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Culturally adaptive healthcare for people with a learning disability from an ethnic minority background: a qualitative synthesis
Get PDFBackground
People with a learning disability face health inequality. Those from ethnic minority backgrounds with a learning disability face ‘double discrimination’ as members of two marginalised groups.
Methods
This codesigned review consolidated the evidence on the healthcare experiences of individuals and their carers from ethnic minority backgrounds with a learning disability. Three electronic databases were searched for UK studies from January 1990 to June 2022. Qualitative data from 28 studies were analysed using thematic framework analysis.
Findings
There was an overarching theme of ‘culture, choice and conflicts of control’, which related to the variable preferences for involvement in healthcare decisions. Cultural and individual factors impacted upon experience, with themes relating to ‘misunderstanding and mistrust’, ‘discrimination and stigma’, ‘isolation’, ‘feelings of shame and blame’, ‘burdens of care’ and ‘carer wellbeing’. Factors associated with healthcare-seeking and care provision are described in the themes ‘triangles of care’, ‘community networks’ and ‘adaptive communication’.
Conclusions
People from ethnic minority backgrounds with learning disability experience complex barriers which influence their healthcare experiences. Recognising and understanding discrimination can be difficult for people with a learning disability. Carers face challenges which influence their own wellbeing. Services need to be responsive to individual cultural contexts, while addressing potential conflicts of control.
Accessible summary
People with a learning disability from ethnic minority backgrounds experience problems using healthcare services and poorer health.
This review compared findings from 28 UK studies which explored the healthcare experiences of people with a learning disability from ethnic minority backgrounds, and their carers.
Patients and carers had different preferences in how they wanted to be involved in their healthcare, which were often unmet by healthcare services.
Services should be responsive to the needs of individuals from different ethnic minority backgrounds with a learning disability, and their carers
Understanding older adults’ travel behaviour and mobility needs during the COVID-19 pandemic through the lens of the hierarchy of travel needs: A systematic review
Get PDFThe aim of this article is to critically review the scientific literature about the changes in travel behaviour and mobility amongst older adults caused by the COVID-19 pandemic across various countries, identify unmet travel needs and highlight patterns of inequalities in older adults’ mobility. We have collected articles from four academic databases: PubMed, Scopus, Transportation Research International Documentation (TRID), and Web of Science. Papers were considered for inclusion if they were published online in 2020 or later, written in English, and referred to urban or rural changes in travel behaviour and mobility of older adults over 50 years old. We examined the pre-existing models developed before the outbreak and classified the articles based on Musselwhite and Haddad’s (2010; 2018) hierarchy of older adults’ travel needs. The synthesis of the selected articles shows a general decline in literal mobility amongst older adults, an increased share of virtual travel, and their decreased capacity to fulfil different levels of travel needs. Findings also indicate an increased gap in older adults’ mobility across geographical regions with various levels of transport infrastructure and digital capital. We conclude the paper with the lessons learned, the opportunities ahead, and the challenges that must be overcome to achieve sustainable development and the UN Decades of Healthy Ageing goals in the post-pandemic world
The Influence of Sidedness in Unilateral Cleft Lip and Palate on Mid Facial Growth at Five Years of Age
Get PDFObjective
To determine whether facial growth at five years is different for children with a left versus right sided cleft lip and palate.
Design
Retrospective cohort study.
Setting
Seven UK regional cleft centres.
Patients
Patients born between 2000-2014 with a complete unilateral cleft lip and palate (UCLP).
Main Outcomes Measure
5-Year-Old's Index scores.
Results
378 children were included. 256 (68%) had a left sided UCLP and 122 (32%) had a right sided UCLP. 5-Year-Old's index scores ranged from 1 (good) to 5 (poor). There was a higher proportion of patients getting good scores (1 and 2) in left UCLP (43%) compared to right UCLP (37%) but there was weak evidence for a difference (Adjusted summary odds ratio 1.27, 95% CI 0.87 to 1.87; P = .22).
Conclusions
Whilst maxillary growth may be different for left versus right sided UCLP, definitive analysis requires older growth indices and arch forms
The Hidden Emotions of Therapists: An Autoethnographic Exploration of Working with Client's who Self-Injure
Get PDFIntroduction
This paper explores how working with clients who self-injure generates significant emotional reactions in therapists, often difficult to manage. Drawing on my clinical experience as a researcher and counsellor, I provide an evocative autoethnographic account, highlighting hidden, forbidden or taboo feelings. The aim was to deepen understanding of therapists' emotional realities and contribute to the limited literature on this subject.
Method
Through journaling, sketching, metaphor and field notes, I detail personal experiences with clients who self-injure. This autoethnography explores my emotions and reactions. A case vignette illustrates my experiences, promoting critical and empathic consideration of how therapist emotions are experienced.
Data Analysis
I use autoethnographic methods to analyse the emotional impact and existential reflections of working with clients who self-injure, employing layers of qualitative interpretation from various personal data sources.
Results
Findings reveal that working with clients who self-injure forces me to confront my mortality, evoking deep existential reflections and intense emotions like vulnerability and fear. This disrupts my sense of immortality, highlighting my role's limitations and evoking shame and self-doubt about my ability to alleviate suffering.
