Search

Background: Evidence for the health benefits of urban green space tends to stem from small, short-term quasi-experimental or cross-sectional observational research, whilst evidence from intervention studies is sparse. The development of an urban greenway (9 km running along 3 rivers) in Northern Ireland provided the opportunity to conduct a natural experiment. This study investigated the public health impact of the urban greenway on a range of physical activity, health, wellbeing, social, and perceptions of the environment outcomes. Methods: A repeated cross-sectional household survey of adult residents (aged ≥16 years) who lived ≤1-mile radius of the greenway (intervention sample) and > 1-mile radius of the greenway (control sample) was conducted pre (2010/2011) and 6-months post implementation (2016/2017). We assessed changes in outcomes pre- and post-intervention follow-up including physical activity behaviour (primary outcome measure: Global Physical Activity Questionnaire), quality of life, mental wellbeing, social capital and perceptions of the built environment. Linear regression was used to calculate the mean difference between post-intervention and baseline measures adjusting for age, season, education, car ownership and deprivation. Multi-level models were fitted using a random intercept at the super output area (smallest geographical unit) to account for clustering within areas. The analyses were stratified by distance from the greenway and deprivation. We assessed change in the social patterning of outcomes over time using an ordered logit to make model-based outcome predictions across strata. Results: The mean ages of intervention samples were 50.3 (SD 18.9) years at baseline (n = 1037) and 51.7 (SD 19.1) years at follow-up (n = 968). Post-intervention, 65% (adjusted OR 0.60, 95% CI 0.35 to 1.00) of residents who lived closest to the greenway (i.e., ≤400 m) and 60% (adjusted OR, 0.64 95% CI 0.41 to 0.99) who lived furthest from the greenway (i.e.,≥1200 m) met the physical activity guidelines - 68% of the intervention sample met the physical activity guidelines before the intervention. Residents in the most deprived quintiles had a similar reduction in physical activity behaviour as residents in less deprived quintiles. Quality of life at follow-up compared to baseline declined and this decline was significantly less than in the control area (adjusted differences in mean EQ5D: -11.0 (95% CI − 14.5 to − 7.4); − 30.5 (95% CI − 37.9 to − 23.2). Significant change in mental wellbeing was not observed despite improvements in some indicators of social capital. Positive perceptions of the local environment in relation to its attractiveness, traffic and safety increased. Conclusions: Our findings illustrate the major challenge of evaluating complex urban interventions and the difficulty of capturing and measuring the network of potential variables that influence or hinder meaningful outcomes. The results indicate at this stage no intervention effect for improvements in population-level physical activity behaviour or mental wellbeing. However, they show some modest improvements for secondary outcomes including positive perceptions of the environment and social capital constructs. The public health impact of urban greenways may take a longer period of time to be realised and there is a need to improve evaluation methodology that captures the complex systems nature of urban regeneration. [ABSTRACT FROM AUTHOR]

Physical inactivity levels are rising globally. In response, public health investigators have sought to design and implement effective interventions to raise levels of physical activity in populations, communities and individuals. Usually, such interventions are built around theories of behaviour change in which notions of motivation and incentivisation loom large. Drawing on focus group evidence derived in the context of a cluster RCT aimed at increasing levels of physical activity in the workplace, this paper offers a critical look at the factors that seemingly stimulate and sustain that activity. In particular, using novel methods of data analysis we illustrate how motives and motivation – often interpreted as a driving force 'in' individuals – can be more usefully seen as distributed; as a property of systems (incorporating technologies, organisational structures, and social interaction) rather than of persons. In our discussion, we outline various theoretical as well as empirical grounds for making such claims and conclude by drawing out the implications of our work for public health policy and research. [ABSTRACT FROM AUTHOR]

This article reports on an ethnography of architectural projects for later life social care in the UK. Informed by recent debates in material studies and "materialities of care" we offer an analysis of a care home project that is sensitive to architectural materials that are not normally associated with care and well‐being. Although the care home design project we focus on in this article was never built, we found that design discussions relating to a curved brick wall and bricks more generally were significant to its architectural "making". The curved wall and the bricks were used by the architects to encode quality and values of care into their design. This was explicit in the design narrative that was core to a successful tender submitted by a consortium comprising architects, developers, contractors, and a care provider to a local authority who commissioned the care home. However, as the project developed, initial consensus for the design features fractured. Using a materialized analysis, we document the tussles generated by the curved wall and the bricks and argue that mundane building materials can be important to, and yet marginalized within, the relations inherent to an "architectural care assemblage." During the design process we saw how decisions about materials are contentious and they act as a catalyst of negotiations that compromise "materialities of care." [ABSTRACT FROM AUTHOR]

