Variability and Vulnerability at the Ecological Level: Implications for Understanding the Social Determinants of Health

Objectives. We examined variability in disease rates to gain understanding of the complex interactions between contextual socioeconomic factors and health. Methods. We compared mortality rates between New York and California counties in the lowest and highest quartiles of socioeconomic status (SES), assessed rate variability between counties for various outcomes, and examined correlations between outcomes’ sensitivity to SES and their variability. Results. Outcomes with mortality rates that differed most by county SES were among those whose variability across counties was high (e.g., AIDS, homicide, cirrhosis). Lower- SES counties manifested greater variability among outcome measures. Conclusions. Differences in health outcome variability reflect differences in SES impact on health. Health variability at the ecological level might reflect the impact of stressors on vulnerable populations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40316/2/Karpati_Variability and Vulnerability at the Ecological_2002.pd

Raising awareness of human trafficking in key professional fields via a multidisciplinary educational approach

Purpose Human trafficking (HT) for sex and labor services is among the fastest growing criminal enterprises, causing significant physical and psychological morbidity to victims. Although many survivors encounter medical, legal and social work professionals during their captivity, lack of awareness of HT in these fields results in under-recognition of victims. The purpose of this study is to evaluate the effectiveness of a multidisciplinary educational conference on raising awareness of HT in these fields. Design/methodology/approach A single-day educational conference on HT was hosted in Miami, Florida. Participants were recruited from medical, law enforcement, social work and political fields. The research team issued a ten-item HT survey at the start and end of the conference. Results were analyzed for improvement in survey score using an exact Wilcoxon sign rank test. The results were analyzed both as a single cohort and stratified by profession. Findings For all participants, there was a significant improvement in post-survey score (0.355, p < 0.05). When stratified by profession, significant improvement was noted in the legal subgroup (0.561, p < 0.05). No significant changes were noted for the other individual professional cohorts, although all subgroups trended toward improvement. Research limitations/implications A multi-disciplinary educational conference may be effective in raising awareness of HT. Further research is needed to determine the effect of increased awareness on actual outcomes for trafficking survivors. Originality/value This study represents unique, original research which provides valuable data as to the effectiveness of educational conferences on raising awareness of HT for professionals with the best opportunity to make meaningful interventions

S43. SADDER BUT WISER: DEPRESSION OUTWEIGHS SEX AND SCHIZOPHRENIA IN SELF ASSESSMENT OF INTERPERSONAL FUNCTIONING

Abstract Background Impairments in social functioning are central features of Schizophrenia (SCZ). Patients with SCZ also have challenges in self-assessment and the ability to evaluate their own level of functioning across cognitive, social cognitive, and functional domains. One of the major correlates of self-assessments in schizophrenia is depression, wherein patients who have very low levels of self-reported depression over-estimate their functioning when compared to objective milestone data and reports of knowledgeable informants. Interestingly, healthy individuals also generated reports of functioning that are related to mood states, wherein mild levels of dysthymia are associated with reduced over-estimation of functioning; this finding appears to be stronger in females than in males. In this study, we examine depression, gender, and psychiatric diagnoses as predictors of self-reported everyday functioning. Methods 372 subjects were enrolled in this study, including 218 with SCZ and 154 healthy controls. Participants self-reported their everyday social functioning using the 31-item Specific Level of Functioning (SLOF) scale. All participants self-reported their depression with the BDI and their impressions of their social cognitive ability on the Observable Social Cognition Rating Scale (OSCAR). The resulting data was analyzed using linear regression models, predicting self-reported social functioning and social cognition with sex, diagnosis, and self-reported depression. Results 64% of subjects were male and 36% were female. Schizophrenia patients reported more depression, poorer social functioning, and worse social cognition. Linear regression analyses revealed a significant correlation between self-reported social functioning and scores on the BDI: R2=.23. BDI scores also predicted self-reported social cognition on the OSCARS: R2=.30. There was no significant effect of sex on either self-reported social functioning or social cognition. Diagnosis accounted for 6% of the variance in OSCARS scores, but none for self-reported social functioning when depression was accounted for. Finally, when both the BDI and OSCARS were added to diagnosis and sex to predict self-reported social functioning, both depression, R2=.23, and OSCARS scores, R2=.06 predicted self-reported social functioning, with no impact of diagnosis or sex. Discussion Self-reported interpersonal functioning is largely determined by levels of depression, with these influences being more important than sex or diagnosis of schizophrenia. Both healthy people and people with schizophrenia judge their social functioning by their level of depression, with the impact of sex not being statistically significant

