Management of persistent pain in the older people

Persistent pain is a commonly experienced symptom. It affects 25% of community-dwelling older adults and up to 80% of nursing home residents, and can have a major impact on quality of life and functional capacity. Unfortunately pain in older patients is often undertreated and misunderstood. Assessment of pain type and severity is important. Most older people, even with moderately impaired cognition, are able to self-report pain. Validated assessment tools using non-verbal pain cues are available for people with more advanced cognitive impairment. Management of pain in older people can be challenging. Physiological changes may impact on pain perception and the pharmacodynamics and pharmacokinetics of medications. Older people are often more sensitive to the adverse effects of analgesic medications and are at risk of drug–drug interactions due to the presence of co-morbidities and polypharmacy. In general, analgesic medications should be commenced at low doses, titrated based on effect and tolerability, and regularly reviewed. Contemporary pain management often utilises multiple analgesics in lower doses to optimise efficacy and avoid dose-related toxicity. A bio-psycho-social approach to the management of persistent pain, utilising a multidisciplinary team and including non-drug strategies, may produce the best results. The goal of pain management is not always to eliminate pain, since this may not be attainable, but rather to enhance function and improve quality of life. This article discusses persistent non-cancer pain in older people, its assessment and management, and the risks and benefits of pharmacological treatment in this population.

Depression in / by / for women : agency, feminism and self-help in groups

Depression in / by / for Women: Agency, Feminism and Self-Help in Groups on ensimmäinen väitöstasoinen tutkimus feministisestä terapiasta Suomessa sijoittuen psykologian, sosiaalitieteellisen mielenterveystutkimuksen sekä feministisen tutkimuksen alueille. Perinteisen näkemyksen mukaan feministisen tutkimuksen tulee olla ”naisista, naisten tekemää ja naisille kohdistettua”. Naiset ja masennus -projektitutkimus keskittyy naisten kokemaan masennukseen sisältäen mahdollisen miesten sekä patriarkaalisen hyvinvointivaltion osuuden masennukseen. Masennusta kokevat naiset ovat tutkimuksessa sekä tutkimuksen kohteena että aktiivisia osanottajia, mikä tuo heidän äänensä kuuluville. Tutkimus perustuu vuosien 1994-2000 välisenä aikana kerättyyn 11 ryhmän osallistujia koskevaan kvalitatiivisiin ja kvantitatiivisiin aineistoon. Irmeli Laitinen on ollut suunnittelemassa, keräämässä ja analysoimassa sitä yhdessä projektin muiden jäsenten kanssa. Tutkimuksessa mitattiin kuinka ryhmiin osallistuvien seka masennuksen tunteet että toiminnat muuttuivat yhden vuoden aikana. Tutkimuksen tavoitteena oli sekä masennuksesta kärsivien naisten osallistuminen feministiseen toimintatutkimukseen että ammatillisesti ohjatun oma-apuryhmämenetelmän kehittäminen suomalaiseen mielenterveyspalveluun. Projektin tutkimustulosten mukaan siihen osallistuneet naiset voimaantuivat ymmärtämään itseään sekä saivat luottamusta sosiaaliisiin taitoihinsa. Pidemmällä aikavälillä naisten tunteet muuttuivat myönteisiksi, heidän suhteensa itseensä positiivisemmaksi ja he aktivoituivat fyysisesti. Lisäksi tutkimustulokset viittaavat siihen, että masennus voi johtua näkymättömästä, sukupuolisesti virittyneestä jännitteestä naisystävällisessä hyvinvointivaltiossa paljastaen ”hyvinvointimasennusoireilun”. Suomalaisen sosiologi Erik Allardtin hyvinvointitypologian - having, loving, being – mukaisesti nämä ryhmään osallistuvat naiset eivät koe puutteita niinkään materiaalisessa hyvinvoinnissa (having) vaan pikeminkin suhteiden, sosiaalisen ja emotionaalisen hyvinvoinnin ulottuvuuksilla (loving ja being). Se, että masentuneet naiset pystyvät tuomaan esille pitkään vaiennettuja kokemuksiaan, voi merkitä paljon heidän paranemisessaan ja voimaantumisessaan. Ammatillisesti ohjatut oma-apuryhmät ja naisystävälliset hoitokäytännöt mahdollistivat tämänkaltaisen paranemisprosessin alkamisen tutkimukseen osallistuneissa ryhmissä.

Ryhmärajoja ja hierarkioita : etnografinen tutkimus peruskoulun yläasteen liikunnanopetuksesta

This study examines gender as a dimension of group divisions and differences in physical education (PE) lessons at school. The aim is to look at those structures and practices which direct the ways the girls and the boys move their bodies at secondary school in 2000’s while growing up to become women and men. Theoretically, the goal is to clarify how the social is inscribed to the bodies in the context of physical education lessons at school. This ethnographic study was conducted in the physical education lessons of 7th graders (13-14-year-olds) by observing the everyday life in five PE groups and by interviewing pupils (N=27) and their teachers (N=2). This method has given the researcher “a sense of the game”; an embodied experience of the feel for the game of the studied phenomenon. The access to the contextual “positions of expertise” does not seem to be socially and materially equally distributed in physical education. In PE the criteria of inclusion and exclusion were intertwined with physical skills and friendships, these hierarchies becoming visible in the situations of team choice in PE lessons. Not all families have possibilities to enable their children to participate in expensive leisure sports activities. Therefore the family’s societal position is in relation to the construction of leisure time activities. The access to certain possibilities demands time and money. In Finland the physical education is mainly carried out in differentiated groups for girls and boys. In physical education, the gender-differentiated groups, and partially the different practices of these groups activate, and on the other hand suppress, situations of gender related borderwork. In this research, both pupils and PE teachers repeatedly mentioned the naturality of the differences while speaking about gender. The differences were also restored to gender. I apply Erving Goffman’s dramaturgical view to the social situations, ethnographic fieldwork and interviews. My central statement is that in ethnography the audience has access to the backstage of the researcher since reporting does not follow the traditional division to the public and the private.

