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1.
Stud Health Technol Inform ; 268: 61-76, 2020 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-32141879

RESUMEN

This chapter presents two case studies where the dominant narrative was subverted, one by citizen participants and one by researchers. Subversion, as a questioning and challenging stance, in the context of co-creation supports the discovery of new pathways for healthy behaviours even in modest projects. We also illustrate how emotion-led and interest-based design is used to increase adoption by end-users. Here we explore the development of an active ageing portal for a local council and the use of 'Kira' the robot to promote social interaction between older adults living with dementia.


Asunto(s)
Envejecimiento , Anciano , Demencia , Estado de Salud , Humanos , Narración , Tecnología
3.
N C Med J ; 81(2): 100, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32132249

Asunto(s)
Narración , Humanos
4.
Am J Occup Ther ; 74(1): 7401347010p1-7401347010p6, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32078522

RESUMEN

Transformative learning involves the questioning of worldviews and underpins shifts in values and identity that are integral to critical occupational therapy practices. Cognitive theories of transformative learning name, but do not address, the experiential dimensions of transformation. The aim of this article is to conceptualize transformative learning from the perspective of narrative phenomenology in occupational therapy. An argument is presented that draws on research in occupational therapy professional reasoning and that makes visible the dimensions of transformation that are inherently experiential and meaning oriented. Three key concepts for a transformative pedagogy are defined and illustrated: scenes, emplotment, and embodied metaphors. The article concludes with the types of learning objectives for which this approach is suited and the pedagogical values that underpin these teaching practices. This article adds to the domain of health care education by defining and illustrating experiential and meaning-based practices as signature pedagogies for transformative learning.


Asunto(s)
Terapia Ocupacional , Humanos , Narración , Terapia Ocupacional/educación , Enseñanza
6.
Acad Med ; 95(2): 175, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31990723
9.
Adv Exp Med Biol ; 1216: 149-152, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31894554

RESUMEN

Frailty is a clinical concept which is gaining increased momentum not only in geriatrics, but in all specialties treating adult patients. In these Future Perspectives, the following roles of frailty in the field of cardiovascular diseases (CVD) will be discussed as a narrative review: (1) Frailty as an adjunct to assess CVD patients in addition to traditional risk scores; (2) bidirectional relationship between frailty and CVD; (3) widening the scope of endpoints in CVD trials-inclusion of frailty; (4) finally, the relationship between geriatrics and cardiology will be shortly discussed.


Asunto(s)
Enfermedades Cardiovasculares/complicaciones , Anciano Frágil , Fragilidad/complicaciones , Anciano , Cardiología , Geriatría , Humanos , Narración
11.
Gesundheitswesen ; 82(2): 151-156, 2020 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-31770778

RESUMEN

AIM OF THE STUDY: Medicine has been criticized for over-emphasizing biological aspects of health and disease while neglecting social determinants. However, the last decades witnessed the rise of a strand of medical theorizing that proposed a biopsychosocial perspective on health and disease. This article investigates from ethnographic perspectives the extent to which contemporary biopsychosocial medicine succeeds in providing medical care to asylum-seekers in order to grasp societal influences on health and illness. METHODS: A mix of ethnographic methods including narrative interviews, semi-structured interviews and participant observation was used. RESULTS: Using examples of legal restrictions in patients' access to care and language barriers, the ethnographic material showed that physicians regularly failed to take asylum seekers' health-related life-world scientifically into account. Instead, they routinely improvised solutions or deferred responsibility for finding solutions to other agents. CONCLUSIONS: Approaches employed in the social sciences - especially in medical anthropology - could help alleviate these difficulties that result in sub-standard care, and should therefore be integrated into medical teaching and postgraduate education. Concurrently, theoretical and methodological gaps that might also concern other groups of patients might be closed.


