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Background: Behavioral theories are often used to better understand and change health-promoting behaviors and develop evidencebased interventions. However, researchers often lack of knowledge on how to use these theories in palliative care and people confronted with serious illness. Clear examples or guidelines are needed. Aim: To describe how behavioral theories can be used to gain insight into critical factors of health-promoting behavior in seriously ill people, using a case example of “starting a conversation about palliative care with the physician” for people with incurable cancer. Methods: We used a health promotion approach. Step 1: We chose a theory. Step 2: We applied and adapted the selected theory by performing interviews with the target population which resulted in a new behavioral model. Step 3: We operationalized the factors of this model. An expert group checked content validity. We tested the questionnaire cognitively. Step 4: We conducted a survey study and performed logistic regression analyses to identify the most important factors. Results: Step 1: We selected the Theory of Planned Behavior. Step 2: This theory was applicable to the target behavior, but needed extending. Step 3: The final survey included 131 items. Step 4: Attitudinal factors were the most important factors associated with the target behavior of starting a conversation about palliative care with the physician. Conclusions: This paper describes a method applied to a specific example, offering guidance for researchers and practitioners interested in understanding and changing a target behavior and its factors in seriously ill people. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a study that examined Vietnamese social work practitioners' conceptions of practice with people who identified as lesbian or gay. The findings presented in this article, drawn from semi-structured interviews with 12 social work practitioners in Hanoi, Vietnam, form part of the findings of a bigger study that looked into the attitudes of Vietnamese social work practitioners toward sexual minorities and how they conceptualise practice in relation to this segment of the population. A notable proportion of the interview participants, all of whom presented as having moderate to positive attitudes toward sexual minorities, were found to hold a heterosexist assumption with regards to the sexual identity of their clients. And while there was consensus in the need for a social work response, there were differences in the practitioners' conceptions of what form this should take. The participants were open to direct practice with individuals and a limited degree of community engagement but were apprehensive with the prospect of undertaking policy advocacy. It is argued that these conceptions of practice are informed by limitations imposed by their political environment as well as dominant ideological and philosophical influences. [ABSTRACT FROM AUTHOR]

Background: Minimal research has been done to determine how well European nursing students understand the core principles of academic integrity and how often they deviate from good academic practice. Aim: The aim of this study was to find out what educational needs nursing students have in terms of academic integrity. Research design: A quantitative cross-sectional study in the form of a survey of nursing students was conducted via questionnaire in the fall of 2020. Participants: The sample was composed of 79 students in the BScN and MScN programs at Zürich University of Applied Sciences. Ethical considerations: An application for a non-competence clearance was approved by the Ethics Committee in Zurich (BASEC No. Req-2020-00868). The survey was anonymous, and informed consent was obtained prior to participation. Results: The participants had a high level of confidence in their own knowledge but were in many cases unable to correctly identify clear-cut examples of misconduct and to differentiate them from questionable practices. About 13% of the participants admitted that during their university education they had copied shorter passages from other sources into their own text without marking them as quotes. Conclusions: The study documents extensive knowledge gaps among nursing students regarding both academic misconduct and questionable practices and indicates a need for improved academic integrity training. [ABSTRACT FROM AUTHOR]

Cardiac rehabilitation (CR) is a comprehensive and multidisciplinary secondary prevention care in coronary heart disease (CHD). There are barriers at the patient and health system levels that prevent CR from being utilized. Cardiac telerehabilitation led by nurses (Ne-CTR) can alleviate the obstacles to participation in CR. A patient perspective can improve CR access. This study was the first pre-program investigation to clarify the status of knowledge and participation in CTR. We sought to clarify the acceptability, the reasons for rejection, the desired form, components, and associated factors with the components needed for (Ne-CTR) in patients with CHD. The study aimed to help develop a protocol for Ne-CTR for Chinese patients with CHD. A cross-sectional study was conducted between 2020 and 2021. Hospitals in four provinces in China were included. The participants were 671 patients with CHD in hospitals located in three regions of China. A self-administered questionnaire collected information about demographics, knowledge, and participation in CTR, acceptability, preferred medium, and components of Ne-CTR. Student's t- test, analysis of variance, and multiple linear regression analyzed the factors associated with component needs. All the analyses were conducted using IBM SPSS version 25.0. Most participants (n = 434, 66.77%) had a poor understanding and participation in CTR. In addition, 65.38% (n = 439) of participants were willing to accept the Ne-CTR program, and 43.56% (n = 98) identified safety as reasons for not accepting such a program. In the group accepting Ne-CTR, 35% chose hospital-designed professional applications as a medium for Ne-CTR when offered. Education (4.44 ± 1.056) and drug information (4.44 ± 1.040) had the highest average need score. Education, monthly income, marital status, previous CTR participation, and health insurance were associated with the demand level scores of Ne-CTR. This study demonstrated high levels of need for Ne-CTR among patients with CHD and identified the desired medium, components, and associated factors of Ne-CTR. These findings provide reference information for the construction of a Ne-CTR program. [ABSTRACT FROM AUTHOR]

