Browsing by Author "Gold, Deborah T"
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Item Open Access Coping With Injury: How High Performance Athletes Mitigate the Biopsychosocial Consequences of Sports Injury(2017-11-06) Anunike, KennyIn this paper, I examined various coping methods that high-performance athletes use to recover from injury in order to determine if further research is warranted. To meet the research purpose of this paper, literature available on coping mechanisms that injured high-performance athletes use to recover from their injuries was reviewed, with a focus on discussions about sports’ injury statistics, stressors, coping theories, intervention, and consequences for not coping with injury properly. Furthermore, conclusions drawn from the review were provided, as well as recommendations for future inquiry on meeting injured athletes’ coping needs. Overall, it appears that enough information is not currently available to cover the magnitude of coping mechanisms being used by injured high-performance athletes to recover from their sport related injuries. Additionally, Researchers are still searching for a comprehensive coping theory that will address the coping needs of high- performance injured athletes. Gaining a good understanding of the coping needs of high-performance athletes will aid medical personnel, athletic trainers, and other care givers to provide better care that is germane to the needs of high-performance athletes seeking to recover from their sports’ related injuries. Discussions in this paper also help to identify the emerging literature available on coping mechanisms injured athletes use to recover from injuries.Item Open Access Creating Meaning Through Storytelling at the End of Life(2017-05-08) Morton, ClaireThis thesis will examine how patients, families, and doctors in the United States create narratives around dying. While this study does not focus extensively on narrative theory, it will explore how different people look back and tell the stories of their lives and the ways in which that storytelling affects dying. Furthermore, the thesis will focus on physicians, rather than the many other essential members of a health care team. This thesis will examine both individuals who craft their own stories as well as the stories that are told about them after their deaths. Examples of this, including fictional examples, help to illustrate these topics. The process of active storytelling can empower patients to create how they want to be remembered and shapes how families use stories in their process of grieving. I argue here that death is a process that expands beyond the biological realm into the narrative. Narratives may help to interpret and revise a patient’s life story, transforming them from passive participants in the end of lives to active creators. This thesis asserts that patients, family members, and physicians use language and narratives at the end of life as a means of attempting to understand and maybe even control death.Item Open Access Evaluating the Influence of Patient Caretakers’ Health Literacy on Delays in Care for Traumatic Brain Injury Patients at Mulago National Referral Hospital, Uganda.(2019-04-24) Nwosu, ChinemeremBackground Caretakers take on caregiving tasks such as feeding and administering oral medication for patients at Mulago National Referral Hospital (MNRH), Uganda and many Low-Middle Income Countries (LMICs) where nurse shortages are prevalent. They shoulder the burden of caretaking responsibilities with little or no knowledge of the patient care. Studies have shown that caretaker’s ability to navigate the healthcare system, find, and use health information to support their patients throughout the care continuum can impact the three delays in care: seeking, reaching and receiving care. With the life-threatening nature of Traumatic Brain Injuries (TBI) in Uganda, caretakers’ play an important role in ensuring patients access care in a timely manner. This study seeks to determine the factors that impact TBI patient caretakers’ health literacy in MNRH and examine how these factors influence the three delays in care. Methods This qualitative research study was carried out in the neurosurgical ward at MNRH, in northern Kampala. The study participants were 27 adult caretakers. Semi-structured in-depth qualitative interviews, outlined through “The Three Delay Framework”, was utilized to understand participants’ experiences with delays in seeking, reaching and receiving care for moderate to severe TBI patients. Thematic content analysis and manual coding was used to analyze interview transcripts and identify overarching themes in the participant responses. Results This study identified three main caretaker health literacy factors, each with three sub-factors, that impact the three delays to care. The main themes identified were Extrinsic, Intrinsic and Health System Factors. The nine sub-themes were Government Support, Community Support, Financial Burdens, Lack of Medical Resources, Access to Health Information, Physician Support, Emotional Challenges, Navigational Skills and Understanding of Health Information. These components were found to influence the delays to care to varying degrees. More importantly, Financial Burdens, Government Support, Emotional Challenges, Physician Support and Lack of Medical Resources were recurring health literacy factors