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Sanders T, Fryer K, Greco M, Mooney C, Deary V, Burton C. Explanation for symptoms and biographical repair in a clinic for persistent physical symptoms. SSM. QUALITATIVE RESEARCH IN HEALTH 2024; 5:100438. [PMID: 38915733 PMCID: PMC11195018 DOI: 10.1016/j.ssmqr.2024.100438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 06/26/2024]
Abstract
Introduction Biographical disruption describes the process by which illness impacts not just on a person's body and their participation in activities, but also on their sense of self. Biographical disruption is often followed by a process of biographical repair in which identity is reconstructed and a new normality is restored. People with persistent physical symptoms (sometimes referred to as medically unexplained symptoms) experience biographical disruption. This can be complicated by lack of explanation and the implication that if the problem is not medical, then it might be the person/psychological. We aimed to examine this tension in people attending a novel "Symptoms Clinic" for people with persistent physical symptoms. Methods This study reports an embedded qualitative study in a UK based randomised controlled trial. Data were collected by audio recordings of consultations and semi-structured interviews with patients. We used theoretically informed thematic analysis with regular coding and discussion meetings of the analysis team. This analysis explores the role of intervention components in facilitating biographical repair. Results The lack of acceptable explanation for persistent symptoms acted as a block to biographical repair. In the clinic, multi-layered explanations were offered and negotiated that viewed persistent symptoms as understandable entities rather than as indicators of something still hidden. These explanations allowed study participants to make sense of their symptoms and in turn opened new opportunities for self-management. The result was that participants were able to reframe their symptoms in a way that enabled them to see themselves differently. Even if symptoms had not yet improved, there was a sense of being better. This can be understood as a process of biographical repair. Conclusion Explaining persistent physical symptoms enables biographical repair.
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Affiliation(s)
- Tom Sanders
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Northumbria Building, Newcastle upon Tyne, NE1 8ST, UK
| | - Kate Fryer
- Division of Population Health, Sam Fox House, Northern General Hospital, University of Sheffield, Sheffield, S5 7AU, UK
| | - Monica Greco
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, BA2 7AY
| | - Cara Mooney
- Clinical Trials Research Unit, School for Health & Related Research, University of Sheffield, Innovation Centre, Sheffield, S1 4DA, UK
| | - Vincent Deary
- Department of Psychology, Northumbria University, Northumbria Building, Newcastle upon Tyne, NE1 8ST, UK
| | - Christopher Burton
- Division of Population Health, Sam Fox House, Northern General Hospital, University of Sheffield, Sheffield, S5 7AU, UK
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Gray SE, Tudtud B, Sheehan LR, Di Donato M. The Association of Physiotherapy Continuity of Care with Duration of Time Loss Among Compensated Australian Workers with Low Back Pain. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10209-8. [PMID: 38795245 DOI: 10.1007/s10926-024-10209-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE The aims of this study are to determine how continuous the care provided by physiotherapists to compensated workers with low back pain is, what factors are associated with physiotherapy continuity of care (CoC; treatment by the same provider), and what the association between physiotherapy CoC and duration of working time loss is. METHODS Workers' compensation claims and payments data from Victoria and South Australia were analysed. Continuity of care was measured with the usual provider continuity metric. Binary logistic regression examined factors associated with CoC. Cox regression models examined the association between working time loss and CoC. RESULTS Thirty-six percent of workers experienced complete CoC, 25.8% high CoC, 26.1% moderate CoC, and 11.7% low CoC. Odds of complete CoC decreased with increased service volume. With decreasing CoC, there was significantly longer duration of compensated time loss. CONCLUSION Higher CoC with a physiotherapist is associated with shorter compensated working time loss duration for Australian workers with low back pain.
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Affiliation(s)
- Shannon E Gray
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.
| | - Benedict Tudtud
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Luke R Sheehan
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Michael Di Donato
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
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Evans RW. The Postconcussion Syndrome and Posttraumatic Headaches in Civilians, Soldiers, and Athletes. Neurol Clin 2024; 42:341-373. [PMID: 38575256 DOI: 10.1016/j.ncl.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Posttraumatic headaches are one of the most common and controversial secondary headache types. After a mild traumatic brain, an estimated 11% to 82% of people develop a postconcussion syndrome, which has been controversial for more than 160 years. Headache is estimated as present in 30% to 90% of patients after a mild head injury. Most headaches are tension-type-like or migraine-like. Headaches in civilians, soldiers, athletes, and postcraniotomy are reviewed. The treatments are the same as for the primary headaches. Persistent posttraumatic headaches can continue for many years.
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Affiliation(s)
- Randolph W Evans
- Neurology, Baylor College of Medicine, 1200 Binz #1370, Houston, TX 77004, USA.
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Boerner KE, Keogh E, Inkster AM, Nahman-Averbuch H, Oberlander TF. A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar. Neurosci Biobehav Rev 2024; 158:105546. [PMID: 38272336 DOI: 10.1016/j.neubiorev.2024.105546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/07/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.
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Affiliation(s)
- Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amy M Inkster
- Department of Medical Genetics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Hadas Nahman-Averbuch
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
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Otón T, Carmona L, Rivera J. Patient-journey of fibromyalgia patients: A scoping review. REUMATOLOGIA CLINICA 2024; 20:96-103. [PMID: 38395498 DOI: 10.1016/j.reumae.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/25/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Fibromyalgia (FM) is a chronic disease characterized by widespread pain. Although much is known about this disease, research has focused on diagnosis and treatment, leaving aside factors related to patient's experience and the relationship with healthcare system. OBJECTIVES The aim was to analyze the available evidence on the experience of FM patients from the first symptoms to diagnosis, treatment, and follow-up. METHODS A scoping review was carried out. Medline and the Cochrane Library were searched for original studies or reviews dealing with FM and focusing on "patient journey". Results were organized using a deductive classification of themes. RESULTS Fifty-four articles were included in the qualitative synthesis. Five themes were identified: the patient journey, the challenge for the health systems, a complex doctor-patient relationship, the importance of the diagnosis, and the difficulty of standardizing the treatment. CONCLUSIONS This scoping review confirms the negative impact of FM on the patient, their social environment, and health systems. It is necessary to minimize the difficulties encountered throughout the diagnosis and follow-up of patients with FM.
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Affiliation(s)
- Teresa Otón
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain.
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain
| | - Javier Rivera
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Otón T, Messina OD, Fernández Ávila DG, Robles San Román M, Mata D, Arguissain C, Galindo Guzmán JM, Pérez M, Carmona L. The patient journey of fibromyalgia in Latin America. REUMATOLOGIA CLINICA 2024; 20:32-42. [PMID: 38182526 DOI: 10.1016/j.reumae.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/13/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable. METHODS Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks. RESULTS Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy. CONCLUSION The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self- management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.
