William C. Yoels

Explaining quality of life for persons with traumatic brain injuries 2 years after injury

OBJECTIVE To model the complex effects of demographic, psychosocial, physical, and rehabilitation variables on quality of life 2 years after hospital discharge. DESIGN Medical record and longitudinal survey data on traumatic brain injury (TBI) survivors who did or did not receive formal rehabilitation services after being injured were analyzed. SETTING The study sample was selected from a representative sample of hospitals in north-central Alabama. PARTICIPANTS Criteria for inclusion were: (1) 18 years and older with TBI; (2) discharged after hospital stay of 3 or more days; and (3) resided and injured in Alabama. There were 293 persons eligible for the 24-month follow-up survey, 186 (63%) of whom participated; the focus was on the 116 persons (of 186) who responded to the surveys themselves. MAIN OUTCOME MEASURE A causal model of hypothesized direct and indirect effects of several variables on quality of life outcomes. RESULTS Employment was the strongest contributor of improved quality of life. Persons unable to pay for health care showed less improvement in functional independence 12 to 24 months postinjury and reported a poorer quality of life. The psychosocial variables of self-blame and family support improved quality of life by reducing impairments and increasing the likelihood of employment. Family support also improved quality of life by increasing functional independence. Fewer physical impairments and gains in functional independence directly improved quality of life. CONCLUSION The interrelationships between psychosocial and physical variables are important when examining quality of life. Interventions are recommended targeting psychosocial variables and functional independence in efforts to improve quality of life.

Comfort Foods: An Exploratory Journey Into The Social and Emotional Significance of Food

This paper uses symbolic interactionist and structuralist perspectives to examine the social construction of some food objects as “comfort foods,” highlighting how cultural studies of food should take into account its social and physiological dimensions. This studys empirical findings are based upon the food items brought to class by 264 undergraduate students at a southeastern university in the United States. Comfort foods are classified into four categories: nostalgic foods, indulgence foods, convenience foods, and physical comfort foods. We describe how particular food objects come to be associated with the relief of distress and show how food objects are manipulated to modify or change emotional states or feelings. The practical implications of this work extend to understanding the role that mood plays in food selection and considering the use of comfort foods under certain circumstances, such as when individuals are experiencing illness.

Determinants of self-efficacy among persons with spinal cord injuries

The purpose of this study was to determine the factors affecting self-efficacy among persons with spinal cord injury (SCI). The study population consisted of 105 persons with SCI who were discharged from one of eight hospitals in north central Alabama between October 1989 and September 1992. Data were derived from a retrospective acute-care medical record review and 12-month annual follow-up telephone interviews. The findings indicate that high self-efficacy is significantly associated with less severe neurological impairment, being white, employed at injury, having a high-school education or beyond, and having an unintentional injury. In terms of marital status our data indicate the odds of divorced persons having high self-efficacy are 8.2 (CL = 0.919, 74.1) times those of married persons. In addition, 64% of those who were divorced during the 12 months after injury had high self-efficacy compared to 50% of those who were divorced prior to injury.

NEVER ENOUGH TIME How Medical Residents Manage a Scarce Resource

This article focuses on the management of time, a scarce resource. We report how medical residents in an outpatient clinic experience the time contingencies of their work setting, particularly, how they seek to control the work process. We analyze how residents learn about time management over the course of their residency and how they seek to control time when conducting examinations, dealing with other residents, and responding to their appointment schedules. Finally, we examine time as both a subjective experience and an axis of social organization.

Sport and Urban Life

The paper draws together historical and sociological literatures on sport with the purpose of more firmly introducing the role of sport into scholarly dialogue about city life. A central thesis of the paper is that there was a mutually transformative relationship between sport and the growth and development of American cities during the nineteenth and early twentieth centuries. Discussed in this regard is the role of sport and games in socializing and controlling immigrants. On a more social psychological level, the significance of sport in providing urbanites with a subjective sense of community identification is examined. The last section of the paper considers how participation in urban playground sports may provide a forum for the expression of self, identity, and individualism in an otherwise anonymous urban world.

