Training Area Agencies on Aging Case Managers to Improve Physical Function,Mood, and Behavior in Persons With Dementia and Caregivers: Examples from the RDAD-Northwest Study

The Reducing Disability in Alzheimer’s Disease (RDAD) program has been shown to be an effective tool for teaching caregivers strategies to improve mood, behavior, and physical function in persons with dementia. This paper describes how RDAD has been translated and implemented for use by Area Agencies on Aging (AAA) case managers across Washington and Oregon. Modifications to the original RDAD program as part of its community translation included decreasing the number of in-person sessions while preserving all educational content; involving caregivers in exercise activities for themselves as well as acting as exercise coaches for care-receivers; and enrolling persons with cognitive impairment due to mixed etiologies. This paper describes these changes and their rationale, the challenges faced by community agencies recruiting for and delivering evidence-based programs, and illustrates the actual RDAD implementation process through several brief case examples. Case examples also illustrate how RDAD-Northwest can be useful with care-receivers with a range of cognitive impairment severity, family caregiving situations, and levels of mood and behavioral challenges.     

If You Go Down to the Woods Today: Infants’ Distress During a Teddy Bear's Picnic in Relation to Peer Relations and Later Emotional Problems

Infants’ emotional reactions to an unusual event were assessed at a simulated birthday party during which two costumed characters enacted a Teddy Bear's Picnic. Two hundred and fifty‐eight firstborn infants in a representative British community sample were observed at a mean age of 12.8 months in the presence of their parents and other participating families, in a laboratory sitting room decorated with balloons and banners. The picnic scenario was followed by free play with the other participating infants. At a mean of 36 months of age, mothers, fathers, and another informant who knew the child well completed the Child Behaviour Check List (CBCL). The majority of infants showed no vocal distress during the picnic scenario. A minority of infants expressed strong distress, which was correlated with elevated heart rate and production of cortisol. Infants who were not distressed were more likely to direct social behavior to their peers and especially likely to use physical force against peers. In comparison with strongly distressed and nondistressed infants, those who had shown mild distress during the picnic scenario were least likely to manifest later emotional problems. This pattern was particularly marked for boys. Taken together, the findings indicate that infants’ strong distress during naturalistic encounters that are meant to be entertaining can suppress sociability and might indicate risk for subsequent emotional problems.     

The Relationships of Information Efficacy and Media Literacy Skills to Knowledge and Self-efficacy for Health-Related Decision Making

Abstract

Objective: To compare the extent to which information efficacy (confidence for acquiring useful information) and media literacy skills predict knowledge and self-efficacy for preventing or treating the health threat of influenza. Participants: A random-sample survey of 1,379 residential students enrolled at a northwestern public university was conducted in fall 2009. Methods: Students accessed an Internet survey through a link provided in an e-mail. Results: Students who self-diagnosed correctly demonstrated higher levels of media literacy skills than those who self-diagnosed incorrectly. Among those who self-diagnosed incorrectly, the only predictor of knowledge was accessibility of information sources; low accessibility was associated with reduced knowledge. Information efficacy predicted self-efficacy for both groups. Conclusions: The results illustrate the limitations of information efficacy in the absence of media literacy skills. To decrease health risks, college health practitioners should promote media literacy while also ensuring easy access to high-quality information.     

Violence towards caregivers of persons with developmental disabilities

OBJECTIVE: Violent and disruptive acts committed by persons with developmental disabilities are a potential work environment problem for caregivers. This study developed and tested an instrument for describing and analyzing violence among persons with developmental disabilities. METHODS: Personnel from four units of one facility recorded daily on a simple form all violent and disruptive acts occurring in a limited range of situations. RESULTS: Acts of violence were associated with a small minority of individuals, but grossly underreported and unrecognized in formal reporting systems. None of the nearly 3000 incidents recorded during the six-week study required sick leave. Violent and disruptive acts occurred most often when an individual was requested to do something he or she did not want to do, when the individual was denied the opportunity to do something they did want to do and when waiting or under-stimulated. Personnel used the data in discussing countermeasures that could be integrated with the care and treatment of the individual. CONCLUSION: Hitting, kicking, pinching etc. of personnel are a work environment problem due to their high frequency and effects upon employee morale. The instrument and procedures can be used to reduce incidents of violence, which would improve the working environment of employees and assist persons with developmental disabilities as they move from institutional environments.     