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Affiliation(s)
- Teresa Otón
- Instituto de Salud Musculoesquelética, (Inmusc), Madrid, Spain.
| | - Osvaldo Daniel Messina
- Investigaciones Reumatológicas y Osteológicas (IRO), Unidad Docente de postgrado en Reumatología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Daniel G Fernández Ávila
- Unidad de Reumatología, Pontificia Universidad Javeriana- Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Darío Mata
- DOM Centro de Reumatología, Buenos Aires, Argentina
| | | | | | | | - Loreto Carmona
- Instituto de Salud Musculoesquelética, (Inmusc), Madrid, Spain
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Bendien E, Kruijthoff DJ, van der Kooi C, Glas G, Abma T. A Dutch Study of Remarkable Recoveries After Prayer: How to Deal with Uncertainties of Explanation. JOURNAL OF RELIGION AND HEALTH 2023; 62:1731-1755. [PMID: 36738396 PMCID: PMC10133067 DOI: 10.1007/s10943-023-01750-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 05/15/2023]
Abstract
This article addresses cases of remarkable recoveries related to healing after prayer. We sought to investigate how people who experienced remarkable recoveries re-construct and give meaning to these experiences, and examine the role that epistemic frameworks available to them, play in this process. Basing ourselves on horizontal epistemology and using grounded theory, we conducted this qualitative empirical research in the Netherlands in 2016-2021. It draws on 14 in-depth interviews. These 14 cases were selected from a group of 27 cases, which were evaluated by a medical assessment team at the Amsterdam University Medical Centre. Each of the participants had experienced a remarkable recovery during or after prayer. The analysis of the interviews, which is based on the grounded theory approach, resulted in three overarching themes, placing possible explanations of the recoveries within (1) the medical discourse, (2) biographical discourse, and (3) a discourse of spiritual and religious transformation. Juxtaposition of these explanatory frameworks provides a way to understand better the transformative experience that underlies remarkable recoveries. Uncertainty regarding an explanation is a component of knowing and can facilitate a dialogue between various domains of knowledge.
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Affiliation(s)
- Elena Bendien
- Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands.
| | - Dirk J Kruijthoff
- Faculty of Theology, Vrije Universiteit (VU), Amsterdam, The Netherlands
- Law, Ethics and Medical Humanities, Amsterdam University Medical Centre, Location VUmc, Amsterdam, The Netherlands
| | | | - Gerrit Glas
- Faculty of Humanities, Vrije Universiteit (VU), Amsterdam, The Netherlands
| | - Tineke Abma
- Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
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Samper-Pardo M, Oliván-Blázquez B, Magallón-Botaya R, Méndez-López F, Bartolomé-Moreno C, León-Herrera S. The emotional well-being of Long COVID patients in relation to their symptoms, social support and stigmatization in social and health services: a qualitative study. BMC Psychiatry 2023; 23:68. [PMID: 36698111 PMCID: PMC9875186 DOI: 10.1186/s12888-022-04497-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/26/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Long COVID patients have experienced a decline in their quality of life due to, in part but not wholly, its negative emotional impact. Some of the most prevalent mental health symptoms presented by long COVID patients are anxiety, depression, and sleep disorders. As such, the need has arisen to analyze the personal experiences of these patients to understand how they are managing their daily lives while dealing with the condition. The objective of this study is to increase understanding about the emotional well-being of people diagnosed with long COVID. METHODS A qualitative design was created and carried out using 35 patients, with 17 participants being interviewed individually and 18 of them taking part in two focus groups. The participating patients were recruited in November and December 2021 from Primary Health Care (PHC) centers in the city of Zaragoza (Northern Spain) and from the Association of Long COVID Patients in Aragon. The study topics were emotional well-being, social support networks, and experience of discrimination. All an inductive thematic content analyses were performed iteratively using NVivo software. RESULTS The Long COVID patients identified low levels of self-perceived well-being due to their persistent symptoms, as well as limitations in their daily lives that had been persistent for many months. Suicidal thoughts were also mentioned by several patients. They referred to anguish and anxiety about the future as well as a fear of reinfection or relapse and returning to work. Many of the participants reported that they have sought the help of a mental health professional. Most participants identified discriminatory situations in health care. CONCLUSIONS It is necessary to continue researching the impact that Long COVID has had on mental health, as well as to provide Primary Health Care professionals with evidence that can guide the emotional treatment of these patients.
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Affiliation(s)
- M. Samper-Pardo
- Institute for Health Research Aragon (IISAragon), Zaragoza, Spain
| | - B. Oliván-Blázquez
- Institute for Health Research Aragon (IISAragon), Zaragoza, Spain ,grid.11205.370000 0001 2152 8769Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain ,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - R. Magallón-Botaya
- Institute for Health Research Aragon (IISAragon), Zaragoza, Spain ,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain ,grid.11205.370000 0001 2152 8769Department of Medicine, University of Zaragoza, Zaragoza, Spain
| | - F. Méndez-López
- Institute for Health Research Aragon (IISAragon), Zaragoza, Spain
| | - C. Bartolomé-Moreno
- Institute for Health Research Aragon (IISAragon), Zaragoza, Spain ,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain ,grid.11205.370000 0001 2152 8769Department of Medicine, University of Zaragoza, Zaragoza, Spain
| | - S. León-Herrera
- grid.11205.370000 0001 2152 8769Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
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Belton J, Birkinshaw H, Pincus T. Patient-centered consultations for persons with musculoskeletal conditions. Chiropr Man Therap 2022; 30:53. [PMID: 36494862 PMCID: PMC9733274 DOI: 10.1186/s12998-022-00466-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Consultations between practitioners and patients are more than a hypothesis-chasing exploration, especially when uncertainty about etiology and prognosis are high. In this article we describe a single individual's account of their lived experience of pain and long journey of consultations. This personal account includes challenges as well as opportunities, and ultimately led to self-awareness, clarity, and living well with pain. We follow each section of this narrative with a short description of the emerging scientific evidence informing on specific aspects of the consultation. Using this novel structure, we portray a framework for understanding consultations for persistent musculoskeletal pain from a position of patient-centered research to inform practice.
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Affiliation(s)
- Joletta Belton
- grid.5491.90000 0004 1936 9297Department of Psychology, University of Southampton, Southampton, UK
| | - Hollie Birkinshaw
- grid.5491.90000 0004 1936 9297Department of Psychology, University of Southampton, Southampton, UK
| | - Tamar Pincus
- Department of Psychology, University of Southampton, Southampton, UK.
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Mengshoel AM. A long, winding trajectory of suffering with no definite start and uncertain future prospects - narratives of individuals recently diagnosed with fibromyalgia. Int J Qual Stud Health Well-being 2022; 17:2056956. [PMID: 35356859 PMCID: PMC8979520 DOI: 10.1080/17482631.2022.2056956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose Fibromyalgia is a contested illness with unknown aetiology and poorly understood development. The present aim is to explore the pre-diagnostic illness trajectory narrated by individuals recently diagnosed with fibromyalgia (FM). Methods Individual interviews about the course of the illness were conducted with seven women and three men (age from early 20s to 50s) who had recently been diagnosed with FM. A narrative analysis of what the interviewees told and how the stories were narrated was conducted. Results The findings are expressed by three storylines. “Strenuous life and alerted body preluding illness” displays a difficult, unsupported life and bodily sensitivity to stimuli. “Recurrent pains unfolding to become a lasting and complex illness” describes individuals pushing themselves to meet social obligations until they come to a full stop. “Diagnosed but still uncertain presence and future” portrays satisfaction with finally being diagnosed with FM and being supported by others, but still there are no solutions as to do about it. Conclusions The three storylines portray a long, winding trajectory of suffering starting before the onset of illness, and unfolding illness gradually becoming persistent and overwhelming. Finally, a diagnosis of FM is arrived at, but how the situation will evolve is uncertain.