Introduction Diabetic macular oedema (DMO) and proliferative diabetic retinopathy (PDR) are the major causes of sight loss in people with diabetes. Due to the increased prevalence of diabetes, the workload related to these complications is increasing making it difficult for Hospital Eye Services (HSE) to meet demands. Methods and analysis Effectiveness of Multimodal imaging for the Evaluation of Retinal oedema And new vesseLs in Diabetic retinopathy (EMERALD) is a prospective, case-referent, cross-sectional diagnostic study. It aims at determining the diagnostic performance, cost-effectiveness and acceptability of a new form of surveillance for people with stable DMO and/or PDR, which entails multimodal imaging and image review by an ophthalmic grader, using the current standard of care (evaluation of patients in clinic by an ophthalmologist) as the reference standard. If safe, cost-effective and acceptable, this pathway could help HES by freeing ophthalmologist time. The primary outcome of EMERALD is sensitivity of the new surveillance pathway in detecting active DMO/PDR. Secondary outcomes include specificity, agreement between new and the standard care pathway, positive and negative likelihood ratios, cost-effectiveness, acceptability, proportion of patients requiring subsequent full clinical assessment, unable to undergo imaging, with inadequate quality images or indeterminate findings. Ethics and dissemination Ethical approval was obtained for this study from the Office for Research Ethics Committees Northern Ireland (reference 17/NI/0124). Study results will be published as a Health Technology Assessment monograph, in peer-reviewed national and international journals and presented at national/ international conferences and to patient groups. [ABSTRACT FROM AUTHOR]

The article reports that inclusion of the callipers was intentional a practical instrument necessary to all serious craniologists who believed it possible to read off racial characteristics from the human skull. Topics include important lessons about the practicalities and ethics of fieldwork in the midst of an epidemic; and Boas was travelling from Europe to North America – whilst retaining access to our current technology.

In the light of the 'peak-car' thesis, this paper explores the driving-related desires and practices of adults aged 16-21 and their parents from the UK. Tropes of freedom and independence were commonly evoked; but were pragmatically framed by concerns of finance, utility and risk. Car ownership was prized only for instrumental reasons, and as one tool in a mixed, collective transport network: it had been decoupled from automobility. Environmental sustainability was notably absent from discussions. It may be too early to herald the end of automobility but, for these participants, its seductions have been rendered ironic, rather than aspirational. [ABSTRACT FROM AUTHOR]

Background: Novice drivers are at relatively high risk of road traffic injury. There is good evidence that Graduated Driving Licensing (GDL) schemes reduce collisions rates, by reducing exposure to risk and by extending learning periods. Legislation for a proposed scheme in Northern Ireland was passed in 2016, providing an opportunity for future evaluation of the full public health impacts of a scheme in a European context within a natural experiment. This qualitative study was designed to inform the logic model for such an evaluation, and provide baseline qualitative data on the role of private cars in health and wellbeing.Methods: Nine group interviews with young people aged 16-23 (N = 43) and two group interviews with parents of young people (N = 8) were conducted in a range of settings in Northern Ireland in 2015. Data were analysed using thematic content analysis.Results: Informal car-pooling within and beyond households led to routine expectations of lift provision and uptake. Experiences of risky driving situations were widespread. In rural areas, extensive use of farm vehicles for transport needs meant many learner drivers had both early driving experience and expectations that legislation may have to be locally adapted to meet social needs. Cars were used as a site for socialising, as well as essential means of transport. Alternative modes (public transport, walking and cycling) were held in low esteem, even where available. Recall of other transport-related public health messages and parents' existing use of GDL-type restrictions suggested GDL schemes were acceptable in principle. There was growing awareness and use of in-car technologies (telematics) used by insurance companies to reward good driving.Conclusions: Key issues to consider in evaluating the broader public health impact of GDL will include: changes in injury rates for licensed car occupants and other populations and modes; changes in exposure to risk in the licensed and general population; and impact on transport exclusion. We suggest an important pathway will be change in social norms around offering and accepting lifts and to risk-taking. The growing adoption of in-car telematics will have implications for future GDL programmes and for evaluation. [ABSTRACT FROM AUTHOR]

The article presents the discussion on professional practices within workshops, opticians' salons, theatres, language classes and clinics for people with brain injury as well as a number of design and business settings. Topics include overwhelming proclivity for tying conversation analysis (CA) as the primary method of exploring the data into visual frames; and claiming about the place of documents in social research and the role of documents as observed in everyday settings. .

Background: Increasing physical activity in the workplace can provide employee physical and mental health benefits, and employer economic benefits through reduced absenteeism and increased productivity. The workplace is an opportune setting to encourage habitual activity. However, there is limited evidence on effective behaviour change interventions that lead to maintained physical activity. This study aims to address this gap and help build the necessary evidence base for effective, and cost-effective, workplace interventions.Methods/design: This cluster randomised control trial will recruit 776 office-based employees from public sector organisations in Belfast and Lisburn city centres, Northern Ireland. Participants will be randomly allocated by cluster to either the Intervention Group or Control Group (waiting list control). The 6-month intervention consists of rewards (retail vouchers, based on similar principles to high street loyalty cards), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of participating workplaces will promote and monitor minutes of physical activity undertaken by participants. Both groups will complete all outcome measures. The primary outcome is steps per day recorded using a pedometer (Yamax Digiwalker CW-701) for 7 consecutive days at baseline, 6, 12 and 18 months. Secondary outcomes include health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Process measures will assess intervention "dose", website usage, and intervention fidelity. An economic evaluation will be conducted from the National Health Service, employer and retailer perspective using both a cost-utility and cost-effectiveness framework. The inclusion of a discrete choice experiment will further generate values for a cost-benefit analysis. Participant focus groups will explore who the intervention worked for and why, and interviews with retailers will elucidate their views on the sustainability of a public health focused loyalty card scheme.Discussion: The study is designed to maximise the potential for roll-out in similar settings, by engaging the public sector and business community in designing and delivering the intervention. We have developed a sustainable business model using a 'points' based loyalty platform, whereby local businesses 'sponsor' the incentive (retail vouchers) in return for increased footfall to their business.Trial Registration: ISRCTN17975376 (Registered 19/09/2014). [ABSTRACT FROM AUTHOR]

