Too Soon or Too Late: Rethinking the Significance of Six Months When Dementia Is a Primary Diagnosis

Cultural narratives shape how we think about the world, including how we decide when the end of life begins. Hospice care has become an integral part of the end-of-life care in the United States, but as it has grown, its policies and practices have also imposed cultural narratives, like those associated with the "six-month rule" that the majority of the end of life takes place in the final six months of life. This idea is embedded in policies for a range of care practices and reimbursement processes, even though six months is not always a meaningful marker. In the case of people living with advanced dementia, six months is both too early in the trajectory to facilitate conversations and too late in the trajectory to ensure decision-making capacity. This essay encourages scholars and policy-makers to consider how cultural narratives may limit what they think is possible in care for people living with dementia.

Opening the Door: Rethinking "Difficult Conversations" about Living and Dying with Dementia

This essay looks closely at metaphors and other figures of speech that often feature in how Americans talk about dementia, becoming part of cultural narratives: shared stories that convey ideas and values, and also worries and fears. It uses approaches from literary studies to analyze how cultural narratives about dementia may surface in conversations with family members or health care professionals. This essay also draws on research on a notable social effect of legalizing medical aid in dying: patients may find it easier to bring up a range of concerns, regardless of whether they have any interest in hastening their own death. The essay proposes that health care professionals rethink an idea prominent within their own culture: that conversations about the end of a person's life are inherently difficult. This framing may make it hard for people facing dementia to bring up their concerns about what lies ahead. We suggest a different way to think about these conversations, using the metaphor of "opening the door" to represent inviting a patient to bring up issues of deepest concern.

Creating something new from past experiences-The meaning of change in repeated narratives

OBJECTIVE

Narrative identity is an essential level of personality, and to develop, the life narrative should entail both stability and change. In this study, we examine the meaning of change in repeated narratives about occupational experiences.

METHOD

Fifty-nine individuals were interviewed at age 25, 29, and 33. In these interviews 544 narratives and 142 sets of repeated narratives were identified, of these 39 sets of repeated narratives had changed between interviews. A thematic narrative analysis was conducted focusing on the meaning of change in repeated narratives.

RESULTS

The analysis resulted in five narrative themes: Gaining insights about one's identity, transforming views of past challenges, increasing agency, increasing motivation for occupational commitments, and accentuating competence and importance. In the context of occupational experiences, the results from the narrative themes illuminate how narrators repeatedly engage with the same narrative to elaborate their narrative identity.

CONCLUSION

This study presents a novel method for capturing identity development, which show that changes in repeated narratives can entail important information about identity growth as well as the way narrators create new stories of their previous experiences in order to continue to make sense of their lives.

Health Communication in the Time of COVID-19 Pandemic: A Qualitative Analysis of Italian Advertisements

In the climate of great uncertainty characterizing the COVID-19 pandemic, health communication played a significant role: several communicative strategies and channels were used to inform, educate and alert. Entropy-related risks were soon translated into the "infodemic", a wide-spread phenomenon with psychosocial and cultural roots. Therefore, new challenges for public institutions occurred: public health communication, especially expressed through advertising and audiovisual spots, was engaged to offer key support in combatting the disease, mitigating its effects and supporting health and psychological wellbeing. This work aims to investigate how the Italian public institutions addressed those challenges by employing institutional spots. We tried to answer two main research questions: (a) in line with the literature concerning persuasive communication, what were the main variables that social advertising concerning health attitudes and behaviors relied on; and (b) how the different variables were combined to propose specific communicative pathways following both the different waves/phases of the COVID-19 pandemic and the elaboration likelihood model. To answer these questions, 34 Italian spots were analyzed by means of qualitative multimodal analysis (including scopes, major narratives themes, central and peripheral cues). The results enabled us to individuate different communicative pathways, oriented by inclusivity, functionality and contamination, in line with different rounds as well as with the holistic configurations of cultural narratives, central and peripheral cues.

