Caring Communities

This paper attempts to increase our understanding of communities and how they may foster a healthy and particularly caring environment. In doing so, it will shed light on broader issues in the study of human ageing and cohabitation. Can we learn from cultures that seem to age ‘successfully’? Can we merge their healthy lifestyles with our Western and highly medicalised care systems? Above all, how do successful communities work and how can they last? These questions speak to a set of further considerations that ought to be placed in a much broader context of public health and medical history. The changes in the sociomedical landscapes we are witnessing in today’s modern societies urge us to examine the role of community care in relation to health. This article further aims to explore the relationship between community and care and how these concepts heavily depend on the socio-political and cultural-moral context. I begin with examples of communities in which cohabitation arrangements have an astonishingly positive influence on their members’ health. This is followed by a discussion of the key factors which appear to contribute to a community’s resilience and vitality and I address research which suggests that social support and a caring environment may even decelerate the biological ageing process. In contrast, I will then consider how the shift from institutionalised medicine and care to more community and home-based approaches are in conflict with the social realities of those facing chronic and age-related diseases and how the split between the two seems unbridgeable

Professionalised Intimacy: How Dementia Care Workers Navigate Between Domestic Intimacy and Institutional Detachment

This paper reports an ethnographic study of the handover routines in Germany’s first Dementia Village, with a central focus on how care is balanced between domestic intimacy and institutional detachment. The term ‘professionalised intimacy’ is used for the vivid interplay between comfort and intimacy that renders the interaction between care workers and residents far more complex than previous theories have articulated. Because of the intimacy involved in community building, however, the promise of personalised care must clash with the bureaucratic structures of an official institution, potentially depriving the care workers of their public, respected identity in the process. The study further suggests that most care workers, in fact, support this division between domestic intimacy and institutional detachment. Even if they subscribe to a dementia village’s philosophy of personalised care, their medical training and enculturation has endowed them with a habitus compatible with the modern health profession, with incentives on achieving quantifiable health goals. The dementia village is thus illustrated as a pioneering health care experiment that negotiates rivalling discourses of intimacy, professionalisation, and medicalisation

The Dementia Village – Between Community and Society

Based on ethnographic fieldwork in Germany’s first Dementia Village, this chapter explores the rewards as well as the trials and tribulations of community creation within the confines of the modern welfare state. The paper shows how the creation of a Dementia Village—created as a communal space for its residents that is governed by societal standards of care—ties into long-standing traditions in social thought and speaks to the tension of combining sociality with rationalised bureaucratic efficiency. Through a review of conversations and ethnographic observations, the paper argues that although care in a Dementia Village at first appeared to redraw the map of dementia care, the landscape remained unaltered. Just as in other care environments, both carers and residents lived and worked in an environment that locates intimacy and compassion in one place and the biomedical and bureaucratic exigencies of modern biomedicine and care philosophies in another

Digital health: meeting the ethical and policy challenges

Digital health encompasses a wide range of novel digital technologies related to health and medicine. Such technologies rely on recent advances in the collection and analysis of ever increasing amounts of data from both patients and healthy citizens. Along with new opportunities, however, come new ethical and policy challenges. These range from the need to adapt current evidencebased standards, to issues of privacy, oversight, accountability and public trust as well as national and international data governance and management. This review illustrates key issues and challenges facing the rapidly unfolding digital health paradigm and reflects on the impact of big data in medical research and clinical practice both internationally and in Switzerland. It concludes by emphasising five conditions that will be crucial to fulfil in order to foster innovation and fair benefit sharing in digital health

Towards engineering heart tissues from bioprinted cardiac spheroids.

