‘Am I really gonna go sixty years without getting cancer again?’ Uncertainty and liminality in young women’s accounts of living with a history of breast cancer

Although much research has examined the experience of breast cancer, the distinctive perspectives and lives of young women have been relatively neglected. Women diagnosed with breast cancer under the age of 45, and who had completed their initial treatment, were interviewed, and social constructionist grounded theory methods were used to analyse the data. The end of initial treatment was accompanied by a sense of unease and uncertainty in relation to recurrence and survival, and also fertility and menopausal status. The young women’s perceptions about the future were altered, and their fears about recurrence were magnified by the possibility of many decades ahead during which breast cancer could recur. The implications for the young women’s life course, in terms of whether they would be able to have children, would not become clear for several years after initial treatment. This resulted in a liminal state, in which young women found themselves neither cancer-free nor cancer patients, neither pre- nor post-menopausal, neither definitively fertile nor infertile. This liminal state had a profound impact on young women’s identities and sense of agency. This extends previous understanding of life after cancer, exploring the age-related dimensions of liminality

No one scans you and says ‘you’re alright now’ : the experience of embodied risk for young women living with a history of breast cancer

The concept of ‘embodied’ risk has been used to understand the experience of being at risk of cancer, yet there has been less engagement of the concept in relation to those who have been diagnosed and treated for the disease. In this paper, I draw on young women’s accounts of living with breast cancer with the aim of developing analyses of embodied risk and expanding our understanding of the concept. Twenty women diagnosed with breast cancer while they were aged 18–44 took part in semi-structured interviews in the UK, and I analysed these interview data using social constructionist grounded theory. The findings illustrate how a sense of risk from within the body shaped the young women’s experiences and perceptions of their bodies, and how their body as risky was relational, becoming salient in interactions with others. I also explore new dimensions of embodied risk related to the age and social circumstances of the young women. Although the fear of cancer recurrence is well documented, this paper explores it as an embodied experience

“Most of the professors were Men” - a qualitative study of female medical students’ perceptions of careers in academic medicine.

Background: Women remain underrepresented in academic medicine, particularly at higher grades. A gender-based disparity in attitudes towards academic medicine has been described in qualified clinicians but not explored in student populations. To explore the perspectives of female graduate entry medical (GEM) students with regards to future careers in academic medicine. Method: A qualitative study using focus groups, facilitated by two female undergraduate medical students. A semi-structured topic guide was developed with a primary focus was on gender. However, the influence of intersecting characteristics was also explored. Findings: Twenty-seven female students from years 2 to 4 of a single GEM school in the West Midlands participated in five focus groups (mean duration 47.2 mins; range 36-59 mins). Thematic analysis revealed seven themes: work-life balance, impact on clinical career progression, personal preferences, GEM specific concerns, role models, imposter syndrome, culture of academia. GEM-specific concerns of financial issues and the influence of previous experience were highlighted. The presence of imposter syndrome, routed in a lack of knowledge about careers, lack of self-confidence and feelings of not belonging was an important recurrent theme. Conclusions: Access to relevant and timely information, support, opportunities, and concordant mentors are essential requirements from the first year of medical school. Fear of discrimination and bias must be addressed across the academic journey. Future exploration of the impact of ethnicity, LGBTQ+ and disability on academic medicine careers is required

Obstacles to returning to work with chronic pain : in-depth interviews with people who are off work due to chronic pain and employers

Background: The global burden of chronic pain is growing with implications for both an ageing workforce and employers. Many obstacles are faced by people with chronic pain in finding employment and returning to work after a period of absence. Few studies have explored obstacles to return-to-work (RTW) from workers’ and employers’ perspectives. Here we explore views of both people in pain and employers about challenges to returning to work of people who are off work with chronic pain. Methods: We did individual semi-structured interviews with people who were off work (unemployed or off sick) with chronic pain recruited from National Health Service (NHS) pain services and employment services, and employers from small, medium, and large public or private sector organisations. We analysed data using the Framework method. Results: We interviewed 15 people off work with chronic pain and 10 employers. Obstacles to RTW for people with chronic pain spanned psychological, pain related, financial and economic, educational, and work-related domains. Employers were concerned about potential attitudinal obstacles, absence, ability of people with chronic pain to fulfil the job requirements, and the implications for workplace relationships. Views on disclosure of the pain condition were conflicting with more than half employers wanting early full disclosure and two-thirds of people with chronic pain declaring they would not disclose for fear of not getting a job or losing a job. Both employers and people with chronic pain thought that lack of confidence was an important obstacle. Changes to the job or work conditions (e.g. making reasonable adjustments, phased return, working from home or redeployment) were seen by both groups as facilitators. People with chronic pain wanted help in preparing to RTW, education for managers about pain and supportive working relationships. Conclusions: People with chronic pain and employers may think differently in terms of perceptions of obstacles to RTW. Views appeared disparate in relation to disclosure of pain and when this needs to occur. They appeared to have more in common regarding opinions about how to facilitate successful RTW. Increased understanding of both perspectives may be used to inform the development of improved RTW interventions

An exploration of the experiences and perceptions of young women living with a history of breast cancer in the UK

