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Articles 2911 - 2940 of 8304
Full-Text Articles in Medicine and Health Sciences
Exploring The Perceived Barriers And Benefits Of Physical Activity Among Wounded, Injured, And/Or Sick Military Veterans, Robert Walker, Caroline Limbert, Paul M. Smith
Exploring The Perceived Barriers And Benefits Of Physical Activity Among Wounded, Injured, And/Or Sick Military Veterans, Robert Walker, Caroline Limbert, Paul M. Smith
Journal of Social, Behavioral, and Health Sciences
Wounded, injured, and/or sick (WIS) military veterans face significant physical and psychosocial challenges following discharge from service. Physical activity can have many positive effects on the holistic wellbeing of such individuals. However, little knowledge exists regarding the perceived barriers and benefits of physical activity within this population, creating challenges surrounding physical activity promotion. Therefore, this study was designed to identify key barriers and benefits among this population, so that informed approaches to encourage participation in physical activity can be developed. A questionnaire related to the perceived barriers and benefits of physical activity was completed by 105 WIS British military veterans. …
A Systematic Review Of Recommendations For Behavioral Health Services For Transgender And Gender Diverse Adults: The Three-Legged Stool Of Evidence-Based Practice Is Unbalanced, Natalie Holt, Allura L. Ralston, Debra A. Hope, Richard Mocarski, Nathan Woodruff
A Systematic Review Of Recommendations For Behavioral Health Services For Transgender And Gender Diverse Adults: The Three-Legged Stool Of Evidence-Based Practice Is Unbalanced, Natalie Holt, Allura L. Ralston, Debra A. Hope, Richard Mocarski, Nathan Woodruff
Trans Collaborations Academic Papers
There is a growing literature of clinical recommendations for transgender and gender diverse (TGD) affirming behavioral health care, yet it is unknown to what extent these recommendations are rooted in evidence-based practice (EBP). This systematic review included 65 articles published between 2009 and 2018 with recommendations for behavioral health services with TGD adults, emphasizing general clinical care. Coded variables included type of article, participant demographics, aspects of EBP, and whether care was informed by objective assessment. Most articles did not equally draw from all components of EBP. Recommendations for specific clinical problems are increasingly available and address diversity within TGD …
Shu Altop News Issue #3, Summer, Dr. Susan L. Davis, Rn & Richard J. Henley College Of Nursing
Shu Altop News Issue #3, Summer, Dr. Susan L. Davis, Rn & Richard J. Henley College Of Nursing
News, Magazines and Reports
Updates from the Davis & Henley College of Nursing Sacred Heart University Alternatives to Opioids for Pain Grant.
Alternatives to Opioids for Pain (ALTOP) is a HRSA funded project to help combat the opioid epidemic in Connecticut.
Delayed Modulation Of Glutamate Receptors By Anti-Epileptic Drugs After Traumatic Brain Injury In Rats, Edgar Rodriguez
Delayed Modulation Of Glutamate Receptors By Anti-Epileptic Drugs After Traumatic Brain Injury In Rats, Edgar Rodriguez
Dissertations, Theses, and Capstone Projects
Traumatic brain injury (TBI) is a significant health concern. Around 74 million people sustain a traumatic brain injury worldwide. The damage caused by TBI produces two types of injury; primary and secondary injuries. Primary injury is caused within milliseconds and is irreversible. Secondary brain injury is delayed and produced by molecular, cellular, and structural disruption after the initial injury. One of the most devastating dysfunction after TBI is glutamate neurotransmitter overactivation that could lead to neurotoxic levels of glutamate in the brain (i.e., excitotoxicity). Excitotoxicity has been linked with the development of epilepsy after TBI, also known as post-traumatic epilepsy …
Mental Health Outcomes Of Various Types Of Fear Among University Students Who Have An Undocumented Legal Status During The Donald Trump Presidency, Liliana Campos
Doctoral Dissertations
