M.Cur. / Schizophrenia is a devastating mental illness and probably the most distressing and disabling mental disorder. It is not the condition of the ill person alone but also of the family which is placed in a crucial and pivotal role and which must take care of the ill relative with schizophrenia. This is so because of the disillusional thinking, altered thought process and distractions of internal stimuli that may interfere with the planning, commitment and rationale for actions, making it difficult for everyone involved. The effects of the illness may be confusing and shocking to families. Parents suffer from great disruptions to their lives and children can struggle with the implications of having a parent suffering from schizophrenia. Siblings of the ill person suffering from chronic schizophrenia are not spared, they even suffer because issues of their own survivorship. The family becomes case managers and primary carers. Family caregivers are vulnerable to emotional manipulation by their mentally ill relative. They are rarely trained/helped to manage difficult circumstances. The family members are called upon for provision of psychological and social therapies, occupational and recreational therapy and attendant care for which they are not trained. The family is also seriously affected and distressed because of the effect schizophrenia has on their relative and the burden of caring. Coping with schizophrenia can especially be difficult for relatives who remember their relative before he or she became ill, giving rise to chronic grieving and sorrow and because of the cyclic nature of schizophrenia giving no definite end point or lengthy respite to complete mourning. The reminders of the "might have been" can be distressing. There is an obvious need for research on the family's experience. It is essential to understand their emotional tones and specific needs in relation to living with a member suffering from chronic schizophrenia as well as to formulate guidelines. The purpose of the study was to explore and describe family member's experiences and to formulate guidelines of care for families living with a member with chronic schizophrenia. The research design was based on qualitative research because of its explorative descriptive and contextual nature. Data were collected by means of indepth phenomenological interviews and naïve sketches. Field notes were written for reflecting upon methods used and the personal notes for the researcher's personal inflections. Literature was used to compare and complement the results. Guba's model on trustworthiness ensured the trustworthiness of the research.

Book Summary: Designed as a supplemental text for introductory courses in public health practice at the undergraduate and graduate levels, Contemporary Public Health provides historical background that contextualizes the current state of the field and explores the major issues practitioners face today. It addresses essential topics such as the social and ecological determinants of health and their impact on practice, marginalized populations, the role of community-oriented primary care, accreditation, and the organizational landscape of the American public health system. Finally, it examines the opioid epidemic, the impact of pandemics including COVID-19, and international public health and explores the potential of systems based on multilevel partnerships of government, academic, and nonprofit organizations. With fresh historical and methodological analyses conducted by an impressive group of distinguished authors, Contemporary Public Health is an essential resource for practitioners, health advocates, students, legislators, and informed citizens.

People with disabilities, including those on the autism spectrum, comprise the world's largest minority and experience significant inequities in Internet use. Existing standards for accessible web sites are necessary but not sufficient without the direct engagement of end users in identifying access needs. Yet little is known about methods for effective engagement, and there are no systematically derived Web accessibility guidelines for autistic end users. Here I explore a hybrid approach to direct engagement using critical systems thinking (CST) and community based participatory research (CBPR) during the co-development of a healthcare-focused web site by the Academic Autism Spectrum Partnership in Research and Education (AASPIRE). I explore these ideas on three levels: theory, practice, and critical self-reflection. On the theory level, I examine the common philosophical and historical roots of CST and CBPR, ways in which they intersect and complement, and propose the hybrid approach exemplified by AASPIRE. On the practice level, I explore our web site development process and evaluate the accessibility, usability, and acceptability of the web site for autistic end users; from that work, comes a set of recommendations for working with people with disabilities in technology development and a set of accessibility guidelines for autistic end users. On the critical self-reflection level, I inquire into my own experiences as an insider-researcher during the web site development. I then synthesize the levels to evaluate whether or not taking a hybrid CST/CBPR approach to web development was effective, as indicated by the team's ability to function as an emancipatory learning organization (an indicator of effective systems thinking on an organizational level), and the overall usability and accessibility of the web site. The result of the synthesis suggests a hybrid CST/CBPR approach was effective. Implications of this work include innovations in CST methods for operationalizing its commitment to human emancipation, potential for drawing a more ideologically-aligned systems thinking literature into the domain of CBPR, a means for individuals wishing to create a more power-balanced learning organization, innovations around including people with disabilities in research and technology development, more accessible web sites for people on the autism spectrum, and a potential small shift of dominant discourse around autism, disability, and the value of insider-researchers over time.

