Reconstructing self-narratives in coping with traumatic brain injury

This study examined qualitative data from ten individuals with traumatic brain injuries (TBI) who felt at ease with their current situations. An analysis based on the grounded theory method revealed that one's experience of coping or adjustment to the disability was represented as narratives about him or herself. Each one with TBI reconstructed certain self-narratives in coping with their changed self-images and daily lives. The common narratives were classified into five categories: "the self better than others," "the grown self," "the recovering self," "the self living here and now," and "the protesting self." These self-narratives reflected renewed ways to view the selves, which were conceptualized to be intact "in spite of TBI" or to be worthwhile "because of TBI." The informants achieved this conceptualization by managing their perspectives on time or on space. This classification will serve as a framework for rehabilitation practice and for future research.     

What's in a story? A text analysis of burn survivors' web-posted narratives

Story-telling has been found to be beneficial following trauma, suggesting a potential intervention for burn survivors who frequently make use of? telling their story? as part of their recovery. This study is the first to examine the word content of burn survivors' Web-posted narratives to explore their perceptions of the event, supportive resources, their post-burn well-being, and re-integration using a comparison group and a text data analysis software developed by the widely recognized James Pennebaker. Suggestions for using expressive writing or story-telling as a guided psychosocial intervention with burn survivors are made.     

Women living with a spinal cord injury: perceptions about their changed bodies

In this article we illuminate the narratives of women living with a spinal cord injury (SCI) with regard to (a) learning how to live with a changed body and (b) exploring the factors that influence how they feel toward their new bodies. An SCI produces immediate physical impairments resulting in a changed body, which can then have physical, emotional, and social consequences to these women. Through its focus on enhancing the body, physical therapy can help to promote a positive view of the self within the changed body. Our analysis of these women's experiences resulted in a fluid, three-phase framework of learning to live with a changed body that generally moves from (a) discomfort, to (b) moving toward comfort, to (c) comfort. Physical therapy can potentially influence the process of women's gaining comfort with their changed bodies following an SCI. The framework provides a basis for future research on adaptation following SCI.     

Personal PM(2.5) exposure among wildland firefighters working at prescribed forest burns in southeastern United States

This study investigated occupational exposure to wood and vegetative smoke in a group of 28 forest firefighters at prescribed forest burns in a southeastern U.S. forest during the winters of 2003-2005. During burn activities, 203 individual person-day PM(2.5) and 149 individual person-day CO samples were collected; during non-burn activities, 37 person-day PM(2.5) samples were collected as controls. Time-activity diaries and post-work shift questionnaires were administered to identify factors influencing smoke exposure and to determine how accurately the firefighters' qualitative assessment estimated their personal level of smoke exposure with discrete responses: "none" or "very little," "low," "moderate," "high," and "very high." An average of 6.7 firefighters were monitored per burn, with samples collected on 30 burn days and 7 non-burn days. Size of burn plots ranged from 1-2745 acres (avg = 687.8). Duration of work shift ranged from 6.8-19.4 hr (avg = 10.3 hr) on burn days. Concentration of PM(2.5) ranged from 5.9-2673 μg/m(3) on burn days. Geometric mean PM(2.5) exposure was 280 μg/m(3) (95% CL = 140, 557 μg/m(3), n = 177) for burn day samples, and 16 μg/m(3) (95% CL = 10, 26 μg/m(3), n = 35) on non-burn days. Average measured PM(2.5) differed across levels of the firefighters' categorical self-assessments of exposure (p < 0.0001): none to very little = 120 μg/m(3) (95% CL = 71, 203 μg/m(3)) and high to very high = 664 μg/m(3) (95% CL = 373, 1185 μg/m(3)); p < 0.0001 on burn days). Time-weighted average PM(2.5) and personal CO averaged over the run times of PM(2.5) pumps were correlated (correlation coefficient estimate, r = 0.79; CLs: 0.72, 0.85). Overall occupational exposures to particulate matter were low, but results indicate that exposure could exceed the ACGIH?-recommended threshold limit value of 3 mg/m(3) for respirable particulate matter in a few extreme situations. Self-assessed exposure levels agreed with measured concentrations of PM(2.5). Correlation analysis shows that either PM(2.5) or CO could be used as a surrogate measure of exposure to woodsmoke at prescribed burns.     

