Intact or in tatters? Family care of older women and men in urban Mexico

This article asks how family relationships affect the living conditions of low-income elderly people in urban Mexico. The existence of so many elderly women living alone in the country is at odds with cultural beliefs portraying mothers as the archetypal recipients of family charity. It is evident that there is little state provision of accommodation for the elderly, forcing older people to rely on their families for care. Living with family is usually thought to be a better option for older people. Yet many poorer families cannot afford to provide care, and some are not willing to do so. In addition, families treat elderly men and women differently, with significant consequences for housing conditions and well-being of men and women in later life.     

Self Report Co-Morbidity and Health Related Quality of Life – A Comparison with Record Based Co-Morbidity Measures

The purpose of this projectwas to compare three hospital-based measures ofco-morbidity to patient self-reportco-morbidity and to determine the relativeproportion of outcome predicted by each of theco-morbidity measures in a population ofindividuals receiving major joint arthroplasty. Baseline measures using the SF-36 generalhealth questionnaire and the Western OntarioMcMaster Osteoarthritis Index (WOMAC) wereobtained from 518 persons undergoing total kneeor hip replacement. A second measure wasobtained six months post-surgery. Co-morbiditywas calculated by summing the self-reportedco-morbidity at baseline, using both thechart-based and administrative data version ofCharlson's Co-morbidity Index, and by summingthe number of International Classification ofDiseases – Version 9 (ICD-9) codes appearingin the electronic health record. Linearregression was used to determine how much ofthe variation in outcome was explained by eachof the co-morbidity measurement methods. Self-report co-morbidity explained as muchvariation in outcome as the hospital-basedindices. Self-report co-morbidity did notperform as well as the other methods inexplaining the variance in health systemutilization. It was concluded that self-reportco-morbidity is minimally as useful asrecord-based systems when measuring the impactof co-morbidity on health related quality oflife (HRQL). This is an important finding, asprivacy legislation, the time until data isavailable and cost are all barriers to usingrecord-based co-morbidity measures.     

A comparison of three maximum likelihood models for stage-frequency data

Summary A comparison has been made between the estimates obtained from maximum likelihood estimation of gamma, inverse normal, and normal distribution models for stage-frequency data. Results have been compared for six of sets of test data, and from many sets of simulated data. It is concluded that (1) some estimates may differ substantially between the models, (2) estimates from the correct model have little bias, and estimated standard errors are generally close to theoretical values, (3) there are problems in determining degrees of freedom for chi-squared goodness of fit tests, so that it is best to compare test statistics with simulated distributions, and (4) goodness of fit tests may not discriminate well between the three models.     

Social Anxiety in Obese Youth in Treatment Setting

The aim of this study was to determine the prevalence of social anxiety in obese children treated in a weight management clinic. We hypothesized that social anxiety would positively correlate with obesity, and that “extremely obese” patients would have significantly higher rates of social anxiety when compared to “obese” patients. Information was collected at a multidisciplinary treatment clinic for obese youth during the first clinic visit. The social anxiety scale was administered (including parent-report and self-report scales for both elementary and adolescent versions) and demographic data was obtained. Social anxiety was found to be significantly positively correlated with BMI percentile. In addition, “extremely obese” patients had significantly higher social anxiety scores than “obese” youth at least for elementary-age youth. Trends in gender differences and racial differences in this obese pediatric clinical sample were consistent with results found in community samples. Social anxiety and obesity were found to be positively correlated in this pediatric clinic-based population. For elementary-age patients, “extremely obese” patients were at greater risk than “obese patients” for social anxiety and its various symptoms—fear of negative evaluation, social avoidance/distress in new situations, and social avoidance/distress in general. Results for adolescents were less clear. Clinical implications of these results were discussed. Limitations of this study, and directions for future research were also discussed.     

Using Community-Level Correlates to Evaluate Nonresponse Effects in a Telephone Survey

Understanding the relationship between nonresponse processesand key research variables is central to evaluating if and hownonresponse introduces bias into survey estimates. In most telephonesurveys, however, little information is available with whichto estimate these effects. We report a procedure for examiningthe potential effects of nonresponse via analyses that (1) investigatethe linkages between community-level (zip code) variables andsurvey nonresponse and (2) examine the associations betweenthese community-level variables and key survey measures. Wedemonstrate these procedures using hierarchical modeling toanalyze data from a state-wide telephone survey in Illinois.One zip code–level indicator of concentrated disadvantage—thepercentage of the population below poverty level—was foundto be positively associated with nonresponse and, among respondents,with both current physical disability status and lack of healthinsurance coverage, suggesting that both may have been underestimatedin this survey. This inexpensive approach has the potentialof enabling researchers to routinely evaluate nonresponse effectsin their survey data.     

