How does urbanization affect the cognitive function among older adults: A geospatial analysis in China.

There has been a plethora of studies on urbanization and older adults, and more recent ones on how older adults adapt to this process with their cognitive competence. Yet it has been unclear about the relationship between them, like how the level and rate of urbanization affect the cognitive function among older adults. This study sourced, formed, and analyzed a set of geospatial big datasets from different sources, such as the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data, and the NPP/VIIRS nighttime light (NTL) data. Results showed a generally negative linear association between the rate of urbanization and cognitive performance among older adults in China. The "U" shaped non-linear relationship between urbanization level and cognitive function, as well as the tipping point, were identified. At the same time, it should be noted that mediators such as education, physical activity, social activity, and community elderly service might be able to mitigate these negative associations. Furthermore, older adults living in eastern regions or urban areas appeared to have better cognitive function than those living in mid-western regions or rural areas in China. The findings also pointed to the importance of focusing on older adults with poor cognitive health status in rapidly urbanizing areas.

Aging and Caring: Exploring Older Adults' Motivation for Informal Caregiving to Other Aging Individuals in Nigeria.

Background and Objectives: Because of the global population aging, more informal carers become older adults. In Nigeria, the African country with the largest population of adults aged 60 years and older, self-construal rooted in the African collectivist philosophy generally shapes informal caregiving for older adults. However, there is a general paucity of studies on older adults' informal caregiving roles, particularly about their motivations for caregiving. This study explored older adults' motives for informal caregiving to their care recipients in urban Southeast Nigeria. Research Design and Methods: This study adopted a hermeneutic phenomenological research design. In-depth interviews were conducted with 30 purposively selected older adults aged 54-88 who were the primary carers of other older adults in the family and community. The collected data were analyzed using van Manen's thematic analysis method, using QSR NVivo 12 software. Results: A total of 4 main themes emerged from the participants' responses: reciprocity of kindness, altruism, a sense of moral responsibility, and eagerness for peaceful longevity. The findings generally showed that religion and culture were the latent factors ingrained in these motivations for informal caregiving. Discussion and Implications: Although the African philosophy emphasizes altruism, reciprocity seems more prominent in specific traditional African communities, as observed in Southeast Nigeria. It serves as a means to prioritize family members' needs. The findings indicate the need for the government to establish sustainable programs and policies that support older people in their caregiving role. Doing so will enable carers to derive psychosocial gains from informal caregiving and sustain the caregiving culture of Nigeria.

What makes Chinese adolescents "trapped" in severe mental illness? An interactionist perspective on self and identity.

The aim of this study was to explore the self and identity perspectives among Chinese adolescents with severe mental illness (SMI), with a focus on their illness experience and subjective meaning of a formal diagnosis. Thirty-one Chinese adolescents were interviewed and the interview data were analysed strictly according to principles suggested by the constructivist grounded theory approach. Five theoretical codes emerged in this study, including changes of personal values and beliefs, accumulated persistent developmental challenges and personal stresses, ineffective coping strategies and development, symptoms and development of mental illness, and changed perceptions and understandings of self. A proposed model of "The dynamic interactions of Chinese adolescents' identity and mental illness", was constructed and visualized. The results revealed that adolescents' identity formation is a fluctuating and non-linear process, but tends to be predominantly negative. The negative self, as informed by long-term ineffective coping with accumulated persistent developmental challenges and stressful events, develops towards a more serious status of negative identity and contributes to relapse symptoms, although this impact occurs variably with perceived personal characteristics. Besides, some participants who had achieved a state of "Buddha-like numbness" made a conscious decision to live a seemingly normal life while coexisting with their illness. The study also highlighted the positive aspects of identity formation that can arise from the experience of illness, including an enhanced sense of realism and increased empathy. Our findings will imply much the need for person-centred treatment plan and services that take into account of individual situations.

Dying in a foreign land: A study of completed suicides among foreign workers in Singapore.