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Affiliation(s)
- Anne Marit Mengshoel
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo, Oslo Norway
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11
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The Association Between Continuity of Care With a Primary Care Physician and Duration of Work Disability for Low Back Pain. J Occup Environ Med 2022; 64:e606-e612. [DOI: 10.1097/jom.0000000000002643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Collie A, Sheehan L, Di Donato M. Variation in General Practice Services Provided to Australian Workers with Low Back Pain: A Cross-Jurisdictional Comparative Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:203-214. [PMID: 34800245 DOI: 10.1007/s10926-021-10013-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To compare the frequency of General Practitioner (GP) services and the time between first and last GP services (service duration) provided to workers with low back pain (LBP) between four Australian workers' compensation jurisdictions. METHODS Retrospective cohort study using service level data collated from the Australian states of Western Australia, South Australia, Victoria and Queensland. Negative binomial regression was used to compare GP service volume between jurisdictions in workers with accepted LBP compensation claims. Quantile regression was used to compare GP service duration. Models were adjusted for sociodemographic factors and occupation. Analyses were repeated in four cohorts with progressively more restrictive cohort definitions to account for the influence of jurisdictional policy variation in employer excess, service delivery and maximum time-loss benefit duration. RESULTS The study sample included 47,185 time-loss claims accepted between July 2010 and June 2015, that were linked with 452,391 GP services. Workers with LBP in Queensland recorded significantly fewer GP services funded and recorded significantly shorter average service duration than in other states. This pattern of jurisdictional variation was evident in all four cohorts, but was attenuated when cohorts excluded short- and long duration claims. In the final, most restricted cohort statistically significant adjusted incidence rate ratios of 1.47-1.60 were observed in Victoria, South Australia and Western Australia, while these states recorded additional service duration of 4.3-20.7 weeks at the median. CONCLUSION There is significant variation in provision of GP services to injured workers with LBP between four Australian workers' compensation jurisdictions. Administrative requirements for time-based provision of work capacity certificates by medical practitioners may be contributing to service variation.
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Affiliation(s)
- Alex Collie
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Australia.
| | - Luke Sheehan
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Australia
| | - Michael Di Donato
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Australia
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Pozzato I, Kifley A, Craig A, Gopinath B, Tran Y, Jagnoor J, Cameron ID. Effects of seeking compensation on the psychological health and recovery of injured patients: the role of stress vulnerability and injury-related disability. Psychol Med 2022; 52:68-79. [PMID: 32515720 DOI: 10.1017/s003329172000166x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Seeking compensation has been shown to have an adverse effect on the psychological health and recovery of injured patients, however, this effect requires clarification. METHODS A total of 2019 adults sustaining a traffic injury were recruited. Of these, 709 (35.1%) lodged a compensation claim. Interviews occurred at 1-, 6- and 12-month post-injury. Outcomes were psychological distress (posttraumatic stress (PTS) and depressive symptoms) and health-related functioning (HrF) (quality of life measured by EQ-5D-3L and disability by WHODAS) over 12-months post-injury. Covariates included individual stress vulnerability (preinjury, injury-related factors). RESULTS Compared with non-compensation participants, compensation groups had higher stress vulnerability (more severe injuries and negative reactions) and poorer baseline outcomes (psychological health and HrF). After adjustment, we found an effect of compensation on HrF [β-0.09 (-0.11 to -0.07), p < 0.001] and PTS [β = 0.36 (0.16 to 0.56), p = 0.0003], but not on depression [β = -0.07 (-0.42 to 0.28), p = 0.7]. Both groups improved over time. Vulnerable individuals (β = 1.23, p < 0.001) and those with poorer baseline outcomes (PTS: β = 0.06, p = 0.002; HrF: β = -1.07, p < 0.001) were more likely to lodge a claim. In turn, higher stress vulnerability, poor baseline outcomes and claiming compensation were associated with long-term psychological distress and HrF. Nevertheless, concurrent HrF in the model fully accounted for the compensation effect on psychological distress (β = -0.14, p = 0.27), but not vice versa. CONCLUSIONS This study provides convincing evidence that seeking compensation is not necessarily harmful to psychological health. The person's stress vulnerability and injury-related disability emerge as major risk factors of long-term psychological distress, requiring a whole-systems approach to address the problem.
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Affiliation(s)
- I Pozzato
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - A Kifley
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - A Craig
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - B Gopinath
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Y Tran
- Centre of Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - J Jagnoor
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, Australia
| | - I D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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14
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Cathébras P, Goutte J, Gramont B, Killian M. ["Long-haul COVID": An opportunity to address the complexity of post-infectious functional syndromes]. Rev Med Interne 2021; 42:492-497. [PMID: 34127310 PMCID: PMC8188509 DOI: 10.1016/j.revmed.2021.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/30/2021] [Indexed: 12/22/2022]
Abstract
In this work, we address the issue of prolonged symptoms following an infection by SARS-CoV-2, labeled "long COVID". This clinically unspecific syndrome must be put in perspective with the post-infectious syndromes known for a long time but ultimately poorly understood and little studied, qualified, for lack of convincing arguments for a unambiguous pathophysiology and better terms, as functional somatic syndromes. The clinical implications for clinical care ("holistic" work-up and care of patients), for research (need for truly "bio-psycho-social" investigations), and the social implications of "long COVID" (social construction of the syndrome through the experiences of patients exposed on social networks, inequalities in the face of the disease and its socioeconomic consequences) are considered. "Long COVID" must be view, because of its expected prevalence, as an opportunity to address the complexity of post-infectious (functional) syndromes, their risk factors, and the biological, psychological and social mechanisms underlying them.
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Affiliation(s)
- P Cathébras
- Service de médecine interne, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
| | - J Goutte
- Service de médecine interne, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - B Gramont
- Service de médecine interne, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - M Killian
- Service de médecine interne, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
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Cathébras P. Patient-Centered Medicine: A Necessary Condition for the Management of Functional Somatic Syndromes and Bodily Distress. Front Med (Lausanne) 2021; 8:585495. [PMID: 33987188 PMCID: PMC8110699 DOI: 10.3389/fmed.2021.585495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/10/2021] [Indexed: 12/02/2022] Open
Abstract
This paper argues that “functional,” “medically unexplained,” or “somatoform” symptoms and disorders necessarily require a patient-centered approach from the clinicians. In the first part, I address the multiple causes of the patients' suffering and I analyze the unease of the doctors faced with these disorders. I emphasize the iatrogenic role of medical investigations and the frequent failure in attempting to reassure the patients. I stress the difficulties in finding the right terms and concepts, despite overabundant nosological categories, to give a full account of psychosomatic complexity. Finally, I discuss the moral dimension attached to assigning a symptom, at times arbitrarily, to a psychogenic origin. The following part presents a brief reminder of the patient-centered approach (PCA) in medicine. In the last part, I aim to explain why and how patient-centered medicine should be applied in the context of functional disorders. First, because PCA focuses on the patients' experience of illness rather than the disease from the medical point of view, which is, indeed, absent. Second, because PCA is the only way to avoid sterile attribution conflicts. Last, because PCA allows doctors and patients to collaboratively create plausible and non-stigmatizing explanations for the symptoms, which paves the way toward effective management.