Asunto(s)
Accesibilidad a los Servicios de Salud , Refugiados , Barreras de Comunicación , Alemania , Humanos , Narración
12.
J Homosex ; 67(2): 265-283, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30582736

RESUMEN

Researchers have often considered the impact that online dating has had on gay communities; with some arguing that changes in social behavior may impact the spread of HIV. However, these conclusions are based on the premise that the Internet has fundamentally changed the way gay and bisexual men connect with their communities. Addressing this issue, we searched the PubMed and Web of Science databases for studies examining Internet use and interpersonal connectedness among gay and bisexual men to determine whether those who used the Internet to find sexual partners exhibited different patterns of community connectedness. Though sporadic, findings suggest that Internet use may be associated with lower gay identity, community attachment, and social embeddedness. However, recent reports have suggested that online sex seeking might be associated with greater, not less, interpersonal connectedness. We conclude that additional longitudinal analyses and consistent measurement of gay men's social behavior are needed to draw more definite conclusions.


Asunto(s)
Bisexualidad , Homosexualidad Masculina , Internet , Relaciones Interpersonales , Conducta Sexual , Infecciones por VIH , Humanos , Internet/estadística & datos numéricos , Masculino , Narración , Parejas Sexuales , Conducta Social
13.
Lancet ; 394(10216): 2283-2284, 2020 12 21.
Artículo en Inglés | MEDLINE | ID: mdl-31868634
14.
Hu Li Za Zhi ; 66(6): 54-65, 2019 Dec.
Artículo en Chino | MEDLINE | ID: mdl-31802455

RESUMEN

BACKGROUND: Day care centers provide supportive services to older individuals with disability and dementia. Those who suffer from cognitive impairment typically also suffer from depression. PURPOSE: To explore whether TimeSlips, a reminiscence creative storytelling approach, improves depressive symptoms and quality of life (QoL) in older individuals of day care centers who have mild to moderate cognitive impairment. METHODS: A randomized non-blind controlled trial design was conducted. A total of 20 older individuals who met the inclusion criteria were recruited and randomly assigned to the experimental group and control group using the Internet randomization system, with 10 subjects in each group. The experimental group participated in the one-hour TimeSlips intervention once a week for six consecutive weeks, while the control group maintained their normal daily activities. We used the Cornell Scale for Depression in Dementia (CSDD) to measure depressive symptoms and used EQ-5D (EuroQol-5 dimensions) VAS (visual analogue scale) and utility values to measure QoL. RESULTS: (1) With the exception of age, there were no significant differences in the demographic data between two groups. (2) Under ANCOVA, when age was used as the covariate and the change in CSDD before and after the intervention was used as the dependent variable, the score of the experimental group was significant lower than that of the control group (p < .05). The interaction between group and age was also a significant difference in the change of CSDD before and after the intervention (p < .05). In terms of QoL, the EQ-5D VAS and EQ-5D utility value both decreased after the intervention in the experimental group. ANCOVA was performed separately using the change of EQ-5D VAS and the ranked change of EQ-5D utility values as dependent variables, with no significant differences found between the groups (p = .37 and p = .20, respectively). CONCLUSIONS: The results indicate that using TimeSlips may significantly improve depressive symptoms in mild to moderate cognitively impaired older individuals of day care centers. However, no evidence was found to support an effect of TimeSlips on QoL. Our findings provide information to help day care centers staffs design related activities.


Asunto(s)
Demencia/psicología , Demencia/terapia , Depresión/psicología , Narración , Calidad de Vida , Anciano , Centros de Día , Humanos , Resultado del Tratamiento
15.
PLoS One ; 14(12): e0226503, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31856262

RESUMEN

We use an interactive story design in which participants read short stories and make two consecutive plot choices about whether protagonists commit low- or high-violence actions. Our study has four main findings. 1) People who choose high violence report greater satisfaction with the story, while those switching to or staying with no violence show lower satisfaction. 2) However, when participants encounter these stories without choices, they reliably rate higher-violence stories as less satisfying than lower-violence stories. 3) Regret seems to account for the low satisfaction of those who choose or switch to low violence. 4) There is a large segment of people (up to 66%) who can be persuaded by different story contexts (genre, perspective) to choose extreme violence in interactive fiction and as a consequence of their choice feel satisfaction. We hypothesize that people who opt for high violence enjoy the story as a result of their choice. Overall, we suggest that choosing violence serves as a gateway for enjoyment by creating an aesthetic zone of control detached from morality.


