Family dynamics and psychosocial functioning in children with SCI/D from Colombia, South America.

OBJECTIVE: The purpose of this study was to examine the connections between family dynamics and the psychosocial functioning of children with spinal cord injuries and disorders (SCI/D). DESIGN: Cross-sectional. SETTING: Participants were recruited from communities in Neiva, Colombia. PARTICIPANTS: Thirty children with SCI/D and their primary caregiver participated. Children were between 8 and 17 years of age, and had sustained their injury at least six months prior to data collection. INTERVENTIONS: NA. OUTCOME MEASURES: Participating children completed measures assessing their own psychosocial functioning (Children's Depression Inventory, Revised Children's Manifest Anxiety Scale-2, Pediatric Quality of Life Inventory), and their primary caregiver completed measures of family dynamics (Family Adaptability and Cohesion Evaluation Scale- Fourth Edition, Family Communication Scale, Family Assessment Device- General Functioning, Family Satisfaction Scale, Relationship-Focused Coping Scale). RESULTS: A correlation matrix showed a number of significant bivariate correlations between child and family variables, and three multiple regressions showed that family satisfaction, empathy, and flexibility significantly explained 27% of the variance in child worry; family satisfaction and communication explained 18% of the variance in child social anxiety; and family cohesion and communication explained 23% of the variance in child emotional functioning. CONCLUSIONS: These findings highlight the importance of rehabilitation professionals considering the association between family dynamics and the psychosocial functioning of children with SCI/D when working with this population.

Pediatric SCI/D caregiver mental health and family dynamics in Colombia, South America.

OBJECTIVE: This study examined the connections between family dynamics and the mental health of caregivers of youth with spinal cord injuries/disorders (SCI/D) caregivers from Colombia, South America. It was hypothesized that lower family functioning would be associated with poorer caregiver mental health. METHODS: A cross-sectional study of self-report data collected from caregivers through the Hospital Universatario Hernando Moncaleano Perdomo in Neiva, Colombia. Thirty caregivers of children with SCI/D from Nevia, Colombia who were a primary caregiver for ≥3 months, providing care for an individual who was ≥6 months post-injury/diagnosis, familiar with the patient's history, and without neurological or psychiatric conditions. Caregivers' average age was 41.30 years (SD = 10.98), and 90% were female. Caregivers completed Spanish versions of instruments assessing their own mental health and family dynamics. RESULTS: Family dynamics explained 43.2% of the variance in caregiver burden and 50.1% of the variance in satisfaction with life, although family dynamics were not significantly associated with caregiver depression in the overall analysis. Family satisfaction was the only family dynamics variable to yield a significant unique association with any index of caregiver mental health (satisfaction with life). CONCLUSIONS: If similar findings emerge in future intervention research, interventions for pediatric SCI/D caregivers in Colombia and other similar global regions could benefit from including techniques to improve family dynamics, especially family satisfaction, given the strong potentially reciprocal connection between these dynamics and caregiver mental health. IMPLICATIONS FOR REHABILITATION: The degree of disability resulting from SCI/D can vary greatly depending on the severity and level of the lesion, though permanent impairment is often present that profoundly impacts both physical and psychological functioning. Very little is known about the impact of pediatric SCI/D in developing countries, despite the high rates of injury reported in these areas. Family interventions could contribute significantly to the lives of children with SCI/D and their families.

Caregiving in Dementia and its Impact on Psychological Functioning and Health-Related Quality of Life: Findings from a Colombian Sample.

Existing published studies about health-related quality of life (HRQOL) in caregivers of dementia patients living in Latin American countries are very limited. However, cultural aspects, personal values, and social structure may affect the way caregivers experience their role in different societies. The current study investigated the relationship between HRQOL and psychological factors using a cross-sectional design. The sample consisted of 102 informal caregivers of patients with dementia from Bogotá, Colombia, South America. Measures included the Patient Health Questionnaire (PHQ-9) for depression, the Satisfaction with Life Scale (SWLS), the Zarit Burden Interview, and the Short Health Questionnaire (SF36) for HRQOL. Canonical correlations revealed that there was a significant relationship between caregivers' mental health and HRQOL, such that caregivers with better satisfaction with life and less symptoms of depression had more vitality and better general health. There is a strong relationship between mental health and health-related quality of life in Colombian caregivers of dementia patients living in their country of origin. Specific aspects of mental health, including satisfaction with life and depression, need to be addressed in order to improve caregivers' quality of life. Given that mental health care resources may be scarce in Latin American countries, culturally appropriate interventions should focus on preventing/treating depression and promote life satisfaction, as a way to improve their quality of life.

Health related quality of life and mental health in children with SCI/D from Neiva, Colombia.

