Social and Behavioral Sciences Commons^™

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 …

Pepfar’S Declining Investment In Treatment, Matthew Kavanagh, Marguerite Thorp

Matthew M. Kavanagh

Since its inception in 2003, the President’s Emergency Plan for AIDS Relief (PEPFAR) has saved millions of lives through providing anti-retroviral (ARV) treatment to people living with HIV/AIDS. However, our analysis of publicly available PEPFAR operational plans shows that funding to AIDS treatment has actually fallen significantly since 2008 in both absolute dollars and as a portion of total budgets—just at a pivotal moment when investment could change the course of the epidemic.

Suburban Poverty: Barriers To Services And Injury Prevention Among Marginalized Women Who Use Methamphetamine, Miriam W. Boeri, Benjamin Tyndall, Denise R. Woodall

Miriam W. Boeri

Objective: This paper aims to identify the needed healthcare and social services barriers for women living in suburban communities who are using or have used methamphetamine. Drug users are vulnerable to injury, violence and transmission of infectious diseases, and having access to healthcare has been shown to positively influence prevention and intervention among this population. Yet little is known regarding the social context of suburban drug users, their risks behaviors, and their access to healthcare. Methods: The data collection involved participant observation in the field, face-to-face interviews and focus groups. Audio-recorded in-depth life histories, drug use histories, and resource needs …

Community Mobility And Dementia: A Review Of The Literature, Nina M. Silverstein, Megan Vanderbur

Nina Silverstein

By the year 2030, 70 million Americans will be 65 or older. Approximately 80 percent of this population will likely be driving themselves. And without appropriate and timely interventions, many are likely to be driving with Alzheimer’s disease (AD). Current estimates suggest that 2 percent of the population 65 to 74, 19 percent of the population 75 to 84, and 47 percent of the population 85 and older are likely to suffer from Alzheimer’s disease or a related disorder. By the year 2050, the number of Americans with Alzheimer’s disease could range from 11.3 million to 16 million. This significant …

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, …

Pathological Personality Traits Among Patients With Absent, Current, And Remitted Substance Use Disorders, Christopher J. Hopwood, Leslie C. Morey, Andrew E. Skodol, Charles A. Sanislow, Carlos M. Grilo, Emily B. Ansell, Thomas H. Mcglashan, John C. Markowitz, Anthony Pinto, Shirley Yen, M. Tracie Shea, John G. Gunderson, Mary C. Zanarini, Robert L. Stout

Charles A. Sanislow, Ph.D.

Personality traits may provide underlying risk factors for and/or sequelae to substance use disorders (SUDs). In this study Schedule for Nonadaptive and Adaptive Personality (SNAP) traits were compared in a clinical sample (N=704, age 18–45) with current, past, or no historical alcohol or non-alcohol substance use disorders (AUD and NASUD) as assessed by DSM-IV semi-structured interview. Results corroborated previous research in showing associations of negative temperament and disinhibition to SUD, highlighting the importance of these traits for indicating substance use proclivity or the chronic effects of substance use. Certain traits (manipulativeness, self-harm, disinhibition, and impulsivity for AUD, and disinhibition and …

Self-Harm Subscale Of The Schedule Of Nonadaptive And Adaptive Personality (Snap): Predicting Suicide Attempts Over 8 Years Of Follow-Up, Shirley Yen, M. Tracie Shea, Zach Walsh, Maria O. Edelen, Christopher J. Hopwood, John C. Markowitz, Emily B. Ansell, Leslie C. Morey, Carlos M. Grilo, Charles A. Sanislow, Andrew E. Skodol, John G. Gunderson, Mary C. Zanarini, Thomas H. Mcglashan

Charles A. Sanislow, Ph.D.

Objective: We examined the predictive power of the self-harm subscale of the Schedule for Nonadaptive and Adaptive Personality (SNAP) to identify suicide attempters in the Collaborative Longitudinal Study of Personality Disorders (CLPS).

Method: The SNAP, a self-report personality inventory, was administered to 733 CLPS participants at baseline, of whom 701 (96%) had at least 6 months of follow-up data. Cox proportional hazards regression analyses were performed to examine the SNAP–self-harm subscale (SNAP- SH) in predicting the 129 suicide attempters over 8 years of follow-up. Possible moderators of prediction were examined, including borderline personality disorder, major depressive disorder (MDD), and substance …

Collaboration With A Public Library, Margot G. Malachowski

Margot G Malachowski, MLS, AHIP

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 …

Living With Alzheimer’S Disease: A Study Of Adult Day Health Services In Massachusetts, Nina M. Silverstein, Cathy M. Wong, Kristen E. Brueck

