Most participants held negative beliefs about the cause of their chronic low back pain, attributing it to an underlying structural or anatomical problem with their spine. These beliefs were traced back to advice received from healthcare practitioners and results shown on spinal imaging. Those who were more disabled by their back pain generally held more negative beliefs and a pessimistic outlook about their future, whereas those who were less disabled tended to have more positive beliefs not influenced by healthcare interactions. The findings suggest that for some Aboriginal Australians, chronic low back pain may have become disabling in part due to interactions with the healthcare system and adoption of a biomedical explanation of the condition promoted by practitioners.
The document examines the chronic low back pain (CLBP) beliefs of Aboriginal Australians through qualitative interviews with 32 Aboriginal participants. It finds that contrary to previous research suggesting Aboriginal Australians were protected from CLBP disability due to cultural beliefs, most participants held negative biomedical beliefs about the structural cause of their pain originating from healthcare interactions. Those with more disability had more negative beliefs and a poorer future outlook, while those with less disability had more positive beliefs not from healthcare. The findings suggest disabling CLBP may be partly iatrogenic and highlight the need for healthcare practitioners to positively influence patient beliefs.
The document provides information on a case study of a 3-month-old male patient admitted to the pediatric ward with a chief complaint of non-productive cough, high grade fever, and convulsive episodes over the past 4 days. The patient's history, physical assessment findings, admitting diagnosis of suspected CNS infection and ARI with severe disease, treatment plan, and applicable nursing care are discussed. A nursing care plan is developed based on Gordon's Functional Health Patterns to address the patient's hyperthermia and risk for seizures related to his conditions. [END SUMMARY]
Isaac Holeman's Medicine In Cuba Project.Isaac Holeman
Cuba has a socialized healthcare system that provides universal coverage to all citizens. Doctors participate in community outreach programs to promote prevention. While clinics have limited equipment and flood damage, doctors are proud of the system's humanitarian achievements in providing care. Doctors are paid little but feel they are champions, not slaves, of the socialized medical system.
This curriculum vitae summarizes the education and experiences of Nicholas A. Younginer. He is currently pursuing his PhD in Health Promotion, Education, and Behavior at the University of South Carolina. His research focuses on food insecurity and nutrition programs. He has over 10 years of experience conducting qualitative research studies and has numerous publications on topics related to childhood hunger and nutrition.
The librarian organized various health education events at the local library to address community needs. These included meetings on diabetes, breastfeeding, drug and alcohol prevention. Partnerships were formed with local health professionals, schools and volunteers to provide lectures, movies and projects on topics like diabetes management, AIDS prevention, non-smoking and aggression prevention. A local volunteer center was also established to expand these initiatives. The goal was to make health information accessible and promote healthy lifestyles among school children and the wider community.
Optimized Aging with Nutritional & Weight Management TechniquesLouis Cady, MD
In this lecture, presented on August 15, 2014 for the USI Mid-America institute on Aging, Dr. Cady covered the under appreciated physiology of micronutrients and deficiency syndrome, the concept of the "Triage Theory of Aging" from Dr. Bruce Ames, and reviewed the literature on nutritional supplementation. This covered carotenoids, peer-reviewed studies on carotenoids and mortality, peer-reviewed studies on carotenoids and risk of breast cancer, peer review articles on lipid preoccupation, antioxidants, and the chances of survival in the institutionalized elderly, Raman spectroscopy as a marker of antioxidant nutritional deficiency, the explosion of obesity in our population in the US, and optimal antiaging strategies. The "Seven Secrets of Optimizing Body Composition" was reviewed at the end. References are attached.
This document provides an overview of a presentation on optimizing neurovascular aging through nutritional and weight management techniques. The presentation discusses the importance of micronutrient adequacy and macronutrient balance in diet and their relationship to neurovascular health issues. It also discusses how our functioning as we age and freedom from disease and depression is dependent on our diet and behaviors. The presentation provides information on common micronutrient deficiencies in North America, physiological effects of deficiencies, and the role of antioxidants in brain and body health.
The document examines the chronic low back pain (CLBP) beliefs of Aboriginal Australians through qualitative interviews with 32 Aboriginal participants. It finds that contrary to previous research suggesting Aboriginal Australians were protected from CLBP disability due to cultural beliefs, most participants held negative biomedical beliefs about the structural cause of their pain originating from healthcare interactions. Those with more disability had more negative beliefs and a poorer future outlook, while those with less disability had more positive beliefs not from healthcare. The findings suggest disabling CLBP may be partly iatrogenic and highlight the need for healthcare practitioners to positively influence patient beliefs.
The document provides information on a case study of a 3-month-old male patient admitted to the pediatric ward with a chief complaint of non-productive cough, high grade fever, and convulsive episodes over the past 4 days. The patient's history, physical assessment findings, admitting diagnosis of suspected CNS infection and ARI with severe disease, treatment plan, and applicable nursing care are discussed. A nursing care plan is developed based on Gordon's Functional Health Patterns to address the patient's hyperthermia and risk for seizures related to his conditions. [END SUMMARY]
Isaac Holeman's Medicine In Cuba Project.Isaac Holeman
Cuba has a socialized healthcare system that provides universal coverage to all citizens. Doctors participate in community outreach programs to promote prevention. While clinics have limited equipment and flood damage, doctors are proud of the system's humanitarian achievements in providing care. Doctors are paid little but feel they are champions, not slaves, of the socialized medical system.
This curriculum vitae summarizes the education and experiences of Nicholas A. Younginer. He is currently pursuing his PhD in Health Promotion, Education, and Behavior at the University of South Carolina. His research focuses on food insecurity and nutrition programs. He has over 10 years of experience conducting qualitative research studies and has numerous publications on topics related to childhood hunger and nutrition.
The librarian organized various health education events at the local library to address community needs. These included meetings on diabetes, breastfeeding, drug and alcohol prevention. Partnerships were formed with local health professionals, schools and volunteers to provide lectures, movies and projects on topics like diabetes management, AIDS prevention, non-smoking and aggression prevention. A local volunteer center was also established to expand these initiatives. The goal was to make health information accessible and promote healthy lifestyles among school children and the wider community.
Optimized Aging with Nutritional & Weight Management TechniquesLouis Cady, MD
In this lecture, presented on August 15, 2014 for the USI Mid-America institute on Aging, Dr. Cady covered the under appreciated physiology of micronutrients and deficiency syndrome, the concept of the "Triage Theory of Aging" from Dr. Bruce Ames, and reviewed the literature on nutritional supplementation. This covered carotenoids, peer-reviewed studies on carotenoids and mortality, peer-reviewed studies on carotenoids and risk of breast cancer, peer review articles on lipid preoccupation, antioxidants, and the chances of survival in the institutionalized elderly, Raman spectroscopy as a marker of antioxidant nutritional deficiency, the explosion of obesity in our population in the US, and optimal antiaging strategies. The "Seven Secrets of Optimizing Body Composition" was reviewed at the end. References are attached.
This document provides an overview of a presentation on optimizing neurovascular aging through nutritional and weight management techniques. The presentation discusses the importance of micronutrient adequacy and macronutrient balance in diet and their relationship to neurovascular health issues. It also discusses how our functioning as we age and freedom from disease and depression is dependent on our diet and behaviors. The presentation provides information on common micronutrient deficiencies in North America, physiological effects of deficiencies, and the role of antioxidants in brain and body health.
La posesión es una situación jurídica que protege el poder de hecho sobre una cosa. Tiene una doble naturaleza como hecho y como derecho. Como hecho, se refiere al dominio material sobre la cosa; como derecho, otorga facultades legales al poseedor independientemente de si tiene o no derecho sobre la cosa. La posesión cumple funciones como proteger al poseedor, legitimar derechos y facilitar la adquisición de la propiedad u otros derechos reales.
This document provides a summary of MD.TANVIR RAHMAN's qualifications and experience for the position of 4th Engineer. It includes details of his previous employment on three ships as an Engine Cadet and Junior Engineer/4th Engineer. It also lists his academic qualifications including a Bachelor's degree in Maritime Science, certificates and courses completed, identity documents, and personal details. References are provided from his time at Bangladesh Marine Academy.
Este documento presenta diferentes estrategias de marketing para fidelizar clientes, incluyendo el uso de bases de datos de clientes, tarjetas de fidelización, y regalos y obsequios promocionales.
This slide presentation summarizes a research study on how smart tourism technology attributes and the perceived value of a destination impact tourist happiness. The study examines a research model and hypotheses about how informativeness, accessibility, interactivity, and personalization of smart tourism technologies can positively impact travel service satisfaction and travel experience satisfaction. It is also hypothesized that the perceived functional, social, and emotional value of a destination can positively impact satisfaction levels. Higher levels of travel service satisfaction and travel experience satisfaction are then expected to positively impact tourist happiness. The study describes its instrument development and operational definitions, data collection from 191 international tourists in Seoul, data analysis using partial least squares analysis, and results supporting the hypotheses regarding convergent and discriminant validity.
Este documento presenta un resumen de los diferentes tipos de oraciones que existen en español, incluyendo oraciones yuxtapuestas, coordinadas y subordinadas. Explica las diferencias entre cada tipo de oración y provee ejemplos para ilustrar cada categoría.
La empresa es una unidad económica de producción que combina factores de capital y trabajo para obtener un beneficio. Tiene objetivos económicos, técnicos, humanos y sociales. Se compone de recursos como el talento humano, recursos materiales, financieros, técnicos y mercadológicos.
Health seeking behavior among the kalazar affected people of the scavenger (m...Md. Nasir Uddin,PhD
This document summarizes a study on the health seeking behaviors of people from the scavenger community in Bogra, Bangladesh who were affected by kala-azar (visceral leishmaniasis). The qualitative study found that the scavenger community has poor health outcomes due to factors like poverty, lack of health awareness, malnutrition, and discrimination. Most people in the community are illiterate adults and rely on folk remedies rather than modern medicine when sick. The researchers observed the community's demographics, family structures, economic hardships, and experiences of prejudice from the majority Bengali population. The community's worldviews and lack of access to healthcare influences their health seeking behaviors for illnesses like kala-azar.
Indigenous Cultural Beliefs and Health Seeking Behaviours of the Mbororo Comm...ijtsrd
The aim of this study was to investigate the effects of indigenous cultural beliefs on the health seeking behaviours of the Mbororo community in Mezam Division of the Northwest Region of Cameroon. The study employed the survey research design with a mix of both quantitative and qualitative techniques. Quantitative data were collected through a questionnaire while a focus group discussion guide and a semi structured interview guide were used to collect qualitative data from a sample of 539 respondents. A total of 500 questionnaires were administered and 6 focus groups discussions were carried out and as well as interviews granted to 3 healthcare professionals. The simple random sampling technique was used to select the sample of the study. Data were analyzed with the aid of the Statistical Package for Social Sciences SPSS version 23.0 for Windows. Descriptive statistics such as simple percentages, mean scores and standard deviation, and inferential statistics such as the Pearson Correlation test were used to analyze quantitative data while qualitative data were analyzed using content analysis with the support of ATLAS.ti software version 8.0. The findings revealed that indigenous cultural beliefs r=0.621, df=98, p 0.05 have a positive correlation with the health seeking behaviours of the Mbororo community. Based on the findings, recommendations were made on the need for the Mbororo community in Mezam Division and beyond to develop more tolerance for conventional or modern medicine and rush to modern hospitals when ill for appropriate screening, diagnosis and treatment of their diseases even as they continue to patronize traditional medicine based on their indigenous cultural beliefs. This would go a long way to improve the health and wellbeing of the Mbororo community in Mezam and beyond. Suggestions for further studies were also made. Foncham Paul Babila "Indigenous Cultural Beliefs and Health-Seeking Behaviours of the Mbororo Community in Mezam Division of North West Cameroon" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-5 , August 2022, URL: https://www.ijtsrd.com/papers/ijtsrd50613.pdf Paper URL: https://www.ijtsrd.com/humanities-and-the-arts/psychology/50613/indigenous-cultural-beliefs-and-healthseeking-behaviours-of-the-mbororo-community-in-mezam-division-of-north-west-cameroon/foncham-paul-babila
Rev. Latino-Am. Enfermagem
2010 May-Jun; 18(3):459-66
www.eerp.usp.br/rlae
Corresponding Author:
Flavio Braune Wiik
Universidade Estadual de Londrina. Centro de Letras e Ciências Humanas.
