New guidance to reduce human error and improve safety released as UK health service falls to its knees

Human factors can be addressed in all parts of the healthcare system to reduce the risk and impact of human errors and adverse events

Peer-Reviewed Publication

AAGBI

 NEWS RELEASE 11-JAN-2023

The UK National Health Service is being brought to its knees by a perfect storm of difficulties: poor flow through hospitals resulting in crowded emergency departments and long ambulance waits, increases in respiratory illnesses causing increased workloads and staff absences, combined with pre-existing staff shortages and strikes due to working conditions and pay in nurses, ambulance crews and potentially in future junior doctors.

More than ever, there is a need to strengthen systems ensuring patient safety and to reduce the impact of human error in health care, using so-called ‘human factors’, an evidence-based scientific discipline used in safety critical industries. New guidance is being published today in the journal Anaesthesia (a journal of the Association of Anaesthetists) for clinicians, departments, hospitals and national healthcare organisations, to enable them to design and maintain safe systems that will reduce the risk and potential impact of human error by individuals or teams.

Human error, reluctance to challenge authority and reliance on inadequate systems were among key factors in a number of high-profile deaths, including those of Elaine Bromiley (2005) and Glenda Logsdail (2020) (see notes to editors). Both patients were having straightforward operations but teamworking and communication problems played a significant part in both of their deaths.

“We are not only discussing avoidable deaths here, but also long-term consequences in patients who survive when avoidable errors and adverse events occur,” says guidance co-author Dr Fiona Kelly, Consultant in Anaesthesia and Intensive care Medicine at the Royal United Hospitals Bath NHS Foundation Trust, Bath, UK. “The new guidance has analysed all the potential areas in anaesthesia where human error can creep in with potentially devastating outcomes, and is likely to be applicable to other healthcare specialities. This ‘human factors’ approach aims to make it easy for workers to do the right thing, and difficult, or ideally impossible, for them to do the wrong thing.”

The guidance has been by produced by a working party of the Difficult Airway Society and the

Association of Anaesthetists, and is supported by the Royal College of Anaesthetists and other

national organisations. The team includes Dr Kelly and Professor Chris Frerk, Consultant Anaesthetist at Northampton General Hospital, University of Leicester Medical School, and Chair of the Clinical Human Factors Group (a charity dedicated to making healthcare safer). The guidance is also being presented in a special session at the Winter Scientific Meeting of the Association of Anaesthetists in London from January 12-13.

The wide-ranging guidance addresses issues including the design of operating theatres; well -designed medical equipment and using the most effective equipment; effective use of checklists before operating; encouraging staff of any seniority to speak up if they have safety concerns; the ability to learn from not only situations where things have gone wrong, sometimes fatally so, but also from situations where things have gone well; and training and education.

Human factors principles and strategies have been incorporated successfully into safety critical industries, including nuclear power, offshore oil and gas, aviation, construction, rail and the military. Implementation of human factors principles, education and methods within healthcare has made some progress in the past 20 years, including, for example, the adoption of regular team briefings and staff safety huddles. This has been due in part to the work of Martin Bromiley (husband of Elaine) who is an airline pilot fully accustomed to the day-in day-out use of safety procedures that minimise the risk of air accidents. The incredibly helpful and cooperative approach of both Mr Bromiley, and others including Richard Logsdail (husband of Glenda), in helping address systemic faults involved in the death of their partners, has played a huge role in enabling today’s new guidance.

Human factors strategies can be categorised into four domains arranged in a pyramid shape (figure 1 full paper) according to their likely effectiveness. Design (of environment, equipment and systems) is the strategy likely to be most effective and forms the base of the pyramid. ‘Designing out’ the chance of an error occurring reduces the requirement for exceptional human performance commonly relied upon in healthcare. Design strategies are followed in order by barriers (which trap errors to prevent them progressing), mitigations (which reduce the consequences of errors - such as analysis of deaths or critical events) and education and training.  However, the authors explain that the current UK healthcare system is more like the pyramid turned upside-down (figure 2 full paper), with heavy reliance on high levels of human performance and a resultant small and unstable foundation for safety. In the current UK healthcare climate, the authors say this upside-down pyramid is even more unstable.

After a 5-year-process, the Working Group agreed on 12 recommendations to form the new guidance, split among different areas of the ‘pyramid.’ (see notes to editors for full recommendations).

The authors say: “Healthcare relies on high levels of human performance, as described by the `human as the hero´ concept. However, human performance varies and is recognised to fall in high-pressure situations, meaning that it is not a reliable method of ensuring safety. Other safety-critical industries embed human factors principles into all aspects of their organisations to improve safety and reduce reliance on exceptional human performance; there is potential to do the same in anaesthesia and in healthcare in the broader sense.”

