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Articles 1531 - 1560 of 3193

Full-Text Articles in Psychiatric and Mental Health

Psychological And Physiological Stress And Burnout Among Maternity Providers In A Rural County In Kenya: Individual And Situational Predictors, Patience A. Afulani, Linnet Ongeri, Joyceline Kinyua, Marleen Temmerman, Wendy Berry Mendes, Sandra J. Weiss Mar 2021

Psychological And Physiological Stress And Burnout Among Maternity Providers In A Rural County In Kenya: Individual And Situational Predictors, Patience A. Afulani, Linnet Ongeri, Joyceline Kinyua, Marleen Temmerman, Wendy Berry Mendes, Sandra J. Weiss

Obstetrics and Gynaecology, East Africa

Background: Stress and burnout among healthcare workers has been recognized as a global crisis needing urgent attention. Yet few studies have examined stress and burnout among healthcare providers in sub-Saharan Africa, and even fewer among maternity providers who work under very stressful conditions. To address these gaps, we examined self-reported stress and burnout levels as well as stress-related physiologic measures of these providers, along with their potential predictors.

Methods: Participants included 101 maternity providers (62 nurses/midwives, 16 clinical officers/doctors, and 23 support staff) in western Kenya. Respondents completed Cohen’s Perceived Stress Scale, the Shirom-Melamed Burnout scale, and other …


Training Needs Of Counseling Trainees In Corrections: A Survey Of Clinical Directors, Frank Dicataldo, Brett Dejesus, Don Whitworth Feb 2021

Training Needs Of Counseling Trainees In Corrections: A Survey Of Clinical Directors, Frank Dicataldo, Brett Dejesus, Don Whitworth

Journal of Counselor Preparation and Supervision

As the mental health treatment needs of adults and adolescents within the criminal justice system has garnered increasing attention, the training of mental health professionals has increasingly focused on serving individuals in forensic and correctional settings. We surveyed 55 clinical directors of mental health programs in forensic and correctional settings in a New England state. Respondents reported that Clinical Mental Health Counselors (CMHCs) broadly participated in assessment, treatment and supervision within these programs. Counseling experience emerged as the most important knowledge/experience domain for prospective job applicants and CMHCs were rated as providing a large share of the treatment within these …


Oxytocin, Cortisol, And Cognitive Control During Acute And Naturalistic Stress, Shari Young Kuchenbecker, Sarah D. Pressman, Jared Celniker, Karen M. Grewen, Ken D. Sumida, Naveen Jonathan, Brendan Everett, George M. Slavich Feb 2021

Oxytocin, Cortisol, And Cognitive Control During Acute And Naturalistic Stress, Shari Young Kuchenbecker, Sarah D. Pressman, Jared Celniker, Karen M. Grewen, Ken D. Sumida, Naveen Jonathan, Brendan Everett, George M. Slavich

Health Sciences and Kinesiology Faculty Articles

Although stress is a strong risk factor for poor health, especially for women, it remains unclear how stress affects the key neurohormones cortisol and oxytocin, which influence stress-related risk and resilience. Whereas cortisol mediates energy mobilization during stress, oxytocin has anti-inflammatory, anxiolytic, and analgesic effects that support social connection and survival across the lifespan. However, how these neurohormones interrelate and are associated with cognitive control of emotional information during stress remains unclear. To address these issues, we recruited 37 college-aged women (Mage = 19.19, SD = 1.58) and randomly assigned each to a one-hour experimental session consisting of …


A Crisis Of Her Own: Fatal Opioid Overdose, Opioid Use Disorder, And Intimate Partner Violence Among Rural Utah Women, Timothy Light, Erin Fanning Madden, Debasree Das Gupta, Hilary Disch, Katie Zaman, Suzanne Prevedel, Sandra H. Sulzer Feb 2021

A Crisis Of Her Own: Fatal Opioid Overdose, Opioid Use Disorder, And Intimate Partner Violence Among Rural Utah Women, Timothy Light, Erin Fanning Madden, Debasree Das Gupta, Hilary Disch, Katie Zaman, Suzanne Prevedel, Sandra H. Sulzer

All Current Publications

The Centers for Disease Control report that the rate of overdose deaths among women is rapidly increasing, with women experiencing a 532% increase in fatal opioid overdose deaths between 1999 and 2017, compared to a 355% increase for men. Among women, those in rural areas have disproportionately higher drug overdose death rates than women in urban areas (Mazure & Fiellin, 2018), indicating an opportunity for targeted rural public health interventions to slow overdose fatality increases among women. This fact sheet reviews Utah trends, potential factors increasing fatal opioid overdose, intimate partner violence and substance use disorders, and provides resources for …


The Relevance Of Modern Stoicism, Maximillian V. Kutch Feb 2021

The Relevance Of Modern Stoicism, Maximillian V. Kutch

Journal of Wellness

No abstract provided.


