Judith Friedland

Coping and social support as determinants of quality of life in HIV/AIDS.

Coping, social support and quality of life (QOL) were examined in 120 HIV+ people (mean age = 37). The sample came from ambulatory clinics and drop-in centres in Toronto: 29% had AIDS, 35% were HIV symptomatic, and 35% were asymptomatic. Information was gathered from self-administered questionnaires. Respondents had good levels of social support and used a variety of coping strategies. Their scores on the behavioural and subjective measures of QOL were somewhat below average. The illness-related measure indicated that their diagnosis had an almost neutral effect on QOL and showed several areas where QOL had been positively affected. Data from male subjects only (n = 107) were analysed using a hierarchical block regression for each QOL measure. Income, emotional social support, and problem-oriented and perception-oriented coping were positively related to QOL. Tangible social support and emotion-oriented coping were negatively related and symptom severity was not related at all. Close friends provided most types of support. Although respondents indicated high levels of satisfaction with support generally, they expressed a need for more emotional support. Unemployment was high despite participants being relatively healthy and well-educated.

Mild traumatic brain injury from motor vehicle accidents: Factors associated with return to work

OBJECTIVES To describe return to work (RTW) for motor vehicle accident (MVA) survivors with mild traumatic brain injury (MTBI) and to examine relationships between RTW and injury severity, cognitive impairment, social interaction, discharge disposition, and sociodemographics. DESIGN Inception cohort assessed within 1 month of injury and at follow-up 6 to 9 months (mean = 7.4) after injury, for comparisons on outcome of RTW. SETTING Tertiary care center in Toronto (time 1); at home for follow-up. PARTICIPANTS Fifty patients with MTBI resulting from MVA who were consecutively admitted during a 20-month period ending April 1994. Thirteen of 63 eligible patients refused consent or were lost to follow-up. Mean age was 31; 62% were men. ELIGIBILITY CRITERIA (1) patients had been working; (2) they had no history of head injury, neurologic disease, or psychiatric illness requiring hospitalization; and (3) they had no catastrophic impairment from accident. MAIN OUTCOME MEASURE Return to work (at premorbid or modified level). RESULTS Of the 42% who returned to work, 12% resumed their premorbid level of employment and 30% returned to modified work. There were significant differences (p<.05) between the groups in level of social interaction, premorbid occupation, and discharge disposition. On one test of cognitive functioning the difference was at p = .06. CONCLUSION Social interaction, jobs with greater decision-making latitude, and discharge home were positively related to RTW for this population. Cognitive impairment within the first month was not a reliable indicator of RTW potential.

Function after motor vehicle accidents : A prospective study of mild head injury and posttraumatic stress

Relationships among mild traumatic brain injury (MTBI), posttraumatic stress (PTS), and function were examined in 99 motor vehicle accident (MVA) admissions: 64 in an MTBI group and 35 in a no-MTBI comparison group. Assessments occurred within the first month and at 6 to 9 months. At follow-up, the sample was moderately disabled on the Sickness Impact Profile (SIP), 71% satisfied on the Reintegration of Normal Living Index (RNL), and 42% had returned to work. Only the SIP Psychosocial score was significantly different for MTBI groups; 24% of the sample showed definite symptoms of PTS. This group was significantly more disabled on the SIP, less satisfied on the RNL, and less likely to return to work. The proportion of variance in outcome explained in each model ranged from 32% (Physical SIP) to 44% (RNL). Results suggest the need for clinicians to be more aware of the strong influence of PTS on functional outcomes.

Expanding the boundaries of occupational therapy practice through student fieldwork experiences: description of a provincially-funded community development project.

The numbers of occupational therapists in community practice are not yet large enough to provide fieldwork placements to accommodate all students. This article describes a project designed to educate community agencies that do not employ occupational therapists, about our service while at the same time securing new fieldwork placements. We used on-site different discipline and offsite same discipline supervision to provide students to selected agencies without cost. Funding for one year from the Ontario Ministry of Health to the Ontario University Programs in Rehabilitation Science enabled us to initiate and evaluate the project. Students in the project developed their ability to work independently and to see their potential role in health promotion and prevention. Despite the lack of ongoing government funding, four years later, community sites are not only being maintained, but the number of sites has increased from 28 to 39, providing a total of 75 student placements. By educating a growing number of community agencies about the work of occupational therapists, the project has also expanded the boundaries of practice.

DESCRIPTION AND VALIDATION OF A MEASURE OF RECEIVED SUPPORT SPECIFIC TO HIV

Validation data are described for the Social Support Inventory for People who are HIV Positive or Have AIDS. This inventory was developed specifically for use with individuals who are HIV-positive to assess three types of received support (instrumental, informational, emotional) for each of four dimensions: whether support is received or wanted, satisfaction with support, and source of the support. It was validated in the context of a larger cross-sectional study of 120 adults with HIV who completed a set of questionnaires. Descriptive statistics, internal consistency coefficients, and evidence of construct validity for the original inventory are presented. An improved, revised version based on the validation data for the original one is also briefly described, but not tested.

