scholarly journals Evaluating Concussion Nondisclosure in College Athletes using a Health Disparities Framework and Appreciation for Social Determinants of Health

2021 ◽  
Author(s):  
Jessica Wallace ◽  
Erica Beidler ◽  
Johna K. Register-Mihalik ◽  
Tamaria Hibbler ◽  
Abigail Bretzin ◽  
...  
Keyword(s):  
High School ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
College Athletes ◽  
Healthcare Access ◽  
Determinants Of Health ◽  
Athletic Trainer ◽  
Black Athletes ◽  
Cross Sectional ◽  
History Of

Abstract Context: There is limited research concerning the relationship between social determinants of health, including race, healthcare access, socioeconomic status (SES), and physical environment; and, concussion nondisclosure in college-athletes. However, in high school athletes, disparities have been noted, with Black athletes attending under-resourced schools and lacking access to an athletic trainer (AT) disclosing fewer concussions. Objective: To investigate whether concussion nondisclosure disparities exist by 1) race, 2) SES, and 3) AT healthcare access prior to college; and to understand the differential reasons for concussion nondisclosure between Black and White college-athletes. Design: Cross-sectional Setting: College athletics Participants: 735 college-athletes (84.6% White, 15.4% Black) Main Outcome Measures: Participants completed a questionnaire that directly assessed concussion nondisclosure, including reasons for not reporting a suspected concussion. With the premise of investigating social determinants of health, race was the primary exposure of interest. The outcome of interest, nondisclosure, was assessed with a binary (yes/no) question, “Have you ever sustained a concussion that you did not report to your coach, athletic trainer, parent, teammate, or anyone else?” Results: Overall, among White and Black athletes 15.6% and 17.7% respectively reported a history of concussion nondisclosure. No significant differences were found by race for distributions of history of concussion nondisclosure (p=0.57). Race was not associated with concussion nondisclosure when evaluated as an effect modification measure or confounder; and, no significant associations were noted by SES or high school AT access. Differences by race for reported reasons for nondisclosure were found for: “At the time I did not think it was a concussion” (p=0.045) and “I thought my teammates would think I am weak” (p=0.03) with Black athletes reporting these more frequently than White athletes. Conclusions: These data help to contextualize race and its intersection with other social determinants of health that could influence concussion nondisclosure outcomes in college-athletes.

600 Social Determinants and Their Impact on Burn Surgery Outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S151-S152
Author(s):  
Luis H Quiroga ◽  
Tomer Lagziel ◽  
Mohammed Asif ◽  
Raymond Fang ◽  
Grace F Rozycki ◽  
...  
Keyword(s):  
Mental Health ◽  
Diabetes Mellitus ◽  
Social Determinants Of Health ◽  
Population Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Hospital Charges ◽  
Burn Patients ◽  
Increased Risk ◽  
History Of

Abstract Introduction To our knowledge, no studies have been conducted assessing the social determinants of health and the impact on the outcomes for burn patients. Such studies are needed considering burn injuries are associated with high costs, severe psychological impact, and a high burden placed on the healthcare systems. The burden is hypothesized to be aggravated by the increasing amount of diabetes and obesity seen in the general population which put patients at increased risk for developing chronic wounds. Studies have shown that several socioeconomic status (SES) factors are associated with increased risk of burns, but none have documented the outcomes of burn patients based on their social determinants of health. In our study, we will be comparing patients in the burn ICU (BICU) to patients in the surgical ICU (SICU). The purpose of this comparison is to evaluate whether the same social determinants of health have similar influences in both groups. Methods We performed a retrospective analysis of population group data from patients admitted to the BICU and SICU from January 1, 2016, to November 18, 2019. The primary outcomes were length-of-stay (LOS), mortality, 30-day-readmission, and hospital charges. Pearson’s chi-square test for categorical variables and t-test for continuous variables were used to compare population health groups. Results We analyzed a total of 487 burn and 510 surgical patients. When comparing BICU and SICU patients, we observed significantly higher mean hospital charges and LOS in burn patients with a history of mental health (mean difference: $42,756.04, p=0.013 and 7.12 days, p=0.0085), ESRD ($57,8124.7, p=0.0047 and 78.62 days, p=0.0104), sepsis ($168,825.19, p=< 0.001 and 20.68 days, p=0.0043), and VTE ($63,9924.1, p=< 0.001 and 72.9 days, p=0.002). Also, higher mortality was observed in burn patients with ESRD, STEMI, sepsis, VTE, and diabetes mellitus. Burn patients with a history of mental health, drug dependence, heart failure, and diabetes mellitus also had greater 30-day-readmissions rates. Conclusions This study sheds new knowledge on the considerable variability that exists between the different population health groups in terms of outcomes for each cohort of critically ill patients. It demonstrates the impacts of population health group on outcomes. These population groups and social determinants have different effects on BICU versus SICU patients and this study provides supporting evidence for the need to identify and develop new strategies to decrease overspending in healthcare. Further research to develop relevant and timely interventions that can improve these outcomes.

