Research on the effect of cardiorespiratory (CR) exercise on upper extremity (UE) limb volume is ... more Research on the effect of cardiorespiratory (CR) exercise on upper extremity (UE) limb volume is limited in women with breast cancer-related lymphedema (BCRL). The aim of this study was to compare changes in UE volume immediately following a symptom-limited CR treadmill test in women with and without BCRL. As part of a cross-sectional study, 133 women post unilateral BC treatment completed symptom-limited treadmill testing. Bioimpedance spectroscopy (BIS) was used to measure UE resistance before and immediately following treadmill testing. Resistance ratios >1 (unaffected side/affected side) indicate greater volume in the affected limb. T-tests and repeated measures ANOVA were performed to evaluate differences between and within groups. Mean age was 56.2 years (SD 9.4); BMI was 26.13 kg m(-2) (SD 5.04). For women with previously diagnosed BCRL (n = 63), the resistance ratio was 1.116 (SD 0.160) pre-treadmill and 1.108 (SD 0.155) post-treadmill. For women without BCRL (n = 70), the resistance ratio was 0.990 (SD 0.041) pre-treadmill and 1.001 (SD 0.044) post-treadmill. Resistance ratios for women with BCRL were higher than those for women without BCRL at both time points (main effect of group: p < 0.001). No main effects were found for time (p = 0.695). A statistically significant effect was found for the time-by-group interaction (p = 0.002). 78% of the women with BCRL wore a compression garment during testing. Following testing, the women with BCRL demonstrated a non-statistically significant decrease in the resistance ratio, suggesting an immediate decrease in interlimb volume difference. The women without BCRL demonstrated an increase in the resistance ratio.
International Journal of Migration, Health and Social Care, 2013
ABSTRACT Purpose – Canadian HIV/AIDS researchers, service providers and policy-makers are faced w... more ABSTRACT Purpose – Canadian HIV/AIDS researchers, service providers and policy-makers are faced with new challenges of providing effective and inclusive care that meets the needs of the changing populations infected with and affected by HIV. Since 2005 immigrants and refugees from ethno-racial minority communities have comprised close to 20 percent of all new HIV infections in Canada. Anecdotes shared by PLWHAs and service providers indicated that mental health challenges faced by newcomer PLWHAs was a priority concern for HIV prevention, treatment and care. This paper reports on the results of an exploratory study, which examined the complex factors that influence the mental health of immigrants and refugees living with HIV/AIDS (IR-PLWHAs). Design/methodology/approach – This exploratory study is informed by a critical social science paradigm, which acknowledges that the everyday reality is shaped by interlocking systems of social processes and unequal power relations. The paper used a qualitative interpretative design and focus groups to explore the intersecting effects of living with HIV/AIDS, migration and settlement, and HIV stigma and discrimination on the mental health of IR-PLWHAs. Findings – The paper found that in addition to social and economic marginalization, IR-PLWHAs experienced multiple stressors associated with their HIV status: neurocognitive and physical impairments, HIV stigma and discrimination, and fear of deportation. The paper also found that the experiences of stigma and discrimination among IR-PLWHAs were complex and contextual, closely linked to their social positions defined by the intersecting dimensions of race, class, gender, citizenship, sexualities, body norms, and HIV status. The paper concludes that effective HIV prevention, treatment and care, and mental health promotion in newcomer and ethno-racial minority communities must consider the bio-psycho-social connections of different stressors and the interlocking systems of oppression faced by IR-PLWHAs. Research limitations/implications – This study was exploratory in nature with a small number of participants who were recruited through AIDS organizations in Toronto. Consequently, the recruitment strategy may reach only those who were connected to the AIDS organizations. The paper believes that IR-PLWHAs who were not connected to the AIDS organizations might experience even more social exclusion and marginalization. These factors may limit the transferability of this study. Originality/value – This is the first study that explores the bio-psycho-social connections and intersecting determinants of mental health among immigrants and refugees living with HIV and AIDS in Canada. The results of this study contribute to cross-sector dialogue among practitioners and researchers in the HIV/AIDS, mental health, and immigration and settlement services sectors.