Departamento de Ciências Sociais
Campus Universitário. Caixa-Postal 6001
CEP 86051-990 Londrina, PR, Brasil
E-mail: [email protected]
Anthropology, Health and Illness: an Introduction to the Concept of
Culture Applied to the Health Sciences
Esther Jean Langdon1
Flávio Braune Wiik2
This article presents a reflection as to how notions and behavior related to the processes of
health and illness are an integral part of the culture of the social group in which they occur.
It is argued that medical and health care systems are cultural systems consonant with the
groups and social realities that produce them. Such a comprehension is fundamental for the
health care professional training.
Descriptors: Culture; Anthropology; Health Care; Health Sciences.
1 Anthropologist, Ph.D. in Anthropology, Full Professor, Universidade Federal de Santa Catarina, SC, Brazil.
Email: [email protected]
2 Social Scientist, Ph.D. in Anthropology, Adjunct Professor, Universidade Estadual de Londrina, PR, Brazil.
Email: [email protected]
Original Article
460
www.eerp.usp.br/rlae
Antropologia, saúde e doença: uma introdução ao conceito de cultura
aplicado às ciências da saúde
O objetivo deste artigo foi apresentar uma reflexão de como as noções e comportamentos
ligados aos processos de saúde e de doença integram a cultura de grupos sociais onde
os mesmos ocorrem. Argumenta-se que os sistemas médicos de atenção à saúde,
assim como as respostas dadas às doenças, são sistemas culturais, consonantes com os
grupos e realidades sociais que os produzem. A compreensão dessa relação se mostra
fundamental para a formação do profissional da saúde.
Descritores: Cultura; Antropologia; Atenção à Saúde; Ciências da Saúde.
Antropología, salud y enfermedad: una introducción al concepto de
cultura aplicado a las ciencias de la salud
Este artículo presenta una reflexión acerca de como las nociones y comportamientos
asociados a los procesos de salud y enfermedad están integrados a la cultura de los
grupos sociales en los que estos procesos ocurren. Se argumenta que los sistemas
médicos de atención a la salud, así como las respuestas dadas a la enfermedad son
sistemas culturales que están en consonancia con los grupos y las realidades sociales
que los producen. Comprender esta relación es crucial para la formación de profesionales
en el área de la salud.
Descriptores: Cultura; Antropología; Atención a la Salud; Ciencias de la Salud.
Introduction
Perhaps it seems out of place to address the theme
of culture in a journal dedicated to the Health Sciences
or to argue that the concept of culture can be useful
for professionals of this area. Everyone has a common
sense idea of what “culture” means. We say that a person
“has culture” when he or sh ...
Social support among the Caregivers of Persons Living with Cancerinventionjournals
:The social support emphasize as the support given to any person in a troublesome or burdensome situation by family members, relatives as well as resources exerted by social connections, is effective in promoting physical health and feeling oneself good. The present study consisted of 300 caregivers of persons with cancer was selected based on simple random sampling, and with inclusion and exclusion criteria. Those patients satisfying the inclusion and exclusion criteria and attending both outpatient and inpatient services of cancer specialty hospital in KIDWAI Bangalore, Karnataka were selected randomly. The data was collected from the patients & caregivers of persons living with cancer who fulfill the inclusion/exclusion criteria were taken up for the study after their consent. Multidimensional Scale of Perceived Social Support (Zimet et al, 1998) was administered to understand Perceived Social Support. The interviews and the instruments were administered by research experts.The Results suggest that there were poor social support found in caregivers of married, female, belong to rural domicile, illiterate, and,caregivers who were not heard about the treatment of cancer.
The document summarizes a student's final project for an anthropology course. It covers several topics related to cultural anthropology, including cultural diversity, anthropological methods, cultural connections, and predictions. The student conducted ethnographic research in a village studying multidrug-resistant tuberculosis, observing cultural patterns of how the disease spreads and what it means to the community. The summary discusses how anthropologists can help navigate crises by understanding multiple cultural perspectives and acting as cultural brokers. It also addresses predicting how diseases may affect groups based on historical patterns.
1 FINAL PROJECT PART B
Final Project Part B
ATH 101
Student Name
SNHU
2 FINAL PROJECT PART B
I. Cultural Diversity
A.1. Cultural diversity is important to understand at any time, but espe cially in a time of a
crisis. For example, when we speak of gender, meaning the cultural expectations of that gender,
not biological differences, this differs considerably among cultures (Ember, Ember, & Peregrine,
2015). W hen people think of fa rming, the y may think of this as male activity, that it is a male
activity in all cultures, but this is not true. Anthropological research has shown that farming or
tending crops may be a male or a female activity, depending on the location. Among the Igbo of
Nigeria, men plant and harvest yams and cassava, but women plant and harvest maize, melons,
okra, a nd beans. Both men and women plant rice (Bonvillain, 2010). The point is that gender
expectations and roles differ among cultures.
A.2. An example of how human sociocultural identity relates to human behavior would
be how different cultures express emotion. Cultures have display rules, m eaning they have
certain cultural expectations of how one should behave wh en feeling a particular emotion.
Specific examples would include how the Japanese might mask anger with a smile or the Dani of
New Guinea show their anger by wrinkling their noses (Heider, 2007).
A.3. Another example would include human sociocultural identity related to animals.
Primates (including human children) engage in play. While cultures have different ways to play,
the purpose of playing as children offers the same functions, a nd primates share these functions
as well. Play teaches the young how to interact with their peers and also expected social
behaviors.
B.1. Anthropologists can help us navigate crises by acting as cultural brokers or working
between the culture of crisis and the outside world, a s anthropologists understand multiple
perspectives. Amy Porter and Paul Farmer contend that anthropologists are needed “to map out
3 FINAL PROJECT PART B
how complex political, economic, and social inequalities” find their way into populations as
disease (Porter & Farmer, 2013, p. 366). It is important to also have cultural sensitivity to the
beliefs of the people you are working with; if you don’t, you won’t make any difference in their
understandings of the disease or your understanding of how the disease is manifested in that
population.
II. Anthropological Methods
A.1. I chose to do ethnography in a village with known cases of multidrug-resistant
tuberculosis (MDR TB). Ethnography was the best option for me, a s I am a cultural
anthropologist. Ethnography allows you to observe people’s actions and participate in t heir daily
lives to be able to make connections in what we are studying (Ember, Ember, & Peregrine,
2015). I was able to interview ...
Balandin and Hemsley's Conversation in Tribute to Joan Sheppard NY July 2019Bronwyn Hemsley
Teacher's College Columbia University New York, presentation in tribute of the impact of Justine Joan Sheppard's work in dysphagia particularly in Australia, India, and Scandinavia (Dysphagia Disorders Survey, Choking Risk Assessment and Pneumonia Risk Assessment). Presentation at Justine Joan Sheppard Memorial Conference, Teacher's College Columbia University New York 27th July 2019 "Dysphagia in Pediatric Populations and Adults with Intellectual Disabilities".
kinesiophobia is not asscociate disability in elderly womenJUSCELIO SILVA
This study investigated the association between kinesiophobia as measured by the FABQ-Phys subscale and disability in 459 elderly women with acute low back pain. The authors found that kinesiophobia as assessed by the FABQ-Phys did not reliably predict disability as measured by the Roland-Morris Questionnaire or gait speed test, explaining less than 1% of additional variability. Body mass index and pain intensity as measured by the VAS were found to be significant predictors of disability. The authors conclude that kinesiophobia as assessed by the FABQ-Phys cannot be generalized to predict disability in this population of elderly women with acute low back pain.
This document discusses Batten disease, a rare neurodegenerative disease that affects children. It provides background on Batten disease, which results in seizures, vision loss, and premature death. The document outlines a research study involving interviews with three groups: caregivers of Batten disease patients, individuals from a rare disease advocacy organization, and individuals from a Batten disease foundation. The goal is to understand the challenges of living with a rare disease and identify ways to improve care and support for patients and families.
Existing climate change policies in Uganda do not adequately address the physical and mental health impacts on vulnerable mountain communities. Studies show evidence of issues like post-traumatic stress disorder linked to climate events. However, the perspectives of affected populations are not well represented in policies. The proposed study aims to document stories and narratives of climate impacts on health to inform policy review and guide communication, filling gaps in understanding the experiences of at-risk groups.
Health Seeking Behaviors following Diabetes Mellitus of Various Ethnic Groups...ijtsrd
The research on Health Seeking Behaviours following Diabetes Mellitus DM of various ethnic groups was conducted because different patients within a given ethnic group or cultural group have different options regarding actions to seek health care services. The purpose of this study was to determine the Health Seeking Behaviours HSB following DM patients from various ethnic groups and the roles of the Health Psychologists HP on the DM patients in Nkwen Health District of Bamenda III Subdivision within Mezam Division of the North West Region of Cameroon. A descriptive survey research design was conducted among 230 sampled DM patients from various ethnic groups in Nkwen Health District. A non probability purposive sampling technique was used to set the population under study. The data was collected using both Focus Groups Discussions FGDs and questionnaire for a period of two months during the period that the DM patients came to Nkwen Health District either to consult or to refill their drugs. The questionnaire were administered to 230 DM patients from the various ethnic groups which were Bali, Bafut, Banso, Bamendankwe, Babanki, Santa, Nkwen and Ndu during this period as well.. The data collected was analysed using both descriptive and inferential statistics with SPSS software tool version 20.0, following the objectives of the study. For HSB, 38.3 agreed that they sought health care from traditional medicine whereas 26.1 remained neutral on traditional medicine. On the other hand, 37.7 disagreed that they used traditional medicine. Cultural believes and distance deterred HSB which were statistically significant with P = 0.001 and P= 0.001 respectively. The options taken to seek health care from the hospital were influenced by family relatives with P=0.001. Therefore, HSB was found to be statistically significant for the first traditional medicine and second line hospital among the different ethnic groups with P = 0.001 and 0.001 respectively. These results showed that poor HSB following DM among the different ethnic groups was statistically significant in Nkwen Health District. Foncham Paul Babila "Health-Seeking Behaviors following Diabetes Mellitus of Various Ethnic Groups in Nkwen Health District of Bamenda III Subdivision, Mezam Division, North West Region of Cameroon" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-5 , August 2022, URL: https://www.ijtsrd.com/papers/ijtsrd51783.pdf Paper URL: https://www.ijtsrd.com/humanities-and-the-arts/psychology/51783/healthseeking-behaviors-following-diabetes-mellitus-of-various-ethnic-groups-in-nkwen-health-district-of-bamenda-iii-subdivision-mezam-division-north-west-region-of-cameroon/foncham-paul-babila
This document discusses the importance of culture in health and healthcare. It begins with an introduction to anthropology and definitions of culture. It then explores how culture shapes views of health, illness, and healers. Various cultural practices that impact health are described, such as hot-cold beliefs, susto, and female genital mutilation. The PEN-3 model for developing culturally-competent health interventions is introduced. Case studies demonstrate how understanding cultural contexts can improve care. The document recommends training healthcare workers in cultural competence and centering culture in approaches to well-being.
