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Social determinants of health (SDoH), such as socioeconomics and neighborhoods, strongly influence health outcomes. However, the current state of standardized SDoH data in electronic health records (EHRs) is lacking, a significant barrier to research and care quality.
Methods:
We conducted a PubMed search using “SDOH” and “EHR” Medical Subject Headings terms, analyzing included articles across 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:
Of 685 articles identified, 324 underwent full review. Key findings include implementation of tailored screening instruments, census and claims data linkage for contextual SDoH profiles, NLP systems extracting SDoH from notes, associations between SDoH and healthcare utilization and chronic disease control, and integrated care management programs. However, variability across data sources, tools, and outcomes underscores the need for standardization.
Discussion:
Despite progress in identifying patient social needs, further development of standards, predictive models, and coordinated interventions is critical for 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.
Arguably the most interesting source for the religious views of the early English evangelical Thomas Bilney (1495–1531) are the annotations in his copy of the Vulgate. Unfortunately, scholars have accessed these annotations almost exclusively through the error-riddled and selective summary provided in 1940 by J. Y. Batley. This study corrects Batley's most significant errors and provides transcriptions and translations of the most interesting annotations that he omitted. These include discussions of clerical celibacy, whether God is the author of evil, which biblical texts are authentically canonical and the nature of the law, justification and salvation.
Although there has been significant research on the relationship between alcohol consumption and demographic and psychological influences, this does not consider the effect of social influence among older drinkers and if these effects differ between men and women. One aspect of social influence is social capital. The aim of this paper is to examine whether relational and cognitive social capital are associated with higher or lower risk of alcohol use among adults aged 50 years or older and to assess the extent to which this relationship differs between men and women. To investigate this, data were collected from a cross-sectional questionnaire survey of adults over the age of 50 in the United Kingdom who were recruited from general practitioners. The sample consisted of 9,984 individuals whose mean age was 63.87 years. From these data, we developed proxy measures of social capital and associate these with the respondent's level of alcohol consumption as measured on the Alcohol Use Disorders Identification Test (AUDIT-10) scale. In the sample, just over 20 per cent reported an increasing risk or dependency on alcohol. Using two expressions of social capital – relational (social relationships) and cognitive (knowledge acquisition and understanding) – we found that greater levels of both are associated with a reduced risk of higher drinking risk. Being female had no significant effect when combined with relational capital but did have a significant effect when combined with cognitive capital. It is argued that interventions to enhance social relations among older people and education to help understand alcohol risks would be helpful to protect older people from the damaging effects of excessive alcohol consumption.
Vancomycin overuse is common, yet few data are available regarding how to improve stewardship of this antibiotic. We identify an association between use of a PCR assay to rule out MRSA pneumonia and a significant, sustained decrease in average vancomycin days of therapy over a 30-month period.
The social and economic forces that shape attitudes toward the welfare state are of central concern to social scientists. Scholarship in this area has paid limited attention to how working part-time, the employment status of nearly 20% of the U.S. workforce, affects redistribution preferences. In this article, we theoretically develop and empirically test an argument about the ways that part-time work, and its relationship to gender, shape redistribution preferences. We articulate two gender-differentiated pathways—one material and one about threats to social status—through which part-time work and gender may jointly shape individuals’ preferences for redistribution. We test our argument using cross-sectional and panel data from the General Social Survey in the United States. We find that the positive relationship between part-time employment, compared to full-time employment, and redistribution preferences is stronger for men than for women. Indeed, we do not detect a relationship between part-time work and redistribution preferences among women. Our results provide support for a gendered relationship between part-time employment and redistribution preferences and demonstrate that both material and status-based mechanisms shape this association.
Healthcare workers (HCWs) have a theoretically increased risk of contracting severe acute respiratory coronavirus virus 2 (SARS-CoV-2) given their occupational exposure. We tested 2,167 HCWs in a London Acute Integrated Care Organisation for antibodies to SARS-CoV-2 in May and June 2020 to evaluate seroprevalence. We found a seropositivity rate of 31.6% among HCWs.
This article examines the theoretical connections between identity and linked fate, extending the latter concept across three countries and four types of (potential) identity groups. This belief, that what happens to one's ethnic group, religious group, region, or class shapes one's own life chances, is an understudied middle ground between ideational and material drivers of political attitudes. The study uses experimental and observational analyses to show that the strength of individuals' beliefs in linked fate and that belief's consequences vary in systematic and predictable ways. From the very material effect of labor market uncertainty to the highly ideational effect of regional identity, linked fate is a cognitive bridge between two very different kinds of social–psychological experiences that can (and should) be applied across a wide range of countries and groups.
