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Influence of Cognitive Performance on Pain Management Among Older Adults with Chronic Pain
No full textPain management is particularly challenging among older adults with cognitive impairment. Self-efficacy for pain management can promote effective pain management; however, the interplay between cognitive performance and self-efficacy on pain management is complicated and not well understood. The aims were to examine the relationship between cognitive performance, self-efficacy for pain management and pain management. Secondary data analyses were performed in 511 participants aged ≥ 70 years, reporting chronic pain (BPI ≥ 1) and pain management information at baseline, from the MOBILIZE Boston study. Cognitive performance was assessed using the Clock in the Box Test (CBT), Letter Fluency Test (LFT), Trail Making Test (TMT) Part A and B, the Hopkins Verbal Learning Test (HVLT), and the WORLD test. Self-efficacy for pain management was measured by the Chronic Pain Self-Efficacy (CPSE) questionnaire. Pain management was assessed by recommended and self-reported effectiveness of pain management. Recommended pain management was defined as using the endorsement of pharmacological and non-pharmacological pain management, while effectiveness of pain management was defined by the self-reported percent of pain relief after pain management. 0% represented no relief and 100% referred to full relief . This study classified effectiveness of pain management to two groups: 1) effective pain relief group, referring to the percentage of pain alleviation ≥ 70%, and 2) ineffective group, referring to \u3c 70%. Multiple linear regression was employed to examine the relationship between cognitive performance and self-efficacy for pain management, and logistic regression analysis was conducted to test the association between cognitive performance, self-efficacy for pain management, and pain management. At baseline, the CPSE mean (standard deviation [SD]) was 34.58 (10.18). 53.62% (229 of 427) of participants had self-reported effective pain management, and 25.44% (130 of 511) of participants employed recommended pain management. After adjusting for sociodemographic characteristics, CBT and TMT-A were associated with self-efficacy for pain management. Cognitive performance was not associated with recommended or self-reported effectiveness of pain management. Self-efficacy for pain management was independently associated with self-reported effective pain management. It was also negatively associated with the likelihood of recommended pain management. The relationship between cognitive performance and pain management did not differ by self-efficacy. Longitudinal analysis showed baseline self-efficacy predicted self-reported effective pain management at 18 months. Healthcare providers should use tailored intervention to improve memory and self-efficacy for pain management to encourage older adults to effectively control pain. Further studies are needed to investigate the effect of other cognitive performance domains on pain management and the strategies to improve self-efficacy in diverse older population
Toward Modular Enzyme Systems for Modifying DNA and Peptides: First Structures of Phage DNA Hypermodification Enzymes and Computational Analysis of NRPS Heterocyclization Domains
No full textIn one use, “modularity” refers to properties of the components of a system that permit them to be separated and preserve functionality upon recombination in various ways. Constraints are often placed on modularity of natural biosynthetic pathways so that a limited set of products is selectively produced. Control is largely achieved by two means: 1) enzyme specificity for substrate features other than the moiety acted on by catalysis and 2) spatiotemporal separation of enzyme activities. Classic examples of modular enzyme systems are found in the megaenzymes of nonribosomal peptide and polyketide biosynthesis. Even in those systems, however, there are substrate and protein-protein interaction specificities such that attempts to mix and match domains have typically resulted in reduced activity for the products targeted by engineering relative to the activities of wild-type systems for their products. The work presented here examines properties that permit and control modularity in the activities of enzymes in two systems. The first body of work describes using experimental phasing techniques to solve the crystal structures of the first two enzymes of DNA hypermodification in Pseudomonas phage M6: the first representative of a family of kinases with the remarkable activity of phosphorylating the major-groove edge of a 5-hydroxymethyldeoxyuridine (5-hmdU) base in double-stranded DNA, and the first representative of a family of transferases that exchange the phosphate group on the DNA base for an amino acid. These structures have identified substrate ATP and metal cofactor binding sites and reveal how evolution has repurposed two common enzyme folds to achieve modification of a nucleobase in the DNA fiber. The second body of work describes computational studies of a heterocyclization domain from the nonribosomal peptide synthetase (NRPS) that produces the plague virulence factor and siderophore yersiniabactin. This work explores substrate binding and the potential roles of domain flexibility in traversing the reaction coordinate as well as in allosteric communication of interdomain binding events to the active site for control of the catalytic cycle. Both projects will be discussed in relation to each system’s modularity and the potential for enhancement and use of that modularity in protein engineering efforts
Age & Dementia Friendly Plymouth: A Community Needs Assessment
