Biomedical Dimensions Research Articles

Circular Health: exploiting the SDG roadmap to fight AMR.

Circular Health is a novel approach to address complex health issues that is based on the expansion of the One Health Paradigm. Circular health recognizes the need for a multidisciplinary convergence effort to complement the biomedical dimension of health. Antimicrobial resistance (AMR) is one of the greatest global concerns for public health that is likely on the rise, given the extensive use of antibiotics during the early Covid-19 years. Prior to the Covid-19 pandemic, an expert group chaired by Jim O'Neill published "The Review on Antimicrobial Resistance", which contains a final report and recommendations on how to tackle AMR. The report, for the first time, considers AMR from a multi-perspective viewpoint highlighting how it cannot be successfully addressed unless there is a converging approach encompassing many dimensions of the problem. In this perspective, we propose to include the recommendations from that seminal report and other more recent reviews which include the lessons learnt from the Covid-19 pandemic, into the operational framework of the sustainable development goals (SDGs). AMR represents a perfect case study to explore how the SDG roadmap has the potential of becoming the driving force and implementation tool to address complex health issues by pursuing the optimization of resources and actions via a convergent and multi-stakeholder approach. The implementation of health-related policies through the whole spectrum of the SDGs could be both a novel and a well-established framework to inform multi-dimensional policies for more sustainable health in the future.

Exercises in Existential Eccentricity. Conceptualising autoimmunity as a variation of the conditio humana

Barb Macek (PhD candidate and fellow (DOC) of the Austrian Academy of Sciences at the Institute of Fine Arts & Media Arts) takes as her starting point self-reflections and her own experiences with the autoimmune disease SLE. She approaches the phenomenon of autoimmunity in relation to fundamental human ambiguity, following the philosophical anthropology of Helmuth Plessner. Macek’s contribution, "Exercises in Existential Eccentricity", explores the bio-philosophical dimension of the disease rather than its bio-medical dimension, showing how autoimmunity raises existential-phenomenological questions regarding bodily ownership, the self, and the notion of the body as “one’s own”. From an assumed embodied diversity, she designs an artistic technique, EEE - Exercises in Existential Eccentricity, drawing on the technique of auto-interviewing, autoethnography and poetics to facilitate a dialogue between different inner voices.

Social representations of malaria in a southern Malian community: an ethnographic qualitative study

BackgroundMalaria is one of the prime reasons for medical consultation and the major cause of morbidity and mortality in Mali. To assess and understand the dynamics of social representations of malaria, the anthropological research was conducted in the Wayerema II neighbourhood of the health district of Sikasso, southern Mali.MethodsThis was an ethnographic study conducted qualitatively in 2011 and 2016 through informal conversations, 70 semi-structured interviews, and participant observations with key actors. The observations, conversations, and interviews investigated local people’s perceptions and knowledge about malaria, and how and to what extent the cultural and popular representations of the disease can have an impact on therapeutic routes.ResultsMosquitoes are the principal agent of the transmission of malaria. However, the ubiquitous yet casually-claimed aetiological agents, causative, nosographic entities differ from—although sometimes integrated into—the biomedical dimension. For example, some communities perceive Kono, a complicated and pernicious form of malaria that often occurs among children, to originate from a supernatural force. “Bird disease” is another term used for Kono in Mali and other West African countries. Thus, overall, Kono is defined through the entanglements with cultural factors, namely the idiosyncratic habits, customs, and beliefs of the population of Wayerema II neighbourhood in the health district of Sikasso, Southern Mali. Wayerema II residents particularly tend to link therapeutic recourse amongst the afflicted not only to biomedical models but to sociocultural and popular perceptions and representations of malaria.ConclusionIn the findings, self-medication through both traditional and modern medical techniques was the most frequent therapeutic modality. Hence, the integration of local popular knowledge with the biomedical register can contribute to a comprehensive understanding of social representations and perceptions of malaria, and qualitative improvements in the malaria control programme.

