Thesis (M.S.P.H.)--University of Michigan, 1937.

Thesis (MPhil)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Worldwide the stigma attached to psychiatric patients, psychiatric disorders, psychiatrists and the field of Psychiatry is of great concern. The stigmatising perceptions of medical practitioners and medical students towards psychiatric patients have a negative impact on effective treatment, considering the increasing burden psychiatric disorders are placing on communities and health systems. Numerous efforts were attempted and recommendations made for destigmatising medical students' perceptions towards psychiatric patients. It was found that perception usually improved after a clinical rotation in Psychiatry, but the stigmatising perceptions mostly returned a year later. The first clinical exposure to Psychiatry for medical students at the Faculty of Medicine and Health Sciences, Stellenbosch University, is during the fourth or fifth year of study. This rotation was revised in 2010 and a service-learning component added. The research question which consequently developed, is: What is the influence of a service-learning approach on destigmatising students' perceptions towards psychiatric patients? The research followed a phenomenological school of thought in an interpretative paradigm with a qualitative-inductive approach. On the last day of a rotation students handed in their written reflections and an in-depth focus group interview was conducted. The focus group interviews were repeated a year later. Students' reflections and the transcribed texts were analysed. This served as the basis for conclusions from which recommendations were made. It was found that students had stigmatising perceptions towards psychiatric patients before their first clinical rotation in Psychiatry. Directly after that students' perceptions were destigmatised to a greater extend. A year later non-stigmatising perceptions of understanding, acceptance, comfortableness, compassion, respect and responsibility were still present, although a few students experienced the limited return of stigmatising perceptions. Students attributed the positive changes to their service-learning experience in combination with the clinical placement at a psychiatric hospital with a friendly atmosphere and where they were exposed to patients not suffering from complex and extreme psychiatric disorders. The non-stigmatising perceptions a year after a clinical rotation in Psychiatry demonstrates the transformative value of service-learning. Service-learning is where meaningful and relevant service is rendered with and in the community, social responsiveness is purposefully emphasised and structured reflections are done to enhance academic learning. As a result of this study medical schools worldwide can take cognisance that a service-learning approach made a significant contribution to the stained destigmatisation of medical students' perceptions towards psychiatric patients. / AFRIKAANSE OPSOMMING: Stigma teenoor psigiatriese pasiënte, psigiatriese steurings, psigiaters en Psigiatrie as vakgebied is wêreldwyd ʼn groot bron van kommer. Medici en mediese studente se stigmatiserende persep-sies teenoor psigiatriese pasiënte het ʼn negatiewe impak op effektiewe behandeling, veral gesien in die lig van die groterwordende las wat die toename in psigiatriese steurings op gemeenskappe en gesondheidsisteme plaas. Heelwat pogings is aangewend en aanbevelings gemaak om mediese studente se persepsies teenoor psigiatriese pasiënte te destigmatiseer. Daar is bevind dat persepsies gewoonlik verbeter direk na ʼn kliniese rotasie in Psigiatrie, maar dat stigmatiserende persepsies meestal binne ʼn jaar terugkeer. Mediese studente aan die Fakulteit Geneeskunde en Gesondheidswetenskappe, Universiteit Stellenbosch, se eerste kliniese blootstelling aan Psigiatrie is tydens die vierde of vyfde studiejaar. In 2010 is dié rotasie hersien en ʼn diensleerkomponent bygevoeg. Die navorsingsvraag wat hieruit ontwikkel is, is: Wat is die invloed van ʼn diensleerbenadering op die destigmatisering van mediese studente se persepsies teenoor psigiatriese pasiënte? Die navorsing het ʼn fenomenologiese denkrigting gevolg in ʼn interpretatiewe paradigma met ʼn kwalitatief-induktiewe benadering. Studente het skriftelike refleksies op die laaste dag van ʼn rotasie ingehandig en ʼn in-diepte fokusgroeponderhoud is gevoer. ʼn Jaar later is die fokus-groeponderhoude herhaal. ʼn Ontleding van studente se refleksies en die getranskribeerde tekste en gedoen. Dit het gedien het as basis vir die gevolgtrekkings waaruit aanbevelings gemaak is. Daar is gevind dat studente voor hulle eerste kliniese rotasie in Psigiatrie, stigmatiserende persepsies teenoor psigiatriese pasiënte gehad het. Direk daarna was studente se persepsies grotendeels gedestigmatiseer. Na ʼn jaar was nie-stigmatiserende persepsies van begrip, aanvaar-ding, gemaklikheid, deernis, respek en verantwoordelikheid steeds teenwoordig, alhoewel stigma-tiserende persepsies tot ʼn mate by sommige teruggekeer het. Studente het die positiewe verande-ring toegeskryf aan die diensleerervaring in kombinasie met 'n kliniese plasing in die psigiatriese hospitaal waar ʼn vriendelike atmosfeer geheers het en waar daar blootstelling was aan pasiënte wat nie aan komplekse en ekstreme psigiatriese steurings gely het nie. Die nie-stigmatiserende persepsies ʼn jaar na ʼn kliniese rotasie in Psigiatrie toon die transformatiewe waarde van diensleer. Met diensleer word sinvolle en relevante diens met en in die gemeenskap gelewer, doelbewuste klem word op sosiale verantwoordbaarheid gelê en ge-struktureerde refleksie word gedoen om beter akademiese leer te laat plaasvind. Na aanleiding van hierdie studie kan mediese skole wêreldwyd kennis neem dat ʼn diensleer-benadering ʼn betekenisvolle bydrae gelewer het tot die volhoubare destigmatisering van mediese studente se persepsies teenoor psigiatriese pasiënte.

