Tolerating Ethical Ambiguity and Social Work Education

Undergraduate Theoretica

The Social Patterning in a Multi-ethnic Population: Associations of Socioeconomic Position, Neighborhood Characteristics and Psychosocial Stressors with Sleep.

Although sleep is instrumental for health and well-being, the vast majority of adults have sleep problems at least a few nights a week or more. Poor sleep is associated with a host of chronic diseases that disproportionately affect minority populations. Evidence indicates minority populations have poorer sleep than non-Hispanic whites. Recent research suggests that socioeconomic position (SEP) neighborhood characteristics and psychosocial stressors may be novel risk factors for sleep outcomes worthy of further exploration, particularly among minority populations where research is lacking. This dissertation uses data from the Stroke Health and Risk Education (SHARE) Project and the Jackson Heart Study (JHS) to investigate the cross-sectional associations of SEP, neighborhood characteristics and psychosocial stressors with sleep outcomes (duration, sleepiness, quality) in Hispanic and African Americans. Multinomial logistic and linear regression models were used to examine the associations of each exposure with sleep duration (short vs. normal, long vs. normal, and continuous sleep duration) and sleep quality after adjustment for demographics, SEP, and risk factors. In the first analysis, we investigated associations between neighborhood characteristics (safety, disadvantage, crime) and sleep (duration and daytime sleepiness) among participants in the SHARE project, a predominantly Hispanic American population. Lower neighborhood safety was associated with a higher daytime sleepiness score after adjustment for confounders. The second analysis using JHS data investigated associations between SEP (education and income), neighborhood characteristics (social cohesion, violence, problems, disadvantage) and sleep (duration and quality) in a population of African Americans. Low individual SEP was associated with long sleep and poor sleep quality; and adverse neighborhood characteristics were associated with longer average sleep duration and poor sleep quality after adjustment for confounders. Lastly, we investigated the associations of psychosocial stressors with sleep (duration, quality) using data from the JHS. Higher levels of psychosocial stressors were associated with short sleep, shorter average sleep duration and poorer sleep quality after adjustment for confounders. The findings of this dissertation improve our understanding of the factors contributing to poor sleep among understudied racial/ethnic groups. Future studies should further examine these associations of SEP, adverse neighborhoods and psychosocial stressors and poor sleep using prospective cohort data.PhDEpidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/111512/1/daynaa_1.pd

Sharing the vision:representing the matters of concern for design-led fledgling companies in Scotland

Design is being performed on an ever-increasing spectrum of complex practices arising in response to emerging markets and technologies, co-design, digital interaction, service design and cultures of innovation. This emerging notion of design has led to an expansive array of collaborative and facilitation skills to demonstrate and share how such methods can shape innovation. The meaning of these design things in practice can't be taken for granted as matters of fact, which raises a key challenge for design to represent its role through the contradictory nature of matters of concern. This paper explores an innovative, object-oriented approach within the field of design research, visually combining an actor-network theory framework with situational analysis, to report on the role of design for fledgling companies in Scotland, established and funded through the knowledge exchange hub Design in Action (DiA). Key findings and visual maps are presented from reflective discussions with actors from a selection of the businesses within DiA's portfolio. The suggestion is that any notions of strategic value, of engendering meaningful change, of sharing the vision of design, through design things, should be grounded in the reflexive interpretations of matters of concern that emerge

Exploring the impact of elevated depressive symptoms on the ability of a tailored asthma intervention to improve medication adherence among urban adolescents with asthma

