Publications by authors named "Amy Bender"

25 Publications

  • Page 1 of 1

Managing Travel Fatigue and Jet Lag in Athletes: A Review and Consensus Statement.

Sports Med 2021 Oct 14;51(10):2029-2050. Epub 2021 Jul 14.

Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa.

Athletes are increasingly required to travel domestically and internationally, often resulting in travel fatigue and jet lag. Despite considerable agreement that travel fatigue and jet lag can be a real and impactful issue for athletes regarding performance and risk of illness and injury, evidence on optimal assessment and management is lacking. Therefore 26 researchers and/or clinicians with knowledge in travel fatigue, jet lag and sleep in the sports setting, formed an expert panel to formalise a review and consensus document. This manuscript includes definitions of terminology commonly used in the field of circadian physiology, outlines basic information on the human circadian system and how it is affected by time-givers, discusses the causes and consequences of travel fatigue and jet lag, and provides consensus on recommendations for managing travel fatigue and jet lag in athletes. The lack of evidence restricts the strength of recommendations that are possible but the consensus group identified the fundamental principles and interventions to consider for both the assessment and management of travel fatigue and jet lag. These are summarised in travel toolboxes including strategies for pre-flight, during flight and post-flight. The consensus group also outlined specific steps to advance theory and practice in these areas.
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http://dx.doi.org/10.1007/s40279-021-01502-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279034PMC
October 2021

Sleep, health, and well-being in elite athletes from different sports, before, during, and after international competition.

Phys Sportsmed 2020 Nov 30:1-9. Epub 2020 Nov 30.

School of Allied Health, University of Limerick, Limerick, Ireland.

Limited research has been conducted on sleep problems in elite athletes at international competition, and how this relates to their general health and well-being. Sixty-five elite international athletes (37 males, 28 females, 21.8 ± 2.1 years) from different sports completed validated sleep (Athlete Sleep Screening Questionnaire), health (Subjective Health Complaints Inventory) and well-being (Sports Profile of Mood States) questionnaires; 1 month pre-competition, at the end of international competition, and 1 month post-competition. Twenty-three percent of the elite athletes were identified as having a moderate or severe clinically significant sleep problem during competition, with 82% reporting less than 8 h of sleep per night. Athletes with a moderate or severe clinically significant sleep problem during competition had significantly greater general health complaints ( = 0.002), mood disturbance ( = 0.001) and poorer sleep hygiene ( = 0.002). Swimmers had more sleep difficulty pre and during competition compared to athletics and soccer ( = 0.009). Sleep disturbance during international competition is common and associated with poorer health and lower mood. Swimmers may be more at risk of sleep difficulty pre and during competition compared to those competing in athletics and soccer. Sleep services may be required to support elite athletes at international competition.
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http://dx.doi.org/10.1080/00913847.2020.1850149DOI Listing
November 2020

Sleep and the athlete: narrative review and 2021 expert consensus recommendations.

Br J Sports Med 2020 Nov 3. Epub 2020 Nov 3.

Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Elite athletes are particularly susceptible to sleep inadequacies, characterised by habitual short sleep (<7 hours/night) and poor sleep quality (eg, sleep fragmentation). Athletic performance is reduced by a night or more without sleep, but the influence on performance of partial sleep restriction over 1-3 nights, a more real-world scenario, remains unclear. Studies investigating sleep in athletes often suffer from inadequate experimental control, a lack of females and questions concerning the validity of the chosen sleep assessment tools. Research only scratches the surface on how sleep influences athlete health. Studies in the wider population show that habitually sleeping <7 hours/night increases susceptibility to respiratory infection. Fortunately, much is known about the salient risk factors for sleep inadequacy in athletes, enabling targeted interventions. For example, athlete sleep is influenced by sport-specific factors (relating to training, travel and competition) and non-sport factors (eg, female gender, stress and anxiety). This expert consensus culminates with a sleep toolbox for practitioners (eg, covering sleep education and screening) to mitigate these risk factors and optimise athlete sleep. A one-size-fits-all approach to athlete sleep recommendations (eg, 7-9 hours/night) is unlikely ideal for health and performance. We recommend an individualised approach that should consider the athlete's perceived sleep needs. Research is needed into the benefits of napping and sleep extension (eg, banking sleep).
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http://dx.doi.org/10.1136/bjsports-2020-102025DOI Listing
November 2020

Examining Different Strategies for Stigma Reduction and Mental Health Promotion in Asian Men in Toronto.

