Social Support Mediates the Association Between Abilities and Participation After Stroke.

Stroke survivors face participation restrictions, yet little is known regarding how social support affects the association between an individual's abilities and participation. Through a Person-Environment-Occupation-Performance (PEOP) model lens, social support was examined as a potential mediator between ability and participation in cognitively and mobility-demanding activities for stroke survivors with aphasia (persons with aphasia [PWA]) and without aphasia (persons without aphasia [PWOA]). A cross-sectional design, including PWA (n = 50) and PWOA (n = 59) examined associations among person factors (physical impairment, cognition), an environmental factor (social support), and occupational participation through cognitively- and mobility-demanding activity subscales of the Activity Card Sort. Cognition was associated with participation in cognitively demanding activities for both groups, though social support was a mediator only for PWA. Physical impairment was associated with participation in mobility-demanding activities for PWOA, though social support did not mediate that relationship. Social support is key to PWA participating in cognitively demanding activities post-stroke.

Social Support's Role in Tasks that Require Cognition or Mobility for Stroke Survivors with and without AphasiaAfter a stroke, people can face difficulties doing the things they need and want to do in their daily life. Sometimes a stroke can cause aphasia, a disorder that can make it hard for someone to communicate. Social support occurs when one person helps someone do the things they need and want to do. Certain tasks may require different skills, like cognition (being able to think) or mobility (being able to move). Results showed that cognition is important to do tasks that require a lot of thinking for people who experience a stroke and social support is essential for people with aphasia to do tasks that require a lot of thinking. In addition, mobility is important to do tasks that require walking or movement for people without aphasia.

A Longitudinal Investigation of the Association Between Stroke and Loneliness.

OBJECTIVES: The present research examined associations between stroke and long-term trajectories of loneliness. METHODS: We conducted secondary analyses in 3 large representative panel studies of adults 50 years and older in the United States, Europe, and Israel: the English Longitudinal Study of Aging (ELSA; analytic N = 14,992); the Survey of Health, Aging, and Retirement in Europe (SHARE; analytic N = 103,782); and the Health and Retirement Study (HRS; analytic N = 22,179). Within each sample, we used discontinuous growth curve modeling to estimate loneliness trajectories across adulthood and the impact of stroke on loneliness trajectories. RESULTS: Across all 3 samples, participants who experienced stroke reported higher levels of loneliness relative to participants who did not experience stroke. In ELSA and HRS (but not SHARE), loneliness levels were higher after stroke onset relative to before stroke onset. DISCUSSION: This research adds to a growing body of evidence demonstrating elevated loneliness among stroke survivors and highlights the need for interventions to increase social connectedness after stroke.

Toward Cultural Competency in Health Care: A Scoping Review of the Diversity and Inclusion Education Literature.

PURPOSE: To explore best practices for increasing cultural competency and reducing health disparities, the authors conducted a scoping review of the existing literature. METHOD: The review was guided by 2 questions: (1) Are health care professionals and medical students learning about implicit bias, health disparities, advocacy, and the needs of diverse patient populations? (2) What educational strategies are being used to increase student and educator cultural competency? In August 2016 and July 2018, the authors searched 10 databases (including Ovid MEDLINE, Embase, and Scopus) and MedEdPORTAL, respectively, using keywords related to multiple health professions and cultural competency or diversity and inclusion education and training. Publications from 2005 to August 2016 were included. Results were screened using a 2-phase process (title and abstract review followed by full-text review) to determine if articles met the inclusion or exclusion criteria. RESULTS: The search identified 89 articles that specifically related to cultural competency or diversity and inclusion education and training within health care. Interventions ranged from single-day workshops to a 10-year curriculum. Eleven educational strategies used to teach cultural competency and about health disparities were identified. Many studies recommended using multiple educational strategies to develop knowledge, awareness, attitudes, and skills. Less than half of the studies reported favorable outcomes. Multiple studies highlighted the difficulty of implementing curricula without trained and knowledgeable faculty. CONCLUSIONS: For the field to progress in supporting a culturally diverse patient population, comprehensive training of trainers, longitudinal evaluations of interventions, and the identification and establishment of best practices will be imperative.