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Gerber KS, Alvarez G, Alamian A, Behar-Zusman V, Downs CA. Symptoms and Functional Outcomes Among Traumatic Brain Injury Patients 3- to 12-Months Post-Injury. J Trauma Nurs 2024; 31:72-81. [PMID: 38484161 DOI: 10.1097/jtn.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Patients with traumatic brain injury (TBI) experience a variety of physical, cognitive, and affective symptoms. However, the evolution of symptoms, especially during the 3- to 12-month convalescence period (when recovery of function is still possible), is understudied. OBJECTIVE This study aims to identify symptoms and the relationships with functional outcomes that occur during the 3- to 12-month period after a TBI. METHODS Participants who were 3 to 12 months post-TBI were recruited from a South Florida TBI clinic from May 2022 to June 2023. Clinical data were obtained from the electronic health record. Participants completed the Brain Injury Association of Virginia Symptom Checklist, Neuro-Quality of Life Cognitive Function, Anxiety, Depression, and Sleep Disturbance assessments to report symptoms, and the Disability Rating Scale and Satisfaction with Life Scale. Descriptive statistics were used to characterize demographics and symptoms. Linear regression was performed to analyze the relationships between symptoms and outcomes. RESULTS A total of N = 39 patients participated in the study. Memory problems and difficulty concentrating were the most common symptoms. Hospital length of stay, intensive care unit length of stay, cognitive, and physical symptoms were significantly associated with the Disability Rating Scale score. Physical, cognitive, depressive, and anxiety symptoms had significant associations with the Satisfaction with Life Scale. CONCLUSION Cognitive symptoms should be integrated into the clinical care of rehabilitating TBI patients. Nurses should monitor for physical, affective, and cognitive symptoms during the recovery phase of TBI.
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Affiliation(s)
- Kathryn S Gerber
- Author Affiliations: Departments of Nursing, University of Miami School of Nursing and Health Studies, Coral Gables, Florida, (Drs Gerber, Alamian, Behar-Zusman, and Downs); and Departments of Neurorehabilitation, University of Miami Miller School of Medicine, Miami, Florida (Dr Alvarez)
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2
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Colón-Burgos JF, Rojas P, Vazquez V, Khalona MA, Canedo M, Pinzón Iregui MC, Gómez-Estern BM, De La Rosa M, Sánchez M, Cano MÁ, Ravelo GJ, Westrick A, Behar-Zusman V. A qualitative community health assessment of HIV prevention awareness in a semi-rural Latinx seasonal farm working community in South Florida. Cult Health Sex 2023:1-16. [PMID: 38156981 DOI: 10.1080/13691058.2023.2296483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
This article explores HIV awareness and prevention in a Latinx seasonal farmworker community of south Miami-Dade County in the USA. The study took place as part of a larger community assessment that aimed to determine community needs and resources related to substance abuse, violence and HIV in the Latinx seasonal farmworker communities of south Miami-Dade County, with a particular focus on fathers' and their male sons' relationships. The study collected data on HIV knowledge and prevention, healthcare-seeking behaviours, cultural norms, and communication barriers about HIV prevention between fathers and sons. Data were collected through in-depth interviews with community leaders, two focus groups with social and health services providers, and four focus groups involving fathers and their adolescent sons. A deductive approach to data analysis was undertaken. Five major themes were identified: (1) HIVrelated knowledge and perception; (2) HIV prevention strategies; (3) barriers and needs for tailored preventive health and care services in the community; (4) stress over sex-related communication; and (5) the dominance of traditional masculine gender norms in the household and the community.