Stocking up on Fish Mox: a Systematic Analysis of Cultural Narratives about Self-medicating in Online Forums

This study is a systematic review of cultural narratives that drive American belief in the value and efficacy of stocking up on fish antibiotics for human consumption. Popularized by “doomsday prepper” forums and survivalist medical professionals' online videos, this narrative suggests that in some scenarios humans may benefit from such treatments—even as they note its contraindication to mainstream public health advice. Discussions in crowd-sourcing forums however, reveal that in practice Americans are using them as a form of home remedy to treat routine infections without missing work or to make up for gaps in insurance coverage. This article argues for greater attention to what makes it plausible and reasonable to treat human conditions with animal medications. It suggests that public health initiatives should address such decisions as emerging from a rational analysis of social and economic conditions rather than dismissing such practices as dangerous to population and individual health outcomes. As social scientists of medicine have long argued, collective narratives about health and medicine illustrate deeply the broader contexts in which communities understand and experience bodily state and shape how communities interact with public health institutions and respond to medical expertise. This study surveys online discussions about “fish mox” to show how participants contest medical expertise and promote a more distributed form of populist expertise. As such, consuming fish mox is both panacea for health inequality and a critique of health institutions for perpetrating such stratification.

On the Defence: UK cultural narratives of mistrust between energy users and providers

In general, households rely on energy providers to supply essential energy services such as gas and electricity. It seems reasonable to assume that it is mutually beneficial to have a customer and supplier relationship invested in trust. Key findings from the qualitative evaluation findings of a UK Comic Relief-funded energy services and managing money better programme, suggest that the programme's effectiveness was strongly affected by negative narratives about energy suppliers. Such narratives, rooted in feelings of being labelled a 'cheat' or incapable of sorting their own affairs on one side and views of energy providers being exploitative and profit-hungry on the other, engendered a common, oppositional 'united against them' culture, built on reciprocal mistrust and disrespect. This analysis is not unique to our research, as nationally, at least and within the last decade, there has been a decline in public trust of energy providers, with a suggestion that profit has come before people. The 3-year evaluation carried out by Northumbria University, UK with the research led by a North East England registered credit union and social landlord, assessed the quality of life impacts of a face-to-face energy advice service. Expert Energy Advisors offered free home visits and gave people aged 50 and over the tools to reduce and manage energy usage, question energy companies about tariff terms and conditions and ensure maximum take up of benefit entitlements. Whilst findings point to positive health and social benefits, including reducing high anxiety about unmanageable bills, being able to question and challenge energy providers 'high' bills and tariffs and passing on such skills to others, there remained a 'taken-for-granted' mistrust of energy providers. We argue that for public good to come from public health research, we need to understand and appropriately address the roots of such cultural narratives.

Infertility, cancer, and changing gender norms

INTRODUCTION

Recent improvements in cancer detection, treatment, and technology have increased survivorship rates. These same life-saving treatments, however, can lead to infertility or sterility. Oncofertility, an emerging field at the intersection of cancer and oncology, centers on providing cancer patients with the potential to preserve their biological fertility.

METHODS

We examine the history of how men and women have been treated for infertility and analyze contemporary studies of how women without cancer respond to infertility.

RESULTS

Both female and male cancer patients and survivors value their fertility, although there is conflicting evidence on the degree to which women and men value fertility. Some studies have found that women and men value their fertility equally while others found that women value their fertility more than men. Gendered norms around fertility and parenthood seem to be changing, which may minimize these discrepancies.

DISCUSSIONS/CONCLUSIONS

Although oncofertility is a nascent field, infertility is a historically relevant medical condition that is characterized by gendered narratives and norms. An analysis of the historical evolution of the understanding and treatment of infertility leads insight into modern conceptualizations of infertility both generally and in the case of cancer. Understanding these historical and current gendered influences helps to define the current context in which cancer patients are confronting potential infertility.

IMPLICATIONS FOR CANCER SURVIVORS

The insight gained from this analysis can be used to inform clinical practice, offering guidance to healthcare providers approaching cancer patients about potential infertility, regardless of gender.