Community Ment Health J 2021 05 19;57(4):655-666. Epub 2020 Oct 19.

Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada.

Mental illness stigma has detrimental effects on health and wellbeing. Approaches to address stigma in racialized populations in Western nations need to emphasize inclusivity, social justice, and sociocultural intersectionality of determinants of health. The current paper evaluates three intervention approaches to reduce stigma of mental illness among Asian men in Toronto, Canada. Participants received one of four group interventions: psychoeducation, Acceptance and Commitment Therapy (ACT), Contact-based Empowerment Education (CEE), and a combination of ACT+CEE. Self-report measures on stigma (CAMI, ISMI) and social change (SJS) were administered before and after the intervention. A total of 535 Asian men completed the interventions. Overall analyses found that all intervention approaches were successful in reducing stigma and promoting social change. Subscale differences suggest that CEE may be more broadly effective in reducing mental illness stigmatizing attitudes while ACT may be more specifically effective in reducing internalized stigma. More work needs to be done to elucidate mechanisms that contribute to socioculturally-informed mental illness stigma interventions for racialized communities and traditionally marginalized populations.
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http://dx.doi.org/10.1007/s10597-020-00723-3DOI Listing
May 2021

How to manage travel fatigue and jet lag in athletes? A systematic review of interventions.

Br J Sports Med 2020 Aug 17;54(16):960-968. Epub 2020 Apr 17.

Faculty of Natural and Agricultural Sciences, Department of Statistics, University of Pretoria, Pretoria, South Africa.

Objectives: We investigated the management of travel fatigue and jet lag in athlete populations by evaluating studies that have applied non-pharmacological interventions (exercise, sleep, light and nutrition), and pharmacological interventions (melatonin, sedatives, stimulants, melatonin analogues, glucocorticoids and antihistamines) following long-haul transmeridian travel-based, or laboratory-based circadian system phase-shifts.

Design: Systematic review Randomised controlled trials (RCTs), and non-RCTs including experimental studies and observational studies, exploring interventions to manage travel fatigue and jet lag involving actual travel-based or laboratory-based phase-shifts. Studies included participants who were athletes, except for interventions rendering no athlete studies, then the search was expanded to include studies on healthy populations.

Data Sources: Electronic searches in PubMed, MEDLINE, CINAHL, Google Scholar and SPORTDiscus from inception to March 2019. We assessed included articles for risk of bias, methodological quality, level of evidence and quality of evidence.

Results: Twenty-two articles were included: 8 non-RCTs and 14 RCTs. No relevant travel fatigue papers were found. For jet lag, only 12 athlete-specific studies were available (six non-RCTs, six RCTs). In total (athletes and healthy populations), 11 non-pharmacological studies (participants 600; intervention group 290; four non-RCTs, seven RCTs) and 11 pharmacological studies (participants 1202; intervention group 870; four non-RCTs, seven RCTs) were included. For non-pharmacological interventions, seven studies across interventions related to actual travel and four to simulated travel. For pharmacological interventions, eight studies were based on actual travel and three on simulated travel.

Conclusions: We found no literature pertaining to the management of travel fatigue. Evidence for the successful management of jet lag in athletes was of low quality. More field-based studies specifically on athlete populations are required with a multifaceted approach, better design and implementation to draw valid conclusions. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42019126852).
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http://dx.doi.org/10.1136/bjsports-2019-101635DOI Listing
August 2020

Sleep in elite multi-sport athletes: Implications for athlete health and wellbeing.

