Does Acculturation Matter? End-of-Life Care Planning and Preference of Foreign-born Older Immigrants in the United States

Abstract Background and Objectives Advance care planning (ACP) is a critical component of health care affecting the quality of later life. Responding to the increase in the older immigrant population in the United States, this empirical study explored the racial/ethnic gaps in ACP behaviors among older immigrants and examined the end-of-life (EOL) care planning and preferences of foreign-born immigrant older adults focusing on race/ethnicity, acculturation, health need factors, and enabling social factors (financial capability, public assistance, and informal supports) after controlling predisposing factors (sociodemographic characteristics). Research Design and Methods Using a subsample from the National Health and Aging Trends Study 2011 and 2012, hierarchical logistic regression models of the EOL plan and preferences were examined with 50 multiple imputation data sets (n = 232). Results Descriptive statistics reveal lower ACP engagement of immigrants from racial/ethnic minority groups. In logistic models, however, only Black immigrants were less likely than Whites to have EOL conversations. Among acculturation factors, age at immigration was only negatively associated with having a durable power of attorney for health, but not significantly associated with other ACP behaviors. Instead, health and social factors, primarily need in health and informal support (i.e., number of coresidents and receiving financial help from family members), were associated with different types of ACP components. Receiving public assistance (i.e., receiving Medicaid and SSI) were positively associated with EOL treatment preferences. Discussion and Implications Older foreign-born immigrants, in general, showed lower ACP engagement than the overall older population. Moreover, minority immigrants were lower on ACP engagement than both White immigrants. This study highlights the need for formal and informal assistance for enhancing EOL planning for older immigrants. Adding to the culturally competent approach, policy efforts should address social and health factors that accrued throughout individuals’ life spans and affect older immigrants’ EOL preparation and care

Using Technology to Enhance the Well-Being of Caregivers of Persons with Dementia: Implications for Social Work Practice and Policy

Indiana University-Purdue University Indianapolis (IUPUI)Difficulties caring for people living with dementia (PWD) contribute to their family caregivers’ diverse unmet needs and adverse outcomes in health and well-being. This dissertation research explored the influence of macro systems on individual caregivers' well-being reflecting on the prevalence of online use among caregivers. Caregivers have migrated to online platforms to seek support. However, there is limited understanding of how online social support [OnSS] compares to offline support [OffSS] in terms of caregivers’ well-being. The first study examined the associations of OnSS and OffSS with the psychological well-being [MH] of caregivers. A subsample of the Health Information National Trends Survey (HINTS) from 2017 to 2018 (n=264) was analyzed. The data indicate that OnSS supplemented rather than replaced OffSS. Emotional support delivered offline had a positive direct association with MH, while OnSS did not. OffSS interacted with caregiving stressors while OnSS interacted with life stressors. Caregivers who are in less favorable situations, such as working part-time while caring for a PWD, living with economic hardship, and being unhealthy, tended to be significantly affected by OnSS. The results suggest that practitioners need to incorporate caregivers’ OffSS into OnSS to maximize the available support resources, specifically for those who are in less favorable conditions. There is limited understanding of caregivers’ experiences within the complex health care system, especially after the significant policy changes brought about by the Affordable Care Act (ACA). The second study analyzed caregivers’ perceptions of and experiences with the ACA using national online forum data posted in 2011-2017 (n=514 posts). Text-mining thematic analysis method was used to analyze the posts. Three overall themes emerged: (a) concern about cost implications of placement decisions for care recipients, (b) skepticism about government and healthcare system support of their caregiving roles, and (c) caregivers’ own well-being and concerns about health insurance. Efforts are needed to enhance clear and effective communication among policymakers and health professionals serving service users, including caregivers of PWD. The present dissertation provides preliminary evidence to increase understanding of the complex contexts that affect the overall well-being of caregivers. Implications and suggestions for practitioners, policymakers, and researchers are discussed

Intention to Use Long-Term Care Facilities: Differences between Korean Pre-elderly and Korean Baby-boomers

