Community centers for older adults and psychosocial factors: Evidence from the German Ageing Survey.

INTRODUCTION: There is a dearth of studies examining the association between the use of community centers for older adults and psychosocial factors. Thus, our aim was to examine the association between the use of community centers for older adults and psychosocial factors (in terms of loneliness, perceived social isolation, and life satisfaction; also stratified by sex)-which is important for successful aging. METHODS/DESIGN: Data were taken from a nationally representative sample-the German Ageing Survey-including older community-dwelling individuals. The De Jong Gierveld tool was used to measure loneliness, the Bude and Lantermann tool was used to measure perceived social isolation, and the Satisfaction with Life Scale was used to quantify life satisfaction. Multiple linear regressions were used to evaluate the hypothesized associations. RESULTS: In the analytical sample, n equaled 3246 individuals (mean age was 75 years, 65-97 years). After adjusting for various socioeconomic, lifestyle-related, and health-related covariates, multiple linear regressions showed that the use of community centers was associated with higher life satisfaction among men (ß = 0.12, p < 0.01), but not women. The use of community centers was not associated with loneliness or perceived social isolation for either gender. CONCLUSIONS: The use of community centers was positively associated with satisfaction with one's own life among male older adults. Thus, encouraging older men to use such services may be beneficial. This quantitative study provides an initial basis for further research in this neglected area. For example, longitudinal studies are required to confirm our present findings.

National sociodemographic disparities in the treatment of high-risk prostate cancer: Do academic cancer centers perform better than community cancer centers?

BACKGROUND: Most major cancer organizations seek to reduce sociodemographic disparities in high-risk cancers partly by increasing access to theoretically high-quality, academic-oriented cancer care. The objective of this study was to determine whether academic centers have less sociodemographic treatment disparities than community centers using high-risk prostate cancer as a test case. METHODS: The National Cancer Data Base was used to identify 138,019 patients who were diagnosed with nonmetastatic, high-risk prostate cancer from 2004 to 2012. Multivariable logistic analysis was used to identify independent determinants of definitive therapy. The Gray test and multivariable Cox regression were used to analyze the timing of therapy. All analyses were stratified by academic versus community cancer center. RESULTS: Compared with white or privately insured patients, black, Hispanic, and uninsured patients with prostate cancer were less likely to receive definitive therapy at both community centers (adjusted odds ratio: 0.60 [95% confidence interval (CI), 0.56-0.64], 0.69 [95% CI, 0.61-0.78], and 0.25 [95% CI, 0.22-0.30], respectively) and academic cancer centers (adjusted odds ratio: 0.50 [95% CI, 0.46-0.54], 0.56 [95% CI, 0.50-0.64], and 0.31 [95% CI, 0.28-0.36], respectively). Among patients who received definitive therapy, black, Hispanic, and uninsured patients were more likely to experience treatment delays at both community centers (≥15, ≥ 10, and ≥19 days, respectively; all Gray P < .001) and academic centers (≥19, ≥ 11, and ≥18 days, respectively); treatment delays were observed among the aforementioned groups even after multivariable Cox regression analysis (P < .001 for all adjusted hazard ratios). CONCLUSIONS: Nationally, academic cancer centers demonstrate similarly high rates of sociodemographic disparities in cancer treatment patterns as community cancer centers. Making community centers conform to academic center standards may not necessarily reduce treatment disparities. Cancer 2016;122:3371-3377. © 2016 American Cancer Society.

Examining sexual minority engagement in recovery community centers.

INTRODUCTION: Research indicates that sexual minority (SM) individuals with alcohol and other drug use disorders may underutilize recovery resources generally but be more likely to use recovery community centers (RCCs). To inform recovery supports, this study characterized SM and heterosexual RCC members by demographics and clinical and recovery support service utilization. METHODS: Cross-sectional secondary analyses compared SM and heterosexual RCC members in the northeastern U.S. (n = 337). Qualitative analyses coded the top three recovery facilitators. RESULTS: Of the 337 participants (Meanage[SD] = 40.98[12.38], 51.8 % female), SM RCC members were more likely than heterosexuals to endorse lifetime psychiatric diagnoses and emergency department mental health treatment (p < .01). RCC service utilization and qualitatively derived recovery facilitators were mostly consistent across groups. CONCLUSIONS: RCCs engaged SM individuals in recovery in ways consistent with heterosexuals. Despite otherwise vastly similar demographic characteristics across sexual identity, findings suggest a need for additional mental health resources for SM individuals in recovery.

