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Leaving Home Care: Decision Making, Risk Scenarios & Services Gaps In The Home Care System, Jacey J. Vaughan, Nina M. Silverstein Dec 2011

Leaving Home Care: Decision Making, Risk Scenarios & Services Gaps In The Home Care System, Jacey J. Vaughan, Nina M. Silverstein

Nina Silverstein

Home and community-based services (HCBS) enable older and disabled adults to age-in-place in their homes and communities by helping them function independently for as long as possible (Grabowski et al., 2010; Wong & Silverstein, 2011). Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home (e.g., Walker, 2010; Fox-Grage, Coleman, & Freiman, 2006). Medicaid is a major source of funding for long-term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional care (National Conference of State Legislatures & AARP, 2009), and older adults and their …


Massachusetts’ Home Care Programs And Reasons For Discharge Into Nursing Homes, Cathy M. Wong, Nina M. Silverstein Nov 2011

Massachusetts’ Home Care Programs And Reasons For Discharge Into Nursing Homes, Cathy M. Wong, Nina M. Silverstein

Nina Silverstein

Home and community-based services (HCBS) are a range of long-term care services intended to enable older adults and persons with disabilities to “age in place” in their own homes and communities. Previous studies well document that older adults prefer receiving HCBS rather than institutional care at a nursing home. One study concluded that 84 percent of older Americans, aged 50 years and older, want to remain in their homes for as long as possible. Medicaid is a major source of funding for long term care. Currently, a large proportion of Medicaid funds in most states has been spent on institutional, …


The Frank J. Manning Certificate In Gerontology Alumni Survey: 21 Years Of Service To Elders, Nina M. Silverstein, Jenai Murtha, Donna Sullivan, May Jawad Oct 2011

The Frank J. Manning Certificate In Gerontology Alumni Survey: 21 Years Of Service To Elders, Nina M. Silverstein, Jenai Murtha, Donna Sullivan, May Jawad

Nina Silverstein

The Certificate Program in Gerontology at the University of Massachusetts Boston, a large urban university, was established in 1979 as part of an Administration on Aging (AoA) grant to develop and expand services to the elderly citizens of the Commonwealth of Massachusetts. In 1984, a line item was added to the state budget by the legislature and governor establishing the Gerontology Institute at the University of Massachusetts Boston and ensuring the continuation of training, research, and policy and advocacy work on behalf of and with Massachusetts’ elders (O’Brien, 1996). Upon Frank J. Manning’s death in 1986, the program was renamed …


Aging In Place At Harbor Point: Outreach Follow-Up Of Older Adults Living In Independent Mixed-Income Apartments, Judith M. Conahan, Nina M. Silverstein, Kelly Fitzgerald Oct 2011

Aging In Place At Harbor Point: Outreach Follow-Up Of Older Adults Living In Independent Mixed-Income Apartments, Judith M. Conahan, Nina M. Silverstein, Kelly Fitzgerald

Nina Silverstein

Most older people, despite functional impairments, plan to stay in their homes and/or communities as long as possible. According to an AARP survey, 82% of adults 65+ reported that they believe that they are “very likely” or “somewhat likely” to stay in their current homes or apartments for the rest of their lives. With increasing age, housing and community characteristics and services gain importance in meeting the challenges of “aging in place.” Staying in their homes maximizes elder’s independence, sustains their social connections, and reaffirms their identity and value.


Seniors Count Follow-Up Study, Nina M. Silverstein, Heather Connors, May Jawad Oct 2011

Seniors Count Follow-Up Study, Nina M. Silverstein, Heather Connors, May Jawad

Nina Silverstein

Seniors Count is an ongoing outreach initiative under the direction of Boston Mayor Thomas M. Menino with the leadership and support of Joyce Williams, Boston's Commissioner on Affairs of the Elderly. The program's purpose is to "identify and reach out to those members of the city's elderly population who live in private housing arrangements and help provide them with the information and services they [may] need" (Boston Commission on Affairs of the Elderly, 2002). Since the program's inception in 1999, it has reached over 5,500 community-dwelling elders in the City of Boston (Boston Commission on Affairs of the Elderly, 2002). …


A Survey Of Health Services And Identification Of Needs For Asian American Elderly Women In The Greater Boston Area, Connie S. Chan, Lin Zhan Oct 2011

A Survey Of Health Services And Identification Of Needs For Asian American Elderly Women In The Greater Boston Area, Connie S. Chan, Lin Zhan

Connie Chan

Over one hundred Asian American and mainstream health care providers in the greater Boston area were surveyed for this study. The authors have identified critical gaps in services for elderly Asian American women.


