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Item Assessing Resident Well-Being After the ABSITE: A Bad Time to Ask?(Wolters Kluwer, 2022-09-28) Cheung, Elaine O.; Hu, Yue-Yung; Jones, Andrew; Ma, Meixi; Schlick, Cary Jo R.; Moskowitz, Judith T.; Agarwal, Gaurava; Bilimoria, Karl Y.; Surgery, School of MedicineObjectives: Assess the association of residents' exam performance and transient emotions with their reports of burnout, suicidality, and mistreatment. Background: An annual survey evaluating surgical resident well-being is administered following the American Board of Surgery In-Training Examination (ABSITE). One concern about administering a survey after the ABSITE is that stress from the exam may influence their responses. Methods: A survey was administered to all general surgery residents following the 2018 ABSITE assessing positive and negative emotions (scales range from 0 to 12), as well as burnout, suicidality over the past 12 months, and mistreatment (discrimination, sexual harassment verbal/emotional or physical abuse) in the past academic year. Multivariable hierarchical regressions assessed the associations of exam performance and emotions with burnout, suicidality, and mistreatment. Results: Residents from 262 programs provided complete responses (N = 6987, 93.6% response rate). Residents reported high mean positive emotion (M = 7.54, SD = 2.35) and low mean negative emotion (M = 5.33, SD = 2.43). While residents in the bottom ABSITE score quartile reported lower positive and higher negative emotion than residents in the top 2 and 3 quartiles, respectively (P < 0.005), exam performance was not associated with the reported likelihood of burnout, suicidality, or mistreatment. Conclusions: Residents' emotions after the ABSITE are largely positive. Although poor exam performance may be associated with lower positive and higher negative emotion, it does not seem to be associated with the likelihood of reporting burnout, suicidality, or mistreatment. After adjusting for exam performance and emotions, mistreatment remained independently associated with burnout and suicidality. These findings support existing evidence demonstrating that burnout and suicidality are stable constructs that are robust to transient stress and/or emotions.Item Effects of Various Commercially Available Enrichment Options on Handling and Chronic Stress Markers in Female ICR Mice(American Association for Laboratory Animal Sciences, 2019-03) Peveler, Jessica L.; Swan, Melissa P.; Wheeler, R'nld R.; Boehm, Christine A.; Hickman, Debra L.; Medicine, School of MedicineAlthough social housing of mice generally is preferred, mice must be individually housed in some situations. In these cases, enhanced attention to environmental enrichment is encouraged, but few studies assess the wellbeing of mice provided various enrichments. In this study, we used female ICR mice to evaluate enrichment strategies that encouraged natural behaviors including foraging, exercise, sheltering, and socialization. After 3 mo of exposure to the assigned enrichment strategy, wellbeing was assessed by evaluating behavioral and physiologic differences between groups. The results suggested that the use of red-tinted igloos may decrease markers of mouse wellbeing. However, none of the selected strategies yielded measures of wellbeing indicating improvement as compared to individually housed mice with no enrichment (negative control). Furthermore, measures were not significantly different between paired mice and individually housed mice with no enrichment.Item Learning to Thrive in a Binary World: Understanding the Gendered Experiences of Nonbinary Individuals and Ways to Bolster Wellbeing(2021-08) Kinney, M. Killian; Victor, Bryan G.; Fortenberry, J. Dennis; Thigpen, Jeffry W.; Wahler, Elizabeth A.Traditionally, gender has been viewed through an essentialist lens with fixed biology-based traits or polarized gender norms between women and men. As awareness of gender diversity grows, increasingly more people identify as nonbinary – or not exclusively a man or woman. Despite a growing literature on the experiences of binary transgender individuals, little has been explored regarding experiences unique to nonbinary individuals. The research that does include nonbinary individuals focuses primarily on adverse risks and outcomes. As such, a dearth of empirical research exists to understand the unique experiences of nonbinary people and how they relate to wellbeing. A qualitative participatory action study using PhotoVoice was conducted virtually to address the identified gaps in the literature on nonbinary individuals concerning gendered experiences and wellbeing. Prevailing theories of wellbeing informed the study along with minority stress theory and the resilience literature to account for environmental factors of oppression and individual and community resilience. A sample of 17 nonbinary adults in the Midwestern United States was recruited using convenience sampling and participated in online group discussions and individual interviews. The findings were reported in sections corresponding with the three study aims: 1) Explore core dimensions of wellbeing as defined by nonbinary individuals, 2) Identify promotive and corrosive factors of that wellbeing, and 3) Provide recommendations to bolster nonbinary wellbeing. The findings provided a thorough description of how nonbinary individuals perceive their wellbeing concerning their gender and as part of a marginalized population. Thematic analysis identified nine wellbeing themes for how participants conceptualized their wellbeing (e.g., Exploring gender identity and expression, Being connected to community, etc.), seven themes of promotive and corrosive factors of wellbeing (e.g., Positive, accurate, and nuanced representation, Coping skills to manage minority stressors, etc.), and three themes of recommendations (e.g., personal, interpersonal, and professional) with eighteen strategies to bolster wellbeing among nonbinary individuals and communities. The significance of the findings to social work was discussed, including practice application