Suicide is a public health issue that impacts a nation's resident and non-resident populations alike. Singapore has one of the largest non-resident (work permit holder) populations in the world, yet very little attention has been given to examining suicide in this population. The current study examined the case materials of all 303 non-resident completed suicides in Singapore in the period January 2011 to December 2014. Their basic profiles were compared with that of the 1,507 resident cases in the same period. A sample of 30 death notes written by non-residents were randomly selected and thematically analyzed to supplement the descriptive findings and discussion. Results showed that suicides were highest among males, those aged 21-35 years old, and South Asians. Most non-resident suicide cases did not have known physical or mental health issues, prior suicide attempts, or suicide notes. Suicide decedents from South Asia and Europe most frequently used hanging, while jumping was most common among decedents from other regions. Relationship and health problems emerged as the top two suspected triggers for suicide based on our analysis of the suicide notes. The unique situation of working abroad may increase non-residents' vulnerability in general, while adverse life events such as relationship and health issues may be too overwhelming to bear, especially when support services are not readily available and accessible. The results have implications for suicide prevention among this neglected group of people who choose to work in foreign lands.

COVID-19: Where are the Nigerian social workers?

The emergence of COVID-19 pandemic has brought untold hardship across the globe. Developed nations have taken relatively commendable actions to quell its impact on livelihood and most have also included social workers in the frontline due to their expertise in working with vulnerable populations. Same cannot be said of developing nations particularly Nigeria who hurriedly copied the measures adopted by the developed nations without carefully considering her peculiarities. Given Nigeria's high poverty rate prior to and even higher during the pandemic as well as the few available resources, it is important that Nigerian social workers should be called upon as frontline workers with regards to the welfare of the vulnerable and the psychosocial well-being of infected persons and their families. Instead, Nigeria has totally ignored the importance of social workers and palliatives have been stolen by those tasked with distribution while the psychosocial well-being of affected persons has been left to fate.

Distress Due to Urinary Problems and Psychosocial Correlates among Retired Men in Hong Kong.

Urinary problems are common among aging men, but there is a paucity of research efforts to understand the psychosocial aspects of the illness. This study aims to understand how common and distressing urinary problems are for newly retired men in Hong Kong and to test the associations between mental health, self-stigma of seeking help, fatigue, self-efficacy, self-esteem, and distress due to urinary problems. To assess this, 139 out of 200 members of a retired men's social club (mean age 63.5) were successfully interviewed. Two-fifths of the participants felt distressed due to their urinary problems and one-third of the participants had been troubled by urinary incontinence or nocturia in the past six months. Yet the majority of the participants (55%) did not seek help from any medical profession. The group who were distressed by urinary problems showed significantly poorer mental health, reported more fatigue symptoms, were less satisfied with their sexual relationships and overall self-esteem, and were less able to stop unpleasant thoughts or to get social support than the non-distressed group. Cultural perceptions of masculinity and decreased sexual vigor might have affected participants' willingness to seek help at an early stage. Targeted health education, mutual support groups, and sensitively designed services at the community level are suggested to address these physical and mental health issues.

Geographical Accessibility of Community Health Assist System General Practitioners for the Elderly Population in Singapore: A Case Study on the Elderly Living in Housing Development Board Flats.

Accessible primary healthcare is important to national healthcare in general and for older persons in particular, in societies where the population is ageing rapidly, as in Singapore. However, although much policy and research efforts have been put into this area, we hardly find any spatial perspective to assess the accessibility of these primary healthcare services. This paper analyzes the geographical accessibility of one major healthcare service in Singapore, namely, General Practitioners (GPs) services under the Community Health Assist Scheme (CHAS) for older persons. A Python script was developed to filter the website data of the Housing Development Board (HDB) of Singapore. The data derived was comprehensively analyzed by an Enhanced 2-Step Floating Catchment Area (E2SFCA) method based on a Gaussian distance-decay function and the GIS technique. This enabled the identification of areas with relatively weak geographical accessibility of CHAS-GPs. The findings are discussed along with suggestions for health practitioners, service planners and policy makers. Despite its initial nature, this study has demonstrated the value of innovative approaches in data collection and processing for the elderly-related studies, and contributed to the field of healthcare services optimization and possibly to other human services.

Spatial illustration of health-care workforce accessibility index in China: How far has our 2009 health-care reform brought us?