Background This paper focuses on the relationships between health 'policy' as it is embodied in official documentation, and health 'practice' as reported and reflected on in the talk of policy-makers, health professionals and patients. The specific context for the study involves a comparison of policies relating to the secondary prevention of coronary heart disease (CHD) in the two jurisdictions of Ireland - involving as they do a predominantly state funded (National Health Service) system in the north and a mixed health-care economy in the south. The key question is to determine how the detail of health policy as contained in policy documents connects to and gets translated into practice and action. Methods The data sources for the study include relevant health-care policy documents ( N = 5) and progress reports ( N = 6) in the two Irish jurisdictions, and semi-structured interviews with a range of policy-makers ( N = 28), practice nurses (14), general practitioners (12) and patients (13) to explore their awareness of the documents' contents and how they saw the impact of 'policy' on primary care practice. Results The findings suggest that although strategic policy documents can be useful for highlighting and channelling attention to health issues that require concerted action, they have little impact on what either professionals or lay people do. Conclusion To influence the latter and to encourage a systematic approach to the delivery of health care it seems likely that contractual arrangements - specifying tasks to be undertaken and methods for monitoring and reporting on activity - are required. [ABSTRACT FROM AUTHOR]

Background There is an urgent need to increase population levels of physical activity, particularly amongst those who are socio-economically disadvantaged. Multiple factors influence physical activity behaviour but the generalisability of current evidence to such 'hard-to-reach' population subgroups is limited by difficulties in recruiting them into studies. Also, rigorous qualitative studies of lay perceptions and perceptions of community leaders about public health efforts to increase physical activity are sparse. We sought to explore, within a socio-economically disadvantaged community, residents' and community leaders' perceptions of physical activity (PA) interventions and issues regarding their implementation, in order to improve understanding of needs, expectations, and social/environmental factors relevant to future interventions. Methods Within an ongoing regeneration project (Connswater Community Greenway), in a socio-economically disadvantaged community in Belfast, we collaborated with a Community Development Agency to purposively sample leaders from public- and voluntary-sector community groups and residents. Individual semi-structured interviews were conducted with 12 leaders. Residents (n = 113), of both genders and a range of ages (14 to 86 years) participated in focus groups (n = 14) in local facilities. Interviews and focus groups were recorded, transcribed verbatim and analysed using a thematic framework. Results Three main themes were identified: awareness of PA interventions; factors contributing to intervention effectiveness; and barriers to participation in PA interventions. Participants reported awareness only of interventions in which they were involved directly, highlighting a need for better communications, both inter- and intra-sectoral, and with residents. Meaningful engagement of residents in planning/organisation, tailoring to local context, supporting volunteers, providing relevant resources and an 'exit strategy' were perceived as important factors related to intervention effectiveness. Negative attitudes such as apathy, disappointing experiences, information with no perceived personal relevance and limited access to facilities were barriers to people participating in interventions. Conclusions These findings illustrate the complexity of influences on a community's participation in PA interventions and support a social-ecological approach to promoting PA. They highlight the need for cross-sector working, effective information exchange, involving residents in bottom-up planning and providing adequate financial and social support. An in-depth understanding of a target population's perspectives is of key importance in translating PA behaviour change theories into practice. [ABSTRACT FROM AUTHOR]

Background This paper focuses on the relationships between health 'policy' as it is embodied in official documentation, and health 'practice' as reported and reflected on in the talk of policy-makers, health professionals and patients. The specific context for the study involves a comparison of policies relating to the secondary prevention of coronary heart disease (CHD) in the two jurisdictions of Ireland - involving as they do a predominantly state funded (National Health Service) system in the north and a mixed health-care economy in the south. The key question is to determine how the detail of health policy as contained in policy documents connects to and gets translated into practice and action. Methods The data sources for the study include relevant health-care policy documents ( N = 5) and progress reports ( N = 6) in the two Irish jurisdictions, and semi-structured interviews with a range of policy-makers ( N = 28), practice nurses (14), general practitioners (12) and patients (13) to explore their awareness of the documents' contents and how they saw the impact of 'policy' on primary care practice. Results The findings suggest that although strategic policy documents can be useful for highlighting and channelling attention to health issues that require concerted action, they have little impact on what either professionals or lay people do. Conclusion To influence the latter and to encourage a systematic approach to the delivery of health care it seems likely that contractual arrangements - specifying tasks to be undertaken and methods for monitoring and reporting on activity - are required. [ABSTRACT FROM AUTHOR]

