HIV Positive Hispanic/Latinos Who Delay HIV Care: Analysis of Multilevel Care Engagement Barriers

This article overviews a Health Resources and Services Administration (HRSA) study with a sample population consisting of 470 Hispanic/Latino persons living with HIV/AIDS who received primary HIV/AIDS medical services from one of five HRSA Special Projects of National Significance (SPNS) Border Health demonstration projects. The study purpose was to identify multilevel barriers that affect delayed entry into HIV/AIDS medical care among Hispanic/Latino persons living along the U.S.–Mexico border. Multilevel variables along individual, community/cultural, and structural/systems were assessed relative to delayed care entry. The results of this examination indicate that individual and structural/system-level variables affect delayed care entry, whereas support was not found for community/cultural-level barriers. Study findings inform treatment engagement strategies aimed to decrease HIV disease progression by bringing Hispanic/Latinos into care sooner.     

“I Didn't Know I Could Turn Colors”: Health Problems and Health Care Experiences of Women Strangled by an Intimate Partner

Strangulation is a unique and particularly pernicious form of intimate partner violence. To increase the relatively little that is known about strangulation survivors, focus groups and interviews were conducted as part of a practice–research engagement with a domestic violence shelter. All of the participants had been strangled and, among them, almost all were strangled multiple times. The loss of consciousness was common. Participants associated “choking” with use of body parts and “strangling” with use of objects. Although some minimized the assault, most considered strangulation to be serious and reported a variety of medical conditions following the assault. Few sought medical care. Of those who did, few disclosed the assault, or were asked about strangulation, which commonly resulted in misdirected treatment. Implications for improving detection and treatment are discussed.     

The Contribution of Psychosocial Factors to Secondary Risk Prevention for Myocardial Infarction in Young Adults

The aim of this study was to explore and identify the contribution of complex psychosocial factors to secondary risk prevention for Myocardial Infarction (MI) among adults under 55 years. Participants included 30 MI patients who were admitted to St. Vincent's Health in Melbourne. A repeated measures mixed measures methodology was used to examine demographic information, depressive symptomatology, physical and emotional wellbeing, and social functioning during hospitalization and at 3 and 6 months post discharge. Participants demonstrated severe depression at initial assessment but this reduced significantly post discharge. Depression at initial assessment aligned with reports of intense fear of increased mortality. The reduction in depression scores at 3 and 6 months aligned with emotional management of the crisis and improvements in general health, and physical and social functioning. The majority of patients did not participate in community rehabilitation, naming informal supports as the most significant. These results lend support to the use of crisis intervention and empowerment strategies as key elements of cardiac rehabilitation programs, to improve physical functioning and attend to depressive symptomatology in a proactive way, to improve secondary risk prevention among young patients who experience an MI event.     

Encouraging Self-Management in Chronically Ill Patients With Co-Morbid Symptoms of Depression and Anxiety: An Emergency Department Study and Response

The complex interrelationship between depressive disorders and chronic disease has significant implications for both chronic disease management and the treatment of depression. In this article, the results of a mixed method, clinical data-mining (CDM) study (Epstein, 2010 Epstein, I. 2010. Clinical Data-Mining: Integrating Practice and Research, New York, NY: Oxford University Press.  [Google Scholar]) were combined with an original survey of Emergency Department staff, to design a program of intervention that targets patients with chronic illness, presenting to an Australian Acute-Care Hospital.     

Mild Traumatic Brain Injury: A Place for Social Work

Mild traumatic brain injury (mTBI) has emerged as a significant public health issue. Increases in both the prevalence and awareness of this injury have resulted in a greater demand for mTBI-informed care. Our exploratory, qualitative study examines the work lives of front-line mTBI professionals. Findings suggest that mTBI rehabilitation work often requires substantial emotional energy given the impact that injury-related issues have on professionals’ therapeutic work with clients. We suggest that social work, with a focus on the psychosocial implications of injury and recovery, is well-positioned to take a larger role in mTBI care and rehabilitation.     