Get PDFThis report describes research undertaken by the Center for Social & Demographic Research on Aging (CSDRA) within the Gerontology Institute at the University of Massachusetts Boston, on behalf of the Town of Plymouth. The goals of this project were to investigate the needs, interests, preferences, and opinions of Plymouth’s residents age 55 or older in support of the Council on Aging’s (COA’s) objective to identify and serve the needs of all Plymouth citizens 55 and older. The contents of this report are meant to inform the Town of Plymouth, the Plymouth COA, the Center for Active Living, and organizations that work with and on behalf of older residents of Plymouth for the purposes of COA mission fulfillment alongside planning and coordination of services for current and future needs of residents. The report will also help to build awareness about issues facing Plymouth among community members at large
Front Matter and Table of Contents
Get PDFFront matter and table of contents for Volume 35, Issue 1 of the New England Journal of Public Policy
A Framework for Introducing and Sustaining Play at Work
Get PDFThis paper presents a framework for introducing and sustaining play at work, focusing on its impact on creativity, problem solving, team performance, psychological safety, and organizational change. The author explores the concept of playfulness in a work setting and its potential to foster divergent thinking. Drawing on a real-life scenario involving a team of high school students participating in a Destination Imagination challenge, the paper highlights the role of play and risk-taking in problem-solving processes. The study emphasizes the importance of creating an environment that encourages play and experimentation while maintaining a sense of safety and support. The findings suggest incorporating play into work environments can enhance creativity, team collaboration, and innovative problem-solving approaches. This framework offers valuable insights for individuals and organizations seeking to cultivate a culture of play in various domains, including work, education, and social movements
Latinos in Massachusetts Selected Areas: Fitchburg
Get PDFFitchburg is a city of 41,946 residents, including 12,608 (30.1%) who identify as Latino or Hispanic, according to the 2020 Decennial Census. Statewide, Latino residents contribute 12.6% of the total population. In Fitchburg, Whites make up the majority (54.6%) of the city, while Blacks and Asians account for 6.1% and 3.6% of the population, respectively.
Between 2010 and 2020, the Latino population grew by 44.5% and was only outpaced by Blacks (59.8%). With these two populations outpacing Fitchburg\u27s 4.0% population growth during the decade, the White population experienced a 16.7% decrease. By comparison, the White population in Massachusetts declined by 4.7%, while the Latino population increased by 41.4%. The smaller Asian population in Fitchburg grew by 3.9%.
The remainder of this profile uses 2017–2021 American Community Survey data in order to analyze the demographic and economic characteristics presented in this profile.
Fitchburg has a well-established Puerto Rican population. There are 9,261 Puerto Ricans, compared to only 972 Mexicans, the second-largest Latino population in the city. Other smaller Latino populations are Uruguayans, Dominicans, and Ecuadorians. Statewide, the five largest Latino populations in Massachusetts in order of size are Puerto Ricans, Dominicans, Salvadorans, Guatemalans, and Mexicans.
Despite having a sizeable Latino community, Fitchburg has a very small foreign-born population, making up only 4.3% of town residents. (Note that Puerto Ricans are U.S. citizens by birth, whether born on the island or the mainland.) By comparison, foreign-born residents of Massachusetts make up 17.3% of the statewide population, and Latinos are 32.1% foreign-born
Latinos in Massachusetts Selected Areas: Haverhill
Get PDFThe city of Haverhill, Massachusetts, has 67,787 residents, of whom 15,998 identify as Latino, according to the 2020 Decennial Census. The city is majority non-Latino White (66.3%), with Latinos making up the second largest ethnic-racial group (23.6%). Latinos are a higher proportion of Haverhill’s population than of the statewide population, of which they account for 12.6%. Black, Asian, and “other” populations collectively make up only 10.1% of Haverhill’s population.
Between 2010 and 2020, Haverhill’s population increased by 11.2%, faster than the statewide increase of 7.4%. The Latino population’s 81.2% increase accounted for much of the city\u27s growth. The statewide Latino population grew by 41.4% during this same time. The larger White population of Haverhill declined by 7.2%, while the Black population grew steeply, by 63.2%, and the smaller Asian population increased by 34.0%.
The remainder of this profile uses 2017–2021 American Community Survey data to analyze the demographic and economic characteristics presented in this profile.
With 11.7% of its population foreign-born, Haverhill has a lower share than the Commonwealth as a whole (17.3%). However, this is not the case among Latinos in Haverhill, as 32.4% of their population is foreign-born, similar to the Latino statewide share (32.1%). (Note that Puerto Ricans are U.S. citizens by birth, whether born on the island or the mainland.)
Latinos in Haverhill look similar to those in other cities and towns around the Commonwealth. Two groups dominate the Latino community in Haverhill—Puerto Ricans and Dominicans—with more than 5,000 residents each. Colombians, Mexicans, and Guatemalans are the next largest Latino groups, though each number fewer than 1,000. Statewide, the five largest Latino populations in Massachusetts in order of size are Puerto Ricans, Dominicans, Salvadorans, Guatemalans, and Mexicans
Latinos in Massachusetts Selected Areas: Quincy
Get PDFQuincy is a city of 101,636 residents, of whom 5,214, or 5.1%, identify as Latino or Hispanic, according to the 2020 Decennial Census. (Statewide, Latino residents constitute 12.6% of the total population.) In Quincy, the largest resident population is Whites (54.2%), followed by Asians (30.7%) and Blacks (5.4%).
