Effects of Community Assets on Major Health Conditions in England: A Data Analytic Approach.

INTRODUCTION: The broader determinants of health including a wide range of community assets are extremely important in relation to public health outcomes. Multiple health conditions, multimorbidity, is a growing problem in many populations worldwide. METHODS: This paper quantified the effect of community assets on major health conditions for the population of England over six years, at a fine spatial scale using a data analytic approach. Community assets, which included indices of the health system, green space, pollution, poverty, urban environment, safety, and sport and leisure facilities, were quantified in relation to major health conditions. The health conditions examined included high blood pressure, obesity, dementia, diabetes, mental health, cardiovascular conditions, musculoskeletal conditions, respiratory conditions, kidney and liver disease, and cancer. Cluster analysis and dendrograms were calculated for the community assets and major health conditions. For each health condition, a statistical model with all community assets was fitted, and model selection was performed. The number of significant community assets for each health condition was recorded. The unique variance, explained by each significant community asset per health condition, was quantified using hierarchical variance partitioning within an analysis of variance model. RESULTS: The resulting data indicate major health conditions are often clustered, as are community assets. The results suggest that diversity and richness of community assets are key to major health condition outcomes. Primary care service waiting times and distance to public parks were significant predictors of all health conditions examined. Primary care waiting times explained the vast majority of the variances across health conditions, with the exception of obesity, which was better explained by absolute poverty. CONCLUSIONS: The implications of the combined findings of the health condition clusters and explanatory power of community assets are discussed. The vast majority of determinants of health could be accounted for by healthcare system performance and distance to public green space, with important covariate socioeconomic factors. Emphases on community approaches, significant relationships, and asset strengths and deficits are needed alongside targeted interventions. Whilst the performance of the public health system remains of key importance, community assets and local infrastructure remain paramount to the broader determinants of health.

The Impact of Culture-, Health- and Nature-Based Engagement on Mitigating the Adverse Effects of Public Health Restrictions on Wellbeing, Social Connectedness and Loneliness during COVID-19: Quantitative Evidence from a Smaller- and Larger-Scale UK Survey.

Numerous UK surveys conducted during COVID-19 examined the pandemic's detrimental effects on health, and the consequences of lockdown and other public health restrictions on mental health. Some surveys considered specific populations and social inequities exacerbated during COVID-19. Fewer surveys examined the ways in which the adverse effects of public health restrictions, such as lockdown, shielding and social distancing, might be alleviated. Drawing upon self-determination theory, the purpose of the current study was to assess whether culture-, health- and nature-based engagement would mitigate the effects of these restrictions on psychological wellbeing, social connectedness and loneliness. Quantitative data from a smaller-scale survey (n = 312) and a subset of questions embedded in a larger-scale survey (n = 3647) were analyzed using univariate and multivariate methods. Frequency of engagement, whether participation was online or offline and with or without other people, and the extent to which type of participation was associated with psychological wellbeing, social connectedness and loneliness were examined. Sports and fitness, gardening and reading occurred frequently in both surveys. For the smaller-scale survey, increases in connectedness and frequency of participation and decreases in loneliness were significantly associated with improved wellbeing, whereas the type of participation and age range were not significant predictors. Outcomes from the smaller-scale survey approximated the larger-scale survey for measures of loneliness, type and frequency of participation and proportion of respondents in each age range. As the frequency of participation was a significant predictor of wellbeing, but the type of participation was not significant, the findings implied that any type of participation in a sufficient quantity would be likely to boost wellbeing.

Understanding and Improving Older People's Well-Being through Social Prescribing Involving the Cultural Sector: Interviews from a Realist Evaluation.

Social prescribing is a non-clinical approach to addressing social, environmental, and economic factors affecting how people feel physical and/or emotionally. It involves connecting people to "community assets" (e.g., local groups, organizations, and charities) that can contribute to positive well-being. We sought to explain in what ways, for whom, and why the cultural sector can support social prescribing with older people. We conducted semi-structured interviews with 28 older people (aged 60+) and 25 cultural sector staff. The following nine concepts, developed from interview data, progressed the understanding of tailoring cultural offers, which came from our previous realist review-immersion, buddying, café culture, capacity, emotional involvement, perseverance, autonomy, elitism, and virtual cultural offers. Through tailoring, we propose that older people might experience one or more of the following benefits from engaging with a cultural offer as part of social prescribing-being immersed, psychological holding, connecting, and transforming through self-growth.

