Social Health Outcomes Research Articles

Access to Network Social Capital and Health Outcomes in Later Life: Understanding the Role of Tie Strength

Our study contributes to the scholarship by examining the concrete ways in which two distinct types of interpersonal connection—strong/close versus weak/distant—are independently related to self-rated health and life satisfaction cross-nationally. In addition, we explore whether and how the two types of interpersonal connection modify the magnitude of the associations between subjective social status (SSS) and health and well-being of older populations cross-nationally. According to results from our multilevel analysis, social capital available through strong ties (family and friends) is positively associated with both outcomes. On the other hand, social capital via weak ties (acquaintances) is positively related to health but negatively related to well-being. We also find that social capital mediated by strong ties significantly buffers the harmful implications of status disadvantage or low SSS on health and well-being of older adults. In comparison, weak tie-mediated social capital provides buffering against status disadvantage only for well-being.

The Impact of Social Media Use among Chinese College Students: A Literature Review of Academic Performance, Emotional Health, and Sleep Quality.

Social networks have become integral to daily life, with billions of users worldwide. While social media offers networking and information-gathering benefits, its impact on psychological well-being raises various concerns. This study investigates the correlation between social media engagement and adverse health outcomes among young adults. Specifically, it examines the effects on depression, anxiety, and sleep irregularities. The research utilizes a quantitative design. The sample comes from a university in Hebei Province, China. Through calculation, 400 representatives are needed to represent the sample size. The study will also explore potential moderating factors such as age, gender, racial status, and socioeconomic status. Data will be analyzed using descriptive and inferential statistics to identify patterns and correlations. Anticipated results include identifying social media usage patterns linked to adverse health outcomes and how demographic factors influence these effects. The findings aim to address research gaps and inform policies to mitigate social media's adverse impact on mental health.

Constantly changing, constantly adapting: Lives and life-course data of children and childhood social care

ObjectivesChildhood social care can lead to lifelong problems affecting health, educational attainment and other areas of a person’s life. Improving outcomes for children are therefore key policy objectives in many nations. The aim of this workshop was to inspire and drive forward life-course research on childhood social care internationally. ApproachThe workshop included presentations on the themes of the data jigsaw across the family life-course and data sovereignty and engagement. Presentations under each theme were followed by group activities and discussions. ResultsAdministrative data collections that include longitudinal details on childhood social care, developmental, health and other outcomes are becoming increasingly available for researcher purposes. Examples include the BEBOLD platform and the New South Wales Child E-Cohort in Australia, ECHILD in England and the Welsh SAIL Databank. First nations data sovereignty and engagement of childhood social care recipients has become a norm in many nations and led to improvements in research, including in methodology and interpretation of results. Together, improved access to data and meaningful stakeholder engagement can inform policy and practice to improve outcomes for children and young people. ConclusionsBarriers exist to understanding the family and home environments, such as very limited or no information about the fathers and other household members. Capturing populations who move between jurisdictions, e.g. migrants, is limited as administrative data is difficult to share across devolved nations/federated states. In some cases, a mismatch exists between expectations of meaningful engagement and institutional/research culture, resource and skill availability.

A Representative Profile of MSW Graduates in the United States.

As the United States faces burgeoning behavioral health needs and a growing recognition of the inextricable link between social conditions and health outcomes and quality-of-life indicators, a current representative profile of the MSW workforce with respect to sociodemographic and employment characteristics can provide a reference point for ongoing assessments of that workforce. The profile also can establish a baseline by which efforts to bolster the diversity and strength of the MSW workforce can be grounded. The core aim of the current study was to generate a nationally representative, descriptive profile of MSW graduates in the United States using a sample of 1,028 MSW graduates (representing a subpopulation of 691,061 individuals) from the 2021 National Survey of College Graduates. Weighted univariate and bivariate analyses were conducted to generate a descriptive profile of MSW graduates with respect to sociodemographic, education, and employment characteristics. Study findings can help employers, health services researchers, policymakers, and practitioners understand the context of the MSW workforce as it relates to diversity, labor workforce projection data, and student loan and salary considerations. This information can guide future policy and training goals to support the future vitality of the social work profession.

