Refugee Births and the Migrant Health Effect in Syracuse NY.

OBJECTIVES: In Syracuse, NY among 5998 births in a 3-year period (2017-2019), 24% were to foreign-born women, among whom nearly 5% were refugees from the Democratic Republic of the Congo and Somalia. The impetus for the study was to identify potential risk factors and birth outcomes of refugee women, other foreign-born women, and US born women to inform care. METHODS: This study reviewed 3 years of births (2017-2019) in a secondary database of births in Syracuse, New York. Data reviewed included maternal demographics, natality, behavioral risk factors (e.g., drug use, tobacco use), employment, health insurance, and education. RESULTS: In a logistic regression model controlling for race, education, insurance status, employment status, tobacco use and illicit drug use, compared to US born mothers, refugees (OR 0.45, 95% CI 0.24-0.83) and other foreign born (OR 0.63, 95% CI 0.47-0.85) had significantly fewer low birth weight births. CONCLUSION: The results of this study supported the "healthy migrant effect," a concept that refugees have fewer low birth weight (LBW) births, premature births, and cesarean section deliveries than US born women. This study adds to the literature on refugee births and the healthy migrant effect.

Walking the Tightrope between Study Participant Autonomy and Researcher Integrity: The Case Study of a Research Participant with Alzheimer's Disease Pursuing Euthanasia in Switzerland.

This article addresses ethical issues in the conduct of ethnographic research with vulnerable study participants, such as individuals with cognitive impairment. Seven ethical issues emerged from this case study, in which a participant diagnosed with Alzheimer's disease wished to pursue euthanasia in Switzerland: (a) How to protect the participant's autonomy while ensuring his decision had not resulted from untreated depression or modifiable social factors; (b) How to interpret self-harm; (c) How to protect the research team members' "mandated reporter" status; (d) How to counteract the attractive qualities of pro-euthanasia videos depicting an easy end to personal suffering; (e) How to find a better alternative to the common practice of reporting self-harm cases to Adult Protective Services and then removing these cases from studies; (f) How to leverage a participant's trust to address these issues; and (g) Whether researchers should do anything further to help address unmet needs in similar situations.

The Precarity of Older Adults Living Alone With Cognitive Impairment.

PURPOSE OF THE STUDY: To examine the lived experience of older adults living alone with cognitive impairment to better understand their needs and concerns. Based on our previous work suggesting that older adults living alone often experience a sense of precarity, we were interested in exploring this construct in older adults living alone with a diagnosis of cognitive impairment. The notion of precarity points to the uncertainty deriving from coping with cumulative pressures while trying to preserve a sense of independence. DESIGN AND METHODS: This is a qualitative study of 12 adults aged 65 and older living alone with cognitive impairment. Six participants had a diagnosis of Alzheimer's disease; 6 had a diagnosis of mild cognitive impairment. Participants' lived experiences were elicited through 40 ethnographic interviews and participant observation in their homes. Using a qualitative content analysis approach, interview transcripts and fieldnotes were analyzed to identify codes and themes. RESULTS: Qualitative analysis of transcripts revealed three themes. Theme 1 described the distress stemming from the uncertainty of having cognitive impairment that has an unpredictable course. Theme 2 drew attention to the tendency of participants to feel responsible for managing their cognitive impairment. Theme 3 described the pressures stemming from the lack of appropriate services to support independent living for persons with cognitive impairment. IMPLICATIONS: These 3 themes all pointed to facets of precarity. Findings also suggest the dearth of programs to support older adults living alone with cognitive impairment and the need to develop novel programs and interventions.

Community Gun Violence as a Social Determinant of Elementary School Achievement.

The association of indirect exposure to firearm-related violence and standardized test scores among third grade elementary school children were analyzed using geospatial mapping of police department data for all gunshots in Syracuse, NY (n = 2, 127) and state standardized test scores from 2009-2015. Confirmed gunshots were geocoded and mapped across the city and neighborhood school catchment areas. Third grade standardized New York State test scores for English Language Arts (ELA) and math were coded as dichotomous variables of proficient and below proficient scores. State standardized test scores for ELA and math were found to be 50% lower in the elementary schools located within higher concentration gunshot areas, than in elementary schools in lower gunshot areas. Higher levels of gun violence within school catchment areas were significantly associated with higher rates of ELA and math failure (p ≤ .05). These findings suggest that community violence may be an important, though under recognized, social determinant of poor school performance.