Ethical considerations for HIV remission clinical research involving participants diagnosed during acute HIV infection

HIV remission clinical researchers are increasingly seeking study participants who are diagnosed and treated during acute HIV infection—the brief period between infection and the point when the body creates detectable HIV antibodies. This earliest stage of infection is often marked by flu-like illness and may be an especially tumultuous period of confusion, guilt, anger, and uncertainty. Such experiences may present added ethical challenges for HIV research recruitment, participation, and retention. The purpose of this paper is to identify potential ethical challenges associated with involving acutely diagnosed people living with HIV in remission research and considerations for how to mitigate them. We identify three domains of potential ethical concern for clinicians, researchers, and ethics committee members to consider: 1) Recruitment and informed consent; (2) Transmission risks and partner protection; and (3) Ancillary and continuing care. We discuss each of these domains with the aim of inspiring further work to advance the ethical conduct of HIV remission research. For example, experiences of confusion and uncertainty regarding illness and diagnosis during acute HIV infection may complicate informed consent procedures in studies that seek to recruit directly after diagnosis. To address this, it may be appropriate to use staged re-consent procedures or comprehension assessment. Responsible conduct of research requires a broad understanding of acute HIV infection that encompasses its biomedical, psychological, social, and behavioral dimensions. We argue that the lived experience of acute HIV infection may introduce ethical concerns that researchers and reviewers should address during study design and ethical approval.

The limited state of training on the social dimensions of antimicrobial resistance.

BackgroundTraining is needed to increase awareness and understanding of the complex problem of antimicrobial resistance (AMR) among professionals. However, AMR capacity building often does not stretch beyond the biomedical sciences, limiting interdisciplinary collaboration.ObjectivesConsidering the relevance of including the social sciences, this scoping review assesses the state of training on the social dimensions of AMR.MethodsTwenty-eight training courses covering social dimensions of AMR were identified via a survey (n = 133), interviews (n = 6) and an additional internet search. General characteristics, quality and social science relevance indicators were extracted and analysed for each of these training courses.ResultsBecause only 57% of the analysed training courses were fully focused on AMR, AMR was usually superficially covered, focusing on the biomedical basics and just mentioning some social aspects without using social science theories or experts. Only 3 of the 28 training courses covered AMR primarily from a social science perspective, while only 14% of the educators involved had social science expertise. Biomedical dimensions of AMR were covered twice as much as the social science dimensions. In the social science domain, institution and policy elements are most frequently covered, while transformations are the least covered.ConclusionsThere is a clear gap in educational resources on AMR, but moreover for social scientists wanting to engage in AMR, or for non-social scientists wanting to learn about the social dimensions of AMR from an interdisciplinary perspective. This gap needs to be bridged if we want social sciences to become a relevant partner in the struggle against AMR.

"If you're talking about poor communities, forget it!": (lack of) human rights advocacy for adequate food in primary healthcare

This study aimed to understand the forms of professional work and proposed actions to achieve the human right to adequate food (HRAF) in the context of primary healthcare (PHC). Using a qualitative approach, the authors conducted semi-structured interviews (from May 2013 to July 2014) with healthcare workers that conducted educational groups on food and nutrition in PHC in the city of São Paulo, Brazil. Content analysis was performed to identify the proposed actions on food, with HRAF as the theoretical basis. We identified three categories of professional work based on the proposed actions for food and nutrition. The first approaches food as a biomedical dimension. The second focuses on access and availability of foods in the territory. The third approaches users' local food reality, centered on the team's work. The proposed actions feature those conducted by individuals with obligations towards HRAF (healthcare workers in PHC) and those performed by rights-holder (users of PHC in the Brazilian Unified National Health System). Food in contexts of poverty is treated as a problem with no solution. This study allowed approximations between "what to do" and "how to act" based on ways of grasping food through the definitions, professional work, and proposed actions to achieve HRAF in PHC. It also allowed elucidating the need to understand food as a human right and strengthening the responsibility of healthcare workers in PHC as duty-bearers towards HRAF in the context of social policies.

Translation and psychometric evaluation of the Hebrew version of the Health Care Providers' Pain and Impairment Relationship Scale.

