scholarly journals After illness, under diagnosis

Author(s):  
Lenore Manderson

A vast portion of the world’s population live with ill health following acute infection or disease and its emergency management. This reflects the increased capacity of technological innovations and pharmaceuticals to interrupt decline or complications, even when cure is unlikely. The authors in this Special Section illustrate how, in different localities, people live with risk for themselves or their offspring; with non-communicable, degenerative, autoimmune, and congenital conditions; with the after-effects of diagnostic procedures and surgical interventions; and with continued treatment and surveillance. We attend to the value of conceptualising this as ‘living under’ diagnosis or description. We illustrate how diagnostic labels overdetermine subsequent embodied states of being, structuring interactions and social relations with family, friends, and health professionals. Living under diagnosis, we argue, impacts on self-care, care for and by others, everyday lives, and anticipations of the future.

2019 ◽  
Author(s):  
Babak Hemmatian ◽  
Sze Yu Yu Chan ◽  
Steven A. Sloman

A label’s entrenchment, its degree of use by members of a community, affects its perceived explanatory value even if the label provides no substantive information (Hemmatian & Sloman, 2018). In three experiments, we show that laypersons and mental health professionals see entrenched psychiatric and non-psychiatric diagnostic labels as better explanations than non-entrenched labels even if they are circular. Using scenarios involving experts who discuss unfamiliar diagnostic categories, we show that this preference is not due to violations of conversational norms, lack of reflectiveness or attentiveness, and the characters’ familiarity or unfamiliarity with the label. In Experiment 1, whether a label provided novel symptom information or not had no impact on lay responses, while its entrenchment enhanced ratings of explanation quality. The effect persisted in Experiment 2 for causally incoherent categories and regardless of direct provision of mechanistic information. The effect of entrenchment was partly related to induced causal beliefs about the category, even when participants were informed there is no causal relation. Most participants in both experiments did not report any effect of entrenchment and the effect was present for those who did not. In Experiment 3, mental health professionals showed the effect using diagnoses that were mere shorthands for symptoms, despite a tendency to rate all explanations as unsatisfactory. The data suggest that bringing experts’ attention to the manipulation eliminates the effect. We discuss practical implications for mental health disciplines and potential ways to mitigate the impact of entrenchment.


2021 ◽  
Author(s):  
Jonas Jardim de Paula ◽  
Danielle de Souza Costa ◽  
Antônio Geraldo Silva ◽  
Débora Marques de Miranda ◽  
Leandro Malloy-Diniz

Quality of Life (QoL) is a multidimensional estimate of biopsychosocial health and wellbeing.1 The COVID-19 pandemic led to an abrupt change in our lifestyle, demanding resilience and coping mechanisms2. Health care providers are in the frontline of COVID-19 patients’ diagnosis, treatment, and rehabilitation, and there is a well-documented impact of this context on their physical and mental health2. This might impact their wellbeing and reduce their quality of life. In this research letter, we investigated which factors are associated with QoL in Brazilian healthcare professionals. We aim to investigate both protective and risk factors for the four main aspects of QoL: physical, psychological, social relations, and environment. We assessed 97.771 Brazilian adults, most (92.3%) health professionals of different professions from all the five-country regions. All included individuals agreed in a written consent to participate. Participants showed an average of 35.45 years old (±9.49) and were predominantly female (80%). They answered an online questionnaire about sociodemographic aspects, measures of mental health, and quality of life in the first semester of 2020. A detailed description of the sample and procedures can be found elsewhere3. All participants answered the WHOQoL-BREF, a standardized tool for QoL assessment developed by the World Health Organization. Stepwise linear regression analysis was used to assess the role of sociodemographic factors, previously diagnosed mental disorders, COVID-19 related symptoms as well a series of specific questions regarding participants worries and perceptions about the pandemic, including the protective behaviors' adoption (social distancing, usage of masks and sanitizer, among others). A full list of variables (64 in total) is available on the SAMBE webpage (http://abpbrasil.org.br/pcabp/). Since we have a large sample size our statistical power is about 99% (alpha=0.01) to detect small effect sizes. To simplify our results and allow a more direct application to real-life settings we only included significant predictors which showed at least 1% of adjusted explained variance in the stepwise models. The stepwise regression model was summarized in the figure below. All regression models were significant (p<0.001) as well all the predictors reported in the Figure. Total explained variance was 26% for Physical QoL, 27% for Psychological, 13% for Social Relations, and 19% for Environmental. A history of previous depression, presence of Headache, and the perception of worsening in home relationships were risk factors for lower QoL in all four domains. Our results suggest a multidimensional pattern of determinants of QoL in health care professionals in the early days of the pandemic. Interesting features emerged as predictors of QoL such as changes in home relationships, worsening in work productivity, and mental health. Expected and new predictors may shed light on which factors should be considered in interventions aiming at the development of mitigation of impact QoL in these populations.


