HIV Status Disclosure among Older African American Men Who Have Sex with Men and Women

Thesis (Ph.D.)--University of Washington, 2016-06

Marketing Approaches to Human Resources Management In the Hospitality Industry

Now that baby boomers are older and pursuing more career-oriented jobs, managers of the hospitality industry are experiencing the effects of the pre- sent labor crisis; they now know that those vacant hourly jobs are going to be tough to fill with quality personnel. The companies able to attract quality personnel by offering employees what they need and want will be the successful ones in the next decade. The authors explain how the labor crisis is currently affecting the hospitality industry and make suggestions about how firms may survive the "labor crash” of the 1990s with the application of marketing technology to human resource management.

Middle -class immigrant identities: Dominican-Americans in South Florida

Identity studies of immigrants are complex because of multiple influences affecting identity reconstruction during immigration and acculturation: nationality, socio-cultural differences, occupations, education, spatial and geographic locations, age, gender, and personal attributes. Most immigrant identity studies deal with lower-income immigrants, who do not have the resources of middle- and upper-middle-class immigrants. South Florida is “home” to many middle-class immigrants, including Dominican-Americans. This dissertation interviewed sixty-six Dominican immigrants in South Florida, in order to determine their reconstructed identities after immigration/resettlement and to discover what influences contributed to these changes in identities. ^ The research design of this dissertation utilized an inductive, qualitative model, with the “grounded theory” method of data collection, categorization, and analysis. Participants were selected by a snowball sampling and interviewed with an informal questionnaire. Results were transcribed, categorized, tabulated, and analyzed for conclusions and theorization on immigrant identity. ^ The dissertation addressed numerous influences relating to identity reconstruction: the differing circumstances of immigration, the unique resources of middle- and higher-class immigrants, the nurturing environment of South Florida for immigrants with education and professional skills, and the boundary protection offered by suburban spaces. The interviewees displayed a wide range of age, length of residence in the United States, reasons for immigration, entry ports, settlement, relocations, occupations, and claimed identities. Identity was cross-tabulated with the various influences, as a means of invalidating certain influences and indicating possible trends. ^ The dissertation concluded that middle-class immigrant identities are diverse and multiple, as are the related influences. None of these immigrants had become totally assimilated, nor have they retained dual, non-overlapping attachments or frames of reference. Instead, many of the immigrants seemed to have developed or negotiated two or more identities, according to need, context, and personal interest. A cosmopolitan community such as South Florida seems to have encouraged such multiplicity of identity. However, rather than forming free-flowing identities, most of these immigrants eventually developed diverse and hybrid identities that have bounded attachments to various networks, groups, and places in South Florida. ^

Ethnic Differences in Insulin Resistance, Adiponectin Levels and Abdominal Obesity: Haitian Americans and African Americans, with and without Type 2 Diabetes Mellitus

Background: Metabolic outcomes of obesity and its associated disorders may not be equivalent across ethnicity and diabetes status. Aim: In this paper, we examined the association of abdominal obesity, by ethnicity and diabetes status, for indicators of glucose metabolism in Blacks. Methods: A cross sectional study was conducted in Haitian Americans (n= 186) and African Americans (n= 148) with and without type 2 diabetes mellitus (T2DM). Student’s t-test and Chi-squared test were used to assess differences in mean and proportion values between ethnicities with and without type 2 diabetes mellitus. Relationship between insulin resistance, ethnicity, diabetes status, abdominal obesity, and adiponectin levels were analyzed by analysis of covariance while controlling for confounding variables. Results:Haitian American participants were older (P = .032), had higher fasting plasma glucose (P = .036), and A1C (P = .016), but had lower levels of Hs-CRP (P < .001), insulin and HOMA2-IR and lower abdominal obesity (P = .030), than African Americans. Haitian Americans had significantly lower HOMA2-IR (P = .008) than African Americans when comparing both ethnicities with T2DM, high abdominal obesity, and adiponectin levels lower than the median ( Conclusion: The clinical significance of observed differences in insulin resistance, abdominal obesity, and adiponectin levels between Haitian Americans and African Americans could assist in forming public health policies that are ethnic specific.

