Trust Black Women: Using Photovoice to Amplify the Voices of Black Women to Identify and Address Barriers to Breastfeeding in Southeast Georgia.

Barriers to breastfeeding for Black mothers are well documented in the literature. Local context is crucial for understanding and addressing barriers. Our research used the photovoice method to amplify the voices of Black mothers in Chatham County, Georgia. Guided by the sociol-ecological model, this photovoice project explored and identified the social, cultural, and physical barriers to breastfeeding that the mothers experienced. Two additional themes emerged through data analysis: personal comfort with public breastfeeding and the women's recommendations for breastfeeding support and normalization. Lack of physical spaces, lack of peer and family support, the need to overcome the stigma associated with breastfeeding, and advocating for more lactation spaces were commonly stated by the participants. These results led to the creation of a policy toolkit, a breastfeeding policy template, a proclamation to make the City of Savannah a Breastfeeding Family Friendly Community, an online photobook to share the experiences of the mothers, and additional paths of dialogue to increase inclusivity and expand health equity within Chatham County.

Psychometric Study of the Pain Drawing.

PURPOSE: The objectives of the study were to (1) assess the extent to which interrater reliability of pain drawing location and dispersion scoring methods are similar across pain disciplines in a sample of patients with cancer treatment-induced neuropathic pain (N = 56) and (2) investigate indicators of validity of the pain drawing in this unique sample. METHODS: Patients undergoing cancer therapy completed the Brief Pain Inventory Body Map, the MD Anderson Symptom Inventory, and the McGill Pain Questionnaire. RESULTS: Intraclass correlation coefficients among medical and psychology professionals ranged from .93-.99. Correlations between pain drawing score and symptom burden severity ranged from .29-.39; correlations between pain drawing score and symptom burden interference ranged from .28-.34. Patients who endorsed pain in the hands and feet more often described their pain as electric, numb, and shooting than patients without pain in the hands and feet. They also endorsed significantly more descriptors of neuropathic pain. CONCLUSIONS: Results suggest a similar understanding among members of a multidisciplinary pain team as to the location and dispersion of pain as represented by patients' pain drawings. In addition, pain drawing scores were related to symptom burden severity and interference and descriptors of neuropathic pain in expected ways.

Patterns of dating violence across adolescence.

Adolescent dating violence (ADV) is a prevalent social and health problem associated with a number of adolescent risk behaviors and negative outcomes. The purpose of this study was to identify patterns of dating violence across adolescence. We used cross-case analysis to analyze interviews with 88 young adults (men and women aged 18 to 21) who were involved in violent dating relationships as teens. We identified four patterns of dating violence throughout adolescence. We also identified two patterns for adolescents who had only one violent relationship based on the length of the relationship-contained ADV and prolonged ADV-and two patterns for those who had multiple violent relationships based on the level of violence severity-repetitive ADV and escalating ADV. Knowledge of these four patterns can be used to guide therapeutic interactions with teens and to develop pattern-specific prevention and intervention strategies.

Adolescent dating violence and Peplau's dimensions of the self.

BACKGROUND: Adolescent dating violence (ADV) is a significant public health problem. Despite an association between ADV and lowered self-esteem, little research has examined identity issues in persons who have experienced ADV. OBJECTIVES: To use Peplau's model of the dimensions of the self to describe identity concerns in those who experienced ADV. DESIGN: Verbatim comments that met Peplau's definitions of self-statements were extracted from the narratives of 50 young adults who had taken part in an ongoing qualitative study on ADV. The statements were coded into Peplau's dimensions using content analysis. RESULTS: 175 verbatim sentences were extracted from the narratives. The statements addressed 16 different personal characteristics, including strength, sociability, and aggressiveness. CONCLUSIONS: Individuals who have experienced ADV have a number of concerns related to self-concept. Recommendations are made regarding how these concerns may be addressed with investigative counseling, as described by Peplau.

Research-based Theatre about veterans transitioning home: A mixed-methods evaluation of audience impacts.

