Intellectual Disabilities and Decision Making at End of Life: A Literature Review.

BACKGROUND: Individuals with an intellectual disability are vulnerable to having end-of-life decisions made for them merely due to the presence of a disability. As a result, decisions made by others may not reflect the exact wishes of the individual. METHODS: This review examines literature on individuals with an intellectual disability in making end-of-life decisions from the years 2000 to 2014. A total of 38 articles were found with 12 articles having a direct focus on end-of-life decision making. RESULTS: The emerging themes include the following: (i) assumption of lack of capacity, (ii) inconsistency in evaluating capacity and communication challenges and (iii) third party decisions. CONCLUSIONS: Earlier discussions about end-of-life planning before the diagnosis of a life-limiting illness would be beneficial. Lacking is a consistent approach to determining capacity for individuals with an intellectual disability. The findings from this review provide a foundation for a decision tree in end-of-life decision making for individuals with an intellectual disability.

Interpersonal violence and traumatic brain injuries among Native Americans and women.

OBJECTIVES: This study aimed to assess the odds of experiencing a traumatic brain injury (TBI) as a result of interpersonal violence (IPV) among Native Americans compared to other races controlling for gender, age, socioeconomic status, rurality and intoxication at the time of the injury. METHODS: A secondary data analysis of the Arizona Trauma Database consisting of 18 944 cases of TBI between 2008-2010 throughout the state of Arizona was conducted. There were 312 patients who experienced injuries caused by IPV in the sample. Descriptive statistics, cross-tabulations, bivariate analyses and a logistic regression model were used for analyses. RESULTS: The logistic regression model found that Native Americans (OR = 1.15), patients from the other race category (OR = 1.18), females (OR = 1.35) and those who were insured (OR = 1.26) had higher odds of experiencing a TBI as a result of IPV. Rurality and intoxication were mediators of the correlation between Native American race and TBI as a result of IPV. CONCLUSIONS: Native Americans are more likely than Whites and females are more likely than males to experience TBIs as a result of IPV.

Traumatic brain injury as a result of violence in Native American and Black communities spanning from childhood to older adulthood.

PRIMARY OBJECTIVE: The purpose of this study was to compare the aetiology of TBI between different race, gender and age groups to understand demographic characteristics of people who experience TBI. RESEARCH DESIGN: A secondary data analysis of the Arizona Trauma Database consisting of 18 868 cases of TBI between 2008-2010 was conducted. METHODS AND PROCEDURES: The sample consisted of patients who ranged in age from 0-79 and were White, Black, Native American, Asian or other race. Cross-tabulations, chi-squares and a logistic regression were conducted. MAIN OUTCOMES AND RESULTS: Standardized residuals indicated that Native Americans and Blacks were more likely to experience violent TBI, regardless of gender or age group (p < 0.01). The logistic regression indicated that Native Americans (OR = 3.13), Blacks (OR = 1.95) and other race (OR = 1.56) patients had statistically significantly (p < 0.001) higher odds of experiencing violent TBI compared to Whites. In addition, females (OR = 0.40), children (OR = 0.75) and older adults (OR = 0.17) had statistically significantly (p < 0.001) lower odds of violent TBI. CONCLUSIONS: Providers of Native American and Black patients who have experienced violence should encourage them to receive assessments and treatment for TBI.

Family Caregiver Support Interventions' Effectiveness Before and During the COVID-19 Pandemic.

The authors aimed to assess the impact of a family caregiver support intervention on caregiver burden and hospital readmission before and during the COVID-19 pandemic. By adopting a quasi-experimental design with no randomization, caregivers (n = 65) received a 90-day home visitation caregiver support intervention before the COVID-19 pandemic and caregivers (n = 41) received a 90-day phone-only visitation caregiver support intervention during the COVID-19 pandemic. Caregiver burden was collected in a survey, and hospital readmission of the care recipient was collected by hospital data. The results of a repeated-measures ANOVA demonstrated that participants of a family caregiver support intervention during the COVID-19 pandemic improved their caregiver burden statistically significantly more than those who received the intervention before the pandemic. There were no significant differences in hospital readmissions before or during the COVID-19 pandemic. The study demonstrates the efficacy of family caregiver support interventions over the phone during a pandemic.

Short-term Clinical Outcomes of Unexpected Culture-positive Cutibacterium acnes (Formerly Propionibacterium acnes) in Open Orthopaedic Surgery.

