bluuebunny/crossref_metadata_2025 huggingface dataset:
Experiencing chronic widespread pain in a family context: giving and receiving practical and emotional support
Authors: Richardson Jane C. , Ong Bie Nio , Sim Julius
Published: August 2010

The impact of pain and chronic illness on the family has been documented, but there is little information about living with chronic widespread pain in the context of the family. This article uses data from a qualitative study of the experience of living with chronic widespread pain to examine the experience and meaning of support for people with this condition in the context of their families. It focuses on the varying, dynamic and reciprocal nature of practical and emotional support in the family. Family members may provide support but are also receivers of support from the person with chronic widespread pain. The factors mediating the provision of this support are also explored, including the nature of the pain and the needs of the person with pain, and the roles, responsibilities and characteristics of other family members.
The linear medical model of disability: mothers of disabled babies resist with counter‐narratives
Authors: Fisher Pamela , Goodley Dan
Published: August 2010

This paper draws on the narratives of parents of disabled babies in order to conceptualise notions of enabling care. This analysis emerges from the Sheffield site of an ESRC research project Parents, Professionals and Disabled Babies: Identifying Enabling Care, which brings together the Universities of Sheffield and Newcastle‐upon‐Tyne. The linear heroic narrative is a dominant theme within Western culture. It is competitive and individualistic and tends to be future‐orientated in that actions conducted in the present are evaluated according to later outcomes. This linear narrative places much store on modernist interventions such as medicine, and tends to uphold professional boundaries and hierarchies. In the lifeworlds of parents, usually mothers, of disabled babies, this narrative can reinforce disempowering interpretations of disability and impairment. On the basis of 25 in‐depth interviews, accompanying stories and ethnographic data, this paper suggests that parents are developing counter‐narratives which, at times, resist linear life models and free parents to enjoy their children as they are. If life is perceived as an open book rather than as a concluding chapter, parents are able to develop stories that are neither linear nor heroic but present and becoming.
‘A politics of what’: the enactment of peritoneal dialysis in indigenous Australians
Authors: McCarthy Alexandra , Martin‐McDonald Kristine
Published: August 2010

This paper explores, on the one hand, the requirements of the technologies and practices that have been developed for a particular type of renal patient and health network in Australia. On the other, we examine the cultural and practical specificities entailed in the performance of these technologies and practices in the Indigenous Australian context. The praxiographic orientation of the actor‐network approach – which has been called ‘the politics of what’ (Mol 2002) – enabled us to understand the difficulties involved in translating renal healthcare networks across cultural contexts in Australia; to understand the dynamic and contested nature of these networks; and to suggest possible strategies that make use of the tensions between these two disparate networks in ways that might ensure better healthcare for Indigenous renal patients.
Partners in health? Exploring resemblance in health between partners in married and cohabiting couples
Authors: Monden Christiaan
Published: August 2010

Sociological theories on family formation and families and health suggest that married and cohabiting partners will resemble each other in health status, positively or negatively. The family is often seen as a health‐enhancing agent for individuals. However, there are large health differences among families. This study aims to answer the question whether it is the case that the healthy live with the healthy and individuals with poor health have partners who are also in poor health. Moreover, it examines whether resemblance in health is a consequence of partner choice – educational homogamy in particular – behaviour or shared circumstances. Younger and older couples are compared to investigate whether health resemblance increases over the lifecourse.

Analyses of a nationally representative sample of almost 12,000 Dutch couples show that partners are indeed significantly alike with regard to several health indicators. Respondents whose partner reports poor health are almost three times more likely to report poor health than respondents whose partner is in good health. There is a strong accumulation of health problems within households. Partner selection with regard to education causes part of the partner resemblance in health. Less support is found for the hypotheses that risk behaviour, mutual influence or the effects of shared circumstances cause similarity between partners’ health status. Surprisingly, partners in older couples, who have been together for a longer time, do not resemble each other significantly more than partners in younger couples. The implications of these findings for sociological theory and social inequalities in health are discussed.
Health‐related quality of life and the transformation of symptoms
Authors: Armstrong David , Lilford Richard , Ogden Jane , Wessely Simon
Published: August 2010

This paper traces the development of health‐related Quality of Life instruments over the last half century. It identifies the emergence of key components of quality of life measurement in other health status questionnaires between about 1950 and 1980 and their formalisation in Quality of Life instruments in the mid 1980s. The common developmental thread that linked these Quality of Life instruments and their precursors was the identification of ‘distal symptoms’ that represented the impact of illness beyond its immediate bodily manifestations. The measurement of distal symptoms through Quality of Life instruments also served to detach symptoms from their customary patho‐physiological referent. Other contemporary examples of these free‐floating symptoms reinforce the argument that the nature and meaning of symptoms has been transformed over recent decades.
Body Mass Index, masculinities and moral worth: men's critical understandings of ‘appropriate’ weight‐for‐height
Authors: Monaghan Lee F.
Published: August 2010