The Relationship Between Depression And Cardiovascular Disease, Jomaries O. Gomez Feb 2021

The Relationship Between Depression And Cardiovascular Disease, Jomaries O. Gomez

The Pegasus Review: UCF Undergraduate Research Journal

While there has been extensive research on the link between depression and cardiovascular disease, few reviews have summarized the array of findings. In this literature review, we examined approximately 50 clinical papers and research studies to determine if reducing depression could reduce the risk of having a cardiovascular incident and if reducing the severity of cardiovascular disease could reduce depression. We identified two major mechanisms through which depression affects the cardiovascular system. We present evidence that depression and cardiovascular disease may have a reciprocal relationship. For instance, depression is as much of a risk factor for heart disease as smoking …


Unmet Needs Are Associated With Increased Stress And Poor Physical And Mental Health In Early Adulthood, Colleen Heflin, Katie Green, Ying Huang, Asiya Validova Feb 2021

Unmet Needs Are Associated With Increased Stress And Poor Physical And Mental Health In Early Adulthood, Colleen Heflin, Katie Green, Ying Huang, Asiya Validova

Population Health Research Brief Series

Material hardship, such as not being able to pay bills, negatively affects both physical and mental health. This research brief examines how different types of material hardship (difficulty paying for food, bills, and health care) are associated with self-rated health, depression, sleep problems, and suicidal thoughts among U.S. young adults (ages 24-32).


Wellness Review 2020, Part 2, Brian Ferguson, Martin Huecker Feb 2021

Wellness Review 2020, Part 2, Brian Ferguson, Martin Huecker

Journal of Wellness

Introduction: This article comprises Part 2 of the Journal of Wellness review of 2020 wellness literature (July – December). In this review, JWellness editors continue the goal of offering a cohesive summary of recent publications within the wellness domain. We summarize new science and resilience initiatives published outside of JWellness that seek understanding of either burnout and its prevention or thriving in the medical community.

Methods: From the interval of 01 July – 31 Dec 2020, PubMed was queried for empirical research studies, review articles, and editorials in accordance with the following algorithm: an article was required to …


Anxiety And Mood Disorders Impacting Physician Opioid Prescribing In The Pediatric Hospital Setting, Candice D. Donaldson, Zeev N. Kain, Louis Ehwerhemuepha, Michelle A. Fortier, Michael T. Phan, Daniel M. Tomaszewski, Sun Yang, William Feaster, Brooke N. Jenkins Feb 2021

Anxiety And Mood Disorders Impacting Physician Opioid Prescribing In The Pediatric Hospital Setting, Candice D. Donaldson, Zeev N. Kain, Louis Ehwerhemuepha, Michelle A. Fortier, Michael T. Phan, Daniel M. Tomaszewski, Sun Yang, William Feaster, Brooke N. Jenkins

Psychology Faculty Articles and Research

This research examined whether pediatric inpatients without an anxiety/mood disorder are more likely to receive opioids in response to pain compared to patients diagnosed with a mental health condition. Research questions were tested using cross-sectional inpatient electronic medical record data. Propensity score matching was used to match patients with a disorder with patients without the disorder (anxiety analyses: N = 2892; mood analyses: N = 1042). Although patients with anxiety and mood disorders experienced greater pain, physicians were less likely to order opioids for these patients. Analyses also disclosed an interaction of anxiety with pain—the pain-opioid relation was stronger for …


St. Andrew’S Gratitude Project: The Impact Of Daily Practices Of Gratitude On Feelings Of Loneliness, Eric Partridge Feb 2021

St. Andrew’S Gratitude Project: The Impact Of Daily Practices Of Gratitude On Feelings Of Loneliness, Eric Partridge

Consensus

No abstract provided.


