bluuebunny/crossref_metadata_2025 huggingface dataset:
The interdisciplinary curriculum: from social medicine to postmodernism
Authors: Turner Bryan S.
Published: August 2010

Academic specialisation has often been criticised, because it brings about a narrow and partial orientation to research and teaching. Hence interdisciplinarity often appears to be a positive and alternative framework for the progressive reorganisation of higher education curricula. This paper examines various aspects of the development of interdisciplinarity in relation to the medical curriculum, locating these changes in the social context of the development of scientific medicine. These interdisciplinary perspectives are illustrated by an examination of four cases (social medicine, sociology of health and illness, the interdisciplinary research centre, and the postmodern melange) which necessarily imply some critical appraisal of the medical profession and its status in society, because they implicitly or explicitly suggest new approaches to the medical curriculum. However, these four examples indicate that the notion of ‘interdisciplinarity’ covers a variety of very different perspectives on curriculum reform in higher education. Social medicine and the sociology of health and illness have been typically critical evaluations of monodisciplinary assumptions about medical intervention and medical training. By contrast, the research centre orientation, which followed the Rothschild Report, has been primarily a response to financial constraints. The development of postmodernism in social theory has also involved a challenge to the unitary assumptions of monodisciplinarity, but there may be a convergence between the commercialisation of medicine and the emergence of postmodernistic criticism of the conventional medical curriculum, in which case interdisciplinarity will produce a fragmentary pastiche of disciplines rather than intellectual integration.
Lay epidemiology and the prevention paradox: the implications of coronary candidacy for health education
Authors: Davison Charlie , Smith George Davey , Frankel Stephen
Published: August 2010

This paper is concerned with the appropriateness of current attempts to prevent chronic disease through behavioural change. Based on extensive ethnographic research in South Wales, the paper suggests that, within contemporary British health culture, there exists a well developed lay epidemiology which has a significant bearing on the public plausibility of modern health promotion messages. The paper describes the notion of the coronary candidate (the ‘kind of person who gets heart trouble’) and discusses the operation of the idea in everyday life. The manner by which lay epidemiology and the population approach to health promotion construct the ‘prevention paradox’ within the social world is outlined. In conclusion it is suggested that lay epidemiology readily accommodates official messages concerning behavioural risks within the important cultural fields of luck, fate and destiny. This simultaneously constitutes a rational way of incorporating potentially troublesome information, and a potential barrier to the aims of health education.
‘Pulling down churches’: accounting for the British Mental Health Users’ Movement
Authors: Rogers Anne , Pilgrim David
Published: August 2010

Abstract A study of the British Mental Health Users’ Movement (MHUM) is reported, based upon interviews with some of its participants. These accounts are analysed in terms of three main themes: ideology and policy; relationships between users and non‐patients; and relationships between the movement and statutory and voluntary agencies. The data are discussed in relation to international comparisons and with regard to preceding opposition to traditional psychiatric theory and practice in Britain. The emergence of the MHUM is accounted for within the context of existing theoretical analyses of new social movements. Strengths and weaknesses of the movement are highlighted and prospects for its future discussed.
Ethnicity and infant deaths: the implications of recent statistical evidence for materialist explanations
Authors: Andrews Ahmed , Jewson Nick
Published: August 2010

The paper begins with a summary of recent OPCS data on ethnic inequalities in infant deaths, emphasizing the diversity of trends which they demonstrate. It continues by reviewing the implications of this evidence for materialist, and other, explanations of health inequalities. It is suggested that further progress in developing explanations for patterns of ethnic minority infant mortality would be facilitated by greater refinement of indices of economic deprivation and ethnicity.
Keeping healthy at home and school: ‘it's my body, so it's my job‘
Authors: Mayall Berry
Published: August 2010

This paper focusses on children as a social group, in order to discuss the division of labour in health care between children, parents and teachers. It draws on data from a qualitative study of children's, parents’ and teachers’ perspectives on the health care of primary school children. The paper argues that the distinctive social and emotional context of the home and the school are critical for the structuring of children's health care activities and experience. In particular the paper considers children's own contributions to health care and the functions of their own social worlds in the division of labour.
Anaesthetists, the discourse on patient fitness and the organisation of surgery
Authors: Fox Nicholas J.
Published: August 2010

The organization of daily procedures within the operating theatre is considered in terms of rival perspectives on their patient held by surgeon and anaesthetist. The privileging of the surgeon's authority is challenged in anaesthetists' efforts to fabricate a distinctive position on the patient. While surgeons focus on patient as the carrier of disease, for the anaesthetist, the focus is upon the patient's complement of fitness.