Loneliness and Social Isolation in Older Adults in Latvia and Iceland During COVID-19

Abstract Background The COVID-19 pandemic has significantly impacted the mental health and wellbeing of older populations across Europe, exacerbating feelings of loneliness and social isolation, known risk factors for poor physical and mental health outcomes. This study aims to understand the extent and implications of these changes in Latvia and Iceland, providing essential insights for targeted public health interventions. Methods This comparative study utilized data from two key sources: the Survey of Health, Ageing, and Retirement in Europe (SHARE) for Latvia and the HL20 study for Iceland, focusing on individuals aged 67 and above. Both quantitative surveys were conducted during the pandemic, offering data on health status, loneliness, and social isolation. A novel approach was applied in analyzing older populations to standardize comparisons between the two distinct datasets. This methodological innovation is part of a bilateral EEA initiative FM2021/23 aimed at strengthening research collaboration between Latvia and Iceland. Descriptive statistics and the Pearson Chi-square test were used to compare outcomes between the two countries and within demographic subgroups. Results The study revealed stark differences between the two countries: 80% of Latvian older adults reported social isolation compared to 42.7% in Iceland. Similarly, 45% of Latvians experienced loneliness versus 30% of Icelanders. Significant associations were found between social isolation, loneliness, and deteriorating mental and physical health, with worse outcomes noted in socially isolated individuals. Conclusions Our findings demonstrate a clear link between social isolation and adverse health outcomes among the older adults, exacerbated by the COVID-19 pandemic. The study supports the need for proactive public health measures in Latvia and Iceland, including the development of community engagement programs and mental health support services tailored to the needs of older adults. Key messages • Study shows significant health impact of social isolation among older adults in Latvia and Iceland, highlighting urgent need for targeted public health interventions. • Effective public health strategies and innovative digital outreach can mitigate adverse effects of loneliness and isolation observed in older populations.

Receipt of social services intervention in childhood, educational attainment and emergency hospital admissions: longitudinal analyses of national administrative health, social care, and education data in Wales, UK

BackgroundResearch consistently finds poorer health and educational outcomes for children who have experienced out-of-home care relative to the general population. Few studies have explored differences between those in care and those in receipt of intervention from social services but not in care. Children receiving social services interventions often experience Adverse Childhood Experiences (ACEs), and deprivation, which are known to negatively impact outcomes. We aimed to estimate the association of different social services interventions with educational outcomes and hospital admissions, while adjusting for ACEs and deprivation.MethodsWe linked retrospective, routinely collected administrative records from health, education, and social care to create a cohort via the Secure Anonymised Information Linkage (SAIL) databank in Wales, UK. We analysed data for children and household members (N = 30,439) across four different groups: [1] no social care intervention; [2] children in need but not in care (CIN); [3] children on the Child Protection Register but not in care (CPR); [4] children in care - i.e. removed from the family home and looked after by the local authority (CLA). Our primary outcome was education outcomes at age 16 years. Secondary outcomes were all cause emergency hospital admissions, and emergency admissions for external causes/injuries.ResultsChildren in receipt of social services intervention were more likely to not attain the expected level upon leaving statutory education at age 16 after adjusting for ACEs and other characteristics (for children who had been in out-of-home care (conditional OR: 1·76, (95%CI) 1·25 − 2·48), in need (2·51, 2·00–3·15) and those at risk (i.e., on the child protection register) (4·04, 2·44 − 6·68). For all-cause emergency admissions, all social care groups were at greater risk compared to children in the general population (children in care (conditional HR: 1·31, 1·01–1·68), children in need (1·62, 1·38 − 1·90), and children at risk (1·51, 1·11 − 2·04).ConclusionsAll groups receiving social service intervention experience poorer educational and health outcomes than peers in the general population. Children who remain with their home parents or caregivers but are identified as ‘in need’ or ‘at risk’ by social care practitioners require further research. Integrated support is needed from multiple sectors, including health, educational and social care.

