scholarly journals Professional resilience in GPs working in areas of socioeconomic deprivation: a qualitative study in primary care

2018 ◽  
Vol 68 (677) ◽  
pp. e819-e825 ◽  
Author(s):  
Eleanor Eley ◽  
Ben Jackson ◽  
Chris Burton ◽  
Elizabeth Walton
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Personal Characteristic ◽  
Socioeconomic Deprivation ◽  
Individual Level ◽  
Trade Offs ◽  
Increased Risk ◽  
Framework Approach ◽  
Data Saturation ◽  
The Individual

BackgroundGPs working in areas of high socioeconomic deprivation face particular challenges, and are at increased risk of professional burnout. Understanding how GPs working in such areas perceive professional resilience is important in order to recruit and retain a GP workforce in these areas.AimTo understand how GPs working in areas of high socioeconomic deprivation consider professional resilience.Design and settingA qualitative study of GPs practising in deprived areas within one primary care region of England.MethodIn total, 14 individual interviews and one focus group of eight participants were undertaken, with sampling to data saturation. A framework approach was used for data analysis.ResultsParticipants described three key themes relating to resilience. First, resilience was seen as involving flexibility and adaptability. This involved making trade-offs in order to keep going, even if this was imperfect. Second, resilience was enacted through teams rather than through individual strength. Third, resilience required the integration of personal and professional values rather than keeping the two separate. This dynamic adaptive view, with an emphasis on the importance of individuals within teams rather than in isolation, contrasts with the discourse of resilience as a personal characteristic, which should be strengthened at the individual level.ConclusionProfessional resilience is about more than individual strength. Policies to promote professional resilience, particularly in settings such as areas of high socioeconomic deprivation, must recognise the importance of flexibility, adaptability, working as teams, and successful integration between work and personal values.

scholarly journals Patient experiences of using skin self-monitoring apps with people at higher risk of melanoma: a qualitative study (Preprint)

2020 ◽  
Author(s):  
Emily Habgood ◽  
Christopher McCormack ◽  
Fiona M Walter ◽  
Jon D Emery
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Early Detection ◽  
Secondary Care ◽  
Mobile Apps ◽  
Healthcare Providers ◽  
Structured Interview ◽  
Self Monitoring ◽  
Increased Risk ◽  
Data Saturation

BACKGROUND Melanoma is the 4th most commonly diagnosed cancer in Australia. Up to 75% of melanomas are first detected by patients or their family/friends. Many mobile apps for melanoma exist, including apps to encourage skin self-monitoring (SSM) to improve the likelihood of early detection. Previous research in this area has focused on their development, diagnostic accuracy, or validation. Little is known about patients’ views and experiences of using these apps. OBJECTIVE This study aims to understand patients’ views and experiences of using commercially available melanoma SSM mobile apps for a period of three months. METHODS This qualitative study was conducted in two populations: primary care (where the MelatoolsQ tool was used to identify patients who were at increased risk of melanoma) and in secondary care (where patients had a previous diagnosis of melanoma, stages 0-3a). Participants downloaded two of four mobile apps for SSM (SkinVision, UMSkinCheck, Mole Monitor or MySkinPal) and were encouraged to use them for three months. After three months, a semi-structured interview was conducted with participants to discuss their experiences of using the SSM mobile apps. RESULTS Fifty-four participants were recruited into the study with 20 (37%) from primary care and 34 (62%) from secondary care. Interviews were conducted with 34 participants when data saturation was reached. Most participants didn’t use the apps at all (n=12) or tried them once but didn’t continue (n=14). Only eight participants used the apps to assist with SSM for the whole duration of the study. Patients discussed the apps in the context of the importance of early detection and their current SSM behaviours. A range of features of ‘perceived quality’ of each app affected engagement to support SSM. Participants described their SSM routines and potential mismatch with the app reminders. They also described technical and practical difficulties experienced using the apps for SSM. The app’s positioning within existing relationships with healthcare providers was crucial to understand use of the apps. CONCLUSIONS This study of patients at increased risk of melanoma highlights several barriers to engagement with apps to support SSM. The results highlight the wide ranging and dynamic influences on engagement with mobile apps, which extend beyond app design and relate to broader contextual factors about SSM routines and relationships with healthcare providers.

scholarly journals Late-Life Vascular Risk Score in Association With Postmortem Cerebrovascular Disease Brain Pathologies

Stroke ◽  
2021 ◽  
Author(s):  
Shahram Oveisgharan ◽  
Lei Yu ◽  
Ana Capuano ◽  
Zoe Arvanitakis ◽  
Lisa L. Barnes ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Cerebral Amyloid Angiopathy ◽  
Risk Score ◽  
Odds Ratio ◽  
Amyloid Angiopathy ◽  
Individual Level ◽  
Framingham Risk ◽  
Increased Risk ◽  
Cerebral Amyloid ◽  
The Individual