Little is known about co-occurring intimate partner violence (IPV) against women and child abuse within families in humanitarian settings. Baseline data from 203 couples in eastern Democratic Republic of Congo were analyzed to assess associations between childhood experiences of abuse with present co-occurring violence. Over half of women (56.1%) and men (50.5%) reported co-occurring violence. Adjusted models demonstrate experiencing physical abuse as a child was associated with greatest odds of recent co-occurring violence while witnessing parental IPV had mixed influence. Programmatic approaches focused on reducing early childhood violence may be promising to prevent both IPV and child abuse. [ABSTRACT FROM AUTHOR]

Limited research has examined predictors of anti-gay victimization among men who have sex with men (MSM), despite anti-gay violence continuing to be a global problem. We conducted a secondary analysis of data from structured interviews with 600 MSM adults to examine anti-gay victimization and earlier sexual debut among MSM in Kazakhstan. Multiple linear regression was used to test for associations between earlier sexual debut—categorized as age of sexual onset between 13 and 15 years of age and prior to 13 years old, with ages 16 and older as the reference group—and recent and lifetime anti-gay victimization. Adjusted logistic regression models were used to assess earlier sexual debut and specific types of victimization. The majority of MSM reported lifetime (89%) or recent (68%) experiences of anti-gay victimization. Earlier sexual debut prior to 13 years of age was significantly associated with greater number of types of lifetime and recent reports of anti-gay victimization. Among specific types of anti-gay victimization, earlier sexual debut was associated with higher odds of experiencing verbal, physical, and sexual violence. Anti-gay violence in Kazakhstan is a significant and prevalent public health issue. Future research and clinical interventions addressing anti-gay victimization among MSM populations should consider the lifetime and current implications of consensual and non-consensual childhood and adolescent sexual experiences. [ABSTRACT FROM AUTHOR]

This study investigates the effects of adolescent bariatric surgery among young adults approximately 10 years post-surgery. Participants were recruited from a hospital-based bariatric registry. We used an exploratory, qualitatively-driven mixed methods design. Findings were integrated with medical chart data and the SF-36, Body QoL, and the Transition Readiness Assessment Questionnaire. Of the 22 participants who completed surveys (14 females and 8 males), 20 participants also completed a phone interview. Median participant age was 25 years (range = 19–30). Median weight-loss was 23% (6.0%‒58%). Four themes emerged: taking control, weight loss challenges, body image adjustment, and growing up. Participants reported physical benefits of surgery yet were challenged by eating habits, body image, and interpersonal relationships. Participants were indifferent to preventative healthcare, despite the potential for vitamin deficiencies and the return of weight-related comorbidities. Clinicians can facilitate the transition to young adulthood by providing continued mental support, education, and medical monitoring. [ABSTRACT FROM AUTHOR]

Coercive control behaviors central to the abuse of power appear more frequent than other types of domestic violence, but little is known about its frequency, features, and consequences for women in India. We aimed to examine the prevalence of domestic coercive control and its association with physical, sexual, and emotional domestic violence in the preceding year and symptoms of depression, anxiety, and suicidal thinking. In a cross-sectional survey, we interviewed 4,906 ever-married women aged 18-49 years living in urban informal settlements in Mumbai, India. We developed a 24-item scale of coercive control, assessed physical, sexual, and emotional violence using existing questions, and screened for symptoms of depression with the Patient Health Questionnaire (PHQ9), anxiety with the Generalized Anxiety Disorder (GAD7) questionnaire, and suicidal thinking with questions developed by the World Health Organization. Estimates involved univariable and multivariable logistic regression models and the prediction of marginal effects. The prevalence of domestic coercive control was 71%. In total, 23% of women reported domestic violence in the past 12 months (emotional 19%, physical 13%, sexual 4%). Adjusted models suggested that women exposed to controlling behavior had greater odds of surviving emotional (aOR 2.1; 95% CI 1.7, 2.7), physical (1.4; 1.0, 1.9), and sexual (1.8; 1.1, 3.0) domestic violence in the past 12 months; and higher odds of a positive screen for moderate or severe depression (1.7; 1.3, 2.2), anxiety (2.1; 1.3, 3.1), and suicidal thinking (1.7; 1.2, 2.3), and increased with each additional indicator of coercive control behavior. When women reported 24 indicators of coercive control, the adjusted predicted proportion with moderate or severe depressive symptoms was 60%, anxiety 42%, and suicidal thinking 17%. Inclusion of coercive control in programs to support domestic violence, would broaden our understanding of domestic abuse to resemble most victims experience and improve interventions. [ABSTRACT FROM AUTHOR]

