Social Isolation in Community-Dwelling Older Adults During COVID-19: Understanding the Role of Resilience.

The COVID-19 pandemic increased social isolation for many older adults, causing concern for their health and well-being. To enhance understanding of how community-dwelling older adults were impacted by prolonged social isolation during COVID-19, a qualitative descriptive study was conducted to: (1) explore the self-reported factors supporting their resilience during COVID-19 related social isolation, and (2) to help understand the intentional and unintentional outcomes of the government mandated health measures. A total of 19 community dwelling older adults were sampled. Factors that supported older adults' resilience during COVID-19 included maintaining positivity, drawing on historical experiences of resilience and finding opportunities to connect with their community. However, collective safety came with losses: such as time, freedom, opportunity, engagement, and initiative. The findings provide insight on contributing factors to resilience against social isolation in older adults and suggest the value of collective, community-based approaches to build resilience across variable contexts in this population.

Health literacy and numeracy: key factors in cancer risk comprehension.

In this age of chronic disease and shared decision making, individuals are encouraged to contribute to decisions about health care. Health literacy, including numeracy, is requisite to meaningful participation and has been accepted as a determinant of health. The purpose of this study was to describe the influence of literacy, consisting of prose and numeracy skill, math anxiety, attained education and context of information on participant ability to comprehend Internet-based colorectal cancer prevention information. Prose, numeracy, and math-anxiety data, as well as demographic details, were collected for 140 Canadian adults, aged 50 + years. Participants had adequate prose literacy (STOFHLA) scores, high STOFHLA numeracy scores, moderate levels of health-context numeracy, poorer general-context numeracy and moderate math anxiety. There was better comprehension by participants of common (9.14/11) compared with uncommon (7.64/11) colorectal cancer information (p < 0.01). Prose literacy, numeracy, math anxiety and attained education accounted for 60% of the variation in participant comprehension scores. Numeracy, ranging from basic to advanced proficiency, is required to understand online cancer risk information. Prose literacy enhances numeracy when the subject matter is less familiar. These findings highlight the importance of presenting Web-based information that accommodates diverse health literacy and numeracy levels.

Resource Utilization and Safety of Outpatient Management Following Intensive Induction or Salvage Chemotherapy for Acute Myeloid Leukemia or Myelodysplastic Syndrome: A Nonrandomized Clinical Comparative Analysis.

IMPORTANCE: Adults with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) typically remain hospitalized after induction or salvage chemotherapy until blood cell count recovery, with resulting prolonged inpatient stays being a primary driver of health care costs. Pilot studies suggest that outpatient management following chemotherapy might be safe and could reduce costs for these patients. OBJECTIVE: To compare safety, resource utilization, infections, and costs between adults discharged early following AML or MDS induction or salvage chemotherapy and inpatient controls. DESIGN: Nonrandomized, phase 2, single-center study conducted at the University of Washington Medical Center. Over a 43-month period (January 1, 2011, through July 31, 2014), 178 adults receiving intensive AML or MDS chemotherapy were enrolled. After completion of chemotherapy, 107 patients met predesignated medical and logistical criteria for early discharge, while 29 met medical criteria only and served as inpatient controls. INTERVENTIONS: Early-discharge patients were released from the hospital at the completion of chemotherapy, and supportive care was provided in the outpatient setting until blood cell count recovery (median, 21 days; range, 2-45 days). Controls received inpatient supportive care (median, 16 days; range, 3-42 days). MAIN OUTCOMES AND MEASURES: We analyzed differences in early mortality, resource utilization including intensive care unit (ICU) days, transfusions per study day, and use of intravenous (IV) antibiotics per study day), numbers of infections, and total and inpatient charges per study day among early-discharge patients vs controls. RESULTS: Four of the 107 early-discharge patients and none of the 29 control patients died within 30 days of enrollment (P=.58). Nine early-discharge patients (8%) but no controls required ICU-level care (P=.20). No differences were noted in the median daily number of transfused red blood cell units (0.27 vs 0.29; P=.55) or number of transfused platelet units (0.26 vs 0.29; P=.31). Early-discharge patients had more positive blood cultures (37 [35%] vs 4 [14%]; P=.04) but required fewer IV antibiotic days per study day (0.48 vs 0.71; P=.01). Overall, daily charges among early-discharge patients were significantly lower than for inpatients (median, $3840 vs $5852; P<.001) despite increased charges per inpatient day when readmitted (median, $7405 vs $5852; P<.001). CONCLUSIONS AND RELEVANCE: Early discharge following intensive AML or MDS chemotherapy can reduce costs and use of IV antibiotics, but attention should be paid to complications that may occur in the outpatient setting.

Functional health literacy and cancer care conversations in online forums for retired persons.

