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- Anthropology
- Anthropology and Sexuality
- Anthropology of Reproduction
- Anthropology of the Body
- Biological Anthropology
- Development anthropology
- Diaspora
- Diasporas
- Ethnography
- Health Outcomes
- Human Evolution
- Medical Anthropology
- Migrant Health (Mathematics)
- Pakistan
- Personal Narrative (Social and Cultural Anthropology)
- Population genetics (Biology)
- Reproduction
- Sexual and Reproductive Health
- Social and Cultural Anthropology
- South Asian Studies
- Visual Anthropology
Papers
GPs’ explanatory models for irritable bowel syndrome: a mismatch with patient models?
published in Family Practice, 2009
Background. Inconsistencies in doctors’ views about causes and treatment of irritable bowel syndrome (IBS) lead to frustration for doctors and in doctor–patient interactions. Diagnosis by 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. GPs were uncertain about the aetiology of IBS, but often viewed it as a consequence of disordered bowel activity in response to stress, which was viewed as a function of people's responses to their environment. GPs tend to diagnose IBS by exclusion, rather than with formal diagnostic criteria. They endeavoured to present the IBS diagnosis to their patients in a way that they would accept, fearing that many would not be satisfied with a diagnosis that had no apparent physical cause. GPs focused on managing symptoms and reassuring patients. Many GPs felt that patients needed to take the responsibility for managing their IBS and for minimizing its impact on their daily lives. However, the GPs had limited awareness of the extent to which IBS affected their patients’ daily lives.
Conclusions. GPs’ diagnostic procedures and EMs for IBS are at odds with patient expectations and current guidelines. Shared discussion of what patients believe to be triggers for symptoms, ways of coping with symptoms and the role of medication may be helpful.
Keywords. Explanatory model, GP perception, irritable bowel syndrome, primary care, qualitative.
DownloadPatients' explanatory models for irritable bowel syndrome: symptoms and treatment more important than explaining aetiology
published in Family Practice, 2009
Background. Irritable bowel syndrome (IBS) is a common condition associated with no certain organic cause, though diet and stress are widely implicated. The condition is frustrating for both sufferers and doctors, and there are problems in diagnosing and treating the condition. Eliciting explanatory models (EMs) is a useful tool for understanding how individuals relate to their illnesses and their expectations for treatment, particularly for illnesses with uncertain aetiology like IBS.
Objectives. To understand the EMs, experiences and expectations for management of patients with IBS.
Methods. Qualitative, semi-structured interviews were conducted with 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 effect on daily life, IBS patients made great efforts not to allow the condition to take over their lives. Triggers of symptoms were more important to patients than understanding the underlying aetiology of IBS. Diet and stress were both recognized as important triggers, but views about which foods were problematic and the extent to which stress was modifiable were inconsistent. Diagnosis and treatment were often a confusing and frustrating process, and patients often expected more diagnostic tests than they were offered before receiving a diagnosis of IBS. However, the often poor outcome of medical interventions does not, in general, appear to have a negative impact on the patient–doctor relationship.
Conclusions. Clinicians should be aware of the extensive impact of IBS on sufferers’ daily life and the frustration that results from repeatedly trying treatments with little effect. Clearly explaining the guidelines for diagnosing IBS and the range of treatment options may help patients to make sense of the diagnostic and treatment processes. The personal EM should be addressed during the consultation with the IBS patient, ensuring that any successive medical interventions match with the patients’ disease perception.
Keywords. Explanatory model, irritable bowel syndrome, patient perception, primary care, qualitative.
PREDICTORS OF AGE AT MENARCHE IN THE NEWCASTLE THOUSAND FAMILIES STUDY
published in Journal of Biosocial Science, 2008
Summary
Several studies have found relationships between early life factors (birth weight, length of gestation, height, weight, duration of breast-feeding, maternal age, social class, periods of infection, presence of adverse life events, and quality of housing conditions in childhood) and age at menarche but none has considered all of these factors in the same study. The follow-up study of the Newcastle Thousand Families birth cohort, established in 1947, provided age at menarche data collected retrospectively at age 50 from 276 women who returned self-completion questionnaires in 1997. Three main independent associations were observed: girls who experienced a shorter gestation, girls whose mothers were younger when they were born, and girls who were heavier at age 9 had earlier menarche. Birth weight, standardized for gestational age, was found to have different relationships with age at menarche depending upon how heavy or light a girl was at age 9. The results of this study support the hypotheses that conditions in fetal and early life are associated with the timing of menarche and that greater childhood growth is associated with earlier menarche. It is suggested that future work should focus on illuminating the mechanisms underlying these statistical relationships.
Indentured migration and differential gender gene flow: The origin and evolution of the East-Indian community of Limón, Costa Rica
published in American Journal of Physical Anthropology, 2007
After the emancipation of African slaves in the Caribbean, the labor void left by out-migrating former slaves was filled by in-migrating indentured servants from prepartition India and China. In some areas of the Caribbean such as Trinidad, Suriname, and Guyana, the East-Indian migrants formed large communities. In this article, we report a study based on mtDNA and Y-chromosomal markers of a small East-Indian community from Limón, Costa Rica. The purpose of the project is to determine the place of origin in the Indian subcontinent of the ancestors of our group and the contributions to its gene pool through gene flow by members of other ethnic groups. Both Y-chromosome and mtDNA suggest that the Indo-Costa Ricans descend from migrants primarily from Central India. While both paternal and maternal markers indicate that this group is overwhelmingly of Indian origin, they also indicate that males and females of African, European, and Amerindian origin contributed to it differently. We discuss our results in the historical context of the virtual extinction of Amerindian Caribbean groups, the forced migration of African slaves to the Caribbean, and the gene flow between Amerindians, Europeans, East-Indians, and Africans that eventually produced the Caribbean's currently diverse gene pool.
The East Indian Diaspora in Costa Rica: Inbreeding Avoidance, Marriage Patterns, and Cultural Survival
published in American Anthropologist, 2007
Anthropologists have long been interested in the survival of Indian cultural traits in the New World. In this article, we present results of an ongoing project with a Costa Rican community that descends from East Indian indentured servants. We focus on the group's marriage patterns and how these patterns might have helped keep the community as a cohesive ethnic group. We investigate the group's level of inbreeding by computing the inbreeding coefficient using two different methods. We show that the community has been successful at keeping its inbreeding low, despite its small size, by allowing marriage with nonmembers of the community. We propose that unless consanguineous marriages are allowed virtually all of the community's marriages will be with noncommunity members. Absorption into tourism, as well as the community's staunch avoidance of consanguineous marriages and virtually universal marriage with noncommunity members, will likely contribute to their disappearance as a viable ethnic group.
Validity of age at menarche self-reported in adulthood
published in Journal of Epidemiology and Community Health, 2006
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.