Phys Ther Sport 2019 Sep 23;39:136-142. Epub 2019 Jul 23.

School of Allied Health, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland. Electronic address:

Objectives: To investigate the prevalence of clinically relevant sleep problems in elite multi-sport athletes and their associations with sleep hygiene, general health, mood, chronotype, and injury.

Design: Cross-sectional study.

Setting: During the competitive season in athletes' home environment.

Participants: Elite multi-sport Irish athletes (n = 58) competing at the 2017 World University Games.

Main Outcome Measures: Category of clinical sleep problem (Athlete-Sleep-Screening-Questionnaire), sleep hygiene (Sleep Hygiene Index), general health (Subjective Health Complaints), mood (Sports Profile of Mood States), chronotype (Morningness-Eveningness Questionnaire), and injury (self-reported injury).

Results: 43% had no clinical sleep problem, 41% had a mild clinical sleep problem, 16% had a moderate clinical sleep problem, none had a severe clinical sleep problem. Therefore, 84% of athletes did not have a clinically significant sleep problem while 16% had a clinically significant sleep problem. One-way-ANOVA revealed significantly worse sleep hygiene (p = 0.002), more general health complaints (p = 0.001) and greater mood disturbance (p = 0.001) among those with clinically significant sleep disturbances compared to those without. No association was found between having a clinically significant sleep problem and either chronotype or previous recent injury.

Conclusions: Athletes with a clinically significant sleep problem were more likely to report worse sleep hygiene, more general health complaints, and mood disturbance.
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http://dx.doi.org/10.1016/j.ptsp.2019.07.006DOI Listing
September 2019

Exploring mental illness stigma among Asian men mobilized to become Community Mental Health Ambassadors in Toronto Canada.

Ethn Health 2019 Jul 24:1-19. Epub 2019 Jul 24.

c Daphne Cockwell School of Nursing, Ryerson University , Toronto , ON , Canada.

Background: Stigma of mental illness contributes to silence, denial and delayed help seeking. Existing stigma reduction strategies seldom consider gender and cultural contexts.

Purpose: The Strengths in Unity study was a multi-site Canadian study that engaged Asian men in three stigma reduction interventions (ACT, CEE, psychoeducation) and mobilized them as Community Mental Health Ambassadors. Our participants included both men living with or affected by mental illness (LWA) as well as community leaders (CL). This paper will: (1) describe the baseline characteristics of the Toronto participants including their sociodemographic information, mental illness stigma (CAMI and ISMI), attitudes towards social change (SJS), and intervention-related process variables (AAQ-II, VLQ, FMI, Empowerment); (2) compare the differences among these variables between LWA and CL; and (3) explore factors that may correlate with socio-economic status and mental health stigma.

Results: A total of 609 Asian men were recruited in Toronto, Canada. Both CL and LWA had similar scores on measures of external and internalized stigma and social change attitudes, except that LWA had more positive views about the acceptance and integration of those with mental illness into the community on the CAMI, while CL had a higher level of perceived behavioral control on the SJS. Group differences were also observed between LWA and CL in some process-related variables. Exploratory analysis suggests that younger and more educated participants had lower stigma.

Conclusion: Our findings underscore the importance of engaging both community leaders and people with lived experience as mental health advocates to address stigma.
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http://dx.doi.org/10.1080/13557858.2019.1640350DOI Listing
July 2019

Building the Case for Nurses' Continuous Professional Development in Ethiopia: A Qualitative Study of the Sick Kids-Ethiopia Paediatrics Perioperative Nursing Training Program.

Ethiop J Health Sci 2018 Sep;28(5):607-614

Undergraduate Medical Education, University of Toronto.

Background: This study describes the in-service training experience of perioperative nurses from the SickKids-Ethiopia Paediatrics Perioperative Nursing Training Program in Addis Ababa, Ethiopia. The study emphasizes specifically how nurses applied the knowledge and skills gained from the Paediatrics Perioperative Nursing Training program in their subsequent practice and consider the situational factors that facilitated or hindered implementing these new knowledge and skills.

