Realism and national identity in 'Y Tu Mamá También': an audience perspective

When referring to cinema and its emancipatory potential, realism, like Plato’s pharmakon, has signified both illness and cure, poison and medicine. On the one hand, realism is regarded as the main feature of so-called classical cinema, inherently conservative and thoroughly ideological, its main raison d’être being to reify and make a particular version of the status quo believable and to pass it out as ‘reality’ (Burch, 1990; MacCabe, 1974). On the other, realism has also been interpreted as a quest for truth and social justice, as in the positivist ethos that informs documentary (Zavattini, 1953). Even in the latter sense, however, the extent to which realism has served colonizing ends when used to investigate the ‘truth’ of the Other has also been noted, rendering the form profoundly suspicious (Chow, 2007, p. 150). For realism has been a Western form of representation, one that can be traced back to the invention of perspective in painting and that peaked with the secular worldview brought about by the Enlightenment. And like realism, the nation state too is a product of the Enlightenment, nationalism being, as it were, a secular replacement for the religious - that is enchanted or fantastic - worldview. In this way, realism, cinema and nation are inextricably linked, and equally strained under the current decline of the Enlightenment paradigm. This chapter looks at Y tu Mamá También by Alfonso Cuarón (2001), a highly successful road movie with documentary features, to explore the ways in which realism, cinema and nation interact with each other in the present conditions of ‘globalization’ as experienced in Mexico. The chapter compares and contrasts various interpretations of the role of realism in this film put forward by critics and scholars and other discourses about it circulating in the media with actual ways of audience engagement with it.

Development of an intervention to support medication management in patients with multimorbidity in primary care

The overarching aim of this thesis was to develop an intervention to support patient-centred prescribing in the context of multimorbidity in primary care. Methods A range of research methods were used to address different components of the Medical Research Council, UK (MRC) guidance on the development and evaluation of complex interventions in health care. The existing evidence on GPs’ perceptions of the management of multimorbidity was systematically reviewed. In qualitative interviews, chart-stimulated recall was used to explore the challenges experienced by GPs when prescribing for multimorbid patients. In a cross-sectional study, the psychosocial issues that complicate the management of multimorbidity were examined. To develop the complex intervention, the Behaviour Change Wheel (BCW) was used to integrate behavioural theory with the findings of these three studies. A feasibility study of the new intervention was then conducted with GPs. Results The systematic review revealed four domains of clinical practice where GPs experienced difficulties in multimorbidity. The qualitative interview study showed that GPs responded to these difficulties by ‘satisficing’. In multimorbid patients perceived as stable, GPs preferred to ‘maintain the status quo’ rather than actively change medications. In the cross-sectional study, the significant association between multimorbidity and negative psychosocial factors was shown. These findings informed the development of the ‘Multimorbidity Collaborative Medication Review and Decision-making’ (MY COMRADE) intervention. The intervention involves peer support: two GPs review the medications prescribed to a complex multimorbid patient together. In the feasibility study, GPs reported that the intervention was appropriate for the context of general practice; was widely applicable to their patients with multimorbidity; and recommendations for optimising medications arose from all collaborative reviews. Conclusion Applying theory to empirical data has led to an intervention that is implementable in clinical practice, and has the potential to positively change GPs’ behaviour in the management of medications for patients with multimorbidity.