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Affiliation(s)
- Pascal Cathébras
- Department of Internal Medicine, Jean-Monnet University, Saint-Etienne, France
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Leaviss J, Davis S, Ren S, Hamilton J, Scope A, Booth A, Sutton A, Parry G, Buszewicz M, Moss-Morris R, White P. Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation. Health Technol Assess 2020; 24:1-490. [PMID: 32975190 PMCID: PMC7548871 DOI: 10.3310/hta24460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The term 'medically unexplained symptoms' is used to cover a wide range of persistent bodily complaints for which adequate examination and appropriate investigations do not reveal sufficiently explanatory structural or other specified pathologies. A wide range of interventions may be delivered to patients presenting with medically unexplained symptoms in primary care. Many of these therapies aim to change the behaviours of the individual who may have worsening symptoms. OBJECTIVES An evidence synthesis to determine the clinical effectiveness and cost-effectiveness of behavioural modification interventions for medically unexplained symptoms delivered in primary care settings was undertaken. Barriers to and facilitators of the effectiveness and acceptability of these interventions from the perspective of patients and service providers were evaluated through qualitative review and realist synthesis. DATA SOURCES Full search strategies were developed to identify relevant literature. Eleven electronic sources were searched. Eligibility criteria - for the review of clinical effectiveness, randomised controlled trials were sought. For the qualitative review, UK studies of any design were included. For the cost-effectiveness review, papers were restricted to UK studies reporting outcomes as quality-adjusted life-year gains. Clinical searches were conducted in November 2015 and December 2015, qualitative searches were conducted in July 2016 and economic searches were conducted in August 2016. The databases searched included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and EMBASE. Updated searches were conducted in February 2019 and March 2019. PARTICIPANTS Adult participants meeting the criteria for medically unexplained symptoms, including somatoform disorders, chronic unexplained pain and functional somatic syndromes. INTERVENTIONS Behavioural interventions were categorised into types. These included psychotherapies, exercise-based interventions, multimodal therapies (consisting of more than one intervention type), relaxation/stretching/social support/emotional support, guided self-help and general practitioner interventions, such as reattribution. Evidence synthesis: a network meta-analysis was conducted to allow a simultaneous comparison of all evaluated interventions in a single coherent analysis. Separate network meta-analyses were performed at three time points: end of treatment, short-term follow-up (< 6 months since the end of treatment) and long-term follow-up (≥ 6 months after the end of treatment). Outcomes included physical and psychological symptoms, physical functioning and impact of the illness on daily activities. Economic evaluation: within-trial estimates of cost-effectiveness were generated for the subset of studies where utility values (or quality-adjusted life-years) were reported or where these could be estimated by mapping from Short Form questionnaire-36 items or Short Form questionnaire-12 items outcomes. RESULTS Fifty-nine studies involving 9077 patients were included in the clinical effectiveness review. There was a large degree of heterogeneity both between and within intervention types, and the networks were sparse across all outcomes. At the end of treatment, behavioural interventions showed some beneficial effects when compared with usual care, in particular for improvement of specific physical symptoms [(1) pain: high-intensity cognitive-behavioural therapy (CBTHI) standardised mean difference (SMD) 0.54 [95% credible interval (CrI) 0.28 to 0.84], multimodal SMD 0.52 (95% CrI 0.19 to 0.89); and (2) fatigue: low-intensity cognitive-behavioural therapy (CBTLI) SMD 0.72 (95% CrI 0.27 to 1.21), relaxation/stretching/social support/emotional support SMD 0.87 (95% CrI 0.20 to 1.55), graded activity SMD 0.51 (95% CrI 0.14 to 0.93), multimodal SMD 0.52 (95% CrI 0.14 to 0.92)] and psychological outcomes [(1) anxiety CBTHI SMD 0.52 (95% CrI 0.06 to 0.96); (2) depression CBTHI SMD 0.80 (95% CrI 0.26 to 1.38); and (3) emotional distress other psychotherapy SMD 0.58 (95% CrI 0.05 to 1.13), relaxation/stretching/social support/emotional support SMD 0.66 (95% CrI 0.18 to 1.28) and sport/exercise SMD 0.49 (95% CrI 0.03 to 1.01)]. At short-term follow-up, behavioural interventions showed some beneficial effects for specific physical symptoms [(1) pain: CBTHI SMD 0.73 (95% CrI 0.10 to 1.39); (2) fatigue: CBTLI SMD 0.62 (95% CrI 0.11 to 1.14), relaxation/stretching/social support/emotional support SMD 0.51 (95% CrI 0.06 to 1.00)] and psychological outcomes [(1) anxiety: CBTHI SMD 0.74 (95% CrI 0.14 to 1.34); (2) depression: CBTHI SMD 0.93 (95% CrI 0.37 to 1.52); and (3) emotional distress: relaxation/stretching/social support/emotional support SMD 0.82 (95% CrI 0.02 to 1.65), multimodal SMD 0.43 (95% CrI 0.04 to 0.91)]. For physical functioning, only multimodal therapy showed beneficial effects: end-of-treatment SMD 0.33 (95% CrI 0.09 to 0.59); and short-term follow-up SMD 0.78 (95% CrI 0.23 to 1.40). For impact on daily activities, CBTHI was the only behavioural intervention to show beneficial effects [end-of-treatment SMD 1.30 (95% CrI 0.59 to 2.00); and short-term follow-up SMD 2.25 (95% CrI 1.34 to 3.16)]. Few effects remained at long-term follow-up. General practitioner interventions showed no significant beneficial effects for any outcome. No intervention group showed conclusive beneficial effects for measures of symptom load (somatisation). A large degree of heterogeneity was found across individual studies in the assessment of cost-effectiveness. Several studies suggested that the interventions produce fewer quality-adjusted life-years than usual care. For those interventions that generated quality-adjusted life-year gains, the mid-point incremental cost-effectiveness ratios (ICERs) ranged from £1397 to £129,267, but, where the mid-point ICER fell below £30,000, the exploratory assessment of uncertainty suggested that it may be above £30,000. LIMITATIONS Sparse networks meant that it was not possible to conduct a metaregression to explain between-study differences in effects. Results were not consistent within intervention type, and there were considerable differences in characteristics between studies of the same type. There were moderate to high levels of statistical heterogeneity. Separate analyses were conducted for three time points and, therefore, analyses are not repeated-measures analyses and do not account for correlations between time points. CONCLUSIONS Behavioural interventions showed some beneficial effects for specific medically unexplained symptoms, but no one behavioural intervention was effective across all medically unexplained symptoms. There was little evidence that these interventions are effective for measures of symptom load (somatisation). General practitioner-led interventions were not shown to be effective. Considerable heterogeneity in interventions, populations and sparse networks mean that results should be interpreted with caution. The relationship between patient and service provider is perceived to play a key role in facilitating a successful intervention. Future research should focus on testing the therapeutic effects of the general practitioner-patient relationship within trials of behavioural interventions, and explaining the observed between-study differences in effects within the same intervention type (e.g. with more detailed reporting of defined mechanisms of the interventions under study). STUDY REGISTRATION This study is registered as PROSPERO CRD42015025520. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joanna Leaviss
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah Davis
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shijie Ren
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Glenys Parry
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Marta Buszewicz
- Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Peter White
- Barts and The London School of Medicine and Dentistry, London, UK
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Auld S, Cartwright D. The Social Construction of PTSD: The Case of the 'Old Guard' Policemen After South African Democracy. Cult Med Psychiatry 2020; 44:175-192. [PMID: 31493169 DOI: 10.1007/s11013-019-09649-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Often, we assume the traumatic nature of first response work has inevitable repercussions. This can lead to assumptions about trauma being the reason for distress, resulting in fixed ideas about diagnosis and treatment, without the complex socio-political and psychodynamic implications being fully considered. This paper challenges such assumptions by exploring the presentation of PTSD in 'old guard' police officers at the cusp of the post-apartheid era in South Africa. Focusing on long serving 'white' Afrikaner policemen, an argument is advanced that, while a diagnosis of PTSD may have enabled the old guard to legitimately access care and support for distress, at another level it served to displace core conflicts related to masculinity (and other aspects of identity) triggered by adjustment difficulties inherent in the transition from apartheid to post-apartheid South Africa. A case study is used to illustrate these observations.
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Affiliation(s)
- Sharon Auld
- Department of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, 4001, KwaZulu-Natal, South Africa.
| | - Duncan Cartwright
- Department of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Howard College Campus, Durban, 4001, KwaZulu-Natal, South Africa
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Abstract
Neurasthenia was a popular diagnosis from 1869 through 1930. Despite being discarded, the core symptoms of neurasthenia can still be found throughout modern society. The present article reviews the symptoms, common course, proposed causes, and common treatments for neurasthenia. Similarities are seen in several familiar diagnoses, including depression, chronic fatigue syndrome, and fibromyalgia. Through reviewing the trends of neurasthenia, modern doctors may learn more about the subtleties of the diagnostic process, as well as the patient-physician relationship. The goal is to learn from the past as it relates to current problems that may be related to the stress of modern living. The history of neurasthenia is presented as it relates to problems that may remain today.