Background Although a significant volume of nursing research has focused on students’ experience... more Background Although a significant volume of nursing research has focused on students’ experiences of clinical placements, to date, none has considered these experiences in the context of workforce recruitment and specifically how they may impact upon preferences for working for health care providers.Methods In this context, the research used a place-sensitive geographical perspective and a combined questionnaire (n = 650), interview (n = 30) and focus group (n = 7) method to collect data on the complex range of clinical experiences which together impact upon the perceived attractiveness of different health care settings.Findings The data identified a range of experiential factors associated with mentorship, ward management, learning opportunities and racism. An important finding was that although students’ experiences are obtained at the micro ward level, even if they may not necessarily reflect what happens throughout the hospital, they potentially impact, both positively and negatively, upon their broader perceptions of the hospital and the likelihood of seeking work there.Implications The study highlighted a variety of issues that should be addressed by both higher education institutions and hospitals so that they may be able to provide a more consistent and positive experience for students. In the longer term, this may pay dividends through increased recruitment of new graduates.
During the past decade, a distinct body of research has started to investigate the dynamics betwe... more During the past decade, a distinct body of research has started to investigate the dynamics between nursing and place. However, despite attention being paid to a wide-range of nursing subjects, few studies have engaged with the important topic of labour force recruitment. In this context, this study uses a combined questionnaire (n=650n=650), interview (n=30n=30) and focus group (n=7n=7) survey of London-based students, and investigates the complex mix of experiences and perceptions that result in hospitals having varying degrees of popularity as potential workplaces. The findings suggest experiences and perceptions of institutions—often gained on clinical placements—to be important, particularly relating to feeling valued, the quality of patient care, clinical and educational opportunities and team cohesion. These are often combined with experiences and perceptions of locality, relating to factors such as cost of living, travel considerations and sense of personnel safety. The study demonstrates that place is relevant to employment decision-making on multiple scales from wards to regions. Furthermore, that perceptions of potential workplaces result from engagements with complex mixes of cultural, economic and physical features, many of which are the consequences of management. It is argued that in order to effectively unpack workplaces, geographical research of nursing labour may benefit from researching simultaneously both ‘inside’ institutions, focusing on their dominant cultures of production and sub-cultures, and ‘outside’, focusing on their local urban or rural contexts.
During the past decade, a distinct body of research has started to investigate the dynamics betwe... more During the past decade, a distinct body of research has started to investigate the dynamics between nursing and place. However, despite attention being paid to a wide-range of nursing subjects, few studies have engaged with the important topic of labour force recruitment. In this context, this study uses a combined questionnaire (n=650), interview (n=30) and focus group (n=7) survey of London-based students, and investigates the complex mix of experiences and perceptions that result in hospitals having varying degrees of popularity as potential workplaces. The findings suggest experiences and perceptions of institutions-often gained on clinical placements-to be important, particularly relating to feeling valued, the quality of patient care, clinical and educational opportunities and team cohesion. These are often combined with experiences and perceptions of locality, relating to factors such as cost of living, travel considerations and sense of personnel safety. The study demonstrates that place is relevant to employment decision-making on multiple scales from wards to regions. Furthermore, that perceptions of potential workplaces result from engagements with complex mixes of cultural, economic and physical features, many of which are the consequences of management. It is argued that in order to effectively unpack workplaces, geographical research of nursing labour may benefit from researching simultaneously both 'inside' institutions, focusing on their dominant cultures of production and sub-cultures, and 'outside', focusing on their local urban or rural contexts.
This is a prospective study examining decision-making abilities in Chinese schizophrenia patients... more This is a prospective study examining decision-making abilities in Chinese schizophrenia patients in Hong Kong. We interviewed patients before their discharge from hospital after a psychotic relapse, examining their decision regarding whether or not they would take maintenance neuroleptic treatment. Decision-making abilities were assessed by the MacArthur Competence Assessment Tool-Treatment, a semistructured questionnaire. We examined their relationships with demographic, clinical, and cognitive variables, measured by standardized instruments. Eighty-one participants were seen. Weaknesses were noted in a range of relevant decision-making abilities. Positive and negative schizophrenic symptoms, specifically lack of judgment and insight, difficulty in abstract thinking, unusual thought content, and conceptual disorganization, were found to be correlated with performance in decision-making abilities, as were cognitive deficits. Verbal working memory was a moderate predictor of the ability to understand treatment information. Decision-making impairments and negative treatment attitude were related to the decision not to adhere to medication.
