Lifting as we climb: Experiences and recommendations from women in neural engineering.

Neural engineering is an emerging and multidisciplinary field in which engineering approaches are applied to neuroscience problems. Women are underrepresented in engineering fields, and indeed in science, technology, engineering, and mathematics (STEM) fields generally. Underrepresentation of women is particularly notable at later academic career stages, suggesting that even though women are interested in the field, barriers exist that ultimately cause them to leave. Here, we investigate many of the obstacles to women's success in the field of neural engineering and provide recommendations and materials to overcome them. We conducted a review of the literature from the past 15 years regarding the experiences of women in academic careers, as well as reports on the number of women in fields closely related to neural engineering from the National Science Foundation (NSF) and the American Society for Engineering Education (ASEE). Additionally, we interviewed six women in neural engineering who are involved in initiatives and outreach concerning the inclusion and experiences of women in engineering. Throughout the literature and interviews, we identified common themes spanning the role of identity and confidence, professional relationships, career-related hurdles, and personal and professional expectations. We explore each of these themes in detail and provide resources to support the growth of women as they climb within the field of neural engineering.

El profesional de enfermería en la promoción de salud en el segundo nivel de atención / The nursing professional in health promotion at the second level of care

La promoción de la salud se concibe como el proceso que permite el control de la salubridad, mediante acciones que desarrollan potencialidades comunitarias, habilidades, destrezas y capacidades personales, modificando las condiciones ambientales y socioeconómicas que impactan en los determinantes de salud. Se desarrolló una investigación con el objetivo de realizar una revisión bibliográfica acerca del accionar de enfermería en la promoción de la salud en el segundo nivel de atención. Los autores indagaron en 213 fuentes de bases de datos científicas: Redalyc, Elsevier, Scopus, ProQuest, PubMed y Enfermería Global, durante el período 2019- 2020. Los hallazgos permitieron concluir que las acciones de enfermería más comunes se dirigen hacia las conductas modificables como: automotivación, autoestima, alimentación saludable y actividad física. Los correspondientes planes de cuidados deben fomentar el autocuidado y la prevención de enfermedades, con una tendencia a la estandarización.

Health promotion is conceived as the process that allows the control of health through actions that develop community potentialities, abilities, skills and personal capacities, modifying the environmental and socioeconomic conditions that impact the determinants of health. This study aimed to conduct a bibliographic review about nursing actions in health promotion at the second level of care. The authors investigated 213 sources of scientific databases: Redalyc, Elsevier, Scopus, ProQuest, PubMed, and Global Nursing, during the period 2019-2020. The findings allowed to conclude that the most common nursing actions are directed towards modifiable behaviors such as: self-motivation, self-esteem, healthy eating, and physical activity. The corresponding care plans should promote self-care and disease prevention, with a trend towards standardization.

Explant Analysis of Utah Electrode Arrays Implanted in Human Cortex for Brain-Computer-Interfaces.

Brain-computer interfaces are being developed to restore movement for people living with paralysis due to injury or disease. Although the therapeutic potential is great, long-term stability of the interface is critical for widespread clinical implementation. While many factors can affect recording and stimulation performance including electrode material stability and host tissue reaction, these factors have not been investigated in human implants. In this clinical study, we sought to characterize the material integrity and biological tissue encapsulation via explant analysis in an effort to identify factors that influence electrophysiological performance. We examined a total of six Utah arrays explanted from two human participants involved in intracortical BCI studies. Two platinum (Pt) arrays were implanted for 980 days in one participant (P1) and two Pt and two iridium oxide (IrOx) arrays were implanted for 182 days in the second participant (P2). We observed that the recording quality followed a similar trend in all six arrays with an initial increase in peak-to-peak voltage during the first 30-40 days and gradual decline thereafter in P1. Using optical and two-photon microscopy we observed a higher degree of tissue encapsulation on both arrays implanted for longer durations in participant P1. We then used scanning electron microscopy and energy dispersive X-ray spectroscopy to assess material degradation. All measures of material degradation for the Pt arrays were found to be more prominent in the participant with a longer implantation time. Two IrOx arrays were subjected to brief survey stimulations, and one of these arrays showed loss of iridium from most of the stimulated sites. Recording performance appeared to be unaffected by this loss of iridium, suggesting that the adhesion of IrOx coating may have been compromised by the stimulation, but the metal layer did not detach until or after array removal. In summary, both tissue encapsulation and material degradation were more pronounced in the arrays that were implanted for a longer duration. Additionally, these arrays also had lower signal amplitude and impedance. New biomaterial strategies that minimize fibrotic encapsulation and enhance material stability should be developed to achieve high quality recording and stimulation for longer implantation periods.

