Wages or Legitimacy? A Qualitative Analysis of Home Care Worker Perspectives in Choosing Work Settings.

Directly-Funded (DF) home care allows users to organize and purchase their own care services and is expanding globally. Little is known about the career pathways of home care workers. Our study asks, what experiences and factors do home care workers consider when choosing a work setting? And, specifically, what influences their decisions to work directly for their clients? Framed with Cranford's (2020) flexibility-security matrix for analyzing home care dynamics, we remotely interviewed 20 home care workers in two Canadian provinces. Three team members conducted axial coding and thematic analysis using Dedoose software. We identified personal and material factors at the intimate and labor market level that workers weigh when choosing whether to work for an agency or directly for a client. At the intimate level, workers value the flexibility, autonomy, and respect facilitated in care relations when working directly for a client. At the labor market level, agencies provide better job security and the benefit of supervisory support but lower wages. Additionally, as care work often serves as a stepping stone for immigration and citizenship agency positions are considered a more "legitimate" option than working directly for a client. Our study shows that workers directly employed by their clients enjoy more flexibility but lack security, whereas agency employed workers risk immediate reductions in working conditions in exchange for limited improvements in safety and supervision and, like other frontline care work, DF home care represents a key career pathway for immigrants with previous experience in health and social care settings.

Compound- and element-specific accumulation characteristics of persistent toxic substances and metals in sediments of the Yellow Sea.

This study investigated the large-scale distributions of persistent toxic substances (PTSs) and heavy metals in sediments of the Yellow Sea, collected from six transects between latitudes 32 and 37 degrees north (n = 35). Elevated concentrations of polychlorinated biphenyls (PCBs) were detected near the mainland, with a predominance of low-chlorinated congeners (di to tetra, ∼60%), indicative of atmospheric deposition. Analysis of traditional and emerging polycyclic aromatic hydrocarbons (t-PAHs and e-PAHs) revealed notable enrichment in the Central Yellow Sea Mud Zone (CYSM), attributing fossil fuel combustion as the significant source. Styrene oligomers and alkylphenols exhibited notable accumulation near the Han River Estuary in South Korea and the Yangtze River Estuary in China, respectively. The accumulation of heavy metals was predominantly observed in the CYSM, with element-specific distribution patterns. Cluster analysis revealed distinct distribution patterns for PTSs and metals, highlighting their source-dependent and grain size-dependent behaviors. In addition, the distribution and accumulation of PTSs tended to depend on their partitioning coefficients, such as the octanol-air partition coefficient (log KOA) and octanol-water partition coefficient (log KOW). This study offers valuable insights into the sources, transport, and fate of hazardous substances in the Yellow Sea, emphasizing the necessity for targeted environmental management strategies.

Care Workers' Turnover Intentions Associated With Workplace Abuse: The Role of Work-Related Stress and Job Satisfaction.

This study examines the association between workplace abuse experienced by care workers at the hands of care recipients and their turnover intentions, as well as the mediating effects of work-related stress and job satisfaction. Compared to care recipients' experiences of abuse, care workers' experiences have been relatively underexplored. Using data from the Korean National Long-Term Care Survey in 2019, the path from workplace abuse to care workers' turnover intentions was examined. Results showed significant mediating effects of work-related stress and job satisfaction in the relationship between workplace abuse and turnover intentions. Findings have policy implications for improving long-term care workers' social awareness and working conditions.

Social Statuses, Quality of Social Relationships, and Self-Esteem Among Older Adults in Canada: Resource Multiplication or Substitution?

This research examines how older adults' self-esteem is shaped by core social statuses and ongoing social relationships. Based on a national survey of Canadian older adults (N = 4010), analyses show that men have greater self-esteem than women, as do people with higher quality of social relationships and a high degree of educational attainment. Neither gender nor quality of social relationships intersect with education to shape self-esteem, but quality of social relationships is more strongly associated with self-esteem for women. Consequently, strong gender differences are observed at low levels of relationship quality, but these gender differences are negated at high levels of relationship quality. This research shows that social statuses and relationships cohere to shape self-esteem in later-life, but gender differences are not evident in the context of high-quality social relationships. Conversely, educational attainment appears to be a key determinant of high self-esteem, irrespective of gender or quality of social relationships.