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Kravvariti E, Kitas GD, Mitsikostas DD, Sfikakis PP. Nocebos in rheumatology: emerging concepts and their implications for clinical practice. Nat Rev Rheumatol 2019; 14:727-740. [PMID: 30361674 DOI: 10.1038/s41584-018-0110-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Nocebo effects are noxious reactions to therapeutic interventions that occur because of negative expectations of the patient. In the past decade, neurobiological data have revealed specific neural pathways induced by nocebos (that is, interventions that cause nocebo effects), as well as the associated mechanisms and predisposing factors of nocebo effects. Epidemiological data suggest that nocebos can have a notable effect on medication adherence, clinical outcomes and health-care policy. Meta-analyses of randomized controlled trials (RCTs) of patients with rheumatic and musculoskeletal diseases (RMDs) indicate that withdrawal of treatment by placebo-arm participants owing to adverse events is common; a proportion of these events could be nocebo effects. Moreover, in large-scale, open-label studies of patients with RMDs who transition from bio-originator to biosimilar therapeutics, biosimilar retention rates were much lower than in previous double-blind switch RCTs. This discrepancy suggests that in addition to the lack of response in some patients because of intrinsic differences between the drugs, nocebos might have an important role in low biosimilar retention, thus increasing the need for awareness and early identification of nocebo effects by rheumatologists and allied health-care professionals.
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Affiliation(s)
- Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - George D Kitas
- Clinical Research Unit, Dudley Group NHS Foundation Trust, Dudley, UK.,Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
| | - Dimos D Mitsikostas
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece.
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20
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Greco M. Biopolitics, psychosomatics, participating bodies. MEDICAL HUMANITIES 2019; 45:103-106. [PMID: 31196868 DOI: 10.1136/medhum-2019-011717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 05/11/2023]
Affiliation(s)
- Monica Greco
- Sociology, Goldsmiths College, London SE14 6NW, UK
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21
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Simas C, Munoz N, Arregoces L, Larson HJ. HPV vaccine confidence and cases of mass psychogenic illness following immunization in Carmen de Bolivar, Colombia. Hum Vaccin Immunother 2018; 15:163-166. [PMID: 30118381 PMCID: PMC6363158 DOI: 10.1080/21645515.2018.1511667] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
We report the case of multiple adverse reactions following HPV vaccination in Colombian adolescents in Carmen de Bolivar. In August 2012, the country introduced a school-based HPV immunization programme which successfully reached over 90% of the target population in the first year. In 2014, between May 29th and June 2nd,15 adolescent girls in one school presented adverse reactions after vaccination and were admitted to the local hospital. Soon, videos of girls fainting, twitching, and arriving unconscious at emergency rooms started to appear in national news media as well as on social media platforms such as YouTube. The viral spread of these videos and disturbing images were followed by the viral spread of symptoms, with over 600 cases reported across Colombia. Thorough epidemiological investigation by Colombian health authorities found no organic association between the teenagers' symptoms and the HPV vaccine, concluding this was a case of mass psychogenic reaction to vaccination. Scientific evidence did not appease the anxious public whose confidence in HPV immunization dropped dramatically. By 2016, HPV vaccine uptake among eligible girls declined to 14% for the first dose and 5% for the complete course, down from 98% and 88%, respectively, in 2012. We document this case and discuss the role of news and social media, particularly YouTube, as a driver of contagious psychogenic reactions. We also discuss the role of health authorities and government, and the importance of acting rapidly and appropriately to contain the spread of such symptoms and maintain public confidence in vaccines.
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Affiliation(s)
- Clarissa Simas
- a London School of Hygiene and Tropical Medicine , London , UK
| | - Nubia Munoz
- b Emeritus Professor at the Cancer Institute of Colombia , International Epidemiological Association , Colombia
| | | | - Heidi J Larson
- a London School of Hygiene and Tropical Medicine , London , UK
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Cathébras P. La perspective de la médecine centrée sur la personne : une condition nécessaire pour apporter une réponse adéquate aux syndromes somatiques fonctionnels. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Greco M, Stenner P. From paradox to pattern shift: Conceptualising liminal hotspots and their affective dynamics. THEORY & PSYCHOLOGY 2017. [DOI: 10.1177/0959354317693120] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article introduces the concept of liminal hotspots as a specifically psychosocial and sociopsychological type of wicked problem, best addressed in a process-theoretical framework. A liminal hotspot is defined as an occasion characterised by the experience of being trapped in the interstitial dimension between different forms-of-process. The paper has two main aims. First, to articulate a nexus of concepts associated with liminal hotspots that together provide general analytic purchase on a wide range of problems concerning “troubled” becoming. Second, to provide concrete illustrations through examples drawn from the health domain. In the conclusion, we briefly indicate the sense in which liminal hotspots are part of broader and deeper historical processes associated with changing modes for the management and navigation of liminality.
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[What's in a name? New and older labels for chronic fatigue]. Rev Med Interne 2016; 37:791-795. [PMID: 27810196 DOI: 10.1016/j.revmed.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 11/22/2022]
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Affiliation(s)
- Nortin M Hadler
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599-7280, USA
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26
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Affiliation(s)
- Joseph Bernstein
- Department of Orthopaedic Surgery, University of Pennsylvania, 424 Stemmler Hall, Philadelphia, PA, 19104, USA.
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Universal No-fault Compensation is Associated With Improved Return to Work Rates in Spine Fusion. Spine (Phila Pa 1976) 2015; 40:1620-31. [PMID: 26731707 DOI: 10.1097/brs.0000000000001096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study and systematic literature review. OBJECTIVE To examine the influence of "universal no-fault compensation" upon return-to-work rates in patients undergoing lumbar spinal fusion, and then to make comparison with workers' compensation (WC) and non-workers' compensation (non-WC) claimants. SUMMARY OF BACKGROUND DATA Compensation has an adverse influence upon outcomes and return to work in lumbar spinal fusion. It is unclear whether this is due to the compensation per se, or due to the features of WC including its adversarial environment, delayed resolution of claims, and need for disability enhancement to promote compensation. The New Zealand Accident Compensation Corporation (ACC) is a universal no-fault system offering early treatment and salary reimbursement. Given the differing features of these compensation systems, comparison of return-to-work rates may give insight into the differing outcomes for the two compensation systems. METHODS From a cohort of 428 patients undergoing lumbar spinal fusion, 178 patients covered by ACC system underwent a structured interview to determine pre-injury, pre-surgical, and post-surgical work status. A systematic literature review was performed relating to lumbar spine fusion, return to work, and WC. RESULTS The return-to-work rate for the ACC patients in work at the time of their injury was 81%. The systematic review of 21 studies including 2519 subjects revealed a return-to-work rate of 40% for WC patients, and 74% for non-WC patients (P < 0.001). There was a significantly greater return-to-work rate for ACC patients than WC patients (P < 0.001), but no difference between ACC and non-WC patients. CONCLUSION The return-to-work rates for a universal no-fault compensation system are higher than those under WC cover, and are compatible with non-WC cases. This suggests that the features of WC may contribute to the inferior return-to-work rates.