A brain-computer interface that evokes tactile sensations improves robotic arm control.

Prosthetic arms controlled by a brain-computer interface can enable people with tetraplegia to perform functional movements. However, vision provides limited feedback because information about grasping objects is best relayed through tactile feedback. We supplemented vision with tactile percepts evoked using a bidirectional brain-computer interface that records neural activity from the motor cortex and generates tactile sensations through intracortical microstimulation of the somatosensory cortex. This enabled a person with tetraplegia to substantially improve performance with a robotic limb; trial times on a clinical upper-limb assessment were reduced by half, from a median time of 20.9 to 10.2 seconds. Faster times were primarily due to less time spent attempting to grasp objects, revealing that mimicking known biological control principles results in task performance that is closer to able-bodied human abilities.

Bidirectional brain-computer interfaces.

Brain-computer interfaces (BCIs) are devices that interface with the brain to enable interaction with the environment. BCIs have the potential to improve the quality of life for many individuals affected by debilitating disorders of the brain, spine, limbs, and sensory organs through direct interface with the nervous system. While much progress has been made in terms of BCI motor control, significantly less attention has been given to the restoration of tactile, or cutaneous sensations, which can be very important during grasping or manipulation of objects. BCIs will need to integrate both the motor and sensory modalities to truly restore arm and hand function. Here we describe a bidirectional BCI, a system which translates neural signals recorded from the motor cortex into signals to control a device and provides somatosensory feedback by translating external sensor information to electric stimulation patterns delivered to the cortex. In this chapter, we review the neuroscience of somatosensation, the history of sensory feedback in BCI applications, specifically for restoration of hand function and cutaneous sensations, and describe additional work that needs to be completed to make bidirectional BCI a clinical reality.

Activin receptor type 2A (ACVR2A) functions directly in osteoblasts as a negative regulator of bone mass.

Bone and skeletal muscle mass are highly correlated in mammals, suggesting the existence of common anabolic signaling networks that coordinate the development of these two anatomically adjacent tissues. The activin signaling pathway is an attractive candidate to fulfill such a role. Here, we generated mice with conditional deletion of activin receptor (ACVR) type 2A, ACVR2B, or both, in osteoblasts, to determine the contribution of activin receptor signaling in regulating bone mass. Immunohistochemistry localized ACVR2A and ACVR2B to osteoblasts and osteocytes. Primary osteoblasts expressed activin signaling components, including ACVR2A, ACVR2B, and ACVR1B (ALK4) and demonstrated increased levels of phosphorylated Smad2/3 upon exposure to activin ligands. Osteoblasts lacking ACVR2B did not show significant changes in vitro However, osteoblasts deficient in ACVR2A exhibited enhanced differentiation indicated by alkaline phosphatase activity, mineral deposition, and transcriptional expression of osterix, osteocalcin, and dentin matrix acidic phosphoprotein 1. To investigate activin signaling in osteoblasts in vivo, we analyzed the skeletal phenotypes of mice lacking these receptors in osteoblasts and osteocytes (osteocalcin-Cre). Similar to the lack of effect in vitro, ACVR2B-deficient mice demonstrated no significant change in any bone parameter. By contrast, mice lacking ACVR2A had significantly increased femoral trabecular bone volume at 6 weeks of age. Moreover, mutant mice lacking both ACVR2A and ACVR2B demonstrated sustained increases in trabecular bone volume, similar to those in ACVR2A single mutants, at 6 and 12 weeks of age. Taken together, these results indicate that activin receptor signaling, predominantly through ACVR2A, directly and negatively regulates bone mass in osteoblasts.