US States with poor social health outcomes and more firearms have more morbidity due to mass shootings.

Mass shootings represent a persistent public health crisis. Prior studies have linked social determinants of health (SDOH) to the phenomenon of gun violence, but there remain limited analyses on mass shooting events specifically. Mass shooting events from 2014-2019 were recorded from the Gun Violence Archive. State-level data regarding population, ATF registered weapons, federal firearm licensees and several SDOHs (poverty, unemployment and educational attainment) were collected from publicly-available US governmental databases. Giffords Law Center rankings were used to assess the relative strictness of each state's gun laws. Gun ownership rates were obtained from the RAND Corporation. Bivariate analyses compared each SDOH, as well as ATF registered weapons, Giffords Center ranking and gun ownership rates, to the death rate, injury rate, and combined injury/death rate from mass shootings in each state. All associations were evaluated via Pearson's Rho. Slope and p-values were analyzed, with a threshold significance value of p less than 0.05. Unadjusted analysis revealed poor mental health, decreased educational attainment and increased unemployment to all be associated with an increased risk of mass shooting-related injury or death. Adjusted analysis revealed fewer firearm regulations, higher gun ownership, lack of handgun magazine restrictions and lack of long-gun registration requirements were associated with an increased risk of mass-shooting death. Similarly, adjusted analysis revealed lack of handgun permit requirements to be associated with both an increased risk of mass shooting-related injury and combined risk of injury/death. This study revealed associations between multiple SDOH and firearm restrictions with morbidity due to mass shooting events.

Physical, Cognitive, Emotional, and Social Health Outcomes of Children in the First 6 Months After Childhood Critical Illness: A Prospective Single-Center Study

Objectives: To describe physical, cognitive, emotional, and social health outcomes of children and their trajectory in the first 6 months after PICU discharge. Design: Prospective, longitudinal observational cohort study. Setting: PICU in a tertiary pediatric hospital in Singapore from January 2021 to June 2022. Patients: One hundred thirty-five children (1 mo to 18 yr), admitted for greater than or equal to 48 hours with at least one organ dysfunction and received PICU therapy. Interventions: None. Measurements and Main Results: Serial self/parent proxy-reported assessments were obtained at: PICU admission, PICU discharge, and 1, 3, and 6 months after PICU discharge. The Pediatric Quality of Life Inventory (PedsQL) scale, Functional Status Scale (FSS), and measures of post-traumatic stress disorder (PTSD) using the Young Child PTSD Screen and the Child and Adolescent PTSD Screen-Parent Version were used. Trajectory groups were identified using group-based trajectory model. One hundred thirty-five children (mean [sd] age, 5.6 yr [5.5 yr]) were recruited. Seventy-eight (52%) were male. The mean (sd) Pediatric Index of Mortality III score was 3.2 (4.1) and PICU length of stay was 10.0 days (21.0 d). The mean (sd) PedsQL total scores were 66.5 (21.1) at baseline, 69.7 (21.4), 75.6 (19.7), and 78.4 (19.8) at 1, 3, and 6 months after PICU discharge, respectively. Overall, the PedsQL and FSS plateaued at 3 months. Our model revealed three distinct trajectory groups. Seventeen and 103 children in the mild and moderate trajectory groups, respectively, demonstrated recovery to baseline. Fifteen children in the severe trajectory group were older in age (mean [sd] 8.3 yr [6.4 yr]), with higher proportion (11/15) of preexisting illness. Five of 15 children in the severe group experienced posttraumatic stress syndrome (PTSS) at 6 months post-discharge. Conclusions: In our cohort of PICU patients, we found three unique trajectory groups. Children in the severe group were older, more likely to have preexisting conditions and at increased risk for PTSS. Early identification and intervention may improve recovery in patients with severe PICU trajectories.