Phylloquinone (Vitamin K₁) Intake and Pulse Pressure as a Measure of Arterial Stiffness in Older Adults

This study examined the relationships among ethnicity/race, lifestyle factors, phylloquinone (vitamin K₁) intake, and arterial pulse pressure in a nationally representative sample of older adults from four ethnic/racial groups: non-Hispanic Whites, non-Hispanic Blacks, Mexican Americans, and other Hispanics. This was a cross-sectional study of U.S. representative sample with data from the National Health and Nutrition Examination Surveys, 2007-2008 and 2009-2010 of adults aged 50 years and older (N = 5296). Vitamin K intake was determined by 24-hour recall. Pulse pressure was calculated as the difference between the averages of systolic blood pressure and diastolic blood pressure. Compared to White non-Hispanics, the other ethnic/racial groups were more likely to have inadequate vitamin K₁ intake. Inadequate vitamin K₁ intake was an independent predictor of high arterial pulse pressure. This was the first study that compared vitamin K₁ inadequacy with arterial pulse pressure across ethnicities/races in U.S. older adults. These findings suggest that vitamin K screening may be a beneficial marker for the health of older adults.

Hospital discharge planning in the provision of food and nutrition services for older adults post discharge

This descriptive study examined whether discharge planning ensures that food and nutrition services are provided to older adults following hospital discharge. The questionnaire was distributed to discharge planning professionals in 11 South Florida hospitals. Of the 84 respondents (88% response rate), most were female nurse case managers. Almost all reported job barriers including excessive patient loads, too many responsibilities, and limited community services. While physicians, registered nurses, social workers, physical therapists, were deemed "very important" in discharge planning,registered dietitians were not, and almost half consulted them infrequently, if at all. Over 84% said nutrition-related medical conditions/factors, "strongly influenced" discharge planning. Many did not have adequate information about nutrition-related community resources, eg, home delivered meals, food stamps, outpatient registered dietitians. Therewere no universal approaches in meeting the nutrition needs in 6 case scenarios. More communication among community services and hospitals is needed.

Age and Life Course Location as Interpretive Resources for Decisions Regarding Disclosure of HIV to Parents and Children: Findings from the HIV and Later Life Study

Studies of disclosure among older people living with HIV (PLWH) are uninformed by critical social-gerontological approaches that can help us to appreciate how older PLWH see and treat age as relevant to disclosure of their HIV status. These approaches include an ethnomethodologically-informed social constructionism that explores how ‘the’ life course (a cultural framework depicting individuals’ movement through predictable developmental stages from birth to death) is used as an interpretive resource for determining self and others’ characteristics, capacities, and social circumstances: a process Rosenfeld and Gallagher (2002) termed ‘lifecoursing’. Applying this approach to our analysis of 74 life-history interviews and three focus groups with older (aged 50+) people living with HIV in the United Kingdom, we uncover the central role that lifecoursing plays in participants’ decision-making surrounding disclosure of their HIV to their children and/or older parents. Analysis of participants’ accounts uncovered four criteria for disclosure: the relevance of their HIV to the other, the other’s knowledge about HIV, the likelihood of the disclosure causing the other emotional distress, and the other’s ability to keep the disclosed confidential. To determine if these criteria were met in relation to specific children and/or elders, participants engaged in lifecoursing, evaluating the other’s knowledge of HIV, and capacity to appropriately manage the disclosure, by reference to their age. The use of assumptions about age and life-course location in decision-making regarding disclosure of HIV reflects a more nuanced engagement with age in the disclosure decision-making process than has been captured by previous research into HIV disclosure, including on the part of people aging with HIV.

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.

Party rules, party resources and the politics of parliamentary democracies How parties organize in the 21st century

This article introduces the first findings of the Political Party Database Project, a major survey of party organizations in parliamentary and semi-presidential democracies. The project’s first round of data covers 122 parties in 19 countries. In this article, we describe the scope of the database, then investigate what it tells us about contemporary party organization in these countries, focusing on parties’ resources, structures and internal decision-making. We examine organizational patterns by country and party family, and where possible we make temporal comparisons with older data sets. Our analyses suggest a remarkable coexistence of uniformity and diversity. In terms of the major organizational resources on which parties can draw, such as members, staff and finance, the new evidence largely confirms the continuation of trends identified in previous research: that is, declining membership, but enhanced financial resources and more paid staff. We also find remarkable uniformity regarding the core architecture of party organizations. At the same time, however, we find substantial variation between countries and party families in terms of their internal processes, with particular regard to how internally democratic they are, and the forms that this democratization takes.

