Biomedical Understanding Research Articles

Differential Peripheral Blood Glycoprotein Profiles in Symptomatic and Asymptomatic COVID-19.

Glycosylation is the most common form of post-translational modification of proteins, critically affecting their structure and function. Using liquid chromatography and mass spectrometry for high-resolution site-specific quantification of glycopeptides coupled with high-throughput artificial intelligence-powered data processing, we analyzed differential protein glycoisoform distributions of 597 abundant serum glycopeptides and nonglycosylated peptides in 50 individuals who had been seriously ill with COVID-19 and in 22 individuals who had recovered after an asymptomatic course of COVID-19. As additional comparison reference phenotypes, we included 12 individuals with a history of infection with a common cold coronavirus, 16 patients with bacterial sepsis, and 15 healthy subjects without history of coronavirus exposure. We found statistically significant differences, at FDR < 0.05, for normalized abundances of 374 of the 597 peptides and glycopeptides interrogated between symptomatic and asymptomatic COVID-19 patients. Similar statistically significant differences were seen when comparing symptomatic COVID-19 patients to healthy controls (350 differentially abundant peptides and glycopeptides) and common cold coronavirus seropositive subjects (353 differentially abundant peptides and glycopeptides). Among healthy controls and sepsis patients, 326 peptides and glycopeptides were found to be differentially abundant, of which 277 overlapped with biomarkers that showed differential expression between symptomatic COVID-19 cases and healthy controls. Among symptomatic COVID-19 cases and sepsis patients, 101 glycopeptide and peptide biomarkers were found to be statistically significantly abundant. Using both supervised and unsupervised machine learning techniques, we found specific glycoprotein profiles to be strongly predictive of symptomatic COVID-19 infection. LASSO-regularized multivariable logistic regression and K-means clustering yielded accuracies of 100% in an independent test set and of 96% overall, respectively. Our findings are consistent with the interpretation that a majority of glycoprotein modifications observed which are shared among symptomatic COVID-19 and sepsis patients likely represent a generic consequence of a severe systemic immune and inflammatory state. However, there are glycoisoform changes that are specific and particular to severe COVID-19 infection. These may be representative of either COVID-19-specific consequences or susceptibility to or predisposition for a severe course of the disease. Our findings support the potential value of glycoproteomic biomarkers in the biomedical understanding and, potentially, the clinical management of serious acute infectious conditions.

Health within illness: The negativity of vulnerability revised.

This paper attempts to philosophically articulate empirical evidence on the positive effects of illness within the wider context of a discussion of the positive aspects of vulnerability. The conventional understanding holds that to be vulnerable is to be open to harms and wrongs; it is to be fragile, defenseless, and of compromised autonomy. In this paper, we challenge the assumption that vulnerability consists of nothing but powerlessness and dependence on others. This paper attempts to: (1) outline the theoretical conceptualisation of the positive aspects of coping with illness, while simultaneously showing how these findings provide empirical support for some classical philosophical ideas; (2) influence a change in the manners in which the ill are usually perceived (as weak, dependent, robbed of a good life) and (3) point to the importance of modernising the prevalent biomedical conception of illness with the subjective dimension of health. Biomedical understanding of illness focuses on the vulnerable experience of the sufferer, suggesting the importance of philosophical additions.

Complexities of biomedicine, theology and politics in Islamic bioethical deliberation over female genital procedures: a reply to ‘The prosecution of Dawoodi Bohra women’ by Richard Shweder

Professor Richard Shweder’s target article, ‘The prosecution of Dawoodi Bohra women: some reasonable doubts’, lays bare the ways in which political motivations influence moral, ethical and legal deliberations over female genital cutting/circumcision in society. He argues that activist stakeholders deploy a provocative lexicon and biased clinical data in order to silence dissenting views about, and legally restrict the practice of, female genital cutting/circumcision. He suggests that a more balanced approach to discourse and more nuanced data analysis would open up avenues for tolerating religiously motivated female genital procedures carried out among Dawoodi Bohra communities residing in liberal democracies. Building upon his sociocultural analysis, this reply will explore the confluence of biomedical, theological and political considerations influencing contemporary Islamic bioethical discussion over the practice. I use my participation in the 2017–19 Fiqh Council of North America’s deliberations over female genital cutting to explore how (1) biomedical understandings and health outcomes data, (2) theological concerns over scriptural evidence and juridical best practices, and (3) political and social considerations influenced religious evaluation of the practice. I contend that Islamic juridical academies pursuing bioethical deliberation are not (and should not consider themselves to be) engaging in the routine application of scriptural reasoning in order to furnish guidance to a Muslim polity; rather, bioethics questions are necessarily layered with social and political considerations that require focused examination. This added dimensionality underscores the need for Islamic bioethics deliberation to move beyond the dyad of clinicians and jurists, and to include social scientists, public policy experts and other relevant scholars in order to properly conceive of and address the ethical problem space. Moreover, in the case of female genital cutting/circumcision, the bioethics veers towards biopolitics, making multidisciplinary deliberation all the more important in both religious and secular spaces.

