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1.
Maturitas ; 150: 14-21, 2021 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-34219903

RESUMEN

Governments, employers, and trade unions are increasingly developing "menopause at work" policies for female staff. Many of the world's most marginalised women work, however, in more informal or insecure jobs, beyond the scope of such employment protections. This narrative review focuses upon the health impact of such casual work upon menopausal women, and specifically upon the menopausal symptoms they experience. Casual work, even in less-then-ideal conditions, is not inherently detrimental to the wellbeing of menopausal women; for many, work helps manage the social and emotional challenges of the menopause transition. Whereas women in higher status work tend to regard vasomotor symptoms as their main physical symptom, women in casual work report musculoskeletal pain as more problematic. Menopausal women in casual work describe high levels of anxiety, though tend to attribute this not to their work as much as their broader life stresses of lifelong poverty and ill-health, increasing caring responsibilities, and the intersectionally gendered ageism of the social gaze. Health and wellbeing at menopause is determined less by current working conditions than by the early life experiences (adverse childhood experiences, poor educational opportunities) predisposing women to poverty and casual work in adulthood. Approaches to supporting menopausal women in casual work must therefore also address the lifelong structural and systemic inequalities such women will have faced. In the era of COVID-19, with its devastating economic, social and health effects upon women and vulnerable groups, menopausal women in casual work are likely to face increased marginalisation and stress. Further research is need.


Asunto(s)
Empleo/psicología , Menopausia/fisiología , Menopausia/psicología , Salud Laboral/normas , Lugar de Trabajo/normas , Femenino , Humanos , Lugar de Trabajo/organización & administración , Lugar de Trabajo/psicología
2.
Med Humanit ; 2021 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-33509802

RESUMEN

Breathlessness is a sensation affecting those living with chronic respiratory disease, obesity, heart disease and anxiety disorders. The Multidimensional Dyspnoea Profile is a respiratory questionnaire which attempts to measure the incommunicable different sensory qualities (and emotional responses) of breathlessness. Drawing on sensorial anthropology we take as our object of study the process of turning sensations into symptoms. We consider how shared cultural templates of 'what counts as a symptom' evolve, mediate and feed into the process of bodily sensations becoming a symptom. Our contribution to the field of sensorial anthropology, as an interdisciplinary collaboration between history, anthropology and the medical humanities, is to provide a critique of how biomedicine and cultures of clinical research have measured the multidimensional sensorial aspects of breathlessness. Using cognitive interviews of respiratory questionnaires with participants from the Breathe Easy groups in the UK, we give examples of how the wording used to describe sensations is often at odds with the language those living with breathlessness understand or use. They struggle to comprehend and map their bodily experience of sensations associated with breathlessness to the words on the respiratory questionnaire. We reflect on the alignment between cognitive interviewing as a method and anthropology as a disciplinary approach. We argue biomedicine brings with it a set of cultural assumptions about what it means to measure (and know) the sensorial breathless body in the context of the respiratory clinic (clinical research). We suggest the mismatch between the descriptions (and confusion) of those responding to the respiratory questionnaire items and those selecting the vocabularies in designing it may be symptomatic of a type of historical testimonial epistemic injustice, founded on the prioritisation of clinical expertise over expertise by experience.

3.
Health (London) ; 25(5): 574-595, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-33317354

RESUMEN

Anecdotal experience and qualitative accounts suggest that singing groups, classes or choirs specifically for people with COPD (henceforth referred to as COPD-SGs) are effective in improving health. However, this is not reflected in the quantitative evidence. This meta-ethnography deployed phenomenological methods to explore this discrepancy. Analysis identified the phenomena of being together, being uplifted and being involved as central benefits of COPD-SGs. When viewed through the phenomenological lens of body-social as distinct from body-subject and body-object, findings demonstrated that the qualitative effectiveness of COPD-SGs is greatest on a collective basis. Qualitative research into the effectiveness of COPD-SGs offers more favourable results because phenomenological approaches can identify collective benefits that quantitative methods cannot. COPD-SGs should seek to maximise these collective benefits by rediscovering their cultural and artistic heritage within the national and global Arts in Health (AiH) movement, which has long emphasised the radical creative and healing power of group activity.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica , Canto , Antropología Cultural , Humanos , Investigación Cualitativa
4.
BMJ Open Respir Res ; 7(1)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33168570