Culturally congruent mentorship can reduce disruptive behavior among elementary school students: results from a pilot study.

BACKGROUND: Our study objective was to examine the feasibility of implementing a culturally congruent mentorship pilot program, Youth-First (YF), that targets behavior modification among elementary school-aged children with disruptive behavior and a history of school suspension. We hypothesize that it is feasible to implement the YF program to reduce disruptive behaviors and recidivism of level III/IV infractions in school settings among at-risk African American students. METHODS: We assessed program feasibility based on the success of program acceptance by parents/guardians, study enrollment, and intervention compliance by students. A pre/posttest study design was used to examine whether the YF program reduced recidivism of disruptive behavior among enrolled at-risk African American elementary school children between September 2016 and January 2017. Generalized linear mixed models examined whether student behavioral scores improved over time and varied by program mentor. A McNemar test examined the reduction in cumulative incidence of level III/IV infractions pre-post YF program intervention. RESULTS: Intervention acceptance, enrollment, and compliance were 100% (95% confidence interval [CI] 86 to 100%), 100% (95% CI 86 to 100%), and 67% (95% CI 45 to 84%), respectively (N = 24). Overall, student behavioral scores improved and plateaued over time (Time2 effect: b = - 0.01, 95% CI - 0.02, < 0.01); a two-week period was associated with a seven-point improvement (effect size: Cohen's d = 0.47, 95% CI 0.03, 0.94) in behavioral scores. Behavioral score improvements were class-specific, based on respectfulness behavior (b = 0.11, 95% CI < 0.01, 0.26). No recidivism of level III/IV infractions was reported during and post YF intervention. CONCLUSION: The integration of culturally congruent mentorship in elementary school-settings is feasible and can reduce risk of disruptive behaviors among at-risk African American students. Future studies should use randomized clinical trials to determine the effectiveness of culturally congruent mentorship interventions (void of potential selection and confounding biases) in reducing disruptive behavior, level III/IV infractions, and school suspensions among at-risk children.

Identity, Semiotics, and Use of Symbols in Adult Day Services.

Purpose: This article explores experiences of older adults attending an Adult Day Service (ADS) center. We focus on semiotics, which is ADS clients' use of symbols to communicate with others and to assert their personal and social identities. We refer to the ADS as a semiosphere-a term that refers to the dense, symbolically mediated interactions among this community. Methods: Ethnographers observed and interviewed clients, family, and staff members at the religiously affiliated ADS. They focused on the daily life worlds of those who attended and worked there. Results: We identified three elements through which clients expressed and communicated in semiotic ways, aspects of their identity: (a) music and dance, (b) individual use of a symbol-a doll and, (c) symbolic organization of space through seating patterns at activity tables. Elements were created and shared communally. Discussion: The ADS, as a cultural entity, is itself an illustration of symbolic complexity. Ideologies about aging, dementia, identity, and the ADS' role in improving elders' cognition and health are structured into the setting, forming a semiosphere. Our study revealed that elders, with staff members' help, created a cultural world at the ADS.

Generation of anisotropy in turbulent flows subjected to rapid distortion.

A computational tool for the anisotropic time-evolution of the spectral velocity correlation tensor is presented. We operate in the linear, rapid distortion limit of the mean-field-coupled equations. Each term of the equations is written in the form of an expansion to arbitrary order in the basis of irreducible representations of the SO(3) symmetry group. The computational algorithm for this calculation solves a system of coupled equations for the scalar weights of each generated anisotropic mode. The analysis demonstrates that rapid distortion rapidly but systematically generates higher-order anisotropic modes. To maintain a tractable computation, the maximum number of rotational modes to be used in a given calculation is specified a priori. The computed Reynolds stress converges to the theoretical result derived by Batchelor and Proudman [Quart. J. Mech. Appl. Math. 7, 83 (1954)QJMMAV0033-561410.1093/qjmam/7.1.83] if a sufficiently large maximum number of rotational modes is utilized; more modes are required to recover the solution at later times. The emergence and evolution of the underlying multidimensional space of functions is presented here using a 64-mode calculation. Alternative implications for modeling strategies are discussed.

