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This dissertation aims to explore the relationship between social support and social and psychological wellbeing in the adult population of sexual and gender minorities, or Lesbian, Gay, Bisexual, Transgender (LGBT) adults. We apply Antonucci’s (1987) Convoy Model of Social Relations as a lens through which to conceptualize social support across four dimensions: structure, function, quality, and closeness. Chapter One contains an introduction to the LGBT adult population; a description of the Convoy Model of Social Relations and of technology used to exchange social support; and an outline of the specific aims addressed in this dissertation. Chapter Two is an integrative review of literature about social support networks of LGBT older adults age 50 years and older. Chapter Three is a study designed to investigate relationships between LGBT identity, social support characteristics, the use of online social communication, and psychological and social wellbeing. Chapter Four is a qualitative descriptive study that explores LGBT older adults’ attitudes, perceptions, and uses of technology for social connectedness and support during COVID-19. Chapter Five contains a synthesis of all findings in this dissertation; a discussion of the results as they relate to the Convoy Model of Social Relations; and implications for clinical interventions and future research.

Health equity and social determinants of health are important concepts to understand when forming health policy in the United States. Health equity refers to a state of health and wellbeing that is not differentiated between groups based on marginalized status or history of oppression. Social determinants of health, perhaps more correctly called structural determinants of health, provide a framework for understanding how race and racism, socioeconomic status (SES), gender and sexuality, and other societal (as opposed to biological) factors influence health and the unequal burden of disease. Vast health disparities between Black and White Americans have been widely reported, although the link between health status and racism is not as commonly articulated. An abundance of studies have linked health insurance status to improved physical and mental health. While universal health insurance cannot overcome racism as a fundamental cause of health disparities, it would ameliorate the effects of living in a profoundly racist society. In order to advance health equity in the United States, legislators should make health insurance free and accessible to all.

Homelessness is now recognized as a significant public health problem in North America and throughout advanced economies of the world. The causes of homelessness are complex but the lack of affordable housing, unemployment, poverty, addiction, and mental illness all contribute to the risk for homelessness. We argue that homelessness is increasingly exacerbated by system-wide infrastructure failures occurring at the municipal, state, and federal government levels and whose catastrophic impacts on population health and the response to the COVID-19 pandemic are the consequence of the decades-long devolution of government and neglect to invest in public infrastructure, including a modern public health system.

Taken from the coda to a book about the aesthetics and politics of care, Rachel Adams' presentation explores the possibilities and perils of extending human care relations to other species, the environment, and non-living matter—including robots. Bryony Roberts' presentation considers how intersectional feminism can inform architectural practice and the designing of spaces, along with infrastructures that engage with experimental and collective models of childcare. Care for the Polis is a conversation that exists in a multitemporal and virtual space, a space designed to reimagine how medical humanities and public humanities shape, and are shaped by, the city and its diverse publics. In a series of weekly Z-Panels, our invited speakers will discuss the effects of health on the conception of cities and publics—including, in the context of pandemic, the foreclosure of public space and what it means to become an online yet domestic-bound public. Together, we will address emerging concerns such as economic impact and recovery, domesticity and democracy, public care and public reconstruction.