The Interface of Mad Studies and Indigenous Ways of Knowing: Innovation, Co-Creation, and Decolonization

This paper explores the interface between Mad Studies and Indigenous ways of knowing, and argues that the dialogical expanse that exists between these two fields could be a site for innovation, co-creation, and decolonization. Mad Studies is a radical approach to studying the ways we organize and respond to mental health experiences. The field questions and unsettles biomedical understandings of mental illness, and frames psychiatric experiences as diverse forms of human emotional or spiritual expression. Indigenous perspectives on disability describe mental health using a holistic, wellness-based lens, with many scholars highlighting the link to colonial violence and oppression. The interface of Mad Studies and Indigenous ways of knowing could provide a unique platform for gaining a broader understanding of Indigenous mental health while resisting Western, psy explanations of emotional distress. Different interpretations and understandings can be discussed and debated, and through ethical spaces (Ermine, 2007) new understandings or ideas may emerge. These, in turn, may help decolonize some of the dominant biomedical biases that underpin many contemporary psychiatric treatment approaches.Social workers have a particularly important role to play in these conversations. Our professional commitment to anti-oppression and social justice implores us to take an active role in these debates. Through our workplaces we can problematize dominant discourses from within dominant systems, and make our contribution to decolonization.

Dementia and the Boundaries of Secular Personhood

&#x0D; For many, dementia disrupts basic ideas about what it means to be human, raising profound philosophical and theological questions on the nature of personhood. In this article I ask what dementia might reveal about personhood in a “secular age.” I suggest that the ill-fitting relationship between Western bioethics, with its emphasis on autonomy, and dementia throws into relief the boundaries of a secular self, and I tease out the ethical implications of the limits of those boundaries by highlighting a biopolitics of secularism. Lastly, I offer a theological account of dementia that situates dependence as a central feature of the human condition, and enriches a secular biomedical understanding of this neurocognitive disorder.&#x0D;

Dementia and the Boundaries of Secular Personhood

&#x0D; For many, dementia disrupts basic ideas about what it means to be human, raising profound philosophical and theological questions on the nature of personhood. In this article I ask what dementia might reveal about personhood in a “secular age.” I suggest that the ill-fitting relationship between Western bioethics, with its emphasis on autonomy, and dementia throws into relief the boundaries of a secular self, and I tease out the ethical implications of the limits of those boundaries by highlighting a biopolitics of secularism. Lastly, I offer a theological account of dementia that situates dependence as a central feature of the human condition, and enriches a secular biomedical understanding of this neurocognitive disorder.&#x0D;

Identifying barriers to care to inform Lassa Fever health policies in rural Nigeria