Work and self-rated memory among native Hawaiian and other Pacific Islander older adults.

OBJECTIVES: Engagement in work has an important association with cognitive health in later life, yet little is known about this association among Native Hawaiian and other Pacific Islander (NHPI) older adults. This study assesses the associations between various work characteristics and memory problems among this population. DESIGN: Using data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS), the research question was explored among those who were aged 50+. RESULTS: Engagement in work, certain occupation types (e.g., clerical or professional occupations compared to blue-collar jobs), and the current/most recent job that is also the longest job held were associated with lower odds of having memory problems. CONCLUSION: The study's results suggest that work characteristics and opportunities to engage in work are important considerations in preventing memory problems in later life. As the NHPI population experiences cognitive health disparities earlier than other groups, timely interventions that focus on work engagement and a culturally relevant environment require further investigation.

Anti-Asian Hate's Impact on Asian American Social Workers: Implications for Professional Training and Education.

This article explores the impact of recent incidents of anti-Asian hate and violence against Asian American social workers, clients, and communities. Asian Americans represent a small but growing proportion of the U.S. population. Yet, Asians are underrepresented in the social work profession-approximately 3.6 percent of the social work workforce and 2.1 percent of licensed social workers are Asian, and data on underrepresented racial and ethnic groups in the workforce continue to omit details on Asian people. Recent social and political framing of the COVID-19 pandemic as attributable to Asian people has fueled racist rhetoric and incidents of hate and bias crimes against Asian people. Through exploratory research to understand the experiences of Asian American social workers in the proliferation of anti-Asian hate, authors identified that more should be done to support and meet the needs of Asian American social workers, clients, and communities by improving social work education and training, by addressing the social work workforce and agency practices, and by expanding upon advocacy and community building.

Attention-Deficit Hyperactivity Disorder among children of immigrants: immigrant generation and family poverty.

OBJECTIVES: Attention-Deficit Hyperactivity Disorder (ADHD) is one of the most common disorders diagnosed among children in the US. However, little knowledge is available about ADHD prevalence among children of immigrants, the fastest-growing population in the US. This study seeks to examine ADHD rates among children of immigrants in different generations compared to children of US-born parents and their association with family poverty. DESIGN: The sample includes 83,362 children aged 0-17 from the National Health Interview Survey (NHIS) 2010-2018 data. Multivariate logistic regression model is used to estimate prevalence of ADHD among children of immigrants compared to children of US-born parents. We then compare ADHD rates among the children sample in different immigrant generations. For all analyses, we examine ADHD occurrence separately for children in families living below the poverty threshold and those at or above the poverty threshold. RESULTS: The odds of having ADHD were significantly lower among children of immigrants compared to children of US-born parents. Both first-generation children and second-generation children of immigrants had significantly lower odds of having ADHD than children of US-born parents. Post hoc tests find that first-generation children had lower odds of having ADHD compared to second-generation children. Likewise, additional analyses showed that children of immigrants, first-generation children in particular, were less likely to have ADHD compared to children of US-born parents, in both lower- and higher-income families. CONCLUSION: Using a nationally representative sample of children, we find that the likelihood of having ADHD increases with higher generations, detecting differences in ADHD prevalence by immigration generation. Importantly, first-generation children had a significantly lower risk of having ADHD conditions compared to second-generation children and children of US-born parents, regardless of family socio-economic status. Public health policy and program development would gain from a clear comprehension of the shielding attributes of ADHD among immigrant families.

Mattering and Self-Esteem as Bulwarks Against the Consequences of Financial Strain for Loneliness in Later Life: Differentiating Between- and Within-Person Processes.