RATIONALE: Contact!Unload, a research-based theatre production, portrays veterans experiencing mental health challenges and overcoming them through therapeutic enactment. It was performed eight times by veteran performers in 2017 for audiences in two Canadian cities comprised of civilians and military-connected personnel and their families (n = 525). METHODS: Drawing upon qualitative and quantitative data sources, this paper evaluates the immediate and longer-term impacts of Contact!Unload as a knowledge translation intervention for audience members. RESULTS: Our findings suggest that the performance: 1) improved knowledge of mental health concerns and symptoms that some veterans experience when transitioning to civilian life, 2) increased knowledge of the need for mental health supports and care for veterans, 3) sustained impacts on awareness and knowledge six months after the play and 4) sparked dialogue and actions after the show for some audience members. Moreover, theatre was seen as a powerful medium to engage audience members both cognitively and affectively in the topic. CONCLUSIONS: Research-based theatre has significant potential as a knowledge translation intervention for mental health topics. The work also points to the untapped potential of using RbT to engage audience members in a mental health literacy intervention. Future work is needed to study how to effectively combine research-based theatre with intervention design frameworks and other mental health literacy interventions.

Bringing disability experiences front stage: Research-based theatre as a teaching approach to promote inclusive health education.

BACKGROUND: Despite efforts to promote inclusion of people living with disabilities in health and human service education and professions, students and clinicians living with disabilities continue to face powerful barriers, arising most notably from the stigma and negative attitudes of their peers. Increased awareness of these lived experiences are needed to affect attitudinal changes and reduce barriers to participation in those professions. To achieve this, information (stories) must be presented to learners in a way that promotes emotional engagement and highlights these issues from multiple perspectives. The following study measures the impact of a Research based Theatre play, based on the collected experiences of people living with disabilities in health and human service professions, as a teaching approach for knowledge and attitudinal change among audiences. METHOD: This mixed-methods study (pre and post surveys, groups and individual interviews) aimed at measuring the impact (knowledge and attitudinal change) incurred among audience members. In total, a 174 students, faculty, staff, and clinicians in health and human service professions across two major Canadian cities completed the surveys before and after witnessing the play. Of these, 20 participants also participated in follow-up interviews. Two-way repeated measures ANOVA was used to compare the pre and post surveys while thematic content analysis was used for the interviews. RESULTS: Two main themes emerged from combined analysis of both the quantitative and qualitative data. First, quantitative data revealed a significant change in participants' attitudes towards people living with disabilities which was corroborated by interview participants who expressed more comfort in their interactions with students and clinicians living with disabilities. Second, learners also reported meaningful and statistically significant change in their knowledge about the experiences of health and human service professionals living with disabilities. CONCLUSIONS: The results of this study support applying Research-based Theatre as a teaching approach that can promote knowledge and attitudinal change among audiences and increase the inclusion and equity of people living with disabilities in health and human service education. Future research in this area might investigate Research-based Theatre's pedagogical impact using a randomized control design and measuring longer term impact.

Aggressive events in adolescent dating violence.

This purpose of this paper is to present a typology of common aggressive events that occur in the context of adolescent dating violence. The typology is based on 42 transcripts of interviews with young adults, ages 18 to 21, who described dating violence they had experienced when adolescents (ages 13-18). One-hundred and eighty-four text units that contained a description of an event involving aggression or violence between the participant and a dating partner were extracted from the transcripts. Cross-case analysis was used to create categories of events that shared similar characteristics. The analysis yielded eight types of aggressive events: (a) tumultuous, (b) explosive, (c) scuffling, (d) violating, (e) threatening, (f) controlling, (g) disparaging, and (h) rejecting, ignoring, or disrespecting. The typology can provide a foundation for further research on adolescent dating violence from a situational perspective and can be used as a tool to promote discussion of dating violence with victimized or at-risk youth.

The essence of healing from sexual violence: a qualitative metasynthesis.

A qualitative metasynthesis was conducted to identify the essence of healing from sexual violence, as described by adults who experienced it as children or as adults. Based on the findings of 51 reports, four domains of healing were identified: (a) managing memories, (b) relating to important others, (c) seeking safety, and (c) reevaluating self. The ways of healing within each domain reflected opposing responses. The dialectical process identified for each of the four domains include, respectively: (a) calling forth memories, (b) regulating relationships with others, (c) constructing an "as-safe-as-possible" lifeworld, and (d) restoring a sense of self. These complex processes resulted in a new reality for the participants that was based on a greater sense of agency and provided a more satisfying life course.

Open label trial of alefacept in palmoplantar pustular psoriasis.