Having an undocumented legal status is a risk factor for mental health conditions such as depression and anxiety among university students. Much of the literature on the experiences of university students who hold an undocumented legal status has primarily focused on better understanding the educational, social, financial, and legal challenges among undergraduate students. The literature has addressed how some of these difficulties impact components of their social and mental health wellness. Yet, there is still a dearth of research focused on further understanding the experiences of students who hold an undocumented legal status from a psychological perspective, and specifically, with …
The Effect Of Anticipatory Anxiety On Fear Extinction Learning, Daniela C. Echeverria
The Effect Of Anticipatory Anxiety On Fear Extinction Learning, Daniela C. Echeverria
Dissertations, Theses, and Capstone Projects
Adaptive regulation of fear is dependent on successful fear extinction learning; therefore, investigating factors that both enhance and diminish fear extinction learning is a critical line of research. In the present study, we induce mild anticipatory anxiety during fear extinction learning in an attempt to modulate how participants extinguish fear memory. In the experiment, we apply a classic three-day fear learning protocol to both control participants (N = 20) and an experimental group (N = 20) with fear acquisition, fear extinction, and fear recovery phases; each phase is separated by a period of 24 hours and we use a skin …
Designing A Replication Study In Kinesiology: Lessons From The Field, Ruben A. Montoya Vega, Regina F. Hockert, Emma L. Cutner, Jafra D. Thomas
Designing A Replication Study In Kinesiology: Lessons From The Field, Ruben A. Montoya Vega, Regina F. Hockert, Emma L. Cutner, Jafra D. Thomas
Kinesiology and Public Health
The submitted presentation material summarizes a project presented at the 2021 Cal Poly Virtual BEACoN Symposium. The title of the project which the presentation is based is, “Towards Equitable Communication: Explorations to Guide Knowledge Translation in Kinesiology.” The uploaded file document presents the presentation abstract, student testimony, as well as suggested citations for individual aspects of the presentation material. Please follow the social media profiles of the faculty mentor to the project, Dr. Thomas, for timely project updates. You may find related work from this lab group published to Cal Poly Digital Commons under the Kinesiology and Public Health section …
Training Novices To Evaluate The Quality Of Physical Activity Promotion Material: Results Of A Pilot Study, Ethan N. Tse, Savannah A. Longoria, Cameron N. Christopher, Jafra D. Thomas
Training Novices To Evaluate The Quality Of Physical Activity Promotion Material: Results Of A Pilot Study, Ethan N. Tse, Savannah A. Longoria, Cameron N. Christopher, Jafra D. Thomas
Kinesiology and Public Health
The credibility and usability of lay physical activity promotion material are a persistent problem (Thomas & Cardinal, 2020, TJACM). These quality issues deter the material in promoting health literacy, a major predictor of prevention-oriented health behaviors (e.g., regular exercise, U.S. National Action Plan to Improve Health Literacy). Few studies, however, have evaluated the quality of lay material over time (Thomas et al., 2018, Quest). PURPOSE: In order to conduct a repeated-measures study of the quality of physical activity promotion web articles for lay adults, one experienced researcher (JDT) trained undergraduates on how to use the Suitability …
Are Kinesiologists Ready To Communicate? Merits Of A Practicum Course On Plain Language Communication, Jafra D. Thomas, Cameron N. Christopher, Winston Kennedy, Bradley J. Cardinal, Caroline N. Smith
Are Kinesiologists Ready To Communicate? Merits Of A Practicum Course On Plain Language Communication, Jafra D. Thomas, Cameron N. Christopher, Winston Kennedy, Bradley J. Cardinal, Caroline N. Smith
Kinesiology and Public Health