Physiotherapists' different attitudes towards low back pain (LBP) are associated with patients' attitudes towards pain and with patients' disability. The Health Care Providers' Pain and Impairment Relationship Scale (HC-Pairs) is a self-administered instrument that assesses the attitudes and beliefs of health care professionals regarding LBP and the patient's daily function. The aims of this study are to translate, culturally adapt, and asses the psychometric properties of the Hebrew version of the HC-Pairs. The English version of the HC-Pairs was forward-backward translated, pretested, and reviewed by a panel of experts. Reliability was determined by computing Cronbach's α, and validity by exploring the correlations between the HC-Pairs' scores and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) scores. Confirmatory factor analysis was performed. A convenience sample of 277 physiotherapists was invited to fill the HC-Pairs and PABS-PT questionnaires and a sociodemographic questionnaire. The forward-backward translation process revealed minor discrepancies between the texts. After the pretest, the expert panel agreed on a final version. A sample of 241 physiotherapists completed the questionnaires (response rate of 87%; 241/277); 213 met the inclusion criteria. Factor analysis suggests that the Hebrew version of the scale fits the one-factor model. Cronbach's α was 0.81 after deletion of two items and indicated good internal consistency. The scores produced by the instrument showed a substantial correlation with those of the biomedical dimension of the PABS-PT, and poor correlation with the behavioural dimension, in the expected directions. The findings of the present study on the psychometric properties of the HC-Pairs are positive. Nevertheless, the Hebrew version of the HC-Pairs is still in a developmental stage. Further psychometric research is needed to assess the attitudes and beliefs of Hebrew-speaking physiotherapists, which have been shown to be associated with treatment orientations and work recommendations.

Successful ageing or resilient ageing: perceptions from elderly Chinese in Hawai’i

ABSTRACTIncreasing studies document the discrepancy between scholarly criteria of successful ageing versus subjective perceptions of successful ageing among older adults. To address this gap, this study aims to examine the lay perceptions of successful ageing among elderly Chinese in Honolulu, Hawai’i. Qualitative data were collected from two focus groups to examine respondents’ perceptions of successful ageing. Many interesting themes relevant to successful ageing emerged from the focus group discussions, including but not limited to: (a) “laughter” and the related concepts of happiness and joy; (b) social engagement; (c) good eating habits; (d) the dependence and independence dilemma; and (e) Hawai’i’s natural environment. Findings suggest that elderly Chinese in Hawai’i have unique perceptions of successful ageing that go beyond the traditional biomedical dimension to include more psychosocial, resilient and environmental components. This indicates a cultural variation of successful ageing.

Unattended explanations on gender gaps in acute myocardial infarction. How can we understand gender gaps in infarction?

Advances in cardiovascular diseases research have shown that there are differences in social groups, which have been solely explained by biomedical dimensions. Although there have been advances in the biological understanding of these diseases, they do not account for the complexity of the phenomenon. To address this, the introduction of psychosocial variables have shown that they may be useful to understand the manifestations and evolution of these conditions. Thus, gender gaps should not be studied exclusively from a biomedical perspective. This article reviews the explanations about the gender gaps in the expression of acute myocardial infarction based on gender stereotypes, as an alternative to the biomedical approach. Stereotypes can predict different consequences when they are used by health professionals or patients. Finally, alternatives are proposed to reduce the negative results of the gender stereotype activation when an acute myocardial infarction is suffered. Also new development lines in theoretical, methodological and interdisciplinary work are proposed.

Prevalence of and factors associated with successful aging in Brazilian older adults: Frailty in Brazilian older people Study (FIBRA RJ).

We aimed to estimate the factors associated with the biomedical dimension of successful aging (SA) and its prevalence in older Brazilian individuals. The conceptual framework for this approach relies on the considerable variation in the biophysiological effects of aging and the need to understand the factors that influence this process. Data from a total of 845 older adults were analyzed. SA operationalization included the following criteria: good physical and cognitive performance, absence of disabilities, and good health conditions. Descriptive analyses were used to estimate the prevalence of SA, and the factors associated with SA were assessed using multivariate logistic regressions. The overall prevalence of SA was 25%, and the associated factors were the absence of (OR 10.5, 95% CI 5.2-21.1) or fewer than two physical morbidities (OR,3.5, 95% CI 2.1-5.9), body mass index in the overweight range (OR 1.8, 95% CI 1.02-3.3), absence of depression (OR ,2.1, 95% CI 1.07 = 4.1), high levels of physical activity (OR 1.88, 95% CI 1.14-3.2), high levels of social participation (OR 2.07, 95% CI 1.16-3.4) and younger age (65-74 years, OR 4.27, 95% CI 1.79-10.1; 75-84 years, OR 2.7, 95% CI 1.18-6.41). A small proportion of older adults met the criteria defining successful aging. Despite the great impact of biological determinants, modifiable social and lifestyle factors predicted successful aging in this population, suggesting that health promotion targeting behavioral changes might lead to tangible benefits for health and well-being in old age. Geriatr Gerontol Int 2018; 18: 1280-1285.