La posesión es una situación jurídica que protege el poder de hecho sobre una cosa. Tiene una doble naturaleza como hecho y como derecho. Como hecho, se refiere al dominio material sobre la cosa; como derecho, otorga facultades legales al poseedor independientemente de si tiene o no derecho sobre la cosa. La posesión cumple funciones como proteger al poseedor, legitimar derechos y facilitar la adquisición de la propiedad u otros derechos reales.
This document provides a summary of MD.TANVIR RAHMAN's qualifications and experience for the position of 4th Engineer. It includes details of his previous employment on three ships as an Engine Cadet and Junior Engineer/4th Engineer. It also lists his academic qualifications including a Bachelor's degree in Maritime Science, certificates and courses completed, identity documents, and personal details. References are provided from his time at Bangladesh Marine Academy.
Este documento presenta diferentes estrategias de marketing para fidelizar clientes, incluyendo el uso de bases de datos de clientes, tarjetas de fidelización, y regalos y obsequios promocionales.
This slide presentation summarizes a research study on how smart tourism technology attributes and the perceived value of a destination impact tourist happiness. The study examines a research model and hypotheses about how informativeness, accessibility, interactivity, and personalization of smart tourism technologies can positively impact travel service satisfaction and travel experience satisfaction. It is also hypothesized that the perceived functional, social, and emotional value of a destination can positively impact satisfaction levels. Higher levels of travel service satisfaction and travel experience satisfaction are then expected to positively impact tourist happiness. The study describes its instrument development and operational definitions, data collection from 191 international tourists in Seoul, data analysis using partial least squares analysis, and results supporting the hypotheses regarding convergent and discriminant validity.
Este documento presenta un resumen de los diferentes tipos de oraciones que existen en español, incluyendo oraciones yuxtapuestas, coordinadas y subordinadas. Explica las diferencias entre cada tipo de oración y provee ejemplos para ilustrar cada categoría.
La empresa es una unidad económica de producción que combina factores de capital y trabajo para obtener un beneficio. Tiene objetivos económicos, técnicos, humanos y sociales. Se compone de recursos como el talento humano, recursos materiales, financieros, técnicos y mercadológicos.
Health seeking behavior among the kalazar affected people of the scavenger (m...Md. Nasir Uddin,PhD
This document summarizes a study on the health seeking behaviors of people from the scavenger community in Bogra, Bangladesh who were affected by kala-azar (visceral leishmaniasis). The qualitative study found that the scavenger community has poor health outcomes due to factors like poverty, lack of health awareness, malnutrition, and discrimination. Most people in the community are illiterate adults and rely on folk remedies rather than modern medicine when sick. The researchers observed the community's demographics, family structures, economic hardships, and experiences of prejudice from the majority Bengali population. The community's worldviews and lack of access to healthcare influences their health seeking behaviors for illnesses like kala-azar.
Indigenous Cultural Beliefs and Health Seeking Behaviours of the Mbororo Comm...ijtsrd
The aim of this study was to investigate the effects of indigenous cultural beliefs on the health seeking behaviours of the Mbororo community in Mezam Division of the Northwest Region of Cameroon. The study employed the survey research design with a mix of both quantitative and qualitative techniques. Quantitative data were collected through a questionnaire while a focus group discussion guide and a semi structured interview guide were used to collect qualitative data from a sample of 539 respondents. A total of 500 questionnaires were administered and 6 focus groups discussions were carried out and as well as interviews granted to 3 healthcare professionals. The simple random sampling technique was used to select the sample of the study. Data were analyzed with the aid of the Statistical Package for Social Sciences SPSS version 23.0 for Windows. Descriptive statistics such as simple percentages, mean scores and standard deviation, and inferential statistics such as the Pearson Correlation test were used to analyze quantitative data while qualitative data were analyzed using content analysis with the support of ATLAS.ti software version 8.0. The findings revealed that indigenous cultural beliefs r=0.621, df=98, p 0.05 have a positive correlation with the health seeking behaviours of the Mbororo community. Based on the findings, recommendations were made on the need for the Mbororo community in Mezam Division and beyond to develop more tolerance for conventional or modern medicine and rush to modern hospitals when ill for appropriate screening, diagnosis and treatment of their diseases even as they continue to patronize traditional medicine based on their indigenous cultural beliefs. This would go a long way to improve the health and wellbeing of the Mbororo community in Mezam and beyond. Suggestions for further studies were also made. Foncham Paul Babila "Indigenous Cultural Beliefs and Health-Seeking Behaviours of the Mbororo Community in Mezam Division of North West Cameroon" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-5 , August 2022, URL: https://www.ijtsrd.com/papers/ijtsrd50613.pdf Paper URL: https://www.ijtsrd.com/humanities-and-the-arts/psychology/50613/indigenous-cultural-beliefs-and-healthseeking-behaviours-of-the-mbororo-community-in-mezam-division-of-north-west-cameroon/foncham-paul-babila
Rev. Latino-Am. Enfermagem
2010 May-Jun; 18(3):459-66
www.eerp.usp.br/rlae
Corresponding Author:
Flavio Braune Wiik
Universidade Estadual de Londrina. Centro de Letras e Ciências Humanas.
Departamento de Ciências Sociais
Campus Universitário. Caixa-Postal 6001
CEP 86051-990 Londrina, PR, Brasil
E-mail: [email protected]
Anthropology, Health and Illness: an Introduction to the Concept of
Culture Applied to the Health Sciences
Esther Jean Langdon1
Flávio Braune Wiik2
This article presents a reflection as to how notions and behavior related to the processes of
health and illness are an integral part of the culture of the social group in which they occur.
It is argued that medical and health care systems are cultural systems consonant with the
groups and social realities that produce them. Such a comprehension is fundamental for the
health care professional training.
Descriptors: Culture; Anthropology; Health Care; Health Sciences.
1 Anthropologist, Ph.D. in Anthropology, Full Professor, Universidade Federal de Santa Catarina, SC, Brazil.
Email: [email protected]
2 Social Scientist, Ph.D. in Anthropology, Adjunct Professor, Universidade Estadual de Londrina, PR, Brazil.
Email: [email protected]
Original Article
460
www.eerp.usp.br/rlae
Antropologia, saúde e doença: uma introdução ao conceito de cultura
aplicado às ciências da saúde
O objetivo deste artigo foi apresentar uma reflexão de como as noções e comportamentos
ligados aos processos de saúde e de doença integram a cultura de grupos sociais onde
os mesmos ocorrem. Argumenta-se que os sistemas médicos de atenção à saúde,
assim como as respostas dadas às doenças, são sistemas culturais, consonantes com os
grupos e realidades sociais que os produzem. A compreensão dessa relação se mostra
fundamental para a formação do profissional da saúde.
Descritores: Cultura; Antropologia; Atenção à Saúde; Ciências da Saúde.
Antropología, salud y enfermedad: una introducción al concepto de
cultura aplicado a las ciencias de la salud
Este artículo presenta una reflexión acerca de como las nociones y comportamientos
asociados a los procesos de salud y enfermedad están integrados a la cultura de los
grupos sociales en los que estos procesos ocurren. Se argumenta que los sistemas
médicos de atención a la salud, así como las respuestas dadas a la enfermedad son
sistemas culturales que están en consonancia con los grupos y las realidades sociales
que los producen. Comprender esta relación es crucial para la formación de profesionales
en el área de la salud.
Descriptores: Cultura; Antropología; Atención a la Salud; Ciencias de la Salud.
Introduction
Perhaps it seems out of place to address the theme
of culture in a journal dedicated to the Health Sciences
or to argue that the concept of culture can be useful
for professionals of this area. Everyone has a common
sense idea of what “culture” means. We say that a person
“has culture” when he or sh ...
Social support among the Caregivers of Persons Living with Cancerinventionjournals
:The social support emphasize as the support given to any person in a troublesome or burdensome situation by family members, relatives as well as resources exerted by social connections, is effective in promoting physical health and feeling oneself good. The present study consisted of 300 caregivers of persons with cancer was selected based on simple random sampling, and with inclusion and exclusion criteria. Those patients satisfying the inclusion and exclusion criteria and attending both outpatient and inpatient services of cancer specialty hospital in KIDWAI Bangalore, Karnataka were selected randomly. The data was collected from the patients & caregivers of persons living with cancer who fulfill the inclusion/exclusion criteria were taken up for the study after their consent. Multidimensional Scale of Perceived Social Support (Zimet et al, 1998) was administered to understand Perceived Social Support. The interviews and the instruments were administered by research experts.The Results suggest that there were poor social support found in caregivers of married, female, belong to rural domicile, illiterate, and,caregivers who were not heard about the treatment of cancer.
The document summarizes a student's final project for an anthropology course. It covers several topics related to cultural anthropology, including cultural diversity, anthropological methods, cultural connections, and predictions. The student conducted ethnographic research in a village studying multidrug-resistant tuberculosis, observing cultural patterns of how the disease spreads and what it means to the community. The summary discusses how anthropologists can help navigate crises by understanding multiple cultural perspectives and acting as cultural brokers. It also addresses predicting how diseases may affect groups based on historical patterns.
1 FINAL PROJECT PART B
Final Project Part B
ATH 101
Student Name
SNHU
2 FINAL PROJECT PART B
I. Cultural Diversity
A.1. Cultural diversity is important to understand at any time, but espe cially in a time of a
crisis. For example, when we speak of gender, meaning the cultural expectations of that gender,
not biological differences, this differs considerably among cultures (Ember, Ember, & Peregrine,
2015). W hen people think of fa rming, the y may think of this as male activity, that it is a male
activity in all cultures, but this is not true. Anthropological research has shown that farming or
tending crops may be a male or a female activity, depending on the location. Among the Igbo of
Nigeria, men plant and harvest yams and cassava, but women plant and harvest maize, melons,
okra, a nd beans. Both men and women plant rice (Bonvillain, 2010). The point is that gender
expectations and roles differ among cultures.
A.2. An example of how human sociocultural identity relates to human behavior would
be how different cultures express emotion. Cultures have display rules, m eaning they have
certain cultural expectations of how one should behave wh en feeling a particular emotion.
Specific examples would include how the Japanese might mask anger with a smile or the Dani of
New Guinea show their anger by wrinkling their noses (Heider, 2007).
A.3. Another example would include human sociocultural identity related to animals.
Primates (including human children) engage in play. While cultures have different ways to play,
the purpose of playing as children offers the same functions, a nd primates share these functions
as well. Play teaches the young how to interact with their peers and also expected social
behaviors.
B.1. Anthropologists can help us navigate crises by acting as cultural brokers or working
between the culture of crisis and the outside world, a s anthropologists understand multiple
perspectives. Amy Porter and Paul Farmer contend that anthropologists are needed “to map out
3 FINAL PROJECT PART B
how complex political, economic, and social inequalities” find their way into populations as
disease (Porter & Farmer, 2013, p. 366). It is important to also have cultural sensitivity to the
beliefs of the people you are working with; if you don’t, you won’t make any difference in their
understandings of the disease or your understanding of how the disease is manifested in that
population.
