bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Tromsø study: factors affecting patient‐initiated and provider‐initiated use of health care services
Authors: Fylkesnes Knut , Johnsen Roar , Førde Olav Helge 
Published: February 2004

AbstractThe aim of this study was to examine factors influencing decisions involved in i) patient‐intiated visits to general practitioners and ii) provider‐initiated use of referral services. The analyses were performed with regression models on a set of data from a comprehensive population study of 7369 men aged 20–61 and 6832 women aged 20–56. Marked gender differences appeared in both patient‐initiated and physician‐initiated health care use. Various health status dimensions were found to be important determinants of patient‐initiated use, in particular self‐rated health, physical distress and transitory morbidities. Further, having a primary provider was found to increase patient‐initated use strongly. Among the health status measures only self‐rated health and chronic disease appeared as important determinants of provider‐initiated use. Age and years of education were negatively associated with GP visits and positively associated with the use of referral services. The higher rate of referral of patients with higher educational achievement indicates a social status bias among general practitioners, creating considerably inequitable access to referral services. Further, the analyses indicate that positive lifestyles are associated with increased health care consumption among men.
All change in the NHS? Implications of the NHS reforms for primary care prevention
Authors: Williams Simon J. , Calnan Michael , Cant Sarah L. , Coyle Joanne 
Published: February 2004

AbstractThe paper provides a review of the implications of the recent NHS reforms ‐ i.e. the Griffiths Report (1983), Promoting Better Health (1987), Working for Patients (1989) and the new GP contract (1990) ‐ for primary care prevention. Three major themes are identified as the leitmotivs running through these reforms: first, the introduction of general management into the NHS; secondly, the introduction of market principles into the NHS, and; thirdly, the increasing emphasis upon health promotion and disease prevention. The first section of the paper offers a critical review of the Government's health promotion strategy, one in which, it is argued, the primary care sector will play a central role. Hence, taking the issue of primary care prevention as a case‐study, the paper then proceeds to discuss the implications of these recent reforms (i.e. managerialism and market principles) for primary care prevention at a number of different levels: namely, for FHSAs, DHAs, GPs, nurses, and consumers. The final section of the paper considers the potential impact of these reforms for the professional autonomy of GPs and nurses, particularly in relation to the proletarianisation and deprofessionalisation theses. The paper concludes with a theoretical discussion and interpretation of the themes and issues raised within the course of the paper.
Women and private medicine
Authors: Wiles Rose 
Published: February 2004

AbstractWomen are higher users of private sector in‐patient health care than men and the difference is more pronounced than in the NHS. This paper draws on data collected early in 1991 for a survey of private patients in one Regional Health Authority in England at a time when public health services were experiencing extensive reforms. Reasons for ‘going private’ identified by women centred around issues of privacy, level of care, and the ability to choose admission dates. While the reasons men gave were broadly similar, a closer examination revealed gender differences in their interpretations. These variations can be accounted for by the different socialisation, social roles and social position of men and women. It is concluded that health care needs and their interpretation are likely to be very different between groups of men and women, with divisions existing along lines of class, age and race as well as gender. Without an understanding of the differing health care needs and wants of these groups, the public sector will not be able to provide services that provide consumer satisfaction.
Perceptions of stigma: the parents of autistic children
Authors: Gray David E. 
Published: February 2004

AbstractThis paper reports the findings of a qualitative study of courtesy stigma among 32 parents of autistic children. The results indicate that autism has uniquely stigmatising aspects because of the extremely disruptive nature of autistic symptoms, the normal physical appearance of autistic children, and the lack of public knowledge and understanding regarding the nature of autism. Most parents perceived themselves to be stigmatised by their child's disorder. There was a strong tendency for mothers to feel more stigmatised than fathers. Parents with more severely disabled children and children who were under the age of twelve were also somewhat more likely to perceive themselves to be stigmatised.
Logical analysis as a qualitative method I: Themes in old age and chronic illness
Authors: Williams R. G. A. 
Published: February 2004

Abstract Qualitative methods have been criticized for their lack of explicit procedures and weakness in explanation. The present paper draws attention to a qualitative approach with a clear procedure and wide explanatory scope — logical analysis. Logic has been neglected as a way of organizing informants’accounts because it has been identified with a procedure for organizing theory. In this paper, the attempt is to reverse the emphasis, and to demonstrate a way of working with informants rather than involving in theoretical prescriptions. The approach is illustrated by some themes arising in old age and chronic illness.First, two conceptions of illness which have been distinguished in the work of Claudine Herzlich are analysed as systems of premises and consequences. Next, the procedures involved in logical analysis, and the explanations and practical uses which arise from it, are illustrated in two case studies. These cases are part of a larger body of data collected, amongst other things, for the purpose of eliciting the logic of old people's thinking.The emphasis is on illustrating the method; and general issues which arise from it, including the analysis of people who entertain contradictory systems of thought, are postponed to a second paper.
The ‘natural’ control of fertility1
Authors: Basker Eileen 
Published: February 2004

