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A co-principal leadership model, where two individuals serve in one leadership position, is considered a special case of distributing leadership (Gronn & Hamilton, 2004). The co-principal leadership model has been suggested as an alternative organizational form that re-structures the role of the principal by enhancing the positive aspects of the position (Chirichello, 2003; Grubb & Flessa, 2006). The purpose of this study is to compare traditional principals and co-principals with regard to their experiences of role conflict, role commitment and job satisfaction. The co-principal model may be a viable option for addressing the demanding and stressful nature of the principalship if co-principals experience less role conflict and more job satisfaction than traditional principals. The results of this comparison provide a first step toward understanding the benefits of this shared leadership model.

An abundance of literature on caregivers of individuals with dementia has been written since the mid-1980s. However, most of this literature focused on the experience of stress, burden, and depression in caregivers, thus excluding the grief experience that also accompanies the caregiving experience. The purpose of this multimethod study is to describe the lived experience of 44 spouses and adult children who are caregivers of persons with Alzheimer's disease and related dementias (ADRD) and scored high on the Marwit and Meuser Caregiver Grief Inventory, Short Form (MM-CGI-SF). This study presents qualitative results from a mixed-methods descriptive study (N = 201). Seven themes emerged from the qualitative data that detailed the caregiving experience of the individuals with high grief: (a) yearning for the past, (b) regret and guilt, (c) isolation, (d) restricted freedom, (e) life stressors, (f) systemic issues, and (g) coping strategies. The first 2 themes reflect grief reactions, whereas isolation, restricted freedom, life stressors, and systemic issues possessed elements of both grief and caregiver burden and stress. Coping strategies used by this group of caregivers included spiritual faith, social supports, and pets. Quantitative analysis confirmed that these themes are unique to individuals with high levels of grief compared with those with moderate/low levels of grief, except for the coping strategies of social support and spiritual faith. Caregivers with high levels of grief may benefit from supportive interventions that are based on reducing feelings of isolation, lack of freedom, and increased guilt and regret, while also addressing feelings of loss. Interventions that facilitate building a supportive network are suggested. Using a screening tool such as the MM-CGI-SF will help in identifying caregivers with high levels of grief who may be in need of additional support. (Contains 1 figure and 2 tables.)

Purpose: The purpose of this study was to describe the grief and personal growth experience of spouses and adult children of individuals with Alzheimer's disease and related dementias and the factors contributing to these experiences. Design and Methods: We used a modification of the Marwit-Meuser-Sanders Caregiver Grief model to examine the factors that contribute to grief and personal growth. We used chi-square tests, t tests, multivariate analyses of variance, correlations, and hierarchical regression analyses in a cross-sectional analysis of 201 spouses and adult children caregivers at various stages of the disease trajectory. Results: Grief increased as the severity of the disease increased. When the spouse with Alzheimer's disease lived out of the home, spouse caregivers experienced more sadness and longing, worry and isolation, and personal sacrifice burden than did adult children caregivers. Different factors influence grief and personal growth for caregivers of individuals with Alzheimer's disease. The majority of caregivers experienced personal growth, with more growth experienced by adult children. Implications: Health care providers should consider using the Marwit and Meuser Caregiver Grief Inventory to screen for high levels of grief in caregivers of individuals with Alzheimer's disease. Supportive services targeted for those with high levels of grief are suggested. (Contains 2 footnotes and 5 tables.)

A major shortcoming to the understanding and development of HIV/AIDS programs to mitigate social stigma is the paucity of research pertaining to how young people in sub-Saharan African countries perceive those infected with HIV, and how these stigmatizing attitudes are formed, projected and reinforced. The purpose of this study was to examine stigmatizing attitudes toward people living with HIV/ AIDS among young people in Swaziland, southern Africa. A purposive convenience sampling provided urban and rural data for this cross-sectional survey. Participants included 941 secondary school students attending four co-educational public schools in Swaziland. Data were collected and analyzed on individual and environmental related factors with students' stigmatizing attitudes toward people with HIV/AIDS as outcome variable. Findings from the study suggest that greater HIV/AIDS knowledge and increased peer influence were associated with lower stigmatizing attitudes. Perceived susceptibility was associated with increased stigma toward people living with HIV/AIDS. Both individual and environmental factors contributed to explaining the variance in social stigma; individual factors accounted for the largest amount. A better understanding of the factors associated with social stigma could assist healthcare and social workers to develop appropriate programs to reduce HIV/AIDS related Stigma. (Contains 3 tables.)