A postmodern analysis of the organization of surgery reflects the continual struggle between the two specialisms to privilege its particular definition of the surgical patient. In some circumstances, the struggle can have damaging consequences for patient care.
Passive smoking and ill‐health: practice and process in the production of medical knowledge
Authors: Jackson Peter W.
Published: August 2010

This paper examines the development of medical knowledge about passive smoking from a constructionist perspective. It draws upon the work of Ludwik Fleck, particularly his central idea that facts are produced in relation to the possibilities of stylised thought. Early epidemiological insights into changing disease patterns, with regard to active smoking, are initially discussed and shown to be related to a style of thought which encourages the production of a world of disconnected bodies. The paper then explores how connections between those bodies were constructed, and the medicalisation of passive smoking advanced, by a stylised perception of tobacco smoke. Problems of ‘subject’ visibility, however, remained; problems overcome by the production rather than the revelation of facts, notably the distinction between mainstream and sidestream smoke. This development opened up the space for the emergence of the previously invisible passive smoker. This processual reordering of reality is then mapped onto other processual patterns and the stylisation of social relationships, particularly apparent in the later ‘spouse as index’ studies, is discussed. The point is further explored in an analysis of the ideas associated with biochemical markers, particularly the notion that once invisible social connections can now be rendered visible through a reading of these markers in the body.
The rise and fall of a fact: the increase in anorexia nervosa
Authors: van't Hof Sonja , Nicolson Malcolm
Published: August 2010

Over the last thirty years, it has regularly been asserted that the incidence of anorexia nervosa is increasing. The paper examines the background of this idea, traces its origins, and analyses the process whereby it became widely accepted within the medical and sociological literature. The study is based upon a citation list of all the epidemiological studies of anorexia nervosa with publication dates between 1960 and the end of 1990, which has been used to identify the most important publications on the prevalence and incidence of the disease. Scrutiny of the content of these key publications has allowed us to follow the emergence, and then the partial break‐up, of a broad consensus ‐ involving clinical psychiatrists and psychoanalysts, as well as medical sociologists and historians‐around the assertion that anorexia nervosa was increasing in incidence. In the course of this historical reconstruction, four distinctive patterns of citation behaviour were revealed. The paper also examines the changing nature of the explanation offered for the putative rise in the numbers of sufferers and suggests reasons why such a perspective upon the disease was widely supported by clinicians and by a variety of other commentators.
Decline vs. retention of medical power through restratification: an examination of the Ontario case
Authors: Coburn David , Rappolt Susan , Bourgeault Ivy
Published: August 2010

Abstract Abstract Though some argue that medical power is declining, others disagree. In particular, Freidson assets that medicine is being restratified with medical elites retaining control over health care though practitioners are losing their individual autonomy to these elites. We use the case of state‐medicine relationships in Ontario to examine the restratification thesis. Our findings indicate that the state partially controls medicine through restratification. There is partial state co‐option of medical organisations and elites. This case also implies that control over the context of care and over the content of medical practice is not as separate as assumed, that profession‐practitioner relationships are increasingly problematic, that the concept of autonomy itself requires theoretical and empirical specification, and that the existence of self‐regulatory and representative organisations cannot be equated with actual professional self‐regulation. The contingent nature of medical power is underlined.
The social patterning of child mortality: the importance of social class, gender, family structure, immigrant status and population density
Authors: Östberg Viveca
Published: August 2010

Which structural dimensions are most important for life chances have been the subject of debate. In this study, which uses data from the Swedish Census‐linked Deaths registry for the period 1980–86, structural differences in child mortality are analysed. The structural dimensions focused on are social class, gender, family structure, immigrant status and population density. When all structural dimensions were controlled for simultaneously, only social class and gender influenced disease mortality. Of these two structural dimensions, social class seemed to be the most important in terms of producing the greatest differences. For mortality due to accidents, on the other hand, all dimensions proved to be important. The mortality risk was higher for children in single‐parent households, for children whose parents were born outside Sweden, and for children living in the least densely populated areas. The greatest differences in mortality from accidents, however, were attributable to gender, followed by social class. Furthermore, mortality differences by the father's, the mother's and the family's class position, determined by the dominance method of class assignment, were compared. The class position of both parents was independently associated with child mortality but the family's position seemed to be the better discriminator in terms of class variation. The implications of these findings are that death risks during the whole childhood period are socially structured in Sweden and that social class is still a structural dimension of great importance.
Notions of child health: mothers' accounts of health in their young babies
Authors: Lauritzen Sonja Olin
Published: August 2010