AbstractThe analysis of the reproductive behaviour of married Jewish women seeking abortions in a hospital in Israel, summarized here, indicates that fertility and its control, for these women and their husbands, was often judged on a dimension of ‘natural’‐‘artificial,’ where ‘natural’ was the valued pole. Representatives of the medical profession, who de facto controlled access to effective contraceptives, often either intentionally or unintentionally undermined couples’ attempts to control their fertility effectively, and gave support to suspicions regarding the dangers in ‘artificial’ medical contraception. The result, for these women, was unwanted and intolerable pregnancy and request for abortion. Abortion, by medical intervention, reinforced the sense that complete control of fertility was impossible; by further contributing toward their feeling of helplessness, it may also have discouraged couples from changing their contraceptive behaviour.
Being epileptic: coming to terms with stigma
Authors: Scambler Graham , Hopkins Anthony 
Published: February 2004

AbstractMost commentators on the stigma associated with epilepsy have assumed that the psycho‐social distress sufferers experience derives wholly or largely from the discriminatory attitudes and behaviour of normal people. This ‘orthodox viewpoint’ is assessed and found to be lacking in empirical support. A study of the impact of epilepsy upon the lives of sufferers is reported, special attention being paid to coping strategies developed in the family and at work. A distinction between ‘enacted’ and ‘felt’ stigma is introduced and utilized in the generation of a new model of people's responses to ‘being epileptic’ which appears to have more explanatory power than the orthodox viewpoint.
Constructing addiction as a moral failing
Authors: Harding Geoffrey 
Published: February 2004

AbstractThe medicinal value of opium as an analgesic has been known to humankind for centuries. In England during the nineteenth century it was regarded, especially among the labouring classes, as a popular panacea for a variety of ailments. However by the end of the century addiction emerged as an issue of public concern ‐ due largely to the ‘moral crusade’ launched by the Victorian anti‐opium movement against the non‐medical use of opium. Central to the movement's campaign was a certain model of addiction, promulgated by its most prominent organisation, the Society for the Suppression of the Opium Trade. This paper examines how this model was taken as an objective reality.
‘They're not the same as us’: midwives' stereotypes of South Asian descent maternity patients
Authors: Bowler Isobel 
Published: February 2004

AbstractThe paper examines the stereotypes of South Asian descent women held by midwives in a British hospital. The data are drawn from a small‐scale ethnographic study which investigated the women's maternity experiences. The midwives’ stereotype contained four main themes: the difficulty of communicating with the women; the women's lack of compliance with care and abuse of the service; their tendency to ‘make a fuss about nothing’; and their lack of ‘normal maternal instinct’. The creation, perpetuation and effects of this negative stereotyping are examined in the light of the wider sociological research on patient typification. Black and minority ethnic patients are particularly vulnerable to negative typification because of their visibility combined with the fact that crude racial stereotypes are common in wider society. Stereotyping reflected and reinforced the view that Asian women are ‘all the same’ but ‘not like us’. Midwives used stereotypes to help them to make judgements about the kind of care different women want, need and deserve. It is therefore argued that stereotyping is a factor in the creation of the inequality in health experiences of black and minority ethnic patients.
Controllers and controlled: an analysis of participant constructions of outpatient commitment
Authors: Scheid‐Cook Teresa L. 
Published: February 2004

AbstractThis paper utilises qualitative data to examine outpatient commitment from two points of view: clinicians (the controllers) and clients (the controlled). Outpatient commitment is a legal mechanism whereby ‘mentally ill’ individuals are court‐ordered to report to their community mental health centre for treatment. In this paper I provide the reader with an understanding of how outpatient commitment works by allowing clinicians and clients to describe the meaning outpatient commitment has for them. While the experience of outpatient commitment varies, and supports the contention that there are multiple definitions of reality, it is clear that in general clinicians favoured the greater control over clients’ outpatient commitment provided and clients were cognisant of the greater liberty it afforded them. This has important theoretical implications for research into medicalisation and social control, in that providers and clients interpret medical dominance and ideology differentially. Consequently I analyse the interpretations of controllers and controlled from those sociological perspectives relevant to the issues of ideology, power, and social control. I conclude by calling for further investigation of those agents who seek to engage in ‘heretical discourse’ (Bourdieu 1991) which challenge dominant medical constructions.
Patients with terminal cancer who use alternative therapies: their beliefs and practices
Authors: Yates Patsy M. , Beadle Geoffrey , Clavarino A. , Najman Jake M. , Thomson Damien , Williams Gail , Kenny Lisbeth , Roberts Sydney , Mason Bernard , Schlect David 
Published: February 2004

