British Pakistani Muslim Masculinity, (In)fertility,and the Clinical Encounter

ABSTRACT

The experiences of men facing fertility disruptions are understudied. For British Pakistanis, the impact of infertility is heightened for women because of normative pressures to bear children. But what of men? I present data from in-depth interviews in North East England with infertile British Pakistani Muslims and relevant health professionals. British Pakistani men’s level of participation in clinical encounters and responses to diagnoses of male factor infertility must be understood in the context of kinship, the construction of Pakistani ethnicity in the UK, and the subordinated forms of masculinity which accompany this identity.     

GPs' explanatory models for irritable bowel syndrome: a mismatch with patient models?

Background. Inconsistencies in doctors’ views about causesand treatment of irritable bowel syndrome (IBS) lead to frustrationfor doctors and in doctor–patient interactions. Diagnosisby GPs does not correspond well to established diagnostic criteria. Objective. To understand GPs’ explanatory models (EMs)and management strategies for IBS. Methods. Qualitative, semi-structured interviews with 30 GPs(15 from the UK and 15 from The Netherlands). Results. Diagnosing IBS in primary care is a complex process,involving symptoms, tests, history and risk calculation. GPswere uncertain about the aetiology of IBS, but often viewedit as a consequence of disordered bowel activity in responseto stress, which was viewed as a function of people's responsesto their environment. GPs tend to diagnose IBS by exclusion,rather than with formal diagnostic criteria. They endeavouredto present the IBS diagnosis to their patients in a way thatthey would accept, fearing that many would not be satisfiedwith a diagnosis that had no apparent physical cause. GPs focusedon managing symptoms and reassuring patients. Many GPs feltthat patients needed to take the responsibility for managingtheir IBS and for minimizing its impact on their daily lives.However, the GPs had limited awareness of the extent to whichIBS affected their patients’ daily lives. Conclusions. GPs’ diagnostic procedures and EMs for IBSare at odds with patient expectations and current guidelines.Shared discussion of what patients believe to be triggers forsymptoms, ways of coping with symptoms and the role of medicationmay be helpful. Keywords. Explanatory model, GP perception, irritable bowel syndrome, primary care, qualitative.     

Patients' explanatory models for irritable bowel syndrome: symptoms and treatment more important than explaining aetiology

Background. Irritable bowel syndrome (IBS) is a common conditionassociated with no certain organic cause, though diet and stressare widely implicated. The condition is frustrating for bothsufferers and doctors, and there are problems in diagnosingand treating the condition. Eliciting explanatory models (EMs)is a useful tool for understanding how individuals relate totheir illnesses and their expectations for treatment, particularlyfor illnesses with uncertain aetiology like IBS. Objectives. To understand the EMs, experiences and expectationsfor management of patients with IBS. Methods. Qualitative, semi-structured interviews were conductedwith 51 primary care patients (31 in the UK, 20 in The Netherlands)meeting the Rome II diagnostic criteria for IBS. Results. Although IBS often had a significant dampening effecton daily life, IBS patients made great efforts not to allowthe condition to take over their lives. Triggers of symptomswere more important to patients than understanding the underlyingaetiology of IBS. Diet and stress were both recognized as importanttriggers, but views about which foods were problematic and theextent to which stress was modifiable were inconsistent. Diagnosisand treatment were often a confusing and frustrating process,and patients often expected more diagnostic tests than theywere offered before receiving a diagnosis of IBS. However, theoften poor outcome of medical interventions does not, in general,appear to have a negative impact on the patient–doctorrelationship. Conclusions. Clinicians should be aware of the extensive impactof IBS on sufferers’ daily life and the frustration thatresults from repeatedly trying treatments with little effect.Clearly explaining the guidelines for diagnosing IBS and therange of treatment options may help patients to make sense ofthe diagnostic and treatment processes. The personal EM shouldbe addressed during the consultation with the IBS patient, ensuringthat any successive medical interventions match with the patients’disease perception. Keywords. Explanatory model, irritable bowel syndrome, patient perception, primary care, qualitative.     

