Loneliness and global cognitive functioning in racially and ethnically diverse US midlife and older adults.

Introduction: Few studies have examined the association of loneliness and cognitive functioning in the US. We used two common measures of loneliness and examined their association in a large sample of US Black, Latino, and White adults (ages ≥ 50). Methods: We analyzed Wave 3 of the National Social Life, Health, and Aging Project (N = 2,757). We examined loneliness using one item from the CES-D and the Felt Loneliness Measure (NFLM); cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA) tool, where higher scores indicated better functioning. We used weighted ordinary least squares regressions to examine the effects of loneliness (CES-D loneliness and NFLM in separate models) on MoCA scores. In exploratory analyses, we examined if these relationships varied by race and ethnicity. We adjusted all models for sociodemographic and other salient factors (e.g., chronic disease, depressive symptoms, living alone). Results: Mean age was 63.49 years, 52% were female, and 9% were Black and 6% Latino persons. Approximately 54% endorsed feeling lonely on at least one measure; 31% (CES-D) and 46% (NFLM). The relationship between loneliness measures was positive and significant, X 2 (1, N = 2,757) = 435.493 p < 0.001. However, only 40% of lonely individuals were identified as lonely on both assessments. CES-D loneliness was inversely (߈ = -0.274, p = 0.032) associated with MoCA scores and this association did not vary by race and ethnicity. Greater NFLM loneliness was positively associated (߈ = 0.445, p < 0.001) with higher MoCA scores for Latino participants only. Discussion: Loneliness appears to be an important predictor of cognitive functioning. However, the association of loneliness and cognitive functioning varied when using the CES-D loneliness item or the NFLM. Future work is needed to understand how loneliness and its clinically relevant dimensions (social, emotional, existential, chronicity) relate to global and individual cognitive domains. Research is needed with racially and ethnically diverse midlife and older adults, particularly to understand our counterintuitive finding for Latino participants. Finally, findings also support the need for research on interventions to prevent cognitive decline targeting loneliness.

Psychological distress mediates the association between COVID-19-related discrimination and subsequent PTSD symptom severity in healthcare workers: a two-year follow-up study.

BACKGROUND: Past research has suggested a cross-sectional association between COVID-19-related discrimination and PTSD symptom severity. However, no cohort study has examined the longitudinal association that better supports causal interpretation. Also, even if such an association genuinely exists, the specific pathway remains unclear. METHODS: We conducted a two-year follow-up study, obtaining data from healthcare workers in a hospital setting. We first evaluated how COVID-19-related discrimination in 2021 was associated with subsequent PTSD symptom severity in 2023. Thereafter, we conducted causal mediation analysis to examine how this association was mediated by psychological distress in 2022, accounting for exposure-mediator interaction. Missing data were handled using random forest imputation. RESULTS: A total of 660 hospital staff were included. The fully adjusted model showed greater PTSD symptom severity in individuals who experienced any COVID-19-related discrimination compared with those without such experiences (ß, 0.44; 95% CI, 0.04-0.90). Regarding each type of discrimination, perceived discrimination was associated with greater PTSD symptom severity (ß, 0.52; 95% CI, 0.08-0.96), whereas verbal discrimination did not reach statistical significance. Psychological distress mediated 28.1%-38.8% of the observed associations. CONCLUSIONS: COVID-19-related discrimination is associated with subsequent PTSD symptom severity in healthcare workers. Psychological distress may serve as an important mediator, underscoring the potential need for interventions targeting this factor.

The impact of social isolation policies during COVID-19 on suburban mothers and pregnant women with opioid use disorder.

The aim of this qualitative research paper was to identify how social isolation policies implemented during the COVID-19 pandemic impacted the lives of pregnant women and mothers with opioid use disorder. Between 2020 and 2022, in-depth interviews were conducted with 37 mothers and pregnant women living in the suburbs of Newark, NJ, and New Haven, CT. Participants had to be at least 18 years old, misused or abused opioids in the last 12 months while residing in a suburban location, and pregnant or caring for children aged 12 and younger. We used syndemics theory to guide our grounded theory analysis to identify relationships between social situations, health conditions, and opioid use disorder. Five major themes emerged that were either directly or indirectly impacted by social isolation caused by policies implemented during the COVID-19 pandemic: Relationships, Environment, Services, Drug Use, and Health. Findings from this study reveal new insights into how mothers and their health were impacted by prolonged social isolation policies and offer suggestions for policymakers and service providers to better address future crisis.

