Introduction: Social risks adversely affect health and are associated with increased healthcare utilization and costs. Emergency department (ED) patients have high rates of social risk; however, little is known about best practices for ED-based screening or linkage to community resources. We examined the perspectives of patients and community organizations regarding social risk screening and linkage from the ED. Methods: Qualitative interviews were conducted with a purposive sample of ED patients and local community organization staff. Participants completed a brief demographic survey, health literacy assessment, and qualitative interview focused on barriers/facilitators to social risk screening in the ED, and ideas for screening and linkage interventions in the ED. Interviews were conducted in English or Spanish, recorded, transcribed, and coded. Themes were identified by consensus. Results: We conducted 22 interviews with 16 patients and six community organization staff. Three categories of themes emerged. The first related to the importance of social risk screening in the ED. The second category encompassed challenges regarding screening and linkage, including fear, mistrust, transmission of accurate information, and time/resource constraints. The third category included suggestions for improvement and program development. Patients had varied preferences for verbal vs electronic strategies for screening. Community organization staff emphasized resource scarcity and multimodal communication strategies. Conclusion: The development of flexible, multimodal, social risk screening tools, and the creation and maintenance of an accurate database of local resources, are strategies that may facilitate improved identification of social risk and successful linkage to available community resources. [West J Emerg Med. 2020;21(4)964-973.] been used to describe these individual-level, adverse social determinants of health. For the purposes of this paper, we will term these "specific adverse social conditions that are associated with poor health" as social risk. 2 Social risks are

No abstract

No abstract

Introduction: Social risks, or adverse social conditions associated with poor health, are prevalent in emergency department (ED) patients, but little is known about how the prevalence of social risk compares to a patient's reported social need, which incorporates patient preference for intervention. The goal of this study was to describe the relationship between social risk and social need, and identify factors associated with differential responses to social risk and social need questions. Methods: We conducted a cross-sectional study with 48 hours of time-shift sampling in a large urban ED. Consenting patients completed a demographic questionnaire and assessments of social risk and social need. We applied descriptive statistics to the prevalence of social risk and social need, and multivariable logistic regression to assess factors associated with social risk, social need, or both. Results: Of the 269 participants, 100 (37%) reported social risk, 83 (31%) reported social need, and 169 (63%) reported neither social risk nor social need. Although social risk and social need were significantly associated (p < 0.01), they incompletely overlapped. Over 50% in each category screened positive in more than one domain (eg, housing instability, food insecurity). In multivariable models, those with higher education (adjusted odds ratio [aOR] 0.44 [95% confidence interval {CI}, 0.24-0.80]) and private insurance (aOR 0.50 [95% CI, 0.29-0.88]) were less likely to report social risk compared to those with lower education and state/public insurance, respectively. Spanish-speakers (aOR 4.07 [95% CI, 1.17-14.10]) and non-Hispanic Black patients (aOR 5.00 [95% CI, 1.91-13.12]) were more likely to report social need, while those with private insurance were less likely to report social need (private vs state/public: aOR 0.13 [95% CI, 0.07-0.26]). Conclusion: Approximately one-third of patients in a large, urban ED screened positive for at least one social risk or social need, with over half in each category reporting risk/need across multiple domains. Different demographic variables were associated with social risk vs social need, suggesting that individuals with social risks differ from those with social needs, and that screening programs should consider including both assessments. [

Objective Previous studies in mice and humans observed down-regulation of the gene expression of ATP6V1H associated with type 2 diabetes. This study identified prospectively changes in ATP6V1H expression before and after overt diabetes. Methods Expression of ATP6V1H in peripheral blood was compared pre and post development of diabetes in nine individuals. Results Considerable variation of ATP6V1H mRNA levels was observed between different individuals. However, within each individual the decrease in expression of ATP6V1H with the development of diabetes was highly statistically significant. Conclusions ATP6V1H may represent a critical molecular mechanism involved in the development of type 2 diabetes and its compilations through its important regulatory effect on vacuolar-ATPase activity.

No abstract

Results: Overall, 614 patients or parents of patients were screened, of whom 483 (79%) were eligible. Of those, 276 (57%) consented and completed the survey. Overall, 103 (37%) of patients screened positive for an HRSN by the screening questions and 87 (32%) screened positive by the direct questions. The overlap in answers for screening modalities varied across each HRSN area. For example, for housing, 64 respondents (23%) screened positive when asked the screening questions versus 40 (15%) when asked for assistance by the direct question. However, for utility challenges, 11 respondents (4%) screened positive when asked the screening questions versus 49 (18%) when asked by direct question; only 6 patients (2%) screened positive by both methods. The complete comparison between both screening modalities can be seen in Table 1.Conclusion: Our data suggest that the format of the question meaningfully affects the ascertainment of HRSN and, thereby, challenges the current paradigm of screening question use. The differences in responses could be related to a number of factors, including cultural background and health literacy. Additional research is needed to identify the best strategies for ascertaining HRSN in the ED to enable effective interventions.

Background: Health care policy and practice-level enthusiasm around social screening has emerged in the absence of a clear appreciation for how patients feel about these activities. Yet patient and caregiver perspectives should be used to establish the rationale and inform the design and implementation of social screening initiatives.Methods: We conducted a systematic scoping review to better understand patient and patient caregiver perspectives regarding multidomain social screening in US health care settings.Results: We identified 16 articles. Thirteen studies assessed the perspectives of patients; a partially overlapping 9 studies assessed the perspectives of adult patient caregivers. Most articles assessing the acceptability of social screening reported that patients and patient caregivers generally found it to be acceptable. Notably, there was some variation by screening approach and prior experiences in health care settings, as well as mixed findings by race/ethnicity and gender. Participants from several articles raised concerns regarding data documentation and sharing, highlighting the potential for social data to contribute to provider bias. Conclusion:The themes emerging in this diverse set of largely descriptive studies warrant deeper and more rigorous exploration as social screening initiatives expand in health care settings across the United States.