Case Stories Research Articles

Uneasiness in interdisciplinary research and the importance of metaphors: A case story on building an interdisciplinary chronic pain research team

Interdisciplinary research is increasingly recognized as a key method to tackle complex societal challenges and stimulate creativity to find innovative solutions. Our key goal when starting our collaboration was to come to innovative ways of treating chronic pain. An ambitious goal that requires out-of-the-box and high-risk-high-gain research. However, interdisciplinary research in practice can be uneasy and will not always be successful. This paper describes a case story focussing on the challenges we faced building an interdisciplinary team. One of the most important lessons is that researchers from different disciplines may think they speak a universal ‘language of science’, but a thorough understanding of each other's ways of working, research paradigms, methods, and concepts is necessary before they can start working together on solving scientific questions. In fact, if researchers cannot understand each other's language, they cannot expect patients to understand scientific language either. Lastly, for academics to engage with a non-scientific audience and vice-versa, we need to find and create places to meet and find ways to interact effectively. Language is the medium through which all these interactions take place. It is therefore essential that language takes a central place in the process of collaboration across disciplines, interdisciplinary research, patient participation and public engagement. In this case story, we share our experiences in creating a common language, summarized in five steps (1: creating the team; 2: metaphor-forced introduction to disciplines; 3: creating common ground; 4: outreach; 5: integration). Metaphors play an important role in this process. We will demonstrate how we reflectively progressed through these steps while enhancing interdisciplinarity, (scientific) innovation and public engagement. This five-step journey can be used as a process-tool for any other high-risk-high-gain research team seeking to innovate through interdisciplinarity – with the risk of becoming a brilliant failure.

PCOS and Homeopathic Treatment: A Case Study Analysis

PCOS is one of the most prevalent endocrine disorders in females of reproductive age, presenting such symptoms as abnormal menstrual cycles, obesity, hirsutism, and acne. However, conventional treatments alleviate symptoms only, whereas many patients search for alternative methods of treatment that include homeopathy. The present paper develops detailed analyses of ten case stories where homeopathic treatment was applied to alleviate symptoms related to PCOS. Results have shown regularization of the menstrual cycle, reduction in size of cysts, and improvement in allied symptoms like obesity, hirsutism, and acne.

Integrating physiotherapy in rural primary health care: Early lessons on the value, feasibility, and emerging role of the physiotherapist from a community-oriented primary care (COPC) program in Rajasthan, India.

Physiotherapists are health professionals who enhance mobility and quality of life (QoL) through clinical reasoning and the application of evaluation and treatment strategies. Their role is crucial in promoting health, preventing injury, and maintaining function. This paper aims to (1) share early experiences and learnings from integrating physiotherapy in rural primary health care, (2) discuss the scope and role of physiotherapists in the primary care team, (3) list the competencies of physiotherapists in rural primary care settings, and (4) advocate for a re-imagined role of physiotherapists as multi-skilled "primary care physiotherapists." Using a selection of case stories from rural primary health care settings, the paper provides insights into the integration and impact of physiotherapy within these communities. The integration of physiotherapy in rural primary health care has demonstrated significant benefits in promoting comprehensive primary health care. The case stories highlight the expanded scope and essential competencies of physiotherapists as vital members of the primary care team. This paper emphasizes the critical role physiotherapy plays in primary health care and calls for broader recognition and support for physiotherapists. It underscores the need for a re-imagined perspective of physiotherapists in rural settings, advocating for their role as multi-skilled primary care professionals.

Living happily alone in Plato’s cave? On loneliness, technology and the metaphysics of presence

In a lot of research on loneliness and technology, there is an underlying premise that actual, physical presence is more real than ‘virtual’ presence. This premise is rarely explicit, yet...

Haxe as a Swiss knife for bioinformatic applications: the SeqPHASE case story.