Methods: The first author led qualitative in-depth interviews with nine perioperative nurses who participated in training in September 2016, and systematically developed descriptive codes and themes to analyze the data.

Results: The authors found that participants experienced improved knowledge, skills, confidence, and job retention related to perioperative nursing practice after participating in Paediatrics Perioperative Nursing Training. Participants also stressed key challenges including lack of access to ongoing perioperative in-service training and problematic staffing policies that impact perioperative nurses' ability to fully utilize and share new knowledge gained during CPD training.

Conclusion: The findings highlighted the value of specialized perioperative CPD training for Ethiopian nurses, yet also pointed to multidimensional challenges for knowledge translation and sustainability of best practices. The authors offer recommendations for individual and institutional strategies to address some of them.
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http://dx.doi.org/10.4314/ejhs.v28i5.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6308780PMC
September 2018

Representations on adherence to the treatment of Multidrug-Resistant Tuberculosis.

Rev Esc Enferm USP 2018 Dec 20;52:e03412. Epub 2018 Dec 20.

University of Toronto, Faculty of Nursing, Toronto, Ontário, Canada.

Objective: To identify representations regarding adherence to the treatment of multidrug-resistant tuberculosis from the perspective of patients who were discharged upon being cured.

Method: A qualitative study with patients who completed the drug treatment for multidrug-resistant tuberculosis in São Paulo. Social Determination was used to interpret the health-disease process, and the testimonies were analyzed according to dialectical hermeneutics and the discourse analysis technique.

Results: Twenty-one patients were interviewed. The majority (80.9%) were men, in the productive age group (90.4%) and on sick leave or unemployed (57.2%) during the treatment. Based on the testimonies, three categories associated with adherence to treatment emerged: the desire to live, support for the development of treatment and care provided by the health services.

Conclusion: For the study sample, adherence to the treatment of multidrug-resistant tuberculosis was related to having a life project and support from the family and health professionals. Free treatment is fundamental for adherence, given the fragilities arising from the social insertion of people affected by the disease. Therefore, special attention is required from the health services to understand patient needs.
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http://dx.doi.org/10.1590/S1980-220X2018010303412DOI Listing
December 2018

Sleep Quality and Chronotype Differences between Elite Athletes and Non-Athlete Controls.

Clocks Sleep 2019 Mar 5;1(1):3-12. Epub 2018 Sep 5.

Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada.

Previous research has found that elite athletes have insufficient sleep, yet the specific kinds of sleep disturbances occurring as compared to a control group are limited. Here we compare the subjective sleep quality and chronotype of elite athletes to a control group of non-athlete good sleepers. Sixty-three winter Canadian National Team athletes (mean age 26.0 ± 0.0; 32% females) completed the Pittsburgh Sleep Quality Index (PSQI) and the Athlete Morningness Eveningness Scale. They were compared to 83 healthy, non-athlete, good-sleeper controls (aged 27.3 ± 3.7; 51% females) who completed the PSQI and the Composite Scale of Morningness. The elite athletes reported poorer sleep quality (PSQI global score 5.0 ± 2.6) relative to the controls (PSQI global score 2.6 ± 1.3), despite there being no group difference in self-reported sleep duration (athletes 8.1 ± 1.0 h; controls 8.0 ± 0.7 h). Further, athletes' chronotype distribution showed a greater skew toward morningness, despite there being no group differences in self-reported usual bedtime and wake time. These results suggest that a misalignment of sleep times with circadian preference could contribute to poorer sleep quality in elite athletes.
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http://dx.doi.org/10.3390/clockssleep1010002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509668PMC
March 2019

Differences in sleep patterns, sleepiness, and physical activity levels between young adults with autism spectrum disorder and typically developing controls.