Depression in women with rheumatoid arthritis (RA) may be related to social role experiences, physical health, and age. The purpose of this study was to examine the social and health factors contributing to depression in two age groups of women with RA. One-hundred and thirty-eight midlife and late-life women with a diagnosis of RA participated in this cross sectional survey study. Multiple regression analysis indicated that social role balance, functional status, number of co-existing health problems, and age were significant predictors of depression in midlife and late-life women with RA. Role balance was the strongest factor contributing to a woman's depression score. Compared to midlife women, late-life women reported significantly higher role balance and lower depression scores, despite poorer functional status and more concomitant health problems.

The purpose of this study was to explore associations and relationships between the domains of perceived stigma and life satisfaction in a sample of HIV-infected African American men in an [...]

Objective: This study was conducted to describe and examine the impact of medication intervention practices among African‐American clients in two nurse‐led community nursing centers (CNCs). Methods: This study used a retrospective‐descriptive design. Omaha System data from visits of 196 African‐American adults living with chronic disease and having two or more CNC visits in which medication regimen was an identified problem and the main reason for the visit was analyzed. Results: The sample had a mean age of 53.1 (6.67) and was primarily women (82%), uninsured, and with high school or less education. A total of 9,259 Medication regimen interventions were documented and implemented during 1,146 client CNC visits. A paired samples t test revealed statistically significant improvements in Knowledge (t = 2.434, p <.01). Behavior (t = 0.077, p =.94) and Status (t = 1.489, p =.14) remained unchanged, although the ratings trended toward improvement for each. Conclusion: This study provides evidence that the nursing center model of care does improve the knowledge of medications among African‐American clients. The study also demonstrated the Omaha System's utility to evaluate the impact of nursing interventions in community settings. [ABSTRACT FROM AUTHOR]

Several initiatives have been embarked upon over the past decade to encourage breast cancer screening and follow-up among women who reside in urban communities. With these efforts, data revealed that many women do not receive the recommended breast cancer screening. Studies have been published in scientific literature that explored barriers faced by women relative to breast cancer screening. But, only a few reports have been published of efforts initiated to define the limits of characteristics of women who have and women who have not been screened. This cross-sectional exploratory study was designed to examine the breast cancer screening practices of women 40-74 years of age and older who reside in a densely populated metropolitan community of S.E. Wisconsin, and to identify and compare the characteristics of women who report breast cancer screening and with characteristics of women who report no breast cancer screening. The organizing framework for this study was derived from the United States Department of Health and Human Services Determinants of Health Model. An investigator-designed instrument was used to assess the influence of age, family history of breast cancer, insurance status, characteristics of residential neighborhood and local access to breast care on breast cancer screening. While the majority of the women surveyed reported breast cancer screening, less than half of the women reported screening that was consistent with recommended breast cancer screening guidelines (i. e. annual mammography and annual clinical breast examination). Deficits in breast cancer screening were noted most among women who were uninsured, with no known family history of breast cancer, who resided in low income neighborhoods, inner-city neighborhoods and neighborhoods without facilities for primary breast care. The results of this study demonstrate the need for clinicians, health care administrators and advocates committed to breast cancer detection and control within targeted communities. They must carefully assess the impact of individual, social and structural factors on breast cancer screening, and the need to design initiatives specifically targeted to women who have received less than optimal or no breast cancer screening. [ABSTRACT FROM AUTHOR]

Purpose The purpose was to explore nurses' and physicians' recognition of signs of deterioration and management of symptoms. Design and Methods This descriptive, cross-sectional study used an electronic survey with 35 nurses and 17 physicians. Results Nurses using the Bedside Paediatric Early Warning System ( Bedside PEWS) were significantly more likely to recognize risk for deterioration and respond with appropriate interventions. Physicians incorporating Bedside PEWS were more likely to choose reliable indicators of deterioration and reported significantly more effective communication from nurses to identify deterioration. Practice Implications Bedside PEWS may improve nurses' and physicians' abilities to recognize early signs of patient deterioration, communicate findings to providers, and plan interventions. [ABSTRACT FROM AUTHOR]

The article presents a study on the impact of factors, such as individual, social and environmental, on breast awareness and screening among African-American urban women, which found the need for breast cancer awareness programs and services in impoverished communities. It is reported that approximately 296,980 women in the U.S. will be affected by breast cancer in 2013. The study also revealed that the more aware women are of their breasts, the more likely they are to get a screening.