INTRODUCTION: The clinical significance and treatment recommendations for an unexpected positive Cutibacterium acnes (C acnes) culture remain unclear. The purpose of our study was to evaluate the clinical effect of a C acnes positive culture in patients undergoing open orthopaedic surgery. METHODS: Patients with a minimum of one positive C acnes intraoperative culture were retrospectively reviewed over a 7-year period. True C acnes infection was defined as culture isolation from ≥1 specimens in the presence of clinical or laboratory indicators of infection. RESULTS: Forty-eight patients had a positive intraoperative C acnes culture. 4.2% had a C acnes monoinfection, and 12.5% of the patients had a coinfection. The remainder was classified as indeterminate. Significant differences were identified between the indeterminate and true C acnes infection groups, specifically in patients with surgery history at the surgical site (P = 0.04), additional antibiotic therapy before surgery (P < 0 .001), and postoperative clinical signs of infection (P < 0 .001). DISCUSSION: Suspicion for true C acnes infection should be raised in patients with surgery site history, antibiotic therapy before surgery, and clinical infectious signs. The indeterminate unexpected positive culture patients had a low risk of developing a true clinical infection that required antibiotic therapy.

A pilot study of Trabajadora de salud, a lay health worker intervention for Latinas/os with traumatic brain injuries and their caregivers.

BACKGROUND: Latinas/os with traumatic brain injuries (TBIs) and their caregivers experience worse outcomes than others. OBJECTIVE: The study aimed to assess the acceptability and promise of Trabajadora de Salud on the functional abilities, hospital readmission, rehabilitation, employment, depression, somatic symptoms, and caregiver burden among Latinas/os with TBIs and their caregivers. METHODS: A pre-posttest experimental pilot study was conducted. A total of eight Latina/o adult patients (50% female) with mild or moderate TBI and six of their caregivers (66.7% female) were randomized to receive Trabajadora de Salud or a telephone only control group. Trabajadora de Salud, a three-month, in-home intervention administered by bilingual lay health workers, focused on: 1) providing empathy and validation of TBI symptoms, 2) addressing basic needs, 3) goal setting, and 4) improving communication with healthcare providers. RESULTS: Trabajadora de Salud was widely accepted by patients, caregivers, and health professionals. The functional, depression, and somatic symptoms of the patients as well as the somatic symptoms and caregiver burden of the caregivers improved more for participants in the intervention group than the control group. CONCLUSIONS: Trabajadora de Salud demonstrated promise in improving outcomes of Latinas/os with TBIs and their caregivers and should be further studied.

Breastfeeding Practices Among Hispanic and Non-Hispanic Women at the Postpartum Visit.

BACKGROUND: Breastfeeding is an active area in public health advocacy. Despite documented benefits for infants and mothers, exclusive breastfeeding is not universal. Ethnicity, among other variables, has been shown to influence breastfeeding practice. Research aim: Our study aimed to determine which variables are associated with infant feeding patterns at the postpartum visit; compare the sociodemographic variables associated with infant feeding patterns between Hispanic and non-Hispanic mothers; and determine the odds of exclusive breastfeeding, mixed feeding, and exclusive formula feeding associated with sociodemographic characteristics. METHODS: A retrospective, cross-sectional two-group comparison design was used. Hispanic and non-Hispanic women's ( N = 666) infant feeding patterns at 6-week postpartum were analyzed. Group comparisons were made of the demographic characteristics and infant feeding practice. RESULTS: Thirty-four percent of Hispanic participants reported exclusive breastfeeding compared with 59% of non-Hispanic White participants. Language and body mass index were significantly associated with infant feeding patterns among Hispanic participants. Compared with non-Hispanic White participants, Hispanic participants had increased odds of reporting mixed feeding and exclusive formula feeding. CONCLUSION: Breastfeeding initiatives should target English-speaking Hispanic mothers and obese Hispanic mothers to align breastfeeding rates with medical recommendations. Healthcare providers may benefit from additional training to address barriers to breastfeeding among obese women and to provide culturally sensitive support that encourages continued breastfeeding in this population.

The Differential Impact of Alcohol and Interpersonal Violence on the Severity of Violent Traumatic Brain Injuries among American Indians.