Optimal radiation dosing in concurrent neoadjuvant chemoradiation for resectable esophageal cancer: a meta-analysis

This is the first meta-analysis to study optimal radiation dose in the setting of concurrent neoadjuvant chemoradiotherapy (cnCRT) for esophageal cancer (EC). We sought to compare outcomes between high dose radiotherapy (HDRT) [>48.85 Gy biologically effective dose (BED)] group and low dose radiotherapy (LDRT) (≤48.85 Gy BED) for patients with EC receiving cnCRT. Medline, Embase, and Cochrane databases were searched independently by two members of our team on August 07, 2017. Articles were screened using Covidence. Study quality was assessed via CONSORT. Eligible studies had to be randomized controlled trials (RCT) comparing cnCRT . surgery alone in full-text English. Those with induction or sequential chemoradiotherapy were excluded. We captured data points including radiation dose, hazard ratios (HRs) for overall survival (OS), and treatment-related mortality (TRM). We analyzed HRs for OS and risk ratio (RR) for TRM and corresponding 95% confidence interval (CI) as the summary statistic. We used both fixed- and random-effects models in the presence of heterogeneity. The primary outcome was OS; secondary endpoint was treatment related mortality (TRM). We compared outcomes by HDRT . LDRT. To minimize chemotherapy heterogeneity, we performed a pre-planned analysis excluding the CROSS trial. The eleven included studies contained a total of 1,697 patients. Eight hundred forty-eight were randomized into the cnCRT. Of these 848 patients, 287 received HDRT and 561 received LDRT. HR for OS was not statistically different between LDRT (HR 0.67; 95% CI, 0.55-0.8) and HDRT (HR 0.68; 95% CI, 0.45-0.91). Excluding the CROSS trial, there was still no difference in outcomes between LDRT and HDRT. TRM was similar between LDRT and HDRT. With no difference in OS or TRM between LDRT and HDRT, 48.85 Gy BED cnCRT may be a sufficient radiation dose for cnCRT for patients with EC fit for surgery

Informing Human Trafficking Clinical Care Through Two Systematic Reviews on Sexual Assault and Intimate Partner Violence

Background: There is a lack of evidence on the clinical management of patients who have suffered human trafficking. Synthesizing the evidence from similar patient populations may provide valuable insight. This review summarizes findings on therapeutic interventions for survivors of sexual assault and intimate partner violence (IPV). Method: We conducted two systematic reviews using the MEDLINE database. We included only randomized controlled trials of therapies with primary outcomes related to health for survivors of sexual assault and IPV. For the sexual assault review, there were 78 abstracts identified, 16 full-text articles reviewed, and 10 studies included. For the IPV review, there were 261 abstracts identified, 24 full-text articles reviewed, and 17 studies included. Analysis compared study size, intervention type, patient population, primary health outcomes, and treatment effect. Results: Although our search included physical and mental health outcomes, almost all the studies meeting inclusion and exclusion criteria focused on mental health. The interventions for sexual assault included spiritually focused group therapy, interference control training, image rehearsal therapy, sexual revictimization prevention, educational videos, cognitive behavioral therapy, and exposure therapy. The interventions in the IPV review included group social support therapy, exposure therapy, empowerment sessions, physician counseling, stress management programs, forgiveness therapy, motivational interviewing, and interpersonal psychotherapy. Conclusions: Insights from these reviews included the importance of culturally specific group therapy, the central role of survivor empowerment, and the overwhelming focus on mental health. These key features provide guidance for the development of interventions to improve the health of human trafficking survivors