With the rapidly increasing number of older adults, dealing with long-term care (LTC) needs becomes an emerging issue in South Korea. This study aims to examine factors affecting the intention to use longtermcare facilities with two groups of young-old adults: (1) Korean pre-elderly (KPE) and (2) Korean babyboomers (KBB). Guided by Andersen's behavioral model of health service use and prior research, predisposing characters, enabling resources, need factors, availabilities of informal care and self-care activities were used as predictors. In the final analyses, 803 KPE and 966 KBB were included. The results of logistic regression analyses showed different findings in two groups. Age, education, spouse's physicalhealth, and self-care activities for relationship with family and friends are significantly associated with intention to use LTC facilities among KPE. However, income, physical health of respondents, and relationship satisfaction with children are significantly related to intention of use LTC facilities in the group of KBB. This study suggests different LTC needs between KPE and KBB. Health care professionals and policy makers need to consider such differences to provide quality LTC care for them

Effective workload management in child welfare: Understanding the relationship between caseload and workload

A common assumption in public social service organizations is that workload may be positively associated with caseload. However, few empirical studies have examined what specific characteristics of caseload affect caseworkers' workloads in the child welfare system. This study attempts to address this gap by identifying specific individual and regional factors that influence both subjective and objective dimensions of workloads. Survey data were collected from 1,244 caseworkers at one public child welfare agency in a Midwestern state in the United States. The data indicated that both perceptions of unmanageable workloads and self‐reported overtime work were significantly higher when caseworkers had a greater number of cases than the state caseload standard for the investigations units and worked with at least two different types of cases simultaneously (e.g., working with both investigation and ongoing service cases). Additionally, sufficient staffing numbers to meet caseload demands at the regional level significantly decreased the odds ratio of having to do overtime work. The major findings suggest that the objective and subjective dimensions of workload vary by individual‐ and regional‐level variables. Practice implications are discussed for effective and efficient workload management in the public child welfare system

Friendsourcing Peer Support for Alzheimer’s Caregivers Using Facebook Social Media

This research piloted an e-health intervention that used social media to friendsource peer support for Alzheimer’s disease (AD) caregivers. Friendsourcing is a variant of crowdsourcing. Crowdsourcing recruits online participants who share a characteristic that makes their volunteerism meaningful when they join to achieve an outcome. Friendsourcing recruits online participants who share membership in a social network that makes their volunteerism meaningful when they join to achieve an outcome. This article introduces our friendsourcing intervention research and examines the effects on the psychological well-being of AD caregivers. After a 6-week intervention, caregivers were found to have significantly decreased burden (Z = −2.01, p < .05) and perceived stress (Z = −2.95, p < .01). Emotional and informational support scores were significantly increased (Z = −2.32, p < .05). Qualitative data analysis of the intervention identified positive effects in new caregiving knowledge acquisition and application and reduced stress in the acceptance of the caregiving role. Joining social networks in support groups through friendsourcing was feasible for AD caregivers who were familiar with social media, and can provide another means of guiding the development of their personal support networks

Comprehensive assessment of youth violence in five Caribbean countries: Gender and age differences

Differences in gender and age have been established in the context of crime, violence, and prevalence of risk and protective factors. These studies are often notable only in the Western Hemisphere. Despite growth in crime and violence in the Caribbean Community (CARICOM), relatively little understanding of violence in CARICOM member states exists. In light of these concerns, the major purposes of this study include: (1) comprehensively assessing the scope of the four behaviors (i.e., engagement, victimization, witness, and report) in relation to violence and youth’s perceptions of risk and protective factors in family and school domains, and (2) examining how they differ by youth’s gender and age. This study draws on assessment data on youth violence in five CARICOM Member States: Antigua and Barbuda, St. Kitts and Nevis, St. Lucia, Jamaica, and Trinidad and Tobago using a completed 51-item quantitative questionnaire from approximately 512 students. The results suggest that violence engagement, victimization, witness, and report significantly differed by gender and age. Male students were more likely to engage in violence, but less likely to report such violence to adults. Similarly, older students reported that they were more likely to engage in and witness violence. For risk and protective factors, female students reported significantly higher scores on domestic violence, whereas male students had higher scores on the access to drugs/weapons. Older students also tended to report higher levels of some school risk factors and lower levels of some protective factors in both family and school

Comparing Crowdsourcing and Friendsourcing: A Social Media-Based Feasibility Study to Support Alzheimer Disease Caregivers