State-Level Influences On Buprenorphine Utilization: Variations In Opioid Addiction Treatment, Lisa M. Lines Mph, Robin E. Clark Phd Jun 2011

State-Level Influences On Buprenorphine Utilization: Variations In Opioid Addiction Treatment, Lisa M. Lines Mph, Robin E. Clark Phd

Lisa M. Lines

Research Objective: Buprenorphine is a medication used to treat opioid addiction. Physicians are required to have special Drug Enforcement Agency certification to prescribe buprenorphine. Although it is more accessible and potentially safer than methadone, the leading opioid addiction treatment modality, there appear to be state-to-state variations in rates of buprenorphine adoption and use. The purpose of this study was to identify state-level influences on the volume of buprenorphine prescribed, using a limited set of supply and demand measures. Study Design: We developed a database using data on buprenorphine prescribing and factors hypothesized to influence variations in prescribing obtained from the …


Virtual Reality In Stroke Rehabilitation: A Meta-Analysis And Practical Implications For Clinicians, Gustavo Saposnik Mar 2011

Virtual Reality In Stroke Rehabilitation: A Meta-Analysis And Practical Implications For Clinicians, Gustavo Saposnik

Gustavo Saposnik

No abstract provided.


Creating The Organizational Capacity To Serve Families With Parental Mental Illness: The Implementation Of Family Options, Kathleen Biebel, Katherine Woolsey Feb 2011

Creating The Organizational Capacity To Serve Families With Parental Mental Illness: The Implementation Of Family Options, Kathleen Biebel, Katherine Woolsey

Kathleen Biebel

Summary: The purpose of this presentation is to present preliminary findings describing the organizational context of a traditionally adult-serving community mental health program, Employment Options, Inc., as they implement a family-centered, strengths-based intervention for families living with parental mental illness.


Iscore: A Risk Score To Predict Stroke Mortality, Gustavo Saposnik Feb 2011

Iscore: A Risk Score To Predict Stroke Mortality, Gustavo Saposnik

Gustavo Saposnik

Stroke is a leading cause of death and adult disability. The ability to estimate prognosis in acute stroke patients directly affects treatment decisions for patients. It may also guide supportive care plans, facilitate patient and/or family counseling or discussions pertaining to end-of-life decisions. At the population level, prognostic estimations may assist policymakers in conducting fair comparisons when evaluating stroke fatality among different facilities for hospital outcomes and performance assessment. Clinicians usually rely on their own personal experience or average mortality reported in observational studies, which do not account for valuable information available at the time of the hospital presentation. Unfortunately, …


Sis-Map; Suicide Risk Assessment Scale, Amresh Srivastava Feb 2011

Sis-Map; Suicide Risk Assessment Scale, Amresh Srivastava

Amresh Srivastava

This is a New Scale for Assessment of suicide risk to evaluate clients referals and disposition. This Copy Right to Amresh Shrivastava and Chrles Nelson


Using N-Of-1 Trials To Improve Patient Management And Save Costs, Paul A. Scuffham, Jane Nikles, Geoffrey K. Mitchell, Michael J. Yelland, Norma Vine, Christopher J. Poulos, Peter I. Pillans, Guy Bashford, Chris Del Mar, Philip J. Schluter, Paul Glasziou Jan 2011

Using N-Of-1 Trials To Improve Patient Management And Save Costs, Paul A. Scuffham, Jane Nikles, Geoffrey K. Mitchell, Michael J. Yelland, Norma Vine, Christopher J. Poulos, Peter I. Pillans, Guy Bashford, Chris Del Mar, Philip J. Schluter, Paul Glasziou

Paul Glasziou

Background: N-of-1 trials test treatment effectiveness within an individual patient. Objective: To assess (i) the impact of three different N-of-1 trials on both clinical and economic outcomes over 12 months and (ii) whether the use of N-of-1 trials to target patients' access to high-cost drugs might be cost-effective in Australia. Design: Descriptive study of management change, persistence, and costs summarizing three N-of-1 trials. Participants: Volunteer patients with osteoarthritis, chronic neuropathic pain or ADHD whose optimal choice of treatment was uncertain. Interventions: Double-blind cyclical alternative medications for the three conditions. Measures: Detailed resource use, treatment and health outcomes (response) data collected …


Stakeholders' Views On The Routine Use Of N-Of-1 Trials To Improve Clinical Care And To Make Resource Allocation Decisions For Drug Use, Jane Nikles, Geoffrey K. Mitchell, Alexandra Clavarino, Michael J. Yelland, Christopher B. Del Mar Jan 2011