and advocacy. This study contributes to PhotoVoice methodology, wellbeing literature, and trans literature.Item Predictors of Caregiver Strain for Parents of Children with Autism Spectrum Disorder(Springer, 2021) Bradshaw, Jessica; Gillespie, Scott; McCracken, Courtney; King, Bryan H.; McCracken, James T.; Johnson, Cynthia R.; Lecavalie, Luc; Smith, Tristram; Swiezy, Naomi; Bearss, Karen; Sikich, Linmarie; Donnelly, Craig; Hollande, Eric; McDougle, Christopher J.; Scahill, Lawrence; Pediatrics, School of MedicineParents of children with autism spectrum disorder (ASD) face higher levels of caregiver strain compared to parents of children with other disabilities. This study examined child clinical features that predict high levels of caregiver strain for 374 parents of children with ASD. Caregiver strain was measured using the Caregiver Strain Questionnaire (CGSQ) objective, subjective internalized, and subjective externalized subscales. Confirmatory factor analysis indicated an acceptable fit for the original CGSQ three-factor solution. The strongest child predictors across CGSQ subscales were: disruptive behavior for objective strain, autism severity and disruptive behavior for subjective internalized strain, and oppositional behavior and hyperactivity for subjective externalized strain. Individualized interventions that attend to specific elements of parental strain may reduce strain and improve family wellbeing.Item Social alignment matters: Following pandemic guidelines is associated with better wellbeing(Springer Nature, 2022-05-03) Tunçgenç, Bahar; Newson, Martha; Sulik, Justin; Zhao, Yi; Dezecache, Guillaume; Deroy, Ophelia; El Zein, Marwa; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public HealthBackground: In response to the Covid-19 pandemic, most countries implemented physical distancing measures. Many mental health experts warned that through increasing social isolation and anxiety, these measures could negatively affect psychosocial wellbeing. However, socially aligning with others by adhering to these measures may also be beneficial for wellbeing. Methods: We examined these two contrasting hypotheses using cross-national survey data (N = 6675) collected fortnightly from participants in 115 countries over 3 months at the beginning of the pandemic. Participants reported their wellbeing, perceptions of how vulnerable they were to Covid-19 (i.e., high risk of infection) and how much they, and others in their social circle and country, were adhering to the distancing measures. Results: Linear mixed-effects models showed that being a woman, having lower educational attainment, living alone and perceived high vulnerability to Covid-19 were risk factors for poorer wellbeing. Being young (18-25) was associated with lower wellbeing, but longitudinal analyses showed that young people's wellbeing improved over 3 months. In contrast to widespread views that physical distancing measures negatively affect wellbeing, results showed that following the guidelines was positively associated with wellbeing even for people in high-risk groups. Conclusions: These findings provide an important counterpart to the idea that pandemic containment measures such as physical distancing negatively impacted wellbeing unequivocally. Despite the overall burden of the pandemic on psychosocial wellbeing, social alignment with others can still contribute to positive wellbeing. The pandemic has manifested our propensity to adapt to challenges, particularly highlighting how social alignment can forge resilience.Item Understanding the Individual Narratives of Women Who Use Formula in Relation to the Master Narrative of "Breast is Best"(2022-05) Scott, Susanna Foxworthy; Bute, Jennifer J.; Brann, Maria; Head, Katharine; Turman, Jack E., Jr.Despite clinical recommendations, only 25.8% of infants in the United States are exclusively breastfed at 6 months of age. Breastfeeding policies and communication campaigns exist to support exclusive breastfeeding, and women who use formula report facing stigma and feeling like a failure. Narratives can be used to discern how individuals make sense of experiences related to health, and narrative theorizing in health communication provides a framework of problematics used to explain how individuals construct stories that reveal the tensions between continuity and disruption and creativity and constraint. Individual experiences are often influenced by master narratives such as “Breast is best,” which are phrases that shape our understanding of the world. Because of the negative impact of using formula on maternal well-being, the purpose of this research was to use a narrative framework to analyze the stories of women who used formula in relation to the master narrative of breast is best. Building off of pilot interviews with 22 mothers, semi-structured interviews were conducted with 20 women who had used formula within the first 6 months after giving birth and had an infant no older than 12 months at the time of the interview. Qualitative analysis revealed that women perceived formula as shameful and costly. Conversely, they viewed breastfeeding as biologically superior, better for bonding, and a way to enact good motherhood. Current messaging about breastfeeding, particularly for women who intend to breastfeed, may have unintended negative effects when women face a disruption to their breastfeeding journey. In addition, women viewed breastfeeding and formula feeding as in relation to and in opposition to one another, reducing the perceived acceptability of behaviors such as combination feeding. Despite constraints in the master narrative regarding acceptable infant feeding practices, women demonstrated creativity in their individual stories and found formula feeding enabled more equitable parenting and preserved mental health. Practical implications include that organizations promoting exclusive breastfeeding in the United States should move away from framing breastfeeding as an all-or-nothing choice and develop tailored and value-neutral messaging recognizing breastfeeding as a complex psychosocial and biological process.