Convivial Populations: Ivan Illich and Public Health in the 21st Century.

Ivan Illich (1926-2002) was a historian, social critic, and professor at multiple universities. He came to intellectual fame through his criticisms of modern institutions, including health care, and his concern with social structures that he believed to impede human flourishing. However, Illich has not been thoroughly explored as a source of insight for public health professionals. Although he populates the medical and public health literature, discourse remains sparse about how Illich might contribute to key conversations in public health today. In this article, I explore Illich's potential contributions to modern public health through one of his seminal works, Tools for Conviviality. I frame Illich as a valuable conversational partner for public health professionals at a crucial moment in the field's history. (Am J Public Health. Published online ahead of print May 9, 2024:e1-e6. https://doi.org/10.2105/AJPH.2024.307675).

A State of Grace: Community, Self-Consciousness, and Faith in W.H. Auden's "The Age of Anxiety".

In this essay, the author examines a highly influential poem, The Age of Anxiety by W.H. Auden, for its engagement with anxiety and religious faith in the modern world. Published in 1947, the book-length poem reveals Auden's deep understanding of western psychology, Judaism, and Christianity. The author argues for the relevance of The Age of Anxiety in this modern moment, but demonstrates that this relevance does not derive from any direct diagnostic or therapeutic implications of the poem. Rather, Auden's work provides readers with an image of a state of grace in the middle of an age of anxiety.

Timing of orthostatic hypotension and its relationship with falls in older adults.

BACKGROUND: There is inconsistent evidence on the optimal time after standing to assess for orthostatic hypotension. We determined the prevalence of orthostatic hypotension at different time points after standing in a population of older adults, as well as fall risk and symptoms associated with orthostatic hypotension. METHODS: We performed a secondary analysis of the Study to Understand Fall Reduction and Vitamin D in You (STURDY), a randomized clinical trial funded by the National Institute on Aging, testing the effect of differing vitamin D3 doses on fall risk in older adults. STURDY occurred between July 2015 and May 2019. Secondary analysis occurred in 2022. Participants were community-dwelling adults, 70 years or older. In the orthostatic hypotension assessment, participants stood upright from supine position and underwent six standing blood pressure measurements (M1-M6) in two clusters of three measurements (immediately and 3 min after standing). Cox proportional hazard models were used to examine the relationship between orthostatic hypotension at each measurement and subsequent falls. Participants were followed until the earlier of their 24-month visit or study completion. RESULTS: Orthostatic hypotension occurred in 32% of assessments at M1, and only 16% at M5 and M6. Orthostatic hypotension from average immediate (M1-3) and average delayed (M4-6) measurements, respectively, predicted higher fall risk (M1-3 = 1.65 [1.08, 2.52]; M4-6 = 1.73 [1.03, 2.91]) (hazard ratio [95% confidence interval]). However, among individual measurements, only orthostatic hypotension at M5 (1.84 [1.16, 2.93]) and M6 (1.85 [1.17, 2.91]) predicted higher fall risk. Participants with orthostatic hypotension at M1 (3.07 [1.48, 6.38]) and M2 (3.72 [1.72, 8.03]) were more likely to have reported orthostatic symptoms. CONCLUSIONS: Orthostatic hypotension was most prevalent and symptomatic immediately within 1-2 min after standing, but more informative for fall risk after 4.5 min. Clinicians may consider both intervals when assessing for orthostatic hypotension.

Dostoevsky's Doctor: Active Love in Modern Medicine and The Brothers Karamazov.

In this essay, the author draws from The Brothers Karamazov, a novel by Fyodor Dostoevsky, to consider the idea of love and its relevance to burnout in modern medicine. They argue that active love, as espoused by one of Dostoevsky's characters, might help clinicians care for their patients even in moments of exhaustion or disillusion. Coherent with Dostoevsky's Christian background, the author examines active love alongside the Christian concept of grace and Simone Weil's concept of attention. These explorations may yield fresh insights for clinicians struggling with burnout in health care, as well as those striving to master the timeless art of caregiving.

Use of Physical Restraints in the Emergency Department: Rationale, Risks, and Benefits.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Acute Psychosis: Differential Diagnosis, Evaluation, and Management.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Diagnosis and Management of Hypertensive Emergency in a Patient With Generalized Anxiety Disorder.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Predicting Homelessness Among U.S. Army Soldiers No Longer on Active Duty.

INTRODUCTION: The ability to predict and prevent homelessness has been an elusive goal. The purpose of this study was to develop a prediction model that identified U.S. Army soldiers at high risk of becoming homeless after transitioning to civilian life based on information available before the time of this transition. METHODS: The prospective cohort study consisted of observations from 16,589 soldiers who were separated or deactivated from service and who had previously participated in 1 of 3 baseline surveys of the Army Study to Assess Risk and Resilience in Servicemembers in 2011-2014. A machine learning model was developed in a 70% training sample and evaluated in the remaining 30% test sample to predict self-reported homelessness in 1 of 2 Longitudinal Study surveys administered in 2016-2018 and 2018-2019. Predictors included survey, administrative, and geospatial variables available before separation/deactivation. Analysis was conducted in November 2020-May 2021. RESULTS: The 12-month prevalence of homelessness was 2.9% (SE=0.2%) in the total Longitudinal Study sample. The area under the receiver operating characteristic curve in the test sample was 0.78 (SE=0.02) for homelessness. The 4 highest ventiles (top 20%) of predicted risk included 61% of respondents with homelessness. Self-reported lifetime histories of depression, trauma of having a loved one murdered, and post-traumatic stress disorder were the 3 strongest predictors of homelessness. CONCLUSIONS: A prediction model for homelessness can accurately target soldiers for preventive intervention before transition to civilian life.

Medicine in Between: Thomas Wolfe, Spirituality, and the Meaning of Life.

Questions of meaning may seem more properly suited to the spheres of religion or philosophy; yet physicians certainly witness some of the greatest sufferings of their patients' lives, and through this suffering, many patients look to their doctors not just for treatments but for answers. In this essay, the author highlights an exchange between patient and doctor in Thomas Wolfe's Look Homeward, Angel, to argue that physicians need not have ready made answers about life, meaning, or spirituality, but should indeed provide comfort and support when their patients ask: "What's it all about?"