Background: There is a dearth of evidence regarding the impact of urban regeneration projects on public health, particularly the nature and degree to which urban regeneration impacts upon health-related behaviour change. Natural experiment methodology enables comprehensive large-scale evaluations of such interventions. The Connswater Community Greenway in Belfast is a major urban regeneration project involving the development of a 9 km linear park, including the provision of new cycle paths and walkways. In addition to the environmental improvements, this complex intervention involves a number of programmes to promote physical activity in the regenerated area. The project affords a unique opportunity to investigate the public health impact of urban regeneration. Methods/Design: The evaluation framework was informed by the socio-ecological model and guided by the RE-AIM Framework. Key components include: (1) a quasi-experimental before-and-after survey of the Greenway population (repeated cross-sectional design), in tandem with data from a parallel Northern Ireland-wide survey for comparison; (2) an assessment of changes in the local built environment and of walkability using geographic information systems; (3) semi-structured interviews with a purposive sample of survey respondents, and a range of community stakeholders, before and after the regeneration project; and (4) a cost-effectiveness analysis. The primary outcome is change in proportion of individuals identified as being regularly physically active, according to the current UK recommendations. The RE-AIM Framework will be used to make an overall assessment of the impact of the Greenway on the physical activity behaviour of local residents. Discussion: The Connswater Community Greenway provides a significant opportunity to achieve long-term, population level behaviour change. We argue that urban regeneration may be conceptualised meaningfully as a complex intervention comprising multiple components with the potential, individually and interactively, to affect the behaviour of a diverse population. The development and implementation of our comprehensive evaluation framework reflects this complexity and illuminates an approach to the empirical, rigorous evaluation of urban regeneration. More specifically, this study will add to the much needed evidence-base about the impact of urban regeneration on public health as well as having important implications for the development of natural experiment methodology. [ABSTRACT FROM AUTHOR]

Aim To explore moral distress in relatives doctors and nurses, in end-of-life care decision-making, in the adult intensive care unit. Background Many deaths in intensive care involve decisions about withholding and withdrawing therapy, potentially triggering moral distress. Moral distress occurs when individuals feel constrained from acting in accordance with moral choice, or act against moral judgement, generating painful, unresolved emotions, and problems that continue long after an event. Prior research has focused mainly on nurses; less is known about doctors' experiences and occurrence and impact on relatives is unknown. Design A narrative inquiry case study approach, funded by a Northern Ireland Health and Social Care Doctorate Fellowship Award (April 2011). Methods In-depth digitally recorded interviews will be conducted with relatives, doctors, and nurses involved in end-of-life cases comprising: (1) withdrawal of therapy, including circulatory death organ donation; (2) non-escalation of therapy; and (3) brain stem death with a request for organ donation. Relatives will be offered the opportunity to share their experiences on 'Healthtalkonline' by copyrighting audio-visual interviews to the Health Experiences Research Group, Oxford University. Research Ethics Committee approval was obtained (April 2012). Discussion This is the first time that moral distress is explored, in a case approach, among relatives, doctors, and nurses intimately involved in end-of-life decisions in intensive care. Dissemination of findings will make a large contribution to international knowledge and understanding in this area and alert healthcare professionals and relatives to an otherwise under-recognized, but potentially detrimental, experience. Findings will inform education, practice, and policy. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate health and social care professionals' perspectives on developing services for children with life limiting conditions at the end-of-life using issues identified by bereaved parents as priorities. The study adopted qualitative methodology using nominal group technique in focus groups (n = 5) to collect data from 35 health and social care professionals. Six issues were identified across professional groupings as particularly challenging within the context of caring for children at the end-of-life: truth telling; symptom management; communication with, and relationships between families and professionals; emotional impact, the withdrawal of feeding or treatment and sibling support. Strong resonance was noted between professionals and parents in the emphasis placed on issues related to talking about death (to child and siblings) and decision-making about the withdrawal of treatment. Conversely, late referral to hospice care and lack of services in the community dominated accounts of parents whose children had non malignant conditions, but were not prioritized by professionals. Although the latter focused on the need for and challenges associated with optimizing symptom management, most parents viewed symptom control as highly effective. Caring for a dying child is a multidimensional experience for both parents and professionals. Convergence of thinking carries three main implications for service development. Firstly, the need for 'joined up' palliative care services, particularly concerning timely referral to the range of support services. Secondly, more structured bereavement services. Third, within an ethos of family centered care, needs of siblings should be addressed effectively. [ABSTRACT FROM AUTHOR]

Objective To examine the experiences of bereaved parents concerning the care provided to children who died from cancer compared to those who died from a non-malignant condition. Design An in-depth qualitative study with bereaved parents of children who died as a result of a life-limiting diagnosis, recruited through two regional centres. Results Although parents' accounts displayed commonalities, key differences were discernible. Typically, parents of children with cancer considered care at the end of life as well resourced and responsive to their and their child's needs. In contrast, parents of children with non-malignant conditions reported under-resourced and inadequately responsive services. Although both groups of parents called extensively on military metaphors such as 'battle', 'fight' and 'struggle', the focus of their respective energies was different. In the one case the adversary was disease and illness; in the other it was service providers and service provision. Conclusions Community-based services for children and young people with cancer at the end of life were perceived by parents as responsive to parent and child needs. Conversely, community services for children and young people with non-malignant conditions were experienced as ad hoc and under-resourced. Community services for children with non-malignant conditions may require further development if they are to meet the levels of support offered to parents of children with cancer. If improvement is to be achieved, the need to raise awareness regarding hospice services, hospice referral and eligibility criteria across the entire gamut of service providers is essential. [ABSTRACT FROM AUTHOR]