Prevalence, Risk And Protective Indicators Of Common Mental Disorders Among Young People Living With Hiv Compared To Their Uninfected Peers From The Kenyan Coast: A Cross-Sectional Study, Moses K. Nyongesa, Paul Mwangi, Michael Kinuthia, Amin S. Hassan, Hans M. Koot, Pim Cuijpers, Charles R. J. C. Newton, Amina Abubakar Feb 2021

Prevalence, Risk And Protective Indicators Of Common Mental Disorders Among Young People Living With Hiv Compared To Their Uninfected Peers From The Kenyan Coast: A Cross-Sectional Study, Moses K. Nyongesa, Paul Mwangi, Michael Kinuthia, Amin S. Hassan, Hans M. Koot, Pim Cuijpers, Charles R. J. C. Newton, Amina Abubakar

Institute for Human Development, East Africa

Background: In sub-Saharan Africa, common mental disorders (CMDs) like depression and anxiety are under investigated amongst young people living with HIV (YLWH). To address the gap, in Kenya we: a) determined the prevalence of CMDs among YLWH compared to their uninfected peers; b) investigated HIV status as an independent predictor of CMDs in young people; c) investigated CMDs risk and protective indicators with more focus on YLWH.

Methods: Between November 2018 and September 2019, 819 young people aged 18–24 years (407 HIV-infected) were recruited from two Counties on the Kenyan coast. Locally adapted pre-existing mental health measures, Patient Health Questionnaire …


Antecedents Of Borderline Personality Disorder And Antisocial Personality Disorder: An Examination Of Gene X Environment Interactions, Amy L. Medina Feb 2021

Antecedents Of Borderline Personality Disorder And Antisocial Personality Disorder: An Examination Of Gene X Environment Interactions, Amy L. Medina

Dissertations, Theses, and Capstone Projects

Current thinking suggests that genotypes associated with impulse-control disorders and negative emotionality, such as monoamine oxidase-a (MAOA), interact with negative early environmental factors like childhood maltreatment and develop into the disorders know as Borderline Personality Disorder (BPD) and Antisocial Personality Disorder (ASPD). Using existing data from a prospective cohort design study of the consequences of child abuse and neglect, participants (N = 896 represent individuals with documented histories of child abuse and neglect and a matched comparison group that were followed up into adulthood and interviewed. A subsample of 631 participants gave permission for DNA extraction and analyses during …


Chronic Use Of Non-Medical Abdominal Compressors: Medical And Psychological Implications, Sawsan Edriss, Bushra Azom, Manar Edriss, Mustafa Edriss, Ann-Cathrin Guertler, Eva Waineo Md, Diane L. Levine Md Jan 2021

Chronic Use Of Non-Medical Abdominal Compressors: Medical And Psychological Implications, Sawsan Edriss, Bushra Azom, Manar Edriss, Mustafa Edriss, Ann-Cathrin Guertler, Eva Waineo Md, Diane L. Levine Md

Medical Student Research Symposium

The popularity of waist cinchers, shapewear, abdominal binders, corsets, and waist trainers has increased in the population. Although corsets have been part of western fashion since the 18th century, abdominal compressors remain in style even today. In 2018, sales for shapewear worldwide were estimated at 2.26 billion USD. 1 Despite its popularity, shapewear safety and medical effects have not been widely studied.

In 1968, “Pantygirdle Syndrome” was described, attributing vulvitis, urethritis, and urinary tract infections to materials used from the “pantygirdle”. 2 The article describes that the girdle caused gastrointestinal symptoms with diaphragmatic and stomach displacement causing gastro-esophageal reflux disease …


Wastewater Testing Shows That Pharmaceutical And Illicit Drug Use Are Higher In Places Where Covid-19 Is More Prevalent, Kerrie Marshall, Arik Palileo, Eric Schiff, Teng Zeng Jan 2021

Wastewater Testing Shows That Pharmaceutical And Illicit Drug Use Are Higher In Places Where Covid-19 Is More Prevalent, Kerrie Marshall, Arik Palileo, Eric Schiff, Teng Zeng

Population Health Research Brief Series

Wastewater testing shows that pharmaceutical and illicit drug use are higher in places were COVID-19 is more prevalent.