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Affiliation(s)
- José F Colón-Burgos
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, FL International University, Miami, FL, USA
| | - Patria Rojas
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, FL International University, Miami, FL, USA
| | - Vicky Vazquez
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, FL International University, Miami, FL, USA
| | - Maria Antonina Khalona
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, FL International University, Miami, FL, USA
| | - Marisabel Canedo
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, FL International University, Miami, FL, USA
| | - María C Pinzón Iregui
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, FL International University, Miami, FL, USA
| | - Beatriz Macías Gómez-Estern
- Department of Social Anthropology, Basic Psychology and Public Health, Universidad Pablo de Olavide, Seville, Spain
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, FL International University, Miami, FL, USA
| | - Mariana Sánchez
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, FL International University, Miami, FL, USA
| | - Miguel Ángel Cano
- School of Public Health, University of TX Southwestern Medical Center, Dallas, TX, USA
| | - Gira J Ravelo
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Robert Stempel College of Public Health and Social Work, Department of Health Promotion & Disease Prevention, FL International University, Miami, FL, USA
| | - Ashly Westrick
- Department of Epidemiology, School of Public Health, University of MI, Ann Arbor, MI, USA
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Chavez JV, Wang P, Larson ME, Vazquez V, De La Rosa M, Behar-Zusman V. Methodologies used in studies examining substance abuse, violence and HIV/AIDS (SAVA) constructs using a syndemic framework: a scoping review. AIDS Care 2023; 35:1708-1715. [PMID: 36942772 PMCID: PMC10511665 DOI: 10.1080/09540121.2023.2176426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/22/2023] [Indexed: 03/23/2023]
Abstract
The syndemic theoretical framework has been used in health disparities research to explain several co-occurring epidemics, particularly in populations facing disparate health conditions. A prominent example of this is seen in Singer's Substance Abuse, Violence and HIV/AIDS (SAVA) syndemic theory. However, even though numerous studies support some of the theoretical underpinnings of the SAVA syndemic, the empirical applications of the theory remain methodologically underdeveloped. The current review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR), to present the state of the science of methodologies examining SAVA constructs using the syndemic framework. Seven bibliographic databases were searched with no language or date restrictions. Studies were synthesized by author, year of publication, study location, total sample size, study population, SAVA outcomes, analytic method of SAVA measurement, intervention type, level of influence, disease interaction and concentration, main findings of the study, and possible future areas of research. Our search yielded a total of 967 articles, and 123 were included in the review. Methodologic and statistical innovation is needed to elevate the impact of syndemic theory for elucidating the synergistic effects of determinants leading to health disparities.
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Affiliation(s)
- Jennifer V. Chavez
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | - Piao Wang
- School of Nursing and Health Studies, University of Miami
| | - Michaela E. Larson
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | - Vicky Vazquez
- Stempel College of Public Health and Social Work, Florida International University
| | - Mario De La Rosa
- Stempel College of Public Health and Social Work, Florida International University
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Lebron CN, Mitsdarffer M, Parra A, Chavez JV, Behar-Zusman V. Latinas and Maternal and Child Health: Research, Policy, and Representation. Matern Child Health J 2023:10.1007/s10995-023-03662-z. [PMID: 37029892 PMCID: PMC10560314 DOI: 10.1007/s10995-023-03662-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
Over the last 50 years, the Latino population in the US has grown and changed. Latinos are the nation's largest minority group and among this group, there is incredible diversity. Much of Latino health research and outcomes have been treated interchangeably with immigrant health, but as the US Latino population evolves so should the focus of Latino health research. We contend that as maternal and child health (MCH) outcomes are an utmost important indicator of a country's health, and as Latinos make up 18% of the US's population, it is imperative that we move past dated research frameworks to a more nuanced understanding of the health of Latina women and children. We summarize how acculturation has been used to describe differences in MCH outcomes, discuss how the umbrella term "Latino" masks subgroups differences, explore Afro-Latinidad in MCH, examine the effects of the sociopolitical climate on the health of families, and demonstrate the limited representation of Latinos in MCH research. We conclude that a deeper understanding of Latino health is necessary to achieve health equity for Latina women and their children.