Sociology in Medical Undergraduate Education: A Survey in Greece

The integration of sociology into medical education is essential for cultivating a nuanced understanding of the complex interplay between social determinants and health outcomes. This national cross-sectional survey utilized a qualitative, descriptive research approach to examine the inclusion of sociology as a course in the undergraduate curricula of medical schools in Greek higher education. Data collection and analysis were conducted through a comprehensive review of the syllabi from all seven medical schools in Greece. The analysis revealed that none of the seven undergraduate medical curricula include sociology as a discrete course. Social medicine is offered as a discrete course in three out of the seven programs, whereas sociological concepts are present in the majority of the medical curricula (six out of seven). A significant gap in the integration of sociology as a discrete course within Greek medical graduate education is revealed. To better equip future medical doctors with sociological lenses towards medical practice, a more comprehensive integration of sociology into medical training is recommended.

A Group Parenting Intervention for Male Postpartum Depression

Male postpartum depression is prevalent across populations; however, there is limited evidence on strategies to address it, particularly in low-income settings. To evaluate the effectiveness of Learning Through Play Plus Dads (LTP + Dads), a nonspecialist-delivered psychosocial intervention, in improving symptoms of male postpartum depression compared to treatment as usual. This cluster randomized clinical trial was conducted in Karachi, Pakistan, between June 2018 and November 2019. Assessors were blind to treatment allocation. Participants were recruited from 2 large towns in the city of Karachi via basic health units. Fathers aged 18 years and older with a DSM-5 diagnosis of major depressive episode and a child younger than 30 months were recruited. Of 1582 fathers approached, 1527 were screened and 357 were randomized in a 1:1 ratio to either the intervention or treatment as usual; 328 were included in the final analysis. Data were analyzed from April to June 2022. LTP + Dads is a manualized intervention combining parenting skills training, play therapy, and cognitive behavior therapy. The intervention was delivered by community health workers via 12 group sessions over 4 months. The primary outcome was change in 17-item Hamilton Depression Rating Scale score at 4 months. Secondary outcomes included anxiety symptoms; parenting stress; intimate partner violence; functioning; quality of life; and child social, emotional, and physical health outcomes. Assessments were completed at baseline and 4 and 6 months postrandomization. Of the 357 fathers included (mean [SD] age, 31.44 [7.24] years), 171 were randomized to the intervention and 186 to treatment as usual. Participants randomized to the intervention demonstrated significantly greater improvements in depression (group difference ratio [GDR], 0.66; 95% CI, 0.47 to 0.91; P < .001), anxiety (GDR, 0.62; 95% CI, 0.48 to 0.81; P < .001), parenting stress (GDR, -12.5; 95% CI, -19.1 to -6.0; P < .001), intimate partner violence (GDR, 0.89; 95% CI, 0.80 to 1.00; P = .05), disability (GDR, 0.77; 95% CI, 0.61 to 0.97; P = .03), and health-related quality of life (GDR, 12.7; 95% CI, 0.17 to 0.34; P < .001) at 4 months. The difference in depression and parenting stress was sustained at 6 months. Children of fathers randomized to the parenting intervention had significantly greater improvements in social-emotional development scores (mean difference, -20.8; 95% CI, -28.8 to -12.9; P < .001) at 6 months. The psychosocial parenting intervention in this study has the potential to improve paternal mental health and child development in Pakistan. Further studies in other populations and with longer follow-up are warranted. ClinicalTrials.gov Identifier: NCT03564847.

Persisting social disadvantage and intercensal social mobility in Northern Ireland: an examination of morbidity and all-cause mortality using three waves of the Northern Ireland Longitudinal Study (NILS).