Rising from the ashes: stories of recovery,adaptation and resiliency in burn survivors

Burn-injured people are confronted with enormous challenges in their recovery process on a physical, emotional, and spiritual level. Despite the magnitude of trauma, there has been a dearth of research exploring adult burn survivors' perception of their experiences. In this qualitative study, eight burn survivors were interviewed. Influences that impacted their experiences such as perceived memories, time, and age when burned were distinguished from the multiple themes of losses to identity, life style, relationships and physical functioning as well as themes of adaptation, coping and resiliency. Drawing from the burn survivors' stories of recovery can provide insights for social workers and other health care professionals in serving this compelling population more effectively.     

Nutrition support strategies for severely burned patients.

Significant weight loss is a common complication of a major burn injury. Before the modern era of early enteral nutrition support, such a complication contributed significantly to impaired wound healing, raised risk of infectious morbidity, and ultimately increased mortality. Nutrition management of the burn patient is designed to promote wound healing while minimizing loss of lean body mass. The burn patient characteristically demonstrates an increase in energy expenditure after the initial injury and period of resuscitation. Studies have demonstrated that early institution of enteral feeding can attenuate the stress response, abate hypermetabolism, and improve patient outcome.     

The experience of posttraumatic growth for people with spinal cord injury

The purpose of this qualitative study was to explore the characteristics of posttraumatic growth for people with spinal cord injury. In this study, we intentionally selected people exhibiting evidence of posttraumatic growth to capture distinctive characteristics of the phenomenon. A thematic analysis was used to examine the narratives of life experiences before and after spinal cord injury. The three most salient themes of posttraumatic growth were identified: experience of meaningful family relationships, experience of meaningful engagement, and appreciation of life. Further investigation into the experience of posttraumatic growth is necessary in the future for a better understanding of the phenomena.     

Community care for people with disability: blurring boundaries between formal and informal caregivers

Health care for individuals with disability is increasingly shifting from institutional settings to the "community," with assistance by those in the formal sector. In this article, the authors examine 5 case studies illustrating interactions and relationships between people with disability and their caregivers, using qualitative data collected as part of a community study of disability conducted in a medium-sized city in the northeastern United States. Employing the task specificity framework, they explore the implications of using either formal care providers to fill needs that are more typically met by family and friends or family caregivers to provide care that is best provided by the formal sector. Although our narratives illustrate the negative implications of mismatched care substitution, we conclude that the framework is less applicable to emerging systems of community care.     

Worksite disability management model for effective return-to-work planning

The growth of disability management programs represents a paradigm shift from traditional clinic-based rehabilitation services to worksite-based interventions that dramatically reduce lost time and costs. Supportive policies and steps in the return-to-work process are illustrated, from the point of worker injury and early intervention, through work ability assessment, return-to-work planning, job-site accommodation, and successful return to work. Creative return-to-work options, including "job banks," are discussed as practical methods to facilitate the worker's gradual return to full duty status while completing the medical recovery process. Worker, worksite, and community resource factors related to return-to-work outcomes are discussed.     

Constructions of various femininities among the oldest old women

This study forms part of the Ume? 85+ Study, and the aim was to explore various gendered constructions of femininities among the oldest old women. Femininities are seen as various ways of shaping oneself as a woman in relation to the impact of historical, social, and cultural circumstances. Thematic narratives were analyzed using qualitative content analysis. Through interpreting these narratives in the light of gender theories, we were able to discern four femininities: "being connected," "being an actor," "living in the shadow of others," and "being alienated." The oldest old women displayed complex outlooks on femininities, and no femininity was interpreted as being in the center related to the other femininities. Further research is needed in order to disclose the complexity of femininities related to factors such as social class, ethnicity, and financial situation among the oldest old, and to acquire a greater knowledge of various femininities.     

