(…) Obrałam sobie cel, by żyć i mieć nad tym życiem kontrolę – zachowania w chorobie przyjmowane przez chorych na SM w celu utrzymania niezależnego funkcjonowania

Przedmiotem rozważań zawartych w artykule są zachowania w chorobie podejmowane przez osoby chore na stwardnienie rozsiane (SM). W artykule przez powyższe rozumie się szereg świadomie realizowanych przez osobę chorą powiązanych ze sobą zachowań, mających pomóc jej w utrzymaniu względnie niezależnego funkcjonowania społecznego. W toku analizy podjęto próbę odpowiedzi na poniższe pytania: jakiego rodzaju zachowania wypracowują osoby chore? jakie są motywacje wpływające na kontynuowanie (bądź zaprzestanie) przyjętych zachowań? jakie zachowania osoby chorujące na stwardnienie rozsiane uznają za „korzystne”, a jakie za „ryzykowne” dla swojego stanu zdrowia? Dociekania zawarte w tekście odnoszą się do subiektywnych znaczeń nadawanych chorobie, dlatego ich teoretyczną wykładnię stanowi koncepcja „zachowań w chorobie” (illness behaviour) autorstwa Davida Mechanica. W celu dotarcia do owych subiektywnych interpretacji i znaczeń, jakie chorzy nadają swojemu SM, zastosowano metodę jakościową, przeprowadzono 30 wywiadów swobodnych z osobami chorymi na SM (postać remisyjno-rzutowa). Ich opinie, opisy wdrażanych działań, przeżytych doświadczeń, emocji i znaczeń, jakie im przypisują, stanowiły przedmiot analizy. Złożoność choroby (SM), nieznajomość jej przyczyn oraz niepewność dotycząca jej przebiegu były czynnikami wpływającymi na to, co osoby chore rozumieją przez „względnie niezależne funkcjonowanie społeczne”, oraz na to, jakie stosują zachowania w chorobie.

The Role of Images on Illness Behaviour: Interdisciplinary Theory, Evidence, and Ideas

If illness behaviour is to be fully understood, the social and behavioural sciences must work together to understand the wider forms in which illness is experienced and communicated with individuals and society. The current paper synthesised literature across social and behavioural sciences exploring illness experience and communication through physical and mental images. It argues that images may have the capacity to embody and influence beliefs, emotions, and health outcomes. While four commonalities exist, facilitating understandings of illness behaviour across the fields (i.e., understanding the importance of the patient perspective; perception of the cause, sense of identity with the illness, consequences, and level of control; health beliefs influencing illness experience, behaviours, and outcomes; and understanding illness beliefs and experiences through an almost exclusive focus on the written or spoken word), we will focus on exploring the fourth commonality. The choice to focus on the role of images on illness behaviour is due to the proliferation of interventions using image-based approaches. While these novel approaches show merit, there is a scarcity of theoretical underpinnings and explorations into the ways in which these are developed and into how people perceive and understand their own illnesses using image representations. The current paper identified that the use of images can elucidate patient and practitioner understandings of illness, facilitate communication, and potentially influence illness behaviours. It further identified commonalities across the social and behavioural sciences to facilitate theory informed understandings of illness behaviour which could be applied to visual intervention development to improve health outcomes.

Erosive rodent ulcer of the ear secondary to neglect

Basal cell carcinomas (BCCs) are slow-growing, locally invasive lesions that rarely metastasise, however, if left untreated can progress to extensive destruction of local structures giving rise to the alternative name ‘the rodent ulcer’. Here we present a case of BCC of the ear progressing to destruction of the pinna and mastoid, involving the facial nerve and breaching dura. This case presentation shows not only the seldom-seen natural progression of the rodent ulcer with impressive imaging and clinical photographs but also highlights a broader topic of capacity and consent in patients displaying maladaptive denial or abnormal illness behaviour, how this can affect patient outcomes and what we as clinicians can do to ensure the best care for our patients.

Nurses’ illness perceptions during presenteeism and absenteeism

Background Presenteeism has been linked with lost productivity, impaired health and absence. Whilst much research has focused on types of diseases associated with presenteeism and absenteeism, there has been little investigation into the role of individuals’ illness perceptions in these episodes. Aims To assess how illness perceptions vary between presenteeism and absenteeism episodes. Methods A cross-sectional questionnaire was distributed to ward-based nurses working with older adults. Data on illness perceptions during presenteeism and absenteeism episodes were collected. Data were analysed via the Paired-Samples t-test, Wilcoxon test and McNemar test. Results Two hundred and seventy cases were analysed (88% response rate). Compared with presenteeism, illnesses during absenteeism were thought to affect lives more (P < 0.001), to have more serious symptoms (P < 0.001), to be more concerning (P = 0.003), more likely to be treated (P = 0.009), more infectious (P < 0.001) and perceived as more legitimate reasons for absenteeism (P < 0.001). Treatment was considered more effective during absenteeism (P < 0.001), whilst workability was better during presenteeism (P < 0.001). Presenteeism was perceived as harmful and absenteeism beneficial for illness. Individuals attended work when presenteeism was expected to be less harmful (P < 0.001) and avoided work when absenteeism was expected to be more beneficial for illness (P < 0.001). Conclusions Illness perceptions varied significantly between presenteeism and absenteeism episodes and should be included in models of illness behaviour. Findings also highlight that policy may influence illness behaviour and that nurses may attend work despite concerning levels of illness.

Illness behaviour and health needs in migrants characterised by low satisfaction with healthcare

Background Previous research shows inequalities in access to and quality of health care for migrants. We aimed to explore in what way individuals with a migrant background, who report different levels of satisfaction with healthcare, differ in terms of illness behaviour, health needs and sociodemographic characteristics. Methods In the rural Southwest of Germany, we conducted a survey with individuals who have a Turkish (n = 217) or Russian (n = 101) background and whom we could contact via cultural centres. Data were analysed using SPSS. Results In the total sample, 47,5% (Turks 53%, Russians 37%) reported always being satisfied with healthcare, 46,9% were sometimes and 5,7% never satisfied. Turks who were not always satisfied with healthcare significantly more often did not have a regular GP, and rarely visited GPs and consultants. They more often reported the need for culture sensitive print material, assistance in applying for ambulant care and culture sensitive treatment in matters such as intimacy and death and dying. Also, they more often demanded accessibility to healthcare providers with the same cultural background compared to Turks who reported more satisfaction with healthcare. Among Russians, not always being satisfied with healthcare was associated with demanding culture sensitive information on ambulant nursing care and demanding more cultural competence in providers regarding the treatment of particular diseases. Gender was not related to satisfaction with healthcare in either group. Conclusions In this sample of migrants from a rural area culture sensitive treatment was reported to be lacking especially in ambulant nursing care and end of life treatment. In view of the increasing heterogenization of society, it is necessary to address the socio-cultural needs of migrants in a home as well as in a hospital context. Therefore, culture-sensitive materials and workshops for health professionals may be useful to complement their own expertise. Key messages A low level of satisfaction with healthcare may be related to low levels of utilization. In this underserved rural area concerns regarding culture sensitive care need to be addressed.