<p> Gay and bisexual Black men experience higher lifetime depression rates than both White and Black heterosexual men. Some social stress researchers argued that this rate may be due to having two stigmatized minority identities and therefore being at greater risk. However, gay and bisexual Black men also experience lifetime depression rates significantly below White LGB people, suggesting resilience to depression for those with these intersecting identities, race and sexuality. This study attempted to address the debate between greater risk versus resilience in gay and bisexual Black men. </p><p> This study investigated whether internalized heterosexism and internalized racism would independently predict depressive symptoms, and whether the interaction of the two would account for more reported depression, supporting the greater risk perspective and minority stress theory (Meyer, 2003). Additionally, the resilience perspective was tested using Africultural coping, culture-specific type of coping, as a moderator of the relationship between internalized stigmas and depressive symptoms. All variables were examined for their relative contributions to depressive symptoms in gay and bisexual Black men to allow for a nuanced view of risk and resilience in this population. </p><p> Eighty-three gay and bisexual Black men of diverse ages, incomes, and educational levels from around the U.S. completed all online surveys and were included in analysis. The single multiple regression was significant with the full model explaining 43% of the variance in depressive symptoms. Internalized heterosexism was positively associated with depressive symptoms. Neither internalized racism, nor the interaction of internalized stigmas (internalized heterosexism x internalized racism) was significant. Thus, minority stress theory was only partially supported and the greater risk perspective was not supported. </p><p> Africultural coping was not significant, in this sample, in predicting depressive symptoms, nor was the interaction of Africultural Coping with each of the two internalized stigmas. In keeping with social stress theory and research, reported low income was significantly and positively associated with depressive symptoms. Possible confounds and limitations are discussed. Implications for theory, methodology and measurement are also discussed.</p>