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Kilgour E, Kosny A, Akkermans A, Collie A. Procedural Justice and the Use of Independent Medical Evaluations in Workers’ Compensation. PSYCHOLOGICAL INJURY & LAW 2015. [DOI: 10.1007/s12207-015-9222-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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van der Meer S, Pieterse M, Reneman M, Verhoeven J, van der Palen J. How does injury compensation affect health and disability in patients with complaints of whiplash? A qualitative study among rehabilitation experts-professionals. Disabil Rehabil 2015; 38:211-7. [DOI: 10.3109/09638288.2015.1035455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kilgour E, Kosny A, McKenzie D, Collie A. Interactions between injured workers and insurers in workers' compensation systems: a systematic review of qualitative research literature. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:160-81. [PMID: 24832892 DOI: 10.1007/s10926-014-9513-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Work-related injury is a major public health problem and a worker's recovery can be shaped by their interactions with employers, healthcare providers and the workers' compensation system. Most research on the effects of compensation has concentrated on examining outcomes rather than considering the compensation process itself. There has been little attention paid to the interactions between stakeholders and only recently has the client's view been considered as worthy of investigation. This systematic review aimed to identify and synthesize findings from peer reviewed qualitative studies that investigated injured workers interactions with insurers in workers' compensation systems. METHOD A search of six electronic library databases revealed 1,006 articles. After screening for relevance, 18 articles were read in full and a search of those bibliographies revealed a further nine relevant articles. Quality assessment of the 27 studies resulted in a final 13 articles of medium and high quality being retained for data extraction. RESULTS Included studies focused mainly on experiences of injured workers, many of whom had long term claims. Findings were synthesized using a meta-ethnographic approach. Six themes were identified which characterised the interactions between insurers and injured workers. The majority of interactions were negative and resulted in considerable psychosocial consequences for injured workers. Positive interactions were less frequently reported and included respectful, understanding and supportive communication and efficient service from insurers. CONCLUSION Findings from this synthesis support the growing consensus that involvement in compensation systems contributes to poorer outcomes for claimants. Interactions between insurers and injured workers were interwoven in cyclical and pathogenic relationships, which influence the development of secondary injury in the form of psychosocial consequences instead of fostering recovery of injured workers. This review suggests that further research is required to investigate positive interactions and identify mechanisms to better support and prevent secondary psychosocial harm to injured workers.
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Affiliation(s)
- Elizabeth Kilgour
- Institute for Safety Compensation and Recovery Research (ISCRR), Monash University, Level 11, 499 St Kilda Rd, Melbourne, VIC, 3004, Australia,
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Kilgour E, Kosny A, McKenzie D, Collie A. Healing or harming? Healthcare provider interactions with injured workers and insurers in workers' compensation systems. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:220-39. [PMID: 24871375 DOI: 10.1007/s10926-014-9521-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Healthcare providers (HCPs) are influential in the injured worker's recovery process and fulfil many roles in the delivery of health services. Interactions between HCPs and insurers can also affect injured workers' engagement in rehabilitation and subsequently their recovery and return to work. Consideration of the injured workers' perceptions and experiences as consumers of medical and compensation services can provide vital information about the quality, efficacy and impact of such systems. The aim of this systematic review was to identify and synthesize published qualitative research that focused on the interactions between injured workers, HCPs and insurers in workers' compensation systems in order to identify processes or interactions which impact injured worker recovery. METHOD A search of six electronic databases for literature published between 1985 and 2012 revealed 1,006 articles. Screening for relevance identified 27 studies which were assessed for quality against set criteria. A final 13 articles of medium and high quality were retained for data extraction. RESULTS Findings were synthesized using a meta-ethnographic approach. Injured workers reported that HCPs could play both healing and harming roles in their recovery. Supportive patient-centred interaction with HCPs is important for injured workers. Difficult interactions between HCPs and insurers were highlighted in themes of adversarial relations and organisational pressures. Insurer and compensation system processes exerted an influence on the therapeutic relationship. Recommendations to improve relationships included streamlining administrative demands and increasing education and communication between the parties. CONCLUSION Injured workers with long term complex injuries experience difficulties with healthcare in the workers' compensation context. Changes in insurer administrative demands and compensation processes could increase HCP participation and job satisfaction. This in turn may improve injured worker recovery. Further research into experiences of distinct healthcare professions with workers' compensation systems is warranted.
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Affiliation(s)
- Elizabeth Kilgour
- Institute for Safety Compensation and Recovery Research (ISCRR) and Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Science, Monash University, Level 11, 499 St Kilda Rd, Melbourne, VIC, 3004, Australia,
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Stone L. Managing the consultation with patients with medically unexplained symptoms: a grounded theory study of supervisors and registrars in general practice. BMC FAMILY PRACTICE 2014; 15:192. [PMID: 25477194 PMCID: PMC4266896 DOI: 10.1186/s12875-014-0192-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 11/10/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with medically unexplained symptoms (MUS) commonly present in general practice. They often experience significant disability and have difficulty accessing appropriate care. Many feel frustrated and helpless. Doctors also describe feeling frustrated and helpless when managing these patients. These shared negative feelings can have a detrimental effect on the therapeutic relationship and on clinical outcomes. The aim of this study was to explore how novice and experienced GPs manage patients with MUS and how these skills are taught and learned in GP training. METHODS A constructivist grounded theory study with 24 general practice registrars and supervisors in GP training practices across Australia. RESULTS Registrars lacked a framework for managing patients with MUS. Some described negative feelings towards patients that were uncomfortable and confronting. Registrars also were uncertain about their clinical role: where their professional responsibilities began and ended. Supervisors utilised a range of strategies to address the practical, interpersonal and therapeutic challenges associated with the care of these patients. CONCLUSIONS Negative feelings and a lack of diagnostic language and frameworks may prevent registrars from managing these patients effectively. Some of these negative feelings, such as frustration, shame and helplessness, are shared between doctors and patients. Registrars need assistance to identify and manage these difficult feelings so that consultations are more effective. The care of these patients also raises issues of professional identity, roles and responsibilities. Supervisors can assist their registrars by proactively sharing models of the consultation, strategies for managing their own feelings and frustrations, and ways of understanding and managing the therapeutic relationship in this difficult area of practice.
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Affiliation(s)
- Louise Stone
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Level 1 Medical Foundation Building, 92-94 Parramatta Road, Camperdown, NSW, 2041, Australia.
- Academic Unit of General Practice, Australian National University Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra ACT, 0200, Australia.
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Lind AB, Delmar C, Nielsen K. Searching for existential security: a prospective qualitative study on the influence of mindfulness therapy on experienced stress and coping strategies among patients with somatoform disorders. J Psychosom Res 2014; 77:516-21. [PMID: 25481403 DOI: 10.1016/j.jpsychores.2014.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim was to explore how mindfulness group therapy for somatoform disorders influenced the patients' stress experiences, coping strategies and contextual psychosocial processes. METHODS A longitudinal pre- and post-treatment design, using 22 semi-structured individual pre- and post-treatment interviews. Data-analysis was based on a thematic methodology. RESULTS Pre-treatment patients were struggling in an existential crisis, feeling existentially insecure about their social identity, the causes, consequences and management of their illness; experiencing difficulties identifying and expressing stress-related cognitions, emotions and feelings, and low bodily and emotional self-contact; often leading to avoidant coping, making these individuals highly stress-vulnerable. Post-treatment, the overall change was conceptualized as increased existential security, defined by patients being more self-confident; more clarified with their social identity, the nature, management and future prospects of their illness; generally using more flexible coping strategies to reduce their daily stress experiences. Four related subthemes were identified contributing to increased existential security: 1) more secure illness perceptions - feeling existentially recognized as "really" ill, 2) enhanced relaxation ability - using mindfulness techniques, 3) increased awareness - connecting differently to mind and body 4) improved ability to identify and express needs and feelings of distress - more active communicating. Patients suggested that mindfulness therapy could be expanded with more time for group-discussions followed by additional individual therapy. CONCLUSION Generally, treatment positively influenced the patients' illness perceptions, stress-experiences, body- and self-awareness, coping strategies, self-image, social identity and social functioning. However, patients identified potentials for treatment improvements, and they needed further treatment to fully recover.