Cancer is primarily a chronic disease of older adults that must be managed and incorporated into everyday activities. Online sites are important sources of health care information and support. Health literacy is necessary for full utilisation of online resources. The objective of this study was to examine and compare cancer related conversations in online forums hosted by Canadian and American associations for retired persons. A content analysis was used to evaluate archived cancer conversations of general-health online forums representing two leading North American associations for retired persons. There were 125/1817 (6.8%) Canadians and 70/892 (7.8%) US cancer discussions among participants in 2006. Online conversations were grouped into three categories: request for information, provision of information and sharing of information. Important subthemes included cancer prevention and screening, treatment and cancer care and health system issues. There were significantly more posts about provision of cancer information from the Canadian compared with the US site (p = 0.023). American more than Canadian conversations emphasised the health system concerns as determinants of cancer care practices. Online discussion forums hosted by retirement associations may serve as an important channel in information dissemination about cancer prevention and screening, treatment and care support and health care advice for seniors.

Health literacy and online health discussions of North American Black women.

PURPOSE: Women increasingly use the Internet for healthcare information. This pilot study examined the use of online chat rooms as a potential health promotion resource for women of color. DESIGN: A directed qualitative content analysis assessed discussions (2002/2003 and 2004/2005) from two Internet chat rooms targeted to North American, English-speaking Black women. METHODS: Verbatim transcripts were assessed using Nutbeam's (2001) model of health literacy. RESULTS: Chat 1 and Chat 2 had 18 and 54 messages, respectively. Transcript readability was below grade 8 level. Discussions provided information on healthy behaviors, social support, and provocation for political action. CONCLUSIONS: The chat rooms provided health promotion information and social support at recommended readability levels and are illustrative of contemporary reorientation of health promotion services.

Chat room computer-mediated support on health issues for aboriginal women.

Within contemporary health care, increases in chronic disease have necessitated a disease management focus. Given that chronic disease is managed, more so than cured, there are increased demands for greater participation by health care consumers and they are expectated to take on increased responsibility for self-care. The emphasis on consumer responsibility has increased the significance of health-promoting behavior change in contending with contemporary health care concerns. In Canada, the reported inequity in health status between Aboriginal and non-Aboriginal Canadians further emphasizes the need for innovative health strategies. For Aboriginal women isolated by geography, changing societal norms (e.g., women working outside of the home, single parent families), and cultural distinction, online chat participation serves as a novel medium for the provision of health knowledge, support, and motivation within a virtual "neighborhood." Recognizing the significance of social support in the promotion of positive health behavior change, we investigated the theme of social support within health conversations among Aboriginal women participating in an online chat room. Content analysis was the primary methodological focus within a mixed methods approach. Of 101 health-based online conversations, the majority reflected one of three forms of social support: (1) emotional support, (2) informational support, or (3) instrumental support. The value of social support and social cohesion within health has been well documented. The current investigation suggests that "community" need not be physically constructed; virtual communities offer great potential for social cohesion around the issues of health and health care.

Ethnicity, genetics, and breast cancer: media portrayal of disease identities.

OBJECTIVE: To describe, compare, and analyze how the risk of breast cancer is framed in newspapers directed towards an ethnic minority population (Jewish) with higher risk of inherited breast cancer compared with newspaper coverage for the general population (Anglo-Canadian) without this risk. DESIGN: This investigation utilized a mixed methods (quantitative and qualitative) approach. The design emphasized a content analysis conducted on ethnically specific and non-ethnic newspaper articles. RESULTS: It is noteworthy that the 'Jewish' newspapers devote a substantially larger proportion of articles on breast cancer to genetic risk as the key risk factor for this disease. Articles in the Jewish newspapers tend to link being a Jewish woman with being at risk for a diagnosis of breast cancer. This ethnic 'identity' is reinforced through the repeated association of Jewish heritage and genetic breast cancer risk at the exclusion of other known risk factors. This isolated genetic link to breast cancer is not a message that is replicated within the provincial newsprint articles. CONCLUSIONS: These findings assist in the facilitation of prevention and treatment of those with or at risk of breast cancer. The health policy implications of this portrayal as well as suggestions for change are considered.

Portrayal of genetic risk for breast cancer in ethnic and non-ethnic newspapers.

There has been enormous attention paid to the genetics of breast cancer in this era of genomic medicine. A great deal of the interest has been generated through discourse in the public mass media. However, genetic risk is a probabilistic concept and one that requires adequate numeracy skills. The purpose of this qualitative content analysis was to describe and evaluate the portrayal of genetic risk for breast cancer in mass print media. Mass print newspapers targeting high (Ashkenazi Jews) and low (general Canadian population) genetic risk audiences and published at least monthly, available in English and accessible through public archives at the National Library of Canada, were identified and hand searched for articles on breast cancer. Approximately 47% of breast cancer articles in 6 Jewish newspapers and published between 1996-2000 identified genetics in the title, first or last paragraph compared with 17% of 145 articles in 6 provincial newspapers published in 2000. The description of breast cancer risk was equally problematic in print media targeting high and low risk audiences. Statistics were presented in complex and contradictory ways, with, for example, the confounding of individual and population based risk estimates. Inconsistent messages about the value of genetic screening for breast cancer characterized articles in both ethnic and non-ethnic newspapers. Deciphering the information into a comprehensible form is likely challenging, particularly in light of widespread numeric-literacy limitations. The publication of discrepant research findings and the perplexing statistical information consequently brought into question the credibility of the scientific process and the recommendations of health care professionals.