Of duty and diaspora: (Re)negotiating the intergenerational contract in South Asian Muslim families.

In recent years, there has been exponential growth in the South Asian Muslim population in the United States. This demographic trend, along with a rapidly aging North American population, implies that very soon, a significant proportion of U.S. adults 65 years and older will identify as South Asian Muslim. Moreover, more than one-half of Muslims (57%) live in a multi-person/multi-generation household where all members identify as Muslim. Despite this evidence, limited research exists on the dynamics of multigenerational living in aging South Asian Muslim households, particularly around intergenerational support exchanges and the nature and strength of affectual bonds between generations. Additionally, research suggests that espoused within internalized cultural norms around filial obligation and duty, kinwork in South Asian families remains highly gendered. Less is known, however, about the gendered nature of kinwork in immigrant South Asian Muslim families. Based on 30 in-depth narrative interviews with three generations of South Asian Muslim women living in the U.S., this paper addresses these gaps, specifically focusing on intersections of faith, culture, gender, age, immigrant status, and age at migration. The findings from this study point to a renegotiation of the intergenerational contract, wherein care and support for a parent or grandparent were understood and enacted within the framework of an overarching Muslim identity, while simultaneously, for their older relatives, it was reinterpreted within shifting local and global realities such as the increasing participation of the middle generation, the daughters and daughters-in-law, in the paid workforce. In addition to providing insights into ethnic and religious-oriented experiences of aging and care, these findings may help inform policymakers and stakeholders (e.g., community service providers and faith leaders such as imams of mosques, researchers, and family members) in culturally congruent ways to support the health and well-being of aging South Asian Muslim families.

Percutaneous coronary intervention vs. coronary artery bypass grafting in emergency and non-emergency unprotected left-main revascularization.

BACKGROUND: The optimal revascularization strategy in patients with left main coronary artery (LMCA) disease in the emergency setting is still controversial. Thus, we aimed to compare the outcomes of percutaneous coronary interventions (PCI) vs. coronary artery bypass grafting (CABG) in patients with and without emergent LMCA disease. METHODS: This retrospective cohort study included 2138 patients recruited from 14 centers between 2015 and 2019. We compared patients with emergent LMCA revascularization who underwent PCI (n = 264) to patients who underwent CABG (n = 196) and patients with non-emergent LMCA revascularization with PCI (n = 958) to those who underwent CABG (n = 720). The study outcomes were in-hospital and follow-up all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS: Emergency PCI patients were older and had a significantly higher prevalence of chronic kidney disease, lower ejection fraction, and higher EuroSCORE than CABG patients. CABG patients had significantly higher SYNTAX scores, multivessel disease, and ostial lesions. In patients presenting with arrest, PCI had significantly lower MACCE (P = 0.017) and in-hospital mortality (P = 0.016) than CABG. In non-emergent revascularization, PCI was associated with lower MACCE in patients with low (P = 0.015) and intermediate (P < 0.001) EuroSCORE. PCI was associated with lower MACCE in patients with low (P = 0.002) and intermediate (P = 0.008) SYNTAX scores. In non-emergent revascularization, PCI was associated with reduced hospital mortality in patients with intermediate (P = 0.001) and high (P = 0.002) EuroSCORE compared to CABG. PCI was associated with lower hospital mortality in patients with low (P = 0.031) and intermediate (P = 0.001) SYNTAX scores. At a median follow-up time of 20 months (IQR: 10-37), emergency PCI had lower MACCE compared to CABG [HR: 0.30 (95% CI 0.14-0.66), P < 0.003], with no significant difference in all-cause mortality between emergency PCI and CABG [HR: 1.18 (95% CI 0.23-6.08), P = 0.845]. CONCLUSIONS: PCI could be advantageous over CABG in revascularizing LMCA disease in emergencies. PCI could be preferred for revascularization of non-emergent LMCA in patients with intermediate EuroSCORE and low and intermediate SYNTAX scores.

Hope and healthy lifestyle behaviors in older adulthood.