This paper is concerned with mothers’ understandings of child health in their young babies. To explore how child health is depicted, explained and contextualised by mothers, altogether 29 mothers in Stockholm and London were interviewed through the baby's first months about day‐to‐day experiences of the baby's health and well‐being. The analysis of the mothers’ accounts reveals how the mothers, in the process of assessing health, try to ‘read’ the bodily signs and reactions in their babies. Some major themes emerge on how the mothers identify and characterise threats to the health of the baby; here described as threats of abnormalities, threats to the survival of the baby, threats to the thriving of the baby and threats from illnesses. Notions of child health are discussed in relation to the ‘bodily’ and the ‘social’, and how the embodied images of child health are intertwined with the mothers’ presentations of themselves as responsible for the health of their children and as ‘worthy’ parents.
The baby and the bath water: disabled women and motherhood in social context
Authors: Thomas Carol
Published: August 2010

The aim of this paper is to explore key dimensions of the reproductive experiences of disabled women who are, or who are thinking about becoming, mothers. The paper reports a qualitative study which involved semi‐structured interviews with 17 disabled women who were contemplating childbearing, or were pregnant, and/or had young children. The interpretation of these women's experiences is situated with reference to current debates on the meaning and nature of disability, and draws attention to the ways in which these experiences can be understood as manifestations of disablism. More specifically, the paper considers three themes which emerged in the data analysis: the women's engagement with the medical ‘risk’ discourse; the pressure felt by disabled women to demonstrate that they are, or could be, ‘good enough mothers’; and their experiences of receiving unhelpful ‘help’ from health and social care workers.
The personal significance of home: habitus and the experience of receiving long‐term home care
Authors: Angus Jan , Kontos Pia , Dyck Isabel , McKeever Patricia , Poland Blake
Published: August 2010

Abstract  The physical, symbolic and experiential aspects of receiving long‐term care are examined in this paper using Bourdieu's concepts of habitus and field. We draw on data from an ethnographic study of home care in 16 homes in urban, rural and remote locations in Ontario, Canada. Across all cases, data about domestic and caregiving routines were gathered through observation, interviews with clients and/or the primary family caregiver, interviews with service providers and videotaped tours of the home. Based on the analysis of these data, we argue that a transposition of logics and practices occurred when the domestic and health care fields were superimposed within the spaces of the home. Although all of the care recipients and their family caregivers indicated a strong preference for home care over institutional care, their experiences and practices within their homes were disrupted and reconfigured by the insertion of logics emanating from the healthcare field. These changes were manifested in three main themes: the politics of aesthetics; the maintenance of order and cleanliness; and transcending the limitations of the home. In each of these dimensions, it became apparent that care recipients engaged in improvisatory social practices that reflected their ambiguous and changing habitus or social location. The material spaces of their homes signified, or prompted, altered or changing social placement.
Securing our genetic health: engendering trust in UK Biobank
Authors: Petersen Alan
Published: August 2010

Abstract The recent development of genetic databases, or ‘biobanks’, in a number of countries reflects scientists’ and policy makers’ beliefs in the future health benefits to be derived from genetics research. In Britain, however, a proposal for a genetic database, UK Biobank, has been the focus of a number of concerns. Establishing consent and legitimacy for any controversial biomedical research involving the participation of human subjects is difficult; it is however, acute for UK Biobank given the scale of the project and the criticisms levelled at it. Analysing recently published documents pertaining to UK Biobank, this article examines how consent for the project has been discursively framed and how this is reflected in its governance. It is argued that the problem of organising consent has been framed narrowly in terms of adherence to a well‐established repertoire of institutional mechanisms which serves to limit debate on the substantive issues at stake. There is little evidence of reflection on the adequacy of such mechanisms for dealing with the unique challenges posed by UK Biobank, including achieving the confidence and participation of a population with diverse perspectives on genetic research. It is concluded that a restricted public discourse about UK Biobank may contribute to a decline in confidence in regulatory systems governing biotechnology and science more generally.
The many meanings of care in clinical research
Authors: Easter Michele M. , Henderson Gail E. , Davis Arlene M. , Churchill Larry R. , King Nancy M. P.
Published: August 2010

The conduct of clinical research often involves two distinguishable sets of relationships: the researcher‐subject relationship, and the clinician‐patient relationship. Some scholars argue that being a patient in a clinical care setting and a subject in a research study are so different that anything that would promote in subjects the view that they are in clinician‐patient relationships is exploitative and deceptive. This paper presents findings intended to initiate a more empirically‐based discussion of this issue. Using data from 82 in‐depth interviews with physician‐investigators, nurse‐study coordinators and patient‐subjects in early phase clinical trials, we find that research personnel are likely to be seen, and to see themselves, as clinical caregivers. We also find evidence that while researchers and subjects often tend to view care and research as conflicting activities, both parties tend to see research as a way of caring for patients. We found no relationship, however, between subjects’ perception of care‐giving by researchers and the tendency to misunderstand that they are in a research study. Because research, by necessity and inclination, is unlikely ever to be ‘care‐free’, we recommend that the ethical debate surrounding the danger of confusing research with treatment take into account the kinds of care described by respondents.
The power of ethics: a case study from Sweden on the social life of moral concerns in policy processes
Authors: Hoeyer Klaus
Published: August 2010