Web-Based Group Conversational Intervention on Cognitive Function and Comprehensive Functional Status Among Japanese Older Adults: Protocol for a 6-Month Randomized Controlled Trial.

BACKGROUND: Social communication is a key factor in maintaining cognitive function and contributes to well-being in later life. OBJECTIVE: This study will examine the effects of "Photo-Integrated Conversation Moderated by Application version 2" (PICMOA-2), which is a web-based conversational intervention, on cognitive performance, frailty, and social and psychological indicators among community-dwelling older adults. METHODS: This study is a randomized controlled trial with an open-label, 2-parallel group trial and 1:1 allocation design. Community dwellers aged 65 years and older were enrolled in the trial and divided into the intervention and control groups. The intervention group receives the PICMOA-2 program, a web-based group conversation, once every 2 weeks for 6 months. The primary outcome is verbal fluency, including phonemic and semantic fluency. The secondary outcomes are other neuropsychiatric batteries, including the Mini-Mental State Examination, Logical Memory (immediate and delay), verbal paired associates, and comprehensive functional status evaluated by questionnaires, including frailty, social status, and well-being. The effect of the intervention will be examined using a mixed linear model. As a secondary aim, we will test whether the intervention effects vary with the covariates at baseline to examine the effective target attributes. RESULTS: Recruitment was completed in July 2023. A total of 66 participants were randomly allocated to intervention or control groups. As of January 1, 2024, the intervention is ongoing. Participants are expected to complete the intervention at the end of February 2024, and the postintervention evaluation will be conducted in March 2024. CONCLUSIONS: This protocol outlines the randomized controlled trial study design evaluating the effect of a 6-month intervention with PICMOA-2. This study will provide evidence on the effectiveness of social interventions on cognitive function and identify effective target images for remote social intervention. TRIAL REGISTRATION: UMIN Clinical Trials UMIN000050877; https://tinyurl.com/5eahsy66. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56608.

Strength in silence: the journey of mothers raising children with hydrocephalus.

BACKGROUND: Raising a child with hydrocephalus can be very challenging, especially in low- and middle-income countries. In Pakistan, mothers being the primary caregivers for their hydrocephalic children are under tremendous stress. METHODS: This study explores the challenges faced by Pakistani mothers raising children with hydrocephalus, employing a qualitative methodology through focus group discussions comprising ten mothers of hydrocephalic babies at Tertiary Care Hospital in Pakistan. RESULTS: The findings highlight three main themes: emotional toll, social isolation, and financial strain. Mothers experience significant emotional stress due to societal stigma and a lack of support, particularly from their husbands and family. Social isolation is prevalent, as mothers fear sharing their burdens and face physical confinement due to their children's needs. Financial strain is another major issue, with high medical costs adding to their economic difficulties. CONCLUSION: The study emphasizes improved access to specialized care, awareness campaigns to reduce stigma, financial assistance, and stronger community support networks to support these mothers better. Addressing these unmet needs is crucial for empowering Pakistani mothers in their caregiving roles and improving the quality of life for their children with hydrocephalus.

Analysis of changes in social isolation, loneliness, or both, and subsequent cognitive function among older adults: Findings from a nationwide cohort study.