Poverty and health: The GP’s role and opportunities

The health consequences of poverty present significant challenges; GPs have a unique and important role in minimising these issues. GPs manage patients and families throughout the life-course, using a holistic approach that incorporates psychosocial and biomedical dimensions of health and illness. GPs are first contact care providers, work in the heart of the community and are commissioners of health services. GPs serve a crucial role in integrating population health needs with individualised patient-centred care and addressing the wider determinants of health and illness to reduce disparities. Innovative approaches are needed and can be targeted in the individual consultation and at the practice, regional (commissioning) and national levels. Awareness, education, collaboration and resources are needed at multiple levels to minimise the health impacts of poverty. These are explored in this article and illustrated with a case study.

What is preventing dentists from providing person-centred care?

Most healthcare professions have shifted the way they teach clinical approaches from a biomedical to a person-centred perspective. Yet, dentistry remains strongly anchored in a biomedical world.The objective of this project was to understand the barriers practicing dentists face to provide what we consider person-centred care. We conducted a qualitative descriptive study that comprised semi-structured interviews with dentists in private practice in the Greater Montreal area. After the analysis, we identified six barriers:• Fear of interpersonal conflict: participants thought that engaging in genuine conversations with patients would lead to situations of disagreement and even conflicts.• Fear of litigation: dentists considered that the legal and licensing infrastructure would judge the treatment they provide through a strict biomedical framework.• Fear of loss of money: participants thought that providing person-centred care was more time consuming and thus financially penalizing. • Pleasure to excel technically: some dentists did not consider offering interventions that provided less procedural pleasure than technical ones.• Narrow interpretation of health: participants considered the biomedical dimension as the only important dimension.• Lack of information: participants knew nothing or very little about person or patient-centred care. They seemed willing to integrate it into their practice had they had known more about it.These findings should help academic institutions to design their programs on person-centred care and respond to the fears expressed by professionals.Also, legal infrastructures must recognize the paradigm shift from the biomedical to the person-centred.

‘I just don't have the tools’ - Italian osteopaths' attitudes and beliefs about the management of patients with chronic pain: A qualitative study

ObjectivesChronic pain is a complex and challenging problem for manual therapists, such as osteopaths, especially in identifying and managing the multiplicity of psychosocial factors associated with chronic musculoskeletal pain. This study explored Italian osteopaths' attitudes and beliefs towards chronic pain, particularly their understanding of the biomedical and biopsychosocial (BPS) dimensions of chronic pain, and the role they play in their clinical practice. MethodsA qualitative study was conducted using in-depth semi-structured interviews. A purposive sample of 11 osteopaths practising in Italy was recruited from a poster advert sent to 8 Italian osteopathic schools. Interview data were transcribed verbatim and interpreted using a constructivist approach to grounded theory as a framework for data collection, analysis, and conceptualisation. ResultsThree themes were constructed from the data: 1) process of patient evaluation; 2) professional view; 3) developing professional knowledge. ConclusionsOsteopaths displayed a greater orientation towards the biomedical dimensions of chronic pain than dimensions associated with the BPS model. Although the importance of the BPS model has been recognised as part of the osteopathic philosophy of clinical practice and the role of psychosocial factors (PS) are considered important in pain experience, the osteopaths included in this study highlighted a lack of knowledge and skills to assess and address psychosocial risk factors in the management of long term pain sufferers. These findings indicate the need for osteopaths to acquire additional skills and knowledge in professional training programs to develop a more operational holistic view in managing chronic pain sufferers.

Integrative review of the social determinants of health in older adults with multimorbidity.