Background: market reforms in England have been identified as making a clear distinction between English health policy and health policy in the devolved systems in Northern Ireland, Scotland and Wales. Patient choice is a high profile policy in the English National Health Service that constitutes significant changes to the demand side of health care. It is not clear what national differences this has led to regarding implementation of policy. This article presents the findings from a large UK-wide study on the development and implementation of policies related to patient choice of provider. The findings reported here relate specifically to the policy development and organizational implementation of choice in order to examine the impact of devolution on health care policy. Aim: this study examines patient choice of provider across all four countries of the UK to understand the effect of differences in national policies on the organization and service how choice of provider presented to patients. Methods: at the macro-level, we interviewed policymakers and examined policy and guidance documents to analyze the provenance and determinants of national policy in each UK nation. At the Primary Care Trust or Health Board level, we interviewed a range of public and private health service providers to identify the range of referral pathways and where and when choices might be made. Finally, we interviewed ear, nose and throat, and orthopaedics patients to understand how such choices were experienced. Findings: while we found that distinct rhetorical differences were identifiable at a national policy level, these were less visible at the level of service organization and the way choices were provided to patients. Conclusion: historical similarities in both the structure and operation of health care, coupled with common operational objectives around efficient resource use and waiting times, mediate how strategic policy is implemented and experienced in the devolved nations of the UK. [ABSTRACT FROM AUTHOR]

This paper is concerned with the language of policy documents in the field of health care, and how ‘readings’ of such documents might be validated in the context of a narrative analysis. The substantive focus is on a comparative study of UK health policy documents (N = 20) as produced by the various assemblies, governments and executives of England, Scotland, Wales and Northern Ireland during the period 2000–09. Following the identification of some key characteristics of narrative structure the authors indicate how text-mining strategies allied with features of semantic and network analysis can be used to unravel the basic elements of policy stories and to facilitate the presentation of data in such a way that readers can verify the strengths (and weaknesses) of any given analysis – with regard to claims concerning, say, the presence, absence or relative importance of key ideas and concepts. Readers can also ‘see’ how the different components of any one story might fit together, and to get a sense of what has been excluded from the narrative as well as what has been included, and thereby assess the reliability and validity of interpretations that have been placed upon the data. [ABSTRACT FROM PUBLISHER]

The author reflects on the notion of finding worlds in a small square of wood essential to understand why an N of 1 can prove useful to scientific inquiry. He points out that research not entirely qualitative nor exclusively quantitative and neither entirely built on big N nor ignorant of small N and that what matters is the justification for choosing N and not the magnitude of N.

The Distress Disclosure Index ( Kahn & Hessling, 2001 ) measures the tendency to disclose psychological distress and is important in understanding psychological well-being, interpersonal relationships, and help seeking. This paper used the disclosure decision model ( Omarzu, 2000 ) to explore the theoretical antecedents of distress disclosure. Results of a community-based survey of 17–18-year-olds in South Wales (United Kingdom), suggesting that private self-consciousness, social support, and femininity were associated with higher distress disclosure. Shame was associated with lower distress disclosure. Moderating effects of gender and gender identity were also explored. Social support and femininity both interacted with gender to predict distress disclosure. The results suggest a number of interventions to increase distress disclosure in young men and women. [ABSTRACT FROM AUTHOR]

In matters of social research sociologists and other social scientists have tended to view documents primarily as sources of evidence and as receptacles of inert content. The key strategies for data exploration have consequently been associated with various styles of content or thematic analysis. Even when discourse analysis has been recommended, there has been a marked tendency to deal with records, files, and the like, primarily as containers--things to be read, understood, and categorized. In this article, however, the author seeks to demonstrate that by focussing on the functioning of documents instead of content, sociology can embrace a much wider range of approaches to both data collection and analysis. Indeed, the adoption of such a programme encourages researchers to see documents as active agents in the world, and to view documentation as a key component of dynamic networks rather than as a set of static and immutable 'things'. [ABSTRACT FROM AUTHOR]

This article is concerned with the ways in which people who work in and use a cancer genetics clinic in the UK talk about the 'gene for cancer'. By conceptualizing such a gene as a boundary object, and using empirical data derived from clinic consultations, observations in a genetics laboratory and interviews with patients, the author seeks to illustrate how the various parties involved adopt different discursive strategies to appropriate, describe and understand what is apparently the 'same' thing. The consequent focus on the ways in which the rhetorical and syntactical features of lay and professional talk interlink and diverge illustrates not merely how our contemporary knowledge of genes and genetics is structured, but also how different publics position themselves with respect to the biochemistry of life. [ABSTRACT FROM AUTHOR]

This paper aims to uncover gendered interpretations of various kinds of suicidal behaviour. Its empirical basis is focus group discussions with a range of young people, including users of social work services. In support of Canetto's research, the authors found some of the young people to be associating ‘successful’ suicides with masculinity and ‘failed’ suicide attempts with femininity. These feminized suicide attempts were subject to some fairly pejorative interpretations, such as being motivated by revenge or manipulation. There was no particular pattern of viewpoints in terms of the sex of respondents. The implications of these findings for social work are discussed. [ABSTRACT FROM AUTHOR]