across the three delays. Conclusion The health literacy factors identified in this study work to influence caretakers’ functional health literacy and the delays to care in a co-dependent manner. A better understanding of how these factors impact patient outcomes is necessary for the development of context and culturally relevant interventions targeted at improving a caretaker’s ability to maneuver the healthcare system and support patients in resource-poor settings. There is a strong need for the state and policy makers to invest in improving health education and communication strategies to support caretakers’ health literacy needs and mitigate the delays to care for TBI patients.Item Open Access Fluidity in Women's Sexuality(2016-08-09) Johonnot, KarliSexual fluidity has been proposed as a key component of women’s sexuality. However, not all women acknowledge or experience fluidity in their sexual attractions and behaviors. Because this is the case, what proportion of women are experiencing sexual fluidity? Research has concluded that a “sizeable minority” of women are experiencing sexual fluidity, with the highest levels found among those that identify as a sexual minority. Furthermore, certain individual differences have been found to be associated with a heightened (or weakened) likelihood of experiencing or embracing sexual fluidity. Through extensive literature reviews on women’s sexuality and sexual fluidity, it has been concluded that sexual orientation identity status, as well as psychological, biological, and social factors, all play roles in the expression or degree of sexual fluidity experienced. This means that certain personal and environmental factors have the ability to both hinder and/or nurture fluidity in a woman’s sexual attractions, behaviors, and experiences. Accepting that women’s sexuality is fluid and teaching about the variability sometimes observed in women’s sexuality allows us to not only see that experiencing same-sex attractions, desires, or experiences is not necessarily abnormal, but also that it may be more common than originally assumed, which has the potential to reduce societal stigma associated with homosexuality.Item Open Access Influence of Caretakers' Health Literacy on Delays to Traumatic Brain Injury Care in Uganda.(Annals of global health, 2020-10) Nwosu, Chinemerem; Spears, Charis A; Pate, Charles; Gold, Deborah T; Bennett, Gary; Haglund, Michael; Fuller, AnthonyBackground
Traumatic brain injury (TBI) is a life-altering condition, and delays to care can significantly impact outcomes. In Uganda, where nurse shortages are prevalent, patients' family members are the primary caretakers of these patients and play an important role in ensuring patients' access to timely care. However, caretakers often have little or no knowledge of appropriate patient care. Caretakers' ability to navigate the healthcare system and find and use health information to support their patients can impact delays in seeking, reaching, and receiving care.Objectives
This study seeks to determine the factors that impact TBI patient caretakers' health literacy and examine how these factors influence delays in care.Methods
This study was carried out in the Mulago National Referral Hospital neurosurgical ward, where 27 adult caretakers were interviewed using semi-structured, in-depth, qualitative interviews. "The Three Delay Framework" was utilized to understand participants' experiences in seeking, reaching, and receiving care for TBI patients. Thematic content analysis and manual coding was used to analyze interview transcripts and identify overarching themes in participant responses.Findings
The main health literacy themes identified were Extrinsic, Intrinsic and Health System Factors. Nine sub-themes were identified: Government Support, Community Support, Financial Burdens, Lack of Medical Resources, Access to Health Information, Physician Support, Emotional Challenges, Navigational Skills, and Understanding of Health Information. These components were found to influence the delays to care to varying degrees. Financial Burdens, Government Support, Emotional Challenges, Physician Support and Lack of Medical Resources were recurring factors across the three delays.Conclusion
The health literacy factors identified in this study influence caretakers' functional health literacy and delays to care in a co-dependent manner. A better understanding of how these factors impact patient outcomes is necessary for the development of interventions targeted at improving a caretaker's ability to maneuver the healthcare system and support patients in resource-poor settings.Item Open Access Keepers of the House: A documentary.(The clinical teacher, 2022-02) Alexopoulos, Evangelia A; Guinee, Emily P; Stewart, Kearsley A; Brown, Candace S; Gold, Deborah T; Engle, Deborah; Talenti, Francesca; Klevansky, Rhonda; Barfield, Raymond; Ross, Elizabeth; Prose, Neil SBackground
Our documentary, Keepers of the House, highlights ways that hospital housekeepers, typically unnoticed care team members, provide emotional support for patients and their families. This film addresses a gap in education by emphasizing the importance of valuing and reflecting on the unique lived experiences of others.Approach