Research shows connections between substance use and traumatic brain injury (TBI), high rates of substance use and interpersonal violence (IPV) in American Indians with TBI, and connections between IPV and TBI. This study assessed the effects of substance use at the time of a violent TBI and possible mediators such as American Indian race on injury severity (injury severity score [ISS]). A secondary data analysis of 3,351 individuals who experienced a TBI due to violence was conducted. American Indians with TBI were more likely to experience IPV (χ2 = 4.19; p = .04) and had significantly higher blood alcohol content level (BAC) scores (t = - 16.78; p = .000) than other racial groups. A regression model explained 27% of the variance in ISS. Significant interaction terms uncovered positive relationships between: (a) American Indian race and ISS when the injury aetiology was not IPV and BAC scores were lower than the legal limit, and (b) IPV and ISS when patients were not American Indian. Alcohol was negatively associated with ISS among American Indians, suggesting that BAC may impact individuals with TBI differentially as a function of race.

Subjective Well-Being in Older Chinese and Korean Immigrants in the United States: Effects of Self-Rated Health and Employment Status.

This study examined the effects of association between self-rated health and employment status on subjective well-being among older Chinese and Korean immigrants in the United States. Data were collected from 171 Chinese and 205 Korean older adult immigrants living in Los Angeles County. The primary variables included demographic data, subjective index of well-being, self-rated health, and employment status. Data support the association between self-rated health and subjective well-being for both groups. Employment, education, and age were associated with the level of subjective well-being only for older Korean immigrants. Similarities and differences were noted in these two Asian American subgroups. Findings suggest the need to develop health promotion services for both populations and employment opportunities targeted more so for Korean older immigrants to further support their subjective well-being. Results may have implications for other for older immigrants.

The Moderation of Blood Alcohol Levels on Higher Odds of Survival among American Indians with Violent, Blunt-Force Traumatic Brain Injuries.

This study assessed the moderation of blood alcohol level (BAL) and American Indian race on survival of patients with violent traumatic brain injury (TBI). An initial logistic regression model indicated that those who were American Indian and insured had higher odds of survival and those with higher injury severity scores and low-medium BAL were less likely to survive. A second logistic regression model including a relationship between American Indians and BAL found that American Indians had a higher odds of survival which tripled when they have no BAL. Low-medium and high BAL were associated with less likelihood of survival among White patients.

The Relationship between Neuroticism, Hopelessness, and Depression in Older Korean Immigrants.

PURPOSE: This study aimed to investigate the relationship between neuroticism, hopelessness, and depression among older Korean immigrants. To extend this line of research, this study aimed to examine the effects of neuroticism and hopelessness in predicting depression among older Korean immigrants. METHODS: Data for this study came from a survey of 220 first generation Korean immigrants aged 65 years or older in Los Angeles County in 2012. Data were collected by face-to-face interviews with trained social workers using a structured questionnaire translated into Korean. All interviews were conducted in Korean. The neuroticism sub-scale of the Eysenck Personality Questionnaire was used to assess neuroticism (EPQN). Hopelessness was measured by the Beck Hopelessness Scale (BHS). Depression was measured by the 20-item Center of Epidemiological Studies Depression (CES-D) scale. RESULTS: The study found that age (ß = .26, p< .01), gender (ß = -.13, p< .01), income (ß = -.13, p< .01), neuroticism (ß = .51, p< .01), and hopelessness (ß = .15, p< .01) were significant predictors of depression. CONCLUSION: The study provides preventive strategies that would help in the development of depression-reduction services or programs for the population, especially for those living with neuroticism and hopelessness.

From discharge planner to "concierge": recommendations for hospital social work by clients with intracerebral hemorrhage.

The Affordable Care Act and budget cuts have changed the role of hospital social workers by placing pressure on them to conduct speedy discharges and decrease readmission rates. This qualitative study aimed to assess if hospital social work is meeting the needs of clients in the hospital and postdischarge. Semistructured interviews with 10 clients with intracerebral hemorrhage (ICH) and 11 caregivers were conducted. Participants reported that social work services were not meeting their needs. Clients with ICH and their caregivers expressed needs from social workers that surpassed their roles as discharge planners, including counseling, help with finances and insurance, and advocacy. Participants wanted social work services to begin early in acute treatment with continuity postdischarge. Social workers should conduct ethical social work by meeting clients where they are, addressing needs as prioritized by the client, and advocating individually and organizationally for clients.