Community-based strategies designed to minimize the impact on local emergency services during mass gathering events (MGEs) require evaluation to provide evidence to inform best practice.
Aim:
This study aimed to describe characteristics and outcomes for people aged 16-18 years requiring emergency care before, during, and after a planned youth MGE “Schoolies week” on the Gold Coast, Australia.
Methods:
A retrospective observational study was undertaken. Presentations from all young adults to the emergency department (ED) or In-Event Health Service (IEHS) over a 21-day period in 2014 were included. Descriptive and inferential analyses were performed to compare across time and to describe characteristics of and outcomes for young adults requiring healthcare.
Results:
A total of 1029 presentations were made by youth aged 16 – 18 to the ED and IEHS over the study period (ED: 139 pre, 275 during, and 195 post; IEHS: 420 during). Patient characteristics and outcomes to the ED that varied significantly between pre, during, and post Schoolies periods included patient’s age (higher proportion of 17-year-olds), residing outside the Gold Coast region, and not waiting for treatment. All were higher during Schoolies week. Of the 24,375 MGE attendees, 420 (1.72% [95% CI, 1.57 – 1.89], 17.2/1,000) presented to the IEHS. The majority were toxicology related (n=169, 44.9%). Transportation to hospital rate was low (0.03% [95% CI, 0.01 – 0.06], 0.3/1,000) for the 24,375 MGE attendees.
Discussion:
Findings from this study support previous research indicating that MGEs can impact local emergency healthcare services. The provision of the IEHS may have limited this impact. The recipients of care delivery, predominantly males with trauma- or toxicology-related problems, warrants further investigation. Research describing the structures and processes of the IEHC could further inform health care delivery in and out of hospital settings.
Comparable household income measures are crucial for most social science analyses of cross-national public opinion survey data. However, income questions in many cross-national surveys suffer from comparability and interpretability limitations that have not been adequately addressed by the existing literature. In this article, we examine the income measure in one major survey, the World Values Survey (WVS), arguing that a variety of problems arise when drawing inferences—descriptive or causal, individual or aggregate—using the standard ten-category measure. We then propose and implement a number of corrections to these potential biases and present a series of diagnostics that confirm the importance of our proposed corrections. We conclude by documenting some of the same challenges in the income measures used in other cross-national surveys. The accompanying data set can be merged with the WVS to make better use of the income measure.
This study explored qualitatively how residents of long-term care (LTC) facilities feel about and adapt to the care they receive. We interviewed and observed a purposeful selection of elderly residents in seven facilities purporting to provide person-centred care. Interpretative descriptions from 43 personal interviews with 23 participants answered the question: How do residents perceive the care rendered in LTC facilities purporting to offer person-centred care? Three themes emerged: (1) the caring environment; (2) preservation of dignity; and (3) maintenance of personal autonomy. Participants were sympathetic to the nursing staff’s workload, but felt distant from the staff. Participants gave examples of poor care and lack of empathy, human indignities, and violations of personal autonomy caused by institutional policies they felt inhibited their ability to receive care based on their preferences. Overall, they challenged the claims of person-centred care, but adapted to cope with an environment that threatened their dignity and autonomy.
The present study aimed to identify themes emerging from an inclusive therapeutic recreational camp experience for children with disabilities who attended a 10-day summer camp. Concept mapping was used to analyse the experience of 42 participants. Results emerged with seven themes: Personal Growth; Nurturing Relationships; Non-judgmental Environment and Attitude; Traditional/Classic Camp Fun; Beneficial and Unique Opportunities; Learning/Thinking with Structures and Rules; and Independence and Recognition. Results suggested that children with disabilities experienced positive personal growth and learned new skills from an integrated, therapeutic camp. These children benefited from the social and psychological aspects of the camp experience, as well as the learned skillset and behaviours. Clinical implications and future research directions are also discussed.
In Canada and the USA, ice hockey is a cause of traumatic brain injury. Post-concussive symptoms are the most important feature of the diagnosis of concussion in sports and it is recommended that athletes not return to play while still symptomatic. Lack of knowledge of concussions could therefore be one of the main detriments to concussion prevention in hockey. The purpose of this research is to describe what minor league hockey players, coaches, parents and trainers know about concussion and its management.
Methods:
A questionnaire to assess concussion knowledge and return to play guidelines was developed and administered to players at different competitive levels (n = 267), coaches, trainers and parents (total adults n = 142) from the Greater Toronto Area.