INTRODUCTION: The study aimed to investigate the associations of changes in social isolation, loneliness, or both, with cognitive function. METHODS: Data were from 7299 older adults in the Chinese Longitudinal Healthy Longevity Survey. We defined four change patterns (no, incident, transient, and persistent) for social isolation and loneliness, and created nine-category variable to represent the joint changes. Tobit regression models and Cox models were performed. RESULTS: Incident, transient, and persistent social isolation or loneliness may accelerate cognitive decline (p < 0.05). Incident, transient, and persistent social isolation were associated with higher cognitive impairment risk, while only persistent loneliness was associated with higher cognitive impairment risk (p < 0.001). Notably, short-term or persistent social isolation was associated with accelerated cognitive decline and incident cognitive impairment, regardless of different loneliness change status (p < 0.05). DISCUSSION: Short-term or persistent social isolation and persistent loneliness may be a salient risk factor for cognitive decline and cognitive impairment. HIGHLIGHTS: Incident, transient, and persistent social isolation were associated with accelerated cognitive decline and higher cognitive impairment risk. Persistent loneliness was associated with accelerated cognitive decline and higher cognitive impairment risk. Short-term or persistent social isolation with concurrent different loneliness change status accelerated cognitive decline and higher cognitive impairment risk.

Gossip and coping with social isolation: the case of migrant truck drivers in Western Europe.

This article examines how employees use gossip as a resource to cope with social isolation. Building on a qualitative study with 32 truck drivers in a Western European company, our research identified gossip in close relationships and gossip in distant relationships as distinct patterns playing a different role in coping with social isolation, and a third pattern in which gossip was not beneficial. First, gossiping with close friends at work helped drivers engage in emotion-focused coping by reducing stress and loneliness. Second, gossiping with distant colleagues helped drivers engage in problem-focused coping by exchanging knowledge involving people in the organization. Third, gossip avoidance occurred in distant relationships, where drivers limited gossip exchanges going beyond instrumentally useful information. Overall, these findings show that drivers relied on different layers of their social network to cope with social isolation. Enriching previous research, this study shows that gossip represents an essential resource for emotion-focused and problem-focused coping.

Longitudinal Relationship Between Baseline Social Frailty and Cognitive Impairment in Older Adults: 14-Year Follow-Up Results From the Korean Longitudinal Study of Ageing.

OBJECTIVES: This study aimed to investigate the longitudinal relationship between social frailty and cognitive impairment among community-dwelling older adults. DESIGN: This retrospective cohort study is based on the first to eighth waves of the Korean Longitudinal Study of Ageing (2006-2020). SETTING AND PARTICIPANTS: The participants were 2106 community-dwelling older adults aged 65 years or older and without cognitive impairment in 2006. METHODS: Social frailty was assessed with 5 items including social support, social activity, social network, loneliness, and living alone (0 = social nonfrailty, 1 = social prefrailty, 2 or more = social frailty). Cognitive function was assessed using the Korean Mini-Mental State Examination, and scores below 24 indicated cognitive impairment. We used the generalized estimating equation to assess the longitudinal relationship between social frailty and cognitive impairment. RESULTS: Of the 2106 participants, 515 (24.4%) had social frailty, 669 (31.8%) had social prefrailty, and 922 (43.8%) were social nonfrailty based on the baseline assessments. Relative to the social nonfrailty group, the odds ratios of the social prefrailty and social frailty groups for cognitive impairment were 1.30 (95% CI 1.10-1.54) and 1.41 (95% CI 1.16-1.71), respectively, during the follow-up. Subgroup analysis showed that social inactivity and loneliness were significantly associated with cognitive impairment. CONCLUSIONS AND IMPLICATIONS: These findings highlight the need for health care providers to introduce and use available social resources for older adults with social frailty to increase the relationships between individual and social context. Social inactivity and loneliness were the major domains associated with cognitive impairment, and loneliness can be resolved by participating in social activities. Therefore, health care providers especially provide opportunities for social activities, such as group-based programs in the community, to reduce social frailty and cognitive impairment.

Using social risks to predict unplanned hospital readmission and emergency care among hospitalized Veterans.