Background: Many adults with Down's syndrome develop Alzheimer's dementia relatively early in their lives, but accurate clinical diagnosis remains difficult.Aims: To develop a user-friendly observer-rated dementia screening questionnaire with strong psychometric properties for adults with intellectual disabilities.Method: We used qualitative methods to gather information from carers of people with Down's syndrome about the symptoms of dementia. This provided the items for the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID), which we then tested for its psychometric properties.Results: The DSQIID was administered to carers of 193 adults with Down's syndrome, 117 of whom were examined by clinicians who confirmed a diagnosis of dementia for 49 according to modified ICD-10 criteria. We established that a total score of 20 provides maximum sensitivity (0.92) and optimum specificity (0.97) for screening. The DSQIID has sound internal consistency (alpha=0.91) for all its 53 items, and good test-retest and interrater reliability. We established a good construct validity by dividing the items into four factors.Conclusions: The DSQIID is a valid, reliable and user-friendly observer-rated questionnaire for screening for dementia among adults with Down's syndrome. [ABSTRACT FROM AUTHOR]

Background Although influenza immunisation is now recommended for all people aged 65 years and over in the UK, many people in that age group still remain unimmunised. Aim To investigate lay beliefs about influenza and influenza vaccine in older people to identify appropriate ways of promoting vaccine uptake. Design Qualitative study using narrative interviews. Setting Urban and rural communities in South Wales. Method Participants were 54 people aged 65 years and over who were interviewed in their own home. Of these, 11 were regularly immunised, 18 had consistently refused immunisation (refusers), 15 had defaulted (defaulters), five had never been offered immunisation, and five had recently been immunised for the first time. Results There was an overwhelming consensus among immunised and unimmunised individuals that they were not at risk from influenza. Even if they did catch influenza, they would not suffer from any serious consequences. Refusers and defaulters were more likely to believe that the influenza vaccine had serious side-effects, while the regularly immunised group were more likely to perceive the vaccine as effective. Multiple prompts from family, friends, or primary care staff were important triggers for receiving immunisation. Conclusion Many older people did not feel vulnerable to influenza, regardless of their age, and this influenced their views on the need for immunisation. Both refusers and defaulters overstated adverse effects from influenza vaccine so this is a potential target for an intervention. Individual prompts, particularly from GPs, seemed to be the most significant motivators to attend for immunisation. [ABSTRACT FROM AUTHOR]

Background To influence GPs' prescribing policies and practices it is necessary to have an understanding of how they make decisions. The limited evidence available suggests that not only do GPs find making decisions about diagnosing and prescribing for depression problematic. but that decisions are severely constrained by lack of resources. As a result, it might be thought that GPs, in line with current guidelines, will inevitably prescribe antidepressants for patients presenting with symptoms of anxiety and depression. This study examines the accuracy of this view. Aim To explore how GPs decide to prescribe antidepressants. Design Focus groups with self-selected GPs. Setting Bristol and the surrounding district. Method Qualitative study of five focus groups with 27 GPS. Results GPs' decisions about whether an antidepressant would be an appropriate form of management are shaped by a set of rules based on 'clinical' and 'social' criteria. The preferred strategy is to 'wait and see', but antidepressants are prescribed earlier when symptoms are perceived to be persistent, unresolving, severe and 'classic'. Decisions to prescribe are also shaped by organisational constraints of time, lack of accessible alternative management options, cost of prescribing and perceived patient attitude. Conclusion The evidence from this study provides little support for the view that GPs take the easy option of prescribing antidepressants in the face of uncertainty. Evidence suggests that the GPs' prescribing was cautious, which indicates that GPs would support the initiative of recent draft guidelines regarding watchful waiting. This guidance, however, needs to be clear about what constitutes mild depression and address the question of prescribing to patients who are experiencing social adversity. Furthermore, alternatives to antidepressants such as counselling would need to be readily and equitably accessible. In addition, GPs need to be convinced that alternatives to antidepressants are at least as effective for patients with so called 'mild depression'. [ABSTRACT FROM AUTHOR]

The article presents the research about promoting illness self-management in patients with diabetes using the Internet as their information. The objective of the research is to provide an interactive medium and information on self-care management to those patients who suffered from diabetes. Majority of the sites provide information essentially and have supported problem-solving assistance to certain patients.