Dev Neurorehabil 2019 Apr 1;22(3):164-173. Epub 2018 Aug 1.

a Faculty of Kinesiology , University of Calgary.

Objective: To investigate the differences in sleep, sleepiness, and physical activity (PA) between young adults with autism spectrum disorder (ASD) and typically developing controls (TDC).

Method: Actigraphic data and questionnaires on sleep, sleepiness, and PA were compared between fifteen adults with ASD (ADOS range 7-19; ages 22.8 ± 4.5 years) and TDC.

Results: In comparison to the TDC group, the ASD group slept longer on average per night but took longer to fall asleep. In relationship to PA levels, the objective PA levels were lower in the ASD group than the TDC group. Fewer wake minutes during the sleep period in the ASD sample were associated with more PA the following day.

Conclusion: The findings support previous research that demonstrates differences in sleep parameters and PA between ASD and TDC. Interventions aimed at increasing PA in an ASD population may be beneficial for improved sleep.
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http://dx.doi.org/10.1080/17518423.2018.1501777DOI Listing
April 2019

The Clinical Validation of the Athlete Sleep Screening Questionnaire: an Instrument to Identify Athletes that Need Further Sleep Assessment.

Sports Med Open 2018 Jun 4;4(1):23. Epub 2018 Jun 4.

Centre for Sleep & Human Performance, 106-51 Sunpark Dr. SE, Calgary, AB, T2X 3V4, Canada.

Background: Previous research has established that general sleep screening questionnaires are not valid and reliable in an athlete population. The Athlete Sleep Screening Questionnaire (ASSQ) was developed to address this need. While the initial validation of the ASSQ has been established, the clinical validity of the ASSQ has yet to be determined. The main objective of the current study was to evaluate the clinical validity of the ASSQ.

Methods: Canadian National Team athletes (N = 199; mean age 24.0 ± 4.2 years, 62% females; from 23 sports) completed the ASSQ. A subset of athletes (N = 46) were randomized to the clinical validation sub-study which required subjects to complete an ASSQ at times 2 and 3 and to have a clinical sleep interview by a sleep medicine physician (SMP) who rated each subjects' category of clinical sleep problem and provided recommendations to improve sleep. To assess clinical validity, the SMP category of clinical sleep problem was compared to the ASSQ.

Results: The internal consistency (Cronbach's alpha = 0.74) and test-retest reliability (r = 0.86) of the ASSQ were acceptable. The ASSQ demonstrated good agreement with the SMP (Cohen's kappa = 0.84) which yielded a diagnostic sensitivity of 81%, specificity of 93%, positive predictive value of 87%, and negative predictive value of 90%. There were 25.1% of athletes identified to have clinically relevant sleep disturbances that required further clinical sleep assessment. Sleep improved from time 1 at baseline to after the recommendations at time 3.

Conclusions: Sleep screening athletes with the ASSQ provides a method of accurately determining which athletes would benefit from preventative measures and which athletes suffer from clinically significant sleep problems. The process of sleep screening athletes and providing recommendations improves sleep and offers a clinical intervention output that is simple and efficient for teams and athletes to implement.
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http://dx.doi.org/10.1186/s40798-018-0140-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986689PMC
June 2018

Sleep continuity is positively correlated with sleep duration in laboratory nighttime sleep recordings.

PLoS One 2017 10;12(4):e0175504. Epub 2017 Apr 10.

Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York, United States of America.

