The guidelines challenge-Philosophy, practice, policy

Translating COVID-19: From Contagion to Containment

This article tests the hypothesis that all pandemics are inherently translational. We argue that translation and translation theory can be fruitfully used to understand and manage epidemics, as they help us explore concepts of infectivity and immunity in terms of cultural and biological resistance. After examining the linkage between translation and coronavirus disease from three different yet interlinked perspectives-cultural, medical, and biocultural-we make a case for a translational medical humanities framework for tackling the multifactorial crisis brought about by the SARS-CoV-2 infection. This innovative entanglement of perspectives has the merit of carving out a new space for translation research at the intersection of the sciences and the humanities, providing sustainable ways to conceptualize the production of science at times of crisis, and challenging conventional views of translation as a primarily linguistic and cultural phenomenon that traditionally does not engage with science.

Learning from a situation of discomfort - a qualitative study of physiotherapy student practice in mental health

Purpose: This qualitative study aimed to explore how physiotherapy students learn during practice as physical activity mentors for mentally ill individuals. The practice took place in an everyday environment without the presence of a supervisor.Methods: Information was collected through three focus group interviews with 16 students in their second year of study. The data were analyzed using thematic analysis, based on a sociocultural learning perspective.Results: Three main categories summarize the students' experiences. 1) Experimenting and adapting the activities. The students were challenged through communication and relationship-building, and they had to adapt the activities to the clients' state of mind; 2) Experiencing clients breaking social and cultural codes. The students felt responsible for ensuring the clients did not draw unwanted attention to themselves, which forced them to explore creative solutions; and 3) Learning from situations of discomfort. The students learned from having to cope with unpredictable and embarrassing situations without a supervisor present.Conclusions: Practice as physical activity mentors for mentally ill individuals can stimulate students' learning through reflection in and on action. To avoid stigmatizing behaviors, process experiences and enhance learning, we suggest a frequent and standardized access to supervision.

Causal Evidence and Dispositions in Medicine and Public Health

Since the introduction of evidence-based medicine, there have been discussions about the epistemic primacy of randomised controlled trials (RCTs) for establishing causality in medicine and public health. A growing movement within philosophy of science calls instead for evidential pluralism: that we need more than one single method to investigate health outcomes. How should such evidential pluralism look in practice? How useful are the various methods available for causal inquiry? Further, how should different types of causal evidence be evaluated? This paper proposes a constructive answer and introduces a framework aimed at supporting scientists in developing appropriate methodological approaches for exploring causality. We start from the philosophical tradition that highlights intrinsic properties (dispositions, causal powers or capacities) as essential features of causality. This abstract idea has wide methodological implications. The paper explains how different methods, such as lab experiments, case studies, N-of-1 trials, case control studies, cohort studies, RCTs and patient narratives, all have some strengths and some limitations for picking out intrinsic causal properties. We explain why considering philosophy of causality is crucial for evaluating causality in the health sciences. In our proposal, we combine the various methods in a temporal process, which could then take us from an observed phenomenon (e.g., a correlation) to a causal hypothesis and, finally, to improved theoretical knowledge.

Treating real people: Science and humanity

Something important is happening in applied, interdisciplinary research, particularly in the field of applied health research. The vast array of papers in this edition are evidence of a broad change in thinking across an impressive range of practice and academic areas. The problems of complexity, the rise of chronic conditions, overdiagnosis, co-morbidity, and multi-morbidity are serious and challenging, but we are rising to that challenge. Key conceptions regarding science, evidence, disease, clinical judgement, and health and social care are being revised and their relationships reconsidered: Boundaries are indeed being redrawn; reasoning is being made "fit for practice." Ideas like "person-centred care" are no longer phrases with potential to be helpful in some yet-to-be-clarified way: Theorists and practitioners are working in collaboration to give them substantive import and application.