Ramon 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.

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.

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.

Veteran family reintegration, primary care needs, and the benefit of the patient-centered medical home model.

Men and women returning from the wars in Afghanistan and Iraq face a multitude of difficulties while integrating back into civilian life, but the importance of their veteran status is often overlooked in primary care settings. Family physicians have the potential to be the first line of defense to ensure the well-being of veterans and their families because many will turn to nonmilitary and non-Veterans Affairs providers for health care needs. An awareness of the unique challenges faced by this population is critical to providing care. A patient-centered medical home orientation can help the family physician provide veterans and their families the care they need. Specific recommendations for family physicians include screening their patient population; providing timely care; treating the whole family; and integrating care from multiple disciplines and specialties, providing veterans and families with “one-stop shopping” care. An awareness of the unique challenges faced by veterans and their families translates into better overall outcomes for this population.

Using Fotonovelas to Promote Healthy Eating in a Latino Community

AN IDENTIFIED NEED EXISTS for culturally relevant and linguistically appropriate health literacy strategies for Latinos. These photos are the product of a community based participatory research project to create a fotonovela—a graphic novel familiar to and popular with many Latinos—to support healthy eating in Latino families. The collaboration between Centro De La Comunidad Unida/United Community Center (UCC) and the Medical College of Wisconsin began with a series of focus groups held at UCC. Latinos living in the community expressed concern that available health education materials were unattractive, difficult to read, and poorly translated. However, participants also indicated interest in learning more about obesity and obesity-related chronic conditions. Like other Latinos nationwide, they lacked culturally and linguistically appropriate nutrition materials to address this issue. Our research team worked alongside community members to create a fotonovela (see next page). Participating community members actively shaped the content and issues in the fotonovela to ensure it was relevant to the culture, ethnicity, gender, social class, and language of the community and specific to identified community health needs. Group discussion and problem solving were inherent in developing the fotonovela. Contributing community team members cooperatively shared ideas and discussed life situations and health concerns to create the story line. The final product conveys ideas and information that other community members can relate to and apply in their own families. This approach empowers the community by encouraging members with few resources to communicate specific individual and general community health concerns. Esperanza Para La Salud: Pasos Para una Alimentacion Saludable (Hope for Health: Steps to Healthy Eating). Source. Centro de la Comunidad Unida (United Community Center). During a 14-month period in 2009 and 2010, a group of women came together at the UCC to learn about health and nutrition. These women were given cameras and used their newly gained knowledge to create this story about one familys discovery of healthy habits. The fotonovela was set in Milwaukee, Wisconsin, and all photos and individuals depicted in the fotonovela come from the community surrounding UCC. The fotonovela includes nutrition information, a recipe, and community-based nutrition and health resources. The overarching goal of this fotonovela is to prevent chronic disease by teaching and developing positive health habits for families. Our team is currently developing two more fotonovelas on critical community topics: depression and dementia caregiving.

Racial and Ethnic Variation in ADHD, Comorbid Illnesses, and Parental Strain

Our objective was to understand the racial and ethnic variation in parental strain for non-Latino White, African American, and Latino parents of children with ADHD and other comorbid diagnoses. We selected 5,397 children with a current diagnosis of ADHD from the 2007 National Survey of Child Health (NSCH) and identified comorbid conditions that could cause additional parental strain. Multivariate regression analyses of parental strain, from ADHD plus comorbid physical and mental health conditions, varied by race and ethnicity in our sample. Additionally we found variables such as mother’s mental health, family structure and social support to play significant roles in parental strain. These findings indicate a need for greater understanding of the family mechanisms in place that affect parental strain for these varying populations of families. Interventions to reduce parental strain also need to be tailored to the specific needs of racially and ethnically diverse parents of children with ADHD.

Activity-Limiting Musculoskeletal Conditions in US Veterans Compared to Non-Veterans: Results from the 2013 National Health Interview Survey

Past military service is associated with health outcomes, both positive and negative. In this study we use the 2013 National Health Interview Survey to examine the constellation of conditions referred to as musculoskeletal disorders (MSDs) for Veterans and non-veterans with health conditions that limit their daily activities. Multivariate logistic regression analysis reveal that Veterans are more likely to report MSDs like neck and back problems, fracture bone and joint problems as an activity limiting problem compared to non-veterans. The relationship between age and reports of activity limiting MSDs is moderated by Veteran status. Veterans in this sample report more activity limiting MSDs at younger ages compared to non-veterans and fewer MSDs at older ages. This research contributes to our understanding of potentially limiting health conditions at earlier ages for Veterans.

Predictors of Health Information Needs among U.S. Mainland and Puerto Rican Caregivers

Stroke caregivers often do not have the information necessary to adequately manage the stroke recovery process at home. We explore how the educational needs of stroke caregivers vary by race, ethnicity, and place, and their association with caregiver characteristics. We surveyed 276 stroke caregivers living on the U.S. Mainland and in Puerto Rico to assess their educational needs related to stroke recovery. Caregivers report a high overall need for educational materials with Puerto Rican stroke caregivers having greater needs compared to whites and African Americans on the Mainland. Increased caregiver educational needs are associated with greater desire to institutionalize, less positive appraisals of caregiving, greater use of coping strategies, and greater burden. All caregivers can benefit from educational materials, but special attention to island-dwelling Puerto Rican caregivers may provide additional benefit. Future research and interventions should focus on tailoring educational materials for race, culture, and other caregiver characteristics.

Military Service and Physical Capital

There are 22 million veterans in the U.S. Armed Forces. Past research on the musculoskeletal health of military veterans has explored the prevalence of musculoskeletal disorders (MSDs) but largely avoids situating findings within a theoretical framework. This article uses Pierre Bourdieu’s theory of cultural capital to contextualize veteran’s greater rates of MSDs compared to nonmilitary civilians. Cultural capital consists of objectified, institutional, and embodied capital that can be transubstantiated to capital in other areas. Embodied or physical capital is central to military service, and military veteran status is beneficial in accessing social and institutional capital. Using the 2012–2014 National Health Interview Survey, we show veterans are more likely to report activity-limiting MSDs, and at younger ages, compared to nonveterans. Physical capital is central to, and impaired by, status as a veteran.