Policy Points Social policies might not only improve economic well-being, but also health. Health policy experts have therefore advocated for investments in social policies both to improve population health and potentially reduce health system costs. Since the 1960s, a large number of social policies have been experimentally evaluated in the United States. Some of these experiments include health outcomes, providing a unique opportunity to inform evidence-based policymaking. Our comprehensive review and meta-analysis of these experiments find suggestive evidence of health benefits associated with investments in early life, income support, and health insurance interventions. However, most studies were underpowered to detect health outcomes. CONTEXT: Insurers and health care providers are investing heavily in nonmedical social interventions in an effort to improve health and potentially reduce health care costs. METHODS: We performed a systematic review and meta-analysis of all known randomized social experiments in the United States that included health outcomes. We reviewed 5,880 papers, reports, and data sources, ultimately including 61 publications from 38 randomized social experiments. After synthesizing the main findings narratively, we conducted risk of bias analyses, power analyses, and random-effects meta-analyses where possible. Finally, we used multivariate regressions to determine which study characteristics were associated with statistically significant improvements in health outcomes. FINDINGS: The risk of bias was low in 17 studies, moderate in 11, and high in 33. Of the 451 parameter estimates reported, 77% were underpowered to detect health outcomes. Among adequately powered parameters, 49% demonstrated a significant health improvement, 44% had no effect on health, and 7% were associated with significant worsening of health. In meta-analyses, early life and education interventions were associated with a reduction in smoking (odds ratio [OR] = 0.92, 95% confidence interval [CI] 0.86-0.99). Income maintenance and health insurance interventions were associated with significant improvements in self-rated health (OR = 1.20, 95% CI 1.06-1.36, and OR = 1.38, 95% CI 1.10-1.73, respectively), whereas some welfare-to-work interventions had a negative impact on self-rated health (OR = 0.77, 95% CI 0.66-0.90). Housing and neighborhood trials had no effect on the outcomes included in the meta-analyses. A positive effect of the trial on its primary socioeconomic outcome was associated with higher odds of reporting health improvements. We found evidence of publication bias for studies with null findings. CONCLUSIONS: Early life, income, and health insurance interventions have the potential to improve health. However, many of the included studies were underpowered to detect health effects and were at high or moderate risk of bias. Future social policy experiments should be better designed to measure the association between interventions and health outcomes.

Leslie Topp showcases historical research on single rooms in psychiatric and prison contexts as a window onto a larger sociopolitical and spatial analysis of current urban experiences of lockdown. In shifting the scale of analysis from the single room to the globe, Alexandre White examines how the course of Covid-19 has refuted the modern west's own colonialist myth of technical and scientific superiority in the face of pandemics. Care for the Polis is a conversation that exists in a multitemporal and virtual space, a space designed to reimagine how medical humanities and public humanities shape, and are shaped by, the city and its diverse publics. In a series of weekly Z-Panels, our invited speakers will discuss the effects of health on the conception of cities and publics—including, in the context of pandemic, the foreclosure of public space and what it means to become an online yet domestic-bound public. Together, we will address emerging concerns such as economic impact and recovery, domesticity and democracy, public care and public reconstruction.

Innovative primary care models that deliver comprehensive primary care to address medical and social needs are an established means of improving health outcomes and reducing healthcare costs among persons living with chronic disease. Care management is one such approach that requires providers to monitor their respective patient panels and intervene on patients requiring care. Health information technology (IT) has been established as a critical component of care management and similar care models. While there exist a plethora of health IT systems for facilitating primary care, there is limited research on their ability to support care management and its emphasis on monitoring panels of patients with complex needs. In this dissertation, I advance the understanding of how computational methods can better support clinicians delivering care management, and use the management of human immunodeficiency virus (HIV) as an example scenario of use. The research described herein is segmented into 3 aims; the first was to understand the processes and barriers associated with care management and assess whether existing IT can support clinicians in this domain. The second and third aim focused on informing potential solutions to the technological shortcomings identified in the first aim. In the studies of the first aim, I conducted interviews and observations in two HIV primary care programs and analyzed the data generated to create a conceptual framework of population monitoring and identify challenges faced by clinicians in delivering care management. In the studies of the second aim, I used computational methods to advance the science of extracting from the patient record social and behavioral determinants of health (SBDH), which are not easily accessible to clinicians and represent an important barrier to care management. In the third aim, I conducted a controlled experimental evaluation to assess whether data visualization can improve clinician’s ability to maintain awareness of their patient panels.

Since the early 17th century the waters of Harrogate had been taken by locals and visitors to the area. The chalybeate springs of High Harrogate were originally the more popular, but by the middle of the 18th century doctors had discovered a satisfactory method of using the sulphur wells of Low Harrogate for internal treatments and extended their use in baths. As well as the newspaper and leaflet advertisements, the town also supported the production and sale of picture postcards for visitors to send to friends and family, or keep as souvenirs. Here follows a selection of the cards and images which show the lighter side of Harrogate’s cure culture, which sadly is no more, though you can still experience the waters at the town’s Pump Museum - if you dare!