AbstractThis paper examines the extent to which patients who have been diagnosed as having terminal cancer choose to use non‐medical therapies. In particular it is concerned with the illness behaviour of patients who are receiving conventional cytotoxic drug and radiation treatments, who also decide to use a wide range of ‘alternative’ medications and therapies. The paper discusses the findings of a study of 152 patients with metastatic cancer that examined the extent to which they used alternative cancer therapies, as well as the beliefs and attitudes they have about their cancer, its treatment, and the practitioners providing that treatment. Four groups of users of alternative therapies, who differ according to their commitment to and the type of therapies they use, were identified. Results of logistic regression analyses indicate that those using alternative therapies were different in range of social attitudes. These differences were primarily their greater reported ‘will to live’ and desire for control over treatment decisions, and the differing beliefs they hold about their disease.
Reshaping of self: a pendular reconstruction of self and identity among adults with traumatic spinal cord injury
Authors: Yoshida Karen K. 
Published: February 2004

AbstractThis paper describes the impact of chronic illness on self and identity among 35 adults with traumatic spinal cord injury (paraplegic), living in the community. The reconstruction of self and identity post spinal cord injury is conceptualised as a pendulum. The pendulum of self represents a dynamic model of identity reconstruction. The pendulum suggests that identity reconstruction is a process that swings back and forth like a pendulum between the nondisabled and disabled aspects of self. The pendulum depicts five predominant identity views (outcomes). These are: 1) the former self; 2) the supernormal identity; 3) the disabled identity as total self; 4) the disabled identity as an aspect of the total self; and 5) the middle self. These identity views are influenced by five experiences (processes). These are: 1) loss; 2) sustainment; 3) integration; 4) continuity and 5) development of the self. It is suggested that frameworks of identity reconstruction or reconstitution which include both process and outcome components may elucidate more clearly the impact of chronic illness on self and identity. In addition, this pendulum model of identity reconstruction is an alternative approach to traditional sociological conceptions of identity reconstruction.
Liberation or oppression? radical feminism and in vitro fertilisation
Authors: Denny Elaine 
Published: February 2004

AbstractQualitative research was conducted to determine to what extent, if at all, the experience of in vitro fertilisation could be explained by radical feminist theories. Ten semi‐focused interviews were conducted, seven with women alone, and three with women and their partners.Radical feminists emphasise the control of women's reproductive role by men as being the root of patriarchal oppression. The development of reproductive technology has been identified as working against the interests of women, and extending male control to the means of conception. Radical feminist literature in the area has taken mainly a theoretical approach to the exclusion of examining the role of women, while empirical research has often been a theoretical, and located within a biomedical framework.Two main areas of interest are discussed here; pro‐natalism, and power and control, which are examined in the light of radical feminist theory. While this approach provides a partial explanation for the experience of some women, the main weakness in radical feminist thinking is to treat women as universally oppressed and passive. By failing to legitimate women's experiences, radical feminism, far from liberating women, provides an alternative form of oppression.
Sex, gender and power: young women's sexuality in the shadow of AIDS
Authors: Holland Janet , Ramazanoglu Caroline , Scott Sue , Sharpe Sue , Thomson Rachel 
Published: February 2004

AbstractWhile the incidence of HIV infection and AIDS amongst non drug injecting heterosexuals is currently low in the UK, epidemiological evidence suggests that this situation may be short lived. The sexual practices of young heterosexuals will then be crucial in determining the extent of the epidemic. Drawing on feminist theory, we argue that if we are to understand young people's sexual relationships we must attend to the power relations within which sexual identities, beliefs and practices are embedded. The social pressures and constraints through which young women negotiate their sexual encounters impinge directly on their ability to make decisions about sexual safety and pleasure. The power of young women to control sexual practices can then play a key role in the transmission or limitation of sexually transmitted diseases. From preliminary analysis of data collected by the Women, Risk and AIDS Project, we argue that the risks young women take in sexual encounters with men arise within a nexus of contradictions through which women are expected to negotiate safer sex practices. However well intentioned, public health campaigns aimed at women cannot be effective unless they recognise that men and women begin their sexual encounters as unequal partners in the battle against the sexual transmission of HIV.
What is the relationship between drug taking and sexual risk? Social relations and social research
Authors: Rhodes Tim , Stimson Gerry V. 
Published: February 2004