RESUMEN

OBJECTIVES: A transdisciplinary research approach was used to develop a holistic understanding of the physical and psychosocial benefits of dance as an intervention for people living with chronic breathlessness. METHODS: The dance programme was developed in collaboration with British Lung Foundation Breathe Easy members in NE England (Darlington) and London (Haringey). Members of the Darlington group were invited to participate in the programme. An exercise instructor, trained and mentored by a dance facilitator delivered 60-90 min dance classes for 10 consecutive weeks. Exercise capacity, mobility, quadriceps strength, health status, mood and interoceptive awareness were assessed at baseline and after the 10-week programme. Second-to-second heart rate (HR) monitoring was conducted during one of the classes. RESULTS: Ten individuals were enrolled (n=8 women). Mean (SD) age was 70 (24); Body Mass Index 29.7 (8.1) kg/m2; one participant used oxygen and one a walking aid. Seven completed the dance programme. Improvements in all outcome measures were detected, with the exception of the Multidimensional Assessment of Interoceptive Awareness, which individuals found hard to comprehend. Eight participants wore HR monitors during one dance class and spent on average 43.5 (21.8) min with HR corresponding to at least moderate intensity physical activity (≥64% HRmax). People found the dance classes enjoyable and those with relevant past experiences who are optimistic, committed to staying well and playful readily adopted the programme. CONCLUSION: A dance programme bringing both physical and psychosocial benefits for people with chronic breathlessness is acceptable when coproduced and evaluated through a transdisciplinary approach.

5.
Body Soc ; 26(2): 30-54, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32587464

RESUMEN

Breath is invisible and yet ever present and vital for living beings. The concept of invisibility in relation to breath operates in concrete and metaphorical ways to extend ideas about breath and breathlessness across disciplines, in clinical spaces and in life experience. Using a critical medical humanities approach, I demonstrate that the poverty of narrative accounts and language for breath outside the health context have had a crucial influence enabling clinically mediated interpretations and accounts to dominate. These third-person accounts are important in the articulation of the 'lived body', but I balance this with a consideration of the subjective sensation of interoception, which has important implications for the visibility of breathlessness in both clinical and lay contexts. This article illustrates the rich potential of the subjects of breath and breathlessness within body studies and this special issue is a key step in making breath such an emergent topic.

7.
Med Humanit ; 45(3): 294-303, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31371484

RESUMEN

Health research is often bounded by disciplinary expertise. While cross-disciplinary collaborations are often forged, the analysis of data which draws on more than one discipline at the same time is underexplored. Life of Breath, a 5-year project funded by the Wellcome Trust to understand the clinical, historical and cultural phenomenology of the breath and breathlessness, brings together an interdisciplinary team, including medical humanities scholars, respiratory clinicians, medical anthropologists, medical historians, cultural theorists, artists and philosophers. While individual members of the Life of Breath team come together to share ongoing work, collaborate and learn from each other's approach, we also had the ambition to explore the feasibility of integrating our approaches in a shared response to the same piece of textual data. In this article, we present our pluralistic, interdisciplinary analysis of an excerpt from a single cognitive interview transcript with a patient with chronic obstructive pulmonary disease. We discuss the variation in the responses and interpretations of the data, why research into breathlessness may particularly benefit from an interdisciplinary approach, and the wider implications of the findings for interdisciplinary research within health and medicine.


Asunto(s)
Investigación Biomédica/métodos , Disnea , Relaciones Interprofesionales , Conducta Cooperativa , Interpretación Estadística de Datos , Humanos , Comunicación Interdisciplinaria
8.
Chron Respir Dis ; 16: 1479973119847659, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31137961

RESUMEN

Pulmonary rehabilitation (PR) is recommended for all individuals living with a lung condition and chronic breathlessness. This article considers how adopting an interdisciplinary, medical humanities approach to the term 'pulmonary rehabilitation' might unpack some of the misconceptions, misrepresentations or negative connotations surrounding it, which have been largely overlooked in explanations of the low uptake of this programme. Taking key insights from Wellcome Trust-funded Life of Breath project, including ethnographic research in community fitness groups in North East England and the 'Breath Lab' special interest group, this article outlines how the whole-body approach of PR is not easily understood by those with lung conditions; how experience can inform breath perception through the pacing of everyday life; and how stigma can impact rehabilitation. This article highlights the value of medical humanities in working through communicative challenges evident in the translation of PR between patient and clinical contexts and sets out two arts-based approaches (Singing for Lung Health and dance movement) as potential options that could be included in the PR referral. Finally, the article outlines the need for collaborative research exploring the communication and meaning of healthcare strategies and experiences at the interface of the arts, humanities and medical practice.