Financial strain likely constitutes a principal risk for loneliness in later-life, but a strong sense of mattering and self-esteem may mitigate these consequences by both offsetting and buffering the influence of financial strain. We test these arguments using data from a national longitudinal survey of older adults gathered between 2021 and 2022 (N = 2384), as nations emerged from the COVID-19 pandemic. Application of a within-between modelling strategy facilitates differentiation of inter-individual (i.e., between-person) and intra-individual (i.e., within-person) factors. Between-person financial strain is associated with greater loneliness, but within- and between-person mattering and self-esteem offset this association by forestalling loneliness. Between-person mattering buffers between-person financial strain, but between-person self-esteem buffers within-person financial strain. Consequently, within-person financial strain is associated with greater loneliness only at low levels of between-person self-esteem. In summary, accruing a strong sense of worth contributes to protecting older adults from the adverse consequences of financial strain for loneliness.

Use of molecular composition and compound-specific isotope analysis for source appointment of PAHs in sediments of a highly industrialized area.

This study utilized both conventional molecular analysis and compound-specific isotopic techniques to identify the sources of polycyclic aromatic hydrocarbons (PAHs) in sediments of Ulsan Bay, South Korea. The concentrations of 15 traditional and 11 emerging PAHs were determined in sediments from 21 source sites and 26 bay sites. The concentrations and compositions of traditional and emerging PAHs varied significantly, even at sites close to the source areas. The results obtained from diagnostic ratios and the positive matrix factorization model for source identification were inconsistent in adjacent source areas. The δ13C profiles of PAHs, such as phenanthrene (Phe), fluoranthene (Fl), pyrene (Py), and benz[a]anthracene (BaA) in the sediments showed distinct features depending on the surrounding sources. In urban sediments, lighter δ13CPhe values were observed (mean: -25.1‰), whereas relatively heavier values of δ13CPy were found in petroleum industry areas (mean: -23.4‰). The Bayesian isotope mixing model indicates that the predominant source of PAHs in Ulsan Bay sediments was the petroleum industry (45%), followed by the non-ferrous metals industry (30%), automobile industry (18%), and urban areas (6.3%). These results demonstrated the utility of stable isotopes in assessing the sources and contributions of PAHs in small-scale regions. However, there are still limitations in compound-specific isotope analysis of PAHs, including insufficient end-members for each source, difficulty in analysis, and the influence of non-point sources; thus, further study is needed to expand its application.

Perceptions of Increases in Cost of Living and Psychological Distress Among Older Adults.

Objectives: This article examines whether older adults' perceptions of an increase in their cost of living during a time of rapid inflation are associated with multiple aspects of psychological distress, as well as whether mastery buffers these associations. Methods: Data were derived from a two-wave longitudinal survey of older adults gathered in 2021 and 2022 (N = 4,010). Multiple regression models examined symptoms of depression, anxiety, and anger. Results: Perceptions of moderate or large increases in cost of living were associated with higher levels of distress at follow-up. Taking baseline financial strain, mastery, and psychological distress into account weakened these associations, but perceptions of a large increase in cost of living were still substantially linked with anger and anxiety. Mastery also buffered associations with anxiety and anger. Discussion: Macroeconomically derived adversities can shape anxiety and anger in later-life, but these mental health consequences fall more heavily on individuals possessing lower levels of mastery.

Denosumab-associated jaw bone necrosis in cancer patients: retrospective descriptive case series study.

BACKGROUND: Denosumab (DMB) is a bone antiresorptive agent used to treat osteoporosis or metastatic cancer of the bones. However, denosumab-associated osteonecrosis of the jaw (DRONJ) has become a common complication in cancer patients. The prevalence of osteonecrosis of the jaw (ONJ) in cancer patients is estimated to be similar for both bisphosphonate-related cases (1.1 to 1.4%) and denosumab-related cases (0.8 to 2%), with the addition of adjunctive therapy with anti-angiogenic agents reportedly increasing its prevalence to 3%. (Spec Care Dentist 36(4):231-236, 2016). The aim of this study is to report on DRONJ in cancer patients treated with DMB (Xgeva®, 120mg). CASE PRESENTATION: In this study, we identified four cases of ONJ among 74 patients receiving DMB therapy for metastatic cancer. Of the four patients, three had prostate cancer and one had breast cancer. Preceding tooth extraction within 2 months of the last DMB injection was found to be a risk factor for DRONJ. Pathological examination revealed that three patients had acute and chronic inflammation, including actinomycosis colonies. Among the four patients with DRONJ referred to us, three were successfully treated without complications and had no recurrence following surgical treatment, while one did not follow up. After healing, one patient experienced a recurrence at a different site. Sequestrectomy in conjunction with antibiotic therapy and cessation of DMB use proved to be effective in managing the condition, and the ONJ site healed after an average 5-month follow-up period. CONCLUSION: Conservative surgery, along with antibiotic therapy and discontinuation of DMB, was found to be effective in managing the condition. Additional studies are needed to investigate the contribution of steroids and anticancer drugs to jaw bone necrosis, the prevalence of multicenter cases, and whether there is any drug interaction with DMB.

