Arthritis psoriatica

The symptoms ofpsoriatic arthritis vary from arthralgia and enthesitis to chronic erosive and mutilating arthritis, and are seen in 6-39% of all psoriasis patients. Because of increasing awareness of the clinical signs of psoriatic arthritis among both dermatologists and rheumatologists, the diagnosis ofpsoriatic arthritis is made more often; this is important since earlier diagnosis and treatment can avoid irreversible joint destruction. The overlap between the immunological mechanisms in the pathogenesis ofpsoriasis and psoriatic arthritis has led to the identification of common therapeutic targets, of which tumour-necrosis factor (TNF) is the most important. The successful treatment of psoriasis patients with TNF-a-blocking agents has not only brought about a marked improvement in the quality of life of many patients but has also improved the insight into the pathogenesis, for example by demonstrating that the role of acquired immunity is much more important than was previously thought. The Dutch Society of Dermatology and Venereology and the Dutch Society of Rheumatology have drawn up guidelines for the treatment of patients with psoriasis and psoriatic arthritis using these so-called biologics.     

Health care for elderly victims of violence in Rio de Janeiro

The scope of this article is to chart, define and qualify the healthcare provided by the Brazilian Unified Health System (SUS) and outsourced services to elderly people in situations of violence in Rio de Janeiro, based on major policies aimed at this group. This is an exploratory study that triangulated quantitative and qualitative methods. The introduction and implementation of policies is differentiated between the units: they are more thoroughly implemented at the pre-hospital and hospital level and less at rehabilitation level. The challenges involve the professional's ability to identify, attend and report cases of violence; to include the topic in care of the elderly; to give visibility to the specific requirements for elderly women; to instruct and orient families about care, creating strategies to redeem the bonds of affection; to monitor the changes that lead to functional disability and enhance the quality of life of the elderly.     

Developing optimal search strategies for retrieving clinically relevant qualitative studies in EMBASE

Qualitative researchers address many issues relevant to patient health care. Their studies appear in an array of journals, making literature searching difficult. Large databases such as EMBASE provide a means of retrieving qualitative research, but these studies represent only a minuscule fraction of published articles, making electronic retrieval problematic. Little work has been done on developing search strategies for the detection of qualitative studies. The objective of this study was to develop optimal search strategies to retrieve qualitative studies in EMBASE for the 2000 publishing year. The authors conducted an analytic survey, comparing hand searches of journals with retrievals from EMBASE for candidate search terms and combinations. Search strategies reached peak sensitivities at 94.2% and peak specificities of 99.7%. Combining search terms to optimize the combination of sensitivity and specificity resulted in values over 89% for both. The authors identified search strategies with high performance for retrieving qualitative studies in EMBASE.     

Qualitative teamwork issues and strategies: coordination through mutual adjustment

Multidisciplinary research teams that include faculty, students, and volunteers can be challenging and enriching for all participants. Although such teams are becoming commonplace, minimal guidance is available about strategies to enhance team effectiveness. In this article, the authors highlight strategies to guide qualitative teamwork through coordination of team members and tasks based on mutual adjustment. Using a grounded theory exemplar, they focus on issues of (a) building the team, (b) developing reflexivity and theoretical sensitivity, (c) tackling analytic and methodological procedures, and (d) developing dissemination guidelines. Sharing information, articulating project goals and elements, acknowledging variation in individual goals, and engaging in reciprocity and respectful collaboration are key elements of mutual adjustment. The authors summarize conclusions about the costs and benefits of the process.     

Aunting as a Call to Public Intellectualism: The Roles of (In)Visibility in Health Communication Research and Service

In this essay, the author identifies the theme of (in)visibility permeating her research on fathers of children with a rare genetic condition, Sturge–Weber syndrome. The tension between physical visibility of the condition and lack of awareness is explored, alongside issues of (in)visibility in coping and support-seeking strategies of fathers. Finally, the author examines her own experiences in the research process through the lens of (in)visibility, in both managing her own emotions and exploring her roles as a researcher, an aunt, and a public intellectual.     

Living a 'normal' life: young people coping with thalassaemia major or sickle cell disorder

This qualitative paper explores the strategies and resources young people use to cope with sickle cell disorder or thalassaemia major, two haemoglobin disorders with serious implications for health and survival. By focusing on coping strategies, we explore how young people attempt to take control over their lives. The respondents, largely of South Asian and African Caribbean origin, aged between 10 and 19 years, valued maintaining a normal' life and struggled to achieve this normalcy. Strategies were employed to minimise difference from peers but these strategies remained vulnerable. Coping occurred in a dynamic space, involving negotiation and engagement with both personal and structural factors. Threats to normalcy did not always reside in the condition; life transitions, changes in social relationships and racist. disablist or sexist marginalisation also threatened coping strategies.     

