A Society of General Internal Medicine Position Statement on the Internists’ Role in Social Determinants of Health

The Society of General Internal Medicine (SGIM) represents the world’s leading academic general internists, dedicated to creating a just system of care in which all people can achieve optimal health. SGIM recognizes that to achieve this vision, we must expand our reach beyond the medical office and hospital bedside to identify and address the broader structures and living conditions that influence health—the social determinants of health (SDOH). Centuries of institutionalized oppression in the form of racism, sexism, and other forms of bigotry have created and perpetuated disadvantage. These underlying social values have translated into public policies and structures which affect the distribution ofmoney and power across society. These in turn have shaped living conditions and access to resources, which influence health behaviors and access to care, and ultimately health outcomes. SGIM acknowledges the full spectrum of SDOH including upstream policies, midstream environmental and behavioral factors, and downstream individual and clinical issues. We highlight an important distinction between societal SDOH that require policy and systems-level change, with downstream unmet individual social needs, like homelessness or food insecurity. The entire range of SDOH impacts the work we do, our ability to care for our individual patients, our partnerships with local community organizations, and our impact on population health and equity. SDOH should also be integrated in how we teach future physicians and collaborate with our colleagues in public health, social work, government, research, and partners in non-health sectors

“In the Beginning, It Was Little Whispers...Now, We’re Almost a Roar”: Conceptualizing a Model for Community and Self in LGBTQ+ Health Information Practices

Although LGBTQ+ populations experience significant health challenges, little research exists that investigates their health from an informational perspective. Our study addresses this gap by exploring the health information practices of LGBTQ+ communities in South Carolina, focusing on how sociocultural context shapes these practices. Thirty semi-structured interviews with South Carolina LGBTQ+ community leaders analyzed using open qualitative coding informed the development of a conceptual framework describing their information practices. Findings show that participants engaged in two broad types of practices – protective and defensive – as responses to risks and barriers experienced, which are in turn produced by social and structural factors. Findings advance information practices and marginalization approaches and offer ways for medical professionals to improve service to LGBTQ+ populations

Community-based directly observed therapy (DOT) versus clinic DOT for tuberculosis: a systematic review and meta-analysis of comparative effectiveness.

Background: Directly observed therapy (DOT), as recommended by the World Health Organization, is used in many countries to deliver tuberculosis (TB) treatment. The effectiveness of community-based (CB DOT) versus clinic DOT has not been adequately assessed to date. We compared TB treatment outcomes of CB DOT (delivered by community health workers or community volunteers), with those achieved through conventional clinic DOT. Methods: We performed a systematic review and meta-analysis of studies before 9 July 2014 comparing treatment outcomes of CB DOT and clinic DOT. The primary outcome was treatment success; the secondary outcome was loss to follow-up. Results: Eight studies were included comparing CB DOT to clinic DOT, one a randomised controlled trial. CB DOT outperformed clinic DOT treatment success (pooled odds ratio (OR) of 1.54, 95% confidence interval (CI) 1.01 – 2.36, p = 0.046, I2 heterogeneity 84%). No statistically significant difference was found between the two DOT modalities for loss to follow-up (pooled OR 0.86, 95% CI 0.48 to 1.55, p = 0.62, I2 83%). Conclusions: Based on this systematic review, CB DOT has a higher treatment success compared to clinic DOT. However, as only one study was a randomised controlled trial, the findings have to be interpreted with caution

The role of health literacy in explaining the association between educational attainment and the use of out-of-hours primary care services in chronically ill people: a survey study

Abstract Background Low socioeconomic status (SES) is persistently associated with poor health and suboptimal use of healthcare services, and more unplanned healthcare use. Suboptimal use of emergency and acute healthcare services may increase health inequalities, due to late diagnosis or lack of continuity of care. Given that health literacy has been associated with healthcare utilisation and with education attainment, we sought to explore whether health literacy is related to the use of out-of-hours (OOH) Primary Care Services (PCSs). Additionally, we aimed to study whether and to what extent health literacy accounts for some of the association between education and OOH PSC use. Methods A survey including measures of education attainment, health literacy (assessed by means of the Dutch version of the nine-dimension Health Literacy Questionnaire) and use of PCS was conducted among a sample of adults diagnosed with (any) somatic chronic condition in the Netherlands (response 76.3%, n = 1811). We conducted linear and logistic regression analyses to examine associations between education level and PCS use in the past year. We performed mediation analyses to assess whether the association between education and PCS use was (partly) explained by different aspects of health literacy. We adjusted the models for patient characteristics such as age and morbidity. Results Higher education attainment was associated with higher scores on the health literacy aspects Appraisal of health information, and Navigating the healthcare system. Additionally, appraisal and navigating the healthcare system partially accounted for educational differences in PCS use. Finally, higher appraisal of health information scores were associated with higher PCS utilisation. Conclusion Several aspects of health literacy were demonstrated to relate to PCS use, and partly accounted for educational differences herein. Accordingly, developing health literacy within individuals or communities may help to reduce inappropriate PCS use among people with low education

Review of base row studies with particular emphasis on Chapman-Korst analysis

An attempt is made to provide a comprehensive review of the13; developments in the base flow studies and a detailed exposition of the Chapman-Korst analysis. This analysis and its derivatives are commonly used in treating numerous13; separated flow problems in the supersonic regime because of their qualitatively correct description of the flow field am relatively simple calculation procedure.13; 13; The review begins with a description of the supersonic flow field past a back step. The flow field is then toto13; various components. Each component is analysed after making13; simplifying assumptions and finally, a synthesis of the component analysis is made to arrive at the solution of base pressure problem.13; 13; The complexities introduced by wall angularities, foreign gases, initial boundary layer and distributed recompression are also discussed

Subsonic turbulent flow past a downstream facing annular step

The flow past a downstream facing annular step was experimentally investigated in the Mach number range of 0.1 to 0.95. The approaching flow was steady and uniform. The boundary layer ahead of the step was turbulent. The upstream influence of the step and the variation of base pressure and recovery pressure with the reference Mach number are described. Results of hot-wire measurements in the shear layer and the locations of reattachment and secondary separation points are also reported

The turbulent flow through a sudden enlargement at subsonic speeds

The flow through a sudden enlargement was experimentally investigated in the Mach number range of 0.1 to 0.95. Results include variation of base pressure and recovery pressure with reference Mach number. The upstream influence distance and the locations of reattachment and secondary separation points are also reported

Calibration of six-component internal strain gage balance

A l2mm six-component internal strain gauge balance was13; calibrated for measuring forces and moments acting on an13; afterbody model. The balance sting and the loading fixture to simulate the loading of the balance during wind tunnel tests were designed and fabricated. Data for calibration was generated by using a calibration rig of the NAL O.3m tunnel. A computer program to fit least square curves was developed and used to obtain the calibration constants from the data obtained during calibration. Another program was developed to predict the forces and moments quot;acting on the model from the known balance voltage output and the calibration constants.13; It was found that incorporating only the linear interaction terms was sufficient to predict the axial force to an accuracy of 99.7 percent. This was considered adequate in the afterbody tests where this balance is proposed to be used

Measurements related to afterbody studies on thrust-minus-drag rig

The need for proper afterbody design is on account of its13; significant influence on the net thrust and total drag of an air-craft. Achievements of such a design has become significantly difficult with ,the advent of multimission aircraft requiring variable geometry nozzle(s) operating over a broad range of conditions. In view of the complexity of flow field in the afterbody region and also due to the limitations of available semi-empirical and analytical methods,; the wind tunnel, tests are essential to get accurate quantitative results