OBJECTIVE: To date, no research has been published on the health related quality of life (HRQOL) and mental health of children with spinal cord injury and disorders (SCI/D) in Latin America, although limited previous research in Western countries has demonstrated the debilitating and chronic nature of these conditions in children. The aim was to examine the connections between HRQOL and mental health in children with SCI/D from Neiva, Colombia. STUDY DESIGN: Thirty children (8- 17 years) were recruited from the Hospital Universatario Hernando Mocaleano Perdomo in Neiva, Colombia. Participants completed self-report measures administered verbally by trained research staff. RESULTS: A correlation matrix generally suggested that higher HRQOL was robustly associated with better mental health. A series of multiple regressions found that HRQOL explained 50.5% of the variance in children's depression, 31.5% of the variance in worry, and 41.9% of the variance in social anxiety. Within these regressions, emotional and social functioning were uniquely associated with depression, and emotional functioning was uniquely associated with social anxiety. CONCLUSION: This is the first published study to examine psychosocial outcomes in children with SCI/D in Latin America, and its findings suggest that future research and interventions for children with SCI/D in Colombia - and possibly in other regions of Latin America - would benefit from emphasizing emotional and social functioning.

Psychological Functioning in Youth With Spina Bifida Living in Colombia, South America.

OBJECTIVE: No studies have examined psychological functioning among youth with spina bifida (SB) living in a developing country where access to mental health resources is often scarce. This study compared self-reported psychological functioning between youth with SB living in Colombia, South America, and a demographically matched comparison group of healthy Colombian children. METHODS: 22 children with SB and 22 comparison children completed assessments of depression and anxiety. Most (68.81%) participants were male, and the sample had a mean age of 13.25 years (SD = 2.65 years). RESULTS: Results revealed that children with SB reported greater total symptoms of depression (p < .05), but fewer worry-related symptoms of anxiety (p < .05). In addition, mean total scores for both depression and anxiety were in the nonclinical range for youth with SB. CONCLUSIONS: These findings highlight the need for targeted mental health (i.e., depression) services for poor children with SB living in Colombia.

Psychosocial and pharmacological management of pain in pediatric sickle cell disease.

For children with sickle cell disease (SCD), pain is associated with significant current and future morbidity and mortality. Unfortunately, few evidence-based guidelines exist for the management of pain episodes in children with SCD. To inform empirically based treatment strategies for pain management in pediatric SCD, this review integrates and evaluates the extant literature on psychosocial and pharmacological approaches to the management of pain. Findings reveal a paucity of rigorous investigations of psychosocial and pharmacological pain management interventions in children with SCD. Psychosocial interventions included were primarily cognitive-behavioral in nature, whereas pharmacological approaches targeted non-opioid analgesics (ie, nonsteroidal anti-inflammatory drugs and corticosteroids) and opioid medications (ie, morphine and oxycodone). However, to date there is not a "gold standard" for pain management among children with SCD. Because psychosocial and physiological processes each play a role in the etiology and experience of pain, effective pain management requires multidimensional, comprehensive treatment approaches. Considering the significant impact of pain on functional outcomes and quality of life among children with SCD, additional clinical trials are warranted to ensure that interventions are safe and efficacious.

The usefulness of self-generation to improve learning and memory in Spanish-speaking individuals with traumatic brain injury from Colombia.

OBJECTIVE: To examine the effect of self-generation on learning and memory in Spanish-speaking individuals with traumatic brain injury (TBI). METHOD: Thirty Spanish-speaking individuals with moderate-to-severe TBI and 31 healthy controls were recruited to read 32 individual sentences and required to remember the last word in each sentence. Target words were presented both in a self-generated and provided condition for each participant. Recall and recognition of the words were examined immediately, after 30 minutes and after 1 week. RESULTS: Findings indicated that both healthy controls and individuals with TBI showed significantly better recall and recognition for words in the generated condition than words that had been provided to them at immediate, 30-minute and 1-week time intervals. CONCLUSION: The self-generation technique effectively improves learning and memory in Spanish-speaking individuals with TBI. Results should encourage researchers and clinicians to use the principles of cognitive psychology to adapt (as opposed to simply translate) cognitive rehabilitation protocols for use in Spanish-speaking populations with neurological conditions.

Factors influencing acceptance of disability in individuals with spinal cord injury in Neiva, Colombia, South America.