II. Anthropological Methods
A.1. I chose to do ethnography in a village with known cases of multidrug-resistant
tuberculosis (MDR TB). Ethnography was the best option for me, a s I am a cultural
anthropologist. Ethnography allows you to observe people’s actions and participate in t heir daily
lives to be able to make connections in what we are studying (Ember, Ember, & Peregrine,
2015). I was able to interview ...
Balandin and Hemsley's Conversation in Tribute to Joan Sheppard NY July 2019Bronwyn Hemsley
Teacher's College Columbia University New York, presentation in tribute of the impact of Justine Joan Sheppard's work in dysphagia particularly in Australia, India, and Scandinavia (Dysphagia Disorders Survey, Choking Risk Assessment and Pneumonia Risk Assessment). Presentation at Justine Joan Sheppard Memorial Conference, Teacher's College Columbia University New York 27th July 2019 "Dysphagia in Pediatric Populations and Adults with Intellectual Disabilities".
kinesiophobia is not asscociate disability in elderly womenJUSCELIO SILVA
This study investigated the association between kinesiophobia as measured by the FABQ-Phys subscale and disability in 459 elderly women with acute low back pain. The authors found that kinesiophobia as assessed by the FABQ-Phys did not reliably predict disability as measured by the Roland-Morris Questionnaire or gait speed test, explaining less than 1% of additional variability. Body mass index and pain intensity as measured by the VAS were found to be significant predictors of disability. The authors conclude that kinesiophobia as assessed by the FABQ-Phys cannot be generalized to predict disability in this population of elderly women with acute low back pain.
This document discusses Batten disease, a rare neurodegenerative disease that affects children. It provides background on Batten disease, which results in seizures, vision loss, and premature death. The document outlines a research study involving interviews with three groups: caregivers of Batten disease patients, individuals from a rare disease advocacy organization, and individuals from a Batten disease foundation. The goal is to understand the challenges of living with a rare disease and identify ways to improve care and support for patients and families.
Existing climate change policies in Uganda do not adequately address the physical and mental health impacts on vulnerable mountain communities. Studies show evidence of issues like post-traumatic stress disorder linked to climate events. However, the perspectives of affected populations are not well represented in policies. The proposed study aims to document stories and narratives of climate impacts on health to inform policy review and guide communication, filling gaps in understanding the experiences of at-risk groups.
Health Seeking Behaviors following Diabetes Mellitus of Various Ethnic Groups...ijtsrd
The research on Health Seeking Behaviours following Diabetes Mellitus DM of various ethnic groups was conducted because different patients within a given ethnic group or cultural group have different options regarding actions to seek health care services. The purpose of this study was to determine the Health Seeking Behaviours HSB following DM patients from various ethnic groups and the roles of the Health Psychologists HP on the DM patients in Nkwen Health District of Bamenda III Subdivision within Mezam Division of the North West Region of Cameroon. A descriptive survey research design was conducted among 230 sampled DM patients from various ethnic groups in Nkwen Health District. A non probability purposive sampling technique was used to set the population under study. The data was collected using both Focus Groups Discussions FGDs and questionnaire for a period of two months during the period that the DM patients came to Nkwen Health District either to consult or to refill their drugs. The questionnaire were administered to 230 DM patients from the various ethnic groups which were Bali, Bafut, Banso, Bamendankwe, Babanki, Santa, Nkwen and Ndu during this period as well.. The data collected was analysed using both descriptive and inferential statistics with SPSS software tool version 20.0, following the objectives of the study. For HSB, 38.3 agreed that they sought health care from traditional medicine whereas 26.1 remained neutral on traditional medicine. On the other hand, 37.7 disagreed that they used traditional medicine. Cultural believes and distance deterred HSB which were statistically significant with P = 0.001 and P= 0.001 respectively. The options taken to seek health care from the hospital were influenced by family relatives with P=0.001. Therefore, HSB was found to be statistically significant for the first traditional medicine and second line hospital among the different ethnic groups with P = 0.001 and 0.001 respectively. These results showed that poor HSB following DM among the different ethnic groups was statistically significant in Nkwen Health District. Foncham Paul Babila "Health-Seeking Behaviors following Diabetes Mellitus of Various Ethnic Groups in Nkwen Health District of Bamenda III Subdivision, Mezam Division, North West Region of Cameroon" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-5 , August 2022, URL: https://www.ijtsrd.com/papers/ijtsrd51783.pdf Paper URL: https://www.ijtsrd.com/humanities-and-the-arts/psychology/51783/healthseeking-behaviors-following-diabetes-mellitus-of-various-ethnic-groups-in-nkwen-health-district-of-bamenda-iii-subdivision-mezam-division-north-west-region-of-cameroon/foncham-paul-babila
This document discusses the importance of culture in health and healthcare. It begins with an introduction to anthropology and definitions of culture. It then explores how culture shapes views of health, illness, and healers. Various cultural practices that impact health are described, such as hot-cold beliefs, susto, and female genital mutilation. The PEN-3 model for developing culturally-competent health interventions is introduced. Case studies demonstrate how understanding cultural contexts can improve care. The document recommends training healthcare workers in cultural competence and centering culture in approaches to well-being.
CKD INTERVIEW 2Illness and Disease Management CKD InVinaOconner450
CKD INTERVIEW 2
Illness and Disease Management CKD Interview
Betsy Quinones
February 27, 2021
NSG4055- Illness And Disease Management across a Lifespan
Professor Amber Mccall
Illness and Disease Management CKD Interview
Introduction
Mr. X has a medical diagnosis of stage 3 chronic kidney disease. According to the interview, he has a little bit of an understanding of his condition, though his level of awareness is low. He pointed out that the condition has changed his relationship with family and friends. The quality of life of individuals is closely related to the quality of life of those around them (Golics, 2019). In this journal, Golics further went and published that most chronic illnesses have the same impact on the family. In this case, chronic kidney disease has disrupted the psychological, emotional, and normal functioning of the family and some friends of Mr. X. Even the study advocates for a family-centered approach to care the disruptions brought about by the disease process negatively affect the wellbeing of the patient.
According to the stages of grief, Mr. X is at the level of acceptance same to the family. This stage means the patient has understood and accepted what the condition means to his life. The family members and friends have also reached the acceptance stage and are with him in his hard moments. Acceptance is not necessarily an uplifting stage of grief, it may mean that there may be more good days than bad but there may be still bad – and that is ok (Holland, 2018).
Coping mechanisms
Dealing with chronic illnesses requires coping skills to avoid sinking into depression. As for Mr. X, the main coping skill is lowering expectations of the awaited outcome. For example, if his blood has been taken for waste analysis before dialysis when the results come, he has trained himself not to expect much to avoid disappointments if otherwise. In addition to lower expectations, Mr. X also asks for help if need be, especially financial support. Change of source of stress and distance from the source of help has also been practiced by Mr. X to cope with stress. Finally, maintaining emotional composure has also been deployed by the patient to avoid stress (Coping skills and strategies, 2017).
Treatment of CKD
The treatment for Mr. X is partly symptomatic and largely therapeutic. For example, on occasions where the hemoglobin levels are low, he is given ferrous sulfate tablets or iron injections to control anemia. Diuretics such as furosemide are given to the patient to control edema. He is put on antihypertensive drugs to control his blood pressure which is the suspected root course of his condition. He also attends two sessions of hemodialysis each week to eliminate wastes from the blood (Medication, 2019).
Support aspects
The support aspect of chronic kidney disease is social, emotional, and psychological. The patient requires family and friends to offer social and emotional support to provide the patient with strength ...
This document discusses an ethnographic study examining how health information provided by community cardiac nurses is incorporated into the daily lives of coronary families. It addresses the challenges of health promotion and whether nurses can reasonably expect changes in patient health behaviors. The author conducted an ethnography of five coronary families to explore their health beliefs, behaviors, and lifestyles in their domestic setting. The paper considers the advantages and difficulties of using ethnography in a health care context and emphasizes the need for rigor and addressing issues of reliability, validity, and researcher bias.
1. The document discusses different worldviews on health, illness, healthcare, and wellness from Western, Eastern, African, and South Asian perspectives.
2. In the Western view, health is seen through a biomedical lens focused on the human body. Illness is viewed as the result of natural phenomena. Healthcare involves evidence-based treatment using modern medicine. Wellness encompasses proper physical functioning of the body's systems.
3. The Eastern perspective views health holistically as a balance of body, mind, and spirit. Illness results from imbalances that can be treated by restoring balance. Healthcare considers individual diagnosis and restoring chi (energy) through natural remedies. Wellness requires harmony within oneself and with one
This document is a letter from the Ancestral Health Team thanking attendees of the 2011 Ancestral Health Symposium and providing information about supporting the Ancestry nonprofit organization. It encourages donations to support future symposia and the development of the Ancestral Health Society, including an academic journal. It also provides contact information and websites to stay connected including AncestryFoundation.org, facebook.com/AncestralHealthSymposium, and the email ancestralhealth@gmail.com.
MEDICINE WHEEL 1 Medicine Wheel STUDENT A AbramMartino96
MEDICINE WHEEL 1
Medicine Wheel
STUDENT A
Master of Social Work, Chamberlain University
MSW517-XXXXX: Advanced Social Work Practice
Dr. McDowell-Porter
DATE
MEDICINE WHEEL 2
Medicine Wheel
The purpose of this paper is to discuss the Medicine Wheel as it relates to KC. As we go
through the four quadrants one can see how physically, spiritually, emotionally, and mentally KC
experiences her untreated mental health issues through this particular lens. The Medicine Wheel,
Four Directions and Circles have been used as an effective and appropriate means and tools for
develop healing strategies. They offer a multilevel strategy that is circular in nature which has
been practiced for thousands of years (Absolon, 2010). Using the Medicine Wheel, one can
analyze conditions of oppression and create actions to combat discrimination. Using my client,
KC, I will use the four directions of the Medicine Wheel to provide insight as to why there is
bias towards mental illness in ethnic minorities.
Case Overview
KC is 44-year-old Afro-Latina woman who was born in New Jersey, then moved to
Massachusetts with her family as a child. She has resided in the same city since childhood. KC
lives in her city’s housing authority on a section 8 voucher, living off social security disability.
KC is formally diagnosed with low IQ, depression, PTSD, and anxiety. She has a boyfriend of 16
years, and two children. DCF has been involved since her first child was born, provided the
turbulent abusive relationship with her boyfriend. Throughout the 15 years, the children have
been taken into foster care at various times. Currently, KC lives in her own one-bedroom
apartment. Her boyfriend lives in a separate two-bedroom apartment with their eldest child. The
youngest child is currently in foster care, awaiting placement back into the boyfriend’s
apartment. Through assessment and observation, KC has been found unable to properly care for
her two children with disabilities. Since the traumatic experience of the family break up in 2017,
MEDICINE WHEEL 3
KC has been experiencing delusions and psychosis relating to her downstairs neighbor. In the
past year, with her two children being placed back in foster care, these delusions have worsened.
Quadrant 1 North
The Native American Medicine Wheel views mental health as a concern that is
considered a misalignment with nature. In the situation with KC medicine wheel can bring
alternative healing to her mental health issues. The question to contemplate is, what are the
socio-economic costs of untreated mental illness in ethnic minorities? Looking at KC’s
circumstance, once can see that she suffers from the inability to hold down a stable job, leaving
her to reside on social security. This is financially constricting, as she relies on food stamps for
subsistence. KC is one of thousands who rely on government support to survive. Publ ...