Haxe is a general purpose, object-oriented programming language supporting syntactic macros. The Haxe compiler is well known for its ability to translate the source code of Haxe programs into the source code of a variety of other programming languages including Java, C++, JavaScript, and Python. Although Haxe is more and more used for a variety of purposes, including games, it has not yet attracted much attention from bioinformaticians. This is surprising, as Haxe allows generating different versions of the same program (e.g. a graphical user interface version in JavaScript running in a web browser for beginners and a command-line version in C++ or Python for increased performance) while maintaining a single code, a feature that should be of interest for many bioinformatic applications. To demonstrate the usefulness of Haxe in bioinformatics, we present here the case story of the program SeqPHASE, written originally in Perl (with a CGI version running on a server) and published in 2010. As Perl+CGI is not desirable anymore for security purposes, we decided to rewrite the SeqPHASE program in Haxe and to host it at Github Pages (https://eeg-ebe.github.io/SeqPHASE), thereby alleviating the need to configure and maintain a dedicated server. Using SeqPHASE as an example, we discuss the advantages and disadvantages of Haxe's source code conversion functionality when it comes to implementing bioinformatic software.

Subjective resilience among women and youth clients of social innovation projects executed in five regions of Ethiopia

The European Union (EU) launched an EU-RESET Plus Innovation Fund in Ethiopia, with a goal of building the resilience and improving the livelihood of targeted vulnerable communities in five regions. The respective social innovation projects (SIPs) introduced social innovations that part with the ‘business-as-usual’ model. Though difficult to study impact due to the limitations of cross-sectional survey design adopted, the study aimed to investigate the level of subjective resilience exhibited by women and youth clients and the predictors of resilience. We collected quantitative data from 910 client households. We also conducted over a dozen case story interviews with project clients. We employed World Food Program (WFP) (2022) subjective resilience score to compute clients’ level of subjective resilience. An ordered logistic regression with subjective resilience as an outcome variable was conducted to determine predictors. The unique contribution of this study is the computation of the subjective resilience of project beneficiaries in objective terms, having three categories. The findings revealed that the SIPs contributed to boosting the resilience of women and youth, with significant predictors including active involvement, empowerment, gender, savings, and livestock ownership. Gender differentials are also found to be for future development projects to consider in their design and practice.

Social Innovations for Empowering Pastoralist Women: Evidence from Dasenech, South Omo, Ethiopia

Innovations are vital for empowering women and youth by introducing alternative pathways for development. This study focuses on a social innovation project executed in Dasenech, South Omo, Ethiopia. The project introduced innovative initiatives (index-based livestock insurance (IBLI), a goat market value-chain system, an eco-friendly hydraulic ram pump, fodder production, and a vet drug store). Key among the goals of these initiatives was the empowerment of pastoralist women by promoting the livelihood base of the Dasenech Pastoralist Community. The present study assessed the contributions of these innovations to the empowerment of women and youth. We employed a mixed-method research approach to pool both quantitative and qualitative data using a household survey through Kobocollect, FGDs, KIIs, and case stories. We computed empowerment by employing a 5DE model with five domains, i.e., production, resources, income, leadership, and time use. The findings suggest that 93% of the project participants were empowered, recording “adequate achievements” in line with the 5DE model, i.e., with scores of at least 80% in four of the five requirements. Technological innovations that properly assess the context of the intervention area and, most importantly, that use proper avenues of implementation with women and youth as owners and leaders, have the capacity to empower such individuals in the economic, social, and political spheres.

Case Records as Medical Stories: A Song-dynasty Doctor’s Narration of His Own Medicine—Xu Shuwei (1080–1154)

Abstract The key point in studying or teaching the history of Chinese medicine is on the doctrines underlying it and on its perception of the body, physiology, pathology, and its treatment. Namely, there is often a tendency to focus on reading and analysing the classical canons and therapy-related texts including formularies and materia medica collections. However, focusing on these sources provides us with a one-sided presentation of Chinese medicine. These primary sources lack the clinical down-to-earth know-how that encompasses medical treatment, which are represented, for instance, in the clinical rounds of modern medical schools. Our traditional focus on the medical canons and formularies provides almost no clinical knowledge, leaving us with a one-sided narrative that ignores how medicine and healing are actually practiced in the field. This paper focuses on the latter aspect of medicine from a historical perspective. Using written and visual sources dating to the Song dynasty, clinical encounters between doctors and patients including their families are depicted based on case records recorded by a physician, members of the patient’s family, and bystanders. This array of case records or case stories will enable us to narrate the interaction between physicians and patients both from the clinical perspective and from the social interaction. This paper will also discuss visual depictions of the medical encounter to provide another perspective for narrating medicine during the Song dynasty. Medical case records and paintings depicting medical encounters are exemplary of the potential of Chinese primary sources for narrative medicine.