Factors associated with patients' participation in rehabilitation services: a comparative injury analysis 12 months post-discharge

Purpose : To determine key characteristics or factors associated with rehabilitation participation during the first year following discharge for persons with either traumatic brain injury (TBI), spinal cord injury (SCI), intra-articular fracture (IAF), or burn injury (BURNS). Method : Medical records and longitudinal survey [telephone questionnaire] data were collected for persons in the four injury groups and analyzed using hierarchical logistic regression procedures for each domain of factors. Results : The only significant predictors with odds ratios greater than one were those for vocational rehabilitation participation. TBI patients lacking private insurance were 2.6 times more likely to participate in vocational rehabilitation; older SCI and TBI patients are about twice as likely to participate in vocational rehabilitation; and finally those with IAF or BURNS who are married at 12 months post discharge are 11.5 and 4.4 times respectively more likely to participate in vocational rehabilitation. Conclusion : Those lacking valuable socio-economic resources, such as private insurance (for TBI) and social support systems provided by marriage (for BURNS and IAF patients) are much more likely to be referred to vocational rehabilitation. This is true for older SCI and TBI patients as well. Lacking such resources, patients may be viewed by referral agents as less likely to benefit from in or outpatient rehabilitation.PURPOSE To determine key characteristics or factors associated with rehabilitation participation during the first year following discharge for persons with either traumatic brain injury (TBI), spinal cord injury (SCI), intra-articular fracture (IAF), or burn injury (BURNS). METHOD Medical records and longitudinal survey [telephone questionnaire] data were collected for persons in the four injury groups and analyzed using hierarchical logistic regression procedures for each domain of factors. RESULTS The only significant predictors with odds ratios greater than one were those for vocational rehabilitation participation. TBI patients lacking private insurance were 2.6 times more likely to participate in vocational rehabilitation; older SCI and TBI patients are about twice as likely to participate in vocational rehabilitation; and finally those with IAF or BURNS who are married at 12 months post discharge are 11.5 and 4.4 times respectively more likely to participate in vocational rehabilitation. CONCLUSION Those lacking valuable socio-economic resources, such as private insurance (for TBI) and social support systems provided by marriage (for BURNS and IAF patients) are much more likely to be referred to vocational rehabilitation. This is true for older SCI and TBI patients as well. Lacking such resources, patients may be viewed by referral agents as less likely to benefit from in or outpatient rehabilitation.

How Physicians View Caregivers: Simmel in the Examination Room

The presence of caregivers in medical encounters changes the doctor-patient relationship. Although there is extensive literature on how caregivers affect medical encounters, there is little research on how physicians view such caregivers. We explore that issue by conducting structured, in-depth interviews with eighteen pediatricians and eighteen geriatricians. The interviews were recorded and transcribed, content analysis was performed, and conceptual codes were developed based on material in the interviews. Findings support Simmels theory about the changes occurring when dyads become triads. Adding caregivers to medical encounters leads to a loss of intimacy between patients and physicians, decreased patient participation, and the formation of coalitions between physicians and caregivers. We conclude by urging medical schools to sensitize physicians to how caregivers affect medical encounters.

Work, careers, and aging

This article relates the literature on work and profession to that on aging as a life-long process. The authors maintain that meanings attached to chronological age arise, in large measure, out of the work experience. An individuals career frames expectations about what he/she should be doing at different ages and thus serves as a yardstick against which to measure life process. Five stages of the work career are identified: (1) preparation and exploration, (2) learning the ropes, (3) coming to grips, (4) settling in, and (5) exiting.

Role-Taking Accuracy in Medical Encounters: A Test of two Theories

Abstract This paper tests five hypotheses derived from two contrasting theoretical perspectives on role-taking accuracy: a social contact theory and an institutional resource theory. We investigate how well doctors and patients perceive one anothers perspectives in a medical encounter. The cumulative weight of the data supports the proposed social contact theory. Increased contact between residents and patients, as reflected in physicians year in residency, contributes to more accurate role-taking on the part of physicians. Conditions of social compatibility between doctors and patients vis a vis gender or race lead to more accurate role-taking. Finally, personal characteristics are better predictors of role-taking accuracy than institutional status variables such as type of residency training program or doctors year in residency status.