Predictors of the Use of Respite Services by Caregivers of Alzheimer\u27s Patients: Racial and Generational Differences

This research applies one prominent model of service utilization (the Andersen- Newman Model) to better understand the way in which family care givers utilize respite services when caring for older relatives. Specifically, this research examines racial (black and white) and generational (spouse and adult-child) differences between caregivers of Alzheimer\u27s patients and the volume and type of respite services used. The sample (N= 359) is drawn from six Northeast Ohio programs in a consortium that uses a personal computer-based information system to collect intake, assessment, service use, and program satisfaction data from respite clients. Racial differences are found in client attrition and turnover. Results also show adult-child caregivers are the greatest users of day care. These generational differences persist despite the similarities in patient and caregiver need. Fee subsidy and relationship strain between the caregiver and elder predict the amount of service used. Findings suggest that practitioners need to take into account racial and generational factors in addition to traditional patient and caregiver needs when formulating care plans

Data-driven analytics to identify school absenteeism associated risk and protective factors for secondary school students

Chronic absenteeism (CA), defined as missing at least 15 school days/year, is recognized as a national problem in the U.S. with devastating long-term impacts for students. Previous studies have been guided by a mixture of diverse CA definitions and measurements which could potentially harm the applicability of findings. Despite the number of CA-associated factors identified, studies utilizing a unified theoretical system to a wide range of risk and protective factors has been scarce

Really Underage Drinkers: Alcohol Use Among Elementary Students

Despite the current societal concern with underage drinking, little attention has been paid to alcohol use within the preadolescent population. This article presents the proceedings of a symposium held at the 2003 Research Society on Alcoholism meeting in Fort Lauderdale, Florida, that was organized and chaired by John E. Donovan. The intent of the symposium was to kick start research on alcohol use among elementary school children by reviewing what is known regarding drinking in childhood. Presentations included (1) The Epidemiology of Children's Alcohol Use, by John E. Donovan; (2) The Validity of Children's Self-Reports of Alcohol Use, by Sharon L. Leech; (3) Predicting Onset of Drinking From Behavior at Three Years of Age: Influence of Early Child Expectancies and Parental Alcohol Involvement Upon Early First Use, by Robert A. Zucker; and (4) Parent, Peer, and Child Risk Factors for Alcohol Use in Two Cohorts of Elementary School Children, by Carol J. Loveland-Cherry. Presentations indicated the need for better nationwide surveillance of children's experience with alcohol; suggested that children's reports of their use of alcohol tend to be reliable and valid; supported children's alcohol use schemas and parental drinking and alcoholism at child age three as independent predictors of early onset drinking; and showed that onset of drinking before fourth or fifth grade, peer pressure, and parental norms and monitoring predict elementary student alcohol use and misuse.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65944/1/01.ALC.0000113922.77569.4E.pd

A controlled trial of Partners in Dementia Care: veteran outcomes after six and twelve months

Introduction: “Partners in Dementia Care” (PDC) tested the effectiveness of a care-coordination program integrating healthcare and community services and supporting veterans with dementia and their caregivers. Delivered via partnerships between Veterans Affairs medical centers and Alzheimer’s Association chapters, PDC targeted both patients and caregivers, distinguishing it from many non-pharmacological interventions. Hypotheses posited PDC would improve five veteran self-reported outcomes: 1) unmet need, 2) embarrassment about memory problems, 3) isolation, 4) relationship strain and 5) depression. Greater impact was expected for more impaired veterans. A unique feature was self-reported research data collected from veterans with dementia. Methods and Findings: Five matched communities were study sites. Two randomly selected sites received PDC for 12 months; comparison sites received usual care. Three structured telephone interviews were completed every 6 months with veterans who could participate. Results: Of 508 consenting veterans, 333 (65.6%) completed baseline interviews. Among those who completed baseline interviews, 263 (79.0%) completed 6-month follow-ups and 194 (58.3%) completed 12-month follow-ups. Regression analyses showed PDC veterans had significantly less adverse outcomes than those receiving usual care, particularly for more impaired veterans after 6 months, including reduced relationship strain (B = −0.09; p = 0.05), depression (B = −0.10; p = 0.03), and unmet need (B = −0.28; p = 0.02; and B = −0.52; p = 0.08). PDC veterans also had less embarrassment about memory problems (B = −0.24; p = 0.08). At 12 months, more impaired veterans had further reductions in unmet need (B = −0.96; p < 0.01) and embarrassment (B = −0.05; p = 0.02). Limitations included use of matched comparison sites rather than within-site randomization and lack of consideration for variation within the PDC group in amounts and types of assistance provided. Conclusions: Partnerships between community and health organizations have the potential to meet the dementia-related needs and improve the psychosocial functioning of persons with dementia. Trial Registry NCT0029116

Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: An individual participant data meta-analysis

Purpose: to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting: primary care sector. Interventions: combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main outcome: activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: quality of life (visual analogue scale 0-10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was -0.01 (95% confidence interval -0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion: compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective

Social capital and families of children with chronic conditions: Instrument development and testing.