In this paper I report on an ethnographic study of an ethics policy developed by a start‐up genomics company at the time it gained all commercial rights to a population‐based biobank in the town of Umeå in northern Sweden. Tracing the interdependencies between power and morality, my research compares moral reflections and stances among 1) policymakers, 2) health professionals and 3) donors, in relation to the issues identified in the policy. These people seem to agree that trust and fairness are important issues and that ‘something’ needs protection in the face of commercial genetic research. However, their perceptions of trust, fairness and what it is that needs protection differ significantly. I conclude by considering the implications of variances in moral perspectives for the social study of ethics.
From biopolitics to bioethics: church, state, medicine and assisted reproductive technology in Ireland
Authors: McDonnell Orla , Allison Jill
Published: August 2010

This paper examines the emerging bioethical debate on assisted reproductive technology (ART) in Ireland, which is shaped by the long‐standing contentious issue of abortion and the constitutional protection afforded to the ‘unborn’. The focus of the paper is on the way in which the terms of this debate are shaped and constrained by the historical relations of power between church, state and medicine. Since the representation of Ireland as a post‐Catholic, plural republic is becoming increasingly mainstream to cultural and political discourse, we pay particular attention to how the Catholic Church embraces bioethics as a meta frame or code for refocusing questions of values, beliefs and meanings to sustain the ideal of Ireland as a ‘pro‐life’ and essentially Catholic nation. The Catholic Church is not simply asserting its voice of dissent in the context of public debate as one voice amongst a plurality of other voices, but to shape the emerging debate as a powerful, institutional actor. The opportunity to do so is afforded by the lack of public debate on bioethical issues and the exceedingly slow pace at which bioethics is moving towards an institutionalised framework in Ireland. These events can be explained by the legacy of the social power of the Catholic Church in Ireland and the direct and indirect influence it has long exercised over public policy vis‐à‐vis the state and its institutions, including medicine. There are two interconnected threads to the contextual analysis presented in our case study: first, the legacy of the social power wielded by the Catholic Church, and its slow and incremental demise reflected in the pace of secularisation in Ireland and the privatisation of morality; second, the emergence of a bioethical regulatory debate on ART, which is mired in the abortion controversy. Our analysis focuses on a number of key contradictions and tensions in the way in which the key institutions of church, state and medicine navigate their own positions vis‐à‐vis a bioethics debate, and how this constrains public participation.
Unhealthy prisons: exploring structural determinants of prison health
Authors: De Viggiani Nick
Published: August 2010

Prisoner health is influenced as much by structural determinants (institutional, environmental, political, economic and social) as it is by physical and mental constitutions of prisoners themselves. Prison health may therefore be better understood with greater insight into how people respond to imprisonment – the psychological pressures of incarceration, the social world of prison, being dislocated from society, and the impact of the institution itself with its regime and architecture. As agencies of disempowerment and deprivation, prisons epitomise the antithesis of a healthy setting. The World Health Organisation's notion of a ‘healthy prison’ is in this sense an oxymoron, yet the UK government has signalled that it is committed to WHO's core health promotion principles as a route to reducing health inequalities. This paper reports on the findings of an ethnographic study which was conducted in an adult male training prison in England, using participant observation, group interviewing, and one‐to‐one semi‐structured interviews with prisoners and prison officers. The paper explores how different layers of prison life impact on the health of prisoners, arguing that health inequalities are enmeshed within the workings of the prison system itself.
Gender, pregnancy and the uptake of antenatal care services in Pakistan
Authors: Mumtaz Zubia , Salway Sarah M.
Published: August 2010