Associations Between Stress, Anxiety, Depression, And Emotional Intelligence Among Osteopathic Medical Students, Nicole A. Doyle, Robert E. Davis, Syed Siraj A. Quadri, Joshua R. Mann, Manoj Sharma, Richard M. Wardrop, Vinayak K. Nahar Jan 2021

Associations Between Stress, Anxiety, Depression, And Emotional Intelligence Among Osteopathic Medical Students, Nicole A. Doyle, Robert E. Davis, Syed Siraj A. Quadri, Joshua R. Mann, Manoj Sharma, Richard M. Wardrop, Vinayak K. Nahar

Environmental & Global Health Faculty Research

Context: Stress, anxiety, and depression affect medical student populations at rates disproportionate to those of general student populations. Emotional intelligence (EI) has been suggested as a protective factor in association with psychological distress. Objective: To explore the relationships between EI and stress, anxiety, and depression among a sample of US osteopathic medical students. Methods: From February to March 2020, a convenience sample of medical students enrolled at an osteopathic medical school in the southeastern region of the United States were invited to complete a voluntary and anonymous 54-item online questionnaire that included sociodemo-graphic items as well as validated and reliable …


Anxious Times And Anxiety Drugs, Noah Atlas, Austin Mcneill Brown Jan 2021

Anxious Times And Anxiety Drugs, Noah Atlas, Austin Mcneill Brown

Population Health Research Brief Series

The COVID-19 pandemic has caused rising anxiety and a corresponding increase in benzodiazepine prescriptions. Experts worry that inconsistent access to physicians as a result of stay-at-home orders will lead dependent patients to seek counterfeit or street drugs if their prescriptions lapse. This brief discusses these repercussions and recommends approaches to monitor and support those suffering from anxiety.


Relationship Between Physician Burnout And Patient’S Perception Of Bedside Time Spent By Physicians, Shannon Leung, Mukta Panda, Georgia Mcintosh, Nargiza Kurbanova, Anna-Carson Rimer Uhelski, Muhammad Mubbashir Sheikh, Rehan Qayyum Jan 2021

Relationship Between Physician Burnout And Patient’S Perception Of Bedside Time Spent By Physicians, Shannon Leung, Mukta Panda, Georgia Mcintosh, Nargiza Kurbanova, Anna-Carson Rimer Uhelski, Muhammad Mubbashir Sheikh, Rehan Qayyum

Journal of Patient-Centered Research and Reviews

Although the adverse effect of burnout on physicians has been widely documented, studies have shown an inconsistent relationship between burnout and the quality of patient care. We hypothesized that physician burnout will have an inverse relationship with the time spent at the bedside by physicians. In a cross-sectional study, we surveyed patients on their perception of the time spent by their physician on the day of the survey (4 categories: 0–5, 6–10, 11–15, > 15 minutes). Oldenburg Burnout Inventory was used to assess physician burnout; burnout was defined as high levels of both exhaustion (≥ 2.25) and disengagement (≥ 2.10). Among …


Punishing The Victim: Model Rule 1.16(A)(2) And Its Relation To Lawyers With Anxiety, Depression, And Bipolar Disorder, Daniel G. Esquivel Jan 2021

Punishing The Victim: Model Rule 1.16(A)(2) And Its Relation To Lawyers With Anxiety, Depression, And Bipolar Disorder, Daniel G. Esquivel

St. Mary's Journal on Legal Malpractice & Ethics

Abstract forthcoming.


When Mental Health Meets “The One-Armed Man” Defense: How Courts Should Deal With Mccoy Defendants, Farid Seyyedi Jan 2021

When Mental Health Meets “The One-Armed Man” Defense: How Courts Should Deal With Mccoy Defendants, Farid Seyyedi

St. Mary's Journal on Legal Malpractice & Ethics

The Supreme Court’s opinion in McCoy v. Louisiana held that a defendant has a constitutional right to insist their attorney not concede guilt as to any element of an offense, even if doing so is the only reasonable trial strategy to give the defendant a chance at life imprisonment instead of the death penalty. Under McCoy’s holding, a defendant can insist on maintaining their innocence—even in the face of overwhelming evidence—and force their attorney to pursue a defense that will land them on death row. The Supreme Court’s holding makes clear that a strategic concession of guilt at trial—over …


Self-Esteem And Long-Term Recovery From Substance Use Disorders, Mariah Brennan Nanni, Austin Mcneill Brown Jan 2021

Self-Esteem And Long-Term Recovery From Substance Use Disorders, Mariah Brennan Nanni, Austin Mcneill Brown

Population Health Research Brief Series

This brief describes how self-esteem and other strength-based measures of personal growth are better indicators of recovery progress.