Asunto(s)
Terapia a traves de la Danza , Disnea/rehabilitación , Comunicación en Salud , Enfermedades Pulmonares/rehabilitación , Participación del Paciente , Terapia Respiratoria , Canto , Terminología como Asunto , Actitud Frente a la Salud , Enfermedad Crónica , Humanidades , Humanos , Estigma Social
9.
Ophthalmic Physiol Opt ; 39(2): 113-126, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30776848

RESUMEN

PURPOSE: To evaluate outcome measures of the Participation and Activity Inventory (PAI) in a sample of adults with acquired visual impairment entering vision rehabilitation. Both Priority Scores, indicating level of rehabilitative need, and Person Measures, indicating goal difficulty, were considered. METHODS: Participants were newly registered adults with visual impairment within Leicestershire, United Kingdom. The importance and difficulty of 48 goals of the PAI were assessed, as were demographic factors, clinical visual function (visual acuity, contrast sensitivity, reading function) and psychosocial function (adjustment to visual loss, depression, anxiety and fear of falling). Priority scores were calculated as the product of importance and difficulty of each goal. All questionnaires were Rasch analysed, and person and item measures of perceived difficulty with goals were derived. RESULTS: Sixty people (mean age ± S.D. = 75.8 ± 13.8 years) took part. PAI goals with greatest rehabilitative need were reading (6.82 ± 2.91), mobility outdoors (6.55 ± 3.92), mobility indoors within an unfamiliar environment (5.52 ± 3.93) and writing (5.27 ± 3.02). Greater rehabilitative need was associated with younger age (ß = -0.46, p < 0.001), and with higher depressive symptomatology (ß = 0.35, p < 0.01; model R2 34%). Goals with greatest difficulty were mending clothing (-1.95 ± 0.35 logits) and hobbies and crafts (-1.32 ± 0.23 logits). Greater difficulty was associated with higher depressive symptomatology (ß = 0.39, p < 0.001), lower visual acuity (ß = 0.42, p < 0.001) and lower adjustment of visual loss (ß = 0.31, p < 0.01; model R2 53%). CONCLUSIONS: Key rehabilitation needs for adults at entry to services require both optical and non-optical interventions. As rehabilitative need was not associated with the level of visual impairment, eyecare professionals should not wait until the end of medical treatment before referral for support. Similarly, rehabilitative need was associated with younger age, indicating the importance to refer younger people with sight loss at an early stage. The use of structured assessment, such as the PAI, ensures goals that have an impact upon quality of life are specifically identified. Depression screening on entry to rehabilitation is relevant as it predicts both perceived difficulty and rehabilitative need.


Asunto(s)
Actividades Cotidianas , Sensibilidad de Contraste/fisiología , Calidad de Vida , Baja Visión/rehabilitación , Agudeza Visual/fisiología , Personas con Daño Visual/psicología , Adulto , Anciano , Anciano de 80 o más Años , Inglaterra/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Lectura , Encuestas y Cuestionarios , Baja Visión/epidemiología , Baja Visión/fisiopatología , Personas con Daño Visual/rehabilitación
11.
J Psychosom Res ; 90: 1-9, 2016 11.
Artículo en Inglés | MEDLINE | ID: mdl-27772554