An integrated analysis of detailed ethnography and large‐scale survey data is presented to explore the gendered influences on women's uptake of antenatal care (ANC) services in Punjab, Pakistan. Pregnancy and its associated decisions were shown to be normatively the older women's domain, with pregnant women and their husbands being distanced from the decision‐making process. Women who successfully claimed ANC did so not by overtly challenging the dominant construction of young femininity, but rather by using existing gendered structures and channels of communication to influence authority figures. The quality of a woman's inter‐personal ties, particularly with her mother‐in‐law and husband, were found to be important in accessing resources, including ANC. Gendered influences were moderated by social class. Family finances were an important determinant of ANC use, as was women's education. Wealthier, higher status women also found it easier to circumvent gendered proscriptions against their mobility while pregnant. As well as illuminating the ways in which the sociocultural construction of gender acts to constrain women's access to ANC, the empirical findings are used to highlight significant inadequacies in the ‘autonomy paradigm’ that has dominated much of the research into women's reproductive health in South Asia.
Illness action rediscovered: a case study of upper limb pain
Authors: Calnan M. , Wainwright D. , O’Neill C. , Winterbottom A. , Watkins C.
Published: August 2010

Theoretical frameworks provide generalised accounts of illness action although empirical studies of the process are still in short supply. This study of upper limb pain provided a case study of illness action; as it is a common condition, there is uncertainty about its treatment and management, orthodox and non‐orthodox care are seen as legitimate sources of help and it is linked with a range of causes.

Face‐to‐face informal interviews were carried out with 47 informants with upper limb pain and their practitioners (n= 19). The data were analysed in two different ways. The general stages of the illness action process were identified through a descriptive analysis of the upper limb pain sufferers’ accounts and the policies and practices reported by their practitioners. Then, case studies were constructed to depict individual pathways through healthcare and consequences for sufferers. The illness action process was characterised by the normalisation and accommodation of pain informed by a discourse that predominantly invoked ageing and the wear and tear of the body. Practitioners also preferred to adopt a biomechanical approach and were reluctant to attribute psychosocial labels. The case studies illustrated the divergent, negotiated and opportunistic nature of the process and showed that the use of both orthodox and non‐orthodox care formed only part of strategies used to manage upper limb pain. Sufferers evaluated the care they received in terms of pain alleviation, and were resigned to searching for the best way of living with their pain.
Watch out for the Aunties! Young British Asians’ accounts of identity and substance use
Authors: Bradby Hannah
Published: August 2010

This paper considers how young people able to trace their origins from Pakistan or India (henceforth ‘Asians’), discuss their use of, or abstention from, alcohol and tobacco in terms of religious and cultural tradition. The role of religion, ethnicity, gender and generation in the uptake or avoidance of alcohol and tobacco was explored in 19 qualitative group and individual interviews with 47 Asians aged 16–26 years and analysed in terms of pioneering and conservative forms of tradition. Religious proscriptions on alcohol and tobacco were reported to be formally gender blind, but concerns about reputation and future marriage chances, sanctioned by gossip, meant that women's behaviour was consistently more constrained than men's. Muslims’ abstinence from alcohol was tightly linked with an Islamic identity in that drinking jeopardised one's claim to being a Muslim, whereas cigarette smoking was tolerated among young men. Sikhs’ and Hindus’ avoidance of tobacco was strongly sanctioned, but smoking did not strongly jeopardise a religious identity. Sikh men's abstention indicated manly strength central to a devout identity. Some experimentation was possible out of view of the older generation, especially the aunties, but the risk of gossip damaging young women's reputations was keenly felt. While damage to women's reputations was hard to undo, men's reputations tarnished by substance use, could be compensated for by their parents’ honourable status. Discussion of tradition as innovation was rare and met with resistance. Tradition was largely experienced as a constraint to be circumvented.
Learning disability and the limits of liberal citizenship: interactional impediments to political empowerment
Authors: Redley Marcus , Weinberg Darin
Published: August 2010

Recent policy initiatives have moved decisively toward empowering learning disabled citizens, recognising ability over disability, and promoting people's political empowerment and voice in the design of public services. While laudable and encouraging, these initiatives raise an important question: to what extent can a group of service users, whose very entitlement to state‐sponsored assistance is justified by putative intellectual impairment, be empowered according to an exclusively liberal model of citizenship that presumes and requires, as its very defining features, intellectual ability and independence? In this paper we consider this question by means of an ethnographic analysis of an innovative advocacy group: the Parliament for People with Learning Disabilities (PPLD). We first document both an institutional and an interactional preference for clients to speak actively for themselves. We then describe three types of interactional trouble that emerged in the PPLD as obstacles to realising this preference in practice and the strikingly similar remedies that were generated to overcome these troubles. We conclude by discussing the limits of an approach to empowering learning disabled individuals that is cast too exclusively in terms drawn from liberal models of citizenship that prioritise voice over care, security, and wellbeing.
Women drug users in North Cumbria: what influences initiation into heroin in this non‐urban setting?
Authors: Payne Jennifer
Published: August 2010