“Complex Problems Don’t Require Complex Solutions:” Case Discussions Using Solution Focused Brief Therapy

This article illustrates solution-focused brief therapy (SFBT) through two case stories, showcasing its pragmatic approach in addressing complex issues with adolescents. SFBT emphasizes strengths, possibilities, and collaborative conversations to co-create solutions. Two case studies of learning disorder and ADHD highlight the significance of focusing on strengths and interests in enabling therapeutic progress and how goal-setting and solution-oriented discussions can foster agency and consistency. These vignettes underscore SFBT’s future-focused and goal-directed nature, prioritizing strengths and the client’s capacity for change. By adhering to SFBT’s philosophy, the therapists guided the clients toward practical and effective solutions to meet their challenges.

Acceptability and effectiveness study of therapist-assisted internet-delivered cognitive behaviour therapy for agriculture producers

Agriculture producers are less likely to seek or to receive mental health services compared to the general population. Additional research is needed to identify effective and accessible mental health interventions for this underserved population. This study used a mixed-methods approach and open trial design to examine the acceptability and effectiveness of therapist-assisted internet-delivered cognitive behaviour therapy (ICBT) supplemented with an additional agricultural resource for clients from agricultural backgrounds receiving ICBT in routine care. Clients (n = 34) participated in an online, five-lesson course that provided psychoeducation and strategies for dealing with symptoms of anxiety and depression, with weekly therapist assistance. Clients also received a tailored resource (developed with input from those with an agricultural background) providing culturally specific information and case stories pertinent to agricultural communities. Intent-to-treat analyses showed that the ICBT program was effective in reducing anxiety and depression symptoms among the agricultural population. Large within-group pre-to-post-treatment Cohen's effect sizes of d = 1.14, 95 % CI [0.41, 1.86] and d = 1.15, 95 % CI [0.42, 1.87] were found for depression and anxiety, respectively and comparable to the same program offered to the general population. Clients also experienced reductions in perceived stress and significant improvements in resiliency from pre- to post-treatment. Semi-structured interviews conducted at post-treatment with the agricultural clients (n = 31) on their experiences with ICBT identified four main themes: perceived strengths of ICBT and the tailored resource, suggestions to improve service delivery for agriculture producers, clients experienced internal and external challenges to participating in ICBT, and the positive impact of the course reached beyond the client. Very high satisfaction rates were found. These results provide support for the acceptability and effectiveness of ICBT with a tailored resource offered in routine care among agriculture producers.

Climate Change and Community Resilience: Insights from South Asia

This book presents case studies, stories and examples of climate change adaptation initiatives from seven South Asian countries—Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka—highlighting traditional and indigenous knowledge with community engagement. The book has 27 studies (chapters) organized under six themes (Parts): concepts and models; traditional knowledge and sustainable agriculture; technology adoption; disaster risk reduction; urban sustainability; and alternative livelihoods.

Digi - Insurance – the Case Story of the Potential in the Life Insurance of Sri Lanka

Digi - Insurance – the Case Story of the Potential in the Life Insurance of Sri Lanka

Variations in the intended utilization of emergency care in case of gastrointestinal diseases

