On sexual well-being in sexually abused Swedish women: Epidemiological aspects

At a time when fewer people are getting married and more marriages are ending in divorce, there is renewed focus on the role of marriage counselling in England and Wales. Knowing how best to support marriages which are in trouble is a consistent dilemma for governments. New initiatives in the provision of information about the consequences of marriage breakdown and the services available to help, and the offer of a novel meeting with a marriage counsellor have been piloted across England and Wales. There is much to be learned from their evaluation about the kinds of support couples need and the varied ways in which relationship counselling can be beneficial before, during and after divorce. The research evidence indicates that marriage support services at the time of divorce can help some people to work on saving their marriage; offer a gateway into the counselling process; or enable people to come to terms with the end of a marriage and move forward to a new future. The article argues for a reduced emphasis on marriage saving as evidence of the success of counselling and increased emphasis on the improvement in the quality of spousal relationships irrespective of whether couples stay together.     

Caregiver experiences of social support following stroke

ObjectivesInformal caregivers need to support their loved ones while performing caregiving responsibilities. A phenomenological qualitative study was done to understand the role of social support accessible for stroke caregivers.Materials and methodsThe respondents were enrolled from different organizations or support groups who were conducting activities specifically for stroke victims and/or their caregivers. Data collection was concluded after 10 participants were interviewed as no new major themes were discovered. Hence, saturation of data was obtained with a sample of 10 respondents.ResultsTwo themes were identified from the interviews: “Response to Stroke” and “Stress and Coping”. Categories in theme one “Response to Stroke” were “Work Life Balance”, “Reaction of Other People or Family to Stroke”, and “Expectations and Responsibility from Caregivers”. Categories in theme two “Stress and Coping” were “Impact of Stroke on Abilities of Victim”, “Stressors and Concerns for the Caregivers”, “Strategies used by Caregivers to Cope with Stress”, and “Role of Support Group and Social Support to Stroke Caregiver and Care Recipient”.ConclusionsStroke can lead to stress that can alter the responsibilities of caregivers of stroke victims. The role of social support and support groups was found to be critical for family caregivers to cope with caregiving issues.     

Mastering Health Following Minor Stroke—A Qualitative Explorative Study

BackgroundPatients with minor stroke or transient ischemic attack are encouraged to adopt a healthy lifestyle to prevent recurrent stroke. After discharge health behaviour is performed in an individual everyday context and must be properly understood within this context, including which aspects act as facilitators or barriers for healthy behaviour.ObjectivesTo explore the experience of daily life in patients discharged home after minor stroke or transient ischemic attack, focusing on perceived health and reflection on health behaviour, and how this is associated with their overall experience of returning to their everyday context in relation to potential sequelae of stroke.MethodsSemi-structured qualitative interviews were conducted 3 - 13 months after discharge with sixteen patients discharged home after minor stroke or transient ischemic attack. Inductive thematic analysis was performed to analyse the interviews.ResultsParticipants associated their health and behaviour within a lens of worrying for future life prospect and triggered by perceived intrusive changes in their life condition. Even though some found it possible to resume participation in everyday life within weeks, they became increasingly aware that minor cognitive deficits, difficulties with planning, multi-tasking, memory, and fatigue influenced their health believes and behavioural patterns. The need for social and professional support had to be balanced against a wish for independence.ConclusionPatients with minor stroke or transient ischemic attacks experience changes as both being concrete in the form of persisting symptoms and abstract in the form of worries and uncertainty about the future. Perceived health was associated with a new sense of vulnerability due to realisations about the risk of recurrent stroke. Worries were anchored within the individual to handle, but for some they serve as a motivator to regulate their behaviour in order to master health.     

Well-being of elderly stroke survivors in Chinese communities: mediating effects of meaning in life

Objectives: This study aims to examine the role of meaning in life as a mediator for the relationship of physical functioning, social support, and optimism with well-being among elderly Chinese stroke survivors.Method: A cross-sectional study was conducted on 214 community-dwelling older stroke survivors (128 men and 86 women), ranging from 60 to 88 years. The physical functioning, social support, optimism, meaning in life, and subjective well-being of the participants were measured.Results: Structural equation modeling revealed that meaning in life fully mediates the relationship of physical functioning, social support, and optimism with subjective well-being.Conclusion: This study examines the role of meaning in life in stroke experience from an existential perspective. The modifiable features of meaning in life may offer an intervening angle for improving the well-being of elderly stroke survivors.     