The very thought of death brings to mind fear and the prospect of facing something unknown. The average person is seldom prepared for death. Encountering death is the worst nightmare for most, only this is the last nightmare. We have funny notions about death. We feel it is alright if a person dies at an advanced age, particularly if without any long-term illness. We call this a ‘good’ death. Deaths after prolonged illnesses or at a young age in tragic circumstances like accidents or suicides are considered ‘bad’ deaths. We associate goodness with less suffering. With the knowledge of impending death, the idea of ego gets attenuated. We take less and less interest in possessing or performing. Our sense of worldly attachments weans away. This book first came into being in the form of a paper in a journal on palliative medicine. The original book in German has been translated as the present book. Monika Renz, the author, has a rich experience of attending to terminally ill patients, and giving them counselling and spiritual guidance.

Introductory course in the medical humanities with focus on English literature. Taught as a general education course. Topics include anatomy, madness, plagues and contagions and death and caregiving.

Objective: To validate various known risk factors of Parkinsonism and to establish basic information to present public health policy with 10-year follow-up cohort model. Methods: This population based nation-wide study was performed in the republic of South Korea using the database of regular health check in 2003 and 2004 of National Health Insurance Database of reimbursement claim of Health Insurance Review and Assessment Service of South Korea with 10 years follow up. Results: The authors identified 7,746 patients with Parkinsonism. The old age, hypertension, diabetes, depression, anxiety, taking statin medication, high body mass index, non-smoking, non-alcohol drinking and low socioeconomic status were each associated with increase in risk of Parkinsonism (fully adjusted Cox proportional hazards model: hazard ratio (HR) 1.259, 95% confidence interval (CI) 1.194 to 1.328 for hypertension, HR 1.255, 95% CI 1.186 to 1.329 for diabetes, HR 1.554, 95% CI 1.664 to 1.965 for depression, HR 1.808, 95% CI 1.462 to 1.652 for anxiety, and HR 1.157, 95% CI 1.072 to 1.250 for taking statin). Conclusions: In our study, old age, depression, anxiety, and nonsmoker were found to be risk factors of Parkinsonism, coincided with previous studies. However, gender, hypertension, diabetes, taking statin medication, non-alcohol drinking, and lower socioeconomic status differ from some previous studies and need to be verified in subsequent studies.

The historical narrative of water purity tends to chart a process of secularisation with an increasing importance on cleanliness. We suggest otherwise – that rhetorically at least, water has never been secularised. Moral impurity and water contamination have a long and interrelated history. Even before the connection had been made between contaminated water and disease, baptismal ideas had long fostered associations of hygiene and piety. The predilection for public bathing during Roman times continued long into the Middle Ages. Although John Wesley had pithily declared, ‘Cleanliness is next to godliness’ in the eighteenth century, it was not until the following century that his words would help to transform the habits of the upper classes of Britain and North America. Invariably, these notions were translated into ideas of moral hygiene. A polarity was established between the clean and the unclean, the refined and the coarse, the disciplined and the disorderly. Through the provision of clean, piped water and flushing of wastes, the sanitary engineer therefore, facilitated acts of physical and moral purification and civilisation.

Importance There have been only a few large-scale studies for risk factor analysis for CTS. No prior study has investigated the relationship between the occurrence of CTS and stratified socioeconomic status which is closely related to a person’s type of job. Objective To determine the correlation between stratified socioeconomic status and the occurrence of CTS. Design We conducted this study using a retrospective cohort model based on the combined databases of the Korean National Health Insurance System from 2003 to 2013; the national periodic health screening program database in 2002–2003 and health insurance database of reimbursement claims from 2003 through 2013. Setting The setting was a population-based retrospective cohort study. Participants First, we randomly sampled 514,795 patients who represented 10% of the 5,147,950 people who took part in periodic health screenings in 2002–2003. Existing CTS patients were excluded from this group. Therefore, this study finally included 512,942 participants and followed up their medical records from 2003 to 2013. Main Outcomes and Measures Desired outcomes were the incidence rate of CTS according to the stratified socioeconomic status and the correlation between the stratified socioeconomic status and the occurrence of the disease (the hazard ratios). Results The incidence rate was higher in people in the lower socioeconomic status. Correlation analysis showed that CTS was more likely to occur in lower socioeconomic status regardless gender. Conclusions and Relevance In our large-scale cohort study, CTS was associated with people of a lower socioeconomic status who usually work in simple but repetitive manual labor jobs in female as well as male population. We believe that the results of our study will be helpful to determine the pathophysiology of CTS and to set up a new industrial health policy for this condition.