Nina Silverstein

The role of adult day health care (ADHC) is gaining increased attention as the nation prepares for the large cohort of baby boomers entering their later years. Many boomers are aging with physical and cognitive impairments, including Alzheimer's disease and related dementias. Projections indicate that Massachusetts, along with the nation as a whole, is experiencing an increasing rate of older persons as baby boomers enter late-life. The Commonwealth can expect that persons with Alzheimer's disease and their care partners will need community-based services that are specifically designed for adults with cognitive impairments. However, a report by the Robert Wood Johnson …

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

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). …

Chronic Disease Self-Management Programs: Relevance For Persons With Dementia, Nina M. Silverstein, Alison S. Gottlieb

Nina Silverstein

The context for this study is the work of the Healthy Brain Initiative. The CDC has established a cooperative agreement with the Alzheimer’s Association to develop and implement a multifaceted approach to look at cognitive health as a public health issue. Late in 2010, the Association commissioned a review of the major chronic disease prevention programs from a systems approach to begin to understand the source of findings that Medicare beneficiaries with Alzheimer’s and related disorders are much higher cost than those simply with a single chronic disease and no AD. This led to the conclusion that Chronic Disease Self‐Management …

With His Hands, David J. Malebranche

David J Malebranche

No abstract provided.

Public Perception Study 2011: Mental Illness, Drug And Alcohol Abuse, Oscar T. Mcknight

Oscar T McKnight Ph.D.

This study examined the public perception of mental illness, drug and alcohol abuse. Field-interviews with participants occurred "on the street" with no difficulty. Participants offered ten general recommendations to professionals developing programs for mental illness, drug or alcohol abuse. The public stressed the professional responsibilities of physicians, pharmacists, counselors and teachers to prevent drug abuse.

Review Essay: Qualitative Inquiry: Critical Perspectives On Methods And Ethics, John Mazzeo

John Mazzeo, Ph.D.

No abstract provided.

Talk, Trust And Time: A Longitudinal Study Evaluating Knowledge Translation And Exchange Processes For Research On Violence Against Women, C. Wathen, Shannon Sibbald, Susan Jack, Harriet Macmillan

Shannon L. Sibbald

BACKGROUND: Violence against women (VAW) is a major public health problem. Translation of VAW research to policy and practice is an area that remains understudied, but provides the opportunity to examine knowledge translation and exchange (KTE) processes in a complex, multi-stakeholder context. In a series of studies including two randomized trials, the McMaster University VAW Research Program studied one key research gap: evidence about the effectiveness of screening women for exposure to intimate partner violence. This project developed and evaluated KTE strategies to share research findings with policymakers, health and community service providers, and women's advocates. METHODS: A longitudinal cross-sectional …

Medicare’S Bundled Payment Pilot For Acute And Postacute Care: Analysis And Recommendations On Where To Begin, Neeraj Sood, Peter Huckfeldt, Jose Escarce, David Grabowski, Joseph Newhouse

Peter J. Huckfeldt

In the National Pilot Program on Payment Bundling, a subset of Medicare providers will receive a single payment for an episode of acute care in a hospital, followed by postacute care in a skilled nursing or rehabilitation facility, the patient’s home, or other appropriate setting. This article examines the promises and pitfalls of bundled payments and addresses two important design decisions for the pilot: which conditions to include, and how long an episode should be. Our analysis of Medicare data found that hip fracture and joint replacement are good conditions to include in the pilot because they exhibit strong potential …

The Double Threat Of Hiv/Aids And Drought On Rural Household Food Security In Southeastern Zimbabwe, John Mazzeo

John Mazzeo, Ph.D.

No abstract provided.

Introduction: Anthropologists Confront Hiv/Aids And Food Insecurity In Sub-Saharan Africa, John Mazzeo

John Mazzeo, Ph.D.

No abstract provided.

Sexual Health And Life Experiences: Voices From Behaviourally Bisexual Latino Men In The Midwestern Usa, Omar Martinez, Brian Dodge, Michael Reece, Phillip W. Schnarrs, Scott D. Rhodes, Gabriel Goncalves, Miguel Munoz-Laboy, David J. Malebranche, Barbara Van Der Pol, Ryan Nix, Guadalupe Kelle, J Dennis Fortenberry

David J Malebranche

Research on behaviourally bisexual Latino men in the USA has not yet examined sexual health issues among men living in diverse areas of the nation, including the Midwest. A community-based participatory research approach was used to engage a diverse sample of 75 behaviourally bisexual men (25 White, 25 Black and 25 Latino). Semi-structured interviews were conducted and standard qualitative analysis procedures were used to explore data from the 25 Latino participants. Men described their unique migration experiences as behaviourally bisexual men in this area of the USA, as well as related sexual risk behaviours and health concerns. Lack of culturally …

Comparing The Temporal Stability Of Self-Report And Interview Assessed Personality Disorder, Douglas B. Samuel, Christopher J. Hopwood, Emily B. Ansell, Leslie C. Morey, Charles A. Sanislow, John C. Markowitz, Shirley Yen, M. Tracie Shea, Andrew E. Skodol, Carlos M. Grilo

Charles A. Sanislow, Ph.D.

