Sociomedical Perspectives on Patient Care

Social change has placed new demands on the practice of medicine, altering almost every aspect of patient care relationships. Just as medicine was encouraged to embrace the biological sciences some 100 years ago, recent directives indicate the importance of the social sciences in understanding biomedical practice. Humanistic challenges call for changes in curative and technological imperatives. In this book, social scientists contribute to such challenges by using social evidence to indicate appropriate new goals for health care in a changing environment. This book was designed to stimulate and challenge all those concerned with the human interactions that constitute medical practice. To encompass a wide range of topics, the authors include researchers; practicing physicians from the specialties of family, general, geriatric, pediatric, and oncological medicine; social and behavioral scientists; and public health representatives. Cutting across disciplinary boundaries, they explore the ethical, economic, and social aspects of patient care. These essays draw on past studies of the patient-doctor relationship and generate new and important questions. They address social behavior in patient care as a way to approach theoretical issues pertinent to the social and medical sciences. The authors also use social variables to study patient care and suggest new areas of sociomedical inquiry and new approaches to medical practice, education, and research. Its cross-disciplinary approach and jargon-free writing make this book an important and accessible tool for physician, scholar, and student. Jeffrey Michael Clair is assistant professor of sociology and medicine and director of the Medical Sociology Program at the University of Alabama at Birmingham. Richard M. Allman is associate professor of medicine and director of the University Center for Aging at the University of Alabama at Birmingham. Provides many unique and revealing perspectives on the doctor-patient relationship. —Journal of the American Medical Associationhttps://uknowledge.uky.edu/upk_medicine_and_health_sciences/1011/thumbnail.jp

Race and Sex Differences in Correlates of Systolic Blood Pressure in Community-Dwelling Older Adults

Objectives: To describe correlates of measured systolic blood pressure (SBP) among community-dwelling older African American and White Medicare beneficiaries. Methods: Participants completed an in-home assessment and factors significantly correlated with SBP were tested using multivariable models. Results: Among the 958 participants (mean age= 75.3 [SD = 6.8]; 49% African American; 49% female; 52% rural) African Americans were more often diagnosed with hypertension, more likely on anti-hypertensives, and on more anti-hypertensive medications. SBP was 2.7 mmHg higher in African Americans than Whites (p=.03). SBP was higher in women than men. Multivariable models revealed differences in the factors associated with SBP by race/sex specific groups. Having a history of smoking and reports of being relaxed and free of tension were associated with higher SBP among African American men. Discussion: Although more likely prescribed anti-hypertensives, mean SBP was higher for older African Americans than Whites. Results support the hypothesis that behavioral and psychosocial factors are more important correlates of SBP levels among older African Americans than among Whites

Housing, the Neighborhood Environment, and Physical Activity among Older African Americans

Abstract This study examines the association of neighborhood environment, as measured by housing factors, with physical activity among older African Americans. Context is provided on the effects of structural inequality as an inhibitor of health enhancing neighborhood environments. The study population included African Americans participating in the UAB Study of Aging (n=433). Participants demonstrated the ability to walk during a baseline in-home assessment. The strength and independence of housing factors were assessed using neighborhood walking for exercise as the outcome variable. Sociodemographic data, co-morbid medical conditions, and rural/urban residence were included as independent control factors. Homeownership, occupancy, and length of residency maintained positive associations with neighborhood walking independent of control factors. Housing factors appear to be predictive of resident engagement in neighborhood walking. Housing factors, specifically high rates of homeownership, reflect functional and positive neighborhood environments conducive for physical activity. Future interventions seeking to promote health-enhancing behavior should focus on developing housing and built-environment assets within the neighborhood environment

Satisfaction with Medical Encounters Among Caregivers of Geriatric Outpatients

Caregivers\u27 experiences and satisfaction with physicians and medical services provided to geriatric patients are reported. An outstanding predictor of satisfaction with physician communication and overall patient care was the extent to which caregivers were experiencing role strain. Other significant predictors included caregiver knowledge of clinic and social support services provided to patients. The data suggest that, irrespective of the quality of clinic services and physician communication style, some caregivers will be dissatisfied because their encounter is mediated by the stress of activities separate from the medical encounter. We assert the importance of specialized geriatric services and argue that if these services are not in place, caregiver satisfaction with the overall medical encounter will likely be much lower

