A Pilot Randomized Trial of an Intervention to Enhance the Health-Promoting Effects of Older Adults’ Activity Portfolios: The Engaged4Life Program

The purpose of this study was to evaluate the feasibility and outcomes of the Engaged4Life program, an intervention to encourage inactive community-dwelling older adults to embed physical activity, cognitive activity, and social interaction into their everyday lives in contexts that are personally meaningful and natural for them. Fifteen participants were randomized to the intervention group (technology-assisted self-monitoring of daily activity via pedometers and daily tablet-based surveys; psychoeducation + goal-setting via a 3-hour workshop; and peer mentoring via phone 2×/week for 2.5 weeks) and 15 to the control (technology-assisted self-monitoring only). Recruitment was shown to be feasible and efficient, but not able to reach the target for men. Retention rate was 83% and participants manifested high adherence and engagement with the intervention. Though this pilot trial was not powered to demonstrate significant differences between groups, daily steps increased by 431 (11% increase) from baseline to Week 4 for the intervention (p < .05), but decreased by 458 for the control, for a net difference of 889 steps (p < .05). Findings were sustained at Week 8 (p < .01). In a future trial, difficulties in recruiting men, barriers due to the technology-intensive design, and the optimization of secondary outcome measures should be addressed.     

The impact of familism on future care planning for Korean parents caring for their children living with disabilities

ABSTRACT

Future care provision is a pervasive concern of parents with children living with disabilities. This article aims to provide an overview of the impact of familism on future care planning for Korean parents. For this qualitative study, data were collected using semi-structured interviews with parents (n = 9) and professionals (n = 9). Using conventional analysis, the study revealed there is strong emphasis on familial care with minimal governmental service provision and intervention; ultimately, this has a negative impact on the planning process. In support of the planning process taking its place as a standard phase of caring, a number of recommendations are made.     

Perceptions of Academic Health Science Research Center Personnel Regarding Informed Consent Processes and Therapeutic Misconception

Introduction: Instrumentation exists to measure voluntariness and misunderstanding in informed consent processes. However, research personnel’s perspectives about using instrumentation to measure therapeutic misconceptions in research participants has not been reported. We designed a workshop to promote research personnel knowledge of emerging instrumentation and to study the perceptions of research personnel regarding such instruments.

Methods and Findings: Two nationally recognized experts who have developed psychometric instruments to measure aspects of informed consent presented their recent findings to research personnel of the Medical University of South Carolina at a one-day workshop. Following the presentations, workshop attendees divided into two focus groups and shared their perceptions regarding the presentation content. Inductive thematic analysis detected themes related to informed consent processes including: investigator/provider role clarity; investigator transparency; therapeutic misconception; and screening subjects for understanding.

Conclusion: Our findings suggest future directions in applied, proactive empirical research to better understand investigator perceptions and practices related to transparency in research, and to develop instrumentation to detect risks to the integrity of informed consent in order to promote voluntariness and autonomy and minimize therapeutic misconception in research practices.     

Impacts of child development accounts on parenting practices: evidence from a randomised statewide experiment

ABSTRACT

This study examines the impact of Child Development Accounts (CDAs) on parenting practices of mothers with young children in a statewide randomised experiment conducted in the United States. The experiment included 2704 primary caregivers of children born in Oklahoma during 2007: 1358 were randomly assigned to the treatment group and 1346 to the control group. Structural equation modelling suggests that the punitive-parenting score among treatment participants was .12 standard deviations smaller than that among control participants (p < . 05). Findings indicate that CDAs reduce punitive parenting, and may serve as an additional tool for positive parent–child interactions.     

From Serodiscordant to Magnetic: The Feasibility and Acceptability of a Pilot Psychoeducational Group Intervention Designed to Improve Relationship Quality

Serodiscordant or magnetic couples experience HIV-related issues that can compound daily stressors. Psychoeducational couples group interventions can build coping skills and increase relationship satisfaction. Throughout Summer 2014, 6 gay male magnetic couples (n = 12) collaboratively designed and participated in an 8-session psychoeducational support group. The intervention was feasible (i.e., recruitment was <2 weeks, it was easy to coordinate) and acceptable (i.e., each session was consistently rated very good or outstanding). Relationship quality improved significantly in all couples regardless of whether couples agreed on how to manage HIV within their relationship. Implementation of this model is encouraged to fully evaluate this promising intervention.     