Keynote presentation by Dirk Pfeiffer, Chow Tak Fung Professor of One Health and Director of the Centre for Applied One Health Research and Policy Advice, City University of Hong Kong. Delivered on 7 February 2024 on the first day of the Final Hub Meeting of the GCRF One Health Poultry Hub.
This document contains summaries of several research papers on topics related to chronic pain, suicide risk, and bipolar disorder:
1) One study found that tapering opioid doses for chronic pain patients was associated with increased risks of overdose and mental health crisis compared to patients who did not taper. Higher tapering speeds were linked to even greater risks.
2) Another study observed chronic pain patients undergoing opioid tapering or transition to buprenorphine treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine use predicted dropout. Pain levels varied after treatment.
3) Research on combat veterans found that those exposed to combat had higher rates of PTSD, suicide attempts, strokes and chronic pain
Labeling Woefulness: The Social Construction of FibromyalgiaPaul Coelho, MD
This document discusses the social construction of fibromyalgia and how it has been established as a legitimate disease label despite a lack of clear biological or clinical evidence. It argues that fibromyalgia serves social and economic purposes for various groups, including patients, doctors, pharmaceutical companies, and the media, but poses risks by medicalizing psychosocial problems. The document proposes that widespread pain is a normal human experience for some that is best addressed by exploring psychosocial factors rather than believing the solution lies in neurobiology. Examining fibromyalgia as a social construct may be more helpful for patients than continuing to medicalize their experiences.
Outcomes in Long-term Opioid Tapering and Buprenorphine Transition: A Retrosp...Paul Coelho, MD
This study analyzed outcomes for 240 patients with chronic pain who were prescribed long-term opioid therapy above 90 mg morphine-equivalent daily doses. Patients were offered an outpatient opioid taper or transition to buprenorphine if taper was not tolerated. 44.6% successfully tapered, 18.8% transitioned to buprenorphine, and 36.6% dropped out of treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine/z-drug use predicted greater dropout. Pain intensity changes after treatment were mixed, with over half of tapered patients reporting increased pain and about half of transitioned patients reporting decreased pain.
This document appears to be a questionnaire assessing symptoms of widespread pain and calculating a WPI (Widespread Pain Index) score and SS (Symptom Severity) score. It asks the respondent to indicate areas of pain on a diagram and rate the severity of symptoms like fatigue, thinking difficulties, and unrefreshed sleep. It also inquires about additional symptoms like abdominal pain, depression, and headaches. The final section rates pain-related worry and fear on a scale. Additional questions determine if the respondent has a workers compensation or disability claim related to their pain complaint.
Fibromyalgia is a condition that causes chronic aches and pains all over the body, fatigue, and often a sleep disorder. The doctor diagnosed the patient with fibromyalgia based on a score of 13 or more on the fibromyalgia questionnaire from the American College of Rheumatology, which is consistent with the syndrome. By focusing on and managing the diagnosis of fibromyalgia, the patient's other pain symptoms can decrease.
This document contains two studies related to psychological treatments for chronic conditions:
1) A study of chronic fatigue syndrome patients found that poorer outcomes were predicted by membership in a self-help group, receiving sickness benefits, and symptoms of dysphoria. Severity and duration of symptoms did not predict response.
2) A randomized controlled trial of 125 fibromyalgia patients compared operant behavioral therapy, cognitive behavioral therapy, and attention placebo. Both behavioral therapies significantly reduced pain intensity while cognitive therapy improved cognitive and affective variables and operant therapy improved physical functioning and behaviors. The attention placebo resulted in no improvement or deterioration.
This document summarizes three studies on the risks and efficacy of opioids for chronic non-cancer pain (CNP). The first study finds that while opioids were associated with small improvements in pain and physical functioning compared to placebo, they also increased the risk of vomiting. Comparisons to other medications found similar benefits to pain and functioning. The second study finds no difference in pain-related function between opioid and non-opioid groups over 12 months, and higher rates of adverse effects and pain intensity in the opioid group. The third study finds limited effectiveness of opioids for CNP, as opioid users did not report improvements in outcomes after 2 years. Regarding risks, higher opioid doses are associated with increased overdose risk across several patient groups in
1) This randomized clinical trial compared opioid vs nonopioid medication therapy over 12 months for patients with chronic back, hip, or knee pain.
2) It found no significant difference in pain-related function between the two groups, but pain intensity was significantly better in the nonopioid group. Adverse effects were significantly more common in the opioid group.
3) The study concludes that opioid therapy was not superior to nonopioid medications for improving pain-related function over 12 months, and the results do not support initiating opioids for moderate to severe chronic musculoskeletal pain.
Mortality quadrupled among opioid-driven hospitalizations notably within lowe...Paul Coelho, MD
This study analyzed national hospitalization data from 1993-2014 to examine trends in mortality and characteristics of hospitalizations related to opioids compared to other drug and non-drug hospitalizations. The key findings were:
1) Mortality among opioid-related hospitalizations quadrupled from 0.43% before 2000 to 2.02% in 2014, increasing 0.12 percentage points per year relative to other drug hospitalizations.
2) While total opioid-related hospitalizations remained stable, diagnoses shifted from opioid dependence/abuse to opioid/heroin poisoning, which have higher mortality rates. Hospitalizations for poisoning grew by 0.01 per 1,000 people annually after 2000.
3) Patients hospitalized for opioid/
Prescriptions filled following an opioid-related hospitalization.Paul Coelho, MD
This study analyzed prescription drug fills within 30 days of discharge for 36,719 patients hospitalized for opioid misuse. Only 16.7% received medications approved for opioid dependence, while 40.3% filled antidepressant prescriptions and 22.4% filled opioid pain medication prescriptions. Concurrently, 13.9% filled benzodiazepine prescriptions and 7.4% filled both benzodiazepine and opioid prescriptions, indicating a need for improved education on risks. Overall, more effort is required to ensure patients receive recommended post-hospitalization treatment and support services.
This study examined the risk of psychiatric hospitalization in the offspring (second generation) of Finns who were evacuated to Sweden without parents during World War II (first generation), compared to offspring of Finns who were not evacuated. The study found that daughters of mothers who were evacuated during childhood had an elevated risk of psychiatric hospitalization, especially for mood disorders. However, there was no increased risk found for offspring of evacuated fathers or for male offspring of evacuated mothers. This suggests that early childhood adversity experienced by the first generation, such as war-related trauma, may be associated with mental health problems that persist into the second generation.
Correlation of opioid mortality with prescriptions and social determinants -a...Paul Coelho, MD
This study analyzed Medicare Part D data from 2013-2014 to examine the relationship between opioid prescription rates, socioeconomic factors, and opioid-related mortality rates at the county level in the United States. The results showed that higher county-level opioid prescription rates, especially those from emergency medicine, family medicine, internal medicine, and physician assistants, were associated with higher opioid-related mortality rates. Higher poverty levels and proportions of white populations in counties also correlated with increased mortality. Additionally, prescribers in the highest quartile of opioid prescription rates had a disproportionate impact on mortality compared to the remaining 75% of prescribers.
This report examines CMS's oversight of Medicare Part D beneficiaries who receive opioid prescriptions and providers who prescribe opioids to these beneficiaries. It finds that while CMS provides guidance to Part D plan sponsors on monitoring beneficiaries at high risk of opioid overuse, it lacks complete data on the full population of beneficiaries at risk. It also finds that CMS oversees prescribing through its contractor NBI MEDIC but does not specifically analyze opioid prescription data or require reporting on actions taken regarding inappropriate opioid prescribing. The report concludes that CMS needs more comprehensive oversight to reduce the risks of opioid misuse, overdose, and inappropriate prescribing among Medicare beneficiaries.
This study analyzed opioid prescription trends among medical specialties in the U.S. from 2007-2012 using a national prescription database. The key findings were:
- Primary care specialties (family practice, internal medicine, general practice) accounted for nearly half of all dispensed opioid prescriptions in 2012.
- Specialties treating pain conditions like pain medicine, surgery, and physical medicine had the highest rates of opioid prescribing.
- Overall opioid prescribing rates increased from 2007-2010 but stabilized from 2010-2012 as most specialties reduced rates.
- The greatest increase in opioid prescribing was among physical medicine specialists, while the largest decreases were in emergency medicine and dentistry.
The place-of-antipsychotics-in-the-therapy-of-anxiety-disorders-and-obsessive...Paul Coelho, MD
This document summarizes a research article about the use of antipsychotic drugs in the treatment of anxiety disorders and obsessive-compulsive disorders. The review finds evidence that certain second-generation antipsychotics (SGAPs), like quetiapine, risperidone, and aripiprazole, can be effective for generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD). Quetiapine in particular receives a recommendation as a first-line treatment for GAD. However, the review finds insufficient evidence for SGAPs in the treatment of social anxiety disorder and panic disorder. First-generation antipsychotics are not recommended for any anxiety disorders based on their side effect profiles
Structured opioid refill clinic epic smartphrases Paul Coelho, MD
#*** I explained to the patient the risks of combining opioids and benzodiazepines based on medical literature. We agreed to slowly taper the patient off benzodiazepines and trial safer alternatives for sleep and anxiety issues.
#*** I showed the patient their fibromyalgia screening questionnaire results, which were consistent with a fibromyalgia diagnosis. Fibromyalgia can amplify other painful conditions and is often the primary source of morbidity when present with other chronic pain diagnoses.
#*** We discussed the patient's high risk opioid regimen based on their dose exceeding CDC guidelines. While willing to work on a harm reduction plan, it will require a taper or switching to buprenorphine due to safety concerns.
Opioids for the Treatment of Chronic Pain: Mistakes Made, Lessons Learned, an...Paul Coelho, MD
This document summarizes the key issues regarding the use of opioids for chronic pain treatment:
1) An overreliance on opioids to treat chronic pain has contributed to the prescription opioid abuse epidemic in the US, as outpatient use allows for abuse and diversion of these addictive drugs.
2) While clinical trials show opioids effectively treat acute pain and are initially effective for chronic pain, real-world use reveals increased risks of abuse, addiction, and poor functional outcomes over the long-term.
3) The evidence supporting chronic opioid therapy was limited and observational in nature, yet convinced the medical community until larger population studies showed increased abuse rates contrary to initial assumptions.
The potential adverse influence of physicians’ words.Paul Coelho, MD
The physician's words can inadvertently amplify patients' symptoms and increase somatic distress if not carefully considered. Learning about potential side effects from medications, procedures, or test results can lead patients to experience and report those effects more frequently through psychological mechanisms like misattribution and increased attention to bodily sensations. Discussing concepts like nocebo and viscerosomatic amplification with patients can help provide reassuring explanations for symptoms and make them feel less intrusive. Physicians should thoughtfully consider their word choices and focus on benefits as well as side effects to minimize undue distress.
This document is an evidence report published by the Institute for Clinical and Economic Review (ICER) that evaluates the comparative clinical effectiveness and value of cognitive and mind-body therapies for chronic low back and neck pain. It was authored by Jeffrey Tice and others from ICER. The report assesses the clinical evidence on therapies such as cognitive behavioral therapy and mindfulness-based stress reduction and presents economic analyses of the long-term cost-effectiveness and potential budget impact of these therapies. It also incorporates input from clinical experts and stakeholders.