Background and Purpose: The general cardiovascular Framingham risk score (FRS) identifies adults at increased risk for stroke. We tested the hypothesis that baseline FRS is associated with the presence of postmortem cerebrovascular disease (CVD) pathologies. Methods: We studied the brains of 1672 older decedents with baseline FRS and measured CVD pathologies including macroinfarcts, microinfarcts, atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy. We employed a series of logistic regressions to examine the association of baseline FRS with each of the 5 CVD pathologies. Results: Average age at baseline was 80.5±7.0 years and average age at death was 89.2±6.7 years. A higher baseline FRS was associated with higher odds of macroinfarcts (odds ratio, 1.10 [95% CI, 1.07–1.13], P <0.001), microinfarcts (odds ratio, 1.04 [95% CI, 1.01–1.07], P =0.009), atherosclerosis (odds ratio, 1.07 [95% CI, 1.04–1.11], P <0.001), and arteriolosclerosis (odds ratio, 1.04 [95% CI, 1.01–1.07], P =0.005). C statistics for these models ranged from 0.537 to 0.595 indicating low accuracy for predicting CVD pathologies. FRS was not associated with the presence of cerebral amyloid angiopathy. Conclusions: A higher FRS score in older adults is associated with higher odds of some, but not all, CVD pathologies, with low discrimination at the individual level. Further work is needed to develop a more robust risk score to identify adults at risk for accumulating CVD pathologies.

scholarly journals Major Evolutionary Transitions in Social Insects, the Importance of Worker Sterility and Life History Trade-Offs

2021 ◽  
Vol 9 ◽  
Author(s):  
Abel Bernadou ◽  
Boris H. Kramer ◽  
Judith Korb
Keyword(s):  
Life History ◽  
Social Insects ◽  
Division Of Labour ◽  
Evolutionary Transitions ◽  
Individual Level ◽  
Individual Fitness ◽  
Trade Offs ◽  
Group Members ◽  
The Individual ◽  
Worker Sterility

The evolution of eusociality in social insects, such as termites, ants, and some bees and wasps, has been regarded as a major evolutionary transition (MET). Yet, there is some debate whether all species qualify. Here, we argue that worker sterility is a decisive criterion to determine whether species have passed a MET (= superorganisms), or not. When workers are sterile, reproductive interests align among group members as individual fitness is transferred to the colony level. Division of labour among cooperating units is a major driver that favours the evolution of METs across all biological scales. Many METs are characterised by a differentiation into reproductive versus maintenance functions. In social insects, the queen specialises on reproduction while workers take over maintenance functions such as food provisioning. Such division of labour allows specialisation and it reshapes life history trade-offs among cooperating units. For instance, individuals within colonies of social insects can overcome the omnipresent fecundity/longevity trade-off, which limits reproductive success in organisms, when increased fecundity shortens lifespan. Social insect queens (particularly in superorganismal species) can reach adult lifespans of several decades and are among the most fecund terrestrial animals. The resulting enormous reproductive output may contribute to explain why some genera of social insects became so successful. Indeed, superorganismal ant lineages have more species than those that have not passed a MET. We conclude that the release from life history constraints at the individual level is a important, yet understudied, factor across METs to explain their evolutionary success.

scholarly journals Experiences of Low Mood in Young People With Cancer: A Qualitative Study

2019 ◽  
Vol 36 (6) ◽  
pp. 424-435 ◽  
Author(s):  
Rosa Reed-Berendt ◽  
Roz Shafran ◽  
Dawn Langdon ◽  
Deborah Christie ◽  
Rachael Hough ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Young People ◽  
Qualitative Study ◽  
Young Person ◽  
Treatment Interventions ◽  
Low Mood ◽  
Psychological Difficulty ◽  
Increased Risk ◽  
Semistructured Interviews ◽  
Framework Approach

Young people with cancer are at increased risk of psychological difficulty; yet there is little research on their experiences of low mood or depressive symptoms to help inform treatment interventions. This qualitative study explored experiences and opinions of low mood or depression in young people with cancer, how their mood related to developmental challenges, strategies used to cope, and how services could improve support. Nineteen young people diagnosed and treated for cancer completed semistructured interviews. Transcripts were thematically analyzed using the framework approach, and analysis produced eight themes, organized into three domains: “A Harder Time of Life,” “Interpersonal Impact of Cancer,” and “Learning to Understand and Describe Low Mood,” Participants interviewed experienced low mood during cancer and predominantly felt “low mood” was a helpful term to describe their emotions. There were similarities and variations in their reported mood compared with clinical depression. The developmental challenges of being a young person with cancer negatively affected their mood. Participants used a variety of different coping strategies to manage these challenges. Young people were clear that they would like others to help them understand negative emotions experienced through cancer are normal to feel and support for low mood to be accessible and available.

