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Marshall CA, Easton C, Javadizadeh E, Holmes J, Phillips B, Isard R. Effectiveness of Interventions for Meaningful Activity Participation in Homelessness: A Systematic Review. Can J Occup Ther 2024:84174241233519. [PMID: 38436121 DOI: 10.1177/00084174241233519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Background. Meaningful activity participation has been identified as a key outcome of services designed to support individuals during and following homelessness. Little is known about the effectiveness of interventions for promoting this outcome. Purpose. To identify the range and effectiveness of interventions on promoting meaningful activity participation among persons with experiences of homelessness. Method. We conducted a systematic review using the Joanna Briggs Institute methodology following PRISMA guidelines including a critical appraisal and narrative synthesis. Findings. Of 12,343 titles and abstracts screened, we included 12 studies. The authors of the included studies primarily used standardized measures of meaningful activity engagement. Critical appraisal scores ranged from 50.0 to 77.8. The most common interventions evaluated in the included studies were psychosocial interventions (n = 6; 50.0%), followed by case management and housing support interventions (n = 4; 33.3%) and Housing First (n = 2; 16.7%). While several interventions demonstrated effectiveness in promoting meaningful activity participation including psychosocial and case management interventions, Housing First, Critical Time Intervention, and a peer support intervention were found to be ineffective for promoting engagement in meaningful activity. Conclusion. Few intervention studies have been conducted that demonstrate effectiveness for promoting participation in meaningful activity for individuals during and following homelessness. Occupational therapy researchers and practitioners can build on existing evidence by developing and evaluating novel approaches by co-designing interventions in collaboration with persons with experiences of homelessness and service providers.
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Marshall CA, Phillips B, Holmes J, Todd E, Hill R, Panter G, Easton C, Landry T, Collins S, Greening T, O’Brien A, Jastak M, Ridge R, Goldszmidt R, Shanoff C, Laliberte Rudman D, Carlsson A, Aryobi S, Szlapinski J, Carrillo-Beck R, Pacheco N, Perez S, Oudshoorn A. "I can't remember the last time I was comfortable about being home": lived experience perspectives on thriving following homelessness. Int J Qual Stud Health Well-being 2023; 18:2176979. [PMID: 36803094 PMCID: PMC9946331 DOI: 10.1080/17482631.2023.2176979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
PURPOSE Strategies for preventing and ending homelessness are frequently measured by their effectiveness on indices of tenancy sustainment. To shift this narrative, we conducted research to identify what is needed to "thrive" following homelessness from the perspectives of persons with lived experience in Ontario, Canada. METHODS Conducted in the context of a community-based participatory research study aimed at informing the development of intervention strategies, we interviewed 46 persons living with mental illness and/or substance use disorder [n = 25 (54.3%) unhoused; n = 21 (45.7%) housed following homelessness] using qualitative interviews. A subsample of 14 participants agreed to engage in photovoice interviews. We analysed these data abductively using thematic analysis informed by health equity and social justice. RESULTS Participants described experiences of "living in a state of lack" following homelessness. This essence was expressed through four themes: 1) housing as part one of the journey to home; 2) finding and keeping "my people"; 3) meaningful activity as critical for thriving following homelessness; and 4) struggling to access mental health supports in the context of challenging circumstances. CONCLUSIONS Individuals struggle to thrive following homelessness in the context of insufficient resources. There is a need to build on existing interventions to address outcomes beyond tenancy sustainment.
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Affiliation(s)
- Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada,CONTACT Carrie Anne Marshall Assistant Professor Western University, Occupational Therapy Director, Social Justice in Mental Health Research Lab – www.sjmhlab.com Faculty of Health Sciences Elborn College, Room 2533 1201 Western Rd., London, ON, Canada N6H 1H1 Tel: 519 661-2111 Ext. 88956
| | - Brooke Phillips
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Julia Holmes
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Eric Todd
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | | | - George Panter
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Corinna Easton
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | | | - Sarah Collins
- Salvation Army London Centre of Hope, London, Canada
| | | | | | - Marlo Jastak
- Addiction and Mental Health Services Kingston, Frontenac, Lennox & Addington (KFLA), Kingston, Canada
| | | | - Rebecca Goldszmidt
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Chelsea Shanoff
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | | | | | - Suliman Aryobi
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Jessica Szlapinski
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Rozelen Carrillo-Beck
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Nicole Pacheco
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Canada
| | - Shauna Perez
- Addiction and Mental Health Services Kingston, Frontenac, Lennox & Addington (KFLA), Kingston, Canada
| | - Abe Oudshoorn
- School of Nursing, Western University, London, Canada
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Marshall CA, Cooke A, Gewurtz R, Barbic S, Roy L, Lysaght R, Kirsh B. Competencies for occupational therapy practice in homelessness: A Delphi study. Scand J Occup Ther 2023; 30:924-938. [PMID: 34784259 DOI: 10.1080/11038128.2021.2002404] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/04/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Homelessness is growing internationally, and resources to guide occupational therapy practice in this area are needed. OBJECTIVES To identify competencies needed for occupational therapists to support individuals during and following homelessness. MATERIAL AND METHODS We conducted a three-round Delphi study with occupational therapy practitioners and researchers with expertise in homelessness. RESULTS Of 35 potential participants, n = 16 participated in Round I, n = 20 participated in Round II, and n = 18 participated in Round III. Participants included occupational therapists and researchers in Canada, United States, Brazil, UK, Ireland and New Zealand. Consensus was achieved on a total of 93 competencies in 10 categories after 15 were eliminated in Rounds II and III. The categories with the greatest number of competencies included occupational knowledge (n = 18), followed by psychosocial competencies (n = 16). CONCLUSIONS AND SIGNIFICANCE This study represents the first to identify the competencies needed for occupational therapists working in the area of homelessness. Practitioners and educators are encouraged to view the identified competencies as a guide for the professional development of occupational therapists in this context. Stakeholders consulted for this study were able to communicate in English and situated in middle to high-income countries. As such, the competencies identified in this study only apply to these sociocultural contexts.
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Affiliation(s)
- Carrie Anne Marshall
- Occupational Therapy, Director, Social Justice in Mental Health Research Lab, Faculty of Health Sciences, Elborn College, Western University, London, Canada
| | - Abrial Cooke
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, Western University, Elborn College, London, Canada
| | - Rebecca Gewurtz
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Skye Barbic
- Occupational Science & Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Laurence Roy
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
| | - Rosemary Lysaght
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Bonnie Kirsh
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
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Marshall CA, Cooke A, Gewurtz R, Barbic S, Roy L, Ross C, Becker A, Lysaght R, Kirsh B. Bridging the transition from homelessness: Developing an occupational therapy framework. Scand J Occup Ther 2023; 30:953-969. [PMID: 34582719 DOI: 10.1080/11038128.2021.1962970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 06/10/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Occupational therapists support individuals experiencing homelessness in traditional roles, and occupational therapy positions focussed specifically on homelessness appear to be growing. OBJECTIVES To develop and refine a framework to guide occupational therapy practice and research in homelessness. METHOD We developed a framework and refined it through a stakeholder consultation process conducted with 17 international occupational therapy experts using an online survey. In this survey, we presented an initial framework and requested qualitative feedback. We analyzed this qualitative data using content analysis. RESULTS Stakeholder feedback was categorized into eight recommendations: (1) Revision to the 'four processes'; (2) Emphasizing social justice and systems-level advocacy; (3) Reflecting intersectionality; (4) Emphasizing meaningful activity; (5) Emphasizing peer support; (6) Incorporating a focus on independent living skills; (7) Increasing a focus on an activity for addressing substance misuse; and (8) Acknowledging cognitive and physical health. Each of these recommendations was incorporated into a refined version of this framework. These recommendations and a refined version of the framework are presented in this paper. CONCLUSIONS We have developed and refined a framework aimed at guiding practice and research in occupational therapy in homelessness that will be evaluated in future research. SIGNIFICANCE Though a range of frameworks exists for guiding the practice of occupational therapists more generally, this framework represents the first that is focussed specifically on guiding occupational therapy practice and research with individuals who experience homelessness. Research and practice implications are discussed.