Barriers and enablers of integrated care in the UK: a rapid evidence review of review articles and grey literature 2018-2022.

Integrated care refers to person-centered and coordinated, health and social care, and community services. Integrated care systems are partnerships of organizations that deliver health and care services which were placed on a statutory footing in England, April 2022. Due to the need for fast, accessible, and relevant evidence, a rapid review was conducted according to World Health Organization methods to determine barriers and enablers of integrated care across the United Kingdom, 2018-2022. Nine databases were searched for review articles reporting evaluation of integrated care interventions involving medical (clinical and diagnostic) and nonmedical (public health services and community-based or social care/person-centred care) approaches, quality checked with the Critical Appraisal Skills Program qualitative checklist. OpenGrey and hand searches were used to identify grey literature, quality checked with the Authority, Accuracy, Coverage, Objectivity, Date, and Significance checklist. Thirty-four reviews and 21 grey literature reports fitted inclusion criteria of adult physical/mental health outcomes/multiple morbidities. Thematic analysis revealed six themes (collaborative approach; costs; evidence and evaluation; integration of care; professional roles; service user factors) with 20 subthemes including key barriers (cost effectiveness; effectiveness of integrated care; evaluation methods; focus of evidence; future research; impact of integration) and enablers (accessing care; collaboration and partnership; concept of integration; inter-professional relationships; person-centered ethos). Findings indicated a paucity of robust research to evaluate such interventions and lack of standardized methodology to assess cost effectiveness, although there is growing interest in co-production that has engendered information sharing and reduced duplication, and inter-professional collaborations that have bridged task-related gaps and overlaps. The importance of identifying elements of integrated care associated with successful outcomes and determining sustainability of interventions meeting joined-up care and preventive population health objectives was highlighted.

Tailoring cultural offers to meet the needs of older people during uncertain times: a rapid realist review.

BACKGROUND: Non-medical issues (e.g. loneliness, financial concerns, housing problems) can shape how people feel physically and psychologically. This has been emphasised during the Covid-19 pandemic, especially for older people. Social prescribing is proposed as a means of addressing non-medical issues, which can include drawing on support offered by the cultural sector. METHOD: A rapid realist review was conducted to explore how the cultural sector (in particular public/curated gardens, libraries and museums), as part of social prescribing, can support the holistic well-being of older people under conditions imposed by the pandemic. An initial programme theory was developed from our existing knowledge and discussions with cultural sector staff. It informed searches on databases and within the grey literature for relevant documents, which were screened against the review's inclusion criteria. Data were extracted from these documents to develop context-mechanism-outcome configurations (CMOCs). We used the CMOCs to refine our initial programme theory. RESULTS: Data were extracted from 42 documents. CMOCs developed from these documents highlighted the importance of tailoring-shaping support available through the cultural sector to the needs and expectations of older people-through messaging, matching, monitoring and partnerships. Tailoring can help to secure benefits that older people may derive from engaging with a cultural offer-being distracted (absorbed in an activity) or psychologically held, making connections or transforming through self-growth. We explored the idea of tailoring in more detail by considering it in relation to Social Exchange Theory. CONCLUSIONS: Tailoring cultural offers to the variety of conditions and circumstances encountered in later life, and to changes in social circumstances (e.g. a global pandemic), is central to social prescribing for older people involving the cultural sector. Adaptations should be directed towards achieving key benefits for older people who have reported feeling lonely, anxious and unwell during the pandemic and recovery from it.

Social prescribing for older people and the role of the cultural sector during the COVID-19 pandemic: What are link workers' views and experiences?