scholarly journals Seasonal Temperature Fluctuations Differently Affect the Immune and Biochemical Parameters of Diploid and Triploid Oncorhynchus mykiss Cage-Cultured in Temperate Latitudes

2020 ◽  
Vol 12 (21) ◽  
pp. 8785 ◽  
Author(s):  
Andreia C. M. Rodrigues ◽  
Carlos Gravato ◽  
Carlos J. M. Silva ◽  
Sílvia F. S. Pires ◽  
Ana P. L. Costa ◽  
...  
Keyword(s):  
Oncorhynchus Mykiss ◽  
Energy Production ◽  
Antioxidant Defenses ◽  
Seasonal Temperature ◽  
Glutathione S Transferase ◽  
Blood Leukocytes ◽  
Individual Level ◽  
Trade Offs ◽  
Resistant Strains ◽  
The Individual

In the coming decades, and despite advances in the selection of resistant strains and the production of triploid organisms, the temperature could seriously affect salmonid aquaculture. Lower environmental tolerance has been hinted at for triploids, but the physiological mechanisms leading to such differences, and whether they are translated to the individual level, are poorly understood. This study aimed to evaluate the effects of seasonal variations on the humoral and immune status in the blood (peripheral blood leukocytes) and plasma (antiprotease, lysozyme and peroxidase activities), the oxidative stress (catalase, glutathione-S-transferase, total glutathione and lipid peroxidation) balance in the liver, and the energy budget (sugars, lipids, proteins and energy production) in the liver and muscle of diploid and triploid Oncorhynchus mykiss. Leukocytes’ numbers changed with the water temperature and differed between fish ploidies. Peroxidase activity was increased in the summer, but lysozyme and antiprotease activities were increased in the winter. Concomitantly, antioxidant defenses were significantly altered seasonally, increasing oxidative damage at higher temperatures. Moreover, warmer waters induced a reduction in the energy production measured in the liver. Differences in feed efficiency, which have been previously reported, were confirmed by the low lipid and protein contents of the muscle of the triploids. In sum, the inherent trade-offs to deal with the seasonal changes culminated in the higher growth observed for diploid fish.

scholarly journals The transformative service paradox: the dilemma of wellbeing trade-offs

2020 ◽  
Vol 31 (4) ◽  
pp. 637-663
Author(s):  
Rebekah Russell–Bennett ◽  
Rory Mulcahy ◽  
Kate Letheren ◽  
Ryan McAndrew ◽  
Uwe Dulleck
Keyword(s):  
Laboratory Experiment ◽  
Qualitative Interviews ◽  
Implicit Assumption ◽  
Trade Off ◽  
Content Type ◽  
Individual Level ◽  
Trade Offs ◽  
Physical Wellbeing ◽  
The Individual ◽  
Future Implication

PurposeA transformative service aims to improve wellbeing; however, current approaches have an implicit assumption that all wellbeing dimensions are equal and more dimensions led to higher wellbeing. The purpose of this paper is to present evidence for a new framework that identifies the paradox of competing wellbeing dimensions for both the individual and others in society – the transformative service paradox (TSP).Design/methodology/approachData is drawn from a mixed-method approach using qualitative (interviews) and quantitative data (lab experiment) in an electricity service context. The first study involves 45 household interviews (n = 118) and deals with the nature of trade-offs at the individual level to establish the concept of the TSP. The second study uses a behavioral economics laboratory experiment (n = 110) to test the self vs. other nature of the trade-off in day-to-day use of electricity.FindingsThe interviews and experiment identified that temporal (now vs. future) and beneficiary-level factors explain why individuals make wellbeing trade-offs for the transformative service of electricity. The laboratory experiment showed that when the future implication of the trade-off is made salient, consumers are more willing to forego physical wellbeing for environmental wellbeing, whereas when the “now” implication is more salient consumers forego financial wellbeing for physical wellbeing.Originality/valueThis research introduces the term “Transformative Service Paradox” and identifies two factors that explain why consumers make wellbeing trade-offs at the individual level and at the societal level; temporal (now vs. future) and wellbeing beneficiary.

scholarly journals Analysis of Desires of the Main Character in the Short Story “Ein Tisch ist ein Tisch” by Peter Bichsel: A Study of Deleuze and Guattari’s Schizoanalysis