To examine how the social determinants of health have been considered in conceptualizations of multimorbidity in older adults in the literature and to identify implications for nursing practice, research and healthcare planning and policy. The common conceptualization of multimorbidity is the presence of multiple chronic conditions where one is not more central than others. The integrative review methodology of Whittemore and Knafl was employed. The World Health Organization Social Determinants of Health framework was used to determine how the social determinants of health have been considered in conceptualizations of multimorbidity. A search of electronic databases (2000-2015) generated 22 relevant articles, including quantitative and qualitative studies and grey literature reports. A systematic process was used to appraise the quality of the documents, conduct qualitative data analysis procedures of data extraction, coding and theme development, and synthesize conclusions. Current conceptualizations of multimorbidity provide limited consideration of the complex interplay of multimorbidity with the broader social determinants of health. Gender, education, behaviours and the health system were the most commonly cited determinants. Ethnicity, socioeconomic status/social class and material circumstances received little attention. Most of the dimensions of socioeconomic political context were not discussed. The predominant conceptualization of multimorbidity focuses on the biomedical dimensions of multimorbidity. Consequently, nursing practice, research and policy informed by this literature could inadvertently sustain the mismatch between the needs of older adults with multimorbidity and the services they receive. Future research to inform a new conceptualization is necessary.

Expression of Ciona intestinalis AOX causes male reproductive defects in Drosophila melanogaster

BackgroundMitochondrial alternative respiratory-chain enzymes are phylogenetically widespread, and buffer stresses affecting oxidative phosphorylation in species that possess them. However, they have been lost in the evolutionary lineages leading to vertebrates and arthropods, raising the question as to what survival or reproductive disadvantages they confer. Recent interest in using them in therapy lends a biomedical dimension to this question.MethodsHere, we examined the impact of the expression of Ciona intestinalis alternative oxidase, AOX, on the reproductive success of Drosophila melanogaster males. Sperm-competition assays were performed between flies carrying three copies of a ubiquitously expressed AOX construct, driven by the α-tubulin promoter, and wild-type males of the same genetic background.ResultsIn sperm-competition assays, AOX conferred a substantial disadvantage, associated with decreased production of mature sperm. Sperm differentiation appeared to proceed until the last stages, but was spatially deranged, with spermatozoids retained in the testis instead of being released to the seminal vesicle. High AOX expression was detected in the outermost cell-layer of the testis sheath, which we hypothesize may disrupt a signal required for sperm maturation.ConclusionsAOX expression in Drosophila thus has effects that are deleterious to male reproductive function. Our results imply that AOX therapy must be developed with caution.

Addicted.pregnant.poor

addicted.pregnant.poor is an ethnography addressing the biomedical, social, political, and ethical dimensions of ongoing illicit drug use during pregnancy. A result of four years of fieldwork in daily-rent hotels – privately owned buildings in which the exploitation of women’s sex work and on-going poor health was normative – the book follows nineteen women who had twenty-three pregnancies. To answer the question ‘What forms of life are possible here?’ I engaged with the social actors who are called upon to produce knowledge about addicted pregnancy, including addicted, pregnant women; an anthropologist; public health epidemiologists; advocates; social policymakers; treatment professionals; bureaucrats; and scientists. In this essay, I describe the relationship between the scientific contours of reproductive health and the personal and social consequences of pregnancy in the context of addiction and housing instability. Pregnant women in the daily-rent hotels existed within multiple temporalities. Here I explore what an ethnographic understanding of memorial time and biomedical time can teach us about the vital politics of viability at work in addicted pregnancy.

A Socio-cultural and Religious Underpinnings and Sentiments Around Male Circumcision in the Context of the HIV Epidemic

In the Indian context male circumcision is strongly associated with specific religions and little is known about the socio-cultural and religious dimensions of this practice at the community level, the sensitivities attached to this practice, and its acceptance as a potential method of HIV infection prevention. Although male circumcision is recommended as an HIV prevention option, the religious, cultural and biomedical dimensions of its feasibility, acceptability and practice in India have not been explored till date. This study explores socio-cultural, beliefs, religion, complications and understanding of the community about adult male circumcision as an HIV prevention option in India.