Older people's well-being can be bolstered by engaging with cultural activities and venues. They may be encouraged to try cultural offers by a link worker as part of social prescribing. However, the cultural sector, like all parts of life, was affected by the COVID-19 pandemic; this has had implications for cultural offers available to link workers. A study was conducted to explore the views and experiences of link workers in using the cultural sector within social prescribing, particularly for older people (aged 60+) during the pandemic. An online questionnaire was distributed to and completed by link workers in the UK. Data were analysed mainly using descriptive statistics. Open text responses were clustered into similar ideas to create key concepts. Useable responses were received from 148 link workers. They highlighted a general lack of interaction between link workers and the cultural sector about how the latter could support social prescribing. Results suggested that personal familiarity with cultural offers might prompt link workers to refer to them. Some respondents proposed that cultural offers were regarded as elitist, which deterred them from referring there. However, there was a general acknowledgement that the cultural sector could contribute to social prescribing. Link workers need to regard the cultural sector as accessible, appropriate, adequate, affordable and available before referring older people to cultural offers as part of social prescribing. Link workers may benefit from becoming more familiar with cultural sector staff and offers, including online resources, so they can then propose them to patients with confidence.

The transition from in-person to virtual museum programing for individuals living with chronic pain - A formative evaluation.

Museum engagement may be an effective approach for decreasing social disconnection and pain among individuals living with chronic pain. In October 2019, we launched a randomized controlled trial to assess the feasibility of museum engagement for individuals living with chronic pain; the study was halted in March, 2020 due to Covid-19-related safety concerns. This paper describes the process of transitioning from in-person to virtual museum programing in order to continue the study. Virtual museum programing is a feasible option for individuals living with chronic pain that is amenable to research and which may improve accessibility, inclusivity, and scalability relative to in-person programing.

Rapid Evidence Review of Community Engagement and Resources in the UK during the COVID-19 Pandemic: How Can Community Assets Redress Health Inequities?

Community engagement, such as participating in arts, nature or leisurely activities, is positively associated with psychological and physiological wellbeing. Community-based engagement during the COVID-19 pandemic facilitated informal and local mutual aid between individuals. This rapid evidence review assesses the emergence of community-based arts, nature, music, theatre and other types of cultural engagement amongst UK communities in response to the COVID-19 pandemic. Here, we focus on all community engagement with a sub-focus on provisions accessed by and targeted towards vulnerable groups. Two hundred and fifty-six resources were included that had been created between February 2020 and January 2021. Resources were identified through Google Scholar, PubMed, Web of Science, MedRXic, PsycharXiv and searches for grey literature and items in the public domain. The majority reported services that had been adapted to become online, telephone-based or delivered at a distance from doorsteps. Several quality assessment frameworks were used to evaluate the quality of data. Whilst a number of peer-reviewed, grey literature and public domain articles were identified, less than half of the identified literature met quality thresholds. The pace of the response to the pandemic may have meant that robust evaluation procedures were not always in place.

Assessing the impact of artistic and cultural activities on the health and well-being of forcibly displaced people using participatory action research.

OBJECTIVE: Drawing on a growing body of research suggesting that taking part in artistic and cultural activities benefits health and well-being, the objective was to develop a participatory action research (PAR) method for assessing the impact of arts interventions on forcibly displaced people, and identify themes concerning perceived benefits of such programmes. DESIGN: A collaborative study following PAR principles of observation, focus groups and in-depth semistructured interviews. SETTING: London-based charity working with asylum seekers and refugees. PARTICIPANTS: An opportunity sample (n=31; 6 males) participated in focus groups comprising refugees/asylum seekers (n=12; 2 males), volunteers (n=4; 1 males) and charity staff (n=15; 3 males). A subset of these (n=17; 3 males) participated in interviews comprising refugees/asylum seekers (n=7; 1 males), volunteers (n=7; 1 males) and charity staff (n=3; 1 males). RESULTS: Focus group findings showed that participants articulated the impact of creative activities around three main themes: skills, social engagement and personal emotions that were explored during in-depth interviews. Thematic analysis of interviews was conducted in NVivo 11 and findings showed that artistic and cultural activities impacted positively by helping participants find a voice, create support networks and learn practical skills useful in the labour market. CONCLUSIONS: The study expanded on arts and well-being research by exploring effects of cultural and creative activities on the psychosocial well-being of refugees and asylum seekers. By focusing on the relationship between arts, well-being and forced displacement, the study was instrumental in actively trying to change the narrative surrounding refugees and asylum seekers, often depicted in negative terms in the public sphere.