This thesis explores the experiences and perceptions of young women living with a history of breast cancer in the UK, diagnosed under age 45. Although much research has examined the experience of breast cancer, the distinctive perspectives and lives of young women have been neglected. The literature review identified the following dimensions to living with a history of breast cancer as a young woman as key areas for exploration: embodiment, biographical disruption, gender, and intersectionality. By analysing the significance of intersectionality, the study aimed to redress the tendency in existing research to treat women with breast cancer as a homogeneous group. Qualitative, semi-structured interviews were undertaken with twenty women aged 22-43 at diagnosis, and a stakeholder panel was held with three further young women. Three women who identified as minority ethnic, and two who identified as lesbians, were purposively recruited to the sample. The methodology was informed by social constructionist grounded theory, feminist, and intersectionality perspectives, and preliminary analysis was carried out concurrently with data collection. Although similarities with older women’s experiences exist, the findings showed that young women felt profoundly at odds with their bodies in a number of ways. These included: embodied risk, related to uncertain treatment outcome; and a dissonance between young women’ expectations of their bodies, and the reality. The effects of diagnosis and treatment resulted in a liminal, or suspended, state, because of uncertainty regarding fertility, pregnancy, and menopausal status. This, and the constraints of the treatment timescale, resulted in a perceived loss of agency over their future. Gendered ideals about young women’s bodies, the association of fertility with femininity, and the performance of emotion work, had a considerable impact. Reflecting the effects of intersecting social divisions, lesbian and minority ethnic respondents identified a series of disadvantages that they experienced in the course of treatment and care. The study contributes a deeper, and more nuanced, account to the limited literature about young women in the UK living beyond breast cancer, identifying the distinctive experiences and perceptions which arise for young women

Patient experience of long term recovery after open fracture of the lower limb : a qualitative study using interviews in a community setting

Objectives Treatment of open fractures is complex and patients may require muscle and skin grafts. The aim of this study was to gain a greater understanding of patient experience of recovery from open fracture of the lower limb 2–4 years postinjury. Design A phenomenological approach was used to guide the design of the study. Interviews took place between October 2016 and April 2017 in the participants’ own homes or via telephone. Setting England, UK. Participants A purposive sample of 25 patients were interviewed with an age range of 26–80 years (median 51), 19 were male and six female, and time since injury was 24–49 months (median 35 months). Results The findings identified a focus on struggling to recover as participants created a new way of living, balancing moving forward with accepting how they are, while being uncertain of the future and experiencing cycles of progress and setbacks. This was expressed through three themes: (i) ‘being disempowered’ with the emotional impact of dependency and uncertainty, (ii) ‘being changed’ and living with being fragile and being unable to move freely and (iii) ‘being myself’ with a loss of self, feeling and looking different, alongside recreation of self in which they integrated the past, present and future to find meaningful ways of being themselves. Conclusion This study identified the long-term disruption caused by serious injury, the hidden work of integration that is required in order to move forward and maximise potential for recovery. Supportive strategies that help people to self-manage their everyday emotional and physical experience of recovery from injury are required. Research should focus on developing and testing effective interventions that provide support and self-management within a holistic rehabilitation plan

Just the tonic! Legume biorefining for alcohol has the potential to reduce Europe’s protein deficit and mitigate climate change

Industrialised agriculture is heavily reliant upon synthetic nitrogen fertilisers and imported protein feeds, posing environmental and food security challenges. Increasing the cultivation of leguminous crops that biologically fix nitrogen and provide high protein feed and food could help to address these challenges. We report on the innovative use of an important leguminous crop, pea (Pisum sativum L.), as a source of starch for alcohol (gin) production, yielding protein-rich animal feed as a co-product. We undertook life cycle assessment (LCA) to compare the environmental footprint of 1 L of packaged gin produced from either 1.43 kg of wheat grain or 2.42 kg of peas via fermentation and distillation into neutral spirit. Allocated environmental footprints for pea-gin were smaller than for wheat-gin across 12 of 14 environmental impact categories considered. Global warming, resource depletion, human toxicity, acidification and terrestrial eutrophication footprints were, respectively, 12%, 15%, 15%, 48% and 68% smaller, but direct land occupation was 112% greater, for pea-gin versus wheat-gin. Expansion of LCA boundaries indicated that co-products arising from the production of 1 L of wheat- or pea-gin could substitute up to 0.33 or 0.66 kg soybean animal feed, respectively, mitigating considerable greenhouse gas emissions associated with land clearing, cultivation, processing and transport of such feed. For pea-gin, this mitigation effect exceeds emissions from gin production and packaging, so that each L of bottled pea gin avoids 2.2 kg CO2 eq. There is great potential to scale the use of legume starches in production of alcoholic beverages and biofuels, reducing dependence on Latin American soybean associated with deforestation and offering considerable global mitigation potential in terms of climate change and nutrient leakage — estimated at circa 439 Tg CO2 eq. and 8.45 Tg N eq. annually

Data for life cycle assessment of legume biorefining for alcohol

Benchmarking the environmental sustainability of alcohol produced from legume starch against alcohol produced from cereal grains requires considering of crop production, nutrient cycling and use of protein-rich co-products via life cycle assessment. This article describes the mass balance flows behind the life cycle inventories for gin produced from wheat and peas (Pisum sativum L.) in an associated article summarising the environmental footprints of wheat- and pea-gin [1], and also presents detailed supplementary results. Activity data were collected from interviews with actors along the entire gin value chain including a distillery manager and ingredient and packaging suppliers. Important fertiliserand animal-feed substitution effects of co-product use were derived using detailed information and models on nutrient flows and animal feed composition, along with linear optimisation modelling. Secondary data on environmental burdens of specific materials and processes were obtained from the Ecoinvent v3.4 life cycle assessment database. This article provides a basis for further quantitative evaluation of the environmental sustainability of legume-alcohol value chains