Adding that improving human factors is in no way a substitute for proper funding and resourcing of hospitals and healthcare systems, the authors conclude: “Although applying human factors science has the potential to save money in the long term, its proper implementation may require investment before reward can be reaped.”

Professor Frerk adds: “Care given within the NHS has become increasingly complex over the last 20 years, and is now delivered by teams of nurses, physiotherapists, pharmacists, doctors and other support staff. As many as 1 in 10 patients are harmed during their interactions with the NHS; this is not because staff don’t care or don’t try hard to do the right thing. The old model of healthcare where we assumed that having knowledge (and experience) about the heart, lungs, cancer or arthritis would be enough to keep patients safe is just not the case anymore. Adopting a ‘human factors’ approach across healthcare, to eliminate the risk and impact of human error, has been on the national agenda for more than 10 years. With this guidance, we want to start to move this approach into everyday practice for everyone in the NHS.”

Notes to editors:

 

The 12 recommendations:

 

Design

 

1. Design of medical equipment should include input from human factors experts at an early stage (where it is possible to still change the design if necessary – this is not currently always the case). The medical equipment procurement process should include human factors assessments.
2. Design of drug ampoules and packaging should incorporate human factors principles to optimise readability and reduce the risk of mis-selection: anaesthetists, pharmacists and procurement departments should ensure that these principles are prioritised during their purchasing processes. Improvements that could make a difference include making the drug name more prominent than the manufacturer’s name and logo, prioritise generic drug names over trade names and consider standardised use of colour, while being mindful of the impact of colour blindness.
3. Design of safe working environments should incorporate human factors principles. Regular reviews should be carried out to ensure that safety has not been compromised – this can cover anything from the design of the whole hospital to operating theatre design, and how moveable equipment is used in each operation.

 

Barriers

 

1. Operating theatre list planning and scheduling should include additional time allocated or complex cases and for high turnover lists to enable adequate preparation and reduce time pressures on staff.
2. Cognitive aids, including algorithms and checklists, should be designed and tested using human factors principles to ensure usability and efficacy.
3. Non-technical skills can be learned and developed, and should be practised during everyday work to ensure that staff become skilled in their use and are able to use them effectively. (Many examples exist and include all staff wearing a name badge and using first names of team members, and situational awareness – being aware of what has happened in a situation, what is currently happening, and what could happen in the coming moments.)

 

Mitigations

 

1. Investigation of critical incidents and adverse events should be performed by teams that include members with human factors training using a human factors investigative tool. Lessons identified should be shared. An example of this is: a new patient safety incident response framework (PSIRF), based on human factors principles, is replacing the existing root cause analysis investigation tools that are currently in use in the UK healthcare system. (Hospitals have been given until Autumn 2023 to implement this.)
2. Morbidity and mortality meetings should be part of the regular work of all anaesthetic departments and should also include learning from cases that go well. Time within job plans should be allocated to enable staff to prepare for and attend these meetings.

 

Education and training

 

1. Human factors education and training should be provided at an appropriate level for all anaesthetists and all members of operating theatre teams. It should include the role of good design in healthcare, an appreciation of a systems perspective, the importance of non-technical skills and strategies to improve these.
2. Non-technical skills training and interprofessional simulation training: Teams that work together should train together. Non-technical skills should be learned during classroom and in-theatre teaching, woven into all anaesthetic workshops and courses and rehearsed during regular interprofessional simulation training. Time and resources should be allocated to allow for this.

 

Well-being

 

1. Staff well-being should be optimised by hospitals and anaesthetic departments by implementing organisational strategies.

 

Strategy

 

1. Each anaesthetic department should have a human factors lead with an appropriate level of training. Every hospital should have patient safety leads with appropriate training and qualifications; in England, this is already included in Health Education England recommendations.

 

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JOURNAL

Anaesthesia

ARTICLE TITLE

Implementing human factors in anaesthesia: guidance for clinicians, departments and hospitals

ARTICLE PUBLICATION DATE

11-Jan-2023

COI STATEMENT

See full article for disclosures

Cutting costs and emissions in beef production

Peer-Reviewed Publication

UNIVERSITY OF QUEENSLAND

 

IMAGE: THE TOOL COULD HELP HAVE THE TRIPLE EFFECT OF HELPING THE GLOBAL BEEF INDUSTRY TO SIMULTANEOUSLY REDUCE COSTS AND GREENHOUSE GAS EMISSIONS WHILE MEETING DEMAND. view more 

CREDIT: ADOBE

A research team led by the University of Queensland has developed a tool to help the global beef industry simultaneously reduce costs and greenhouse gas emissions while meeting demand for meat.