Frequent utilization of emergency care and overcrowded emergency departments (EDs) are highly relevant topics due to their harmful consequences for patients and staff. The present study examines variations of intended health care use in urgent and non-urgent cases among the general population. In a cross-sectional telephone survey, a sample of N = 1,204 adults residing in Hamburg, Germany, was randomly drawn. At the beginning of the survey, one of 24 different vignettes (case stories) describing symptoms of inflammatory gastrointestinal diseases were presented to the participants. The vignettes varied in sex (male/female), age (15, 49, 72 years), daytime (Tuesday morning, Tuesday evening), and urgency (low, high). Participants were asked in an open-ended question about their primal intended utilization if they or their children would be affected by such symptoms. Overall, about 14 % chose emergency facilities (ED, ambulance, emergency practice) despite presentation of non-urgent conditions (n = 602). Intended emergency care use varied considerably even if the degree of urgency was comparable. Adolescence, male sex, and symptoms occurring in the evening were associated with increased ED and ambulance use. Inappropriate utilization of ED and ambulance (analyses regarding utilization due to non-urgent problems) was more often observed among male respondents and those with a migration background (1st generation). Information campaigns focused on emergency care use and reorganisation of emergency care wards are possible interventions.

Dry stone walling. Rural artisan enterprise in the urban economy

Usually, dry stone walls are a feature of rural locations but this paper presents a case story of how two experienced dry stone Wallers were commissioned to build a dry stone wall in an urban location. Through narrative story telling using photographs, this work charts the progress of the construction of the Wall from the commissioning process in December 2021 from visiting stone quarries to search for appropriate stone in January 2022, to the building of the wall itself in May–June 2022.The paper demonstrates how engaging in simple artisanal tasks, such as building a dry stone wall, is a source of fascination to the observer and also a process of discovery. Methodologically, it uses a Dramaturgical lens (Goffman, 1959) to capture the experience of both the construction of the wall itself and the lenses which the casual observer uses to understand the process of walling.The paper explores the significance of what are perceived to be ‘rural’ ‘creative enterprise’ and artisanship but transported to an urban environment. It expands an earlier work of a case study of two dry stone wallers, based in North Yorkshire, a region of the UK (McElwee, 2022).By so doing, it demonstrates how creative enterprise skills in the rural economy can be transported into the urban environment. By this simple process the paradox is that more actors are able to enjoy and appreciate a rural skill, than they would in a more ‘traditional’ environment. One further consequence of this is that urban-based actors are able to appreciate at first hand, the beauty of a well-constructed dry stone wall.Importantly it points to the significance of the dry stone wall for the continued sustainability of rural regions. In the UK, the dry stone wall is perceived to be a ‘Public good’. Indeed, the UK Domestic Agricultural Policy (DAP) is centred around the idea of ‘public money for public goods’, which incentivises farmers for providing services that the public can benefit from i.e., countryside access, sustainable farming practices and increasing biodiversity (Defra, 2021).

Decolonising Management. Reflections of a Human Resource Practitioner from the Global South

This article takes a slight detour from this edition's theme – decolonising systemic practice – by suggesting that systemic practices can be used to decolonise dominant discourses, such as Western-centric management and its associated form of knowledge production. My views are voiced from an insider–outsider, intersectional positionality – a person from the Global South now working as a Human Resource Practitioner in the United Kingdom. The article posits management and human resource management as Western in their cultural roots and neoliberal in their economic worldview and proposes that underlying assumptions embedded in these discourses have resulted in epistemic othering and subjugation on an international scale. It suggests that decolonising management could begin with making the paradigm shift from a diagnostic to a dialogical understanding of organising human systems. It holds up this epiphany as an example of embracing indigenous knowledge and practices. The article also suggests, through a case story, the use of a systemic practice known as Social GRACEs (Burnham, 1992), that systemic reflexivity and the re-constitution of language games are paramount for making such a paradigmatic shift to decolonised practice.