Inviting pain? Pain,dualism and embodiment in narratives of self‐injury

The role of pain in the practice of self‐injury is not straightforward. Existing accounts suggest that self‐injury does not cause ‘physical’ pain, however self‐injury is also said to alleviate ‘emotional’ pain by inflicting ‘physical’ pain. This article explores these tensions using sociological theories regarding the socio‐cultural and subjective nature of pain. Analysis derives from in‐depth, life‐story interviews carried out in the UK with people who had self‐injured. Findings contribute to on‐going debates within social science regarding the nature of pain. Participants’ narratives about pain and self‐injury both drew on and challenged dualistic models of embodiment. I suggest that self‐injury offers a unique case on which to extend existing theoretical work, which has tended to focus on pain as an unwanted and uninvited entity. In contrast, accounts of self‐injury can feature pain as a central aspect of the practice, voluntarily invited into lived experience.     

Life review as a therapeutic frame in the treatment of young adults with AIDS

In this article, the author describes developmental and clinical issues in the use of life review as a therapeutic frame in psychotherapy of young adults with acquired immune deficiency syndrome. Presentation of clinical data suggests that elaboration of life narratives, by means of reminiscence, may help people to regain a cohesive sense of self, carry out psychological and social tasks, and revise life structures in the context of the illness experience. The author demonstrates how narrative approaches, informed by developmental theory, shift the focus from disability and dysfunction to concern for relative health and personal growth in social intervention with this population. Emergent research issues also are identified.     

"A waste of time": Hispanic women's attitudes toward physical activity

Despite a lack of studies on Hispanic midlife women's physical activity, the existing studies have indicated that Hispanics' ethnic-specific attitudes toward physical activity contributed to their lack of physical activity. However, little is still clearly known about Hispanic midlife women's attitudes toward physical activity. The purpose of this study was to explore Hispanic midlife women's attitudes toward physical activity using a feminist perspective. The study was a 6-month qualitative online forum among 23 Hispanic women who were recruited through Internet communities/groups. The data were collected using 17 online forum topics on attitudes toward physical activity and ethnic-specific contexts. The data were analyzed using thematic analysis. Three major themes emerged from the data analysis process: (a) "family first, no time for myself," (b) "little exercise, but naturally healthy," and (c) "dad died of a heart attack." Although some of the women perceived the importance of physical activity due to their family history of chronic diseases, the study participants thought that physical activity would be a waste of time in their busy daily schedules. These findings provided directions for future health care practice and research to increase physical activity among Hispanic midlife women.     

Family practice patients' experiences and beliefs in faith healing

Faith healers have become more visible as an alternative to traditional medicine because of the growth of television evangelism. The extent to which patients engage in alternative therapies such as faith healing, however, is not fully known. To further explore patients' involvement in faith healing, a cross-sectional survey was administered to 207 patients in one rural family practice. Most respondents (58 percent) reported that faith healers are "quacks," but 29 percent believed that faith healers can help some people who physicians cannot help. Twenty-one percent had attended a faith-healing service. Six percent stated they had actually been healed by faith healers, and 15 percent reported they personally knew someone who had been healed. Participation in faith-healing services was significantly higher among blacks (P less than .01) and those with less than a high school education (P less than .01). The finding that many patients embrace faith healing has implications for traditional family practice and may explain why patients sometimes reject medical treatment. Physicians need to be sensitive to patients' beliefs about "faith," and must determine the extent to which patients reject the scientific approach before physicians can become effective "healers."     

A state trauma registry as a tool for occupational injury surveillance.