The impact of itch symptoms in psoriasis: results from physician interviews and patient focus groups

Background  

The objective of this qualitative study was to better understand the impact of psoriasis symptoms using a 3-part process: 1) develop a disease model for psoriasis to identify the most important concepts relevant to psoriasis patients; 2) conduct interviews with dermatologists to identify key areas of clinical concern; and 3) explore psoriasis patients' perceptions of the impact of psoriasis.     

Communication about parental illness with children who have learning disabilities and behavioural problems: three case studies

Parental illness can have a profound impact on family relationships and children's behaviour. The amount and nature of communication between parents and children about the illness can play an important role, both positively and negatively, in mediating the outcomes. When children have a disability, families can be reluctant to communicate with them about family difficulties. They are often concerned about the impact that parental unavailability may have on their child's life. This paper reports on three families in which the mother was diagnosed with breast cancer and one child in the family had a disability. The extent and specific characteristics of their communication about the maternal illness with their children, behavioural changes in the children, explanations of communication strategies and attributions of behavioural changes are described. Family coping strategies are examined with reference to Lazarus's process model of stress and coping and the use of either problem-focused or emotion-focused strategies. Implications for possible clinical interventions are proposed. In particular it is suggested that families be offered consultation about: what children might understand ways in which to communicate effectively and strategies for coping with the long-term implications of serious parental illness.     

Recruiting participants from a community of Bangladeshi immigrants for a study of spousal abuse: an appropriate cultural approach

In this article, the authors describe a recruitment strategy used to enroll female Bangladeshi immigrants into a study of spousal abuse, crucial in the process of identifying abuse in this community. The researchers used a qualitative method involving a three-staged process designed for sampling and recruiting for focus groups and in-depth interviews. The Bangladeshi women declined participation in either of these qualitative genres, but the modified and adapted strategies proved effective in recruiting participants from the tightly knit immigrant community. Key to the success of the effort was the involvement of a Bangladeshi investigator, unspecified time to establish rapport with key informants and representatives of the larger community, and maintaining contact with the target population after completion of the project.     

The impact of working with disturbing secondary data: reading suicide files in a coroner's office

The article discusses the effects on the researcher of reading disturbing secondary data (defined here as evidence gathered by someone other than the researcher). The case study is a qualitative sociological autopsy of suicide, and the secondary data--written documents and photographs--are all from case files in a British coroner's office. Following ethnographic detail about the research setting and research process, there is discussion of the diverse secondary data sources in these files, particularly in relation to the impact on the researcher. Some general observations are made about emotion in the research process and potential strategies for responding to emotion. The authors locate their responses to reading about suicides within the broader context of the social processing of death and distress, and also consider whether emotional reactions to data have any analytical purchase.     

Coping and quality of life in patients with psoriasis

The aim of the present study was to investigate the relationship between coping dimensions and overall quality of life, disability and health status in patients' with psoriasis. Psoriasis is one of several chronic diseases which requires self-management in order to ensure an enhanced quality of life. The sample comprised 334 patients who were treated consecutively at three dermatology departments in eastern Norway. A total number of 273 patients completed the questionnaire, yielding a response rate of 82% (20% in-patients and 80% out-patients). The following questionnaires were used: The Jalowiec Coping Scale, the Psoriasis Disability Index, the Quality of Life Scale, and the SF-36. Results showed that patients who used combined emotive coping strategies reported more disability, poorer mental health and worse overall quality of life. Furthermore, patients who more frequently used normalising/optimistic coping reported higher levels of mental health. However, the variance explained by coping effort was low to moderate. Coping explained the variance in mental health and overall quality of life to a greater extent than that in physical health. Knowledge about the relationships between coping and quality of life dimensions is important with regard to the establishment and implementation of appropriate psychosocial interventions for patients with psoriasis.     

Nutritional Therapy in Persons Suffering from Psoriasis

Psoriasis is a chronic inflammatory skin disease. Immunological, genetic, and environmental factors, including diet, play a part in the pathogenesis of psoriasis. Metabolic syndrome or its components are frequent co-morbidities in persons with psoriasis. A change of eating habits can improve the quality of life of patients by relieving skin lesions and by reducing the risk of other diseases. A low-energy diet is recommended for patients with excess body weight. Persons suffering from psoriasis should limit the intake of saturated fatty acids and replace them with polyunsaturated fatty acids from the omega-3 family, which have an anti-inflammatory effect. In diet therapy for persons with psoriasis, the introduction of antioxidants such as vitamin A, vitamin C, vitamin E, carotenoids, flavonoids, and selenium is extremely important. Vitamin D supplementation is also recommended. Some authors suggest that alternative diets have a positive effect on the course of psoriasis. These diets include: a gluten-free diet, a vegetarian diet, and a Mediterranean diet. Diet therapy for patients with psoriasis should also be tailored to pharmacological treatment. For instance, folic acid supplementation is introduced in persons taking methotrexate. The purpose of this paper is to discuss in detail the nutritional recommendations for persons with psoriasis.     