This paper reports on a qualitative study which has investigated female problem drug use in North Cumbria, a relatively isolated area of the UK. Cumbria is the second most sparsely populated county in England with some of the most beautiful countryside juxtaposed with areas of disadvantage, particularly in towns along the west coast. Previous research has focused on female city dwellers and less is known about the social and cultural context of drug use in non‐urban settings. The reasons for women's drug use remain controversial but gender differences appear to emerge. One frequent explanation is the influence of male oppression but some studies describe women as active players in their initiation. Findings from North Cumbria challenge the conventional view of women being coerced into illicit drug use and present greater complexity. The data derived from semi‐structured interviews account for the impact of curiosity and trust, motives often tempered by a range of complex personal circumstances. A known individual, usually male, was often present at initiation and this relationship appears pivotal. I discuss these factors and will call for prevention initiatives to recognise the gender‐specific determinants of initiation into problem drug use.
‘No one agrees except for those of us who have it’: endometriosis patients as an epistemological community
Authors: Whelan Emma
Published: August 2010

This paper contributes to the literature on patients’ claims‐making work by analysing the epistemological strategies and standards used by members of an endometriosis patient community. It draws upon focus group research with members of a support group for endometriosis sufferers, and an open‐ended survey of an e‐mail list for women with the disease. Lynn Hankinson Nelson's (1993) concept of epistemological community is used to examine standards and practices for developing and evaluating knowledge used by women with endometriosis. Particular attention is paid to the use and centrality of the notion of experience within this community.
Explaining non‐help‐seeking amongst young adults with mental distress: a dynamic interpretive model of illness behaviour
Authors: Biddle Lucy , Donovan Jenny , Sharp Debbie , Gunnell David
Published: August 2010

Mental disorder is common amongst young adults and is associated with many adverse outcomes. Data, however, indicate that young adults are particularly unlikely to seek help for such distress. This paper describes a qualitative study of 23 young adults (aged 16 to 24 years) with mental distress. Interviewing was used to obtain detailed narratives of illness behaviour and to explore reasons for non‐help‐seeking. Help‐seekers and non‐help‐seekers were interviewed. The findings allowed development of an explanatory model – the cycle of avoidance (COA) – which contributes towards attempts to provide a dynamic understanding of help‐seeking behaviour. Dominant approaches tend to be deterministic and static and to account for non‐help‐seeking in terms of ‘barriers’ to care, which although easily translated into targets for policy intervention, are superficial representations of complex issues. The COA conceptualises help‐seeking as a circular process and offers a model of ‘non‐help‐seeking’ in which lay conceptions of mental distress, the social meanings attached to ‘help‐seeking’ and treatment, and the purposeful action of individuals, assume central importance. Although derived in the context of young adulthood and mental distress, this model may have wider applicability as a theoretical template for explaining non‐help‐seeking in other age groups and conditions, and other illness behaviours.
Consent and nothing but consent? The organ retention scandal
Authors: Sheach Leith Valerie M.
Published: August 2010

The organ retention scandal arose in the UK in the autumn of 1999 when knowledge of the practice of organ and tissue retention after post‐mortem for subsequent diagnostic, teaching, audit and research purposes fully entered the public domain. Many families were shocked and distressed to realise that by allowing a post‐mortem on their relative or child they were also deemed to have agreed to the long‐term retention of organs and tissues and thus had buried or cremated, as they perceived it, not a ‘whole’ body but an ‘empty shell’. Subsequently, informed consent was placed at the centre of recommendations for reform, now given expression in the Human Tissue Act (2004). Through a discourse analysis of the documentary evidence produced in the wake of the organ retention scandal, I argue that the emphasis on informed consent masks concerns about body wholeness. In addition, whilst informed consent is posited as key in ‘balancing’ the rights of the individual over the needs of medical science, this position is tempered by the concurrent presence of notions of the gift relationship and post‐mortem citizenship. Incorporating these notions alongside the discourse of consent also renders concerns about the commodification of the body less acute.
Obesity and household roles: gender and social class in Morocco
Authors: Batnitzky Adina
Published: August 2010

Often referred to as the developing world's new burden of disease, obesity constitutes a major and growing health epidemic in Morocco, in particular for women (22% of women versus 8% of men). Through an analysis of qualitative data, I demonstrate how gender roles influence obesity risk in the Moroccan context. Current social and economic theories, including the nutrition transition theory, are inadequate in explaining the persistent gender differentials in health status across time and place. I suggest that Moroccan women's higher prevalence of obesity is predominantly the outcome of different risks acquired from their distinct roles. In the Moroccan context, we can gain insight into how men and women divide household labour and how the overall non‐egalitarian nature of social roles may deleteriously affect women's health. I hypothesise that marital status, age and socioeconomic status determine Moroccan women's household roles and help to explain why women are more likely to be obese than men. The main findings support this hypothesis and demonstrate the interactive relationship between culture and structure in influencing obesity risk.
Redefining a technology: public and private genetic testing in Aotearoa New Zealand
Authors: Scott Anne , Du Plessis Rosemary
Published: August 2010