<p>Preeclampsia and other hypertensive disorders of pregnancy impact 2-8% of pregnancies with often devastating results. Current treatment methods resort to birth, which forces the fetus into the world before they are fully developed but can save the mother’s life. Preeclampsia is broadly considered to be of placental origin and current etiologic understanding focuses on systemic endothelial dysfunction triggered by an imbalance of vasoregulatory factors released by this maternal/fetal organ. This imbalance explains many early-term cases but fails to adequately address later cases where this imbalance is not always seen. Conversely, ischemia-reperfusion of the kidney is known to correlate with endothelial dysfunction, and preeclamptic women are known to have a stenosis in their left renal vein (LRV) in the supine position (on their back). Herein, we suggest that extrinsic compression of the LRV by the gravid uterus, without collaterals, produces a renal injury which can induce systemic endothelial cell dysfunction. We theorize this compression is position dependent and produces renal ischemia through an unchecked cycle of increased intrarenal pressure, subsequent afferent arteriole constriction and decreased glomerular perfusion, and activation of the renin-angiotensin-aldosterone system. We aim to elucidate this through murine studies of a surgically induced LRV stenosis and a retrospective clinical study where the maternal renal veins are measured from magnetic resonance images. Findings from this work suggest partial renal venous outflow obstruction leads to renal injury but could be moderated through alternative maternal resting positions. This potential alternative pathologic mechanism has significant clinical implications for future therapies targeting this condition.</p>

Thesis advisor: Jane Flanagan / Background: Over the past decade, increasing numbers of emerging adults, defined as ages 18 to 22, have journeyed to the United States (US) from Guatemala, Honduras and El Salvador. Upon arrival to the US, many experience inequities in health and healthcare access. The inequities are shaped by US political practices and choices attributed to broad structural and systemic-level barriers within planetary, social, economic and necropolitical forces. Applying a critical framework of antiracism, anti-oppression and anticolonialism, nurses and other healthcare providers must seek to understand the health patterning and life experiences of emerging adult im/migrants from Guatemala, Honduras, and El Salvador so that their health and healthcare needs may be supported. Approach: This qualitative research project aimed to explore health patterning of emerging adult immigrants from Guatemala, Honduras, and El Salvador using the nursing specific research praxis of Health as Expanding Consciousness (HEC). The second aim explored themes across the group. Critical posthuman, feminist, and new materialist assumptions also informed the approach to the study. Between June 2021 to November 2022 thirteen emerging adult participants from Guatemala and Honduras were interviewed twice. Enrollment occurred through community-based recruitment and snowball sampling methods. Each person’s individual story was explored using the HEC praxis method. Results: Participants’ stories uncovered unique profiles with situated, context-specific individual health patterning. Four themes were identified across stories using the qualitative analytic method of Sort and Sift, Think and Shift: Family is Fundamental, The Journey Holds Meaning, Opportunities Exist Amidst Constraints, and Movement and Art are Healing. Conclusions: The discussion section reviews main implications for building critical nursing praxis; understanding intersections of health, nursing care and human mobility; advancing nursing policy for people excluded from care; advancing research using HEC praxis as a caring act of accompaniment; and transforming nursing education for social justice and radical possibility. Im/migration and asylum-seeking were viewed as fundamental human rights including critically advancing the right to health and safety for people in mobility contexts. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

<p>Increasingly over the last few decades, funders and academic institutions have promoted the idea of interdisciplinarity as a way of harnessing new knowledge and fostering innovation in science. This dissertation of 4 papers sought to articulate how interdisciplinarity is experienced by health researchers involved in interdisciplinary research and to develop and implement a literature-based, researcher-informed framework for assessing interdisciplinarity. Findings from Paper 1 suggested that interdisciplinary teams tend to be formed based on who can contribute tangible skills needed for answering the research question, however interpersonal factors (e.g. previous positive working relationship) also drive how teams are formed. Paper 2 involved the development of the Framework for Interdisciplinary Research Assessment (FIRA). The literature revealed limited empirical work related to interdisciplinary evaluation, however, a detailed list of issues and possible metrics for evaluation was compiled, and characteristics common to the structure-process-outcome framework of quality were used to conceptualize interdisciplinary health research evaluation. In Paper 3, interviews and a survey were used to populate the FIRA model. Overall, there was a sense that skills, personality, and knowledge were greater considerations than disciplinary affiliation. Paper 4 involved the application of social network analysis in order to understand knowledge sharing in an interdisciplinary team and results highlighted the important role of staff as conduits of information. Overall, findings indicated that though interdisciplinarity is valued conceptually, it can be challenging to operationalize in practice. The FIRA model offers a viable structured approach for teams to engage in formative and summative assessment of interdisciplinarity.</p> / Doctor of Philosophy (PhD)