Objective and ApproachUsing census returns from three waves of NILS (1991, 2001, 2011) linked with mortality data, we examined morbidity/mortality outcomes by socio-economic disadvantage over time (using an individual-level deprivation index derived from educational attainment, social class, housing tenure and household car availability at each census). These were combined to generate two indicators of Intercensal social mobility: measuring no change, and upward/downward mobility between censuses. The relationship between mobility (2001-2011) and (separately) self-reported mental ill-health (MIH) at the 2011 Census and all-cause mortality (2011-2015) were examined using logistic regression and Cox PH modelling respectively. Results Population comprised 288,262 individuals aged 25-74 in 2011, recording 19,318 deaths (2011-2015) and 23,959 (8.3%) reporting MIH. MIH: those with no intercensal mobility followed the standard pathway associated with persisting disadvantage (comparing with the most advantaged the least advantaged recorded OR=16.13:95%CI=13.50,19.28); and while both the upwardly and downwardly mobile generally recorded higher ORs than those consistently most advantaged, the magnitude of ORs increased with social distance traversed; and ORs for downward mobility were consistently higher than with upward mobility. Patterns associated with all-cause mortality were similar. ConclusionsThis suggests: upward mobility retains something of the social patterning pertaining in social disadvantage levels left behind; downward mobility may be connected to ongoing health issues. Poor health outcomes remain strongly associated with socio-economic circumstance. Implications Research focusing on relationship between social mobility, disadvantage and health outcomes in NI is limited: access to more precise administrative data will enhance possibilities associated with evidence-based policy formation.

Healthy persuasion: a values-based messaging approach to leisure air travel decision-making

“Healthy persuasion” is a public health social marketing strategy that aims to counter corporate efforts to drive the desire to consume products that cause negative individual (personal) and/or collective (social and/or environmental) health outcomes. In this paper, we argue that healthy persuasion might be usefully borrowed from public health and applied to leisure air travel (over) consumption to facilitate behaviour changes that past facts-based messaging has failed to evoke. We implemented mixed methods to generate quantitative and qualitative insights into the air travel decision making of Norwegian leisure travellers. Our analysis identifies and explores the values held by three groups relating to reduced leisure air travel – supporters, persuadables and opponents. We draw insights into values-based message framings that are likely to be effective in appealing to supporters and persuadables to reshape their air travel consumer decisions and conclude with important avenues of future research.

The Impact of Social Support on Health Outcomes of Diabetic Patients: A Systematic Review.

Type 2 diabetes mellitus (T2DM) is a common chronic disease worldwide. The prevalence of T2DM has consistently increased over the past few decades.Factors affecting patient management of diabetes are important in preventing diabetic complications. Social support has been cited as one of the most important aspects of managing chronic conditions. This systematic review aims to consolidate the existing literature discussing the impact of social support on managing type 1 diabetes mellitus (T1DM) and T2DM. To begin our review, the Ovid MEDLINE (Medical Literature Analysis and Retrieval System Online) database was searched for all current literature on social support and diabetes health outcomes. Articles were then included and removed according to specific inclusion and exclusion criteria, and a systematic review was performed on the remaining articles. Twenty-two papers that met the inclusion and exclusion criteria were selected, and after data collection, a significant correlation was found between social support and health outcomes of diabetic patients and most articles reported that social support improves the health outcomes of diabetic patients. Studies show that there is some correlation between social support and improved health outcomes for diabetic patients. Further studies should be done to determine the exact correlations between social support and T2DM management and to explore the long-term impacts of social support on health outcomes for diabetic patients.