Based on the Body Mass Index (BMI, kg/m2), most men in nations such as the UK and USA are reportedly overweight or obese. This is authoritatively defined as a massive and growing problem. Drawing from embodied sociology, critical obesity literature and qualitative data generated during an Economic and Social Research Council funded project on masculinities and weight‐related issues, this paper offers a critical realist contribution to the obesity debate. Rather than endorsing the institutionalised war on fat, and correcting so‐called ‘laymen’ who dismiss medicalised weight‐for‐height recommendations, the following presents and honours men's justificatory accounts for levels of body mass that medicine labels too heavy (implicitly or explicitly too fat). Men's critical understandings, which are connected to their displays of moral worth, are considered under three headings: the compatibility of heaviness, healthiness and physical fitness; looking and feeling ill at a supposedly ‘healthy’ BMI; and resisting irrational standardisation. By empirically ‘bringing in’ men's meanings, sensibilities and culturally informed aesthetics, this paper casts a different light on medicalised measures that support potentially corrosive obesity epidemic psychology.
‘When you have children, you’re obliged to live’1: motherhood, chronic illness and biographical disruption
Authors: Wilson Sarah
Published: August 2010

Recent work on biographical disruption has emphasised the critical importance of timing and context to the understanding of the effects of illness on identity. This paper takes a different approach by examining the inter‐relationship between illness and key sources of identity, in this instance HIV infection and motherhood. It is argued that, viewed in this light, biographical disruption remains a powerful analytic framework with which to explore the intense threat which may be posed to key identities by chronic, potentially fatal illnesses, and the fundamental re‐working of such identities occasioned by such threats. With reference to the empirical study on which this paper draws, it is shown that the twelve respondents’ emphasis on their need to survive and to protect their children, represented a fundamental re‐formulation of their identities as mothers and, therefore, a type of biographical disruption while paradoxically also containing elements of biographical reinforcement. It is further argued that the incorporation of such key identities into the analysis problematises work that suggests that biographical disruption is less relevant to those who have experienced difficult lives, while also highlighting the need to take greater account of gender and caring responsibilities in further work in this field.
Judging without criteria? Sickness certification in Dutch disability schemes
Authors: Meershoek Agnes , Krumeich Anja , Vos Rein
Published: August 2010

The gate‐keeping function that physicians perform in determining clients’ physical and mental incapacities is widely assumed to be the main reason for the rising numbers of disabled people. The sharp rise in the number of disabled has led many to claim that the disability benefits schemes are untenable. In order to regain public control and to make disabled eligibility procedures more transparent guidelines have been introduced in which medical evaluations are conceptualised as formal rational decisions. It is, however, questionable whether such measures are helpful in achieving their stated aims. This paper is based on ethnographic research on the ways physicians evaluate the eligibility of clients for disability benefits. It argues that assessing incapacity involves much more than formal rational decision‐making. Doctors’ reasoning is contextual and deliberative in character, and thus their assessment of a client's incapacity is less a technical matter than a normative one. Instead of generating transparency, guidelines based on formal rationality make the complex deliberations on which such judgments are based invisible, because they deny the normative dimension of medical expert decision‐making. Therefore, different measures have to be developed that allow this normative dimension to be articulated, since insight into this normative dimension is a necessary pre‐condition to be able to criticise disability judgments at all.
The (ir)relevance of genetics: engendering parallel worlds of procreation and reproduction
Authors: Grace Victoria M. , Daniels Ken R.
Published: August 2010

Informing offspring of the nature of their conception when conceived via donated gametes such as donor sperm, is increasingly considered by professionals and policy makers to be desirable for many reasons. The aim of this research is to explore and understand processes within families that either facilitate or hinder the telling of children about their conception. This exploration includes analysing the complexity of sociocultural processes surrounding parents’ attempts to make sense of, and construct meanings of ‘family’. We analyse the stories of a group of New Zealand parents, representing 41 families, who have formed their families with the assistance of donor insemination. The analysis takes its point of departure from current sociological and anthropological debates in the field of kinship, or family studies. We argue that parents generate a parallel construct whereby genetic inheritance is seen to be simultaneously irrelevant (to the constitution of the family), and yet at the same time relevant (in highly bounded domains, for example related to medically specified conditions). We analyse the ambiguities of interpreting this construct as one reflecting a separation of procreation from the process of reproduction, and reflect on the implications for information‐sharing.
‘Good luck to them if they can get it’: exploring working class men's understandings and experiences of income inequality and material standards
Authors: Dolan Alan
Published: August 2010

