Trends in Activity Limitations From an International Perspective: Differential Changes Between Age Groups Across 30 Countries.

Objectives: Examine trends in limitations among young (15-39), middle-aged (40-64) and older age-groups (>=65) and their socioeconomic differences. Methods: Population-based European Social Survey data (N = 396,853) were used, covering 30 mostly European countries and spanning the time-period 2002-2018. Limitations were measured using a global activity limitations indicator. Results: Age-differential trends in limitations were found. Activity limitations generally decreased in older adults, whereas trends varied among younger and middle-aged participants, with decreasing limitations in some countries but increasing limitations in others. These age-differential trends were replicated across limitation severity and socioeconomic groups; however, stronger limitation increases occurred regarding less-severe limitations. Discussion: Functional health has improved in older adults. Contrarily, the increasing limitations in younger and middle-aged individuals seem concerning, which were mostly observed in Western and Northern European countries. Given its public health importance, future studies should investigate the reasons for this declining functional health in the young and middle-aged.

The power of informal cancer caregivers' writings: results from a thematic and narrative analysis.

BACKGROUND: Cancer is a disease that disrupts not only the patient's life, but that of the entire family as well, from a care, organizational, and emotional perspective. Patients share their experience of illness frequently with their informal caregiver (IC), a partner, son/daughter, friend, volunteer, or any other person in the family or social network who offers to support them during their clinical journey. The purpose of this study was to investigate ICs' still unknown cancer experiences through the stories of IC participants in a Literary Artistic Competition the Centro di Riferimento Oncologico di Aviano (CRO) IRCSS organized, and understand the themes that emerged from their texts and hence, the power of expressive writing. MATERIALS AND METHODS: A qualitative study was carried out on literary texts using Mishler's three levels of narrative analysis: thematic (to detect themes and subthemes); structural (to support the thematic level), and performative (to understand the narratives' meaning). In addition, the narratives were classified based on Kleinman and Frank's models. A particular focus was placed on the language of the narratives to identify figures of speech, e.g., metaphors related to cancer. RESULTS: Seven main themes emerged from the 40 stories' thematic analysis: perceptions of the disease; biographical breakdown; relationships; transformation of the sick body; IC's role; encounter with death; and strength of memory. The ICs' stories also highlighted the strengths and weaknesses of the patient's clinical pathway. ICs are a resource not only for the patient, who, thanks to them, is assured of continuous assistance but also for the healthcare organization, above all because they serve a relational role as a "bridge" between patients and healthcare workers. ICs have important messages to offer to healthcare organizations. If involved adequately, they can provide a strategic strength in supporting patients and healthcare workers themselves. The in-depth analysis of the themes and subthemes in this study led the authors to hypothesize that expressive writing benefit ICs with respect to the possibility of sharing their experiences with others and giving evidence of their role. Their stories are a testimony that can help those who face a similar experience.

A Mediterranean paradigm? Convergence and divergence in the Southern European Health Care Systems / Um paradigma mediterrâneo? Convergência e divergência nos Sistemas de Saúde da Europa Meridional / ¿Un paradigma mediterráneo? Convergencia y divergencia en los Sistemas de Salud de Europa Meridional

The concept of a 'Mediterranean paradigm' was raised by Josep Figueras in 1994 as a distinctive Southern European model for the health care systems of Italy, Spain and Greece based on the basis of six factors. The subsequent debate (including Portugal, too) is reconstructed on the basis of pros and cons arguments. The specific contribution of the author to the debate - consisting in the proposal of the concept of 'health macro-region' as an analytic tool to pursue a more comprehensive approach in comparative terms on the basis of a connectionist model - is then presented in details by showing the peculiar characteristics of the Southern European health macro-region. Finally, an historical perspective involving three different kinds of temporality (long, middle and short span) is proposed in order to explain both the substantial similar timing (diachronic convergence) and, at the same time, the significant differences (synchronic divergences) among Southern European health care systems in the way and levels their national health services were implemented. (AU)

O conceito de um "paradigma mediterrâneo" foi levantado por Josep Figueras em 1994, como um modelo distinto do Sul da Europa para os sistemas de saúde da Itália, Espanha e Grécia, com base em seis fatores. O debate subsequente (incluindo também Portugal) é reconstruído com base em argumentos prós e contras. A contribuição específica do autor para o debate - consistindo na proposta do conceito de 'macrorregião da saúde' como ferramenta analítica para buscar uma abordagem mais abrangente em termos comparativos a partir de um modelo conexionista - é então apresentada em detalhes. mostrando as características peculiares da macrorregião da saúde do Sul da Europa. Finalmente, uma perspectiva histórica envolvendo três diferentes tipos de temporalidade (período longo, médio e curto) é proposta para explicar tanto o tempo substancialmente semelhante (convergência diacrônica) quanto, ao mesmo tempo, as diferenças significativas (divergências sincrônicas) entre os sistemas de saúde da Europa Meridional na forma e níveis de como seus serviços nacionais de saúde foram implementados. (AU)

El concepto de un "paradigma mediterráneo" fue levantado por Josep Figueras en 1994, como un modelo distinto del Sur de Europa para los sistemas de salud de Italia, España y Grecia, con base en seis factores. El debate subsecuente (que incluyó también a Portugal) se reconstruye con base en argumentos de pro y contra. La contribución específica del autor para el debate, que consiste en la propuesta del concepto de la 'macrorregión de la salud' como herramienta analítica para buscar un abordaje más incluyente en términos comparativos a partir de un modelo conexionista, se presenta entonces en detalles, mostrando las características peculiares de la macrorregión de la salud del sur de Europa. Finalmente, se propone una perspectiva histórica envolviendo tres diferentes tipos de temporalidad (largo, medio y corto espacio) para explicar tanto el tiempo substancialmente semejante (convergencia diacrónica) como, al mismo tiempo, las diferencias significativas (divergencias sincrónicas) entre los sistemas de salud de Europa Meridional en la forma y niveles en que se implementaron sus servicios nacionales de salud. (AU)

Self-help/mutual aid as active citizenship associations: a case-study of the chronically ill in Italy.

Contrary to the most widespread conception that considers self-help/mutual aid as a component of the 'third sector', an approach is proposed which assumes, on the basis of the specific nature of the social bond and of the social action that characterizes it, it can be more properly considered as part of the 'new civil society' as it has been configured during the time in Western societies. This implies its location in the public non-state and non-systemic space that it has been created in the specific form of associations of citizenship. An interuniversity research project is then presented which, using this approach, studied the case of self-help/mutual aid associations for the chronically ill in Italy, offering some of the findings regarding the origin, structural characteristics, geographical distribution and activities of these associations in order to at least partially verify the heuristic value of this approach and its implications for the processes of reform of the health systems.

Qualitative pain classification in hospice and pain therapy unit.

In this study, we investigated patient's meaning attribution to pain in hospice and pain therapy unit, using a qualitative approach: narrative-based medicine. The data presented here were related to patients (n = 17) hospitalized in Rimini Hospice (Italy). These data were compared to those of patients (n = 21) with noncancer pain (control sample). The interviews were then analyzed according to the technique of thematic narrative analysis. The results of our research identified a differential process in pain processing in relationship to the meaning that the patient attributed to pain. The thematic analysis of the interviews allowed the inductive construction of a specific network of pain dimensions, which were summarized in "the pain chronogram."