The submitted presentation material summarizes a project presented at the 2021 American College of Sports Medicine Virtual Annual Meeting and World Congress on Exercise is Medicine®. The project which the presentation is based on is titled, “Towards Knowledge Translation in Kinesiology: Investigating Barriers and Identifying Opportunities - Part 1.” The uploaded documents consist of the following material: (a) the presentation abstract, and (b) a copy of the e-poster presented at the virtual event. Please follow the social media profiles of Dr. Jafrā Thomas, for timely project updates (e.g., ResearchGate dot net and GoogleScholar dot com). You may find related work …
Detecting Receptivity For Mhealth Interventions In The Natural Environment, Varun Mishra, Florian Künzler, Jan-Niklas Kramer, Elgar Fleisch, Tobias Kowatsch, David Kotz
Detecting Receptivity For Mhealth Interventions In The Natural Environment, Varun Mishra, Florian Künzler, Jan-Niklas Kramer, Elgar Fleisch, Tobias Kowatsch, David Kotz
Dartmouth Scholarship
Just-In-Time Adaptive Intervention (JITAI) is an emerging technique with great potential to support health behavior by providing the right type and amount of support at the right time. A crucial aspect of JITAIs is properly timing the delivery of interventions, to ensure that a user is receptive and ready to process and use the support provided. Some prior works have explored the association of context and some user-specific traits on receptivity, and have built post-study machine-learning models to detect receptivity. For effective intervention delivery, however, a JITAI system needs to make in-the-moment decisions about a user's receptivity. To this end, …
Atypical Structural Neuroconnectivity Associated With Emotional Face Processing And Clinical Affect In Children With Chromosome 22q11.2 Deletion Syndrome, David Dodd Stephenson Jr
Atypical Structural Neuroconnectivity Associated With Emotional Face Processing And Clinical Affect In Children With Chromosome 22q11.2 Deletion Syndrome, David Dodd Stephenson Jr
LSU New Orleans Theses and Dissertations
Schizophrenia spectrum disorder (SCZ) is a debilitating psychiatric disorder that affects approximately 1% of the general population. The etiopathology of this disorder is not fully understood with genetic and environmental factors underpinning vulnerability and disease progression. Children with chromosome 22q11.2 deletion syndrome (22q11.2DS) are at ultra-high risk for developing SCZ with 30% developing the disorder in adolescence or young adulthood. To investigate associations with psychosis vulnerability, much work has been performed looking at neurological underpinnings between schizophrenia and 22q11.2DS to assess similarities between both genetic and idiopathic forms of schizophrenia in adults. However, many past studies have assessed this using …
Fruit And Vegetable Intake Is Inversely Associated With Perceived Stress Across The Adult Lifespan, Simone Radavelli-Bagatini, Lauren C. Blekkenhorst, Marc Sim, Richard L. Prince, Nicola P. Bondonno, Catherine P. Bondonno, Richard Woodman, Reindolf Anokye, James Dimmock, Ben Jackson, Leesa Costello, Amanda Devine, Mandy J. Stanley, Joanne M. Dickson, Dianna J. Magliano, Jonathan E. Shaw, Robin M. Daly, Jonathan M. Hodgson, Joshua R. Lewis
Fruit And Vegetable Intake Is Inversely Associated With Perceived Stress Across The Adult Lifespan, Simone Radavelli-Bagatini, Lauren C. Blekkenhorst, Marc Sim, Richard L. Prince, Nicola P. Bondonno, Catherine P. Bondonno, Richard Woodman, Reindolf Anokye, James Dimmock, Ben Jackson, Leesa Costello, Amanda Devine, Mandy J. Stanley, Joanne M. Dickson, Dianna J. Magliano, Jonathan E. Shaw, Robin M. Daly, Jonathan M. Hodgson, Joshua R. Lewis
Research outputs 2014 to 2021
Background & aims: Poor nutritional habits are linked to higher perceived stress, but the relationship between fruit and vegetable (FV) intake and stress is uncertain. The primary aim of this cross-sectional study was to explore the relationship between FV intake and perceived stress in a population-based cohort of men and women aged ≥ 25 years from the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. A secondary aim was to investigate the relationship between serum carotenoids, biomarkers of FV intake, and perceived stress.