The team assessed the economic and emissions impacts of different cattle feeds at different locations around the globe to formulate a framework to guide and inform industry sustainability efforts.

Postdoctoral Research Fellow Adam C. Castonguay from UQ’s School of Veterinary Science said the study showed that as much as 85 per cent of emissions could be cut without an overall economic hit to the beef sector.

“This can be achieved by opting for more efficient feeds and locations, and restoring forests in inefficient areas, without increasing global costs of production or reducing demand for beef,” Mr Castonguay said.

“We have mapped out the most efficient locations around the world to produce beef and the maps change when factors are altered, such as how much society values reducing emissions over reducing production costs.

“This has given us an unprecedented insight into the ‘what, where, and why’ of beef production at a global level and decisions about the future of the industry can be informed by inputting trade-offs and opportunities.”

The research group says the tool could be used by governments and industry to develop policy and strategy.  

“There will be continued global demand for beef and there are a huge number of livelihoods associated with it, so this research aims to find an appropriate balance to maintain the bottom line of the sector,” Mr Castonguay said.

“Further economic modelling and fine-tuning the data for specific locations would reveal the implications of any changes, including on beef prices for consumers.”

Mr Castonguay said the optimisation method developed by the team using mapping technology overcame historic roadblocks to finding an environmental-economic balance.

“There are many innovations in cattle feed to increase productivity or reduce emissions which have not been analysed as a trade-off with other values and goals,” he said.

“Our results highlight the massive potential for improvements in the way we produce beef, to help us to meet global sustainability goals.

“The extent to which we reduce emissions and production costs depends on our values or preferences as a society.”

This research has been published in Nature Sustainability.

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JOURNAL

Nature Sustainability

DOI

10.1038/s41893-022-01017-0 

ARTICLE TITLE

Navigating sustainability trade-offs in global beef production

Symptoms of illness help pathogens spread amongst songbirds

Both songbirds and humans suffer from contagious disease outbreaks. Studying what aspects of illness makes a sick animal contagious can help predict whether some pathogens will become more harmful over time

Peer-Reviewed Publication

VIRGINIA TECH

 

IMAGE: THIS IMAGE SHOWS THE INERT FLUORESCENT POWDER PLACED AROUND THE EYES OF BIRDS TO MEASURE HOW WELL THEY "SPREAD" THE POWDER WHILE INFECTED WITH CONJUNCTIVITIS. PHOTO COURTESY OF DANA HAWLEY. view more 

CREDIT: VIRGINIA TECH

It’s “Treasure Island” author Robert Louis Stevenson who is credited with coining the phrase, “You cannot make an omelet without breaking eggs.” For us humans, it’s now cliché. For pathogens, it’s words to live by. Or, rather, spread by.

Like all living organisms, pathogens want to thrive. Aside from cellular reproduction, though, the best future for them lies in moving from host to host. Think of each host as Stevenson’s eggs, unwittingly waiting to be, if not broken, certainly cracked. Meaning ill. That’s why pathogens — from conjunctivitis, commonly known as pink eye, or a common cold or a disease as severe as COVID-19 — make their hosts sick: Spread is sometimes only made possible by expulsion via swollen red eyes; ,coughing or sneezing, or passing through bodily fluids, according to Virginia Tech biologist Dana Hawley.

“For a pathogen, ‘spreading’ is their key form of reproduction. And when we think about why pathogens make their hosts sick, it’s long been a mystery, because making a host sick or making your host die is superficially not a good way for a pathogen to be able to spread. A very sick host will stay home and not interact as much as others, which means less spread potential for a pathogen,” said Hawley, a professor in the Department of Biological Sciences, part of the Virginia Tech College of Science.

But here’s the caveat: “Making your hosts feel ill can be important for getting some of the copies of yourself out of the host you are infecting and into another. So there is a trade-off for the pathogen,” Hawley said. “Making your host feel sick means that host may not interact with as many other hosts as they normally would — this is bad for the pathogen — but when they do have interactions, a very sick host that is coughing or has swollen eyes is going to be much more likely to spread whatever pathogen it has in its body. This is good for the pathogen.”

Using songbirds, a type known as finches, whose populations are affected by a pink-eye disease in nature, Hawley and a team of researchers from Virginia Tech and the University of Memphis in Tennessee have shown just how easily these pathogens — in this case, a form of conjunctivitis common in birds, but harmless to humans — spread. And they did it without having the pink eye pathogen itself spread from bird to bird.