Currentin vivoandin vitromodels fail to accurately recapitulate the human heart microenvironment for biomedical applications. This study explores the use of cardiac spheroids (CSs) to biofabricate advancedin vitromodels of the human heart. CSs were created from human cardiac myocytes, fibroblasts and endothelial cells (ECs), mixed within optimal alginate/gelatin hydrogels and then bioprinted on a microelectrode plate for drug testing. Bioprinted CSs maintained their structure and viability for at least 30 d after printing. Vascular endothelial growth factor (VEGF) promoted EC branching from CSs within hydrogels. Alginate/gelatin-based hydrogels enabled spheroids fusion, which was further facilitated by addition of VEGF. Bioprinted CSs contracted spontaneously and under stimulation, allowing to record contractile and electrical signals on the microelectrode plates for industrial applications. Taken together, our findings indicate that bioprinted CSs can be used to biofabricate human heart tissues for long termin vitrotesting. This has the potential to be used to study biochemical, physiological and pharmacological features of human heart tissue

Enabling posthumous medical data donation: a plea for the ethical utilisation of personal health data

This article argues that personal medical data should be made available for scientific research, by enabling and encouraging individuals to donate their medical records once deceased, in a way similar to how they can already donate organs or bodies. This research is part of a project on posthumous medical data donation developed by the Digital Ethics Lab at the Oxford Internet Institute. Ten arguments are provided to support the need to foster posthumous medical data donation. Two major risks are also identified—harm to others, and lack of control over the use of data—which could follow from unregulated donation of medical data. The argument that record-based medical research should proceed without the need to ask for informed consent is rejected, and it instead a voluntary and participatory approach to using personal medical data should be followed. The analysis concludes by stressing the need to develop an ethical code for data donation to minimise the risks providing five foundational principles for ethical medical data donation; and suggesting a draft for such a code

Conclusion: Asking the Right Questions

The dyadic relation between a person in need and a person who provides help is one of the core elements of care. Nonetheless, identifying core elements of care alone cannot supply simple solutions to the challenges that are rooted in the ambivalences and tensions of the notion of care in healthcare. Care practices are extensive, situated, and complex. Questions concerning ambivalences and tensions within care include: Can care practices include coercion? Is care compatible with exclusion? Can it be passive or invisible? Can it be incorporated into standardised and regulated routines? Can care and its vocabulary be adjusted to clinical procedures and medical terminology

Evaluation of 24-h urine collection quality in the Swiss Kidney Stone Cohort-NCCR Kidney.CH

Background Kidney stone affect one in ten adults in Switzerland. Diet plays a key role in the development and management of kidney stones. We collected data on the dietary habits of stone formers and controls using two consecutive 24-h dietary recalls and 24-h urine collections as well as blood chemistry. We explored the quality and completeness of 24-hour urine collections of participants prior to using 24-h urinary electrolytes and urea excretions as biomarkers of dietary intakes. Methods The Swiss Kidney Stone Cohort (SKSC) is a multicentric cohort of stone formers. A control group, free of kidney stone on CT-scan, was recruited in the general adult population. The SKSC includes 803 kidney stones formers and 207 controls (table 1). We evaluated the quality of the 24-h urine collection at baseline using urinary creatinine excretion (μmol/kg/24h). We also used a multiple linear regression model, including age, sex, BMI and linguistic region as covariates, to explore whether urinary volume and creatinine excretion differed between cases and controls. Results Of the 1882 urinary collections available, 631(33,5%) were outside the 10th-90th percentiles of the expected urinary creatinine excretion values. Mean 24-h urinary volume (day 1) was 1809±786ml (SKSC) and 2078±827ml (controls). After adjusting for age, sex, BMI and linguistic region, controls have a higher urinary volume than cases (+263±66ml, p <0.001). Swiss Germans have higher urinary volumes (+153±52ml, p <0.01). Adjusted mean 24-h urinary creatinine excretion (day 1) was similar in cases (164±52μmol/kg/24h) and controls (166±43μmol/kg/24h, p = 0.6). Conclusions The percentage of inadequate collections falls within a range previously described in the literature. Patients have lower 24-h urinary volume, but similar creatinine excretion than controls. Swiss Germans have higher urinary volumes. Further analysis will be conducted using 24-h urinary electrolytes (sodium, potassium) and urea excretions to assess the dietary intake of the participants. (Table Presented)