OBJECTIVES: (1) To estimate the association of social risk factors with unplanned readmission and emergency care after a hospital stay. (2) To create a social risk scoring index. DATA SOURCES AND SETTING: We analyzed administrative data from the Department of Veterans Affairs (VA) Corporate Data Warehouse. Settings were VA medical centers that participated in a national social work staffing program. STUDY DESIGN: We grouped socially relevant diagnoses, screenings, assessments, and procedure codes into nine social risk domains. We used logistic regression to examine the extent to which domains predicted unplanned hospital readmission and emergency department (ED) use in 30 days after hospital discharge. Covariates were age, sex, and medical readmission risk score. We used model estimates to create a percentile score signaling Veterans' health-related social risk. DATA EXTRACTION: We included 156,690 Veterans' admissions to a VA hospital with discharged to home from 1 October, 2016 to 30 September, 2022. PRINCIPAL FINDINGS: The 30-day rate of unplanned readmission was 0.074 and of ED use was 0.240. After adjustment, the social risks with greatest probability of readmission were food insecurity (adjusted probability = 0.091 [95% confidence interval: 0.082, 0.101]), legal need (0.090 [0.079, 0.102]), and neighborhood deprivation (0.081 [0.081, 0.108]); versus no social risk (0.052). The greatest adjusted probabilities of ED use were among those who had experienced food insecurity (adjusted probability 0.28 [0.26, 0.30]), legal problems (0.28 [0.26, 0.30]), and violence (0.27 [0.25, 0.29]), versus no social risk (0.21). Veterans with social risk scores in the 95th percentile had greater rates of unplanned care than those with 95th percentile Care Assessment Needs score, a clinical prediction tool used in the VA. CONCLUSIONS: Veterans with social risks may need specialized interventions and targeted resources after a hospital stay. We propose a scoring method to rate social risk for use in clinical practice and future research.

NARP-related alterations in the excitatory and inhibitory circuitry of socially isolated mice: developmental insights and implications for autism spectrum disorder.

Background: Social isolation during critical periods of development is associated with alterations in behavior and neuronal circuitry. This study aimed to investigate the immediate and developmental effects of social isolation on firing properties, neuronal activity-regulated pentraxin (NARP) and parvalbumin (PV) expression in the prefrontal cortex (PFC), social behavior in juvenile socially isolated mice, and the biological relevance of NARP expression in autism spectrum disorder (ASD). Methods: Mice were subjected to social isolation during postnatal days 21-35 (P21-P35) and were compared with group-housed control mice. Firing properties in the PFC pyramidal neurons were altered in P35 socially isolated mice, which might be associated with alterations in NARP and PV expression. Results: In adulthood, mice that underwent juvenile social isolation exhibited difficulty distinguishing between novel and familiar mice during a social memory task, while maintaining similar levels of social interaction as the control mice. Furthermore, a marked decrease in NARP expression in lymphoblastoid cell lines derived from adolescent humans with ASD as compared to typically developing (TD) humans was found. Conclusion: Our study highlights the role of electrophysiological properties, as well as NARP and PV expression in the PFC in mediating the developmental consequences of social isolation on behavior.

Can 'What Is Known' about Social Isolation and Loneliness Interventions Sufficiently Inform the Clinical Practice of Health Care and Social Service Professionals Who Work with Older Adults? Exploring Knowledge-to-Practice Gaps.

Establishing intervention effectiveness is an important component of a broader knowledge translation (KT) process. However, mobilizing the implementation of these interventions into practice is perhaps the most important aspect of the KT cycle. The purpose of the current study was to conduct an umbrella review to (a) identify promising interventions for SI&L in older adults, (b) interpret (translate) the findings to inform clinical knowledge and practice interventions in different settings and contexts, and (c) highlight research gaps that may hinder the uptake of these interventions in practice. The broader purpose of this study was to inform evidence-based clinical practice guidelines on SI&L for HCSSPs. In line with other reviews, our study noted variations in methods and intervention designs that prohibit definitive statements about intervention effectiveness. Perhaps, the most significant contribution of the current review was in identifying knowledge-to-practice gaps that inhibit the implementation of interventions into practice-based realities.

A Systematic Review of the Relationship between Social Isolation and Physical Health in Adults.

