Health changes in Hispanic older adults in a Spanish arthritis self -management education program

Arthritis is the most common chronic condition affecting older people and is a major cause of limited activity. Arthritis education programs in English have demonstrated a positive impact on health but these programs have not reached the Hispanic communities where arthritis is the leading cause of disability. Minorities, such as Hispanics, have traditionally been reluctant to pursue self-help programs, and have been identified as an under-served population in terms of medical care. This study examined the effectiveness of one community health adult education program targeting Hispanic older adults with arthritis, the Spanish Arthritis Self Management Education Program (SASMEP), by evaluating changes in the participants' general health, pain, disability, self-efficacy, health perceptions, frequency of physician visits, and exercise. A pre and post control group experimental design and analyses of covariance were used to determine the pre and post differences in health status and health behaviors for a group participating in the SASMEP and a group who did not using gender and age as covariates. A repeated measures design was also used, and repeated measures analyses of variance and post hoc tests were done on health status and health behavior data collected pre, post and one-year post education to determine long-term differences. ^ Results indicated the participants' health status significantly improved in general health, significantly decreased in pain, and significantly decreased in arthritic disability immediately following the education. Self-efficacy and health perceptions increased for both groups but not significantly. The participants' health behaviors showed significantly fewer physician visits and significantly increased time spent performing stretching and strengthening exercise and time spent performing aerobic exercise. No group differences were found in the frequency of arthritis physician visits. ^ The improvements seen immediately after the SASMEP participation were not reflected in the post one-year scores. No significant differences were found for the participants' health status or health behaviors one year following the education. Health status and health behaviors did not return below baseline scores after one year suggesting the participants' health, although not improved, did not deteriorate. Therefore, the SASMEP education provided short-term health benefits for older Hispanic adults with arthritis, but not long-term health benefits. ^

Investigating the Outcomes of a Physical Activity Program offered to Older Adults in South Florida and Understanding the Correlates of Completion

Despite the well-known benefits of physical activity, in 2012, only 37.5% of older adults aged 60 years or older met recommended aerobic physical activity levels and 16.1% met muscle-strengthening guidelines. Effective exercise programs can help combat the problem of inactivity but 50% of those who start participating in an exercise program drop out within first few weeks, preventing them from gaining any health benefits. Since fall 2008, the Healthy Aging Regional Collaborative of South Florida has offered EnhanceFitness (EF), an evidence-based physical activity program to older adults. This dissertation compared EF effectiveness at 4-, 8-, and 12-months and examined the factors that were associated with program completion. A paired sample t-test identified changes at 4-months and repeated measures design was used to identify changes from baseline to 4-, 8-, and 12- months. Logistic regression was used to identify correlates associated with completion. Between October 1, 2008 and December 31, 2012, 4,531 older adults (>=60 years) attended one or more EF sessions. Participants showed significant improvement in the number of chair stands performed in 30-seconds with mean change of 1.7, 1.6, and 2.0 respectively at 4-,8-,and 12- months (pp<0.001). Results suggest Black, non-Haitian men were less likely to complete the program when compared to white, non-Hispanic men (OR=0.41, p=0.02). Men who self-reported having at least one risk factor were more likely to complete the program (OR=1.81, p= 0.03). In addition, women who lived in Miami-Dade County (OR=2.13, ppppp<0.01). Effectiveness results revealed that all participants improved on outcome measures. However, improvement is more than double for those who completed recommended sessions (p

Condições de trabalho e terceiro setor: implicações contemporâneas para o serviço social

