Symptom profiles of subsyndromal depression in disease clusters of diabetes, excess weight, and progressive cerebrovascular conditions: a promising new type of finding from a reliable innovation to estimate exhaustively specified multiple indicators-multiple causes (MIMIC) models.

Addressing subsyndromal depression in cerebrovascular conditions, diabetes, and obesity reduces morbidity and risk of major depression. However, depression may be masked because self-reported symptoms may not reveal dysphoric (sad) mood. In this study, the first wave (2,812 elders) from the New Haven Epidemiological Study of the Elderly (EPESE) was used.

The Role of Social Workers in Spiritual Care to Facilitate Coping With Chronic Illness and Self-Determination in Advance Care Planning.

Spiritual values and beliefs of patients and families influence resilience during chronic illness and shape patient choices during advance care planning. The spiritual needs of Baby Boomers will be more diverse than previous generations, in connection with the questioning, experimental mind-set of this group and the fact that it includes a higher proportion of immigrant populations outside the Judeo-Christian tradition. Social workers are trained explicitly to intervene with diverse populations and are well positioned to offer spiritual support in ways that do not necessarily conform to traditional religions.

Using an innovative multiple regression procedure in a cancer population (Part II): fever, depressive affect, and mobility problems clarify an influential symptom pair (pain-fatigue/weakness) and cluster (pain-fatigue/weakness-sleep problems).

Background: Most patients with advanced cancer experience symptom pairs or clusters among pain, fatigue, and insomnia. However, only combinations where symptoms are mutually influential hold potential for identifying patient subgroups at greater risk, and in some contexts, interventions with "cross-over" (multisymptom) effects. Improved methods to detect and interpret interactions among symptoms, signs, or biomarkers are needed to reveal these influential pairs and clusters.

Using an innovative multiple regression procedure in a cancer population (Part 1): detecting and probing relationships of common interacting symptoms (pain, fatigue/weakness, sleep problems) as a strategy to discover influential symptom pairs and clusters.

Background: The majority of patients with advanced cancer experience symptom pairs or clusters among pain, fatigue, and insomnia. Improved methods are needed to detect and interpret interactions among symptoms or diesease markers to reveal influential pairs or clusters. In prior work, I developed and validated sequential residual centering (SRC), a method that improves the sensitivity of multiple regression to detect interactions among predictors, by conditioning for multicollinearity (shared variation) among interactions and component predictors.

Ensuring safe access to medication for palliative care while preventing prescription drug abuse: innovations for American inner cities, rural areas, and communities overwhelmed by addiction.

This article proposes and develops novel components of community-oriented programs for creating and affording access to safe medication dispensing centers in existing retail pharmacies and in permanent or travelling pharmacy clinics that are guarded by assigned or off-duty police officers. Pharmacists at these centers would work with police, medical providers, social workers, hospital administrators, and other professionals in: planning and overseeing the safe storage of controlled substance medications in off-site community safe-deposit boxes; strengthening communication and cooperation with the prescribing medical provider; assisting the prescribing medical provider in patient monitoring (checking the state prescription registry, providing pill counts and urine samples); expanding access to lower-cost, and in some cases, abuse-resistant formulations of controlled substance medications; improving transportation access for underserved patients and caregivers to obtain prescriptions; and integrating community agencies and social networks as resources for patient support and monitoring. Novel components of two related community-oriented programs, which may be hosted outside of safe medication dispensing centers, are also suggested and described: (1) developing medication purchasing cooperatives (ie, to help patients, families, and health institutions afford the costs of medications, including tamper-or abuse-resistant/deterrent drug formulations); and (2) expanding the role of inner-city methadone maintenance treatment programs in palliative care (ie, to provide additional patient monitoring from a second treatment team focusing on narcotics addiction, and potentially, to serve as an untapped source of opioid medication for pain that is less subject to abuse, misuse, or diversion).

Interpreting interactions of ordinal or continuous variables in moderated regression using the zero slope comparison: tutorial, new extensions, and cancer symptom applications.