<p> Substance use disorders (SUD) can lead to many adverse health effects including nutritional deficiencies and malnutrition. Research shows that proper nutrition can have a positive effect on recovery outcomes; however, nutrition services and education are often undervalued and not adequately utilized in substance abuse treatment centers. Previous research indicates that barriers to healthy eating are often due to ones lack of self-confidence in preparing and purchasing healthy foods. The purpose of this study was to investigate the effectiveness of a "hands-on" nutrition and culinary intervention in a SUD treatment center. Specifically, this study measured the participants' positive and negative attitudes towards cooking, as well as their perceived self-efficacy in relation to purchasing and preparing healthy foods. </p><p> There was a significant difference in the participants' overall self-efficacy related to food preparations skills, specifically in their ability to prepare whole grains. Participants also became more confident in purchasing whole grain products by the end of intervention. Further review of the study revealed that the participants' enjoyment of cooking increased significantly after completion of the cooking classes.</p>

This study investigated the effect of postpartum home teaching on primiparous women's knowledge of infant care. Twenty-one low-risk primigravidae women were randomly placed in a control or experimental group. Subjects in the experimental group viewed a videotaped program on infant care a second time, at home on the third day postpartum. Tests were administered prior to hospital discharge, on the third day postpartum, and at 28-32 days postpartum. A short interview was conducted to obtain opinions regarding videotaped educational materials. The subjects (n = 21) retained most of the information presented after the first viewing and expressed satisfaction with the educational format. The results were not statistically significant, though mean test scores increased over the three test intervals.

The issue of satanic ritual abuse has gained widespread public and professional attention in the past ten years. During therapy, many adult Multiple Personality Disorder (MPD) clients describe memories of Satanic Ritual Abuse (SRA) beginning in childhood. Basically, the only information circulating in the mental health professional community about MPD/SRA issues is derived from workshops and lectures at trainings and professional meetings. The intent of this project was to determine the need for an in-depth educational training film for mental health professionals to assess, diagnose and treat satanic ritual abuse survivors in conjunction with multiple personality disorder. A questionnaire was used to determine whether a video educational training film would be beneficial. The conclusion was reached that an educational training film would be useful in helping mental health professionals. It was also concluded that educational training films in the behavioral sciences is an effective training tool.

The population today is getting older, leading to increases in the number of women in the postmenopausal stage of life. The fact that women in the United States have an average life expectancy of 79 years, means that approximately one third of a woman's life will be spent after menopause (Odom, Carr, & MacDonald, 1990). For nurses working with older populations, estrogen replacement therapy is a common issue to confront. It is of considerable concern then that more knowledge be obtained on HRT and on characteristics of those women who elect to use it. The purpose of this study was to describe the profile of one group of older, middle-income women, on estrogen replacement therapy. In this study, premarin is the most common method of estrogen replacement therapy. A majority of the sample practiced the health promotion behaviors of no smoking, limited fat intake and regular exercise. Approximately 85% (n = 41) of the sample had a papanicolaou smear within the past two years, 92% (n = 44) had a mammogram within the past one year and 59% performed occasional breast self exam.

This thesis is an investigation into women’s experiences of repeatedly attempting to lose weight and maintain a weight they find acceptable, and the implications of this for health education. This was an interpretivist inquiry which generated data through narrative interviews. The data was analysed using three different strategies to enable deeper understanding of the participants’ experiences. To set the context health education resources relating to body weight, healthy eating and activity were collected from local community and health settings. A former local practice nurse was also interviewed about her role in assisting women with weight loss. A literature review revealed an emphasis on research and policy that focuses on the dangers of overweight and obesity, prioritising individual behaviour and energy-deficit approaches to losing weight. A qualitative method was used to collect data from a convenience sample of five women. Data from interviews and autobiographical writing were recorded, transcribed and analysed within a narrative analysis framework. Analysis of the findings using three interpretive lenses are presented first as re-storied accounts of the women’s narratives, and secondly thematic analysis addressing issues of control, pleasure and pain, and embodiment and alienation. Finally a relational analysis reveals the ways in which participants position themselves in relation to themselves, other characters and the interviewer in order to build their desired identities. The data shows that the participants had followed a wide and diverse range of diets, eating and exercise plans, none of which had been successful in both reducing their weight and maintaining it at a level they were happy with, even after repeated attempts. Whilst biomedical literature suggests a dividing line between pathological eating disorders such as anorexia nervosa/bulimia and normality, the disordered eating and emotional difficulties described by the participants supports the view that a broad range of eating and body-image problems may be more culturally normative than is generally recognised. Dieting and weight cycling were common experiences. The findings of the thesis suggest that contrary to current public policy, the views of these women who are unhappy with their body weight are complex, idiosyncratic and demonstrate resistance to health messages that target individual responsibility for weight management. Their views are developed from personal experiences - the findings suggest that these women are stigmatised. However, one response to this can be to stigmatise other people whom they see as more overweight than themselves. Normative femininity is increasingly centred on appearance and women who do not comply with the requirements risk alienation and pain. The identities that the women construct are relevant for health education but not taken into account when national policy and strategies are developed to address overweight and obesity. The risks to health of weight cycling are also not addressed by policy. The implications of the thesis are discussed in relation to the embodied experiences and gendered roles of women, the role of health education and its relationship with biomedicine.