Elucidating survival and functional outcomes in patients with primary head and neck malignancies treated in academic versus community settings.

BACKGROUND: Differences in treatment outcomes between community or academic centers are incompletely understood. METHODS: Retrospective review of head and neck cancer patients between 2010 and 2020 in a rural health region. Kaplan-Meier curves and log-rank tests were used to evaluate survival outcomes, along with bivariate and multivariable Cox proportional hazards models. Linear regression was used for functional outcomes of tracheotomy and gastrostomy tube dependence. RESULTS: Two hundred and forty-eight patients treated at an academic center were compared with 94 patients treated in community centers. In multivariable analysis, the risk of death (HR = 0.60, p = 0.019), and risk of recurrence were lower (HR = 0.29, p < 0.001) for patients treated in academic centers. Patients treated in community centers had longer gastrostomy tube dependence (p = 0.002). CONCLUSION: Our findings suggest that treatment at an academic center was associated with a lower risk of recurrence and shorter gastrostomy tube dependence compared to treatment in the community.

Quality of participants' relationships to peer recovery support specialists as a function of perceived similarities: An exploratory analysis.

Background: A growing evidence base supports the value of peer recovery support specialists (PRSS), particularly due to shared lived experience with participants (recipients of PRSS services). However, little research has examined whether congruence on certain aspects of "peerness" (e.g., demographics, experiences) matters for PRSS-participant relationships. Methods: Through a pilot study under the NIDA-funded Initiative for Justice and Emerging Adult Populations (JEAP), adults who had recently received PRSS services (N=100) were interviewed. Participants completed a modified version of the Scales for Participant Alliance with Recovery Coach (SPARC), a measure of PRSS-participant relationship quality, and rated themselves as different/similar to their PRSS in several domains using a six-point scale. Results: Participants had met with their PRSS for a median of 10 sessions over two months. SPARC scores were unrelated to participant demographics or lived experiences. However, better-quality relationships were reported by participants who believed their PRSS was similar to them in relationships with family (p=.004), spirituality/religion (p=.001), age (p<.001), and overall recovery pathway (p<.001). Total SPARC scores were not significantly correlated with perceived PRSS-participant similarities on gender, race/ethnicity, substances of choice, and history of incarceration or substance use treatment. Discussion: Results from this pilot study suggest that PRSS-participant alignment on past experiences (e.g., prior incarceration, choice of drugs) may not be needed to establish good-quality working relationships. However, similarities on factors related to current life stage (e.g., age, family relationships) and/or recovery process (e.g., overall pathway, spirituality) may be more important. Future research should employ mixed-methods approaches to elucidate these unique findings.

Acute lymphoblastic leukemia (ALL) in adults: disparities in treatment intervention based on access to treatment facility.

Adult acute lymphoblastic leukemia (ALL) is associated with poor outcomes. We evaluated differences by facility type in the parameters of 6766 adult ALL patients ≥ 40 years of age diagnosed from 2004 to 2015 in the National Cancer DataBase (NCDB) and survival outcomes using two-sample t-tests or chi-square tests and Cox proportional hazards models. Those treated in academic facilities were younger (mean 58.5 versus 61.7 years, p < 0.001), Black (8.1% versus 5.6%, p < 0.001), had private insurance (50.9% versus 44.0%, p < 0.001), and more likely to receive chemotherapy (93.2% versus 81.4%, p < 0.001), any radiotherapy (14.9% versus 7.3%, p < 0.001), stem cell transplant (9.4% versus 2.5%, p < 0.001), or total body irradiation (TBI) (11.3% versus 4.3%, p < 0.001). Patients treated at an academic facility had a higher hazard of death (p<.05) while those that received any chemotherapy or TBI or CNS radiation had a lower risk of death (all p < 0.05). These parameters should be evaluated in future studies.

HPV vaccination initiation among white, black and Middle East North African (MENA) males.