Reducing structural drivers of intimate partner violence (IPV), including gender inequity in education, employment, and health, surrounding women worldwide represents a clear public health priority. Within countries, some women are at disproportionate risk of IPV compared to other women, including sexual minority women, immigrant women, and women in poverty. However, limited research has assessed women's IPV risk and related circumstances, including police involvement following IPV experiences and IPV-related worry, across sexual orientation, immigration status, and socioeconomic status in a population-based survey of women across countries. Further, few studies have examined IPV against minority women as a function of gender-based structural stigma. This study aimed to determine whether gender-based structural stigma is associated with IPV and related circumstances among European women; examine minority-majority IPV disparities; and assess whether structural stigma is associated with IPV disparities. We used the population-based 2012 Violence Against Women Survey (n = 42,000) administered across 28 European Union countries: 724 (1.7%) identified as sexual minority, 841 (2.0%) as immigrant, and 2,272 (5.4%) as living in poverty. Women in high gender-based structural stigma countries had a greater risk of past-12-month IPV (AOR: 1.18, 95% CI = 1.04, 1.34) and IPV-related worry (AOR: 1.09, 95% CI = 1.04, 1.15) than women in low structural stigma countries. All minority women were at disproportionate risk of IPV and IPV-related worry compared to majority women. Associations between gender-based structural stigma and IPV and related circumstances differed across minority status. Country-level structural stigma can possibly perpetuate women's risk of IPV and related circumstances. Associations between structural stigma and IPV and related circumstances for sexual minority women, immigrant women, and women in poverty call for research into the IPV experiences of minority populations across structural contexts. [ABSTRACT FROM AUTHOR]

This study examines whether victims of violent street crimes who are known to the police as past offenders, when compared with victims with no arrest history, have different outcomes related to receipt of victim and health-related services, while taking into consideration whether or not police responded to the victimization incident. The sample is comprised of 103 men and women between the age of 18 and 40 living in one Mid-Atlantic city who were victims of street violence within the year before study recruitment. Logistic regression was used to assess the impact of police response to the victimization incident on receipt of victim services, and receipt of victim services on engagement with counseling and mental health services. The results show that prior arrests were not associated with receipt of services. However, having police officers respond to the victimization was associated with higher odds of receiving victim services, and in turn, victim services were associated with receiving mental health treatment. Police response appears to set victims on a path to accessing services. Although the number of arrests was not associated with service receipt, a small percentage of victims who did not receive services stated they were reluctant to cooperate with the police, thus limiting their opportunity for victim services. Because most victims who did not access victim services did not know that they existed, policies that promote more knowledge of and initial engagement with victim services could improve access to needed health and mental health services. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper is to assess Australian young people’s awareness of mental health services available for their age group. Of particular interest was awareness of headspace, which was created in 2006 to provide youth-oriented mental health services, and has expanded to 30 centres nationally in 5 years.Method: In 2011, a telephone interview was conducted with a national sample of 3021 Australians aged between 15 and 25 years. Participants were asked questions about awareness of mental health organizations, where they would seek help for themselves and how they would assist a peer with a mental health problem.Results: There were very low frequencies of spontaneous mentions of headspace as a mental health organization, or as a service where respondents would seek help for themselves or refer a peer to. However, when prompted, about half of respondents recognized headspace as a mental health organization. Living within a headspace service area predicted better recognition of headspace. However, past-year psychological distress was unrelated to recognition of headspace as a mental health organization.Conclusions: In order to reach them more effectively, young people need to be aware of youth-oriented services that are available to them and their peers. Awareness campaigns need to be targeted to the subgroups of young people who have the greatest need for headspace services, namely those with recent mental health problems. [ABSTRACT FROM PUBLISHER]

