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Objectives To provide the first report on prevalence of vitamin D deficiency in newly admitted nursing home ( NH) residents and associations with functional disabilities and chronic diseases. Design Retrospective chart review. Setting Nursing home ( NH). Participants Male veterans newly admitted to a NH for rehabilitation, skilled-nursing care, intermediate care, or respite care between January 2011 and June 2012. Measurements Total serum 25-hydroxyvitamin D (25(OH)D) levels were measured on admission. Vitamin D supplement users and those without 25(OH)D measurement within 7 days of admission were excluded, leaving an analytical sample of 104 residents. Vitamin D deficiency was defined as 25(OH)D less than 20 ng/ mL. Data were collected on age, ethnicity, season, body mass index (BMI), functional disability in activities of daily living (ADLs) (mobility, bathing, dressing, toileting, continence, and feeding), and prevalent chronic diseases. Results Prevalence of vitamin D deficiency was 49.0%. In multivariate logistic regression models adjusted for age, ethnicity, and BMI, vitamin D deficiency was significantly associated with number of ADL disabilities (odds ratio ( OR) = 1.4 for each 1-point increase in ADL disability score, P = .03) and prevalent diabetes mellitus ( OR = 3.0, P = .03). In regression models using each ADL disability as a separate variable, only disability in feeding ( OR = 4.7, P = .05) and diabetes mellitus ( OR = 2.9, P = .04) remained significant. Conclusion Almost half the individuals entering the NH and not taking vitamin D supplements had vitamin D deficiency. Greater number of ADL disabilities, disability in feeding, and prevalent diabetes mellitus were independently associated with vitamin D deficiency. [ABSTRACT FROM AUTHOR]

Introduction: Many Marshall Islanders seek healthcare services in Hawai'i. Little is known about traditional Marshallese palliative care practices. Our purpose was to learn about traditional Marshallese palliative care practices to provide culturally appropriate care. Methods: We performed 2 focus groups in 2011-2012 among Marshall Islanders living in or visiting the island of Oahu, Hawai'i. Group facilitators were uniformly trained to conduct focus groups using prepared script, with a native speaking interpreter. Data were analyzed using classical thematic triangulation methods to identify specific Marshallese palliative care practices and the effect of economic and social challenges in Hawai'i. Results: Six females and seven males, ages 46-79 years, participated. A "good death" was defined as "peaceful and pain free," occurring naturally with avoidance of artificial life prolongation. Factors associated with a "good death" included gathering of family to absolve conflicts, and proper and timely cultural practices such as Ilomej (wake) and Eorak (post-burial memorial service). Dying at home is the norm among people living in the Marshall Islands. After migrating to Hawai'i, having family present at the time of death was more important than the actual locale of death. Factors associated with "bad deaths" included young age, active suffering, accidents, suicides, or "black magic/curses," lack of timely burial or proper burial site. Barriers included mortuary fees, cost of transporting bodies, US government policies, and wait times for death certificates. Conclusions: There are many underlying cultural factors contributing to "good or bad" death. Overcoming identified barriers may facilitate cultural practices necessary for a good death. [ABSTRACT FROM AUTHOR]

Little is known about Marshallese palliative care practices. We explored traditional and contemporary Marshallese palliative care practices and examined generational differences. We performed three focus groups in 2011-2012 among Marshall Islanders in Hawai'i. A native speaking interpreter assisted group facilitators. Data were analyzed using classical thematic triangulation methods to identify specific Marshallese palliative care practices, the effect of economic and social challenges in Hawai'i, and generational differences comparing young and old. Nineteen persons (10 men and 9 women, youth aged 17-27 years, and elders as defined in Marshallese culture, aged 46-79) participated. A "good death" was defined as "peaceful and pain free," occurring from natural causes. Factors associated with a "good death" included gathering of family to absolve conflicts, and proper and timely cultural practices. Factors associated with "bad deaths" included young age, active suffering, accidents, suicides, "black magic/curses," or lack of timely or proper burial. Comparing generational differences, older Marshallese had differing opinions regarding preferred place of death, burial site, cultural practice preservation, artificial prolongation of life, and cremation. Barriers included mortuary fees, cost of transporting bodies, United States (US) government policies, and wait times for death certificates. Many cultural factors contribute to "good" or "bad" deaths. Attitudes toward palliative care practices differ by generation. Having previously documented different approaches by Yapese, a generalized "one size fits all" approach to Micronesians is inappropriate. Overcoming identified barriers may facilitate practices necessary for a good death in Micronesian populations in their home nations and as they migrate to communities throughout the US., (©Copyright 2020 by University Health Partners of Hawai‘i (UHP Hawai‘i).)