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Affiliation(s)
- Carrie Anne Marshall
- School of Occupational Therapy, Social Justice in Mental Health Research Lab, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Abrial Cooke
- School of Occupational Therapy, Social Justice in Mental Health Research Lab, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Rebecca Gewurtz
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Skye Barbic
- Occupational Science & Occupational Therapy, Faculty of Medicine, Vancouver, Canada
| | - Laurence Roy
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Caitlin Ross
- Community Mental Health Services, Vancouver Island Health Authority, Victoria, Canada
| | - Alyssa Becker
- School of Occupational Therapy, Queens University, Dhaka, Bangladesh
- VHA Home Healthcare London, Canada
| | - Rosemary Lysaght
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Bonnie Kirsh
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
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Kerman N, Kidd SA, Mutschler C, Sylvestre J, Henwood BF, Oudshoorn A, Marshall CA, Aubry T, Stergiopoulos V. Managing high-risk behaviours and challenges to prevent housing loss in permanent supportive housing: a rapid review. Harm Reduct J 2023; 20:140. [PMID: 37775776 PMCID: PMC10542260 DOI: 10.1186/s12954-023-00873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023] Open
Abstract
Permanent supportive housing is an effective intervention for stably housing most people experiencing homelessness and mental illness who have complex support needs. However, high-risk behaviours and challenges are prevalent among this population and have the potential to seriously harm health and threaten housing tenures. Yet, the research on the relationship between high-risk issues and housing stability in permanent supportive housing has not been previously synthesized. This rapid review aimed to identify the housing-related outcomes of high-risk behaviours and challenges in permanent supportive housing settings, as well as the approaches used by agencies and residents to address them. A range of high-risk behaviours and challenges were examined, including risks to self (overdose, suicide/suicide attempts, non-suicidal self-injury, falls/fall-related injuries), and risks to multiple parties and/or building (fire-setting/arson, hoarding, apartment takeovers, physical/sexual violence, property damage, drug selling, sex trafficking). The search strategy included four components to identify relevant academic and grey literature: (1) searches of MEDLINE, APA PsycINFO, and CINAHL Plus; (2) hand searches of three journals with aims specific to housing and homelessness; (3) website browsing/searching of seven homelessness, supportive housing, and mental health agencies and networks; and (4) Advanced Google searches. A total of 32 articles were eligible and included in the review. Six studies examined the impacts of high-risk behaviours and challenges on housing tenancies, with overdose being identified as a notable cause of death. Twenty-six studies examined approaches and barriers to managing high-risk behaviours and challenges in PSH programs. These were categorized into eight types of approaches: (1) clinical, (2) relational/educational, (3) surveillant, (4) restrictive, (5) strategic, (6) design-based, (7) legal, and (8) self-defence. Consistent across all approaches was a lack of rigorous examination of their effectiveness. Further, some approaches that are legal, restrictive, surveillant, or strategic in nature may be used to promote safety, but may conflict with other program objectives, including housing stability, or resident empowerment and choice. Research priorities were identified to address the key evidence gaps and move toward best practices for preventing and managing high-risk behaviours and challenges in permanent supportive housing.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - John Sylvestre
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
| | - Benjamin F Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | | | - Tim Aubry
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Kerman N, Kidd SA, Voronov J, Marshall CA, O'Shaughnessy B, Abramovich A, Stergiopoulos V. Victimization, safety, and overdose in homeless shelters: A systematic review and narrative synthesis. Health Place 2023; 83:103092. [PMID: 37515964 DOI: 10.1016/j.healthplace.2023.103092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
The objective of this prospectively registered systematic review was to identify the factors that contribute to sense of safety, victimization, and overdose risk in homeless shelters, as well as groups that are at greater risk of shelter-based victimization. Fifty-five articles were included in the review. Findings demonstrated that fears of violence and other forms of harm were prominent concerns for people experiencing homelessness when accessing shelters. Service users' perceptions of shelter dangerousness were shaped by the service model and environment, interpersonal relationships and interactions in shelter, availability of drugs, and previous living arrangements. 2SLGBTQ+ individuals were identified as being at heightened risk of victimization in shelters. No studies examined rates of shelter-based victimization or tested interventions to improve safety, with the exception of overdose risk. These knowledge gaps hinder the establishment of evidence-based practices for promoting safety and preventing violence in shelter settings.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Voronov
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | | | - Alex Abramovich
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Adu J, Oudshoorn A, Anderson K, Marshall CA, Stuart H. Experiences of familial stigma among individuals living with mental illnesses: A meta-synthesis of qualitative literature from high-income countries. J Psychiatr Ment Health Nurs 2023; 30:208-233. [PMID: 36031879 DOI: 10.1111/jpm.12869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/29/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Mental illness stigma has been long acknowledged as a social problem that continues to persist and contribute to social exclusion of affected persons globally. Researchers have explored mental illness stigma in the general public and among health professionals, with little focus on stigma from family members and close relatives of persons with mental illnesses. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study appears to be the first meta-synthesis of familial mental illness stigma in high-income countries. Family members or close relatives of persons with mental illnesses may be perpetrators of stigma. That is, the family may enact stigma of mental illness against their relative to "save face" or by avoiding or narrowing their social contacts. Familial stigma is harmful due to the likely disaffection it brings within one's home environment. Familial mental stigma from the existing literature seems to be a by-product of public stigma and stigma by association WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further research is necessary to look at the existence of familial mental illness stigma as well as available policies to reduce its impact on affected individuals in high-income countries. Researchers in high-income countries should endeavour to examine the relationship between familial, public and associative stigma to establish baseline metrics to inform future anti-stigma programs seeking to reduce familial mental illness stigma. ABSTRACT INTRODUCTION: Familial mental illness stigma is a pervasive issue but very subtle in high-income countries. Familial mental illness stigma implies persons living with mental illnesses are discriminated against by their family members or close relatives. AIM/QUESTION This meta-synthesis explored the experiences of familial stigma among individuals living with mental illnesses in high-income countries, focusing on empirical literature, to understand the breadth of current literature and ways to reduce this form of stigma. METHOD We conducted a meta-synthesis through a structured search of qualitative data from six electronic databases (Sociological Abstract, CINAHL, Medline, PsycINFO, Google Scholar and Embase). Inclusion criteria comprised: empirical primary research, primary technique for data collection is qualitative, studies published in a peer-reviewed journal in the English language between 2000 and 2020, studies reported on experiences of familial mental illness stigma, and studies conducted in high-income countries. The exclusion criteria were as follows: all grey literature, studies not written in English and non-peer-reviewed, studies not focused on familial mental illness stigma, quantitative peer-reviewed articles on the related concept and peer-reviewed articles on the related topic before the year 2000. RESULTS The study identified only 28 peer-reviewed articles on the topic within two decades. Concealment of familial stigma was found to be detrimental due to the potential for alienation within one's home environment. Disclosure and social contact within the family system were considered as critical interventions to provide some safety nets for individuals with mental illnesses. DISCUSSION AND IMPLICATIONS FOR PRACTICE The paucity of studies over the review period highlights the need for further attention to support optimal environments for persons living with mental illnesses. Families' understanding of the difficulties of mental illness stigma is vital to supporting the development of policies and interventions towards the avoidance of social exclusion within societies. Families should make concerted efforts to reduce stigma, and this includes within the family system. Education and training approaches around mental illness-related stigma should involve individuals with lived experience and their families, as well as service providers and the general public.
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Affiliation(s)
- Joseph Adu
- Department of Health and Rehabilitation Sciences, Elborn College, Western University, London, Ontario, Canada
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Kelly Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Carrie Anne Marshall
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Heather Stuart
- Department of Public Health Sciences, Department of Psychiatry and the School of Rehabilitation Therapy, Queens University, Kingston, Ontario, Canada
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Marshall CA, Gewurtz R, Holmes J, Phillips B, Aryobi S, Smith-Carrier T. Meaningful Activity, Psychosocial Wellbeing, and Poverty During COVID-19: A Longitudinal Study. Can J Occup Ther 2023; 90:136-151. [PMID: 36959694 PMCID: PMC10040486 DOI: 10.1177/00084174231160950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Background: Only a few studies have explored experiences of meaningful activity and associations with psychosocial wellbeing during COVID-19. None reflect a Canadian context or focus on persons living in poverty. Purpose: To identify experiences and associations between meaningful activity and psychosocial wellbeing for persons living in poverty during the first year of COVID-19. Method: We delivered a quantitative survey at three time points during the first year of the pandemic supplemented by qualitative interviews at Time(T) 1 and 1 year later at T3. Findings: One hundred and eight participants completed T1 surveys, and 27 participated in qualitative interviews. Several statistically significant correlations between indices of meaningful activity engagement and psychosocial wellbeing were identified across T1-T3. Meaningful activity decreased from T1-T3 [X2 (2, n = 49) = 9.110, p < .05], with a significant decline from T2-T3 (z = -3.375, p < .001). In T1 qualitative interviews, participants indicated that physical distancing exacerbated exclusion from meaningful activities early in the pandemic. At T3 (1 year later), they described how classist and ableist physical distancing policies layered additional burdens on daily life. Implications: Meaningful activity engagement and psychosocial wellbeing are closely associated and need to be accounted for in the development of pandemic policies that affect persons living in low income. Occupational therapists have a key role in pandemic recovery.
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Affiliation(s)
- Carrie Anne Marshall
- Carrie Anne Marshall, Occupational Therapy, Western University, Social Justice in Mental Health Research Lab, Faculty of Health Sciences, Elborn College, 1201 Western Rd., London, ON, N6H 1H1, Canada.
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Abstract
PURPOSE Studying humor in the rehabilitation professions is important given its positive effects on health and well-being. We conducted a scoping review to understand how the use of humor has been explored in the existing literature in four rehabilitation professions. The rehabilitation professions included audiology, speech-language pathology, physical therapy, and occupational therapy. MATERIALS AND METHODS The five-stage method identified by Arksey and O'Malley was used to conduct this review. Six databases were searched. We included 57 articles in our final review, summarized in a narrative synthesis. RESULTS We generated seven themes in our analysis: (1) humour as a management strategy in therapy; (2) humour as a power establisher vs. equalizer; (3) humour as a coping mechanism in rehabilitation; (4) conceptualizations of non-verbal humor cues in therapy; (5) Is humour trainable? (6) Humor used to foster group cohesion; and (7) Attitudes and beliefs surrounding humor practice. CONCLUSIONS Our findings emphasize the importance of using humor in the rehabilitation professions, and the ways in which humor is conceptualized in a multitude of ways for both clinician and client. Future work is needed to further understand the presence and use of humor in rehabilitation professions.IMPLICATIONS FOR REHABILITATIONIn a scoping review of the literature, this study showed that humor was used mainly positively in rehabilitation by the included professions of audiology, speech-language pathology, physical therapy, and occupational therapy and contributed to a sense of belonging.Humor may be an effective way to improve management of client/clinician relations as well as improving group cohesion in rehabilitation settings.In the rehabilitation professions of audiology, speech-language pathology, physical therapy, and occupational therapy, non-verbal humor cues were used in instances where communication was difficult or impaired for clients.
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Affiliation(s)
- Marisa L Kfrerer
- Health & Rehabilitation Sciences, University of Western Ontario, London, Canada
| | - Debbie Laliberte Rudman
- School of Occupational Therapy & Graduate Program in Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Julie Aitken Schermer
- Management and Organizational Studies, Faculty of Social Science, University of Western Ontario, London, Canada
| | - Marnie Wedlake
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Michelle Murphy
- School of Occupational Therapy, University of Western Ontario, London, Canada
| | - Carrie Anne Marshall
- School of Occupational Therapy & Graduate Program in Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Canada
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Marshall CA, Crowley P, Carmichael D, Goldszmidt R, Aryobi S, Holmes J, Easton C, Isard R, Murphy S. Effectiveness of Suicide Safety Planning Interventions: A Systematic Review Informing Occupational Therapy. Can J Occup Ther 2022; 90:208-236. [PMID: 36324257 DOI: 10.1177/00084174221132097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background. Suicide safety planning (SSP) is a suicide prevention approach that involves developing a collaborative plan between a service provider such as an occupational therapist and a person who is at risk of suicide. Purpose. To synthesize effectiveness studies on SSP. Method. Using the Joanna Briggs Institute methodology, we conducted a systematic review of effectiveness studies including a: (1) title and abstract screening; (2) full-text review; (3) critical appraisal; and (4) narrative synthesis. Findings. We included 22 studies. Critical appraisal scores ranged from 38.5 to 92.3 (m = 63.7). The types of interventions included were: standard and enhanced SSP (n = 11); electronically delivered SSP (n = 5); and SSP integrated with other approaches (n = 6). Only three studies identified meaningful activity as a component of SSP. Evidence across a range of studies indicates that SSP is effective for reducing suicide behavior (SB) and ideation (SI). While some studies have demonstrated effectiveness for reducing symptoms of mental illness, promoting resilience and service use, the number of studies exploring these outcomes is currently limited. Implications. Occupational therapists support individuals expressing SI, and SSP is a necessary skill for practice.
