In her research with transnational Mexicans, Deborah A. Boehm has often asked individuals: if there were no barriers to your movement between Mexico and the United States, where would you choose to ...live? Almost always, they desire the freedom to come and go. Yet the barriers preventing such movement are many. Because of the United States' rigid immigration policies, Mexican immigrants often find themselves living long distances from family members and unable to easily cross the U.S.-Mexico border. Transnational Mexicans experience what Boehm calls intimate migrations, flows that both shape and are structured by gendered and familial actions and interactions, but are always defined by the presence of the U.S. state. Intimate Migrations is based on over a decade of ethnographic research, focusing on Mexican immigrants with ties to a small, rural community in the Mexican state of San Luis Potosi and several states in the U.S. West. By showing how intimate relations direct migration, and by looking at kin and gender relationships through the lens of illegality, Boehm sheds new light on the study of gender and kinship, as well as understandings of the state and transnational migration.
Returned Boehm, Deborah A
2016., 20160510, 2016, 2016-05-10, Letnik:
39
eBook
Returned follows transnational Mexicans as they experience the alienation and unpredictability of deportation, tracing the particular ways that U.S. immigration policies and state removals affect ...families. Deportation—an emergent global order of social injustice—reaches far beyond the individual deportee, as family members with diverse U.S. immigration statuses, including U.S. citizens, also return after deportation or migrate for the first time. The book includes accounts of displacement, struggle, suffering, and profound loss but also of resilience, flexibility, and imaginings of what may come. Returned tells the story of the chaos, and design, of deportation and its aftermath.
Purpose The purpose of this study was to develop and validate a new comprehensive patient-reported measure of treatment burden—the Patient Experience with Treatment and Self-management (PETS). ...Methods A conceptual framework was used to derive the PETS with items reviewed and cognitively tested with patients. A survey battery, including a pilot version of the PETS, was mailed to 838 multi-morbid patients from two healthcare institutions for validation. Results A total of 332 multi-morbid patients returned completed surveys. Diagnostics supported deletion and consolidation of some items and domains. Confirmatory factor analysis supported a domain model for scaling comprised of 9 factors: medical information, medications, medical appointments, monitoring health, interpersonal challenges, medical/healthcare expenses, difficulty with healthcare services, role/social activity limitations, and physical/mental exhaustion. Scales showed good internal consistency (α range 0.79-0.95). Higher PETS scores, indicative of greater treatment burden, were correlated with more distress, less satisfaction with medications, lower self-efficacy, worse physical and mental health, and lower convenience of healthcare (Ps < 0.001). Patients with lower health literacy, less adherence to medications, and more financial difficulties reported higher PETS scores (Ps < 0.01). Conclusion A comprehensive patient-reported measure of treatment burden can help to better characterize the impact of treatment and self-management burden on patient well-being and guide care toward minimally disruptive medicine.
For antidepressants, the translation of evidence of comparative effectiveness into practice is suboptimal. This deficit directly affects outcomes and quality of care for patients with depression. To ...overcome this problem, we developed the Depression Medication Choice (DMC) encounter decision aid, designed to help patients and clinicians consider the available antidepressants and the extent to which they improved depression and other issues important to patients.
Estimate the effect of DMC on quality of the decision-making process and depression outcomes.
We conducted a cluster randomized trial of adults with moderate to severe depression considering treatment with an antidepressant. Primary care practices in 10 rural, suburban, and urban primary care practices across Minnesota and Wisconsin were randomly allocated to treatment of depression with or without use of the DMC decision aid.
Depression Medication Choice, a series of cards, each highlighting the effect of the available options on an issue of importance to patients for use during face-to-face consultations.
Decision-making quality as judged by patient knowledge and involvement in decision making, patient and clinician decisional comfort (Decisional Conflict Scale) and satisfaction, encounter duration, medication adherence, depression symptoms, and the Patient Health Questionnaire for depression (PHQ-9).
We enrolled 117 clinicians and 301 patients (67% women; mean SD age, 44 15 years; mean SD PHQ-9 score, 15 4) into the trial. Compared with usual care (UC), use of DMC significantly improved patients' decisional comfort (DMC, 80% vs UC, 75%; P = .02), knowledge (DMC, 65% vs UC, 56%; P = .03), satisfaction (risk ratio RR, from 1.25 P = .81 to RR, 2.4 P = .002 depending on satisfaction domain), and involvement (DMC, 47% vs UC, 33%; P<.001). It also improved clinicians' decisional comfort (DMC, 80% vs UC, 68%; P < .001) and satisfaction (RR, 1.64; P = .02). There were no differences in encounter duration, medication adherence, or improvement of depression control between arms.
The DMC decision aid helped primary care clinicians and patients with moderate to severe depression select antidepressants together, improving the decision-making process without extending the visit. On the other hand, DMC had no discernible effect on medication adherence or depression outcomes. By translating comparative effectiveness into patient-centered care, use of DMC improved the quality of primary care for patients with depression.
clinicaltrials.gov Identifier: NCT01502891.
Interruptions Disrupt Reading Comprehension Foroughi, Cyrus K.; Werner, Nicole E.; Barragán, Daniela ...