Background: Despite the many harms and limited efficacy of opioids in managing chronic noncancer pain (CNCP), they are commonly prescribed for these patients in North America. One of the harms associated with prolonged opioid use is opioid use disorder (OUD); however, the risk of addiction is uncertain. We systematically reviewed observational studies to establish the prevalence of (OUD), and to explore factors associated with OUD in patients with CNCP. Methods: We searched MEDLINE, EMBASE, CINAHL, Cochrane Library, and PsycINFO from inception to December 2018 to identify studies that explored the prevalence of OUD or risk factors for OUD in patients with CNCP. Two specialists in addiction medicine reviewed each potentially eligible study, blinded to results, to ensure their outcome met DSM-5 criteria for OUD. We pooled estimates of OUD across eligible studies using random-effects models. When possible, we pooled estimates of association with OUD for all independent variables reported by more than one study. Results: Twenty-two studies reported the prevalence of OUD, and six studies reported the association of 36 factors with OUD in patients with CNCP. The pooled prevalence of OUD was 20% (95% CI: 15% to 25%); however, we found evidence for small study effects (interaction p<0.001). When restricted to larger studies (≥900 patients), the pooled prevalence of OUD was 5.8% (95% CI: 2.8% to 9.5%; moderate certainty evidence). The prevalence of OUD was not associated with level of certainty of OUD criteria, under- or overestimation of instruments compared to DSM-5 criteria, severity of OUD, or risk of bias (interaction p values ranged from 0.34 to 0.92). Moderate certainty evidence demonstrated an association between OUD and male sex (OR 1.50 [95% CI: 1.05 to 2.14]; absolute risk increase (ARI) 2.7% [95% CI: 0.3% more to 5.8% more]), current smokers (OR 1.63; [95% CI: 1.25 to 2.12]; ARI 3.3% [1.3% more to 5.7% more]), and a history of mental health disorders (OR 1.49 [95% CI: 1.17 to 1.89]; ARI 2.6% [95% CI: 0.9% more to 4.6% more]). Low certainty evidence demonstrated an association between OUD and younger age (OR for every 10-year decrement, 1.60 [95% CI: 1.11 to 2.30]; ARI, 3.2% for every 10-year decrement [95% CI: 0.6% more to 6.6% more]). Moderate certainty evidence suggested no association between OUD and a history of alcohol abuse/dependence (OR 1.32 [95% CI: 0.84 to 2.07]; ARI 1.7% [95% CI: 0.9% less to 5.5% more]), and low certainty evidence suggested no association between OUD and a history of drug abuse (OR 1.51 [95% CI: 0.75 to 3.02]; ARI 2.7% [95% CI: 1.4% less to 9.9% more]). Conclusion: Moderate certainty evidence suggests that 6% of CNCP patients prescribed opioids will develop OUD. Younger men who smoke, with a history of mental health disorders, are at higher risk. Additional research is needed to establish the association between OUD and a history of drug or alcohol abuse. / Thesis / Master of Science (MSc) / Opioids are commonly prescribed for patients with chronic pain that is not due to cancer; however, long-term opioid use inevitably leads to physical dependence and may result in addiction. Prior studies have reported extremely variable rates of opioid use disorder (OUD) following prescription for chronic noncancer pain, ranging from less than 1% to more than 50%, which has led to considerable confusion. My systematic review found moderate certainty evidence that the prevalence of OUD following prescription for chronic pain is 5.8% (95% CI: 2.8% to 9.5%). Patients who were younger, current smokers, males, and had a history of mental health disorders, had a higher risk of developing OUD. These findings will help support shared care decision-making between patients with chronic pain considering opioid therapy and their healthcare providers.