Roles of Vegetable Surface Properties and Sanitizer Type on Annual Disease Burden of Rotavirus Illness by Consumption of Rotavirus-Contaminated Fresh Vegetables: A Quantitative Microbial Risk Assessment

Enteric viruses are often detected in water used for crop irrigation. One concern is foodborne viral disease via the consumption of fresh produce irrigated with virus-contaminated water. Although the food industry routinely uses chemical sanitizers to disinfect post-harvest fresh produce, it remains unknown how sanitizer and fresh produce properties affect the risk of viral illness through fresh produce consumption. A quantitative microbial risk assessment model was conducted to estimate (i) the health risks associated with consumption of rotavirus (RV)-contaminated fresh produce with different surface properties (endive and kale) and (ii) how risks changed when using peracetic acid (PAA) or a surfactant-based sanitizer. The modeling results showed that the annual disease burden depended on the combination of sanitizer and vegetable type when vegetables were irrigated with RV-contaminated water. Global sensitivity analyses revealed that the most influential factors in the disease burden were RV concentration in irrigation water and postharvest disinfection efficacy. A postharvest disinfection efficacy of higher than 99% (2-log₁₀) was needed to decrease the disease burden below the World Health Organization (WHO) threshold, even in scenarios with low RV concentrations in irrigation water (i.e., river water). All scenarios tested here with at least 99.9% (3-log₁₀) disinfection efficacy had a disease burden lower than the WHO threshold, except for the endive treated with PAA. The disinfection efficacy for the endive treated with PAA was only about 80%, leading to a disease burden 100 times higher than the WHO threshold. These findings should be considered and incorporated into future models for estimating foodborne viral illness risks.     

Exploring an HIV paradox: an ethnography of sexual minority women injectors

HIV risk and infection are markedly increased among sexual minority women injectors compared to other injecting drug users. Our ethnographic exploration of this well-documented but poorly understood phenomenon included 270 interviews and over 350 field observations with 65 sexual minority women injectors in New York City and Boston. We discuss findings in relation to four preliminary hypotheses. Neither the presence of gay or bisexual men in risk networks, nor a sense of invulnerability due to lesbian (or other sexual minority) identity seem to be plausible explanations of increased HIV among sexual minority women injectors. However, multiple marginalization was found to be pervasive and to have severe consequences that can be traced to increased HIV risk for many women in the study.     

Attitudes of welfare recipients toward marriage and childbearing

The 1996 Personal Responsibility and Work Opportunities Reconciliation Act (PRWORA) put the need for attitudinal change at the center of efforts to help welfare recipients become economically independent, avoid out-of-wedlock childbearing, and embrace marriage. In this paper, we focus specifically on attitudes, analyzing both differences in values and attitudes between welfare recipients and other women on the cusp of reform, as well as the effects of TANF reforms in two states on the attitudes and behaviors of women subject to the reforms. National data reveal few differences in values and attitudes between welfare recipients and other women once background characteristics are held constant. A majority of both groups believes that prospective parents should marry, but single parents can raise a child as well as married parents. Personal aspirations for marriage and further childbearing also are fairly similar. These similarities may be one reason that the literature has shown TANF to have limited effects on marriage and childbearing. A second set of analyses investigates the degree to which welfare recipients in Delaware and Indiana report that reforms affected their aspirations for marriage and childbearing. Self-reported impacts are greater for fertility than marriage attitudes. Even among those who report their attitudes were affected by reform, recipients appear to have difficulty acting on their marital and childbearing desires, dampening any effects on behavior. These findings reinforce the current sense among researchers and policy makers that more direct reforms are needed to have a substantial effect on marriage and out-of-wedlock childbearing.