Melanie Sberna Hinojosa

Transition Experiences of Stroke Survivors Following Discharge Home

Abstract Background: Little is known about the transition experiences of stroke survivors after discharge home. Purpose: The purpose of this article is to describe three domains of psychosocial experiences of stroke survivors during the first month following discharge for acute stroke. Method: Data were collected from 125 stroke survivors interviewed at 1 month following discharge home. Results: Findings indicate that changes in sense of self, connectedness with others, and community integration presented the major challenges.

BLACK-WHITE DIFFERENCES IN SCHOOL SUSPENSION: EFFECT OF STUDENT BELIEFS ABOUT TEACHERS

Research suggests that there are differences in the frequency with which white and African American students are punished in schools, with African American students being 2.3 times more likely to be suspended than white students. Most of the research on school punishment has focused on documenting race differences and looking for student and school-level factors to help explain disproportionality in out-of-school suspension. This study aims to fill the gap in the literature by analyzing the role of the teacher in affecting student punishment in a large, urban, primarily minority student district. Results indicate that positive teacher behavior toward students and positive teacher expectations of students reduces suspension from school.

Subjective sleep, burden, depression, and general health among caregivers of veterans poststroke.

The purposes of this article are to explore and describe subjective sleep experiences of informal caregivers of stroke survivors and to explore the relationships between subjective sleep experiences, caregiver burden, depression, and health to provide a broader portrait of the role that sleep plays in the stroke caregiving experience. A total of 276 caregivers and veterans participated in the study. Results indicate a greater risk of depression (Center for Epidemiologic Studies-Depression Scale) among caregivers who sleep less, have difficulty achieving daytime enthusiasm, use sleep medications, and have poor sleep quality. Caregivers who sleep less have difficulty achieving daytime enthusiasm and are at greater risk of poor health. Greater caregiver burden was associated with less sleep and use of sleep medications. This descriptive analysis demonstrates the important relationship between sleep, depression, health, and burden and can lead to interventions to diagnose and treat sleep difficulties in caregivers.

Social Isolation Poststroke: Relationship Between Race/Ethnicity, Depression, and Functional Independence

Abstract Research suggests that individuals recovering from a stroke often experience social isolation, which is linked to increased depressive symptomatology and decreased ability to manage activities of daily living. Research also indicates that different racial and ethnic groups are more adversely affected than whites. This article uses poststroke narratives to explore the relationship between social isolation, depressive symptomatology, and the ability to manage activities of daily living poststroke for white, African American, and Puerto Rican veterans. Findings suggest those who were socially isolated during the first year of poststroke recovery reported higher levels of depressive symptoms and a decreased ability to manage daily activities. Implications for stroke rehabilitation practice are discussed.

Identifying at-risk, ethnically diverse stroke caregivers for counseling: a longitudinal study of mental health.

PURPOSE This study examined (1) causality in the relationship between stroke caregiver mental health and care-recipient functioning, and (2) the prediction from stroke caregiver and care-recipient variables 5 months and 11 months later. RESEARCH METHOD Questionnaire, interview, and observational data were collected from 124 ethnically diverse stroke caregiver/care-recipient dyads in the homes of care recipients at 1, 6, and 12 months after discharge. RESULTS The magnitudes of the causal pathways between stroke caregiver mental health and care-recipient functioning were not significantly different. At 1 month after discharge, the best predictors of poor caregiver mental health 11 months later were care-recipient low daily functioning and caregiver low sense of coherence, high burden, and high depression. CONCLUSIONS Caregiver mental health and care-recipient functioning may have reciprocal causal influence on each other, so one of the first steps in stroke rehabilitation may be providing counseling to the primary caregiver. Caregivers with high burden, a low sense of coherence, and a low-functioning care recipient are those most at risk for poor mental health outcomes.

Association between health education needs and stroke caregiver injury.

Objectives: Many stroke caregivers are inadequately informed about stroke and its sequelae and have little preparation for the physical demands of moving, lifting, and handling often required. Our objectives are to examine the association between health education needs and physical injury sustained as a result of activities related to the caregiving role. Method: A total of 276 caregivers of veterans who suffered an acute stroke event were surveyed about their information needs and injury status.We used multivariate logistic regression analysis to calculate adjusted and unadjusted odds ratios for injury status. Results: Results indicate that in the adjusted model, caregivers who had increased educational needs were almost twice as likely (OR: 1.80; 95% CI: 1.74-1.94) to have incurred an injury related to caregiving activities. Conclusions: Health education interventions that provide stroke caregivers with educational materials may help reduce caregiver injuries.

