Current policy and research around type 2 diabetes (T2D) interventions largely invoke a behavioral model. We suggest that activation of the physiologic stress response (PSR) from chronic exposure to stressors, low socioeconomic status (SES), severe mental health problems, or aggressive behavior increases the risk of T2D. This article is a comprehensive review of the literature on the link between T2D and psychosocial factors focusing on prospective studies of the risk for developing diabetes. The review found an increased risk for T2D in people: exposed to stressful working conditions or traumatic events; with depression; with personality traits or mental health problems that put them in conflict with others; of low SES, either currently or in childhood; and in racial/ethnic minority populations, independent of current SES. This review suggests that T2D prevention research would be more effective if (a) the PSR to psychosocial factors (especially social disparities) was recognized and (b) intervention programs evaluated reduction in social disparities as part of a comprehensive approach.
Experiences of the diagnosis and management of tuberculosis: a focused ethnography of Somali patients and healthcare professionals in the UK. Abstract Aim.To explore experiences of the diagnosis and management of tuberculosis from the perspective of Somali patients and healthcare professionals involved in their care.
Plain English summary Whilst Patient and Public Involvement and Engagement (PPIE) are widely regarded as critical to developing clinical research, there is a perception that older adults may not be able to contribute and there is less emphasis on gaining a wide range of opinions before developing research questions or projects; for example an organisational change. This PPIE initiative used three PPIE processes including existing panels and wider networking to access older adults in the community who had used the hospital services and been discharged. Older adults expressed a range of views about their experience of discharge planning and this provided an important perspective on patients’ research priorities associated with their personal independence. Efforts were taken to ensure representative views across a cross section of the population. As a result of this initial PPIE, a permanent, co-ordinated ‘elders’ panel has been established to ensure a representation of older adult views for research, service development and evaluation. This panel has permanent, fully supported members who provide reflection and feedback on any projects and programmes relating to older people’s services in the City. Abstract Background Clinical academic research and service improvement is planned using Patient and Public Involvement and Engagement (PPIE) but older PPIE participants are consulted less often due to the perception that they are vulnerable or hard to engage. Objectives To consult frail older adults about a recently adopted service, discharge to assess (D2A), and to prioritise services improvements and research topics associated with the design and delivery of discharge from hospital. To use successive PPIE processes to enable a permanent PPIE panel to be established. Participants Following guidance from an established hospital PPI panel 27 older adult participants were recruited. Participants from Black, Asian and Minority Ethnic (BAME) communities, affluent and non-affluent areas and varied social circumstances were included. Methods Focus groups and individual interviews were conducted in participants own homes or nearby social venues. Results Priorities for discharge included remaining independent despite often feeling lonely at home; to remain in hospital if needed; and for services to ensure effective communication with families. The main research priority identified was facilitating independence, whilst establishing a permanent PPIE panel involving older adults was viewed favourably. Conclusions Taking a structured approach to PPIE enabled varied older peoples’ voices to express their priorities and concerns into early discharge from hospital, as well as enabling the development of health services research into hospital discharge planning and management. Older people as participants identified research...
Purpose -Evidence, though limited, suggests that UK minority ethnic individuals have lower referral rates for eating disorders than their White British counterparts. Missed or delayed diagnosis may be an important contributory factor. This paper seeks to identify key areas that require attention for early detection and treatment of eating disorders in minority ethnic people.Design/methodology/approach -The approach taken was a community-based qualitative study in Sheffield, England: interviews with relatives of people with eating disorders (n ¼ 3); key informant interviews (n ¼ 15); group discussions with community members aged 18-24 (n ¼ 4, 24 participants).Findings -Several factors appear to influence the recognition of, and response to, eating disorders among minority ethnic people with potential implications for timely diagnosis and treatment. Low public awareness was an important barrier to seeking medical attention. Norms and ideals relating to food and body image, as well as some religious practices, can also discourage prompt recognition of illness, though there is much diversity within and between families and communities. Some service providers can be slow to consider the possibility of eating disorders among minority ethnic individuals, while others lack confidence to deal with the needs of minority ethnic people. Poor past experiences with services also undermine people's willingness to engage with services.Originality/value -The paper provides insights into socio-cultural influences on the experiences of people living with eating disorders that require greater attention by services. Healthcare practitioners need enhanced awareness that eating disorders do affect minority ethnic people and greater confidence to engage with these patients to gain the information needed for prompt diagnosis and effective treatment.
Aim. To ascertain the socio-cultural meaning and consequences of tuberculosis among people of Somali origin living in the UK.Background. In countries where treatment has not been readily available, tuberculosis has become highly stigmatized.
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