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Affiliation(s)
- Annemette Bondo Lind
- Department of Psychology and Behavioural Sciences, Aarhus University, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Charlotte Delmar
- Department of Clinical Medicine, Aarhus University, Denmark; Department of Science in Nursing, Aarhus University, Denmark
| | - Klaus Nielsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
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The experience of adjusting to a diagnosis of non-epileptic attack disorder (NEAD) and the subsequent process of psychological therapy. Seizure 2014; 23:799-807. [DOI: 10.1016/j.seizure.2014.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 06/06/2014] [Accepted: 06/23/2014] [Indexed: 11/24/2022] Open
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Durif-Bruckert C, Roux P, Rousset H. Medication and the patient-doctor relationship: a qualitative study with patients suffering from fibromyalgia. Health Expect 2014; 18:2584-94. [PMID: 24995371 DOI: 10.1111/hex.12230] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Fibromyalgia is characterized by a diffuse and predominantly axial and chronic pain, for which there is no explicit rationale for treatment options. OBJECTIVE This qualitative study aims to understand the medication experience of patients with fibromyalgia and their relationship with the doctors derived from treatment negotiation. DESIGN A qualitative approach was used, based on interviews with patients. SETTING AND PARTICIPANTS Semi-structured interviews were held in a public hospital, with 35 patients diagnosed with fibromyalgia. Qualitative content analysis was performed. RESULTS The first axis is centred on the unsuccessful quest for an effective treatment for pain and the feeling of dismissal of patients, who are in search of validation and recognition. The second part of the accounts explains the medication adjustments and the search for collaboration. Developing a model of partnership with the doctor enables the patients to shape their own illness, through the medication. DISCUSSION It is by mediating their relationship with medication that patients gain access to this state of co-expertise and that they put sense into the collaboration they develop with their doctors. Through this collaboration, useful drugs are identified and adjusted to treat the pain.
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Affiliation(s)
- Christine Durif-Bruckert
- Social Psychology Research Group, EA 4163, Psychology Department, University of Lyon (Lyon 2), Bron, France
| | - Pauline Roux
- Social Psychology Research Group, EA 4163, Psychology Department, University of Lyon (Lyon 2), Bron, France
| | - Hugues Rousset
- Lyon - Internal Medicine, Claude Bernard University, University Hospital of Lyon South, Lyon, France
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Arnold MH, Finniss DG, Kerridge I. Medicine's inconvenient truth: the placebo and nocebo effect. Intern Med J 2014; 44:398-405. [DOI: 10.1111/imj.12380] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 12/29/2013] [Indexed: 12/19/2022]
Affiliation(s)
- M. H. Arnold
- Northern Clinical School; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Centre for Values; Ethics and the Law in Medicine; School of Public Health; University of Sydney; Sydney New South Wales Australia
- Department of Rheumatology; Royal North Shore Hospital; Sydney New South Wales Australia
| | - D. G. Finniss
- Pain Management Research Institute; University of Sydney and Royal North Shore Hospital; Sydney New South Wales Australia
- School of Rehabilitation Sciences; Griffith University; Brisbane Queensland Australia
| | - I. Kerridge
- Northern Clinical School; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
- Centre for Values; Ethics and the Law in Medicine; School of Public Health; University of Sydney; Sydney New South Wales Australia
- Haematology Department; Royal North Shore Hospital; Sydney New South Wales Australia
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Struggling in an emotional avoidance culture: a qualitative study of stress as a predisposing factor for somatoform disorders. J Psychosom Res 2014; 76:94-8. [PMID: 24439683 DOI: 10.1016/j.jpsychores.2013.11.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 11/28/2013] [Accepted: 11/29/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To explore patterns of experienced stress and stress reactions before the onset of illness in the life history of patients with severe somatoform disorders to identify predisposing stress-mechanisms. METHODS A systematic, thematic analysis was conducted on data collected from 24 semi-structured individual life history interviews. RESULTS Generally, patients had experienced high psychosocial stress during childhood/youth. However, there was considerable variability. Characteristic of all patients were narrations of how communication with significant adults about problems, concerns, and emotions related to stress were experienced to be difficult. The patients described how this involved conflicts stemming from perceived absent, insufficient, or dismissive communication during interactions with significant adults. We conceptualized this empirically based core theme as "emotional avoidance culture." Further, three related subthemes were identified: Generally, patients 1.) experienced difficulties communicating problems, concerns, and related complex feelings in close social relations; 2.) adapted their emotional reactions and communication to an emotional avoidance culture, suppressing their needs, vulnerability and feelings of sadness and anger that were not recognized by significant adults; and 3.) disconnected their stress reaction awareness from stressful bodily sensations by using avoidant behaviors e.g. by being highly active. CONCLUSION Patients adapted to an emotional avoidance culture characterized by difficult and conflicting communication of concerns and related emotions in social interactions with significant adults. Patients experienced low ability to identify and express stress-related cognitions, emotions and feelings, and low bodily and emotional self-contact, which made them vulnerable to stressors. Generally, patients resolved stress by avoidant behaviors, prolonging their stress experience.
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O’Mahony S, Shanahan F. Ethereal and material gain: unanticipated opportunity with illness or disability. Clin Med (Lond) 2014; 14:44-6. [PMID: 24532744 PMCID: PMC5873620 DOI: 10.7861/clinmedicine.14-1-44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
When caregivers address the positive aspects of illness or disability, there is a risk of patronising the sufferer. It is equally problematic when secondary gain is judged in a negative light and impedes an effective doctor-patient relationship. Changing attitudes, and particularly the negative perception of a patient's gain from illness, are reflected in biographies of artists, philosophers and other creative individuals. In contrast, some memoirs about illness feature a retrospective discussion of the positive features of the experience - from one who is now free from the ordeal. The experience of continual sufferers may be more instructive. We examine contemporary examples of unanticipated advantage or gain arising from ongoing disability or illness. The contribution of disability/illness to remarkable achievement promotes enhanced self-appreciation for patients and may foster in others a better understanding of what it means to suffer and live with disability.
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Affiliation(s)
- Seamus O’Mahony
- University College Cork, National University of Ireland, Cork, Ireland
| | - Fergus Shanahan
- Department of Medicine, University College Cork, Ireland and director, Alimentary Pharmabiotic Centre, Cork, Ireland
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Bartholomew RE, Wessely S, Rubin GJ. Mass psychogenic illness and the social network: is it changing the pattern of outbreaks? J R Soc Med 2013; 105:509-12. [PMID: 23288084 DOI: 10.1258/jrsm.2012.120053] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Robert E Bartholomew
- Department of History and Social Sciences, Botany College, Manukau, Auckland, New Zealand
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Delayed recovery in patients with whiplash-associated disorders. Injury 2012; 43:1141-7. [PMID: 22475071 DOI: 10.1016/j.injury.2012.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 01/10/2012] [Accepted: 03/04/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prognosis of whiplash injury has been found to be related to a number of sociodemographic, treatment and clinical factors. In the current study, we attempt to identify several novel prognostic factors for delayed recovery in whiplash-associated disorders (WADs), using a validated and reliable measure of recovery. PATIENTS AND METHODS Retrospective review of a large database of a national network of physiotherapy and rehabilitation service providers in Canada yielded 5581 individuals injured in motor vehicle collisions. Cases were grouped into 3 cohorts based on time lapsed between injury date and initial presentation. Acute (n=3075), early chronic (n=958) and chronic (n=1548) patient cohorts were compared regarding treatment outcome and relative distribution of 29 prognostic factors. Outcome was defined by a minimally important clinical change (10%) on a previously validated disability questionnaire between initial and discharge rehabilitation visits. RESULTS Analysis demonstrated positive outcomes to be proportionally fewer in the chronic cohort (52.1%) relative to the early chronic (61.4%), which was in turn lower than the acute cohort (72.3%). Furthermore, individuals presenting with chronic pain were more likely to: (1) be female; (2) present with lower limb pain or nonorganic signs; (3) have returned to work; (4) have retained a lawyer; or (5) have undergone previous spinal surgery, and were less likely to: (1) present with neck or midback pain; (2) live in Ontario or Nova Scotia; or (3) have modified duties upon return to work. Acute, early chronic and chronic cohorts were also found to differ in the distribution of several other prognostic factors at initial clinical visit. CONCLUSIONS Recovery in whiplash-associated disorder appears to be multifactorial with both medical and non-injury related factors influencing outcome. Further characterisation of these factors may prove invaluable in guiding future clinical treatment and referral practices.