Sleep duration varies widely across individuals and appears to be trait-like. Differences in the stability of underlying sleep processes may underlie this phenomenon. To investigate underlying mechanisms, we examined the relationship between sleep duration and sleep continuity in baseline polysomnography (PSG) recordings from three independently collected datasets: 1) 134 healthy controls (ages 37 ± 13 years) from the São Paulo Epidemiologic Sleep Study, who spent one night in a sleep laboratory, 2) 21 obstructive sleep apnea (OSA) patients who were treated with continuous positive airway pressure for at least 2 months (45 ± 12 years, respiratory disturbance index <15), who spent one night in a sleep laboratory with previous experience of multiple PSG studies, and 3) 62 healthy controls (28 ± 6 years) who, as part of larger experiments, spent 2 consecutive nights in a sleep laboratory. For each dataset, we used total sleep time (TST) to separate subjects into those with shorter sleep (S-TST) and those with longer sleep (L-TST). In all three datasets, survival curves of continuous sleep segments showed greater sleep continuity in L-TST than in S-TST. Correlation analyses with TST as a continuous variable corroborated the results; and the results also held true after controlling for age. There were no significant differences in baseline waking performance and sleepiness between S-TST and L-TST. In conclusion, in both healthy controls and treated OSA patients, sleep continuity was positively correlated with sleep duration. These findings suggest that S-TST may differ from L-TST in processes underlying sleep continuity, shedding new light on mechanisms underlying individual differences in sleep duration.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175504PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5386280PMC
September 2017

Comment on: "Does Elite Sport Degrade Sleep Quality? A Systematic Review".

Sports Med 2017 07;47(7):1453-1454

Centre for Sleep and Human Performance, 106, 51 Sunpark Drive SE, Calgary, AB, T2X 3V4, Canada.

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http://dx.doi.org/10.1007/s40279-017-0712-4DOI Listing
July 2017

Tuberculosis and common mental disorders: international lessons for Canadian immigrant health.

Can J Nurs Res 2012 Dec;44(4):56-75

Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada.

Tuberculosis is a pressing global health issue. Its association with other infections, illnesses, and social factors, including immigration, is well known, yet comparatively little research has examined the connections between tuberculosis and mental disorder, particularly among immigrants in Canada. The authors report on a scoping review conducted to better understand the synergies of tuberculosis, mental disorders, and underlying social conditions as they affect immigrants' health. They highlight the articles that focused on the co-occurrence of tuberculosis and depression/anxiety. After describing their approach and strategy, the authors present key thematic categories: prevalence, clinical presentation, and effects of stigma and poverty. Examining the research within the global context, they argue that migration contributes to these synergistic conditions. The review shows that Canadians stand to gain much by learning from low- and middle-income countries about what constitutes best evidence in approaching complex global health issues.
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December 2012

The obligation of debriefing in global health education.

Med Teach 2013 26;35(3):e1027-34. Epub 2012 Oct 26.

Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada.

Background: An outcome of globalization and internationalization in higher education in the health professions has been increasing global health placements. There is, however, a lack of literature on debriefing and support following these placements. The authors undertook a participatory project to develop peer support and debriefing in a global health nursing elective, during which this gap in literature was addressed.

Aims: The purpose of the project was to develop a peer support component of the course and revise the debriefing component based on results of a previous course evaluation.

Methods: The methods were guided by a participatory approach involving course alumni and included a scoping review and focus groups.

Results: The project resulted in development of: (1) a peer support statement and (2) a debriefing framework.

Conclusions: Key lessons about the obligation of appropriate debriefing for students returning from global health placements include importance of affective learning, a pedagogy of discomfort, and global health ethics.
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http://dx.doi.org/10.3109/0142159X.2012.733449DOI Listing
September 2013

Towards a global interdisciplinary evidence-informed practice: intimate partner violence in the ethiopian context.

ISRN Nurs 2012 20;2012:307271. Epub 2012 May 20.

School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, Canada M5B 2K3.