The article presents a study which analyzed the attitude of African-American community leaders towards genetics and genomics research and bio-banking. Due to technology advancements in the areas of genetics and genomics research, the ability to predict an individual's risks for developing certain diseases is now within reach. Findings of the study revealed that 76.2% of the African-American leaders favored medical research and 47.6% participated in medical studies.

The involvement of African Americans in research has long been expressed as a concern by the scientific community. While efforts have been undertaken to identify factors inhibiting the participation of African Americans in health-related research, few efforts have been undertaken to have highlight factors associated with their engagement of health-related research. An exploratory study of factors presumed to be associated with participation in health-related research was conducted among a nonprobability sample of African Americans (n = 212) from a large urban community in the Midwest. The study was guided by a framework that hypothesized the influence of knowledge, beliefs, and perceptions about genetics and the involvement of providers in decision-making on willingness to participate in health-related genetic research. The results revealed that knowledge, beliefs, and perceptions about genetics and the involvement of providers were associated with willingness to engage in health-related genetic research (p < .05). The most interesting, however, was that 88.7% of the participants who had not previously been involved in a health related study who expressed a willingness to participate reported that they "had never been asked." Study findings suggest the need for research that further examines factors associated with the involvement of African Americans in health-related genetic research. [ABSTRACT FROM AUTHOR]

This study describes health services utilization patterns and barriers to healthcare analyzing relationships among participant and situational variables. Using a cross sectional design with a sample of 117 HIV-infected African American men aged 21 to 60, a survey was administered to assess: socio-demographic indicators, health care utilization patterns, stigma, and self-efficacy relative to perceived attitudes toward their HIV healthcare providers (AHHCP). Fifty-seven percent reported not seeking health care when needed and 51 percent reported having missed appointments. Results revealed correlations between time spent by healthcare provider (HCP), ability to access care, lack of HCP commitment, and denial of care. Self-efficacy was correlated to the total AHHCP score and its subscales. This study provides important contextual perspectives on healthcare utilization barriers among HIV-infected African men in an urban setting. To reduce access barriers for HIV-infected patients, health care providers must understand better the patients' perspectives on the difficulties of accessing care and navigating the healthcare system. [ABSTRACT FROM AUTHOR]

As rates of HIV infection in the African American community--specifically among men, continue to rise, how barriers to healthcare and HIV stigma interact and are related to Health Related Quality of Life (HRQOL) is an important area to understand. The purpose of this study was to investigate HRQOL in a sample of urban HIV-infected African American men to see how it was influenced by personal and structural factors. Participants were recruited through a local African American community-based health-related organization in a Midwest urban area and through recommendations from prior participants. The sample consisted of 55 African American men who self-reported as being HIV infected. Data were collected on: (a) personal factors (sociodemographic, social support, and disease progression variables), (b) structural factors (barriers to health care and perceived stigma), and (c) health related quality of life. The dependent variable was HRQOL. Participants' ages ranged from 23 to 66 years, (M = 43.84, SD = 7.67) and the average length of time since diagnosis with HIV infection was 10.8 years. The African American men in this study had poor to moderate quality of life as measured by the HRQOL scale. Subjects rated financial worries as their biggest quality of life concern. The better they rated their health, the fewer health worries they had. In addition, better self-rated health scores were associated with better overall life functioning and greater satisfaction with life. Structurally, the greater the barriers to healthcare and the greater the perceived HIV stigma, the lower the HRQOL scores were for participants in this study. On the HRQOL scale, lower scores are indicative of poorer quality of life. In the regression model, personal factors accounted for 27.3 percent of the variance in explaining HRQOL. Structural factors accounted for an additional 35.3 percent of the variance in explaining HRQOL. Together, personal and structural factors accounted for 62.5 percent explained in the regression model. Findings suggest that the influences of structural factors are critical to the understanding of HRQOL among HIV-infected African American men. For programs geared towards enhancing the HRQOL for HIV infected African American men to be more effective, holistic approaches should be used that addresses both personal and structural related factors. [ABSTRACT FROM AUTHOR]