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Marshall CA, Phillips B, Holmes J, Todd E, Hill R, Panter G, Easton C, Landry T, Collins S, Greening T, O'Brien A, Jastak M, Ridge R, Goldszmidt R, Shanoff C, Laliberte Rudman D, Carlsson A, Aryobi S, Perez S, Oudshoorn A. 'We stick people in a house and say okay, you're housed. The problem is solved': A qualitative study of service provider and organisational leader perspectives on thriving following homelessness. Health Soc Care Community 2022; 30:e6018-e6029. [PMID: 36128972 DOI: 10.1111/hsc.14035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/27/2022] [Accepted: 09/12/2022] [Indexed: 06/15/2023]
Abstract
Research aimed at identifying and evaluating approaches to homelessness has predominately focused on strategies for supporting tenancy sustainment. Fewer studies focus on strategies for enabling thriving following homelessness, and the perspectives of service providers and organisational leaders (SPOL) on this topic are rare. We conducted this study in the context of a community-based participatory research project in two cities in Ontario, Canada. This research was aimed at identifying the strengths and challenges of existing supports in enabling thriving following homelessness, followed by co-designing a novel intervention alongside persons with lived experience of homelessness (PWLEH) and SPOL. The current study presents the findings of interviews conducted in 2020-2021 with SPOL in organisations serving PWLEH. We interviewed 60 individuals including service providers (n = 38; 63.3%) and organisational leaders (n = 22; 36.7%) using semi-structured qualitative interviews. Interviews were conducted and recorded on Zoom to align with physical distancing protocols associated with the COVID-19 pandemic. Recordings were transcribed verbatim and analysed abductively informed by the lenses of social justice and health equity. The essence of our findings is represented by a quote from a research participant: 'We stick people in a house and say okay, you're housed. The problem is solved'. This essence was expressed through five themes: (1) stuck in a system that prevents thriving, (2) substance use as an important coping strategy that prevents tenancy sustainment and thriving, (3) the critical importance of targeting community integration following homelessness, (4) incorporating peer expertise as imperative and (5) people need to be afforded options in selecting housing and services following homelessness. Our findings indicate that SPOL envision possibilities of thriving following homelessness yet are embedded within a system that often prevents them from supporting individuals who are leaving homelessness to do so. Research, practice and policy implications are discussed.
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Affiliation(s)
- Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Brooke Phillips
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Julia Holmes
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Eric Todd
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - River Hill
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - George Panter
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Corinna Easton
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Terry Landry
- Providence Care Hospital, Kingston, Ontario, Canada
| | - Sarah Collins
- Salvation Army London Centre of Hope, London, Ontario, Canada
| | | | - Ashley O'Brien
- HIV and Aids Regional Services, Kingston, Ontario, Canada
| | - Marlo Jastak
- Addiction and Mental Health Services Kingston, Frontenac, Lennox & Addington (KFLA), Kingston, Ontario, Canada
| | | | - Rebecca Goldszmidt
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Chelsea Shanoff
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | | | | | - Suliman Aryobi
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Shauna Perez
- Addiction and Mental Health Services Kingston, Frontenac, Lennox & Addington (KFLA), Kingston, Ontario, Canada
| | - Abe Oudshoorn
- School of Nursing, Western University, London, Ontario, Canada
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Marshall CA, Boland L, Westover LA, Goldszmidt R, Bengall J, Aryobi S, Isard R, Easton C, Gewurtz R. Effectiveness of employment-based interventions for persons experiencing homelessness: A systematic review. Health Soc Care Community 2022; 30:2142-2169. [PMID: 35748222 DOI: 10.1111/hsc.13892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/26/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
Employment is frequently desired by persons who experience homelessness yet is often elusive. Little is known about the range and effectiveness of employment-based interventions evaluated in existing literature on key psychosocial outcomes including employment participation, mental well-being, housing tenure, community integration and substance use. To identify and synthesise existing studies, we conducted a systematic review of effectiveness using the methodology proposed by the Joanna Briggs Institute (JBI) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Following the removal of duplicates, we screened 13,398 titles and abstracts, and reviewed 79 studies at the full-text review stage using two independent raters. A total of 16 studies met criteria for inclusion in a narrative synthesis and were subjected to critical appraisal. The majority of studies were conducted in the US (n = 14; 87.5%) with other studies published in Canada (n = 1; 6.3%) and Australia (n = 1; 6.3%). Interventions evaluated in existing studies included combined substance use and vocational skills interventions (n = 7; 43.8%), supported employment (n = 6; 37.5%), and integrated supports including an employment component (n = 3; 18.8%). The effectiveness of these interventions on employment, mental well-being, housing tenure, community integration, and substance use is presented. Findings suggest that research evaluating employment interventions for persons who experience homelessness is in an early stage of development. Researchers and practitioners may consider collaborating with persons with lived experiences of homelessness and practitioners in co-designing and modifying existing approaches to target key outcomes more effectively. Policymakers may consider allocating resources to such initiatives to further the development of practice and research aimed at supporting persons who experience homelessness to secure and sustain employment during and following homelessness.
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Affiliation(s)
- Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Leonie Boland
- Faculty of Health and Human Sciences, Occupational Therapy, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | - Lee Ann Westover
- Teacher's College, Columbia University, New York City, New York, USA
| | - Rebecca Goldszmidt
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Jordana Bengall
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Suliman Aryobi
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Roxanne Isard
- Disciplinary Coordinator for the Faculty of Information & Media Studies & the Faculty of Education, Allyn & Betty Taylor Library, Western University, London, Ontario, Canada
| | - Corinna Easton
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Rebecca Gewurtz
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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13
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Marshall CA, McKinley C, Costantini J, Murphy S, Lysaght R, Hart BP. 'The Big Island Model': Resident experiences of a novel permanent supportive housing model for responding to rural homelessness. Health Soc Care Community 2022; 30:e5047-e5061. [PMID: 35880677 DOI: 10.1111/hsc.13920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 06/09/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Research on rural homelessness focuses primarily on describing the experiences and prevalence of homelessness in rural contexts, with little focus on intervention strategies. We conducted a case study of the 'Big Island Model' (BIM), a novel approach to providing housing and support to individuals experiencing homelessness that has been developed for, and reflects, a rural context. We interviewed 13 participants (n = 10 men; n = 3 women) supported by the BIM using mixed interviews including qualitative and quantitative components exploring experiences of living within this model and aspects of psychosocial well-being. Descriptive statistics were calculated to represent demographic data and participants' scores on standardised measures. Wilcoxon signed-rank tests were conducted with threshold scores and population norms derived from existing literature to identify any differences between residents' median scores on each standardised scale and scores derived from published literature. Qualitative data were analysed using thematic analysis. On measures of meaningful activity, residents reported significantly lower levels of boredom (p < 0.01) and a greater degree of engagement in productivity (p < 0.01) compared with participants in other studies. Mental well-being was reported to be higher (p < 0.05) and drug use was significantly lower than a low-moderate range (p < 0.01). Community integration scores revealed significantly lower physical integration (p < 0.05) and significantly higher psychological integration than individuals who had transitioned to housing in another study (p < 0.001). Our analysis of qualitative interviews resulted in the identification of a central essence characterising residents' experiences: 'Becoming Through Belonging'. This essence was represented by four distinct themes: (1) the healing qualities of nature; (2) being meaningfully occupied; (3) living in a mutually supportive environment; and (4) this place is here to help.
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Affiliation(s)
- Carrie Anne Marshall
- Faculty of Health Sciences, Elborn College, Occupational Therapy, Western University, London, Ontario, Canada
| | | | | | - Susanne Murphy
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Rosemary Lysaght
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Brian P Hart
- Kate's Rest Foundation, Demorestville, Ontario, Canada
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14
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Easton C, Oudshoorn A, Smith-Carrier T, Forchuk C, Marshall CA. The experience of food insecurity during and following homelessness in high-income countries: A systematic review and meta-aggregation. Health Soc Care Community 2022; 30:e3384-e3405. [PMID: 35869792 DOI: 10.1111/hsc.13939] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/30/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Homelessness is a pervasive challenge caused by poverty which continues to grow in economically developed countries, posing significant health impacts (Fazel et al., Lancet, 384: 1529-1540, 2014). While food security related to poverty and low income has been investigated, this review specifically explores the experience of food security during and following homelessness. Given the fact that the health of individuals who experience homelessness is known to be poor and the importance of nutrition, this is a necessary contribution. Informed by a health equity lens, this review synthesises the findings and quality of the literature regarding experiences of food security during and following homelessness in high-income countries. We used the Joanna Briggs Institute methodology, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Qualitative studies published to date were obtained from six databases. We conducted a meta-aggregation of existing qualitative findings. Twenty-four studies on 462 participants were included in the review. Through meta-aggregation four themes were created: (1) imposed food options as a determinant of health out of my control; (2) obtaining food for survival despite stigma or other consequences; (3) situated within a system that maintains food insecurity; and (4) surviving hardships. Persons during and following homelessness in high-income countries face multiple challenges when securing food while situated in an oppressive system that lacks choice. Despite this, persons who have experienced homelessness demonstrate resilience by finding ways to meet their basic needs in the face of imposed barriers. Implications for research, policy and practice are offered.