Research evidence suggests that clinical placements are important to both the perceptions and out... more Research evidence suggests that clinical placements are important to both the perceptions and outcomes of nurse education. Nevertheless, despite this knowledge, research also indicates that many students receive negative experiences whilst attending these ‘remote’ settings, sometimes resulting in missed opportunities for learning and negative impressions of potential places of employment.In this context, this study investigates the experiences and perceptions of students relating to their clinical placements and, in particular, their views on professional structuring. Specifically it addresses the roles of, and communications between, the key academics, clinical professionals and institutions responsible for their organization.Focus group discussions with students (n=7) and an interview survey of ex-students (n=30) each from two British universities in Southeast England.The research highlights the diverse experiences that student receive on clinical placements, as well as their own suggestions for improvements. Student informed models of worst, minimum, current and best practice are then presented, as well as a cross-setting evaluation feedback model. These highlight responsibilities and communications across health professionals and educational sites. The models include an emphasis on the roles of ward managers, mentors, link tutors and more generally on shared but clearly delineated institutional responsibility for quality assurance mechanisms. They offer the opportunity to improve educational practice in clinically-based education and concurrently to improve student experiences and outcomes.Clinical placements are designed to provide practical learning through a ‘slice of practice life’. However, it is necessary to maximize this learning experience. Placements certainly need not be the worst slice.
In recent years we have witnessed an increase in Asian men who use gay Internet chatrooms in Toro... more In recent years we have witnessed an increase in Asian men who use gay Internet chatrooms in Toronto. Previous research has shown that many men who had sex with men (MSM) sought sex partners through the Internet and that meeting sex partners via the Internet increases sexually transmitted infection (STI) and HIV risk. This study aims to (1) explore psychosocial issues relating to Asian men who use gay chatrooms and (2) identify culturally appropriate HIV prevention strategies for this population. In-depth interviews were conducted with a total of 21 East and Southeast Asian men who used Internet gay chatrooms. Unstructured, open-ended questions were used to obtain narrative data to help understand their lived, psychosocial experiences of gay chatrooms. Transcripts of the interviews were read to highlight themes and concepts. Analysis revealed complex lived, psychosocial experiences of Asian men who use gay chatrooms in Toronto. They tended to be socially isolated and highly marginalized, which had led to intense needs for social connections and thus left some Asian men vulnerable to sexual exploitation. Although they were fully aware that they should use condoms in anal intercourse with a casual partner, they had some misconceptions about HIV. Moreover, they rarely, if ever, used condoms in oral sex with a casual partner, which might leave them vulnerable to STI. It is important for service providers to continually provide accurate information about STIs and HIV/AIDS including how they can be contracted. However, HIV prevention strategies for this population must also address issues relating to social isolation and marginalization in order to combat the spread of HIV/AIDS effectively. This can be accomplished by an online peer support program.
Homophobia and heterosexism are ubiquitous in Canadian society. They contribute to significant he... more Homophobia and heterosexism are ubiquitous in Canadian society. They contribute to significant health and mental health disparities for lesbian, gay and bisexual youth and their families. Anti-homophobia efforts tend to focus on students and teachers at school. While these efforts are important, they do not reach parents, who play an important role in shaping young people's attitudes towards gender and sexuality. To eliminate bullying and victimisation associated with homophobia at school and in the community, concerted efforts are urgently needed to mobilise parents to become champions against homophobia and heterosexism. In this paper, we report on our use of storytelling and critical dialogue to engage a group of Hong Kong Chinese immigrant parents in Toronto to interrogate their values and assumptions about homosexuality. In particular, we illustrate how we use storytelling to create a liminal space whereby the narrators and listeners collaborate to create counter-discourses that challenge social domination and exclusion. We then discuss the implications of using a critical dialogical approach to integrate anti-homophobia efforts in community parenting programmes.