Integrating the social determinants of health into two interprofessional courses: Findings from a pilot study.

Five colleges and universities in Upstate New York, United States, created the 'Route-90 Collaborative' to support faculty implementing the Institute of Medicine's (IOM) Framework for Educating Health Professionals to Address the Social Determinants of Health. The two courses described herein used a flipped classroom approach in which students from 14 different nations were responsible for facilitating individual classes. This descriptive study used an educational intervention in two interprofessional courses - reproductive health and global health - based on the IOM Framework into two courses. The evaluation used quantitative and open-ended text response data from students. Course evaluations indicated the students found the courses helped them to learn more about health issues and service delivery in various countries, expand their knowledge base on sociocultural and ecological influences on health care, and broaden their perspectives on various health topics so they will be able to provide higher quality healthcare. Although this is the first effort of our Collaborative to implement the Framework, given the student feedback, we believe implementing the Framework in various courses has the potential to enhance healthcare service delivery and reduce the negative impact of social determinants of health.

The Effects and Meanings of Receiving a Diagnosis of Mild Cognitive Impairment or Alzheimer's Disease When One Lives Alone.

BACKGROUND: One third of older adults with cognitive impairment live alone and are at high risk for poor health outcomes. Little is known about how older adults who live alone experience the process of receiving a diagnosis of mild cognitive impairment (MCI) or Alzheimer's disease (AD). OBJECTIVE: The aim of this study was to understand the effects and meanings of receiving a diagnosis of MCI or AD on the lived experience of older adults living alone. METHODS: This is a qualitative study of adults age 65 and over living alone with cognitive impairment. Participants' lived experiences were elicited through ethnographic interviews and participant observation in their homes. Using a qualitative content analysis approach, interview transcripts and fieldnotes were analyzed to identify codes and themes. RESULTS: Twenty-nine older adults and 6 members of their social circles completed 114 ethnographic interviews. Core themes included: relief, distress, ambiguous recollections, and not knowing what to do. Participants sometimes felt uplifted and relieved by the diagnostic process. Some participants did not mention having received a diagnosis or had only partial recollections about it. Participants reported that, as time passed, they did not know what to do with regard to the treatment of their condition. Sometimes they also did not know how to prepare for a likely worsening of their condition, which they would experience while living alone. CONCLUSION: Findings suggest the need for more tailored care and follow-up as soon as MCI or AD is diagnosed in persons living alone.

Filling out the forms: Health literacy among the uninsured.

This study addresses health literacy among patients at a free clinic in Syracuse, NY. Researchers conducted chart reviews of 600 patients and qualitative interviews with 22 patients and 7 providers. Most clinic patients had a high school, or higher, level education and no difficulty with reading comprehension. Nevertheless, a majority had at least some difficulty with comprehending and following through on health information. For many interviewees, the greatest difficulty was completing the required forms for entitlement programs. The findings demonstrate that low health literacy may occur even among well-educated patients and recommend that health literacy be assessed for all patients.

Spatio-temporal patterns of gun violence in Syracuse, New York 2009-2015.

Gun violence in the United States of America is a large public health problem that disproportionately affects urban areas. The epidemiology of gun violence reflects various aspects of an infectious disease including spatial and temporal clustering. We examined the spatial and temporal trends of gun violence in Syracuse, New York, a city of 145,000. We used a spatial scan statistic to reveal spatio-temporal clusters of gunshots investigated and corroborated by Syracuse City Police Department for the years 2009-2015. We also examined predictors of areas with increased gun violence using a multi-level zero-inflated Poisson regression with data from the 2010 census. Two space-time clusters of gun violence were revealed in the city. Higher rates of segregation, poverty and the summer months were all associated with increased risk of gun violence. Previous gunshots in the area were associated with a 26.8% increase in the risk of gun violence. Gun violence in Syracuse, NY is both spatially and temporally stable, with some neighborhoods of the city greatly afflicted.

