Conference Presentations by Eduardo Piqueiras
American Anthropological Association, 2022
How the “case” for study is envisioned and deployed (Ragin & Becker 1992) is foundational to anth... more How the “case” for study is envisioned and deployed (Ragin & Becker 1992) is foundational to anthropological modes of thinking and to unsettling conventional landscapes of inquiry. Recent new “cases” for study providing fresh basic units for analysis and description include concepts of syndemics, biological citizenship, and global assemblages (Singer & Mendenhall, Petryna 2002, Rose & Novas 2005) which reconceptualized conventional boundaries and processes. These concepts resist the dominant medical case which transforms the uniqueness and complexity of a person’s story into an instance of a normatively defined pathology rather than the situated complex representation and symbolism of multiple processes, stakeholders, goals, and interpretations. Yet, within our field, ‘casing’ remains at times elusive, situated as both a strength and a productive irritation. Contentions about cases arise especially working across disciplines where normative constructs for cases reign, prefiguring and delimiting what is ‘the case’ for study and submerging theoretical tensions ‘cases’ represent. We argue for rethinking and surfacing challenges in the bounding of cases as a varied and submerged part of the anthropological toolkit. Questioning is needed of the nature and modes of developing “the case” which attends to phenomena as in motion, as unfolding over time, assemblages of diverse phenomena rooted in particular locales which undermine taken-for-granted categories. That is, we query knowing what to assess, not how to measure or count.
This session brings “casing” into dialogue at multiple scale levels. The casing of Legionella infections will focus on how the social and built infrastructural world comingles with the domain of Legionnaires’ disease infection while critiquing our categorization of illness where claims to resources and access to care are contingent on a particular biologic status. Casing tension is revealed in the construction of persons from administrative case files of girls for fosterage and adoption in online vignettes, “heart galleries,” where social workers write of a particular girl/case, yet the scope of the case is ambiguous and exists as an assemblage of State administrative files embodying details of the child, contextual factors such as family dynamics, and child welfare, law, and social constructs of family. Redefining the salient ‘body’ that is the case for intervention led to success in a program to reduce violence in hospital worksites (staff-staff, patient-staff) by refashioning the cases and capacity for change as biosocially defined temporally informed local units rather than isolated separate incidents of violence. Caring for a person dying at home is explored to highlight the dilemmas of constructing the “case” where practices and experiences are an ever coalescing and unfolding engagement of temporal multiplicities of past-present-anticipated experiences and processes, convergent ethical and morality ambitions and concerns in action, for the constellation of carers, the dying person, and others.
Panelists will build on these examples to explore casing strategies and question our understanding of “what is this a case of?” We ask under what circumstances, in what place, across what temporality do “cases” get defined and created? What are ways in which we as anthropologists, can ask better questions that disturb and situate the phenomena under study in new and useful ways?
Science of Team Science Conference, 2022
Teams embody novel scientific opportunities, but collaborative research can also create interpers... more Teams embody novel scientific opportunities, but collaborative research can also create interpersonal, epistemological, and institutional challenges that can slow progress and present unique difficulties in achieving the goals driving a team-based approach to research. This study employs ethnographic methods to further discussions in the team science literature about how barriers, tensions, and challenges arise and affect the scientific conduct of active teams.
We argue that by employing ethnographic methods and epistemologies, team science scholars can advance research on collaborative science, and practicing teams can locate a self-evaluative method to reflect on their performance and relationships. To do this, we engage ethnography as both methodology and epistemology to reveal how barriers to teamwork appearing in various contexts and at multiple scales may hinder team science's collaborative potential.
We conducted a multimethod ethnographic study of a multi-sited, interdisciplinary research team through participant observation of weekly meetings (in-person and virtual), document analysis of proposal and funding documentation, and day-to-day management of logistics of the project were all included. A focus group and follow-up semi-structured interviews with nine team members, along with a post-interview anonymous online survey, investigated the roles, relationships, and tensions that emerged within an interdisciplinary, federally-funded study.
Qualitative analysis indicated that barriers faced in the process of team science are often multi-scalar and converge at three primary levels: (1) academic culture, (2) institutional structures, and (3) interpersonal dynamics. We explore how team members manage, normalize, and overcome challenges within these distinct but overlapping contexts. We conclude that the in-depth, nuanced, and contextual analysis of the ethnographic approach can help both researchers of team science and active teams learn how to improve the study and performance of scientific collaboration. An ethnographic approach has the advantage of providing a holistic and more complete picture of team science implementation as it is experienced by real-world teams.
Our findings suggest that ethnographic studies of team science can uncover and mitigate the particular barriers facing collaborative research teams with an in-depth understanding of the contextual factors that affect active teams
National LGBTQ+ Conference, 2022
Background: Within Transgender and Gender Expansive (TGE) communities, individuals experience pro... more Background: Within Transgender and Gender Expansive (TGE) communities, individuals experience pronounced health disparities and prevalence of negative health outcomes related to key social determinants of health. Social determinants of health (SDOH) refer to the social, economic, and physical conditions in which people live that may affect their health. COVID-19 has affected many communities with increasing morbidity and mortality, compounding existing vulnerabilities for TGE patients by limiting employment and healthcare access. Pre-existing and new housing insecurity within TGE communities may have a more pronounced impact during COVID-19 as individuals may be forced to remain in unsafe conditions such as shelters or homes of family members who are hostile to their gender identities. The objectives of this study were to understand experiences during COVID-19 among TGE individuals.
Methods: A total of 30 participants (>18) who identify as TGE were recruited. Purposive sampling was adopted for the recruitment of participants as part of a local Gender Health Program. The study team conducted semi-structured video interviews at four-time points over 12 months to better understand TGE experiences during COVID-19. Interviews were transcribed and coded by three investigators to generate salient themes via thematic analysis.
Results: Findings suggested that while many barriers exist for TGE communities, social determinants play an important role in health outcomes. We identified three major themes that exemplify these critical areas during COVID-19 that have far reaching consequences beyond the current pandemic restrictions: (1) participants noted their social orientation – typically referring to their own or others’ introversion or extroversion – as a major moderator of the effects of physical isolation, e.g., more introverted participants noted that their social lives existed substantially online prior to the pandemic and thus required less adjustment; (2) participants highlighted employment status – particularly whether they were able to work remotely or not – as significantly impacting their choices when the lockdowns began and their well-being as the pandemic continued; and (3) access to essential gender-affirming healthcare was delayed, having profound impacts on mental and social well-being. A substantial proportion of our participants also noted pre-existing health concerns that made them more vulnerable to mortality and morbidity if exposed to COVID-19; the fear of exposure for these individuals shaped every choice they made in the context of the pandemic.
Conclusion: Social determinants are prevalent factors in TGE patients' lives, exhibiting strong associations with negative health outcomes. Documenting social determinants as part of providing comprehensive care can help providers to identify and address these factors in treatment goals to better understand patient needs and connect them with resources, particularly in the context of pre-existing conditions.
American Anthropological Association, 2021
Legionella bacterium, found naturally in freshwater environments (lakes, streams), is responsible... more Legionella bacterium, found naturally in freshwater environments (lakes, streams), is responsible for a fatal form of pneumonia known as Legionnaire's disease (LD). Human-built environments create growth rich sites for aerosolization and inhalation of the bacteria leading to serious infections from a still poorly recognized range of water infrastructures beyond newsworthy cooling towers. Symptoms mimic common colds and delays in antibiotic therapy can lead to hospitalization, death, or lifelong debilities. Afflicted disproportionately are minorities, elderly, and immune-compromised persons.