The longitudinal relationship between acceptance and anxiety and depression in people who have had a stroke

ABSTRACT

Objectives: The role that acceptance may play in anxiety and depression has received little attention in stroke, unlike other chronic conditions. This study aimed to clarify whether acceptance of a stroke is related to anxiety and depression post-stroke when controlling for social support.

Design: A longitudinal design was employed with 35 participants completing measures at two time points: three-month and nine-month post-stroke.

Methods: Forty-one stroke patients, who were three-month post-stroke, were recruited from a stroke service register. Participants completed measures of anxiety, depression, social support and acceptance at two time points, six months apart.

Results: Acceptance was moderately and negatively correlated with anxiety and depression at three- and nine-month post-stroke. Acceptance showed a moderate and positive correlation with emotional and practical social support at Time 1 but not at Time 2. Acceptance at Time 1 was a stronger predictor of both anxiety and depression at Time 2 than emotional or practical social support.

Conclusions: Acceptance is an important area to consider in relation to rehabilitation and adjustment following a stroke.     

Development and Validation of the Stroke Knowledge Test

Abstract

Purpose: The purpose of this study was to develop a measure of stroke knowledge (the Stroke Knowledge Test [SKT]) using a systematic test construction process and to investigate the psychometric properties of this test. There are relatively few published measures of stroke knowledge, and, of those that exist, relatively little is documented about test construction or psychometric properties. Such tests are important for evaluation of stroke education programs. Method: Test construction involved systematic generation of pilot test items, expert review of pilot items, and calculation of pilot item properties. After final item selection, two experiments were conducted to determine if the SKT was sensitive to varying levels of stroke knowledge and to estimate the reliability of the test. Results: The final version of the test included 20 items with good content coverage, acceptable item properties, and positive expert review ratings. Results from psychometric investigations suggest that SKT has relatively good reliability (internal consistency and test-retest reliability) and construct validity (i.e., SKT scores significantly increased after stroke education [cf. nonstroke education], and community-dwelling older adults who had a relative with stroke [and more prior exposure to stroke information] scored higher on the SKT than those without a stroke relative). Conclusion: Findings provide preliminary support for the SKT as a valid and reliable tool for assessing stroke knowledge. The SKT may be used to identify individual information needs of stroke survivors and their caregivers or as a tool to evaluate group- or community-based stroke education programs.     

Impact of social support on participation after stroke in Nigeria

Background: Participation which entails involvement in life situations and represents a higher level of functioning can be severely restricted after a stroke. This study investigated the impact of social support on participation of stroke survivors in Nigeria.

Methods: Ninety-six community-residing stroke survivors were recruited from physiotherapy outpatient departments of two tertiary care hospitals in Northern Nigeria. Socio-demographic, clinical, participation (London Handicap Scale), and social support (Multidimensional Scale of Perceived Social Support) data were obtained. The impact of social support on global and domain-specific participation was examined using bivariate analyses and multiple regression analyses.

Results: Mean (SD) age of the stroke survivors was 56.6 (12.0) years. Social support was a significant (β = 0.41, p < 0.0001) and independent determinant of the economic self-sufficiency domain of participation (p < 0.0001) in a regression model that accounted for 27% of the variance in the domain (R² = 0.27). Social support, however, had no independent effect on overall participation and the other participation domains namely mobility, physical independence, occupation, social integration, and orientation.

Conclusion: The impact of social support was significant only in the economic self-sufficiency domain of participation with higher availability of social support related to better economic self-sufficiency. This finding provides additional information on the importance of social support post-stroke.     

Perceived social support and social constraints in Hausa women stroke survivors: A cross-sectional study

ABSTRACT

Background: Social factors modulating stroke outcomes are found to be culturally and gender inclined. We examined social support and social constraints in Hausa women stroke survivors.

Aim: To determine social support and social constraints in Hausa women after stroke.

Materials and methods: Seventy-four (74) Hausa women stroke survivors were conveniently recruited from three tertiary health centers to participate in this cross-sectional study. Sociodemographic and stroke-related attributes of the participants were obtained. Perceived social support and social constraints were assessed using multidimentional scale of perceived social support (MSPSS) and the social problem questionnaire (SPQ), respectively. The relationship and association between different variables were assessed using Pearson’s correlation and chi-square test, respectively.

Results: Majority of the participants (60.8%) reported adequate level of social support. Similarly, most participants reported fairly low level of social constraints in total family stress (91.9%) and nonchild-related stress (90.5%). None of the participants’ sociodemographic features had a significant relationship with either social support or social constraints (p > .05). Findings indicated an inverse relationship between social support and social constraint.