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Affiliation(s)
- Corinna Easton
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
| | - Abe Oudshoorn
- School of Nursing, Western University, London, Ontario, Canada
| | - Tracy Smith-Carrier
- School of Humanitarian Studies, Royal Roads University, Victoria, British Columbia, Canada
| | - Cheryl Forchuk
- School of Nursing, Western University, London, Ontario, Canada
| | - Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, School of Occupational Therapy, Western University, London, Ontario, Canada
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15
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Carrillo Beck R, Szlapinski J, Pacheco N, Sabri Laghaei S, Isard R, Oudshoorn A, Marshall CA. Violence and victimisation in the lives of persons experiencing homelessness who use methamphetamine: A scoping review. Health Soc Care Community 2022; 30:1619-1636. [PMID: 35032080 DOI: 10.1111/hsc.13716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/30/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Methamphetamine (MA) use among individuals who experience homelessness has tripled in recent years. This is a problematic trend given the harmful impacts of this substance on health and social well-being. While there is a large body of literature on the relationship between substance use and trauma, little is known about the scope of existing empirical literature exploring this topic related to MA use. Anecdotally, MA is frequently associated with violence and victimisation, which may be related to stigma associated with using MA. However, little is known about the scope of empirical literature exploring violence and victimisation in the lives of individuals who experience homelessness and use MA. We conducted a scoping review to fill this gap in existing literature using Arksey and O'Malley's methodological framework. Our search was conducted between January 2021 and March 2021 and was deployed in seven databases: Medline, Embase, CINAHL, PsycINFO, Sociological Abstracts, Nursing and Allied Health and AMED. Two independent raters screened 700 titles and abstracts after the removal of duplicates. A total of 54 articles were subjected to a full-text review and 20 articles met the inclusion criteria. We generated two themes: methamphetamine and victimisation and challenging behaviours. Six (30%) of the included articles explored MA use in relation to violence, while 18 (90%) explored experiences of victimisation among persons experiencing homelessness. Our findings highlight that individual who experience homelessness and use MA are particularly vulnerable to experiences of trauma. Though existing literature does acknowledge the challenging behaviour associated with MA use, only three existing studies demonstrated a relationship between MA use and physical violence. Research exploring the impacts of MA use on victimisation among persons who experience homelessness, and the development of interventions for managing challenging behaviours associated with MA use are needed.
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Affiliation(s)
- Rozelen Carrillo Beck
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, London, Ontario, Canada
| | - Jessica Szlapinski
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, London, Ontario, Canada
| | - Nicole Pacheco
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, London, Ontario, Canada
| | - Shahriar Sabri Laghaei
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, London, Ontario, Canada
| | - Roxanne Isard
- Weldon Library, Western University, London, Ontario, Canada
| | - Abe Oudshoorn
- School of Nursing, Western University, London, Ontario, Canada
| | - Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, London, Ontario, Canada
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Marshall CA, Murphy M, Marchiori K, Aryobi S, Wener P, White C, Larivière N, Isard R, Chohan A, Forhan M, Kiepek N, Barbic S, Sarunsky V, Moll S. Psychotherapy Within Occupational Therapy Literature: A Scoping Review. Can J Occup Ther 2022; 89:376-394. [PMID: 35881541 DOI: 10.1177/00084174221102732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Recent changes in the Canadian regulatory landscape have prompted reflections on the role and scope of occupational therapy in the provision of psychotherapy. Purpose. To document how psychotherapy has been explored in occupational therapy literature. Method. We conducted a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review (PRISMA-ScR) guidelines by searching eight databases (e.g., Medline, AMED, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Sociological Abstracts, and ProQuest Dissertations & Theses). Articles included at the full-text stage were subjected to a narrative synthesis. Findings. A total of 207 articles met the criteria for inclusion, spanning 93 years. 47.3% of these articles represented non-empirical literature, with only 14% representing effectiveness studies, suggesting that this body of literature remains in an early stage of development. Implications. Occupational therapists have been writing about and practicing psychotherapy for nearly a century, yet there remains an important opportunity to develop and evaluate occupation-based psychotherapy approaches. Effectiveness studies are needed.
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Adu J, Oudshoorn A, Anderson K, Marshall CA, Stuart H. Social Contact: Next Steps in an Effective Strategy to Mitigate the Stigma of Mental Illness. Issues Ment Health Nurs 2022; 43:485-488. [PMID: 34652979 DOI: 10.1080/01612840.2021.1986757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
People living with mental illnesses and their families may conceal their conditions to avoid prejudice and discrimination. Stigma often prevents people from receiving adequate health care and other social support services which could exacerbate social and health consequences such as unemployment, homelessness, substance use, and compulsory hospitalization. In this paper, we discuss social contact as a promising anti-stigma strategy for enhancing social interactions among people with mental illnesses, their families, and those without mental illnesses. In particularly, we consider next steps for an approach that works to reduce the stigma-related burden of mental illness. For social contact to be effective in reducing mental illness stigma, it requires broad social buy-in as well as implementation within care systems. Engagement with this approach can be driven through diverse contact-based education using collaborative efforts of society, academic institutions, policy-makers, health professionals, media, and governments. Ultimately, this work aims to consider the next steps in enacting social contact as an anti-stigma strategy through direct interventions and contact-based education. The success of this approach requires pragmatic public policies to support its implementation.
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Affiliation(s)
- Joseph Adu
- Department of Health and Rehabilitation Sciences, Elborn College, Western University, London, Ontario, Canada
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Kelly Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Carrie Anne Marshall
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Heather Stuart
- Department of Public Health Sciences, Queens University, Kingston, Ontario, Canada.,Department of Psychiatry and the School of Rehabilitation Therapy, Queens University, Kingston, Ontario, Canada
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Adu J, Oudshoorn A, Anderson K, Marshall CA, Stuart H, Stanley M. Policies and Interventions to Reduce Familial Mental Illness Stigma: A Scoping Review of Empirical Literature. Issues Ment Health Nurs 2021; 42:1123-1137. [PMID: 34319817 DOI: 10.1080/01612840.2021.1936710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although research to date has shown that there can be no health or sustainable development without good mental health, mental illness continues to significantly impact societies. A major challenge confronting people with mental illnesses and their families is the stigma that they endure. In this study, empirical literature was reviewed to assess policies and interventions that seek to reduce familial mental illness stigma across four countries. We used Arksey and O'Malley methodological framework, and a qualitative content analysis was employed to augment the descriptive data extracted. Seven studies published between 2000 and 2020 were analyzed. We propose herein three themes that align with interventions to reduce familial mental illness stigma: transformative education, sharing and disclosure, and social networking and support. The findings indicate that persuasive and purposeful education directed at the public to correct misconceptions surrounding mental illness, with attention to language, may help in reducing familial mental illness stigma. Disclosure of mental illness is encouraged among persons with mental illnesses and their families as a strategy to enhance mutual understanding. Social sharing also affords persons with mental illnesses opportunities to engage with their peers at different levels within the public sphere. Apart from these recommendations, we have noted a paucity of broad governmental-level policies and interventions to comprehensively address the negative attitudes of families toward their relatives. Future work must address this gap to identify effective interventions to create healthier and supportive environments that address familial mental illness stigma.
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Affiliation(s)
- Joseph Adu
- Department of Health and Rehabilitation Sciences, Elborn College, Western University, London, Ontario, Canada
| | - Abram Oudshoorn
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Kelly Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Carrie Anne Marshall
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Heather Stuart
- Department of Public Health Sciences, Department of Psychiatry, and the School of Rehabilitation Therapy, Queens University, Kingston, Ontario, Canada
| | - Meagan Stanley
- Teaching and Learning Librarian, Health & Medicine Disciplinary Coordinator, Western University, London, Ontario, Canada
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19
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Marshall CA, Boland L, Westover LA, Marcellus B, Weil S, Wickett S. Effectiveness of interventions targeting community integration among individuals with lived experiences of homelessness: A systematic review. Health Soc Care Community 2020; 28:1843-1862. [PMID: 32458462 DOI: 10.1111/hsc.13030] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/13/2020] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Abstract
Community integration (CI) has been identified as a key outcome of programs designed to improve the lives of homeless and recently housed individuals (Gaetz, The State of Homelessness in Canada 2016, 2016). Although researchers have explored the extent to which Housing First (HF) impacts on social integration (Quilgars & Pleace, Soc. Incl., 4, 2016), little is known about the range and effectiveness of other interventions on CI more broadly. We conducted a systematic review of experimental studies using Joanna Briggs Institute (JBI) guidelines. Our search strategy was deployed in six databases: EMBASE, CINAHL, PsychINFO, Medline, Sociological Abstracts, and Proquest Dissertations and Theses. Our search was initiated in 2017 and updated on May 5, 2019. Using the definition of CI identified by Wong & Solomon (Ment. Health Serv. Res., 4:13-28, 2002), two independent raters screened 14,158 titles and abstracts after the removal of duplicates. A total of 157 articles were subjected to full-text review. Studies published in the English language and involving participants of any age were included. We conducted a critical appraisal of 25 studies using the JBI checklists for quasi-experimental and randomised controlled trials (Tufanaru, Joanna Briggs Institute Reviewers Manual, 2017), and subsequently excluded four studies as they did not meet a pre-established quality threshold score of 50/100. A total of 21 studies were included in a narrative synthesis. Critical appraisal scores ranged from 53.8-100 (Mdn = 69.2). Interventions evaluated in existing literature included housing and housing support interventions (n = 9), HF (n = 5), psychosocial interventions (n = 5), and employment interventions (n = 2). A meta-analysis could not be performed due to the heterogeneity of outcomes in included studies. Aspects of CI measured by researchers included social (n = 17), psychological (n = 6), and physical (n = 4) integration. Studies that evaluated HF and housing and housing support interventions demonstrated surprisingly mixed or a lack of effectiveness for promoting CI. Psychosocial interventions were the most promising, specifically those which incorporated an element of peer support. Findings of literature included in this review suggests that there is inconsistency in the extent to which existing interventions are effectively targeting CI as an outcome. Furthermore, we contend that existing systems-level interventions, including HF and permanent supportive housing alone may not be enough to promote CI among homeless and formerly homeless individuals. Future research should focus on the development and evaluation of interventions that more effectively target this critical construct.
