Background Low socioeconomic status (SES) is a strong predictor of many health problems, including asthma impairment; however, little is understood about why some individuals defy this trend by exhibiting good asthma control despite living in adverse environments. Objective This study sought to test whether a psychological characteristic – “shift-and-persist” (dealing with stressors by reframing them more positively, while at the same time, persisting in optimistic thoughts about the future) - protects low SES children with asthma. Methods 121 children physician-diagnosed with asthma, ages 9-18, were recruited from medical practices and community advertisements (M age=12.6, 67% male, 61% Caucasian). Shift-and-persist and asthma inflammation (eosinophil counts, stimulated IL-4 cytokine production) were assessed at baseline, and asthma impairment (daily diary measures of rescue inhaler use and school absences), and daily peak flow were monitored at baseline and at a 6-month follow-up. Results Children who came from low SES backgrounds but who engaged in shift-and-persist strategies displayed less asthma inflammation at baseline (β=.19, p<.05), as well as less asthma impairment (reduced rescue inhaler use and fewer school absences; β=.32, p<.01) prospectively at a 6 month follow-up period. In contrast, shift-and-persist strategies were not beneficial among high SES children with asthma. Conclusion An approach that focuses on the psychological qualities that low SES children develop to adapt to stressors may represent one practical and effective starting point for reducing health disparities. Moreover, the approaches that are effective in low SES communities may be different from those that are optimal in a high SES context.

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BackgroundFrail seniors often receive ineffective care, which does not meet their needs. It is still unclear how healthcare systems should be redesigned to be more sensitive to the needs and values of frail seniors and their caregivers. We thus aimed to describe key stakeholders’ perspectives on the current healthcare and services available to frail seniors.MethodsIn this qualitative descriptive study, we conducted semi-structured interviews with a convenience sample of 42 frail seniors, caregivers, clinicians, or healthcare administrators/decision makers involved in frail senior care from five Canadian provinces. We explored participants’ perspectives on the quality of care and services for frail seniors. We used an inductive/deductive thematic data analysis approach based on the Square-of-Care model, including emerging themes using the constant comparison method.ResultsWe grouped participants’ perspectives into strengths, weaknesses and opportunities for improvement, and then into nine themes: care processes, continuity of care, social frailty, access to healthcare and services, models of healthcare delivery, cost of care, healthcare staff management and professional development of healthcare providers, material resources and environmental design of healthcare facilities, and coordination of care. Our findings suggest redesigning assessment, communication with frail seniors and their caregivers, targeting care and services to the needs, and integrating care better across settings and in time.ConclusionsA systematic identification of frail older people is the first step to adapt healthcare systems to this population’s needs. Participation of frail older people and their caregivers to decision making would also allow choosing care plans meeting their care goals. The integration of care and services across settings, over time, and with various providers, is also needed to meet frail senior needs.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0969-y) contains supplementary material, which is available to authorized users.

Using a qualitative design, the purpose of this study was to examine how people describe their relationship with their dog and what they do that suggest this bond represents a meaningful relationship. Dog owners (N = 27) aged 19 years and older were invited to participate in one of seven focus group discussions. A qualitative content analysis revealed the presence of three themes: (a) the impact of dogs on interpersonal relationships, (b) dogs as subjective beings, and (c) psychological and health benefits of dogs. The second theme reflects the personal agency of dogs and their unique contributions to the human-dog relationship. These themes are discussed in light of the current research in the field. The findings suggest implications for counseling research and practice in improving the health and well-being of dog owners.