Fiabilidad de los resultados analíticos de muestra sanguínea desechando el doble del espacio muerto del catéter / Reliability of laboratory findings from blood samples when only the double dead space in catheter is discarded

OOBJETIVO: determinar la fiabilidad de dos métodos de extracción desangre a través de catéter arterial en los pacientes ingresados en una unidad de reanimación postquirúrgica. MATERIAL Y MÉTODO: estudio cuasi experimental realizado en el Hospital de la Princesa de Madrid, de febrero a mayo de 2010, en el que se compararon dos métodos de extracción de muestra de sangre para análisis a través de catéter arterial periférico, realizados secuencialmente: primero la intervención= 2 cc sangre desechada + 13,5 muestra a analizar, y segundo el control= inmediatamente después de la extracción previa= 15,5 cc + 13,5 muestra a analizar, en relación a los resultados de parámetros analíticos bioquímicos, hematológicos y de coagulación. RESULTADOS: la diferencia de las medias es muy pequeña en todos los parámetros estudiados; en todos los casos el "0" se encuentra incluido en los respectivos intervalos de confianza, no siendo estadísticamente significativos (p> 0,05). Las correlaciones son superiores a 0,93 en todos los parámetros estudiados en el caso de la bioquímica, superiores a0,84 en el caso de la hematimetría y superiores a 0,90 en el caso de la coagulación, obteniendo en todos los casos unos valores de p< de 0,05.CONCLUSIONES: para garantizar la calidad de los resultados de laboratorio es suficiente desechar el volumen correspondiente al doble del espacio muerto del sistema (en el presente estudio 2 cc)

PURPOSE: to assess reliability of two blood sample drawing methods though an arterial catheter in patients admitted to a postoperative resuscitation unit. MATERIAL AND METHODS: a quasi-experimental study was carried out at Hospital de la Princesa, Madrid, Spain, from February to May 2010.Two sequentially used methods for drawing blood samples for laboratory tests through a peripheral arterial catheter were compared: firstly the intervention procedure = 2 cc of blood discarded + a 13.5 sample for laboratory testing; and secondly the control procedure = immediately after previous sample drawing = 15.5 cc + a 13.5 sample for laboratory testing. Biochemistry, hematology and coagulation laboratory parameters were compared. RESULTS: differences in mean values were very low for all assessed parameters. Zero value is always included in confidence intervals; therefore, differences were not statistically significant (p > 0.05). Correlation is higher than 0.93 for all assessed biochemistry parameters, higher than 0.84 for hematology parameters, and higher than 0.90 for coagulation parameters (p < 0.05 for all comparisons).CONCLUSIONS: discarding the volume corresponding to the doubledead space in the system (2 cc in our study) is adequate to ensure quality in laboratory testing results

Opportunity costs associated with caring for older Mexican-Americans.

Long-term care use among older Mexican-Americans is poorly understood, despite the adverse effects on health and economic disadvantage in this vulnerable population. This study examines gender-based risk of long-term care use in 628 women and 391 men, age 70 and over in the 2000-2001 and 2004-2005 waves of the Hispanic Established Populations for Epidemiologic Studies of the Elderly. Logistic regression models are employed to assess the impact of the opportunity cost implications of family support (kin availability and co-residence) relative to health care needs (quality-adjusted life years (QALY) weighted scores and functional limitations) on women's risk of entry into a nursing home. A small percentage (~5%) of men and women had entered a long-term care facility. Women had lower weights for QALY weights and greater disability than men, but on average were more likely to live with or in closer proximity to an adult child. Higher disability rates (p < 0.01) increased the risk of institutionalization regardless of gender because disability increases time burdens. Families with fewer adult children faced higher time burdens per child in caring for elderly parents; particularly for elderly mothers. Demographic trends suggest that the number of adult children available to share the caregiving load may decrease long-term care use.

Local health department assurance of services and the health of California's seniors.