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Less specific arm illnesses. J Hand Ther 2011; 24:118-22; quiz 123. [PMID: 21392938 DOI: 10.1016/j.jht.2010.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 12/11/2010] [Accepted: 12/12/2010] [Indexed: 02/03/2023]
Abstract
Unexplained symptoms are among the most common complaints addressed by health providers. Nonspecific (or less specific) arm pain, in particular, is characterized by vague, diffuse, uncharacteristic symptoms, and disproportionate pain and disability. Many of the conditions diagnosed and treated by hand specialists as specific abnormalities might be better considered nonspecific because no distinct, unique, characteristic pathology or pathophysiology can be identified. An approach that assumes that symptoms are directly related to underlying pathophysiology and ignores the important psychological and sociological contributions to illness risks hindering recovery.
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Samoocha D, Snels IAK, Bruinvels DJ, Anema JR, van der Beek AJ. Effectiveness of an interactive website aimed at empowerment of disability benefit claimants: results of a pragmatic randomized controlled trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21:410-420. [PMID: 21258848 PMCID: PMC3173646 DOI: 10.1007/s10926-010-9283-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the effectiveness of an interactive website aimed at empowerment of disability claimants, prior to the assessment of disability by an insurance physician. METHODS A randomized controlled trial was conducted. Claimants applying for a work disability pension after being sick-listed for 104 weeks, were randomized into either an intervention group or control group. Participants who were randomized into the intervention group were able to logon to the website www.wiagesprek.nl , which mainly consisted of five interactive modules aimed at increasing knowledge, self-awareness, expectations, self-efficacy, and active participation. Participants from the control group were directed to a 'sham' website with commonly available information only. The primary outcome was empowerment. Secondary outcomes included coping, knowledge, claimant satisfaction, perceived justice, and physician satisfaction. Outcomes were assessed at baseline, 2 days before the disability assessment, as well as 1 day after, 6 weeks, and 4 months after the disability assessment. RESULTS Claimants were randomly assigned to the intervention group (n = 123) or a control group (n = 119). The intervention had no significant short- and long-term effects on empowerment, but the intervention increased claimants' knowledge significantly compared to the control group. Claimant satisfaction with the disability assessment interview and claimant perceived justice on the outcome of the assessment were lower in the intervention group (statistically not significant). Furthermore, the intervention had a significant negative effect on claimants perceived procedural justice. CONCLUSION Although knowledge increased significantly, the intervention www.wiagesprek.nl was not successful in reaching its primary target, that is, to increase levels of empowerment among disability claimants, prior to the assessment of disability.
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Affiliation(s)
- David Samoocha
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
- Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Ingrid A. K. Snels
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
- Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - David J. Bruinvels
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
- Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Johannes R. Anema
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
- Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Allard J. van der Beek
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
- Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
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Resisting Pathology: GID and the Contested Terrain of Diagnosis in the Transgender Rights Movement. ADVANCES IN MEDICAL SOCIOLOGY 2011. [DOI: 10.1108/s1057-6290(2011)0000012013] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Individuals with fibromyalgia generally experience chronic widespread pain, which can be accompanied by further symptoms including fatigue, sleep disturbances, cognitive dysfunction, anxiety and depressive episodes. As the recognition and diagnosis of fibromyalgia has improved, the availability of therapeutic options for patients has increased. Furthermore, research into the neurobiological mechanisms that contribute to the chronic pain and concomitant symptoms experienced by patients with fibromyalgia has advanced our understanding of this debilitating disorder. In this Review, we aim to provide an overview of existing pathophysiological concepts. The roles of biological and psychological stress, genetic factors, and pain and sensory processing in the pathophysiology of fibromyalgia and related conditions are discussed. In addition, pharmacological treatments, including monoamine modulators, calcium channel modulators and γ-aminobutyric acid modulators, as well as nonpharmacological treatment options are considered.
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Affiliation(s)
- Tobias Schmidt-Wilcke
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, 48106, USA. tobiass@ med.umich.edu
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Re: Spearing and Connelly. Is compensation bad for your health? A systematic meta-review. Injury 2011;42:15-24. Injury 2011; 42:428-9; author reply 429-30. [PMID: 21163479 DOI: 10.1016/j.injury.2010.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 11/10/2010] [Indexed: 02/02/2023]
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Broersen JPJ, Mulders HPG, Schellart AJM, van der Beek AJ. The dimensional structure of the functional abilities in cases of long-term sickness absence. BMC Public Health 2011; 11:99. [PMID: 21320333 PMCID: PMC3046913 DOI: 10.1186/1471-2458-11-99] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 02/14/2011] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The health problems that working people suffer can affect their functional abilities and, consequently, can cause a mismatch between those abilities and the demands of the work, leading to sickness absence. A lasting decrease in functional abilities can lead to long-term sickness absence and work disability, with negative consequences for both the worker and the larger society. The objective of this study was to identify common disability characteristics among large groups of long-term sick-listed and disabled employees. METHODS As part of the disability benefit entitlement procedure in the Netherlands, an insurance physician assesses the functional abilities of the claimant in a standardised form, known as the List of Functional Abilities (LFA), which consists of six sections containing a total of 106 items. For the purposes of this study, we compiled data from 50,931 assessments. These data were used in an exploratory factor analyses, and the results were then used to construct scales. The stability of dimensional structure of the LFA and of the internal consistency of the scales was studied using data from 80,968 assessments carried out earlier, under a slightly different legislation. RESULTS Three separate factor analyses carried out on the functional abilities of five sections of the LFA resulted in 14 scale variables, and one extra scale variable was based on the items from the sixth section. The resulting scale variables showed Cronbach's Alphas ranging from 0.59 to 0.97, with the exception of one of 0.54. The dimensional structure of the LFA in the verification population differed in some aspects. The Cronbach's Alphas of the verification population ranged from 0.58 to 0.97, again with the exception of the same scale: Alpha = 0.49. CONCLUSION The differences between the dimensional structures of the primary data and the earlier data we found in this study restrict the possibilities to generalise the results. The scales we constructed can be utilised to produce a compact description of the functional abilities of groups of claimants in the Netherlands. Moreover, the matching work demands can be used to identify jobs low on those demands as being the most accessible for the specific type of disabled employees, particularly severely disabled individuals.
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Affiliation(s)
- Jake PJ Broersen
- Research Centre for Insurance Medicine, collaboration between AMC-UMCG-UWV-VUmc, Amsterdam, the Netherlands
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Henny PG Mulders
- Research Centre for Insurance Medicine, collaboration between AMC-UMCG-UWV-VUmc, Amsterdam, the Netherlands
- Knowledge Centre of the Employee Insurance Authority, Amsterdam, the Netherlands
| | - Antonius JM Schellart
- Research Centre for Insurance Medicine, collaboration between AMC-UMCG-UWV-VUmc, Amsterdam, the Netherlands
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Allard J van der Beek
- Research Centre for Insurance Medicine, collaboration between AMC-UMCG-UWV-VUmc, Amsterdam, the Netherlands
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
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