Asunto(s)
Conducta de Elección , Narración , Placer , Violencia/psicología , Adulto , Femenino , Humanos , Masculino , Factores Sexuales
16.
J Am Dent Assoc ; 150(11): 933-939.e2, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31668172

RESUMEN

BACKGROUND: A significant amount of clinical information captured as free-text narratives could be better used for several applications, such as clinical decision support, ontology development, evidence-based practice, and research. The Human Phenotype Ontology (HPO) is specifically used for semantic comparisons for diagnostic purposes. All these functions require quality coverage of the domain of interest. The authors used natural language processing to capture craniofacial and oral phenotype signatures from electronic health records and then used these signatures for evaluation of existing oral phenotype ontology coverage. METHODS: The authors applied a text-processing pipeline based on the clinical Text Analysis and Knowledge Extraction System to annotate the clinical notes with Unified Medical Language System codes. The authors extracted the disease or disorder phenotype terms, which were then compared with HPO terms and their synonyms. RESULTS: The authors retrieved 2,153 deidentified clinical notes from 558 patients. Finally, 2,416 unique diseases or disorders phenotype terms were extracted, which included 210 craniofacial or oral phenotype terms. Twenty-six of these phenotypes were not found in the HPO. CONCLUSIONS: The authors demonstrated that natural language processing tools could extract relevant phenotype terms from clinical narratives, which could help identify gaps in existing ontologies and enhance craniofacial and dental phenotyping vocabularies. PRACTICAL IMPLICATIONS: The expansion of terms in the dental, oral, and craniofacial domains in the HPO is particularly important as the dental community moves toward electronic health records.


Asunto(s)
Procesamiento de Lenguaje Natural , Vocabulario , Registros Electrónicos de Salud , Humanos , Narración , Fenotipo
17.
BMC Health Serv Res ; 19(1): 883, 2019 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-31760955

RESUMEN

BACKGROUND: The transition from acute mental health inpatient to community care is often a vulnerable period in the pathway, where people can experience additional risks and anxiety. Researchers globally have developed and tested a number of interventions that aim to improve continuity of care and safety in these transitions. However, there has been little attempt to compare and contrast the interventions and specify the variety of safety threats they attempt to resolve. METHODS: The study aimed to identify the evidence base for interventions to support continuity of care and safety in the transition from acute mental health inpatient to community services at the point of discharge. Electronic Databases including PsycINFO, MEDLINE, Embase, HMIC, CINAHL, IBSS, Cochrane Library Trials, ASSIA, Web of Science and Scopus, were searched between 2000 and May 2018. Peer reviewed papers were eligible for inclusion if they addressed adults admitted to an acute inpatient mental health ward and reported on health interventions relating to discharge from the acute ward to the community. The results were analysed using a narrative synthesis technique. RESULTS: The total number of papers from which data were extracted was 45. The review found various interventions implemented across continents, addressing problems related to different aspects of discharge. Some interventions followed a distinct named approach (i.e. Critical Time Intervention, Transitional Discharge Model), others were grouped based on key components (i.e. peer support, pharmacist involvement). The primary problems interventions looked to address were reducing readmission, improving wellbeing, reducing homelessness, improving treatment adherence, accelerating discharge, reducing suicide. The 69 outcomes reported across studies were heterogeneous, meaning it was difficult to conduct comparative quantitative meta-analysis or synthesis. CONCLUSIONS: The interventions reviewed are spread across a spectrum ranging from addressing a single problem within a single agency with a single solution, to multiple solutions addressing multi-agency problems. We recommend that future research attempts to improve homogeneity in outcome reporting.