Results:
Although a majority of adults and players could identify mechanisms responsible for concussion, about one-quarter of adults and about a quarter to a half of children could not recall any symptoms or recalled only one symptom of a concussion. A significant number of players and some adults did not know what a concussion was or how it occurred. Almost half of the players and a fifth of the adults incorrectly stated that concussion was treated with medication or physical therapy. Nearly one quarter of all players did not know if an athlete experiencing symptoms of concussion should continue playing.
Conclusions:
This study demonstrated that a significant number of people held misconceptions about concussion in hockey which could lead to serious health consequences and creates a need for better preventive and educational strategies.
While there are many studies on the impact of the economy on elections, there is little evidence on the full mechanism of economic voting implied by performance-based theories of elections. Addressing the scarcity of evidence on the mechanism, this study provides the first estimates of the linkage between macroeconomic performance, individual economic evaluations, and vote choice. Building on recent advances in the statistical analysis of causal mechanisms, we conduct a causal mediation analysis in a data set covering 151 surveys in 18 countries. We find that the effect of economic performance on the incumbent vote is largely accounted for by voters’ retrospective evaluations of the national economy. The effect is stronger in contexts where policymaking power is concentrated rather than dispersed. Altogether, the results imply that the performance-based channel of voting is more relevant in accounting for election outcomes than suggested by recent individual-level studies.
Do economic considerations shape attitudes toward immigration? In this article, we consider the relationship between economic interests and immigration preferences by examining how developments in individuals’ sectors of employment affect these views. Using survey data across European countries from 2002 to 2009 and employing new measures of industry-level exposure to immigration, we find that sectoral economies shape opinions about immigration. Individuals employed in growing sectors are more likely to support immigration than are those employed in shrinking sectors. Moreover, the economic context matters: making use of the exogenous shock to national economies represented by the 2008 financial crisis, we show that sector-level inflows of immigrant workers have little effect on preferences when economies are expanding, but that they dampen support for immigration when economic conditions deteriorate and confidence in the economy declines. These sectoral effects remain even when controlling for natives’ views about the impact of immigration on the national economy and culture. When evaluating immigration policy, individuals thus appear to take into account whether their sector of employment benefits economically from immigration.
Objectives: The mode of contact and response levels of authors who had been asked to provide missing or incomplete data for a systematic review on diet and exercise interventions for weight loss was examined.
Methods: We contacted authors by electronic mail, letter, or both. Survival analyses were performed with the Kaplan–Meier method to determine differences in the proportion of responders over time among the different modes of contact and to determine whether response rates differed between authors from the United States and those from other countries. Logistic regression was used to determine whether the number of items requested and publication date influenced the likelihood of response.
Results: Two hundred forty-one (39.9 percent) studies had missing or incomplete data (e.g., sample size, age, caloric restriction, exercise amount, and so on). We were unable to locate ninety-five authors (39.4 percent). Of the remaining authors, forty-six authors (31.5 percent) responded to information requests. Time to respond differed by contact method (p<.05): e-mail (3 ± 3 days), letter (27 ± 30 days), and both (13 ±12 days). Response rates from U.S. authors did not differ from those of other countries.
Conclusions: Our study suggests poor success in the acquisition of essential information. Given considerable time and resources, weight loss studies require improved reporting standards to minimize the relatively unsuccessful attempt to contact authors for important and necessary information.
Objectives: Much has been written about the costs and cost-effectiveness of community care for people with learning disabilities resettled from long stay hospital care. However, comparatively little has been published about the cost of hospital services relating to the preparatory process before eventual resettlement and the disengagement of formal, sustained input from hospital staff. This study describes and costs the input provided by a hospital based multi-disciplinary team into the resettlement of adults with learning disabilities from long stay wards in Muckamore Abbey Hospital in Northern Ireland between 1996 and 1999 (n = 71).
Method: The study employs a retrospective survey design. Information about the nature and frequency of the input of each member of hospital multi-disciplinary team was collected for each former client. According to the level of professional resources expended during the resettlement process, each former client was then categorised into one of three categories. One case was then selected at random to represent each category. A summary of clinical information, a description of the resettlement process and an estimate of the cost of the process was provided for each case.
Results: Approximately 55% of people resettled in the community during the study period did so with a modest degree of input from hospital staff. For 18% resettlement proved to be a demanding and prolonged process, requiring intensive input from hospital staff. Financial costs of the resettlement process ranged from approximately stg£1,500 to stg£8,000, with an average of stg£3,400 for each person.
Conclusion: This study provides evidence of the input by hospital staff into the process of community resettlement of long stay hospital clients and the associated costs. These costs must be included in service budgets if quality care and appropriate service provision is to be maintained in resettlement practice.