Instead, the team used UV fluorescent powder coatings and tracked that and not the pathogen. During the experiment, birds were divided up into three groups: not ill, mildly ill, and strongly ill, all with conjunctivitis, and each bird was housed with four healthy flockmates. By applying a powder coating around the outer eye of each bird, but not inside the eye, the researchers could track how much powder was spread to flockmates from birds that were strongly, mildly, or not ill with pink eye.

“We weren’t actually tracing the spread of conjunctivitis. We were tracing the spread of powder as a model for the likely spread of conjunctivitis,” said Hawley, who is also an affiliated member of the Virginia Tech Fralin Life Sciences Institute’s Global Change Center and its Center for Emerging, Zoonotic, and Arthropod-borne Pathogens, about the study, published today in the journal Royal Society Open Science.

During the study, birds were kept in large-flight cages, sharing feeders and potentially spreading powder to cage mates. Feeder surfaces are one main avenue of the powder’s travel, according to the study.

There were some surprises along the way, Hawley said. The finches experiencing the strongest conjunctivitis symptoms were far less likely to eat but nonetheless spread the powder at a higher rate than the mildly ill birds who spent more time feeding.

“In our study system, the benefits of making your host sicker by increasing eye swelling outweighed the cost of making the finches feed and interact less,” Hawley said. “So overall, this pathogen is going to likely evolve to cause more harm to birds in nature so that it can spread at a higher rate, but up to some limit, because if the pathogen kills a bird immediately, the pathogen doesn’t have a chance to spread at all.”

The human factor

What does all this mean for humans and the spread of a common cold or COVID-19 at a doctor’s office or the cinema, or the spread of conjunctivitis amongst young children at a nursery school or day care?

The mantra of “stay home if you’re sick” still applies more than ever, according to Hawley. This study suggests that symptoms will make the spread of anything you are infected with much more likely. And wear a face mask — and not just for potential spread of COVID. “Wearing masks when you are coughing from any illness can likely go a long way in preventing disease spread,” Hawley said. “For pink eye, keeping kids isolated is going to be key because young children are just not going to be able to wash their hands or avoid touching each other — speaking from experience as a parent.”

Evolution plays another part. Again, pathogens are living organisms and prone to the rules of life, including evolution. “This goes back to the idea that everyone hoped that COVID would evolve to become milder over time,” Hawley said. “Our study shows that the pressures on pathogens are complicated. On the one hand, being mild is good for pathogens if it keeps your host out and about and in others’ company — good for spread, but on the other hand, being mild may mean that none of the pathogen makes it out of the host and into another because your host isn’t coughing or depositing as much pathogen onto hands or other surfaces. So pathogens are in many cases going to be favored to make us sick.”

In other words, for humans, common sense actions can prevent us from being those proverbial eggs spoken of by Stevenson.

Co-authors on the paper include Courtney A. Thomason, a former postdoctoral associate at Virginia Tech from January 2015 to October 2017, who is now at the Tennessee Department of Environment and Conservation; Matt Aberle, who earned a master's degree in biological sciences in 2018 and is now a wildlife biologist with Oregon Department of Forestry; and Richard Brown, who graduated with a bachelor’s degree in wildlife conservation from the Virginia Tech College of Natural Resources and Environment in 2017 and is now a master's student at George Mason University; as well as James S. Adelman, an assistant professor at the University of Memphis.

Funding for the study came from two National Science Foundation grants and additional funding from the National Institute of General Medical Sciences, the latter part of the National Institutes for Health.

 

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JOURNAL

Royal Society Open Science

As climate warms, drier air likely to be more stressful than less rainfall for Douglas-fir trees

Peer-Reviewed Publication

OREGON STATE UNIVERSITY

 

IMAGE: DOUGLAS-FIR view more 

CREDIT: LINA DIGREGORIO

CORVALLIS, Ore. – Douglas-fir trees will likely experience more stress from drier air as the climate changes than they will from less rain, computer modeling by Oregon State University scientists shows.

The research is important because Douglas-fir are widespread throughout the Pacific Northwest, an iconic species with ecological, cultural and economic significance, and learning how the trees respond to drought is crucial for understanding forest sensitivity to a shifting climate.

Douglas-fir grow in a range that stretches from northern British Columbia to central California, and also includes the Rocky Mountains and northeastern Mexico. In Oregon, Douglas-fir are found in a variety of mixed conifer and hardwood forests, from sea level to 5,000 feet, and can reach a massive size; a tree on Bureau of Land Management land in Coos County is more than 300 feet tall and greater than 11 feet in diameter.