Transformative value, communities and service designs for sustainability

PurposeThe purpose of this transformative service research (TSR) is to apply, innovate on and extend the understanding of service-dominant logic (SDL) perspectives, sustainable service ecosystem design ideas, transformative value and meeting sustainable development goals (SDGs). This study explores these through volunteers’ lived experiences and their perceived health and well-being outcomes in the context of botanic gardens as health-care service settings.Design/methodology/approachA total of 3 UK botanic gardens and 84 volunteers between 22 and 87 years of age participated in this qualitative study. Volunteering stories were collected through emails, telephone exchanges, online and in-person interviews, free-flowing discussion and field observations. These were coded and analysed by using computer-assisted qualitative data analysis software, NVivo 14 Plus and Leximancer. Thematic analysis facilitated the mapping of well-being outcomes highlighting transformative value against existing health and well-being indices.FindingsInsights extend knowledge into SDL, TSR and transformative value experienced by volunteers across three UK botanic garden service ecosystems. Environmental, organisational and personal factors, and physical, mental and social health outcomes are presented to emphasise transformative value experienced, especially in retiree volunteers. Theoretical contribution is in the form of empirical evidence to support and extend insights about transformative value and more so, significant epistemological change and meeting SDGs in botanic gardens. Results add to contemporary TSR on health-care-related well-being outcomes and ideas regarding sustainable service ecosystem design.Research limitations/implicationsIt is recommended that service research be extended across other botanic gardens, as well as other novel underexplored contexts for comparative studies of transformative value. Continued development and consideration of service designs as ongoing efforts to redefine and reimagine services marketing innovation for botanic gardens are recommended. Botanic gardens are complex service ecosystems worthy of rigorous service research to capture and measure the impact and outcome of ongoing work of the sector in advancing SDGs and having a transformative effect on individual and societal health and well-being.Practical implicationsThis study highlights opportunities for greater area-based, coordinated, collaborative, multi-stakeholder services marketing partnerships for strategic sustainable service ecosystem design for the botanic gardens and health-care sectors. These sectors can make better use of service research and marketing to further innovate and co-develop health and well-being strategies, campaigns and opportunities to develop services to transform and influence positive health and well-being outcomes for people. Results reveal greater opportunities for collaborative partnership and services marketing’s role and practice for the ongoing vitality and viability of botanic gardens. Joint efforts would enable innovation on sustainable service ecosystem design, advancing SDGs and improving life on planet Earth.Social implicationsTransformative value linked to newfound life experiences and meaning to life after retiring with a range of factors, and health and well-being outcomes were prominent. Social connections to the wider community were present, revealing links to a range of people who may not have traditionally had contact with botanic garden heritage and their strategic efforts. Therefore, it is services marketing opportunities for botanic gardens that hold one key to greater transformative value, sustainability and greater influence and impact on individual and societal health and well-being.Originality/valueTo the best of the author’s knowledge, this is the first TSR on botanic gardens as health-care service settings, resulting in a conceptual framework on transformative value and well-being outcomes in meeting SDGs. It extends insights on SDL, sustainable service ecosystem design and roles of marketing for the common good. Botanic gardens are unique research institutes, highly acclaimed for research, conservation, education and displays of special botanical collections, as well as providing health care, among other impactful SDG opportunities. This can be made more explicit through ecosystemic thinking, service research and integrated services marketing of botanic garden’ roles and contributions worldwide.

Physical, Cognitive, Emotional, and Social Health Outcomes of Parents in the First Six Months after Childhood Critical Illness: A Prospective Single Centre Study.

Childhood critical illness can have long-term effects on families, but the extent and trajectory of recovery for parents are unknown. Using prospective longitudinal design, we describe the health outcomes of parents and their trajectory six months after paediatric intensive care unit (PICU) discharge. Parents reported health outcomes at PICU discharge (baseline), and 1-, 3-, and 6-months post-discharge. We used the Pediatric Quality-of-Life Family Impact Module, Patient Health Questionnaire-4, and post-traumatic stress disorder (PTSD) Checklist for DSM-5. The group-based trajectory model was used to identify recovery patterns. We included 128 parents of children aged 1 month to 18 years, admitted to the PICU for ≥48 h. Three post-discharge composite health trajectory groups were classified: 54 mild (42%), 68 moderate (53%), and 6 severe (4%). Parents in the mild and moderate groups returned to baseline health within the first 3 months, but those in the severe group exhibited worse outcomes at 6-months. The mean (SD) PICU stay durations for mild, moderate, and severe groups were 9 (16), 7 (10), and 38 (61) days; days of mechanical ventilation were 4 (5), 4 (7), and 18 (25) days; and readmission rates were 12 (22%), 23 (34%), and 4 (66%), respectively. Identifying these trajectories enables novel, targeted interventions for at-risk parents, underscoring the significance of integrated PICU follow-up care.