Effectiveness of a screening tool to detect injuries during Army Health Care Specialist training

The purpose of this project was to evaluate the effectiveness of an initial screening and referral process in reducing the impact of musculosketetal injuries among soldiers attending Health Care Specialist training. Musculoskeletal injury among Army Health Care Specialist students have been reported to be approximately 24% for men and 24-30% for women. The highest student visit rate to the troop medical clinic for musculoskeletal injuries, for men and women, occurs during the first week of training. Anecdotal reports indicate that many students arrive for training with existing injuries or symptoms. This project was designed to assess whether formalized early screening, referral, and intervention could 1) identify arriving students who need musculoskeletal injury-related medical attention, 2) reduce the number of students receiving limited duty status during their 10-week training, 3) decrease the total number of limited duty days for students, and 4) decrease the number of students who cannot graduate due to musculoskeletal injury. Students (N=291) from one company were divided into three groups of 97 students. Three methods were used to screen and refer students for medical intervention: 1) traditional (T), 2) by health care providers (HCP), or 3) by Drill Sergeants (DS). Screening by HCP and DSs involved using a new screening tool to identify and consequently refer students with symptoms to a troop medical clinic (TMC) for early evaluation and intervention. Using the screening tool, HCPs identified 92% of students with injuries, while DSs accurately identified 80%. The screening did not reduce the number of students receiving limited duty status, total limited duty days, or the number of students that could not graduate due to musculoskeletal injury ("holdovers") (p>0.05). The screening tool demonstrated good sensitivity and specificity whether conducted by HCPs or DSs. It failed to demonstrate efficacy in reducing the impact of musculoskeletal injuries among Combat Medic soldiers, as measured by limited duty days and holdovers.     

Parameters for Safer Gambling Behavior: Examining the Empirical Research

There have been claims that new gambling technology is hazardous to player health, and that technological interventions can alleviate gambling-related harm. In this paper, we systematically review the empirical research about the nexus between gambling and technology to evaluate the veracity of these claims. We use a public health perspective (i.e., the Epidemiologic Triangle) to organize and present study results (i.e., agent, host, and environment). This review intends to offer insight about emerging technology and identify areas that indicate a need for additional research. Forty-seven studies met our inclusion and exclusion criteria; a review of this body of work shows that attempts to develop and implement safety features for new gambling technology are promising, but methodologically are rudimentary and limited in scope. Increased attention to the dynamic interaction among host, agent, and environment factors hold potential to advance the field. In addition, improved study methods (e.g., longitudinal analyses of actual betting behavior), and collaboration among policymakers, manufacturers, and researchers can increase understanding of how new gambling technology affects the public health and stimulate new strategies for implementing effective public health interventions.

Being with a Person in Our Care: Person-Centered Social Work Practice that is Authentically Person-Centered

ABSTRACT

Person-centered care (PCC) has emerged over the last several decades as the benchmark for providing quality care for diverse populations, including older adults with multiple chronic conditions that affect daily life. This article critiques current conceptualizations of PCC, including the social work competencies recently developed by the Council on Social Work Education, finding that they do not fully incorporate certain key elements that would make them authentically person-centered. In addition to integrating traditional social work values and practice, social work’s PCC should be grounded in the principles of classical Rogerian person-centered counseling and an expanded conceptualization of personhood that incorporates Kitwood’s concepts for working with persons with dementia. Critically important in such a model of care is the relationship between the caring professional and the care recipient. This article recommends new social work competencies that incorporate both the relationship-building attitudes and skills needed to provide PCC that is authentically person-centered.     

Paternal Incarceration and the Housing Security of Urban Mothers

High rates of imprisonment among American fathers have motivated an ongoing examination of incarceration's role in family life. A growing literature suggests that incarceration creates material and socioemotional challenges not only for prisoners and former prisoners but also for their families and communities. The authors examined the relationship between fathers' incarceration and one such challenge: the housing insecurity of the mothers of their children. Using data from the Fragile Families and Child Wellbeing Study (N = 4,125) and a series of longitudinal regression models, they found that mothers' housing security was compromised following their partners' incarceration, an association likely driven in part, but not entirely, by financial challenges following his time in prison or jail. Given the importance of stable housing for the continuity of adult employment, children's schooling, and other inputs to healthy child development, the findings suggest a grave threat to the well‐being of children with incarcerated fathers.