<p> Cervical cancer, although not widely considered a fatal disease in this day and age, still has a major impact on women&rsquo;s health around the world and in the U.S. Worldwide, invasive cervical cancer is the second most common cancer among women and is prominent in Mexico. Screening rates for cervical cancer are lower among Hispanic women. Although interventions have been tested to determine effectiveness in increasing the uptake of cervical cancer screening, there is no support of the effectiveness of group education, especially among Hispanic women. The overarching goal of the current research was to determine the mode of educational delivery &ndash; individual or group &mdash; that is most effective in encouraging cervical cancer screening so as to reduce the burden of cervical cancer in Texas Border Counties. We also assessed the effect of mode of intervention delivery on knowledge, perceived susceptibility, perceived seriousness, perceived benefits, perceived barriers, subjective norms, and self-efficacy. A secondary data analysis of a randomized controlled study embedded within the <i>De Case en Casa</i> program was conducted in El Paso and Hudspeth County. 300 women between the ages of 21 and 65 who were uninsured, had never been diagnosed with cervical cancer or never had a hysterectomy, had not had a Pap test in the past 3 years, and had an income greater than 200% of the federal poverty level participated in the study. 150 women received the intervention in a group setting and 150 women received the intervention individually. 80.7% of participants were screened. No significant difference was found in uptake of cervical cancer screening by mode of educational delivery. The decrease in perceived barriers reached significance by mode of intervention delivery, with a larger decrease among those who received the education in a group setting. There was a significant increase in perceived benefits by uptake of cervical cancer screening with a larger increase among those who were not screened. No other construct reached significance. In conclusion, findings demonstrated that group education is effective in increasing cervical cancer screening among Hispanic women in a border county.</p>

The body of knowledge that exists regarding cracked teeth is limited. The purpose of this study was to determine the prevalence of cracks among extracted teeth. This retrospective longitudinal cohort study included patients of the Virginia Commonwealth University School of Dentistry that underwent extraction procedures over a 6 year period. The sample consisted of 20,408 patients and 40,870 teeth. Statistical analysis software was used to identify diagnoses of a crack, fracture, or split tooth prior to extraction of the tooth by analyzing the Electronic Health Record (EHR) (axiUm™, Version 6.03.03.1035, Exan Corporation, Vancouver, BC, Canada). There were 3,228 teeth identified as cracked in the 40,870 extracted teeth—an overall prevalence of 7.90%. The percentage of cracked teeth were compared using a chi-square test of homogeneity. The prevalence of cracked teeth varied according to tooth type (chi-square = 95.5, df = 7, p < .0001). Tukey’s multiple-comparison procedure identified the groups of tooth types with a significantly different cracked prevalence. The mandibular 2nd molar had the highest prevalence (9.72%). Age and gender were also significantly correlated with cracked teeth.