New genus of extinct Holocene gibbon associated with humans in Imperial China.

Although all extant apes are threatened with extinction, there is no evidence for human-caused extinctions of apes or other primates in postglacial continental ecosystems, despite intensive anthropogenic pressures associated with biodiversity loss for millennia in many regions. Here, we report a new, globally extinct genus and species of gibbon, Junzi imperialis, described from a partial cranium and mandible from a ~2200- to 2300-year-old tomb from Shaanxi, China. Junzi can be differentiated from extant hylobatid genera and the extinct Quaternary gibbon Bunopithecus by using univariate and multivariate analyses of craniodental morphometric data. Primates are poorly represented in the Chinese Quaternary fossil record, but historical accounts suggest that China may have contained an endemic ape radiation that has only recently disappeared.

Effects of a museum-based social prescription intervention on quantitative measures of psychological wellbeing in older adults.

AIMS: To assess psychological wellbeing in a novel social prescription intervention for older adults called Museums on Prescription and to explore the extent of change over time in six self-rated emotions ('absorbed', 'active', 'cheerful', 'encouraged', 'enlightened' and 'inspired'). METHODS: Participants ( n = 115) aged 65-94 years were referred to museum-based programmes comprising 10 weekly sessions, by healthcare and third sector organisations using inclusion criteria (e.g. socially isolated, able to give informed consent, not in employment, not regularly attending social or cultural activities) and exclusion criteria (e.g. unable to travel to the museum, unable to function in a group situation, unlikely to be able to attend all sessions, unable to take part in interviews and complete questionnaires). In a within-participants' design, the Museum Wellbeing Measure for Older Adults (MWM-OA) was administered pre-post session at start-, mid- and end-programme. A total of 12 programmes, facilitated by museum staff and volunteers, were conducted in seven museums in central London and across Kent. In addition to the quantitative measures, participants, carers where present, museum staff and researchers kept weekly diaries following guideline questions and took part in end-programme in-depth interviews. RESULTS: Multivariate analyses of variance showed significant participant improvements in all six MWM-OA emotions, pre-post session at start-, mid- and end-programme. Two emotions, 'absorbed' and 'enlightened', increased pre-post session disproportionately to the others; 'cheerful' attained the highest pre-post session scores whereas 'active' was consistently lowest. CONCLUSION: Museums can be instrumental in offering museum-based programmes for older adults to improve psychological wellbeing over time. Participants in the study experienced a sense of privilege, valued the opportunity to liaise with curators, visit parts of the museum closed to the public and handle objects normally behind glass. Participants appreciated opportunities afforded by creative and co-productive activities to acquire learning and skills, and get to know new people in a different context.

Museum-based programs for socially isolated older adults: Understanding what works.

This paper presents research findings that help to understand how museum programs created opportunities to enhance wellbeing and health, and changed experiences of social isolation in older adults. The research conceptualized how program elements enabled both individual experiences and relational processes to occur. These components operated within a context that was enriched by the museum as a place to support wellbeing and enhance social interaction. To meaningfully support socially isolated older people as part of local public health strategies, museums need to be accessible and engaging places that purposively support social interaction by involving people and objects, participating in multiple sessions over time, that are facilitated by skilled and knowledgeable staff.

Spatiotemporal requirements of the Hainan gibbon: Does home range constrain recovery of the world's rarest ape?

