Discover and read the best of Twitter Threads about #SDoH

Most recents (24)

Feb @Health_Affairs is out!

We did a formal return on investment (ROI) analysis of the IMPaCT community health worker program using randomized controlled trial evidence.

Each dollar invested by Medicaid returns $2.47, annually.

bit.ly/2QNt4v4

@threadreaderapp unroll
This paper is important because most estimates of ROI from #SDOH programs are likely exaggerated because they are based on pre-post studies.
It’s important to note that IMPaCT is highly structured with fixed caseloads, clear hiring protocols and good supervision. I think those program elements are key to seeing this kind of financial return. So #hclrds, resist the impulse to skimp!
Read 7 tweets
Hey #medtwitter and #medstudenttwitter! A while ago, I gave a #dermatology presentation on the intersection of derm and #trans health.

I learned a lot. So here's a #medthread on some of the takeaways I found most valuable.

1/10
Let's start with our transfeminine pts.

Derm can provide a number of facial feminization procedures (FFP): e.g. botox, soft-tissue augmentation.

These FFPs can be more affordable/less invasive than feminizing surgeries such as forehead or mandibular contouring.

2/10
Note: tho traditionally considered "cosmetic", these interventions have MATERIAL psychosocial benefits – studies show that facial feminization has a demonstrated positive impact on QoL + mental health outcomes.

3/10

ncbi.nlm.nih.gov/pubmed/26818277

ncbi.nlm.nih.gov/pubmed/20461468
Read 10 tweets
A thread on some quotes from @gautambhatia88’s “The transformative constitution “In equality jurisprudence, the approach of focusing on the disproportionately exclusionary impact if politics rather than their formal character or motive is known as disparate impact”
“It is based on the premise that inequality and discrimination result not (only) from individual hostile acts, but from structures and institutions.” @gautambhatia88 Only in brackets important & added by me.
An test for entry may be “neutral” but yet exclude by aligning with exclusionary institutions; if an physical entrance test for firefighter includes activities not necessary for fulfilling duties and unintentionally poses #gender-barriers, deserves to be struck down. #NoteToSelf
Read 95 tweets
1/ So, today was a big day for @DrJRMarcelin and I. We've been developing curricula on "Structural Challenges & Inequities in Healthcare Delivery" for the @UNMCCOM M1 students as part of the Health Systems Science coil.

Thread on this #MedEd project + today's capstone 👇🏾
2/ With inspiration from @JonathanMetzl & Dr. Helena Hanson's work on #StructuralCompetency, we wanted to assemble a pilot set of experiences that would give @UNMC students a glimpse into local health inequities, from historical & community perspectives:
3/ We gave the M1s several introductory lectures & assignments focused on big-picture issues like #SDoH & disparities, creating a "structural DDx" for patients, unconscious #bias & #microaggressions, developing structural humility, and #racism in medicine...
Read 11 tweets
BEFORE READING THIS THREAD, do you think this statement is TRUE or FALSE?

Despite being a documented #epidemic for decades, @HHSGov's #CenterForDiseaseControl(@CDCgov) intentionally obstructs its collecting #statistics on what causes at least 10% of deaths NEEDLESSLY every year.
2

HINT: You already know of these systemic #DataScams due to #PublicCorruption & #RegulatoryCapture:

🤥#HackedVoting/#illegitimateResults
🤥#UScensus is maliciously biased
🤥#Gerrymandering

Thread coming soon about #CauseOfDeath #DataFraud

#AmericanSwamp #MedicalControlFraud
3

ANOTHER HINT: My inability to escape intrahospital, interhospital & health/disability insurers’ #ConspiracyAgainstRights using #MedicalControlFrauds exposes motive of the right answer.

Watch this video later to understand #PublicCorruption by example📽️
Read 43 tweets
#medtwitter

I love to provide structure for my learners. A couple years ago I adopted a set of rules for rounds and ward teams. These continue to evolve.

I share them on day 1, and refer back to them frequently while on service.
👇

#TeamRules #MedEd
What are your #teamrules?
Rule 1: We treat patients, not diseases or numbers.