Background: Head injuries are a common occurrence, with continuing care in the years following injury being provided by primary care teams and a variety of speciality services. The literature on outcome currently reflects areas considered important by health-care professionals, though these may differ in some respects from the views of head injured individuals themselves. Our study aimed to identify aspects of outcome considered important by survivors of traumatic head injury. Methods: Thirty-two individuals were interviewed, each of whom had suffered head injury between one and ten years previously from which they still had residual difficulties. Purposive sampling was used in order to ensure that views were represented from individuals of differing age, gender and level of disability. These interviews were fully transcribed and analysed qualitatively by a psychologist, a sociologist and a psychiatrist with regular meetings to discuss the coding. Results: Aspects of outcome mentioned by head injury survivors which have received less attention previously included: specific difficulties with group conversations; changes in physical appearance due to scarring or weight change; a sense of loss for the life and sense of self that they had before the injury; and negative reactions of others, often due to lack of understanding of the consequences of injury amongst both family and general public. Conclusion: Some aspects of outcome viewed as important by survivors of head injury may be overlooked by health professionals. Consideration of these areas of outcome and the development of suitable interventions should help to improve functional outcome for patients. [ABSTRACT FROM AUTHOR]

This paper reports on the routine decision making practices of health professionals working within a genetics service. Specifically the paper focuses on professionals' assessments of whether patients are at increased risk of inheriting a gene that predisposes the individual to developing cancer. By analysing professionals' talk and actions whilst assessing risk, the paper develops an understanding of both routine and complex decision making. Whilst some decisions were unproblematic, there were a number of situations in which geneticists appear to challenge the decision rules. Such situations occur when faced with a borderline case, an interesting case, when the patient appears particularly anxious or when the rules themselves are judged to be inadequate. Whilst decision support technologies are able to assist clinical decision making they are not relied upon by geneticists above and beyond their own knowledge. Thus, when knowledge is uncertain the decisions that clinicians make are not a consequence of the standard application of scientific protocols but are locally determined according to experience, circumstance and case. This suggests that the transfer of decision support technologies to general practice or to the general public are unlikely to be effective, given the importance of clinical experience to the risk assessment process. [ABSTRACT FROM AUTHOR]

The paper has three main aims. First, to trace – through the pages of Sociology of Health and Illness – the changing ways in which lay understandings of health and illness have been represented during the 1979–2002 period. Second, to say something about the limits of lay knowledge (and particularly lay expertise) in matters of health and medicine. Third, to call for a re–assessment of what lay people can offer to a democratised and customer–sensitive system of health care and to attempt to draw a boundary around the domain of expertise. In following through on those aims, the author calls upon data derived from three current projects. These latter concern the diagnosis of Alzheimer’s disease in people with Down’s syndrome; the development of an outcome measure for people who have suffered a traumatic brain injury; and a study of why older people might reject annual influenza vaccinations. [ABSTRACT FROM AUTHOR]

Abstract Background The common mental disorders of depression and anxiety often remain undetected in general practice. Psychiatric screening instruments have been recommended to assist detection. Aim To assess patients' attitudes towards the use of psychiatric screening questionnaires for common mental disorders within general practice. Design Twenty focus groups comprising 127 patients were conducted in Wales, UK. The groups were distinguished by age, sex and locality. Results The majority of respondents felt that the use of a screening questionnaire was acceptable and would be willing to complete one within a general practice setting. However, a number of individuals expressed concern about the validity of the kinds of questions asked and the usefulness of the instrument in practice. Respondents also discussed their concerns relating to issues of confidentiality and the doctor's response to the assessment. Conclusion The study indicates that lay beliefs towards mental illness, particularly relating to perceived stigma, will continue to pose problems for the routine use of psychiatric case-finding questionnaires within general practice. [ABSTRACT FROM AUTHOR]

Whilst analysis of 'risk' (in its many conceptual shapes) has loomed large in both medicine and social sciences over the past 25 years, detailed investigations as to how risk assessments are actually put together (in either lay or professional contexts) are few in number. The studies that are available usually focus on the use of words or everyday conversation in assembling risk. Talking about risk is, of course, important, but what tends to be ignored is the fact that risk can be and is often made visible. For example, it can be made visible through the use of tables, charts, diagrams and various kinds of sophisticated laboratory images. This paper concentrates on the role of such images in the context of a cancer genetics clinic and its associated laboratory. Precisely how these images are tied into the production of risk estimates, how professionals discuss and use such images in clinical work, and how professionals reference them to display facts about risk is the focus of the paper. The paper concludes by highlighting the significance of different kinds of visibility for an understanding of genetic abnormalities and how such differences might impact on the attempts of lay people to get to grips with risk. [ABSTRACT FROM AUTHOR]

This paper focuses on issues relating to rationing in the context of cancer genetics. It indicates how the allocation of scarce resources to patients in need is not simply a managerial process, but something that is routinely woven into the fine web of organisational activity. In the framework of this study – executed within a UK regional cancer genetics clinic – much of that activity circulates around issues relating to risk assessment. The author first illustrates how risk assessments in cancer genetics affect the distribution of clinical benefits in general. Following that, it is explained how professionals assemble risk categories and how the assembly work relates to rationing. The paper concludes by suggesting that rationing principles should more properly be seen as stratagems that are called upon and manipulated by lay and professional parties, rather than as a set of guide rules imposed top-down by managerial agents. [ABSTRACT FROM AUTHOR]

How, why, and under what kinds of circumstances lay people consult for symptoms of emotional distress are topics that have commanded various degrees of attention from secondary and primary care professionals. We argue below that many of the responses made by such professionals to these issues carry within them a set of very important assumptions about how members of the lay public view psychiatric symptoms. Whether such assumptions are justified by the evidence is, however, a matter of some debate. In what follows we draw on some recent, sociologically informed research on lay attitudes to emotional distress so as to highlight the debates and to suggest some ways in which they might be resolved. [ABSTRACT FROM PUBLISHER]