The goal of occupational surveillance is to identify and determine the magnitude of work-related disease and injury and workplace hazards for the purposes of focusing prevention programs and tracking their effectiveness. There are a number of databases that collect information on pieces of the puzzle of workplace exposure and adverse health outcomes. Other than that for the fatalities, none of these datasets specifically describes the most severe occupational injuries or their attendant disability. The goal of this study was to evaluate the usefulness of the Illinois Trauma Registry (ITR) in the surveillance of occupational injuries. The entire dataset of the ITR was obtained from the Illinois Department of Public Health for the years 1993 and 1994. The occupational injuries were extracted and frequency distributions were determined for all demographic and health variables. Background population, employment, and death-rate data were obtained for the purpose of rate calculation and for comparison of raw data. Mean costs for acute occupational injuries were calculated. There were 5844 occupational cases, comprising 6.7% of the total group. The majority of injuries had occurred in males (86%), in urban settings (81%), and were of the "blunt" injury type. External cause (coded according to the International Classification of Diseases, 9th Revision, External Injury) categories for work-related injuries were "Cut/Struck," 39%; "Falls," 36%; "Transportation," 12%; "Environmental," 6%; "Violence," 3%; and the remainder, 5%. By definition, all cases were admitted to the hospital, with 62% classified as "minor," 28% "moderate," and the remaining 11% "severe" to "life threatening." Surgery was performed in 54%, and admission to a monitored bed or the intensive care unit occurred in 15%. Although 93% were discharged home, only 54% ambulated independently. Seven percent were not independent with regard to self-feeding status. The mean hospital charge was $10,802 (standard deviation, $31,438). A pyramidal model of the place of ITR cases in the universe of occupational injuries is presented. The ITR contains a unique set of variables that broaden our understanding of serious work-related injuries. It is recommended that these variables--"occupation," "type of industry," and "nature of injury"--be added to the ITR so that it may be linked with other databases to check its validity and completeness and to enhance its value in occupational surveillance.     

Maintaining integrity: women and treatment seeking for the symptoms of potential cardiac illness

Cardiac disease is the number one killer of Canadian women. Therapy is highly time-dependent, yet treatment-seeking delay persists. The purpose of this grounded theory study was to explore how women seeking treatment for the symptoms of potential cardiac illness interpreted their symptoms, made decisions about seeking treatment, and understood experiences of care in the emergency department. Data were drawn from 100 hours of naturalistic observation, in-depth interviews with 16 women who visited one of two urban emergency departments between June 2005 and June 2006, and three interviews with nurses. The basic social psychological process of maintaining integrity was identified, encompassing three distinct phases: "resisting disruption," "suspending agency," and "integrating experiences and knowledge." The findings suggest that in the face of a threat to life, women are first and foremost striving to maintain both the integrity of their sense of self and their ability to carry out role responsibilities.     

Not lost in translation: nutrition education, a critical component of translational research

Translational research is an emerging field of science, embracing disciplines in medicine and public health to create a full-spectrum research agenda. Often described as science "from bench to bedside and back again," translational research may be better described as "from bench to behavior," as it strives to apply laboratory results to clinical settings. Because the demand for translational research has emerged, it is critical for nutrition educators to ensure that translational research includes community and policy areas and to recognize themselves as translation researchers. The purpose of this report is to provide a framework for nutrition educators to better understand translational research and to recognize their role in translational research, using type 2 diabetes as an example.     

The future of the public's health: vision, values, and strategies

The expansive vision of modern public health, "healthy people in healthy communities," is politically charged. This paper offers a justification for this broad vision and offers concrete proposals. By pointing to the poor condition of public health agencies; urging a transition to an intersectoral public health system; promoting the adoption of bold changes in U.S. physical, social, and economic conditions; and endorsing a values shift to a commitment to collective interest in healthier communities, we hope to take a dramatic step toward achieving these aspirations for "healthy people in healthy communities."