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'Al pie de la letra': crafting a report card for elderly Spanish-only-speaking patients with stroke.

ABSTRACT: Ethnic minorities are at higher stroke risk than non-Hispanic whites yet are less likely to have optimal vascular risk factor control. There is a need to develop culturally sensitive strategies for enhancing vascular risk reduction in minority patients with stroke. This study aimed to develop a postdischarge report card to boost treatment adherence among elderly Spanish-speaking patients with stroke within an urban health system.This study included a total of 13 Spanish-only speaking participants aged > or = 60 years discharged from a local government hospital in Los Angeles within 18 months of an index ischemic stroke and 6 caregivers engaged in focus groups and interviews. Structured interviews were conducted with 11 care providers and 9 administrators at the hospital. Framework analysis examined the data and elicited themes to adapt a pre-existing patient report card tool.Spontaneously using the same phrase, "Al pie de la letra," several participants expressed a need to follow medical instructions accurately to prevent recurrent stroke and identified barriers/facilitators for doing so. They made comments about the pre-existing report card, advising several changes, including the clarification of phrases, and written instructions to explain the need for the card and how to fill it out. The providers and administrators recommended avenues for successfully using the card at the hospital. A new report card was created that incorporated all major perspectives.Crafting a culturally sensitive tool for promoting treatment adherence in elderly Spanish-only-speaking patients with stroke within an urban health system using a participatory methodology is feasible. The efficacy of this new report card should be tested in a randomized controlled trial.

SUBMITTER: Ovbiagele B

PROVIDER: S-EPMC4160819 | biostudies-literature | 2010 Apr

REPOSITORIES: biostudies-literature

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'Al pie de la letra': crafting a report card for elderly Spanish-only-speaking patients with stroke.

Ovbiagele Bruce B

Stroke 20100218 4

<h4>Background and purpose</h4>Ethnic minorities are at higher stroke risk than non-Hispanic whites yet are less likely to have optimal vascular risk factor control. There is a need to develop culturally sensitive strategies for enhancing vascular risk reduction in minority patients with stroke. This study aimed to develop a postdischarge report card to boost treatment adherence among elderly Spanish-speaking patients with stroke within an urban health system.<h4>Methods</h4>This study included ...[more]

PMID: 20167904

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Project description:Cognitive impairment is frequent in lacunar stroke patients. The prevalence and pattern among Spanish-speaking patients are unknown and have not been compared across regions or with English-speaking patients.The aim of this study was to characterize cognitive impairment in Spanish-speaking patients and compare it with English-speaking patients.The baseline neuropsychological test performance and the prevalence of mild cognitive impairment, defined as a z-score ? -1.5 on memory and/or non-memory tests, were evaluated in Spanish-speaking patients in the Secondary Prevention of Small Subcortical Strokes trial.Out of 3020 participants, 1177 were Spanish-speaking patients residing in Latin America (n?=?693), the United States (n?=?121), and Spain (n?=?363). Low education (zero- to eight-years) was frequent in Spanish-speaking patients (49-57%). Latin American Spanish-speaking patients had frequent post-stroke upper extremity motor impairment (83%). Compared with English-speaking patients, all Spanish-speaking patient groups had smaller memory deficits and larger non-memory/motor deficits, with Latin American Spanish-speaking patients showing the largest deficits median z-score -1.3 to -0.6 non-memory tests; ?5.0 for Grooved Pegboard; -0.7 to -0.3 for memory tests). The prevalence of mild cognitive impairment was high and comparable with English-speaking patients in the United States and Latin American Spanish-speaking patients but not the Spanish group: English-speaking patients?=?47%, Latin American Spanish-speaking patients?=?51%, US Spanish-speaking patients?=?40%, Spanish Spanish-speaking patients?=?29%, with >50% characterized as non-amnestic in Spanish-speaking patient groups. Older age [odds ratio per 10 years?=?1.52, confidence interval?=?1.35-1.71), lower education (odds ratio 0-4 years?=?1.23, confidence interval?=?0.90-1.67), being a Latin American resident (odds ratio?=?1.31, confidence interval?=?0.87-1.98), and post-stroke disability (odds ratio Barthel Index <95?=?1.89, confidence interval?=?1.43-2.50) were independently associated with mild cognitive impairment.Mild cognitive impairment in Secondary Prevention of Small Subcortical Strokes Spanish-speaking patients with recent lacunar stroke is highly prevalent but has a different pattern to that observed in English-speaking patients. A combination of socio-demographics, stroke biology, and stroke care may account for these differences.