Native Americans traditionally used the wood of Douglas-fir, Oregon’s official state tree since 1936, for fuel and for tools, its pitch as a sealant and many parts of the tree for medicinal purposes.

A versatile timber tree, Douglas-fir is a source of softwood products including boards, railroad ties, plywood veneer and wood fiber. Oregon leads all U.S. states in softwood production and most of that is Douglas-fir.

The OSU study, published in Agricultural and Forest Meteorology, simulated the response of a 50-year-old stand of Douglas-fir on the Oregon Cascade Range’s west slope to less rain and higher “vapor pressure deficit,” or VPD – basically the atmosphere’s drying power.

A team led by Karla Jarecke, a postdoctoral researcher in the OSU College of Earth, Ocean, and Atmospheric Sciences, sought to look at how the mechanisms behind carbon fixation and water “fluxes” – exchanges of water between trees and the atmosphere – would respond to decreases in rainfall and increases in VPD.

Douglas-fir, like other plants, create food for themselves using sunlight, carbon dioxide and water during photosynthesis. The process pulls CO2, a greenhouse gas, from the air, releases oxygen and results in the long-term storage of carbon in the wood and roots.

“What governs carbon fixation and water fluxes in response to increased temperatures and water limitation in regions with Mediterranean climates – wet winters and dry summers – is only partially understood,” said Jarecke, who began the research as a doctoral student in the OSU College of Forestry. “High VPD and lack of soil moisture can create significant water stress in forests, but dry atmosphere and lack of rainfall are strongly linked, making it difficult to discern their independent effects. They tend to both occur during the summer.”

Jarecke and collaborators including the College of Forestry’s Kevin Bladon and Linnia Hawkins and the U.S. Forest Service’s Steven Wondzell used a computer model to disentangle the effects of the two phenomena. The model uses a series of equations that illustrate how well Douglas-firs are equipped to deal with water stress, and it showed that less spring and summer rain is likely to have a comparatively smaller impact on forest productivity than increased VPD.

“Decreasing spring and summer precipitation did not have much of an effect on Douglas-fir water stress because moisture remained plentiful deep in the soil profile,” Jarecke said. “This demonstrated that the effect of reduced rainfall under future climate change may be minimal but will depend on subsurface water availability, which is determined by soil properties and rooting depths.”

She said heat-driven increases in vapor pressure deficit, however, are likely to cause water stress regardless of the amount of moisture in the soil, adding that “many knowledge gaps remain concerning how trees will respond to extreme temperatures and VPD anomalies such as the record-breaking temperatures that occurred in the Northwest in the summer of 2021.”

Bladon added that the Oregon State study shows the important role of atmospheric droughts in creating stress conditions for trees.

“This has potential implications for not only driving substantial tree mortality, but also influencing wildfires, as other studies have shown strong relationships between VPD and forest area burned in the western United States,” he said.

Karla Jarecke, left, and Lauren Roof collect soil samples (photo by Lina DiGregorio).

CREDIT

Lina DiGregorio

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JOURNAL

Agricultural and Forest Meteorology

DOI

10.1016/j.agrformet.2022.109267 

METHOD OF RESEARCH

Computational simulation/modeling

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Carbon uptake by Douglas-fir is more sensitive to increased temperature and vapor pressure deficit than reduced rainfall in the western Cascade Mountains, Oregon, USA

Study refutes industry claims that ban on menthol cigarettes leads to increased use of illegal smokes

Research on Canada’s ban shows no uptick in illicit cigarettes

Peer-Reviewed Publication

UNIVERSITY OF WATERLOO

A new research study has found that banning menthol cigarettes does not lead more smokers to purchase menthols from illicit sources, contradicting claims made by the tobacco industry that the proposed ban of menthol cigarettes in the U.S. by the Food and Drug Administration (FDA) will lead to a significant increase in illicit cigarettes.

Researchers at the International Tobacco Control (ITC) Policy Evaluation Project at the University of Waterloo evaluated the impact of federal and provincial menthol cigarette bans in Canada by surveying smokers of menthol and non-menthol cigarettes before and after Canada’s menthol ban. 

Smokers were asked whether their usual cigarette brand was menthol-flavoured and to report their last brand purchased. Those who were still smoking after the menthol ban were also asked where they last purchased their cigarettes. 

Results showed that after the ban, there was no significant change in the purchase of cigarettes from First Nations reserves, the main source of illicit cigarettes in Canada. 