Always always put the disease and number into context for that specific patient. And get to know the patient.

It’s good medicine, and makes the job so much more interesting.

#SDOH #IllnessInContext #EBM
Rule 2: Rounds are done by noon.

Come prepared and we will get the work done together

Stick with the 4 Ds - decompensated, discharges, diagnostic dilemmas, the C Diff patients last. Stop wherever we are at 11:30 and finish running the list.

HT @thecurbsiders ep157

#efficient
Read 7 tweets
New @NASEM_Health @theNAMedicine report “Integrating Social Care Into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health” #SocialCare

full report: nationalacademies.org/SocialCare

Summary in @JAMA_current

My THREAD 1/18

ja.ma/2opPlEz
Great committee of outstanding experts in medicine, public health, social work, healthcare financing, digital platforms, implementation sciences, nursing, law, gerontology, health equity #SocialCare cc: @djmasonrn @KedarMate @LisaCooperMD @KBDeSalvo (2/18)
Why this topic?

⬆️ healthcare spending, but outcomes lag

⬆️ focus on healthcare value

Social factors ▶️ health, but not necessarily addressed in healthcare

⬆️ activity integrating social care into healthcare -> need framework to design/evaluate/improve #SocialCare (3/18)
Read 19 tweets
#TRIBECON begins #Pravara; felicitations to #AbhayBang @SearchGad & #sudarshan #VGKK for their inspiring work on #TribalHealth; @DrLahariya @whoindia among others felicitated
#abhayBang #healthsystem design for tribal communities need to be relooked for #UHC; strategies & schemes must adapt with local social & cultural context; recollects #Brainstorming with @DesirajuKeshav at @SearchGad leading to #ExpertCommittee #tribalhealth @TribalHealthIND
#TRIBECON #AbhayBang notes with happiness increasing interest in #tribalhealth research, yet this continues to be “off the beaten path”; congratulations to #pravara medical college in bringing this together; the proposed #Bandardhara declaration to improve #tribalhealth research
Read 81 tweets
#MedTwitter has been discussing “Take Two Aspirin + Call Me By My Pronouns,” an op-ed claiming social justice is taking time from sci ed + decreasing the quality of #MedEd.

So here’s my take:
“Take Two Aspirin + Read a Curriculum”
THREAD.

#MedTwitter #SoMeDocs #DoubleDocs
As always, I start threads with my POV: #LatinasInMedicine #DoubleDocs student in year 2 of #medschool. I have interests in both #MedEd + #HealthJustice. I am about to finish my term as diversity rep on our med student govt. I care a lot about advocacy.
Let’s take a moment to learn about the author: Stanley Goldfarb is a nephrologist, *former* assoc dean of curriculum at UPenn Med. He graduated from med school in 1969. Ffolks who studied at UPenn have brought up negative experiences with Dr. Goldfarb.
Read 55 tweets
Thanks, Mr Hennessey. Apropos for the @WSJopinion deputy editor to label the respondents to the outrageous and iconoclastic op-ed as "intersectional lunatics."
On the money? No. Audacious? Yes.
#SDoH #medtwitter
@WSJopinion The only problem, Mr Hennessey, is that you proved a point, but it wasn't that one.
@WSJopinion Here's @P_Yerramilli's response @statnews with the right points statnews.com/2019/09/16/med…
Read 4 tweets
As voted upon, a #Tweeotorial #Medthread:
#perioperative medicine meets #backtobedside
.
.
.
so let’s talk about functional capacity and METS!

1/x
METS?
“metabolic equivalent of task”

Huh?

Have you ever seen that report out on exercise equipment? Usually a number < 10?
It’s a measure of physical activity via oxygen consumption

Again, huh? #backtobedside??
Stay with me…
2/x
en.wikipedia.org/wiki/Metabolic…
Recall that the 2007 and 2014 ACC/AHA perioperative guidelines both include a step in their algorithms that no additional ischemic testing is recommended for patients who can achieve > 4 METS

So...how about those METS???
3/x
Read 27 tweets
New in @socscimed: We study the impact of IMF structural adjustment programs on health in developing countries; w/ T Forster, @thomstubbs, L King

In short: IMF programs increase neonatal mortality & lower access to health systems.