Conservation management requires an evidence-based approach, as uninformed decisions can signify the difference between species recovery and loss. The Hainan gibbon, the world's rarest ape, reportedly exploits the largest home range of any gibbon species, with these apparently large spatial requirements potentially limiting population recovery. However, previous home range assessments rarely reported survey methods, effort, or analytical approaches, hindering critical evaluation of estimate reliability. For extremely rare species where data collection is challenging, it also is unclear what impact such limitations have on estimating home range requirements. We re-evaluated Hainan gibbon spatial ecology using 75 hr of observations from 35 contact days over 93 field-days across dry (November 2010-February 2011) and wet (June 2011-September 2011) seasons. We calculated home range area for three social groups (N = 21 individuals) across the sampling period, seasonal estimates for one group (based on 24 days of observation; 12 days per season), and between-group home range overlap using multiple approaches (Minimum Convex Polygon, Kernel Density Estimation, Local Convex Hull, Brownian Bridge Movement Model), and assessed estimate reliability and representativeness using three approaches (Incremental Area Analysis, spatial concordance, and exclusion of expected holes). We estimated a yearly home range of 1-2 km2 , with 1.49 km2 closest to the median of all estimates. Although Hainan gibbon spatial requirements are relatively large for gibbons, our new estimates are smaller than previous estimates used to explain the species' limited recovery, suggesting that habitat availability may be less important in limiting population growth. We argue that other ecological, genetic, and/or anthropogenic factors are more likely to constrain Hainan gibbon recovery, and conservation attention should focus on elucidating and managing these factors. RESEARCH HIGHLIGHTS: Re-evaluation reveals Hainan gibbon home range as c. 1-2 km2 . Hainan gibbon home range is, therefore, similar to other Nomascus gibbons. Limited data for extremely rare species does not necessarily prevent derivation of robust home range estimates.

Well-Being With Objects: Evaluating a Museum Object-Handling Intervention for Older Adults in Health Care Settings.

The extent to which a museum object-handling intervention enhanced older adult well-being across three health care settings was examined. The program aimed to determine whether therapeutic benefits could be measured objectively using clinical scales. Facilitator-led, 30 to 40 min sessions handling and discussing museum objects were conducted in acute and elderly care (11 one-to-ones), residential (4 one-to-ones and 1 group of five), and psychiatric (4 groups of five) settings. Pre-post measures of psychological well-being (Positive Affect and Negative Affect Schedule) and subjective wellness and happiness (Visual Analogue Scales) were compared. Positive affect and wellness increased significantly in acute and elderly and residential care though not psychiatric care whereas negative affect decreased and happiness increased in all settings. Examination of audio recordings revealed enhanced confidence, social interaction, and learning. The program allowed adults access to a museum activity who by virtue of age and ill health would not otherwise have engaged with museum objects.

Identifying environmental versus phylogenetic correlates of behavioural ecology in gibbons: implications for conservation management of the world's rarest ape.

BACKGROUND: For conservation of highly threatened species to be effective, it is crucial to differentiate natural population parameters from atypical behavioural, ecological and demographic characteristics associated with human disturbance and habitat degradation, which can constrain population growth and recovery. Unfortunately, these parameters can be very hard to determine for species of extreme rarity. The Hainan gibbon (Nomascus hainanus), the world's rarest ape, consists of a single population of c.25 individuals, but intensive management is constrained by a limited understanding of the species' expected population characteristics and environmental requirements. In order to generate a more robust evidence-base for Hainan gibbon conservation, we employed a comparative approach to identify intrinsic and extrinsic drivers of variation in key ecological and behavioural traits (home range size, social group size, mating system) across the Hylobatidae while controlling for phylogenetic non-independence. RESULTS: All three studied traits show strong phylogenetic signals across the Hylobatidae. Although the Hainan gibbon and some closely related species have large reported group sizes, no observed gibbon group size is significantly different from the values expected on the basis of phylogenetic relationship alone. However, the Hainan gibbon and two other Nomascus species (N. concolor, N. nasutus) show home range values that are higher than expected relative to all other gibbon species. Predictive models incorporating intraspecific trait variation but controlling for covariance between population samples due to phylogenetic relatedness reveal additional environmental and biological determinants of variation in gibbon ranging requirements and social structure, but not those immediately associated with recent habitat degradation. CONCLUSIONS: Our study represents the first systematic assessment of behavioural and ecological trait patterns across the Hylobatidae using recent approaches in comparative analysis. By formally contextualising the Hainan gibbon's observed behavioural and ecological characteristics within family-wide variation in gibbons, we are able to determine natural population parameters expected for this Critically Endangered species, as well as wider correlates of variation for key population characteristics across the Hylobatidae. This approach reveals key insights with a direct impact on future Hainan gibbon conservation planning, and demonstrates the usefulness of the comparative approach for informing management of species of conservation concern.