OBJECTIVE: To examine the extent to which local health department (LHD) assurance of select services known to promote and protect the health of older adults is associated with more favorable population health indicators among seniors. DESIGN: Data from the California Health Interview Survey (CHIS: 2003, 2005, and 2007) were linked with the 2005 wave of the National Association of County and City Health Officials profile survey and the Area Resource File to assess the association of LHD assurance and senior health indicators. Assurance was measured by an index of 5 services, either directly provided or contracted by LHDs: cancer screening, injury prevention, comprehensive primary care, home health care, and chronic disease prevention. Multilevel regression models estimated the association of LHD assurance of services and each of 6 older adult health indicators, controlling for individual, LHD, and county characteristics that included key social determinants of health, such as poverty. SETTING: Fifty-seven California counties. PARTICIPANTS: 33,154 older adults (age 65 and older). MAIN OUTCOME MEASURES: Colorectal cancer screening, mammography, healthy eating, physical activity, and multiple falls among older adults. RESULTS: Local health departments provided or contracted a median of 2 of the 5 services. In adjusted analyses, LHD assurance of services was generally unassociated with the seniors' health behaviors, screening, and falls. Greater LHD expenditures per capita were associated with significantly better mammography screening rates (adjusted odds ratio [AOR] = 1.22, P < 0.01) compared to jurisdictions in the bottom one-third of per capita LHD spending. Greater county-level poverty (a social determinant of health) was associated with greater junk food consumption (AOR = 1.14, P < 0.01) and worse fruit and vegetable consumption (AOR = 0.97, P < 0.01). Highly impoverished counties were consistently in the bottom quartile of performance across all indicators. CONCLUSIONS: The LHD's assurance of select services known to promote and protect the health of older adults does not appear to translate into higher rates of colorectal cancer screening, mammography, healthy eating, physical activity, and fewer falls among seniors. County-level poverty is most strongly associated with older adult health, underscoring a key barrier to address in local senior health improvement efforts.

To what factors do rural-dwelling hispanics attribute depressive symptoms?

This study is a retrospective chart review comparing rural-dwelling Caucasian and Hispanic outpatients' attribution of depressive symptoms. Based on the data gathered at intake, Hispanics were more likely to attribute depression to curse/spell and supernatural causes, while Caucasians were more likely to attribute symptoms to hereditary factors or job stress. Among both groups, higher CESD score was associated with problems with significant others or how they got along with others. Among Hispanics, depression severity was additionally associated with problems related to job or finances. Our findings point to a consequential role for clinical inquiry into attributed causes of depressive symptoms.

Variation in Older Americans Act caregiver service use, unmet hours of care, and independence among Hispanics, African Americans, and Whites.

Home- and community-based services (HCBS) are underused by minority seniors and their caregivers, despite greater rates of disability. We examined racial/ethnic variation among 1,749 Hispanics, African Americans, and Whites receiving Older Americans Act Title III caregiver services in 2009. In addition, we identified the volume of services used by caregivers, their unmet hours of respite care, and the relationship between service use and seniors' ability to live independently. Minority caregivers cared for seniors in urban areas who had higher rates of disability, poverty, and Medicaid coverage. Hispanics had the highest rate of unmet hours of care, while caregiver services were less likely to help African Americans remain at home. Minorities sought services through community agencies and were more educated than demographically similar national cohorts. Greater efforts to reach minority caregivers of less educated, disabled seniors in urban areas and through community agencies may reduce unmet needs and support independent living.

Psychosocial and cognitive health differences by caregiver status among older Mexican Americans.

This study identifies the risk and protective factors associated with informal caregiving by older (≥70 years) Mexican Americans and profiles caregiving arrangements. Overall, a greater number of informal caregivers (n = 92) were married and female. They also had higher physical functioning and better cognition than non-caregivers (n = 1,888) but fewer visited a physician regularly. Informal caregivers also showed an increased risk of depressive symptoms. A third of caregivers spent more than 20 h/day caregiving and the majority (84%) of care recipients were family members. In order to support the efforts of this disproportionately burdened caregiver group, increased social support and healthcare services are needed.

Disminución de la hemoglobina en pacientes postquirúrgicos y muestras sanguíneas diagnósticas / Decrease of hemoglobin in post-surgical patients and diagnostic blood testing

La anemia es un problema frecuente en los pacientes ingresados en cuidados intensivos. Su etiología es multifactorial, aumentando los requerimientos transfusionales y la morbimortalidad. Objetivo: conocer la prevalencia de anemia y transfusión de los pacientes postquirúrgicos durante los cinco primeros días de ingreso en la unidad e reanimación y si existe relación con las pérdidas sanguíneas por la obtención de muestras analíticas .Material y métodos: estudio descriptivo, observacional y retrospectivo, de los pacientes ingresados en la unidad de reanimación postquirúrgica, desde enero a diciembre de 2008, del Hospital Universitario de "La Princesa" (Madrid). Se incluyeron en el estudio los pacientes postquirúrgicos ingresados en la unidad de reanimación durante un tiempo igual o superior a cinco días. Se excluyeron del estudio a los fallecidos durante ese periodo, sometidos a cirugía cardiaca, los politraumatizados y aquéllos con una tendencia hemorrágica mayor a la habitual. Se analizaron datos relativos a la anemia, las transfusiones y las pérdidas de masa eritrocitaria y volumen sanguíneo de las extracciones de muestras para análisis. Resultados: se han revisado las historias clínicas de los 65 pacientes ingresados que cumplían los criterios de inclusión. La prevalencia de (..) (AU)