PURPOSE: The aim of the present study was to determine the level of acceptance of disability as measured by the Acceptance of Disability Scale (ADS) within a sample of individuals with spinal cord injury (SCI) from Neiva, Colombia and to examine the influence of sociodemographic variables, injury characteristics, and level of depression on ADS score. METHODS: The ADS was administered to 40 adults with SCI from Nieva, Colombia who were recruited from an organization that connects individuals with disabilities to resources. Most (92.5%) participants were men, with a mean age of 34.75 years and approximately 12 years since injury. Fifty-five percent of subjects were diagnosed with paraplegia and the remainder with tetraplegia. Descriptive, linear model and multiple regression analyses were used to describe the relationship between the independent and dependent variables. RESULTS: The mean total ADS score of this sample was 171.5, indicating overall low disability acceptance. After controlling for level of depression and time since injury, gender was significantly related to ADS score such that women reported higher acceptance of disability. After controlling for gender and time since injury, level of depression was significantly related to ADS score. CONCLUSION: Acceptance of disability is a serious problem in this group of SCI survivors in Neiva, Colombia, especially among women and individuals with higher levels of depression. Because acceptance of disability is likely a problem for many individuals living with disability in the developing world, future researchers should investigate what interventions (e.g. counseling, pharmacological intervention, social service programs) can be implemented to improve acceptance of disability in this population.

Health-related quality of life in caregivers of individuals with traumatic brain injury from Guadalajara, Mexico.

OBJECTIVE: The goal of the present study was to assess the health-related quality of life of a group of family caregivers of individuals with traumatic brain injury from Guadalajara, Mexico. PATIENTS AND METHODS: Ninety family caregivers of individuals with traumatic brain injury and 83 healthy controls completed the Short-Form 36, a self-report health-related quality of life measure composed of 8 component areas: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, mental health, and role-emotional. The samples were statistically similar with respect to age, gender, marital status, and education. However, caregivers had significantly lower household income than controls. RESULTS: After controlling for income, results showed significantly lower scores for traumatic brain injury caregivers compared with healthy controls on 6 Short-Form 36 subscales: role-emotional, vitality, mental health, social functioning, bodily pain, and general health. CONCLUSION: Caregivers of individuals with traumatic brain injury living in Guadalajara, Mexico report having poorer health-related quality of life across various domains including mental and general health. Future studies should be conducted to determine which specific factors (e.g. lack of services, physical strain of providing care) are responsible for reduced health-related quality of life in these areas. It is likely that resources, such as respite services, adult day-care, aides, outpatient rehabilitation, psycho-educational programs, and support groups would increase health-related quality of life for these individuals.

Health-related quality of life in individuals with spinal cord injury in Colombia, South America.

OBJECTIVE: To assess health-related quality of life (HRQOL) of individuals with Spinal Cord Injury (SCI) in Neiva, Colombia. DESIGN: Cross-sectional. PARTICIPANTS/METHODS: 40 Colombians with SCI and 42 age- and gender-matched controls completed the SF-36, a self-report measure composed of eight component areas (physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions). RESULTS: Compared to healthy controls, individuals with SCI had significantly lower means on five SF-36 subscales: physical functioning (22.5 vs. 94.0; p < 0.001), role limitations due to physical problems (54.4 vs. 77.4; p < 0.01), social functioning (67.5 vs. 80.1; p < 0.05), pain (65.4 vs. 79.5; p < 0.01), and general health (54.9 vs. 69.4; p < 0.01). Both groups scored similarly on the SF-36 emotional well-being subscale. CONCLUSION: Individuals with SCI from Neiva, Colombia report having poorer quality of life across various domains than healthy controls, primarily in the area of physical functioning. These findings suggest the need for rehabilitation health professionals to develop and implement interventions to improve HRQOL in individuals with SCI.

Family needs in caregivers of individuals with traumatic brain injury from Colombia, South America.

OBJECTIVE: The aim of the present study was to determine the most and least important family needs in a group of family caregivers of individuals with TBI from Cali, Colombia, and to examine which of those needs were more likely to be met and unmet. DESIGN: Cross-sectional descriptive study. SETTING: Valle University Hospital in Cali, Colombia. PARTICIPANTS: Twenty-nine family caregivers of individuals with traumatic brain injury. OUTCOME MEASURE: The Family Needs Questionnaire, a 40-item questionnaire divided into six sub-scales. RESULTS: Health Information, Community Support Network and Professional Support Network sub-scales were the most important needs reported by this group of Colombian TBI family caregivers. The most frequently met needs in the present study fell within Health Information, Involvement with Care and Instrumental Support sub-scales and the most frequently unmet needs fell within the Emotional Support, Instrumental Support and Professional Support sub-scales. CONCLUSIONS: Family needs in caregivers of individuals with TBI from Colombia are similar, but more likely to be unmet, than those reported in previous studies. Interventions designed to meet family caregivers' needs in these areas should be implemented in Colombia.