2020 ◽  
Vol 30 (Supplement_2) ◽  
Author(s):  
S Martins ◽  
Z Moreira

Abstract Introduction Cyclophosphamide is a cytotoxic widely used in the treatment of various cancers. It has been observed, for many years, that those responsible for its handling and administration are exposed and levels of contamination have been detected in biological samples collected from these professionals, in surfaces and in the air. Objectives To review the literature on occupational contamination by cyclophosphamide. Methodology The following inclusion criteria were selected: articles published until the present year, articles in English, scientific papers on cyclophosphamide contamination in hospital health professionals, scientific articles on contamination detection methods and articles on the effects that can outcome from cyclophosphamide contamination. Results The cyclophosphamide levels have been decreasing with the implementation of preparation and cleaning guidelines as well as with the emergence of new techniques of manipulation and technological innovations. However, the dermal route remains the main route of contamination and those responsible for cytotoxic manipulation are not the only ones exposed. It was verified that hospital professionals, who in their profession would not be in contact with cyclophosphamide, also presented levels of contamination in the collected urine samples. Conclusion It is necessary to continue to alert hospital professionals to the importance of always complying with the handling and cleaning protocols, since one of the main causes of contamination is precisely the performance of incorrect procedures during both tasks. This is a topic that should be further studied in order to minimize the exposure and consequently the associated risks.


2015 ◽  
Vol 44 (3) ◽  
pp. 361-373 ◽  
Author(s):  
Danny C.K. Lam ◽  
Elena V. Poplavskaya ◽  
Paul M. Salkovskis ◽  
Lorna I. Hogg ◽  
Holly Panting

Background: There is concern that diagnostic labels for psychiatric disorders may invoke damaging stigma, stereotypes and misunderstanding. Aims: This study investigated clinicians’ reactions to diagnostic labelling by examining their positive and negative reactions to the label borderline personality disorder (BPD). Method: Mental health professionals (n = 265) viewed a videotape of a patient suffering from panic disorder and agoraphobia undergoing assessment. Prior to viewing the videotape, participants were randomly allocated to one of three conditions and were given the following information about the patient: (a) general background information; (b) additional descriptive information about behaviour corresponding to BPD; and (c) additional descriptive information about behaviour corresponding to BPD, but explicitly adding BPD as a possible comorbid diagnostic label. All participants were then asked to note things they had seen in the videotape that made them feel optimistic or pessimistic about treatment outcome. Results: Participants in the group that were explicitly informed that the patient had a BPD diagnostic label reported significantly fewer reasons to be optimistic than the other two groups. Conclusions: Diagnostic labels may negatively impact on clinicians’ judgments and perceptions of individuals and therefore clinicians should think carefully about whether, and how, they use diagnoses and efforts should be made to destigmatize diagnostic terms.


2005 ◽  
Vol 35 (3) ◽  
pp. 169-171 ◽  
Author(s):  
D A Ndububa ◽  
O S Ojo ◽  
A O Aladegbaiye ◽  
R A Adebayo ◽  
V A Adetiloye ◽  
...  

Child-Pugh grading is an important determinant of treatment options, surgical interventions and prognosis in chronic liver disease. Sixty-four liver cirrhosis patients (49 men, 15 women) seen at Ile-Ife, Nigeria were graded according to the Child-Pugh parameters. Only one (1.6%) was in Class A, while 21 (32.8%) and 42 (65.6%) were in Classes B and C, respectively. Thirty-four either had coagulopathy or were already in encephalopathy at the time of presentation. Hepatitis B virus-associated disease was present in 64% of the patients. Most Nigerian cirrhosis patients present with very advanced disease; they are thus poor-risk candidates for diagnostic procedures and surgery. Efforts should be intensified at making the diagnosis at a much earlier stage and universal immunization with the hepatitis B vaccine should be commenced to reduce the incidence of HBV-related chronic liver disease in Nigeria.


Hadmérnök ◽  
2019 ◽  
Vol 14 (2) ◽  
pp. 347-353
Author(s):  
Zsolt Fejes ◽  
Sándor Mihók ◽  
Márk Péter Matusz

The use of medical diagnostics and therapeutic instruments supported by infocommunication systems is increasingly widespread. These devices are capable of conducting new telemedicine therapeutic methods, remote monitoring system and diagnostic procedures and may serve as additional tools for prevention, as well as health education. However, legal regulation of the area is very difficult owing to technological innovations and the emergence of new fields of application, but is nevertheless indispensable today. We strive to create an objective image that is typical of the current situation.


2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Senthamil Sindhu ◽  
Nithya Jagannathan

The ability to monitor the health and disease status of the patient through saliva is a highly desirable goal for the health professionals. Considering the microconcentration of salivary constituents, saliva is explored to be diagnostic tool as it also meets the demands for an inexpensive, noninvasive and easy to use screening method. The incorporation of salivary diagnostics into clinical practice is gaining reality and will be of diagnostic value in the prospective future. The investigative use of saliva is not being applied only in dental health but also in various other systemic disorders. The advent of molecular techniques is gaining attention and this has triggered its application as a specific and sensitive biomarker in proteomics, genomics, and transcriptomics. This review discusses the basics of salivary diagnostics, expectoration techniques, and its application in various local and systemic disorders.


2000 ◽  
Vol 9 (4) ◽  
pp. 443-445 ◽  
Author(s):  
Paul J. Reitemeier

The bioethics literature on collective labor protest actions by health professionals is modest and recent, focusing almost exclusively on strike actions—although that is beginning to change. The essays in this special section of the Cambridge Quarterly seek to further explore many of the key ethical issues in some detail. The authors analyze existing ethical tensions and propose responses (none presume to call them solutions) to the increasingly hostile conflicts between licensed health professionals and the new corporate management of healthcare organizations.


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