This paper seeks to contribute to the recent debate within the field of inequalities in health that has focused on the relationship between income distribution and health. This has contested the extent to which the main effects of income on health are not directly related to material standards but operate through psychosocial mechanisms, linked to how people experience and perceive their relative position. However, whilst this has focused attention on the qualitative dimensions of income inequality as a potential determinant of health inequality, very little empirical work has directly examined lay perspectives. In this study I attempted to address this gap by exploring how two groups of working class men living in contrasting socio‐economic areas understood and experienced differences in income and material circumstances and how these were perceived to impact on their health. This study shows that the anger and resentment felt by these men had their roots largely in the perceptions of others and the way others treated them, rather than in income differentials per se. There was little evidence of feelings of shame or inferiority. For men at the bottom of the social ladder, financial hardship was additionally perceived as having the greatest impact on their health and well‐being.
Explaining chronic obstructive pulmonary disease (COPD): perceptions of the role played by smoking
Authors: Hansen Emily C. , Walters Julia , Wood Baker Richard
Published: August 2010

There are few studies that investigate how people personally affected by a chronic disease associated with cigarette smoking account for their illness. Chronic obstructive pulmonary disease (COPD) is a respiratory condition largely caused by cigarette smoking. In order to better understand how people diagnosed with COPD view the relationship between cigarette smoking and their illness we conducted semi‐structured interviews with 19 participants. We found a widespread scepticism among our respondents about medical attempts to link their illness with cigarette smoking, and doubts about whether their illness was in fact COPD at all. Only four participants described smoking as the principal reason why they had developed breathing problems. Most participants gave multi‐causal accounts that emphasised explanatory factors such as a familial tendency to respiratory illness or workplace exposure to pollution. Our findings have relevance for the development of smoking cessation interventions for people with COPD.
The fuzzy buzz word: conceptualisations of disability in disability research classics
Authors: Grönvik Lars
Published: August 2010

The article analyses five classical texts from the field of disability research/studies. The focus of the analysis is on how disability is defined both on a theoretical level and on an empirical or applied level. The findings suggest that definitional clarity can be questioned. First, a ‘traditional’ problem of validity occurs in some of the texts. Secondly, lack of clearly expressed and explicit definitions makes it difficult for the reader to understand what the author means with the term disability. Thirdly, some authors alter the definition of disability through their texts, without any explanations, making it arduous for the reader to follow the use and meaning of the term. It is suggested that these problems stem from the lack of proper theorising within the field of disability research. Disability researchers have been focusing on defining separate concepts, without any ambitions to relate them to each other in a theoretical frame. This means that the field of disability research consists of free‐floating concepts, poorly related to each other.
The loss of possibility: scientisation of death and the special case of early miscarriage
Authors: Frost Julia , Bradley Harriet , Levitas Ruth , Smith Lindsay , Garcia Jo
Published: August 2010

This paper explores the special nature of bereavement in the case of first trimester miscarriage. It is theoretically informed by the sociological literature concerning death and bereavement and is empirically grounded in interviews with 79 women. We argue that the ‘scientisation of death’ in modern societies contributes to the uncertainty and isolation which distinguish early miscarriage as a unique form of loss. In the absence of clear cultural scripts to draw upon, many women interviewed gave meaning to their loss as ‘what might have been’ or what we call ‘the loss of possibility’. Some women juxtaposed the failure of their pregnancy with that of modern medicine either to prevent the loss or provide a credible explanation for their miscarriage.

Little research has been conducted in this area, since the pioneering work of Lovell (1983) and Cecil (1984). Our research draws on one of the largest and most systematic bodies of data ever collected on early miscarriage, and provides continued evidence of the traumas of miscarriage. The strategies employed by women to make sense of, and come to terms with, their experience of miscarriage are explored, employing a typology of pre‐modern, modern and postmodern responses.
Health, morality, and infant feeding: British mothers’ experiences of formula milk use in the early weeks
Authors: Lee Ellie
Published: August 2010

The way mothers feed their babies is, internationally, the subject of research, health policy initiatives, and popular discussion, which commonly affirm the mantra ‘breast is best’. On one level, this mantra reflects scientific evidence about nutrition and maternal and infant health. From a socio‐cultural perspective, the pro‐breastfeeding message has, however, been considered an aspect of morality, which influences maternal identity in important ways. This article explores this idea. It does so primarily by reporting and discussing some findings from a study about British mothers’ experiences of using formula milk for infant feeding. The paper begins by contextualising this discussion by briefly outlining some aspects of the construction of infant feeding as a social problem in Britain, focusing in particular on the influence of ‘the new paradigm of health’.
Choosing embryos: ethical complexity and relational autonomy in staff accounts of PGD
Authors: Ehrich Kathryn , Williams Clare , Farsides Bobbie , Sandall Jane , Scott Rosamund
Published: August 2010