AbstractThis paper examines the dynamics of the relationship between drug taking, sexual activity and sexual risk. While epidemiological research has provided essential indicators of levels of drug taking and sexual risk behaviour, the determinants of the relationship between drug‐taking and sexual risk remain unclear. A review of recent epidemiological research indicates two main contentions. First, that the use of certain drugs increases (or decreases) sexual desire and levels of sexual activity. Second, that the use of drugs (licit and illicit) has a disinhibitory effect on safer sex compliance. Critical examination of the literature shows that evidence in support for either of these contentions is both limited and variable. This paper argues that there is little empirical certainty about the causal determinants of the relationship between (a) the reputed pharmacological effects of drug use on sexual activity and (b) the social, situational and cultural factors which may influence sexual activity and safer sex compliance in drug use related encounters. The paper concludes that understandings of the relationship between drug‐taking and sexual risk rest as much upon commonsense understanding as on empirical evidence. In response, the paper outlines the needs and parameters of future social research, which as a primary focus aims to examine the social interaction and social relations of drug use and sexual activity.
The condom: why more people don't put it on
Authors: Browne Jan , Minichiello Victor 
Published: February 2004

AbstractThis study sheds light on an important topic emerging in the sexual health debate – identifying the interpersonal nature of sexual relationships which influence condom use. Using the principles of grounded theory, in‐depth interviews were conducted with heterosexual men and women to understand the impact of the dyadic context of ‘heterosex’ on decisions to use condoms, condom availability and partner support and receptivity to cooperate in safer sex practices. The study found that condom dialogues occur at two levels ‐ ‘the interpersonal condom dialogues’ and the ‘internal or discursive condom dialogues’. These dialogues shape condom use/non‐use negotiations and the sexual encounter. Individuals also enter into sexual relations with a dislike of condoms and a perception of condom sex as ‘other sex’, which sets the context for their sexual experiences. Gender constructions of socially ‘appropriate’ sexual behaviour for men and women are implicated in the decisions to use condoms. The study highlights the importance of promoting condom sex as good and pleasurable sex if education and public health intervention programmes are to be effective in changing attitudes towards safer sex practices.
The interactional form of professional dominance
Authors: Hak Tony 
Published: February 2004

AbstractStudies of ‘the interactional form of professional dominance’ portray particular conversational phenomena, such as interruptions and specific types of questions, as effective means by which doctors inhibit patients from getting the floor. Such strategies, however, depend on the patient's cooperation and, hence, cannot assure the doctor's dominance. In this paper it is argued that the Freidsonian concept of ‘professional dominance’ does not in the first place refer to the asymmetrical distribution of interactional tasks but rather to the asymmetrical distribution of specialised professional knowledge. Hence an ‘interactional form of professional dominance’ should not be sought in the doctor's strategies for controlling turns but rather in the unequal distribution of the parties' access to each other's objectives. The question is then how this asymmetry of access can be ‘discovered’ in conversational data. It is argued that this can be done (only) by an analysis of how episodes of the interaction function in the process of professional assessment as a whole.
Expert medical decisions in occupational medicine: a sociological analysis of medical judgment
Authors: Dodier Nicolas 
Published: February 2004

AbstractAn ethnographic study of expert medical decisions in the field of occupational medicine explores the doctor's role in the attribution of rights to sick people. Two ‘frames’ are displayed: the ‘clinical frame’ and the ‘solicitude frame’. It is demonstrated how these correspond to the status of conditions in medical work doctrines. Then, it is shown how the ‘psychosomatic frame’ displaces the treatment of physical complaints, and how the clinical and solicitude frame exert their presence again in the psychic domain. The meaning of these results for expert medical judgments is discussed, considering comparable work in other areas of medicine.
Power and persons: on ethical stylisation and person‐centred medicine
Authors: Osborne Thomas 
Published: February 2004

AbstractThis paper focuses on the relation of systems of ethics to the fabrication of medical power. After a brief consideration of the role of ethical cultivation in clinical medicine, the main body of the paper presents a case‐study of the influential ‘person‐centred’ medical rationality developed at the Royal College of General Practitioners in the 1960s and 1970s, and concludes‐partially by way of a brief discussion of the work of David Armstrong – with some reflections on the nature of ethical problematisations and their relation to the constitution of authority in modern societies.
Coping with autism: stresses and strategies
Authors: Gray David E. 
Published: February 2004

AbstractThis paper presents the results of a qualitative study of coping stresses and strategies among a sample of parents with autistic children. The most serious stresses that parents faced included problems with the lack of normal language, disruptive and violent behaviour, inappropriate eating and toileting and inappropriate sexual expression. Most parents used a variety of coping strategies, the most common of which included the use of service agencies, family support, social withdrawal, religion, normalisation, individualism and activism. Although no single coping strategy seemed to provide a definitively better outcome for the parents' adjustment, the use of services and family support appeared to provide the most successful strategy of coping for a substantial number of parents.