RESUMEN

BACKGROUND: The term 'difficult' is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists' experiences with and attitudes towards patients suffering from MUS. DESIGN: Qualitative design employing semi-structured open-ended interviews systematically analysed in three stages: first, data were analysed according to the principles of content analysis. The analysis subsequently focused on the use of the term 'difficult'. Iterations of the term were extracted by summative analysis and thematic coding revealed its different meanings. Finally, alternative expressions were explored. SETTING: Three NHS trust secondary care hospitals in North-East England. PARTICIPANTS: 17 senior clinicians from seven medical and two surgical specialities. RESULTS: Unsolicited use of the term 'difficult' was common. 'Difficult' was rarely used as a patient characteristic or to describe the therapeutic relationship. Participants used 'difficult' to describe their experience of diagnosing, explaining, communicating and managing these conditions and their own emotional reactions. Health care system deficits and the conceptual basis for MUS were other facets of 'difficult'. Participants also reported experiences that were rewarding and positive. CONCLUSIONS: This study shows that blanket statements such as 'difficult patients' mask the complexity of doctors' experiences in the context of MUS. Our nuanced analysis of the use of 'difficult' challenges preconceived attitudes. This can help counter the unreflexive perpetuation of negative evaluations that stigmatize patients with MUS, encourage greater acknowledgement of doctors' emotions, and lead to more appropriate conceptualizations and management of MUS.


Asunto(s)
Síntomas sin Explicación Médica , Médicos/normas , Investigación Cualitativa , Atención Secundaria de Salud/normas , Especialización/normas , Adulto , Atención a la Salud , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Médicos/psicología , Atención Secundaria de Salud/métodos
12.
Curr Opin Support Palliat Care ; 10(3): 256-61, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-27490147

RESUMEN

PURPOSE OF REVIEW: Breathlessness can be debilitating for those with chronic conditions, requiring continual management. Yet, the meaning of breathlessness for those who live with it is poorly understood in respect of its subjective, cultural, and experiential significance. This article discusses a number of current issues in understanding the experience of breathlessness. RECENT FINDINGS: Effective communication concerning the experience of breathlessness is crucial for diagnosis, to identify appropriate treatment, and to provide patients with the capacity to self-manage their condition. However, there is an evident disconnect between the way breathlessness is understood between clinical and lay perspectives, in terms of awareness of breathlessness, the way symptoms are expressed, and acknowledgement of how it affects the daily lives of patients. SUMMARY: The review highlights the need for integrated multidisciplinary work on breathlessness, and suggests that effective understanding and management of breathlessness considers its wider subjective and social significance.


Asunto(s)
Disnea/psicología , Adaptación Psicológica , Concienciación , Enfermedad Crónica , Características Culturales , Disnea/fisiopatología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Relaciones Interprofesionales , Autocuidado , Estigma Social
14.
Cad Saude Publica ; 30(1): 55-67, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24627013

RESUMEN

This article explores some effects of the British payment for performance model on general practitioners' principles and practice, which may contribute to issues related to financial incentive modalities and quality of primary healthcare services in low and middle-income countries. Aiming to investigate what general practitioners have to say about the effect of the British payment for performance on their professional ethos we carried out semi-structured interviews with 13 general practitioner educators and leaders working in academic medicine across the UK. The results show a shift towards a more biomedical practice model and fragmented care with nurse practitioners and other health care staff focused more on specific disease conditions. There has also been an increased medicalisation of the patient experience both through labelling and the tendency to prescribe medications rather than non-pharmacological interventions. Thus, the British payment for performance has gradually strengthened a scientific-bureaucratic model of medical practice which has had profound effects on the way family medicine is practiced in the UK.


Asunto(s)
Médicos Generales/economía , Atención Primaria de Salud/economía , Calidad de la Atención de Salud , Inglaterra , Medicina Familiar y Comunitaria/economía , Medicina Familiar y Comunitaria/tendencias , Femenino , Médicos Generales/tendencias , Humanos , Masculino , Atención Primaria de Salud/tendencias , Relaciones Profesional-Paciente , Calidad de la Atención de Salud/economía
15.
Cad. saúde pública ; 30(1): 55-67, 01/2014. tab
Artículo en Inglés | LILACS | ID: lil-700178

RESUMEN

This article explores some effects of the British payment for performance model on general practitioners’ principles and practice, which may contribute to issues related to financial incentive modalities and quality of primary healthcare services in low and middle-income countries. Aiming to investigate what general practitioners have to say about the effect of the British payment for performance on their professional ethos we carried out semi-structured interviews with 13 general practitioner educators and leaders working in academic medicine across the UK. The results show a shift towards a more biomedical practice model and fragmented care with nurse practitioners and other health care staff focused more on specific disease conditions. There has also been an increased medicalisation of the patient experience both through labelling and the tendency to prescribe medications rather than non-pharmacological interventions. Thus, the British payment for performance has gradually strengthened a scientific-bureaucratic model of medical practice which has had profound effects on the way family medicine is practiced in the UK.