The Influence Of Cyber-Sexual Assault On The Mental Health Outcomes Of Survivors, Kelley R. Holladay, W. Bryce Hagedorn, David Boote Jan 2021

The Influence Of Cyber-Sexual Assault On The Mental Health Outcomes Of Survivors, Kelley R. Holladay, W. Bryce Hagedorn, David Boote

Journal of Counseling Sexology & Sexual Wellness: Research, Practice, and Education

Researchers examined data collected from the only national sample of cyber-sexual assault (CBSA) survivors (N = 97; 3.75\% response rate to the online survey) using three valid instruments that measure symptomology of sexual assault. We found that participants scored high across each of the inventories, indicating CBSA survivors respond in ways that are similar to sexual assault survivors concerning emotional dysregulation, depression, and post-traumatic stress symptomology, particularly if they had a history of sexual assault. Implications for counselors are reviewed, and clinical recommendations are offered.


A Predictable Home Environment May Protect Child Mental Health During The Covid-19 Pandemic, Laura M. Glynn, Elyssia Poggi Davis, Joan L. Luby, Tallie Z. Baram, Curt A. Sandman Jan 2021

A Predictable Home Environment May Protect Child Mental Health During The Covid-19 Pandemic, Laura M. Glynn, Elyssia Poggi Davis, Joan L. Luby, Tallie Z. Baram, Curt A. Sandman

Psychology Faculty Articles and Research

Objective

Information about the adverse effects of the COVID-19 pandemic on adolescent and adult mental health is growing, yet the impacts on preschool children are only emerging. Importantly, environmental factors that augment or protect from the multidimensional and stressful influences of the pandemic on emotional development of young children are poorly understood.

Methods

Depressive symptoms in 169 preschool children (mean age 4.1 years) were assessed with the Preschool Feelings Checklist during a state-wide stay-at-home order in Southern California. Mothers (46% Latinx) also reported on externalizing behaviors with the Strengths & Difficulties Questionnaire. To assess the role of environmental factors in …


Effectiveness Of Two Frequently Used Screening Tools In Identifying Depression And Anxiety In Collegiate Athletes, Adriana C. Isacke Do, Amy Haskins Phd, Christina Holt Md, Msc, Williams Dexter Md, Facsm Jan 2021

Effectiveness Of Two Frequently Used Screening Tools In Identifying Depression And Anxiety In Collegiate Athletes, Adriana C. Isacke Do, Amy Haskins Phd, Christina Holt Md, Msc, Williams Dexter Md, Facsm

Journal of Maine Medical Center

Introduction: To determine whether the Electronic Pre-participation Physical Examination (EPPE), a proprietary and frequently used tool, is an effective method for depression and anxiety screening in the collegiate athlete population as compared to the Patient Health Questionnaire-4 (PHQ-4).

Methods: College athletes at a Division III university completed PHQ-4 questionnaires and a proprietary EPPE. Positive reponse rates to depression and/or anxiety for both questionnaires were collected and analyzed with a kappa (κ) statistic.

Results: Among 420 students, we found that 9 (2%) reported depression and/or anxiety via the EPPE. Of the 26 students (6%) who answered positively on the PHQ-4, we …


Improving Psychological Trauma Awareness For Culturally Responsive Care: A Dnp Project, Jose M. Cruz Jan 2021

Improving Psychological Trauma Awareness For Culturally Responsive Care: A Dnp Project, Jose M. Cruz

Doctor of Nursing Practice Projects

Racism and racial discrimination occur in a variety of forms (Kendi, 2017). Both can contribute to poor mental health outcomes in the United States (Alvarez, Liang, & Neville, 2016; Comas-Diaz, Hall, & Neville, 2019; Levy, 2019; Malott & Schaefle, 2015; Williams, Lawrence, Davis, & Vu, 2019). These social conditions have been identified as chronic stressors that can illicit trauma symptoms, result in post-traumatic stress disorder (PTSD), and contribute to increased suicidality (French et al., 2020). Providers should understand the ramifications of the psychological trauma that can occur and endeavor to deliver evidence-based solutions. This doctoral project was designed to develop, …