Validation of multidimensional scale of perceived social support in middle-aged Korean women with diabetes

Purpose: The purpose of this study was to validate the Multidimensional Scale of Perceived Social Support (MSPSS) among middle-aged Korean women with type 2 diabetes. Methods: Data were collected from 123 middle-aged Korean women with diabetes. Construct and concurrent validity were examined using factor analysis. Results: Factor analysis extracted three factors: spouse, family, and friends. The MSPSS had relatively good concurrent validity (r = .66, p < .0001), construct validity, and strong reliability (Cronbach's alpha = .90). Conclusion: We concluded that the MSPSS is a simple and well-established instrument to measure social support in middle-aged Korean women with diabetes.     

Suicide Prevention Training Program for Gatekeepers Working in Community Hospice Settings

Gatekeepers in community hospice settings encounter patients and caregivers struggling with suicidal thoughts. Limited guidance is available for training staff on the prevention of suicide in hospice care. This study evaluated one promising, evidence-based, suicide prevention program with a behavioral rehearsal practice session. A pre- and post-, one group design, was utilized to measure the training impact and educational needs of staff working in community hospice settings (N =39). Training increased awareness of the risk factors for suicide, as reported by nearly 80% of participants. Self-efficacy scores showed a statistically significant Increase, t(df = 35), ?9.59, p= .00 (two-tailed), from pretraining (n=36, M=2.21, SD= .65) to posttraining (n=36, M=3.03, SD=.56). Satisfaction and the need for additional devoted time for suicide prevention training were highly rated. Suicide prevention training programs can enhance self-efficacy, knowledge, and skills for gatekeepers working in community hospice settings.     

Disclosure,Consent, and the Exercise of Patient Autonomy in Surgical Innovation: A Systematic Content Analysis of the Conceptual Literature

The classification of surgical innovation as clinical care, research, or as third distinct type of activity creates ambiguity which impacts standards for disclosure and informed consent. We conducted a systematic review of the conceptual literature to identify positions expressed about consent and disclosure, as well as major tension points associated with this issue. Literature overwhelmingly favors special consent and disclosure. Four major tension points were identified: the use of biasing/biased terminology to characterize innovation; patient vulnerability; the relationship between surgeon-innovator and patient; and practices and associated gaps related to consent and disclosure. Recommendations often focused on the informed consent process.     

Success of University Student Volunteers in Obtaining Consent for Reviewing Private Health Information for Emergency Research

This study aimed to determine the success of university student volunteers in obtaining consent from parents to allow review of their child’s personal health information (PHI) for emergency research screening. This study also aimed to examine the variables associated with successful consent. This was a prospective cross-sectional study conducted at a pediatric emergency department (ED). University students, who functioned as delegates of the health information custodian, approached parents for consent. Of 2,506 parents, 1,852 (73.9%) provided consent to allow review of their child’s PHI for research screening. Variables associated with successful consent were high (≥12 months) versus low (<12 months) volunteer experience (OR = 2.0), research related (vs. unrelated) to the child’s chief complaint (OR = 2.0), child treated regularly by specialists at the study institution (OR = 1.7), and ED presentation mid-week vs. weekend (OR = 1.7) and morning vs. evening presentation (OR = 1.4). When approached by a university student volunteer, about 25% of parents declined to have their child’s PHI reviewed for research screening. This model of obtaining consent may put some emergency research at risk for selection bias. Variables that increase the odds of successful consent can be considered in program design to improve the effectiveness of this model.     

EXCLUDING PARTICULAR INFORMATION FROM CONSENT FORMS

Although the informed consent process is crucial to protecting human research subjects, there are cases when particular information within the consent form may present risks to those subjects. In this paper, we examine a case in which including the sponsor’s name on the consent form may allow the form to serve as a surrogate for subjects’ HIV status.