Transition Into the Caregiver Role Among Older Adults: A Study of Social Participation and Social Support Based on the Canadian Longitudinal Study on Aging.

OBJECTIVES: Older adults (65 years and older) are increasingly providing care for their spouses, family members, and nonkin others (e.g., friends and neighbors). However, available knowledge of older caregivers is limited to spousal caregivers and their psychological outcomes. Other caregiver role types or social outcomes among older caregivers are less well studied. Thus, this study examines the social participation and social support among older caregivers by comparing 3 types of older caregivers, including spousal caregivers, nonspouse family caregivers, and nonkin caregivers. METHODS: Participants for this study were drawn from the Baseline and Follow-up 1 data from the Canadian Longitudinal Study on Aging. A total of 3,789 older adults became caregivers during the 2 data collection time points. Linear mixed models were applied to examine the change of social participation and social support among the three caregiver role types over the course of survey. RESULTS: The study finds that after transitioning into the caregiving role, spousal caregivers, and nonkin caregivers experienced a decline in social participation, and spousal caregivers also received less social support over time. When comparing the 3 caregiver role types, spousal caregivers reported the greatest decline in social participation and social support. DISCUSSION: This study adds to the relatively limited knowledge of older caregivers by presenting the changes in social participation and social support after transitioning into 3 types of caregiver roles. The results indicate the need to provide support for caregivers, particularly spousal and nonkin caregivers, to help them maintain social relationships and networks for participation and support.

A Profile of Positive and Negative Caregiving Experiences Among Canadian Older Adults: The Relevance of Demographic and Care Contexts.

This study examines the predictors of burdens and benefits of informal caregiving to caregivers by examining how demographic characteristics and care contexts simultaneously predict separate scales of positive and negative caregiving experiences. The Caregiving, Aging, and Financial Experiences study is a national survey which examines a representative sample of 4010 Canadians between the ages of 65 and 85, including 1641 informal caregivers that are the focus of the current analysis. Seemingly unrelated regression analyses show that there are similarities as well as differences in predictors between the two caregiving experiences. More frequent involvement in caregiving is associated with greater negative caregiving experiences but those are not significant predictors for less positive caregiving experiences. This study demonstrates that there are some overlaps of determinants of the two caregiving experiences, and a few of them are distinct. Further studies should warrant to identify additional, unobserved factors explaining variance in positive caregiving experience.

Anti-Asian Racism and COVID-19 Impact on Older Adults: The Voices of Social Workers.

Heightened anti-Asian racism and hate crimes during the COVID-19 pandemic impacted older adults and the social workers who supported them. Yet, the experiences of Asian and Asian American (AAA) social workers are unknown. This study aimed to explore the perspectives and experiences of social workers focusing on the aging population during the anti-Asian racism climate and the COVID-19 pandemic. Guided by a qualitative approach, seventeen AAA social workers participated in semi-structured interviews. Based on thematic analysis, the following themes were identified: concerns about safety and discrimination, perceived service and support needs for older adults, and perceived generational gaps in advocacy. Social work practice, policy, and research implications are discussed.

Characteristics of metal pollution and multi-isotopic signatures for C, Cu, Zn, and Pb in coastal sediments from special management areas in Korea.