Conclusion: Findings of this study suggest that adequate social support potentially limits the level of social constraint encountered by women who suffered stroke. The Hausa culture seems to be impressive in characteristically demonstrating high level of social support as found in this study. It is recommended that physiotherapist should assist by providing educative programs that would increase caregiver’s knowledge of social support and how to develop it and cultural values that emphasize positive social interaction should be encouraged.     

Clinical Characteristics of Stroke with COVID-19: A Systematic Review and Meta-Analysis

BackgroundThe coronavirus disease 2019 (COVID-19) potentially increases the risk of thromboembolism and stroke. Numerous case reports and retrospective cohort studies have been published with mixed characteristics of COVID-19 patients with stroke regarding age, comorbidities, treatment, and outcome. We aimed to depict the frequency and clinical characteristics of COVID-19 patients with stroke.MethodsPubMed and EMBASE were searched on June 10, 2020, to investigate COVID-19 and stroke through retrospective cross-sectional studies, case series/reports according to PRISMA guidelines. Study-specific estimates were combined using one-group meta-analysis in a random-effects model.Results10 retrospective cohort studies and 16 case series/reports were identified including 183 patients with COVID-19 and stroke. The frequency of detected stroke in hospitalized COVID-19 patients was 1.1% ([95% confidential interval (CI)]: [0.6-1.6], I² = 62.9%). Mean age was 66.6 ([58.4-74.9], I² = 95.1%), 65.6% was male (61/93 patients). Mean days from symptom onset of COVID-19 to stroke was 8.0 ([4.1-11.9], p< 0.001, I² = 93.1%). D-dimer was 3.3 μg/mL ([1.7-4.9], I² = 86.3%), and cryptogenic stroke was most common as etiology at 50.7% ([31.0-70.4] I² = 64.1%, 39/71patients). Case fatality rate was 44.2% ([27.9-60.5], I² = 66.7%, 40/100 patients).ConclusionsThis systematic review assessed the frequency and clinical characteristics of stroke in COVID-19 patients. The frequency of detected stroke in hospitalized COVID-19 patients was 1.1% and associated with older age and stroke risk factors. Frequent cryptogenic stroke and elevated d-dimer level support increased risk of thromboembolism in COVID-19 associated with high mortality. Further study is needed to elucidate the pathophysiology and prognosis of stroke in COVID-19 to achieve most effective care for this population.     

Hippocampal Volume and Memory Performance in Children With Perinatal Stroke

BackgroundPediatric neurologists and neonatologists often are asked to predict cognitive outcome after perinatal brain injury (including likely memory and learning outcomes). However, relatively few data exist on how accurate predictions can be made. Furthermore, although the consequences of brain injury on hippocampal volume and memory performance have been studied extensively in adults, little work has been done in children.MethodsWe measured the volume of the hippocampus in 27 children with perinatal stroke and 19 controls, and measured their performance on standardized verbal and non-verbal memory tests.ResultsWe discovered the following: (1) As a group, children with perinatal stroke had smaller left and right hippocampi compared with control children. (2) Individually, children with perinatal stroke demonstrated 1 of 3 findings: no hippocampal loss, unilateral hippocampal loss, or bilateral hippocampal volume loss compared with control children. (3) Hippocampal volume inversely correlated with memory test performance in the perinatal stroke group, with smaller left and right hippocampal volumes related to poorer verbal and non-verbal memory test performance, respectively. (4) Seizures played a significant role in determining memory deficit and extent of hippocampal volume reduction in patients with perinatal stroke.ConclusionsThese findings support the view that, in the developing brain, the left and right hippocampi preferentially support verbal and nonverbal memory respectively, a consistent finding in the adult literature but a subject of debate in the pediatric literature. This is the first work to report that children with focal brain injury incurred from perinatal stroke have volume reduction in the hippocampus and impairments in certain aspects of declarative memory.     

Evaluation of self-care skills training and solution-focused counselling for health professionals in psychiatric medicine: a pilot study

Objective: The purpose of this pilot study was to implement and to evaluate a self-care skills training with solution-focused counselling to support psychiatrists in handling their daily work challenges.

Methods: A total of 72 psychiatrists working in a psychiatric clinic were randomised in a single-blind trial to either an intervention group or a control group. Outcomes were measured at baseline and at the end of the training (follow-up 1: after 3 months; follow-up 2: after 6 months). A validated questionnaire including the Perceived Stress Questionnaire, the Copenhagen Psychosocial Questionnaire, Brief Resilient Coping Scale, Self-Efficacy Scale and the Quality of Relationship Inventory was used.

