Cultural and Intergenerational Narratives: Understanding Responses to Elderly Family Members in Declining Health

Culture exerts powerful influences on each generations' responses to older members in declining health. Narratives, the stories people tell about their lives, depict the different the ways that the elderly and their children experience their world. Their personal narratives chronicle their connections to culture the past. They also illustrate the ways that the cultural values are transformed to accommodate the present and future. The stories are influenced by immigration, assimilation, development, interpersonal relationships, and life events. These differences between the cultural narratives of the elderly and the following generation are particularly apparent during times of chronic stress. One such situation occurs during chronic illness when the younger generation is called upon to provide for the elderly and chronically ill.     

A Profile of Support Group Use and Need Among Middle-Aged and Older Adults with Multiple Sclerosis

This study compared middle-aged and older adults with multiple sclerosis (MS, N = 1,275) according to their use of support groups and identified factors associated with perceived need. Over 64.6% (n = 824) of participants had attended a MS support group meeting at least once. Individuals who had never attended a group were more likely to reside in urban or suburban communities, report lower symptom interference, and fewer activity limitations. Women, individuals without a helper, and people with greater symptom interference were more likely to perceive a need for a support group. Findings raise questions for professionals involved in developing and implementing multiple sclerosis support groups.     

Older patient-physician discussions about exercise

This cross-sectional observational study examined the frequency of older patient-physician discussions about exercise, who initiates discussions, and the quality of questioning, informing, and support about exercise. The study used a convenience sample of 396 follow-up visits at 3 community-based practice sites, with 376 community-dwelling older patients and 43 primary-care physicians. Audiotapes were analyzed using the Multi-Dimensional Interaction Analysis coding system. Results demonstrate that exercise was discussed in 13% of visits and the subject was raised equally by patients and physicians. Exercise was significantly more likely to be discussed in dyadic visits (14.7%) than in triadic visits (4.1%). Patient level of education, patient overall physical health, and the physician's being female were significant predictors of the occurrence of exercise discussion. Given the importance of exercise for maintaining health and independence in older adults, more clinical and research attention is needed to address barriers to effective discussions in this area.     

Union formation in fragile families

In this article, we use data from a new longitudinal survey--the Fragile Families and Child Wellbeing Study--to examine union formation among unmarried parents who have just had a child together. We used multinomial logistic regression to estimate the effects of economic, cultural/interpersonal, and other factors on whether (relative to having no romantic relationship) parents are romantically involved and living apart, cohabiting, or married to each other about one year after the child's birth. Net of other factors (including baseline relationship status), women's education and men's earnings encourage marriage. Cultural and interpersonal factors also have strong effects: women's trust of men, both parents' positive attitudes toward marriage, and both parents' assessment of the supportiveness in their relationship encourage marriage. Supportiveness also encourages cohabitation, while fathers having a problem with alcohol or drugs and reporting higher conflict in the relationship discourage cohabitation: Fathers' physical violence deters couples' remaining in romantic nonresident relationships.     

Missing data in linear models with correlated errors

One common method for analyzing data in experimental designs when observations are missing was devised by Yates (1933), who developed his procedure based upon a suggestion by R. A. Fisher. Considering a linear model with independent, equi-variate errors, Yates substituted algebraic values for the missing data and then minimized the error sum of squares with respect to both the unknown parameters and the algebraic values. Yates showed that this procedure yielded the correct error sum of squares and a positively biased hypothesis sum of squares.

Others have elaborated on this technique. Chakrabarti (1962) gave a formal proof of Fisher's rule that produced a way to simplify the calculations of the auxiliary values to be used in place of the missing observations. Kshirsagar (1971) proved that the hypothesis sum of squares based on these values was biased, and developed an easy way to compute that bias. Sclove     

A Simple Approach to Inference in Random Coefficient Models

Random coefficient regression models have been used to analyze cross-sectional and longitudinal data in economics and growth-curve data from biological and agricultural experiments. In the literature several estimators, including the ordinary least squares and the estimated generalized least squares (EGLS), have been considered for estimating the parameters of the mean model. Based on the asymptotic properties of the EGLS estimators, test statistics have been proposed for testing linear hypotheses involving the parameters of the mean model. An alternative estimator, the simple mean of the individual regression coefficients, provides estimation and hypothesis-testing procedures that are simple to compute and teach. The large sample properties of this simple estimator are shown to be similar to that of the EGLS estimator. The performance of the proposed estimator is compared with that of the existing estimators by Monte Carlo simulation.     

Twenty-first century learning in school systems: the case of the Metropolitan School District of Lawrence Township, Indianapolis, Indiana

To empower students with skills such as information and technological literacy, global awareness and cultural competence, self-direction, and sound reasoning, teachers must master these skills themselves. This chapter examines how the Digital Age Literacy Initiative of the Metropolitan School District of Lawrence Township in Indianapolis, Indiana, which is funded by the Lilly Endowment, incorporated twenty-first century learning through a systemic approach involving teacher training and the use of data. The authors explain the district's content, process, and context goals toward accomplishing its mission of empowering students with the necessary twenty-first century skills to succeed in the digital age. The district places a strong emphasis on professional development for teachers. To support the necessary teacher learning and therefore sustain the work of the initiative, the district has adopted action research, self-assessment, and an online professional development network. To support teachers in implementing new strategies, master teachers serve as digital age literacy coaches. The chapter discusses the initiative's focus on evidence of progress. Through a partnership with the Metiri Group of California, the district has built a range of assessments including online inventories and twenty-first century skill rubrics. For example, the Mankato Survey collected teacher and student data around access, ability, and use of technology in the classroom in 2001 and then in 2004. This research showed significant gains in some technologies across all grade levels and consistent gains in nearly all technologies for middle and high school students. As it moves into the next phase of implementing the Digital Age Literacy Initiative, the district embraces the systemic shifts in school culture necessary to institutionalize twenty-first century learning.     

Distance as a barrier to using a fitness-program benefit for managed Medicare enrollees

This study evaluated the effect of distance on the likelihood of initiating and maintaining regular use of a fitness-program benefit in a population of managed Medicare seniors. We studied 8,162 participants and nonparticipants in a managed-care fitness-program benefit: a structured group exercise program or an unstructured health-club membership. Participants in both programs lived significantly closer to facilities than nonparticipants did (structured, p < .001; unstructured, p = .017). Participants living closer to unstructured-program sites attended more frequently than those farther away (p = .008). Distance was not correlated with frequency of use in the structured program (p = .49). Collectively, these analyses demonstrate that distance is related to uptake and, in some cases, continued use of a fitness-program benefit. Health systems providing fitness-program benefits as a way to increase physical activity levels of their plan members should consider location of program facilities in relation to members' home addresses to maximize use of the benefit.     

HIV/AIDS and return to work: a literature review one-decade post-introduction of combination therapy (HAART)

It has been a little over one decade since the introduction of the first protease inhibitor that ushered in new era of treatment for persons living with human immunodeficiency virus (HIV) and Acquired Immune-Deficiency Syndrome (AIDS). As of the end of 2003, an estimated 37.8 million people worldwide were infected with the HIV. It is estimated that there are 850,000-950,000 persons in the United States living with human immunodeficiency virus (HIV) and that the incident rate is new cases each year. Since AIDS affects so many people of working age in the US, issues of employment, work rehabilitation and AIDS in the workplace have all become major concerns. The paper presents a review of the literature published during a ten year period that is relevant to understanding the various needs and barriers related to work as well as services designed to address them.