Objectives: US males initiate HPV vaccination at older ages than females and currently have low population coverage. We aim to describe the prevalence and predictors of HPV vaccination initiation among males of White, Black, and Middle-Eastern/North-African (MENA) descent in southeast Michigan. Methods: We conducted three community-based surveys in 2019 that provided primary data via self report. Using population weights and multivariate modeling, we measured the prevalence and predictors of HPV vaccine initiation in each race/ethnicity of men (age 18-34 years) analyzed. Results: The vaccine initiation rates were 44.5 % (95 % CI: 44.4, 44.6) for White men, 46.2 % (46.0, 46.4) for Black men, and 23.2 % (22.8, 23.6) for MENA men, (p < 0.001). Being a student, compared to unemployed or disabled, was significantly associated with HPV vaccine initiation across all three races/ethnicities. Married men of any race/ethnicity were unlikely to be vaccinated. MENA men born in the US and having some college education were also more likely to initiate HPV vaccination. Conclusions: White, Black, and MENA men are not vaccinated in accord with Healthy (Healthy People 2030, 2022) goals. Each race/ethnicity has different predictors of vaccination.

Neighborhood Environmental Factors and Physical Activity Status among Rural Older Adults in Japan.

(1) Background: Although several neighborhood environmental factors have been identified to be associated with older adults' physical activity, little research has been done in rural areas where the population is aging. This study aimed to investigate neighborhood environmental factors and the longitudinal change of physical activity status among rural older adults in Japan. (2) Methods: The study included 2211 older adults, aged over 60 years, residing in three municipalities in Shimane prefecture and participating at least twice in annual health checkups between 2010 and 2019. Physical activity was identified based on self-report. Hilliness, bus stop density, intersection density, residential density, and distance to a community center were calculated for each subject. Hazard ratios for the incidence of physical inactivity were estimated using Cox proportional hazards models. (3) Results: We found that 994 (45%) of the study subjects became physically inactive during the follow-up. Those living far from a community center had a lower risk of becoming physically inactive compared to those living close to a community center. When the analysis was stratified by residential municipality, this association remained in Ohnan town. Those living in hilly areas had a higher risk of becoming physically inactive in Okinoshima town. (4) Conclusions: The impact of neighborhood environmental factors on older adults' physical activity status might differ by region possibly due to different terrain and local lifestyles.

Survival trends among non-small-cell lung cancer patients over a decade: impact of initial therapy at academic centers.

BACKGROUND: Treatment of non-small-cell lung cancer (NSCLC) has been rapidly advancing over the last decade. Academic centers are considered equipped with better expertise. NSCLC outcome trends in novel therapeutic era and impact of initial treatment at academic centers have not been reported. METHODS: The National Cancer Database (NCDB) was used to identify NSCLC incident cases from 2004 to 2013. Overall survival (OS) was plotted by year of diagnosis and type of initial treatment center, accounting for several factors available in NCDB. RESULTS: A total of 1 150 722 NSCLC patients were included and separated by initial treatment center type (academic: 31.5%; nonacademic: 68.5%). Median follow-up and OS for all patients were 11.8 months (range: 0-133.6 months) and 13.1 months (95% CI: 13.08-13.17), respectively. Median OS improved significantly for those diagnosed in 2010-2013 (14.8 months [95% CI: 14.7-14.9]) as compared to 2004-2009 (12.4 months [95% CI: 12.3-12.5]) (P < 0.001). Treatment at academic centers was associated with improved OS (multivariate HR for OS = 0.929 [95% CI: 0.92-0.94], P < 0.0010). Four-year OS for academic and nonacademic cohorts was 28.5%% and 22.1%, respectively (P < 0.001), and the difference was more pronounced in stage I to III NSCLC. CONCLUSION: In this largest analysis, thus far, NSCLC survival has improved over time, and type of initial treatment center significantly influences survival. Identifying and removing barriers to obtaining initial treatment of NSCLC at academic medical centers could improve OS.

Implementation of a tobacco-free workplace program at a local mental health authority.

