Erica B. Stern

Community Education for Stroke Awareness An Efficacy Study

BACKGROUND AND PURPOSE This study examined the effectiveness of a slide/audio community education program aimed at increasing knowledge of stroke risk factors, stroke warning signs, and action needed when stroke warning signs occur. The program targets audiences at higher risk for stroke, especially individuals who are black or >50 years of age. METHODS Subjects were 657 adults living in the community or in senior independent-living settings. The study examined the effectiveness of the program when presented alone and when accompanied by discussion (facilitation) led by a trained individual. Knowledge of stroke risk factors and warning signs was assessed using parallel pretests and posttests developed and validated specifically for the study. RESULTS ANCOVA indicated that neither pretesting nor facilitation had a significant effect on posttest measures of knowledge. Paired t tests of groups receiving both the pretest and posttest demonstrated significant increase in knowledge (mean increase, 10.87%; P<0.001). ANCOVA indicated that these gains in knowledge were similar across subjects of different sex, race, age, and educational level. No significant differences could be ascribed to facilitation. CONCLUSIONS The data indicate that the slide/audio program is effective in increasing knowledge of stroke risk factors, warning signs, and necessary action in subjects of varying ages, races, and education. Pretesting and facilitation did not significantly affect the short-term acquisition of information. The slide/audio program appears to offer a short, easily used educational experience for diverse communities, whether as a stand-alone program or with facilitated discussion.

Finger dexterity and hand function: Effect of three commercial wrist extensor orthoses on patients with rheumatoid arthritis

OBJECTIVE To investigate the effect of 3 commercial wrist orthoses on finger dexterity and hand function of patients with rheumatoid arthritis (RA). METHODS Forty-two patients with definite RA participated in the cross-over study comparing 3 styles of commercial wrist orthoses. Finger dexterity and hand function of the dominant hand were assessed while splinted and unsplinted, at the initial session and after 1 week of intermittent orthosis use. Finger dexterity was assessed using two subtests from the Purdue Pegboard Test (Purdue) and hand function was assessed using the Jebsen-Taylor Hand Function Test (Jebsen-Taylor). RESULTS Both finger dexterity and hand function were reduced by splinting; men and women were affected similarly. There was no difference in finger dexterity or hand function afforded by the 3 orthoses. Results on both the Purdue and Jebsen-Taylor tests showed a significant learning effect across time. CONCLUSIONS The 3 commercial wrist orthoses studied reduce dexterity similarly and significantly. When commercial wrist orthoses are to be used during tasks that require maximum dexterity, this reduction should be weighed against the known benefits of splinting.

Effectiveness of two finger splints for swan neck deformity in patients with rheumatoid arthritis: a randomized, crossover trial.

OBJECTIVE To compare the effectiveness and acceptability of silver ring splints (SRS) and commercial prefabricated thermoplastic splints (PTS) in treating swan neck deformities in patients with rheumatoid arthritis (RA). METHODS Consecutive patients with RA and a mobile swan neck deformity were included in a randomized, crossover trial. In 2 different sequences, patients used both splints for 4 weeks, with a washout period of 2 weeks. Afterward, patients used the preferred splint for another 12 weeks. The primary outcome measure was dexterity measured with the Sequential Occupational Dexterity Assessment (SODA). Secondary outcome measures included other measures of hand function, satisfaction with the splints, and splint preference. RESULTS Fifty patients were included, and 47 (94%) of those completed the study. Eighteen patients (36%) had 1 swan neck deformity, whereas the other patients had 2 or more. The improvement of the total SODA score with the SRS (11.2; 95% confidence interval [95% CI] 8.1, 14.3) and PTS (10.8; 95% CI 7.5, 14.1) was similar (difference -0.5; 95% CI -2.2, 1.2). In addition, there were no significant differences in change scores regarding the other clinical outcome measures, or satisfaction. Twenty-four patients preferred the SRS, 21 preferred the PTS, and 2 patients chose neither. A comparison in the 12-week followup period yielded similar clinical outcomes, with the exception of a significantly higher score in 3 items of satisfaction in the SRS group. CONCLUSION For patients with RA and a mobile swan neck deformity, SRS and PTS are equally effective and acceptable.

Readability of patient education materials: a comparison of rural and urban cardiac rehabilitation sites in Minnesota.

