Why do people lose their friends after a stroke?

Background: It is well-known that people lose friends after a stroke; what is less well understood is why this occurs. Aims: This study explored why people lose contact with their friends, and whether there are any protective factors. It also examined how friendship loss and change is perceived by the individual. Methods and Procedures: Participants with a first stroke were recruited from one acute stroke unit in the UK. In-depth qualitative interviews took place between 8 and 15 months post stroke. Outcomes and Results: 29 participants were recruited of whom 10 had aphasia. The main reasons given for losing friends were: loss of shared activities, reduced energy levels, physical disability, aphasia, unhelpful responses of others, environmental barriers, and changing social desires. The subset of participants who experienced the most extensive loss of friends were those who described a sense that they were ‘closing in’ on themselves leading to a withdrawal from social contact and a new preference for meeting only close friends and family. Those with aphasia experienced the most hurtful negative responses from others and found it more difficult to retain their friends unless they had strong supportive friendship patterns prior to the stroke. The factors which helped to protect friendships included: having a shared history, friends who showed concern, who lived locally, where the friendship was not activity-based, and where the participant had a ‘friends-based’ social network prior to the stroke. Conclusions and Implications: Given the link between depression and loss of friends post stroke, supporting an individual in maintaining a social network is likely to be beneficial. For intervention to be effective, however, it may need to take into account not only the impact of new physical and language disabilities, but also changing social desires

Continuity and change in the social organisation of the Ibos in London.

This thesis is the study of the social organisation af an ethnic minority - the Ibos of South Eastern Nigeria - in London. It examines the interaction of major variables in three historical periods, beginning with the early years of Ibo migration and culminating in the period following the Nigeria-Biafra War of 1967-1970. Attention is focussed on the interrelationship of power relations and symbolic action. Activities associated with kinship and marriage are revealed as the forces which sustain the group in changing structural circumstances. In the years preceding the war, the Ibos are a community of students. Financial dependence on kin, and the expectation of a speedy return home, promote conformity to traditional norms of marriage. The following period sees a radical change in social organisation. With the termination of financial support the Ibos become a community of workers, their studies suspended or abandoned. In the face of external pressure relationships within the group are intensified and internal social barriers lowered. A kinship ideology is used to mobilise support for the war effort. The emphasis on unity is reflected in patterns of marriage. In the contemporary period external pressures are absent and individual energies are spent in the promotion of private interests. But an awareness of common interests is apparent in the sphere of kinship and marriage. The senior members of the group strive to ensure that certain standards are upheld in the process of marital selection and legalisation, the conduct of marital affairs and the settlement of disputes. Thus it is seen that the Ibos remain culturally distinct despite economic incorporation in the host society. It is argued, in conclusion, that the study of continuity and change in a particular ethnic group has implications for the perpetuation of minority groups in general

Conducting longitudinal research with older widows : Exploring personal communities through multiple methods

This article reports on the process of undertaking a longitudinal multiple methods study with older women experiencing the transition of later life widowhood. A series of three qualitative in depth interviews were conducted with twenty-six older widows in North Staffordshire, United Kingdom. Interviews included the use of personal community diagrams to identify the structure of personal communities, and Christmas and Christmas cards to further explore social relationships and practices during transition. Examples of cases are given to illustrate the findings derived from the methods employed. The cases demonstrate the diverse and often paradoxical nature of social relationships within similar networks

The interaction of age and gender in illness narratives

Recognition of the greater capacity of older women to draw on supportive social networks has now supplemented an earlier focus of research into gender and ageing which portrayed older men as a 'privileged gerontocracy' because of their greater access to financial resources and spousal care. This study of the experiences of cancer among people of three different age groups conducted a comparative keyword analysis of their narratives to consider the gender differentiation of a third resource: access to medical information and personnel. The analysed narratives were sampled from a large archive of research interviews. It was found that older men with cancer demonstrated a greater involvement with medicine as an expert system than younger men or women or older women. This stemmed from their social confidence when interacting with doctors and their interest in treating their illness as a 'problem' to be fixed with medico-scientific solutions. Compared with younger men and women of all ages, older men were less likely to draw on informal social and family networks for support, or to discuss in a direct style the emotional dimension of illness experience. Our findings contrast with other studies that have reported linguistic disadvantage in older people in elderly care settings, which underlines the importance of context for linguistic studies. © 2008 Cambridge University Press

Source apportionment of groundwater pollutants in Apulian agricultural sites using multivariate statistical analyses: case study of Foggia province

<p>Abstract</p> <p>The electric grid in the United States has been suffering from underinvestment for years, and now faces pressing challenges from rising demand and deteriorating infrastructure. High congestion levels in transmission lines are greatly reducing the efficiency of electricity generation and distribution. In this paper, we assess the faults of the current electric grid and quantify the costs of maintaining the current system into the future. While the proposed “smart grid” contains many proposals to upgrade the ailing infrastructure of the electric grid, we argue that smart meter installation in each U.S. household will offer a significant reduction in peak demand on the current system. A smart meter is a device which monitors a household’s electricity consumption in real-time, and has the ability to display real-time pricing in each household. We conclude that these devices will provide short-term and long-term benefits to utilities and consumers. The smart meter will enable utilities to closely monitor electricity consumption in real-time, while also allowing households to adjust electricity consumption in response to real-time price adjustments.</p

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles, and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Using Narratives to Understand Older People’s Decision-Making Processes

Despite the availability of health and social care services designed to support people in their own homes, older people often underuse or refuse these services. It is now acknowledged that this phenomenon contributes to older people being admitted to hospital and long-term care in circumstances that could be avoided. To understand how the uptake of supportive and preventative services can be improved, the first author, supervised by the second and third authors, developed a constructivist inquiry to explore what factors enhance or bar service use. This article describes how narratives were used not only to help identify decision- and choice-making influences, but also as a way of enhancing the hermeneutic processes associated with constructivism