Journal of experimental psychology. General,
06/2015, Letnik:
144, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Previous research suggests that being interrupted while reading a text does not disrupt the later recognition or recall of information from that text. This research is used as support for Ericsson ...and Kintsch's (1995) long-term working memory (LT-WM) theory, which posits that disruptions while reading (e.g., interruptions) do not impair subsequent text comprehension. However, to fully comprehend a text, individuals may need to do more than recognize or recall information that has been presented in the text at a later time. Reading comprehension often requires individuals to connect and synthesize information across a text (e.g., successfully identifying complex topics such as themes and tones) and not just make a familiarity-based decision (i.e., recognition). The goal for this study was to determine whether interruptions while reading disrupt reading comprehension when the questions assessing comprehension require participants to connect and synthesize information across the passage. In Experiment 1, interruptions disrupted reading comprehension. In Experiment 2, interruptions disrupted reading comprehension but not recognition of information from the text. In Experiment 3, the addition of a 15-s time-out prior to the interruption successfully removed these negative effects. These data suggest that the time it takes to process the information needed to successfully comprehend text when reading is greater than that required for recognition. Any interference (e.g., an interruption) that occurs during the comprehension process may disrupt reading comprehension. This evidence supports the need for transient activation of information in working memory for successful text comprehension and does not support LT-WM theory.
The time to resume task goals after an interruption varied depending on the duration and cognitive demand of interruptions, as predicted by the memory for goals model (
Altmann & Trafton, 2002
). ...Three experiments using an interleaved tasks interruption paradigm showed that longer and more demanding interruptions led to longer resumption times in a hierarchical, interactive task. The resumption time profile for durations up to 1 min supported the role of decay in defining resumption costs, and the interaction between duration and demand supported the importance of goal rehearsal in mitigating decay. These findings supported the memory for goals model, and had practical implications for context where tasks are frequently interleaved such as office settings, driving, emergency rooms, and aircraft cockpits.
Transnational children-ranging from infants to teenagers-reside in, and migrate to and from, both Mexico and the United States. This paper considers this understudied population, the youngest members ...of Mexican migrant communities, to understand shifting configurations of kinship in a transnational space. By focusing on transnational families with ties to San Luis Potosí and several locales in the U.S. Southwest, I study the everyday experiences of Mexican migrants to demonstrate the presence and power of the U.S. state in family life. This paper examines a dilemma in transnational lives: a primary motivation for migration is to support and benefit children, and yet children are repeatedly in precarious or threatening situations precisely because of transnational movement, their own and that of their family members. The inclusion of children in the study of transnationality, I argue, nuances our understanding of the (re)production and (re)structuring of kinship. Moreover, a focus on children as embedded within families problematizes popular conceptions of migrants as solely autonomous agents, uncovering the multiple ways in which the actions of parents, children, and other family members are repeatedly shaped and constrained by state policies.
Scholars have suggested that migration from Mexico to the United States benefits women by challenging often rigid gender norms. The results of ethnographic field research in San Luis Potosí and New ...Mexico complicate this view. Here migration results in a complex interplay between males and females—a series of negotiations through which women exercise increased autonomy in some circumstances but also face the reassertion of male dominance and in which males reproduce patriarchal power even as they create new ways to express masculinity. This research problematizes previous understandings of the impact of migration on gender roles and underscores the need to make a gendered analysis central to theories of transnationalism and the study of (im)migration.
The workload of health care and its impact on patient functioning and well-being is known as treatment burden. The purpose of this study was to finalize a conceptual framework of treatment burden ...that will be used to inform a new patient-reported measure of this construct.
Semi-structured interviews were conducted with 50 chronically ill patients from a large academic medical center (n=32) and an urban safety-net hospital (n=18). We coded themes identifying treatment burden, with the themes harmonized through discussion between multiple coders. Four focus groups, each with five to eight participants with chronic illness, were subsequently held to confirm the thematic structure that emerged from the interviews.
Most interviewed patients (98%) were coping with multiple chronic conditions. A preliminary conceptual framework using data from the first 32 interviews was evaluated and was modified using narrative data from 18 additional interviews with a racially and socioeconomically diverse sample of patients. The final framework features three overarching themes with associated subthemes. These themes included: 1) work patients must do to care for their health (eg, taking medications, keeping medical appointments, monitoring health); 2) challenges/stressors that exacerbate perceived burden (eg, financial, interpersonal, provider obstacles); and 3) impacts of burden (eg, role limitations, mental exhaustion). All themes and subthemes were subsequently confirmed in focus groups.
The final conceptual framework can be used as a foundation for building a patient self-report measure to systematically study treatment burden for research and analytical purposes, as well as to promote meaningful clinic-based dialogue between patients and providers about the challenges inherent in maintaining complex self-management of health.
Having multiple chronic conditions (MCCs) can lead to appreciable treatment and self-management burden. Healthcare provider relational quality (HPRQ) - the communicative and interpersonal skill of ...the provider - may mitigate treatment burden and promote self-management. The objectives of this study were to 1) identify the associations between HPRQ, treatment burden, and psychosocial outcomes in adults with MCCs, and 2) determine if certain indicators of HPRQ are more strongly associated than others with these outcomes.
This is a cross-sectional survey study of 332 people with MCCs. Patients completed a 7-item measure of HPRQ and measures of treatment and self-management burden, chronic condition distress, self-efficacy, provider satisfaction, medication adherence, and physical and mental health. Associations between HPRQ, treatment burden, and psychosocial outcomes were determined using correlational analyses and independent samples
-tests, which were repeated in item-level analyses to explore which indicators of HPRQ were most strongly associated with the outcomes.
Most respondents (69%) were diagnosed with ≥3 chronic conditions. Better HPRQ was found to be associated with less treatment and self-management burden and better psychosocial outcomes (
<0.001), even after controlling for physical and mental health. Those reporting 100% adherence to prescribed medications had higher HPRQ scores than those reporting less than perfect adherence (
<0.001). HPRQ items showing the strongest associations with outcomes were "my healthcare provider spends enough time with me", "my healthcare provider listens carefully to me", and "I have trust in my healthcare provider".
Good communication and interpersonal skills of healthcare providers may lessen feelings of treatment burden and empower patients to feel confident in their self-management. Patient trust in the provider is an important element of HPRQ. Educating healthcare providers about the importance of interpersonal and relational skills could lead to more patient-centered care.
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