This paper deploys the case of LD to explore how culture-bound notions of 'resistance' too narrowly conceptualize the bacterium (and antibiotics) as the salient "case" unit for study. I outline analytic strategies for constructing understandings of microbial resistance which go beyond antibiotic resistance/overuse: (1) at the level of the disrupted life course, where biomedical drug interventions fail to return the body to a pre-infection state disrupting survivors expectable life plan; 2) "resistance" in policy and the built environment where legionella bacteria have adapted, through amoebae impregnation, to escape countermeasures from water and water infrastructure treatments, and 3) at intersecting levels of infrastructure and public health policy where NYC (the sole US jurisdiction with laws mandating testing water cooling towers) confronts new LD spikes breaking new records because narrow policy views exclude a deteriorating and underfunded water infrastructure. Final discussion considers the wider implications of LD for an anthropological engagement with microbes.
American Public Health Association Conference, 2021
Transgender and Gender-Expansive (TGE) communities routinely face many barriers to healthcare, in... more Transgender and Gender-Expansive (TGE) communities routinely face many barriers to healthcare, including challenges in finding healthcare providers who are knowledgeable about, and sensitive to, TGE health. However, healthcare providers receive little training on this patient population, and as a result, TGE patients are forced to endure negative healthcare encounters further creating barriers to care. These barriers have been further amplified by the effect of COVID-19 on TGE communities.
A total of 30 participants (>18) were recruited who identify as part of TGE communities over 6 months. Purposive sampling was adopted for the recruitment of participants from the Greater Los Angeles area. The study team conducted semi-structured video interviews at three-time points to better understand the patient experiences during the health encounter.
The findings suggest that there is a lack of cultural competence regarding TGE health that creates significant barriers to care for TGE communities. Qualitative analysis indicates that: (1) many TGE patients are often engaging with healthcare providers with limited to no cultural competency in TGE health issues; (2) these encounters often result in TGE patients educating healthcare providers on the needs of TGE communities; and (3) some patients are forced to endure negative or inappropriate lines of questioning unrelated to the immediate TGE health concern. These outcomes are closely related to cultural competency training in TGE health for healthcare providers. Improving access to and training in TGE health can empower healthcare providers to identify and change the systemic barriers to care that cause TGE inequity.
American Public Health Association Conference, 2021
Legionnaires’ Disease (LD) rates continue to rise across the United States. LD infection increas... more Legionnaires’ Disease (LD) rates continue to rise across the United States. LD infection increases mortality, morbidity and functional decline. The long-term outcomes of older adult patients (>65) recovering from LD infection returning to a pre-diagnosis quality of life is currently unknown. The aim of the present study was to examine the recovery experiences and utilization of formal and informal care networks of home-dwelling older adult residents in the Bronx. When recognized early and treated with appropriate antibiotics near the onset of pneumonia, recovery is likely. However, delays in proper therapy often result in prolonged hospitalization, long-term complications, and death. Similarly, even when diagnosed and treated early, recovery can result in equally long-term complications in the form of fatigue, loss of energy and mobility, and cognitive impairment (CI) for months after the acute infection.
A total of 48 participants (>65 years) were recruited following LD diagnosis and treatment in the Bronx, NY at various stages of diagnosis, treatment, and recovery over a 14-month period. Purposive sampling was adopted for recruitment of participants from previous community health outreach and educational campaigns specific to LD outbreaks and infections across the New York City metropolitan area.
The findings suggest that post-treatment follow-up, LD-related care, and support networks are critical yet rarely utilized aspects of LD infection and there remains a pressing need for more holistic and inclusive post-treatment care for this growing demographic. Qualitative analysis indicates the following outcomes: (1) LD has long-lasting impacts on health status among older adult patients in the Bronx (2) participants navigate through existing relations to seek support and those actions are aimed at replacing new gaps in care networks as a result of gentrification and changing neighborhood characteristics (3) current biomedical guidelines fail to establish a Chronic Disease Management Plan for the care of older adult patients recovering from LD and (4) older adult patients recovering from LD from lower socio-economic backgrounds have various unmet needs in managing their recovery and other comorbidities as a result of LD infection. These outcomes are closely related to broader societal factors such as socio-demographic characteristics, support systems, urban planning and public policies, and health systems factors. Policy decisions to address these needs require an integrated multi-sectoral approach grounded in the principles of health equity.
La legionelosis es una enfermedad bacteriana transmitida por el agua que se origina en la infraes... more La legionelosis es una enfermedad bacteriana transmitida por el agua que se origina en la infraestructura del sistema de suministro de agua que contiene el agente biológico Legionella sp. Un factor importante en el desarrollo de la tendencia al alza en las tasas de infección global se debe al deterioro de la infraestructura del sistema de suministro de agua. Esta presentación se centra en la epidemiología de la legionelosis y la importancia de controlar la transmisión de bacterias en la lucha contra la enfermedad. Usando el caso reciente del brote de NYC como guía para destacar las últimas tendencias que no previenen la transmisión y la infección.
University of New Orleans, 2013
Papers by Eduardo Piqueiras
The Journal of Sexual Medicine, 2024
Introduction
Despite the negative societal stigma on receptive anal intercourse (RAI), this beha... more Introduction
Despite the negative societal stigma on receptive anal intercourse (RAI), this behavior has a positive influence on individuals’ sexual and relationship health. No large studies have previously looked at the sensations experienced during RAI, especially their association with lifelong exposure.
Objective
This study aims to quantify commonly reported pelvic sensations during RAI and determine whether their presentation changes with increasing experience to RAI.
Methods
An internet survey was conducted on sensations felt during RAI among people with prostates (i.e. cis men and trans women) from July 2022-January 2023. The survey content was developed based on a mixed-methods qualitative study and inquired about demographic and sexual histories as well as sensations (pleasure, pain, urinary, and bowel) experienced during RAI. We used descriptive statistics to describe demographic and sexual histories. All data was stratified by lifetime exposure to RAI. The primary outcomes assessed included both the quantification of the primary sensations experience during RAI and associated bother.
Results
975 participants completed the survey. Nine percent reported less than 10 experiences with RAI, 26% reported 11-50 RAI experiences, 32% reported 51-200 experiences, 16% reported 201-500 experiences, and 18% reported >500 experiences. As the number of experiences with RAI increased (from <10 exposures to >500 exposures), the reported frequency of pleasurable sensation and satisfaction with pleasure at the level of anus increased from 41% to 92% (p<0.0001), whereas severe pain and symptoms of bowel urgency decreased from 39% to 13% and from 21% to 6% respectively (p<0.0001). Urinary urgency sensation did not differ by lifetime RAI experience.
Conclusions
Lifetime exposure to RAI is positively associated with pleasure and is negatively associated with pain and bowel urgency. Pelvic sensations experienced during RAI appear to be dependent on lifetime RAI exposure history regardless of age. Lifetime RAI exposure can be readily assessed and correlates not only with pelvic sensation but also many other aspects of sexual health. These results imply that the etiology of dissatisfaction with pleasure or anodyspareunia during RAI may be distinct by lifetime RAI exposure status. This is the first study assessing pelvic sensations experienced during RAI among a large sample of individuals. This is a cross-sectional study, and we cannot conclude how pelvic sensations change overtime among individuals. Internet based participants may not be representative of clinical populations.