Caregiving in long-term care before and during the COVID-19 pandemic: a scoping review.

The COVID-19 pandemic magnified pre-existing socioeconomic, operational, and structural challenges in long-term care across the world. In Canada, the long-term care sector's dependence on caregivers as a supplement to care workers became apparent once restrictive visitation policies were employed. We conducted a scoping review to better understand the associations between caregiving and resident, formal and informal caregiver health in long-term care before and during the COVID-19 pandemic. A literature search was performed using MEDLINE, AgeLine, Google Advanced, ArXiv, PROSPERO, and OSF. Pairs of independent reviewers screened titles and abstracts followed by a review of full texts. Studies were included if they reported biological, psychological, or social health outcomes associated with caregiving (or lack thereof). After screening and reviewing 252 records identified by the search strategy, a total of 20 full-text records were eligible and included in this review. According to our results, research on caregiving increased during the pandemic, and researchers noted restrictive visitation policies had an adverse impact on health outcomes for residents and formal and informal caregivers. In comparison, caregiving in long-term care prior to the pandemic, and once visitation policies became less restrictive, led to mostly beneficial health outcomes. Caregiver interventions, for the most part, appear to promote better health outcomes for long-term care residents and formal and informal caregivers. Suggestions to better support caregiving in long-term care settings are offered.

A Review of Trauma-Informed Care for Youth and Their Families in Inpatient Pediatric Settings.

Due to the pervasiveness of trauma, it is likely that many children and families seen in pediatric health settings have incurred traumatic experiences. These experiences can lead to a variety of negative medical, psychological, and social health outcomes. Therefore, a provider's focus on supporting resilience is integral. The use of trauma-informed care (TIC) is one way providers can work toward promoting a family's resilience. TIC is considered an organizational, attitudinal shift to understanding the broad impacts of trauma. This shift can contribute to changes in policies and procedures to make each system more welcoming to all those accessing the health system. This review will discuss the current pervasiveness of trauma, its associated impacts, the importance of TIC, and practical applications of TIC based on guiding principles provided by the Substance Abuse and Mental Health Services Administration. [Pediatr Ann. 2024;53(8):e299-e304.].

Social Isolation Changes and Long-Term Outcomes Among Older Adults

While the association between cross-sectional measures of social isolation and adverse health outcomes is well established, less is known about the association between changes in social isolation and health outcomes. To assess changes of social isolation and mortality, physical function, cognitive function, cardiovascular disease (CVD), and stroke. In a cohort design, social isolation changes in 4 years and subsequent risk of mortality and other outcomes were assessed using the 13 649 eligible Health and Retirement Study (HRS) respondents from the 2006 to 2020 waves. Data were analyzed from October 11, 2023, to April 26, 2024. The main exposure was the change in social isolation measured by the Steptoe 5-item Social Isolation Index from the initial assessment to a second assessment conducted 4 years later. Participants were classified into decreased isolation, stable, or increased isolation groups, stratified by their baseline isolation status. The primary outcomes were mortality, self-reported dependencies in activities of daily living, Alzheimer disease and Alzheimer disease-related dementia, CVD, and stroke. Dementia, CVD, and stroke were assessed using HRS-linked Medicare records. Incidence rates (IRs) of each group were estimated and a Cox proportional hazards regression model was used, with inverse-probability treatment weighting to adjust for confounders. Among 13 649 participants (mean [SD] age at baseline, 65.3 [9.5] years; 8011 [58.7%] women) isolated at baseline, those with increased isolation had higher mortality (n = 693; IR = 68.19; 95% CI, 60.89-76.36 per 1000 person-years) than those who were stable (n = 1796; IR = 44.02; 95% CI, 40.47-47.88 person-years) or had decreased isolation (n = 2067; IR = 37.77; 95% CI, 34.73-41.09 person-years) isolation. Increased isolation was associated with higher risks of mortality (adjusted hazard ratio [AHR], 1.29; 95% CI, 1.09-1.51), disability (AHR, 1.35; 95% CI, 1.09-1.67), and dementia (AHR, 1.40; 95% CI, 1.02-1.93) compared with stable isolation. Similar findings were observed among socially nonisolated participants at baseline. In this cohort study, increased isolation was associated with elevated risks of mortality, disability, and dementia, irrespective of baseline isolation status. These results underscore the importance of interventions targeting the prevention of increased isolation among older adults to mitigate its adverse effects on mortality, as well as physical and cognitive function decline.