OBJECTIVE: The objective of the study was to evaluate the effectiveness of China's health-care reform from 2009 to 2011 by examining China's annual health-care workforce statistics of 2008 and 2011. DESIGN: The design of the study was a secondary data analysis. MAIN OUTCOME MEASURE: The main outcome measure used was the Primary Health Care Worker Accessibility Index (PHCWA). RESULTS: The statistics illustrated the impact health-care reform had on the provision of primary health care in rural areas. The results showed that the health-care reform of 2009 generally improved access to the primary health-care workforce in all 28 areas (range of increase: 13.18-324.0%). However, an increasing disparity in regional health care based on the increase of the standard deviations of PHCWA (range of increase: 36.44-77.10%) may be an issue that policy-makers and analysts will have to face. CONCLUSIONS: Concerted policy efforts from both the provincial and central governments are needed to narrow the gaps. Regional development should not only focus on the economic aspect, but also account for the fact that the adequate provision of primary health care is part of the infrastructure that makes development possible and sustainable.

Application of SCOPE-C to Measure Social Inclusion Among Mental Health Services Users in Hong Kong.

This study describes the construction of the Chinese version of the Social and Communities Opportunities Profile (SCOPE), henceforth, the SCOPE-C, to measure social inclusion among mental health services users in Hong Kong. The SCOPE-C was developed based on concept-mapping and benchmarking of census questions. The questionnaire consisted of 56 items, went through a standardized linguistic validation process and was pilot tested with qualitative feedback from five users of mental health services. Altogether 168 Chinese service users were recruited through various NGO mental health services to have three times face-to-face interview between October 2013 and July 2014. Results indicated that items related to satisfaction with opportunities and perceived opportunities in various social domains had high consistency. Nearly all the Kappa statistics and Pearson correlation coefficients between the baseline and two rounds of re-test were significant. The SCOPE-C was considered a valid instrument for Hong Kong mental health user population.

The mediating effect of affective stigma between face concern and general mental health - The case of Chinese caregivers of children with intellectual disability.

An earlier study revealed that the mental health of caregivers of children with intellectual disability is related to the affective dimension of affiliated stigma, loss of face and anxiety level. However, how cultural values such as face concern interplay with stigma remains largely unknown. This extended study goes further to test the mediating role of affective stigma on two slightly different pathway models between the face concern and the mental health outcome of 211 caregivers in two Chinese cities, against the required standards and procedure of being a mediator. The mediating effect of affective stigma is confirmed by meeting Baron and Kenny's required standards. Two viable path models are worked out: one model with anxiety as a co-mediating variable successfully accounts for 17% more of the variance on the outcome than another model without anxiety, explaining a total of 56% of the variance. This provides empirical evidence for the first time that cultural values such as face value do not influence directly one's mental health; but works through the experience of real stigma or anticipated stigma situations, to induce anxiety and worsen mental health. Practitioners may need to employ anti-stigma and anxiety reduction strategy in promoting better mental health and to explore cultural elements that can be tapped on for better coping.

The influence of weather on health-related help-seeking behavior of senior citizens in Hong Kong.

It is believed that extreme hot and cold weather has a negative impact on general health conditions. Much research focuses on mortality, but there is relatively little community health research. This study is aimed at identifying high-risk groups who are sensitive to extreme weather conditions, in particular, very hot and cold days, through an analysis of the health-related help-seeking patterns of over 60,000 Personal Emergency Link (PE-link) users in Hong Kong relative to weather conditions. In the study, 1,659,716 PE-link calls to the help center were analyzed. Results showed that females, older elderly, people who did not live alone, non-subsidized (relatively high-income) users, and those without medical histories of heart disease, hypertension, stroke, and diabetes were more sensitive to extreme weather condition. The results suggest that using official government weather forecast reports to predict health-related help-seeking behavior is feasible. An evidence-based strategic plan could be formulated by using a method similar to that used in this study to identify high-risk groups. Preventive measures could be established for protecting the target groups when extreme weather conditions are forecasted.

Rasch analysis of the SAMHSA recovery inventory for Chinese (SAMHSA-RIC).