Tobacco-free workplace policies that incorporate evidence-based practices can increase the reach and effectiveness of tobacco dependence treatment among underserved populations but may be underutilized due to limited knowledge about implementation processes. This paper describes the implementation of a comprehensive tobacco-free workplace program at a behavioral healthcare community center in Texas. The center participated in a tobacco-free workplace program implementation project that provided guidance and resources and allowed center autonomy in implementation. Six employee-based subcommittees guided implementation of program components including consumer and staff surveys, policy development, signage, tobacco use assessments, communication, and nicotine replacement distribution. Timeline development, successes, challenges, lessons learned, and sustainability initiatives are delineated. Concerns about the tobacco-free workplace policy from the center's staff and consumers were gradually replaced by strong support for the initiative. Program success was enabled by consistent support from the center's leadership, publicity of program efforts, and educational campaigns. The center surpassed the program expectations when it adopted a tobacco-free hiring policy, which was not an initial program goal. This center's path to a tobacco-free workplace provides an implementation and sustainability model for other behavioral health community centers and other organizations to become tobacco free.

Investigando a Experirncia de usußrios em um Centro de Convivrncia sob a perspectiva da psicologia humanista e da fenomenologia / Investigating the Experience of users in a Coexistence Community Center from the perspective of humanistic psychology and phenomenology / Investigando la Experiencia de usuarios en un Centro de Convivencia desde la perspectiva de la psicologÝa humanista y la fenomenologÝa

Este artigo apresenta os resultados de uma pesquisa qualitativa de natureza fenomenol?gica que objetivou compreender a experirncia de pessoas que frequentam um Centro de Convivrncia (CECO). Foram realizados encontros dial?gicos individuais com sete usußrios adultos, de ambos os sexos. Ap?s cada encontro, o pesquisador redigiu uma Narrativa Compreensiva, a partir de suas pr?prias impress§es, sobre a experirncia do (a) participante. Uma Narrativa SÝntese foi construÝda, em seguida, contendo os elementos significativos da experirncia de todos os participantes em relašNo Ós vivrncias no CECO. Os elementos fenomenologicamente desvelados, que constituÝram os resultados da pesquisa, podem ser assim expressos: (1) as relaš§es interpessoais, mediadas pelos profissionais no contexto do CECO, sNo orientadas por respeito, compreensNo e interesse m?tuo; (2) a partir da convivrncia cotidiana com outras pessoas e da participašNo em atividades coletivas, os usußrios podem desenvolver criativamente suas habilidades e interesses; e (3) ao se sentirem acolhidos e respeitados como pessoas, os usußrios tambÚm desenvolvem uma relašNo afetiva positiva com o servišo. Concluindo, o CECO Ú um espašo propÝcio ao desenvolvimento de potencialidades individuais e coletivas e Ó valorizašNo de relaš§es sociais construtivas que facilitam e preservam a tendrncia inerente das pessoas para o crescimento, a autonomia e o amadurecimento psicol?gico.

This paper presents the results of a qualitative research of phenomenological nature that aimed to understand the experience of people who attend a Coexistence Community Center (CECO). Individual dialogical encounters were held with seven adult users of both sexes. After each meeting, the researcher wrote a Comprehensive Narrative, based on his own impressions, about the participant's experience. A Narrative Synthesis was then constructed containing the significant elements of the experience of all participants in relation to the experiences in the CECO. The phenomenologically revealed elements, that constituted the results of the research, can be expressed as follows: (1) interpersonal relations, mediated by professionals in the context of the CECO, are guided by respect, understanding and mutual interest; (2) from the daily coexistence with other people and from participation in collective activities, users can creatively develop their skills and interests; and (3) when they feel welcomed and respected as people, users also develop a positive affective relationship with the service. In conclusion, CECO is a space conducive to the development of individual and collective potentialities and to the valorization of constructive social relations that facilitate and preserve the inherent tendency of people for growth, autonomy and psychological maturation.

Este artÝculo presenta los resultados de una investigaci?n cualitativa de naturaleza fenomenol?gica que objetiv? comprender la experiencia de personas que frecuentan un Centro de Convivrncia (CECO). Se realizaron encuentros dial?gicos individuales com siete usußrios adultos de ambos sexos. DespuÚs de cada encuentro, el investigador redact? una Narrativa Comprensiva, a partir de sus propias impresiones, sobre la experiencia del participante. A continuaci?n, una Narrativa SÝntesis fue construÝda conteniendo los elementos significativos de la experiencia de todos los participantes en relaci?n a las vivencias en el CECO. Los elementos fenomenol?gicamente desvelados, que constituyeron los resultados de la investigaci?n, pueden ser asÝ expresados: (1) las relaciones interpersonales mediadas por los profesionales en el contexto del CECO se orientan por respeto, comprensi?n y interÚs mutuo; (2) a partir de la convivencia cotidiana con otras personas y de la participaci?n en actividades colectivas, los usuarios pueden desarrollar creativamente sus habilidades e intereses; y (3) al sentirse acogidos y respetados como personas, los usuarios tambiÚn desarrollan una relaci?n afectiva positiva con el servicio. Concluyendo, el CECO es un espacio propicio para el desarrollo de potencialidades individuales y colectivas y la valorizaci?n de relaciones sociales constructivas que facilitan y preservan la tendencia inherente de las personas hacia el crecimiento, la autonomÝa y la maduraci?n psicol?gica.