Why Crafts? Influences on the Development of Occupational Therapy in Canada from 1890 to 1930:

heMuriel Driver Award comes tome just one year beforemy formal retirement from academia and has given me a fine opportunity for reflection onmy own career and on our discipline of occupational therapy. The fact that most of my recent research has been historical has enabledme to address questions and ideas that I have grappled with over time. To be more accurate, it is probably the other way around; I have chosen to do historical research now because of these questions. Foremost among these questions is: “Why Crafts?” Crafts were there at the beginning and there are many settings and situations where they are still appropriate. Yet we prefer to dismiss them as an unfortunate part of our past. Indeed, it is as if we are ashamed of these occupations. When I was a student (many years ago!) we learned a lot of crafts. And although we laughed about them andwere embarrassed to talk about them, we enjoyed engaging in those activities. When I graduated in 1960 and worked in psychiatry, we used crafts a great deal, and our patients (as they were then called) appeared to benefit from them. But for all the activity analysis, even when that process became more sophisticated in later years, I never understoodwhy crafts were used over other occupations. Now I want to share with you some of what I have learned about “Why Crafts?” My question takes me into an exploration of influences on the development of occupational therapy in Canada from about 1890 to1930. My rationale is that a better understanding of our beginnings will help us develop more fully. It is also possible that there was something inherent in crafts as an occupation that we have otherwise not been able to provide. Perhaps we can find a modern-day equivalent, if we know more about that je ne sais quoi. I begin with a description of the background in terms of the social and political context of the times; I will then describe the foreground, highlighting three social movements that I believe influenced our development. With the start of World War I, the events that mark our beginnings and the various players involved will emerge. I will conclude with an epilogue, bringing us back to the present and back to the future.

Development of a Multidimensional Index for Assessing Social Support in Rehabilitation

Social support has been shown, in many instances, to moderate health outcomes after stress or strain. On the basis of the buffering hypothesis, which suggests that support acts to modify stress and therefore to diminish its impact on health (Turner, 1983), social support may be an important factor in the adjustment process that follows a major disabling illness or injury. Before social support can be used in rehabilitation, however, measurement tools are needed that explicitly define social support, assess support in a multidimensional way, and measure the unique support issues of persons with disabilities. This paper discusses the development and preliminary psychometric evaluation of such a measure. The instrument, called the Social Support Inventory for Stroke Survivors (SSISS), was developed specifically for use with stroke patients. With minor modifications, it can also be used with persons who have other disabilities. Research and clinical implications of the SSISS are discussed. Test–retest reliability of the SSISS over 1 week was established at .91. Internal consistency of the scaled version of the instrument was .85. Test construction procedures contributed to content and face validity, and empirical work supported construct and concurrent validity. Multidimensional scaling revealed an underlying structure that was consistent with the theoretical framework for the test.

From Confrontation to Collaboration: Making a Place for Dialogue on Seniorsʼ Driving

When senior drivers do not have a medical condition that mandates driving cessation, self-regulation takes on a potentially significant role in enhancing safety. In a previous qualitative study, we used focus groups to explore self-regulation from the perspectives of aging drivers and family physicians. Our analysis resulted in a model that included intrapersonal, interpersonal, and environmental factors. In this article, we draw on the data related to the interpersonal aspects of driving self-regulation. Secondary analysis revealed barriers and facilitators to opening a dialogue on driving among seniors, families, and physicians. Recommendations to decrease confrontation and enhance collaboration at the service delivery and societal levels are made.

Illness intrusiveness and subjective well-being in schizophrenia.

This study evaluated the extent to which schizophrenia and its treatment interferes with participation in valued life activities and its impact on subjective well-being. The Illness Intrusiveness Ratings Scale was completed by 78 individuals with schizophrenia on 3 measurement occasions. Clinicians working with participants, plus a relative/friend of each participant also provided independent ratings of the person. The Illness Intrusiveness Ratings Scale displayed internal consistency (coefficient α = 0.82), and temporal stability across 1 day (r = 0.89), 1 week (r = 0.51), and 1 month (r = 0.78). Reported intrusiveness was high (M = 50.5) and was among the highest compared with populations with other serious medical and psychiatric illnesses. Ratings correlated with staff and family/friends’ ratings of intrusiveness (r = 0.33 and r = 0.40), measures of symptomatology (average r = 0.25), and subjective well-being (average r = 0.41). Path analysis indicated that lifestyle disruption mediates the impact of symptoms and treatment on well-being. Implications for these findings and future directions for research are discussed.

Development and breakdown of written language

This article presents an overview of the development and breakdown of written language. Development of written language is reviewed for both the species and the child. Breakdown in written language is discussed in relation to the disorder of linguistic agraphia, with particular reference to studies involving cases that have resulted from a cerebral vascular accident. It is hoped that the juxtaposition of these perspectives of development and breakdown of written language may act as a catalyst for new research endeavors.