Moderated multiple regression (MMR) can model behaviours as multiple interdependencies within a system. When MMR reveals a statistically significant interaction term composed of ordinal or continuous variables, a follow-up procedure is required to interpret its nature and strength across the primary predictor (x) range. A follow-up procedure should probe when interactions reveal magnifier (or aggravating) effects and/or buffering (or relieving) effects that qualify the x-y relationship, especially when interpreting multiple interactions, or a complex interaction involving curvilinearity or multiple co-moderator variables.

Agency social workers could monitor hypertension in the community.

Uncontrolled hypertension is highly prevalent, presents without symptoms, and constitutes a major risk factor for atherosclerosis, heart disease, stroke, and diabetes. Several factors impede individuals from adhering to treatment, while others work against physician monitoring and medication adjustment as the condition changes. As family counselors and leaders of self-help and mutual aid groups, social workers are among the best positioned professionals to help individuals, couples, and families improve psychosocial dynamics associated with hypertension, secure support, and overcome barriers to lifestyle changes or medication adherence.

Use of an Income-Equivalence Scale to Understand Age-Related Changes in Financial Strain.

Income-equivalence scales (IES) provide distinct advantages over poverty indices to adjust family income for differences in family size, including improved specification of hypothesized causal relationships involving objective measures of economic well-being. In a novel IES application, cancer patients' out-of-pocket health costs are adjusted for differences in family income and size and, along with five other subindices, contribute to an overall index of "objective family financial stress." Age-related changes are modeled simultaneously within relationships between overall objective family financial stress and subjective patient perceptions about financial strain.

The influence of age on perceptions of anticipated financial inadequacy by palliative radiation outpatients.

Objective: A consistent body of knowledge suggests that with advancing age, adults tend to report lower financial strain from their current economic condition. But are more negative perceptions shifted onto their expectations about their future economic condition? This study of seriously ill outpatients investigates whether advancing age is related to more negative expectations of future health-related financial strain, in which illness progression would necessitate greater health care consumption.

Methods: Ordinal probit multivariate regression was conducted on survey findings from 268 outpatients initiating palliative radiation for recurrent cancer.

Palliative care in the inner city. Patient religious affiliation, underinsurance, and symptom attitude.

Many barriers, including being uninsured or having less than comprehensive health insurance coverage, reduce access to palliative and end-of-life care by inner city minorities. Medicaid or Medicare coverage alone can limit options for pain and symptom management, especially when late referrals make it more difficult to achieve symptom control. Patient affiliation with a religion could offset perceived difficulties with pain medication as well as negative pain and symptom attitudes.

A flexible item to screen for depression in inner-city minorities during palliative care symptom assessment.

Objective: There is inconsistent evidence for the validity of a single item to screen depression. In inner-city minority populations, the "yes/no" forced-response option may encourage bias, especially in elders and men, who view depression as stigmatizing or the healthcare system as untrustworthy. In contrast, an open-choice format with a category for ambivalent and missing responses could be acceptable if administered during the legitimized context of a physical symptom assessment.

Cumulative financial stress and strain in palliative radiation outpatients: The role of age and disability.

Objective financial stress, which incorporates all medical and non-medical financial stressors by households, shapes patients' subjective perceptions of financial strain. This study addresses whether patient age and disability days reveal patients to have different perceptions of financial strain even when their households incur the same level of financial stress. Among patients with the same level of household financial stress, older patients perceived less financial strain from difficulty paying bills than younger patients.

A national agenda for social work research in palliative and end-of-life care.

Background: Social work practitioners have the potential to make meaningful contributions to improving palliative and end-of-life care because of their work in varied and divergent practice settings across the lifespan, their role in addressing mental health needs, grief and psychosocial aspects of well-being, and their commitment to promoting culturally competent, effective, and humane care, particularly for the most vulnerable and oppressed members of society. The federal government and several national and professional institutes have called for steps to increase the participation of social work researchers as well as to improve the quality, quantity, and dissemination of social work research.

Objective: This paper proposes a national agenda for social work research in palliative and end-of-life care.

The relationship of cancer symptom clusters to depressive affect in the initial phase of palliative radiation.

Research on comorbidity across cancer symptoms, including pain, fatigue, and depression, could suggest if crossover effects from symptom-specific interventions are plausible. Secondary analyses were conducted on a survey of 268 cancer patients with recurrent disease from a northeastern U.S.