Post-cure

The curative imaginary is a powerful driver of hope and investment in medicine, often displacing attention and resources given to other illness-related fields of practice. Whereas cure implies an end to the sick role and the possibility of an absolute state of health, in practice those fields that are touted as having high curative potential grapple with the ongoing nature and incompleteness of post-cure care. By capturing the public imagination and channelling research and funding in particular directions, the motif of cure risks drawing resources away from other, less seductive forms of treatment, and towards the technological at the expense of the social. Drawing on our research into precision medicine and deep brain stimulation, we track how cure operates as a concept in these fields, and compare this to how medical practitioners actually care for patients. We argue that a critical engagement with post-cure possibilities offers an opportunity to challenge and rethink what constitutes good medical care, as well as the social, political, and economic underpinnings of medical innovation

Orchestrating home

The private space of the home is an important site of health care in most industrialised countries, and rehabilitation following intensive in-hospital treatment largely takes place in domestic settings. Home in this context is implicitly understood by individuals affected by illness (people with illness, family members, friends, carers), health care providers, and policy makers as an a priori entity that naturally provides continuity and stability. This takes for granted that family carers will maintain both therapeutic activities and the sense of ‘being at home’ – and all of the accompanying emotional dimensions – within the home environment. Drawing on ethnographic research with relatively young spousal carers in Victoria, Australia, we explore how the reconstruction of home as a site for post-stroke recovery changed the experiences and meanings given to the idea of home. Home as a therapeutic place depended on constant orchestrating work that reconfigured the physical, symbolic, and practical elements of home. This was not a straightforward or singular process, as tensions arose in trying to integrate the new, post-stroke therapeutic landscape and pre-stroke conceptualisations and lived realities of home life

Neurodegeneration and the intersubjectivities of care

Caring for a family member or friend with a serious health condition is a common feature of social life. Often, such care is framed as a burden; an unwelcome rupture in the fabric of everyday life. We draw on research conducted in Australia and the UK to examine care in the everyday lives of people living with and caring for neurodegenerative diseases and to trouble care as a burden. Participants in our studies mobilised practices of care to collaboratively produce a “good life”. We argue that above all, care is a relational, enacted practice requiring examination in its local context

Perceived personal, social and environmental barriers to weight maintenance among young women: A community survey

BACKGROUND: Young women are a group at high risk of weight gain. This study examined a range of perceived personal, social and environmental barriers to physical activity and healthy eating for weight maintenance among young women, and how these varied by socioeconomic status (SES), overweight status and domestic situation. METHODS: In October-December 2001, a total of 445 women aged 18–32 years, selected randomly from the Australian electoral roll, completed a mailed self-report survey that included questions on 11 barriers to physical activity and 11 barriers to healthy eating (relating to personal, social and environmental factors). Height, weight and socio-demographic details were also obtained. Statistical analyses were conducted mid-2003. RESULTS: The most common perceived barriers to physical activity and healthy eating encountered by young women were related to motivation, time and cost. Women with children were particularly likely to report a lack of social support as an important barrier to physical activity, and lack of social support and time as important barriers to healthy eating. Perceived barriers did not differ by SES or overweight status. CONCLUSIONS: Health promotion strategies aimed at preventing weight gain should take into account the specific perceived barriers to physical activity and healthy eating faced by women in this age group, particularly lack of motivation, lack of time, and cost. Strategies targeting perceived lack of time and lack of social support are particularly required for young women with children

How feasible are healthy eating and physical activity for young women?

Objective: This study investigated young women&rsquo;s perceptions of the feasibility of physical activity and healthy eating behaviours, and how these vary by socioeconomic status, domestic characteristics and weight status. Design: This population-based study used a mailed questionnaire to investigate perceptions of the feasibility of commonly recommended healthy eating and physical activity behaviours among a sample of young women. The feasibility of 29 physical activity behaviours (e.g. relating to frequency, intensity, duration, domain/setting) and 15 healthy eating behaviours (e.g. relating to location/setting, fruit and vegetable intake, fat/sugar intake) was assessed. Height, weight and sociodemographic details were also obtained. Setting: Nation-wide community-based survey. Subjects: A total of 445 women aged 18&ndash;32 years selected randomly from the Australian electoral roll. Results: Most women reported that they either were already engaged in many of the healthy eating behaviours or saw these as highly feasible. Many physical activity behaviours, on the other hand, were perceived as less feasible, particularly among women with children and women who were overweight. Conclusions: Health promotion messages and strategies aimed at increasing physical activity and healthy eating are unlikely to succeed unless they take into account perceptions that these behaviours are not feasible. For young women, this may involve promoting more time-effective, flexible ways of achieving recommended physical activity. Messages specifically targeted to women with children, and women who are overweight, are required.<br /

Parental engagement in preventive parenting programs for child mental health: a systematic review of predictors and strategies to increase engagement

Background. Child mental health problems are now recognised as a key public health concern. Parenting programs have been developed as one solution to reduce children's risk of developing mental health problems. However, their potential for widespread dissemination is hindered by low parental engagement, which includes intent to enrol, enrolment, and attendance. To increase parental engagement in preventive parenting programs, we need a better understanding of the predictors of engagement, and the strategies that can be used to enhance engagement. Method. Employing a PRISMA method, we conducted a systematic review of the predictors of parent engagement and engagement enhancement strategies in preventive parenting programs. Key inclusion criteria included: (1) the intervention is directed primarily at the parent, (2) parent age >18 years, the article is (3) written in English and (4) published between 2004-2016, Stouffer's method of combining p-values was used to determine whether associations between variables were reliable. Results. Twenty-three articles reported a variety of predictors of parental engagement and engagement enhancement strategies. Only one of eleven predictors (child mental health symptoms) demonstrated a reliable association with enrolment (Stouffer's p < .01). Discussion. There was a lack of consistent evidence for predictors of parental engagement. Nonetheless, preliminary evidence suggests that engagement enhancement strategies modelled on theories, such as the Health Belief Model and Theory of Planned Behaviour, may increase parents' engagement