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Affiliation(s)
- Cynthia N Lebron
- University of Miami School of Nursing and Health Studies, 5030 Brunson Avenue, Coral Gables, FL, 33146, USA.
| | - Mary Mitsdarffer
- Biden School of Public Policy & Administration, University of Delaware, Newark, USA
| | - Alexa Parra
- University of Miami School of Nursing and Health Studies, 5030 Brunson Avenue, Coral Gables, FL, 33146, USA
| | | | - Victoria Behar-Zusman
- University of Miami School of Nursing and Health Studies, 5030 Brunson Avenue, Coral Gables, FL, 33146, USA
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5
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Iriarte E, Larson ME, Behar-Zusman V. The Impact of COVID-19 Household Isolation on Conflict and Cohesion in One-, Two-, and Three-Generation Households With Older Adults. J Gerontol Nurs 2023; 49:47-56. [PMID: 36989472 DOI: 10.3928/00989134-20230310-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
The current cross-sectional study examined the effect of coronavirus disease 2019 (COVID-19) household isolation on household conflict and cohesion in one-, two-, and three-generation households with older adults (aged ≥65 years). Participants were 757 adults (aged ≥18 years) with at least one older adult in their household. Respondents were from 51 countries. Study variables were measured with the COVID-19 Household Environmental Scale. Non-parametric tests were used to assess differences between groups. Most participants (n = 437, 57.7%) lived in three-generation homes. Three-generation homes reported greater increases in conflict (p < 0.001) and cohesion (p < 0.001) during household isolation compared to oneand two-generation homes. Findings suggest that older adults living in multigenerational households experienced more cohesive and conflictive household environments as a function of the COVID-19 pandemic. Further research should explore how family or health care interventions could better support older adults and families as a unit of care to avoid adverse outcomes and boost resilience. [Journal of Gerontological Nursing, 49(4), 47-56.].
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Chavez JV, Crenshaw D, Kripalani S, Szetela C, Bruce MA, Isasi R, Behar-Zusman V. Helping the science speak for itself: lessons learned developing video summaries for a precision medicine and health disparities collaborative. Per Med 2022; 19:475-482. [PMID: 36250524 PMCID: PMC9709906 DOI: 10.2217/pme-2021-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 07/10/2022] [Indexed: 11/21/2022]
Abstract
Skills to effectively communicate research findings are important to expand meaningful inclusion of the public in research, but attempts to summarize findings may be challenging given increasing reliance on succinct communications. Led by our Ethics Advisory Board and within the context of this work with the Precision Medicine and Health Disparities Collaborative, the authors decided to engage in the iterative process of developing video summaries. Our stakeholders taught us to incorporate novel strategies to engage broader audiences, leading to the production of two video summaries, a public summary toolbox and an adapted process for developing video summaries. The authors refreshed the static concept of 'research summaries' and found ways of producing summaries which emphasized a dynamic reframing of the shared benefits of science.
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Affiliation(s)
- Jennifer V Chavez
- University of Miami School of Nursing & Health Studies, Coral Gables, FL 33146, USA
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - David Crenshaw
- Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Sunil Kripalani
- Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | | - Marino A Bruce
- University of Houston, Tilman J Fertitta Family College of Medicine, Houston, TX 77204, USA
| | - Rosario Isasi
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Bastida E, Ravelo GJ, Benitez P, Chavez J, Metheny N, Baeza Robba MJ, Colón-Burgos JF, De La Rosa M, Behar-Zusman V, Carrasquillo O. COVID-19, science, vaccines and family in a multi origin Latinx population in South Florida. Front Public Health 2022; 10:997449. [PMID: 36176522 PMCID: PMC9514221 DOI: 10.3389/fpubh.2022.997449] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023] Open
Abstract
During the Spring of 2021 in Miami-Dade County, four virtual focus groups were held with 31 participants from four diverse local Latinx communities as part of the Florida Community Engagement Alliance (FL-CEAL) Against COVID-19 Disparities project. The main objective was to explore attitudes about COVID-19 information and prevention strategies among South Florida's diverse Latinx populations, across a broad geographical area. The study used a semi-structured focus group qualitative design and chose participants from four well established Latinx neighborhoods. Participants were mostly women, diversity was strong with birth regions including the Caribbean, North, Central and South America. Though a third (n = 11) were born in the United States, almost all (n = 28) reported speaking Spanish at home. Three themes and six subthemes were identified to underscore Latinx attitudes toward COVID-19 vaccine uptake or hesitancy. These were: (1) Attitudes regarding vaccine intake; (2) Sources of Information; and (3) Science Education. The degree to which each of these themes exercised influence on vaccine intake or hesitancy varied. The multi origin Latinx participation in the focus groups strengthened findings by broadening representation and discussion. In the end and despite the various national origins, all participants indicated receiving most of their information on COVID-19 related topics from their family, physicians, social networks, and some form of media.