scholarly journals Riesgo de diabetes mellitus tipo 2 y sus determinantes

2022 ◽  
Vol 21 (1) ◽  
pp. 179-202
Author(s):  
Mariel Heredia ◽  
Esther Carlota Gallegos Cabriales
Keyword(s):  
Diabetes Mellitus ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Healthcare Providers ◽  
Determinants Of Health ◽  
Risk Indicators ◽  
Short Version ◽  
Cross Sectional ◽  
Factores De Riesgo

Objective: Describe the relationship between social determinants of health and risk of type 2 diabetes mellitus in Mexican population.Methods: This was a cross-sectional descriptive correlational study of a sample of 256 individuals from a rural community in Sinaloa, Mexico. Data collection was carried out from October 2020 to February 2021. A snowball non-probability sampling method was used. The Instruments used were the International Physical Activity Questionnaire (IPAQ), short version, the IPAQ-A for adults, the IPAQ-C for children, and a sociodemographic, anthropometric, and clinical data sheet.Results: The most frequent risk indicators for T2DM for adults are hypertension (81.7%) and overweight/obesity (68.6%); in children, it was overweight/obesity (34.9%). The risk of T2DM increased according to age (r = .560, p < .01) but decreased as education level increased (r = −.127, p < .05)Conclusions: The approach to T2DM risk factors from the perspective of social determinants of health allows strategic healthcare planning that considers the contextual factors associated with a lifestyle that reinforces the actions of healthcare providers. Objetivo: Describir la relación de los determinantes sociales de salud con el riesgo de DMT2 en población mexicana.Métodos: Estudio descriptivo correlacional transversal, con una muestra de 256 individuos de una comunidad rural de Sinaloa, México. La recolección de datos se realizó durante octubre de 2020 y febrero de 2021. El muestreo fue no probabilístico por bola de nieve. Los instrumentos utilizados fueron el cuestionario internacional de actividad física (IPAQ) versión corta, IPAQ-A, IPAQ-C y una hoja de registro datos sociodemográficos, antropométricos y clínicos.Resultados: Los indicadores de riesgo de DMT2 con mayor frecuencia para adultos fue padecer hipertensión arterial (81.7%) y SP/OB (68.6%) y para menores de edad fue tener SP/OB (34.9%). Resultó que el riesgo de DMT2 se acrecentaba según lo hacía la edad (r = .560, p < .01) pero disminuía al aumentar la escolaridad de las personas (r = -.127, p < .05).Conclusiones: El abordaje de factores de riesgo de DMT2 bajo la perspectiva de los DSS brinda la oportunidad de plantear estrategias de salud que contemplen factores contextuales simultáneos al estilo de vida que refuercen las acciones del personal de salud para contribuir a la reducción de los índices de morbimortalidad causados por la DMT2.

scholarly journals Physician Assessment of Social Determinants of Health: A Necessary Component in Improving Care of Patients

2021 ◽  
Vol 11 (S1) ◽  
Author(s):  
Emaan Chaudry
Keyword(s):  
Socioeconomic Status ◽  
Social Determinants Of Health ◽  
Social History ◽  
Low Socioeconomic Status ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Sexual History ◽  
History Of ◽  
Asking Questions ◽  
The Government

