed significantly more core visits than Caucasian patients (p = 0.007); this became even more significant when controlling for other factors in the multivariable analysis (p < 0.001). African American patients were more likely to have public insurance, while Caucasian patients were more likely to have private insurance (p = 0.025). When evaluating survival, no health disparities were identified.CONCLUSIONSNo significant health disparities were identified when evaluating the timing of presentation and survival. A racial disparity was noted when evaluating missed follow-up visits. Future work should focus on identifying reasons for differences and whether social determinants of health affect other aspects of treatment.


Author(s):  
Sridhar Venkatapuram

The term health disparities (also called health inequalities) refers to the differences in health outcomes and related events across individuals and social groups. Social determinants of health, meanwhile, refers to certain types of causes of ill health in individuals, including lack of early infant care and stimulation, lack of safe and secure employment, poor housing conditions, discrimination, lack of self-respect, poor personal relationships, low community cohesion, and income inequality. These social determinants stand in contrast to others, such as individual biology, behaviors, and proximate exposures to harmful agents. This chapter presents some of the revolutionary findings of social epidemiology and the science of social determinants of health, and shows how health disparities and social determinants raise profound questions in public health ethics and social/global justice philosophy.


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