Background: According to the World Health Organization, social isolation, particularly of older adults, is a public health issue endangering the well-being of individuals, families, and communities. Social isolation affects health through biological, behavioral, and psychological pathways and is associated with physical and psychological/emotional well-being, increases morbidity and mortality rates, and lowers quality of life. Purpose: This systematic review examined the relationship between social isolation and physical health, including subjective and objective dimensions, and factors that influence this relationship in adults. Methods: This systematic review examined six electronic databases covering the field of health and human services and included results from 1 January 2017 to 10 March 2023 with key terms including adult social connection or social isolation coupled with health, physical, psychological, emotional, mental, or behavioral. The initial search yielded 925 research articles across all databases and was narrowed to 710 when the decision was made to focus on social isolation and physical health. Covidence was used throughout the retrieval and appraisal process, as provided in a PRISMA flow diagram. Twenty-four studies that scored 90 or above in the appraisal process were included in the systematic review. Results: The studies represented included seven studies conducted in the United States and seventeen studies conducted internationally. Regarding study design, twenty-three studies were quantitative, one was qualitative, and one was mixed methods. The majority of quantitative studies were correlational in design with nine being longitudinal. The majority of studies were based on large national data sets representing in total 298,653 participants aged 50 and older. The results indicate that social isolation is related to increases in inflammatory biomarkers associated with diseases, all-cause mortality, lower expectations of longevity, and frailty. In addition, social isolation was associated with cognitive decline and disruptions in sleep. Poor oral health increased social isolation. The results further indicated that decreased physical performance/function and a decline in physical activity were associated with social isolation, as well as decreased overall physical health, poor health behaviors, and self-care, and decreased health-related quality of life. Further research is warranted to examine the possible bidirectionality of these relationships and possible mediating, moderating, or confounding variables. Implications: Future research is needed to explore the biological and behavioral pathways in which social isolation negatively impacts physical health. Going forward, studies are needed that move beyond descriptive, exploratory methods and integrate data from qualitative and mixed-method designs that will inform the development and testing of a conceptual framework related to social isolation and health. By advancing the science behind social isolation, comprehensive interventions can be identified and tested with implications at the individual, family, community, and societal levels to reduce social isolation, particularly among adults, and improve health and quality of life.

Stress-related gene regulation: Do isolated and connected individuals differ?

BACKGROUND: Social isolation and loneliness (known as social disconnection, collectively) lead to serious downstream health effects, including shortening of lifespan and higher risk for cardiac disease. We must better understand how isolation and loneliness lead to these negative health outcomes. Previous literature has demonstrated that social motivation and social ability are contributors to the likelihood of social isolation and loneliness. We examined the effect of the above social factors on immune gene expression in socially-connected and -isolated individuals. METHODS: Recruitment occurred via two online advertisements, one for socially isolated individuals and another for general research participants. Participants (n = 102) were separated into groups (isolated versus connected) based on which ad they responded to, and provided data on isolation, loneliness, social motivation, and social ability. The Conserved Transcriptional Response to Adversity (CTRA) stress gene regulation program was assessed with genome-wide transcriptional profiling. RESULTS: CTRA gene expression patterns were reversed between connected and isolated groups across several variables. Social isolation was associated with higher CTRA levels in the connected group, but lower levels in the isolated group. Social approach was associated with lower CTRA levels in the connected group, but higher in the isolated group, and the converse was true for social avoidance. CTRA levels were minimally affected by social ability measures. CONCLUSION: Prior work on social isolation and loneliness has focused on loneliness and has identified many negative downstream health effects. In this study we demonstrate that objective social isolation may not be associated with the same negative downstream health effects, and in fact, social interaction may be more stressful than social isolation for some socially-isolated individuals.

Resocialization mitigates depressive behaviors induced by social isolation stress in mice: Attenuation of hippocampal neuroinflammation and nitrite level.

