Transferring Stroke Knowledge from Children to Parents: A Systematic Review and Meta-Analysis of Community Stroke Educational Programs
Ilunga Tshiswaka, D., Sikes, L. E., Iwelunmor, J., Ogedegbe, G., & Williams, O.
Journal of Stroke and Cerebrovascular Diseases
Background: The purpose of this systematic review and meta-analysis on child-to-parent communication of stroke information (Child-Mediated Stroke Communication, CMSC) is to provide the highest levels of evidence supporting the role of this approach in community education. Methods: Databases such as PubMed, Google Scholar, PsycINFO, Web of Science, MEDLINE, and CINHAL were searched to gather information on CMSC followed by a meta-analysis. The eligibility criteria were as follows: (a) children aged 9-15 years and parents, (b) randomized or nonrandomized trials, and (c) outcome variables that included the proportions of parents answering the pretest and post-test on stroke knowledge regarding risk factors, symptoms, and what to do in the event of stroke. Results: Of the 1668 retrieved studies, 9 articles were included. Meta-analytical findings yielded that the proportions of correct answers for stroke symptoms and its risk factors among parents were 0.686 (95% CI: 0.594-0.777) at baseline and increased to 0.847 (95% CI: 0.808-0.886) at immediate post-test and 0.845 (95% CI: 0.804-0.886) delayed post-test. The proportions of correct answers for behavioral intent to call 911 when witnessing stroke was 0.712 (95% CI: 0.578-0.846) at baseline, rising to 0.860 (95% CI: 0.767-0.953) at immediate post-test, and 0.846 (95% CI: 0.688-1.004) at delayed post-test. Conclusions: CMSC is effective for educating families. More work is needed to increase the use of validated stroke literacy instruments and behavioral theory, and to reduce parental attrition in research studies.
Improving community stroke preparedness in the HHS (hip-hop stroke) randomized clinical trial
Williams, O., Quinn, E. L., Teresi, J., Eimicke, J. P., Kong, J., Ogedegbe, G., & Noble, J.
Background and Purpose-Defciencies in stroke preparedness cause major delays to stroke thrombolysis, particularly among economically disadvantaged minorities. We evaluated the effectiveness of a stroke preparedness intervention delivered to preadolescent urban public school children on the stroke knowledge/preparedness of their parents. Methods-We recruited 3070 fourth through sixth graders and 1144 parents from 22 schools into a cluster randomized trial with schools randomized to the HHS (Hip-Hop Stroke) intervention or attentional control (nutrition classes). HHS is a 3-hour culturally tailored, theory-based, multimedia stroke literacy intervention targeting school children, which systematically empowers children to share stroke information with parents. Our main outcome measures were stroke knowledge/preparedness of children and parents using validated surrogates. Results-Among children, it was estimated that 1% (95% confdence interval [CI], 0%-1%) of controls and 2% (95% CI, 1%-4%; P=0.09) of the intervention group demonstrated optimal stroke preparedness (perfect scores on the knowledge/preparedness test) at baseline, increasing to 57% (95% CI, 44%-69%) immediately after the program in the intervention group compared with 1% (95% CI, 0%-1%; P<0.001) among controls. At 3-month follow-up, 24% (95% CI, 15%-33%) of the intervention group retained optimal preparedness, compared with 2% (95% CI, 0%-3%; P<0.001) of controls. Only 3% (95% CI, 2%-4%) of parents in the intervention group could identify all 4 letters of the stroke FAST (Facial droop, Arm weakness, Speech disturbance, Time to call 911) acronym at baseline, increasing to 20% at immediate posttest (95% CI, 16%-24%) and 17% at 3-month delayed post-test (95% CI, 13%-21%; P=0.0062), with no signifcant changes (3% identifcation) among controls. Four children, all in the intervention group, called 911 for real-life stroke symptoms, in 1 case overruling a parent's wait-and-see approach. Conclusions-HHS is an effective, intergenerational model for increasing stroke preparedness among economically disadvantaged minorities.
An agent-based model for ideal cardiovascular health
Li, Y., Kong, N., Lawley, M. A., & Pagan, J. A. In Decision Analytics and Optimization in Disease Prevention and Treatment.
Sunlight-mediated inactivation of health-relevant microorganisms in water: a review of mechanisms and modeling approaches
Nelson, K. L., Boehm, A. B., Davies-Colley, R. J., Dodd, M. C., Kohn, T., Linden, K. G., Liu, Y., Maraccini, P. A., McNeill, K., Mitch, W. A., Nguyen, T. H., Parker, K. M., Rodriguez, R. A., Sassoubre, L. M., Silverman, A. I., Wigginton, K. R., & Zepp, R. G.
Environmental Science: Processes and Impacts
Health-relevant microorganisms present in natural surface waters and engineered treatment systems that are exposed to sunlight can be inactivated by a complex set of interacting mechanisms. The net impact of sunlight depends on the solar spectral irradiance, the susceptibility of the specific microorganism to each mechanism, and the water quality; inactivation rates can vary by orders of magnitude depending on the organism and environmental conditions. Natural organic matter (NOM) has a large influence, as it can attenuate radiation and thus decrease inactivation by endogenous mechanisms. Simultaneously NOM sensitizes the formation of reactive intermediates that can damage microorganisms via exogenous mechanisms. To accurately predict inactivation and design engineered systems that enhance solar inactivation, it is necessary to model these processes, although some details are not yet sufficiently well understood. In this critical review, we summarize the photo-physics, -chemistry, and -biology that underpin sunlight-mediated inactivation, as well as the targets of damage and cellular responses to sunlight exposure. Viruses that are not susceptible to exogenous inactivation are only inactivated if UVB wavelengths (280-320 nm) are present, such as in very clear, open waters or in containers that are transparent to UVB. Bacteria are susceptible to slightly longer wavelengths. Some viruses and bacteria (especially Gram-positive) are susceptible to exogenous inactivation, which can be initiated by visible as well as UV wavelengths. We review approaches to model sunlight-mediated inactivation and illustrate how the environmental conditions can dramatically shift the inactivation rate of organisms. The implications of this mechanistic understanding of solar inactivation are discussed for a range of applications, including recreational water quality, natural treatment systems, solar disinfection of drinking water (SODIS), and enhanced inactivation via the use of sensitizers and photocatalysts. Finally, priorities for future research are identified that will further our understanding of the key role that sunlight disinfection plays in natural systems and the potential to enhance this process in engineered systems.
Etiology of respiratory tract infections in the community and clinic in Ilorin, Nigeria
Kolawole, O., Oguntoye, M., Dam, T., & Chunara, R.
BMC research notes
OBJECTIVE: Recognizing increasing interest in community disease surveillance globally, the goal of this study was to investigate whether respiratory viruses circulating in the community may be represented through clinical (hospital) surveillance in Nigeria.RESULTS: Children were selected via convenience sampling from communities and a tertiary care center (n = 91) during spring 2017 in Ilorin, Nigeria. Nasal swabs were collected and tested using polymerase chain reaction. The majority (79.1%) of subjects were under 6 years old, of whom 46 were infected (63.9%). A total of 33 of the 91 subjects had one or more respiratory tract virus; there were 10 cases of triple infection and 5 of quadruple. Parainfluenza virus 4, respiratory syncytial virus B and enterovirus were the most common viruses in the clinical sample; present in 93.8% (15/16) of clinical subjects, and 6.7% (5/75) of community subjects (significant difference, p < 0.001). Coronavirus OC43 was the most common virus detected in community members (13.3%, 10/75). A different strain, Coronavirus OC 229 E/NL63 was detected among subjects from the clinic (2/16) and not detected in the community. This pilot study provides evidence that data from the community can potentially represent different information than that sourced clinically, suggesting the need for community surveillance to enhance public health efforts and scientific understanding of respiratory infections.
Economic burden of caregiving for persons with severe mental illness in sub-Saharan Africa: A systematic review
Addo, R., Agyemang, S. A., Tozan, Y., & Nonvignon, J.
Background Over the past two decades, the focus of mental health care has shifted from institutionalisation to community-based programs and short hospital stays. This change means that there is an increased role for caregivers, mostly family members, in managing persons with mental illness. Although there is evidence to support the benefits of deinstitutionalisation of mental health care, there are also indications of substantial burden experienced by caregivers; the evidence of which is limited in sub-Saharan Africa. However, knowledge of the nature and extent of this burden can inform the planning of mental health services that will not only benefit patients, but also caregivers and households. Objective To systematically review the available evidence on the economic burden of severe mental illness on primary family caregivers in sub-Saharan Africa. Methods A comprehensive search was conducted in Pubmed, CINAHL, Econlit and Web of Science with no date limitations up to September 2016 using keywords such as "burden", "cost of illness" and "economic burden" to identify relevant published literature. Articles were appraised using a standardised data extraction tool covering themes such as physical, psychological and socioeconomic burden. Results Seven papers were included in the review. Caregivers were mostly family members with a mean age of 46.34, female and unemployed. Five out of seven studies (71%) estimated the full economic burden of severe mental illness on caregivers. The remainder of studies just described the caregiver burden. All seven papers reported moderate to severe caregiver burden characterised by financial constraint, productivity loss and lost employment. The caregiver’s level of income and employment status, severity of patient’s condition and duration of mental illness were reported to negatively affect the economic burden experienced by caregivers. Conclusion There is paucity of studies reporting the burden of severe mental illness on caregivers in sub-Saharan Africa. Further research is needed to present the nature and extent of this burden to inform service planning and policymaking.
Stress levels are associated with poor sleep health among sexual minority men in Paris, France
Mountcastle, H. D., Park, S. H., Al-Ajlouni, Y. A., Goedel, W. C., Cook, S., Lupien, S., Obasi, E. M., Hale, L., Jean-Louis, G., Redline, S., & Duncan, D. T.