Investigation of Stroke Needs (INVISION) Study: Stroke Awareness and Education.

The objective of this study was to assess the overall understanding and effectiveness of current inpatient stroke education practice by using the data from the Investigation of Stroke Needs (INVISION) Study, a qualitative study assessing various challenges and barriers of the hemorrhagic stroke survivors and their caregivers. Semi-structured interviews were conducted on patients who were recently hospitalized with intracerebral hemorrhage (ICH) and their caregivers during the follow-up visits. The electronic medical record for each patient was reviewed to assess whether they received standard stroke education material during their hospitalization. A phenomenological approach was utilized to identify gaps of education and knowledge in the targeted sample. A total of 21 participants were interviewed. Despite receiving formal stroke education material during their hospitalization, there were three major gaps in stroke knowledge that participants noted, including (1) lack of stroke knowledge/awareness, (2) need for stroke education, and (3) fear of recurrent stroke and comorbid diseases. The majority of ICH survivors had no memory of their hospitalization. This study suggests a need for increased continuity and communication with health-care providers to address the evolving educational and practical needs of stroke patients and their caregivers after hospital discharge.

Factors associated with the health service utilization of unsheltered, chronically homeless adults.

Individuals who are chronically homeless have significantly higher rates of morbidity at significantly younger ages because they experience homelessness, physical and mental health impairments, and substance use disorders. The health status and health service utilization of 260 unsheltered, chronically homeless individuals in a large southwestern, metropolitan community are reported. The behavioral model for vulnerable populations was used to conceptualize the factors associated with hospital, mental health, and substance abuse service utilization among the sample. Health insurance coverage was positively associated with the use of all health services. Other factors were also observed to exert differential relationships to health service utilization.

Experiences with pregnancy of adolescents with disabilities from the perspectives of the school social workers who serve them.

Adolescents with disabilities are more likely than adolescents without disabilities to become pregnant, although very little is known about the lived contexts of their sexual and pregnancy experiences. Such youths are often deprived of sexual health information across a range of potential sources, although school social workers are in a unique position to provide them services. Thirteen school social workers working primarily with adolescents with disabilities were interviewed using a phenomenological study design to offer their perspectives concerning the sexual and pregnancy experiences of such youths. Inductive content analysis revealed that school social workers provided services for pregnant and parenting adolescents with a range of disabilities in areas that included making decisions about sex, deciphering whether they were pregnant, and making decisions once they were pregnant. These experiences were complicated by cognitive impairments; emotional struggles; desires to fit in with peers; histories of sexual abuse; and issues with communication, self-esteem, and impulsivity. School social workers play an integral role in preventing pregnancy and supporting adolescents with disabilities who are pregnant. Recommendations pertaining to the provision of sexual health services for adolescents with disabilities are provided.

A qualitative study of transportation challenges among intracerebral hemorrhage survivors and their caregivers.

Post-discharge barriers of hemorrhagic stroke survivors in Hawai'i have not been extensively studied. The purpose of this qualitative study was to identify common driving and transportation barriers among patients with intracerebral hemorrhage (ICH) and their caregivers in the Honolulu community. Semi-structured interviews were conducted with ICH patients (n = 10) and caregivers (n = 11) regarding their driving and transportation barriers. Inductive content analysis was used to analyze the interviews. Participants reported that they needed transportation to attend to their recovery and remain safe. Informal transportation was desired, yet not always available to patients. A local paratransit service for people with disabilities was the most common form of alternative transportation used by patients; however, they reported difficulty obtaining this method of transportation. Participants with no other option used costly, private transportation. Most ICH survivors expressed great challenges with the available transportation services that are essential to their reintegration into the community after hospitalization. Greater effort to provide transportation options and eligibility information to the ICH patients and their caregivers may be needed to improve their post-discharge care.

Concerns about identity and services among people with autism and Asperger's regarding DSM-5 changes.

The Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2012 ) now includes a new autism spectrum diagnosis (ASD) with previous separate diagnoses of autism removed. This study explores the concerns of people with Asperger's syndrome (AS) and autistic disorder (AD). Discussion forum data of people with AS and AD (N = 76) were analyzed using phenomenological, inductive-content analysis to gather qualitative data about the concerns of people with AS and AD regarding the changes in the DSM-5. People with AS and AD were concerned about identity, community, the cure movement, and services. They also discussed using advocacy and solidarity to address their concerns.