Validation of a clinical and genetic model for predicting severe COVID-19

Using nested case-control data from the Lifelines COVID-19 cohort, we undertook a validation study of a clinical and genetic model to predict the risk of severe COVID-19 in people with confirmed COVID-19 and in people with confirmed or self-reported COVID-19. The model performed well in terms of discrimination of cases and controls for all ages (area under the receiver operating characteristic curve (AUC) = 0.680 for confirmed COVID-19 and AUC = 0.689 for confirmed and self-reported COVID-19) and in the age group in which the model was developed (50 years and older; AUC = 0.658 for confirmed COVID-19 and AUC = 0.651 for confirmed and self-reported COVID-19). There was no evidence of over- or under-dispersion of risk scores but there was evidence of overall over-estimation of risk in all analyses (all P < 0.0001). In the light of large numbers of people worldwide remaining unvaccinated and continuing uncertainty regarding vaccine efficacy over time and against variants of concern, identification of people at high risk of severe COVID-19 may encourage the uptake of vaccinations (including boosters) and the use of non-pharmaceutical inventions

Medial Prefrontal and Anterior Insular Connectivity in Early Schizophrenia and Major Depressive Disorder: A Resting Functional MRI Evaluation of Large-Scale Brain Network Models

Anomalies in the medial prefrontal cortex, anterior insulae, and large-scale brain networks associated with them have been proposed to underlie the pathophysiology of schizophrenia and major depressive disorder (MDD). In this study, we examined the connectivity of the medial prefrontal cortices and anterior insulae in 24 healthy controls, 24 patients with schizophrenia, and 24 patients with MDD early in illness with seed based resting state functional magnetic resonance imaging analysis using Statistical Probability Mapping. As hypothesized, reduced connectivity was found between the medial prefrontal cortex and the dorsal anterior cingulate cortex and other nodes associated with directed effort in patients with schizophrenia compared to controls while patients with MDD had reduced connectivity between the medial prefrontal cortex and ventral prefrontal emotional encoding regions compared to controls. Reduced connectivity was found between the anterior insulae and the medial prefrontal cortex in schizophrenia compared to controls, but contrary to some models emotion processing regions failed to demonstrate increased connectivity with the medial prefrontal cortex in MDD compared to controls. Although, not statistically significant after correction for multiple comparisons, patients with schizophrenia tended to demonstrate decreased connectivity between basal ganglia-thalamocortical regions and the medial prefrontal cortex compared to patients with MDD, which might be expected as these regions effect action. Results were interpreted to support anomalies in nodes associated with directed effort in schizophrenia and nodes associated with emotional encoding network in MDD compared to healthy controls

Association of diuretic use and overactive bladder syndrome in older adults: A propensity score analysis

Diuretics use and overactive bladder syndrome are common in older adults. However, the relationship between the two has not been well studied. Data were collected by self-administered questionnaires including the Urge Urinary Distress Inventory (Urge-UDI) and the Urge Incontinence Impact Questionnaire (Urge-IIQ), and by outpatient chart abstraction. Patients (n = 172) had a mean age of 79 ± 7.5 (± S.D.), 76% were women, and 48% were African Americans; 76% had hypertension, 32% had heart failure, and 66% were receiving diuretics (57% loop diuretics). Overall, 72%, 68%, and 73% of patients respectively reported urinary frequency, urgency and urge incontinence. Diuretic use was associated with increased frequency (81% versus 55% non-diuretic; odds ratio = OR = 3.48; 95% confidence interval = CI = 1.73–7.03) and urgency (74% versus 57% non-diuretic; OR = 2.17; 95% CI = 1.11–4.24) but not with incontinence (OR = 1.74; 95% CI = 0.87–3.50). When adjusted for propensity scores, diuretic use had independent associations with frequency (adjusted OR = 3.09; 95% CI = 1.20–7.97) and urgency (adjusted OR = 2.50; 95% CI = 1.00–6.27). In addition to frequency and urgency, loop diuretic use was also associated with incontinence (OR = 2.54; 95% CI = 1.09–5.91), which lost significance after propensity adjustment (adjusted OR = 1.88; 95% CI = 0.57–6.17). Overall summary mean Urge-IIQ score was 1.83 ± 0.85 (±S.D.) with 1.75 ± 0.86, 1.68 ± 0.76, and 2.03 ± 0.88, respectively for no-diuretic, non-loop, and loop-diuretic patients (one-way ANOVA p = 0.063). Overactive bladder symptoms were common among ambulatory older adults and were associated with diuretic use, and had stronger associations with loop diuretic use

Similar clinical benefits from below‐target and target dose enalapril in patients with heart failure in the SOLVD Treatment trial

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142515/1/ejhf937.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142515/2/ejhf937_am.pd