Methods: In Australian men and women, dietary intake was assessed using a Food Frequency Questionnaire in 1999–2000 (n …
Helping Babies: The Mental And Physical Effects Of Massage Therapy On Preterm Infants, Sadie Johnson
Helping Babies: The Mental And Physical Effects Of Massage Therapy On Preterm Infants, Sadie Johnson
Intuition: The BYU Undergraduate Journal of Psychology
The purpose of this paper is to address and review the literature regarding the effects of massage therapy on preterm infants. Each of the studies done focused on infants aged 0–12 months. The literature specifically looks at irritability states, stress, analgesia, weight-gain, sleep-wake cycles, cognition, and gastrointestinal function. In accordance with the studies reviewed in this article, I deduce that massage therapy can be used with preterm infants to reduce irritability and stress, increase weight-gain, support greater rest, facilitate short-term cognitive improvement, and create a greater improvement in gastrointestinal function. Massage therapy can also reduce pain in infants who have …
The Comorbidity Of Drug And Alcohol Consumption In Relation To Mental Health Disorders, Sydney Dawson
The Comorbidity Of Drug And Alcohol Consumption In Relation To Mental Health Disorders, Sydney Dawson
Intuition: The BYU Undergraduate Journal of Psychology
The constantly increasing use of drugs and alcohol in young adults has created great controversy in the medical community on the long-term effects of these substances. The average brain development of adolescence and young adults is not complete until the age of 25, though drug and alcohol intake occur across the United States at younger ages each year. Impulsive behavior and underdeveloped neural pathways create a strong pull for addiction formulations and the development of severe mental-health problems. This paper reviews the positive and negative effects of illicit drugs and alcohol intake and their comorbidity with mental health disorders. There …
The Biopsychosocial Model And Clinical Decision Science In The Age Of Black Lives Matter: A Clinical Reflection, Abdul-Rahman M. Suleiman, Samer Ilayan
The Biopsychosocial Model And Clinical Decision Science In The Age Of Black Lives Matter: A Clinical Reflection, Abdul-Rahman M. Suleiman, Samer Ilayan
Clinical Research in Practice: The Journal of Team Hippocrates
The author reflects on the biopsychosocial considerations of elevated blood pressure in teenage African American youth during the era of Black Lives Matter (BLM). Parallels are drawn between Dr. Engel’s biopsychosocial model and clinical decision science.
Post-Operative Pain Management Modalities Employed In Clinical Trials For Adult Patients In Lmic; A Systematic Review, Gauhar Afshan, Robyna Irshad Khan, Aliya Ahmed, Ali Sarfraz Siddiqui, Azhar Rehman, Syed Amir Raza, Rozina Kerai, Khawaja Mustafa
Post-Operative Pain Management Modalities Employed In Clinical Trials For Adult Patients In Lmic; A Systematic Review, Gauhar Afshan, Robyna Irshad Khan, Aliya Ahmed, Ali Sarfraz Siddiqui, Azhar Rehman, Syed Amir Raza, Rozina Kerai, Khawaja Mustafa
Department of Anaesthesia
Background: Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade.
Methods: A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal …
From Managing Nurses To Serving Nurses: The Case For Transfusing Nursing Management With Servant Leadership During The Global Covid-19 Pandemic, William P. Jimenez, Seterra D. Burleson, Matthew J. Haugh
From Managing Nurses To Serving Nurses: The Case For Transfusing Nursing Management With Servant Leadership During The Global Covid-19 Pandemic, William P. Jimenez, Seterra D. Burleson, Matthew J. Haugh
Psychology Faculty Publications
No abstract provided.
Family Bereavement Implications For Military Personnel: A Policy Proposal, Dehussa Urbieta
Family Bereavement Implications For Military Personnel: A Policy Proposal, Dehussa Urbieta
Doctor of Nursing Practice Final Manuscripts
Introduction: The death of a child is a devastating tragedy. Evidence demonstrates a link between bereavement and increased mortality risks and decrements in physical and mental health. Factors are compounded in active-duty service members through arduous duty environments, deployments, relocations, and inadequate support systems.
Methods: A focused literature search of bereavement specifically concentrated on child loss and the sequela on survivor mental health and functioning was conducted. The quality of the evidence was assessed using the Melnyk Evidence-Based Practice Model. The Evidence-Based Public Health Model was used as a guide for policy development.
Evidence-Based Intervention: Draft a military parental bereavement …
Community Art For Rebuilding College Communities Following The Covid-19 Pandemic: A Literature Review, Amber Haney
Community Art For Rebuilding College Communities Following The Covid-19 Pandemic: A Literature Review, Amber Haney
Expressive Therapies Capstone Theses
This paper is an examination of arts-based community engagement projects as a way to creatively engage, support, and endorse healing in college communities. This paper was written with consideration for potential long-term impacts on college students, individually and collectively, as a result of the COVID-19 pandemic. Throughout this paper, college student mental health trends in the United States are addressed and existing community engagement projects that center around community, healing, and resilience are examined. This paper argues that art therapy practices that are meant to advance societal healing can occur outside of the traditional, clinical individual or group therapy session …
Using Paper Theatres As An Expressive Arts Therapy Method: Activating Imaginal Worlds In Community Arts Practice, Silvina S. Ibanez
Using Paper Theatres As An Expressive Arts Therapy Method: Activating Imaginal Worlds In Community Arts Practice, Silvina S. Ibanez
Expressive Therapies Capstone Theses
Paper theatres are an artistic form that became widely popular in 19th century Europe. Also known as toy theatre and model theatre, a paper theatre has a small build-your-own proscenium and pre-cut paper characters that can be manipulated. Different styles of paper theatre can be found in several cultures.