“The tobacco industry has a long history of claiming that policies to reduce smoking will lead to substantial increases in illicit trade,” said Dr. Janet Chung-Hall, a research scientist for ITC and lead author of the new study. “We can add the Canadian menthol ban to the long list of effective policies, such as graphic warnings and plain packaging, whose evaluation disproved the scare tactics by industry—showing that illicit trade did not, in fact, increase.”

A 2022 study that combined the ITC Project data with data from a comparable Ontario evaluation study showed that the Canadian menthol ban led to an increase of 7.3 per cent in quitting among menthol smokers above that of non-menthol smokers. Projecting this effect to the U.S., whose Food and Drug Administration (FDA) has proposed its own menthol ban, the ITC researchers estimate that a U.S. menthol ban would lead 1.33 million smokers to quit.

“Our previous research from Canada and the Netherlands showed that a menthol cigarette ban leads to significant reductions in smoking,” said Dr. Geoffrey Fong, principal investigator of the ITC Project and professor of psychology and public health sciences at Waterloo. “These findings combine to provide powerful evidence in support of FDA’s proposed menthol ban.”

Smoking is still the number-one preventable cause of disease and death around the world. Health authorities, including the World Health Organization, have long called for banning menthol in cigarettes because they promote smoking. Canada was one of the first countries to ban menthol cigarettes, with more than 30 countries implementing similar bans to date.  

The study appears in the journal Tobacco Control.  

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JOURNAL

Tobacco Control

The far right also knows how to exploit love

They use love to divide and build a wall between conservative-leaning Spain, and feminism and the defense of policies for gender equality

Peer-Reviewed Publication

UNIVERSITAT OBERTA DE CATALUNYA (UOC)

The rise of the far right in Western democracies in recent years has revived interest in how these movements and parties engage in politics. Given the generalizations that indicate that these ideologies are only constructed based on hate speech, two researchers at the Universitat Oberta de Catalunya (UOC) argue that this political tendency in Spain also uses love and other positive feelings to a great extent, although it does so from its own perspective, which is based around the family, the nation and equality.

A scientific article by Alexandre Pichel, a predoctoral researcher on the UOC's doctoral programme in Humanities and Communication, and Begonya Enguix, a member of the Faculty of Arts and Humanities and lead researcher of the Genders in Transition: Masculinities, Affects, Bodies, and Technoscience (MEDUSA) group, who is also supervising Pichel's thesis, examines how the far right in Spain uses love, and argues that this political tendency is motivated by feelings "that go far beyond rejection".

What role do rejected realities play among so much love?

On 8 March 2020, a few days before the declaration of the lockdown for the Covid pandemic in Spain, and while a wide range of feminist demonstrations were being held in various Spanish cities, the political party VOX organized an event at the Palacio de Vistalegre in Madrid. At that event, the third largest political force in Spain's Congress of Deputies set out a large proportion of its arguments. After analysing the main speeches that were given on that day, the researchers examine how the party's leaders use love as an element for division.

"Very conservative ideologies use love for the same reason as the left, the mainstream right and any other type of ideology. This political trend doesn't use love to hide its true face, which is a rejection of those who don't identify with its values. This political tendency loves – but the problem is what it loves. It loves a Spain which is a single nation and exclusive. The far right generates hate for the things it loves, but that love is completely genuine," explained Alexandre Pichel.

As the researchers point out in the article, love is used as a tool for establishing a difference between "us" (traditional families, white men and native Spaniards) and "them", who may be the elite (embodied in the governing classes and feminism) or those who are different (non-traditional families or migrants). To that end, the leaders of the far right create this feeling in their speeches through their relationship with the family, equality and violence.

 

Love and the traditional family

Over the last decade, defending the traditional family structure has become one of the cornerstones of the ultra-conservative discourse. The researchers observe that feminism and the LGBTQI movement are highlighted in these discourses as the main threats to a type of family unit that is identified as the only "normal and natural" one. In addition, in their article Pichel and Enguix conclude that this type of family provides a direct link with the past, tradition and the cultural legacy of previous generations, i.e. with some of the cornerstones of the most conservative discourse.

The experts point out that conservative ideas about the family define the political boundaries between opponents of the traditional family (who are identified as feminists and LGBTQI people) and those who protect, love and are willing to pass on Spain's national and moral, natural sexual and gender values. The researchers argue that, within the discourse of this political doctrine, "feminists, queers and leftists betray the moral norms of the nation and aim to destroy Spain and the traditional family".

