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Chinese Elders' views on their interactions in general practice: a Grounded Theory study
No full textThis article has been accepted for publication in Health and Ethnicity, published by Taylor & Francis.Objectives. The Chinese ethnic population are among the UK's largest visible minority but there is limited evidence about this population, their views about their interactions with General Practitioners (GPs) and how this impacts on their health. This study aimed to explore Chinese Elders' experiences of and attitudes towards the provision of health services in primary care.
Design. The method of investigation was a Grounded Theory study using open-ended in-depth interviews. Purposive and theoretical sampling was used to recruit thirty-three Chinese Elders from Chinese communities in the North West of England. Face-to-face interviews were conducted and audio-recorded; transcripts were translated, back translated, analysed and coded by all members of the research team to identify concepts following the Grounded Theory approach. Themes were generated from the data and were used to guide the study into the theoretical sampling phase of the investigation.
Results. Chinese Elders were inclined to present to GPs only when health concerns were perceived as serious. This was defined as being beyond their ability to self-manage. Elders tended to adopt self-management strategies rather than follow professional advice. This was mainly due to communication difficulties, poor understanding of the advice doctors gave, and the way that Chinese patients interpreted and used the advice they were given. Chinese Elders reported that the purpose of contacting doctors was to obtain medicines. They presumed that once medication had been prescribed their symptoms would be cured, and then they believed that they could self-manage their health, usually without further GP or other medical follow up.
Conclusion. These data suggest that significant misunderstandings between Chinese Elders and GPs exist. The findings highlight the dissatisfaction expressed by Elders regarding their interactions with UK health professionals. Chinese Elders' perceptions are influenced by the way Chinese people think about health and illness, and also by their GPs' assumptions. These findings are of value to UK GPs and family doctors worldwide who are concerned with improving the quality of health services provided to an increasingly ageing migrant Chinese population
Mind your Language: Discursive Practices Produce Unequal Power and Control Over Infectious Disease: A Critical Discourse Analysis
Get PDFA review of how the language use to describe noncommunicable disease create heroes and vilians and maginalise the economic south populations.Abstract
Background: Power, socioeconomic inequalities, and poverty are recognized as some of the fundamental determinants of differences in vulnerability of societies to infectious disease threats. The economic south is carrying a higher burden than those in the economic north. This raises questions about whether social preventions and biomedical preventions for infectious disease are given equal consideration, and about social institutions and structures that frame the debate about infectious disease.
This article examines how institutionalized ways of talking about infectious disease reinforces, creates, and sustains health inequalities.
Methodology: Critical discourse analysis was considered to be epistemologically and ontologically consistent with the aims and context of this study.
Results: The study examined three types of infectious disease:
• Emerging infectious diseases/pathogens
• Neglected tropical diseases
• Vector-borne infections.
Examination revealed that poverty is the most common determinant of all three.
Conclusion: A sustainable reduction in infectious disease in the southern countries is most likely to be achieved through tackling socioeconomic determinants. There is a need for a change in the discourse on infectious disease, and adopt a discourse that promotes self-determination, rather than one that reinforces the hero-victim scenario and power inequalities.
Keyword: Critical discourse, inequalities, infectious disease, poverty, powe
Evidence-informed practice: simplifying and applying the concept for nursing students and academics
Get PDFThis document is the Accepted Manuscript version of a Published Work that appeared in final form in British Journal of Nursing, copyright © MA Healthcare, after peer review and technical editing by the publisher. To access the final edited and published work see [https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2022.31.6.322].Abstract Background: Nurses’ ability to effectively apply evidence into practice is a critical factor in the delivery of quality patient care. Evidence-Based Practice (EBP) is recognized as the gold standard for the delivery of safe and effective person-centred care. Yet, after several decades of its inception, nurses continue to encounter difficulties in implementing the concept. Existing models for implementing EBP offer stepwise approaches, nevertheless, certain factors, such as the context of care and its mechanistic nature act as barriers to the effective and consistent implementation of EBP. It is, therefore, imperative that a solution to solving the way in which evidence is applied into practice is found. Evidence-Informed Practice (EIP) is an evolving concept. In recent times, there has been a focus on EIP as an alternative to EBP. This has generated an international debate as to which of the two concepts better facilitate the application of evidence into practice. While several EBP models and educational interventions exist, there is limited research directed towards understanding the concept of EIP and how it facilitates the application of evidence into clinical nursing practice. Aim: This article aims at clarifying the concept of EIP and provides an integrated systems-based model of EIP in facilitating the application of evidence into clinical nursing practice. This is achieved through the application of two nursing case scenarios. Case scenario 1 is about caring for a high-dependent patient and case scenario 2 involves a patient with a low white blood cell count. Method: this article takes the reader through the various factors, elements, and associated systems and processes of the EIP model. Results: The case scenarios detail the various factors and elements of the EIP model and defines how it facilitates the application of evidence into clinical nursing practice. Conclusion: The EIP model provides a framework for nurses (indeed all healthcare practitioners) to deliver clinically effective care, and to be able to defend the processes used and the service provided by referring to reliable evidence.