Asunto(s)
Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Trastornos Mentales/terapia , Alta del Paciente/normas , Adulto , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Salud Mental , Narración , Educación del Paciente como Asunto , Readmisión del Paciente/normas , Transferencia de Pacientes , Rol Profesional , Mejoramiento de la Calidad/normas
18.
Lancet Psychiatry ; 6(12): 1039-1053, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31777340

RESUMEN

BACKGROUND: Use of involuntary psychiatric hospitalisation varies widely within and between countries. The factors that place individuals and populations at increased risk of involuntary hospitalisation are unclear, and evidence is needed to understand these disparities and inform development of interventions to reduce involuntary hospitalisation. We did a systematic review, meta-analysis, and narrative synthesis to investigate risk factors at the patient, service, and area level associated with involuntary psychiatric hospitalisation of adults. METHODS: We searched MEDLINE, PsycINFO, Embase, and the Cochrane Controlled Clinical Register of Trials from Jan 1, 1983, to Aug 14, 2019, for studies comparing the characteristics of voluntary and involuntary psychiatric inpatients, and studies investigating the characteristics of involuntarily hospitalised individuals in general population samples. We synthesised results using random effects meta-analysis and narrative synthesis. Our review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and is registered on PROSPERO, CRD42018095103. FINDINGS: 77 studies were included from 22 countries. Involuntary rather than voluntary hospitalisation was associated with male gender (odds ratio 1·23, 95% CI 1·14-1·32; p<0·0001), single marital status (1·47, 1·18-1·83; p<0·0001), unemployment (1·43, 1·07-1·90; p=0·020), receiving welfare benefits (1·71, 1·28-2·27; p<0·0001), being diagnosed with a psychotic disorder (2·18, 1·95-2·44; p<0·0001) or bipolar disorder (1·48, 1·24-1·76; p<0·0001), and previous involuntary hospitalisation (2·17, 1·62-2·91; p<0·0001). Using narrative synthesis, we found associations between involuntary psychiatric hospitalisation and perceived risk to others, positive symptoms of psychosis, reduced insight into illness, reduced adherence to treatment before hospitalisation, and police involvement in admission. On a population level, some evidence was noted of a positive dose-response relation between area deprivation and involuntary hospitalisation. INTERPRETATION: Previous involuntary hospitalisation and diagnosis of a psychotic disorder were factors associated with the greatest risk of involuntary psychiatric hospitalisation. People with these risk factors represent an important target group for preventive interventions, such as crisis planning. Economic deprivation on an individual level and at the population level was associated with increased risk for involuntary hospitalisation. Mechanisms underpinning the risk factors could not be identified using the available evidence. Further research is therefore needed with an integrative approach, which examines clinical, social, and structural factors, alongside qualitative research into clinical decision-making processes and patients' experiences of the detention process. FUNDING: Commissioned by the Department of Health and funded by the National Institute of Health Research (NIHR) via the NIHR Mental Health Policy Research Unit.


Asunto(s)
Hospitales Psiquiátricos/estadística & datos numéricos , Tratamiento Involuntario/estadística & datos numéricos , Narración , Trastornos Psicóticos/diagnóstico , Humanos , Internacionalidad , Factores de Riesgo , Factores Sexuales
20.
Codas ; 31(6): e20180197, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31778423

RESUMEN

PURPOSE: This study aimed to characterize and compare the use of typical story grammar elements and global coherence level in the oral narrative of children with Attention Deficit Hyperactivity Disorder with the narrative of children without the disorder and with typical development. METHODS: A total of 40 children of both sexes aged 5 to 10 years who attended elementary school participated in the study, 20 of whom were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD Group), and 20 with typical development (TD Group). Participants from each group were similar in sex, chronological age, schooling and socioeconomic status. The wordless picture book Frog, Where Are You? was used to elicit the oral narrative analyzed for the presence of the main typical elements of the story schema (character, theme/topic, event/plot and outcome), and afterwards their narration was classified according to four different levels of organization corresponding to the global story coherence level. RESULTS: The ADHD Group presented lower scores on the structural elements "theme/ topic" and "outcome" and a narrative with lower degree of coherence compared to the TD Group. CONCLUSION: The children with ADHD included in this study presented difficulties to use typical story grammar elements, mainly related to the maintenance of the central theme and outcome of the story. These elements are considered fundamental for construction of narrative coherence, which justifies the lower levels of global coherence found in the oral narrative of the ADHD Group.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Trastornos del Desarrollo del Lenguaje/fisiopatología , Narración , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Estudios de Casos y Controles , Niño , Lenguaje Infantil , Preescolar , Femenino , Humanos , Desarrollo del Lenguaje , Trastornos del Desarrollo del Lenguaje/diagnóstico , Lingüística , Masculino
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