The concentrations and isotopic compositions of carbon (C), copper (Cu), zinc (Zn), and lead (Pb) in coastal sediments were analyzed to identify potential pollution sources. High concentrations of total organic carbon (TOC) and metals were found close to cities and industrial areas. The isotopic compositions of C, Cu, Zn, and Pb tended to decrease as their concentrations increased. Bi-plots between δ65Cu and δ66Zn showed that the isotopic compositions in most coastal sediments, except sediments around a smelter, were similar to the isotopic compositions of road dust in urban and industrial areas of Korea. Our results suggest that heavy metal pollution in coastal sediments is greatly influenced by the pollution source, such that most metals originate from traffic and industrial activities in the urban environment. This analysis of multiple isotopes provides insights concerning the transport mechanisms and clarifies potential sources of metal contamination in coastal environments.

Inequities in access to directly-funded home care in Canada: a privilege only afforded to some.

BACKGROUND: Directly-funded home care (DF) provides government funds to people who need assistance with the activities of daily living, allowing them to arrange their own services. As programs expand globally, many allow DF clients to hire home care agencies to organize their services rather than finding their own workers. In Canada, half of the DF home care programs allow users to purchase agency services. The goal of this research is to describe the role of agency providers in DF home care in Canada and consider potential equity implications for service access from the perspectives of clients and families. METHODS: Framed with intersectionality, the study included online focus groups with families and clients (n = 56) in the two Canadian provinces of Alberta and Manitoba between June 2021-April 2022. All transcripts underwent qualitative thematic analysis using open and axial coding techniques. Each transcript was analyzed by two of three possible independent coders using Dedoose qualitative analysis software. RESULTS: The article presents five thematic findings. First, the focus groups document high rates of satisfaction with the care regardless of whether the client uses agency providers. Second, agency providers mediate some of the administrative barriers and emotional strain of using DF home care, and this is especially important for family caregivers who are working or have additional care responsibilities. Third, there are out-of-pocket expenses reported by most participants, with agency clients describing administrative fees despite lower pay for the frontline care workers. Fourth, agencies are not generally effective for linguistic and/or cultural matching between workers and families. Finally, we find that DF care programs cannot compensate for a limited informal support network. CONCLUSIONS: Clients and families often intentionally choose DF home care after negative experiences with other public service options, yet the results suggest that in some Canadian contexts, DF home care is a privilege only afforded to some. Given the growing inequalities that exist in Canadian society, all public home care options must be open to all who need it, irrespective of ability to pay, degree of social support, or competence in the English language.

Mental Health Benefits and Detriments of Caregiving Demands: A Nonlinear Association in the Canadian Longitudinal Study on Aging.

OBJECTIVES: This study examines whether the association between caregiving demands and mental health is non-linear and also, whether this non-linear association is contingent on the marital status of the caregiver. METHODS: We analyze the data from the Canadian Longitudinal Study on Aging, applying OLS regression and quadratic interaction terms. RESULTS: A lower level of demands is salubriously associated with symptoms of depression and life satisfaction, but this association becomes deleterious at higher levels of demands. Moreover, a connection to a marital partner extends the benefits of caregiving demands and stems the adverse consequences. DISCUSSION: This research shows that acts of caregiving may not themselves be detrimental. Instead, the degree and way in which caregiving relates to mental health may vary by both the extent of the demands of the caregiving role and familial relationships in which caregivers are embedded.

Preventive Care and Outcomes of Interprofessional Medicare Annual Wellness Visits for Older Adults.

As we anticipate a growing population of older adults, we will see an increase in chronic conditions such as dementia and falls. To meet these public health needs, we must systematically provide screening, education, preventive care, and supportive care for older patients and their caregivers in a primary care setting. This will require a workforce trained in providing for the complex medical and psychosocial needs of an older adult population in an interprofessional and collaborative fashion. By integrating geriatric screening tools into an interdisciplinary Annual Wellness Visit teaching clinic, we were able to successfully improve rates of geriatric screening for dementia, depression, falls, medication reconciliation and advance care planning. We also saw improvements in patient care and satisfaction and provided the opportunity for interprofessional collaboration and education for students in medicine, nursing, pharmacy and social work.