The technique of preimplantation genetic diagnosis (PGD) is commonly explained as a way of checking the genes of embryos produced by IVF for serious genetic diseases. However, complex accounts of this technique emerged during ethics discussion groups held for PGD staff. These form part of a study exploring the social processes, meanings and institutions that frame and produce ‘ethical problems’ for practitioners, scientists and others working in the specialty of PGD in the UK. Two ‘grey areas’ raised by staff are discussed in terms of how far staff are, or in the future may be, able to support autonomous choices of women/couples: accepting ‘carrier’ embryos within the goal of creating a ‘healthy’ child; and sex selection of embryos for social reasons. These grey areas challenged the staff's resolve to offer individual informed choice, in the face of their awareness of possible collective social effects that might ensue from individual choices. We therefore argue that these new forms of choice pose a challenge to conventional models of individual autonomy used in UK genetic and reproductive counselling, and that ‘relational autonomy’ may be a more suitable ethical model to describe the ethical principles being drawn on by staff working in this area.
A genetic future for coronary heart disease?
Authors: Weiner Kate , Martin Paul
Published: August 2010

This paper is concerned with changing conceptions of genetic disease. It is based on an analysis of biomedical literature and focuses on the treatment of coronary heart disease (CHD) in four published commentary papers. The aim of this analysis is to explore the ways in which CHD is constructed as genetic and the place of genetic discourses in the wider set of ideas that circulate about the disease. This analysis is then used to consider some of the claims of the geneticisation thesis (Lippman 1991, 1992). The analysis suggests that a genetic vision for understanding and managing CHD has emerged, which has many of the hallmarks of the geneticisation imagined by Lippman. However, a number of alternative and competing models of CHD are also supported within the biomedical discourse. These are related to the different disciplines with a stake in the field of CHD, and their struggles for authority. In conclusion, it is suggested that the geneticisation thesis, as a universal claim, is at odds with the diffuse and distributed nature of biomedical knowledge and practice. Rather than analysing geneticisation in a literal way, it may be more fruitful to see the thesis, itself, as a form of boundary work (Gieryn 1983).
Like a prayer: the role of spirituality and religion for people living with HIV in the UK
Authors: Ridge Damien , Williams Ian , Anderson Jane , Elford Jonathan
Published: August 2010

Over 40,000 people are now living with diagnosed HIV in the UK. There is, however, uncertainty about how people with HIV use religion or spirituality to cope with their infection. Adopting a modified grounded theory approach, we analysed individual and group interviews with the people most affected by HIV in the UK: black African heterosexual men and women and gay men (mostly white). For the majority of black African heterosexual men and women in our study, religion was extremely important. We found that gay men in the study were less religious than black Africans, although many were spiritual in some way. Black African individuals constructed their spiritual narratives as largely Christian or collective, while gay men described more individualistic or ‘New Age’ approaches. We developed a six‐level heuristic device to examine the ways in which prayer and meditation were deployed in narratives to modulate subjective wellbeing. These were: (i) creating a dialogue with an absent counsellor; (ii) constructing a compassionate ‘life scheme’; (iii) interrupting rumination; (iv) establishing mindfulness; (v) promoting positive thinking, and (vi) getting results. That people with HIV report specific subjective benefits from prayer or meditation presents a challenge to secular healthcare professionals and sociologists.
Pierre Bourdieu and transformative agency: a study of how patients in Benin negotiate blame and accountability in the context of severe obstetric events
Authors: Béhague Dominique P. , Kanhonou Lydie G. , Filippi Véronique , Lègonou Solange , Ronsmans Carine
Published: August 2010

This paper explores the social and institutional processes that constrain and enable obstetric patients in Benin to critically evaluate quality of healthcare and to stimulate positive changes in the health system. Based on qualitative data collected as part of a hospital auditing system, the paper analyses semi‐structured patient feedback interviews and their function as a primary mechanism through which critical patient evaluation can develop constructively. Using a Bourdieuan framework, we explore the dynamic social conditions that give rise to transformative agency and institutional change. Our results show that hospitals are often permeated with the habitus of employment, kinship and reproductive social fields, through which a number of social, economic and healthcare conflicts, power struggles and blame‐inducing interactions emerge. These conflicts generally serve to keep patients quiescent and passive when it comes to developing critical statements of quality of care. In a subset of cases, however, these conflicts are transformed by patients and their family members into opportunities for modifying the values and practices of each habitus in new and creative ways. The active negotiation of social conflict and blame enabled a minority of patients actively to divert blame from themselves and to develop and maintain critical healthcare evaluations.
Wellbeing and empowerment: the importance of recognition
Authors: Fisher Pamela
Published: August 2010

Health and wellbeing are now located within a policy framework that emphasises the empowerment of the individual ‘consumer’. Within this paradigm, empowerment is writ large and wellbeing is seen as a ‘civic duty’. The role of the health and social care services has been identified as one of enabling service users to promote their own wellbeing. In this paper, it is argued that dominant narratives relating to ‘achievement’ and ‘normality’ may result in forms of ‘misrecognition’ that act to undermine the positive sense of self that is crucial for self‐empowerment. It is suggested that while the parents of disabled babies often act reflexively to create empowering life narratives within the private sphere, this is not always facilitated by their encounters with health and social care organisations where neo‐liberal ideas and biomedical narratives, based on a modernist view of identity as individual and existing prior to society, mean that parents and children are attributed ‘deficient’ identities in ways that undermine empowerment. With reference to ‘the politics of recognition’, it is argued that services that seek to empower must value diversity and alterity whilst respecting human dependency on intersubjective recognition.
Holistic sickening: breast cancer and the discursive worlds of complementary and alternative practitioners
Authors: Sered Susan , Agigian Amy
Published: August 2010

