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Focus groups were conducted with 33 community dwelling, urban and rural, custodial grandparents to explore their willingness to comply with a behavioral intervention targeting improving their well-being and financial management. Most participants were African American (91%), female (79%) and middle-aged. Major themes included: 1) inability to access social services; 2) legal assistance; 3) emotional well-being; 4) problems related to the parents of grandchildren; and 5) identification of structured activities for grandchildren. Findings suggest custodial grandparents underutilize services. Future research should address methods to enhance grandparents' utilization of resources facilitated via a peer navigator system along with policy level changes.

Rural custodial grandparents have been understudied. As the grandparent caregiving population increases, more attention is needed to understand custodial grandparents in rural settings. This article explores the state of knowledge of the experiences of rural grandparents. A systematic review of the caregiving literature is conducted to understand the issues affecting this caregiving population. The results suggest that rural grandparents often are minority grandmothers with limited resources who provide care to older grandchildren in isolated environments. Attention is given to the social ecological framework as one model that can help to inform how social workers intervene with this population. Recommendations are offered for social work research, practice, and policy.

This research explored the link between coronary heart disease (CHD) prevalence and metropolitan-area level occupational structure among 137 metropolitan/micropolitan statistical areas (MMSA) in the United States. Using data from the 2006-2008 Behavioral Risk Factor Surveillance System and 2007 County Business Patterns, logistic mixed models were developed to estimate CHD prevalence between MMSAs controlling for individual-level socioeconomic characteristics and various types of occupational structure. Results showed that CHD prevalence was lower in MMSAs where their economy was dominated by 'tourism and resort' and 'the quaternary sector' and higher in MMSAs dominated by 'manufacturing', 'transportation and warehousing', and 'mining'. MMSA-level effects on CHD were found in 'tourism and resort' and 'the quaternary sector' having lower risk and 'mining' having higher risk of CHD. Although these effects prevailed in many MMSAs, some MMSAs did not fit into these effects. Additional analysis indicated a possible link between metropolitan population loss and higher CHD prevalence especially in the coal mining region of the Appalachian Mountains.

This paper describes the opportunities for promoting collaborative research and improving rural health care delivery by the implementation of REDCap software. In the era of advanced technologies, rapid development and dissemination of electronic health data may be possible. Health data are accessed by collaborating researchers in various academic disciplines through the Internet. Community-based approaches to health care delivery through the mobile health clinics may be integrated into the development and utilization of databases through REDCap to improve rural health. Multifunctional features of REDCap provide useful tools in various stages of health care delivery planning that support both research and operational endeavors. The authors will discuss potential usage of REDCap using an existing mobile health clinic in South Central Kentucky as a primary source of data, and describe how health data may be used in conjunction with REDCap with the goal of improving the health of rural communities in South Central Kentucky.

In this study, the influence of culture and discrimination on care-seeking behavior of elderly African Americans was explored. This was a qualitative phenomenological study that involved in-depth interviews with 15 African American men and women aged 60 and older in Alabama. The sample size of 15 was adequate for the phenomenological method of this study. While this was a small exploratory study and was not intended for any generalizations, it did provide a unique opportunity to hear the voices, the concerns, and the stories of elderly African Americans, which have often been overlooked in the literature. The following themes emerged from the analysis of data: (1) perception of health as ability to be active, (2) reluctance toward prescription medicine use, (3) lack of trust in doctors, (4) avoidance of bad news, (5) race of doctors, (6) use of home remedies, and (7) importance of God and spirituality on health, illness, and healing.

Focus groups were conducted with 33 community dwelling, urban and rural, custodial grandparents to explore their willingness to comply with a behavioral intervention targeting improving their well-being and financial management. Most participants were African American (91%), female (79%) and middle-aged. Major themes included: 1) inability to access social services; 2) legal assistance; 3) emotional well-being; 4) problems related to the parents of grandchildren; and 5) identification of structured activities for grandchildren. Findings suggest custodial grandparents underutilize services. Future research should address methods to enhance grandparents’ utilization of resources facilitated via a peer navigator system along with policy level changes.