BACKGROUND: Palmoplantar pustular psoriasis (PPP) is difficult to treat. We assessed the effectiveness of alefacept in PPP and the safety of a 30 mg/week dose. METHODS: Fifteen individuals with PPP were started on 15 mg/week intramuscularly (IM) alefacept. Efficacy was measured by the PPP severity instrument (PSI). Treatment was continued for 16 weeks, and the alefacept dose was increased to 30 mg/week IM at week 9 if the PSI did not decrease by at least 25%. Other outcomes included physician's global assessment (PGA), reported adverse events and CD4+ T-lymphocyte counts. Clinical response was observed for 12 weeks after the last injection. RESULTS: The severity of PPP improved in both the PSI and the PGA (p<0.0001 and p = 0.0009, respectively). Much of the improvement occurred after 10 weeks of therapy. Nail severity scores improved (p = 0.0003). CD4+ counts decreased, but all remained >250 cells/mm3. There were no severe adverse effects or discontinuations due to adverse events. CONCLUSIONS: Alefacept in doses up to 30 mg/week was well tolerated in patients with PPP and appeared to have some efficacy. The use of concomitant therapy, the lack of a comparator, and the small sample size are limitations of the study.

Effectiveness of Splanchnic Nerve Neurolysis for Targeting Location of Cancer Pain: Using the Pain Drawing as an Outcome Variable.

The effectiveness of splanchnic nerve neurolysis (SNN) for cancer-related abdominal pain has been investigated using numeric pain intensity rating as an outcome variable. The outcome variable in this study used the grid method for obtaining a targeted pain drawing score on 60 patients with pain from pancreatic or gastro-intestinal primary cancers or metastatic disease to the abdominal region. Results demonstrate excellent inter-rater agreement (intra-class correlation [ICC] coefficient at pre-SNN = 0.97 and ICC at within one month post-SNN = 0.98) for the grid method of scoring the pain drawing and demonstrate psychometric generalizability among patients with cancer-related pain. Using the Wilcoxon signed rank test and associated effect sizes, results show significant improvement in dispersion of pain following SNN. Effect sizes for the difference in pre-SNN to 2 post-SNN time points were higher for the pain drawing than for pain intensity rating. Specifically, the effect size difference from pre- to within one month post-SNN was r = 0.42 for pain drawing versus r = 0.23 for pain intensity rating. Based on a smaller subset of patients who were seen within 1 - 6 months following SNN, the effect size difference from pre-SNN was r = 0.46 for pain drawing versus r = 0.00 for pain intensity rating. Collectively, these data support the use of the pain drawing as a reliable outcome measure among patients with cancer pain for procedures such as SNN that target specific location and dispersion of pain.

A comparative analysis of current microbial water quality risk assessment and management practices in British Columbia and Ontario, Canada.

Bacteria, protozoa and viruses are ubiquitous in aquatic environments and may pose threats to water quality for both human and ecosystem health. Microbial risk assessment and management in the water sector is a focus of governmental regulation and scientific inquiry; however, stark gaps remain in their application and interpretation. This paper evaluates how water managers practice microbial risk assessment and management in two Canadian provinces (BC and Ontario). We assess three types of entities engaged in water management along the source-to-tap spectrum (watershed agencies, water utilities, and public health authorities). We analyze and compare the approaches used by these agencies to assess and manage microbial risk (including scope, frequency, and tools). We evaluate key similarities and differences, and situate them with respect to international best practices derived from literatures related to microbial risk assessment and management. We find considerable variability in microbial risk assessment frameworks and management tools in that approaches 1) vary between provinces; 2) vary within provinces and between similar types of agencies; 3) have limited focus on microbial risk assessment for ecosystem health and 4) diverge considerably from the literature on best practices. We find that risk assessments that are formalized, routine and applied system-wide (i.e. from source-to-tap) are limited. We identify key limitations of current testing methodologies and looking forward consider the outcomes of this research within the context of new developments in microbial water quality monitoring such as tests derived from genomics and metagenomics based research.

A Meta-Summary of Qualitative Findings about Professional Services for Survivors of Sexual Violence.

Sexual violence occurs at alarming rates in children and adults. Survivors experience myriad negative health outcomes and legal problems, which place them in need of professional services. A meta-summary was conducted of 31 published qualitative studies on adults' responses to sexual violence, with a focus on survivors' use of professional services. Combined samples included 46 men, 984 women, and six couples who had experienced sexual violence at any point in their lives. Findings indicated that qualities of professional service providers and outcomes of professional services were perceived either positively or negatively (rather than neutrally) by survivors, regardless of the provider's professional discipline. Professionals who work with sexual violence survivors can use these findings to improve their practices.