Abstract Lassa fever (LF) is an emerging viral haemorrhagic disease endemic to West Africa that can potentially cause a global pandemic. Nigeria has experienced yearly LF outbreaks since 2012 and the 2018 outbreak recorded an unprecedented number of cases and deaths. A critical gap in controlling neglected tropical diseases such as LF is our limited understanding of how people access care and how structural and cultural factors constitute barriers to care. This study examines concepts of illness and healthcare-seeking behaviours to investigate these barriers. From October to December 2019, we conducted a mixed-methods community-based study consisting of 51 interviews, 21 focus groups, and direct observations, in 5 villages of a 2018 LF hotspot in Ebonyi state, Nigeria. Participants' perceived severity and frequency of diseases aligned with the current biomedical understanding. In contrast, some diseases were associated with witchcraft or bad behaviours. Most participants knew LF disease but denied its yearly recurrence. In addition, LF victims and caregivers suffered from a strong stigmatisation. We identified a mismatch between preferred and actual healthcare-seeking behaviours. Most participants preferred hospital care but defaulted to traditional healers and patent medicine vendors (chemists). Reasons reported were high care fees, life-sustaining jobs conflicting with commuting time to hospitals, and a low English literacy. Age and education correlated with healthcare-seeking behaviours: elder and less formally educated people preferred traditional healers. LF-related stigma reportedly impacted timeliness and adequacy of care during the 2018 outbreak. Participants had a good knowledge of the diseases and true barriers to care came from structural factors and LF-related stigma. This led to mismatches between disease knowledge and healthcare-seeking behaviours. Awareness campaigns may have a limited impact if they focus on disease knowledge without addressing barriers to care. Key messages To enhance LF detection and control, LF policies in rural Nigeria should focus on barriers to care through public health messaging addressing stigma and through bringing care closer to remote areas. This community-based study illustrates the importance of understanding the socio-cultural ecology of the diseases to inform evidence-based and locally adapted strategies for disease control.

PET/CT Technology in Adult Zebrafish: A Pilot Study Toward Live Longitudinal Imaging.

Decades of research have confirmed the beneficial and advantageous use of zebrafish (Danio rerio) as a model of human disease in biomedical studies. Not only are 71% of human genes shared with the zebrafish many of these genes are linked to human diseases. Currently, numerous transgenic and mutant genetic zebrafish lines are now widely available for use in research. Furthermore, zebrafish are relatively inexpensive to maintain compared to rodents. However, a limiting factor to fully utilising adult zebrafish in research is not the fish but the technological imaging tools available. In order to increase the utilisation of adult zebrafish, which are not naturally transparent, requires new imaging approaches. Therefore, this feasibility study: (1) presents an innovative designed PET/CT adult zebrafish imaging platform, capable of maintaining normal aquatic physiology during scanning; (2) assesses the practical aspects of adult zebrafish imaging; and (3) set basic procedural guidelines for zebrafish imaging during a PET/CT acquisition.Methods: With computer aided design (CAD) software an imaging platform was developed for 3D printing. A 3D printed zebrafish model was created from a CT acquisition of a zebrafish using the CAD software. This model and subsequently euthanised zebrafish were imaged post-injection using different concentrations of the radiotracer [18F]FDG with CT contrast.Results: PET/CT imaging was successful, revealing levels as low as 0.01 MBq could be detected in the fish. In the zebrafish imaging post-injection distribution of the radiotracer was observed away from the injection site as well as tissue uptake. Potential preliminary husbandry and welfare guidelines for the fish during and after PET/CT imaging were determined.Conclusion: Using PET/CT for adult zebrafish imaging as a viable non-invasive technological tool is feasible. Adult zebrafish PET/CT imaging has the potential to be a key imaging technique offering the possibilities of enhanced biomedical understanding and new translational data sets.

Arts-based interventions for people living with dementia: Measuring 'in the moment' wellbeing with the Canterbury Wellbeing Scales.

Background: There is growing acknowledgement for the need to move beyond exclusive biomedical understandings of dementia and also focus on how to improve the lives and wellbeing of people living with dementia. A mounting body of research advocates for the benefits of arts-based interventions for this population. The purpose of this study was to explore the links between multiple components of arts-based interventions and subjective wellbeing in order to help assess if these activities might contribute to meaningful community-based dementia care initiatives. Methods: Using previously collected data across different intervention sites, a within- and between- participants design was used that assessed wellbeing through the Canterbury Wellbeing Scales (CWS) in people with mild-to-moderate dementias (N = 201) who participated in various community arts-based interventions (ABI). Data were analysed using non-parametric statistical analyses and bootstrapped moderation models. Results: Increases in subjective wellbeing were associated with all forms of ABI. Co-creative sessions significantly strengthened the relationship between number of sessions attended and overall wellbeing as well as optimism. No significant moderating effect was observed between number of sessions attended and carer presence. Conclusions: In the largest study of its kind to date to assess wellbeing using arts activities in a community-based dementia sample, findings support the use and acceptability of the CWS as a measurement tool for people with early-to-middle stages of dementia and suggest that the CWS can reliably measure wellbeing in this population. In addition, the positive effect of arts-based interactions on specific aspects of wellbeing were found, which provide a better understanding of the conditions under which these effects can be prolonged and sustained. Further research is needed to better understand the environmental, social, and psychological mechanisms through which these improvements operate.