FC11: Guided low-intensity behavioural activation intervention delivery preferences among people with dementia, informal caregivers, and professional stakeholders: a qualitative study (the INVOLVERA Study)

Background:Despite a need to provide support to people with dementia and informal caregivers to live well with dementia, the availability of psychological interventions to enhance wellbeing and support mental health problems such as depression for people with dementia are limited. A potential solution is behavioural activation, an evidence-based intervention for depression that seeks to target behavioural avoidance. Behavioural activation can be delivered in a written self-help format, with support provided by an informal caregiver, who in turn receives guidance from a healthcare professional. However, it is necessary to develop and tailor self-help interventions to the needs and preferences of specific populations.Objective:To explore the needs and preferences of people with dementia, informal caregivers, and professional stakeholders to ensure cultural appropriateness, relevancy, and acceptability of the intervention.Methods:Participatory action research with co-design principles using semi-structured interviews and focus groups. People with dementia (n=8), informal caregivers (n=19), healthcare professionals (n=18), and community stakeholders (n=7) were provided with draft versions of the behavioral activation written self-help intervention and a proposed intervention delivery model. Open-ended questions explored preferences concerning preferred intervention delivery setting, type of support and guidance provided, perceived relevance of the intervention content and language, and ways to enhance relevancy, cultural appropriateness, and acceptability.Results:Analysis resulted in an overarching theme: Tailoring and flexibility, and three categories: Intervention process, material and context; Support and guidance; and Time. Results informed adaptations to the intervention content and delivery model, including: (1) reducing the amount of material to minimise treatment burden; (2) increasing the relevance of case stories and illustrations to Swedish society and culture; (3) modernising the design and illustrations; (4) including a case story of a person with young onset-dementia; (5) increasing the flexibility of the delivery model (e.g., delivery outside of traditional health care settings); and (6) providing additional guidance to informal caregivers.Conclusion:Stakeholders expressed a need for tailoring and flexibility throughout intervention delivery, and for cultural adaptations to intervention content to improve perceived appropriateness and relevance. A planned feasibility study will examine the feasibility, acceptability, relevancy and cultural appropriateness of the intervention and delivery model.

Development of a self‐help behavioural activation intervention INVOLVERA for people with dementia: a qualitative study

AbstractBackgroundDespite dementia being highly prevalent there is a lack of interventions to support people with dementia, and their informal caregivers, to live well. A guided, self‐help, behavioural activation‐based intervention (INVOLVERA), designed to support people with dementia to re‐engage with pleasurable, routine, and self‐care activities they have stopped doing, may represent a solution (Svedin et al., 2021). An innovative aspect of INVOLVERA is that support to the person with dementia to use INVOLVERA is provided by an informal caregiver, who themselves receives guidance from a healthcare professional. To enhance intervention acceptability and relevance interventions should meet the needs and preferences of the target population. Following Phase I (Development) of the Medical Research Council’s Framework for the development of complex interventions (Skivington et al., 2021), this study explores the needs and preferences of people with dementia, informal caregivers, and professional stakeholders to enhance the acceptability and relevancy of INVOLVERA for people with dementia.MethodsSemi‐structured interviews and focus group discussions were held with people with dementia (n = 8), informal caregivers (n = 19), healthcare professionals (n = 18), and community stakeholders (n = 7). A written draft of INVOLVERA and proposed intervention delivery model were provided to participants. Open‐ended questions explored intervention content, language and intervention delivery preferences. Data were analysed using manifest content analysis.ResultsOne overarching theme: Tailoring and flexibility, and three categories: Intervention process, material and context; Support and guidance; and Time derived from analysis. Results informed the following adaptations: (1) increased flexibility of intervention delivery (e.g., outside of traditional healthcare settings); (2) additional guidance and training to informal caregivers; (3) reduced written material (to minimise treatment burden); (4) modernisation of design and illustrations; (5) improved relevance of case stories and illustrations to the Swedish context; and (6) increased diversity of persons in case stories.ConclusionThis study highlights the importance of developing interventions alongside stakeholders. We anticipate the approach will optimise the acceptability and relevancy of INVOLVERA. Next, we will examine the acceptability and feasibility of INVOLVERA.