At Malayali Kerala Spa Ajman, Full Service includes individualized care for every client. We specifically design each massage session for the individual needs of the client. Our therapists are always willing to adjust the treatments based on the client's instruction and feedback. This guarantees that every client receives the treatment they expect.
By offering a variety of massage services, our Ajman Spa Massage Center can tackle physical, mental, and emotional illnesses. In addition, efficient identification of specific health conditions and designing treatment plans accordingly can significantly enhance the quality of massaging.
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The Importance of Black Women Understanding the Chemicals in Their Personal C...bkling
Certain chemicals, such as phthalates and parabens, can disrupt the body's hormones and have significant effects on health. According to data, hormone-related health issues such as uterine fibroids, infertility, early puberty and more aggressive forms of breast and endometrial cancers disproportionately affect Black women. Our guest speaker, Jasmine A. McDonald, PhD, an Assistant Professor in the Department of Epidemiology at Columbia University in New York City, discusses the scientific reasons why Black women should pay attention to specific chemicals in their personal care products, like hair care, and ways to minimize their exposure.
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVedanta A
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
More@: https://tinyurl.com/2shrryhx
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Mental Health and well-being Presentation. Exploring innovative approaches and strategies for enhancing mental well-being. Discover cutting-edge research, effective strategies, and practical methods for fostering mental well-being.
Joker Wigs has been a one-stop-shop for hair products for over 26 years. We provide high-quality hair wigs, hair extensions, hair toppers, hair patch, and more for both men and women.
Get Covid Testing at Fit to Fly PCR TestNX Healthcare
A Fit-to-Fly PCR Test is a crucial service for travelers needing to meet the entry requirements of various countries or airlines. This test involves a polymerase chain reaction (PCR) test for COVID-19, which is considered the gold standard for detecting active infections. At our travel clinic in Leeds, we offer fast and reliable Fit to Fly PCR testing, providing you with an official certificate verifying your negative COVID-19 status. Our process is designed for convenience and accuracy, with quick turnaround times to ensure you receive your results and certificate in time for your departure. Trust our professional and experienced medical team to help you travel safely and compliantly, giving you peace of mind for your journey.www.nxhealthcare.co.uk
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
1. Disabling chronic low back pain
as an iatrogenic disorder: a qualitative
study in Aboriginal Australians
Ivan B Lin,1,2
Peter B O’Sullivan,2
Juli A Coffin,3
Donna B Mak,4
Sandy Toussaint,5
Leon M Straker2
To cite: Lin IB, O’Sullivan PB,
Coffin JA, et al. Disabling
chronic low back pain
as an iatrogenic disorder: a
qualitative study in Aboriginal
Australians. BMJ Open
2013;3:e002654.
doi:10.1136/bmjopen-2013-
002654
▸ Prepublication history for
this paper are available
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Received 30 January 2013
Revised 7 March 2013
Accepted 7 March 2013
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Correspondence to
Ivan B Lin;
ivan.lin@cucrh.uwa.edu.au
ABSTRACT
Objectives: To determine the low back pain beliefs of
Aboriginal Australians; a population previously
identified as protected against the disabling effects of
low back pain due to cultural beliefs.
Design: Qualitative study employing culturally
appropriate methods within a clinical ethnographic
framework.
Setting: One rural and two remote towns in Western
Australia.
Participants: Thirty-two Aboriginal people with
chronic low-back pain (CLBP; 21 men, 11 women).
Participants included those who were highly,
moderately and mildly disabled.
Results: Most participants held biomedical beliefs
about the cause of CLBP, attributing pain to structural/
anatomical vulnerability of their spine. This belief
was attributed to the advice from healthcare
practitioners and the results of spinal radiological
imaging. Negative causal beliefs and a pessimistic
future outlook were more common among those who
were more disabled. Conversely, those who were less
disabled held more positive beliefs that did not
originate from interactions with healthcare
practitioners.
Conclusions: Findings are consistent with research in
other populations and support that disabling CLBP
may be at least partly iatrogenic. This raises concerns
for all populations exposed to Western biomedical
approaches to examination and management of low
back pain. The challenge for healthcare practitioners
dealing with people with low back pain from any
culture is to communicate in a way that builds positive
beliefs about low back pain and its future
consequences, enhancing resilience to disability.
INTRODUCTION
Contemporary evidence for chronic low back
pain (CLBP) recognises the biological, psy-
chological and social influences on the
natural history on the condition; the biopsy-
chosocial model.1 2
Within this framework
the roles of CLBP beliefs and misperceptions
have been gaining prominence as the
economic and social impacts of CLBP on
Westerni
societies have been increasing3 4
and the failure of biomedical approaches to
CLBP care is apparent.5
Negative beliefs
about CLBP have been reported to predict
CLBP disability, such as the perceptions of a
biomedical cause of pain (eg, underlying
structural/anatomical problem), that pain
will be permanent or get worse in the future,
and excessive fear of activity or movement
out of concern of causing damage.2 6–8
Misperceptions about CLBP such as these
ARTICLE SUMMARY
Article focus
▪ The low back pain (LBP) beliefs of Aboriginal
Australians with chronic LBP.
Key messages
▪ Contrary to previous research negative beliefs,
including an anatomical/structural cause of pain
and pessimistic future outlook, were common.
▪ Negative beliefs originated from interactions with
healthcare practitioners suggesting disabling
LBP may be partly iatrogenic.
▪ Biomedical-orientated management approaches
to LBP are far reaching, highlighting the need for
healthcare practitioners to positively influence
beliefs as part of LBP care in all settings.
Strengths and limitations of this study
▪ The use of a qualitative and culturally secure
research approach, and extended engagement
with participants gave a unique insight into LBP
beliefs among Aboriginal Australians and
increased the rigour of the study.
▪ Findings were in line with research in other
countries and cultural groups.
i
The authors recognise that use of the term ‘Western’
assumes one homogenous group regardless of region,
sociality and cultural life. Here the term is used with
caution to draw a distinction between Indigenous
cultures and those arising primarily from
non-Indigenous beliefs and practices, often designated
‘Western’.
Lin IB, O’Sullivan PB, Coffin JA, et al. BMJ Open 2013;3:e002654. doi:10.1136/bmjopen-2013-002654 1
Open Access Research
2. are common in British, Norwegian and Canadian popu-
lations,9–11
as well as among healthcare practitioners
such as medical practitioners, physiotherapists and chiro-
practors.12 13
By influencing or perpetuating negative
beliefs, there is the potential for healthcare practitioners
to have a negative impact on their patients disorder.
Negative perceptions about CLBP reflect widespread
sociocultural attitudes in Western societies and are
hypothesised to underlie the 20th century ‘epidemic’ of
CLBP disability.2
Despite suffering a tremendous burden of disease
Aboriginal Australians have been uniquely identified as
protected from the disabling effects of CLBP because of
cultural beliefs. One study found that, despite a high
prevalence of CLBP in one remote central Australian
Aboriginal community, the impact of CLBP was small as
few pain behaviours were observed and people did not
seek healthcare.14
This reported limited impact of CLBP
has been attributed to cultural beliefs where ‘[Aboriginal]
people do not regard back pain as a health issue’14
; a con-
clusion that has been cited to illustrate the influence of
culture on CLBP.2
It is likely that traditional Aboriginal cul-
tural beliefs posit CLBP as of ‘natural cause’ (as opposed
to environmental or supernatural) and are an accepted
part of everyday life resulting in a temporary state of weak-
ness,15
rather than a chronic illness which is disabling and
unlikely to improve. However, this study was conducted in
the early 1990’s and the findings may not be valid for the
contemporary situation.
If the conclusions of previous research are substantiated,
valuable lessons for Western societies may be learned.
However our recent research in regional and remote areas
of Western Australia found that contrary to earlier find-
ings, CLBP had substantial impacts on the lives of
Aboriginal men and women, affecting emotional well-
being, work, family and cultural participation.16
These
impacts, when understood within the context of
Aboriginal society, were profound for the Aboriginal men
and women who were most disabled.16
Furthermore,
although previous research has made certain claims about
the CLBP beliefs of Aboriginal people,14
these were not
examined in detail. Therefore, the aim of the current
study was to provide an in-depth exploration of back pain
beliefs in Aboriginal people with CLBP and their relation-
ship to disability.
METHODS
Settings
The research was undertaken in three towns in Western
Australia; a regional town assigned the pseudonym of
‘Regiontown’—population35 000, and two remote
towns—‘Goldstone’ and ‘Desertedge’ with populations
under 1000 and 500 people. Goldstone and Desertedge
were classified as ‘very remote’17
with limited accessibil-
ity to material goods and services. Medical emergencies
would necessitate medical evacuation via the Royal
Flying Doctor Service. In Regiontown, Aboriginal people
were approximately 10% of all residents while the major-
ity of residents in Goldstone and Desertedge were
Aboriginal (Aboriginal and Torres Strait Islander people
represent 2.5% of the Australian population and 3.8%
of the Western Australian population18
). Each town
includes culturally distinct Aboriginal language groups;
however, there are extended sociocultural, economic
and family networks across the region.
Study approach, design and rationale
This qualitative study was approached from an interpretive
perspective, developing from the premise that the reality
of CLBP is constructed by Aboriginal men and women
who experience it, and their daily interactions in an imme-
diate and wider social world.19 20
The framework of
clinical ethnography21
was applied to ‘understand the rela-
tionship between the lived experience of an illness (the
bodily experience and know how) and the illness as
domesticated and understood theoretically and ‘scientific-
ally’ by medicine’.22
The position of the researchers was
conceptualised as interpreting Aboriginal people’s experi-
ences within the context of contemporary understandings
of CLBP, and the theoretical framework guiding the
inquiry was a biopsychosocial model of CLBP.1 2
A second substantive methodological consideration
was cultural security, which refers to processes that
ensure that the research was conducted in a manner
respectful of Aboriginal cultural values and beliefs.23 24
This consideration is essential for ethical purposes,25
improves data quality and ensures that the interpretation
incorporates an Aboriginal cultural lens.
Participants
Eligible participants were Aboriginal adults with dominant
pain in the low back region (T12 to gluteal fold) that had
occurred episodically within a 6-month period or lasted
for more than 3 months with or without accompanying
leg pain.26
Purposive sampling27
of eligible clients through
Aboriginal Community Controlled Health Services
(ACCHS) and Aboriginal community organisations was
undertaken. Snowball sampling through ‘word of mouth’
among participants, their families and community net-
works augmented these strategies.27
Utilising community
networks within a sampling strategy has been recom-
mended in Aboriginal health research.28
Eligible participants were contacted either by IBL, an
Aboriginal coinvestigator, or by an existing participant
who explained the project. After the project had been
described and following consent, arrangements were
made for an extended discussion. Participants were
advised they were free to withdraw from the study or
withdraw their data with no consequences. Thirty-two
Aboriginal men (21) and women (11) participated.
Most participants were from Regiontown (16), then
Goldstone (9) and then Desertedge (7). Participants
ranged in age between 26 and 72 years; the majority
were middle aged (see table 1). With the exception of
2 Lin IB, O’Sullivan PB, Coffin JA, et al. BMJ Open 2013;3:e002654. doi:10.1136/bmjopen-2013-002654
Chronic low back pain in Aboriginal Australians
3. one participant, all had sought healthcare at some point
for their CLBP.