Findings from several large-scale, longitudinal studies over the last decade have challenged the long-held assumption that personality disorders (PDs) are stable and enduring. However, the findings, including those from the Collaborative Longitudinal Personality Disorders Study (CLPS; Gunderson et al., 2000), rely primarily on results from semistructured interviews. As a result, less is known about the stability of PD scores from self-report questionnaires, which differ from interviews in important ways (e.g., source of the ratings, item development, and instrument length) that might increase temporal stability. The current study directly compared the stability of the Diagnostic and Statistical Manual of Mental Disorders …

Ten-Year Course Of Borderline Personality Disorder: Psychopathology And Function From The Collaborative Longitudinal Personality Study, John G. Gunderson, Robert L. Stout, Thomas H. Mcglashan, M. Tracie Shea, Leslie C. Morey, Carlos M. Grilo, Mary C. Zanarini, Shirley Yen, John C. Markowitz, Charles A. Sanislow, Emily B. Ansell, Anthony Pinto, Andrew E. Skodol

Charles A. Sanislow, Ph.D.

Context: Borderline personality disorder (BPD) is traditionally considered chronic and intractable.

Objective: To compare the course of BPD’s psychopathology and social function with that of other personality disorders and with major depressive disorder (MDD) over 10 years. Design: A collaborative study of treatment-seeking, 18- to 45-year-old patients followed up with standardized, reliable, and repeated measures of diagnostic remission and relapse and of both global social functioning and subtypes of social functioning.

Setting: Nineteen clinical settings (hospital and outpatient) in 4 northeastern US cities.

Participants: Three study groups, including 175 patients with BPD, 312 with cluster C personality disorders, and 95 …

A Qualitative Study Examining Tensions In Interdoctor Telephone Consultations, Anupma Wadhwa, Lorelei Lingard

Lorelei Lingard

OBJECTIVE: Communication skills have gained increasing attention in medical education. Much of the existing literature and medical curricula addresses issues of doctor-patient communication. The critical importance of communication between health professionals, however, is now coming under the spotlight. The interdoctor telephone consultation is a common health care setting in which health professional communication skills are exercised. Breakdowns in this communication commonly occur and, surprisingly, this skill is not formally addressed in medical training. This study sought to clarify the communication issues that can occur during interdoctor telephone consultations in order to inform future educational initiatives in this domain. METHODS: Data …

Towards Safer Interprofessional Communication: Constructing A Model Of "Utility" From Preoperative Team Briefings, Lorelei Lingard, Sarah Whyte, Sherry Espin, G. Baker, Beverley Orser, Diane Doran

Lorelei Lingard

"Improved team communication" is broadly advocated in the discourse on safety but rarely supported by a precise understanding of the relationship between specific communication practices and concrete improvements in collaborative work processes. We sought to improve such understanding by analyzing the discourse arising from structured preoperative team briefings among surgeons, nurses, and anesthesiologists prior to general surgery procedures. Analysis of observers' fieldnotes from 302 briefings yielded a two-part model of communicative "utility", defined as the visible impact of communication on team awareness and behavior. "Informational utility" occurred when team awareness or knowledge was improved by provision of new information, explicit …

A Theory-Based Instrument To Evaluate Team Communication In The Operating Room: Balancing Measurement Authenticity And Reliability, Lorelei Lingard, Glenn Regehr, Sherry Espin, Sarah Whyte

Lorelei Lingard

BACKGROUND: Breakdown in communication among members of the healthcare team threatens the effective delivery of health services, and raises the risk of errors and adverse events. AIM: To describe the process of developing an authentic, theory-based evaluation instrument that measures communication among members of the operating room team by documenting communication failures. METHODS: 25 procedures were viewed by 3 observers observing in pairs, and records of events on each communication failure observed were independently completed by each observer. Each record included the type and outcome of the failure (both selected from a checklist of options), as well as the time …

The Rhetorical 'Turn' In Medical Education: What Have We Learned And Where Are We Going?, Lorelei Lingard

Lorelei Lingard

This paper presents a critical reflection on the contributions and challenges associated with one rhetorical approach to studying teaching and learning communication in health professions education. A rhetorical approach treats language as a social act, and attends to the role of language in establishing professional identities and relationships. The research has produced insights into the use of standard communication formats to teach novices, the nature of socialization on clinical teams, and the relationship between communication patterns and patient safety. Challenges and emerging questions include the problem of accounting for the material dimensions of communication in a rhetorical model, grappling with …

What Is A Reasonable Compromise On Health Care Reform?, Peter Dreier

Peter Dreier

No abstract provided.

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 …

The Migration Of People From The Caribbean To The Bahamas, John Mazzeo

John Mazzeo, Ph.D.

No abstract provided.