Stakeholders' Views On The Routine Use Of N-Of-1 Trials To Improve Clinical Care And To Make Resource Allocation Decisions For Drug Use, Jane Nikles, Geoffrey K. Mitchell, Alexandra Clavarino, Michael J. Yelland, Christopher B. Del Mar

Christopher Del Mar

N-of-1 trials are empirical formal tests using a within-patient randomised, double-blind, cross-over comparison of drug and placebo (or another drug), which we adapted to study individual patients’ responses as a clinical tool to guide clinical management. We administered semi-structured interviews to gauge stakeholder perspectives on the possibility of using routine n-of-1 trials for this purpose. Stakeholders included government and non-government health care sector, and patient, clinician and consumer, organisations. Stakeholders supported more widespread implementation of n-of-1 trials, in a targeted fashion, with some caveats. Barriers to their widespread implementation included constraints on doctors’ time, doctors’ acceptance, drug company acceptance, patient …


The Role Of Problem Orientation Cognitive Distortions In Depression And Anxiety Intervention For Young Adults., Coralie Wilson Dec 2010

The Role Of Problem Orientation Cognitive Distortions In Depression And Anxiety Intervention For Young Adults., Coralie Wilson

Coralie J Wilson

Interventions that aim to improve social problem-solving skills can significantly reduce the severity of anxiety and depression symptoms in young people. Anxious and depressed individuals often have a negative orientation to problem solution which acts as a barrier to implementing problem-solving skills. Research with older adults suggests that symptoms impair problem-solving abilities through cognitive processes associated with the development of anxiety and depression. In this study we extend previous investigations by assessing the extent to which specific cognitive distortions and symptoms of anxiety and depression are associated with negative problem orientation in a sample of 285 young adults aged 18 …


Rural Adolescents’ Help Seeking Intentions For Emotional Problems: The Influence Of Perceived Benefits And Stoicism., Coralie Wilson Dec 2010

Rural Adolescents’ Help Seeking Intentions For Emotional Problems: The Influence Of Perceived Benefits And Stoicism., Coralie Wilson

Coralie J Wilson

This paper is the second from a larger multi-cite study developed and led by the third author which explores factors that influence adolescents' help-seeking intentions. Specifically, this paper investigates the extent to which perceived benefits of help seeking, stoicism, gender and symptoms of psychological distress are associated with intentions to seek professional help for emotional problems. A cross sectional self-report questionnaire was administered to adolescents recruited from seven high schools in rural towns in the Riverina region of New South Wales. A total of 778 adolescents were recruited. The sample included 373 male and 404 female participants between 13 and …


Predicting Adolescents’ Future Intentions To Seek Help For Mental Health Problems., Coralie J. Wilson Dec 2010

Predicting Adolescents’ Future Intentions To Seek Help For Mental Health Problems., Coralie J. Wilson

Frank Deane

This study examined whether high school students’ current symptoms of general psychological distress, self-rated social problem-solving skills, and recent help-seeking experiences predict their future intentions to seek help for a mental health problem. At Time 1, 98 high school students, aged 12-17 years, completed the study self-report survey that included measures of psychological distress, social problem-solving skill, and recent help-seeking behaviour. At Time 2, three weeks later, the same students completed measures of help-seeking intentions. Students with more severe levels of distress symptoms at Time 1 had lower intentions to seek help for a mental health problem at Time 2. …


Factors Related To Poor Practice Of Pap Smear Screening Among Secondary School Teachers In Malaysia, Tin Tin Su Dec 2010

Factors Related To Poor Practice Of Pap Smear Screening Among Secondary School Teachers In Malaysia, Tin Tin Su

Tin Tin Su

Introduction: The Pap smear test has been regarded as a promising cervical screening tool since 1940s. Yet its importance has been overlooked by beneficiaries in Malaysia. This underlines the need to identify the prevalence of Pap smear practice and influencing factors towards the practice among educated working women. Methods: A survey was conducted with 403 female teachers from 40 public secondary schools in Malaysia selected by cluster random sampling. Data were collected from January to March 2010 using a self-administered questionnaire. Multivariate logistic regression was performed to identify the factors related to the Pap smear practice. Results: The rate for …


Qualidade De Vida: Considerações Sobre Os Indicadores E Instrumentos De Medida / Quality Of Life: Consideration Of Indicators And Instruments Of Measure, Everton Fernando Alves Dec 2010

Qualidade De Vida: Considerações Sobre Os Indicadores E Instrumentos De Medida / Quality Of Life: Consideration Of Indicators And Instruments Of Measure, Everton Fernando Alves