Research on the effect of cardiorespiratory (CR) exercise on upper extremity (UE) limb volume is ... more Research on the effect of cardiorespiratory (CR) exercise on upper extremity (UE) limb volume is limited in women with breast cancer-related lymphedema (BCRL). The aim of this study was to compare changes in UE volume immediately following a symptom-limited CR treadmill test in women with and without BCRL. As part of a cross-sectional study, 133 women post unilateral BC treatment completed symptom-limited treadmill testing. Bioimpedance spectroscopy (BIS) was used to measure UE resistance before and immediately following treadmill testing. Resistance ratios >1 (unaffected side/affected side) indicate greater volume in the affected limb. T-tests and repeated measures ANOVA were performed to evaluate differences between and within groups. Mean age was 56.2 years (SD 9.4); BMI was 26.13 kg m(-2) (SD 5.04). For women with previously diagnosed BCRL (n = 63), the resistance ratio was 1.116 (SD 0.160) pre-treadmill and 1.108 (SD 0.155) post-treadmill. For women without BCRL (n = 70), the resistance ratio was 0.990 (SD 0.041) pre-treadmill and 1.001 (SD 0.044) post-treadmill. Resistance ratios for women with BCRL were higher than those for women without BCRL at both time points (main effect of group: p < 0.001). No main effects were found for time (p = 0.695). A statistically significant effect was found for the time-by-group interaction (p = 0.002). 78% of the women with BCRL wore a compression garment during testing. Following testing, the women with BCRL demonstrated a non-statistically significant decrease in the resistance ratio, suggesting an immediate decrease in interlimb volume difference. The women without BCRL demonstrated an increase in the resistance ratio.
International Journal of Migration, Health and Social Care, 2013
ABSTRACT Purpose – Canadian HIV/AIDS researchers, service providers and policy-makers are faced w... more ABSTRACT Purpose – Canadian HIV/AIDS researchers, service providers and policy-makers are faced with new challenges of providing effective and inclusive care that meets the needs of the changing populations infected with and affected by HIV. Since 2005 immigrants and refugees from ethno-racial minority communities have comprised close to 20 percent of all new HIV infections in Canada. Anecdotes shared by PLWHAs and service providers indicated that mental health challenges faced by newcomer PLWHAs was a priority concern for HIV prevention, treatment and care. This paper reports on the results of an exploratory study, which examined the complex factors that influence the mental health of immigrants and refugees living with HIV/AIDS (IR-PLWHAs). Design/methodology/approach – This exploratory study is informed by a critical social science paradigm, which acknowledges that the everyday reality is shaped by interlocking systems of social processes and unequal power relations. The paper used a qualitative interpretative design and focus groups to explore the intersecting effects of living with HIV/AIDS, migration and settlement, and HIV stigma and discrimination on the mental health of IR-PLWHAs. Findings – The paper found that in addition to social and economic marginalization, IR-PLWHAs experienced multiple stressors associated with their HIV status: neurocognitive and physical impairments, HIV stigma and discrimination, and fear of deportation. The paper also found that the experiences of stigma and discrimination among IR-PLWHAs were complex and contextual, closely linked to their social positions defined by the intersecting dimensions of race, class, gender, citizenship, sexualities, body norms, and HIV status. The paper concludes that effective HIV prevention, treatment and care, and mental health promotion in newcomer and ethno-racial minority communities must consider the bio-psycho-social connections of different stressors and the interlocking systems of oppression faced by IR-PLWHAs. Research limitations/implications – This study was exploratory in nature with a small number of participants who were recruited through AIDS organizations in Toronto. Consequently, the recruitment strategy may reach only those who were connected to the AIDS organizations. The paper believes that IR-PLWHAs who were not connected to the AIDS organizations might experience even more social exclusion and marginalization. These factors may limit the transferability of this study. Originality/value – This is the first study that explores the bio-psycho-social connections and intersecting determinants of mental health among immigrants and refugees living with HIV and AIDS in Canada. The results of this study contribute to cross-sector dialogue among practitioners and researchers in the HIV/AIDS, mental health, and immigration and settlement services sectors.