Anemia is a common problem in patients admitted to the Intensive Care Unit. It has a multifactorial etiology, with increased transfusion requirements and higher morbimortality. Objective: to ascertain the prevalence of anemia and the transfusion of post-surgical patients during the first five days of admission to the recovery room, and if there is blood loss related to the collection of blood samples for laboratory work. Material and methods: a descriptive, observational and retrospective study of patients admitted to the postoperative recovery unit, from January to december 2008, at the "The Princess" University Hospital (Madrid). Post-surgical patients admitted to the recovery room for a period of no less than five days were included in the study. Those patients who had died during the study period, those who had undergone cardiac surgery, those with multiple trauma injuries and those with a tendency higher than usual to bleed were excluded from analysis. Data relative to anemia, transfusions and loss of blood volume and red cell (..) (AU)

Geographic proximity of HRSA, VA, and DOD clinics: opportunities for interagency collaboration to improve quality.

Clinics funded by the Department of Veterans Affairs (VA), Department of Defense's Military Health System (MHS), and Department of Health and Human Services' Health Resources and Services Administration (HRSA) all play a role in serving the military, veterans, and their families. Publicly available location data on federal health care clinics was merged, analyzed, and geographically overlaid using GIS. Results showed that 20% of U.S. counties contain both HRSA and VA sites, and 5% contain HRSA and MHS facilities. Additionally, 80% of VA and 76% of MHS clinics are within 10 miles of a HRSA clinic. Specific clinic types of interest also overlay; for instance, 90% of HRSA homeless clinics are in the same county as a VA facility. This demonstrated geographic proximity of health care sites may indicate prime opportunities for collaboration between HRSA, VA, and MHS systems to improve quality of care for the military, veterans, and their families.

Immigrant status and cognitive functioning in late-life: an examination of gender variations in the healthy immigrant effect.

Although some research suggests that the healthy immigrant effect extends to cognitive functioning, it is unclear whether this general pattern varies according to gender. We use six waves of data collected from the original cohort of the Hispanic Established Populations for the Epidemiologic Study of the Elderly to estimate a series of linear growth curve models to assess variations in cognitive functioning trajectories by nativity status and age at migration to the U.S.A. among women and men. Our results show, among women and men, no differences in baseline cognitive status (intercepts) between early- (before age 20) and late-life (50 and older) immigrants and U.S.-born individuals of Mexican-origin. We also find, among women and men, that middle-life (between the ages of 20 and 49) immigrants tend to exhibit higher levels of baseline cognitive functioning than the U.S.-born. Our growth curve analyses suggest that the cognitive functioning trajectories (slopes) of women do not vary according to nativity status and age at migration. The cognitive functioning trajectories of early- and late-life immigrant men are also similar to those of U.S.-born men; however, those men who migrated in middle-life tend to exhibit slower rates of cognitive decline. A statistically significant interaction term suggests that the pattern for middle-life migration is more pronounced for men (or attenuated for women). In other words, although women and men who migrated in middle-life exhibit higher levels of baseline cognitive functioning, immigrant men tend to maintain this advantage for a longer period of time. Taken together, these patterns confirm that gender is an important conditioning factor in the association between immigrant status and cognitive functioning.

The provision of diabetes-monitoring exams to older Latinos.

OBJECTIVES: To explore factors associated with the provision of diabetes-monitoring practices among older Latinos with type 2 diabetes. METHOD: Data from 547 Latinos (≥ 55 years) were analyzed from the 2007 California Health Interview Survey. Multivariate logistic regression modeled the relationship between health status and sociodemographic factors and the receipt of semiannual HbA1c tests, annual foot exams, and annual retinal exams. RESULTS: The majority of older Latino diabetics received foot exams (87%) and retinal exams (77%), but the provision of semiannual HbA1c tests (30%) was low. Higher English-language proficiency and health insurance coverage were associated with the provision of HbA1c tests and foot exams, but not retinal exams. Insulin therapy was positively associated with semiannual HbA1c testing, but negatively associated with foot exams. DISCUSSION: There are considerable missed opportunities in the provision of diabetes monitoring for older Latinos, particularly those with limited English proficiency, less comprehensive insurance, and noninsulin therapy.