In the contemporaneity, due to the implementation of the neoliberal project in which one verifies the withdrawal of the State in regard to the development of social policies, it is observed a new way of responding to the multifaceted expressions of the social issue, which is the emergence and expansion of a supposed "third sector" in society. Thus, the productive restructuring process has led to the deterioration of labor relations, as well as a super exploration of human labor power, also triggering structural unemployment. By being delineated in classist interests, the emergence of the "third sector" brings contradictory aspects to the society, one of these being the very concept of "third sector", more ideological than real. By seeking to answer the expressions of the social issue, demands the intervention of social workers in the institutions that "composes it". This way, arises the interest in researching what are the current conditions and labor relations of the social workers who work in the institutions of the "third sector" in Mossoró-RN. Therefore, this study is constituted by a survey for the conclusion of a Master's degree in Social Service at the Universidade Federal do Rio Grande do Norte. Therefore, it was listed out as general objective to identify and analyze the conditions and labor relations of the social workers entered in the institutions of the "third sector" in Mossoró-RN. And by specific objectives: to map the institutions that are part of the "third sector" in the city of Mossoró, which have social workers on its professional staff, in order to profile the same; and, analyze the main challenges presented to the work of the social worker in these institutions. We used the bibliographic and documental research to enlighten the knowledge of the topic approached and the development of the field research, in which for the analysis of the data obtained, through field research, it was used the quantitative and qualitative approach. The search results confirmed that half of the institutions was identified as philanthropics, and most of them are funded by the federal government and that such organizations develop activities in several areas, particularly health and welfare. Concerning the conditions and labor relations, was highlighted the fact that half of the professionals insert themselves within the institutions by appointment; regarding the salary, 57.1% of employees receive between 3 and 4 minimum wages, which is considered relatively low. Was satisfactory the analysis related to the labor rights, because almost all offer a formal contract, which ensures, in great measure, the effectuation of such rights. Now with regard to the workload, 5 of 6 institutions implemented the Law Nº. 12.317/2010 ensuring 30 hours a week for social workers. However, it were cited many challenges relating the reality of the "third sector" to the conditions and labor relations, among them stands out: the delay of salary and non-salary adjustment; the realization of activities that do not relate to professionals, functions and duties; the development of many activities by a single professional. Two important data are the not incentive to a postgraduate and the charging of the fulfillment of the goals for the professional productivity. Here, it is worth to reflect that, although this study presents elements that provide to identify some aspects of labor relations and conditions of social workers in the "third sector" in Mossoró- RN, as well as some challenges that permeate this space of professional insertion, is meant that there is much to be unveiled, and other studies can later do so in an attempt to a better understanding of the complexity of processes that permeate the "third sector"

Mapping area variability in social and behavioural difficulties among Glasgow pre-schoolers : linkage of a survey of pre-school staff with routine monitoring data

Funded by The Scottish Government

Mapping area variability in social and behavioural difficulties among Glasgow pre-schoolers : linkage of a survey of pre-school staff with routine monitoring data

Funded by The Scottish Government

A Role for Provenance in Social Computation

Postprint

Older woman in marathon

General note: Title and date provided by Bettye Lane.

Older woman in restaurant (loneliness)

General note: Title and date provided by Bettye Lane.

Writer Susan Sontag speaks at conference on older women in NYC

General note: Title and date provided by Bettye Lane.

Production and presence in the countries of Central America in Scopus on the theme of Documentation in Social Communication (1986-2013)

Describes and analyzes the results obtained after analysis of the publications present in Scopus data base and used that tool rankings generated by the research group Scimago on the production of the different countries of Central America on the issue of documentation the means of mass communication. Performed a comparative about different countries in the region and the scientific analyzes. Finally, and given and data analysis, a number of recommendations are made to improve the production and the presence in indexed database.

Sustained effectiveness of a multifaceted intervention to reduce potentially inappropriate prescribing in older patients in primary care (OPTI-SCRIPT study)

Background: Potentially inappropriate prescribing (PIP) is common in older people in primary care and can result in increased morbidity, adverse drug events and hospitalisations. We previously demonstrated the success of a multifaceted intervention in decreasing PIP in primary care in a cluster randomised controlled trial (RCT).
Objective: We sought to determine whether the improvement in PIP in the short term was sustained at 1-year follow-up.
Methods: A cluster RCT was conducted with 21 GP practices and 196 patients (aged ≥70) with PIP in Irish primary care. Intervention participants received a complex multifaceted intervention incorporating academic detailing, medicine review with web-based pharmaceutical treatment algorithms that provide recommended alternative treatment options, and tailored patient information leaflets. Control practices delivered usual care and received simple, patient-level PIP feedback. Primary outcomes were the proportion of patients with PIP and the mean number of potentially inappropriate prescriptions at 1-year follow-up. Intention-to-treat analysis using random effects regression was used.
Results: All 21 GP practices and 186 (95 %) patients were followed up. We found that at 1-year follow-up, the significant reduction in the odds of PIP exposure achieved during the intervention was sustained after its discontinuation (adjusted OR 0.28, 95 % CI 0.11 to 0.76, P = 0.01). Intervention participants had significantly lower odds of having a potentially inappropriate proton pump inhibitor compared to controls (adjusted OR 0.40, 95 % CI 0.17 to 0.94, P = 0.04).
Conclusion: The significant reduction in the odds of PIP achieved during the intervention was sustained after its discontinuation. These results indicate that improvements in prescribing quality can be maintained over time.