Stroke caregiver information needs: Comparison of Mainland and Puerto Rican caregivers

Research indicates that informal caregivers of stroke survivors often do not have the information necessary to adequately manage the recovery process at home. This article presents findings on the information sources and needs of stroke caregivers both in Puerto Rico and the Mainland United States. Data were collected from 120 caregivers (42 Puerto Rican, 78 Mainland) of veterans who had experienced a stroke. Of all caregivers, 22% to 50% reported the need for information related to stroke recovery. This need was greater for Puerto Rican caregivers compared with Mainland caregivers. Caregivers receive most of their information from their doctors, the Veterans Health Administration (VHA), and the Internet. This study highlights the need for information dissemination to Puerto Rican and Mainland caregivers within the VHA system. This dissemination is an important and ongoing goal of the Stroke Quality Enhancement Research Initiative and the VHA/ Department of Defense Clinical Practice Guidelines.

Parental strain, parental health, and community characteristics among children with attention deficit-hyperactivity disorder

OBJECTIVE It has been documented that parenting a child with attention deficit-hyperactivity disorder (ADHD) can cause family strain, but less is known about the added stress of additional child health diagnoses on levels of strain. This study explores the relationship between family stressors (such as child comorbid conditions) and family resources (such as social support, community characteristics, and parental health) on parental strain. METHODS We used the 2007 National Survey of Childrens Health (NSCH) to identify children with ADHD and other comorbid mental and physical health conditions (n = 5473). Descriptive, bivariate, and multivariate analyses were conducted to explore the association between parental strain, social support, mothers mental health, and neighborhood amenities within groups of children with ADHD and comorbid conditions. RESULTS Parental strain was greatest when ADHD was paired with a conduct disorder, physical disorder, or other mental health disorder. Specifically, parental strain was greatest for children with ADHD plus a comorbid conduct disorder compared with ADHD alone. It was also greater for children with other mental and physical health diagnoses compared with children with ADHD alone. Better mental health of mothers in the sample is related to reduced parental strain. Greater access to social support and neighborhood amenities also are related to reduced parental strain. CONCLUSIONS Greater levels of social support and better mental health of parents is associated with decreased strain. Interventions aimed at relieving stress and building strategies to improve mental health can be beneficial for families with children with ADHD and comorbid conditions.

Salud de la Mujer: Using Fotonovelas to Increase Health Literacy Among Latinas

Background: There is an identified need for health literacy strategies to be culturally sensitive and linguistically appropriate.Objectives: The goal of our community-based participatory research (CBPR) project related to health and nutrition is to demonstrate that active community involvement in the creation of health education fotonovelas that are relevant to culture, ethnicity, gender, social class, and language can increase the health literacy of women in a disadvantaged community.Methods: We recruited 12 women to take part in our pilot fotonovela intervention about healthy eating and nutrition. Pre- and post-test assessments of knowledge, attitudes, and behavior around nutrition were given at baseline and will be collected after the completion of the project.Results: We hypothesize that post-test assessments of our participants will reveal increased nutrition knowledge as well as positive changes in attitudes and behavior toward healthy eating.Conclusions: We believe that our fotonovelas will represent experiences of community members and encourage good health practices by increasing knowledge and cooperation among community members.

Patterns of informal care among Puerto Rican, African American, and white stroke survivors

Background. There has been an increase in the number of non-institutionalized stroke survivors over the past few decades leading to larger numbers of family caregivers. Less is known about the patterns of informal caregiving within racially and ethnically diverse families even though there is greater post-stroke morbidity and mortality for these groups. Research aims. The purpose of our research is to examine the informal caregiving networks of white, African American, and Puerto Rican caregivers. Methodology. We examine data collected from 118 stroke survivors and caregivers to explore the dynamics of caregiving. Data are drawn from a diverse group of whites, African Americans, and Puerto Ricans living on the US Mainland and Puerto Rico at three different time points over the course of 12 months. Analysis. We examine the size, stability, change, and family dynamics of informal caregiving networks. Findings and implications. We find that whites, African Americans, and Puerto Ricans each have differing caregiving structures highlighted by expansion and contraction across time, size of network, and relationship to the stroke survivor. Greater cultural awareness among health professionals can lead to improved coordination of information or formal care services. These findings may also be used as a baseline for understanding the caregiving patterns of other Spanish-speaking Caribbean nations.