Words as Events : Cretan Mantinádes in Performance and Composition

Words as Events introduces the tradition of short, communicative rhyming couplets, the mantinádes, which are still sung and recited in a variety of performance situations on the island of Crete. The local focus on communicative economy and artistry is further examined in an in-depth analysis of the processes and ideals of composition. Short genres of oral poetry have been widely neglected in folklore research; however, their demand for structural and semantic coherence as well as their dialogic nature appeals to very different human needs from those of the longer poems. In contemporary Crete, poems also appear in written contexts, they are submitted to modern mass media, and people widely exchange them as text messages. By striving to understand the tradition during a period of change, this study analyzes the larger principles that ground the communication, self-expression and creativity in the genre. The aim of this research is thus twofold: to present this specific register of dialogic oral poetry as well as to create a theoretical approach sensitive to the creativity of such short registers. The study is based on long-term ethnographic fieldwork conducted in Crete between the years 1997 2009. An important aspect of the methodology was to create long-term ties with a number of key-informants who composed mantinádes. The interdisciplinary theoretical and methodological basis for this analysis is in the contemporary Finnish and international research on oral poetry and on anthropological research on communicative speech genres. These theoretical insights are extended by addressing questions of spontaneity and individual agency. Since mantinádes are at the same time a model for composition and a reserve of poems in fixed form, the aesthetics and objectives of performance and composition are also plural. In a traditional singing event, the basic motivation for the singers is to provide a meaningful contribution to a selected theme, which is the shared topic of the poetic dialogue. Consequently, similar topics giving rise to poetic associations can be encountered during various moments of everyday life: the dialogic nature is embodied in the tradition to such degree that it also arises in the performances and composition of single poems and outside of any institutionalized performance arenas. Therefore, as this study discusses in detail, even the apparently non-contextualized poems recited between locals or occurring in the contemporary mass media arenas, are understood and evaluated as utterances that provide an individual perspective within a certain dialogue.

Roman Ingarden’s Objectivity vs. Subjectivity as a problem of Translatability

Ingarden (1962, 1964) postulates that artworks exist in an “Objective purely intentional” way. According to this view, objectivity and subjectivity are opposed forms of existence, parallel to the opposition between realism and idealism. Using arguments of cognitive science, experimental psychology, and semiotics, this lecture proposes that, particularly in the aesthetic phenomena, realism and idealism are not pure oppositions; rather they are aspects of a single process of cognition in different strata. Furthermore, the concept of realism can be conceived as an empirical extreme of idealism, and the concept of idealism can be conceived as a pre-operative extreme of realism. Both kind of systems of knowledge are mutually associated by a synecdoche, performing major tasks of mental order and categorisation. This contribution suggests that the supposed opposition between objectivity and subjectivity, raises, first of all, a problem of translatability, more than a problem of existential categories. Synecdoche seems to be a very basic transaction of the mind, establishing ontologies (in the more Ingardean way of the term). Wegrzecki (1994, 220) defines ontology as “the central domain of philosophy to which other its parts directly or indirectly refer”. Thus, ontology operates within philosophy as the synecdoche does within language, pointing the sense of the general into the particular and/or viceversa. The many affinities and similarities between different sign systems, like those found across the interrelationships of the arts, are embedded into a transversal, synecdochic intersemiosis. An important question, from this view, is whether Ingardean’s pure objectivities lie basically on the impossibility of translation, therefore being absolute self-referential constructions. In such a case, it would be impossible to translate pure intentionality into something else, like acts or products.

The Impact of Readily Detected- and Underlying Attributes on Social Integration in Cross-Cultural Settings

The benefits and drawbacks of homogeneity and heterogeneity have been debated at length. Whereas some researchers assert that heterogeneity is beneficial for groups that are engaged in complex problem solving, the other researchers emphasize the potential costs associated with diversity. The inconsistency is a result of the incomplete measurement of diversity and focus one or two types of diversity. Most research concentrates on the readily detected/visible characteristics, making the assumption that such characteristics are related to underlying attributes (e.g., attitudes and values). In many cases, the demographic characteristics do not covary perfectly with the psychological attributes. Thus both types of attributes need to be utilized to fully understand the impact of diversity. The present research with four essays takes into account both types of attributes and tests their impact on social integration in cross-cultural settings. The results indicate that: (1) readily detectable- and underlying attributes are not related; (2) diversity has overall a negative impact on social integration; (3) socio-cultural context potentially influences the salience of diversity; and (4) diversity and social integration influences the formation of social cognition in form of transactive memory directories. The limits of research and managerial implications are discussed.

Towards a Conceptual History of Narrative

The article outlines a conceptual history of narrative, in particular the changes over the movement called “narrative turn” in the social sciences. According to Quentin Skinner, conceptual changes may take place on three separate levels: by changing the criteria of the concept, by changing the range of reference, and by changing the appraisal of the concept. Recent theorizing on narrative epitomizes all of these levels, but unevenly. In spite of the rhetoric of interdisciplinarity, two almost totally separate traditions of narrative theory persist: the narratological and the narrative-turn theories. Paradoxically, the narrative turn literature has radicalized the range of reference of narrative by attaching the concept to life and identity, but has left the criteria of the concept practically intact. This has extended the reign of a simplified Aristotelian concept of narrative as a chain of beginnings, middles, and ends. The narratological tradition of theorizing, instead, has debated extensively on the correct criteria of the concept, but enlarged the range of reference rather in the direction of cognition.