Procedures
Consultation with 11 Aboriginal community leaders
and four non-Aboriginal representatives from ACCHSs
was undertaken prior to the study starting with feedback
validating study cause and approach. Data collection was
undertaken between 2007 and 2010. Ethical approval
was granted by the Western Australian Aboriginal Health
Ethics Committee and Curtin University Human
Research Ethics Committee.
The primary data collection method was in-depth semi-
structured interviews using ‘yarning’, an Aboriginal cul-
tural form of conversation involving the sharing and
exchange of information between two or more people and
requiring the researcher to ‘develop and build a relation-
ship that is accountable to Indigenous people participat-
ing in the research’.29
Interviews were conducted by IBL
with a male or female Aboriginal coinvestigator and typic-
ally begun with a ‘social yarn’ in which investigators estab-
lished or reaffirmed an interpersonal connection, before
moving on to a ‘research yarn’.29
Most interviews were
informal; however, an interview schedule was developed to
guide the research yarn. Interviews were conducted in
English or Aboriginal English. The interview schedule
included open-ended questions, (eg, ‘tell us the story of
your pain’) used with prompts to explore underlying
beliefs (eg, ‘what do you feel is causing your pain? How do
you feel your pain will go in the future?’). Interviews lasted
from 30 min to 2.5 h (typically longer than 1 h). With the
exception of three interviews, all were audio-recorded.
Three interviews were not recorded due to recorder mal-
function or because the investigators judged that commen-
cing recording may have disrupted the flow of an
important yarn. Hand-written notes were taken of non-
recorded interviews. Follow-up interviews were undertaken
with 19 participants (described below). Interview data
were augmented by field observations recorded in a
research journal.
Analysis
Transcripts were imported into NVivo qualitative data
analysis software.30
Transcribed interviews and interview
notes were repeatedly read by all members of the
research team so all were familiar with the data. Equal
weight was given to verbatim and interview note tran-
scripts in the analysis. An initial analysis was undertaken
by IBL who had undertaken transcription. Initially, a
process of ‘describe-compare-relate’ was undertaken.31
Related stories, statements, words and phrases related to
participants’ beliefs about CLBP were coded into
common themes in NVivo and a back and forth process
between data undertaken to substantiate or challenge
identified themes. Initial summaries of the data were
reviewed by members of the interprofessional research
team (physiotherapy, Aboriginal health, public health
medicine and anthropology), and Aboriginal coinvesti-
gators to include perspectives, themes and issues that
might not otherwise have been considered. This
informed ongoing writing and reflection, a process inte-
gral to data interpretation and analysis.31 32
A deeper level of analysis was then undertaken by com-
paring data between people who were more and less dis-
abled. Participants were classified as high, moderate or low
levels of disability informed by the multidimensional classi-
fication of Dunn et al33
and our analysis of the impacts of
CLBP including effects on life participation and emotional
well-being.34
Comparisons were also made between cases
by examining participants of different disability levels,
genders, towns, ages and across theme groupings by gener-
ating a series of matrices in NVivo. Patterns, similarities,
contradictions and exceptions were identified and
informed ongoing analysis.35
The synthesis of this analysis
was again discussed among the research team.
Preliminary findings were discussed during follow-up
interviews with 19 participants, including a description
Table 1 Participant characteristics
Location Code Gender Age Disability level
Regiontown R1 M 48 Moderate
R2 M 53 Moderate
R3 F 48 Mild
R4 M 54 High
R5 M 42 High
R6 F 53 Mild
R7 M 49 Moderate
R8 M 68 Mild
R9 M 41 Moderate
R10 F 35 Moderate
R11 F 53 Moderate
R12 F 31 Mild
R13 M 26 Moderate
R14 M 68 Mild
R15 F 52 Mild
R16 M 54 High
Goldstone G1 M 62 Mild
G2 F * Mild
G3 M * Mild
G4 M 48 High
G5 M 30 Moderate
G6 M 73 Moderate
G7 F 44 Moderate
G8 M 58 Mild
G9 M 60’s Mild
Desertedge D1 F * Moderate
D2 M 42 High
D3 F * Moderate
D4 M 44 Mild
D5 F 56 Moderate
D6 M 35 Mild
D7 M * High
*Not discussed during conversations.
B—Mild level CLBP disability.
B—Moderate level CLBP disability.
B—High level CLBP disability.
CLBP, chronic low-back pain.
Lin IB, O’Sullivan PB, Coffin JA, et al. BMJ Open 2013;3:e002654. doi:10.1136/bmjopen-2013-002654 3
Chronic low back pain in Aboriginal Australians
4. of the interpreted level of disability, to verify the accur-
acy of preliminary findings through member checking.35
Priority was given to those who were most disabled by
CLBP. Otherwise there were no particular features of
those who were able to be followed up (eg, location, sex
and age). All participants able to be contacted corrobo-
rated the content of initial interviews and most of them
elaborated upon initial data. Participants were not fol-
lowed up if they moved away, did not attend the
arranged follow-up appointment times or were unable
to be contacted during the study period. Repeating the
above steps by re-examining the findings against raw
data and a second level of writing completed a second
round of formal analysis. Refined written summaries cir-
culated again to members of the research team for dis-
cussion, critique and a ‘reality check’31
from which a
finalised summary was developed.
RESULTS
This paper focuses on two primary beliefs that emerged:
the believed cause of pain including the origins of these
beliefs, and future beliefs (‘looking to the future’). The
relationship between these beliefs and disability was
examined.
Cause of pain
More than half of the participants believed that there
were one or more structural or anatomical problems of
their spine that were responsible for the cause of their
pain (table 2). The majority attributed pain to damage
of the disc or wear and tear of the spine (‘they gave me
an x-ray of the lower back, and um... it’s all worn down’:
G11). Although this belief was expressed by those of
varying level of disability, this was most common to those
who were highly disabled:
Well I got told by [medical specialist] that it might be a
trapped nerve or, that was before I had my first MRI, and
then they said no you’ve got lower lumbar … and as I
said it’s just bone crunchin’ on bone (R5: 42-year-old
man with highly disabling CLBP)
With the exception of one individual the belief of
an underlying structural–anatomical cause of pain
originated following the advice from a healthcare practi-
tioner such as a medical specialist, general practitioner
(GP), physiotherapist or chiropractor:
And the physio and chiro were both saying that it could
be a hint of arthritis so went and got xrays and I think it
was a CAT scan or MRI I had done on my back and then
they found out that it was arthritis in the L4, L5 verte-
brae. And it hasn’t been getting any better since. When I
first found out they put me on prescription medicine.
(R13: 26-year-old man with moderately disabling CLBP)
The results of spinal radiological imaging were central
to what participants believed was the cause of their pain.
For several men who were moderately or highly disabled,
these explanations, based on radiological imaging find-
ings, adversely affected their emotional well-being:
At first I felt a bit weird with them telling me I had arth-
ritis and that. I thought it was a bit of a joke. Then they
showed me the x-rays and that and MRI, cat scan, what-
ever it was, it was a bit depressing and a bit shocking
being young and finding out you’ve got arthritis. It wasn’t
too good. (R13)
R5: on the lower part I’ve got no natural gel so it’s bone
crunchin’ on bone…and I’ve got no coccyx bone too.
Hmm....that was after my last MRI
IBL: okay. How does that make you feel with your back?
R5: depressed. Depressing.
Some participants recounted a diagnosis they had
been given many years previously, highlighting how
some advice from a healthcare practitioner can have a
long lasting influence on beliefs. For example, R6 dis-
cussed her belief of a ‘slipped disc’ after interactions
with a medical specialist 30 years previously:
That doc said I had a slipped disc … it all depends on
how your movements or your lifting (R6: 55-year-old
woman with mildly disabling CLBP)
The belief of an anatomical cause of pain was com-
monly associated with other negative beliefs about pain;
such as the inevitable negative future consequences of
Table 2 Believed causes of pain (several participants expressed multiple causes)
Believed cause High disability (number of participants) Moderate disability Mild disability
Disc 2 4 1
Worn out/arthritis 2 2 2
Bones (eg, ‘shrinkage’, ‘crunching’) 2 1
Crooked/out of shape – 2 –
Muscles – 1 1
Weight – 1 1
Stress – 1 –
Do not know 1 3 3
Did not identify ongoing cause – 1 3
4 Lin IB, O’Sullivan PB, Coffin JA, et al. BMJ Open 2013;3:e002654. doi:10.1136/bmjopen-2013-002654
Chronic low back pain in Aboriginal Australians
5. pain. These beliefs were pronounced, although not a
unique feature, of those with higher levels of disability
(‘I’ve already got them [the damage]. It’s there for the
rest of my life’: R11).
In a number of instances the belief of an anatomical/
structural vulnerability of the spine became ingrained
when reinforced on multiple occasions. G4 recounted
numerous interactions with healthcare practitioners that
influenced his beliefs. In particular, information from a
medical specialist and multiple spinal operations to
address a structural/anatomical pathology powerfully
reinforced a structural-anatomical explanation of his
pain and a catastrophic future outlook:
Well the last, second operation I had, one of the doctors
reckoned, you know that’s it, there were about 3 doctors
or 4 doctors, the bloke who’d done the operation, you
other ones were.. he said ‘listen, you know your back is
just stuffed’ he said. ‘I wouldn’t worry about going in
there and digging around again’. (G4: 48-year-old man
with highly disabling CLBP)
A reliance on radiological imaging for a diagnosis also
had negative consequences for several men for whom
these investigations failed to provide a satisfactory diag-
nosis. One man in a remote town attributed the lack of
imaging findings to what he perceived as the poor
quality of radiological equipment in the remote health
clinic. A lack of imaging findings also resulted in frustra-
tion with the inference that the pain was not legitimate:
He [doctor] said ‘nothin’s here, he might be f*****
going silly, he might have imagined all this pain down
here’, cause no-one’s telling me anythin’. Is it up here
[in the head]? Psychological or whatever you know? Is
something wrong with me? (R7: 49-year-old man with
moderately disabling CLBP)
A smaller number of participants discussed how they
did not know the cause of their CLBP. The reasons
varied and in some instances were dependent on the
past interactions with healthcare practitioners. Several
participants were unsure because of a lack of explan-
ation and speculated as to possible causes (‘Landed on
my tail bone must have jarred it. I’m not sure: R12),
while others disbelieved previous explanations they had
been given by a healthcare practitioner due to the lon-
gevity of their pain:
I don’t know if it’s the muscles or bloody, actually the
spine itself or.. wouldn’t have the faintest idea…. the
doctor has been saying it’s just the tightness of your back.