The Journal of Sex Research , 2024
Sexualized drug use (SDU) describes use of any psychoactive substance before or during planned se... more Sexualized drug use (SDU) describes use of any psychoactive substance before or during planned sexual activity to facilitate, intensify, or prolong intercourse. The impact of pain, pleasure, and other mediators on SDU is not well characterized. This study aimed to distinguish the motivations behind different classes and frequencies of substance use during receptive anal intercourse (RAI). Data were from an internet-based survey conducted between July 2022-January 2023. We measured the frequency of SDU for five substances: poppers, alcohol, marijuana, methamphetamine, and nicotine. Satisfaction with pleasurable sensations during RAI and any type of pain bother during RAI were assessed on a 5-point scale. Multivariable logistic regression was performed for 1,119 respondents. Our results showed a strong association between bothersome pain during RAI and frequent alcohol (aOR 2.1), marijuana (aOR 2.4), nicotine (aOR 3.1), and meth (aOR 5.9) use. None of the five substance classes studied was correlated with dissatisfaction with pleasure during RAI. Frequent popper use was associated with increasing lifetime RAI experience and number of sexual partners. The mechanism behind SDU during RAI is substance-specific and multifactorial. Bothersome pain during RAI is highly associated with frequent SDU. Inquiring about pain during RAI may offer avenues for intervention.
Contraception , 2024
Objectives
We aimed to explore the experiences of people obtaining medication abortion through t... more Objectives
We aimed to explore the experiences of people obtaining medication abortion through telemedicine medication abortion and clinic-based medication abortion at a single academic center.
Methods
We conducted an exploratory qualitative study utilizing semi-structured teleconference interviews with 23 (9 telemedicine medication abortion and 14 clinic-based medication abortion) patients with a gestational age up to 77 days who obtained a medication abortion between June 2018 and December 2022. Purposive sampling was adopted for the recruitment of participants at a single academic center in California. All interviews were recorded, transcribed, and coded by the authors to generate salient themes via thematic analysis.
Results
Participants discussed the effects of abortion stigma from society and social networks, leading to an increased desire for privacy, support, and urgency with time to appointment. Qualitative analysis indicates that telemedicine medication abortion participants preferred the increased privacy afforded via telemedicine. Clinic-based medication abortion participants highlighted the in-clinic environment as more invasive to their privacy, often requiring more people to know about their abortion which increased feelings of unease. Many participants described uncertainty about sharing abortion information with social networks because they (1) did not want to introduce others' opinions into their decision-making and (2) were unclear about how they might feel or react.
Conclusions
The results suggest that telemedicine abortion is an important tool to counteract pervasive societal stigma as well as improve accessibility. This study also suggests that abortion stigma (both actual and perceived) significantly impacts patient experiences despite being in a state with protective abortion laws, and improving accessibility and privacy can counteract the stigma associated with abortion care.
Journal of Pediatric Urology , 2024
Background
A varicocele is an abnormal dilation of the pampiniform plexus of veins in the scrotu... more Background
A varicocele is an abnormal dilation of the pampiniform plexus of veins in the scrotum that commonly affects postpubertal males. The condition has been associated with male infertility, testicular hypotrophy, and pain. However, the clinical experiences of adolescent patients and their families regarding the evaluation, surveillance, and management of varicoceles have not been previously examined.
Objective
This study explores the patient’s and family’s experiences of varicocele diagnosis and subsequent management to better understand the salient factors impacting decision-making and care.
Methods
We conducted semi-structured interviews with patients and their families between August 2022 and January 2023. A total of 39 participants (16 adolescent males and 23 parents) were recruited following varicocele diagnosis and treatment at an urban, tertiary care hospital in California. Purposive sampling was adopted for the recruitment of participants through medical record screening to identify eligibility. Utilizing a modified grounded theory approach through the use of constant comparison and memo writing, the analysis consisted of open coding, axial coding, and selective coding, resulting in the production of core concepts and categories.
Results
Results demonstrate that parents and adolescents can benefit from improved understanding and education about long-term expectations during the diagnosis and treatment of adolescent varicoceles. Qualitative analysis indicates: 1) parents and adolescents have common concerns regarding fertility; however, this is exacerbated by the complexity of medical decision-making being dependent on adolescent and parental understanding of the full scope of varicocele impacts and outcomes, and 2) the psychosocial impact of a varicocele on adolescent self-esteem and sexual function are significant drivers for seeking care, which often manifested through discussions on masculinity through notions of ‘manhood’ and future sexual performance.
Discussion
Discussions with patients and families largely focused on their concerns regarding fertility, sexual function, and aesthetics (impacting self-esteem); however, their primary concern was for the need for more accurate and comprehensive information, which includes the natural history of the condition and the full scope of treatment options. Future studies should examine the experiences of patients and families from diverse backgrounds and geographic locations to identify potential differences in experiences.
Conclusion
Findings identified the need for potential improvement in communication between pediatric urologists and families to alleviate anxiety and uncertainty among patients and families and empower them to make informed decisions about their care.
Supportive Care in Cancer, 2024
Low-income prostate cancer survivors, who typically have worse outcomes and greater all-cause mor... more Low-income prostate cancer survivors, who typically have worse outcomes and greater all-cause mortality, often have poor health-promoting behaviors. Our objective was to assess perceived facilitators of and barriers to healthy behavior change by interviewing low-income men with prostate cancer who received no-cost treatment through a state-funded program.
Between September 2021 and April 2022, we conducted semi-structured interviews with 19 men (ages 60-75). Purposive sampling was utilized from participants of a cohort of men with prostate cancer from low-income backgrounds. Interviews were recorded, transcribed, and then coded by the authors to generate salient themes via thematic analysis.
We found internal characteristics and structural characteristics that functioned independently and in concert to promote and/or hinder healthy behavior change. Internal characteristics such as motivations (prostate cancer diagnosis, self-perceptions, support system, and preferences) and determination, defined as level of motivation, drove behavior actualization. Structural characteristics that influenced behavior change included resources (access to food and opportunities for exercise) and social support.
These outcomes suggest that motivation and determination can serve as protective facilitators encouraging healthy behaviors despite structural barriers low-income prostate cancer survivors may face. However, motivations challenged by financial constraints were not sufficient to guide healthy behavior change. With this in mind, we recommend that interventions promoting healthy behavior change among this population should focus on identifying and strengthening internal assets such as motivations, self-perceptions, preferences, and support systems.
The Journal of Sexual Medicine, 2023
Background: Despite the negative stigma on receptive anal intercourse (RAI), this behavior has a ... more Background: Despite the negative stigma on receptive anal intercourse (RAI), this behavior has a positive influence on individuals' sexual and relationship health. No large studies have previously looked at specific sensations experienced during RAI and how these sensations may change with experience. Aim: In this study we aimed to quantify commonly reported pelvic sensations during RAI and determine whether their presentation changes with increasing experience of RAI. Methods: An internet survey was conducted on sensations felt during RAI among people with prostates from July 2022-January 2023. The survey content was developed based on a mixed-methods qualitative study and inquired about demographic and sexual histories as well as sensations (pleasure, pain, urinary, and bowel) experienced during RAI. We used descriptive statistics to describe demographic and sexual histories. All data were stratified by lifetime exposure to RAI. Outcomes: The primary outcomes assessed included the quantification of both the primary sensations experienced during RAI and the associated bother. Results: In total, 975 participants completed the survey. The median age was 32 (range 18-78) years. The average age of first participation in RAI was 21 ± 6.6 years. Most respondents were having sex at least once a week (65%). Nine percent of respondents reported fewer than 10 experiences with RAI, 26% reported 11-50 RAI experiences, 32% reported 51-200 experiences, 16% reported 201-500 experiences, and 18% reported >500 experiences. As the number of experiences with RAI increased (from <10 to >500 exposures), the reported frequency of pleasurable sensation increased from 41% to 92% (P < .0001), whereas severe insertional pain and symptoms of bowel urgency decreased from 39% to 13% and from 21% to 6%, respectively (P < .0001). Urinary urgency sensation did not differ by lifetime RAI experience. Clinical Implications: Lifetime RAI exposure can be readily assessed and correlates not only with pelvic sensation but also many other aspects of sexual health. These results imply that the etiology of dissatisfaction with pleasure or anodyspareunia during RAI may differ by lifetime RAI exposure. Strengths and Limitations: This is the first study to our knowledge to assess pelvic sensations experienced during RAI among a large sample of individuals. This is a cross-sectional study, and we cannot conclude how pelvic sensations change over time among individuals. Internet-based participants may not be representative of clinical populations. Conclusion: Lifetime exposure to RAI is positively associated with pleasure and is negatively associated with pain and bowel urgency. Pelvic sensations experienced during RAI appear to be dependent on lifetime RAI exposure history regardless of age.