2020 ◽  
Vol 4 (1) ◽  
pp. 29
Author(s):  
M. Kharis ◽  
Rosyidah Rosyidah ◽  
Sawitri Retnantiti
Keyword(s):  
Qualitative Study ◽  
Short Story ◽  
Research Data ◽  
Main Character ◽  
Social Formation ◽  
Individual Level ◽  
Descriptive Approach ◽  
The Creation ◽  
The Individual ◽  
Recording Techniques

This study aims to describe the desires of the main character ‘der Mann’ in the short story by Peter Bichsel using Deleuze and Guattari’s Schizoanalysis theory. This was a qualitative study with a descriptive approach. The research data were comprised of words, phrases, and sentences. The collected data were subsequently categorized into types of desires. Data were analyzed using reading and recording techniques and described based on the proportion of desires. The results of the analysis showed that the main character receives constant pressures from society, leading to the emergence of paranoid desire, a desire that is formed due to the pressure of particular systems or social codes outside of the main character. This desire is schizophrenic at the individual level. In the short story, this desire is manifested through the creation of a new language by ‘der Mann’. In the end, the main character ‘der Mann’ can use new vocabulary at the levels of phrases and sentences, but unable to influence other language users. As a result, his newly self-created language is unacceptable in society. However, the schizophrenic desire at the individual level has the potential to destruct social formation

scholarly journals Peripheral arterial disease diagnosis and management in primary care: a qualitative study

BJGP Open ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. bjgpopen19X101659 ◽  
Author(s):  
Jan Lecouturier ◽  
Jason Scott ◽  
Nikki Rousseau ◽  
Gerard Stansby ◽  
Andrew Sims ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Disease Diagnosis ◽  
Diagnosis And Management ◽  
Increased Risk ◽  
Peripheral Arterial ◽  
The Impact

BackgroundPatients diagnosed with peripheral arterial disease (PAD) are at an increased risk of coronary heart disease, stroke, heart attack, and PAD progression. If diagnosed early, cardiovascular risk factors can be treated and the risk of other cardiovascular diseases can be reduced. There are clear guidelines on PAD diagnosis and management, but little is known about the issues faced in primary care with regards adherence to these, and about the impact of these issues on patients.AimTo identify the issues for primary care health professionals (HPs) and patients in PAD diagnosis and management, and to explore the impact of these on HPs and PAD patients.Design & settingQualitative study conducted in a primary care setting in the North East of England. Data was collected between December 2014 and July 2017.MethodSemi-structured interviews and focus groups were conducted with PAD register patients (n = 17), practice nurses ([PNs], n = 17), district nurses (DNs], n = 20), tissue viability nurses (n = 21), and GPs (n = 21).ResultsHPs’ attitudes to PAD, difficulty accessing tests, and patient delays impacted upon diagnosis. Some HPs had a reactive approach to PAD identification. Patients lacked understanding about PAD and some reported a delay consulting their GP after the onset of PAD symptoms. After diagnosis, few were attending for regular GP follow-up.ConclusionPatient education about PAD symptoms and risks, and questioning about exercise tolerance, could address the problem of under-reporting. Annual reviews could provide an opportunity to probe for PAD symptoms and highlight those requiring further investigation. Improved information when PAD is diagnosed and, considering the propensity for patients to tolerate worsening symptoms, the introduction of annual follow-up (at minimum) is warranted.

Individual- and School-Level Factors Contributing to Disproportionate Suspension Rates: A Multilevel Analysis of One State

2018 ◽  
Vol 27 (4) ◽  
pp. 209-220 ◽  
Author(s):  
Kristine A. Camacho ◽  
Michael P. Krezmien
Keyword(s):  
High Schools ◽  
Students With Disabilities ◽  
Multilevel Model ◽  
English Language ◽  
School Enrollment ◽  
School Level ◽  
Highly Qualified ◽  
Individual Level ◽  
Increased Risk ◽  
The Individual

Data from middle schools ( n = 219), high schools ( n = 200), and combined middle and high schools ( n = 20) were used to examine individual- and school-level factors within a multilevel model associated with an increased risk of suspension for minority students and students with disabilities. Results indicate that the individual-level variables of race and disability status were associated with an increased risk of suspension. Multiple school-level factors were also found to be associated with an increased risk of suspension including school enrollment, attendance, mobility, the percent of highly qualified teachers, the percent of students receiving free and reduced priced meals, the percent of students receiving special education services, the school’s Title I status, the student-to-teacher ratio, English Language Arts state exam scores, and the percent of White students in the school. In both analyses, the majority of variance was associated with the multilevel model which indicates the importance of examining individual factors within the context of school-level factors when trying to understand and respond to disproportionate suspension practices.

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