In Canada, as elsewhere, introspective and nostalgic views of community and nation-state are being challenged by the impacts of globalism and cosmopolitanism. The impact of these transformations is acute in the context of Canada, where a liberal multiculturalism is transmuting into a hybrid pluralism. Current strategies of identity formation have to accommodate a hybridity that is being fostered by an ever-increasing diasporic population for whom "lived-in places" exhibit transnationalist connections. Too often, established mnemonic tropes relate to past iconic values and norms of the nation-state, even though they are no longer connected with emerging new values that search for new modes of expression. This paper discusses the crucial role of the arts and heritage in this local anchoring of the transnational polity, arguing that symbolic landscapes become sites where new values are contested and traditional iconic values are challenged.Résumé : Içi, comme ailleurs, des représentations introspectives et nostalgiques de communauté et d'État sont remises en question suite à l'impacte des effets de la mondialisation et du cosmopolitisme. La conséquence de ces transformations est fortement marquée dans un contexte canadien où un certain multiculturalisme libéral est en voie de se transformer en pluralisme hybride. Les stratégies courantes de création d'identité doivent accommoder une hybridité stimulée par une population diasporique grandissante chez qui le lieu d'habitation présente un contenu trans-nationaliste. Il se trouve trop souvent que des tropes mnémoniques préétablis s'apparentent à des valeurs iconiques traditionnelles et à des normes de l'État, même quand ils ne sont plus rattachés aux valeurs émergentes qui cherchent à élaborer de nouveaux modes d'expression. Cette communication examine le rôle critique des arts et du patrimoine vis-à-vis l'insertion au niveau local de l'entité transnationale. Il propose que les paysages symboliques deviennent des sites où de nouvelles valeurs sont contestées et où les valeurs ioniques traditionnelles sont remises au défi.
BackgroundPeople with enduring mental illness (EMI) have higher morbidity and mortality from chronic diseases than the general population, and this results in a significantly reduced relative life expectancy—accounted for primarily by physical illness. This gap may be partly influenced by the reduced likelihood of access to and uptake of regular physical health screening.AimTo establish Irish service providers’ perspectives regarding the care of the physical health of people with EMI in an effort to inform future service developments aimed at improving the physical health of people with EMI.Design and settingQualitative study of healthcare providers—general practitioners (GPs) and members of the community mental health teams—in Ireland.ParticipantsGPs and mental health service providers.MethodsQualitative semi-structured interviews were conducted with 34 service providers. Thematic analysis was undertaken.ResultsParticipants considered that the physical health of people with EMI is not currently regularly addressed by the patient’s GP or the mental health team. Factors associated with this include patient compliance with attendance, time constraints in consultations to adequately support patient self-management, communication difficulties with the patient and between primary and secondary care, and lack of clarity as to whose responsibility it is to ensure physical health is monitored. In participants’ view, a barrier to improvement is the present funding approach.ConclusionThe evidence from this study has the potential to form the basis for innovation and change in service delivery for people with an EMI in Ireland and internationally, specifically in countries where it is not clear who has the overall responsibility to monitor the physical health of patients with EMI. This role requires time and regular contact, and both the organisation and the funding of the health system need to support it.
IntroductionDespite advances in the co-creation of clinical research involving consumers in the last few decades, consumer engagement in health services research generally remains inconsistent and is too often treated as a perfunctory exercise.ObjectiveDrawing on a health services study on diagnostic test result management, communication and follow-up, we: (1) outline practical strategies used to enhance the contribution of health consumer representatives across all stages of health services research, including active involvement in prioritising objectives for data analysis and participating in data analysis and the dissemination of findings; and (2) describe the impact of continued engagement of consumers on the programme of research, the interpretation of findings and their translational potential.Key innovationsKey enabling innovations for engagement included: (1) planned opportunities for long-term consumer involvement across all stages of the research process from conception to dissemination; (2) enhanced consumer engagement capacity; (3) purposeful recruitment of appropriately trained consumers; (4) provision of support structures for active consumer involvement in research design, analysis and write-up; and (5) financial support for consumer involvement.Impact/ConclusionEnhancing consumer contribution and establishing inclusive research design requires a negotiated, interactive, meaningful and transparent process. As a collaborative approach, consumer-driven research involvement offers opportunities for new, often unexpected or unexplored perspectives to feature across the whole research process. In a move away from tokenistic consumer involvement, consumers and researchers who participated in this novel and immersive research project identified inclusive research as a powerful tool to enhance health services research and its translation into effective policy.
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