BACKGROUND AND AIM: Social isolation stress (SIS) is a stressor known to trigger depressive behaviors. Psychiatric disorders are associated with neurobiological changes, such as neuroinflammation and an increase in nitric oxide (NO) signaling. Despite the well-established detrimental effects of SIS and the involvement of neuroinflammation and NO in depression, potential management strategies, especially resocialization, remain insufficiently explored. Our aim was to elucidate the effects of resocialization on depressive behaviors in socially isolated mice, with a focus on the possible involvement of neuroinflammation and nitrite in the hippocampus (HIP). METHODS: We utilized 24 Naval Medical Research Institute male mice, maintained under both social and isolation conditions (SC and IC). After the isolation period, the mice were divided into two groups of eight, including the SIS group and a resocialized group. The SC group was kept without exposure to isolation stress. We conducted the open-field test, forced swimming test, and splash test to evaluate depressive behaviors. Additionally, nitrite levels, as well as the gene expression of interleukin (IL)-1ß, tumor necrosis factor (TNF), and toll-like receptor 4 (TLR4) in the HIP, were measured. RESULTS: The study found that resocialization significantly reduces depressive behaviors in SIS mice. The results suggest that the antidepressive effects of resocialization may be partially due to the modulation of the neuroinflammatory response and nitrite levels in the HIP. This is supported by the observed decrease in hippocampal gene expression of IL-1ß, TLR4, and TNF, along with a reduction in nitrite levels following resocialization. CONCLUSION: These insights could pave the way for new management strategies for depression, emphasizing the potential benefits of social interactions.

The impact of social isolation and loneliness on cardiovascular disease risk factors: a systematic review, meta-analysis, and bibliometric investigation.

Data on the association between social isolation, loneliness, and risk of incident coronary heart disease (CVD) are conflicting. The objective of this study is to determine the relationship between social isolation and loneliness, and the risk of developing cardiovascular disease (CVD) in middle age and elderly using meta-analysis. The purpose of the bibliometric analysis is to systematically evaluate the existing literature on the relationship between social isolation, loneliness, and the risk of developing cardiovascular disease (CVD) in middle-aged and elderly individuals. A comprehensive search through four electronic databases (MEDLINE, Google Scholar, Scopus, and Web of Science) was conducted for published articles that determined the association between social isolation and/or loneliness and the risk of developing coronary heart disease from June 2015 to May 2023. Two independent reviewers reviewed the titles and abstracts of the records. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline to conduct the systematic review and meta-analysis. Data for the bibliometric analysis was obtained from the Scopus database and analyzed using VOSviewer and Bibliometrix applications. Six studies involving 104,511 patients were included in the final qualitative review and meta-analysis after screening the records. The prevalence of loneliness ranged from 5 to 65.3%, and social isolation ranged from 2 to 56.5%. A total of 5073 cardiovascular events were recorded after follow-up, ranging between 4 and 13 years. Poor social relationships were associated with a 16% increase in the risk of incident CVD (Hazard Ratio of new CVD when comparing high versus low loneliness or social isolation was 1.16 (95% Confidence Interval (CI) 1.10-1.22). The bibliometric analysis shows a rapidly growing field (9.77% annual growth) with common collaboration (6.37 co-authors/document, 26.53% international). The US leads research output, followed by the UK and Australia. Top institutions include University College London, Inserm, and the University of Glasgow. Research focuses on "elderly," "cardiovascular disease," and "psychosocial stress," with recent trends in "mental health," "social determinants," and "COVID-19". Social isolation and loneliness increase the risk of and worsen outcomes in incident cardiovascular diseases. However, the observed effect estimate is small, and this may be attributable to residual confounding from incomplete measurement of potentially confounding or mediating factors. The results of the bibliometric analysis highlight the multidimensional nature of CVD research, covering factors such as social, psychological, and environmental determinants, as well as their interplay with various demographic and health-related variables.

Communal nesting shapes the sex-dependent glutamatergic response to early life stress in the rat prefrontal cortex.

Introduction: Early social environment, either positive or negative, shapes the adult brain. Communal nesting (CN), a naturalistic setting in which 2-3 females keep their pups in a single nest sharing care-giving behavior, provides high level of peer interaction for pups. Early social isolation (ESI) from dam and siblings represents, instead, an adverse condition providing no peer interaction. Methods: We investigated whether CN (enrichment setting) might influence the response to ESI (impoverishment setting) in terms of social behavior and glutamate system in the medial prefrontal cortex (mPFC) of adult and adolescent male and female rats. Results: Pinning (a rewarding component of social play behavior) was significantly more pronounced in males than in females exposed to the combination of CN and ESI. CN sensitized the glutamate synapse in the mPFC of ESI-exposed male, but not female, rats. Accordingly, we observed (i) a potentiation of the glutamatergic neurotransmission in the mPFC of both adolescent and adult males, as shown by the recruitment of NMDA receptor subunits together with increased expression/activation of PSD95, SynCAM 1, Synapsin I and αCaMKII; (ii) a de-recruiting of NMDA receptors from active synaptic zones of same-age females, together with reduced expression/activation of the above-mentioned proteins, which might reduce the glutamate transmission. Whether similar sex-dependent glutamate homeostasis modulation occurs in other brain areas remains to be elucidated. Discussion: CN and ESI interact to shape social behavior and mPFC glutamate synapse homeostasis in an age- and sex-dependent fashion, suggesting that early-life social environment may play a crucial role in regulating the risk to develop psychopathology.