Avaliação da qualidade de vida: comparação entre idosos não institucionalizados participantes de um centro de convivência e idosos institucionalizados em Ji-Paraná/RO / Evaluation of quality of life: a comparison between non- institutionalized elderly participatingin a community center and institutionalizd elderly in Ji-Paraná/RO

Os idosos no Brasil representam uma população significativa em números, com tendência a aumentar nas próximas décadas. Com isso, surge a preocupação com a qualidade de vida desta população. Assim, o presente trabalho objetivou avaliar a qualidade de vida de idosos não institucionalizados, participantes de um centro de convivência e de idosos institucionalizados, comparando os resultados entre os dois grupos. Para a coleta de dados foram utilizados dois instrumentos de avaliação da qualidade de vida da Organização Mundial da Saúde, o WHOQOL-OLD e o WHOQOL-bref. Estes foram aplicados a 100 idosos, composto por 37 homens e 63 mulheres de um centro de convivência e a 36 idosos, composto de 25 homens e 11 mulheres, residentes em uma instituição de longa permanência, sendo os dois grupos de Ji-Paraná, Rondônia. Utilizou-se o software SPSS for Windows versão 20.0 para análise dos dados e as variáveis do estudo receberam tratamento estatístico descritivo. Também, foram realizados testes de inferência estatística para verifi car possíveis associações entre as variáveis. Para as análises inferenciais foi utilizado o nível de significância α = 1%. Os resultados demonstraram relevância significativa na comparação entre os grupos. Os idosos institucionalizados apresentaram grau de satisfação inferior, comparados aos idosos não institucionalizados, nos quatro domínios (físico, psicológico, relações sociais e meio ambiente) do WHOQOL- -bref, e nos seis domínios (função sensorial, autonomia, atividades passadas, presentes e futuras, participação social, morte e morrer e intimidade) do WHOQOL-OLD. Por isso, é necessária a atenção urgente aos idosos institucionalizados, é preciso buscar formas de inseri-los no convívio social e sempre que possível, criar condições para que os mesmos possam manter vínculos com seus familiares.

The elderly are a significant part of the population of Brazil, and the number of old age people tends to increase in the coming decades. With this comes an increasing concern about the quality of life of this segment of the population. Thus, the present study aimed to evaluate the quality of life of two groups: one formed by non-institutionalized elderly participating in a community center; and the other formed by institutionalized elderly, and compare the results between them. To collect data, two instruments for assessing the quality of life of the World Health Organization were used: the WHOQOL-OLD and the WHOQOL-BREF. These assessment tools were applied to 100 elderly people, comprising 37 men and 63 women from a community center, and 36 elderly, comprising 25 men and 11 women, living in a long stay institution, both groups from the municipality of Ji-Paraná, Rondônia, Brazil. The SPSS software for Windows version 20.0 was used for data analysis and the variables in the study received a descriptive statistical treatment. Statistical inference tests were also performed to verify possible associations between variables. For inferential analysis, the level of significance α = 1% was used. The results showed relevant statistical significance in the comparison between groups. The institutionalized elderly showed lower levels of satisfaction when compared to the non-institutionalized elderly in the four domains of WHOQOL-BREF (physical health; psychological; social relationships; and environment), as well as in the six domains of WHOQOL-OLD (sensory abilities; autonomy; past, present and future activities; social participation; death and dying; and intimacy). Therefore, institutionalized elderly require urgent attention. It is a must to fi nd ways of inserting them into social life and, whenever possible, to create conditions for them to keep in touch and maintain ties with their families.