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Affiliation(s)
- Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, Occupational Therapy, Faculty of Health Sciences, Elborn College, Western University, London, ON, Canada
| | - Leonie Boland
- Occupational Therapy, Faculty of Health and Human Sciences, University of Plymouth, Peninsula Allied Health Centre, Plymouth, UK
| | | | | | - Silka Weil
- St. Anne's Hospital, Montreal, QC, Canada
| | - Sarah Wickett
- Bracken Health Sciences Library, Queen's University, Kingston, ON, Canada
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Marshall CA, Keogh-Lim D, Koop M, Barbic S, Gewurtz R. Meaningful Activity and Boredom in the Transition from Homelessness: Two Narratives. Can J Occup Ther 2020; 87:253-264. [DOI: 10.1177/0008417420941782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Few studies have examined boredom and meaningful activity during the transition from homeless to housed, and those that exist are retrospective. Purpose. To prospectively examine how meaningful activities and boredom are experienced during the process of leaving homelessness. Method. Using a mixed-methods case study design, we interviewed 13 homeless participants at baseline using a 92-item quantitative interview, followed by a semi-structured qualitative interview. Two participants were located six months later and were interviewed again using the same protocol. Quantitative data are presented descriptively. Qualitative data were analyzed using narrative analysis. Findings. Qualitative data revealed two unique narratives of boredom and meaningful activity engagement in the transition from homeless to housed, with opportunities for engagement in meaningful activity limited largely by the social and housing environments in which both participants were situated. Quantitative data indicates that boredom and meaningful activity changed little before and after homelessness. At both baseline and follow-up, boredom scores for both participants were comparable to a sample of participants who were exposed to a “boredom” condition in an experimental study ( Hunter, Dyer, Cribbie, & Eastwood, 2016 ). Implications. Formerly homeless persons may struggle to engage in meaningful activity, and boredom may negatively affect mental well-being. Research with larger samples is needed.
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Marshall CA, Boland L, Westover LA, Isard R, Gutman SA. A systematic review of occupational therapy interventions in the transition from homelessness. Scand J Occup Ther 2020; 28:171-187. [PMID: 32476575 DOI: 10.1080/11038128.2020.1764094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although systematic and scoping reviews have identified a range of interventions for persons experiencing homelessness, no known reviews have captured the range and quality of intervention studies aimed at supporting a transition from homelessness. OBJECTIVES To capture the range and quality of occupational therapy intervention studies aimed at supporting a transition to housing following homelessness. METHOD Using Joanna Briggs Institute (JBI) guidelines, we conducted a systematic review including a critical appraisal and narrative synthesis of experimental studies. RESULTS Eleven studies were included. Critical appraisal scores ranged from 33.3 to 88.9 of a possible score of 100 (Mdn = 62.5; IQR = 33.4). The majority of studies evaluated interventions for the development of life skills (n = 9; 81.8%), and all were conducted in the USA. Several of the included studies were exploratory evaluation and feasibility studies, and all were quasi-experimental in design. Only three studies (27.2%) incorporated a control group. Intervention strategies included (1) integrated group and individual life skills interventions (n = 6); (2) group-based life skills interventions (n = 3); and (3) psychosocial and consultative interventions (n = 2). CONCLUSIONS Research evaluating occupational therapy interventions aimed at supporting homeless individuals as they transition to housing is in an early stage of development. SIGNIFICANCE Implications for research and practice are discussed.
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Affiliation(s)
- Carrie Anne Marshall
- Occupational Therapy, Faculty of Health Sciences, Elborn College, Western University, London, ON, Canada
| | - Leonie Boland
- Occupational Therapy, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | | | - Roxanne Isard
- Faculty of Information & Media Studies & the Faculty of Social Sciences, Allyn & Betty Taylor Library, Western University, London, ON, Canada
| | - Sharon A Gutman
- Programs in Occupational Therapy, Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, USA
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22
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Marshall CA, Boland L, Westover LA, Wickett S, Roy L, Mace J, Gewurtz R, Barbic S, Kirsh B. Occupational experiences of homelessness: A systematic review and meta-aggregation. Scand J Occup Ther 2019; 27:394-407. [DOI: 10.1080/11038128.2019.1689292] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Carrie Anne Marshall
- Occupational Therapy, Faculty of Health Sciences, Elborn College, Western University, London, Canada
| | - Leonie Boland
- Occupational Therapy, Faculty of Health and Human Sciences, Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK
| | | | - Sarah Wickett
- Bracken Health Sciences Library, Queen’s University, Kingston, Canada
| | - Laurence Roy
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
| | - Jenni Mace
- Department of Occupational Science and Therapy, Auckland University of Technology, Auckland, New Zealand
| | - Rebecca Gewurtz
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - Skye Barbic
- Occupational Science & Occupational Therapy, Faculty of Medicine, Vancouver, Canada
| | - Bonnie Kirsh
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
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Affiliation(s)
| | - Emma McIntosh
- Addiction and Mental Health Services, Kingston, ON, Canada. At the time of this study, Emma McIntosh was a student in the MSc.OT program at Queen's University, Kingston, ON, Canada
| | - Almas Sohrabi
- Addiction and Mental Health Services, Kingston, ON, Canada. At the time of this study, Emma McIntosh was a student in the MSc.OT program at Queen's University, Kingston, ON, Canada
| | - Adam Amir
- At the time of this study, Almas Sohrabi was a student in the MSc.OT program at Queen's University, Kingston, ON
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Marshall CA, Davidson L, Li A, Gewurtz R, Roy L, Barbic S, Kirsh B, Lysaght R. Boredom and Meaningful Activity in Adults Experiencing Homelessness. Am J Occup Ther 2019. [DOI: 10.5014/ajot.2019.73s1-po7025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 04/06/19
Boredom is an under-acknowledged phenomenon in the literature on homelessness, and of particular relevance to OT and occupational science. This study explores boredom experienced by homeless persons, confirming that it is a serious challenge faced by this population that imposes a negative impact on mental health and well-being. Future research with larger sample sizes will allow a finer analysis of the ways in which boredom impacts homeless persons.
Primary Author and Speaker: Carrie Anne Marshall
Contributing Authors: Lisa Davidson, Andrea Li, Rebecca Gewurtz, Laurence Roy, Skye Barbic, Bonnie Kirsh, Rosemary Lysaght
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Affiliation(s)
| | | | - Andrea Li
- Karp Rehabilitation, Vancouver, BC, Canada
| | | | | | - Skye Barbic
- University of British Columbia, Vancouver, BC, Canada
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Marshall CA, Tjornstrand C, Drake F, Downs E, Eerkes R. Psychosocial Needs of Women Living in Social Housing. Am J Occup Ther 2019. [DOI: 10.5014/ajot.2019.73s1-rp201c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 04/05/19
Women in social housing are situated in environments that may impose negative impacts on their psychosocial health. We used an exploratory, sequential, mixed-methods design to identify the met and unmet psychosocial needs and disabilities experienced by this population. Several psychosocial needs of the women went unmet, and disability was significant. Participants identified several areas for how their needs could be addressed. Research and practice implications will be explored.
Primary Author and Speaker: Carrie Anne Marshall
Contributing Authors: Carina Tjornstrand, Fiona Drake, Emily Downs, Rebecca Eerkes
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Affiliation(s)
| | | | - Fiona Drake
- Kingston Frontenac Housing Corporation, Kingston, ON, Canada
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Marshall CA, Westover L, Boland L, Gewurtz R, Kirsh B, Roy L, DipNZOT JM, Wickett S. Occupational Experience and Homelessness: A Systematic Review and Meta-Aggregation. Am J Occup Ther 2019. [DOI: 10.5014/ajot.2019.73s1-po2002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 04/04/19
A number of studies have emerged in the OT, occupational science, and interdisciplinary literature that explore the occupational and time use experiences of homeless persons. Since these studies have begun to accumulate, it is advantageous to provide a summary of their findings to direct future occupation-based research in the area of homelessness. Using JBI guidelines, we conducted a systematic review and performed a meta-aggregation of included studies.
Primary Author and Speaker: Carrie Anne Marshall
Additional Authors and Speakers: Lee Westover
Contributing Authors: Leonie Boland, Rebecca Gewurtz, Bonnie Kirsh, Laurence Roy, Jenni Mace, Sarah Wickett
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Marshall CA, Davidson L, Li A, Gewurtz R, Roy L, Barbic S, Kirsh B, Lysaght R. Boredom and meaningful activity in adults experiencing homelessness: A mixed-methods study. Can J Occup Ther 2019; 86:357-370. [PMID: 30987447 DOI: 10.1177/0008417419833402] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND. Boredom has been reported as a frequent problem experienced by homeless persons, with implications for mental and social well-being. PURPOSE. This study aimed to explore the nature and impact of boredom in the lives of homeless and formerly homeless persons. METHOD. A mixed-methods design was used to engage 13 participants in a structured 92-item quantitative interview using six standardized measures, followed by a semistructured qualitative interview. Correlational analyses were performed with the data compiled from the quantitative interviews, and grounded theory strategies were used to analyze our qualitative data. The two analyses were integrated at the stage of interpretation. FINDINGS. Boredom was described as a profound and pervasive experience for homeless persons, imposing deleterious impacts on mental well-being and driving substance use. A strong positive correlation between meaningful activity and mental well-being (r s = .767, p <. 01) and a strong negative correlation between boredom and belonging in one's community (r s = -.771, p < .01) were identified. IMPLICATIONS. Boredom is a critical topic of study for occupational therapy in the area of homelessness. Future research is needed to design and test interventions to optimize the mental well-being, participation, and social connectedness of this population.