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Affiliation(s)
- Elena Bastida
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Gira J. Ravelo
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Pablo Benitez
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Jennifer Chavez
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, United States
| | - Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, United States
| | - María José Baeza Robba
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, United States
- Escuela de Enfermer, Pontificia Universidad Cat3lica de Chile, Santiago, Chile
| | - José Félix Colón-Burgos
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Victoria Behar-Zusman
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, United States
| | - Olveen Carrasquillo
- Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
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Gerber KS, Alvarez G, Alamian A, Behar-Zusman V, Downs CA. Biomarkers of Neuroinflammation in Traumatic Brain Injury. Clin Nurs Res 2022; 31:1203-1218. [PMID: 35770330 DOI: 10.1177/10547738221107081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traumatic brain injury (TBI) is characterized by neuroinflammation and structural damage leading to symptoms and altered brain function. Biomarkers are useful in understanding neuroinflammation and correlations with TBI sequalae. The purpose of this paper is to identify and discuss biomarkers of neuroinflammation used to study TBI and its sequalae. A systematic review was conducted using PubMed, CINAHL, Embase, and Web of Science. A total of 350 articles met criteria; 70 used biomarkers. PRISMA criteria were used for Quality Assessment. Articles included reviews (n = 17), case-control (n = 25), cross-sectional (n = 25) studies, and randomized controlled trials (n = 3). Twenty-seven biomarkers were identified, including inflammasomes, cytokines, neuropeptides, complement complexes, miRNA and exosomes, and glial cell-specific proteins. Biomarkers aid in predicting morbidity and mortality and advance our understanding of neuroinflammation in TBI. This systematic review advances our understanding of the neuroinflammatory response to better enable nurses and clinicians to provide informed care of TBI patients.
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Affiliation(s)
- Kathryn S Gerber
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Gema Alvarez
- University of Miami Miller School of Medicine, FL, USA
| | - Arsham Alamian
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | | | - Charles A Downs
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
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Larson ME, Chavez JV, Behar-Zusman V. Family functioning in an international sample of households reporting adult caregiving during the COVID-19 pandemic. Fam Syst Health 2021; 39:609-617. [PMID: 34498888 DOI: 10.1037/fsh0000653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Introduction: The COVID-19 pandemic has dramatically altered the functioning of households. Because of the vulnerability of high-risk groups, such as older adults and people with compromised immune systems, households caring for these vulnerable adults may be facing elevated levels of caregiving-related stress and burden. The current study sought to examine the impact of the pandemic on conflict and cohesion in households with adults requiring caregiving versus noncaregiving households. Methods: Respondent demographic, household level, and family functioning data were collected anonymously from an international sample (N = 4,241). Responses were examined using descriptive and bivariate analyses. Results: Overall, respondents in caregiving households (n = 667) reported a significantly greater negative impact of social distancing on their family functioning, with greater increase in conflict than nonadult caregiving households (n = 3,574). Significantly more caregiving households also reported that someone had stopped working due to the pandemic. No differences were observed for cohesion between the two groups, with both reporting a little bit more cohesion when compared with the period before social distancing. Conclusions: Our findings add to a body of literature demonstrating that caregiving families experience greater disruption and strain during disaster situations such as the COVID-19 pandemic. Future research is needed to establish the causality of the collected proximal factors, such as job loss and education, with pandemic related family functioning among homes caring for adults, and examining the impact of contextual factors, such as level of caregiving need and caregiving support. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Chavez JV, Lee TK, Larson ME, Behar-Zusman V. Assessing the Impact of COVID-19 Social Distancing and Social Vulnerability on Family Functioning in an International Sample of Households with and without Children. Couple Family Psychol 2021; 10:233-248. [PMID: 35178284 PMCID: PMC8846441 DOI: 10.1037/cfp0000166] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The COVID-19 pandemic is a worldwide event that has exacerbated stress and caused significant disruptions in the day-to-day living of families. Of particular concern are socially vulnerable families, which have felt the impacts of the pandemic most acutely. Because stress can alter family dynamics, it is important to understand which stressors impact families the most, and what resources can be leveraged to strengthen family functioning. The current study examined the impacts of COVID-19 on the conflict and cohesion of households with children compared to households without children. Additionally, we sought to assess how conflict and cohesion are related to social vulnerabilities in the context of the pandemic. Using an international sample, we analyzed responses to the COVID-19 Household Environment Scale (N = 4122) using descriptive and bivariate analyses. Latent class analysis was used to identify patterns of family functioning in households with and without children. We found that social vulnerability was associated with more disrupted family functioning, and that households with children (n = 2666) reported less disrupted family functioning when compared to households without children (n = 1456), despite having higher social vulnerability scores. Our exploratory latent class analysis identified a 5-class model among both subgroups. Conflict, cohesion, family functioning and social vulnerability varied significantly by subgroup and class membership. Our findings add to a body of evidence that argues that despite facing greater vulnerability, households with children have many strengths to draw from. Family interventions that help to promote family cohesion and conflict resolution can foster resilience in stressful circumstances.
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Affiliation(s)
| | - Tae Kyoung Lee
- School of Nursing and Health Studies, University of Miami
- Department of Public Health Sciences, University of Miami Miller School of Medicine
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Matsuda Y, McCabe BE, Behar-Zusman V. Mothering in the Context of Mental Disorder: Effect of Caregiving Load on Maternal Health in a Predominantly Hispanic Sample. J Am Psychiatr Nurses Assoc 2021; 27:373-382. [PMID: 32102585 PMCID: PMC8560279 DOI: 10.1177/1078390320907693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mothering in the context of mental disorders presents with multiple challenges. However, this phenomenon is poorly understood: It is not known how child caregiving affects the health of their mothers. AIMS The purpose of this study was to examine associations between child caregiving load and health indicators in mothers receiving outpatient behavioral health services for mental or substance use disorders. METHOD A total of 172 mothers (80% Hispanic/Latina) completed surveys on their mental and physical health, and children's behaviors and medical problems. Child caregiving load consisted of number of children living with the mother, and presence of children's internalizing, externalizing, or medical problems. RESULTS Child caregiving load had significantly positive associations with mother's psychological distress, fatigue, pain, and body mass index. Child internalizing and medical problems were associated with mothers' poor health status. CONCLUSIONS Hispanics/Latinos experience health disparities, and Hispanic/Latina mothers who are already at risk due to their mental disorders experience an additional health burden associated with caring for children with emotional or health problems. Psychiatric and mental health nurse practitioners should assess child caregiving impact on mothers with mental disorders and seek to mitigate their caregiving burden and maintain their health. Further research is needed to clarify child characteristics and the mechanisms associated with maternal caregiver burden, suboptimal self-care, and adverse health outcomes. Structural Ecosystems Therapy for women in Recovery (SET-R) study/Healthy Home; Clinical Trial ID NCT02702193.
