Jacoby, Sara Fredricka
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Publication The Effect of Early Psychological Symptom Severity on Long-term Functional Recovery: A Secondary Analysis of Data from a Cohort Study of Minor Injury Patients(2017-01-01) Jacoby, Sara Fredricka; Richmond, Therese S; Shults, JustineBackground: The mental health consequences of injuries can interfere with recovery to pre-injury levels of function and long term wellbeing. Objectives: The purpose of this study was to explore the relationship between psychological symptoms after minor injury and long-term functional recovery and disability. Design: This exploratory study uses secondary data derived from a longitudinal cohort study of psychological outcomes after minor injury. Setting: Participants were recruited from the Emergency Department of an urban hospital in the United States. Participants: A cohort of 275 patients was randomly selected from 1100 consecutive emergency department admissions for minor injury. Potential participants were identified as having sustained minor injury by the combination of three standard criteria including: presentation to the emergency department for medical care within 24 h of a physical injury, evidence of anatomical injury defined as minor by an injury severity score between 2 and 8 and normal physiology as defined by a triage-Revised Trauma Score of 12. Patients with central nervous system injuries, injury requiring medical care in the past 2 years and/or resulting from domestic violence, and those diagnosed with major depression or psychotic disorders were excluded. Methods: Psychological symptom severity was assessed within 2 weeks of injury, and outcome measures for functional limitations and disability were collected at 3, 6 and 12 months. A quasi-least squares approach was used to examine the relationship between psychological symptom scores at intake and work performance and requirement for bed rest in the year after injury. Results: Adjusting for demographic and injury covariates, depression symptoms at the time of injury predicted (p ≤ 0.05) both poorer work performance and increased number of days in bed due to health in the year after injury. Anxiety symptoms predicted (p ≤ 0.05) bed days at 3, 6, and 12 months and work performance at 3 months. Conclusions: Depression and anxiety soon after minor injury may help predict important markers of long-term recovery. With further research, simple assessment tools for psychological symptoms may be useful to screen for patients who are at higher risk for poor long-term recoveries and who may benefit from targeted interventions.Publication Road Safety Perspectives Among Employees of a Multinational Corporation in Urban India: Local Context for Global Injury Prevention(2017-01-24) Jacoby, Sara Fredricka; Richmond, Therese S; Winston, FlauraIn rapidly developing economies, like urban India, where road traffic injury rates are among the world's highest, the corporate workplace offers a non-traditional venue for road safety interventions. In partnership with a major multinational corporation (MNC) with a large Indian workforce, this study aimed to elicit local employee perspectives on road safety to inform a global corporate health platform. The safety attitudes and behaviours of 75 employees were collected through self-report survey and focus groups in the MNC offices in Bangalore and Pune. Analysis of these data uncovered incongruity between employee knowledge of safety strategies and their enacted safety behaviours and identified local preference for interventions and policy-level actions. The methods modelled by this study offer a straightforward approach for eliciting employee perspective for local road safety interventions that fit within a global strategy to improve employee health. Study findings suggest that MNCs can employ a range of strategies to improve the road traffic safety of their employees in settings like urban India including: implementing corporate traffic safety policy, making local infrastructure changes to improve road and traffic conditions, advocating for road safety with government partners and providing employees with education and access to safety equipment and safe transportation options.Publication An Ethnographic Study of the Experience of Black Traumatically Injured Patients at a Trauma Center in Philadelphia(2015-01-01) Jacoby, Sara Fredricka; Jacoby, Sara Fredricka; Jacoby, Sara FredrickaThe intent of this ethnographic study of trauma care was to contextualize the etiologic factors that perpetuate disparities in survival and recovery among Black traumatically injured patients in the United States. Race-based disparities in trauma injury outcomes in the U.S. are perplexing given the legislative protections that require that all people, regardless of insurance status, are admitted to trauma centers and that accreditation of these centers requires adherence to strict standards of care. This dissertation offers an interpretive analysis of ethnographic data collected among twelve Black traumatically injured patients and the clinicians who provided their medical and nursing care between December 2012 and December 2013 in a Trauma I Medical Center in Philadelphia. Participants discussed their perceptions of injury care and the consequence of being injured in the context of their lived experiences, shaped by violence, poverty, underemployment, lack of health insurance, and disenfranchisement from local healthcare institutions. The socio-structural context of the trauma center and its clinical culture were similarly constituted by these racialized economic and political dynamics of the city-at-large. These findings prompt re-thinking of practice and processes in clinical trauma care to recognize and accommodate the lived experiences of socially marginalized patients in medical and public health responses to injury in the urban environment.