Prescribing of Psychoactive Drugs for Older People in Nursing Homes: An Analysis of Treatment Culture

Background There is increasing interest in how culture may affect the quality of healthcare services, and previous research has shown that ‘treatment culture’—of which there are three categories (resident centred, ambiguous and traditional)—in a nursing home may influence prescribing of psychoactive medications. Objective The objective of this study was to explore and understand treatment culture in prescribing of psychoactive medications for older people with dementia in nursing homes. Method Six nursing homes—two from each treatment culture category—participated in this study. Qualitative data were collected through semi-structured interviews with nursing home staff and general practitioners (GPs), which sought to determine participants’ views on prescribing and administration of psychoactive medication, and their understanding of treatment culture and its potential influence on prescribing of psychoactive drugs. Following verbatim transcription, the data were analysed and themes were identified, facilitated by NVivo and discussion within the research team. Results Interviews took place with five managers, seven nurses, 13 care assistants and two GPs. Four themes emerged: the characteristics of the setting, the characteristics of the individual, relationships and decision making. The characteristics of the setting were exemplified by views of the setting, daily routines and staff training. The characteristics of the individual were demonstrated by views on the personhood of residents and staff attitudes. Relationships varied between staff within and outside the home. These relationships appeared to influence decision making about prescribing of medications. The data analysis found that each home exhibited traits that were indicative of its respective assigned treatment culture. Conclusion Nursing home treatment culture appeared to be influenced by four main themes. Modification of these factors may lead to a shift in culture towards a more flexible, resident-centred culture and a reduction in prescribing and use of psychoactive medication. 

A process evaluation of a cluster randomised trial to reduce potentially inappropriate prescribing in older people in primary care (OPTI-SCRIPT study)

Background
The OPTI-SCRIPT cluster randomised controlled trial (RCT) found that a three-phase multifaceted intervention including academic detailing with a pharmacist, GP-led medicines reviews, supported by web-based pharmaceutical treatment algorithms, and tailored patient information leaflets, was effective in reducing potentially inappropriate prescribing (PIP) in Irish primary care. We report a process evaluation exploring the implementation of the intervention, the experiences of those participating in the study and lessons for future implementation.

Methods
The OPTI-SCRIPT trial included 21 GP practices and 196 patients. The process evaluation used mixed methods. Quantitative data were collected from all GP practices and semi-structured interviews were conducted with GPs from intervention and control groups, and a purposive sample of patients from the intervention group. All interviews were transcribed verbatim and analysed using a thematic analysis.

Results
Despite receiving a standardised academic detailing session, intervention delivery varied among GP practices. Just over 70 % of practices completed medicines review as recommended with the patient present. Only single-handed practices conducted reviews without patients present, highlighting the influence of practice characteristics and resources on variation. Medications were more likely to be completely stopped or switched to another more appropriate medication when reviews were conducted with patients present. The patient information leaflets were not used by any of the intervention practices. Both GP (32 %) and patient (40 %) recruitment rates were modest. For those who did participate, overall, the experience was positively viewed, with GPs and patients referring to the value of medication reviews to improve prescribing and reduce unnecessary medications. Lack of time in busy GP practices and remuneration were identified as organisational barriers to future implementation.

Conclusions
The OPTI-SCRIPT intervention was positively viewed by both GPs and patients, both of whom valued the study’s objectives. Patient information leaflets were not a successful component of the intervention. Academic detailing and medication reviews are important components in changing PIP, and having patients present during the review process seems to be a more effective approach for decreasing PIP.