AIMS: To generate a short version of a newly developed inventory that adopted the conceptual framework of the Substance Abuse and Mental Health Services Administration (SAMHSA) consensus statement on recovery. METHODS: Through Rasch analysis, this paper presents how this recovery inventory (SAMHSA-RIC), with its original 111 items, can be reduced to a much shorter version with only 41 items. RESULTS: Although internal consistency is slightly lowered because of item reduction, the short version maintains satisfactory and significant correlations with quality of life measures. Overall, the canonical correlation between the scale and WHOQOL-BREF was virtually the same, with only a 0.2% decrease. CONCLUSIONS: SAMHSA-RIC (short version) has strong potential to become a general tool for evaluating rehabilitative services for persons with persistent and severe mental illness. A validation study of the short version with clinical samples is warranted.

Modeling self-agency among people with schizophrenia: empirical evidence for consumer-based recovery.

BACKGROUND: Self-agency--the awareness of one's own capacity to make decisions and to engage in deliberate action - is often interfered with or lost during the course of severe mental illness. Most existing literature on self-agency is either of experimental or qualitative nature, and empirical evidence is scanty. SAMPLING AND METHODS: This paper draws on a subset of empirical data from a larger recovery study that involved 204 people with schizophrenia in the community. Structural equation models are built to contrast the models with and without the contribution of self-agency. RESULTS: The self-agency factor loads significantly on variables from five major areas of recovery (hope, empowerment, resilience, self-responsibility and self-mastery). Structural equation models show that the incorporation of this self-agency construct has vastly improved the modeling of the adverse effect of stigma on the quality of life of these subjects. The model with self-agency fitted the criteria better, and explained more total variance (increased from 56 to 80%) for the quality of life of these subjects. CONCLUSIONS: Cross-sectional empirical findings appear to support the claim that self-agency is an important construct that cuts through many dimensions of recovery. Initial discussions are made on the nature and function of self-agency, and its relations with recovery concepts and components.

Predictors of dating violence among Chinese adolescents: the role of gender-role beliefs and justification of violence.

In Chinese societies, violence among adolescent dating partners remains a largely ignored and invisible phenomenon. The goal of this study is to examine the relationships among gender-role beliefs, attitudes justifying dating violence, and the experiences of dating-violence perpetration and victimization among Chinese adolescents. This study has used self-reporting measures to collect data from a probability sample of 976 adolescents (mean age = 15.9) in three Chinese societies: Taiwan, Hong Kong, and Shanghai. Research results reveal a high prevalence of dating violence (including physical violence, sexual violence, and controlling behavior) among Chinese adolescents with dating experience: the perpetration rate is 27.3% and the victimization rate is 39%. Study results demonstrate that adolescents who endorse traditional gender-role beliefs tend to view dating violence as acceptable behavior. Boys' endorsement of traditional gender roles, boys' attitudes justifying boy-on-girl violence, and boys' attitudes against girl-on-boy violence predict boys' actual sexual-violence behavior. Moreover, boys' attitudes justifying boy-on-girl dating violence is the strongest predictor of boys' perpetration of physical and sexual dating violence. This study also shows that boys' hostility is a significant predictor of boys' controlling behavior. Programs for preventing dating violence should include components designed to challenge traditional gender-role beliefs and attitudes justifying dating violence.

Personal tragedy or system failure: a qualitative analysis of narratives of caregivers of people with severe mental illness in Hong Kong and Taiwan.

BACKGROUND: Most studies agree that mental illness brings a heavy objective and subjective burden of care on the family and especially the caregivers. However, very little attention has been paid to the wider context in which this burden is shaped and sustained. MATERIAL: In-depth interviews were conducted with 11 caregivers in Hong Kong and Taiwan and subsequent analysis identified four major themes: mystical knowledge beyond understanding, persistent self-blame and lay explanation, inertia of caregivers and non-responsive service system, and unsatisfying encounters with medical staff. DISCUSSION: The results of the study indicate that these families did not get the services they needed. In spite of recounting many system failures, most respondents attributed their situation to tragedy and misfortune at personal and family levels. Such a discourse is closely connected to a wider context of health and social care. The Hong Kong subjects complained more, felt more helpless, and had more persistent self-blame and lay explanation than the Taiwanese subjects. CONCLUSIONS: To reduce such experiences, this paper calls for inclusive policies for the family, new education strategies and reflections on the roles of mental health professionals in empowerment and advocacy beyond conventional treatment, counseling and education.