This paper introduces the concept of holistic sickening to the sociological literature on illness narratives. Drawing on interviews with 46 Boston‐area complementary and alternative medicine (CAM) practitioners who treat breast cancer patients, we found that the CAM practitioners redefine their patients’ breast cancer diagnoses in ways that expand and transform their illness, sometimes into a lifetime journey. The practitioners, for the most part, espouse broad and complex etiological frameworks that help give meaning to the woman's cancer. They tend to speak about breast cancer as a symptom of problems that exceed the cancer itself, at times suggesting that women are responsible, to some extent, for their own breast cancer. The practitioners articulate holistic philosophies that describe healing as open‐ended with correspondingly expansive definitions of what it means to be healed, rarely articulating clear ways of conceptualising or measuring the efficacy of their own treatments. Their use of expansive and detailed etiological frameworks alongside vague and unelaborated efficacy frameworks make up the holistic sickening phenomenon described in this paper.
Collective memory, candidacy, and victimisation: community epidemiologies of breast cancer risk
Authors: Salant Talya , Gehlert Sarah
Published: August 2010

Collectively shared ideas of community may be equally relevant for the study of health disparities as quantifying the relationship between community structures and health. Data from focus groups (N = 18) that explored understandings of breast cancer and breast cancer risk in African American neighbourhoods revealed three conceptual domains where shared ideas of community informed responses: collective memory, community candidacy, and community victimisation by external aggressors. Reading the focus group responses in terms of these domains identified perceptions of risk and of candidacy that may be overlooked by individualised or quantitative approaches to studying breast cancer risk perceptions and related behaviours. These include novel perceived risks, such as the ‘risk of knowing’, as well as community‐level constructions of breast cancer candidacy. ‘Lay epidemiologies’ of breast cancer within this population might therefore be better understood as ‘community epidemiologies’, where community is central to the interpretation and operationalisation of breast cancer risk. Paying attention to such community epidemiologies of breast cancer provides theoretical insights for studying breast cancer disparities and risk perceptions as well as useful guidance for designing interventions.
The dilemma for staff in ‘playing a game’ with a person with profound intellectual disabilities: empowerment, inclusion and competence in interactional practice
Authors: Finlay W.M.L. , Antaki Charles , Walton Chris , Stribling Penny
Published: August 2010

Games between staff and people with intellectual disabilities serve to promote social engagement and inclusion. However, when the person has limited and idiosyncratic communicative abilities, it may be hard to gauge what his/her own view of the matter is. We examine video‐taped records of two episodes in which a staff member of a group home prompted a resident with profound intellectual disabilities to play a verbal and a non‐verbal ‘game’. We examine how the staff member in these two cases designs her actions to solve the dilemma she faces between, on the one hand, abandoning an activity when the resident does not provide clear indications that she/he wants to continue or, on the other hand, persisting with it until the resident begins to enjoy it or, at least, participate more fully. The solution lies in a pervasive institutional practice: treat resistance or ambiguity as temporary reluctance. We discuss these interactions as examples of how principles of empowerment, inclusion and independence play out in the details of everyday interaction.
Making monsters: heterosexuality, crime and race in recent Western media coverage of HIV
Authors: Persson Asha , Newman Christy
Published: August 2010

In the early HIV epidemic, Western media coverage encouraged the idea that infection was linked to ‘other’ identities located outside the ‘mainstream’; outside ‘proper’ heterosexuality. Today, however, HIV has become repositioned as a global heterosexual epidemic. Analyses show that since the 1990s Western media have shifted away from blame and hysteria to an increasingly routinised reporting of HIV as a health story and social justice issue. But recent years have seen the emergence of a new media story in many Western countries; the criminal prosecution for HIV‐related offences, and with it a reframing of old discourses of ‘innocence’ and ‘guilt’, but now with heterosexuals in focus. We examine this story in recent domestic media coverage in Australia, a country where heterosexual HIV transmission is rare by global comparison. Echoing similar stories in other Western media, in Australian coverage the idea of criminal intent converges with the symbolic weight of black sexuality and African origins to produce a ‘monstrous’ masculinity, which at the local level taps into contemporary racial tensions and, in so doing, conjures an imagined Anglo‐heterosexuality at once vulnerable to and safe from HIV in a globalised epidemic and world.
Birds of a feather flock together – and fall ill? Migrant homophily and health in Sweden
Authors: Rostila Mikael
Published: August 2010