Este artigo explora alguns efeitos do modelo de pagamento por desempenho nos princípios e prática dos médicos generalistas britânicos, podendo contribuir para o debate sobre a relação entre modalidades de incentivos financeiros e qualidade dos serviços na atenção primária à saúde em países de moderada e baixa renda. Objetivando investigar o que os médicos generalistas têm a dizer dos efeitos do pagamento por desempenho britânico sobre seu ethos profissional, conduzimos entrevistas semiestruturadas com 13 médicos generalistas, educadores e líderes no meio acadêmico da medicina no Reino Unido. Os resultados apontam um modelo de prática mais biomédica e fragmentação do cuidado, com enfermeiras e outros profissionais mais focados em doenças específicas. Houve também um aumento da medicalização da vivência dos pacientes, pela rotulação e tendência a prescrever mais medicação e menor uso de intervenções não farmacológicas. Assim, o pagamento por desempenho britânico tem gradualmente fortalecido um modelo científico-burocrático de prática médica que teve efeitos profundos sobre a forma como a medicina de família vem sendo praticada no Reino Unido.


Este artículo explora algunos efectos del modelo británico de pago por desempeño en los principios y práctica de médicos generales que pueden contribuir a cuestiones relacionadas con modalidades de incentivos financieros y calidad de servicios de atención primaria en países de bajos y medios ingresos. La investigación tuvo por objetivo lo que los médicos tienden a decir sobre el efecto del pago por desempeño británico en su ethos profesional; se realizaron entrevistas semi-estructuradas con 13 médicos generales, educadores y líderes en medicina académica del Reino Unido. Los resultados muestran cambios hacia un modelo de práctica más biomédica y atención fragmentada con enfermeras y otros profesionales enfocados en enfermedades específicas. También produjo un aumento en medicalización de la experiencia del paciente a través de rotulaciones y tendencia a prescribir medicamentos en lugar de intervenciones no farmacológicas. Así, el pago por desempeño británico ha reforzado gradualmente un modelo científico-burocrático de práctica que ha tenido profundos efectos en la forma en la que la medicina familiar está siendo practicada en el Reino Unido.


Asunto(s)
Femenino , Humanos , Masculino , Médicos Generales/economía , Atención Primaria de Salud/economía , Calidad de la Atención de Salud , Inglaterra , Medicina Familiar y Comunitaria/economía , Medicina Familiar y Comunitaria/tendencias , Médicos Generales/tendencias , Relaciones Profesional-Paciente , Atención Primaria de Salud/tendencias , Calidad de la Atención de Salud/economía
17.
Adv Psychiatr Treat ; 15(5): 322-327, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24077903

RESUMEN

A judgement is an assertion made with evidence or good reason in a context of uncertainty. In psychiatry the uncertainty is inherent in the professional context, and the evidence derives from the academic literature and scientific studies as they are applied to a specific patient. The nature of the uncertainty and the factors which should inform professional judgement are explored. Professional judgement is currently facing two serious challenges: an obsession with numbers, which comes from within medicine, and the 'patient choice' agenda, which is politically inspired and comes from outside medicine. This paper strives to defend professional judgement in the clinic against both challenges.

19.
Crit Public Health ; 22(4): 455-469, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23060687

RESUMEN

The idea of the smoking person portrayed in public health has been criticised as being based on too narrow a view of human nature. This article discusses that view: that of a person with a stable core and epiphenomenal 'behaviours' that can be removed by rational persuasion or Pavlovian manipulation, and examines social scientific critiques of it. The social sciences explore the meanings smoking has for individuals and portray human identity as malleable, the result of ongoing interactions with human and non-human others. Aspects of smokers' experience revealed in qualitative research - descriptions of cigarettes as 'companions' or 'friends', deep reliance, sensual pleasure - are sometimes difficult to articulate but can be given full voice in the context of the literary arts. We explore some examples of these sources and argue that a complete picture of smoking meanings is impossible without reference to them. We take a pragmatic approach, following the philosopher William James, who argued that emotional and spiritual experiences contribute to the truth of human existence as much as material explanations, to suggest that this understanding should be part of a critical but supportive engagement with public health research in order to develop more nuanced and humane approaches to smoking cessation.

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