Women's COPD

Chronic obstructive pulmonary disease (COPD) is no longer a respiratory disease that predominantly affects men, to the point where the prevalence among women has equaled that of men since 2008, partly due to their increasing exposure to tobacco and to biomass fuels. Indeed, COPD has become the leading cause of death in women in the USA. A higher susceptibility of female to smoking and pollutants could explain this phenomenon. Besides, the clinical presentation appears different among women with more frequent breathlessness, anxiety or depression, lung cancer (especially adenocarcinoma), undernutrition and osteoporosis. Quality of life is also more significantly impaired in women. The theories advanced to explain these differences involve the role of estrogens, smaller bronchi, impaired gas exchange in the lungs and smoking habits. Usual medications (bronchodilators, ICS) demonstrated similar trends for exacerbation prevention and lung function improvement in men and women. There is an urgent need to recognize the increasing burden of COPD in women and therefore to facilitate global improvements in disease management (smoking cessation, pulmonary rehabilitation…) in half of the population. Nevertheless, important limitations to the treatment of women with COPD include greater under-diagnosis than in men, fewer spirometry tests and medical consultations. In conclusion there is an urgent need to recognize the increasing burden of COPD in women and therefore to facilitate globally improvements in disease management in this specific population.

“I Don’t Know, I’m Just the Interpreter”: A first approach to the role of healthcare interpreters beyond bilingual medical encounters

Researchers have long been preoccupied with the issue of role in healthcare interpreting. However, most studies approach this construct in the course of medical consultations, leaving somewhat unattended other spaces and activities in which interpreters also participate. This paper aims to contribute to a better understanding of the healthcare interpreters’ role in these areas. Drawing on participant observation, I examined the roles played by five interpreters at a hospital in Madrid for five months in activities different to provider-patient interactions (e.g. waiting with patients). Seven key roles were identified outside medical consultations: intercultural and moral mediator, patient advocate, institutional navigator, healthcare ambassador, information miner and companion/conversation partner. A key finding is that most events in which interpreters participate occur outside medical consultations, which makes it essential to shift the attention to the roles played in these alternative spaces. Understanding the role of healthcare interpreters in different activities within the realm of healthcare scenarios is essential to construct an accurate vision of what being just an interpreter really means.

THE INTERACTIONAL ORGANISATION OF PAIN DISPLAYS IN MEDICAL CONSULTATIONS

<p>Pain is commonly understood as a private experience situated within the individual. However, pain also takes place in the social world, emerging as an interactional event between individuals. The current thesis examined pain displays in interaction and showed how they are sensitive to, and shaped by, the immediate social environment. Discursive psychology and conversation analysis were used as theoretical and methodological frameworks to investigate pain displays as social actions. The empirical data of the study were video recordings of medical consultations between general practitioners and patients. Pain displays within physical examinations were analysed as complex multimodal Gestalts following Mondada (2014b); these are locally constituted from a web of embodied and vocal resources. The first analytic chapter focused on pain displays and the organisation of turns. Participants oriented to pain displays as structural units with an onset, peak, and projectable completion place that organised when and how they built their turns-at-talk. Pain displays were also visible in the progressivity of turns-at-talk, emerging at transition relevant places, suspended and re-initiated with respect to speaker turns. The second analytic chapter showed that pain displays were sequentially organised. Pain displays were oriented to as responsive actions that progressed pain solicitations. However, they did not lead to activity closure, raising questions about the status of pain displays as conditionally relevant next actions. The thesis demonstrated the orderly ways pain displays were coordinated with, and contributed to, the diagnostic work of the ongoing medical interaction. Pain displays were found to be inextricably tied to the interactional environment, a finding supported by other research which has shown internal states like pain and emotion are produced as socially-organised practices. Finally, the thesis contributes to debates within multimodal research, providing support for the utility of talk-focused conversation analytic concepts to describe embodied action. The findings also have practical applications for people seeking medical help for pain.</p>

THE INTERACTIONAL ORGANISATION OF PAIN DISPLAYS IN MEDICAL CONSULTATIONS

<p>Pain is commonly understood as a private experience situated within the individual. However, pain also takes place in the social world, emerging as an interactional event between individuals. The current thesis examined pain displays in interaction and showed how they are sensitive to, and shaped by, the immediate social environment. Discursive psychology and conversation analysis were used as theoretical and methodological frameworks to investigate pain displays as social actions. The empirical data of the study were video recordings of medical consultations between general practitioners and patients. Pain displays within physical examinations were analysed as complex multimodal Gestalts following Mondada (2014b); these are locally constituted from a web of embodied and vocal resources. The first analytic chapter focused on pain displays and the organisation of turns. Participants oriented to pain displays as structural units with an onset, peak, and projectable completion place that organised when and how they built their turns-at-talk. Pain displays were also visible in the progressivity of turns-at-talk, emerging at transition relevant places, suspended and re-initiated with respect to speaker turns. The second analytic chapter showed that pain displays were sequentially organised. Pain displays were oriented to as responsive actions that progressed pain solicitations. However, they did not lead to activity closure, raising questions about the status of pain displays as conditionally relevant next actions. The thesis demonstrated the orderly ways pain displays were coordinated with, and contributed to, the diagnostic work of the ongoing medical interaction. Pain displays were found to be inextricably tied to the interactional environment, a finding supported by other research which has shown internal states like pain and emotion are produced as socially-organised practices. Finally, the thesis contributes to debates within multimodal research, providing support for the utility of talk-focused conversation analytic concepts to describe embodied action. The findings also have practical applications for people seeking medical help for pain.</p>