Implications for Practice
This paper advances research on self-injury and emphasises autoethnography as a valuable avenue for counsellors engaging in research. Grounded in PhD study, this paper makes an original contribution to knowledge. Integrating discussions on mortality and emotional vulnerability into supervision and training is crucial, alongside comprehensive training that addresses emotional and unconscious issues. Accessible supervision fosters growth, reduces stigma and supports therapists working with clients who self-injure
Oral Pharmacological Management of Bertolotti Syndrome presenting as Chronic Low Back Pain – A Case Report and Review of Literature
Get PDFBackground
Bertolotti syndrome (BS) is often a missed cause of chronic lower back pain in young individuals, commonly associated with the presence of anomalous lumbosacral transitional vertebrae.
Case Presentation
A 19-year-old female with no significant medical or family history presented with persistent lower back pain localized to the gluteal region and posterolateral aspect of the left lower back. The pain worsened over time and limited their movements, including walking. A Ferguson radiograph revealed fusion of the left transverse process of the L5 vertebral segment with the left sacral ala. History, examination findings, and radiological workup confirmed the diagnosis of BS. The patient preferred conservative management, receiving oral pharmacological therapy for six weeks, along with education on preventive measures and routine exercises for postural stability. At a six-month follow-up, the patient remained asymptomatic and managed well.
Conclusions
Conservative oral pharmacological treatment presents a unique and viable alternative to traditional methods for managing BS, which often involve surgery or steroids/anesthetics at the pseudo-articulation site. Given that BS is common yet underdiagnosed in young patients with chronic back pain, this report also underscores the importance of including it in differential diagnoses for chronic lower back pain in this demographic
Spatial Modesty: The Everyday Production of Gendered Space in Segregated and Assimilative Organizations
Get PDFThis article explores the relations between organizational spatiality, gender and religion‐informed cultural practices. Theoretically grounded in Lefebvre's spatial theory and informed by Islamic feminism, it examines the significance of Islamic spatial modesty in (re)constructing and sustaining gender (in)equalities in financial institutions in Pakistan. The analysis reveals that the work‐space of Pakistani banks is gendered in ways that reflect the practices of purdah (Islamic modesty), while being adjusted and resisted to fit with the cultural practices of the organization, in what we call ‘selective appropriation of spatial modesty’. The article advances gender and organizational space scholarship by critically assessing Lefebvre's theory of space through the lenses of Islamic feminism and offers a cultural‐religious understanding of space theory
Examining forensic service effectiveness within an NHS Trust: Outcomes and considerations for practice
Get PDFThe current study examines whole service effectiveness using a secure version of the Health of the Nation Outcome Scales (HoNOS-Secure), further supplemented in some services by the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) and the Patient Reported Experience and Outcome Measure (PREOM). The utility of these measures were considered across the full remit of forensic services within a single NHS Trust. A total of 1,038 service users were included (male, n = 876), with the majority of these presenting with HoNOS-Secure ratings. It was predicted that there would be differences pre and post therapy indicated using these measures, that there would be further differences in relation to period of contact with services, and an association also noted in relation to aggression within services. Results indicated that HoNOS-Secure scores decreased following treatment and as a function of time spent in secure care, however no statistically significant improvement or deterioration were observed on patient-reported outcome measures (CORE-OM and PREOM). The paper concludes with a comparative examination evaluating potential arguments regarding why low levels of distress are observed within forensic populations, and why discrepancies exist between clinician-rated and patient-reported routine outcome measures
From curiosity to commitment: exploring the longevity of science festival impacts one year post-event
Get PDFScience festivals are known to boost aspects of science capital in the short term, but little work has been done to determine their longer-term impacts. We surveyed festival participants one year after attendance, and found that a large proportion retained knowledge acquired during the experience. Many had also been prompted to take further science-related actions, and some reported sustained impacts from previous visits 3+ years previously. We propose two mechanisms by which such a transient event can have long-term impacts; the role of curiosity in facilitating knowledge acquisition, and the experiential nature of festivals which prompts a cycle of learning
Commentary on “High-frequency Hearing Loss among Smart Mobile Phone Users: A Case-Control Study”
Get PDFUncovering the Persistence of Touch DNA on human skin and its implications for violent crime investigations
Get PDFThis study investigates the persistence of touch DNA on human skin to enhance forensic methodologies in violent crime investigations. Touch DNA, a critical piece of forensic evidence, can link suspects to crimes through genetic material recovered from skin surfaces. However, its recovery presents challenges, particularly regarding the temporal window for effective collection and the impact of environmental factors on DNA preservation. Through a controlled experimental setup, this research examined how the quantity and detectability of touch DNA change over time, with a focus on the effects of post-deposition activities such as washing. The findings reveal that while DNA quantity increases over time, recovering alleles from mixed DNA profiles—comprising both victim and perpetrator DNA—becomes increasingly difficult. Notably, alleles from the perpetrator become undetectable after 72 hours (p < 0.05), and environmental interactions, such as washing or sweating, further complicate recovery. This study underscores the importance of timely evidence collection and proposes considerations for forensic protocols to optimize touch DNA recovery and analysis. It also highlights the need for further investigation into how skin type and individual DNA shedding rates affect touch DNA persistence. Ultimately, this research contributes valuable insights that can improve the resolution of violent crime investigations through more effective DNA recovery strategies