There is no literature addressing the ethical acceptability of excluding particular information from consent forms, and there exists little regulatory guidance on this issue. We argue that excluding information from the consent form is, in fact, obligatory when that information is disclosed orally during the consent process but its presence on the form poses risks to the subjects the consent process is designed to protect. Further, we argue that the regulations ought to be amended to reflect this obligation.     

Reflexive Research Ethics in Fetal Tissue Xenotransplantation Research

For biomedical research in which the only involvement of the human subject is the provision of tissue or organ samples, a blanket consent, i.e., consent to use the tissue for anything researchers wish to do, is considered by many to be adequate for legal and Institutional Review Board (IRB) requirements. Alternatively, a detailed informed consent provides patients or study participants with more thorough information about the research topic. We document here the beliefs and opinions of the research staff on informed consent and the discussion-based reflexive research ethics process that we employed in our fetal tissue xenotransplantion research on the impact of environmental exposures on fetal development. Reflexive research ethics entails the continued adjustment of research practice according to relational and reflexive understandings of what might be beneficent or harmful. Such reflexivity is not solely an individual endeavor, but rather a collective relationship between all actors in the research process.     

Evaluation of Early Adolescent Subjective Well-Being in Terms of Submissive Behavior and Self-Esteem

This research aimed to investigate the correlation between subjective well-being and submissive behavior and self-esteem in students in the early adolescent period. The research was completed with a relational design. The research group comprised sixth, seventh, and eighth class middle school students in the spring term of the 2015–2016 academic year in Trabzon province. Data collection tools included a Personal Information Form, Submissive Behavior Scale, Two-Dimensional Self-Respect Scale (Self-Liking and Self-Confidence Scale), Satisfaction with Life Scale and Positive and Negative Affect Schedule. The results of the correlation analysis found a significant positive correlation between subjective well-being and self-esteem (r?=?0.54, p?<?0.01; 95% CI [0.44, 0.61], Cohen’s d?=?1.28); however, the correlation between subjective well-being and submissive behavior was not significant (r?=?–0.02, p?>?0.05; 95% CI [–0.11, 0.09], Cohen’s d?=?0.04). There was a significant negative correlation identified between self-esteem and submissive behavior (r?=?–0.10, p < 0.05; 95% CI [–0.20, –0.01], Cohen’s d?=?–0.20). Additionally, according to our findings, self-esteem accounts for 29% of the variation in well-being (F(1, 367)?=?150.79, p?<?0.001). The contribution of self-esteem to the subjective well-being explanatory model was found to be significant (sz?=?0.54, p?<?0.001).     

Assessment of multiple constructs of social integration for older adults living in nursing homes

ABSTRACT

A variety of terms and measures have been used in the literature to denote being socially integrated, and many studies of older adults focus on only social networks or social support and often only include those living in the community. The purpose of this study was to assess multiple constructs of social integration (i.e., social networks, social capital, social support, and social engagement) for older adults in nursing homes. Data were collected from 140 older adults at 30 nursing homes in Kansas. We interviewed older adults’ in-person using a survey questionnaire, and used multilevel confirmatory factor analysis to analyze the data. The final model that included the four constructs had acceptable fit (χ² = 174.71; df = 112; p < .01; CFI = .93; RMSEA = .06; SRMR-W = .06; SRMR-B = .12). The results showed that the proposed model was supported at the individual level. At the between-level, social networks and social support were supported. Study results have methodological and practice/policy implications for the study of older adults in long term care settings. In particular, this study contributes to understanding how to operationally define and differentiate social integration variables in studies of older adults, particularly when study data are hierarchical.     

