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ObjectivesTravelling communities are a significant, but poorly understood, group of ethnic minorities known to experience inequalities in many aspects of healthcare, including at the end of life. This study explored the end of life care experiences and needs of Travellers, along with the perspectives of healthcare professionals.MethodsSecondary thematic analysis of data from two focus groups and 16 interviews. Eighteen UK-based members of Travelling communities and three healthcare professionals took part in two focus groups. Sixteen hospice staff were interviewed. Data were collected by UK charity One Voice 4 Travellers in 2018.ResultsTensions permeated the healthcare experience of Travellers. The perceived need for concealment of ethnic identity in the healthcare setting conflicted with participants’ desire for personalised care and tailored services. Healthcare professionals’ limited awareness of Travellers’ cultural rituals around death led to difficulties, including misunderstandings relating to the large numbers of family gathered at the bedside of dying relatives in hospital and hospice settings. Approaches that could increase the acceptability of healthcare included Travellers working in liaison roles, increased provision of space for visiting family and cultural competency training for staff. However, challenges remain in converting ideal solutions into feasible changes.ConclusionsImproved communication and understanding between Travelling communities and healthcare professionals is needed to relieve the multilevel tensions experienced at the end of life. At an individual level, this would enable personalised care; at a systems level, cocreation of end of life care services with Travellers would help ensure that their cultural needs are met.

It is well-known that people with an intellectual disability often face a host of health inequalities and co-morbidities. These include childhood obesity, mental health problems, and challenging behaviour. People with an intellectual disability also have reduced life expectancy. GPs are uniquely placed to advocate for and signpost these patients, ensuring they have access to appropriate support. However, it is often unclear what resources are, in reality, both available and beneficial. Here we aim to summarise some of the common inequalities and complexities when working with patients with an intellectual disability and provide an overview of some potentially helpful services.

Anatomy education by cadaveric dissection teaches medical students not only the formal curriculum in human anatomy, but also a ‘hidden curriculum’ whereby they learn the attitudes, identities and behaviours expected of doctors. While dissection has been investigated as a challenge to and training in emotional regulation, little attention has been paid hitherto to the forms of medical knowledge and identity which students encounter and develop in the dissection room. This study analyses a corpus of 119 tributes written by three consecutive cohorts of first-year medical students at a university to their cadaveric donors. We employ a Foucauldian discourse analysis methodology, seeking to elucidate the features of the subject position, the narrative ‘I’ or ‘we’ of the tributes, and the modes of knowledge which operate between that subject position and its object, the donor. We observe that students find themselves in a transitional state between personal and scientific modes of knowledge of the human, which correspond to different models of the subject position occupied by the student. While in many tributes these modes exist in an uneasy disjunction, others employ creative reflection to suggest new modes of knowledge and identity which may inform ethical practice.

Children and young people who are adopted from care, in care, or at risk of going into care are at higher risk of attachment difficulties and disorders. This may increase the likelihood of mental health conditions and poor emotional regulation. GPs play a role in managing this risk in the community in conjunction with a multi-disciplinary team and supporting referrals to secondary care. However, many GPs are unfamiliar with the terminology of attachment difficulties, attachment disorders, secure attachment and insecure attachment. This article aims to explain these terms and provide an update for GPs on the implications of the National Institute for Health and Clinical Excellence guidelines on child attachment, which focuses on looked after children.

Distinguishing autism spectrum behaviors from behaviors relating to disorganized attachment can be challenging. There is, for instance, a notable overlap between both conditions in terms of behaviors deemed stereotypical. In addition, there are also similarities regarding some atypical social overtures. Responding to this overlap has been the subject for much debate in the literature. Disorganized attachment was first introduced and conceptualized by the attachment researcher, Mary Main. Main is considered the leading authority on coding this phenomenon. During the course of archival research, we obtained Main’s notes on coding attachment in a group of 15 children with autism spectrum conditions (hereafter ASC). Drawing on these texts, this article explores Main’s reasoning when making distinctions between ASC and attachment at the behavioral level. Our approach is informed by Chang’s argument for the potential of “history as complementary science.” Analysis indicates that, for Main, frequency and timing were important differential factors when attributing a behavior to either ASC or the child’s attachment pattern.

In her lead article in this special issue, Monica Greco (2018) offers the concept of participating bodies as a ’possibility of conceiving bodies themselves—and bodily events such as disease/illness—as expressing values and perhaps even socially meaningful "preferences"’. Such a position seeks to avoid capitulation to a) an image of bodily processes as without values or responsiveness, object rather than participant; b) an image of human agents as unitary, self-knowing, sovereign choosers—unless ill. This article will explore this perspective as applied to the idea of coping. The article will explore strategies of everyday living, through particular consideration of Lauren Berlant’s reading of Two Girls, Fat and Thin by Mary Gaitskill. In her interpretation of the novel, Berlant assesses the kinds of problems for subjects and bodies that may be solved or managed through participation in or refraining from participation in thinking, food or sex. The account of coping and embodiment in Berlant’s reflections will then be placed in dialogue with findings by Alexandra Michel, who watched the process of physical burnout in investment banking associates during a 13-year cultural ethnography, observing as the bankers heeded or ignored the cues their bodies gave about the limits of feasible demands. The article as a whole offers an illustration of the value of Greco’s reflections for offering a fresh and valuable perspective on the concept of coping.

This article undertakes a systematic exposition and analysis of Patricia Crittenden's dynamic–maturational model of attachment and adaptation. It traces Crittenden's information-processing model of attachment behavior to her work with Mary Ainsworth, and shows how this account came to underpin her integration of insights from cognitive science with developmental psychology. The article draws surprising conclusions regarding the differences between the dynamic-maturational model and mainstream attachment theory, clarifying the meaning of contested concepts and identifying important flaws in previous interpretations of Crittenden's work.

New formulations and responses to classic questions have emerged in recent feminist thinking on the relationship between gender and consumption. One instance of this is the work of Abigail Bray on the damage caused by the media sexualisation of girls. She offers important insights into some problems with the discourse of media and sexual empowerment, and also critically considers the social distinction that such an discourse tends to confer. This article offers a sympathetic account of her argument, but also moves beyond Bray to express concerns regarding the class and race codings of the discourse of childhood innocence.

IntroductionPatients can be reluctant to say that they need help and support, telling clinicians they are ‘’fine’’ despite having unmet needs. Research with patients in mental health settings suggests that when patients do this they are less likely to follow their treatment plans, and that their informal carers may be at a risk of depression. To date these findings have not been explored in patients with advancing physical health conditions or their carers.AimTo explore the presence and role of “I’m Fine” or equivalent assertions for patients with advanced COPD and their carers; and to examine the impact denials of support needs may have on their health and service-use.MethodsCriteria based on Attachment Theory was used to identify ‘I’m Fine’ cases from the Living with Breathlessness Study (LWB) dataset of 235 patient and 115 carer qualitative interview transcripts. Data will be further analysed to explore discourses within cases using a Framework approach.ResultsPatients and carers who asserted they were ‘fine’ and not in need of further clinical support despite unmet needs had a distinct profile. Patients’ self-management attitudes and beliefs included minimising the effects and symptoms towards COPD, avoidance of thinking about the future and using stoical language in an attempt to downplay experiences. Carers focused on the needs of the patient whilst downplaying their own problems or distress.ConclusionBetter understanding of the processes and implications of assertions of status will support future work on interventions to support patients and carers.