Results: Psychiatrists in the intervention group reached a significant reduction in perceived job stress (p?=?0.01, d?=?0.05), improvements in job satisfaction (p?=?0.02, d?=?0.04), resilience (p?=?0.02, d?=?0.04) and self-efficacy (p?=?0.04, d?=?0.02) from baseline to all follow-ups with no comparable results seen in the control group. Psychiatrists stated an improved quality of physician–patient relationship (e.g. support, conflict management; p?Conclusions: A self-care skills training, including solution-focused counselling, for psychiatrists was associated with significant improvements in perceived stress, job satisfaction, individual protective skills and quality of relationship to patients. This training is suitable to implement as a group training program for psychiatrists.     

Do family-oriented interventions reduce poststroke depression? A systematic review and recommendations for practice

Introduction:Up to half of all stroke survivors become depressed. Poststroke depression (PSD) negatively impacts on quality of life and rehabilitation outcomes and increases risk of mortality. Depression is also common in carers, leading to poorer outcomes in survivors. Few stroke patients receive adequate care to support prevention and management of PSD. We aimed to systematically review the evidence regarding the effectiveness of family-oriented interventions to prevent and manage depression after stroke and identify components of effective interventions.

Methods:A systematic review was conducted, adhering to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eight databases were searched, and relevant journals and reference lists were hand searched. Abstracts were screened for relevance and two authors independently assessed selected full texts against inclusion criteria. Studies were included if they (1) engaged stroke patients and their informal/family caregivers; (2) measured changes in depression due to an intervention; and (3) were available in English.

Results:Twenty-five of 2741 identified citations met the inclusion criteria. Five studies demonstrated significant reductions in depression. Commonalities across effective studies included the delivery of interventions that were structured and multicomponent, actively engaged patients and families, coordinated care, and were initiated soon after a stroke.

Conclusion:Family-oriented stroke rehabilitation may reduce depression in stroke survivors and their family caregivers. More research is required to clarify the effectiveness, feasibility, and acceptability of working with families and patients living with or who may be at risk of PSD.     

Extraordinary experiences in its cultural and theoretical context

Abstract

The growing complexity, opaqueness and specialization of many areas of life and – above all – a booming psychological and esoteric market create the necessity for counselling and advice for individuals who encounter so-called ‘paranormal’ experiences. These experiences are often interpreted as ‘transpersonal’ or ‘spiritual’, depending on the cultural background and religious traditions. The term ‘spiritual crisis’ has become a fashionable diagnosis with some transpersonal psychotherapists. Paranormal experiences, regardless of their acceptance of academic psychology and psychiatry, are still a taboo subject in society. The Parapsychological Counselling Office in Freiburg is a professional unit with governmental support, which helps individuals to cope with such experiences adequately. The work and responsibilities of the counselling centre are presented. A large collection of cases in the form of letters, which were sent in by individuals wanting to communicate their unusual or extraordinary experiences have been analysed. Some of the results are reported here. Finally, we discuss a special form of ‘inexplicable experiences’ based on a theoretical model. Its recommendations seem counter-intuitive but are ultimately successful. The model starts from a system-theoretical viewpoint and uses concepts such as complementarity and entanglement of generalized quantum theory (GQT) and the model of pragmatic information (MPI). Since it turned out that individuals who contact the counselling centre also offer their own interpretations and ‘explanation’, the question arises, how these resources can be used to help clients.     

Does training sitting balance on a platform tilted 10° to the weak side improve trunk control in the acute phase after stroke? A randomized,controlled trial

Background: Trunk performance and sitting balance, especially lateral sitting control, are important predictors of functional outcome after stroke. However, no studies have focused only on trunk function in the frontal plane for persons with acute-phase stroke.

Objective: To investigate the effects of lateral sitting training on a tilting platform in persons with stroke.

Methods: An assessor-blinded, randomized, controlled trial was carried out involving inpatients at a stroke rehabilitation center. Patients were allocated to either an experimental group (n?=?15) or a control group (n?=?15). The experimental group sat without leg support on a platform tilted 10° to the paretic side in the frontal plane, while the controls sat on a horizontal platform. Both groups were asked to move their trunk laterally from the paretic side to the nonparetic side. In addition to conventional therapy, this training was performed 60 times/session, with 6 sessions/week. Trunk function was assessed using the Trunk Control Test (TCT), and the ability to move the trunk laterally was evaluated kinematically. Measurements were performed at baseline and after training. Two-way repeated measures analysis of variance was used to test the significance between and within treatments for each dependent variable.

Results: None of the demographic data differed between the groups. After training, a significant improvement was noted in the experimental group compared to the controls in the TCT and the ability for lateral trunk transference (P?<?0.05, 1???β?=?0.98, effect size?=?0.4).