Objective: The objective of this study was to examine the association between perceived stress and sleep health among a sample of sexual minority men (SMM). Design: Cross-sectional survey. Setting: Paris, France. Participants: Gay, bisexual and other SMM users ≥18 years on a geosocial networking application in Paris, France (N = 580). Measurements: Participants were directed to a web-based survey measuring stress, sleep health, and socio-demographics. Multivariate log-binomial regression models were used to estimate the adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) to examine how stress may affect different dimensions of sleep health: 1) poor sleep quality, 2) short sleep duration, 3) problems falling asleep, and 4) problems staying awake in the daytime. Results: Most participants (69.9%) reported at least sometimes feeling stressed (compared to never or rarely). Additionally, results demonstrate that higher perceived stress was associated with poorer sleep health; compared with those who reported feeling stress never or rarely, those who felt stress sometimes, often, or always were more likely to experience poor sleep quality (aRR = 6.67; 95% CI = 3.61–12.3), short sleep duration (aRR = 1.67; 95% CI = 1.17–2.38), problems falling asleep (aRR = 3.20; 95% CI = 2.26–4.52), and problems staying awake during the daytime (aRR = 3.52; 95% CI = 1.64–7.53). Conclusion: Elevated perceived stress can negatively influence sleep health among SMM in Paris, France.
Teacher-Based Racial Discrimination: The Role of Racial Pride and Religiosity Among African American and Caribbean Black Adolescents
Butler-Barnes, S. T., Cook, S., Leath, S., & Caldwell, C.
Race and Social Problems
This study explored the extent to which private regard and religiosity beliefs serve as protective factors for school bonding among African American and Caribbean black adolescents who experience racial discrimination in school. Findings are drawn from a nationally representative sample of (n = 810) African American and (n = 360) Caribbean black adolescents (52% girls) aged 13–17 (Mage = 15, SD = 1.42) years. Results suggest that perceiving racial discrimination from teachers was associated with lower levels of school bonding for African American and Caribbean black adolescents. For African American adolescents, perceiving more racial discrimination from teachers and reporting lower private regard beliefs was associated with less school bonding. The findings for Caribbean black adolescents revealed that endorsing moderate levels of religiosity and perceiving higher rates of teacher discrimination was associated with less school bonding. The developmental significance and implications for future research are discussed.
Sexual orientation moderates the association between parental overprotection and stress biomarker profiles
Cook, S. H., Pruessner, J. C., Lupien, S. J., & Juster, R. P.
Psychology and Sexuality
Early experiences with parents may be particularly difficult for lesbian, gay and bisexual (LGB) individuals who face stigma that is linked to potentially distinct stress-related biobehavioural profiles. This study examined the association between parental bonding in relation to acute stress (cortisol reactivity) and chronic stress (allostatic load) in LGB and heterosexual individuals. The sample consisted of 87 healthy adults (mean [SD] age = 24.6 [0.6] years; LGB: n = 46, 43% women; and heterosexual n = 41, 49% women). Regressions tested the main effects of retrospectively assessed parental overprotection and care before the age of 16 on stress reactive cortisol (area under the curve) and allostatic load (indexed using 21 neuroendocrine, immune, metabolic and cardiovascular biomarkers), and whether sexual orientation status moderated this association. Results revealed that parental overprotection was associated with increased cortisol reactivity only for LGB participants, but not for heterosexual participants. By contrast, parental overprotection was associated with higher allostatic load only for heterosexual participants, but not for LGB participants. While the functional significance of this requires further study, these preliminary findings suggest that adaptive processes among LGB individuals may mitigate the negative effects of parental overprotection on markers of chronic stress.
Understanding Attachment Transitions Through the Lived Experiences of Young Black Gay and Bisexual Men
Cook, S. H., Valera, P., Wood, E. P., Calebs, B. J., & Wilson, P. A.
Journal of Sex Research
We conducted a mixed-methods study to identify factors that influence transitions in attachment style between childhood and adulthood among 28 young Black gay and bisexual men (YBGBM) in the United States. We used a phenomenological approach to data integration, with the major component to the results being garnered from the qualitative interviews. We organized our results by four attachment transition groups: stable secure (secure attachment in childhood and young adulthood), stable insecure (insecure attachment in childhood and young adulthood), secure to insecure (secure in childhood and insecure in adulthood) and insecure to secure (insecure in childhood and secure in adulthood). Within each of the typologies, two major themes emerged: social support and religion. Generally, transitions from secure to insecure attachment were related to experiences of perceived rejection by a parental figure during adolescence that corresponded with sexual orientation disclosure. Transitions from insecure to secure attachment appeared to be related to the absence of an attachment figure early in life, but with the acquisition of an attachment figure during early to late adolescence. The findings from our study suggest a need for attachment-based approaches to social support interventions, as well as for an increased understanding of social and cultural factors that impact attachment changes among practitioners who use attachment-based therapy models for YBGBM.