Neighborhood Trauma Due to Violence: A Multilevel Analysis.

In Syracuse, New York the social determinants of trauma from neighborhood violence are rooted in historical processes, including urban renewal, the Rockefeller drug laws, and de-industrialization. These contributed to destabilizing Syracuse communities of color, resulting in disproportionate incarceration, family disruption, and economic devastation. Community violence, clustering in densely populated neighborhoods, creates unmanageable stress for the families who live in them. A map of gunshots and gun fatalities (2009 to 2014) illustrates the continuing onslaught of bullets being fired, often in close proximity to elementary schools. A community survey indicated that over half of respondents personally knew more than 10 murder victims. Half the respondents scored positive on the Civilian PTSD Checklist; there thus is a great deal of unaddressed traumatic stress in the community. This analysis, conducted to prepare for planning future interventions to reduce the community trauma and violence, is part of an ongoing university-community collaboration.

Visitors and Resident Autonomy: Spoken and Unspoken Rules in Assisted Living.

Purpose of the Study: This article explores resident autonomy in assisted living (AL) and the effects that visitors and visiting the AL have on that autonomy. We examine formal and informal policies that govern visiting in AL, stakeholders' views and enforcement of these policies, and the complex arrangements that visiting often entails in everyday life in the setting. Design and Methods: Data are drawn from a multiyear ethnographic study of autonomy in AL. Research from multiple sites included participant observation, informal and in-depth, open-ended interviews of various stakeholders, and the writing of field notes. Research team biweekly discussions and the Atlas.ti software program facilitated coding and analysis of interview transcripts and fieldnotes. Results: Our ethnographic data highlight complicated factors related to visitors and visiting in AL. We discuss two important aspects of visiting: (a) formal and informal policies at each setting; and (b) how resident autonomy is expressed or suppressed through rules about visiting in AL. Implications: Our data underscore the importance of resident autonomy and quality of care in relation to visitors and visiting, especially how this relationship is affected by inconsistent and confusing formal and informal visiting policies in AL.

Chronic Illness and Generativity in Late Life: A Case Study.

Purpose of the Study: This article presents a narrative-based case study about chronic illness and genetic uncertainty and their relationship to generativity throughout the life course. Our focus is a woman who experienced vision loss early in life and interpreted its impact on her generativity through present-day biographical rescripting. Design and Methods: The case we present was chosen from the study "Generativity and Lifestyles of Older Women," which explored life history, social relations, and forms of generativity in an ethnographic interview format with 200 older women. Results: In constructing a present-day identity, the informant used shifting and conflicted self-constructions to produce a self-image as generative. Three critical themes emerged in understanding her life course: (a) retrospective interpretations of autonomy; (b) renegotiating control in the present, and (c) generativity across the life course. Implications: This article contributes an understanding of childlessness as observed through the lenses of chronic illness, autonomy, and generativity. We conclude that a history of chronic illness, as it is co-occurring with internal debates about the meaning of key life events, may influence older adults' present-day identity. Implications for later life care needs are discussed.

Successful Aging Among African American Older Adults With Type 2 Diabetes.

OBJECTIVES: Rowe and Kahn's concept of successful aging remains an important model of well-being; additional research is needed, however, to identify how economically and socially disadvantaged older adults experience well-being, including the role of life events. The findings presented here help address this gap by examining the subjective construction of well-being among urban African American adults (age ≥ 50) with Type 2 diabetes. METHOD: As part of the National Institute on Aging-funded Subjective Experience of Diabetes among Urban Older Adults study, ethnographers interviewed African American older adults with diabetes (n = 41) using an adaptation of the McGill Illness Narrative Interview. Data were coded using an inductively derived codebook. Codes related to aging, disease prognosis, and "worldview" were thematically analyzed to identify constructions of well-being. RESULTS: Participants evaluate their well-being through comparisons to the past and to the illnesses of friends and family. Diabetes self-care motivates social engagement and care of others. At times, distrust of medical institutions means well-being also is established through nonadherence to suggested biomedical treatment. DISCUSSION: Hardship and illness in participants' lives frame their diabetes experience and notions of well-being. Providers need to be aware of the social, economic, and political lenses shaping diabetes self-management and subjective well-being.