Search strategies for identifying qualitative studies in CINAHL

Nurses, allied health professionals, clinicians, and researchers increasingly use online access to evidence in the course of patient care or when conducting reviews on a particular topic. Qualitative research has an important role in evidence-based health care. Online searching for qualitative studies can be difficult, however, resulting in the need to develop search filters. The objective of this study was to develop optimal search strategies to retrieve qualitative studies in CINAHL for the 2000 publishing year. The authors conducted an analytic survey comparing hand searches of journals with retrievals from CINAHL for candidate search terms and combinations. Combinations of search terms reached peak sensitivities of 98.9% and peak specificities of 99.5%. Combining search terms optimized both sensitivity and specificity at 94.2%. Empirically derived search strategies combining indexing terms and textwords can achieve high sensitivity and high specificity for retrieving qualitative studies from CINAHL.     

A Communication Competence Approach to Examining Health Care Social Support,Stress, and Job Burnout

This piece begins with a brief literature review that focuses upon how media attempt to make sense of news events and construct meaning about HIV/AIDS. We then focus specifically on a linguistic process identified in French dailies in articles about the prevalence and incidence of HIV/AIDS, namely, the presence of certain adverbs. The impact of this linguistic process is also investigated in an experimental study. The results indicated that participants who were exposed to a message within which epidemiological data were marked by such adverbs compared to those who processed a message without such an adverbial marking expressed a higher level of perceived risk and declared a stronger intention to use a condom and to practice a screening test. They also judged the epidemiological situation as more serious and were more supportive of a coercive management of the epidemic. These effects also appeared when the message referred to a sexually transmitted infection with which the subjects were not familiar.     

Defining osteoarthritis of the hip for epidemiologic studies

The authors compared seven radiologic indices of hip osteoarthritis to establish which provided the best definition of the disease for epidemiologic purposes. Hip joints were assessed from intravenous urograms taken in a British hospital between 1982 and 1987 in 1,315 men aged 60-75 years. The indices examined were an overall qualitative grading of osteoarthritis, four measures of joint space, the maximum thickness of subchondral sclerosis, and the size of the largest osteophyte. Minimal joint space (i.e., the shortest distance between the femoral head margin and the acetabulum) was the index most strongly associated with other radiologic features of osteoarthritis. Among a subset of 759 men who answered a questionnaire about symptoms, the overall qualitative grading, minimal joint space, and thickness of subchondral sclerosis were the radiologic indices most predictive of hip pain. Within- and between-observer repeatability were tested in a subset of 50 subjects. Measures of joint space were more reproducible than other indices. These data suggest that, at least in men, minimal joint space is the best radiologic criterion of hip osteoarthritis for use in epidemiologic studies.     

Gendered embodiment and survival for young people with cystic fibrosis

In the context of improvements in both longevity and the quality of life for people with chronic disease, this paper takes as its sense of problem the differential life expectancy for young men as against young women suffering from cystic fibrosis. From a qualitative study of the transition to adulthood for young people with the disease, a theory of gendered embodiment is proposed to explain this differential. The social construction of masculinity and femininity as social practices resulted in the former being more conducive to survival than the latter in this case. There were marked differences between the young women and young men in attitudes to: the meaning of life, death, career and body image; all of which affected adherence to medical regimen.     

How providers can preserve mutually beneficial joint ventures

Joint ventures between hospitals and physicians were formed at a dizzying pace during the 1980s. Many of these joint ventures are now a source of concern for both hospital and physician partners. In the following article, the authors discuss their experience with joint ventures in the wake of recent and proposed regulatory and legislative activity and present several practical strategies for hospital executives to consider regarding their joint ventures.     

"From the heart of my bottom": negotiating humor in focus group discussions

Reporting and analyzing interactional data collected during focus groups can be a significant challenge for qualitative health researchers. In this article, the authors explore the use of humor among focus group participants as one area of interaction and negotiation that is methodologically interesting and theoretically insightful. They explore discussions about service user involvement in medical education across eight focus groups consisting of medical educators, medical students, and service users. The findings suggest that humor can be used among focus group participants to maintain solidarity, navigate coping strategies, and negotiate power. Not only is humor useful when exploring new concepts, it can also be an indication of wider views that might not be explicit in an analysis of focus group members' comments alone. The authors urge qualitative health researchers to examine interactions among focus group participants, and their analysis of humor illustrates how this can be achieved.