Evolve therapeutic services: a 5-year outcome study of children and young people in out-of-home care with complex and extreme behavioural and mental health problems

Background: Little evaluation research has been conducted on the effectiveness of services and intervention provided to children in out-of-home care. This study evaluated an innovative Queensland, Australia program employing a collaborative wrap-round model of care in combination with a flexible intervention approach, individually tailored to children and young people in out-of-home care presenting with complex and extreme behavioural and mental health problems

Examining the role of government inshaping disability inclusiveness around COVID-19: a framework analysis of Australian guidelines

Background:The COVID-19 pandemic has uncovered the ways in which disabled people are made morevulnerable due to structural inequalities. These vulnerabilities are the result of the interaction between individualand structural factors that shape how risk is experienced by disabled people. In Australia, these vulnerabilities areinfluenced by the way disability services and care for disabled people are delivered through a consumer-directedapproach. We analysed the policies and documentation made by the Australian Government and state and territorygovernments during the pandemic to explore whether these were disability-inclusive. We aimed to unpack howthese policies shaped disabled people as vulnerable citizens.Methods:Guided by documentary research, we used framework analysis to examine the policies of the AustralianGovernment and state and territory governments. We analysed legislation that was given royal assent by thefederal, state and territory governments, and documents (reports, fact sheets, guidance documents, etc.) publishedby the federal government and the state of Victoria (given that this state experienced the brunt of the epidemic inAustralia) between February 2020 to August of 2020.Results:We found that most of the resources were not aimed at disabled people, but at carers and workers withindisability services. In addition, most policies formulated by the Australian Government were related to theexpansion of welfare services and the creation of economic stimulus schemes. However, while the stimulusincluded unemployed people, the expansion of benefits explicitly excluded disabled people who were notemployed. Most of the legislation and documents offered accessibility options, though most of these options wereonly available in English. Disability oriented agencies offered more extensive accessibility options

Challenges for Diagnostic Clarity for Post-stroke Cognitive Impairment and Behavioural Issues in Middle-Income Countries: Case Studies From Malaysia

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Following stroke, individuals require ongoing screening, diagnosis and monitoring for cognitive impairment. Services and policies around these vary widely between settings, and reports from many countries highlight persistent under-diagnosis of cognitive impairment in the months and years after stroke. Missed and delayed diagnosis of post-stroke cognitive impairment, including dementia, are important factors in shaping the experiences of people so affected and their family members, especially in low- and middle-income countries. Drawing upon ethnographic research conducted in Malaysia, this article draws upon three case studies to examine the continued health-seeking behaviour after the appearance of salient cognitive and behavioural symptoms that occurred after stroke. Findings highlight the challenges in getting formal diagnostic clarity for cognitive and behavioural symptoms in a rural setting within a middle-income country. No study participants sought help for memory or cognitive problems, partly due to limited lay awareness of cognitive impairment but more significantly due to health service factors. Despite their elevated risk for dementia, participants were not monitored for cognitive impairment during any follow-up care in various health facilities. Furthermore, caregivers' attempts to seek help when behavioural issues became untenable were met with multiple health system barriers. The journey was complicated by the meanings attached to the reactions towards cognitive symptoms at the community level. We suggest that strategies seek to increase the awareness of post-stroke cognitive and behavioural symptoms, and incorporate clear treatment pathways into the long-term care plans of community-dwelling stroke survivors.https://doi.org/10.3389/fneur.2021.62887612pubpu

Interpretations of self-rated health in stroke survivors from a semi-rural community in South East Asia

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Purpose: Stroke survivors report poorer self-rated health (SRH) compared to the general population but there is limited understanding on what contributes to SRH. This ethnographic study examined the individual and contextual factors that shape stroke survivors’ SRH in a rural middle income country situated in South East Asia. Methods: Ethnographic methods which encompasses various data collection methods from different data sources were used in this study to describe the socio-cultural context of 16 stroke survivors living in a rural village. Within this context, the experiences of these participants were then interpreted in terms of what contributed to their perception of health and recovery, juxtaposed with objectively measure physical and cognitive states. Results: SRH reflected the post stroke adjustment of stroke survivors. Better SRH was influenced by good post-stroke adjustment that was achieved by a combination of physical functioning, cognitive functioning, emotional well-being and family support. Poorer SRH appear to reflect poor post-stroke adjustment regardless of the objective physical and cognitive states of the stroke survivors. It was also observed that cognitive deficits, though its presence was acknowledged by participants, were usually not taken into account when rating SRH. However, while physical functioning was perceived by participants to directly impact SRH, the presence of cognitive deficits (often in tandem with depressive symptoms) indirectly complicated the recovery of physical functions treasured by participants. Conclusion: Stroke survivors reporting poorer SRH warrant further attention and intervention from health practitioners supporting the longer-term needs of stroke survivors in similar settings.https://doi.org/10.1080/17482631.2019.161387514pubpub