Prenatal Depression: Screening and Referral for Women Who Are Low Income during Antenatal Care.

This study uses prenatal clinical chart reviews of 245 women who were screened for depression while receiving antenatal care services at an urban hospital-based clinic in Syracuse, New York. The results indicate that more than one half of the mothers who screened positive are not being adequately referred and followed-up on to ensure they are receiving proper treatment. Among the mothers who are not being successfully referred are women who are non-English speaking, facing multiple life stressors, and inadequately insured. Recommendations for colocating services that may ease the ongoing burdens of new motherhood are addressed.

The meaningfulness of time; Narratives of cancer among chronically ill older adults.

This study, using ethnographically-based interviews, sought to describe how chronically ill older adults experience a new cancer diagnosis and the effects of this on their interpretations of personal health, aging, and the future. Three semi-structured interviews were conducted with each of the fifteen informants. We asked questions that explored each individual's life history, chronic illness occurrence, and direct experiences with cancer. Interviews were structured to provide social and historical contexts to enhance our understanding of the informants' illness narratives. Interview transcripts were analyzed thematically to describe how individuals described the cancer experience, its meaning, and its consequences. One of the major findings of our study was the role of cancer in disrupting individual biography, an interruption that fragmented time into three distinct segments: the Recalled Past, the Existent Present, and the Imagined Future. We highlight three main themes around the experience of illness-related time: (1) disruption found in individual biographical accounts as a result of fragmented time dimensions; (2) altered projections of a continuous sense of self into the future; and (3) modified treatment decisions resulting from a perceived altered life course and the finitude of advancing age. We further introduce the concept of Anomalous Time as a permutation of time central to individual experiences of cancer. Implications for how older adults understood their cancer and individual reactions relevant to seeking care are discussed.

Generativity in Elderly Oblate Sisters of Providence.

PURPOSE OF THE STUDY: We explored how generativity and well-being merged in a group of childless older women: African and Hispanic Roman Catholic Religious Sisters, linking two minority identity characteristics. DESIGN AND METHODS: We qualitatively interviewed 8 Oblate Sisters of Providence (OSP), by providing a framework for examining the range of the women's generativity-cultural spheres in which generativity is rooted and outlets for generativity. RESULTS: Early negative experiences, such as fleeing despotism in Haiti and Cuba and racism within the Catholic Church, occurred alongside positive experiences-families who stressed education, and Caucasian Religious who taught children of color. This became a foundation for the Sister's generative commitment. IMPLICATIONS: Findings highlight that research gains from a phenomenological understanding of how religious faith promotes generative cognitions and emotions. Findings also reveal that the experiences of a subculture in society-African-American elderly women religious-add to theories and definitions of generativity.

Certified Nurse Aides and Scope of Practice: Clinical Outcomes and Patient Safety.

To understand the impact of scope of practice and allowable certified nurse aide (CNA) tasks across states, the current study compared clinical outcomes in states with a basic scope of practice versus those that allowed for an expanded scope. The current study used data from the Minimum Data Set as well as staffing data from the Centers for Medicare and Medicaid Services. Clinical outcomes included: (a) percent of residents whose need for help with daily activities has increased, (b) percent of high-risk residents with pressure ulcers, (c) percent of residents who self-report moderate to severe pain, (d) percent of residents experiencing one or more falls with major injury, and (e) CNA staffing hours. There was no difference in clinical outcomes between states with expanded or basic scopes. Many factors influence clinical outcomes among residents and additional staffing and facility characteristics should be considered in future studies.