Speaking Our Minds is Lisa Snyder's insightful accounts of seven interviews with individuals diagnosed with Alzheimer's disease. The major focus of the book is to bring “the voices” of persons livi...

This study examined demographic and mental health correlates of subjective well-being (i.e., life satisfaction, happiness) using a national sample of older African Americans with psychiatric disorders. We used a subsample of 185 African Americans, 55 and older with at least one of thirteen lifetime psychiatric disorders from The National Survey of American Life: Coping with Stress in the 21st Century (NSAL). The findings indicated that among this population of older adults who had a lifetime psychiatric disorder, having a lifetime suicidal ideation was associated with life satisfaction but not happiness. Further, having a 12-month anxiety disorder or a lifetime suicidal ideation was not associated with happiness. Having a 12-month mood disorder, however, was negatively associated with an individual's level of happiness, as well as their life satisfaction. Additionally, there were two significant interactions. Among men, employment was positively associated with life satisfaction, and marriage was associated with higher levels of happiness among men but not women. The overall pattern of findings reflects both similarities and departures from prior research confirming that well-being evaluations are associated with multiple factors.

The intent of this exploratory descriptive study was to examine mental health literacy (MHL) with 28 African American elders who reside in Kentucky. Collectively, all elders were partially literate of mental disorders and familiar with self-help and professional interventions and Alzheimer's and depression were the most recognized mental disorders. An awareness of MHL is an essential first step to understanding African American elders' views about mental health which then can facilitate the design and development of culturally relevant psychoeducational programs geared to this subset of the aging population.

Although the therapeutic strategy of serial 6-hour intravenous infusions of nesiritide for advanced chronic heart failure (HF) is currently under investigation, frequent hospital or clinic visits may present logistical challenges for many patients with HF. Therefore, a pilot study was conducted to evaluate the safety and tolerability of serial nesiritide infusions administered at home in this patient population. Twenty patients with advanced HF were enrolled into a protocol for the administration of 12 weekly intravenous infusions of nesiritide (2 microg/kg bolus, 0.01 microg/kg/min for 6 hours) at home. Blood samples and weights were obtained weekly, and clinical assessments were made at 4 and 12 weeks. During the 12-week study period, there were 3 deaths unrelated to nesiritide therapy. Six patients requiredor=1 hospitalization for HF. Two of 204 infusions resulted in symptomatic hypotension, and there were no adverse renal events. Mean body weight decreased at week 4 but returned to baseline by week 12. Antibodies to nesiritide were not detected in any patient. In conclusion, serial home infusions of nesiritide in patients with advanced HF appear to be safe and well tolerated, but the efficacy of this therapeutic strategy requires definition in a larger, randomized trial.

Background Dental caries is one of the most common chronic childhood diseases affecting a large portion of children in the United States. The prevalence of childhood dental caries in Kentucky is among the highest in the nation. The purposes of this study are to (1) compare sociodemographic differences between caries and no caries groups and (2) investigate factors associated with untreated dental caries among children who visited a mobile dental clinic in South Central Kentucky. Methods Study subjects were children aged 6 to 15 years who participated in the school-based dental sealant program through the mobile dental clinic operated by the Institute for Rural Health at Western Kentucky University between September 2006 and May 2011 (n = 2,453). Descriptive statistics were calculated for sociodemographic factors (age, gender, race/ethnicity, insurance status, and urban versus rural residential location) and caries status. We used chi-square tests to compare sociodemographic differences of children stratified by caries and no caries status as well as three levels of caries severity. We developed a logistic regression model to investigate factors associated with untreated dental caries while controlling for sociodemographic characteristics. Results The proportion of children having untreated dental caries was 49.7% and the mean number of untreated dental caries was 2.0. The proportion of untreated dental caries was higher in older children, children with no insurance and living in rural residential locations, and caries severity was also higher in these groups. Odds ratio indicated that older ages, not having private insurance (having only public, government-sponsored insurance or no insurance at all) and rural residential location were associated with having untreated dental caries after controlling for sociodemographic characteristics of children. Conclusions Untreated dental caries was more likely to be present in older children living in rural areas without insurance. Health interventionists may use this information and target rural children without having proper insurance in order to reduce geographic disparities in untreated dental caries in South Central Kentucky.