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Marshall CA, Nalder E, Colquhoun H, Lenton E, Hansen M, Dawson DR, Zabjek K, Bottari C. Interventions to address burden among family caregivers of persons aging with TBI: A scoping review. Brain Inj 2018; 33:255-265. [DOI: 10.1080/02699052.2018.1553308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Emily Nalder
- Department of Occupational Science and Occupational Therapy & Rehabilitation Sciences Institute, University of Toronto, March of Dimes Canada, Toronto, ON, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Canada
| | - Erica Lenton
- Faculty Liaison & Instruction Librarian, Gerstein Library Science Information Centre, University of Toronto, Canada
| | - Melissa Hansen
- Advance Concussion Clinic, Vancouver, British Columbia, Canada
| | - Deirdre R. Dawson
- Department of Occupational Science and Occupational Therapy, and Rehabilitation Sciences Institute, University of Toronto, Rotman Research Institute, Baycrest Health Sciences, Toronto, Canada
| | - Karl Zabjek
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | - Carolina Bottari
- Occupational Therapy Program, School of Rehabilitation, Université de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
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Marshall CA, Lysaght R, Krupa T. Occupational transition in the process of becoming housed following chronic homelessness. Can J Occup Ther 2018; 85:33-45. [DOI: 10.1177/0008417417723351] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Stokes CA, Kaur R, Edwards MR, Mondhe M, Robinson D, Prestwich EC, Hume RD, Marshall CA, Perrie Y, O'Donnell VB, Harwood JL, Sabroe I, Parker LC. Human rhinovirus-induced inflammatory responses are inhibited by phosphatidylserine containing liposomes. Mucosal Immunol 2017; 10:829. [PMID: 28435153 DOI: 10.1038/mi.2017.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Roy L, Vallée C, Kirsh BH, Marshall CA, Marval R, Low A. Occupation-based practices and homelessness: A scoping review. Can J Occup Ther 2017; 84:98-110. [DOI: 10.1177/0008417416688709] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Persons experiencing or at risk of homelessness have occupational needs that are seldom addressed in the Canadian system of care. The lack of documented evidence on occupational therapy practices in this field hinders the development of the profession. Purpose. This article identifies current and potential practices that aim to enable or support the occupations of persons experiencing or at risk of homelessness. Method. A scoping review was conducted, including evidence from both occupational therapy and non–occupational therapy sources. Findings. One hundred and seventy-eight papers were selected in the areas of occupational performance skills training, enrichment of occupational repertoire, employment/education, physical rehabilitation services, child/family services, community building, occupational transition from homeless to housed, literacy, and disaster relief. Implications. Occupational therapists can build environments and create opportunities that facilitate occupational engagement of individuals experiencing homelessness. Gaps in knowledge include the evaluation of occupational therapy practices, the Canadian context of family homelessness, and the cultural safety of occupational therapy interventions.
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Marshall CA, Heinemann L, Trimmer C, Broad A. The Meaning of Participating in a Group Music Intervention in Early Psychosis. Am J Occup Ther 2016. [DOI: 10.5014/ajot.2016.70s1-po2070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 4/7/2016
During phenomenology-informed interviews with 5 young adults enrolled in an early psychosis intervention (EPI) program in Canada, participants discussed the meaning of participating in a music group offered by the EPI program and the positive benefits that contributed to their recovery.
Primary Author and Speaker: Carrie Anne Marshall
Additional Authors and Speakers: Lyn Heinemann, Chris Trimmer, Adam Broad
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Marshall CA, Lysaght R. The Experience of Occupational Transition From Homelessness to Becoming Housed. Am J Occup Ther 2016. [DOI: 10.5014/ajot.2016.70s1-rp301b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 4/9/2016
In phenomenology-informed interviews with 11 housed adults with a history of chronic homelessness, participants described their experience of a challenging and rewarding occupational transition in relation to identity. Implications for an occupational perspective of homelessness are presented.
Primary Author and Speaker: Carrie Anne Marshall
Contributing Author: Rosemary Lysaght
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Abstract
Background. The incorporation of meaningful activity or occupation in supporting those transitioning from homelessness to being housed has been promoted by researchers; however, there is little evidence to support the promotion of initiatives encouraging its use in support models. Purpose. This manuscript aims to advocate for further research into the role of occupation in supporting persons transitioning from homelessness to permanent housing. Key Issues. The transition from homelessness to becoming housed can be facilitated through use of occupation as a way of promoting the security of meaningful roles and a “housed identity” among persons experiencing homelessness. Implications. By promoting an emphasis on occupation, persons experiencing homelessness may undergo a positive change in identity. This change may improve housing tenure and the likelihood of a more permanent transition away from homelessness. More research is required to identify the relationship between occupation and the transition from homelessness.
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Lysaght R, Sparring C, Ouellette-Kuntz HLN, Marshall CA. Injury incidence and patterns in workers with intellectual disability: a comparative study. J Intellect Dev Disabil 2011; 36:280-284. [PMID: 22050409 DOI: 10.3109/13668250.2011.625927] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Workplace safety is a concern in the employment of persons with intellectual disability, due to both real concerns for employee well-being, and the effect that negative perceptions of safety risk can have on hiring. METHOD This study involved a retrospective analysis of workplace insurance claim records for workers with and without disability in a Canadian social enterprise. RESULTS Workers with intellectual disability sustained fewer injuries and experienced fewer absences due to injury than workers without disability. Lost-time injury rates for this business were not significantly different from those reported by other employers in the jurisdiction. CONCLUSION Workplace safety is a concern for all workers, but fear of increased injury rates and heightened compensation costs should not be perceived as a risk when hiring individuals with intellectual disability.
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Johnson SR, Finifrock D, Marshall CA, Jaakola J, Setterquist J, Burross HL, Hodge FS. Cancer, employment, and American Indians: A participatory action research pilot study. Rehabil Couns Bull 2010; 54:175-180. [PMID: 30853720 DOI: 10.1177/0034355210380143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
American Indian cancer survivors are an underserved and understudied group. In this pilot study we attempted to address, through participatory action research, missing information about those factors that serve to either facilitate employment or hinder it for adult cancer survivors. One task of the study was to develop and/or modify instrumentation that could be used in a subsequent, in-depth census study. The pilot sample consisted of 10 cancer survivors, all members of a Northern Minnesota American Indian tribe, and 10 family members. All survivors reported having health problems such as fatigue since their cancer treatments. Rehabilitation counselors can assist survivors and their family members by advising them in regard to employment discrimination and accommodations such as flexible work schedules.
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Affiliation(s)
| | - D Finifrock
- Fond du Lac Human Services, Cloquet, MN, USA
| | - C A Marshall
- Northern Arizona University, Flagstaff, USA.,University of Arizona, Tucson, USA
| | - J Jaakola
- Fond du Lac Human Services, Cloquet, MN, USA
| | | | | | - F S Hodge
- University of California, Los Angeles, USA
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Cruz WS, Kwon G, Marshall CA, McDaniel ML, Semenkovich CF. Glucose and insulin stimulate heparin-releasable lipoprotein lipase activity in mouse islets and INS-1 cells. A potential link between insulin resistance and beta-cell dysfunction. J Biol Chem 2001; 276:12162-8. [PMID: 11154699 DOI: 10.1074/jbc.m010707200] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Lipoprotein lipase (LpL) provides tissues with triglyceride-derived fatty acids. Fatty acids affect beta-cell function, and LpL overexpression decreases insulin secretion in cell lines, but whether LpL is regulated in beta-cells is unknown. To test the hypothesis that glucose and insulin regulate LpL activity in beta-cells, we studied pancreatic islets and INS-1 cells. Acute exposure of beta-cells to physiological concentrations of glucose stimulated both total cellular LpL activity and heparin-releasable LpL activity. Glucose had no effect on total LpL protein mass but instead promoted the appearance of LpL protein in a heparin-releasable fraction, suggesting that glucose stimulates the translocation of LpL from intracellular to extracellular sites in beta-cells. The induction of heparin-releasable LpL activity was unaffected by treatment with diazoxide, an inhibitor of insulin exocytosis that does not alter glucose metabolism but was blocked by conditions that inhibit glucose metabolism. In vitro hyperinsulinemia had no effect on LpL activity in the presence of low concentrations of glucose but increased LpL activity in the presence of 20 mm glucose. Using dual-laser confocal microscopy, we detected intracellular LpL in vesicles distinct from those containing insulin. LpL was also detected at the cell surface and was displaced from this site by heparin in dispersed islets and INS-1 cells. These results show that glucose metabolism controls the trafficking of LpL activity in beta-cells independent of insulin secretion. They suggest that hyperglycemia and hyperinsulinemia associated with insulin resistance may contribute to progressive beta-cell dysfunction by increasing LpL-mediated delivery of lipid to islets.
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Affiliation(s)
- W S Cruz
- Departments of Medicine, Pathology and Immunology, and Cell Biology and Physiology and the Center for Cardiovascular Research, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Abstract
Recent findings have demonstrated that the branched-chain amino acid leucine can activate the translational regulators, phosphorylated heat- and acid-stable protein regulated by insulin (PHAS-I) and p70 S6 kinase (p70S6k), in an insulin-independent and rapamycin-sensitive manner through mammalian target of rapamycin (mTOR), although the mechanism for this activation is undefined. It has been previously established that leucine-induced insulin secretion by beta-cells involves increased mitochondrial metabolism by oxidative decarboxylation and allosteric activation of glutamate dehydrogenase (GDH). We now show that these same intramitochondrial events that generate signals for leucine-induced insulin exocytosis are required to activate the mTOR mitogenic signaling pathway by beta-cells. Thus, a minimal model consisting of leucine and glutamine as substrates for oxidative decarboxylation and an activator of GDH, respectively, confirmed the requirement for these two metabolic components and mimicked closely the synergistic interactions achieved by a complete complement of amino acids to activate p70s6k in a rapamycin-sensitive manner. Studies using various leucine analogs also confirmed the close association of mitochondrial metabolism and the ability of leucine analogs to activate p70s6k. Furthermore, selective inhibitors of mitochondrial function blocked this activation in a reversible manner, which was not associated with a global reduction in ATP levels. These findings indicate that leucine at physiological concentrations stimulates p70s6k phosphorylation via the mTOR pathway, in part, by serving both as a mitochondrial fuel and an allosteric activator of GDH. Leucine-mediated activation of protein translation through mTOR may contribute to enhanced beta-cell function by stimulating growth-related protein synthesis and proliferation associated with the maintenance of beta-cell mass.