Phenomenology of Illness and the Need for a More Comprehensive Approach: Lessons from a Discussion of Plato's Charmides.

Phenomenology informs a number of contemporary attempts to give more weight to the lived experience of patients and overcome the limitations of a one-sidedly biomedical understanding of illness. Susan Bredlau has recently presented a reading of Plato's dialogue Charmides, which portrays Socrates as a pioneer of the phenomenological approach to illness. I use a critical discussion of Bredlau's interpretation of the Charmides to show that the phenomenology of illness also has its shortcomings and needs to be complemented by still other approaches. While Bredlau does make a number of highly apt and relevant suggestions as to how a narrow biomedical approach to illness may be corrected, some (but not all) of which are related to phenomenology, the attribution to Plato's Socrates of a phenomenological approach is mistaken. Characteristically, Socrates shows little interest in the personal experience of a patient. He is more concerned with the patient's lifestyle and conduct and so suggests an alternative or complementary perspective, stressing the importance of education and prevention to health care.

Genomics pipelines to investigate susceptibility in whole genome and exome sequenced data for variant discovery, annotation, prediction and genotyping.

Over the last few decades, genomics is leading toward audacious future, and has been changing our views about conducting biomedical research, studying diseases, and understanding diversity in our society across the human species. The whole genome and exome sequencing (WGS/WES) are two of the most popular next-generation sequencing (NGS) methodologies that are currently being used to detect genetic variations of clinical significance. Investigating WGS/WES data for the variant discovery and genotyping is based on the nexus of different data analytic applications. Although several bioinformatics applications have been developed, and many of those are freely available and published. Timely finding and interpreting genetic variants are still challenging tasks among diagnostic laboratories and clinicians. In this study, we are interested in understanding, evaluating, and reporting the current state of solutions available to process the NGS data of variable lengths and types for the identification of variants, alleles, and haplotypes. Residing within the scope, we consulted high quality peer reviewed literature published in last 10 years. We were focused on the standalone and networked bioinformatics applications proposed to efficiently process WGS and WES data, and support downstream analysis for gene-variant discovery, annotation, prediction, and interpretation. We have discussed our findings in this manuscript, which include but not are limited to the set of operations, workflow, data handling, involved tools, technologies and algorithms and limitations of the assessed applications.

Patients’ understanding, management practices, and challenges regarding hypertension: A qualitative study among hypertensive women in a rural Bangladesh

BackgroundHypertension, as one of the main predisposing factors of many non-communicable diseases, is generally underdiagnosed among women with a significant uncontrolled rate. This study explores the understanding, management practice and challenges related to hypertension among hypertensive women in rural Bangladesh. MethodsA qualitative study was conducted among hypertensive rural women at Kumarkhali Upazilla, Kushtia, Bangladesh, using purposive and snowball sampling technique. Data was collected through in-depth interviews among twenty-three hypertensive women until they reached saturation. Data were analyzed thematically. ResultsFindings of the study found that a small number of participants perceived the symptoms, risk factors, management and treatment of hypertension based on biomedical understanding. Also, their awareness level and adherence to preventive practices reflected a significant gap between biomedical preventive practices and local practices. A substantial number of participants preferred home management and alternative treatment for hypertension over the medication adherence and hospital treatment. This investigation revealed that poor socio-economic conditions, such as financial insufficiency, and, gender-based negligence impacted women's perception of and practice for hypertension and resulted in risky hypertension management behaviors. ConclusionBased on the study, formulation of a comprehensive health education program for creating awareness, provisioning of significant interventions services related to hypertensive care are needed. Further intensive research is needed at the community-level to manage this chronic disease.