The Effect of Chair Yoga on Biopsychosocial Changes in English- and Spanish-Speaking Community-Dwelling Older Adults with Lower-Extremity Osteoarthritis

Chair yoga (CY), a mind-body therapy, is a safe nonpharmacological approach for managing osteoarthritis (OA) in older adults who cannot participate in standing exercise. However, there is no linguistically tailored CY program for those with limited English proficiency (LEP). This 2-arm randomized controlled trial compared the effects of a linguistically tailored yoga program (English and Spanish versions) on the outcomes of pain, physical function, and psychosocial factors compared to the effects of a linguistically tailored Health Education Program (HEP; English and Spanish versions). Participants with lower-extremity OA, recruited from 2 community sites, completed the Spanish (n = 40) or English (n = 60) version of twice-weekly 45-min CY or HEP sessions for 8 weeks. Data were collected at baseline, 4 weeks, 8 weeks, and 1- and 3-month follow-ups. English and Spanish CY groups (but neither HEP language group) showed significant decreases in pain interference. Measures of OA symptoms, balance, depression, and social activities were not significantly different between English and Spanish versions of CY and English and Spanish versions of HEP. It was concluded that the Spanish and English versions of CY and HEP were equivalent. Linguistically tailored CY could be implemented in aging-serving communities for persons with LEP.     

Is religious and existential well-being important in quality of life in Hong Kong Chinese?

The present study aims to determine the extent to which general QoL is predicted by religious and existential well-being, taking into consideration the intensity of participants’ religious and personal beliefs. Additionally, we examine the differences between Christians, believers in the Chinese religions, and those who are not religious. The study is based on the secondary analysis of a cross-sectional survey on the Spiritual Well-being scale (SWBS), which encompasses religious (RWB) and existential well-being (EWB). Participants (N = 445) were comprised of three religious subsamples for known group comparisons: a Chinese religions group (CRG) (n = 133), comprising Buddhism (23.1%), Taoism (5.2%), folk religions and ancestral worship (1.5%); a Christian group (n = 144) consisting of Roman Catholics (8.3%) and Protestants (24%); and non-believers (NRel) (n = 167). Regardless of their religious affiliations, QoL scores were the same in the overall sample. However, when taking the extent of religious commitment and sense of belonging into consideration, religious believers had higher scores in QoL and SWBS than non-believers (highest in Christians, followed by CRG and NRel). Hierarchical regressions showed that EWB was the only significant predictor of QoL after controlling for gender, age, and the extent of religious belief and commitment. The data indicated positive influences of religious beliefs on QoL and SWBS, although distinct affiliations might have affected these scores to a different extent. Fostering RWB and EWB are vital to promoting QoL.     

Pathways to age-friendly communities in diverse urban neighborhoods: Do social capital and social cohesion matter?

ABSTRACT

Using a social capital and social cohesion lens, we reposition the concept of civic engagement among older adults to examine pathways for building age-friendly communities. We analyzed data drawn from a Community-Based Participatory Research study in the Southern U.S. that explored lived experiences of older adults, age 55 and above, who participated in individual interviews (n = 15) and six focus group discussions (n = 45) to examine their perceptions of social identity, social connectedness, and civic engagement geared toward an age-friendly city. Findings indicated that several older adults had access to social networks and socially invested resources, thereby having opportunities for civic engagement and building age-friendly neighborhoods. However, social, cultural, linguistic, and structural barriers were more evident among certain diverse ethnic populations. Marginalized low-income minorities and immigrants, such as Hispanic participants, felt the lack of social cohesion among the larger society limited their ability to give back, thus decreasing their civic engagement activities. In contrast, Caucasian and African-American older adults were able to contribute to the political process through more civic participation activities. We provide implications for examining the role of social capital and social engagement to bolster civic engagement among older adults in building age-friendly communities.     

Disclosure Issues in Neuroscience Research

Issues of disclosure arise in neuroscientific research during the informed consent process, whenever incidental findings are identified, and when study results are generated. The possibility of disclosure of incidental findings and/or research results may raise informational expectations on the part of subjects and may alter a study's risk:benefit ratio. We recommend that the informed consent process address this potential consequence of research participation, and specify the conditions under which particular types of information will be offered, the conditions under which information may not be disclosed, and any provisions for helping subjects make sense of the information to be disclosed.