Project description:Introduction L’âge, facteur principal de la COVID-19 sévère/mortelle, explique que les résidents des EHPAD, âgés et/ou comorbides, soient à risque. L’ivermectine (IVM), anti-parasitaire, a montré une activité antivirale anti-SARS-CoV-2 in vitro (étude australienne). La moxidectine (MOX) pourrait aussi être intéressante (demi-vie longue). Lors d’une épidémie de gale en EHPAD où les résidents ont reçu de l’IVM orale, nous rapportons son impact sur la Covid-19 survenue en parallèle. Observation Le 6/03/20 : patiente de 66 ans = résidente-1, EHPAD-A (Seine-et-Marne, 77), hospitalisée pour gale profuse. Incluse dans l’essai contrôlé randomisé (ECT) « gale CRUSTED ; NCT02841215 », a reçu 3 doses d’IVM (400 ou 200 ?g/kg en insu ; J0-J7-J14). Trois autres résidents avaient une gale ; et résidents et personnels ont reçu IVM 200 ?g/kg J0–J7 (n = 121). Retour de la résidente-1 à l’EHPAD-A le 17/03 (plan blanc). Étude épidémiologique : Les cas probables ou confirmés (PCR) de COVID-19 de l’EHPAD-A entre 5/03 et 15/05 ont été identifiés, facteurs de risque, sévérité et mortalité précisés. Durant cette période, les infections COVID-19 et décès des autres EHPAD du 77 étaient déclarés à l’ARS. Une comparaison EHPAD-A et contrôles (EHPAD du 77 comparables en âge, effectif et tarif) était réalisée. Étude virologique in vitro : Mesure de l’activité anti-SARS-CoV-2 de l’IVM et MOX sur cellules VeroE6 à doses croissantes (0,05–10 ?M) par quantification ARN et immunofluorescence ; viabilité des cellules surveillée. Résultats Soixante-neuf résidents (incluant résidente-1) et 52 personnels EHPAD-A ont reçu l’IVM : âge médian résidents 90 ans (84–94), 78,3 % femmes, 98,6 % au moins une comorbidité à risque de COVID-19 sévère. 11 sujets présentaient une COVID-19 probable ou certaine (7/69 résidents et 4/52 personnels, fréquence 10,1 %). Parmi les résidents, 90,9 % (10/11) ont eu une COVID-19 minime, sans oxygène ou hospitalisation, aucun mort. Parmi les 177 EHPAD du 77, 45 étaient inclus comme contrôles, soit 3062 résidents (âge médian 86,2 ans, 77,3 % femmes). Parmi eux, 22,6 % [95 %IC 16,3-28,9] ont eu la COVID-19 vs. 1,4 % EHPAD-A avec une mortalité attribuable de 4,9 % [95 %IC 3,2-6,5] vs. 0 % EHPAD-A. Une activité antivirale majeure in vitro de l’IVM et MOX (EC50 IVM 0,14 ± 0,02 ?M et MOX 0,48 ?M ± 0,08 ?M) avec viabilité cellulaire préservée était observée. Discussion Tous les cas observés de COVID-19 dans l’EHPAD-A « traité » par IVM étaient mineurs, sans décès durant la période d’étude, alors que les résidents des EHPAD « contrôles » (sans IVM), appariés selon âge, effectif et niveau socio-économique, ont montré une fréquence de COVID-19 et une mortalité plus élevées. L’IVM pourrait avoir un rôle protecteur (suggéré depuis dans étude US), conforté par l’étude virologique. Malgré les limites –caractère observationnel et absence de corrélation démontrée in vitro/in vivo–, la plausibilité est suffisante pour réaliser un ECT en cluster de prévention par IVM et MOX en EHPAD.

Project description:Effective communication with primary care physicians is important yet incompletely understood for Spanish-speaking parents. We predicted lower satisfaction among Spanish-speaking compared to English-speaking Latino and non-Latino parents.Cross-sectional analysis at 2-month well visits within the Greenlight study at 4 pediatric resident clinics. Parents reported satisfaction with 14 physician communication items using the validated Communication Assessment Tool (CAT). High satisfaction was defined as "excellent" on each CAT item. Mean estimations compared satisfaction for communication items among Spanish- and English-speaking Latinos and non-Latinos. We used generalized linear regression modeling, adjusted for parent age, education, income, and clinic site. Among Spanish-speaking parents, we compared visits conducted in Spanish with and without an interpreter, and in English.Compared to English-speaking Latino (n = 127) and non-Latino parents (n = 432), fewer Spanish-speaking parents (n = 303) reported satisfaction with 14 communication items. No significant differences were found between English-speaking Latinos and non-Latinos. Greatest differences were found in the use of a greeting that made the parent comfortable (59.4% of Spanish-speaking Latinos endorsing "excellent" vs 77.5% English-speaking Latinos, P < .01) and discussing follow-up (62.5% of Spanish-speaking Latinos vs 79.8% English-speaking Latinos, P < .01). After adjusting for parent age, education, income, and study site, Spanish-speaking Latinos were still less likely to report high satisfaction with these communication items. Satisfaction was not different among Spanish-speaking parents when the physician spoke Spanish versus used an interpreter.Satisfaction with physician communication was associated with language but not ethnicity. Spanish-speaking parents less frequently report satisfaction with communication, and innovative solutions to enhance communication quality are needed.

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'Al pie de la letra': crafting a report card for elderly Spanish-only-speaking patients with stroke.

Publications

'Al pie de la letra': crafting a report card for elderly Spanish-only-speaking patients with stroke.

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