Validity of age at menarche self-reported in adulthood

OBJECTIVE: To test the validity of age at menarche self-reported in adulthood and examine whether socioeconomic position, education, experience of gynaecological events and psychological symptoms influence the accuracy of recall. DESIGN: Prospective birth cohort study. SETTING: England, Scotland and Wales. PARTICIPANTS: 1050 women from the Medical Research Council National Survey of Health and Development, with two measures of age at menarche, one recorded in adolescence and the other self-reported at age 48 years. RESULTS: By calculating the limits of agreement, kappa statistic and Pearson's correlation coefficients (r), we found that the validity of age at menarche self-reported in middle age compared with that recorded in adolescence was moderate (kappa = 0.35, r = 0.66, n = 1050). Validity was improved by categorising age at menarche into three groups: early, normal and late (kappa = 0.43). Agreement was influenced by educational level and having had a stillbirth or miscarriage. CONCLUSIONS: The level of validity shown in this study throws some doubt on whether it is justifiable to use age at menarche self-reported in middle age. It is likely to introduce error and bias, and researchers should be aware of these limitations and use such measures with caution.     

Association of HIV status with sexual function in women aged 45–60 in England: results from two national surveys

ABSTRACT

Increasing numbers of women living with HIV are reaching their midlife. We explore the association of HIV status with sexual function (SF) in women aged 45–60 using two national cross-sectional surveys: the third British National Survey of Sexual Attitudes and Lifestyles (“Natsal-3”) and “PRIME”, a survey of women living with HIV attending HIV clinics across England. Both studies asked the same questions about SF that take account not only sexual difficulties but also the relationship context and overall level of satisfaction, which collectively allowed an overall SF score to be derived. We undertook analyses of sexually-active women aged 45–60 from Natsal-3 (N?=?1228, presumed HIV-negative given the low estimated prevalence of HIV in Britain) and PRIME (N?=?386 women living with HIV). Women living with HIV were compared to Natsal-3 participants using multivariable logistic regression (adjusting for key confounders identified a priori: ethnicity, ongoing relationship status, depression and number of chronic conditions) and propensity scoring. Relative to Natsal-3 participants, women living with HIV were more likely to: have low overall SF (adjusted odds ratio (AOR) 3.75 [2.15–6.56]), report ≥1 sexual problem(s) lasting ≥3 months (AOR 2.44 [1.49–4.00]), and report almost all 8 sexual problems asked about (AORs all ≥2.30). The association between HIV status and low SF remained statistically significant when using propensity scoring (AOR 2.43 [1.68–3.51]). Among women living with HIV (only), low SF was more common in those who were postmenopausal vs. Premenopausal (55.6% vs. 40.4%). This study suggests a negative association between HIV status and sexual function in women aged 45–60. We recommend routine assessment of SF in women living with HIV.     

'Everybody is moving on': infertility, relationality and the aesthetics of family among British-Pakistani Muslims

It is now widely recognised that experiences of infertility are socially and culturally contingent. Drawing on reproductive narratives of 108 British-Pakistani Muslims living in Northeast England (collected from 2007 to 2010), we show that subjective experiences of infertility in this population can take many forms, from 'straightforward' childlessness to concerns about inability to fulfil a range of reproductive expectations, desires and obligations, regarding timing, gender balance and number of offspring. Extended family relations are pivotal in the processes through which reproduction (or lack thereof) becomes defined as problematic. Changing family aesthetics can thus shape individuals' experiences of infertility in important ways. A growing emphasis on conjugal relationships for some couples offers a greater range of reproductive possibilities (enabling, for example, a period of voluntary childlessness). For others, increasing nuclearisation of family life reduces the possibilities for extended families to 'plug the gap' by providing proxy-children and a normalised social role for infertile couples. Moreover, such social roles may be time-limited, creating serious challenges for the long-term childless, who find themselves caught 'betwixt and between' two disparate sets of values.