Primary Health Care Providers' Perspectives: Facilitating Older Patients' Access to Community Support Services

The purpose of the study examined in this article was to understand how non-physician health care professionals working in Canadian primary health care settings facilitate older persons’ access to community support services (CSSs). The use of CSSs has positive impacts for clients, yet they are underused from lack of awareness. Using a qualitative description approach, we interviewed 20 health care professionals from various disciplines and primary health care models about the processes they use to link older patients to CSSs. Participants collaborated extensively with interprofessional colleagues within and outside their organizations to fi nd relevant CSSs. They actively engaged patients and families in making these linkages and ensured follow-up. It was troubling to fi nd that they relied on out-of-date resources and ineffi cient search strategies to fi nd CSSs. Our fi ndings can be used to develop resources and approaches to better support primary health care providers in linking older adults to relevant CSSs. 

Impact of a community-based exercise programme on physical fitness in middle-aged and older patients with type 2 diabetes

Objectives: Physical fitness is related to all-cause mortality, quality of life and risk of falls in patients with type 2 diabetes. This study aimed to analyse the impact of a long-term community-based combined exercise program (aerobic + resistance + agility/balance + flexibility) developed with minimum and low-cost material resources on physical fitness in middle-aged and older patients with type 2 diabetes. Methods: This was a non-experimental pre-post evaluation study. Participants (N = 43; 62.92 ± 5.92 years old) were engaged in a community-based supervised exercise programme (consisting of combined aerobic, resistance, agility/balance and flexibility exercises; three sessions per week; 70 min per session) of 9 months' duration. Aerobic fitness (6-Minute Walk Test), muscle strength (30-Second Chair Stand Test), agility/balance (Timed Up and Go Test) and flexibility (Chair Sit and Reach Test) were assessed before (baseline) and after the exercise intervention. Results: Significant improvements in the performance of the 6-Minute Walk Test (Δ = 8.20%, p < 0.001), 30-Second Chair Stand Test (Δ = 28.84%, p < 0.001), Timed Up and Go Test (Δ = 14.31%, p < 0.001), and Chair Sit and Reach Test (Δ = 102.90%, p < 0.001) were identified between baseline and end-exercise intervention time points. Conclusions: A long-term community-based combined exercise programme, developed with low-cost exercise strategies, produced significant benefits in physical fitness in middle-aged and older patients with type 2 diabetes. This supervised group exercise programme significantly improved aerobic fitness, muscle strength, agility/balance and flexibility, assessed with field tests in community settings.

Meaning in life in earlier and later older-adulthood : confirmatory factor analysis and correlates of the meaning in life questionnaire

OBJECTIVE: To validate the Meaning in Life Questionnaire (MLQ) in earlier and later older-adulthood, and examine its correlates. METHOD: Participants in earlier (n = 341, M age = 68.5) and later older-adulthood (n = 341, M age = 78.6) completed the MLQ and other measures. Confirmatory multigroup analysis, correlations, and regression models were conducted. RESULTS: A two-factor (presence and search), eight-item model of the MLQ had a good fit and was age-invariant. Presence and search for meaning were largely unrelated. Meaning was associated with life satisfaction, well-being across a range of domains, and psychological resources. Searching for meaning correlated negatively with these variables, but to a lesser degree in later older-adulthood. DISCUSSION: The MLQ is valid in older-adulthood. Meaning in life is psychologically adaptive in older-adulthood. Searching for meaning appears less important, especially in later older-adulthood. Findings are discussed in the context of aging and psychosocial development.

Optimising health literacy and access of service provision to community dwelling older people with diabetes receiving home nursing support

Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia) study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS).

Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method.

Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients' diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice.

Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management.

Self-care in older people with functional deficit: needs of long-term care.

The group of 65-year-olds is becoming more numerous and with greater needs for health care. So, is necessary the reflection about new models of provision, organization, and allocation of health resources. According to the United Nations Organization, 2015, in 2050 elderly people will reach two million people (20% of the world’s population), what mean that the number of people over 60 years old will exceed a population of young people under 15 years. Parallel to aging, less healthy lifestyles have contributed to the prevalence of chronic diseases, especially cerebrovascular diseases. Hypertension and diabetes mellitus are risk factors and increase predisposition to other diseases. With aging, there is an increased risk for developing chronic, oncological and degenerative diseases, which account for more than 50% of the burden of diseases, with profound implications on independency, use of health care and services.