Between the 2010 and 2020 Decennial Censuses, Quincy experienced 10.1% population growth, slightly higher than the state’s 7.4% growth. Latinos, however, increased by a much higher percentage in Quincy (68.8%) than statewide (41.4%). The Asian population grew by 41.0%, and the Black population increased by 36.3%. Similar to many other cities and towns, the White population in Quincy declined by 8.9%.
The remainder of this profile uses 2017-2021 American Community Survey data in order to analyze the demographic and economic characteristics presented in this profile.
Like most other cities and towns in the metro region, Quincy has long been a destination for international migrants. Today, the city has a greater share of foreign-born residents (33.0%) than the Commonwealth as a whole (17.3%). This is also the case among Latinos. In Quincy, 35.5% of the Latino population is foreign-born, slightly more than the 32.1% foreign-born among Latino statewide.
The Latino population in Quincy is a mix of Latinos of different origins. Puerto Ricans are the largest single group in Quincy, and Dominicans are the second largest, followed by Peruvians, Colombians, and Mexicans. Statewide, the five largest Latino populations in Massachusetts in order of size are Puerto Ricans, Dominicans, Salvadorans, Guatemalans, and Mexicans. Puerto Ricans, who are citizens, are not counted among the foreign-born regardless of where they were born
Implementation of a Decision Aid to Increase the Rate of Routine Breast Cancer Screening Among Women Between 50 to 74 Years Old at a Federally Qualified Health Center
Get PDFBackground: Breast cancer is the most prevalent form of cancer in the U.S. Cancer screenings can result in prompt treatments and positive health outcomes. Disparities in screening rates are prevalent among vulnerable populations. At a Federally Qualified Health Center (FQHC), where the project occurred, the rate of breast cancer screening in 2021 (64%) was lower than the target set by the Healthy People 2030 (77%). This quality improvement project aimed to increase the rate of routine breast cancer screening among women aged 50-74 years old in the FQHC.
Methods: Previous studies have reported that decision aids on breast cancer screening can decrease decisional conflict, increase screening intention and screening rates. In collaboration with an on-site committee, a standardized patient outreach process using a decision aid on breast cancer screening was developed and assessed.
Intervention: A phone script incorporating a decision aid was used to provide information on mammograms to eligible patients. The patients were offered an appointment for a mammogram. Four months after this call, the participants’ medical charts were reviewed for the completion of the scheduled mammogram. A group of FQHC staff reviewed the outcomes and provided feedback. Follow up calls were made to patients who declined the decision aid, declined the mammogram after completing the decision aid, and missed their scheduled mammogram.
Results: Sixty-five percent of eligible patients (n = 103) were successfully contacted. Of this number, 30% completed the decision aid, in which 75% of these patients scheduled a mammogram and 47% completed the screening. Of the patients who did not complete the decision aid, 57% scheduled a mammogram, and 67% completed the screening. Ninety-five percent of participants who completed the decision aid thought they made an informed decision about having a mammogram.
Conclusion: Consistent with the improved screening rates for mammograms after implementation of a decision aid reported in the literature (47%), the outreach calls with the decision aid led to more scheduled mammograms (47%) at the project site. The decision aid appears to promote more awareness about breast cancer screening at the project site rather than increase screening rate
The Messy Middle : A Framework for Analyzing Raciolinguistic Inequity
Get PDFExisting research has demonstrated that bilingual education in the United States is highly inequitable, providing greater benefits to white English speakers than to students from minoritized backgrounds (e.g., Babino & Stewart, 2017; Palmer, 2009). Additional research has suggested that bilingual spaces also uphold whiteness and English hegemony outside of classrooms, in spaces like parent groups to administrative decisions (e.g., Gallo, 2017; Jacobsen et al., 2019). This ethnographic case study of a Spanish-English Two-Way Dual Language (TWDL) elementary school examines raciolinguistic positioning and interactions among students, teachers, and parents. Drawing on dysconscious racism (King, 1991), LangCrit (Crump, 2014), and critical consciousness (Freire, 2018), this study utilizes a continuum of adherence to existing raciolinguistic power structures to examine the intersection of race and language in TWDL at the classroom, school, and community levels, with a particular emphasis on the ‘messy middle’. I argue that the ‘messy middle’ is a useful lens that offers new and more nuanced language to examine raciolinguistic power structures in bilingual education. Implications for future research in bilingual education and practical recommendations for TWDL communities are discussed