Detection and follow-up of chronic health conditions in Rio de Janeiro – the impact of residency training in family medicine

Background There is a need for evidence that residency training in family medicine can benefit the care of patients in primary care in low- and middle-income countries. We tested the hypothesis that two years of residency training in family medicine enables doctors to better detect chronic health conditions while requesting fewer laboratory tests and providing more follow-up visits. Methods We performed a retrospective longitudinal observational analysis of medical consultations from 2013 to 2018 in primary care in Rio de Janeiro, comparing doctors without residency training in family medicine (Generalists) versus family physicians (FPs). Multivariate multilevel binomial regression models estimated the risks of patients being diagnosed for a list of 31 chronic health conditions, having a follow-up visit for these conditions, and having laboratory tests ordered from a list of 30 exams. Results 569.289 patients had 2.908.864 medical consultations performed by 734 generalists and 231 FPs. Patients seen by FPs were at a higher risk of being detected for most of the chronic health conditions, at a lower risk of having any of the 30 laboratory tests requested, and at a higher risk of having a follow-up visit in primary care. Conclusions Residency training in family medicine can make physicians more skilled to work in primary care. Policymakers must prioritize investments in capacity building of healthcare workforce to make primary care truly comprehensive.

When My Child Has Alzheimer’s Disease

The significant increment in life expectancy, associated to the existence of high-performing older adults, and the appropriate diagnosis of early dementias, lead to an uncommon scenario, of healthy parents accompanying their children with Alzheimer’s disease or another dementia to medical consultations. Here, we reported three peculiar clinical vignettes of patients diagnosed with a dementia, who were accompanied by healthy parents. This is a modern situation that tends to become more frequent, and must be properly discussed, since multidisciplinary care and specific training are necessary.

Talen en spiralen: kennis en besluitvorming in anticonceptieconsultaties met een taalbarrière

Misconception and contraception: knowledge and decision-making in contraceptive consultations with a language barrier Just like in general medical consultations, different domains of knowledge come together and are negotiated in contraceptive consultations, followed by decision-making on the contraceptive method. Research shows that a language barrier can hamper knowledge negotiation and decision-making in medical consultations. Our paper contributes to those findings by focussing on contraceptive counselling as a specific and underexplored consultation type. We gathered our data in a Belgian abortion clinic, where contraception is discussed during the consultations, and where an important part of the consultations are characterised by a language barrier. We adopt a Bourdieusian view on language as capital, and use a linguistic ethnographic and interactional sociolinguistic approach, complemented with analytical tools from conversation analysis on epistemics and deontics. The analysis of data fragments, ranging from a limited to a double language barrier, shows that this barrier is connected in various ways with how, and how much, knowledge is negotiated. Incomplete renditions, interruptions, epistemic and deontic claims from non-professional interpreters, along with a lack of shared contextualisation, impede clients to gather information and therefore influence decision-making. We conclude that a language barrier involves a potential risk for knowledge negotiation and decision-making in contraceptive consultations. More attention from healthcare professionals to language barriers could empower women in their sexual and reproductive health choices.

Next-generation rheumatoid arthritis specialized telemedicine enabled by IoT and AI

Ageing populations in developed countries place strain on healthcare systems and when ageing populations live far away from the specialists they require to treat their chronic diseases, the logistics can be challenging to say the least. This is a particularly acute issue in Japan, which is made up of small islands. The COVID-19 pandemic has served to emphasise the need for better systems for remote medical consultations. Dr Fumiaki Nonaka at Goto Chuou Hospital and Professor Atsushi Kawakami and Dr Shinya Kawashiri at Nagasaki University Hospital have collaborated with Microsoft to create the first remote consultation systems for rheumatoid arthritis (RA) that uses mixed reality. Early detection is crucial to managing RA but it is often difficult to make an accurate diagnosis and treatment of the disease in remote islands. This issue became particularly pressing in the context of COVID-19. Working with Microsoft, the researchers sought to develop a method of viewing and rendering the joints in 3D. Microsoft adapted their Azure Kinect DK cameras into a rig covering three different angles of any joint and an array of seven microphones was also installed. Using a reality headset called HoloLens2, the images of the joint can be rendered a 3D hologram to the user, enabling doctors to freely observe the joint from any direction. Combining this with Microsoft's Teams, a face-t-face consultation is facilitated.