Although studies show that health inequities between ethnic groups exist, few have expressed interest in the origins of these disparities. As homophily (the phenomenon that people principally form relationships with those who are similar to them) influences people’s norms and interactions, it might be an important property of migrants’ networks, and have implications on their health. The aim of this study is to examine health inequities between natives and immigrants in Sweden and the health consequences arising from participation in homogenous migrant networks. Using total population registers and representative survey data initial analyses show that migrants experience poorer health than native Swedes. The findings further suggest that homophily is a prominent feature of migrant social networks and that migrants in networks with a high proportion of other migrants experience poorer health than those who include a high proportion of natives in their networks. However, unhealthy behaviour and disadvantaged social conditions may account for a considerable share of their excess risk. Hence, network closure may reinforce and maintain norms leading to negative behaviour and social conditions in such networks.
The clinical assessment of patients admitted to hospital following an episode of self‐harm: a qualitative study
Authors: Redley Marcus
Published: August 2010

Based upon qualitative interviews with clinicians responsible for assessing patients admitted to hospital following an episode of self‐harm by overdose, this paper documents interactional factors that shape both how clinicians conduct these assessments and their understanding of what ‘causes’ someone to harm themselves. The analysis first documents how the patients’ overdoses are framed as essentially impulsive acts committed in response to adverse circumstances. This is achieved by clinicians’ avoidance of any engagement with, or assessment of, a patient’s reasons for taking an overdose. Secondly, the analysis considers why the patients’ reasons for taking an overdose do not feature in the clinicians’ assessments, and shows, by an examination of two deviant cases, that clinicians avoid engaging with patients’ motivations so as to: minimise the risk of generating bedside disagreements; avoid the possibility of being drawn into the emotional life of a patient, and shield themselves from the social and economic inequalities that are a feature of many patients’ lives. The paper concludes with a discussion of how bedside assessments that do not engage with patients’ reasons for taking an overdose might be experienced by the patients themselves and the deleterious effect this could have upon their clinical management.
Diagnostic ambivalence: psychiatric workarounds and the Diagnostic and Statistical Manual of Mental Disorders
Authors: Whooley Owen
Published: August 2010

In 1980 the American Psychiatric Association (APA), faced with increased professional competition, revised the Diagnostic and Statistical Manual of Mental Disorders (DSM). Psychiatric expertise was redefined along a biomedical model via a standardised nosology. While they were an integral part of capturing professional authority, the revisions demystified psychiatric expertise, leaving psychiatrists vulnerable to infringements upon their autonomy by institutions adopting the DSM literally. This research explores the tensions surrounding standardisation in psychiatry. Drawing on in‐depth interviews with psychiatrists, I explore the ‘sociological ambivalence’ psychiatrists feel towards the DSM, which arises from the tension between the desire for autonomy in practice and the professional goal of legitimacy within the system of mental health professions. To carve a space for autonomy for their practice, psychiatrists develop ‘workarounds’ that undermine the DSM in practice. These workarounds include employing alternative diagnostic typologies, fudging the numbers (or codes) on official paperwork and negotiating diagnoses with patients. In creating opportunities for patient input and resistance to fixed diagnoses, the varied use of the DSM raises fundamental questions for psychiatrists about the role of the biomedical model of mental illness, especially its particular manifestation in the DSM.
Vulvovaginal Candida infection: current perspectives
Authors: Odds F.C.
Published: August 2010

Candida Vulvovaginitis remains the subject of considerable research attention. Yeast species other than Candida albicans are being incriminated with increasing frequency as causes of vaginitis in some recent publications, while analysis of C. albicans strain types by DNA fingerprinting has provided preliminary evidence that the fungus may be able to make minor adaptations of its genotype that facilitate vaginal colonization. The current perception of C. albicans as a potentially virulent microbe relates several molecular factors to invasive processes. These include secretion of hydrolytic enzymes, in particular a proteolytic enzyme, and an inherent tendency to rapid phenotypic switching. Molecular biological experimentation with the genes determining secretion of enzymes should be able to demonstrate definitively the role played by such proteins in the pathogenetic process.
Prevention and early diagnosis of melanoma: a regional experience in Italy
Authors: Arcangeli F. , Catrani S. , Greco I. , Pierleoni M. , Landi G.
Published: August 2010

Background Over the 1980s several education campaigns for prevention and early diagnosis of cutaneous melanoma have been reported from various parts of the world.

Aim To improve incidence and prognosis of cutaneous melanoma in 1985 we started, in our area, an information and health education campaign aimed at identifying precursors of melanoma (congenital melanocytic nevi), suspicious lesions (changing moles) and subjects with increased risk of melanoma.

Method Precursors and suspicious lesions were promptly removed, and high‐risk persons entered the follow‐up program.

Result As a general effect of these activities the percentage of thin melanomas diagnosed in our division after 1985 increased from 25 to 37.

Conclusion We believe that education campaigns and screening of a targeted population, particularly of subjects presenting increased risk of melanoma, may be helpful in the early diagnosis of melanoma.
Skin changes in epilepsy
Authors: Yell J.A. , Marren P.M.
Published: August 2010

Aims To establish the skin changes found in epileptics, and to relate these changes to drug therapy.