Shame-Sensitive Public Health.

In this article, we argue that shaming interventions and messages during Covid-19 have drawn the relationship between public health and shame into a heightened state of contention, offering us a valuable opportunity to reconsider shame as a desired outcome of public health work, and to push back against the logics of individual responsibility and blame for illness and disease on which it sits. We begin by defining shame and demonstrating how it is conceptually and practically distinct from stigma. We then set out evidence on the consequences of shame for social and relational health outcomes and assess the past and present dimensions of shame in the context of the Covid-19 pandemic, primarily through a corpus of international news stories on the shaming of people perceived to have transgressed public health directions or advice. Following a brief note on shame (and policymaking) in a cultural context, we turn to the concept and practice of 'shame-sensitivity' in order to theorise a set of practical and adaptable principles that could be used to assist policymakers in short- and medium-term decision-making on urgent, tenacious, and emerging issues within public health. Finally, we consider the longer consequences of pandemic shame, making a wider case for the acknowledgement of the emotion as a key determinant of health.

Social participation in the promoting activity, independence and stability in early dementia (PrAISED), a home-based therapy intervention for people living with dementia: a realist evaluation

BackgroundInterventions promoting social activity may reduce behavioural psychological symptoms and improve quality of life in people living with dementia. This study aimed to identify social benefits for participants living with dementia in the context of Promoting Activity, Independence and Stability in Early Dementia (PrAISED), an exercise intervention programme promoting physical activity and independence in participants living with dementia in England.MethodsThis was a multi-method realist evaluation undertaking secondary analysis of data collected during the PrAISED process evaluation, including qualitative interviews with participants with dementia, caregivers and therapists, personal notes of researchers, and video recordings of therapy sessions. The study consisted of four phases: (1) Setting operational definition of social outcomes in PrAISED; (2) Developing Context, Mechanisms, Outcome (CMO) configurations; (3) Testing and refining CMOs; and (4) Synthesising definitive CMOs into a middle range theory.ResultsTwo CMOs were identified. (1) When therapists were able to make therapy sessions engaging and had the caregivers’ support, the participants experienced therapy sessions as an opportunity to achieve goals in areas they were interested in. They also found the sessions enjoyable. This all led to the participants being highly engaged in their social interactions with the therapists. (2) When the participants realised that they were gaining benefits and progress through the PrAISED intervention, such as increased balance, this boosted their confidence in physical ability. It might also reduce caregivers’ risk-aversion/gatekeeping attitude, which in turn would lead to participants’ increased participation in social activities.ConclusionThe PrAISED intervention supported social participation in participants living with dementia. Under certain circumstances, home-based therapy interventions can be beneficial for social health (regardless of physical health gains). Given the limitations of currently available outcome measures to assess social participation, qualitative methods should be used to explore social health outcomes.