The purpose of this prospective study was to identify factors in 66 spouses and adult child caregivers of person's with Alzheimer's disease prior to the death that predicted higher levels of grief in bereavement. A hierarchical regression model was tested. Predeath grief, dysfunctional coping, depression, social support, and decreased positive states of mind explained 54.7% of the variance in postdeath grief. Factors that contributed significantly to postdeath grief included predeath grief and depression. Results from this study indicate that risk factors for postdeath grief can be predicted prior to the death.

Advances in genetic and genomic research are shifting the typical disease timeline. For those afflicted by disease and for population groups known to experience excess disease-related morbidity and mortality, the ability to use genetics and genomics to predict an individuals' predisposition for developing a disease and/or to anticipate an individual's response to treatments holds tremendous promise. Over the past two decades several public and private institutions within the United States have been established for the purpose of collecting and storing biological specimens for the purpose of conducting genetic/genomic research. Multiple reports indicate that the involvement of racial/ethnic minority participants in these bio-repositories is limited. Little is known about the willingness of African-Americans, one of the largest and most vulnerable racial/ethnic population groups, to participate in genetic research, genomic research, and to contribute biological specimens to bio-repositories. An exploratory study was undertaken using principles of community engagement and community-based participatory research to examine the perspectives of leaders within the African-American community about participation in genetics research, genomics research, and bio-banking. Semi-structured focus groups with twenty-one African-American community leaders were the primary means of gathering the study data. Reflections and commentary of the community leaders were interspersed with sentiments of "Sankofa." The emergent themes, health-related disparities, historical injustices in medical research, the promise of genetic and genomic research, and genetics/genomic research engagement, implicated the importance of conducting genetics/genomics research in the context of the community interdependent with efforts to address determinants of health and health disparities.

While several reports of studies undertaken to examine the influence of individual factors and access to quality care on the breast cancer outcomes of African-American women have been published, few studies have been reported that examined the interaction of these factors with variables associated with the social and physical environment. This report presents a summary of outcomes of a study undertaken to explore the impact of individual factors, social factors, environmental factors, and access to quality breast care on breast awareness and breast cancer screening practices among a targeted group of African-American urban women. The findings revealed that awareness and screening were significantly influenced by the participant's age, insurance status, characteristics of their social environment, and their breast awareness. The findings emphasize the need for targeted programming and services in low-income communities and inner-city neighborhoods where women may be less inclined to "venture out" and where clinicians, educators, researchers, and representatives of institutions dedicated to breast cancer control have been less inclined to "venture in."

Theories and studies about the psychological processes of midlife propose a transition that may result in a more integrated personality structure throughout the second half of life. This more integrated structure includes concepts such as generativity, self-assertion, and independence. However, this structure, especially in early middle-age, can be affected by a life-threatening health disruption such as heart disease. One hundred and fifty-five women participated in a cross-sectional survey designed to investigate depression in early middle age, midlife, and elderly women who had undergone heart surgery. Women aged 40-55 years composed the early middle-age group, women aged 56-65 years composed the midlife age group, and women aged 66+ years were identified as the elderly age group. Affective components of depression were measured by asking participants to respond to three items regarding frequency of sadness, depression, and "the blues." Affective depression scores were summed and a mean score derived. Mean scores significantly differed by age group (F [2, 152] = 3.05, p =.05). Older women in the study fared better than their younger counterparts in terms of depression scores after a major cardiac health disruption. Post hoc comparisons indicated that mean scores for the early middle-age participants were significantly higher than for the midlife and older participants. Depression in the context of a cardiac health disruption appears to be linked to the developmental stage of a woman's life trajectory on which it is superimposed.