Background Skin changes in epileptics, although welt acknowledged, have been subjected to few recent large‐scale surveys. Newer anti‐epileptic drugs, in addition to the older therapies, including phenytoin, phenobarbitone and primidone, are now popular. In an effort to update our knowledge of skin changes in epileptics, a study of 200 patients in a long‐term epilepsy hospital was performed.

Methods The study included taking a history, recording drug therapy and examining the skin of 200 patients.

Results Patients ranged in age from 21 to over 70. 60% were men and 40% women. Their epilepsy was mostly well controlled, varying in length from less than 10 to greater than 40 years. 57.5% had post traumatic scars. 32.5% had gum hypertrophy, only half having dental caries. Dupuytren's contracture occurred in 24.5%. Seborrheic dermatitis was seen in 15%. 12.5% had coarse facial features and 11.5% had acne. 57.5% of women had facial hirsutes. 17.5% of all patients had sacral hirsutes, which is an unique feature in this group of patients. These clinical findings were correlated with drugs taken at the time, the age of the patients and length of epilepsy. 52% were on carbamazepine, 48% on phenytoin and 42% on primidone or phenobarbitone, singly or in combination.

Conclusions A number of skin conditions are more common among epileptics. Phenytoin and phenobarbitone are linked to gingival hypertrophy, palmar fibromatosis, hypertrichosis, coarse fades and acne. Carbamazepine, too, may be implicated in gum hypertrophy, palmar fibromatosis, hypertrichosis, more specifically sacral hirsutes, seborrheic dermatitis, acne and coarse facies.
Mometasone furoate in the treatment of atopic dermatitis in children
Authors: Rafanelli Arturo , Rafanelli Silvia , Stanganelli Ignazio , Marchesi Enrico
Published: August 2010

Background Efforts are being made to find a non‐fluorinated topical corticosteroid with higher anti‐inflammatory activity for use in chronic dermatoses.

Patients and methods In a third‐party blind evaluation study we compared Mometasone cream, 0.1% once a day, with Clobetasone cream, 0.05% twice daily, in 60 children with atopic dermatitis treated for 3 weeks. At each visit carried out at days 0, 7, 14. 21 we evaluated signs and symptoms, therapeutic response and skin atrophy. Further visits were carried out at days 2, 3, 4 to evaluate the onset of action. During the first and last visit we also carried out laboratory tests including blood cortisol.

Results Mometasone was more effective and rapid in reducing signs and symptoms than Clobetasone. The difference between the two drugs was statistically significant (P < 0.05) from the fourth day of treatment for pruritus, and from days 7 and 14 for induration and eythema, respectively. At the end of the study 50% of the patients treated with Mometasone showed no symptoms vs 6.7% of those treated with Clobetasone. Topical and systemic tolerability were very good and laboratory tests were not significantly affected by either drug.

Conclusions Monometasone cream seems to represent an interesting therapeutic approach to chronic dermatoses, i.e., atopic dermatitis.
Monolateral atrophoderma vermiculatum
Authors: Lorusso B. , Benci M. , Lotti T.
Published: August 2010

An extremely rare disease is reported. An 11‐year‐old boy presented with atrophoderma vermiculatum. The condition occurred autonomously only on the right cheek; the lesions were rounded, pit‐like atrophic scars without the typical ‘worm eaten’ aspect.
Autoimmune progesterone dermatitis with summertime remission
Authors: Acay M. Coşkun , Doǧruöz Keramettin , Harmanyeri Yavuz
Published: August 2010

An unusual case of autoimmune progesterone dermatitis is reported. The lesions followed a cyclical pattern, with premenstrual flares and a tendency to improve spontaneously at the start of menstruation, but the patient did not experience any exacerbation of her skin lesions in the summer months (June, July, August).
The spectrum of psoriasis in an Irish HIV population
Authors: Healy Eugene , Mulcahy Fiona , Barnes Louise
Published: August 2010

Object Report of the pattern of psoriasis and response to therapy in psoriatic patients infected with HIV‐1.

Setting Department of Dermatology, St. James's Hospital, Dublin

Subjects Seven HIV‐positive patients with psoriasis: six seen as part of a prospective dermatological assessment of all HIV‐positive patients; one separately referred

Observations Three patients had psoriasis vulgaris which was limited and responsive to conventional therapy; one also had flexural psoriasis which proved difficult to control.

Four patients had features of keratodermia blennorrhagicum; their skin disease was severe and warranted systemic treatment in three cases, without adverse affects. However, only one patient fulfilled the complete criteria for Reiter's syndrome.