In contemporary art, the use of paper theatres in several modalities led to an exploration of whether such theatres also could be used as an art therapy method. Research was conducted into expressive art therapy principles, Jungian perspectives, and recent studies in neurosciences. The studies included in the literature review confirmed …
Exploring The Therapeutic Relationship As A Central Focus Through Expressive Arts Therapy In Oncology, Akshata Parekh
Exploring The Therapeutic Relationship As A Central Focus Through Expressive Arts Therapy In Oncology, Akshata Parekh
Expressive Therapies Capstone Theses
The treatment for cancer can be physically, mentally, emotionally and socially challenging. These treatments have side effects like physical body pain, hair loss, changes in weight, energy, nausea and more. These physical changes impact the social, mental and emotional well-being of the patient and makes this journey of the life-threating prognosis of cancer very tough to confront. Expressive arts therapy provides a safe space for the patients to address their mental health concerns as a result of this treatment. The Capstone Thesis Project explored expressive arts therapy interventions with 95 patients through single or multiple sessions while going through their …
Making Room: Addressing The Counter-Therapeutic Nature Of Psychiatric Hospitalization Through Containment- Based Group Expressive Therapy, Max Sandor Copans
Making Room: Addressing The Counter-Therapeutic Nature Of Psychiatric Hospitalization Through Containment- Based Group Expressive Therapy, Max Sandor Copans
Expressive Therapies Capstone Theses
The process of hospitalization and the environment of a typical psychiatric hospital is often counter-therapeutic. To challenge this problem, clinicians may introduce the concept of psychological containment. To elaborate, being hospitalized anywhere can be disorienting, frightening and even traumatic. This problem is only further exacerbated in psychiatric hospitals where patients may be disorganized, manic, or struggling with psychosis. Furthermore, psychological containment is essentially the ability for psychiatric patients to prevent their intense emotions from effecting others negatively, and to act with resiliency when other patients are unable to contain their own disruptive behaviors. This paper utilizes both an initial literature …
Language As The Medium: A Literature Review. Harnessing The Prolific Power Of Dramatic Language As A Therapeutic Tool In Drama Therapy, Edward Freeman
Language As The Medium: A Literature Review. Harnessing The Prolific Power Of Dramatic Language As A Therapeutic Tool In Drama Therapy, Edward Freeman
Expressive Therapies Capstone Theses
Language in and of the theatre, with its palate of variegated writing styles and playwrights from throughout time, has the potential to be harnessed, focused, and systematized for use as a therapeutic tool within drama therapy – the field’s artistic medium. Drama therapy could benefit from having a specific medium germane to its artform which has the potential to provide practitioners with a common resource and means of communication, assessment, diagnosis, and treatment planning, as well as align the field with other creative arts therapies. Language encompasses all forms of human communication – speaking, writing, signing, gesturing, expressing facially – …
Bringing The Body Into Art Therapy: The Use Of Touch And Body Awareness In Creative Healing, Janna Corsetti
Bringing The Body Into Art Therapy: The Use Of Touch And Body Awareness In Creative Healing, Janna Corsetti
Expressive Therapies Capstone Theses
The focus on the use of healing touch and body awareness in art therapy is critically lacking. Despite the research supporting the use of body-oriented techniques in clinical therapy, there is little research related to this use specifically in art therapy. Research reveals that healing touch and body awareness can be instrumental in healing trauma, if done with the proper training and boundaries in place. The first form of attachment and comfort for children is that of touch. Therefore, it is imperative to acknowledge the power of touch and body awareness when healing from traumatic experiences. The purpose of this …
Self-Compassion Integrated Art Therapy For Mothers During A Pandemic, Shannon Dover
Self-Compassion Integrated Art Therapy For Mothers During A Pandemic, Shannon Dover
Expressive Therapies Capstone Theses