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Delivering a sports participation legacy from the London 2012 Olympic and Paralympic Games: evidence from sport development workers in Birmingham and their experiences of a double-bind
Get PDFThis is an Accepted Manuscript of an article published by Taylor & Francis in Leisure Studies on 11 March 2020, available online: https://doi.org/10.1080/02614367.2020.1738534Legacy promises from London 2012 meant that those working in sport in local, non-host areas in Britain were expected to facilitate more sporting opportunities for local citizens. Legacy preparations occurred in the context of many other constraints that stemmed from Government budget cuts and provision of leisure-time sport and other leisure activities. This paper presents new evidence on a significantly under-researched area of leisure studies, namely: the experiences of those delivering leisure-sport opportunities in a non-host city and how they responded to national legacy promises. Using Elias’s concept of the double-bind, we explain the ‘crisis situation’ in which some local sports workers were enmeshed and how their acceptance of ‘fantasy-laden beliefs’ of expected demonstration effects from mega-events exacerbated their ‘crisis’ (Elias, 2007). We also draw upon participants’ post-Games reflections to consider how future host nations may wish to leverage greater leisure-sporting legacies from a mega-event
Effects of a four-week touch rugby and self-paced interval running intervention on health markers in active young men.
Get PDFBackground: Modified team sport activity has been proposed as effective exercise modality for promoting markers of health that are comparable or greater than continuous forms of activity. However, research using modified team sports is currently limited to sedentary populations using 2-3 sessions across a minimum of 8 weeks.
Aim: To investigate the effects of a four-week touch rugby and self-paced interval running intervention on a range of health markers in active men.
Methods: Sixteen participants (age 26.4 ± 6.4 years) were matched for age, demographic and physical activity before completing a single touch rugby (n = 8) or running (n = 8) session per week for four weeks. Measures of systolic and diastolic blood pressure, resting heart rate (RHR), body composition and biochemical status were recorded pre- and post-intervention.
Results: ANCOVA analysis revealed between-group differences for impedance (P = 0.027), fat mass (P = 0.008), percentage body fat (P = 0.008) and fat free mass (P = 0.002), with greater changes after touch rugby. Systolic blood pressure decreased for both groups with greater reductions observed after touch rugby (P = 0.002). No between-group difference was observed for RHR, interleukin-6 or C-reactive protein (P > 0.05). Contrasting internal, external and perceptual loads were observed.
Conclusion: The results of this study suggest that a single session of touch rugby over a 4-week period elicited greater improvements in body composition and SBP that self-paced running, with both equally beneficial for improving RHR, diastolic blood pressure and improved inflammatory status in active young men
What are the benefits and harms of risk stratified screening as part of the NHS breast screening Programme? Study protocol for a multi-site non-randomised comparison of BC-predict versus usual screening (NCT04359420)
Get PDFFrom Springer Nature via Jisc Publications RouterHistory: received 2020-05-01, accepted 2020-06-09, registration 2020-06-09, pub-electronic 2020-06-18, online 2020-06-18, collection 2020-12Publication status: PublishedFunder: Programme Grants for Applied Research; doi: http://dx.doi.org/10.13039/501100007602; Grant(s): RP-PG-1214-20016Funder: Manchester Biomedical Research Centre; doi: http://dx.doi.org/10.13039/100014653; Grant(s): IS-BRC-1215-20007Funder: Genesis Research Trust; doi: http://dx.doi.org/10.13039/100012156; Grant(s): GA15-003Funder: Prevent Breast Cancer; Grant(s): GA18-001Funder: Breast Cancer Now; Grant(s): 2018RP005Abstract: Background: In principle, risk-stratification as a routine part of the NHS Breast Screening Programme (NHSBSP) should produce a better balance of benefits and harms. The main benefit is the offer of NICE-approved more frequent screening and/ or chemoprevention for women who are at increased risk, but are unaware of this. We have developed BC-Predict, to be offered to women when invited to NHSBSP which collects information on risk factors (self-reported information on family history and hormone-related factors via questionnaire; mammographic density; and in a sub-sample, Single Nucleotide Polymorphisms). BC-Predict produces risk feedback letters, inviting women at high risk (≥8% 10-year) or moderate risk (≥5 to < 8% 10-year) to have discussion of prevention and early detection options at Family History, Risk and Prevention Clinics. Despite the promise of systems such as BC-Predict, there are still too many uncertainties for a fully-powered definitive trial to be appropriate or ethical. The present research aims to identify these key uncertainties regarding the feasibility of integrating BC-Predict into the NHSBSP. Key objectives of the present research are to quantify important potential benefits and harms, and identify key drivers of the relative cost-effectiveness of embedding BC-Predict into NHSBSP. Methods: A non-randomised fully counterbalanced study design will be used, to include approximately equal numbers of women offered NHSBSP (n = 18,700) and BC-Predict (n = 18,700) from selected screening sites (n = 7). In the