Whence Social Determinants of Health?: Effective Personalized Medicine and the 2010 Patient Protection and Affordable Care Act

2012 ◽  
Vol 04 (02) ◽  
Author(s):  
Priya Venkatesan Hays
Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1191
Author(s):  
Talía Sainz ◽  
Valeria Pignataro ◽  
Donato Bonifazi ◽  
Simona Ravera ◽  
María José Mellado ◽  
...  

The evolving field of microbiome research offers an excellent opportunity for biomarker identification, understanding drug metabolization disparities, and improving personalized medicine. However, the complexities of host–microbe ecological interactions hinder clinical transferability. Among other factors, the microbiome is deeply influenced by age and social determinants of health, including environmental factors such as diet and lifestyle conditions. In this article, the bidirectionality of social and host–microorganism interactions in health will be discussed. While the field of microbiome-related personalized medicine evolves, it is clear that social determinants of health should be mitigated. Furthermore, microbiome research exemplifies the need for specific pediatric investigation plans to improve children’s health.


2021 ◽  
Author(s):  
Thejus Jayakrishnan ◽  
Veli Bakalov ◽  
Gene Finley ◽  
Dulabh Monga ◽  
Rodney E Wegner

Abstract BackgroundTo achieve progress in cancer treatment, socioeconomic disparities impacting the care need to be recognized and addressed. We hypothesized that social determinants of health may predict a delay in systemic therapy for metastatic hepatocellular carcinoma patients (HCC) and sought to examine the impact of the Affordable Care Act (ACA).MethodsNational Cancer Database (NCDB) was queried for patients with metastatic hepatocellular carcinoma diagnosed from 2004-2015 and considered for first line systemic therapy within 6 months (180 days) of diagnosis. Time to initiation (TTI) was defined as the time in days(d) from diagnosis of cancer to initiation of systemic therapy. Survival was measured in months(m) from the day of diagnosis. Multivariate analyses were performed using 2010 as a cut-off between pre-and post-ACA for analysis.Results630 patients meeting the eligibility criteria. Median TTI in the group was 57d. The only factor associated with delayed TTI (defined as the fourth quartile of TTI) in a multivariate logistic regression was non-Hispanic Black (NHB) race Odds Ratio OR 1.94(95%CI 1.0–3.3), p-value=0.052. The OR showed improvement with implementation of ACA – OR3.6(95%CI 1.4-9.4),p-value 0.008 during pre-ACA vs. 1.3(0.5-3.1),p-value=0.6 post-ACA. There was a non-significant trend towards higher mortality among NHB vs. NHW (HR 1.2, 95% CI 1.0-1.6) and lower mortality for those insured vs. uninsured (HR 0.8, 95% CI 0.5-1.1. ConclusionRace appears to impact timeliness to therapy in metastatic HCC patients and was positively impacted by ACA. Continued research to monitor disparities in care and identify underlying mechanisms to mitigate them are warranted.


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.


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