Conclusion: Lateral sitting training on the tilting platform improved the impaired trunk function of persons with stroke.     

Quality of Life in Pediatric Moyamoya Disease

BackgroundMoyamoya disease (MMD) is a progressive intracranial arteriopathy with high risk of stroke. Its impact on quality of life is unstudied. We surveyed children with moyamoya disease and compared their quality of life to chronically ill children and children with stroke to better understand the impact of this diagnosis.MethodsChildren with moyamoya disease aged seven to 17 years from Stanford's Moyamoya Clinic between June 2014 and March 2015 were included. Children with syndromic neurodevelopmental diagnoses were excluded. Patients were surveyed using the Pediatric Quality of Life 4.0, in addition to the Pediatric Stroke Outcome Measure or Recovery Recurrence Questionnaire. Mean scores were compared to normative data sets. Linear regression models compared total quality of life scores in patients with and without stroke, after adjusting for confounders.ResultsThis cross-sectional study included 30 children with moyamoya disease; ten were male, and the median age was 13.5 years (range, 7 to 17 years). Twenty children (67%) had a stroke, and 14 of these had good neurological outcome (70%). Mean parent-proxy Pediatric Quality of Life scores were lower in all domains compared to healthy controls (P < 0.05), and all scores were comparable to chronically ill children and children with non–moyamoya disease stroke. There was no significant difference in total quality of life between patients with and without stroke.ConclusionsEven in the absence of stroke, children with moyamoya disease have lower quality of life than healthy controls and a similar quality of life to chronically ill children and those with non–moyamoya disease stroke. Children with moyamoya disease would benefit from mental health support beyond what a mild physical presentation may indicate.     

Moving towards independent living in Ghana: Narratives from young adults about their kinship care experience

IntroductionIn most sub-Saharan African countries, studies on the impact of out-of-home care experience on the transition of young adults leaving care are limited to those leaving institutional or foster care with no empirical evidence on the experiences of those moving out of kinship care. This study reports findings from interviews with young adults with experience of kinship care in Ghana, about what lessons their kinship care experiences provided in their transition to adulthood.MethodTwenty-five young adults aged 21–25 years (17 males, 8 females) with kinship care experience from rural communities in Ghana were purposively selected. Using a semi-structured interview guide, a qualitative short narrative approach was employed. Consistent patterns from the short narratives were analysed using the qualitative thematic approach.ResultsKey themes identified from the participants’ narratives were a) learning from life experiences b) better decision making and c) development of resilient strategies. Young adults reported that they shaped their lives with lessons from negative experiences, advice received from caregivers and management skills obtained from the unskilled income generating activities they undertook whilst in kinship care.ConclusionThe study provides evidence for policymakers to consider kinship care as an effective, suitable and cost-effective alternative care arrangement for children in need of adequate parental care in Ghana. When assessing kin's suitability to provide care, some emphasis should be on caregivers' needs and assessment of activities engaged in by children living in kinship care. Social workers should provide counselling and education support to children moving out of kinship care.     

Risk Prediction of Cognitive Decline after Stroke

Background and purposeCognitive decline is one of the major outcomes after stroke. We have developed and evaluated a risk predictive tool of post-stroke cognitive decline and assessed its clinical utility.MethodsIn this population-based cohort, 4,783 patients with first-ever stroke from the South London Stroke Register (1995-2010) were included in developing the model. Cognitive impairment was measured using the Mini Mental State Examination (cut off 24/30) and the Abbreviated Mental Test (cut off 8/10) at 3-months and yearly thereafter. A penalised mixed-effects linear model was developed and temporal-validated in a new cohort consisted of 1,718 stroke register participants recruited from (2011-2018). Prediction errors on discrimination and calibration were assessed. The clinical utility of the model was evaluated using prognostic accuracy measurements and decision curve analysis.ResultsThe overall predictive model showed good accuracy, with root mean squared error of 0.12 and R2 of 73%. Good prognostic accuracy for predicting severe cognitive decline was observed AUC: (88%, 95% CI [85-90]), (89.6%, 95% CI [86-92]), (87%, 95% CI [85-91]) at 3 months, one and 5 years respectively. Average predicted recovery patterns were analysed by age, stroke subtype, Glasgow-coma scale, and left-stroke and showed variability.Decisioncurve analysis showed an increased clinical benefit, particularly at threshold probabilities of above 15% for predictive risk of cognitive impairment.ConclusionsThe derived prognostic model seems to accurately screen the risk of post-stroke cognitive decline. Such prediction could support the development of more tailored management evaluations and identify groups for further study and future trials.