 

Love for equality

"On the far right, equality stems from the idea of a completely uniform society. If the Spanish people is uniform, then inequality is impossible," explained Pichel. "On the other hand, in leftist movements and feminism, equality is considered in terms of a concept that understands and highlights differences in order to create an open community. The far right believes that gender quotas are restrictive of gender equality, since they don't understand the need to specify differences. The same applies to sex education in schools. This idea of equality leads ultra-conservative schools of thought to masculinize and heterosexualize a uniform society."

Love plays a role in this area. This love is for the traditional woman, the central figure of the family, for example. From this perspective, the researchers argue that the most conservative facets of Spanish politics believe that women have already reached their maximum levels of intelligence, freedom, strength and independence, and as such they have no need for feminism. In their study, the UOC experts point out that love is once again used to divide and to build a wall between conservative-leaning Spain, and feminism and everyone who defends policies for gender equality.

 

Love and its relationship with gender violence

The authors believe that the discourse of the Spanish far right uses the distinction between gender violence and sexual violence to maintain an ambivalent narrative. On the one hand, they use it to accuse feminism of criminalizing men with regard to gender violence. While, on the other hand, they use it to portray immigrant men as potential sexual abusers. As the researchers say in their paper, "nativism, nationalism, and xenophobia are entangled with affects and violence in a complex way."

"The link between love and the family, Spain and its idea of equality is the result of what the British sociologist Jeff Hearn calls the hegemony of men. If we look at the affective and political mechanisms that are used, we can see how the defence of men is present in each one," said Pichel. "The far right loves the family in order to protect the concept of paternal domination, it loves the country to restore the role of men as national leaders, and it loves equality to defend men against the advances made by feminism."

 

This research contributes to Sustainable Development Goal (SDG) 5: Achieve gender equality and empower all women and girls.

 

UOC R&I

The UOC's research and innovation (R&I) is helping overcome pressing challenges faced by global societies in the 21st century by studying interactions between technology and human & social sciences with a specific focus on the network society, e-learning and e-health.

Over 500 researchers and 51 research groups work in the UOC's seven faculties, its eLearning Research programme and its two research centres: the Internet Interdisciplinary Institute (IN3) and the eHealth Center (eHC).

The university also develops online learning innovations at its eLearning Innovation Center (eLinC), as well as UOC community entrepreneurship and knowledge transfer via the Hubbik platform.

Open knowledge and the goals of the United Nations 2030 Agenda for Sustainable Development serve as strategic pillars for the UOC's teaching, research and innovation. More information: research.uoc.edu.

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JOURNAL

South European Society & Politics

DOI

10.1080/13608746.2022.2115185 

Meditation and mindfulness may be as effective as medication for treating certain conditions

by Hilary A. Marusak, The Conversation

Credit: Unsplash/CC0 Public Domain

Many people look to diet trends or new exercise regimens—often with questionable benefit—to get a healthier start on the new year. But there is one strategy that's been shown time and again to boost both mood and health: meditation.

In late 2022, a high-profile study made a splash when it claimed that meditation may work as well as a common drug named Lexapro for the treatment of anxiety. Over the past couple of decades, similar evidence has emerged about mindfulness and meditation's broad array of health benefits, for purposes ranging from stress and pain reduction to depression treatments to boosting brain health and helping to manage excessive inflammation and long COVID-19.

Despite the mounting body of evidence showing the health benefits of meditation, it can be hard to weigh the science and to know how robust it is.

I am a neuroscientist studying the effects of stress and trauma on brain development in children and adolescents. I also study how mindfulness, meditation and exercise can positively affect brain development and mental health in youth.

I am very excited about how meditation can be used as a tool to provide powerful new insights into the ways the mind and brain work, and to fundamentally change a person's outlook on life. And as a mental health researcher, I see the promise of meditation as a low- or no-cost, evidence-based tool to improve health that can be relatively easily integrated into daily life.

Meditation requires some training, discipline and practice—which are not always easy to come by. But with some specific tools and strategies, it can be accessible to everyone.

What are mindfulness and meditation?

There are many different types of meditation, and mindfulness is one of the most common. Fundamentally, mindfulness is a mental state that, according to Jon Kabat-Zinn a renowned expert in mindfulness-based practices, involves "awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally."

This means not ruminating about something that happened in the past or worrying about that to-do list. Being focused on the present, or living in the moment, has been shown to have a broad array of benefits, including elevating mood, reducing anxiety, lessening pain and potentially improving cognitive performance.

Mindfulness is a skill that can be practiced and cultivated over time. The goal is that, with repetition, the benefits of practicing mindfulness carry over into everyday life—when you aren't actively meditating. For example, if you learn that you aren't defined by an emotion that arises transiently, like anger, then it may be harder to stay angry for long.