PURPOSE Printed materials play a major role in cardiac rehabilitation (CR) patient education. Past studies have demonstrated a marked disparity between the average American reading ability (8th grade) and the readability levels of printed CR patient materials. This study compares the readability of facility-developed patient education materials used by rural and urban CR sites in Minnesota. METHODS By random selection, 30 rural and 30 urban CR sites were invited to submit printed education materials addressing home programs, exercise and activity guidelines, and leisure and recreation. Materials from 7 rural and 10 urban sites were submitted and assessed using the SMOG and SMOG-C readability formulas. RESULTS On the average, the materials from both urban and rural CR sites were written at a 10th-grade level. More than 87% of the sites required reading skills above the eighth-grade level. An independent t test showed no significant difference in the readability levels between the urban and rural sites. This study primarily compared readability across sites. However, the distribution of the 36 pieces of written material also was examined. Only 9% of the urban materials and 14% of the rural materials were written at or below the targeted eighth-grade level. CONCLUSIONS There was no significant difference in mean readability levels between urban and rural CR sites in Minnesota. On the average, the readability levels were two grades higher than recommended, with 87.5% of the CR sites expecting patients to learn information from materials too difficult for average American adults. The large number of polysyllabic words appears to be the main culprit for difficult readability levels.

Driving-related anxiety in recently deployed service members: cues, mental health correlates, and help-seeking behavior.

ABSTRACTRecent military operations have involved repeated trauma exposure while driving vehicles. Combat deployment and post-traumatic stress disorder (PTSD) have been associated with risky driving practices, increasing the likelihood of fatalities and problems adjusting to civilian life. However, no studies have specifically examined the role of driving-related anxiety, including common cues and mental health correlates. This study conducted structured interviews with 46 recently deployed service members. Interviews assessed the prevalence of driving-related anxiety or hyperarousal (anger or irritation) in relation to civilian driving scenarios, combat exposure, post-traumatic stress symptoms, depression symptoms, and help-seeking behavior. The majority of participants reported high driving anxiety or hyperarousal in response to scenarios involving close proximity to other cars. Driving-related anxiety was positively correlated with PTSD and depression. Although PTSD and driving anxiety were positively a...Recent military operations have involved repeated trauma exposure while driving vehicles. Combat deployment and post-traumatic stress disorder (PTSD) have been associated with risky driving practices, increasing the likelihood of fatalities and problems adjusting to civilian life. However, no studies have specifically examined the role of driving-related anxiety, including common cues and mental health correlates. This study conducted structured interviews with 46 recently deployed service members. Interviews assessed the prevalence of driving-related anxiety or hyperarousal (anger or irritation) in relation to civilian driving scenarios, combat exposure, post-traumatic stress symptoms, depression symptoms, and help-seeking behavior. The majority of participants reported high driving anxiety or hyperarousal in response to scenarios involving close proximity to other cars. Driving-related anxiety was positively correlated with PTSD and depression. Although PTSD and driving anxiety were positively associated with help seeking, only one-third of soldiers sought help for driving anxiety and most sought help from informal sources (i.e., friend and battle buddy). The findings underscore the need to address driving-related anxiety in combat-exposed service members with mental health symptoms, with a particular focus on specific anxiety-provoking situations. Furthermore, interventions that reduce stigma and improve access to formal care could improve help seeking and treatment for these problems.

Driving-related anxiety in recently deployed service members

ABSTRACTRecent military operations have involved repeated trauma exposure while driving vehicles. Combat deployment and post-traumatic stress disorder (PTSD) have been associated with risky driving practices, increasing the likelihood of fatalities and problems adjusting to civilian life. However, no studies have specifically examined the role of driving-related anxiety, including common cues and mental health correlates. This study conducted structured interviews with 46 recently deployed service members. Interviews assessed the prevalence of driving-related anxiety or hyperarousal (anger or irritation) in relation to civilian driving scenarios, combat exposure, post-traumatic stress symptoms, depression symptoms, and help-seeking behavior. The majority of participants reported high driving anxiety or hyperarousal in response to scenarios involving close proximity to other cars. Driving-related anxiety was positively correlated with PTSD and depression. Although PTSD and driving anxiety were positively a...Recent military operations have involved repeated trauma exposure while driving vehicles. Combat deployment and post-traumatic stress disorder (PTSD) have been associated with risky driving practices, increasing the likelihood of fatalities and problems adjusting to civilian life. However, no studies have specifically examined the role of driving-related anxiety, including common cues and mental health correlates. This study conducted structured interviews with 46 recently deployed service members. Interviews assessed the prevalence of driving-related anxiety or hyperarousal (anger or irritation) in relation to civilian driving scenarios, combat exposure, post-traumatic stress symptoms, depression symptoms, and help-seeking behavior. The majority of participants reported high driving anxiety or hyperarousal in response to scenarios involving close proximity to other cars. Driving-related anxiety was positively correlated with PTSD and depression. Although PTSD and driving anxiety were positively associated with help seeking, only one-third of soldiers sought help for driving anxiety and most sought help from informal sources (i.e., friend and battle buddy). The findings underscore the need to address driving-related anxiety in combat-exposed service members with mental health symptoms, with a particular focus on specific anxiety-provoking situations. Furthermore, interventions that reduce stigma and improve access to formal care could improve help seeking and treatment for these problems.