This paper examines lay accounts of illness and health gathered - by means of eight focus groups - from people living in two Cantonese-speaking communities in England. The authors concentrate on the manner in which Cantonese speakers recruit and mobilise various agents - such as traditional Chinese medicine (TCM), spirits, demons, food and the weather - to describe and explain aspects of their bodily and mental wellbeing. As well as providing information on what Cantonese speakers say about such matters, the data are also used to indicate how a concentration on 'accounts', rather than on 'beliefs', enables sociology to side-step a concern with the subjective and psychological and to focus, instead, on what is publicly available and verifiable. [ABSTRACT FROM AUTHOR]

The article presents information on several books related to sociology of health and illness. In the book "The Anti-Depressant Era," by D. Healy, he argues that the reconceptualization of psychiatric disorder has been intimately linked to developments in pharmacology and he traces such developments in detail. Healy suggests that the increase in the number of diagnosed depressive disorders since the 1950s is one instance of this and that an increase in panic disorder might be another. One of the main thesis of G. Beck's book "Disrupted Lives: How People Create Meaning in a Chaotic World," is that Western culture emphasizes predictability and order about the life-course and the events within it. Yet, in any society, disruption is an inevitable component of the human condition. Becker not only provides fascinating insight into the lives of her subjects, but also reflects thoughtfully on the philosophical and anthropological issues that are associated with them. It is in this latter respect that the body and embodiment loom large.

This paper focuses upon the nature of the mortuary as a socio-medical institution and the discourse of pathology which operates within it. More specifically, by examining the manner in which pathology is operationalised in Belfast it demonstrates: (i) how medical interests are frequently fused with those of the wider politico-technological system within which they are ensconced; (ii) how the assumptions and investigative principles of pathology are grounded in social rather than specifically clinical concerns, and (iii) how the subject population on which pathology concentrates is selected in accordance with social as well as clinical characteristics. [ABSTRACT FROM AUTHOR]

The paper opens with a review of recent developments in the sociology of spatial organization and after an examination of the ontological and epistemological assumptions which are embedded within current theorizations of space a number of arguments are advanced concerning the inter-relationships which hold between forms of knowledge, social practice and physical design. Using architectural plans, these arguments are then developed with reference to the study of the spatial organization of hospital wards in three contexts; the care and treatment of children, the containment of madness in the pre-1845 period and the management of psychiatric patients 1973-1982. The paper concludes that schemes of spatial organization are best understood in relation to the discursive practices of which they form a part rather than as decontextualised and reified social facts which exhibit their own 'logic'. [ABSTRACT FROM AUTHOR]

This paper is concerned with an examination of the investigatory resources and explanatory principles which surround the dead. The central focus is upon the distinctions which are drawn between natural and unnatural death, and the paper has two main aims. First, it attempts to measure the direction and flow of investigatory and observatory power which emanates from the coroners' court. Second, it attempts to unravel the connotations embodied in the concept of unnatural death. It is argued that the characteristics of the natural and the unnatural are not to be found within the anatomy or physiology of the corpse, but rather in the principles of an aetiological framework which seeks to decontextualise death and disease from their social base, and which consequently distorts our vision of the human condition at death. The data on which the arguments are based are drawn from studies of those deemed to have died unnaturally in Belfast at various periods during the twentieth century. [ABSTRACT FROM AUTHOR]

This paper is concerned with the socio-medical organisation of psychiatric disorder. The main line of analysis demonstrates how different psychiatric ideologies produce different objects of professional focus arid, consequently, radically different forms of therapy and therapeutic environment. By way of empirical evidence, the paper examines in some detail three contrasting contexts in which psychiatric disorder has been described and organised. The first is represented in Freud and Breuer's Studies on Hysteria, the second in the case books of a turn of the century asylum, and the third in the activities and practices of a modem psychiatric ward. By drawing on these sources of data, it is argued that an understanding of large scale changes in the organisation of psychiatric health care (such as is evident, for example, in modem trends from hospital to community care), firmly depends upon a study of the inner structure of psychiatric ideologies. Furthermore, and as a corollary of this it is claimed that appeals to extra-psychiatric (economic) interests and/or scientific (pharmacological) advances as key factors for explaining processes or organisational change (especially the process of deinstitutionalisation), are essentially misleading. [ABSTRACT FROM AUTHOR]

This article focuses on the rationalization of death, in reference to the medicolegal system and the elimination of human agency. Death could not be comprehended as "a merely physical event" nor was death to be understood as occurring in one instantaneous act. The significance of distinguishing between somatic, cellular, and social death was quite naturally accentuated by the commencement of transplant surgery in 1954 and it was probably the advances made by clinical technology which were primarily responsible for what is referred to as the rediscovery of death in social science literature. It is the core of this medico-legal system that shall concentrate upon at this stage together with the network of rules and practices which bind together the whole system. First, a valid cause of death is a medical cause. Second, that there is always one and only one underlying cause of death. Third, that the principal cause must always be a medical cause. And fourth, that a clinical diagnosis of death is only partly responsible for the ultimate allocation of the principal cause.