In the last ten years there has been a rapid expansion in the number of genetic tests and increased interest in accessing the information available through these tests. The expansion of access to genetic testing occurs against the background of mixed systems for delivering health services, including DNA testing. This paper draws on theory relating to the social shaping of technologies and the concept of technological ‘scripts’ to offer a critical analysis of recent debate in Aotearoa New Zealand about private provision of genetic testing. An apparent ‘turf war’ between professionals about who will provide genetic tests obscures attention to a more serious issue – the redefinition of a technology. What is at stake is not just who will do the tests, but what technology is available – either genetic testing as a commodity, or an integrated set of genetic services. While focused on a particular national context, this paper addresses issues relevant to the provision of genetic services in other nation states characterised by a mixture of public and private provision of health services.
The moral economy of selfhood and caring: negotiating boundaries of personal care as embodied moral practice
Authors: Chattoo Sangeeta , Ahmad Waqar I.U.
Published: August 2010

This paper engages with the dichotomous notions of caring underpinning social policy and practice in Britain, that splits up the ‘carer’ and ‘cared for’ into autonomous, unitary subjects, by locating personal care as an embodied, moral practice within a theoretical framework of relational ontology. Drawing on empirical accounts and narratives related to personal care within the context of advanced cancer, we argue that personal care involves negotiation of boundaries between notions of relatedness and legitimate dependence on one hand, and independence and integrity of the embodied self on the other; and we analyse how these boundaries are informed by particular cultural or religious scripts on gender, relatedness, conjugality and filial obligations. The paper draws on data and analysis based on observations and in‐depth interviews with White and South Asian participants between 19 and 89 years of age receiving treatment for cancer, and family members closely involved in their personal care. In using a comparative method for analysis and understanding caring as an embodied moral practice and site of subjectivity across cultural/religious groups, it is suggested that ethnicity is not necessarily the only useful analytical concept to explore the illness and caring experiences of research participants from minority ethnic backgrounds.
Health inequalities according to educational level in different welfare regimes: a comparison of 23 European countries
Authors: Eikemo Terje A. , Huisman Martijn , Bambra Clare , Kunst Anton E.
Published: August 2010

The object of this study was to determine whether the magnitude of educational health inequalities varies between European countries with different welfare regimes. The data source is based on the first and second wave of the European Social Survey. The first health indicator describes people's mental and physical health in general, while the second reports cases of any limiting longstanding illness. Educational inequalities in health were measured as the difference in health between people with an average number of years of education and people whose educational years lay one standard deviation below the national average. Moreover, South European welfare regimes had the largest health inequalities, while countries with Bismarckian welfare regimes tended to demonstrate the smallest. Although the other welfare regimes ranked relatively close to each other, the Scandinavian welfare regimes were placed less favourably than the Anglo‐Saxon and East European. Thus, this study shows an evident patterning of magnitudes of health inequalities according to features of European welfare regimes. Although the greater distribution of welfare benefits within the Scandinavian countries are likely to have a protective effect for disadvantaged cities in these countries, other factors such as relative deprivation and class‐patterned health behaviours might be acting to widen health inequalities.
Childbirth embodiment: problematic aspects of current understandings
Authors: Walsh Denis J.
Published: August 2010

The experience of childbirth is one of the most corporeal of the human condition. Against a backdrop of profound change in the milieu of birthing over the past 30 years, especially in the developed world, a number of discourses now compete for the status of the safest, most fulfilling birth experience. Supporters of biomedical and ‘natural’ approaches make their respective claims to those, with obstetricians broadly aligning their professional interests with the former and midwives with the latter. There is mounting evidence that childbearing women’s experiences of birth are often shaped in the uneasy space between the two. Within sociological discourse in health, embodiment is a dominant theme but, to date, research has concentrated mainly on new reproductive technologies, and there is a dearth of recent research and theorising around the act of parturition itself. This paper argues that because of this, there has been a polarising tendency in current discourses which is having a largely negative impact on women, professionals and the maternity services. A call is made for an integration of traditional childbirth embodiment theories, mediated through compassionate, relationally focused maternity care, especially when labour complications develop.
Questioning the answer: questioning style, choice and self‐determination in interactions with young people with intellectual disabilities*
Authors: Pilnick Alison , Clegg Jennifer , Murphy Elizabeth , Almack Kathryn
Published: August 2010