Implementation of Health and Mental Health Evidence-Based Practices in Safety Net Settings

Implementation of evidence-based practices (EBP) in health and mental health settings has not been as successful as anticipated. Patients in safety net settings have even less opportunity to receive evidence-based care. Translation research has been dominated by efficacy trials, which often do not translate to the complexity of safety net settings. Implementation research to date seems to focus mostly on provider and organizational contextual factors more than macro and patient factors crucial to outcomes in safety net settings. Focus on translation and adaptation of interventions to safety net settings, and use of qualitative methods to flesh out complex processes and involve more stakeholders will help give safety net patients access to state of the art care. This issue is important for social workers to understand due to their ethical obligation to advocate for social justice and access to care for vulnerable and oppressed populations.     

Access Barriers to and Unmet Needs for Home- and Community-Based Services Among Older Korean Americans

This cross-sectional survey study of 146 caregivers of older Korean Americans explored access barriers to and unmet needs for home- and community-based services (HCBS) programs (respite care, adult day care, personal care, home health, housekeeping, and transportation). Most often reported access barriers were lack of awareness and care recipient refusal. Predictors of unmet needs varied depending on the type of service, but included caregiver gender, relationship, education, caregiving duration, Medicaid coverage, English proficiency, caregiver self-efficacy, care recipient functional dependency, cognitive impairment, and caregiving hours. This study highlighted unmet needs for HCBS in Korean American communities, pointing to the pressing need for a collaborative effort to develop plans that modify and expand HCBS programs for older Korean Americans.     

Tasks Performed by Migrant Live-In Care Workers During Hospitalization of Their Older Care Recipients

The goals of the study were to examine: (a) the tasks that migrant live-in care workers are expected to perform and actually perform during the hospitalization of their care recipients, and (b) the factors that explain the level of involvement by care workers in caring for hospitalized care recipients. A sample of 535 dyads of family caregivers and care workers of hospitalized care recipients in two general hospitals in Israel was interviewed. Results showed a high level of congruence between the care workers' and family caregivers' perceptions of the roles that the paid carers should perform. Paid carers' involvement in care provision varied by hospital and type of ward and was best explained by the hospital characteristics and congruence in the care workers' perceived roles. The extensive needs of hospitalized functionally disabled older adults necessitate explicit policies and guidelines regarding private care provided in hospital wards.     

Rapid repeat pregnancy and experiences of interpersonal violence among low-income adolescents

CONTEXT: Rapid repeat pregnancy (RRP) among adolescents, usually defined as pregnancy onset within 12-24 months of the previous pregnancy outcome, has frequently been the target of public health interventions, due to the exacerbation of negative consequences associated with recurrent adolescent pregnancy (and more specifically with childbearing). OBJECTIVE: To examine what, if any, relationship exists between RRP and the experience of interpersonal violence and abuse among low-income adolescents at one semi-urban health center. DESIGN: Case-control study using retrospective chart review. PARTICIPANTS AND SETTING: 100 women aged 13-21 who received prenatal care at one independent nonprofit health center that serves adolescents and their children from June 1994 through June 1996. MAIN OUTCOME MEASURES: Number and timing of pregnancies, occurrence of physical or sexual abuse; other psychosocial risk factors were evaluated. RESULTS: In this population, the experience of any form of physical or sexual violence during the study interval was associated with RRP within 12 months (p = 0.01, OR = 3.46) and 18 months (p = 0.013, OR = 4.29). Other previously reported predictors of RRP, including family stress, financial stress, and other environmental stressors did not reach statistical significance at either 12 months or 18 months in this sample. Of additional note, young women who experienced any form of abuse during the 12-month study interval were substantially more likely to miscarry than were their nonabused peers, and spontaneous abortion was also very strongly associated with RRP (p < 0.00001; OR = 22.6). CONCLUSIONS: The experience of interpersonal violence is correlated with rapid repeat pregnancy among low-income adolescents. This study strongly suggests a need for both extensive screening for partner and family violence among pregnant and postpartum adolescents, and follow-up safety planning support in combination with family planning interventions.