Everton Fernando Alves

Os instrumentos de medida são desenvolvidos para as mais diversas finalidades e indicações. Sua funcionalidade depende de escalas genéricas, do estado de saúde e escalas específicas a uma determinada situação. O presente estudo teve como objetivo discorrer sobre os aspectos importantes que permeiam a utilização dos instrumentos de medida e apresentar de forma sistematizada os indicadores e instrumentos de medida de QV, utilizados e validados no Brasil. Realizou-se um estudo de revisão narrativa do conhecimento disponível na literatura, com consulta às seguintes bases de dados: DEDALUS, LILACS, MEDLINE e Scielo, tendo como base os períodos de 1995-2008. Observou-se que os …


Organized Outpatient Stroke Care, Gustavo Saposnik Dec 2010

Organized Outpatient Stroke Care, Gustavo Saposnik

Gustavo Saposnik

Background and Purpose—Organized inpatient stroke care decreases mortality and morbidity irrespective of patient age, stroke severity, or stroke subtype. Limited information is available on whether organized outpatient care models such as stroke prevention clinics (SPC) improve outcomes after a transient ischemic attack or ischemic stroke. We compared 1-year mortality and stroke readmission in patients with transient ischemic attack or ischemic stroke referred versus not referred to an SPC. Methods—This was a retrospective cohort study including 16 468 consecutive patients with ischemic stroke or transient ischemic attack who were seen in the emergency department or admitted to a hospital between July …


Penumonia: Risk Factors And Outcomes After Stroke, Gustavo Saposnik Dec 2010

Penumonia: Risk Factors And Outcomes After Stroke, Gustavo Saposnik

Gustavo Saposnik

No abstract provided.


Vitamin B In Stroke Prevention: A Journey From Observational Studies To Rct's., Gustavo Saposnik Dec 2010

Vitamin B In Stroke Prevention: A Journey From Observational Studies To Rct's., Gustavo Saposnik

Gustavo Saposnik

No abstract provided.


Care And Outcomes In Patients With Ischemic Stroke With And Without Preexisting Dementia, Gustavo Saposnik Dec 2010

Care And Outcomes In Patients With Ischemic Stroke With And Without Preexisting Dementia, Gustavo Saposnik

Gustavo Saposnik

No abstract provided.


Rural Adolescents’ Help Seeking Intentions For Emotional Problems: The Influence Of Perceived Benefits And Stoicism., Coralie J. Wilson Dec 2010

Rural Adolescents’ Help Seeking Intentions For Emotional Problems: The Influence Of Perceived Benefits And Stoicism., Coralie J. Wilson

Frank Deane

This paper is the second from a larger multi-cite study developed and led by the third author which explores factors that influence adolescents' help-seeking intentions. Specifically, this paper investigates the extent to which perceived benefits of help seeking, stoicism, gender and symptoms of psychological distress are associated with intentions to seek professional help for emotional problems. A cross sectional self-report questionnaire was administered to adolescents recruited from seven high schools in rural towns in the Riverina region of New South Wales. A total of 778 adolescents were recruited. The sample included 373 male and 404 female participants between 13 and …


The Effects Of Need For Autonomy And Preference For Seeking Help From Informal Sources On Emerging Adults’ Intentions To Access Mental Health Services For Common Mental Disorders And Suicidal Thoughts., Coralie J. Wilson Dec 2010

The Effects Of Need For Autonomy And Preference For Seeking Help From Informal Sources On Emerging Adults’ Intentions To Access Mental Health Services For Common Mental Disorders And Suicidal Thoughts., Coralie J. Wilson

Coralie J Wilson

Emerging or early adulthood is the life stage spanning 18-25 years of age. In Australia, anxiety and affective disorders (often classified as ‘common mental disorders’) are prevalent in this age group and suicide is also a concern. Professional mental health care can reduce the long-term impact of these mental health problems and protect against the development of severe forms of these disorders. However, up to three-quarters of young people with mental health needs do not seek professional help for their condition. This study aimed to examine the extent to which belief in the need for autonomy and intentions to seek …


Technological Iatrogenesis: The Manifestation Of Inadequate Organizational Planning And The Integration Of Health Information Technology., Patrick Albert Palmieri Dec 2010

Technological Iatrogenesis: The Manifestation Of Inadequate Organizational Planning And The Integration Of Health Information Technology., Patrick Albert Palmieri

Patrick Albert Palmieri

The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational–technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern. Recognizing the technology–organizational misalignments that result from HIT adoption is …