The importance of building a therapeutic relationship between a physician and a patient is taught early on in a medical student's training, specifically through the practice of obtaining a patient history. This process consists of gathering information in four main categories: the history of the present illness, personal social history, past medical history, and family history. Each piece of information obtained within these categories is vital in ensuring a patient receives appropriate and effective care. Specifically, a social history consists of asking about a patient's relationship status, support system, home environment, interests, exercise, nutritional habits, substance use, and sexual history. To complete a successful and full social history, one should try to address the social determinants of health. As per the Government of Canada’s website, social determinants of health “refer to a specific group of social and economic factors within the broader determinants of health. These relate to an individual’s place in society such as income, education or employment” [1]. Consequently, a critical component of a complete social history interview should be investigating a patients socioeconomic status. Low socioeconomic status (LSES) has been found to play a role in incidence and susceptibility to a variety of health conditions. As such, I believe that screening for and asking questions pertaining to the socioeconomic status of a patient should be considered a vital and essential component of every patient assessment.

scholarly journals Collection of social determinants of health in the community clinic setting: a cross-sectional study

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Sheila V. Kusnoor ◽  
Taneya Y. Koonce ◽  
Suzanne T. Hurley ◽  
Kalonji M. McClellan ◽  
Mallory N. Blasingame ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Cross Sectional Study ◽  
Determinants Of Health ◽  
Sectional Study ◽  
Cross Sectional ◽  
Community Clinic ◽  
Clinic Setting

The foundations of health promotion.

2021 ◽  
pp. 1-40
Author(s):  
Ruth Cross ◽  
Simon Rowlands ◽  
Sally Foster
Keyword(s):  
Health Promotion ◽  
Social Determinants Of Health ◽  
Recent Work ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Threshold Concepts ◽  
The Social ◽  
Concepts Of Health ◽  
History Of

Abstract This book chapter seeks to: (i) explore concepts of 'health' held by lay people and health promoters; (ii) introduce recent work on the social determinants of health; (iii) introduce certain threshold concepts including salutogenesis, social models of health and upstream thinking; (iv) establish the value base of health promotion; (v) introduce the disciplinary foundations of health promotion; (vi) outline in more detail 'empowerment' as a key value in health promotion; and (vii) describe the key WHO conferences, which provide the milestones in the development of health promotion. This chapter has provided a foundation upon which to base further study; it has presented the key values and principles of health promotion; emphasized the need to tackle the social determinants of health; presented a history of health promotion's development through the WHO-led conferences; introduced some threshold concepts; introduced the disciplines that contribute to health promotion; outlined professional and lay concepts of health; and suggested that empowerment approaches are the essence of health promotion.

Abstract P449: The Impact of Race and Social Determinants of Health on Imaging Biomarkers in Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kristie Bauman ◽  
Shashank Agarwal ◽  
Shadi Yaghi ◽  
Ariane Lewis ◽  
Aaron Lord ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Education Level ◽  
Determinants Of Health ◽  
Imaging Biomarkers ◽  
Median Income ◽  
Black Race ◽  
History Of ◽  
The Brain ◽  
Zip Code

Introduction: The association between race and white matter hyperintensities (WMH) and cerebral microbleeds in patients with intracerebral hemorrhage (ICH) is controversial. We examined the relationship between race and social determinants of health with WMH and microbleeds in ICH. Methods: We performed a retrospective study of patients at a tertiary care hospital between 2013 and 2020 who presented with ICH and underwent MRI of the brain. MRIs were evaluated for the presence of microbleeds and WMH severity (defined by the Fazekas scale; severe WMH defined as Fazekas 3). We assessed for an association of sex, race, ethnicity, employment status, median household income by zip code, education level, and insurance status with the severity of WMH or presence of microbleeds. Results: We identified 105 patients (median age 65.5 (IQR 53-76); 51% females; 13.2% Black) with ICH who had an MRI of the brain. Median ICH score was 1 [IQR 0-2] and median hematoma size was 15.9 ml (SD 19.7). High school graduation was the highest education level in 13.2%, and 57.5% had private insurance. Median income by zip code was $87,667 (IQR $65,900-$117,923). Severe WMH was observed in 19.8% and 52.8% of patients had microbleeds. There was no significant difference in sex, insurance status or median income for patients with or without severe WMH nor those with or without microbleeds. Severe WMH was more common among older patients (p=0.001), Black patients (p=0.03), patients with hypertension (p=0.03), and those with lower levels of education (p=0.03). In multivariable analyses, Black race was associated with severe WMH when adjusting for age and history of hypertension (OR 6.13 95% CI 1.14-25.98, p=0.01) but the effect size attenuated and the association disappears when adding education level to the model (OR 3.38 95% CI 0.48-23.76, p = 0.2). Age and history of hypertension were associated with presence of microbleeds (p<0.01 for both), but there was no association between presence of microbleeds and Black race or education level. Conclusion: Although Black race was associated with severe WMH, this association did not remain after adjusting for level of education. Our findings suggest that social determinants of health can modify the association between race and imaging biomarkers of ICH.