And I said it’s gotta be something else cause I’ve been
living with this pain since I was twenty five (D6:
35-year-old man with mildly disabling CLBP)
Looking to the future
The majority of people expressed a negative future
outlook, believing that their pain would get worse
(table 3). This belief was almost invariably influenced by
interactions with a healthcare practitioner
Well my doctors tell me that as you get older it will start,
cause I got all, like pins and screws and all that there
now, and a few other things, yeah. And they reckon as
you get older it will start getting worser. As you get older
then you’ll probably be in a wheelchair for life, or some-
thing like that. So the doctors told me (G5: 30-year-old
man with moderately disabling CLBP)
And R5 who was highly disabled
And he (specialist) laid out the cards on the table, and
said like you know, if you overdo it, you just, you know,
you might eventually end up in a wheelchair for the rest
of your life (R5: 42-year-old man)
As noted above, six people explicitly spoke of concern
about ‘ending up in a wheelchair’, a sentiment attribu-
ted in each case to the advice from a doctor
It’s the doc that said that, you know if I don’t slow down
or quit playing sports or whatever I could, you know, do
more damage or end up in a wheelchair or whatever …
if I don’t have sports I don’t really have anything.. I feel
bored, I don’t have life. I’m itching to get back out on
the field now. Yeah, it’s just, what do I do? (R13:
26-year-old man with moderately disabling CLBP)
A common narrative shared by those who were more
highly disabled was the presence of two coexisting beliefs;
the perception of an anatomical/structural spinal
problem, and a negative future outlook. In some cases
this was also associated with a somewhat passive attitude
towards management of pain and an apparent reliance
on the medical system; for example, seeking a medical
cure for the pain
well I’m hoping that they’ll [medical specialists] make a
decision, you know a compromise whether I’m going to
get a fusion or cortisone (R5: 42-year-old man with highly
disabling CLBP)
Four people held negative future beliefs without the
belief there was an underlying structural or anatomical
issue. In most cases, these individuals were unsure of the
cause of their pain, based their opinion on a familial
Table 3 Future beliefs about pain
Future
outlook
Highly
disabled
(number of
participants)
Moderately
disabled
Mildly
disabled
Negative 5 8 3
Positive – 2 5
Unsure 1 1 2
Stay same – – 2
Not discussed – 2 1
Lin IB, O’Sullivan PB, Coffin JA, et al. BMJ Open 2013;3:e002654. doi:10.1136/bmjopen-2013-002654 5
Chronic low back pain in Aboriginal Australians
6. history of back pain, or felt that a worsening of pain was
inevitable with age
R7: well it’ll get worse as you get older. I’m fifty next year.
IBL: yep, why’s that?
R7: well because no-one can do anything about it and I
can’t do anything about it cause I don’t know what’s
wrong with it
Seven people held a positive outlook about their
future, believing that they would improve. In general
these people were less disabled by pain (table 3). With
the exception of one man, participants with a positive
future outlook did not hold these views because of inter-
actions with a healthcare practitioner. Rather, a positive
future outlook was a self-held belief. Participants related
their positive future belief to what they could do to self-
manage their pain, a viewpoint suggestive of higher
self-efficacy:
I’m under the impression that if I lost weight I’ll be right,
you know. To me it’s not major but I know it’s there. I’m
one of the ones that don’t really let it get me down. (R3:
48-year-old woman with mildly disabling CLBP)
For one woman, a positive outlook had been rein-
forced by her previous successful experience of man-
aging her pain
Years ago when I was quite active it was yeah, right (R10:
35-year-old woman with moderately disabling CLBP)
One man was an exception, having received advice
from a healthcare practitioner that had contributed to a
positive future outlook. His words highlight how advice
from his GP, in addition to a positive experience of
recovery, assisted a positive outlook
It’s all right, doc reckons it’s not that serious … the
longer it’s going my back’s getting better and better (D4:
44-year-old man with mildly disabling CLBP)
A small number of people were unsure how their pain
would impact on their later lives. Two of the cause of
their pain and recounted receiving ambiguous, and
sometimes conflicting information, from healthcare
practitioners or from family members. Two older men
who were mildly disabled believed their pain would stay
the same. These men had lived with CLBP in excess of
20 years suggesting the length of time they had lived
with their symptoms influenced this belief.
DISCUSSION
This study found that Aboriginal men and women in a
regional and two remote areas of Australia held predomin-
antly negative beliefs about CLBP arising from healthcare
interactions with medical specialists, general practitioners,
physiotherapists and chiropractors. Negative beliefs were
most common among those who more disabled and
suggest that CLBP disability is partly iatrogenic. Strategies
to improve CLBP beliefs must address the beliefs of those
with CLBP as well as healthcare practitioners. Our findings
demonstrate the far-reaching influences of biomedical
approaches to CLBP including the powerful influence
that healthcare practitioner beliefs and communication
can have on a person with pain. These findings are a
potential lesson for all populations exposed to Western
biomedical approaches to examination and management
of low back pain (LBP).
Our findings differ from previous research undertaken
more than a decade ago that concluded that the cultural
beliefs of Aboriginal people were such that CLBP was not
viewed as a health issue and these protected against disab-
ling CLBP.14
In contrast to the previous research, one of
the explicit aims of our study was to explore CLBP
beliefs. Qualitative research methods and a focus on cul-
tural security may have enabled a more accurate insight.
Alternatively, the findings may represent an erosion of
traditional beliefs due to greater exposure to biomedi-
cally orientated approaches for LBP. These findings high-
light the potential of these approaches to increase
disability via creating or reinforcing negative beliefs. We
have previously reported how the maintenance of
Aboriginal cultural beliefs and practices was integral to
many participants’ lives34
; however, it appeared that
CLBP beliefs were vulnerable to unhelpful Western influ-
ences. This raises concerns about the detrimental effects
of biomedical oriented CLBP healthcare practices that
dominate the management of LBP in Western societies.2 5
This may have important implications for the
Westernisation of health systems around the world. For
example addressing the emerging burden of CLBP
among rural communities in developing countries36
must
be considered carefully when there is the potential for
Western biomedical approaches to increase disability.
Aboriginal participants most commonly expressed the
belief that there was an anatomical/structural dysfunction
causing their CLBP. Anatomical/structural beliefs of spinal
dysfunction were invariably based on the findings of radio-
logical imaging. Routine radiological imaging for LBP is
not recommended by clinical guidelines because of the
potential to cause more harm than good.37 38
However
overall, adherence to spinal imaging guidelines is known
to be poor among healthcare practitioners highlighting
that current practice is still dominated by negative biomed-
ical beliefs,39
as was reported by participants in this study.
A number of participants indicated that beliefs based on
radiological imaging findings were longstanding. The lon-
gevity of these perceptions may be problematic as they
may hold an inherent ‘stickiness’, are long lasting and may
be resistant to change.
The confluence of different negative beliefs; that of an
anatomical/structural vulnerability and the perception of
a negative future outlook, distinguished those who were
highly disabled. The perception of a negative future
6 Lin IB, O’Sullivan PB, Coffin JA, et al. BMJ Open 2013;3:e002654. doi:10.1136/bmjopen-2013-002654
Chronic low back pain in Aboriginal Australians
7. outlook has been reported to independently predict
ongoing disability.6 8
In our study it appeared that the
combination of structural/anatomical beliefs, negative
future perceptions, and the involvement of healthcare
practitioners in the origins and reinforcement of these
beliefs were critical. Conversely, participants who were
less disabled held a more positive future outlook even
when there was the perception of a structural/anatomical
origin of pain. However with the notable exception of
one individual, participants with a more positive future
outlook did not hold this view because of advice they had
received during healthcare; instead these were self-held
beliefs. Our data supports the notion that individuals
who are less disabled possess a ‘resilient self-belief system’
with a positive future outlook and employing more posi-
tive strategies to manage their pain.6
Again, these key
findings reinforce the potential for biomedically based
CLBP care to be highly detrimental.2 5
Concurrent strategies to address the beliefs of
Aboriginal patients with CLBP and healthcare practi-
tioners are needed. The need to address the gap between
healthcare practice and evidence-based CLBP care is con-
sistent with previous research.12 13
For patients, addressing
beliefs about CLBP are at the ‘heart of the consultation’.40
Simple patient information targeting beliefs has been
shown to improve beliefs and reduce disability among
those with the most pronounced negative beliefs41
and
providing tailored and culturally appropriate information
that compliments clinical care is recommended by guide-
lines.42
The evidence from successful Aboriginal health-
care programmes has demonstrated that the process by
which CLBP information is developed is important to the
success of outcomes. The principles of collaboration and
partnership between Aboriginal and non-Aboriginal staff,
community involvement and control, building on identi-
fied community resources and non-Aboriginal staff who
are culturally secure43 44
in part parallel the imperative for
consumer participation in healthcare and for developing
meaningful health information for consumers.45 46
A strength of this study was the extended engagement
with Aboriginal participants resulting in a rigorous
process of ‘member check’.35
Although it was not pos-
sible to follow-up all participants the researchers are
confident that all important issues were raised by those
who did participate. Explicit attention to cultural secur-
ity and engaging with people via their own beliefs and
practices reinforced the cultural and ethical rigour of
findings. Practical steps to ensure cultural security
included consultation with Aboriginal people prior to
starting the research, close collaboration with Aboriginal
people within the research team, during data collection
and analysis, and the use of culturally suitable research
methods such as yarning. Other strengths were the mul-
tiple and contextually different sites in the study
(regional and remote) and a cross discipline research
team of non-Aboriginal and Aboriginal researchers from
physiotherapy, Aboriginal health, public health medicine
and anthropology. Although the sampling strategy was
suitable and recommended in Aboriginal health
research28
a limitation was that fewer women than men
were interviewed meaning the issues for women may not
have been fully represented. The imbalance possibly
arose because Aboriginal women may have preferred a
female researcher.47
IBL is male, although he worked
closely with female coinvestigators. Cultural reasons such
as ‘shame’48
may also have meant that women did not
want to participate. The issue of social desirability is a
potential limitation, with participants responding in a
manner perceived favourable to the researchers. We
believe this is unlikely due to the application of cultur-
ally secure research methods, attendance to language, a
demedicalised approach using yarning and the frank dis-
closure of participants’ during interviews.
CONCLUSION
This study provides evidence that negative beliefs about
CLBP and its future consequences among Aboriginal
people living in rural and remote areas of Western
Australia are influenced by interactions with healthcare
practitioners who communicate negative biomedical
beliefs about LBP to their patients. These findings are con-
sistent with research in other populations and support that
disabling CLBP may be at least partly iatrogenic. The chal-
lenge for healthcare practitioners who work with people
with LBP from any culture is to communicate in a way that
builds positive beliefs about LBP and its future conse-
quences, enhancing resilience to disability.
Author affiliations
1
Combined Universities Centre for Rural Health, University of Western
Australia, Geraldton, Western Australia, Australia
2
School of Physiotherapy, Curtin University, Perth, Australia
3
Combined Universities Centre for Rural Health, University of Western
Australia, Geraldton, Western Australia, Australia and Geraldton Regional
Aboriginal Medical Service, Geraldton, Western Australia, Australia
4
School of Medicine, The University of Notre Dame Australia, Perth, Australia
5
Anthropology and Sociology, The University of Western Australia, Perth,
Australia
Acknowledgements We gratefully acknowledge the participation of Aboriginal
people and communities in one regional and two remote Western Australian
towns. We also acknowledge the considered input and assistance in data
collection of Uncle Des Thompson, Gwen Rakabula, Eric Dalgety, Virginia
Cameron and Patrick Cameron. We thank Fiona Stanley for her comments on
an earlier draft of this paper.
Contributors IBL had the idea for the study and all authors collectively
developed the study concept and design. IBL collected the data with listed
collaborators. All authors contributed to data analysis. IBL drafted the initial
manuscript and all authors contributed to ongoing writing and critical
revision. All authors approved the final manuscript.
Funding This research received no specific grant from any funding agency in
the public, commercial or not-for-profit sectors.
Competing interests None.
Ethics approval Western Australian Aboriginal Health Ethics Committee and
Curtin University Human Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
Lin IB, O’Sullivan PB, Coffin JA, et al. BMJ Open 2013;3:e002654. doi:10.1136/bmjopen-2013-002654 7
Chronic low back pain in Aboriginal Australians
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