Constructing osteoarthritis through discourse – a qualitative analysis of six patient information leaflets on osteoarthritis

BACKGROUND: Health service policy in the United Kingdom emphasises the importance of self-care by patients with chronic conditions. Written information for patients about their condition is seen as an important aid to help patients look after themselves. From a discourse analysis perspective written texts such as patient information leaflets do not simply describe the reality of a medical condition and its management but by drawing on some sorts of knowledge and evidence rather than others help construct the reality of that condition. This study explored patient information leaflets on osteoarthritis (OA) to see how OA was constructed and to consider the implications for self-care. METHODS: Systematic and repeated readings of six patient information leaflets on osteoarthritis to look for similarities and differences across leaflets, contradictions within leaflets and the resources called on to make claims about the nature of OA and its management. RESULTS: Biomedical discourse of OA as a joint disease dominated. Only one leaflet included an illness discourse albeit limited, and was also the only one to feature patient experiences of living with OA. The leaflets had different views on the causes of OA including the role of lifestyle and ageing. Most emphasised patient responsibility for preventing the progression of OA. Advice about changing behaviour such as diet and exercise was not grounded in lived experience. There were inconsistent messages about using painkillers, exercise and the need to involve professionals when making changes to lifestyle. CONCLUSION: The nature of the discourse impacted on how OA and the respective roles of patients and professionals were depicted. Limited discourse on illness meant that the complexity of living with OA and its consequences was underestimated. Written information needs to shift from joint biology to helping patients live with osteoarthritis. Written information should incorporate patient experience and value it alongside biomedical knowledge

Rainfall events drive foraging choices by an urban coloniser

Using a seven-year data set of visitation of an inner city park by the Australian white ibis, we investigated whether rain events were correlated with ibis abundance in the park. The park is associated with high levels of anthropogenic food, but relatively low levels of natural food sources. For all magnitudes of rainfall tested, ibis abundance significantly decreased after a rainfall event, although stronger responses were associated with higher rainfall, with a 46% decline in ibis abundance following rainfall events of ¿60 mm. Average ibis abundance was higher during the dry, non-breeding period than during the breeding period, and variation associated with rainfall was particularly pronounced in the non-breeding period. However, the rainfall response was still evident in both periods. Results suggest that rainfall influences the ibis distribution in urban centres either by decreasing anthropogenic food supplied to the birds, forcing the birds to relocate to forage, or increasing the amount of natural food available elsewhere, or a combination of the two. Increased rainfall intensified the response by ibis, and our results demonstrate the importance of climatic processes on the behaviour of urban birds