Background: Efficient national health research systems (NHRS) generate knowledge to improve health outcomes while accounting for local health system specificities. African NHRS have a limited capacity to generate such knowledge; and rely on global or external sources of evidence which require adaptation. However, systematic, timely and comprehensive identification of local evidence needed for adaptation is challenging. Thus, the objectives of this study are to develop a centralized database of health research from Cameroon and test its applicability for informing future research production and use. Methods: We used an evidence mapping design. From October 2018 to May 2019, we searched 10 electronic databases and hand searched the archives of non-indexed African and Cameroonian journals. We screened titles, abstracts, and full texts based on these criteria: peer reviewed journal articles; published between 1999 and 2019; in English or French; investigating health-related outcomes in Cameroon. We extracted relevant study characteristics using a pre-established guide. We developed a coding scheme to label studies and ease searches on the database. Studies were coded independently by two reviewers and discrepancies resolved by consensus. We used the database to create evidence maps and identify knowledge gaps on sexual and reproductive health (SRH) priorities. Results: We included 4384 studies. Most were open access (76.3%); published in English (79.7%); conducted in the Centre region (45%) with an observational design (71.6%). The domains with the highest frequency were medical specialties (89.0%), and diseases (80.4%). The most researched specialty, diseases and population were infectiology, infectious diseases, and children respectively. Our gap maps revealed: (1) geographic and demographic disparities in the local evidence on adolescents’ contraceptive use (2) gaps in the type of local evidence needed for contextualisation and policymaking on obstetric fistula. Conclusion: Local evidence mapping and gap analysis can contribute to improving national research production and use in decision-making. / Thesis / Master of Science (MSc) / National health research systems answer questions about individuals’ health and the health care system they use. To do this, it is important to determine what we already know, which questions have not been answered and where resources should be directed in the future. Cameroon’s health research system needs to improve its research production capacity. It needs to produce answers which can be used to improve the health of Cameroonians and the decisions which are made about their health care system. As a first step towards achieving these goals, we created a database of health research from Cameroon. We used the database to create maps of what we know and don’t know about health topics such as adolescents’ use of contraception. We also made recommendations for future research in this field. The database will be useful for researchers, students, health professionals, funders and stakeholders involved with health research in Cameroon

Yes / The importance of including members of the public has been accorded a significant position in health planning, service delivery and research. But this position masks a lack of clarity about terms that are used. This paper identifies terms that are in common use in the lexicon of community based involvement and engagement in health with the intention of clarifying meaning and thus reducing ambiguity. We define and distinguish between key terms related to inclusion, we consider the terminology attached to community processes and to the challenges of inclusion and we engage with the strengths and weaknesses of the commonly used metaphor of "a ladder of participation". We wish to contribute to the clear communication of intentions, challenges and achievements in pursuing varied forms of inclusion in health.

This thesis critically examines a national programme in mental health which has been driven by the implementation of National Institute of Health and Clinical Excellence (NICE) guidance. Assumptions which underpin research method, drawn from the natural sciences, are critiqued in terms of their adequacy in accounting for human relating and expert therapeutic practice. The work of Dreyfus and Dreyfus (1986) is problematized in how they account for proficiency and expertise as intuition and the leap that they make from calculative to deliberative rationality. An alternative source of understanding, based on non-linear causality and complex responsive processes, is developed, building on the work of Stacey (2001, 2005, 2007). The ineffability of expert practice (or clinical judgement) is contrasted with competence based, rule governed practice, which necessarily underpins the early stages of learning. It is argued that because research practices undertaken in randomised controlled trials (RCTs) must be describable, measurable and focussed on predictable outcomes, then these cannot account for expert practice, therefore the assertion that the Improving Access to Psychological Therapies programme (IAPT) is wholly based on research based, evidence based therapies, cannot be substantiated. The work explores professionalism and specifically considers the role of psychiatrists, psychologists and psychological therapists in mental health and in increasing access to psychological therapies. The role of managers and managerialism are explored, specifically how the NHS has sought to manage 3 professional staff and multi-disciplinary teams in adopting corporate and new ways of working (NWW). This includes the importance of and difficulty in countering professional identity using competence based approaches. The performance management processes in the NHS are recognised as an equally relevant source of evidence (to that of NICE), despite there being a poor (traditional) evidence base for it (Stacey, 2010; Seddon, 2008). Power relating in human relationships is identified as immanent, using the context of a management group, and it is argued that Foucault’s concept of disciplinary power (1994) can account for what is considered to be knowledge and truth, drawing on specialist expertise based on science and research, with a forceful potential for rendering others silent as well as pervasively self-silencing, in processes of inclusion and exclusion (Elias, 1978). It is argued that these on-going processes of relating influence policy decisions at national and local levels and how these policies are implemented in practice. The inevitability of unpredictable outcomes is highlighted, despite strong centralised programme management along with the provision of an explicit blueprint for implementation.