OBJECTIVES: Hope has been associated with better health and social well-being outcomes, including emotional adjustment, positive affect, life satisfaction, reduced risk of all-cause mortality, and increased physical activity, yet how hope as a construct impacts these health benefits in older adults is not very well-understood. This study examined: (1) the relationship between hope and health behaviors in older adults; (2) how this relationship may differ across different socio-demographic groups; and (3) how hope relates to perceived future selves among older adults. METHODS: The study used cross-sectional data from 711 community-dwelling adults aged ≥55 years (280 men, 431 women). Survey measures included the Snyder Adult Dispositional Hope Scale (ADHS) and the Herth Hope Index (HHI), a health behaviors checklist, self-reported health, and a future self-scale. Data were analyzed using bivariate and multiple regressions. RESULTS: Hope was positively associated with healthy behaviors in older adults. Participants with higher levels of hope also reported more positive future selves and better health. The associations were similar across different racial/ethnic groups. CONCLUSIONS: This study fills an important gap in our understanding of hope and its association with health behaviors in community-dwelling older adults. These findings highlight a need to promote hope in older adults in order to enhance their sense of well-being.

Health Care Worker Violent Deaths in the Workplace: A Summary of Cases From the National Violent Death Reporting System.

BACKGROUND: Violent workplace deaths among health care workers (HCWs) remain understudied in the extant literature despite the potential for serious long-term implications for staff and patient safety. This descriptive study summarized the number and types of HCWs who experienced violent deaths while at work, including the location in which the fatal injury occurred. METHODS: Cases were identified from the Centers for Disease Control and Prevention's National Violent Death Reporting System between 2003 and 2016. Coded variables included type of HCW injured, type of facility, and location within the facility and perpetrator type among homicides. Frequencies were calculated using Excel. FINDINGS: Among 61 HCW deaths, 32 (52%) were suicides and 21 (34%) were homicides; eight (13%) were of undetermined intent. The occupations of victims included physicians (28%), followed by nurses (21%), administration/support operations (21%), security and support services (16%), and therapists and technicians (13%). Most deaths occurred in hospitals (46%) and nonresidential treatment services (20%). Within facility, locations included offices/clinics (20%) and wards/units (18%). Among homicide perpetrators, both Type II (perpetrator was client/patient/family member) and Type IV (personal relationship to perpetrator) were equally common (33%). CONCLUSION/ APPLICATIONS TO PRACTICE: Suicide was more common than homicide among HCW fatal injuries. Workplace violence prevention programs may want to consider both types of injuries. Although fatal HCW injuries are rare, planning for all types of violent deaths could help minimize consequences for staff, patients, and visitors.

Diabetes and Diabetes Care among Nonobese Japanese-Americans: Findings from a Population-Based Study.

OBJECTIVES: The objectives of this study are as follows: (1) to determine the prevalence of diabetes among nonobese Japanese-Americans and to determine the adjusted odds of diabetes among nonobese Japanese-Americans compared to non-Hispanic Whites (NHWs); (2) to identify the risk factors associated with having diabetes in a large sample of nonobese Japanese-Americans; and (3) to determine the prevalence and adjusted odds of diabetes management behaviors among nonobese Japanese-Americans with diabetes in comparison to NHWs with diabetes. METHODS: The combined 2007-2016 waves of the adult California Health Interview Survey (CHIS) were used to analyze a nonobese (BMI<30) sample of 2,295 Japanese-Americans and 119,651 NHWs. Chi-square and logistic regression analyses were performed using Stata. RESULTS: The findings of this representative community study of nonobese Californians indicate that the prevalence of diabetes among Japanese-American respondents was higher than their NHW counterparts (8.0% versus 4.5%). Prevalence increased markedly with age; one-quarter of nonobese Japanese Americans aged 80 and older had diabetes. CONCLUSIONS: The prevalence of diabetes among nonobese Japanese-Americans is significantly higher than that among NHWs. There is an urgent need to develop appropriate intervention and prevention approaches with lifestyle modification specifically targeted towards nonobese Japanese-Americans.