Family Caregiver Communication in the ICU: Toward a Relational View of Health Literacy

We interviewed 18 family caregivers about their communication experiences in the ICUs at an urban hospital. Analysis of their narratives suggests health literacy is important in family caregiver/healthcare provider communication, especially as complicated illnesses move the caregiver deeper into decision making. Using the domains of Yuen et al.’s conceptual model of caregiver health literacy (2015), we identified three themes within the context of ICU communication: agency, coordinated communication, and caregiver’s evolving role. We saw family caregivers negotiating domains of health literacy as they built upon knowledge of the patient’s needs, their rights as family caregivers, and the hierarchy of the professional staff. We found that these narratives represent co-created, or relational communication, rather than individual health literacy skills. Conceptualized in the transaction of relationship, health literacy is enacted; it is socially constructed and is the scaffolding upon which family caregivers make decisions, care for their loved one, and care for themselves.     

“Family? … Not Just Blood”: Discursive Constructions of “Family” in Adult,Former Foster Children’s Narratives

Framed by Relational Dialectics Theory, this study explores the ways adult, former foster children discursively construct meanings of “family.” Contrapuntal analysis of 24 interviews revealed two discourses as competing to constitute family: the Discourse of Family as Irreplaceable and Inescapable (Permanence) and the Discourse of Family as Performative Kinning (Performance). Permanence was constituted by themes of biology and historical connection, reifying normative understandings. Performance, comprised of role enactment, need for tolerance, and unconditional love, challenged the Permanence discourse. Throughout the narratives, Performance competed with Permanence for dominance, illustrating the cultural pervasiveness and power of Permanence yet, in some moments, privileging the marginalized Performance discourse. This discursive competition constructed meanings of family in narratives of life before, during, and after foster care. Overall, participant’s talk constructed complex webs of family relationships, allowing access to an important social institution—family—regardless of the presence/absence of culturally valued markers of family (e.g., biology, legality).     

Family Communication and Adolescent Alcohol Use in Nicaragua,Central America: A Test of Primary Socialization Theory

ABSTRACT

Applying primary socialization theory to a sample of early adolescents from Nicaragua, this study examines direct and indirect associations between family bonding and adolescent alcohol use via substance specific prevention communication (SSPC) and adolescent efficacy. Early adolescents in 7th and 8th grades completed a self-report, cross-sectional survey. Structural equation modeling revealed that family expressiveness was significantly indirectly related to adolescent lifetime alcohol use through SSPC. Results are discussed in relation to primary socialization theory, family communication, and international substance use prevention efforts. This study provides supportive evidence for the important role of positive family communication as a protective factor for early adolescents in Nicaragua.     

Attention to Threat as a Predictor of Shyness in the Context of Internalizing and Externalizing Behavior

The duration of children's attention to putative threat has been documented as a consistent predictor of later anxiety in inhibited children across childhood (Fox, New Directions for Child and Adolescent Development, 127, 2010, 33; Pérez‐Edgar & Fox, Child and Adolescent Psychiatric Clinics of North America, 14, 2005, 681). However, attention to threat has not been broadly examined within existing behavioral contexts and has seldom been studied in very early childhood. Whereas toddlers with high levels of internalizing behavior may view fear‐inducing stimuli as a threat, toddlers with high levels of externalizing behavior may demonstrate attention out of interest or sensation seeking. Thus, attention to threat was expected to predict increased toddler shyness in the context of either high internalizing problems or low externalizing behavior. We examined 117 twenty‐four‐month‐old toddlers to determine whether attention to threat interacted with internalizing and externalizing behavior at 24 months of age to predict toddler shyness one year later. Results indicated that attention to threat predicted toddlers' lower shyness at 36 months when toddlers’ externalizing behavior at age 24 months were high, but there was no significant interaction between toddlers’ internalizing behavior and their attention to threat in predicting later shyness. These results expand our understanding of the contexts in which attention to threat in early childhood is a viable predictor of later shyness.     

Does education influence wildlife friendly landscaping preferences?

In sprawling metropolitan areas, residential landscaping is a major concern with respect to biodiversity conservation, and it could play a critical role in conserving wildlife habitat. In the United States, residential landscaping typically consists of maintained lawns with specimen plantings of non-native trees and shrubs; such designs provide poor habitat for urban wildlife species. We conducted a case study of Raleigh, North Carolina residents to determine how providing information about the benefits of native plant landscaping to bird species influenced urban residents’ landscaping preferences. We used Wilcoxon Signed Rank tests to determine if respondent preferences for 0, 50, 75 and 100 % native plant landscaping coverages changed after residents were informed about the benefits that native plants provide for birds. Initially, the 50 % native landscaping coverage was most preferred by residents; however, preferences for all four native plant landscaping coverage designs were significantly different after the informational treatment. Neutrality changed to opposition for the 0 % native plant coverage, while opposition changed to support and neutrality for the 75 and 100 % native plant coverage designs, respectively. After the informational treatment, the 50 and 75 % native plant landscaping coverage had the highest mean preference levels, although the 100 % design was ranked first more than any other design. Our findings suggest that residential support for native plant landscaping is higher than is reflected by typical residential landscaping practices, and that dissemination of information regarding the benefits of native plant landscaping to birds could alter public preferences for native plant landscaping.     