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Affiliation(s)
- G Xu
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Marshall BA, Tordjman K, Host HH, Ensor NJ, Kwon G, Marshall CA, Coleman T, McDaniel ML, Semenkovich CF. Relative hypoglycemia and hyperinsulinemia in mice with heterozygous lipoprotein lipase (LPL) deficiency. Islet LPL regulates insulin secretion. J Biol Chem 1999; 274:27426-32. [PMID: 10488074 DOI: 10.1074/jbc.274.39.27426] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Lipoprotein lipase (LPL) provides tissues with fatty acids, which have complex effects on glucose utilization and insulin secretion. To determine if LPL has direct effects on glucose metabolism, we studied mice with heterozygous LPL deficiency (LPL+/-). LPL+/- mice had mean fasting glucose values that were up to 39 mg/dl lower than LPL+/+ littermates. Despite having lower glucose levels, LPL+/- mice had fasting insulin levels that were twice those of +/+ mice. Hyperinsulinemic clamp experiments showed no effect of genotype on basal or insulin-stimulated glucose utilization. LPL message was detected in mouse islets, INS-1 cells (a rat insulinoma cell line), and human islets. LPL enzyme activity was detected in the media from both mouse and human islets incubated in vitro. In mice, +/- islets expressed half the enzyme activity of +/+ islets. Islets isolated from +/+ mice secreted less insulin in vitro than +/- and -/- islets, suggesting that LPL suppresses insulin secretion. To test this notion directly, LPL enzyme activity was manipulated in INS-1 cells. INS-1 cells treated with an adeno-associated virus expressing human LPL had more LPL enzyme activity and secreted less insulin than adeno-associated virus-beta-galactosidase-treated cells. INS-1 cells transfected with an antisense LPL oligonucleotide had less LPL enzyme activity and secreted more insulin than cells transfected with a control oligonucleotide. These data suggest that islet LPL is a novel regulator of insulin secretion. They further suggest that genetically determined levels of LPL play a role in establishing glucose levels in mice.
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Affiliation(s)
- B A Marshall
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Affiliation(s)
- C A Marshall
- American Indian Rehabilitation Research and Training Center, Northern Arizona University, Flagstaff, USA.
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Kearns RJ, Hayek MG, Turek JJ, Meydani M, Burr JR, Greene RJ, Marshall CA, Adams SM, Borgert RC, Reinhart GA. Effect of age, breed and dietary omega-6 (n-6): omega-3 (n-3) fatty acid ratio on immune function, eicosanoid production, and lipid peroxidation in young and aged dogs. Vet Immunol Immunopathol 1999; 69:165-83. [PMID: 10507303 DOI: 10.1016/s0165-2427(99)00052-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The focus of this study was to examine the influence of age and diet on various parameters of immune function in young and old Fox Terriers and Labrador Retrievers. Eighteen young and old dogs were utilized for this study. Young and old dogs were fed a basal diet containing an (n-6):(n-3) ratio of 25:1 for sixty days (Phase I). Half of the dogs were then switched to a diet with an (n-6):(n-3) ratio of 5:1, and all were maintained on their respective diets for an additional sixty days (Phase II). Results from these studies revealed an age-associated decline in several immune parameters measured. Both these breeds demonstrated a reduction in sheep red blood cell titers, as well as in their ability to respond to different mitogens. Interestingly, this decline was greater in Fox Terriers, suggesting a decrease in cellular proliferative capacity in lymphocytes isolated from the larger breed. Neither cytokine production or DTH response was affected by age. Diet and breed interactions resulted in a significant increase in T- and B-cell mitogen responsiveness. In contrast, supplementation with n-3 fatty acids did not affect IL-1, IL-6 or TNF-alpha production. Supplementation with n-3 fatty acids resulted in increased PGE3 production from peritoneal macrophages but had no effect on PGE2 production from peripheral blood mononuclear cells or peritoneal macrophages. The n-3 fatty acid supplementation did not influence alpha-tocopherol status although older dogs had significantly lower serum alpha-tocopherol concentrations. Oxidative status of these dogs was assessed by serum levels of malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE). Feeding an n-3-enriched diet did not affect 4-HNE levels but significantly decreased MDA levels in old dogs. In summary, this study indicates that feeding a diet containing an (n-6):(n-3) fatty acid ratio of 5:1 had a positive, rather than a negative, effect on the immune response of young or geriatric dogs.
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Kwon G, Xu G, Marshall CA, McDaniel ML. Tumor necrosis factor alpha-induced pancreatic beta-cell insulin resistance is mediated by nitric oxide and prevented by 15-deoxy-Delta12,14-prostaglandin J2 and aminoguanidine. A role for peroxisome proliferator-activated receptor gamma activation and inos expression. J Biol Chem 1999; 274:18702-8. [PMID: 10373483 DOI: 10.1074/jbc.274.26.18702] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Recent studies have identified a beta-cell insulin receptor that functions in the regulation of protein translation and mitogenic signaling similar to that described for insulin-sensitive cells. These findings have raised the novel possibility that beta-cells may exhibit insulin resistance similar to skeletal muscle, liver, and fat. To test this hypothesis, the effects of tumor necrosis factor-alpha (TNFalpha), a cytokine proposed to mediate insulin resistance by interfering with insulin signaling at the level of the insulin receptor and its substrates, was evaluated. TNFalpha inhibited p70(s6k) activation by glucose-stimulated beta-cells of the islets of Langerhans in a dose- and time-dependent manner, with maximal inhibition observed at approximately 20-50 ng/ml, detected after 24 and 48 h of exposure. Exogenous insulin failed to prevent TNFalpha-induced inhibition of p70(s6k), suggesting a defect in the insulin signaling pathway. To further define mechanisms responsible for this inhibition and also to exclude cytokine-induced nitric oxide (NO) as a mediator, the ability of exogenous or endogenous insulin +/- inhibitors of nitric-oxide synthase (NOS) activity, aminoguanidine or N-monomethyl-L-arginine, was evaluated. Unexpectedly, TNFalpha and also interleukin 1 (IL-1)-induced inhibition of p70(s6k) was completely prevented by inhibitors that block NO production. Western blot analysis verified inducible NOS (iNOS) expression after TNFalpha exposure. Furthermore, the ability of IL-1 receptor antagonist protein, IRAP, to block TNFalpha-induced inhibition of p70(s6k) indicated that activation of intra-islet macrophages and the release of IL-1 that induces iNOS expression in beta-cells was responsible for the inhibitory effects of TNFalpha. This mechanism was confirmed by the ability of the peroxisome proliferator-activated receptor-gamma agonist 15-deoxy-Delta12, 14-prostaglandin J2 to attenuate TNFalpha-induced insulin resistance by down-regulating iNOS expression and/or blocking IL-1 release from activated macrophages. Overall, TNFalpha-mediated insulin resistance in beta-cells is characterized by a global inhibition of metabolism mediated by NO differing from that proposed for this proinflammatory cytokine in insulin-sensitive cells.
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Affiliation(s)
- G Kwon
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Xu G, Kwon G, Marshall CA, Lin TA, Lawrence JC, McDaniel ML. Branched-chain amino acids are essential in the regulation of PHAS-I and p70 S6 kinase by pancreatic beta-cells. A possible role in protein translation and mitogenic signaling. J Biol Chem 1998; 273:28178-84. [PMID: 9774438 DOI: 10.1074/jbc.273.43.28178] [Citation(s) in RCA: 200] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Amino acids have been identified as important signaling molecules involved in pancreatic beta-cell proliferation, although the cellular mechanism responsible for this effect is not well defined. We previously reported that amino acids are required for glucose or exogenous insulin to stimulate phosphorylation of PHAS-I (phosphorylated heat- and acid-stable protein regulated by insulin), a recently discovered regulator of translation initiation during cell mitogenesis. Here we demonstrate that essential amino acids, in particular branched-chain amino acids (leucine, valine, and isoleucine), are largely responsible for mediating this effect. The transamination product of leucine, alpha-ketoisocaproic acid, also stimulates PHAS-I phosphorylation although the transamination products of isoleucine and valine are ineffective. Since amino acids are secretagogues for insulin secretion by beta-cells, we investigated whether endogenous insulin secreted by beta-cells is involved. Interestingly, branched-chain amino acids stimulate phosphorylation of PHAS-I independent of endogenous insulin secretion since genistein (10 microM) and herbimycin A (1 microM), two tyrosine kinase inhibitors in the insulin signaling pathway, exert no effect on amino acid-induced phosphorylation of PHAS-I. Furthermore, branched-chain amino acids retain their ability to induce phosphorylation of PHAS-I under conditions that block insulin secretion from beta-cells. In exploring the signaling pathway responsible for these effects, we find that rapamycin (25 nM) inhibits the ability of branched-chain amino acids to stimulate the phosphorylation of PHAS-I and p70(s6) kinase, suggesting that the mammalian target of rapamycin signaling pathway is involved. The branched-chain amino acid, leucine, also exerts similar effects on PHAS-I phosphorylation in isolated pancreatic islets. In addition, we find that amino acids are necessary for insulin-like growth factor (IGF-I) to stimulate the phosphorylation of PHAS-I indicating that a requirement for amino acids may be essential for other beta-cell growth factors in addition to insulin and IGF-I to activate this signaling pathway. We propose that amino acids, in particular branched-chain amino acids, may promote beta-cell proliferation either by stimulating phosphorylation of PHAS-I and p70(s6k) via the mammalian target of rapamycin pathway and/or by facilitating the proliferative effect mediated by growth factors such as insulin and IGF-I.
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Affiliation(s)
- G Xu
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Xu G, Marshall CA, Lin TA, Kwon G, Munivenkatappa RB, Hill JR, Lawrence JC, McDaniel ML. Insulin mediates glucose-stimulated phosphorylation of PHAS-I by pancreatic beta cells. An insulin-receptor mechanism for autoregulation of protein synthesis by translation. J Biol Chem 1998; 273:4485-91. [PMID: 9468502 DOI: 10.1074/jbc.273.8.4485] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although glucose regulates the biosynthesis of a variety of beta cell proteins at the level of translation, the mechanism responsible for this effect is unknown. We demonstrate that incubation of pancreatic islets with elevated glucose levels results in rapid and concentration-dependent phosphorylation of PHAS-I, an inhibitor of mRNA cap-binding protein, eukaryotic initiation factor (eIF)-4E. Our initial approach was to determine if this effect is mediated by the metabolism of glucose and activation of islet cell protein kinases, or whether insulin secreted from the beta cell stimulates phosphorylation of PHAS-I via an insulin-receptor mechanism as described for insulin-sensitive cells. In support of the latter mechanism, inhibitors of islet cell protein kinases A and C exert no effect on glucose-stimulated phosphorylation of PHAS-I, whereas the phosphatidylinositol 3-kinase inhibitor, wortmannin, the immunosuppressant, rapamycin, and theophylline, a phosphodiesterase inhibitor, promote marked dephosphorylation of PHAS-I. In addition, exogenous insulin and endogenous insulin secreted by the beta cell line, betaTC6-F7, increase phosphorylation of PHAS-I, suggesting that beta cells of the islet, in part, mediate this effect. Studies with beta cell lines and islets indicate that amino acids are required for glucose or exogenous insulin to stimulate the phosphorylation of PHAS-I, and amino acids alone dose-dependently stimulate the phosphorylation of PHAS-I, which is further enhanced by insulin. Furthermore, rapamycin inhibits by approximately 62% the increase in total protein synthesis stimulated by high glucose concentrations. These results indicate that glucose stimulates PHAS-I phosphorylation via insulin interacting with its own receptor on the beta cell which may serve as an important mechanism for autoregulation of protein synthesis by translation.