Journal of Organizational Ethnography, 2023
Purpose: The purpose of this paper is to expand the use of ethnography to advance research on tea... more Purpose: The purpose of this paper is to expand the use of ethnography to advance research on team science by revealing the barriers to teamwork as manifesting at institutional, cultural, and interpersonal contextual scales. The analysis suggests strategies to enhance team science's collaborative potential.
Design/methodology/approach: This paper considers some of the practical and analytical challenges of team science through the use of ethnographic methods. The authors formed a three-person subteam within a larger multisited, federally-funded, interdisciplinary scientific team. The authors conducted six months of participant observation, semi-structured interviews, and a focus group, using iterative deductive and inductive analyses to investigate the larger team's roles, relationships, dynamics, and tensions.
Findings: Integrating ethnography into the study of team science can uncover and mitigate barriers faced by teams at three primary levels: (1) academic culture, (2) institutional structures, and (3) interpersonal dynamics. The authors found that these three contextual factors are often taken for granted and hidden in the team science process as well as that they are interactive and influence teams at multiple scales of analysis. These outcomes are closely related to how team science is funded and implemented in academic and institutional settings.
Journal of Urology, 2023
INTRODUCTION AND OBJECTIVE:
The experiences of adolescents and families contending with varico... more INTRODUCTION AND OBJECTIVE:
The experiences of adolescents and families contending with varicocele diagnosis and treatment decision-making remain largely unknown. The objective of this ongoing qualitative study is to explore first-person attitudes and concerns among adolescents and their parents regarding varicocele diagnosis and subsequent management using a qualitative approach to elicit core themes affecting decision-making.
METHODS:
Using an IRB-approved exploratory qualitative design, semi-structured interviews were conducted separately with adolescents diagnosed with varicoceles and their parents from 8/2022-11/2022. Purposive sampling identified eligible patients between the ages of 10-19 diagnosed with a varicocele and seen in the urology clinic who elected conservative management or surgical varicocelectomy. Seven adolescents and 12 parents were interviewed. A standardized interview script was employed to cover the following topics: potential long-term impacts of varicoceles on fertility and sexual function; varicocele-specific knowledge; family experiences with diagnosis; factors involved in decision-making; level of parent involvement; and attitudes toward semen analysis testing.
RESULTS:
Semi-structured interviews revealed that care preferences, treatment-related decisional conflict, and educational resources are critical yet underutilized aspects of adolescent varicocele diagnosis and treatment. Qualitative analysis indicated: 1) fertility concerns for patients and parents are poorly addressed; 2) family discomfort with semen analysis requires sensitive, direct communication; 3) a high degree of uncertainty impacts follow up; 4) scrotal aesthetics and impact on perceived masculinity are an important consideration for patients and parents; and 5) families have limited knowledge of the condition and potential short- and long-term impacts (Table 1).
CONCLUSIONS:
This study describes previously unexamined patient and family experiences that may improve care and decision-making interventions regarding adolescent varicoceles. The perspectives gleaned can be used to guide family-centered education and informed decision-making.
The Journal of Sexual Medicine, 2023
Background Receptive anal intercourse (RAI) is commonly practiced among individuals of all sexual... more Background Receptive anal intercourse (RAI) is commonly practiced among individuals of all sexual orientations. However, negative stigmatization by society and health care professionals leads to the underreporting or this practice. Aim We sought to assess and describe the subjective role of the prostate as a pleasure center in participants with diverse RAI experiences. The secondary aim was to describe nonprostatic areas within the anorectal region that produce erotic sensation and/or pain. Methods The exploratory sequential multimethod study design included focus groups and semistructured interviews with 30 individuals with prostates who had engaged in RAI. We used graphic elicitation of natal male anatomy to enhance visualization and assess participant perspectives. Outcomes The main outcome of interest was the identification of anatomic locations of erogenous sensation and pain during RAI. Results Among the participants (median age 38, range 24–77 years), most participants (90%) ...
Journal of the American Medical Informatics Association
Objective Visual timelines of patient-reported outcomes (PRO) can help prostate cancer survivors ... more Objective Visual timelines of patient-reported outcomes (PRO) can help prostate cancer survivors manage longitudinal data, compare with population averages, and consider future trajectories. PRO visualizations are most effective when designed with deliberate consideration of users. Yet, graph literacy is often overlooked as a design constraint, particularly when users with limited graph literacy are not engaged in their development. We conducted user testing to assess comprehension, utility, and preference of longitudinal PRO visualizations designed for prostate cancer survivors with limited literacy. Materials and methods Building upon our prior work co-designing longitudinal PRO visualizations with survivors, we engaged 18 prostate cancer survivors in a user study to assess 4 prototypes: Meter, Words, Comic, and Emoji. During remote sessions, we collected data on prototype comprehension (gist and verbatim), utility, and preference. Results Participants were aged 61–77 (M = 69), of...
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Conference Presentations by Eduardo Piqueiras
This session brings “casing” into dialogue at multiple scale levels. The casing of Legionella infections will focus on how the social and built infrastructural world comingles with the domain of Legionnaires’ disease infection while critiquing our categorization of illness where claims to resources and access to care are contingent on a particular biologic status. Casing tension is revealed in the construction of persons from administrative case files of girls for fosterage and adoption in online vignettes, “heart galleries,” where social workers write of a particular girl/case, yet the scope of the case is ambiguous and exists as an assemblage of State administrative files embodying details of the child, contextual factors such as family dynamics, and child welfare, law, and social constructs of family. Redefining the salient ‘body’ that is the case for intervention led to success in a program to reduce violence in hospital worksites (staff-staff, patient-staff) by refashioning the cases and capacity for change as biosocially defined temporally informed local units rather than isolated separate incidents of violence. Caring for a person dying at home is explored to highlight the dilemmas of constructing the “case” where practices and experiences are an ever coalescing and unfolding engagement of temporal multiplicities of past-present-anticipated experiences and processes, convergent ethical and morality ambitions and concerns in action, for the constellation of carers, the dying person, and others.
Panelists will build on these examples to explore casing strategies and question our understanding of “what is this a case of?” We ask under what circumstances, in what place, across what temporality do “cases” get defined and created? What are ways in which we as anthropologists, can ask better questions that disturb and situate the phenomena under study in new and useful ways?
We argue that by employing ethnographic methods and epistemologies, team science scholars can advance research on collaborative science, and practicing teams can locate a self-evaluative method to reflect on their performance and relationships. To do this, we engage ethnography as both methodology and epistemology to reveal how barriers to teamwork appearing in various contexts and at multiple scales may hinder team science's collaborative potential.
We conducted a multimethod ethnographic study of a multi-sited, interdisciplinary research team through participant observation of weekly meetings (in-person and virtual), document analysis of proposal and funding documentation, and day-to-day management of logistics of the project were all included. A focus group and follow-up semi-structured interviews with nine team members, along with a post-interview anonymous online survey, investigated the roles, relationships, and tensions that emerged within an interdisciplinary, federally-funded study.