Mixed methods evaluation of well-being benefits derived from a heritage-in-health intervention with hospital patients.

BACKGROUND: This study sought to determine the effects of a heritage-in-health intervention on well-being. Benefits of arts-in-health interventions are relatively well-documented yet little robust research has been conducted using heritage-in-health interventions, such as those involving museum objects. METHODS: Hospital patients (n = 57) participated in semi-structured, 30-40 minute facilitated interview sessions, discussing and handling museum objects comprising selections of six artefacts and specimens loaned from archaeology, art, geology and natural history collections. Well-being measures (Positive Affect Negative Affect Scale, Visual Analogue Scales) evaluated the sessions while inductive and deductive thematic analysis investigated psycho-educational features accounting for changes. RESULTS: Comparison of pre- and post-session quantitative measures showed significant increases in well-being and happiness. Qualitative investigation revealed thinking and meaning-making opportunities for participants engaged with objects. CONCLUSIONS: Heritage-in-health sessions enhanced positive mood and social interaction, endorsing the need for provision of well-being-related museum and gallery activities for socially excluded or vulnerable healthcare audiences.

Museums and art galleries as partners for public health interventions.

The majority of public health programmes are based in schools, places of employment and in community settings. Likewise, nearly all health-care interventions occur in clinics and hospitals. An underdeveloped area for public health-related planning that carries international implications is the cultural heritage sector, and specifically museums and art galleries. This paper presents a rationale for the use of museums and art galleries as sites for public health interventions and health promotion programmes through discussing the social role of these organisations in the health and well-being of the communities they serve. Recent research from several countries is reviewed and integrated into a proposed framework for future collaboration between cultural heritage, health-care and university sectors to further advance research, policy development and evidence-based practice.

Enhancing cancer patient well-being with a nonpharmacological, heritage-focused intervention.

CONTEXT: Nonpharmacological, arts-focused interventions in health care have demonstrated considerable improvements in cancer patient well-being, although there is a little clinically robust, empirical evidence to demonstrate the value of heritage-focused practices. OBJECTIVES: This study examined the effectiveness of a novel, nonpharmacological, heritage-focused intervention with adult female inpatients receiving cancer treatment in oncology wards of a large, central London hospital. METHODS: In the tactile experimental condition, participants handled and discussed a selection of museum objects with a facilitator, whereas in the visual control condition, participants discussed photographs of the same objects. Sessions were conducted on a one-to-one basis at patients' bedsides and lasted about half an hour. Quantitative measures of psychological well-being with proven reliability and validity were used in a pretest/post-test control group, quasi-experimental design. RESULTS: Levels of positive emotion, well-being, and happiness were significantly enhanced in the experimental condition compared with the control condition for both oncology and nononcology patients. CONCLUSION: Findings indicate a future role for heritage-focused practices in enhancing health care environments.

Inter- and intra-specific scaling of articular surface areas in the hominoid talus.

The morphology of postcranial articular surfaces is expected to reflect their weight-bearing properties, as well as the stability and mobility of the articulations to which they contribute. Previous studies have mainly confirmed earlier predictions of isometric scaling between articular surface areas and body mass; the exception to this is 'male-type', convex articular surface areas, which may scale allometrically due to differences in locomotor strategies within the analysed samples. In the present study, we used new surface scanning technology to quantify more accurately articular surface areas and to test those predictions within the talus of hominoid primates, including modern humans. Our results, contrary to predictions, suggest that there are no generalised rules of articular scaling within the talus of hominoids. Instead, we suggest that articular scaling patterns are highly context-specific, depending on the role of each articulation during locomotion, as well as taxon- and sex-specific differences in locomotion and ontogenetic growth trajectories within any given sample. While this may prove problematic for inferring body mass based on articular surface area, it also offers new opportunities of gaining substantial insights into the locomotor patterns of extinct species.