This thesis reviews literature related to parental mental health and the novel coronavirus (COVID-19). COVID-19 is a collective trauma in which individuals experience the trauma differently depending on race, gender, and class. Women’s experience of living during COVID-19 related to changes in the workplace, caretaking, and more. The pandemic influenced parents and notably mothers with increased stress, depression, grief, and anxiety. The practice of self-compassion reduces shame and self-criticism which are common experiences during parenting and trauma. Self-compassion and art therapy can aid in resiliency and make living during COVID-19 more comfortable. With a literature review, results yield the following …
Exploring The Usefulness Of Mindfulness Practices Through Zoom Meetings In Reducing Anxiety And/Or Stress Of Adults With Learning And Developmental Disabilities During The Covid-19 Pandemic, Thatiane Abra
Expressive Therapies Capstone Theses
This thesis explored which mindfulness meditations or mindfulness practices could be beneficial in the online sessions, the extent to which adults with learning and developmental disabilities could learn the practices remotely, and how stress and anxiety disorders could be reduced through online mindfulness interventions. Furthermore, it was also necessary to address the online sessions as the only mental health treatment possibility during the Coronavirus pandemic for the clients observed and the benefits and limitations of these interventions. Additionally, the importance of structure and routine for this population, the multi-modal structure of the interventions, and how attunement plays an important role …
Exploring Tactile Art-Making With Deafblind Students And Their Families: An Opportunity For Creative Play, Alice Rodgers
Exploring Tactile Art-Making With Deafblind Students And Their Families: An Opportunity For Creative Play, Alice Rodgers
Expressive Therapies Capstone Theses
The impact of a deafblind diagnosis on an individual’s mental health and the well-being of the family involved can be profound. However, current research and available literature for the mental health treatment and therapy practices of deafblind persons and their families is limited (Kyzar et al., 2016; “WFDB Global Report 2018,” n.d.). This thesis used the Leeds Family Psychology and Therapy Service principles (Leeds FPTS) and the Expressive Therapies Continuum with established deafblind teaching strategies to facilitate an original arts-based community project entitled: “Things We Like.” This project provided an opportunity for deafblind students (ages three to 22) and their …
"It's The Way You Sing It": Translating Music Therapy For Isolated Older Adults Affected By Covid-19 To The Television Screen, Eunice Wong
Expressive Therapies Capstone Theses
The current Covid-19 pandemic has increased the likelihood of loneliness and social isolation among older adults due to the restrictions on movement and visitations in care facilities. Loneliness and social isolation have consistently been identified as risk factors for poor mental and physical health in older people. Meanwhile, a growing number of older adults are utilizing technological resources to enhance their interpersonal relationships and overall quality of life. In the winter of 2020/2021, an innovative music therapy-informed television program was designed and produced for isolated older adults in need of mental and emotional support. This project, produced jointly by a …
Knowing What We Know: Leveraging Community Knowledge Through Automated Text-Mining, Justin Gardner, Jonathan Tory Toole, Hemant Kalia, Garry Spink Jr., Gordon Broderick
Knowing What We Know: Leveraging Community Knowledge Through Automated Text-Mining, Justin Gardner, Jonathan Tory Toole, Hemant Kalia, Garry Spink Jr., Gordon Broderick
Advances in Clinical Medical Research and Healthcare Delivery
No abstract provided.
Exploring Social Determinants Of Covid-19 Related Sickness And Suffering In The Bronx, Hamida Chumpa
Exploring Social Determinants Of Covid-19 Related Sickness And Suffering In The Bronx, Hamida Chumpa
Student Theses and Dissertations
Through a positivistic and phenomenological approach, the study examines social determinants of COVID-19 related sickness and suffering in the Bronx, New York City, New York, ZIP codes 10462, 10472, 10467, 10458, 10474, and 10464. I utilize a violence paradigm (structural and everyday violence) to describe the social determinants of risk and sickness-related suffering and deploy an assemblage framework to shed light on how these determinants create negative synergies that undermine wellbeing and render certain communities vulnerable to extreme suffering. The mixed methods include 64 surveys and eight interviews. Analysis methods include a descriptive analysis of survey results and a thematic …