Inconsistent use of social capital as a theoretical concept in literature to date has led to a lack of consensus and precision in communication about its utility and measurement. The objective of the research presented here was to explore social capital as a concept using both qualitative and quantitative approaches, and to produce a reliable, valid instrument to measure social capital in the context of families caring a child with a chronic health condition. The results of this research may serve to focus nursing research on health as an asset gained through social interactions. Such an approach will guide the promotion of health in both specific and general populations. It will also contribute to the establishment of consensus and precision in communication about social capital's utility and measurement in nursing and related disciplines. Three phases of the instrument development process are presented. In the first, a review of literature is discussed in light of social capital's strengths and weaknesses as a concept, and implications for nursing as a discipline are explored. The second section discusses the results of a series of focus groups conducted by the author to qualitatively define social capital from the perspectives of parents and caregivers of children with chronic conditions, and the phenomenological examination of data toward a structural definition of social capital. The final section describes the development and testing of a scale to quantitatively measure social capital in this population, as operationalized by the processes described above. Analyses of data are discussed as they relate to the social capital scale and its utility for nursing research. Results suggest that this 20-item measure of social capital may reliably and validly measure families' investments in relationships in the community as a health-related asset.Ph.D.Health and Environmental SciencesNursingPsychologyQuantitative psychologySocial SciencesSocial researchUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/123645/2/3096147.pd

Collective Impact Partnerships: The Data to Action Hourglass Model

Models are needed to guide positive health care and social transformation using real-world data, particularly in an era of data-driven science and accountability. We describe the Data-to-Action Hourglass Model, which synthesizes ideas of collective impact, partnership theory and practice, knowledge complexity, design justice, and systems thinking toward this goal. The Hourglass Model is an ecological (nested) perspective, placing knowledge management within the context of health at levels ranging from planetary to personal, and then using knowledge to inform collective action to influence policy. We offer in-depth commentary and resources to guide use of the Hourglass Model in research, education, and practice, and invite collaboration and discourse related to the model

Psychometric testing of the Iceland Health Care Practitioner Illness Beliefs Questionnaire among school nurses

To access publisher's full text version of this article click on the hyperlink belowBACKGROUND: Beliefs have been found to have an effect on how people deal with illness. Therefore, knowing healthcare practitioners' beliefs about specific high frequency illnesses are vital when caring for vulnerable populations such as school-age children with chronic illnesses or disorders. AIM: To psychometrically test the Iceland Health Care Practitioner Illness Beliefs Questionnaire for healthcare professionals who are working with families of school-age children with asthma and attention deficit/hyperactivity disorder. DESIGN: The Iceland Health Care Practitioner Illness Beliefs Questionnaire is a 7-item Likert-type instrument with four additional open-ended questions that was developed from the Iceland Family Illness Belief Questionnaire. The questionnaire is designed to measure a provider's beliefs about their understanding of the meaning of the illness situation for families. The questionnaire was administered to 162 school nurses in Iceland and the state of Minnesota. METHOD: Two condition-specific versions of the Iceland Health Care Practitioner Illness Beliefs Questionnaire were developed in this study: one to measure beliefs about families of children with asthma and one to measure beliefs about families of children with attention deficit hyperactivity disorder. Higher scores on the questionnaire indicate that healthcare professionals are more confident in their illness beliefs. After initial development, the questionnaire was translated into English. Participants completed the questionnaire using an online survey platform and parallel study procedures in both countries. RESULTS: Based on exploratory factor analysis using principal component analysis, the Iceland Health Care Practitioner Illness Beliefs Questionnaire was found to have a one-factor solution with good construct validity (Cronbach's α = 0.91). Confirmatory factor analysis supported the one-factor solution (Cronbach's α = 0.91). CONCLUSION: This instrument is a promising tool for measuring illness beliefs among healthcare practitioners in clinical and research settings.Icelandic Nursing Association University of Iceland School of Nursing Foundation, University of Minnesota National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH