Premarital counseling and culture: A narrative inquiry of couples\u27 insights

Premarital counseling programs have emerged as a way to lower the chances of divorce and also to increase couple satisfaction after marriage. Premarital programs provide couples with necessary skills to enhance communication, problem solving, and decrease conflict by addressing expectations within marriage. Although these programs have been shown to be helpful to couples, they often present a one size fits all approach to assisting couples. This is particularly true in relation to culture and premarital counseling programs. To date, there has been a lack of attention in the literature to cultural differences within premarital programs; therefore, this study aimed to explore couples\u27 and therapists\u27 perceptions of ways Latino/a culture can be addressed within premarital counseling. In this study, six married couples in which at least one person considered himself/herself Latino/a and three therapists that had extensive experience working with the Latino/a population were interviewed. Through a narrative approach, couples\u27 stories around Latino/a culture and Latino marriage were analyzed. Three major themes emerged, which were; unique aspects of Latino/a culture, Latino marriage, and premarital counseling with Latino couples. Subthemes for Latino/a culture included: dress, language, religion, tradition, and extended family. Subthemes for Latino marriage included: extended family, birth order, parenting skills, roles, communication, respect and trust, sex, and immigration. Subthemes for the premarital counseling with Latino couples included: delivery of religious influence, delivery, cost, and therapist training. The discussion addresses how themes and past literature related directly to the research questions of the current study and provides suggestions for therapists working with premarital Latino couples. Suggestions for future research include additional research with particular ethnic groups, particular immigration groups, intercultural couples, and the structure of premarital counseling

Pilotażowy test interwencji świadomej medytacji w redukcji stresu u młodszych pacjentów z udarem mózgu

Introduction. The population of younger people having strokes is growing. Persons who are younger and have a stroke have specific stressors after a stroke that those over 60 may not experience (e.g., ability to earn an income, provide for a family, returning to work, etc.).Aim. In order to address some of these age-specific stressors, new and novel approaches to stress mediation are needed. In order to address this gap in the literature this study piloted a mindfulness meditation with younger in hospital stroke survivors.Material and Methods. Prospective non-randomized pilot study of in-hospital stroke patients < 60 years of age. Baseline assessment included the Perceived Stress Scale (PSS), heart rate (HR), blood pressure (BP), and respiratory rate (RR). Patients received a 10-minute mindfulness training session with instructions for home use. PSS, HR, BP, and RR were collected immediately after training and telephone assessments of PSS were collected 30-day post discharge.Results. The mean age of the 21 patients included in the final analysis was 47.4 years. Paired t-test showed statistically significant differences in heart rate (p < 0.001) and respiratory rate (p < 0.001) before and after the intervention, but no statistically significant differences in pre and post training blood pressure (p = 0.480). There was no statistically significant difference in PSS scores before and after the training.Conclusions. The findings of this study suggest that the mindfulness intervention is feasible for in-hospital stroke patients and shows promise for reducing stress, as indicated by physiologic changes such as lowering heart and blood pressure rates. (JNNN 2019;8(2):48–53)Wstęp. Wzrasta populacja młodych ludzi zapadających na udary mózgu. Osoby młodsze w wyniku udaru odczuwają określone czynniki stresogenne, których osoby powyżej 60. roku życia mogą nie doświadczyć (np. zdolność do zarabiania pieniędzy, utrzymanie rodziny, powrót do pracy itp.).Cel. Aby odnieść się do niektórych z tych specyficznych dla danego wieku czynników stresogennych, potrzebne są nowe i nowatorskie podejścia do mediacji w zakresie stresu. W celu zajęcia się tą luką w literaturze, w badaniu tym przeprowadzono pilotażową świadomą medytację w szpitalu z młodszymi osobami, które przeżyły udar mózgu.Materiał i metody. Prospektywne, nierandomizowane badanie pilotażowe u pacjentów po udarze mózgu w wieku poniżej 60 lat przeprowadzono w warunkach szpitalnych. Ocena stanu wyjściowego obejmowała skalę postrzeganego stresu (PSS), częstość akcji serca (HR), ciśnienie krwi (BP) i częstość oddechową (RR). Pacjenci otrzymali 10-minutowy trening świadomego myślenia oraz instrukcje wykonywania w warunkach domowych. PSS, HR, BP i RR zebrano natychmiast po przeszkoleniu, a oceny telefoniczne PSS zebrano 30 dni po wypisie ze szpitala.Wyniki. Średni wiek 21 pacjentów objętych finalną analizą wynosił 47,4 lat. Analiza t-testem wykazała istotne statystycznie różnice w częstości akcji serca (p < 0,001) i częstości oddechu (p < 0,001) przed i po interwencji, jednakże nie wykazano istotnych statystycznie różnic w ciśnieniu krwi przed i po instruktażu (p = 0,480). Nie odnotowano statystycznie istotnej różnicy w wynikach PSS przed i po szkoleniu.Wnioski. Wyniki tego badania sugerują, że interwencja w zakresie świadomego myślenia jest wykonalna dla pacjentów po udarze mózgu w warunkach szpitalnych i wskazuje na obiecujące możliwości zmniejszenia stresu, na co wskazują zmiany fizjologiczne, takie jak obniżenie częstości akcji serca i ciśnienia krwi. (PNN 2019;8(2):48–53

Rola zarejestrowanej objętości wyrzutu płynu mózgowo-rdzeniowego w przewidywaniu wyniku w zmodyfikowanej skali Rankina przy wypisie ze szpitala u pacjentów z krwawieniami podpajęczynówkowymi (DROPSS)

Introduction. External ventricular drain (EVD) placement is common among aneurysmal subarachnoid hemorrhage (aSAH). Draining cerebrospinal fluid (CSF) from the EVD is also common, yet little is known about how much to drain, the length of time to drain, or how drainage impacts patient outcomes. Aim. The purpose of this study is to correlate amount of CSF drainage to patient outcomes, via modified Rankin Score (mRS). Material and Methods. This retrospective review of data located in a local hospital-based registry and electronic medical record. A linear mixed effects model was constructed to examine CSF drainage volume as a predictor of mRS at discharge. Results. Data from 82 patients was included in this analysis. There was no statistically significant relationship between CSF totals and mRS at hospital discharge (p = 0.3614, r² = 0.01). After controlling for age, Hunt and Hess score, and subject as random effect, there was still no significant relationship between CSF drained and mRS score at hospital discharge (p = .9042). Conclusions. There is no correlation between the total volume of CSF drained and mRS at discharge. Future research should explore CSF drainage documentation practices. (JNNN 2022;11(2):43–48) Key Words: acute care, aneurysmal subarachnoid hemorrhage, cerebrospinal fluid, external ventricular drain, patient outcomesWstęp. Założenie drenu komorowego zewnętrznego (EVD) jest powszechne w przypadku tętniakowatego krwotoku podpajęczynówkowego (aSAH). Drenaż płynu mózgowo-rdzeniowego (cerebrospinal fluid, CSF) z EVD jest również powszechny, jednak niewiele wiadomo na temat ilości płynu, czasu trwania drenażu i wpływu drenażu na wyniki leczenia. Cel. Celem tego badania jest korelacja ilości drenażu płynu mózgowo-rdzeniowego z wynikami leczenia pacjentów w zmodyfikowanej skali Rankina (modified Rankin Score, mRS). Materiał i metody. Retrospektywny przegląd danych znajdujących się w lokalnym rejestrze szpitalnym i elektronicznej dokumentacji medycznej. W celu zbadania objętości drenażu płynu mózgowo-rdzeniowego jako predyktora mRS przy wypisie ze szpitala skonstruowano liniowy model efektów mieszanych. Wyniki. Do analizy włączono dane od 82 pacjentów. Nie stwierdzono istotnej statystycznie zależności między całkowitą objętością płynu mózgowo-rdzeniowego a mRS przy wypisie ze szpitala (p = 0,3614, r² = 0,01). Po uwzględnieniu wieku, punktacji w skali Hunta i Hessa oraz podmiotu jako efektu losowego, nadal nie było istotnej zależności między odsączonym płynem mózgowo-rdzeniowym a wynikiem mRS przy wypisie ze szpitala (p = .9042). Wnioski. Nie ma korelacji między całkowitą objętością zdrenowanego płynu mózgowo-rdzeniowego a mRS przy wypisie ze szpitala. W przyszłych badaniach należy przeanalizować sposób prowadzenia dokumentacji drenażu płynu mózgowo-rdzeniowego. (PNN 2022;11(2):43–48)

Comparison of stroke knowledge before and after education in Ethiopia (The ask project)

Background: In order to address the growing burden of stroke in Africa, it is essential to have teaching tools that are accessible to a wide variety of communities. Resources for stroke, recognition of symptoms, steps to assist a stroke victim, or any educational tools are scarce. In order to increase education about stroke, we introduced a stroke education intervention in Bahir Dar, Ethiopia in the Amharic language. The aim of the intervention was to see if stroke knowledge and recognition of stroke symptoms increased post-education. Methods: An anonymous pre-test questionnaire was given to identify their baseline stroke knowledge, and then participants viewed the video about stroke. The Amharic BE-FAST acronym was introduced in the video to evaluate participants’ retention of stroke symptoms, while emphasizing the importance of rapid response. Participants were given a survey to post-test survey of their short-term memory recall, along with another satisfaction survey. Results: Over 50% of participants remembered all five letters of the Amharic BE-FAST acronym, nearly 80% answered that they learned about stroke prevention, 90% were satisfied with the video, and 98% thought it should be available widely to the general public. The data presented showed that there was an improvement in stroke education retention with the use of the stroke education video. Conclusions: The Amharic BE-FAST acronym demonstrated to be an effective tool in communicating the symptoms of stroke from English to Amharic. Stroke education was well received, which provided insight on how to design and implement new medical concepts in native languages.   French title:Connaissances sur les accidents vasulaires cerebraux avant et apres une education en Éthiopie (Projet ask)   Introduction: Afin de faire face au fardeau croissant des AVC en Afrique, il est essentiel de disposer d'outils pédagogiques accssibles à une grande variété de communautés. Les ressources pour l'AVC, la reconnaissance des symptômes, les étapes pour aider une victime d'AVC ou tout autre outil éducatif sont rares. Afin d'accroître l'éducation sur l'AVC, nous avons introduit une intervention d'éducation sur l'AVC à Bahir Dar, en Ethiopie, en langue amharique. Le but de l'intervention était de voir si la connaissance et la reconnaissance des symptômes de l'AVC augmentaient après l'éducation. Méthodes: Un questionnaire pré-test anonyme a été donné pour identifier leurs connaissances de base sur l'AVC, puis les participants ont visionné la vidéo sur l'AVC. L'acronyme amharique BE-FAST a été introduit dans la vidéo pour évaluer la rétention des symptômes d'AVC par les participants, tout en soulignant l'importance d'une réponse rapide. Les participants ont reçu une enquête pour post-test de leur mémoire à court terme, ainsi qu'une autre enquête de satisfaction. Résultats: Plus de 50% des participants se sont souvenus des cinq lettres de l'acronyme amharique BE-FAST, près de 80% ont répondu avoir appris la prévention des AVC, 90% étaient satisfaits de la vidéo et 98% pensaient qu'elle devrait être largement accessible au grand public. Les données présentées ont montré qu'il y avait une amélioration de la rétention de l'éducation sur l'AVC grâce à l'utilisation de la vidéo d'éducation sur l'AVC. Conclusion: L'acronyme amharique BE-FAST s'est révélé être un outil efficace pour communiquer les symptômes de l'AVC de l'anglais à l'amharique. L'éducation sur l'AVC a été bien accueillie, ce qui a permis de comprendre comment concevoir et mettre en oeuvre de nouveaux concepts médicaux dans les langues maternelles

Quantitative pupillometry and radiographic markers of intracranial midline shift: A pilot study