‘TB is a disease which hides in the body’: Qualitative data on conceptualisations of tuberculosis recurrence among patients in Zambia and South Africa

ABSTRACT The WHO estimates 58 million people experienced one or more TB disease episodes between 2000 and 2018. These ‘former TB patients’ are at greater risk of future TB infection and death than TB naïve people. Additionally, former TB patients experience social, psychological, and physiological difficulties after microbiological cure. Drawing on semi-structured interviews collected with 28 people from communities in Zambia (n = 8) and South Africa (n = 2) between October 2018 and March 2019, we describe their perceptions of having two or more TB episodes. Utilising a discursive analytic approach, we interrogated how participants conceptualise their risk of disease recurrence. Despite being surprised by subsequent TB episodes, participants utilised their bodily experiences of TB signs and symptoms alongside their experiential knowledge of health systems processes to procure timely diagnosis and care. Yet, many participants were unable to resume social and economic participation. Experiences of multiple TB episodes and correlating social, economic, and physiological vulnerabilities, challenged participants biomedical understanding of TBs curability. Through notions of dirt and ‘staining’, participants conceptualise TB as a sinister, malicious presence they are bound to encounter time and again. Health providers should discuss the risk of TB recurrence with patients and promote prevention, early detection, and diagnosis of TB disease.

Nuya kankantawa (we are feeling healthy): Understandings of health and wellbeing among Shawi of the Peruvian Amazon

Promoting and supporting Indigenous health includes ensuring health services reflect local concepts of health. There is, therefore, a need to better understand context-specific Indigenous understandings of health in order to design culturally appropriate health services. To this end, this study characterized two Shawi communities' understandings of what it means to be healthy. Using a community-based participatory research approach, 40 semi-structured interviews and a series of informal interviews were conducted and analysed thematically, using a constant comparative method. The Shawi definition of health extended beyond individual physical welfare and focused on emotional, collective, and environmental wellbeing. The primary factors underlying Shawi perceptions of health and wellbeing included providing for the family, ensuring the welfare of others, maintaining positive social relationships, preserving traditional values and practices, and living harmoniously with the natural environment. Conversely, Shawi classified illnesses according to their cause or treatment. These included illnesses caused by sorcery, those caused by spirits of the forest, and ‘new diseases,’ that first appeared in the communities when they were contacted by the Western civilization, for which no traditional remedies existed. Consequently, according to Shawi, sociocultural, environmental, and climatic changes are posing imminent health threats. This study highlights the differences between biomedical and Indigenous Shawi health understandings, and therefore emphasizes the importance of acknowledging and embracing Shawi culture and beliefs within the formal healthcare system.

A multicentric study on stigma towards people with mental illness in health sciences students

BackgroundThere is evidence of negative attitudes among health professionals towards people with mental illness but there is also a knowledge gap on what training must be given to these health professionals during their education. The purpose of this study is to compare the attitudes of students of health sciences: nursing, medical, occupational therapy, and psychology.MethodsA comparative and cross-sectional study in which 927 final-year students from health sciences university programmes were evaluated using the Mental Illness: Clinicians’ Attitudes (both MICA-2 and MICA-4) scale. The sample was taken in six universities from Chile and Spain.ResultsWe found consistent results indicating that stigma varies across university programmes. Medical and nursing students showed more negative attitudes than psychology and occupational therapy students in several stigma-related themes: recovery, dangerousness, uncomfortability, disclosure, and discriminatory behaviour.ConclusionsOur study presents a relevant description of the attitudes of each university programme for education against stigma in the formative years. Results show that the biomedical understanding of mental disorders can have negative effects on attitudes, and that education based on the psychosocial model allows a more holistic view of the person over the diagnosis.

Multi-Omics Model Applied to Cancer Genetics.

In this review, we focus on bioinformatic oncology as an integrative discipline that incorporates knowledge from the mathematical, physical, and computational fields to further the biomedical understanding of cancer. Before providing a deeper insight into the bioinformatics approach and utilities involved in oncology, we must understand what is a system biology framework and the genetic connection, because of the high heterogenicity of the backgrounds of people approaching precision medicine. In fact, it is essential to providing general theoretical information on genomics, epigenomics, and transcriptomics to understand the phases of multi-omics approach. We consider how to create a multi-omics model. In the last section, we describe the new frontiers and future perspectives of this field.

From Producing to Reducing Trauma: A Call for “Trauma-Informed” Research(ers) to Interrogate How Schools Harm Students

Although “trauma-informed education” has gained momentum across the United States in recent years, a question remains neglected by the research community: How can education research inform understandings of “trauma-informed” approaches when education itself is trauma-producing for many students? This article (1) explores limitations of traumainformed educational scholarship, particularly its reliance on individualized, biomedical understandings of trauma; (2) articulates theoretical reconceptualizations for subsequent research to account for historical trauma and ways schools and research inflict harm on students; and (3) calls for expansion of relational, participatory, and humanizing methodologies. Overall, we argue for a shift from research that focuses on “trauma-informed education” to scholarship that enacts a sociohistorical trauma-reducing framework to more effectively interrogate the intersections of trauma, schooling, and research.

