Purpose The purpose of this investigation was to (a) identify the relationship between level of acculturation, and quality of life (QOL) and stigma and (b) explore the QOL experiences for Hispanic New Mexicans with dysphagia. Method This study includes 7 New Mexicans who self-identified as Hispanic. This prospective investigation was completed in 2 phases. In the quantitative phase, all participants completed the (a) the SWAL-QOL ( McHorney et al., 2000 ), (b) the Neuro-QoL Stigma subtest ( Gershon et al., 2012 ), and (c) the Acculturation Rating Scale for Mexican Americans–II (ARSMA-II; Cuellar, Arnold, & Maldonado, 1995 ). In the qualitative phase, 3 participants were selected from the quantitative phase to complete the qualitative phase. These participants were selected to allow for distribution across levels of acculturation, and each of them participated in interviews designed to explore QOL experiences. Interviews were analyzed to identify themes. The occurrence of themes is discussed as a function of level of acculturation. Results There is no clear relationship between acculturation and QOL. A strong nonsignificant correlation was observed between acculturation and stigma. QOL experiences, as identified from the interviews, were classified into 2 broad categories: emotional experiences (stigma, distrust, fear, frustration, religion, and impact) and swallow safety (symptoms, treatment, triggers, and compensatory strategies). Conclusions Level of acculturation did not relate to measures of mental health or fatigue. Yet, both quantitative and qualitative analyses support a relationship between level of acculturation, and symptom reporting and religion, as well as patient perception of stigma.
Purpose The presence of oropharyngeal dysphagia increases the likelihood of prandial aspiration, and aspiration increases the likelihood of a dysphagia-related pulmonary sequelae such as aspiration pneumonia, acute respiratory distress syndrome, pulmonary fibrosis, and even death. Although these outcomes are unfortunate, it is important to point out that these consequences are not solely determined by the presence of aspiration. The purpose of this tutorial is to provide current information on pulmonary defenses and the variables that increase risk of an adverse outcome in individuals who aspirate. Method This tutorial reviews the basics of lung defenses and summarizes the literature to make the case that the host is a central theme in dysphagia management. Case studies are employed to highlight the key variables. Results Based on a literature review, a series of questions are proposed for consideration in dysphagia management. These questions, which take the focus away from the presence of aspiration and toward the associated risks within an individual, are then applied to two case studies. Conclusions A guiding framework is proposed to encourage clinicians to assess more than the presence of aspiration and consider the individual's ability to cope with the aspirated material. In the presence of aspiration, clinicians are urged to focus on the risk factors that can lead to a negative consequence, identify which factors are modifiable, and determine when a level of risk is acceptable.
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