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Affiliation(s)
- Yui Matsuda
- Yui Matsuda, PhD, APHN-BC, MPH, University of Miami, Coral Gables, FL, USA
| | - Brian E McCabe
- Brian E. McCabe, PhD, Auburn University, Auburn, AL, USA
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Williams JR, McCabe BE, Tantillo LD, Levoy K, Behar-Zusman V. Health Correlates of Abuse History and Moderating Effect of Parenting Stress for Mothers with Mental Disorders. Issues Ment Health Nurs 2021; 42:555-563. [PMID: 32965137 PMCID: PMC8020494 DOI: 10.1080/01612840.2020.1820121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Parenting stress is common and may lead to worsening health, particularly in the context of other risk factors such as mental disorders or a history of abuse. This study investigated how parenting-related stress impacts the effect of abuse experiences on health among mothers with mental health disorders. Survey data was analyzed from 172 predominantly Hispanic mothers receiving outpatient behavioral health services. Most (80.2%) mothers had experienced abuse. Those reporting childhood abuse had 3.82 greater odds of experiencing abuse in adulthood. Findings demonstrated worse health outcomes among those experiencing abuse in both childhood and adulthood and those with a greater number of abuse experiences. Caregiving load intensified the relationship between abuse and anxiety and sleep disturbance. Parenting self-agency intensified the relationship between abuse and cigarette use. These findings have important implications for mental health nursing practice by identifying parenting-stress as an important target for interventions to improve health among women with histories of abuse and mental health disorders.
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Affiliation(s)
- Jessica R Williams
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian E McCabe
- Department of Special Education, Rehabilitation, and Counseling, Auburn University, Auburn, Alabama, USA
| | - Lila de Tantillo
- Keigwin School of Nursing, Jacksonville University, Jacksonville, Florida, USA
| | - Kristin Levoy
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria Behar-Zusman
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
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Nana-Sinkam P, Kraschnewski J, Sacco R, Chavez J, Fouad M, Gal T, AuYoung M, Namoos A, Winn R, Sheppard V, Corbie-Smith G, Behar-Zusman V. Health disparities and equity in the era of COVID-19. J Clin Transl Sci 2021; 5:e99. [PMID: 34192054 PMCID: PMC8167251 DOI: 10.1017/cts.2021.23] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/28/2021] [Accepted: 03/04/2021] [Indexed: 01/21/2023] Open
Abstract
Over the last year, COVID-19 has emerged as a highly transmissible and lethal infection. As we address this global pandemic, its disproportionate impact on Black, Indigenous, and Latinx communities has served to further magnify the health inequities in access and treatment that persist in our communities. These sobering realities should serve as the impetus for reexamination of the root causes of inequities in our health system. An increased commitment to strategic partnerships between academic and nonacademic health systems, industry, local communities, and policy-makers may serve as the foundation. Here, we examine the impact of the recent COVID-19 pandemic on health care inequities and propose a strategic roadmap for integration of clinical and translational research into our understanding of health inequities.
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Affiliation(s)
| | - Jennifer Kraschnewski
- Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Ralph Sacco
- Department of Neurology, University of Miami Health, Miami, FL, USA
| | | | - Mona Fouad
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Tamas Gal
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Asmaa Namoos
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Robert Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Vanessa Sheppard
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Giselle Corbie-Smith
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Behar-Zusman V, Chavez JV, Gattamorta K. Developing a Measure of the Impact of COVID-19 Social Distancing on Household Conflict and Cohesion. Fam Process 2020; 59:1045-1059. [PMID: 32621755 PMCID: PMC7362045 DOI: 10.1111/famp.12579] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This report introduces the COVID-19 Family Environment Scale (CHES), which aims to measure the impact of social distancing due to COVID-19 on household conflict and cohesion. Existing measures do not capture household experiences relevant to the pandemic, in which families are largely confined to their homes while sharing a life-threatening situation. Using best practice guidelines, we developed a pool of items and revised them with review by a panel of experts, and cognitive interviewing with community respondents. We administered the CHES by online survey to 3,965 adults. The CHES consists of 15 items for each of two subscales, household conflict (α = .847) and household cohesion (α = .887). Exploratory factor analysis yielded two factors, corresponding to the intended conflict and cohesion items, which accounted for 29% of variance. Confirmatory factor analysis partially supported the 2-factor model (RMSEA = .057; CFI = .729, TLI = .708, and SRMR = .098). The CHES also contains 25 optional items to describe respondent and household characteristics, and household-level COVID-19 exposure. The CHES, publicly available at https://elcentro.sonhs.miami.edu/research/measures-library/covid-19/index.html, provides a tool for measuring the impact of the COVID-19 pandemic on important determinants of resilience in the face of major stressful events. Further work is needed to address the factor structure and establish validity of the CHES.