The health benefits of meditation and other strategies aimed at stress reduction are thought to stem from increasing levels of overall mindfulness through practice. Elements of mindfulness are also present in practices like yoga, martial arts and dance that require focusing attention and discipline.

The vast body of evidence supporting the health benefits of meditation is too expansive to cover exhaustively. But the studies I reference below represent some of the top tier, or the highest-quality and most rigorous summaries of scientific data on the topic to date. Many of these include systematic reviews and meta-analyses, which synthesize many studies on a given topic.

Stress and mental health

Mindfulness-based programs have been shown to significantly reduce stress in a variety of populations, ranging from caregivers of people living with dementia to children during the COVID-19 pandemic.

Meta-analyses published during the pandemic show that mindfulness programs are effective for reducing symptoms of post-traumatic stress disorder, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder and depression—including the particularly vulnerable time during pregnancy and the postnatal period.

Mindfulness-based programs also show promise as a treatment option for anxiety disorders, which are the most common mental disorders, affecting an estimated 301 million people globally. While effective treatments for anxiety exist, many patients do not have access to them because they lack insurance coverage or transportation to providers, for instance, or they may experience only limited relief.

In addition to improving mood and lowering stress, mindfulness has been shown to elevate cognitive performance, cut down on mind wandering and distractibility and increase emotional intelligence.

It's important to note, however, that for those affected by mental or substance use disorders, mindfulness-based approaches should not replace first-line treatments like medicine and psychotherapy such as cognitive behavioral therapy. Mindfulness strategies should be seen as a supplement to these evidence-based treatments and a complement to healthy lifestyle interventions like physical activity and healthy eating.

How does meditation work? A look into the brain

Studies show that regular meditators experience better attention control and improved control of heart rate, breathing and autonomic nervous system functioning, which regulates involuntary responses in the body, such as blood pressure. Research also shows that people who meditate have lower levels of cortisol—a hormone involved in the stress response—than those who don't.

A recent systematic review of neuroimaging studies showed that focused attention meditation is associated with functional changes in several brain regions involved in cognitive control and emotion-related processing. The review also found that more experienced meditators had stronger activation of the brain regions involved in those cognitive and emotional processes, suggesting that the brain benefits improve with more practice.

A regular meditation practice may also stave off age-related thinning of the cerebral cortex, which may help to protect against age-related disease and cognitive impairment.

Limitations of meditation research

This research does have limits. These include a lack of a consistent definition for the types of programs used, and a lack of rigorously controlled studies. In gold-standard randomized controlled trials with medications, study participants don't know whether they are getting the active drug or a placebo.

In contrast, in trials of mindfulness-based interventions, participants know what condition they are assigned to and are not "blinded," so they may expect that some of the health benefits may happen to them. This creates a sense of expectancy, which can be a confounding variable in studies. Many meditation studies also don't frequently include a control group, which is needed to assess how it compares with other treatments.

Benefits and wider applications

Compared with medications, mindfulness-based programs may be more easily accessible and have fewer negative side effects. However, medication and psychotherapy—particularly cognitive behavioral therapy—work well for many, and a combination approach may be best. Mindfulness-based interventions are also cost-effective and have better health outcomes than usual care, particularly among high-risk patient populations—so there are economic benefits as well.

Researchers are studying ways to deliver mindfulness tools on a computer or smartphone app, or with virtual reality, which may be more effective than conventional in-person meditation training.

Importantly, mindfulness is not just for those with physical or mental health diagnoses. Anyone can use these strategies to reduce the risk of disease and to take advantage of the health benefits in everyday life, such as improved sleep and cognitive performance, elevated mood and lowered stress and anxiety.

Where to get started?

Many recreation centers, fitness studios and even universities offer in-person meditation classes. For those looking to see if meditation can help with the treatment of a physical or mental condition, there are over 600 clinical trials currently recruiting participants for various conditions, such as pain, cancer and depression.

If you want to try meditation from the comfort of your home, there are many free online videos on how to practice, including meditations for sleep, stress reduction, mindful eating and more. Several apps, such as Headspace, appear promising, with randomized controlled trials showing benefits for users.

The hardest part is, of course, getting started. However, if you set an alarm to practice every day, it will become a habit and may even translate into everyday life—which is the ultimate goal. For some, this may take some time and practice, and for others, this may start to happen pretty quickly. Even a single five-minute session can have positive health effects.

Provided by The Conversation 

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How effective is mindfulness for treating mental ill-health? And what about the apps?