Objectives The objective of the study was to assess the patient safety situation in Ghana. Specifically, the study aimed at assessing the WHO's 12 action areas of patient safety. Design This was a descriptive cross-sectional survey. Data collection methods included interviews and observation using WHO adapted questionnaire. Setting The setting was mainly 16 selected hospitals, including two teaching hospitals selected from the northern and southern parts of the Ghana. Participants Respondents were purposively selected based on their position in the health facilities and the type of information required. Main Outcome Measure(s): The main outcome measures were the WHO's 12 action areas of patient safety. Results The median bed capacity of the hospitals assessed was 93 (min = 60, max = 1812). The country's highest score (94%) was in the action area of knowledge and learning in patient safety where all (16, 100%) sampled facilities had systems in place for recording adverse events, specific protocols for patient care, etc. Five (5) of the 12 action areas (i.e. national patient policy, hospital acquired infections, surgical safety, patient safety partnerships and patient safety funding) had scores lower than the mean score (66%). Conclusion The key strength identified in the patient safety situational analysis of Ghana was knowledge and learning in patient safety while patient safety surveillance was the weakest action area identified. There were also weaknesses in areas such as national patient policy, healthcare associated infections, surgical safety, patient safety partnerships and patient safety funding, respectively. [ABSTRACT FROM AUTHOR]

This research note presents findings from a qualitative study exploring female, system-involved intimate partner violence (IPV) survivors’ perspectives on substance use disclosure in the context of research studies. The study sample includes 22 women who completed a court- and/or child protective services (CPS)–mandated IPV parenting program. Analyses revealed three key areas of participants’ perspectives on substance use assessment and disclosure: (a) administration setting/format and measurement clarity, (b) administrator characteristics, and (c) repercussions due to breach of confidentiality. Findings from the current study offer insights into barriers for survivors reporting their substance use and suggestions for researchers seeking to assess substance use among this population. [ABSTRACT FROM AUTHOR]

To be effective, nurse care coordination must be targeted at individuals who will use the service. The purpose of this study was to identify variables that predicted use of care coordination by primary care patients. Data on the potential predictor variables were obtained from patient interviews, the electronic health record, and an administrative database of 178 adults eligible for care coordination. Use of care coordination was obtained from an administrative database. A multivariable logistic regression model was developed using a bootstrap sampling approach. Variables predicting use of care coordination were dependence in both activities of daily living (ADL) and instrumental activities of daily living (IADL; odds ratio [OR] = 5.30, p = .002), independent for ADL but dependent for IADL (OR = 2.68, p = .01), and number of prescription medications (OR = 1.12, p = .002). Consideration of these variables may improve identification of patients to target for care coordination. [ABSTRACT FROM AUTHOR]

A growing number of studies have examined the “immigrant paradox” with respect to health behaviors in the United States. However, little research attention has been afforded to the study of adverse childhood experiences (ACE; neglect, physical and sexual abuse, and witnessing violence) among immigrants in the United States. The present study, using Waves I and II data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), aims to address these gaps by comparing forms of ACE of first- and second-generation immigrants with native-born American adults in the United States. We also examined the latent structure of ACE among immigrants and conducted analyses to assess the psychiatric correlates of identified latent classes. With the exception of neglect, the prevalence of ACE was markedly higher among native-born Americans and second-generation immigrants compared with first-generation immigrants. Four latent classes were identified—limited adverse experience (n = 3,497), emotional and physical abuse (n = 1,262), family violence (n = 358), and global adversity (n = 246). The latter three classes evinced greater likelihood of being diagnosed with a mood, anxiety, personality, and substance use disorder, and to report violent and non-violent antisocial behavior. Consistent with prior research examining the associations between the immigrant paradox and health outcomes, results suggest that first-generation immigrants to the United States are less likely to have experienced physical and sexual abuse and witness domestic violence. However, likely due to cultural circumstances, first-generation immigrants were more likely to report experiences that are deemed neglectful by Western standards. [ABSTRACT FROM AUTHOR]

Introduction This English study is the first to focus on the contribution of occupational therapists to the work of community mental health teams for older people. Method A mixed methods study comprising: a national survey of community mental health team managers; caseload audit; qualitative interviews; and a practitioner survey provided information on team membership and functions, user characteristics, accounts of occupational therapists’ roles and experiences, and work characteristics. Findings Occupational therapists worked mainly with people with dementia and were involved in both generic and specialist tasks, with the latter focusing largely on maintaining functionality. They had found ways to balance their roles for the benefit of the team without loss of professional identity. Some differences of opinion between clinical leads and occupational therapists were reported. Stress levels among occupational therapists were similar to those of professional colleagues. Conclusion Some findings contrast with earlier studies of community mental health teams for working-age adults, offering new insights into the nature of the occupational therapists’ experiences. To ensure that occupational therapists in these settings are able to contribute effectively, a shared understanding of their role is required between them and their clinical leads. [ABSTRACT FROM AUTHOR]

