Social Determinants of Health: An Overview for the Primary Care Provider.

Social determinants of health (SDoH) are reflected in how people live (access to health care, economic stability, built environment, food security, climate), learn (the educational environment), work (occupational environment), and play/socialize (social context and digital domain). All of these day-to-day conditions play a vital role in a patient's overall health, and a primary care provider should be prepared to understand their role to screen, assess, and address SDoH in clinical practice.

Monitoring Social Determinants of Health Assessing Patients and Communities.

Because of the devastating health effects of social determinants of health (SDoH), it is important for the primary care provider to assess and monitor these types of stressors. This can be done via surveys, geomapping, or various biomarkers. To date, however, each of these methods is fraught with obstacles. There are currently are no validated "best" SDoH screening tools for use in clinical practice. Nor is geomapping, a perfect solution. Although mapping can collect location specific factors, it does not account for the fact that patients may live in one area, work in another and travel frequently to a third.

An Introduction to Primary Care in Underserved Populations: Definitions, Scope, and Challenges.

This article addresses the scope of the problem primary care physicians face when caring for the underserved, both nationally and internationally. It touches on the statistics used to define medically underserved communities, the pervasiveness of poverty, and how primary care physician shortages may soon reach a crisis point. The definitions of socioeconomic status, allostatic load, and structural violence are also reviewed.

Exercise and Sports Medicine Issues in Underserved Populations.

Primary care providers can make a strong argument for exercise promotion in underserved communities. The benefits are vitally important in adolescent physical, cognitive, and psychological development as well as in adult disease prevention and treatment. In counseling such patients, we should take into account a patient's readiness for change and the barriers to exercise.

Environmental Justice and Underserved Communities.

Underserved communities suffer from environmental inequities. Gases lead to hypoxia and respiratory compromise, ozone to increased respiratory illnesses and decreased mental acuity, and mercury to prenatal cognitive disabilities and antisocial behaviors. Lead toxicity is associated with developmental delays. Cadmium is linked with cancer. The smaller sizes of air pollution particulate matter are pathogenic and are associated with cardiovascular and pulmonary disease and nervous system disorders. Bisphenol A is being studied for possible links to cancer and pregnancy risks. Physicians should be aware of these dangers, especially in underserved communities and populations. Investigating possible environmental risks and education are key.

Climate Change and Underserved Communities.

Climate change is the greatest global health threat of the twenty-first century, yet it is not widely understood as a health hazard by primary care providers in the United States. Aside from increasing displacement of populations and acute trauma resulting from increasing frequency of natural disasters, the impact of climate change on temperature stress, vector-borne illnesses, cardiovascular and respiratory illnesses, and mental health is significant, with disproportionate impact on underserved and marginalized populations. Primary care providers must be aware of the impact of climate change on the health of their patients and advocate for adaptation and mitigation policies for the populations they serve.

International Comparisons in Underserved Health: Issues, Policies, Needs and Projections.

Health care globally has made great strides; for example, there are lower rates of infant and maternal mortality. Increased incomes have led to lower rates of diseases accompanying poverty and hunger. There has been a shift away from the infectious diseases so deadly in developing nations toward first-world conditions. This article presents health care statistics across age groups and geographic areas to help the primary care physician understand these changes. There is a special focus on underserved populations. New technologies in health and health care spending internationally are addressed, emphasizing universal health care. The article concludes with recommendations for the future.

The athlete's hip and groin.

Groin and hip injuries are seen in athletes who perform quick directional changes and cutting movements. Because forces generated through athletic performance are transferred through the hip, injuries to these areas may limit athletes with mild pain or lead to career-ending injuries. The anatomy of the hip and groin is complex and symptoms often overlap. This article discusses some athletic causes, but other medical conditions may be associated with hip and groin pain as well. Updates in evaluation and treatment are discussed for adductor strains, hip osteoarthritis, femoroacetabular impingement, sports hernia, osteitis pubis, and obturator nerve entrapment.

