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.

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.

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.

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.

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.

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.