Background. Intimate partner violence is a global health issue and is associated with a range of health problems for women. Nurses, as the largest health workforce globally, are well positioned to provide care for abused women. Objectives. This nursing-led interdisciplinary project was conducted to understand the current state of knowledge about intimate partner violence in Ethiopia and make recommendations for country-specific activities to improve response to intimate partner violence through practice changes, education, and research. Methods. The project involved two phases: review of relevant literature and an interdisciplinary stakeholder forum and a meeting with nurse educators. Findings. The literature review identified the pervasiveness and complexity of intimate partner violence and its sociocultural determinants in the Ethiopian context. Two significant themes emerged from the forum and the meeting: the value of bringing multiple disciplines together to address the complex issue of intimate partner violence and the need for health care professionals to better understand their roles and responsibilities in actively addressing intimate partner violence. Conclusions. Further research on the topic is needed, including studies of prevention and resilience and "best practices" for education and intervention. Interdisciplinary and international research networks can support local efforts to address and prevent intimate partner violence.
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http://dx.doi.org/10.5402/2012/307271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363987PMC
August 2012

Gender and TB: illness narratives.

Authors:
Amy Bender

Can Nurse 2012 Apr;108(4)

Lawrence S. Bloomberg Faculty of Nursing, University of Toronto.

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April 2012

Systematic individual differences in sleep homeostatic and circadian rhythm contributions to neurobehavioral impairment during sleep deprivation.

Accid Anal Prev 2012 Mar 23;45 Suppl:11-6. Epub 2011 Nov 23.

Sleep and Performance Research Center, Washington State University Spokane, PO Box 1495, Spokane, WA 99210-1495, USA.

Individual differences in vulnerability to neurobehavioral performance impairment during sleep deprivation are considerable and represent a neurobiological trait. Genetic polymorphisms reported to be predictors have suggested the involvement of the homeostatic and circadian processes of sleep regulation in determining this trait. We applied mathematical and statistical modeling of these two processes to psychomotor vigilance performance and sleep physiological data from a laboratory study of repeated exposure to 36 h of total sleep deprivation in 9 healthy young adults. This served to quantify the respective contributions of individual differences in the two processes to the magnitudes of participants' individual vulnerabilities to sleep deprivation. For the homeostatic process, the standard deviation for individual differences was found to be about 60% as expressed relative to its group-average contribution to neurobehavioral performance impairment. The same was found for the circadian process. Across the span of the total sleep deprivation period, the group-average effect of the homeostatic process was twice as big as that of the circadian process. In absolute terms, therefore, the impact of the individual differences in the homeostatic process was twice as large as the impact of the individual differences in the circadian process in this study. These modeling results indicated that individualized applications of mathematical models predicting performance on the basis of a homeostatic and a circadian process should account for individual differences in both processes.
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http://dx.doi.org/10.1016/j.aap.2011.09.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3260461PMC
March 2012

International research collaboration as social relation: an Ethiopian-Canadian example.

Can J Nurs Res 2011 Jun;43(2):62-75

Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada.

International collaboration in nursing and other health disciplines is vital for addressing global health issues. While the results and processes of such collaborations have been reported, few publications have addressed their philosophical or theoretical underpinnings, particularly with respect to collaboration between those in low- and high-income countries. Piaget's notion of social relations of cooperation and constraint and Habermas's notion of "lifeworld" provide a theoretical lens through which to examine international collaboration as a construction of knowledge. This article is an exploration of these ideas as seen in the collective experience of Canadians and Ethiopians organizing an interdisciplinary forum on intimate partner violence in Ethiopia. The project is presented as a case study for reflecting on international collaboration as a manifestation of social relations. Such re-visioning of international collaboration may be useful for improving collaborative processes and their outcomes.
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June 2011

Welcome intrusions: an interpretive phenomenological study of TB nurses' relational work.

Int J Nurs Stud 2011 Nov 20;48(11):1409-19. Epub 2011 May 20.

Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario M5T 1P8, Canada.

Background: Nurse-client relationships are valued in descriptions of public health practice and require consideration as work involving knowledge, skill, and personal engagement. Even so, in public health, they are largely taken-for-granted, particularly in the area of tuberculosis (TB). Instead, TB nursing is often structured by a population focus, which at times challenges individually focused relationship ideals.

Purpose And Design: This paper describes an interpretive phenomenological study which was undertaken to understand the nature of TB nurses' relational work.

Methods: Data were collected over an eight month period through observations of usual nurse-client visits and semi-structured interviews.