BACKGROUND: In the United States, over 15 million informal caregivers provide unpaid care to people with Alzheimer disease (AD). Compared with others in their age group, AD caregivers have higher rates of stress, and medical and psychiatric illnesses. Psychosocial interventions improve the health of caregivers. However, constraints of time, distance, and availability inhibit the use of these services. Newer online technologies, such as social media, online groups, friendsourcing, and crowdsourcing, present alternative methods of delivering support. However, limited work has been done in this area with caregivers. OBJECTIVE: The primary aims of this study were to determine (1) the feasibility of innovating peer support group work delivered through social media with friendsourcing, (2) whether the intervention provides an acceptable method for AD caregivers to obtain support, and (3) whether caregiver outcomes were affected by the intervention. A Facebook app provided support to AD caregivers through collecting friendsourced answers to caregiver questions from participants' social networks. The study's secondary aim was to descriptively compare friendsourced answers versus crowdsourced answers. METHODS: We recruited AD caregivers online to participate in a 6-week-long asynchronous, online, closed group on Facebook, where caregivers received support through moderator prompts, group member interactions, and friendsourced answers to caregiver questions. We surveyed and interviewed participants before and after the online group to assess their needs, views on technology, and experience with the intervention. Caregiver questions were pushed automatically to the participants' Facebook News Feed, allowing participants' Facebook friends to see and post answers to the caregiver questions (Friendsourced answers). Of these caregiver questions, 2 were pushed to crowdsource workers through the Amazon Mechanical Turk platform. We descriptively compared characteristics of these crowdsourced answers with the friendsourced answers. RESULTS: In total, 6 AD caregivers completed the initial online survey and semistructured telephone interview. Of these, 4 AD caregivers agreed to participate in the online Facebook closed group activity portion of the study. Friendsourcing and crowdsourcing answers to caregiver questions had similar rates of acceptability as rated by content experts: 90% (27/30) and 100% (45/45), respectively. Rates of emotional support and informational support for both groups of answers appeared to trend with the type of support emphasized in the caregiver question (emotional vs informational support question). Friendsourced answers included more shared experiences (20/30, 67%) than did crowdsourced answers (4/45, 9%). CONCLUSIONS: We found an asynchronous, online, closed group on Facebook to be generally acceptable as a means to deliver support to caregivers of people with AD. This pilot is too small to make judgments on effectiveness; however, results trended toward an improvement in caregivers' self-efficacy, sense of support, and perceived stress, but these results were not statistically significant. Both friendsourced and crowdsourced answers may be an acceptable way to provide informational and emotional support to caregivers of people with AD

A HISTORICAL APPROACH TO SYPHILIS INFECTION IN KOREA

From the end of the 15th century, syphilis spread worldwide, posing a serious threat to public health. Venereal syphilis has been a major research topic, not only in clinical medicine but also in paleopathology, especially because it is a disease of questionable origin and of high prevalence until the discovery of antibiotics. Syphilis in history has been studied extensively in Europe and the Americas, though less so in Asia. In this review, based on extant historical documents and available paleopathological data, we pinpoint the introduction and trace the spread of venereal syphilis in Korea to the end of the 19th century. This review provides fundamental information that will be of great help to future research on pre-20th century syphilis in Korea

6,7-Dimethoxy-4-methylcoumarin suppresses pro-inflammatory mediator expression through inactivation of the NF-kappaB and MAPK pathways in LPS-induced RAW 264.7 cells

In this study, we investigated the ability of 6,7-dimethoxy-4-methylcoumarin (DMC) to inhibit lipopolysaccharide (LPS)-induced expression of pro-inflammatory mediators in mouse macrophage (RAW 264.7) cells, and the molecular mechanism through which this inhibition occurred. Our results indicated that DMC down regulated LPS-induced nitric oxide (NO) synthase (iNOS) and cyclooxygenase-2 (COX-2) expression, thereby reducing the production of NO and prostaglandin E2 (PGE2) in LPS-activated RAW 264.7 cells. Furthermore, DMC suppressed LPS-induced production of pro-inflammatory cytokines such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α. To elucidate the mechanism underlying the anti- inflammatory activity of DMC, we assessed its effects on the mitogen-activated protein kinase (MAPK) pathway and the activity and expression of nuclear transcription factor kappa-B (NF-κB). The experiments demonstrated that DMC inhibited LPS-induced phosphorylation of extracellular signal-regulated kinases (ERKs), c-Jun N-terminal kinase (JNK), and p38. In addition, it attenuated LPS-induced NF-κB activation via the inhibition of IκB-α phosphorylation. Taken together, these data suggest that DMC exerts its anti-inflammatory effects in RAW 264.7 cells through the inhibition of LPS-stimulated NF-κB and MAPK signaling, thereby downregulating the expression of pro-inflammatory mediators