BACKGROUND: In patients with asthma, medication adherence is a voluntary behavior that can be affected by numerous factors. Depression is an important co-morbidity in adolescents with asthma that may significantly impact their controller medication adherence and other asthma-related outcomes. The modifying effect of depressive symptoms on an asthma intervention’s ability to improve asthma controller medication adherence among urban adolescents with asthma has not yet been reported. OBJECTIVE: To assess self-reported symptoms of depression as an effect modifier of the relationship between randomization group and controller medication adherence at 6-month follow-up. METHODS: These analyses use data from a randomized controlled trial (RCT) conducted in Detroit high schools to evaluate a tailored asthma management program. The intervention included referrals to school or community resources for students reporting symptoms of depression and other issues. “Elevated depressive symptoms” was defined as a positive answer to ≥ 5 of 7 questions from a validated tool included on the baseline questionnaire. Self-reported adherence to controller medication was collected at intervention onset (session 1) and at 6-month follow up. Analyses were restricted to students with report of a controller medication at baseline. Logistic regression was used to assess elevated depressive symptoms as an effect modifier of the relationship between randomization group and 6-month adherence. RESULTS: Of the 422 students enrolled in the RCT, a controller medication was reported at intervention onset by n = 123 adolescents (29%). Analyzing this group, we observed an interaction between elevated depressive symptoms and adherence (p = 0.073). Stratified analysis showed better adherence in treatment group adolescents meeting criteria for elevated depressive symptoms at baseline as compared to the control group (adjusted Odds Ratio [aOR] = 9.50; p = 0.024). For adolescents without elevated depressive symptoms at baseline, differences in adherence by group assignment did not reach statistical significance (aOR 1.40, p = 0.49). CONCLUSIONS: In this sample of students reporting controller medications at baseline, report of elevated depressive symptoms at baseline and randomization to the intervention group was associated with significantly better adherence at 6-month follow up when compared to that of a control group. Larger studies are needed to evaluate the impact of depression on the relationship between adherence and asthma intervention effectiveness

Influence of neighbourhood‐level crowding on sleep‐disordered breathing severity: mediation by body size

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113768/1/jsr12305.pd

Exploring the opportunities for UK games businesses in China:a case study of two industry-led mobile game prototypes

This case study of game development R&amp;D brought together researchers, developers, and industrial partners to explore co-production of experimental games for UK-China markets. Postgraduate teams comprising British, Chinese and international developers were tasked with responding to industry-led challenges related to UK-China games industry interests. The case study examines issues such as bringing British IP to China, how social play is managed in the Chinese market, and cross cultural representation both within game products and within development teams.The final work comprises two original game prototypes that serve as pathfinders for UK games businesses with interests in the Chinese games market, and a final project video documenting the experiences of industry, academic, and developer experience on the project.<br/

Sexual orientation identity disparities in health behaviors, outcomes, and services use among men and women in the United States: a cross-sectional study

Background: Research shows that sexual minorities (e.g., lesbian, gay, and bisexual individuals) experience higher levels of discrimination, stigma, and stress and are at higher risk of some poor health outcomes and health behaviors compared to their heterosexual counterparts. However, the majority of studies have examined sexual orientation disparities in a narrow range of health outcomes and behaviors using convenience samples comprised of either men or women living in restricted geographic areas. Methods: To investigate the relationship between sexual orientation identity and health among U.S. women and men, we used Poisson regression with robust variance to estimate prevalence ratios for health behaviors, outcomes, and services use comparing sexual minorities to heterosexual individuals using 2013 and 2014 National Health Interview Survey data (N = 69,270). Results: Three percent of the sample identified as sexual minorities. Compared to heterosexual women, lesbian (prevalence ratio (PR) = 1.65 [95 % confidence interval (CI): 1.14, 2.37]) and bisexual (PR = 2.16 [1.46, 3.18]) women were more likely to report heavy drinking. Lesbians had a higher prevalence of obesity (PR = 1.20 [1.02, 1.42]), stroke (PR = 1.96 [1.14, 3.39]), and functional limitation (PR = 1.17 [1.02, 1.34] than heterosexual women. Gay men were more likely to have hypertension (PR = 1.21 [1.03, 1.43]) and heart disease (PR = 1.39 [1.02, 1.88]). Despite no difference in health insurance status, sexual minorities were more likely than heterosexual individuals to delay seeking healthcare because of cost; however, members of this group were also more likely to have received an HIV test and initiated HPV vaccination. Conclusion: Sexual minorities had a higher prevalence of some poor health behaviors and outcomes