This study tested depression as a mediator between childhood sexual abuse and adherence to antiretroviral therapy, an effect moderated by resilience. In total, 149 HIV+ Latino men who have sex with men were recruited for this study. Using a regression-based bootstrap approach, depression mediated the relationship between childhood sexual abuse and antiretroviral therapy adherence, with worse adherence for participants at lowest percentiles of the resilience index. The prevalence of childhood sexual abuse and depression in HIV+ men who have sex with men is high and must be addressed to better prevent disease progression and reduce transmission, especially in expanding Latino populations. [ABSTRACT FROM AUTHOR]

The goal of this study was to test a mediation model in which social skills mediate the relationship between participation in organized activities and conduct problems among elementary school children. Two moderators of these associations were also examined, namely, gender and reception of special education services. A total of 563 children (45% girls; M[age] [=] 8.44) were surveyed. The findings revealed that, after controlling for important covariates, more frequent activity participation predicted better social skills, which, in turn, predicted fewer subsequent conduct problems among children. These associations were not moderated by gender or reception of special education services. These findings suggest that organized activities may provide a positive developmental context for children with conduct problems. [ABSTRACT FROM AUTHOR]

While the official retirement age for most Organization for Economic Co-operation and Development (OECD) countries is 65 years, the average employee in the majority of OECD countries retires considerably earlier. With the coming retirement of the baby boom generation, increasing life expectancy, and budget restrictions due to the financial crisis, most countries want to motivate employees to work longer. For these reasons, studying early retirement is highly relevant. In this article, we examine the determinants of early retirement among working and retired senior teachers between 45 and 65 years old in Flanders, Belgium. Although a widespread early exit culture exists among teachers and teacher shortages are expected in several countries, little attention has been given to the specific determinants of early retirement among teachers. Using multivariate linear regression analysis, we study the preferred retirement age of working teachers (n = 1,878) and the actual retirement age of retired teachers (n = 1,246). Financial factors, feelings of emotional exhaustion, and dissatisfaction with nonteaching-related workload (such as meetings and paperwork) have an important influence on the retirement decision. Results show that the majority of teachers make use of early exit schemes. This illustrates the existence of a widespread early exit culture among senior teachers in Flanders. [ABSTRACT FROM PUBLISHER]

Objective: To describe older people’s perceptions of anemia in a rural Ugandan population. Method: Quantitative and qualitative data on anemia were collected from participants aged ≥50 years from January 2012 to January 2013 using questionnaires and in-depth interviews. Quantitative data were collected from 1,455 participants. Qualitative data were collected from 10 people who were purposively selected. Data were analyzed using STATA software and thematic content analysis. Results: 33.8% men and 17.4% women had anemia. Older people perceived themselves to be anemic because of symptoms and beliefs about causes. Those with anemia were more likely to perceive that they had anemia (18.4% vs. 10.2%, p < .001). Poor diet, diseases, poor living conditions, and over work were mentioned as causes of anemia. Use of traditional methods for treating anemia was common. Discussion: Anemia prevention and control programs in Uganda should target older people and correct misconceptions about the causes and treatment of anemia. [ABSTRACT FROM AUTHOR]

The article presents a case study on the multi-method assessment of non-profit and voluntary sector governance in Cornwall, England to determine the level at which the board was functioning. It states that 65 chairpersons of organisations completed a Board Self-Assessment Questionnaire (BSAQ). It mentions that the board members who reported good awareness of the personalisation agenda preparedness was accounted for by the BSAQ scores of the organisations.