As six of the seven cases occurred in a prospective age‐ and sex‐matched controlled study of skin disease in 92 HIV‐1‐infected patients in which only two controls had psoriasis, it would suggest that there may be an increased prevalence of psoriasis in the HIV‐1 population.
The effect bathing in a thermal lagoon in Iceland has on psoriasis. A preliminary study
Authors: Ólafsson Jón Hjaltalín , Sigurgeirsson Báòur , Pálsdóttir Rannveig
Published: August 2010

Objective To investigate if bathing in a unique thermal lagoon in Iceland has a therapeutic effect on psoriasis.

Design An open study where twenty‐seven psoriasis patients bathed for three weeks in the lagoon. Psoriasis Area and Severity Index (PASI) was used to evaluate the severity of the disease before during and after bathing.

Results The mean PASI score decreased from 16.1 to 8.1 (p= 0.01). The PASI score decreased most in the first week. The area of the lesions did not diminish but scaling erythema and infiltration decreased. Only very limited UV‐radiation was observed during the bathing period.

Conclusions Bathing in the lagoon has a favourable effect on psoriasis although in some cases it may not be sufficient as a single treatment. Further studies over longer period are needed.
Clinico‐pathological study and five‐year follow‐up of 10 cases of hypopigmented mycosis fungoides
Authors: Ratnam K.V. , Pang Bryan K.
Published: August 2010

Background Hypopigmented (HMF) macular lesions are extremely rare manifestations of Mycosis fungoides (MF) with a predilection for blacks. Little is known of its prevalence, natural history and response to therapy in Asians.

Objective The aim of the study was to investigate the natural history and clinicopathotogical aspects of HMF in an Asian population.

Study Design A retrospective study of patient records from 1982 to 1989 was carried out and $100 immunostain was performed on sun exposed skin and covered skin of HMF patients and, as control, of healthy volunteers.

Result 10 HMF patients (eight males and two females), of 18 (51.8%) who were seen for mycosis fungoides during this period, were studied. The majority were skin type III and IV, buttocks and limbs being important sites of predilection. Mean age at presentation and duration of disease prior to diagnosis were 20 and 4 years, respectively. Reduced melanin granules in basal keratinocytes and melanocytes, lymphocytic epidermotrophism and increased Langerhan's cell density were the most consistent microscopic findings. Response of patients to PUVA was excellent, with post treatment biopsy showing normal histology. Two patients with frequent relapse had extensive involvement and change in clinical pattern. On 5‐year follow‐up, HMF patients remained in stage 1. HMF variant is a common mode of presentation in young Asians, especially in males. It responds well to PUVA and has an excellent prognosis.
Low‐dose cyclosporin A in palmoplantar psoriasis: evaluation of efficacy and safety
Authors: Peter Ralf U. , Färber Lothar , Weiβ Jürgen , Kohnen Ralf , Weidinger G. , Ruzicka Thomas
Published: August 2010

Background The immunosuppressant cyclosporin A has been used with success in the treatment of chronic plaque‐type psoriasis; little is known about its effect on palmoplantar psoriasis.

Subjects and methods Thirty‐three patients (12 women, 21 men; mean age = 44.2 years, range 22‐68 years) with palmoplantar psoriasis were treated with oral cyclosporin A, (CyA), 2.5 mg/kg/day, which could be increased to 5 mg/kg/day, for 12 weeks. Patients were followed up for a further 4 weeks without CyA treatment. A total of 26 patients completed the 12‐week treatment course, an additional six patients were followed up during 4 weeks after premature withdrawal. Efficacy was assessed by calculating the Psoriasis Area and Severity Index (PASl). a Local Psoriasis Severity Index (LPS1), and estimation of the area involved.

Results Clinical response, being defined as at least 50% reduction of these parameters at the end of the therapeutic phase compared to baseline before treatment, was reached in 84% of the patients; 61% of the patients showed clinical response after only 6 weeks of treatment. No signs of severe hepatic or renal toxicity were noted during the study period; mild hypertension, which developed in one case, resolved after termination of the treatment. Relapses after treatment never reached the pretreatment baseline levels.

Conclusions It is concluded that palmoplantar psoriasis can be treated effectively and safely with oral CyA at the low‐dose range of 2.5‐5 mg/kg/day. The results demonstrate the necessity for evaluation of a maintenance treatment in this special form of psoriasis, the doses and safety of which remain to be determined in future controlled clinical trials.
Dermato‐venereology: An historical perspective⋆
Authors: Waugh Michael
Published: August 2010

Although, at present dermatology and venereology in the United Kingdom and Eire are practiced separately, the influence of the European Economic Community may cause certain changes. This article refers to events over the course of centuries which have caused the disciplines to develop separate paths.
Dirofilariasis in Turkey: a case of subcutaneous dirofilariasis
Authors: Öztek İbrahim , Yenen Osman Şadi , Özertürk Yusuf , Uçmakh Ergün , Harmanyeri Yavuz
Published: August 2010

A case of dirofilariasis is presented. The disease showed in our case subcutaneous location and was identified 9 years after the initial admittance of the patient. The mass was finally removed surgically.