Qualitative analysis indicated that barriers faced in the process of team science are often multi-scalar and converge at three primary levels: (1) academic culture, (2) institutional structures, and (3) interpersonal dynamics. We explore how team members manage, normalize, and overcome challenges within these distinct but overlapping contexts. We conclude that the in-depth, nuanced, and contextual analysis of the ethnographic approach can help both researchers of team science and active teams learn how to improve the study and performance of scientific collaboration. An ethnographic approach has the advantage of providing a holistic and more complete picture of team science implementation as it is experienced by real-world teams.
Our findings suggest that ethnographic studies of team science can uncover and mitigate the particular barriers facing collaborative research teams with an in-depth understanding of the contextual factors that affect active teams
Methods: A total of 30 participants (>18) who identify as TGE were recruited. Purposive sampling was adopted for the recruitment of participants as part of a local Gender Health Program. The study team conducted semi-structured video interviews at four-time points over 12 months to better understand TGE experiences during COVID-19. Interviews were transcribed and coded by three investigators to generate salient themes via thematic analysis.
Results: Findings suggested that while many barriers exist for TGE communities, social determinants play an important role in health outcomes. We identified three major themes that exemplify these critical areas during COVID-19 that have far reaching consequences beyond the current pandemic restrictions: (1) participants noted their social orientation – typically referring to their own or others’ introversion or extroversion – as a major moderator of the effects of physical isolation, e.g., more introverted participants noted that their social lives existed substantially online prior to the pandemic and thus required less adjustment; (2) participants highlighted employment status – particularly whether they were able to work remotely or not – as significantly impacting their choices when the lockdowns began and their well-being as the pandemic continued; and (3) access to essential gender-affirming healthcare was delayed, having profound impacts on mental and social well-being. A substantial proportion of our participants also noted pre-existing health concerns that made them more vulnerable to mortality and morbidity if exposed to COVID-19; the fear of exposure for these individuals shaped every choice they made in the context of the pandemic.
Conclusion: Social determinants are prevalent factors in TGE patients' lives, exhibiting strong associations with negative health outcomes. Documenting social determinants as part of providing comprehensive care can help providers to identify and address these factors in treatment goals to better understand patient needs and connect them with resources, particularly in the context of pre-existing conditions.
This paper deploys the case of LD to explore how culture-bound notions of 'resistance' too narrowly conceptualize the bacterium (and antibiotics) as the salient "case" unit for study. I outline analytic strategies for constructing understandings of microbial resistance which go beyond antibiotic resistance/overuse: (1) at the level of the disrupted life course, where biomedical drug interventions fail to return the body to a pre-infection state disrupting survivors expectable life plan; 2) "resistance" in policy and the built environment where legionella bacteria have adapted, through amoebae impregnation, to escape countermeasures from water and water infrastructure treatments, and 3) at intersecting levels of infrastructure and public health policy where NYC (the sole US jurisdiction with laws mandating testing water cooling towers) confronts new LD spikes breaking new records because narrow policy views exclude a deteriorating and underfunded water infrastructure. Final discussion considers the wider implications of LD for an anthropological engagement with microbes.
A total of 30 participants (>18) were recruited who identify as part of TGE communities over 6 months. Purposive sampling was adopted for the recruitment of participants from the Greater Los Angeles area. The study team conducted semi-structured video interviews at three-time points to better understand the patient experiences during the health encounter.
The findings suggest that there is a lack of cultural competence regarding TGE health that creates significant barriers to care for TGE communities. Qualitative analysis indicates that: (1) many TGE patients are often engaging with healthcare providers with limited to no cultural competency in TGE health issues; (2) these encounters often result in TGE patients educating healthcare providers on the needs of TGE communities; and (3) some patients are forced to endure negative or inappropriate lines of questioning unrelated to the immediate TGE health concern. These outcomes are closely related to cultural competency training in TGE health for healthcare providers. Improving access to and training in TGE health can empower healthcare providers to identify and change the systemic barriers to care that cause TGE inequity.
A total of 48 participants (>65 years) were recruited following LD diagnosis and treatment in the Bronx, NY at various stages of diagnosis, treatment, and recovery over a 14-month period. Purposive sampling was adopted for recruitment of participants from previous community health outreach and educational campaigns specific to LD outbreaks and infections across the New York City metropolitan area.
The findings suggest that post-treatment follow-up, LD-related care, and support networks are critical yet rarely utilized aspects of LD infection and there remains a pressing need for more holistic and inclusive post-treatment care for this growing demographic. Qualitative analysis indicates the following outcomes: (1) LD has long-lasting impacts on health status among older adult patients in the Bronx (2) participants navigate through existing relations to seek support and those actions are aimed at replacing new gaps in care networks as a result of gentrification and changing neighborhood characteristics (3) current biomedical guidelines fail to establish a Chronic Disease Management Plan for the care of older adult patients recovering from LD and (4) older adult patients recovering from LD from lower socio-economic backgrounds have various unmet needs in managing their recovery and other comorbidities as a result of LD infection. These outcomes are closely related to broader societal factors such as socio-demographic characteristics, support systems, urban planning and public policies, and health systems factors. Policy decisions to address these needs require an integrated multi-sectoral approach grounded in the principles of health equity.
Papers by Eduardo Piqueiras
Despite the negative societal stigma on receptive anal intercourse (RAI), this behavior has a positive influence on individuals’ sexual and relationship health. No large studies have previously looked at the sensations experienced during RAI, especially their association with lifelong exposure.
Objective
This study aims to quantify commonly reported pelvic sensations during RAI and determine whether their presentation changes with increasing experience to RAI.
Methods
An internet survey was conducted on sensations felt during RAI among people with prostates (i.e. cis men and trans women) from July 2022-January 2023. The survey content was developed based on a mixed-methods qualitative study and inquired about demographic and sexual histories as well as sensations (pleasure, pain, urinary, and bowel) experienced during RAI. We used descriptive statistics to describe demographic and sexual histories. All data was stratified by lifetime exposure to RAI. The primary outcomes assessed included both the quantification of the primary sensations experience during RAI and associated bother.
Results
975 participants completed the survey. Nine percent reported less than 10 experiences with RAI, 26% reported 11-50 RAI experiences, 32% reported 51-200 experiences, 16% reported 201-500 experiences, and 18% reported >500 experiences. As the number of experiences with RAI increased (from <10 exposures to >500 exposures), the reported frequency of pleasurable sensation and satisfaction with pleasure at the level of anus increased from 41% to 92% (p<0.0001), whereas severe pain and symptoms of bowel urgency decreased from 39% to 13% and from 21% to 6% respectively (p<0.0001). Urinary urgency sensation did not differ by lifetime RAI experience.
Conclusions
Lifetime exposure to RAI is positively associated with pleasure and is negatively associated with pain and bowel urgency. Pelvic sensations experienced during RAI appear to be dependent on lifetime RAI exposure history regardless of age. Lifetime RAI exposure can be readily assessed and correlates not only with pelvic sensation but also many other aspects of sexual health. These results imply that the etiology of dissatisfaction with pleasure or anodyspareunia during RAI may be distinct by lifetime RAI exposure status. This is the first study assessing pelvic sensations experienced during RAI among a large sample of individuals. This is a cross-sectional study, and we cannot conclude how pelvic sensations change overtime among individuals. Internet based participants may not be representative of clinical populations.
We aimed to explore the experiences of people obtaining medication abortion through telemedicine medication abortion and clinic-based medication abortion at a single academic center.
Methods
We conducted an exploratory qualitative study utilizing semi-structured teleconference interviews with 23 (9 telemedicine medication abortion and 14 clinic-based medication abortion) patients with a gestational age up to 77 days who obtained a medication abortion between June 2018 and December 2022. Purposive sampling was adopted for the recruitment of participants at a single academic center in California. All interviews were recorded, transcribed, and coded by the authors to generate salient themes via thematic analysis.