Nancy S. Jecker, Zohar Lederman, and Anita Ho reply.

This letter replies to the letter "Colonial and Neocolonial Barriers to Companion Digital Humans in Africa," by Luís Cordeiro-Rodrigues, in the same, May-June 2024, issue of the Hastings Center Report.

Colonial and Neocolonial Barriers to Companion Digital Humans in Africa.

This letter responds to the essay "Digital Humans to Combat Loneliness and Social Isolation: Ethics Concerns and Policy Recommendation," by Nancy S. Jecker, Robert Sparrow, Zohar Lederman, and Anita Ho, in the January-February 2024 issue of the Hastings Center Report.

Loneliness, social isolation and incident chronic kidney disease among patients with diabetes.

Background: Individuals with diabetes have a significantly higher risk of developing chronic kidney disease (CKD) and higher levels of social isolation and loneliness compared with those without diabetes. Recently, the American Heart Association highlighted the importance of considering social determinants of health (SDOH) in conjunction with traditional risk factors in patients with diabetes. Aims: To investigate the associations of loneliness and social isolation with incident CKD risk in patients with diabetes in the UK Biobank. Methods: A total of 18 972 patients with diabetes were included in this prospective study. Loneliness and Social Isolation Scales were created based on self-reported factors. An adjusted Cox proportional hazard model was used to investigate the associations of loneliness and social isolation with CKD risk among patients with diabetes. The relative importance in predicting CKD was also calculated alongside traditional risk factors. Results: During a median follow-up of 10.8 years, 1127 incident CKD cases were reported. A higher loneliness scale, but not social isolation, was significantly associated with a 25% higher risk of CKD, independent of traditional risk factors, among patients with diabetes. Among the individual loneliness factors, the sense of feeling lonely emerged as the primary contributing factor to the elevated risk of CKD. Compared with individuals not experiencing feelings of loneliness, those who felt lonely exhibited a 22% increased likelihood of developing CKD. In addition, feeling lonely demonstrated greater relative importance of predicting CKD compared with traditional risk factors such as body mass index, smoking, physical activity and diet. Conclusions: This study indicates the significant relationship between loneliness and CKD risk among patients with diabetes, highlighting the need to address SDOH in preventing CKD in this population.

The Role of the Multidisciplinary HIV Care Center in Mitigating Social Isolation Among Patients with HIV During the Early COVID-19 Pandemic.

As the COVID-19 pandemic began in 2020, significant public health mitigation efforts were vital to combat an unprecedented health crisis. These efforts, which involved social distancing and self-quarantine, likely worsened a public health crisis of social isolation and loneliness in the U.S., particularly among people with HIV (PWH). Multidisciplinary HIV care centers, which served as the main source of clinical care for PWH and in some cases the only point of social contact, faced evolving dynamics of in-person visits during the COVID-19 pandemic, as well as a shift to telehealth services. Using in-depth interviews, we explored the role that multidisciplinary HIV care centers and providers played in the experience of social isolation among PWH in New York City. We recruited participants (n = 30) from a multidisciplinary HIV care center in NYC between October 2020 and June 2021. We conducted semi-structured interviews to understand the specific domains of social isolation that were mitigated. In this cohort, the major theme that drove both in-person and telehealth care continuity was the strength of the patient-provider relationship. We found that participants saw members of the HIV care center as part of their social network, and providers served both as a source of emotional support and provided important social resources and benefits. Thus, in times of heightened social isolation, HIV care centers can play a critical role in providing social support in addition to clinical care.