Managing in the Trenches of Consumer Care: The Challenges of Understanding and Initiating the Advance Care Planning Process

To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.     

Influence of a Community Health Worker Intervention on Mental Health Outcomes among Low-Income Latino and African American Adults with Type 2 Diabetes

This study investigated the influence of a community health worker (CHW) diabetes lifestyle intervention on mental health outcomes. Our study was guided by the principles of community-based participatory research. Data were collected from 164 African American (N = 94) and Hispanic adults (N = 70) participating in a randomized, 6-month delayed intervention group design for improving glycemic control. The intervention time periods were baseline to 6 months for the treatment group and 6–12 months for the delayed group. Linear mixed models were used to conduct longitudinal analyses of the Problem Areas in Diabetes (PAID) and Patient Health Questionnaire (PHQ) scales. In the model adjusted for demographics, the PAID dropped significantly from pre-intervention to post-intervention within both the treatment and delayed groups (p < 0.05) with an average intervention effect of ?6.4 (p < 0.01). The PAID dropped even further within the immediate group from 6 to 12 months. Although the PHQ did not change significantly, the PHQ-2 had an average intervention effect of ?0.3 (p < 0.05) in the model adjusted for demographics. This study contributes to an understanding of how a CHW-led diabetes intervention can result in positive mental health outcomes for Latinos and African Americans with Type 2 diabetes. It also highlights the importance of further exploring what factors may contribute to racial/ethnic variation in mental health outcomes for African Americans and Latinos with diabetes and the role CHWs can play.     

Correlates of Interpersonal Ethnoracial Discrimination Among Latino Adults with Diabetes: Findings from the REACH Detroit Study

ABSTRACT

The purpose of this study is to identify the social and economic correlates of reported experiences of interpersonal ethnoracial discrimination among Latino adults in Detroit. We examine whether the correlates of interpersonal ethnoracial discrimination vary according to the domain of discrimination and compare findings for individual domains of discrimination to a composite measure of experiences of discrimination. This study suggests that the frequency of reported discrimination is moderately high, and relatively common among Latinos with diabetes who live in Detroit. The findings demonstrate that immigration and ethnicity-related factors, such as greater comfort speaking Spanish and being born in the United States, were persistent correlates of more frequent encounters of interpersonal ethnoracial discrimination. Implications for social work research and practice are presented.     

Video game playing,dependency and delinquency: A question of methodology?

A methodological challenge to Fisher's (1992) study of adolescent fruit machine gamblers was carried out with young video game players. Fisher (1992) described an association between frequency fruit machine playing, dependency and delinquency. Some methodological concerns were considered that might weaken this conclusion, in particular the use of heterogeneous measures that fail to distinguish between variables. As such measures feature elsewhere in contemporary gambling research it was deemed important to examine some of the potential problems that may arise. 183 11–16 year old video game players (152 males; 31 females) were recruited from four amusement arcades to answer a computerised questionnaire. Using an analysis similar to Fisher (1992) her results for adolescent fruit machine use were confirmed. However a separation of key variables and the use of a multiple regression analysis showed that of money spent, time spent and impaired choice, only the first was a significant predictor of delinquency. It is suggested that delinquents have higher disposable incomes to spend on their leisure activities. Video game playing and possibly fruit machine gambling appear to be independently associated with delinquency; in video game playing this association is not mediated by dependency. It was argued that a similar methodology should be used in the UK to re-examine Fisher's (1992) conclusions for children who use gaming machines.The authors wish to thank Timezone Amusement Arcades for the generous use of their centres, Colin Davis for programming the questionnaire and Dr. Sung-Mook Hong for statistical advice.     

Income taxation and equity: new dominance criteria with a microsimulation application

The Journal of Economic Inequality - This paper addresses the problem of the normative evaluation of income tax systems and income tax reforms. While most of the existing criteria, framed in the...