Results
Participants discussed the effects of abortion stigma from society and social networks, leading to an increased desire for privacy, support, and urgency with time to appointment. Qualitative analysis indicates that telemedicine medication abortion participants preferred the increased privacy afforded via telemedicine. Clinic-based medication abortion participants highlighted the in-clinic environment as more invasive to their privacy, often requiring more people to know about their abortion which increased feelings of unease. Many participants described uncertainty about sharing abortion information with social networks because they (1) did not want to introduce others' opinions into their decision-making and (2) were unclear about how they might feel or react.
Conclusions
The results suggest that telemedicine abortion is an important tool to counteract pervasive societal stigma as well as improve accessibility. This study also suggests that abortion stigma (both actual and perceived) significantly impacts patient experiences despite being in a state with protective abortion laws, and improving accessibility and privacy can counteract the stigma associated with abortion care.
A varicocele is an abnormal dilation of the pampiniform plexus of veins in the scrotum that commonly affects postpubertal males. The condition has been associated with male infertility, testicular hypotrophy, and pain. However, the clinical experiences of adolescent patients and their families regarding the evaluation, surveillance, and management of varicoceles have not been previously examined.
Objective
This study explores the patient’s and family’s experiences of varicocele diagnosis and subsequent management to better understand the salient factors impacting decision-making and care.
Methods
We conducted semi-structured interviews with patients and their families between August 2022 and January 2023. A total of 39 participants (16 adolescent males and 23 parents) were recruited following varicocele diagnosis and treatment at an urban, tertiary care hospital in California. Purposive sampling was adopted for the recruitment of participants through medical record screening to identify eligibility. Utilizing a modified grounded theory approach through the use of constant comparison and memo writing, the analysis consisted of open coding, axial coding, and selective coding, resulting in the production of core concepts and categories.
Results
Results demonstrate that parents and adolescents can benefit from improved understanding and education about long-term expectations during the diagnosis and treatment of adolescent varicoceles. Qualitative analysis indicates: 1) parents and adolescents have common concerns regarding fertility; however, this is exacerbated by the complexity of medical decision-making being dependent on adolescent and parental understanding of the full scope of varicocele impacts and outcomes, and 2) the psychosocial impact of a varicocele on adolescent self-esteem and sexual function are significant drivers for seeking care, which often manifested through discussions on masculinity through notions of ‘manhood’ and future sexual performance.
Discussion
Discussions with patients and families largely focused on their concerns regarding fertility, sexual function, and aesthetics (impacting self-esteem); however, their primary concern was for the need for more accurate and comprehensive information, which includes the natural history of the condition and the full scope of treatment options. Future studies should examine the experiences of patients and families from diverse backgrounds and geographic locations to identify potential differences in experiences.
Conclusion
Findings identified the need for potential improvement in communication between pediatric urologists and families to alleviate anxiety and uncertainty among patients and families and empower them to make informed decisions about their care.
Between September 2021 and April 2022, we conducted semi-structured interviews with 19 men (ages 60-75). Purposive sampling was utilized from participants of a cohort of men with prostate cancer from low-income backgrounds. Interviews were recorded, transcribed, and then coded by the authors to generate salient themes via thematic analysis.
We found internal characteristics and structural characteristics that functioned independently and in concert to promote and/or hinder healthy behavior change. Internal characteristics such as motivations (prostate cancer diagnosis, self-perceptions, support system, and preferences) and determination, defined as level of motivation, drove behavior actualization. Structural characteristics that influenced behavior change included resources (access to food and opportunities for exercise) and social support.
These outcomes suggest that motivation and determination can serve as protective facilitators encouraging healthy behaviors despite structural barriers low-income prostate cancer survivors may face. However, motivations challenged by financial constraints were not sufficient to guide healthy behavior change. With this in mind, we recommend that interventions promoting healthy behavior change among this population should focus on identifying and strengthening internal assets such as motivations, self-perceptions, preferences, and support systems.
Design/methodology/approach: This paper considers some of the practical and analytical challenges of team science through the use of ethnographic methods. The authors formed a three-person subteam within a larger multisited, federally-funded, interdisciplinary scientific team. The authors conducted six months of participant observation, semi-structured interviews, and a focus group, using iterative deductive and inductive analyses to investigate the larger team's roles, relationships, dynamics, and tensions.
Findings: Integrating ethnography into the study of team science can uncover and mitigate barriers faced by teams at three primary levels: (1) academic culture, (2) institutional structures, and (3) interpersonal dynamics. The authors found that these three contextual factors are often taken for granted and hidden in the team science process as well as that they are interactive and influence teams at multiple scales of analysis. These outcomes are closely related to how team science is funded and implemented in academic and institutional settings.
The experiences of adolescents and families contending with varicocele diagnosis and treatment decision-making remain largely unknown. The objective of this ongoing qualitative study is to explore first-person attitudes and concerns among adolescents and their parents regarding varicocele diagnosis and subsequent management using a qualitative approach to elicit core themes affecting decision-making.
METHODS:
Using an IRB-approved exploratory qualitative design, semi-structured interviews were conducted separately with adolescents diagnosed with varicoceles and their parents from 8/2022-11/2022. Purposive sampling identified eligible patients between the ages of 10-19 diagnosed with a varicocele and seen in the urology clinic who elected conservative management or surgical varicocelectomy. Seven adolescents and 12 parents were interviewed. A standardized interview script was employed to cover the following topics: potential long-term impacts of varicoceles on fertility and sexual function; varicocele-specific knowledge; family experiences with diagnosis; factors involved in decision-making; level of parent involvement; and attitudes toward semen analysis testing.
RESULTS:
Semi-structured interviews revealed that care preferences, treatment-related decisional conflict, and educational resources are critical yet underutilized aspects of adolescent varicocele diagnosis and treatment. Qualitative analysis indicated: 1) fertility concerns for patients and parents are poorly addressed; 2) family discomfort with semen analysis requires sensitive, direct communication; 3) a high degree of uncertainty impacts follow up; 4) scrotal aesthetics and impact on perceived masculinity are an important consideration for patients and parents; and 5) families have limited knowledge of the condition and potential short- and long-term impacts (Table 1).
CONCLUSIONS:
This study describes previously unexamined patient and family experiences that may improve care and decision-making interventions regarding adolescent varicoceles. The perspectives gleaned can be used to guide family-centered education and informed decision-making.
This session brings “casing” into dialogue at multiple scale levels. The casing of Legionella infections will focus on how the social and built infrastructural world comingles with the domain of Legionnaires’ disease infection while critiquing our categorization of illness where claims to resources and access to care are contingent on a particular biologic status. Casing tension is revealed in the construction of persons from administrative case files of girls for fosterage and adoption in online vignettes, “heart galleries,” where social workers write of a particular girl/case, yet the scope of the case is ambiguous and exists as an assemblage of State administrative files embodying details of the child, contextual factors such as family dynamics, and child welfare, law, and social constructs of family. Redefining the salient ‘body’ that is the case for intervention led to success in a program to reduce violence in hospital worksites (staff-staff, patient-staff) by refashioning the cases and capacity for change as biosocially defined temporally informed local units rather than isolated separate incidents of violence. Caring for a person dying at home is explored to highlight the dilemmas of constructing the “case” where practices and experiences are an ever coalescing and unfolding engagement of temporal multiplicities of past-present-anticipated experiences and processes, convergent ethical and morality ambitions and concerns in action, for the constellation of carers, the dying person, and others.
Panelists will build on these examples to explore casing strategies and question our understanding of “what is this a case of?” We ask under what circumstances, in what place, across what temporality do “cases” get defined and created? What are ways in which we as anthropologists, can ask better questions that disturb and situate the phenomena under study in new and useful ways?