Emotional and cognitive health correlates of leisure activities in older Latino and Caucasian women.

This study examined differences in the frequency of leisure activity participation and relationships to depressive symptom burden and cognition in Latino and Caucasian women. Cross-sectional data were obtained from a demographically matched subsample of Latino and Caucasian (n = 113 each) postmenopausal women (age ≥60 years), interviewed in 2004-2006 for a multiethnic cohort study of successful aging in San Diego County. Frequencies of engagement in 16 leisure activities and associations between objective cognitive performance and depressive symptom burden by ethnicity were identified using bivariate and linear regression, adjusted for physical functioning and demographic covariates. Compared to Caucasian women, Latinas were significantly more likely to be caregivers and used computers less often. Engaging in organized social activity was associated with fewer depressive symptoms in both groups. Listening to the radio was positively correlated with lower depressive symptom burden for Latinas and better cognitive functioning in Caucasians. Cognitive functioning was better in Latinas who read and did puzzles. Housework was negatively associated with Latinas' emotional health and Caucasians' cognitive functioning. Latino and Caucasian women participate in different patterns of leisure activities. Additionally, ethnicity significantly affects the relationship between leisure activities and both emotional and cognitive health.

Disparate inclusion of older adults in clinical trials: priorities and opportunities for policy and practice change.

Older adults are vastly underrepresented in clinical trials in spite of shouldering a disproportionate burden of disease and consumption of prescription drugs and therapies, restricting treatments' generalizability, efficacy, and safety. Eliminating Disparities in Clinical Trials, a national initiative comprising a stakeholder network of researchers, community advocates, policymakers, and federal representatives, undertook a critical analysis of older adults' structural barriers to clinical trial participation. We present practice and policy change recommendations emerging from this process and their rationale, which spanned multiple themes: (1) decision making with cognitively impaired patients; (2) pharmacokinetic differences and physiological age; (3) health literacy, communication, and aging; (4) geriatric training; (5) federal monitoring and accountability; (6) clinical trial costs; and (7) cumulative effects of aging and ethnicity.

"Pesticides protect the fruit, but not the people": using community-based ethnography to understand farmworker pesticide-exposure risks.

OBJECTIVES: We used community-based ethnography and public health risk assessment to assess beliefs about pesticide exposure risks among farmworkers in the Lower Yakima Valley of Washington State. METHODS: We used unstructured and semistructured interviews, work-site observation, and detailed field notes to gather data on pesticide exposure risks from 99 farmworkers. RESULTS: Farmworkers' pesticide-relevant beliefs and attitudes could be grouped into 5 major themes: (1) dry pesticides are often perceived as a virtually harmless powder, (2) farmworkers who identify themselves as allergic to pesticides are more acutely affected by exposure, (3) the effect of pesticide exposure is more severe for those perceived as physically weak, (4) protective equipment is used selectively in response to financial pressure to work rapidly, and (5) some farmworkers delay decontamination until they find water deemed an appropriate temperature for handwashing. CONCLUSIONS: We elucidated farmworkers' pesticide-relevant beliefs regarding perceived danger and susceptibility to pesticides, the need to put safety second to financial considerations, and reasons for delaying decontamination. Researchers and policymakers should incorporate these data in study designs and legislation concerned with farmworker exposure to pesticides.

Caregiving burden, acculturation, familism, and Mexican American elders' use of home care services.

Caregiving burden has been shown to predict use of home care services among Anglo Americans. In a previous study, only one of two dimensions of caregiving burden predicted such use among Mexican American caregivers. Because acculturation and familism may affect burden, we conducted analyses to test three hypotheses: increased acculturation decreases familism; decreased familism increases burden; and increased burden increases use of home care services. Among 140 Mexican American family caregivers, acculturation was positively correlated with familism; familism was not significantly correlated with burden; objective burden was positively correlated with use of home care services, and objective and subjective burden significantly interacted in their effect on the use of home care services. Targeted interventions may be needed to increase use of home care services and preserve the well-being of Mexican American elders and caregivers.