Children’s perceptions of illness and health: An analysis of drawings

Objective: The purpose of this study was to explore possible age differences in children’s perceptions of illness and health and to what extent these differ from adults’ perceptions. Design: Cross-sectional design. Setting: Selected nursery and primary schools in Greece. Method: The sample consisted of 347 children aged 5–11 years and 114 adults – as a comparison group. Each participant was asked to create two drawings, depicting illness and health respectively, and to give an explanatory title for each. Drawings were categorised into three main categories, depending on the aspect of illness or health depicted, namely biomedical, psychosocial and lifestyle. Results: Older children produced more multifaceted depictions of illness and health than their younger counterparts, while the youngest group had difficulty to represent the two concepts clearly. A comparison of children’s perception of illness and health revealed that the first is perceived mainly as a biomedical phenomenon, while the latter as a psychosocial one. Finally, a comparison of adults’ and children’s representations showed that children understand illness mainly through its biomedical dimensions, unlike adults who seem to prefer to stress psychosocial ones. Conclusions: Knowledge of children’s subjective perceptions of illness and health may be useful in designing health prevention programmes and for medical professionals working with children experiencing chronic illness.

Sexual function following menopausal hormone treatment: Benefits of multidisciplinary team counseling

Introduction: Menopause and andropause introduce changes in the body, psyche and social relations that also affect sexuality. The FeM-Poli is an independent treatment center for gynecology and sexology allowing for peer consultation on a daily basis. Case presentation: A 51-year-oldmarriedwomanwas referred for complaints of hot flashes.When asked, she alsomentioned dyspareunia and loss of sexual interest. She had a family history of cardiovascular disease and used Paroxetine 20mg daily. Her 21year-old son from a previous marriage had an addiction problem. Three months after starting oral menopause hormone treatment (MHT) the vasomotor complaints had disappeared, but persisting sexual pain and loss of interest necessitated referral for further counseling. A biopsychosocial approach was proposed as follows: for the biomedical dimension, her medication would be continued and she started exercise to improve sleep. The psychological dimension consisted of parent education to address the problems with their son that affected their relationship and her guilt issues towardsherhusbandandson. Sociocultural aspectsweredealtwith as the relationship became more intimate after sexual counseling, the couplebecamemore receptive to specificmarriage/relationship therapy. Discussion: This case illustrates how a multidisciplinary approach can aid in diagnosis and therapy of menopausal complaints, using biopsychosocial treatment principles resulting in a structured holistic care model. Each separate intervention reinforces the next: better sleep and physical condition facilitated dealing with the challenges encountered in parent education and sexual counseling. In our view consultations combining the knowledge and skills gynecologists, sexologists, psychotherapists and other specialists supported by validated treatment principles are more advantageous for individuals requiring menopause care.

Community and healthcare providers' perspectives on male circumcision: a multi-centric qualitative study in India.

BackgroundAlthough male circumcision (MC) is recommended as an HIV prevention option, the religious, cultural and biomedical dimensions of its feasibility, acceptability and practice in India have not been explored till date. This study explores beliefs, experiences and understanding of the community and healthcare providers (HCPs) about adult MC as an HIV prevention option in India.MethodsThis qualitative study covered 134 in-depth interviews from Belgaum, Kolkata, Meerut and Mumbai cities of India. Of these, 62 respondents were the members of circumcising (CC)/non-circumcising communities (NCC); including medically and traditionally circumcised men, parents of circumcised children, spouses of circumcised men, and religious clerics. Additionally, 58 registered healthcare providers (RHCPs) such as general and pediatric surgeons, pediatricians, skin and venereal disease specialists, general practitioners, and operation theatre nurses were interviewed. Fourteen traditional circumcisers were also interviewed. The data were coded and analyzed in QSR NUD*IST ver. 6.0. The study has not explored the participants' views about neonatal versus adult circumcision.ResultsMembers of CC/NCC, traditional circumcisers and RCHPs expressed sharp religious sensitivities around the issue of MC. Six themes emerged: Male circumcision as the religious rite; Multiple meanings of MC: MC for ‘religious identity/privilege/sacrifice’ or ‘hygiene’; MC inflicts pain and cost; Medical indications outweigh faith; Hesitation exists in accepting ‘foreign’ evidence supporting MC; and communication is the key for acceptance of MCs. Medical indications could make members of NCC accept MC following appropriate counseling. Majority of the RHCPs demanded local in-country evidence.ConclusionHCPs must educate high-risk groups regarding the preventive and therapeutic role of MC. Communities need to discuss and create new social norms about male circumcision for better societal acceptance especially among the NCC. Feasibility studies on MC as an individual specific option for the high risk groups in health care setting needs to be explored.