Using a Social Determinants of Health Summary Measure to Predict General Health Status in the BRFSS

2021 ◽  
pp. 089011712110449
Author(s):  
Candace C. Nelson
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
General Health ◽  
Poor Mental Health ◽  
Determinants Of Health ◽  
Social Risk ◽  
Summary Measure ◽  
Cross Sectional

Purpose This study aims to assess the relationship between social determinants of health (SDoH) burden and overall health. Design Three years of Behavioral Risk Factor Surveillance System (BRFSS) data (2017–2019) were combined for this cross-sectional study. Setting Massachusetts. Subjects Out of a possible 21,312 respondents, 16,929 (79%) were eligible for inclusion. Measures To create the SDoH summary measure, items assessing social risk experiences including financial instability (1 item), housing instability (2 items), perceptions of neighborhood crime (1 item), and food insecurity (2 items) were summed to create a count of risk experiences. Outcome measures included self-rated general health, days of poor physical health, and days of poor mental health. Analysis Multivariable logistic regression was used to evaluate the association between each outcome and the SDoH summary measure, adjusting for demographic confounders. Results In adjusted analyses, respondents who reported experiencing 1, 2, 3, or 4+ SDoH had a 1.6 (95% CI: 1.3–2.0), 2.9 (95% CI: 2.3–3.7), 3.2 (95% CI: 2.4–4.3), or 5.3 (95% CI: 4.0–7.0) increased odds (respectively) of self-rated fair/poor health, compared to those who reported zero SDoH. The adjusted relationship between the SDoH summary measure and physical health and mental health was similar in magnitude and statistically significant. Conclusions These results demonstrate that the overall burden of risk due to SDoH is an important predictor of health.

scholarly journals Quality of life of men with AIDS and the model of social determinants of health

2015 ◽  
Vol 23 (2) ◽  
pp. 183-191 ◽  
Author(s):  
Gilmara Holanda da Cunha ◽  
Maria Luciana Teles Fiuza ◽  
Elucir Gir ◽  
Priscila de Souza Aquino ◽  
Ana Karina Bezerra Pinheiro ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Cross Sectional Study ◽  
Determinants Of Health ◽  
University Hospital ◽  
Cross Sectional ◽  
Institutional Review ◽  
One Year

OBJECTIVE: to analyze the quality of life (QoL) of men with AIDS from the perspective of the model of social determinants of health (MSDH). METHOD: cross-sectional study conducted in an outpatient infectious diseases clinic from a Brazilian university hospital over the course of one year with a sample of 138 patients. A form based on the MSDH was used to collect sociodemographic data addressing individual, proximal, intermediate determinants and the influence of social networks together with an instrument used to assess the QoL of people with HIV/AIDS. The project was approved by the Institutional Review Board (Protocol No. 040.06.12). RESULTS: according to MSDH, most men with AIDS were between 30 and 49 years old (68.1%), mixed race (59.4%), heterosexual (46.4%), single (64.5%), Catholic (68.8%), had a bachelor's degree (39.2%), had no children (61.6%), and had a formal job (71.0%). The perception of QoL in the physical, level of independence, environment, and spirituality domains was intermediate, while QoL was perceived to be superior in the domains of psychological and social relationship. A perception of lower QoL was presented by homosexual (p=0.037) and married men (p=0.077), and those with income below one times the minimum wage (p=0.042). A perception of greater QoL was presented by those without a religion (p=0.005), living with a partner (p=0.049), and those who had a formal job (p=0.045). CONCLUSION: social determinants influence the QoL of men with AIDS.

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