Critical Discourse,Applied Inquiry and Public Health Action with Urban Middle School Students: Lessons Learned Engaging Youth in Critical Service-Learning

The Nuestro Futuro Saludable partnership designed a critical service-learning intervention focused on health equity and action. The 10-week afterschool intervention was implemented in a Boston middle school. Youths who took part in the intervention were knowledgeable about the social determinants of health in their communities, as well as to the barriers to health. Our findings indicate that engaging young people in a meaningful way will be critical if health improvement efforts are to be realized. We found that a critical service-learning framework that incorporates elements of applied inquiry and critical pedagogy was effective as a health intervention and provided opportunities for action.     

Dynamic heterogeneity: a framework to promote ecological integration and hypothesis generation in urban systems

Urban areas are understood to be extraordinarily spatially heterogeneous. Spatial heterogeneity, and its causes, consequences, and changes, are central to ecological science. The social sciences and urban design and planning professions also include spatial heterogeneity as a key concern. However, urban ecology, as a pursuit that integrates across these disciplines, lacks a theoretical framework that synthesizes the diverse and important aspects of heterogeneity. This paper presents the concept of dynamic heterogeneity as a tool to explore how social and ecological heterogeneities interact and how they together act as both an outcome of past interactions and a driver future heterogeneity and system functions. To accomplish this goal, we relate heterogeneity to the fundamental concept of the human ecosystem. The human ecosystem concept identifies key processes that require operationalized models of dynamic heterogeneity in three process realms: the flow of materials, the assembly of urban ecosystem biota, and the locational choices humans make concerning land. We exemplify a specific dynamic model of heterogeneity in each of these realms, and indicate a range of complementary statistical approaches to integrate the drivers and outcomes of dynamic heterogeneity across the three realms. We synthesize a hierarchical framework for a theory of dynamic urban heterogeneity, noting its complementarity to other major urban theories and general model approaches. We hypothesize that human actions and structures amplify the dynamics of heterogeneity in urban systems.     

Aging and sexual health: getting to the problem

Erectile dysfunction (ED) is one of the most common disorders in male and is often associated with other age-related comorbidities. The aging process affects the structural organization and function of penile erectile components such as smooth muscle cell and vascular architecture. These modifications affect penile hemodynamics by impairing cavernosal smooth muscle cell relaxation, reducing penile elasticity, compliance and promoting fibrosis. This review aims to identify the mechanisms of ED in the penile aging process in experimental and clinical data. It also highlights areas that are in need of more research. The search strategies yielded total records screened from PubMed. Clarification of the molecular mechanisms that accompanies corpus cavernosum aging and aging-associated ED will aid new perspectives in the development of novel mechanism-based therapeutic approaches. Age is not a limiting factor for ED medical management, and it is never too late to treat. Hypogonadism should be managed regardless of age, and synergistic effects have been found during testosterone (T) replacement therapy when used along with oral phosphodiesterase-5 (PDE-5) inhibitors. Therefore, the clinical management of ED related to aging can be done by therapeutic interventions that include PDE-5 inhibitors, and other pharmacological treatments.     

Kinship care and issues in permanency planning

Kinship caregivers are a child-care resource for families experiencing stress or temporary parenting due to illness, incarceration, or death of a parent. This article examines whether and how felt caregiver burden influences the reported propensity of caregivers to want to adopt the children in their care. Kinship caregivers who were enrolled in KinNET completed the survey (N = 102) and the data were entered anonymously into SPSS for analysis. Their mean age was 57.51 years (SD = 10.13), 95% were female (SD = .19), and two-thirds were non-white (SD = .73). Using “likelihood of adopting the child in my care,” as the outcome variable in the linear regression analysis, caregiver’s age, monthly income, and total hours employed were significant predictors. Total pressures, family service needs, and physical problems scales were not statistically significant predictors. The adjusted R square was .439 and significant (.006). Understanding the factors that are predictive of adopting children in kinship care will help programs target services more effectively. Helping kinship caregivers and the children in their care is also important in promoting their health and social well-being.