For young people with intellectual disabilities (ID), the transition from children’s to adult services has long been recognised as a challenging move. One of the aims of the White Paper Valuing People (2001) was to address some of the problems associated with this transition. This paper reports on data from a project which examines the impact of these service changes, and the ways in which transition is negotiated by carers, professionals and users. It presents a conversation analysis of eight tape‐recorded formal review meetings at which transition to adult services is discussed. It takes as its starting point the existing interactional work on ID and the way in which this demonstrates the effects of the local and contextual specifics of particular kinds of interaction on the eventual outcomes (e.g. Rapley 2004, Antaki 2001, Maynard and Marlaire 1992). We show that an attempt to allow self‐determination in the context of transitions can paradoxically result in undermining user choice and control. We also argue that, while a rule‐based approach to practice may offer moral clarity for professionals, it can result in interactional and practical difficulties which cannot be easily reconciled.
Pemphigoid gestationis
Authors: Jenkins Rachel E. , Shornick Jeff K. , Black Martin M.
Published: August 2010

PG is a rare autoimmune bullous dermatosis of pregnancy that is characterised by linear deposition of C3, and occasionally IgG1 along the BMZ of lesional, perilesional and clinically normal skin when examined by direct immunofluorescence. Frequently there is a circulating IgG1 autoantibody (PG factor) directed against a BMZ antigen that avidly binds complement.

The aberrant expression of MHC class II molecules in the placenta is important in triggering the immune response against a glycoprotein of 180 kDa found in the lamina lucida of the basement membrane of the amnion which cross reacts with that in the skin. The deposition of immune reagents in the placentae in PG has been implicated in the placental dysfunction and impaired foetal outcome which has been shown to occur in PG, Al present immunofluorescence is the key to differentiating PG from other clinically similar diseases.
Morsus insecti from flea bites: seasonal appearance and relation to sex and age of flea‐exposed persons
Authors: Hallas T.E. , Roesdahl K.
Published: August 2010

Objectives To elucidate (1) the seasonal appearance of Morsus insecti from flea bites and (2)the prevalence of this disease in males and females.

Material (1) 182 patients suspected of being bitten by fleas from dogs and/or cats and 9697 non‐patients complaining of ‘flea bites’ and (2) 514 non‐patients exposed to and bitten by (cat) fleas.

Methods (1) Clinical examination of patients and microscopic investigation of fur samples from their pets and (2) inquiries about the sex and age of bitten vs non‐bitten members of the households.

Results (1) Non‐patients are mainly affected by bird fleas from April to May and to cat fleas from August to October, as are patients, but examinations of fur gave insufficient verification in April‐May (expected) and in October (unexpected). (2) Children of both sexes (0–10 years) are equally bitten, but adult women are more often bitten (i.e., show Morsus insecti symptoms) than adult men.

Conclusion (1) Examination of the patients' pets for signs of fleas is a useful diagnostic tool, but should be supplemented with knowledge of the seasonal appearance of flea bites. (2) It is necessary to elucidate why Morsus insecti from fleas preferentially appear in adult women. Some possible explanations are given, but none is conclusive.
Drugs against chloroquine antimalarial itch
Authors: Asawalam Beatrice , Osifo Nosakhare Guy , Haller Louis
Published: August 2010

Background Limb activity meters are useful in correlation with subjective measurements for studying the antipruritic effects of drugs against current chloroquine itch among patients with malarial fever, in a tropical environment.

Objective To prospectively monitor the palliative effects of drugs, without any presumptively significant antipuritic effects known, against moderate to severe chloroquine‐related pruritus among patients with malaria.

Methods Using a standard ordinal (0–10) scale questionnaire and limb activity meters on all limbs, 60 subjects (50 malarial patients plus 10 healthy controls; both sexes; aged 16–32 years) were recruited for study. Forty patients and the 10 healthy unmedicated controls completed the study and were used for data analysis.

Results Dapsone (50 mg tablets, 8 hourly, orally) significantly reduced pruritus ordinal scores (below 2.5) and limb activity recordings to levels comparable with unmedicated controls by the second or third night of nocturnal monitoring the chloroquine itch among the patients. Clemastine or ketotifen (1 mg tablets, 8 hourly, orally) or prednisolone (5 mg tablets, 12 hourly, for 3 days, then tapered to 5 mg daily for another 2 days, orally), did not significantly exceed the placebo responsiveness to vitamin B‐comple.x tablets (one 8 hourly, orally, for 3 days).

Conclusion Dapsone. or sulphapyridine (500 mg tablets, 6 hourly, orally daily for 5 days in another recent investigation) have now emerged as potent symptomatic palliatives against chloroquine pruritus.