Time and Collective Biology: Relationships Between Individual and Societal Life Course Ideologies in Mexican Men’s Sexual Health Treatment

People may seek to embody cultural ideals of the life course through their use or rejection of medical interventions, including but not limited to anti-aging treatments. Here, I analyze this phenomenon via interviews with men engaging with two different forms of sexual health medicine in urban Mexico: erectile-dysfunction treatment and testing for sexually transmitted infections (STIs). I argue that, in contrast to the biomedical understanding of patients as individuals who change during their lives, my interlocutors understood themselves as components in broader “collective biologies” that change on a longer timeline. These are culturally-defined groups that people understand to be comprised of interrelated members whose behaviors concretely affect the group’s physical and social well-being over time. In both medical arenas discussed here, men used or rejected sexual health interventions in response to local narratives about the nature of the Mexican population as a collective biology, including ideas about how it should change over time away from its roots in the colonial past. They characterized predispositions to machismo and disinterest in preventative health care as embodied inheritances that the Mexican population should reject in order to achieve health-promoting modernity in the future. My analysis describes how these interlocutors sought to live out desirably modern forms of race and gender through their medical decisions in a way that they hoped would contribute to positive, embodied change in the Mexican social body over time. These findings show that, despite the assumptions of individualism generally naturalized in anti-aging treatment and biomedicine, people may make medical decisions in an effort to aid collective change over population-level timescales.

Arts-based interventions for people living with dementia: Measuring 'in the moment' wellbeing with the Canterbury Wellbeing Scales.

Background: There is growing acknowledgement for the need to move beyond exclusive biomedical understandings of dementia and also focus on how to improve the lives and wellbeing of people living with dementia. A mounting body of research advocates for the benefits of arts-based interventions for this population. The purpose of this study was to explore the links between multiple components of arts-based interventions and subjective wellbeing in order to help assess if these activities might contribute to meaningful community-based dementia care initiatives. Methods: Using previously collected data across different intervention sites, a within- and between- participants design was used that assessed wellbeing through the Canterbury Wellbeing Scales (CWS) in people with mild-to-moderate dementias (N = 201) who participated in various community arts-based interventions (ABI). Data were analysed using non-parametric statistical analyses and bootstrapped moderation models. Results: Increases in subjective wellbeing were associated with all forms of ABI. Co-creative sessions significantly strengthened the relationship between number of sessions attended and overall wellbeing as well as optimism. No significant moderating effect was observed between number of sessions attended and carer presence. Conclusions: In the largest study of its kind to date to assess wellbeing using arts activities in a community-based dementia sample, findings support the use and acceptability of the CWS as a measurement tool for people with early-to-middle stages of dementia and suggest that the CWS can reliably measure wellbeing in this population. In addition, the positive effect of arts-based interactions on specific aspects of wellbeing were found, which provide a better understanding of the conditions under which these effects can be prolonged and sustained. Further research is needed to better understand the environmental, social, and psychological mechanisms through which these improvements operate.

Tempering hope with Intimate Knowledge: Contrasting emergences of the concept 'uninfectious' in HIV.

In this paper, we contrast two emergences of the concept of 'uninfectious' (that pharmaceuticals can render someone living with HIV non-infectious) in HIV. First, using Novas' framing of 'political economies of hope', we describe the deployment of 'uninfectious' as part of global health campaigns. Second, we draw on Raffles' (International Social Science Journal, 2002, 54, 325) concept of 'intimate knowledge' to theorise our own account of 'uninfectious' through a re-analysis of qualitative data comprising the intimate experiences of people living with or around HIV collected at various points over the last 25years. Framed as intimate knowledge, 'uninfectious' becomes known through people's multiple engagements with and developing understandings of HIV over a prolonged period. As contingent and specific, intimate knowledge does not register within the biomedical/scientific ontological system that underpins discourses of hope employed in global campaigns. The concept of intimate knowledge offers the potential to critique discourses of hope in biomedicine problematising claims to universality whilst enriching biomedical understandings with accounts of affective, embodied experience. Intimate knowledge may also provide a bridge between different epistemological traditions in the sociology of health and illness.