Background Although a significant volume of nursing research has focused on students’ experience... more Background Although a significant volume of nursing research has focused on students’ experiences of clinical placements, to date, none has considered these experiences in the context of workforce recruitment and specifically how they may impact upon preferences for working for health care providers.Methods In this context, the research used a place-sensitive geographical perspective and a combined questionnaire (n = 650), interview (n = 30) and focus group (n = 7) method to collect data on the complex range of clinical experiences which together impact upon the perceived attractiveness of different health care settings.Findings The data identified a range of experiential factors associated with mentorship, ward management, learning opportunities and racism. An important finding was that although students’ experiences are obtained at the micro ward level, even if they may not necessarily reflect what happens throughout the hospital, they potentially impact, both positively and negatively, upon their broader perceptions of the hospital and the likelihood of seeking work there.Implications The study highlighted a variety of issues that should be addressed by both higher education institutions and hospitals so that they may be able to provide a more consistent and positive experience for students. In the longer term, this may pay dividends through increased recruitment of new graduates.
During the past decade, a distinct body of research has started to investigate the dynamics betwe... more During the past decade, a distinct body of research has started to investigate the dynamics between nursing and place. However, despite attention being paid to a wide-range of nursing subjects, few studies have engaged with the important topic of labour force recruitment. In this context, this study uses a combined questionnaire (n=650n=650), interview (n=30n=30) and focus group (n=7n=7) survey of London-based students, and investigates the complex mix of experiences and perceptions that result in hospitals having varying degrees of popularity as potential workplaces. The findings suggest experiences and perceptions of institutions—often gained on clinical placements—to be important, particularly relating to feeling valued, the quality of patient care, clinical and educational opportunities and team cohesion. These are often combined with experiences and perceptions of locality, relating to factors such as cost of living, travel considerations and sense of personnel safety. The study demonstrates that place is relevant to employment decision-making on multiple scales from wards to regions. Furthermore, that perceptions of potential workplaces result from engagements with complex mixes of cultural, economic and physical features, many of which are the consequences of management. It is argued that in order to effectively unpack workplaces, geographical research of nursing labour may benefit from researching simultaneously both ‘inside’ institutions, focusing on their dominant cultures of production and sub-cultures, and ‘outside’, focusing on their local urban or rural contexts.
During the past decade, a distinct body of research has started to investigate the dynamics betwe... more During the past decade, a distinct body of research has started to investigate the dynamics between nursing and place. However, despite attention being paid to a wide-range of nursing subjects, few studies have engaged with the important topic of labour force recruitment. In this context, this study uses a combined questionnaire (n=650), interview (n=30) and focus group (n=7) survey of London-based students, and investigates the complex mix of experiences and perceptions that result in hospitals having varying degrees of popularity as potential workplaces. The findings suggest experiences and perceptions of institutions-often gained on clinical placements-to be important, particularly relating to feeling valued, the quality of patient care, clinical and educational opportunities and team cohesion. These are often combined with experiences and perceptions of locality, relating to factors such as cost of living, travel considerations and sense of personnel safety. The study demonstrates that place is relevant to employment decision-making on multiple scales from wards to regions. Furthermore, that perceptions of potential workplaces result from engagements with complex mixes of cultural, economic and physical features, many of which are the consequences of management. It is argued that in order to effectively unpack workplaces, geographical research of nursing labour may benefit from researching simultaneously both 'inside' institutions, focusing on their dominant cultures of production and sub-cultures, and 'outside', focusing on their local urban or rural contexts.
This is a prospective study examining decision-making abilities in Chinese schizophrenia patients... more This is a prospective study examining decision-making abilities in Chinese schizophrenia patients in Hong Kong. We interviewed patients before their discharge from hospital after a psychotic relapse, examining their decision regarding whether or not they would take maintenance neuroleptic treatment. Decision-making abilities were assessed by the MacArthur Competence Assessment Tool-Treatment, a semistructured questionnaire. We examined their relationships with demographic, clinical, and cognitive variables, measured by standardized instruments. Eighty-one participants were seen. Weaknesses were noted in a range of relevant decision-making abilities. Positive and negative schizophrenic symptoms, specifically lack of judgment and insight, difficulty in abstract thinking, unusual thought content, and conceptual disorganization, were found to be correlated with performance in decision-making abilities, as were cognitive deficits. Verbal working memory was a moderate predictor of the ability to understand treatment information. Decision-making impairments and negative treatment attitude were related to the decision not to adhere to medication.