THREAD.

Open-access: doi.org/10.1016/j.socs…
International organizations are broadcasting their commitment to aiding #SDG attainment. But might their actual policy advice hurt progress towards these goals? We look at the case of the #IMF.

2/9
IMF structural adjustment programs—mandating austerity, deregulation, liberalization, & privatization—have been the workhorse of neoliberal globalization. For the history of such policies, see here:

3/9

Read 10 tweets
@EricTopol @NewYorker @joshuarothman @MelvinBackman Yes! But a few thoughts:

1) We should organize as health workers, not doctors.

2) We need to avoid saviorism, learn allyship.

3) We need to organize for self-protection, quality patient care, better societal structures, and the political change that enables all of the above.
@EricTopol @NewYorker @joshuarothman @MelvinBackman 4) We need to learn from actual organizers e.g.:

@resist_school from the community organizers who trained Obama youtube.com/channel/UCqC33…

@momentum_tweets of Sunrise/GND prominence youtube.com/user/MovementM…

@rsgexp No Shortcuts, and listen to this:
@EricTopol @NewYorker @joshuarothman @MelvinBackman @resist_school @momentum_tweets @rsgexp 5a) We need to fix the meta-narrative from the technical, utilitarian "health units aren't optimized or equitable one."

We must focus more on the personal, inter-personal, and moral.
Read 21 tweets
My next session on methods for complex data is happening now in Nicollet A!

I’ll be talking about pragmatic trials & per-protocol effects.
But first, @JessiePBuckley for Alex Keil on a new g-computation approach for causal effects of exposure mixtures.

One benefit over existing approaches: unlike weighted quartile sums regression, this method doesn’t assume all components work in the same direction.
There’s a preprint, so I’ll for sure be checking that out! The link is: arxiv.org/abs/1902.04200
Read 10 tweets
My approach to family meetings in the ICU & some #TipsForNewDocs I've learned along the way. Here is my approach - - my favorite part is the mandatory interpreter!
<THREAD>
Set the stage: invite the right people (HCP, RN), consider ambiance & setup, have a plan w objectives but manage your own expectations! It's work to you, but life & death to the family.

Sometimes the patient's room itself is the best location, esp if they can participate!
✨The Jargonese Interpreter ✨
Empower someone to interrupt you & ask for clarifications before the meeting. "Can you explain what you mean by ventilation?"

We use way more jargon than we think, and the family may not ask for nearly as much translation as is needed.
Read 16 tweets
1/ #medtwitter #twitternists #proudtobeGIM

I've been sitting on a @SocietyGIM #sgim19 debrief #medthread since the meeting, and thought I might finally take a swing at it - here goes ..

I am considering whether I can do more division/systems leadership in coming years .. ->
2/ Theme of the conference was 'Courage to Lead', and single best workshop for me was :

Leading Change: Tools/Tips for Change Management

Crediting Alfred Burger, Emily Fondahn, Brent Petty, Nathan Spell, Dan Steinberg - can't find them on Twitter, so giving proper 🗣🗣.
3/ would like to share key concepts for all of us trying to lead in academic medicine or in #advocacy spaces.

First key Slide/thoughts:

The hard stuff - barriers to change .. ->
Read 16 tweets
I want to put a 🙌 out to #MedTwitter

I may not tweet a lot but I do follow and gain quite a bit so I want to share how it has changed the way I carry myself and provide care.

It’s a thread.
2/
Patient asks the case manager when the doctor is going to see him

I spent 30 minutes updating him earlier that day 🤔

Pre-twitter: ok
Post-twitter: Sir, I’m in charge of your care, tell me a bit more about why you didn’t think I was your doctor.
#WomenInMedicine @AMarshallMD
3/
Overhear the nurses talking about a patient who made a veiled but serious threat to them during the course of care.