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Affiliation(s)
- G Xu
- Department of Pathology, Washington University School of Medicine, St. Louis Missouri 63110, USA
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Hill JR, Kwon G, Marshall CA, McDaniel ML. Hyperglycemic levels of glucose inhibit interleukin 1 release from RAW 264.7 murine macrophages by activation of protein kinase C. J Biol Chem 1998; 273:3308-13. [PMID: 9452447 DOI: 10.1074/jbc.273.6.3308] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Diabetic patients with hyperglycemia (high blood glucose) have frequent and persistent bacterial infections linked to significantly diminished bactericidal activity and macrophage function. Interleukin-1 (IL-1), released primarily from activated macrophages, is a key mediator of effective host defense against microorganisms. We observe that hyperglycemic levels of D-glucose (8-20 mM) inhibit the release of IL-1 by lipopolysaccharide-stimulated RAW 264.7 murine macrophage cells. An inhibitor of glucose transport and metabolism, 2-deoxyglucose, prevents this inhibition of IL-1 release. High levels (8-20 mM) of fructose and mannose (but not galactose or L-glucose) also inhibit the release of IL-1 activity, suggesting that metabolism is required for IL-1 inhibition. Immunoprecipitation and activity measurements demonstrate that high glucose levels block the release of IL-1 but do not inhibit IL-1 production. High glucose levels (20 mM) increase protein kinase C (PKC) activity, and inhibitors of PKC block the inhibitory effects of glucose. Phorbol 12-myristate 13-acetate, an agonist of PKC, mimics glucose-induced inhibition of IL-1 release. These results demonstrate that high glucose levels inhibit IL-1 release (but not production) by RAW 264. 7 murine macrophages, and this inhibition is mediated by PKC activation. These studies suggest that persistent infections in hyperglycemic patients may be due to an inhibition of IL-1 release from macrophages.
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Affiliation(s)
- J R Hill
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Scarim AL, Arnush M, Hill JR, Marshall CA, Baldwin A, McDaniel ML, Corbett JA. Evidence for the presence of type I IL-1 receptors on beta-cells of islets of Langerhans. Biochim Biophys Acta 1997; 1361:313-20. [PMID: 9375806 DOI: 10.1016/s0925-4439(97)00039-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The cytokine interleukin-1beta (IL-1beta) has been shown to inhibit insulin secretion and destroy pancreatic islets by a mechanism that involves the expression of inducible nitric oxide synthase (iNOS), and the production of nitric oxide (NO). Insulin containing beta-cells, selectively destroyed during the development of autoimmune diabetes, appear to be the islet cellular source of iNOS following treatment with IL-1beta. In this study we have evaluated the presence of type I IL-1 signaling receptors on purified pancreatic beta-cells. We show that the interleukin-1 receptor antagonist protein (IRAP) prevents IL-1beta-induced nitrite formation and IL-1beta-induced inhibition of insulin secretion by isolated islets and primary beta-cells purified by fluorescence-activated cell sorting (FACS). The protective effects of IRAP correlate with an inhibition of IL-1beta-induced iNOS expression by islets and FACS purified beta-cells. To provide direct evidence to support beta-cell expression of IL-1 type I signaling receptors, we show that antiserum specific for the type I IL-1 receptor neutralizes IL-1beta-induced nitrite formation by RINm5F cells, and that RINm5F cells express the type I IL-1 receptor at the protein level. Using reverse transcriptase-polymerase chain reaction (RT-PCR), the expression of type I IL-1 signaling receptors by FACS purified beta-cells and not alpha-cells is demonstrated. These results provide direct support for the expression of type I IL-1 receptors by primary pancreatic beta-cells, the cell type selectively destroyed during the development of autoimmune diabetes.
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Affiliation(s)
- A L Scarim
- Edward A. Doisy Department of Biochemistry and Molecular Biology, Saint Louis University School of Medicine, MO 63104, USA.
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Abstract
The bioactivity of interleukin-1 (IL-1), a major proinflammatory cytokine, can be modulated by a variety of factors including inhibitors of IL-1 production and release and receptor blockade by IL-1 receptor antagonist and by binding to nonsignaling soluble receptors. This study demonstrates that the free radical nitric oxide (NO) is also a regulator of IL-1 bioactivity. Lipopolysaccharide-activated murine macrophage RAW264.7 cells, and lipopolysaccharide plus interferon-gamma-activated murine peritoneal macrophages release IL-1 bioactivity, which is increased 10-fold over control levels by 24 h. NG-Monomethyl -arginine (NMMA), a nitric oxide synthase (NOS) inhibitor, almost completely inhibits the release of IL-1 bioactivity from activated macrophages in a time- and concentration-dependent manner with an IC50 of 50 microM. IL-1 activity was determined by thymocyte proliferation bioassay and by a new spectrophotometric bioassay based on IL-1-specific induction of NOS and NO production by an insulinoma cell line, RINm5F. Neither NO nor NOS inhibitors present in the macrophage supernatant interfere with the bioassays. Aminoguanidine and iodonium diphenyl, mechanistically unrelated NOS inhibitors, also prevent the release of IL-1 activity from RAW 264.7 cells. The addition of the NO donor S-nitroso-acetylpenicillamine reconstituted the release of IL-1 bioactivity inhibited by NMMA in a concentration-dependent manner. NO appears to increase the amount of IL-1 protein released by activated macrophages as determined by enzyme-linked immunosorbent assay, but not by mechanisms involving cell death nor modification of IL-1 precursor processing. A cGMP donor, 8-bromo-cGMP, dose-dependently reverses NMMA inhibition of bioactive IL-1 release, suggesting that NO regulates IL-1 release by a cGMP-dependent mechanism. These observations suggest that NO stimulation of the activity of IL-1, a key mediator of the immune response, may be a potentially important mechanism for control of IL-1 activity in vivo.
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Affiliation(s)
- J R Hill
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Abstract
Cytokines released by both T lymphocytes and activated macrophages, in particular interleukin-1 (IL-1), have been implicated as immunological effector molecules that both inhibit insulin secretion from the pancreatic beta cell and induce beta-cell destruction. Recent findings have demonstrated that production of the free radical nitric oxide (NO), resulting from the expression of the cytokine-inducible isoform of NO synthase (iNOS), mediates these deleterious effects. The cellular mechanism responsible for inhibition of beta-cell function and destruction by NO involves, in part, inactivation of enzymes specifically localized to the beta-cell mitochondria that contain iron- sulfur centers or clusters. Intraislet release of IL-1 also inhibits beta-cell function by this same cellular mechanism involving the overproduction of NO. In addition, the cytokine, IL-1, induces the co-expression of both iNOS and the cytokine-inducible isoform of cyclooxygenase, COX-2. The expression of COX-2 results in the overproduction of the proinflammatory prostaglandins and thromboxanes. Furthermore, NO produced by iNOS directly stimulates the activities of both constitutive and inducible isoforms of COX, further augmenting the overproduction of these proinflammatory mediators, NO and prostaglandins, which may be important in initiating or maintaining the inflammatory response and destruction of the beta cell associated with autoimmune diabetes.
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Affiliation(s)
- M L McDaniel
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri 63110-1010, USA
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Aguilar-Diosdado M, Parkinson D, Corbett JA, Kwon G, Marshall CA, Gingerich RL, Santiago JV, McDaniel ML. Potential autoantigens in IDDM. Expression of carboxypeptidase-H and insulin but not glutamate decarboxylase on the beta-cell surface. Diabetes 1994; 43:418-25. [PMID: 8314014 DOI: 10.2337/diab.43.3.418] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Insulin, carboxypeptidase-H (CP-H), and glutamate decarboxylase (GAD) have been identified as potential autoantigens in insulin-dependent diabetes mellitus (IDDM). Previous studies have described immunoreactive insulin as a surface molecule on the plasma membrane of rat islet cells and suggested that cell-surface insulin was derived during exocytosis by the fusion of insulin secretory granules with the beta-cell plasma membrane. These findings predict that insulin and other secretory granule-derived proteins such as the putative autoantigen CP-H may be colocalized with insulin at specific sites of exocytosis on the beta-cell surface. In studies to test this hypothesis, cell-surface staining of dispersed rat islet cells occurred in a granule-like pattern with antibodies for CP-H and insulin. The specificity of the CP-H antiserum was confirmed by immunoblotting and indicated that the antiserum was essentially monospecific for CP-H. Confocal laser microscopy confirmed that immunoreactive staining for CP-H and insulin was confined to the beta-cell surface. Colocalization of CP-H and insulin on the cell surface of beta-cells was demonstrated by double staining with antibodies to CP-H and insulin, and the percentage of beta-cells positive for both of these autoantigens increased twofold with increases in insulin secretion. In contrast, islet cells failed to reveal cell-surface staining for GAD65, another putative autoantigen in IDDM, under either basal or insulin stimulatory conditions or following exposure of islet cells to the cytokines interleukin-1 beta, tumor necrosis factor-alpha, and recombinant human interferon-gamma.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Aguilar-Diosdado
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri 63110
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Abstract
Patients who smoke cigarettes suffer increased postoperative morbidity. A prospective, controlled trial was designed to evaluate the effectiveness of written pre-operative advice to stop smoking before admission for elective surgery and to record the duration of abstinence immediately before the operation. Although the advice was ineffective in persuading patients to stop smoking, it was associated with a reduction in the amount of tobacco consumed. Nicotine and carbon monoxide have important short-term adverse effects but 15% of all patients continued to smoke within an hour of surgery. If patients are unable to give up cigarette smoking completely, it is still worthwhile stopping on admission to hospital.
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Affiliation(s)
- I T Munday
- St Mary's Hospital Medical School, London
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