We created this documentary to expose students to the experiences and perceptions of hospital housekeepers. A focus group with six hospital housekeepers informed an interview script for the film's creation. Nine additional housekeepers were then interviewed, which developed into a 15-min documentary. Healthcare students and educators from five disciplines viewed the documentary during their institution's Medical Education Day.Evaluation
To expose students and educators to housekeepers' experiences, we designed our post-viewing survey to address whether the housekeepers' stories impacted their understanding of the role and value of these workers. Viewers were surprised by the depth and breadth of patient-housekeeper interactions, the trauma housekeepers experienced from patient loss and the pride housekeepers take in their work. The stories that touched the viewers varied but centred on connections between housekeepers and patients. Lessons learned focused on recognizing the contributions of unseen team members.Implications
This innovative documentary amplifies the perspectives of voices rarely heard in healthcare. We aim to use this film, alongside its associated learning session, in education and grand round settings to foster discussion around empathy, valuing underrecognised team members and applying these insights in practice. This work can be disseminated to other institutions, further amplifying underrepresented narratives in healthcare.Item Open Access “Lifelong Learning to Beat AD”: Educational Attainment and Alzheimer’s Disease(2019-04-19) Bailey, JenniferAlzheimer’s disease (AD) affects people around the world, and there is no cure. Not only is AD a significant contributor to health care costs, it also has a deep emotional impact on society. There is a seemingly universal fear of AD which contributes to stigma against those who have this disease, a stigma that prevents people from seeking a medical diagnosis or help. There are modifiable risk behaviors that may delay the effects of AD for those who have the disease, one of which is educational attainment. Educational attainment appears to have an impact on an individual’s cognitive reserves, a phenomenon which becomes a significant factor in delaying the effects of AD. In this paper, I review current research on AD and educational attainment. With the research literature as a base, I then develop a public health campaign targeting younger people that stresses the importance of delaying Alzheimer’s disease by continuing educational activities throughout life.Item Open Access “Lifelong Learning to Beat AD”: Educational Attainment and Alzheimer’s Disease(2019-05-23) Bailey, JenniferAlzheimer’s disease (AD) affects people around the world, and there is no cure. Not only is AD a significant contributor to health care costs, it also has a deep emotional impact on society. There is a seemingly universal fear of AD which contributes to stigma against those who have this disease, a stigma that prevents people from seeking a medical diagnosis or help. There are modifiable risk behaviors that may delay the effects of AD for those who have the disease, one of which is educational attainment. Educational attainment appears to have an impact on an individual’s cognitive reserves, a phenomenon which becomes a significant factor in delaying the effects of AD. In this paper, I review current research on AD and educational attainment. With the research literature as a base, I then develop a public health campaign targeting younger people that stresses the importance of delaying Alzheimer’s disease by continuing educational activities throughout life.Item Open Access Medicinal Marijuana: Therapeutic Criteria and Contraindications for Marginalized Populations of the Baby Boom Cohort(2017-04-25) Beck, Teresa AThe purpose of this study is to present a systematic review of the available evidence-based literature to answer the question: What are the ways in which exposure to social change early in adulthood might enhance the likelihood that several marginalized groups within the Baby Boom cohort will accept medical marijuana as a viable therapeutic option as they age? In this paper, I review the shift in the legal, cultural and therapeutic landscapes regarding medicinal marijuana and the impact this will have on several marginalized groups of an aging US population: those suffering with mental illness, veterans, and substance abusers. The impact on an already over-burdened healthcare system will be significant as the US will be ill-prepared to respond to the needs of the Baby Boom generation. The Baby Boomers came of age during the 1960s and 1970s when disruption and social change were commonplace, and they participated in activities which initiated or encouraged such change. Studies in psychology and sociology have reached consensus that although medicinal marijuana has known therapeutic benefits, there are also considerable risks. However, legal field has less uniformity and displays considerable ambiguity in the laws in states where medical marijuana legalization has occurred. Politically motivated anti-drug campaigns may influence the perception of the dangers and risks, compromising efforts to change the public perception of marijuana as a legitimate therapeutic option. Conversely, that same perception may entice members of marginalized groups to experiment with marijuana without realizing the potential negatives.Item Open Access Obeying an Evolving Cultural Value: Influences of Filial Piety and Acculturation on