BackgroundAsymmetric pupil reactivity or size can be early clinical indicators of midbrain compression due to supratentorial ischemic stroke or primary intraparenchymal hemorrhage (IPH). Radiographic midline shift is associated with worse functional outcomes and life-saving interventions. Better understanding of quantitative pupil characteristics would be a non–invasive, safe, and cost-effective way to improve identification of life-threatening mass effect and resource utilization of emergent radiographic imaging. We aimed to better characterize the association between midline shift at various anatomic levels and quantitative pupil characteristics.MethodsWe conducted a multicenter retrospective study of brain CT images within 75 min of a quantitative pupil observation from patients admitted to Neuro-ICUs between 2016 and 2020 with large (>1/3 of the middle cerebral artery territory) acute supratentorial ischemic stroke or primary IPH > 30 mm3. For each image, we measured midline shift at the septum pellucidum (MLS-SP), pineal gland shift (PGS), the ratio of the ipsilateral to contralateral midbrain width (IMW/CMW), and other exploratory markers of radiographic shift/compression. Pupil reactivity was measured using an automated infrared pupillometer (NeurOptics®, Inc.), specifically the proprietary algorithm for Neurological Pupil Index® (NPi). We used rank-normalization and linear mixed-effects models, stratified by diagnosis and hemorrhagic conversion, to test associations of radiographic markers of shift and asymmetric pupil reactivity (Diff NPi), adjusting for age, lesion volume, Glasgow Coma Scale, and osmotic medications.ResultsOf 53 patients with 74 CT images, 26 (49.1%) were female, and median age was 67 years. MLS-SP and PGS were greater in patients with IPH, compared to patients with ischemic stroke (6.2 v. 4.0 mm, 5.6 v. 3.4 mm, respectively). We found no significant associations between pupil reactivity and the radiographic markers of shift when adjusting for confounders. However, we found potentially relevant relationships between MLS-SP and Diff NPi in our IPH cohort (β = 0.11, SE 0.04, P = 0.01), and PGS and Diff NPi in the ischemic stroke cohort (β = 0.16, SE 0.09, P = 0.07).ConclusionWe found the relationship between midline shift and asymmetric pupil reactivity may differ between IPH and ischemic stroke. Our study may serve as necessary preliminary data to guide further prospective investigation into how clinical manifestations of radiographic midline shift differ by diagnosis and proximity to the midbrain

Premarital counseling and culture: A narrative inquiry of couples' insights

Premarital counseling programs have emerged as a way to lower the chances of divorce and also to increase couple satisfaction after marriage. Premarital programs provide couples with necessary skills to enhance communication, problem solving, and decrease conflict by addressing expectations within marriage. Although these programs have been shown to be helpful to couples, they often present a "one size fits all" approach to assisting couples. This is particularly true in relation to culture and premarital counseling programs. To date, there has been a lack of attention in the literature to cultural differences within premarital programs; therefore, this study aimed to explore couples' and therapists' perceptions of ways Latino/a culture can be addressed within premarital counseling. In this study, six married couples in which at least one person considered himself/herself Latino/a and three therapists that had extensive experience working with the Latino/a population were interviewed. Through a narrative approach, couples' stories around Latino/a culture and Latino marriage were analyzed. Three major themes emerged, which were; unique aspects of Latino/a culture, Latino marriage, and premarital counseling with Latino couples. Subthemes for Latino/a culture included: dress, language, religion, tradition, and extended family. Subthemes for Latino marriage included: extended family, birth order, parenting skills, roles, communication, respect and trust, sex, and immigration. Subthemes for the premarital counseling with Latino couples included: delivery of religious influence, delivery, cost, and therapist training. The discussion addresses how themes and past literature related directly to the research questions of the current study and provides suggestions for therapists working with premarital Latino couples. Suggestions for future research include additional research with particular ethnic groups, particular immigration groups, intercultural couples, and the structure of premarital counseling.</p

Individual and partner effects: Influences of anxiety and warmth on marital satisfaction among African American spouses

African Americans are currently the 2nd largest minority group in the United States (U.S. Census, 2004); however, there is a paucity of research within this population examining the unique context and characteristics of both individuals and couples related to marital and emotional distress. The current study addressed these limitations through the utilization of self-reported and observational data measures of partner warmth provided through the Family and Community Health Study (FACHS). The current analyses focused on the longitudinal effects of anxiety and partner warmth on marital satisfaction among 99 African American couples within FACHS. Hierarchical regression analyses revealed significant associations between self-reported partner warmth, community racism, and marital satisfaction among men. For women, financial strain was significantly linked to subsequent marital satisfaction. The discussion highlights the role of gender differences, socioeconomic status, and neighborhood influences which play a role in the current study findings. Also of relevance to clinical settings, the current findings suggest that identification of stressors (i.e., financial strain and community racism) may assist clinicians working with African American clients by facilitating understanding and more appropriate assessment of important influences on African American marital satisfaction.</p