Role of ChatGPT and Google Bard in the Diagnosis of Psychiatric Disorders: A Comparative Study

Introduction The incorporation of artificial intelligence (AI) in the medical decision-making matrix has captured interest across diverse medical domains. This study aimed to juxtapose the decision-making patterns of humans and artificial intelligence regarding psychiatric disorders. Methods A set of case stories composed of 20 questions and the ideal answers were developed by a psychiatrist (the first author) based on International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders. The cases and replies were revised by other authors, and one by one, they were presented to ChatGPT and Google Bard. The results were presented in a table. Results Both ChatGPT and Google Bard reported a high rate of precision in the spot diagnosis of the cases. ChatGPT provided a correct diagnosis for 15 cases (75%), while Google Bard diagnosed 14 cases (70%) successfully. Conclusion ChatGPT and Google Bard's success in this study opens the door for deeper AI integration in psychiatric evaluations. As technology evolves, the boundary between human and AI decision-making may become less distinct, promising a new era in psychiatric care. Moving forward, we must approach AI in healthcare with enthusiasm, collaboration, and caution.

CHH: Health community accessing environmental information from the Copernicus Programme

Abstract Copernicus is the Earth observation component of the European Union's Space programme, looking at our planet and its environment to benefit all European citizens. The Copernicus services transform wealth of satellite and ground-based measurements into value-added information by processing and analysing the products. All the information is provided with an open and free data policy to help public national and European authorities, policy makers, international organisations and service providers to improve European citizens’ quality of life. There are six operational Copernicus Services covering the whole Earth System including ocean, land, atmosphere and more horizontal domains such as climate change, emergency and security. To facilitate the use of these information by the different user communities, some Thematic Hubs have been created and are under development. One of the first hubs is the Copernicus Health Hub (CHH) and it is focusing on the health community. The CHH collects and provides all the Copernicus environmental information that are pertinent to Health, following WHO definition: Physical, Mental and Well-being. The health Hub is also supporting the users in better exploiting and uptake Copernicus data and products (via documentation, access to catalogues, inspirational use case stories, ...). In addition, the CHH should collect new requirements for the evolution of the Copernicus programme. In this presentation, the CHH will be introduced in more details, the different types of environmental information will be presented accompanied by some use cases to inspire further developments and new applications for the health community. Key messages • The Copernicus Health Hub is a facilitator between the Health community and the Earth Observation and environmental science community. • The Copernicus Health Hub provide all environmental data at Globale and European scale.

Internet-Delivered Cognitive Behavioral Therapy Tailored to Spouses and Significant Others of Public Safety Personnel: Formative Evaluation Study.

Spouses and significant others (SSOs) of public safety personnel (PSP) are affected by the risks and requirements of these occupations. Internet-delivered cognitive behavioral therapy (ICBT) provides a convenient and accessible treatment format that can be tailored to the needs of SSOs of PSP. This study aimed to assess the initial use and client perceptions (eg, likes, helpfulness, and areas for improvement) of a self-guided, transdiagnostic ICBT course designed for Canadian SSOs of PSP and identify opportunities to further tailor ICBT for this group. SSOs were invited to complete a 5-lesson, self-guided, transdiagnostic ICBT course. Descriptive statistics were used to analyze the demographic and clinical characteristics of participants. Content analysis was used to analyze the data from open-ended survey responses and interviews to understand their experiences with ICBT. Clients (N=118) endorsed various mental health concerns (eg, depression, anxiety, posttraumatic stress symptoms, and relationship concerns) with a range of severity levels. Most clients identified as White (110/116, 94.8%) and women (108/116, 91.5%), with a mean age of 42.03 (SD 9.36) years. Of the 26 clients who were interviewed, 89% (23/26) reported believing that ICBT is helpful and 92% (24/26) reported finding at least 1 skill helpful. Clients provided suggestions for course improvements. On the basis of this feedback and quantitative data, changes were made to areas such as the delivery of materials, content, case stories, and timelines. Overall, the results indicated that many SSOs of PSP had positive perceptions of ICBT tailored to their needs and found several aspects of the course helpful, supporting the continued delivery of tailored ICBT to this population. However, there remains a need for continued promotion of the course and outreach to diverse groups of SSOs of PSP. Findings from this formative evaluation provide insight into the unique experiences and needs of SSOs of PSP and provide preliminary evidence for the use of tailored ICBT to support the mental health of this group in Canada.