Asian-Americans(2018-07-24) Choy, MichaelElder care is a concern for adult children with aging parents in Asia, America or practically anywhere else in the world. Yet, it is a particularly acute issue for members of the Asian-American community due, in no small measure, to the profound influences of the Asian cultural value of filial piety and acculturation. After all, filial piety dictates an expectation grounded in moral principles that children must care for their parents in old age; however, as Asian immigrants and their children face acculturation, they are exposed to new and different American cultural influences relating to parental elder care. Drawing on this author’s personal family story as inspiration and as an anecdote, this paper explores the ways in which the notions of filial piety and acculturation, ostensibly at odds, affect Asian-Americans’ expectations and behaviors relating to elder care responsibilities for aging immigrant parents. In doing so, this exploration seeks to inform questions about the extent to which filial piety and acculturation create cultural conflict in managing cultural expectations of elder care, and how such conflict might be reconciled. Based on a review of the literature discussed in this paper, filial piety and acculturation may not necessarily be at odds, based on the idea that expectations of caregiving affecting Asian-Americans are evolving in ways that reflect the dual influences of traditional Asian culture and American culture on both parents and adult children in ways seemingly compatible to both. As a result, it seems fair to suggest that Asian-Americans can gain a sense of comfort in knowing that elder care need not be the subject of cultural conflict and angst because cultural expectations of care are evolving as their cultural values are evolving.Item Embargo Preparing for Widowhood - While Your Husband is Still Living(2022-07-11) Rose, JillResearch on widowhood challenges has suggested that married women, with unhealthy husbands, should consider preparing in advance for widowhood. However, many women might have an easier transition into widowhood if some preparation tasks or actions are completed while married. What is often overlooked is that these widowhood challenges exist, and that married women can either prepare for them while married or react to them when widowed. Analyzing the transcripts from 70 interviews that were conducted over three months, the results of this study show that there are opportunities and benefits for married women to prepare in advance for widowhood for known widowhood challenges. Some of these preparation tasks and actions are similar to the interventions that widows utilize to overcome the widowhood challenges they encounter. My primary and secondary research findings complement the literature on widowhood challenges, potential widowhood interventions, and how married women might prepare in advance for widowhood while their husbands are still living.Item Open Access Psychometric properties of the osteoporosis assessment questionnaire (OPAQ) 2.0: results from the multiple outcomes of raloxifene evaluation (MORE) study.(BMC musculoskeletal disorders, 2014-01) Shen, Wei; Burge, Russel; Naegeli, April N; Shih, Jeremy; Alam, Jahangir; Gold, Deborah T; Silverman, StuartBACKGROUND: We explored psychometric properties of the Osteoporosis Assessment Questionnaire 2.0 in terms of reliability, validity, and responsiveness with generic, clinical, demographic, and preference-based data collected from a population of postmenopausal women with osteoporosis. METHODS: The Multiple Outcomes of Raloxifene Evaluation study was a randomized, placebo-controlled, multinational clinical trial evaluating efficacy and safety of raloxifene. The Osteoporosis Assessment Questionnaire 2.0, a generic quality of life measure (Nottingham Health Profile), and a preference-based measure (Health Utilities Index) were administered at baseline and annually. Psychometric properties of the 14 Osteoporosis Assessment Questionnaire 2.0 domains were evaluated by standard statistical techniques. RESULTS: This study included a subset of 1477 women from the Multiple Outcomes of Raloxifene Evaluation study population completing the questionnaires. Mean (standard deviation) age was 68.4 (6.8) years. Prevalent vertebral fractures were found in 70% (n =1038) of women. Internal consistency was >0.7 in 9 Osteoporosis Assessment Questionnaire 2.0 domains. Correlations were moderate and significant for similar Osteoporosis Assessment Questionnaire 2.0 domain scores, Nottingham Health Profile domains, and Health Utilities Index scores. All but 2 Osteoporosis Assessment Questionnaire 2.0 domains distinguished between patients with or without prevalent vertebral fractures and detected worsening with increased number of vertebral fractures. Women with ≥ 1 incident vertebral fracture generally had a greater worsening in Osteoporosis Assessment Questionnaire 2.0 scores (excluding social activity and support of family and friends) from baseline to study endpoint compared with women without incident vertebral fractures. CONCLUSIONS: Most domains in the Osteoporosis Assessment Questionnaire 2.0 demonstrated robust psychometric properties; however, several domains not showing these criteria may need to be reassessed and removed for a potentially shorter and validated version of the Osteoporosis Assessment Questionnaire.