Introduction: Musculoskeletal conditions are a common cause of sickness absence and work disability. Little is known about the work-related advice and support that occupational therapists provide to this client group and their employers. The purpose of this study was to report on current occupational therapy practice in this area in the United Kingdom. Method: A questionnaire survey was conducted, of United Kingdom occupational therapists treating employed clients with musculoskeletal conditions in community or outpatient settings. Questionnaires were posted to 960 hospitals or units, identified through National Health Service websites to reach as many respondents as possible, and the survey was also available online. Findings: 257 respondents reported on their provision of work-related advice and support. Of these, over 30% (n = 82) reported that this involved a moderate amount of their time; 60% (n = 154) had experience of contacting employers and 21% (n = 55) had met with clients' employers in the previous year. Time and resources, concern about legal implications, and having the appropriate skills had an impact on communication between therapists and employers. Conclusion: The findings demonstrate considerable variations in service delivery, interventions, and the contact made with employers. These need urgent attention if the profession is to meet the challenges of the government's agenda for improving health at work. [ABSTRACT FROM AUTHOR]

Objectives: To estimate transition probabilities between disability states, total life expectancy, and the latter’s decomposition into years spent disabled and disability-free by age, sex, and education among older adults in São Paulo, Brazil, and urban areas in Mexico. Methods: Applied a micro-simulation method (Interpolative Markov Chains) using longitudinal data. Results: We found large between-country educational differences in incidence of and recovery from disability with higher rates in Mexico than in São Paulo, but no differences in mortality. Older adults in Mexico spent longer time being disability-free than in São Paulo for both levels of education. Males and females in São Paulo spent a larger fraction of their remaining life disabled at every age than their counterparts in urban areas in Mexico. Discussion: There were educational differences in the prevalence of disability in São Paulo and urban areas in Mexico, and significant educational differences in disability incidence and recovery across sites. [ABSTRACT FROM PUBLISHER]

Aims: Little has been reported on self-harm among the UK Armed Forces, partly due to the difficulties in recording self-harm, within an often-difficult-to-reach population. This study assesses the lifetime prevalence of attempted suicide and self-harm within currently serving and ex-service personnel of the UK Armed Forces. Methods: Telephone interviews were conducted with 821 personnel who had previously participated in the King's Centre for Military Health Research military health study. Within the telephone interview, participants were asked about attempted suicide and episodes of self-harm. Results: A lifetime prevalence of 5.6% for intentional self-harm (self-harm or attempted suicide) was reported. Intentional self-harm was associated with psychological morbidity (in particular, post-traumatic stress disorder) and adverse experiences in childhood. Ex-service personnel reported lifetime prevalence more than double that of serving personnel (10.5% vs 4.2%, respectively). Participants reporting intentional self-harm were younger (34.4 years vs 39.8 years). Conclusion: A lifetime prevalence of 5.6% for attempted suicide and self-harm is higher than previous research has suggested. Younger service personnel, those who have experienced adversity in childhood, those with other psychological morbidity, and ex-service personnel are more likely to report self-harm behaviours. [ABSTRACT FROM AUTHOR]

Background: Socioeconomically disadvantaged adults experience greater healthcare disparities and increased risk of depression compared to higher-income groups.Aim: To create a depression care model for disadvantaged adults utilizing service agencies, through a community–academic partnership.Methods: Using participatory research methods, an organizational needs assessment was performed to ascertain depression care needs, identify barriers to clients receiving treatment, and marshal resources. Interviews and surveys were conducted with community organizational leaders. Focus groups were conducted with clients who used the service agencies.Results: Interviews and surveys identified barriers including discontinuity of care and unmet basic needs for food, housing, health insurance and transportation. Focus groups enriched the understanding of barriers including lack of motivation to seek depression care, lack of social support and needed resources for the uninsured, underinsured and homeless. The findings were used to develop a depression care model combining depression management with motivational interviewing to evaluate and meet needs, and peer education to motivate and provide support.Conclusions: This partnership facilitated the development of a community-driven intervention that academic researchers acting alone could not realize. To provide depression care to socioeconomically disadvantaged individuals, the intervention must include mitigating solutions to barriers. [ABSTRACT FROM PUBLISHER]

Objectives: Numerous studies have examined the association between body mass index (BMI) and mortality. The precise shape of their association, however, has not been established. We use nonparametric methods to determine the relationship between BMI and mortality. Method: Data from the National Health Interview Survey-Linked Mortality Files 1986-2006 for adults aged 50 to 80 are analyzed using a Poisson approach to survival modeling within the generalized additive model (GAM) framework. Results: The BMI-mortality association is more V shaped than U shaped, with the odds of dying rising steeply from the lowest risk point at BMIs of 23 to 26. The association varies considerably by time since interview and cause of death. For instance, the association has an inverted J shape for respiratory causes but is monotonically increasing for diabetes deaths. Discussion: Our findings have implications for interpreting results from BMI-mortality studies and suggest caution in translating the findings into public health messages. [ABSTRACT FROM PUBLISHER]