Research evidence suggests that clinical placements are important to both the perceptions and out... more Research evidence suggests that clinical placements are important to both the perceptions and outcomes of nurse education. Nevertheless, despite this knowledge, research also indicates that many students receive negative experiences whilst attending these ‘remote’ settings, sometimes resulting in missed opportunities for learning and negative impressions of potential places of employment.In this context, this study investigates the experiences and perceptions of students relating to their clinical placements and, in particular, their views on professional structuring. Specifically it addresses the roles of, and communications between, the key academics, clinical professionals and institutions responsible for their organization.Focus group discussions with students (n=7) and an interview survey of ex-students (n=30) each from two British universities in Southeast England.The research highlights the diverse experiences that student receive on clinical placements, as well as their own suggestions for improvements. Student informed models of worst, minimum, current and best practice are then presented, as well as a cross-setting evaluation feedback model. These highlight responsibilities and communications across health professionals and educational sites. The models include an emphasis on the roles of ward managers, mentors, link tutors and more generally on shared but clearly delineated institutional responsibility for quality assurance mechanisms. They offer the opportunity to improve educational practice in clinically-based education and concurrently to improve student experiences and outcomes.Clinical placements are designed to provide practical learning through a ‘slice of practice life’. However, it is necessary to maximize this learning experience. Placements certainly need not be the worst slice.
In recent years we have witnessed an increase in Asian men who use gay Internet chatrooms in Toro... more In recent years we have witnessed an increase in Asian men who use gay Internet chatrooms in Toronto. Previous research has shown that many men who had sex with men (MSM) sought sex partners through the Internet and that meeting sex partners via the Internet increases sexually transmitted infection (STI) and HIV risk. This study aims to (1) explore psychosocial issues relating to Asian men who use gay chatrooms and (2) identify culturally appropriate HIV prevention strategies for this population. In-depth interviews were conducted with a total of 21 East and Southeast Asian men who used Internet gay chatrooms. Unstructured, open-ended questions were used to obtain narrative data to help understand their lived, psychosocial experiences of gay chatrooms. Transcripts of the interviews were read to highlight themes and concepts. Analysis revealed complex lived, psychosocial experiences of Asian men who use gay chatrooms in Toronto. They tended to be socially isolated and highly marginalized, which had led to intense needs for social connections and thus left some Asian men vulnerable to sexual exploitation. Although they were fully aware that they should use condoms in anal intercourse with a casual partner, they had some misconceptions about HIV. Moreover, they rarely, if ever, used condoms in oral sex with a casual partner, which might leave them vulnerable to STI. It is important for service providers to continually provide accurate information about STIs and HIV/AIDS including how they can be contracted. However, HIV prevention strategies for this population must also address issues relating to social isolation and marginalization in order to combat the spread of HIV/AIDS effectively. This can be accomplished by an online peer support program.
Homophobia and heterosexism are ubiquitous in Canadian society. They contribute to significant he... more Homophobia and heterosexism are ubiquitous in Canadian society. They contribute to significant health and mental health disparities for lesbian, gay and bisexual youth and their families. Anti-homophobia efforts tend to focus on students and teachers at school. While these efforts are important, they do not reach parents, who play an important role in shaping young people's attitudes towards gender and sexuality. To eliminate bullying and victimisation associated with homophobia at school and in the community, concerted efforts are urgently needed to mobilise parents to become champions against homophobia and heterosexism. In this paper, we report on our use of storytelling and critical dialogue to engage a group of Hong Kong Chinese immigrant parents in Toronto to interrogate their values and assumptions about homosexuality. In particular, we illustrate how we use storytelling to create a liminal space whereby the narrators and listeners collaborate to create counter-discourses that challenge social domination and exclusion. We then discuss the implications of using a critical dialogical approach to integrate anti-homophobia efforts in community parenting programmes.
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Papers by Josephine Wong