initial 8-month time period, women eligible for NHSBSP will be offered BC-Predict in four screening sites. Three screening sites will offer women usual NHSBSP. In the following 8-months the study sites offering usual NHSBSP switch to BC-Predict and vice versa. Key potential benefits including uptake of risk consultations, chemoprevention and additional screening will be obtained for both groups. Key potential harms such as increased anxiety will be obtained via self-report questionnaires, with embedded qualitative process analysis. A decision-analytic model-based cost-effectiveness analysis will identify the key uncertainties underpinning the relative cost-effectiveness of embedding BC-Predict into NHSBSP. Discussion: We will assess the feasibility of integrating BC-Predict into the NHSBSP, and identify the main uncertainties for a definitive evaluation of the clinical and cost-effectiveness of BC-Predict. Trial registration: Retrospectively registered with clinicaltrials.gov (NCT04359420)
Secret Hunger: The Case of Anorexia Nervosa
Get PDFFrom Springer Nature via Jisc Publications RouterHistory: accepted 2020-09-06, registration 2020-09-06, online 2020-09-28, pub-electronic 2020-09-28, pub-print 2021-07Publication status: PublishedAbstract: Anorexia nervosa is currently classed as a mental disorder. It is considered as a puzzling condition, scarcely understood and recalcitrant to treatment. This paper reviews the main hypotheses relating to the aetiology of anorexia nervosa. In particular, it focuses on family and sociological studies of anorexia. By reflecting on the hypotheses provided within these domains, and on the questions that these studies leave unanswered, this paper suggests that anorexic behaviour is understandable and rational, if seen in light of ordinary moral values
The Möbius strip of market spatiality: mobilizing transdisciplinary dialogues between CCT and the marketing mainstream
Get PDFFrom Springer Nature via Jisc Publications RouterHistory: received 2020-02-17, accepted 2020-11-25, registration 2020-12-12, pub-electronic 2021-01-25, online 2021-01-25, pub-print 2021-06Publication status: PublishedAbstract: This paper develops the Möbius strip as an ‘ordering theory’ (Sandberg and Alvesson, 2020) that brings CCT studies into dialogue with mainstream marketing approaches. The aim is to work toward a transdisciplinary understanding of market spatiality, a topic that has become increasingly important for theorists and practitioners (Warnaby and Medway, 2013; Castilhos et al., 2016; Chatzidakis et al., 2018). Building on psychosocial interpretations of the Möbius strip as a ‘tactical’ way of thinking, a range of insights and ideas are organized along a single strip of theorization. This paper maps a continuous plane of logic between the concepts of space, place, emplacement, spatiality, implacement, and displacement. The potential applications of the Möbius strip are then demonstrated by showing how the transdisciplinary topic of ‘atmosphere’ can be theorized from multiple perspectives. The paper concludes by exploring how the Möbius strip might also be employed in other areas of marketing theory and practice, potentially generating further transdisciplinary conversations between CCT and the marketing mainstream
Treatment patterns and health outcomes in metastatic renal cell carcinoma patients treated with targeted systemic therapies in the UK
Get PDFFrom Springer Nature via Jisc Publications RouterHistory: received 2020-03-23, accepted 2020-07-08, registration 2020-07-09, pub-electronic 2020-07-17, online 2020-07-17, collection 2020-12Publication status: PublishedFunder: Bristol Myers Squibb Pharmaceuticals Ltd.Abstract: Background: Patients with metastatic renal cell carcinoma (mRCC) treated with targeted systemic therapies have demonstrated favourable outcomes in randomised controlled trials, however real-world evidence is limited. Thus, this study aimed to determine the effectiveness of targeted systemic therapies for patients with mRCC in routine clinical practice in the UK. Methods: A retrospective, observational, longitudinal study based on chart review of newly diagnosed adult mRCC patients treated at two UK hospitals from 2008 to 2015 was conducted. Targeted systemic therapies recommended for use in mRCC patients were evaluated across first to third lines of therapy (1LOT-3LOT). Important exclusions were treatment with cytokine therapy and within non-standard of care clinical trials. Primary outcome measure was overall survival (OS); data were analysed descriptively and using Kaplan-Meyer analysis. Results: 652 patients (65.3% male, 35.0% ≥70 years) were included. In 1LOT, 98.5% of patients received sunitinib or pazopanib. In 2LOT and 3LOT, 99.0 and 94.4% received axitinib or everolimus. Median OS was 12.9, 6.5 and 5.9 months at 1LOT, 2LOT and 3LOT respectively. Estimated OS at 1-year was 52.4% (95% CI: 48.6–56.4%) in 1LOT, 31.5% (25.2–39.5%) in 2LOT and 23.8% (10.1–55.9%) in 3LOT. Median OS from 1LOT in favourable, intermediate and poor MSKCC were 39.7, 15.8 and 6.1 months respectively. Conclusions: In this study, treatment was consistent with current National Institute for Health and Care Excellence (NICE) guidelines for mRCC patients. Although the study population favoured poorer prognosis patients, outcomes were more favourable than those for England at the same time. However, overall survival in this ‘real-world’ population remains poor and indicates significant unmet need for effective and safe treatment options to improve survival among mRCC patients
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