Setting And Participants: The study took place in the TB program of a public health department of a large multicultural Canadian city with nine nurses and 24 clients.

Results: The phrase 'welcome intrusions' represents the nature of relational work and along with three key themes, 'getting through the door', 'doing TB but more than that', and 'beyond a professional', speaks to the central tension in this relational work: balancing its dual surveillance-care focus.

Conclusions: Together these themes emphasize the importance of nurses' skill of involvement in two key domains of TB nursing practice: providing comfort and being watchful.
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http://dx.doi.org/10.1016/j.ijnurstu.2011.04.012DOI Listing
November 2011

Becoming a global citizen through nursing education: lessons learned in developing evaluation tools.

Int J Nurs Educ Scholarsh 2010 21;7:Article 44. Epub 2010 Dec 21.

University of Toronto, Canada.

While global health practica are being increasingly described in nursing education literature, course evaluation of same receives comparatively less attention. In this article, authors report on an evaluation project, undertaken to rigorously examine the existing evaluation methods for an elective global health practicum with placements in India and northern Canada. Sixteen students were interviewed and course evaluation tools were reviewed. Resulting themes include students' sense of preparedness, the centrality of the student-preceptor relationship, the importance of supported self-reflection, and the usefulness of evaluation methods. Participants viewed existing course evaluation methods as generally useful, therefore requiring only minor adjustments. There were also structural revisions to the preparation, placement, and post-placement phases of the course and broader lessons learned. Lessons include the importance of critical social perspectives and the value of past students revisiting their experiences in such a way as make conscious connections between placement experiences and their current professional practice.
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http://dx.doi.org/10.2202/1548-923X.1974DOI Listing
April 2011

Displacement and tuberculosis: recognition in nursing care.

Health Place 2010 Nov 20;16(6):1069-76. Epub 2010 Jun 20.

Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada.

Through a qualitative of study of public health nurses and their clients in Toronto, Canada, displacement is described as a central feature in illness and care. Specifically, how client experiences are anchored in circumstances of international migration and contagiousness is described, along with how nurses take up understandings of displacement as part of their daily work through diminishing the social displacement of immigration, connecting here and there, and minimizing the displacement of contagiousness. The research illustrates how responding to the implacing and displacing elements of the illness experience and broader lifecourse can be an important part of professional practice. Moreover it highlights how place sensitive geographical inquiry is insightful with respect to understanding the interplay between illness, wellbeing, and health care work.
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http://dx.doi.org/10.1016/j.healthplace.2010.06.007DOI Listing
November 2010

Considering place in community health nursing.

Can J Nurs Res 2009 Mar;41(1):128-43

Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada.

When a geographic location is assigned meaning, it becomes a place. The authors argue that place matters as both geographical location and lived experience.They extend the current conceptualization of nursing geography to encompass community health nursing and address intricacies of community nursing practice and research that often go unnoticed. They do so by exploring the notion of place in home and community, including the structural/spatial dimensions of the nurse-client relationship. The authors review the health geography literatures, then discuss the implications for practice and research in community health. They invite community health nurses to critically examine their practice and research with reference to such issues as the power of the nurse, marginalized places as determinants of health, and how best to care for clients living in diverse community settings.
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March 2009

Considering place in community health nursing.

Can J Nurs Res 2007 Sep;39(3):20-35

Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada.

When a geographic location is assigned meaning, it becomes a place. The authors argue that place matters as both geographical location and lived experience. They extend the current conceptualization of nursing geography to encompass community health nursing and address intricacies of community nursing practice and research that often go unnoticed. They do so by exploring the notion of place in home and community, including the structural/spatial dimensions of the nurse-client relationship. The authors review the health geography literatures, then discuss the implications for practice and research in community health. They invite community health nurses to critically examine their practice and research with reference to such issues as the power of the nurse, marginalized places as determinants of health, and how best to care for clients living in diverse community settings.
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September 2007
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