A Protocol For Improving Early Recognition And Treatment Of Bipolar Disorder, Zelluyah Gaitho Jan 2021

A Protocol For Improving Early Recognition And Treatment Of Bipolar Disorder, Zelluyah Gaitho

Doctor of Nursing Practice Projects

In bipolar disorder, patients present to a clinician during depressive episodes often leading to a misdiagnosis. In turn, this could lead to inappropriate treatment. This failure to diagnose could be attributed to lack of use of validated screening tools and deviation from clinical guidelines. The purpose of this quality improvement project was to develop a protocol that will help improve early recognition and treatment of bipolar disorder by using the Mood Disorder Questionnaire. A training program was developed to increase knowledge on the proper use of the Mood Disorder Questionnaire (MDQ) and the Quality-of-Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). …


Spreading Encouragement To Seniors In A Pandemic, Bonnie L. Rogulj, Lashia Hicks Jan 2021

Spreading Encouragement To Seniors In A Pandemic, Bonnie L. Rogulj, Lashia Hicks

Physical Therapy Collection

This brief note describes a "virtual calendar" project created by students of the University of St. Augustine for Health Sciences. The calendar of images and poetry was shared with older adult community members to reduce loneliness and increase mental health and wellness in this population during the COVID-19 pandemic.


Benefits Of Child Life Procedural Preparation In Postoperative Long Term Recovery Of Pediatric Patients, Adriana Silva-Nevers Jan 2021

Benefits Of Child Life Procedural Preparation In Postoperative Long Term Recovery Of Pediatric Patients, Adriana Silva-Nevers

Graduate Student Independent Studies

This literature review is an examination of the benefits of child life preparation in children undergoing surgery, and the significant minimization of trauma from such interventions from the framework of family-centered care. This article also explores the harmful consequences of accumulated trauma, such as not receiving appropriate interventions prior to surgery. The cultural implications surrounding family centered care serve to suggest options for adapting to the particular needs of children and families. Consideration of current research in child life services and the reported benefits to patients, families, staff, and hospitals are included.


Informative Journaling Application (Unwind) For Ambient Awareness On Mood In Young Adults To Reduce Anxiety And Depression: A Randomized, Placebo-Controlled Trial, Jalen Wang Jan 2021

Informative Journaling Application (Unwind) For Ambient Awareness On Mood In Young Adults To Reduce Anxiety And Depression: A Randomized, Placebo-Controlled Trial, Jalen Wang

Dartmouth College Undergraduate Theses

The mental health of young adults in America is worsening. Technology-based interventions may offer an accessible way to help with this problem. The objective of the study was to determine the feasibility and preliminary efficacy of an informative journaling application to reduce symptoms of anxiety and depression for young adults. In an unblinded trial, 20 individuals age 18-22 were recruited from Dartmouth College and were randomized to either participate in using the informative journaling application (Unwind) (n=10) or were directed to a National Institute of Mental Health pamphlet as part of the control group (n=10). All participants completed the 9-item …


Sensory Over-Responsivity And Its Relation To Anxiety: A Literature Review, Katrina Powers Jan 2021

Sensory Over-Responsivity And Its Relation To Anxiety: A Literature Review, Katrina Powers

A with Honors Projects

This honors project examines relevant literature to sensory over-responsivity as it relates to anxiety.


Comparing The Trends Of Postpartum Depression Screening Scores During And Before The Covid-19 Pandemic, Elif S. Duran, Dung Dang, Tony Ogburn Jan 2021

Comparing The Trends Of Postpartum Depression Screening Scores During And Before The Covid-19 Pandemic, Elif S. Duran, Dung Dang, Tony Ogburn

MEDI 9331 Scholarly Activities Clinical Years

Introduction:

Postpartum depression includes major and minor depressive disorders affecting women in the time period after childbirth. The studies reviewed in our literature found that the COVID-19 pandemic has increased the risk of postpartum depression for women. Our study location, the Rio Grande Valley is one of the hardest-hit locations by the COVID-19 pandemic in the United States. Our patient population is also one with the higher risk factors for postpartum depression. As such, we are expecting the psychological impact of the pandemic to be even more magnified, and thus, actions need to be taken to support the vulnerable population …