Ligamentous injuries of the knee: anterior cruciate, medial collateral, posterior cruciate, and posterolateral corner injuries.

This article discusses athletic injuries of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and posterolateral corner. Best evidence to date validates that conservative management of ACL ruptures is a reasonable strategy. Current data also seem to advocate nonoperative management of PCL injuries. All isolated MCL injuries, regardless of grade, are usually treated with a brief period of immobilization and symptomatic management. Although the surgical literature often advocates surgical treatment of posterolateral corner injuries, there have been no randomized trials substantiating that these injuries are best treated surgically.

Meniscal, plica, patellar, and patellofemoral injuries of the knee: updates, controversies and advancements.

In athletes, meniscus tears and cysts, patellar tendonitis, patellofemoral pain syndrome (PFPS), and plica are common injuries. Meniscus tears are usually best treated by partial meniscectomy. Up to 90% of patients with patellar tendonitis can be successfully treated conservatively with expectation of good results. Nonoperative treatment of PFPS, properly focused on the causative factors, can be expected to be successful in most cases. For plica, most physicians recommend a trial of conservative therapy for at least 6 to 8 weeks, followed perhaps by a steroid injection, and ultimately, if symptoms persist, surgery.

The potential role of sports psychology in the obesity epidemic.

Sports psychologists play an important role in enhancing performance among athletes. In conjunction with team physicians, they can also shed light on psychological disorders common in athletes, such as mood and eating disorders, and overtraining syndrome. Sports psychologists can also lend their expertise to assist with injury prevention and recovery and compliance issues. Sports psychology has a role in helping to reverse the growing obesity epidemic among school-aged children. These professionals, working with coaches, can increase children's levels of physical activity. Cognitive-behavioral techniques could lead to enhanced enjoyment, increased participation, improved school performance, and a reduction in obesity.

Hormone replacement therapy in the geriatric patient: current state of the evidence and questions for the future--estrogen, progesterone, testosterone, and thyroid hormone augmentation in geriatric clinical practice: part 2.

The data reviewed herein show that hormone replacement therapies improve some conditions associated with aging. Additionally, some of the long-held fears of significant side effects associated with hormone supplementation may be overstated, especially when providing patients with individualized care and optimal monitoring. We encourage clinicians to consider such interventions based on the evidence presented.More long-term studies are needed to further quantify and substantiate the risks and benefits associated with the use of such therapies.

Aging and exercise.

In older adults, regular exercise provides numerous health benefits that include improvements in blood pressure, coronary artery disease,diabetes, lipid profile, osteoarthritis, osteoporosis, mood,neurocognitive function, and overall morbidity and mortality. This article discusses the benefits of exercise in the elderly and how physicians can help such patients overcome barriers to exercise (eg,sedentary lifestyle, lack of education, coexisting morbidities), and offers some practical exercise prescriptions for both healthy and compromised elderly patients.

Fatigue and chronic fatigue in the elderly: definitions, diagnoses, and treatments.

Because fatigue is so prevalent in the elderly population, it is important that physicians be well versed in the evaluation and management of this complaint. This article discusses the clinical manifestations and predisposing factors for the three major categories of fatigue: recent, prolonged, and chronic. The CDC classification of chronic fatigue syndrome is included. Patient dissatisfaction with the care for their fatigue is a common problem. Several pharmaceutical treatment methods are presented. Non-pharmacologic options, such as use of vitamins, exercise, behavior modification,and diet are also discussed.

Toward a comprehensive differential diagnosis and clinical approach to fatigue in the elderly.

This article provides primary care physicians with an encompassing approach to fatigue to help generate a comprehensive differential diagnosis. Two-thirds of patients with fatigue will have an identifiable cause that can be elucidated with a careful history and appropriate laboratory tests. Accordingly, a wide range of differential diagnoses is presented.