We argue that by employing ethnographic methods and epistemologies, team science scholars can advance research on collaborative science, and practicing teams can locate a self-evaluative method to reflect on their performance and relationships. To do this, we engage ethnography as both methodology and epistemology to reveal how barriers to teamwork appearing in various contexts and at multiple scales may hinder team science's collaborative potential.
We conducted a multimethod ethnographic study of a multi-sited, interdisciplinary research team through participant observation of weekly meetings (in-person and virtual), document analysis of proposal and funding documentation, and day-to-day management of logistics of the project were all included. A focus group and follow-up semi-structured interviews with nine team members, along with a post-interview anonymous online survey, investigated the roles, relationships, and tensions that emerged within an interdisciplinary, federally-funded study.
Qualitative analysis indicated that barriers faced in the process of team science are often multi-scalar and converge at three primary levels: (1) academic culture, (2) institutional structures, and (3) interpersonal dynamics. We explore how team members manage, normalize, and overcome challenges within these distinct but overlapping contexts. We conclude that the in-depth, nuanced, and contextual analysis of the ethnographic approach can help both researchers of team science and active teams learn how to improve the study and performance of scientific collaboration. An ethnographic approach has the advantage of providing a holistic and more complete picture of team science implementation as it is experienced by real-world teams.
Our findings suggest that ethnographic studies of team science can uncover and mitigate the particular barriers facing collaborative research teams with an in-depth understanding of the contextual factors that affect active teams
Methods: A total of 30 participants (>18) who identify as TGE were recruited. Purposive sampling was adopted for the recruitment of participants as part of a local Gender Health Program. The study team conducted semi-structured video interviews at four-time points over 12 months to better understand TGE experiences during COVID-19. Interviews were transcribed and coded by three investigators to generate salient themes via thematic analysis.
Results: Findings suggested that while many barriers exist for TGE communities, social determinants play an important role in health outcomes. We identified three major themes that exemplify these critical areas during COVID-19 that have far reaching consequences beyond the current pandemic restrictions: (1) participants noted their social orientation – typically referring to their own or others’ introversion or extroversion – as a major moderator of the effects of physical isolation, e.g., more introverted participants noted that their social lives existed substantially online prior to the pandemic and thus required less adjustment; (2) participants highlighted employment status – particularly whether they were able to work remotely or not – as significantly impacting their choices when the lockdowns began and their well-being as the pandemic continued; and (3) access to essential gender-affirming healthcare was delayed, having profound impacts on mental and social well-being. A substantial proportion of our participants also noted pre-existing health concerns that made them more vulnerable to mortality and morbidity if exposed to COVID-19; the fear of exposure for these individuals shaped every choice they made in the context of the pandemic.
Conclusion: Social determinants are prevalent factors in TGE patients' lives, exhibiting strong associations with negative health outcomes. Documenting social determinants as part of providing comprehensive care can help providers to identify and address these factors in treatment goals to better understand patient needs and connect them with resources, particularly in the context of pre-existing conditions.
This paper deploys the case of LD to explore how culture-bound notions of 'resistance' too narrowly conceptualize the bacterium (and antibiotics) as the salient "case" unit for study. I outline analytic strategies for constructing understandings of microbial resistance which go beyond antibiotic resistance/overuse: (1) at the level of the disrupted life course, where biomedical drug interventions fail to return the body to a pre-infection state disrupting survivors expectable life plan; 2) "resistance" in policy and the built environment where legionella bacteria have adapted, through amoebae impregnation, to escape countermeasures from water and water infrastructure treatments, and 3) at intersecting levels of infrastructure and public health policy where NYC (the sole US jurisdiction with laws mandating testing water cooling towers) confronts new LD spikes breaking new records because narrow policy views exclude a deteriorating and underfunded water infrastructure. Final discussion considers the wider implications of LD for an anthropological engagement with microbes.
A total of 30 participants (>18) were recruited who identify as part of TGE communities over 6 months. Purposive sampling was adopted for the recruitment of participants from the Greater Los Angeles area. The study team conducted semi-structured video interviews at three-time points to better understand the patient experiences during the health encounter.
The findings suggest that there is a lack of cultural competence regarding TGE health that creates significant barriers to care for TGE communities. Qualitative analysis indicates that: (1) many TGE patients are often engaging with healthcare providers with limited to no cultural competency in TGE health issues; (2) these encounters often result in TGE patients educating healthcare providers on the needs of TGE communities; and (3) some patients are forced to endure negative or inappropriate lines of questioning unrelated to the immediate TGE health concern. These outcomes are closely related to cultural competency training in TGE health for healthcare providers. Improving access to and training in TGE health can empower healthcare providers to identify and change the systemic barriers to care that cause TGE inequity.
A total of 48 participants (>65 years) were recruited following LD diagnosis and treatment in the Bronx, NY at various stages of diagnosis, treatment, and recovery over a 14-month period. Purposive sampling was adopted for recruitment of participants from previous community health outreach and educational campaigns specific to LD outbreaks and infections across the New York City metropolitan area.
The findings suggest that post-treatment follow-up, LD-related care, and support networks are critical yet rarely utilized aspects of LD infection and there remains a pressing need for more holistic and inclusive post-treatment care for this growing demographic. Qualitative analysis indicates the following outcomes: (1) LD has long-lasting impacts on health status among older adult patients in the Bronx (2) participants navigate through existing relations to seek support and those actions are aimed at replacing new gaps in care networks as a result of gentrification and changing neighborhood characteristics (3) current biomedical guidelines fail to establish a Chronic Disease Management Plan for the care of older adult patients recovering from LD and (4) older adult patients recovering from LD from lower socio-economic backgrounds have various unmet needs in managing their recovery and other comorbidities as a result of LD infection. These outcomes are closely related to broader societal factors such as socio-demographic characteristics, support systems, urban planning and public policies, and health systems factors. Policy decisions to address these needs require an integrated multi-sectoral approach grounded in the principles of health equity.
Despite the negative societal stigma on receptive anal intercourse (RAI), this behavior has a positive influence on individuals’ sexual and relationship health. No large studies have previously looked at the sensations experienced during RAI, especially their association with lifelong exposure.
Objective
This study aims to quantify commonly reported pelvic sensations during RAI and determine whether their presentation changes with increasing experience to RAI.
Methods
An internet survey was conducted on sensations felt during RAI among people with prostates (i.e. cis men and trans women) from July 2022-January 2023. The survey content was developed based on a mixed-methods qualitative study and inquired about demographic and sexual histories as well as sensations (pleasure, pain, urinary, and bowel) experienced during RAI. We used descriptive statistics to describe demographic and sexual histories. All data was stratified by lifetime exposure to RAI. The primary outcomes assessed included both the quantification of the primary sensations experience during RAI and associated bother.
Results
975 participants completed the survey. Nine percent reported less than 10 experiences with RAI, 26% reported 11-50 RAI experiences, 32% reported 51-200 experiences, 16% reported 201-500 experiences, and 18% reported >500 experiences. As the number of experiences with RAI increased (from <10 exposures to >500 exposures), the reported frequency of pleasurable sensation and satisfaction with pleasure at the level of anus increased from 41% to 92% (p<0.0001), whereas severe pain and symptoms of bowel urgency decreased from 39% to 13% and from 21% to 6% respectively (p<0.0001). Urinary urgency sensation did not differ by lifetime RAI experience.
Conclusions
Lifetime exposure to RAI is positively associated with pleasure and is negatively associated with pain and bowel urgency. Pelvic sensations experienced during RAI appear to be dependent on lifetime RAI exposure history regardless of age. Lifetime RAI exposure can be readily assessed and correlates not only with pelvic sensation but also many other aspects of sexual health. These results imply that the etiology of dissatisfaction with pleasure or anodyspareunia during RAI may be distinct by lifetime RAI exposure status. This is the first study assessing pelvic sensations experienced during RAI among a large sample of individuals. This is a cross-sectional study, and we cannot conclude how pelvic sensations change overtime among individuals. Internet based participants may not be representative of clinical populations.