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Harkness A, Gattamorta KA, Estrada Y, Jimenez D, Kanamori M, Prado G, Behar-Zusman V. Latinx Health Disparities Research During COVID-19: Challenges and Innovations. Ann Behav Med 2020; 54:544-547. [PMID: 32716033 PMCID: PMC7414290 DOI: 10.1093/abm/kaaa054] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Center for Latino Health Research Opportunities (CLaRO) supports and facilitates research addressing substance abuse, violence/trauma, and HIV/AIDS among diverse and underserved Latinx populations. CLaRO runs a pilot awards program for early-stage investigators conducting Latinx health disparities research. This pilot awards program was impacted by the COVID-19 pandemic, necessitating innovative responses for research continuity. PURPOSE The purpose of this commentary is to describe the challenges and innovative research methods developed in response to COVID-19 to continue Latinx health disparities research in the context of COVID-19. METHODS/RESULTS This commentary provides a brief description of each CLaRO pilot project, the challenges introduced by COVID-19, and innovative research methods to continue Latinx health disparities research during and beyond COVID-19. CONCLUSIONS Despite the challenges COVID-19 presents to the continuity of health disparities research, it also presents unprecedented opportunities to innovate. Such innovation is essential for solving persistent scientific, public health, and clinical challenges underlying current and emerging health disparities.
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Affiliation(s)
- Audrey Harkness
- Department of Public Health Sciences, University of Miami, Clinical Research Center, Miami, FL, USA
| | | | - Yannine Estrada
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| | - Daniel Jimenez
- Department of Psychiatry, University of Miami, Miami, FL, USA
| | - Mariano Kanamori
- Department of Public Health Sciences, University of Miami, Clinical Research Center, Miami, FL, USA
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
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16
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Levoy K, Buck H, Behar-Zusman V. The Impact of Varying Levels of Advance Care Planning Engagement on Perceptions of the End-of-Life Experience Among Caregivers of Deceased Patients With Cancer. Am J Hosp Palliat Care 2020; 37:1045-1052. [PMID: 32281390 DOI: 10.1177/1049909120917899] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Advance care planning (ACP) is used to prepare patients and caregivers for future "in the moment" decisions at the end-of-life. Patients with cancer generally do not engage in all 3 components of ACP (documented living will, health-care surrogate, end-of-life discussions); however, little is known about the impact of these varying levels of ACP engagement on caregivers postdeath. OBJECTIVE To examine the relationship between varying levels of ACP engagement and caregivers' perceptions of cancer decedents' end-of-life experiences. METHODS A secondary analysis of the 2002 to 2014 waves of the Health and Retirement Study data using structural equation modeling was conducted. Five levels of ACP engagement were defined: full (discussions/documents), augmented discussions, documents only, discussions only, and no engagement. RESULTS Among the 2172 cancer death cases, the analyzed sample included 983 cases where end-of-life decisions occurred. Compared to no ACP, all levels of ACP were significantly associated with caregivers' positive perceptions of cancer decedents' end-of-life experiences (P ≤ .001), controlling for sex, race, and Hispanic ethnicity (R 2 = .21). However, the relative impact of each level of ACP engagement was not equal; full engagement (β = .61) was associated with a greater impact compared to each of the partial levels of engagement (augmented discussions [β = .33], documents only [β = .17], discussions only [β = .17]). CONCLUSION Partial ACP engagement, not just nonengagement, serves as an important clinically modifiable target to improve the end-of-life care experience among patients with cancer and the perceptions of those experiences among bereaved caregivers.
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Affiliation(s)
- Kristin Levoy
- NewCourtland Center for Transitions and Health, 6572University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Harleah Buck
- 7831University of South Florida College of Nursing, Tampa, FL, USA
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