Pre-twitter: I’m sorry.
Post-twitter: 😠 that’s not OK. How can I support you?

#MedTwitter #NurseTwitter
@BrowofJustice
Read 11 tweets
Today’s @ONS data shows a staggering level of variation in the years of life you can expect to live in good health in England and Wales depending on your social and economic circumstances. (1/3)
People born in the most deprived areas of England are expected to have over 18 fewer years of life in good health than those born in the least deprived areas. (2/3)
To reduce these stark inequalities, cross-government action and investment is needed on the wider determinants that influence our health.

Watch our animation below to find out more and read our full response to the @ONS release here: health.org.uk/news-and-comme… (3/3)

#SDoH
Read 3 tweets
Disconnection from nature can be bad for our mental health.

qz.com/1557308/psycho…
“What I am attempting to do now is develop a rich psychoterratic typology that provides a language and conceptual landscape to match the rich range of emotions and feelings people have about nature and place."

psychoterratica.com/more.html @GlennAlb
To see that societies & natural environments continually ‘co-produce’ each other in the same spot is to understand our problem synthetically as one of ‘humanity-in-nature’ and ‘nature-in-humanity’ rather than merely additively as one of humanity & nature.

Read 12 tweets
Handing public assets and services over to the free market has been a boon for corporate America and a disaster for the working class.

#SDoH #HiAP #Interdependence inthesetimes.com/article/21689/…
“We can decide what makes public ownership efficient. We can decide what makes public ownership successful and that doesn’t have to be a profit, unlike private corporations. That could be environmental sustainability and is in many cases.”

thenextsystem.org/learn/stories/…
The latent, unused power of citizens—and the production of public collateral.

“To grasp and deploy this financial power in the interests of society and the ecosystem, citizens need to understand that this was and is ultimately our power.”

thenextsystem.org/learn/stories/…
Read 6 tweets
In 2014, medical outlays lowered the median income for the poorest decile of US individuals by 47.6% vs 2.7% for the wealthiest decile.

“First do no harm” must extend to the financial impact of delivering health care.

#SDoH #HiAP #Interdependence
"In spite of all the efforts in the US to control health spending over the past 25 years, the story remains the same.”

Read 115 tweets
I will do my best to state this concisely, but of course difficult in a tweet.
1 - In order for there to be trust, there must be full recognition and accounting of the harm that has been created to FB patient support groups, so that people like @itsMandaPanda have justice for what happened to them. That must be initiated by Facebook.
Read 12 tweets
In case @hmkyale + @drjrums wonder why I got so shirty about JAMA article calling for #SDOH mining from social networks like, say, Facebook (shirty evidence here: threadreaderapp.com/thread/1075892…) allow me to expound. #cyberwoke
First, ICYMI, Facebook's treachery against patient + #MeToo communities in wake of Cambridge Analytica cock-up reveal. PHI revealed in what members thought were walled gardens? NOPE. cnbc.com/2018/07/11/fac… #HBOC #cyberwoke
Then there was the #MeToo community - 10s of 1000s of members - that got its plug pulled when they complained: wired.com/story/how-a-me… #cyberwoke
Read 10 tweets
OK. So there's a piece (no paywall) on @JAMA_current today by Freddy Abnousi (head of #healthcare @facebook), @hmkyale, +@DrJRums "Social Determinants of Health in the Digital Age: Determining the Source Code for Nurture." jamanetwork.com/journals/jama/… #cyberwoke /1
Before you think this is any kind of good news, remember that @Facebook has successfully incinerated democracy in several places, in the process turning all of us into meat puppet data cash machines (we don't get the cash) and now ... #cyberwoke /2
In addition to knowing where we are, who we're with, what we like, and what we think, they want our health data? How big of a FUCK NO, NO WAY, OMFG HAVE YOU LOST YOUR EVERLOVIN' MIND will we have to raise to kill this? #cyberwoke /3
Read 9 tweets

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