We aimed to explore the experiences of people obtaining medication abortion through telemedicine medication abortion and clinic-based medication abortion at a single academic center.
Methods
We conducted an exploratory qualitative study utilizing semi-structured teleconference interviews with 23 (9 telemedicine medication abortion and 14 clinic-based medication abortion) patients with a gestational age up to 77 days who obtained a medication abortion between June 2018 and December 2022. Purposive sampling was adopted for the recruitment of participants at a single academic center in California. All interviews were recorded, transcribed, and coded by the authors to generate salient themes via thematic analysis.
Results
Participants discussed the effects of abortion stigma from society and social networks, leading to an increased desire for privacy, support, and urgency with time to appointment. Qualitative analysis indicates that telemedicine medication abortion participants preferred the increased privacy afforded via telemedicine. Clinic-based medication abortion participants highlighted the in-clinic environment as more invasive to their privacy, often requiring more people to know about their abortion which increased feelings of unease. Many participants described uncertainty about sharing abortion information with social networks because they (1) did not want to introduce others' opinions into their decision-making and (2) were unclear about how they might feel or react.
Conclusions
The results suggest that telemedicine abortion is an important tool to counteract pervasive societal stigma as well as improve accessibility. This study also suggests that abortion stigma (both actual and perceived) significantly impacts patient experiences despite being in a state with protective abortion laws, and improving accessibility and privacy can counteract the stigma associated with abortion care.
A varicocele is an abnormal dilation of the pampiniform plexus of veins in the scrotum that commonly affects postpubertal males. The condition has been associated with male infertility, testicular hypotrophy, and pain. However, the clinical experiences of adolescent patients and their families regarding the evaluation, surveillance, and management of varicoceles have not been previously examined.
Objective
This study explores the patient’s and family’s experiences of varicocele diagnosis and subsequent management to better understand the salient factors impacting decision-making and care.
Methods
We conducted semi-structured interviews with patients and their families between August 2022 and January 2023. A total of 39 participants (16 adolescent males and 23 parents) were recruited following varicocele diagnosis and treatment at an urban, tertiary care hospital in California. Purposive sampling was adopted for the recruitment of participants through medical record screening to identify eligibility. Utilizing a modified grounded theory approach through the use of constant comparison and memo writing, the analysis consisted of open coding, axial coding, and selective coding, resulting in the production of core concepts and categories.
Results
Results demonstrate that parents and adolescents can benefit from improved understanding and education about long-term expectations during the diagnosis and treatment of adolescent varicoceles. Qualitative analysis indicates: 1) parents and adolescents have common concerns regarding fertility; however, this is exacerbated by the complexity of medical decision-making being dependent on adolescent and parental understanding of the full scope of varicocele impacts and outcomes, and 2) the psychosocial impact of a varicocele on adolescent self-esteem and sexual function are significant drivers for seeking care, which often manifested through discussions on masculinity through notions of ‘manhood’ and future sexual performance.
Discussion
Discussions with patients and families largely focused on their concerns regarding fertility, sexual function, and aesthetics (impacting self-esteem); however, their primary concern was for the need for more accurate and comprehensive information, which includes the natural history of the condition and the full scope of treatment options. Future studies should examine the experiences of patients and families from diverse backgrounds and geographic locations to identify potential differences in experiences.
Conclusion
Findings identified the need for potential improvement in communication between pediatric urologists and families to alleviate anxiety and uncertainty among patients and families and empower them to make informed decisions about their care.
Between September 2021 and April 2022, we conducted semi-structured interviews with 19 men (ages 60-75). Purposive sampling was utilized from participants of a cohort of men with prostate cancer from low-income backgrounds. Interviews were recorded, transcribed, and then coded by the authors to generate salient themes via thematic analysis.
We found internal characteristics and structural characteristics that functioned independently and in concert to promote and/or hinder healthy behavior change. Internal characteristics such as motivations (prostate cancer diagnosis, self-perceptions, support system, and preferences) and determination, defined as level of motivation, drove behavior actualization. Structural characteristics that influenced behavior change included resources (access to food and opportunities for exercise) and social support.
These outcomes suggest that motivation and determination can serve as protective facilitators encouraging healthy behaviors despite structural barriers low-income prostate cancer survivors may face. However, motivations challenged by financial constraints were not sufficient to guide healthy behavior change. With this in mind, we recommend that interventions promoting healthy behavior change among this population should focus on identifying and strengthening internal assets such as motivations, self-perceptions, preferences, and support systems.
Design/methodology/approach: This paper considers some of the practical and analytical challenges of team science through the use of ethnographic methods. The authors formed a three-person subteam within a larger multisited, federally-funded, interdisciplinary scientific team. The authors conducted six months of participant observation, semi-structured interviews, and a focus group, using iterative deductive and inductive analyses to investigate the larger team's roles, relationships, dynamics, and tensions.
Findings: Integrating ethnography into the study of team science can uncover and mitigate barriers faced by teams at three primary levels: (1) academic culture, (2) institutional structures, and (3) interpersonal dynamics. The authors found that these three contextual factors are often taken for granted and hidden in the team science process as well as that they are interactive and influence teams at multiple scales of analysis. These outcomes are closely related to how team science is funded and implemented in academic and institutional settings.
The experiences of adolescents and families contending with varicocele diagnosis and treatment decision-making remain largely unknown. The objective of this ongoing qualitative study is to explore first-person attitudes and concerns among adolescents and their parents regarding varicocele diagnosis and subsequent management using a qualitative approach to elicit core themes affecting decision-making.
METHODS:
Using an IRB-approved exploratory qualitative design, semi-structured interviews were conducted separately with adolescents diagnosed with varicoceles and their parents from 8/2022-11/2022. Purposive sampling identified eligible patients between the ages of 10-19 diagnosed with a varicocele and seen in the urology clinic who elected conservative management or surgical varicocelectomy. Seven adolescents and 12 parents were interviewed. A standardized interview script was employed to cover the following topics: potential long-term impacts of varicoceles on fertility and sexual function; varicocele-specific knowledge; family experiences with diagnosis; factors involved in decision-making; level of parent involvement; and attitudes toward semen analysis testing.
RESULTS:
Semi-structured interviews revealed that care preferences, treatment-related decisional conflict, and educational resources are critical yet underutilized aspects of adolescent varicocele diagnosis and treatment. Qualitative analysis indicated: 1) fertility concerns for patients and parents are poorly addressed; 2) family discomfort with semen analysis requires sensitive, direct communication; 3) a high degree of uncertainty impacts follow up; 4) scrotal aesthetics and impact on perceived masculinity are an important consideration for patients and parents; and 5) families have limited knowledge of the condition and potential short- and long-term impacts (Table 1).
CONCLUSIONS:
This study describes previously unexamined patient and family experiences that may improve care and decision-making interventions regarding adolescent varicoceles. The perspectives gleaned can be used to guide family-centered education and informed decision-making.
Plus précisément, cet essai utilise à la fois des méthodes anthropologiques et de santé publique dans un cadre d'écologie politique de la santé pour comparer les taux de LD dans diverses communautés de la Catalogne. Les résultats indiquent que l'échec de l'infrastructure et l'instabilité économique ne sont pas les facteurs les plus importants qui contribuent à l'augmentation de l'incidence de LD. Au lieu de cela, les taux croissants peuvent être liés à d'autres indicateurs importants tels que l'accès aux soins de santé, l'infrastructure de transport et la sensibilisation à la LD dans la région.